scholarly journals Epidemiology of Gall Stone Diseases among Patients attending Surgical Department of a Tertiary Care Hospital in Nepal

2020 ◽  
Vol 8 (1) ◽  
pp. 50-55
Author(s):  
Sanjay Chaudhary

Background and Objectives: Gallstone disease (GSD) is a chronic disease that consumes a lot of economic and medical resources. It not only affects patients’ life quality, but also is associated with the potential risks of the development of consequences of gallstone diseases. Therefore, the study is aimed to investigate the epidemiology and risk factors of gall stone diseases among patients attending tertiary care centre in Nepal. Material and Methods: A cross sectional study was conducted among patients attending surgical department of Janaki Medical College Teaching Hospital (JMCTH) over a period of one year from January 2019 to December 2019. Chi-square test was applied to show the association between the two groups. P-value < 0.05 was considered statistically significant. Results: In a total of 148 patients, 69.59% had mixed gallstone, 17.57% had cholesterol stone and 12.84% had pigment gallstone. Types of gallstone was found significant for age group (p=0.006), gender (p=0.027) and presence of diabetes (p=0.003) but insignificant with presence of hypertension (p=0.992). Conclusion: Age of the patients, gender and presence of diabetes were found significant for the all types of gall stone. Further large scale research need to be conducted.

2021 ◽  
pp. 7-10
Author(s):  
Nupoor Vaghasia ◽  
Bharatsing D. Rathod ◽  
Vidya Nagar

BACKGROUND: Tuberculous meningitis (TBM) is one of the most fatal forms of tuberculosis, early diagnosis and treatment of which can reduce morbidity and mortality. This study was undertaken to achieve data regarding clinical prole and outcome of patients from western India as epidemiological data is lacking from this region. METHODS: This prospective observational study was conducted on 136 patients admitted in medical ward and critical care unit of a tertiary care hospital in Maharashtra over 18 months. Clinical, biochemical, radiological and microbiological evaluation was done. Data was analyzed using SPSS 22 version software and p value of <0.05 as signicant. RESULTS: The mean age of cases was 35.2 ± 14.69 years, majority from age group of 18 - 40 years. Out of 136 cases, 62 (45.6%) were males and 74 (54.4%) females. Commonest clinical features were fever and headache, followed by altered sensorium and seizure. Symptoms were mostly of acute onset (<14 days). 42 cases (30.9%) were associated with present or past pulmonary tuberculosis and 34 (25%) with retroviral disease. 7 cases (5.2%) had hemiparesis and 3 (2.2%) had ophthalmoplegia. Mean ESR was 56.59 + 22.87. CSF showed lymphocytosis (mean 88.4 + 18.09 %), low glucose percentage (mean 39.57 + 0.2 %) and high protein (mean 146.02 + 106.62 mg/dl). 117 cases (86%) showed positive neuroimaging. Outcome was poor in stage III disease. CONCLUSION: Tuberculous meningitis usually presents as acute onset illness with fever, headache or altered sensorium. CSF Gene Xpert has low sensitivity as compared to neuroimaging. Advanced disease was associated with poor outcome.


Author(s):  
Anjaneya Prasad V. ◽  
Anjani Kumar C. ◽  
Neelima V. ◽  
Sai Prasanth R.

