Sukumar Kumar | KGMU - Academia.edu (original) (raw)

Papers by Sukumar Kumar

International Surgery Journal, 2018

Background: Minimally invasive esophagectomy (MIE) has shown an increasing trend, especially in t... more Background: Minimally invasive esophagectomy (MIE) has shown an increasing trend, especially in the last decade, in the management of esophageal malignancy. The aim of the present study was to present a cohort of patients who underwent MIE between June 2008 to June 2016 at a single tertiary care centre.Methods: A total of 103 esophagectomies were performed for esophageal malignancy which included 69 patients by minimally invasive technique. The procedure was performed by thoracoscopic mobilization of esophagus initially followed by reconstruction part done by either by minilaparotomy or by laparoscopic approach i.e. total thoracolaparoscopic esophagectomy (TLE).Results: The MIE was successfully completed in 65 (94.2%) patients. Operative time ranged from 275 to 420 min (average 356 min). The number of dissected lymph nodes were 5–15 (9 on average). The postoperative period was uneventful - without any complications in 36 (52.17%) patients. The most common postoperative complications...

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2019

Introduction: Correct and urgent decision making in Acute Appendicitis (AA) is very challenging. ... more Introduction: Correct and urgent decision making in Acute Appendicitis (AA) is very challenging. Operative treatment based only on clinical examination has a high Negative Appendectomy Rate (NAR). Diagnostic accuracy of clinical algorithm is poor thus many surgeons resort to imaging modalities. There are medicolegal risks to surgeons either due to delayed treatment or due to diagnostic error in cases of AA leading to cases of litigation against them. Thus, complimenting a clinical diagnosis with imaging becomes a safe option in the current surgical practice. Aim: To assess the utility of abdominal Ultrasonography (USG) and Computed Tomography (CT) Scan in reducing diagnostic errors in AA.

International Surgery Journal, 2018

Background: Minimally invasive esophagectomy (MIE) has shown an increasing trend, especially in t... more Background: Minimally invasive esophagectomy (MIE) has shown an increasing trend, especially in the last decade, in the management of esophageal malignancy. The aim of the present study was to present a cohort of patients who underwent MIE between June 2008 to June 2016 at a single tertiary care centre.
Methods: A total of 103 esophagectomies were performed for esophageal malignancy which included 69 patients by minimally invasive technique. The procedure was performed by thoracoscopic mobilization of esophagus initially followed by reconstruction part done by either by minilaparotomy or by laparoscopic approach i.e. total thoracolaparoscopic esophagectomy (TLE).
Results: The MIE was successfully completed in 65 (94.2%) patients. Operative time ranged from 275 to 420 min (average 356 min). The number of dissected lymph nodes were 5–15 (9 on average). The postoperative period was uneventful - without any complications in 36 (52.17%) patients. The most common postoperative complications were respiratory complications which were observed in 22 (31.88%) patients. Other complications included post-operative bowel obstruction (1 patient), anastomotic leak (4 patients), and necrosis of the gastroplasty (1 patient). One patient had chyle leak while cardiac complication was seen in three cases. The overall morbidity of patients underwent MIE was 47.8%. Thirty-day mortality was 5.79%.
Conclusions: Esophagectomy performed by minimally invasive technique is a widely accepted surgical procedure for patients with middle and lower esophageal malignancy. The biggest benefit of MIE is avoidance of thoracotomy / laparotomy associated pain with resultant decrease in morbidity. The success of MIE requires a dedicated surgical team well trained in both MIE as well as in open surgical procedure.

