Student's Journal of Health Research Africa
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A COMPARATIVE PROSPECTIVE STUDY LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN ADULTS.
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A common surgical emergency that typically necessitates an appendicectomy is appendicitis. The decision between laparoscopic and open appendicectomy has generated a lot of discussion, as each procedure has unique benefits and drawbacks. Although laparoscopic surgery is frequently chosen due to its minimally invasive nature, questions still surround its wider applicability, especially in situations of complex appendicitis. Based on several intraoperative and postoperative factors, this study sought to compare laparoscopic versus open appendicectomies.
Materials and Methods
Two groups of fifty patients undergoing interval appendicectomies were randomly assigned. Twenty-five patients in group A had laparoscopic appendicectomies, while twenty-five patients in group B had open appendicectomies.
Results
It was simpler to evaluate the intraoperative findings and confirm the diagnosis in group A patients. Furthermore, patients in group A experienced less discomfort, fewer post-operative problems, and a shorter hospital stay.
Conclusion
Laparoscopic appendicectomy is the preferred method for appendicectomy due to its superior results.
Recommendation
The authors recommend LA as a routine surgical approach for acute appendicitis
COMPARISON BETWEEN OPEN REDUCTION INTERNAL FIXATION AND PERCUTANEOUS FIXATION IN THE OUTCOME OF SCAPHOID FRACTURE: A PROSPECTIVE STUDY
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Almost 2-7% comprising all the fractures that included scaphoid. Mainly, they were observed in participants of the age group of 20-29 years. It occurs in 10.6 per 100,000 people in a year. Percutaneous screw fixation was possessed to be simpler which helped in the reduction of fracture as well as its fixation and not causing further injuries.
Objectives
The study aimed to compare the Open Reduction Internal Fixation approach to the percutaneous fixation technique for scaphoid fractures to examine the clinical, radiological, and functional results.
Materials and methods
The design of the study was prospective which took place at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. The study was conducted for one year from August 2023 to July 2024. Overall, 40 patients were enrolled in the study.
Results
The average age of all the participants was 34.1±8.3. Most of the participating patients were males. The right side of the side of fracture was present in 18 (45%) participants, while the left side of the fracture was present in 22 (55%).
Conclusion
The study found that a variety of surgical techniques can be used to treat scaphoid fractures. Two of the most effective methods for treating these fractures are the ORIF technique and percutaneous screw fixation with Herbert screws.
Recommendation
The incidence of non-union in acute proximal pole scaphoid fractures managed conservatively is significantly elevated; hence, open reduction internal fixation (ORIF) is advised
A PROSPECTIVE STUDY ON THE HAEMODYNAMIC STRESS RESPONSES TO SURGERIES AND THE INTRA-OPERATIVE AND POST-OPERATIVE EFFECTS OF DEXMEDETOMIDINE
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The surgical stress response triggers neuroendocrine and hemodynamic variations that can compromise patient outcomes. Dexmedetomidine, an alpha-2 adrenoceptor agonist, offers sedation, analgesia, and hemodynamic stability without respiratory depression.
Methods
This prospective study was carried out at Deen Dayal Upadhyay Hospital over six months and included 100 adult patients (ASA I/II) undergoing elective surgeries lasting over one hour. Patients were categorized into two groups: one receiving dexmedetomidine and the other a saline placebo. Hemodynamic parameters, anesthetic and analgesic requirements, and postoperative pain scores were monitored.
Results
Dexmedetomidine significantly stabilized heart rate, with a reduction from 78.0 ± 4.1 bpm in the placebo group to 69.0 ± 3.5 bpm before induction (p = 0.0001). Mean arterial pressure (MAP) was lower in the dexmedetomidine group after intubation (96.5 ± 2.0 mm Hg vs. 105.4 ± 3.2 mm Hg, p = 0.0001) and during surgery, with values of 84.3 ± 2.2 mm Hg compared to 89.8 ± 2.5 mm Hg (p = 0.0001). Additionally, patients in the dexmedetomidine group required significantly less propofol (93.5 ± 3.1 mg vs. 110.8 ± 7.5 mg, p = 0.0001) and reported lower postoperative pain scores at 60 minutes (0.5 ± 0.3 vs. 1.2 ± 0.4, p = 0.0001).
