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Khanna SK, Khanna N, Sharma A, Bayad HC, Kishore K, Tewari VV. Ten Years Analysis of Parental Counselling-in-Continuum in Paediatric Surgery: Psychosocial and Medico-legal Outcome. Afr J Paediatr Surg 2024; 21:90-96. [PMID: 38546245 PMCID: PMC11003569 DOI: 10.4103/ajps.ajps_110_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Parents are anxious and apprehensive about the health of their children. A standardised, reproducible and meticulous parental counselling is helpful to both the parents and the treating doctors, as well as markedly reduces instances of scrimmage and medico-legal litigations. The aim of this study is to assess the psychosocial and medico-legal outcomes of parental counselling-in-continuum (PCiC) in paediatric surgery. MATERIALS AND METHODS The study was conducted at two government-run Tertiary Healthcare Centres in North India. The study design involves prospective feedback-based study. It included all the admitted paediatric surgery patients. Periodic multisession PCiC was done for each patient by three paediatric surgery teams from 2011 to 2021. At the time of discharge, feedback was taken to assess the psychosocial outcome of PCiC, and the medico-legal outcome was calculated based on the number of litigations. RESULTS A total of 22,353 admissions were done in paediatric wards at these institutes. 1574 cases were managed conservatively and 20,779 patients who underwent surgeries were included in the study. 4758 (22.89%) were emergency procedures and 16,021 (77.11%) were elective procedures. Parents rated the counselling efforts excellent in 18,285 (81.80%), good in 3162 (14.14%), satisfactory in 876 (3.91%) and poor in 30 (0.13%) cases with zero medico-legal litigations and 12 incidents of scrimmage. CONCLUSIONS PCiC, being a novel concept, should form a centerpiece of paediatric surgical management as it maximally enhances the patient satisfaction level and protects the treating paediatric surgical team from scrimmage and medico-legal litigations.
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Affiliation(s)
- Sanat Kumar Khanna
- Department of Paediatric Surgery, Command Hospital (Western Command), Chandi Mandir, Haryana, India
| | - Neelu Khanna
- Department of Paediatric Surgery, Command Hospital (Western Command), Chandi Mandir, Haryana, India
| | - Avinash Sharma
- Department of Surgery, Military Hospital, Shimla, Himachal Pradesh, India
| | - Himanshu Chhagan Bayad
- Department of Otorhinolaryngology (ENT), Military Hospital, Shimla, Himachal Pradesh, India
| | - Kamal Kishore
- Department of Paediatric Surgery, Army Hospital Research and Referral, New Delhi, India
| | - Vishal Vishnu Tewari
- Department of Paediatrics, Command Hospital (Western Command), Chandi Mandir, Haryana, India
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Rajanna LB, Datta R, Raina S, Bayad HC, Madakshira MG, Upadhyay K, Tripathi S, Srivastava A, Chahar OS, Singh O. Our Experience with Sinonasal Glomangiopericytoma in North India: A Case Series. Indian J Otolaryngol Head Neck Surg 2024; 76:88-93. [PMID: 38440622 PMCID: PMC10908769 DOI: 10.1007/s12070-023-04088-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/13/2023] [Indexed: 03/06/2024] Open
Abstract
Glomangiopericytoma (GPC) is a rare benign sinonasal tumor originating from Zimmerman's Pericytes surrounding capillaries and accounting for less than 0.05% of all sinonasal tumors. Glomangiopericytoma has low malignant potential (5-10%) and is mostly diagnosed in the 6th or 7th decade of age with slight female preponderance. We presented here a case series of 5 patients with sinonasal GPC. This research was conducted at a tertiary healthcare centre in North India. In our case series, all the patients were evaluated and underwent endoscopic surgical resection. All patients underwent digital subtraction angiography (DSA) and preoperative embolization. The coblation technique used for haemostasis proved very effective and time-saving. All patients exhibited cytoplasmic SMA positivity (a marker of GPC) and CD34 negativity, while one patient exhibited a high Ki-67 index (> 10%), which is a predictor of aggressive tumor behavior. None of the patients showed any recurrence in follow-up. We recommend performing complete endoscopic surgical excision to prevent recurrence. The use of DSA, preoperative embolization, and intraoperative use of the coblation technique provides a cleaner surgical field and reduced operating time.
