Indications and challenges of limb amputation in children; Experience in a tertiary hospital in Enugu Nigeria

Amputation may be used to treat a diseased limb or improve its function, and it is considered the last, albeit valuable option when limb salvage is impossible. The decision to amputate a limb is an emotional process for the patient and the patient's family. The result is often loss of economic power of the individual and his/her independence when not sufficiently rehabilitated back into the society. The aim of the study was to determine early psychological outcome of major limb amputation. This was a prospective study, where 54 consenting patients admitted via either the accident and emergency unit or general outpatient clinic of a tertiary hospital for major limb amputation that met the inclusion criteria were recruited into the study consecutively over a period of one year. They were assessed for depression with Mini International Neuropsychiatric Interview (MINI) Instrument, while Rehabilitation outcome was graded using functional independence measure. Intensive counseling with psycho education was commence before amputation and continues after amputation by counselors. Physiotherapy, occupational therapy, coping skills and other life skill training commence after amputation to 3 months of follow up. Only 1 (1.9%) of the respondents was diagnosed with major depressive episode out of the 54 that completed the study. Some of the remaining 53 (98.1%) had few symptoms of depression but did not fulfilled the diagnostic criteria for major depressive episode according to M.I.N.I. The rehabilitation of all the patients were good with a mean functional measure score of 117.59 (sd=3.328) and a P-value of 0.00 at discharge and even after follow up. Our findings show that early and proper rehabilitation of amputees seem to reduce their psychological symptoms. Tendency to get depressed following amputation is more common in the younger age group, female gender and in amputations as a result of trauma while rehabilitation seems better in same and vice versa.

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Identifying Factors Predicting Hospital Length-of stay and Receiving Prosthesis of Lower Limb Amputee Patients after Amputation Surgery- A Singapore Perspective

Indian Journal of Physical Medicine and Rehabilitation ◽

10.5005/ijopmr-27-2-41 ◽

2016 ◽

Vol 27 (2) ◽

pp. 41-54

Author(s):

Tan Yeow Leng ◽

Lee Chooi Lynn ◽

Saw Hay Mar ◽

Ashfaq Ahmed Larck

Keyword(s):

Length Of Stay ◽

Wound Infection ◽

Lower Limb ◽

Inpatient Rehabilitation ◽

Tertiary Hospital ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Limb Amputation ◽

Care Giver ◽

Singapore General Hospital

Abstract Aims To identify predictors affecting total hospital length of stay(TLOS) and receiving lower limb prosthesis of amputees after surgery in a Singapore tertiary hospital. Materials and Methods A retrospective study of 96 patients was undertaken with various levels of lower limb amputation admitted to Singapore General Hospital (SGH) from January 2009 to December 2014. Patients were divided into two groups: 40-59 and 60 to 80 years old. We correlate clinical variables with TLOS and receiving prosthesis at 6 months from surgery. Results For the cohort of age 40-59, presence of IHD (B=22.4), wound infection (B=17.8) and those needing inpatient rehabilitation(B=36.8) correlate to increased TLOS. Premorbid independence (B=28.6) and presence of care-giver (B=23.3) led to a reduction of TLOS. For successful receiving of prosthesis at 6months from surgery, diabetes (B=0.69) and CRF (B=0.31)were negative predictors. In the older cohort, presence of care-giver (B=18.6) predicted shorter TLOS whereas those needing inpatient rehabilitation contributed to longer TLOS(B=25.61). Those who needed for inpatient rehabilitation had statistically signifi cant higher chance of receiving prosthesis later(B=0.53). Conclusion IHD, wound infection and need for inpatient rehabilitation, premorbid independence and care-giver availability are important predictors of TLOS. For receiving of prosthesis at 6months, predictors include needing inpatient rehabilitation, diabetes and CRF.

