RESUMO
Appendiceal mucocele is an appendicular dilatation secondary to the intraluminal accumulation of mucous material. Adequate pre-operative diagnosis and surgical resection remains the standard management. Here, we present three cases of appendiceal mucocele. In the first case, a 60-year-old female presented with signs and symptoms of acute appendicitis and was admitted and operated. An inflamed distended globular cystic mass of appendix measuring 10 × 6 × 4 cm with a wide base was found and the patient underwent right hemicolectomy. In the second case, a 30-year-old male with symptoms and signs of acute appendicitis was admitted to the emergency department. An open surgery was performed and a distended, tense, and inflamed appendix without perforation of size 6 × 1 × 1 cm was discovered and removed. The diagnosis of mucocele appendix was suspected and confirmed by postoperative dissection of the specimen and histopathology. In the third case, a 25-year-old female patient was subjected to diagnostic laparoscopy in view of non-specific pain abdomen. A diagnosis of mucocele of appendix was made intraoperatively and removed using a specimen bag. Appendiceal mucocele with acute presentation is a rare pathology that clinically resembles acute appendicitis. Preoperative detailed investigations to reach a definitive diagnosis are critical for adequate surgical resection and overall outcome.
RESUMO
Background: Male circumcision is recommended practice in Muslim tradition and one of the oldest operations performed all over the world. Male circumcision is universal in our Muslim-dominated valley of Kashmir for religious reasons. It can be performed by different techniques such as the conventional open methods, the device methods and sutureless methods. The objective of this study was to report our practice of male circumcision amongst children and compare the different common surgical techniques and highlight the circumcision mishaps conducted by quacks in the Kashmir Valley. Materials and Methods: This was a comparative observational study conducted at SKIMS Medical College and Hospital, from 2017 to 2021. Children who presented for primary circumcision were subjected to one of two different surgical techniques; the dorsal slit or Guillotine method. The prospective analysis of children managed for circumcision mishaps conducted by non-professionals was also included in the study. Circumcisions done after 2 years of age were defined as delayed. The data were collected analysed using SPSS software (SPSS version 22, IBM, Armonk, NY, USA). Results: Total of 689 Kashmiri Muslim male children between 1 day and 10 years of age over a period of 5 years were studied. Six hundred and fifty-five children for primary circumcision and 34 children managed for circumcision mishaps were included in the study. Amongst the subjects for primary circumcision, the most number of children were between 1 and 2 years of age (33.28%). One hundred and fourteen (25.73%) hospital-delivered babies and 201 (94.81%) home-delivered babies had delayed circumcision that is after 2 years of age (P = 0.00001). Religious requirement was the only indication for circumcision in this study. Three hundred and ninety-six (60.46%) children were circumcised with dorsal slit and 259 (39.54%) with guillotine method using computer-generated random numbers. Complications were found 8.08% of subjects in dorsal slit method as compared to 16.60% in guillotine technique (P = 0.008). Out of 34 children managed for circumcision mishaps, 11 (32.35%) presented with massive bleeding after primary circumcision by half doctors, 18 (52.94%) had incomplete circumcision, 3 (8.82%) had multiple skin bridges and 2 (5.88%) had incomplete circumcision with glans injury. All the patients with circumcision mishaps were treated with good outcome. There was no mortality. Conclusion: Circumcision occurs at a wide range of ages and male circumcision is universal in our Muslim-dominated valley for religious reasons. Circumcision by quacks and the associated complications are still prevalent in our society. The procedure is safe and free of any major complications when conducted by trained medical personnel under aseptic conditions of the operation theatre and hence should be encouraged.
Assuntos
Circuncisão Masculina , Criança , Pré-Escolar , Humanos , Lactente , MasculinoRESUMO
BACKGROUND: Intestinal ascariasis is considered as state subject in our valley of Kashmir. The aim of our study was to analyse the age, clinical presentation, diagnosis, surgical complications, and management of Ascaris lumbricoides in children and adults. METHODS: Total of 312 patients above 2 years of age with definite clinical and radiological diagnosis of intestinal ascariasis and associated complications were included in our study. All our patients received anthelminthic drug (Albenzadole 400 mg stat) after termination of acute phase and attached to our Out-Patient Department for follow-up. Each patient was given second dose of antihelminthic drug at second follow-up visit. RESULTS: Total of 312 subjects included 131 (41.99%) males and 181 (58.01%) females. The highest number of patients was in age group of 6-10 years (46.47%). Colicky abdomen pain was the most common presentation and present in 80.12% patients followed by vomiting (64.1%). Palpable worm bolus was a cardinal sign present in 46.47% of our subjects. Two-hundred sixty-five (84.94%) patients responded uneventfully and were relieved of colic and obstruction after conservative non-operative treatment. Twenty (6.41%) patients underwent enterotomy and evacuation of worms, 2 (0.64%) subjects underwent resection anastomosis, and 8 (2.56%) patients had laparotomy and milking of worms into colon. None of patient expired during the study period. CONCLUSION: Ascaris lumbricoides is common cause of acute abdomen in our valley attributed to poor hygiene and low socioeconomic background. In patients of high clinical suspicion of worm obstruction, prompt investigations should be advised to reach a definitive diagnosis and prevent the development of complications. Significant efforts must be channelised at political and society levels for the prevention of this disease. Mass deworming programs should be adopted to overcome this menace.
