Day Care Basis Research Articles

Evaluation of Outcomes Following Endovenous Laser Therapy (EVLT) for Chronic Venous Insufficiency (CVI) on a Daycare Basis in a Tertiary Healthcare Centre of Northern India: A Prospective Cohort Study

Evaluation of Outcomes Following Endovenous Laser Therapy (EVLT) for Chronic Venous Insufficiency (CVI) on a Daycare Basis in a Tertiary Healthcare Centre of Northern India: A Prospective Cohort Study

The Changing Landscape of Urologic Practice, An Issue of Urologic IR: 2022

Interventional Uroradiology or Urological IR covers various minimally invasive procedures to treat problems that affect the kidney, bladder and ureter (the tube connecting the kidney to the bladder), and testes. Almost all patients in the UK with obstructed and/or infected kidneys are referred to interventional radiology for percutaneous nephrostomy and/or placement of an anterograde JJ stent. Although this ‘tradition’ is going strong in the UK, urologists worldwide have evolved their practice to encompass such interventional procedures in their remit.1 Advances in imaging technology, especially in the last two decades, have led to a paradigm shift in the field of image-guided interventions in urology. While the traditional biopsy and drainage techniques are firmly established, image-based stone management and endovascular management of hematuria have evolved further. Ablative techniques for renal and prostate cancer and prostate artery embolization for benign prostatic hypertrophy have evolved into viable alternative treatments. Many urologic diseases that were earlier treated surgically are now effectively managed using minimally invasive image-guided techniques, often on a daycare basis using only local anaesthesia or conscious sedation. This article presents an overview of the technique and status of various image-guided urological procedures, including recent emerging techniques. Bangladesh J. Urol. 2022; 25(2): 106-121

Outcomes of Transaortic Celiac Plexus Block for Upper Abdominal Malignancies Performed as a Day-care Procedure: A Retrospective Observational Study

Background: Severe abdominal pain refractory to opioids significantly affects the quality of life (QoL) in patients with abdominal primary cancer or metastatic disease. A neurolytic celiac plexus block (CPB) would be necessary to alleviate pain and improve QoL until death. Aims: The aim of this retrospective study is to investigate pain relief after a transaortic celiac plexus neurolysis for patients with upper gastrointestinal malignancies. Settings and Design: This retrospective observational study was done in the Pain Department, Shri Siddhivinayak Cancer Hospital, Miraj from January 2005 to January 2015. Materials and Methods: One hundred and twenty-four patients with upper abdominal malignancy received a computed trans-aortic celiac plexus block (TAoCPB) on a day-care basis. The primary outcome was pain as assessed with numerical rating scale ranging from 0 to 10; the secondary outcome measures were morphine consumption per day, QoL, and complications, if any. These were recorded before intervention, on day 1 after the block and at 1 month interval until 6 months. Statistical Analysis Used: Bonferroni correction for multiple comparisons and a P < 0.0167 (0.05/3) was considered to be statistically significant due to 3 co-primary outcomes being measured (visual analog scale [VAS] scores, morphine consumption, and QoL). Results: Up to 4.5 months, the VAS score, daily morphine consumption, and the QoL showed improvement for the duration of the study. Pain gradually increased at 6 months with a deterioration of QoL. Respiratory distress and burning sensation in chest occurred in one patient each. Conclusions: A low-volume TAoCPB is effective and established procedure as a day-care procedure. Although pain relief occurs until 4.5 months, a gradual increase was perceived with a decline of quality of health at 6 months.

Is daycare tonsillectomy a safe outpatient surgery at Pokhara ENT Center, Nepal

Introduction: Tonsillectomy is one of the most common surgical procedure in the world performed by Ear, Nose and Throat surgeon. Over the past decade, there has been progress in surgical techniques for tonsillectomy, yet pain and bleeding after tonsillectomy remain important surgical complications. With the increasing need to reduce healthcare costs in developing countries, there is currently a trend towards performing tonsillectomy on a daycare basis and this study aims at evaluating how efficacious it may be in our setting. Methods: A retrospective review of all the daycare tonsillectomy surgeries performed at the Pokhara ENT Center, Pokhara, Nepal from February 2018 to January 2019. Patients aged 15 years and up of either sex who met the paradise criteria were included while patients who met the same but had a contraindication for tonsillectomy surgery were excluded. Demographic information as well as complications within six hours of surgery before discharge and on follow-up on the seventh post-operative day were evaluated, as were any emergency room visits in the first 24 hours and any complications requiring a visit to a healthcare facility. Results: On day of surgery 17% had worst pain and on seventh post-operative day 75% had no pain, only 2% presented with primary hemorrhage and 3% presented with secondary hemorrhage. None of them required revision surgery. Conclusions: Daycare tonsillectomy is being done in only some of the centers owing to the risk of postoperative complications in our country. In our study, the number of complications was lower and not life-threatening. It can be considered a safe and cost-effective method, though patient selection is crucial.

