Incidence and Management of Iatrogenic Colonoscopic Perforations, in a Tertiary Care Center in Ahmedabad: A Retrospective Study

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.

A post marketing randomized placebo controlled study to evaluate the efficacy of study product UPLAT® (Carica papaya leaf extract + Tinospora cordifolia extract) in the cancer patients with thrombocytopenia induced by chemotherapy

Background:Thrombocytopenia refers to abnormal decrease in platelet count in an individual. The condition may rise at different grades of severity in cancer patients under chemotherapy. In most of the cases, thrombocytopenic condition of cancer patient becomes a major therapy limiting factor. Generally, the treatment of thrombocytopenia lies in dose reduction and/or dose delay but this may adversely affect the treatment plan of cancer. Therefore, managing chemotherapy induced thrombocytopenia is still a challenge. This study was conducted to examine the platelet count improving effect of marketed product UPLAT® (Carica papayaleaf extract + Tinospora cordifoliaextract) in cancer patients with chemotherapy induced thrombocytopenia (CIT).Methods:Fourty (40) subjects were recruited as „case? and twenty (20) as „control?. „Cases? were cancer patients with chemotherapy induced thrombocytopenia. UPLAT® containing following active ingredients;Carica papayaleaf extract: 350mg (standardized to 2% flavonoids)and Tinospora cardifoliaextract: 150mg (standardized to 3% bitters) was given twice daily (2units each) for 10 consecutive days. Platelet count was observed at baseline and day 15 (end of the study). Then pre and post-treatment platelet counts were compared individually in both arms by statistical tests. Response was evaluated in fourty (40) „cases? and twenty „control?y.Results:Mean change for platelet count in case group (93990.00±63896.73) was much higher than control group(27600.00±29758.42).No adverse events with the treatment were observed. Conclusions: This study proves the effectiveness of platelet booster UPLAT® (combination of Carica papayaleaf extract and Tinospora cordifolia) as it significantly increased thrombocytes/platelet count in post-chemotherapy cancer patients.

A study of clinical profile of cardiovascular manifestations in postmenopausal women

Background: In today’s era lifestyle related diseases like diabetes mellitus, have emerged as a major public health problem. Diabetes mellitus, a common metabolic disorder, which accounts for a high incidence of morbidity leads to various events including micro and macro vascular complications. This study aims to assess the baseline levels of (KAP) knowledge, attitude and practices of general population of Vadodara. Materials and methods: The present cross sectional study was carried out on general population of Vadodara with the help of a suitably designed and validated KAP questionnaire. The questionnaire was pretested and verified for errors. The data was analyzed statistically. Results: Altogether, 60.12 % of respondents scored 100% in the questions related with knowledge. However 23.54% scored 100% in the attitude questions and12.80% scored 100% in practice questions. Conclusions: We can conclude that the responders had good knowledge but poor attitude and practice towards diabetes. We can overcome this by increasing quality of health education and improving applicability of scope of health education at all level. The effect of the hormonal changes associated with menopause may play an important role in most cardiovascular disorders in post-menopausal women. So the present study was undertaken to identify various cardiovascular profile changes in postmenopausal women and women were recruited for the study. We check for various parameters like hypertension, diabetes, Ischemic heart disease, Cerebrovascular Stroke, metabolic syndrome, anaemia, fundus examination. Results: Prevalence of Hypertension, dyslipidaemia, metabolic Bhavik Prajapati, Shirish Raval, Jigar Patel, Ishwar Parmar, Janak Chokshi, Nilay Thakore. A study of clinical profile of cardiovascular manifestations in postmenopausal women. IAIM, 2018; 5(4): 100-106. Page 101 syndrome, CV stroke, ischemic heart disease is higher in postmenopausal women. Five deaths due to cardiovascular disease were observed. This study showed high prevalence of most of the conventional cardiovascular risk factors, especially diabetes, hypertension, dyslipidemia, obesity, and other risk factors in postmenopausal women. Therefore it is important to consider each and every postmenopausal woman to undergo screening for cardiovascular profile and very important to identify and treat these cardiovascular risk factors properly to prevent mortality and morbidity.

