scholarly journals STUDY OF CLINICAL EVALUATION OF INTESTINAL OBSTRUCTION

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Dr. Aseem Majumdar ◽  
Dr. Ajay Kumar Agarwal
Keyword(s):  
Intestinal Obstruction ◽  
Early Recognition ◽  
Primary Anastomosis ◽  
Age Groups ◽  
Morbidity And Mortality ◽  
Electrolyte Imbalance ◽  
Age Group ◽  
Presenting Symptoms ◽  
Surgical Emergency ◽  
Mode Of Presentation

Introduction: All over world Intestinal obstruction is a common surgical emergency.  Intra-abdominal problems are one of the most common as Intestinal Obstruction by general surgeons in their practice. Intestinal obstruction is defined as obstruction in forward propulsion of contents of the intestine either due to active or inactive or pseudo-obstruction. It is predisposed by varying underlying abnormality diseases that are difficult to define pre-operatively. About 12% to 16% of acute abdominal emergencies may be contributed to intestinal obstruction. With multiple etiologies for intestinal obstruction of either the small or large bowel which become to be a major cause of morbidity and mortality. There are various Mode of presentation for intestinal obstruction underlying various cause in each age group. In ancients period mortality and morbidity was very high. Nowadays due to improvement and understanding of pathophysiology,  diagnosis techniques of radiology, electrolyte imbalance and high degree of refinement in correction of fluid, introduction of antibiotics to effective bacteriological control, introduction of techniques in gastrointestinal decompression, introduction of new surgical principles and primary anastomosis has replaced staged procedures and number of days stay in hospital with caring  and with Improvement in field of anesthesia has all contributed to decreasing the morbidity and mortality. About 5 to 15% of cases of severe abdominal pain were due to Mechanical obstruction acquiring sudden onset requiring admission to hospital. Therefore all factors are making difference in outcome of any operative procedure in relation to morbidity and mortality. Patient with acute intestinal obstruction depends largely upon early diagnosis which is useful for success in treatment. Most of the mortality occurs in elderly age with late treatment and who are having associated pre-existing diseases like, diabetes mellitus, COPD and cardiac diseases. However intestinal obstruction is most often the result of colorectal malignancies and lesions usually arise in the sigmoid or recto sigmoid area.  Aim: The main aim of this study is to explore different modes of presentations of intestinal obstruction in different age group. Material and method: All patients are informed consents. Total 50 patients having intestinal obstruction with various problems were taken in this study attending to hospital as in patient department (IPD) and outpatient department (OPD) of our hospital. A clinical study of intestinal obstruction were selected has to come across this surgical emergency and treatment and skillful management in surgery department of our hospital. The patients with age group 0-80 years were included in this study. Result:  In this study of 50 cases of intestinal obstruction was studied during period of 1 year. The study was done in all age groups with a mean age of 35 years. Occurrence of intestinal obstruction was common in male (72%) as compare to female (28%). Maximum presenting symptoms in this study was pain abdomen (80%) followed by vomiting (72%), Tenderness (86%), distension of abdomen (56%) and constipation (52%), most of patients with overlapping of symptoms. Conclusion: Intestinal obstruction is more common in males compared to females. Mode of presentation also differs in different levels of intestinal obstruction. Adhesions accounted for majority of intestinal obstruction.  Intestinal obstruction was found more common in children than other age groups. Malignancies are also common causes of intestinal obstruction. The clinical examination stressed upon vital signs and abdominal examination and Routine necessary investigations were carried out. Hence early recognition and timely intervention is important to prevent the intestinal obstruction.  Keywords:  Intestinal obstruction, Intussusception, adhesions, hernia, intraperitoneal malignancy.

scholarly journals PREVALENCE, DISTRIBUTION AND DETERMINANTS OF INTESTINAL TUBERCULOSIS IN ADULT INDOOR PATIENTS WITH ACUTE SMALL INTESTINAL OBSTRUCTION IN POPULATION OF PESHAWAR DIVISION, PAKISTAN

