International Surgery Journal

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https://imsear.searo.who.int/handle/123456789/156148

Editor-in-Chief: Dr. Bhaven Kataria
ISSN: 2349-3305 (Print); 2349-2902 (Online)

Frequency: Quarterly

Language: English

Open Access Peer-reviewed journal

Web site: https://www.ijsurgery.com/

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Now showing 1 - 20 of 1617

Effect of prehabilitation on outcomes following upper gastrointestinal surgery: a systematic review and meta-analysis
(Medip Academy, 2024-12) Findlay, N; Han, S; Pillinger, N.
It is accepted in several areas of surgery that prehabilitation can improve post-operative outcomes. Prehabilitation describes preoperative interventions aimed at optimizing patient condition prior to surgery to improve postoperative outcomes. It is hypothesized that prehabilitation reduces postoperative complications in the setting of upper gastrointestinal surgery. A systematic search strategy was performed based on a research question formulated with reference to the PICO framework. Eligible studies were those that included a predefined prehabilitation intervention, a comparison to usual care and conducted on patients undergoing upper gastrointestinal surgery. Included studies were evaluated for bias and underwent data extraction. Meta-analysis was also performed for outcomes where possible. Eight studies met criteria for inclusion in this review. The nature and length of prehabilitation programs varied widely, with interventions lasting from two to six weeks. Reported outcomes included post-operative pulmonary complications, mortality and length of hospital stay. A meta-analysis was undertaken for mortality and postoperative pulmonary complications. Meta-analysis showed postoperative pulmonary complications were reduced (RR0.68, 95% CI 0.50-0.93) in the intervention group compared to the control group, as was mortality (RR 0.59, 95% CI 0.35-1.00). Prehabilitation, especially inspiratory muscle training appears to be effective in reducing pulmonary complications in patients scheduled for upper gastrointestinal surgery. With the available data it is uncertain if this translates to reduced length of stay or mortality. There is scope for further research to better define a role for prehabilitation in upper gastrointestinal surgery, specifically the optimal prehabilitation modality and length.
Outcome of total hip arthroplasty versus hip hemiarthroplasty for femoral neck fractures in the elderly: a meta-analysis of randomized control trial
(Medip Academy, 2024-12) Cahyadi, NIT; Steven, P.
Background: Roughly 50% of all hip fractures are femoral neck fractures, these fractures are subtype of intracapsular hip fractures. Elderly patient's femoral neck fracture is typically the consequence of a straightforward fall from standing height with low energy. Total hip arthroplasty (THA) versus hip hemiarthroplasty (HHA) is a topic of controversy that sparked discussions over half century ago, between these two types technique have own advantages and disadvantages. Methods: A comprehensive search conducted across major electronic databases for relevant studies published from 2014-2024. Studies THA with HA for elderly patients with femoral neck fractures were included. Data regarding study characteristics, surgical techniques, outcomes, and garden classification were extracted and analyzed using appropriate statistical methods. Our primary outcomes were surgical duration, functional outcome and complications. Results: The initial search yielded total 825 studies, which 7 studies met the inclusion criteria, consisting of total 747 patients THA and HA for elderly patients with femoral neck fractures. THA had longer surgery duration compared with HA (MD=32.48, 95% CI:5.13 to 59.83, p=0.02). THA showed better ratings Harris hip score (HHS) during a year follow-up periods (MD=2.31, 95 CI:0.42 to 4.21, p=0.02). There was no significant difference in complications. Conclusions: THA advantageous over hemiarthroplasty in the terms of HHS but HA favoured in surgical duration. Ultimately, only large well-conducted studies will result in improvements in the outcomes of treatment and resolve the longstanding controversy of whether THA or HA is the preferred treatment modality for femoral neck fracture in elderly.
A comparative study of modified Bassini's repair and Lichtenstein's repair for indirect inguinal hernia in young age population
(Medip Academy, 2024-12) Zahoor, A; Charokar, K; Singh, P.
