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Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh
AKM Shamsul Haque,
Habibun Nobi Md Shafiquzzaman,
Md Shohorab Hossain,
Goutom Kumar Ghosh
Issue:
Volume 8, Issue 6, December 2020
Pages:
171-177
Received:
16 June 2020
Accepted:
13 July 2020
Published:
4 November 2020
Abstract: Diabetic foot complications are the most common cause of non-traumatic lower extremity amputations. The aim of this study was to determine the different pattern of foot complication associated with Diabetes mellitus. Methods & Materials: This experimental study was conducted on a total of 50 patients of diabetic foot complications admitted in the department of Surgery (in-patient) in Rajshahi Medical College & Hospital (RMCH), Rajshahi, Bangladesh during the period from June 2009 to December, 2009. Either sex ranging from above 15 years were included in the study. Approval committee of BCPS approved the dissertation protocol including the Ethical clearance. Written consent was obtained from each subject. Data were collected using a structured questionnaire containing all the variables of interest (research instrument). The researcher used simple statistical data analyzed tools to analyze the collected data to determine the findings of this study. Results: A total of 50 diabetic patients were included in this study as per inclusion criteria of either sex. Among the patients 30 (60%) were male and 20 (40%) were female. The age group of the patients (30-40) years, were 02 (4%), (41-50) years, were 10 (20%), (51-60) years, were 32 (64%), (61-70) years, were 06 (12%). The overall diabetic foot complications of the patients were as follows: ulceration were 13 (26%) cellulitis were 08 (16%), cellulitis with abscess were 21 (42%), gangrene were 06 (12%), gangrene with septicemia was 01 (2%), and bony involvement was 01 (2%). The trauma were found in 28 (56%) patients. After operation, the foot complication prevailed in 06 (12%) patients and from skin diseases, the foot complication arose in 04 (08%) patients as well as from other causes 12 (24%) patients suffered from foot complications. Neurological changes were noted only in 12 (24%) patients. Vascular changes were found only in the feet of the 06 (12%) patients. Mid foot were the highest number 30 (60%) of the location of foot ulcers. Culture was done 25 (50%) of the studied patients. Proteus were 05 (20%), Klebsiela were 03 (12%), Staphylococci were 04 (16%) and Pseudomonus were 02 (8%). Pain impaired/absent in one/both feet were found in 31 (62%) of the patients. Impaired/absent temperature sensation was noted in 07 (14%) of the patients and absent ankle reflex were noted in 09 (18%) patients. Dry skin were 14 (28%), hyper pigmentation were 05 (10%), hypo pigmentation were 04 (8%), cracked skin were 06 (12%) and normal skin was found in 21 (42%) cases. Wound debridement and dressing were 23 (46%) highest in treatment modalities option. Conclusion: Combined with an aggressive wound care program, can result in a favorable outcomes.
Abstract: Diabetic foot complications are the most common cause of non-traumatic lower extremity amputations. The aim of this study was to determine the different pattern of foot complication associated with Diabetes mellitus. Methods & Materials: This experimental study was conducted on a total of 50 patients of diabetic foot complications admitted in the d...
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Intelligent Ultrasonic Energy: New Adaptive Tissue Technology in Harmonic Shears
David Singleton,
Natalia Juncosa-Melvin,
Patrick Scoggins,
Geisa Paulin-Curlee,
John Cummings,
Crystal Ricketts
Issue:
Volume 8, Issue 6, December 2020
Pages:
178-183
Received:
6 October 2020
Accepted:
23 October 2020
Published:
4 November 2020
Abstract: Objective: Development of ultrasonic technology in surgical devices includes mechanisms of monitoring and adjusting energy delivery to target tissues for the purpose of limiting thermal spread. The objective of the current study was to evaluate performance of a new Adaptive Tissue Technology algorithm, designed to enhance thermal management in the HARMONIC 1100 Shears. Methods: The HARMONIC 1100 Shears were evaluated with bench-top and in vivo preclinical (porcine) analyses for tissue thermal spread, blade heat, transection speed, hemostasis and vessel sealing performance. Testing was performed in parallel with the current production HARMONIC HD 1000i Shears to confirm non-inferiority of the new Adaptive Tissue Technology algorithm. Results: Bench top analysis revealed significantly lower average maximum blade temperatures for HARMONIC 1100 compared to HARMONIC HD 1000i as well as HARMONIC ACE+ 7 Shears with Advanced Hemostasis. Thermal spread, transection speeds, and burst pressure tests of excised porcine carotid arteries did not show a statistical difference between HARMONIC 1100 and HD 1000iShears. In vivo analysis of hemostasis following sealing/transection of various blood vessels in acute porcine testing demonstrated similar efficacy for HARMONIC 1100 and HD 1000i Shears. Likewise, tissue lateral thermal damage showed no statistical difference between the new and previous generation Harmonic device in the porcine model. Conclusion: The new Adaptive Tissue Technology in HARMONIC 1100 Shears allows for reduced maximum blade temperatures while providing effective hemostasis, sealing strength, transection speed, and limited thermal damage.
