Outcomes of Microvascular Free Flap Reconstruction after Major Head and Neck Ablative Surgery at a Tertiary Teaching Hospital in Eastern Nepal.

Background Reconstruction with free flaps has significantly changed the outcome of patients with head and neck cancer. Microsurgery is still considered a specialized procedure and is not routinely performed in the resource-constrained environment of developing country like Nepal. Objective To evaluate the clinical outcomes in patients who underwent different microvascular free flap reconstructions of head and neck defects after major ablative surgery. Method A retrospective study was conducted to review and analyze the data of patients with head and neck cancer who underwent microvascular free flap reconstruction after major ablative surgery from November 2017 to April 2021. The descriptive statistics were calculated using Microsoft Excel 2010. Result Out of 207 patients, 129 (62.32%) were males. Mean age was of 55.17±13.44 years. About 133 (64.25%) tumors were on gingivobuccal complex. Anterolateral thigh flap was the most common flap 112, (54.11%) used for the reconstruction. Facial artery was used in 174 (84.06%) patients for anastomosis. The overall success rate was 97.5%. Re-exploration was done in 22 (10.63%) cases out of which 11 (50%) cases were having flap compromise. Delayed flap failure occurred in 5 cases (2.5%) and salvage surgery was done with pectoralis major myocutanuos flap with a salvage rate of 54%. Minor complications were observed in 39 cases (18.84%) out of which donor site graft loss was observed in 19 (9.18%) patients. Conclusion In spite of advanced set up, with trained dedicated manpower the microvascular free flap reconstruction of head and neck defects is safe with high success rate even in resource constrained country like Nepal.

Medical Students' Perception towards Online Education at Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.

Background Online education has gained popularity in various fields, including medicine, owing to its flexibility and time-saving advantages. The COVID-19 pandemic has further accelerated its adoption as an alternative to traditional in-person learning. Medical students appreciate the ability to study at their own pace, access resources remotely, and engage in virtual collaboration and networking. Objective The objective of this study was to determine the perception of online education among medical students. Method A cross-sectional descriptive study was conducted at Kathmandu University School of Medical Sciences (KUSMS), Nepal, comprising 332 participants. A Google Form questionnaire was used to assess their perceptions and responses deliberated on a three-point Likert scale. Descriptive analysis was used to determine the respondents' views. Result The results showed that a significant majority (64.8%) of the respondents agreed that accessing the internet for online education was easy. However, only 35.5% felt comfortable attending online lectures at home. Regarding the effectiveness of online learning, the majority (66.3%) disagreed that it was similar to traditional classroom lectures. More than half (51.5%) of the respondents agreed that online classes were time-consuming and (71%) required breaks during sessions. Surprisingly, only 27% expressed a preference for online education. Additionally, a notable proportion (87%) disagreed that online education could provide similar real-world skills. Moreover, the majority (85%) disagreed that conducting exams for theoretical and practical/clinical courses virtually was possible. Conclusion Despite the availability of internet access for the majority of students, a significant proportion expressed discomfort with online education. Only a quarter preferred it, and many disagreed that it could replicate the traditional classroom experience or provide comparable skills. Training all faculties, providing high-speed internet, improving student interaction, and giving online demonstrations can enhance student preferences and online quality.

Analysis of Prognostic Factors of Bell's Palsy in a Tertiary Care Centre of Eastern Nepal.

Background Bell's palsy is the most common cause of acute facial peripheral neuropathy commonly encountered in otolaryngology clinics. Studies regarding epidemiology, risk factors, treatment and prognosis of Bell's palsy are sparse in our settings. Objective To analyze the prognostic factors of Bell's palsy in tertiary care Centre of eastern Nepal. Method A retrospective chart review of patients diagnosed with Bell's palsy from 1st January 2005 to 31st December 2018 was done. Records of the patients were obtained from medical record section of BP Koirala Institute of Health Sciences. Result A Total of 208 patients were included for analysis. After six months 72.6% patients had complete recovery. Patients who presented with lower House Brackmann (HB) grade had significantly better complete recovery than those with high grade (89.1% vs 45.6%). The complete recovery was 80.3%, 73.8%, 63.5% and 50% for the patients of more than 30 yrs, 31-45 years, 46-60 years and more than 60 years respectively and the difference was significant (p= 0.012). Alcohol significantly reduced the complete recovery (p= 0.043). Multivariate analysis showed high HB grade score at presentation to be significant predictor of poor prognosis. (p= 0.001 odds ratio 11.262). Conclusion Old age, use of alcohol and the severity of facial nerve palsy at the time of presentation were the bad prognostic factors, severity of the palsy was found to be most significant predictor.

