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A Prospective and Retrospective study on Factors Determining Operative and Non-Operative Management in Blunt Injury Abdomen
No full textINTRODUCTION:
The main cause of trauma is Road Traffic Accident which alone accounts for more than 1 million deaths per year and liability of 20-50 million people. In 1982, the trimodal distribution of death has been described for injuries. In case of blunt injury abdomen, the third peak can be prevented with adequate ICU setup, proper and serial patient care. It is due to sepsis and multiple organ dysfunction. This management of blunt injury abdomen is a multimodality approach with early recognition, resuscitation and severity grading with analyzing the clinical status, radiological
findings. These combined factors with the presence of ICU care with close monitoring/ tertiary setup may help us in conservative management in blunt injury abdomen in certain hemodynamically stable patients.
AIM/ OBJECTIVE OF THE STUDY:
The aim of this study is to analyse the various factors involved in and which determines the management in blunt trauma abdomen: 1.operative (surgeries) 2.non-operative (conservative, pigtail insertia, angioembolisation) Management.
The various factors analysed are
• Age of the patient.
• Time of presentation.
• Latent period between presentation and resuscitation.
• Hemodynamic stability during the course of hospital.
• Per abdominal examination findings.
• eFAST/ CT severity grating-AAST grading.
• Isolated injury or associated with other injuries.
• ICU care with close monitoring.
• Immobilization followed by restricted mobility.
• Initiation of oral diet.
METHODOLGY:
STUDY DESIGN: Hospital based PROSPECTIVE AND RETROSPECTIVE
OBSERVATIONAL STUDY with a sample size of 60.
STUDY POPULATION: SINGLE CENTRE- RAJIV GANDHI GOVERNMENT GENERAL HOSPITAL-Patients coming to Trauma ward with Blunt Trauma Abdomen.
INCLUSION CRITERIA:
• All the patients of age more than 14 years of both male and female sex presenting with blunt injury abdomen.
• Patients associated with radiographical documentation of Liver, Spleen, Kidney, Pancreas, Hollow viscus (Bowel and Urinary Bladder).
EXCLUSION CRITERIA:
• Age less than 14 years.
• Penetrating trauma to abdomen.
• Patients with major head injury and polytrauma.
RESULTS:
➢ In the current study, patients with blunt injury abdomen, most of them were males accounting to 88%. The average age of the participants was 32.62 years, with the vast
majority (68%) falling within the age range of 21 to 40.
➢ The commonest mode of injury in our study was RTA (76.7%).
➢ In our study, 33% had Liver injury, 32% had Splenic injury. In the liver injury, 75.07% were managed conservatively and 24.9% non-conservatively. Amongst the Splenic injury, 65.2% were managed non operatively and 34.71% were managed by operative procedures. With positive clinical findings, 6.7% in the current study had grade III
splenic injury, 3.3% with grade II liver injury, 3.3% with grade IV liver injury.
➢ When the latent period between presentation after injury and resuscitation is less, more patients are going into conservative management as within 1-5 hours, 71.4% of the patients went into conservative management as compared with 28.5% of the patients who were operated. When the patients were presented after 56 hours nearly 75% of the patients were operated as compared with 25% of the patients who were managed conservatively.
➢ Positive clinical per abdomen findings plays an important role in deciding the line of management.
➢ eFAST was positive in 68% while it was negative in 31%. Out of 60 patients, 13% were managed conservatively and 21% non conservatively. i.e., 38% conservatively and 61.7% by operative methods in eFAST positive patients.
➢ 53% of the individuals were admitted in ICU while 46% were managed in ward who required operative management. 41.17% were admitted in ICU whereas 58.8% were not.
ICU admission helps in early identification of operative management.
➢ In conservative management the mean days of immobilization are 8-14 days in which 26% of them were managed. In operative line of management, the mean days of
immobilization are 0-7 days in which 18% of them were managed. In conservative management the death is after 15 days and that is after immobilization.i.e., 2%.
➢ 48% of the study respondents were managed conservatively, 5% needed icd insertion for pneumothorax, emergency laparotomy with splenectomy was done in 5%, bladder repair
in 1.7%, nephrectomy in 1.7%, emergency laparotomy with packing was done in 3.3%. in total 56.7% were managed with non-operative management and 43.3% were operated.
➢ There is significant mean difference between operative and non-operative procedure when compared with latent period, pulse rate, immobilisation days which is statistically significant with p-value<0.05. The mean pulse rate in conservative management is 96/min, whereas it is 131/min in operative management.
