A Rare Occurrence: Triple 'True' Metachronous Endometrial, Nasal Cavity and Recto-Sigmoid Cancer.

Incidence of multiple primary malignancies is reportedly increasing globally. Limited cases of triple metachronous cancers are available in the literature. Here, we report a case of a female with an unusual combination of triple metachronous malignancy over a span of 15 years involving endometrium, nasal cavity and rectosigmoid that has not been reported before in the literature. Keywords: multiple primary malignancy; triple metachronous cancer; nasal squamous cell cancer; endometrial cancer; recto-sigmoid cancer; Lynch Syndrome.

Seroprevalence of dengue in blood donors in an outbreak: experience of a blood bank in north India.

Our aim was to determine the prevalence of dengue among blood donors at a centre in north India during an outbreak. A retrospective cross-sectional study was conducted using stored serum samples of 369 blood donors at the All India Institute of Medical Sciences (AIIMS), Rishikesh between August and November 2016. Serum samples were tested by an immune-chromatographic rapid test for the screening of dengue markers (IgG/IgM and NS-1). We found prevalence rates of IgG and NS-1 to be 14.9 and 0.54%, respectively.

Prevalence of True Median Cleft of Upper Lip as Reflected from a Small Central Indian Population: Attempt to Report and Review the True Median Cleft of Upper Lip.

AIMS AND OBJECTIVES: The median clefts of the facial skeleton and soft tissue are least in occurrence. Here we have attempted to analyze and review the prevalence of median clefts in our center. MATERIALS AND METHODS: All the patients who reported with congenital deformities from January 2013 to June 2016 were included in the study. A detailed list of patients was then re-evaluated to preclude duplication of the record which could have occurred during the admission process. All the characteristics which can be evaluated epidemiologically were individually tabulated and evaluated in detail. RESULTS: Out of the 1184 patients included in the study only 2 were affected with median cleft. The prevalence of true median cleft was hence determined to be 0.17% among the cleft population. CONCLUSION: The prevalence of the true median cleft lip is rare and hence makes it difficult to classify these clefts, and also the treatment protocol needs to be fabricated for the treatment of such clefts.

Altered Red Cell Indices in Repeat Blood Donors: Experience of a North Indian Blood Bank.

Subclinical Iron deficiency appearing in blood donors after blood donation is a recognized problem. Donors at an increased risk of iron deficiency need to be identified. Blood donors meeting national selection criteria were included in the study. Complete blood counts were done using Sysmex XP-100 three part hematology analyzer. Differences in RBC indices among donor groups defined by previous donations were then analyzed statistically. Six hundred and seventy three males and ninety six females were studied. In males, Kruskal-Wallis test showed significant differences between groups defined by number of donations for MCH and MCV (P value < 0.001), but not for MCHC (P value = 0.09) and RDW (P value = 0.6). Post-hoc tests showed statistically significant difference between donors having six or more donations compared to donors having no previous donations for both MCH as well as MCV. No significant difference was found between donor subgroups in females for any of the indices; however, no female donated blood more than three times in the study. There is increased risk for iron deficiency in donors having six or more previous donations, and evidence for starting an iron screening and supplementation programme for these donors.

Storage of blood samples at or above 33℃ leads to rapid appearance of appreciable systemic bias in platelet and mean corpuscular volume related parameters: an important pre-analytical factor in tropical conditions.

There is scant documentation of the stability of common haematological parameters on storage of blood samples under tropical conditions. K2EDTA samples in multiple vials were taken from 20 healthy blood donors, baseline readings taken, and stored at 33°C and 37°C. Readings from the stored vials were taken after 1, 3 and 6 h. The percent change against the baseline readings at each time point for each storage temperature was calculated. Platelet counts showed an unacceptable shift within 1 h at 37°C and 3 h at 33°C; red cell volume related parameters showed an unacceptable shift within 3 h at 37°C and 6 h at 33°C. Haemoglobin, red blood cell count, white blood cell count and mean corpuscular haemoglobin remained stable for 6 h at both temperatures. The unacceptable change for many parameters on storage at ≥33°C demonstrates the importance of ensuring pre-analytical control in regions experiencing such climatic conditions.

Cryosurgery: A Simple Tool to Address Oral Lesions.

AIM: The study was aimed at evaluating the efficacy of cryosurgery in the management of oral mucosal lesions. Time taken for healing, postoperative pain, secondary infection, and recurrence of lesion was evaluated. MATERIALS AND METHODS: A total of 30 patients with oral mucosal lesions were included in the study. The patients were evaluated for pain and postoperative infection which was documented on the 1st, 3rd, 7th, 21st day after the procedure. Other parameters such as healing time and scarring were assessed at 21st day. Recurrence of the lesion was evaluated in the 3rd and 6th postoperative month. All these data were statistically evaluated. RESULTS: The pain and swelling which reduced mainly during the 7th postoperative day which was highly significant. The discomfort of the patient was relatively less. Only three patients showed delayed healing out of all patients. Recurrence of lesion was noted in two cases which conclude to about 6.7%. CONCLUSION: The cryosurgery is overall a better modality for treatment of oral lesions as it is more reasonable with adequate success. The procedure is relatively more acceptable and has shown to have a faster recovery.

Storage stability of commonly used haematological parameters at 33 °C: Electronic supplementary material available online for this article.

