A Study on Role of Continuous Suction Drain Tube in Postmastectomy Seroma Collection in Carcinoma Breast

INTRODUCTION: The most common mastectomy-associated complication is seroma formation. Seromas can be associated with other more serious complications such as skin flap necrosis, delayed wound healing, infection, and lymphedema. The continuous suction drain tube procedure has been suggested as one potential technique to reduce the incidence of postmastectomy seromas. Seromas are a significant cause of morbidity after modified radical mastectomy. Continuous suction of the drain tube through vacuum pump combined with early removal of suction drains is associated with a low incidence of seroma formation after mastectomy. Use of this technique has important economic and clinical implications for patients who had mastectomy. The continuous suction DT procedure 1) reduces postmastectomy seromas and 2) reduces the amount of postoperative hospital visits and care. Any intervention that could reduce the volume and duration of postoperative drainage would be beneficial. Creating negative pressure would obliterate dead space and encourage adhesions of the flaps to the underlying muscles. This would decrease postoperative drainage, afford earlier drain removal, and reduce subsequent seroma formation. AIMS & OBJECTIVES: 1. To study the effect of continuous mechanical suction drain tube in modified radical mastectomy patients of carcinoma breast. 2. To compare the role of continuous suction drain tube with that of standard wound closure and standard closed suction drain in reducing post-mastectomy seroma. MATERIALS AND METHODS: PLACE OF STUDY: Department of General Surgery, Govt. Stanley Medical College & Hospital, Chennai. DURATION: Jan 2016 to Sep 2016. STUDY DESIGN: Prospective study. SAMPLE SIZE: 30. INCLUSION CRITERIA: Patients undergoing Modified Radical Mastectomy for Carcinoma Breast. EXCLUSION CRITERIA: Patients undergoing - Breast Conservation Surgery, Breast Reconstruction, Previously operated Patients. METHODOLOGY: Patients undergoing Modified Radical Mastectomy for Carcinoma Breast in our Department are included in this study. • During closure,the wound is closed with a closed-suction drain. suction drain end is connected with vacuum pump which is available in the wards. suction drain is disconnected from pump for every three hours with one hour interval. The amount of seroma collected in vacuum is calculated in a standard measuring jar everyday. • The volume of seroma are compared to those patients undergoing conventional closure of wound with suction drain. • Drains were removed when the total daily amount was <30 cc. • Postoperative drainage volume, total days with drain, and frequency of seroma formation were recorded for each patient. • Observations are tabulated according to the pre-designed proforma. • The results are analyzed using Microsoft Excel for tabular transformation and graphical representation. For comparing the parameters & statistical analysis 2 sample Z test is used CONCLUSION: The role of continuous suction drain tube in Modified Radical Mastectomy has reduced the formation of seroma significantly and has led to early removal of drains,instituition of 1st cycle of chemotherapy before discharging the patient and thus reducing the hospital stay. It has also led to low incidence of flap necrosis post operatively. However, further studies are needed to know whether co-morbid illness like Diabetes, Hypertension and instituition of Neo-Adjuvant Chemotherapy has any confounding effect on the formation of seroma. Several prospective studies have shown that continuous suction drain tube in obliterating the dead space has proved to be useful for smoother recovery

Determination of expected time to recruitment in manpower planning

            Manpower planning in a sense, according to Barthlomew [1], is concerned with matching the supply of people with the jobs available. Recruitment is required to compensate the wastage of manpower; wastage refers to the loss of manpower in the organization. Recruitment cannot be made frequently since it involves cost. The threshold level is the maximum amount of wastage that can be permitted in the organization beyond which the organization reaches a point of breakdown. It is similar to the concept of shock model and cumulative damage discussed by Esary et al. [2]. In this paper we made an attempt to determine the expected time to recruitment, assuming that the threshold as exponentiated exponential distribution which introduced by Gupta and Kundu [3]

Cross sectional study evaluating the correlation of thyroid dysfunction with severity of disease in rheumatoid arthritis

