Peritonitis – the Eastern experience

Peritonitis is a common emergency encountered by surgeons the world over. This paper aims to provide an overview of the spectrum of peritonitis seen in the East. Studies dealing with the overall spectrum of secondary peritonitis in various countries of this region were identified using Pubmed and Google. These were analyzed for the site and cause of perforation and the mortality. It was observed that perforation of duodenal ulcers was the most the commonly encountered perforations. These are followed by small bowel and appendicular perforations. Colonic perforations were uncommon. The overall mortality ranges between 6–27%

Evaluation of fungal and bacterial antagonists' seed treatment for controlling damping-off disease in forest nurseries

Biological control potential of six well reported biocontrol agents, Trichomerma viride, T. harzianum, Gliocladium virens, Bacillus sp., B. subtilis and Pseudomonas fluorescens against Rhizoctonia solani, R. bataticola, Fusarium oxysporum, F. moniliformae, F. solani and Phythium aphanidermatum causing damping-off in forest nurseries was studied in vitro and under screen house conditions. In vitro evaluation of biocontrol agents by dual inoculation method revealed that P. fluorescens, Bacillus sp. and T. viride significantly inhibited mycelial growth of the damping-offfungi. In pot experiments, seed treatment of T. viride and P. fluorescens proved superior to other fungal and bacterial biocontrol agents in reducing damping off (pre and post emergence) incidence compared to untreated controls

Cardiovascular abnormalities in severe scrub typhus

Background: Himachal Pradesh is an endemic area for scrub typhus. If not treated early, it can lead to life threatening complications, affecting various systems of the body. Hence, this study was done with an objective to study the cardiovascular abnormalities in patients of severe scrub typhus.Methods: Authors conducted a hospital-based study in Departments of Medicine and Cardiology, of a tertiary care hospital in Sub-himalayan region in patients of severe scrub typhus from June 2016 to May 2017.Results: Thirty-two (55%) patients were aged <60 years with female preponderance (72%).   Electrocardiographic changes included sinus tachycardia in 56 (97%), axis deviation in 5(9%), ST-T changes in 3(5%) and atrial fibrillation in 1(2%). Echocardiographic changes included tricuspid regurgitation in 14(24%), pericardial effusion in 4(7%), myocarditis in 1(2%) and Regional wall motion abnormality in 1(2%). Left ventricular ejection fraction >45% in 47 (81%) and <45% in 11(19%).  Fifty-one patients had hypotension at presentation and 49 (90%) of them improved. Interestingly, 10 of 11 patients with reduced EF (<45%) survived whereas 6 of total 7 patients, who died, had preserved EF (>45 %).Conclusions: Severe scrub typhus manifested with ST/T changes, myocarditis, pericardial effusion, arrhythmias, shock and patients with reduced EF on Echocardiography had better outcome

The management of large perforations of duodenal ulcers

BACKGROUND: Duodenal ulcer perforations are a common surgical emergency, but literature is silent on the exact definition, incidence, management and complications of large perforations of duodenal ulcers. METHODS: The case files of 162 patients who underwent emergency laparotomy for duodenal ulcer perforations over a period of three years (2001 – 2003) were retrospectively reviewed and sorted into groups based on the size of the perforations – one group was defined as 'small 'perforations (less than 1 cm in diameter), another 'large' (when the perforation was more than 1 cm but less than 3 cms), and the third, 'giant'(when the perforation exceeded 3 cm). These groups of patients were then compared with each other in regard to the patient particulars, duration of symptoms, surgery performed and the outcome. RESULTS: A total of 40 patients were identified to have duodenal ulcer perforations more than 1 cm in size, thus accounting for nearly 25 % of all duodenal ulcer perforations operated during this period. These patients had a significantly higher incidence of leak, morbidity and mortality when compared to those with smaller perforations. CONCLUSION: There are three distinct types of perforations of duodenal ulcers that are encountered in clinical practice. The first, are the 'small' perforations that are easy to manage and have low morbidity and mortality. The second are the 'large' perforations, that are also not uncommon, and omental patch closure gives the best results even in this subset of patients. The word 'giant' should be reserved for perforations that exceed 3 cms in diameter, and these are extremely uncommon

