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A Comparative study between Onlay Mesh Repair Vs Retrorectus Mesh Repair for Ventral Hernias in Diabetic Patients in Terms of Surgical Site Infections
No full textAIMS AND OBJECTIVES:
To study about surgical site infections especially in diabetics with ventral hernias who have undergone onlay/retrorectus mesh repair.
Primary objective: COMPARATIVE STUDY to find out which method Onlay vs Retro-rectus mesh repair is suitable for ventral hernia repair in diabetics with less surgical site infections (SSI’s)
Secondary objective: To find out performance status of patient postoperatively in both arms in terms of functionality and chronic post-operative pain.
Methodology.
Inclusion criteria:
1. patients >12 years of age.
2. With T1/T2 diabetes.
3. Any ventral hernia, including incisional hernia
4. with minor alignments hypertension, asthma, smoking history, bmi >25 included.
Exclusion criteria:
1. Pts <12 years of age.
2. With severe debilitating conditions malignancy, intra-abdominal pathology like TB, skin pathology, blood dyscrasias.
METHODOLOGY: ANALYTICAL COMPARATIVE STUDY.
STUDY PERIOD: DEC 2020-SEP 2022.
STUDY CENTRE: RAJIV GANDHI GOVERNMENT GENERAL HOSPITAL
Sample size calculation for comparison of two proportion
N= 2[Z1−α/2+Z1−β]²∗[p1q1]+[p2q2]}
d2.
N=78 total sample size.
Z1-α/2= 95% level of confidence Z1-β= power of test i.e., 80%.
P1P2= Probability of event in respective groups i.e, 48% and 25% Q1Q2= (1-P1),(1-P2).
d2= expected difference in error margin i.e, 9%.
STATSTICS:
An analytical comparative study was conducted in department of with sample size of 80 which was randomly divided between two groups as 41 for onlay and 39 for retrorectus. Descriptive statistics was given by mean, sd, frequency, percentage and graphs. Analytical statistics was given by chi- square test to find the relationship between groups and other parameters. P-value<0.05 considered to be significant throughout the study.
RESULTS:
To summarize 80 diabetic patients were studied regarding onlay vs Retrorectus mesh repair in terms of surgical site infections. In this study 51.2% of the participants were included in onlay repair group while 48.8% accounted to retro rectus group. Surgical site infection was present in only 38.8%. There is significant difference between people having surgical site infection and they undergoing different procedures (p-value<0.05). Surgical site infection was seen in 8% in onlay group and none in retrorectus group. The incidence of seroma formation was 20% in the onlay group (15 patients) and 2.67% in the sublay group (2 patients). The erythema rate was 5.63 percent in the onlay group and 1.35 percent in the retrorectus group. In our study, 98.8% of the patients didn’t report recurrence of hernia following repair. The post operative duration of hospital stay in onlay group was mean 12 days (SD 5) and in other group it was 8 days with SD of 5 by Mann Whitney U test. There is no significant difference between recurrence of event and two groups with p-value 0.96. Patient satisfaction in terms of chronic pain was studied and 58.8% of them reported satisfactory which was statistically significant.
Mean pain score on post operative day 2,3 and 7 using VAS scale and reported there was statistical difference between both groups for all three days. Compared to those in the sublay group, patients in the onlay group report a greater amount of pain in the days following surgery.
