bluuebunny/crossref_metadata_2025 huggingface dataset:
Early versus delayed cholecystectomy in acute cholecystitis: a comparative study in a tertiary care hospital
Authors: Ahmed Jamal Uddin , Rajbongshi Subal , Hiquemat Najim
Published: July 2020

Background: For patients with acute cholecystitis the timing of operative intervention has two broad approaches- early cholecystectomy and elective or delayed cholecystectomy. The main advantage of early cholecystectomy is that, it offers a definitive treatment during the same admission and avoids the problem of failed conservative treatment. The present study is an endeavour to discuss and to compare the outcome of management of acute cholecystitis with early and delayed cholecystectomy.Methods: 100 patients with clinical diagnosis of acute cholecystitis, admitted in the surgical wards of Gauhati Medical College and Hospital during the period of 1st July 2017 to 30th June 2018 were selected for the study. 40 patients underwent early cholecystectomy (within 7 days of onset of symptoms) and 60 patients underwent elective or late cholecystectomy (after a gap of 6-8 weeks from the acute attack).Results: In the present series the average duration of surgery was 90.37±11.96 minutes in the early group and 65.3±7.83 minutes for the elective group which is found to be statistically significant (p value<0.05). In the early surgery group 8.33% required conversion to open surgery. In the elective surgery group 3.63% required conversion. Wound infection, biliary leakage, bile duct injury, and respiratory tract infection was found to be statistically not significant between the two groups.Conclusions: Early cholecystectomy is feasible and safe for acute cholecystitis and is better method of treatment because of its shorter hospital stay, which is a major economic benefit to both the patient and health care system.
A comparative study of postoperative hypocalcaemia following total thyroidectomy in patients with Hashimoto’s thyroiditis and multinodular goitre in a rural tertiary care hospital
Authors: P. Amrutha , Joseph Arun P. , Mathew Anna , Raj John Michael
Published: July 2020

Background: Recurrent laryngeal nerve injury, hypothyroidism and hypocalcaemia have long been recognized as the three main sequalae of thyroidectomy. Persistent hypocalcaemia may cause intracranial lesions and cardiac arrhythmias. As the definitive diagnosis of Hashimoto’s thyroiditis was not always possible with clinical and cytological parameters when antibody testing was not done, surgery was planned with the diagnosis of multinodular goitre. This study was conducted to find out the incidence of post-operative hypocalcaemia following total thyroidectomy by skilled surgeons in patients with multinodular goitre and Hashimoto’s thyroiditis.Methods: This was a cross-sectional study to compare the incidence of hypocalcaemia in patients with biopsy-proven Hashimoto’s thyroiditis and multinodular goitre. After obtaining approval from the institutional review board and ethics committee, data was collected serially, from the surgical records of 123 patients who underwent total thyroidectomy in this tertiary care centre, during the past two years.Results: The incidence of post-operative hypocalcaemia (71.1%) in patients undergoing total thyroidectomy with Hashimoto’s thyroiditis was significantly higher than in patients with multinodular goitre (56.4%). Of the 45 patients who had a biopsy report of Hashimoto’s thyroiditis, 8 (17.8 %) developed permanent hypocalcaemia while only 8 (10.3%) of the 78 patients with histopathological diagnosis of multinodular goitre developed persistent hypocalcaemia needing supplementation following total thyroidectomy in this rural tertiary care hospital.Conclusions: The significant risk of post-operative hypocalcaemia should be kept in mind before opting for total thyroidectomy for benign lesions of the thyroid and pre-operative antibody studies must be done to diagnose Hashimoto’s thyroiditis.
A prospective study of proportion of Helicobacter pylori infection in patients presenting with dyspeptic symptoms in S. Nijalingappa Medical College and H.S.K. Hospital, Bagalkot
Authors: Kuntoji Shrikanth B. , Naik Ankita A. , S. Suhas D.
Published: July 2020

Background: More than half of the world’s population is infected with Helicobacter pylori, the primary cause of chronic gastritis. Chronic gastritis is associated with peptic ulcer and in advanced stages with an increased risk of developing gastric adenocarcinoma. The aim of the study was to determine the prevalence of Helicobacter pylori infection in dyspeptic patients and its relationship with gastroduodenal pathologies using gastric biopsy histology.Methods: A cross sectional prospective study was conducted from 1st January 2018 to 30th June 2019. It included out-patients and in-patients, presenting with dyspeptic symptoms and undergoing upper GI Endoscopy, at S. Nijalingappa Medical College and HSK hospital, Bagalkot, Karnataka, India. Endoscopic impressions were noted. In case of any abnormal findings on upper gastrointestinal endoscopy, endoscopic biopsy was obtained. Histopathological assessment of gastric mucosa was done after staining with H and E stain and Giemsa stain. The histopathological diagnosis of Helicobacter pylori infection in biopsy specimen will be mainly done using the Modified Giemsa stain.Results: 105 patients with dyspepsia were studied in total. Out of which, 44 patients (41.9%) were detected positive for Helicobacter pylori infection.Conclusions: The burden of Helicobacter pylori infection in patients with dyspepsia was high. Early diagnosis and eradication of Helicobacter pylori not only improves symptoms but also help to prevent complications associated with Helicobacter pylori infections.
A retrospective study of blunt trauma abdomen in a tertiary center in central India: evaluation, management and outcome
Authors: Sisodiya Sanjay , Malpani Prateek
Published: July 2020

