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A Comparative study on the Efficacy of Povidone-Iodine and Chlorhexidine as Skin Antiseptic Agents for Reducing Surgical Site Infection following Caesarean Delivery
Full text linkCaesarean delivery is considered to be a major obstetrical surgical procedure that aims at saving the lives of both mothers and fetuses. Even though many complications may accompany a Caesarean delivery, the most common complication is surgical site infection (SSI). The rate at which SSI occurs after Caesarean delivery varies from 3% to 15% across the world.
▪ SSI that accompanies a Caesarean delivery may escalate the rate of maternal mortality and morbidity. Additionally, for a mother who is trying to recover from the Caesarean procedure, the occurrence of SSI could be quite frustrating. There is a possibility that it may lead to an unnecessary extension of maternal hospitalization. As a result, the cost associated with health and personal care may increase and there may be other socio-economic repercussions.
▪ It has been reported that identifying risk factors, specifically those factors which can be adjusted like appropriate skin preparation prior to the surgery and utilization of well-defined surgical techniques have proven to have a direct impact on the rate of surgical site infections. The present study is to compare the effect of Povidone-Iodine and Chlorhexidine in lowering the risk of SSI after caesarean section and to assess the effects of Povidone-Iodine and Chlorhexidine in patients with obstetric high-risk factors such as obesity, Gestational diabetes, Gestational hypertension, previous Caesarean section, Premature Rupture of Membrane, Chorioamnionitis and Medical comorbidities like Anemia, hypothyroid, heart disease, seizure disorder, bronchial asthma and renal disorder.
▪ The study involved 940 pregnant women, split into two groups of 470 each. One group received Povidone-iodine and the other group received Chlorhexidine for pre-operative skin preparation. Out of the 940 participants, 43 of them had Surgical Site infection after Caesarean delivery, which comprises about 4.57% of the entire population. Out of the 43 patients who had surgical site infections, 29 (6.17%) belonged to the Povidone-Iodine group and 14 (2.97%) belonged to the Chlorhexidine group. Hence, it was concluded that the use of Chlorhexidine for preoperative skin preparation significantly reduces the degree of surgical-site infection post caesarean delivery, when compared to Povidone-Iodine.
▪ The subgroup analysis, which was conducted to compare the effects of Povidone-Iodine and Chlorhexidine in patients that come under high-risk categories, revealed that the number of positive SSI cases was similar in both the study groups for all the high-risk category patients. The most common organism causing wound infection in our institution was found to be ‘Escherichia Coli’, which was sensitive to ‘Piperacillin tazobactam’
Role of Single Serum Progesterone Level in Predicting Continuation of Pregnancy in Early Threatened Miscarriage
No full textINTRODUCTION:
Nearly 20-25% of pregnant women have some degree of vaginal bleeding during the first 20 weeks of pregnancy and about 50% of these progress to an actual abortion. Progesterone is a hormone that aids in the preservation of pregnancy. Progesterone production in early pregnancy reflects the interaction between the trophoblast and corpus luteum. There is positive feedback between the rise in serum β‐hCG and progesterone production by the corpus luteum. It has been reported that spontaneous pregnancy failure decreases with increasing maternal serum progesterone levels. Predicting continuation of pregnancy is crucial in cases of threatened abortion in order to provide appropriate care and effective management.
OBJECTIVES:
To study the role of single serum progesterone levels on day of threatened miscarriage to predicting continuation of pregnancy. To study the relationship between continuation of pregnancy in early threatened miscarriage and risk factors like anemia, body mass index.
MATERIAL & METHODS:
The study involved 160 study participants, pregnant women with less than or equal to 12 weeks of gestation with complaint of spotting or bleeding PV. Patients with Pregnant mother more than 12 week of gestation, Inevitable miscarriage, Ectopic pregnancy, Multiple Pregnancy, Molar Pregnancy, Pregnancy by artificial reproductive technique, Anomalous uterus, Multiple Fibroid complicating pregnancy[except sub serosal type] were excluded from the study. After obtaining informed consent basic sociodemographic and clinical history was recorded.3 ml of venous blood was collected from the pregnant women. Serum progesterone and hemoglobin levels were assessed from the obtained blood samples. The data was entered and analyzed using SPSS software package (Version 24). Graphs and tables were generated using Microsoft Excel.
RESULTS:
The results from our present study showed that the mean age for the study participants was 25.3± 4.08 years. Majority (76.6%) of the participants were in the age group between 20-30 years of age. Primi mothers constituted 47.5% of the study population. The most common presenting symptom in the study population was bleeding per vagina and Spotting per vagina which constituted 46% of the total study population each. Anemia was observed in 22.6 % of the study population. The mean hemoglobin value was 10.23±1.1 g/dl. The mean serum progesterone value was 19.76±9.3 ng/ml. Increased values of serum progesterone levels had a significant association with the continuation of pregnancy while no significant association was noted between hemoglobin levels, body mass index and outcome of pregnancy.
CONCLUSION:
Serum progesterone levels could be used as an effective diagnostic tool in aiding the diagnosis of viable pregnancies. The estimation of serum progesterone levels at a single point also alleviates the patients of inconvenient procedures and is also a cost effective alternative
Correlation of Reid's Colposcopic Index (RCI) with Histopathology in Identifying Cervical Intraepithelial Neoplasia (CIN): A Prospective study
No full textBACKGROUND:
Cervical cancer being a global health problem, is the leading cause of death in women in developing countries. WHO projections in 2005 says that over 5,00,000 new cases of cervical cancer are being identified, of which over 90% were from developing countries. Screening procedures include Pap smear, HPV DNA testing, visual inspection with acetic acid and visual inspection with lugol’s iodine. However, colposcopy remains the gold standard for assessing the validity of all the screening procedures. Reid Colposcopic Index (RCI), an objective index to make colposcopic diagnosis less subjective. This study was mainly undertaken to identify and evaluate the diagnostic efficacy of colposcopy using RCI and to determine the degree of correlation between colposcopic impression and histopathology.
AIMS AND OBJECTIVES:
1. To estimate the diagnostic efficacy of colposcopy.
2. To determine the strength of correlation between Reid's colposcopic index and histopathological report in determining cervical intraepithelial neoplasia.
MATERIALS AND METHODS:
All women with VIA and VILLI positive from general OPD are sent to Colposcopy room .After obtaining informed consent for the study from the patients in the colposcopy room, colposcopy and biopsy are performed. Adequate colposcopy was defined when all four quadrants of cervix visible. The margins of the atypical cervical epithelium were graded according to a number of features, including sharpness, conformation, and thickness of the border and the presence of internal margins in a lesion. And Finally, the lesion was assessed after iodine staining. Scoring of all the findings based on Reid's score is made. Correlated with histopathological report prospectively obtained.
RESULTS:
Association between RCI and histopathology had a significant association between both (p value <0.001, using Fischer’s exact test). We tried to evaluate the level of agreement between both the test using Kappa statistic, and we found
that the level of agreement was found to be K=0.72 (95%CI 0.63-0.80), i.e, there was 72% agreement between both the tests in diagnosis of cervical cancer. And this was found to be statistically significant (p value 0.045). Colposcopic RCI index did an overestimation in around 23 (15%) individuals, and it underestimated the results in 17 (11%) of the study participants. We did spearmen correlation analysis to interpret the correlation between Colposcopic RCI index interpretation and Biopsy findings. We found that found were highly correlated with an r value of 0.85 (p value < 0.001).
CONCLUSION:
Colposcopy is an indispensable tool in the diagnosis of precancerous lesions that is cervical intraepithelial neoplasia. There is a good correlation between colposcopic impression using RCI & histopathology which makes it a good reproducible technique which is easy to implement in colposcopy clinics.
LIMITATIONS OF THE STUDY:
1. Colposcopy and its details need expertise, which is of utmost importance for delineating the lesions and identifying them correctly.
2. Not everybody in the peripheral centers are very well trained in colposcopy which makes this study difficult to be applied in centers lacking people trained in colposcopy.
