Resolution of symptoms after Heller's cardiomyotomy with DOR fundoplication versus endoscopic balloon dilatation in patients with achalasia Cardia at tertiary care hospital

2021 ◽  
Author(s):  
Shahriyar Ghazanfar ◽  
Sajida Qureshi ◽  
Ali Rasheed ◽  
Fahad Memon ◽  
Mohammad Saeed Quraishy
Keyword(s):  
Balloon Dilatation ◽  
Treatment Success ◽  
Tertiary Care ◽  
Pneumatic Dilatation ◽  
Care Hospital ◽  
Dor Fundoplication ◽  
Achalasia Cardia ◽  
Heller’S Myotomy ◽  
Heller's Myotomy

Objective: The objective was to compare symptoms improvement following Heller's myotomy with DOR fundoplication (HM-DOR) and endoscopic pneumatic dilatation (PD) for the treatment of achalasia cardia at one year follow up. Methods: This prospective comparative study was conducted at department of upper GI and minimally invasive surgery, Civil hospital Karachi from February 2016- January 2019. All patients diagnosed as a case of achalasia cardia on esophageal manometry were included in this study. Subjects were grouped into two treatment groups: Endoscopic Pneumatic Dilatation(PD) and laparoscopic Heller's myotomy with DOR fundoplication (HM-DOR). Results: A total of 42 patients were taken into study, of which 21 patients were randomly assigned in each of the two groups (surgery and endoscopic). Mean age of patients undergoing laparoscopic Heller’s myotomy and endoscopic pneumatic balloon dilatation was 34±8.59 and 37±12.87 years respectively. Treatment success in PD group was 52% (11/21) as compared to HM-DOR group which was 76% (16/21). Post Eckardt scores reduction at 1 year follow up between PD and HM-DOR were statistically significant (p<0.001). Patient satisfaction measured by likert's scale was significantly more in the surgery group. Conclusion: The efficacy of HM appears to be greater than PD for improvement in dysphagia and overall patients satisfaction score over a 1 year follow up period. Keywords: Esophageal achalasia, Heller’s myotomy (HM), Endoscopic pneumatic dilatation (PD). Continuous...

The Use of Rigiflex Pneumatic Balloon Dilator during Laparoscopic Heller's Myotomy in Patients with Achalasia: A Novel Technical Method and Its Surgical Outcomes

2018 ◽  
Vol 84 (11) ◽  
pp. 1796-1800
Author(s):  
Erdal Birol Bostanci ◽  
Volkan Oter ◽  
Kerem Karaman
Keyword(s):  
Surgical Outcomes ◽  
Balloon Dilatation ◽  
Treatment Options ◽  
Heller’S Myotomy ◽  
Eckardt Score ◽  
Valuable Method ◽  
Heller's Myotomy ◽  
Balloon Dilator ◽  
Pneumatic Balloon Dilatation

Pneumatic balloon dilatation (BD) and laparoscopic Heller's myotomy (LHM) are usually preferred treatment options for relieving dysphagia symptoms in achalasia. The aim of the present study was to describe a new technical method for a safe and effective LHM. Endoscopic BD tube (Rigiflex 30-mm pneumatic balloon) is simultaneously insufflated and desufflated in the esophagus during LHM to assess myotomy in 50 consecutive patients. Dysphagia symptoms were determined using Eckardt's score. Three esophageal mucosal perforations occurred during surgery, which was primary repaired. The preoperative Eckardt score improved significantly from 4.54 ± 1.85 to 0.54 ± 0.73 ( P < 0.001) at the first postoperative annual follow-up. The use of endoscopic BD tube during LHM is an easy and valuable method that allows to assess whether the dissection of muscular fibers in the myotomy area is appropriate or not.

scholarly journals A case report on achalasia cardia type - II

2019 ◽  
Vol 6 (9) ◽  
pp. 3401
Author(s):  
Sadiya Mustafavi ◽  
Atif Abdul Samee ◽  
Shafia Siddiqui ◽  
Tanveer Yousra
Keyword(s):  
Case Report ◽  
Neurodegenerative Disorder ◽  
Delayed Diagnosis ◽  
Autoimmune Disorder ◽  
Pneumatic Dilatation ◽  
Achalasia Cardia ◽  
Heller’S Myotomy ◽  
Heller's Myotomy ◽  
One Year ◽  
Dor’S Fundoplication

