Comparative Study of Tamsulosin versus Placebo in the Management of Lower Ureteric Stone

Aim: This study aims to compare the effect of tamsulosin versus placebo in the management of lower ureteric stones.Material and Methods: A total of 100 diagnosed patients of lower ureteric stone from the period of June 1, 2018, to May 31, 2019(12 months), were taken for the study. The study group was divided into three groups, Group A taken tamsulosin 0.4 mg + steroids(deflozacort 6 mg), Group B taken tamsulosin 0.4 mg + dicyclomine 20 mg, and Group C dicyclomine 20 mg alone. The results ofthree group were compared by expulsion rate and expulsion time of stones. Chi-square test was used for calculating the effect.Results: The mean age of Group A was 38.46 ± 10.68 years, Group B was 33.87 ± 9.62 years, and in Group C 32.94 ± 7.07 years.There was no significant relation between ages in stone expulsion. The mean calculus size in Group A was 5.93 ± 2.12 mm, Group Bwas 6.00 ± 2.03 mm, and Group C was 5.00 ± 2.01 mm. P = 0.784 was not statistically significant. In Group A, 40% of stones were onthe left side and 29.7% on the right side, in Group B, 20% of stones were on the left side and 40% on the right side, and in Group C,40% of stones were on the left side and 30.7% on the right side. P = 0.126 is not statistically significant. The mean time taken for stoneexpulsion in Group A was 5.39 ± 1.94 days, Group B was 4.75 ± 2.03 days, and Group C was 6.76 ± 1.90 days. P = 0.006 (<0.05)is highly statistically significant. Hence, in the present study, in Group A, 29 patients out of 33 patients, in Group B, 28 patients outof 33, and in Group C, 22 patients out of 34 patients, the stone was expelled out. P = 0.040 (<0.05) is highly statistically significant.There was no statistically significant difference which was found between the three groups in age, size, and side of stone.Conclusion: The results of this study have shown a potentially important role of tamsulosin for conservative expulsive therapyof distal ureteral stones, broadening pharmacological indications rather than endoscopic treatments for the resolution of thisdisease. Obviously, further studies with larger number of cases are necessary to validate these promising and statisticallysignificant results. The comparison with minimally invasive procedures in terms of cost and efficacy was useful, highlighting apredominant role of first-line pharmacological treatment, which can be easily be provided in an outpatient setting and not onlyat large, technologically advanced, centers. The drug tamsulosin proved to be safe and effective as demonstr ated by the lowincidence of side effects and the increased stone expulsion rate and reduced expulsion time. Moreover, medical expulsivetherapy with tamsulosin considerably decreased the analgesic use, thereby reducing additional need for pain relief and servedas an effective bridge between watch-and-wait management and surgical intervention.

Methicillin-resistant Staphylococcus aureus-prevalence and Antimicrobial Sensitivity Pattern among Burn Patients in a Tertiary Care Hospital in Vindhya Region

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a well-recognized public health problem throughout theworld. The evolution of new genetically distinct community-acquired and livestock-acquired MRSA and extended resistance toother non-β-lactams including vancomycin has only amplified the crisis. This paper presents data on the prevalence of MRSAand resistance pattern to other antibiotics on the selected specimen from burn patients.Materials and Methods: This is a prospective study conducted in the burn unit of Shyam Shah Medical College and SanjayGandhi Memorial Hospital, Rewa (M.P.), from June 2018 to May 2019, where all patients with flame and scald burns wereincluded in the study who had up to a second degree or partial-thickness burns.Results: A total of 558 patients were admitted in the burn unit throu`ghout the year, the age ranged from 2 months to 85 years.About 56.10% were females and 43.90% were males. Pseudomonas aeruginosa (37.5%) was the most common isolatefollowed by S. aureus (18.75%). The prevalence of MRSA was 57.14% but all the MRSA isolates showed 100% sensitivity tovancomycin and linezolid closely followed by piperacillin and tazobactam combination. The prevalence of methicillin resistanceoverall among S. aureus and Staphylococcus epidermidis was found to be 51.72%.Conclusion: MRSA is prevalent among the burn wounds but is 100% sensitive to vancomycin and linezolid. To ensure earlyand appropriate therapy, routine microbiological surveillance and a regular update of their antimicrobial susceptibility patterncould help in the prevention of development of multidrug resistance.

