Utility of surgical APGAR score in predicting post-operative morbidity and mortality in patients undergoing laparotomy – A prospective study

Background: The best model to determine the postoperative complications must be simple and easily applicable to the majority of surgical patients. The complications and their incidence should be precisely defined and estimated. The model should also have a low threshold to identify them. The ASA classification was initially intended as a means to stratify a patient’s systemic illness but not post-operative risk. Although the ASA classification has proved to be a predictive pre-operative risk factor in mortality models, its subjective nature and inconsistent scoring between providers make it less than ideal for performing evidence-based post-operative risk calculation. Aim of the study: The aim of the study was to determine the applicability of the Surgical Apgar Score in post-operative risk stratification for morbidity and mortality during the 30 days postlaparotomy. Materials and methods: In this study, 152 in-patient Visiting Government Stanley Medical College General Hospital from March 2017 to April 2018 had been studied. Patients undergone laparotomy at Department of General Surgery, Government Stanley Medical College were managed by a tier of doctors from anesthetic technicians, medical officer interns, medical officers, postgraduates in general surgery and anesthesiology and their consultants. Interns and postgraduates in general surgery provided the pre and postoperative care and participate in general surgical procedures whenever indicated. Anesthesiologists apart from providing anesthesia during surgery extended their care in the intensive care unit. Parimala, G. Venkatesh, P. Vijayaraghavan. Utility of surgical APGAR score in predicting post-operative morbidity and mortality in patients undergoing laparotomy – A prospective study. IAIM, 2019; 6(6): 67-74. Page 68 Results: 132 patients were operated as an emergency and only 20 patients were operated selectively. 86.8% of the surgeries were emergency laparotomies and only 13.2% of the surgeries were elective. This showed our efficient functioning and round the clock services of our emergency theatres. The most common causes in descending order include penetrating injury, intestinal obstruction, peritonitis, perforated duodenal ulcer, blunt injury abdomen, intra-abdominal abscess, hydatid cyst, obstructed hernia, mesenteric ischemia, cholecystitis. A significantly higher complication was noted among female patients at 63.2% compared to male patients at 33.3%. 43.9% of the postoperative complications occurred in emergency setting whereas only 20% of the complications occurred in the elective setting. When the complications were compared with the duration of surgery, those surgeries that lasted more than 120 minutes had a higher complication rate of 68.6% whereas surgeries with a shorter duration only had a complication rate of 26.7%. Conclusion: Surgical Apgar Score is very effective in identifying high-risk patients who are capable of developing significant complications following laparotomy within the first 30 postoperative days. This identification of high-risk patients helps us in the judicious use of healthcare resources towards the proper monitoring and follow up of these patients.

Reappraising the neurosurgical significance of the pterion location, morphology, and its relationship to optic canal and sphenoid ridge and neurosurgical implications / 대한해부학회지

Temporal, buccal and masticator space infections in an immunocompromised patient: report on a rare case

@#AIDS” is a term used to describe the various clinical syndromes, specific opportunistic infections or malignancies that occur with HIV infection. Oral manifestations are common in people with HIV infection. .Oral lesions may be due to decline in immune function. Hence patients with AIDS are subjected to recurrent, Life threatening opportunistic infection. Here is a case report of a 70 year old female who presented with right buccal, masticator and submandibular space infection. A routine blood test reveals seropositivity positive for HIV infection. She was treated with antibiotics and underwent an incision and drainage following hospitalization

Designing A Contemporary Anatomy Museum: Anatomists' Perspective.

Background: A research study was conducted in sixteen anatomy museums across India. Aim: The aim of the study is to have an integrated approach while designing a museum. Objective: The objective is to stress on the need to have a holistic approach while designing a museum so that that the museum is well planned and organised and has a huge sectional diversity that spans all aspects related to anatomy. Materials and Methods: All the museums were studied using a planned proforma that emphasised on special features of the museum with special emphasis on sectional variety. Observations: The various techniques of specimen preparation, preservation, mounting and display were observed and photographed. The sectional variety was noted. Moreover the various methods of maintaining specimen related information in pictorial and computerised catalogues was observed. Results and Conclusion: A design of a contemporary anatomymuseumcan nowbe conceived that incorporates all aspects of anatomy from history, evolution, embryology, cross-sectional anatomy, comparative anatomy, teratology, genetics and clinical anatomy to sections with modern techniques like plastination. Such amuseum will certainly have a more holistic approach to anatomy and will be more educative and scientific.

To study the effect of Yoga Training on auditory and visual reaction time.

Reaction time is the easiest methods of assessing the sensory and motor performance of an individual. It is an indicator of performance in surgeons, sports personnel etc. Yoga can improve the reaction time. Hence, this study was undertaken to study the effect of yoga training on visual and auditory reaction time. Fifty healthy subjects aged between 18 and 25 years were selected. Auditory reaction time and visual reaction time were assessed before and after yoga training. There was significant decrease (p<0.05) in the alert values of both Auditory reaction time and Visual reaction time after two months of yoga training. Yoga training enhances the reaction times which are helpful in surgeons, sportsmen and skilled workers.

A Comparative Study Of Tracheobronchial Pattern Using Luminal Plastination.

Background: The tracheobronchial pattern of human lungs is well known. An attempt was made to compare the pattern with that of sheep lung using luminal plastination of sheep lung. Several similarities were observed between the two patterns, due to which, the sheep lung serves as an ideal experimental model to study the effect of treatment in several human airway diseases. Objective: The first objective was to compare the two tracheobronchial patterns. Moreover the study also provided an opportunity to the authors to attempt a luminal plastination. The final objective is to highlight the various advantages of advances in luminal plastination in current medical education and research. Materials and methods: Silicon sealant was injected into the tracheobroncheal tree of sheep after thoroughly cleaning the lungs with saline. After the sealant solidified the surrounding lung tissue was destroyed by boiling. Thus a luminal cast was prepared. Result: The result was a splendid luminal cast of the sheep lung showing its tracheobronchial pattern. Conclusion: It was observed that the tracheobronchial division pattern showed significant similarities and a single variation. Therefore the sheep lung is an ideal experimental model and luminal plastination can be applied to comparative anatomical study to identify more such models.

Acromegaloid Facial Appearance Syndrome: A New Case in India

Acromegaloid Facial Appearance syndrome is a very rare syndrome combining acromegaloid-like facial appearance, thickened lips and oral mucosa and acral enlargement. Progressive facial dysmorphism is characterized by a coarse facies, a long bulbous nose, high-arched eyebrows, and thickening of the lips, oral mucosa leading to exaggerated rugae and frenula, furrowed tongue and narrow palpebral fissures. We report a case of acromegaloid facial appearance syndrome in a 19-year-old male patient who presented with all the characteristic features of the syndrome along with previously unreported anomalies like dystrophic nails, postaxial polydactyly and incisal notching of teeth.

Anatomy and morphology of the nasopalatine canal using cone-beam computed tomography

PURPOSE: This study was performed to evaluate the general anatomy and morphology of the nasopalatine canal using cone-beam computed tomography (CBCT) and to determine the human anatomic variability of the nasopalatine canal in relation to age and gender. MATERIALS AND METHODS: The study included 100 subjects aged between 20 and 86 years who were divided into the following 3 groups: 1) 20-34 years old; 2) 35-49 years old; 3) > or =50 years old. The subjects were equally distributed between the genders. CBCT was performed using a standard exposure and patient positioning protocol. The data of the CBCT images were sliced in three dimensions. Image planes on the three axes (X, Y, and Z) were sequentially analyzed for the location, morphology and dimensions of the nasopalatine canal by two independent observers. The correlation of age and gender with all the variables was evaluated. RESULTS: The present study did not reveal statistically significant differences in the number of openings at the nasal fossa; diameter of the nasal fossa openings; diameter of the incisive fossa; shape, curvature, and angulation of the canal as viewed in the sagittal sections; antero-posterior dimensions and length of the canal in the sagittal sections; or the level of division of the canal in the coronal plane by age. However, males and females showed significant differences in the length of the canal in the sagittal sections and level of the division of the canal in the coronal plane. CONCLUSION: The present study highlighted important variability observed in the anatomy and morphology of the nasopalatine canal.

