ABSTRACT
Antecedentes: Enhanced recovery after surgery (ERAS) mejora la recuperación tras la cirugía. El objetivo de este estudio fue determinar si ERAS causa una reducción de la estancia hospitalaria y mejora la recuperación funcional global tras la cirugía de cáncer de cabeza y cuello. Métodos Realizamos un estudio prospectivo de control de casos histórico tras la aplicación de ERAS. La base de datos del hospital seleccionó 50 pacientes elegibles confirmados para el grupo control no ERAS, incluyéndose prospectivamente 54 pacientes en el grupo ERAS. El resultado primario fue el tiempo transcurrido hasta la disposición al alta (TRD), siendo los resultados secundarios la duración de la estancia hospitalaria (DEH), la tasa de reingreso de hasta 30 días y la puntuación QoR-15 (Quality of recovery). Los datos fueron comparados mediante pruebas paramétricas y no paramétricas adecuadas. Resultados Los datos demográficos basales de los pacientes fueron comparables entre ambos grupos. Los pacientes del grupo ERAS reflejaron un TRD significativamente más breve, en comparación con el grupo no ERAS: 8 (6-10) frente a 11 (8-16); p=0,002. La DEH fue también significativamente más corta en el grupo ERAS en comparación con el grupo no ERAS (8 [7-11] frente a 12 [9-17]; valor p=0,002). El reingreso en el plazo de 30 días no fue diferente, con una cifra de 6 pacientes en cada grupo. La puntuación QoR-15 fue estadísticamente mejor en el grupo ERAS (94,88±12,50) en comparación con el grupo no ERAS (85,44±12,68; p <0,001). Conclusión La implementación del programa ERAS redujo el TRD y la DEH, mejorando la puntuación QoR-15 sobre el resultado de la recuperación reportado por el paciente en las cirugías de cáncer de cabeza y cuello. (AU)
Background: Enhanced recovery after surgery (ERAS) improve recovery after surgery. This study aimed to determine whether ERAS leads to a decrease in stay in the hospital and improves global and functional recovery after head and neck neoplasms surgery. Methods We performed a prospective case and historical control study after the ERAS application. The hospital database selected 50 confirmed eligible patients in control non-ERAS group. Prospectively 54 patients were included in the ERAS group. The primary outcome was time to readiness for discharge (TRD); secondary outcomes were the length of stay (LOS), readmission rate of up to 30 days and Quality of recovery score QoR-15. Data were compared with appropriate parametric and nonparametric tests. Results Baseline demographic data of patients were comparable between the two groups. Patients in ERAS group had significantly shorter TRD compared to the non-ERAS group 8 (6-10) versus 11 (8-16); P=.002. LOS was also significantly shorter in the ERAS group compared to the non-ERAS group (8 [7-11] versus 12 [9-17]; P=.002). Readmission at 30-days was no different, with six patients in each group. QoR-15 score was statistically better in ERAS group (94.88±12.50) compared to non-ERAS group (85.44±12.68; P<.001). Conclusion Implementing the ERAS programme decreased TRD and LOS and improved patient-reported recovery outcome QoR-15 in head and neck neoplasms surgery. (AU)
Subject(s)
Humans , Head and Neck Neoplasms/surgery , Length of Stay , Patient DischargeABSTRACT
BACKGROUND: Enhanced recovery after surgery (ERAS) improve recovery after surgery. This study aimed to determine whether ERAS leads to a decrease in stay in the hospital and improves global and functional recovery after head and neck neoplasms surgery. METHODS: We performed a prospective case and historical control study after the ERAS application. The hospital database selected 50 confirmed eligible patients in control non-ERAS group. Prospectively 54 patients were included in the ERAS group. The primary outcome was time to readiness for discharge (TRD); secondary outcomes were the length of stay (LOS), readmission rate of up to 30 days and Quality of recovery score QoR-15. Data were compared with appropriate parametric and nonparametric tests. RESULTS: Baseline demographic data of patients were comparable between the two groups. Patients in ERAS group had significantly shorter TRD compared to the non-ERAS group 8 (6-10) vs 11 (8-16); p-valueâ¯=â¯0.002. LOS was also significantly shorter in the ERAS group compared to the non-ERAS group [8 (7-11) vs 12 (9-17); p-valueâ¯=â¯0.002]. Readmission at 30-days was no different, with six patients in each group. QoR-15 score was statistically better in ERAS group (94.88⯱â¯12.50) compared to non-ERAS group (85.44⯱â¯12.68) [p valueâ¯<â¯0.001]. CONCLUSION: Implementing the ERAS programme decreased TRD and LOS and improved patient-reported recovery outcome QoR-15 in head and neck neoplasms surgery.
