Indentifing Risk Factor for Low OutCome in General Surgical Practice using Portsmouth Possum Scoring System

BACKGROUND AND OBJECTIVES: The aim of the present study was to compare the outcome of various surgical modalities using the Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) and its modification the Portsmouth POSSUM. It should be quick and easy to use and should be applicable to all general surgical procedure in both the emergency and elective situation. It should be of use in all type of hospital and should provide educational information. In this prospective study, the validity of P-POSSUM was test in patient undergoing for major surgery and identifying the risk factor for low out come were noted. METHODS: Prospective study on 75 patients undergoing major surgeries both in emergency and elective sitting .The disease severity was assessed in all patient using P-POOSUM scoring system. Predicted post operative mortality rates was calculated using the P-POSSUM equation by linear analysis method. It was then compared with the actual out comes and also the risk factors as scored in the possum criteria were noted. RESULTS: By Applying linear analysis, an observed to expected ratio of 0.96 was obtained this indicating a significant fit for predicting the post operative adverse outcome. There was no significant difference between the observed and predicted mortality rates (x2 = 1.667, 9 d.f.,P = 0.9957). It was found to be comparable to other studies. In all the risk factors studied, a positive correlation was found between deaths and higher POSSUM scores. INTERPRETATION AND CONCLUSION: To conclude, the present study suggest that the out come of surgical patients is reasonably good. Portsmouth POSSUM scoring system serves as a good predictor of post operative outcome in major general surgical procedures and was applicable even in our setup and be used for comparing various treatment modalities and assessing the quality of care provided

Value of endometrial aspiration cytology in assessing the endometrial status in symptomatic peri and postmenopausal women and its histological correlation with fractional curettage

Background: Abnormal uterine bleeding (AUB) is associated with a wide variety of endometrium. Endometrial interpretation is valuable not only to find the etiology of AUB but also to rule out any organic cause for abnormal uterine bleeding. Fractional curettage is one of the most reliable and commonly performed diagnostic techniques used in the investigation of AUB. To evaluate the efficacy of endometrial aspiration cytology in the diagnosis of abnormal uterine bleeding by correlating it with histopathology.Methods: This comparative study to be conducted in100 patients attending antenatal clinic at Department of OBG, Tirunelveli Government medical college hospital from January 2018– July 2019. (17) months. Specific investigations like abdominal ultrasonography, thyroid profile, platelet count, bleeding time, clotting time, prothrombin time, etc were done whenever required. Informed consent was taken from all the study patients. Prior to Fractional curettage, endometrial aspiration was done using plastic disposable pipelines of 3 mm diameter.Results: The sensitivity of the cytology in detecting carcinoma of the endometrium was 83.3%. The specificity of cytology is 100%. Hence the test is highly specific in diagnosis. The positive predictive value is also 100% and the negative predictive value is 99%.Conclusions: It can also detect a few of the endometrial pathologies like endometrial hyperplasia, atrophy, and atypia. It is office Procedure. reduction in associated surgical risks, expense, post-operative pain, and need for operative anesthesia as seen in fractional curettage

Borderline oligohydramnios in term pregnancy and it's relation with pregnancy outcome

Background: Oligohydramnios can lead to contamination of amniotic fluid, fetal distress, neonatal asphyxia, aspiration pneumonia, increased perinatal mortality and adverse pregnancy outcomes. Because of atypical clinical symptoms, the critical point is to treat patients with oligohydramnios in late pregnancy. The objectives of the research were to study the mode of delivery/rate of operative interference/incidence of cesarean section due to fetal distress/non-reassuring fetal heart rate status in cases of term pregnancy with borderline amniotic fluid index (AFI), and to study the perinatal outcome in cases of term pregnancy with borderline AFI.Methods: The study is a prospective comparative study to be conducted in patients attending antenatal clinic at department of obstetrics and gynaecology, Tirunelveli government medical college hospital from from January 2018 till January 2019 (12 months). Data collected with regards to age, demographic characteristics, and socioeconomic status, detailed history including patient’s complaints, duration of complaints, menstrual and obstetric history, significant past, family and personal history. 265 cases of borderline oligohydramnios were detected of which 150 cases were selected for the study after applying exclusion criteria.Results: APGAR scores between the two groups. The mean APGAR scores of the normal group were 8.3±0.7 and the same of the borderline AFI group was 8.0±0.9. The difference between the means was statistically highly significant (p<0.01).Conclusions: Cumulative analysis of various studies, it will be reasonable to conclude that antepartum surveillance for borderline oligohydramnios is indicated in cases associated with fetal growth restriction or suboptimal fetal growth

Hydrogeochemical Characteristics of Groundwater: A Case Study from KadavanarWatershed, Amaravathi Sub-basin, Cauvery River, South India

1627-1639The aim of this study is to the groundwater chemistry at Kadavanar watershed, Cauvery river, South-India. This paper demonstrated that the interrelationship of rock types and groundwater chemistry using piper trilinear diagram and multi-rectangular diagram (MDRs). Well-developed sampling technique was used for this study. Four km equal grids were designed in plain region. Each intersect points are selected for groundwater sample locations. Groundwater samples 147 m.l. were collected on April 2016 (Pre-monsoon). Groundwater samples were analyzed for major ions (pH, EC, Ca2+, K+, Na+, Mg2+, HCO3-, SO42-, NO3-, CO3-). Analytical results were used, to prepare the Piper Triangles Diagram and multi-rectangular diagram (MRD), Gibb’s, USSL and Wilcox diagrams with respect to geology. As per the piper triangles diagram reveals that 53.06 % samples fall under Sodium chloride (NaCl) alkalies exceed alkaline earth class. Concluded that the Multi-rectangular diagram (MRD) interpretation result is reflected same as reveals piper triangles diagram result. Gibb’s diagram shows that the chemical concentration of the groundwater in mainly depends upon the rock water-interaction. Other irrigational classification diagrams such as USSL (63.95 %) and Wilcox’s (67.35 %) diagrams interpretation reavel that the majority of the groundwater samples fell under suitable for agricultural uses

Perforated Right Side Colonic Diverticulum with Abscess

Colonic perforation is a rare cause of intraabdominal abscess. It presents, more frequently in frail elderly patients, with heterogeneous signs and symptoms which hamper the clinical diagnosis. Subcutaneous emphysema with pneumomediastinum and&nbsp; muscle abscess are unusual signs. Colonic&nbsp; perforation may be consequent to diverticulitis or locally advanced colon cancer. Due to the anatomy of the abdominal space and different physiopathology, diverticular perforation may present with air and pus collection; on the other hand perforated colon cancer may cause groin mass and psoas abscess

HER 2 NEU and BMI 1 gene expression in Invasive Ductal Carcinoma Breast and Its correlation with hormone receptors and other known prognostic factors

INTRODUCTION: Carcinoma of breast is one of the most common human neoplasms both in developed and developing countries accounting for 23% of all the cancers in females.1 There is a steady rise in the incidence of breast cancer worldwide. It is the leading cancer among Asian women. Early detection and advances in treatment have begun to reduce mortality rates. Breast carcinoma exhibits a wide range of morphological phenotypes. The histological appearances of tumor cannot fully reveal the prognosis. Exploration of the molecular pathways of carcinogenesis provides explanation for the different morphologic phenotypes and behavior. A large number of genetic alterations have been identified in breast carcinoma, many of which have potential prognostic and predictive values. Thus estrogen and progesterone receptor expression predict response to tamoxifen therapy and Her2neu over expression predict response to trastuzumab. Recent research in breast biology has provided support for the cancer stem cell hypothesis. Tumor originates from the tissue stem cells through dysregulation of the normally tightly regulated process of self renewal. Cancer stem cells have the potential to self renew and differentiate to generate phenotypically derived cancer cells. The polycomb gene Bmi1 is the critical regulator of self renewal of stem cells and is over expressed in breast cancer. Genomic studies provide a new method of classification of breast cancers based on gene expression patterns. Recently immunohistochemical markers such as ER, PR, Her 2 neu, CK5/6 and EGFR have been used as surrogates for DNA microarray in subtyping breast cancer10. These subtypes predict outcome, patient response to chemotherapy or targeted therapy. Thorough use of molecular techniques like immunohistochemistry and polymerase chain reaction to study the protein and DNA expression profiles may help to predict clinical outcome in individual patients and thus guides to plan personalized therapy. In this study of 60 cases, an attempt is made to assess molecular subtypes of breast cancers and to compare the Bmi 1 gene and Her 2 neu oncoprotein expression with other known prognostic factors. AIMS AND OBJECTIVES: 1. To identify the relative frequency and distribution of breast carcinoma in population. 2. To study the histomorphological features of breast carcinoma including grade, lymph node status, lymphovascular invasion, lymphocytic response, and necrosis. 3. To study the immunohistochemical expression of estrogen and progesterone receptors in invasive ductal carcinoma breast. 4. To study the immunohistochemical expression of Her2neu protein in invasive ductal carcinoma breast. 5. To study the Bmi1 gene expression in invasive ductal carcinoma breast with respect to grading. 6. To determine the correlation of Her2neu and Bmi1 gene expression with hormone receptor status and other known prognostic factors such as tumor size, histological grade, axillary node status, presence of tumor necrosis, lymphocytic response, lymphatic and vascular invasion by tumor. MATERIALS AND METHODS: This study is a retrospective descriptive study of invasive breast cancers conducted in the Institute of Pathology, Madras Medical College and Government Hospital, Chennai during the period between July 2008 and May 2010. Source of data: The invasive ductal carcinoma cases reported in mastectomy specimen received in the Institute of pathology, Madras Medical College between July 2008 to May 2010 from the Department of Surgery, Oncology, Plastic Surgery and Geriatrics, Government General Hospital. A total of 238 mastectomy specimens (simple, modified radical or radical mastectomy) were received during this period. Inclusion Criteria: All the invasive ductal carcinoma cases reported in mastectomy specimens irrespective of the age and sex were included for the study. Exclusion Criteria: • Non neoplastic lesions and benign tumors of breast. • Ductal carcinoma breast reported in incision/excision biopsy and completion mastectomy specimens. • Cases with inadequate material from the tumor for doing both immunohistochemistry and polymerase chain reaction were not included in the study. SUMMARY: 60 breast cancer samples were subjected to immunohistochemistry and polymerase chain reaction to assess the Her2neu and Bmi 1 gene expression and the results were correlated with hormone receptor status and other known clinicopathological prognostic factors. • The relative frequency of breast carcinoma among other surgical cases of Madras Medical College is 2.1%. • The non neoplastic breast lesions form 30.24 %, benign tumors 33.54% and malignant tumors 36.22%. • Breast carcinoma had a peak incidence in the age group of 41 to 50 years. • The most common histological subtype was Invasive ductal carcinoma NOS type which constituted 86.13%. • 52% of the breast cancer presented with T2 size (2 to 5 cm) tumors. • Grade II was the most common grade observed accounting for 52.92%. • Nodal metastasis observed in 52 %. • Lymphatic invasion and vascular invasion were seen in 58% and 22% respectively. • Skin infiltration was seen in 17 % of the tumors. • Lymphocytic infiltration was observed in 65% of the tumors. • Necrosis was found in 52% of the tumors. • Estrogen and progesterone receptor expression was seen in 41% and 51% of the tumors. • Her 2 neu over expression was found in 30 % of the study population. • Immunohistochemical molecular subtyping revealed 45% luminal A type, 12% luminal B subtype, 18% Her 2 type, 7% basal type and 17% unclassified type of tumors. • Her 2 neu over expression showed statistically significant association with high grade tumors and hormone receptor negativity. • No association was found between Her 2 neu expression and menopausal status, size, nodal status, lymphovascular invasion, skin infiltration, lymphocytic infiltration or necrosis. • Higher relative Bmi 1 gene expression was significantly correlated with premenopausal age group, small size tumors, ER negativity, Her 2 neu negativity and luminal A molecular subtype. • No correlation was found between Bmi 1 gene expression and grade, lymph node status, PR status, lymphovascular invasion, skin infiltration, lymphocytic infiltration and necrosis. • Bmi 1 gene expression of this study was not in concordance with the results of the studies conducted in Spain and Netherlands while higher expression was observed in small size tumors similar to the study conducted in Korean population. The variation in expression could be hypothesized as due to many reasons including racial differences between European and Asian population which needs extensive and larger study sample . • Further studies have to be conducted in future to define the clinicopathological importance of Bmi 1 gene expression and the possibility of using this gene as an novel prognostic marker in breast cancer patients. CONCLUSION: The incidence of Invasive ductal carcinoma NOS was higher in this study. Many of our patients presented in younger age with large sized tumors accounting for aggressive nature of breast cancer in our population. Her 2 molecular types were more frequent and Basal type tumors were less frequent in the present study when compared to the western literature. Her 2 overexpression was common with high grade, hormone receptor negative tumors. Higher Bmi 1 gene expression was associated with premenopausal, small size, ER negative, luminal A subtype tumors in concordance to the study conducted in Korean population. Hormone receptor negativity and Her 2 neu overexpression is more common in breast cancers of Indian women than the western population. Due to high prognostic significance, Her 2 neu should be checked in all breast cancer patients so that positive cases can benefit by herceptin therapy and anthracycline based chemotherapy which can improve the survival in these patients. The ethnical difference between European and Asian races may explain the variation in the expression of Bmi1 gene expression. However, further studies have to be conducted in future on a larger number of samples to assess the actual role of Bmi 1 gene expression in Indian population and to explore the possibility of using this gene as a novel prognostic marker in breast cancers

