Consultation section

Background: Study of various surgical health problems among school children is of paramount importance. Most of school children belong to low socio economic background. Because of poverty, lack of awareness, and negligence the surgical health problems are neglected. School is the best place to cover maximum number of children and to identify the surgical health problems and offer them the free treatment and surgery. The objective of this study was to study the prevalence and pattern of various surgical health problems among school children. Methods: A community based cross sectional study was carried out among 274591 school children of Latur district from July 2008 to March 2009. A team of doctors, pharmacist, and staff nurse and health worker screened all the 274591 school children. Those children suspected of having any surgical health problem were listed out. Then a team of qualified surgeons examined the suspected children of having any surgical health problem. Based on the surgeon’s decision or diagnosis, the children were offered the appropriate treatment in the form of medicines or surgery. The appropriate treatment was given free of cost to all. Results: A total of 116 children were found to be suffering from various surgical health problems. Among these positive cases, maximum were found to have hernia i.e. 46 cases followed by undescended testis in 20 cases, phimosis in 17 cases, hydrocele in 14 cases and 19 cases presented with other surgical conditions. A significantly higher number of males were found to have the surgical health problem i.e. 97 out of total 116. 66.4% of the cases were operated, 12.9% of the cases were given the treatment. In 5.2% of the cases no intervention was required. But 14.7% of the cases declined the offered treatment of choice. One case left against the medical advice. Conclusions: A significant number of children were found to have surgical health problems like hernia, hydrocele, phimosis, undescended testis and others.

Acute care of the surgical neonate

The goal of this study was to estimate the prevalence of surgical conditions among refugees in East Africa. Surgery is a foundational aspect to high functioning health care systems. In the wake of the Lancet Commission on Global Surgery, previous research has focused on defining the burden of surgical conditions in low- and middle-income countries. Despite numbering over 80 million people globally, forced migrant populations have often been neglected from this body of research. We administered a validated survey using random cluster sampling to determine surgical need among refugees in western Tanzania. Primary outcome was history or presence of a surgical problem. Analysis included descriptive and multivariable logistic regression including an average marginal effects model. We analyzed data from 3,574 refugee participants in East Africa. A total of 1,654 participants (46.3%) reported a history or presence of at least one problem that may be surgical in nature. Of those 1,654 participants who did report a problem 1,022 participants (61.8%) reported the problem was still ongoing. Multivariable analysis revealed several factors associated with having a surgical problem (increasing age, occupation, illness within past year). To our knowledge, this is the first and largest population-based survey in estimating the prevalence of surgical disease among refugees in sub-Saharan Africa. Our results imply that more than one-in-four refugees has an ongoing surgical problem, suggesting over double the burden of surgical need in refugee populations compared to non-refugee settings.

Peptic ulcer as a surgical problem

There is no previous data published on the frequency and reasons for dental emergencies in the Italian Army. In this study, all the 329 soldiers who sought dental help during a 5-month period in the Military Hospital in Bologna were investigated. Prior to clinical examination, the soldiers filled out a questionnaire concerning their subjective perception about their dental treatment needs. Data from the questionnaire were then compared with the actual status findings. The results showed that endodontic problems comprised the majority of the cases (37.1%), followed by surgical problems as the second most frequent emergency (33.1%). The subjects' own perceptions showed good agreement with the clinical record in cases with endodontal or surgical problems, excluding problems related to wisdom teeth, while those related to caries and periodontal disease were less frequently correctly assessed by the soldiers.

Push and Pull Between the Public and Professional

Syndrome of intraabdominal hypertension: pathophysiological aspects and surgical problems

This study aimed to determine the effect of sociodemographic factors on anxiety, depression, and perceived social support in patients with internal medicine and surgical problems. The study comprised 522 patients who were hospitalized at the internal medicine and surgical clinics of the training and research hospital of a university. Of all the patients, 27% were at the risk of anxiety and 51.7% at the risk of depression. Sociodemographic characteristics, health-related issues, and disease characteristics, besides hospitalization-related matters, affected anxiety, depression, and social support levels of patients. It was determined that more than half of the patients were at the risk of depression. Perceived social support is essential to reduce the risk of anxiety and depression.

Back to table of contents Previous article Next article Letter to the EditorFull AccessChange Diagnosis to “Alcohol Withdrawal Delirium”?MILTON ROSENBAUM, M.D., MILTON ROSENBAUMSearch for more papers by this author, M.D., Albuquerque, N. Mex.Published Online:1 Jul 2003https://doi.org/10.1176/appi.ajp.160.7.1357-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In 1980 APA replaced the DSM-III diagnosis “delirium tremens” with “alcohol withdrawal delirium.” In the following, I describe a study that stemmed from the concern that not only can the term “alcohol withdrawal delirium” be easily confused with “alcohol withdrawal” but the diagnosis “alcohol withdrawal delirium” in general medicine is used indiscriminately, such that other potentially important underlying causes for delirium are often overlooked.Fifty patient charts from the University of New Mexico Hospital with a discharge diagnosis of “alcohol withdrawal delirium” were randomly selected by a medical records computer for 1994, 1996, and 1998 and were reviewed by me (director of the Psychiatric Consultation and Liaison Service), a trained research assistant, and a medical intern. Data were obtained regarding diagnosis, mental status observations, nursing notes, drinking history from the patient and his or her family, and presence of major medical and surgical problems. A retrospective diagnosis was made by consensus of the two senior clinicians.The patients were 47 men and three women with a mean age of 42 years (range=29–75). Most (N=34) were treated in medical units, 13 were in surgical units, and three were in the neurology service. They had a mean length of stay of 9.8 days (range=1–83.) The history of recent drinking for three patients was none. Their retrospective diagnoses included 20 with delirium tremens, six with acute intoxication, four with alcohol withdrawal, two with seizures without delirium, and one with alcohol hallucinosis=1. The remaining 17 patients met our criteria for “multifactorial delirium in chronic alcoholics”; that is, these patients with delirium also had serious medical and surgical problems, especially traumatic injuries, which were more extensive than those ordinarily seen in patients with delirium tremens. There were two deaths; both patients were retrospectively diagnosed as having multifactorial delirium.The 13 patients without delirium (26.0%) obviously represented considerable diagnostic error. The 17 patients with multifactorial delirium (34.0%) had longer lengths of stay, with a mean stay of 17.5 days, compared to 5.3 days for the patients with delirium tremens. Fourteen of the 20 patients retrospectively diagnosed as having delirium tremens had episodes occurring during a drinking binge, compared to six patients who had episodes occurring during withdrawal.A history of alcohol abuse influences the diagnosis of patients with delirium, no matter how medically complicated it is. Some of the difficulties may result from diagnostic terminology. I hope this report, despite the well-known problems of chart review, will stimulate interested clinicians to undertake similar retrospective and prospective studies and alert the current DSM-V committee to consider changing the term “alcohol withdrawal delirium” to “delirium tremens” and to consider introducing a new diagnostic term: “multifactorial delirium in chronic alcoholics.”[Dr. Rosenbaum died May 20, 2003.] FiguresReferencesCited byDetailsCited ByEuropean Journal of Neurology, Vol. 20, No. 12The American Journal on Addictions, Vol. 21, No. 2European Journal of Internal Medicine, Vol. 22, No. 6 Volume 160Issue 7 July 2003Pages 1357-a-1358 Metrics History Published online 1 July 2003 Published in print 1 July 2003

27 - Surgical Problems in Infancy and Childhood

BackgroundIn Japan, even if physicians have not experienced surgical training, they face many instances in which they must provide initial surgical treatment, especially during off‐hours. This study aimed to identify the frequency and fields of commonly encountered problems in a Japanese emergency department.MethodsA retrospective review was performed to identify walk‐in outpatients with exogenous problems visiting during off‐hours in the Japanese educational hospital providing primary to tertiary emergency care between January 1 and December 31, 2014. Diseases were aggregated according to International Classification of Primary Care (Second Edition; ICPC‐2).ResultsDuring the study period, 33 424 patients visited and 7476 were classified into the “exogenous” group. We analyzed the data of 7421 patients after excluding 55 who were deemed undiagnosable based on reviews of the charts. The median age of patients who visited the ED during off‐hours was 29 years (range: 0‐101 years, IQR: 8‐60 years). Altogether, 226 types of problems included in ICPC‐2 were identified during the study period. The majority fields of exogenous problems were ‘skin,’ ‘Musculoskeletal,’ and ‘eye.’ The 15 problems with the highest frequencies accounted for 50.2% of the total problems.ConclusionsWe identified surgical problems with high treatment frequencies among patients visiting the ED during off‐hours. Providing education focusing on these frequent surgical problems can help to improve the initial treatment quality and reduce the anxiety for those doctors who provide initial surgical treatment.