Disseminated non-Hodgkin's lymphoma presenting as bilateral salivary gland enlargement: a case report

Non-Hodgkin's lymphoma (NHL) constitutes a group of malignancies those arises from cellular components of lymphoid or extranodal tissues. The head and neck is the most common area for the presentation of these lymphoproliferative disorders. Primary involvement of salivary glands is uncommon. This report described a case of a 73-year-old female patient who presented with involvement of both nodal and extranodal sites, with predominant involvement of salivary glands. The tumor staging worked up along with imaging, histopathological, and immunohistochemical findings were discussed. Computed tomographic images showed the involvement of Waldeyer's ring, larynx, orbit, and spleen. This report described imaging and prognostic tumor markers in diagnosing, treatment planning, and prognosis.

Mejores resultados en ruptura de aneurismas de aorta abdominal manejados con reparación endovascular: Algoritmo sugerido / Improved outcome of ruptured abdominal aortic aneurysms managed with endovascular repair: A suggested algorithm

Antecedentes: El propósito de este estudio es comparar la morbilidad y la mortalidad tanto de la reparación abierta (RA) como endovascular de la ruptura del aneurisma aórtico abdominal(rAAAs); y de presentar un algoritmo para el tratamiento y evaluaciones de la tomografía computarizada (CT) para determinar el uso de un balón oclusivo supra-celíaco. Métodos: Una revisión gráfica retrospectiva se realizó de los rAAAs tratados ya sea con reaparicióna cielo abierto (RA), ya sea con reparación aórtica endovascular (EVAR) entre junio de 1998 y junio de 2009. Se informaron las co-morbilidades, los datos peri-procedimientos y tanto la morbosidad como la mortalidad. Las TC se revisaron desde el uso inicial del balón oclusivo (Marzo de 2001) a fin de evaluar el hematoma retroperitoneal. Se desarrolló un algoritmo para determinarcuándo el balón oclusivo se debería implementar. El test exacto de Fisher, el t-test, y el test log rank fueron los que se utilizaron para el análisis estadístico.Resultados: Entre junio de 1998 y junio de 2009, 105 pacientes, 75 (71.4%) hombres, edad promedio de 74 años (rango 47-93) presentaron un rAAA y a 69 (65.2%) se les realizó la reparación a cielo abierto. 87 pacientes (82.9%) fueron sintomáticos y 25 (23.8%) tenían un AAA conocido. El tiempo medio transcurrido entre el diagnóstico y el tratamiento fue de 5 a 6 horas, 4.5 horas para la RA y de 8 horas para EVAR. El test rank log mostró una mejoría en la supervivencia con EVARa pesar del tiempo promedio más prolongado desde el diagnóstico al tratamiento. (p=0.02). Se administraron casi tres veces más concentrados de hematíes en el cohorte de reparación a cielo abierto (RA), 6.3 unidades y en EVAR 2.2 unidades. Se utilizaron vasopresores perioperatorios en el 57.1% de los casos, dos veces más en la RA, 69.6%, que con EVAR 33.3%. Se utilizó el balón oclusivo aórtico en el 27,6% de los casos, dos veces más frecuente en RA que en EVAR (41,7% verus 20,3%)...

Antecedentes: O propósito deste estudo é comparar a morbilidade e a mortalidade tanto da reparação aberta (RA) quanto endovascular, utilizadas no tratamento da ruptura do aneurisma aórtico abdominal (rAAAs); e de apresentar um algorítmo para o tratamento e avaliações da tomografiacomputarizada (CT) para assim determinar o uso de um balão para oclusão supra-celíaca. Métodos: Realizou-se uma revisão gráfica retrospectiva das rAAAs tratadas, seja com reparação a céu aberto (RA), ou com reparação aórtica endovascualar (EVAR) entre os meses de junho de1998 e junho de 2009. Informaram-se as comorbilidades, os dados periprocedimentos , além da morbidade e mortalidade. As TC foram revisadas desde o uso inicial do balão oclusivo (março de 2001) com o objetivo de avaliar o hematoma retroperitoneal. Desenvolveu-se um algorítmo para determinar quando o balão oclusivo deveria ser implementado. Para esta análise estatística, utilizaram-se o teste exato de Fisher, o t-test, e o test log Rank. Resultados: Entre junho de 1998 ejunho de 2009, 105 pacientes, 75 (71.4%) homens, com média de idade de 74 anos (média 47-93) apresentaram uma rAAA e em 69 (65.2%) realizou-se uma reparação a céu aberto. 87 pacientes (82.9%) foram sintomáticos e 25 (23.8%) tinham um AAA conhecido. O tempo médio transcorrido entre o diagnóstico e o tratamento foi de 5 a 6 horas, 4.5 horas para a RA e de 8 horas para aEVAR. O test rank log mostrou uma melhoria na sobrevivência com a EVAR, apesar do tempo médio mais prolongado do diagnóstico ao tratamento. (p=0.02). Administraram-se quase três vezes mais concentrados de hematies no grupo de reparação a céu aberto (RA), 6.3 unidades e no grupo EVAR, 2.2 unidades. Utilizaram-se vasopressores perioperatórios em 57.1% dos casos: 33.3% com EVAR e 69.6% com a RA, ou seja, duas vezes a mais. Utilizou-se o balão oclusivo aórtico em 27.6 % dos casos, duas vezes mais frequente nos casos da RA do que nos de EVAR (41.7 % versus 20.3%)...