CONCLUSION:
In Blunt Trauma Abdomen, there is significant relation between the latent period and line of management, initial resuscitation with fluids and blood with close monitoring is crucial to decrease the operative management in solid organ injuries. There is significant relation between tachycardia, hemodynamic instability and operative management. When there is massive hemoperitoneum with hemodynamic instability or activation of massive blood transfusion protocol, then emergency surgical intervention should be considered. Hollow viscus perforation needs prompt and early surgical intervention. Delay in its management increases the morbidity and mortality. Positive per abdominal findings with bedside eFAST in addition to ICU care with close monitoring has a significant role in early decision for surgery
A Comparative study between Ligation of Intersphincteric Fistula Tract and Fistulectomy in the Treatment of Perianal Fistula in a Tertiary Care Centre
No full textBACKGROUND AND OBJECTIVES:
A fistula-in-ano is a granulation tissue lined tract, which connects an opening on the perianal skin (external) to another opening inside the anal canal or the lower rectum (internal). It is the chronic phase of anorectal suppuration. Surgical therapies are required to achieve a cure which include fistulotomy, fistulectomy, excision of tract with primary closure and staged operations which help to reduce recurrences. Recent advances being fibrin glue,
fistula plugs, LIFT and VAAFT procedures. To assess the following parameters in patients with perianal fistula treated with LIFT and conventional Fistulectomy:
a. Post operative pain,
b. Post operative wound healing time,
c. Fecal incontinence,
d. Recurrence after surgery.
METHOD:
This prospective randomised control trial was conducted in patients with perianal fistula admitted in the Institute of General Surgery in Madras Medical College, Chennai. 30 patients divided into two groups of 15 each admitted in the period between June 2022 and December 2022 GROUP A - Patients undergoing LIFT GROUP B - Patients undergoing Fistulectomy.
RESULTS:
There is significant difference between two groups when compared with post operative pain with p-value<0.05 i.e., 0.02. In our study, the average post operative pain measured by Visual Analog Score was 2 in Group A (LIFT) and 5 in Group B (Fistulectomy). There is significant difference between two groups when compared with wound infection which is significant with p-value<0.05 i.e. 0.01. There is significant difference between two groups when compared with recurrence of pain with p-value<0.05 i.e., 0.009.
CONCLUSION:
LIFT (Ligation of Intersphincteric Fistula Tract) technique has lesser post-operative pain and wound infection, with better wound healing rates, compared to Fistulectomy. The duration of hospital stay is short with early resumption of daily activities in patients undergoing LIFT. The risk of incontinence and recurrence is also minimal with LIFT. Hence, it is concluded that, compared to fistulectomy, LIFT (Ligation of Intersphincteric Fistula Tract) procedure is cost-effective, safe and preferred sphincter saving technique for perianal fistula
The Incidence of Autoimmune Hemolytic Anemia in Antenatal Women presenting with Severe Anemia and Its Maternal and Perinatal Challenges
No full textThe entire study population 425 cases are recruited from antenatal clinic from Government RSRM lying in hospital and the pregnant women presenting with severe anemia.
• In our study out of 425 cases, 207 cases are in the age group of 30 years, remaining 102 cases are in the age group of 26-30 years. AIHA positive 2 cases are in the age group of <25 years. There is no significant difference between Age and AIHA positive cases. P value is 0.570 not significant.
• Out of 425 cases, 206 cases had low Hb ie 4 &5, remaining 209 cases had Hb level of 6&7. AIHA positive 2 cases are in the low hb level group. There is no significant difference between Hb and AIHA positive cases. P value is 0.904 not significant.
• There is no significant difference between PCV and AIHA positive cases. P value is 0.922 not significant.
• Reticulocyte count is significantly correlated with AIHA positive cases. Out of 425 cases, 3 cases had AIHA positive, all three positive cases their reticulocyte count is >3. P value is < 0.001 significant.
• DCT is significantly correlated with AIHA positive cases. Out of 425 cases, 3 cases are AIHA positive, all three AIHA positive cases also positive for DCT. P value is < 0.001 significant.
• Total bilirubin is significantly correlated with AIHA positive cases. Out of 425 cases, 19 cases had >2 bilirubin level, all three AIHA positive cases are in the group of bilirubin level of >2. P value is < 0.001 significant.
• No significant correlation between complications and AIHA positive cases. P value is 0.766 not significant.
• No significant correlation between Gestational age and AIHA positive cases. P value is 0.797 not significant.
• No significant correlation between mode of delivery and AIHA positive cases. P value is 0.760 not significant.
