20 research outputs found
Footboards: Indigenous and novel method of screening for diabetes peripheral neuropathy – A pilot study
No full textBackground: To validate the effectiveness of indigenously designed “footboard (FB)” in early diagnosis of diabetic peripheral neuropathy (PNP) by comparing it with Semmes–Weinstein monofilament (SWM) and vibration perception (VP). Materials and Methods: Two hundred and forty-four patients with diabetes were examined for PNP using SWM and 128 Hz tuning fork. The findings were compared with indigenously designed FBs with 1, 2, and 3 mm elevations. Results: Out of 108 patients who did not have protective sensation as per SWM, only 10 (9.2%) felt 1 mm board bearings, and out of 72 patients who did not feel vibration, only 8 (11.1%) felt 1 mm board bearings. Out of 136 patients who had protective sensation, 128 (94.11%) felt 2 mm elevated board bearings, and out of 172 patients who had VP, only 152 patients (88.3%) felt 2 mm board bearings. With SWM as standard, the sensitivities and specificities, respectively, were 63% and 90% (1 mm board), and 94% and 60% (2 mm board). With VP, the sensitivities and specificities, respectively, were 59% and 90% (1 mm board), and 88% and 61% (2 mm board). Conclusions: FB, which simultaneously tests touch and pressure sensation, shows a high level of performance in detecting at-risk feet. FB may be simple, time-efficient, and inexpensive test for detection of neuropathy and needs further validation in a larger study
Microbiological and quantitative analysis of burn wounds in the burn unit at a tertiary care hospital in Kashmir
No full textBackground: The burn wound represents a susceptible site for opportunistic colonization by organisms of endogenous and exogenous origin. The present study was undertaken to analyze the microflora of burn wounds of the burn patients from a tertiary care hospital in Kashmir, India. Materials sand Methods: The study included all patients with acute burns admitted from January 2010 to December 2011 (2 years). The standard techniques, as practiced during collection of microbiological specimens, were used during wound swab/biopsy collection. Results: 74.19% of swab cultures yielded single isolates. On swab culture, Pseudomonas aeruginosa was the commonly isolated organism (46.86%). Staphylococcus aureus was the most common isolate isolated during 1st postburn week (30.86%). 258/288 (89.58%) blood cultures were sterile. 8/58 (13.79%) blood cultures were positive during the second postburn week. S. aureus was the most common organism grown on blood culture (44.44%). P. aeruginosa was mostly sensitive to polymyxin B (86.0%), amikacin (40.0%), and ciprofloxacin (37.3%), respectively. S. aureus was most commonly sensitive to linezolid (85.0%) and vancomycin (78.8%%) whereas Acinetobacter spp. was sensitive to polymyxin B (65.3%), piperacillin/tazobactam (44.9%), and amikacin (38.8%). Patients (27.27%) who showed local signs of burn wound infection and positive blood culture were subjected to burn wound biopsy. 93.33% of patients who had counts >105 colony-forming unit/g of tissue showed significant association with local signs of burn wound infection and positive blood culture for any organism. Conclusion: The microbiological surveillance of burn wounds needs to be continued for a rational antibiotic policy and prevention of emergence of resistant organisms. Burn wound biopsy culture is an effective tool for quantitative analysis of burn wounds; however, subjecting this biopsy to histological examination is more predictable of burn wound infection and its correlation with burn wound sepsis
A review of the blood transfusion practices in neuroanesthesia in the perioperative period in a tertiary care hospital
