Mean Duration Of Hospital Research Articles

Effectiveness of betadine-soaked gauze covering umbilical catheter connectors on the outcome of neonates: A randomized control trial

BackgroundNeonatal sepsis is the critical underlying cause of morbidity and mortality among neonates. In Neonatal Intensive Care Unit most commonly umbilical catheters are used for vascular access. However, certain complications are also associated with its use. One of them is Umbilical-catheter related sepsis. To enable safe IV access, a small critical piece of equipment is a connector that connects to the end of the catheter. As the external surface of the connector is exposed and contaminated, it can lead to umbilical catheter connector-related sepsis. ObjectiveThe present study was conducted with an aim to assess the effectiveness of betadine-soaked gauze covering umbilical catheter connectors on the outcome of neonates, admitted to NICU. MethodologyA RCT design was used and a total of 70 neonates were enrolled out of which 7 neonates did not match the inclusion criteria and 5 abstained from participating in the study. Therefore, 58 neonates were then randomized using a computer-assisted method. ResultsThe incidence of sepsis in the experimental group was lower (24.1%) than in the control group (44.8%). However, this difference was found to be statistically non-significant (p = 0.0973). The mean duration of hospitalization in the experimental group was found to be 18.48 ± 9.977 and in the control group 16.38 ± 8.801. The difference was non-significant (p = 0.3989). No neonatal death was recorded in the groups. ConclusionThe study findings conclude that although there was a lower incidence of sepsis in the experimental group as compared to the control group, this difference was found to be statistically non-significant. However, consideration should be given to connector-related infection practices.

A clinical comparative study of thyroid surgeries with and without drain.

Most of the thyroid surgeries are accompanied by drain placement. The possibility of hematoma or seroma formation postoperatively is of concern to surgeons, as, thyroid is a highly vascular structure and a minor hemorrhage might also turn out to be life threatening, despite actual incidence of it being only 0.3-1%. Thus, drains are placed with an intention to obliterate dead space and clear the collecting blood or serum. Conversely, several studies have indicated chances of clots blocking the drainage tube and resulting in missing out of early detection of a massive bleed. Drains have also been known to add more discomfort to the patient, increase chances of infection, increase post operative pain, scar formation and longer duration of hospital stay. Thus, some surgeons believe in not placing a drain. To compare the outcomes of thyroid surgeries done with drain versus those thyroid surgeries done without drain. 40 patients, of either sex, between 18 and 70years of age, who underwent thyroid surgeries for various thyroid disorders over a period of 6months, were randomly allocated to either 'with drain' (group A) or 'without drain' (group B). The surgeon was made aware of drain status only intraoperatively. Patients were assessed for post-operative pain based on Visual Analogue Scale (VAS) at 6 and 24h post-operatively. Post-operative complications including hematoma, seroma, and wound infection, if any, along with duration of hospitalization, were also documented. Patient was followed up one week post-operatively for wound check and suture removal. Both groups were homogenous according to age, sex, TIRADS, Bethesda, diagnosis and surgery performed. Postoperative pain at 6 and 24h was significantly higher in group A than in group B [6.15 ± 1.31 vs 3.50 ± 0.88 (p = 0.001) (6h), 4.45 ± 0.99 vs 1.20 ± 1.10 (p = 0.001) (24h)]. Mean duration of hospitalization following thyroid surgery was significantly higher among group A than group B [3.80 ± 1.15 vs 2.15 ± 0.36days (p = 0.001)]. Though not statistically significant, wound pain at 1week and overall complications were higher in Group A than in Group B (p = 0.182, p = 0.127 respectively). Thyroid surgeries done without drain placement are likely to cause significantly lesser post-operative pain and shorter duration of hospitalization.