Recent Updates in Surgical Treatment of Benign Prostatic Hyperplasia: A Review Article

Benign prostatic hyperplasia refers to the non-malignant growth or enlargement of the prostate gland and is a general cause of lower urinary tract symptoms in men which rises with growing age. There is a wide range of management options available from watchful waiting, and medicinal therapy to various surgical intervention methods. Though medicinal therapy is the preliminary treatment for benign prostatic hyperplasia, some patients lack the desire to keep on with the extended duration, and on occasion, they must break either due to treatment failure or side effects. Lately, numerous innovative surgical methodologies have been established to provide patients with efficient therapy on a day-care basis, without the risk of general anaesthesia and with rapid recovery, marginal morbidity, and safeguarding the reproductive function. Existing treatment alternatives for benign prostatic hyperplasia differ in the extent of intrusiveness, efficiency, complications, and cost-effectiveness. Various treatment modalities are available these days that are less invasive and have lesser complications as compared to conventional transurethral resection of the prostate. It helps curtail expenses, preserve time for recovery, curb untoward general and reproductive side effects. Laser, endoscopic, robotic, water vapor utilization, and various other minimally invasive methods have demonstrated their effectiveness in the treatment of benign prostatic hyperplasia in various studies.

A Comparative Study of Isobaric 1% Chloroprocaine With 0.5% Isobaric Bupivacaine for Ureteroscopic Lithotripsy Under Spinal Anaesthesia: A Prospective Randomised Study.

IntroductionDay-care surgery has become an immensely popular modality of treatment throughout the globe. Ureteroscopic lithotripsy (URSL) surgery is commonly performed on a day-care basis, and the duration of surgery ranges from 15 minutes to 45 minutes. URSL is routinely done under spinal anaesthesia. Spinal anaesthesia with conventional drugs has its problems like delayed regression and urinary retention, necessitating a longer hospital stay, thereby increasing the time and resources needed. For day-care surgery, short-acting local anaesthetics have a quicker onset with fewer side effects, and drugs that ensure quicker hospital discharge are more often preferred over long-acting anaesthetics. For spinal anaesthesia, we planned to perform a randomised prospective study to compare the effectiveness of 40 mg of preservative-free 1% chloroprocaine over 10 mg of plain 0.5% isobaric bupivacaine.Materials and methodAfter obtaining clearance from the institute’s ethical committee and written informed consent from the patients, 64 patients between the ages of 18 and 50 years of either sex belonging to American Society of Anesthesiologists (ASA) 1 and 2 scheduled for URSL surgery were included in our study. They were randomised using a computer-generated sealed envelope technique into two groups. Group C received 4 ml of 1% isobaric chloroprocaine, and group B received 2 ml of 0.5% isobaric bupivacaine in the intrathecal space. The primary outcome was to compare the in-hospital time among both groups. Our secondary outcomes were the onset time of motor and sensory blocks, the duration of the blocks, time to unaided ambulation and voiding, the need for an overnight stay, and the side effects like postoperative nausea and vomiting (PONV), and urinary retention. The data were analysed using the unpaired t-test and chi-square test and calculated by SPSS 20.0 software version (IBM Corp., Armonk, NY).ResultsFinal analyses were done among 60 patients. In-hospital time was significantly lower in group C as compared to group B (p<0.05). The onset time of sensory and motor blockade was significantly lower in group C as compared to group B (p<0.005). The duration of sensory and motor blockade was significantly less in group C as compared to group B (p<0.005). The time for unaided voiding and ambulation was less in group C as compared to group B. The need for an overnight stay was only needed in group B. The incidence of PONV and urinary retention was higher in group B.ConclusionIn URSL surgery, the use of intrathecal 1% isobaric chloroprocaine 40 mg resulted in a reduced hospital stay time as compared to the use of intrathecal 10 mg of 0.5% isobaric bupivacaine. Also, it resulted in a significantly faster onset and faster regression of the block, less duration of the blockade, shorter time to ambulation and micturition, and a requirement for an overnight stay when compared with isobaric spinal bupivacaine.

