A Comparative Study of Diagnostic Performance of CT and MRI for Abdominal Staging of Paediatric Renal Tumours-A Report from Tertiary Care Centre Hospital

Objective: To compare the diagnostic performance of CT and MRI for local staging of pediatric renal tumours. Materials and Methods: The study population was derived from our hospital Medical College Kolkata and Hospital. Baseline abdominal imaging performed with both CT and MRI.A retrospective review was done with 50 renal tumour cases selected and planned for nephrectomy over a study period of one year from October 2020 to November 2021. Each case was evaluated for capsular penetration, lymph node metastasis, tumour thrombus, preoperative tumour rupture, and synchronous contralateral lesions. The surgical and pathological findings were the reference gold standard. Results: The sensitivity of CT and MRI for detecting capsular penetration was 70% and 60%, respectively (P=0.73), while specificity was 84.3% and 84% (P=1.0). The sensitivity of CT and MRI for detecting lymph node metastasis was 80% and 53% (P=0.22), and specificity was 88% and 92% (P=1.0). Synchronous contralateral lesions were identified by CT in 5/12 cases and by MRI in 8/12 cases. Conclusion: CT and MRI have similar diagnostic performance for detection of lymph node metastasis and capsular penetration. MRI was more accurate in detecting contralateral synchronous lesions; how-ever these were observed in a very a smaller number of cases. Hence either modality can be used for initial loco–regional staging of paediatric renal tumours

Efficacy of Tamsulosin as Compared to Placebo, in Reducing Post Operative Flank Pain during Voiding, in Patients with Ureteric Stent

Objective: To evaluate the efficacy of tamsulosin in reducing post operative flank pain during voiding, in patients with ureteric stent. Study Design: This is a Randomized control trial (RCT) study. Place and Duration: Study carried out at Department of Urology, Jinnah Post Graduate Medical Centre, Hospital, Karachi, Pakistan, from June 2016 to November 2016. Methodology: 60 patients aged between 15 – 45years, undergone placement of ureteric stent to treat ureteric and renal calculi and have pain score >4, were included in the study. Divided into two groups ‘group A’ and ‘group B’. In group ‘A’ and group ‘B’ Tamsulosin and Placebo was given respectively in patients with ureteric stent and reduction in post-operative flank pain was measured and compared. Tamsulosin was given post operatively when NPO is broken after 2 hours – 6 hours. Patients having uretral trauma, patients having BPH, patient underwent TURP or TURBT, patent having urinary tract infection and patients with pregnancy or lactating females were excluded. All patients were received intravenous antibiotic (Ceftrixone 1gr). Also all patients were receive oral analgesic (diclofenic sodium 50mg BID) and antispasmodics (Drotaverine 80mg BID). Patients were discharged after 24 hours. Postoperatively stent related flank pain during voiding was assessed via Pain Scale. Results: 60 Patients who got operated for ureteric stent. In group ‘A’ there were 21 males (70%) and 9 females (30%), the mean age of group A was 35.67±5.99 as In group ‘B’ there were of 21 males (70%) and 9 females (30%) and mean age of group B was 35.04±6.42 (Table 1). Mean Pain score in ‘Group A’ (Tamsulosin) in week 1, 2, 3, 4, 5, 6 was 4.1, 3.5, 2.9, 2.3, 1.9, 1.3 respectively as shown in Table 2. Mean Pain score in ‘group B’ (Placebo) in week1, 2, 3, 4, 5, 6 was 6.9, 6.3, 5.9, 5.6, 5, 4.2 respectively as shown in Table 2. Average pain score in ‘group A’ and ‘group B’ came out to be 2.67 and 5.64 respectively (P value 0.005). Conclusion: Alpha blockers reduces the post-operative flank pain and voiding complaints in patients with ureteric stent. Our study shows that the efficacy of Tamsulosin in reducing post-operatice flank pain in patients with uretercic stent is better than placebo.

Histomorphological spectrum of intracranial space occupying lesions: Experience at tertiary care centre

An “Intra-cranial space occupying lesion” (ICSOL) is defined as a mass in the cranial cavity with a diverse etiology like benign or malignant neoplasm, inflammatory or parasitic lesion, haematoma or arterio-venous malformation. The aim was to study the histomorphological spectrum of intracranial space occupying lesions at a tertiary care centre hospital in order to give accurate pretherapeutic diagnosis to facilitate better therapeutic results. This prospective and descriptive type of study of two years duration was carried out from November 2017 to October 2019 in Govt. Medical College and Superspeciality Hospital, Nagpur in the Department of Pathology. A total of 300 samples were received from Department of Neurosurgery. Detailed collection of clinical data was done in all patients regarding age, sex, clinical symptoms and radiological findings.The samples were received in 10% formalin and subjected to routine histopathological processing. Slides prepared were stained with hematoxylin and eosin stain. Special stains were done wherever required. Total 300 cases were studied of which 261 cases (87%) were neoplastic in nature and 39 cases (13%) were non neoplastic. Amongst primary tumours, most common were gliomas (48%) followed by meningiomas (20%) and schwannomas (9%). ICSOLs can present with nonspecific clinical features. Radio diagnostic investigations are helpful adjunct tools but cannot give exact diagnosis. Histopathological examination remains a gold standard for diagnosing and grading of tumours on which basis clinician can decide further line of management.