Anastomosis for distal gastrectomy in Chinese patients: uncut roux-Y or roux-Y?

BACKGROUND: An appropriate method of anastomosis is crucial for gastric cancer patients who require gastrojejunal anastomosis. Surgeons have proposed different types of modified gastrojejunostomies in the last two decades. We focused on two types of standard anastomosis, i.e., Uncut Roux-Y and Roux-Y gastrojejunostomies, and compared the differences in immediate postoperative complications between the two types. METHODS: This is a retrospective study on 236 gastric cancer patients who underwent curative distal gastrectomy with gastrojejunal Roux-Y or Uncut Roux-Y anastomosis for six consecutive years. Immediate postoperative complications were compared between the two groups. The authors discussed the causes of the significant complications and their management. RESULTS: There was no difference in demographics between the two groups (92 Roux-y Versus 144 Uncut Roux-y). The overall complication rate was 20.8% with 1.4% anastomotic leakage in the Uncut Roux-Y group versus 33.7% with 7.6% anastomotic failures in the Roux-Y group (p < 0.05). More abdominal infections occurred in the Roux-Y anastomosis group compared with the Uncut Roux-Y anastomosis group (p < 0.05). Duration of postoperative stay was significantly longer in patients with Roux-y anastomosis group (p < 0.05). CONCLUSIONS: Considering the surgical simplicity and postoperative complications, the Uncut Roux-Y is a better choice for anastomosis in patients with gastric cancer undergoing gastrojejunostomy. A well-designed large cohort in a multi-centre randomized controlled trial is necessary to support these findings and compare other aspects.

Antioxidative and antibacterial peptides derived from bovine milk proteins.

The search for alternative preservatives is on the rise due to safety issues linked with the application of synthetic antioxidants and the extensive increase in bacterial resistance to several conventional antibiotics. Therefore, the quest for finding suitable alternatives including bioactive peptides has received attention. This article reports a comprehensive insight concerning antioxidative and antibacterial peptides derived from milk proteins, a prolific source of peptides having various bioactivities. Caseins and whey proteins have also been evaluated for antioxidative and antibacterial potential using the BIOPEP database. A notable number of potentially active peptides are present in milk proteins. Technological approaches are here reported for the production of these peptides. The findings of this review show potentiality of utilizing dairy derived antioxidative and antibacterial peptides in the development of a superior alternative to the current generation of preservatives and therapeutic agents, as well as a functional ingredient in dietetic or pharmaceutical applications.

Benefit of 18F-fluorocholine PET imaging in parathyroid surgery.

OBJECTIVES: To assess the additional diagnostic value of 18F-fluorocholine PET imaging in preoperative localization of pathologic parathyroid glands in clinically manifest hyperparathyroidism in case of negative or conflicting ultrasound and scintigraphy results. METHODS: A retrospective, single-institution study of 26 patients diagnosed with hyperparathyroidism. In cases where ultrasound and scintigraphy failed to detect the location of an adenoma in order to allow a focused surgical approach, an additional 18F-fluorocholine PET scan was performed and its results were compared with the intraoperative findings. RESULTS: A total of 26 patients underwent 18F-fluorocholine PET/CT (n = 11) or PET/MRI (n = 15). Adenomas were detected in 25 patients (96.2%). All patients underwent surgery, and the location predicted by PET hybrid imaging was confirmed intraoperatively by frozen section and adequate parathyroid hormone drop after removal. None of the patients needed revision surgery during follow-up. CONCLUSIONS: These results demonstrate that 18F-fluorocholine PET imaging is a highly accurate method to detect parathyroid adenomas even in case of previous localization failure by other imaging examinations. KEY POINTS: • With 18 F-fluorocholine PET imaging, parathyroid adenomas could be detected in 96.2%. • 18 F-fluorocholine imaging is a highly accurate method to detect parathyroid adenomas. • We encourage its use, where ultrasound fails to detect an adenoma.

