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Background: Around the world breast cancer is the most common cancer in women. In India, peak incidence is between 45-50 years of age. Early diagnosis improves survival, hence reducing diagnostic delay in breast cancer will have major social and economic implications besides improving the quality of life. This observational study aims to decipher various factors influencing diagnostic delay so that early treatment can be instituted.Methods: We interviewed 212 consecutive patients who attended the twice weekly breast clinic conducted by Department of general surgery and department of radiotherapy, government medical college, Kozhikode between September 2014 and February 2015. All patients with primary breast cancer were included in the study. Exclusion criteria included recurrence, second primaries, history of partial treatment and incomplete records. Finally, we interviewed 202 patients with the help of a pretested semi-structured questionnaire.Results: In present study, the commonest age group was 40-50 years with 62.4% participants presenting with early breast cancer and 37.6% having advanced breast cancer. Most of present study subjects were educated up to high school and unemployed. Awareness about breast cancer was 74.25% but many were ignorant of its symptomatology. Practice of breast self-examination (BSE) was low at 32.1%. Side and quadrant were statistically significant factor.Conclusions: In present study religion, educational status, marital status, breast cancer awareness, practice of BSE and location of tumor were statistically significant factors influencing delay in diagnosis. There was a general lack of knowledge about the importance of self-examination in breast cancer which needs health education and need for active social propaganda in print and electronic media regarding its importance. In future institution of a screening programme will hasten diagnosis and improve survival of breast cancer patients.

BACKGROUND Traditional approach of high rate of negative appendicectomies is being questioned in today's era of cost-effective healthcare. The goal of surgical treatment is removal of an inflamed appendix before it goes in for complications with minimal number of negative appendicectomies. Because of the high morbidity of complicated appendicitis, prompt diagnosis and treatment is imperative. The aim of the study is to study the relation between Alvarado score and C-reactive protein in predicting severity of acute appendicitis. MATERIALS AND METHODS Study was conducted in Government Medical College, Calicut. All patients with clinical diagnosis of acute appendicitis presenting to surgery casualty, qualifying the inclusion criteria of the study were evaluated with routine investigations. Patients were informed regarding the study and consent obtained. RESULTS CRP cannot replace clinical diagnosis, but is an useful adjunct in predicting the severity of appendicectomies. It has been found that negative appendicectomies belonged to group with <7 Alvarado score and most of complicated appendicectomies had score >7. CONCLUSION Both Alvarado score and CRP are reliable indicators in predicting the severity of appendicitis. Comparing the two CRP is a better predictor of severity of acute appendicitis.

Background: Post-mastectomy pain syndrome (PMPS) is a complication experienced by majority of the patients who undergo breast surgery for cancer. The etiology of this chronic neuropathic pain syndrome seems to be complex and it is still understood below par. Injury to the intercostobrachial (ICB) nerve is presumed to be the dominant one for developing PMPS. This prospective study was designed to appraise the effect of preservation of intercostobrachial nerve on post-mastectomy pain syndrome and also to determine the most common anatomical variation of the intercostobrachial nerve during surgery. Methods: A total of 100 patients were included in this study and were divided into 2 groups. Group A included patients with ICB nerve preserved and Group B patients with ICB nerve sectioned. The patients were evaluated for pain subjectively on the 2 nd day, 1 month and in the 3 rd month post-operatively by short form of McGill pain questionnaire and visual analog scale. During surgical dissection, anatomical variation of ICB nerve was ascertained each time. Results: After 3 months, 68.2% of the patients were asymptomatic in Group A (ICB nerve preservation group) and 31.8% in the Group B (nerve section group) (chi-square test was applied and p value was 0.002). We found that type 1 anatomical variation was commonest with 87%. Conclusions: Preservation of ICB nerve might greatly decrease the incidence of PMPS. Hence, the insight of the anatomical variations of this nerve is very crucial for the operating surgeons to preserve them and to prevent PMPS.

BACKGROUND The incidence of breast cancer is on the rise in developing countries. Though, there have been significant advances in general anaesthesia, surgery in elderly and those with comorbid illness still have an attendant morbidity and mortality. After the introduction of local anaesthesia by Kolher in 1884 and in spite of steady refinement, local anaesthesia is still not being widely used in major general surgical procedures. MATERIALS AND METHODS The study was conducted in Government Medical College, Calicut, a tertiary care centre in Kerala. The outcome of Modified Radical Mastectomy performed under Local Anaesthesia (LA) and dexmedetomidine infusion was compared to similar cases done under General Anaesthesia (GA). RESULTS Rapid recovery from sedation leading to early restoration of normal physical activity was observed in the LA group when compared to GA group. Early initiation of oral feeds was possible in the former group as Postoperative Nausea and Vomiting (PONV) was significantly less. Effective postoperative pain relief and significant reduction in respiratory complications was observed in the LA group compared to GA group.