Nonfatal agriculture injuries in children - A retrospective study

Introduction: A larger proportion of the population in the world is involved in agriculture. Agricultural injuries are a major cause of morbidity and mortality both in developed as well as developing countries. These injuries can occur in all age groups. Objective: Since India is a predominantly agricultural country, we undertook this study to find out the pattern of agricultural injuries in children. Materials and Methods: This is a retrospective hospital-based study. Children <18 years of age, who presented to the hospital with agriculture-related injury from January 2009 to January 2013, were included in the study. The following data were recovered for each case - age, sex, type and cause of injury, and the body part involved. All fatalities were excluded from the study. Simple frequencies and percentages were obtained for various variables. Results: A total of 146 patients were included in the study. 94 (64.4%) were males and 52 (35.6%) were females. The most common age group involved was 7-13 years. Fractures and dislocation were the most common injuries (29.7%). Most of the injuries were to the upper extremities (57.3%). There was a wide variety of causes of agricultural injury in our study, falls and slips being the most common cause. Conclusion: Our study shows that males in the age group of 7-13 years were the most frequent victims of agricultural injuries. Falls and slips were the most common mechanism of injury with fracture and dislocations being the most common type of injury. The results from this study will help in identifying the risk factors for agriculture injuries in children and also to look for the prevention measures to be applied

PENGARUH ATRIBUT PRODUK WISATA TERHADAP KEPUASAN WISATAWAN NUSANTARA KE PANTAI MELASTI, BADUNG PADA MASA PANDEMI COVID-19

This study focuses on the influence of tourism product attributes on the satisfaction of domestic tourists visiting Melasti Beach Tourist Attractions during the Covid-19 Pandemic. Attractions, facilities and accessibility are important attributes in tourism areas to shape and increase or maintain tourist satisfaction for the long term and sustainable. The purpose of this study is to determine the effect of Tourism Product Attributes (Attraction, Amenity, Accessibilities) on the satisfaction of domestic tourists who visit Melasti Beach Tourist Attractions during the Covid-19 Pandemic. This study uses a non-probability sampling technique with a special technique of purposive sampling. The sampling technique used in this research is online using google form. The number of samples in this study were 100 samples, which were determined based on the slovin formula with the number of domestic tourists visiting Melasti Beach. The analysis technique in this research is quantitative descriptive analysis. The results of the study based on the results of the t test showed that partially the attraction and facility variables had a significant influence on the satisfaction of domestic tourists visiting Melasti Beach in Badung Regency during the Covid-19 Pandemic. Meanwhile, the accessibility variable does not have a significant effect on the satisfaction of domestic tourists visiting Melasti Beach in Badung Regency during the Covid-19 Pandemic. Based on the results of the F test, it shows that simultaneously the attributes of tourism products have a positive and significant effect on the satisfaction of domestic tourists who visit the Melasti Beach Tourist Attraction in Badung Regency during the Covid 19 Pandemic by 31% obtained from the results of the determination analysis

Enhanced Recovery after Surgery

Enhanced recovery after surgery (ERAS) protocols are specialized perioperative care guidelines. The protocol was first published in 2005. Since then, it has been associated with improved perioperative outcomes. This multimodal peri-operative protocols standardize the perioperative care to minimize the surgical stress response and post-operative pain, reduce complications, improve post-operative outcomes, expedite recovery and decrease the length of hospital stay. It initially started with colorectal surgery, but now it is used in hepatobiliary, upper gastrointestinal system, urology, gynecology, vascular surgery, bariatric, and non-gastro intestinal specialties. Its role is well established in elective surgery. Now there are enough evidence suggesting its role in emergency surgeries as well. There are 24 elements of the ERAS bundle. However, only some critical elements of the ERAS bundle are feasible to be used in emergency surgery. Postoperative pain management is one of the significant elements in the ERAS bundle. Multimodal analgesia is the optimal modality for pain control. It facilitates early ambulation and rehabilitation. Current evidence recommends the ERAS protocol. However, each item within the protocol constantly changes over time, depending upon the evidence

Role of Gut Microbiome and Enteric Bacteria in Gallbladder Cancer

Gallbladder cancer (GBC) is associated with a sinister prognosis, a short survival time, and early metastasis to distant sites. Chronic inflammation of the gallbladder due to gallstone disease and biliary bacteria remain key factors in the pathogenesis of GBC. The association of chronic bacterial infections with the development of GBC has provided a new perspective on the causation of GBC. A strong link between chronic Salmonella infection and enterohepatic strains of Helicobacter species with GBC has been suggested. It is believed that many other enteric bacterial strains, predominantly the Enterobacteriaceae species, are associated with the development of GBC. However, the available literature mainly comprises observational studies and small meta-analyses necessitating the requirement of a higher level of evidence. This chapter discusses the role of the gut microbiome, dysbiosis and its association with carcinogenesis, and the organisms associated with the causation of GBC

How e-Health Has Influenced Patient Care and Medical Education: Lessons Learned from the COVID-19 Pandemic