COMPARISON OF HEURISTIC EVALUATION AND COGNITIVE WALKTHROUGH METHODS IN DOING USABILITY EVALUATION OF MOBILE-BASED DEL EGOV CENTRE HOSPITAL INFORMATION SYSTEM

Usability is a factor that indicates the success of an interactive product or system, such as a mobile application. The increasing use of smartphones demands a more accurate and effective usability evaluation method to find usability problems, so that they can be used for product improvement in the development process. This study compares the Cognitive Walkthrough method with Heuristic Evaluation in evaluating the usability of the SIRS Del eGov Center mobile application. Evaluation with these two methods will be carried out by three evaluators who act as experts. Finding problems and recommending improvements from each method will produce an improvement prototype made in the form of a high-fidelity prototype. Each prototype will be tested against ten participants using the Usability Testing method, which will generate scores through the SUS table. From the test scores, the percentage of Likert scale and the success rate of each prototype will be found. The results show that between the two usability evaluation methods, the Heuristic Evaluation method is the more effective method, finds more usability problems, and has a higher Likert scale percentage, which is 66.5%, while Cognitive Walkthrough is 64.75%.

MRI Evaluation of Patients with Empty Sella - A Retrospective Study K.S. Hegde Medical Academy, Mangalore

BACKGROUND Empty Sella is often an incidental finding in brain imaging studies. However, in the recent past, its association with hormonal and intracranial hypertension has been researched by various authors. The main purpose of the present study was to evaluate the MRI features of patients with empty sella presented for routine MRI brain imaging. METHODS This is a single-centre, hospital-based, observational, and retrospective study. MRI brain of 67 patients with empty sella was retrospectively reviewed from January 2012 to October 2020. All patients had been referred to the Department of Radiodiagnosis with clinical suspicion of intracranial pathology. The various manifestations and their complications were evaluated. RESULTS This present study comprised 39 males (58 %) and 28 females (42 %). The most common age group was 41 - 60 years with a mean age of 49 years. The most common presenting symptom was headache (34 %). In MRI brain study, 93 % of the cases of empty sella was an incidental finding. In 24 % of the patients, empty sella was associated with MRI features of intracranial hypertension and 13 % with idiopathic intracranial hypertension. 62.5 % of the patients with intracranial hypertension had complete empty sella compared to 82 % of the patients with no features of intracranial hypertension and had partial empty sella even though the association was not statistically significant. CONCLUSIONS The significance of the MRI finding of an empty sella turcica can be determined using a combination of clinical and imaging findings. KEY WORDS Empty Sella, MRI, Intracranial Hypertension.

Rondas interprofesionales de heridas antes y después de Best Practice Spotlight Organization (BPSO)

Introducción. El modelo de cuidado a pacientes en el Salvation Army Toronto Grace Health Centre Hospital está basado en los principios de cuidado centrado en el paciente y la familia como parte integral del equipo interprofesional. Dentro de este marco se diseñan y se implementan diferentes programas para que se mejore constantemente y se mantenga un buen nivel de cuidados y calidad de vida de los pacientes, dentro de las limitaciones que conlleva el estar hospitalizado, esto después de convertirse en Best Practice Spotlight. Objetivo. Presentar la experiencia de las rondas interprofesionales de heridas antes y después de Best Practice Spotlight. Síntesis. Antes de ser BPSO los documentos de pólizas y procedimientos que guiaban las prácticas alrededor de úlceras o heridas por presión, en el hospital se utilizaban como referencia las guías basadas en las evidencias de la Asociación de Enfermeras de Ontario (RNAO). Sin embargo, no estaba formalizada la ejecución o aplicación de estas prácticas al punto de cuidado directo al paciente. En este artículo se presenta la transición y los aspectos relevantes para que sea una realidad el cuidado centrado en el paciente y la familia como parte del equipo interprofesional en el componente de las rondas interprofesionales de heridas. Conclusiones. El éxito de la implementación efectiva de las guías ha sido el programa BPSO, que se ha convertido en una identidad colectiva de organizaciones que trabajan en pro de los mejores resultados en las organizaciones de salud en instituciones nacionales e internacionales.

