Conventional versus Flap Tracheostomy: Operative Simplicity, Stomal Care, Complications

Introduction Tracheostomy is a life saving procedure and its operative principle has withstood the test of time although the operative techniques have evolved. Inferiorly based flap on the anterior tracheal wall (Bjork flap) was demonstrated in 1952. The present study aims to compare conventional tracheostomy with flap tracheostomy. Materials and Methods A Randomized Control Trial was conducted in a tertiary care teaching medical institute comparing conventionally tracheostomised patients (Group A) with the group where flap based method was followed (Group B). Results The study population was comprised of 110 patients with equitable distribution in the groups. Per-operative time to establish an airway was measured and statistically correlated. 9.26% patients of Group A had difficult tube change, with none in Group B. Ease of stomal care by the patient and family members (Visual Analogue Scale), depicted it to be “very easy” in 76.36% of the patients in Group B and 16.36% in Group A. Stomal healing in first week was proper in 61.82% of patients in Group A and 80% of the patients in Group B. Tracheo-cutaneous fistula (TCF) developed in 18.18% of the adult and geriatric patients of Group A undergoing stomal closure. None of the patients in Group B had TCF following stomal closure. Conclusion Establishing Bjork flap tracheostomy is equally quick making the process suited for emergency situations. Flap based tracheostomy has early stomal maturation so, care of the stoma by health assistants and family members is easy.

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Post-Operative Outcomes of Intravenous Lidocaine Infusion on Major Abdominal Surgery in Pediatric Patients: A Randomized Control Trial in a Tertiary Care Hospital

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v10i1.38899 ◽

2018 ◽

Vol 10 (1) ◽

pp. 23-27

Author(s):

Nirupama Saha ◽

Nadiuzzaman Khan ◽

Mirza Kamrul Zahid ◽

Shah Alam Talukder ◽

ASM Meftahuzzaman

Keyword(s):

Abdominal Surgery ◽

Tertiary Care ◽

Major Abdominal Surgery ◽

P Value ◽

Care Hospital ◽

Intravenous Lidocaine ◽

Operative Outcomes ◽

Group A ◽

Randomized Control ◽

Group B

Background: Post-operative outcomes of a major abdominal surgery depend on careful & effective post-operative management. But it is a critical job especially in children. Obtaining adequate analgesia after major surgery is a problematic issue and postoperative pain still imposes a major burden of suffering in surgical patients.Objectives: The principle objectives of the study is to evaluate the effects of intravenous lidocaine infusion in pain management of pediatric population undergone in major abdominal surgery; to reduce post-operative morbidity & enhance better surgical outcome in children.Methodology: This is a randomized control trial carried out from January 2015-June2015,in a tertiary care hospital among 60 cases of 4 to 14 years children with major abdominal surgery without having any pulmonary, cardiac, hepatic or renal insufficiency. Grouping of patients that is lidocaine infusion group (Group A) and control group (Group B) was made among admitted cases for elective abdominal surgery by simple random technique by means of lottery. For assessment of postoperative pain FLACC Scale was used in both groups. Clinical examination findings & specifically designed data collection sheet with a set questionnaire were used as research instruments. Formulated data was analyzed by SPSS version 17, taking p value <0.05 as significant.Results: It is noted that, after 24 hours of operation most of the patients 56.7% of group A had mild pain whereas 90% patients of group B had moderate pain (p<0.001)& during that time there was no patient with severe pain in group A whereas in group B 10% patients were with severe pain. At 48 hours, pain was absent in 13.3% children of group A and 6.7% in group B. In group A most of the children 76.7%had mild pain compared to moderate pain 18 (60%) in group B children at that hours (P<0.001). Again, regarding required amount of analgesics, patients received I/V lidocaine required less amount of analgesics than its counterpart. In present study, complications was noted only 3.3% patien in group A, where as in the opposite group it was found in 23.3% & p was <0.05. In group A, in 50% patients post operative bowel sound was returned within 72 hours, compared to 73.3% patients in group B. The p value was 0.001. About post-operative hospital stay, 83.3% children of the group A were released from hospital after 5th P.O.D whereas, in group B, only 50% children were released after 7th P.O.D of operation. The P value was 0.03 that is also significant.Conclusion: Intravenous lidocaine could improve immediate and late post-operative pain with early recovery after major abdominal surgery in children & it can contribute to rapid postoperative rehabilitation programs.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 23-27

