Teaching Hospital Research Articles

Predicting falls with ultrasound, physical parameters or fall-risk questions among older adults: A prospective cohort study

BackgroundFalls are a significant issue among older adults, leading to morbidity and mortality. Screening for fall risk in the ED is crucial but challenging due to time limitations and patient conditions. Sarcopenia, characterized by muscle loss, is associated with increased fall risk, and ultrasound has been proposed as a non-invasive tool to measure muscle mass in this context. MethodsThis prospective cohort study enrolled 174 older adults from an urban teaching hospital's EDOU, assessing muscle mass via POCUS, grip strength, Timed Up and Go (TUG) test, and fall risk using the STEADI toolkit. The patients were followed up over six months to assess if they had fallen or not. ResultsFollow-up identified 37 participants (21 %) as patients who fell. There was no significant association between POCUS-measured muscle mass, grip strength, or TUG test performance with future falls. In contrast, STEADI questionnaire responses demonstrated significant differences between patients who fell and did not fall, suggesting its potential utility in predicting fall risk in this population. ConclusionThe simpler tool, the STEADI questionnaire, may offer more practicality in screening fall risk compared to complex ultrasound measurements or physical performance tests among the older in ED.

Opt-out HIV screening in adults attending the Emergency Department of a London teaching hospital

BackgroundOpt-out Emergency Department blood borne virus (EDBBV) screening was introduced at the Royal Free Hospital under the NHSEI (NHS England and NHS Improvement) programme to expand opt-out testing in local authority areas with high HIV prevalence. This initiative was part of the “Toward Zero” policy towards ending HIV transmission in England by 2030. MethodsAll patients attending the Royal Free Hospital Emergency Department (ED) aged 16 and over were screened for blood borne viruses (HIV/HBV/HCV) unless they opted out. We looked at HIV data from patients seen in ED between the initiation of EDBBV testing on the 12th of April and 12th of August 2022. Hepatitis B and C data was reviewed in a separate study. OutcomeA total of 12,208 samples from 10,641 patients were screened for HIV. Amongst these samples there were 88 which were positive, giving a seroprevalence of 0.84%. There were 48 patients who were already known to local HIV services, 35 were known to HIV services outside of our trust and 5 were new diagnoses. ConclusionOur results confirmed our local HIV prevalence to be very high as per the UK Health Security Agency and supports the need for HIV testing. Opt-out ED BBV screening has been a highly effective method for identifying people living with HIV who are unaware of their status.

Feasibility, clinical outcomes, and learning curves of robotic-assisted colorectal cancer surgery in a high-volume district general hospital: a cohort study

Introduction: Robotic-assisted surgery (RAS) is one of the most influential surgical advances with widespread clinical and health-economic benefits. West Hertfordshire Teaching Hospital NHS Trust was the first in the UK to simultaneously integrate two CMR Surgical Versius robots. This study aims to investigate clinical outcomes of RAS, explore surgeon learning curves and assess the feasibility of implementation within a district general hospital (DGH). Methods: A prospective cohort study of 100 consecutive patient data were collected between July 2022 and August 2023, including demographics, operative and clinical variables, and compared with laparoscopic surgery (LS) data from the National Bowel Cancer Audit. Surgeon learning curves were analysed using sequential surgical and console times. Results: In the RAS cohort, the median age was 70 (IQR 57–78 years) and 60% were male. Retrieval of a minimum of 12 lymph nodes significantly increased in RAS compared to LS (95% vs. 88%, P=0.05). The negative mesorectal margin rate was similar between RAS and LS (97% vs. 91%, P=0.10), as well as length of stay greater than 5 days (42% vs. 39%, P=0.27). For anterior resections performed by the highest volume surgeon (n=16), surgical time was reduced over 1 year by 35% (304.9–196.9 min), whilst console time increased by 111% (63.0–132.8 min). Conclusions: Key quality performance indicators were either unchanged or improved with RAS. There is potential for improved theatre utilisation and cost-savings with increased RAS. This study demonstrates the feasibility and easy integration of robotic platforms into DGHs, offering wider training opportunities for the next generation of surgeons.

