Non Iatrogenic Colonic Barotrauma- A Case Report

Barotrauma is injury caused by high pressure. Colonic barotrauma can range from only mucosal injury to multiple perforations. Most common cause of colonic barotrauma is due to air insufflation during colonoscopy. Here, we are presenting the case of a 20- year-old young male working in a wheat flour packaging factory. He suffered sigmoid colon perforation as a result of non iatrogenic barotrauma. Sigmoid perforation was closed in two layers with diversion loop ileostomy created and seromuscular injuries repaired. Ileostomy was closed after three months. In this case, high pressure pipe was not inserted inside but directed from a distance. Machines used in the industries deliver compressed air at much higher pressure than the one required to perforate intestine. Such high pressure along with funnel like configuration of thighs, buttocks and perineum facilitates easy entry of air in the colon. Air can enter through anus even if the air hose is kept near it for few seconds without actually inserting inside. Thus, it is important to make workers aware of hazardous consequences of the machines use

Laparoscopic-assisted transanal pull-through for Hirschsprung′s disease: Comparison between partial and near total laparoscopic mobilization of rectum

Background: Transanal pull-through with laparoscopic assistance is gaining popularity. How much rectal dissection to do laparoscopically and how much transanally is not clear. Laparoscopic rectal mobilization is akin to open pelvic dissection of Swenson′s operation - the most physiological procedure. Through this comparative study, we aim to evolve a technique that maximizes the benefits of Swenson′s technique and minimizes the problems of a transanal procedure. Materials and Methods: Twenty patients (19 boys and one girl, newborn to 6 years) with Hirschsprung′s disease (HD) were randomized for laparoscopic-assisted transanal pull-through (LATAPT) either by near complete (Group A) or partial (Group B) laparoscopic mobilization of rectum. Patients were followed up for at least 3 months. Demographic profile; operative details (time taken, blood loss, operative difficulty, and complications); postoperative course (duration of urinary catheter, oral feeding, and hospital stay); and follow-up stooling pattern, consistency, and continence were compared in the two groups. Results: The time taken for laparoscopic mobilization was marginally higher in group A, but the time taken for transanal dissection in this group was significantly less than in group B. All other comparisons showed no significant difference in the two groups. Stool frequency and continence improved with time in both groups. Conclusion: Extent of laparoscopic mobilization of rectum does not appear to be a factor deciding the outcomes. No recommendations could be made in view of the small number of cases. However, it shows that laparoscopic assistance can be used to maximize the benefits of Swenson type of operation and a transanal pull-through

NEURAL TUBE DEFECT REPAIR AND VENTRICULOPERITONEAL SHUNTING: INDICATIONS AND OUTCOME

Neural tube defect with its global involvement of nervous system has lot of implications. There is cotroversy in terms of timing of repair, simultaneous or metachronous ventriculoperitoneal shunt and criteria for shunt surgery in neonatal age. We are reporting our approach and results of management of this disease in neonatal period

Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 204 intensive care units of 57 hospitals in 19 cities of India: International Nosocomial Infection Control Consortium (INICC) findings

•We report peripheral venous catheters (PVC)-related BSI rates from 2013 to 2019.•We collected prospective data from 204 ICUs in 57 hospitals in 19 cities of India.•We followed 7,513 ICU patients for 296,893 bed-days and 295,795 PVC-days.•We identified 863 PVC-related BSIs, amounting to a rate of 2.91/1,000 PVC-days. Short-term peripheral venous catheters-related bloodstream infections (PVCR-BSIs) rates have not been systematically studied in developing countries, and data on their incidence by number of device-days are not available. Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013 to May 31, 2019 in 204 intensive care units (ICUs), members of the International Nosocomial Infection Control Consortium (INICC), from 57 hospitals in 19 cities of India. We applied US INICC definition criteria and reported methods using the INICC Surveillance Online System. We followed 7,513 ICU patients for 296,893 bed-days and 295,795 short term peripheral venous catheter (PVC)-days. We identified 863 PVCR-BSIs, amounting to a rate of 2.91/1,000 PVC-days. Mortality in patients with PVC but without PVCR-BSI was 4.14%, and 11.59% in patients with PVCR-BSI. The length of stay in patients with PVC but without PVCR-BSI was 4.13 days, and 5.9 days in patients with PVCR-BSI. The micro-organism profile showed 68% of gram negative bacteria: Escherichia coli (23%), Klebsiella spp (15%), Pseudomonas aeruginosa (5%), and others. The predominant gram-positive bacteria were Staphylococcus aureus (10%). PVCR-BSI rates found in our ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs