Genetic Diversity, Mycotoxin Profiles, and Population Structure of Fusarium spp. Associated with Fusarium Head Blight in Georgia, U.S.A

Fusarium head blight (FHB) has become a limiting factor in soft red winter wheat production in the southeast US. Recent epidemics have occurred in Georgia, however genetic information on the Fusarium species responsible for FHB is unknown. This study aimed to assess pathogen population structure and genetic diversity, trichothecene profiles, and representative pathogenicity of 196 Fusarium isolates collected from 44 wheat (n = 85) and 53 corn (n = 111) fields in Georgia. Phylogenetic analysis using the translation elongation factor 1-alpha (635 bp) and RNA polymerase second largest subunit (930 bp) sequence data resolved isolates into 185 haplotypes, representing 12 Fusarium species grouped under five species complexes. F. graminearum with 15-acetyl-deoxynivalenol (15ADON) chemotype (75.6%) and F. incarnatum (57.7%) predominated in wheat and corn, respectively, with a surprisingly higher frequency of NIV F. graminearum (21.8%). Using nine variable number of tandem repeat markers, 82 multilocus genotypes out of 86 F. graminearum isolates were identified and grouped into two genetic clusters, pop1fg (n = 29) and pop2fg (n = 32), as part of the North American populations (NA1 and NA2), but with no chemotype differentiation. F. graminearum populations in Georgia are mostly clonal and might have evolved through at least two introductions from the northeast US and Canada and local adaptation to maintain high genetic diversity. Pathogenicity of F. graminearum isolates from wheat and corn had high FHB severity (>60%) in wheat, depicting the risk they can pose towards future FHB outbreaks. Overall, this baseline study provided important information on Fusarium species diversity including F. graminearum associated with FHB in Georgia that will be useful to formulate integrated disease management incorporating improved host resistance and fungicide spray program.

Quantitative Trait Locus Analysis of Hessian Fly Resistance in Soft Red Winter Wheat

The Hessian fly (HF) is an invasive insect that has caused millions of dollars in yield losses to southeastern US wheat farms. Genetic resistance is the most sustainable solution to control HF. However, emerging biotypes are quickly overcoming resistance genes in the southeast; therefore, identifying novel sources of resistance is critical. The resistant line "UGA 111729" and susceptible variety "AGS 2038" were crossbred to generate a population of 225 recombinant inbred lines. This population was phenotyped in the growth chamber (GC) during 2019 and 2021 and in field (F) trials in Georgia during the 2021-2022 growing seasons. Visual scoring was utilized in GC studies. The percentage of infested tillers and number of pupae/larvae per tiller, and infested tiller per sample were measured in studies from 2021 to 2022. Averaging across all traits, a major QTL on chromosome 3D explained 42.27% (GC) and 10.43% (F) phenotypic variance within 9.86 centimorgans (cM). SNP marker IWB65911 was associated with the quantitative trait locus (QTL) peak with logarithm of odds (LOD) values of 14.98 (F) and 62.22 (GC). IWB65911 colocalized with resistance gene H32. KASP marker validation verified that UGA 111729 and KS89WGRC06 express H32. IWB65911 may be used for marker-assisted selection.

Sensitivity of Clarireedia spp. to benzimidazoles and dimethyl inhibitors fungicides and efficacy of biofungicides on dollar spot of warm season turfgrass

