Medico Research Chronicles

Comparative Study Between Subcuticular Suture and Skin Staples for Skin Closure in Elective Surgery in A Tertiary Care Hospital in Bangladesh

Wasih Wasih Uddin — 2023-07-18

Background: With the development of accelerated rehabilitation and the pressure placed on surgeons to reduce length of hospital stay, the method of skin closure has become increasingly important. The ideal surgical wound would be as strong as normal tissue; the moment it is closed. It is widely accepted that both sutures and staples can achieve the basic goals of wound closure. Both methods endeavor to re-approximate the skin by creating a watertight, tension-free, non-inverted opposition of the edges that promotes rapid healing and a cosmetically acceptable scar.

Objective: The aim of the study was to see the comparison between subcuticular suture and skin staples for skin closure in elective surgery.

Methods: This prospective type of comparative study was carried out at the department of Surgery, Mugda Medical College and Hospital, Bangladesh, from July 2019 to June 2020. A total of 380 patients were included in this study, divided in two groups based on the technique of wound closure: (i) subcuticular suture and (ii) skin staples group. Data was collected by face-to-face interview using a prepared structured questionnaires & checklist and analyzed on SPSS 22.

Results: Operation time in group I was less than operation time for the same aged group II at 73.55<80.26, which makes suture more efficient. Even the standard deviation error is more prominent in the staple group at 15.53 minutes compared to the suture group at13.65 minutes. The P value is significant at 5% significant level for the Suture group in case of operation time. Comparisons of independent post-operative parameters between two groups of study population. It was observed that majority patients in the poor alignment variable belonged to ‘No’ parameter. The poor alignment of scar variable is significant at 1% significant level. The suture group had lower people belonging in the poor alignment of scar than that of the staple group at 20%<41.58. It can be observed that group II has almost double the samples that have poor alignment of scar than that of the group I. Other post-operative observations, such as the presence of hypertrophic scar and keloid are not significant.

Conclusion: The study suggests that subcuticular suture is comparatively better than skin staples according to BNS score and prospective observation.

To Identify the Clinical Parameters Suggestive of Stroke in Patients Presenting to Emergency Department with Vertigo

Thulasi Kumar — 2023-07-06

Background and Purpose: Investigating every vertigo patient for central or peripheral MRI and other treatments is expensive and taxing for the system. Thus, emergency physicians must identify stroke patients and give immediate treatment to minimize disastrous results.

Methods: 500-bed BGS Global hospital prospective cohort research. Consecutive vertigo patients endure history, head impulse, nystagmus, skew deviation, and neurological symptoms such leg or truncal ataxia. Scheduled brain MRIs. MRI found strokes. Clinical assessment and normal MRI found peripheral lesions.

Results: Of the 102 acute vertigo patients, 70 were peripheral and 32 central (29 posterior circulation stroke, 2 anterior circulation, and 1 central venous thrombosis). Vertigo patients averaged 49.64706 ± 14.3931 (SD). 36 women, 66 males (64.3%). ED presentation averages 12.54902 ± 10.76355 (SD) hours. Central and peripheral causes were explored. Vomiting, hearing problems, headaches, and tinnitus did not discriminate central from peripheral causes (p <0.01). Diplopia, Dysphagia, Dysarthria, Head impulse test, Nystagmus examination, Skew deviation test, and neurological indicators such limb or truncal ataxia separate central from peripheral causes (p <0.01). Diplopia, Dysarthria, Dysphagia, Nystagmus, Skew deviation, and ataxia have poor sensitivity and high specificity. High-sensitivity, low-specificity head impulse test. This study shows that individual characteristics cannot distinguish central from peripheral vertigo. The study showed good sensitivity 92.31% (0.63 to 0.99) and specificity 100% (0.87 to 1). This test distinguishes central from peripheral vertigo.

Conclusions: Absence of Diplopia, Dysphagia, Dysarthria, abnormal head impulse test, No direction-changing Nystagmus, and absence of Skew deviation in the first clinical visit with vertigo can reliably exclude central cause and discharged home from ED safely without further investigations and imaging.

Efficacy and Safety of Intrathecal Morphine For Post Cesarean Analgesia Under Spinal Anesthesia

Md. Kabir Uddin Shikder — 2023-07-26

Background: Cesarean section is the most common operation in obstetrics. It is also a well-known fact that mother has to bear severe post-operative pain because of unavailability of better analgesic and modern techniques of pain control at all the centre and that too free of cost, in the current era of cost containment. Objective: To evaluate the efficacy and safety of intrathecal morphine for post cesarean analgesia under spinal anesthesia. Methods: This prospective, randomized, case-control study was conducted in Department of Anaesthesiology, Gonoshasthaya Samaj Vittik Medical College, Savar, Dhaka, Bangladesh from January to June 2022. A total of 150 parturients posted for Cesarean section under spinal anesthesia were divided into two groups of 75 each in this prospective randomized case-control study. Morphine group received 0.15 mg of intrathecal morphine mixed in 12 mg of 0.5% bupivacaine heavy while control group received 12 mg of 0.5% bupivacaine heavy alone, after proper preparation of spinal anesthesia. The parturients were assessed for first request of analgesic as per Visual Analog Scale, frequency of analgesics required within 24hr, nausea, vomiting, pruritus, sedation and respiratory depression. Results: Postoperative analgesia was significantly greater in morphine group as compare to control group (12.1±7.6 vs 3.7±2.9hr). Frequency of analgesics requirements was also significantly lower in morphine group (1.7±2.0 vs 3.4±8.1). Visual Analog Scale was below 4 at most of time in morphine group. The incidence of nausea, vomiting and pruritus were more in morphine group as compare to control group but without any respiratory depression. There was no significant difference in APGAR score among fetus. Conclusion: Mixing low dose of intrathecal morphine in standard dose of spinal anesthesia effectively prolongs the duration of post cesarean analgesia and decreases the frequency of analgesics requirement without any major complication in parturients or fetus.

Classifications and Theories of Orbital Fractures: A Review of Literature

Neha Chodankar — 2023-09-06

Orbital fractures occur in isolation or may even be associated with other maxillofacial injuries. The classifications of these fractures are dispersed in literature and an encompassing review of classifications is unavailable. The authors thus attempt to comprehensively review the classifications of orbital fractures while also reviewing the historical background and etiologic theories of the same.