The Influence of Psychosocial Dysfunctions in Chronic Schizophrenia Patients in Remission: A Hospital-Based Study.

BACKGROUND: Psychosocial dysfunctions in the various psychosocial areas in chronic schizophrenic patients predict the long-term course, outcome, and quality of life of these patients, which always varies with years of treatment. OBJECTIVE: To know the influence and compare the level of psychosocial dysfunctions and severity of disability burden in chronic schizophrenic patients who are in remission with duration of 5 and 20 years. MATERIALS AND METHODS: The sample was collected from the OPD of Mental Health Institute (COE), S.C.B. Medical College, Cuttack, Odisha, India. This study is a cross-sectional study. A total of 120 remitted schizophrenic patients (60 patients of each group with duration of 5 and 20 years), who fulfilled Nancy Andreasen criteria for Remission were selected for the study. Regional language of dysfunction analysis questionnaire (DAQ) was used to assess the level of psychosocial dysfunctions in personal, familial, social, vocational, and cognitive areas of each patient. RESULTS: Qualitative data were analyzed using Chi-square and quantitative data were analyzed using t-test and correlation as a test of significance. Statistically significant differences (P < 0.05) were found in all five domains of DAQ between two groups. Statistically significant difference (P < 0.05) was found between the two groups with respect to severity of the disability. CONCLUSION: This study confirms that there are definite and substantial psychosocial dysfunctions in personal, familial, social, vocational, and cognitive spheres with the advancement of the duration of illness in chronic schizophrenic patients.

A prospective study of the Bedside Index for Severity in Acute Pancreatitis (BISAP) score in acute pancreatitis: an Indian perspective.

INTRODUCTION: A simple and easily applicable system for stratifying patients with acute pancreatitis is lacking. The aim of our study was to evaluate the ability of BISAP score to predict mortality in acute pancreatitis patients from our institution and to predict which patients are at risk for development of organ failure, persistent organ failure and pancreatic necrosis. METHODS: All patients with acute pancreatitis were included in the study. BISAP score was calculated within 24 h of admission. A Contrast CT was used to differentiate interstitial from necrotizing pancreatitis within seven days of hospitalization whereas Marshall Scoring System was used to characterize organ failure. RESULTS: Among 246 patients M:F = 153:93, most common aetiology among men was alcoholism and among women was gallstone disease. 207 patients had no organ failure and remaining 39 developed organ failure. 17 patients had persistent organ failure, 16 of those with BISAP score ≥3. 13 patients in our study died, out of which 12 patients had BISAP score ≥3. We also found that a BISAP score of ≥3 had a sensitivity of 92%, specificity of 76%, a positive predictive value of 17%, and a negative predictive value of 99% for mortality. DISCUSSION: The BISAP score is a simple and accurate method for the early identification of patients at increased risk for in hospital mortality and morbidity.

A rare presentation of a huge mature mediastinal teratoma with right lung cavitation.

A school-going child presented with fever and productive cough for a short period, which after laboratory and radiological survey was diagnosed as mediastinal teratoma with lung cavitation. Preoperatively the exact cause of lung pathology could not be established, although more common causes prevalent in this zone such as, tuberculosis and lung abscess were excluded. Surgical treatment was planned and excision of the mediastinal mass with segmentectomy of the right-upper lobe carried out through median sternotomy. Mature teratoma is the most common primary germ cell tumour of the mediastinum accounting for 60-70% of all mediastinal germ cell tumours. On very rare occasions it involves the adjacent lung, usually the left lung, producing secondary changes inviting suspicion of a separate lung pathology. Here we present a rare case of a huge mature mediastinal teratoma with secondary right lung cavitation.

Gardner's syndrome, a rare combination in surgical practice.

A 45-year-old man presented to the emergency ward with features of intestinal obstruction of 2 days duration. On admission, there was abdominal distension and multiple sessile polyps found on digital rectal examination. In addition, a soft tissue swelling near the elbow and a bony swelling over scalp were noted. Abdominal radiography revealed gaseous distension of the small and large bowel, and ultrasound revealed diffuse, gas-filled bowel with sluggish peristalsis. The obstruction failed to resolve with conservative measures and at emergency laparotomy an irregular hard recto-sigmoid junction mass was identified. A defunctioning transverse loop colostomy was undertaken and the abdomen closed. During recovery, a colonoscopy was performed and a malignant appearing lesion was identified 15 cm proximal to the anal verge. Further per-stomal colonoscopy revealed multiple sessile polyps from the ileo-caecal valve to the descending colon. The cutaneous and abdominal findings were consistent with a rare acute presentation of Gardner's syndrome.

Fracture penis: a case more heard about than seen in general surgical practice.

A 36-year-old man presented to the emergency department with a history of trauma to genitalia during intercourse. The patient reported the forceful collision between his penis and the bed and audible clicking sound with swollen penis thereafter. On examination, the genitalia was swollen with an 'S' shaped deformity. The skin over the swelling was apparently normal, with no local rise of temperature. A provisional diagnosis was made after clinical evaluation. Scrotum and testes examination revealed no abnormality. A subcoronal circumferential incision with de-gloving of penile skin was used to access the tunica. A rent in tunica albuginea and corpora cavernosa identified and the defect repaired with absorbable suture material after removal of clot and properly maintaining haemostasis. The patient's postoperative recovery was uneventful. The following case report demonstrates a typical case of fracture penis.