Dollar spot caused by Clarireedia spp. (formerly Sclerotinia homoeocarpa) is an economically destructive fungal disease of turfgrass that can significantly compromise turf quality, playability, and aesthetic value. Fungicides are frequently used to manage the disease but are costly and potentially unfavorable to the environment. Repeated use of some active ingredients has resulted in reduced efficacy on C. jacksonii causing dollar spot in cool-season turfgrasses in the US. Experiments were conducted to study fungicide sensitivity of Clarireedia spp. as well as to develop alternatives to fungicides against dollar spot on warm-season turfgrass in Georgia. First, 79 isolates of Clarireedia spp. collected across the state were tested on fungicide-amended agar plates for their sensitivity to thiophanate-methyl (benzimidazole) and propiconazole (dimethyl inhibitor). Seventy-seven isolates (97.5%) were sensitive (0.001 to 0.654 μg/mL) and two isolates (2.5%) were found resistant (>1000 μg/mL) to thiophanate-methyl. However, in the case of propiconazole, 27 isolates (34.2%) were sensitive (0.005 to 0.098 μg/mL) while 52 isolates (65.8%) were resistant (0.101 to 3.820 μg/mL). Next, the efficacy of three bio- and six synthetic fungicides and ten different combinations were tested in vitro against C. monteithiana. Seven bio- and synthetic fungicide spray programs comprising Bacillus subtilis QST713 and propiconazole were further tested, either alone or in a tank mix in a reduced rate, on dollar spot infected bermudagrass 'TifTuf' in growth chamber and field environments. These fungicides were selected as they were found to significantly reduce pathogen growth up to 100% on in vitro assays. The most effective spray program in growth chamber assays was 100% B. subtilis QST713 in rotation with 75% B. subtilis QST713 + 25% propiconazole tank mix applied every 14 days. However, the stand-alone application of the biofungicide B. subtilis QST713 every seven days was an effective alternative and equally efficacious as propiconazole, suppressing dollar spot severity and AUDPC up to 75%, while resulting in acceptable turf quality (>7.0) in field experiments. Our study suggests that increased resistance of Clarireedia spp. to benzimidazoles and dimethyl inhibitors warrants continuous surveillance and that biofungicides hold promise to complement synthetic fungicides in an efficacious and environmentally friendly disease management program.

Wheat end-use quality: State of art, genetics, genomics-assisted improvement, future challenges, and opportunities

Wheat is the most important source of food, feed, and nutrition for humans and livestock around the world. The expanding population has increasing demands for various wheat products with different quality attributes requiring the development of wheat cultivars that fulfills specific demands of end-users including millers and bakers in the international market. Therefore, wheat breeding programs continually strive to meet these quality standards by screening their improved breeding lines every year. However, the direct measurement of various end-use quality traits such as milling and baking qualities requires a large quantity of grain, traits-specific expensive instruments, time, and an expert workforce which limits the screening process. With the advancement of sequencing technologies, the study of the entire plant genome is possible, and genetic mapping techniques such as quantitative trait locus mapping and genome-wide association studies have enabled researchers to identify loci/genes associated with various end-use quality traits in wheat. Modern breeding techniques such as marker-assisted selection and genomic selection allow the utilization of these genomic resources for the prediction of quality attributes with high accuracy and efficiency which speeds up crop improvement and cultivar development endeavors. In addition, the candidate gene approach through functional as well as comparative genomics has facilitated the translation of the genomic information from several crop species including wild relatives to wheat. This review discusses the various end-use quality traits of wheat, their genetic control mechanisms, the use of genetics and genomics approaches for their improvement, and future challenges and opportunities for wheat breeding.

Myocardial Infarction in Non-obstructive Coronary Arteries (MINOCA) in the Perioperative Period can Epinephrine be Responsible?

Ephedrine, metaraminol, epinephrine and maneuvers like carotid sinus stimulation used during intraoperative period have been postulated to cause temporary spasm of the coronary vessels leading to decrease supply to the myocardium and precipitating myocardial infraction in non-obstructive coronary arteries (MINOCA). As an anaesthesiologists, we should be aware that even a dose as small as 25 mcg epinephrine infiltrated along with local anaesthetic in the subcutaneous plane may be responsible for coronary vessel spasm and thus myocardial infraction in nonobstructive coronary arteries. We report a case of 45 years old female with papillary carcinoma of thyroid who developed features of non-ST elevation myocardial infarction 5 minutes after the subcutaneous infiltration of 5 ml of 2% Xylocaine with 1:200000 Epinephrine. Patient was managed for acute Myocardial Infarction. Coronary angiogram done the next day revealed normal coronary arteries, hence the diagnosis Myocardial infraction in non-obstructive coronary arteries was made.