Abstract: Objective: Development of ultrasonic technology in surgical devices includes mechanisms of monitoring and adjusting energy delivery to target tissues for the purpose of limiting thermal spread. The objective of the current study was to evaluate performance of a new Adaptive Tissue Technology algorithm, designed to enhance thermal management in the ...
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Difficult to Heal Wounds Intralesional Insulin Therapy Trial
Neide Kalil Gaspar,
Antonio Pedro de Andrade Gaspar
Issue:
Volume 8, Issue 6, December 2020
Pages:
184-189
Received:
14 January 2020
Accepted:
7 February 2020
Published:
9 November 2020
Abstract: Introduction-Insulin exerts metabolic and growth-stimulating actions both through its own receptors and the receptors of its homologous factors (IGFs), although with different degrees of affinity. The A receptor of insulin acts more intensely on the cell membrane, with a metabolic response, whereas the B receptor is quickly internalized, stimulates cell growth, can be directed to the treatment of wounds difficult to heal. Objective-we proposes to evaluate the potential of insulin as an inducing agent in the regeneration of wounds that are difficult to heal as a therapeutic option. Methodology-Simultaneous intra and perilesional injections of 0.01ml of the solution containing 5UI of NPH single-component insulin diluted in 1 ml of lidocaine into various planes and wound sites. Clinical, glycemic and photographic evaluations of the patients were performed. Results-The cicatricial response occured in all patients and observed since the first applications. Withouth glycemic changes. Comments - The responses obtained can be attributed to both the stimulation of insulin receptors and that of their counterparts. Conclusions-The method was effective and without adverse effects. Different intervals between applications did not change the results. The availability of insulin and safety for its use indicate the method as a therapeutic option in difficult to heal wounds.
Abstract: Introduction-Insulin exerts metabolic and growth-stimulating actions both through its own receptors and the receptors of its homologous factors (IGFs), although with different degrees of affinity. The A receptor of insulin acts more intensely on the cell membrane, with a metabolic response, whereas the B receptor is quickly internalized, stimulates...
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A 7-year Prospective Epidemiological Study of Acute Elbow Admissions to a Trauma Unit
Alex Bolt,
Siddharth Govilkar,
Caroline Dover,
John Blackwell,
Stuart Hay
Issue:
Volume 8, Issue 6, December 2020
Pages:
190-196
Received:
28 September 2020
Accepted:
16 October 2020
Published:
11 November 2020
Abstract: Introduction: This study represents an analysis of data collected prospectively over a seven-year period to our trauma unit, to identify the epidemiological background behind the admissions of patients with acute elbow problems and to highlight the impact of these admissions on our trauma service. Method: Nearly 16,000 patients were included in our database. The admissions were initially categorized into A) fractures/dislocations or B) soft tissue trauma. The fractures/dislocations were then further classified by radiographic anatomical location, with data also collected on length of stay and operative management. In total 509 admissions were included in this study; 193 were paediatric cases and 316 were adults. This included 428 admissions with fractures/dislocations and 81 cases of soft tissue trauma. Conclusion: In conclusion, this data allows us to identify relative frequency of acute elbow conditions, including the incidence of common fracture patterns. These figures help to facilitate resource planning, such as expertise amongst personnel or the acquisition of equipment, including radial head replacement, elbow arthroplasty, and periarticular locking plates.
Abstract: Introduction: This study represents an analysis of data collected prospectively over a seven-year period to our trauma unit, to identify the epidemiological background behind the admissions of patients with acute elbow problems and to highlight the impact of these admissions on our trauma service. Method: Nearly 16,000 patients were included in our...
