Evaluation of the impact of binocular versus monocular cataract surgery using Catquest-9SF: a randomized controlled trial

ABSTRACT Purpose: This prospective, randomized, unmasked, clinical trial aimed to report the visual outcomes of cataract surgery on both eyes versus cataract surgery on one eye in Brazilian patients. Methods: This study included patients with bilateral cataracts and binocular visual acuity worse than or equal to 0.3 logarithm of the minimum angle of resolution. The patients were randomly assigned to undergo surgery on one (Control Group) or both eyes (one eye at a time; Intervention Group). Postoperatively, self-reported visual function using Catquest-9SF (primary outcome measure), binocular visual acuity, stereopsis, and ocular dominance (secondary outcome measures) were compared. Results: A total of 151 patients (77 and 148 eyes in the Control and Intervention Groups, respectively) completed the follow-up. Patients who underwent surgery on both eyes exhibited significantly better self-reported visual function (p=0.036) and stereopsis (p=0.026) than those who underwent surgery on one eye. Binocular visual acuity and ocular dominance did not affect the group comparisons. Conclusions: Surgery on both eyes resulted in significantly better self-reported visual function and stereopsis than surgery on one eye.

Conocimiento en estudiantes de enfermería sobre sepsis quirúrgico / Knowledge in nursing students about surgical sepsis

Objetivo: Determinar el nivel de conocimiento de los estudiantes de enfermería de la Universidad Técnica de Ambato sobre sepsis quirúrgica. Material y método: La presente investigación tiene un diseño de desarrollo observacional, de tipo descriptivo, cohorte transversal, con un enfoque cuantitativo, ya que el nivel de cono-cimiento se verá representado mediante tablas y gráficos para des-cribir la problemática del periodo octubre 2023 febrero 2024. Re-sultados: Se evidencia un alto porcentaje de respuestas incorrectas por cada ítem por parte de los estudiantes. La categoría Nivel de Conocimiento sobre Definición de Sepsis, fue respondida de ma-nera incorrecta con un porcentaje del 83,9%, la categoría Nivel de Conocimiento sobre Diagnóstico de Sepsis obtuvo 51,7% y, por úl-timo, la Nivel de Conocimiento sobre Tratamiento de Sepsis con el 29,2%. Conclusiones: El nivel de conocimiento de los estudiantes sobre Sepsis Quirúrgica es malo, debido a que existe una subesti-mación de la gravedad de la sepsis como afección potencialmente mortal, lo que puede traer un impacto negativo en los pacientes[AU]

Objective: Determine the level of knowledge of nursing students at the Technical University of Ambato about surgical sepsis. Mate-rials and methods: This research has an observational, descriptive, transversal development design, with a quantitative approach since the level of knowledge will be represented through tables and gra-phs to describe the problems of the period October 2023-February 2024. Results: A high percentage of incorrect answers for each item by the students is evident. The category Level of Knowledge about Definition of Sepsis was answered incorrectly with a percentage of 83.9%, the category Level of Knowledge about Diagnosis of Sepsis obtained 51.7% and, finally, the category Level of Knowledge about Treatment of Sepsis. Sepsis with 29.2%. Conclusions: The level of knowledge of students about Surgical Sepsis is poor because there is an underestimation of the severity of sepsis as a potentially fatal condition, which can have a negative impact on patients[AU]

Objetivo: Determinar o nível de conhecimento dos estudantes de enfermagem da Universidade Técnica de Ambato sobre sepse ci-rúrgica. Material e método: Esta pesquisa possui desenho de coor-te observacional, descritivo, transversal, com abordagem quantita-tiva, uma vez que o nível de conhecimento será representado por meio de tabelas e gráficos para descrever o problema no período de outubro de 2023 a fevereiro de 2024. Resultados: Uma parada. É evidente o percentual de respostas incorretas para cada item por parte dos alunos. A categoria Nível de Conhecimento sobre Defi-nição de Sepse foi respondida incorretamente com percentual de 83,9%, a categoria Nível de Conhecimento sobre Diagnóstico de Sepse obteve 51,7% e por fim, a categoria Nível de Conhecimen-to sobre Tratamento de Sepse com 29,2%. Conclusões: O nível de conhecimento dos estudantes sobre a Sepse Cirúrgica é baixo, pois há uma subestimação da gravidade da sepse como uma condição potencialmente fatal, que pode ter um impacto negativo nos pa-cientes[AU]

Complicaciones quirúrgicas: un tema complicado / Surgical complications: A complicated topic

Introducción. Las complicaciones quirúrgicas son un tema relevante, difícil de abordar e inmerso en una cultura punitiva y vergonzosa hacia el médico. La ausencia de una medición sistemática, confiable y socializada es un desafío para los servicios quirúrgicos. El desconocimiento de las medidas de frecuencia y el impacto de las complicaciones quirúrgicas en las instituciones, y a su vez, dentro de los servicios quirúrgicos, evidencia la necesidad de abordar el tema desde una perspectiva de mejoramiento continuo. Métodos. Se hizo un análisis crítico y reflexivo sobre la conceptualización de las complicaciones quirúrgicas, los avances en su proceso de evaluación y su utilidad como indicador de calidad en los servicios quirúrgicos. Se ilustraron las metodologías con ejemplos clínicos que facilitan su entendimiento y aplicabilidad. Resultados. El trabajo inicial de los doctores Clavien & Dindo se ha fortalecido al considerar integralmente el proceso de atención quirúrgica como un indicador de calidad de la atención en salud. El desarrollo del Índice Integral de Complicaciones (CCI), para los eventos en el período posoperatorio, representa un paso adicional en el abordaje del problema. Su potencialidad en el análisis de los eventos ofrece una oportunidad para la implementación y la investigación en el tema. Conclusiones. Las complicaciones quirúrgicas representan un indicador robusto que permite evaluar el desempeño individual y grupal en un servicio quirúrgico. Hay metodologías recientes que deben ser incorporadas en la actividad asistencial de los cirujanos. Representan un insumo en la educación médica a todo nivel e, igualmente, un elemento de crecimiento personal y académico para todo cirujano.

Introduction. Surgical complications are a relevant topic, difficult to address and immersed in a punitive and shameful culture towards the doctor. The absence of systematic, reliable, and socialized measurement is a challenge for surgical services. The lack of knowledge of frequency measurements and the impact of surgical complications in institutions, and in turn, within surgical services, shows the need to address the issue from a perspective of continuous improvement. Methods. A critical and reflective analysis was carried out on the conceptualization of surgical complications, the advances in their evaluation process and their usefulness as an indicator of quality in surgical services. The methodologies were illustrated with clinical examples that facilitate their understanding and applicability. Results. The initial work of doctors Clavien & Dindo has been strengthened by comprehensively considering the surgical care process as an indicator of quality of health care. The development of the Comprehensive Complication Index (CCI), for events in the postoperative period, represents an additional step in addressing the problem. Its potential in the analysis of events offers an opportunity for implementation and research on the topic. Conclusions. Surgical complications represent a robust indicator that allows evaluating individual and group performance in a surgical service. There are recent methodologies that must be incorporated into the care activity of surgeons. They represent an input in medical education at all levels and equally, an element of personal and academic growth for every surgeon.

Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology / Insuficiência renal aguda: experiência de um centro terciário de Nefrologia Pediátrica

ABSTRACT Introduction: Acute kidney injury (AKI) is an abrupt deterioration of kidney function. The incidence of pediatric AKI is increasing worldwide, both in critically and non-critically ill settings. We aimed to characterize the presentation, etiology, evolution, and outcome of AKI in pediatric patients admitted to a tertiary care center. Methods: We performed a retrospective observational single-center study of patients aged 29 days to 17 years and 365 days admitted to our Pediatric Nephrology Unit from January 2012 to December 2021, with the diagnosis of AKI. AKI severity was categorized according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The outcomes considered were death or sequelae (proteinuria, hypertension, or changes in renal function at 3 to 6 months follow-up assessments). Results: Forty-six patients with a median age of 13.0 (3.5-15.5) years were included. About half of the patients (n = 24, 52.2%) had an identifiable risk factor for the development of AKI. Thirteen patients (28.3%) were anuric, and all of those were categorized as AKI KDIGO stage 3 (p < 0.001). Almost one quarter (n = 10, 21.7%) of patients required renal replacement therapy. Approximately 60% of patients (n = 26) had at least one sequelae, with proteinuria being the most common (n = 15, 38.5%; median (P25-75) urinary protein-to-creatinine ratio 0.30 (0.27-0.44) mg/mg), followed by reduced glomerular filtration rate (GFR) (n = 11, 27.5%; median (P25-75) GFR 75 (62-83) mL/min/1.73 m2). Conclusions: Pediatric AKI is associated with substantial morbidity, with potential for proteinuria development and renal function impairment and a relevant impact on long-term prognosis.

