Urethral mobilization and advancement technique in distal types of hypospadias: short-term local experience

Background A prospective study was conducted on 65 cases with distal hypospadias operated using the urethral mobilization technique between July 2017 and December 2019. Patients with proximal hypospadias and those with distal hypospadias, but with a hypoplastic urethra, were excluded from the study. In this technique, the urethral tube was mobilized proximally in a ratio of 3–4:1 (the ratio of mobilized urethral length to the initial distance between the native meatus and the tip of the glans) then positioned distally after creating wide glans wings. The aim of this study was to assess the outcome of the urethral mobilization technique in distal hypospadias in our center. Results The age of patients was ranged 9 months to 7 years old (mean 37.5 months); 17 (26%) cases were already circumcised. During the postoperative follow-up, 62 (95.4%) patients had a good caliber neomeatus with a good and straight urinary stream; the remaining 3 (4.6%) cases developed meatal stenosis which responded well to urethral dilatation. One (1.5%) patient had a minor retraction of neomeatus but remained within the glans and not requiring further intervention. Four (6%) cases developed minor hematoma which was resolved on conservative measures. Six (9.2%) patients developed minor wound infection which was treated with daily dressing and antibiotic coverage. Conclusion The urethral mobilization technique is a good choice for repairing distal hypospadias especially for boys who are previously circumcised as the preputial flap is not required in this technique. It provides good cosmetic and functional results, with a fewer complication rate.

Febrile morbidity post laparoscopic myomectomy for symptomatic large submucous myoma in an adolescent girl

The occurrence of post-operative fever after myomectomy without an apparent infectious cause has been reported in various studies. We here in report a case of an 18-year girl with abnormal uterine bleeding and severe anemia resulting from a large 5 cm submucosal fibroid. She underwent laparoscopic myomectomy. Surgery was uneventful. Post-operative she had fever of 100.4°F which lasted for 48 hours. Antibiotic coverage was continued for 48 hours. Her urine culture and hemogram were negative for infection. Early postoperative fever is most commonly caused by inflammatory changes rather than infectious causes. Large submucous fibroids can be managed by laparoscopy with excellent clinical outcomes and minimal morbidity.

An observational prospective study of microbiological profiling in necrotizing fasciitis patients at tertiary care centre

Background: Necrotizing fasciitis (NF) is described as the most aggressive form of skin and soft tissue infections. NF requires prompt diagnosis and urgent surgical procedure along with appropriate antibiotic coverage. Still NF has high morbidity and mortality. The aim of the study was to provide microbiological profile in necrotizing fasciitis patients and discover the appropriate antibiotics regimen to treat them early and appropriately.Methods: This observational prospective study was done of patients of necrotizing fasciitis between June 2016 to June 2018 in the department of plastic surgery in the central area of India.Results: In this study monomicrobial culture was positive in 66.7%, polymicrobial culture was positive 16.7% and no organism was found in 16.7% of patients. In our study most commonly, used antibiotic was colistine followed by tigecycline.Conclusions: Microbiological profiling and early use of sensitive antibiotic is a key to treat the necrotizing fasciitis. It renders the progression of disease and decreases the morbidity and mortality in necrotizing fasciitis.

Listeriosis in infants: Prospective surveillance studies in Canada and Switzerland

Objectives International data on listeriosis during infancy from large populations are essential to guide evidence-based empiric antibiotic guidelines for sepsis in infancy. We aimed to determine the incidence, clinical manifestations, and outcome of listeriosis in infants <6 months of age in Canada and Switzerland. Methods Prospective, active surveillance of listeriosis in infants <6 months of age was conducted through the Canadian Paediatric Surveillance Program (May 2015 to April 2017) and the Swiss Paediatric Surveillance Unit (April 2017 to March 2018). Confirmed and probable cases were included. Results In Canada, eight sporadic listeriosis cases were reported (incidence, 1.1/100,000 live births/year). In Switzerland, four cases were reported (incidence, 4.5/100,000 live births/year) of which three were part of a confirmed outbreak with an unclear source. In the two countries, eight of the 12 cases (66.6%) presented as early-onset disease (within the first 7 days of life) and none presented after 28 days life. Conclusions Neonatal listeriosis is rare. Infants presenting with sepsis, especially after 4 weeks of life, may not routinely require empiric antibiotic coverage for listeriosis. Outbreak-related cases still occur. Continued surveillance is important.

Early versus Delayed Laparoscopic Cholecystectomy in Acute Calculus Cholecystitis in Southern Odisha - A Prospective Comparative Study

BACKGROUND Acute cholecystitis is a pathology of inflammatory origin, usually associated with cholelithiasis, with a high incidence in the world. Its treatment involves an important socioeconomic impact. There are two surgical therapeutic options: early laparoscopic cholecystectomy (ELC) done within 72 hours of onset of pain or delayed laparoscopic cholecystectomy (DLC) done after 6 weeks of conservative treatment. The present study intends to compare between the effectiveness of ELC vs DLC in the management of acute cholecystitis in a tertiary care setup. METHODS The study sample included 65 patients who were clearly documented and radiologically proven cases of acute calculous cholecystitis, met the inclusion criteria, admitted to the surgery department of MKCG MCH, Berhampur, between August 2018 and July 2020. Out of 65 patients, 33 and 32 patients were selected randomly for ELC and DLC respectively. In ELC group surgery was done within 72 hours of the onset of pain while in DLC group surgery was done after 6 weeks of initial conservative treatment. The study was conducted using a case record proforma, prepared in their local language. The questionnaire included timing of cholecystectomy, duration of antibiotic coverage, mean duration of hospital stay, number of intraoperative and postoperative complications, conversion to open cholecystectomy, and follow-up. The data was compiled and tabulated in MS ® Excel and statistically analysed using IBM ® SPSS 22.0. RESULTS The overall morbidity and mortality were less in ELC compared to DLC. The mean duration of surgery was less in ELC (47.36 minutes) compared to DLC (65.75 minutes). The mean duration of antibiotic coverage was lesser in ELC (3.58 days) compared to DLC (5.50 days).The mean hospital stay was less in ELC (4.67 days) to DLC (6.50 days). The overall morbidity and mortality were less in ELC. CONCLUSIONS ELC is considered to be a safe modality of treatment in patients with acute cholecystitis and leads to an economical treatment. KEYWORDS Acute Calculus Cholecystitis, Early Laparoscopic Cholecystectomy, Delayed Laparoscopic Cholecystectomy

A Retrospective, Facility Based, Analytical Study of Burn Injury, and Correlation of Various Factors with Outcome in a Tertiary Care Hospital of Kashmir

BACKGROUND The skin is the largest organ of our body with a complex function. Burn injuries result in damage to the skin by electrical, chemical, thermal or radiation energies or a combination of them, by far the most common being the thermal injuries. However, most burn injuries are preventable and hence need preventive strategies. Outcome is dependent on various factors. The focus of this study is to provide an overview of various factors and clinical presentation of burn injury and their correlation of these various factors with outcome of burn injury. METHODS A retrospective facility-based document review analytical study was conducted on 215 patients admitted in the emergency (burn ward) department of Government Medical College and Hospital, Srinagar, Kashmir from September 2019 to September 2020. RESULTS In our study, out of total 215 hospitalized burn patients, 101 (47 %) were female and 114 (53 %) were males. In 103 (47.9 %) patients, burn injury was caused by scald burn, kangri burn was present in 3 (1.4 %) patients; 207 (96.3 %) patients had accidental burns and 8 (3.7 %) patients had suicidal burn injuries; 181 (84.2 %) had received good pre-hospital intervention; 165 (76.7 %) patients were discharged without complications. Various parameters – degree of burn, cause of burn, nature of burn, nutritional status and antibiotic coverage show statistical significance with P-value < 0.05. CONCLUSIONS Kashmir is a valley surrounded by mountains, has cold weather for about threequarters of year. People here are more prone to burn injuries especially thermal injuries. Outcome of burn injuries is better for lesser degree of burns and mortality increases with severe degree of burns. Patients without complications, patients with good nutritional status at presentation and patients with proper antibiotic coverage had good outcome. KEYWORDS Burn Injury, Kangri, Outcome of Burn

EFFECT OF EMPIRICAL ANTIBIOTIC THERAPY ON THE CLINICAL OUTCOME OF ACUTE CALCULOUS CHOLECYSTITIS

INTRODUCTION Acute calculous cholecystitis (ACC) is the second surgical cause of emergency consultation in the Western world. According to the Tokyo International Guidelines 2018 (TIG18), the treatment of choice is laparoscopic cholecystectomy in patients with mild or moderate cholecystitis. However, in severe cases there is a great variability of therapeutic options. We analyzed the adequacy of antibiotic therapy by studying intraoperative cultures (bile and peritoneal fluid) and preoperative blood cultures, to identify the effect of this antibiotic therapy on complication and mortality rates. MATERIAL AND METHODS A retrospective unicentric study on a prospective database of 725 ACCs between 2012 and 2016. More than 200 general, clinical, postoperative and microbiological variables are collected, including the antibiogram of the isolated germs in order to determine the adequacy of each administered antibiotic. RESULTS Cultures were performed in 76.1% of the cases, with a greater tendency to cultivate in older patients, men or with greater severity according to TIG18 (p &lt; 0.001). Cultured patients had a higher rate of postoperative complications (p = 0.001). Patients who received adequate empirical antibiotic therapy had a lower rate of complications (50% vs 64%;p=0.037) and lower mortality (2.8% vs 11.8%;p=0.003) compared to patients with resistant germs to the antibiotic therapy given, especially important in severe ACC (3.7% vs 15.7%;p=0.022). CONCLUSIONS Adequate empirical antibiotic therapy is associated with fewer complications, as well as a lower mortality rate, especially in severe ACCs. Patients with severe ACC will probably require empirical broad-spectrum antibiotic coverage.