Rahul Gorka - Academia.edu (original) (raw)

Papers by Rahul Gorka

International Journal of Medical and Health Research, 2021

IntechOpen eBooks, Apr 6, 2022

In this chapter, we shall look into the prerequisites for a successful skin grafting. This includ... more In this chapter, we shall look into the prerequisites for a successful skin grafting. This includes patient selection, identifying various factors-patient related, environment related, treatment related, and optimizing them for a successful outcome. Avoiding/removing the adverse factors and improving the wound bed environment require knowledge, experience, and checklist to be followed, so as not to miss any of these prerequisites. This would ensure complete take of the skin graft, with good reconstructive and esthetic outcome. Various factors include patients' general health, comorbidities, etiology of wound, duration and contamination, granulation tissue, local wound blood supply, wound sepsis, edema, vascular disease, wound bacteriology culture sensitivity, etc. The ultimate goal of improving success of skin grafting will lead to early recovery of patient, reducing hospital stay, burden on health infrastructure, and reduced loss of workdays, thereby reducing the socioeconomic impact of wound.

East and Central African Journal of Surgery, Jul 11, 2013

Background: Laparoscopic cholecystectomy in acute cholecystitis is associated with a relatively h... more Background: Laparoscopic cholecystectomy in acute cholecystitis is associated with a relatively high rate of conversion as well as complications. The aim of this study was to analyze prospectively various pre-operative and per-operative factors influencing the complications and conversion rate. Methods: A total of 60 patients (45 females and 15 males) undergoing laparoscopic cholecystectomy for acute cholecystitis were studied prospectively by analyzing the data accumulated in the process of investigation and treatment. Factors associated with conversion and complications were assessed to determine their significance. Results: Out of 60 patients, 10 patients (16.67%) were converted. Age > 65 years (p= 0.005), body mass index >30 kg/m 2 (p= 0.01), previous attack of acute cholecystitis (p= 0.02), clinically palpable lump right hypochondrium (p= 0.001), time of surgery > 48 hours from admission (p= 0.002), time of surgery > 96 hours from symptom onset (p= 0.005), short inflamed cystic duct (p= 0.01) and empyema gallbladder (p= 0.01) were significantly associated with conversion. 9 patients had major intra-operative complications (cystic duct avulsion = 3 patients, liver bed bleed = 3 patients, cystic artery bleed = 2 patients and duodenal injury = 1 patients) and 3 patients had post-operative complications(bile leak = 3 patients). Body mass index > 30 kg/m 2 (p= 0.01), previous attack of acute cholecystitis (p= 0.01), clinically palpable lump right hypochondrium (p= 0.01), impacted stone at gallbladder neck (p= 0.007) and empyema gallbladder (p= 0.04) were associated with higher complication rates. Conclusion: Laparoscopic cholecystectomy can be performed safely for acute cholecystitis, with acceptable low conversion and complication rates in selected cases. However, larger study groups will enable us to evaluate these predictors of conversions and complications more accurately.

Craniomaxillofacial Trauma and Reconstruction, Dec 1, 2017

Journal of applied hematology, 2016

In haemophilia-A patients, if the plasma concentration of factor VIII could be maintained at an o... more In haemophilia-A patients, if the plasma concentration of factor VIII could be maintained at an optimum level, an open wound can be easily covered with split-thickness skin grafting without any significant bleeding or complication. Removing a split-thickness layer of skin should cause no more difficulty than in a normal individual. This can be attributed to normal bleeding time, prothrombin time, clot retraction and platelet count found in such patients. Skin grafting over non-healing raw areas in haemophiliac patients can significantly decrease the morbidity and length of hospitalization required, thereby, decreasing health expenditure. We present a case report of a haemophilia-A patient having raw area over lower limb, which was managed successfully by skin grafting.

East and Central African Journal of Surgery, 2013

Background : Laparoscopic cholecystectomy in acute cholecystitis is associated with a relatively ... more Background : Laparoscopic cholecystectomy in acute cholecystitis is associated with a relatively high rate of conversion as well as complications. The aim of this study was to analyze prospectively various pre-operative and per-operative factors influencing the complications and conversion rate. Methods : A total of 60 patients (45 females and 15 males) undergoing laparoscopic cholecystectomy for acute cholecystitis were studied prospectively by analyzing the data accumulated in the process of investigation and treatment. Factors associated with conversion and complications were assessed to determine their significance. Results : Out of 60 patients, 10 patients (16.67%) were converted. Age > 65 years (p=0.005), body mass index >30 kg/m2 (p= 0.01), previous attack of acute cholecystitis (p=0.02), clinically palpable lump right hypochondrium (p= 0.001), time of surgery > 48 hours from admission (p= 0.002), time of surgery > 96 hours from symptom onset (p= 0.005), short inf...

