Review of Paediatric Typhoid Perforation Cases Managed at a Tertiary Care Centre

Background: Any criteria (clinical, pathologic, microbiological or histo-pathologic) attributing a case of Paediatric gastrointestinal perforation to Typhoid would be of help in reaching a proper diagnosis to guide appropriate management. Aims and Objectives: To review all cases of Typhoid perforation for their clinical, pathologic and intra-operative findings. Materials and Methods: A retrospective study was conducted on all cases of typhoid perforation (gastrointestinal perforation with positive Widal test) operated at a tertiary care centre from September 2015 to September 2018. Data regarding their clinical findings, investigation results, intraoperative findings, nature of the surgical intervention, postoperative results and histopathological findings were collected from their records and analysed. Results: A total of 13 patients were operated during this period with positive Widal’s test at presentation. 6/13 had single ileal perforation; two patients had multiple ileal perforations; perforation at atypical sites were found in four patients (one each at gastric, duodenal, caecal and rectal); one patient presented with Meckel’s band obstruction with multiple ulcers – this patient was sick and died despite a diverting ileostomy in the postoperative period. While 8/13 patients had primary closure of the perforation site, diversion through ileostomy was performed in five patients. All patients did well in the post-operative period except one patient of multiple ulcers and obstructing Meckel’s band who died in the post-operative period. Conclusion: On encountering a gastrointestinal perforation, no definite symptomatology or its pattern, no clinical examination findings, no intraoperative characteristics of the perforation and no biopsy can definitively point towards Typhoid as the cause. Therefore, we still have to depend on serological tests in correlation with clinical features to reach a conclusive diagnosis. Cultures and PCR, although sensitive are either time-taking or expensive to guide management. Typhoid perforation can have vivid and atypical presentation depending on the number and site of perforation.

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Evaluation of paediatric lymphadenopathy at a rural tertiary care centre

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20210655 ◽

2021 ◽

Vol 8 (3) ◽

pp. 507

Author(s):

Mamatha Pakala ◽

Shreya Tanneru ◽

Prasada Thanda ◽

Prabhakar Vuppala

Keyword(s):

Bacterial Infections ◽

Viral Infections ◽

Tertiary Care ◽

Cervical Lymphadenopathy ◽

Clinical Findings ◽

Tuberculous Lymphadenitis ◽

Paediatric Surgery ◽

Tertiary Care Centre ◽

Serological Tests ◽

Gold Standard Method

Background: The aim and objectives of the present study was to determine the various etiologies of lymphadenopathy in children in our region and its associated clinical findings and prevalence of malignancy in children presented with significant lymphadenopathy.Methods: Sixty-five patients with significant lymphadenopathy charts were reviewed retrospectively from department of Paediatrics and Paediatric Surgery during the period of September 2018-2020. Patient’s records were evaluated in terms of age, gender, complaints, and characteristics of lymph nodes in terms of site, consistency, discharge, sinus and clinical course of a patient. Physical findings of all the cases were noted. Hematological and serological tests were done to know the source of infection. Clinical findings and laboratory results were corroborated with pathological diagnostic tests like FNAC and Excision biopsies in children with significant lymphadenopathyResults: The etiology was confirmed in 94% children and couldn’t be diagnosed in 6% children presented with significant lymphadenopathy. On evaluation commonest etiology was infection with reactive hyperplasia in 58% of children secondary to bacterial or viral infections, Kawasaki disease, suppurative lymphadenitis in 17%, tuberculous lymphadenitis in 14%, and malignancy in 11%. Majority of children presented with cervical lymphadenopathy. An unusual presentation of Non Hodgkin lymphoma as intestinal obstruction with no significant mass per abdomen, a case of nasopharyngeal carcinoma presented as torticollis due to massive unilateral cervical lymphadenopathy were diagnosedConclusions: The most widely encountered cause of lymphadenopathy in children was infection. Most of them are secondary to non specific viral or bacterial infections. The most important concern in children presenting with complaints of lymphadenopathy is the detection of underlying malignant disease. There was significant malignancy rate in our study in children with lymphadenopathy with few atypical presentations. Excisional biopsy is the gold standard method to confirm the diagnosis.

