Pub Date : 2022-09-01DOI: 10.4103/jssrp.jssrp_27_22
Raman K Kumar
The shortfall of human resources in health has resulted in skewing the distribution of health workers such that vulnerable populations in rural, tribal, and hilly areas continue to be extremely underserved. To address the regional disparities in medical education and availability of human resources in health, the policy of establishing one medical college at each district in India was initiated. The situation of human resources in health remains inadequate. To address the regional disparities in medical education and availability of human resources in health, the policy of establishing one medical college at each district in India was initiated. Impressive progress has been made during the past few years with respect to opening new medical colleges in the area of need across geographical coverage.
{"title":"District medical colleges in India – Addressing the rural health-care needs","authors":"Raman K Kumar","doi":"10.4103/jssrp.jssrp_27_22","DOIUrl":"https://doi.org/10.4103/jssrp.jssrp_27_22","url":null,"abstract":"The shortfall of human resources in health has resulted in skewing the distribution of health workers such that vulnerable populations in rural, tribal, and hilly areas continue to be extremely underserved. To address the regional disparities in medical education and availability of human resources in health, the policy of establishing one medical college at each district in India was initiated. The situation of human resources in health remains inadequate. To address the regional disparities in medical education and availability of human resources in health, the policy of establishing one medical college at each district in India was initiated. Impressive progress has been made during the past few years with respect to opening new medical colleges in the area of need across geographical coverage.","PeriodicalId":355285,"journal":{"name":"Journal of Surgical Specialties and Rural Practice","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128773772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.4103/jssrp.jssrp_9_22
A. Dixit, D. Javed, Nibha Giri
Pilonidal sinus (PNS) occurs beneath the skin in the gluteal cleft just above the anus. It continues to pose a number of therapeutic challenges and its treatment is mostly surgical. A 33-year-old male shopkeeper consulted the homeopathy outpatient department of AYUSH with complaints of mild pain and bloody pus (serosanguinous) from the sinus tract and intermittent mild fever, for the past 2 years. The patient was apprehensive about the surgery and did not want it. We devised a therapy strategy for the patient. Depilation of the tract followed by the adding of a Kshar solution to spontaneously cauterize the scar tissue was performed. Finally, the homeopathic drug Silicea 200 was given for 3 months period, and the case was followed for more than 9 months. The case exhibited a marked reduction in probing of the tract (1.7–0 cm), Visual Analog Scale (VAS) for pain (3-0), and discharge (+++ to NIL) after 3 months of treatment. The Outcome in Relation to Impact on Daily Living scale score was +4, indicating that he is back to normal in terms of both the main complaint and overall well-being. At the final visit, the Modified Naranjo Criteria for Homeopathy score was +8 on a scale of −6 to +13. Homeopathy in combination with the Kshar solution can be an effective alternative approach to the management of PNS. As a result, controlled clinical trials are warranted.