2020 ◽  
Vol 18 (3) ◽  
pp. 107-115
Author(s):  
Aftab Hussain ◽  
Sheikh Muhammad Ibqar Azeem ◽  
Imran Ullah ◽  
Shahidullah Ahmad ◽  
Muhammad Faisal Khan ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Teaching Hospital ◽  
Goodness Of Fit ◽  
Intestinal Tuberculosis ◽  
Age Groups ◽  
Morbidity And Mortality ◽  
Age Group ◽  
Chi Square ◽  
Small Intestinal Obstruction ◽  
Small Intestinal

Background: Acute small intestinal obstruction (ASIO) is one of the commonest causes of emergency hospital admissions, morbidity and mortality. Intestinal tuberculosis (ITB) is common cause of ASIO in developing countries leading to significant morbidity and mortality. Our objectives were to determine prevalence, distribution and determinants of ITB in adult indoor patients with ASIO in population of Peshawar Division, Pakistan.Materials Methods: This cross-sectional study was conducted at Department of Surgery Peshawar Medical College, Peshawar, Pakistan from January 2019 to June 2020.  The data was collected from its three affiliated hospitals; Mercy Teaching Hospital, Kuwait Teaching Hospital Prime Teaching Hospital, Peshawar. 207 ASIO subjects were selected from population at risk consecutively. Sex, age groups and presence of ITB were variables. Prevalence and distribution were described by count, percentage and confidence intervals for proportion for population. Hypotheses for distribution were tested by chi-square goodness of fit and of association by chi-square test of association.Results: Out of 207 patients with ASIO, 128 (61.84%) were men and 79 (38.16%) women, 87 (42.03%) were in age group 18-40 and 120 (57.97%) in 41-60 years. Out of 207 patients with ASIO, 41 (19.81%) had ITB, while 166 (80.19%) had no ITB. Out of 41 ITB patients, 25 (12.08%) were men and 16 (7.73%) women, 17 (8.21%) in age group 18-40 and 24 (11.60%) in 41-60 years. The prevalence of ITB was similar to expected (p=.5695). The distribution across sex (p=.00001) was different and across age groups (p=.12501) was similar to expected. Presence of ITB was not associated to sex (p=.8992) and age groups (p=.9347).Conclusion: Prevalence of intestinal TB in adult indoor acute small intestinal obstruction (ASIO) population of Peshawar Division, Pakistan was 19.81%. Prevalence was higher in men than women and higher in 41-60 years than 18-40 years age group population. Overall prevalence of intestinal TB was similar to expected. Observed distribution across sex was different and across age groups was similar to expected. Presence of intestinal TB was not associated to sex and age groups respectively.

scholarly journals GUILLAIN BARRE SYNDROME;

2013 ◽  
Vol 20 (03) ◽  
pp. 348-353
Author(s):  
SOHAIL ASHRAF ◽  
ARSHALOOZ J. RAHMAN
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Features ◽  
Acute Flaccid Paralysis ◽  
Early Recognition ◽  
Age Groups ◽  
Rapid Onset ◽  
Flaccid Paralysis ◽  
Initial Symptom ◽  
Age Group ◽  
Main Factor

Background: Guillian Barre Syndrome is a polyradiculopathy characterized by symmetric ascending paralysis andareflexia. It affects all age groups and both sexes with an unpredictable outcome. Objectives: The aims of this study were to identify thevarious diseases presenting as Acute Flaccid Paralysis and notice clinical features and outcome of cases of Guillian Barre Syndrome.Materials and Methods: Retrospective analysis of 53 patients presenting as Acute Flaccid Paralysis was done. Clinical features andlaboratory investigations of 39 patients of Guillian Barre syndrome were reviewed. Results: Among all cases of Acute Flaccid Paralysis,Guillian Barre syndrome formed the bulk of the cases (73.6%).It was more common in females and in age group of 10 years or below. Inmajority of the cases, rapid onset of weakness was the initial symptom. Mortality was 100% in patients who had respiratory muscleinvolvement and who required mechanical ventilation. Conclusions: In our study the main factor causing death in a case of Guillian Barresyndrome was bulbar involvement requiring mechanical ventilation. Early recognition of the prognostic factors may lead to decreasedmortality in case of Guillian Barre syndrome.

