Seroma formation after modified radical mastectomy: analysing risk factors and incidence

Background: Breast cancer is a prevalent form that affects women and is a leading cause of death among women. The development of seroma is a frequent complication that can arise after breast cancer surgery, and its underlying mechanisms are still not fully understood. Consequently, data was collected to analyze the occurrence and factors that contribute to the development of seroma in patients. We aimed to enhance our comprehension and ultimately discover methods to mitigate it. Methods: A prospective group research study was conducted on a sample of 86 female patients who underwent mastectomy from August 2020 to August 2023. This study was carried out as part of the senior residency program at Nalanda Medical College and Hospital in Patna, Bihar, India. Patients who develop seroma within four weeks of surgery are usually recommended to undergo, specifically ultrasonography, and radiological evaluation to determine the size. Results: 27 out of 86 patients (31%) were found to have seroma. Several factors are closely linked to the development of seroma. Factors that may contribute to increased risk The minimum age at which seroma production occurs following MRM ≥56 or older, having a BMI of 26.50 or higher, a tumour measuring 4 cm or larger undergoing the removal of more than 12 lymph nodes, and having a level 3 axillary dissection. Conclusions: After surgery, a certain group of people in the study experienced seroma formation within four weeks. These individuals had undergone MRM. Age, BMI, tumour size, level 3 axillary dissection, the removal of more than 12 lymph nodes during surgery, and the occurrence of seroma after MRM were found to be positively correlated. There was no observed connection between seroma production and a range of factors, such as neoadjuvant chemotherapy, the timing of drain removal, shoulder workouts, and the use of breast bandages

Intestinal obstruction caused by tuberculosis: unmasking a silent risk

Background: Intestinal tuberculosis (TB) remains a global health challenge, especially in regions with a high TB prevalence. This manifestation, distinct from pulmonary TB, involves the gastrointestinal tract, often leading to intestinal obstruction. The study addresses the insidious nature of the disease, emphasizing the urgency for timely diagnosis and intervention. Recognizing the multifaceted impact of TB on various organs, the study explores the pathophysiology, clinical presentation, and diagnostic complexities of intestinal TB. Methods: This study was conducted at Nalanda medical college and hospital in Patna, Bihar, India, the retrospective study spans three years focusing on 127 patients with intestinal obstruction due to TB. Inclusion criteria prioritized histopathological confirmation of TB, ensuring cohort accuracy. The study employed preliminary investigations, including hemogram, chest X-ray, abdominal X-ray, ultrasonogram, sputum examination, and Mantoux test and CECT whole abdomen. Clinical presentations were systematically analyzed, guiding tailored management protocols based on the mode of presentation. Results: Demographically, the study identified TB as the cause in 127 cases, with a balanced gender distribution and a peak incidence in the 21-30 years age group. Presentations varied, predominantly with acute symptoms. Common complaints included abdominal pain, vomiting, constipation, and distension. Surgical intervention within 24 hours was crucial in 61.1% of cases. Intraoperatively, findings comprised mesenteric thickening, lymph nodal enlargement, and adhesions. Adhesionolysis was the primary procedure. Postoperative complications, mainly wound infections, were noted but had a limited impact on mortality. Conclusions: This study reveals TB as a significant contributor to intestinal obstruction, emphasizing challenges in early diagnosis. Adhesionolysis emerges as a key operative procedure, underscoring the need for surgical flexibility. Postoperative complications, while notable, have minimal impact on mortality

Partial N=2→N=1{\cal N}=2 \to {\cal N}=1 supersymmetry breaking and gravity deformed chiral rings

We present a derivation of the chiral ring relations, arising in ${\cal N}=1$ gauge theories in the presence of (anti-)self-dual background gravitational field $G_{\alpha\beta\gamma}$ and graviphoton field strength $F_{\alpha\beta}$. These were previously considered in the literature in order to prove the relation between gravitational F-terms in the gauge theory and coefficients of the topological expansion of the related matrix integral. We consider the spontaneous breaking of ${\cal N} =2$ to ${\cal N} =1$ supergravity coupled to vector- and hyper-multiplets, and take a rigid limit which keeps a non-trivial $G_{\alpha\beta\gamma}$ and $F_{\alpha\beta}$ with a finite supersymmetry breaking scale. We derive the resulting effective, global, ${\cal N}=1$ theory and show that the chiral ring relations are just a consequence of the standard ${\cal N}=2$ supergravity Bianchi identities . We can also obtain models with matter in different representations and in particular quiver theories. We also show that, in the presence of non-trivial $F_{\alpha\beta}$, consistency of the Konishi-anomaly loop equations with the chiral ring relations, demands that the gauge kinetic function and the superpotential, a priori unrelated for an ${\cal N}=1$ theory, should be derived from a prepotential, indicating an underlying ${\cal N}=2$ structure.Comment: 42 pages, uses JHEP.cls;v2: typos corrected and references adde

