Secondary Tuberculosis of Breast: Case Report

Tuberculosis of breast is a rare disease which is difficult to differentiate from carcinoma of breast. The involvement of breast can be primary or secondary to some focus in body. A case of secondary tuberculosis of right breast in a 21-year-old female from Kashmir, India, is being reported. Presentation was as a painless discharging sinus of right breast. A tubercular foci of rib was the affecting source of disease. No other evidence of tuberculosis was present in the body. Resection of involved rib segment, along with the discharging sinus, was performed. The patient had antitubercular therapy for 9 months, with no recurrence seen in followup

Nontraumatic terminal ileal perforation

BACKGROUND: There is still confusion and controversy over the diagnosis and optimal surgical treatment of non traumatic terminal ileal perforation-a cause of obscure peritonitis. METHODS: This study was a prospective study aimed at evaluating the clinical profile, etiology and optimal surgical management of patients with nontraumatic terminal ileal perforation. RESULTS: There were 79 cases of nontraumatic terminal ileal perforation; the causes for perforation were enteric fever(62%), nonspecific inflammation(26%), obstruction(6%), tuberculosis(4%) and radiation enteritis (1%). Simple closure of the perforation (49%) and end to side ileotransverse anastomosis(42%) were the mainstay of the surgical management. CONCLUSION: Terminal ileal perforation should be suspected in all cases of peritonitis especially in developing countries and surgical treatment should be optimized taking various accounts like etiology, delay in surgery and operative findings into consideration to reduce the incidence of deadly complications like fecal fistula

Spectrum of abdominal organ injury in a primary blast type

Research articl

Patient safety with reference to the occurrence of adverse events in admitted patients on the basis of incident reporting in a tertiary care hospital in North India

Background: A good quality report should lend itself for detailed analysis of the chain of events that lead to the incident. This knowledge can then be used to consider what interventions, and at what level in the chain, can prevent the incident from occurring again. Aim was to study the occurrence of adverse events on the basis of incident reporting.Methods: Critical analysis of incident reporting of adverse events taking place in admitted patients for one year by using WHO Structured questionnaire on patient safety (RF-1 & RF-2 forms) along with their record review and interview to the concerned staff.Results: 253 incidents of adverse events were reported during the study period of one year. Most common screening criteria being, Patient/family dissatisfaction with care received, documented or expressed during the current (221 incidents i.e. 87.35%), followed by hospital acquired infection/sepsis (29 incidents i.e. 11.46%). 13 incidents (5.13%) were reported for unexpected deaths due to adverse events. 38.9% of reported adverse events studied showed signs of health care team responsible for causing adverse events. 39% of adverse events were found preventable and 61% of adverse event was found non-preventable.Conclusions: Incident reporting of adverse events should be encouraged in all hospitals. 

A comparative study on patient safety with reference to methods of detection of adverse events in a tertiary care hospital in North India

Background:Considerable investments have been made to devise methods to detect actual and potential adverse events in health care in order to address risk and improve patient safety. Objective of the study was to compare the methods of detection of number of adverse events taking place in admitted patients.Method: A prospective study for a period of one year. Three adverse events detection modules were studied, i.e. current record review, Incident reporting and cases discussed in Mortality Meets. A World Health Organization structured questionnaire on patient safety Review form-1 (RF-1) and Review form-2 (RF-2) was used. RF-1 form was used to screen adverse events. Screened positive patients were subjected to RF-2 form to calculate preventability of adverse events. Adverse events as well as preventability were compared to detect the preferred module of detection of errors in care.Results: Current record review was able to detect 15.5% of adverse events with 71.33% preventability. Incident reporting module was able to detect only 0.73% of adverse events with 39% of preventability and mortality meets were able to study only 0.17% of adverse events with 47% of preventability.Conclusion: Current record review was found to be preferred module of detection of adverse events.

Breast Gangrene

<p>Abstract</p> <p>Background</p> <p>Breast gangrene is rare in surgical practice. Gangrene of breast can be idiopathic or secondary to some causative factor. Antibiotics and debridement are used for management. Acute inflammatory infiltrate, severe necrosis of breast tissue, necrotizing arteritis, and venous thrombosis is observed on histopathology. The aim of was to study patients who had breast gangrene.</p> <p>Methods</p> <p>A prospective study of 10 patients who had breast gangrene over a period of 6 years were analyzed</p> <p>Results</p> <p>All the patients in the study group were female. Total of 10 patients were encountered who had breast gangrene. Six patients presented with breast gangrene on the right breast whereas four had on left breast. Out of 10 patients, three had breast abscess after teeth bite followed by gangrene, one had iatrogenic trauma by needle aspiration of erythematous area of breast under septic conditions. Four had history of application of belladonna on cutaneous breast abscess and had then gangrene. All were lactating female. Amongst the rest two were elderly, one of which was a diabetic who had gangrene of breast and had no application of belladonna. All except one had debridement under cover of broad spectrum antibiotics. Three patients had grafting to cover the raw area.</p> <p>Conclusion</p> <p>Breast gangrene occurs rarely. Etiology is variable and mutifactorial. Teeth bite while lactation and the iatrogenic trauma by needle aspiration of breast abscess under unsterlised conditions could be causative. Uncontrolled diabetes can be one more causative factor for the breast gangrene. Belladonna application as a topical agent could be inciting factor. Sometimes gangrene of breast can be idiopathic. Treatment is antibiotics and debridement.</p

Patient safety with special reference to adverse events taking place in the cases discussed in mortality and morbidity meets

Background: There is an increasing belief that an institution’s ability to avoid patient harm will be realized when it creates a culture of safety among its staff members. Aims to study the cases discussed in mortality meets.Methods: Critical analysis of cases discussed in mortality and morbidity meet were done for one year by using WHO Structured questionnaire on patient safety (RF-1 & RF-2 forms) along with their record review and interview to the concerned staff.Results: 62 mortality and morbidity meetings were conducted during the study period of one year. Cardiac/ Respiratory arrest was the most common adverse event studied (67.7%) followed by unexpected death (48.4%). 52.7% of studied adverse events showed signs of healthcare team responsible for causing adverse events, mainly related to the therapeutic care (64.8%). 47% of adverse events were categorized preventable.Conclusions: Mortality and Morbidity Meets should be made mandatory in all hospitals

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI