Cecal volvulus following appendectomy in a teenage patient: A case report

Patients mimicking appendicitis symptoms in a rural setting or those post-appendectomy, indicating cecal volvulus, should always be considered. Swift action can prevent catastrophic consequences.

Abstract

We present a case of a 14-year-old female who initially underwent open appendectomy for acute appendicitis and subsequently experienced symptoms of abdominal distention, vomiting, and fever. Her condition deteriorated following the appendectomy, despite a prior appendectomy for similar symptoms at a different facility. A computed tomography (CT) scan identified cecal volvulus as the underlying issue. This led to the performance of a laparotomy, cecopexy, and decompressive ileostomy. After six weeks, ileostomy closure was successfully carried out, and the patient currently enjoys good health. This case highlights the significance of considering uncommon factors as potential contributors to postoperative complications in young patients.

Knowledge, Attitude and Practice Regarding COVID-19 and its Impact on Dentistry: A Cross-sectional Survey among Nepalese Dentists

Background Coronavirus Disease, 2019 (COVID-19) is a highly infectious respiratory disease with high transmissibility. Dentists are at inherent risk because of aerosol generating procedures exposing dentists to the respiratory and oral secretions of the patients. Objective To assess the knowledge, awareness, and practice (KAP) of the Dentists to combat the pandemic which could help shape future guidelines and policies to be implemented in dental settings. Method This cross-sectional descriptive study included series of multiple-choice questions distributed online, assessing dentists' KAP towards COVID-19, its impact on dentistry and their psychological well-being. Statistical analysis was performed using SPSS (Statistical Package for Social Sciences) version 20 for mac Operating System (OS). Descriptive statistics was performed, and frequencies of responses were reported in proportion. Non-parametric tests of independence and Chi-square test were performed to see the association between the categorical variables. Result Around 84% of the respondents accurately answered mode of transmission, 68% inquired about the travel history while only 49% measured the body temperature. Also, only 42% were receiving salary. A statistically significant difference concerning impact and practice during the COVID-19 was observed between general practitioner and specialist working at different work places. Conclusion Majority of Dentists have good knowledge and awareness but there were certain pitfalls in attitude and practice level calling out for more efficient training programs, precise guidelines, and treatment protocols to put into practice. Also, the mental distress and the financial impact subjected upon dentist require to be further explored determining the association between their mental health during and post COVID-19 outbreak.

Knowledge and practice among the caretakers of bedridden patients on prevention of urinary tract infection

INTRODUCTION: Urinary tract infection (UTI) is one of the major complications of immobility or bedridden condition. Between 46-59% of spinal cord injury patients develop urinary tract infection during the first year of trauma. UTI is a second most common type of infection, accounting for nearly 25% of all infections and a serious health problem affecting millions of people each year. The findings of the study might be helpful to the long term care health institution for the development the strategies to involve the caretakers to prevent urinary tract infection in bedridden patients. OBJECTIVE: The purpose of the study was to find out the level of knowledge and current practice of caretakers of bedridden patients on prevention of urinary tract infection. METHODS: The descriptive and cross-sectional study design was adopted in this study. A self-prepared structured interview questionnaire and observation checklist was used to collect data from 30 caretakers of hospitalized bedridden patients of Nepal Orthopedic Hospital and Spinal Injury Rehabilitation Center Jorpati implying purposive & convenient sampling technique. RESULTS: Out of30 caretakers, no one had adequate (>80%) knowledge and 46.6% had moderate (50-80%) knowledge and 53.3% had low (<50%) knowledge on meaning, high risk group, contributing factors, signs & symptoms, consequences and preventive measures of UTI as a whole. Caretaker's preventive practices of UTI for their bedridden patients were not satisfactory except encourage the patient for drinking 2-3 liters water per day. CONCLUSION: Majorities (53.3%) of the caretakers of bedridden patients had low level knowledge on preventive measures of UTI. Similarly UTI preventive practices of caretakers were also not satisfactory. Therefore, awareness raising programme on preventive measures of UTI need to be organized specially for caretakers.DOI: http://dx.doi.org/10.3126/jucms.v2i1.10488 Journal of Universal College of Medical Sciences (2014) Vol.2(1): 24-29

Comparison of outcomes by modality for critically ill patients requiring renal replacement therapy: a single-centre cohort study adjusting for time-varying illness severity and modality exposure

Prolonged intermittent renal replacement therapy (PIRRT) is a recently defined acute modality for critically ill patients, and in theory combines the superior detoxification and haemodynamic stability of continuous renal replacement therapy (CRRT) with the operational convenience and low cost of intermittent haemodialysis (iHD). We performed a retrospective cohort study for all critically ill adults treated with renal replacement therapy at our centre in Auckland, New Zealand from 1 January 2002 to 31 December 2008. The exposure of interest was modality (PIRRT, CRRT, iHD). Primary and secondary outcomes were patient mortality determined at hospital discharge and 90 days post renal replacement therapy inception, respectively. Co-variates included co-morbidity and baseline illness severity measured by Acute Physiology and Chronic Health Evaluation IV and Sepsis-Related Organ Failure Assessment (SOFA) and time-varying illness severity measured by daily SOFA scores. We used Marginal Structural Modelling to estimate mortality risk adjusting for both time-varying illness severity and modality exposure. A total of 146 patients with 633 treatment-days had sufficient data for modelling. With PIRRT as the reference, the adjusted hazard ratios for patient hospital mortality were 1.31 (0.60 to 2.90) for CRRT and 1.22 (0.21 to 2.29) for iHD. Corresponding estimates for mortality at 90 days were 0.96 (0.39 to 2.36) and 2.22 (0.49 to 10.11), respectively, reflecting the poorer longer-term prognosis of patients still on iHD at hospital discharge with delayed or non-recovery of acute kidney injury. Our study supports the recent increased use of PIRRT, which within limits can be regarded as safe and effective.