DAY-CARE VERSUS ROUTINE LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy has been performed as a day-care procedure for many years. Few studies have been conducted with primary focus on patient acceptance and preferences in terms of quality of life for this practice compared with overnight stay. Data from 100 patients with symptomatic gallstones randomized to laparoscopic cholecystectomy performed either as a day-care procedure or with routine were analyzed. Complications, admissions, and readmissions were assessed. Forty-eight (92 per cent) of 52 patients in day-care group were discharged 4– 8 h after the operation. Forty-two (88 per cent) of 48 in the overnight group went home on routine basis after surgery. The overall conversion rate was 2 per cent. Two patients had complications after surgery, both in the day-care group. No patient in either group was readmitted. There was no signicant difference in total quality of life score between the two groups.

Indwelling Pleural Catheters

Indwelling pleural catheters (IPC) are now being considered worldwide for patients with recurrent pleural effusions. It is commonly used for patients with malignant pleural effusions (MPE) and can be performed as outpatient based day care procedure. In malignant pleural effusions, indwelling catheters are particularly useful in patients with trapped lung or failed pleurodesis. Patients and care givers are advised to drain at least 3 times a week or in presence of symptoms i.e. dyspnoea. Normal drainage timing may lasts for 15–20 min which subsequently improves their symptoms and quality of life. Complications which are directly related to IPC insertion are extremely rare. IPC’s are being recently used even for benign effusions in case hepatic hydrothorax and in patients with CKD related pleural effusions. Removal of IPC is often not required in most of the patients. It can be performed safely as a day care procedure with consistently lower rates of complications, reduced inpatient stay. They are relatively easy to insert, manage and remove, and provide the ability to empower patients in both the decisions regarding their treatment and the management of their disease itself.

Intralesional 3% sodium tetradecyl sulphate versus hot water in oral cavity hemangioma: a comparative study

<p class="abstract"><strong>Background:</strong> Oral cavity lesions fall among the few most common presentations in the outpatient department of ENT. Hemangioma in oral cavity though do not usually account for any life threatening or serious condition but hampers day to day activities like chewing, speaking and occasionally bleeding from oral cavity. Timely diagnosis and treatment solves the above problem. Though there are various modalities of treatment ranging from cryosurgery to surgical ablation, sclerotherapy is an evolving, effective and easy method for reduction of the size of lesion and preventing recurrence. It can be done as a day care procedure. The aim was to compare between the efficacy of 3% sodium tetradecyl sulphate and hot water in oral cavity hemangiomas.</p><p class="abstract"><strong>Methods:</strong> A total of 20 patients presenting to the OPD, department of ENT, VIMSAR, Burla, with diagnosis of hemangioma in oral cavity between January 2018 to January 2019 were selected for the study. They were divided into two groups. Group A was administered 3% sodium tetradecyl sulphate whereas group B was administered hot water, both intralesionally, at multiple sites of lesion. Injection were repeated after an interval of 2 weeks for a period of 3-4 months. The results were routinely analysed clinically and statistically and the statistical significance was set at p&lt;0.05.</p><p class="abstract"><strong>Results:</strong> There was a significant improvement (p&lt;0.05) in most of the parameters measured, in group A patients as compared to group B patients.</p><p class="abstract"><strong>Conclusions:</strong> 3% sodium tetradecyl sulphate is a better sclerosing agent than hot water in cases of oral cavity hemangiomas.</p>

Surgical management of gynaecomastia by using cross chest liposuction and limited periareolar incision for gland excision: an interesting case report

Gynaecomastia is excessive or abnormal enlargement of male breast tissue. It is one of a common problem among young men. The term gynaecomastia means female like enlargement of male breast due to increase ductal tissue, stroma or fat. Most common cause of gynaecomastia is idiopathic. Surgical treatment of gynaecomastia involves liposuction and glandular excision and in few cases skin excision. Here author presents a case of 24 years old young healthy male with Simon’s grade 2B bilateral gynaecomastia. He had stubborn fat over bilateral chest which was resistant to exercise. Gynaecomastia was mixed type in characteristic having adipose tissue as well as glandular tissue enlargement. Bilateral liposuction and glandular excision by limited periareolar incision under general anesthesia as a day care procedure was done. In our procedure we used Cross chest liposuction. Patient was discharged at the same evening without any complications. After four months of follow up patient has male pattern chest with almost invisible scar and intact Nipple areolar complex (NAC) sensation.

