iosr-JDMS   Volume-4 ~ Issue-6

Abstract: Isolated duodenal injury in abdominal trauma is extremely rare. A diagnosis of isolated duodenal injury may be very difficult to make out in abdominal trauma, even with the availability of Ultrasound and CT scan. Delays in diagnosis due to late clinical presentation, and intra operative dilemmas due to retroperitoneal location of the duodenum, its proximity to important abdominal structures, lead to difficulties in management and considerably increase morbidity and mortality in these patients We report a case of fall from height with a puncture wound over the right loin presented after 20 hours with pain abdomen.USG abdomen ,CT abdomen ,DPL show minimal hemoperitoneum which prompted us to doDiagnostic laparoscope .except a small mesenteric injury solid and hollow viscera were found normal, 4 days later patient had greenish discharge from the puncture wound back evaluated and diagnosed as duodenocutaneous fistula by contrast and upper GI scope .patient was treated with simple gastrojejejunostomy and keeping ryle's tube inafferent loop for decompression of duodenum and feeding jejunostomyfor nutrition. Fistula healed and patient was discharged on 11th postop day A small punctured wound over the back in a trauma abdomen presenting as to duodeno-cutaneous fistula after 96 hours is an unusual presentation.

Key words: Trauma abdomen ,duodenal injury,

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Abstract: Objective: To identify the influence of sputum grading on conversion and cure rate Methodology: It is retrospective study. The new smear positive patients their initial smear grading, conversion and outcome were recorded. The data were collected and analyzed with Excel and Epi info Result: Total number of TB patients collected 208 out of which sputum grading scanty 14%, 1+ 43%, 2+ 21% and 3+ 22%. The conversion rates for Scanty 83%, 1+ 84%, 2+ 81% and 3+ 72% p. value >.05 while the success rate is scanty 93%, 1+ 89%, 2+ 88% and 3+ 72% with p. value <.05. The mortality rate among sputum grading, scanty 0%, 1+ 3%, 2+ 7% and 3+ 15% P. value <.05. Conclusion: The conversion rate of sputum is associated with initial sputum grading. The conversion rate is reduced in sputum grade of 3+ although there was increase in the conversion rate from scanty to 1+. The success rate in treatment of TB reduces with increase in the grading and mortality increases. It may be necessary to consider the sputum grading in the treatment of patients. Key words: Sputum conversion, outcome, smear grading and tuberculosis

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