Background: Prevalence of anaemia is very high in rural tertiary care hospital O.P.D patients. Anemia is the most common morbidity among micronutrients and affects health, education, economy, and productivity of the entire nation. Anemia, like fever, is a manifestation and not a disease per se. The most common group among the causes for anemia is malnutrition and among that group, iron deficiency makes up the bulk of it. Girls are more likely to be a victim due to various reasons. In a family with limited resources, the female child is more likely to be neglected. She is deprived of good food and education and is utilized as an extra working hand to carry out the household chores. The added burden of menstrual blood loss, normal or abnormal, precipitates the crises too often. Anemia can usually be prevented at a low cost, and the benefit/cost ratio of implementing preventive programs is recognized as one of the highest in the realm of public health. This information has equipped everyone in public health to take action against this long-standing problem and to do whatever is needed to be done.Methods: In our study 200 people attending medical outpatient department at a tertiary care centre were enrolled. Assessment of the anaemic problem is worked out.Results: Out of 200 patients, 107 were females and 93 were males. 49 females out of 107 had haemoglobin less than 10 and 9 males out of 93 are having haemoglobin less than 10. Among people with hemoglobin less than 10, 84.5% are females. Significant p value was observed in females (<0.0001).Conclusions:Anemia continues to be a major health problem in developing countries like India, particularly rural India. Despite different strategies and programs have been taken by government of India the growing menace of anaemia is not solved. So newer strategies must be taken.Background: Prevalence of anaemia is very high in rural tertiary care hospital O.P.D patients. Anemia is the most common morbidity among micronutrients and affects health, education, economy, and productivity of the entire nation. Anemia, like fever, is a manifestation and not a disease per se. The most common group among the causes for anemia is malnutrition and among that group, iron deficiency makes up the bulk of it. Girls are more likely to be a victim due to various reasons. In a family with limited resources, the female child is more likely to be neglected. She is deprived of good food and education and is utilized as an extra working hand to carry out the household chores. The added burden of menstrual blood loss, normal or abnormal, precipitates the crises too often. Anemia can usually be prevented at a low cost, and the benefit/cost ratio of implementing preventive programs is recognized as one of the highest in the realm of public health. This information has equipped everyone in public health to take action against this long-standing problem and to do whatever is needed to be done.Methods: In our study 200 people attending medical outpatient department at a tertiary care centre were enrolled. Assessment of the anaemic problem is worked out.Results: Out of 200 patients, 107 were females and 93 were males. 49 females out of 107 had haemoglobin less than 10 and 9 males out of 93 are having haemoglobin less than 10. Among people with hemoglobin less than 10, 84.5% are females. Significant p value was observed in females (<0.0001).Conclusions: Anemia continues to be a major health problem in developing countries like India, particularly rural India. Despite different strategies and programs have been taken by government of India the growing menace of anaemia is not solved. So newer strategies must be taken.


2020 ◽  
pp. 7-10
Author(s):  
Swapnil Sen ◽  
Sandeep Kumar

Cholelithiasis is one of the most common surgical conditions requiring intervention worldwide. Since its introduction nearly four decades ago, laparoscopic cholecystectomy has become the gold standard of treatment for gallstone disease AIM: To critically evaluate our experience of laparoscopic cholecystectomy in a tertiary care centre of eastern India. MATERIALS AND METHODS: Hospital based observational study on 180 patients subjected to elective laparoscopic cholecystectomy with features of gall stone disease and meeting the inclusion and exclusion criteria. RESULTS: Our conversion rate of 10% is somewhat higher than that reported in any other series. This probably reflects that few of our surgeons are in their early learning curve. This can be reduced with the experience of the surgeons. A bile duct injury rate of 0.5% compares favourably with an incidence of 0-1% in several large series. Overall complication rate of 5.5% also compares favourably with an incidence of 1.6-8.6% in several large series. CONCLUSION: Laparoscopic cholecystectomy when performed in properly selected patients is very much effective in the treatment of symptomatic cholelithiasis – in terms of earlier return of bowel function, less postoperative pain, improved cosmesis, shorter length of hospital stay, earlier return of full activity and decreased overall cost. It is vital for the surgeons and patients to understand that conversion to open surgery is not failure; in fact, it implies a safe approach and a sound surgical judgment. The conversion rate is low with experienced surgeons indicating direct relationship between experience and conversion. It should be stressed that conversion if required should be done early rather than after an imminent complication.


