scholarly journals APPROACH TOWARDS DEVELOPING AN ALGORITHM FOR GAP NONUNION

2020 ◽  
pp. 1-6
Author(s):  
Nirjhar Maji
Keyword(s):  
Tertiary Care ◽  
Functional Results ◽  
Time Frame ◽  
Activity Level ◽  
Treatment Modalities ◽  
Long Bone ◽  
Care Hospital ◽  
Non Union ◽  
Formidable Challenge ◽  
Back Ground

Back ground and objectives The treatment of Gap or Defect non-union presents a formidable challenge to Orthopaedic surgeons. Not only a union but also good functional outcome is the target of modern-day Orthopaedics. The objective of this study is to consider knowledge of all treatment modalities, time frame, and functional results of long bone defects and develop an algorithm. Summary The study is designed as retrospective, prospective observational study. It is conducted in tertiary care hospital (MIOT Hospitals, Chennai). Initial evaluation of all cases were done by Maurizio Catagni’s Classification. Type of surgeries, time spent in hospital, union time were calculated. Patients were followed up for a period of 1year. Patients with average defect size of 6.29cm on an average underwent 4.47 procedures and for an overall time of 17.8 weeks with around 83.80 % of individuals were able to return to their preinjury activity level. Analysis of all data was done and algorithm developed.

scholarly journals ROLE OF DIFFERENT CRITERIA IN OUTCOME ANALYSIS OF MANAGEMENT OF GAP NON-UNION

2020 ◽  
pp. 1-6
Author(s):  
Nirjhar Maji
Keyword(s):  
Tertiary Care ◽  
Evaluation Criteria ◽  
Activity Level ◽  
Lower Limbs ◽  
Outcome Analysis ◽  
Functional Evaluation ◽  
Care Hospital ◽  
Non Union ◽  
Functional Limb

Back ground and objectives Gap or Defect non-union is not uncommon in Orthopaedic practice. Management involves prolonged periods of tedious procedures and decision making. The endpoint of such management does not reveal itself as a well-defined point. Follow ups must include some analysable outcome which should have a standardised criteria-based endpoint. A well-aligned, painless, noninfected, and functional limb is the goal of treatment. The objective of this study is to understand the role of different criterion to understand whether the goal has been reached. Summary The study is designed as retrospective, prospective observational study. It is conducted in tertiary care hospital (MIOT Hospitals, Chennai). Initial evaluation of all cases were done by Maurizio Catagni’s Classification. Type of surgeries, time spent in hospital, union time were calculated. Patients were followed up for a period of 1year. Patients with average defect size of 6.29cm on an average underwent 4.47 procedures and for an overall time of 17.8 weeks with around 83.80 % of individuals were able to return to their preinjury activity level. Analysis of the outcome was done by ASAMI bone criteria, ASAMI functional criteria, Cattneo et al criteria and Karstrom-Olerud’s functional evaluation criteria for lower limbs at onset of treatment, 6 months and 1 year of treatment,

scholarly journals Microbiological Screening and Antimicrobial Sensitivity Profiling of Wound Infections in a Tertiary Care Hospital of Bangladesh

2020 ◽  
pp. 101-106
Keyword(s):  
Wound Infection ◽  
Primary Care Physicians ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Treatment Modalities ◽  
Care Hospital ◽  
Bacterial Isolates ◽  
Gram Positive ◽  
Gram Negative ◽  
Antimicrobial Sensitivity

Wound infection is a major problem in hospitals in developing countries. Wound infection causes morbidity and prolonged hospital stay thus this prospective study was conducted for a period of seven months (January 2019 to July 2019). A total of 217 specimens (wound swabs and pus exudates) from wound infected patients in a Tertiary Care Hospital in Bangladesh. A retrospective study of the microbiological evaluation was done by cultural growth as well as Gram staining and biochemical examination to identify the bacterial isolates. Finally, the antimicrobial vulnerability testing was performed by Kirby-Bauer disc diffusion conventional method. A total of 295 samples were tested. Out of which 217 (73.5%) were found culture positive. E. coli was the most predominant gram-negative isolates whereas Staphylococcus aureus and Coagulase-negative Staphylococcus were the most commonly isolated gram-positive organisms. Antimicrobial sensitivity profile of bacterial isolates revealed imipenem, meropenem, amikacin, and nitrofurantoin to be the most effective antimicrobials against gram-negative isolates, whereas imipenem, meropenem, amikacin, nitrofurantoin, amoxiclav, and gentamicin were the most effective drugs against gram-positive isolates. The result of this examination contributes to the identification of basic causative microbes involved in wound infection and findings of antibiotic susceptibility patterns can be helpful for primary care physicians to optimize the treatment modalities, articulate policies for empiric antimicrobial therapy, and to minimize the rate of infection among wound infected patients.

