Clinical Efficacy and Safety of Remdesivir in Moderate to Severe COVID- 19 Disease in Patients Hospitalized in ICU | Chapter 4| Medicine and Medical Research: New Perspectives Vol. 8

Background: The COVID-19 pandemic has had a profound impact on global health and economies, and continues to pose significant challenges worldwide. Among the various drugs approved for treating COVID-19, Remdesivir, a purine nucleoside analogue inhibiting RNA-dependent RNA polymerase, has emerged as a key option in managing moderate-to-severe cases. This study evaluated the clinical efficacy and safety of Remdesivir in hospitalized patients with RT-PCR-confirmed moderate-to-severe COVID-19 disease. Conducted in the ICU of a hospital in Bihar, it provided real-world data on Remdesivir's impact on clinical outcomes, including hospital stay and mortality, particularly among patients with comorbidities. The study shows significant improvements in inflammatory markers post-treatment, highlighting the drug's role in managing the disease. It also adds valuable local data to the global understanding of COVID-19 treatment, guiding healthcare providers in similar settings.

Materials and Methods: This was a prospective, observational, cross-sectional study based on data collected from patients. A total of 100 patients with moderate-to-severe COVID-19 (RT-PCR positive) were admitted to the intensive care unit (ICU) of Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, Bihar, India were enrolled in the study from 12th August to 11th November 2020. All patients with moderate to severe COVID-19 received an injection of Remdesivir, starting with a 200 mg intravenous (IV) loading dose on Day 1, followed by 100 mg IV daily for the next four days, in conjunction with other standard treatments.

Results: Out of 100 patients, 88 patients recovered and were discharged, while 12 patients died. The mean age of patients was 54 ± 16 years with male preponderance (4:1). Mean duration of hospital stay was 10.6 ± 5.4 days. C-reactive protein, D-dimer, ferritin and interleukin-6 decreased significantly after treatment with Remdesivir, with p-value <0.01, as compared to values at the time of admission, without any significant side effects.

Conclusion: Early Remdesvir administration demonstrated significant efficacy in moderate to severe COVID-19 patients hospitalized in ICU, reducing time to clinical improvement and mortality rate. It has been shown in previous studies to be of significant use in managing moderate to severe COVID-19 and reducing the mortality rate. As cases of COVID-19 are still rampant in our country it may be used in future practice.

 

Author (s) Details

Jyoti Prakash
Department of General Medicine, AIIMS Patna, India.

 

B Das
Department of Medicine, Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, Bihar, India.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v8/2421

 

The Challenges of Cesarean Delivery at Teaching Hospital Gabriel Toure, Bamako Mali | Chapter 1 | Medical Science: Trends and Innovations Vol. 9

 Introduction: Cesarean permits to treat difficulties related to vaginal delivery and risk situations of fetal asphyxia. It also permits to save the mother and fetus. However, in developing countries as ours, complications related to this cesarean are not to be neglected. It constitutes an important cause of maternal and fetal morbidity and mortality. Here, the experience of the structure of complications of cesarean is reported.

Objectives: The objectives of this study were to study the complications of cesarean section at the teaching hospital Gabriel TOURE, Bamako, Mali.

Materials and Methods: A cross-sectional analytic study from January 1st 2003 to December 31st 2013 was carried out. All the patients who gave birth by cesarean operation in the gynecology-obstetric service of the teaching hospital Gabriel TOURE were included during this period of study. Descriptive statistics were used, Chi-square test, Pearson, and Cochran Armitage test have been used to calculate the P-value of trend. A multivariate analyses with a high alpha threshold of 10%, and then logistic regression multivariate was performed. It has been applied to appreciate the effect of maternal characteristics, obstetric practice, systemic factors, on the cesarean delivery rate and the complications.