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Covid-19 and Co-Infection in Children: The Indian Perspectives

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmab073 ◽

2021 ◽

Author(s):

Dibyendu Raychaudhuri ◽

Mihir Sarkar ◽

Aniket Roy ◽

Debapriya Roy ◽

Kalpana Datta ◽

...

Keyword(s):

Prospective Observational Study ◽

Viral Infections ◽

Severe Disease ◽

Tertiary Care ◽

Supportive Therapy ◽

Appropriate Treatment ◽

Group A ◽

Study Population ◽

Tertiary Care Institution ◽

Group B

Abstract BACKGROUND AND OBJECTIVES Assessing the co-infections with COVID-19 is crucial to delineate its true clinical impact. Pediatric information in this aspect is limited. Our study aims to analyze the spectrum of co-infections in pediatric COVID-19 patients and determine the clinical as well as laboratory parameters predicting co-infection. METHODOLOGY In this prospective observational study conducted from June to December, 2020 in a single tertiary care institution, data pertaining to demographic, illness and treatment-related variables were analyzed among two subsets of pediatric patients of age 1 month -12 years with RTPCR-confirmed COVID-19 infection-Group A: those with confirmed co-infection and Group B: moderate to severe disease without co-infection. Among Group A, etiology of co-infection was characterized through relevant microbiological examination within 48 hours admission. RESULT Among our study population, 15.03% and 20.6% had co-infections and moderate to severe disease respectively. Among those with confirmed co-infection, 32.5%, 11.6% and 6.97% recorded blood culture, respiratory secretion and CSF growth respectively, the picture being dominated by Methicillin resistant and sensitive Staph. Aureus. Serum serology demonstrated Scrub typhus infection to be most prevalent. Concurrent respiratory viral infections were seen in 11.6%. Children with co-infection had significantly higher morbidity and need for supportive therapy. Predictors of co-infection were localization of infection, Neutrophil count >/= 10 x 109, age specific lymphopenia, CRP > 100 mg/dL and hyper-ferritinemia. CONCLUSION Co-infections are an important factor prognosticating pediatric Covid infection .Their early detection, prompt and appropriate treatment is of paramount importance.

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Cosmetic outcomes of grafted tubularized incised plate urethroplasty in primary distal penile hypospadias: prospective comparative study with the classic Snodgrass repair

African Journal of Urology ◽

10.1186/s12301-021-00255-6 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Shabib Ahmed ◽

Yasser A. Noureldin ◽

Hammoda Sherif ◽

Ahmed Zahran ◽

Rabea Omar

Keyword(s):

Success Rate ◽

Operative Time ◽

Tertiary Care ◽

Meatal Stenosis ◽

Tubularized Incised Plate ◽

Group A ◽

Prospective Comparative Study ◽

Tertiary Care Institution ◽

Cosmetic Outcomes ◽

Group B

Abstract Background To compare the outcomes between classic tubularized incised plate (C-TIP), known as Snodgrass urethroplasty, and grafted TIP (G-TIP) in the repair of primary distal penile hypospadias. Methods Parents of all children presented to our tertiary care institution with primary distal penile hypospadias were asked to participate in this study. Patients were equally randomized using closed envelope method into two groups; Group A underwent repair using G-TIP and Group B underwent repair using the C-TIP. Circumcised cases and/or cases with penile chordee > 30 degrees were excluded from this study. Urethral catheter was kept for 7 to 10 days after surgery. The success rate and cosmetic outcomes assessed by HOSE score were evaluated at 6-month postoperatively. Results A total of 55 patients were recruited in each group. One hundred and seven patients of the 110 patients (54 and 53 in groups A and B, respectively) were evaluated at 6-month postoperatively using HOSE score. All preoperative data were comparable in both groups. Success was documented in 49/54 patients (90.7%) in group A. The five failures were secondary to two cases of glans dehiscence and three cases of residual postoperative chordee. Whereas, success was documented in 48/53 patients (90.5%) in group B. Complications were: a case of meatal stenosis, three cases of fistula, and a case of combined meatal stenosis and fistula. The HOSE score was comparable between the two groups (15.4 ± 1.09 vs. 15.6 ± 0.55; p = 0.29). However, the operative time was statistically longer in the G-TIP compared with the C-TIP (91.4 ± 6.2 min vs. 85.2 ± 6.3 min; p < 0.001), respectively. Conclusion The G-TIP urethroplasty provided comparable results with C-TIP in terms of cosmoses, success rate, and complications. However, G-TIP was accompanied with significantly longer operative time.

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BENEFITS OF EARLY POST-ERCP LAPAROSCOPIC CHOLECYSTECTOMY: A SINGLE CENTRE PROSPECTIVE STUDY

Journal of University Medical & Dental College ◽

10.37723/jumdc.v12i3.567 ◽

2021 ◽

Vol 12 (3) ◽

Author(s):

Farhan javed ◽

Saira Saleem ◽

Ayesha Rehman ◽

Faiza Wattoo ◽

Nadia Bano ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Operative Time ◽

Statistical Tests ◽

P Value ◽

Cross Sectional ◽

Increased Risk ◽

Group A ◽

Study Population ◽

Group B

ABSTRACT: BACKGROUND & OBJECTIVE: Laparoscopic cholecystectomy (LC) following Endoscopic retrograde cholangiopancreatography (ERCP) is associated with an increased risk of complications. ERCP is associated with increased incidence of complications during LC. Surgery may be performed in same anesthesia with ERCP or up to 6 weeks later. We aimed to determine the benefits of performing LC within 72hrs of ERCP. METHODOLOGY: After institutional ethical approval this prospective cross-sectional study was performed at Madinah Teaching Hospital Faisalabad from April 2019 to June 2020. By performing convenience sampling, all patients undergoing LC after uneventful ERCP in our hospital were included. Study population was divided based on interval between ERCP and Cholecystectomy; Group-A had LC within 72hrs of ERCP, Group B had LC in same hospital stay after 72hrs and Group-C patients were discharged after ERCP and readmitted for LC. Data was collected using custom designed questionnaire, tabulated using Microsoft Excel 2016 and subjected to statistical tests to compare outcomes. Primary outcome was incidence of complications, while operative time, hospital stay and cost were considered as secondary outcomes. p-value of <0.05 was considered significant. RESULTS: Total 75 patients were included in study, 32 in Group-A, 20 in Group-B and 23 in Group-C. Average age was 44.987 ± 14.819 and study population was predominantly female (86.67%). Complication rate, duration of hospital stay and average cost were less in Group A as compared to other groups (p<0.05). Mean operative time in 3 groups was similar. CONCLUSION: LC within 72hrs after ERCP provides superior results in terms of fewer complications, shorter hospital stays and lesser cost.

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Outcome of tonsillectomy in children without the use of postoperative antibiotics at two tertiary care hospitals of Peshawar

Journal of Rehman Medical Institute ◽

10.52442/jrmi.v6i4.170 ◽

2021 ◽

Vol 6 (4) ◽

pp. 21-23

Author(s):

Saqib Aziz Dawar ◽

Saba Rehman ◽

Humera Khan Dawar ◽

Abid Salahuddin ◽

Aziz Khan Dawar

Keyword(s):

Tertiary Care ◽

Medical Institute ◽

Secondary Hemorrhage ◽

Keywords Tonsillectomy ◽

Quasi Experimental ◽

Group A ◽

Group B ◽

Aseptic Conditions ◽

Tract Infections ◽

Tertiary Care Hospitals

Introduction: Overuse of antibiotics can lead to antimicrobial resistance and unnecessary costs. Although early studies reported improved outcomes following use of perioperative antibiotics for tonsillectomy, more recent studies have not been able to demonstrate a significant benefit on post tonsillectomy morbidity. Objective: To determine the need for postoperative antibiotics in children undergoing tonsillectomy under aseptic conditions at two tertiary care hospitals of Peshawar. Materials & Methods: Children aged 5-14 years admitted to the departments of Otorhinolaryngology-A unit of Hayatabad Medical Complex and Rehman Medical Institute, Peshawar from March 01, 2018 to September 30, 2018 for recurrent sore throat and recurrent quinsy were included in this quasi-experimental study based on prospective data collection and convenience sampling. Children with blood dyscrasias, upper and lower respiratory tract infections, and cardiopulmonary diseases were excluded. Routine preoperative investigations were done, and all were given postoperative analgesics. The patients were divided into two consecutive groups of 60 each; Group-A was given Co-amoxiclav 20mg/5mg/kg/day for 10 days and Group-B was not given any antibiotic. During their stay in the hospital and on follow up they were asked about pain via Visual Analogue Scale, and presence of fever and/or bleeding were documented. Results: Of 120 children, 50 (41.6%) were males and 70 (58.4%) were females, of ages 05-14 years; 01(1.6%) from Group-A and 01(1.6%) from Group-B presented with reactionary hemorrhage. However, 01(1.6%) from Group-A and 25(40%) from Group-B presented with secondary hemorrhage for which they were readmitted and put on injectable antibiotics. Similarly, 05(8.3%) from Group-A and 14(23.3%) from Group-B presented with pain for which pain killers were prescribed. Conclusion: Post tonsillectomy antibiotics may have a role in reducing the morbidities associated with the procedure in our setup. Keywords: Tonsillectomy; Postoperative Infections; Antibiotic Resistance; Hemorrhage.

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Efficacy of Local use of Metronidazole Solution among Acute Appendicitis Patients for the Prevention of Wound Infection after Appendectomy: A Randomized Control Trial

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v6i1.48031 ◽

2020 ◽

Vol 6 (1) ◽

pp. 54-58

Author(s):

ABM Mir Mubinul Islam ◽

Nasima Akhter ◽

Md Zafar Imam ◽

Mafiur Rahman ◽

Jalal Uddin Mohammad Rumi

Keyword(s):

Acute Appendicitis ◽

Wound Infection ◽

Randomized Control Trial ◽

Local Application ◽

Control Group ◽

College Hospital ◽

Group A ◽

Study Population ◽

Randomized Control ◽

Group B

Background: Prevention of wound infection after appendectomy is very important for the post-operative management of the acute appendicitis patients. Objective: The purpose of the present study was to validate the efficacy of local application of metronidazole solution in the wound after closing of peritoneum in the prevention of appendectomy wound infection. Methodology: This randomized control trial was conducted in the Department of Surgery at Rajshahi Medical College Hospital, Rajshahi, Bangladesh from July 2009 to June 2011 for a period of two years. Patients admitted with features of uncomplicated and complicated acute appendicitis (Gangrenous or perforated) underwent emergency appendectomy by grid iron incision in all the units of surgery were selected as study population. The study population were divided into two groups into group A and group B. In group A (treatment group) after closure of peritoneum the exposed tissue was washed and was flooded with 100ml of metronidazole solution with 5 gm/ml concentration and was waited for one minute and in group B (control group) with the same amount of sterile saline solution. All patients were evaluated daily for evidence of wound infection such as fever, unusual wound pain with recording of pulse, temperature. Suspected wounds were checked on 3rd, 5th and 7th POD routinely after removal of dressing. Result: A total number of 200 patients were recruited for this study and was divided into two groups in equal number. Therefore, 100 cases were in group A and the rest of 100 cases were enrolled in group B. The mean age with SD of group A and B were 25.06±9.14 years and 23.82±7.51 years respectively. Uncomplicated appendicitis was found in 66 cases and 70 cases in group A and B respectively (p>0.05). In metronidazole wound wash group only 5 patients developed wound infection, however, in saline wash group 22 patients developed infection. Among the positive cultures Staphylococcus aureus was 3 cases and Escherichia coli was in 7 cases. Conclusion: In conclusion rate of wound infection is less in the group treated with the local application of metronidazole solution after appendectomy Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 54-58

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A Comparative Study of Endoscopic Versus Navigation Guided Microscopic Transsphenoidal Pituitary Surgery at Tertiary Care Centre in India

Romanian Neurosurgery ◽

10.2478/romneu-2018-0055 ◽

2018 ◽

Vol 32 (3) ◽

pp. 443-457

Author(s):

Anurag Sahu ◽

Sharad Pandey ◽

Kulwant Singh ◽

Vivek Sharma

Keyword(s):

Operative Time ◽

Tertiary Care ◽

Pituitary Surgery ◽

Controlled Study ◽

Complication Rates ◽

Care Hospital ◽

Significant Difference ◽

Transsphenoidal Pituitary Surgery ◽

Group A ◽

Group B

Abstract Introduction: The transsphenoidal route for pituitary surgery is considered the standard treatment for pituitary adenomas. The disadvantage of the smaller exposure of this route is partially compensated for by the introduction of the microscope with its coaxial illumination, stereoscopic view, adequate magnification, and microsurgical instruments. However, there are only few reports about the outcome of endonasal endoscopic transphenoidal technique. Aims & Objectives: Current study has been conducted to compare the efficacy, advantages and dis advantages of endoscopic versus navigation guided microscopic transsphenoidal Pituitary surgery. Material and methods: A controlled study was done in the department of neurosurgery, at tertiary care hospital in India, from the period of August 2012 to December 2017 prospectively. In Group A- 30 patients in whom endoscopic transnasal trans Sphenoidal pituitary surgery and in Group B - 30 patients, intraoperative neuronavigation was used. Observations and Results: Both the groups were similar in demographic variables. The most common age group of pituitary tumor patients was 30-40 years. Fourteen (46.6 %) patients in group A and fifteen (50 %) of the patients in group B had tumor volume less than 5 ml. In group A, thirteen (43%) patients had intrasellar tumors with no suprasellar extension, while in group B, fifteen (50%) patients had intrasellar tumors with no extension. Operative time was noted from incision to closure and average time taken in both the groups was compared. Twenty five (83%) cases of group A took between 2-3 hours and only four cases (13%) took more than 3 hours. While in group B, twenty (66%) cases took between 4-5 hours. This shows a significant difference by fisher extact test (p<0.001) in the operative time required in both the groups. Eighteen (60%) patients in group B had a residual volume between 1-1.5 ml while only two patients in group A had so. This difference is also significant Fischer Exact test (p<0.001). Four (13.3%) patients in group A had diabites insipidus while only half of this, i.e. two (6.6%) had so in group B. however this difference in postoperative complication rate is not statistically significant between two groups. Conclusion: The results of our study correlate with many previous studies to compare endoscopic and microscopic transsphenoidal surgery. These two approaches are equally efficacious in oncological outcomes and the complication rates are comparable.

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Comparison of Ciprofloxacin and Amoxicillin/Clavulanic Acid in the Treatment of Chronic Rhinosinusitis

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v7i4.324 ◽

2019 ◽

Vol 7 (4) ◽

Author(s):

Zaimal Shahan ◽

Ghulam Saqulain ◽

Jawwad Ahmed

Keyword(s):

Clavulanic Acid ◽

Chronic Rhinosinusitis ◽

P Value ◽

Chi Square ◽

Group A ◽

Amoxicillin Clavulanic Acid ◽

Study Population ◽

Chronic Rhino Sinusitis ◽

Randomized Control ◽

Group B

Objective: To compare ciprofloxacin with amoxicillin/ clavulanic acid in the treatment of chronic rhinosinusitis (CRS) in terms of frequency of improvement in symptom score.Patients and Methods: This randomized control trial was conducted at Department of Otorhinolaryngology, Capital Hospital Islamabad, from March 2015 to March 2016. Study population included 190 cases of Chronic Rhino Sinusitis (CRS) of either gender, aged 18 to 50 years and excluding confounders, divided in two groups. Group A received Ciprofloxacin 500 mg BD and Group B received Amoxicillin/ clavulanic acid 625 mg TDS for 10 days. Symptom score was recorded at start of treatment and finally at 16th week. Data analysis was done by SPSS 17.0. Chi Square was used to compare improvement of two groups. P-value ≤ 0.05 was considered significant.

