Minor Operation Theatre Research Articles

Psychosocial, physical problems and coping strategies of patients having long term / permanent tracheostomy

BackgroundTracheostomy is a common surgical procedure in which a stoma is created in trachea by direct incision over the anterior aspect of the neck, which can cause disfigurement of the anterior neck and many other associated physical and psychosocial issues. Patients with long-term/permanent tracheostomy have to live with tracheostomy even after getting discharged from the hospital, which can further complicate the condition of the patients as they are unable to cope up with the problems associated with long-term tracheostomy. There is dearth of literature related to intensity of problems among patients having long term/ permanent tracheostomy in India. Therefore, the aim of the study is to assess psychosocial, physical problems and coping mechanism in patients with long-term/permanent tracheostomy.MethodsA cross-sectional descriptive study was conducted at ENT outpatient department and ENT Minor operation theatre, tertiary care hospital India. Total of 100 patients having long term/permanent tracheostomy were enrolled by convenient sampling. Data regarding demographics and clinical characteristics, Physical and Psychosocial problems, and Coping strategies were collected by structured questionnaires.ResultThe majority of individuals who had long-term or permanent tracheostomies had only minor health issues. Patients experienced more psychosocial issues than people in the general healthy population. The majority of patients employed active coping, acceptance, and religion as coping mechanisms, whereas the coping mechanisms which were minimally used includes: humor and substance abuse. Patients' coping strategies vary significantly according on their age, employment status, marital status, and the duration of their tracheostomy.ConclusionLong-term/Permanent tracheostomy can cause multiple physical and psychosocial issues in patients, but eventually, patients get adapted to it. Support from family members and significant others plays a vital role in better coping with tracheostomy in situ, also it is critical for health care providers to be aware of their problems and coping mechanisms so that they can provide required care and assistance.

Pilomatricoma with Osseous Metaplasia in the Shoulder Joint: A Common Lesion with Rare Differentiation

Pilomatricoma, also known as calcifying epithelioma of Malherbe, is a tumour that shows differentiation towards hair cortex cells. It was first described by Malherbe and Chenantais in 1880. It most commonly occurs in the first two decades of life, with a female preponderance, and accounts for 1% of all benign skin lesions. Pilomatricoma undergoes calcification and ossification, but ossification is rare and poorly documented. The head and neck region, as well as the upper extremities, are the most common sites. Here, the authors present a rare case of pilomatricoma with osseous metaplasia in a 15-year-old male who presented with shoulder swelling for one year. The patient had a firm to hard, mobile swelling over the right shoulder, which was not fixed to the overlying skin or underlying structures. Clinically, calcified epidermal cysts were considered. Excision was performed in a minor operation theatre, and the specimen was sent for histopathological examination. On gross examination, the specimen was a firm to hard, globular 1×0.8 cm tissue that was difficult to cut. Microscopic examination revealed a lesion composed of two types of epithelium: inner shadow cells and outer basophilic cells. Bony trabeculae with osteocyte rimming were present around the shadow cells, and giant cells were also observed. Based on the histopathological examination, the diagnosis of pilomatricoma with osseous metaplasia was made. The patient was discharged after one week and followed-up for three months, during which satisfactory wound healing and no local recurrence were observed. Pilomatricoma with osseous metaplasia should be considered as a differential diagnosis when a patient presents with a firm to hard nodule.

Impact of COVID-19 pandemic in management of Surgical patients during Nationwide COVID-19 Lockdown in a Military hospital

Introduction: The COVID-19 pandemic has had a major impact on healthcare in many countries. This study assessed the effect of a nationwide lockdown during the second wave of COVID-19 on surgical management for acute surgical conditions and the subsequent impact on postoperative mortality. Methods: This was a retrospective study, evaluating data from the hospital discharge database during the second wave of COVID -19 pandemic. All adult patients admitted through the emergency and outpatient department requiring surgical treatment between April 29 and June 29, 2021 were included in the study. The primary outcome was the change in number of hospital admissions for acute surgical conditions. Mortality was assessed among the patients with COVID-19 infected cases. Results: During the second wave of nationwide COVID-19 lockdown period, a total of 329 patients were provided surgical consultation either in emergency or outpatient basis. Among them, 227 cases required surgery. Out of this 122(53.74%) required minor surgeries and were performed in minor operation theatre in local anesthesia (LA) while 105(46.2%) underwent major surgical procedures. Of all the patients who underwent major surgical procedures 76(72.3%) were surgical emergencies, 15(14.2%) were GI and breast malignancies while 14(13.3 %) were elective cases. The mortality rate due to COVID-19 in surgical patients was 02(16.66 %) during the lockdown period. Conclusion: A decrease in hospital admissions for elective surgical cases with prioritization to emergency and malignant cases was observed during the lockdown period.

