bluuebunny/crossref_metadata_2025 huggingface dataset:
COMPARISON OF SURGICAL INTERVENTIONS FOR DEGENERATIVE DEFORMITIES AND INSTABILITY OF THE SPINE AMONG ELDERLY PATIENTS
Authors: Mikhaylov Dmitrii , Denisov Anton , Ptashnikov Dmitrii , Masevnin Sergei , Zaborovskii Nikita
Published: October 2018

ABSTRACT Objective: To evaluate the surgical results among elderly patients with degenerative deformities and instability of the spine. Methods: A retrospective study of 437 patients (337 women, 100 men) with a mean age 60. The mean follow-up time was five years. The inclusion criteria were diseases and complications following spinal trauma associated with deformities, degenerative processes, acute pain syndrome, and spinal stenosis with neurological deficit. Four study groups (A, B, C and D) were created and defined by type of surgical intervention. Group A patients (the reference group) - decompression of neural structures on both sides without fixation. Group B - decompression and transpedicular fixation performed without correction of the deformity. Group C - patients operated up to the lower-thoracic region with transpedicular screws, correction of the deformity and decompression of spinal stenosis. Group D - transpedicular fixation up to higher-thoracic region; correction of the deformity and decompression of neurological structures. The mean follow-up time was five years. Results: Group D patients achieved the best outcome. The results observed were good in 57.2% of cases (60 patients); satisfactory in 40% of cases (42 patients); and unsatisfactory in 2.8% of cases (three patients). The worst findings were observed in Group A: satisfactory in 13.4% of cases (15 patients); and, unsatisfactory in 86.6% of cases (97 patients). No good results were observed in this group. Conclusion: The results suggest that performing full deformity correction with transpedicular fixation up to the higher-thoracic region gives the best outcomes for elderly patients, and helps to prevent long-term complications. Evidence level III; Retrospective Comparative Study.
Sınıf Öğretmenlerinin İçerik Okuma ile İlgili Görüşleri
Authors: ÖZDEMİR Yusuf , KIROĞLU Kasım
Published: October 2018

İlkokul üçüncü sınıftan dördüncü sınıfa geçen öğrencileri
zorlu bir yıl beklemektedir. Artık alan derslerinde okuma yapmaları
gerekecektir. Alan derslerinde ise ilk üç yılda fazla alışık olmadıkları farklı
içeriklerde metinler kullanılmaktadır. İlkokulun ilk yıllarında daha çok
yazınsal metinler üzerinde çalışan, bilgilendirici metinleri çok az kullanan
öğrencilerden, dördüncü sınıf itibari ile farklı alanlar ile ilgili metinleri
okuyup bilgiye ulaşmaları istenmektedir. İçerik okuma, sosyal bilgiler, fen
bilimleri, matematik gibi farklı disiplinlerdeki okuma faaliyetlerini
içermektedir. Bir nevi bu derslerde verilen yeni içeriği kazanabilmek için
gerekli olan okuma becerisi olarak tanımlanabilmektedir. “Her öğretmen bir
okuma öğretmenidir.” sözünden hareketle her ders bir anlamda okuma dersidir,
denilebilir. Bunun için her derste öğrencilerin okuduğunu anlama becerisini
geliştirmek için çalışmaların yapılması bir zorunluluk haline gelmektedir. Alan
öğretmenlerinin daha çok öğrencilerin alan bilgisi üzerinde durmaları,
kendilerini okuma öğretmeni olarak görmemeleri ve bu alanda eğitim de
almamaları, sınıf öğretmenlerinin bu alanlarda yaptıkları okuma uygulamalarını
daha önemli hale getirmektedir. Bu araştırmada sınıf öğretmenlerinin alan
derslerinde okuma öğretimi ile ilgili neler yaptıklarının ortaya çıkarılması
amaçlanmıştır. Araştırma 2015-2016 eğitim-öğretim yılında, Samsun ilinin Alaçam
ilçesinde görev yapan ve amaçlı örnekleme yolu ile belirlenen 20 öğretmen ile
gerçekleştirilmiştir. Araştırmada nitel araştırma yöntemlerinden görüşme
yöntemi kullanılmıştır. Araştırmanın verileri araştırmacı tarafından ilgili
alanyazın incelenerek oluşturulan yarı yapılandırılmış görüşme formu ile
toplanmıştır. Nitel verilerin analizinde ise betimsel analiz yöntemi
kullanılmıştır. Araştırmanın sonucunda sınıf öğretmenlerinin okuma ile ilgili
ilkokuma yazma öğretimi dışında herhangi bir kurs almadıkları görülmüştür.
Sınıf öğretmenlerinin içerik metinlerini okumadan önce soru sorma; okurken
önemli yerleri belirtme ya da not aldırma; okuma bittikten sonra ise özetleme
ya da test çözme gibi uygulamalar yaptıkları belirlenmiştir. İlkokul dördüncü
sınıflarda içerik okuma stratejilerinin nadiren kullanıldığı sonucuna
ulaşılmıştır.
Okul Öncesi Dönem Çocuklarının Hikâye Anlama ile Zihin Kuramı Becerileri Arasındaki İlişkinin İncelenmesi
Authors: SARI Burcu , ALTUN Dilek
Published: October 2018

Bu araştırmanın amacı okul öncesi
dönem çocuklarının hikâye anlama ile Zihin Kuramı becerileri arasındaki
ilişkiyi araştırmaktır. Araştırma ilişkisel tarama modelinde yürütülmüştür.
Araştırmanın çalışma grubunu, 2017-2018 eğitim öğretim yılı güz döneminde
Kırşehir il merkezinde bulunan Milli Eğitim Bakanlığına
bağlı dört bağımsız anaokulunda eğitimine devam eden 133 (67 kız, 66
erkek) çocuk oluşturmaktadır. Araştırmanın verileri Zihin Kuramı Ölçeği ve Hikâye
Anlama Soruları kullanılarak toplanmıştır. Çalışma kapsamında Frederick ve Ağustos Böceği ile Karınca hikâyeleri çocuklara okunmuştur. Araştırma
bulguları, hikâye anlama toplam puanları ile Zihin Kuramı Ölçeği toplam
puanları arasında pozitif yönlü orta düzeyde bir ilişki (r=.46) olduğunu
göstermiştir. Zihin Kuramı Ölçeği’nin alt boyutları ile Hikâye anlama toplam puanları
arasındaki ilişki incelendiğinde, İçerik
Yanlış İnanış alt boyutu en yüksek korelasyon katsayısına (r=.43) sahipken,
Farklı İstek alt boyutu en düşük
korelasyon katsayısına (r=.16) sahip olduğu bulunmuştur. Ayrıca, çocukların hikâye anlama ve Zihin Kuramı puanları
arasında cinsiyet değişkeni açısından kızların lehine anlamlı bir fark
bulunmuştur. Çalışma bulguları ilgili alanyazın ışığında tartışılmıştır.
Gobernanza e instrumentos de política: un análisis de la política de turismo comunitario del Ecuador
Authors: Unkuch Saant Sayda Marlene , Rodrigues de Caires Carlos Miguel
Published: October 2018

Este artículo tiene por objetivo analizar la política de turismo comunitario del Ecuador. A partir de una perspectiva instrumental, se argumenta que el reglamento para normar los centros de turismo comunitario constituye un instrumento de "bloqueo" que impide el despliegue de los otros instrumentos, es inconsistente con un objetivo central de la política y contradice la práctica del turismo comunitario. Estos problemas serían consecuencia de la interacción desplegada en torno a la política entre diferentes lógicas y modos de gobernanza, particularmente de la imposición de un modo de gobernanza jerárquico en la concepción y el diseño del mencionado reglamento.
Petróleo, desarrollo y etnicidad
Authors: Lagos Pablo Francisco
Published: October 2018

En base a una metodología etnográfica se identifican y analizan visiones de diferentes actores frente al proyecto urbanístico Ciudad del Milenio en la comunidad A'i cofán Dureno, provincia de Sucumbíos. En un relato sobre las condiciones políticas, sociales y territoriales, ordenadas en tres momentos socio históricos, que avanzan desde el inicio de la actividad petrolera en la Amazonía norte ecuatoriana, hasta la actualidad. A raíz de estos acontecimientos interesa presentar las consecuencias del extractivismo y de las políticas de desarrollo ligadas a él, tales como la Ciudad del Milenio cofán Dureno.
François Houtart. Una sociología de la liberación
Authors: Pleyers Geoffrey
Published: October 2018

Para François Houtart, el compromiso religioso y el compromiso social no podían ser disociados, como tampoco podían serlo el análisis de la realidad social y las luchas sociales por transformarla. Era al mismo tiempo teólogo, sociólogo y militante global. Este artículo analiza los principales ejes de las contribuciones de François Houtart a las ciencias sociales contemporáneas a partir de las convicciones que guiaron su compromiso como sociólogo junto a los actores sociales. La primera parte hace un breve recorrido de su trayectoria y su contribución a la teología de la liberación. La segunda enfatiza el rol precursor de François Houtart en las ciencias sociales en particular en el diálogo con las epistemologías del Sur que invita a analizar el mundo, los mecanismos de opresión y los proyectos de emancipación desde las perspectivas de los actores sociales y de los oprimidos del Sur del planeta siguiendo el enfoque de "otra mundialización".
DISMANTLING OF THE BUILDING IN THE CITY
Authors: DOLADOV Yury I. , DOBRYANIN Konstantin E. , KHMYLYOVA Olga Yu. , VASILCHIKOVA Zinaida F.
Published: October 2018

The results of preparations for dismantling and demolition work of a semi-destroyed two-storeyed apartment building with a basement in the central part of Samara are presented. The dwelling house adjoining the destroyed house has a common wall with it. The object is on the street with active pedestrian and automobile traffi c. For the demolition of a residential house a project for the production of work (PPW) was developed with incomplete initial data. The document selected the means of mechanization, determined the sequence of work, shows the most dangerous elements in the production of works, proposed security measures. The work of the contractor for an additional survey of a dangerous object using a quadrocopter DJI Phantom 3 Standard is refl ected. An additional correction of the PPW is introduced. The illustrations of both the design part and the order of the works on the dismantling of the building are given.
PERMAFROST SOILS THAWING UNDER BUILDINGS IN NORILSK
Authors: POROSHINA Svetlana S.
Published: October 2018