• Out of 425 cases, 246 cases are affected by PPH, all three AIHA positive cases are in the group of PPH. But there is no significant difference between PPH and AIHA positive cases. P value is 0.375 not significant.
• Out of 425 cases, only 54 cases had low apgar score, all three AIHA positive cases are in the group of low apgar score. There is a significant difference between baby apgar and AIHA positive cases. P value is <0.001 significant.
• Out of 425 cases, 178 cases are need of NICU admission, all three AIHA positive cases are in this group. But there is no significant difference between PPH and AIHA positive cases. P value is 0.149 not significant.
• Out of 425 cases, their 170 babies had low birth weight of < 2.5 kgs, all three AIHA positive cases are in this low birth weight group. But there is no significant difference between Birth weight and AIHA positive cases. P value is 0.129 not significant.
• Out of 425 cases, only 2 cases are affected by neonatal anemia, same 2 cases had AIHA positive. So, there is a significant difference between neonatal anemia and AIHA positive cases. P value is < 0.001 significant.
• Out of 425 cases, 219 cases are affected by puerperal sepsis, out of these, 2 cases had AIHA positive. But there is no significant difference between puerperal sepsis and AIHA positive cases. P value is 0.955 not significant
Clinical Profile of Hypokalemic Periodic Paralysis
No full textBACKGROUND: Multiple electrolyte problems, such as hypokalemia, hyperkalemia, hypercalcemia, and hypo or hypermagnesemia, are linked to muscle weakness. However, hypokalemia turns out to be the most common reason for periodic paralysis. A group of different illnesses known as acute hypokalemic paralysis appear with sudden muscular weakness and can present a life-threatening risk. complications resulting from respiratory failure or cardiac arrhythmias.
AIM OF THE STUDY: To Assess the clinical profile of hypokalemic periodic paralysis patient with reference to the clinical presentation and to assess the etiological factors and metabolic profile of all patients presenting with Hypokalemic periodic paralysis and to assess patient’s outcome with treatment.
MATERIALS AND METHODS: 51 Patients admitted with acute onset of flaccid weakness and documented serum potassium of < 3.5mEq/l during the episode were included in the study.
Clinical data collected included age, gender, ethnic origin, history of symptom evolution, triggering variables such as high carbohydrate intake in the previous 24 hours, alcohol usage, and treatment received. Any family history of similar disease was investigated, and reports of weakness, thyroid disease, diarrhoea, vomiting, hypertension, bone pain, fractures, dry mouth, dry eyes, and renal disease were documented. The use of diuretics, 2 agonists, decongestants, insulin, laxatives, and antipsychotics was observed. Caffeine and herbal medication use were restricted. Anthropometry, pulse, blood pressure, anaemia, and thyroid status were all tested. A thorough neurological examination was carried out. Schirmer's test was performed on a subset of patients. The parameters considered were age, sex, past history, family history, precipitating factors, Serum potassium levels, ECG changes, treatment outcomes.
RESULTS: Around 50% cases were in their 3rd decades , 25% of cases were in their 2nd decade. Around 75% are males and 25% are females. About 40% of the cases were found to have suffered similar attacks in the past. Good carbohydrate diet followed by sleep was found to be the risk factor in many patients. About 72% of the patients had presented with Quadriparesis / plegia. Maximum number of patients had serum potassium levels between 2-3 meq/L. 11 Patients had normal ECG despite of weakness. Despite the use of various treatment methods, oral potassium chloride alone was used to treat nearly 82% of patient.
CONCLUSION: Our study showed that Incidence ratio is M: F = 3:1 and 40% have had similar attacks in the past. Flaccid quadriparesis was the most common mode of presentation. About 37% of the patient had first degree relative with similar attacks. Most of the patient had serum potassium level between 2 to 3 meq/L. ECG abnormalities was observed in 80% of the patients. Most of these patients were treated with oral potassium chloride alone. Outcome was good in all patients
Serum Chloride Level as a Prognostic Indicator in Acute Decompensated Heart Failure
No full textBACKGROUND: Chloride plays a critical role in plasma electroneutrality, acid-base homeostasis, and the stimulation of neurohormone systems like the RAAS. The effects of serial changes in serum chloride, however, on morbidity and mortality in ADHF patients during hospitalisation have not been thoroughly documented. Diuretics are recommended in clinical guidelines for the treatment of HF, however not to reduce mortality but rather to lessen symptoms and hospitalizations. The mainstay of the early management of acute HF is systemic diuretic decongestion. Due to the increase of sodium and water uptake in the loop of Henle, low blood chloride levels can result in impaired diuretic response. With these factors in mind, this study was carried out to determine the relationship between serum sodium levels and the influence of admission serum chloride concentrations on the length of hospital stay in HF patients.