Intra lesional injection of triamcinolone acetonide- An aesthetic method of treating chalazion

Aim: To study the efficacy of intra lesional injection of triamcinolone acetonide in treating chalazion. Materials and Method: This is a prospective interventional study conducted on 100 cases of chalazion at the department of Oculoplasty and orbital disease of Sarojini Devi eye hospital, during July 2013 to June 2015. 100 cases of chalazion who came to the out patient department of Sarojini Devi Eye Hospital were included in the study. Recurrent cases, cases of acute hordeolum internum, Lid malignancies, and children were excluded from the study. Informed consent was obtained from cases selected. They were investigated for Routine surgical profile and size of chalazion measured in millimetres by a transparent ruler. Then Injection of 0.1 ml of triamcinolone was given intra lesionally into the chalazion in minor operation theatre taking all Aseptic Precautions. Cases were followed post operatively after Ist week and fourth week for reduction in size of chalazion. Result: Out of 100 cases 80 had complete resolution, 11 had reduction in size and 9 didn’t respond to treatment. Conclusion: Intra lesional injection of triamcinolone is Aesthetic method of treating chalazion. Keywords: Chalazion, Intra lesional injection, Triamcinolone acetonide

Bacterial Etiology of Wound Exudates in Tertiary Care Cancer Patients and Antibiogram of the Isolates.

Introduction:Patients with malignancies frequently develop infections as a result of surgical procedures and fungating wounds leading to pus formation. This cross-sectional study was conducted to explore the bacteriological spectra of infections of various cancer sites and their antibiotic sensitivity patterns among the patients visiting minor operation theatre (OT) of B.P. Koirala Memorial Cancer Hospital (BPKMCH), Chitwan, Nepal.Methods:Over a period of 3 months from September to November 2018, a total of 183 wound exudates and pus samples were collected and analyzed by standard microbiological procedures. Isolates were identified based on the colony characters, Gram staining and an array of biochemical tests. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion technique according to criteria set by CLSI, 2016. Methicillin resistance in Staphylococcus aureus was tested with the help of cefoxitin using disc diffusion method.Results:Out of the 183 samples, 149 (81.4%) were culture positive. Among 13 different isolates identified, S. aureus (43.0%) was predominant followed by E. coli (14.0%). Higher incidence of bacteria was seen among the males (52.3%), in the age group 51 to 60 years (26.8%) and among the patients undergoing surgical intervention to deal with cancer (34.2%). The prevalence of wound infection was significantly affected by gender, age, and treatment regimen (P < .01). Out of the total 68 S. aureus isolates, 38 (44.1%) were deemed as Methicillin-resistant Staphylococcus aureus (MRSA). Among the 158 isolates, 85 (53.8%) were multi-drug resistant (MDR). Cefepime was the most effective antibiotic for Gram positive isolates whereas both imipenem and meropenem were found to be equally more effective for Gram negative isolates.Conclusion:This study suggests that patients with malignancies harbor pathogenic bacteria; therefore, prudent use of antibiotics is essential to prevent the emergence of MDR pathogens.

