Comparison of Tubeless Mini Percutaneous Nephrolithotomy with Conventional Technique in a Tertiary Care Center

Introduction: Mini Percutaneous Nephrolithotomy (mPCNL) is a safe and efficient method for management of nephrolithiasis. Post procedure nephrostomy tube drainage is considered as the standard practice. In recent years, tubeless mPCNL with the use of double J (DJ) stent alone has replaced the placement of the nephrostomy tube. Aims: This study intends to evaluate the safety and efficacy of tubeless Mini Percutaneous Nephrolithotomy. Methods: A total of 80 patients with Nephrolithiasis, admitted to Urology Unit of Nepalgunj Medical College, between September 2018 and September 2019 were enrolled in the study and divided into two groups: Tubeless group where tube was omitted and Standard Group where it was placed. The two groups were compared with respect to hemoglobin drop and blood transfusion requirement, hospital stay and analgesic requirement in the post-operative period. Results: Mean age of the patients was 34.30 ± 13.19 years. Mean stone size was 19.03 mm. The mean change in hemoglobin after standard mPCNL was 1.68 gm/dl and that in the tubeless group was 1.11 (p=0.018). The tubeless group had a significantly (p=0.001) shorter hospital stay (3.05 ± 1.23 days) compared to standard group (3.85 ± 0.86). The postoperative pain as assessed by visual analogue scale, was more in the standard group necessitating additional analgesia. It was significantly higher in the standard group at 12, 24, 48 hours, as compared to the tubeless group. Conclusion: Placement of nephrostomy tube can be omitted as a routine practice as Tubeless mini PCNL has an added advantage of significantly reduced postoperative pain, less analgesic requirement, shorter hospital stay, less postoperative blood loss.

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COMPARATIVE STUDY BETWEEN STANDARD AND TUBELESS PERCUTANEOUS NEPHROLITHOTOMY PROCEDURES FOR SURGICAL MANAGEMENT OF KIDNEY STONES.

10.36106/ijsr/5310038 ◽

2020 ◽

pp. 1-2

Author(s):

Rahul Goel ◽

Dalvir Singh ◽

Shivangi Middha ◽

Jyoti Yadav

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Statistical Significance ◽

Randomised Trial ◽

Standard Group ◽

Residual Stone ◽

Analgesic Requirement ◽

Duration Of Hospital Stay ◽

Significant Difference ◽

Duration Of Surgery

Introduction: Percutaneous Nephrolithotomy (PCNL) is an effective treatment for renal stone. Due to significant pain and morbidity after standard PCNL because of nephrostomy tubes, various modifications of PCNL are being performed. We report a randomised trial comparing these modalities. Material and method: 50 patients were randomised in two groups of 25 each: standard PCNL with nephrostomy tubes (Group 1) and tubeless PCNL with ureteric stent and no nephrostomy (Group 2). At the end of procedure randomisation was done for those patients satisfying the inclusion criteria based on duration of surgery, single puncture tract, intraoperative bleeding, stone burden, intact pelvicalyceal system and no residual stone at end of procedure. Hb drop, haemorrhage, need for blood transfusion, pyrexia, urine leak, pain score, analgesic requirement and duration of hospital stay were measured. Results: No significant difference in haemorrhage was observed. Urinary leak was only seen in one patient of standard group. Duration of hospital stay and analgesic requirement attained statistical significance in favour of tubeless group compared to standard. Conclusion: Tubeless is effective and safe method for management of renal stones. It reduces postoperative pain and morbidity compared to standard group.

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Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

Current Diabetes Reviews ◽

10.2174/1573399814666180119142254 ◽

2019 ◽

Vol 15 (2) ◽

pp. 133-140 ◽

Cited By ~ 1

Author(s):

Ghada El Khoury ◽

Hanine Mansour ◽

Wissam K. Kabbara ◽

Nibal Chamoun ◽

Nadim Atallah ◽

...

Keyword(s):

Hospital Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Center ◽

Descriptive Analysis ◽

Tertiary Care ◽

Multivariable Analysis ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

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Tu1144 Comparison of Length of Hospital Stay of Children Admitted With Acute Pancreatitis Among Hospital Services At a Single Pediatric Tertiary Care Center

Gastroenterology ◽

10.1016/s0016-5085(14)62765-7 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-765 ◽

Cited By ~ 1

Author(s):

Flora K. Szabo ◽

Joseph J. Palermo ◽

Tom K. Lin ◽

Maisam Abu-El-Haija

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Care Center ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Tertiary Care Center ◽

Hospital Services

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Efficacy and safety of percutaneous nephrolithotomy in patients with chronic kidney disease: Outcomes from a tertiary care center

Journal of Endourology ◽

10.1089/end.2021.0514 ◽

2021 ◽

Author(s):