Tubercular appendicitis – a case report

Tuberculosis of the appendix remains a rarity despite the frequency of intestinal tuberculosis. We report a case of acute appendicitis that underwent appendectomy at our hospital, and the histopathology of the specimen revealed tuberculosis

Role of autofluorescence technique in detection of mycobacterial bacilli on fine needle aspiration cytology in tubercular lymphadenitis in comparison to conventional methods

Background: Lymphadenopathy is the most common presentation of extrapulmonary tuberculosis. Fine needle aspiration cytology (FNAC) has emerged an important role in the evaluation of peripheral adenopathy as a possible non-invasive procedure. Conventional Ziehl-Neelsen (ZN) method for acid fast bacilli (AFB) plays an important role in the diagnosis and the monitoring of treatment in tuberculosis. Fluorescence microscopy using auramine-rhodamine (AR) or Papanicolaou (PAP) staining has been considered superior to ZN staining.Methods: The study was conducted in tertiary care centre for a period of 2 years. A total number of 75 patients were included in the study. Four smears made from each aspirate: three air dried smears were stained with Giemsa, ZN, and AR stains and one was wet fixed for PAP stain for autofluorescence. Aspirate sent for culture over Lowenstein-Jensen medium was taken as a reference method.Results: Seventy five aspirates reported as tuberculous lymphadenitis on cytomorphology were stained with various methods. Autofluorescence was of more diagnostic utility for detection of AFB when cytologically only necrosis (64.71%) or granulomatous lymphadenitis (42.11%) was seen. With necrotising granulomatous lymphadenitis reported cases, Auramine Rhodamine was positive in maximum cases (66.7%) and was significant statistically. Overall taking culture as gold standard ZN stain was most specific (100%) and Auramine Rhodamine was most sensitive (82%).Conclusions: There is a definite advantage of autofluorescence in detecting mycobacteria over Ziehl-Neelsen and auramine rhodamine stain as it is more sensitive as well as an inexpensive technique. Autofluorescence can be a useful addition to routine cytology for early diagnosis and effective treatment

Chediak higashi syndrome: A case report of rare anomaly

Chediak Higashi syndrome (CHS) is a rare autosomal recessive immunodeficiency disorder that arises due to the mutation of a trafficking protein which leads to a decrease in phagocytosis. This results in frequent pyogenic infections, albinism, and peripheral neuropathy. Infections in these patients tend to be very serious and life-threatening. CHS is caused by mutations in a gene LYST on chromosome 1. Here, we report the case of CHS in a 4-year-old boy who presented to us with recurrent fever, splenomegaly, and hypopigmentation. This case is being presented due to its rarity and presentation of pancytopenia without hemophagocytosis

Protean Career Orientation and Perceived Employability: The Mediating Role of Career Self-Management

The study examines the relationship between protean career orientation and perceived employability along with the engagement in proactive career behavior. The main objective of this paper is to understand how protean career orientation would form perceptions of student's employability with career self-management as a mediator. Data was collected with the help of a questionnaire from 182 business school students at Panjab University, Chandigarh. The result of correlation analysis indicates that a positive relationship exists between protean career orientation and perceived employability. PROCESS macro given by Hayes has been used to test the mediation. Analysis by bootstrapping method reveals that career self-management fully mediates the relationship between the two variables. Theoretically, this study extends the presence of protean career orientation beyond the work domain into the student life. It also adds on to the cross-cultural research by examining protean career orientation that is a US rooted concept in the Indian scenario. The practical implication of this study is that it improves perception of students towards their employability by indulging in career self-management initiatives. Further, business school management should aim at interventions to increase the self-directed and values-driven nature of students to make them more proactive with regards to their career management