Clinical Profile of Patients with Acute Epichlorohydrin Poisoning - An Observational Study.

Epichlorohydrin is an organochlorine compound and a epoxide. It is a colourless liquid with a pungent, garlic like odour, moderately soluble in water, but miscible with most polar organic solvents. It is used in the production of glycerol, plastics, epoxy glues and resins, epoxy diluents and elastomers. Epichlorohydrin is a common chemical used in industry and Accidental exposure to Epichlorohydrin can occur in workers working in glycerol, plastics, epoxy glues and resins, epoxy diluents and elastomer factories. AIMS AND OBJECTIVES: To study the clinical profile of patients with Acute Epichlorohydrin Poisoning And identify the frequency and nature of lung involvement. MATERIALS AND METHOD: 30 patients of age 18 and above with Acute Epichlorohydrin poisoning were included in the study. Symptomatology and History, ABG, chest Xray and Hrct chest findings were included in the clinical profile. Distribution of responses were examined using frequencies and percentages and cross tabulation were done between various subgroups. OBSERVATION AND RESULTS: All the patients had accidental direct exposure to Epichlorohydrin. All the patients presented with acute onset respiratory distress and dry cough. Burning sensation and redness and watering from eyes with watering from nose were present in all the patients. Burning sensation in the throat was present in two third of the patient. Two third of the patients developed ARDS and of them 60 % developed moderate to severe ARDS. Two thirds of the patient required ICU admission and out of them 60 % required NIV support and rest 40% were managed by Oxygen via Facemask. Rest one third patient required admission in general ward. All the patients show heterogenous opacities in chest Xray. All the patients show patchy areas of consolidation with Ground Glass changes in HRCT Chest. Two third of the patients show pleural effusion in both Chest Xray and HRCT Chest and out of them 80 % patients show bilateral pleural effusion. CONCLUSION: ARDS of varying degree with mucosal irritation is the most common presenting feature of patients with ACUTE EPICHLOROHYDRIN POISONING. Pneumonia with HRCT chest showing Ground Glass Opacities are common.

A Prospective Comparative Study of 3-Stitch Mesh Hernioplasty with Conventional Lichtenstein Repair.

Background: Hernioplasty, in which a mesh is used to strengthen a weakness or defect in the inguinal wall, has replaced simple tissue repair. As it is associated with low recurrence, it is considered the gold standard and is one of the most common general surgical procedures. The ideal repair should be rapid, safe and simple to do, requires minimal dissection to create sufficient space, be cost-effective and be accompanied by a brief hospital stay, reduced pain, and fewer recurrences. The aim of the present study was to compare the efficacy of 3-stitch mesh fixation with that of traditional Lichtenstein mesh fixation of inguinal hernia repair. Materials and Methods: Between July 2018 and December 2019, 59 cases of primary, uncomplicated inguinal hernias were surgically treated. Both the classical Lichtenstein technique (group A, n = 30) and the Lichtenstein technique with the three-stitch fixation method (group B, n = 29) were used on patients with inguinal hernias. Between the two groups, the mean operative times, post-surgical pain scores, average hospital stays and postoperative complications including recurrence rates were compared. Results: With a P-value of 0.001, the 3-point fixation group (group B) took 3.41 ± 0.58 min less time to fix the mesh than the Lichtenstein group (group A, 5.52 ± 0.59 min). The pain after surgery was much less for participants who had 3-point mesh fixation than for those who had conventional mesh fixation in the early (1, 3, 7 and 15 days after surgery) and late (1 month and 3 months) postoperative periods, with a P-value of 0.0001. When compared to the classical mesh fixation group, the 3-point mesh fixation group had less urinary retention, seroma and swelling. Both groups had the same number of other complications. Conclusions: The three-point hernioplasty is a simple procedure that is easier to adopt, less time-consuming, causes less trauma and has a lower risk of postoperative discomfort including chronic groin pain.

Microalbuminuria and Essential Hypertension: A Critical Evaluation

Background: Recent advancements in diagnostic modalities for microalbuminuria have shown that urinaryexcretion of albumin is more in hypertensive patients as compared to subjects with normal blood pressure.Microalbuminuria is known to be associated with certain complications like dyslipidemia, cardiac complications,atherosclerosis and kidney disease. Purpose: To analyze the prevalence of microalbuminuria and its clinicalcorrelation with essential hypertension. Material and Methods: The study was of cross-sectional design,which was carried out in outpatient and inpatient departments of Medicine in DY Patil Medical School andHospital, Nerul, Navi Mumbai. Results: Out of total 190 study participants 96 were normotensive controls,while 94 were hypertensive patients. Mean age in control group was 48 ± 9.4 years, while that in hypertensivegroup, it was 49.2 ± 10.2 years. The 24 hours mean urinary excretion of albumin in hypertensive patients withmicroalbuminuria was found to be 80.21, while it was 12.91 and 7.89 in hypertensive patients withoutmicroalbuminuria and control groups, respectively. Conclusion: Early screening to detect microalbuminuriain early stages will help to initiate appropriate treatment regimen and prevent the risk of complications and thusimprovement in prognosis.

Prospective study of laparoscopic surgery in paediatric patients

Background: Laparoscopic cholecystectomy and laparoscopic appendectomy is gold standard treatment modality for symptomatic cholelithiasis and appendicitis. Laparoscopy in paediatric patient have many limitations and  factors restricting its use in paediatric patient are smaller surface area for access, compliant abdominal wall,  the liver margin  below the rib cage, the bladder being  an intra-abdominal structure, the viscera close to  anterior abdominal wall and small sized abdominal cavity and conventional instruments too long for paediatrics use.  The so-called obliterated structures like umbilical vein, umbilical artery and urachus remain relatively large and partially patent in infants further restricting use of therapeutic laparoscopy.Methods: The present study was carried out in Department of General Surgery, MDM Hospital, Dr. S. N. Medical College, Jodhpur, Rajasthan. Total 50 patients were included in the present study of laparoscopic surgery in paediatric patients below 14 years of age and were studied in terms of, duration of surgery, postoperative pain, analgesic requirement, postoperative hospital stay, intraoperative and postoperative complication and factors necessitating conversion of laparoscopic procedure to open method.Results: As per the present study inguinal hernia was most common diagnosis (48%) followed by hydrocele (22%) and acute appendicitis (22%).Conclusions: It is concluded from the present study that laparoscopic surgery in paediatric patients is safe, complication free, had less analgesic requirement, shorter duration of surgery, short postoperative hospital and total hospital stay and better cosmetic results.