Role of acute physiology and chronic health evaluation II scoring system in risk stratification and management of small bowel perforations

Background: Despite the surgical treatment, sophisticated intensive care units, latest generation antibiotics and a better understanding of pathophysiology, the morbidity and mortality rate of perforation peritonitis are still high. Patients are usually managed by subjective decision of surgeon based on which mortality is very high.Methods: This was a double-blind observational study conducted over a period of 18 months on 50 patients with small bowel perforations. Based on the acute physiology and chronic health evaluation (APACHE) II score at presentation, patients were triaged into 3 groups: group 1 (score ≤10), group 2 (score 11 to 20) and group 3 (score >20). Study population was managed by the subjective decision of the operating surgeon who was blinded off the APACHE II score of patients. Hence removing the possibility of bias and observing a correlation between surgical outcome and APACHE II score of the patient.Results: Patients with higher APACHE II score (>10) were more likely to undergo exteriorization of bowel. Length of hospital stay was also found to be increased with an increase in score. APACHE II score of 10 was found to predict mortality with significant difference between 2 groups. Below this score the mortality was 0% and above this score the mortality rate rose to 31.25%.Conclusions: APACHE II can be used as a reliable and uniform scoring system as its assessment at presentation in patients of small bowel perforations provides an insight to their surgical management as well as predicting overall outcome.

Neuroendocrine tumour of colon mimicking psoas abscess: an unusual presentation of an uncommon malignancy

Psoas abscess is a rare disease usually arising due to a benign underlying pathology such as tuberculous disease of spine, Crohn’s disease and diverticulitis. But it can be an uncommon presentation of intra abdominal malignancy. Spontaneous rupture of colon cancer, combined with psoas abscess formation is very rare. Most of these cases have been reported in relation to carcinoma colon. Colon is an uncommon site for neuroendocrine tumors. 70-80% of these tumors are asymptomatic and are found incidentally at the time of surgery or on colonoscopy. Through this article we report a rare case of neuroendocrine tumor (NET) of colon in an elderly man presenting as psoas abscess associated with intestinal obstruction.

A rare case of testicular dislocation with inguinal hernia as a delayed presentation after scrotal trauma

Testis can be damaged either by blunt or penetrating trauma. Traumatic dislocation of testis is rare sequelae of scrotal trauma. Patients usually present at the time of injury and diagnosis is usually made on emergent basis. However, delayed or missed diagnosis may occur as scrotal injury may be overlooked in the presence of other associated injuries or due to lack of awareness of its possible occurrence. In this article, we report a case of 60 years old gentleman who presented with inguinal hernia with empty left hemiscrotum with history of blunt injury to scrotum 15 years back. The peculiarity of case lies in the fact that the dislocation of testis was diagnosed 15 years after trauma and the displaced testis was found to be atrophic.

Study of mullerian anomalies over 5 years in a tertiary care centre

Background: Mullerian anomalies-developmental anomalies of the mullerian system might involve the uterus, cervix, fallopian tubes and vagina of which anomalies of the uterus are the most common. They are often regarded as a treatable form of infertility and have a prevalence of 0.5% in the general population. Though most of them remain asymptomatic, they contribute a good proportion of recurrent pregnancy losses, obstetric complications and infertility. Their timely diagnosis, management and evaluation of associated anomalies proves to be necessary.Methods: A prospective observational study was undertaken at KIMS, Hubli from 2014 to 2018. The study involved those women who were admitted in the department of obstetrics and gynecology at KIMS, Hubli for various reasons and were detected to have a mullerian anomaly. Their mode of presentation, method of detection, associated anomalies were analysed and statistical conclusions drawn from the same.Results: During the study period of 5 years, a total of 85 cases of mullerian anomalies were detected amounting to an incidence of 0.15%. 35% of them were asymptomatic, infertility (24%) being the next common mode of presentation. Septate/sub-septate uterus was found to have the poorest obstetric outcome. Mullerian anomalies were seen in combination in 14% of the cases and had an association with other anomalies like renal anomalies in 10% of the cases. Surgical correction was done for most of the cases of vaginal septum and septate/sub-septate uterus.Conclusions: Mullerian anomalies are often regarded as an uncommon but treatable form of infertility. Their timely detection, treatment and watchful obstetric management is in need.

Elective induction of labour at 39 weeks versus expectant management up to 41 weeks in a tertiary care centre

Background: The timing of delivery and effective management of labour at term makes a huge difference in the obstetric and perinatal outcome. There have always been controversies between choosing the elective induction of labour at 39 weeks versus expectant management up to 41/42 weeks which can result in placental ageing, reduced liquor, non-assuring fetal heart tracings, meconium stained amniotic fluid and fetal macrosomia.  our objective was to perform a comparative effectiveness analysis of elective induction of labor at 39 weeks gestational age among nulliparous women with uncomplicated singleton pregnancies as compared to expectant management up to 41 weeks.Methods: 120 primigravidae with singleton pregnancies with fetus in cephalic presentation were recruited into the study and divided into 2 groups of 60 each A: Patients were induced electively using dinoprostone gel (maximum 3 doses 8 hours apart) B: They were managed expectantly up to 41 weeks allowing for spontaneous onset of labour, induction or cesarean section was done for obstetric indications between 39 and 41 weeks and pregnancy was  terminated by induction for those who continued up to 41 weeks. Their obstetric and perinatal outcome were noted.Results: The cesarean section rates were higher in the expectantly managed group (21%) when compared to the electively induced group (16%). The same was with instrumental delivery rates (15% versus 10%). The perinatal outcome was poorer for the expectantly managed group with 20% NICU admissions and 5% perinatal deaths compared to the electively induced group which had 12% NICU admissions and 3.3% perinatal deaths. The expectantly managed group also resulted in respiratory distress in a larger number of fetuses and resulted in problems due to reduced liquor.Conclusions: Elective induction at 39 weeks gestational age was found to be a better option compared to expectant management up to 41 weeks in terms of obstetric and perinatal outcomes.

A comparative study between ferrous carboxy maltose and iron sucrose in the management of post-partum anaemia in tertiary care hospital

Background: Anaemia is a global public health problem contributing tremendously to maternal morbidity and mortality. It is the most common indirect cause of maternal mortality. Variety of injectable iron preparations are now available which can be effective tools for combating post-partum anaemia. This study aims to compare FCM (Ferrous carboxy maltose) and iron sucrose in the treatment of iron deficiency anaemia in post-partum women at KIMS, Hubli, Karnataka, India.Methods: This study was conducted at KIMS, Hubli in the year 2018-19 wherein 100 post-partum women with hb levels ranging from 5-10g% were selected for the study and randomly allocated into 2 groups- FCM group and iron sucrose group. They were administered 1g of FCM and 1g of iron sucrose respectively after clinical evaluation and baseline measurement of hb. They were followed up after 2 weeks for repeat hb% and review of signs and symptoms. FCM and iron sucrose were compared in terms of their efficacy.Results: The mean increase in hb% was found to be 3.2 g% in the FCM group and 2 g% in the iron sucrose group. FCM was also found to be more efficacious in providing relief of common signs and symptoms like easy fatigability and pallor compared to iron sucrose.Conclusions: Ferrous carboxy maltose was found to be more efficacious compared to iron sucrose.