The diagnostic utility of nanopore targeted sequencing in suspected endophthalmitis

PurposeThis paper aimed to assess the diagnostic utility of a newly developed gene-based technology-nanopore targeted sequencing (NTS) in suspected endophthalmitis patients.MethodsThis retrospective study included 43 patients (44 eyes) with suspected endophthalmitis. NTS was applied along with microbiological culture to detect unknown pathogens in intraocular fluid samples. The diagnostic utility of NTS was mainly evaluated from three aspects, including the positivity rate of bacterial/fungal presence, diagnostic turnaround time and the frequency of change in treatment based on etiology test results. Non-parametric, two-sided Wilcoxon rank sum test, the McNemar’s test and the kappa statistic were used for statistical comparisons.ResultsNTS showed significant advantages over traditional culture in positivity rates and diagnostic time (P < 0.001, kappa = 0.082; Z = −5.805, P < 0. 001). As regards antibiotic strategy, 17 patients (39.53%) and 5 patients (11.63%) underwent medication change following NTS and culture results respectively (P < 0.001, kappa = 0.335). With reasonable use of antibiotic and surgical intervention, most patients responded favorably, judged by significantly improved visual acuity (Z = −4.249, P < 0.001). The mean duration of hospitalization was 8.49 ± 2.45 days (range, 1–16 days).ConclusionThe high efficiency feature of NTS in pathogen detection renders it a valuable supplementary to traditional culture. Additionally, it has facilitated patients’ management for the early and precise diagnosis of endophthalmitis.

"In Situ" Methotrexate Injection Followed by Hysteroscopic Resection for Caesarean Scar Pregnancy: A Single-Center Experience.

We evaluated the efficacy of local methotrexate (MTX) treatment followed by hysteroscopic resection for caesarean scar pregnancy and its impact on future fertility. Monocentric, prospective, observational study performed in the Haykel Hospital between June 2016 and December 2020. Twenty-one women with caesarean scar pregnancy underwent a transcutaneous ultrasound-guided direct injection of MTX into the gestational sac in an outpatient setting. Hysteroscopic resection of residual trophoblastic retention was then performed according to perisaccular blood flow. Two patients had complete spontaneous trophoblast expulsion after MTX injection, and hysteroscopy was performed in 19 patients for residual trophoblastic retention 1 to 12 weeks after MTX injection. Successful preservation of a healthy uterus with the combined procedure was obtained in 94.8% of patients. Hemostatic hysterectomy was required in one patient. Mean hospitalization duration was 1.5 days. Three patients had spontaneous pregnancy after the procedure. Direct MTX injection into the gestational sac for caesarean scar pregnancy followed by hysteroscopic resection was an effective technique with a short hospitalization, fertility preservation and a low major complication rate compared with other modalities of treatment reported in the literature. Further larger prospective comparative studies are needed to confirm the efficacy of this procedure.

Early Cholecystectomy versus Conservative Management in Mucocele Gall Bladder

Aim: To compare the early cholecystectomy versus conservative management in mucocele gall bladder. Study design: Retrospective study Place and duration of study: Department of General Surgery, Ward-2, JPMC/Jinnah Sindh Medical University, Karachi from 1st October 2020 to 30th September 2022. Methodology: One hundred patients suffering from cholelithiasis with mucocele gall bladder were included. The patients were divided into two groups on the basis of stone location. Group 1 was those where the stone was found on the base of common bile duct (CBD) and elective/early surgery was conducted for the cases of cholelithiasis. Group 2 was those where conservative/delayed surgical technique was applied due to stone location not in the CBD for treatment. While in each group there were 50 cases which were age and gender matched. The first priority for surgical option was through laparoscopic surgery. Results: The mean age of the patients was 45.2±3.3 years. Out of the total cases in group 1 the process of ERCP was conducted in 64% of the cases before laparoscopy. There were 1% and 10% cases which were shifted to open surgery from laparoscopic in group1 and 2 respectively. Consequently, the mean operative time and hospital duration was increased in group 2. Within the Group 2 cases the risk of sepsis, wound contamination and perforation of gall bladder was much higher than in the Group 1 by a value of 10%, 12% and 6% respectively. There was 1 case of mortality and 2 cases of pancreatitis in group 2. Conclusion: The early cholecystectomy is a much safer and efficient procedure on treatment of mucocele gall bladder cases verses conservative management. Keywords: Early cholecystectomy, Conservative management, Mucocele gall bladder

