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Background: Tetanus is a life-threatening disease in developing country like India, with high morbidity and mortality rate. Though maternal and neonatal tetanus is eliminated, adult tetanus still remains in boom and is overlooked. Methods: An observational descriptive study using retrospective secondary data was undertaken among the patients admitted to a regional referral hospital to study the epidemiological factors influencing tet-anus, clinical features and the outcome of tetanus. Results: Analysis of 41 clinically diagnosed cases of tetanus showed that, majority were in 50-69 years of age group who resided in rural area and agriculture was their main occupation. Case fatality rate was 53.6% which revealed that mortality was the major outcome. And 95% of those infected were not aware of their immunization status. Conclusion: An early diagnosis, a proper wound management immediately after the injury, health edu-cation programs to create awareness among the public not to neglect even trivial injuries would definite-ly lead India to the path of elimination of adult tetanus. Strong emphasis is to be laid on adult immuniza-tion beyond the age of 10 years.
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Haemorrhoids are nowadays a very common anorectal disease in the community. It may be attributed to increased consumption of more refined and junk food by the present generation of people. We have been seeing symptomatic haemorrhoids as early as late teenagers, and early 20's. Well, there are plenty of treatment options available, among them, in our hospital we have been doing Ferguson's closed haemorrhoidectomy, but pain and urinary retention are frequently seen and sometimes troublesome requiring removal of per-anal pack overnight/Foley’s catheterization. And also, in those patients with tight sphincters, because of straining to pass the stools for the first time, the wound margins used to give away, converting into an open haemorrhoidectomy. Aim of this study was to assess the effect of sphincterotomy in patients undergoing closed haemorrhoidectomy, in terms of immediate post-operative pain and urinary retention.METHODSPatients who came with symptomatic haemorrhoids to our hospital during the period January 2018 to August 2019 were assessed and patients requiring haemorrhoidectomy were included in the study according to inclusion and exclusion criteria. Patients included in the study were randomly divided into 2 groups (without/with sphincterotomy) till target of 50 was achieved. Post-operative outcomes of pain and incidence of urinary retention was compared among the 2 groups.RESULTSOn analysing the data regarding severity of pain and incidence of urinary retention between the 2 groups, there was significant difference (p value <0.001) in perceiving pain on all the days of assessment, and incidence of urinary retention was significantly low in sphincterotomy group (p value 0.001).CONCLUSIONSDoing internal sphincterotomy at the base of haemorrhoidectomy wound significantly reduces the immediate post-operative pain and urinary retention following closed haemorrhoidectomy. So, when sphincter tone is high, it's better and safer to do sphincterotomy to alleviate immediate post-operative pain and urinary retention.
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Small intestinal anastomosis is a common GI procedure. Anastomotic leaks increase morbidity, mortality and hospital stay in patients undergoing bowel anastomosis. Understanding the risk factors associated with anastomotic leak not only helps to reduce the incidence of leaks but also to identify the patients who are candidates for creation of stomas. The aim of the study is to define the risk factors associated with anastomotic leak following small bowel anastomosis.METHODSA total of 74 patients who underwent small bowel anastomosis in our study period between September 2016 and December 2019 in Karuna Medical College, Palakkad, were prospectively followed up and divided into two groups, leak and non-leak group depending on occurrence of anastomotic leak. Many host and disease related factors known to influence the outcome of anastomosis were recorded in both groups and compared.RESULTSOut of 74 patients, 40 were males and 34 females. 10 patients were aged more than 60 years. 26 of them had perforation and peritoneal contamination. Out of 74, 67 were emergency surgeries and 7 were elective surgeries. 14 patients were anaemic, 19 were hyponatraemic and 12 were hypoalbunemic. In total, 13 patients developed anastomotic leak. Overall mortality and morbidity was 6.7% (5 patients) and morbidity was 40.5% (30 patients). Mortality in anastomotic leak group was 23% (3 patients).CONCLUSIONSHypoalbuminemia (P value- 0.016) and presence of peritoneal contamination (P value= 0.004) were found to significantly increase the risk of anastomotic leak in the present study. In the presence these risk factors, it is better to consider the patient for diverting stoma in emergency setting and consider improving patient nutritional status in elective setting.