scholarly journals Assessment of pain management intervention for treatment of long bone fractures in tertiary care hospital

2019 ◽  
Vol 6 (5) ◽  
pp. 1544
Author(s):  
Elizabeth C. Sada ◽  
Firdaus Bhot ◽  
Rohit Kanishetty
Keyword(s):  
Pain Management ◽  
Lower Limb ◽  
Initial Treatment ◽  
Personal Experience ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Long Bone ◽  
Study Patient ◽  
Care Hospital ◽  
Management Intervention

Background: Musculoskeletal trauma represents a considerable global health burden. Pain is a complex, subjective personal experience. The assessment of pain is the essential perquisite for successful pain management. It is useful to decide the plan of initial treatment but also to reassess the degree of success. So the purpose of the study was to do assessment of pain management intervention, post-op analgesics for treatment of long bone fractures.Methods: All adult patients (more than IS years) reporting to Emergency Medicine Department of a tertiary care hospital with long hone fractures of lower limb were included in the study. Patient pain management was assessed by visual analogue score (VAS). Pain is a complex, subjective personal experience. The assessment of pain is the essential perquisite for successful pain management. It is useful to decide the plan of initial treatment but also to reassess the degree of success. The entire data is statistically analyzed using SPSS software. p-values less than 0.05 are considered to be statistically significant.Results:  74 cases got operated, 64 cases (86.5.0%) did not have any intra-op complications and 10 cases (13.50%) had intra-op complications .Postoperative analgesia the 74 cases operated was as follows: 17 cases (23.0%) epidural anaesthesia 41 Cases (55.4%) had epidural + intravenous analgesics. Recent was managed with 1.V, analgesics alone; 12 cases (16.20%) had tramadol, 2 cases (2.7%) received paracetamol and 2 cases (2.7%) had dynaper for post-operative analgesia.Conclusion: Adequate pain management on arrival in the Emergency Department is an important aspect in patient care and is not at all difficult to achieve. Femoral nerve block in Proximal lower limb fractures is very effective and easy to perform.

scholarly journals Pediatric Germ Cell Tumors: An Experience of 7 Years in a Tertiary Hospital of Bangladesh

2020 ◽  
Vol 35 (2) ◽  
pp. 119-122
Author(s):  
SM Rashed Zahangir Kabir ◽  
Md Waheed Akhtar ◽  
Farida Yasmin
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumor ◽  
Tertiary Care ◽  
Germ Cell Tumors ◽  
Yolk Sac ◽  
Cell Tumor ◽  
Yolk Sac Tumor ◽  
Treatment Modalities ◽  
Care Hospital ◽  
Childhood Malignancies

Introduction: Germ cell tumors are a group of tumors with different clinical presentation and histological and biological characteristics. Malignant germ cell tumors occur at all ages with a trend of bimodal distribution in infancy and adolescence. Objective: To evaluate the demographic characteristics, distribution of different types of germ cell tumor, treatment modalities and outcome of germ cell tumor in children in a tertiary care hospital of Bangladesh. Methods: In this retrospective study, data regarding age and sex distribution, location, types of tumors, management of germ cell tumor in children were retrieved from the medical records of pediatric oncology department in NICRH, Dhaka from 2008 to 2014. Results: Out of total 87 patients female were 50 and male 37. Most of the patients were up to 5 years of age. The gonadal germ cell tumors (80%) were more than extragonadal tumor (20%) in both male and female patients. The most common germ cell tumor was dysgerminoma (32%) followed by yolk sac tumor (29.8%) and teratoma (19.5%). Yolk Sac Tumor (51.4%) was the most common in male and dysgerminoma (56%) the commonest in female. Out of 87, seventy two (82.7%) received chemotherapy following surgery. Among those 72 patients who received chemotherapy 49 (68 %) patients completed their treatment. Until the last follow up 71.4% patients remained alive and tumor free. Conclusion: Germ cell tumors are the most variable tumor of all childhood malignancies that has difference in age, sex, location and histological subtypes. Gonadal tumors have better prognosis than extragonadal tumors in both the sex. DS (Child) H J 2019; 35(2) : 119-122

scholarly journals A prospective clinical study of fistula in ano: comparing different treatment modalities in a tertiary care hospital

