Bethesda Hospital

About: Bethesda Hospital is a healthcare organization based out in Ambur, Tamil Nadu, India. It is known for research contribution in the topics: Population & Helicobacter pylori. The organization has 386 authors who have published 472 publications receiving 15193 citations.

Bilateral epilepsy surgery in a 4-year-old child

Abstract: Objective: Reports on bilateral epilepsy surgical interventions are anecdotal because of the possible neurological deficits caused by them. Methods: We report on a four-year-old amaurotic child with catastrophic epilepsy due to bilateral occipital cortical dysplasia. After video-EEG monitoring and intraoperative electrocorticography he underwent a two-step bilateral occipital lobectomy. Results: The first resection resulted in only temporary seizure cessation; however, he became seizure-free after the second operation (follow-up: 20 months). Conclusion: Patients with catastrophic epilepsy due to bilateral epileptogenic lesions but without a high risk of additional post-surgical deficit may be good candidates for epilepsy surgery.

Arthroscopic treatment of patellar dislocations with medial retinacular repair

Abstract: Objectives: Patellar dislocation is a common problem in skeletally immature subjects. Nonoperative treatment of these dislocations results in unsatisfactory outcomes. The aim of this study was to evaluate the results of minimally invasive arthroscopic treatment for acute and recurrent patellar dislocations. Patients and methods: Twelve patients underwent arthroscopic medial retinaculum suture for patellar dislocations. The dislocations were acute in seven patients (mean age 14 years; range 13 to 17 years) and recurrent in five patients (mean age 22 years; range 17 to 32 years). In some cases, arthroscopic medial retinaculum suture was combined with a lateral release. The patients were evaluated by physical examination and with the Lysholm-Gillquist score and the Bandi knee global assessment score. The mean follow-up period was 9.8 months (range 2 to 28 months). Two patients were excluded from the final evaluations: one was lost to follow-up and the other underwent surgery. Results: The mean Lysholm-Gillquist score after treatment was 97.6±1.5 (range 85 to 100). The results were excellent in nine patients, and good in one patient. The global objective assessment score of Bandi was good in all the patients. None of the patients experienced recurrent luxations during the follow-up period. The patients had no complaints and were satisfied with treatment. None of them reported pain or swelling. All the knees had normal range of motion. Most of the patients returned to competitive sports activities. Some patients refrained from active sporting even though they had no physical complaints. Conclusion: Arthroscopic medial retinacular suture combined with lateral release is a safe and effective treatment modality in acute and recurrent patellar dislocations and in chronic subluxations.

Computer-based diagnostic support systems in histopathology: what should they do?

Abstract: In many fields in histopathology diagnosis making is notoriously difficult. We explored the diagnostic process in the area of CL and related disorders. The field of cutaneous lymphomas (CL) and borderline lesions is complex and representative for the type of diagnostic problems encountered. A review of diagnostic support systems in diagnostic pathology revealed that the usefulness of these systems has been disappointing. We contribute this to the fact that these systems target only part of the diagnostic process. A tentative model of diagnosis making in pathology is presented. This model assumes a two-step process, from observation to feature recognition and from features to diagnosis. In a retrospective study of existing skin biopsy pathology reports we assessed detail and scope of the histological descriptions. In a second, prospective study, a pathologist panel described a set of 16 skin biopsies using a standard set of descriptors. The retrospective study showed a large variability in the nature and details of described features, whereas the prospective study showed lack of consensus regarding both feature descriptions and diagnostic category. Both studies provide an indication that lack of consensus in feature recognition may be an important contributor to lack of consensus at the diagnostic level. Diagnostic expert systems target the step from feature to diagnosis. Evidently different input into such systems produces different output. We conclude that support of the feature recognition step can contribute to better diagnostic consensus because of more uniform interpretation of observations.

Effect of the Dutch Hip Fracture Audit implementation on mortality, length of hospital stay and time until surgery in elderly hip fracture patients; a multi-center cohort study.

Abstract: Background In 2040 the estimated number of people with a hip fracture in the Netherlands will be about 24,000. The medical care for this group of patients is complicated and challenging. Multidisciplinary approaches aim to improve clinical outcome. Quality indicators that gain insight in the treatment and outcome of hip fracture patients may help to optimize and monitor the standard of medical care. The Dutch Hip Fracture Audit (DHFA) is a new multidisciplinary quality indicator that is implemented in the Dutch hospitals in 2017. Aim The aim of this study was to determine the effect of the implementation of the DHFA on 30-day mortality, length of hospital stay and time until surgery in elderly with a hip fracture in the Netherlands. Methods A multicenter retrospective comparative cohort study was conducted and data were extracted from the Dutch Nationwide Trauma Registration (LTR). Included were patients aged 60 years and older with a hip fracture (femoral neck and trochanteric) and admitted in one of the ten participating hospitals registered in 2015 and 2017. Data from 2015, before implementation of DHFA, were compared with data from 2017, when the DHFA was implemented. The primary outcome was 30-day mortality; secondary outcomes were length of hospital stay and time until surgery. Multivariable regression models were used to compare outcomes between groups. Results 3808 patients were included, 1839 in the 2015 cohort and 1969 in the 2017 cohort. 29% was male; mean age 82 years. The multilevel analysis showed a positive non-significant difference between groups on the primary outcome30-day mortality (OR adjusted 1.23, 95%CI 0.93 - 1.63). The secondary outcomes length of hospital stay (adjusted effect estimates -0.002, 95%CI -0.03 - 0.03) and time until surgery (adjusted effect estimates 0.292, 95%CI -2.68 - 3.26) showed no differences between groups. Conclusions Implementation of the DHFA quality indicator does have a positive non-significant trend on 30-day mortality, but showed no impact on length of hospital stay and time until surgery. More research on relevant quality indicators seems therefore mandatory.