Priapism in South West Nigeria—Short and Intermediate-Term Outcomes

Abstract Background: Priapism is usually defined as penile erection that lasts more than 4 h beyond sexual stimulation and orgasm or is unrelated to sexual stimulation. The overwhelmingly more common low-flow priapism is typically painful, while high-flow priapism is typically painless. Interventions are varied depending on the aetiology and timing of the presentation. The outcome in most cases depends on the timing of the intervention. Objective: This study aimed to review the presentation and short- and intermediate-term outcomes of treatment of priapism in patients in Southern Nigeria. Materials and Methods: This was a retrospective 10-year study conducted from 2010 to 2019 of all adult patients diagnosed with priapism who were admitted to the adult urology units in two Government University Teaching hospitals in South West Nigeria. Results: The records of 61 patients were analysed. The mean age was 27.54 years ± 6.22 with a range of 15–56 years. The median duration of symptoms before presentation was 36 h with a range of 2 to 336 h. Eleven patients (18%) presented within 24 h of onset of symptoms. Sickle cell disease (SCD) and idiopathic aetiology were the most common causes of priapism, accounting for 44 (72.1%) and 8 (13.1%) respectively. Corporal aspiration resolved the priapism in 22 (36.1.%), while corpora–glandular shunt was the final treatment in 36 (59.1%). Fifty-seven per cent had erectile dysfunction (ED), while penile gangrene with autoamputation was observed in one patient (1.6%). Sixty-six per cent and 62% of patients who presented within < 36 h and 36–72 h, respectively, experienced normal erection at 6 months after surgery. Erectile function got progressively worse after 72 h, with all patients with ischemic priapism lasting more than 1 week developing ED. There was no statistically significant relationship between the variants of SCD and the risk of ED in patients who presented within 72 h. Conclusion: The incidence of ischemic priapism was high, with sickle cell disease being the most common cause. The risk of ED was significantly worse after 72 h. The aetiology of priapism did not significantly influence the risk of ED.

How Much is Too Much? Evaluation of the Clinical Relevance of Routine Preoperative Investigations in American Society of Anaesthesiologist (ASA) Grades I and II Patients Undergoing Minor to Intermediate Elective Surgeries at Tertiary Care Teaching Hospital - Influence on Change in the Surgical Plan and Outcome

Abstract Background: In recent decades, experts have questioned the necessity of routine preoperative investigations due to their limited influence on perioperative management, higher expenses, postponed surgical procedures, patient anxiety resulting from false-positive results for minor operations and increased workload for laboratories. Objective: Our objective was to systematically evaluate the impact of pre-operative investigations on the treatment of patients opting for elective procedures. The study aimed to evaluate the impact of pre-operative investigations and peri-operative management on elective surgeries of the American Society of Anesthesiologists (ASA) physical status classification grades I and II, identifying common inappropriate investigations and assessing the impact of abnormal results on patient management. Materials and Methods: We conducted a prospective, cross-sectional, clinical, observational, single-centre study from February 2020 to March 2021 on 500 cases in the General Surgery Department of Tertiary Care Teaching Hospital. This study assessed the importance of pre-operative investigations in low-risk patients undergoing low-grade elective general surgical procedures. We recruited consecutive patients from the surgery wards of the institute, who fulfilled the inclusion criteria and obtained informed written consent for anaesthesia, surgery and participation in the study. Demographic data, the type of investigation conducted and test results were noted. We followed up with patients who had abnormal test results to record the consequences of the abnormality, such as the postponement of surgery and the requirement for additional investigations. Pre-operative transfusion, change in the management plan and change in the anaesthesia plan were recorded. Results: In the current study, the age of the patients ranged from 20 years to 45 years, and the mean age of the patients was 32.208 ± 9.16. The age group of 20–30 years was the commonest, being 158 (31.6%) patients. Out of 500 patients, 296 (59.2%) patients were males and the remaining 204 (40.8%) were female patients. Out of 500 tests, 44 (8.8%) had abnormal results. Most of the changes in our study were based on abnormal ECG findings. Out of a total of 500 surgical procedures performed, 497 (99.4%) were carried out without any difficulty, with two (0.4%) postponed due to abnormality in the pre-operative investigations and one (0.2%) cancelled. A total of 490 (98%) patients did not have any post-operative complications. Only ten (2%) patients developed post-operative complications, and out of those, only one (0.1%) had some abnormality in the pre-operative investigations. Conclusion: Preoperative laboratory investigations do not significantly influence the surgical outcome of the patients belonging to ASA grades I and II.

