Clinical spectrum and histopathological analysis of cervical lymphadenopathy: a rural hospital study

Background: The analysis of lymph node enlargement in the neck is not an easy task. These diseases which can be neoplastic also demands correct diagnosis for further management. The study intended to find out systematically the various pathological conditions presenting with enlarged lymph nodes in the neck, also the various modes of clinical presentation and behaviour of these conditions.Methods: The study population consisted of patients above 12 years presenting with cervical lymph node enlargement. The proforma which was drafted is used. Patient was examined systematically giving utmost importance to local examination. After making a clinical diagnosis, further relevant investigations were done to confirm the diagnosis. Treatment was instituted appropriately and followed up the patients.Results: Majority of the cases in this study had non-neoplastic causes for cervical lymphadenopathy in which tuberculosis is most common. Posterior triangle group of lymph nodes was most commonly affected in tuberculosis. Variable results were noted among the groups of lesions, with regard to local characteristics like number, laterality, mobility and involvement of other group of lymph nodes, etc. FNAC by virtue of it being inexpensive, quick in getting the results and easy to perform, is one of the important and essential diagnostic procedures.Conclusions: As cervical lymphadenopathy is an important disease, it always calls for meticulous attention, analysis and treatment. FNAC is found to be a frontline investigation of choice with biopsy and histopathological examination done for confirmation. Most of the non-neoplastic lesions are medically curable with limited role for surgery.</jats:p

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)