CONCLUSION:
Sublay (Retromuscular) mesh repair is a good alternative to onlay mesh repairs especially in diabetic patients, this comparative study method of ventral hernia repair CONCURS the same finding as established in reputed journals, it can be applicable to all sites of ventral hernia, the mesh is mostly hidden and anchored behind the rectus sheath, the complication rate is low and there is a low recurrence rate. Post op patient satisfaction rate is better with retrorectus group, than the onlay group .To move forward its better to say that Reterorectus mesh repair may be the ideal technique for ventral hernias in diabetic patients whenever possible
A Comparative study Between Small Tissue Bite Versus Large Tissue Bite in Midline Fascial Closure with Reference to Incidence of Wound Dehiscence and Surgical Site Infection
No full textAn Experimental study to Assess the Effectiveness of Therapeutic Play using Virtual Reality Computer Games, in Promoting the Physiological and Psychological Well-Being of Children Hospitalized with Cancer
No full textA Study to Assess the Effectiveness of Mother Steered Essential Preemies Care Bundle on the Level of Anxiety, Knowledge, Practice among Mothers and Outcome of Preemies Admitted at Selected Hospitals in Chennai
No full textA Comparative study to Assess the Effectiveness of Fenugreek Seed Powder Verses Jamun Seed Powder in Maintaining Blood Glucose Level among NIDDM Patients at Selected Diabetic Clinic in Kanyakumari District
No full textImpact of Hospital to Home Initiative (H2H) on Therapeutic Compliance, Functional Ability and Health Related Quality of Life among Patients with Heart Failure
No full textAssociation between 24 Hour Urinary Sodium and Potassium Excretion and Blood Pressure
No full textBACKGROUND AND PURPOSE:
The primary global risk factor for stroke, kidney disease, congestive heart failure, myocardial infarction and
death continues to be high blood pressure (BP). Controlling dietary sodium intake may lower the prevalence and severity of hypertension, as research has linked blood pressure to potassium and salt intake.
AIM OF THE STUDY:
This study aims to assess the level of sodium and potassium intake and their associations with blood pressure (BP) using
assessment of 24-hour urinary Sodium and Potassium in patients with essential hypertension
MATERIALS AND METHODS:
Our analysis included 110 individuals aged
18 to 75 years (55 cases and 55 controls). Patients with secondary
hypertension, patients on NSAIDs, RAAS inhibitors, ARBs, oral contraceptive pills and diuretics are excluded. Patients with Malignant Hypertension and Congestive cardiac failure are excluded.
RESULTS:
Among total of 110 subjects, among 55 cases with
hypertension, with a mean systolic BP of 166.8 mmHg ,44 cases had 24 hour Urinary sodium excretion greater than 165 mmol/L, with a P value of 0.001, which shows significant association between dietary Sodium intake and Hypertension. There is no significant association found between dietary potassium intake and hypertension.
CONCLUSION:
A high sodium consumption may be the cause of
hypertension, which is indicated by a markedly higher 24 hour sodium excretion in hypertensives. Therefore, a long-term reduction in salt intake will greatly lower the prevalence of hypertension and, as a result, a reduction in the morbidity and death that are directly related to it
The Prospective study of Role of Mean Platelet Volume, Platelet Distribution Width as Prognostic Markers in Acute Ischemic Stroke Patients
No full textINTRODUCTION:
The sudden onset of a neurological deficit that can be linked to a specific vascular cause is what defines a stroke. The burden of stroke is predicted to automatically rise in the approaching years due to the increase in the population's elderly people. Physiological parameters of haemostatic significance is mean platelet volume (MPV) and Platelet Distribution Width (PDW), a measure of platelet function. Platelet count is not as crucial to haemostasis as changes in MPV and PDW.
OBJECTIVES:
To establish the correlation between mean platelet volume and platelet distribution width with severity of acute ischemic stroke and to assess the usefulness of MPV and PDW in predicting prognosis in acute ischemic stroke.
METHODOLOGY:
All Patients admitted with Acute Ischaemic Stroke in inpatient wards, Department of General Medicine, Thanjavur Medical College were consecutively selected till the sample size of 75 was reached. After obtaining Ethical committee clearance and obtaining informed written consent, the following investigations like complete hemogram, Diabetic profile, Blood pressure, Mean Platelet Volume, Platelet Distribution Width were to be done for the purpose of the study and
results were to be done. MRS scale was used to assess severity of stroke. All data were entered into Microsoft excel and analyse using SPSS version 16.
RESULTS:
The mean Age (years) among the subjects was 60.52 (± 7.33) ranging from 43 to 75 years. Among the subjects, 33 (44%) were in 61 - 70 years, 30 (40%) were in 51 - 60 years and 8 (10.67%) were in < 50 years. Among the subjects, 47 (62.67%) were Males and 28 (37.33%) were Females. Among the subjects, 29 (38.67%) were Smoker, 33 (44%) were Alcoholic. Among the subjects, 60 (80%) had Hypertension. Among the subjects, 32 (42.67%) had Diabetes Mellitus. The mean Mean Platelet Volume (fl) among the subjects was 10.28 (± 0.99) fl ranging from 8.7 to 12.4 fl. The mean Platelet Distribution Width among the subjects was 14.91 (± 1.23) ranging from 9 to 18.1%. Among the subjects, 40 (53.33%) had MRS Score 3 - 6 and 35 (46.67%) had MRS Score 0 – 2 on day 1. Among the subjects, 46 (61.33%) had MRS Score 3 - 6 and 29 (38.67%) had MRS Score 0 – 2 on day 7.