The experience of the construction of buildings on permafrost in the city of Norilsk is considered, the main methods of construction under the given conditions are indicated, their advantages and disadvantages are revealed. The study of the localization of deformations in the building, the nature of the deformations shows their consequences. It is revealed that the main cause of mass destruction of buildings is the fi ssion of the soil under the building. The main possible causes of this process are indicated. The economic costs associated with the elimination of the consequences of destruction caused by the ground-breaking have been analyzed, and methods for solving this problem have been proposed.
HISTORY OF DEVELOPMENT OF SECTIONAL TYPE MASS HOUSING IN RUSSIA
Authors: GENERALOVA Elena M.
Published: October 2018

The history of typological development of apartment houses of sectional type is considered as the most complex, constantly developing housing on the territory of Russia. Particular attention is paid to the search for economical sectional houses with small apartments for further mass construction and experimental design work for the sett lement and their introduction in the pilot demonstration and experimental construction of the 9th and 12th microdistricts of Moscow. The system of stage-by-stage development of mass housing in the territory of Russia is disclosed until the 1990s. and in subsequent periods. It is proposed to single out six main stages in the development of mass housing with the defi nition of characteristic features for each stage. The euphoria of the construction of residential apartments and houses which was observed in the 90’s. has passed and at the present time the seventh stage in the development of residential buildings is being formed but this stage requires its solution and comprehension.
ROLE OF THE CONTEXT IN THE REHABILITATION OF URBAN AREAS DISTURBED BY INDUSTRIAL ACTIVITY
Authors: RYBAKOVA Daria S. , FEDOTOV Alexandr S.
Published: October 2018

The article is devoted to the study of problems of urban areas, disturbed by industrial activity, as well as methods of their rehabilitation and inclusion in the city public life. In the course of the research domestic and foreign experience was analyzed using the example of realized objects of the last 10-15 years refl ecting two principal approaches to solving this issue: demolition and complete cleaning of the territory with subsequent new construction; full or partial modifi cation of the functional program of the facility while preserving the most valuable elements from the architectural and planning point of view, and complementing them with modern architectural objects (reconstruction). The methods of reconstruction are listed and classifi ed: restoration, modernization, restructuring, revitalization and renovation. According to the results of the research the main principle that architects should follow is att ention to the context of the place in all its manifestations (historical, social, fi gurative-emotional, natural or urban).
THE INTENSIFICATION OF THE PROCESS OF SLUDGE DEWATERING OF URBAN SEWAGE
Authors: POGREBNYAK Svetlana A. , KOLOVA Alevtina F. , PAZENKO Tatyana Ya.
Published: October 2018

Urban wastewater sludge is highly humid, large and poorly dehydrated. Dehydration of sludge in natural conditions has a number of shortcomings: low effi ciency, sludge areas require huge land areas, worsen the ecological situation, pollute groundwater, soil, etc. One way to eliminate the problem and improve the effi ciency of sludge dewatering in urban wastewater is to switch to mechanical dehydration using fl occulants. The work is devoted to the selection of the most eff ective fl occulant and was carried out on the natural sediments of the right-bank treatment facilities in Krasnoyarsk and the sewage treatment plants in the sett lement of Emelyanovo. The experiment showed that fl occulants Praestol 851BC and Zetag 7485 at a dose of 3 kg / t dry matt er of the precipitate have the greatest eff ectiveness.
ESTIMATION OF SEASONAL VARIABILITY OF WATER QUALITY IN A SURFACE SOURCE OF DRINKING WATER SUPPLY
Authors: SELEZNEVA Alexandra V. , BESPALOVA Ksenia V. , SELEZNEV Vladimir A.
Published: October 2018

The results of water quality monitoring of the Saratov reservoir for the period 2000-2016 are presented. Observations were carried out monthly at a stationary station located in the lower tail of the Zhigulevskaya HPP. It is established that the quality of water in the source of water supply is characterized by signifi cant seasonal variability. During the mass development of algae the organic contamination of the reservoir increases and the concentration of nutrients decreases. Excessive content of organic substances in the summer low water complicates the technological processes of water purifi cation. It is concluded that phosphate is the limiting factor restraining the mass development of algae, the concentration of which in the peak of “fl owering” of water is reduced to almost zero.
DIALECTICS OF THE TOTALITY OF THEORETICAL, METHODOLOGICAL AND NORMATIVE PROVISIONS APPLIED FOR THE DESIGN OF THE SETTLEMENTS SEWAGE SYSTEM
Authors: SHUVALOV Mikhail V.
Published: October 2018

On the base of the system analysis of technical literature and regulatory documentation on the sewerage of sett lements and industrial enterprises it is established that in the history of the development of sanitary equipment for the period from the middle of the 19th century onwards up to the present time it is possible to roughly distinguish fi ve stages diff ering from each other in that for a certain period of time in developed countries a certain system of theoretical and normative provisions on the collection, removal and disposal of sewage water dominated. In the fi rst quarter of the XX century the generally accepted paradigm is the method of sewerage of sett lements by a centralized scheme with the installation of communal sewage treatment plants by a biological method. At the beginning of the XXI century there is a paradigm shift in the collection, management and purifi cation of domestic wastewater due to the resumption of search for resource-saving technologies that reduce the emission of pollutants into the environment through the introduction of technological solutions for the separation of domestic (sanitary) wastewater into separate fl ows for the purpose production from waste water components of secondary products. In the short term, after the development and approval of normative documents regulating the basic sanitary rules and technological norms for the introduction of advanced modifi ed technologies for the separation of human excrement and household wastewater with the purpose of separate treatment with the disposal of sewage components, a gradual transition from a centralized to a decentralized separate sewerage system will be carried out domestic and sanitary sewage.
Benign and malignant lesions of the breast: clinico-pathological perspective from a government teaching hospital in West Bengal, India
Authors: Sarkar Saurav , Lahiri Arista , Bandyopadhyay Soumyajyoti , Das Snehasish , Chakraborty Tamal
Published: October 2018

