GMC Patiala Journal of Research and Medical Education

Feasibility of Posterior Component Separation with Transversus Abdominis release in complex ventral hernias : outcomes and experience at a single centre

Harnam Singh Rekhi — 2024-06-20

Introduction : Complex ventral hernias are a challenging entity which require some form of myofascial separation to achieve a tension free repair and adequate mesh placement. Posterior component separation with transversus abdominis release (TAR) has come up as an exciting tool in achieving the same albeit preserving the neurovascular arcade and recording lesser wound morbidity. In this study, we present our experience with this technique whilst operating on patients with complex ventral hernias.

Methodology : 20 patients requiring TAR (based upon the pre-operative imaging fulfilling the required criteria of defect width or size or the intra-operative need) were included in the study extending from January 2021 to April 2023. All the patients were operated at a single centre by the same surgical team.

Results : Majority of the patients were females (12; 60%) with a mean age of 56.4 years, a mean BMI of 28.8kg/m² and a median ASA score of 2. Three of these patients had loss of domain. Fifteen (75%) patients had a history of previous surgery (incisional hernia). The mean defect width and total defect area were 10.8 + 2.16 cm and 193 + 20.45 (110-450) cm², respectively. The mean surgical time was 207 minutes with an average of 7.8cm of medialisation of linea alba achieved. The mean visual analog scale (VAS) pain score on the first postoperative day was 4.2 and the median hospital length of stay (LOS) was 5 days. There were only four (20%) cases of minor wound related complications which were managed conservatively with no major complication/ re-surgery recorded. During the follow-up period (mean of 21.6 months), only one (5%) recurrence was recorded.

Conclusion : TAR offers an excellent option in managing complex and large ventral hernias with fairly less complications and wound morbidity adding to the armamentarium of the hernia surgeon.

INFECTIOUS CAUSES OF PRURITUS OF PREGNANCY: A STUDY ON EVALUATION AND OUTCOME

Beant Singh — 2024-06-20

Introduction: Pruritus in pregnancy is a common and burdensome symptom that can occur due to various underlying conditions. It may be the first sign of a pregnancy-specific pruritic disease or a dermatosis that coincides with pregnancy by chance. It is essential to recognize and address this symptom promptly, as some conditions can have detrimental outcomes for both the mother and the foetus.

Aims & Objective: To analyse the various infectious causes of pruritus in pregnancy and their maternal and foetal outcomes.

Material & Method: The present study was conducted in Department of Obstetrics & Gynaecology and Department of Venerology & Dermatology, GMC & Rajendra Hospital, Patiala. It was an observational prospective study in which all the cases presenting with pruritus were taken during the period from May 2020 to April 2021.

Results: During the study period, 218 pregnant women presented with complaint of pruritus. Infection was the most common cause of pruritus in pregnancy accounting for 46.3% subjects. The most commonly reported infection was fungal infection (17.4%). Vaginitis accounted for 15.1% cases with candida vaginalis being the most common (7.8%). Maternal and fetal complications were Preterm delivery, Premature rupture of membrane (PROM), preterm premature rupture of membrane (PPROM), Premature babies and NICU admission.

Conclusion: This study highlights the various causes of pruritus in pregnancy. Infection contributes the major cause of pruritus in pregnancy followed by specific dermatoses in pregnancy. In mother pruritus can cause sleep disturbance and affect quality of life. Among infectious causes like candida vaginalis, bacterial vaginosis and trichomonas can cause preterm delivery, PROM, PPROM, oligohydramnios and LBW babies. Chicken pox in early trimester can cause congenital varicella syndrome. Thus, early diagnosis and prompt treatment can improve maternal and fetal prognosis and can decrease morbidity.