International Journal of Medical and Health Research, 2020

International Journal of Medical and Health Research, 2021

Skin Grafts for Successful Wound Closure, Apr 6, 2022

Angiosarcoma of the breast was first reported by Schmidt in 1887 (1). It accounts for 0.04 % of p... more Angiosarcoma of the breast was first reported by Schmidt in 1887 (1). It accounts for 0.04 % of primary mammary tumors (2). In Asian women it has a frequency of one in 1700-2300 cases (3). Histologically it is composed of anatomizing vascular channels lined by atypical endothelial cells. Owing to its propensity to metastasize hematogenously, it carries a very poor prognosis (4,5).We report a rare primary case of localized angiosarcoma of breast. Case Report 40years old female presented with a lump in the right breast of three month duration. Lump on examination was hard but mobile. It measured approximately 5 x 4cms in the lower outer quadrant. Skin over the lump was free.There were no signs of inflammation. No evidence of lymphadenopathy on examination (clinically T2N0). FNAC of the lump was suggestive of carcinoma of breast. After metastatic evaluation patient was subjected to mastectomy with axillary lymphadenectomy (Level1 and Level 2). Post operatively patient recovered well an...

International Journal Of Community Medicine And Public Health, 2021

Background: Burns are one of the most common and devastating forms of trauma in life. Patients wi... more Background: Burns are one of the most common and devastating forms of trauma in life. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Thermal injury creates a breach in the surface of the skin. It is difficult to evaluate the immediate effects of burn injury on serum levels of vitamin D metabolites because the binding proteins for 25-hydroxyvitamin D (25(OH)D), the main circulating form of the vitamin, and for 1,25-dihydroxyvitamin D (1,25(OH)2D) are low.Methods: This study is a cross-sectional study. It was carried out in burn ward of Government medical college Jammu during June to November 2020. 52 burn patients of both sexes and all age groups were enrolled in this study.Results: Fifty-two patients were evaluated in this study including 36 males and 16 females. In second degree superficial burns the mean level of 25(OH)D was 13.60 ng/ml (SD=7.27) ,in second degree deep burns the mean level of 25(OH)D was 13.88 ...

Introduction Axillary burns and contractures are physically debilitating. Early splintage and pat... more Introduction Axillary burns and contractures are physically debilitating. Early splintage and patient compliance is critical to improve functional outcomes. Traditional treatment of axillary contractures involved use of airplane splints which provided fixed abduction at the shoulder joint. These splints pose physical, social and environmental restrictions for the patient in crowded and narrow spaces like washrooms, buses and other means of local transport. Aims and objectives The wearability and compliance of static airplane splints were found to be surprisingly low in such patients. Hence, to overcome these problems, we designed a modified self-adjustable airplane splint. Material and methods The abduction support and locking mechanism with adjustable hook were fabricated using simple hardware (a cabin hook and eye arrangement-the one used commonly in windows and doors). Results and conclusion A modification to the design of a pre-existing airplane splint has been attempted. Easy a...

Burn injury ensues catabolism that leads to a significant increase in the energy and protein requ... more Burn injury ensues catabolism that leads to a significant increase in the energy and protein requirements of the patient. To meet these demands, they need some other form of enteral formula diet along with a regular diet. At our centre, a hospital-based diet prepared by the dietary department was used for this purpose. The research aimed to examine the efficacy of this formulation post-burn nutritional support. Material and methods This study was carried out in 40 patients with more than 20 % TBSA burns who fulfilled the inclusion criteria, admitted in our burns centre from Jan 2011 to Dec 2016 and received hospital-based supplementary burns feed (SBF). They were studied based on the length of hospital stay, weight loss, serum prealbumin, and albumin levels, the number of surgeries, and other parameters. Results Out of the 40 patients, 36 were able to maintain less than 10 % weight loss with improvement in serum prealbumin levels and a direct correlation of weight loss with the dura...

Journal of Applied Hematology

Craniomaxillofacial Trauma and Reconstruction, 2017

Intermaxillary fixation (IMF) is a basic and fundamental principle in the management of patients ... more Intermaxillary fixation (IMF) is a basic and fundamental principle in the management of patients with fractures of the maxillomandibular complex. There are several shortcomings related to the conventionally recommended tooth-mounted devices that are used to achieve IMF. To circumvent these, the use of bone-borne screws has been advocated. We present a series of maxillary fractures treated with IMF screws. Over a 12-month period, 15 cases of maxillary fracture were managed with open reduction and bone plate fixation. IMF screws were used to achieve IMF intraoperatively and for a short duration postoperatively. Eight cortical titanium screws were inserted transmucosally, two for each quadrant at the junction of the attached and mobile mucosa. Satisfactory occlusion was achieved in all the patients with few complications. IMF screw fixation was observed to be a safe and quick method for open reduction of maxillary fractures. Tooth-borne devices are associated with problems such as poor...

