Study on the effectiveness of clinical scoring in predicting the outcome of diabetic foot

Background: Diabetic patients will develop diabetic foot ulcerations of which 14-20% will go on to amputation. By this study we aimed to investigate the effectiveness of clinical scoring system predicting the outcome of diabetic foot and also to know whether neuropathy or vasculopathy predominated in these patients.Methods: Patients with Type 2 diabetic ulcers are selected, and the ulcer was graded according to Wagner’s grading. The vasculopathy and Neuropathy were assessed by Doppler study and monofilament tests respectively. The patients were grouped based on the grade of ulcer and presence or absence of neuropathy and vasculopathy. These patients were followed up for a duration of 1 year.Results: The patients belonging up to group 6 had better outcome(healing) on conservative management and those in group 8 and group 9 had a bad outcome (amputations). 66% of patients had neuropathy predominance.Conclusions: Even though clinical scoring system could predict the outcome, statistically it is not found to be significant. Neuropathy was the more predominant factor among the patients with diabetic foot

Acute pancreatitis: a study of urine trypsinogen-2 measurement as a screening test

Background: Usefulness of urine trypsinogen-2 as screening test for acute pancreatitis in Indian population.Methods:We prospectively compared the urinary trypsinogen-2 dipstick test and serum amylase assays in 100 consecutive patients with acute abdominal pain at the emergency department. Urine samples were obtained on admission and tested for the dipstick. The diagnosis of acute pancreatitis was made on the basis of a typical clinical picture and serum amylase at least more than threefold the upper reference limit (300 IU) and/or radiological evidence (Abdominal X ray/ultrasonography/contrast enhanced CT).Results: 1. Urine trypsinogen-2 dipstick test was having 100% sensitivity and 85.71% specificity in diagnosing acute pancreatitis in Indian population. 2. Serum amylase was having 61.36% sensitivity and 78.57% specificity in diagnosing acute pancreatitis. 3. Sensitivity and specificity of urine trypsinogen-2 dipstick test is more than that of serum amylase in diagnosing acute pancreatitis which is statistically proved to be significant (P <0.05).Conclusion:Detection of trypsinogen-2 in urine is a simple office test in diagnosing acute pancreatitis in emergency department. As the sensitivity and specificity are high, detection of urine trypsinogen-2 in urine can be used as a screening test, which will definitely help in early diagnosis and prompt treatment of acute pancreatitis.

Delay in diagnosis of breast cancer in a developing country: a single centre observational study in a tertiary care hospital in North Kerala, India

Background: Around the world breast cancer is the most common cancer in women. In India, peak incidence is between 45-50 years of age. Early diagnosis improves survival, hence reducing diagnostic delay in breast cancer will have major social and economic implications besides improving the quality of life. This observational study aims to decipher various factors influencing diagnostic delay so that early treatment can be instituted.Methods: We interviewed 212 consecutive patients who attended the twice weekly breast clinic conducted by Department of general surgery and department of radiotherapy, government medical college, Kozhikode between September 2014 and February 2015. All patients with primary breast cancer were included in the study. Exclusion criteria included recurrence, second primaries, history of partial treatment and incomplete records. Finally, we interviewed 202 patients with the help of a pretested semi-structured questionnaire.Results: In present study, the commonest age group was 40-50 years with 62.4% participants presenting with early breast cancer and 37.6% having advanced breast cancer. Most of present study subjects were educated up to high school and unemployed. Awareness about breast cancer was 74.25% but many were ignorant of its symptomatology. Practice of breast self-examination (BSE) was low at 32.1%. Side and quadrant were statistically significant factor.Conclusions: In present study religion, educational status, marital status, breast cancer awareness, practice of BSE and location of tumor were statistically significant factors influencing delay in diagnosis. There was a general lack of knowledge about the importance of self-examination in breast cancer which needs health education and need for active social propaganda in print and electronic media regarding its importance. In future institution of a screening programme will hasten diagnosis and improve survival of breast cancer patients

