International Journal of General Medicine & Surgery (original) (raw)
Papers by International Journal of General Medicine & Surgery
International Journal of General Medicine & Surgery, 2021
Background: Antenatal care is a routine follow-up during pregnancy to ensure a healthy mother and... more Background: Antenatal care is a routine follow-up during pregnancy to ensure a healthy mother and a healthy baby which can be provided in community and healthcare facilities. Utilization of antenatal care services by Sudanese women seems to be the lowest among African countries, so many complications are recognized among patients who do not attend antenatal care during the whole period of their pregnancy, when compared to patients who utilize antenatal care services. The aim of the study was to compare the pregnancy outcome between booked and un-booked primigravidae who came in labor in Omdurman New Hospital, Sudan. Methods: This cross-sectional and hospital-based study conducted in 290 primigravidae who attended Omdurman New Hospital during a period of 4 months. Subjects who voluntarily accepted to participate in the study were included. The data were collected by a pretested questionnaire that included clinical examination part. Data were collected by trained medical professionals and analyzed by SPSS version 23. Results: The results showed that there were 166 (57.2%) un-booked compared to 124 (42.8%) booked primigravidae. The main age group was 18-30 years old however, there were younger patients among un-booked group. Also, un-booked patients were less educated and more prone to be unemployed housewives, has no or little knowledge about the importance of the antenatal care and most of them were coming from rural areas. Also, there were also more cases of hypertensive disorder among um-booked group when compared to booked group who rates of diabetes and cardiac diseases were higher. Regarding baby's outcome, un-booked mothers in this study were more prone to have preterm and postdates babies with lower birth weight, 29.6% of them were less than 2 kg compared to only 1.6% of the booked group. Also, un-booked patients have increased number of IUFD und early neonatal death compared to booked mothers. Conclusion: Most of the un-booked pregnant women are young, less educated, housewives and coming from rural areas. The rate of preterm
International Journal of General Medicine & Surgery
Introduction: Due to the high number of assaults and increasing violence within our society, face... more Introduction: Due to the high number of assaults and increasing violence within our society, face trauma is among the most common injuries, and the number of gunshot wounds especially in the craniofacial region has been shown relatively high numbers. Such lesions can cause a variety of injuries and may evolve from permanent sequelae to death. Objectives: The purpose of this article is to describe a clinical case of a 16-year-old female patient with gunshot injury, with a displacement of the dental germ into the maxillary sinus and retention of the projectile in the infra-temporal space, with the orifice of the projectile in the region of the infra-spinal muscle. Conclusion: The treatment of gunshot wounds on the face depends on the degree of injury caused by the projectile, and haemorrhage control and airway protection are essential steps for successful treatment.
International Journal of General Medicine & Surgery
Introduction: Due to the high number of assaults and increasing violence within our society, face... more Introduction: Due to the high number of assaults and increasing violence within our society, face trauma is among the most common injuries, and the number of gunshot wounds especially in the craniofacial region has been shown relatively high numbers. Such lesions can cause a variety of injuries and may evolve from permanent sequelae to death. Objectives: The purpose of this article is to describe a clinical case of a 16-year-old female patient with gunshot injury, with a displacement of the dental germ into the maxillary sinus and retention of the projectile in the infra-temporal space, with the orifice of the projectile in the region of the infra-spinal muscle. Conclusion: The treatment of gunshot wounds on the face depends on the degree of injury caused by the projectile, and haemorrhage control and airway protection are essential steps for successful treatment.
International Journal of General Medicine & Surgery
Cushing's syndrome (CS) is a condition caused by prolonged exposure to elevated levels of glucoco... more Cushing's syndrome (CS) is a condition caused by prolonged exposure to elevated levels of glucocorticoids either endogenous or exogenous. The most common cause of CS is exogenous and depends on frequency and spectrum of medical condition which require glucocorticoid treatment. Exogenous CS is usually identified on the basis of history and laboratory studies. In our case a 55-year old female presented with complains of generalized weakness, easy fatigability, joint pain, generalized body swelling and facial puffiness with recent history of hypertension and diabetes. On clinical examination, she had truncal obesity moon facies, acanthosis nigricans, truncal obesity, pedal edema and high blood pressure. On enquiry patient gives history consumption of some medications for joint pain since last 6 months. She had persistent hypokalemia and high blood sugars. So, on clinical and biochemical features exogenous CS was suspected. Her morning 8 am serum Cortisol levels were 0.96ug/dl which was strongly suggestive exogenous CS. The patient showed clinical and biochemical improvement after stopping of all other medications.
International Journal of General Medicine & Surgery
Intramuscular hemangiomas are rare benign vascular tumors which account for less than 1% of all h... more Intramuscular hemangiomas are rare benign vascular tumors which account for less than 1% of all hemangiomas (though their true incidence and prevalence are difficult to calculate due to common misdiagnosis secondary to its diverse clinical presentation, deep location and rarity). They predominantly affect the trunk and extremities but, in rare occasions, can be found in the head and neck region mostly involving the masseter and trapezius muscles. An intramuscular hemangioma in the omohyoid muscle is considered an extremely rare finding. This case report is that of a 26-year-old Afro-Caribbean male who presented with a painless mass on the right anterior aspect of the neck which was investigated using ultrasound and MRI and later confirmed as an intramuscular hemangioma in the omohyoid muscle by biopsy and histopathology.