Results: We have registered 28,376 deliveries with 9509 cases of cesarean (33.5%) and a complication cesarean rate of 32% (3049/9509). The main risk factors for cesarean operation completions were adolescence, primiparity, obesity, the non-realization of antenatal care, evacuations and co-morbidities. Intraoperative complications were dominated by hemorrhage 8.3% and bladder lesion 1.1%, whereas anemia (58.8%) and parietal infection (21.1%) dominated the postoperative complications table. The evacuation (Odds Ratio adjusted (ORa) = 1.96) as well as pre-eclampsia/eclampsia (ORa = 2.34) and the sickle cell disease (ORa = 9.99) were the main influencing factors of maternal death. Praevia placenta (ORa = 1.75) abruption placenta (ORa = 11.08) and fetal malformation (ORa = 2.21) dominated the influencing factors of perinatal death. Conclusion: The cesarean complications rates were high in our improvement of the quality of antenatal care. The reorganization and revitalization of the reference and against reference system will permit the program some cesarean operations to reduce the morbidity related to cesarean.

 

Author (s) Details

Abdoulaye Sissoko
Teaching Hospital Gabriel TOURE, Bamako, Mali.

 

Alassane Traore
Teaching Hospital, Bamako, Mali.

 

Ibrahim Kante
Teaching Hospital Point G, Bamako, Mali.

 

Amadou Bocoum
Teaching Hospital Gabriel TOURE, Bamako, Mali.

 

Soumana Oumar Traore
District Hospital Commune V, Bamako, Mali.

 

Seydou Fane
Teaching Hospital Gabriel TOURE, Bamako, Mali.

 

Daniel Dembele
Teaching Hospital Gabriel TOURE, Bamako, Mali.

 

Aminata Kouma
Teaching Hospital Kati, Bamako, Mali.

 

Mamadou Sima
Teaching Hospital Point G, Bamako, Mali.

 

Fatoumata K. Tounkara
Research Center CHU of Quebec, University of Laval, Quebec, Canada.

 

Amadou Fomba
Teaching Hospital Gabriel TOURE, Bamako, Mali.

 

Ibrahima Teguete
Teaching Hospital Gabriel TOURE, Bamako, Mali.

 

Youssouf Traore
Teaching Hospital Gabriel TOURE, Bamako, Mali.

Soumaila Keita
Teaching Hospital Point G, Bamako, Mali.

 

Niani Moukoro
Teaching Hospital Gabriel TOURE, Bamako, Mali.

 

Please see the book here:- https://doi.org/10.9734/bpi/msti/v9/4224

Role of Possum Scoring System to Assess the Expected Morbidity and Mortality in Patients Undergoing Laparotomy | Chapter 4 | Medical Science: Trends and Innovations Vol. 1

Background: In the era of evidence-based medicine, a sound knowledge of expected complications is essential in surgical practice. Understanding and stratifying patients based on an objective scoring method is imperative in both patient education and surgical team preparedness. Among the variety of scoring systems used to identify the “high-risk” patient, POSSUM scoring is the most widely used.

Methods: This was a descriptive study done on 154 patients who underwent midline laparotomy in this institute from October 2016 to October 2017. Patients undergoing laparotomy were sampled by using purposive sampling and their physiological severity score on admission and operative severity score at the end of 30 days were calculated. The morbidity and mortality rates were compared with the POSSUM score predicted rates.

Results: In the elective surgery group morbidity rates were higher in patients with higher POSSUM scores but due to low overall morbidity conclusions could not be drawn. while in the emergency group, POSSUM-predicted morbidity correlated well with observed results. The low mortality rates in the entire study population precluded meaningful analysis.

Conclusion: POSSUM has been proven to be one of the best scoring systems that could predict morbidity and mortality risk with reasonable accuracy. POSSUM scoring system has an undeniable advantage in our set-up for better patient counseling, improving the surgical outcomes in both emergency and elective wards and better management of limited resources and manpower.

 

Author (s) Details

G.V. Manoharan
Department of General Surgery, Sri Manakula Vinayagar Medical College & Hospital, Pondicherry 605107, India.