{"title":"Management of pilonidal sinus using homoeopathic medicine in combination with Kshar Solution: A case report of a novel approach","authors":"A. Dixit, D. Javed, Nibha Giri","doi":"10.4103/jssrp.jssrp_9_22","DOIUrl":"https://doi.org/10.4103/jssrp.jssrp_9_22","url":null,"abstract":"Pilonidal sinus (PNS) occurs beneath the skin in the gluteal cleft just above the anus. It continues to pose a number of therapeutic challenges and its treatment is mostly surgical. A 33-year-old male shopkeeper consulted the homeopathy outpatient department of AYUSH with complaints of mild pain and bloody pus (serosanguinous) from the sinus tract and intermittent mild fever, for the past 2 years. The patient was apprehensive about the surgery and did not want it. We devised a therapy strategy for the patient. Depilation of the tract followed by the adding of a Kshar solution to spontaneously cauterize the scar tissue was performed. Finally, the homeopathic drug Silicea 200 was given for 3 months period, and the case was followed for more than 9 months. The case exhibited a marked reduction in probing of the tract (1.7–0 cm), Visual Analog Scale (VAS) for pain (3-0), and discharge (+++ to NIL) after 3 months of treatment. The Outcome in Relation to Impact on Daily Living scale score was +4, indicating that he is back to normal in terms of both the main complaint and overall well-being. At the final visit, the Modified Naranjo Criteria for Homeopathy score was +8 on a scale of −6 to +13. Homeopathy in combination with the Kshar solution can be an effective alternative approach to the management of PNS. As a result, controlled clinical trials are warranted.","PeriodicalId":355285,"journal":{"name":"Journal of Surgical Specialties and Rural Practice","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116951503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.4103/jssrp.jssrp_6_22
Jitender Singh, T. Sharma
In the current pandemic, the incidence of fungal infections-associated COVID-19 is surging. Diabetes mellitus, overzealous steroid, and antibiotic use for COVID-19 management may cause or exacerbate the fungal disease. In paranasal sinus (PNS), ethmoids followed by the maxillary sinus are commonly involved with the risk of intra-orbital or/and intracranial involvement is quite common. In lungs, COVID-19 infection has higher mortality rate, if there is an associated fungal infection. Aspergillus fumigates is the most common fungus that cause lung infection and present as discrete lesion different from COVID-19 manifestation. Two cases of COVID-associated fungal infections, i.e., rhino-mucormycosis and pulmonary aspergillosis are described here. In the first case, computed tomography (CT) of PNS was done for the complaints of mild right-sided facial swelling and mild restriction of the eye globe on day 27 of illness. CT showed hyperdense content involving the right-sided nasal sinus with the remodeling of bones with erosion and thinning of the inferior and medial orbital wall with the extension of soft tissue into the extraorbital space. The patient was treated with Amphotericin B and posaconazole oral suspension as the first-line antifungal monotherapy. In the second case, on complaints of cough with expectoration on the 20th day of illness, X-ray chest and CT chest were done which confirmed a thick-walled cavity in the right lung and other post COVID features. The tracheal aspirate culture was suggestive of Aspergillus fumigatus and Aspergillus antigen galactomannan was found positive in the fluid. The patient was treated for the same with antifungal therapy. Hence it is important to pay attention to the high probability of fungal infections in COVID-19 patients. The association of coronavirus with mucormycosis of the PNSs and aspergillosis of the lung must be given outmost consideration. Noncontrast CT of the PNSs is usually the first investigation of choice for PNS involvement, and CT chest help in the diagnosis of pulmonary fungal infection. Uncontrolled diabetes and use of steroids are two of the main factors for aggravating factors. Both early surgical intervention and anti-fungal treatment should be sought for the management.