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Major limb amputation and mortality in patients with neuro‐ischaemic lower extremity wounds managed in a tertiary hospital: Focus on the differences among patients with diabetes, peripheral arterial disease and both

International Wound Journal ◽

10.1111/iwj.13724 ◽

2021 ◽

Author(s):

Lingyan Meng ◽

Nicholas Graves ◽

Ruo Chen Du ◽

Jia Yi Lee ◽

Koy Min Chue ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Lower Extremity ◽

Arterial Disease ◽

Tertiary Hospital ◽

Limb Amputation ◽

Patients With Diabetes ◽

Peripheral Arterial

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Mortality from necrotizing fasciitis: a cross-sectional study

International Surgery Journal ◽

10.18203/2349-2902.isj20201036 ◽

2020 ◽

Vol 7 (4) ◽

pp. 1036

Author(s):

Patric Paul ◽

Induprabhayadev Prabhakaran ◽

Meer Chisthi

Keyword(s):

Diabetes Mellitus ◽

Necrotizing Fasciitis ◽

High Mortality ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Limb Amputation ◽

Type I ◽

Sectional Study ◽

Cross Sectional ◽

Increased Risk

Background: Necrotizing fasciitis refers to the rapidly progressive inflammation of the fascia, with secondary necrosis of subcutaneous tissues. Due to the high mortality, it is considered a surgical emergency, needing timely diagnosis and appropriate treatment with early debridement. The aim of the study was to analyse the clinical profile of patients with necrotizing fasciitis so as to determine the mortality and the risk factors associated with mortality and other poor outcomes.Methods: This retrospective cross-sectional study was conducted in a tertiary hospital in Kerala, from January 2016 through January 2018. 175 cases were identified through the ICD codes for necrotizing fasciitis and Fournier’s gangrene in the discharge and death registers; and data were obtained about these patients. The data were analyzed to assess the study objectives.Results: In this study mortality was found to be 22.7%. Diabetes mellitus was found to be the most common co-morbid disease and had a significant association with increased risk of amputation. Mixed growth (type I NF) was the most common microbiological isolate and Pseudomonas was the most common gram-negative isolate. 4 cases of MRSA were recorded. Klebsiella infection was found to have increased risk of undergoing limb amputation. 7.4% of the patients required amputation during hospital stay for infection control.Conclusions: Necrotizing fasciitis has a high mortality. Diabetes mellitus was found to be the most common co-morbid disease. Increased blood glucose and low serum albumin had a significant association with an increased risk of amputation. Proper control of these factors is essential to reduce mortality from this condition.

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VALIDATION OF PREDICTIVE MODELS FOR INADEQUATE BOWEL PREPARATION IN COLONOSCOPIES IN A TERTIARY HOSPITAL POPULATION

10.1055/s-0040-1704209 ◽

2020 ◽

Author(s):

E Afecto ◽

A Ponte ◽

JC Silva ◽

C Gomes ◽

S Fernandes ◽

...

Keyword(s):

Bowel Preparation ◽

Predictive Models ◽

Tertiary Hospital ◽

Hospital Population ◽

Inadequate Bowel Preparation

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Healthcare associated infections caused by non-fermenting Gram negative rods (NFGNR): six years of experience of a tertiary hospital

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v7i2.19326 ◽

2013 ◽

Vol 7 (2) ◽

pp. 06-12

Author(s):

Zahidul Hasan ◽

Md. Kamrul Islam ◽

Arifa Hossain

Keyword(s):

Blood Stream Infection ◽

Tertiary Care ◽

Blood Stream ◽

Tertiary Hospital ◽

Healthcare Associated Infections ◽

Care Hospital ◽

Gram Negative ◽

Acinetobacter Spp ◽

Tract Infections ◽

Healthcare Associated

Recently non-fermenting Gram negative rods (NFGNR) are playing an important role in healthcare associated infections. This observational study in a tertiary care hospital of Dhaka city conducted during 01August 2007 to 30 June 2013 found that 34.8% isolated organisms from patients with healthcare associated infections were NFGNR. Majority (74.3 %) of these infections were occurring inside critical care areas. Pseudomonas and Acinetobacter together constituted 79.6% of the total NFGNR whereas Burkholderia cephacia complex (15.4%), Stenotrophomonas (4.3%) and Chryseobacterium species (0.7%) combined constituted remaining 20.4%. Out of total NFGNRs, Pseudomonas was responsible for highest number of catheter associated urinary tract infections (55.6%), ventilator associated pneumonia (46.3%), respiratory tract infection (65.8%) and surgical site infection (70.6%). Blood stream infection was predominantly caused by Burkholderia cephacia complex (33.5%) and Acinetobacter spp. (39.5%). Other than colistin most of the organisms were resistant to antibiotics commonly recommended for NFGNR.DOI: http://dx.doi.org/10.3329/bjmm.v7i2.19326 Bangladesh J Med Microbiol 2013; 07(02): 6-12

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