Validation of the use of POSSUM score in enteric perforation peritonitis - results of a prospective study

Introduction: The objective of the study was to present our last 5-years experience of peritonitis and validate POSSUM score in predicting mortality and morbidity in patients of enteric perforation (EP) peritonitis. Methods: Data was collected prospectively for all peritonitis cases admitted in single surgical unit from January 2005 to December 2009. Parameters for calculating POSSUM were also retrieved; in these patients, O:E (Observed vs. Expected) ratio of mortality and morbidity were estimated after calculating predicted mortality and morbidity by exponential regression equations. Results: 887 patients with peritonitis were admitted and treated in this unit during the 5 years of study period. Duodenal (n=431; 48%) followed by ileal (n=380; 42.8%) perforations were the commonest. Mean age of the patients was 34 years and 86% were males. Mean delay in presentation was 78.5 hrs. Mean duration of hospital and ICU stay was 13 and 7.2 days. Postoperative complications were seen in 481 (54%) patients, and 90 (10%) patients died. POSSUM scores and predicted mortality/morbidity were calculated in 380 patients of ileal perforation peritonitis; O:E ratio of mortality and morbidity were 0.47 and 0.85 in these patients. Conclusion: POSSUM and P-POSSUM are accurate tools for predicting morbidity and mortality respectively in EP patients. Though they may sometime over or under predict morbidity as well as mortality.Key words: Enteric perforation, Peritonitis, POSSUM , P-POSSU

Efficacy of bio agents and fungicides against Colletotrichum blight of large cardamom (Amomum subulatum Roxb.) under field condition in Sankhuwasabha District, Nepal

The field experiment was carried out in five years old Golsai variety of large cardamom (Amomum subulatum Roxb.) at Khandbari-4, Pangma of Sankhuwasabha district between February and April 2022 to evaluate the efficacy of bioagents and fungicides against Colletotrichum blight of large cardamom (A. subulatum). Two bioagents, three fungicides, and control/water were taken as treatments, and the experiment was established in a Randomized Complete Block Design (RCBD) with an area of 4×3 sqm in each experimental unit having 6 treatments with 4 replications. Treatment wise application of bioagents and fungicides was given by using a high-volume knapsack sprayer with the required concentration. Subsequent sprays were given at seven-day intervals. The result of the study showed that among the tested fungicides, TOPCARE (Azoxystrobin 50% WDG) and bioagent Trichoderma viride significantly reduced blight under field conditions. So, spraying of the fungicide TOPCARE (Azoxystrobin 50% WDG) and bioagent T. viride will be best for controlling Colletotrichum blight on large cardamom in the Sankhuwasabha district

Efficacy of various botanical pesticides against leaf eating caterpillar (Artona chorista Jordan) on large cardamom (Amomum subulatum Roxb.) field of Sankhuwasabha District, Nepal

Four treatments (Dadaguard Plus (0.05%), mugwort (Titepati) Oil (0.05%), azadiractin (Neem) Oil (0.25%), and tobacco extract (1%) of different botanicals and an absolute control) were evaluated in a field experiment against a lepidopteran pest, the leaf eating caterpillar infesting large cardamom, in a randomized complete block design (RCBD) with an area of 4.2× 3.88 m2 in each experimental unit having 5 treatments with 4 replications at Khandbari, Sankhuwasabha, Nepal. Leaf-eating caterpillars cause a white papery thin epidermis-like structure at the primary stage and defoliation of the plant, leaving the midrib of the leaves, symptoms at the severe stage. Treatment-wise application of botanicals was done by using a high-volume knapsack sprayer, and the number of larvae per plant was counted at different time intervals, viz., 3, 5, and 7 days after spraying (DAS), to access the effectiveness of the treatments. The botanical pesticides caused significant differences in their effects against the leaf-eating caterpillar. Among the different botanicals, Dadaguard Plus (0.05 %) was found highly effective in managing the leaf-eating caterpillar in large cardamom, followed by neem oil (0.25%), tobacco extract (1%), titepati oil (0.05%), and untreated control, respectively. Dadaguard could be considered an effective botanical in the successful management of the pest leaf eating caterpillar due to its efficacy.

Knowledge, Attitude and Practice of Mothers regarding Diarrhoeal Illness in Children under Five Years of Age: A Cross Sectional Study in an Urban Slum of Delhi, India

