PERITONEAL CLOSURE VERSUS NON-CLOSURE IN OPEN APPENDICECTOMIES

Acute Appendicitis is a common surgical emergency and Open Appendicectomy is widely performed. This study aims to analyze the difference of outcome in peritoneal closure versus Non closure in open appendicectomy. Adult patients (18- 65 years) admitted and operated for Acute appendicitis were studied prospectively from July 2019 to July 2020 at King George Hospital, Visakhapatnam. The intra operative time, post-operative pain, wound infection and duration of hospital stay were analyzed. Between July 2019 and July 2020 there were 86 patients with diagnosis of Acute appendicitis to the emergency casualty of KGH, Visakhapatnam and underwent Open appendicectomy. They were divided into two groups randomly, Group A: Open appendicectomy with peritoneal closure (39) and Group B: Open appendicectomy with non-closure of peritoneum (47). There was found to be a reduction in the duration of surgery, less post operative pain and shorter duration of hospital stay in patients who underwent non-closure of peritoneum compared to patients who underwent peritoneal closure. There was no difference in incidence of post-operative wound infection when compared to closure of peritoneum. Non closure of peritoneum is associated with shorter operative time, reduced requirement of post-operative analgesia and shorter duration of hospital stay and hence can be safely recommended.

Intracranial Lesions Presenting as Bony Swellings of Scalp – An Observational Study of 13 Cases at King George Hospital, Visakhapatnam, A Tertiary Care Government Hospital

BACKGROUND The purpose of this study was to evaluate the intracranial lesions eroding the calvarium and presenting as bony swellings of the scalp. This kind of presentation is usually rare. This is because intracranial tumours usually manifest early with focal neurological deficits, seizures or features of raised intracranial pressure. Only a few patients, in whom the intracranial lesions, despite being present for a long duration, do not have neurological manifestations but erode the overlying bone and may present as bony swellings of the scalp. We studied the clinical presentation of such lesions, analysed their radiological and histological characteristics. METHODS This is an observational study from October 2018 to September 2020. A total of thirteen cases were studied in the Department of Neurosurgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh. After clinical examination, an appropriate diagnostic workup was done, and all the cases were taken up for surgery. The clinical behaviour and histopathological features of the lesions were analysed. RESULTS In our study of thirteen cases, the most common cause of an intracranial lesion presenting as bony scalp swelling is meningioma which comprised almost 53.8 %, the second most common lesion is secondaries. Others included fibrous dysplasia and malignant small blue round cell tumour. CONCLUSIONS Intracranial lesions eroding the bone and presenting as scalp swellings are rare. In our study, the spectrum of these scalp swellings has ranged from benign lesions like meningioma to malignant lesions like secondary deposits. KEYWORDS Bony Scalp Lesions, Intracranial Tumours with Bony Erosion, Dumbbell Brain Tumours

Ectopic Pregnancy - A 1 Year Clinical Study in King George Hospital, Visakhapatnam

BACKGROUND Ruptured ectopic is a life threatening obstetric emergency. Obstetrician must have a high index of suspicion for ectopic pregnancy and should be aware of importance of early diagnosis and early intervention. The present study was undertaken to evaluate the incidence, clinical presentation, risk factors, treatment and morbidity associated with ectopic pregnancy. METHODS Retrospective analysis of ectopic pregnancy was done in King George Hospital, Visakhapatnam from January 2020 to December 2020 in the department of OBG. The following parameters: Age, risk factors, clinical presentation, site of ectopic, diagnostic methods, mode of treatment were noted. RESULTS A total of 63 cases were reported during this time frame. It is a tertiary care centre getting referrals from nearby districts and other hospitals. Incidence of ectopic pregnancy in the present study is 0.89 %. 41.26 % of patients belonged to age group between 26 to 30 years. Out of 63 cases 49.20 % were multigravida. 28 % of the cases were associated with previous H/O abortions and 23 % of the cases were associated with PID and in 17.4 % of the cases there was no predisposing factors. 96.82 % the patients presented with pain abdomen. Shock in 34.92 % of the cases. Ampulla is the most common site of ectopic. In 76 % of the cases there was hemoperitoneum > 500 ml. Salpingectomy was done in 79.3 % cases. 84 % of cases required blood transfusion > 1 unit. There was no mortality. CONCLUSIONS Ectopic pregnancy is one of the obstetric emergency with significant morbidity and mortality. PID and post abortal sepsis are one of the important risk factors for ectopic pregnancy. As many patients may not have recognizable risk factors, a high index of suspicion is critical for early diagnosis. Early USG diagnosis of ectopic pregnancies reduces mortality and enables us to offer the patient conservative medical and surgical treatment. KEYWORDS Ectopic Pregnancy, TVS, Ampulla, Salpingectomy

