Total colectomy of patients having synchronous lessons of five cases in Sylhet MAG Osmani Medical College, Bangladesh

Mohammad Abdul Quadir — 2024-11-21

Background: Synchronous colorectal lesions present unique challenges in diagnosis and treatment, particularly in resource-limited settings. This study aims to evaluate the outcomes of total colectomy for synchronous colorectal lesions in a regional medical center in Bangladesh.

Methods: A retrospective case series of five patients who underwent total colectomy for synchronous colorectal lesions at Sylhet MAG Osmani Medical College Hospital between January 2019 and December 2023 was conducted. Patient demographics, clinical presentation, operative details, histopathological findings, and short-term outcomes were analyzed.

Results: The median age was 62 years (range: 48-75), with a male-to-female ratio of 3:2. The median number of synchronous lesions was 3 (range: 2-5). Three patients underwent open surgery, while two had laparoscopic-assisted procedures. The median operative time was 285 minutes (range: 240-360), with a median estimated blood loss of 350 mL (range: 200-600). Histopathology revealed adenocarcinoma in at least one lesion in three patients. The median length of hospital stay was 10 days (range: 8-15). Postoperative complications included ileus (n=2) and wound infection (n=1). No mortality or anastomotic leaks were observed within 30 days postoperatively. At 30-day follow-up, all patients reported satisfactory bowel function with a median stool frequency of 4 times per day.

Conclusion: Total colectomy for synchronous colorectal lesions can be safely performed with acceptable short-term outcomes in a regional medical center in Bangladesh. However, challenges remain in terms of resource availability and long-term follow-up. Further research is needed to optimize patient selection and perioperative management in resource-constrained settings.

Refeeding Syndrome: A Multidisciplinary Challenge in Patient Care – A Narrative Review

Fauzia Jawaid Kazi — 2024-11-29

Refeeding syndrome (RFS) is a serious metabolic condition that occurs when nutrition is reintroduced to malnourished individuals after prolonged fasting or starvation. The abrupt shift from catabolism to anabolism triggers rapid insulin release, leading to critical electrolyte imbalances such as hypophosphatemia, hypokalaemia, and hypomagnesemia, which can result in cardiac, respiratory, and neurological complications.

The incidence of RFS varies across populations, with higher prevalence in ICU patients, those receiving total parenteral nutrition, the elderly, individuals with chronic illnesses, pregnant women, and those with anorexia nervosa. Major risk factors include prolonged fasting, malnutrition, gastrointestinal diseases, and alcoholism. Clinical features range from fluid retention, arrhythmias, confusion, and muscle weakness to life-threatening outcomes like heart failure or respiratory collapse.

Prevention involves gradual reintroduction of calories, electrolyte monitoring, and thiamine supplementation to minimize complications. Nurses play a pivotal role by identifying at-risk patients, monitoring electrolyte levels, and ensuring appropriate nutritional support. Their responsibilities extend to educating patients and families, providing emotional support, and coordinating care with dietitians and physicians to prevent adverse outcomes. A multidisciplinary approach is essential for the safe management of RFS, ensuring better patient recovery and survival.

International Journal of Medical Research and Review

Total colectomy of patients having synchronous lessons of five cases in Sylhet MAG Osmani Medical College, Bangladesh

Refeeding Syndrome: A Multidisciplinary Challenge in Patient Care – A Narrative Review