scholarly journals An Analytical Study on Anemia in Rural Population

2020 ◽  
Vol 3 (2) ◽  
pp. 28-33
Author(s):  
Shirish Ardhapuskar ◽  
Raghu Rammulu
Keyword(s):  
Age Groups ◽  
The Elderly ◽  
Medical Problem ◽  
Morbidity And Mortality ◽  
Common Symptom ◽  
Age Group ◽  
Expert Group ◽  
Adult Males ◽  
Medical College ◽  
The Common

Background: Anemia is one of the common Hematological disorders in India and worldwide. It affects all the age groups both in Males and Females. Moderate to Severe Anemia causes increased morbidity and mortality in elderly patients (AWHO expert group) - According to Worlds Health Organization, Anemia is a define when adults males are having Hemoglobin less than 13.5gr% when adults females non-pregnant less than 12 gr% and when pregnant females are having less than 11 ger%. The incidence of Anemia is very high in old age people who are more than 75 years of age. It ranges from 9% to 41%. In India Anemia is commonly due to nutrition, pregnancy, Hookworm infestation, DUB in the case of females, and Malignancy. The prevalence of anemia in the elderly has been found to range from 9% to 42% with the highest prevalence in 80 years and above. The common causes of anemia in India are Nutritional, Pregnancy, Hookworm infestation, and DUB in the case of Females and Malignancy. The common symptom is General weakness, Fatigue, Lack of concentration, Shortness of Breath, and Palpitations. A WHO expert group proposed that anemia should be considered when hemoglobin level below 13.5gr& in adult males; 12gr% in adults females non-pregnant; 11 gr% in adult female pregnant; 12gr% in children over 14yrs(1). The aim is to evaluate the etiology and clinical features of anemia in adults in rural medical colleges. Subjects & Methods: This study is conducted at GEMS Medical College, Srikakulam, A.P for the period of 1 year from April 2018 to March 2019. This study includes 120 patients with Anemia. The age group is between 20 years and 70 years. Males were 56 and females were 64. Results: We have conducted this study at GEMS Medical College, Srikakulam for 1 year, from April 2019 to March 2019 total no. of patients included in this study are 120 males 56 and females 64. The age group is between 20 years and 70 years. The maximum patients are in between 30 years and 70 years in both sexes. Conclusion: Anemia is a common medical problem in developing countries. In a rural part of India, the disorders will complicate the pregnancy also. So periodical examination and education of the people can decrease morbidity and mortality. In our area still, the common cause is nutritional.

scholarly journals A prospective study of intestinal obstruction in paediatric age group

2017 ◽  
Vol 4 (6) ◽  
pp. 1979
Author(s):  
Amul Bhedi ◽  
Miten Prajapati ◽  
Arnab Sarkar
Keyword(s):  
Intestinal Obstruction ◽  
Prospective Study ◽  
Hypertrophic Pyloric Stenosis ◽  
Age Groups ◽  
Total Mortality ◽  
Infants And Children ◽  
Age Group ◽  
Female Ratio ◽  
Paediatric Age ◽  
A Prospective Study

