Correlation between preoperative axillary ultrasound and histopathology of resected lymph nodes in patients with carcinoma breast

Background: Axillary Ultrasound is an important tool in assessing regional lymph node status in women who are node negative clinically as many of them will prove to have axillary lymph node involvement on histopathology. The aim of the present study was to establish the role of axillary ultrasound in preoperative assessment of lymph node status in women with carcinoma breast and to correlate the findings of axillary ultrasound with the histopathology of resected axillary nodes.Methods: Forty patients (all women) were included in this study and the preoperative axillary ultrasound was done to know the status of axillary lymph nodes and the findings were correlated with histopathological findings of the resected nodes.Results: The sensitivity of axillary ultrasound was found to be 66.67%, specificity was 87.5%, accuracy 75%, positive predictive value (PPV) of 88.89% and negative predictive value of 63.4%.Conclusions: Axillary ultrasound is very important tool in assessing preoperative axillary lymph node status in patients with carcinoma breast. It is also important in assessment after inadequate axillary dissection and for follow up of non-treated axilla

A Rare Case of Large Impacted Stone in Jejunum Causing Obstruction in a Patient of Gallstone Ileus

Gallstone ileus is a rare complication of cholelithiasis that occurs as a result of occlusion of the intestinal lumen by a large sized gallstone accounting for 1-4% cases of small bowel obstruction. The aim of this work is to introduce a case report that emphasize the diagnostic and therapeutic management of gallstone ileus with an enterolith impacted in jejunum (an uncommon site)

Combined Use of Modified Alvarado Score and Focused Appendicitis Ultrasonography in Predicting Acute Appendicitis in Children: How to Reduce the Need for Unnecessary Ct Scans: Combined Use of Modified Alvarado Score and Focused Appendicitis Ultrasonography in Predicting Acute Appendicitis

Introduction: Acute appendicitis is one of the most common abdominal emergencies worldwide. The Modified Alvarado score is 9-point scoring system for diagnosis of appendicitis based on clinical signs and symptoms and differential leucocyte count. Previous studies have suggested that Alvarado score alone is inadequate as a diagnostic test, but it has been advocated as a means of select­ing patients who should undergo imaging. To evaluate the effectiveness of Modified Alvarado Score and Focused Appendicitis Ultrasonography in predicting acute appendicitis and to compare the accuracy of two modalities alone and combined. Materials and Methods: The study was performed in the postgraduate department of General Surgery, Government Medical College, Jammu over a period of one year from November 2021 to October 2022. 100 patients who were under the age of 18 years irrespective of their gender suspected to have appendicitis were included in the study.   Results: There were 64 males and 36 females. The majority of patients were in the age group of 12-15 years (51%). Modified Alvarado Score alone has sensitivity of 84.51%, specificity of 33.33%, Positive predictive value of 83.53%, negative predictive value of 34.98% and accuracy of 74.27%. Focused ultrasonography alone has sensitivity of 100% and accuracy of 80.00%, positive predictive value of 80%. The combined sensitivity of MAS+ focused appendicitis ultrasonography is 98.80 % with specificity of 11.76%, positive predictive value of 81.75%, negative predictive value of 70.94% and accuracy of 81.39%. The percentage of negative appendectomies was 14.45%.    Conclusion:  The sensitivity of Modified Alvarado Score is less than the sensitivity of Focused Appendicitis Ultrasonography. When both investigations combined together, their sensitivity, specificity, positive value, negative predictive value and the accuracy improves the diagnosis of acute appendicitis

A retrospective analysis of data collected over 05 years for prevalence of Helicobacter pylori infestation in symptomatic patients from Jammu and Kashmir