Comparing intrathecal 1% 2-chloroprocaine and 0.5% bupivacaine for patients undergoing saddle block in daycare surgeries with respect to recovery and home readiness: A prospective double blind randomised study

Preservative free 2-chloroprocaine seems to be a better alternative to lidocaine and bupivacaine for day care procedures, because of its short duration of action. This study was designed to compare 2-chlorprocaine with low dose bupivacaine for saddle block in elective perineal surgeries on day care basis in terms of recovery and home readiness. To compare 1% 2- chloroprocaine with 0.5% bupivacaine with respect to time taken to obtain discharge criteria from post-anaesthesia care unit (PACU) to post-operative ward, from hospital to home and time taken for ambulation and micturition. This is a prospective, randomized, double blind, parallel group clinical study, conducted on ASA class I and II patients undergoing elective perineal surgeries on daycare basis in MIMS teaching hospital, Mandya. After obtaining approval from institutional ethical committee, a total of 100 patients were enrolled in this study. Saddle anaesthesia was achieved with 7.5 mg 0.5% hyperbaric bupivacaine (Group B, n = 49) or 1% 2- chloroprocaine 40 mg (Group C, n = 50). After completion of surgery, patients were monitored in PACU and postoperative ward using modified Aldrete’s score and PADSS. After discharging, patients were contacted at 24 hours and followed up for 7 days via telephone to assess potential complications of saddle block. Data analysis was done using IBM SPSS version 20. Chi-square test, Fisher’s exact test and independent t-test were used to compare the variables. P value of &amp;#60;0.05 is considered statistically significant. Mean time required to attain discharge eligibility from hospital in Group B was 296.24 min and Group C was 213.3 min with a difference of 83 mins (P &amp;#60; 0.001). Mean duration of time spent in PACU in Group B was 105.18 min and Group C was 27.22 min (P &amp;#60; 0.001). Time to unassisted ambulation and micturition was also significantly lower in Group C. None of the patient in both study groups required additional analgesia in the intraoperative period. However, 26% patients in Group C experienced more pain in the post-operative period compared to Group B (4%) (P = 0.04). Chloroprocaine provides satisfactory anaesthesia with advantage of faster regression of block, early ambulation and micturition, and thus early discharge from the hospital.

Comparison between efficacy of intrathecal 1% 2-Chloroprocaine VS intrathecal 0.5% Bupivacaine with General anaesthesia for short duration laparoscopic surgeries

Background: The ideal anesthetic technique for laparoscopic surgery should maintain stable cardiovascular and respiratory functions, provide rapid postoperative recovery, lead to minimal postoperative nausea and vomiting and provide good postoperative pain relief for early mobility. Administering subarachnoid blocks before general anesthesia in laparoscopic surgeries offer the benefits of good surgery field, hemodynamic stability and reduced requirement of general anesthesia. When subarachnoid block is utilised for short duration laparoscopic surgeries, sympathectomy counteracts the increased systemic vascular resistance (due to pneumoperitoneum) and it contracts the bowel, thereby giving a better field to the surgeon. Methodology: In this study, 60 patients, aged 18-60 years belonging to ASA class I and II were taken and randomly allocated in 2 groups of 30 each. Group A (30 patients) given intrathecal 1% 2- chloroprocaine 30mg(3ml) combined with General anesthesia and Group B (30 patients) given intrathecal 0.5% bupivacaine 15mg (3ml) combined with General anesthesia. Result: The study revealed there is significant difference (p value <0.05) between both the groups with respect to recovery from sensory and motor blockade but no significant difference (p value > 0.05) between both the groups with respect to hemodynamic parameters. Conclusion: Recovery from sensory motor blockade was faster with 1% 2-chloroprocaine thereby enabling surgeons to perform short duration laparoscopic surgeries on a day-care basis and hence minimising hospital stay. We recommend conjunction of two anesthesia techniques in patients undergoing short duration laparoscopic surgeries.

