Utility of Surgical APGAR Score in Predicting Postoperative Morbidity and Mortality in patients Undergoing Laparotomy: A Prospective study

BACKGROUND: Health facilities strive to offer quality surgical care by minimizing postoperative complications. Predicting complications facilitates objective clinical decision making during recovery. Compared to existing morbidity and mortality predictive scores, the Surgical Apgar Score is simple and effective. Morbidity and mortality in patients undergoing laparotomy are high; an effective scoring system can reduce these. OBJECTIVE: To determine the utility of the Surgical Apgar Score in predicting the thirty day major postoperative complications rates for patients undergoing laporotomy. Study Design: Prospective descriptive study. Study Population: 154 patients aged 13 years and above undergoing laparotomy at Madras Medical College & Rajiv Gandhi Govt. General Hospital, Chennai were selected by consecutive sampling until the desired sample size was achieved. Study Duration: March 2016 to September 2016. MATERIAL AND METHODS: Intra operative values of the lowest mean arterial pressure, the lowest heart rate and the blood loss were collected using a questionnaire immediately after surgery and the Surgical Apgar Score was derived for each patient. The occurrence of major complications and the mortality rate was determined during a thirty day period starting immediately after surgery. Data was obtained from the admitting ward, the ICU and surgical outpatient clinic notes. Major complication definitions were according to the one described by Copeland et al. Data collected was entered and analyzed using statistics. P values were generated using t test for means, x2 for comparison of proportions, analysis of variance (ANOVA) and where applicable Fischer’s exact test. Results were presented in graph, tables and charts. RESULTS: 154 patients were recruited of which 2 were lost on follow up. The mean age in this study was 35.18 years. This study had a skewed distribution of gender with 75% of patients being male. The most common reason for laparotomy is penetrating abdominal injury. This is18.4% of the overall cause of laparotomy. It could be seen that emergency laparotomy is the major cause for the development of major postoperative complications when compared to elective laparotomies. Female sex, 40 years or lesser age and surgery time more than 2 hours are other noted factors in our study that was found to be associated with a significantly higher rates of complications. It can be observed in our study that, long duration of surgery and a low mean Surgical Apgar Score is having a strong association. From our study we can interpret that, patients having a SAS 0f 0 – 4 who belong to the high risk group had a higher complication rate of 58.3% when compared with the patients having a score of 8 – 10 who belong to low risk group. This group had a lower complication rate of 16.6%. It was statistically significant too. This clearly demonstrates the efficacy of the Surgical Apgar Score in selecting patients who are at a higher risk of developing major complications from patients who are at an average risk of developing complications. CONCLUSION: Laparotomy surgery is associated with significant morbidity and mortality. The SAS, despite using simple and widely available intra-operative parameters, is useful tool to predict occurrence of 30 day major complications and mortality following laporotomy surgery

Immunoregulatory pathways in pregnancy

207-219Murine pregnancy is characterized by transient thymic atrophy and splenomegally. Several laboratories are investigating the immunoregulatory mechanisms during pregnancy, and the majority of these studies are primarily focused on the immunological changes either in the uterus or the thymus and not much information is available on the immunological changes in the spleen that result in transient splenomegally. An attempt has been made in this review to understand the significance of thymic atrophy, splenomegally and local immune changes in the uterus to understand the overall immunomodulatory mechanisms in pregnant mother. The most significant change which occurs soon after mating is the infiltration of immune cell s such as macrophages and yδ-T cells into the uterus indicating that the mother's immune system detects the presence of foreign antigens in the reproductive tract. The sensitized cells appear to migrate to the secondary lymphoid organs including the spleen. The microenvironment in the spleen is conducive for the cell -cell contact and generation of immune response. The major changes that occur in the spleen are,t he induction of T-cell dependent B-cell response on day-1 post-coitum (P.C), generation of antibody producing B-cells on day-3 and also proliferation of CD8+ T-cells that peaks on day-3 of pregnancy. The weight of the spleen reaches a peak on day- 10 in mice. Thereafter, on day-15 of pregnancy, lymphocyte apoptosis is seen in the spleen indicating the deletion of peripheral sensitized cells. This results in decrease in spleen weight to that of normal non-pregnant mice. The decrease in thymic weight after day-5 pregnancy was associated with the increased apoptosis of cortical thymocytes. This perhaps is due to negative selection of self-reactive thymocytes. Our studies have demonstrated that the pregnancy associated monoclonal antibodies react with antigens of sperm indicating that the mother's immune system recognizes and responds to the constituents of the semen to produce nonprecipitating asymmetric auto antibodies (NPAA) or blocking antibodies which have favourable effects on pregnancy. It is postulated that the mother's immune response could be directed to some antigens of sperm along with some conserved antigens such as heat shock proteins (HSP) that are present both in sperm and in the mother. It may be speculated that after the initial priming to some conserved antigens of sperm and due to the presence of similar an ti gens in the mother, these activated clones are eliminated both in the primary and secondary lymphoid organs to prevent autoimmunity in the mother during pregnancy

