COMPARITIVE STUDY OF DELAYED PRIMARY CLOSURE VERSUS PRIMARY CLOSURE OF SKIN IN CONTAMINATED AND DIRTY ABDOMINAL WOUNDS/ INCISION

Background: It is still a matter of debate whether delayed primary  closure (DPC) of contaminated abdominal incision reduces surgical site infection compared with primary closure (PC ). The rate of wound infection for dirty abdominal wound is approximately 40%, but the optimal method of wound closure remains controversial. Aims and objectives: To determine whether delayed primary skin closure of contaminated and dirty abdominal wounds reduces the rate of surgical site infection (SSI) compared with primary skin closure. Method: Patient diagnosed as acute peritonitis and posted for exploratory laparotomy during the period of October 1 2013 to September 1 2015 were included. The study was conducted at Shri B M Patil Medical College and Hospital, Bijapur. In this series a total of 100 patients were included and were divided in two groups. Each group had 50 patients. For primary closure group, wounds were closed with monofilament interrupted suture. For Delayed primary closure, skin and subcutaneous tissue are left open and packed with 10 % (betadine) povidone iodine soaked gauge, which was changed daily to prevent excessive collection of exudates. The outcome of wound was assessed on post - operative days. Result: In this entire series, wound infection developed after incision closure was 33% .The primary group had a higher rate of wound infection 54% and  delayed primary closure was  12% (P<0.001) and longer length of hospital stay 19.4 days in primary closure group  and 16.5 days in delayed primary closure group (P<0.002). Conclusion: Laparotomy wound complications are multifactorial, it depends on many factors. A strategy of DPC of dirty abdominal wound, clinically appears to decrease the rate of wound infection, when compared with PC without increasing the length hospital of stay

Empyema Thoracis- the role of open thoracotomy with decortication in the era of video-assisted thoracoscopic surgery

Background: Empyema Thoracis, a condition in which purulent fluid accumulates within the pleural cavity, is commonly caused by bacterial infection (both Gram- positive and Gram-negative), such as Mycobacterium tuberculosis, and rarely by fungal infection. Timely intervention significantly reduces morbidity and mortality. Surgical intervention is needed in advanced disease. This study aimed evaluate decortications performed through video-assisted thoracoscopic surgery (VATS) and open thoracotomy. Methods: This retrospective study included 47 patients who underwent decortications by either VATS or open thoracotomy for empyema Thoracis at the Department of Surgery of, BLDE DU Shri B M Patil Medical College from May 2015 to August 2020. Results: Tuberculosis was the most common etiological factor for empyema Thoracis. In 19 patients who underwent VATS decortications, VATS was converted to open thoracotomy in 11 patients. Only 8 patients achieved successful decortication with VATS. Thirty- nine patients (including 11 whose VATS was converted to open thoracotomy) underwent successful open thoracotomy decortications. Thirty-two patients had postoperative bronchopleural fistula, and all cases were successfully managed conservatively. The timing of the surgical intervention is critical in reducing morbidity and mortality. The more advanced the disease, the higher the failure rate of VATS in attaining complete decortications. Conclusion: Open thoracotomy decortication remains the gold standard in attaining complete decortications in advanced empyema Thoracis

Assessment of surgical outcome in general surgery using Portsmouth possum scoring

Objective: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and its modification, Portsmouth POSSUM, are considered as methods of risk scoring. Application of this scoring system helps in assessing the quality of the health care provided& surgical outcome. Its utilization in our country where the level of healthcare and resources differ is limited. Hence, a prospective study to assess the outcome of surgeries using P Possum scoring system in a teaching hospital at district level and compare with other health care facilities with similar and different settings was taken up. Methods: 175 major surgeries were studied. Using P-POSSUM equation, predicted mortality rates were calculated & compared with the actual outcome. The predicted mortality & actual outcome was compared with other studies done in similar and different health care levels. Results: An observed to expected ratio of 0.96 was obtained, indicating there was no significant difference between expected to observed mortality rates suggesting a reasonably good quality of outcome in comparison with other health care systems. Conclusion: The quality of surgical care provided and surgical outcome are comparable to other health care systems with observed to expected mortality ratio being nearly same. P Possum can be used as a tool for outcome audits

Case Report - Hernia uterine inguinale

Herniation of the Mullerian duct derivatives in males is termed hernia uterine inguinale or patent Mullerian duct syndrome. It is a rare syndrome with male pseudohermaphroditism presenting in either neonatal or adult life with inguinal hernia or cryptorchidism or both. Such a case with an unusual cause for haemoperitoneum is presented here with review of literature

Conflict of Interest - Serious Issue on Publication Ethics for Indian Medical Journals

Background: There are several vested interest lies on research publication hence the editorial policy is the sole important factor to control and regulate ethical publications in medical sciences especially on ‘conflict of interest’ issue. Aim: the study was aimed to assess on awareness of ‘conflict of interest’ issue in medical research and publication among the editorial staff, peer reviewers and authors of Indian medical journals. Methods: 61 authors who have published research articles recently in Indian medical journals (2008-2012), 56 peer reviewers who reviewed the manuscripts during same period and 35 editorial board members of various Indian medical journals were assessed by questionnaire and telephone interview regarding their understanding and knowledge on ‘conflict of interest’ issue for ethical publication. Results: Only 12% of the authors knew about the ‘conflict of interest’ issue and 19% of the medical authors have just heard about it! Out of 12% of authors who knew ‘conflict of interest’ issue only 5% provided that statement to the journals. Among the peer reviewers only 30% knew about ‘conflict of interest’ of which 91.5% stated that they do not bother about this issue while reviewing the manuscripts! But interestingly 75% of the peer reviewers confessed that they had a bias on the topics written by their friends or students! Among the editorial board members of Indian medical journals only 25% have any idea on ‘conflict of interest issue’. Conclusions: Results clearly shows poor understanding of ‘conflict of interest’ like important ethical issue among Indian medical scientists or journals. Keywords: authors; conflict of Interest; editorial members; peer reviewers; Indian Medical Journals

Prepubertal Bilateral Giant Fibroadenoma of Breast with Ulceration: A Case Report

Breast masses are uncommon in childhood. Juvenile fibroadenoma is a rare clinical entity and forms 4% of the total fibroadenomas, and giant juvenile fibroadenoma constitutes only 0.5% of all fibroadenomas. A rare case of bilateral juvenile giant fibroadenoma of breasts in a pre pubertal child who developed mass related complications of ulceration, bleeding and backache is reported here