International Journal of General Medicine & Surgery
Background: Gastric bypass is most commonly performed via the laparoscopic approach. However, som... more Background: Gastric bypass is most commonly performed via the laparoscopic approach. However, some believe that the robotic approach could overcome limitations of laparoscopic surgery. In this study we seek to compare the outcomes of robotic and laparoscopic approaches to gastric bypass. Methods: We analyzed data of patients who underwent gastric bypass surgery using the National Inpatient Sample database between 2008-2013. Utilization and outcome measures including demographics, primary expected payer, in-hospital mortality, pre-existing comorbidities, complications, length of hospital stay, and total hospital charge were compared between the two different surgical approaches. These parameters were analyzed by chi-square, non-parametric tests and multivariate linear regression. Results: The six-year number of patients who underwent elective Roux-en-Y gastric bypass procedures in the United States from 2008 to 2013 is estimated to be 395,954. Of these, 97.9% were conducted via the laparoscopic approach, while 2.1% were conducted via the robot-assisted approach. The mean ages at the time of procedure were 44.82 ± 11.9 and 46.19 ± 12.2 in laparoscopic and robotic approaches, respectively (p<0.001). Females represented most of the patients (79% and 76.5% in laparoscopic and robotic groups, respectively, p=0.013). No significant differences existed between the two groups when compared in respect to race, diabetes mellitus, hypertension, ischemic heart disease, chronic kidney disease, and chronic obstructive pulmonary disease (COPD). Postoperative complications were comparable between groups with respect to pulmonary embolism, deep venous thrombosis, pain, bleeding, bowel obstruction, paralytic ileus, abscess, atelectasis, adhesion, and anastomotic leak. The overall mortality was similar between both the laparoscopic and robot-assisted groups (0.1% vs. 0.2%, respectively, p=0.44). Length of hospital stay was statistically significantly longer in the robotic approach (mean 2.7 days vs. 2.4 days, p<0.001). Patients who underwent robotic surgery had significantly higher total hospital charges compared to patients who underwent laparoscopic surgery (median 56,114vs.56,114 vs. 56,114vs.39,765 USD, p<0.001). Conclusions: Most gastric bypass procedures are done via the laparoscopic approach. The robotic technique has no clinical advantages in relation to morbidity and mortality. Additionally, the robotic procedure has significantly higher total charges.
International Journal of General Medicine & Surgery
Objective: Antibiotic treatment is standard after appendectomy for advanced appendicitis in child... more Objective: Antibiotic treatment is standard after appendectomy for advanced appendicitis in children with the aim to reduce postoperative complications. However, the evidence for deciding the duration of administration of the intravenous antibiotics (IVA) is limited. We present our experience focussing on the duration of IVA and the strategy for managing the complications. Methods: Retrospective review of patients undergoing an emergency appendectomy supervised by the senior surgeon (TT) over an 11-year period (2006-16) was done. Patient records were reviewed for operative findings, duration of IVA and oral antibiotics and post-operative complications. All patients diagnosed with advanced appendicitis were included. Post-operatively for the initial 3 days all received IVA viz. amoxicillin, metronidazole and gentamycin; continuing them further was based on the clinical course. The outcome and complications were analysed with respect to the duration of the (IVA) required. Results: 79 patients with advanced appendicitis were included in this study; 74 done laparoscopically and 5 open. There were 52 males and 27 females, with a mean age of 9.2 years (2.5-16). Median postoperative hospital stay was 4 days (3-24). 38 (48%) and 4 (5%) patients were able to stop IVA after 3 and 4 days respectively, the rest 37 (47%) required a longer course of IVA.15 were discharged home with oral antibiotics completing a total of 10 days antibiotics. The overall complications was 11.4%, wound infection in 4 patients and abscess in 5 .On statistical analysis, the higher incidence of complications in the 5 or more days IVA group was not significant comparing to those who received for shorter duration. Conclusion: In our experience children operated for advanced appendicitis early review and consideration of short course (minimum of 3 days) IV antibiotics based on clinical status is a safe and efficient method to treat with minimal complication rates.
