ABSTRACT
Background: Laparoscopic cholecystectomy is often associated with intra operative difficulties leading to increased intra and post-operative morbidity. Accurate prediction of a difficult laparoscopic cholecystectomy can reduce the complication rate, rate of conversion and overall medical cost. This study was an attempt to validate a scoring system developed to predict difficult laparoscopic cholecystectomy.Methods: 100 patients undergoing laparoscopic cholecystectomy were included. Details such as age, sex, BMI, previous surgical history, history of hospitalisation for biliary disease, sonographical wall thickness, pericholecystic collection and presence of impacted stone were noted. With these, pre-operative score was calculated using the scoring system. Intra operative details and complications were noted and were classified as easy, difficult and very difficult. Student t test and chi square test was used to test the difference of significance (p<0.05).Results: Male sex, higher BMI, a history of previous surgery, a history of prior hospitalisation for biliary disease, a palpable gall bladder, a thickened gall bladder wall, impacted stone and pericholecystic collection all had a statistically significant accurate prediction of the difficulty in laparoscopic cholecystectomy. The mean duration of surgery was 62.7±33.15 minutes. The scoring system developed by Randhawa et al predicted difficult laparoscopic cholecystectomy with a sensitivity of 77.8%, specificity of 78.1%, positive predictive value of 66.7% and a negative predictive value of 86.2%.Conclusions: The proposed scoring system predicted difficult laparoscopic cholecystectomy with a sensitivity of 77.8%, specificity of 78.1%, positive predictive value of 66.7% and a negative predictive value of 86.2%.
ABSTRACT
Background: Antibiotic resistance is rising to alarming levels that necessitates the evaluation of prescription patterns for the rational use of antibiotics. Hence this study was conducted to evaluate antibiotic use in a government run general hospital.Methods: A prospective observational study was conducted to evaluate the rationality of antimicrobial prescription in a paediatric intensive care unit (PICU) of a government run tertiary care teaching hospital using the USAID indicators for rational use of antibiotics. Case records of 104 patients were documented and analysed.Results: The most common antimicrobials prescribed were 3rd generation Cephalosporins namely Ceftriaxone, followed by Aminoglycosides (Amikacin), Imipenams (Meropenam), Anti-Influenza Antiviral (Oseltamivir) and Oxazolidinones (Linezolid). A common trend of antibiotic overuse emerged due to paucity of resources to support decision making and choice of antibiotic. This led to patients being exposed to a high number of antibiotics with an associated increase in morbidity.Conclusions: Antibiotic resistance would remain a challenge until systems for rapid, precise and low cost detection of the causative micro-organisms and antibiotic sensitivity are developed, surveillance systems are increased and antibiotic stewardship programs are enforced.