bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of prognostic value of Fernandez scoring system on the management of ectopic pregnancy in the emergency room at Suez Canal University Hospitals, Egypt
Authors: Essa Ahmed A. , Madny Elham H. , Zayed Osama M. , Elshaboury Islam M. , Mahmoud Bassma M. 
Published: March 2017

Background: Ectopic pregnancy is a major cause of morbidity and mortality in reproductive-aged women, accounting for 9% of pregnancy-related deaths in the first trimester. Clinical prediction tools have been developed to aid management decision making. Fernandez et al “1991” developed a score based on gestational age, β-hCG level, progesterone level, abdominal pain, hemo-peritoneum volume, and hematosalpinx diameter. A score of less than 12 predicts more than 80% success with expectant or nonsurgical management. Aim of the study was to improve the outcome of patients with ectopic pregnancy attending the emergency room at Suez Canal University hospitals, Egypt.Methods: This is a descriptive (cross-sectional) study conducted on 62 patients diagnosed to have ectopic pregnancy in the emergency department in Suez Canal University Hospital. The patients were subjected to full assessment including full history, examination, investigation and Fernandez score. These data were collected in a questionnaire, interpretted using SPSS program and the score was calculated.Results: The study revealed that 48.8% of the patients were in the age group between 31-40 years. It was found that in 61 patients (98%) the decision matched using Fernandez score and experts’s opinion while only one patient was given a different decision. Using Fernandez score, 40 patients had results less than 12 which guided to conservative management and 22 patients had a score more than 12 which guided to operative management.Conclusions: It was found that Fernandez score has 100% sensitivity and 95.2% specificity.
A case series of standard surgical management of bulbo-membranous stricture
Authors: Selukar Dhananjay , Pothare Amit Narayan , Meshram Kunal , Rahangdale Vinay , Jibhkate Nikhilesh , Hedaoo Jagdish , Helgeri Samir 
Published: March 2017

Background: Urethral stricture is an acquired permanent narrowing of the urethra impeding the flow of urine during micturition. It is one of the oldest urological diseases, and its treatment remains a challenge for urologists. Urethral stricture disease affects about 300 per 100,000 men. Most common causes are trauma and infections in developing countries and idiopathic in developed countries. Treatment options for short bulbar urethral strictures include dilatation, direct visual internal urethrotomy and anastomotic urethroplasty. Excision and end to end anastomosis (anastomotic urethroplasty) for short bulbo-membranous urethral strictures and buccal mucosal graft gives excellent long term results with reduced recurrence rate.Methods: Sixty-three patients who had undergone anastomotic urethroplasty from 2013 to 2016 at Government Medical College and Superspeciality Hospital, Nagpur, Maharashtra, India Department of Urology were included in the study. For strictures less than 2cm, excision of stricture and anastomosis done, while for stricture more than 2cm buccal mucosal grafting done over 16 F Foleys catheter. Postoperative follow up done up to 1 year.Results: The total number of patients included is 63 and study conducted between January 2013 to December 2016. End to end urethroplasty was done in 41 patients and had mean duration of surgery of about 120 minutes, while buccal mucosal grafting was done in 22 patients. Age ranges from 14 to 78 years with highest incidence of stricture was seen after 5th decade of life, mainly due to iatrogenic causes of previous instrumentation and post TURP surgery. Strictures in younger adults are mainly as a result of trauma by fall astride injury and pelvic fractures and seen during 3rd and 4th decade of life. Most common length of stricture observed was 1-2cm in about 65.07% and mainly occurred due to post urethral procedures. Long strictures more than 2cm were mainly because of trauma in about 35%. Seven patients had recurrence in follow up, out of which 2 managed conservatively by repeated dilatation and 5 patients needed reoperation.Conclusions: The present results suggest that in patients with strictures too long to be excised and re-anastomosed a tension-free buccal mucosal graft provides better results. However, in patients with short strictures, in whom a completely tension-free anastomosis can be achieved, direct end-to-end anastomosis remains good option.
Aetiopathological and demographic profile of diabetic foot: a prospective cross sectional study from a tertiary hospital in South India
Authors: Valappil Ragesh Kalikottu , Krishnan Sheena , Matad Siddharth , Vayalipath Shameej Kinakool 
Published: March 2017

