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Manoj Sikand

Publications and source records attributed to Manoj Sikand.

4 recordsLinked to original sources
PubMed2006

Healing of arthroscopic portals: a randomised trial comparing three methods of portal closure.

We carried out a single blind, randomised trial in which we examined the healing of portal wounds treated by three techniques: suturing, approximating the edges of the wound with sterile adhesive tapes (steristrips) or covering them with a simple sterile dressing. The study included patients who underwent arthroscopy of the knee joint, either for diagnostic purposes or for small therapeutic procedures. All patients were admitted as day cases. Outcome measures adopted were level of pain at the portal site, redness, swelling and cosmesis. The power of the study was designed to detect 10% difference with 95% confidence and p < 0.05. A total of 160 patients with an average age of 40 years were studied : 45 patients had their wounds covered with simple sterile dressing, 52 had steristrips, and 63 had sutures on the portals. The total numbers of portals were 380. No patient was lost to follow-up. There was significant difference between the three groups with regards to post operative swelling and redness : 29% patients in the suture group had swelling as compared to around 11% in the two other groups (p = 0.02); 37% patients in the suture group and 23% patients in the steristrips group developed redness while only 9% patients in the simple dressing group had redness at 4 weeks (p = 0.004). Patients in the suture group experienced more pain as measured by visual analogue scale; however there was no statistically significant difference (p = 0.37) in the number of patients who had pain. All patients in the steristrips and simple dressing group were satisfied cosmetically; 8% in the suture group were not. There were no major complications. The present study shows that suturing the portals has no additional advantage. There is little to choose between the other two methods and treating these wounds with either simple dressing or steristrips is easy and causes less discomfort to the patient.

Adult↗
PubMed2005

Early mortality after hip fracture: is delay before surgery important?

BACKGROUND: Hip fracture is associated with high mortality among the elderly. Most patients require surgery, but the timing of the operation remains controversial. Surgery within twenty-four hours after admission has been recommended, but evidence supporting this approach is lacking. The objective of this study was to determine whether a delay in surgery for hip fractures affects postoperative mortality among elderly patients. METHODS: We conducted a prospective, observational study of 2660 patients who underwent surgical treatment of a hip fracture at one university hospital. We measured mortality rates following the surgery in relation to the delay in the surgery and the acute medical comorbidities on admission. RESULTS: The mortality following the hip fracture surgery was 9% (246 of 2660) at thirty days, 19% at ninety days, and 30% at twelve months. Of the patients who had been declared fit for surgery, those operated on without delay had a thirty-day mortality of 8.7% and those for whom the surgery had been delayed between one and four days had a thirty-day mortality of 7.3%. This difference was not significant (p = 0.51). The thirty-day mortality for patients for whom the surgery had been delayed for more than four days was 10.7%, and this small group had significantly increased mortality at ninety days (hazard ratio = 2.25; p = 0.001) and one year (hazard ratio = 2.4; p = 0.001). Patients who had been admitted with an acute medical comorbidity that required treatment prior to the surgery had a thirty-day mortality of 17%, which was nearly 2.5 times greater than that for patients who had been initially considered fit for surgery (hazard ratio = 2.3, 95% confidence interval = 1.6 to 3.3; p < 0.001). CONCLUSIONS: The thirty-day mortality following surgery for a hip fracture was 9%. Patients with medical comorbidities that delayed surgery had 2.5 times the risk of death within thirty days after the surgery compared with patients without comorbidities that delayed surgery. Mortality was not increased when the surgery was delayed up to four days for patients who were otherwise fit for hip fracture surgery. However, a delay of more than four days significantly increased mortality.

Adolescent↗
PubMed2003

Study on the use of gonadal protection shields during paediatric pelvic X-rays.

BACKGROUND: There are national guidelines issued by all hospital radiology departments concerning the use of gonadal protection shields for taking X-rays of the pelvis. It is important to follow these guidelines especially when paediatric X-rays are taken. Gonads are very susceptible to radiation as they fall directly in the line of radiation exposure when pelvic X-rays are taken. AIM: To examine whether these guidelines were being followed. METHODS: This audit considered 355 radiographs taken in a 6-month period on 149 patients, under the age of 16 years, attending the orthopaedic department at King's Mill Hospital. RESULTS: In only 23% of the cases studied, the correct use of gonad protection shields had been performed. In 67% of the unprotected patients, the shields were not used at all. In the remainder, the shield was incorrectly applied. Out of all the patients, 45% had more than one X-ray thus exposing the gonads to unnecessary radiation. In addition, 8% of patients had a CT scan, 6% had fluoroscopy and 42% had radiographs of other regions of the body. CONCLUSIONS: Guidelines should be adhered to as far as possible and efforts always be made to decrease radiation exposure. Application of the current guidelines excludes the first X-ray exposure of the female pelvis and of the pelvis of trauma patients from the use of shields, thus adding to the number of the X-rays done without protection.

Adolescent↗