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Affiliation(s)
- Lohith Banavara Rajanna
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Rakesh Datta
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Sheetal Raina
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Himanshu Chhagan Bayad
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Manoj Gopal Madakshira
- Department of Pathology, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Kiran Upadhyay
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Shailendra Tripathi
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Anchita Srivastava
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Omvir Singh Chahar
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Ombir Singh
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
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Rajanna L, Raina S, Bayad HC, Tripathi S, Chahar OS, Singh O. A Rare Case of Retropharyngeal Abscess in a 3 Month Old Male Infant: Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:4066-4070. [PMID: 37974837 PMCID: PMC10646015 DOI: 10.1007/s12070-023-04043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/26/2023] [Indexed: 11/19/2023] Open
Abstract
Retropharyngeal abscess (RPA) is a rare, potentially fatal condition found more frequently in young children usually who were having a history of Upper respiratory infection. RPA is an acute suppurative infection of the retropharyngeal space. In view of scarce literature availability and atypical presentation in infants, it poses a definitive diagnostic dilemma to the clinicians. Here, we are reporting a three-month-old male infant presented with feeding difficulty, obstructive sleep apnea and intermittent inspiratory stridor. Child was managed in a pediatric ICU with a multidisciplinary approach which involved pediatrician, otorhinolaryngologist pediatric anesthesiologist, microbiologist, and radiologist. With the recent advances, early radio imaging have a vital role in diagnosing the condition and also helps in planning of surgery. Prompt diagnosis and surgical management with appropriate antimicrobial therapy for this condition is imperative to prevent complications such as airway obstruction and mediastinitis. Timely surgical intervention, preferably intraoral transpharyngeal approach, to drain the abscess is recommended.
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Affiliation(s)
- Lohith Rajanna
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Sheetal Raina
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Himanshu Chhagan Bayad
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Shailendra Tripathi
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Omvir Singh Chahar
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Ombir Singh
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
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Rajanna LB, Raina S, Bhatia R, Tripathi S, Bayad HC, Ranjan R, Srivastava A, Chahar OS. Gestational Mild COVID-19 Infection Associated Neonatal Hearing Loss: A Case-Control Study from North India. Indian J Otolaryngol Head Neck Surg 2023:1-6. [PMID: 37362118 PMCID: PMC10109224 DOI: 10.1007/s12070-023-03786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/05/2023] [Indexed: 06/28/2023] Open
Abstract
COVID-19 infection during pregnancy is potentially dangerous to neonatal hearing, as it is the period of organogenesis, and associated hyperthermia may cause vascular damage, disruption of cell migration, and death of the dividing neuroblasts. To investigate the possible association between neonatal hearing loss and gestational mild COVID-19 infection. A prospective case-control study was conducted at a tertiary healthcare centre in North India from March 2020 to Oct 2022. Cases included the neonates born to COVID-19-positive mothers were subjected to hearing screening at 1, 3 and 6 months using otoacoustic emission (OAE) and automated auditory brainstem response (AABR). Similar protocol was applied to controls, i.e., neonates borne to mothers with no gestational history of COVID infection. Results were analyzed statistically. Our study reported that the statistical difference between groups A (n = 942) and B (n = 942) for gestational COVID-19 infection and neonatal hearing loss was insignificant at 1 month (p-value 0.272 for OAE and p-value 0.634 for AABR) and also insignificant at 3 and 6 months (p-value 0.679 for AABR, for both). The association between gestational mild COVID-19 infection during gestation and neonatal hearing loss is statistically insignificant at initial screening as well as sequential screenings.
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Affiliation(s)
- Lohith Banavara Rajanna
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Sheetal Raina
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Ritika Bhatia
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Shailendra Tripathi
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Himanshu Chhagan Bayad
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Ranjeet Ranjan
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Anchita Srivastava
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Omvir Singh Chahar
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
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Khanna SK, Khanna N, Malav MK, Bayad HC, Sood A, Abraham L. Profiling Cognitive Impairment in Mild COVID-19 Patients: A Case-Control Study at a Secondary Healthcare Centre in the Hilly Region of North India. Ann Indian Acad Neurol 2022; 25:1099-1103. [PMID: 36911430 PMCID: PMC9996485 DOI: 10.4103/aian.aian_543_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/21/2022] [Accepted: 07/24/2022] [Indexed: 11/21/2022] Open
Abstract
Context COVID-19 pandemic continues to be a serious threat to humanity even after the last 2.5 years and multiple reported waves. Post-COVID-19 cognitive impairment has a detrimental effect on the quality of life, education, occupation, psychosocial as well as adaptive functioning and independence. Aims and Objective Profiling the cognitive impairment in the mild COVID-19 recovered patients. Settings and Design Interview-based case-control study. Materials and Methods This study was conducted at a secondary healthcare center in a hilly region of north India. Group A included mild COVID-19 recovered patients and Group B included local non-COVID healthy individuals. Both groups of participants were interviewed using Montreal Cognitive Assessment (MoCA) to identify global and domain-wise cognitive impairment. Statistics Used Descriptive statistics were used to analyze the demographic and clinical variables. The Chi-square test was used to evaluate these results and statistical analysis was done using the Statistical Package for Social Sciences (version 23) program. Results A total of 284 individuals were enrolled in our study, equally split into Groups A (cases) and B (controls). No global cognitive decline was found in any participant. However, 40 cases scored low on MoCA. The decrease in domain-wise cognitive function was statistically significant for visuospatial skill/executive function and attention. Conclusion Our results have demonstrated that there is domain-wise cognitive impairment associated with mild COVID-19 disease. We recommend lowering the threshold of the MoCA to identify the early cognitive impairment and the inclusion of detailed cognitive assessment in post-COVID-19 follow-ups to initiate early cognitive rehabilitation among these patients.
