scholarly journals Bilayer Mesh Repair for Inguinal Hernia- The Open Alternative to Laparoscopic Repairs

2021 ◽  
Author(s):  
Abinash Kanungo ◽  
Chinmaya Ranjan Behera ◽  
Riddhika Majumder ◽  
Subrajit Mishra ◽  
Subrat Kumar Sahu ◽  
...  
Keyword(s):  
Mesh Repair ◽  
Tertiary Care ◽  
Uneventful Recovery ◽  
Minimal Risk ◽  
Care Hospital ◽  
Inguinal Hernias ◽  
Resource Setting ◽  
Total Extraperitoneal ◽  
Patch Plasty ◽  
Dual Mesh

Introduction: In 1999, Gilbert described the technique of using a bilayer mesh device, Prolene Hernia System (PHS) for tension free repairs of inguinal hernias through an open anterior approach. This provides an anterior, posterior and plug repair, and hence successfully covers the myopectineal orifice, the lack of which is a glaring drawback for the Lichtensteins repair. This also confers the same benefit provided by the laparoscopic hernia repairs which uses the preperitoneal space to cover this same region that is, Transabdominal Preperitoneal Patch Plasty (TAPP) and Total Extraperitoneal patch Plasty (TEP). Aim: To observe the overall outcome of using the open bi-layered dual mesh in a population of Odisha, attending a tertiary care hospital. Materials and Methods: All patients admitted with inguinal hernias in the Department of General Surgery, Pradyumna Bal Memorial Hospital, KIMS, Odisha, India were included in the study. They all underwent the PHS bilayer mesh repair. The relevant patient specifics like, preoperative clinical findings and intra and postoperative results were noted in a master chart. Patients were followed-up for one year, and further long-term complications were noted, if any. Results: There were a total of 40 patients. The mean duration for the procedure was 61 minutes (SD-22.8) and there was no inadvertent injury. The patients were encouraged to resume all physical activities from the first postoperative day. All the patients had an uneventful recovery, with a mean hospital stay of four days. Four patients presented with seroma after one week of surgery, while 22 patients had cord oedema. Both subsided spontaneously within three weeks, without further intervention. No recurrence was noted in any of the patients. Conclusion: The PHS bilayer dual mesh repair is ideally suited for population in a low resource setting. It ensures coverage of the entire vulnerable area of groin along with a considerably shorter duration of operation, minimal risk of intraoperative injury.

scholarly journals Effective Utilization of Limited Isolation Rooms to Provide Safe Patient Care and Staff Safety in a Low- and Middle-Income Country

2020 ◽  
Vol 41 (S1) ◽  
pp. s203-s204
Author(s):  
Rozina Roshanali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Limited Resource ◽  
Multidrug Resistant ◽  
Communicable Diseases ◽  
Care Hospital ◽  
Middle Income ◽  
Safe Patient Care ◽  
Bed Management ◽  
Resource Setting

Background: My tertiary-care hospital is a 750-bed hospital with only 17 airborne infection isolation room (AIIR) and negative-pressure rooms to isolate patients who have been diagnosed or are suspected with prevalent diseases like tuberculosis, measles, and chickenpox. On the other hand, only 14 single-patient isolation rooms are available to isolate patients with multidrug-resistant organisms (MDROs) such as CRE (carbapenum-resistant Enterobacter) or colistin-resistant MDROs. Due to the limited number of isolation rooms, the average number of hours to isolate infected patients was ~20 hours, which ultimately directly placed healthcare workers (HCWs) at risk of exposure to infected patients. Methods: Plan-Do-Study-Act (PDSA) quality improvement methodology was utilized to decrease the average number of hours to isolate infected patients and to reduce the exposure of HCWs to communicable diseases. A detailed analysis were performed to identify root causes and their effects at multiple levels. A multidisciplinary team implemented several strategies: coordination with information and technology team to place isolation alerts in the charting system; screening flyers and questions at emergency department triage; close coordination with admission and bed management office; daily morning and evening rounds by infection preventionists in the emergency department; daily morning meeting with microbiology and bed management office to intervene immediately to isolate patients in a timely way; infection preventionist on-call system (24 hours per day, 7 days per week) to provide recommendations for patient placement and cohorting of infected patients wherever possible. Results: In 1 year, a significant reduction was achieved in the number of hours to isolate infected patients, from 20 hours to 4 hours. As a result, HCW exposures to communicable diseases also decreased from 6.7 to 1.5; HCW exposures to TB decreased from 6.0 to 1.9; exposures measles decreased from 4.75 to 1.5; and exposures chickenpox decreased from 7.3 to 1.0. Significant reductions in cost incurred by the organization for the employees who were exposed to these diseases for postexposure prophylaxis also decreased, from ~Rs. 290,000 (~US$3,000) to ~Rs. 59,520 (~US$600). Conclusions: This multidisciplinary approach achieved infection prevention improvements and enhanced patient and HCW safety in a limited-resource setting.Funding: NoneDisclosures: None

scholarly journals Use of the Maternal Foetal Triage Index- Addressing the Third Delay in Obstetrics: An Observational Study