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COMPARISON OF EFFECTIVENESS OF MOBILIZATION AND SELF-EXERCISES IN ADHESIVE CAPSULITIS OF SHOULDER

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.7.1/004 ◽

2018 ◽

Vol 7 (1) ◽

pp. 35-41

Author(s):

Muhammad Usman Khan ◽

Ghazala Noor Nizami ◽

Ali Farhad

Keyword(s):

Pain Intensity ◽

Adhesive Capsulitis ◽

Descriptive Analysis ◽

Tertiary Care ◽

Sampling Technique ◽

Simple Random Sampling ◽

T Test ◽

P Value ◽

Group A ◽

Group B

OBJECTIVE To compare the effectiveness of mobilization and self-exercises in the management of adhesive capsulitis of shoulder STUDY DESIGN Randomized Control Trial SAMPLE SELECTION 30 patients of adhesive capsulitis of shoulder from physiotherapy department of tertiary care hospitals of Karachi were selected through simple random sampling technique. PROCEDURE Treatment was continued for 5 days per week for the period of 3 weeks followed by assessment. Patients were randomly divided into two equal groups. Group A was treated with midrange mobilization while group B performed self-exercises. Both groups received TENS and hot pack prior to the exercises. Mean ± SD, frequencies and percentages were used for descriptive analysis. ROM via goniometry and pain intensity through VAS was analyzed by paired t-test within the groups and by independent t-test between the groups, using SPSS. P-value of less than 0.05 was considered significant. RESULTS 60% were females (n=18) and 40% were males (n=12) with mean age of 50.17±6.37 years. Significant improvement (p-value <0.05) in pain and shoulder ROM was observed among patients of Group A as compared to Group B. Pain intensity was decreased to 1.67 ± 0.62 in group A, whereas ROMs in these patients were also better than other group.

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ABO groups can play a role in susceptibility and severity of COVID-19

Egyptian Journal of Bronchology ◽

10.1186/s43168-020-00051-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

S. Samra ◽

M. Habeb ◽

R. Nafae

Keyword(s):

Blood Group ◽

Abo Blood Group ◽

Infection Group ◽

Mechanically Ventilated ◽

Blood Group A ◽

Group A ◽

Study Population ◽

Group B ◽

The Relationship ◽

Seriously Ill

Abstract Background A few people infected by the coronavirus become seriously ill, while others show little to no signs of the symptoms, or are asymptomatic. Recent researches are pointing to the fact that the ABO blood group might play an important role in a person’s susceptibility and severity of COVID-19 infection. Aim of the study: try to understand the relationship between ABO groups and COVID-19 (susceptibility and severity). Results A total of (507) patients were included in this study. The study population was divided based on the ABO blood group into types A+, A−, B+, AB, O+, and O−. Blood group A was associated with high susceptibility of infection: group A, 381 (75.1%); and less common in group O, 97 (19.2%), group B, 18 (3.5%), and group AB, 11 (2.2%). The severity of COVID-19 infection was common in non-blood group O where (20 (7.1%), 4 (26.7%), 2 (11%), and 1 (9%) in type A+, A−, B+, and AB, respectively), while in type O 3.1%. And mechanically ventilated patients were 22 (5.9%), 2 (13.4%), 2 (11.1%), and 1 (1%). Mortality was high in blood groups A and B, 16 (4.37%) and 1 (5.5%), respectively, while in blood group O, it was 1%. Conclusion The incidence, severity, and mortality of COVID-19 were common in non-blood group O. While blood group O was protected against COVID-19.

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