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Background: Open appendectomy has been the conventional choice of treatment for acute appendicitis. However, nowadays laparoscopic approach is emerging for the benefits it provides, like lesser postoperative pain and lesser duration of hospital stay, but at the cost of higher expenses and longer operative duration. Methods: A retrospective cohort study was done at Shree Birendra Hospital from January 2018 to December 2021, with a total study population of 450 participants (300 in open appendectomy and 150 in laparoscopic appendectomy). Preoperative. Intraoperative and postoperative parameters were compared and analyzed between two groups using SPSS-25. Results: The mean age was 26.72 ± 9.70 in the open appendectomy (OA) and years 23.89 ± 6.32 in the laparoscopic appendectomy (LA) group. (p = 0.010) There was a significant difference between the mean operative time (46.08 ± 13.10 min in OA and 56.86 ± 11.70 min in LA, p = 0.000), length of hospital stay (1.28 ± 0.80 days in OA and 1.07 ± 0.25 days in LA, p = 0.000), course of oral analgesics (3.55 ± 0.68 days in OA and 3.00 days in LA p = 0.000) between OA groups and LA groups, while the total number of complications was less in the LA group however there was no statistically significant difference postoperative complications (p = 0.124) between the two groups in the surgical findings. Conclusion: All in all, the laparoscopic approach is a better option for uncomplicated appendicitis due to its less postoperative pain and shorter duration of hospital stay.
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Introduction: Acute pancreatitis is the inflammation of pancreatic parenchyma characterised by severe abdominal pain and nausea. It is a common gastrointestinal disease requiring hospital admission. The death rate for mild acute pancreatitis is low but severe acute pancreatitis can reach up to 40%. This study aimed to find the prevalence of acute pancreatitis among patients attending the Department of Surgery in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted from 1 October 2021 to 30 March 2022. The study was conducted after receiving ethical approval from the Institutional Review Committee (Registration number: 454). Patients with age more than 18 years were included and patients less than 18 years of age including those suffering from chronic pancreatitis, pancreatic malignancy or immunocompromised states were excluded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 1560 patients, the prevalence of acute pancreatitis in our study is 120 (7.69%) (2.92-12.46, 95% Confidence Interval). Out of them, 57 (47.50%) were males and 63 (52.50%) were females. Out of total, hypertension found in 52 (43.33%) was the most common co-morbidity observed followed by diabetes mellitus 18 (15%). Similarly, 80 (66.67%) patients had mild pancreatitis whereas 40 (33.33%) had moderate pancreatitis and 8 (6.67%) had severe pancreatitis. Conclusions: The prevalence of acute pancreatitis among hospital admissions in the department of surgery in a tertiary care centre was found to be similar to other studies done in a similar setting. Keywords: acute pancreatitis; gastrointestinal disease; prevalence.
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Pancreatitis , Femenino , Masculino , Humanos , Adolescente , Pancreatitis/epidemiología , Estudios Transversales , Centros de Atención Terciaria , Enfermedad Aguda , InflamaciónRESUMEN
Introduction: The incidence of acute mesenteric ischemia (AMI) among critically ill COVID-19 patients has been reported ranging from 3.8 to 4 %. Presentation of case: A 57-year-old female presented with acute abdomen for last three days and tested positive for COVID-19. Abdominal X-ray showed prominent dilated small bowel loops with multiple air fluid levels, and absence of a completely visible colon. She underwent emergency laparotomy where blackish gangrenous bowel loops were seen and resected. Discussion: CECT scan in over half of the AMI patients may show patent mesenteric vessels. However, such patency of mesenteric vessels should not rule out the possibility of AMI in cases of COVID-19 with prominent GI signs and symptoms, especially those admitted in ICU. Conclusion: AMI is a life-threatening complication that may occur in COVID-19 patients. It should be suspected in COVID-19 patients complaining of severe abdominal pain in addition to pulmonary symptoms.
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The presentation of solitary rectal ulcer syndrome is very similar to a wide variety of conditions including inflammatory bowel diseases, ischemic colitis and rectal carcinoma. Histopathological examination comes as an important tool for its diagnosis. Hence, high index of suspicion is required for early diagnosis of this rare condition.