Emergency practitioner-administered ultrasound nerve blocks in the emergency department: A retrospective analysis

Abstract OBJECTIVES: In the realm of acute pain management within emergency departments (EDs), the prevalent reliance on systemic analgesics, notably opioids, presents challenges due to associated risks and suboptimal efficacy. The emerging alternative of ultrasound-guided nerve blocks (USGNBs) has shown promise in prospective studies. However, the safety and efficacy of USGNBs when performed by emergency medicine practitioners remain largely unexplored, necessitating this study to address the research gap. The primary objectives of this study were to assess the efficacy of Emergency physician-performed USGNBs and changes in patient-reported pain (pre- and postnerve block) at 15 and 30 min. In addition, the time taken to perform nerve blocks, type of nerve block, frequency, indications, procedure time, and complications were all studied. METHODS: Conducted at a Tertiary Care Teaching Hospital in Pune, India, this single-center, retrospective observational study aimed to evaluate the effectiveness of USGNBs in the ED context. A retrospective analysis covered 274 emergency practitioner-performed USGNBs recorded from January 2022 to December 2023. Participants included consecutive ED patients consenting to nerve blocks, with practitioners utilizing bupivacaine (0.25%) and ropivacaine (0.25%) based on individual preferences. The study systematically recorded patient demographics, block types, indications, complications, and pre- and postpain scores on a Numerical Rating Scale. RESULTS: The study demonstrated a significant reduction in pain scores post-USGNB, with an average decrease of 2.9 ± 1.08 at 15 min and 5.8 ± 1.39 at 30 min. Commonly performed blocks included the femoral nerve, fascia iliaca, and serratus anterior, with notable pain relief in fracture management cases. Procedural durations varied, ranging from 2 to 12 min, while four complications were reported, including diaphragmatic paresis and arterial punctures during interscalene nerve block and fascia iliac compartment blocks, respectively. CONCLUSION: This extensive study in an academic ED setting supports the proficiency of emergency practitioners in performing USGNBs. The findings emphasize the transformative potential of USGNBs in academic ED pain management, showcasing notable pain reduction and minimal complications. These results advocate for the integration of advanced pain relief techniques into emergency medicine training programs, contributing to a comprehensive approach to acute pain management.

Spectrum of Ocular Tuberculosis in Tertiary Care Hospitals of Khyber Pakhtunkhwa Peshawar

Purpose: To describe the spectrum of ocular tuberculosis (TB), highlight the difficulty in diagnosis and treatment of such cases encountered in a tertiary care hospital of Peshawar, Pakistan. Study Design: Descriptive Case series. Place and Duration of Study: Khyber teaching hospital MTI Peshawar from Jan 2021 till July 2022. Methods: Eleven cases with Ocular tuberculosis are described. At presentation, complete history was taken and detailed examination was done including fundus examination and OCT macula. For diagnosis, a combination of Tuberculin skin test (TST) and Quantiferon-Gold was performed. On the basis of results of both tests Anti-TB treatment (ATT) was started and continued for an average of 9 months. Results: This study highlights the diverse ocular manifestations of TB in patients, even without a known history of systemic disease. Among 11 patients, 3 presented with panuveitis, 6 with posterior uveitis, and 2 with serpiginous-like choroidopathy with uveitis. Notably, only 2 had a known history of systemic TB. The patients were treated primarily with Anti-Tuberculosis Therapy (ATT) along with steroids or other adjunct therapies. Most cases showed improved vision and stable disease post-treatment, with visual acuity ranging from 6/24 to 6/6. However, two patients were lost to follow-up, leaving their outcomes unknown. Conclusion: In this case series, we explore different cases of Ocular Tuberculosis (OTB) seen at a busy hospital in Peshawar, Pakistan. There are variety of symptoms with which the patients present. The combined use of TST and Quantiferon-Gold proved an effective and affordable approach for diagnosis and timely initiation of ATT in ocular TB.

Nurse knowledge, attitudes, and barriers to pressure injuries: A cross-sectional study in an Australian metropolitan teaching hospital

Nurse knowledge, attitudes, and barriers to pressure injuries: A cross-sectional study in an Australian metropolitan teaching hospital

An Appraisal of Anaesthesia Practices for Obstetric and Gynaecologic Surgeries in a Tertiary Health Center in Zaria, North Western Nigeria

Abstract Background: Anaesthesia is a critical aspect of every surgical procedure. Various options exist depending on the type of procedure, nature and the clinical state of the patient. This study reviewed the anaesthesia practices for Obstetric and Gynaecologic surgeries at Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: It was a retrospective cross-sectional descriptive study conducted at Ahmadu Bello University Teaching Hospital, Zaria. Obstetric and Gynaecologic surgeries performed from 1 November 2022 to 31 October 2023 were included in the study. Relevant data for the study were obtained from the anaesthesia register in the theatre. The data were analysed with SPSS 20. Results: The mean age ± SD of patients who had surgery was 32.1 ± 9.1 years. A total of 547 cases were reviewed, of which 273 (49.9%) were elective cases and 274 (51.1%) were emergency cases. Out of these, 254 (46.4%) were obstetric emergencies, 20 (3.7%) were gynaecologic emergencies, 149 (27.2%) were elective gynaecologic cases, and 124 (22.7%) were elective obstetric cases. The majority of the cases, 407 (74.4%), were American Society of Anaesthesiologists II. Spinal anaesthesia was the commonest type of anaesthesia used in obstetric surgeries 336 (91.8%), while general anaesthesia was the commonest type of anaesthesia used in gynaecologic surgeries 89 (79.5%). Senior registrars gave anaesthesia in 457 (83.5%) cases. Heavy Bupivacaine (0.5%) was the commonest agent used for spinal anaesthesia in 327(89.3%) cases, while plain bupivacaine (0.5%) was the least agent used in 39(10.7%). Propofol was the most common agent used for the induction of general anaesthesia in 72 (64.3%) cases, while ketamine was the least used agent in 40 (35.7%). Anaesthesia complications were recorded in only 24 (4.4%) of cases. The complications were recorded in 13 (54.2%) procedures done under neuraxial anaesthesia and 11 (45.8%) cases done under general anaesthesia. Cardiovascular instability was the most common complication recorded in 10 (41.7%) cases. Conclusion: Spinal anaesthesia was the most common technique of anaesthesia in Obstetric surgeries, while general anaesthesia was the most common in Gynaecologic surgeries during the period under review. Complications of anaesthesia were uncommon.

Quality of life (QOL) of patients with schizophrenia and epilepsy attending an outpatient clinic in a tertiary care hospital in Sri Lanka

Background: Schizophrenia and epilepsy are chronic relapsing disorders, that share common disadvantages that affects QOL.Methods: A cross-sectional descriptive study was conducted on 68 patients with schizophrenia and 68 patients with epilepsy, presenting to psychiatry and neurology clinics of the Colombo South Teaching Hospital (CSTH). The validated Sinhala and Tamil version of the WHO QOL 100 was used to assess the QOL.Results: Schizophrenia group had poorer QOL in physical (p<0.05), social (p<0.01), independence (p<0.05) and environmental (p<0.05) domains, compared to epilepsy. Longer duration of illness (> 5 years) was associated with poorer QOL in the independence (p<0.05) and social domains (p<0.05) and longer duration of untreated illness was associated with lower QOL in the physical (p<0.01) and social domains (p<0.01) in schizophrenia group.Conclusions: Patients with schizophrenia had poorer QOL compared to patients with epilepsy. Longer duration of untreated illness was associated with poorer QOL in both groups.