Background: Inguinal hernia surgery has significant world-wide diversity in management. European Hernia Society guidelines 2020, for management of groin hernias recommends the use of open non-mesh repair in specific patients or types (e.g. young males with lateral hernia)as an acceptable alternative to a Lichtenstein technique. The present study deals with the comparison of intra operative, postoperative course and clinical outcome of modified bassinis repair (non mesh) and Lichtenstein repair [mesh repair] for indirect inguinal hernia in young age population. Methods: Observational analytical prospective cohort study, conducted in General Surgery, Peoples hospital, Bhopal from November 2022 to February 2024. Patient of indirect inguinal hernia in the age (16-35 years) group and operated by either Modified Bassinis (Group A, n=34) or lichtenstein hernia repair (Group B, n=48). The above study arms group were studied and compared. Results: Mean duration of surgery among Group A patients was 62.65 minutes and 57.19 minutes in Group B. Seropurulent discharge among 2.9% patients in Group A and 4.2% in Group B and superficial SSI among 2.9% patients in Group A and 4.2% in Group B was reported. Chronic post-operative pain VAS score was assessed at end of 2nd week, end of 1 month and end of 3 months with statistically no significant among two groups. Conclusions: Our study did not demonstrate any significant difference of one repair method over the other. However, an Individualized approach for cases with a customized strategy is recommended for surgical management of hernia.
Evaluation and management of pressure ulcers in plastic surgery department at tertiary care center in India
(Medip Academy, 2024-12) Sinwar, PD; Jain, RK; Kalra, S; Sharma, R.
Background: A pressure ulcer also known as decubitus ulcers, bedsores, or pressure sores is a localized injury to the skin and/ or underlying tissue usually over a bony prominence, as a result of unrelieved pressure or pressure in combination with shear. When extrinsic pressure exceeds the capillary pressure of 32 mmHg than vessel occluded and blood flow stops. When pressure not relieved for 5 minute every 2 hour, then necrosis and ulceration will result. Methods: Retrospective study of 74 patients with pressure injury admitted in SMS hospital Jaipur during 3 year duration from September 2019 to August 2022 requiring plastic surgery intervention. Patient specific factor, wound characteristics and flap outcomes analysed in study. Results: Patients with early-stage pressure injury (stage I and II) and advance stage (stage III and IV) with deteriorating or terminal co-morbidities, managed with conservative treatment in form of dressing with pressure management. Patients with advance stage pressure injury (stage III and IV) managed with active operative intervention in form of debridement and flap cover surgery. Conclusions: Prevention of pressure ulcer development is mainstay in management of both development and recurrence of pressure ulcer.
Study of below knee amputation in patients with diabetic foot ulcer in a tertiary care centre in India
(Medip Academy, 2024-12) Saravana, KI; Pathak, AL.
Background: This study aims to evaluate the predictive factors affecting the clinical outcome of below knee amputation performed in diabetic foot patients who had developed foot ulcers. Methods: This is a retrospective study of 25 random patients who underwent below-knee amputation for diabetic foot ulcers. These patients were admitted in the Department of Surgery, Shri MP Shah Medical College, Jamnagar, between November 2017 and October 2019. Results: The patient’s age ranged from 30 to 80 years, with a mean age of 62.92 years. 60% were between the ages of 51 and 70. Of the total, 14 were male and 11 were female, suggesting that males due to generally more active lifestyles, may be at higher risk for foot injuries leading to diabetic ulcers. 64% were from a lower socio-economic background. All 25 patients had previous admissions, 12 had a history of previous amputation, while 13 treated conservatively. Most patients presented with infected or non-healing ulcers, cellulitis and/or gangrene. Primary healing occurred in 13 patients, 7 required refashioning for healing, 3 required transfemoral amputation and 2 patients unfortunately passed away. The mean duration of hospital stay was 49.82±28.07 days. Conclusions: Lack of awareness, poor glycaemic control and duration of diabetes where the main factors causing diabetic foot problems. For patients with infected feet, difficulty with mobility and prolonged immobilization were common issues. Timely below-knee amputation helped restore movement and improved the ability to use prosthetic limbs, allowing for greater mobility and independence.
Role of repeat neuroimaging in complicated mild traumatic brain injury: a single centre study
(Medip Academy, 2024-12) Vinodh, KKS; Sankar, L.