3. Not all centers have colposcope and expertise in colposcopy.
4. Reid's index gives score by 4 attributes and the scores usually gives reports which are overlapping, which makes RCI to provide Cut off for each value to identify it as CIN I or II or III
A Cross Sectional study on Rhino-Orbital Mucormycosis in Post COVID Patients during COVID Pandemic in a Tertiary Hospital
No full textINTRODUCTION:
Covid-19 or Corona virus disease 2019 is a new disease which is caused due to infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It began in Wuhan, China in December 2019, later spreading rapidly throughout the world. World Health Organization declared it to be a pandemic on March 11, 2020.
India reported its first case of Covid-19 on 30th January, 2020 in Kerala. As of December 2021, a total of 278,891,403 cases and 5,392,790 deaths were reported in the world and in India reporting 34 765 976 cases and 478 759 deaths due to Covid-19.
JUSTIFICATION:
a. Identification of incidence, clinical profile of rhinoorbital Mucormycosis in post covid patients will provide useful knowledge for the prevention, early
identification, treatment and reduction of morbidity and mortality.
b. I chose this study due to paucity of studies related to rhino-orbital Mucormycosis in post covid patients in Tamilnadu.
OBJECTIVES:
1. To study the incidence of Rhino orbital Mucormycosis in post covid patients.
2. To analyse the clinical profile of rhino orbital Mucormycosis in post covid patients.
3. To study the risk factors and Immunisation status among the post covid patients developing Mucormycosis.
4. Role of mycology, Histopathology and radiology in the diagnosis of Rhino-orbito-cerebral Mucormycosis.
5. To develop a diagnostic-criteria for Mucormycosis based on clinical profile and Investigations.
METHODOLOGY:
STUDY DESIGN:
This study is a hospital based Cross sectional study conducted in RGGGH, MMC, Chennai.
STUDY POPULATION:
Patient who admitted in Mucor ward in RGGGH, Chennai.
STUDY DURATION:
MAY 2021 TO SEPTEMBER 2021 (6 months period).
STUDY AREA:
Rajiv Gandhi Government General Hospital, Chennai - 600 003.
INCLUSION CRITERIA:
Post covid patients with new onset rhinoorbital mucormycosis
Those who are willing to give informed consent.
EXCLUSION CRITERIA:
Patients with pre-existing rhino-orbital mucormycosis
Those who are not willing to give consent.
DATA COLLECTION TOOL:
To collect A detailed clinical history, microbiological and radiological investigations in post covid patients with rhino-orbital mucormycosis.
SAMPLING METHOD:
Convenient sampling.
CONCLUSION:
➢ Covid Associated Mucormycosis is more common in males and in the fifth decade.
➢ The most common risk factors associated with Mucormycosis in our study are post Covid status, Diabetes Mellitus, hospitalization and steroid administration. ➢ This epidemic within a pandemic stresses the fact that vaccine against Covid-19 is an indispensable tool in fighting the pandemic & its associated afflictions and highlights the burning need for 100% vaccination against Covid-19.
➢ Covid Associated Mucormycosis was not associated with steam inhalation, industrial oxygen or zinc supplementation.
➢ The predominant symptoms seen in Covid associated Mucormycosis were discerned to be nasal obstruction, nasal discharge, facial swelling and facial pain.
➢ The earliest sign of orbital involvement is abduction restriction. ➢ Our study accentuates the ability of CT paranasal sinuses with orbital cuts in identifying early subtle fat stranding in extra sinus tissues and highlights the diagnostic value of CT in recognizing Mucormycosis at an early stage. Though MRI is preferred and is better at picking up soft tissue changes, CT should be favoured due to its limited cost and easy accessibility with MRI being reserved for cases suspected to have advanced stage disease to promptly identify the same.
➢ Direct microscopy is a better screening tool for early diagnosis and initiation of treatment in Covid Associated Mucormycosis.
LIMITATIONS:
1. our study was hospital based, not a community-based study.
