Objective: The aim of the study was to see the effect of intravenous steroids in patients with blunt chest trauma-lung contusion and to compare the effect of steroid use based on improvement in oxygen saturation, ABG, and hospital stay, in the study group and control group. Methods: A prospective and observational study was carried out on patients with blunt chest trauma having lung contusion who were admitted to the multispecialty hospital for 2 years. Data were collected in a predesigned proforma. All patients with radiologically proven lung contusion were observed based on the steroid treatment given or not. Group A was steroid (study) group and Group B was non-steroid (control) group with 25 sample size in each group. Group A patients were treated with steroid (hydrocortisone) 20 mg/kg/day 6 hourly which was tapered over time. Control group patients were treated identically except for steroid use. Results: Most of the injuries affected the middle age group (25 to 65 years) which accounted for a total of 84%. The percentage of males and females in the study were 76% and 24%, respectively. The most common mode of injury was road traffic accidents which account for 76% as compared to non-road traffic accidents (24%). Statistical analysis showed there was an improvement in both groups in parameters such as Spo2, ABG-Pco2, and ABG-Sao2 and were statistically significant. While other improvements like ABG-Po2, radiological CT, and hospital stays were statistically insignificant. Conclusions: As both groups were showing improvements and there was no statistically much difference seen in both groups, we concluded that there is no role of intra-venous steroid use in lung contusion. However, every patient must undergo CT for a better assessment of the injury. Objective scoring systems are required in CT assessment of lung injury and studies with increased sample size and carried out at multiple centers are required for better conclusions.
Simple or complicated inguinal hernias are the common inguinal lumps of any surgical emergency or outpatient settings. However, inguinal hematoma, abscess, enlarged inguinal lymph node, undescended testis, lipoma, or encysted hydrocele of the spermatic cord are few relatively less common entities seen in inguinal region whereas inguinal supernumerary pectineus bursa, preperitoneal lipoma, pedunculated uterine fibromyoma, angioma of uterine ligament, inguinal endometriosis, aneurysm of femoral artery, saphena varix, and thrombophlebitis are extremely uncommon entities of the groin region. We present an interesting case in which patient presented with painful firm lump in inguinal region and the history and clinical examination was consistent with the diagnosis of an incarcerated inguinal hernia but intraoperative findings amazed us and subsequently histopathological analysis labeled it a dermoid cyst.
Objectives: The aim of the study was to assess patients belonging to four main molecular subtypes (Luminal A, Luminal B, HER2 neu positive and Triple negative) and their treatment plans with a view to compare their early surgical complications and the final outcomes specific to the surgical procedure adopted and molecular subtype. Methods: A Cross-sectional observational study at a Tertiary care center in central UP in a two-year period with Inclusion Criteria and Exclusion Criteria. Data Collection was carried out from the patients, diagnostic confirmation to rule out any exclusion criteria was performed. Clinical staging was done using the standard TNM criteria. All the specimens were subjected to immune-histochemical evaluation for surrogate molecular subtyping to see later the early surgical outcomes. Results: Mean age ranged from 47.57±9.57 (Group III) to 50.67±8.08 (Group II) years and BMI ranged from 23.71 (Group IV) to 26.38 kg/m2 (Group II). Neoadjuvant chemotherapy use was reported in 15.6% of Luminal A group, 33.3% of Luminal B group, 40% of Her2 negative and 52.2% of Triple negative group cases. Statistically, there was a significant difference among groups with respect to use of neoadjuvant chemotherapy. Breast conservation therapy was the preferred surgical intervention in majority of cases with Luminal A (60%) and Luminal B subtype (66.7%) whereas MRM was preferred in 54.3% of Her2 negative and 65.2% of Triple negative cases. MRM was performed in 36% of Luminal A cases. Primary surgical intervention failure (BCS) was seen in 1 (4%) case with Luminal A subtype. In this patient, mastectomy was performed as the corrective measure. Surgical site infection was noted in 1 (4%) case in Luminal A group only. Seroma formation was noted in 4 (16%) of Luminal A, 8 (22.9%) of Her2 negative and 2 (8.7%) of Triple negative patients. No case of flap necrosis was noted. Follow-up duration ranged from 15 days to 36 months. Median duration of follow-up was 6 months. No mortality was noticed in any group. Conclusion: Different surgical management strategies suggested that breast conservative surgery was more feasible in Luminal A cases whereas MRM was the preferred mode of surgery in other molecular subtypes. Within the limitations of short duration of follow-up, there was no significant difference among different molecular subtypes with respect to late complications and survival. Further studies with longer duration of follow-up and larger sample size are recommended.