Background: Patients with mild traumatic brain injury (TBI) and positive initial CT brain findings undergo routine repeat CT brain for follow-up usually after 48 hours as a Standard of care. Use of repeat routine neuro imaging is controversial in mild TBI. We hypothesized that in patients with mild TB I repeat neuro imaging of the brain would not alter the outcome or patient’s care. Aims and objectives were to evaluate the role of repeat CT brain in patients with complicated mild TBI (c-mild TBI) who were determined non-surgical medical line of management at the time of admission. Methods: It is a hospital based prospective observational single centre study. Clinical and demographic data including age, gender, admission and discharge GCS and timing of the first and second CT brain of the patients included in the study were recorded on pre-designed and pre-tested proforma. department of neurosurgery, government Mohan Kumaramangalam medical college hospital, Salem-01, Tamil Nadu, India. Results: Out of 552 patients, our study found that 46 (8.33%) patients had neurological deterioration in the form of drop in GCS, change in pupillary size, increased focal deficit, seizures or raised ICP symptoms, 94 (17.02%) patients had radiological progression in the form of increase in size of hematoma or edema and out of which only 21 (3.8%) patients underwent surgical intervention following second CT and all the patients who underwent surgical intervention had clinical neurological deterioration. Conclusions: For patients with c-mild TBI a repeat CT brain should be obtained only in patients who have neurological worsening and serial neurological examination and observation after the injury is recommended. With this approach, patients who need delayed neurosurgical intervention can be identified while unnecessary imaging procedures can be avoided.
Association of serum procalcitonin level with acute respiratory distress syndrome in patients following cardiopulmonary bypass
(Medip Academy, 2024-12) Islam, MA; Tamal, SMTY; Sama, A; Islam, S; Karmokar, S; Ghosh, R; Raju, MR; Zafar-Al-Nimari, M; Azim, A.
Background: Acute respiratory distress syndrome is a potentially life-threatening complication after cardiac surgery. Systemic inflammatory response is activated during cardiopulmonary bypass time which may cause acute respiratory distress syndrome and serum procalcitonin level also increases during systemic inflammatory response. This study aimed to see the association of serum procalcitonin level with acute respiratory distress syndrome in patients following cardiopulmonary bypass. Methods: This was a prospective observational study conducted in the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh during the period from September, 2020 to August, 2022. In our study, we included 140 patients who underwent cardiac surgery with cardiopulmonary bypass. Patients were divided into two groups- group A included 70 patients with serum procalcitonin levels <7 ng/ml and group B included 70 patients with serum procalcitonin levels>7 ng/ml. Results: The mean (±SD) age of the patients was 43.20 (±13.18) years and 46.61 (±13.75) years in group A and group B respectively. In group A, 41.4% of patients were male and 58.6% were female; in group B, 52.9% were male and 47.1% were female. On 1st postoperative day, in group, A serum procalcitonin levels were 1.36(±0.97) ng/ml and in group B serum procalcitonin levels were 27.09(±26.11) ng/ml (p<0.001). The incidence of ARDS was significantly higher in group B than in group A (35.7% versus 8.5%, p= 0.002). Conclusion: This study concluded that there was an association of serum procalcitonin level with acute respiratory distress syndrome in patients following cardiopulmonary bypass.
Our experience at Bangabandhu Sheikh Mujib Medical University on laparoscopic assisted surgery for rectal cancer
(Medip Academy, 2024-12) Islam, MS; Miah, M; Ali, MS; Akter, J; Siddiquee, MA; Haque, AA; Hossain, T; Ovi, MRA; Eastiak, MF.