Background: The present study was conducted to evaluate the correlation of disease severity in RA and thyroid dysfunction.Methods: The present cross-sectional descriptive study enrolled 164 participants aged 12 years and above diagnosed as having RA. Use of drugs causing thyroid dysfunction, malignancy, diabetes mellitus, systemic hypertension, pregnancy and prior thyroidectomy were the criteria for exclusion. Data was analyzed using R and tests of significance were Chi square test and independent sample t-test and Pearson correlation. Institutional ethics committee approved the study and written informed consent was obtained from all study participants.Results: Serum TSH positively correlated with DAS 28 (r=0.2, p=0.005), ESR (r=0.2, p=0.03), CRP (r=0.2, p=0.006), RA factor (r=0.2, p=0.003), subjective assessment (r=0.3, p= 0.001) and anti TPO antibodies (r=0.7, p=0.001). Free T4 negatively correlated with DAS28 (r=-0.2, p=0.006), ESR (r=-0.2, p=0.02), CRP (r=-0.2, p=0.01). RA factor (r=-0.2, p=0.01), subjective assessment (r=-0.2, p= 0.01), anti TPO (r=-0.6, p=0.001) and Free T3 negatively correlated with DAS28 score (r=-0.2, p=0.02) , ESR (r=-0.2, p=0.03), RA factor (r=-0.3, p=0.001) and anti TPO antibodies (r=- 0.3, p=0.001).Conclusions: Hypothyroidism was significantly associated with disease severity of RA with linear positive correlation of TSH with DAS28 score, ESR, CRP, RA factor, subjective assessment and anti TPO antibodies, linear negative correlation of serum free T4 with DAS 28 score, ESR, CRP, RA factor, subjective assessment and anti TPO antibody and linear negative correlation of free T3 with DAS28 score, ESR, RA factor and anti TPO antibody was observed

Prevalence of microorganisms causing catheter associated urinary tract infections (CAUTI) among catheterised patients admitted in a tertiary care hospital

Background: Catheter-associated urinary tract infection (CAUTI) is an important cause of morbidity and mortality in Indian subjects, affecting all age groups. Bacteriuria orcandiduria is almost inevitable in nearly half of the patients who require an indwelling urinary catheter for more than 5 days. The objective of this study was to find the prevalence of CAUTI infection and to determine their antibiotic profileMethods: The present cross-sectional study included 50 patients admitted to medicine and surgery wards in our hospital. The urine from catheter is collected from each patient and subjected to culture and antibiotic susceptibility testing.Results: The prevalence of catheter associated urinary tract infection in our hospital is about 20% and asymptomatic bacterial colonization is 50% which is nearequal to Danchaivijitr S et al study. The common pathogens found in this study are Escherichia coli (22%), Klebsiella (18%), Enterobacter (8%), Staph. aureus (6%) which include MRSA (4%), Pseudomonas (6%), Enterococcus (4%), Candida sps. (4%) Andproteus (2%).Conclusions: CAUTI has low prevalence 20% and asymptomatic colonisation 50% in our hospital with common pathogen being Escherichia coli. It is one of the important notable pathogen causing nosocomial infection among admitted patients. The patients present mainly as asymptomatic bacterial colonisation and risk of CAUTI increases with longer duration of catheterisation. All patients those who had catheter for more than 6 days, aged 60 and above, should be checked for UTI symptoms. And their urine should be cultured regularly in order to diagnose and prevent CAUTI and its complications which are very dangerous and difficult to treat

Study of Prognostic Significance of Hyponatremia in Acute Phase of ST Elevation Myocardial Infarction