Background: Diabetes mellitus is a chronic disorder affecting large segment of population and is a major public health problem.Methods: A prospective cross sectional study of 150 patients conducted in the Department of Surgery at Government Medical College, Kozhikode, Kerala, IndiaResults: Maximum numbers of patients were in the age group of 60-69. Male to female ratio is 3.04:1.50% had duration of diabetes <10 years and 50% had duration ≥10. years. 81 (54%) patients had neuropathy, 53 (35.3%) had PVD, 41 (27.3%) had history of prior foot ulcer, 70 (46.7%) had poor glycemic control (RBS >200 mg/dl) at the time of admission and 44 (29.3%) had history of smoking.Conclusions: Most important risk factors for diabetic foot ulcers were neuropathy (54%), poor glycemic control (46.7%) and PVD (35.3%), diabetic foot requires a comprehensive management.
Prediction of difficulties during laparoscopic cholecystectomy by preoperative clinical examination and ultrasonography
Authors: Kumar Arun , Singh Kunwar Vishal , Shakya Jugendra Pal Singh , Sahu Sangita , Dhiman Soniya , Agrawal Neelabh 
Published: March 2017

Background: Cholelithiasis (gall stone disease) is a well-known disease worldwide. Ultrasonography is the most common screening test for cholecystitis and cholelithiasis. Laparoscopic Cholecystectomy is considered the treatment of choice for symptomatic gall stone disease. It is important to know the different clinical, radiological parameter and specific predictor that give some prediction of difficult LC. The aim of this study was to predict the difficulty of LC and the possibility of conversion to OC before surgery using the clinical and ultrasonographic criteria in our set up.Methods: The present study was carried out in the Department of surgery, Sarojini Naidu Medical College Agra, from November 2014 to October 2016. A total of 210 patients were enrolled for the laparoscopic cholecystectomy. All patients who were included in the study were undergone detailed history and clinical examination. A number of clinical and ultrasonographical parameters were noted.Results: Amongst the 210 patients admitted for laparoscopic cholecystectomy, 21 (10%) were male and 189 (90%) female, with age ranging from 12–60 years. The conversion rate in our study was 4.5% (9 of 210). In our study significant pre-operative factors which increased the conversion rate to open cholecystectomy includes male gender, obesity, abdominal scar of previous surgery, contracted and thickened gall bladder and patients having stone impacted at the neck of gall bladder.Conclusions: From this study, we conclude that preoperative ultrasonography is a good predictor of difficult laparoscopic cholecystectomy in the majority of cases and should be used as a screening procedure.
Is it time to write obituary for open choledocholithotomy in the present era of endoscopic management? Outcome of surgery for failed endoscopic extraction, retrospective study
Authors: Sharma Rajkumar , Kumar Vipan , Gupta Niraj , Rana Kirti , Dogra Amit , Nanda Anupam 
Published: March 2017