 

G. Vijayalakshmi
Department of Surgical Oncology, Government Royapettah Hospital, Chennai 600014, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/msti/v1/3210

Psychological Stress and Type-2 Diabetes Mellitus: A Relationship | Chapter 24 | Socio-Scientific Interaction in Diabetes and Cancer and Its Management

 Diabetes mellitus (DM) is a disease that occurs due to circulating blood glucose levels being too high. But it also occurs due to psychological issues, consumption of a high calorie diet and sedentary lifestyle. Diabetes is a long-lasting chronic metabolic disorder; it has established psychobiological relationships. Diabetes has much more effects on the human body and also the mind. This review article shows the relationship between   psychological stress and type-2 diabetes mellitus. Psychological stress affects the behaviors of people living with type-2 diabetes. Type-2 diabetes is caused due to stress, anxiety, depression and insomnia. These risk factors are associated with qualitative and quantitative defects in insulin secretion. Morbidity diabetic patients want passive euthanasia (legalized in Indian Supreme Court in 2018, India), for last resort. It is important to understand that the individuals who are suffering from diabetes mellitus, must have any psychological issue. It can't be denied that there is a possible correlation between psychological stress and diabetes mellitus.

Author(s) Details:

Sweta Singh,
Department of Psychology, K. S. College Laheriasarai, L.N. Mithila University, Darbhanga, India.

Please see the link here: https://stm.bookpi.org/SSIDCIM/article/view/12742

Prevalence and Risk Factors in Perinatal Morbidity and Mortality in the Hospital Environment of Kinshasa, DRC | Chapter 16 | Advanced Concepts in Medicine and Medical Research Vol. 5

 This episode aimed to decide the prevalence and risk determinants of perinatal morbidity and mortality in wards in the City Province of Kinshasa. The outcome of neonates sustaining hospitalization at early postnatal growth is associated with fetal and postnatal morbidities.We conducted a descriptive-correlational cross-divided study in the city province of Kinshasa, in two well-being zones drawn by portion in order to guarantee the haphazard aspect of the participants. Data were filed in Excel 2013 and then exported to SPSS 21 program for statistical reasoning. The determination of risk determinants for perinatal morbidity and mortality is fashioned possible on account of logistic regression at the meaning level of 0.05.The prevalence of prematurity in the emergency room setting was 13.8%; that of low beginning weight was 5.6% and the perinatal humanness rate was 50.4 per thousand live births. The perinatal mortality rate was 50.4‰ accompanying 35.1‰ of stillbirths and 15.9‰ of early neonatal mortality. The results of a logistic reversion analysis indicated that birth outside of a healing facility, polygyny, primigravida, strenuous work before birth, the presence of at least two ailments during pregnancy, and lack of tetanus immunization were risk factors for perinatal melancholy and mortality.Improving the mom's sociodemographic, economic, and cultural dowry as well as providing her accompanying high-quality fetal and postnatal care will be essential to guaranteeing the security of perinatal life. It would likewise be desirable to complete activity similar best studies for a broad reflection concerning this scourge throughout the City and the country as far as likely.

Author(s) Details:

Pascal Mamenepi Atuba,
Higher Institute of Medical Techniques of Kinshasa, Kinshasa, Democratic Republic of the Congo.

Louise Lohatame Pala,
Higher Institute of Medical Techniques of Lodja, Lodja, Democratic Republic of the Congo.

Angel Ngongo Andjelani,
Higher Institute of Medical Techniques of Kinshasa, Kinshasa, Democratic Republic of the Congo.

Please see the link here: https://stm.bookpi.org/ACMMR-V5/article/view/12593

Perforative Peritonitis: A Clinical Overview | Chapter 10 | Advanced Concepts in Medicine and Medical Research Vol. 5

