Role of bundled intervention in reducing surgical site infection rate in gynecologic surgeries

Background: Surgical site infection (SSI) is most common nosocomial infection (15%) among surgical patient’s and contributes significantly to morbidity and mortality. CDC (2015) provides “bundled intervention for prevention of SSI. The present study was planned to evaluate the feasibility and usefulness of these bundled intervention in reducing SSI in our setup. Objectives of this study to study the effect of bundled interventions on SSI in gynaecologic surgery.Methods: A total 50 cases  undergoing gynecological surgery in elective OT included in pilot group and bundled intervention followed  these pilot group cases compared with 50 control group operated in same OT in which bundled intervention not followed outcome measures recorded were Incidence of SSI, type of SSI, need for antibiotic usage, need for secondary suturing, duration of hospital stay.Results: Out of 50 subjects in pilot group, five developed signs and symptoms of SSI giving an SSI rate of 10%. Out of those five, two had superficial SSI and three had deep SSI, none of the patient had organ space SSI.SSI rate in 50 cases operated in the same operating room during the same time period without use of bundled interventions (control group) was 12%.Conclusions: Bundled approach is easy and feasible in all setups. It adds only three extra minutes to the total duration of the surgery with risk reduction of SSI.

Assessment of Maternal Consequences of Caesarean Section: A Retrospective Study

Background: Rates of caesarean delivery continue to riseworldwide. Maternal preferences are an important influence ondecisions about mode of delivery. At present, evidence oflonger-term complications of caesarean delivery has not beenadequately synthesized to allow fully informed decisions aboutmode of delivery to be made. Hence; the present study wasundertaken for assessing maternal consequences ofcaesarean section.Materials & Methods: Data record of a total of 130 womenwas enrolled in the present study. These 130 women werebroadly divided into two study groups as follows: Group 1:Primary elective group (n=58), and Group 2: Failed vaginaldelivery (n=72). Complete demographic details of all thesubjects were obtained from the data record files. An excelchart was prepared and outcome and complications wererecorded systematically.Results: Overall, out of 130 females, complications were foundto be present in 18 women (13.85%). However; among patientsof Group 1, complications were found to be present in 5patients (8.62%) while among patients of Group 2,complications were found to be present in 13 patients(18.06%). On comparing statistically, overall prevalence ofcomplications was significantly higher among patients of group2. Uterine corpus was the most common maternal complicationwas found to be present in 2 patients of group 1 and 4 patientsof group 2.Conclusion: Emergency caesarean section is associated withsignificantly higher risk of maternal complications incomparison to elective caesarean procedures.

Evaluation of Clinical Profile of Migraine in Pediatric Patients

Background: Headache is a common chief complaint inpediatric offices and may be a symptom of a host of illnessesfrom viral infection to intracranial neoplasm to migraine. Thepresent study was conducted to assess the profile of migrainein children.Materials & Methods: This study was conducted on 348pediatric patients of both genders. Information such as name,age, gender, type of house, mother’s education, duration ofillness, site of headache, frequency of headache wererecorded. Symptoms such as visual disturbances, vomiting,abdominal pain etc. were recorded.Results: Out of 348 patients, 210 were males while 138 werefemales. Clinical features were nausea/ vomiting seen in 310patients, visual disturbances in 280, vertigo in 302 patients andmore than 1 symptom in 238 patients. The difference wassignificant (P < 0.05).Conclusion: Migraine headache is not uncommon in children.Common clinical features were nausea/ vomiting, visualdisturbances and vertigo.

Syndromic approach to identify cases of vaginal discharge: a cross-sectional study among females of Shaheed Nagar, Bhopal, Madhya Pradesh

Background: Management of Sexually Transmitted Infections (STIs) is important in controlling STIs and to break the chain of infection and transmission.Syndromic case management is a standardized evidence-based approach which utilizes clinical management algorithms and flowcharts that are handy and can be consistently used across health care providers. The objectives of the study were to identify cases of vaginal discharge in Shaheed Nagar, Bhopal and to provide them treatment following syndromic approach.Methods: Prospective cross-sectional study carried out over a period of three months among reproductive age group females (15-45 years) in Shaheed Nagar, Bhopal. Purposive sampling by conducting door- to- door survey until 150 women fulfilling study criteria was interviewed. A pre-designed questionnaire used for data collection. Educational intervention given to all participants. 37 participants identified with vaginal discharge syndrome and were assisted by study team to gynecological OPD for obtaining treatment based on syndromic approach. Data entered in MS Excel 2007 and statistical analysis carried out using epi-info 7.2. Proportions and percentages were calculated. Chi-square was used to find out association between prevalence of vaginal discharge and qualitative variables. P value <0.05 considered statistically significant.Results: Prevalence of vaginal discharge was 24.67%. The most common presenting complaint was general weakness (52%). The most common diagnosis was cervicitis (8.67%) followed by vaginitis (4.67%). Statistically significant correlation was found between presence of disease (STI) and use of intra- uterine device (IUD), non-use of sanitary pads, marital status, occupation and socio- economic class.Conclusions: Abnormal vaginal discharge can both be the cause as well as the effect of pelvic inflammatory disease.