Author(s):  
Juwereya Memon ◽  
Muhammad Jarwar ◽  
Sohail Ahmed Soomro ◽  
Abdul Sattar Memon ◽  
Riffat Jabeen Memon

Background: Gallstone disease (cholelithiasis) remains the commonest medical issue leading to surgical intervention. Causes of the Gall stone has been not properly understood, but it is thought to have several factors. Untreated gall stones can cause the various complications like inflammation of gall bladder, tissue damage, gallbladder tears and infection. Objective: To determine the clinical pattern and frequency of comorbidities among patients presented with cholelithiasis at Isra University Hospital Hyderabad, Pakistan. Materials and methods: This cross-sectional study was conducted at general Surgery department, Isra University Hospital, Hyderabad. All the patients having diagnosis of gall stone disease, age>18 years and either of gender were included in the study. Patients were selected on outpatient department (OPD) basis. Complete clinical examination was done including abdominal ultrasound and required laboratory investigations. Data regarding demographic information including clinical presentational and comorbidities like diabetes, hypertension and obesity was recorded and also smoking status was assessed. All the data was recorded via study proforma and was analyzed by SPSS version 20. Results: A total of 149 patients were studied, their mean age was 49.23+7.33 years. Females were commonest as 57(38.3%) and males were 92(61.7%). As per clinical presentation pain was found to be most common, particularly as epigastrium pain was found in (93.95%) cases, right Hypochondrium pain (73.82%), pain radiation was more towards scapula (50.33%), dyspepsia was noted in (49.66%), nausea was observed in 44 patients, flatulence in 45 patients and vomiting was least common (21.47%). Diabetes mellitus was 76(51.0%), hypertension was 67(45.0%), overweight were 63(42.3%), obese were 25(16.8%), HCV positive cases were 34(22.8%) and HBV positive cases were 09(59.7%). However smokers were 48(32.2%) and 06(4.0%) were alcohol consumers. Diabetes mellitus, hypertension and obesity were significantly more prevalent in females as compared to males (p=<0.05). Smoking habits and alcohol consumption were mostly found in males (p=<0.05). However HCV and HBV infections were statically insignificant according to gender. Conclusion: It was concluded that gallstone is a common problem and most of the patients who were diagnosed with gallstones were females, obese (BMI>27kg/m2), diabetes mellitus and belonged to fourth decade (40 to 50 years) of their life. Commonest clinical presentations were epigastrium pain, right Hypochondrium pain, pain radiation towards scapula and dyspepsia.


Author(s):  
Noor Ahmed Shaikh ◽  
Nabi Bux Napar ◽  
Zulfiqar Ali Bhatti ◽  
Hameed Ur Rahman ◽  
Ishrat Mahtam ◽  
...  

Background: Intussusception is an important disease of childhood & has been recognized since ancient time. It commonly involves young infants of 3 ½ months to 10 months of age. Diagnosis is mostly clinical on the basis of classical triad or quarter of pain in abdomen, vomiting palpable abdominal mass and currant red jelly stools. It is confirmed by ultrasound, barium enema which also has a therapeutic potential. The parents in our region lacks awareness regarding the intussusception. They usually bring the child to hospitals after trying various homemade or herbal remedies. The delay in diagnosis always results in severity in symptoms and aggressive mode of treatment. Objective: The current study was aimed to identify the Frequency, associated symptoms and post-operative complications of intussusception in tertiary care hospital of Province Sindh Methodology: It was a cross sectional study conducted from July 2017 to June 2020 at department of Pediatric Surgery Ghulam Mohammad Mahar Medical College Teaching Hospital Sukkur. Data regarding symptoms and prognosis was noted on the file of patient and written informed consent was taken from parents. Data was analyzed by using SPSS version 20. Chi square was applied as test of significance at 95%confidance interval and p-value less than 0.05 was considered as significant. Results: Fourty patients of intussusceptions were reported the mean age was 5.88 ± 1.5 months while 8 (20%) patients were 1to10 years with mean age of 3.88± 3.18 years. Thirteen (32.5%) patients presented within 24 hours of onset of symptoms and 27 (67.5%) presented after 24 hours 19 (47.5%) patients had history of diarrhea while 6 (15%) patients had respiratory tract infection. The most common postoperative complication was gut gangrene. Conclusion: In three years of study we found only 40 children who came to our hospital with diarrhea and the triad i.e. abdominal pain, abdominal mass and bleeding per rectum. Ultrasound abdomen was found to be best diagnostic modality with impressive accuracy rate at our setup. Gut gangrene was postoperative complication and recurrence was uncommon.