Achalasia cardia is the rare chronic neurodegenerative disorder of the esophagus which causes progressive delay in contractility of lower esophageal muscles during swallowing leading to backup of food contents and fluids in later stages within the region of esophagus. It is considered as the common leading cause of motor dysphagia. The underlying etiology include autoimmune disorder, nervous degeneration due to loss of inhibitory ganglion in myenteric plexus of esophagus, presence of inhibitory neurotransmitters such as nitric oxide and its receptors in lower esophagus. At initial presentation drugs are prescribed as the symptoms mimic other GI disorders which often lead to delayed diagnosis. The symptoms mainly include severe pain or discomfort of chest after eating, weight loss, regurgitation of bland undigested food or saliva, severe heartburn, dysphagia, aspiration. Initial treatment includes the pharmacotherapeutic management to alleviate the symptoms and improve the esophageal outflow. Surgical treatment involves pneumatic dilatation, Heller’s myotomy, preoral endoscopic myotomy, esophagectomy. Heller’s myotomy may be performed by open or laparoscopic procedure. It is done along with Dor’s fundoplication. Case report discussed below is of a 55 years old female patient presented with dysphagia for one year. The symptoms of which worsened for 2 months along with vomiting of undigested foul-smelling food.

Outcomes of pneumatic dilatation and Heller’s myotomy for achalasia in England between 2005 and 2016

Gut ◽  
2019 ◽  
Vol 68 (7) ◽  
pp. 1146-1151 ◽  
Author(s):  
Philip R Harvey ◽  
Ben Coupland ◽  
Jemma Mytton ◽  
Felicity Evison ◽  
Prashant Patel ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
National Level ◽  
Lower Oesophageal Sphincter ◽  
Pneumatic Dilatation ◽  
Long Term Outcomes ◽  
Heller’S Myotomy ◽  
Charlson Comorbidity Score ◽  
Heller's Myotomy

IntroductionAchalasia is a disorder characterised by failed relaxation of the lower oesophageal sphincter. The aim of this study was to examine, at a national level, the long-term outcomes of achalasia therapies.MethodsHospital Episode Statistics include diagnostic and procedural data for all English National Health Service–funded hospital admissions. Subjects with a code for achalasia who had their initial treatment between January 2006 and December 2015 were grouped by treatment; pneumatic dilatation (PD) or surgical Heller’s myotomy (HM). Procedural failure was defined as time to a further episode of the same therapy or a change to a different therapy. Up to three PDs were permitted without being considered a therapy failure.Results6938 subjects were included; 3619 (52.2%) were men and median age at diagnosis was 59 (IQR 43–75) years. 4748 (68.4%) initially received PD and 2190 (31.6%) HM. The perforation rate following PD was 1.6%. Mortality at 30 days was 0.0% for HM and 1.9% for PD, and <8% after perforation following PD. Factors associated with increased mortality after PD included age quintile 66–77 (OR 4.55 (95% CI 2.00 to 10.38), p<0.001), >77 (9.78 (4.33 to 22.06), p<0.001); Charlson comorbidity score >4 (2.87 (2.08 to 3.95), p<0.001); previous HM (2.47 (1.33 to 4.62), p<0.001); and repeat PD 1–3 (1.58 (1.15 to 2.16), p=0.005), >3 (1.97 (1.21 to 3.19), p=0.006). Durability of up to 3 PD and HM over 10 years of follow-up was 86.2% and 81.9%, respectively (p<0.001).DiscussionThe efficacy of PD for achalasia appears to be greater than HM over 10 years. There was no mortality associated with HM, but 1.9% of subjects died within 30 days of PD. Mortality was associated with increasing age, comorbidity, previous HM and repeat PD.

THE OUTCOMES OF TRABECULECTOMY WITH ADJUNCTIVE SUBCONJUNCTIVAL MITOMYCIN C AMONG PATIENTS REQUIRING GLAUCOMA SURGERY AT A TERTIARY CARE HOSPITAL IN RAJASTHAN, INDIA

2021 ◽  
pp. 1-2
Author(s):  
Prachi Mathur ◽  
Rakesh Porwal
Keyword(s):  
Postoperative Complications ◽  
Mitomycin C ◽  
Treatment Success ◽  
Tertiary Care ◽  
Glaucoma Surgery ◽  
Good Alternative ◽  
Care Hospital ◽  
Good Patient Outcome ◽  
Maximal Medical Therapy

