Background: Continuous audit of surgical practice is essential in enhancing patient care and lowering health care cost. This prospective study aimed to assess the validity of the Portsmouth- physiologic and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) score in predicting the risk of morbidity and mortality and to identify the risk factors for poor outcome at a tertiary care teaching hospital in India.Methods: A prospective study of 100 patients (70 emergency and 30 elective) undergoing exploratory laparotomy admitted in Department of General Surgery over a 10 months period at Rabindranath Tagore Medical College, Udaipur, Rajasthan, were included in the study group. The risks of mortality and morbidity were calculated by using P-POSSUM equation. The predicted risks were compared with the observed risks of mortality and morbidity and statistically analysed.Results: The overall mortality rate of 11% with (O:E=0.85, p=0.59) and morbidity rate of 41% with (O:E=0.78, p=0.089). Higher percentage of mortality and morbidity were found with patients not able to be resuscitated successfully before surgery. Chest infections (18%), pyrexia (15%) and wound infections (14%) are areas requiring prompt care to minimize mortality rate.Conclusions: Even though P-POSSUM over predicted mortality it was not statistically significant as concluded by other studies. With P-POSSUM outcome of the patient and operative risk can be predicted and pre-operative counselling, optimization, implementing resuscitative measures and adequate care in specific high risk groups can be given with targeted interventions; improving quality of care and cost reduction.

A 12-year-old male presented with a 2-month history of recurrent episodes of dysuria, haematuria of 10 days' duration and on and off fever of 4 months duration. There is no history of previous tuberculous infection. Urinalysis revealed leucocyturia and numerous red blood cells, but no growth on multiple urine cultures. The patient showed minimal symptomatic improvement after two courses of nitrofurantoin. Contrast material-enhanced Computed Tomography (CT) of the abdomen was performed for further evaluation of the persistent haematuria and pyuria. Mycobacterium tuberculosis was isolated at acid-fast bacteria urine culture.

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Multiple system atrophy (MSA) is a sporadic, neurodegenerative disorder, clinically characterized by Parkinsonian, autonomic, cerebellar and pyramidal signs. We describe two patients showing different presentations of the same disease. The patient on case 1 presents features of MSA-C or olivopontocerebellar atrophy with the pontine "Cross sign" on brain MRI. The second case reports a patient presenting MSA-P or striatonigral degeneration and the brain MRI shows lenticular nucleus sign alteration. Multiple system atrophy (MSA) is a sporadic, neurodegenerative disorder, characterized by several combinations of parkinsonian, autonomic, cerebellar and pyramidal signs.

Lymphangioleiomyomatosis (LAM) is an uncommon interstitial lung disease that exclusively affects women, usually during their reproductive years. LAM is characterized pathologically by abnormal proliferation of LAM cells in the lungs and in thoracic and retroperitoneal lymphatics. 1 We presented a case of 40-year-old female presented to Department of Pulmonary Medicine, Gauhati Medical College with cough and chest pain for 6 months, which was diagnosed to be pulmonary manifestation of Lymphangioleiomyomatosis in HRCT chest.