Non-Surgical Pneumoperitoneum.

Pneumoperitoneum is mostly caused by visceral perforation and surgical intervention; however non-surgical pneumoperitoneum has been reported without evidence of visceral disease. Blunt chest trauma causing an abrupt rise in thoracic pressure can leak air through the microscopic diaphragmatic defects or the mediastinum along perivascular connective tissue and cause pneumoperitoneum. We hereby present a case of non-surgical pneumoperitoneum after blunt chest trauma that was brought to the emergency department of college of medical sciences teaching hospital with features of bilateral pneumothorax with subcutaneous emphysema and abdominal distension which was diagnosed and managed promptly with bilateral chest drain and other supportive treatments.

Antibacterial and antiproliferative peptides in synbiotic yogurt-Release and stability during refrigerated storage.

The search for alternative therapeutics is on the rise due to the extensive increase in bacterial resistance to various conventional antibiotics and side effects of conventional cancer therapies. Bioactive peptides released from natural sources such as dairy foods by lactic acid bacteria have received attention as a potential source of biotherapeutic peptides. However, liberation of peptides in yogurt depends on proteolytic activities of the cultures used. Thus, this research was conducted to establish generation of inhibitory peptides in yogurt against pathogenic bacteria and cancer cells during storage at 4°C for 28d. Water-soluble crude peptide extracts were prepared by high-speed centrifugation of plain and probiotic yogurts supplemented with or without pineapple peel powder (PPP). The inhibition zones against Escherichia coli and Staphylococcus aureus by PPP-fortified probiotic yogurt at 28d of storage were, respectively, 25.89 and 11.72mm in diameter, significantly higher than that of nonsupplemented control yogurts. Antiproliferative activity against HT29 colon cancer cells was also significantly higher in probiotic yogurt with PPP than in nonsupplemented probiotic yogurt. Overall, crude water-soluble peptide extracts of the probiotic yogurt with PPP possessed stronger inhibitory activities against bacteria and cancer cells than controls, and these activities were maintained during storage. However, activities were lowered substantially during in vitro gastrointestinal digestion. These findings support the possibility of utilizing dairy-derived bioactive peptides in the development of a superior alternative to the current generation of antibacterial and anticancer agents, as well as a functional ingredient in foods, nutraceuticals, and pharmaceuticals.

Effect of pineapple waste powder on probiotic growth, antioxidant and antimutagenic activities of yogurt.

Although many fruit by-products are good sources of nutrients, little is known about their prebiotic potential. This research was aimed at establishing the prebiotic effect of pineapple wastes on probiotics including Lactobacillus (L.) acidophilus (ATCC® 4356™), L. casei (ATCC® 393™) and L. paracasei spp. paracasei (ATCC® BAA52™) and the subsequent release of antioxidant and antimutagenic peptides in yogurt during their growth. Oven- and freeze- dried peel and pomace were milled separately into powders and tested for prebiotic activities. The net probiotic growth (1.28-2.14 log cfu/g) in customized MRS broth containing the pineapple powders as a direct carbohydrate source was comparable to MRS broth containing glucose. The powders were also separately added to milk during the manufacturing of yogurt with or without probiotics. An increase (by 0.3-1.4 log cycle) in probiotic populations was observed in the yogurts as a consequence of pineapple powder supplementation. Crude water-soluble peptide extracts, prepared by high-speed centrifugation of the yogurts, displayed remarkable antioxidant activities assessed through in vitro assays, namely scavenging activity of 1,1-diphenyl-2-picrylhydrazyl radicals (IC50 = 0.37-0.19 mg/ml) and hydroxyl radicals (58.52-73.55 %). The peptide extracts also exhibited antimutagenic activities (18.60-32.72 %) as sodium azide inhibitor in the Salmonella mutagenicity test. Together, these results suggest that pineapple by-products exhibited prebiotic properties and could possibly be commercially applied in new functional food formulations.

Diagnostic performance of 18F-FDG-PET/CT in vascular graft infections.

OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy of positron emission tomography/computed tomography with (18)F-fludeoxyglucose (FDG-PET/CT) in a population with suspected graft infection and to validate a new diagnostic imaging score for FDG-PET/CT. METHODS: This was a prospective cohort study. FDG-PET/CT was performed prospectively in 34 patients with suspected graft infection, in 12 of them before the start of antimicrobial treatment. Diagnostic accuracy was assessed using a new five point visual grading score and by using a binary score. Maximum standardized uptake values (SUVmax) were calculated for quantitative measurements of metabolic activity, and cut off points were calculated using the receiver operator curve (ROC). The standard of reference was a microbiological culture, obtained after open biopsy or graft explantation. RESULTS: Using the new scale, FDG-PET/CT correctly recognized 27 patients with graft infection, one patient was diagnosed as false positive, six patients were correctly classified as true negative, and no patients were rated false negative. Hence, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FDG-PET/CT for the diagnosis of graft infections were 100%, 86%, 96%, 100%, and 97%, respectively. Using a previously established binary score, sensitivity, specificity, PPV, NPV, and accuracy were 96%, 86%, 96%, 86%, and 94% respectively. ROC analysis suggested an SUVmax cut off value of ≥3.8 to differentiate between infected and non-infected grafts (p < .001). Additionally, FDG-PET/CT provided a conclusive clinical diagnosis in six of seven patients without graft infection (i.e., other sites of infections). CONCLUSIONS: The diagnostic accuracy of FDG-PET/CT in the detection of aortic graft infection is high. A newly introduced five point visual grading score and early imaging prior to antimicrobial treatment may further improve the diagnostic accuracy.

Effect of refrigerated storage on probiotic viability and the production and stability of antimutagenic and antioxidant peptides in yogurt supplemented with pineapple peel.

Fruit by-products are good resources of carbohydrates, proteins, vitamins, and minerals, which may function as growth nutrients for probiotic bacteria. This research aimed at evaluating effects of pineapple peel powder addition on the viability and activity of Lactobacillus acidophilus (ATCC 4356), Lactobacillus casei (ATCC393), and Lactobacillus paracasei ssp. paracasei (ATCC BAA52) in yogurts throughout storage at 4°C for 28d. Plain and probiotic yogurts supplemented with or without pineapple peel powder or inulin were prepared. The probiotic counts in supplemented yogurts at 28d of storage ranged from 7.68 and 8.03 log cfu/g, one log cycle higher compared with nonsupplemented control yogurt. Degree of proteolysis in synbiotic yogurts was significantly higher than plain yogurts and increased substantially during storage. Crude water-soluble peptide extract of the probiotic yogurt with peel possessed stronger antimutagenic and antioxidant activities [evaluated measuring reducing power and scavenging capacity of 1,1-diphenyl-2-picrylhydrazyl; 2,2'-azino-bis(3-ethyl benzothiazoline-6-sulfonic acid), and hydroxyl radicals] than control and maintained during storage. Pineapple peel, a by-product of juice production, could be proposed as a prebiotic ingredient in the manufacture of yogurts with enhanced nutrition, and functionality.

Identification of Anticancer Peptides from Bovine Milk Proteins and Their Potential Roles in Management of Cancer: A Critical Review.

Cancer is the most widely recognized reason for human deaths globally. Conventional anticancer therapies, including chemotherapy and radiation, are very costly and induce severe side effects on the individual. The discovery of natural anticancer compounds like peptides may thus be a better alternative for cancer prevention and management. The anticancer peptides also exist in the amino acid chain of milk proteins and can be generated during proteolytic activities such as gastrointestinal digestion or food processing including fermentation. This paper presents an exhaustive overview of the contemporary literature on antitumor activities of peptides released from milk proteins. In addition, caseins and whey proteins have been evaluated for anticancer potential using the AntiCP database, a web-based prediction server. Proline and lysine, respectively, dominate at various positions in anticancer peptides obtained from caseins and whey proteins. The remarkable number of potential anticancer peptides revealed milk proteins as favorable candidates for the development of anticancer agents or milk and milk products for reduction of cancer risks. Moreover, anticancer peptides liberated from milk proteins can be identified from fermented dairy products. Although current findings of correlation between dairy food intakes and cancer risks lack consistency, dairy-derived peptides show promise as candidates for cancer therapy. This critical review supports the notion that milk proteins are not only a nutritious part of a normal daily diet but also have potential for prevention and/or management of cancer.

