Risk factors influencing postoperative outcome in patients with perforated peptic ulcer: a prospective cohort study.

BACKGROUND: Perforated peptic ulcer (PPU) has been associated with substantially high incidence of morbidity and mortality. The aim of this study was to analyze the factors affecting the outcome of patients having perforated peptic ulcer undergoing surgical intervention. MATERIALS AND METHODS: Medical records of 112 patients with PPU who underwent emergency laparotomy between December 2014 and November 2016 were prospectively analyzed. Primary suture of the perforation and pedicled omentoplasty was done in all the patients. Data regarding patients was collected and correlated with the postoperative outcome. RESULTS: The overall postoperative morbidity and mortality were 62.5% and 30.4%, respectively. On univariate analysis advanced age (≥ 60 years) [(p = 0.005), (OR = 3.6), (95% CI = 1.5-8.8)], pre-operative shock [(p < 0.001), (OR = 7.4), (95% CI = 2.6-21.0)], delayed presentation (> 24 h) [(p = 0.007), (OR = 4.0), (95% CI = 1.5-11.2)] and raised serum creatinine [(p < 0.001), (OR = 7.7), (95% CI = 3.1-19.0)] were found to be significantly associated with the post-operative morbidity. For mortality, advanced age (≥ 60 year) [(p < 0.001), (OR = 5.02), (95% CI = 2.1-11.9)], pre-operative shock [(p < 0.001), (OR = 19.3), (95% CI = 6.9-53.6)], comorbidity [(p = 0.03), (OR = 6.6), (95% CI = 1.2-35.7)] and raised serum creatinine [(p < 0.001), (OR = 13.1), (95% CI = 4.5-37.8)] were statistically significant factors. Multivariate analysis showed advanced age (≥ 60 years) (p = 0.05) and raised serum creatinine (p = 0.004) as significant factors for increased risk of post-operative morbidity. Advanced age (≥ 60 years), pre-operative shock and raised serum creatinine were found to be independent risk factors influencing post-operative mortality (p < 0.05). CONCLUSION: A thorough clinical evaluation, adequate resuscitation, sepsis control, addressing comorbidities and early access to hospital can reduce the risk morbidity and mortality in patients with PPU.

Thermophysiological comfort of sonochemically synthesized nano TiO2 coated woven fabrics.

This work investigates thermophysiological comfort properties of sonochemically synthesized nano TiO2 coated cotton and polyester woven fabrics. The obtained results were analysed on heat and mass transfer basis. Moisture management tester and Alambeta were utilised for moisture transportation and thermal evaluation. This study precisely investigates the effects of sonication on surface roughness of nano TiO2 coated and uncoated samples. Ultrasonic acoustic method was applied to imbibe nano TiO2 on fabric samples. Surface topography, morphology and the existence of nano TiO2 on investigated samples were analysed by scanning electron microscopy and inductively coupled plasma atomic emission spectroscopy. In addition, standard test methods were applied to estimate physical and thermophysiological comfort properties i.e. thermal resistance, thermal diffusivity, heat flow, wetting time and accumulative one-way transport index of uncoated and nano TiO2 coated samples.

Rising HIV seroconversion rates & associated risks among employees of organization 'X': A case control study, Pakistan, 2017.

BACKGROUND AND OBJECTIVES: In 2004 Pakistan escalated from 'low-prevalence' to 'concentrated' phase of HIV epidemic. Despite global decline in HIV incidence since 1997, rate of HIV infections in Pakistan is persistently rising since 1990. Available literature focusses on key populations or localized outbreaks limited by short study duration and regional applicability of results. We studied HIV seroconversion trends over a period of 8 years in a geographically diverse population and evaluated associated risk factors. METHODS: A desk review of HIV surveillance data from 2010 to 2017 was carried out at Armed Forces Institute of Pathology. A case was defined as any adult employed in organization 'X', initially screened for HIV but later seroconverted on ELISA and western blot. Case-control study was conducted on cases diagnosed in 2017. Age and sex matched controls were identified from same population sub-group. Structured telephonic interviews were conducted and statistical analysis done at 5% margin of error. RESULTS: The annual HIV diagnosis rate remained relatively stable till 2015 (< 40 /100,000/yr) after which it rose sharply to 60/100,000/yr in 2016 .Upward trend continued in 2017 to reach 125/100,000/yr (>200% increase from baseline). Acquisition of HIV was significantly associated with commercial sex activities (OR=9; 95% CI: 1.25-395). CONCLUSION: HIV seroconversion rates among employees of organization X have increased significantly in the past two years. Unlike HIV outbreaks previously reported from Pakistan, sexual route seems to be the predominant mode of transmission. Focus is mandated on prevention of sexual transmission of HIV at national level as well for all vulnerable populations.

Experience with Haemorrhoidal artery ligation under direct vision at a tertiary care hospital: A case series.

