scholarly journals Anaesthesia and Perioperative Care in Remote Health Camps- Patients’ Concerns

2010 ◽  
Vol 49 (179) ◽  
Author(s):  
Balkrishna Bhattarai ◽  
A Ghimire ◽  
BK Baral ◽  
A Shrestha ◽  
Y Dhungana
Keyword(s):  
Observational Study ◽  
Perioperative Care ◽  
Local Anaesthesia ◽  
Prospective Observational Study ◽  
Main Concern ◽  
Surgical Experience ◽  
Female Ratio ◽  
Male Female Ratio ◽  
The Mean ◽  
Remote Health

INTRODUCTION:Identifying patients' concerns and expectations regarding anaesthesia and perioperative care in mobile surgical camps is relevant for the camp workers. This prospective observational study was conducted to assess knowledge, concerns, and expectations about anaesthesia and perioperative care in patients undergoing surgery in mobile surgical camps in remote mountainous districts of Eastern Nepal.METHODS:A questionnaire with seven items related to anaesthesia and perioperative care was used for interviewing 80 individuals of age > or = 12 years, 20 from each camp at Solukhumbu, Sankhuwasabha, Khotang and Bhojpur districts.RESULTS:Data of two patients were lost leaving only 78 individuals for analysis. The mean age of the subjects was 30.5 (+/- 14.6) years with the male: female ratio of 43: 35. Fifty-eight (74.4%) patients had some gross idea about the modality of administration of anaesthetics. Twenty-six (33.3%) individuals preferred GA over local anaesthesia, whereas 22 (28.2%) were happy either way if there was no pain. Pain was the main concern for 73.1% of the patients. Of the 25 patients expressing fear of GA, death or not being able to wake up anymore was the main concern for 60.0%. Increasing age was associated with lower fear of GA (p < 0.05). Surgical experience was distressing for 17 (21.8%) patients. The overall experience of the anaesthesia and surgery was worse than expected for 25.6% of the patients.CONCLUSIONS:Patients presenting to these health camps have limited knowledge regarding anaesthesia and perioperative care but have valid concerns and expectations in respect of their safety, comfort and outcome.

Intramedullary Nailing with Blocking Screws in the Treatment of Fractures of Proximal and Distal Ends of Tibia - A Prospective Observational Study in a Tertiary Care Hospital of Kannur, Kerala

2021 ◽  
Vol 8 (39) ◽  
pp. 3448-3453
Author(s):  
Adnan Siddique P. ◽  
Prateek Chandak M. ◽  
Sasikumar Sasidharan
Keyword(s):  
Observational Study ◽  
Internal Fixation ◽  
Intramedullary Nailing ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Care Hospital ◽  
Distal Fragment ◽  
Intramedullary Nails ◽  
Female Ratio ◽  
The Mean

BACKGROUND Fractures of both proximal and distal metaphyses with small distal fragment of tibia are not uncommon. Internal fixation using intramedullary nails alone could lead to misalignment. Using blocking screws (Poller screws) in addition to intramedullary nails would help in narrowing the medullary cavity and decreases the degree of misalignment and chances of displacement. The present study was conducted to evaluate functional and radiological outcome of blocking screws with intramedullary nail in the treatment of proximal and distal metaphyses fractures of tibia with short distal fragment. METHODS A prospective observational study of 34 patients with proximal and distal tibial metaphyses fractures was treated with statically locked intramedullary nailing with supplementary blocking screws. The study was conducted from January 2018 to December 2020 with a maximum follow up of 18 months. Medullary canal diameter was measured at the levels of fracture and isthmus. RESULTS Among the 34 patients, 29 (85.29 %) were males and 05 (14.70 %) were females with a male to female ratio of 5.8 : 1. The mean age was 34.97 ± 3.10 years. The mean healing period was 20 ± 1.45 weeks. 25/34 (73.52 %) of the patients showed Karlstrom and Olerud functional grading score of excellent. The fracture varus/valgus alignment was 1.9 ± 0.3 degrees. The mean antecurvatum/recurvatum alignment was 0.3 degrees. CONCLUSIONS Blocking screws act as reduction tools, help in reducing the medullary lumen of distal metaphyses and prevent failures in initial reduction. They extend the indication of intramedullary nailing to the distal segment of tibia and minimize the misalignment in terms of varus /valgus and/or antecurvatum/recurvatum. KEYWORDS Tibia, Intramedullary, Blocking Screws, Internal Fixation and Misalignment

scholarly journals AB0287 HEMATOLOGICAL SIDE EFFECTS OF BIOLOGICAL THERAPY IN RHEUMATOLOGY: DATA FROM THE TUNISIAN REGISTER