Journal of Clinical and Diagnostic Research, 2019

Appendicitis (AA) is very challenging. Operative treatment based only on clinical examination has... more Appendicitis (AA) is very challenging. Operative treatment based only on clinical examination has a high Negative Appendectomy Rate (NAR). Diagnostic accuracy of clinical algorithm is poor thus many surgeons resort to imaging modalities. There are medico-legal risks to surgeons either due to delayed treatment or due to diagnostic error in cases of AA leading to cases of litigation against them. Thus, complimenting a clinical diagnosis with imaging becomes a safe option in the current surgical practice.
Aim: To assess the utility of abdominal Ultrasonography (USG) and Computed Tomography (CT) Scan in reducing diagnostic errors in AA.
Materials and Methods: A prospective observational study was done in a tertiary care teaching hospital. The diagnostic efficacy of Alvarado Scores (AS), USG and CT scan were studied in terms of measurable outcomes such as sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), diagnostic accuracy and NAR.
Results: Seventy five males and 27 females with a mean age of 27.5±10.0 years were studied. All patients underwent appendiceal USG, while 33 patients underwent CT scan. NAR was 9.33% in males and 14.8% in females with overall NAR of 10.78%. The overall sensitivity, specificity, PPV, NPV and diagnostic accuracy of AS was 78.02%, 72.73%, 95.95%, 28.57% and 77.45% respectively which was higher in males. The overall sensitivity, specificity, PPV, NPV and diagnostic accuracy of USG was 94.51%, 81.82%, 97.73%, 64.29% and 93.14% respectively and had a higher value in males. CT scan had an overall sensitivity of 96.00% and specificity of 100%. In patients with AS <7, USG and CT scan had better sensitivity, specificity, PPV, NPV and higher diagnostic accuracy.
Conclusion: AS is a useful tool for diagnosing AA when AS is ≥7. USG is more sensitive, specific and has a higher diagnostic accuracy than AS. In patients with AS <7, USG has better sensitivity, specificity, NPV and diagnostic accuracy. CT scan has highest sensitivity, specificity and diagnostic accuracy compared to AS and USG. CT scan is more beneficial when AS is <7. On combining AS, USG and CT scan overall sensitivity, NPV and diagnostic accuracy of tests improved. USG should be used as an adjunct in all patients of suspected AA. CT scan use is highlighted in equivocal cases in which AS and USG cannot establish thereby reducing diagnostic errors in AA.

Introduction: Colorectal carcinoma is a common malignancy with a worldwide distribution. AJCC tum... more Introduction: Colorectal carcinoma is a common malignancy with a worldwide distribution. AJCC tumour staging is the single most important prognostic indicator which is also used for selecting cases for postoperative adjuvant therapy. However, a considerable number of curatively treated colon cancer patients ultimately develop disease recurrence prompting the need to identify additional prognostic markers. Extensive research into the biology of colorectal cancer has identified some molecular markers such as Epidermal Growth Factor Receptor (EGFR) which, in addition to providing an insight into the carcinogenesis of colorectal carcinoma, also provide prognostic information.
Aim: To evaluate the prognostic value of expression of EGFR in colorectal carcinoma by correlating it with established prognostic markers such as grade and stage of the tumour.
Materials and Methods: Retrospective cohort study of 100 cases of colorectal carcinoma who underwent radical surgery at a large tertiary care hospital was done. Relevant clinical data of the cases was collected from medical records. Histopathologic evaluation of tumour grade, depth of invasion, number of lymph nodes involved and pathologic stage was done. Immunohistochemistry (IHC) was performed for assessment of EGFR expression, which was categorised as positive if >1% of the tumour cells showed EGFR immune-specific membranous brown staining. Expression of EGFR was correlated with the tumour site, histological grade and the pathologic stage by chi-squared test (χ2). Values were considered significant at p<0.05.
Results: Among the stage I and stage II tumours, 18% and 31%, respectively, were positive for EGFR, while among the stage III and stage IV tumours, 74% and 80%, respectively, were positive for EGFR. A highly positive and significant correlation (p<0.01), along with a linear association was noted between the pathologic stage and the EGFR expression of the tumours. No significant association was noted between either the expression of EGFR and the histological grade (p=0.51) or the expression of EGFR and the site of tumour (p=0.10).
Conclusion: Epidermal growth factor receptor, due to its strong correlation with the pathologic stage of colorectal carcinoma, can be of prognostic significance. This may have a role in selecting those patients who are at high risk for disease progression and therefore are likely to benefit from adjuvant therapy.

