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   2016| July-December  | Volume 22 | Issue 2  
    Online since August 24, 2016

 
 
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ORIGINAL ARTICLES
New visual prostate symptom score versus international prostate symptom score in men with lower urinary tract symptoms: A prospective comparision in Indian rural population
Ashutosh Roy, Amandeep Singh, Darshan Singh Sidhu, RP Jindal, Mishi Malhotra, Haramritpal Kaur
July-December 2016, 22(2):111-117
DOI:10.4103/1117-6806.189002  PMID:27843276
Introduction: Benign prostrate hyperplasia (BPH) is a leading source of healthcare problem in aging men around the world including India. Both International Prostate Symptom Score (IPSS) and New Visual Prostate Symptom Score (VPSS) are used to assess the lower urinary tracts symptoms (LUTSs) in men. The present study was planned to compare these two scores, IPSS and VPSS in Indian rural men prospectively and their efficacy was compared with urodynamic evaluation of the patients. Materials and Methods: With Institutional Ethical Committee approval, this study was conducted on 100 patients having LUTS and BPH after obtaining written informed consent. Patients' educational status was noted. All the patients were requested to complete the IPSS and VPSS questionnaire, and they were correlated. The urodynamic study was performed on all the patients with uroflowmeter. Two parameters of uroflowmetry, Q max (maximum urine flow rate expressed in ml/s) and Q avrg (average urine flow rate expressed in ml/s) were measured and correlated. Results: Most of the patients (55%) in this study were uneducated. Out of 100 patients, 83% were able to fill the VPSS questionnaire without assistance as compared to only 40% patients in IPSS questionnaire (Z = 6.557, P < 0.001). There was a positive correlation between IPSS and VPSS total score in this study (r = 0.453 and P ≤ 0.001). It was noticed that IPSS Question 2 for frequency of urination had a positive correlation with VPSS Question 1 (day time frequency of urination) r = 0.645 (P = 0.000). Similarly, IPSS Question 7 for night frequency when compared with VPSS Question 2 (nocturia); the value for r was found to be 0.536 (P = 0.000).The IPSS Question 5 for straining when compared to the VPSS Question 3, i.e., the question for the strength of stream during micturition; the positive correlation was found to be 0.266 (P = 0.007). There was a negative correlation between IPSS total score and Q avrg with value − 0.368 (P = 0.000) and between IPSS total score and Q max of − 0.433 (P = 0.000). A negative correlation is also noted between VPSS total score and Q avrg of value 0.497 (P = 0.000) and VPSS total score and Q max of value − 0.719 (P = 0.000). Conclusion: VPSS correlates significantly with the IPSS to quantify the LUTS due to BPH. The VPSS can be used instead of the IPSS for the assessment of symptom severity in men with LUTS, who are illiterate or have limited education.
  6,114 193 2
Reasons for patronage of traditional bone setters
Innocent Egbeji Abang, Joseph Asuquo, NE Ngim, Ikpeme Asanye Ikpeme, P Agweye, SE Urom, C Anisi, E Mpama
July-December 2016, 22(2):102-106
DOI:10.4103/1117-6806.188993  PMID:27843274
Aims and Objectives: The objectives of this study were to analyze the different reasons why patients with fractures patronize traditional bone setters (TBS) and their impression of the outcome of the treatment by the TBS. Materials and Methods: A 24 month prospective observational study was conducted from February 2012 to January 2014. All the patients were recruited from the orthopedics outpatient clinic. The demographic data of each patient, the type of injury, presentation to hospital or not, reasons for leaving the hospital, reasons for patronage of the TBS and their impression of the outcome of TBS' treatment, effect of educational background on patronage of TBS and reason for presenting to hospital for orthodox treatment. Data Analysis: Analysis was done with SPSS software Version 20. Results: A total 79 patients were recruited for the study and they had different reasons for patronizing TBS. These reasons include an external locus of decision making in 19 (24.1%) patients, and greater faith in TBS compared to orthodox medicine in 16 (20.3%). Twelve (15.2%) believed that TBS are more competent than orthodox medical practitioners while another group 11 (13.9%) considered the fees of TBS cheaper than those in the hospital. The delay in treatment in the hospital, forceful removal of patients from hospital against their will and nonsatisfaction with hospital treatment accounted for 5 (6.3%). Poor attitude of hospital staff, fear of amputation, and patients being unconscious during the injury accounted for 2 (2.5%). Their ages ranged from 17 to 83 years, with mean age of 36.8 ± 11.8 years. The male: female ratio was 1.5:1. Conclusions and Recommendations: With recent advancements in the practice of orthopedics and trauma, there is still a very high patronage of the TBS by most of our patients. This is largely due to the dependence of the patients on their sponsors for treatment, while the influence of cultural and religious beliefs continues to play a major role in these decisions.