A prospective multicenter cohort study. This study evaluates the risk for surgical site infections (SSIs) or wound healing problems (WHPs) in patients who underwent corticosteroid injection before lumbar decompression surgery. Corticosteroid injections are often used for the treatment of the degenerated spine. However, their well-known immunosuppressive effects could increase the risk for local infections, particularly if a surgical intervention follows the injection rapidly. The Swiss Lumbar Stenosis Outcome Study (LSOS), which is a prospective multicenter cohort study of patients with symptomatic lumbar spinal stenosis, was used as database. Of 743 patients, 422 patients underwent surgery and were eligible for the study. Ten patients (2.4%) were revised for either SSIs (n = 6) or WHPs (n = 4). A control group (n = 19) was constructed matched according to age, sex, diabetes, and body mass index (BMI). Odds ratios (ORs) were calculated by using a conditional logistic regression model to quantify the risk of SSI or WHP after preoperative corticosteroid injection. Subgroup analysis was performed for patients with injection within 0 to 3 months before surgery, 0 to 6 months before surgery, or any injection at all before surgery. Within this cohort, no significant association could be found between preoperative corticosteroid injection and postoperative SSI or WHP in patients with corticosteroid injections within 0 to 3 months before surgery [OR = 0.36, 95% confidence interval (95% CI) 0.04-3.22], 0 to 6 months before surgery (OR = 0.69 95% CI 0.14-3.49), or any time before surgery (OR = 0.43, 95% CI 0.04-3.22). Within the here investigated cohort, the risk of SSIs or WHPs following lumbar spinal decompression surgery seems not highly associated with preoperative corticosteroid injections. However, the safe time interval between corticosteroid infiltrations and surgery remains unknown, should not be decreased incautiously, and is the subject of further research. 2.

The efficient surgical scheduling of the operating theatre plays a significant role in hospital’s income and cost. Currently surgical scheduling only considered the surgery process in operating room and ignored other stages which should not be left out in real situations. The surgical scheduling problem is regarded as the hybrid flow-shop scheduling problem in this study. Each elective surgery which need local anesthesia has to go through a two-stage surgery procedure. Beds and operating rooms are represented as parallel machines. A mathematical model for such surgical scheduling problem is proposed and solved by LINGO. A case study with its optimal solution is also presented to verify the model.

Complications Following Surgically Assisted Rapid Palatal Expansion: A Retrospective Cohort Study

Introduction: Evaluation of the effectof educational intervention on early initiation of breast feeding in full term normally delivered baby 1 & 6 months andfactors affectingbreast feeding. Methods: interventional study with subjects as mothers with vaginal delivered newborns excluding preterm, VLBW/ LBW / /IUGR babies, newborn with medical or surgical problems and whose child didn’t survive Cases were pregnant women attending antenatal clinic of KRH (n=124) and controls were mothers delivered at government hospital except KRH.(n=120). Mothers counseled antenatally and helped for initiation of breast feeding immediately after birth and again counseled individually at discharge, on follow up at end of1st and 6months. In control group breast feeding practices were recorded at 1 and 6 months after birth without any counseling. Results: There were 76.8% (n = 80) mothers who had early initiation of breast feedingin interventional groupcompared to 10.56% (n = 12) in non-interventional group with odds ratio of32. 93 and 83%mothers in interventional group were practicing EBF (p = 0.01)against only 63 %, and 49% mothersat 1 and 6 months respectively in non-interventional group. Effect of counseling in cases for EBF was more in primiparous(70.83% and 91.30%) than in multiparous (29.16% and 60.41%) at 1 and 6 months respectively (p = 0.01and 0.04). Conclusion: counseling antenatally and at regular intervals significantly increase early initiation and sustainedexclusive breast feeding. This influence primiparous mothers more.