RESUMO Introdução: Insuficiência renal aguda (IRA) é uma deterioração abrupta da função renal. A incidência de IRA pediátrica está aumentando em todo o mundo, em ambientes críticos e não críticos. Nosso objetivo foi caracterizar apresentação, etiologia, evolução e desfechos da IRA em pacientes pediátricos internados em um centro de atendimento terciário. Métodos: Realizamos estudo retrospectivo observacional de centro único de pacientes com idade entre 29 dias a 17 anos e 365 dias internados em nossa Unidade de Nefrologia Pediátrica, de janeiro de 2012 a dezembro de 2021, com diagnóstico de IRA. A gravidade da IRA foi categorizada de acordo com os critérios do Kidney Disease Improving Global Outcomes (KDIGO). Os desfechos considerados foram óbito ou sequelas (proteinúria, hipertensão ou alterações na função renal em avaliações de acompanhamento de 3 a 6 meses). Resultados: Incluímos 46 pacientes com idade mediana de 13,0 (3,5-15,5) anos. Cerca de metade (n = 24; 52,2%) apresentou um fator de risco identificável para o desenvolvimento de IRA. Treze pacientes (28,3%) eram anúricos; todos foram classificados como IRA KDIGO 3 (p < 0,001). Quase um quarto (n = 10; 21,7%) dos pacientes necessitaram de terapia renal substitutiva. Aproximadamente 60% (n = 26) apresentou pelo menos uma sequela, sendo proteinúria a mais comum (n = 15; 38,5%; mediana (P25-75) da relação proteína/creatinina urinária 0,30 (0,27-0,44) mg/mg), seguida de taxa de filtração glomerular (TFG) reduzida (n = 11; 27,5%; mediana (P25-75) da TFG 75 (62-83) mL/min/1,73 m2). Conclusões: A IRA pediátrica está associada à morbidade substancial, com potencial para desenvolvimento de proteinúria e comprometimento da função renal e impacto relevante no prognóstico de longo prazo.

Bone aluminum accumulation in the current era / Acúmulo de alumínio no tecido ósseo na era atual

In the last few years, evidence from the Brazilian Registry of Bone Biopsy (REBRABO) has pointed out a high incidence of aluminum (Al) accumulation in the bones of patients with CKD under dialysis. This surprising finding does not appear to be merely a passive metal accumulation, as prospective data from REBRABO suggest that the presence of Al in bone may be independently associated with major adverse cardiovascular events. This information contrasts with the perception of epidemiologic control of this condition around the world. In this opinion paper, we discussed why the diagnosis of Al accumulation in bone is not reported in other parts of the world. We also discuss a range of possibilities to understand why bone Al accumulation still occurs, not as a classical syndrome with systemic signs of intoxication, as occurred it has in the past.

Nos últimos anos, evidências do Registro Brasileiro de Biópsia óssea (REBRABO) apontaram uma alta incidência de intoxicação por alumínio (Al) no tecido ósseo de pacientes com DRC em diálise. Essa surpreendente informação parece representar não apenas um acúmulo passivo deste metal, visto que dados prospectivos do REBRABO sugerem que a presença de Al no tecido ósseo pode estar independentemente relacionada a eventos cardiovasculares adversos maiores. Essas informações contrastam com a percepção mundial do controle epidemiológico dessa condição. Neste artigo de opinião, discutimos por que o diagnóstico de acúmulo ósseo de Al não é relatado em outras partes do mundo, e também discutimos uma gama de possibilidades para entender por que nós acreditamos que o acúmulo de Al no tecido ósseo ainda ocorre, não como se apresentava no passado, ou seja, como uma síndrome com sinais e sintomas sistêmicos de intoxicação.