Background: Blunt abdominal trauma is fairly common emergency and it is one of the important components of polytrauma. It requires high degree of suspicion, investigation and management. Inspite of improved imaging techniques leading to early recognition it is still associated with high morbidity and mortality. Trauma is the leading cause of blunt abdominal injury. This aim of the study was to find etiology, early diagnosis and management of patients with blunt abdominal trauma.Methods: This a retrospective study conducted in Gandhi medical college, Bhopal in which 90 cases of blunt abdominal trauma presented to emergency and outpatient department were included in the study duration of January 2019 to December 2019.Results: Motor vehicle accident was the most common mode of injury. Liver being the most common visceral organ injured while the most common surgery performed was the repair or resection and anastomosis of hollow viscous perforation. Rib fracture was the most common extra abdominal injury seen in 17.7% cases. Mortality rate was 5.5%. Most of the liver, spleen and renal injuries can be managed non-operatively whereas hollow viscous injury needs laparotomy.Conclusions: The result of present study is similar to other studies. Rapid diagnosis, early and timely referral, adequate and trained staff, close and careful monitoring, early wise and skilled decision to go for operative or non-operative management can help save many lives.
Safe tracheostomy in COVID-19 patients: a case series
Authors: Meghpara Melissa K. , Devanabanda Bhavana , Jimenez Mercy , Louis Martine A. , Mandava Neil
Published: July 2020

The coronavirus (COVID-19) pandemic has led to a critical need in treating severe respiratory disease while providing adequate protection to healthcare workers. Critically ill COVID-19 patients have required prolonged intubation and mechanical ventilation, not limited to those with multiple comorbidities or the elderly. At the height of the pandemic in New York City; our institution intubated 192 COVID-19 patients. Many institutions have avoided performing tracheostomy in this population due to high risk of virus aerosolization. This study is a retrospective, IRB approved, single center case series of 14 consecutive tracheostomies in COVID-19 patients at a community hospital in Flushing, New York City. Data from 1 March to 31 May 2020 was collected from electronic medical records. All COVID-19 positive patients undergoing tracheostomy were included; patients undergoing tracheostomy that were not COVID-19 positive were excluded. Fourteen patients underwent tracheostomy during the study period. Average age was 62 and 64.3% were male (n=9). Hispanic males represented 50% of patients undergoing tracheostomy and 71.4% were from home. Average days from initial intubation to tracheostomy was 20.6, ranging from 12 to 43 days. With the exception of two patients, all underwent a single intubation. No involved operating room staff became ill during or after these procedures. Tracheostomy may be safely performed in COVID-19 patients while minimizing risk to staff; however, patient outcomes may not be significantly altered. Further research is needed to determine the optimal timing and overall benefit of tracheostomy in this population.
Paget’s disease of the breast: a case series
Authors: Elenwo Solomon N. , Jamabo Rollings S.
Published: July 2020

Paget’s disease of the nipple is a rare disease with a rather bizarre presentation which makes the diagnosis easily missed. Three cases are presented here with different modes of presentation and histological findings. A biopsy provided the definitive diagnosis in the three patients and the treatments offered was based on the histological findings - modified radical mastectomy and simple mastectomy for invasive carcinoma and carcinoma in-situ respectively.
Kodamaea Ohmeri: a rare fungus causing a severe case of necrotizing fasciitis
Authors: Jimenez Mercy , Seltzer Emily S. , Shakil Javeria , Louis Martine
Published: July 2020

Necrotizing soft tissue infection, NSTI, involves the soft tissue characterized by rapid spread of infection and consequent cell necrosis. NSTI, in particular necrotizing fasciitis (NF), is a significant disease burden in the US with an annual mortality of 4.8 per 1,000,000 person years. Here we describe a rare fungal pathogen, Kodamaea Ohmeri, as a cause of NF in a diabetic but otherwise healthy male patient. In the past K. Ohmeri has been described in children, immunocompromised individuals, and in cases with IV catheters and prolonged use of IV antibiotics. A febrile and hypotensive male (LRINEC score of 6) presented after sustaining abrasions of his right lower extremity. He was initially started on broad-spectrum antibiotics and underwent surgical exploration. During the following weeks, the patient developed sepsis and endured a total of four debridement. Wound cultures resulted K. Ohmeri with sensitivity to miconazole and voriconazole. Anti-fungal, silver dressings and wound vacuum, were utilized to assist in treatment and tissue granulation. To our knowledge, this is the first case describing Kodamea ohmeri as a causative agent of NF. K. Ohmeri should be on the radar of the health care providers taking care of patients with NF, especially in the context of intermittent bouts of sepsis and prolonged hospital course. Our case illustrates the fact that prompt identification, addition of fungal cultures and appropriate surgical treatment are crucial to improve patient outcomes.
Cystic lymphangioma of abdominal wall in an adult: a rare site
Authors: Anand Krishnanand , Bansal Vishal , Paliwal Palak
Published: July 2020

Cystic lymphangiomas are rare, congenital, benign lesions occurring early in life, mainly in the head, neck, and oral cavity, rarely occur in abdominal wall and its discovery in adult is also very rare. It is due to aberrant proliferation of lymphatic vessels resulting from abnormal development of the lymphatic system. These are soft, variable in size and shape and tend to grow extensively if not surgically excised. These are multilocular cysts filled with clear or yellow lymph fluid, sometime mixed with blood. The present case report describes a case of cystic lymphangioma of right lower abdominal wall in a 36 years old male and its clinical, ultrasonographic, CECT, and histopathological correlation.
Colonic stenting as a bridge to surgery in malignant colonic obstruction
Authors: J. I. Ortiz De Elguea-Lizarraga , Riojas-Garza Alberto , Chapa-Lobo Alberto , Rodarte-Shade Mario , Rangel-Rios Hugo , Salgado-Cruz Luis Enrique
Published: July 2020

Upto 80% of patients with colorectal cancer that show up to the emergency room have an obstructive pathology. The use of colonic stenting as a bridge to surgery may resolve the occlusive disorder, allowing the surgeon to do a laparoscopic procedure and safer anastomosis avoiding therefore any stomas. A 65 years old male presented with obstructing sigmoid cancer. A colonic stent was placed, resolved his obstruction and five days later he had an oncological laparoscopic procedure followed by an uneventful recovery. Colonic stenting as a bridge to surgery compared to emergent surgery in obstructing colon cancer decreases definitive stomas, length of hospital stays, anastomotic leakage, early adverse events, and increases primary anastomotic rate. There is no difference in short-term mortality. Use of colonic stent as a bridge to surgery did not showed difference in terms of overall survival, disease free survival, and recurrence.
Ganglioneuroma mimicking adrenal tumor
Authors: Jain Abhijeet A. , Bakhshi Girish D. , Shah Jessika , Pawar Dinesh , Marathe Aditya B. , Gonnade Avinash , Kedare Abhay , Gada Parth B.
Published: July 2020

Ganglioneuromas arise from neural crest sympathogonia and are rare benign neurogenic tumors. The most common affected sites are posterior mediastinum and the retroperitoneum. They rarely affect adrenal glands. Ganglioneuromas often present as solitary, painless and slow growing mass and are benign in nature. These tumors are closely related to major vessels. Hence, surgical management of retroperitoneal pathologies may require multiorgan resection in order to achieve complete surgical resection while preservation of surrounding organs especially in case of benign tumors. We present a case report of a 21 year old male with a 12×10×10 cm size right sided retroperitoneal ganglioneuroma which on computed tomography (CT) mimicked adrenal tumor crossing the midline and abutting the aorta and splaying the inferior venal cava and renal vein. Present paper is an attempt to review the various surgical options available while dealing with these benign retroperitoneal tumors which are related closely to retroperitoneal organs and major vessels.
An unusual case of giant multilobulated lipoma over left truncal region
Authors: Singh Sandesh Bharat , Vardhan Harsha , Chauhan Neelam , Singh Arun Kumar
Published: July 2020

Lipomas can virtually occur anywhere in the human body. They can be of varying sizes. Small lipomas are more frequently found, whereas giant lipomas are comparatively rare. These slow-growing, nearly always benign, tumors usually present as non painful, round, mobile masses with a characteristic soft, doughy feel. They are one of the most common benign tumours found in the body. Difference through histopathology and immunochemistry has to be done to rule out other conditions such as liposarcoma. In this report we present a case of a female with a large swelling with multilobulations over the anterolateral aspect of the left thigh and gluteal region. Incision biopsy revealed a lipoma for which primary excision was done safeguarding vital structures. The lipoma was unusual in its size, its appearance and site of occurrence. Histopathology and immunochemistry revealed it to be a lipoma.
Benign peripheral nerve sheath tumor-varied clinical presentation
Authors: Kumar Saravana , Kumar Divya
Published: July 2020

Peripheral nerve sheath tumors (PNST) are a group of heterogeneous, often benign and a rare condition that originates from the neuroectodermal or neural crest and display features that mirror the elements of the nerve. Schwannomas are one such peripheral nerve sheath tumors which entirely are made up of benign neoplastic Schwann cells. The objective of this case report is to highlight the diverse clinical presentations of these swellings. In this presentation, reporting three cases of PNST in which two presented with neurological symptoms of paraesthesia and pain and one who was asymptomatic swelling over his neck. All of whom were diagnosed with an alternate soft tissue swelling post clinical examination and taken up for excision as there were no significant clinical evidence for imaging. Intra-operatively we noted that all were closely related to the peripheral nerve of that anatomical region. Histopathological study revealed it to be PNST. PNST and schwannoma in particular although an entity that is not so common to come across in the surgical clinic we need to have and high indices of suspicion when associated close to peripheral nerves and symptomatic of a nerve involvement as we discuss here below.
Incarcerated Amyand hernia: a rare entity
Authors: Rai Vijeth , Siva Ranadheer Raju Cholaraju , Deep Gagan
Published: July 2020