The concept of e-Health involves the application of information and communication technologies from off-site locations to various domains of healthcare ranging from patient care, public health, and administration to health education. It refers to health informatics, telemedicine, electronic health records, and clinical decision support systems. The e-health initiatives aim to improve health outcomes in terms of quality, access, affordability, and efficient monitoring. The application of e-health interventions has particularly expanded in recent times because of the restrictions imposed by the pandemic. It has been proven to be nearly as effective as in-person care along with high patient and provider satisfaction and at decreased costs. We present our experience from the use of various e-health interventions during the COVID-19 pandemic along with a review of related literature. This ranged from Internet-based services, interactive TV or Polycom’s, kiosks, online monitoring of patient’s vital signs, and remote consultations with experts. Our success and experience with various e-health interventions during the pandemic allow us to provide a more hybrid form of healthcare in the future both for patient care and medical education and training

Telesurgery and Robotics: Current Status and Future Perspectives

The concept of telehealth has revolutionized the healthcare delivery system. Based on this concept, telesurgery has emerged as a promising and feasible option, providing surgical care to remotely located patients. This has become possible by advancements in the robotic system combined with the cutting-edge technology of telecommunication. Since the ability to perform telepresence surgery was hypothesized, consistent development and research in this novel area have led to the beginning of telesurgical care, which can fulfill the demand for surgical care in remote locations. In addition to the benefits of robotic-assisted minimally invasive surgery, telesurgery eliminates geographical barriers, which helps patients have better access to quality surgical care. It may reduce the overall financial burden by eliminating the travel expense of the patients, providing expertise through the telepresence of experienced surgeons, and reducing the operating room personnel. The telesurgical approach is also being utilized for telementoring, i.e., real-time guidance and technical assistance in surgical procedures by highly skilled surgeons. Despite the numerous technological improvements in telesurgery, its widespread implementation in clinical setting still lags, mandating the identification of the offending factors that limit its clinical translation

Bowel Preparation before Elective Colorectal Surgery: Its Current Role

Bowel preparation for elective colorectal surgery has been performed for decades with the assumption to decrease infectious complications and anastomotic leaks. Nevertheless, the scientific basis of the same is still debatable. Various methods of bowel preparation are mechanical bowel preparation (MBP) with or without prophylactic oral antibiotics (POA), preoperative POA alone without MBP, and preoperative enema alone without MBP and POA. However, there is no consensus on the optimal type of bowel preparation. The available agents for MBP are polyethylene glycol (PEG) and sodium phosphate (NaP) or picosulphate. The most common prophylactic oral antibiotic regimen used in preoperative bowel preparation is Neomycin and Metronidazole a day before surgery, although the microbiological basis of this is unverified. Most studies around the beginning of this century indicate inadequate evidence for using MBP for colorectal surgery to suggest harm caused by the process and accordingly advise against it. However, several retrospective studies and meta-analyses, which were done after 2014, arguably demonstrate that preoperative MBP and POA reduce the postoperative surgical site infection rate. However, as per the current evidence, it can be suggested that MBP and preoperative POA can be safely included in the preoperative preparation of elective colorectal surgery

Use of Otoscope as a Diagnostic and Therapeutic Aid in Umbilical Pilonidal Sinus: A Novel Technique

Introduction: Umbilical disorders are frequently encountered in general surgical practice. Although the sacrococcygeal region is the most common site for pilonidal sinus disease, it can be seen occasionally in periumbilical area. Treatment is mostly conservative for umbilical pilonidal sinus in contrast to the sacrococcygeal sinus where it is always surgical. In the era of endoscopy and minimally invasive surgery, we describe the use of otoscope as a novel technique for the diagnosis and treatment of umbilical pilonidal sinus. Subject and Method: In this prospective study, patients with a clinical suspicion of umbilical pilonidal sinus were included and diagnosis was confirmed on the basis of otoscopic finding. All patients were planned for conservative management i.e. extraction of hair fragments with the help of an otoscope followed by oral antibiotics treatment. On follow-up, response of treatment was noted by evaluation of symptoms and otoscopic examination.Result: Total 15 patients were included in this study. By using otoscope for removal of hair fragments from umbilical sinus, we found successful result in all patients with conservative treatment. Discussion: In umbilical pilonidal sinus, the success of conservative treatment depends on the effective extraction of hair and maintenance of personal hygiene by the patient. Our study showed 100% successful result of conservative treatment, probably due to proper and complete extraction of hair fragment with the help of the otoscope. Conclusion: Otoscopic examination and hair extraction for umbilical pilonidal sinus is a simple, cost-effective, and easy treatment that can be done in the outpatient department and does not require any formal training for its use

Spigelian Hernia: Clinical Features and Management

The Spigelian hernia is a rare variety of ventral hernia and has an incidence ranging from 0.1–2% of all abdominal wall hernias. It occurs through a well-defined defect in the Spiegel’s fascia adjacent to the semilunar line. It can be congenital or acquired. The acquired variety is predisposed by stretching and weakening of the abdominal wall by factors that increase the intraabdominal pressure. These hernias are most commonly located in the interparietal plane with no visible or palpable mass, and only 50% of cases could be diagnosed clinically before any surgical intervention. Radiological investigations like USG and CT scans confirm the clinical diagnosis or pick up the subclinical varieties that present with non-specific pain in the anterior abdominal wall. Surgery is the mainstay of management. These hernias are prone to early incarceration and strangulation and therefore should be operated at the earliest. It is stressed that a prosthetic mesh should be used for a better outcome as it decreases recurrence. Conventional open hernioplasty has been largely replaced by a laparoscopic approach such as TAPP, TEP, IPOM and robotic-assisted surgery. Early diagnosis and surgery prevent morbidity and dreaded complications