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Background: Intra-peritoneal onlay mesh (IPOM) repair, a type of Laparoscopic Ventral Hernia Repair (LVHR), comprises bridging the defect from the peritoneal side with a composite mesh. Recently, IPOM-Plus has become the recommended type of LVHR in which the defect in the fascia is sutured before placing the mesh. Materials and methods: This study is a retrospective cohort study conducted at Shree Birendra Hospital (SBH), Nepal. Patients who had undergone IPOM-Plus or IPOM during the past five years (Aug 2016 to Aug 2021) were selected. Data regarding demographics, intraoperative and post-operative outcomes were collected from individual case sheets. Recurrence of hernia was checked at six-month follow-up. Data analysis was performed using SPSS version 25 taking a p-value of <0.05 as statistically significant. Results: A total of 130 patients were included in this study, out of which 73 patients had undergone IPOM (Group I) and 57 patients underwent IPOM-Plus (Group II). In both the groups, there were no statistical difference in age, sex and Body Mass Index (BMI) of the patients. Hernia defect size among Group I and II varied significantly (p-value < 0.001). The mean operative time for Group II (111.05 ± 28.14 min) was significantly higher than Group I (80.00 ± 27.96 min) (p-value < 0.001). Hernia recurrence within six months was higher in Group I (15.1%) than Group II (3.5%) (p-value = 0.029). The adjusted odds ratio (AOR) for six-month recurrence after IPOM repair was 14.86 (95% CI: 2.51-87.85, p-value = 0.003) times higher than that after IPOM-Plus repair. Conclusions: Although the operative time and length of hospital stay is longer, IPOM-Plus repair has shown better outcomes regarding six-month recurrence compared to IPOM repair.
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Introduction: Chronic kidney disease is defined as structural or functional damage of the kidney persisting for three or more months. Studies have shown hypertension and diabetes as the leading causes of chronic kidney disease. The aim of this study is to find out the prevalence of end-stage renal disease patients undergoing haemodialysis in a tertiary care hospital. Methods: This was a descriptive cross-sectional study conducted among 96 patients undergoing haemodialysis from February 13, 2021 to April 4, 2021 in the hemodialysis unit of a tertiary care centre after receiving ethical clearance from the Institutional Review Committee (Reference number: 354). Convenience sampling was done and all patients older than 18 years who were on maintenance haemodialysis on an outpatient basis were included in the study. Data were collected using a self-administered questionnaire. Data were analysed using the Statistical Package for the Social Science version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data and mean with standard deviation for continuous data. Results: Among 96 patients undergoing haemodialysis, the prevalence of end-stage renal disease was 83 (86.45%) (79.60-93.30 at 95% Confidence Interval). The most common underlying condition was hypertensive nephropathy in 34 (40.96%) patients, followed by both hypertensive and diabetic nephropathy in 26 (31.33%) patients. Conclusions: The prevalence of end-stage renal disease in our study was higher when compared to similar studies conducted in similar settings. Early diagnosis and adequate treatment of hypertension and diabetes could be crucial to reducing the prevalence of the end-stage renal disease. Keywords: chronic kidney failure; chronic renal insufficiency; end stage renal disease; hemodialysis; Nepal.
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Nefropatías Diabéticas , Hipertensión , Fallo Renal Crónico , Insuficiencia Renal Crónica , Estudios Transversales , Unidades de Hemodiálisis en Hospital , Humanos , Hipertensión/epidemiología , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/terapia , Diálisis Renal , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/terapia , Centros de Atención TerciariaRESUMEN
INTRODUCTION AND IMPORTANCE: In blunt abdominal trauma, small bowel and mesentery injury (SBMI) is the third most common organ injury with an estimated incidence of 1-5%. Traumatic mesenteric injuries are difficult to diagnose and their undiagnosed complications are severe with high mortality rates. CASE PRESENTATION: A 21-year-old male presented to the emergency room with severe colicky pain in the right-hypochondrium 2 h after dinner. He gave history of nausea, vomiting and diarrhea after dinner and before the pain started. The morning after admission, a Contrast Enhanced Computed Tomography (CECT) scan was done which showed a large mesenteric hematoma. On subsequent questioning, the patient then recalled a blow to the abdomen while playing basketball two days ago. Since the patient was hemodynamically stable, non-operative management (NOM) was chosen with close monitoring. Regular follow-up ultrasonography (USG) scans showed progressive spontaneous resolution of the hematoma. CLINICAL DISCUSSION: Nonspecific symptoms of mesenteric hematoma make it difficult to reach a diagnosis. It is usually identified by history or medical imaging. Mesenteric hematoma can be managed conservatively if there is no active bleeding. In stable patients, selective visceral angiography should be performed and bleeding vessels should be embolized where possible. CONCLUSION: This case highlights a successful conservative management of a large traumatic mesenteric hematoma. It also emphasizes the importance of eliciting a detailed history of major or minor trauma for any patient with abdominal pain. Previous cases have also highlighted the importance of non-operative management and avoidance of emergency laparotomy in stable patients.
