International Journal of Research in Medical Sciences
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Left gallbladder: surgical challenge in laparoscopic cholecystectomy: a case report
Get PDFLeft-sided gallbladder (LSGB) without situs inversus is a rare genetic anatomical abnormality, defined by the location of the gallbladder to the left side of the liver falciform and round ligaments, with incidences ranging from 0.04% to 0-7% according to various literature reports. It is gaining relevance as it becomes a surgical challenge given the potential variants of the biliary tract. This article describes the case of 55-year-old female scheduled for elective laparoscopic cholecystectomy due to 3-months-old cholelithiasis, incidentally diagnosed, in which a left gallbladder was identified. She underwent multiport laparoscopic cholecystectomy (LC), where a gallbladder implanted on the left side (in the hepatic segment III) was identified with no other apparent anomalies of the biliary tree. The procedure was performed without incident. LSGB without situs inversus, also known as “sinistraposition,” is a rare and often incidental finding that can represents a technical and surgical challenge for the general surgeon unrelated to these variants, thus increasing morbidity
Clinical and microbiological spectrum of catheter-related bloodstream infections in non-tunneled and tunneled internal jugular vein hemodialysis catheters at a tertiary care hospital in Uttarakhand
Get PDFBackground: Catheter-related bloodstream infection (CRBSI) is a significant cause of morbidity and mortality in patients undergoing hemodialysis. In this prospective cohort study, we studied the incidence rate of CRBSI as well as the clinical and microbiological profile in non-tunneled and tunneled hemodialysis catheters.
Methods: Patients were recruited as per inclusion/exclusion criteria. Patients with non-tunneled internal jugular catheters were followed for 1 month and tunneled internal jugular were followed for 3 months. Patients with clinical signs and symptoms suggestive of CRBSI were admitted. We followed the centers for disease control and prevention (CDC) guidelines for the diagnosis of catheter-associated bloodstream infections microbiological methods-blood samples were inoculated on an automated BACTEC system for 5 days. If microbial growth was detected by the automated system, Gram staining was performed and growth was sub-cultured on culture media.
Results: The 202 patients underwent internal jugular vein hemodialysis catheter insertion. The 21 patients were excluded from the study. Total 181 patients were confirmed eligible. The 16.0% of the participants (29 patients) developed CRBSI during follow up. Incidence of CRBSI in our study was 3.73 episodes per 1000 catheter days. Diabetes mellitus and low BMI were risk factors for CRBSI. Most of the CRBSI were caused by gram negative organism. Overall, 65.5% of CRBSI were caused by multidrug resistant organisms.
Conclusions: Incidence of CRBSI was high in non-tunneled catheters as compared to tunneled catheters
Hoffmann's syndrome: delayed onset and progression in the elderly - a case report
No full textHoffmann's syndrome (HS) is typically characterized by myopathy and linked to hypothyroidism. It is distinguished by hypothyroidism, muscle weakness, and pseudohypertrophy of particular muscles. In the present case report, a 70-year-old man was brought to the hospital with major complaints of hematuria and swelling in both legs, and a small wound on his right leg. He had a known history of type 2 diabetes mellitus with irregular medication. The hematological investigation reveals abnormalities, including an irregular Q-wave, an inverted T-wave, and low voltage in the limb leads, as identified by electrocardiography (ECG). Troponin I was negative, cardiac indicators were aberrant, and the creatine kinase myocardial band (CK-MB) level was 132 U/l. To manage the symptoms and stabilize the patient’s condition, he was treated initially with antibiotics, metformin, metoprolol, furosemide, aspirin, and clopidogrel. Contrarily, the leg swelling did not improve. Later, the hematological investigation revealed that abnormal thyroxine levels (T3-0.26 ng/ml, T4-0.5 ng/ml, and TSH-60.0 mIU/l) and prominent right leg swelling were associated with chronic kidney disease (CKD) and Hypothyroidism. The swelling and cellulitis gradually reduced after intravenous meropenem and oral thyroxine treatment. He was continuously monitored, and signs and symptoms steadily improved. In this instance, it is crucial to stress that, particularly in the absence of obvious signs of hypothyroidism, a differential diagnosis of musculoskeletal problems should be taken into consideration when a patient presents with leg swelling, and early detection of Hoffman’s disorder leads to a more effective treatment outcome
Comparing the efficacy of concurrent capecitabine with external beam radiotherapy versus radiotherapy alone in pain management of osseous metastasis from breast cancer
Get PDFBackground: Breast cancer is the most common cancer in women globally, and bone metastases significantly affect the quality of life and survival. This study aimed to compare the efficacy of concurrent capecitabine with EBRT versus EBRT alone in managing pain from osseous metastases in breast cancer patients.
