PROSPECTIVE COMPARATIVE STUDY OF CONSERVATIVE VERSUS OPERATIVE MANAGEMENT AMONG PATIENT WITH CELLULITIS

INTRODUCTION: Cellulitis is a bacterial infection of the skin and subcutaneous tissuethat is more generalized than erysipelas and associated with broken skin and pre-existingulceration. Mild cases of cellulitis are generally treated with oral antibiotics, GlycerinMgSO4 dressing & affected part elevation and severe cases required admission & higherantibiotics, skin & blood culture & sensitivity & in case of systemic symptoms & abscessoperative management is required.AIMS AND OBJECTIVES:• To observe the outcome of conservative and operative patients in view ofcomorbidity and after treatment complications.• Following factors are accounting before conclusive outcome.• To understand the patients characteristics, comorbidity and mode of presentation.• To study spectrum of organism isolated from patient undergoing conservative oroperative management.• To compare treatment modality and outcome in management of cellulitis.MATERIAL & METHODS: Data consists of primary data collected by the principalinvestigator directly from the patients who were admitted from OPD in the GCS medicalcollege and hospital. It was observational study for a period of six months from April2022 to September 2022 under sample size was 50 cases.CONCLUSION: We recommended Operative management over Conservativemanagement in cellulitis because single operative incision can release toxic fluid fromaffected part and can promote faster healing and better recovery and less hospital stay.Patient has less mental trauma, less pain and more economical benefits in Operativemanagement therefore study concludes Operative management is superior Compared toConservative management. However, conservative management is preferable in earlystages of cellulitis.

Evaluation of Radiological and Functional Outcome of Intra-articular Proximal Tibia Plateau Fracture Treated with Plating

@#Introduction: Proximal tibial plateau fractures are one of the major problems in orthopaedic surgery and are associated with high complication rates. Intra-articular proximal tibia plateau fractures represent approximately 1% of fractures in adults. Various modalities of proximal tibial plateau fracture management have been considered, ranging from simple external fixators in impending compartment syndrome to periarticular proximal tibia plates and inter-locking nails with poller screws. Purpose of this study is to determine clinical outcomes of proximal tibial plateau fractures treated with plate. Materials and methods: We did this study of proximal tibial plateau fracture according to Schatzker’s classification treated with proximal tibial periarticular plates in 53 patients prospectively admitted at the author’s institute from June 2018 to May 2020 with follow-up period of 6 months. Results: In our study, the average knee score was 89.30 (ranging from 79 to 93) and functional knee score was 97.92 (ranging from 75 to 100). Fifty-one (51) patients (96.23%) showed excellent results and 2 patients (3.77%) showed good results according to Knee Society Score, which suggest that internal fixation of proximal tibia plateau fracture with plating provides better results. Out of 53 patients, 9 patients had post-operative complications. Average radiological union was seen at 14 weeks. Conclusion: Locking compression plate in proximal tibia plateau fractures act as a good biological fixation provide stable fixation, articular reduction and limb alignment even in difficult fracture situations. Fixation of proximal tibia plateau fractures with plate gives excellent to good knee society score, with satisfactory functional and radiological outcome.

Comparative study in patients of vaginal and cervical discharge:SYNDROMIC VS. EVIDANCE BASED MANAGEMENT

IntroductionThe syndromic management has been the cornerstone of management of sexually transmitted infections (STIs) over the last few decades especially in developing countries. But due to its inability to treat asymptomatic cases leading to undesirable sequeale, it has received a lot of criticism recently. On the other hand, Evidence based management of patients of vaginal and cervical discharge has lead to effective and timely management of these patient but has increased the financial burden.Objective:The goal of the study is to compare syndromic vs. Evidence based approach in the management of vaginal and cervical discharge.Method:The present study was conducted in the outpatient department of dermatology, venereology & leprology of a tertiary care teaching hospital. 354 patients of clinical impression of vaginal and cervical discharge were included in the study. Detailed history and examination was recorded. Patients selected for syndromic management were managed as per NACO guidelines. For evidence based management special investigations were carried out and patients were managed accordingly.Result:Out of total 342 cases of VD, treated with syndromic and evidence based approach, p value is significant for 7,14 and 21 days follow-up which means evidence based approach is better than syndromic approach. Similar findings were observed in patients of cervical discharge.Also, among CVV patients managed on lines of syndromic approach only 10% showed improvement by end of one week.Conclusion:The control of STIs in resource-poor settings remains a major challenge.Focus is now shifting towards a diagnostic model of STI care, given the improving economic status of developing countries and availability of affordable point-ofcare testing. Also, various changes in the syndromic approach are needed immediately for it to still remain relevant.