  4,616 230 2
Bacteriology of urine specimens obtained from men with symptomatic benign prostatic hyperplasia
Jude Orumuah Agbugui, EO Obarisiagbon, II Osaigbovo
July-December 2016, 22(2):65-69
DOI:10.4103/1117-6806.177415  PMID:27843267
Background: Bacteriuria and urinary tract infections are common sequelae of benign prostatic hyperplasia (BPH). Thus, the knowledge of urine bacteriology in men with symptomatic BPH in our environment may play a complementary role in management. Objectives: To determine the incidence of bacteriuria and the antibiotic sensitivity pattern of bacterial isolates in cultured urine samples of men with symptomatic BPH. Patients and Methods: This was a 1 year prospective study. All patients who presented with lower urinary tract symptoms due to BPH and who met the inclusion criteria were studied. Urine samples were obtained from the patients for microscopy, culture, and sensitivity following standard protocol. Results: Ninety-four patients were studied. The age range was 53-80 years with a mean of 65.5 ΁ 7.8 years. Bacterial isolates were noted in 42 (44.7%) patients. Six of these had two different species of bacterial organisms isolated. Escherichia coli noted in 20 (47.6%) specimens was the most common organism isolated while the least common, Providencia species, was noted in 1 (2.4%). The bacterial isolates were mostly sensitive to imipenem, meropenem, and nitrofurantoin, but showed greater resistance to cefuroxime, gentamicin, and ofloxacin. There was no significant difference between the means for age (P = 0.80), duration of symptoms (P = 0.09), and prostate size (P = 0.52) in the patients with and those without bacteriuria. Conclusion: Bacteriuria is a common finding in patients with symptomatic BPH in our setting. The bacterial isolates showed high level of resistance to oral cephalosporins and fluoroquinolones. There is a need to update guidelines in empiric use of antibiotics in this group of patients.
  3,148 161 -
Comparative efficacy of amoxicillin/clavulanic acid and levofloxacin in the reduction of postsurgical sequelae after third molar surgery: a randomized, double-blind, clinical trial in a Nigerian university teaching hospital
Kizito Chioma Ndukwe, Ramat Oyebunmi Braimah, John Foluso Owotade, Stephen Babatunde Aregbesola
July-December 2016, 22(2):70-76
DOI:10.4103/1117-6806.179830  PMID:27843268
Background: The most common sequelae after surgical removal of mandibular third molar are pain, trismus, swelling, and dysphagia. However, these symptoms can also signal the onset of surgical site infection and alveoli osteitis. The aim of this study was to evaluate the efficacy of prophylactic amoxicillin/clavulanic acid and levofloxacin and preemptive therapy of amoxicillin/clavulanic acid in the reduction of postinflammatory complications, surgical site infection, and alveolar osteitis following the third molar surgery. Patients and Methods: A total of 135 patients were randomized into three equal groups: Group A (preemptive therapy of amoxicillin/clavulanic acid) with preoperative dose of 875/125 mg amoxicillin/clavulanic acid followed by 500/125 mg amoxicillin/clavulanic acid 12 hourly for 5 days, Group B (amoxicillin/clavulanic acid prophylaxis) with a single preoperative dose of amoxicillin/clavulanic acid 875/125 mg tablets, and Group C (levofloxacin prophylaxis) with a single preoperative dose of levofloxacin 1000 mg tablets. All patients had ostectomy using surgical handpiece and burs and received same analgesics (tabs ibuprofen 400 mg 8 hourly for 3 days). Results: No case of surgical site infection or alveoli osteitis was recorded in the study groups. There were no statistically significant differences between the treatment groups with regard to pain, mouth opening, postoperative facial dimension, and body temperature. Conclusion: Amoxicillin/clavulanic acid as a single preoperative bolus should be adequate for the prevention of postoperative wound infection and alveoli osteitis following the third molar extraction as there is no need for an extension of the antibiotic. Moreover, levofloxacin can be utilized as prophylaxis in patients undergoing mandibular third molar extraction if such patients are allergic to penicillins.