Right sided inguinal hernia containing vermiform appendix in its sac is called as amyand’s hernia. It accounts for ∼1% of all inguinal hernias. It is an intra operative finding during an inguinal hernia repair. A 64 years old male patient came with complains of swelling in the right inguinal region, associated with pain and vomiting. On examination of the right inguinal region there was a tender irreducible swelling palpable. Based on the characteristic finding it was diagnosed clinically as right sided irreducible obstructed inguinal hernia. Ultrasound abdomen was done which was suggestive of right inguinal hernia with herniation of bowel and omentum with features of strangulated/ obstructed hernia. Patient was taken up for right inguinal hernia repair and appendix was noted in the hernial sac intra-operatively. Although occurrence of amyand’s hernia is rare. The attendant surgeon should be vigilant about the presence of it. Preoperative diagnosis of amyand’s hernia is not common because in majority of cases objective of imaging is to exclude conditions that predispose to inguinal hernia formation. The Losanoff and Basson’s criterion is used as a guide for deciding whether to perform appendectomy and type of repair, depend on the clinical scenario.
A rare case of primary pulmonary Hodgkin’s lymphoma
Authors: Prasad Dinesh , Baleviya Sachin
Published: July 2020

A 46 years old male presented with fever, chest pain, dry cough, weight loss, and breathlessness over the preceding 3 months. CT scans of thorax revealed diffuse sclerosis with multiple ill-defined small erosion and pleural thickening of the right lung with bulky lymph node in a subcarinal region measuring approximately 13.5×11×27.5 mm and 20×5 mm soft tissue parenchymal lesion in a right apical zone. Examination of pleural fluid cytology was not diagnostic. Bronchoscopic fluid cytology was also not contributory. Hilar and pre aortic lymph node biopsies showed only reactive change. Video-assisted thoracoscopic surgery (VATS) with biopsy from all suspicious areas of lung and pleura was taken, which on evaluation confirmed the diagnosis of primary pulmonary Hodgkin’s lymphoma. We present here a rare case of primary pulmonary Hodgkin’s lymphoma with a review of the literature.
A case report on facial subcutaneous dirofilariasis with intraoral extension
Authors: Malviya Vikas , Goyal Sakshi
Published: July 2020

Dirofilarial is parasitic nematodes of domestic and wild animals that can infect humans accidently via vectors. This disease is endemic in South Eastern United States, Australia, Europe and Central and Southern Asia. Dirofilaria immitis and Drepens are the common mosquito borne filarial nematodes that cause infection. The most frequent presentation of human dirofilariasis is a single submucosal nodule without signs of inflammation. Oral dirofilariasis is extremely rare and only a few cases have been documented. We report an interesting case of subcutaneous dirofilariasis in a patient who presented with a facial swelling. Laboratory investigations and radiographs were non-contributory to diagnosis. This paper stresses the importance of considering dirofilariasis as differential diagnosis for subcutaneous swelling of the face with intraoral extension, especially in areas where it is endemic.
Superior mesenteric artery syndrome masquerading as chronic gastric volvulus in a child with severe acute malnutrition: a case report
Authors: Ali M. Mokarram , Kumar Amit , . Rashi , Sinha Amit K. , Kumar Bindey
Published: July 2020

Superior mesenteric artery (SMA) syndrome is a rare cause of high intestinal obstruction. It is commonly seen in severely malnourished patients presenting with repeated episodes of vomiting. We report a case of SMA syndrome in a 3 years old male child provisionally diagnosed as chronic gastric volvulus with severe acute malnutrition. The diagnosis of SMA syndrome was confirmed on abdominal exploration. SMA syndrome is a rare case of intestinal obstruction in paediatric age group. Chronic malnutrition is one of the common causes of this entity. There should be a high index of suspicion for this syndrome when we encounter a child with severe malnutrition and recurrent vomiting.
Squamous cell carcinoma of gallbladder: a rare entity
Authors: Shaikh Oseen Hajilal , Verma Shikhar , Balasubramanian Gopal , Kumbhar Uday Shamrao , Bhattarai Sandeep
Published: July 2020

Adenocarcinoma is the most common variant of gallbladder carcinoma. Adenosquamous carcinoma and pure squamous cell carcinoma are rare variants accounting for only up to 3% of the tumors. Pure squamous cell carcinoma of the gallbladder is reported and its incidence is less than 1%. Usually they present at advanced stage and many of the times these are unresectable. Hence survival in patients with squamous cell carcinoma is less than adenocarcinoma, and carries a bad prognosis. We report a rare case of squamous cell carcinoma gallbladder, which was well differentiated, diagnosed early and resected completely. Postoperatively patient is planned for adjuvant chemotherapy.
Iso-peristaltic colonic loop interposition for the treatment of benign oesophageal stricture: a case report with review of literature
Authors: Balineni Pradeep , Kumar C. Venkata Pavan , E. Debaraju Reddy
Published: July 2020

