scholarly journals BLOOD LOSS IN LAPAROSCOPIC NEPHRECTOMY -AN INITIAL EXPERIENCE IN IGMC, SHIMLA

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Bhartendu Nagesh ◽  
D.K Verma ◽  
R S Jhobta ◽  
Sanjiv Sharma ◽  
Mehar Chand
Keyword(s):  
Blood Loss ◽  
Standard Of Care ◽  
Laparoscopic Nephrectomy ◽  
P Value ◽  
Dense Adhesion ◽  
Medical College ◽  
The Mean ◽  
Gandhi Medical College ◽  
End Stage ◽  
Hydronephrotic Kidney

Background: Laparoscopic nephrectomy has been established as the standard of care for the management of benign non-functioning kidneys and has gained worldwide popularity over the past decade. Methods: This study was conducted in the Department of General surgery, Indira Gandhi medical college, Shimla on 20 selected patients of benign non functional kidney admitted for elective Laparoscopic Nephrectomy between July 2018 to June 2019 Results: Less than 100 ml of blood was lost in 3(15%) of the patient. 100 to 200 ml was lost in 9(45%) and in 3(15%) patients 200 to 300 ml blood was lost and 5 (25%) had blood loss more than 300 ml. The mean blood loss in successful laparoscopic nephrectomy was 129 +123 ml and in lap converted to open was 435.7 + 174.9 ml. which is significantly less in successful lap nephrectomy which is statistically significant with a p-value of o.oo3 Conclusion: Mean blood loss in laparoscopic nephrectomy was 145 +144 ml and in converted cases, it was 350+200 ml.  mean blood loss in hydronephrotic kidney was 145+ 144.2 ml in pyonephrotic kidney 325+ 318 in end stage nephrolithiasis  350+ 200  ml .There was more  blood loss in ESRD and pyonephrotic  kidney due   to dense adhesion whereas blood loss is less in hydronephrotic kidney due to well maintained plane for dissection . Keywords: Laparoscopy, Nephrectomy, Blood loss

scholarly journals DURATION OF SURGERY OF LAPAROSCOPIC NEPHRECTOMY -AN INITIAL EXPERIENCE IN IGMC, SHIMLA

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Bhartendu Nagesh ◽  
D.K Verma ◽  
R S Jhobta ◽  
Sanjiv Sharma ◽  
Mehar Chand
Keyword(s):  
Operating Time ◽  
Standard Of Care ◽  
Laparoscopic Nephrectomy ◽  
P Value ◽  
Dense Adhesion ◽  
Medical College ◽  
Duration Of Surgery ◽  
The Mean ◽  
Gandhi Medical College ◽  
Hydronephrotic Kidney

Background: Laparoscopic nephrectomy has been established as the standard of care for the management of benign non-functioning kidneys and has gained worldwide popularity over the past decade. Methods- This study was conducted in the Department of General surgery, Indira Gandhi medical college, Shimla on 20 selected patients of benign non functional kidney admitted for elective Laparoscopic Nephrectomy between July 2018 to June 2019 Results: In this study, the mean operating time in success full laparoscopic nephrectomies was 103.7 + 20.6 min in lap converted to open it was    165 .7 +26.99 min and in hand-assisted tame taken was 150 min which is statically not significant with p value =0.1317. Conclusion: The mean time taken for completion of laparoscopic nephrectomy in first 4 cases was 105 min and in next 4 cases was 108 min and in last 4 cases it was 97 min there was definitive learning curve as in last 4 cases operating time was less as compared to initial cases but operating time also depends on other factors like in hydronephrotic kidney due to well maintained plane dissection take less time ,but in  pyonephrotic kidney ,tubercular kidney,previously intervension like PCN, there were dense adhesion resulting in more time for disection. Keywords: Laparoscopy, Nephrectomy, Duration of surgery

scholarly journals Validity of the Diabetes, Hypertension and Hyperlipidaemia (DHL) Knowledge Instrument among Medical Students of Karachi