Study of clinical features, haematological changes and outcome in snake bite cases

Background: Snake bite is a common acute medical emergency faced by rural populations in tropical and subtropical countries. In India, a large proportion of snake bites occur when people are working barefoot in the fields or while walking at night. More than 2,000 species of snakes are known worldwide, of which around 400 are poisonous. These snakes belong to the families Elapidae, Viperidae, Hydrophiidae and Colubridae. Methods: A prospective was done at medicine department of SDH Sawantwadi, Sindhudurgh. Study duration was 3 months (May 2023 to July 2023). Study population included all cases admitted in SDH Sawantwadi with history of snake bite. Sample size was 50. Results: Majority of cases found in the age group of 18-30 years 19 cases (38%) followed by 9 cases in 31-45 age group, 12 in 46-60 age group and 10 cases in 61 and above group. Majority of patients with history of snake bite were males contributing 27 (54%). Snake bites were more common in males as compared to females 23 (46%). 14% snake bite cases have activated partial thromboplastin time (APTT) >30 seconds, 10% of snake bite cases had prothrombin time (PT) >15 sec, 30% had platelet count <100000, increased leucocyte count >11000 was seen in 22% cases and 12% victims showed whole blood clotting test (WBCT) >20 minutes. Clinical outcome was 90% discharged after treatment and 10% death during treatment. Correlation between PT and clinical outcome is significant at p<0.5. Conclusions: Association between PT and mortality among snake bite patients was statistically significant.

Fetomaternal outcome in pregnancy with cardiac disease-a case series

Cardiac disease is an important cause of maternal mortality and morbidity in ante partum and postpartum period. Incidence of heart disease in pregnancy is <1%. Pre pregnancy diagnosis, counselling, antenatal supervision, delivery at equipped centre and management with multidisciplinary approach favours the maternal and fetal outcome. This consists of case series of 16 patients with cardiac disease admitted in the department of obstetrics and gynecology at Gulbarga institute of medical sciences, Kalaburgi from January 2022 to June 2023.

Maternal and perinatal outcome in placenta previa

Background: Placenta previa is a serious and life-threatening pregnancy complication characterized by bleeding originating from the placental site located in the lower uterine segment. This condition typically occurs during the latter half of pregnancy when the lower uterine segment undergoes stretching.Methods: This study is a retrospective observational study of total 30 cases of placenta previa from October 2022 to February 2024 at the department of obstetrics and gynecology at SVP Hospital, tertiary center, western Ahmedabad. All women with placenta previa included in this study except patients suffering from any other bleeding disorder. These women were analyzed with age, parity, gestational age, past history of bleeding, clinical features at presentation, blood transfusion, period of gestation at time of delivery, mode of delivery and perinatal outcome.Results: In present study 30 cases were taken. Majority were registered 66.7% (20), age group between 21 to 30 year patients 87% (26), multiparous 73.4% (22) patients. Most common risk factor is caesarean section 20% (6) followed by D&E 16.6% (5). Common complications include 33.33% (10) postpartum haemorrhage.Conclusions: Placenta previa is a major risk factor for adverse maternal and perinatal outcome. Good antenatal care, early diagnosis, availability of emergency obstetrics services with senior obstetricians, blood bank facility, ICU care and nicu services can improve maternal and neonatal outcome in high risk cases.

Prognostic significance of cerebro-placental ratio in predicting perinatal

Background: Cerebro-placental ratio (CPR), measured by Ultrasound Doppler velocimetry in pregnancy, has gained much attention in recent years as an important tool in predicting perinatal outcomes. The study aimed to calculate the cerebro-placental ratio and correlateit with perinatal outcome in terms of intrapartum fetal heart variation, meconium staining of liquor, mode of delivery, Apgar score at birth, and NICU admissions.Methods: It was hospital-based prospective cross-sectional study on 119 pregnant women with high-risk pregnancies. All women had doppler velocimetry ultrasound, and cerebro-placental ration was calculated. Perinatal outcome was noted in terms of FHR variability in labor, Meconium staining of liquor, Apgar score and need for NICU admission.Results: Out of the total of 119 women, 88 women had CPR >1.08 and 31 women had CPR of <1.08. Meconium staining of liquor, low Apgar score, and NICU admission was mound in significantly more babies with low CPR.Conclusions: CPR has a good prognostic value in predicting many adverse perinatal outcomes.