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Spectrum of ectopic pregnancy in tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181331 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1435

Author(s):

Ishrat Zuber ◽

Vaishali Chaurasia

Keyword(s):

Ectopic Pregnancy ◽

Clinical Presentation ◽

Tertiary Care ◽

Previous History ◽

Stable State ◽

Clinical Findings ◽

Age Group ◽

Care Centre ◽

Tertiary Care Centre ◽

Presenting Symptoms

Background: Ectopic pregnancy is a catastrophic and life-threatening condition and one of the commonest acute abdominal emergency in day-to-day practice. Objectives of present study were to know the incidence of Ectopic pregnancy at Tertiary care centre, the age group, parity and risk factor of ectopic pregnancy, the clinical presentation of ectopic pregnancy and the outcome and management of ectopic pregnancy.Methods: It was a retrospective study conducted at Chirayu Medical College and Hospital, Bhopal from 1st June 2009 to 31st May 2014. A total of 42 patients with ectopic pregnancy were analyzed on clinical presentation, clinical findings, investigations, operative findings and outcome.Results: A majority of women (64.29%) were in the age group of 21-30 years and 78.57% were multigravida. Commonest risk factors were previous history of abortion (23.80%) and pelvic inflammatory disease (14.28%) Amenorrhea (92.85%) and pain abdomen (89.22%) were the most common presenting symptoms. Ampulla of fallopian tube was the commonest site (45.23%). Unilateral salpingectomy was performed in 40.47% patients. There were no maternal deaths and majority (80.96%) were discharged within seven days.Conclusions: Ectopic pregnancy still remains one of the major causes of maternal morbidity and mortality. Early diagnosis and referral in hemodynamically stable state along with use of minimal access surgery or medical management can change the scenario of ectopic pregnancy in the developing world.

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A retrospective observational comparative study of VDRL vs. TPHA and their role in serodiagnosis of syphilis in a tertiary care centre

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20173122 ◽

2017 ◽

Vol 3 (3) ◽

pp. 444

Author(s):

Sivakumar S. ◽

Banupriya K.

Keyword(s):

Past History ◽

Correct Diagnosis ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Serological Tests ◽

Group 3 ◽

Serodiagnosis Of Syphilis ◽

Group 1

Background: Syphilis is difficult to diagnose challenging the clinicians. Combined use of both non treponemal and treponemal serological tests will give correct diagnosis of syphilis.The aim of the study was to evaluate the role of VDRL and TPHA in the serodiagnosis of syphilis.Methods: Open label retrospective study done in the department of dermatology of a tertiary care centre after getting IEC approval. One hundred and seventy patients’ serological reports done for syphilis during the month January 2017 to May 2017 were taken for the study and were analysed retrospectively after categorizing into three groups. Frequency and percentage of patients who were reactive to VDRL, weakly reactive to VDRL, positive for prozone phenomenon and reactive to TPHA were noted in each group and analysed statistically.Results: In our study two cases showed biological false positive results in group 1 and three cases in group 3 were biological false reactors. In our study five patients in group 1 and three patients in group 3 were non-reactive to VDRL but were reactive to TPHA due to the presence of Ig G antibodies and all these patients gave a past history of treatment of syphilis. Conclusions: Our study was successful in evaluating the role of TPHA and VDRL in the sero-diagnosis of syphilis. The VDRL and TPHA being simple and economical tests can be combined in the assessment of syphilis and ensures that no cases are missed.

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Clinical and epidemiological profile of patients with nasal manifestations of granulomatous disorders in a rural tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20173150 ◽

2017 ◽

Vol 3 (4) ◽

pp. 807

Author(s):

Mohit Sinha ◽

Narendra Hirani ◽

Ajeet Kumar Khilnani ◽

Yash Dhamecha ◽

Jitendra Pareek

Keyword(s):