Background: Laparoscopic cholecystectomy (LC), the gold standard of treatment of gallstone diseas... more Background: Laparoscopic cholecystectomy (LC), the gold standard of treatment of gallstone disease, is a widely performed surgery, but it can become a challenge to complete at times. Aim of present study was to find out the possible preoperative features in a gallstone disease patient that predispose him to having a difficult LC.
Methods: All cases of gallstone disease undergoing LC at a tertiary care hospital were studied over one year. Patients with jaundice, abnormal liver function tests, concomitant common bile duct stones, ongoing acute cholecystitis or concurrent gallstone pancreatitis were excluded. Various preoperative clinical, laboratory and ultrasound parameters were studied to see their correlation with different aspects of difficult LC.
Results: 166 patients were studied with age ranging from 10-80 years, maximum incidence (36.14%) being in the age group 35-50 years. The time taken for LC increased significantly with increasing age. 70.48% were females but gender status did not affect the difficulty. Pain in the preceding 15 days of surgery increased the operating time as did the association of diabetes mellitus. Increasing body mass index (BMI) also increased the surgery time as well as the conversion rate (7.69% in patients with BMI >30Kg/m2). Clinically palpable gallbladder increased the surgery duration, difficulty and conversion rate. TLC >11000/mm3, contracted gallbladder, wall thickness ≥4mm made LC longer, while multiple stones increased surgeon’s difficulty and impacted stone in gallbladder neck increased the conversion rate.
Conclusions: Certain factors that increase the difficulty of LC can be identified preoperatively and this knowledge should be used when planning LC.

Journal of Clinical and Diagnostic Research, 2018

Introduction: Acute Appendicitis (AA) requires prompt surgery to prevent complications, and the d... more Introduction: Acute Appendicitis (AA) requires prompt surgery to prevent complications, and the diagnosis is mostly based on clinical features where scoring systems like Modified Alvarado Score (MAS) have been found to be helpful. However, as clinical findings tend to be subjective, Abdominal Ultrasound (AUS) can be used to add some objectivity to the diagnosis of AA.
Aim: The aim of the present study was to assess the effectiveness of MAS and AUS in diagnosing AA.
Materials and Methods: The present study was designed as a study of Diagnostic Accuracy and was carried out using STARD guidelines at a Tertiary Care Teaching Hospital in India. Prospective collection of data of 100 consecutive patients (70 male and 30 female) who were taken up for Emergency appendectomy for AA during the period from April 2009 to April 2011 was done. Patients with complicated Appendicitis, e.g., perforation-peritonitis, abscess; appendicular lump and pregnant women were excluded. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Likelihood Ratios (LR+ and LR-), Diagnostic Odds Ratio (DOR) and Negative Appendectomy Rate (NAR) were calculated for MAS and AUS by standard statistical calculators.
Results: The present study included 70 males and 30 females belonging to various ages ranging from 11-62 years. Majority of patients (42%) were in their third decade of age. A total of 76% of patients who underwent surgery for AA had MAS of ≥7. All the 24% remaining patients had MAS of 4-6. Overall AUS revealed inflamed appendix in 67% cases, while in the rest, either the appendix could not be visualised or was reported as normal. Sensitivity, specificity, PPV, NPV, LR+, LR-, DOR and NAR of MAS and AUS were 81.61%, 61.54%, 93.42%, 33.33%, 2.12, 0.30, 7.10, 6.58%; and 71.26%, 61.54%, 92.54%, 24.24%, 1.85, 0.47, 3.97, 7.46% respectively. Between the sexes, diagnostic parameters of MAS were slightly better in males. In contrast, in females the parameters of AUS fared marginally better. AUS had much better diagnostic accuracy in diagnosing AA in MAS <7, when compared to MAS ≥7.
Conclusion: The MAS is a good diagnostic tool for AA and should be adequate in uncomplicated AA, if score is ≥7. In those patients where the score is 4-6, AUS should be added to aid in early diagnosis and prompt surgical management of AA. The AUS is also recommended in female patients with suspected AA.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2019