264 Changes in Optic Nerve Sheath Diameter Following Rigid Cervical Collar Application in Patients With Traumatic Brain Injury: A Prospective Observational Study in a Tertiary Care Teaching Hospital

264 Changes in Optic Nerve Sheath Diameter Following Rigid Cervical Collar Application in Patients With Traumatic Brain Injury: A Prospective Observational Study in a Tertiary Care Teaching Hospital

Outcomes of Dose Escalation of Imatinib in Chronic Myeloid Leukemia Patients: A Retrospective Analysis From an Indian University Teaching Hospital

Outcomes of Dose Escalation of Imatinib in Chronic Myeloid Leukemia Patients: A Retrospective Analysis From an Indian University Teaching Hospital

Incidence of and risk factors for post-operative venous thromboembolism after free flap breast reconstruction in a London teaching hospital: A retrospective cohort study

Incidence of and risk factors for post-operative venous thromboembolism after free flap breast reconstruction in a London teaching hospital: A retrospective cohort study

Blood culture bottles meet the operating room: enhancing the diagnostic accuracy of infectious spondylitis through open microsurgical biopsy and intraoperative inoculation.

Infectious spondylitis is caused by hematogenous seeding or adjacent soft tissue infection. No study has provided evidence that incubating biopsy specimens in blood culture bottles could enhance detection rates, nor has any study compared this method with conventional culture techniques. We aimed to assess the diagnostic yield of open microsurgical biopsies for infectious spondylitis and the efficacy of various culture media in the presence and absence of pre-biopsy antibiotic therapy. This retrospective study, which was conducted at a university-affiliated teaching hospital in Korea, enrolled 165 adult patients with suspected infectious spondylitis between February 2014 and September 2020. The diagnostic yield of open biopsy was compared among three culture media, namely, blood culture bottles, swab culture using transport media, and tissue culture using plain tubes, while considering preoperative antibiotic exposure. Causative bacteria were identified in 84.2% of all cases. Blood culture bottles had the highest positivity rate (83.5%), followed by swab cultures (64.4%) and tissue cultures (44.9%). The differences in positivity rates were significant (P < 0.001). Preoperative antibiotic therapy reduced detection rates across all media, particularly in tissue cultures. We established the high diagnostic yield of open microsurgical biopsy using blood culture bottles, suggesting that pre-biopsy antibiotic therapy significantly affects bacterial detection, thereby underscoring the importance of culture medium selection in the diagnosis of infectious spondylitis.

Centchroman and tamoxifen in mastalgia: A randomized controlled trial

BackgroundMastalgia can be incapacitating for some individuals, necessitating medical intervention. Only a limited number of drugs have demonstrated effectiveness in managing the symptoms. An emerging option is oral centchroman, purported to be effective in this condition. Clinical trials are necessary to determine its role in the treatment of mastalgia. MethodsAn evaluator-blinded randomized controlled trial was conducted at a tertiary care teaching hospital to compare the efficacy of tamoxifen 10 mg and centchroman 30 mg daily. The study aimed to investigate the effect of treatment on the Visual Analog Scale (VAS) score of pain and the number of painful days per menstrual cycle or month. Following appropriate exclusion and randomization procedures, 51 patients completed the treatment and follow-up. ResultsCentchroman was more effective in controlling pain in the first month (p =0.04). No significant difference in the VAS score of pain was observed at the third or sixth month. Both drugs were effective in reducing the number of painful days, with no statistically significant difference between them. The recurrence rate at the sixth month was also not different (P = 0.41). Overall, 32% of patients on centchroman and 38.4% of patients on tamoxifen either failed to achieve satisfactory pain relief or experienced recurrences. ConclusionCentchroman is a safe and effective substitute for tamoxifen, demonstrating superior early symptom control, albeit with a slightly increased occurrence of adverse effects. In the event that no symptomatic relief is observed within a one-month trial of either medication, discontinuation is recommended, as prolonged use is unlikely to yield additional relief.