BACKGROUND: Globally, 17.5 million deaths in 2012 was due to Cardiovascular diseases. Developing countries contributed more than 75% of cardiovascular deaths. Epidemiological transition i.e. industrialization, urbanization, and related lifestyle changes has cause a rapid increase in death rate in developing countries, as compared to developed countries. About a Quarter of all mortality is caused by Cardio Vascular Disease. More than 80% of CVD deaths are attributable to Ischemic heart disease and stroke. In India Cardio Vascular Disease death rate of 272 per 100,000 population, is higher than the global average of 235 per 100,000 population according to The Global Burden of Disease study. The high CVD mortality in South Asian countries and India are due to various factors. These are: (a) lack of policies for control of primordial risk factors (smoking, smokeless tobacco, alcohol, physical inactivity, and unhealthy diet); (b) poor control of risk factors like smoking, management; and (d) lack of appropriate long-term care (cardiovascular rehabilitative and secondary prevention i.e. high blood pressure, obesity, high cholesterol and diabetes mellitus (c) low availability and, at times, substandard acute Coronary Heart Disease management programs). In Heart failure due to low cardiac output and reduced systemic blood pressure there is decrease perfusion of the baroreceptors (in carotid sinus) and the renal afferent arteriole, there by activating "hypovolemic" hormones/Neurohormonal, such as rennin, ADH (Antidiuretic hormone), and norepinephrine, which leads to an increased plasma and extracellular fluid volumes in already edematous patient. This Neurohormonal release causes reduction in the serum sodium concentration parallel the severity of the heart failure. The same Neurohormonal mechanism operating in acute STEMI patients to cause Hyponatremia. MATERIAL AND METHODS: Patients admitted in intensive coronary care unit (ICCU) of Coimbatore medical college a n d hospital between the period, February 2017 and February 2018, with acute ST elevation myocardial infarction (STEMI) were studied in a prospective manner. A total of 200 patients were studied. All the patient admitted with history suggestive of myocardial infarction was taken standard 12 lead ECG. If the patient had inferior wall MI right side ECG was taken ie RV3, RV4. On admission basic investigation like, random Blood sugar, Blood urea, serum creatinine and electrolytes, LFT (liver function test), CBC (complete blood count) were done for all the patients. Chest X-ray, ECHO, lipid profile was taken for all the patients during hospital stay. On admission and at 24, 48 and 72 hours, Plasma Sodium levels were obtained. For every 100mg/dl rise in blood sugar level, the plasma sodium level was decreased by 1.4 meq/dl. All the patients were followed up for one week and mortality and morbidity data were recorded. All the data were analysised .Analysis was done using “t” test. confidence interval was taken as 95%. A p value of < 0.05% was taken as significant. RESULTS AND OBSERVATIONS: In my study maximum number of patients were from 41-60 years of age. In the present study 72 % of the population belongs to male and 28% female gender. Risk factors in the study population, 42% had hypertension, 47% had diabetes mellitus and 54% had smoking. AWMI is the most common type of presentation of MI in our case study. Number of patient with normal sodium and thereafter is 132, hyponatremia on admission was 26 and hyponatremia after admission was 42. In the study the mean age of Group A was 48 years, Group B was 54 years and Group C was 56 years. Majority of the study population were male constituting Group A 94, group B 22 and group C 28. The incidence of Anterior wall MI (AWMI) among patients with normal sodium levels was 80.3%, decreased sodium on admission was 92% and patients who developed decrease in sodium level within 72 hours was 71.4%. Around 31% of patients with hyponatremia on admission belonged to killip class I and 69 % belonged to killip class II-IV. Among patients with hyponatremia within 72 hours 33% belonged to class I killip, 67% belonged to class II-IV killip. The mean Ejection fraction (EF) was less among patients who presented with Hyponatremia (mean EF 47.24%) or developed Hyponatremia within 72 hours (mean EF 47.15%) of admission when compared to patients with normal sodium levels (mean EF 48.28%). The overall mortality rate in my study was 17%. Mortality among Patients with normal sodium levels on admission and thereafter was 09 %, mortality in patients with Hyponatremia on admission was 38%, and mortality in Hyponatremia within 72 hours of admission was 29%. Survivors had mean serum sodium level of 137.81 Meq/L and lowest level was 123meq/l. In non survivors h a d mean serum sodium level of 132.42 Meq/L and lowest level was 121meq/l. CONCLUSION: In acute STEMI Hyponatremia on admission or development of hyponatremia within 72 hours after admission was associated with a poor prognostic outcome. Hyponatremia severity predicts the mortality in acute STEMI patients. Most of the patients were males, belongs to a higher age group, with lower Ejection fraction (EF), Anterior wall infarction (AWMI) and a higher proportion of patients were Smokers, Systemic Hypertensive, Diabetes mellitus and had Dyslipidemia. Thus development of hyponatremia appeared to be a significant independant risk factor in predicting the short term mortality along with other risk factors in AcuteMI

A Clinical study of Serum Amyalse in Organophosphorus Poisoning in a Tertiary Care Hospital

BACKGROUND: Organophosphorus poisoning is one of the most common poisoning world wide.It produce clinical alterations in the serum amylase. previously plasma cholinesterase are used to assess the severity of poisoning. At present serum amylase is one best indicator to assess the severity of poisoning. The study aim was to estimate serum amylase in organophosphorus poisoning cases and correlation of serum amylase with outcome of patient. MATERIALS AND METHODS: It is cross sectional study sample size of 100 patient those who are admitted in our hospital with history of organophosphorus poisoning with clinical features and evidence of poisoning. POP scale and serum amylase were analysed for first 48 hours after poison consumption and their prognostic values were used to assess severity in predicting respiratory failure patients. RESULTS: In our study poison consumption is predominant in middle age group between 31-40 years of age(36%). male shows predominant (69%). compound most commonly consumed is monocrotophos (22%). In our study amylase value were significantly increased at the time of admission and shows reduction gradually by treatment. Patients those need ventilator support have increased amylase levels on day 1(403.88 IU/L) compared to patients does not need support (155.47 IU/L) it shows P value is significant <0.0001. And outcome of patients those who are expired showed significantly increased amylase values in day 1 (490.12 IU/L) compared to alive patients (182.70 IU/L) it was also statistically significant. CONCLUSION: Serum amylase is considered as marker for organophosphorus poisoning patients. Hence earlier elevation of serum amylase we can predict those who are all risk of developing complications like respiratory failure and require ventilator support

Processing and characterization of polystyrene nanocomposites based on CoAl layered double hydroxide