Genetics of Fusarium head blight resistance in soft red winter wheat using a genome-wide association study

Host resistance is an effective and sustainable approach to manage the negative impact of Fusarium head blight (FHB) on wheat (Triticum aestivum L.) grain yield and quality. The objective of this study was to characterize the phenotypic responses and identify quantitative trait loci (QTL) conditioning different FHB resistance types using a panel of 236 elite soft red winter wheat (SRWW) lines in a genome-wide association study (GWAS). The panel was phenotyped for five FHB and three morphological traits under two field and two greenhouse environments in 2018-2019 and 2019-2020. We identified 160 significant marker-trait associations (MTAs) for FHB traits and 11 MTAs for plant height. Eleven QTL showed major effects and explained >10% phenotypic variation (PV) for FHB resistance. Among these major loci, three QTL were stable and five QTL exhibited a pleiotropic effect. The QTL QFhb-3BL, QFhb-5AS, QFhb-5BL, QFhb-7AS.1, QFhb-7AS.2, and QFhb-7BS are presumed to be novel. Pyramiding multiple resistance alleles from all the major-effect QTL resulted in a significant reduction in FHB incidence, severity, index, deoxynivalenol (DON), and Fusarium-damaged kernel (FDK) by 17, 43, 45, 55, and 25%, respectively. Further validation of these QTL could potentially facilitate successful introgression of these resistance loci in new cultivars for improved FHB resistance in breeding programs.

Assessment of Quinone Outside Inhibitor Sensitivity and Frogeye Leaf Spot Race of Cercospora sojina in Georgia Soybean

Frogeye leaf spot (FLS), caused by the fungal pathogen Cercospora sojina K. Hara, is a foliar disease of soybean (Glycine max L. [Merr.]) responsible for yield reductions throughout the major soybean-producing regions of the world. In the United States, management of FLS relies heavily on the use of resistant cultivars and in-season fungicide applications, specifically within the class of quinone outside inhibitors (QoIs), which has resulted in the development of fungicide resistance in many states. In 2018 and 2019, 80 isolates of C. sojina were collected from six counties in Georgia and screened for QoI fungicide resistance using molecular and in vitro assays, with resistant isolates being confirmed from three counties. Additionally, 50 isolates, including a "baseline isolate" with no prior fungicide exposure, were used to determine the percent reduction of mycelial growth to two fungicides, azoxystrobin and pyraclostrobin, at six concentrations: 0.0001, 0.001, 0.01, 0.1, 1, and 10 μg ml-1. Mycelial growth observed for resistant isolates varied significantly from both sensitive isolates and baseline isolate for azoxystrobin concentrations of 10, 1, 0.1, and 0.01 μg ml-1 and for pyraclostrobin concentrations of 10, 1, 0.1, 0.01, and 0.001 μg ml-1. Moreover, 40 isolates were used to evaluate pathogen race on six soybean differential cultivars by assessing susceptible or resistant reactions. Isolate reactions suggested 12 races of C. sojina present in Georgia, 4 of which have not been previously described. Species richness indicators (rarefaction and abundance-based coverage estimators) indicated that within-county C. sojina race numbers were undersampled in this study, suggesting the potential for the presence of either additional undescribed races or known but unaccounted for races in Georgia. However, no isolates were pathogenic on 'Davis', a differential cultivar carrying the Rcs3 resistance allele, suggesting that the gene is still an effective source of resistance in Georgia.

Displaced Intra-Articular Calcaneal Fractures: Evaluation of Clinical and Radiological Outcome Following Open Reduction and Internal Fixation with Locking Branched Calcaneal Plate

Background An introduction of the World Health Organization Surgical Safety Checklist (WHO SSC) is essential to promote surgical safety. Objective To obtain country-specific information regarding the checklist in a leading medical institution in Nepal. Method The present research was a cross-sectional study with a survey conducted among healthcare professionals working in the operation theatre at the Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal. A questionnaire was distributed to 150 healthcare professionals working in the operating theatre. Responses to the questionnaire were analysed descriptively and regression analyses used to identify factors associated with awareness of the checklist. Result In total, 127 healthcare professionals participated in the study, of whom 118 (92.9%) had been aware of the WHO SSC. A substantial proportion of participants (108, 91.5%) were not satisfied with the prevailing practice whereby the checklist was not routinely used during surgery. Lack of appropriate training was the most prevalent barrier to the checklist use (72, 67.9%), followed by unwillingness of staff to use the checklist (54, 50.9%), and lack of experience (42, 39.7%). The mean score on the survey was 6.0 out of 10. Regarding the results of the regression model on survey scores, surgeons had higher scores compared to nurses (unadjusted coefficient 0.80, 95% CI 0.20-1.40). Conclusion Most of the healthcare professionals were aware of the WHO SSC, however multiple barriers to the checklist use were identified. It is important to establish an effective use of WHO SSC in the operation theatre.