ANTIMICROBIAL PROFILES ANTIMICROBIAL PROFILES OF UROPATHOGENS IN A TERTIARY CARE HOSPITAL OF NORTHWESTERN INDIA

Rupinder Bakshi — 2024-06-20

Background: Urinary tract infections (UTIs) are extensively studied due to their high prevalence and potential severity, particularly concerning antimicrobial properties.. This study evaluated the prevalence of common uropathogens and their antimicrobial resistance.

Method: A prospective cross-sectional study was conducted on a total of 16,077 urine samples at a tertiary care hospital in Patiala, Punjab, from January 2022 to December 2022, using standardized microbiological methods. The isolated microorganisms underwent antibiotic resistance testing using the Kirby-Bauer disk diffusion method.

Results: A total of 16,077 urine samples were analyzed among Gram-negative microorganism Esch. coli (n=1962) was the most prevalent microorganism, followed by Klebsiella pneumoniae (n=722), Pseudomonas aeruginosa (n=572), Acinetobacter Baumanni Complex(451), Citrobacter species (n=132), Proteus spp. (n=96), and Enterobacter spp. (n=12). Among Gram positive Enterococcus spp. (n=786) was most prevalent, followed by Staphylococcus aureus (n=420), and MRSA (n=30); antibiotic profile data revealed that Gram-negative have high resistance rates towards Ampicillin, Ciprofloxacin, and Amoxicillin-clavulanate and among gram-positive resistance rate was higher in Ampicillin, CiprofloxacinAmoxicillin-clavulanate, Gentamicin, Levofloxacin, Erythromycin, and Netilmicin.

Conclusion: Esch. coli and Enterococcus spp. emerged as the predominant uropathogen, exhibiting high antibiotic resistance against various antibiotics.

Keywords: Antibiotic resistance; Urinary tract infections; Uropathogens; gram negative;gram positive; Healthcare-associated infections

TO COMPARE THE DELINEATION OF FETAL BRAIN LAMINATION BETWEEN T2-WEIGHTED SINGLE-SHOT FAST SPIN ECHO AND ECHO PLANAR IMAGING FLUID ATTENUATED INVERSION RECOVERY IMAGES

Antarjot Rekhi — 2024-06-20

The human cerebrum undergoes age-specific lamination changes during development. Notably, the subplate zone stands out as the most significant transient area, where major afferent systems temporarily settle, form synapses, and engage in essential cellular interactions critical for future cortical development. Our research utilized magnetic resonance imaging (MRI) to track the developmental history of this key cortical layer (the subplate zone) and other laminar regions of the fetal cerebral wall from 26 to 32 weeks post-ovulation. The study revealed that alterations in the MRI lamination pattern of the fetal cerebral wall are largely attributed to changes in the subplate zone. This zone is vital for creating important connections between the thalamus and cortex, coinciding with the period when the cortical mantle starts forming sulci and gyri. The present study was conducted on 50 patients and focused on the comparison of fetal brain lamination (Subplate) between T2-weighted SSFSE and EPI-FLAIR sequences to help guide the decision on the utilization of neuroimaging in the diagnostic workup referred to the Radiodiagnosis Department in Government Rajindra Hospital, Patiala.

Ectopic lingual thyroid as unusual cause of progressive Dysphagia

Monika Garg — 2024-06-20

Lingual thyroid gland is a rare clinical entity that is due to abnormal migration of the thyroidtissue during embryonic development. Wepresent a case of lingual thyroid with hemi-agenesis of right lobe and colloid nodule in the left lobe presenting with difficulty in breathing and swallowing with choking episodes. Thorough clinical examination and investigations were carried out. The lingual mass was removed and sent for histopathological examination, which ultimately confirmed the diagnosis of lingual thyroid tissue. We are presenting the case for its rarity in general practice and because of its unusual presentation. Theliterature is reviewed regarding the incidence and diagnosis of lingual thyroid with possible treatment options discussed. The clinicians and the radiologists must be aware of this entity to avoid mistaking itfor evidence of invasion by a malignant neoplasm.

A RARE CASE REPORT OF NON - PANCREATIC INTRA - PERITONEAL PSEUDOCYST

Rajat Gupta — 2024-06-20

INTRODUCTION Non-pancreatic pseudocysts are lesions usually arising from mesentery or omentum and are a rare occurrence. The internal content of these cysts could be blood, pus, serous or chylous fluid. In majority of the scenarios, causation of these cysts is related to trauma, surgery or infection. Pseudocysts related to pancreatitis occur in 5 – 15 % of patients who have peripancreatic fluid collection after an episode of acute pancreatitis. It takes at least 4 – 8 weeks for fibrotic reaction to develop and hence for the formation of cyst capsule which is composed of collagen and granulation tissue and is not lined by a true epithelial lining.

CASE PRESENTATION A 31year old male presented in surgery OPD with chief complaints of gradually progressive abdominal distension associated with pain epigastrium for past 2 ½ months with intermittent vomiting for past 2 months. There was a positive history of addiction to alcohol, tobacco chewing, and opium was present.

On examination, there was a large ill-defined solitary swelling present in left side of abdomen extending approx. 6 cm above and approx. 7 cm below the umbilicus. On head raising test swelling disappeared indicating intraperitoneal origin. USG whole abdomen revealed a large midline septated fluid collection extending from epigastrium to infra-umbilical region with heterogeneous internal echoes with few thin internal septations. CECT whole abdomen showed a large well-defined thick-walled fluid density cystic lesion in the peritoneal cavity few partial thin septations and was seen involving the omentum.

CONCLUSION Non pancreatic pseudocyst is a rare finding and one should be aware of this entity.

Intussusception in adults: A rare presentation

Dr sonali Rao — 2024-06-20

Intussusception is a potentially fatal condition that happens when a section of the intestine bends like a telescope, with one segment slipping inside another. The proximal portion that telescopes into the intestine is known as the intussceptum, and the distal portion that receives the proximal portion is known as the intussuscipiens. This process can lead to multiple complications such as bowel obstruction, bowel necrosis/gangrene leading to sepsis. The disease process is much more common in the paediatric population and uncommon in adults, but when present is likely to be due to a pathological lead point such as benign or malignant masses

MULTIDISCIPLINARY APPROACH TO CHRONIC PAIN MANAGEMENT

Editor — 2024-06-20

The current International Association for the Study of Pain (IASP) defines pain as ‘‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’’.

This definition recognizes the interplay between the objective, physiological sensory aspects of pain and its subjective, emotional, and psychological components.The response to pain can be highly variable among different individuals as well as in the same person at different times. There are differences related to both gender and age in pain perception, experiences, and coping strategies.

Renal Artery : Variations and It's Clinical Significance

manju — 2024-06-20

Anatomy of renal artery and its variations is well known in literature. Anatomical variations in renal vessels have significant importance in diagnostic and therapeutic procedures. Knowledge of Accessory or aberrant renal artery is important for performing endovascular ,radiological, laparoscopic procedures and surgical interventions in transplants, nephrectomies and renal vascular disorders. The present study was conducted in department of anatomy Govt. medical college Patiala ,India during routine abdominal dissection for medical undergraduate students. Kidneys along with its arteries were exposed in 13 cadavers (12 males and 1 female). Variation in the form of accessory renal artery was found in two cadavers. Knowledge of variations in renal vasculature is important for clinicians uroradiological procedures and renal surgeries.

Successful management of sewage gas poisoning- Case report

Balwinder Kaur Rekhi — 2024-06-20

Management of poisoning cases is still a big challenge to the critical care field. These poisons could be accidental, suicidal or homicidal. And in many cases antidotes are not there or they are not rapidly available. And most of the time victims are brought to critical care in mentally obtended state where the history is not even available. And one of the highly fataltype of poisoning is sewage gas poisoning. Victims scum to the toxic substance or due to secondary phenomenon of multi-organ failure.