BackgroundPsoas abscess (PA) is an uncommon disease involving infection of the psoas muscle with abscess formation. The evidence concerning clinical and diagnostic characteristics of PA and its outcomes is limited. The literature is heterogenous, with varying presentations and outcomes in different regions worldwide. We present a retrospective analysis of the clinical, radiological, and laboratory characteristics of PA, its management, and outcomes from a tertiary care center in North India.
MethodologyWe reviewed the clinical records of confirmed cases of PA treated in our institute from January 2016 to December 2020 with a minimum follow-up of one year. Further, we performed a descriptive analysis of demographic characteristics, clinical features, laboratory parameters, radiological investigations, the basis of diagnosis confirmation, causative microorganisms, definitive management, treatment outcomes, and complications.
ResultsWe reviewed 33 cases with a mean age of 29.9 ± 16.8 years. Overall, 48.4% of PAs were right-sided, and 24.2% were bilateral. Abdominal discomfort was the most common presenting symptom. Blood laboratory parameters were mostly within the near-normal range except for the elevated erythrocyte sedimentation rate, C-reactive protein, and neutrophil-to-lymphocyte ratio. Ultrasonography was the most commonly performed radiological investigation and was the basis of diagnosis confirmation. Mycobacterium tuberculosis was the most common causative microorganism. Most patients required percutaneous drainage, and around one-fourth required open drainage. All patients had symptomatic as well as radiological improvement and no major complications.
ConclusionsTuberculosis is the most prevalent cause of PA in the North Indian population. Most patients respond well to the less invasive treatment with percutaneous therapeutic drainage and antitubercular drugs, with few patients requiring open drainage. However, tissue diagnosis may remain inconclusive in a few patients, and antitubercular treatment may need to be initiated based on the clinicoradiological evaluation. Nevertheless, the rate of complications is low, with nil mortality probably related to the mild-to-moderate disease course of tuberculosis.
Background: Often hysterectomy remains the only option available in many gynaecological conditions, though it is resented by most women. This study aims to analyse the cases of hysterectomy performed in a tertiary care centre in India, with a view to modify and improve health care provided to women.Methods: A retrospective analysis of 500 cases of elective hysterectomy in Sree Gokulam Medical College and Research Foundation from January 2016 to December 2017 was done from hospital records. The observations according to age, indications of hysterectomy, route of hysterectomy and preservation of ovaries were statistically analysed.Results: 35.2% (176 cases) were between 45 and 50 years. Mean age was 48±2 years. 90.4% (452 cases) were done in women above 40 years of age. The commonest indication for hysterectomy was symptomatic fibroid uterus 59.4% (297 cases). 81.8% (409 cases) women underwent abdominal hysterectomy while 18.2 % (91 cases) women underwent vaginal hysterectomy or laparoscopic assisted vaginal hysterectomy. 84.6% (77 of 91 cases) of vaginal hysterectomy was done for prolapse uterus. Preservation of one or both ovaries was done in 47.2% (236 cases).Conclusions: Hysterectomy is usually done after the age of 40 years with the mean age being 48±2 years. Symptomatic fibroid uterus was the most common indication. The rates of vaginal hysterectomy were lower for indications other than prolapse uterus. Ovaries were preserved in several cases.
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