{"title":"COVID-19-associated rhino-mucormycosis and pulmonary aspergillosis infection","authors":"Jitender Singh, T. Sharma","doi":"10.4103/jssrp.jssrp_6_22","DOIUrl":"https://doi.org/10.4103/jssrp.jssrp_6_22","url":null,"abstract":"In the current pandemic, the incidence of fungal infections-associated COVID-19 is surging. Diabetes mellitus, overzealous steroid, and antibiotic use for COVID-19 management may cause or exacerbate the fungal disease. In paranasal sinus (PNS), ethmoids followed by the maxillary sinus are commonly involved with the risk of intra-orbital or/and intracranial involvement is quite common. In lungs, COVID-19 infection has higher mortality rate, if there is an associated fungal infection. Aspergillus fumigates is the most common fungus that cause lung infection and present as discrete lesion different from COVID-19 manifestation. Two cases of COVID-associated fungal infections, i.e., rhino-mucormycosis and pulmonary aspergillosis are described here. In the first case, computed tomography (CT) of PNS was done for the complaints of mild right-sided facial swelling and mild restriction of the eye globe on day 27 of illness. CT showed hyperdense content involving the right-sided nasal sinus with the remodeling of bones with erosion and thinning of the inferior and medial orbital wall with the extension of soft tissue into the extraorbital space. The patient was treated with Amphotericin B and posaconazole oral suspension as the first-line antifungal monotherapy. In the second case, on complaints of cough with expectoration on the 20th day of illness, X-ray chest and CT chest were done which confirmed a thick-walled cavity in the right lung and other post COVID features. The tracheal aspirate culture was suggestive of Aspergillus fumigatus and Aspergillus antigen galactomannan was found positive in the fluid. The patient was treated for the same with antifungal therapy. Hence it is important to pay attention to the high probability of fungal infections in COVID-19 patients. The association of coronavirus with mucormycosis of the PNSs and aspergillosis of the lung must be given outmost consideration. Noncontrast CT of the PNSs is usually the first investigation of choice for PNS involvement, and CT chest help in the diagnosis of pulmonary fungal infection. Uncontrolled diabetes and use of steroids are two of the main factors for aggravating factors. Both early surgical intervention and anti-fungal treatment should be sought for the management.","PeriodicalId":355285,"journal":{"name":"Journal of Surgical Specialties and Rural Practice","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116178843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.4103/jssrp.jssrp_8_22
D. Javed, S. Anwar
{"title":"Learning curve for laparoscopic surgery: Bypass to open procedures?","authors":"D. Javed, S. Anwar","doi":"10.4103/jssrp.jssrp_8_22","DOIUrl":"https://doi.org/10.4103/jssrp.jssrp_8_22","url":null,"abstract":"","PeriodicalId":355285,"journal":{"name":"Journal of Surgical Specialties and Rural Practice","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123673722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.4103/jssrp.jssrp_13_22
I. Lata, Ruchi Gupta, Amrit Gupta, P. Prasad
Placenta accreta spectrum (PAS) disorders (accreta, increta, and percreta) are rare but are potentially life-threatening obstetric conditions of high maternal and fetal or neonatal morbidity and mortality. In the patient at risk for accreta, obstetrical ultrasonography should be performed and it can be complemented with magnetic resonance imaging. In suspected cases, a multidisciplinary team with clinical expertise should be involved. Anencephaly is a major lethal fetal anomaly of severe central nervous system malformation and the most common type of neural tube defect (NTD). Although the etiology of anencephaly remains unclear, various maternal-related environmental and genetic risk factors have been reported. Termination of pregnancy is offered for all prenatally diagnosed cases. We are presenting management of the rare case of a pregnant woman having placenta increta with fetal NTD malformation in the form of anencephaly.
{"title":"Fetal malformation anencephaly with placenta accreta spectrum (increta): Two different tales in a pregnancy – A rare case report","authors":"I. Lata, Ruchi Gupta, Amrit Gupta, P. Prasad","doi":"10.4103/jssrp.jssrp_13_22","DOIUrl":"https://doi.org/10.4103/jssrp.jssrp_13_22","url":null,"abstract":"Placenta accreta spectrum (PAS) disorders (accreta, increta, and percreta) are rare but are potentially life-threatening obstetric conditions of high maternal and fetal or neonatal morbidity and mortality. In the patient at risk for accreta, obstetrical ultrasonography should be performed and it can be complemented with magnetic resonance imaging. In suspected cases, a multidisciplinary team with clinical expertise should be involved. Anencephaly is a major lethal fetal anomaly of severe central nervous system malformation and the most common type of neural tube defect (NTD). Although the etiology of anencephaly remains unclear, various maternal-related environmental and genetic risk factors have been reported. Termination of pregnancy is offered for all prenatally diagnosed cases. We are presenting management of the rare case of a pregnant woman having placenta increta with fetal NTD malformation in the form of anencephaly.","PeriodicalId":355285,"journal":{"name":"Journal of Surgical Specialties and Rural Practice","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128370953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.4103/jssrp.jssrp_12_22