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1442.2-1442
Author(s):  
H. Bettaieb ◽  
S. Boussaid ◽  
S. Jemmali ◽  
S. Rekik ◽  
E. Cheour ◽  
...  
Keyword(s):  
Side Effects ◽  
Biological Treatment ◽  
Blood Count ◽  
Biological Therapy ◽  
National Registry ◽  
Close Monitoring ◽  
Female Ratio ◽  
Therapy Initiation ◽  
Male Female Ratio ◽  
The Mean

Background:During the last decade, the treatment of chronic inflammatory rheumatism (CIR) has been greatly improved with the advent of biotherapy.However, the use of biological treatment can lead to a number of side effects including abnormalities in the blood count.Objectives:The aim of this study was to assess the different hematological side effects of biological treatment in patients with rheumatoid arthritis (RA) and spondyloarthitis (SA).Methods:This study included patients with RA (ACR/EULAR 2010) and SA (ASAS 2009) registred with the Tunisian Biologic National Registry (BINAR).Patients were followed and treated with biologics for 2 years of less. Clinical data relative to biological treatment, including haematological side effects, have been collected.Results:Two hundred and ninety-eight patients (178 women and 111 men) were included in the study.The mean age was 49.2 ± 14.1 years. The male/female ratio was 0.6. The mean diseases durations for RA and SA were respectively 6.7 ± 3.5 years and 6.5 ±3.6 years.Anti-TNFα agents were prescribed in 87.9% of patients (n = 263) with respectively: Infliximab (20.4%) Etanercept (23.1%), Adalimumab (24.6%) and Certolizumab (26.5%).Tocilizumab and Rituximab were prescribed in 10.4% and 5% of the patients, respectively.Blood count abnormalities were noted in 15.4 % of patients (n=46).Neutropenia was the most frequently anomaly met on the hemogram (9.1%) followed by anemia (3.4%) and thrombocytopenia (3%). Pancytopenia was found in 11.4% of patients (n=34).The median time between biological therapy initiation and the onset of hematologic manifestations was 4.8 months [1-12]. Biological treatment was interrupted in two patients.In the other cases, the biological treatment was maintained with close monitoring of blood cell count. No case of death related to these hematological disturbances has been reported.Conclusion:In our registry, hematological side effects of biological treatment were found in 15.4% of cases and were noted with a median delay of 4.8 [1-12] months after the treatment initiation. Further studies are needed to confirm our preliminary results.Disclosure of Interests:None declared

scholarly journals Profile of Secondary Glaucoma at a Tertiary Hospital in East Java

2021 ◽  
Vol 56 (1) ◽  
pp. 56
Author(s):  
Evelyn Komaratih ◽  
Yuyun Rindiastuti ◽  
Yulia Primitasari
Keyword(s):  
Intraocular Pressure ◽  
Observational Study ◽  
Surgical Complication ◽  
Anterior Segment ◽  
Tertiary Hospital ◽  
Secondary Glaucoma ◽  
Female Ratio ◽  
Poor Vision ◽  
Detailed History ◽  
Male Female Ratio

Glaucoma is the leading cause of irreversible blindness. The aim of this study was to review the profile of secondary glaucoma cases visiting a tertiary hospital in East Java. This is retrospective observational study, completed case records of new patients with secondary glaucoma who presented to glaucoma clinic from January 2014 to April 2016 were included. Out of the 363 case records screened, 66 cases were found to eligible for inclusion. The evaluation included a detailed history and examination performed including vision, anterior segment examination, intraocular pressure (IOP), gonioscopy, and fundus evaluation. Diagnosis of secondary glaucoma was made on the basis of presence of a secondary cause for presence of raised IOP. 66 cases were eligible for inclusion in the study, most of the cases was occurred in the range age 21-50 years. The male female ratio was 1.3:1. Frequent causes of secondary glaucoma were lens factor 30.8%, steroid induced 29.5%, uveitic 20.5%, neovascular15.4%, and surgical complication 3.8%. Most patients with secondary glaucoma have poor vision < 0.1 with high IOP at presentation. Assessment and early detection of underlying cause is the key guide to treatment strategy.

scholarly journals Laryngopharyngeal Reflux: Is It the Real Culprit in Patients with Laryngeal Complaints?