International Journal of General Medicine & Surgery
Objective: The study intended to evaluate the extracorporeal shockwave therapy (ESWT) vs ultrasou... more Objective: The study intended to evaluate the extracorporeal shockwave therapy (ESWT) vs ultrasound (US) for patients with osteoarthritis (OA) of the knee. Methods: A pilot randomized controlled trial (RCT) with concealed allocation, assessor blinding, and intention-to-treat analysis. The study occurred in the Physiotherapy Outpatient Department of the Regional Hospital in Zywiec, Poland. The participants were randomly assigned to an ESWT group, n=30 and a US group, n=30. The participants in both groups attended 5-week treatments. The ESWT group received 5 treatments once per week. The US group received 10 treatments twice per week. The primary outcome was physical function using Knee injury and Osteoarthritis Outcome Score (KOOS). The secondary outcome measured mobility, pressure pain threshold (PPT), and pain on visual analog scale (VAS). Results: Post-intervention, the physical function improved on the KOOS for ESWT and US with regard to pain by a mean of 14 ± 10 and 7 ± 9 points (p=0.003), other symptoms and function in daily living by a mean of 12 ± 11 and 4 ± 7 points (p<0.001), function in sport/recreation by a mean of 22 ± 16 and 4 ± 14 points (p<0.001), knee-related quality of life by a mean of 20 ± 16 and 6 ± 6 points (p<0.001), pain on VAS by a mean of 2 ± 2 and 1 ± 1 points (p<0.001) respectively. The statistical significant between groups differences favouring the ESWT were found. Conclusion: Patients with OA of the knee can achieve significantly better physical function caused by ESWT than by US.
International Journal of General Medicine & Surgery
Objective: Conduction a systematic review of randomized controlled trials (RCTs) to assess the ef... more Objective: Conduction a systematic review of randomized controlled trials (RCTs) to assess the effectiveness of extracorporeal shock wave therapy (ESWT) on plantar heel pain. Methods: The study was designed as a meta-analysis of RCTs identified from the Cochrane Controlled trials register, MEDLINE, EMBASE and CINAHL from January 2000 till December 2016. We included such randomized trials, which evaluated ESWT used to treat plantar heel pain. The trials comparing ESWT with placebo, focused extracorporeal shock wave therapy (FESWT) or orthotics, kinesiotherapy, local cortison injection were considered for the inclusion in the review. Ten RCTs (n=1239) permitted a pooled estimate of the effectiveness based on the collected pain scores using 10 cm visual analogue scale (VAS) for the daily pain. Results: The estimated total weighted mean difference (WMD) was 0.9 (95% confidence interval 0.1 to 1.8) representing less than 1.0 cm on the VAS. There were evidences of heterogeneity, so we used a random effects model. Conclusion: A meta-analysis of data from ten RCTs included a total of 1239 patients and reported poor outcomes evaluating ESWT for plantar heel pain. This meta-analysis shows that using of ESWT for plantar heel pain is uncertain in clinical practice. Nevertheless, it suggests that further studies to establish efficacy dose of ESWT for heel pain are needed.
International Journal of General Medicine & Surgery
Aim: To determine the microbiological profile and antibiotic susceptibility pattern of organisms ... more Aim: To determine the microbiological profile and antibiotic susceptibility pattern of organisms in diabetic foot ulcers in our population. Settings and Design: A prospective observational study Material and Method: A prospective study was carried out on 62 patients of diabetic foot ulcers attending the endocrine OPD. The aerobic bacterial agents were isolated, and their antibiotic susceptibility pattern was studied. Results: Organisms were cultured from 90.32% cases of diabetic foot ulcers. Staphylococcus aureus (both MRSA and non-MRSA) was the commonest organism found in 36.77% cases followed by E. coli in 30.88%, Enterococci in 7.35%, Pseudomonas aerogenosa in 5.88% and Klebsiella in 5.88% of cases. Polymicrobial infection was seen in 9.68% cases. In 47.05% of the cases infections was due to gram negative organisms. Staphylococcus aureus was chiefly susceptible to levofloxacin, vancomycin, pipracillin tazobactum, linezolid while E. coli to levofloxacin, piperacillin tazobactum, and meropenem. Conclusion: Gram-negative organisms were most frequent type of isolate. Staphylococcus aureus was the most common type of bacteria. All bacterial isolate in our study have sensitivity for levofloxacin, pipracillin-tazobactum linezolid, and meropenem.
International Journal of General Medicine & Surgery
Objective: Evaluation the effectiveness of two conservative treatments on quality of life in fema... more Objective: Evaluation the effectiveness of two conservative treatments on quality of life in females with knee osteoarthritis (OA). Methods: 60 females (age 40-75) were randomized to a five-week treatment of extracorporeal shockwave therapy group (ESWT, n=30) or a kinesiotherapy group (KIN, n=30). At baseline and after the 5-weeks' treatment, quality of life (WOMAC), pain (VAS), movement of the knees in extension and flexion (ROM), and a walked distance (6-MWT) were recorded. Results: Post-intervention both groups reached improvement of health status, but the significant differences favoring the ESWT were found with regard to WOMAC, MD (mean difference)=20 points, 95% CI (confidence interval) [-25 to-4], p=0.006 for total scores, VAS in the right and left knees, MD=2 cm, 95% CI [-2 to-1], p <0.001, and MD=1 cm, 95% CI [-2 to-1], p=0.007 respectively, ROM (extension) in both knees, MD=3 degrees, 95% CI [-4 to-1], p=0.028 and p=0.014 respectively, ROM (flexion) in both knees, MD=7 degrees, 95% CI [3 to 10, and 4 to 11], p=0.007 and p < 0.001 respectively, and 6-MWT, MD=44 m, 95% CI [26 to 62], p<0.001. Conclusion: Among the females, treated for OA of the knee, ESWT led to greater health benefits than KIN protocol.