Multidisciplinary Approach ◽

Tertiary Care ◽

Final Diagnosis ◽

Care Centre ◽

Tertiary Care Centre ◽

Serological Tests ◽

Recurrent Epistaxis ◽

Epidemiological Profile ◽

Granulomatous Diseases ◽

Granulomatous Disorders

Background: Most of the times granulomatous disorders have obvious manifestations; however, sometimes they are difficult to diagnose. A literature review reveals that patients with granulomatous diseases may be frequently incorrectly diagnosed and treated.At present limited data is available on the clinical and epidemiological profile of such patients in rural India. As such rural setup lacks the expert services of rheumatologist and the patients are frequently inconsistent with diagnostic protocols despite best efforts of the clinicians.Methods: This is a prospective study conducted in a tertiary care centre at Bhuj, Gujarat, India between January 2016 and May 2017. Patients included in the study had multi systemic complaints along with nasal manifestations such as recurrent epistaxis, saddling, synechia or swelling over nose. These patients were subjected to detailed history taking including demographic profile. They underwent detailed ENT examination, biopsies, radiological and serological tests and were discussed at multidisciplinary review meetings which involved physicians, otorhinolaryngologists, dermatologist, ophthalmologist, pathologist and radiologist. Results: Of the 19 patients included in this study, 53% patients were females. 84% (16 patients) belonged to rural household and 68% (13 patients) belonged to lower socioeconomic status. 9 patients (47%) were diagnosed with tuberculosis while Wegener’s granulomatosis and leprosy accounted for 3 cases (16%) each. 2 patients each were diagnosed with Cutaneous Leishmaniasis and fungal granulomas respectively. The average period between onset of symptoms and final diagnosis was 8 months. However, it took an average of 4.75 days after patient arrived at our centre to reach a final diagnosis.Conclusions:Early diagnosis of granulomatous disorders requires a multidisciplinary approach. The role of ENT surgeons is obvious as many granulomatous disorders have nasal manifestations. A multidisciplinary approach helps cut short the time between onset of disease and diagnosis, thus benefitting the patients by reducing the hospital stay and visits as most of these illnesses require outpatient treatment. Background: Most of the times granulomatous disorders have obvious manifestations; however, sometimes they are difficult to diagnose. A literature review reveals that patients with granulomatous diseases may be frequently incorrectly diagnosed and treated.At present limited data is available on the clinical and epidemiological profile of such patients in rural India. As such rural setup lacks the expert services of rheumatologist and the patients are frequently inconsistent with diagnostic protocols despite best efforts of the clinicians.Methods: This is a prospective study conducted in a tertiary care centre at Bhuj, Gujarat, India between January 2016 and May 2017. Patients included in the study had multi systemic complaints along with nasal manifestations such as recurrent epistaxis, saddling, synechia or swelling over nose. These patients were subjected to detailed history taking including demographic profile. They underwent detailed ENT examination, biopsies, radiological and serological tests and were discussed at multidisciplinary review meetings which involved physicians, otorhinolaryngologists, dermatologist, ophthalmologist, pathologist and radiologist. Results: Of the 19 patients included in this study, 53% patients were females. 84% (16 patients) belonged to rural household and 68% (13 patients) belonged to lower socioeconomic status. 9 patients (47%) were diagnosed with tuberculosis while Wegener’s granulomatosis and leprosy accounted for 3 cases (16%) each. 2 patients each were diagnosed with Cutaneous Leishmaniasis and fungal granulomas respectively. The average period between onset of symptoms and final diagnosis was 8 months. However, it took an average of 4.75 days after patient arrived at our centre to reach a final diagnosis.Conclusions: Early diagnosis of granulomatous disorders requires a multidisciplinary approach. The role of ENT surgeons is obvious as many granulomatous disorders have nasal manifestations. A multidisciplinary approach helps cut short the time between onset of disease and diagnosis, thus benefitting the patients by reducing the hospital stay and visits as most of these illnesses require outpatient treatment.

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Erythroderma: a clinico etiological study of 77 patients in a tertiary care centre in Kerala

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20205599 ◽

2020 ◽

Vol 7 (1) ◽

pp. 73

Author(s):

Abin Abraham Itty ◽

Rajiv Sridharan ◽

Anoop Thyvalappil ◽

Bindurani Sudhamani

Keyword(s):

Tertiary Care ◽

Disease Process ◽

Underlying Disease ◽

Clinical Findings ◽

Care Centre ◽

Tertiary Care Centre ◽

Female Ratio ◽

Histopathological Correlation ◽

Elderly Males ◽

Etiological Study

Background: Erythroderma is defined as generalized erythema and scaling of the skin affecting more than 90% of body surface area. Identification of the underlying disease process represents one of the most complex challenges in proper patient care.Methods: A retrospective study was done in Department of Dermatology in a Tertiary Care Centre. History, clinical findings and investigations of erythroderma patients were recorded and clinic-histopathological correlation was analyzed by kappa coefficient (К).Results: Erythroderma was more prevalent in elderly males with a mean age of 64.56 years and a male to female ratio of 3:1. A clinical evidence of pre-existing dermatoses was found in 65 patients, commonest being eczema (41.3%) followed by psoriasis (40.3%). Evidence of a trigger was seen in 54.54% patients, commonest being the use of ayurvedic medications (42.8%). Clinico-histopathological correlation was seen in 53.9% cases.Conclusions: Although the clinical presentation of erythroderma is similar, etiological factors are varied and it depends largely on the population studied. Most commonly, erythroderma is due to generalization of pre-existing dermatoses as seen in our study. Hence careful evaluation of clinical clues and histopathological correlation plays a pivotal role in diagnosis of the primary cause and the effective management of erythroderma.