Background: Rectal cancer is a leading cause of mortality worldwide, with laparoscopic surgery emerging as a viable alternative to open surgery due to its benefits in postoperative recovery, pain management and survival rates. Despite its advantages, laparoscopic colorectal resection faces scrutiny over oncologic safety and technical demands, limiting its widespread adoption. Methods: This retrospective descriptive study analyzed 60 patients with colorectal adenocarcinoma treated at the Department of Colorectal Surgery, BSMMU, from January 2018 to December 2018. Inclusion criteria encompassed clinically diagnosed colorectal cancer with histological confirmation. Data on demographics, tumor characteristics, surgical details and postoperative outcomes were collected and analyzed with SPSS software. Results: Among the 60 patients, 32 were male, with a mean age of 52 years. Tumors within 5 cm of the anal verge necessitated abdominoperineal resections (n=44), while anterior resections were performed for the remaining (n=16). All patients achieved adequate proximal margins (>5 cm) and most (90%) had distal margins >2 cm. The average operative time ranged from 190 to 270 minutes, with no intraoperative complications and a postoperative stay of 3-5 days. Patients reported less postoperative pain and faster recovery. Conclusions: Laparoscopic colorectal surgery demonstrated similar oncologic outcomes to open surgery but involved a longer operative time and required advanced surgical skills. The benefits included reduced blood loss, lower postoperative pain and a shorter hospital stay, although costs were higher. A need for expert surgeons in selected patients is emphasized for optimal outcomes. Laparoscopic resection for rectal cancer aligns with oncologic principles and offers a safe, effective approach, yielding improved recovery metrics compared to traditional surgery. Further analysis on cost-effectiveness, especially for lower socioeconomic populations, is warranted to enhance accessibility.
The impact of Hashimoto’s thyroiditis on the diagnostic utility of P63 and CK19 immunohistochemistry markers in predicting thyroid cancer
(Medip Academy, 2024-12) Karunakaran, P; Jayaraman, S; Periyasamy, S; Subburaman, R.
Background: The incidence of thyroid cancer (TC) and Hashimoto’s thyroiditis (HT) is increasing worldwide. Coexisting HT adds to diagnostic confusion in establishing TC on histopathological examination (HPE). Studies have shown the promising role of immunohistochemistry markers in predicting cancer, but the impact of coexisting HT is unclear. This prospective study determined the impact of HT on the diagnostic utility of p63 and CK19 in predicting thyroid cancer. Methods: Out of 103 patients undergoing total thyroidectomy for benign or malignant thyroid nodules, 31 patients (mean age=39.7 years, Male:Female=4:27) with elevated thyroid autoantibodies were studied. HPE of formalin-fixed paraffin-embedded tissue from surgical specimens confirmed the final diagnosis. Sections 2-4? were stained for immunohistochemistry using the standard avidin-biotin complex method with antibodies against P63 and CK19. Expression in 10% or more of neoplastic cells qualified as positive while expression in less than 10% was considered negative. Receiver Operating Characteristic (ROC) assessed the diagnostic accuracy. Results: Histopathology comprised 58.1% benign and 41.9% malignant lesions. CK19 exhibited membranous expression in 87.1%, while p63 exhibited focal nuclear expression in 35.5% of cases. In ROC analysis predicting TC for entire cohort, the area under curve (AUC) of P63 was 0.6 and CK19 was 0.532. In subgroup with HT, the AUC of p63 was 0.8. Each P>0.05. Conclusions: P63 expression had better predictability for thyroid cancer with co-existent Hashimoto’s thyroiditis but was not statistically significant. Whereas, CK19 was non-specific and unreliable. Histomorphological features on HPE are the gold standard for diagnostic decisions.
A comparative study between early and conventional intestinal stoma closure in a tertiary care institute
(Medip Academy, 2024-12) Vatvani, V; Khoja, HR; Krishna, CV; Rustagi, S; Jain, R.
Background: Little is known about ideal time for stoma closure. Therefore, the aim of this study is to compare early versus conventional stoma closure following bowel surgery in terms of quality of life (QoL), length of hospital stay (LoH), and postoperative complications. Methods: This randomized controlled trial was conducted at a medical college affiliated teaching hospital from May 2023 to June 2024. The 116 patients undergoing bowel surgery with temporary stoma creation were randomized into early closure (3 weeks post-surgery) and conventional closure (8-12 weeks post-surgery) groups. Primary outcome was anastomotic leak rate. Secondary outcomes included other postoperative complications, LoH, and QoL assessed using the EORTC QLQ-C30 questionnaire. Results: There was no significant difference in anastomotic leak rates between early (6.9%) and conventional (12.1%) closure groups. Overall complication rates were similar (56.9% early vs 50% conventional). LoH did not differ significantly between groups. QoL scores were significantly higher in the early closure group, with 100% of patients achieving considerable improvement (EORTC score 26-36) compared to 79.3% in the conventional group (p<0.05). Conclusions: Early stoma closure is safe and feasible in appropriately selected patients, with no increased risk of anastomotic leak or other complications. It significantly improves QoL compared to conventional closure timing, without prolonging hospital stay. These findings suggest that early stoma closure may be a beneficial option for suitable patients following bowel surgery.