Endoscopic Stone Extraction followed by Laparoscopic Cholecystectomy in Tandem for Concomitant Cholelithiasis and Choledocholithiasis: A Prospective Study

Single-session endoscopic stone extraction (ESE) and laparoscopic cholecystectomy (LC) has the best outcome in managing concomitant cholelithiasis (gallstone disease [GSD]) and choledocholithiasis (common bile duct stone [CBDS]). Traditional rendezvous technique with an intraoperative cholangiogram is associated with various technical (bowel distention, frozen Calot's triangle, limitation of intraoperative cholangiogramand so on) and logistical difficulties (lack of trained personnel and equipment for ESE in the operating room). We modified our approach of ESE-LC (tandem ESE-LC) to study the safety of the approach and overcome these disadvantages of the traditional rendezvous approach. A prospective study of patients with GSD and suspected CBDS from January 2017 to December 2019 was conducted. Tandem ESE-LC involves ESE and LC under the same general anaesthesia in a single day, while ESE is performed in the endoscopic suite using carbon dioxide insufflation, a balloon/basket was used for achieving bile duct clearance and the same was confirmed with an occlusion cholangiogram. Patients were then shifted to the operating room for LC. The primary outcome included bile duct clearance and safety of the procedure. Of 56 patients assessed for eligibility, 42 were included in the study (median age: 53 years, 25 [60%] women). Biliary colic was the most common presenting symptom (n= 24, 57%), followed by acute cholecystitis (n= 11, 26%). The median number of stones and stone size was 1 (1-6) and 4mm (3-10), respectively. All patients had successful bile duct clearance. Stenting was performed in 5 (12%) patients.Intraoperatively, Calot's dissection was difficult and frozen in 10 and 11 patients respectively. The cystic duct was short and wide in 13 (31%) patients. Subtotal cholecystectomy was performed in 6 (14%) patients. The median duration of postprocedural hospital stay was 1 (0-13) day. Three patients had tandem ESE-LC on a day-care basis. One patient had post-endoscopic retrograde cholangiopancretography pancreatitis, and another required percutaneous drainage for gall bladder fossa collection. No patient had retained CBDS at a median follow-up of 18 (3-28) months. Tandem ESE-LC is safe and effective method in managing concomitant GSD and CBDS.

An Analysis of Safety and Efficacy of Day-care Surgery in Children in a Tertiary Care Hospital in India.

Background:Advances in surgery and anesthesia have paved the way for the establishment of day-care surgery (DCS). Observations that children achieve better convalescence in the home environment along with significant economic advantages have led to this paradigm shift in clinical practice.Aims and Objectives:This study is aimed to evaluate the feasibility of performing various surgical procedures on day-care basis and assess parental satisfaction with DCS in children.Materials and Methods:In this prospective observational study, all children >3 months of age undergoing various elective surgical procedures as day-care cases in our institution were enrolled. Types of operations, complications, including any unplanned admissions and parental satisfaction, were recorded.Results:Between December 2015 and December 2018, a total of 654 day-care surgeries were performed in our institution by pediatric surgeons. The mean age was 5.5 years with M: F 5.5:1. Thirty different surgical procedures were successfully performed as DCS, the common procedures being inguinal herniotomy (31.5%), and orchidopexy (14.3%). Unplanned admissions were recorded in 2.29% (15/654) patients (scrotal edema-5, postoperative pain-8, and a long recovery from anesthesia-2). No major complications occurred; two minor complications during follow-up were superficial wound infection and drug reaction. Overall parental satisfaction was very high (100%)-preoperative prolonged fasting period and long waiting time in the preoperative room of afternoon shift patients (7.95% and 8.3%) were the reasons for their discontent.Conclusions:DCS in children is safe and effective with high parental satisfaction. It can substantially reduce the waiting list for several surgical procedures in children.