A study on feto-maternal outcome in patients with preterm premature rupture of membranes

Background: Preterm premature rupture of membranes (PPROM) is rupture of fetal membranes prior to labor in pregnancies between 28-37 weeks. PPROM is associated with significant maternal and neonatal morbidity or mortality. The present study was conducted to evaluate risk factor and etiology of PPROM and its fetomaternal effect in tertiary care hospital.Methods: A cross-sectional study was conducted in the department of obstetrics and gynaecology, SMS Hospital, Ahemdabad. From August 2023 to February 2024.The study included 50 pregnant women between 28-37 weeks gestation with PPROM were subjected to detailed history and examination. Each patient was followed till her delivery and fetomaternal outcome was recorded.Results: PPROM is a fair complication of pregnancy. 80% were belongs to 20-29 age, 70% were unbooked, 76% from low SE-class, 68% with gestational age of 34-36 weeks. Vaginal delivery was common 58%. The babies born to mothers with PPROM more in weight of 2-2.5 kg (48%). 34 had no risk factors to develop PPROM. Most common etiology for PPROM infection 16% and malpresentation 10%. Most of the mothers with PPROM had no complications. 17 (34%) babies required NICU admissions for complaints of premturity, respiratory distress, birth asphyxia, and sepsis. RDS was most common neonatal complication. 2 neonatal deaths in this study due to RDS and prematurity.Conclusions: Effective PPROM Mx involves evaluating the risks and advantage of conservative Mx strategies. Whenever possible, Rx should be focused towards prophylactic use of antibiotics and steroids during pregnancy can reduce fetal and mother morbidity and mortality. Termination of pregnancy should be considered at the 1st sign of chorioamnionitis.

Potential effect of COVID-19 pandemic on pregnancy outcome: a prospective observational study

Background: The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, particularly impacting vulnerable populations such as pregnant women. Physiological changes during pregnancy may increase susceptibility to severe outcomes from COVID-19, necessitating a deeper understanding of its effects on maternal and fetal health. This study aimed to observe the outcomes of pregnant patients diagnosed with COVID-19, focusing on maternal morbidity, fetal outcomes, and the impact on healthcare resources.Methods: A multicenter, non-randomized, quasi-experimental prospective observational study was conducted at Rajshahi Medical College Hospital, Bangladesh, from July 2020 to June 2021. A total of 81 pregnant women with confirmed COVID-19 were included in the study. Data were collected using a pre-prepared data collection sheet and analyzed using SPSS version 26.Results: The majority of patients were in the third trimester (49.1%) and between 35-40 weeks gestation (83%). Common symptoms included severe cough (26%) and fever (14%). Six patients (7.4%) experienced multiorgan failure, while 3 (3.7%) required mechanical ventilation. There were 3 spontaneous abortions, 52 deliveries (64.2%), and 2 neonates were COVID-positive. Maternal hospital stays averaged 13.1 days (SD�37), with a mean breastfeeding interval of 13.3 days (SD�44).Conclusions: COVID-19 had a detrimental impact on both maternal and fetal health, emphasizing the need for improved treatment strategies and resource allocation. This study highlights the importance of further research to better understand and mitigate the effects of COVID-19 on pregnant women.

Análisis de calidad a través de la medición de los resultados de libro quirúrgico y oncológico en 26 amputaciones abdominoperineales por cáncer de recto bajo / Quality analysis based on measuring textbook surgical outcome and textbook oncologic outcome in 26 abdominoperineal amputations for low rectal cancer

RESUMEN Antecedentes: La medición de la calidad en cirugía, a través de las intervenciones de mejora, favorece mejores resultados para los pacientes y menos costos institucionales. Los resultados de libro quirúrgico (RLq) y los de libro oncológico (RLo) son una forma organizada de medir la calidad de la actividad quirúrgica. Objetivo: Estimar el cumplimiento de los parámetros de los RLq y RLo en una serie de pacientes con cáncer de recto bajo operados con amputación abdominoperineal por un mismo equipo. Material y métodos: Se realizó un estudio observacional descriptivo a partir de la revisión retrospectiva de los parámetros de los RLq y RLo en pacientes sometidos a una amputación abdominoperineal por cáncer de recto, entre agosto de 2015 y marzo de 2023, y se estimaron los porcentajes de cumplimiento en ambos libros. Resultados: Se incluyeron 26 pacientes cuyo promedio de edad fue de 52,07 años, y de ellos 18 (69,2%) fueron varones. En 25 casos (96 %) se realizó neoadyuvancia. Los RLq se cumplieron en 20 pacientes (76,9%), mientras que los RLo en 14 (53,8%), y ambos juntos en 13 (50%). Los ítems que más se presentaron para no llegar al 100% de cualquiera de los resultados fueron las complicaciones y el número de ganglios resecados igual a 12 o mayor, y, en menor medida, la resección R0, los días de estadía y la readmisión. Conclusión: Se lograron RLq y RLo adecuados en el 50% de los pacientes con amputaciones abdominoperineales. El análisis permite conocer dónde debemos actuar para mejorar la calidad de nuestros resultados.