Background: While breast cancer is one of the most commonly diagnosed cancer more than half of the women develop some benign disease of breast in their lifetime. The current study was conducted to describe the clinico-pathological findings associated with breast diseases and study their relationship.Methods: A record-based cross-sectional study was conducted on the samples of breast tissue obtained by fine needle aspiration cytology (FNAC) examination. The clinical variables like age, sex, presenting complaint, involved side (right/left/both) etc. were taken from the clinical notes sent, and nature of the aspirate, histopathological diagnosis, nature of the diagnosed disease (benign/malignant), and axillary metastasis were taken as variables from pathological examination.Results: The mean age of the patients was 33.49 years (±13.24 years) with majority belonging to 20-40 years. Among the 184 specimens examined, 94.57% belonged to female patients. The most frequent presentation was with lump (95.11%). Complaint arising out of right breast (47.83%) were higher compared to left breast (40.76%). Involvement of the supero-lateral quadrant was seen in 75.54%. In 30.44% of the cases the material was bloody or blood-mixed. Majority of the patients (86.41%) were diagnosed with benign disease commonest being fibroadenoma. Ductal carcinoma was the commonest malignant lesion. Younger age group, absence of bloody discharge and absence of peau d’orange were associated with benign lesion in a statistically significant way (p-value <0.001).Conclusions: In consonance with published literature the findings suggest association of older age group with malignant lesions. Blood-mixed aspirate, peau d’orange appear to be danger signs.
Spectrum and outcome of gastric outlet obstruction in a tertiary care hospital
Authors: V. Sachin , R. S. Ravya , V. Sunil Kumar
Published: October 2018

Background: Gastric Outlet Obstruction is a disorder wherein there is an obstruction in the opening of the stomach (Pylorus), blocking the entrance of ingested food coming from the stomach to the duodenum. Gastric Outlet Obstruction is the one of the most common clinical scenarios encountered in general surgery. Pyloric obstruction occurs in 2-4% of patients with chronic duodenal ulcer and it is described by Sir James Walton as “the stomach you can hear, the stomach you can feel and the stomach you can see”. Predominant cause for Gastric Outlet Obstruction has changed substantially with identification of H. Pylori and the use of proton pump inhibitor. In this study the various aspects and management of Gastric Outlet Obstruction are analysed.Methods: This prospective cohort study of 18 months duration was conducted among 50 patients in the department of general surgery from August 2016 to February 2018. The study population included patients presenting with gastric outlet obstruction in the deparment of general surgery who are treated on in-patient basis. An elaborate study of these cases was done and data pertaining to history, clinical features, investigations, management and follow up collected in a structured proforma.Results: Of the 50 cases of gastric outlet obstruction, 30 patients were diagnosed carcinoma pylorus and 17 of them were found to have cicatrising ulcer. Remaining 3 patients had other causes attributed to the presentation. The age incidence of the patients in this study ranged from 20 to 70 years with a mean age of 45.2 years. Majority of patients were manual labourers. 70% of the study subjects were smokers and 60% consumes alcohol. Vomiting and abdominal pain were the predominant symptom with recorded loss of weight in 35 cases.Conclusions: Gastric outlet obstruction is a common presentation of malignancy and cicactrising duodenal ulcers. However there has been changing trends in the pattern of disease incidence in view of changing trends in management and investigation modalities.
Incidence and risk factors influencing morbidity and mortality in cases of burst abdomen after emergency and elective midline laparotomies
Authors: Vardhini K. Viveka , Kishan D.
Published: October 2018

Background: Burst abdomen is a serious postoperative complication faced by surgeons and of greatest concern because of risk of evisceration, the need for immediate intervention and the possibility of repeat dehiscence. Wound dehiscence carries with it a substantial morbidity and mortality. In addition, there is an increase in the cost, increased hospital stays, nursing and manpower cost in managing its complications.Methods: In this study a total 202 patients enrolled who underwent emergency and elective midline laparotomies. Patients clinically presenting as gaping of abdominal wound were included in study. Diagnosis was established by clinical examination. In all cases gentle probing of the wound with gloved finger done to confirm defect.Results: In this study incidence of burst abdomen was seen in 80 patients (39.6%) and was common in patients who underwent emergency surgeries. Patients who had stoma construction had maximum number of burst abdomen. 150 (74%) cases underwent emergency laparotomies in which 64 (42%) cases developed burst abdomen. In 60 cases closure done with re-suturing of fascia and remaining cases by skin closure only due to sepsis, poor general condition of patients. Mortality was seen in (22.5%) patients due to postoperative complicationsConclusions: Burst abdomen is more common in emergency surgeries than elective surgeries. Wound infection and stoma construction increase the rate of burst abdomen. Mid-mid line incisions have increased incidence of wound dehiscence. Mortality is high despite early treatment due to complications.
Evaluation of validation of Anderson score for diagnosis of acute appendicitis by histopathology
Authors: Goel Kanwar Singh , Goel Sapna
Published: October 2018