A Clinical Study of Effect of Centchroman on Fibroadenoma

Background: Centchroman has been studied earlier and literature mentions it to be a novel non-steroidal, selective estrogenreceptor modulator, antiestrogen, and mild anti-inflammatory drug with a significant decrease in size of fibroadenoma. Ourstudy aims to check the reduction in the size of fibroadenoma in response to centchroman.Materials and Methods: A prospective observational study was carried out in patients of fibroadenoma attending surgeryoutpatient department and wards of Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa(Madhya Pradesh) from August 2015 to July 2016. Patients were included in the study after obtaining an informed consent.Patients were followed up for 12 weeks.Results: In our study, the maximum number of fibroadenomas was found in the left upper outer quadrant; of 102 patients,total lesions (fibroadenoma) were 130. Of 102 patients studied for the effect of centchroman on fibroadenoma, there was aresponse in 36 patients, which accounted for 35.29%. In 66 (64.8%) patients, there was no response after the treatment withcentchroman and they were subjected to excision and biopsy. The mean difference in volumes of fibroadenoma was statisticallyinsignificant. However, there was a reduction in size of mean volume of fibroadenoma which was 4.085 at the presentation andwhich was 3.24 at the end of the 12th week.Conclusion: Fibroadenoma was common in the age group of 21–30 years. The left breast was more involved in fibroadenomas.The most common site for fibroadenoma was the left upper outer quadrant. The effect of centchroman on decrease in volume offibroadenoma was seen in 35.29% of patients. Reduction in volume of fibroadenoma was statistically insignificant. More than 50%reduction in volume of fibroadenoma was seen only in 3 patients (2.94%). Surgical excision and biopsy were the preferred modalityof treatment for fibroadenomas in patients where the drug centchroman showed no response in regression in volume (64.8%).

Effect of Liquid Paraffin Gauze Dressing In Burn Wounds: A Prospective Study

Introduction: Burn injury causes a considerable amount of disability, prolonged hospital stay, and burden on the public healthsector. Main requirement in burn wound management is an economical, easy to apply, readily available dressing, or method ofcoverage that will provide good pain relief, protect the wound from infection, promote healing, prevent heat and fluid loss, beelastic, non-antigenic, and adhere well to the wound while waiting for spontaneous epithelialization of superficial partial thicknessburns. The sterilized paraffin gauze dressing is non-adherent and non-allergenic and helps in speedy recovery of burn wounds.Materials and Methods: A prospective study of 90 patients with partial thickness burns who were salvageable (≤40% bodysurface area), admitted to Burn unit of Shyam Shah Medical College and associated Sanjay Gandhi Memorial Hospital,Rewa from June 1, 2017, to May 31, 2018. The autoclaved liquid paraffin gauze was applied over burn wound. Patients wereassessed on the basis of subsidence of pain, time of epithelialization if occurred after liquid paraffin gauze dressing. Patients’blood investigations were noted and the assessment of the effect of hemoglobin (anemia) and platelet counts in burn woundhealing in terms of mean epithelialization time were done.Results: Mean epithelialization time was 16 days. In 25% of cases epithelialization developed in 10–12 days. Post-burn painsubsided in 4–6 days in maximum in 54.44% cases. Mild and moderate anemia had no significant effect on wound healingtime (mean epithelialization time). Patient with less than normal platelet counts (<1.5 lakh/cumm) had more epithelializationtime and with normal platelet count had less epithelialization time. 15 patients developed complications and most commoncomplication was hyper granulation (11.11%).Conclusion: Burn wounds pose a great burden on health-care infrastructure and burn units. We can conclude that liquid paraffingauze dressing has good patient acceptability and less painful, it is easily available and relatively less expensive. In developingand resource-poor countries, most of the patients are from the rural background so these patients will need a dressing that isrelatively less expensive and easily available such as liquid paraffin gauze dressing.