Numerical Analysis on Modelling Thermal Comfort Minor Operation Theatre

An operation theatre (OT) is a special room inside the hospital where medical surgery is carried out by a surgeon with the help of medical personnel. Technical standards or requirements which have been set for heating, ventilation and air conditioning (HVAC) inside an operation theatre is important not only for the comfort of surgeon, patient, and medical personnel, but also to reduce the risk of surgical site infection during surgery. This research focus on Minor Operation Theatre (MOT) which is dental surgery room at Universiti Malaysia Perlis Health Centre with room dimensions of 2.89 m(H)×3.12 m(W)×3.4 m(L) is used for numerical analysis. The air flow supplied to the MOT is from single unit air-conditioning system. Computational Fluid Dynamics (CFD) analysis is a part of an investigation to determine the air flow and temperature distribution inside the MOT. A simulation conducted by using ANSYS Fluent only consider dry air inside MOT. Therefore, the main aim of this research is to compare and analyze the simulation of dry air conducted with previously obtained experimental data of humid air distribution inside the MOT. The comparison of humid and dry air temperature throughout the MOT shows that the difference is 25.3%. The average temperature of humid air inside the MOT is 21.8 °C while for dry air is 16.3 °C. Moreover, the cooling capacity of humid air and dry air are 2.23 kW and 1.64 kW respectively. Thus, the difference between humid air and dry air-cooling capacity is 26.5%. However, the dry air simulation and humid air simulation is the same if only the process is considered as simple cooling.

A Study on Possibility of CFD Simulation on Air Simulation in Minor Operation Theatre

Inadequate air flow distribution in room is undesired as it will cause discomfort to the occupant. Fair air flow distribution is important as it will affect the performance of the occupant as well. The objective of this research work is to develop a realistic Computational Fluid Dynamics (CFD) model of Minor Operation Theatre for investigating the air flow pattern in Minor Operation Theatre. One unit of Air Conditioner in Minor Operation Theatre has been selected for this study. The distribution of air flow pattern is analysed. The real measurement is conducted using a digital air flow anemometer with USB interface and the channels digital handheld temperature thermometer meter data loggers for validation purpose. CFD simulation is conducted by applying ANSYS Fluent software. The result of measurement and simulation are compared and validated. Based on the simulation and experiment findings, it proofs that ANSYS Fluent can be used for air simulation and relocation recommendation is proposed with the purpose for better distribution of air flow in Minor Operation Theatre.

A Test of Possibility on Relative Humidity Function in Minor Operation Theatre

High humidity air flow in Minor Operation Theatre (MOT) is undesired as it will cause discomfort to the occupant. Acceptable humidity air flow is important as it will affect the pureness of the indoor environment as well. The objective of this research work is to construct a realistic Computational Fluid Dynamics (CFD) model of MOT for investigation. The MOT which is occupied with one unit of Air Conditioner has been selected for this study. The RH of air is analysed. The experimental data is collected by applying a digital air flow anemometer with USB interface and the channels digital handheld temperature thermometer meter data loggers for validation purpose. CFD simulation is conducted by applying ANSYS Fluent software. The experimental result and simulation is compared and validated. Based on the simulation and experiment findings, it reveals that ANSYS Fluent can be used for RH in MOT.

Comparison of “medicated seton versus fistulectomy” in the management of fistula-in-ano in tertiary care hospital

Background: Fistula-in-ano is defined as communication between anal canal or rectum to external surface. The main objectives of the study are to compare management of fistula-in-ano by “Medicated seton Vs Fistulectomy” and its outcome in term of complications and the recurrences if any.Methods: This study is a randomized controlled trial. Total 46 consecutive patients presenting to the Department of Surgery at SVNGMC Medical College Yavatmal with fistula-in-ano during the time of Sep-13 to Oct-15 were included in the study. All the patients were studied as per the proforma and treated by either medicated seton or fistulectomy.Results: It was observed that operative time required (min) in medicated seton was significantly less than fistulectomy procedure. Hospital stay (days) required was significantly more in fistulectomy procedure as compared to medicated seton. Time required for complete healing (days) was significantly more in medicated seton as compared to fistulectomy.Conclusions: It is concluded that treatment of fistula-in-ano by medicated seton is simple, easy, and safe. Medicated seton treatment is an outpatient procedure and can be done in a minor operation theatre or even at Primary Health Care level. Procedure not left with a large perineal wound and its associated morbidity.

Difficult bag mask ventilation: Catheter mount cap, a cause for concern.

