Most patients who come to a general hospital in a developing country are poor. The most important prohibiting factor for use of polypropylene mesh in hernia repair is its exorbitant cost. Hence, research workers have been on the lookout for an equally effective but economically affordable mesh. Worldwide, surgical repair of inguinal hernia is the most common general surgery procedure performed at the present. Lifetime risk of groin hernia is 15% in males and 5% in females. Most of the patients who visit a general hospital are from either lower middle class or poor socioeconomic strata. The most important prohibiting factor for use of polypropylene mesh in hernia repair for the common man is its exorbitant cost. The aim of this study is to document the feasibility, safety and cost-effectiveness of the use of polyethylene mesh. A single blind, prospective, randomized controlled study, comparing 35 patients of two groups was conducted in a tertiary teaching hospital over a period of 5 years. The patients in both groups underwent inguinal hernioplasty, and were administered similar antibiotics and analgesics. The postoperative course with regard to pain, seroma formation, infection, hospital stay, recurrence and scar quality was evaluated and compared. Statistical analysis was performed with Chi square test. The properties of both meshes were the same with respect to ease of handling, pain score, seroma formation, infection rate, resumption of daily activities, scar quality and mesh rejection. Recurrence rate was zero for both groups. Polyethylene mesh was 2,808 times cheaper than the commercially available polypropylene mesh. This study proved the safety, simplicity, efficacy and cost-effectiveness of polyethylene mesh for inguinal hernia meshplasty, insuring economical, accessible health care for the financially weak section of the population.
Carbuncles are debilitating skin infections commonly seen in diabetic patients. Excision of these infective lesions leads to large defects that require prolonged hospital stay and repeated dressings with ensuing pain and bleeding. This study is an attempt to cover the wounds resulting from excision of carbuncle with primary skin grafting so as to decrease the hospital stay and frequency of dressings.
Background: The vagaries of presentation and the variability of signs in acute appendicitis are such that even the most experienced surgeons may remove normal appendices or conserve those with perforation. Diagnostic scoring systems and imaging techniques may reduce the number of unnecessary appendectomies.Methods: 75 patients who presented with acute right Iliac fossa pain were analyzed using four different scoring systems. An abdominal ultrasound was also performed when necessary. The results of these scores, USG findings were compared to the intra operative findings and final histopathological report.Results: The Alvarado score had the best positive predictive value with high sensitivity. The Fenyo score was most sensitive for males, whereas the Teicher score was most sensitive for females. The Teicher score was the most specific. The Ohmann score had the highest negative predictive value. Ultrasonography showed a low sensitivity and specificity.Conclusions: There was a 24% negative appendicectomy rate in our study. The Alvarado score is ideal for borderline cases where a quick decision needs to be taken. Ohmann’s score can be used to rule out appendicitis in the casualty setting as it has the best negative predictive value. Fenyo and Teicher’s score with their high sensitivity can be used to reduce the number of negative appendicectomies.
Introduction. Restoration of an intact skin barrier is of utmost importance to prevent infection and wound contractures. Skin grafting is a rapid, effective method of wound coverage. The chief goal of management of the donor area is to achieve early epithelialization without infection. The donor areas need optimum local care to achieve this goal with minimal pain and in a cost-effective manner. Objective. This study compared nonadhesive polyethylene dressings with chlorhexidine-impregnated tulle gras dressings for donor areas. Material and Methods. This was a prospective, randomized, observational study in a tertiary hospital and included 60 patients with posttraumatic, postinfective, or burn wounds. Patients were randomized into 2 groups to receive either chlorhexidine-impregnated tulle gras or polyethylene film for donor area coverage. The pain score, comfort score, completeness of epithelialization, and sequelae were studied in both groups. Results. Patients in the polyethylene film group showed a significantly better comfort score and reduced pain on day 14 as compared with the chlorhexidine group. Time to complete epithelialization was similar in both groups. Conclusions. Polyethylene nonadhesive film dressing is a low-cost, inert, safe, and easily available alternative for donor area dressing and is superior to chlorhexidine-impregnated tulle gras in terms of pain and comfort.
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