Introduction: The conventional method of tissue processing involves a long turnaround time. An ea... more Introduction: The conventional method of tissue processing involves a long turnaround time. An early diagnosis of tissue biopsies would enable quick decision making and prompt institution of therapy. The use of microwave in tissue processing can reduce the turnaround time of biopsy reports from hours to minutes. Aim: To compare the quality of tissue processed by a microwave with that of the conventional method. Materials and Methods: This was a prospective study in which 40 pairs of tissues were studied as test and control groups. Both groups were processed by the microwave and the conventional methods and stained with Haematoxylin and Eosin (H&E), special histochemical stains and immunohistochemical stains. Quality of tissues of both groups was compared using statistical analysis. Results: Use of microwave reduced the time required for tissue processing from 17 hours to 36 minutes. The strength of agreement between the results obtained by the two methods was very good (Kappa coefficient: 0.806). Tissue sections of both groups were optimal for rendering diagnoses. Tissues of both groups showed crisp and specific staining with histochemical stains and immunohistochemical stains. Conclusion: The study shows that use of microwave significantly reduces processing time for biopsies without compromising either quality or suitability for special stains including immunohistochemistry. This method has tremendous potential in reducing the turnaround time of routine biopsy reports and in intraoperative diagnosis.

International Surgery Journal, 2018

Background: Blunt abdominal trauma (BAT) is one of the common causes of admission in surgical war... more Background: Blunt abdominal trauma (BAT) is one of the common causes of admission in surgical ward in any hospital. It requires high level of suspicion, urgent evaluation and timely management to decrease morbidity and mortality. Aim of present study was to find out demographic details, causes of injury, management options and treatment outcomes of BAT.Methods: Retrospective study of cases of BAT was carried out at a tertiary care hospital of India spanning five years, between June 2012 to June 2017. Authors analyzed the demographic profile of the trauma victims, etiological factors of BAT, the abdominal organs involved, the treatment modalities adopted and the final outcome.Results: There were 231 cases of BAT. Most common age group was 11 to 30 years which accounted for 42.42% of the total. The study had 181 (78.35%) males and 50 (21.64%) females. Road traffic accident was the most common cause of BAT and it accounted for 67.97%. Liver (34.20%) was the most commonly involved organ...

International Surgery Journal, 2018

Background: Minimally invasive esophagectomy (MIE) has shown an increasing trend, especially in t... more Background: Minimally invasive esophagectomy (MIE) has shown an increasing trend, especially in the last decade, in the management of esophageal malignancy. The aim of the present study was to present a cohort of patients who underwent MIE between June 2008 to June 2016 at a single tertiary care centre.Methods: A total of 103 esophagectomies were performed for esophageal malignancy which included 69 patients by minimally invasive technique. The procedure was performed by thoracoscopic mobilization of esophagus initially followed by reconstruction part done by either by minilaparotomy or by laparoscopic approach i.e. total thoracolaparoscopic esophagectomy (TLE).Results: The MIE was successfully completed in 65 (94.2%) patients. Operative time ranged from 275 to 420 min (average 356 min). The number of dissected lymph nodes were 5–15 (9 on average). The postoperative period was uneventful - without any complications in 36 (52.17%) patients. The most common postoperative complications...

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2019

Introduction: Correct and urgent decision making in Acute Appendicitis (AA) is very challenging. ... more Introduction: Correct and urgent decision making in Acute Appendicitis (AA) is very challenging. Operative treatment based only on clinical examination has a high Negative Appendectomy Rate (NAR). Diagnostic accuracy of clinical algorithm is poor thus many surgeons resort to imaging modalities. There are medicolegal risks to surgeons either due to delayed treatment or due to diagnostic error in cases of AA leading to cases of litigation against them. Thus, complimenting a clinical diagnosis with imaging becomes a safe option in the current surgical practice. Aim: To assess the utility of abdominal Ultrasonography (USG) and Computed Tomography (CT) Scan in reducing diagnostic errors in AA.

