A clinical study of post-operative complications of emergency and elective (open and laparoscopic) appendicectomy

Background: Post-operative complications which follows appendicectomy are not common and it reflect the level of peritonitis that is present during the time of surgery and the diseases which may be predisposed to complications. There are various types of complications that occurred after the appendicectomy surgery. Of them, the commonest complications are fever and surgical site infection. Post-operative complications of appendicectomy have wide range of presentation from fever to fecal fistula. In this study, the patients presenting with features of post-operative complications of appendicectomy will undergo detailed history taking, clinical examination & investigations like complete blood count, blood sugar, urea and lipid profile, serum creatinine, X-ray chest and wound pus culture sensitivity. The study purpose was to assess the age distribution, sex distribution & to discuss various types of complication. Materials and methods: 100 cases that had presented with features of post-operative complications of appendicectomy in the department of surgery, Tirunelveli Medical College and Hospital were evaluated during the study period from April 2012 to October 2013. Results: Our study of 100 randomly selected patients who presented with postoperative complications of appendicectomy. The commonest post-operative complications of appendicectomy were fever (73%), followed by surgical site infection (37%). Most common age group, in which post-operative complications seen, was > 20 years, followed by the 20-30 age group. The surgical site infections were most commonly due to E.coli (64.86%) and Klebsiella species (8.1%). The common day of presentation of fever was 2nd POD with 57.3% cases. In this study 97% case of postoperative complications of appendicectomy occurred after emergency surgeries. R. Maheshwari, Rakesh Fernando. A clinical study of post-operative complications of emergency and elective (open and laparoscopic) appendicectomy. IAIM, 2018; 5(7): 62-66. Page 63 Conclusion: Major complications were rare in elective appendicectomies which may reflect the reduced virulence of organisms in those cases.

Fine Needle Aspiration Cytology in the Diagnosis and Management of Thyroid Diseases

Background: Swellings of thyroid are frequently encountered in surgical practice. With clinical evaluation it is difficult to distinguish early malignant lesions from common benign goiters. Surgical excision is the only means by which a definitive diagnosis is obtained based on HPE. An alternative approach is called for other than surgery as most cases are benign. FNAC is a simpler and safer procedure carried out in the OPD with minimal equipment and has good patient compliance. The present study aims at correlating the cytological diagnosis with the final histological diagnosis to evaluate the sensitivity, specificity and accuracy of FNAC smears, thereby its role in preoperative diagnosis in planning proper management. Aim: To determine the accuracy and the role of fine needle aspiration cytology (FNAC) as a diagnostic modality in the diagnosis and treatment of thyroid diseases. Materials and methods: A proforma was drafted for the study of all patients presenting with history of palpable thyroid swelling and undergo surgery in our hospital. Clinical presentations, FNAC and histopathology of all cases were documented. Results: 100 cases who presented with thyroid swellings were studied and their histopathological diagnosis was compared with the FNAC. Of the 86 cases which were seen benign by FNAC, 82 were confirmed by histopathology. Of the 18 cases which were proved to be malignant by histopathology 14 were only seen as malignant by FNAC. The sensitivity of FNAC in the diagnosis of benign lesions was found to be 77.78%, specificity was 100%, positive predictive value 100% and accuracy is 96%. Conclusion: Most of our patients were between third and fourth decade, with females being predominant. Most cases were benign of which multinodular goiter being the most dominant pathology (25%). Among the malignancies, majority being papillary carcinoma (78.94%). The R. Maheshwari, Rakesh Fernando. Fine Needle Aspiration Cytology in the Diagnosis and Management of Thyroid Diseases. IAIM, 2017; 4(9): 75-81. Page 76 sensitivity, specificity and predictive value of positive smears being 77.78%, 100%, and 100% respectively. FNAC was of greater help in the preoperative management of thyroid swellings. Multinodular goiters and colloid goiters were distinguished easily by FNAC but confusion prevailed in cases of follicular adenomas. In patients who cannot be followed up regularly clinical suspicion should be one of the indications for surgery despite of FNAC being negative. FNAC is simpler, safer, quicker and more informative, when compared with other sophisticated methods in the diagnosis of thyroid lesions.