PREVALENCE OF PSEUDOMONAS CAUSING SECONDARY INFECTION IN PULMONARY TUBERCULOSIS PATIENTS

Background: Secondary bacterial infection is one of the most common complications in pulmonary tuberculosis (PTB) patients. Gram negative bacteria were commonly isolated from from adults hospitalized with secondary bacterial infection. So we conducted this study to assess the prevalence of secondary infection caused by Pseudomonas among active pulmonary tuberculosis patients. Materials and Method: It is a single centre hospital based observational study. 115 pulmonary tuberculosis patients aged above 14 years, with suspicion of secondary infection clinically or having complaints of fever, productive cough, chest pain, shortness of breath, and increased sputum purulence, inspite of taking antitubercular therapy or pulmonary tuberculosis patients with high total leucocyte counts were included. Results: Out of 115 samples sent for sputum pyogenic culture, approximately one fth (17.39%) were positive for Pseudomonas. Mean age was 46.69 ± 16.40 years in our study. Conclusion: Pseudomonas species are a major cause of secondary bacterial infection in patients with PTB on treatment.

Cholangiocarcinoma in South India: unprecedented, unanticipated and underreported

Background: The incidence of CCA in India is on the rise especially in Kerala. However, the clinical profile and outcome of these patients has never been reported. The aim of this study was to identify region specific epidemiological trends and natural history of CCA in Kerala.Methods: This was a single centre, hospital based epidemiology study where incident cases of CCA from January 2014 to August 2016 were studied. Patient demographics and relevant clinical and laboratory data, imaging studies and treatment, were recorded in a predesigned Performa.Results: A total of 137 patients (mean age 62.92 ± 12.5 years, M:F=1.2) were studied of which 109 patients had Hilar CCA (pCCA), 16 patients had Distal CCA (dCCA) and 12 patients had Intrahepatic CCA (iCCA). A majority of patients were from coastal areas and rubber plantations. Known risk factors were absent in our patients. Bismuth Type IV disease was seen in 55 patients (50.5%). Most intrahepatic CCA (iCCA) (7/12) patients had stage IV disease at presentation. Curative resection was possible in 17/38 patients (44.7%). Patients who underwent treatment with a curative intent were younger with less advanced disease and therefore, had a significant 3 month, 6 month and 1 year survival advantage (p<0.05). The overall 1-year mortality was 66.1% (91/137). The 30-day post-op mortality was 4.3%.Conclusions: This study highlights a unique epidemiological pattern in our patients characterised by absence of known risk factors and unique geographic clusters. Palliative chemotherapy showed a significant survival benefit in this study which needs further validation.

Experiences of introducing new drugs for drug-resistant TB at the ALERT Hospital, Addis Ababa, Ethiopia, 2017–2019

BACKGROUND: Drug-resistant TB (DR-TB) remains a major public health concern. DR-TB patient data from ALERT (All Africa Leprosy, Tuberculosis and Rehabilitation Training Centre) Hospital, Addis Ababa, Ethiopia, who received bedaquiline (BDQ) and/or delamanid (DLM) containing regimens were analysed.RESULTS: From 2017 to 2019, 51 DR-TB patients were enrolled. Of 33 patients, 31 (93.9%) had culture converted at 6 months. Of those with final outcomes, 77% (n = 10) were cured. Thirty (58.8%) developed adverse events, the most frequent of which were gastrointestinal disorders (70%), haematological disorders (16.7%) and QTc prolongation (16.7%). Twenty patients discontinued the offending drug permanently.CONCLUSION: With close monitoring, introduction of new DR-TB regimens brought good early results, which encouraged wider programmatic implementation in Ethiopia.

The introduction of a paediatric ENT and anaesthesia skills course in Kilimanjaro Christian Medical Centre hospital, (KCMC), Moshi, Tanzania

Human factors and a safe operating theatre environment are of paramount importance, wherever surgery is undertaken. The majority of patients in sub-Saharan Africa do not yet have access to safe surgery. The Paediatric ENT Skills and Airway Course introduced and evaluated here was designed to improve outcomes and safety in a typical East African environment. The lectures, tutorials and practicals covered technical and non-technical skills. Responses from pre- and post-course questionnaires were evaluated as an initial surrogate for effectiveness of this course. The latter showed improvement in all taught skills and found universal recommendation. The course had been established to try to minimise morbidity and mortality after paediatric surgery at our institution, KCMC. We encouraged team co-operation in the care of patients, and recommend other centres consider similar courses building on human factors for safer operating theatre working practices.