Methods: A quasi-experimental study was conducted with 56 breast cancer patients with bone metastases. Patients were divided into two groups: Group A received EBRT alone, while group B received concurrent capecitabine (825 mg/m2, 5 days/week) with EBRT.
Results: In this study, group A (n=28) and group B (n=28) were compared across various parameters. The mean ages were similar (Group A: 42.9±8.4 years, group B: 42.1±12.5 years, p=0.780). ECOG performance status was significantly better in group B (e.g., 12th week: group A: 1.14±0.65, group B: 0.71±0.59, p=0.012). Treatment response showed that by the 12th week, 42.9% of group B had a complete response (CR) compared to 14.3% in group A (p=0.027). No significant differences were observed in treatment-related side effects.
Conclusions: The study found that combining capecitabine with EBRT improved pain management and reduced the need for pain medications in breast cancer patients with bone metastasis. Both treatment groups showed similar side effects, indicating good tolerance for both regimens
Literacy and health-seeking behaviours for HIV/AIDS: the moderating role of economic status in India
Get PDFBackground: Literacy determines how people access healthcare services, particularly in cases such as condom use, HIV testing and pregnancy testing. Economic disparities and literacy differences in India result in unequal access to preventive and medical care.
Methods: This research utilizes secondary data to examine the relationships between healthcare behavior and economic status moderation in India's 34 states, employing a cross-sectional approach. Moderation analysis was conducted by using PROCESS Macro v4.2 in SPSS.
Results: Significant moderation effects were found for economic status on the relationship between literacy rate and health-seeking behaviors, especially for pregnancy and HIV testing.
Conclusions: The research findings highlight the need for developing public health programs that address literacy and economic barriers. Underprivileged communities require specific approaches that account for monetary constraints to achieve better results in HIV prevention combined with reproductive health outcomes
From chaos to coordination: leveraging technology for efficient bed management in a large and complex healthcare system
Get PDFBackground: Effective bed management is fundamental to hospital operations, significantly impacting patient care, resource utilization, and overall efficiency. AIG Hospitals, Hyderabad (India) accommodates 620 in-patient beds catering to more than 2,500 outpatients daily. The emergency department caters to over 70 visits each day and a 65% in-patient admission conversion rate. On average, the hospital handles 100 admissions and 100 internal transfer requests daily, maintaining a bed occupancy rate exceeding 75%. The Hospital tried handling through shared Excel sheets however bed management efficiency was a concern.
Methods: To solve the problem, the hospital decided to leverage modern technology with good user interface to undertake real-time bed management.
Results: This led to improvement in bed occupancy from 75% to 80%, increase in bed turnover rate by 11%, reduction in admission to arrival turnaround time (TAT) by 65% and improvement in net promoter score (NPS) by 14%. Average monthly admission went up by 12% on an average – converting to 323 additional admissions per month. The correlation for bed occupancy rate admission to arrival TAT and NPS was statistically significant.
Conclusions: This article explores this innovative solution that revolutionized bed management by leveraging real-time tracking, intelligent analytics, and improved communication. As healthcare demand grows, hospitals must adopt innovative solutions. This study demonstrates how integrating a web-based bed management system can transform hospital operations, optimize resource use, and improve care delivery-setting a new benchmark in hospital efficiency
Comparison between catgut endoloop versus vicryl endoloop in laparoscopic appendicular stump closure
Get PDFBackground: Laparoscopic appendectomy has become the standard of care for acute appendicitis, offering numerous advantages over open surgery. The closure of the appendicular stump remains a critical step in this procedure, with various techniques available. This study aimed to compare the efficacy and outcomes of catgut versus vicryl endoloops in appendicular stump closure.
Methods: A prospective observational study was conducted at tertiary care hospitals in Mangalore from March 2022 to March 2024. Thirty-five patients undergoing laparoscopic appendectomy were included and divided into catgut (n=18) and vicryl (n=17) endoloop groups. Parameters evaluated included operative time, hospital stay duration, post-operative complications, and follow-up outcomes.