2019 ◽  
Vol 6 (7) ◽  
pp. 2411
Author(s):  
Hareesh G. S. R. ◽  
Siva Prasad Naik Nenavath
Keyword(s):  
Tertiary Care ◽  
Treatment Modalities ◽  
Prospective Clinical Study ◽  
Care Hospital ◽  
College Hospital ◽  
Common Procedure ◽  
Fistula In Ano ◽  
Low Level ◽  
Complex Fistula ◽  
A Prospective Study

Background: Fistula in ano is one of the common anorectal condition, which is easy to diagnose but difficult to manage because of post-operative complications like incontinence and recurrence. Also numerous procedures have been described for its treatment so as to individualize treatment options.The aim of the study was to assess the efficacy of different treatment modalities in fistula in ano.Methods: This is a prospective study carried out in a tertiary medical college hospital where 75 patients with fistula in ano are analysed for clinical features and surgical modalities compared.Results: Total 75 patients are studied. 82.70% patients presented with discharge in perianal region. Posterior fistulas are seen in 93.30% and anterior in 6.70% patients. 94.70% patients have low level fistula, 84% patients had simple fistula & 16% had complex fistula. 49.30% patients were treated with fistulectomy. 36.0% have undergone fistulotomy. 8.0% had LIFT and 6.7% had SETON. Recurrence is seen in 6.70% of patients.70.70% patients have stayed 4-6 days.Conclusions: Most of the fistulas are simple, posterior and low level fistulas. Fistulectomy is the most common procedure performed. Newer procedures like LIFT and Seton application show promising results with less complications. 

scholarly journals Pediatric Autoimmune encephalitis: Experience from a Tertiary Care Hospital in Bangladesh

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Kanij Fatema ◽  
Md Mizanur Rahman
Keyword(s):  
Psychiatric Disorder ◽  
Movement Disorder ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Autoimmune Encephalitis ◽  
Treatment Modalities ◽  
Oral Steroid ◽  
Clinical Feature ◽  
Temporal Region ◽  
Care Hospital

Background: Autoimmune encephalitis (AIE) are distinct group of encephalitis where production of autoimmune antibody causes neuroinflammation. The core clinical features are encephalopathy, psychiatric disorder, movement disorder and seizure. The investigation and treatment modalities are different from that of infectious encephalitis. There are limited studies in pediatric population in particularly in developing country like Bangladesh. Thus this study has been done to describe patients with AIE from a tertiary care hospital. Method: This is a retrospective study done in children of 1-16 year from January 2018 to December 2019. AIE was diagnosed on the basis of clinical, electrographic and neuroimaging features and was confirmed with detection of autoantibody in CSF. Treatment was given according to the published literature with immunotherapy mainly. Results: Total 15 children were studied, 14 patients were antiNMDAR encephalitis and 1 was antiMOG antibody syndrome. Mean age was 5.98 and 4.5 year respectively. Seizure was the most common clinical feature, mostly focal in nature. Other manifestations were movement disorder, psychiatric disorder, loss of consciousness etc. Most of the patients had abnormal EE, focal epileptic discharge being the commonest. Eight out of 15 had abnormal MRI of brain. Cortical  hyperintensity was important feature located mostly in temporal region. In the case of antiMOG antibody syndrome there was demyelinating lesion in multiple areas. Cornerstone of the treatment was mostly combination immunotherapy with IV methylprednisolone and IV immunoglobulin followed by oral steroid. Majority of the patients showed improvement however 3 patients had complete recovery. Complications observed were epilepsy, speech disorder, cognitive disorder, behavioural disorder, ataxia and visual impairment. Conclusion:  Timely diagnosis and prompt treatment of AIE is very important as proper treatment can cause significant improvement.  

Percutaneous Coronary Intervention (PCI) of Left Main (LM) Stem Disease: Our Experiences in a Tertiary Care Hospital

2021 ◽  
Vol 35 (2) ◽  
pp. 78-86
Author(s):  
AHM Waliul Islam ◽  
Shams Munwar ◽  
AQM Reza ◽  
Shahabuddin Talukder ◽  
Tamzeed Ahmed ◽  
...  
Keyword(s):  
Patient Population ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Tertiary Care ◽  
Coronary Intervention ◽  
Treatment Modalities ◽  
Care Hospital ◽  
Left Main ◽  
Cardiac Events ◽  
Stent Patency

