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Objective: Despite the high prevalence and poor outcome of skin and soft tissue infections (SSTIs), very few studies from India have dealt with the subject. We planned a prospective study of inpatients with SSTIs to study the aetiology, clinical presentation (severity) and outcome of patients with SSTIs in our facility. Method: Patients with SSTIs involving >5% body surface area (BSA) and/or systemic signs were admitted to the surgery department of a teaching tertiary level hospital in Delhi, India, and were clinically classified into cellulitis, necrotising soft tissue infections (NSTIs), pyomyositis, and abscess. Demographic and clinical variables such as: age; sex; occupation; history of trauma/insect or animal bites; duration of illness; presenting symptoms and signs; comorbid conditions; predisposing factors such as lymphoedema or venous disease; hospital course; treatment instituted; complications; hospital outcome; presence of crepitus, bullae, gangrene, muscle necrosis and compartment syndrome were recorded. The chief outcome parameters were death and length of hospital stay; others, such as abscess drainage, the need for plastic surgical procedures and amputations were also noted. Results: Out of 250 patients enrolled in the study, 145 (58%) had NSTIs, 64 (26%) had abscesses, 15 (6%) had cellulitis and 26 (10%) had pyomyositis. Mortality was observed with NSTIs (27/145, 19%) and with pyomyositis (3/26, 11.5%). Factors affecting mortality by univariate analysis in the NSTI group were: abnormal pulse; hypotension; tachypnea; bullae; increased blood urea and serum creatinine; inotrope or ventilator support (all with p<0.001); local tenderness, gangrene, dialysis support and BSA (9.33±6.44 versus 5.12±3.62; p<0.05 for the last four). No factor was found to be significant on multivariate analysis. Variables associated with hospital stay >12 days were immunocompromise, pus discharge, ulceration or gangrene, and after interventions such as blood transfusion, drainage or skin grafting. Conclusion: High prevalence of NSTI and pyomyositis with high mortality was observed in our SSTI patients, often in immunocompetent young individuals. Epidemiological studies focused on virulent strains of Staphylococcus aureus may be required to identify the cause, since Staphylococcal toxins have been implicated in other infections. [ABSTRACT FROM AUTHOR]

Twenty-nine shelf sediment samples have been collected from the Southwestern part of the Bay of Bengal in 5 transects lying offshore between the coasts of Cuddalore and Nagapattinam district, Tamil Nadu, India. Collected samples were analyzed for sediment texture, organic matter (OM), and trace metals (Fe, Cu, Co, Mn, Pb, Zn, Cr, and Ni). Sandy fractions were found to be abundant in all transects except transect 3, because of the existence of the Pichavaram estuary fed by river Vellar in the north and Coleroon in the south. Among all the trace metals, Fe is the most abundant in the sediment samples. And metals such as Co, Pb, Cr and Ni are higher than the average background values, suggesting adverse effects of human activities in polluting the marine environment. The pollution indices viz. Enrichment Factor (EF), Geoaccumulation Index (Igeo), and Contamination Factor (CF) were calculated to assess trace metal pollution. The results imply that Cu, Co, Mn, Pb, Zn, Cr, and Ni in most of the sampling sites are highly contaminated in terms of Geoaccumulation Index (Igeo). Pb, Zn and Cr are heavily contaminated, while Cu, Mn, Ni, and Co showed moderate contamination, as demonstrated by the CF values. Pearson correlation and principal component analysis (PCA), explain the combination of geogenic and anthropogenic sources contributing trace metals to the marine system. [ABSTRACT FROM AUTHOR]