Ischemic Stroke as a Manifestation of Cholesterol Embolization Syndrome Following Percutaneous Coronary Intervention

Cholesterol embolization syndrome (CES) is one of the major, yet underdiagnosed cause of morbidity and mortality following invasive coronary interventions. The major risk factors are elderly, male, atherosclerotic disease, anticoagulation and femoral access route. This multisystem disease affects skin, kidney, brain, eye and gastrointestinal tract. Only few cases of cholesterol embolization syndrome manifesting as an ischemic stroke are reported. We present a case of an elderly man, admitted to our ICU after percutaneous coronary intervention (PCI) who developed neurological deficits along with skin changes and renal failure. cholesterol embolization syndrome was suspected based upon the presence of cardiovascular risk factors, invasive cardiovascular intervention and clinical signs. The diagnosis of ischemic stroke made through plain MRI brain, revealed multiple areas of lacunar infarcts. He was treated with intermittent hemodialysis, statins and anti-platelet agents. On follow up, skin lesions and renal functions were improved; but slurring of speech and paresis persisted.

A novel adult plant leaf rust resistance gene Lr2K38 mapped on wheat chromosome 1AL

Soft red winter wheat (SRWW) cultivar AGS 2038 has a high level of seedling and adult plant leaf rust (LR) resistance. To map and characterize LR resistance in AGS 2038, a recombinant inbred line (RIL) population consisting of 225 lines was developed from a cross between AGS 2038 and moderately resistant line UGA 111729. The parents and RIL population were phenotyped for LR response in three field environments at Plains and Griffin, GA, in the 2017-2018 and 2018-2019 growing seasons, one greenhouse environment at the adult-plant stage, and at seedling stage. The RIL population was genotyped with the Illumina iSelect 90K SNP marker array, and a total of 7667 polymorphic markers representing 1513 unique loci were used to construct a linkage map. Quantitative trait loci (QTL) analysis detected six QTL, QLr.ags-1AL, QLr.ags-2AS, QLr.ags-2BS1, QLr.ags-2BS2, QLr.ags-2BS3, and QLr.ags-2DS, for seedling and adult plant LR resistance. Of these, the major adult plant leaf rust resistance QTL, QLr.ags-1AL, was detected on all field and greenhouse adult plant tests and explained up to 34.45% of the phenotypic variation. QLr.ags-1AL, tightly flanked by IWB20487 and IWA4022 markers, was contributed by AGS 2038. Molecular marker analysis using a diagnostic marker linked to Lr59 showed that QLr.ags-1AL was different from Lr59, the only known LR resistance gene on 1AL. Therefore, the QTL was temporarily designated as Lr2K38. Lr2K38-linked marker IWB20487 was highly polymorphic among 30 SRWW lines and should be useful for selecting the Lr2K38 in wheat breeding programs.

First Report of Fusarium poae Causing Fusarium Head Blight of Wheat in Georgia, USA