Diarrhoea is one of the lead killers of children worldwide. This study was done with an aim to determine the knowledge, attitude and practice regarding diarrhoeal illness, its prevention and management in mothers of under- five children. A descriptive cross- sectional study; 125 mothers were randomly selected from an urban slum of Delhi and were interviewed using a structured questionnaire. 96% mothers defined diarrhoea appropriately. Most common perceived causes of diarrhoea were contaminated food and drinking water (80%). Though 83% mothers believed that clean drinking water prevents diarrhoea, yet water treatment was practiced by only 36%. Most mothers believed in (90%) and practiced (88%) hand washing with soap post-defecation to prevent diarrhoea. While only 31% had knowledge on importance of use of latrine, fewer (19%) accepted that safe disposal of stool was very important and just 58% reported practicing it. Less than a third of the mothers recognized critical signs of dehydration. 79% mothers recognized importance of increased fluid requirement and 70% practiced it for management of diarrhoea. Though 76% mothers used ORS, only 26% considered it as the mainstay treatment of diarrhoea. Also, 42% mothers had incomplete knowledge regarding proper preparation of ORS. Though only 22% were aware of the role of breastfeeding in prevention of diarrhoea, a positive attitude towards (74%) and healthier practice (90%) of exclusive breast-feeding was observed. Thus, we conclude that though the community knowledge, attitude and practices on diarrhoeal illness and its prevention is marginally satisfactory, the poor knowledge regarding signs of dehydration and relevance of ORS as primary management component is a matter of concern for child survival

Unraveling Prostaglandin and NLRP3 Inflammasomemediated Pathways of Primary Dysmenorrhea and the Role of Mefenamic Acid and Its Combinations

Painful menstrual cramps during or around the time of the monthly cycle are known as dysmenorrhea. The estimated global prevalence in women of reproductive age ranges from 45% to 95%. It has a significant negative impact on regular activities and productivity at work. However, despite the severe consequences on quality of life, primary dysmenorrhea (PD) is underdiagnosed. Dysmenorrhea has complex pathogenesis. It involves the release of prostaglandins and activation of the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome and also includes the involvement of other mediators such as bradykinin, histamine and acetylcholine. Even though nonsteroidal anti-inflammatory drugs (NSAIDs) remain the most common type of pain medication, the question of which one should be the most preferred is still open to debate. The current review examines the existing evidence for the pathogenesis of PD and makes evidence based and clinical experience based recommendations for the use of mefenamic acid and its combination in the treatment of dysmenorrhea. Mefenamic acid alleviates PD by inhibiting endometrial prostaglandin formation, restoring normal uterine activity, and reducing the inflammatory response by inhibiting the NLRP3 inflammasome and reducing the release of cytokines such as interleukin (IL)-1β. It is also known to have bradykinin antagonist activity. Dicyclomine has a dual action of blocking the muscarinic action of acetylcholine in postganglionic parasympathetic effect or regions and acting directly on uterine smooth muscle by blocking bradykinin and histamine receptors to relieve spasms. According to the experts, mefenamic acid and dicyclomine act synergistically by acting on the different pathways of dysmenorrhea by blocking multifactorial agents attributed to the cause of dysmenorrhea. Hence, the combination of mefenamic acid and dicyclomine should be the preferred treatment option for dysmenorrhea

Culture-level dimensions of social axioms and their correlates across 41 cultures

Leung and colleagues have revealed a five-dimensional structure of social axioms across individuals from five cultural groups. The present research was designed to reveal the culture level factor structure of social axioms and its correlates across 41 nations. An ecological factor analysis on the 60 items of the Social Axioms Survey extracted two factors: Dynamic Externality correlates with value measures tapping collectivism, hierarchy, and conservatism and with national indices indicative of lower social development. Societal Cynicism is less strongly and broadly correlated with previous values measures or other national indices and seems to define a novel cultural syndrome. Its national correlates suggest that it taps the cognitive component of a cultural constellation labeled maleficence, a cultural syndrome associated with a general mistrust of social systems and other people. Discussion focused on the meaning of these national level factors of beliefs and on their relationships with individual level factors of belief derived from the same data set.(undefined

Medical errors and consequent adverse events in critically ill surgical patients in a tertiary care teaching hospital in Delhi

Background: Medical errors and adverse events (AE), though common worldwide, have never been studied in India. We believe that though common these are under reported. Aim: The aim of this study was to study medical errors and consequent AE in patients presenting with trauma and bowel perforation peritonitis. Methods: Five hundred and eighty-six consecutive patients with trauma or peritonitis, presenting to surgery emergency of UCMS-GTBH, were prospectively studied using review form (RF) 1 and 2. AE was defined as an outcome not expected to be part of the illness. RF 1 was filled for all and indicated if AE was present or not. RF2 was filled when RF 1 indicated presence of AE; it further confirmed the occurrence of AE and pointed to the type of medical error and resultant disability. All results were expressed as percentage. Results: There were 500 (85%) males. Mean age of the patients was 31 years. There were 332 patients with peritonitis and 254 with trauma. AE and its consequences were present in 185 (31.5%) and 183 (31.2%) patients, respectively. Consequences were as follows: disability - 157 (85%), increased hospital stay and/or increased visits in the OPD - 28 (15.3%) and both-101 (55.2%) patients. Disabilities were: death - 62 (40%), temporary disability - 90 (58%) and permanent disability - 05 (3.1%) patients. AE in 133 (71.8%) patients was definitely (level of confidence 6) due to error in healthcare management. All AE were considered preventable. Error of omission accounted for AE in 122 (65.9%) patients. System and operative errors were the commonest, 84.3% and 82.7%, respectively. One hundred and sixty-seven (90%) patients had multiple errors. Conclusions: The study proves that medical errors and AE are a serious problem in our set-up and calls for immediate system improvement