Introduction Testicular torsion is a condition requiring immediate attention and the golden time period for its management is 6 hours at which rate of salvageability of the testes is 90 percent (NICE). This decreases considerably with passing time. Imaging has minimal value. Method The electronic data of 36 patients from June 2020 to May 2021 were reviewed and analysed. Majority of patients were between the age of 11–20 i.e., 21. We analysed the mode of admission of these patients, the time between the A&E triage and surgical clerking and A&E triage and induction of anaesthesia. Results Majority (70 percent) patients were admitted through Emergency A&E. The time between the A&E triage and surgical clerking was less than 30 minutes for 10 patients while 11 patients had no proper documentation of time. The time between the A&E triage and the induction of anaesthesia was less than 6 hours in 23 patients, and more than 6 hours for 7 of them. 14 underwent Scrotal Exploration and Bilateral orchidopexy and 13 orchidectomies. Out of 13 orchidectomies, 6 had crossed the golden time period at the time of induction. Out of 10 patients booked for USS testis, 8 underwent Orchidectomy and 6 had crossed the golden hour (6 Hours). Conclusions Early presentation, diagnosis and exploration of testicular torsion improves the salvable rate of testes. 6 patients who underwent USS testis passed the golden timeframe which shows that there is a scope for faster and appropriate management of testicular torsion.
Aim National Institute for Health and Care Excellence (NICE), British Society of Gastroenterology, the American College of Gastroenterology and the trust guidelines do not recommend prophylactic antibiotics in patients with uncomplicated acute pancreatitis. Our three-cycle study was focused on finding out adherence to these guidelines. Method Three cycles of the study were conducted over a span of 2 years with 87, 78 and 121 patients with the peak age range of 20–40 in the first, 41–60 in the others respectively. Unspecified acute pancreatitis and gallstone pancreatitis were the most common diagnosis in the second and third cycles respectively. Majority of patients were prescribed antibiotics on 1–2 days after admission in the first and second cycle and on the day of admission in the third cycle. Results 44.8%, 39.7%, 35.5% of the patients admitted with pancreatitis were prescribed antibiotics in the three cycles respectively. Interestingly, in the first cycle 74.3% patients were prescribed antibiotics without any clear indication. However, we saw an improvement in the trend of prescribing antibiotics without indication from 45% in the second cycle to 37.2% in the last cycle. The maximum number of patients had a hospital stay of 2–4 days in all the cycles. Co-amoxiclav was the most prescribed antibiotic in the first and the third cycle. In the second cycle, the order was Metronidazole followed by Amoxicillin. Conclusion The prescription of empirical antibiotics in acute pancreatitis doesn't improve the duration or outcome of the disease. Therefore, antibiotics must be used judiciously in this era of ever-increasing antibiotic- resistant microbes.
Aim The trust guidelines do not recommend prescription of Co-amoxiclav and Metronidazole concurrently in the mentioned group of patients. This study aims to discern and improve the adherence to trust guidelines of antibiotics prescription in general surgery and urology patients. Methods A retrospective review over a period of three months was analyzed, wherein record sampling was done on two occasions with 584 and 490 patients respectively, with majority (280 and 254) admitted electively. The study comprised patients admitted to general surgery and urology departments. Data was assembled on patient demographics and use of antibiotics. Results 51 patients (8.73% of 584) were prescribed both Co-Amoxiclav and Metronidazole during the first cycle. This number fell to 34 (6.9% of 490) during the second cycle. Prescription of antibiotics was observed to be maximum in emergency patients admitted in A&E. Furthermore, one patient in the first cycle was prescribed Metronidazole despite being allergic to it. Patients reported to be penicillin allergic were 48 and 26 in the two cycles respectively. It was found out that majority of the patients were discharged on the same day of admission. Conclusion Although, a minimal improvement (1.8%) in antibiotic (Co-Amoxiclav & Metronidazole) prescription was observed over the duration of the study, the trust guidelines on antimicrobials usage was not adhered to satisfactorily. Therefore, there is a need to create awareness among clinicians regarding the guidelines of appropriate antibiotic prescription.
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