Background: The purpose of this study is to compare morbidity and mortality of open and endovascular repair of ruptured abdominal aortic aneurysms (rAAAs); and present a treatment algorithm and assessment of computer tomography (CT) to determine usage of a supra-celiac occlusive balloon.Methods: Restrospective chart review was done of rAAAs treated with open (OR) or endovascular aortic repair (EVAR) between June 1998 and June 2009. Comorbidities, periprocedural data, and postoperative morbidity and mortality were recorded. CTs were reviewed from the initial use of the occlusive balloon (March 2001) to assess the retroperitoneal hematoma. An algorithm was developed determining when the occlusive balloon should be implemented. Fisher’s exact test, and log rank test were used for statistical analysis. Results: Between June 1998 and June 2009, 105 patients, 75 (71.4%) males, mean age of 74.0 years (range 47-93), presented with a rAAA and 69 (65.2%) received open repair. Eighty-seven patients(82.9%) were symptomatic and 25 (23.8%) had a known AAA. Mean time elapsed between diagnosis to treatment was 5.6 hours, 4.5 hours for OR and 8.0 hours for EVAR. Log rank test showsimproved survivability with the EVAR despite higher mean time from diagnosis to intervention (p=0.02). Nearly three times as much packed red blood cells were given in open repair cohort, O,6.3 units and EVAR, 2.2 units. Perioperative vasopressors were used in 57.1% of total cases, more than 2 times as often for O, 69.6%, and EVAR, 33.3%. Aortic occlusive balloon was used in 27.6% of cases, twice as often in EVAR (41.7% versus 20.3%)...

Evaluation of osteoporosis in diabetic individuals using digital intra oral periapical radiographs / Avaliação de osteoporose em indivíduos diabéticos utilizando radiografias periapicais digitais

Introduction: Osteoporosis is a major cause of fractures in middle aged individuals. There has been drastic increase in the number of osteoporotic patients over the past two decades. The relationship of osteoporosis and diabetes continues to be a topic of debate among research workers. Detection of osteoporosis is very important for oral diagnostics as it can bring changes in treatment plan and modifications in oral procedures. Current literature is directed at diagnosing this condition on dental radiographs. Objectives: The present study was aimed at detecting osteoporosis using digital dental radiographs of premolar and molar region using Adobe Photoshop CS2 software. Materials and methods: A total of 40 patients visiting the dental department who were already diagnosed with type II diabetes for minimum of 1 year Arch Oral Res. 2011 May/Aug.;7(2)169-75 Mutalik S, Goyal M, Sanghamesh B, Guttal SK, Naikmasur VG, Mutalik VS. 170 obesity, hyperglycemia and advanced glycation end products. Albright and Reifenstein were first to report low mineral density and risk of fracture in diabetic subjects in 1948 (3). The relationship between diabetes and osteoporosis continues to be debated among the research workers. A recent meta-analysis showed that diabetic patients had higher hip bone mineral density (BMD) than non-Diabetic controls suggesting that BMD values may not reflect bone fragility in diabetic patients (4). Bone density is determined by several modalities ranging from quantitative computed tomography (qCT) to dual energy x-ray absorptiometry (DEXA) or peripheral ultrasound measurement. Each modality has been shown to be independently predictive of fracture risk, yet each has its own limitations (5). Introduction Osteoporosis is a systemic skeletal disease characterized by reduced bone mineral density and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. It is one of the most common...