Demographic and clinical profile of patients with acute biliary pancreatitis: an experience in Patan academy of health sciences
(Medip Academy, 2024-12) Duwal, S; Suwal, B; Maharjan, S; Bhandari, U.
Background: Acute pancreatitis is one of the most common causes of acute abdomen encountered in emergency department with wide range of severity from mild self-limiting disease to severe and rapidly progressive illness leading to multi organ failure and even death. Gall stones are leading cause of acute pancreatitis. This study has been carried out to find out demographic pattern and clinical profile of patients with acute biliary pancreatitis. Methods: This is a prospective cross-sectional study carried out in the department of surgery in Patan academy of health sciences (PAHS) in the time period between May 1, 2021 and April 30, 2022. The process of data collection was started after obtaining ethical approval from institutional review committee (IRC) of PAHS, and written informed consent was obtained from patients. Total sampling was done and 66 patients were enrolled into the study, who were diagnosed as acute biliary pancreatitis. Data was analyzed with SPSS ver 25 and Microsoft excel 2016. Results: Out of total 66 patients in the study 25 (37.9%) were male and 41 (62.1%) were female with male: female ratio of 1:1.64. Mean age was 48.42±16.62 years. ranging from 16-88 years. Epigastric abdominal pain was predominant presenting symptoms accounting for 57 (86.4%) cases. Pleural effusion was most common complication seen in 17 (25.8%) cases. Mortality occurs in 2 (3%) cases, both of cases had severe pancreatitis. Only 21 (31.8%) patients underwent cholecystectomy among which 13 (19.7%) interval and 8 (12.1%) index cholecystectomy. Conclusions: Female gender with age group of 40-60 years. predominates acute biliary pancreatitis. Though most of the cases are mild and have benign course, severe cases and patients with advanced age are associated with high mortality. Acceptance of index cholecystectomy is very low.
Prevalence of causative bacteria on cell phones of patients with chronic suppurative otitis media: a descriptive cross-sectional study
(Medip Academy, 2024-12) Ekanayake, LSB; Uganathan, A; Abeykoon, M.
Background: The aim of this study is to identify the prevalence of causative bacteria on the cell phones of patients with chronic suppurative otitis media (CSOM). Methods: Fifty clinic patients were randomly selected according to the eligibility criteria. Ear swab samples and swabs from the ear-piece area of their cell phones were collected for laboratory investigation. Additionally, 20 controls were recruited for comparison. Results: Among the 50 subjects, 60% were Females, and the highest prevalence was observed in the 36-45 age group. Ear swab cultures showed bacterial growth in 32 samples (64%), with Pseudomonas spp. (24%) being the most prevalent, followed by coagulase-negative Staphylococcus spp. (14%) and Staphylococcus aureus (14%). Only 11 out of 50 phone swabs (22%) showed bacterial growth, predominantly coagulase-negative Staphylococcus spp. (18%). In three cases, the same non-pathogenic bacteria (coagulase-negative Staphylococcus spp.) were found in both ear and phone samples. Among the controls, 55% were female, and the highest prevalence was in the 26-35 age group. Four ear swab samples (20%) from the controls grew coagulase-negative Staphylococcus spp., but phone samples showed inconsistent laboratory results due to technical issues. Conclusions: Based on the findings, there is no significant prevalence of CSOM causative bacteria on the cell phones of patients. However, limitations, including sample size and the inability to establish a causal relationship, should be considered. Larger studies exploring multiple environmental reservoirs may better clarify potential transmission routes for CSOM pathogens.
Association between KRAS, NRAS, and BRAF mutations and tumor localization in colorectal cancer patients in BSMMU
(Medip Academy, 2024-12) Siddiquee, MA; Rahman, SAM; Islam, MS; Ovi, MRA; Jalal, MT; Haque, AA; Saha, KK; Hossain, T; Ali, MS; Akter, J.