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A Review of Deep Neck Space Infections: Perspective from a Sub-Saharan African Center
Moses Ikechukwu Ajaero,
Samuel Uchechukwu Nduagu,
Chidiebere Peter Echieh,
Raphael Arinze Onyekwelu
Issue:
Volume 8, Issue 6, December 2020
Pages:
197-203
Received:
19 October 2020
Accepted:
28 October 2020
Published:
27 November 2020
Abstract: Deep neck space infections (DNSI) are inflammation often with abscess collection within potential fascial spaces in the head and neck region. The incidence of DNSIs is relatively higher in populations of low socioeconomic status This study aimed at analyzing the pattern of presentation and management of DNSIs seen at our facility over 10 years. Data were extracted from patients’ case notes and medical records. A total of 72 patients (47 males and 25 females) were studied with a Male to Female ratio of 1.88:1. The patients’ ages ranged from 4years to 80 years with mean age of 46.2±21.3 years. the commonest presenting complaints were pain (95.8%), dysphagia (81.9%) and odynophagia (70.8%). The mean duration of complaints prior to presentation was 10.9±4.1days. Majority of the DNSIs were of odontogenic origin (56.9%) and diabetes mellitus (26.4%) was the most commonly encountered co-morbid condition. Submandibular and sublingual infections were the most common (40.3%) followed by peritonsillar space infections (23.6%) and retropharyngeal and prevertebral space infections (16.7%). S. aureus (15.3%) was the most commonly isolated organism among the rest with the infection being polymicrobial in 33.3% of the patients. The commonest complications were septicaemia (18.1%), necrotizing fasciitis (12.4%) and mediastinitis (2.8%). In Sub-Saharan Africa, DNSIs can affect all age groups; appear to have more morbidity in people with low socioeconomic class and co-morbidities. They can be managed with a combination of incision and drainage and intravenous antibiotics. Attention to oro-dental hygiene may help reduce the incidence of DNSI as majority are found to be linked with odontogenic and pharyngo-tonsillar conditions.
Abstract: Deep neck space infections (DNSI) are inflammation often with abscess collection within potential fascial spaces in the head and neck region. The incidence of DNSIs is relatively higher in populations of low socioeconomic status This study aimed at analyzing the pattern of presentation and management of DNSIs seen at our facility over 10 years. Dat...
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Analysis of Risk Factors of Recurrent Vertebral Fractures After Percutaneous Vertebroplasty
Jiang Du,
Chenhuan Lu,
Jing Wang
Issue:
Volume 8, Issue 6, December 2020
Pages:
204-208
Received:
1 November 2020
Accepted:
19 November 2020
Published:
30 November 2020
Abstract: Background: Investigate the risk factors of recurrent vertebral compression fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF). Method: Data of 401 patients with osteoporotic vertebral compression fractures treated by PVP from March 2013 to June 2018 were retrospectively analyzed, and were divided into re-fracture group and nonre-fracture group according to the postoperative recurrence of vertebral compression fractures. The following parameters were observed, including age, gender, bone mineral density (BMD), correction degree of kyphosis, recovery degree of vertebral height, amount of bone cement injected, Pfirrmann classification of adjacent intervertebral disc of hurt vertebral, and bone cement leakage in intervertebral disc. Then, the above parameters were statistically analyzed by univariate and multivariate analysis to explore the risk factors of vertebral recurrent fracture after PVP. Result: Among 401 patients, 34 (34 /401, 8.4%) recurred OVCF after PVP. Statistical analysis showed that the risk of recurrent vertebral fracture increased by 3.732 times (95% CI 1.107-12.581) when Pfirrmann classification of adjacent intervertebral disc was in degeneration grade. The risk of recurrent vertebral fracture was significantly increased by 31.818 times (95% CI 13.384-75.640) when bone cement leakage occurred in intervertebral disc. Conclusion: Pfirrmann classification of adjacent intervertebral disc and bone cement leakage in intervertebral disc are significantly correlated with the recurrence of vertebral fracture after PVP. In PVP operation, avoiding the bone cement leakage in intervertebral disc can significantly reduce the recurrence of vertebral compression fractures.
Abstract: Background: Investigate the risk factors of recurrent vertebral compression fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF). Method: Data of 401 patients with osteoporotic vertebral compression fractures treated by PVP from March 2013 to June 2018 were retrospectively analyzed, and were divi...