Rise of robots in surgical territory

Robotic surgery is a rapid advancement in the scientific strata of artificial intelligence and has evolved into a refined tool for the surgeons. Over the last 30 years, this field has evolved in leaps and bounds with wide applications in the field of surgery by improving the dexterity and accessibility for the surgeons in various array of major complicated cases. The surgical armamentarium has been strengthened by evolution of robotic surgery to an extent that man may be replaced by artificial intelligence-based robots in the operation theatre, thereby eliminating the possibility of human errors and limitations

Fractal Based SVPWM Algorithm for Two Legged Three Phase Multilevel Inverters

Abstract: This paper proposes a Space Vector PWM (SVPWM) algorithm based on fractals for two legged three phase multilevel inverters. The paper presents the observation that the space vector representation of two legged three phase multilevel inverter has an inherent fractal structure. The properties of fractal structure together with the simplicity of fractal arithmetic are utilized to propose a generalized algorithm for SVPWM generation for two legged multilevel inverters and it can be easily extended to n-level inverters. The voltage space vectors of higher level inverter can be generated from the voltage vectors of an equivalent 2-level inverter using simple addition operations. Sector identification and switching vector determination in SVPWM generation are carried out using simple arithmetic operations without any computational complexity. The proposed algorithm doesn&apos;t use any look up table for sector identification and switching vector determination. The validation of the algorithm through simulations in MATLAB/SIMULINK has been carried out for two legged 3-level and 5-level inverter configurations for which the results are also presented. . Multilevel inverters gained more attention in recent years due to its inherent advantages of high voltage handling and good harmonic rejection capabilities with currently available power devices. The requirement of more number of semiconductor switches is the major disadvantage of multilevel inverters. Although low voltage rated switches can be used in a multilevel inverter, each switch requires a related gate drive protection circuits and the overall system becomes more complex and expensive. In addition increased number of switches increases the switching losses and electromagnetic interference (EMI). The increased switches have limited the usage of multilevel inverters in many critical applications particularly in the field of aerospace applications. The reduction in the number of power semiconductor switches for the inverters is drawing significant research attention. The four switch three phase inverter topology [FSTPI] is one of the techniques to reduce the switches in the inverte

Retrospective analysis of random and systematic errors in radiation therapy of head and neck cancer patients and its clinical predictive implications with VMAT treatment

Background: The accuracy of radiotherapy is based on the matching of 2D portal/CBCT image with a reference image. The aim of this study is to determine the random and systematic setup errors (in cm) in radiotherapy of head and neck cancer patients and to derive the setup margin and its clinical implications.Methods: Author retrospectively reviewed the records of 25 head and neck cancer (HNC) patients treated with radiotherapy between Dec 2017 and July 2018. After immobilization, setup accuracy was assessed by registration of XVI image with planning reference image using Elekta XVI image guidance system and the isocenter correction was applied. For each patient 10 CBCT image sets were taken. The translational errors in X, Y and Z directions were used to estimate systematic (Σ) and random (σ) errors and to derive the final setup margin by using van Herk’s formula (2.5Σ + 0.7σ).Results: The mean translational errors ranges from -0.23 cm to 0.32 cm in Lateral (X), -0.15 to 0.16 cm in Longitudinal (Y) and -0.11 to 0.17 cm in vertical (Z) directions. The Mean and SD for systematic errors 0.21±0.13, 0.11±0.18, 0.14±0.11 and random error (in cm) are -0.03±0.33, 0.00±0.21 and 0.05±0.30 in X, Y and Z axis respectively. The final total margin for CTV to PTV including setup margin in the X, Y and Z directions (in cm) were 0.56, 0.61, and 0.47 respectively.Conclusion: Thus, the precise immobilization techniques are very important to reduce the setup margins, and the number of CBCTs during head and neck radiotherapy treatment

The mRNA expression of SETD2 in human breast cancer: Correlation with clinico-athological parameters