 This stage was aimed to identify determinants in patients accompanying peritonitis which have a significant concerning morbidity and death.In India, perforative peritonitis is the most frequent surgical emergency needing immediate surgical care. Even with improvements in surgical procedures, antibiotic situations, and critical care assistance, directing peritonitis remains extremely disputing, complex, and demanding. The study was a alone center, prospective observational study administered in Lokmanya Tilak Municipal Hospital, Sion, Mumbai, India. Consecutive patients accompanying perforative peritonitis admitted to the emergency and those the one were fitting into the eligibility tests included in the study. A particularized history and clinical test and blood review performed followed by use of appropriate demonstrative procedures such as X-ray, CT-thumb through with supplementary help of USG and diagnostic paracentesis if required and in accordance with the need of the hour. A total of 50 patients intentional with age range 18-60 age with mean age of presentation 36.80 age and mortality rate was 16%. The result tells that 33.33% of the mortality rate in age group 41-50 age which is highest attended by the grave in age group 51-60 years is 28.6%. There is growing trend in humanness with age except there is slight visit age group 51-60 and 60% of >10 day nursing home stay was found in that group of same status.. We found most of the patients bearing no growth in peritoneal adulteration followed by E. coli (34%) highly alert amikacin. Most common complication was wound contamination. study indicated that most low surgical procedure used is basic closure as most common study of plants was gastroduodenal perforation. Patients' condition deteriorates on account of delayed hospital admittance, which is a big contributing factor to antagonistic outcomes. The characteristics that considerably predict demise are anemia, renal failure, infection of blood, quantity of dirtiness, size, and number of perforations. These risks are all significant at 5%. Therefore, humanness can be decreased if inmates exhibiting the earlier symptoms are identified early and endure the appropriate treatment.

Author(s) Details:

Ranjeet S. Kamble,
Department of Surgery, LTMMC and LTMGH, Sion, Mumbai-400022, India.

Mansha Singh,
Department of Surgery, LTMMC and LTMGH, Sion, Mumbai-400022, India.

Please see the link here: https://stm.bookpi.org/ACMMR-V5/article/view/12562

A Study Comparing Dosimetric Parameters and Clinical Outcomes in Inversely Planned Intensity-Modulated Radiotherapy (IMRT) and Field-in-Field Forward Planned IMRT for Breast Cancer Treatment | Chapter 12 | Novel Research Aspects in Medicine and Medical Science Vol. 4

 This study proposed to evaluate IP IMRT accompanying field-in-field FP IMRT in patients experiencing adjuvant radiation later a modified radical mastectomy (MRM) for feelings cancer. In the situation of breast malignancy, radiotherapy has been an essential component of the multimodality action. Dose distribution was improved by more recent methods in the way that three-dimensional fallout. Intensity-modulated dissemination (IMRT) improved uniformity much further. The purpose of this study was to judge dosimetric characteristics and dispassionate results of inverse projected IMRT (IP IMRT) and field-in-field forward planned IMRT (FP IMRT) in cases with breast malignancy receiving post-reduced radical mastectomy (MRM) adjuvant fallout. Fifty patients accompanying breast malignancy who had MRM and needed supplementary radiation were carelessly randomized to one of two groups (25 each) utilizing IP IMRT and FP IMRT procedures. The urged dose was 50 Gy open over five weeks in 25 portions. In IP IMRT, five to seven tangential beams were employed for the breast wall, nodal books were set at appropriate angles utilizing beam optimization, and the examining anisotropic technique was used to reckon. In order to ensure uniform dose disposal to the planned aim volume (PTV), underrate hot spot fields, and restrict uncovering to the ipsilateral lung and contralateral breast, two antagonistic tangential fields were grown for FP IMRT. The dosimetric parameters in conditions of PTV are better for IP IMRT plans compared to FP IMRT plans (V95%: 92.3% vs 75.2%, p = 0.0001; D90%: 47.4 Gy vs 42.9 Gy, p = 0.0001; D95%: 44.9 Gy vs 37.1, p = 0.0004). The ipsilateral pleura (V10Gy: 71.9% vs 41%, p = 0.00001; V20Gy: 42.14% vs 36.35%, p = 0.03; V40Gy: 17.31% vs 26.95%, p = 0.00004; Dmean: 20.91 Gy vs 17.88 Gy, p = 0.01) and contralateral lung (V5Gy: 31.8% vs 0.1%, p < 0.00001; V10Gy: 6.2% vs 0.08%, p = 0.0001) taken statistically significant lesser doses in agreements of low prescription parameters in FP IMRT. In the essence, the dosimetric parameter V5 was considerably lower for FP IMRT (61.7% vs 9.7%, p = 0.00001) along with Dmean (10.92 Gy vs 4.01 Gy, p = 0.001). Similarly, LAD limits showed comparable extreme dose capacities (V40Gy: 21.02% vs 16.26%; p = 0.29) in both groups and a flow toward reduction in mean lot (17.1% vs 9.2%; p = 0.05) in FP IMRT group, although reduced dose volumes were taller in IP IMRT group. In contralateral breast, doses in tinier volumes were better for FP IMRT plans (V0.5Gy: 59.7% vs 43.8%, p = 0.01; V0.6Gy: 54.07% vs 37.6%, p = 0.007; V1Gy: 40.9% vs 22.1%, p = 0.001; V2Gy: 28.7% vs 9.4%, p = 0.00003; V5Gy: 12.07% vs 4.2%, p = 0.0001). In neck, statistically significant lower doses were visualized only in terms of Dmean (10.29 Gy vs 5.1 Gy; p = 0.03) with FP IMRT. No meaningful difference in agreements of skin reactions and dysphagia was visualized in both the groups. Both IP IMRT and FP IMRT offer benefits and disadvantages, and the superiority of individual approach over the other cannot be proved in this place study. The decision to select one approach over another can likewise be influenced by patient-connected criteria to a degree the risk of loco-regional repetition vs the danger of dissemination-induced sequelae.