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An Exploration of the Active Ingredients of Cortex phellodendri in the Treatment of Hemorrhoids and Its Mechanism Based on Network Pharmacology
Xianchang Yu,
Xiongdong Zhong
Issue:
Volume 8, Issue 6, December 2020
Pages:
209-216
Received:
20 November 2020
Accepted:
30 November 2020
Published:
4 December 2020
Abstract: Background: Huangbo, also known as Cortex phellodendri in Latin, is an important drug which has the pharmacological action of clearing heat, drying dampness, purging fire and detoxifying. In recent years, it has been reported that Huangbo also has the activity of treating hemorrhoids. Objective: The aim of this study was to explore the Active Ingredients of Cortex phellodendri in the Treatment of hemorrhoids and Its Mechanism. Study Design: We analyzed Active components and target genes of Cortex phellodendri in the Traditional Chinese Medicine System Pharmacology (TCMSP) database and analysis platform. We then searched the GeneCards database for target genes related to hemorrhoids and the intersection of these genes with the active components of Cortex phellodendri. Target genes related to hemorrhoids were taken as common potential target genes of Cortex phellodendri, which could act on hemorrhoids. Using the R programming language, we drew a Venn map of these common potential target genes. The “component–target gene–disease” network of Cortex phellodendri in the treatment of hemorrhoids was established using Cytoscape software version 3.7.1; the protein–protein interaction (PPI) network was constructed in the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database. With the help of R and Perl languages, we performed gene ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses of potential target genes of Cortex phellodendri in the treatment of hemorrhoids. Results: We extracted a total of 10 active components from Cortex phellodendri, including quercetin and rutaecarpine and so on, as well as 29 potential target genes for hemorrhoids. According to the Degree ranking in Cytoscape3.7.1 software, the top 10 potential target genes were interleukin-6 (IL-6), CCL2, CXCL8, MMP9, vascular endothelial growth factor A (VEGFA), Myc, IL-10, ICAM1, MMP2, and MMP3. Pathway enrichment mainly involved signaling pathways such as advanced glycation end products and receptor for advanced glycation end products (AGE-RAGE) signaling pathway in diabetic complications, hypoxia-inducible factor 1 (HIF-1), IL-17, and Relaxin. Conclusion: Based on network pharmacology, Cortex phellodendri is expected to be mined as a candidate Traditional Chinese Medicine (TCM) for the treatment of hemorrhoids. Its mechanism for treating this disease operates via multiple components and pathways. This study provides the basic theory and the basis for further research.
Abstract: Background: Huangbo, also known as Cortex phellodendri in Latin, is an important drug which has the pharmacological action of clearing heat, drying dampness, purging fire and detoxifying. In recent years, it has been reported that Huangbo also has the activity of treating hemorrhoids. Objective: The aim of this study was to explore the Active Ingre...
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Contribution of Imaging to the Management of Surgical Emergencies in the General Surgery Department of the Ignace Deen National Hospital
Diakite Sandaly,
Mamy Gnan Francis,
Camara Soriba Naby,
Soumaoro Labile Togba,
Dabo Mamoudou,
Fofana Houssein,
Fofana Naby,
Camara Mariame,
Camara Fode Lansana,
Diakite Saikou Yaya,
Touré Aboubacar,
Diallo Aissatou Taran
Issue:
Volume 8, Issue 6, December 2020
Pages:
217-221
Received:
29 October 2020
Accepted:
11 November 2020
Published:
8 December 2020
Abstract: The aim of this work was to eassess the contribution of imaging in the management of non-traumatic abdominal surgical emergencies at the General Surgery Department of the Ignace Deen National Hospital. Material and methods: This was a prospective, descriptive study that included for 6 months all patients admitted and operated for a non-traumatic abdominal surgical emergency and having performed at least one imaging test. Results: During our study period, Non-traumatic abdominal surgical emergencies accounted for 25.27% of admissions. The average age was37.58 years old with a male predominance (65.3%) and a sex ratio of 1.88. The mean consultation time was 66.92h±40.15. PSA was the most performed imaging test (86.44%) followed by abdominal ultrasound (8.47%). The main non-traumatic abdominal surgical emergencies observed were acute generalized peritonitis (45.8%), followed by acute intestinal obstruction (44.1%). The agreement between imaging and operative diagnosis was 93.46% on PSA, 92.86% on abdominal ultrasound and 100% on abdominal CT. Conclusion: Non-traumatic abdominal surgical emergencies are frequent, imaging examinations (ASP, ultrasound) allow a good appreciation of all non-traumatic abdominal emergencies when they are judiciously used. In addition, CT, although essential, remains inaccessible due to its cost, thus limiting its emergency use.