Background: India has a significant backlog in terms of renal transplant waiting lists, and progress of deceased donor transplant is limited by social and cultural hurdles. Newer strategies in living donation are needed. Materials and Methods: A prospective comparative study was conducted at our tertiary hospital over 3 years, between living related donor (LRD) and living unrelated donor (LURD) renal transplant outcomes, chiefly acute rejection and graft dysfunction. Confounding variables and outcome parameters such as mortality, hospital stay >21 days, and complications were recorded for 6 months. Results: LRD (n = 78) and LURD (n = 42) groups differed significantly in median recipient age (25 [22-34] vs. 40 [33-50] years; P < 0.001) and human leukocyte antigen (HLA) mismatches >3 (3/78 [3.8%] vs. 32/78 [76.2%]; P < 0.001, respectively). Yet, there was no significant difference in donor age, gender, immunosuppression, preoperative hemodialysis, nephrectomy time, or warm ischemia time. No significant difference was noted between LRD and LURD in acute rejection rate, graft dysfunction at 1 week and 6 months, mortality, hospital stay >21 days, or complication rate. Among factors predictive for acute rejection, only anastomotic time had a significant association (β coefficient = 0.006 [0.001--0.010]; Pearson's coefficient "r" =0.208; P < 0.01), while for early graft dysfunction, it was only mean donor nephrectomy time in minutes (β coefficient=-0.002 [-0.004-0.000]; Pearson's coefficient "r" = -0.158; P = 0.042). Conclusion: Despite differences in HLA-mismatches and age, LRD and LURD had a similar short-term outcome with respect to acute rejection and graft dysfunction. This is linked to better and standardized immunosuppression available, making it possible to expand the scope of LURD beyond spousal, within the legal and ethical boundaries. [ABSTRACT FROM AUTHOR]

Currently, the ASFA has not included TPE in the management of HLH but many cases reports have reported successful role of TPE in HLH. Here we are presenting a case in which HLH was managed successfully with TPE. Diagnosis of HLH is based on the HLH 2004 diagnostic criteria proposed by HLH society. TPE was done using COM.TEC (Fresenius Kabi, Germany). Patient required three sessions of TPE. After three sessions of TPE patient's clinical condition improved remarkably and he was switched to IV Dexamethasone as maintenance treatment. One standard TPE procedure was 1.5 plasma volume exchanges. In view of deranged coagulation profile fresh frozen plasma was used as a replacement fluid. During follow up after one month of discharge, patient was absolutely normal. In developing countries like India, where infections are still a prime concern to the physicians, making an accurate diagnosis of HLH is a great concern. High suspicion, timely diagnosis and early start of TPE can be life saving in such patients. [ABSTRACT FROM AUTHOR]

In India and some neighboring countries, ileal perforation is a leading indication for an emergent laparotomy, and making a temporary ileostomy is probably the safest practice for these patients with peritonitis. This apparently disfiguring surgery changes body image, and significantly influences physical, mental, emotional, and social life of the stoma patients. Further stress is added by the stoma related complications. The quality of life (QoL) issues of patients with temporary ileostomy for ileal perforations have not been addressed; hence, there is a gap in our existing knowledge about the various factors affecting the quality of life of these patients. This study aimed at assessing the QoL in this particular group of patients with the help of an objective standardized proforma-based interview. Despite being limited by its small sample size, the study identifies important associations and provides a platform for further research to improve QoL of these patients. [ABSTRACT FROM AUTHOR]

Background: Benign conditions of the breast are common, but a great deal of confusion exists in their nomenclature, classification, and, treatment protocols. The Aberration of Normal Development and Involution (ANDI) classification provides a comprehensive framework within which to correlate clinical presentation with pathogenesis. Most clinical studies have not used this classification system. We studied the spectrum of benign breast conditions in Indian patients with reference to the ANDI system and performed a clinicopathologic correlation. Methods: This prospective study was carried out on 262 consecutive patients attending the surgery department on an outpatient basis for benign breast conditions. Results: A total of 199 (76 %) patients had a diagnosis of benign breast disorder, and 44 (17 %) had benign breast disease. There were 19 (7 %) women with non-ANDI and other conditions. The spectrum of benign breast disorders included fibroadenoma 77, mastalgia with nodularity 98, galactocele 7, cysts 4, and nipple discharge (ND) 13. Benign breast diseases included giant/multiple fibroadenomas 18, incapacitating mastalgia and nodularity 13, subareolar abscess with mammary fistula 7, periductal mastitis with suppuration 4, and ND 2. Cytopathologic correlation performed in 115 patients showed nonproliferative disease in 82, proliferative disease without atypia in 19, proliferative disease with atypia in 3, and miscellaneous 11. Conclusions: The ANDI classification is a comprehensive system that delineates the borderline between normal and abnormal, achieves correlation of clinical signs and symptoms with histologic changes, and provides risk stratification and pragmatic definition of management protocols. [ABSTRACT FROM AUTHOR]

Random donor platelet (RDP) is not sufficient to improve the platelet count in most thrombocytopenic patients. Single donor platelet (SDP) or buffy coat pooled platelet (BCPP) are the two choices to provide a full therapeutic dose of platelets. However, there are constraints in the preparation of SDP due to stringent donor selection procedure, time required for procedure, and need of special expensive equipments and kits. BCPP is widely practiced, especially in the European countries, since 1995. In India, we decided to adopt the procedure of buffy coat pooling of platelets, especially for economically backward patients and for emergencies. This study was prospectively conducted from September 2009 to September 2010. A total of 129 units of BCPP [tested prior for viral markers by enzyme-linked immunosorbent assay (ELISA) and individual donor nucleic acid amplification test (ID-NAT)] were issued to 129 patients suffering from dengue and were included in this study. For comparison between efficacy of SDP and BCCP, patients were divided into two groups of 50 each. The post-transfusion platelet counts of the patients were noted after 2 hours of transfusion for each type of component. The platelet yield varied from 2.5 to 4.4 × 10¹¹ in BCPP samples. The samples analyzed were sterile without any contamination. The different biochemical parameters were analyzed in detail. The observed post-transfusion platelet recovery and corrected count increment (CCI) at 1 hour and 24 hours after BCPP transfusion were similar to that after SDP transfusion. Hence, we concluded that BCPP can be a low cost alternative to SDP in the times of emergencies like dengue and non-affordability by the patient for SDP.\ [ABSTRACT FROM AUTHOR]

Background: Over the past 30 years, pretransfusion tests have undergone considerable modification. In 1984, AABB recommended that the full cross match could be replaced by an abbreviated cross match in patients with negative antibody screen. However, before implementation of such a policy, issue regarding safety of T & S needs to be evaluated. Objectives: The aim of pretransfusion testing (PTT) is to ensure that enough red blood cells (RBCs) in the selected red cell components will survive when transfused. Results and Conclusion: We have, therefore in this study; evaluated safety of T & S procedure for PTT in comparison with conventional test tube cross match. The T & S procedure gave a safety of 91.6%. Also, the usefulness of the T & S was shown through the detection of unexpected antibodies in 0.75% (15 out of 2026) of cases. [ABSTRACT FROM AUTHOR]

Introduction & Aims: Though platelet transfusions have greatly reduced the incidence of major haemorrhagic complications associated with the management of haematological and oncological disorders, refractoriness to infused platelets becomes a major clinical problem for many of these patients. Materials and methods: The present study was done to determine the percentage of platelet alloimmunisation due to platelet-reactive antibodies in 340 patients with hematologic or oncologic diseases who had received multiple transfusions (> 10) of blood and blood components and showed platelet refractoriness in 1-hour post transfusion sample. Results: Platelet-reactive antibodies were detected in the sera of 127 out of 340 patients (37.35%) who received multiple transfusions (> 10) and showed platelet refractoriness. Conclusion: Platelet-reactive antibodies appear to be an important cause of platelet refractoriness in patients of acute leukaemia, aplastic anaemia, NHL, MDS and multiple myeloma receiving multiple platelet transfusions. Platelet refractoriness in patients of ITP and chronic leukaemia appears to be due to other causes and not due to platelet-reactive antibodies. [ABSTRACT FROM AUTHOR]

The article discusses the prevalence of weak D antigen in the northern hilly areas of Uttarakhand, India that is around 94.8% and is similar to other studies that have been conducted in the country. The two reasons stated for the weakness are varying geographical areas in India and other studies using a conventional technology in comparison to the one used by the authors. It is also stressed that a wide study in the real chances of D negative persons is to be performed for more information.