No full textBackground: Blood transfusion involves the administration of blood and blood components. Neurosurgical procedures are associated with significant blood loss with the need for blood transfusion in the preoperative, intraoperative and postoperative period to maintain optimal hemodynamic and cerebral oxygenation. Various neurosurgical procedures as traumatic brain injury, complex spinal surgeries, and endovascular neurosurgical procedures may need blood transfusions to maintain the optimal physiology.Methods: This study was performed prospectively at a tertiary care hospital in northern India with about a work load of 800 to 1000 elective neurosurgical surgical procedures being done per year. This data was collected prospectively over a period of one year from the patients being operated for elective neurosurgical procedures and later on shifted to the neurosurgical intensive care unit and the neurosurgical wards. The patients operated for emergency procedures for traumatic brain surgery were not included in the study.Results: A total of 455 elective neurosurgical procedures were done during the study period. Out of these 455 patients there were 95 patients who were in the paediatric age group with age less than 12 years. Out of 360 adult patients 85 patients were in need of blood transfusion which constituted 23.6 percent of the operated patients. Out of these 85 patients 45 patients needed two transfusions in the form of whole blood or packed cells, 40 patients needed a single transfusion.42 units of fresh frozen plasma were transfused to 17 patients with 15 patients receiving platelet transfusions.Conclusions: In conclusion, neurosurgical population is associated with significant blood loss and a requirement of blood transfusion. About 47 percent of paediatric population needed blood transfusion in our study with around 24 percent of adult population. The transfusion requirement was mainly seen in patients with craniostenosis, meningiomas, cerebello pontine tumours and meningiomas.</jats:p
Bringing electricity to rural India
No full textIn today’s Development environment, characterised by a scarcity of resources for projects and interventions, non-governmental organizations (NGOs) must fiercely compete for funds. This has led NGOs to adhere to the donor’s narrative, language and Neoliberal values – with storytelling assuming a prominent position – potentially creating stereotyping issues in their communication outputs – while also facing the contrasting forces of market, state and communities. This thesis focuses on the case-study of the Bijli project, an energy access initiative for rural villages in India, created by The Climate Group – an important actor in the field and the charity where the author of this thesis still works. After a quick analysis of how the energy issue has shaped development in India, this work uses the academic tools of Discourse Analysis and Representation to examine the issues of stereotypes and marginalisation in the video produced by The Climate Group at the end of the Bijli program. Then, the ‘lessons learned’ have been applied to the video script for a new, potential video for a similar project that The Climate Group is now developing. Finally, such empirical application has shown how the issues arisen in the analysis relate to the modern debate in the Communication for Development field and how these new partnerships both challenge and reinforce the existing power relationships in the current Neoliberal climate. A more participatory, inclusive model could help the Global North audience better understand the reality in which it wants to intervene, but at the same time state and market are two powerful, useful actors to bring a more equitable development
Results of snodgrass repair.
No full textObjectives: Snodgrass repair is fast becoming the procedure of choice in distal penile hypospadias. Multiple series document excellent cosmetic outcome in conjuction with low complication rates.
Study Design: Prospective.
Material & Methods: A prospective study of 26 patients in whom Snodgrass repair for distal penile hypospadias was done over a period of two and a half years. All patients with hypospadias other than distal penile were excluded from the study.
Results: Mean age of the patients was 6.2±3.2years. Mean operative time was 68.7 minutes. Mean hospital stay was 15.4 days. Wound infection, bleeding/haematoma and urethrocutaneous fistula were the three complications seen in our patients with equal incidence (3.8%). Cosmetic as well as functional outcome was very good in our patients.
Conclusions: Snodgrass Repair has revolutionised the management of distal penile hypospadias. Meticulous technique coupled with careful patient selection permit a high rate of success with minimal morbidity
Comparison of post-dural puncture headache- incidence and severity in obstetric patients after spinal anesthesia for caesarean section with 25G and 27G quincke needle
No full textBackground: The use of neuraxial anesthesia for caesarean section has dramatically increased in last 2 decades because it is easier to perform, safe to the mother and the fetus, and has a high degree of success rate. However, post-dural puncture headache is a well-known complication of spinal anesthesia. It is a common and incapacitating compliation following dura-arachnoid puncture and results in increased morbidity, prolonged hospital stay, increased cost, and patient dissatisfaction.Methods: It was a double-blinded comparative study conducted on 75 consecutive pregnant patients meeting the inclusion criteria of the study. Patient and anesthesiologist involved in collection of data were blinded to the gauge of the needle used. Standard anesthesia protocol was followed in all the patients and spinal anesthesia performed using 25G Quincke needle in 38 patients and 27G Quincke needle in 37 patients.Results: we included 75 consecutive patients in the age group 20-35 years in the study. Overall incidence of PDPH was 14.67% (11/75) in present study. 23.68% (9/38) and 5.4% (2/37) patients who received spinal anesthesia with 25G and 27G needles respectively developed PDPH. Difference was statistically insignificant.Conclusions: The incidence of PDPH was less in patients who underwent caesarean section under spinal anesthesia with 27G needle compared to that of patients in whom block was performed using 25G needles. However, there was no definite advantage of 27G Quincke needle over 25G Quincke needle as far as the incidence of PDPH is concerned
Management of Wounds with Exposed Bones or Tendons in Children by Vacuum-Assisted Closure Therapy: A Prospective Study
No full textBackground The management of complex soft tissue defects with exposed bones/tendons is always a challenging task for the surgeon and the problem becomes more pronounced when it comes to the management of these wounds in children. Though flap procedures are considered the standard for managing the complex soft tissue defects with exposed bones/tendons yet small blood vessels for anastomosis, long operative period, increased chances of perioperative thrombosis, and difficult perioperative management in children add to the difficulty in performing flap procedures in children. The vacuum-assisted closure (VAC) therapy has emerged as a novel modality for the management of the difficult wounds with added advantages, especially in children.
Objective To evaluate the efficacy of VAC in the management of wounds with exposed bones/tendons in children.
Patients and Method Forty-six children of complex wounds with exposed bones/tendons were included in the study from July 2016 to June 2018.
Results Out of 46 patients, 31 were male; the patients had a mean age of 8.4 years. Road traffic accident was the most common mode of injury (54%), with most of the wounds located over extremities. The mean duration of VAC therapy was 12 days. More than 90% coverage of the exposed structure was seen in 89% of patients. The wounds were definitively managed by split-thickness skin graft in 89% of patients and flap cover in 6.5% of patients. The mean cost of the VAC therapy at our government run hospital was 187 Indian rupees per day. No significant major complications were seen during the treatment.
Conclusion VAC therapy is an efficient, safe, and cost-effective modality of treatment for the management of complex wounds in the pediatric population
Isolated aglossia in a six year old child presenting with impaired speech: a case report
No full textContralateral lumbo-umbilical flap: A versatile technique for volar finger coverage
No full textBackground: While contemplating any difficult soft tissue reconstruction, patient comfort and compliance is of paramount importance. Reconstruction of the volar aspect of fingers and hand by the ipsilateral pedicled flaps (groin flap, abdominal flaps) is demanding as the flap inset is difficult for the surgeon and very uncomfortable for the patient. This often leads to flap complications. For the comfort of the patient, better compliance and ease of complete inset, we planned to manage soft tissue defects of the volar aspect of fingers and hand by a new contralateral pedicled lumbo-umbilical flap. This flap is based on the paraumbilical perforators of deep inferior epigastric artery. Materials and Methods: The contralateral pedicled lumbo-umbilical flap was used in eight patients with high-tension electrical burn injuries involving the volar aspect of fingers and hand. The patients were closely observed for first 6 weeks for any flap or donor site complications and then followed monthly to assess donor and recipient site characteristics for 6 months to 2 years. Results and Conclusion: Large flaps up to 8 cm × 16 cm were raised. All but one flaps survived completely. All patients were mobilised within 48 h and five were discharged in less than a week after initial inset. The flap is reliable, easy to harvest and easy to inset on the volar aspect of fingers. The arm is positioned in a very comfortable position. The main disadvantage, however, is a conspicuous abdominal scar