Harkirat Singh Talwar ◽

Ankur Mittal ◽

Vikas Kumar Panwar ◽

Jyoti Mohan Tosh ◽

Gurpremjit Singh ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Percutaneous Nephrolithotomy ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Efficacy And Safety ◽

Disease Outcomes

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An Experience with Management of Hemoperitoneum in Blunt Injury of Abdomen at Tertiary Care Center of Western Nepal

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v7i1.24689 ◽

2019 ◽

Vol 7 (1) ◽

pp. 37-41

Author(s):

Santosh Mishra ◽

Kailash Chandra ◽

Kumar Paudel

Keyword(s):

Hospital Stay ◽

Road Traffic Accident ◽

Traffic Accident ◽

Road Traffic ◽

Care Center ◽

Tertiary Care ◽

Operative Management ◽

Blunt Injury ◽

Physical Assault ◽

Non Operative Management

INTRODUCTION: Blunt abdominal trauma results in huge burden of morbidity and mortality among all age groups caused mainly by road traffic accident, fall from height and physical assault. This study was designed to evaluate the outcome of management of hemoperitoneum in blunt injury of abdomen. MATERIAL AND METHODS: This is a prospective observational study involving 100 cases of blunt abdominal injury during the period from 1st December, 2014 to 13th March 2016 in UCMS-TH, Bhairahawa, Nepal. Documentation of the patients which included identification, history, clinical findings, diagnostic tests, operative findings, operative procedures, complications during hospital-stay was done. The decision regarding operative or non- operative management was made by specialist surgeon. RESULTS: The majority of the patients belonged to 21- 30 years age group. 72 cases were male while 28 were female. 93 patients were managed conservatively while 7 patients were operated. Most common mode of injury was road traffic accident (RTA) (74%) followed by fall form height (20%). Most common organ to be injured was spleen (65%) followed by liver (26%). 93 % patients underwent non-operative management while 7 % were operated. Mortality rate was 0% among the non- operative and 14.29% in operative cases. CONCLUSION: Non operative management in patient with hemoperitoneum with regular monitoring of vitals and repeated clinical assessment can reduce the operative need , morbidity and length of hospital stay. Non-operative Management (NOM) for blunt abdominal injuries was found to be highly successful in 93% of the patients in this study.

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Efficacy of Dexmedetomidine as an Adjuvant to Local Anesthetic Agent in Scalp Block and Scalp Infiltration to Control Postcraniotomy Pain: A Double-Blind Randomized Trial

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_310_17 ◽

2018 ◽

Vol 09 (01) ◽

pp. 073-079 ◽

Cited By ~ 8

Author(s):

Shankar Vallapu ◽

Nidhi Bidyut Panda ◽

Navneh Samagh ◽

Neerja Bharti

Keyword(s):

Nerve Block ◽

Care Center ◽

Tertiary Care ◽

Primary Objective ◽

Analgesic Requirement ◽

Double Blind ◽

Respiratory Parameters ◽

Scalp Block ◽

American Society ◽

American Society Of Anesthesiologists

ABSTRACT Context: Scalp infiltration and scalp block are being used to manage postcraniotomy pain. Dexmedetomidine has been successfully used as an adjuvant in regional anesthesia. The study was intended to compare whether addition of dexmedetomidine prolonged the duration of analgesia as well as to compare the two techniques. Aims: The primary objective was to assess whether addition of dexmedetomidine to bupivacaine prolonged the duration of analgesia. The secondary objective was to compare between scalp nerve block and scalp infiltration as techniques for pain relief. Settings and Design: The randomized control study was conducted in a tertiary care center from November 2013 to October 2014. Materials and Methods: A total of 150 American Society of Anesthesiologists Physical Status I–II patients, aged 18–70 years undergoing elective craniotomy were included. Patients were randomized into three groups of 50 patients, i.e., Group BI (bupivacaine infiltration), Group BDI (bupivacaine and dexmedetomidine infiltration), and Group BDNB (bupivacaine and dexmedetomidine scalp nerve block). Patient's pain score, pain-free interval, rescue analgesic requirement, and hemodynamic and respiratory parameters were noted for 48 h. Patients were followed up at 1 and 3 months to assess postcraniotomy pain. Results: Pain-free period was significantly longer in Group BDNB than Groups BDI and BI (P < 0.0001) and pain control was better in dexmedetomidine containing groups than in bupivacaine group (BI) (P < 0.0001). The rescue analgesic requirement was significantly lower in Group BDNB and Group BDI compared to Group BI. Conclusion: The addition of dexmedetomidine (1 µg/kg) to bupivacaine prolonged the pain-free period. Scalp nerve block is a superior technique than scalp infiltration.