Fusarium head blight (FHB) is one of the most troublesome fungal diseases challenging US wheat (Triticum aestivum L.) production (Savary et al. 2019). Harmful mycotoxin contamination, primarily due to deoxynivalenol (DON) in the Fusarium-damaged kernels (FDK), can negatively impact human and livestock health (McMullen et al. 1997). Although Fusarium graminearum is the primary causal agent of FHB, several other species including F. poae could pose a risk by producing dangerous mycotoxins such as nivalenol, DON, HT-2, and T-2 (Stenglein 2009). Severe FHB epidemics on wheat have occurred in recent years along with increased corn acreage across the southeast US specifically in Georgia (Ghimire et al. 2020). Five symptomatic wheat heads displaying bleaching symptoms were randomly collected from 19 different fields across 13 counties of Georgia in late spring of 2018. Infected kernels were dipped in 6% sodium hypochlorite for 10 min and rinsed three times with sterilized water. Blot dried kernels were placed on potato dextrose agar (PDA) and incubated for 7 days at 25°C under 12-h photoperiod. Three isolates (GA18W-2.1.6, GA18W-6.1.4, and GA18W-10.2.3) from Terrell, Peach, and Sumter counties exhibited dense, whitish mycelium colony typical of F. poae (Leslie and Summerell 2006). When grown in carboxymethylcellulose broth, isolates produced globose to piriform microconidia (5.1 to 12.4 µm by 4.4 to 11.2 µm) that were aseptate or had a single septation. The morphological identification was further confirmed by DNA sequencing. Single hyphal tip isolates were grown on cellophane overlain on PDA for 10 days. Fungal DNA was extracted using a Qiagen DNeasy Plant Mini Kit. Genomic DNA was sequenced using TEF1 and TEF2 primer pairs that target the translation elongation factor 1-α (EF1-α) locus (O'Donnell et al. 1998). BLASTn query of the obtained sequences of GA18W-2.1.6 (accession no. MT856907) and GA18W-10.2.3 (accession no. MT856909) were identified as F. poae with a 99% sequence homology with GenBank reference accession MK629641, while GA18W-6.1.4 (accession no. MT856908) displayed 100% similarity with F. poae accession KJ947343. Koch's postulates were performed under greenhouse conditions. Three seeds of the FHB susceptible wheat cultivar 'SS8641' were planted in individual cone-tainers with three replications (two cone-tainers/replicate). Wheat plants were vernalized for six weeks and then moved back to the greenhouse. Each F. poae isolate was spray inoculated (50,000 spores/ml) at the flowering stage onto 18-24 wheat heads. A field isolate of F. graminearum was included as a positive control whereas heads mock-inoculated with water were used as a negative control. Inoculated wheat heads were incubated in black plastic bags for 48 hours. Disease severity and FDK were recorded three weeks post inoculation. Disease severities were 6.7% (GA18W-2.1.6), 8.3% (GA18W-10.2.3), and 15.2% (GA18W-6.1.4) compared to 90.0% in the positive control similar to Arrúa et al (2019). No symptoms were observed in the negative control. FDK was 18% (GA18W-2.1.6), 28% (GA18W-10.2.3) and 44% (GA18W-6.1.4). F. poae was re-isolated from the infected heads and found to be morphologically identical to the isolates used for inoculation. To our knowledge, this is the first report of F. poae associated with FHB of wheat in the state of Georgia, USA. F. poae isolates from Georgia might produce mycotoxins in addition to reducing grain yield which needs further study.

Fusarium Head Blight and Rust Diseases in Soft Red Winter Wheat in the Southeast United States: State of the Art, Challenges and Future Perspective for Breeding

Among the biotic constraints to wheat (Triticum aestivum L.) production, fusarium head blight (FHB), caused by Fusarium graminearum, leaf rust (LR), caused by Puccinia triticina, and stripe rust (SR) caused by Puccinia striiformis are problematic fungal diseases worldwide. Each can significantly reduce grain yield while FHB causes additional food and feed safety concerns due to mycotoxin contamination of grain. Genetic resistance is the most effective and sustainable approach for managing wheat diseases. In the past 20 years, over 500 quantitative trait loci (QTLs) conferring small to moderate effects for the different FHB resistance types have been reported in wheat. Similarly, 79 Lr-genes and more than 200 QTLs and 82 Yr-genes and 140 QTLs have been reported for seedling and adult plant LR and SR resistance, respectively. Most QTLs conferring rust resistance are race-specific generally conforming to a classical gene-for-gene interaction while resistance to FHB exhibits complex polygenic inheritance with several genetic loci contributing to one resistance type. Identification and deployment of additional genes/QTLs associated with FHB and rust resistance can expedite wheat breeding through marker-assisted and/or genomic selection to combine small-effect QTL in the gene pool. LR disease has been present in the southeast United States for decades while SR and FHB have become increasingly problematic in the past 20 years, with FHB arguably due to increased corn acreage in the region. Currently, QTLs on chromosome 1B from Jamestown, 1A, 1B, 2A, 2B, 2D, 4A, 5A, and 6A from W14, Ning7840, Ernie, Bess, Massey, NC-Neuse, and Truman, and 3B (Fhb1) from Sumai 3 for FHB resistance, Lr9, Lr10, Lr18, Lr24, Lr37, LrA2K, and Lr2K38 genes for LR resistance, and Yr17 and YrR61 for SR resistance have been extensively deployed in southeast wheat breeding programs. This review aims to disclose the current status of FHB, LR, and SR diseases, summarize the genetics of resistance and breeding efforts for the deployment of FHB and rust resistance QTL on soft red winter wheat cultivars, and present breeding strategies to achieve sustainable management of these diseases in the southeast US.