International Journal of General Medicine & Surgery
Pneumoperitoneum without intraabdominal hollow viscus perforation is termed as nonsurgical or spo... more Pneumoperitoneum without intraabdominal hollow viscus perforation is termed as nonsurgical or spontaneous pneumoperitoneum, which does not demand surgical intervention. Because of rarity of this condition and symptomatic similarity with the pneumoperitomeum due to gut perforation, the condition diagnosed only after a negative laparotomy. Awareness of this entity, a detailed history and clinical evaluation is necessary to clear this diagnostic dilemma. The treatment of such cases solely depends on the primary causes of pneumoperitoneum. Here, we report two cases of pneumoperitoneum of different etiologies with a brief discussion of similar cases as reported in literature.
International Journal of General Medicine & Surgery
Objective: To develop the method of preventive diagnosis of venous thrombosis using the ultrasoun... more Objective: To develop the method of preventive diagnosis of venous thrombosis using the ultrasound duplex scanning (USDS). Materials and methods: 306 persons were examined, 146 were patients with acute venous thrombosis, 108 patients-with varicose veins and 52 healthy persons (control group). All participants were examined using USDS and D-dimer level was evaluated. Results: As the result of the conducted research an ultrasound phenomenon of echogenic particles in valvular sinus area (further referred to as spontaneous echo contrast) is described. A classification of this phenomenon is developed; two degrees of spontaneous echo contrast are documented. Spontaneous echo contrast of the 1st degree reflects the fact that the valvular sinus area is the most thrombogenic zone. Spontaneous echo contrast of the 2nd degree is characterized as pathological, it is a prethrombotic state and can serve as one of the earliest predictors of developing venous thrombosis. A high correlation between phenomenon of spontaneous echo contrast of the 2nd degree, venous thrombosis and D-dimer level indicators is determined (r=0.89, P<0.05). Conclusions: An ultrasound study of valvular sinus is a simple, available and reproducible method of screening and can be applied as a preventive diagnostic of acute venous thrombosis. The results of the investigations permit us to form risk groups of deep vein thrombosis and perform timely prevention of this pathology.
International Journal of General Medicine & Surgery
Breast masses are uncommon in children and adolescent. Giant fibroadenoma account for 0.5%-2% of ... more Breast masses are uncommon in children and adolescent. Giant fibroadenoma account for 0.5%-2% of all fibroadenoma& (and the) exact etiology is not known. Fibroadenomas tend to grow slowly and often reach a maximum diameter of 2-3 cm in size. Among breast masses pathologic lesion such as giant fibroadenoma, phylloides tumor and virginal breast hypertrophy (juvenile macromastia) rapidly & massively increase in size over a short time. We present a case of giant fibroadenoma having florid adenomyoepithelial adenosis with focal microglandular adenosis.
International Journal of General Medicine & Surgery
Lipomas are benign tumor found in areas of abundant adipose tissue. They can be found anywhere in... more Lipomas are benign tumor found in areas of abundant adipose tissue. They can be found anywhere in the body but are uncommon in hands and even rare in fingers. We report a case of lipoma in 71-year-old female who presented to us with a painless swelling of finger. Diagnosis was confirmed by clinical, radiological and pathological examination. Surgical excision was done. Lipoma should always be kept in mind as differential diagnosis in a finger swelling. Complete surgical excision is required to prevent the recurrence.
International Journal of General Medicine & Surgery
Irritable bowel syndrome (IBS) was shown to be far more frequent in patients with epilepsy compar... more Irritable bowel syndrome (IBS) was shown to be far more frequent in patients with epilepsy compared with that in healthy controls; 16% in patients with epilepsy and 3% in controls. The so-called brain-gut axis has recently been demonstrated to be crucial for the maintenance of cognitive performance and abnormal interaction in this axis has been shown to be one of the relevant pathophysiological mechanisms for the development of IBS. Similarly, Nikiforova in 2014, and after comparing epileptic EEG patterns and colonic contractile electrical complexes, has hypothesized that peripherally organized electrographic patterns associated with stress induced gut symptoms actively participate in creating epileptic susceptibility.
International Journal of General Medicine & Surgery
Internal snapping hip is a recognized cause of hip pain caused by recurrent subluxation of the il... more Internal snapping hip is a recognized cause of hip pain caused by recurrent subluxation of the iliopsoas tendon. When conservative treatment fails, surgical release of the iliopsoas tendon may be indicated using an arthroscopic or open hip approach. Results have been better with arthroscopic release. We report a case of a 32-year-old active female with a painful internal snapping hip. The right hip extension from a flexed position produced a strong and audible snap. A tenotomy of the iliopsoas in combination with a resection of the lesser trochanter was performed, using a limited medial hip approach different than the one described by Ludloff and Ferguson. The pain and snapping phenomenon were solved; however, a slight heterotopic ossification, as well as a weakness in the flexion of the hip was noted after the procedure, with no functional limitation. The minimally invasive medial hip approach appears to be a simple, reproducible and successful operation for the treatment of an internal snapping hip caused by the iliopsoas tendon, namely in orthopaedics departments with limited experience in hip arthroscopic approach, but it is not superior to arthroscopic release.