2016 ◽  
Vol 9 (1) ◽  
pp. 265
Author(s):  
Muhammad Bilal ◽  
Abdul Haseeb ◽  
Aleena Zehra Merchant ◽  
Muhammad Ahad Sher Khan ◽  
Arsalan Majeed Adam ◽  
...  
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Knowledge Score ◽  
Educational Status ◽  
Educational Programs ◽  
P Value ◽  
Medical College ◽  
Knowledge Based ◽  
The Mean ◽  
Knowledge Levels

BACKGROUND: While there have been a number of studies on DM, hypertension and hyperlipidaemia, an instrument which assesses knowledge based on all three conditions has neither been established nor authorized in Pakistan. Hence, the focus of this study was to establish a pre- tested extensive questionnaire to evaluate medical students’ understanding of DM, hypertension, hyperlipidaemia and their medications for use.METHODS: A pre-validated and pre-tested DHL instrument was employed on 250 students of Dow Medical and Sindh Medical College and on 45 physicians working in a leading teaching hospital of Karachi. The DHL knowledge instrument was then distributed a second time to the very same set of students, after a period of 2 months, at the end of the foundation module, once they had received some basic formal medical education including diabetes and CVS diseases.RESULTS: The overall internal consistency for the DHL instrument failed to comply with the set standard of more than or equal to 0.7 as our results yielded Cronbach’s α of 0.6. Overall the average difficulty factor of 28 questions is 0.41, which highlighted that the instrument was moderately tough. The mean scores for all domains were substantially lower in the students section in comparison to that of the professional section, which had remarkable impact on the overall mean(SD) knowledge score (40.58 ± 14.63 vs. 63.49 ± 06.67 ; p value = 0.00).CONCLUSION: The instrument can be used to recognize people who require educational programs and keep an account of the changes with the passage of time as it could help in differentiating the knowledge levels among its participants based on their educational status.

An Evaluation of the Effect of Catheter-Directed Continuous Infusion of Local Anesthetic by Elastomeric Pump on Opioid Usage Following Donor Kidney Nephrectomy

2021 ◽  
pp. 106002802110178
Author(s):  
Jessica Goldsby ◽  
Kerry Schwarz ◽  
Ike Kim ◽  
Victor Lewis ◽  
Clark Lyda
Keyword(s):  
Continuous Infusion ◽  
Oral Morphine ◽  
Standard Of Care ◽  
Postoperative Pain Management ◽  
Bowel Function ◽  
Laparoscopic Nephrectomy ◽  
Kidney Donors ◽  
Pain Scores ◽  
The Mean ◽  
Postoperative Administration

Background Postoperative pain management following donor nephrectomy can prove challenging for immediate discharge on postoperative day 1 or 2. Although the standard for pain control is utilization of opioids, this increases the risk of postoperative ileus and, if continued inappropriately, increases excess opioids circulating in the community. One strategy that proposes to limit postoperative opioids in kidney donors is the continuous infusion of local anesthetics (CILA), though the effect on patient outcomes is unclear. Objective The purpose of this study was to evaluate the effectiveness of postoperative CILA to decrease opioid usage in kidney donors who undergo laparoscopic nephrectomy. Methods A retrospective analysis was conducted of kidney donors who underwent laparoscopic nephrectomy and received CILA (CILA group) compared with kidney donors who received standard-of-care (SOC) postoperative analgesia. The primary outcome was the mean total oral morphine equivalents (OMEs) administered following surgery. Results A total of 176 kidney donors were evaluated, 88 in each group. The mean OME administered in the CILA group was significantly higher than in the SOC group: 194.8 versus 133.5 mg ( P = 0.003). Mean total postoperative administration of acetaminophen was also increased in the CILA group: 3736.9 versus 2611.6 mg ( P = 0.0041). Mean length of stay following surgery was higher in the kidney donors who received CILA, whereas return to bowel function, time to ambulation, and pain scores were not significantly different. Conclusion and Relevance This report demonstrated that CILA is not an effective modality to reduce opioid utilization or improve recovery in kidney donors following laparoscopic nephrectomy.

scholarly journals TO STUDY THE FUNCTIONAL AND THE RADIOLOGICAL OUTCOME OF TUBERCULOSIS OF SPINE OPERATED BY POSTERIOR APPROACH.

