Demography, Spectrum, and Characteristics of Symptoms Associated With Post-operative Relief After Cholecystectomy.

Background Cholecystectomy is one of the most commonly performed surgical procedures, and it is indicated for symptomatic gallstone disease. Symptoms of gallstone disease vary; many patients complain of the persistence of symptoms post-operatively. Hence, it is imperative to know the characteristics of symptoms that predict post-operative resolution. Methodology A prospective cross-sectional study was performed at a tertiary care centre. Patient demography and pre-operative symptoms were noted. Post-operative persistence or relief of symptoms was also documented. The occurrence of any new symptoms was noted. Data were collected at three and six months after surgery. Results Pain was the most common (85%) symptom. The mean frequency of pain was 2.45 per year (range 0-10). The mean duration of pain was 39.7 minutes (range 15-90 minutes). The right hypochondrium (39%) and the epigastric region (42%), along with 8% of patients who experienced pain in both places, were the most frequent locations of pain. The radiation of pain to the right-side scapula is present in 48% of patients. The pain persisted after one-week follow-up in 28 (34%) of patients, 26 (22%) at the end of one month, and 18 (21%) at the end of six months. Dyspepsia was unresolved in 25%, 20%, and 13% of individuals after one week, one month, and six months, respectively. Upper abdominal discomfort was still persistent in 29%, 26%, and 24% of study subjects at the time of follow-up periods, respectively. Similar persistence is found in symptoms of post-prandial fullness and nausea, where unresolved complaints of post-prandial fullness were present in 18%, 13%, and 10% of patients, respectively, and 26%, 14%, and 10% of patients complained of nausea. Conclusion The persistence of symptoms such as upper abdominal discomfort, dyspepsia, post-prandial fullness, and nausea is present, which gradually decreases in severity and presentation over the course of time after the surgical procedure. Some symptoms present after surgery, such as flatulence. Such persistent symptoms might lead to a decreased outcome in terms of patient satisfaction. Patients with atypical pain or dyspepsia need to be counselled pre-operatively regarding the poor resolution of such symptoms.

Practice of antimicrobial stewardship in a government hospital of India and its impact on extended point prevalence of antibiotic usage.

BACKGROUND: Antimicrobial resistance (AMR) is a global concern requiring immediate attention. Among many proven measures of decreasing AMR, practice of antimicrobial stewardship is the lowest hanging which can be adapted with negligible financial implications. METHODS: This is a case record based extended cross-sectional type of observational operation research study conducted at an institute of national importance established by Government of India. Point prevalence of antibiotic usage among the patients admitted in the hospital, on four different days in four different quarters of a year was done to study the impact of antimicrobial stewardship program (AMSP). RESULTS: A cumulative 711 patients were exposed on antibiotics among 1396 study participants. There was a significant decrease in antibiotic consumption across the 1st and 4th quarter. The average antibiotic usage was 50.9% (61.75, 60%, 48.4%, and 39% respectively in the 1st to 4th quarter). Among the total number of patients, intravenous antibiotic usage was 47.9% (60.71%, 58.4%, 44.9%, and 34.2% respectively in 1st to 4th quarter). Among the newly admitted patients, the consumption of antibiotic usage decreased from 45.9% to 25.7%. Among the intravenous antibiotics, the top 10 consumed antibiotics were 3rd generation cephalosporin (39.8%), aminoglycoside (14.8%), amoxicillin/amoxy-clav (12.5%), piperacillin-tazobactum (8.5%), carbapenams (6.6%), cefuroxime (6.4%), quinolones (4.3%), vancomycin/linezolid (4.1%), colistin (0.8%), and others (0.8%). CONCLUSION: Government run hospitals can run low budget antimicrobial stewardship program with sustainable impact on antibiotic consumption. For a successful AMSP, it requires change in attitude, commitment, and administrative support rather than a huge financial support.

Recurrent phyllodes tumour of breast infiltrating the latissimus dorsi reconstruction flap.

Phyllodes tumour is a rare breast tumour with potential of malignancy. Recurrence in phyllodes tumour may also be suggestive of malignant transformation. We report a case of 29-year-old woman with recurrent phyllodes tumour infiltrating the latissimus dorsi reconstruction flap. Re-excision of the tumour along with excision of latissimus dorsi flap was done. Histopathology confirmed malignant phyllode tumour. A significantly higher incidence of recurrence is seen in phyllodes tumour of large size, tumours with infiltrative borders, increased mitotic activity, malignant histology and positive margins. Surgeons should always take into consideration the risk factors for recurrence before planning reconstructive breast surgery in recurrent phyllodes tumour. A preoperative MRI imaging and incisional biopsy are essential in planning surgery for these patients.

Characterization of the Southwestern Desert Aerosol, Meadview, AZ.

Sulfate, organic carbon, and soil dust were the major components of the fine aerosol at Meadview, AZ, during the summer of 1992. Sulfate mass median diameters (typically 0.15-0.27 µm) were much smaller than mass median diameters for organic carbon (typically 0.43-0.83 µm). Organic carbon size distributions were broader and more varied. Intersampler comparisons show that sulfur and sulfate measurement technology provided precise and relatively accurate (within 2-22%) concentrations. However, large differences were observed between IMPROVE filter and MOUDI impactor carbon concentrations. This is indicative of the large uncertainties with which carbon concentrations are measured. The IMPROVE backup filter subtraction procedure was partially responsible for these differences. Meadview sulfate was not completely neutralized by ammonium; SO2 concentrations were comparable to sulfate concentrations; and virtually all of the nitrate was present as gas-phase nitric acid. Our estimates suggest that primary organic aerosol from urban areas accounts for no more than 24% on average of the organic aerosol found at Meadview, AZ. The remainder is most likely secondary and biogenic OC, as well as OC from local and regional anthropogenic sources.

The Development of a Model to Examine Source-Receptor Relationships for Visibility on the Colorado Plateau.

This paper describes the development and application of the Visibility and Haze in the Western Atmosphere (VISHWA) model to understand the source-receptor relationships that govern chemical species relevant to visibility degradation in the western United States. The model was developed as part of a project referred to as Visibility Assessment for Regional Emission Distributions (VARED), the objective of which is to estimate the contributions of various geographical regions, compounds, and emission sources to light scattering and absorption by particles on the Colorado Plateau. The VISHWA model is a modified version of a comprehensive Eulerian model, known as the Acid Deposition and Oxidant Model.1 The modifications were designed to obtain the computational efficiency required to simulate a one-year period at about 1/25th of real time, and at the same time incorporate mechanistic features relevant to realistic modeling of the fate and transport of visibility degrading species. The modifications included use of a condensed chemical mechanism; incorporation of reactions to simulate the formation of secondary organic particles; and use of a semi-Lagrangian advection scheme to preserve concentration peaks during advection. The model was evaluated with 1992 air quality data from Project MOHAVE (Measurements of Haze and Visual Effects) intensive experiments. An important conclusion of this evaluation is that aqueous-phase oxidation of SO2 to sulfate in nonprecipitating clouds makes a significant contribution to observed sulfate levels during winter as well as summer. Model estimates of ambient sulfate for the winter intensive were within a factor of 2 of the observations for 75% of the values. The corresponding statistic for the summer intensive was 90%. Model estimates of carbon were within a factor of 2 of the limited set of observations.