  3,025 266 -
Assessment of the survival of dental implants in irradiated jaws following treatment of oral cancer: A retrospective study
Meenakshi Chauhan Rana, Swati Solanki, Sudarshan C Pujari, Eisha Shaw, Swati Sharma, Abhishek Anand Anand, Harkanwal Preet Singh
July-December 2016, 22(2):81-85
DOI:10.4103/1117-6806.182741  PMID:27843270
Background: In patients undergoing head and neck surgery for various pathologic conditions, implants are one of the best restorative options and are increasing widely used. Therefore, we evaluated the success of dental implants in the irradiated jaws of patients following treatment of oral cancer oral cancer treated patients. Materials and Methods: Data of oral cancer treated patients was collected retrospectively from 2002 to 2008. We took 46 oral cancer treated patients in which implants were placed in irradiated jaws for rehabilitation. Results: It was found that out of 162 dental implants placed, 52 failed. Furthermore, there was no variation in the implant survival rate in between both the jaws. Radiation dose of <50 Gy units also showed significantly increased amount of implant survival rate. Conclusions: Implant survival is multifactorial and depends upon a number of factors like level of radiation exposure in that area, time gap between last radiation doses etc., Further research is required in this field to improve the esthetics and quality of life of cancer treated patients.
  2,940 193 -
Pediatric adenotonsillectomy in a low resource setting: Lessons and implications
Sanyaolu Alani Ameye, Afolabi Muyiwa Owojuyigbe, Adekunle Adeyemo, Anthony T Adenekan, Sylvia Ouche
July-December 2016, 22(2):77-80
DOI:10.4103/1117-6806.182742  PMID:27843269
Objectives: To examine the practices related paediatric adenotonsillectomy in our setting especially in relation to blood request and transfusion, routine investigations, post-operative analgesic practice and complications. Methods: We reviewed the record of paediatric patients who had adenotonsillectomy in our facility over a 5-year period to obtain relevant information to our study. Results: There were 33 males and 19 females with mean age of 3.27 ± 2.76 years. Sinus tachycardia was found in 11(21.2 %) of the subjects and T wave anomaly in 1(1.9%) of the subject. Thirty-five (67.3%) patient had adenotonsillectomy, 13(25.0 %) adenoidectomy only and 4(7.7%) tonsillectomy only. Majority of the patients (24, 46.2%) were classified as ASA physical status I. Pre-operative blood request rate was high (49, 94.3%) though the transfusion rate was 1.9 % (1 patient). Acetaminophen combined with other analgesics was used for post-operative analgesia for most of the patients. There was significant weight gain post-operatively among patient Conclusions: Cold steel adenotonsillectomy is safe and effective in our environment. We believe that there is no justification for routine pre-operative blood request as a preconditions for surgery. We also like to suggest that post-operative pain management be streamlined taking into consideration the available analgesics in our setting.
  2,829 130 1
CASE REPORTS
Cryotherapy for treatment of mouth mucocele
Kamaldeep K Aulakh, Ramandeep S Brar, Anurag Azad, Swati Sharma, Abhishek Anand, Bhuvan Jyoti
July-December 2016, 22(2):130-133
DOI:10.4103/1117-6806.179832  PMID:27843280
A mucocele is a common salivary gland disorder that most commonly affects young adults. A 35-year-old female patient reported to the Department of Oral and Maxillofacial Surgery, with the chief complaint of swelling on the left side of floor of mouth. The aim of this case report is to present the management of mucocele present in floor of the mouth in a young female patient using liquid nitrogen cryosurgery. The present case report has also discussed mechanism of action, current protocol of cryosurgery with emphasis on clinical pros and cons along with the clinical outcomes.