This study aims to share the results of haemorrhoidal artery ligation under direct vision in the management of symptomatic haemorrhoids. We conducted a case series of 70 patients at Combined Military Hospital Rawalpindi & Quetta, from January 2015 to October 2017. All patients underwent Haemorrhoidal Artery Ligation (HAL) and Recto Anal Repair (RAR). Ligation of superior haemorrhoidal artery was done under direct vision following manual palpation. Patients were followed up postoperatively at 1, 3 and 6 months. At 1 month follow up, all 70 (100%) patients were pain free. Post operative bleeding was observed in 7 (10%) patients but did not require surgical intervention. Sixty two (89%) patients were able to return to their daily activities 1 week after surgery and 57 (81%) resumed military duties or joined their work place at 2 weeks. 70 (100%) patients were asymptomatic and 45 (64%) highly satisfied with their surgery at 3 months. This increased to 53 (75%) at 6 months. 48 (69%) said that they would recommend this procedure to someone else. Prolapse recurrence was observed in 1(1.42%) patient 6 months post operatively which was dealt by band ligation. All patients completed follow-up at 1, 3 and 6 months. HAL is a simple yet safe technique with few complications, acceptable patient satisfaction and early return to work.

Primary Supraclavicular Cystic Lymphangioma in an Adult: A Rare Presentation.

Cervicothoracic cystic lymphangiomas are found commonly in children less than 2 years of age, but the same are rare in adults. These form as a result of abberant development of embryonic lymph sac which is gradually filled with lymph fluid.1 They are commonly found in the head and neck region but can be present anywhere in the body. Preoperative diagnosis is based on careful history of a soft, painless, fluctuant, gradually enlarging mass and imaging. Surgery constitutes the basis of treatment and provides postoperative confirmation of diagnosis via histology. We, here report a case of cervicothoracic cystic lymphangioma in a 24-year male. The rationale of reporting this case is to discuss its presentation, diagnosis and surgical management. Moreover, we also want to highlight its scarcity in adults, the swelling being a diagnostic challenge and role of histology in affirmative diagnosis.

Ten-Year Experience of Managing Giant Duodenal Ulcer Perforations with Triple Tube Ostomy at Tertiary Hospital of North India.

Duodenal ulcer perforations have been known since 1600 AD. It is a common surgical emergency and every surgeon will encounter it. The perforation size of >2 cm has been used as the criteria for defining Giant duodenal ulcers. The management of giant duodenal perforations in hemodynamically unstable patient with comorbid condition is taxing because of high incidence of the postoperative leak and mortality. We have used the simple technique of Triple Tube Ostomy after the primary closure of the defect with encouraging results. It is a retrospective study done at the J. N medical college AMU Aligarh from May 2005 to May 2015. Hemodynamically unstable patients who have presented to the emergency with preoperative diagnoses of giant duodenal ulcer perforation and had undergone triple tube ostomy with primary repair of the perforation were included in the study. There were 34 patients of giant duodenal perforation who presented in shock. All of them underwent triple-tube-ostomy after primary repair of the duodenum. Thirty-two patients recovered with two mortalities (5.8 %). Several definite surgical techniques have been described for the management of giant duodenal ulcer perforation but they are complex, have very high morbidity and mortality rate and require an expert surgeon. A close retrospective scrutiny of the patients suggests that simple triple-tube-ostomy technique which is based on the principle of damage control surgery has good postoperative results Therefore, we recommend it as the procedure of choice in these patients.

Actinomycetoma leg ulcers in north India.

INTRODUCTION: Actinomycetoma is a chronic subcutaneous infection caused by aerobic branching actinomycetes. Its clinical features are firm tumefaction of the affected site and the presence of abscesses, nodules, and sinuses that drain a seropurulent exudate containing filamenting granules. Cutaneous actinomycetoma has traditionally been deemed uncommon in the northern part of India, but recent studies have refuted this long-held notion. Thus, clinicians have to be more vigilant when they come across patients with long-standing cutaneous lesions with typical mycetomic features, as early diagnosis and treatment hold the key to a cure. MATERIALS AND METHODS: This prospective study was carried out from June 2009 to December 2012 and comprises 13 cases of chronic nonhealing ulcers of the lower limb subsequently diagnosed as mycetoma. Socioetiological aspects, prevalence, early diagnosis, and treatment modalities of this condition are described in the study along with a simple, yet inclusive, scoring system to evaluate the post-treatment results. RESULTS: Ten out of 13 cases with clinical suspicion of actinomycetoma were diagnosed with the condition. A majority of these diagnosed patients were middle aged and belonged to lower socioeconomic status. There was no sexual preponderance. Early treatment in the form of modified Welsh regime (amikacin + cotrimoxazole + rifampicin) was started and showed acceptable results. Post-treatment outcomes were measured on the basis of a new scoring system (Masoodi's score) devised by the authors. Two patients had a score of > 7 (good), 5 patients had a score of 4-6 (fair), and 3 patients had a score of ≤ 3 (poor). CONCLUSION: Correct identification of the infective aetiological agent is imperative to direct therapy against actinomycetoma. Treatment success depends on an early diagnosis and instigation of treatment. Efficacy of chemotherapy, if started after an early diagnosis in the form of modified Welsh regime, produces acceptable results in the form of clinical and physical remission or cure. The functional and cosmetic parameters do not respond as well to treatment and the authors propose a new scoring system which takes into account the post-treatment results in totality.