Background: Between 05 to 20 percent of patients undergoing cholecystectomy for gallstones, have choledocholithiasis. Treatment of the common bile duct (CBD) stones can be conducted as open cholecystectomy and open CBD exploration or laparoscopic cholecystectomy plus laparoscopic CBD exploration (LC + LCBDE) versus pre- or post-cholecystectomy endoscopic retrograde cholangiopancreatography (ERCP) in two stages, usually combined with either sphincterotomy or sphincteroplasty (papillary dilatation) for CBD clearance. The merits and demerits of individual techniques are yet to be settled.Methods: We reviewed the outcome of patients operated at our centre after failed endoscopic clearance of CBD stones. Over a period of 03 years, total 2145 laparoscopic/open cholecystectomies were performed at our institute. In the same time period, 14 patients (06 males and 08 females) presented with choledocholithiasis after failed ERCP extraction (median age 59 years, range 29-62 years). All the patients had undergone ERCP and ± sphincterotomy/sphincteroplasty with failed clearance. None of the patient had undergone a cholecystectomy previously.Results: We performed open choledocholithotomy with T-tube drainage plus cholecystectomy in all the patients. There were no deaths and only one major complication. Surgery resulted in complete duct clearance in 93% of patients.Conclusions: Open surgery can be performed safely and effectively in patients with retained bile duct stones and surgery can be offered as primary modality of treatment over combined endoscopic management after appropriated patient selection.
Non-traumatic intestinal perforation in the regional hospital Borgou of Benin: epidemiological and therapeutic characteristics
Authors: Allode Alexandre S. , Dossou Francis M. , Hodonou Adrien M. , Séto Morel , Gbessi Gaspard D. , Sambo Bio Tamou , Olory-Togbé Jean-Léon T. 
Published: March 2017

Background: Non-traumatic small bowel perforation is common condition in our income countries. This study aims to determine the pattern of non-traumatic intestinal perforation in our environment.Methods: The demographics, clinical features, relevant investigations, surgery performed and outcome of all the patients confirmed at surgery with intestinal perforation were collected for five years and the data analyzed using version 3.5.1 of Epi Info.Results: Out of the 69 cases involved in this study, there were 46 (66.7%) males and 23 (33.3%) females with a male/female ratio of 2; their mean age was 22.5±13.7 years (range 2 - 68 years). Young people in school constituted 23 (33,34%) of the cases and typhoid intestinal perforation was responsible for 64 (92.8%) cases while ischemic perforation as a result of postoperative flange, strangulated hernia and acute intussusception was responsible in 5 (7.2%) cases. The average duration before presentation in the hospital was 3 days while the average duration between presentation at the hospital and surgery was 2 days. The surgery offered was simple closure after freshening the edges in 35 (50.7%) cases, resection and anastomosis in 28 (40.5%) cases and resection with ileostomy in 6 (8.8 %) cases. The immediate postoperative course was uneventful in 64 (92.8%) case while the mortality was 10 (14.5%). The cause of death was not identified in 3 cases. The average hospital stay was 14.5±12.8 days with extremes of 7 and 55 days.Conclusions: NTIP is relatively common among the causes of widespread acute peritonitis in sub-Saharan Africa and its management remains difficult with high mortality.
Low dose spinal anesthesia for open cholecystectomy: a feasibility and safety study
Authors: Laoutid Jaouad , Sakit Fouad , Jbili Nabil , Hachimi Moulay Ahmed 
Published: March 2017

Background: Cholecystectomy is performed either open or a laparascopic route. the traditional and invasive open cholecystectomy is still in frequent practice for various reasons. Spinal anesthesia (SA) has been widely used as alternative to General Anesthesia (GA) for laparoscopic cholecystectomy. SA could be a safe and effective anaesthetic procedure for open cholecystectomy. This study was conducted to uncover feasibility and safety of low dose SA for conducting open cholecystectomy.Methods: All consented patients of ASA grade I and II of either sex scheduled for elective open cholecystectomy received SA using 2 ml of 0.5% hyperbaric Bupivacaine mixed with 100 µg Morphine. Peri-operative preparations and management were all standardized. Other drugs being only administered to manage anxiety, pain, nausea/vomiting, hypotension, and any adverse event. Open cholecystectomy by right oblique incision. Intra-operative events and post-operative events were observed for 48 hours, operative difficulty, post operative pain free interval, analgesia requirements, hospital stay and the surgeon and patient satisfaction were studied.Results: 20 patients were included in the study from 1st may 2016 to December 2016. Spinal anesthesia was adequate for surgery in all patients. Operative difficulty scores were minimal and surgery in one patient was converted to open cholecystectomy. Intraoperatively, five patients presented hypotension and Ephedrine was given. Four patients experienced pain and received Fentanyl and midazolam. Postoperatively, pain scores were minimal and paracetamol was not sufficient only in four patients who received ketoprofen and no patient received opioid. One patient required antiemetic for vomiting and two patients suffered urinary retention and one headache. 19 patients were discharged within 48 hours of surgery and patient satisfaction scores were very good.Conclusions: Spinal anesthesia is safe and effective anesthetic technic for uncomplicated open cholecystectomy in terms of peri-operative events and, in prolonged post-operative analgesia, as well as in terms of patient and surgeon’s satisfaction.
Clinical study and management of pseudocyst of pancreas
Authors: Babu G. Rajashekara , Venkatesh Sahanashree , K. Ramakrishnan , Jain Pravesh 
Published: March 2017