Study of Peripheral Vascular Disease in Patients with Diabetic Foot using Doppler Ultrasound

Objective: The objective of the study was to determine the extent of vasculopathy in patients with diabetic foot using Dopplerultrasound scanning.Methodology: This descriptive study was carried out in surgical wards SS Medical College and SGMH Rewa from June 1,2017, to May 31, 2018. All patients having diabetic foot complications including abscess formation, cellulitis, ulceration, andgangrene were included in the study after taking informed consent. Peripheral pulses such as posterior tibial, dorsalis pedis,and popliteal arteries were checked. The presence of vasculopathy was checked with Doppler scanning of dorsalis pedis artery,posterior tibial artery, and popliteal artery. The data were collected on a pro forma that was especially designed for this study.Results: A total of 115 patients were included in this study. Out of total cases of the diabetic foot, 21% of cases peripheralpulses were not palpable, 30% of cases were weakly palpable, and in 50% of cases were palpable. In right affected limb outof 66 affected limb, peripheral pulses were palpable in 45% of cases, weakly palpable in 32% of cases, and absent in 23% ofcases and left affected limb out of 49 affected limb peripheral pulses were palpable in 55% of cases, weakly palpable in 26%of cases, and absent in 19% of cases, with a male preponderance.Conclusion: This study shows that vasculopathy is a strong independent risk factor in the development of diabetic foot lesions.The usual symptoms and signs of lower limb ischemia may not be present and indeed may be misleading in diabetic foot disease.

A Comparative Study Between Laparoscopic Appendectomy and Conventional Open Appendectomy

Objective: A comparative study between laparoscopic appendectomy and conventional open appendectomy (OA). Materials and Methods: Our study was carried out on 88 patients admitted in surgical wards of Sanjay Gandhi Memorial Hospital associated with S. S. Medical College Rewa, Madhya Pradesh. Patients of acute and/or recurrent appendicitis, or cases who came for interval appendectomy, admitted through casualty or transferred from other department or reported in OPD during the period of study were included in the study. Detailed history and clinical examination, baseline blood investigations, and radiological investigations were done. Initial conservative management, including IV fluid resuscitation with Ringer’s lactate solution/Foley’s catheterization/nasogastric intubation, was done as per need. Operative procedure (laparoscopic appendectomy or OA) was planned and performed as per the patient choice and patient’s consent of that particular operation and patient’s pre-operative condition. Both procedures were compared in relation to duration of operation, post-operative pain, postoperative hospital stay, complications, conversion rate, time taken for return to normal activity, diagnosis of additional pathologies, relief of symptoms, and cosmesis. Result: Laparoscopic appendectomy is better as compare to OA in relation to post-operative pain, post-operative hospital stay, early return to normal activity, diagnosis of additional pathologies (especially in female patients and patients with diagnostic uncertainty), and subjective cosmesis. Disadvantage of laparoscopic appendectomy is longer mean operating time and conversion into OA. Overall complication rate and relief of symptoms are similar in laparoscopic and OA group. Conclusion: Laparoscopic appendectomy is thus a safe, simple, and efficient technique for treatment of appendicitis in experienced hands. Cases with unsure anatomy due to adhesions were the most difficult to complete lap

Role of Diagnostic Laparoscopy in Chronic Abdominal Pain and Its Correlation with Clinical and Radiological Findings

Background and Objective: Diagnostic laparoscopy is an emerging tool in diagnosis of chronic non-specific abdominal pain, the diagnosis of which remains uncertain despite employing the requisite laboratory and non-invasive imaging investigations. The aim of our study was to evaluate the role of diagnostic laparoscopy in chronic abdominal pain and its correlation with clinical and radiological finding. Materials and Methods: Our study was carried out on 48 patients admitted in surgical wards. All patients having chronic abdominal pain were included in the study, and patients with acute abdominal pain, with an uncorrectable coagulopathy, or uncorrectable hypercapnia and pregnant females were excluded from the study. Detailed history, examination, baseline blood, and radiological investigations were done to reach to diagnosis. Patients were subjected to diagnostic laparoscopy, and the necessary surgical therapeutic interventions during laparoscopy were employed as per the etiology after taking informed written consent. The usefulness of laparoscopy to confirm the diagnosis and clinical management of these patients of chronic abdominal pain was evaluated. Result: The incidence of chronic abdominal pain was almost equal in both genders. Peak incidence was seen in the age group of 31–40 years. Koch’s abdomen was the most common finding during laparoscopy followed by chronic/recurrent appendicitis. Definitive diagnosis was made in 43 patients, and 38 patients had shown resolution of pain after diagnostic laparoscopy. Conclusion: Laparoscopy offers a definitive diagnosis in a large number of patients of chronic abdominal pain and also provides therapeutic intervention. An early resort to laparoscopy can resolve the diagnostic dilemma and early treatment can be instituted.