A PROSPECTIVE COMPARATIVE STUDY OF CONSERVATIVE AND SURGICAL MANAGEMENT OF VARICOSE VEINS

Introduction : Varicose Veins are Defined as “ Permanently Elongated, Dilated vein/veins withtortuous path causing pathological circulation”.Varicose veins can develop anywhere in the bodybut are most commonly seen in the lower limbs. A detailed knowledge of the mechanism ofhemodynamic failure and the underlying anatomy is important in deciding treatment of the patientwith chronic venous disease.Methodology : The aim of this study was to determine the correlation between differentcomplications of varicose veins and Recurrence rate of Complications with the treatmentundergone by the patient. Total 30 patients were randomly assigned to Conservative management(i.e. Limb End Elevation, Elastic Stockings Application & Intermittent Bed rest to avoid prolongedStanding) or Surgical management (i.e. Trendelenburg Operation with Great Saphenous VeinStripping).Special focus was given to the follow-up visit of the patients who were asked to be present forreview every week, till two months so as to be vigilant regarding the occurrence of complications.Results : Out of 30 patients, 15 were treated surgically while 15 were treated conservatively. Eleven(11) patients in total developed some complications in post treatment part. The commonestcomplication observed in post surgical patients was haematoma. Recurrence of Varicosity wasseen in 4 patients who were previously managed conservatively. A single case of wound infectionand ulcer formation were observed in each respectively. Out of the 11 patients who had developedsome complications, 5 patients had undergone surgical management, while 6 patients hadundergone conservative management.Conclusion : Surgical Intervention is better than conservative management in Varicose veins. Therate of complications / recurrence over a 2 months period was less in the surgical group than in thegroup managed by conservative therapy.

COMPARISON OF TWO SECOND GENERATION SUPRAGLOTTIC AIRWAY DEVICES I-GEL VERSUS LMA PROSEAL IN PATIENTS UNDERGOING ELECTIVE SURGERIES.

INTRODUCTION:Management of airway is one of the primary responsibilities of anesthesiologist1.Supraglottic airway devices have become a standard fixture in airway management, filling aniche between the face mask and tracheal tube in terms of both anatomical position anddegree of invasiveness. They have separate gastric channel to reduce regurgitation &pulmonary aspiration2.Proseal LMA has unique double cuff arrangement, main cuff is inflated to seal the laryngealopening and additional pharyngeal cuff helps to improve the airway seal which make thePLMA ideal for positive pressure ventilation. ‘I-gel’ is a non-inflatable supraglottic airwaydevice designed to avoid compression trauma.Objectives of the study were Quality of insertion, Complications duringinsertion, Quality of airway sealing, Analysis of hemodynamic parameters, Postoperative complications.METHODS: Total 60 patients were divided in 2 groups: A & B. Airway secured with I-gel& PLMA respectively.Ease of insertion of devices, airway sealing quality score, ease & number of attempts ofgastric tube insertion were noted.RESULTS: I-gel is better than PLMA in term of faster & easy insertion requiring lessmanipulation with low incidence of complications during insertion, less hemodynamic stressresponse and lower postoperative complications.CONCLUSION: Among the second generation supraglottic airway device I-gel is a better &safe alternative to PLMA during elective surgeries

Evaluation of Results of Open Reduction and Internal Fixation (ORIF) of Fracture of Distal End of Femur with Intra-Articular Extension

@#Introduction: Fractures of the distal femur account for 0.4% of all fractures. They involve about 7% of all femur fractures, with bimodal age distribution, commonly occur during high-velocity trauma of motor vehicle accidents in the younger group of patients and are frequently associated with other skeletal injuries. The treatment of distal femoral fractures has evolved from conservative treatment to more aggressive operative treatment. The aim is to achieve and maintain a good reduction of the joint to allow early active mobilisation, thus minimising the joint stiffness and severe muscular atrophy encountered in the conservative treatment. Materials and methods: This is a retrospective study of 25 patients with distal femur fracture with intra-articular extension treated with open reduction and internal fixation with DFLP, admitted at our institute between 2016 to 2019, with a minimum follow-up of six months. Results: In our study, 19 (76%) patients had excellent to good results. Three (12%) patients had fair outcomes, and three (12%) patients had poor outcomes according to Neer’s score. The average time for bone union in closed fractures was earlier (4.25 months) than open fractures, averaging 5.86 months. The outcome was almost similar between closed and open fractures. There were 2 (8%) cases of infection in the early post-operative period, 7 (12%) patients suffered from knee stiffness, and there were 3 (12%) cases with a pre-operative bone loss that required bone grafting. Conclusion: Management of complex intra-articular distal femur fracture has always been a challenge. Anatomical reduction of articular fragments and rigid fixation of these fractures are a must. DFLP provides angular stability with multiple options to secure fixation of both metaphyseal and articular fragments with the restoration of the joint congruity, limb length, alignment and rotation, allowing early mobilisation and aggressive physiotherapy without loss of fixation, resulting in gratifying functional outcome and low complication rate.

A Comparative Study of Laboratory Diagnosis ofGenital Chlamydial Infections InWomen By Immunofluorescence And By Conventional Staining Method.

Objective: The major objective of this study was to carry out concurrent testing of cervical swab samples with both conventional and fluorescent staining method using Giemsa stain & direct fluorescent antibody stain (DFA) respectively. The study would enable us to establish an appropriate, effective and sensitive method of diagnosis of genital chlamydial infections within the present set-up.Material & methods: The study “A Comparative Study of laboratory Diagnosis of Genital Chlamydial Infections in Women by Immunofluorescence and Conventional Staining Method” was conducted on 50 patients attending the OPD of a tertiary care hospital of Ahmedabad. Results: Out of the total 50 cases tested, four samples were found positive containing dark-purple inclusion bodies of Chlamydia trachomatis surrounding the nuclei of the host cells in Giemsa and the same were positive for elementary bodies of C. trachomatis by the DFA staining. Based on these samples, the prevalence of is 8% only.Conclusion: The present comparative study of Giemsa and DFA staining for Chlamydia trachomatis infections in females showed that both methods are equally sensitive for the detection of the microorganism.