ABSTRACT
Although the incidence of iatrogenic colonoscopic perforation is low, it can result in severe complications and mortality. This study assessed the incidence and management of colonic perforations during an eight year period at a tertiary medical center in Ahmedabad (Gujarat). Methods: We reviewed all the medical records of patients received colonoscopies from January 2011 to December 2018. We collected the patient’s demographic data, colonoscopic reports, and data regarding the location of perforations, their treatment and outcome. Results: During the 8-year period, out of a total of 4650 colonoscopies, 9 cases (0.19%) involved in colonoscopic perforations (6 men, 3 women). Of the 9 perforations 6 (66%) occurred in the sigmoid colon. Out of 9 perforation 7 (77%) of perforations were treated surgically and two (23%) medically with intestinal rest and intravenous antibiotics. The two patient who were treated medically were having small perforation occurred by biopsy forceps, these people kept nil by mouth for 72 hours and antibiotics were given and watched carefully for any signs of peritonitis. Convincingly these two people did not need surgical intervention. In the group treated surgically, four patients received primary repair with proximal diversion, two received colonic diversion and one patient received resection with anastomosis. No patient of colonic perforation died in our institute. Conclusion: Iatrogenic colonoscopic perforation is a serious but rare complication. Its early recognition and treatment are essential. We found a perforation rate of 0.19%. Some patients with small colonoscopic perforations may be safely treated nonoperatively, while others with large perforation or diffuse peritonitis may require surgery.
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Background: Rabies is a preventable enzootic endemic disease in India, it is a viral disease caused by Lysavirus causing acute inflammation of brain in humans and other warm blooded animals. It is typically transmitted through bites from infected animal. Human rabies deaths are almost entirely preventable through prompt delivery of post-exposure prophylaxis (PEP) to victims of bites by rabid animal. Appropriate knowledge regarding rabies and its prevention among medical students is very important to prevent rabies deaths. The aims and objectives of the study were to assess awareness regarding rabies amongst medical students.Methods: This was a cross sectional study which was conducted in month of April 2018. There were total of 496 students, we could obtain the information from 373 students as the questionnaire was given during a theory class and some of the students were absent. A pretested, structured questionnaire was administered to assess their knowledge about rabies, classification and management of bite wounds, including different vaccination schedules, site and dose. The data was entered using Microsoft excel and statically analysed by Epi Info 7.Results: Almost all (97.32%) students knew that rabies is a fatal disease and 78.02% knew that dog was the primary transmitting animal. Only 41.29% students were aware that head, neck and face to be the danger site of bite. Almost all 98.6% students were aware about washing the wound with soap and water as the primary first aid measure following dog bite whereas 0.27% said suturing as first aid measure.Conclusions: Awareness of medical students regarding cause of rabies and its fatality were good but they had less awareness about the danger sites of animal bite.
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ackground: Post operative nausea and vomiting (PONV) have been considered among most distressing symptoms after surgery under anaesthesia. Different combinations of anti-emetic drugs have been used but no drug has achieved 100% efficacy in reducing PONV after laparoscopic surgery. Therefore, the present study was designed to assess if there is any effect of granisetron and ondansetron with dexamethasone in prevention of PONV after general anaesthesia for laparoscopic cholecystectomy. Methods: The study population was divided into three groups according to introduced combination of drugs. Group I (n=50), group II (n=50) and group III (n=50) were introduced Ondansetron (4mg) & Dexamethasone 8mg, Granisetron (1mg) & Dexamethasone 8mg and Normal saline & Dexamethasone 8mg respectively. VAS scale from 0-10 was used to assess the intensity of pain after operation. PONV scoring system considering 0 as no nausea, 1 as nausea and 3 as vomiting was incorporated in this study. Results: The incidence of PONV (score-1,2,3) are tabulated at intervals of 6 hours and complete response was noted in all three groups. There was no statistical difference observed between group I and II in first 24 hours but significant difference was observed between group I, group II and control group III. Complete response score 96%, 98% and 56% respectively for group I, group II and group III correspondingly after at 6 to 12 hours. Conclusion: Findings of the present study suggest that PONV was significantly decreased in group I ondansetron & dexamethasone and group II of granisetron & dexamethasone. Therefore, we strongly suggest that combination of dexamethasone either with ondansetron or granisetron are equally effective in decreasing incidence of PONV in laparoscopic cholecystectomy patients as prophylaxis.
