1.A case of acute epididymo-orchitis due to Pseudomonas aeruginosa presenting as ARDS in an immunocompetent host.
Sameer SINGHAL ; D D WAGH ; Shivali KASHIKAR ; Yeshwant LONKAR
Asian Pacific Journal of Tropical Biomedicine 2011;1(1):83-84
Acute eididymo-orchitis is the most common cause of intrascrotal inflammation, and retrograde ascent of pathogens is the usual route of infection. Here we intend to present a case of young boy, not sexually active, suffering from acute epididymo-orchitis due to Pseudomonas aeruginosa presented with acute respiratory distress syndrome. Proper timely diagnosis of the primary cause and prompt treatment including support with non invasive ventilation lead to a favourable outcome in the same case.
Adolescent
;
Dyspnea
;
Epididymitis
;
Humans
;
Male
;
Orchitis
;
Pseudomonas Infections
;
Pseudomonas aeruginosa
;
Respiratory Distress Syndrome, Adult
2.National perioperative outcomes of flap coverage for pressure ulcers from 2005 to 2015 using American College of Surgeons National Surgical Quality Improvement Program.
Bao Ngoc N TRAN ; Austin D CHEN ; Parisa KAMALI ; Dhruv SINGHAL ; Bernard T LEE ; Eugene Y FUKUDOME
Archives of Plastic Surgery 2018;45(5):418-424
BACKGROUND: Complication rates after flap coverage for pressure ulcers have been high historically. These patients have multiple risk factors associated with poor wound healing and complications including marginal nutritional status, prolonged immobilization, and a high comorbidities index. This study utilizes the National Surgical Quality Improvement Program (NSQIP) to examine perioperative outcomes of flap coverage for pressure ulcers. METHODS: Data from the NSQIP database (2005–2015) for patient undergoing flap coverage for pressure ulcers was identified. Demographic, perioperative information, and complications were reviewed. One-way analysis of variance and Pearson chi-square were used to assess differences for continuous variables and nominal variables, respectively. Multivariate logistic regression was performed to identify independent risk factors for complications. RESULTS: There were 755 cases identified: 365 (48.3%) sacral ulcers, 321 (42.5%) ischial ulcers, and 69 (9.1%) trochanteric ulcers. Most patients were older male, with some degree of dependency, neurosensory impairment, high functional comorbidities score, and American Society of Anesthesiologists class 3 or above. The sacral ulcer group had the highest incidence of septic shock and bleeding, while the trochanteric ulcer group had the highest incidence of superficial surgical site infection. There was an overall complication rate of 25% at 30-day follow-up. There was no statistical difference in overall complication among groups. Total operating time, diabetes, and non-elective case were independent risk factors for overall complications. CONCLUSIONS: Despite patients with poor baseline functional status, flap coverage for pressure ulcer patients is safe with acceptable postoperative complications. This type of treatment should be considered for properly selected patients.
Comorbidity
;
Femur
;
Follow-Up Studies
;
Hemorrhage
;
Humans
;
Immobilization
;
Incidence
;
Logistic Models
;
Male
;
Nutritional Status
;
Postoperative Complications
;
Pressure Ulcer*
;
Quality Improvement*
;
Reconstructive Surgical Procedures
;
Risk Factors
;
Shock, Septic
;
Surgeons*
;
Surgical Wound Infection
;
Ulcer
;
Wound Healing
;
Wounds and Injuries
3.Surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the American College of Surgeons-National Surgical Quality Improvement Program database
Bao Ngoc N TRAN ; Austin D CHEN ; Melisa D GRANOFF ; Anna Rose JOHNSON ; Parisa KAMALI ; Dhruv SINGHAL ; Bernard T LEE ; Eugene Y FUKUDOME
Archives of Plastic Surgery 2019;46(4):336-343
BACKGROUND: Sternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database. METHODS: Patients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications. RESULTS: There were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation >48 hours (16.5%), and reoperation/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P<0.001), nonelective procedure (OR, 2.164; P=0.010), congestive heart failure (OR, 2.152; P=0.048), open wound (OR, 1.977; P=0.024), and operating time (OR, 1.005; P<0.001). CONCLUSIONS: Sternal RPF is associated with increased rates of three primary complications: blood loss requiring transfusion, ventilation >48 hours, and reoperation/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF's purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.
Bone Plates
;
Demography
;
Dyspnea
;
Heart Failure
;
Hemorrhage
;
Humans
;
Logistic Models
;
Postoperative Complications
;
Quality Improvement
;
Respiration, Artificial
;
Risk Factors
;
Steel
;
Sternum
;
Surgical Wound Infection
;
Treatment Outcome
;
Ventilation
;
Wound Healing
;
Wounds and Injuries
4.Predicting Quadruple Semitendinosus Graft Size for Anterior Cruciate Ligament Reconstruction by Patient Anthropometric Variables: A Cohort Study of 280 Cases
Singhal D ; Kanodia N ; Singh R ; Singh SK ; Agrawal S
Malaysian Orthopaedic Journal 2021;15(No.3):71-77
Introduction: Pre-operative identification of patients with
inadequate hamstring graft for anterior cruciate ligament
reconstruction is still a subject of interest. The purpose of
this study is to correlate dimension of a harvested
dimensions graft with patient physical anthropometric
variables.
Materials and methods: This cohort study included 280
patients (male = 226, female = 54) scheduled for primary
anterior cruciate ligament (ACL) reconstruction.
Interrelationships between quadruple semitendinosus (ST)
graft and anthropometric parameters (age, sex, height,
weight, and BMI) were assessed using Pearson Correlation
test and regression analysis. Difference among gender was
analysed using Mann Whitney and t test. The observed graft
diameter was also compared with the literature using Bland
– Altman plot.
Results: Mean age of cohort was 29 years (range, 17-50
years), mean height was 1.69m (range, 1.6-1.9m), mean
weight was 75 kg (range, 50-116kg) and mean BMI was
26kg/m2 (range 16.65-40.40kg/m2). Mean quadruple length
of harvested ST graft was 7cm (7.1±0.6 cm, range, 5.6-
8.8cm) and mean diameter was 8mm (8.2±0.8mm, range,
6.5-10mm). Only height and weight were significantly
correlated with graft length and diameter in both sex (p value
<0.05). Female, compared to male, had significantly smaller
(p<0.0001) and thinner graft (p<0.0001). There was a strong
agreement between the literature and our observed graft
diameter, but with an overestimated graft diameter in 18.5%
of the cases.
Conclusion: Among anthropometric parameter, only height
and weight had moderate positive correlation with graft
diameter. Males had longer and wider ST graft in contrast to
age-matched female group.