Pinaki Ranjan Debnath

Abstract

Aim: To compare single dose preoperative antibiotic versus five days antibiotic course in preventing surgical site infection for the pediatric inguinal herniotomy. Materials and Methods: The present study was conducted on 100 patients of elective inguinal herniotomy from January 2019 to April 2020 and compared on the basis of single dose preoperative antibiotic versus five days antibiotic course. All the patients were evaluated on the 3rd, 7th and 28th post-operative period and instructions were given to the guardians about wound care and to attend for early follow up if any signs & symptoms of wound infection appear. Results: 50% of the patients were treated with prophylactic single dose antibiotic, i.e. inj. Ceftriaxone (30 mg/kg/dose) at the time of induction only and rest 50% were treated with inj. Ceftriaxone(30mg/kg/dose) at the time of induction as well as postoperatively at night followed by four days of oral antibiotic with Syr/Tablet. Cephalexin (25mg/kg/day) three times daily for another 4 days. Surgical Site Infection (SSI) in Group-B (4.0%) was higher than that of Group-A (2.0%) on day 3 but it was not significant (p=0.40). There was no significant difference in health status of the patients of the two groups when compared on post-operative day 7 and day 28 (p=0.99, p=0.99 respectively). Conclusion: Implementation of single dose antibiotic prophylaxis regimes tailored to the prevalent organisms in the institution can result in enormous savings, as the study shows significant reduction in hospital stay with no significant increase in incidence of SSI. Keywords: Pediatric, Inguinal hernia, Surgical site infection, Prophylaxis, Antibiotic

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Abstract

Introduction: Umbilical granuloma is one of the distressing problem to the patient’s and parents due it’s red fleshy look and continuous ooze of watery fluids. It is the most common umbilical problem in infant’s. Normally umbilical cord separates 7-10 days after birth and umbilical cicatrix gets epithelised thereafter. It has been found that table salt/common salt has therapeutic effect in curing umbilical granuloma. Materials and Methods: This prospective observational study was done at GSV medical College, Kanpur enrolling 126 infants of age 4th to 20 weeks from Jan 2010 to July 2017. After excluding other umbilical problems, all granuloma patient’s mother were advised to apply common salt on it twice a day for one week. Patients were followed up on 1st and 4th week of starting treatment. Results: In our study out of 126 patients 121 showed excellent result. In this group 78 were male and 43 were female infants. Overall cure rate was 96.3% which is as per international standard by other study group. Discussion: It has been postulated that due to some infection the normal epithelisation of umbilical cicatrix does not happen and overgrowth of granulomatous tissue takes place. This granuloma is devoid of any nerve tissue. Spontaneous regression of this granuloma is unknown, so there are different treatment modalities evolved for this problem. The desicant effect of common salt is the main mechanism of action of its curing property. Conclusion: Treatment of umbilical granuloma with table salt is very effective, easy and safe on out patient basis. Parents can directly involve here with great satisfaction as it is cost effective too. Keywords: Umbilical granuloma, Table salt, Infants, Common salt.

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Purpose: The aim of this study was to assess the functional outcome in patients of Hirschprung’s disease (HD) following two stages Duhamel pull through operation, that is levelling colostomy followed by the pull through. Materials and Methods: The study was conducted in the Department of Pediatric Surgery of a busy tertiary care children’s hospital. Patients who completed the two stage Duhamel pull through operation at least 6 months prior and aged more than three years were included in the study. The quality of life (QOL) was assessed by using a questionnaire to the parents and clinical examination of the child. Continence status was assessed by applying the Krickenbeck Score. Results: Thirty patients were assessed after completion of two stage Duhamel pull through operation. Quality of life (QOL) was good in 27 patients (90%), fair in 2 patients (6.6%) and poor in 1 patient (3.3%). Voluntary Bowel Movement was present in 25 patients (83.3%) and absent in 5 patients (16.6%). Soiling was absent in 27 patients (90%) and present in 3 patients (10%). Among these 3 patients, 2 patients had grade 1 and 1 patient had grade 2 soiling. Constipation was absent in 26 patients (86.6%) and present in 4 patients (13.3%). Among these 4 patients, 1 patient had grade1 and 3 patients had grade 2 constipation. Conclusion: In patients of Hirschprung’s disease, fecal continence and the quality of life was satisfactory after the two stage Duhamel pull through operation. Keywords: Hirschprung disease, Duhamel pull through, Continence, Quality of life.

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