Corrosive oesophageal strictures are a common and debilitating condition in India. Patients generally have dysphagia, cachexia, drooling of saliva, aspiration pneumonitis, and lung abscess. Though endoscopic dilatations are done in cases of short segment strictures, surgical oesophageal by pass is the permanent solution for this condition. A 24 years female presented with complaints of dysphagia and cachexia, due to corrosive stricture. Patient had a history of poison ingestion 2 years back. Intra-operatively stricturous mucosa is excised and an iso peristaltic colonic loop by pass was carried out. Post operatively patient had a complication of anastomotic leak which was treated conservatively, excepting which patient is symptom free and gaining weight on a follow up period of 1 year. Ever since first described by Kelling and Vuillet in 1911 colonic interposition is mostly used around the globe for oesophageal bypass in both benign and malignant conditions. Stomach and jejunum are the other conduits that can be used. Iso peristaltic loop is mostly used to reduce the incidence of reflux. Right colon or transverse colon graft based on the mid colic artery or the left colic artery owing to the reliable blood supply and less diameter. This procedure has a high complication rate of around 27% most of which are due to the vascular comprise of the graft.
An interesting case of spindle cell sarcoma of elbow
Authors: Aboosalih Sana , Kamal V. Shruthi , Venkata Mahipathy Surya Rao , Azhisoor Chandrasekhar Senthil Kumar , Krishnamurthy Mahendra Balu , Prasath Jayachandiran Anand , Sundaramurthy Narayanamurthy
Published: July 2020

Spindle cell sarcomas are a group of aggressive malignant soft tissue tumors with a diverse clinical presentation. A 32 years old woman presented with a recurrent nerve sheath tumour, involving flexor carpi ulnaris and a portion of ulnar nerve. Wide local excision of the tumour was done creating a 4 cm gap defect in the ulnar nerve. Distal nerve transfer and Guyon’s canal release was done and anterior transposition of ulnar nerve to distal motor branch of ulnar nerve end to side (ETS) supercharge was done preserving motor function to the little and ring finger. Achieving negative surgical margins in primary soft tissue sarcoma is a critical for local disease control. The anatomical and functional compromise that can occur while giving adequate clearance margin for the tumor can be overcome by microsurgical techniques and neuroanastomosis with positive outcomes like preservation of function and better prognosis.
Calcinosis cutis associated with systemic sclerosis: a rare case report
Authors: Rao Venkata Mahipathy Surya Rao , Durairaj Alagar Raja , Sundaramurthy Narayanamurthy , Jayachandiran Anand Prasath
Published: July 2020

Calcinosis cutis is abnormal calcium deposition in the skin and subcutaneous tissues of the body. It is generally associated with autoimmune connective tissue disorders and in our case, it is systemic sclerosis. It most commonly occurs in the fingers presenting with pain and functional impairment. Here, we present a case of calcinosis cutis with systemic sclerosis in a teenage girl presented with bilateral gluteal pressure sores and multiple sites of calcium deposition like sacrum, upper limbs, knees and the face. We treated here with reconstructive surgery with Limberg flaps for the pressure ulcers with excision and primary closure of the other sites with calcium deposits.
Bilateral branchial arch anomaly: a rare case report
Authors: Tiwari Saurabh , Kulkarni Apoorva , Gupta Abhaya , Kothari Paras
Published: July 2020

Anomalies of branchial arches are uncommon anomalies of embryonic development and may present as cysts, sinus tracts, fistulae or cartilaginous remnants. They represent the embryological precursors of face, neck and pharynx and are the second most common congenital lesions of head and neck in children. Although pharyngeal apparatus (branchial) anomalies are frequently seen, bilateral cases are rare (only 2% to 3%). Our patient was a 3 months old child with a swelling on right side of neck and discharging sinus from left side since birth. Surgical excision of the right branchial cyst with its complete tract was done along with excision of the left branchial fistulous tract upto the tonsillar fossa. Post-operative course was uneventful and patient was discharged the next day.
An unusual presentation of acute gastric volvulus in the elderly patient: a case report and literature review
Authors: Padhy Aditya Prasad , Pranay Inturi , Biradar Sarvesh
Published: July 2020

Gastric volvulus is nothing but the torsion of stomach in thoracic cavity by more than 1800 along its transverse or longitudinal axis. A very rare case occurring both in male and female. The term first described by Berti after doing an autopsy of a female, in 1886. We found a case of 65 years old male with history of dyspepsia since, 1 year with history of vomiting and pain abdomen since, 1 day. On evaluation, clinically gurgling sound heard on left side chest and with investigations like USG and CT whole abdomen, we came to know about mesentrico axial volvulus which is more common in children. Acute gastric volvulus cases have high mortality rate also requires emergency surgery. Gastric volvulus is very rare with variable and non-specific clinical presentations, hence high level of suspicion for radiologic diagnosis may require. Acute gastric volvulus is a potentially life-threatening occurrence with a good outcome when treated in a timely fashion. Chronic volvulus may be more difficult to recognize. Timely diagnosis with proper treatment can potentially decreases morbidity and mortality of the patient.
Left lung and liver hydatid cyst: managed in single surgery
Authors: Anand Krishnanand , Bansal Vishal
Published: July 2020