2021 ◽  
Author(s):  
Nirzarini Vora ◽  
Nandita Maitra ◽  
Priyam Pandya
Keyword(s):  
Observational Study ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
Care Hospital ◽  
Convenience Sample ◽  
The Third ◽  
Resource Setting ◽  
Maternal And Neonatal Outcomes ◽  
A Priority

OBJECTIVE: The Maternal Foetal Triage Index (MFTI), a five-tier scale designed by Ruhl et al (2015) has been evaluated in this study for women attending the triage area of a tertiary hospital, to examine the effect on third delay and maternal and neonatal outcomes. DESIGN: Prospective observational study SETTING: The Labour and Delivery Unit of a tertiary care hospital SAMPLE: A convenience sample of 1000 women METHODS: Assessment included maternal history, baseline vital signs and obstetric examination and categorised the woman as per the MFTI scale. Evaluation of the MFTI score was assessed based on predefined maternal and neonatal outcomes within 24h of attendance. MAIN OUTCOME MEASURES: Flow of patients to triage, presenting complaints, Duration of hospital stay, maternal and neonatal outcomes within 24h of admission. RESULTS: A priority wise distribution of subjects based on their clinical diagnosis was found to be statistically significant for anaemia, previous caesarean, postpartum haemorrhage, miscarriage and hypertensive disorders. Sixty seven percent of the subjects belonged to Priority 3-4 and the mean hospital stay duration varied from 8.26±7.68 days for Priority 1 to 3.82±2.74 days for Priority 4 ((p<0.0001). The average time spent in the triage room was 30±17minutes. A priority wise analysis of maternal and neonatal outcomes based on OBICU and NICU admissions, mortality and stillbirths was found to be significant. CONCLUSION: The MFTI scale significantly reduced the third delay, which is crucial in a high-volume, low resource setting. This also simplified handover, improved documentation and decreased time to secondary healthcare provider assessment. KEYWORDS:obstetrictriage,acuity,thirddelay,maternalmortality

scholarly journals A prospective study on incisional hernia, its incidence, etiology and management in a tertiary care hospital of Odisha

2019 ◽  
Vol 6 (4) ◽  
pp. 1280
Author(s):  
S. K. Pattanaik ◽  
Afroza Firodous ◽  
Ajax John ◽  
Harsha Pattnaik ◽  
Biplab Mishra ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Mesh Repair ◽  
Tertiary Care ◽  
Operating Time ◽  
Surgical Techniques ◽  
Wound Management ◽  
Anatomical Reconstruction ◽  
Suture Repair ◽  
Care Hospital ◽  
Open Mesh Repair

Background: Incisional hernia (IH) is defined as the hernia protruding through incompletely healed abdominal surgical wound. Management of IH can be preventive (avoidance of infection and suture line tension, proper abdominal wound closure) or operative (anatomical reconstruction or repair with synthetic non-absorbable mesh either by open or laparoscopy method).Methods: A descriptive prospective observational study on 51 patients with age >15 yrs was conducted in the Department of General Surgery, SCB Medical College and Hospital, Cuttack from August 2015 to August 2017. Diagnosis was made with clinical history, physical examination, X-ray abdomen and USG abdomen. The patients underwent different surgical procedures depending on size of defect, patient’s consent and expertise available. Post-operative complications were noted and patients were followed up to 1 year for any recurrence.Results: 28 males and 23 females were included. The mean age was 42.3 years. Most common cause of IH was post-operative wound infection (47.1%). Maximum cases were following emergency surgery (88.2%). Midline incision contributes maximum number (52.9%) followed by Pfannenstiel incision (25.4%). Open hernioplasty was the most common procedure (58.8%) followed by anatomical repair (19.6%) and laparoscopic hernioplasty (15.6%). Recurrence with suture repair was 10%, open mesh repair 3.3% and no recurrence was observed following laparoscopic repair.Conclusions: Prevention of IH is to be taken care of, by avoiding infection during index operation with thorough peritoneal toileting, proper surgical techniques and appropriate antibiotics. Although laparoscopic mesh repair needs more operating time and skill, it has lesser blood loss, hospital stay and recurrence rate when compared to other procedures.

scholarly journals THE RATE OF SUCCESS IN UTEROVAGINAL PACKING IN ATONIC UTERUS IN A TERTIARY CARE HOSPITAL IN LOW RESOURCE SETTING

2021 ◽  
Vol 29 (03) ◽  
Author(s):  
Samina aliya Sabir ◽  
Shahida Sultan
Keyword(s):  
Medical Treatment ◽  
Success Rate ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Prospective Trial ◽  
Care Hospital ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Internal Iliac

Abstract:Objective: To find out the success rate of uterovaginal packing of Atonic Uterus in a tertiary care hospital, in low resource setting.Methods: This was a interventional prospective trial conducted in Gynae department of Lady Reading Hospital from January 2019 to December 2019. Our study included those patients with PPH not responding to medical treatment in vaginal delivery. Patients in shock with PPH and PPH after Csection were excluded from the study. The study was approved by the ethical committee of hospital.Results: In our study 250 patients with Atonic Uterus with PPH with failed medical treatment were done uterovaginal packing, the success rate after 12 hours was 86.4%, in rest of the patients PPH was controlled by second line surgical intervention in 34 cases (13.6%), B Lynch was done in 18 (7.2%) cases, subtotal hysterectomies 13 (5.2%) cases and internal Iliac ligation in 3 cases (1.2%)Conclusion: Uterovaginal packing is an effective, easy, quick and life saving method in the control of PPH in low resource setting.

scholarly journals A Documentation of Hepatitis Outbreak in Chittagong

2019 ◽  
Vol 17 (2) ◽  
pp. 2-5
Author(s):  
Rajat Sanker Roy Biswas ◽  
Fahim Ul Hasan ◽  
Aklima Sultana ◽  
Md Kamal Uddin ◽  
Debashis Chowdhury ◽  
...  
Keyword(s):  
Hepatic Failure ◽  
Demographic Data ◽  
Tertiary Care ◽  
Age Groups ◽  
Hepatitis E ◽  
Uneventful Recovery ◽  
Care Hospital ◽  
Younger Age ◽  
History Of ◽  
Dark Color

Introduction: Hepatitis E Virus (HEV) causes outbreaks of jaundice and it is associated with morbidity and higher maternal mortality. There is a recent outbreak of hepatitis in the Chittagong city and present study is aimed to observe the clinical and serological trends along with outcome of hepatitis cases visiting two tertiary care hospitals Chittagong, Bangladesh. Methods: It was an observational study done in two tertiary care hospital of Chittagong in a period of 3 months (May, June & July 2018) among 230 patients of hepatitis. After inclusion with written informed consent patients were introduced a questionnaire. Their demographic data, risk behaviors were noted, history related to hepatitis were recorded. Examination was done and evaluation regarding presence of hepatic encephalopathy at bed site was noted. Later serological findings were evaluated. After collection of all data it were compiled and analyzed by SPSS- 20. Results: Among 230 cases age group, gender and locality of the study patients were analyzed where younger age groups specially 21-30 years 114(49.6%) and 31-40 years 38(16.5%) were the most affected group. Gender distribution was found mostly same. Halishahar area which is located in western part of the Chittagong city was found mostly affected 196(85.2%). Use of water from WASA (Water and Sewerage Authority) supply was 168(73%) and deep tubewel water was 56(24.3%). Among them 80(34.8%) subjects do not boil water Anorexia (74.8%) nausea (77.4%) vomiting (83.5%) history of fever (89.6%) passage of dark color urine (99.1%) and weakness (97.4%) were some common presenting complaints. Family history of jaundice was found in 40.9% of cases. Among all 216(93.91%) had clinical jaundice, 91(39.56%) had right upper quadrant of the abdomen pain, 41(17.8%) had hepatomegally, 14(6.1%) had spleenomegally, 24(10.4%) had signs of hepatic failure and 34(14.8%) female were pregnant. Anti HEV was found positive in 164(71.3%) cases, 12(5.2%) were positive for anti HAV, 6(2.6%) were positive for HBsAg. None was found anti HCV positive. Among all 4(1.8%) cases died due to hepatic failure or multi-organ failure with AKI. All of them were pregnant. Two pregnant lady had missed abortion. Among all 11(4.7%) cases loosed follow and 213(92.60%) cases had uneventful recovery. Conclusion: This outbreak of HEV was of usual pattern of morbidity and mortality, and therefore points to water supply and sanitation issues. Chatt Maa Shi Hosp Med Coll J; Vol.17 (2); Jul 2018; Page 2-5

scholarly journals A clinical study on obstructed inguinal hernia: a descriptive study on 53 cases