Conclusion
Dexmedetomidine is effective as an anesthetic adjunct, enhancing hemodynamic stability and postoperative analgesia while reducing anesthetic and opioid requirements.
Recommendation
We recommend researchers to do additional studies with a substantial sample size, incorporating invasive blood pressure measurement and multicenter randomized controlled trials
WHICH SHOULD BE PRIORITISED: KNEE SURGERY OR SPINE SURGERY? A RETROSPECTIVE STUDY ON TREATMENT PROTOCOLS FOR PATIENTS WITH COEXISTING PATHOLOGIES.
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The increasing prevalence of concurrent degenerative knee and lumbar spine disorders presents a challenge for surgical intervention, as the optimal order of treatment remains unclear. This study aims to investigate the influence of knee deformity on surgeons' preferences for treatment orders, contributing to informed decision-making in managing these complex cases.
Methods
This retrospective study, conducted over one year at the Indira Gandhi Institute of Medical Sciences (IGIMS) in Patna, involved 50 patients with low back pain and radiculopathy. Participants underwent comprehensive assessments based on predefined inclusion and exclusion criteria, followed by caudal epidural steroid injections.
Results
Responses were obtained from 25 knee arthroplasty and 25 spine surgeons, achieving response rates of 50% for each specialty. The median clinical experience post-training was 26 years for both groups. Recommendations for "TKA first" varied significantly among knee arthroplasty surgeons, with rates of 32%, 76%, 60%, 8%, and 80% across five scenarios (P < 0.001). In comparison, spine surgeons recommended "spine surgery first" at rates of 24%, 80%, 52%, 16%, and 76%, also showing significant differences (P < 0.001). Most spine surgeons indicated their decision would remain unchanged if the procedure was a decompression.
Conclusion
This study emphasizes the significant influence of knee deformity on treatment order preferences among knee arthroplasty and spine surgeons, highlighting the need for individualized decision-making in managing patients with concurrent degenerative knee and lumbar spine disorders
CLINICAL CHARACTERISTICS AND ENDOSCOPIC FINDINGS OF SYMPTOMATIC DYSPEPSIA PATIENTS IN RURAL AND URBAN AREAS: A RETROSPECTIVE COMPARATIVE STUDY.
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Dyspepsia is a common gastrointestinal disorder affecting a substantial portion of the global population, characterized by various symptoms such as epigastric pain and early satiety. Understanding the differences in dyspeptic presentations among diverse populations can inform more effective diagnostic and treatment strategies. This study seeks to contrast the clinical characteristics and endoscopic findings of dyspeptic patients from rural and urban areas.
Methods
This retrospective comparative study was conducted at SCB Medical College & Hospital in Cuttack over one year, involving 100 patients diagnosed with dyspepsia. Participants were selected using non-probability consecutive sampling, with inclusion criteria focused on individuals aged 16 to 75 years presenting with relevant gastrointestinal symptoms. Endoscopic evaluations were performed to assess the underlying conditions.
Results
The study revealed that the majority of patients were aged 31-40 years (25%), with a slight female predominance (55%). The rapid urease test indicated a 60% positive rate for Helicobacter pylori infection among participants. Notable endoscopic findings included erosive antral gastritis observed in 30 rural patients and 35 urban patients, highlighting the differences in gastrointestinal conditions between populations.
Conclusion
The findings underscore the need for tailored healthcare interventions based on demographic factors, as urban patients exhibited a higher prevalence of certain dyspeptic symptoms. This study emphasizes the importance of understanding the clinical and endoscopic variations of dyspepsia to enhance patient care.
Recommendations
Initial endoscopy for new-onset dyspepsia is recommended in patients 50 years of age or older or those with alarm features
A COMPARATIVE STUDY OF AUTOLOGOUS BLOOD VERSUS CONVENTIONAL CONJUNCTIVAL AUTOGRAFT SURGERY FOR PTERYGIUM
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Pterygium is a common ocular condition characterized by fibrovascular conjunctival tissue growth onto the cornea. Surgical excision and conjunctival autografting are the main treatments to reduce recurrence. The use of autologous blood (AB) as a graft adhesive has become more popular due to its cost-effectiveness, shorter surgical time, and elimination of extraneous materials.
Objective: To compare autologous blood graft fixation's efficacy, safety, and recurrence rates to conventional suture fixation in conjunctival autograft surgery for primary pterygium.