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Anil Kumar ◽  
Manoj Kumar Thakur ◽  
Rahul Kumar Singh
Keyword(s):  
Lumbar Spine ◽  
Posterior Approach ◽  
P Value ◽  
Radiological Outcome ◽  
Skeletal System ◽  
Kyphotic Angle ◽  
Medical College ◽  
Significant Difference ◽  
Gandhi Medical College ◽  
Tuberculosis Of Spine

Background: Tuberculosis is ubiquitous in distribution. Globally, nearly 30 million people suffer from tuberculosis. 3 million deaths occur due to tuberculosis per year. India has burden of 6 million cases. Of these 1-3% constitutes skeletal system involvement. Methods: The present study included prospective cases of tuberculosis of dorsal and lumbar spine admitted and operated at Indira Gandhi Medical College, Shimla between May 2017 to May 2018 and retrospective patients who have been operated before May 2017. Results: There was improvement from preoperative kyphotic angle to postoperative kyphotic angle and improvement in kyphotic angle as a significant difference less than 0.05 (p value is 0.01). Conclusion: At the end of our study, we concluded that good sagittal balance along with good fusion of the vertebrae leads to better functional outcome in patients. Keywords: Spine, TB, Kyphotic angle.

Factors predicting the occurrence of syringomyelia in patients with Chiari I malformations

2019 ◽  
Vol 7 (8) ◽  
pp. 2967
Author(s):  
Vijayan Peettakkandy ◽  
Bijukrishnan Rajagopalawarrier ◽  
Sreenath Kuniyil ◽  
Jithin Veliyath Thankaraj
Keyword(s):  
Foramen Magnum ◽  
P Value ◽  
Tonsillar Herniation ◽  
Duration Of Symptoms ◽  
Medical College ◽  
Chiari I ◽  
The Mean ◽  
Time Of Presentation ◽  
Common Association ◽  
Cerebellar Tonsils

Background: Chiari I malformations are defined as the downward herniation of cerebellar tonsils more than 5 mm through the foramen magnum. Syringomyelia is a common association of Chiari I malformation.Methods: This purpose of this study was to determine the various factors predicting the occurrence of syringomyelia in patients with Chiari I malformations. This retrospective study was conducted in Government medical college, Thrissur, Kerala, India. 27 patients admitted with diagnosis of symptomatic Chiari I malformations during the period of January 2015 to January 2019 were selected for the study.Results: The mean age was 22.8 years and syringomyelia was more common in patients older than 10 years (p value0.005). Females were 17(63%) and males were 10(37%) but there no difference in occurrence of syringomyelia among both sexes(p value is 0.16). Syringomyelia was present in 17(63%) cases. Association between various factors and syringomyelia measured by calculating P value which was 0.005 for age >10 years, 0.16 for sex, 0.093 for duration of symptoms >12 months, 0.05 for tonsillar descend >10mm and 0.097 for hypertension. The p value for the association of duration of symptoms >12months and extend of tonsillar descend is 0.001 Mean duration of symptoms (onset of first symptom to the time of presentation) was 16.3 months and syringomyelia was more common in patients with duration of symptoms more than 12 months but this difference was statistically not significant (p value 0.093). Mean tonsillar descend from the level of foramen magnum was 11.3 mms and syringomyelia was more common in patients with tonsillar herniation more than 10mm (p value 0.05). There is a statistically significant relationship between duration of symptoms more than 12 months and tonsillar descend more than 10mm(p value 0.001).There is no significant association between hypertension and occurrence of syringomyelia in patients with Chiari I malformation.Conclusions: Incidence of Chiari I Malformations is more among adults and it is slightly higher in females. Syringomyelia is a common association of Chiari I Malformations. The occurrence of syringomyelia in patients with Chiari I Malformations associated with increasing age of patients and extend of tonsillar herniation. There is no statistically significant association between syringomyelia and duration of symptoms or hypertension.

scholarly journals A Comparative Study of Active Management of the Third Stage of Labor IV Methergine and IM Oxytocin

