Background: In this era of staplers and advanced techniques in surgery Milligan Morgan technique of open haemorrhoidectomy is still considered as gold standard procedure for symptomatic haemorrhoids. Stapler haemorrhoidectomy, even though it is practiced in many centres has not become common due to various factors. The present study was done to compare the efficacy, safety and advantages, if any, of the stapled haemorrhoidectomy to open procedure.Methods: This prospective study was performed in the department of general surgery, Government medical college, Thiruvananthapuram, Kerala over a period of 12 months from March 2015 to March 2016. Symptomatic patients with grade 3 and4 haemorrhoids were selected for the study. The patients were randomized into two equal groups of 20 each. Group A underwent conventional open haemorrhoidectomy and group B, stapled haemorrhoidectomy.Results: Mean operative time period for group A was 39.25 ±5.5 minutes and group B was 26.75±4.7 minutes. There was significant difference in the pain score between these procedures on first 3 post-operative days. There was also significant difference in group A and group B which was 6.55±1.099 and 3.55±0.759 days respectively for mean hospital stay and 9.90±1.651 and 5.70±0.865 days respectively for return to normal work.Conclusions: Stapler haemorrhoidectomy is associated with lower pain scores postoperatively and shorter duration of hospital stay with early return to work when compared to conventional open haemorrhoidectomy.
Background: The pattern of burns in victims varies with the manner of infliction of burns. Age plays an important role in deciding the mortality and morbidity of burn victims. Other factors that decide the prognosis of burn victims are the total body surface area (TBSA), Depth of burns, and inhalational injury as evidenced by facial burns. Assessment of these epidemiological factors and inhalational injury can be done as a part of the initial evaluation. Such an assessment aid in resuscitation including emergent airway and decision making regarding the need for skin grafts or escharotomy. Serial measurement of total leucocyte count also helps in identifying the onset of infection and progress to septicaemia and increased mortality rates.Methods: As a part of the initial evaluation, we attempt to study the relation between TBSA, Depth of burns, facial burns, and total WBC count with mortality. A background of septicaemia was also noticed in the majority of patients.Results: For analysis, patients were divided into two groups- Survivors and Non-survivors. A fall in total WBC count coincided with the onset of sepsis and mortality. The other three factors also had a direct correlation with mortality rates.Conclusions: A scoring system constituting all the factors is essential as an initial diagnostic step and it will help in deciding early intubation, escharotomy, and aggressive fluid resuscitation.
Background: Thyrotoxicosis is a clinical syndrome characterized by an excess of free thyroxine and triiodothyronine or both. One of the major and usual causes of thyrotoxicosis is Graves’ disease. Morbidity associated with the situation is very high and it demands early diagnosis and treatment. This can reduce the burden of the disease it imparts on the society. The aim of the study is to analyse the etiology, prevalence, clinical presentation, age, and sex-wise distribution of thyrotoxicosis among thyroid disorders presenting to Government Medical College, Thiruvananthapuram.Methods: It is a prospective study undertaken in tertiary care and teaching hospital over a period of one year. 2401 patients admitted in the general ward with thyroid disorders were included in the study. Definite inclusion and exclusion criteria were followed. Relevant blood tests were done in all cases.Results: On analysis of the data which were entered in excel format the prevalence of thyrotoxicosis was 2.5%. The majority of the study population was in the twenties and forties. Incidences in females were more mainly due to increased prevalence.Conclusions: By studying the etiology, prevalence, clinical presentation, age, and sex-wise distribution of Thyrotoxicosis, the disease burden in the population can be understood and early diagnosis and proper treatment can be instituted. Our study prevalence was comparable with similar studies done in other institutions.
Background: Burns can affect the population of all age groups and regions. There has been a reduction in the mortality and morbidity of burn patients due to improvements in standards of medical care. Several laboratory values were proposed to indicate the prognosis of burns patients. Of these, the oldest is abbreviated burn severity index (ABSI), which includes variables such as sex, age, total burned body surface area (BSA), full-thickness injuries, and burns attributable to inhalation. Later the acute physiology and chronic health evaluation (APACHE) II and APACHE III scales which incorporates biochemical markers to improve predictive power evolved.Methods: In this study, in a tertiary care government institution, we attempt to assess platelet count and serum albumin independently in the prognosis of burns patient, in a background of sepsis.Results: For analysis, patients were divided into two groups- survivors and non-survivors as sepsis development and mortality was observed. There was a progressive decline in the platelet count in non-survivors, while the initial fall improved in those who survived. There was only a marginal difference between the two groups in serum albumin levels.Conclusions: A serial fall in platelet count is a predictor of sepsis and mortality in burn patients. It is an indicator of bone marrow depression and correlation with leucocyte count needs to be evaluated. In those patients where the initial fall in platelet count improved, survival rates were high. As a biochemical marker, serum albumin was not a reliable marker in predicting sepsis and mortality.
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