Experience with surgical management of intestinal tuberculosis at a rural teaching hospital

Background: Tuberculosis is a major global health problem and still considered as a social disease in India reflecting the standards of living in a community. It possesses a diagnostic and therapeutic challenge to practicing surgeon in resource limited contries. The aim of the present study was to study different surgical management of Intestinal tuberculosis.Methods: 100 cases of intestinal tuberculosis were studied over a period of three years in the department of General Surgery at Katihar Medical College with emphasis on surgical management of these cases.Results: 64% of the cases were in the age group of 21-40 years. The sex incidence revealed a female to male ratio of 1.17:1 showing a female preponderance. Low haemoglobin value and high erythrocyte sedimentation rate with lymphocytosis were present in majority of the cases. Radiological finding in plain X ray abdomen was of definite diagnostic aid in cases of intestinal obstruction and perforation. On laparotomy, diagnosis was supported by presence of tubercles, macroscopic caseation, enlarged and calcified lymph glands, bands, adhesion and strictures. The commonest site involved was small bowel followed by the ileocaecal region. The commonest type of lesion was stricture, which mostly involved the small bowel followed by hyperplastic lesions which were more common in caecum and ascending colon. Acute complications of the disease were perforation and obstruction, which forced the patients to undergo emergency surgical treatment. Wound infection (30%) was the most common complication.Conclusions: Multidisciplinary approach with high index of suspicion for the disease is required in these cases. Mostly a disease of low socio - economic people, health education and awareness among people is the need as this disease is very prevalent in this region.

Clinical presentation and bacteriological profile of diabetic foot in Eastern Bihar, India

Background: Diabetes is a worldwide problem. A majority of diabetic patients develop foot ulcers in one point of time or other during the course of their illness. Chronic wound, especially non-healing types are the most common surgical conditions. The etiopathogenesis of diabetic foot lesions are multi-factorial like diabetic neuropathies, vasculopathy, poor control of diabetes and bacterial infection. The aim of the present study was to study various modes of presentation and microbiological profile in management of diabetic foot.Methods: 100 diagnosed cases of diabetic foot were studied over a period of three years in the department of General Surgery at Katihar Medical College with emphasis on clinical features and microbiological picture of diabetic foot and its complications.Results: Males are more prone to surgical complications three times than females because of more outdoor activities. It is more prevalent in age group 51-60 years (36%). In the present study, cases presenting with ulcer were maximum (52%) followed by cellulitis (20%), cases presenting with gangrene of toe or foot was minimum (12%). Staphylococcus Aureus was found in majority of cases of septic lesions on culture of pus (41%). Other organisms isolated were Pseudomonas, Klebsiella, E.Coli, Proteus etc.Conclusions: Diabetic foot has varied presentation. The prevalence of diabetes mellitus and its surgical complications can be attributed to poor patient knowledge, education and awareness of the disease. Patient education for care of feet such as pairing of nails, wearing proper footwear and prompt reporting to doctor in case of early lesions is essential.

A prospective comparative evaluation of octenidine dihydrochloride and saline dressing in the management of diabetic foot ulcers

Aim: To evaluate the effectiveness of octenidine dihydrochloride dressing and saline dressing in healing diabetic foot ulcers. Material and methods: This was a prospective comparative study conducted in the Department of General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for 18 months. A total of 100 patients, 50 patients in each arm of Octenidine dihydrochloride dressing group and Saline dressing group, with complaints of chronic DFU, were included in this study. Regular wound dressings were done with octenidine dihydrochloride topical ointment in one group and with saline in other group and the wounds were assessed regularly for healing progress during the study period. Results: A total of 100 subjects with 50 in each group of octenidine dihydrochloride group and saline group completed the follow-up period. Among the total of 100 subjects, 76(76%) were male and 24 (24%) were female. There was a male preponderance in both the groups (72% males in octenidine dihydrochloride group and 80% males in saline group). Mean age was 57.1 in octenidine dihydrochloride group and 56.3 in saline dressing group. About 52% in octenidine dihydrochloride group and 50% in saline group had a habit of smoking and 40% in octenidine dihydrochloride group and 36% in saline group had a habit of alcohol consumption. Among the blood investigations done, haemoglobin (Hb) was taken into consideration for statistical analysis. Mean Hb in octenidine dihydrochloride group was 10.8 gm% and in saline group was 11.5 gm%. Mean duration of diabetes was 10.8 years in octenidine dihydrochloride group and 10.2 years in saline group. The comparison between the outcomes of octenidine dihydrochloride dressing group and saline dressing group in terms of surface area reduction of wounds were made. Conclusion: octenidine dihydrochloride dressing is more effective than saline dressing in achieving complete healing, reducing wound surface area, and decreasing morbidity in patients with DFU