Aditya Singhal, P. Agrawal, V. Agrawal
Background: Ever since the cluster of COVID-19 cases seen in Wuhan, China, the animal-origin virus has created havoc. These changes in clinical manifestations have been tracked in different waves, in different countries, also the virus behaving differently according to race and culture. To assess the prevalence of symptoms of COVID-19 infection during the third wave and compare it with seasonal flu and allergic rhinitis. Materials and Methods: A cross-sectional, comparative study was conducted at a tertiary hospital in Bareilly. A close-ended questionnaire was prepared to assess the otorhinolaryngological symptoms of COVID-19, seasonal flu, and allergic rhinitis. ENT findings were further confirmed by a suitable test. Results: A total of 145 tested positive for COVID-19 infection, 121 patients were diagnosed with seasonal flu, and 124 patients were diagnosed as cases of allergic rhinitis. Fever was the most common symptom in seasonal flu (100%) and COVID (93.8%) patients. Rhinorrhea (100%), lacrimation (100%), and sneezing (100%) were common symptoms in the allergic rhinitis group. A Chi-square test with Bonferroni correction showed a significant difference in the prevalence of symptoms in all three groups (P < 0.0001). Vaccination also contributed to less severity of COVID-19 disease. Conclusion: Involvement of otorhinolaryngology is considered a biomarker in all three groups with less frequent pulmonary features. It becomes necessary to correctly differentiate COVID-19 from the other two diseases for the proper treatment of patients.
{"title":"Prevalence of otorhinolaryngological manifestations of COVID-19 infection during third wave and comparison from seasonal flu and allergic rhinitis in a tertiary care hospital","authors":"Aditya Singhal, P. Agrawal, V. Agrawal","doi":"10.4103/jssrp.jssrp_12_22","DOIUrl":"https://doi.org/10.4103/jssrp.jssrp_12_22","url":null,"abstract":"Background: Ever since the cluster of COVID-19 cases seen in Wuhan, China, the animal-origin virus has created havoc. These changes in clinical manifestations have been tracked in different waves, in different countries, also the virus behaving differently according to race and culture. To assess the prevalence of symptoms of COVID-19 infection during the third wave and compare it with seasonal flu and allergic rhinitis. Materials and Methods: A cross-sectional, comparative study was conducted at a tertiary hospital in Bareilly. A close-ended questionnaire was prepared to assess the otorhinolaryngological symptoms of COVID-19, seasonal flu, and allergic rhinitis. ENT findings were further confirmed by a suitable test. Results: A total of 145 tested positive for COVID-19 infection, 121 patients were diagnosed with seasonal flu, and 124 patients were diagnosed as cases of allergic rhinitis. Fever was the most common symptom in seasonal flu (100%) and COVID (93.8%) patients. Rhinorrhea (100%), lacrimation (100%), and sneezing (100%) were common symptoms in the allergic rhinitis group. A Chi-square test with Bonferroni correction showed a significant difference in the prevalence of symptoms in all three groups (P < 0.0001). Vaccination also contributed to less severity of COVID-19 disease. Conclusion: Involvement of otorhinolaryngology is considered a biomarker in all three groups with less frequent pulmonary features. It becomes necessary to correctly differentiate COVID-19 from the other two diseases for the proper treatment of patients.","PeriodicalId":355285,"journal":{"name":"Journal of Surgical Specialties and Rural Practice","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114600363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.4103/jssrp.jssrp_3_22
G. Dharmshaktu
{"title":"A handy kitchen tool for simple wire or pin removal at rural clinics","authors":"G. Dharmshaktu","doi":"10.4103/jssrp.jssrp_3_22","DOIUrl":"https://doi.org/10.4103/jssrp.jssrp_3_22","url":null,"abstract":"","PeriodicalId":355285,"journal":{"name":"Journal of Surgical Specialties and Rural Practice","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131590095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.4103/jssrp.jssrp_4_22
G. Dharmshaktu
The skill stations are becoming the essential part of undergraduate medical training but availability and uniformity in their structure and functioning are still not universal across institutions. In the absence of cutting edge technology or paraphernalia in newer medical colleges, innovative and creative use of easily available materials to make models for teaching, training, and assessment purpose is highly desirable and attempts should be made by teachers and students both to hone their skills in this regard. A simple intravenous catheterization, which is one of the many essential core skill, is presented here as an example to generate the interest of fellow colleagues.