2019 ◽  
Vol 6 (6) ◽  
pp. 1965 ◽  
Author(s):  
Gaddam Padmasree
Keyword(s):  
Inguinal Hernia ◽  
Wound Infection ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Care Hospital ◽  
Inguinal Hernias ◽  
Primary Physicians ◽  
Obstructed Hernia ◽  
Emergency Surgical Intervention ◽  
Common Content

Background: Inguinal hernias are the common causes of surgical admissions and referral of patients from primary physicians. Although we have made a great progress in treating hernia the management of its complications has progressed only a little. The aim of study was to determine the various modes of presentation, clinical features, diagnostic and therapeutic strategies and to evaluate the post-operative outcome in obstructed hernia surgeries.Methods: After obtaining written and informed consent from the patients, cases for the study were randomly selected from patients admitted to this tertiary care hospital for surgical intervention of inguinal hernias during the period between 2015 and 2017. Cases with inguinal hernias which had signs of obstruction and inability to reduce the hernia are taken up for emergency surgical intervention within 6-8 hours.Results: 53 obstructed inguinal hernia patients were evaluated and found that, incarceration was the commonest complication seen in 92.45% of cases followed by strangulation (7.54%). Viable bowel was seen 88.67% of cases. Bowel resection and end-to-end anastomosis was done in all cases of non-viable bowel. The commonest post-operative complication encountered in the study was wound infection (9.43%) and scrotal seroma (9.43%).Conclusions: The most common content was small bowel followed by omentum (52.8% and 35.8% respectively). Wound infection and seroma were the most common complications (9.43%) and mortality was observed in two patients (3.7%) and the causes of death were sepsis and acute respiratory distress syndrome.

scholarly journals MESH REPAIR

2016 ◽  
Vol 23 (07) ◽  
pp. 840-843
Author(s):  
Muhammad Paryal Tagar ◽  
Khawar Saeed Jamali ◽  
Muhammad Jawed ◽  
Sarang Tagar
Keyword(s):  
Mesh Repair ◽  
Tertiary Care ◽  
Chronic Obstructive ◽  
Care Hospital ◽  
Obstructive Pulmonary Disease ◽  
Surgical Department ◽  
Hospital Patients ◽  
End Stage ◽  
Sublay Mesh ◽  
Repair Group

Objectives: Compare the complications of inlay versus sublay mesh repairin epigastric hernia. Study Design: Observational study. Setting: Surgical department ofmultiple hospitals and compares the results, JPMC, Civil Hospital Karachi and NaushahroFeroze. Period: March 2015 to February 2016. Methodology: 94 patients presenting withupper abdomen midline swellings aged between 25 to 60 years attended as outdoor patientat a tertiary care hospital. Patients associated with chronic obstructive pulmonary disease likeasthma, abdominal malignancies and cirrhosis with end stage liver disease, multiple hernia,patients with prior hernia repair with mesh and defects < 4cm were excluded. Results: Outof the 94 patients, the majority was found to be male. 61 (64.89%) males and 33 (35.10%)females. Mean age was found to be 41.57+4.54 years. Inlay mesh repair group observed highcomplications as compared to sublay mesh repair group. Wound Infection observed 4(8.5%) cases inlay mesh repair group and 2(4.25%) cases in sublay mesh repair group. SeromaInfection observed 3(6.38 %) cases inlay mesh repair group and 1(2.12 %) cases in sublay meshrepair group. Recurrence occurred inlay mesh repair group was observed in 2(4.25%) cases.Short Hospital stay was observed in sublay mesh repair group. Conclusion: We concludethat sublay mesh repair is a better alternative to only mesh repair for all forms of ventral herniacases.

scholarly journals Chocolate cyst became ovarian abscess following IVF: a serious surgical emergency