Introduction: Infection with H. pylori infection is common. About two-third of the population in the world carry H pylori in their bodies. The infection is acquired in the childhood and persist despite of local and systemic immune response.Materials and Methods: This was a prospective observational study done on 1000 patients at a tertiary health care hospital in Jammu, India, over a period of 04 years (March 2016 to March 2020). Written and informed consent regarding the purpose, procedures, and risks was obtained from all patients. Data were collected by conducting personal interview and doing a complete physical examination of the participants of the study. All patients underwent basic investigations as per symptoms and comorbidities. UGIE was performed on all the study participants using a video gastroscope. Gross features of the upper GI tract were noted and biopsies were obtained from the stomach (antrum, body, and fundus), and second part of the duodenum. One antral and one corpus biopsy sample each were used for rapid urease test (RUT).Results: A total of 1000 patients underwent UGIE for different set of complaints. Most common complaint in this study group was epigastric pain (43%) followed by dyspepsia (33.2%) and 80.23% and 78.61% patients were positive for H pylori on RUT. On UGI endoscopy duodenal ulcer was seen in 430 patients and among them 85.34% were H. pylori positive on RUT, gastric ulcer was seen in 240 patients and among them 73.33% were H pylori positive. Most common comorbidity was hypertension in the study group and among these patients 138(88.46%) were H. pylori positive, 2nd common comorbidity was Diabetes mellitus and among them 133(91.86%) were H. pylori positive. Overall prevalence of H. pylori manifestation in study group was seen in 78.5% patients.Conclusion: Among all symptomatic patients enrolled in this study the most symptom was epigastric pain followed by dyspepsia and most common comorbidities in the study group were HTN and Diabetes mellitus. Rapid urease test was performed on UGI endoscopic biopsy specimen for H pylori infestation and 78.5% patients were found to be positive

Characterization of Lie-Type Higher Derivations of von Neumann Algebras with Local Actions

Let m and n be fixed positive integers. Suppose that A is a von Neumann algebra with no central summands of type I1, and Lm:A→A is a Lie-type higher derivation. In continuation of the rigorous and versatile framework for investigating the structure and properties of operators on Hilbert spaces, more facts are needed to characterize Lie-type higher derivations of von Neumann algebras with local actions. In the present paper, our main aim is to characterize Lie-type higher derivations on von Neumann algebras and prove that in cases of zero products, there exists an additive higher derivation ϕm:A→A and an additive higher map ζm:A→Z(A), which annihilates every (n−1)th commutator pn(S1,S2,⋯,Sn) with S1S2=0 such that Lm(S)=ϕm(S)+ζm(S)forallS∈A. We also demonstrate that the result holds true for the case of the projection product. Further, we discuss some more related results

Hysterectomy in a male? A rare case report

INTRODUCTION: Persistent Mullerian duct syndrome is a rare form of male pseudo-hermaphroditism characterized by the presence of Mullerian duct structures in an otherwise phenotypically, as well as genotypically, normal man; only a few cases have been reported in the worldwide literature. A great variety of organs have been found in indirect inguinal hernial sacs. PRESENTATION OF CASE: We report a case of 70 year old man, father of 4 children with unilateral cryptorchidism on the right side and left-sided obstructed inguinal hernia containing uterus and fallopian tube (that is, hernia uteri inguinalis; type I male form of persistent Mullerian duct syndrome) coincidentally detected during an operation for an obstructed left inguinal hernia. DISCUSSION: PMDS is usually coincidently detected during surgical operation, as was in our case. However pre-operative ultrasonography, computerized tomography and MRI allow possible pre-operative diagnosis.3 CONCLUSION: In cases of unilateral or bilateral cryptorchidism associated with hernia, as in our patient's case, the possibility of PMDS should be kept in mind

Pulmonary tuberculosis presenting with acute respiratory distress syndrome (ARDS): A case report and review of literature

Tuberculosis is a very highly prevalent disease particularly in the developing world. In India one person dies of tuberculosis every minute. It can be a differential diagnosis of any disease ranging from infections to malignancies. But tuberculosis as a primary cause of respiratory failure requiring mechanical ventilation is an uncommon occurrence. Among patients with pulmonary tuberculosis, those with miliary or disseminated disease or having comorbidities like acquired immunodeficiency syndrome (AIDS) are especially prone to develop acute respiratory distress syndrome (ARDS). We present a case of a young female with no comorbidities or immuno suppression who presented with ARDS to us. We initially managed with mechanical ventilation and broad spectrum antibiotics, but there was no improvement. Only after anti tubercular therapy (ATT) and corticosteroids the patient recovered

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways