Journal of clinical and diagnostic research : JCDR
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In oral and maxillofacial surgeries, nasotracheal intubation is carried out to increase the surgeon's access to the oral cavity. During nasotracheal intubation the risk of trauma is higher than that in orotracheal intubation as there is passage of the tube through the mucosa of the nasal tract due to which bacteria might get transported into the trachea. ⋯ Use of mupirocin before nasotracheal intubation decreased the complications of nasal intubation in addition to decreasing the risk of colonization of S. aureus and other gram-negative bacteria.
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Wilms' tumour, a renal malignancy, primarily occurs in children with a peak incidence between 2 to 5 years age group and accounts for approximately 95% of childhood renal malignancies. Though rarely, it may also occur in adults with an incidence rate of less than 0.2 per million per year. Microscopically, there is no difference between Wilms' tumour of paediatric and adult age groups. ⋯ Nephrectomy was performed and a final morphological diagnosis of Wilms' tumour was given. Immunohistochemical study showed strong Wilms' Tumour 1(WT1) positivity in both blastemal and epithelial components confirming the morphological diagnosis. In view of its diagnostic difficulty and rare occurrence in adults, this case is being reported.
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Laparoscopic Cholecystectomy (LC) is the most frequently performed elective daycare surgery and provision of postoperative pain relief is of importance. After laparoscopic cholecystectomy shoulder and abdominal pain causes considerable distress. Visceral pain during coughing, respiration and mobilization increases morbidity, hospital stay and costs. ⋯ Intraperitoneal infiltration of LA significantly reduces pain intensity scores in the early postoperative period after LC surgery and helps in improving the postoperative recovery profile and outcome. This makes LC surgery more amenable to day care surgical setup. Ropivacaine (0.375%) is more efficacious, longer acting with a higher intensity of postoperative analgesia than bupivacaine (0.25%).
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Management of unstable intertrochanteric fractures poses challenges in terms of obtaining stable fixation and good postoperative outcomes. There is a paucity of clinical data comparing the commonly used Proximal Femoral Nail (PFN) and Proximal Femoral Nail Antirotation (PFNA) implants, especially in relation to osteoporosis. ⋯ Although functional outcomes achieved with both implants are similar (p=0.83), number of implant related complications were fewer with PFNA (p=0.02), even in osteoporotic group (p=0.04). We recommend use of the PFNA in unstable fractures, especially in the elderly osteoporotic population.
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Rising concerns about antimicrobial resistance and inadequate development of effective new anti-infective drugs have stimulated universal efforts to strengthen infection-control interventions. Antimicrobial stewardship is a rational, systematic approach to promote the optimal selection, dosing, and duration of therapy for antimicrobial agents throughout the course of their use in order to improve the outcomes. ⋯ In-depth analysis of the study revealed a positive impact of ASP and antibiotic policy. Implementation of ASP in year 2013, brought an effective increase in the appropriate use of antimicrobials.