2021 ◽  
pp. 267-272
Author(s):  
K. Sharmila
Keyword(s):  
Blood Loss ◽  
The United States ◽  
Active Management ◽  
P Value ◽  
Negative Effects ◽  
The Third ◽  
Third Stage Of Labor ◽  
Group I ◽  
Third Stage ◽  
The Mean

Postpartum haemorrhage (PPH) has been more common over the last three decades, accounting for 11% of all pregnancy-related deaths in the United States. In the third stage of labour, risk classification and active management are crucial preventative techniques. To avoid negative effects, a multidisciplinary approach to PPH patient care is required. To treat uterine atony, uterotonic medicines like oxytocin are used in combination with manipulative procedures like uterine massage and balloon tamponade. The amount of blood loss, duration of the third stage, need for MRP, incidence of PPH, need for repeated oxytocics, and its side effects were measured in Group I 100 women who were administered injection oxytocin 10 IU injection methergin 0.2 mg IV within one minute of the baby's delivery. The mean blood loss at vaginal delivery in Group I was 100-150 ml and in group I P value 0.027, which was statistically significant .In  Group II was 160-200 ml with P value 0.036, which was statistically significant. The mean duration of third stag labour in Group 1 was 124.6 min and Group 2 was 144.8 min intravenous methergin is a better uterotonic when compared to intramuscular oxytocin to reduce the amount of blood loss at delivery and prevent complications like atonic PPH.

scholarly journals Study on outcome of laparoscopic donor nephrectomy

2017 ◽  
Vol 4 (8) ◽  
pp. 2811
Author(s):  
Subha Kanesh S. K. ◽  
Govindarajan P.
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operating Time ◽  
Donor Nephrectomy ◽  
Laparoscopic Donor Nephrectomy ◽  
Analgesic Requirement ◽  
Ischemic Time ◽  
Medical College ◽  
Duration Of Hospital Stay ◽  
The Mean

Background: Laparoscopic donor nephrectomy is being performed in increasing numbers since 1995. Now laparoscopic donor nephrectomy has been accepted as good alternate to open procedure as seen in various other abdominal surgeries. This was the basis of the present study. So, the present study was designed to analyse and compare the outcome of Laparoscopic donor nephrectomy and Open donor nephrectomies.Methods: The prospective and observational study was conducted at Stanley Medical College in Department of Urology in 61 Patients aged between 25-50 years who underwent left donor nephrectomy The Mean operating time, warm ischemic time, blood loss, analgesic requirement and duration of hospital stay were recorded and analysed statistically.Results: Out of 61 donor nephrectomies, 16 kidneys harvested by laparoscopic method with only 2 (12%) conversion to open due bleeding. Mean operating time was 179.9±47.6 minutes. Present study showed mean blood loss of (163±93 ml). Analgesic requirement of the LDN (mean 1.25 days) was significantly lower when compared to open group (mean 3.75 days). The present study shows duration of hospital stay was lower in LDN (mean 5.1days).Conclusions: Laparoscopic donor nephrectomy is an effective, safe and rewarding though it is time consuming and technically challenging. The analgesic requirement, duration of hospital stay and the blood loss were less with the laparoscopic surgery. Results of graft functioning of kidneys in both procedures were equivalent. So laparoscopic donor nephrectomy can be made as the procedure of choice in future.

scholarly journals Management of Symptomatic Renal Cysts by Laparoscopy: Our Initial Experience

2020 ◽  
Vol 21 (2) ◽  
pp. 137-139
Author(s):  
Mohammad Mahfuzur Rahman Chowdhury ◽  
AKM Shahadat Hossain ◽  
Rifat Zaman ◽  
Prodyut Kumar Saha ◽  
Hafiz Al Asad ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Renal Cysts ◽  
Standard Of Care ◽  
Drain Tube ◽  
College Hospital ◽  
Medical College ◽  
Cyst Recurrence ◽  
The Mean