Pencemaran Jarum Infus Intervena (IV) di Rumah Sakit Khusus Penyakit Menular, Jakarta

A prospective survey to evaluate rate of intravenous needle contamination was conducted at Infectious Diseases Hospital of Jakarta among patients whom received intravenous (i.v.) fluid or transfusion during 1 year period in 1982-1983. The survey was conducted through random culture of the distal part of the intravenous needle placed in the patients vein after completion of intravenous treatment. The exact time for the needle placement and extraction, local and systemic reactions observed in patients, were all recorded. From 559 culture of the i.v. needles which fulfilled the survey criteria, 238 were positive, indicating 42.3% contamination rate of the i.v. needles. The rate was higher in febrile patients (47.2%) compared to diarrhea patients (41.5%) Average duration of infusion (the duration of time the needle stayed in the vein) was 38.9 hours, with average of 15.8 hours in diarrhea patients and 104,6 hours in febrile patients. Mean duration of time for local reaction development was 36.8 hours, with 24.3 hours in diarrhea patients and 65.9 hours in febrile patients. Patients with positive culture had higher rate of local reaction (17.6% vs 13.4%), systemic reaction (18.4% vs 11.8%), nosokomial bacteremia (88% vs 4,4%) and community acquired infection (5.9% vs 3.7%) compared to patients with negative cultures. For patients with longer than 48 hours infusion, 58.5% had positive culture from i.v. needles, 21.9% had local reaction, 40.2% had systemic reaction which all were higher compared to patients who had less than 48 hour infusion with p<0.001, p<0.02 and p<0.001 respectively. Isolated bacteria from i.v. needles were 74.6% gram positive bacterias and 25.4% gram negative, with Staphylococcus epidermidis (38%) as the leading positive culture. Isolated bacteria had high rate of resistancy \u27oward commonly used antibiotics in the hospital

Infeksi Nosokomial Saluran Kencing (Insk) di Rumah Sakit Khusus Penyakit Menular, Jakarta

A prospective survey to establish the incidence of urinary tract nosocomial infection (UTNI) was conducted at the Infectious Diseases Hospital of Jakarta for one year duration in 1982-1983. The study was done by taking random samples from patients hospitalized for longer than 2 days through urine cultures on day 1, 3 and 7 and other necessary examination. From 2288 patients hospitalized during that period, 723 patients (aged 2 months-70 years) met the requirement to be included in the study, and 115 (15.9%) of them met the criteria for UTNI. Female patients had higher rate of UTNI compared to male patients (19.8% vs 12.4%). The age group with highest rate of UTNI was children with < 1 year of age and the rate of UTNI decreased as the age of patients increased. Febrile patients had significantly higher rate of UTNI compared to diarrhea patients (33.4% vs 2,4%, p < 0.001). Patients who had catheterization had significantly higher rate of UTNI compared to patients without catheter placement (85.7% vs 12.3% p <0.05). Antibiotics treatment prior to hospitalization was associated with higher rate of UTNI compared to patients without it (22.8% vs 12.6% p < 0.01) as it was also observed with hospitalization for 7 days or longer (15.8% vs 11.9%) of it is compared to shorter duration of hospitalization. Gram negative bacterias were the most commonly recovered from the urine cultures compared to gram positive (89.8% vs 10.2%) with E. coli (24.2%) as the leading organism. Other recovered organism, Proteus spp and Citrobacter bacilli showed high resistancy toward antibiotics commonly used in the hospital. Average duration of hospitalization for patients with UTNI (9.6 days) was longer compared to average duration for patients without UTNI (4.4 days). Six out of 115 patients with UTNI died (5.2%) compared to only 1.3% mortality in patients without UTNI. No single factor was significantly shown to be responsible for higher mortality rate of patients with UTNI, possibly was due to more severe condition of underlying disease of patients with UTNI