İkinci basamak devlet hastanesinde laparoskopik adrenalektomi uygulanabilirliği ve deneyimlerimiz

Objective: Since the laparoscopy education had became widespread, the advance laparoscopic procedures can be performed even at secondary public hospitals. In this study, we aimed to present our experience of the first seven years of laparoscopic transperitoneal adrenalectomy. Material And Methods: the study included 30 patients with laparoscopic transperitoneal adrenalectomy (LA) performed from October 2012 to April 2019. The retrospective assessment investigated age, sex, body mass index, adrenal mass characteristics, hormonal activity, operation duration, hemorrhage status, transfusion requirements, final pathology and complication rates. Results: Mean age was 54.3±11.5 years and mean body mass index was 25.6±2.7 kg/m2. Mean mass size was 48.5±23 mm and mean operation duration was 70.2±21.6 minutes. Mean peroperative hemorrhage amount was 41±48.8 cc, while only 2 patients required transfusion. Mean hospitalization duration was 1.3±0.88 days. None of the laparoscopic cases was converted to open surgery, and no major complications such as death recorded. Conclusion: Transperitoneal laparoscopic adrenalectomy (LA) surgery may be performed safely after adequate training for appropriate patients with low morbidity and mortality. Keywords: laparoscopy, adrenalectomy, experience, open surgery, transperitoneal

Risk Factors for Mortality in Severe Fever with Thrombocytopenia Syndrome Patients with Central Nervous System Complications.

BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a zoonotic viral hemorrhagic fever caused by the SFTS virus (SFTSV), which is a newly identified tick-borne bunyavirus, recently named Dabie bandavirus. In rural China, SFTSV or Dabie bandavirus is commonly transmitted by Haemaphysalis longicornis, the Asian longhorned tick. In recent years, SFTS has been of great concern due to its high morbidity and mortality. The present study investigated the risk factors for mortality in patients with SFTS complicated by central nervous system involvement. MATERIAL AND METHODS We studied 69 SFTS patients hospitalized between 2013 and 2020. We analyzed the laboratory test results and clinical data through univariate and multivariate regression. RESULTS Neurological complications occurred in 59 patients in the survival group and 10 in the mortality group. No significant gender difference was found between the 2 groups. No significant difference was found in age, hospitalization duration, or occurrence of encephalitis between the 2 groups. The mean duration of hospitalization and course of the disease in the mortality group were significantly shorter than those in the survival group (P<0.01). The mean values of platelet count, potassium, and sodium in the mortality group were significantly lower, while the mean values of aspartate aminotransferase, lactic dehydrogenase, creatine kinase-MB (CK-MB) and procalcitonin were higher than those in the survival group. Low platelet count and high CK-MB were independent risk factors for mortality in patients. For each unit increase in platelet count, the risk of mortality decreased by 24.2%, and for each unit increase in CK-MB, the probability of mortality increased by 118.6%. CONCLUSIONS Decreased platelets and increased CK-MB were independent risk factors for mortality in encephalitis patients. SFTS patients with encephalitis should be monitored for changes in these 2 indicators.

Ventral Hernia Repair and Diabetes Mellitus - A Prospective, Observational and Comparative Study of Outcomes.

Diabetes mellitus (DM) and obesity are known to influence postoperative outcomes in surgical patients. This study aimed to analyze the divergence in outcomes between patients with and without DM who underwent ventral hernia repair, while also assessing the additional impact of obesity on postoperative complications, hospitalization, and costs. A prospective, non-interventional, observational study was conducted over five years (2018-2022) at the First Surgical Clinic of Craiova Emergency Clinical Hospital. The study included 216 patients, with 42 (19.44%) having DM, half of whom were also obese. There were no significant differences in age between patients with or without DM. However, diabetes and obesity were more prevalent in female patients. The mean duration of hospitalization was 10.7±8.6 days, with no significant differences observed between patients with or without DM or obesity. Statistical analysis revealed that patients with DM had a higher incidence of seroma formation, wound infection, and hematoma formation compared to patients without DM. However, there were no significant differences in mesh infection, hospitalization days, or costs between the two groups. Similarly, no significant differences were found between obese and non-obese patients in terms of complications, hospitalization days, or costs. In conclusion, this study highlights that DM is associated with an increased risk of specific complications in ventral hernia repair, including seroma formation, wound infection, and hematoma formation. However, the impact of obesity on these outcomes appears to be limited. Individualized preoperative optimization and targeted interventions are necessary to mitigate the risk of complications in patients with DM or obesity.

