International Medical Journal

We report a case of a 39-year-old lady with underlying osteopetrosis who was planned for a staged bilateral total hip replacement. The aim of this case study is to discuss the surgical challenges that an orthopedic surgeon should be aware of pre-operatively and intraoperatively to overcome the challenges when treating an osteopetrosis patient with osteoarthritis of the hip requiring a total hip replacement.

Many surgeons face a challenging situation of uncertain or unexplainable diagnosis while treating the intraabdominal malignancies. Intraoperative surprise or the tumour unrepeatability are the two main situations which an operating surgeon will try to not encounter. The aim of the study is to evaluate the role of preoperative laparoscopy as an additional tool to diagnose, assess staging and operability of intraabdominal malignant tumours. The group consisted of 30 patients with abdominal malignancy diagnosed by radiological criteria were submitted to staging laparoscopy before a planned open exploration and resection. The type of the study is the prospective observational case series. Patients were followed every three monthly. In follow up visits all patients underwent detailed clinical examination for metastasis. USG abdomen and chest X-ray were done on follow up. 43.3% patients in the current study were avoided from unnecessary laparotomy which is on the higher range than the as the literacy rate and the awareness about the disease varies when it is compared with the western population. Majority of the cases present at the advanced stage. Pre-operative Laparoscopic assessment is found to have a role in the staging of intra-abdominal malignancies, it appears to be a safe and effective means of directing appropriate therapy and avoiding unnecessary exploration. A Staging Laparoscopy performed initially before the planned surgical procedure to evaluate the operability is found to be safe & effective and need not be performed as a separate procedure in an another setting. Laparoscopic assessment pre operatively increases the respectability rate, decreases the nontherapeutic laparotomy rate, and decreases length of stay in patients with unrespectable disease.

The reflection and retraction of mucoperiosteal flap is an essential step in most of the surgical procedures. Austin’s and Langenbeck’s retractors are most commonly used for flap retraction during intraoral surgical procedures. There is no literature on the amount of trauma created to the periosteal layer of the flap by these retractors. Hence, the present study aims at assessing and comparing the extent of trauma created to the periosteal layer of the flap when retracted with Austin’s and Langenbeck’s retractors during surgical removal of impacted mandibular third molars. The results show that 72% of flaps retracted with Austin’s retractor and only 16% of flaps retracted with Langenbeck’s retractor exhibited trauma to the periosteal layer as a result of flap retraction. Thus results indicate a significant increase in trauma rate to the periosteal layer of the flap when Austin’s retractor is used. Pearson Chi-Square test revealed a significant correlation between duration of the flap retraction and trauma rate in Austin’s group (p<0.05), but no such correlation was evident in Langenbeck’s group (p=0.466). Austin’s retractor causes more trauma to the periosteal layer of the mucoperiosteal flap compared to the Langenbeck’s retractor during the flap retraction.

To determine the antibacterial activity of a mixture of Sphatika, Navasadara, Suryakshara against common urinary pathogens. Evaluation of Sphatika, Navasadara, Suryakshara against common urinary pathogens and compare the antimicrobial activity of the Ayurvedic medicines with the standard urinary antibiotics. The material includes Mullor Hinton Agar, Sterile cotton swab, Sterile plane discs, Forceps, Sterile test tubes, Sterile cotton, Conical flasks, distilled water, Autoclave, Hot air oven, Incubator and the test organisms include Escherichia coli, Klebsiella pneumoniae, Proteus species, Pseudomonas aeruginosa, Serratia species, Staphylococcus aureus. Kirby Bauer disc diffusion method was employed to determine the antibacterial effect of the drug. Escherichia-coli, Klebsiella pneumonia and Serratia species showed sensitivity at 2000mg, 3000mg, and 3500mg but were resistant to lower concentrations. At the same time, staphylococcus aures and Proteus vulgaris exhibited resistance to the formulation of all the concentrations with a slight irrelevant zone with higher two concentrations. The formulation is a choice for treating urinary tract infection, considering its nil side effect, and further studies must be in place for advancement.

The mortality and risk factors in poor access dialysis patients especially during the Covid-19 period has not been fully explored. Objective: We designed the present retrospective cohort study to evaluate the survival and mortality risk factors of poor access hemodialysis patients with femoral tunneled catheters. All 62 poor venous access patients with femoral permanent catheters (permicath) on chronic hemodialysis at our university hospital were enrolled in the study between September 2019 and April 2021. Poor venous access was defined as people who had no other mean for dialysis access other than the femoral catheter. Causes of deaths were divided into 4 groups: Catheter-related (Bleeding, sepsis,), catheter-non related (cardiovascular disease, Pneumonia, pulmonary edema, cancer, ICH), no access for hemodialysis and Covid-19. Death time was classified as less than 30 days, between 1-6 months and after 6 months. The mean age was 54.56 (SD: 15.70) years. Of 25 deaths 5 deaths (8.1%) happened when the patients didn’t have any vascular access for dialysis. The most frequent cause of death during 2020-2021 was covid-19 (9.7%). Survival rate at 6 months and 1 year was 76% and 61% respectively. Poor access HD patients had a lower survival rate than the general HD population and we should do our best to improve the survival by improving their comorbidities status, using the best catheters as we can, and educating dialysis nurses and patients to save their catheters as no access is one of the important causes of their mortality.