Browsing by Author "Awaneesh Katiyar"

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A Case Series Analysis of Pancreatic Injury Patients from Level 1 Trauma Centre
(Springer, 2025) Prashant Shukla; Awaneesh Katiyar; Shashi Prakash Mishra
Traumatic pancreatic injuries account for less than 1% of all traumas. These injuries are often associated with high-energy mechanisms, such as motor vehicle collisions, falls from heights, and penetrating injuries. We analyzed pancreatic trauma patients to determine outcomes following surgical or non-surgical management of traumatic pancreatic injuries. Once the diagnosis is made, patient management depends on multiple variables. We analysed the Level 1 trauma center database from 2019 to 2023. Data reviewed included patients’ demographics, mode of injury, grade of pancreatic injury, associated injuries, type of management, complications, and mortality, which were collected for analysis. Fifty-one patients with pancreatic injuries were included, with a median age of 34 years (19–58). Among these, 43(84%) were male, and 8 (15%) were female. Road traffic injuries were the most common cause of pancreatic injury. The mechanism of injury was blunt in 93% of cases and penetrating in 7%. The median injury grade was 3. Most injuries involved the pancreatic head (60%). The mean Injury Severity Score (ISS) at the presentation was 11. Nine patients (17.64%) were managed surgically, while the remaining were managed non-operatively. Ileus and associated organ injuries were the most significant factors predicting failure of non-operative management (NOM). Fourteen per cent of patients required total parenteral nutrition (TPN), most of whom were managed non-operatively. There were three needed readmissions, and no patient required re-operation. Mortality occurred in 7 patients (14%). Blunt trauma is the primary mechanism of pancreatic injuries, with road traffic accidents being the most common cause. While the majority of cases (84%) can be managed conservatively, a significant proportion (17.64%) required surgical intervention due to complex injuries or failure of non-operative management. Ileus and associated organ injuries are critical predictors of conservative management failure. Nutritional support in the form of TPN was frequently required, particularly in non-operatively managed patients. Mortality (14%) underscores the seriousness of pancreatic injuries, particularly in those with higher injury grades or complications. Pancreatic injuries, especially high-grade and delayed presentations, are associated with significant morbidity and mortality. Non-operative management was effective for low-grade injuries, while higher-grade injuries often required surgical intervention. Mortality correlated with polytrauma, high ISS, and physiological derangements. Early diagnosis, timely intervention, and multidisciplinary care are critical for improving outcomes. © Association of Surgeons of India 2025.
Bacteriological Study of Varicose Vein Specimens
(Springer, 2023) Ajay K. Khanna; Awaneesh Katiyar; Soumya Khanna; Gopal Nath; Puneet Kumar; Satyendra K. Tiwary
Varicosity and chronic venous insufficiency (CVI) are thought to be due to reflux or pathologic retrograde flow caused by an incompetent venous valve leading to venous hypertension followed by reflux. A variety of factors have been postulated in association with varicose veins. Venous hypertension leading to reflux and varicosity may be associated with inflammation due to microbiological activity. This study was carried out with the objective that infection can be an etiological factor for varicose veins. A prospective study was carried out at a tertiary health care center from June 2014 to December 2020. A total of 100 patients with varicose veins (with 120 limb involvement) were recruited. Samples of normal leg veins were taken as control from 10 patients who were undergoing saphenous vein bypass grafting or amputated limb following road traffic accidents. We studied the primary varicose veins for microbiological etiology of the disease by culture studies of varicose veins and further confirmation by 16 s-rRNA PCR analysis. The sample of veins harvested during intervention was submitted for microbiological culture. Out of 42 cultures, Pseudomonas spp. in 6 cases (14.29%), Klebsiella spp. in 4 cases (9.52%), 2 cases (4.76%) each of Staphylococcus aureus and Proteus spp., and one case of Citrobacter on bacterial culture of truncal veins and on 16 s-rRNA PCR on DNA extracted from truncal varicose vein samples. Pseudomonas spp., Staphylococcus aureus, Klebsiella spp., Proteus spp., and Citrobacter spp. were detected in 10 cases (23.81%), 6 cases (14.29%), 5 cases (11.9%), 2 cases (4.76%), and 1 case (2.38%), respectively. In the ten specimens of normal vein, taken as control, 9 cases show no bacterial growth and 1 (10%) case shows a growth of micrococci. In consideration of the results of the present study, microbiological etiology of varicose veins is a distinct association which was confirmed in this study. © 2021, Association of Surgeons of India.