2. The possibility of recall bias among the study population while data collection.
3. With many patients having treated for Covid elsewhere, the proper details regarding the Covid management couldn’t be collected satisfactorily
A Study on Oral Manifestations in Mucormycosis and Its Surgical Management
No full textINTRODUCTION:
Mucormycosis is a fatal, rapidly progressing opportunistic infection occurring as a result of infection by fungi from the class Zygomycetes/Phycomycetes and from the order Mucorales. These organisms are ubiquitous and generally harmless. However under certain circumstances including diabetics, malnutrition, renal failure, in immunosuppression drugs, antibiotics, steroid therapy, and blood dyscrasias etc, they become pathogenic.
The mucormycosis in humans was first described in the year 1885, by Paltauf. However, the frequency of the condition has been in raise in the past 2 decades. Oral symptoms of mucormycosis are typically in the palate where the mucoperiosteum gets ischemic necrosis with bony denudation. Literature have shown that the ulcers have also been described on the lips, gingiva, cheeks, alveolar ridge, mandible and tongue.
AIM AND OBJECTIVES:
The main objective of the study includes
1. To study the demographics of oral manifestations in mucormycosis.
2. To study the various predisposing factors involved in case of oral manifestations in mucormycosis.
3. To study the various clinical presentations of oral manifestations in mucormycosis.
4. To study the time taken for appearance of first symptom and sign of oral manifestations from the onset of mucormycosis.
5. To study the various surgical procedures in its management.
6. To assess the prognosis in patients with oral manifestations in mucormycosis.
MATERIALS AND METHODS:
Study Design: This study was a cross sectional study.
Study Setting: This study was conducted in a Upgraded institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Chennai.
Study Duration: The study was conducted from May 2021 to September 2021s after the approval of hospital ethical committee.
Study Population: Patients satisfying the inclusion criteria were included in the study.
Inclusion criteria:
• Patients with new onset mucormycosis with oral manifestations.
• Those who are willing to give informed consent.
Exclusion criteria:
• Patients with pre-existing oral manifestation.
• Those who were not willing to give consent.
Sample size:
Considering prevalence as 50%, with a 95% Confidence interval and absolute precision of 15%, sample size is derived.
CONCLUSION:
❖ OIM usually develops as an extension of ROCM, or as the primary site of mucormycosis. The disease is rapidly progressing and often depends on the metabolic and immune status of the patient.
❖ COVID‑19‑associated OIM predominantly affects middle-aged and older males.
❖ COVID-19 infection in recent past and diabetes (pre-existing or new onset; diagnosed during COVID-19) are the two most important risk factors, though most often ROCM is associated with the simultaneous presence of multiple risk factors. Covid-19 associated with T2 Diabetes Mellitus was the most major predisposing factor in our investigation.
❖ The most common clinical presentation in OIM included palatal ulcers, maxillary involvement (upper jaw involvement including tooth) was also observed.
❖ Following inhalation of fungal spores, the process begins in the paranasal sinuses. Symptoms of OIM manifesting as palatal discoloration and perforation, decreased sensitivity and loose tooth, soft tissue oedema are the first signs of the disease. Then it progresses quickly, expanding into neighbouring tissues. As vessels thrombose and tissues necrotic, involved tissues turn red, then violaceous, and eventually black. The palate usually develops black or pale necrotic ulcers, with well-defined edges, disease progression depends on the underlying metabolic comorbidities.
❖ In the hard palate, extension of the sinuses into the mouth generates painful, black necrotic ulcerations. The lesion is typically extensive and deep, causing the underlying bone to be denuded.
❖ OIM usually develops lysis of the maxilla and adjacent structures like the alveolar ridge, mandible, lips, and cheeks.
❖ In the present study, to find out the early extension of OIM progression, CT scan and MRI were done aiming to avoid multiple or Radical surgery in future for the patients.
❖ When compared to antifungal medication alone, a combined medical/surgical strategy improves survival. The amount of the patient's infection determines the surgical procedure. In mucormycosis, vascular thrombosis and tissue necrosis prevent antifungal agents from penetrating the diseased area; therefore, debridement of necrotic tissue may be the most definitive method of eradicating the disease.
❖ Most instances of OIM require surgical debridement to be successfully managed. Antifungal therapy alone may not be enough to control infection because it is accompanied with angioinvasion and severe necrosis.