International Journal of Medical and Health Research, 2021

IntechOpen eBooks, Apr 6, 2022

In this chapter, we shall look into the prerequisites for a successful skin grafting. This includ... more In this chapter, we shall look into the prerequisites for a successful skin grafting. This includes patient selection, identifying various factors-patient related, environment related, treatment related, and optimizing them for a successful outcome. Avoiding/removing the adverse factors and improving the wound bed environment require knowledge, experience, and checklist to be followed, so as not to miss any of these prerequisites. This would ensure complete take of the skin graft, with good reconstructive and esthetic outcome. Various factors include patients' general health, comorbidities, etiology of wound, duration and contamination, granulation tissue, local wound blood supply, wound sepsis, edema, vascular disease, wound bacteriology culture sensitivity, etc. The ultimate goal of improving success of skin grafting will lead to early recovery of patient, reducing hospital stay, burden on health infrastructure, and reduced loss of workdays, thereby reducing the socioeconomic impact of wound.

East and Central African Journal of Surgery, Jul 11, 2013

Background: Laparoscopic cholecystectomy in acute cholecystitis is associated with a relatively h... more Background: Laparoscopic cholecystectomy in acute cholecystitis is associated with a relatively high rate of conversion as well as complications. The aim of this study was to analyze prospectively various pre-operative and per-operative factors influencing the complications and conversion rate. Methods: A total of 60 patients (45 females and 15 males) undergoing laparoscopic cholecystectomy for acute cholecystitis were studied prospectively by analyzing the data accumulated in the process of investigation and treatment. Factors associated with conversion and complications were assessed to determine their significance. Results: Out of 60 patients, 10 patients (16.67%) were converted. Age > 65 years (p= 0.005), body mass index >30 kg/m 2 (p= 0.01), previous attack of acute cholecystitis (p= 0.02), clinically palpable lump right hypochondrium (p= 0.001), time of surgery > 48 hours from admission (p= 0.002), time of surgery > 96 hours from symptom onset (p= 0.005), short inflamed cystic duct (p= 0.01) and empyema gallbladder (p= 0.01) were significantly associated with conversion. 9 patients had major intra-operative complications (cystic duct avulsion = 3 patients, liver bed bleed = 3 patients, cystic artery bleed = 2 patients and duodenal injury = 1 patients) and 3 patients had post-operative complications(bile leak = 3 patients). Body mass index > 30 kg/m 2 (p= 0.01), previous attack of acute cholecystitis (p= 0.01), clinically palpable lump right hypochondrium (p= 0.01), impacted stone at gallbladder neck (p= 0.007) and empyema gallbladder (p= 0.04) were associated with higher complication rates. Conclusion: Laparoscopic cholecystectomy can be performed safely for acute cholecystitis, with acceptable low conversion and complication rates in selected cases. However, larger study groups will enable us to evaluate these predictors of conversions and complications more accurately.

Craniomaxillofacial Trauma and Reconstruction, Dec 1, 2017

Journal of applied hematology, 2016

In haemophilia-A patients, if the plasma concentration of factor VIII could be maintained at an o... more In haemophilia-A patients, if the plasma concentration of factor VIII could be maintained at an optimum level, an open wound can be easily covered with split-thickness skin grafting without any significant bleeding or complication. Removing a split-thickness layer of skin should cause no more difficulty than in a normal individual. This can be attributed to normal bleeding time, prothrombin time, clot retraction and platelet count found in such patients. Skin grafting over non-healing raw areas in haemophiliac patients can significantly decrease the morbidity and length of hospitalization required, thereby, decreasing health expenditure. We present a case report of a haemophilia-A patient having raw area over lower limb, which was managed successfully by skin grafting.

East and Central African Journal of Surgery, 2013

Background : Laparoscopic cholecystectomy in acute cholecystitis is associated with a relatively ... more Background : Laparoscopic cholecystectomy in acute cholecystitis is associated with a relatively high rate of conversion as well as complications. The aim of this study was to analyze prospectively various pre-operative and per-operative factors influencing the complications and conversion rate. Methods : A total of 60 patients (45 females and 15 males) undergoing laparoscopic cholecystectomy for acute cholecystitis were studied prospectively by analyzing the data accumulated in the process of investigation and treatment. Factors associated with conversion and complications were assessed to determine their significance. Results : Out of 60 patients, 10 patients (16.67%) were converted. Age > 65 years (p=0.005), body mass index >30 kg/m2 (p= 0.01), previous attack of acute cholecystitis (p=0.02), clinically palpable lump right hypochondrium (p= 0.001), time of surgery > 48 hours from admission (p= 0.002), time of surgery > 96 hours from symptom onset (p= 0.005), short inf...