Author(s) Details:

S. K. Azharuddin,
Radiation Oncology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, India.

Piyush Kumar,
Radiation Oncology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, India.

Navitha S.,
Medical Physics, Shri RamMurti Smarak Institute of Medical Sciences, Bareilly, India.

Arvind Kumar Chauhan,
Radiation Oncology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, India.

Pavan Kumar,
Radiation Oncology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, India.

Jitendra Nigam,
Medical Physics, Shri RamMurti Smarak Institute of Medical Sciences, Bareilly, India.

Ankita Mehta,
Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, India.

Please see the link here: https://stm.bookpi.org/NRAMMS-V4/article/view/12106

Morbidity and Mortality in Newborns Exposed to Maternal Chorioamnionitis: An Update | Chapter 3 | Research Highlights in Disease and Health Research Vol. 6

 Chorioamnionitis (CA) is a average complication of pregnancy guide significant motherly, perinatal, and long-term adverse consequences. Adverse maternal effects include postpartum infections and infection of blood while adverse baby outcomes include stillbirth, rash birth, neonatal infection of blood, chronic lung ailment and brain harm leading to cerebral palsy and additional neurodevelopmental disabilities. CA is a term usually used to refer to different dispassionate or pathological environments characterized by an infectious and/or angering process that affects generally the chorioamniotic membranes, but also the amniotic fluid (AF), vessels of the chorionic plate and, sooner or later, the umbilical rope (funisitis) and the foetus. Its incidence is higher at lower gestational ages (GA), and the main system is believed expected the ascending bacterial infection from the motherly genital area, even with intact membranes. The angering complications guide chorioamnionitis have been well described, and these belongings may last into maturity. It diagnosis can be established clinical tests, amniotic fluid biochemical or microbiological examination, or by histopathological study of the placenta. CA is an main cause of stillbirth, premature rupture of membranes (PROM), preterm transfer and adverse maternal and neonatal effects such as early-attack neonatal sepsis (EONS) and necrotizing enterocolitis (NEC). Its causal partnership to other neonatal morbidities is questionable. Comparison of studies is challenging due to variety in diagnostic tests and morbidity definitions, and results are inconsistent. Additionally, the process's event and intensity are usually ignored. For all of these reasons, it is challenging to authorize evidence-based pieces of advice for the management of the mother and baby in these positions, and clinical practise changes greatly.

Author(s) Details:

Gloria Mercedes Galán Henríquez,
Servicio de Neonatología, Complejo Hospital Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain.

Fermín García-Muñoz Rodrigo,
Servicio de Neonatología, Complejo Hospital Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain.