Days lost due to disability of diclofenac-induced adverse drug reactions

Disability Adjusted Life Years (DALY) is a widely used measure to quantify the burden of diseases or illness. DALYs for a disease is calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the equivalent healthy Years Lost due to Disability (YLD). The only difference from the YLD and Days Lost due to Disability (DLD) calculation is that instead of considering the duration of Adverse Drug Reaction (ADR) in years, it is calculated in days. Objective: DLD was measured for diclofenac tablets to prepare the ADR profile. Methods: The study was done on the patients (18- 65 years old) attending the community pharmacy at Kasaragod district, South India, with prescription of diclofenac tablets. Patients reported ADRs on their next visit to the pharmacy or they had called to the provided phone number and reported it. Disability Weight (DW) was calculated in an analogue scale from 0-1. Zero represent complete health and 1 represent death or equivalent condition. DW was multiplied with occurrence and duration of ADRs in days. Results: About 943 patients received diclofenac tablets in 1000 prescriptions were successfully followed up for possible, probable and definite ADRs. A total of 561 reactions reported in 2010 for diclofenac tablet in the study population. There were 34 different types of ADRs under 12 physiological systems/organs. Most common reactions were on gastrointestinal (GI) system (48%), followed by skin (14%), Central Nervous System (10%), renal (7%), and cardiovascular (7%). Abdominal pain, cramps or flatulence was the highest occurring GI ADR (107), followed by 43 rashes, 42 nausea/vomiting, 37 indigestion, 34 peptic ulcers, 31 edema etc. DLD for peptic ulcer was considerably high (0.078) per 1000 of the study population on diclofenac. The most damaging ADR were peptic ulcer with or without perforation, followed by rash 0.036 DLD and edema 0.027 DLD. There was considerable DLD by acute renal failure (0.012) Steven-Johnson syndrom (0.013) even though few cases were reported. Conclusion: Diclofenac has a complex adverse drug profile. Around 34 types of reactions were reported. Diclofenac was widely prescribed because of the experiential belief of comparative safety with other NSAIDs. The study shows the importance of pharmacovigilance even on the most prescribed medicine. Most disabling ADR for the study population was peptic ulcer with or without perforation. YLD or DLD are useful measures of calculating disability caused by ADRs. Future studies could focus on improving the usefulness & precision of DLD.Los años de vida ajustados a la discapacidad (DALY) es una medida ampliamente usada para cuantificar el daño de la enfermedad. Los DALY para una enfermedad se calculan por la suma de los años de vida perdidos (YLL) debido a mortalidad prematura en la población y el equivalente años de vida saludable perdidos por la discapacidad (YDL). La única diferencia en el cálculo de los YLD y los días perdidos por discapacidad (DLD) es que en lugar de considerar la duración de la reacción adversa en años, se calcula en días. Objetivo: Se midió los DLD por el diclofenaco tabletas para preparar el perfil de RAM. Métodos: El estudio se realizó en pacientes (18-65 años) que visitaron la farmacia comunitaria del distrito de Kasaragod, Sur-India, con una receta de diclofenac en tabletas. Los pacientes comunicaron las RAM en su posterior visita a la farmacia o llamaron o se les llamó por teléfono y las comunicaron. El peso de la discapacidad (DW) se calculó en una escala de 0-1. Cero representaba la salud completa y 1 representaba la muerte o situación equivalente. El DW se multiplicaba por la aparición y duración en días de las RAM. Resultados: Unos 943 pacientes que recibieron diclofenac tabletas en 1000 recetas fueron seguidos con éxito para sus RAM posibles, probables y confirmadas. Durante 2010 se comunicó un total de 561 reacciones en la población en estudio. Hubo 34 tipos diferentes de RAM sobre 12 órganos o sistemas diferentes. Las reacciones más comunes fueron en el sistema gastrointestinal (48%), seguidas de piel (14%), sistema nervioso central (10%), renal (7%), y cardiovascular (7%). Dolor abdominal, calambres o flatulencia fueron las RAM GI más frecuentes, seguidas de 43 irritaciones, 42 nauseas/vómitos, 37 indigestiones, 34 úlceras pépticas, y 31 edemas. Los DLD para úlcera péptica fueron considerablemente elevados (0,078) por 1000 individuos en estudio con diclofenac. La RAM más dañina fue la úlcera péptica con o sin perforación, seguida de la irritación con 0,036 DLD y el edema con 0,027 DLD. Hubo considerables DLD por fallo renal agudo (0,012) e incluso se comunicaron algunos casos de síndrome de Steven- Johnson (0,013). Conclusión: El diclofenac tiene un perfil de reacciones adversas complejo. Se comunicaron 34 tipos de reacciones. El diclofenac era ampliamente prescrito por la creencia empírica de la seguridad comparativa contra otros AINE. El estudio demuestra la importancia de la farmacovigilancia, incluso en los fármacos más prescritos. La RAM más incapacitante para la población de estudio fue la úlcera péptica con o sin perforación. Los YLD o los DLD son medidas útiles para calcular la incapacidad causada por RAM. Futuros estudios podrían centrarse en mejorar la utilidad y precisión de los DLD

