Management and pattern of pellet gun injuries in war conflicted Kashmir Valley, India

AbstractBackground: The pellet gun is a shot gun weapon which is used by law enforcement agencies to maintain law and order in conflict zones whenever need arises. Sometimes these minute sized pellets may lead to grave injuries to vital structures of the body which may sometimes led to permanent disability. The objective of this study was to investigations and manages these fatal injuries in war conflicted valley. Methods: The prospective study conducted in a tertiary care hospital of Government Medical College Srinagar at the time of civilian unrest in 2016 and onwards when thousands of people were injured with pellets by security agencies. Results: Maximum number (67.1%) of patients had injuries to eyes and face, among the total number of patients 69 (17.2%) of patients had abdominal injuries. CECT abdomen showed pellets in all 69 (100%) of patients, pellets in gut lumen in 48 (69.5%) of patients. In the abdominal group 40 patients underwent laparotomy which showed hemoperitoneum in 49 (71.01%), pneumoperitoneum in 6 (8.69%) of patients. Conclusion: Pellet gun weapon has become a common arsenal to suppress the unarmed civilian agitation which may lead to fatal injuries to vital structures of body, where prognosis remained poor despite of best available treatment.

Role of colonoscopy in haemorrhoids with other colorectal disorders

Background: Haemorrhoids are the enlargement or engorgement of the normal fibrovascular anal cushions. These fibrovascular cushions lose their attachment to the underlying rectal wall and lead to prolapse with repeated straining over time, thinning of rectal mucosa and subsequent bleeding. The objective of the present endeavour was to study the prevalence of associated colorectal lesions like colonic carcinoma, diverticular disease, inflammatory bowel disease which present the rectal bleeding and role of colonoscopy in these lesionsMethods: This study was conducted in hundred fifty patients presenting with bleeding and haemorrhoids were analyzed. All patients were examined locally and endoscopically. All significant endoscopic findings (diverticuli, polyps, cancer, angiodysplasia and varices or colitis) were recorded.Results: Majority of patients were males (102), accounting for (68 percent). The main symptom at the time of presentation was rectal bleeding (90 percent). The digital rectal examination was normal in 114 patients. The commonest finding on proctoscopy examination was haemorrhoids. Colonoscopy showed haemorrhoids in maximum patients (147 percent). The associate lesions with altered bowel habits were growth in 12, worm in 6, solitary rectal ulcer in 3, pancolitis in 3.Conclusions: It can be concluded that in the present study colonoscopy revealed a high proportion of colorectal pathologies with haemorrhoids presenting with bleeding per rectum.  Colonoscopy thus proved to be very useful procedure in patients with haemorrhoids especially in elderly.

Carotid disease in diabetic patients undergoing coronary artery bypass grafting

Objective: To compare the severity of carotid artery disease in diabetic and non-diabetic patients undergoing coronary artery bypass grafting. Methods: From January to June 2008, 379 patients undergoing elective coronary artery bypass surgery were preoperatively evaluated for the presence of carotid stenoses by duplex scanning. Patients were divided into two groups, Group I, 156 [41.2%] diabetic patients and Group II, 223 [58.8%] non-diabetic patients. Results: There were 314 [82.8%] males and 65 [17.2%] females with a mean age of 57.2 +/- 9.1 years. In diabetic group there were 125 [80.1%] males and 31 [19.9%] females with a mean age of 56.3 +/- 8.9 years. Left main stem stenosis was present in 59 [37.8%] diabetics and 45 [20.2%] non-diabetics [p<0.0001]. Diffuse disease in left anterior descending [LAD] artery was observed in more diabetic patients 72 [46.2%] as compared to non-diabetics 83 [37.2%] [p<0.295]. Single tight stenosis in LAD was observed in more non-diabetics. Significant carotid artery stenosis was observed in 50 [13.2%] patients. Carotid artery stenosis was observed in 30 [19.2%] diabetics as compared to 20 [9%] non-diabetics [p<0.004]. Analysis of percentage stenosis of carotid artery disease in the study population revealed that >70% stenosis was present in 20 [5.3%] with 13 [8.3%] diabetics and 7 [3.1%] non-diabetics [p<0.025]. Stenosis of 50– 70% was observed in 30 [7.9%] of which 17 [10.9%] were diabetics and 13 [5.8%] were non-diabetics. Conclusion: Presence of diabetes mellitus is associated with diffuse coronary artery disease and significant carotid artery disease in patients undergoing coronary artery bypass grafting

Diabetic macular oedema and role of intra viteral triamcinolone acetonide

The aim of this study was to determine efficiency of intravitreal injection of triamcinolone [IVT] in diffuse macular edema secondary to diabetes mellitus. Twenty eight eyes of 28 patients who fulfilled the inclusion criteria were selected for the study. Patients had a full ophthalmic examination carried out. Injection triamcinolone acetonide [Kenalog] was given intravitreally with full aseptic measures patients were followed up at selected intervals of time. At one month post injection interval 54% patients showed improvement in visual acuity. Three months post injection 43% patients maintained improvement in visual acuity. At six months post injections 18% maintained improvement while 43% showed no change and 14% showed deterioration of vision. We conclude that IVT has a favorable outcome in significant number of patients and may be an alternative to laser photocoagulation in diffuse macular edema secondary to diabetes mellitus

Day surgery: a need for guidelines

Day surgery is being increasingly carried out throughout the world. In our country the concept of day surgery is still in its infancy. In order to practice day surgery safely, we need to have guidelines as to the nature of procedures to be carried out, patient selection, discharge criteria instructions to the patients. We tested our locally devised guidelines on 203 patients admitted as day surgery patients between June 2000 and May 2002. We conclude that day surgery is a safe option with a very high patient satisfaction rate. It should be developed further and for its full utilization we need to have proper guidelines and protocols. Ideally there should be Day Surgery Units in all major hospitals

Single dose dexamethasone as antiemetic following abdominal hysterectomy

The purpose of the study was to evaluate the prophylactic effect of single -dose dexamethasone [8 mg] on postoperative nausea and vomiting [PONV] in women undergoing abdominal hysterectomy. Metoclopramide and saline served as controls. One hundred twenty women [40 in each of the three groups] undergoing abdominal hysterectomy under general anesthesia were enrolled in this randomized, double-blinded, placebo-controlled study. After tracheal intubation, group I received IV dexamethasone 8 mg, whereas groups II and III received IV metoclopramide 10 mg and saline, respectively. Patients in-group I reported a lower incidence of PONV and requested less rescue antiemetics than those in group III during the first four postoperative hours [P <0.01]. Patients in group I reported a lower incidence of PONV than those in groups II [P <0.05] and III [P <0.01] during the 24-hr postoperative period. Groups II and III did not differ from each other in the incidence of PONV and the proportion of patients who requested rescue antiemetics. We thus conclude that prophylactic IV dexamethasone 8 mg significantly reduces the incidence of PONV in women undergoing abdominal hysterectomy. At this dose, dexamethasone is more effective than metoclopramide 10 mg or placebo