Experience with surgical management of intestinal tuberculosis at a rural teaching hospital

Background: Tuberculosis is a major global health problem and still considered as a social disease in India reflecting the standards of living in a community. It possesses a diagnostic and therapeutic challenge to practicing surgeon in resource limited contries. The aim of the present study was to study different surgical management of Intestinal tuberculosis.Methods: 100 cases of intestinal tuberculosis were studied over a period of three years in the department of General Surgery at Katihar Medical College with emphasis on surgical management of these cases.Results: 64% of the cases were in the age group of 21-40 years. The sex incidence revealed a female to male ratio of 1.17:1 showing a female preponderance. Low haemoglobin value and high erythrocyte sedimentation rate with lymphocytosis were present in majority of the cases. Radiological finding in plain X ray abdomen was of definite diagnostic aid in cases of intestinal obstruction and perforation. On laparotomy, diagnosis was supported by presence of tubercles, macroscopic caseation, enlarged and calcified lymph glands, bands, adhesion and strictures. The commonest site involved was small bowel followed by the ileocaecal region. The commonest type of lesion was stricture, which mostly involved the small bowel followed by hyperplastic lesions which were more common in caecum and ascending colon. Acute complications of the disease were perforation and obstruction, which forced the patients to undergo emergency surgical treatment. Wound infection (30%) was the most common complication.Conclusions: Multidisciplinary approach with high index of suspicion for the disease is required in these cases. Mostly a disease of low socio - economic people, health education and awareness among people is the need as this disease is very prevalent in this region.

Diagnostic value of serum ADA level in extra pulmonary tuberculosis cases in a tertiary care hospital, Bihar

Travelling through time, space and history if there is one disease which always comes to our mind is tuberculosis (TB). Still on many occasions it remains undiagnosed and hence not treated appropriately. In many instances patient is not able to give proper sputum sample or in a way it should be. On the top of it in resource poor countries availability of health care professionals is an issue to examine the sputum. Furthermore, when extra pulmonary TB is the case invasive diagnostic procedures such as biopsy becomes important which is a challenging thing to perform in many of our setups in our state. So, the aim of this study was to investigate the diagnostic value of ADA in extra pulmonary TB. Methods: It is an analytical study in which serum ADA values in EPTB cases were compared with controls.100 patients matched for age and sex were included. Data analysis was done using SPSS version 27. Results: Our data analysis showed mean ADA levels in EPTB patients was 43.6 which was significantly higher than control group(p value <0.001)

Comparative study of different diagnostic methods for detection of mycobacteria in clinically suspected patients of extrapulmonary tuberculosis at IGIMS, Patna

Background: Tuberculosis is a global problem and incidence of extra pulmonary tuberculosis is increasing day by day. Diagnosis of extra pulmonary tuberculosis is a little bit difficult than pulmonary tuberculosis. Aim and Objective: The aim of this study is to compare different diagnostic methods like ZN staining, LED-FM and GeneXpert assay for detection of Mycobacterium tuberculosis in extrapulmonary tuberculosis (EPTB) cases in respect to their sensitivity, specificity, PPV and NPV respectively. Methodology: This prospective study was carried out in the Department of Microbiology, IGIMS, Patna, Bihar. Samples from 210 suspected extrapulmonary cases were collected and processed for ZN-stain, LED-FM, GeneXpert assay and MGIT culture. Taking the MGIT culture result as Gold standard, result of ZN-stain, LED-FM and GeneXpert were compared.  Result: Out of 210 samples, detection rate of ZN staining, LED-FM, GeneXpert assay and MGIT culture were 10.47%, 14.28 %, 30.47% and 36.66% respectively. The sensitivity, specificity, PPV and NPV of ZN staining and LED-FM were 28.27 %, 100%, 100%, 70.74% and 39.96%, 100%, 100%, 73.88% respectively. The sensitivity, specificity, PPV and NPV of GeneXpert were 59.74%, 86.46%, 71.87% and 78.76% respectively