Abdominal Tuberculosis: Clinical-pathological Profile and Role of Surgery in its Management

Background: Abdominal tuberculosis (TB) is an essential clinical element having a varied mode of clinical presentation. Diagnosis of abdominal TB is a troublesome and cautious way to deal with the patients, and strong examination and supportive investigations are important to make the last finding. Objectives of the study were to evaluate the clinic-pathological profile of patients with abdominal TB and the role of surgery in its management in a tertiary care center in northern India. Methods: This is a retrospective study conducted in the department of general surgery and medical college DOTS center of northern India. A total of 97 patients with abdominal TB diagnosed on the basis of clinical profile and supported investigation data were selected for this study. Radiological findings, diagnostic laparoscopy, laparotomy, and histological findings are taken into account. Results: Of the 97 patients, 56 were males and 41 females with age ranging 16–82 (mean 32.3) years. Abdominal pain was the most common presenting symptom in 84 (86.59%). The diagnosis of abdominal TB was confirmed by histopathology in 78 (80.41%). Remaining 19 (19.5%) cases were diagnosed microscopically and with supportive clinical and imaging background. All the patients were treated under DOTS. Conclusions: Early diagnosis is the key factor in avoiding systemic and local complications of intestinal TB. No clinical features, laboratory, radiological or bacteriological, and histopathological findings are gold standard in the diagnosis of abdominal TB. In emergency cases, prompt surgical exploration, anti-TB drugs, and vigilant care are met with good recovery

Maternal and fetal outcome in oligohydramnios- Study of 100 cases.

Background: Decrease in amniotic fluid volume or Oligohydramnios has been correlated with increased risk of intrauterine growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and mortality one side and decreased caesarean deliveries on the other side. Aims & Objective: (1) To study affects Oligohydramnios on fetal outcome in form of (a) Fetal distress (b) Growth retardation (c) NICU admission (2) To study APGAR scores of newborn babies in relation to Oligohydramnios (3) To study incidence of congenital malformation (4) To study early neonatal morbidity and mortality (5) To study maternal morbidity in form of operative delivery and induced labour. Material and Methods: Present study was done over a period from May 2009 to November 2011. 100 patients in third trimester of pregnancy with Oligohydramnios selected randomly after satisfying inclusion and exclusion criteria. A detailed history and examination were done. All required investigation done. Oligohydramnios confirmed by measuring AFI. Results: Mean maternal age-23.66 years. Incidence of oligohydramnios was more in primipara (52%) in our study. And operative morbidity was also more in primipara. Most common cause of Oligohydramnios is idiopathic (52%). Second commonest cause is PIH (25%). Operative morbidity is highest in PIH (60%). Operative morbidity was significantly higher in NST (non-stress test) non-reactive (3.12 ± 75=78.12%) group than NST reactive (26.47%) group. Most common reason to perform caesarean was fetal distress which was either due to cord compression or IUGR. 7% patients were found with fetoplacental insufficiency on Doppler study. Oligohydramnios was related to higher rate of growth retardation and NICU (neonatal intensive care unit) admission. Conclusion: Oligohydramnios is frequent occurrence and demands intensive fetal surveillance and proper antepartum and intrapartum care. Due to intrapartum complication and high rate of perinatal morbidity and mortality, rates of caesarean section are rising, but decision between vaginal delivery and caesarean section should be well balanced so that unnecessary maternal morbidity prevented and other side timely intervention can reduce perinatal morbidity and mortality.

Efficacy of misoprostol administration 24 hours after mifepristone for termination of early pregnancy.

Introduction: Mifepristone and misoprostol are the two drugs which are given at 36-48 h interval for medical abortion. This study was designed to study the efficacy of early administration of misoprostol (24 h after mifepristone) for medical termination of pregnancy less than 9 weeks and to compare this with standard protocol of mifepristone misoprostol combination at 48 h interval. Materials and Methods: Subjects for this single center prospective randomized case-control study were enrolled from the family planning outdoor patient department at our hospital with gestational age of less than 9 weeks. All subjects initially received 200 mg of oral mifepristone and then were randomly assigned to receive per vaginal 400 μg misoprostol at 24 h (study group) and 48 h (control group). They were then followed up after 14 days with transvaginal sonography to confirm completion of expulsion. Treatment was considered failed if surgical evacuation was needed for any indication. Primary outcome measure was success rate of the two treatment regimens. Results: Totally, 200 subjects were randomly allocated to each treatment arm (100 each). Complete expulsion was seen in 94% (94/100) in study group and 95% (95/100) in control group according to intention to treat analysis (P value ns). According to per protocol analysis success rate in study group was 93.6% and 94.3% in control group (P value ns). High failure rate after 7 weeks period of gestation in both the study and control group was found (26.3% and 30.0%; P value ns). Adverse effects were mostly similar in both the groups. Conclusion: Efficacy of mifepristone misoprostol combination at 24 h interval was similar to that at 48 h interval for medical abortion of pregnancy less than 9 weeks without compromising the safety (CTRI No. 2010/091/001422).

Swine flu: An overview.

Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza viruses belonging to family Orthomyxoviridae) that infect the respiratory tract of pigs and result in nasal secretions, a barking-like cough, decreased appetite, and listless behaviour. Oseltamivir (Tamiflu) and zanamivir (Relenza) is the recommended drug both for prophylaxis and treatment. The best treatment for influenza infections in humans is prevention by vaccination.