BACKGROUND: SET domain containing protein 2 (SETD2) is a histone methyltransferase that is involved in transcriptional elongation. There is evidence that SETD2 interacts with p53 and selectively regulates its downstream genes. Therefore, it could be implicated in the process of carcinogenesis. Furthermore, this gene is located on the short arm of chromosome 3p and we previously demonstrated that the 3p21.31 region of chromosome 3 was associated with permanent growth arrest of breast cancer cells. This region includes closely related genes namely: MYL3, CCDC12, KIF9, KLHL18 and SETD2. Based on the biological function of these genes, SETD2 is the most likely gene to play a tumour suppressor role and explain our previous findings. Our objective was to determine, using quantitative PCR, whether the mRNA expression levels of SETD2 were consistent with a tumour suppressive function in breast cancer. This is the first study in the literature to examine the direct relationship between SETD2 and breast cancer. METHODS: A total of 153 samples were analysed. The levels of transcription of SETD2 were determined using quantitative PCR and normalized against (CK19). Transcript levels within breast cancer specimens were compared to normal background tissues and analyzed against conventional pathological parameters and clinical outcome over a 10 year follow-up period. RESULTS: The levels of SETD2 mRNA were significantly lower in malignant samples (p = 0.0345) and decreased with increasing tumour stage. SETD2 expression levels were significantly lower in samples from patients who developed metastasis, local recurrence, or died of breast cancer when compared to those who were disease free for > 10 years (p = 0.041). CONCLUSION: This study demonstrates a compelling trend for SETD2 transcription levels to be lower in cancerous tissues and in patients who developed progressive disease. These findings are consistent with a possible tumour suppressor function of this gene in breast cancer

Health care restructuring and family physician care for those who died of cancer

BACKGROUND: During the 1990s, health care restructuring in Nova Scotia resulted in downsized hospitals, reduced inpatient length of stay, capped physician incomes and restricted practice locations. Concurrently, the provincial homecare program was redeveloped and out-of-hospital cancer deaths increased from 20% (1992) to 30% (1998). These factors all pointed to a transfer of end-of-life inpatient hospital care to more community-based care. The purpose of this study was to describe the trends in the provision of Family Physician (FP) visits to advanced cancer patients in Nova Scotia (NS) during the years of health care restructuring. METHODS: Design Secondary multivariate analysis of linked population-based datafiles including the Queen Elizabeth II Health Sciences Centre Oncology Patient Information System (NS Cancer Registry, Vital Statistics), the NS Hospital Admissions/Separations file and the Medical Services Insurance Physician Services database. Setting Nova Scotia, an eastern Canadian province (population: 950,000). Subjects: All patients who died of lung, colorectal, breast or prostate cancer between April 1992 and March 1998 (N = 7,212). Outcome Measures Inpatient and ambulatory FP visits, ambulatory visits by location (office, home, long-term care facility, emergency department), time of day (regular hours, after hours), total length of inpatient hospital stay and number of hospital admissions during the last six months of life. RESULTS: In total, 139,641 visits were provided by family physicians: 15% of visits in the office, 10% in the home, 5% in the emergency department (ED), 5% in a long-term-care centre and 64% to hospital inpatients. There was no change in the rate of FP visits received for office, home and long-term care despite the fact that there were 13% fewer hospital admissions, and length of hospital stay declined by 21%. Age-sex adjusted estimates using negative binomial regression indicate a decline in hospital inpatient FP visits over time compared to 1992–93 levels (for 1997–98, adjusted RR = 0.88, 95%CI = 0.81–0.95) and an increase in FP ED visits (for 1997–98, adjusted RR = 1.18, 95%CI = 1.05–1.34). CONCLUSION: Despite hospital downsizing and fewer deaths occurring in hospitals, FP ambulatory visits (except for ED visits) did not rise correspondingly. Although such restructuring resulted in more people dying out of hospital, it does not appear FPs responded by providing more medical care to them in the community