Liver Abscess Management Based on Ultrasonographic Parameters: Conservative Versus Intervention

Background: Liver abscess is the most common infection affecting the liver. Amoebic liver abscess is more common than pyogenic liver abscess on a global scale. Younger age, recent travel to areas of endemic amoebiasis, diarrhea, and marked abdominal pain raise the clinical suspicion of amoebic abscess. Pyogenic liver abscess is still a serious illness and a diagnostic challenge. Antibiotics and antiamoebics are the basis of the effective therapy for liver abscess depending on the underlying cause. Aims: The aim is to study the role of ultrasonographic parameters to determine management and to study the efficacy of conservative management in patients with small abscess cavity. Material and Methods: The study was carried out in Sanjay Gandhi Memorial Hospital associated with S.S. Medical College, Rewa (M.P.), on 100 patients of liver abscess during from June 1st, 2016 to May 31st, 2017. Ultrasonography (USG) was done on all patients. Patients with the volume of abscess cavity <150 cc were subjected to conservative management and those with the volume of abscess cavity >150 cc underwent intervention. Result: The success rate of conservative management was 91.18% in patients with volume of abscess cavity <150 cc. Thus, we can go for conservative management in patients with small abscess cavity. Conclusion: USG plays a major role in both diagnosis as well as treatment of the disease. The improvement demonstrated by this study may be attributed to earlier diagnosis and earlier intervention. The basic key to avoid this disease is to maintain a good and healthy lifestyle

Comparative Study of Lateral Internal Sphincterotomy and Diltiazem 2% Topical Ointment in the Treatment of Chronic Fissure in Ano: A Prospective Study.

Introduction: Anal fissure was first described by Recamier in 1829. It is a linear ulcer in the anoderm. Anal fissures are most commonly seen in young adults and have a slight female preponderance. Although a relatively minor entity, the morbidity in the general population is very large. Our knowledge of the pathophysiology and management of anal fissure has rapidly progressed over the past 15 years. All methods of treatment aim to reduce the anal sphincter spasm and aid in pain relief and healing of fissure. Aim: The main aim of this study is to compare the efficacy of topical 2% Diltiazem ointment and lateral internal sphincterotomy (LIS) in the management of chronic fissure in ano. Materials and Methods: This is a prospective study of 70 patients with chronic fissure in ano. A number of 35 patients were treated with diltiazem (2%) topical ointment and 35 patients were treated with LIS. The effectiveness of both treatment modalities was assessed on 2, 4, and 6 weeks follow-up. Result: Healing of fissure was complete in 24 (68.7%) patients of topical diltiazem group and 33 (94.28%) patients of LIS group after 6 weeks of treatment. A maximum number of patients (97.14%) achieved symptomatic relief who underwent LIS at 4 weeks follow-up. Patients who underwent LIS had an immediate pain relief when compared to those who were treated with topical diltiazem 2% ointment. Both topical diltiazem 2% ointment and LIS were equally effective in reducing bleeding per rectum in patients with chronic fissure in ano. Conclusion: Time taken for fissure healing in topical diltiazem group is long in comparison to LIS group. Surgical treatment with LIS is the treatment of choice in chronic fissure in ano.

Pattern of Pediatric Trauma in Rural Background of Central India.

Background: Trauma is emerging as an epidemic and a leading cause of morbidity and mortality in children. Children <15 years of age comprise about 32.8% or 1/3th of the total Indian population. In India, up to one-fourth of hospital admissions and approximately 15% of deaths in children are due to injury. The burden of child injuries in India is not clearly known, as there is a lack of proper trauma database in India and even in Indian studies the population covered was metro city based. Aim: The present study aims to analyze the different aspects related to trauma in children particularly from rural background. Materials and Methods: A prospective, observational study was carried out in 510 patients of the age group 0-15 years admitted to the surgical wards of a tertiary care hospital, with a history of trauma during the period from August 2013 to July 2014. Results: Incidence of pediatric trauma was found to be 20.08%. The cases among males were 297 (58.24%) and females were 213 (41.76%) with male:female ratio of 1.39:1. Road traffic accidents (RTA) 32.15% and fall from height (30.78%) were the most common modes of injury. Isolated head injuries 216 (60.5%) were the leading type of injuries. Poly-trauma patients had the highest mortality rates. Conclusion: RTA and fall from height are the most common causes of pediatric trauma. Pediatric trauma and injury are preventable conditions. Educating the health care providers about the pediatric trauma care centers and the establishment of the same at nodal or tertiary care centers is advisable for the proper treatment of pediatric trauma victims. The management of pediatric trauma is specialized teamwork.