Background The most prevalent clinical entity of extra pulmonary tuberculosis is tuberculous lymphadenitis. However, it resembles other granulomatous conditions pathologically and obtaining tissue for microbiological diagnosis is also difficult. Thus it is a challenging task for diagnosis and early initiation of management. Fine needle aspiration cytology and biopsy are the diagnostic methods generally used to obtain the lymph node samples for histopathological and microbiological diagnosis. Mycobacterium culture on Lowenstein-Jensen medium remains the gold standard for definitive diagnosis, but its major limitations is a prolonged turn-around time of 2–4 weeks. The GeneXpert Mtuberculosis/RIF assay is a novel molecular diagnostic method for rapid diagnosis of tuberculosis and rifampicin resistance in clinical specimens. Methods This was a cross sectional analytical study conducted on 67 cases of suspected tubercular lymphadenitis at R.L Jalappa Hospital and Research Centre, Tamaka, Kolar. The study was carried out between December 2017 to June 2019. The samples were collected using excision biopsy and subjected to GeneXpert Mtuberculosis/RIF assay and histopathology. Further, sensitivity, specificity, positive predictive value and negative predictive value was measured and compared with histopathology. Results The average age of the patients was 37.04 ± 19.27 and majority was males. The lymph nodes were predominantly present in cervical region. Histopathology analysis reveals 46 positive cases of tuberculosis Lymphadenitis and GeneXpert Mtuberculosis/RIF assay detects 42 cases of tuberculosis Lymphadenitis. In the present study, GeneXpert Mtuberculosis/RIF assay had a sensitivity of 82.60% and specificity of 85% when compared to histopathology. Further the PPV and NPV was found to be 92.68% and 68% respectively. GeneXpert Mtuberculosis/RIF showed 2 cases of rifampicin resistance out of 67 cases. In this study, the GeneXpert Mtuberculosis/RIF showed the results in 0.79 days. Conclusion The present study showed that GeneXpert Mtuberculosis/RIF is a simple and reliable technique for diagnosing tuberculosis Lymphadenitis with high specificity and sensitivity as compared histopathology. Further, the methods elicit rapid diagnosis and also detected rifampicin resistance. It is thus a reliable and useful diagnostic modality in rapid detection of the causative agent and initiation of appropriate category anti-tubercular therapy when necessary.

Background: Helicobacter pylori infections have proven to be associated with gastritis and peptic ulcer, adenocarcinoma, gastric lymphoma. But its association with peptic ulcer perforations has not been completely proved. This study is intended to find out the association and give clarity of the pathology. The objective of the study was to observe the presence or absence of H. pylori in perforated peptic ulcer disease by obtaining biopsy from ulcer margin for rapid urease test, giemsa staining as well as serological method (antibodies IgA and IgG)Methods: This is an observational non-blinded study carried out in all cases of perforated peptic ulcer reporting in surgical wards, Emergency Department of the medical college during 2016-2018. Biopsy was taken from the ulcer margin and the tissue was subjected to histo-pathological examination, rapid urease test and blood sample was sent for serological examination.Results: Of the 46 patients participated in our study, 41 (89.1%) happened to be male, 5 (10.9%) were female. Only 2.2% of the patients were positive for H. pylori and remaining 95.7% were negative for H. pylori. The difference in the age group and H. pylori infection was found to be not statistically significant (p>0.05).Conclusions: In our study, frequency of H. pylori in perforated peptic ulcer cases was found to be only 2.2% which proves that there may be other contributing factors in perforated peptic ulcer cases, which need to be further evaluated.

Background: Peritonitis is classified as primary, secondary and tertiary. In primary peritonitis and continuous ambulatory peritoneal dialysis-associated peritonitis, the source of the infection is not due a breach in the gastrointestinal tract and usually caused by a single organism. Secondary peritonitis ensues, which may be localized and contained or diffuse carrying a high mortality in the absence of surgical intervention and appropriate antimicrobial therapy. In contrast, secondary peritonitis following perforation of the gastrointestinal tract or an infection originating in an intra-abdominal structure. Tertiary peritonitis is an ill-defined entity, which occurs despite adequate treatment of primary or secondary peritonitis.Methods: This is a prospective clinical study conducted on 140 consecutive patients who presented to the surgical department of RL Jalappa Hospital and Research Centre, Tamaka, Kolar with peritonitis secondary to hollow viscus perforation.Results: A total of 140 patients who presented with peritonitis secondary to hollow viscus perforation, admitted and treated in RL Jalappa Hospital and Research Centre attached to Sri Devaraj Urs Medical College, Kolar were studied during the period of December 2015 to June 2017.There was decrease in postoperative complications and hospital stay in Group B.Conclusions: In present study peritonitis is more common in men compared to women. The most common age group is in between 21-40 years in cases of peritonitis with the mean age of 37 years. Duodenal ulcer perforation is the commonest site of perforation. Escherichia coli is the most common organism isolated in the peritoneal fluid. usage of three antimicrobials (p<0.05) is beneficial in reduction in postoperative complications and hospital stay when compared to usage of two antimicrobials which is statistically significant.

