Quality of Life and Coping Strategies among Parents of Children Admitted in Thalassemia Ward

Background: Thalassemia is a hereditary disease of defective hemoglobin synthesis. Thalassemia results from an anomaly of genes involved in the production of hemoglobin. Every year approximately 10,000 children are born with thalassemia in India. Parents of thalassemic children feel depressed, frustrated, and helpless and have numerous emotional, psychosocial, and financial sufferings. Methods: Parent's quality of life was evaluated by a standardized WHOQOL Bref scale and coping status was assessed using the coping health inventory scale (CHIP), a sample of 100 parents of thalassemic children admitted to thalassemia ward at HSK hospital, Bagalkot was selected using purposive sampling technique, descriptive survey design was adopted. Statistical data were tested and scrutinized using descriptive and inferential analysis. Results: Total 70% of parents experienced moderate QOL, 9% had good and 21% parents had poor QOL. The mean percentage of QOL of parents was 48.11% with a mean and SD was 63�. Most of the parents had moderate (88%), 08% had good and 4% of parents� level of coping status was low. No association was found between QOL scores with study variables. A significant association was found among coping strategies with the type of family (?2=8.66, p<0.05), previous knowledge regarding thalassemia (?2= 4.912, p<0.05), relationship with the thalassemic child (?2=6.37, p<0.05). A positive correlation (r= 0.0829 p<0.05) was found between QOL and coping strategies. Conclusion: Most parents had moderate QOL and coping strategies. This study is effective to identify the QOL and coping status of parents having a child with thalassemia.

Blunt abdominal trauma: the experience in rural India and review of literature

Background: Blunt Abdominal trauma is one of the most common injuries caused due to road traffic accidents. The rapid increase in number of motor vehicles and its aftermath has caused rapid increase in number of victims due to blunt abdominal trauma. As the care of patients with blunt abdominal injuries is largely a surgical responsibility and abdominal injuries involving major hemorrhage from solid viscera constitute surgical emergencies. Abdominal blunt traumas represent a real diagnostic and therapeutic challenge to even a most experienced surgeon, thereby representing importance of its study. Early diagnosis and effective management help in decreasing mortality in blunt abdominal trauma.Methods: Prospective study of 50 patients admitted to the institute with history of Blunt Abdominal Trauma. After initial resuscitation of the patients, thorough assessments for injuries were carried out in all the patients. Documentation of patients, which included identification, history, clinical findings, diagnostic test, operative findings, operative procedures and complications during the stay in the hospital were all recorded on a Performa specially prepared. The management was decided depending upon history, clinical examination and investigations.Results: Males were predominantly affected, and most cases were between the age group of 21-40 years (76%). Majority of the patients (90%) presented with the complaint of abdominal pain followed by abdominal distension (56%). 36(60%) patients were managed conservatively while operative interventions were required in 24(40%) patients. The common surgeries performed in the patients included splenectomy, primary closure of perforation and resection and anastomosis of bowel. Majority of the patients (80%) were discharged within 20 days of admission. The mortality in present study was 13.3%.Conclusions: Blunt Abdominal Trauma is one of the important causes of morbidity and mortality in young adults. Immediate resuscitative measures, management of associated injuries and appropriate operative intervention are important parts of management of such cases.

Study of adverse drug reactions in a tertiary care hospital

Background: The objectives of the study were to evaluate incidence and preventability of adverse drug events (ADEs) and potential ADEs and to analyse preventable events to develop prevention strategies.Methods: The study was retrospective observational study conducted at a rural tertiary care hospital at Maharashtra, for 12 months. Patients of both gender and all age group were included in the study. These entire adverse drug reactions were reported either by the PVPI assistance and/or hospital staff and their severity and causality assessments was performed as per Naranjo’s and Hartwig’s assessment criteria respectively. Data was analyzed by using Microsoft Excel.Results: There were total 256 ADR (adverse drug reactions) were reported in 12 months from January 2018 to December 2018 in various departments of the study center. Most of the adverse drug reactions were reported among age group of 21–40 years patients. Rash and itching (69) were most commonly reported ADR’s. ART (31.25%), antibiotics (28.90%) were reported to induce maximum number of ADRs. Most of the adverse drug reactions were possible (194, 75.78%) and mild (208, 81.25%) in nature.Conclusions: The antibiotics, ART drugs were most common drugs to reported ADRs. The commonly reported reactions were rash and itching.