International Journal of General Medicine & Surgery, 2021
Background: Antenatal care is a routine follow-up during pregnancy to ensure a healthy mother and... more Background: Antenatal care is a routine follow-up during pregnancy to ensure a healthy mother and a healthy baby which can be provided in community and healthcare facilities. Utilization of antenatal care services by Sudanese women seems to be the lowest among African countries, so many complications are recognized among patients who do not attend antenatal care during the whole period of their pregnancy, when compared to patients who utilize antenatal care services. The aim of the study was to compare the pregnancy outcome between booked and un-booked primigravidae who came in labor in Omdurman New Hospital, Sudan. Methods: This cross-sectional and hospital-based study conducted in 290 primigravidae who attended Omdurman New Hospital during a period of 4 months. Subjects who voluntarily accepted to participate in the study were included. The data were collected by a pretested questionnaire that included clinical examination part. Data were collected by trained medical professionals and analyzed by SPSS version 23. Results: The results showed that there were 166 (57.2%) un-booked compared to 124 (42.8%) booked primigravidae. The main age group was 18-30 years old however, there were younger patients among un-booked group. Also, un-booked patients were less educated and more prone to be unemployed housewives, has no or little knowledge about the importance of the antenatal care and most of them were coming from rural areas. Also, there were also more cases of hypertensive disorder among um-booked group when compared to booked group who rates of diabetes and cardiac diseases were higher. Regarding baby's outcome, un-booked mothers in this study were more prone to have preterm and postdates babies with lower birth weight, 29.6% of them were less than 2 kg compared to only 1.6% of the booked group. Also, un-booked patients have increased number of IUFD und early neonatal death compared to booked mothers. Conclusion: Most of the un-booked pregnant women are young, less educated, housewives and coming from rural areas. The rate of preterm
International Journal of General Medicine & Surgery
Introduction: Due to the high number of assaults and increasing violence within our society, face... more Introduction: Due to the high number of assaults and increasing violence within our society, face trauma is among the most common injuries, and the number of gunshot wounds especially in the craniofacial region has been shown relatively high numbers. Such lesions can cause a variety of injuries and may evolve from permanent sequelae to death. Objectives: The purpose of this article is to describe a clinical case of a 16-year-old female patient with gunshot injury, with a displacement of the dental germ into the maxillary sinus and retention of the projectile in the infra-temporal space, with the orifice of the projectile in the region of the infra-spinal muscle. Conclusion: The treatment of gunshot wounds on the face depends on the degree of injury caused by the projectile, and haemorrhage control and airway protection are essential steps for successful treatment.
International Journal of General Medicine & Surgery
Introduction: Due to the high number of assaults and increasing violence within our society, face... more Introduction: Due to the high number of assaults and increasing violence within our society, face trauma is among the most common injuries, and the number of gunshot wounds especially in the craniofacial region has been shown relatively high numbers. Such lesions can cause a variety of injuries and may evolve from permanent sequelae to death. Objectives: The purpose of this article is to describe a clinical case of a 16-year-old female patient with gunshot injury, with a displacement of the dental germ into the maxillary sinus and retention of the projectile in the infra-temporal space, with the orifice of the projectile in the region of the infra-spinal muscle. Conclusion: The treatment of gunshot wounds on the face depends on the degree of injury caused by the projectile, and haemorrhage control and airway protection are essential steps for successful treatment.
International Journal of General Medicine & Surgery
Cushing's syndrome (CS) is a condition caused by prolonged exposure to elevated levels of glucoco... more Cushing's syndrome (CS) is a condition caused by prolonged exposure to elevated levels of glucocorticoids either endogenous or exogenous. The most common cause of CS is exogenous and depends on frequency and spectrum of medical condition which require glucocorticoid treatment. Exogenous CS is usually identified on the basis of history and laboratory studies. In our case a 55-year old female presented with complains of generalized weakness, easy fatigability, joint pain, generalized body swelling and facial puffiness with recent history of hypertension and diabetes. On clinical examination, she had truncal obesity moon facies, acanthosis nigricans, truncal obesity, pedal edema and high blood pressure. On enquiry patient gives history consumption of some medications for joint pain since last 6 months. She had persistent hypokalemia and high blood sugars. So, on clinical and biochemical features exogenous CS was suspected. Her morning 8 am serum Cortisol levels were 0.96ug/dl which was strongly suggestive exogenous CS. The patient showed clinical and biochemical improvement after stopping of all other medications.
International Journal of General Medicine & Surgery
Intramuscular hemangiomas are rare benign vascular tumors which account for less than 1% of all h... more Intramuscular hemangiomas are rare benign vascular tumors which account for less than 1% of all hemangiomas (though their true incidence and prevalence are difficult to calculate due to common misdiagnosis secondary to its diverse clinical presentation, deep location and rarity). They predominantly affect the trunk and extremities but, in rare occasions, can be found in the head and neck region mostly involving the masseter and trapezius muscles. An intramuscular hemangioma in the omohyoid muscle is considered an extremely rare finding. This case report is that of a 26-year-old Afro-Caribbean male who presented with a painless mass on the right anterior aspect of the neck which was investigated using ultrasound and MRI and later confirmed as an intramuscular hemangioma in the omohyoid muscle by biopsy and histopathology.
International Journal of General Medicine & Surgery
Background: Gastric bypass is most commonly performed via the laparoscopic approach. However, som... more Background: Gastric bypass is most commonly performed via the laparoscopic approach. However, some believe that the robotic approach could overcome limitations of laparoscopic surgery. In this study we seek to compare the outcomes of robotic and laparoscopic approaches to gastric bypass. Methods: We analyzed data of patients who underwent gastric bypass surgery using the National Inpatient Sample database between 2008-2013. Utilization and outcome measures including demographics, primary expected payer, in-hospital mortality, pre-existing comorbidities, complications, length of hospital stay, and total hospital charge were compared between the two different surgical approaches. These parameters were analyzed by chi-square, non-parametric tests and multivariate linear regression. Results: The six-year number of patients who underwent elective Roux-en-Y gastric bypass procedures in the United States from 2008 to 2013 is estimated to be 395,954. Of these, 97.9% were conducted via the laparoscopic approach, while 2.1% were conducted via the robot-assisted approach. The mean ages at the time of procedure were 44.82 ± 11.9 and 46.19 ± 12.2 in laparoscopic and robotic approaches, respectively (p<0.001). Females represented most of the patients (79% and 76.5% in laparoscopic and robotic groups, respectively, p=0.013). No significant differences existed between the two groups when compared in respect to race, diabetes mellitus, hypertension, ischemic heart disease, chronic kidney disease, and chronic obstructive pulmonary disease (COPD). Postoperative complications were comparable between groups with respect to pulmonary embolism, deep venous thrombosis, pain, bleeding, bowel obstruction, paralytic ileus, abscess, atelectasis, adhesion, and anastomotic leak. The overall mortality was similar between both the laparoscopic and robot-assisted groups (0.1% vs. 0.2%, respectively, p=0.44). Length of hospital stay was statistically significantly longer in the robotic approach (mean 2.7 days vs. 2.4 days, p<0.001). Patients who underwent robotic surgery had significantly higher total hospital charges compared to patients who underwent laparoscopic surgery (median 56,114vs.56,114 vs. 56,114vs.39,765 USD, p<0.001). Conclusions: Most gastric bypass procedures are done via the laparoscopic approach. The robotic technique has no clinical advantages in relation to morbidity and mortality. Additionally, the robotic procedure has significantly higher total charges.
International Journal of General Medicine & Surgery
Objective: Antibiotic treatment is standard after appendectomy for advanced appendicitis in child... more Objective: Antibiotic treatment is standard after appendectomy for advanced appendicitis in children with the aim to reduce postoperative complications. However, the evidence for deciding the duration of administration of the intravenous antibiotics (IVA) is limited. We present our experience focussing on the duration of IVA and the strategy for managing the complications. Methods: Retrospective review of patients undergoing an emergency appendectomy supervised by the senior surgeon (TT) over an 11-year period (2006-16) was done. Patient records were reviewed for operative findings, duration of IVA and oral antibiotics and post-operative complications. All patients diagnosed with advanced appendicitis were included. Post-operatively for the initial 3 days all received IVA viz. amoxicillin, metronidazole and gentamycin; continuing them further was based on the clinical course. The outcome and complications were analysed with respect to the duration of the (IVA) required. Results: 79 patients with advanced appendicitis were included in this study; 74 done laparoscopically and 5 open. There were 52 males and 27 females, with a mean age of 9.2 years (2.5-16). Median postoperative hospital stay was 4 days (3-24). 38 (48%) and 4 (5%) patients were able to stop IVA after 3 and 4 days respectively, the rest 37 (47%) required a longer course of IVA.15 were discharged home with oral antibiotics completing a total of 10 days antibiotics. The overall complications was 11.4%, wound infection in 4 patients and abscess in 5 .On statistical analysis, the higher incidence of complications in the 5 or more days IVA group was not significant comparing to those who received for shorter duration. Conclusion: In our experience children operated for advanced appendicitis early review and consideration of short course (minimum of 3 days) IV antibiotics based on clinical status is a safe and efficient method to treat with minimal complication rates.
International Journal of General Medicine & Surgery
Objective: The study intended to evaluate the extracorporeal shockwave therapy (ESWT) vs ultrasou... more Objective: The study intended to evaluate the extracorporeal shockwave therapy (ESWT) vs ultrasound (US) for patients with osteoarthritis (OA) of the knee. Methods: A pilot randomized controlled trial (RCT) with concealed allocation, assessor blinding, and intention-to-treat analysis. The study occurred in the Physiotherapy Outpatient Department of the Regional Hospital in Zywiec, Poland. The participants were randomly assigned to an ESWT group, n=30 and a US group, n=30. The participants in both groups attended 5-week treatments. The ESWT group received 5 treatments once per week. The US group received 10 treatments twice per week. The primary outcome was physical function using Knee injury and Osteoarthritis Outcome Score (KOOS). The secondary outcome measured mobility, pressure pain threshold (PPT), and pain on visual analog scale (VAS). Results: Post-intervention, the physical function improved on the KOOS for ESWT and US with regard to pain by a mean of 14 ± 10 and 7 ± 9 points (p=0.003), other symptoms and function in daily living by a mean of 12 ± 11 and 4 ± 7 points (p<0.001), function in sport/recreation by a mean of 22 ± 16 and 4 ± 14 points (p<0.001), knee-related quality of life by a mean of 20 ± 16 and 6 ± 6 points (p<0.001), pain on VAS by a mean of 2 ± 2 and 1 ± 1 points (p<0.001) respectively. The statistical significant between groups differences favouring the ESWT were found. Conclusion: Patients with OA of the knee can achieve significantly better physical function caused by ESWT than by US.