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Characteristics of a Breast Pathology Consultation Practice

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2016-0371-oa ◽

2017 ◽

Vol 141 (4) ◽

pp. 578-584 ◽

Cited By ~ 4

Author(s):

Ellen G. East ◽

Lili Zhao ◽

Judy C. Pang ◽

Julie M. Jorns

Keyword(s):

Spindle Cell ◽

Care Center ◽

Tertiary Care ◽

Routine Practice ◽

Diagnostic Challenge ◽

Breast Pathology ◽

Prognostic Features ◽

Tertiary Center ◽

Lesion Classification

Context.— Intradepartmental consultation is a routine practice commonly used for new diagnoses. Expert interinstitutional case review provides insight into particularly challenging cases. Objective.— To investigate the practice of breast pathology consultation at a large tertiary care center. Design.— We reviewed breast pathology cases sent for private consultation and internal cases reviewed by multiple pathologists at a tertiary center. Requisitions and reports were evaluated for diagnostic reason for consultation, rate of multiple pathologist review at the tertiary center, use of immunohistochemistry, and, for private consultation cases, type of sender and concordance with the outside diagnosis. Results.— In the 985 private consultation cases, the most frequent reasons for review were borderline atypia (292 of 878; 33.3%), papillary lesion classification (151 of 878; 17.2%), evaluating invasion (123 of 878; 14%), subtyping carcinoma (75 of 878; 8.5%), and spindle cell (67 of 878; 7.6%) and fibroepithelial (65 of 878; 7.4%) lesion classification. Of 4981 consecutive internal cases, 358 (7.2%) were reviewed, most frequently for borderline atypia (90 of 358; 25.1%), subtyping carcinoma (63 of 358; 17.6%), staging/prognostic features (59 of 358; 16.5%), fibroepithelial lesion classification (45 of 358; 12.6%), evaluating invasion (37 of 358; 10.3%), and papillary (20 of 358; 5.6%) and spindle cell (18 of 358; 5.0%) lesion classification. Of all internal cases, those with a final diagnosis of atypia had a significantly higher rate of review (58 of 241; 24.1%) than those with benign (119 of 2933; 4.1%) or carcinoma (182 of 1807; 10.1%) diagnoses. Immunohistochemistry aided in diagnosis of 39.7% (391 of 985) and 21.2% (76 of 359) of consultation and internally reviewed cases, respectively. Conclusions.— This study confirms areas of breast pathology that represent diagnostic challenge and supports that pathologists are appropriately using expert consultation.

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Validation of a Breastfeeding History Questionnaire for the Risk of In-Hospital Formula Supplementation Among Multiparous Women

Journal of Human Lactation ◽

10.1177/0890334419868157 ◽

2019 ◽

Vol 35 (4) ◽

pp. 665-671

Author(s):

Whitney R. Bender ◽

Nathanael C. Koelper ◽

Mary D. Sammel ◽

Celeste Durnwald

Keyword(s):

Hospital Stay ◽

Care Center ◽

Tertiary Care ◽

Categorical Variables ◽

Chi Square ◽

Multiparous Women ◽

Chi Square Test ◽

Student’S T ◽

Relationship Of ◽

The Relationship

Background: A woman’s prior breastfeeding history may influence future decisions regarding infant feeding. Few quantitative tools utilizing this information have been demonstrated to predict breastfeeding success. Research aim: To evaluate the efficacy of a prenatal breastfeeding history (BAP) questionnaire administered in prenatal care to predict in-hospital formula supplementation among multiparous women. Methods: This is a prospective observational study of multiparous women with singleton pregnancies who presented to a Baby-Friendly urban tertiary care center for 1st prenatal visit at < 20 weeks’ gestation. The BAP tool generates a numerical score, with higher score (≥ 2) indicating prior successful breastfeeding experiences. The primary outcome was occurrence of non-medically indicated formula supplementation during the postpartum hospital stay. Student’s t test and Pearson’s chi-square test were used to compare continuous and categorical variables. A multivariable logistic regression was performed to assess the relationship of BAP score to formula supplementation. Of 587 women screened, 433 (73.8%) mother–infant dyads were analyzed. Results: Rates of formula supplementation in women with BAP scores ≤ 1 were 67% (156/234) compared with 37% (73/199) in women with higher scores ( p < 0.0001). After controlling for race/ethnicity, insurance, and obesity, women with BAP scores of ≤ 1 were 2.6 times more likely to supplement formula than women with higher scores (a OR 2.62, 95% CI [1.70, 4.04], p < .0001). Conclusion: In this prospective validation study, women with negative prior breastfeeding experiences, as evidenced by a lower BAP score, were more likely to supplement formula during the postpartum hospital stay.

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