Results: The mean operative duration was comparable between groups (catgut: 1.2±0.4 hours, vicryl: 1.4±0.6 hours, p>0.05). The catgut group demonstrated significantly shorter hospital stays (3.0±0.8 versus 4.1±0.8 days, p<0.05). Post-operative complications were similar between groups, with pain being the most common (catgut: 50%, vicryl: 41.2%). Early oral intake was achieved in 60% of patients by post-operative day one. Follow-up showed good recovery in 71.4% of patients, with no reported cases of stump appendicitis among those who completed follow-up.
Conclusions: Both catgut and vicryl endoloops demonstrate comparable safety and efficacy in laparoscopic appendicular stump closure. While catgut endoloops showed advantages in hospital stay duration, both methods proved reliable with similar complication rates. The choice between materials can be based on surgeon preference and institutional protocols without compromising patient outcomes
First report of hyperphosphatemic familial tumoral calcinosis due to homozygous GALNT3 mutation in a 16-year-old boy
Get PDFHyperphosphatemic familial tumoral calcinosis (HFTC) is a rare disorder HFTC is caused by a loss of function in fibroblast growth factor 23 (FGF23), leading to increased phosphate levels in the body and calcium deposition. It also has an autosomal trait with presentation early in childhood or 2nd decade of life. Mutation of polypeptide N-acetylgalactosaminyltransferase 3 (GALNT3) and Klotho (KL) gene are seen in HFTC. We present the first reported case of a 16-year-old boy diagnosed witsh HFTC due to a homozygous GALNT3 gene mutation at exon 5 (Leu366Arg). The patient exhibited calcinosis in the left gluteal region and hyperphosphatemia. Surgical excision and genetic analysis confirmed the diagnosis. Our aim is to highlight the role of genetic screening in HFTC diagnosis and explore novel mutations, advancing research in rare metabolic disorders
Improving maternal and neonatal outcomes through enhanced recovery after caesarean approach: a systematic review
Get PDFThe responsibilities of caring for the newborn are affected by factors before, during and immediately after caesarean section. Enhanced recovery after caesarean section (ERAC) enables faster return to preoperative functions and thus, has beneficial effects on the mother and her infant. Authors conducted a systematic review of the literature in January 2025 that involved searching 4 databases for peer-reviewed articles on ERAC protocol and traditional techniques between 2015 and 2024. The year of publication, first author’s country, study design, sample size, gestational age, indications for surgery, type of caesarean section and other key findings were extracted from the articles that met the inclusion criteria. The full articles, abstracts, guidelines and conference papers retrieved were 467 with 450 removed for duplications, only abstracts, being guidelines, not meeting our targets and publications outside the stated years. Only 17 articles were included in the review. The primary authors of the included articles originated from 8 countries spanning four (4) continents and 41.2% came from Asia, 23.5% from Africa, and 17.6% each from North America and Europe. Majority (35.3%) of the articles were randomized controlled trials and 29.4% were cohort studies. Interestingly, 88.2% of the articles were published in the last 5 years. Only one study (5.9%) discussed the parental sense of security following discharge from hospital. The socio-demographic variables, past obstetrics, types of caesarean section, gestational age at delivery and type of anaesthesia were factors affecting the success of enhanced recovery after caesarean section and its outcomes
Evolution of aesthetic rhinoplasty: an analysis of surgical techniques and outcomes at the Dr. Eduardo Liceaga General Hospital of Mexico (2019-2025)
Get PDFBackground: Rhinoplasty is a highly sought-after surgical procedure that has evolved with the concepts of function and aesthetics, achieved through precise modification of bony and cartilaginous structures using both open and closed approaches. To analyze the surgical techniques employed in aesthetic rhinoplasty between 2019 and 2025 at the Hospital General de México Dr. Eduardo Liceaga (HGM).
Methods: A retrospective, descriptive, observational study was conducted on 300 patients who underwent rhinoplasty. Demographic data, type of rhinoplasty (primary/secondary), surgical approach (open/closed), incisions, osteotomies, grafts and complications were organized and analyzed within an excel table. Patient satisfaction was assessed via telephone surveys.
Results: The sample was predominantly female (65%) with a mean age of 34.5 years. The majority underwent primary rhinoplasty (82%). Open and closed approaches were distributed almost equally (52% vs. 48%). The complication rate was 12%, with no significant differences between the two approaches. Overall satisfaction was high (8.5/10 for function and 8.0/10 for aesthetics), with a slight trend toward greater aesthetic satisfaction with the open approach.
Conclusions: The choice between open and closed approaches should be based on nasal anatomy, patient goals and the surgeon's experience. Both techniques produce satisfactory results, underscoring the importance of minimizing complications to improve patient perception.