Background: Head injuries are a major cause of mortality and morbidity across the world. Effective initial assessment and early intervention is of importance in patients with traumatic brain injury, so as to ensure the maximum favorable outcome. Glasgow Coma Scale is the widely accepted scale to assess severity in head injury patients, albeit with many inadequacies. The objective of this study was to test the validity of full outline of unresponsiveness score, an alternate tool, in assessing severity in patients with traumatic brain injury.Methods: This was a descriptive study, conducted on 69 patients admitted to the general surgical and neuro-surgical wards of Government Medical College, Trivandrum, India with traumatic head injury. For all these patients, full outline of unresponsiveness score and Glasgow Coma Scale were calculated at the time of presentation and serially thereafter. The predictive value of full outline of unresponsiveness score as well as its correlation with Glasgow Coma Scale was studied.Results: A statistically significant correlation was found between full outline of unresponsiveness score and Glasgow Coma Scale in estimating the severity of head injury. Also Full Outline of unresponsiveness score was able to furnish better details about the neurological status of trauma patients.Conclusions: As per the results, it can be concluded that the full outline of unresponsiveness score can be applied as an ideal tool to evaluate consciousness levels and patients’ status in patients with traumatic head injury. It can be used as the ideal replacement for Glasgow Coma Scale.
Background Acute appendicitis remains difficult-to-diagnose in spite of being a common acute abdominal condition. Early and correct diagnosis is essential either to proceed with early appendectomy or conservative approach so that complications and negative explorations can be minimised. Scoring systems can help in quick diagnosis and decision making. Though the Alvarado scoring is the widely used system, differences in diagnostic accuracy have been observed when it is applied to varied populations. Materials and methods The objective was to find the predictive accuracy of Modified Alvarado score, Appendicitis Inflammatory Response score and Raja Isteri Pengiran Anak Saleha Appendicitis score, in a diagnostic test evaluation study. From first January 2018 to first January 2019, 107 consecutive patients admitted with a diagnosis of suspected appendicitis were assessed with these scores. Sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio and area under curve were determined for each. Results Negative appendicectomy rate was 15.89%. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 64.44%, 58.82%, 89.23%, 23.81% and 63.55% respectively for Modified Alvarado; 97.78%, 29.41%, 88%, 71.43% and 86.92% respectively for Appendicitis Inflammatory Response; 87.78%, 76.47%, 95.18%, 54.17% and 85.98% respectively for Raja Isteri Pengiran Anak Saleha Appendicitis. Area under the curve was 0.726797 for Modified Alvarado, 0.946732 for Appendicitis Inflammatory Response and 0.910131 for Raja Isteri Pengiran Anak Saleha Appendicitis . Conclusion Appendicitis Inflammatory Response score probably is superior to Alvarado in the paediatric population because the variables scored are easy to apply to children, while Alvarado requires children to identify subjective symptoms which may not always be accurate. Appendicitis Inflammatory Response and Raja Isteri Pengiran Anak Saleha Appendicitis are better diagnostic scoring system for acute appendicitis than Modified Alvarado. Also, both these scores can be easily calculated by complete history, detailed clinical examination and basic laboratory investigations.
We conclude that there is no association between Cytomegalo virus sero-positivity and breast cancer. Another conclusion is that the studied adult population has been exposed to Cytomegalo virus in some point of their lives. Further studies of a larger magnitude are essential to confirm our results.
Background: Pancreaticoduodenectomy, also referred to as Whipple's resection, refers to the en bloc surgical resection of the pancreatic head, uncinate process, duodenum, gall bladder, and common bile duct. Though generally done for oncologic indications, the procedure can be warranted in benign or pre-neoplastic conditions of the peri-ampullary region also. Pathologic assessment of surgical specimens from pancreaticoduodenectomy needs special attention in order to accurately evaluate many factors that are prognostically important. The objective of the study was to analyze the clinical as well as histopathological profile of patients who underwent Whipple's resection over a 3-year period at a tertiary level institution. Methods: This descriptive study included patients from the General Surgery and Surgical Gastroenterology wards of Medical College Trivandrum, who underwent pancreaticoduodenectomy from January 2012 to January 2015. Results: The mean age was 55.18 years, with the majority of patients being females. Jaundice was the most common symptom, followed by itching. Among tumour markers, CA 19-9 was elevated in majority of patients, followed by CEA. Majority of the patients underwent PPPD rather than classical Whipple's resection. Head of the pancreas was the most common primary site followed by bile duct, ampulla of Vater and duodenum respectively. Adenocarcinoma was the most common pathological type among all sites with the majority being well-differentiated tumours. Conclusion: Adenocarcinoma of the head of the pancreas is the most common tumour for which majority of the patients undergoes pancreaticoduodenectomy at this institution. Majority of surgeons prefer the pylorus preserving type over the classical Whipple's procedure.
Introduction Acute-aortic-dissection (AAD) represents a serious cardiovascular emergency, with an associated mortality of 1-2% per hour after symptom onset. It is known that the relative infrequency of AAD and plausible differentials can negatively impact on a timely diagnosis. Female sex, absence of typical features and high-risk examination findings (hypotension/pulse deficits) shown to delay diagnosis. In UK, services for AAD are centralised, working on established volume/outcome relationships. However, this has the potential to introduce delays in rapidly diagnosing patients without on-site specialist support and in the logistics of transferring patients across large distances. This study aims to report on time taken for patients to receive surgery after first presentation at local hospital and identify points that contribute to maximal delay. Method Retrospective analysis of all operated type-A-aortic-dissections at our hospital in 2019. Hospital database used to identify patients, and local/referring hospital documentation reviewed to establish times. Results Mean time from A&E presentation to surgery is 8-hours-and-30 minutes (4:16–13:43). Largest contributor to delay is time from A&E admission to CT scan. Conclusions Our findings suggest greatest impact on improving times from presentation to surgery is to increase awareness of AAD in regional, non-specialist hospitals and to encourage rapid imaging.
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