International Surgery Journal, 2018

Background: Minimally invasive esophagectomy (MIE) has shown an increasing trend, especially in t... more Background: Minimally invasive esophagectomy (MIE) has shown an increasing trend, especially in the last decade, in the management of esophageal malignancy. The aim of the present study was to present a cohort of patients who underwent MIE between June 2008 to June 2016 at a single tertiary care centre.
Methods: A total of 103 esophagectomies were performed for esophageal malignancy which included 69 patients by minimally invasive technique. The procedure was performed by thoracoscopic mobilization of esophagus initially followed by reconstruction part done by either by minilaparotomy or by laparoscopic approach i.e. total thoracolaparoscopic esophagectomy (TLE).
Results: The MIE was successfully completed in 65 (94.2%) patients. Operative time ranged from 275 to 420 min (average 356 min). The number of dissected lymph nodes were 5–15 (9 on average). The postoperative period was uneventful - without any complications in 36 (52.17%) patients. The most common postoperative complications were respiratory complications which were observed in 22 (31.88%) patients. Other complications included post-operative bowel obstruction (1 patient), anastomotic leak (4 patients), and necrosis of the gastroplasty (1 patient). One patient had chyle leak while cardiac complication was seen in three cases. The overall morbidity of patients underwent MIE was 47.8%. Thirty-day mortality was 5.79%.
Conclusions: Esophagectomy performed by minimally invasive technique is a widely accepted surgical procedure for patients with middle and lower esophageal malignancy. The biggest benefit of MIE is avoidance of thoracotomy / laparotomy associated pain with resultant decrease in morbidity. The success of MIE requires a dedicated surgical team well trained in both MIE as well as in open surgical procedure.

Journal of Clinical and Diagnostic Research, 2019

Appendicitis (AA) is very challenging. Operative treatment based only on clinical examination has... more Appendicitis (AA) is very challenging. Operative treatment based only on clinical examination has a high Negative Appendectomy Rate (NAR). Diagnostic accuracy of clinical algorithm is poor thus many surgeons resort to imaging modalities. There are medico-legal risks to surgeons either due to delayed treatment or due to diagnostic error in cases of AA leading to cases of litigation against them. Thus, complimenting a clinical diagnosis with imaging becomes a safe option in the current surgical practice.
Aim: To assess the utility of abdominal Ultrasonography (USG) and Computed Tomography (CT) Scan in reducing diagnostic errors in AA.
Materials and Methods: A prospective observational study was done in a tertiary care teaching hospital. The diagnostic efficacy of Alvarado Scores (AS), USG and CT scan were studied in terms of measurable outcomes such as sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), diagnostic accuracy and NAR.
Results: Seventy five males and 27 females with a mean age of 27.5±10.0 years were studied. All patients underwent appendiceal USG, while 33 patients underwent CT scan. NAR was 9.33% in males and 14.8% in females with overall NAR of 10.78%. The overall sensitivity, specificity, PPV, NPV and diagnostic accuracy of AS was 78.02%, 72.73%, 95.95%, 28.57% and 77.45% respectively which was higher in males. The overall sensitivity, specificity, PPV, NPV and diagnostic accuracy of USG was 94.51%, 81.82%, 97.73%, 64.29% and 93.14% respectively and had a higher value in males. CT scan had an overall sensitivity of 96.00% and specificity of 100%. In patients with AS <7, USG and CT scan had better sensitivity, specificity, PPV, NPV and higher diagnostic accuracy.
Conclusion: AS is a useful tool for diagnosing AA when AS is ≥7. USG is more sensitive, specific and has a higher diagnostic accuracy than AS. In patients with AS <7, USG has better sensitivity, specificity, NPV and diagnostic accuracy. CT scan has highest sensitivity, specificity and diagnostic accuracy compared to AS and USG. CT scan is more beneficial when AS is <7. On combining AS, USG and CT scan overall sensitivity, NPV and diagnostic accuracy of tests improved. USG should be used as an adjunct in all patients of suspected AA. CT scan use is highlighted in equivocal cases in which AS and USG cannot establish thereby reducing diagnostic errors in AA.