  2,633 208 2
Unusual presentation of ulcerative postauricular swelling as sebaceous cell carcinoma
Prem Chand, Ashok Kumar, Paramjit Singh, Lakshay Singla
July-December 2016, 22(2):127-129
DOI:10.4103/1117-6806.169819  PMID:27843279
Sebaceous glands have high concentration over head and neck region. Despite high concentration, sebaceous cell adenoma and carcinomas are infrequent. Sebaceous cell carcinoma is an uncommon, cutaneous aggressive tumor arising from the sebaceous glands and seen almost exclusively on the eyelids (75%). It accounts for just 0.2-0.7% of all eyelid tumors in the USA and very few cases that have originated in areas other than the eyelids have been reported. A 67-year-old male presented with swelling (3 cm Χ 4 cm), on the right postauricular region, since about 1-month. The swelling became ulcerative and associated with progressive tinnitus and hoarseness of voice. The patient was investigated. Fine-needle aspiration cytology suggested sebaceous cell carcinoma. Then excision biopsy was done, and histopathological examination of excised tissue confirmed the diagnosis. Extraorbital sebaceous cell carcinoma is an aggressive and invasive malignancy. It clinically mimics other diseases and is difficult to diagnose. Hence, an accurate and prompt diagnosis is crucial because of its fulminant course, serious associations with Muir-Torre syndrome and high potential for regional and distant metastasis.
  2,386 85 1
ORIGINAL ARTICLES
Impact of preoperative patient characteristics on posturethroplasty recurrence: The significance of stricture length and prior treatments
Jibril Oyekunle Bello
July-December 2016, 22(2):86-89
DOI:10.4103/1117-6806.188979  PMID:27843271
Introduction: Urethral strictures are common in urologic practice of Sub-Saharan Africa including Nigeria. We determine the rate of stricture recurrence following urethroplasty for anterior urethral strictures and evaluate preoperative variables that predict of stricture recurrence in our practice. Subjects and Methods: Thirty-six men who had urethroplasty for proven anterior urethral stricture disease between February 2012 and January 2015 were retrospectively analyzed. Preoperative factors including age, socioeconomic factors, comorbidities, etiology of strictures, stricture location, stricture length, periurethral spongiofibrosis, and prior stricture treatments were assessed for independent predictors of stricture recurrence. Results: The median age was 49.5 years (range 21-90), median stricture length was 4 cm (range 1-18 cm) and the overall recurrence rate was 27.8%. Postinfectious strictures, pan urethral strictures or multiple strictures involving the penile and bulbar urethra were more common. Most patients had penile circular fasciocutaneous flap urethroplasty. Following univariate analysis of potential preoperative predictors of stricture recurrence, stricture length, and prior treatments with dilations or urethrotomies were found to be significantly associated with stricture recurrence. On multivariate analysis, they both remained statistically significant. Patients who had prior treatments had greater odds of having a recurrent stricture (odds ratio 18, 95% confidence interval [CI] 1.4-224.3). Stricture length was dichotomized based on receiver operating characteristic (ROC) analysis, and strictures of length ≥5 cm had significantly greater recurrence (area under ROC curve of 0.825, 95% CI 0.690-0.960, P = 0.032). Conclusion: Patients who had prior dilatations or urethrotomies and those with long strictures particularly strictures ≥5 cm have significantly greater odds of developing a recurrence following urethroplasty in Nigerian urology practice.
  2,361 96 3
Open intramedullary nailing for segmental long bone fractures: An effective alternative in a resource-restricted environment
Olasunkanmi M Babalola, Gbadebo Hakeem Ibraheem, Bola A Ahmed, Ayokunle Olawepo, Samuel B Agaja, Adebowale Adeniyi
July-December 2016, 22(2):90-95
DOI:10.4103/1117-6806.188983  PMID:27843272
Background: Closed, locked intramedullary nailing has been accepted as the gold standard in the care of femoral fractures, with reported union rates as high as 98-100%. Closed, locked intramedullary nailing often requires expensive equipment which is a challenge in developing countries. Segmental long bone fractures are often a result of high-energy trauma and hence often associated with a lot of injuries to the surrounding soft tissues. This consequently results in higher rates of delayed or nonunion. This study was proposed to review the outcome of management of segmental fractures with locked intramedullary nails, using an open method of reduction. Methods: A retrospective analysis was made of data obtained from all segmental long bone fractures treated with intramedullary nailing over a 1-year period. Records were retrieved from the folders of patients operated on from January 2011 to December 2011. Patients were followed up for a minimum of 1 year after the surgery. Results: We managed a total of 12 segmental long bone fractures in 11 patients. Eight of the 12 fractures were femoral fractures and 10 of the fractures were closed fractures. All but one fracture (91.7%) achieved union within 4 months with no major complications. Conclusions: Open method of locked intramedullary nailing achieves satisfactory results when used for the management of long bone fractures. The method can be used for segmental fractures of the humerus, femur, and tibia, with high union rates. This is particularly useful in low-income societies where the use of intraoperative imaging may be unavailable or unaffordable. It gives patients in such societies, a chance for comparable outcomes in terms of union rates as well as avoidance of major complications. Larger prospective studies will be necessary to conclusively validate the efficacy of this fixation method in this environment.