Emerging artificial intelligence-aided diagnosis and management methods for ischemic strokes and vascular occlusions: A comprehensive review.

Large-vessel occlusion (LVO) stroke is a promising field for the use of AI, especially machine learning (ML) because optimal results are highly dependent on timely diagnosis, communication, and treatment. In order to better understand the current state of artificial intelligence (AI) in relation to LVO strokes, its efficacy, and potential future applications, we searched relevant literature to perform a comprehensive evaluation of the topic. The databases PubMed, Embase, and Scopus were extensively searched for this review. Studies were then screened using title and abstract criteria and duplicate studies were excluded. By using pre-established inclusion and exclusion criteria, it was decided whether or not to include full-text papers in the final analysis. The studies were analyzed, and the relevant information was retrieved. In recognizing LVO on computed tomography, ML approaches were very accurate. There is a shortage of AI applications for thrombectomy patient selection, despite the fact that certain research accurately evaluates individual patient eligibility for endovascular therapy. Machine learning algorithms may reasonably predict clinical and angiographic outcomes as well as associated factors. AI has shown promise in the diagnosis and treatment of people who have just suffered a stroke. However, the usefulness of AI in management and forecasting remains restricted, necessitating more studies into machine learning applications that can guide decision making in the future.

Reoperative characteristics after microfracture of knee cartilage lesions in 454 patients.

PURPOSE: There is only limited information on those patients who fail following microfracture treatment at the knee joint. Evaluation was made of factors associated with treatment failure and clinical outcome assessment among this collective. METHODS: The study included a total of 560 patients who had previously undergone microfracture for the treatment of symptomatic knee joint cartilage lesions. For the remainder of this study, inclusion criteria were patients that underwent reoperation at the initially operated knee joint (index knee) due to symptoms related to the primary site of microfracture intervention (failure patients) with a minimum postoperative follow-up of 2 years. The remaining cohort of patients served as internal control (non-failure patients). Chart reviews were performed to identify patient and defect characteristics. Patients were evaluated for postoperative Lysholm knee scores, Tegner activity scale, as well as preoperative and postoperative numeric analogue scales (NAS) for function and pain (10 = highest possible function, no pain). RESULTS: A total of 454/560 (81.1 %) subjects were completely evaluated. Overall, 123/454 patients (26.9 %) (age at operation 43.9 ± 14.1 years, 56 female, BMI 25.8 ± 3.6, 30 smokers, 61.1 ± 68.3 month symptom duration, postoperative follow-up 5.0 ± 2.1) met the inclusion criteria. The postoperative Lysholm score was 63.0 ± 24.6 and the Tegner score was 4.0; NAS function improved from 2.8 ± 1.8 to 4.8 ± 2.2 (P < 0.001), and NAS pain improved from 3.2 ± 2.1 to 5.0 ± 2.4 (P < 0.001). Exclusively, the overall defect size/knee joint was smaller (P = 0.006), postoperative follow-up was longer (P = 0.002), and existense of previous surgery (77.2 vs. 51.6 %, P < 0.001) was more frequent in failure subjects when comparing to non-failure patients (n = 331). The overall clinical outcome among failure subjects was significantly worse when comparing to non-failure subjects. Regression analysis identified that lower preoperative NAS values, being a smoker, and patello-femoral lesions were associated with a higher probability of reoperation. CONCLUSION: Within the collective presented here, microfracturing was associated with a high frequency of reoperation. Clinical outcome is worse when compared with that of patients without reoperation. Specific parameters can be identified that increase the eventuality of failure following microfracture treatment. LEVEL OF EVIDENCE: IV.

Clinical outcome following the first-line, single lesion microfracture at the knee joint.