Background: Appendicectomy is a very common operation performed. Removing normal appendix leads to multiphasic problems. Furthermore, appendix has proved to be a useful structure in reconstructive surgeries. We are going to evaluate validation of Anderson score for diagnosis of acute appendicitis and confirm the result by histopathology.Methods: This prospective observational study was performed in Surgery Department in SGT Medical College, Gurugram, Haryana. Total patients were 100. A detailed history was taken, clinical examination and investigations were done. All patients were subjected to Anderson score. Patients were operated. Appendix was sent for Histopathology examination. Analysis of the data was done by SPSS software version 23. Sensitivity, specificity, positive predictive value and negative predictive values were found out. Chi square test was duly applied.Results: In 70 patients, Anderson score was >8, was in favour of acute appendicitis. It means these patients should require surgery. In 30 patients score was <8. Most common histopathology finding was acute appendicitis then diffuse suppurative appendicitis followed by gangrenous appendicitis still followed by diffuse suppurative appendicitis with peri appendicitis.Conclusions: we have found out that if Anderson score is ≥8, appendicectomy should be done. But if Anderson score is <8, as per Anderson scoring system, appendicectomy should not be done, but we should not go by this. We should review the patient, further investigations should be carried out, senior surgeon’s opinion should be taken, and then final decision should be taken.
The utility of surgeon performed transcutaneous laryngeal ultrasound for the assessment of vocal cords in post-thyroidectomy patients
Authors: Sadacharan Dhalapathy , Ferdinant Jabamalai , Rakeshchandru Kaharin , Thalavai Sundarram
Published: October 2018

Background: Post-thyroidectomy vocal cord palsy is a significant procedure associated complication and a notable contributor for medico-legal litigation. The standard technique for vocal cord evaluation and the most commonly used tool is direct laryngoscopy. Endocrine surgeons generally address the patients to otolaryngologist for laryngoscopy, leading to extra expense and time loss. Laryngoscopy causes patient annoyance and could potentially contribute to poor patient compliance. Ultrasonography is a non-invasive technique that is regularly used by endocrine surgeons to examine the thyroid region.Methods: A prospective study conducted on patients who underwent thyroidectomy between September 2016 and August 2017 at endocrine surgery department in a tertiary care institute (South India), Surgeon performed ultrasound (SPU) and Video laryngoscopy (VDL) was performed before and after elective thyroidectomy.Results: 155 patients who consented were categorized in the study, 2 of the patients included in the study had preoperative vocal cord palsy and 12 of them had unilateral postoperative vocal cord palsy detected using VDL. In general, the postoperative vocal cord palsy rate was 6.45%. Postoperative SPU was ineffective in assessing vocal cords in 16(10.32%) of patients. SPU had a sensitivity of 83.33% and negative predictive value of 97.90%, for the visualization of vocal cords in the postoperative period.Conclusions: SPU is convenient and non-invasive technique which could provide our speciality with cheap yet powerful diagnostic tool for vocal cord assessment in post-thyroidectomy patients and can potentially decrease the requirement of difficult and cumbersome VDL.
A study to compare outcomes of Sodium tetra-decyl sulphate and Polidocanol in the treatment of varicosities due to incompetent tributaries of superficial vein of leg: a randomized controlled trial
Authors: Kushwaha Jitendra K. , Anand Akshay , Sonkar Abhinav A. , Gupta Rajni
Published: October 2018

Background: Various options for treatment of varicosities of tributaries are mini-phlebectomy, hook phlebectomy, Trivex and sclerotherapy. Sodium tetra-decyl sulphate (STD) and polidocanol (POL) are most commonly used sclerosants. Adverse events caused by sclerosants are pain, thrombophlebitis, hyperpigmentation, allergy, anaphylactic shock, cutaneous necrosis, deep venous thrombosis, headache, visual disturbances and chest tightness. Foam sclerotherapy has been considered to be better than liquid sclerosant. In this study we have compared foam prepared by STD versus POL in the treatment of varicosities of tributaries of superficial vein of Leg.Methods: Patients treated for SFJ or SPJ incompetency post their primary admission and management were attended and evaluated in outpatient department. Patients having varicosities were enrolled for study and treated in OPD by foam sclerotherapy. Patients were randomized to two groups - A or B. Patients were followed up for one month and various clinical outcomes were analyzed.Results: In group A (STD) out of n=20 patients pain, hyperpigmentation and skin necrosis was present in n1=18 patients, n2=14 patients and in n3=2 patients respectively on the first post-operative day while in group B (POL) out of 24 patients it was present in n1=14, n2=8 and n3=1 patient respectively. Post sclerotherapy at one month follow up, in Group A pain and hyperpigmentation decreased to n1=08 and n2=04 patients respectively but skin necrosis was persisting in all n3=02 patients. In-group B pain and hyperpigmentation was present in patients each n1= n2=02 and skin necrosis was present in n3=01 patient.Conclusions: Polidocanol is better than Sodium tetra-decyl sulphate for foam sclerotherapy in terms of better cosmetic outcomes.
A tertiary care centre experience of modified early warning score (MEWS) in post-operative patients
Authors: Somasundaram Umesh Raj , Santhiyagappan Esakki
Published: October 2018