Live-related renal transplantation in India by "caregiver donors" provides huge financial, emotional, and physical support. Their psychological and mental health has not been addressed. We performed a prospective study using the World Health Organization Quality of Life (WHOQoL) BREF Scores and the Hospital Anxiety and Depression Scales preoperatively, at two weeks and three months after transplant. We included 30 pairs; most donors were females (80%, 60% mothers, 28% wives). The mean age of donors was 43.77 ± 10.64 years (34.8 ± 9.01 for recipients). There was improvement in the WHOQoL BREF after two weeks and three months as follows: physical domain (74.30 ± 9.74 vs. 78.30 ± 8.20; P = 0.001), and (74.30 ± 9.74 vs. 86.23 ± 7.25; P <0.001); psychological (74.90 ± 8.44 vs. 82.07 ± 7.19; P <0.001) and (74.90 ± 8.44 vs. 88.07 ± 6.89; P <0.001); environmental (75.33 ± 8.09 vs. 79.57 ± 6.18; P <0.001), and, (75.33 ± 8.09 vs. 86.97 ± 3.8; P <0.001); social-relationships (77.73 ± 8.28 vs. 79.77 ± 7.99; P <0.001), and (77.73 ± 8.28 vs. 84.77 ± 7.45; P <0.001). The recipient scores were similar. Factors with significant Pearson's or standardized beta co-efficient were donor age <20 years, donor complications, donor anxiety, education (<12 th standard), recipient hospital stay (>3 weeks), and, recipient complications (increased creatinine, hemodialysis, lymphocele, and graft dysfunction). The median anxiety scores of donors increased significantly two weeks after operation but later became normal. Caregiver donors have improved QoL scores, despite kidney donation; a larger study is needed.

Background: An adequate, safe supply of blood and blood components is a crucial part of blood transfusion services. Blood donors with reactive screening test results are informed of their results by letter and telephone call, and are requested to come for counselling either at the blood centre or the integrated counselling and testing centre. Many notified donors either do not respond at all or do not follow up their first visit to the blood bank. This study was undertaken to determine the response of voluntary blood donors after notification of their reactive status by telephone call or letter., Material and Methods: We considered reactive donations during a 2-year period (January 2010 to December 2011). Blood donors with reactive test results were notified and their response rates were evaluated at various levels., Results: During the study period, 416 donors (0.87%) were found to be reactive for different markers. Of these 416 reactive donors, 249 (59.8%) responded positively to the notification calls and attended counselling. The response rate was highest among donors reactive for hepatitis B virus (HBV) (154/225 i.e. 68.4%). After their first visit, around 6% donors could not be contacted further and were lost to follow up. Fifty donors (22.3%) did not continue their treatment and two (both reported to be HBV reactive) were subsequently found to be negative. Therefore, at 6 months of follow-up, only 182 donors (43.7%) were continuing/had completed their treatment., Discussion: The response rate of reactive blood donors in developing countries is quite low. These results suggest insufficient health care knowledge and a poor understanding of screening tests.

Background: Polydactyly is the most common malformation of the limbs. "Crossed" polydactyly of hands and feet, i.e., preaxial in one and postaxial in the other, is extremely rare. It has not been included in the standard classification of hand and feet anomalies., Methods: We report an Indian family with 7 affected members across 4 generations who had "crossed polysyndactyly". All but one affected member had involvement of all four limbs. There were no other congenital anomalies in any of the family members., Results: Familial crossed polysyndactyly appeared to follow an autosomal dominant transmission. This is probably the first case of familial crossed polysyndactyly without any associated anomalies., Conclusion: Familial crossed polysyndactyly is a rare malformation and all family members should be screened for other congenital malformations.

Background: Peritonitis secondary to gut perforation is still one of the commonest surgical emergencies in India and is associated with high morbidity and mortality. The present study examines the aetiology and outcome of peritonitis cases operated on in our surgical unit, and compares our findings with those of previous studies performed between 1981 and 1991., Method: A retrospective study of 260 peritonitis patients operated on in a single surgical unit from 1995 to 2006 was done and data involving clinical presentation, operative findings and post-operative course were studied and analysed., Results: Causes of peritonitis were small bowel perforation (96 ileal, 17 jejunal), peptic perforation (45 duodenal, 16 gastric), appendicular perforation (36), primary peritonitis (8), and others (42). The incidence of major complications was 25% (burst-11%, leak-5%, intraabdominal abscess-5%, multi-organ failure-6.5%). The overall mortality was 10%. High mortality was observed in jejunal, gall bladder and liver abscess perforation cases (> 20%). Histopathological evaluation (143 specimens) revealed tuberculosis in 42 (mostly small bowel), malignancy in 8, and inflammation in the rest. Comparisons with a similar study carried out in the same unit and published in 1995 revealed similar demographic features and mortality, but a change in the most common cause (peptic ulcer perforation to small bowel perforation), and an increased performance of enterostomy compared with primary repair in small bowel perforation and a decrease in the leak rate (13% to 4%)., Conclusion: Small bowel perforation is the commonest form of perforation and the mortality rate associated with peritonitis remains unchanged.