Abstract: The aim of this work was to eassess the contribution of imaging in the management of non-traumatic abdominal surgical emergencies at the General Surgery Department of the Ignace Deen National Hospital. Material and methods: This was a prospective, descriptive study that included for 6 months all patients admitted and operated for a non-traumatic ab...
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Urinary Tract Lesions After Surgery for Gynecological Pelvic Cancers at the Conakry University Hospital
Koundouno Aly Mampan,
Traore Bangaly,
Camara Soriba Naby,
Keita Mamady,
Diakité Saikou Yaya,
Camara Fode Lansana,
Baldé Abdoulaye Korse,
Balde Oumar Taibata,
Diallo Abdoulaye Bobo,
Toure Aboubacar
Issue:
Volume 8, Issue 6, December 2020
Pages:
222-227
Received:
16 November 2020
Accepted:
30 November 2020
Published:
16 December 2020
Abstract: The aim of this study was to describe the urinary complications of surgery for gynecological pelvic cancers and their management at the university hospital in Conakry. Patients and methods: This was a descriptive multicenter study in the main surgical treatment services for gynecological pelvic cancer at the University Hospital of Conakry from 2007 to 2017. Results: Out of 22 cases collected, we found 10 (45.5%) cases during surgery and 12 cases of postoperative complications, including 8 (36.36%) early and 4 (18.18%) late. Direct suture on a ureteral probe in 3 cases and by reimplantation according to the Politano Leadbetter method in 2 cases. Laparotomy fistulorrhaphy was performed in 2 (9.1%) cases of VF. the Latzko technique for 6 (27.3%) other cases of FVV. The 2 cases of FUV were repaired by ureteral reimplantation according to the Lich-Grégoire method. In cases of stenosis, we proceeded to segmental resection followed by suturing on a ureteral probe. The morbidity consisted of: 2 cases of secondary VF, suppuration, 2 urinary incontinence, Operative mortality was 3 (13.6%) cases. Conclusion: The prevention of these lesions is the best way and requires a good knowledge of the anatomy and the surgical techniques. Early diagnosis of gynecologic pelvic cancer is necessary to minimize surgical risks.
Abstract: The aim of this study was to describe the urinary complications of surgery for gynecological pelvic cancers and their management at the university hospital in Conakry. Patients and methods: This was a descriptive multicenter study in the main surgical treatment services for gynecological pelvic cancer at the University Hospital of Conakry from 2007...
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Surgeon Preference May Be More Important Than Models of Care When It Comes to Early Laparoscopic Cholecystectomy Rates for Acute Cholecystitis
Daniel Feng,
Luke Petschack,
Georgia Marr,
Jon Gani
Issue:
Volume 8, Issue 6, December 2020
Pages:
228-232
Received:
16 November 2020
Accepted:
7 December 2020
Published:
22 December 2020
Abstract: Aim: Early Laparoscopic Cholecystectomy (ELC) for acute cholecystitis is widely accepted as the standard of care. The capacity to deliver this has been strongly linked to the establishment of Acute Surgical Units (ASU). This study aimed to determine the relative effects of surgeon preference on ELC rates. Method: A retrospective audit of patients with acute cholecystitis was carried out over 6 months in 3 hospitals in 2018. One hospital had an ASU and 2 hospitals had no ASU. The timing of cholecystectomy, intraoperative cholangiogram rates and length of hospital stay were collected. Results: 175 patients were included; 92 admitted to the ASU hospital and 83 admitted to non-ASU hospitals. When adjusted for severity, the ELC rate was 62% and 31% (P<0.0001) in the ASU hospital and non-ASU hospitals respectively in patients with mild (Tokyo Grade I) disease. There was no difference between intraoperative cholangiogram rates between hospitals. The initial length of stay was on average 2.4 days shorter in the early ELC patients (MD=-2.4, 95% CI 1.3 to 3.4). The 2 Non-ASU hospitals varied significantly in ELC rates (19% and 48% P=0.0158), the hospital with the higher ELC rates shared senior surgical staff with the ASU hospital. Conclusion: Hospitals with an ASU are better able to provide timely surgery to patients presenting with acute cholecystitis and this is associated with a reduction of time in hospital for these patients, but surgeon preference may be more important in determining ELC rates than the ASU model of care.
Abstract: Aim: Early Laparoscopic Cholecystectomy (ELC) for acute cholecystitis is widely accepted as the standard of care. The capacity to deliver this has been strongly linked to the establishment of Acute Surgical Units (ASU). This study aimed to determine the relative effects of surgeon preference on ELC rates. Method: A retrospective audit of patients w...
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