International Journal of General Medicine & Surgery
Objective: Conduction a systematic review of randomized controlled trials (RCTs) to assess the ef... more Objective: Conduction a systematic review of randomized controlled trials (RCTs) to assess the effectiveness of extracorporeal shock wave therapy (ESWT) on plantar heel pain. Methods: The study was designed as a meta-analysis of RCTs identified from the Cochrane Controlled trials register, MEDLINE, EMBASE and CINAHL from January 2000 till December 2016. We included such randomized trials, which evaluated ESWT used to treat plantar heel pain. The trials comparing ESWT with placebo, focused extracorporeal shock wave therapy (FESWT) or orthotics, kinesiotherapy, local cortison injection were considered for the inclusion in the review. Ten RCTs (n=1239) permitted a pooled estimate of the effectiveness based on the collected pain scores using 10 cm visual analogue scale (VAS) for the daily pain. Results: The estimated total weighted mean difference (WMD) was 0.9 (95% confidence interval 0.1 to 1.8) representing less than 1.0 cm on the VAS. There were evidences of heterogeneity, so we used a random effects model. Conclusion: A meta-analysis of data from ten RCTs included a total of 1239 patients and reported poor outcomes evaluating ESWT for plantar heel pain. This meta-analysis shows that using of ESWT for plantar heel pain is uncertain in clinical practice. Nevertheless, it suggests that further studies to establish efficacy dose of ESWT for heel pain are needed.
International Journal of General Medicine & Surgery
Aim: To determine the microbiological profile and antibiotic susceptibility pattern of organisms ... more Aim: To determine the microbiological profile and antibiotic susceptibility pattern of organisms in diabetic foot ulcers in our population. Settings and Design: A prospective observational study Material and Method: A prospective study was carried out on 62 patients of diabetic foot ulcers attending the endocrine OPD. The aerobic bacterial agents were isolated, and their antibiotic susceptibility pattern was studied. Results: Organisms were cultured from 90.32% cases of diabetic foot ulcers. Staphylococcus aureus (both MRSA and non-MRSA) was the commonest organism found in 36.77% cases followed by E. coli in 30.88%, Enterococci in 7.35%, Pseudomonas aerogenosa in 5.88% and Klebsiella in 5.88% of cases. Polymicrobial infection was seen in 9.68% cases. In 47.05% of the cases infections was due to gram negative organisms. Staphylococcus aureus was chiefly susceptible to levofloxacin, vancomycin, pipracillin tazobactum, linezolid while E. coli to levofloxacin, piperacillin tazobactum, and meropenem. Conclusion: Gram-negative organisms were most frequent type of isolate. Staphylococcus aureus was the most common type of bacteria. All bacterial isolate in our study have sensitivity for levofloxacin, pipracillin-tazobactum linezolid, and meropenem.
International Journal of General Medicine & Surgery
Objective: Evaluation the effectiveness of two conservative treatments on quality of life in fema... more Objective: Evaluation the effectiveness of two conservative treatments on quality of life in females with knee osteoarthritis (OA). Methods: 60 females (age 40-75) were randomized to a five-week treatment of extracorporeal shockwave therapy group (ESWT, n=30) or a kinesiotherapy group (KIN, n=30). At baseline and after the 5-weeks' treatment, quality of life (WOMAC), pain (VAS), movement of the knees in extension and flexion (ROM), and a walked distance (6-MWT) were recorded. Results: Post-intervention both groups reached improvement of health status, but the significant differences favoring the ESWT were found with regard to WOMAC, MD (mean difference)=20 points, 95% CI (confidence interval) [-25 to-4], p=0.006 for total scores, VAS in the right and left knees, MD=2 cm, 95% CI [-2 to-1], p <0.001, and MD=1 cm, 95% CI [-2 to-1], p=0.007 respectively, ROM (extension) in both knees, MD=3 degrees, 95% CI [-4 to-1], p=0.028 and p=0.014 respectively, ROM (flexion) in both knees, MD=7 degrees, 95% CI [3 to 10, and 4 to 11], p=0.007 and p < 0.001 respectively, and 6-MWT, MD=44 m, 95% CI [26 to 62], p<0.001. Conclusion: Among the females, treated for OA of the knee, ESWT led to greater health benefits than KIN protocol.