{"title":"An easy low-cost model for teaching and training of intravenous cannulation: A technical tip","authors":"G. Dharmshaktu","doi":"10.4103/jssrp.jssrp_4_22","DOIUrl":"https://doi.org/10.4103/jssrp.jssrp_4_22","url":null,"abstract":"The skill stations are becoming the essential part of undergraduate medical training but availability and uniformity in their structure and functioning are still not universal across institutions. In the absence of cutting edge technology or paraphernalia in newer medical colleges, innovative and creative use of easily available materials to make models for teaching, training, and assessment purpose is highly desirable and attempts should be made by teachers and students both to hone their skills in this regard. A simple intravenous catheterization, which is one of the many essential core skill, is presented here as an example to generate the interest of fellow colleagues.","PeriodicalId":355285,"journal":{"name":"Journal of Surgical Specialties and Rural Practice","volume":"110 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114995332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.4103/jssrp.jssrp_23_21
Manju K Rajora, M. Choudhary, Savita Gahlain
Background: Acute kidney injury (AKI) is growing as a serious manifestation of multiple etiologies globally. As majority of the admitted patients are in direct contact with nurses, nurses have a pivotal role in the early detection and management of AKI. Nurses must possess knowledge and information about AKI for its early detection and management. Aim: This study aimed to assess knowledge of nurses regarding AKI. Materials and Methods: This cross-sectional descriptive survey was carried out in the emergency department and outpatient departments of selected hospital, New Delhi, over a period of 5 months. Eligibility criteria for inclusion included nurses working in the emergency department and outpatient departments, who can understand or read either English or Hindi language; and were willing to participate in the study. Two hundred and forty-five nurses were recruited as study samples using total enumerative sampling technique. Results: The results of the study revealed that majority 77.1% of the subjects had good knowledge regarding AKI and only 22.9% of participants had poor knowledge regarding AKI. Majority (i.e., 69.4%, 64.1%, 77.1%, and 84.1%) of nurses were familiar with causes of prerenal failure, the various modalities of treatment of AKI, cases that require dialysis, and complications of AKI, respectively. However, only 20.4% of subjects were aware of RIFLE criteria for AKI. Conclusion: The study identified that most of the nurses carry good knowledge regarding AKI, however, still knowledge is lacking in few important aspects pertaining to assessment and management of AKI, which needs to be considered by nursing administrators while planning in-service and continuing education for nurses.
{"title":"A cross-sectional survey to assess the knowledge of nurses regarding acute kidney injury in a tertiary care hospital in Delhi","authors":"Manju K Rajora, M. Choudhary, Savita Gahlain","doi":"10.4103/jssrp.jssrp_23_21","DOIUrl":"https://doi.org/10.4103/jssrp.jssrp_23_21","url":null,"abstract":"Background: Acute kidney injury (AKI) is growing as a serious manifestation of multiple etiologies globally. As majority of the admitted patients are in direct contact with nurses, nurses have a pivotal role in the early detection and management of AKI. Nurses must possess knowledge and information about AKI for its early detection and management. Aim: This study aimed to assess knowledge of nurses regarding AKI. Materials and Methods: This cross-sectional descriptive survey was carried out in the emergency department and outpatient departments of selected hospital, New Delhi, over a period of 5 months. Eligibility criteria for inclusion included nurses working in the emergency department and outpatient departments, who can understand or read either English or Hindi language; and were willing to participate in the study. Two hundred and forty-five nurses were recruited as study samples using total enumerative sampling technique. Results: The results of the study revealed that majority 77.1% of the subjects had good knowledge regarding AKI and only 22.9% of participants had poor knowledge regarding AKI. Majority (i.e., 69.4%, 64.1%, 77.1%, and 84.1%) of nurses were familiar with causes of prerenal failure, the various modalities of treatment of AKI, cases that require dialysis, and complications of AKI, respectively. However, only 20.4% of subjects were aware of RIFLE criteria for AKI. Conclusion: The study identified that most of the nurses carry good knowledge regarding AKI, however, still knowledge is lacking in few important aspects pertaining to assessment and management of AKI, which needs to be considered by nursing administrators while planning in-service and continuing education for nurses.","PeriodicalId":355285,"journal":{"name":"Journal of Surgical Specialties and Rural Practice","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133139368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.4103/jssrp.jssrp_1_22