ABSTRACT Background: Measuring quality in surgery through improvement interventions favors better patient outcomes and lower institutional costs. Textbook surgical outcome (TSO) and textbook oncologic outcome (TOO) are an organized way to measure the quality of surgical activity. Objective: The aim of the present study was to evaluate the proportion of patients with low rectal cancer who underwent abdominoperineal amputation by the same surgical team and achieved the TSO and TOO. Material and methods: We conducted a descriptive observational study based on the retrospective review of TSO and TOO parameters in patients undergoing abdominoperineal amputation for rectal cancer, between August 2015 and March 2023. The percentage of patients who achieved the TSO and TOO was estimated. Results: A total of 26 patients were included; mean age was 52.07 years and 18 (69.2%) were men and 25 patients (96%) received neoadjuvant therapy. The TSO was achieved in 20 patients (76.9%); 14 patients (53.8%) achieved the TOO and 13 patients (59%) achieved both textbook outcomes. The presence of complications and < 12 lymph nodes resected were the most common reasons for not achieving 100% of both textbook outcomes; other items were R0 resection, length of hospital stay and readmission. Conclusion: Fifty percent of patients with abdominoperineal amputations achieved an adequate TSO and TOO. The analysis allows us to understand where we must take action in order to improve the quality of our results.

Mais Complicações em Mulheres após Revascularização do Miocárdio Mesmo com Tempos Cirúrgicos Reduzidos: Atenção por Equidade e Melhoria da Qualidade / More Hospital Complications in Women after Cabg Even for Reduced Surgical Times: Call to Action for Equity in Quality Improvement

Resumo Fundamento Análises em grandes registros apontam desfechos desfavoráveis para mulheres submetidas à cirurgia de revascularização do miocárdio (CRM), enquanto estudos randomizados sofrem com a falta de representatividade. Objetivo Comparar os resultados hospitalares ajustados entre homens e mulheres submetidos à CRM. Métodos Entre julho de 2017 e junho de 2019, 3991 pacientes foram submetidos à CRM primária isolada, tanto de forma eletiva como de urgência, em 5 hospitais de estado de São Paulo, Brasil. Para equilibrar as diferenças entre homens e mulheres, as populações foram ajustadas utilizando o Propensity Score Matching. Os desfechos considerados para análise foram os utilizados pelo STS Adult Database. As análises foram conduzidas no software R, considerando significância valores de p < 0,05. Resultados Após o Propensity Score Matching (1:1), cada grupo incluiu 1089 pacientes. Em relação às variáveis intraoperatórias os homens apresentaram maior tempo de CEC (p<0,001), tempo cirúrgico (p<0,001), número de anastomoses distais (p<0,001) e uso de enxertos arteriais. Em relação aos desfechos as mulheres apresentaram maior incidência de infecção de ferida profunda (p=0,006), tempo prolongado na Unidade de Terapia Intensiva (p=0,002), maior necessidade do uso de balão intraórtico (p=0,04), maior taxa de transfusão sanguínea (p<0,001), maior readmissão hospitalar em até 30 dias após a cirurgia (p=0,002) e maior taxa de óbitos (p=0,03). Conclusões Apesar dos homens terem apresentado um maior tempo de CEC, maior número de enxertos arteriais e maior número de anastomoses distais, os resultados imediatos após CRM foram piores em mulheres.

Abstract Background Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. Objective To compare adjusted hospital outcomes between men and women undergoing CABG. Methods From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05. Results After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). Conclusions Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

Treatment outcome of tuberculosis patients in the directly observed treatment short course centres of Dibrugarh, Assam

Background: Tuberculosis (TB), second leading cause of mortality in India. Despite of so many efforts of National Tuberculosis Elimination Programme (NTEP), tuberculosis is still prevalent. Therefore, this study was conducted to assess socio-demographic, clinical profile and treatment outcomes of patients on fixed drug combination (FDC) daily regimen. Methods: Retrospective record-based study was conducted in two DOTS centres of Dibrugarh selected using simple random sampling. A total of 85 medical record were selected and reviewed. Information from treatment card were extracted using a pre-designed online format. Data collected were entered and analysed in SPSS version 25 software and presented using descriptive statistics. Results: Total of 85 patients records were reviewed. Gender ratio was 54.1%: 45.9% for male:female. Majority 31.8% belonged to most productive age group of 25-34 years of age. Treatment completion rate was 80%, cured rate was 18.8% while 1.2% was died. Conclusions: Male gender were reported with higher incidence of Tuberculosis. The low percentage of cure rate suggested the need for strengthening of TB services in the DOTs centres.