Ultrasonographic Udder Monitoring and Disease diagnosis in She-goat

Ultrasonography is an effective, non-invasive technique for regular monitoring of udder health to ensure the best quality of milk. The study was conducted to measure the diameter of gland cistern before and after milking and evaluate the effect of breeds, age, and seasons on udder diseases in she-goats. The diameter was measured through ultrasonography before and after milking and retrospective data (breed, age, season) were collected from the Veterinary Teaching Hospital, Mymensingh. Variation in gland cistern diameter (mm) was significant (p&lt;0.05), meaning that the gland cistern’s diameter changed more before and after milking. Results also revealed an insignificant (p&gt;0.05) difference between the left and right quarter gland cistern’s diameter independent of time. This study showed that the occurrence of udder diseases was higher in the Black Bengal breed (82%) compared to Jamuna Pari (18%). Mastitis mostly occurred at the age of between 2 to 3 years old (25.7%) and at the winter season (39.8%). All age groups had an affected incidence of 1.8% for udder wounds and showed higher occurrence during the summer season (5.3%). Furthermore, this study indicated that udder edema affection is more common in the group of goats younger than two years old and during the winter season (3.5%) This study concludes that normal physiological structures i.e. udder parenchyma, gland cistern and different pathological conditions such as mastitis, fibrosis can be easily monitored through transcutaneous ultrasonography. J Bangladesh Agril Univ 22(3): 396-403, 2024

Sleep, Well-Being, and Cognition in Medical Interns on a Float or Overnight Call Schedule

Extended work hours and night shifts are essential in health care, but negatively affect physician sleep, well-being, and patient care. Alternative schedules with shorter work hours and/or reduced irregularity might mitigate these issues. To compare sleep, well-being, and cognition between interns working irregular, extended shifts (call schedule), and those working a more regular schedule with restricted hours (float schedule). In this observational longitudinal cohort study, interns in a Singapore-based teaching hospital were studied for 8 weeks from January 2022 to July 2023. Data were analyzed from July 2023 to July 2024. Participants worked either regular approximately 10-hour workdays, interspersed with 24 hour or more overnight calls 4 to 5 times a month, or a float schedule, which included regular approximately 10-hour workdays, and 5 to 7 consecutive approximately 12-hour night shifts every 2 months. Exposure was based on departmental training and operational needs. Sleep was measured with wearable sleep trackers and an electronic diary. Day-to-day well-being and cognitive assessments were collected through a smartphone application. Assessments included the Sleep Regularity Index (SRI; determines the probability of an individual being in the same state [sleep or wake] at any 2 time points 24 hours apart, with 0 indicating highly random sleep patterns and 100 denoting perfect regularity) and Pittsburgh Sleep Quality Inventory (PSQI; scores ranges from 0 to 21, with higher scores indicating poorer sleep; a score greater than 5 suggests significant sleep difficulties). Participants (mean [SD] age, 24.7 [1.1] years; 57 female participants [59.4%]; 41 on call schedule [42.7%]; 55 on float schedule [57.3%]) provided 4808 nights of sleep (84.2%) and 3390 days (59.3%) of well-being and cognition assessments. Participants on a float schedule had higher SRI scores (mean [SD] score, 69.4 [6.16]) and had better quality sleep (PSQI mean [SD] score, 5.4 [2.3]), than participants on call schedules (SRI mean [SD] score, 56.1 [11.3]; t91 = 6.81; mean difference, 13.3; 95% CI, 9.40 to 17.22; P < .001; PSQI mean [SD] score, 6.5 [2.3]; t79 = 2.16; 95% CI, 0.09 to 2.15; P = .03). Overnight call shifts, but not night float shifts, were associated with poorer mood (-13%; β = -6.79; 95% CI, -9.32 to -4.27; P < .001), motivation (-21%; β = -10.09; 95% CI, -12.55 to -7.63; P < .001), and sleepiness ratings (29%; β = 15.96; 95% CI, 13.01 to 18.90; P < .001) and impaired vigilance (21 ms slower; β = 20.68; 95% CI, 15.89 to 25.47; P < .001) compared with regular day shifts. Night shifts with naps were associated with better vigilance (16 ms faster; β = -15.72; 95% CI, -28.27 to -3.17; P = .01) than nights without naps. In this cohort study, 24-hour call schedules were associated with poorer sleep, well-being, and cognition outcomes than float schedules. Naps during night shifts benefited vigilance in both schedules.