A Clinicopathological study on Cervical Lymphadenopathy

Background: Cervical lymphadenopathy can be a confounding problem in surgical practice. The analysis of cervical lymphadenopathy is never straightforward and the difficulty is compounded by the differential diagnoses that include several diseases that resemble each other. Clinical evaluation, aspiration cytology, and open biopsy are some of the methods available for this purpose. Aim: To study the prevalence of the cervical lymphadenopathy in respect to age, sex, to study about the various clinical presentation of cervical lymphadenopathy, to correlate the pathological findings with the clinical diagnosis and to study the role of FNAC by correlating with confirmed biopsy report. Materials and methods: 75 patients with cervical lymphadenopathy were selected from the General Surgery OPD of Tirunelveli medical college. They were subjected to FNAC and excision biopsy of the nodes after a thorough history and clinical examination. The results were tabulated and analyzed. Results: The most common diagnosis was Tuberculous lymphadenitis (67%) followed by reactive (9%) and non-specific lymphadenitis (9%) with malignant secondaries (11%) and lymphomas (4%). There was a slight male preponderance (57.3%) The most common presenting age groups were between 31 to 40 years followed by 21 to 30 years. The most common presenting symptom was neck swelling (88%) followed by fever (37.3%) and Loss of weight (18.7%). Conclusion: Tuberculous lymphadenopathy continues to be the major reason for cervical lymphadenopathy with malignancy as an important differential diagnosis. FNAC is a versatile diagnostic tool and one of the least invasive tests in the workup of cervical lymphadenopathy. It is very accurate in diagnosing malignancy and lymphomas and reasonably so in diagnosing tuberculosis.

Red man Syndrome: an unusual complication of vancomycin beads.

Vancomycin is a bactericidal antibiotic. It is commonly used to treat Methicillin Resistant Staphylococcus Aureus (MRSA) infections. It is also used locally with Polymethyl methacrylate to treat chronic bone infections. Locally placed beads deliver high concentration of antibiotics locally with few adverse effects as compared to parenteral therapy. There are two complications mentioned on intravenous infusion of vancomycin namely anaphylactic reaction and red man syndrome; but there is no known literature on complications arising from vancomycin impregnated cement beads. We report a case of red man syndrome following usage of vancomycin impregnated cement beads which is not reported in any available orthopaedic literature.

Possibility of scrub typhus in fever of unknown origin (FUO) cases: An experience from Rajasthan.

Purpose: Fever of unknown origin (FUO) has multiple causes. Scrub typhus is less known cause of FUO in India. The present study reports a recent epidemic of scrub typhus amongst cases of FUO from different areas of Rajasthan, India. There was high mortality in undiagnosed cases of FUO which lead to the diagnosis of scrub typhus. Objective: To study the possibility of scrub typhus as a causative factor in FUO cases by qualitative detection of IgM antibodies with ELISA. Materials and Methods: From September 2012 to December 2012, 271 serum samples of FUO cases were analysed for IgM antibodies to Orientia tsutsugamushi along with dengue, malaria, typhoid, tuberculosis and brucellosis. Results: Scrub typhus IgM antibodies by ELISA were detected in 133 (49.1%) patients. Scrub typhus positivity was significantly higher among female in comparison to males (P < 0.05). Maximum positivity of scrub typhus was found in females of 46‑60 years age group. The laboratory parameters were abnormal in most of the patients as evident by thrombocytopenia (63%), deranged liver functions (56%) and renal functions (25%). Conclusion: The present study emphasises the importance of scrub typhus among cases of FUO especially after rainy season and during early cooler months. The study also highlights the significance of ELISA method for rapid and early reporting and ruling out scrub typhus in FUO cases.

Neural network-based species identification in venom-interacted cases in India

India is home to a number of venomous species. Every year in harvesting season, a large number of productive citizens are envenomed by such species. For efficient medical management of the victims, identification of the aggressor species as well as assessment of the envenomation degree is necessary. Species identification is generally based on the visual description by the victim or a witness and is therefore quite likely to be erroneous. Symptomatic identification remains the only available method. In a previous published work, the authors proposed a classification table for snake species based on manifested symptoms applicable in Indian subcontinent. The classification table serves the purpose to a great deal but as a manual method it demands human expertise. The current paper presents a neural network-based symptomatic species identification system. A symptom vector is fed as input to the neural network and the system yields the most probable species as well as the envenomation severity as the output. The severity status can be very helpful in calculating the antivenom dosage and in deciding the species-specific prognostic measures for efficient medical management.(AU)

Toxicity and symptomatic identification of species involved in snakebites in the Indian subcontinent

Snakebites, being the major occupational hazard for farm workers, claim a large number of lives in the Indian subcontinent. During the course of medical management, identification of the biting species is given a low priority, resorting to prescription of polyvalent anti-snake venom. Whereas the World Health Organization (WHO) recommends monospecific anti-snake venom instead of polyvalent anti-snake venom. Thus, it is essential to identify the aggressor species either by a visual inspection or by the symptoms of the victim. Along with the four deadly venomous species (cobra, krait, Russell's viper, and saw-scaled viper), there are a number of other species of medical importance, whose venoms and bites have not been paid much attention. Thus, a misclassification resulting into erroneous treatment cannot be ruled out. This paper discusses the nature, constitution, and toxicity of venoms and their possible toxic effects on victims of snakebites. An attempt has also been made to categorize the distinctive symptoms due to the bites of the four major venomous species and their severity grading.(AU)

Juvenile neuronal ceroid lipofuscinosis.