Safe and easy method with little modification in technique is useful for successful internal jugular vein cannulation on same side even after intra‑arterial puncture without using ultrasound guidance in adult cardiac patients.

Background: The modification in technique is useful for successful right-sided internal jugular vein (IJV) cannulation on the same side even after intra-arterial puncture without using ultrasound guidance in adult patients. Materials and Methods: This study was carried out in total 160 adult patient from American Society of Anesthesiologists Grade II to III patients male (n = 95) and female (n = 65) who underwent cardiac surgery where cannulation was done on right sided by triple lumen catheter (7 French) using Seldinger technique. Results: Majority of patients were cannulated successfully by Seldinger technique with single or double attempt except for five patients in which arterial puncture occurred. All five patients were cannulated successfully on the same side with this modified technique without any significant major complications. They were managed by application of blocker at the end of arterial needle puncture without removing it. In our routine practice, we were used to removing this needle and applying compression for few minutes to prevent hematoma formation after an arterial puncture. In this study, cannula was used as a marker or guideline for the relocation of IJV on the same side and recannulation was performed by changing the direction of needle on same side lateral to the previous one and without going towards the same direction to prevent the arterial puncture again. Conclusion: Most simple and useful modified technique for institutes where the complications are most common with trainee doctors and in hospitals where there is no advanced facility like ultrasound-guided cannulation available. By this modification, it will be time saving, very comfortable, and user-friendly technique with high success rate.

Management of Large Mandibular Ameloblastoma Crossing Midline: Reconstructed by Bilateral Iliac Crest Graft: A Rare Entity.

Ameloblastoma is a true neoplasm of odontogenic epithelial origin. It is the second most common odontogenic neoplasm. It’s incidence approximately 1% of all oral tumors and 18% of all odontogenic tumors. More than 80% of cases of ameloblastoma occur in mandible. The ameloblastoma occurs in three variants solid or multicystic, unicystic, and peripheral. A painless expansion of the jaws is the most common clinical presentation. The correct diagnosis can be easily made with the help of plain X-rays and tissue biopsy. The standard management of ameloblastoma is marginal resection but sometimes a large tumor requires complete resection of affected part. Untreated tumors may lead to tremendous facial disfigurement, a severe malocclusion and pathological fractures of the jaw. Here we present a case of a young man with the chief complaint of facial asymmetry. The orthopantomogram of the patient was showing a multilocular radiolucency with Buccal and lingual cortical expansion. A diagnosis was made on the basis of the biopsy as multicystic ameloblastoma, and resection of the mandible was carried out. The mandibular primary reconstruction was done with avascular bilateral iliac crest bone graft. Long term prognosis showed satisfactory healing and good facial esthetics.

Interpositional Arthroplasty with Temporomyofascial Flap to Correct TMJ Reankylosis in Child: A Case Report.

Temporomandibular joint ankylosis (TMA) is a highly distressing condition in which the temporomandibular joint (TMJ) is replaced by scar tissue. Most frequently reported complications after surgical treatment are limited mouth opening and re-ankylosis. Reankylosis happens due to inadequate bone removal, lack of sufficient interpositional material, fibrous tissue adhesions and elongation of coronoid process and regrowth of bone in the sigmoid notch area. In gap arthroplasty treatment chances to recurrence is 53% than interpositional arthroplasy. We treated a case of right sided TMJ reankylosis by interpositional arthroplasty with temporomyofacial flap and physiotherapy was started 3 days after surgery and maintained for 6 months. In 2 years follow-up, no signs of recurrence and maximum mouth opening 45 mm were observed. The success in preventing reankylosis after TMJ interpositional arthroplasty with temporomyofacial flap is relatively better than gap arthroplasty alone.

Duodenal perforation: role of multi detector computed tomography (MDCT).

Perforation of peptic ulcers, more specifically; ulcers of the first part of the duodenum carry mortality up to 11 %, with a higher mortality seen in patients over the age of 50 years. Main symptoms are acute onset abdominal pain and vomiting. Guarding & rigidity is present on examination. Conventional X-ray abdomen standing is the first investigation, which shows free gas under diaphragm. MDCT scan is required for identifying the presence, site and cause of gastrointestinal tract perforation. Early diagnosis and treatment is mandatory as it is a grave emergency condition.