Please see the link here: https://stm.bookpi.org/RHDHR-V6/article/view/10281

Adult Sigmoid Volvulus in a Referral Hospital in East Africa | Chapter 10 | Current Innovations in Medicine and Medical Science Vol. 2

 The purpose of this study was to report the presentation and management of a case of uncomplicated sigmoid volvulus in a referral hospital in East Africa. Sigmoid volvulus occurs due to twisting of the enlarged loop of the sigmoid colon about its mesenteric axis, resulting in acute colonic obstruction and eventual entrapment of the colon. A 46-year-old man had complained of his 7-day stomach pain, inability to defecate, and bloating. His abdomen was tympanic, distended and nontender. After his resuscitation, a laparotomy was performed, revealing volvulus of the sigmoid colon without intestinal ischemia or gangrene. A one-stage sigma colectomy and primary anastomosis were performed, and the patient recovered without complications. Endoscopic decompression is not available in East African emergency scenarios. Our patient underwent emergency laparotomy because he had a simple sigmoid torsion and no endoscopic torsion or rectal tube insertion. There was no morbidity after colon sigma resection and primary anastomosis. He recovered without complications. Single-stage sigma colectomy is reported to have a  mortality rate of 7.7% in East Africa. Septic shock is the leading cause of death in patients presenting with volvulus of the sigmoid colon. Early diagnosis and prompt treatment are necessary to  reduce morbidity and mortality in patients with intestinal obstruction due to volvulus of the sigmoid colon.

Author(s) Details:

Richard Wismayer,
Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda and Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda.

Please see the link here: https://stm.bookpi.org/CIMMS-V2/article/view/8227

Morphological Spectrum of Benign Lesions of the Uterine Cervix at a Tertiary Care Hospital in Tamilnadu, India: A Cross Sectional Study | Chapter 8 | Current Practice in Medical Science Vol. 8

Uterine cervix often makes up the majority of specimens received in the histopathology section of the pathology department. Cervical lesions can manifest in a variety of ways, making diagnosis challenging. It is advantageous in this situation to perform a complete histomorphological investigation of the cervix's non-neoplastic lesions. 833 samples of the uterine cervix from hysterectomies or biopsies were used in this investigation. Before being divided into different lesions, these cervices were thoroughly examined under the microscope and in the gross light. 16 different forms of benign lesions were discovered in the investigation. The most prevalent lesion, chronic cervicitis (non-specific), was discovered in 678 individuals (81.39 percent), while TB, endometriosis, and decidual alteration were all only discovered in one case (0.12 percent ). Throughout the experiment, several cervical non-neoplastic lesions were discovered, which greatly raised the patients' morbidity. The purpose of this study is to look into these more common but less frequently reported lesions.

 

Author (s) Details

Naveen Kumar B. J.

Department of Pathology, The Oxford Medical college Hospital and Research Centre, India.

 

 

Please see the link here:-  https://stm.bookpi.org/CPMS-V8/article/view/7797

Therational Design of Precision Drugs | Chapter 16 | Challenges and Advances in Pharmaceutical Research Vol. 4

The molecular target of the disease must be precisely characterised in order to rationally build perfect precision therapeutics. This essay explores ways to address this need by modifying the current pharmaceutical development process. The next phase, the creation of precision drugs—medications that target illnesses with no, or very few, side effects—is demonstrated in the article using examples from earlier drug development. To do this, different molecular structures connected to illnesses must be found, and then drugs that particularly bind to these structures must be developed. Finally, future medication development must follow this new paradigm.

Author (s) Details:

Karel Petrak,
Nangio Tx Inc., 50 Rector St Suite 1403 Newark, NJ07102, United States.

Please see the link here: https://stm.bookpi.org/CAPR-V4/article/view/7525

Management and Outcomes of Open Abdomen: A Review of the Literature and Two Case Reports from Central Uganda | Chapter 18 | New Horizons in Medicine and Medical Research Vol. 3