Coblation tonsillectomy: our experience as a day care procedure

<p class="abstract"><strong>Background: </strong>A prospective study to cite our experience in adult and pediatric patients undergoing coblation tonsillectomy. We emphasised on the intra operative and post operative morbidity in coblation tonsillectomy and its feasibility as a day care procedure.</p><p class="abstract"><strong>Methods: </strong>It is a prospective study done on both paediatric and adult cases presenting to our tertiary care centre between January 2018 to February 2020. Study was done to analyse operating time, intraoperative blood loss, post-operative pain, post-operative haemorrhage and post-operative return to home and normal diet.</p><p class="abstract"><strong>Results: </strong>114 cases were selected where bilateral tonsillectomy was performed using Coblation technique. 83 were adult patients and 31 paediatric. 56 were females and 58 males. 1 case presented with secondary haemorrhage, none with primary haemorrhage. No other complications were noted.</p><p class="abstract"><strong>Conclusions: </strong>Coblation tonsillectomy yielded good results in reference to patient morbidity and low complication rate. It turned out to be a success as a day care procedure. Short operating time, minimal blood loss, less post-operative pain specially in the early post-operative period, minimal chance of complication and short stay at hospital as a day care surgery, Coblation tonsillectomy stood out as a hands down winner in our study. In this fast paced life, where consumerism demands everything instant, coblation tonsillectomy as a day care procedure provides good alternative to the patient requiring tonsillectomy. yroidectomies.</p>

Current forecast of COVID-19: a Bayesian and Machine Learning approaches

We address the estimation of the effective reproductive number Rt based on serological data using Bayesian inference. We also explore the Bayesian learning paradigm to estimate Rt. We calculate Rt for the top five most affected principal regions of Mexico. We present a forecast of the spread of coronavirus in Mexico based on a contact tracing model using Bayesian inference inspired in a data-driven approach. We investigate the health profile of individuals diagnosed with coronavirus in order to predict their type of patient care (inpatient or outpatient) and survival. Specifically, we analyze the comorbidity associated with coronavirus using Machine Learning. We implemented two classifiers, the first one, to predict the type of care procedure a diagnosed person with coronavirus presenting chronic diseases will obtain: outpatient or hospitalized. Second one, a classifier for the survival of the patient: survived or deceased. We present two techniques to deal with these kinds of unbalanced dataset related with outpatient/hospitalized and survived/deceased cases, occurring in general for these type coronavirus datasets in the world, in order obtain to a better performance for the classification.

Uterine Anomalies in Infertility - An Evaluation by Diagnostic Hysterolaparoscopy

BACKGROUND About 10 - 15 % of reproductive age couples are affected by infertility.1 According to WHO 60 - 80 million couples currently suffer from infertility.2 Prevalence of infertility is rapidly increasing globally.3 Uterine factors of infertility include uterine anomalies, fibroid uterus, synechiae, Asherman’s syndrome, and failure of implantation without any known primary causes. Congenital uterine malformations are seen in 10 % cases of infertile women. We wanted to evaluate the anomalies of uterus in case of primary and secondary infertility by DHL (diagnostic hysterolaperoscopy). METHODS This is a hospital-based, observational study, conducted in the Department of Obstetrics and Gynaecology, VIMSAR, Burla, from November 2017 to October 2019. Diagnostic hysterolaparoscopy was done in 100 infertility cases. RESULTS In our study, uterine anomaly i.e. septate uterus was the most common hysteroscopic abnormaly found in 23 cases followed by submucous fibroid, polyp, synechiae and bicornuate uterus. CONCLUSIONS With proper selection of cases, and when done by skilled surgeon, can be considered as standard day care procedure for female infertility evaluation. KEYWORDS Infertility, Uterine Anomalies, Diagnostic Hysterolaparoscopy

Efficacy of Simple Eye Ointment, Polyethylene Cover, and Eyelid Taping in Prevention of Ocular Surface Disorders in Critically Ill Patients: A Randomized Clinical Trial

Background. Under normal conditions, the cornea of the eye is protected from bacterial invasion, physical injury, and drying by the presence of tears, eyelids, and blinking reflex. However, patients admitted to the intensive care unit (ICU) for several reasons including loss of consciousness, receiving sedative and neuromuscular blocking agents, and mechanical ventilation may lose eye-protective mechanisms causing exposure keratopathy. Therefore, this study intended to compare three eye care methods to prevent ocular surface disorders (OSDs) in ICU patients. Methods. This study was a double-blind clinical trial (IRCT: 201109225426N3, https://www.irct.ir/trial/5825), in which 152 patients were randomized into three groups and each group underwent a different eye care procedure. The eye care methods included simple eye ointment, polyethylene cover, and eyelid taping. The eligible patients received the care procedure for seven days, and their corneas were examined daily for OSD by a portable slit lamp with fluorescein staining. Descriptive and analytical tests (ANOVA, chi-square, logistic regression, and zero-inflated Poisson regression) were used for statistical analysis by STATA14. Results. The odds of OSD (chances of getting an OSD grade between I and VI) in the ointment group were 0.19 (95% CI: 0.09, 0.41), and the odds of OSD in the polyethylene cover group were 0.06 (95% CI: 0.01, 0.20), showing a significant difference with the tape group (p=0.0001). Despite the lower odds of OSD in the cover group than in the ointment group, there was no significant between-group difference (p=0.08). However, the mean OSD scores in both the ointment and polyethylene cover groups were significantly lower than that in the tape group. Conclusion. The results of this study showed that polyethylene cover followed by simple eye ointment and eyelid taping were the most effective methods in preventing OSD. Therefore, polyethylene cover and simple eye ointment are recommended as effective eye care methods in ICU.