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Pyoderma gangrenosum – a rare, neutrophilicdermatosis – is associated with diseases, including inflammatory bowel disease, arthritis and haematologic disease. It is a condition of unknown etiology. It is the result of an exaggerated response to specific and non-specific stimuli. First-line treatment is with a steroid, usually prednisone. Here we report a case of 60-year-old female presented to us with Pyoderma gangrenosum.
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Salmonella typhi is a rare cause of liver abscess. Numerous extra-intestinal complications can occur with S.typhi infection, including the involvement of the cardiovascular system, pulmonary system, bone and joints, hepatobiliary system, genitourinary system etc. We describe a 65-year-old diabetic male with liver abscesses due to S. typhi. Ultrasonography revealed the rounded 8x4 cm lesion in the right lobe of liver with low echogenicity. Gram stain, abscess culture (with sensitivity testing) and blood culture provide valuable information to guide successful therapy. The patient did not respond appropriately to amebicidal therapy and culture of the liver aspirate yielded S. typhi. Percutaneous aspiration combined with appropriate antibiotic therapy resulted in a complete recovery. In the present case, we did not have definite evidence such as positive stool culture; however, we thought that gastrointestinal focus would be most likely.
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Gutka or Gutkha is a partial grinded mixture of areca nut (beetle nut or supari), smokeless tobacco, catechu, paraffin and sweet smelling chemicals in limewater. It is popular and mainly manufactured in India and exported to some other countries like Bangladesh, Pakistan, Nepal etc and is used as a mild stimulant and highly addictive. It is consumed like smokeless or chewing tobacco and causes several health hazards. It is a leading cause of oral cancer born deaths in India. It is continuously selling in some parts of India by shopkeepers without any care of imposing a ban for a high profit on the other hand clever manufacturers provide Gutka stuff.
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Cubosome dispersions are thermodinamically stable, bioadhesive and biocompatible.Because of their properties, cubosome are versatile systems, administrable by different ways such as orally, percutaneously and parenterally. The discovery of cubosomes is a unique story and spans the fields of food science, differential geometry, biological membranes, and digestive processes. Despite the early realization of their potential, the manufacture of cubosomes on a large scale embodied difficulty because of their complex phase behaviour and viscous properties. Contributions to cubosome research have come from the fields of biology, material science, medicine, and mathematics and much is known about their formation and properties. At the center of much of the discovery and innovation is the technique of cryo-transmission electron microscopy. Another cubosome advantage is related to the simple production procedure and the chemico-physical stability. With respect to liposome, cubosome possesses a larger ratio between the bilayer area and the particle volume and a larger breaking resistance. Cubosome structure by means of electron microscopy, “light scattering”, x-ray and “NMR”, nevertheless few researchers have been studying the potential of cubosome as “delivery systems”.
ABSTRACT
Peripheral giant cell granuloma (PGCG) is a non-neoplastic lesion representing a local hyperplastic reaction. It is a tumorlike pathologic condition arising on the buccal or lingual attached gingival or alveolar mucosa and the crest of the edentulous alveolar ridge, of uncertain etiology; it is probably a reactive lesion caused by chronic local irritants or trauma rather than a true neoplasm. PGCG is thought to originate from elements of the periodontal ligament or from the periosteum. Clinically, it appears as a sessile or broadly pedunculated, bluish to purple-red, fleshy or firm swelling with a frequently ulcerated surface. It may be difficult to distinguish PGCG from pyogenic granuloma and peripheral odontogenic tumors. The clinical appearance of all these lesions is similar, the definitive diagnosis with histological examination is mandatory. Treatment of choice is surgical excision with total removal of the base of the lesion This case aims to present a case of PGCG in 11 year old girl in which surgical resection of the lesion was done to restore functions and esthetics.