 The purposeful separation of the musculofascial and cutaneous layers of the abdominal wall is known as a laparostomy. Surgeons employ the open abdomen technique to lessen the impact of life-threatening insults that might cause intra-abdominal hypertension and, finally, abdominal compartment syndrome. Despite the high prevalence of illnesses needing open abdomen surgery in East Africa, there are few papers documenting its use and outcomes. The author describes two patients in central Uganda who were treated with an open abdomen. One of the patients had a perforated peptic ulcer, while the other had an anastomotic leak. A Bagota bag was employed for temporary abdominal closure in both cases. Fascial closure was eventually completed in this case series, and no mortality was documented. The goal was to conduct a literature evaluation on the various procedures for temporary abdominal closure as well as the management of these critically ill surgical patients. Only 25% of patients who survived in Africa had their fascia closed, despite the fact that laparostomy mortality in Africa is as high as 44%. This could be attributable to the severity of the underlying condition rather than the temporary abdominal closure procedure performed. More study is needed in East Africa to better understand the reasons for open abdomen surgery and the best treatment techniques to reduce morbidity and death in these surgically severely ill individuals.

Author(S) Details

Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda and Department of Surgery, Faculty of Health Sciences, Habib Medical School, Kampala, Uganda.

View Book:- https://stm.bookpi.org/NHMMR-V3/article/view/6347

Spontaneous Couniaud Segmen V Hepatic Haemorrhage from Hepatic Cirrhosis: A Rare Clinical Complication and Post Operative Evalution | Chapter 10 | Issues and Developments in Medicine and Medical Research Vol. 8

 A spontaneous hepatic haemorrhage (SHH) is an uncommon disorder in which the hepatic parenchyma ruptures without apparent cause. It's a surgical emergency because it produces intra-abdominal bleeding, which can lead to haemorrhagic shock and death if it's not treated. The clinical presentation is typically non-specific but urgent, needing prompt diagnosis and treatment, which may include interventional radiology, hepatology, and surgery. SHH is an uncommon complication induced most usually by HCC and hepatic adenoma, although it can also be caused by a variety of other lesions, including all known benign and malignant hepatic tumours, as well as metastatic malignancy. The cause of spontaneous bleeding is unknown, but there is evidence of vascular impairment, at least in HCC patients, and the disorder is more common in people with connective tissue illnesses. In patients with a known underlying disease, SHH is diagnosed using a clinical index of suspicion. This is not always the case, as SHH is a rare consequence in people with connective tissue disease who have never been in a car accident.

The goal of this study was to assess the long-term prognosis of this uncommon complication of hepatic cirrhosis using continuous liver function monitoring and abdominal computed tomography scanning.

Spontaneous hepatic bleeding is a serious abdominal emergency with a high rate of morbidity and fatality. The management of this case relies heavily on emergency operations.

Author(S) Details

I. B. Budhi
Department of Surgery, Sebelas Maret University, Indonesia.

I. B. Metria
Medical Faculty, Sebelas Maret University, Indonesia.

View Book:- https://stm.bookpi.org/IDMMR-V8/article/view/5804

Inguinal Hernia Repairs in a Rural Setting in East Africa: A Clinical Approach| Chapter 01 | Issues and Developments in Medicine and Medical Research Vol. 3

 In the poor world, inguinal hernias are a leading source of morbidity and mortality. Due to the late presentation of inguinal hernias and the lack of availability and cost of mesh and laparoscopy in resource-constrained settings in rural Africa, clinical care of inguinal hernias may represent a therapeutic challenge to the surgeon. There is a scarcity of data and literature on the surgical treatment of inguinal hernias in our setting. Inguinal hernia affects 3% of women and 27% of men over their lifetime, with rates declining after 45 years of age. The goal of this study was to look at the clinical profile and results of inguinal hernia repair patients at our institution.

Methods: From April 1, 2008, to July 31, 2012, a descriptive retrospective study was conducted on all patients 15 years of age who had an inguinal hernia repair. The patients were evaluated on the surgical ward after surgery and again three months later at the surgical out-patient clinic. The following data were obtained using a pretested questionnaire: age, sex, recurrence of hernia, post-operative pain, and post-operative complications. Physical examination was performed to check for post-operative recurrence and evidence of haematomas, seromas, or acute wound sepsis that necessitated surgery.