INTRODUCTION: This study aimed to investigate the analytical bias in haematological parameters induced by storage at 33 ºC. MATERIALS AND METHODS: Blood from the diversion pouch of 20 blood donors were collected in K 2 EDTA vials and stored at 33 ºC. Readings from each vial were taken at 0, 4, 6, 12, 24, 48 and 72 hours after collection on the Sysmex XP-100 analyser (Sysmex Corporation, Kobe, Japan). The percent difference from the baseline readings were calculated and subjected to a Wilcoxon signed rank test at a Holm corrected significance level of 0.05. A median percent difference, which was statistically significant and greater than the maximum acceptable bias (taken from studies of biological variation), was taken as evidence of unacceptable shift. If the median shift was lesser than the maximum acceptable bias, two one-sided Wilcoxon signed rank tests for equivalence were used to determine whether the percent differences were significantly lesser than the maximum acceptable bias. RESULTS: Haemoglobin, red blood cell count, white blood cell count, mean corpuscular haemoglobin and lymphocyte count showed acceptable bias after storage for at least 24 hours at 33 ºC. Haematocrit, mean corpuscular volume, mean corpuscular haemoglobin concentration, platelet count and mean platelet volume showed unacceptable shift in less than 4 hours when stored at 33 ºC. CONCLUSIONS: Since many haematological parameters show unacceptable bias within 4 hours of sample storage at 33 ºC, the recommended limit of time from collection to processing should be revised for areas where high environmental temperatures are common.

Intra- and inter-model reliability of Hemocue Hb 201+ and HemoCue Hb 301 devices.

AIM: The study intended to estimate the intra- and inter-model reliability and agreement between the HemoCue Models 201+ and 301 in a blood bank donor screening setting. MATERIALS AND METHODS: Venous blood samples from 115 blood donors were analyzed by two Hemocue 201+ instruments and two HemoCue 301 instruments. The Lin's concordance correlation coefficient (CCC) as well as the Bland-Altman limits of agreement was measured. RESULTS: The 95% lower confidence interval (CI) of all the CCCs had a value >0.90. The CCC between instruments belonging to the same model was compared to instruments belonging to different models. The mean of HemoCue 301 was higher than HemoCue 201+ by 3.04 g/L with the 95% CI of the differences (i.e., the limits of agreement) between the two models ranging from -3.35 to 9.44 g/L. The bias between two instruments was lesser, and the limits of agreement were even narrower between instruments belonging to the same model. CONCLUSION: The inter-instrument reliability and agreement are satisfactory in a blood bank setting.

Surgical management and prognosis of perforation secondary to typhoid fever.

Introduction: Enteric perforation is a serious complication of typhoid fever and the condition has a high morbidity and mortality in many developing countries including India. No consensus exists concerning the best procedure to be performed in these cases. Aim: Aim: The purpose of this study was to analyse our clinical experience in surgical management of enteric perforation and to determine the prognostic factors associated with morbidity and mortality. Methods: It was a prospective study of patients who underwent surgery for typhoid intestinal perforation at SMS Medical College and Hospital, Jaipur, India, between April 2012 and October 2013. Laparotomy was performed by a midline incision. Management of perforation was based on the intraoperative findings and the procedure to be performed was decided by the operating surgeon. Results: 88 patients were studied with a male to female ratio of 6.3:1. The mean age was 36.4 years. The peak incidence was between 21 to 30 years. All the patients presented with abdominal pain and distension. More than 90% patients showed free gas under diaphragm. 71% patients had a single perforation and 97% patients had perforations confined to ileum. Debridement with double layered closure was performed in about 58% patients, ileostomy in 25% and resection anastomosis in 18% of patients. Overall complication rate was 44.3% with surgical site infection being the most common morbidity. The mortality rate was 17.1% which was significantly affected by perforation-admission interval of more than 48 hours, number of perforations and occurrence of postoperative complications. Conclusion: Typhoid fever leading to development of intestinal perforation continues to be a significant health problem with a high morbidity and mortality especially in rural India. The management of the disease requires an early and appropriate surgical intervention.

Validation of Boey's score in predicting morbidity and mortality in peptic perforation peritonitis in Northwestern India.

BACKGROUND: The major complications of peptic ulcer are hemorrhage, perforation and gastric outlet obstruction with perforation occurring in about 2-10% of patients. Patients with perforated peptic ulcer still have a high rate of morbidity and mortality and to improve the outcomes it is important to stratify the patients into different categories. AIMS: To evaluate the accuracy of Boey scoring system in predicting postoperative morbidity and mortality in patients operated for peptic perforation. METHODS: It was a prospective observational single centre study conducted at SMS Medical College and Hospital, Jaipur, from October 2011 to October 2012 on 180 patients undergoing open surgery for peptic ulcer perforation. Postoperative outcomes in terms of recovery and complications were studied. For prediction of morbidity and mortality by Boey risk stratification, the odds ratio (OR) and 95% confidence interval (95% CI) of each risk score were compared with the outcomes of "0" risk score. RESULTS: The mortality rate increased progressively with increasing numbers of the Boey score: 1.9%, 7.1%, 31.7% and 40% for 0, 1, 2, and 3 scores, respectively (p < 0.001). The morbidity rates for 0, 1, 2, and 3 Boey scores were 13%, 45.7%, 70.7% and 73.3% respectively (p < 0.001). CONCLUSIONS: Boey score is a useful tool for assessing the prognosis of operated cases of peptic perforation and helps in the assessment of mortality and morbidity of these patients.

Staged management of giant traumatic abdominal wall defect: A rare case report.

Blunt traumatic abdominal wall disruptions associated with evisceration (abdominal wall injury grade type VI) are very rare. We describe a case of large traumatic abdominal wall disruption with bowel evisceration and complete transection of jejunum and sigmoid colon that occurred after a 30-year-old male sustained run over injury to abdomen. Abdominal exploration and primary end to end jejuno-jejunal and colo-colic anastomosis were done. Staged management of giant abdominal wall defect was performed without any plastic reconstruction with good clinical outcome.