“IMPACT ON CLINICAL OUTCOME AND TOTAL HOSPITAL STAY DURATION OF VACCINATED RTPCR POSITIVE PATIENTS ATTENDING TERTIARY CARE CENTRE”

Back ground: India responded swiftly to the global pandemic - COVID 19 , by starting administration of vaccines to its people from January 2021.At end of an year after starting vaccine drive, there was a need of ground reality assessment to check its impact on people. Aims &amp; Objective: The aim is to study the impact on clinical outcome and hospital stay duration of the COVID 19 vaccine status among RTPCR positive patients attending tertiary care centre. The objectives are to estimate mean hospital stay duration and number of death and discharges among RTPCR postive unvaccinated, partially and fully vaccinated patients. Materials And Methods: A total of 57 patients were included in study and at admission level, they were grouped into A, B, C as unvaccinated, partially vaccinated, fully vaccinated respectively. They were followed throughout their disease course and clinical outcomes were measured as either death or discharge and number of days of hospital stay. The clinical outcomes were compared in each group and checked for any statistical signicance. Results: The mean hospital duration in days are 8,7,5 and discharges are 3,7,33 and deaths are 6,7,1 in group A,B,C respectively (p&lt;0.05). Conclusion: Thus vaccinated have lower hospital stay duration , lower death rates and higher discharge rates than partially vaccinated than unvaccinated ones.

Pulmonary Complications in Renal Transplant Recipients

Background Kidney transplantation recipients are at an increased risk of lung complications due to infectious or non-infectious reasons. We aimed to determine the lung complications after transplantation and what we could do to prevent the complications during the follow-up, retrospectively.&#x0D; Material and Methods The 296 patients who underwent kidney transplantation surgery in our centre between the years 1999 to 2006 were included in the study.&#x0D; Results 75% of the patients were male (n: 222). 77% of the patients (n: 228) had a living-related donor. The mean hospitalisation duration in the post-transplantation period was 13.3±9.07 days. During the follow-up, 37.2% of the patients (n: 110) had rejection, and pulse steroid treatments were given to the 74.5% of these patients. In our study, the lung complication development ratio was 16.2%, and 84% of these complications were due to infections. A specific aetiology was not identified in 63.5% of patients. The patients with a living-related donor had more lung complications due to infection (p

Civilian penetrating traumatic brain injury: A 5-year single-center experience.

The aim of this study was to report the demographics and clinical features of patients with penetrating traumatic brain injury (PTBI) during the past 5 years in Rajaee Hospital, a tertiary referral trauma center in Shiraz, southern Iran. We conducted a 5-year retrospective evaluation of all patients diagnosed with PTBI who were referred to Rajaee Hospital. We retrieved the following items from the hospital's database and PACS system: patients' demographics, on-admission Glasgow Coma Scale (GCS), presence of trauma to other organs, duration of the hospital and ICU stay, the neurosurgical interventions, any necessity of tracheostomy, duration of ventilator dependency, the entrance point of the trauma in the skull, type of assault, length of trajectory in the brain parenchyma, the number of remaining objects in the brain, the occurrence of any hemorrhagic phenomenon, the cross of the bullet from the midline or coronal suture, and the presence of the pneumocephalus. A total of 59 patients with a mean age of 28.75 ± 9.40 had PTBI over the 5 years. The mortality rate was 8.5%. Stab wounds, shotguns, gunshots, and airguns were the cause of injury in 33 (56%), 14 (23.7%), 10 (17%), and 2 (3.4%) patients, respectively. The median initial GCS of patients was 15 (3-15). Intracranial hemorrhage was observed in 33 cases, subdural hematoma in 18 cases, intraventricular hemorrhage in eight cases, and subarachnoid hemorrhage in four cases. The mean duration of hospitalization was 10.05 ± 10.75 (ranging from 1 to 62 days). Furthermore, 43 patients experienced ICU admission with mean days of 6.5 ± 5.62 (1-23). The temporal and frontal regions were the most common entrance points, in 23 and 19 patients, respectively. The incidence of PTBI is relatively low in our center, possibly due to the prohibition of possession or using warm weapons in Iran. Further, multicenter studies with larger sample sizes are needed to determine prognostic factors associated with worse clinical outcomes after PTBI.

Laboratory Findings and Clinical Outcomes of ICU-admitted COVID-19 Patients: A Retrospective Assessment of Particularities Identified among Romanian Minorities

The Roma population accounts for over 3% (approximately 10 to 15 million) of Romania's permanent population, and it represents one of Europe's most impoverished populations. Due to poverty and unemployment, Romania's Roma minority may have diminished access to healthcare and preventive medicine. The limited existing evidence suggests that the European Roma group has been at a higher risk of becoming ill and dying during the pandemic owing to their lifestyle choices, socioeconomic circumstances, and genetic pathophysiological traits. As a result, the purpose of the present research was to investigate the link between the inflammatory markers implicated and the clinical progression of COVID-19 in Roma patients who were brought to the intensive care unit. We considered 71 Roma patients admitted to the ICU with SARS-CoV-2 infection and 213 controls from the general population with the same inclusion criteria. The body mass index of patients was statistically significantly higher among Roma patients, with more than 57% being overweight, compared with 40.7% in the control group. Frequent smoking was more prevalent in patients of Roma ethnicity admitted to the ICU and the number of comorbidities. We observed a significantly higher proportion of severe imaging features at admission in the group of cases, although this difference may have been associated with the higher prevalence of smoking in this group. The mean duration of hospitalization was longer by 1.8 days than the control group. Elevated ESR levels were observed in 54.0% of Roma patients at admission, compared with 38.9% in the control group. Similarly, 47.6% of them had elevated CRP levels. IL-6 increased significantly at the time of ICU admission, similarly to the significant rise in the CRP levels, compared with the general population. However, the proportion of intubated patients and mortality did not differ significantly. On multivariate analysis, the Roma ethnicity significantly influenced the CRP (β = 1.93, p-value = 0.020) and IL-6 (β = 1.85, p-value = 0.044). It is necessary to plan different healthcare strategies aimed at special populations, such as the Roma ethnicity, to prevent the reduced disparities presented in in this study.

Review of first 60 pituitary adenoma cases of a skull base team, one center experience

Background: Endoscopic endonasal transsphenoid approach of pituitary gland is being effectively replacing microscopic approach. This approach need a lot of training and stepwise learning to reach perfection. This study discuss the experience and pitfalls of an evolving skull base team in one institute. Aim of the work: Analysis of first sixty pituitary adenomas patients operated by an evolving skull base teams in one institute, and highlighting modifications introduced in their technique. Methodology: This is a retrospective analytical study of the medical records of first 60 pituitary adenoma patients who had presented to one center and had endoscopic trans-nasal trans-sphenoidal approach by conjoined skull base team. Results: There were 60 cases of pituitary adenoma; 23 males, and 37 females. Mean age were 46 years old. 37 cases (61%) had temporal field defect, 22 cases had visual acuity loss, 41 patients (68%) had nonfunctioning adenomas, and 18% were prolactinomas. Fifty two cases (86.6%) were macroadenoma, and 2 patients (3.3%) were microadenoma. 48 cases (80%) had suprasellar extension, while 19 cases (19%) had parasellar extension. Three cases (5%) were recurrent. Trans-nasal cavity approach was adopted in 58 cases (96.6%). 4 cases needed middle turbinate resection. Mean operative time was 3 hours. Gross total removal of the tumor were achieved in 49 cases (81.6%). Intraoperative CSF leakage occurred in 31 patients (51%). Failure of reconstruction occurred in 4 cases (6.6%). Mean duration of hospital, and ICU stay was 8, 2 days respectively. Postoperative temporary diabetes insipidus occurred in 35 cases (58.3%), 5 of them (8.3%) had permanent DI. Major CNS complications occurred in 2 cases (3%). Conclusion: The more experience gained the more modifications introduced to improve surgical outcome; more gross total resection rate, less morbidity, and mortality rates, less operative time, better quality of life of patients and less time and effort exhaustion of the team work.

