A comparative analysis between Mannheim peritonitis score and acute physiological and chronic health evaluation II score in predicting prognosis of patients of perforation peritonitis

Background: The early assessment and recognition of peritonitis patient is required in surgical emergency. Various scoring system have been designed successfully to assess the prognosis and outcome of peritonitis. The present study was carried out with an aim to evaluate the usefulness and severity of Mannheim peritonitis (MPI) score in comparison to acute physiological and chronic health evaluation II (APACHE II) scoring system for prediction of the outcome in patients with perforation peritonitis and thus decision making in perforation peritonitis.Methods: A prospective observational study was carried out at Department of Surgery, King George’s Medical University (KGMU), Lucknow for a period of one year from July 2018 to June 2019. A total of 100 patients were enrolled in the study.Results: Majority of patients were males compared to females. Maximum number of patients (40%) was aged 51-60 years. Maximum number of patients (42%) had duodenal perforation. A significant association between higher MPI scores and mortality was seen (p<0.001). Statistically, the association between APACHE II scores and mortality was significant (p<0.001).Conclusions: APACHE II had a slightly higher sensitivity as well as specificity as compared to MPI. MPI is easy to calculate but accuracy of APACHE II is more, compared to MPI.

A cross sectional study of cutaneous manifestations in 300 patients of diabetes mellitus

Background: Diabetes Mellitus (DM) is a worldwide problem and one of the most common endocrine disorder. The skin is affected by both the acute metabolic derangements and the chronic degenerative complications of diabetes.Methods: The present study was a one-year cross sectional study from January 2014 to December 2014. All confirmed cases of DM with cutaneous manifestations irrespective of age, sex, duration of illness and associated diseases, willing to participate in the study were included in the study. Routine haematological and urine investigations, FBS, RBS and HbA1c levels were carried out in all patients.Results: A total of 300 patients of diabetes mellitus with cutaneous manifestations were studied. Majority belonged to the 4th decade (33%) and 3rd decade (27.7%) respectively. Males constituted 65% of the cases and male to female ratio was 1.85:1. Type 2 DM was most commonly observed (96%). Among the 300 diabetic patients, 73 patients (24.3%) had good control of DM with HbA1c levels in the range of 6.5-7% while 132 patients (44%) had a poor control of DM with HbA1c levels >8%. Hypertension was the most commonly associated systemic illness (37.6%). Cutaneous infections (63%) were the most commonly observed manifestation of which fungal infections (35.3%) were most frequently observed. Some of the other dermatoses observed were generalized pruritus (15.3%), acrochordons (11%), acanthosis nigricans (6%), diabetic dermopathy (5.33%), diabetic foot (3%), peripheral vascular disease (2.66%), vitiligo (2.66%), xanthelasma palpebrarum (2.33%), diabetic bullae (1%). Cutaneous infections, dermatoses associated with microangiopathy were more common in the uncontrolled diabetic patients which was statistically significant.Conclusions: Infections were the most common cutaneous manifestations in diabetics followed by dermatoses most commonly associated with diabetes. Proper skin care and long-term control of blood glucose levels may reduce the risk of some of the skin diseases.

Biodiesel production from seed oil of Cleome viscosa L.

Edible oil seed crops, such as rapeseed, sunflower, soyabean and safflower and non-edible seed oil plantation crops Jatropha and Pongamia have proved to be internationally viable commercial sources of vegetable oils for biodiesel production. Considering the paucity of edible oils and unsustainability of arable land under perennial plantation of Jatropha and Pongamia in countries such as India, the prospects of seed oil producing Cleome viscosa, an annual wild short duration plant species of the Indogangetic plains, were evaluated for it to serve as a resource for biodiesel. The seeds of C. viscosa resourced from its natural populations growing in Rajasthan, Haryana and Delhi areas of Aravali range were solvent extracted to obtain the seed oil. The oil was observed to be similar in fatty acid composition to the non-edible oils of rubber, Jatropha and Pongamia plantation crops and soybean, sunflower, safflower, linseed and rapeseed edible oil plants in richness of unsaturated fatty acids. The Cleome oil shared the properties of viscosity, density, saponification and calorific values with the Jatropha and Pongamia oils, except that it was comparatively acidic. The C. viscosa biodiesel had the properties of standard biodiesel specified by ASTM and Indian Standard Bureau, except that it had low oxidation stability. It proved to be similar to Jatropha biodiesel except in cloud point, pour point, cold filter plugging point and oxidation stability. In view of the annual habit of species and biodiesel quality, it can be concluded that C. viscosa has prospects to be developed into a short-duration biodiesel crop.

Florid cutaneous papillomatosis with adenocarcinoma of stomach in a 35 year old male.

Various paraneoplastic dermatoses may be seen in association with underlying visceral, especially gastrointestinal, malignancy. Florid cutaneous papillomatosis describes the sudden appearance of multiple acuminate keratotic papules that morphologically resemble viral warts. It may be seen in association with acanthosis nigricans and/or the sign of Leser Triotalat. We report a 35-year-old male with extensive seborrhoeic keratoses and florid cutaneous papillomatosis. Unusually marked verrucous changes caused disfigurement of the hands and feet. The patient also reported dyspepsia, abdominal distention and weight loss 6 months prior to the development of cutaneous lesions. Gastroscopy revealed a large growth in the stomach. Histopathology of the tumor showed features of adenocarcinoma.

Juvenile hyaline fibromatosis in siblings.

Juvenile hyaline fibromatosis (JHF) is a rare, autosomal recessively inherited disorder. We report two siblings with multiple large tumors on the scalp, translucent papules on the nape of the neck, hypertrophic gingiva, and severe flexural contractures of large joints. The histopathology from the skin lesions showed features characteristic of juvenile hyaline fibromatosis. The cases are being reported on account of the extreme rarity of the condition.