Assuntos
Ascaríase , Obstrução Intestinal , Animais , Ascaríase/complicações , Ascaríase/diagnóstico , Ascaríase/cirurgia , Ascaris lumbricoides , Feminino , Hospitais , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestinos , MasculinoRESUMO
Type III von Willebrand disease is present in the Punjab province of Pakistan along with other inherited bleeding disorders like hemophilia. Cousin marriages are very common in Pakistan so genetic studies help to establish protocols for screening, especially at the antenatal level. Factors behind the phenotypic variation of the severity of bleeding in type III vWD are largely unknown. The study was conducted to determine Mutations/genetic alterations in type III von Willebrand disease and also to determine the association of different mutations, methylation status, ITGA2B/B3 mutations and alloimmunization with the severity of type III vWD. After informed consent and detailed history of the patients, routine tests and DNA extraction from blood, mutational analysis was performed by Next Generation Sequencing on Ion Torrent PGM. DNA methylation status was also checked with the help of PCR. In our cohort, 55 cases were detected with pathogenic mutations. A total of 27 different mutations were identified in 55 solved cases; 16 (59.2%) were novel. The mean bleeding score in truncating mutations and essential splice site mutations was relatively higher than weak and strong missense mutations. The mean bleeding score showed insignificant variation for different DNA methylation statuses of the VWF gene at the cg23551979 CpG site. Mutations in exons 7,10, 25, 28, 31, 43, and intron 41 splice site account for 75% of the mutations.
Assuntos
Doença de von Willebrand Tipo 3 , Doenças de von Willebrand , Metilação de DNA/genética , Feminino , Hemorragia/genética , Humanos , Isoanticorpos/genética , Mutação , Fenótipo , Gravidez , Doença de von Willebrand Tipo 3/diagnóstico , Doença de von Willebrand Tipo 3/genética , Doenças de von Willebrand/diagnóstico , Doenças de von Willebrand/genética , Fator de von Willebrand/genéticaRESUMO
We assessed the level of regular, periodic deworming and awareness of National Deworming Day in the local population in the endemic region of Kashmir by conducting a cross-sectional survey in the local population of patients (or their attendants for patients 18 years of age or younger) who visited the hospital as outpatients or were admitted as inpatients. The study team presented questionnaires with simple questions about deworming and child immunization to 1150 participants, noted responses, and then compiled the data. We found that the level of regular deworming was very low: only 3.7% (43/1150) of respondents regularly dewormed themselves and 16.34% (188/1150) dewormed their children at least once in a year. None of 1150 participants was aware of national deworming day despite having adequate knowledge about the immunization infrastructure. The immunization infrastructure can be used to improve public health in such circumstances.
Assuntos
Antinematódeos/uso terapêutico , Ascaríase/prevenção & controle , Promoção da Saúde , Programas de Imunização/organização & administração , Adolescente , Adulto , Antinematódeos/administração & dosagem , Criança , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Humanos , Programas de Imunização/métodos , Índia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Background : A comprehensive, thorough, accurate, legible and professional operative note allows seamless and proper transfer of patient care from the operating table to the postoperative care room and beyond. Further, incomplete and illegible handwritten operative notes in medico legal cases may be an Achilles heel in the surgeon’s defense. Aims : This study audited the quality of operative note keeping of general surgical procedures against the standards set by the Royal College of Surgeons of England (RCSE) guidelines. The aim of the study was to assess the compliance while also improving record keeping, documentation, the quality of operative notes, and educating surgery residents. Materials and Methods : The information from operative notes of every patient undergoing general surgical procedures was collected over a period of seven months. The data was formulated and analyzed using the SPSS version 20. Results : Total of 560 operative notes were recruited and audited. All the notes were hand-written, with the majority being written by postgraduate residents (86%).The postoperative care advice, fluid and antibiotic instructions were documented in the finest manner (100%). However, only 1% of the notes mentioned the Patients’ name, Gender and Age. All operative notes (>99 percent) included the names of the operative surgeon and assistants. The consultant in charge was documented in only 12 percent emergency notes and 100 percent elective procedures. The name of runners (Nursing Orderly) was missing from all the notes. Notably, no details of closure techniques were mentioned in any of the operative notes. Almost all of the operative notes were not signed properly to include the resident’s name and code. Conclusion : The quality of the operation notes that were entered into the patient’s case sheets was poor and insufficient, and it needed to be greatly improved. The findings of the study underline the necessity for residents to receive mandatory training on data collection and how to produce operative notes according to institutional