Study of 52 Pediatric Patients Who Required 78 Hospital Admissions for Cerebral Venous Sinus Thrombosis from 2013 to 2020 Using Data from the Polish National Health Fund Registry.

BACKGROUND Cerebral venous sinus thrombosis (CVST) in children is a rare disease with a complex, multifactorial etiopathogenesis. The Polish National Health Fund (NHF) Registry [Narodowy Fundusz Zdrowia (NFZ)], contains health insurance data from all 16 national provinces, or voivodeships. This study used data from the Polish NHF Registry to evaluate 52 pediatric patients who required 78 hospital admissions for CVST from 2013 to 2020. MATERIAL AND METHODS The data in the Polish NHF Registry were acquired based on the disease code I67.6 from the International Classification of Diseases, Tenth Revision (ICD-10), and the patients' age (up to 18 years old). RESULTS We identified 78 hospitalizations of 52 pediatric patients due to CVST in Poland from 2013 to 2020 (63.5% boys and 36.5% girls, mean age 9.7±5.8 years old). The mean duration of hospitalization was 10.5±11.7 days, the mean cost of hospitalization was 3273±2191 Polish zloty (PLN). The most common age subgroup was adolescents (27%). Ten percent of patients were hospitalized in a region other than their region of residence. The duration and cost of hospitalization were positively correlated with each other (r=0.512, P<0.001). The most common type of admission was an emergency (51%), and the most common discharge was referral for further outpatient treatment (50%). CONCLUSIONS Polish registry data showed that from 2013 to 2020, CVST was more commonly diagnosed in male adolescents from 15 to 18 years of age who presented as emergency hospital admissions. There were regional differences in incidence and duration of hospital stay and healthcare costs between patients.

The Effect of Clofibrate and Phototherapy on Prolonged Jaundice due to Breast Milk in Full-Term Neonates.

Jaundice is one of the most common problems during infancy. It is believed that breast milk jaundice is one of the reasons for the persistence of jaundice after 14 days of prolonged jaundice. This study evaluates the effect of Clofibrate and phototherapy on prolonged jaundice originating from breast milk in term and healthy neonates. This double-blind clinical trial study was performed on 100 randomly divided neonates in the neonatal ward of Besat Hospital. In addition to phototherapy, the case group received a single dose of edible Clofibrate (50 mg/kg) dissolved in 2 CCs of distilled water. The control group received the same amount of distilled water as the phototherapy group. After treatment, bilirubin change rate, duration of hospitalization, and any association with gender, gestational age, hemoglobin, blood type, and Rh of neonates were determined and compared throughout the 2 groups. Data analysis showed that the bilirubin reduction rate was statistically significantly higher in the case group than in the control group (P < .05). The mean duration of hospitalization and phototherapy in the case group was significantly lower than in the control group (P = .005). The bilirubin reduction rate was not affected significantly by gestational age, blood type, or Rh. This study's results demonstrated that Clofibrate effectively decreased bilirubin levels and shortened the duration of phototherapy and hospitalization in infants with probable breast milk jaundice. IRCT2012092910933N1.