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Safety of Fixed drug Combination in Post –Operative Cataract Patients, at Tertiary Care Centre – In South India

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v9i1.17534 ◽

2017 ◽

Vol 9 (1) ◽

pp. 24-29

Author(s):

M Vidyadevi ◽

A Anuradha ◽

G Rashmi ◽

R Shilpa ◽

S Nishath

Keyword(s):

Drug Combination ◽

South India ◽

Tertiary Care ◽

Eye Drops ◽

Care Centre ◽

Interventional Study ◽

Tertiary Care Centre ◽

Post Operative Period ◽

Fixed Drug ◽

The Cost

Introduction: Cataract is any opacification in lens or its capsule, which accounts for about 50% of treatable blindness worldwide. The prevalence of cataract in India is about 62.6%. The incidence of post operative endophthalmitis ranges from 0.05% -0.14% and so the use of post-operative antibiotics and steroids is necessary to control infection and prevent inflammation. Fixed drug combinations not only cut the cost but also the dosage & improve the compliance of patients in the immediate post operative period. In this regard, the present study was conducted with the aim of studying the efficacy of using fixed drug combination (Difluprednate and Moxifloxacin) in reducing ocular inflammation & pain in post-operative patients undergoing cataract surgery. Methodology: Study design: Prospective interventional study, in which 749 eyes underwent SICS with IOL. All of them were treated with Difluprednate and Moxifloxacin, combination eye drops postoperatively 4 times a day, and reviewed on day 1, 5 and once in two weeks up to 6 weeks. Results: Out of 749 eyes, 730 were normal, 10 eyes had minimal raise in IOP in the range of 21 mmHg-31mmHg (considering 21mmHg as baseline) which decreased without any intervention within 3 weeks and only 9 eyes had raise in IOP of more than 31mmHg, which did not decrease in spite of discontinuing the drops and needed anti-glaucoma treatment. Conclusion: Our study clearly shows that fixed drug combination of antibiotic and steroid does not cause raised IOP in about 97% of cases of SICS in the post-operative period and also improves the compliance of the patients.

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Abstract #1100: Tumor Induced Osteomalacia: Clinical; Biochemical and Radiological Features from a Single Tertiary Care Centre with Emphasis on Functional Imaging.

Endocrine Practice ◽

10.1016/s1530-891x(20)44225-9 ◽

2017 ◽

Vol 23 ◽

pp. 289

Author(s):

Vineet Surana ◽

Rajesh Khadgawat ◽

Nikhil Tandon ◽

Chandrashekhar Bal ◽

Kandasamy Devasenathipathy

Keyword(s):

Functional Imaging ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Radiological Features

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Emerging Antimicrobial Resistance Among Methicillin Resistant Staphylococcus Aureus (MRSA) in a Tertiary Care Centre in North India

JMS SKIMS ◽

10.33883/jms.v23i1.747 ◽

2020 ◽

Vol 23 (1) ◽

pp. 48-49

Author(s):

Javaid Ahmad Bhat ◽

Shariq Rashid Masoodi

Keyword(s):

Staphylococcus Aureus ◽

Antimicrobial Resistance ◽

Tertiary Care ◽

Resistance Mechanisms ◽

North India ◽

Global Public Health ◽

Care Centre ◽

Tertiary Care Centre ◽

Effective Prevention ◽

Mupirocin Resistance

Apropos to the article by Dr Bali, titled “Mupirocin resistance in clinical isolates of methicillin-sensitive and resistant Staphylococcus aureus in a tertiary care centre of North India” (1), the authors have raised important issue of emerging antimicrobial resistance (AMR). Antimicrobial resistance is an increasingly serious threat to global public health that requires action across all government sectors and society. As per WHO, AMR lurks the effective prevention and management of an ever-increasing spectrum of infections caused by bacteria, parasites, fungi and viruses. Novel resistance mechanisms are emerging and spreading globally, threatening the man’s ability to treat common infectious diseases.

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