Background: The aim of the study is to analyse and implement the modified early warning score (MEWS) in assessment of need of early intervention and surgical intensive care unit (SICU) admission in patients undergoing elective and emergency major surgical procedures.Methods: This prospective study was done in Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu. It included 150 patients who underwent major emergency and elective surgical procedures under regional or general anaesthesia with monitoring of physiological parameters in the P.O period.Results: The predictability of MEWS system was analyzed with the following results: MEWS 1=77 patients were alive (51.3%) of the study population. MEWS 8=3 patients were alive (2.1%) and 7 patients died (100%) of the study population. This indicates that the greater MEWS the mortality of the patient rises, and the lesser MEWS score the chances of mortality in the P.O period is very minimal. In our study, we have derived that MEWS score of 7 or 8 implicates the need for SICU admission and it indicates an increased mortality of the patient in the P.O period.Conclusions: The Modified Early Warning Score (MEWS) is an effective tool in identifying the early deterioration of the patients undergoing major surgical procedures and assessing the need for admission in SICU for further interventions.
Neutrophil to lymphocyte ratio (NLR) in acute pancreatitis as an early predictor of severity and outcome
Authors: Bhanou Noor Mohammed Shawnas , Balachandran Gayatri , Jain Nisha B.
Published: October 2018

Background: The management of Acute Pancreatitis (AP) is determined by an accurate assessment of severity of the disease. Numerous severity indicators have been described till date, most of which require reassessment after admission and resuscitation. We propose a novel indicator, the Neutrophil to Lymphocyte ratio (NLR), as a predictor of severity of acute pancreatitis at the initial time of diagnosis. NLR may have a role in predicting the length of hospital stay and ICU admission and also to predict adverse manifestations of Severe Acute Pancreatitis (SAP) including organ failure.Methods: A retrospective analysis was performed of 107 patients diagnosed with acute pancreatitis based on Atlanta 2012 definitions, who were admitted and treated between August 2017 and November 2017. The patients were grouped according to severity of acute pancreatitis and organ failure occurrence and a comparative analysis was performed to compare the NLR between groups. NLR was also compared with the modified Marshall score as a standard predictor of organ failure in acute pancreatitis.Results: Median NLR among the severe group is significantly higher compared to mild and moderate group (P <0.001). NLR significantly correlated with length of hospital stay (p 0.004) and also had a statistically significant correlation with ICU stay (p < 0.001). We found in our study that NLR at admission correlated significantly with the modified Marshall score in predicting the organ failure (p <0.001) in patients with acute pancreatitis. The receiver operator characteristic (ROC) curve analysis showed a cut-off values of NLR >8.5 at admission correlated with adverse outcomes in patients with acute pancreatitis.Conclusions: Neutrophil to Lymphocyte ratio (NLR) can be used as a predictor of severity of acute pancreatitis, right at the time of initial diagnosis. Further it may predict adverse outcomes, need for ICU care as well as length of hospital stay. NLR can be used as a tool to refer at risk patients to tertiary center needing ICU admission.
Comparison of surgical outcome of patients in whom bowel is prepared with intravenous fluid replacement with those who are not given intravenous fluid replacement
Authors: Thakur Bhushankumar A. , Bhalerao S. , Shinde Parnika Ravindra
Published: October 2018

Background: Adequate cleansing is essential for reliable diagnostic and surgical colon procedures. Accuracy and safety depend on good preparation. Patient compliance is enhanced by simplicity and well-tolerated method. About mechanical bowel preparation with PEG and Nap, it is noted that PEG is more effective and better tolerated than the diet combined with cathartic regimens that were used before 1980. PEG also is safer and more effective than high-volume balanced electrolyte solutions. The aim of this prospective study is to assess whether perioperative outcome is affected by administrating a calculated amount of intravenous fluid during bowel preparation as compared to subjects who do not get I V fluids during bowel preparation.Methods: This is randomized prospective case control study, carried out government general hospital and teaching tertiary care institute located in Mumbai. Total 86 patients were included in this and randomly allocated to case or control group after applying inclusion and exclusion criteria.Results: More and more studies then compared the quality of preparation of bowel during colonoscopy with PEG and NaP and superiority of one over other was discovered. Also, this led to development of low dose 2 lit regimen of PEG and flavoring agents. Studies then were more inquisitive regarding the side effect of bowel preparation in regard to healing of anastomosis, chances of leak and effects of dehydration postoperatively. Present study is for same purposeConclusions: In present study it is observed that there is increase in I V fluid requirement in the patients in whom mechanical bowel preparation is given without I V fluid rehydration and the post-operative outcome in view of returning of bowel activity was unaltered.
A clinical study and different modalities of management of ventral hernias
Authors: Lavanya S. , Manvi P. Naga
Published: October 2018

Background: Ventral hernias are a common problem encountered by the surgeons. Patients developing hernias become restricted from work or usual activities as the hernia enlarges and this demands surgical repair. The objective of this study is to evaluate the predisposing factors, the different modes of presentation, the different methods of surgical repair including the newer methods.Methods: A prospective random study done at Alluri Sita Rama Raju Academy of Medical sciences, Eluru, where in 50 cases of ventral hernias were randomly selected. A thorough case history taken as per the proforma enclosed and relevant investigations were done following which a selective surgical treatment such as anatomical repair and mesh repair were used. Anatomical repair was mainly considered in pediatric and infected cases and the remaining with open and laparoscopic mesh repair.Results: Majority of ventral hernias were seen in the age group of 21 to 60 years with a major female preponderance in umbilical, paraumbilical and incisional hernias, and epigastric hernias common in males. The common predisposing factors identified were previous surgeries, followed by anaemia, multiparity. Majority patients presented with mass or swelling over the abdomen which were reducible. The lower midline incisions were the most common cause for incisional hernias. Most of the patients had a fair preoperative presentation. In this study anatomical and mesh repair (open and laparoscopic) were done. 7 cases lost follow up and no recurrences noted.Conclusions: Among the ventral hernias infraumbilical incisional hernias were common with majority being gyneacological and obstetric procedures. Maximum cases were repaired with Open mesh repair (onlay >inlay) followed by laparoscopic and anatomical repair. With the good knowledge of anatomy, good relaxed anaesthesia and improved surgical skills, the use of synthetic suture and prosthetic material, coverage with antibiotics, post-operative care the outcome of treatment for hernia has improved with insignificant recurrence.
Comparative study of patient reported rates of chronic pain with the use of heavy weight and light weight mesh in open hernia repair in a tertiary care hospital
Authors: B. S. Madhu , M. G. Lokesh , S. R. Avinash
Published: October 2018