Author(s):  
Noorelle Karim Khan ◽  
Suchitra Shenoy M ◽  
Deepak Madi ◽  
Vaman Kulkarni

Background: H1N1 is known to cause periodic seasonal flu in the Indian subcontinent since 2009. The clinical course and the underlying immunity of the host contribute to the development of secondary bacterial infections in the infected patients. Objectives: This study aims at analyzing the secondary bacterial infections in confirmed H1N1 cases admitted in our hospital (from 2015 to 2018) with respect to the comorbidities, complications, associated bacteria with its antibiotic susceptibility pattern and the outcome of such episodes. Material and methods: Data of 164 patients admitted in a tertiary care hospital with H1N1 was extracted from medical records using a semi-structured case report form. Data was entered and analyzed with SPSS version 17. A p value of <0.05 was considered as statistically significant. Results: Most patients were aged above 40 years with female preponderance. In our study 42% of patients had comorbidities. Only 14 (8.53%) had secondary bacterial infection confirmed by culture. Klebsiella pneumoniae and Acinetobacter baumannii were the most common bacteria that were isolated. They were treated based on the culture reports. There was no mortality in patients with secondary bacterial infection. Conclusion: The early start of the antiviral agents and adherence to the antibiotic policy of the hospital contributed to lower secondary bacterial infections and zero mortality.


2019 ◽  
Vol 6 (12) ◽  
pp. 4354
Author(s):  
Arnab Bandyopadhyay ◽  
Rajnish Talwar ◽  
Amol Patel ◽  
Pradeep Jaiswal

Background: Necrosis of flap margins, postoperative pain and shoulder dysfunction are amongst the main concerns of the breast surgeon performing modified radical mastectomy (MRM). This pilot study is aimed to evaluate the effects of these procedural modifications and whether should it be included as a standard practice.Methods: A total of 150 MRM patients are evaluated in this single arm cohort study in a tertiary care centre over a time period of 2 years (2014-2016). The following modifications are adopted in the usual procedure of the MRM: double skin incision and elective excision of the skin margins, injecting long acting local anesthetic agent (bupivacaine) preoperatively around the nerve pedicles in axilla and postoperative positioning of arm in hyper abduction and early resumption of Shoulder exercisesResults: Flap margin necrosis has reduced considerably (2.6%) in comparison to historical data (15%). Pain relief was significantly less on first post-operative day (mean VAS score 2.93) which encouraged early shoulder mobilisation. Flap necrosis was more in T4 tumours (75% vs 25%) which was significant with a p value of .004. Similarly flap necrosis at 48hrs was more with the patients who received neoadjuvant chemotherapy (NACT) with a p value of 0.047. Higher nodal burden was significantly correlated with flap necrosis with a p value of .002.Conclusions: This pilot study provides preliminary evidence of the positive effects of the proposed modifications on minimising morbidity following MRM further convincing evidence by way of multi-centric randomized control trials, will be required to validate the conclusions of this study.


Author(s):  
T. V. D. Sasi Sekhar ◽  
Ramya Appalaneni ◽  
Avinash Jada ◽  
Shalima Pinnamaneni