  2,345 111 2
Assessment of severity of peritonitis using mannheim peritonitis index
Sanjeev Sharma, Sumitoj Singh, Nikhil Makkar, Ashok Kumar, Mandeep Singh Sandhu
July-December 2016, 22(2):118-122
DOI:10.4103/1117-6806.189009  PMID:27843277
Introduction: Peritonitis is one of the most common problems in general surgery practice with high mortality rate. One of the reasons for high mortality is that peritonitis affects the general condition and leads to complications causing multiple organ failure, renal failure, sepsis, and postoperative ventilatory support. Early prognostic evaluation of patients with peritonitis is desirable to select high-risk patients for intensive management and also to provide a reliable objective classification of severity and operative risk. Patients and Methods: Fifty cases with diagnosis of peritonitis coming to Government Medical College, Amritsar, were studied. Stratification of these patients was done according to Mannheim peritonitis index (MPI), and their outcome was examined. Results: Mortality steadily increases with increase in MPI score. For patients with a score <21, the mortality rate was 0%; for score 21-27, it was 27.28%; and for score >27, it was 100% (P < 0.001). For patients with a score <21, the morbidity rate was 13.33%; for score 21-27, it was 65.71%; and for score >27, it was 100% (P < 0.001). Duration of pain >24 h, organ failure on admission, female sex, and feculent exudate were found to be independently significant factors in predicting the mortality among the study population. For a score of 27, the sensitivity was 66.67%, specificity was 100%, and positive predictive value for mortality is 100% at an accuracy of 94%. Conclusion: This study proves that MPI scoring system is a simple and effective tool for assessing the morbidity and mortality in patients with peritonitis.
  2,165 183 -
Squamous cell carcinoma of the palm in Nigeria
Wilson IB Onuigbo, Gabriel E Njeze
July-December 2016, 22(2):123-126
DOI:10.4103/1117-6806.169872  PMID:27843278
Objective: To document six cases of squamous cell carcinoma (SCC) of the palm. Materials and Methods: A review of patients' records seen from 1986 to 1998, at the Plastic Surgical Unit of the National Orthopaedic Hospital, Enugu was undertaken. The accumulated data were analyzed with the reference to those diagnosed as SCCs. Results: Four males and two females with a mean age of 61.3 years were afflicted with SCC of the palm. All but one of these patients farmed. There were long delays before presentation, and extents of the lesions reflected that. Conclusion: The Public health education is indicated in our community, if the patients are to recognize the nature of this lesion and report early.
  2,127 76 -
CASE REPORTS
A rare presentation of lower back swelling as tailgut cyst
Prem Chand, Simmi Bhatnagar, Ashok Kumar, Nisha Rani
July-December 2016, 22(2):134-137
DOI:10.4103/1117-6806.189023  PMID:27843281
Retrorectal cystic hamartoma, also known as tailgut cyst, is a rare congenital developmental lesion arising from postnatal primitive gut remnants in the retrorectal space. The rarity of the lesion and its anatomical position usually leads to difficulty in diagnosis and surgical management. This cyst predominantly occurs in women (female to male ratio, 3:1). Tailgut cysts can present as incidental findings during the routine examination but over half of the patients are thought to present with symptoms. Computed tomography or magnetic resonance imaging has a crucial role in diagnosing these misdiagnosed cysts. Complete surgical excision is the treatment of choice for tailgut cysts as this provides a definitive diagnosis, relieves symptoms, and prevents possible complications such as infection, fistula formation, and malignant degeneration. We present a case of a 40-year-old female, who presented to us with lower back swelling (7 cm × 5 cm) for last 2 years, which had become more prominent to her while sitting. The patient was investigated. Ultrasonography demonstrated ill-defined large cystic lesion (8 cm × 7 cm), posterior to the uterus. Fine needle aspiration cytology suggested sebaceous cyst. A lumbosacral contrast-enhanced computed tomography demonstrated well-defined fluid density mass/collection with enhancing walls in the retrorectal, presacral, precoccygeal area, and suggested tailgut duplication cyst/retrorectal cystic hamartoma. Surgical complete excision of the cystic mass was done with both anterior (transabdominal) and posterior approach. Histopathology confirmed a tailgut cyst.