The mean Mean Platelet Volume (fl) with MRS score day 1showed that among Score 0 - 2 MPV was 9.83 (± 0.72) which is lower by 0.84 and statistically significant compared to MPV 10.67 (± 1.04) in Score 3 – 6. The mean Mean Platelet Volume (fl) with MRS score at day 7, among Score 0 - 2 MPV was 9.52 (± 0.47) which is lower by 1.23 and statistically significant compared to MPV 10.75 (± 0.94) in Score 3 – 6.
The mean Platelet Distribution Width with MRS score day 1, among Score 0 – 2 PDW was 14.81 (± 1.11) which is lower by 0.2 but not statistically significant compared to PDW 15 (±
1.34) in Score 3 – 6. The mean Platelet Distribution Width with MRS score day 7, among Score 0 - 2 PDW was 14.47 (± 0.91) which is lower by 0.71 and statistically significant compared to PDW 15.19 (± 1.33) in Score 3 – 6.
92.3% of the obese subjects, and 83.3% of the subjects with dyslipidemia had MRS score 3 – 6 with higher severity of stroke and the differences were statistically significant. The Mean Platelet Volume among those with Hypertension, Diabetes and Dyslipidemia were significantly higher compared to those without the risk factors. Subjects with more than 60 years of age and obese subjects had significantly higher mean platelet volume and the differences were statistically significant. The Platelet Distribution Width among those with higher age group and Dyslipidemia were significantly higher compared to those without the risk factors.
CONCLUSION:
Independent predictors of the risk of stroke, MPV and PDW are elevated in acute ischemic stroke. Higher MPV and PDW are linked to more severe stroke and have a worse prognosis. A quick and uncomplicated test called the mean platelet volume and platelet distribution width, which measures platelet reactivity, can be used to predict the severity and course of an acute ischemic stroke in patients
A Study of Left Ventricular Dysfunction in CKD Patients and Its Correlation with eGFR (Estimated Glomerular Filtration Rate)
No full textBACKGROUND AND OBJECTIVE:
In Chronic Kidney disease there is a higher incidence of cardiovascular events and they constitute major cause of morbidity and mortality in CKD patients. Cardiovascular events may be present even in the earlier stages of CKD. Thus, early detection of LV dysfunction and management can improve the prognosis in CKD.
Echocardiography provides a simple non-invasive investigation to asses the left ventricular structure and function. This study was done to estimate the prevalence of LV dysfunction and its correlation with eGFR in CKD patients.
METHODS:
This cross sectional study was conducted among 80 CKD patients admitted in Government Thanjavur Medical College between May 2021 to April 2022 of which 40 CKD patients were hypertensive and 40 CKD patients were normotensive. The results were compared with 40 age and sex matched individuals.
The study group were divided into various stages of CKD using eGFR by CKD-EPI formula. Echocardiography was done to all those individuals. Those with an EF <50% were classified under systolic dysfunction. LV diastolic dysfunction was divided into three grades based on E/A ratio. The collected data was analysed using various statistical methods.
RESULTS:
Among 80 CKD patients LVH was present in 80% of hypertensive and 60% of normotensive patients(p<0.001). systolic dysfunction was seen in 17.5% of hypertensive and 5% of normotensive CKD patients (p<0.05). LV diastolic dysfunction was present in 82.5% of hypertensive CKD patients and 67.5% in normotensive CKD patients (p<0.001)
CONCLUSION:
LV diastolic dysfunction can occur even in the absence of hypertension in CKD. This emphasizes the need for correction of uremia related factors. Echocardiographic screening of
LV dysfunction in early stages of CKD help to plan appropriate management to sloe the progression of cardiac dysfunction and mortality