Subject(s)
Enhanced Recovery After Surgery , Head and Neck Neoplasms , Humans , Retrospective Studies , Perioperative Care , Length of Stay , Head and Neck Neoplasms/surgeryABSTRACT
To see the radiological anatomy of inner ear malformations in hearing impaired children. This study was a prospective observational study done at a tertiary care teaching hospital in north India. The included were children of 1-7 years with first time detected severe to profound SNHL. The evaluation of hearing was done by brainstem evoked response audiometry. Those with history of chronic suppurative otitis media and conductive hearing loss were excluded. The all included were undergone high resolution computed tomography of the tympano-mastoid region. A written informed consent was taken. The institutional ethics committee approved the study protocol. We screened 130 children of 1-7 years of age with complaints of severe to profound hearing impairment (SNHL) by BERA. We excluded 38 and 14 children who had conductive hearing loss with or without CSOM and did not give consent, respectively. Among recruited 78 children, 47 (60.3%) had severe (71-90 dB) and 31 (39.7%) had profound (> 90 dB) SNHL. The majority of children (60/78, 76.9%) had a bilateral hearing impairment, only 18 (23.1%) had unilateral hearing impairment. The mean ± SD of age was 3.9 ± 1.3 years (95% CI = 3.6-4.2). The incidence of severe to profound SNHL was higher, though not statistically significant among the girls. Only 7.7% children with severe to profound SNHL were detected within first 2 years of life. Most of the children (92.3%) with severe to profound SNHL were detected after 2 years of age. Among 78 with severe to profound SNHL, 16 (20.5%) children had structural anomalies in their internal ears. Only 2 (6.9%) ears had single anomaly, others (27, 93.1%) had multiple anomalies. A maximum number of anomalies found in one ear were 5. The most common anomalies were found in the vestibule. The total number of anomalies were 115. Five children (6.4%) with severe to profound SNHL had craniofacial dysmorphism. Approximately 20% of children with severe to profound SNHL have congenital anomalies in their internal ears. It is crucial to know these anomalies before planning of CI. HRCT of tympano-mastoid is the first modality to know these anomalies. MRI should also be included to know the details of vestibulocochlear nerve. Since, the neurocognitive outcome would be the best if CI will be done as early as possible preferably around 1 year of age. Therefore, children must be screened at the appropriate age, firstly by OAE followed by BERA.
ABSTRACT
Schwannomas are benign tumor of the schwann cells. These are common in eighth, tenth cranial nerves and parasympathetic chain. Hypoglossal schwannomas are rare. Among the hypoglossal schwannomas the intracranial and dumb-bell shaped schwannomas are frequent but extra cranial hypoglossal schwannomas are rare. We describe a parapharyngeal hypoglossal schwannoma in a 25 years female presenting as slow growing mass in right side of the neck.
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OBJECTIVES: To assess the effect of risk factors tobacco, alcohol, and smoking habits in oral precancer patients with epithelial dysplasia status. MATERIAL AND METHODS: The study sample included biopsy proven cases of 29 oral submucous fibrosis (OSMF) and 43 cases of clinical leukoplakia. Histopathological diagnosis was made from formalin fixed paraffin embedded tissues as per WHO criteria. The relevant clinical and demographic details were recorded after interviewing the patients. Risk for tobacco, alcohol and smoking was determined by logistic regression analysis by SPSS software. RESULTS: Presence of epithelial dysplasia was significantly associated with tobacco in OSMF & both tobacco and smoking habits in leukoplakia. In OSMF tobacco was associated with 14.16-fold (95% CI, 1.36-147.07; p < 0.026) and in leukoplakia tobacco was associated with 4.66-fold (95% CI, 1.00-21.63; p < 0.047) and smoking was associated with 9.20-fold (95% CI, 1.65-51.28; p < 0.011) increased risk of epithelial dysplasia. CONCLUSION: Tobacco consumption was independent risk factor for epithelial dysplasia in OSMF and both tobacco and cigarette smoking were independent factors for epithelial dysplasia in leukoplakia.
ABSTRACT
Nasal myiasis is a manifestation of the nasal cavities by larvae of the fly of genus Chrysomia. It is prevalent in tropical countries. Atrophic rhinitis is the most commonest predisposing factor for this condition. The maggots can cause extensive erosion of the nose, face and intra-cranial structures occasionally causing meningitis and death. Conservative management by packing the nose with a chloroform and turpentine (1:4) mixture followed by manual removal of the dead maggots is an effective method. Recurrence is known but partial closure of both nostrils to improve the condition of nasal mucosa is the important part of management.