A 35 years male presented with history of pain left chest wall associated with cough, fever and blood in sputum on and off, complaint of pain in abdomen which was dull aching gradually progressive in nature since, 2 months. Radiologically diagnosed to have huge hydatid cysts both in left lung and liver. It is unusual to find such large cysts at multiple sites and organs as in this case. There are reports in the literature of staged management as well as simultaneous management of lung and liver hydatid cysts. Though concomitant cysts in lung and liver may be treated comfortably by one stage surgery. Here both cysts were enucleated in the same sitting by a combined thoracic and abdominal approach (left thoracotomy followed by laparotomy through right subcoastal incision). The technique is safe and results were comparable to two stage surgery. Albendazole treatment in post-operative period helps to prevent recurrence. This report emphasizes that surgical intervention for hydatid cysts at multiple sites done in a single stage is safe, lessens the financial burden and hospital stay by avoiding multiple surgeries and anaesthesia.
“This above all: to thine own self be true…” the effects of the COVID-19 pandemic on surgical residency training and education
Authors: Dockter Andrew Grayson , Angelos George C.
Published: July 2020

COVID-19 has drastically affected the current surgical training paradigm. Fellows anticipate a 10-25% decrease in procedural volumes for this year because of the pandemic. With a reduction in elective cases, surgical programs have transitioned to resident coverage cutbacks and/or reassigning trainees to non-surgical wards to assist with pandemic relief.
Trends on management of superficial venous disease
Authors: Ghosh Shantonu Kumar
Published: July 2020

Venous disease is more common in the society but less addressed than peripheral arterial disease. This is commonest in people who are sedentary workers, people standing for prolonged period, obase. Usually this group of people do not visit a doctor until it restricts him from regular work, ultimately causing a burden in the community. Early diagnosis of venous disease and its’ management is important. Understanding venous pathology, educating people about disease, conducting awareness program among target group of people are essential. Superficial venous disease includes both venous insufficiency and venous thrombosis. Management options of varicose vein and thrombophlebitis are discussed in the presentation.
Patients related factors influencing the clients’ satisfaction on maternal healthcare services: a case of Rongai Sub-County Health Institutions of Nakuru County, Kenya
Authors: Tirop Wendy Jemeli , Esilaba Moses , Donde Oscar O.
Published: July 2020

Background: Maternal health care (MHC) intervention and its quality is an important health service and its quality is an important concern in addressing the challenges of high maternal mortality experienced in many counties of Kenya. Objective of this study was to determine patients related factors that influence the satisfaction of clients receiving maternal healthcare in Rongai Sub-County health institutions of Nakuru County, Kenya.Methods: The study adopted descriptive cross-sectional design with simple random sampling where the health care facilities were clustered according to administrative locations, the wards and the respective levels of care; hospitals, health centres and dispensaries. Simple random sampling was used to select the facilities for the study. Convenience sampling was applied to get 465 mothers and purposive sampling method used to get healthcare practitioners in charge of the selected healthcare facilities. A questionnaire was administered to women seeking maternal health care services in the facilities within Rongai Sub County to determine the clients’ satisfaction.Results: The finding of the study indicates that education level, employment status, level of income and distance from the healthcare facilities had significant influence on client satisfaction to maternal health services (p=0.040, 0.006, 0.0.023 and 0.031 respectively).Conclusions: The study recommends the need to organize community outreach to sensitize the community on issues pertaining to maternal healthcare. Additionally, there is need for adequate education and economic empowerment within Rongai Sub-county for proper provision and adoption of MHC Services.
Level of stress, factors associated with stress and coping strategies among advanced level students attending tuition classes in a selected educational zone in Sri Lanka
Authors: Athukorale Uthpalee P. , Balasooriya Naduni A. P. , Jayasinghe Pradeesha L. S. , Nagawegedara Pavithri M. , Ranasinghe Chamini Y. , Perera Ramani , Goonewardena Sampatha E.
Published: July 2020

Background: Advanced level is a challenging examination due to the limitation of University entrance opportunities leading to high level of stress. Several issues have affected them irrespective of the stream of study, for which they tend to adapt different coping strategies. Therefore, the objective of this study was to determine the level of stress, factors associated with stress and coping strategies among advanced level (A/L) students attending tuition classes in selected Educational zone, Sri Lanka.Methods: A descriptive cross- sectional study was conducted among 364 A/L students aged between 17-20 years attending a selected tuition class. Self-administered questionnaire was used with 35 item coping strategy check list and DASS-21, both tools were pretested and validated in Sri Lanka. Data was analysed using SPSS 15.0 software.Results: Vastness of the A/L curriculum was a significant stress factor between males and females (p=0.001). Stress of getting lower grades and poor time management were higher among females (p=0.027, p=0.003).  Males reported change in sexual habits (p=0.003) and alcohol /cigarette use (p=0.001). Lack of vacation and fear of academic failure were the most common physical and emotional stressors respectively. Seeking advice from a trusted person, being with others, blaming themselves for the situation, engaging in religious activities, listening to music, constantly thinking about the problem and crying to self were common coping strategies adopted by females. Immediate problem solving and consuming alcohol/ drugs were common coping strategies by males.Conclusions: Males had more social and physical stress associated factors whereas females had academic and emotional stressors. Different methods of coping strategies were adopted by males and females.
Utilization of adolescent friendly health services and its associated factors in Dang district of Nepal
Authors: Giri Niraj , Shrestha Shushila , Uprety Srijana , Sangroula Raj Kumar
Published: July 2020