The results of 158 patients who had an inguinal hernia repaired with the Modified Bassini method were studied. The average age was 44.84. The male to female ratio was 3.65:1, with males outnumbering females. 4 (2.53%) of patients had emergency inguinal hernia repairs, while the majority of patients, 154 (97.47%), had elective inguinal hernia repairs. 1(0.63 percent) seroma, 1(0.63 percent) haematoma, 1(0.63 percent) necrotizing fasciitis, and 1(0.63 percent) enterocutaneous fistula were among the morbidities. Overall, 3.16 percent of patients had complications.

Conclusions: Patients with inguinal hernias in rural Africa should be encouraged to present early with inguinal hernia signs and symptoms. Elective inguinal hernia surgery, regardless of the kind of repair, will reduce morbidity and death associated with this frequent condition in East Africa.

Author(S) Details

Richard Wismayer
Department of Surgery, St. Joseph’s Maracha Hospital, West Nile, Uganda and Department of Surgery, Habib Medical School, IUIU University, Kampala, Uganda.

View Book:- https://stm.bookpi.org/IDMMR-V3/article/view/5462

A Retrospective Evaluation of Morbidity Pattern and Outcome of Patients Admitted in Paediatric Intensive Care Unit in a Tertiary Care Rural Teaching Hospital | Chapter 7 | Recent Developments in Medicine and Medical Research Vol. 8

 Background: One of the most demanding and difficult aspects of paediatrics remains to be the care of extremely ill children. The Paediatric Intensive Care Unit's primary purpose is to prevent death by closely monitoring and treating critically ill children who are at high risk of dying. In impoverished nations, there is a scarcity of data on paediatric critical care. The outcomes of medical interventions can be used to measure therapy efficacy. This allows for better decision-making, higher-quality care, and, if necessary, a shift in management's future direction. This research will also help with the investigation of the causes of morbidity and mortality in our hospital's children. The study's goals and objectives are to assess the morbidity pattern and outcomes of admissions to a rural teaching hospital's PICU, as well as to improve critical care facilities to reduce morbidity and death.

Methods: This was a retrospective analysis of cases admitted to our teaching hospital's paediatric ICU in the previous two and a half years, with the estimated sample size taken into consideration. The PICU and the Medical Records Department will provide information. The medical record will be utilised to research the specifics, which will then be analysed and interpreted depending on the data in the medical record.

Results: Over the duration of the study's 30 months, 417 individuals were admitted to our PICU. The maximum number of cases studied, 180 (43.2%), were under the age of one year. The age range for the participants was 1 day to 18 years. Males accounted for 228 (54.7%) of the cases, while females accounted for 189 (45.3%). The most common diagnosis was LRTI, which accounted for 61 (14.7 percent) of cases. The most commonly implicated system was the respiratory system, which accounted for 101 (21.8%) of all cases. 357 (85.6%) of the overall cases investigated were released, 36 (8.6%) had DAMA (discharge against medical advice), and 24 (5.8%) had expired.

Conclusions: Our PICU had a low mortality rate. Based on the outcomes of this study, we conclude that with better treatment protocols and trained expertise/Pediatric Intensivist, we have a greater possibility of facilitating the care of critically sick patients and obtaining a favourable outcome in our rural PICU.

Author(S) Details

Deepali A. Ambike
Department of Pediatrics, YCM Hospital, Pimpri, Pune, Maharashtra, India.

Vijay L. Bhavari
Department of Pediatrics, MIMER Medical College, Talegaon Dabhade, Pune, Maharashtra, India.

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Brief Overview of High Cesarean Section Rates in Latin America, a Reflection of a Different Approach to Labor? | Chapter 6 | Research Trends and Challenges in Medical Science Vol.3

Increasing rates of cesarean section, as high as 50% in some countries in Latin America, compared with the rest of the world, demand a closer analysis of its causes and implications. The significant morbidity for both mother and baby associated with cesarean section requires immediate action from national and international societies to confront the situation with specific solutions, including patient education. We recommend a consensus meeting of Latin American ACOG (American College of Obstetricians and Gynecologists) section members to address the issue and to consider adopting guidelines based on evidence and reflecting the realities of the countries involved

Author(s) Details

Eghon Guzman 
Hospital Dr. Sotero del Rio Integramedica Bupa Santiago, Chile.

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