Background: Hernia repair one of the most common operations performed by general surgeons. Mesh repair is the gold standard for these repairs, the rates of postoperative chronic pain associated with these meshes are still unclear. The aim of the study is to compare the post-operative persisting pain after 3 months in open hernia repair with light weight and heavyweight mesh.Methods: A randomized control study was conducted in a tertiary care hospital with sample size of 80. lightweight and heavyweight mesh were used after randomization with equal participants in each group. Postoperative pain was analysed 1 week, 2 week and 3 months after surgery using visual analogue scale.Results: The study was conducted on a total of 80 participants. The mean age was 53(±16) and 46(±19) in those who received heavyweight mesh and lightweight mesh respectively. Majority of them 73(91.2%) were males and only 7 (8.8%) of them were females. Out of 80 participants, number of participants operated with lightweight mesh and heavyweight mesh was equal (1:1). At three months follow up, only mild and moderate pain was reported with both the groups. Among patients treated with heavy weight meshes 14 patients (35%) reported moderate pain with 26 patients (65%) reported mild pain. Among patients treated with lightweight mesh reported only 4 patients (10%) reported moderate pain with 36 patients (90%) reported only mild pain. There was significant difference in the mean of VAS score between the groups and there was significant difference between the type of mesh used and pain after 3 months (P<0.01).Conclusions: Partially absorbable lightweight mesh can be used for open inguinal hernia repair with significantly less chronic postoperative pain with improved quality of life and functional outcome.
Upper limb lymphedema related to breast cancer therapy: incidence, risk factors, diagnostic techniques, risk reduction and optimal management
Authors: Saleh Hatem A. , Rageh Tarek M. , Alhassanin Suzan A. , Megahed Mohamed A.
Published: October 2018

Background: Lymphedema remains to be a great source of morbidity for breast cancer survivors. The aim of this work is to study upper limb lymphedema following breast cancer therapy for breast cancer patients regarding its incidence, risk factors, diagnostic techniques, risk reduction and optimal management.Methods: This prospective study was done on two hundred breast cancer patients who underwent breast cancer management. The study was done in the period between May 2016 and July 2018. Exclusion criteria were Male patients, Female patients with metastatic breast cancer and who already had upper limb lymphedema before breast cancer management. All patients underwent follow up for incidence, risk factors, diagnostic techniques and management of lymphedema. Statistical analysis used: The collected data were organized, tabulated and statistically analyzed using SPSS softwareResults: The incidence of lymphedema was (18 %) distributed as follow: grade I = 55.6%, grade II = 33.3%, grade III = 11.1 % and grade IV = 0 %. The most relevant risk factors for development of lymphedema were: age between 41 and 50 years and diabetes mellitus. Higher incidence of pain (66.7%) and restricted motion (61.1%) were observed in lymphedema cases.Conclusions: Old (41:50 years) and diabetic patients are at the highest risk for developing lymphedema. Breast cancer patients of stage IIIB who had undergone modified radical mastectomy or who developed postoperative seroma are at higher risk for developing lymphedema. Physical exercises and compression garment are important part of treatment plan.
Surgical safety checklist implementation and its impact on patient safety
Authors: Dinesh H. N. , R. S. Ravya , V. Sunil Kumar
Published: October 2018

Background: Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. Although surgical and anesthetic caregivers seek to deliver optimal quality in peri-operative service, surgery still carries considerable risk for the patient. WHO surgical safety checklist outlines essential standards of surgical care and has been shown to reduce complications and death associated with surgery.Methods: Pre-intervention and post-intervention study. The effect on patient outcomes and documentation of WHO surgical safety checklist was examined. After an education programme, the checklist implementation and patient safety outcome indicators were studied.Results: Checklist compliance increased over time. The median number of items documented was 16. After implementation of the checklist, mortality decreased from 3.13% to 2.85%. Most causes of death did not significantly differ between the implementation periods, except for multiorgan failure and major bleeding. Adjustment of the association between implementation period and outcome for all variables revealed a decreased mortality after checklist implementation.Conclusions: Implementation of the checklist showed improved outcomes. Use of the WHO surgical safety checklist in urgent operations is feasible and should be considered. Implementation proved neither costly nor lengthy. Further research is needed to confirm these findings and reveal additional factors supportive of checklist implementation.
Clinical efficacy of two anti-microbials (ceftriaxone and metronidazole) versus three antimicrobials (ceftriaxone, metronidazole and amikacin) in perforative peritonitis
Authors: Keerthi Nemalidinne , K. Mohan Kumar , A. Bhaskaran , K. Krishna Prasad , C. A. Shashirekha , Dave Prakash , P. N. Sreeramulu
Published: October 2018