2017 ◽  
Vol 7 (1) ◽  
pp. 6-9 ◽  
Author(s):  
Rajesh Vishwakarma ◽  
Ruta V Shah
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Female Ratio ◽  
The Real ◽  
Body Sensation ◽  
Male Female Ratio ◽  
The Mean ◽  
Nose And Throat

ABSTRACT Aim The aim of this study is to evaluate the role of laryngopharyngeal reflux (LPR) in patients with laryngeal complaints and study the correlation between reflux symptom index (RSI) and reflux finding score (RFS). Materials and methods This is a study of 104 patients, who presented in the ear, nose, and throat outpatient department at the Civil Hospital, Ahmedabad, India, from April 2015 to April 2016, with complaints like change of voice, chronic cough, foreign body sensation, throat clearing, difficulty swallowing, and regurgitation. All the patients were examined with 90° endoscope by a single examiner, and an RSI ≥13 was considered as indicative of reflux. Observation and discussion The mean age of the 104 patients was 47.2 years. The male-female ratio was 1:1.8. The RSI ranged from 5 to 44, with a mean of 22.99 and standard deviation (SD) of 7.43. The RFS ranged from 4 to 22, with a mean of 11.04 and SD of 3.07. Both the parameters showed high correlation (correlation coefficient 0.98). Conclusion The LPR plays an important contributory role in patients with laryngeal complaints. The RFS and RSI can be used as routine parameters in establishing the diagnosis of reflux. How to cite this article Shah RV, Vishwakarma R. Laryngopharyngeal Reflux: Is It the Real Culprit in Patients with Laryngeal Complaints? Int J Phonosurg Laryngol 2017; 7(1):6-9.

scholarly journals Role of JIGSAW method of teaching in improving clinical diagnosis among final year medical students – A prospective observational study

2021 ◽  
Vol 12 (12) ◽  
pp. 44-49
Author(s):  
Appandraj S ◽  
Sivagamasundari V ◽  
Varatharajan Sakthivadivel
Keyword(s):  
Observational Study ◽  
Test Score ◽  
Prospective Observational Study ◽  
Coronary Syndrome ◽  
Post Test ◽  
Jigsaw Method ◽  
The Mean ◽  
The Difference ◽  
Didactic Lecture ◽  
Teaching Learning

Background: The Jigsaw method is a form of cooperative learning, in which students are actively involved in the teaching-learning process that improves the long-term retention of acquired knowledge. Aims and Objectives: The objective of this study was to assess the knowledge acquired by students using the Jigsaw learning method in Internal Medicine. Materials and Methods: A prospective observational study was conducted with 100 students. The acute coronary syndrome was taken for 1 h as a didactic lecture, and a pre-test was conducted. The students were divided into five groups and were put for the intervention “Jigsaw.” The pre- and post-test were conducted, and feedback was collected from the students. Paired t-test was used to perform analysis of pre- and post-test. Feedback evaluation was done by a 5-point Liker scale. P<0.05 was considered statistically significant, and the data were analyzed using CoGuide software. Results: The mean pre-test score was 8.44 ± 2.33 ranged (3–14) and the mean post-test score was 11.03 ± 2.07 (ranged 6–15). The difference of 2.39 (95% CI: 2.19–2.59) increase in marks post-test after the Jigsaw method was statistically significant (P<0.001). The satisfaction level was 50–55% on the Likert scale based on the questionnaire given. There was a significant improvement in the post-test scores of the students after Jigsaw. Conclusion: The Jigsaw method improved knowledge in the short-term by engaging students in group work and motivation to learn. Overall response based on the questionnaire about the Jigsaw method was positive.

Laparoscopic Cholecystectomy for Acute Cholecystitis: Indication, Risk, and Outcome

2021 ◽  
Vol 8 (06) ◽  
pp. 5508-5513
Author(s):  
Dr. Shiladitya Shil ◽  
Dr. Ashutosh Deb Sarma ◽  
Dr. Md. Alomgir Islam ◽  
Dr. Md. Abdullah-Hel-Baki Abdul ◽  
Dr.Monira Begum
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Prospective Observational Study ◽  
The Other ◽  
Surgical Indication ◽  
College Hospital ◽  
Female Ratio ◽  
Medical College ◽  
The Mean ◽  
Good Treatment Option