Background: Intestinal obstruction can occur at any age in the paediatric population1-4. Bowel obstruction in children differs from that in adults in terms of etiology, presentation and even the management. The aim of the study was to find out various etiologies, clinical features, outcome and mortality of paediatric age groups with intestinal obstruction and their relation to age and sex distribution.Methods: This is a prospective study of 50 cases of paediatric age group with signs and symptoms of intestinal obstruction which were admitted in Sir Sayajirao Gaekwad Hospital, Vadodara, India during period of December 2004 to November 2006. Surgical intervention was carried out where indicated otherwise patients were managed conservatively. Data was analysed in SPSS version 10 statistical software for percentage and frequencies.Results: Total 50 patients were included in the study. Among these 30 were males and 20 were females with M: F ratio of 3:2. Majority of them were 25 neonates of age group of 1-7 days (50%), followed by 7 infants of 1 months- 1 years (14%) and 18 children aged 1 years-12 years (36%).  Out of 50 patients, 41 (82%) patients had congenital causes in which 21(42%) patients had imperforate anus followed by Hirschprung’s disease in 8(16%), Meckel’s diverticulum in 6(12%), jejunal atresia in 4(8%), hypertrophic pyloric stenosis in 2 patients (4%) and 9(18%) patients had acquired causes in which intussusception was in 5(10%) patients, abdominal tuberculosis in 2(4%) and gangrenous appendix in 2(4%) patients. Total mortality was 6 out of 25 neonates and there were no mortality in infants and children groups.Conclusions: Majority of patients were neonates than infants and children with slight male preponderance with male: female ratio of 3:2. Congenital causes of intestinal obstruction were more common (82%) than the acquired causes (18%). Postoperative septicaemia was more common and overall mortality was exclusively in neonates.

scholarly journals Incidence and Trends in Lower Extremity Amputations in the United States

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Leah Herzog ◽  
Charles Johnson ◽  
Christopher E. Gross
Keyword(s):  
United States ◽  
Lower Extremity ◽  
Pearson Correlation ◽  
Age Groups ◽  
The United States ◽  
Morbidity And Mortality ◽  
Common Mechanism ◽  
High Morbidity ◽  
Injury Incidence ◽  
Age Group

Category: Trauma Introduction/Purpose: Currently there is minimal focus on traumatic lower extremity amputations due to their relatively low incidence, but they often come with a higher morbidity and mortality than its upper extremity counterparts. The purpose of this study was to evaluate the incidence and trends of lower extremity amputations in the United States over a ten-year period. Methods: The National Electronic Injury Surveillance System (NEISS), was used for evaluation of lower extremity amputations that presented to the United States emergency departments. The overall incidence rate of lower extremity amputations within the United States was calculated as per 100,000 persons. After grouping mechanisms of injury, the data were stratified by both age groups and gender. Chi-square tests were used for direct comparisons of proportions. The five most common mechanisms were ranked for each age group and the most common overall age group for lower extremity amputations were determined using descriptive statistics. Trends for injury incidence and hospital admissions were evaluated using linear regression and Pearson correlation with Bonferroni correction. Results: From 2008 to 2017, 393 patients were reported to have sustained lower extremity amputations via the NIESS database with an estimated 11,475 patients sustaining a lower extremity amputation over the past ten years and an incidence of 2.2/100,000 person-years. The incidence of lower extremity amputations is highest in those less than five years old. Lawnmower incidents are the most common mechanism of injury in all age groups. Conclusion: Due to the high morbidity and mortality associated with these injuries, it is prudent to follow the trends in lower extremity amputations.

scholarly journals Cervical artery dissection in patients ≥60 years

Neurology ◽  
2017 ◽  
Vol 88 (14) ◽  
pp. 1313-1320 ◽  
Author(s):  
Christopher Traenka ◽  
Daphne Dougoud ◽  
Barbara Goeggel Simonetti ◽  
Tiina M. Metso ◽  
Stéphanie Debette ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Age Groups ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Age Group ◽  
Presenting Symptoms ◽  
Cervical Artery ◽  
Secondary Analyses ◽  
Study Population

Objective:In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged <60 vs ≥60 years.Methods:We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic Stroke Patients–Plus consortium). We dichotomized cases into 2 groups, age ≥60 and <60 years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled individual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated.Results:Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33–0.66]), headache (ORadjusted 0.58 [0.42–0.79]), mechanical trigger events (ORadjusted 0.53 [0.36–0.77]), and migraine (ORadjusted 0.58 [0.39–0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1–2.10]) and hypertension (ORadjusted 3.08 [2.25–4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0–2) was less frequent in the older age group (ORadjusted 0.45 [0.25, 0.83]).Conclusion:In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.

scholarly journals Evolution of morbidity and mortality due to Multiple Sclerosis in Bahia from 2008 to 2019