AbstractThe present work deals with the development of polystyrene (PS) nanocomposites through solvent blending technique with diverse contents of modified CoAl layered double hydroxide (LDH). The prepared PS as well as PS/CoAl LDH (1–7 wt.%) nanocomposites were characterized by X-ray diffraction (XRD), transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR), rheological analysis, thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). The XRD results suggested the formation of exfoliated structure, while TEM images clearly indicated the intercalated morphology of PS nanocomposites at higher loading. The presence of various functional groups in the CoAl LDH and PS/CoAl LDH nanocomposites was verified by FTIR analysis. TGA data confirmed that the thermal stability of PS composites was enhanced significantly as compared to pristine PS. While considering 15% weight loss as a reference point, it was found that the thermal degradation (Td) temperature increased up to 28.5 °C for PS nanocomposites prepared with 7 wt.% CoAl LDH loading over pristine PS. All the nanocomposite samples displayed superior glass transition temperature (Tg), in which PS nanocomposites containing 7 wt.% LDH showed about 5.5 °C higher Tg over pristine PS. In addition, the kinetics for thermal degradation of the composites was studied using Coats-Redfern method. The Criado method was ultimately used to evaluate the decomposition reaction mechanism of the nanocomposites. The complex viscosity and rheological muduli of nanocomposites were found to be higher than that of pristine PS when the frequency increased from 0.01 to 100 s−1

Comparative study of adverse drug reaction pattern of two anti-asthma groups of drugs in a tertiary care hospital

Background: Bronchial Asthma is one of the worldwide health problems associated with increased morbidity and also mortality. Bronchial Asthma is a disease of airways that is characterized by increased responsiveness of the trachea-bronchial tree. Anti asthmatic drugs are associated with adverse effects which can affect the compliance and course of treatment. Monitoring adverse drug reactions in asthma will play a vital role in alerting physicians about the possibility and circumstances of such events, thereby protecting the user population from avoidable harm.Methods: The study was conducted in 500 bronchial asthma patients (250 patients in Beta 2 agonist group (Salbutamol) and 250 patients in Methylxanthine group (Deriphyllin) who fulfilled the study criteria and were observed for three months at Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai. Their prescriptions were collected and analysed. Adverse drug reactions(ADRs) in each group were collected and evaluated. The causality assessment was done by WHO-UMC assessment scale and severity by using Modified Hartwig-Seigel severity assessment scale.Results: Total 38% of patients taking anti-asthma drugs were encountered adverse drug reactions and were more common in elderly females (61 to 70 years). Adverse Drug Reactions were more common in Methylxanthine group (48%) compared to Beta 2 agonist group (28%). Headache (38%) was the commonest ADR in Methylxanthine group and Tremors (31%) in Beta 2 agonist group. Most of ADRs were mild (95 %), manageable and comes under possible (60 %) category of WHO causality assessment scale.Conclusions: Treatment of Bronchial Asthma is mainly based on Beta 2 agonist and Methylxanthine group. So, occurrence of ADR is much common. Our study offers a representative idea of the ADR profile of anti asthmatic drugs. Constant vigil in detecting ADRs and subsequent dose adjustments can make therapy with anti asthmatic drugs safer and more effective. This, in turn, will improve compliance

A Study on Minimal Hepatic Encephalopathy in Cirrhotics.

INTRODUCTION : Hepatic encephalopathy includes a spectrum of transient and reversible neurological and psychiatric manifestations usually found in patients with chronic liver disease and portal hypertension. Its occurrence indicates a poor prognostic factor with a projected one year survival rate of 43%. It occurs in 50% to 70% of cirrhotic patients. The least severe form of hepatic encephalopathy, which is not recognized on clinical examination is Minimal hepatic encephalopathy (MHE). It impairs health related quality of life (HRQOL). It can be detected by using sensitive tests like number connection tests, line tracing tests and figure connection tests, EEG, visual, auditory and somatosensory evoked potentials. Ammonia levels are found to be elevated in patients with minimal hepatic encephalopathy and therefore can play a role in the causation of minimal hepatic encephalopathy. Minimal hepatic encephalopathy has a subtle but negative impact on a patient’s spatial and motor skills, the ability to perform complex tasks such as driving, and even quality of life. Some studies have reported that patients with MHE can progress and later on develop overt hepatic encephalopathy. Due to its negative impact on daily living, it has been suggested that the failure to diagnose this condition could be classified as a medical error. Helicobacter pylori, a gram negative microaerophilic bacteria produces ammonia from urea, which is absorbed in the gastric lumen into circulation.Infection with these bacteria can result in hyperammonemia and hepatic encephalopathy and eradication of these bacteria results in decreased ammonia levels. AIM AND OBJECTIVES : 1. To study the incidence of minimal hepatic encephalopathy in asymptomatic cirrhotics. 2. To study the prevalence of helicobacter pylori in asymptomatic cirrhotics with minimal hepatic encephalopathy. CONCLUSION : This study shows the high incidence of minimal hepatic encephalopathy in asymptomatic cirrhotic patients. This study proves that the prevalence of H.pylori is markedly high in patients with minimal hepatic encephalopathy