Dorsal onlay buccal mucosal graft urethroplasty in inflammatory stricture of urethra – Our experience

Urethral stricture is a common disease with changing etiology and changing practices in management. Management options were grossly determined by cause, site, length of stricture and also by other factors like prior attempts of repair and local genital skin condition. Treatment options vary from dilatation, optical urethrotomy to various types of urethroplasty. Substitution urtethroplasty is done using various types of graft materials like skin, buccal mucosa, bladder mucosa or colonic mucosa. Over the past 10-15 years buccal mucosa grafts have been increasingly used in the urethral reconstruction. Barbagli technique (Dorsal onlay technique) has the advantages of no sacculation which is seen with ventral onlay grafts, good neovascularity and less shrinkage (10%) rate. We have presented the results and complications of doral onlay buccal mucosa graft urethroplasty (Barbagli technique) in 20 cases performed over a period of 30 months in our institution. Our study showed a success rate of 80% at the end of 2yrs follow up, comparable with other studies, with a restructure rate of 20%. None of our patients developed urethrocutaneous fistula and urethral diverticulum.

Our experience with ileocystoplasty for augmentation of tuberculous bladders

Augmentation cystoplasty has traditionally been used in the treatment of low capacity, poorly compliant or contracted bladders. Various bowel segments can be used for augmentation with its own advantages and disadvantages like ileum, sigmoid, cecum, ileo cecal, stomach etc. The surgical technique involves detubularisation and reconfiguration of bowel to create a patch. A successful clinical outcome depends on creating a large capacity, low pressure reservoir to store urine. Present study was retrospective study conducted from November 2010 to March 2014 on 7 patients (5 men, 2 women with mean age 32 years). Early complications: wound infection in 3 cases, wound dehiscence in 2 cases, urinary leakage in 1 case. Late complications: recurrent UTI in 2 cases, increased mucus production in one case, bladder stone formation in one case. All were grade I to III according to Clavien- Dindo classification. No major (grade IV or V) complications. As in our experience ileocystoplasty for augmentation of tuberculous bladder is a safe and effective procedure.

A simple technique to fabricate a surgical obturator restoring the defect in original anatomical form

Oral cancer treatment involves the surgical removal of all or part of the maxilla, leaving the patient with a defect that compromises the integrity and function of the oral cavity. The postoperative restoration of esthetics, deglutition, and speech shortens recovery time in the hospital and expedites the patient's return to the community as a functioning member. The surgical obturator is the proven treatment option in such situations. This article describes a simple technique to fabricate a surgical obturator that restores patient's original dentition and facial and palatal tissue form. The obturator fabricated with this technique utilizes the vacuum formed index of patient's original tissue form and duplicated partly in heat and partly in auto polymerizing acrylic resin. Duplication of the original tissue form helps patient to minimize the immense physiological trauma immediately after the surgical resection. The obturator fabricated with this technique supports soft tissues after surgery and minimizes scar contracture and disfigurement, and thus may have a positive effect on the patients' psychology.

Blood lactate levels during cardiopulmonary bypass for valvular heart surgery.

Cardiopulmonary bypass (CPB) is widely used to maintain systemic perfusion and oxygenation during open-heart surgery. Tissue hypoperfusion with resultant lactic acidosis during CPB, may occur during hypothermia, extreme haemodilution, low flow CPB, and excessive neurohormonal activation. There has been no documentation of the correlation between blood lactate level elevations in the perioperative period, and its relation to preoperative New York Heart Association (NYHA) classification and the use of ionotropic support during weaning from CPB, duration of postoperative ventilatory support and perioperative mortality. We studied the perioperative blood lactate levels in 82 patients undergoing valvular heart surgery. Arterial blood samples were collected at different stages of CPB. The observed mean baseline lactate levels were 1.9+/-0.8 mmol/L (normal range of 0.9 to 1.7 mmol/L). The mean circulating lactate levels at 15 min and 45 min after institution of CPB increased to 7.01+/-2.6 mmol/L and 9.92+/-3.5 mmol/L. A progressive decline in the mean lactate level, was seen during rewarming (at 35 degrees C), immediately off-bypass, 24 hours and 48 hours postoperatively with mean lactate levels being 7.01+/-3.2 mmol/L, 4.75+/-1.01 mmol/L, 3.06+/-1.1 mmol/L, and 2.10+/-1.05 mmol/L respectively. Comparison of mean lactate levels in NYHA class I, II, III, and IV patients showed that in the intraoperative period and immediately after CPB, the elevation in lactate levels were statistically significant (p< 0.001) in patients in NYHA Class IV. However the values, in all classes, were similar at 24 and 48 hours after CPB. Also, patients with lactate levels >4 mmol/ L required prolonged inotropic and ventilatory support.