Infeksi Komunitas (Ik)/infeksi Luar Rumah Sakit (Ilrs) (Community Acquired Infection) di Rumah Sakit Khusus Penyakit Menular, Jakarta

A one year prospective study was conducted at the Infectious Diseases Hospital (IDH) of Jakarta in 1982-1983 to survey the rate of community acquired infection (CAI). Blood culture, rectal swab, urine culture and in some patients cerebro spinal fluid culture were obtained randomly from hospitalized patient at the time of admission. From 723 patients with age 2 months-70 years, who were examined and fulfilled the study criteria, 504 (69,7%) patients were positive for CAI resulted in total of 611 CAIs. Based on anatomical location, this number consists of 53.5% CAI of GI Tract, 20.9% CAI of Urinary Tract, 9.5% CAI bacteremia and 0.6% CAI involving central nervous system. Incidence rate was significantly higher in female (74.1%) compared to male (65.7%) (p12 years patients (73.9%) compared to children <12 years (p<0,01). Diarrhea patients had significantly higher CAI (77.4%) compared to febrile patients (55.2%) (p<0,01). Patients who had not received antibiotic prior to admission had higher rate of CAI (70.9%) compared to who received it prior to admission (67.1%) Etiologic agents most commonly recovered were gram negative bacterias (94.9%) with Vibrio cholerae (48.6%) as the leading cause, and only 5.1% were gram positive. Some of bacteria found as the etiologic agent of CAI, were Salmonella group D, Salmonella group E4, Proteus vulgaris and ruttgerii, Klebsiella pneumoniae, Mima polymorpha, Alkaligenes sp showed high rate of resistancy to commonly used antibiotics. (Ampicillin, Tetracycline, Chloramphenicol and Trimethoprim + Sulfamethoxazole). Average duration of hospitalization for CAI cases (6,4 days) was longer than in cases without CAI (4,3 days). There were 11 deaths (2.2%) in cases with CAI and 2 deaths (1.4%) in patients without CAI, with death rate was higher in males (2.4%) compared to female (1.9%), and highest was in less than 1 year old age group patient (13.6%), also significantly higher in febrile patients compared to diarrhea patients (7.2% vs 0.3%, p< 0.001). The higher mortality rate in CAI is due to more severe condition of underlying disease of patients who had CAI

Infeksi Nosokomial Saluran Nafas Bawah (Insnb) di Rumah Sakit Khusus Penyakit Menular, Jakarta

A prospective study to determine the incidence of lower respiratory tract nosocomial infection (LRNI) was conducted at the Infectious Diseases Hospital of Jakarta (IDH) in 1982-1983 for one year duration. Samples were taken randomly from 2 group of hospitalized patients: diarrheal and febrile patients. The criteria for development of lower respiratory infection were based on history, physical examination and chest x-ray examination, which was done only Li some of the patients those with duration of hospitalization &gt;2 days. From 2288 patients hospitalized during that period,723 (31.6%) patients fulfilled the criteria to be included in the nosocomial study, and from this group 34 (4.7%) of them met the criteria for LRNI. The LRNI was observed in almost similar percentage in both sexes of patients (4.5% in males and 4.9% in females). Comparison of different age group of patients showed that 5-11 years old children had highest rate of LRNI (14,5%) and significantly (p&lt;0,01) compare to &gt; 12 years old followed by children 1-4 year old (7,1%), while children &lt;1 year had 5.9%, and the lowest rate was in &gt; 12 years group with 2.7% Febrile patients had significantly higher rate of LRNI compared to diarrhea patients (11.6% vs 1.1%; p&lt; 0,001). Patients who received oxygen and bronchial mucus suction had significantly higher rate of LRNI (27.4%) vs 3.1%; p&lt;0,001) compared to those who did not (3,1%, p&lt; 0,001). Average duration of hospitalization for patients with LRNI was longer than for patients without it (11.1 vs 5.1 days). Case fatality rate in patients with LRNI was also higher 17.7%, compared only 1.2% in patients without LRNI. Factors involved in CFR was mostly due to severity of underlying disease and respiratory failure due to pneumonia in patients who developed LRNI