International Journal of General Medicine & Surgery
Pneumoperitoneum without intraabdominal hollow viscus perforation is termed as nonsurgical or spo... more Pneumoperitoneum without intraabdominal hollow viscus perforation is termed as nonsurgical or spontaneous pneumoperitoneum, which does not demand surgical intervention. Because of rarity of this condition and symptomatic similarity with the pneumoperitomeum due to gut perforation, the condition diagnosed only after a negative laparotomy. Awareness of this entity, a detailed history and clinical evaluation is necessary to clear this diagnostic dilemma. The treatment of such cases solely depends on the primary causes of pneumoperitoneum. Here, we report two cases of pneumoperitoneum of different etiologies with a brief discussion of similar cases as reported in literature.
International Journal of General Medicine & Surgery
Objective: To develop the method of preventive diagnosis of venous thrombosis using the ultrasoun... more Objective: To develop the method of preventive diagnosis of venous thrombosis using the ultrasound duplex scanning (USDS). Materials and methods: 306 persons were examined, 146 were patients with acute venous thrombosis, 108 patients-with varicose veins and 52 healthy persons (control group). All participants were examined using USDS and D-dimer level was evaluated. Results: As the result of the conducted research an ultrasound phenomenon of echogenic particles in valvular sinus area (further referred to as spontaneous echo contrast) is described. A classification of this phenomenon is developed; two degrees of spontaneous echo contrast are documented. Spontaneous echo contrast of the 1st degree reflects the fact that the valvular sinus area is the most thrombogenic zone. Spontaneous echo contrast of the 2nd degree is characterized as pathological, it is a prethrombotic state and can serve as one of the earliest predictors of developing venous thrombosis. A high correlation between phenomenon of spontaneous echo contrast of the 2nd degree, venous thrombosis and D-dimer level indicators is determined (r=0.89, P<0.05). Conclusions: An ultrasound study of valvular sinus is a simple, available and reproducible method of screening and can be applied as a preventive diagnostic of acute venous thrombosis. The results of the investigations permit us to form risk groups of deep vein thrombosis and perform timely prevention of this pathology.
International Journal of General Medicine & Surgery
Breast masses are uncommon in children and adolescent. Giant fibroadenoma account for 0.5%-2% of ... more Breast masses are uncommon in children and adolescent. Giant fibroadenoma account for 0.5%-2% of all fibroadenoma& (and the) exact etiology is not known. Fibroadenomas tend to grow slowly and often reach a maximum diameter of 2-3 cm in size. Among breast masses pathologic lesion such as giant fibroadenoma, phylloides tumor and virginal breast hypertrophy (juvenile macromastia) rapidly & massively increase in size over a short time. We present a case of giant fibroadenoma having florid adenomyoepithelial adenosis with focal microglandular adenosis.
International Journal of General Medicine & Surgery
Lipomas are benign tumor found in areas of abundant adipose tissue. They can be found anywhere in... more Lipomas are benign tumor found in areas of abundant adipose tissue. They can be found anywhere in the body but are uncommon in hands and even rare in fingers. We report a case of lipoma in 71-year-old female who presented to us with a painless swelling of finger. Diagnosis was confirmed by clinical, radiological and pathological examination. Surgical excision was done. Lipoma should always be kept in mind as differential diagnosis in a finger swelling. Complete surgical excision is required to prevent the recurrence.
International Journal of General Medicine & Surgery
Irritable bowel syndrome (IBS) was shown to be far more frequent in patients with epilepsy compar... more Irritable bowel syndrome (IBS) was shown to be far more frequent in patients with epilepsy compared with that in healthy controls; 16% in patients with epilepsy and 3% in controls. The so-called brain-gut axis has recently been demonstrated to be crucial for the maintenance of cognitive performance and abnormal interaction in this axis has been shown to be one of the relevant pathophysiological mechanisms for the development of IBS. Similarly, Nikiforova in 2014, and after comparing epileptic EEG patterns and colonic contractile electrical complexes, has hypothesized that peripherally organized electrographic patterns associated with stress induced gut symptoms actively participate in creating epileptic susceptibility.
International Journal of General Medicine & Surgery
Internal snapping hip is a recognized cause of hip pain caused by recurrent subluxation of the il... more Internal snapping hip is a recognized cause of hip pain caused by recurrent subluxation of the iliopsoas tendon. When conservative treatment fails, surgical release of the iliopsoas tendon may be indicated using an arthroscopic or open hip approach. Results have been better with arthroscopic release. We report a case of a 32-year-old active female with a painful internal snapping hip. The right hip extension from a flexed position produced a strong and audible snap. A tenotomy of the iliopsoas in combination with a resection of the lesser trochanter was performed, using a limited medial hip approach different than the one described by Ludloff and Ferguson. The pain and snapping phenomenon were solved; however, a slight heterotopic ossification, as well as a weakness in the flexion of the hip was noted after the procedure, with no functional limitation. The minimally invasive medial hip approach appears to be a simple, reproducible and successful operation for the treatment of an internal snapping hip caused by the iliopsoas tendon, namely in orthopaedics departments with limited experience in hip arthroscopic approach, but it is not superior to arthroscopic release.