Taha Mollah, Shanthapriya Tellambura
Cholecystostomy tubes are an established treatment option for patients with acute cholecystitis who are considered high risk for cholecystectomy. This is typically done as an interventional radiology procedure through a pigtail catheter inserted percutaneously. A 63-year-old diabetic male presented to our remote Emergency Department in rural North-Western Victoria (Modified Monash Model 4), with severe, stabbing epigastric pain. Despite normal bloods and imaging, the patient became progressively unwell necessitating a diagnostic laparoscopy and open conversion, which revealed acute acalculous gangrenous cholecystitis. A cholecystectomy was attempted and subsequently abandoned as safe dissection within Calot's triangle, without damaging biliary structures, was not possible. Based on the limited available resources at our rural center, a urinary (Foley) catheter was placed in the gallbladder and Hartmann's pouch sutured around it to act as a temporizng cholecystostomy tube while awaiting transfer to a tertiary center. The Foley catheter was removed after 6 weeks with no further intervention required with the patient making a full recovery. Compared to patients in urban areas, rural residents are more likely to experience health-care disadvantages, including increased likelihood to undergo procedures by specialists operating outside of their scope of practice and higher rates of emergency-related intensive care unit admissions. Despite this, and regardless of acuity, specialist availability, or resource distribution, patients will continue to present to rural services with serious medical issues. In such situations and in resource-poor settings, creative solutions are required to temporize ill patients, as we have reported, and represent an important facet of care in a rural setting.
{"title":"Creative resource utilization in rural settings: The urinary catheter as a cholecystostomy tube","authors":"Taha Mollah, Shanthapriya Tellambura","doi":"10.4103/jssrp.jssrp_1_22","DOIUrl":"https://doi.org/10.4103/jssrp.jssrp_1_22","url":null,"abstract":"Cholecystostomy tubes are an established treatment option for patients with acute cholecystitis who are considered high risk for cholecystectomy. This is typically done as an interventional radiology procedure through a pigtail catheter inserted percutaneously. A 63-year-old diabetic male presented to our remote Emergency Department in rural North-Western Victoria (Modified Monash Model 4), with severe, stabbing epigastric pain. Despite normal bloods and imaging, the patient became progressively unwell necessitating a diagnostic laparoscopy and open conversion, which revealed acute acalculous gangrenous cholecystitis. A cholecystectomy was attempted and subsequently abandoned as safe dissection within Calot's triangle, without damaging biliary structures, was not possible. Based on the limited available resources at our rural center, a urinary (Foley) catheter was placed in the gallbladder and Hartmann's pouch sutured around it to act as a temporizng cholecystostomy tube while awaiting transfer to a tertiary center. The Foley catheter was removed after 6 weeks with no further intervention required with the patient making a full recovery. Compared to patients in urban areas, rural residents are more likely to experience health-care disadvantages, including increased likelihood to undergo procedures by specialists operating outside of their scope of practice and higher rates of emergency-related intensive care unit admissions. Despite this, and regardless of acuity, specialist availability, or resource distribution, patients will continue to present to rural services with serious medical issues. In such situations and in resource-poor settings, creative solutions are required to temporize ill patients, as we have reported, and represent an important facet of care in a rural setting.","PeriodicalId":355285,"journal":{"name":"Journal of Surgical Specialties and Rural Practice","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127874756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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