Background: Colorectal cancer (CRC) is a common malignancy with significant genetic heterogeneity. Mutations in proto-oncogenes such as KRAS, NRAS, and BRAF play a pivotal role in CRC development, impacting prognosis and treatment. This study aims to correlate mutations in these genes with tumor localization in both primary and metastatic CRC in the Bangabandhu Sheikh Mujib medical university (BSMMU) cohort. Methods: This prospective cross-sectional study was conducted between July 2023 and June 2024 at BSMMU. A total of 30 CRC patients, confirmed via histopathology, were included. Purposive sampling was used to select patients. Tumor tissue samples were collected and analyzed for KRAS, NRAS, and BRAF mutations using DNA isolation, PCR amplification, and sequencing techniques. Results: Among the 30 patients, the majority were male (66.7%) with a mean age of 50.4 years. KRAS mutations were found in 5 patients (16.7%), while no mutations in NRAS or BRAF were detected. Rectal cancer was the most frequent tumor location (36.7%), followed by hepatic and splenic flexure (16.7% each). No significant correlation was observed between KRAS mutations and tumor localization?. Conclusions: There was no statistically significant correlation between KRAS, NRAS, and BRAF mutations and tumor localization in the BSMMU CRC patient cohort. The study highlights the need for larger sample sizes to better understand the genetic landscape of CRC in Bangladesh?. Small sample size may limit the ability to detect significant associations. Further large-scale studies could offer more conclusive insights.
Prevalence, risk factors, and management of ascites in the western sub-divisional hospitals of Fiji: a multi-center retrospective study
(Medip Academy, 2024-12) Bancod, RA; Gogoi, A; Buenafe, DG.
Background: Ascites, a condition characterized by fluid accumulation in the abdominal cavity, is a common complication of chronic liver disease and other serious health conditions. In resource-limited settings such as Fiji, managing ascites presents unique challenges. This study investigates the prevalence, associated risk factors, and current management approaches for ascites in the Western Sub-Divisional Hospitals of Fiji, focusing on population demographics and healthcare practices. Methods: This retrospective study analyzed patient records from January 2021 to December 2023 across five hospitals—Sigatoka, Nadi, Ba, Tavua and Rakiraki. Data on demographics, medical history, lifestyle factors and treatment practices were collected. The study adhered to ethical standards, with approval from the Fiji National Research. Results: Ascites primarily affected individuals over the age of 50, with a higher prevalence among men and individuals of Indian descent. Key risk factors included alcohol abuse, chronic liver disease, and metabolic syndrome. Management typically involved sodium restriction, diuretics and in limited cases, Transjugular Intrahepatic Portosystemic Shunt (TIPSS) due to accessibility constraints. Conclusions: The findings highlight a need for culturally responsive healthcare strategies, improved screening, and multidisciplinary treatment protocols to manage and prevent ascites effectively in this population. Enhanced public health initiatives and clinical guidelines could significantly impact patient outcomes in Fiji.
A prospective study comparing intra-operative and postoperative complications in totally extra peritoneal repair vs extended totally extra peritoneal for inguinal hernia
(Medip Academy, 2024-10) Aggarwal, P; Kochar, MP; Sharma, BK; Bansal, A; Sharma, S.
Introduction: Inguinal hernia repair is one of the most common surgical procedures worldwide. Total extra peritoneal repair (TEP) and Extended-TEP (eTEP) are widely used minimally invasive methods. TEP involves creating a space in the preperitoneal plane without entering the abdominal cavity, whereas eTEP extends this approach, allowing for a broader operative field.This study compares the intra-operative and postoperative complications of TEP and eTEP, contributing to the optimisation of inguinal hernia management. Methods: It is a prospective study. A total of 60 patients who underwent TEP and e-TEP for inguinal hernia, who fulfilled the inclusion criteria. Patients were randomised by simple random sampling technique and were divided into two groups of 30 each (group A-TEP and group B-eTEP). Data of both groups were compared and analysed for statistical significance using Chi square test and Student ‘t’ test. Result: The comparative analysis between TEP and eTEP procedures shows no significant differences in demographic parameters. However, eTEP demonstrates significantly shorter operative time and hospital stay, quicker return to work. Both procedures have similar rates of low intra-operative and postoperative complications, indicating comparable safety profiles. Conclusion: Our study suggest that both techniques are associated with low complication rates and good patient outcomes, with eTEP showing potential advantages in terms of pain, recovery and wider access. These findings help to take better surgical decision, to make and helped optimize patient care in inguinal hernia management.