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Affiliation(s)
- Sanat Kumar Khanna
- Department of Surgery, Military Hospital Shimla, Shimla, Himachal Pradesh, India
| | - Neelu Khanna
- Department of Medicine, Shimla, Himachal Pradesh, India
| | - Manoj Kumar Malav
- Department of Neurology, SN Medical College, Agra, Uttar Pradesh, India
| | - Himanshu Chhagan Bayad
- Department of Otorhinolaryngology (ENT), Military Hospital Shimla, Shimla, Himachal Pradesh, India
| | - Akshay Sood
- Department of Emergency Medicine, Military Hospital Shimla, Shimla, Himachal Pradesh, India
| | - Leena Abraham
- Department of Medicine, Military Hospital Shimla, Shimla, Himachal Pradesh, India
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Khanna SK, Maheshwari S, Bayad HC, Adersh MK, Rajput NS. The Role of Otorhinolaryngological Manifestations of Mild Covid-19 Disease in Hilly Terrain: Lessons Learnt at a Secondary Care Hospital. Indian J Otolaryngol Head Neck Surg 2022; 74:3337-3343. [PMID: 36267490 PMCID: PMC9568902 DOI: 10.1007/s12070-022-03174-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/18/2022] [Indexed: 01/08/2023] Open
Abstract
We conducted the study to find the prevalence of ENT symptoms amongst mild Covid-19 patients from the hilly region of North India and attempted to propose a solution to curb the spread of Covid-19 through early identification, isolation, and treatment. A retrospective, cross-sectional study at a secondary healthcare center in a hilly region of North India covered 423 mildly symptomatic Covid-19 patients from April 2020 to March 2022. These patients were telephonically contacted or called in person at the outpatient department to answer a preset questionnaire with various parameters such as age, gender, ENT symptoms, and time to recover. The data obtained were statistically analyzed. 207 out of 423 mild Covid-19 patients complained of different ENT symptoms. Cough was the most common ENT symptom and was reported by 162 patients. Dizziness was the least common ENT symptom and was reported by 9 patients. Recovery time for tinnitus was maximum (persistent till six months in 5 patients). A high index of suspicion for Covid-19 disease in patients with ENT symptoms must be practiced. As the Covid-19 restrictions are gradually relaxed, widespread community education for strict adherence to Covid-19 appropriate behaviour and sensitization of General Practitioners a well as Otorhinolaryngologists regarding the importance of ENT symptoms in mild Covid19 disease will play a pivotal role in the early identification, isolation, and treatment of mild Covid-19 disease, which eventually may curb the future waves.
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Affiliation(s)
| | | | | | - M. K. Adersh
- Military Hospital, Shimla, Himachal Pradesh 171006 India
| | - Nakul Singh Rajput
- Army Medical Corps Centre and College, Lucknow, Uttar Pradesh 226001 India
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Khanna SK, Maheshwari S, Goud Vaggu SV, Bayad HC, Samyal S. The Saga of Non-COVID Patients in COVID Times: Our Experience in a Secondary Care Hospital in Hilly Terrain, Northern India. Hosp Pract Res 2022. [DOI: 10.34172/hpr.2022.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in the diversion of all the resources, attention, and energy of the medical personnel and administration towards the management of COVID-19 patients. This resulted in unforeseen difficulties and hazards for non-COVID-19 patients in accessing healthcare professionals and facilities. Objectives: The objective of this study was to analyze the impact of the COVID-19 pandemic and repeated lockdowns on the non-COVID patients; to understand the social, psychological, and medical issues faced by them; and propose solutions for difficulties faced by this specific cohort of patients. Methods: We conducted a retrospective observational study on all non-COVID patients reporting for non-COVID-19 illnesses. We conducted the data analysis by comparing the trends for 15 months each in the pre-pandemic (1 January 2019 to 31 March 2020) and pandemic periods (1 April 2020 to 30 June 2021). Results: There was a 65.92% decrease in Out Patient Department (OPD) attendance, a 56.05% decrease in admissions, and a 90.33 % decrease in elective surgical procedures in non-COVID-19 patients. However, there was a significant increase in emergency surgeries by 62.16%. Conclusion: There has been a significant albeit much-needed diversion of time, energy, and resources to manage COVID-19 patients in recent times. This has led to a paucity of care opportunities for non-COVID-19 patients, which has been further compounded by the frequent lockdowns. We attempted to understand the impact of the pandemic on non-COVID-19 patients, particularly in peripheral hospitals in Hilly Terrains. We propose the solutions to tackle these issues and describe our experience with them.
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Affiliation(s)
| | | | | | | | - Shruti Samyal
- Military Hospital Shimla, Shimla, Himachal Pradesh, India
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