Prospective study on Midtrimter Anomaly Scan and Analysis in Govt. Rajaji Hospital, Madurai

The study of MIDTRIMESTER ANAMOLY SCAN AND ITS ANALYSIS was conducted in the department of Obstetrics and Gynaecology at Government Rajaji Hospital,Madurai in the year 2013 June to 2014 July. About 150 patients examined perday in the outpatient antenatal clinic. Among them 150 antenatal patients who fulfilled the selection criteria were randomly selected and included serially for this study, about 33 cases of anomalies were detected and analysed. By analyzing the risk factors mothers at high risk for anomalies can be subjected earlier even at 14 weeks for level II scan and early diagnosis of lethal congenital anomalies, and can be terminated, thereby decreasing the maternal morbidity, psychological upset and also decrease the workload of the health care provider. Early detection of correctable anomalies compatible with life helps us to plan the mode of therapy and referral to higher centers for immediate ante partum, intrapartum and neonatal help, thereby decreasing the prenatal mortality and morbidity. In case of neural tube defects we can decrease the incidence of recurrence by proper periconceptional folic acid supplementation therapy. MY STUDY REEMPHASIES THAT CONSANGUINEOUS MARRIAGES TO BE AVOIDED. GENERAL NUTRITIONAL STATUS TO BE IMPROVED

COMPARISON OF ANTIBACTERIAL ACTIVITY OF EXTRACT OF PROSOPIS JULIFLORA SEEDS AGAINST AEROBIC AND ANAEROBIC BACTERIA

Objective: To compare the antibacterial activity of prosopisjuliflora seed extract against aerobic and anaerobic bacteria. Methods: A cross sectional study was conducted for 6 mo in the clinical microbiology laboratory of SMCH. Agar cup diffusion technique is used to isolate the strains of Clostridium perfringens ATCC 3624, Staphylococcus aureus ATCC 25923 and Escherechiacoli ATCC 25922. The prosopisjulifloraseeds are collected from the saveetha medical college. Results: By performing the research with proper guidance it is observed that all the three bacterias–Staphylococcus aureus, Escherechia coli, Clostridium perfringens showed sensitivity to prosopisjulifloraseed extract. Conclusion: Due to its vast antibacterial activity it can be used along with other antibiotics to increase its efficacy. This is used for the treatment of infectious diseases

ANTI-MICROBIAL EFFECTIVENESS OF LEMON GRASS OIL (CYMBOPOGAN CITRATE) AGAINST AEROBIC AND ANAEROBIC ORGANISMS

Objective: To find the antibacterial effectiveness of lemon grass (Cymbopogan citrate) oil against aerobic and anaerobic bacteria. Methods:This is an observational study conducted at Microbiology Clinical laboratory, Department of Microbiology, Saveetha Medical College and Hospital, Chennai. It was done over a period of 3 mo from January to March. The extracts of lemongrass leaves were investigated for its effectiveness against Staphylococcus aureus(S.aureus), Escherichia coli(E.coli) and Clostridium perfringens(C.perfringens) by Disc Diffusion assay. Results:Our study indicates that the extract of lemongrass oil shows antibacterial activity. Among the tested organisms,&nbsp;aerobic organisms were sensitive. Conclusion: This study thus provides insightful knowledge on antibacterial activity that would lead to further development of lemongrass oil for infectious diseases in the future

7-(2-Chloro­phen­yl)-2,6,9-trimethyl­dibenzo[b,h][1,6]naphthyridine

In the title compound, C25H19ClN2, the dibenzo[b,h][1,6]naphthyridine system is planar to within 0.16 (2) Å, and the chloro­phenyl ring is inclined to it by 82.53 (7)°. In the crystal, mol­ecules are linked by C—H⋯N hydrogen bonds, forming chains propagating in [100]. There are also a number of weak π–π stacking inter­actions present [centroid–centroid distances = 3.8531 (1) and 3.7631 (1) Å]