CASE SERIES: Level of evidence, 4. BACKGROUND: Arthroscopic microfracture of chondral defects across the knee joint is a frequent treatment modality. There is only limited information on the clinical outcome in patients without previous surgery and single lesions. PURPOSE: Evaluation of clinical outcome following microfracture in patients without previous surgery and single lesions and identification of prognostic factors. METHODS: Inclusion criteria were patients with single-lesion knee joint first-line microfracturing at minimum 2 years postoperatively. Charts were reviewed to identify patient and defect characteristics. Clinical outcome was evaluated by IKDC and Lysholm knee scores, Tegner activity scale and a numeric analogue scale (NAS) for function and pain (10 = highest possible function, no pain). RESULTS: Totally, 145 patients (age at operation 47.92 ± 15.7) met inclusion criteria. Average defect size was 2.7 ± 1.9 cm(2). Postoperatively, IKDC was 73.1 ± 18.5, Lysholm 77.6 ± 19.1, Tegner 4.5 ± 1.7, NAS pain 6.5 ± 2.6 and NAS function 6.4 ± 2.3. Significantly better clinical outcome was observed in male patients than in female patients. Regression analysis including all patient and defect characteristics highlighted that singly the parameter shorter symptom duration (P = 0.018) significantly predicted an improved postoperative clinical outcome. CONCLUSION: Microfracturing results in a satisfying clinical outcome, but no full recovery in patients without previous surgery and single lesions. Specific parameters facilitate outcome prognosis and therefore may aid in indicating surgery.

Perception of Health-Care Professionals on Presumed Consent in Formulation of Proper Organ Transplantation Regulatory System.

Background: Owing to the advancement in organ transplantation, treating an individual with organ failure in today's world has become possible. However, organ transplantation is lagging in the absence of adequate organ donations. Shortage of organs for transplantation is a challenge to developing countries like Nepal and developed countries like the USA and UK. Despite various efforts to increase the rate of organ donation, the problem persists. The primary reason for the failure to accomplish adequacy in organ do-nation is the immediate dependency on an available donor. On top of that, reluctance to decide on organ donation after death, regarded as an onerous moment, at least by the general public, has another impact on the subject. Some countries have shifted while some are planning to change from an informed consent system to a presumed consent system, in which if an individual does not make any decision during life-time, it is presumed that his/her organ can be removed for organ transplantation after death. Objective: To perceive the perception of healthcare professionals of the tertiary care centre of eastern Nepal regarding the presumed consent system. Methods: Purposive sampling of 221 health care professionals (Faculties, Nursing In-charges, Lab-technicians, and Radiology technicians) participated in the study. Results: Most healthcare professionals (90.5%) support using a presumed consent system in Nepal and agree on considering the family's opinion in the decision-making for cadaveric organ donation. Conclusion: Most healthcare professionals have shown their perception in favors of presumed consent to support the increasing organ donation rate.

Cholera in India: an analysis of reports, 1997-2006.

OBJECTIVE: To more accurately define the annual incidence of cholera in India, believed to be higher than reported to the World Health Organization (WHO). METHODS: We searched the biomedical literature to extract data on the cases of cholera reported in India from 1997 to 2006 and compared the numbers found to those reported annually to WHO over the same period. The latter were obtained from WHO's annual summaries of reported cholera cases and National health profile 2006, published by India's Central Bureau of Health Intelligence. FINDINGS: Of India's 35 states or union territories, 21 reported cholera cases during at least one year between 1997 and 2006. The state of West Bengal reported cases during all 10 years, while the state of Maharashtra and the union territory of Delhi reported cases during nine, and Orissa during seven. There were 68 outbreaks in 18 states, and 222 038 cases were detected overall. This figure is about six times higher than the number reported to WHO (37 783) over the same period. The states of Orissa, West Bengal, Andaman and Nicobar Islands, Assam and Chhattisgarh accounted for 91% of all outbreak-related cases. CONCLUSION: The reporting of cholera cases in India is incomplete and the methods used to keep statistics on cholera incidence are inadequate. Although the data are sparse and heterogeneous, cholera notification in India is highly deficient.

Post-operative complications of gastric cancer surgery: female gender at high risk.