❖ Surgery, with the goal of removing all necrotic tissue, should be considered early in the course of treatment for controlling disease progression. The need for repeated debridement is essential
Cartilage Tympanoplasty: A Comparative study Between Conchal Cartilage Versus Tragal Cartilage in Coimbatore Medical College
No full textINTRODUCTION:
The atelectatic ear management is one of the most controversial issues faced by the otolaryngologist. It is often due to poor understanding of the pathophysiologic conditions which lead to changes in the tympanic membrane, resulting in atrophy, retraction and cholesteatoma formation. The fact is, in the early course of the disease , hearing loss will be minimal and the patient may be asymptomatic. It is prudent to do cartilage tympanoplasty for a patient with atelectatic ear drum even without symptoms to prevent the development of cholesteatoma or hearing loss.
But in these situations, fascia and perichondrium undergo atrophy which results in failure of the procedure. So it is better to use materials that are less compliant and more rigid to prevent adhesion of tympanic membrane to middle ear. As cartilage is more rigid in quality it resists retraction and resorption even in the presence of severe Eustachian tube dysfunction. Most commonly used cartilages are conchal and tragal cartilages. In this study,
I have presented my experience in cartilage tympanoplasty while comparing conchal and tragal cartilage with regard to graft uptake, its durability, its stability and hearing improvement.
AIMS AND OBJECTIVES:
1. A comprehensive study of conchal and tragal cartilage in cartilage tympanoplasty.
2. To assess the stability of cartilage.
3. To assess hearing improvement after procedure.
MATERIALS AND METHODS:
This study included 40 patients with grade 3 or 4 retraction, without complication with their consent for participation in the study after obtaining ethical committee approval.
Group A:
20 patients with cortical mastoidectomy with conchal cartilage tympanoplasty.
Group B:
20 patients with cortical mastoidectomy with tragal cartilage tympanoplasty.
This Study was Done in the Department of Otolaryngology
in Coimbatore Medical College.
Study Period:
January 2020-June 2021.
Study Design:
Prospective Randomised Comparative Clinical study.
Study Population:
Age Group Between 15 To 70 Years.
SAMPLE SIZE:
Total 40 Patients. 20 Patients: conchal cartilage tympanoplasty. 20 Patients: tragal cartilage tympanoplasty.
INCLUSION CRITERIA:
● Patients of both sexes equal to and more than 10 years of age.
● Patients with history of ear discharge.
● With grade 3 or 4 retraction.
● Patient willing for surgery and regular follow up.
● Patient with conductive hearing loss.
● Ear should be dry for 4-6 weeks prior to surgery.
EXCLUSION CRITERIA:
● Subtotal, total perforation.
● Patients with unsafe ear.
● Active discharging ear.
● Otitis externa, otomycosis.
● Uncontrolled diabetes mellitus.
● Patients having upper respiratory tract infection at the time of surgery.
● Patients not willing for study or regular follow up.
CONCLUSION:
From our study, conchal cartilage and tragal cartilage were equal in graft uptake and hearing improvement, when used for cartilage tympanoplasty. Conchal and tragal cartilage are excellent for reinforcement of tympanic membrane in cases of posterosuperior retraction pocket, atelectasis & adhesive otitis media. Cartilage resists constant negative pressure and can withstand longstanding Eustachian tube dysfunction. Advantages of conchal cartilage are it can be easily harvested from same incision, same site in case of post auricular approach and availability of large size.
Harvesting Tragal cartilage is little difficult compared to conchal cartilage and it is smaller in size compared to conchal cartilage, and sometimes it can lead to cosmetic deformity when whole cartilage is harvested. I would like to conclude this study that, both conchal and tragal cartilages are good graft material for cartilage tympanoplasty, in terms of graft uptake and hearing improvement. However availability of conchal cartilage is in abundance and easy to harvest without any cosmetic deformity
Positioning of Acetabular and Femoral Component in Primary Total Hip Arthroplasty using CT Evaluated Patient Native Anatomy: A Study of Functional Outcome
No full text