Introduction: Glaucoma is a chronic multifactorial degenerative optic neuropathy and is the second leading cause of irreversible blindness worldwide. Material And Methods: 50 eyes of 50 patients of diagnosed glaucoma not controlled by maximal medical therapy underwent trabeculectomy adjuncted with subconjunctival Mitomycin C. Preoperative data included age, gender, IOP(intraocular pressure) and number of preoperative medications. Postoperatively IOP, number of glaucoma medications and postoperative complications if any were recorded on follow up at seven days, one month and three months. Results: Baseline characteristics were matched. Preoperative IOP was 33.23±8.41 mm of hg which drastically dropped to 14.67±5.78 mm of hg 3 months postoperatively. The need for postoperative antiglaucoma medications also dropped from 3.92±1.14 medications used preoperatively to 1.14±1.26 postoperatively. Success rate was 50% out of which 46% had complete success while 44% had qualied success. Postoperative complications seen were hypotony(14%), Flat AC(12%), Hyphema (6%), Flat Ac with raised IOP(2%), and Cystoid macular edema (2%). Discussion: In conclusion, this study shows that trabeculectomy with adjunctive MMC provides good patient outcome in the form of treatment success in 90% and reduced postoperative antiglaucoma medications in patients and is a good alternative to trabeculectomy alone.

Chemo-prophylaxis of COVID-19 with hydroxychloroquine: a study of health care workers attitude, adherence to regime and toxicities/side effects (Preprint)

2020 ◽  
Author(s):  
Debajyoti Bhattacharyya ◽  
Neeraj Raizada ◽  
Bharathnag Nagappa ◽  
Arvind Tomar ◽  
Prateek Maurya ◽  
...  
Keyword(s):  
Side Effects ◽  
Health Care Workers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Perceived Threat ◽  
Care Hospital ◽  
Care Workers ◽  
Perceived Danger ◽  
Structured Questionnaire

BACKGROUND There are apprehensions among healthcare worker (HCWs) about COVID-19. The HCWs have been given hydroxychloroquine (HCQ) chemo-prophylaxis for seven weeks as per Government of India guidelines. OBJECTIVE To assess the apprehensions among HCWs about COVID-19 and to document accessibility, adherence and side effects related to HCQ prophylaxis in HCWs. METHODS A longitudinal follow up study was conducted in a tertiary care hospital. HCQ was given in the dose of 400 mg twice on day one, and then 400 mg weekly for seven weeks. 391 HCWs were interviewed using semi structured questionnaire. RESULTS 62.2% HCWs expressed perceived danger posted by COVID-19 infection. Doctors (54%) showed least acceptance and paramedics (88%) showed highest acceptance to chemo-prophylaxis. 17.5% participants developed at least one of the side effects to HCQ. Females and nursing profession were significantly associated with adverse effects. Common side effects were gastro-intestinal symptoms, headache and abnormal mood change. Most of these were mild, not requiring any intervention. Gender, professions and perceived threat of COVID-19 were significantly associated with acceptance and adherence to HCQ prophylaxis. CONCLUSIONS Two third of HCWs had perceived danger due to COVID-19. Three fourth of the HCWs accepted chemo-prophylaxis and four out of five who accepted had complete adherence to prophylaxis schedule. One out of five had developed at least one of side effects; however, most of these were mild not requiring any intervention.

scholarly journals Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Faizus Sazzad ◽  
Ong Zhi Xian ◽  
Ashlynn Ler ◽  
Chang Guohao ◽  
Kang Giap Swee ◽  
...  
Keyword(s):  
Heart Valve ◽  
Operative Time ◽  
Tertiary Care ◽  
Paravalvular Leak ◽  
Valvular Regurgitation ◽  
Care Hospital ◽  
Valve Repair ◽  
Replacement Surgery ◽  
Triple Valve

Abstract Background CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. Methods Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 132 patients between January 2016 and June 2018. Results In our study, the overall mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. Fifty-eight patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. After reviewed by the cardiologist blinded towards the study, we report trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography was found in 1 (1.01%) patients. There were no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. Single mitral valve and aortic surgeries had comparable incidences of post surgical complications. Conclusion We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.

scholarly journals 99. Effectiveness of Antibiotic Prophylaxis Among Patients Undergoing Elective Transurethral Resection of the Prostate in the Era of Antibiotic Resistance

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S179-S180
Author(s):  
Thana Khawcharoenporn ◽  
Pimjira Kanoktipakorn
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Prophylaxis ◽  
Transurethral Resection ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Prophylactic Antibiotics ◽  
Care Hospital ◽  
Extended Spectrum Beta Lactamase ◽  
Observational Cohort