Methods
A 13-month prospective, comparative study was conducted at Jawahar Lal Nehru Medical College and Hospital in Bhagalpur. The 127 primary nasal pterygium patients were divided into two groups: Group A (n=64): Autologous blood graft adhesion. Traditional 8-0 Vicryl suturing (Group B, n=63). All procedures were performed under local anesthesia by the same surgeon. After surgery, patients were monitored on days 1, 7, 30, 90, and 180. The parameters assessed included operation duration, postoperative pain, graft stability, complication rates, and recurrence (≥1 mm fibrovascular regrowth into the cornea).
Results
The average operating duration was significantly shorter in Group A (18.5 ± 3.2 minutes) compared to Group B (30.2 ± 4.1 minutes; p<0.001). Group A had significantly less postoperative pain and erythema in the first week. Graft displacement occurred in 4.6% of Group A and 0% in Group B (p<0.05). Three patients (4.6%) in Group A and two (3.1%) in Group B had recurrence at six months, which was not statistically significant (p>0.05). Conclusion
Autologous blood is a safe, effective, and cost-effective alternative to sutures for fixing conjunctival autografts in primary pterygium. It significantly reduces surgery time and postoperative pain. Graft displacement is slightly more likely, but proper surgical technique can reduce it. Both procedures have similar recurrence rates, suggesting autologous blood is a viable alternative in high-volume, resource-constrained ophthalmology
COMPARATIVE STUDY BETWEEN THE USE OF ULTRASONIC CRITERIA OF WEANING VERSUS THE CONVENTIONAL CRITERIA OF WEANING IN POST-TRAUMATIC ACUTE RESPIRATORY DISTRESS SYNDROME PATIENTS WHO WERE VENTILATED FOR A LONG TIME
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Critically ill trauma patients often need mechanical breathing due to post-traumatic Acute Respiratory Distress Syndrome (ARDS). Weaning from ventilation quickly and precisely prevents ventilator-related issues, shortens ICU stays, and improves outcomes. Traditionally, weaning guidelines rely on clinical assessment and respiratory metrics, which may be insensitive. Recently developed ultrasonography tests, like diaphragmatic excursion and lung ultrasound scores, may better assess weaning readiness objectively and quickly.
Objective: To compare ultrasonic criteria to traditional clinical criteria for weaning post-traumatic ARDS patients who require extended mechanical breathing.
Methods
The study included 87 post-traumatic ARDS patients who needed ventilation for over 72 hours. Patients were randomly assigned to two groups: Group A (Conventional Weaning Criteria): Respiratory rate, tidal volume, minute ventilation, and Rapid Shallow Breathing Index are clinical and laboratory metrics. Group B (Ultrasonic Weaning Criteria): Bedside ultrasound metrics like diaphragmatic excursion (>1 cm), thickening fraction (>30%), and lung ultrasound B-line resolution determine this group. Effective weaning—48 hours of spontaneous breathing without re-intubation—was the main goal. Weaning failure, ICU stay, and post-extubation issues were secondary outcomes.
Results
Group B (ultrasound-guided) had higher weaning success rates (85.7%) than Group A (70.4%). Group B had a shorter average ICU stay (6.2 ± 1.8 days) than Group A (8.4 ± 2.3 days). Ultrasound measurements predicted weaning success with 91% sensitivity and 82% specificity. Ultrasound reduced post-extubation respiratory distress.
Conclusion
Ultrasonographic examination is more accurate and reliable than traditional criteria for assessing weaning readiness in post-traumatic ARDS patients. Its inclusion in critical care protocols may improve weaning and reduce ICU strain
COMPARISON OF HEMODYNAMIC CHANGES IN THORACIC SEGMENTAL SPINAL ANAESTHESIA AND GENERAL ANAESTHESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY
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Laparoscopic cholecystectomy is the standard surgical procedure for symptomatic gallstone disease, typically performed under general anesthesia. Increasing evidence suggests that thoracic segmental spinal anesthesia (TSSA) improves perioperative hemodynamic stability and reduces postoperative complications. Therapeutically, comparing the physiological effects of both methods on intraoperative and postoperative hemodynamic measures is important.