Background: Pancreatic pseudocysts can occur as a complication of acute or chronic pancreatitis. Understanding of pseudocysts has changed with times due to advancement in radiology and introduction of new treatment modalities. This study was done to access clinical features etiology and various managements for pseudocyst in a tertiary care hospital.Methods: It is a prospective study of 40 adult patients admitted in Victoria and Bowring and Lady Curzon Hospital, attached to Bangalore Medical College and Research Institute, Karnataka, India from January 2015 to December 2016.Results: Pseudocysts are more common in males. The commonest etiology associated was alcohol. Ultrasound was the basic radiological investigation done in all patients followed by CECT abdomen. Complications associated with pseudocyst were Gastric outlet obstruction and ascites. Internal drainage was done in most of the patients. Post drainage complications included infection which was managed by antibiotics and endoscopic drainage in case of recollection. Pain was most important post-operative complication. Endoscopic drainage is being preferred as it is less invasive, has a high long term success rate, has shorter duration of hospital stay and more patient comfort.Conclusions: Pseudocyst of pancreas is most commonly seen in males probably because of alcoholism. Clinical presentation can be varied, with pain abdomen being the most common complaint followed by, nausea vomiting. Initial management consists of supportive care and if the symptoms persist and complications develop surgical drainage was the most common management modality. Newer modalities of treatments like endoscopic intervention have an added advantage of lesser pain, shorter duration of hospital stay and recurrence.
Cervical lymphadenopathy: a clinicopathological study
Authors: Motiwala Mohammed Ali , Dalmia Deepak , Behara Sanjaya Kumar 
Published: March 2017

<p class="abstract">Cervical lymphadenopathy is one of the commonest presentations of underlying pathology of the head and neck region which has large number of differential diagnosis like neoplasms, infections (specific and non-specific), immune deficiency disorders and rare disorders like Inflammation. Pseudotumour (plasma cell granuloma) and Kikuchi-Fujimoto disease.</p><p class="abstract"><strong>Methods:</strong> The present study is a prospective study conducted in our institution Dr B.A.M. Central Railway Hospital, Mumbai. Our study included 115 patients with cervical lymphadenopathy presenting with swelling of more than 1.5 cm size in longest diameter. All the patients included in our study are more than 12 years of age, in whom the lymph node did not regress after adequate antibiotic therapy in acute cases (i.e. Conservative management for at least 2 week), and all the chronic cervical lymphadenopathy patients. </p><p class="abstract"><strong>Results:</strong> Tuberculosis was found to be the most common cause of cervical Lymphadenopathy in 54.78% cases followed by reactive lymphadenitis in 22.61% cases, chronic nonspecific lymphadenitis in 12.17% cases and metastatic lymphadenopathy in 7.83% cases. Other causes were unknown primary in 1.74% cases and non-Hodgkin’s lymphoma in 0.87% cases. Sensitivity and specificity of FNAC was 79.36% and 100% respectively.</p><p><strong>Conclusions:</strong> Tuberculosis, reactive lymphadenitis and malignancy are the most important cause of cervical Lymphadenopathy. They present in different age groups with different clinical feature. Fine Needle Aspiration Cytology (FNAC) is extremely sensitive and highly specific investigation for early diagnosis</p>
Accuracy of FNAC in diagnosing thyroid swelling: a retrospective study
Authors: Shetty Hamsa , S. Sridhar , K. S. Gangadhar 
Published: March 2017