Abstract Background Data existing on effectiveness of antibiotic prophylaxis (AP) for transurethral resection of the prostate (TURP) are limited in the era of antibiotic resistance. Methods A 4-year prospective observational cohort study was conducted among patients undergoing TURP in an academic tertiary-care hospital during 2016–2019. Patients were excluded if pre-operative (pre-op) urine cultures were not sent or grew mixed (&gt;2) organisms, or they had pre-op urinary tract infection (UTI) or lost follow-up after TURP. Appropriateness of AP was defined as 1) correct dosing and duration and narrowest spectrum according to the hospital AP guidelines and local epidemiology and 2) being active against uropathogens isolated from the pre-op culture. Primary outcome was the rate of UTI within 30 days post TURP compared between appropriate antibiotic prophylaxis (AAP) and inappropriate antibiotic prophylaxis (IAP) groups. Results 342 patients were screened and 61 were excluded. Of the 281 patients included, 139 (49%) received AAP and 142 (51%) received IAP. The reasons for IAP were prescribing too broad-spectrum antibiotics (57%), inactive antibiotics (41%) and incorrect dosing (2%). Pre-op urine cultures were no growth in 148 patients (53%). Among the 133 positive urine cultures with 144 isolates, Escherichia coli (52%) was the most commonly isolated. Thirty-one percent of these 144 isolates produced extended-spectrum beta-lactamase (ESBL) and 23 (16%) isolates were multidrug-resistant. The resistant rates of Enterobacteriaceae were 73% for ciprofloxacin, 65% for TMP-SMX and 46% for ceftriaxone. The two most commonly prescribed prophylactic antibiotics were ceftriaxone (51%) and ciprofloxacin (34%). The rate of UTI within 30 days post-TURP was significantly higher in IAP group compared to AAP group (47% vs 27%; P&lt; 0.001). Prescribing inactive prophylactic antibiotics was the independent factor associated with 30-day post-TURP UTI (adjusted odds ratio 2.88; P=0.001). Conclusion Appropriate antibiotic prophylaxis significantly reduced UTI within 30 days of elective TURP. Obtaining pre-op urine culture and prescribing an active prophylactic agent are critical for preventing post-TURP UTI in the era of antibiotic resistance. Disclosures All Authors: No reported disclosures

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

2021 ◽  
pp. 000992282110472
Author(s):  
Andrew Brown ◽  
Mary Quaile ◽  
Hannah Morris ◽  
Dmitry Tumin ◽  
Clayten L. Parker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Care Coordination ◽  
Chronic Conditions ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Admission ◽  
Complex Chronic Conditions

Objective To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. Methods We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children’s hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Results Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission ( P = .020) and prolonged length of stay ( P = .004) were associated with decreased likelihood of completing recommended follow-up. Conclusions Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

A STUDY OF 50 CASES OF DIABETIC FOOT AT TERTIARY CARE HOSPITAL

2021 ◽  
pp. 27-29
Author(s):  
Deep N. Patel ◽  
Rajnish R. Patel ◽  
Hitendra K. Desai ◽  
Rajesh K. Patel ◽  
Haresh Memariya ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Tertiary Care ◽  
Care Hospital ◽  
Economic Class ◽  
Control Of Diabetes ◽  
Education And Awareness ◽  
Careful Assessment ◽  
Diabetes Melitus

BACKGROUND AND OBJECTIVES :- The present study was attempted to nd out the role of conventional and newer modalities for the treatment and rehabilitation and prevention of complication of diabetic foot patients. MATERIALAND METHOD:-. 50 patients of diabetic foot admitted in civil Hospital,ahmedabad were studied within two years from 2018 to 2020 and careful assessment of history, clinical ndings, investigation, management and follow-up of these patients done. RESULT:-According to my study, Diabetic foot is common in males & 51-60 years of age group,in smokers, in lower socio-economic class, with average duration of 8 to 10 years of diabetes melitus, most common type of lesion was abscess,most common site was forefoot, mostly was of neuropathic in nature & mostly managed by debridement. Mean hospital stay was 1 week to 1 month. CONCLUSION:- Patient education and awareness regarding good sugar control of diabetes, use of proper antibiotics, adequate debridement and proper dressing ;with eusol, betadine hydrogen peroxide along with newer dressing methods like vacuum dressing found to be effective. Amputation done only for gangrene and proper rehabilitation method carried out for these patients.

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