Introduction and objective: Over the last decade laparoscopic surgery has been popularized and developed to such an extent that it can be considered gold standard for many types of procedures in urology. Currently the majority of operations in urologic field can be performed by laparoscopy. This is because it is as effective as open surgery, but associated with less postoperative pain, shorter hospital stay, faster recovery and has better cosmetic result. The aim of the study is to evaluate the results of our experience of treating symptomatic renal cysts by laparoscopy. Materials and methods: This prospective study was conducted from January 2015 to December 2017 in the Department of Urology in a single unit of Dhaka Medical College Hospital. All the patients were admitted through out-patient department. Among them those who fulfilled the criteria were selected for laparoscopic surgery. All patients were diagnosed by ultrasonography and computed tomography to determine the Bosniak classification of the cyst & informed written consent was taken. Total five laparoscopic decortication of renal cysts were performed and the results of our experience were compared with data from published article. Pain and cyst recurrence were assessed during the follow-up. Results: Our study described the results of 05 laparoscopic decortication of renal cysts. All procedures were completed successfully by transperitoneal approach, with no major intraoperative and postoperative complications. There was a placement of drain tube in one patient. The mean (range) operative duration was 68 (40–110) min, affected by the site and number of cysts decorticated. The mean post operative hospital stay was 1.8 (1- 3) days. All patients were symptom-free and no sign of recurrence during the follow-up. Conclusion: Laparoscopic decortication of symptomatic renal cysts should be the standard of care and it is feasible with conventional laparoscopic instruments and gives a better cosmetic outcome. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.137-139

scholarly journals Pengaruh Edukasi Pendekatan Spiritual Berbasis Video terhadap Kepatuhan Pembatasan Cairan Klien ESRD yang Menjalani Hemodialisa

2018 ◽  
Vol 1 (2) ◽  
pp. 17-31
Author(s):  
Andri Kusuma Wijaya ◽  
Busjra Busjra ◽  
Rohman Azzam
Keyword(s):  
Weight Gain ◽  
Health Education ◽  
Family Support ◽  
Sampling Method ◽  
P Value ◽  
Fluid Restriction ◽  
Post Test ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

The purpose of this research to know effect of health education with spiritual approach based video toward adherence fluid restriction or interdialysis weight gain of patients  undergoing hemodialysis. This is a pre experimental onegroup pretest post test. Using total sampling method 22 patients. The mean of samples interdialysis weight gain total score after education was significantly decrease than before education p value 0.011. While proved there was significantly between the adherence fluid restriction patients undergoing hemodialysis will be increas after health education spiritual approach with video based controlled by family support p value 0, 047 while proved was no significantly  between the ages of p value 0.364, education level alue 0.949 to interdialysis weight gain of patients undergoing hemodialysis. Health education with spiritual approach to improve adherence fluid restriction in patients undergoing hemodialysis, which is expected to implemented in order clinic especially patients who undergoing hemodialysis therapy who experienced non-compliance restrictions fluid. Keywords     : Spiritual Based Video, End Stage Renal Disease    

scholarly journals Effectiveness of teacher training conducted at Chitwan Medical College, Bharatpur, Nepal

2015 ◽  
Vol 5 (2) ◽  
pp. 1-5
Author(s):  
G P Dhungana ◽  
R M Piryani ◽  
M L Chapagain ◽  
M Neupane
Keyword(s):  
Teaching And Learning ◽  
Knowledge Score ◽  
P Value ◽  
Medical College ◽  
Adequate Knowledge ◽  
Before And After ◽  
Post Test ◽  
The Mean ◽  
Teachers Training ◽  
Experimental Group

Teaching and learning are equally important for the teacher. For teaching to be effective, whereby participants learn better, training of teachers is imperative. Teacher’s training is one of the important aspects of faculty development at Chitwan Medical College (CMC) and this study was done to assess the effectiveness of the teachers’ training pre test, post test experimental group design. In pre test, only 5.6% of the participants had adequate knowledge whereas after teacher’s training, 27.7 % had adequate knowledge. The mean (±SD) knowledge score before and after the intervention was 26.7±5.6 and 33.6 ± 5.6 respectively. The percent change in knowledge after intervention was 25.8 was statistically significant p value <0.001 .Which suggesting that the teachers’ training was an effective intervention.

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