2018 ◽  
Vol 7 (5) ◽  
pp. 2052 ◽  
Author(s):  
Poonam Yadav ◽  
Namita Agrawal ◽  
Sarah Zaidi ◽  
S. Fayyaz
Keyword(s):  
In Vitro Fertilization ◽  
Abdominal Mass ◽  
Tertiary Care ◽  
Uneventful Recovery ◽  
Medical Illness ◽  
Care Hospital ◽  
Vitro Fertilization ◽  
Future Fertility ◽  
Ovarian Abscess

We are reporting a rare case of ovarian abscess in an endometrioma following ultrasound guided oocyte retrieval during in vitro fertilization technique. Ovarian abscess within an endometrioma is a rare gynaecological problem. We are presenting a case of a giant abscess formation in an endometrioma following in vitro fertilization in a 36-year-old woman in view of secondary infertility. She presented with high grade fever with chills and rigor for more than 2 months associated with pain in abdomen with a progressively increasing lower abdominal mass. Patient was treated at a tertiary care hospital with multidisciplinary approach. Laparotomy was performed, and two litres of the foul-smelling pus was drained, followed by bilateral salpingooophorectomy. Uterus was left in situ to preserve her future fertility potential. Histology of the specimen confirmed endometriotic nature of the cyst. Pus on culture sensitivity was sterile. Patient had an uneventful recovery and was discharged on the 7th post-operative day. In our case endometrioma presented as failure of in vitro fertilization technique followed by a medical illness. This case highlights that endometrioma became not only a cause of failure of in vitro fertilization technique but also presented as a medical illness and should be dealt as one.

scholarly journals Corona Virus Infection among Healthcare Workers in a COVID Dedicated Tertiary Care Hospital in Dhaka, Bangladesh

2020 ◽  
pp. 43-49 ◽  
Author(s):  
Rubina Yasmin ◽  
Rahnuma Parveen ◽  
Nazim Al Azad ◽  
Sudip Ranjan Deb ◽  
Nandita Paul ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
Uneventful Recovery ◽  
Infection Prevention And Control ◽  
Care Hospital ◽  
College Hospital ◽  
Hospital Authority ◽  
Medical College ◽  
Adequate Knowledge ◽  
And Control

Background: Health care workers (HCWs) are at high risk of acquiring infections during this ongoing COVID-19 outbreak. This study was aimed at determining the prevalence of SARS-CoV-2 infection, the socio demographic and clinical profile and the possible risk factors for infection among the HCWs at Mugda Medical College Hospital (MuMCH). Method: This retrospective observational study was done among the HCWs of MuMCH from 19 April, 2020 to 15 May, 2020. The SARS-CoV-2 positive 37 HCWs were interviewed over telephone by a structured questionnaire and the obtained data were analyzed by using descriptive statistics. Result: Out of total 343 HCWs, total 37(10.79%) cases were detected COVID-19 positive. Out of them, 13(35.14%) were male and 24 (64.86%) were female. The median age was 36 years. Among the infected HCWs, 26 (70.27%) did not have any pre-existing comorbidities. Bronchial asthma (13.51%) and HTN (13.51%) were the most prevalent comorbidities. Around 43.24% (16) had no definite symptoms for COVID- 19. Among the 21(56.76%) symptomatic cases, 15(40.54%) had mild and 6(16.22%) had moderate symptoms. The most common symptoms were cough (16, 43.24%), fever (11, 29.73%), sore throat (7, 18.92%) and fatigue/malaise (7, 18.92%). All had completely recovered uneventfully although 22(59.46%) got admitted to hospital. Only 12(32.43%) were involved in aerosol generating procedure. Total 26 cases (70.27%) used appropriate PPE during their duty. Although only 4(10.81%) got adequate training on PPE use, 33(89.19%) of them had adequate knowledge on that. About 15(40.54%) were reusing PPEs. Most of them (33, 89.20%) were not taking any chemoprophylaxis; all were following traditional preventive measures. Among the HCWs, 26(70.27%) were not satisfied with the infection prevention and control (IPC) measures taken by the hospital authority. All of them presumed that, their occupational exposure was the possible source of COVID-19 infection. Conclusion: More than 1 in 10 HCWs at MuMCH was infected with SARS-CoV-2 while working at the hospital. They represented the younger age group, had fewer comorbidities. Nurses were the most affected category. All experienced uneventful recovery and most of them were not satisfied with the IPC measures taken by the hospital authority. Further studies are required to identify the level of risk of infection, possible risk factors and outcomes and to improve the IPC measures of the hospital. J Bangladesh Coll Phys Surg 2020; 38(0): 43-49

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