Sir, Use of disposable products is common in anaesthesia practice. Occasionally, aberrations can occur in this type of equipment. Failure to check equipment properly is an important factor leading to potential critical events. Proper checking of equipment before use may help prevent equipment-related morbidity and mortality, improve preventive maintenance and educate the provider about equipment.[1] Unfortunately, failure to perform a proper check before use is common.[2] A 54-year-old female patient was posted for examination under anaesthesia and a cervical biopsy in the minor operation theatre. Prior to induction of general anaesthesia, the oxygen saturation was 99%. Following induction with fentanyl and propofol, we encountered a tight bag situation while using the face mask and could not ventilate the patient. There was no chest rise and no air entry on auscultation. We increased the depth of anaesthesia, optimised mask holding and used an oral airway. On visual inspection, the anaesthesia circuit assembly appeared appropriate. The bag continued to remain tight with no chest expansion, with no obvious reason for difficult mask ventilation. Post-induction, the oxygen saturation was 98%. The mask was disconnected from the circuit to connect to a self-inflating reservoir bag for ventilation, anticipating desaturation due to the lapsed time. The patient could be ventilated easily using the self-inflating reservoir bag. Much to our surprise, we saw a red-coloured cap occluding the mask, which was completely concealed when connected to the catheter mount [Figure 1a]. The red-coloured catheter mount cap was not removed before connecting to the mask and had resulted in the complete circuit obstruction [Figure 1b]. Once recognized, the cap was removed, the patient could be ventilated easily and the anaesthesia proceeded uneventfully. Figure 1 (a) Catheter mount cap concealed in the mask, (b) complete obstruction of the mask with cap (viewed from above), (c) complete obstruction of the mask with cap (viewed from below), (d) catheter mount covered with cap The red cap covering the catheter mount connected to the mask if not noticed on time could have led to potentially dangerous consequences. This was not a manufacturing defect, and interestingly, the cap fitted perfectly well into the mask [Figure 1c]. This was not detected through the mask as it was semi-opaque. These caps may often be transparent and may not be picked up even through a transparent mask. The catheter mount with the cap [Figure 1d] was connected to the mask by a new operating room technician who was unaware of the consequences. In a busy place like the minor operation theatre with a rapid turnover, due to paucity of time, things are often hurried leading to failure to perform a proper equipment check. A visual check may well have picked up the fault.[3] On doing a root cause analysis, we discovered that the circuit had been checked by the provider; however, the disposable catheter mount was attached in the circuit and fitted to the mask by the technician just prior to induction of anaesthesia and the cap thus went unnoticed. The anesthesia apparatus check-out recommendations[4] clearly states that though the technician may have a role in checking the equipment, the ultimate responsibility for ensuring that the equipment functions properly lies with the anaesthesia provider. Thus, failure to check the complete breathing system assembly may account for serious negligence on the part of the anaesthesia provider. This case reaffirms the importance of a complete cockpit drill before conducting anaesthesia. Financial support and sponsorship We have no financial support and sponsorship Conflicts of interest There are no conflicts of interest.

Band ligation in grade-I and grade-II internal haemorrhoids: a prospective observational study

Background: Haemorrhoids are one of the most common benign anorectal problems worldwide with high prevalence. There are various modalities of treatment for grade I and II hemorrhoids like: medical management, instrumental techniques viz rubber band ligation, sclerotherapy, infrared photocoagulation, cryotherapy, doppler guided haemorrhoid artery ligation, laser therapy etc. Rubber band ligation resolves haemorrhoids without need of hospitalization /anesthesia and with lower incidence of complication and is too economic. Hence study was conducted to evaluate efficacy of rubber band ligation in grade I and II internal haemorrhoids. Methods: The present study was conducted with 60 patients of grade-I and grade-II. Band ligation was done on outpatient basis in minor operation theatre with no anesthesia, multiple banding was done in single session. Post procedure follow up was done on 10th day, 1st month and 6th month for symptomatic improvement. Results: In our study maximum no of patients were in a age group of 36 to 45 years. Of them 45 (75%) were males and 15 (25%) were females. 80% of the cases assessed treatment as excellent and 20% with some residual symptoms assessed the treatment as of moderate help. Conclusions: Rubber band ligation for internal hemorrhoids is an effective modality of treatment in 10 and 2° hemorrhoid which is convenient, simple, cost efficient has high patient acceptance with limitations as post procedure discomfort and pain.

