BACKGROUND Necrotising Fasciitis (NF) is a serious infection involving the fascia and subcutaneous tissues. Distinguishing necrotising fasciitis from a less severe infection is difficult, but crucial, since necrotising fasciitis is a surgical emergency. The treatment of choice for NF is rapid surgical debridement/fasciotomy and broad-spectrum antibiotic therapy. Since, NF occurs rarely, reports on its epidemiology, clinical features, resource utilisation and outcomes are commonly based on relatively small case series and cohorts limiting generalisation of reported findings. The aim of the study is to examine the epidemiological features and explore clinical characteristics of patients diagnosed with necrotising fasciitis. The findings may be applied in clinical evaluation, raise awareness and help in the prevention of disease complications. MATERIALS AND METHODS This was a retrospective study of 35 patients with necrotising fasciitis between 2011 to April 2015. This study was done through the periods between 2011 to April 2015. Following history taking and physical examination, patients were subjected to routine laboratory investigations, plain chest x-ray and cardiological evaluation was done when indicated. After a diagnosis of NF was made, the patient was started empirically on broad-spectrum antibiotics and underwent serial wound debridement/fasciotomy and tissue samples were sent for culture and sensitivity. Based on the quantitative growth of organism and its antibiotic sensitivity, they were started on appropriate antibiotics. Serial dressings were done at the time of admission. Data was collected in a retrospective manner and were analysed and compared with other studies. Data charting was done using MS Excel 2010.
In recent times, the incidence and prevalence of thyroid disorders has been increasing in the Indian population. Autoimmune thyroiditis or Hashimoto's thyroiditis is one of the most common causes of thyroid disease. Antithyroid antibodies rarely develop before 20 years of age, but they may be a prelude to the development of subsequent hypothyroidism. It is universally known that iodine deficiency causes hypothyroidism. However, sustained unnecessary iodine supplementation may be harmful. Goitre, thyroid dysfunction (both hypo-and hyperthyroidism) and thyroid autoimmunity have been reported as a result of sustained supplementation in the iodine-replete state. Data on the impact of iodisation on thyroid function in adults is sparse. A study was conducted with an objective to estimate the problem of thyroid autoimmunity in patients who presented to the OPD. PATIENTS AND METHODS Patients who presented to the surgical OPD with clinical features of thyroid disease were included in the study after obtaining informed consent. Demographic details and clinical features of thyroid disease were noted. Thyroid status was estimated with the help of serum levels of thyroid stimulating hormone (TSH), free l-thyroxine (FT4), and free tri-iodothyronine (FT3). Autoantibodies to thyroid peroxidase (Anti-TPO) were estimated. Findings were tabulated and analysed. RESULTS AND CONCLUSION The prevalence of antibody positivity was 69.7% (209 out of the 300 patients) in this study. Among age-groups, the maximum prevalence was found in the third decade of life (75/99 patients, 75.8%). Among those who were antibody-positive, 69.9% were euthyroid, 26.8% were hypothyroid and 3.3% were thyrotoxic. Hypothyroidism (elevated S. TSH) had a significant positive correlation (r = 0.324, p = 0.003) with antibody-positivity (elevated S. AMA).
BACKGROUND Acute Appendicitis commonest community-acquired intra-abdominal infections. Acute appendicitis and its associated complications are significant source of morbidity and sometimes mortality. The Modified Alvarado Scoring System (MASS) has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. Diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting. The aim of the study is to evaluate the efficacy of the modified Alvarado score as a diagnostic tool in Acute Appendicitis, as the diagnosis of appendicitis depends on the onset of symptoms and the subjective interpretation of the physical examination. MATERIALS AND METHODS This was a prospective study carried out in Pondicherry Institute of Medical Science during the period of November 2013 to May 2015. This study was done on 50 patients diagnosed with Acute Appendicitis and admitted in General Surgery. RESULTS In this study, there were a total of 50 patients who were taken up for surgery based on clinical and radiological diagnosis. Our study demonstrates that modified Alvarado score applied to all adult patients of acute appendicitis in adults with a sensitivity of 60% and a specificity of 40% only. Showing it wasn't efficient in diagnosing acute appendicitis. The positive predictive value shown by our study was 80% which is marginally lower than that explained in literature which reports 87.5%. Negative appendicectomy rate in this study is 12%. CONCLUSION Alvarado score is a non-invasive, safe diagnostic procedure, which is simple, fast reliable and repeatable; it can be used in all conditions, without expensive and complicated supportive diagnostic methods. Alvarado score increases the diagnostic certainty of clinical examination in diagnosis of acute appendicitis. The implementation of Modified Alvarado Score though simple, effective and reliable can only be used as a guide in the diagnosis of appendicitis and not as a definite modality to diagnose appendicitis. However, additional investigations may be required to confirm the diagnosis in case of atypical presentation.
BACKGROUND Wound healing is a complex and changing process with the wound environment changing along with the changing health status of the individual. Laser light, when reduced in its energy output to a low level, may be utilized for tissue healing and repair, cutting as in surgery, shrinking tumours, unblocking clogged arteries, eradicating infections, and other therapeutic purposes. For bringing about health enhancement, the application of these amazing beams of light is called "Low Level Laser Therapy". Biological effects caused by low level lasers are due to the energy deposited into tissues results in many therapeutic effects. This results in the analgesic and anti-inflammatory effects as well as in improvement in healing. METHODS This study was conducted in 50 patients, who were randomized into two groups. Group 1 (LLLT) and Group 2 (control) with 25 patients in each group. Initial condition of the ulcer was recorded, and adequate wound debridement was done if necessary in both the groups. Patients in group A underwent LLLT once in three days along with regular dressings, whereas patients in group B underwent only conventional dressings. Observations were made during dressing and examination of the patients. Data was recorded on every third day from the date of admission till the 12 th day. The efficacy evaluation was based on the size of ulcer, discharge from the wound, granulation tissue, and presence of epithelialization at the site of the wound. RESULTS The wound was assessed on every third day up to 12 days of treatment. In group 1, reduction in size of ulcer started within a minimum of 3 days to a maximum of 6 days with a mean period of 3.84 days. In group 1, granulations were seen in the ulcer from 3 rd day to 9 th day with a mean period of 4.32 days; whereas, in group 2 granulations started to appear from 3 rd day to 9 th day with a mean period of 6.12 days. In group 1, epithelialisation started within 3 rd day to 9 th day and mean period was 4.92 days. Altogether in this group, the mean time for the healing process to start was 3.84 days to 8.4 days whereas in group 2, Epithelialisation started within 3 rd day to 9 th day and mean period was 6.72 days. CONCLUSIONS LLLT helps in wound healing by decreasing the time taken for healing, promoting granulation and early epithelialization and can also be used as an adjunct to conventional treatment in treatment of ulcers. Patients treated with LLLT did not develop any complications during the study period and hence can be safely used.
Desmoid tumours are rare; they account for about 0.03 percent of all neoplasms and less than 3 percent of all soft tissue tumours. The estimated incidence in the general population is two to four per million population per year. Here reporting a case of a 34-year-old female presenting with pain abdomen and swelling chest, excised mass diagnosed to be a desmoid tumour. KEYWORDSDesmoid Tumour. HOW TO CITE THIS ARTICLE: Philip AJ, Manoharan P, Ravy N. A case of desmoid tumour -abdominal fibromatosis in a young female, presenting with abdominal pain.
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