Diaphragm-sparing efficacy of subparaneural upper trunk block for arthroscopic shoulder surgery: A randomised controlled trial.

Inter-scalene block (ISB) is associated with an inevitable risk of hemi-diaphragmatic paresis (HDP). To reduce the risk of HDP, an upper trunk block (UTB) has been proposed at the brachial plexus division level. We hypothesised that UTB would be associated with a lower incidence of HDP than ISB while providing sufficient analgesia following arthroscopic shoulder surgery. Randomised controlled trial. A tertiary teaching hospital. Seventy patients aged 20 to 80 years undergoing arthroscopic rotator cuff repair. Ultrasound-guided ISB or UTB was performed with 5 ml 0.75% ropivacaine. The primary outcome was the incidence of complete HDP, assessed by diaphragm excursion using ultrasound, defined as a decrease to 25% or less of baseline or occurrence of paradoxical movement. Postoperative pulmonary function change, pain scores, opioid consumption and pain-related outcomes were the secondary outcomes. The UTB group had a significantly lower incidence of complete HDP than the ISB group [5.9% (2/34) vs. 41.7% (15/36); absolute difference, 35.8%; 95% confidence interval (CI), 17.8 to 53.7%; P < 0.001]. The postblockade decline in pulmonary function was more pronounced in the ISB group than that in the UTB group. The pain score at 1 h postoperatively was not significantly different between the groups (ISB vs. UTB group: median 0 vs. 1; median difference, -1; 95% CI, -2 to 0.5). No significant difference was observed in any other secondary outcomes. UTB was associated with a lower incidence of HDP compared with ISB while providing excellent analgesia in arthroscopic shoulder surgery. Clinical Trial Registry of Korea ( https://cris.nih.go.kr ) identifier: KCT0007002. Chungnam National University Hospital Institutional Review Board No. 2021-12-069.

Risk of short-term cardiovascular disease in relation to the mode of delivery in singleton pregnancies: a retrospective cohort study

Cardiovascular disease (CVD) is increasing in prevalence and affects up to 4% of pregnancies in otherwise healthy persons. The specific factors that drive the development of CVD in pregnant people are poorly characterised. This study aimed to determine whether the mode of delivery in singletons affects the risk of cardiovascular morbidity and mortality within one year in patients without prior CVD. We designed a retrospective cohort study utilising the Nationwide Readmissions Database (NRD) to identify singleton delivery hospitalisations in the United States from Jan 1, 2010 to Nov 30, 2018. International Classification of Disease (ICD) versions 9 and 10 codes were used to identify patients with readmission for CVD within the calendar year of index delivery. Patients aged 15-54 who underwent a singleton vaginal or caesarean delivery were included. Patients with pre-existing CVD hospitalisations before or during delivery, ectopic pregnancies, or abortive outcomes were excluded. Participant data was retrieved from the NRD database. The primary outcome was hospital readmission, defined by ICD 9 and 10 codes for fatal or non-fatal CVD in the same calendar year as delivery. Cox proportional hazard regression models were used to adjust for confounders. These included maternal age, hospital bed size, hospital type, hospital teaching status, income quartile, insurance, and year of delivery. Additional sub-analyses were performed adjusting for hypertensive disorders of pregnancy and diabetes mellitus. Of the 14,179,299 singleton deliveries, 32% (n=4,553,492) underwent a caesarean. CVD readmissions occurred in 255.2 per 100,000 (n=11,710) caesarean deliveries compared with 133.9 per 100,000 (n=12,507) vaginal deliveries (rate difference [RD], 121.4, 95% confidence interval [CI], 114.8-127.9; hazard ratio [HR] adjusted for all confounders including hypertensive disorders of pregnancy and diabetes mellitus was 1.42, 95% CI 1.35-1.50). This association was highest in the first 0-29 days following delivery (HR 1.68, 95% CI 1.59-1.78). The risk of readmission for CVD persisted for one year. These findings suggest that caesarean delivery of singletons is associated with a higher risk of cardiovascular morbidity in patients without pre-existing CVD. This risk was highest in the first month but remained elevated for one year after delivery. These findings add to the accumulating evidence that undergoing caesarean delivery may have long-standing health implications and support the extension of the post-partum surveillance period. Limitations of this study include the lack of adjustment for body mass index, race, and parity. We were also unable to determine the reason for the caesarean delivery. None.