Background: Peritonitis is classified as primary, secondary and tertiary. In primary peritonitis and continuous ambulatory peritoneal dialysis-associated peritonitis, the source of the infection is not due a breach in the gastrointestinal tract and usually caused by a single organism. Secondary peritonitis ensues, which may be localized and contained or diffuse carrying a high mortality in the absence of surgical intervention and appropriate antimicrobial therapy. In contrast, secondary peritonitis following perforation of the gastrointestinal tract or an infection originating in an intra-abdominal structure. Tertiary peritonitis is an ill-defined entity, which occurs despite adequate treatment of primary or secondary peritonitis.Methods: This is a prospective clinical study conducted on 140 consecutive patients who presented to the surgical department of RL Jalappa Hospital and Research Centre, Tamaka, Kolar with peritonitis secondary to hollow viscus perforation.Results: A total of 140 patients who presented with peritonitis secondary to hollow viscus perforation, admitted and treated in RL Jalappa Hospital and Research Centre attached to Sri Devaraj Urs Medical College, Kolar were studied during the period of December 2015 to June 2017.There was decrease in postoperative complications and hospital stay in Group B.Conclusions: In present study peritonitis is more common in men compared to women. The most common age group is in between 21-40 years in cases of peritonitis with the mean age of 37 years. Duodenal ulcer perforation is the commonest site of perforation. Escherichia coli is the most common organism isolated in the peritoneal fluid. usage of three antimicrobials (p<0.05) is beneficial in reduction in postoperative complications and hospital stay when compared to usage of two antimicrobials which is statistically significant.
Survival and prognostic factors of lymphadenectomy in endometrial cancer: a Tunisian single center experience
Authors: Safta Ines Ben , Jaidane Olfa , Mansouri Houyem , Doghri Raoudha , Gadria Selma , Mrad Karima , Hassouna Jamel Ben , Rahal Khaled
Published: October 2018

Background: Endometrial cancer (EC) is the most common pelvic gynecological cancer. The purpose of the present study is to identify histoprognostic risk factors for lymph node involvement, evaluate the impact of lymphadenectomy on relapse and overall survival and assess prognostic factors influencing the survival rates in endometrial cancer.Methods: This was a retrospective study of 249 cases of endometrial cancer, over a period of 16 years (2000-2015). We analyzed the clinical, pathological features and outcome of our patients. Curves of overall and recurrence-free survival were performed.Results: In our cohort, stage IA was found in 46.6% of cases, stage IB in 14.5%, stage II in 13.7%, stage IIIA in 3.6%, stage IIIB in 2%, stage IIIC1 in 8.8%, stage IIIC2 in 4.4% and stage IV in 6.4%. The histologic type (p=0.02, OR=2.702, CI [1.169; 6.25]), myometrial invasion (p<0.001, OR=4.524, CI [1.960; 10.416]), lymphovascular space invasion (p=0.047, OR=2.267; CI [1.013; 5.076]) were the only independent factors of lymph node invasion in multivariate analysis. 5-years overall and recurrence free survival was 76.3% and 81.5%, respectively. Overall survival at 5 years was 64.6% with a lymph node ratio of less than 10%, 22.2% with a lymph node ratio between 10 and 50%, and zero with a lymph node ration greater than 50% (p=0.016). By studying the number of lymph nodes removed during lymphadenectomy, survival trend to be improved when the lymph node count increased.Conclusions: The lymphadenectomy has an incontestable diagnostic and prognostic value. Present retrospective study showed the therapeutic interest of lymph node dissection in endometrial cancers.
Effective treatment options in amoebic liver abscess in a tertiary care setting in West Bengal: an observational study, India
Authors: Mondal Ankan , Lahiri Arista , Ray Prama , Bhattacharjee Atanu
Published: October 2018

Background: Conservative management and image guided drainage have emerged as mainstay of the treatment in Amoebic Liver Abscess (ALA), with surgery used in complicated cases. The current study was conducted with an objective to demonstrate the effectiveness of the different treatment options in ALA.Methods: An observational study was conducted on 100 patients, aged 19 to 60 years, admitted with sonographic evidence of Amoebic Liver Abscess (ALA) in the General Surgery wards of a tertiary care hospital in Kolkata. Patients coming for regular follow-up after completing treatment were included. On completion of the treatment before discharge a repeat ultrasonography of the upper abdomen was done to confirm remission.Results: Majority of the patients were male, Muslim, rural resident and within 30 – 40 years age. Chief complaints were pain (100%), fever (60%) and abdominal swelling (80%). Tender hepatomegaly (80%) and icterus (36%) were present. Majority patients had the left lobe of the liver affected (72%) and abscess dimension <6 cms (66.67%). Out of the participants with unruptured abscess 21.87% had multiple abscesses. Out of 64 patients subjected to conservative therapy, 44 were successfully managed. Success rate of 72.73% was observed among 44 patients receiving ultrasound guided needle aspiration. All twenty patients subjected for pigtail catheter drainage were cured. Four patients underwent laparotomy and open drainage following intraperitoneal rupture.Conclusions: Conservative treatment was observed to be sufficient in majority of cases of amoebic liver abscess of lesser size with percutaneous catheter drainage useful in large abscess. Surgical intervention was required in ruptured or complicated abscesses.