Pancreaticoduodenectomies in a Low Volume, Small Island Eastern Caribbean State: A Retrospective Cohort Study

Background: Although pancreaticoduodenectomy (PD) is safe when performed in high-volume hospitals, many patients in low-income countries cannot access these hospitals. Barbados is a small island that does not have a high-volume pancreatic center. We sought to document peri-operative outcomes when PD was performed in Barbados. Methods: We carried out a retrospective cohort study of all consecutive patients who underwent PDs over from August 1, 2016 to October 30, 2022. Therapeutic outcomes, post-operative morbidity and mortality were evaluated. Statistical analyses were performed using SPSS ver 16.0. Results: Six patients at a mean age of 54.8 years underwent PD (mean annual case volume of 1). Two patients underwent planned vein resections and reconstruction. In this subset, the mean operating time was 325 minutes (Range 300-250; Median 325; SD ±35.4), mean estimated blood loss was 825mls (Range 750-900; Median 825; SD±106.1), and the mean transfusion requirement was 1 unit of packed cells (Range 0-2; Median 1; SD±1.41). In the four patients without vein resection, mean operating time was 308 minutes (Range 280-350; Median 300; SD±24.01), median blood loss was 575 ml (Range 150-900; Median 700; SD±320.6) and mean transfusion requirements were 0.5 units of packed cells (Range 0-2; Median 0; SD ±0.84). The mean ICU stay was 2.17 days (Range 1-3; Median 2.5; SD±0.98), and the mean duration of hospitalization was 9.3 days (Range 7-11; Median 9.5; SD±1.37). There were no recorded peri-operative deaths, but there was 1 (17%) minor complication (delayed gastric emptying) and 1 (17%) major complication (myocardial infarction). Conclusion: In Barbados, there are good peri-operative outcomes after PD despite the low volume and challenging healthcare environment. We believe that (1) surgeon experience (2) continuous adaptive hospital learning and (3) regular audit of hospital data are better indicators of PD quality than volume data alone.

Management of uncomplicated acute appendicitis during the COVID-19 pandemic: Appendectomy or non-surgical treatment?

This study aims to compare medical treatment and appendectomy in patients diagnosed with uncomplicated acute appendicitis during the COVID-19 pandemic. Retrospectively analyzed were the data of 80 patients who received medical or surgical treatment for uncomplicated acute appendicitis between March 15, 2020, and August 31, 2020. The demographic characteristics of the patients, length of hospital stay, physical examination and radiology findings, laboratory results, and any complications were recorded. Patients were divided into two groups depending on the mode of treatment, as surgical and non-surgical. Forty patients were given medical treatment and 40 patients were directly operated on for appendicitis. Of the 40 patients who received medical treatment, 8 (20%) ended up requiring an operation due to recurrence. The mean duration of hospitalization was 2 days (range: 1-3), and the mean follow-up duration was 285.35±65.66 days (range: 101-379). The white blood cell count was significantly higher in the surgical group (p=0.004), and the length of hospital stay was longer in the non-surgical group (p<0.001). The prevalence of post-operative complications was similar for patients who underwent appendectomy directly on admission or after recurrence (p=1.000). Among the patients who received medical treatment, the most important predictors of requiring surgery were the red cell distribution width and increased appendix diameter in computed tomography (p<0.05). Medical treatment is an effective alternative in patients with uncomplicated appendicitis. Even in the case of a recurrence in follow-up, surgery due to a potential recurrence is not associated with an increased rate of complication compared to direct surgery.

Pattern of Illness in Prisoners Admitted in a Tertiary Care Hospital of South Eastern Rajasthan

The delivery of health care among prisoners is one of the most important aspects of improving human rights compliance. Estimating common healthcare problems in prisoners will be helpful in assessing their health status and recommending the rectifying steps. Therefore, knowing the types of morbidities will help us in making health policies which will be helpful in reducing the health burden in prisoners and will also help in reintegration of prisoners into mainstream society. The present study is a retrospective analysis to find out the common medical conditions in prisoners. The study was carried out by collecting data of 500 admitted prisoner in a tertiary care institute in south-east Rajasthan. The majority (95.2%) of referred prisoners were male, from age group of 30-39 years, mean age of prisoners being 39.6 years and the majority (90%) were referred from Central Jail, Kota. The majority (53.2%) of prisoners were admitted to medicine department followed by psychiatry department (26.4%). A higher prevalence of anemia and pulmonary tuberculosis was reported among prisoners. Surgical illness related to infectious etiology and poor personal hygiene was common in prisoners. Psychosis not specified (17%), schizophrenia (8%), mixed anxiety depressive disorder (8%) and substance use disorders (16%) were common psychiatric conditions. Mean duration of hospitalization was 9 days.

