Introduction: Lower gastrointestinal bleeding (LGIB) is one of the leading causes for hospital admissions in gastroenterology wards all over the world. Patients usually present with hematochezia or bloody diarrhea. Colonoscopy is usually the initial diagnostic intervention followed by other more sophisticated tests. Bleeding may stop spontaneously, but evaluation is important because patients may harbor a sinister lesion like cancer. Aim of the Study: To determine the various etiologies, clinical presentations, a diagnostic test used and treatments received by LGIB patients admitted in our department. Materials and Methods: A total of 300 cases were studied which included 180 retrospective cases and 120 prospective cases. For retrospective cases, all the information was obtained by analyzing their case records while as prospective patients were managed as per a predefined protocol and details of various investigations and treatments documented. Results: Most commonly affected was elderly population (>60 years), constituting 40% (120/300) of studied population. Males constituted 59% (177/300) and females 41% (123/300). The most common clinical presentation of LGIB in our patients was hematochezia (63.6%, 191/300). Growth/polyp was the most common finding on colonoscopic examination seen in 29.3% (n = 88) patients. Inflammatory lesions were seen in 77 out of 239 (25.7%) patients. Wireless capsule endoscopy was positive in 13 out of 24 patients (54%). Computed tomography (CT) enterography showed positive results in 6 out of 25 (24%) cases. Red blood cell scan was done in seven patients while as CT angiography in in four patients. Therapeutic endoscopy was successful in 115 out of 239 patients with positive colonoscopy, polypectomy was the commonest procedure performed. Medical management was carried out in 34.6% patients. Surgical treatment was offered to 21% patients. Conclusion: Colonoscopy is the initial and most common investigation used in the evaluation of GI bleed. A polyp is the most common diagnosis while as polypectomy the most common therapeutic procedure.
Drug reaction with eosinophilia and systemic symptom syndrome (DRESS) is a hypersensitivity drug reaction, most frequently associated with antiepileptic drugs, characterized by skin rash, fever, pharyngitis, lymphadenopathy, and visceral organ involvement, typically presenting within 8 weeks of initiation of therapy. Management involves prompt withdrawal of the offending drug and use of systemic corticosteroids. We here present a rare case of DRESS secondary to levetiracetam. Only few case reports of DRESS secondary to levetiracetam have been published so far.
Miller Fisher syndrome (MFS), is an acute peripheral neuropathy, a variant of Guillain-Barre syndrome, that develops following exposure to different viral, bacterial, and fungal pathogens. Patients usually present with a triad of ophthalmoplegia, ataxia, and areflexia. During Covid pandemic MFS has been described associated with novel coronavirus disease 2019 (COVID-19). Here we describe the clinical course, Cerebrospinal fluid (CSF) findings, nerve conduction studies, treatment and outcome of the patient having MFS concurrent with COVID 19.
Introduction: Laparoscopy has revolutionised Surgery with its widespread acceptance as predominantly minimally invasive to intraabdominal surgical procedures. Creation of pneumoperitoneum is indispensable primary step of the procedure as it allows creation of operative field. It can be achieved by various techniques viz Classical open method as described by Hasson. The aim of the study was to ascertain safety of direct trocar insertion in creation of pneumoperitoneum in laparoscopic surgeries and adopt the same as an alternative to veress technique. Material and methods: A total of 576 patients were included in the study, Group A comprised of patients in whom we created pneumoperitoneum by classical veress needle insertion and included 327 patients. Group B comprised of 249 patients in whom we created pneumoperitoneum by direct trocar insertion method. Results: The mean age of patients was 47.54 years SD 11 with a male female ratio of 1:1.56. Laparoscopic cholecystectomy (52.08%) was most frequent followed by laparoscopic appendectomy (13.02%). Group A patients witnessed omental emphysema (7.95%) as commonest complication followed by preperitoneal insufflation(5.19%) while as the most common complication in group B was omental emphysema (0.81%). Port site infection (4.28%) and subcutaneous emphysema (3.36%) predominated in group A and port site infection (1.2%) and seroma formation (1.2%) were common in group B. Conclusion: There are many methods to create pneumoperitoneum. The closed technique modified to direct trocar insertion versus classical method by Veress were compared in patients undergoing laparocopic procedures at SMHS hospital for a period of one and a half year. The results are fascinating as the modified technique overshadows its classical version in terms of feasibility, efficacy and consumption of time.
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