EVALUATION OF EFFICACY OF JALOUKAVACHARANA AND SIRAVYADHANA IN THE MANAGEMENT OF VATARAKTA: A COMPARATIVE STUDY

Vatarakta is the illness that exhibits different signs and symptoms based upon the Dosha, Utthana and Gambheera Avastha. Dietary habits and life style modalities play a major role in the causation of Vatarakta. Though various remedies are there to treat it, Raktamokshana is said to be an effective, and standard technique. Hence it is claimed to be an important affective tool in the management of Vatarakta. This study is undertaken to explore and compare the efficacy of Jaloukavacharana and Siravyadhana in Vatarakta.&#x0D; Randomized comparative clinical trial was adopted in this study. 40 subjects fulfilling diagnostic and inclusion criteria were selected and divided into two groups. The day on which the procedure was conducted was considered as first day of the trail. Follow up was on 8th &amp; 15th day. Total duration of Study was 15 days. In both the group there is a significant improvement of subjective and objective symptoms except on Vaivarnya. The collected data is statistically analysed Jaloukavacharana is found to be more effective in the features Daha and Shopha. Siravydhana is more effective in Shoola and Vivarnya. Both the procedure shows equal effect on Sparshaasahatva. The overall results of Group A are 82.11% and Group B is 82.76%. Both the treatments are equally effective in Vatarakta. Hence alternative hypothesis H3 is proved. This simple and cost-effective treatments are painless do not require any anaesthesia. Hence it can be easily performed in OPD level on day-care basis.

Outcome of ultrasound-guided, single session pleurodesis in malignant pleural effusion

BackgroundChemical pleurodesis is frequently indicated to relieve symptoms imposed by large/recurrent malignant pleural effusion (MPE). Traditionally, a drain is left in the pleural space till the cessation of fluid accumulation before pleurodesis. Chest ultrasound can detect an amount of pleural fluid as less as 50 ml and can confirm apposition of the pleural surfaces which is required for successful pleurodesis. This work assessed the efficiency and safety of ultrasound-guided, single-session pleurodesis in cases with MPE.ResultsSeventeen of the patients completed a 2-month follow-up. The technique demonstrated a high success rate (88.2%). The mean duration from the start of pleural drainage till pleurodesis was 1.65 ± 0.70 h ranging from 1 to 3 h. A duration of 2.5 h or less was statistically proposed as a cutoff value not to exceed to predict success (sensitivity 100%, specificity 100%). The mean time for total hospital stay related to pleurodesis was 9.88 ± 3.12 h (range 4–12 h). No complications attributed to the procedure were recorded. Pleural Adherence Score and Absent Sliding Score (ASS) had a highly statistically significant correlation (p value < 0.001).ConclusionsAn ultrasound-guided completion of the process of pleurodesis in a single session with a shorter duration of pleural fluid drainage and shorter hospital stay (can be done on a day-care basis) is efficient, safe, and cost-effective. This technique is strongly recommended to replace the traditional practice of keeping the indwelling pleural drain for several days waiting for the cessation of pleural fluid reaccumulation. An ultrasound-derived ASS can be used as early as day 1 and day 15 to confirm pleural adherence and to expect the outcome of pleurodesis.

Ultrasound-Guided Non-radio Opaque Symptomatic Foreign Body Removal

This is a case of a 20-year-old lady presenting in surgical OPD with history of trauma 1 year ago with foreign body in situ in the right distal forearm where she had history of unsuccessful attempt of surgery for foreign body removal at the time of injury. She was investigated with ultrasonography of local part which suggested thorn within the tendon of flexor group of muscles. Thorn removal was performed with ultrasonography guidance under brachial block. Thorn was found to be completely within the tendon of flexor digitorum profundus with close vicinity to ulnar artery. The surgery was performed on day-care basis without intraoperative or postoperative complication, and she was discharged with utmost satisfaction on the same evening.

Fatal peripheral T-cell lymphoma presenting as hypereosinophilia and spontaneous tumor lysis syndrome: A rare case report

Peripheral T-cell lymphomas (TCLs) are a heterogeneous group of aggressive, uncommon forms of T-cell or natural killer cell-derived non-Hodgkin's lymphomas. Acute tumor lysis syndrome (TLS) is a multiple metabolic derangement that occurs due to the treatment of malignancies or spontaneous tumor cell death. We report the case of a 56-year-old male patient who presented with marked eosinophilic leukocytosis, rash, and lymphadenopathy at the initial visit but finally manifested with TCL and spontaneous TLS. On the first visit, hemogram showed a marked eosinophilic leukocytosis and raised lactate dehydrogenase. The patient refused for admission; however, lymph node biopsy was done on day-care basis. After 3 days, the patient presented in the emergency room with shortness of breath, altered renal and liver parameters, and dyselectrolytemia. Based on histopathological with immunohistochemistry findings on lymph node biopsy and clinical and laboratory finding, the patient was diagnosed as TCL-not otherwise specified with TLS.