Background: Thyroid hormones play a key role in the maintenance of body growth by modulating metabolism and the immune system. These alterations in thyroid hormone levels are referred to as “euthyroid sick syndrome” or “non thyroidal illness syndrome” (NTIS), which is characterized by low serum levels of free and total triiodothyronine (T3) and high levels of reverse T3 (rT3) accompanied by normal or low levels of thyroxine (T4) and thyroid-stimulating hormone (TSH). During critical illness, changes in circulating hormone levels are a common phenomenon. These alterations are correlated with the severity of morbidity and the outcomes of patients in ICU.Methods: This study was carried out at a tertiary care hospital. 100 patients of age above 18yrs, both sexes, admitted to intensive care units with following diseases Septicemia, ARF, Respiratory failure, CCF, DKA, Stroke were taken into the cross-sectional study. Relevant hematological and radiological examination are done. Fasting venous blood samples were collected immediately on admission to ICU from all patients and were subjected for hormone analyses. Samples were tested for total T3, total T4, and TSH. The hormone estimation was done by chemiluminescence assay.Results: Patients (59%) had low T3 level, 41(41%) patients had normal T3, 31 patients (31%) had low T4, 69 patients (69%) had normal T4 level and TSH was low in 11 patients (11%), 76 patients (76%) had normal TSH and 14 patients (14%) slightly high. Our study showed low T3 (59%) is the commonest abnormality in ICU admitted patients. There is a significant relation present between T3 and mortality (p value-0.0001) and need for ventilation (p value 0.004).Conclusions: Our study suggests that low T3 is an important marker of mortality in ICU admitted patients. We suggest that in ICU patients T3 levels should be done and used as a prognostic marker for mortality and need for ventilation.


2020 ◽  
pp. 1-3
Author(s):  
Sujeeva Swapna R ◽  
Siva Sankar Naik V ◽  
Neeraja M ◽  
Bhavani C ◽  
Jhansi Rani C

INTRODUCTION: Majority of the specimens which reach the histopathology laboratory are from gynecology department. The accessibility of the cervix to direct examination makes it the object of intensive and large scale study. Various inflammatory as well as infectious lesions are common in uterine cervix due to vulnerability to sexual trauma and being an easy access to various infections. Cervical cancer is one of the most frequently seen cancer in women in India. AIM: The present study is aimed to find out the most common types of the cervical lesions, incidence and histological variants of malignancies in women so as to understand the distribution of various diseases. MATERIAL AND METHODS: This is a retrospective study done in Government Medical College , Ananthapuram , a Tertiary Care Centre, for a period of 2 years, from January 2017 to December 2018. RESULTS: A total of 448 cases were retrieved from histopathology department and evaluated. The age group of the patients was between 20-80years. There was about 388 (86.6%) cases were non –neoplastic and 60 (13.39%) cases were neoplastic. CONCLUSION: The most common of non neoplastic lesions was chronic non-specific cervicitis. Most common neoplastic lesion was squamous cell carcinoma.


2020 ◽  
Vol 8 (1) ◽  
pp. 91
Author(s):  
Himank Gandhi ◽  
Gopal Swaroop Bhargava ◽  
Darpan Bansal ◽  
Karaninder Singh

Background: Calculus biliary tract disease continues to be a major health concern. It is normal to see predisposing factors such as cirrhosis, ileal resection in the West; while infection predominates in South East Asia as a cause. We prospectively examined gall stones in this study to investigate the causes and role of bacteria in the disease of gall stone disease.Methods: This is a cross sectional study conducted in department of surgery, Sri Guru Ram Das University of Health Sciences, Sri Amritsar, India, from November 2018-August 2020. Total 50 cases were selected and operated by lap/open cholecystectomy were included in this study. During cholecystectomy bile was aspirated and was sent to laboratory for culture. Gallstone retrieved from the specimen was classified based on morphological appearance. Results: Gallstone disease found to be common in female 92% and in the age group of 4-50 years. Bile of gallstones patients is often infected. In this study though morphologically cholesterol stones were commonest but mixed stones were associated with highest infection rates. Most common bile infecting bacterium in all kinds of stones was found to be E. coli 60.8% followed by klebsiella 17.3% and proteus 17.3%. All the organisms cultured were sensitive to cephalosporins, quinolones, aminoglycosides and penicillin group of antibiotics.Conclusions: Bile culture was positive in 46% of the cases. Morphologically cholesterol stones were commonest 52% but mixed stones were associated with highest infection rates (80%). Most common bile infecting bacterium in all kinds of stones was found to be E. coli.  


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