Evaluation of oxidative stress and DNA damage in benign prostatic hyperplasia patients and comparison with controls.

In the present study, oxidative stress and lymphocytic DNA damage in both pre-op and post-op benign prostrate hyperplasia (BPH) patients with age >50 years was evaluated and compared with normal healthy subjects (controls- without any evidence of disease) of the same sex and age group. From December 2007 to November 2009, oxidative stress in 45 BPH patients were evaluated both before (pre-op patients) and after 7 days of surgery (post-op patients) in terms of measurements of plasma levels of (1) various anti-oxidative enzymes, (2) non-enzymatic antioxidants and (3) malondialdehyde which is a product of lipid peroxidation. The lymphocyte DNA damage was also evaluated by single cell alkaline gel electrophoresis in terms of tail length migration in these patients. These values were compared with their respective control subjects of similar sex and age group. The activities of antioxidant enzymes and the levels of antioxidant, reduced glutathione were found significantly decreased (p < 0.05) in serum samples of pre-operative group of BPH patients as compared to the controls. These altered parameters increased significantly (p < 0.05) and returned to their near normal control values, but not up to baseline values, in post operative patients i.e. after the cancer load was decreased by surgery. Lymphocytic DNA damage was found to be significantly increased in pre-op group as compared to controls and was reduced after surgery in post-op group. The present study therefore, shows significantly increased levels of oxidative stress and DNA damage in BPH patients which were reduced after removal of tumour load. Thus oxidative damage plays an important role in prostate tumourogenesis and timely management of oxidative stress can be of importance in preventing the occurrence of BPH.

Persistent port-site sinus in a patient after laparoscopic cholecystectomy: watch out for gallbladder tuberculosis.

BACKGROUND: The gallbladder is rarely affected by mycobacterium tuberculosis. The diagnosis of gallbladder tuberculosis is often not suspected prior to surgery or biopsy. METHOD: A young female patient underwent laparoscopic cholecystectomy but presented with a persistently discharging sinus from the port site. RESULTS: The gallbladder biopsy revealed granulomas typical of chronic granulomatous tuberculosis. The condition of the patient was improved by antitubercular treatment. CONCLUSIONS: Presentation of gallbladder tuberculosis as a persistent discharging sinus at the port site in a patient who has undergone a laparoscopic cholecystectomy is extremely rare. The diagnosis was reached by histopathology only. The rarity of the presentation prompted us to report the case.

Mammography-guided stereotactic fine needle aspiration cytology of breast lesions.

The purpose of the present study was to evaluate the efficacy of mammographic guided stereotactic fine needle aspiration cytology in 136 patients with breast lesions including mammographic features, cytomorphological findings and nuclear grading in malignant cases. Majority of the cases were predictable correctly by combination of the three modalities of diagnosis viz, clinical examination, mammography and cytology.

Neurohumoral alterations and their role in amoebiasis.

Amoebiasis is world wide in distribution and continues to be an important Public health problem. Intestinal amoebiasis may be present as dysentery, diarrhea or may stimulate other intra abdominal conditions. Clinical symptoms may not be seen in majority of patients, while amebic cysts are passed in the stool. This single-celled parasite is transmitted to humans via contaminated water and food. Amoebic dysentery can be accompanied by amebic infection of the liver and other organs. The present study was carried out to evaluate the changes in the circulating levels of neurohumors, their metabolizing enzymes and cortisol in these patients both before and after one month of chemotherapy. In the patients of amoebiasis the circulating acetylcholine (ACh), histamine, histaminase, cortisol, 5-Hydroxy tryptamine (serotonin) levels were significnatly enhanced with no change in the Dopamine-beta-hydroxylase (DBH) activity, while the activities of erythrocyte aceytylcholinesterase (AChE) and plasma Monoamine oxidase (MAO) were found decreased in comparison to normal healthy controls. After one month of treatment all the parameters reverted towards their control values, while the level of plasma histaminase remained still significantly high. The normal DBH activity reflects that there is no alteration in the circulating catecholamine levels. while the alteration in the levels of histamine, serotonin and cortisol may be due to the nonspecific response of the body to the stress of the disease and the parasitic infestation.

Pulmonary hydatidosis--a surgical experience.

Twenty-five cases of pulmonary hydatid cysts were studied with emphasis on age, sex and site distribution. In the present study, the youngest patient was of 4 years. Male predominance (2.125:1) with peak incidnce at 21-40 years was observed. Right lung was involved more frequently. Pain chest and haemoptysis were the commonest symptoms. No recurrence and no mortality were reported.