PREVALENCE AND OUTCOME OF THROMBOCYTOPENIA AND ITS CORRELATION WITH CRP IN NEONATAL INTENSIVE CARE UNIT

Introduction: Neonatal thrombocytopenia, one of the most common hematological abnormalities in neonates particularly in premature and sick neonates. The aim of this study to study the prevalence and outcome of Thrombocytopenia and its correlation with CRP in the neonatal intensive care unit. Objectives: 1. To nd the prevalence of Thrombocytopenia in the Neonatal intensive care unit in King George Hospital. 2. Factors that predisposing to Thrombocytopenia in neonates 3. Outcomes of thrombocytopenia in neonates. 4. Correlation of thrombocytopenia with the C-reactive protein (CRP) in neonates. Materials And Methods: It is a cross -sectional study in 80 Newborns less than or equal to 28 days admitted in NICU, king George hospital, Visakhapatnam from JANUARY 2019 to JUNE 2020 over period of 18 months. Data is collected from the medical records. Results: The prevalence of thrombocytopenia in this study is 40% with early-onset thrombocytopenia being 65% whereas, that of late-onset thrombocytopenia is 35% ,strong assosciation is found between thrombocytopenia and sepsis ,with mild to moderate variety being (86.4%) and (40%) of severe thrombocytopenia group. Of 80 newborns ,90% of severely thrombocytopenic group have positive CRP, whereas it is 40.9% in the mild to moderate group and 1.4% in normal group.40% of severe thrombocytopenic group had elevated PT, APTT, INR. There was higher proportion of bleeding (45.5%) in severe thrombocytopenia group. gastrointestinal bleeding constituted for 36.4% and intracranial bleeding 2.1% . Conclusion: Positive septic workup is signicantly association with thrombocytopenia, CRP was signicantly association with thrombocytopenia in this study

SURGICAL MANAGEMENT OF ODONTOID FRACTURES, AN INSTITUTIONAL EXPERIENCE.

Introduction- Odontoid fractures occur as a result of high impact trauma to the cervical spine. Hyperextension of the cervical spine is The most common mechanism of injury. Odontoid fractures occurs in 10 to 15% of all cervical spine fractures . Fracture of the odontoid process is classied into one of three types which are type I, type II, or type III fractures. Of all the types of odontoid fractures, type II is the most common and accounts for over 50% of all odontoid fractures . Materials and Methods- This is a prospective study conducted over 2 years in Neurosurgery Department, Andhra Medical College & King George Hospital, Visakhapatnam. Result: A total of 18 odontoid fractures were managed in the period of two years, out of which 2 were kept conservative and 16 were operated. Out of 16, 11were operated with odontoid screw and 2 underwent C1-C2 xation and 3 patients underwent Transoral Odontoidectomy with posterior occipito-cervical xation Conclusion: The treatment of odontoid fracture is complex and should be planned according to the type of odontoid fracture and neurological decit. Odontoid screw will sufce in patients with type II fracture with undisplaced fragments. Posterior C1-C2 xation is a better choice for complex odontoid fractures. Transoral odontoidectomy and occipito-cervical xation is reserved as the last option.

An incident of massive styrene monomer gas poisoning

Following a temporary and partial shutdown of the LG polymers factory for nearly 44 days due to the COVID-19 lockdown, routine maintenance of the plant was affected. At around 3 a.m. on 7May 2020, a failure of the refrigeration system and the inhibitor tank attached to the styrene storage tank, resulted in an auto polymerization reaction that caused nearly half of the 1800 tonnes styrene gas stored to leak into the atmosphere. Since the volatile organic compound detection system was defunct, no alert or alarm was raised and, driven by north easterly winds, a cloud of toxic styrene gas spread over a radius of nearly 3 km, affecting five villages in the vicinity. The pungent smell was initially mistaken by the residents as emanating from a fire accident or a COVID-19 sanitization measure in the vicinity. Following initial triage, over 350 victims were hospitalized in various hospitals. 254 symptomatic adults and 64 children were shifted to the Government King George hospital. The main symptoms were burning sensation of eyes, skin and throat, nausea, vomiting, diplopia, muscle twitching, breathlessness and loss of consciousness. Nearly 10,000 residents from five villages were evacuated to relief camps set up in the perimeter and given first aid and food. There were 11 human and 22 animal fatalities in the immediate vicinity. This incident reports the world’s first fatalities due to massive styrene poisoning

Prevalence of surgical site infections and their sensitivity patterns in elective abdominal surgeries in King George Hospital, Visakhapatnam

Background: Surgical site infections are one of the most common complications in the postoperative period leading to increased morbidity, prolonged hospital stay and reduced quality of life. The present study aims to identify the incidence of surgical site infection (SSI), risk factors, causative organisms, and their sensitivity patterns in patients who have undergone elective abdominal surgeries.Methods: A prospective study containing 200 patients who have undergone elective abdominal surgeries from May 2018 to January 2020 were evaluated. A thorough history was taken in all the patients. A detailed clinical examination and routine investigations were done. Parameters such as body mass index (BMI), diabetic status, type of surgery, wound grading, culture, and sensitivity patterns were considered. The patients underwent treatment based on their investigatory reports.Results: In the present study, 54 patients developed surgical site infection, and among them, 22 are diabetics. Only ten patients with normal BMI developed SSI, whereas the other 44 patients who developed SSI had abnormal BMI. The incidence of SSI was higher in clean-contaminated surgeries comprising up to 89% of cases. Staphylococcus aureus was the most commonly isolated organism, and cefoperazone plus sulbactam was the most sensitive on antibiogram.Conclusions: The surgical site infections are on rising trend due to the emergence of antibiotic-resistant microorganisms. Treatment of the underlying risk factors, regular wound dressings, and antibiotics, according to sensitivity patterns, are the mainstay.

Study of onychomycosis

Background: Onychomycosis is one of the most common fungal nail infections caused by Dermatophytes, Non-Dermatophytic Molds (NDM) and Yeast. Though it is not life-threatening, can cause pain, discomfort, and disfigurement. It decreases the nail growth rate. Objectives: This study was carried out to document the clinico-mycological pattern and antifungal susceptibility pattern of onychomycosis.Methods: The study group included 130 consecutive patients with suspected fungal nail infections, attending Dermatology outpatient department of King George Hospital, Visakhapatnam, Andhra Pradesh during November 2012 to August 2014. The nail clippings of the patients were collected and subjected to KOH mounts for direct microscopy and fungal culture and antifungal susceptibility tests.Results: Onychomycosis was common among males (66.92%) than females (33.08%) with highest incidence was in age group 31-40 years (41.37%). Finger or toenails were exclusively involved in 32.18% and 55.18% patients respectively while these were involved concurrently in the rest of the 12.65% patients. Distal and lateral subungual onychomycosis seen in 64.36% of the patients was the most common clinical type. KOH and culture positivity were recorded in 56.92% and 48.46% cases respectively. Dermatophytes (50.58%) were predominant isolate followed by NDM (27.58%) and yeast (21.84%). Clotrimazole and ketoconazole were most effective antifungals against dermatophytes. For NDM, itraconazole, nystatin and amphotericin B and for yeast fluconazole and itraconazole were effective.Conclusions: The present study gives an insight about the aetiological agents causing onychomycosis and their anti-fungal susceptibility pattern in this region. Thus, it can help in taking adequate control measures to prevent it.