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INTRODUCTION: Scrub typhus presents with diverse clinical manifestations which range from sub-clinical disease to organ failure and fatal disease. CASE PRESENTATION: The patient presented with fever followed by acute abdominal pain and later developed septic shock with multi-organ failure. Radiological evaluations were normal, however, on thorough physical examination, an eschar was found in her right inguinal region. CLINICAL DISCUSSION: Aside from classical clinical symptoms, it can also involve various organs, most commonly of respiratory, cardiovascular and hepatic systems. Additionally, suspected patients should be thoroughly examined for the presence of an eschar, especially over the covered areas such as the groin, genitalia, infra-mammary area and axilla. CONCLUSION: Scrub typhus should be considered in all patients from an endemic area presenting as acute undifferentiated febrile illness associated with organ involvement. Positive finding of an eschar and high index of suspicion for the various presentations of scrub typhus can avoid unnecessary surgical exploration and aid in prompt diagnosis and treatment.
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INTRODUCTION AND IMPORTANCE: Appendiceal neuroendocrine tumors (ANETs) are incidentally found in 0.2-0.7% of appendectomies for suspected appendicitis. CASE PRESENTATION: A 29-year-old female presented with pain in the right lower quadrant of her abdomen for the past 48 h. On emergency appendectomy for suspected acute appendicitis, a perforated appendix was found. Histopathological examination showed grade 1 (low) ANET. CLINICAL DISCUSSION: Appendiceal neuroendocrine neoplasms (ANENs) are commonly found at the tip of the appendix and are treated with appendectomy alone. For few ANENs located at the base, or small tumors (≤2 cm) infiltrating the submucosa, the muscularis, the subserosa layer or the mesoappendix, right hemicolectomy is recommended. However, no guidelines have been established concerning patients with appendiceal perforation in case of ANENs. CONCLUSION: Although rare, ANETs should be considered in the differential diagnosis of acute appendicitis. Since, ANETs are rarely diagnosed preoperatively, subsequent patient evaluation after appendectomy is crucial for management of the patient.
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INTRODUCTION AND IMPORTANCE: Delayed Splenic Rupture (DSR) is a rare but well-known presentation of Blunt Splenic Injury (BSI), most of which occur due to motor accidents, fall from height or direct blow to the left thorax or abdomen. Here we present a case of DSR five days after a trivial trauma. CASE PRESENTATION: A 37-year-old female presented with pain in the left-hypochondrium after an accidental bump against a furniture at home. Initially, it was a grade III splenic injury but upon arrival to our hospital from her hometown it had progressed to grade IV. Since the patient was hemodynamically stable, non-operative management (NOM) was chosen with close monitoring at the intensive care unit (ICU). However, the next morning, the patient deteriorated, showing signs of hemorrhagic shock, and a successful emergency splenectomy was done. CLINICAL DISCUSSION: Over the last two decades, there has been an increasing inclination of surgeons towards NOM, even for high grade injury. NOM failure has been found to be associated with advancing age, high Injury Severity Score (ISS) or splenic injury. Some factors that improve the success of NOM are admission to ICU/floor, frequent monitoring of hemoglobin/hematocrit, vital signs, abdominal examination, and limiting heavy physical activity. CONCLUSION: Clinicians should not limit the possibility of occurrence of DSR to only major traumatic events. It is imperative that a detailed history of major or trivial trauma in the preceding weeks be elicited for any patients presenting with abdominal pain.
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BACKGROUND: Medical students are more prone to burnout than the general population and students of other faculties due to the demanding nature of medical education with limited time and resources. Burnout has a negative impact on the academics and personal life of the students which can continue into their professional life and ultimately hamper patient care. The purpose of this study is to determine the prevalence of burnout among medical students of a medical college and find its association with age, gender, and year of study. MATERIALS AND METHODS: This cross-sectional study was conducted among medical students of a medical college in Kathmandu, Nepal from 14 January to 7 March, 2021. Stratified sampling followed by a simple random sampling technique was employed to select study participants. Data was collected through a self-administered questionnaire using the English version of the Oldenburg Burnout Inventory adapted for students (OLBI-S) and analyzed in STATA version 15. RESULTS: The prevalence of burnout was found out to be 65.9% (n = 229). And of the remaining, 12.7% were exhausted, 11.4% were disengaged and 10.0% were neither exhausted nor disengaged. Burnout had no significant association with age in years, gender, and year of study. CONCLUSIONS: This study shows an alarming prevalence of burnout in almost two-thirds of medical students. These results indicate the necessity of employing effective strategies by relevant authorities for the mental well-being of future physicians. Further multicenter prospective studies are required for a better understanding of the prevalence and associated factors of burnout.