Tender erythematous papule on the face

A 36 year old male visited our dermatological outpatient department (OPD) with a chief complaint of a raised reddish skin lesion on the left side of the face for the last one month. There is history of local discomfort associated with the lesion. The patient denied any history of trauma at the affected site. On physical examination, there was an erythematous papule around 1 cm in diameter present on the left side of the face 2-3 cm below the left lower eyelid (Fig. 1). It was firm in consistency and exquisitely tender. The summit of the papule was relatively harder and was the site of maximum tenderness. After manipulating the lesion in the minor operation theatre, a glass fragment of the size 9-10 mm × 2-3 mm was removed from the lesion (Figs 2A-B, and 3). A diagnosis of foreign body reaction to the glass was made. The affected skin at the lesional site was irrigated with normal saline. The patient was prescribed topical fluticasone plus mupirocin ointment

Bloodless, sutureless circumcision

W e present our experience of sutureless and bloodless elective circumcision in neonates and infants with Gomco clamp. From March 2008 to May 2011, 200 babies with age ranging from 2 weeks to 7 months underwent Gomco circumcision. All patients were given chlorohydrate 50 mg/kg, paracetamol suppository 15 mg/kg, and local anesthesia. Procedure was done in minor operation theatre (OT) and babies were observed for 1 h in recovery room before discharging them home. Two of our patients (1%) required immediate suturing on table after Gomco clamp was removed, five patients (2.5%) were shifted back from the recovery room to minor OT for suture repair and eight patients (4%) required reinforcement of primary dressing to control the minor ooze. There was no other complication. Cosmesis was to the satisfaction of the surgeon as well as the parents. Gomco clamp is a bloodless, sutureless, simple, and safe method of circumcision in newborns and infants. It is cost-effective and can be performed under local anesthesia and sedation with excellent cosmetic results.

Intramuscular ketamine in acute depression: A report on two cases

It takes about 2 weeks for the onset of antidepressant action of drugs while electroconvulsive therapy though faster, is a cumbersome procedure requiring an anaesthetist and at least a minor operation theatre. Recent studies have shown that Ketamine, when given to severely depressed patients in the dose of 0.5 mg/kg as a slow intravenous infusion over 40 minutes, brought about acute relief from depression and amelioration of suicidal risk within a few hours. The improvement, however, was transient and lasted for up to a week but could be sustained by further weekly or biweekly injections. As the dose of ketamine administered was found to be safe, it was now tried in the intramuscular route in two severely depressed patients with similar rapid improvement. The cases are reported here which pave way for an easier mode of treating acute depression.

Routine Antibiotic Prophylaxis is not Necessary for No Scalpel Vasectomy

No scalpel vasectomy (NSV) is the recommended technique for male contraception. Majority of surgeons use oral antibiotics for 3-5 days following the procedure. The reasons cited for routine use of antibiotics include that most of these operations are performed in camps where asepsis in less than adequate, most patients are unclean and unhygienic surrounding environment. However, there is no database of wound infection following NSV. This study was undertaken to find out the incidence of wound infection following No scalpel vasectomy if no antibiotic prophylaxis is used. Patients undergoing NSV in the minor operation theatre attached to the Surgical Out Patient Department were included in the study. A standard preoperative part preparation protocol was followed in all patients. All procedures were performed under local anesthesia after obtaining informed consent. Post-operatively patients were advised an oral anti-inflammatory drug for 3-5 days and were reviewed after 1 week for development of wound infection. Over a 4-year period, 322 patients underwent NSV and no patient developed wound infection. Hence, it is concluded that routine antibiotic prophylaxis is not necessary for NSV.

Diagnostic accuracy of benign eyelid skin lesions in the minor operation theatre

PURPOSE To determine the accuracy of the clinical diagnosis of benign eyelid skin lesions in a minor operation theatre (MOT) setting. METHODS This study was carried out prospectively over a 6-month period. Subjects attending the minor operation theatre set-up with eyelid skin lesions were assessed and lesions were labelled as benign, pre-malignant or malignant. All patients underwent excision biopsy of the lesion. Histopathologic diagnosis was obtained for each lesion, which was then matched with the respective clinical diagnosis. The Diagnostic Accuracy (DA) was calculated for benign lesions using the formula proposed by Lightstone et al. RESULTS Two hundred eyelid skin lesions from 183 consecutive patients were included in the study. Clinically, 187 lesions were labelled as benign, 12 as malignant and 1 as pre-malignant. The histopathologic report matched with the clinical diagnosis in 192 cases (96%). However, incorrect diagnoses included 3 malignant and 3 premalignant lesions that were labelled as benign clinically. The DA for benign lesion was 95.7%. CONCLUSION Histopathologic confirmation may be necessary for most cases in the MOT.