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Introduction: Acute organophosphorus (OP) pesticidepoisoning is widespread and is the most common poisoningin many developing countries and vary in differentgeographic regions. Organophosphorus compounds are antiacetylcholinesterase’s which exert their toxicity by interferingwith the normal function of acetylcholine. So the present studywas done to assess the serum cholinesterase levels correlationwith clinical severity to determine the treatment outcome(Need for mechanical ventilation and mortality).Material and methods: A cross-sectional study wasconducted among 100 patients admitted with OPC poisoningin the department of general medicine, Velammal MedicalCollege Hospital and Research Institute, Madurai fromJanuary 2016 to July 2019. The diagnosis was made basedon history or evidence of exposure to OP compound within24 hours; Clinical severity was assessed and categorizedaccording to POP scale. Serum Cholinesterase values weredefined as per Proudfoot classification. IBM SPSS version 22was used for statistical analysis.Results: OP poisoning predominantly affected males in theage group 21 to 40 years. The majority had a moderate gradeof poisoning with Serum cholinesterase levels between 2001to 5000 (IU/l). In this study, the mortality was 25%, and 40%of patients had to be ventilated. There was no statisticallysignificant relationship between age, gender, clinical severity,time-lapse, Serum cholinesterase levels, mortality withmechanical ventilation. Mortality rate showed a statisticallysignificant relation with clinical severity (p<0.001).Conclusion: Clinical severity was associated with treatmentoutcomes. No particular trend of the association was observedbetween clinical severity and serum cholinesterase levels.Serum cholinesterase levels had shown no association withoutcomes
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Objectives: To evaluate the efficacy of curcumin preparation on the palatal changes associated with reversesmoking. Materials and methods: The study sample was divided into two groups with ten reverse smokingpatients each. Group A patients were advised to use curcumin oral gel on an acrylic palatal plate whereasgroup B patients were instructed about the benefits of smoking cessation. Clinical and cytological smearexaminations were performed at the first visit and at the end of the third visit. Data obtained was subjectedto statistical analysis. Results: Evident improvement with reduction in size and severity of the clinical lesionwas observed among the study group at both first and third visits (p < 0.001, significant). However, thecytological appearances remained the same in all the cases, except for three cases from the study group,which demonstrated a transition from moderate dysplastic features to milder dysplastic features (p = 0.28,not significant). Conclusion: Due to its diverse array of molecular targets, curcumin affords great potentialas a therapeutic agent for precancerous and cancerous conditions. Results from our pilot study have clearlyshown that curcumin is effective in the treatment of the palatal changes associated with reverse smoking.
Objetivos: Avaliar a eficácia da curcumina sobre as alterações palatais associadas ao fumo reverso. Materiaise métodos: A amostra foi dividida em dois grupos com dez pacientes fumantes cada. No grupo A os pacientesforam aconselhados a usar o gel de curcumina oral em uma placa de acrílico palatina, enquanto os pacientesdo grupo B foram instruídos sobre os benefícios da cessação tabágica. Exames de esfregaço citológico e examesclínicos foram realizados na primeira visita e no fim da terceira visita. Os dados obtidos foram submetidosà análise estatística. Resultados: Observou-se evidente melhora na redução do tamanho e na gravidadeda lesão clínica no grupo de estudo em ambas as visitas (p < 0,001, significativo). No entanto, a aparênciacitológica permaneceu a mesma em todos os casos, exceto em três casos do grupo de estudo, os quais demonstraramuma transição de características displásicas moderadas para leves (p = 0,28; não significativo).Conclusão: A curcumina, em virtude de seu conjunto diversificado de alvos moleculares, proporciona umgrande potencial como agente terapêutico para as condições cancerosas e pré-cancerosas. Os resultados donosso estudo piloto mostraram claramente que a curcumina é eficaz no tratamento das alterações palataisassociadas ao fumo reverso.