2021 ◽  
Author(s):  
Marina Chaves Nascimento ◽  
André Moisés de Oliveira Nunes ◽  
Gabriel Barreto Marques Mathias ◽  
Iandra Silva Souza
Keyword(s):  
Multiple Sclerosis ◽  
Time Series ◽  
Average Rate ◽  
Age Groups ◽  
Hospitalization Rate ◽  
Morbidity And Mortality ◽  
Age Group ◽  
Demyelinating Neuropathy ◽  
Increase Rate ◽  
Males And Females

Introduction:Multiple sclerosis is a rare,incurable,demyelinating neuropathy of autoimmune inflammatory etiology with a diverse presentation and repercussions on the patient’s life.The study seeks to evaluate the evolution of morbidity and mortality due to Multiple Sclerosis in Bahia,comparing sex and age group. Methods:This was an Aggregate Observational study,by mixed,ecological and time series analysis,in Bahia between 2008-2019.Data from the Information Systems of Hospital and Mortality from DATASUS about Multiple Sclerosis was collected,analyzing the variables mortality,hospitalizations,sex and age group. Results:The hospitalization rate for males and females increased by 320% and 216.66% respectively,and was,on average,172.66% higher for women.There was an overall increase of 239.13% in hospitalization.In the age groups 15 to 19,20 to 29,30 to 39,40 to 49,50 to 59,60 to 69,70 to 79 years the increase rate was,respectively,0 for 4 patients,183.33%,400%,75%,550%,200%,0 for 1 patient.In the age group of 80 years or more,there were no changes.About mortality,there was an overall increase of 8.33%.There was a 50% reduction in males and an increase in females by 37.5%.The average rate was 61% higher among women.There was an increase in the 30 to 39,50 to 59,70 to 79 age groups in 0 to 3 deaths,150%,200%,respectively,and a reduction in the 20 to 29,40 to 49,80 years or more,respectively,1 for 0 deaths,3 for 0 deaths,75%.No changes in other age groups. Conclusion:Although the male presented an increase of the cases,there was a reduction in its mortality.The female had an important increase numbers of hospitalization and mortality,as did the age group of 50 to 59 years.

scholarly journals Pediatric appendicitis- five year experience at tertiary care pediatric surgery department: a cohort study

2020 ◽  
Vol 7 (6) ◽  
pp. 1793
Author(s):  
Manisha Albal ◽  
Prasad Y. Bansod ◽  
Deep Mashru
Keyword(s):  
Cohort Study ◽  
Acute Appendicitis ◽  
Early Recognition ◽  
Pediatric Population ◽  
Iliac Fossa ◽  
Tertiary Care ◽  
Complication Rates ◽  
Age Group ◽  
Female Ratio ◽  
Presenting Symptoms

Background: Acute appendicitis is one of the most common abdominal surgical condition in pediatric population. It accounts for 1-8% of children presenting in pediatric surgical emergency. The aim of this study was to evaluate pediatric appendectomy in our department.Methods: It was a hospital based prospective cohort study spanning over a period of 5 years, where all diagnosed cases of pediatric appendicitis were enrolled. Demographic profile, clinical features and operative findings were analyzed. Patients were kept on regular follow-up and complications were noted.Results: During the study period 146 patients were enrolled for the study. Male: female ratio was 1:1. Maximum patients belonged to age group of 11-15 years (42%). Pain in abdomen and fever were the most common presenting symptoms. Tenderness in right iliac fossa was the most common clinical sign (89.72%) and inflamed appendix was the most common operative finding in the study (83.91%).Conclusions: The diagnosis of acute appendicitis is based on clinical examination. Atypical symptoms may lead to delay in the diagnosis and management. Imaging and lab investigations are supportive. Early recognition of symptoms, access to healthcare facility with a surgeon can significantly reduce the morbidity and complication rates in pediatric age group.