Background: A laparoscopic cholecystectomy is a fundamental approach to treating acute cholecystitis, and the timing of performing this given treatment is associated with clinical outcomes. It is unknown whether surgical indication, risk, and consequences of laparoscopic cholecystectomy for acute cholecystitis differ from those for the chronic form, making it questionable whether urgent laparoscopic cholecystectomy is the best approach even in severe acute cases. Objective: This study aimed to evaluate surgical indication, risk, and outcomes of laparoscopic cholecystectomy for acute cholecystitis. Methods: This prospective observational study was carried out at Bangladesh Medical College Hospital (Uttara Campus) from July 2006 to November 2008. A total of 103 acute cholecystitis patients were observed to evaluate the safety, risk, and outcomes (includes hospital stay, joining to routine daily works) of laparoscopic cholecystectomy. Result: Male and female ratio is 1:4, and the mean age in our series is 47 years. Acute calculas cholecystitis ultra-sonogram feature shows the highest percentage (85.4%) compare to the other four parts. The study also confirmations around 69% did not get any complications, and bleeding was the most frequently observed (16%) complication. The overall outcomes in this research were observed around 75% of total operated patients did not experience any difficulty and said they fit entirely. The other 19% who had some complications include Pain, RTI, Seroma, Jaundice, Cholangitis, Wound infection). Conclusion: Regarding bile duct injury and prolonged complications, laparoscopic surgery is not a very good treatment option for acute cholecystitis.

Glissonean pedicle approach using Takasaki method in liver resection at Hue Central Hospital

2019 ◽  
pp. 8-11
Author(s):  
Van Linh Ho
Keyword(s):  
Operative Time ◽  
Hepatic Duct ◽  
Postoperative Mortality ◽  
Descriptive Study ◽  
Common Hepatic Duct ◽  
Effective Technique ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Glissonean Pedicle ◽  
The Mean

Objective: To apply hepatectomy using Takasaki procedure to control Glissonean pedicle. Methods: A prospective, descriptive study on 31 patients undergoing hepatectomy using Takasaki Glissonean pedicle approach. Results: The mean age was 55 ± 11.7 (39 – 73 years), male/female ratio was 7.3. The mean operative time was 115 ± 37 minutes. The mean blood loss was 271 ± 119 ml. There was one case of common hepatic duct injury (3.6%). Postoperative complications occurred in 7(22.4%) patients. There was no postoperative mortality. Conclusions: Hepatectomy using Takasaki Glissonean pedicle approach was safe and effective technique. Keywords: Glissonean pedicle approach, hepatectomy

scholarly journals Incisional Hernia Repair in Contaminated Surgical fields (I.H.R.C.S.) study using biological prostheses in emergency surgery setting with contaminated hernias: a multicenter prospective observational study

2016 ◽  
Author(s):  
Belinda De Simone ◽  
Fausto Catena ◽  
Antonio Biondi ◽  
Gianluca Baiocchi ◽  
Fabio Campanile ◽  
...  
Keyword(s):  
Observational Study ◽  
Incisional Hernia ◽  
Prospective Observational Study ◽  
Wound Complication ◽  
Hernia Recurrence ◽  
Mesh Placement ◽  
Asa Score ◽  
Surgical Field ◽  
The Mean ◽  
Biological Prostheses

There are still difficulties to find appropriate indication for prosthetic implant in hernia surgery in contaminated surgical fields. Biologic prosthetic materials have been developed and proposed for the clinical use in contaminated surgical fields with interesting outcomes. The aim of this study is to analyze data from nine Italian Emergency Surgery Units concerning patients consecutively admitted with diagnosis of strangulated incisional hernia (IH), submitted to surgery in emergency and treated with biological prostheses. This is a prospective observational study. Subjects submitted to singlestaged IH repair in a contaminated surgical field, with the use of biologic mesh, were prospectively studied over a 1-year time period. All patients enrolled in this study were submitted to bowel/intestinal resection at the same operative time for perforation. Primary end points of our study were wound complication and hernia recurrence. Seventy-one patients were enrolled (F=21, M=50); the mean age was 69.2±11.1 standard deviation (SD) years and the mean American Society of Anesthesiologist (ASA) score was 3.1±0.8 SD. Twenty-one patients (29.57%) had a wound complication, associated with high ASA score, diabetes, smoking, chronic immunosuppression, number of previous hernia repairs, dirty surgical field, sublay extra peritoneal mesh placement and no anterior fascia closure. After a mean follow up time of 27.2 months, hernia recurrence occurred in 19 patients (26.76%). Predictors of hernia recurrence included wound complications, high ASA score, diabetes, chronic immunosuppression, dirty surgical field and sublay extra peritoneal mesh placement. Use of biological prostheses in contaminated fields is safe with favorable medium term recurrence rate (26.76% in our experience). Surgical technique performed is important to decrease hernia recurrence rate.

scholarly journals Premedication practices for tracheal intubation in neonates transported by French medical transport teams: a prospective observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e034052 ◽  
Author(s):  
Ricardo Carbajal ◽  
Noella Lode ◽  
Azzedine Ayachi ◽  
Ourida Chouakri ◽  
Véronique Henry-Larzul ◽  
...  
Keyword(s):  
Adverse Events ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Drug Regimen ◽  
Muscle Rigidity ◽  
Neonatal Transport ◽  
Registration Number ◽  
Medical Transport ◽  
The Mean ◽  
Paris Region

ObjectivesPremedication practices for neonatal tracheal intubations have not yet been described for neonatal transport teams. Our objective is to describe the use of sedation/analgesia (SA) for tracheal intubations and to assess its tolerance in neonates transported by medical transport teams in France.SettingThis prospective observational study was part of the EPIPPAIN 2 project and collected around-the-clock data on SA practices in neonates intubated by all five paediatric medical transport teams of the Paris region during a 2-month period. Intubations were classified as emergent, semiemergent and non-emergent. Sedation level and conditions of intubation were assessed with the Tonus, Reactivity, Awareness and Conditions of intubation to Help in Endotracheal intubation Assessment (TRACHEA score). The scores range from 0 to 10 representing an increasing ladder from adequate to inadequate sedation, and from excellent to very poor conditions of intubation.Participants40 neonates intubated in 28 different centres.ResultsThe mean (SD) age was 34.9 (3.9) weeks, and 62.5% were intubated in the delivery room. 30/40 (75%) of intubations were performed with the use of SA. In 18/30 (60.0%) intubations performed with SA, the drug regimen was the association of sufentanil and midazolam. Atropine was given in 19/40 intubations. From the 16, 21 and 3 intubations classified as emergent, semiemergent and non-emergent, respectively, 8 (50%), 19 (90.5%) and 3 (100%) were performed with SA premedication. 79.3% of intubations performed with SA had TRACHEA scores of 3 or less. 22/40 (55%) infants had at least one of the following adverse events: muscle rigidity, bradycardia below 100/min, desaturation below 80% and nose or pharynx–larynx bleeding. 7/24 (29.2%) of those who had only one attempt presented at least one of these adverse events compared with 15/16 (93.8%) of those who needed two or more attempts (p<0.001).ConclusionSA premedication is largely feasible for tracheal intubations performed in neonates transported by medical transport teams including intubations judged as emergent or semiemergent.Trial registration numberNCT01346813; Results.

scholarly journals How do palliative care doctors recognise imminently dying patients? A judgement analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e024996 ◽  
Author(s):  
Nicola White ◽  
Priscilla Harries ◽  
Adam JL Harris ◽  
Victoria Vickerstaff ◽  
Philip Lodge ◽  
...  
Keyword(s):  
Palliative Care ◽  
Observational Study ◽  
Phase I ◽  
Phase Ii ◽  
Prospective Observational Study ◽  
Clinical Signs ◽  
Brier Score ◽  
Prognostic Test ◽  
Probability Of Death ◽  
The Mean

ObjectivesTo identify a group of palliative care doctors who perform well on a prognostic test and to understand how they make their survival predictions.DesignProspective observational study and two cross-sectional online studies.SettingPhase I: an online prognostic test, developed from a prospective observational study of patients referred to palliative care. Phase II: an online judgement task consisting of 50 hypothetical vignettes.ParticipantsAll members of the Association of Palliative Medicine (APM) were eligible (n=~1100). 99 doctors completed the prognostic test and were included in the phase I analysis. The top 20% were invited to participate in phase II; 14/19 doctors completed the judgement task and were included in the phase II analysis.MeasuresPhase I: participants were asked to give a probability of death within 72 hours (0%–100%) for all 20 cases. Accuracy on the prognostic test was measured with the Brier score which was used to identify the ‘expert’ group (scale range: 0 (expert)–1 (non-expert)). Phase II: participants gave a probability of death within 72 hours (0%–100%). A mixed model regression analysis was completed using the percentage estimate as the outcome and the patient information included in the vignettes as the predictors.ResultsThe mean Brier score of all participants was 0.237 (95% CI 0.235 to 0.239). The mean Brier score of the ‘experts’ was 0.184 (95% CI 0.176 to 0.192). Six of the seven prognostic variables included in the hypothetical vignettes were significantly associated with clinician predictions of death. The Palliative Performance Score was identified as being the most influential in the doctors’ prognostic decision making (β=0.48, p<0.001).ConclusionsThis study identified six clinical signs and symptoms which influenced the judgement policies of palliative care doctors. These results may be used to teach novice doctors how to improve their prognostic skills.

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