Background: American College of Surgeon’s National Surgical Quality Improvement Program (ACS NSQIP) risk calculator is a valuable tool exercised in the hospitals across the USA for predicting risk rates for 8 post-operative complications till the 30th post-operative day, taking into account 21 risk factors. Its applicability in the surgical practice in India has not been popular. This study explores, if this model is accurate in predicting risk of post-operative complications in surgical patients in India.  Methods: Retrospective study done on 368 patients who underwent elective and emergency surgical procedures in a medical college hospital. Demographic data, contemplated surgery, co-morbid factors entered into the risk calculator and predicted personal risk calculated and compared to average risk. Post-operative progress reports retrieved. Complications till 30th post op day compared with the predicted risk estimates. Brier score, sensitivity and specificity, PPV/NPV, z and p values calculated for the probabilistic, predictive values of the model for validation.Results: Emergency procedures done in 143 and elective in 225. 67 developed major, 35 minor, 11 fatal complications. The average Brier score was 0.00324. Mean sensitivity was 96.08 %, specificity 98.94%. Mean PPV 82.6%, NPV 99.6%. The predictions were inaccurate for serious, “any” complications, discharge to nursing and rehabilitative facility, the colectomy ileus and length of stay. The percentage of error ranged from 2.22 to 25.Conclusions: Overall, the ACS NSQIP surgical risk calculator very fairly predicted the complications till the 30th post-operative day which naturally matched with actual complications that were seen.

Background: The severity of the injury may be such that ongoing care of the individual patient is futile, and this can lead to disagreement with the family or friends of the patient with regard to further treatment. Patient capacity or ability to participate in the informed consent process may be compromised and the patient is therefore managed by the clinical team on the basis of the best interest’s principle, with clinicians relying on proxy consent or substituted judgment. These sections of the hospital have their own ethical and medico-legal issues for the trauma patient and the treating clinician. The aims and objectives were to estimate the time of triage/ specialist care given in the Emergency Medical department (EMD) in Trauma case; to compare the result with Australasian triage scale and Manchester triage scale system and to study about the demography and audit the necessary findings from trauma patients in casualty.Methods: This is a Prospective observational study done at R. L. Jalappa Hospital a constituent of Sri Devaraj Urs Medical College and Research, Kolar, Karnataka a rural based tertiary teaching hospital.Results: A total of n=108 patients were evaluated in this study, severity of the injury was moderate been the highest with 52 (48%), severe been 33 (30.6%), mild been 20 (18.5%). Majority of the injury was in the age group 21-40, mostly been the major working population and bread winners involved in the Road traffic accidents. Mean time of specialist (surgeon) attending to the case was 70 minutes i.e. the interval between CMO and consultant attending to the trauma case in EMD.Conclusions: Management of Trauma patients involves very meticulous work which can be achieved only with proper team-work and planning protocol and the more important aspects towards the management involves the documentation and proper communication with patient attendants and responsible persons. On concluding, the triage system followed in our setup with specialist care been provided is equal in its efficacy in comparison to the Manchester triage scale and is almost in par with the Australasian triage scale.

In recent decade there has been a substantial increase in breast cancer both in developed and developing countries. It's also has been the major cause of mortality in women, despite much progress in treatment for breast cancer. There is always a debate in assessment of prognosis in breast cancer. Inflammation play a major role in pathogenesis of breast cancer based of the cell type. Neutrophil-to-lymphocyte ratio is a simple parameter which helps in predicting the prognosis of the patient. In this study, we would like to analyse peripheral blood neutrophil-lymphocyte ratio (NLR) in breast cancer patients and its correlation with disease staging. This cross-sectional study was conducted in R.L Jalappa hospital. A total of 30 female patients with breast cancer met the inclusion criteria. Exclusion criteria included clinical evidence of active infection, presence of haematological disorders, acute as well as chronic inflammatory or autoimmune diseases, or prior steroid therapy. There was no association between the tumour size and age of patients with NLR. There was a significant relationship between NLR and staging of the disease.

BACKGROUND: Survival studies may serve as benchmarks to develop cancer-related policies and estimate baseline survival rates in a given patient population AIM: To study the trends of breast cancer and its management in rural areas. PATIENTS AND METHODS: This was a prospective study conducted between period of September 2018 to august 2019 for the period of 1 year RESULTS: Most common age group involved was 41-50 years with mean age of 49.7 years which shows the importance of regular screening for the patient in premenopausal state. Most common surgery performed was modied radical mastectomy with breast conservative surgery performed only for 4 cases. CONCLUSIONS: The importance of auditing institutional data cannot be stressed more strongly to help understand better, the benets of current practices based on evidence. It also serves as a benchmark for comparing outcomes following further improvements in practices that can be brought into patient care with advancing technology and medical treatment