Introdução: A osteoporose é uma das principais causas de fraturas em indivíduos de meia idade. Houve aumentodrástico no número de pacientes com osteoporose nas duas últimas décadas. A relação entre osteoporosee diabetes continua a ser um tema de debate entre os pesquisadores. A detecção da osteoporose é muitoimportante no diagnosticador bucal, uma vez que ela pode refletir em mudanças no plano de tratamento emodificações nos procedimentos bucais. O diagnóstico dessta condição por meio de radiografias dentais temsido discutido na literatura atual. Objetivos: O presente estudo teve como objetivo detectar a osteoporose utilizandoradiografias digitais dentais da região de pré-molar e molar utilizando o software Adobe PhotoshopCS2. Materiais e métodos: Um total de 40 pacientes que visitaram o departamento de odontologia e já previamentediagnosticados com diabetes tipo II no período mínimo de um ano foram selecionados aleatoriamentepara o estudo. Radiografias digitais intra-orais periapicais orais da região inferior de pré-molar e molar foramobtidos pela técnica de paralelismo. As imagens foram então convertidas em formato de arquivo bitmap eavaliadas usando o software Adobe Photoshop CS2. O número de trabéculas em uma área específica foi contadoe comparado com indivíduos saudáveis de mesma idade e sexo e controle glicêmico normal. Resultados:A média do número de trabéculas/mm2 em indivíduos normais foi 0,1987 ± 0,0244, e de 0,1737 ± 0,0279 parao grupo diabético, sendo a diferença estatisticamente significativa (p < 0,05). Conclusão: Este estudo confirmouque o número de trabéculas/mm2 em indivíduos diabéticos foi menor em comparação aos observados emindivíduos normais.

Diagnosis of anomalous origin of left coronary artery from pulmonary artery in an adult by 64-slice CT angiography.

Anomalous origin of Left Coronary Artery from Pulmonary Artery (ALCAPA) presenting in adult age is a rare entity. We report an adult patient with exertional angina, who was diagnosed to have ALCAPA conclusively and non-invasively by 64-slice CT angiography.

Evaluation of a new premedication protocol for administration of equine rabies immunoglobulin in patients with hypersensitivity.

OBJECTIVES: The present study was undertaken to standardize skin testing and to develop a safe and effective premedication protocol for administration of ERIG in those with skin test positivity/hypersensitivity. METHODS: A method of grading of skin testing was developed using injection histamine as a positive control. This was evaluated by using it on 517 subjects who had severe (WHO category III) exposure to rabies. A premedication protocol consisting of injections pheniramine, ranitidine, hydrocortisone and adrenaline was evaluated by using it on fifty one subjects who were skin test positive/hypersensitive to ERIG. RESULTS: The premedication protocol was safe and effective as all the S1 subjects could be administered the full dose of ERIG despite being skin test positive/hypersensitive to ERIG. Besides the premedication drugs/protocol did not affect the immune response to vaccine and ERIG therapy.

Boosting effect of purified chick embryo cell rabies vaccine using the intradermal route in persons previously immunized by the intramuscular route or vice versa.

BACKGROUND: At present, in the event of re-exposure to rabies, 2 booster doses are recommended for people who have been previously vaccinated with cell culture rabies vaccines by the conventional intramuscular route. As the intradermal route of vaccination is likely to be introduced in the future, we investigated the immune response to a cell culture rabies vaccine after crossing over from the intramuscular to the intradermal route and vice versa. METHODS: Twenty healthy adult volunteers who had received a primary course of rabies vaccination with purified chick embryo cell rabies vaccine by either the intramuscular (n = 10) or intradermal (n = 10) route received booster vaccination with the same vaccine by the alternative route. The regimen used was 0.1 ml of vaccine by the intradermal route at two sites (deltoid area) for the intramuscular group, or 1 ml of vaccine by the intramuscular route (deltoid muscle) to the intradermal group on days 0 and 3. RESULTS: There was a 15-fold rise in the rabies virus neutralizing antibody response both by the intradermal and intramuscular routes of booster vaccination (p < 0.0001). Thus, the change of route of purified chick embryo cell booster vaccination did not alter the anamnestic immune response to the vaccine. No side-effects were observed after vaccination with either of the routes. CONCLUSION: Purified chick embryo cell vaccine was found to be safe and immunologically efficacious following booster vaccination after cross-over from the intradermal to the intramuscular route and vice versa.