Differential affinity of anti-Pr-β-hCG-TT antibodies for hCG and hLH

Sera from four women immunized with the vaccine Pr-β-hCG-TT have been analysed for binding with hCG and hLH. Resolution of Scatchard plots showed the presence of more than one population of antibodies in these sera. In each case the Association Constants (Ka) of a population of antibodies for binding with hCG were distinctly higher than those for hLH. Results indicate the likely presence in β-hCG of determinants and/or conformations immunologically unique to hCG besides common regions

Situational analysis of prevailing practices in the management of first‐episode psychosis in Chennai, India

Aim This paper aims to examine how existing mental health within the city of Chennai, India manages first‐episode psychosis, to determine lacunae and barriers in providing effective early intervention and to make appropriate recommendations to improve the care of first‐episode psychosis patients. Methods Interviews were held with 15 health professionals to capture information on current practices and facilities available for the management of first‐episode psychosis. Results No specialized clinic or services were available for individuals with first‐episode psychosis in Chennai, except one. Pharmacotherapy was the main treatment modality with psychological support to patients and families. Most common drugs used were Risperidone, Olanzapine, and Haloperidol in their recommended doses. General practitioners and paediatricians, due to inadequate training in mental health, referred patients with psychosis to mental health professionals. Conclusions Equipping the existing mental health services to manage FEP and training all health professionals on psychosis will improve FEP management in Chennai

The Effect of Magneto-Priming on the Physiological Quality of Soybean Seeds

Microwaves have been applied to the drying of seeds of several species due to their maintenance of the quality of the seeds and reduction of time and costs. However, few is known about the effect of microwaves on the increase of the physiological quality of soybean seeds and especially their effects on longevity. Therefore, the use of microwaves as magneto-priming in soybean seeds was the object of study in this work. For this purpose, two soybean cultivars were selected and submitted to the ultra-high frequency (UHF) microwave exposure of 2.45 GHz, in the wavelength of 11 cm, and power of 0.2 W/g, for 15 min. The results showed that this condition of exposure to the microwave brought benefits in both cultivars after treatment. Incremental improvements were observed in the germinability indexes, the seedling length, the water absorption by the seeds, the fresh mass, dry mass, and longevity. The genes related to seed germination and longevity showed superior expression (HSFA3, HSP21, HSP17.6b, EXP, ABI3) with magneto-priming treatment. The data found ensure the use of the technique as a viable option for pre-treatment as magneto-priming in soybean seeds in order to improve seed quality