Iliopsoas bleeds in patients with hemophilia

Background: Iliopsoas bleed is a serious complication in people with hemophilia (PWH), with significant morbidity. Studies examining the profile, incidence, and outcomes in psoas bleeds are scarce and will shed more light and increase awareness about its management. Material and Methods: Data of 453 PWH with confirmed iliopsoas bleed treated at Bangalore Medical College were retrospectively analyzed. Results: Eighty-five (18.8%) PWH presented with total of 154 psoas bleeds. Their mean age was 21.96 years. Common symptoms were thigh/hip/groin pain (100.0%), hip flexion spasm (41.2%), numbness/tingling in quadriceps muscle (5.9%), abdominal tenderness (3.5%), hematuria, and anemia requiring blood transfusion in 2.4% each. Long-term complications were quadriceps atrophy (9.4%), permanent abnormal posture (10.6%), transient paresthesia in the distribution of femoral nerve (3.5%), and pseudo tumor in pelvis (1.2%). The overall average duration of therapy with clotting factor concentrate was 1.7 days with a mean duration of therapy of 1.4 days in patients without inhibitors and 2.8 days in patients with inhibitors (p = 0.010). The overall mean duration of hospitalization was 7.2 days with 5.3 days in PWH without inhibitors and 8.3 days in PWH with inhibitors (p = 0.342). Conclusion: Pain in hip joint/groin/hip flexion spasm suggests the possibility of an iliopsoas hematoma and early factor replacement therapy should be started to prevent complications. Early treatment at first sign of discomfort reduces the duration of treatment, and prevents severe complication and invasive interventions. Patients with inhibitors were overrepresented in the cohort who needed longer duration of factor replacement therapy.

Laparoscopic Common Bile Duct Exploration for Stones at a Resource Poor Hospital in Trinidad &amp; Tobago: A Retrospective Study

exploration at the time of cholecystectomy because exploration is perceived to have low clearance rates. We routinely perform laparoscopic explorations for CBD stones at the Port of Spain General Hospital in Trinidad &amp; Tobago. This retrospective study sought to document outcomes after laparoscopic CBD exploration. Methods: We identified all patients who underwent laparoscopic CBD exploration for stone extraction at the General Hospital in Port of Spain over a ten-year period from January 1, 2013 to January 30, 2023. The following data were extracted: demographic details, operating time, stone clearance rates, retained stone rates, conversions, complications. All data were entered into an excel database and the data were analyzed with SPSS version 20. Results: Intra-operative cholangiograms were performed in 49 patients, and CBD stones identified in 12 (25%) patients at a mean age of 48.7+/- 8.63 years. These patients underwent laparoscopic CBD exploration without prior endoscopic retrograde cholangio-pancreatography. The mean stone burden was 4.7+/-2.54 stones. Four (33%) patients had attempts at trans-cystic exploration, and they all required choledochotomies to complete CBD exploration. Eight patients had initial attempts at choledochotomy for stone extraction. The mean operating time for laparoscopic cholecystectomy, operative cholangiography and CBD exploration with duct clearance was 169.6+/-35.1 minutes. There were 2 (17%) conversions, 1 (8.3%) complication (bile leak) and no mortality. Stone clearance rate was 91.7% (11). The mean duration of hospitalization was 0.6 days. There were no instances of retained or recurrent CBD stones in this series. Conclusions: While laparoscopic CBD exploration does demand increased skill sets, such as laparoscopic suturing, mastering duct exploration techniques, interpreting biliary anatomy and operative cholangiography, we have shown that it is feasible in the resource poor Caribbean setting. Surgeons planning to perform laparoscopic CBD exploration should have a working knowledge of biliary anatomy and variations and the ability to suture laparoscopically.