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Background/Aims@#Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. @*Methods@#We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. @*Results@#From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p=0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. @*Conclusions@#Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.
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Background: Numerous variations of intramedullary nailing have been evolved over the years for stable fixation and early mobilisation of subtrochanteric fracture, out of which one is proximal femoral nail. Aims and objectives 朩e conducted this study with an objective to evaluate the results of internal fixation of subtrochanteric fractures of the femur with proximal femoral nail � AO type Design.Methods:This was a prospective study carried out at our tertiary care institute on 30 patients who had suffered subtrochanteric fracture and were subsequently treated with a proximal femoral nail (PFN). Proximal femoral nail was inserted through the tip of greater trochanter. All patients were followed up for a period of one year; at an interval of 3 months and during each follow-up visit for the functional outcome by modified Harris Hip Score, was assessed in the form of walking, squatting, sitting and rising from chair.Results:Modified Harris hip score was used for the evaluation of results in our study which showed excellent result in 21 patients (70%), good results in 3 cases(10%), fair results in 3 patient (10%) and poor results in 3 cases(10%). The mean Harris hip score in our study was 90.6.Conclusion:PFN is an intramedullary load sharing implant. Reduction and management of subtrochanteric fractures is challenging in traumatology. Proximal femoral nailing spanning whole femur with proximal and distal locking appears to be a satisfactory implant in management of fractures of subtrochanteric femur.
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Background/Aims@#Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR) for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR for nonpedunculated polyps ≥10 mm. @*Methods@#We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting the outcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first follow-up, en bloc resection, incomplete resection, and adverse events after UEMR. @*Results@#A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval [CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps ≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleeding were 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%. @*Conclusions@#Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm is safe and effective with a low rate of recurrence.
ABSTRACT
Background/Aims@#Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR) for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR for nonpedunculated polyps ≥10 mm. @*Methods@#We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting the outcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first follow-up, en bloc resection, incomplete resection, and adverse events after UEMR. @*Results@#A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval [CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps ≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleeding were 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%. @*Conclusions@#Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm is safe and effective with a low rate of recurrence.
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@#Traumatic myiasis, the invasion of live tissues by fly larvae, is a commonly observed phenomenon in animals like sheep and cattle, but is also witnessed sometimes among humans. It is a parasitic infestation in which the dipteran larvae invade the neglected open wounds and foul smelling body apertures of vertebrate animals thereby using the living or necrotic tissue of their host as a nutritional source. A case of severe human traumatic myiasis is reported from India in the scalp wound of a 3-year-old female patient. The causative larvae were identified as the third instars of Old World Screwworm Fly- Chrysomya bezziana (Diptera: Calliphoridae). The myiasis in the present case was a complication of an open neglected wound. Ignorance played a key role in non-treatment of the patient for a long period of time. The authors emphasize the necessity to raise awareness among the general public about the problem.
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Background: Osteoarthritis is a chronic and debilitating disease. Management of disease is a big challenge. NSAIDS play an important role but have many adverse reactions. So, this study was designed to evaluate the efficacy and safety of natural compound rosehip versus glucosamine and chondroitin sulphate in patients of osteoarthritis.Methods: An open label, randomized, parallel group comparative study, conducted on patients of either sex with confirmed diagnosis of osteoarthritis on standard NSAIDs therapy, attending the outpatient department of orthopedics in a tertiary care centre. 150 patients were enrolled and divided into three groups (group A, group B and group C) of 50 each. Patients of group A were given Glucosamine plus chondroitin sulphate for 12 weeks. Group B was given rosehip for 12 weeks and group C placebo. These supplements were given as add on therapy. Patients were monitored and adverse drug reactions were noted. The data was analysed statistically using t- test for efficacy and descriptive stats for assessing the safety.Results: Efficacy was assessed by comparing mean reduction in the pain intensity between group A and B, group B gives highly significant results as compared to group A. While comparing joint tenderness, swelling around joint, mean functional capacity and improvement in the overall assessment, group B gives significant results as compared to group A. It was also observed that group A and group B were better than group C in all the efficacy parameters. All the drugs were well tolerated and systemically safe.Conclusions: There was significant difference in efficacy of rosehip compared with glaucosamine and chondroitin sulphate in patients of osteoarthritis. In comparison there was no significant difference in safety of two drugs and both were considered safe in patients.
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Introduction: In India hepatitis B virus (HBV) and human immunodeficiency virus (HIV) co-infection is estimated to vary between 2% and 14% in various studies. HIV negatively impacts the disease outcome of hepatitis B and HBV increases hepatic complications in HIV. Objective: To study the prevalence of HBsAg positivity in HIV infected patients attending the anti-retroviral therapy center of Guru Nanak Dev Hospital, Amritsar. Material and methods: This retrospective cross-sectional study involved the collection of the results of hepatitis B virus surface antigen (HBsAg)test of all HIV patients who were registered over a period of one year. The data was tabulated and analyzed statistically. Results: Of the 435 participants 285 (65.52%) were males and 150 (34.48%) were females, the hepatitis B surface antigen positivity rate was 3.68%. Male in the age group of 19 to 40 years and injection drug users were more susceptible. Conclusion:Analyzing this data lead to certain helpful insight that the prevalence of almost 3.68% stresses upon the need for testing for HBsAg in HIV infected patients. For prevention of hepatic complications early treatment should be initiated and those who are negative should be vaccinated.
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Introduction:- Carditis is a group of inflammatory cardiac diseases with the affection of myocardium, i.e. "Myocarditis is inflammation of the myocardium". It is caused by an infection or toxins or autoimmunity or other causes. It is present in all age groups, but more frequent in children of the first years of life with predominance of boys. From data of autopsy, nonrheumatic carditis are found in 3-9% of children, who died from unknown causes. Its manifestations are age dependent. In early infancy- viral myocarditis often occurs as a acute, fulminant disease. In toddlers, young children - it occurs as an acute myopericarditis. In older children, adolescents it is often asymptomatic and comes to clinical attention primarily as a precursor to DCM. Here I present a case of a young boy who presented with dyspnoea of few years duration. He was found to have dilated cardiomyopathy secondary to chronic CMVinfection. He responded to treatment.
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Background: The stress response to laryngoscopy and endotracheal intubation is a commonly encountered physiological phenomenon. Though the response can be transient and harmless in normotensive healthy patients, but it may prove hazardous amongst patient with underlying cardiac disease, or hypertensive disease and its sequelae. Present study was planned to evaluate the efficacy of IV dexmedetomidine infusion and IV lignocaine in attenuating the hemodynamic responses during laryngoscopy and intubation
Methodology: On approval from hospital ethical committee, 120 ASA grade I and II, normotensive patients in the age group of 18-60 years, planned for elective surgery under general anesthesia were enrolled in the study. Patients were divided into 3 equal groups of 40 each; Group A [Lignocaine group] received lignocaine 1.5 mg/kg IV 2 min before induction, Group B [dexmedetomidine group ] received dexmedetomidine 1 micro /kg IV infusion with syringe pump 10 min before induction, and Group C [control group] received normal saline before induction. Heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], oxygen saturation of arterial blood [SpO2] and electrocardiogram [ECG] were monitored at induction, intubation and post intubation at one minute interval till 10th minute
Results: A better control of stress response was observed in patients receiving dexmedetomidine infusion. More decrease in HR was noted in Group B as compared to Group A [9.28 % vs. 13.40%] respectively. The decrease in MAP was also more in Group B as compared to group receiving lignocaine [5.49 % vs. 10.72%] respectively
Conclusion: Dexmedetomidine 1 micro g/kg IV is more effective in blunting stress response to laryngoscopy and endotracheal intubation as compared to lignocaine 1.5 mg/kg IV
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Lidocaine/pharmacology , Administration, Intravenous , Hemodynamics , Laryngoscopy , Intubation, Intratracheal , Double-Blind MethodABSTRACT
Myiasis, the tissue invasion of living vertebrate animals by the fly larvae is commonly observed throughout tropical regions of the world. The phenomenon is also witnessed among humans where unhygienic conditions are prevalent and domestic animals are in their close vicinity. Tissue infestation by fly larvae is well recognized complication of neglected wounds. A rare case of recurrence of human myiasis is reported in the chronic wound of an 18-yearsold male patient suffering from ‘equinovarus’- a congenital feet deformity. The causative maggots were identified as third instar larvae of the Old World Screwworm fly- Chrysomya bezziana. The recurrence of human wound myiasis due to C. bezziana is reported for the first time from India. It is concluded that neglected open wounds and poor hygienic conditions are the critical predisposing risk factors for the recurrence of myiasis.
ABSTRACT
Spinal and epidural blocks are widely used for cesarean section. Spinal hematoma causing cauda equina syndrome is a rare complication after spinal anesthesia [SA], but can lead to severe neurological deficit. It is usually associated with difficult SA and requires surgical decompression in most of the cases
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Psoriasis is often associated with psychological disorders and social discomfort. To compare depression and subcomponents of anxiety among psoriasis patients and controls with other chronic skin disorders. 162 psoriasis patients and 200 patients with other chronic skin disorders in the age group of 14-60 years were selected from Dermatology and Venereology Outpatient Department of Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. The participants responded to IPAT Anxiety scale and Zungs Self-Rating Depression Scale. The data was analyzed statistically. The results of present study clearly revealed that psoriasis patients scored higher on depression and different sub-components of anxiety namely low self control, suspicion, apprehension and tension as compared to the control group. The findings of the present study highlight the higher prevalence of depression and anxiety in the psoriasis patients as compared to patients with other chronic skin diseases; it also shows importance of psychological adjustment in patient with psoriasis. It is recommended that the patients with psoriasis require psychological evaluation and management along with medical treatment