Comparative study on the outcome of primary skin closure versus delayed primary skin closure in case of emergency laparotomies

Introduction: One of the most common complications that one can encounter is the surgical site infection (SSI) after any surgical procedures especially after exploratory laparotomy for perforative peritonitis. A surgical wound is considered as infected when there is purulent drainage from the wound. The purpose of the present study was to compare the primary wound closure technique and delayed primary wound closure technique with regard to the rate of wound infection and other complications which are usually associated with the infection like wound dehiscence, stitch sinuses, incisional hernias and duration of hospital stay. Materials and Methodology: 120 participants were randomly divided into two groups with 60 subjects each for primary wound closure and delayed primary wound closure. Data was coded and entered in Microsoft Excel sheet and the data analysis was done using SPSS-17. Association between qualitative variables will be analysed using Chi-square test. Associations between quantitative variables were analysed using independent sample t-test. Non parametric tests were if whenever necessary. When a p value of less than 0.05 is considered as statistically significant.&nbsp

Comparative Study of Different Diagnostic Methods for Detection of Mycobacteria in Clinically Suspected Patients of Extrapulmonary Tuberculosis at IGIMS, Patna

Background: Tuberculosis is a global problem and incidence of extra pulmonary tuberculosis is increasing day by day. Diagnosis of extra pulmonary tuberculosis is a little bit difficult than pulmonary tuberculosis. Aim and Objective: The aim of this study is to compare different diagnostic methods like ZN staining, LED-FM and GeneXpert assay for detection of Mycobacterium tuberculosis in extrapulmonary tuberculosis (EPTB) cases in respect to their sensitivity, specificity, PPV and NPV respectively. Methodology: This prospective study was carried out in the Department of Microbiology, IGIMS, Patna, Bihar. Samples from 210 suspected extrapulmonary cases were collected and processed for ZN-stain, LED-FM, GeneXpert assay and MGIT culture. Taking the MGIT culture result as Gold standard, result of ZN-stain, LED-FM and GeneXpert were compared.  Result: Out of 210 samples, detection rate of ZN staining, LED-FM, GeneXpert assay and MGIT culture were 10.47%, 14.28 %, 30.47% and 36.66% respectively. The sensitivity, specificity, PPV and NPV of ZN staining and LED-FM were 28.27 %, 100%, 100%, 70.74% and 39.96%, 100%, 100%, 73.88% respectively. The sensitivity, specificity, PPV and NPV of GeneXpert were 59.74%, 86.46%, 71.87% and 78.76% respectively

Comparative Study on the Outcome of Primary Skin Closure Versus Delayed Primary Skin Closure in Case of Emergency Laparotomies

Introduction: One of the most common complications that one can encounter is the surgical site infection (SSI) after any surgical procedures especially after exploratory laparotomy for perforative peritonitis. A surgical wound is considered as infected when there is purulent drainage from the wound. The purpose of the present study was to compare the primary wound closure technique and delayed primary wound closure technique with regard to the rate of wound infection and other complications which are usually associated with the infection like wound dehiscence, stitch sinuses, incisional hernias and duration of hospital stay. Materials and Methodology: 120 participants were randomly divided into two groups with 60 subjects each for primary wound closure and delayed primary wound closure. Data was coded and entered in Microsoft Excel sheet and the data analysis was done using SPSS-17. Association between qualitative variables will be analysed using Chi-square test. Associations between quantitative variables were analysed using independent sample t-test. Non parametric tests were if whenever necessary. When a p value of less than 0.05 is considered as statistically significant.&nbsp