Introduction: Colorectal carcinoma is a common malignancy with a worldwide distribution. AJCC tum... more Introduction: Colorectal carcinoma is a common malignancy with a worldwide distribution. AJCC tumour staging is the single most important prognostic indicator which is also used for selecting cases for postoperative adjuvant therapy. However, a considerable number of curatively treated colon cancer patients ultimately develop disease recurrence prompting the need to identify additional prognostic markers. Extensive research into the biology of colorectal cancer has identified some molecular markers such as Epidermal Growth Factor Receptor (EGFR) which, in addition to providing an insight into the carcinogenesis of colorectal carcinoma, also provide prognostic information.
Aim: To evaluate the prognostic value of expression of EGFR in colorectal carcinoma by correlating it with established prognostic markers such as grade and stage of the tumour.
Materials and Methods: Retrospective cohort study of 100 cases of colorectal carcinoma who underwent radical surgery at a large tertiary care hospital was done. Relevant clinical data of the cases was collected from medical records. Histopathologic evaluation of tumour grade, depth of invasion, number of lymph nodes involved and pathologic stage was done. Immunohistochemistry (IHC) was performed for assessment of EGFR expression, which was categorised as positive if >1% of the tumour cells showed EGFR immune-specific membranous brown staining. Expression of EGFR was correlated with the tumour site, histological grade and the pathologic stage by chi-squared test (χ2). Values were considered significant at p<0.05.
Results: Among the stage I and stage II tumours, 18% and 31%, respectively, were positive for EGFR, while among the stage III and stage IV tumours, 74% and 80%, respectively, were positive for EGFR. A highly positive and significant correlation (p<0.01), along with a linear association was noted between the pathologic stage and the EGFR expression of the tumours. No significant association was noted between either the expression of EGFR and the histological grade (p=0.51) or the expression of EGFR and the site of tumour (p=0.10).
Conclusion: Epidermal growth factor receptor, due to its strong correlation with the pathologic stage of colorectal carcinoma, can be of prognostic significance. This may have a role in selecting those patients who are at high risk for disease progression and therefore are likely to benefit from adjuvant therapy.

Background: Laparoscopic cholecystectomy (LC), the gold standard of treatment of gallstone diseas... more Background: Laparoscopic cholecystectomy (LC), the gold standard of treatment of gallstone disease, is a widely performed surgery, but it can become a challenge to complete at times. Aim of present study was to find out the possible preoperative features in a gallstone disease patient that predispose him to having a difficult LC.
Methods: All cases of gallstone disease undergoing LC at a tertiary care hospital were studied over one year. Patients with jaundice, abnormal liver function tests, concomitant common bile duct stones, ongoing acute cholecystitis or concurrent gallstone pancreatitis were excluded. Various preoperative clinical, laboratory and ultrasound parameters were studied to see their correlation with different aspects of difficult LC.
Results: 166 patients were studied with age ranging from 10-80 years, maximum incidence (36.14%) being in the age group 35-50 years. The time taken for LC increased significantly with increasing age. 70.48% were females but gender status did not affect the difficulty. Pain in the preceding 15 days of surgery increased the operating time as did the association of diabetes mellitus. Increasing body mass index (BMI) also increased the surgery time as well as the conversion rate (7.69% in patients with BMI >30Kg/m2). Clinically palpable gallbladder increased the surgery duration, difficulty and conversion rate. TLC >11000/mm3, contracted gallbladder, wall thickness ≥4mm made LC longer, while multiple stones increased surgeon’s difficulty and impacted stone in gallbladder neck increased the conversion rate.
Conclusions: Certain factors that increase the difficulty of LC can be identified preoperatively and this knowledge should be used when planning LC.

Journal of Clinical and Diagnostic Research, 2018

Introduction: Acute Appendicitis (AA) requires prompt surgery to prevent complications, and the d... more Introduction: Acute Appendicitis (AA) requires prompt surgery to prevent complications, and the diagnosis is mostly based on clinical features where scoring systems like Modified Alvarado Score (MAS) have been found to be helpful. However, as clinical findings tend to be subjective, Abdominal Ultrasound (AUS) can be used to add some objectivity to the diagnosis of AA.
Aim: The aim of the present study was to assess the effectiveness of MAS and AUS in diagnosing AA.
Materials and Methods: The present study was designed as a study of Diagnostic Accuracy and was carried out using STARD guidelines at a Tertiary Care Teaching Hospital in India. Prospective collection of data of 100 consecutive patients (70 male and 30 female) who were taken up for Emergency appendectomy for AA during the period from April 2009 to April 2011 was done. Patients with complicated Appendicitis, e.g., perforation-peritonitis, abscess; appendicular lump and pregnant women were excluded. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Likelihood Ratios (LR+ and LR-), Diagnostic Odds Ratio (DOR) and Negative Appendectomy Rate (NAR) were calculated for MAS and AUS by standard statistical calculators.
Results: The present study included 70 males and 30 females belonging to various ages ranging from 11-62 years. Majority of patients (42%) were in their third decade of age. A total of 76% of patients who underwent surgery for AA had MAS of ≥7. All the 24% remaining patients had MAS of 4-6. Overall AUS revealed inflamed appendix in 67% cases, while in the rest, either the appendix could not be visualised or was reported as normal. Sensitivity, specificity, PPV, NPV, LR+, LR-, DOR and NAR of MAS and AUS were 81.61%, 61.54%, 93.42%, 33.33%, 2.12, 0.30, 7.10, 6.58%; and 71.26%, 61.54%, 92.54%, 24.24%, 1.85, 0.47, 3.97, 7.46% respectively. Between the sexes, diagnostic parameters of MAS were slightly better in males. In contrast, in females the parameters of AUS fared marginally better. AUS had much better diagnostic accuracy in diagnosing AA in MAS <7, when compared to MAS ≥7.
Conclusion: The MAS is a good diagnostic tool for AA and should be adequate in uncomplicated AA, if score is ≥7. In those patients where the score is 4-6, AUS should be added to aid in early diagnosis and prompt surgical management of AA. The AUS is also recommended in female patients with suspected AA.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2019

Introduction: The conventional method of tissue processing involves a long turnaround time. An ea... more Introduction: The conventional method of tissue processing involves a long turnaround time. An early diagnosis of tissue biopsies would enable quick decision making and prompt institution of therapy. The use of microwave in tissue processing can reduce the turnaround time of biopsy reports from hours to minutes. Aim: To compare the quality of tissue processed by a microwave with that of the conventional method. Materials and Methods: This was a prospective study in which 40 pairs of tissues were studied as test and control groups. Both groups were processed by the microwave and the conventional methods and stained with Haematoxylin and Eosin (H&E), special histochemical stains and immunohistochemical stains. Quality of tissues of both groups was compared using statistical analysis. Results: Use of microwave reduced the time required for tissue processing from 17 hours to 36 minutes. The strength of agreement between the results obtained by the two methods was very good (Kappa coefficient: 0.806). Tissue sections of both groups were optimal for rendering diagnoses. Tissues of both groups showed crisp and specific staining with histochemical stains and immunohistochemical stains. Conclusion: The study shows that use of microwave significantly reduces processing time for biopsies without compromising either quality or suitability for special stains including immunohistochemistry. This method has tremendous potential in reducing the turnaround time of routine biopsy reports and in intraoperative diagnosis.

International Surgery Journal, 2018

Background: Blunt abdominal trauma (BAT) is one of the common causes of admission in surgical war... more Background: Blunt abdominal trauma (BAT) is one of the common causes of admission in surgical ward in any hospital. It requires high level of suspicion, urgent evaluation and timely management to decrease morbidity and mortality. Aim of present study was to find out demographic details, causes of injury, management options and treatment outcomes of BAT.Methods: Retrospective study of cases of BAT was carried out at a tertiary care hospital of India spanning five years, between June 2012 to June 2017. Authors analyzed the demographic profile of the trauma victims, etiological factors of BAT, the abdominal organs involved, the treatment modalities adopted and the final outcome.Results: There were 231 cases of BAT. Most common age group was 11 to 30 years which accounted for 42.42% of the total. The study had 181 (78.35%) males and 50 (21.64%) females. Road traffic accident was the most common cause of BAT and it accounted for 67.97%. Liver (34.20%) was the most commonly involved organ...