A STUDY ON MATERNAL AND FETAL OUTCOME IN OLIGOHYDRAMNIOS

Background: Amniotic fluid provides a protected milieu for growing fetus, cushioning the fetus against mechanical and biological injury. It also supplies nutrients and facilitates growth and movement.Oligohydramnios is defined as Amniotic fluid index (AFI) less than 5 cm, or deep vertical pocket &lt; 21. It occurs in 1–5% pregnancies at term, with the incidence increasing in postdate pregnancies to 11%.2 Maternal conditions associated with decreased AFV ( amniotic fluid volume)include post-dated pregnancy, preterm premature rupture of membranes (PPROM), hypertension, autoimmune disorders and maternal medication like prostaglandin synthetase inhibitors. Fetal factors: Which influence AFV are essentially related to fetal growth (intrauterine growth restriction) and fetal anomalies, particularly of the renal tract. The most commonly associated renal anomalies with oligohydramnios include bilateral renal agenesis, multicystic dysplastic kidneys, bladder outlet obstruction and infantile polycystic kidney disease.The aim of this study is to evaluate the etiological risk factors of oligohydramnios and to know the clinical significance and mode of delivery and maternal and perinatal outcome. Methods: This was a retrospective study conducted on 100 cases in Basaveshwar Medical and Teaching Hospital attached to MahadevappaRampure Medical college, Kalaburagi from 1-8-2023 to 1-6-2024.All cases coming to Basaveshwar medical and teaching hospital with oligohydramnios were included in the study after fulfilling inclusion and exclusion criteria Results: Of the 100 cases in the present study,40 cases were in 25-30 years accounting for 40% of cases with maximum number of cases in this age group.56 cases were primigravida accounting for 56% of cases with majority of cases being primigravida and 44 cases were multigravida accounting for 44% of cases.The number of cases with preterm rupture of membranes were 21 ( 21%), cases with Intra uterine growth restriction were 15 (15%). 6 cases (6%) had congenital anamolies. The number of cases withpost dated pregnancy were 22 (22%), Pregnancy induced hypertension cases were 28 (28%). Cases with autoimmune diseases were 1 (1%) and 7 cases (7%) were idiopathic.The most important cause for oligohydramnios was pregnancy induced hypertension and post-dated pregnancy. 13 of the cases had spontaneous onset of labouri.e 13% cases, 28 cases (28%) were induced and 59 cases underwent cesarean section accounting for 59% of all cases.In the present study, total of 19 cases underwent cesarean section because of fetal distress accounting for 19% of cases with the most common indication for cesarean section.11 cases (11%) underwent LSCS due to IUGR, ,4 cases (4%) underwent cesarean section because of non-progression of labour, 2 cases(2%) underwent LSCS because of malpresentation/malposition, 9 cases (9%) had cephalopelvic disproportion, 2 cases (2%) refused for induction of labour and 12 cases (12%) were previous LSCS.Among the 100 cases studied ,there were 8 cases (8%) with meconium aspiration syndrome, 5 cases (5%) had respiratory distress, 6 cases (6%) had low birth weight, 6 cases (6%) with congenital anomalies, 21 cases (21%)had NICU admissions, 4 cases (4%) were still born and 2 cases(2%) had intrauterine fetal death Conclusion: Oligohydramnios is associated with fetal distress, meconium aspiration syndrome ,respiratory distress syndrome ,increased NICU admissions, low birth weight, perinatal mortality, morbidity and increased maternal morbidity due to increased cesarean section rates.Oligohydramnios requires intense fetal monitoring with proper antenatal and intrapartum care.Hence, AFI can be used as a primary tool in fetal surveillance in antenatal and intrapartum period and can help in categorization of fetus into high risk and low risk .One can have favourable outcome with good antenatal and intrapartum care