Role of dexmedetomidine as an anaesthetic adjuvant in breast cancer surgery as a day-care procedure: A randomised controlled study.

Background and Aims:Breast cancer surgery can be carried out as day-care procedure to increase patient turnover, decrease disease progression and financial burden. The present study was carried out to assess the role of dexmedetomidine in breast cancer surgery as a day-care procedure.Methods:This prospective randomised, double-blind study was carried out on 100 patients screened for day-care breast cancer surgery. They were divided into two groups of 50 each; who received either normal saline (Group NS) or 0.6 μg/kg/h dexmedetomidine (Group D) infusion from 10 min before induction until skin closure. All patients were given general anaesthesia. The incidence of discharge, post-operative pain (POP), average rescue analgesia (fentanyl) required and side effects were noted. Statistical analysis was performed using Student's t-test and Chi-square test.Results:Incidence of discharge in group NS was 60% compared to 88% in Group D (P = 0.001). Average rescue analgesia requirement by group NS was 136.07 ± 43.06 μg, whereas it was 77.5 ± 29.86 μg in Group D (P = 0.01). The incidence of POP in 6 h and within 2 h of expected discharge time in Group NS was 56% and 28%, respectively, and in Group D, it was 8% in both the periods (P < 0.001 and 0.01). Side effects such as post-operative nausea, vomiting and bleeding were encountered in eight and two patients, respectively, in Group NS and two and one patients, respectively, in Group D.Conclusion:Dexmedetomidine as an anaesthetic adjuvant makes breast cancer surgery feasible on day-care basis.

Brow Position after Endoscopic Brow Lift

Background: Over the past few years, other methods have been replaced by endoscopic forehead rejuvenation. In many cases, it is the treatment of choice and it is widely used for the rejuvenation of the upper third of the face, especially to raise eyebrows. Objectives: Due to the growing number of cosmetic surgeries and particularly endoscopic surgeries, awareness of the effectivity and longevity of endoscopic surgery appears necessary due to relatively high costs and complications that the patient imposes. There is still ambiguity about changes which appear during aging in the forehead area, however, almost all forehead rejuvenation surgeries are based upon the fact that forehead aging causes eyebrow dropping. Methods: All patients, who had endoscopic brow lift surgery at Amir Aalam hospital in 2013, were considered in this study. The surgeries were performed at Amir Aalam hospital of Tehran, Iran, by a plastic surgeon and usually on an outpatient basis (day-care basis) and by means of the standard procedures during 1 year. All patients had sub-periosteal endoscopic brow lift surgery, which was performed by 5 separate incisions. Standard photography was performed for all patients with standard views before and after surgery. Complications and surgical techniques were described for the patients in an understandable (simplified) manner. To evaluate the position of the brows before and after surgery, photography was performed before and after the surgery. Results: Twenty-five patients had an endoscopic brow lift surgery at Amir Aalam hospital, during year 2013. The information and the photography of 20 patients were evaluated. The average age of the patients was 54 years old. Eighteen patients were female and 2 were male. All patients were Iranian. The photographic comparison before and after surgery clearly showed elevation of the brows. On the medial side, the average elevation was 5.25 mm and on the lateral side that was 4.5 mm. In all cases, there were statistically significant differences (P = 0.001). Conclusions: Based on the results of this study, we could conclude that endoscopic forehead rejuvenation surgery, which is used for the rejuvenation of the upper third of the face, has had a clear brow elevation with complete satisfaction in Iranian patients. Most patients (95.2%) were satisfied and only encountered slight side effects.

Is Daycare Tonsillectomy Safe?

Tonsillectomy is one of the most common procedures performed by Ear, Nose, and Throat surgeon. Usually, the procedure is carried out as an inpatient surgery. With the increasing need to reduce healthcare costs, spare precious hospital beds, and shorten elective surgery lists, there is currently a trend towards performing tonsillectomy on a daycare basis. A prospective review of all tonsillectomies performed at the University Malaya Medical Center was undertaken for the year 2013. Demographic details, qualifying indications, and complication rates were evaluated. There was no incidence of primary hemorrhage among the 96 tonsillectomies performed. There was no significant correlation in terms of secondary hemorrhage between inpatient and day-case tonsillectomy (P=0.54). Only two patients required revision surgery to stop post-tonsillectomy bleeding. None of the patients required blood transfusion, and there were no mortalities. Daycare tonsillectomy is safe as long as the patient is carefully selected. Both medical and social aspects should be taken into consideration. A post-operative observation period of at least 6 to 8 hours is important. The surgeon should personally review the patient post-operatively and decides if he or she should be hospitalized for observation, or safe for discharge.