Pseudotumor Cerebri Syndrome: From Childhood to Adulthood Risk Factors and Clinical Presentation

2020 ◽  
Vol 35 (5) ◽  
pp. 311-316 ◽  
Author(s):  
Muhammad Mahajnah ◽  
Jacob Genizi ◽  
Hazar Zahalka ◽  
Ronza Andreus ◽  
Nathanel Zelnik
Keyword(s):  
Risk Factors ◽  
Young Children ◽  
Clinical Presentation ◽  
Age Groups ◽  
Pseudotumor Cerebri ◽  
Published Data ◽  
Age Group ◽  
Adult Age ◽  
Presenting Symptoms ◽  
Pseudotumor Cerebri Syndrome

Introduction: Although considered uncommon, pseudotumor cerebri syndrome (PTC) is a significant cause of headache among children and adults. However, the presenting symptoms may be different among diverse age groups. In the present study, we compared the risk factors and clinical presentation of PTC across life—from childhood to adulthood. Methods: A retrospective survey of PTC patients aged 7 years or older between 2011 and 2013 was carried out. Pooled analyses were performed comparing characteristics from our data with those of published data subdivided into 3 age groups: pre-young children, adolescents, and adults. Results: Our cohort consisted of 72 patients: 32 children (10 pre-young children, 22 adolescents) and 40 adults. Within the pre-young children age group: 20% were females versus 82% in the adolescent age group and 85% of the adult age group. Obesity was found in 10% of the young children group, 64% of the adolescents, and 80% of the adults. Headache was reported in 70% young children, 82% adolescents, and 83% adults. Pooled analysis of 1499 patients showed that young children with PTC tend to complain less about headache compared with older ones. Vomiting and visual impairment were most common among adolescents, and dizziness and tinnitus were most common in adults. Conclusion: PTC has different risk factors and clinical presentation throughout life. In young children, there is no gender preference and most patients are not obese. Risk factors in adolescents resemble those of adults.

scholarly journals Cerebellar cavernous malformation in pediatric patients: defining clinical, neuroimaging, and therapeutic characteristics

2015 ◽  
Vol 16 (3) ◽  
pp. 256-266 ◽  
Author(s):  
Friederike Knerlich-Lukoschus ◽  
Paul Steinbok ◽  
Christopher Dunham ◽  
David Douglas Cochrane
Keyword(s):  
Surgical Complication ◽  
Case Reports ◽  
Age Groups ◽  
Imaging Features ◽  
Age Group ◽  
Pediatric Age ◽  
Cavernous Malformations ◽  
Efficient Treatment ◽  
Presenting Symptoms ◽  
Pediatric Age Group

OBJECT Cerebellar cavernous malformations (CCMs) have not been specifically described in the pediatric age group. Authors of this study, after considering the published literature, describe the characteristic clinical, radiological, and surgical features of CCM in children. METHOSDS Patients younger than 18 years of age who were known to have CCM and had undergone surgery between 1992 and 2014 at the authors’ institution were reviewed. Pediatric CCM cases reported in the literature (case reports and cases included in series on CMs in the pediatric age group) were also analyzed for specific features of this entity. RESULTS Four male patients and 1 female patient (2.5–14 years of age) with CCM presented acutely with severe headache followed by cerebellar dysfunction. In all patients, neuroimaging (cranial CT and MRI) demonstrated hemorrhagic cerebellar lesions with heterogeneous T1 and T2 signal intensities and hyperintense blooming on susceptibility-weighted imaging. The lesions reached large sizes exhibiting spherical, cystic, and often “pseudotumoral” morphology. In 3 patients, developmental venous anomalies (DVAs) were found. In 4 of the 5 patients, the CCMs and hematomas were totally removed. All patients had a clinically excellent functional outcome without surgical complication and with complete resolution of their presenting symptoms. CONCLUSIONS Cerebellar CMs occur in all pediatric age groups and display characteristic clinical and imaging features. In children, CCMs reach large sizes and can result in massive hemorrhage, often leading to a possible diagnosis of hemorrhage into a tumor. An associated DVA is quite common. Surgery is a safe and efficient treatment option with excellent outcomes in patients.

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