International Journal of Medical and Health Research, 2020

International Journal of Medical and Health Research, 2021

Skin Grafts for Successful Wound Closure, Apr 6, 2022

Angiosarcoma of the breast was first reported by Schmidt in 1887 (1). It accounts for 0.04 % of p... more Angiosarcoma of the breast was first reported by Schmidt in 1887 (1). It accounts for 0.04 % of primary mammary tumors (2). In Asian women it has a frequency of one in 1700-2300 cases (3). Histologically it is composed of anatomizing vascular channels lined by atypical endothelial cells. Owing to its propensity to metastasize hematogenously, it carries a very poor prognosis (4,5).We report a rare primary case of localized angiosarcoma of breast. Case Report 40years old female presented with a lump in the right breast of three month duration. Lump on examination was hard but mobile. It measured approximately 5 x 4cms in the lower outer quadrant. Skin over the lump was free.There were no signs of inflammation. No evidence of lymphadenopathy on examination (clinically T2N0). FNAC of the lump was suggestive of carcinoma of breast. After metastatic evaluation patient was subjected to mastectomy with axillary lymphadenectomy (Level1 and Level 2). Post operatively patient recovered well an...

International Journal Of Community Medicine And Public Health, 2021

Background: Burns are one of the most common and devastating forms of trauma in life. Patients wi... more Background: Burns are one of the most common and devastating forms of trauma in life. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Thermal injury creates a breach in the surface of the skin. It is difficult to evaluate the immediate effects of burn injury on serum levels of vitamin D metabolites because the binding proteins for 25-hydroxyvitamin D (25(OH)D), the main circulating form of the vitamin, and for 1,25-dihydroxyvitamin D (1,25(OH)2D) are low.Methods: This study is a cross-sectional study. It was carried out in burn ward of Government medical college Jammu during June to November 2020. 52 burn patients of both sexes and all age groups were enrolled in this study.Results: Fifty-two patients were evaluated in this study including 36 males and 16 females. In second degree superficial burns the mean level of 25(OH)D was 13.60 ng/ml (SD=7.27) ,in second degree deep burns the mean level of 25(OH)D was 13.88 ...

Introduction Axillary burns and contractures are physically debilitating. Early splintage and pat... more Introduction Axillary burns and contractures are physically debilitating. Early splintage and patient compliance is critical to improve functional outcomes. Traditional treatment of axillary contractures involved use of airplane splints which provided fixed abduction at the shoulder joint. These splints pose physical, social and environmental restrictions for the patient in crowded and narrow spaces like washrooms, buses and other means of local transport. Aims and objectives The wearability and compliance of static airplane splints were found to be surprisingly low in such patients. Hence, to overcome these problems, we designed a modified self-adjustable airplane splint. Material and methods The abduction support and locking mechanism with adjustable hook were fabricated using simple hardware (a cabin hook and eye arrangement-the one used commonly in windows and doors). Results and conclusion A modification to the design of a pre-existing airplane splint has been attempted. Easy a...

Burn injury ensues catabolism that leads to a significant increase in the energy and protein requ... more Burn injury ensues catabolism that leads to a significant increase in the energy and protein requirements of the patient. To meet these demands, they need some other form of enteral formula diet along with a regular diet. At our centre, a hospital-based diet prepared by the dietary department was used for this purpose. The research aimed to examine the efficacy of this formulation post-burn nutritional support. Material and methods This study was carried out in 40 patients with more than 20 % TBSA burns who fulfilled the inclusion criteria, admitted in our burns centre from Jan 2011 to Dec 2016 and received hospital-based supplementary burns feed (SBF). They were studied based on the length of hospital stay, weight loss, serum prealbumin, and albumin levels, the number of surgeries, and other parameters. Results Out of the 40 patients, 36 were able to maintain less than 10 % weight loss with improvement in serum prealbumin levels and a direct correlation of weight loss with the dura...

Journal of Applied Hematology

Craniomaxillofacial Trauma and Reconstruction, 2017

Intermaxillary fixation (IMF) is a basic and fundamental principle in the management of patients ... more Intermaxillary fixation (IMF) is a basic and fundamental principle in the management of patients with fractures of the maxillomandibular complex. There are several shortcomings related to the conventionally recommended tooth-mounted devices that are used to achieve IMF. To circumvent these, the use of bone-borne screws has been advocated. We present a series of maxillary fractures treated with IMF screws. Over a 12-month period, 15 cases of maxillary fracture were managed with open reduction and bone plate fixation. IMF screws were used to achieve IMF intraoperatively and for a short duration postoperatively. Eight cortical titanium screws were inserted transmucosally, two for each quadrant at the junction of the attached and mobile mucosa. Satisfactory occlusion was achieved in all the patients with few complications. IMF screw fixation was observed to be a safe and quick method for open reduction of maxillary fractures. Tooth-borne devices are associated with problems such as poor...