OBJECTIVES: To study the impact of admission Sr. Chloride levels on stay duration in ADHF and to assess the outcome, morbidity, mortality in patients presenting with ADHF.
METHODS: This study was conducted as observational cross sectional study in the department of General medicine in Thanjavur Medical College among cases with ADHF during November 2021 to August 2022. A total of 170 cases with ADHF were included in the study. Ethical committee approval was obtained for this study from the Institutional Human Ethics Committee Principal investigator assessed the detailed history of the participants and clinical examination was done. Sr. electrolytes were done on the patients on the day of their admission. Patients are followed up till discharge from the hospital and assessment was done on stay duration in hospital, mortality outcomes also assessed in association with Sr. Cholride level. The data was entered in excel sheet and analyzed using SPSS (Version 19).
RESULTS: In the present study among the study participants Dilated CM was diagnosed among 31.8% of the study cases while 50.6% of the cases had Ischemic CM. Chloride level at the time of admission was noted to be 101 meq/L among 27.6%, 52.4% and 20% of the cases respectively in this study. On assessing the difference between admission serum Cl levels with other clinical parameters, age, SBP, DBP, Serum Sodium, LVEF, duration of stay in hospital and mortality were found to be significantly differs with serum chloride levels where as the parameters like gender, BMI, presence of DM, hypertension, dyslipidemia, previous history of MI, CKD, COPD, habit of amoking, alcohol consumption, medications, type of cardiomyopathy, Hemoglobin, Serum Urea, Serum Creatinine, Serum potassium and AF were found to be similar in all groups of serum chloride without any significant difference.
CONCLUSION: We conclude that admission serum chloride among the cases with ADHF had a strong impact on the prognosis and duration of hospital stay. Hence it is important to assess the serum chloride levels during the time of admission, with which we can assess the likely duration of hospital stay and the prognosis also
A Prospective Observational study on Total Cholesterol, HDL Cholesterol and Risk of Post Operative Nosocomial Infective in Abdominal Surgeries in a tertiary Care Centre, Chennai
No full text
A Prospective study between Clinical Examination Versus Focused Abdominal Sonography in Trauma (Fast) Versus Contrast Enhanced Computerised Tomography in Blunt Injury Abdomen
No full textCorrelation of Serum Alkaline Phosphatase Levels with Poor Functional Outcome and Cognitive Impairment in Ischaemic and Hemorrhagic Stroke
No full textINTRODUCTION: Stroke is one of the most common causes of disability and death. Post-stroke cognitive impairment (PSCI) may occur in approximately one-third of stroke survivors. PSCI is associated with poor functional prognosis, including reduced quality of life, higher risk of recurrent stroke and increased economic. Higher ALP levels have been associated with poor functional outcomes and mortality in stroke patients in previous studies. However, further studies are needed to potentiate the role of alkaline phosphatase in post stroke functional and cognitive impairment.
AIMS AND OBJECTIVES:
1. To assess correlation between serum alkaline phosphatase levels and poor functional outcome and cognitive decline in patients with acute ischaemic and hemorrhagic stroke using modified rankin scale and MMSE score at 3 months follow up of patients in General medicine ward at a tertiary care centre in Chennai.
2. To identify other clinical and biochemical factors affecting the prognosis of acute ischemic and hemorrhagic stroke.
3. To measure the stroke severity at admission using NIHSS score.
MATERIALS AND METHODS:
This longitudinal study containing 119 patients who got admitted in medical wards of our hospital with first instance of ischemic/ hemorrhagic stroke within the first 72 hours of onset of symptoms. These patients were included in the study after getting informed consent either from the patient or from the legal guardian.
RESULTS:
Patients who had elevated serum alkaline phosphatase levels at the time of admission also had worser NIHSS score which was done at the time of admission. There was strong positive correlation between elevated serum alkaline phosphatase levels at the time of admission and worse outcomes in MRS score at 90 days. There was also strong positive correlation between elevated serum alkaline phosphatase levels at the time of admission to poor cognitive impairment at 90 days as evidenced by poor MMSE Scores.
CONCLUSION:
1. Serum alkaline phosphatase levels were higher in patients with poor NIHSS score at the time of admission.
2. Among the patients with acute ischaemic and hemorrhagic stroke, higher alkaline phosphatase levels correlates with
a. Clinical severity assessed by National institute of health stroke scale.
b. Poor functional outcome as assessed by Modified Rankin scale.
c. Cognitive impairment as assessed by MMSE