  2,096 73 1
ORIGINAL ARTICLES
Current trends in treatment outcomes of orbital cellulitis in a tertiary hospital in Southern Nigeria
Odarosa M Uhumwangho, Dumebi H Kayoma
July-December 2016, 22(2):107-110
DOI:10.4103/1117-6806.188997  PMID:27843275
Background: Orbital cellulitis refers to the inflammation or infection of the soft tissues of the orbit located behind the orbital septum. Aim: To determine the current trends in the outcomes following the management of orbital cellulitis in a tertiary hospital in Southern Nigeria. Patients and Methods: A retrospective review of medical records of patients with orbital cellulitis from January 2008 to December 2014 was conducted. The age, sex, duration of symptoms, predisposing factors, clinical findings, laboratory/radiological investigations, treatment provided, complications, and follow-up were recorded. Results were analyzed with SPSS Version 21 program. Results: Forty-two patients were seen made of 17 (40.5%) males and 25 (59.5%) females with a mean age of 18.2 ± 18.7 years of which children <16 years constituted 24 (57.1%) of cases. Orbital cellulitis was a unilateral occurrence in 38 (90.5%) patients. Trauma and sinusitis were the common predisposing causes in 20 (47.6%) and 6 (14.3%) patients, respectively. The most common complaint was eye swelling 36 (52.9%). Most patients had visual acuities of >6/18 at presentation, 38 (82.6%) and at discharge, 39 (84.8%). The mean duration of presenting complaints was 15.5 ± 31.6 days. Patients who presented early were less likely to develop complications, P = 0.003. The most common complication was exposure keratopathy in 8 (44.4%) eyes. The only surgical intervention performed was incision and drainage of abscess in 3 (7.1%) eyes. No patient came for follow-up. Conclusion: Prompt institution of effective antibiotics and management of complications that may arise improves prognosis of orbital cellulitis.
  1,873 101 2
Severity, challenges, and outcome of retroperitoneal hematoma in a Nigeria Tertiary Hospital
Arowolo Olukayode Adeolu, Adisa Adewale Oluseye, Kolawole Oladapo Adedayo, Rotimi Adedeji David, Funmilola Olanike Wuraola
July-December 2016, 22(2):96-101
DOI:10.4103/1117-6806.188986  PMID:27843273
Background: Retroperitoneal hematoma (RH) can present as an acute life-threatening condition, report on RH in low-income countries are lacking. Objective: We present the severity, pattern, challenges, and outcome of RH in a low-resource country such as Nigeria. Methods: This was a retrospective observational study of all patients with blunt or penetrating abdominal injury needing surgery, patients with RH among them were analyzed. Results: In the last one decade spanning 2005-2015, our operation database record showed that 247 patients had exploratory laparotomy for blunt and penetrating abdominal trauma. Out of the 115 patients with complete record available, only 43 had RH. The median age of the patients was 30 years, and the most affected age group was 20-29 years. Female to male ratio was 1:13. Only eight patients (18.6%) reached the hospital from the accident site within the first "Golden Hour" of accident, which is the first 1 h postrauma during which treatment intervention believed to have the best outcome. Only two patients (4.7%) got to operating theater within 1 h of reaching hospital. None of our patients had preoperative diagnosis of RH; overall, mortality was two patients (4.7%). Conclusion: Logistical infrastructural inadequacies such as lack of sterile theater bundle and drapes/nonavailability or busy theater space caused delay for patients between presentation in the Accident and Emergency Center and operating theater. None of our patients had a preoperative diagnosis of RH because of lack of access to computerized tomography scan dedicated to trauma in Accident and Emergency Center. The overall mortality of 4.7% in this study, which is on the low side, tends to suggest that mostly mild and stable cases which can make it to the operating table were eventually operated upon.
  1,836 86 -
ABSTRACTS
NSRS/ASON Abstracts Nnewi 2016

July-December 2016, 22(2):138-146
DOI:10.4103/1117-6806.189029  
  1,350 52 -
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