A rare case of congenital methemoglobinemia in pregnancy

When iron in haemoglobin is replaced from Fe+2 (ferrous) to Fe+3 (ferric), it leads to formation of methemoglobin. Normal levels of methemoglobin are <1%. This is maintained by redox balance between activity of NADH methemoglobin reductase enzyme and amount of oxidised hemoglobin. When levels of methemoglobin are increased, it leads to methemoglobinemia. Methemoglobin has less affinity to bind to oxygen & results in left shift of oxygen杊emoglobin dissociation curve. As most of the cases of congenital methemoglobinemia are asymptomatic, it is often diagnosed first time during pregnancy. Here we report a case, Primigravida with 38 weeks of gestation posted for emergency LSCS i/v/o meconium-stained liquor, who had SPO2 of 84%, was clinically asymptomatic, vitally stable and with ABG, CXR, ECG and 2DECHO normal. Efforts to find out the cause of reduced oxygen saturation led to diagnosis of rare hemoglobinopathy, methemoglobinemia.

A study of fetomaternal outcome in pregnancy beyond expected date of delivery in obstetrics and gynaecology department of a tertiary health care center of South Gujarat

Background: Post-dated pregnancy is that extends beyond 40 weeks plus one or more days (anytime past the estimated due date). Mother and the foetus are at increased risk of adverse events when the pregnancy continues beyond the expected date of delivery (EDD).Method: This prospective observational study was conducted at obstetrics and gynaecology department of tertiary care centre of South Gujarat for 1 year period after official approval from human research ethical committee.Results: In our study total 200 postdated pregnant women included. Majority i.e. 134 (67%) patients had delivered as normal vaginally, whereas 68 (34%) patients required caesarean section. The most common indication for cesarean section was meconium-stained liquor (42.6%, n=68) follow by fetal distress, 2nd stage CPD, non-progress of labor, failure of induction etc. Altogether 19 newborn need NICU admission for different complication of which the most common neonate抯 complication was perinatal asphyxia followed by meconium aspiration syndrome and RDS and only one neonate had early neonate death (END) due to RDS. Conclusions: In pregnancies beyond 40 weeks, timely confirmed of postdated pregnancy, effective fetal monitoring and timely induction and with proper intervention could preclude the adverse feto-maternal outcome.

Renal diseases in children at the university of Gondar hospital, Ethiopia: pattern and outcome

Background: In developing countries, renal diseases in children are becoming common causes of morbidity and mortality. In Ethiopia, there are no adequate data about patterns and outcome of these disorders. We conducted this study to provide evidences on patterns and outcome of renal diseases in children admitted to a tertiary hospital in Gondar, Ethiopia.Methods: A retrospective record review of all pediatric patients admitted with renal diseases over a period of two-years (January 2022-December 2023) to the university of Gondar hospital (UoGH), was conducted.Results: A total of 456, comprising 231 (50.7%) females and 225 (49.3%) males, patients were studied. Majority (37.7%) of patients were below 5 years of age. Renal diseases accounted for 3.6% of all admissions during the 2-years period. Common renal problems were urinary tract infection (UTI) (29%), acute glomerulonephritis (AGN) (24.1%), nephrotic syndrome (18.6%), acute kidney injury (AKI) (14.3%), nephroblastoma (9%) and chronic kidney diseases (CKD) (2.4%). Finally; 71.9% were discharged improved and 10.5% died. The highest case fatality rates were in patients with rapidly progressive glomerulonephritis (36.7%) followed by CKD (36.4%), and AKI (21.5%).Conclusions: This study revealed high prevalence and mortality rate of renal diseases in children. The major causes of death were AGN/RPGN, CKD and AKI. All the above evidences clearly disclosed that establishment of a pediatric nephrology unit and get a trained pediatric nephrologist in our university hospital is critical.