Objectives: The aim of the study was to predict the outcome and mortality of patients with sepsis in a tertiary care hospital using defined scores such as APACHE II, SAPS II, and SOFA scores. Methods: This prospective and observational study was carried out in intensive care units (ICUs) setup of multispecialty hospital in Western Maharashtra. Sample size was 90 patients with sepsis who were admitted to ICU (surgical) directly or indirectly, during the duration of 1 1/2 month. The study was approved by the Institutional Ethical Committee and written informed consent from all the patients or their guardians/legal representatives. The detailed history, clinical examination, and all the relevant laboratory investigations were done including blood culture. The parameters as mentioned in APACHEII, SAPS II, and SOFA scores were recorded daily. For statistical analysis, Chi-square test, Fisher’s exact test, MannWhitney test, and Binary Logistic Regression were used. SPSS software was used for analysis. Results: Out of these 90 patients, 64 (71.1%) were males and 26 (28.8%) were females. Mean age of the study population was 61.86 years. Mean duration of stay in the ICU was found out to be 3.33 days. Culture positivity was found in 53 cases (58.8%). Gram-negative organisms were responsible for 37 (69.8%) cases while Gram-positive organisms were responsible for 16 (30.1%) cases. Statistics of various variables among cases and other detailed results were studied. SOFA score (p=0.046) and APACHE II score (p=0.00042) have been found to be statistically significant predictors of “Death”; higher the SOFA score and APACHE II score-more probability of patient dying. However, mortality as per SAPS II (p=0.202) was not found to be statistically significant predictor of death. Conclusions: APACHE II, SAPS II, and SOFA scores can be used for prediction of mortality by using appropriate statistical tests. People of older age, male gender, and preexisting chronic health conditions are chiefly prone to develop Septic shock; hence, prevention strategies should be targeted at these susceptible populations. The epidemiology of Septic shock in developing countries warrants greater attention in the future studies.
Methods: A cross-sectional observational study was conducted on patients scheduled for vascular, reconstructive, gynaecological, and day care surgeries for whom propofol (P) and sevoflurane (S) were used as induction agent for LMA insertion. All patients who fulfilled the inclusion and exclusion criteria and had given propofol or sevoflurane at various departments during the specified duration were included in the study and data were collected using pre-defined protocol. A total of 100 consecutive patients (50 patients in each group) were included in the study. Objectives: The objectives of the study were to evaluate and compare sevoflurane in one vital capacity breath with propofol in dose of 2 mg/kg for ease of laryngeal mask airway (LMA) insertion in adults. Results: The mean age for sevoflurane (S) group and propofol (P) group was 35.30, standard deviation (SD) 8.74 and 34.88, SD 9.37, respectively. Heart rate (HR) at 2 min, 3 min, and 4 min after induction showed a fall with propofol which was statistically significant. There was statistically significant difference in systolic blood pressure at on 1 min, 2 min, 3 min, and 4 min when compared between the two groups. A statistically significant fall in the systolic blood pressure in Group P was noted when compared to Group S. There was statistically significant difference in diastolic blood pressure at 4 min when compared between the two groups. A fall in the diastolic blood pressure in Group P was noted when compared to Group S at 4 min. There was fall in blood pressure in Group P when compared with Group S and this was significant. Fall in oxygen saturation in 3 and 4 min was significant. However, this fall was not clinically significant, as the values remained above 94%. There was increase in end-tidal carbon dioxide in 1, 2, 3, and 4 min and was statistically significant between the two groups. Sevoflurane took longer time for induction and LMA insertion. Loss of eye lash reflex, jaw relaxation, and LMA insertion were lost earlier with propofol and were statistically significant. The overall LMA insertion was excellent with propofol in 50 patients and with sevoflurane 48 patients had excellent condition and two were satisfactory. Conclusion: In our study, sevoflurane was associated with good hemodynamic stability, but quality of anesthesia provided with propofol was superior. Delayed jaw relaxation with sevoflurane when compared to propofol delayed LMA insertion. The overall insertion was excellent with propofol with all 50 patients as compared to sevoflurane.
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