Background: Adolescence is a period of transition from childhood to adulthood. It is very crucial for adolescents to use the adolescent friendly health services in order to meet sexual and reproductive health needs. This study aimed to assess the factors associated with utilization of adolescent friendly health services in Dang district of Nepal.Methods: A community based analytical cross-sectional study was conducted in Dang district of Nepal. Five adolescent friendly health facilities were randomly selected and proportionate sampling was done to fulfill the required sample size. The adolescents were selected conveniently from the areas. Verbal informed consent was taken from the participants and their parents in case of age below 16 years. Approval was taken from Institutional Review Committee of Chitwan Medical College. Bivariate analysis was performed to detect the factors associated with utilization of adolescent friendly health services.Results: Nearly half (48.7%) of the adolescents had utilized adolescent friendly health services. Different socio-demographic factors like age of the participants, current educational status, mother’s education, ethnicity was significantly associated with utilization of adolescent friendly health services. Other factors like awareness about were services, convenient opening days and hour of health facilities and shyness to utilize the services were significantly associated with the utilization of the services.Conclusions: The utilization of the adolescent friendly services was found to be low among the adolescents of Dang district. In order to increase awareness among the adolescent regarding utilization of the services, there is need of coordination between schools, health institutions, communities etc. to conduct various awareness related program.
Awareness and utilization of contraceptives among males of reproductive age, Jos North, Plateau state, Nigeria
Authors: Osagie Ize A. , Envuladu Esther A. , Thilza Solomon , Amina Mohammed , Nnanna Jemie U. , Rijam Vasita N. , Gloria Joseph E.
Published: July 2020

Background: Modern contraceptives are relevant interventions in the reduction of maternal and child morbidity and mortality. Its uptake by females of reproductive age has been found to be influenced by male partners’ awareness and utilization. This study aimed to determine the awareness of contraceptives, utilization prevalence and sociodemographic predictors for use among males of reproductive age in Jos North.Methods: A cross sectional study involving 406 males of reproductive age who were selected by multistage sampling technique. Data was collected using an interviewer-administered semi-structure questionnaire and analysed using SPSS version 23.0. At 95% confidence interval, a p value of <0.05 was considered statistically significant.Results: There was a high awareness prevalence of contraceptives 378 (93.1%). However, the prevalence of current contraceptive use with partners was low 160 (42.3%). Respondents who were single were more likely to use contraceptives than those who were married or separated (OR 1.8; 95% CI 1.109-2.251). Those between the ages of 35-44 years also had a higher likelihood of using modern contraceptives than younger men (OR 2; 95% CI 0.410-2.436). Education, occupation and family size had no statistically significant association with contraceptive use among respondents.Conclusions: Despite the high awareness of modern contraceptives among respondents in this study, utilization with partners was low. Predictors of utilization were being single and being in the third decade of life. This could impact on increased risk for both maternal and child mortality. Male targeted contraceptive education is necessary at community levels to improve uptake.
The demographical analysis of COVID-19 in the South western province of Pakistan, an approach to analysing its low mortality rates
Authors: Zarak Muhammad Samsoor , Arshad Zara , Khan Sarmad Saeed , Nithikathkul Choosak
Published: July 2020

Background: COVID-19 cases are exponentially surging around the globe. At the time of study, Pakistan had 7,993 cases and 159 deaths. Out of these positive cases, 432 cases were from Baluchistan. Baluchistan being the South western province of Pakistan; is the basin of the first contact of the virus in Pakistan.Methods: A retrospective study was conducted where data was included from the very first tested case up till 19th April 2020. A total data of 432 patients were acquired and analyzed using SPSS version 20.  Results: The proportion of males was 308 (71.3%), belonging to the middle age group 21-30 years (23.4%, n=101). Contrary to popular belief, 60.6% (n=262) of these cases had been infected by local spread, while only 28.9% (n=125) were pilgrims (Zaireen) returning from Iran. Moreover, 146 (33.8%) cases have been reported in just the last five days of acquired data. Quetta and Loralai have displayed the highest COVID-19 attack rate of 14 among all the other districts. Furthermore, the mortality rate was 1.15% and all cases were of age above 40 years.Conclusions: There has been a rapid surge in several cases in Baluchistan, as portrayed herein. While this study depicts a fair picture of the COVID-19 demographic trend, the study has clear indications for the provincial, local spread that have been realized by this data along with a spike in cases in the last few days, which is maybe due to non-compliance to physical distancing rules.
Assessing knowledge of Ebola virus among health sciences students and healthcare professionals: a cross-sectional study in Ajman, UAE
Authors: Arida Abdul Karim , Al Jarrad Ahmad , Alramahi Mu’ayyad , Ahmad Waleed , Janoudi Ahmad , Gopakumar Aji , Thoppuram Nithin Koshy , Muttappallymyalil Jayakumary
Published: July 2020