A case of juvenile neuronal ceroid lipofuscinosis (JNCL) diagnosed on the basis of clinical features, electrophysiologic studies and skin electron microscopy is reported. JNCL was suspected on the basis of characteristic symptoms including progressive loss of vision, seizures, mental retardation and motor disabilities. Diagnosis was confirmed by neurophysiological and biopsy studies. The disease is caused by 23 different mutations in a gene recently isolated on chromosome 16 p11.2-12.1. Although universally fatal, characterisation of mutations can help in prenatal diagnosis in future pregnancies.

Incidence and risk factors of retinopathy of prematurity in a tertiary care newborn unit in New Delhi.

BACKGROUND: Retinopathy of prematurity (RoP) has become more common in developed countries with an improvement in survival of very premature infants. Though previously rare, it is likely to emerge as a major problem in India because of improving outcome of 'at-risk' preterm infants. METHODS: In a prospective study we estimated the incidence of RoP among at-risk neonates in a tertiary care unit. Infants with birth-weights of < 1500 g, gestation < 35 weeks and preterm neonates who required supplemental oxygen for > 24 hours were subjected to periodic ophthalmological evaluation for detection of RoP until full retinal vascularization occurred. RESULTS: Sixty-six eligible infants completed the full protocol during the 15-month study period. The incidence of RoP was 20% in the cohort and 27% among the very low birth-weight neonates. The incidence of threshold RoP was 7% in the cohort. The occurrence of RoP was inversely related to the gestation and birth-weight. RoP typically developed at the post-conceptional age of 32-35 weeks. Blood transfusion and clinical sepsis emerged as independent risk factors of RoP on step-wise logistic regression analysis. Cryotherapy undertaken in 5 cases (9 eyes) led to amelioration of the changes of RoP. CONCLUSION: The incidence of RoP in our neonates was lower than that reported from other centres. Blood transfusion and clinical sepsis are risk factors for RoP in our newborn infants.

Thermophilic fungi: an assessment of their potential for growth in soil.

An attempt has been made to forecast the potential of thermophilic fungi to grow in soil in the laboratory and in the field in the presence of a predominantly mesophilic fungal flora at usual temperature. The respiratory rate of thermophilic fungi was markedly responsive to changes in temperature, but that of mesophilic fungi was relatively independent of such changes. This suggested that in a thermally fluctuating environment, thermophilic fungi may be at a physiological disadvantage compared to mesophilic fungi. In mixed cultures in soil plates, thermophilic fungi outgrew mesophilic fungi under a fluctuating temperature regime only when the amplitude of the fluctuating temperatures was small and approached their temperature optima for growth. An antibody probe was used to detect the activity of native or an introduced strain of a thermophilic fungus, Thermomyces lanuginosus, under field conditions. The results suggest that although widespread, thermophilic fungi are ordinarily not an active component of soil microflora. Their presence in soil most likely may be the result of the aerial dissemination of propagules from composting plant material.

Potentiation of immune response against malaria in immunocompromised mice through glucan as an immunoadjuvant.

Untreated mice were fully immunocompetent but their treatment with various immunosuppressors rendered them immunocompromised with respect to one or the other or both limbs of immunity. Both, humoral immune response or cell mediated immune response suppressed mice were only partially protected against the challenge with Plasmodium berghei following their immunization. Hydrocortisone treated mice, in which both types of immune responses were suppressed, were not protected against the challenge with P. berghei following their immunization. In contrast, untreated immunized mice, were fully protected against the challenge with P. berghei. The results suggest that glucan potentiated both limbs of immunity and both were involved in the host defence against malaria.

Immunoprotection by beta-1,3 glucan antigen combination in Plasmodium berghei infection in mice.

In an attempt to protect mice against experimental infection with P. berghei, mice were immunized against soluble extract of P. berghei in combination with beta-1,3 glucan or FCA and also independently. Mice immunized against P. berghei antigen-glucan developed well defined cell mediated and humoral immune responses, while mice injected with antigen FCA or antigen alone developed only an antibody response. Antigen-glucan immunization afforded a high degree of immune protection to the host against the challenge with live parasites.