Ocular Morbidity in Patan Community Based Rehabilitation Center

Introduction: Community based rehabilitation centers work for the betterment of people with disabilities within the communities. This study was conducted to find out ocular morbidity in Patan community based rehabilitation center.Methods: A cross-sectional study was conducted at Patan Community Based Rehabilitation Center, Patan at Lalitpur district of Nepal with sample size of 42, where children and adults of different age groups come on daycare basis. All patients underwent assessment of visual acuity, orthoptic evaluation, anterior segment and posterior segment evaluation and cycloplegic refraction.Results: Age ranged from 7 to 35 years (mean age 14.5 years) with 64.28% of participants within the age group 11-20 years followed by 26.19% within the age group 1-10 years. Male:Female ratio was 1:1.33. Regarding the ethnicity, 71.43% comprised of Tibeto-Burman origin and 28.57% of Indo-Aryan origin.Regarding the general morbidity, 40.48% among the participants had intellectual disability, 16.67% had autism, 14.29% had cerebral palsy, 11.90% had down syndrome, 11.90% had multiple disabilities, 2.38% had physical disability and 2.38% had visual impairment.Regarding the ocular diseases, 26.19% had refractive error only, 19.04% had strabismus only, 9.52% had refractive error and strabismus, 4.76% had cataract, 2.38% optic atrophy and 2.3% had retinitis pigmentosa.Conclusion: Refractive error and strabismus are the commonest ocular morbidities found in Patan community based rehabilitation center.

Percutaneous bunionette correction: Results of a 49-case retrospective study at a mean 34 months’ follow-up

IntroductionBunionette consists in a lateral prominence of the head of the fifth metatarsal (M5), inducing a callus. Toe malpositioning determines the varus, supraductus or infraductus form. HypothesisA percutaneous method without osteosynthesis was assessed in 38 patients suffering from this pathology. Patients and methodsA continuous single-operator multicenter series operated on between May 2005 and January 2012 was analyzed with mean follow-up of 34 months. The inclusion criterion was bunionette with or without varus deviation. All patients were operated on percutaneously without tourniquet, on a day-care basis. All were clinically assessed, preoperatively and at latest FU, by visual analog pain scale (VAS), AOFAS and Coughlin scores, and callus status. Standard radiological assessment comprised monitoring of intermetatarsal (M4M5) and metatarsophalangeal (M5P1) angles. ResultsVAS decreased from 8 (range, 6–9) preoperatively to 0.3 (range, 0–1) out of 10 at follow-up. AOFAS score increased from 58 (range, 52–75) to 97 (range, 80–100) out of 100. According to the Coughlin score, 97.5% of patients were satisfied or very satisfied. Deformity correction was systematic, with disappearance of preoperative callus. M4M5 and M5P1 angles decreased respectively from 10° (range, 6–13°) and 16.2° (range, 8–24°) preoperatively to 5.5° (range, 4–8°) and 4.3° (range, 2–9°). There was 1 case of complex regional pain syndrome and 1 delayed consolidation. DiscussionThis procedure appeared reliable for correcting all types of bunionette deformity. Other minimally invasive methods with comparable results use pin fixation. The advantages over conventional techniques are the quality of results, low morbidity and absence of osteosynthesis material. The percutaneous technique should, we believe, be widely adopted in this indication. Level of evidenceIV.

Future of dexmedetomidine in gastrointestinal endoscopy

In the scenario of gastroendoscopic setup, sedation is meant to enhance the comfort of the patient and to allay anxiety associated with the procedure. Most of the procedures under gastroendoscopic setup are performed on daycare basis; hence, the drugs with shorter half-life and which are easily metabolized are preferred. Dexmedetomidine is an attractive alternative to sedatives when the patient needs to be spontaneously breathing and easily arousable from sedation.