Background: This study aimed to evaluate the knowledge of Ebola virus infection among students enrolled in health sciences programmes (Medicine, Dentistry and Allied Health Professions) and healthcare professionals in a private hospital in Ajman, UAE.Methods: It was a population based study where no samples collected and sampling technique involved. This cross-sectional study included 719 participants, among which 463 were health sciences students and 256 healthcare professionals. A self-administered questionnaire was given to all participants. A score of 50% or more in the questionnaire was considered a good score, representing a good level of knowledge and practice. Non-parametric statistical tests such as Mann-Whitney U test, Kruskal-Wallis test, and Chi-squared test were applied along with logistic regression model using SPSS version 21.Results: 100% of healthcare professionals (256) and 90.1% of students across all programs (417) were identified as having a good level of knowledge about Ebola virus infection. This observed difference in knowledge between type of participant was found to be statistically significant (p≤0.001). Compared to students, healthcare professionals were 8.9 times more likely to have higher levels of knowledge (score ≥75% in the questionnaire; COR: 8.9, CI: 5.5-14.3, p≤0.001). Higher knowledge identified among students of MBBS program (96.8%), clinical years of study, age ≥20 years old (92.4%), and students from South East Asia.Conclusions: Various factors were found to contribute significantly to participants having good levels of knowledge, including type of participant (healthcare profession vs student), students’ program of study and participants’ region of origin.
Contraceptive practice among married women of reproductive age group in rural Telangana: a cross sectional study
Authors: Salgar A. H. , Bhargavi A. N. , Nagaiah G.
Published: July 2020

Background: Contraceptive practice in India is known to be very heavily skewed towards terminal methods which mean that contraception in India is practiced primarily for birth limitation rather than birth planning. The objective of the study was to study contraceptive practice among married women of reproductive age in rural area.Methods: The study was a cross sectional study among married women with reproductive age group in rural areas of Sangareddy district carried out in Department of Community Medicine, MNR Medical College, Sangareddy, during November 2015 to February 2016. A total sample size of 113 women who are married in age group of 15-45 years and presumed to be sexually active were included in study. The data were collected using structured questionnaire and in-depth interview guide in local language. The collected data were analyzed with proper statistical methods using MS excel 2010.Results: Out of 113 women majority of women were in age group 20-29 years (52.21%). The utilization of contraceptive method was present in 52.21% women with oral contraceptive pills (23.89%) as a choice of method in majority of women.Conclusions: Hence, we conclude that still there is need to create awareness regarding importance of contraception among rural women.
Can we predict the duration of COVID-19 pandemic? an observational analysis
Authors: Patra Bijoy , Behura Jharna , Dewan Vivek , Yadav T. P. , Datta Vikram , Bahl Dheeraj
Published: July 2020

Background: Since the outbreak of 2019 novel corona virus pneumonia in the Wuhan city, China, the whole world has been ravaged by the pandemic of COVID-19. In this bleak scenario, China is witnessing the near cessation of the disease. The aim of the present study was to analyze the epidemiology curve of China and five other countries, and attempts to extrapolate these findings in the epidemiology curve of individual country to answer the question how long will the pandemic last on this globe.Methods: For the current study data from six countries namely China, Germany, Italy, South Korea Singapore, and India were considered. The resources for data collection were WHO Situation reports for corona virus disease (COVID-19), and Worldometer statistics for corona. Data were entered in to excel sheet and analyzed.Results: Data for total cases, active cases, death, recovery, inactive cases were analyzed for each country and construed in graphs. The epidemic curve of total cumulative cases in China can be observed to have four phases and the total duration of epidemic is around 24week±2 weeks. China is in last phase of the epidemic. In South Korea, Germany, Italy the epidemic curve of active and inactive cases has crossed each other and are in 3rd phase. India and Singapore are in phase 1.Conclusions: Despite the multitude of variables of COVID-19, the glimmer of hope for the end of pandemic can be inferred from the analysis of China, South Korea, Italy and Germany and can be extrapolated for India and Singapore.
Scenario of under nutrition among under five years children in India and its states: findings from National Family Health Survey
Authors: Mishra Piyush Kumar , Mishra Vijay Kumar
Published: July 2020

Background: The status of undernutrition among under 5years children living in India is a public health concern. Our study identified contributed factors of undernutrition and current scenario of undernutrition among children living across Indian states. Objective of the study was to know the current scenario of undernutrition among under 5 years children across Indian states and to examine the associated factors with this.Methods: This study used data from 4th round of National Family Health Survey (NFHS-4) that was coordinated by International Institute for Population Sciences (IIPS) during 2015-16 under the ministry of health and family welfare, GoI. Multiple logistic regression model was done to study the association between outcome (under nutrition) and socio-economic and bio-medical predictors.Results: This study identified four empowered action group (EAG) states as the problem states because of the greater number of undernourished children living in these states than other Indian states. The children whose mothers were fully exposed to mass media like newspapers/radio/television, have lower prevalence of undernutrition (50.6%). The results of multiple logistic regression revealed that the children belonging to poorest households were 2 times more likely [OR-CI, 2.35 (2.27-2.44)] to be undernourished than those belonging to richest.Conclusions: Undernutrition can be reduced through awareness with the help of mass media, providing higher education to women and reducing socio-economic inequalities. It is necessary to re-think about nutritional policy with respect to children under 5 years and frame a full proof implementation plan to reduce undernutrition in India.