Objective: to compare the hemodynamic effects of thoracic segmental spinal anesthesia to general anesthesia in laparoscopic cholecystectomy patients. Secondary outcomes include analgesic requirements, nausea/vomiting, and recovery profile.
Methods
A 13-month prospective, comparative research study at Patna Medical College & Hospital involved 107 adult patients undergoing elective laparoscopic cholecystectomy. Patients were randomly assigned to two groups: A (n=53) had thoracic segmental spinal anesthesia (TSSA), while B (n=54) received general anesthesia. At regular intervals, hemodynamic parameters like HR, MAP, and SpO₂ were recorded during and after the procedure. Analgesics, recovery time, and side effects like nausea and hypotension were recorded.
Results
Compared to GA, TSSA resulted in more stable hemodynamic parameters, with significantly reduced MAP and HR oscillations (p < 0.05). TSSA patients needed fewer intraoperative analgesics, recovered faster, and had less postoperative nausea and vomiting. TSSA had more hypotension early in surgery, but vasopressors controlled it. No high spinal block or neurological sequelae were observed.
Conclusion
Thoracic segmental spinal anesthesia offers a safe and effective alternative to general anesthesia for laparoscopic cholecystectomy, resulting in improved hemodynamic stability, reduced perioperative complications, and faster recovery. TSSA is beneficial for those at risk of general anesthesia
UNDERSTANDING STUDENT PERCEPTIONS OF CLIMATE CHANGE THROUGH VIDEO-BASED EDUCATION: A QUALITATIVE ANALYSIS
Get PDFExploring undergraduate students' perceptions and behavioural changes following a video-based educational intervention on climate change is a novel concept. Using qualitative thematic analysis, this study uncovered key insights into students’ evolving attitudes and engagement with sustainable practices. A thematic analysis was conducted using NVivo software, and a word cloud was used to visualize recurring themes.
The study identified three primary themes: increased awareness, behavioural change and empowerment and advocacy. Students demonstrated a more comprehensive understanding of human-induced climate change,
with post-intervention responses showing greater recognition of its causes and consequences. Participants also expressed increased motivation to adopt sustainable habits, such as reducing plastic use and participating in advocacy efforts. Limitations of the study included potential response bias, short-term evaluation, and a geographically limited sample. Findings emphasize the need for interactive and experiential learning methodologies to cultivate climate-conscious behaviours among youth. The findings reinforce the effectiveness of video-based education in fostering environmental awareness and advocacy, suggesting its potential integration into formal education systems
RELEVANCE OF MATERNAL FACTOR ON LOW BIRTH WEIGHT IN FULL-TERM NEONATES AT NAKIVALE HEALTH CENTER III, ISINGIRO DISTRICT.A CROSS-SECTIONAL STUDY.
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Low birth weight (LBW) among neonates constitutes a significant global public health challenge with implications for immediate and long-term maternal and child health outcomes. This study investigated the relevance of maternal demographic factors on LBW neonates: specifically focusing on the association of maternal age, residential category status, and the relationship between gravidity and parity, and health status with low birth weight in full-term neonates at Nakivale Health Center III, Isingiro district.
Methodology
The study adopted a descriptive cross-sectional research design conducted among 98 mothers. The data was collected from the maternal register and analyzed using descriptive, exploratory, and logistic regression analysis.
Results
The average age of mothers was approximately 25.37 years, A logistic regression model fitted to explore the simultaneous influence of multiple maternal demographic factors on the likelihood of LBWs recorded Age = 0.779, Gravidity = 0.997, Parity:p = 0.997, Nulliparity: (Yes vs. No): p = 1.000. The null model's null deviance was 93.4760 with 97 degrees of freedom, all participants were recorded with an HIV-negative status and the average weight of babies was 2.247 Kg, with a range from 1.5 to 2.4 Kg.
Conclusion
The study offered valuable insights into the factors potentially influencing LBW at Nakivale Health Center III. While maternal age, residential category, gravidity, and parity were explored, only maternal age showed no significant association with LBW
Recommendation
To improve the accuracy and depth of our findings, health centers should prioritize complete and comprehensive data collection, especially concerning maternal health statuses.
Culturally sensitive interventions focusing on socioeconomic inequalities, timely access to antenatal and prenatal care, and health education promotion will be crucial in reducing LBW incidence and improving maternal and child health outcomes.