Instrumental deliveries and its outcome in tertiary care center

Background: Objective of the study was to determine the incidence and indication of assisted vaginal deliveries and to compare the fetal and maternal outcome of vacuum and forceps deliveries.Methods: This study done over a period of one and half year from March 2022 to August 2023 at NRI Medical College, Chinnakakani. Total number of vaginal deliveries are 1617, out of which 33 had a successful assisted vaginal delivery and studied in terms of maternal and fetal outcome. Verbal consent was taken, indication for instrumental application documented and pre requisites fulfilled before instrument application.Results: Out of 1617 vaginal deliveries in our institute, 33 cases successful underwent assisted vaginal deliveries in which 49% were vacuum assisted, 51% were forceps assisted deliveries. Most common indication for instrument application were fetal distress (51%), failure of maternal forces followed by maternal exhaustion (30%). We had 2nd degree perineal tear - 2 (11.76%), cervical tear - 1 (5.88%), PPH-1 (5.88%), 1- vaginal laceration (6.25%) as maternal complications. Out of 16 vacuum and 17 forceps deliveries, 5/16 (31.25%) and 8/17 (47.06%) were admitted in NICU respectively.Conclusions: In the present study showed that most common indication for assisted vaginal deliveries are fetal distress and maternal exhaustion. Maternal complications are seen more in forceps deliveries when compared to vaccum. There is no significant difference between vaccum and forceps deliveries in neonatal complications when compared.

Feto-maternal outcome in term and late term pregnancies following induction of labour with misoprostol

Background: Induction of labour is the artificial initiation of labour before its spontaneous onset for the purpose of achieving vaginal delivery of the feto-placental unit. It is a common obstetric procedure which is indicated when the benefits to mother or fetus outweigh the benefits of continuing the pregnancy. Most common indication for induction is postdated pregnancy.Methods: Longitudinal Study carried out in department of obstetrics and gynaecology, RIMS, Imphal, Manipur, conducted for duration of two calendar years, with effect from January 2021 in 168 primigravidas who had reached full term or late term pregnancy admitted in ante-natal ward of RIMS, Obstetrics and Gynaecology department.Results: Study was conducted on 168 pregnant women, most of the participants belonged to the age group of 18-34 years (77.9%). Vaginal delivery was the most common mode of delivery (64.8%). Most of the babies (72%) delivered were having birth weight of between 2.5 kg to 3.9 kg. PPH and uterine hyperstimulation are comparatively more in the late term pregnancy as compared to full term pregnancy. Meconium-stained liquor was slightly more in late term pregnancy group as compared to full term pregnancy. Babies delivered by full term pregnant women were having better APGAR score in 1 minute and 5 minutes than the babies delivered by late term pregnancy.Conclusions: Late term Pregnancy is comparatively common in low socio-economic group. The CS rate is comparatively high in Late term pregnancy as compared to Full Term Pregnancy. Poor APGAR score is highly associated with Late term Pregnancy outcome.

Treatment results of female pelvic organ prolapse by surgical placement of synthetic vaginal mesh: a prospective study at An Giang Obstetrics and Pediatrics Hospital

Background: Pelvic organ prolapse is a common condition in Vietnam. At An Giang obstetrics and pediatrics hospital, vaginal mesh surgery for the treatment of female pelvic organ prolapse has recently been introduced, which is a new technique for the hospital and requires evaluation and research. This study aims to evaluate the treatment results of female pelvic organ prolapse by surgical placement of a synthetic vaginal mesh at An Giang obstetrics and pediatrics hospital in 2020-2021.Methods: Cross-sectional descriptive and prospective study. All women diagnosed with pelvic organ prolapse stage II or higher according to POP-Q criteria who underwent vaginal mesh placement surgery.Results: The study results of 47 cases of pelvic fractures showed that the average age of patients was 67 years old. The main anesthesia method was spinal anesthesia, accounting for 91.5%. The average surgery time was 97.1±21.2 minutes. The average blood loss during surgery was 70.2±55.5 ml. The average length of hospital stay was 6.1±1.9 days.Conclusions: The effectiveness of the surgical method of placing a synthetic vaginal graft for the treatment of female pelvic organ prolapse achieves a success rate of 95.7%. 98% of patients express satisfaction with this surgical method and are enthusiastic about recommending this surgical method to other women.