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Aim of the study was to determine the accuracy of FNAC in diagnosing thyroid swellings. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A Retrospective study was conducted over a period of one year (September 2014 to September 2015), which included 54 patients, who presented with thyroid swelling to the ENT outpatient department.All the above patients were subjected to FNAC,and were operated for the swelling, their histopathological report were correlated with the pre-operative FNAC report to determine the accuracy of FNAC in correctly diagnosing the thyroid swelling. The data in this study was analysed using statistics analysis system (SAS) software. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Majority of the patients was in 3rd decade and females were more than males. The accuracy of FNAC in diagnosing thyroid swelling in the present study was found to be 77.78%. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">FNAC is a safe, quick and inexpensive technique in diagnosing thyroid swelling with high degree of accuracy.</span></p>
Comparative study between microscopic and endoscopic stapes surgery
Authors: Harikumar B. , Arun Kumar K. J. 
Published: March 2017

<p class="abstract"><strong>Background:</strong> To investigate whether endoscopic stapes surgery is safer and less invasive than conventional stapes surgery using an operating microscope.</p><p class="abstract"><strong>Methods:</strong> The subjects were 60 patients who were divided consecutively into group A undergoing microscopic stapedotomy and group B undergoing endoscopic stapedotomy. The procedures for endoscopic surgery were fundamentally the same as those for microscopic surgery, except for post aural incision used in some patients in microscopic group. The two surgical techniques were compared with respect to the operating time, approach, drilling of posterosuperior canal, manipulation of chorda tympani, visualisation of anterior crus, postoperative hearing, postoperative pain, and complications. </p><p class="abstract"><strong>Results:</strong> There were no differences of operating time or postoperative hearing between the endoscopic and microscopic groups. There was very little postoperative pain in the endoscopic group. Drilling at the posterosuperior part of the external auditory canal was less extensive in the endoscopic group than in the microscopic group. Visualisation of anterior crus of stapes was good in endoscopic group.</p><p><strong>Conclusions:</strong> Endoscopic stapes surgeries are technically feasible, safe and promising. The main advantages were: easy access, virtually no trauma to the chorda tympani nerve and excellent vision. The disadvantages were the lack of stereoscopic vision, having to work with one hand only and the learning curve. </p>
Obstructive sleep apnoea in children –a neglected entity
Authors: K. Biniyam , Thotambailu Amulya M. , Kamath Shrinath 
Published: March 2017

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Obstructive sleep apnoea syndrome (OSAS) is a spectrum which includes primary snoring, upper airway resistance syndrome, obstructive hypoventilation and obstructive sleep apnoea. Sleep disordered breathing (SDB) is characterized by snoring, witnessed apnoea, frequent arousal, mouth breathing, restless sleep, irritability, recurrent upper respiratory tract infections etc. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This was a prospective observational study which included 20 children who presented to the otorhinolaryngology, pulmonary medicine, paediatric, oral and maxillofacial department were included in the study with clinical symptoms of obstructive sleep apnoea. </span></p><p class="abstract"><strong>Results:</strong> 20 children, 13 (65%) males and 7 (35%) females were included. Snoring was the most common complaint.15 (75%) were obese, 5 had adenotonsillar hypertrophy(25%) as the risk factor for OSA. 15 out of the 20 children were graded under mallampati class 1(75%), 4 class 2(20%), 1under class 3(5%). There was no significant association in severity of OSA between 2 genders (p=0.82). <span lang="EN-IN">Positive correlation (r=0.52) was found between AHI and BMI and is found to be statistically significant (p=0.02), which suggests that degree of obesity does predict the severity of OSA. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Obesity is the most significant risk factor among them followed by adenotonsillar hypertrophy. Hence children who snore should undergo polysomnography and necessary corrective measures should be prescribed.</span></p>