Background: It is well known that coronary artery bypass graft (CABG) is considered as gold standard treatment of left main (LM) stem disease. Over the years PCI of left main (LM) stem disease, proved its non-inferiority to CABG in treating LM stem disease Objectives: Exact data of LM stem PCI and its procedural success, in-hospital, and post-procedural one-year survival outcome in-terms of repeat hospitalization due to re-infarction, LVF and death, in our population not known clearly. Therefore, we have carried out this prospective observational cohort to see the overall outcomes of LM Stem, PCI in our population Methods and materials: Patients who underwent elective CAG and found LM stem disease and planned for PCI, were enrolled in this non-randomized observational study between November 2013 to September 2019. Total 146 patient (F 29; Male 117) were enrolled in this study. Results: Out of 146 patients, female :19.8% (n=29) vs Male: 80.1% (n=117). Among, these patient females were more obese (BMI: Female 29.8 ± 3.6 vs male 26.8 ± 3.8). Male patients were older than female; Male 59 yrs. vs female 56 yrs. Among the CAD risk factors Hypertension (HTN) 67.8% (n=99), dyslipidemia 56.2% (n=82), Diabetes Mellitus (DM) 51.4% (n=75), smoking 31.5% (n=46), Family history of CAD (FH) 21.2% (n=31). In this study, 19.2%(n=28) patient had CABG in the past. Common Stented territories were ostial LM 6.8%(n=10), shaft of LM 28.8% (n=42), distal LMLAD 47.3% (n=69), distal LM-LCX 15.1% (n=22) and distal LM-RI 2.7% (n=4). Common DES were Everolimus 69.9% (n=102), Sirolimus 12.3% (n=18), Zotarolimus 9.6%(n=14), BMS 4.8% (n=7), Sirolimus with Epithelial Progenitor Cell 3.4% (n=5), and Biolimus 2.1% (n=3). In terms of post procedural dual antiplatelet therapy (DAPT), patients receiving Clopidogrel were 57.5% (n=85), Ticagrelor 28.8% (n=42), and Prasugrel 13.7% (n=20). Total 12 patient died due to acute, sub-acute stent thrombosis or reinfarction with or without arrhythmia. Relook CAG done was only in 14.4% (n=21) patients, Stent patency 80.9% (n=17), significant ISR, later went to CABG 14.3%(n=3) and mild ISR 4.7% (n=1). IVUS guided PCI were done only in 10.9% (n=16) patients. Major adverse cardiac events in terms of periprocedural MI, repeat hospitalization or death were not common in this study. Conclusion: PCI of LM stem disease is one of the important treatment modalities over CABG in our patient population. Very few patients developed re-stenosis, that needs repeat revascularization either by PCI or CABG. Thus, we may conclude, PCI of LM stem disease might be an alternative to CABG and needs comparative multicenter study to justify its superiority outcome in our patient population. Bangladesh Heart Journal 2020; 35(2) : 78-86

scholarly journals HEMATOLOGICAL PROFILE IN PATIENTS OF CHRONIC KIDNEY DISEASE WITH ITS SEVERITY IN A TERTIARY CARE HOSPITAL, NORTH ODISHA

2020 ◽  
pp. 182-187
Author(s):  
BIBHU PRASAD BEHERA
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Hematological Parameters ◽  
Tertiary Care ◽  
Microcytic Anemia ◽  
Treatment Modalities ◽  
Unknown Etiology ◽  
Care Hospital ◽  
College Hospital ◽  
Correct Treatment

Objective: Efforts can be made to normalize the hematological parameters and slow the progress of the disease so that the morbidity and mortality in these patients with chronic kidney disease could be effectively reduced. Methods: The observational study was carried out in the Department of General Medicine, Pandit Raghunath Murmu Medical College Hospital, Baripada, between May 2018 and January 2019. Two hundred seventy patients of chronic kidney disease (CKD) above 15 years of age, satisfying the inclusion and exclusion criteria, were included in the study. Results: In our study, 179 (66.30%) were male, and 91 (33.70%) were female with M:F of 1.97:1. The average age of the patients in the study was 55.72±12.77 years. About 42.59 % (115) of the patients were between 46 and 60 years of age. About 35.56% of CKD cases had determined etiology and, 64.44% of cases had unknown etiology. Hemoglobin, RBC, and packed cell volume were significantly lower in the patients with CKD compared to the controls (p=0.0001), and RDW was considerably higher in the patients with CKD compared to the controls (p=0.0001). Microcytic anemia was the most prevalent type of anemia. There was a hugely significant association between the prevalence of thrombocytopenia and the severity of CKD (p=0.006). Conclusion: This study concluded that patients with CKD show abnormal hematological parameters. Evaluation of hematological parameters in these patients helps in classifying the type of anemia, aids in choosing the correct treatment modalities, and decreases mortality.

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