We applied physiological and operative severity score for the enumeration of morbidity and mortality (POSSUM) to evaluate overall surgical outcome and investigated the role of gender for early post-operative complications in gastric cancer surgery. The data from a total of 357 patients of gastric cancer were analysed by univariate and multivariate analysis. Post-operative complications were recorded according to definition of POSSUM. Post-operative complications of male and female patients were compared separately. The observed to estimated morbidity ratio (O:E) was 1.01. Among the pre-operative variables, patient gender was one of the independent risk factors for a higher rate of post-operative complications (risk ratio 1.777, P = 0.024). Post-operative complication was significantly higher in female patients. Similarly, post-operative length of stay was significantly longer and more severe complications were observed in female patients (P = 0.03). In conclusion, POSSUM system is a valid algorithm for risk-adjusted surgical audit. We conclude that a patient's gender influences the early post-operative complications after gastric cancer surgery. A detailed understanding on disparity of early post-operative complications between men and women may provide valuable information to improve surgical outcome of gastric cancer. However, results of this study need further confirmation by a prospective study involving a larger cohort.

Gastric cancer surgery and its hazards: post operative infection is the most important complication.

BACKGROUND/AIMS: To evaluate early surgical outcome and analyze postoperative complications of gastric cancer surgery, on the basis of standard auditing system. METHODOLOGY: 357 patients who underwent operations for gastric cancer were included in this study. We applied POSSUM (Physiological and Operative Severity Score for the enumeration of Morbidity and mortality) system to predict morbidity. The observed to estimated morbidity ratio (O: E) was calculated to give risk adjusted morbidity. All the complications were stratified according to its severity and analyzed separately. RESULTS: Observed morbidity was not significantly different from predicted value, the O: E ratio was 1.01. Overall, 137 patients were observed to have postop complications (including 5 death); infection was the main complication which complicated about 17 per cent patients and occupying 44 per cent of all complications. Pulmonary infection rate was on the top. CONCLUSIONS: Post operative complication is higher in gastric cancer surgery. POSSUM system along with stratification of complications is a reliable algorithm in surgical audit to analyze various complications. Postoperative infection is the culprit of various complications. Postoperative infection especially the pulmo-nary infection stands on the top of all complications. More prospective study including basic researches is necessary to explore the etiology of different compilations.

Effectiveness of addition of neostigmine or dexamethasone to local anaesthetic in providing perioperative analgesia for brachial plexus block: A prospective, randomized, double blinded, controlled study.

BACKGROUND: Various local anaesthetic agents are used for brachial plexus block.We compared effectiveness of addition of Dexamethasone versus Neostigmine to Lignocaine, adrenaline admixtures for Brachial plexus block in providing perioperative analgesia. METHODS: Ninety patients were randomized in three groups and were received 24 ml of study drugs. The group A [Lignocaine with adrenaline (1.5%)], group B [Lignocaine with adrenaline (1.5%)] +500 microg Neostigmine, and group C (Lignocaine with adrenaline (1.5%) +4 mg Dexamethasone) for brachial plexus block through supraclavicular approach. The observed parameters were onset of analgesia, completion of sensory and motor blockade, Duration of analgesia, Surgeon's score, side effects, number of supplemental analgesics doses and Visual analogue scale (VAS) score for pain in 12 hour of post-operative period. RESULTS: Mean onset of analgesia 4.6+/-1.1 , 4.4 +/-0.8 , 3.8+/-1.8 mins in group A,B and C respectively and the Mean onset of motor blockade were 7.7+/- 2.0, 7.0+/-1.8, 6.0 +/- 2.1 mins in group A,B and C respectively. Similarly Mean Complete sensory block in 10.6 +/-3, 10.4+/-2.5, and 8.9+/-2.2 mins and Mean complete motor block in 17.3+/-4.3, 17.2 +/-4.0 and 14.7+/-3.5 mins in group A, B and C respectively were achieved. Duration of analgesia was 176.5+/-53.5, 225.7+/-53.3 and 454.2+/-110.7 mins in group A, B and C respectively. Duration of analgesia in group C was statistically significant in comparison with other groups. The number of mean analgesic requirement by group C (0.9+/-0.4) was significantly (p-0.005) lower. The mean VAS was significantly lower in group C in 12 hours post-operatively. CONCLUSION: The onsets of action, duration of analgesia were better in dexamethasone group and also need less number of rescue analgesics requirement.