Role of tranexamic acid as an adjunctive for chronic sub dural hematoma for early resolution and reduced recurrence rate: a prospective case-control study
(Medip Academy, 2024-12) Sri, PV; Sankar, L.
Background: Literature shows the effective use of tranexamic acid to reduce CSDH either as a primary treatment or as an adjunctive treatment. However, literature lacks conclusive evidence on the use of tranexamic acid for CSDH. There are not many Indian studies also on this subject. This study was aimed at finding the effectiveness of tranexamic acid in reducing the recurrence rate following surgery and early resolution. Methods: From May 2023 to May 2024, single centric case control study was done in a tertiary care center (Government Mohan Kumaramangalam medical college hospital, Salem) in Southern India. All patients with chronic subdural hematoma with Markwalder grading 2-4 and grade 1 with midline shift more than 1 cm were included in the study. Patients with severe cardio-cerebrovascular disease, patients with allergy to tranexamic acid and patients not willing to participate were excluded from the study. Tranexamic acid was given at a dose of 500 mg twice a day for 10 days. Patients were allocated into two groups: group A: where tranexamic acid was used, group B: where tranexamic acid was not used. Results: The mean duration of hospital stay was lesser in tranexamic acid group (p<0.005). The mean SDH thickness was lesser at 4th and 8th week in tranexamic acid group (p<0.005). Recurrence rate was lesser in tranexamic acid group at three months (p>0.05). Conclusions: This study of patients with CSDH showed that the adjunctive use of TXA after burr-hole drainage is effective in achieving resolution of CSDH through faster hematoma reduction. TXA may have a favorable effect in reducing recurrence and can be administered safely in selected patients.
Location of venous reflux in our duplex test of patients with primary chronic venous insufficiency and comparison with that of the literature
(Medip Academy, 2024-12) Chowdhury, MR; Hossain, MA; Choudhury, NA; Al-Miraj, AK; Sarker, NMA.
Background: Chronic venous insufficiency (CVI) significantly impacts patients’ quality of life and poses economic burdens on healthcare systems. Accurate assessment of venous reflux is crucial for effective management. This study aimed to identify the sites of deep, superficial, and perforator venous reflux, including junctional incompetencies between superficial and deep veins in patients with primary CVI. Methods: A prospective observational study was conducted from July 1, 2022 to June 30, 2024, utilizing non-invasive Duplex ultrasonography on patients in our clinical practice. Data were collected without patient identification, and informed consent was obtained prior to procedures. Reflux was defined as venous flow reversal lasting over 0.5 seconds. Results: A total of 50 limbs from patients aged 20 to 77 years (mean age 43) were examined, with a male-to-female ratio of 52:48. Reflux was detected in the external iliac (41 limbs), common femoral (39 limbs), superficial femoral (21 limbs), popliteal (26 limbs), posterior tibial (7 limbs) and perforator veins (21 limbs). Sapheno-femoral junction incompetency was observed in 28 cases, with 6 cases indicating early-stage reflux. Dilatation of the great saphenous vein was noted in 33 cases, while 14 cases exhibited short saphenous vein dilatation. Conclusions: The detection of venous reflux reveals significant insights for diagnosing and managing CVI. This study highlights areas for improvement in Duplex examination techniques, advocating for enhanced training for healthcare professionals to elevate diagnostic standards, ultimately benefiting patient outcomes and reducing societal burdens associated with CVI.
A 10-year retrospective study of 43 female patients presenting with idiopathic granulomatous mastitis
(Medip Academy, 2024-12) Tian, J; Curry, S; Kiarie, PK; Sneed, C; Mourad, Y; Bhatia, S; Hassanesfahani, M; Miele, A; Keating, L; Louis, MA; John, SS.
Background: Idiopathic Granulomatous Mastitis (IGM) is a rare inflammatory breast condition affecting middle aged women. IGM typically presents as a unilateral, painful and challenging-to-treat breast mass, with a high recurrence rate. Common treatments include corticosteroids and antibiotics, with surgical excision reserved for resistant cases. However, the absence of a standardized treatment protocol leads to variability in management across different settings and providers. Methods: We present a case series of 43 patients diagnosed with IGM at a community hospital in New York, aiming to facilitate early recognition and treatment of this rare condition. This study identifies risk factors and reviews best practices in imaging and treatment, emphasizing the importance of considering IGM in the differential diagnosis, particularly in cases of recurrent disease. Results: The sample comprised 43 patients with an average age of 34.65 years, 31 (72%) of whom were Hispanic. The most commonly reported symptoms were pain, mass, erythema, and swelling. In all cases, IGM was confirmed by histopathological examination. Treatment modalities included incision and drainage (I and D), corticosteroids, antibiotics, methotrexate and surgical intervention. Conclusions: IGM is a rare condition often mistaken for breast cellulitis, abscess or carcinoma. Maintaining a high index of suspicion is crucial, particularly in Hispanic women who may be at increased risk. Histopathological diagnosis is essential to prevent unnecessary surgical interventions and antibiotic use, thereby reducing recurrence rates. Early initiation of corticosteroids or alternatives like methotrexate can optimize patient outcomes and reduce healthcare costs.
Outcome of combined surgery with compression therapy for management of venous leg ulcer
(Medip Academy, 2024-12) Khurshid, MR; Islam, MA; Al Mahmud, H; Chowdhury, MTA; Linda, NS.
Background: Venous leg ulcers (VLUs) are late indicators of chronic venous insufficiency (CVI) and venous hypertension. Compression therapy (CT) with multilayer bandage is the first line of treatment modality of ulcer management. But CT has a slow ulcer healing rate and high chance of recurrence. The present study was conducted to identify the outcome of combined surgery with compression therapy to manage VLU. Methods: In this prospective study, 60 patients were included who presented to the department of cardiovascular surgery of Dhaka Medical College and Hospital between January 2021 to December 2023. The patients were divided into two groups. Group A included the patients who underwent surgery combined with compression therapy while Group B patients received only compression therapy (CT). Ulcer healing time, recurrence rate and Venous Clinical Scoring System (VCSS) were analysed to determine the outcome. Results: There was no significant difference in the demographic variables between two groups. 30 limb ulcers healed in the combined treatment group with a median healing time of 1.6 months (95% CI, 1.42–1.82), while 24 limb ulcers healed in the CT alone group with a median healing time of 2.15 months (95% CI, 1.92–2.45). The ulcer healing time was shorter in the combined treatment group than in the CT alone group (HR for ulcer healing 1.98, 95% CI, 1.474–2.309, p<0.05). Recurrence rate was higher in CT group (16.66% vs 53.33%). Besides VCSS was lower in Combined group that CT group after 1month, 6 month and 12 month of follow-up which was statistically significant. (p<0.05) Conclusions: The present study has demonstrated combined treatments can shorten the ulcer healing time and reduce the ulcer recurrence rate compared with CT alone for treating VLU. Further randomized large scale multicenter study is recommended to provide a better management to the patients.
Bilateral multiple ribs and sternum fracture causing central flail chest with respiratory failure
(Medip Academy, 2024-11) Charokar, K; Rathor, DKS; Besra, S; Rathore, A.
Bilateral thoracic blunt injuries in a patient may present with central Flail chest, and acute respiratory failure which is one of the life-threatening complications. We present a case of central flail chest caused by blunt trauma, successfully managed with operative rib and sternum fixation. A 35-year male with a central flail chest with acute respiratory failure caused by road-traffic accident who was managed initially with bilateral intercostal chest-tube drainage for significant bilateral hemopneumothorax and lung contusions. The patient was intubated and connected to mechanical ventilatory support with positive pressure ventilation for the internal pneumatic stabilization. There were multiple rib fractures anteriorly (first to seventh rib bilaterally) and fracture of the sternum - the flail chest, for which he underwent bilateral rib fixation and fixation of sternum with titanium reconstruction plate and screws on the 9th postinjury day. Tracheostomy was done along with fixation in the same sitting. Post-operatively, after 48 hours of positive pressure mechanical ventilation, the weaning was started and by the 4-5th day, the patient was on room air with a tracheostomy tube. The patient recovered uneventfully and was discharged on the eighth postoperative day.

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