Trend in Gastric Outlet Obstruction at Patients Attending Tribhuvan University Teaching Hospital, Kathmandu, Nepal

IntroductionGastric outlet obstruction (GOO) involves obstruc_on in the antro-pyloric region or bulb of duodenum. Malignancy is common cause of GOO in adults but many patients with GOO have benign causes. Despite the improvement in medical management, about 5% patients with complicated duodenal ulcer disease and 1%-2% with complicated gastric ulcer disease respectively develop this problem.ObjectiveThe purpose of this study was to find the etiologies of GOO, their management options and outcome in Tribhuvan University Teaching Hospital.MethodologyIn this retrospective study, the records of 44 patients admited with diagnosis of GOO from September 2007 to August 2010 in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal were retrieved. Patients' demography, etiologies of GOO, treatment given and their outcome were analysed.ResultsThirty two patients (73%) were male and 12 (27%) were female with M:F ratio of 2.7:1. The mean age of patients was 57.40 years and duration of symptoms 2.68 months. Carcinoma of stomach, 28 cases (64%) was most common ecology of GOO followed by PUD, 9 (21%), duodenal malignancy,3 (7%), corrosive stricture, 2 (5%), advanced gallbladder carcinoma, 1 (2%) and chronic pancreatis, 1 (2%). Seventeen (39%) patients were treated by gastrojejunostomy, 14 (32%) by subtotal gastrectomy and gastrojejunostomy, 5 (11%) by truncal vagotomy and gastrojejunostomy, 4 (9%) by medical management, 2 (4.5%) by feeding jejunostomy, and 2 (4.5%) were discharged on request. Complications occurred in 7 (16%) patients and mortality in 1 (2%). Twenty three (52%) patients were candidates for chemotherapy either in an adjuvant or palliative seting.ConclusionGastric malignancy was the most common cause of gastric outlet obstruction. Most of the patients in our setup presented with advanced disease and were candidates of palliative treatment only. Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 219-221

Visceral artery aneurysms: an institutional review

Methods: It is a retrospective review of prospectively kept data of patients treated for visceral artery aneurysms in Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Center from 1997 to 2009.Results: Fifteen patients were diagnosed with 16 visceral artery aneurysms. These consisted of 7 splenic (in 6 patients), 4 hepatic, 2 superior mesenteric, 1 gastroduodenal, and 1 renal artery aneurysms. There were 14 symptomatic patients including 4 who presented with rupture. Commonest presenting symptom was pain abdomen (14/15), followed by gastrointestinal bleed (6/15) and mass abdomen (5/15). The diagnosis was made with the help of CECT of abdomen in 13 patients, which was confirmed by conventional angiography in three patients. In two patients with obscure GI bleeding, diagnosis was clinched by conventional angiogram. Eight patients were treated only surgically, with three mortality. Transcatheter embolization alone was used in 5 patients. Two patients were treated with combination of surgical and endovascular therapy. One patient with superior mesenteric artery aneurysm in whom nothing could be done during laparotomy died six months later. Average follow up duration was one year.Conclusion: Splenic artery remains the most commonly afflicted vessel among the visceral artery aneurysms. The VAAs can be treated surgically or with endovascular means with fair success, although the best mode of treatment needs to be individualized.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 3-6

Annular pancreas presenting as gastric outlet obstruction in an adult: a case report

Annular pancreas is a rare congenital abnormality which arises in the embryo by persistence of pancreatic tissue in the track which the ventral pancreatic bud follows in its rotation round the duodenum.  A 21 years old male was admitted because of a non bilious vomiting and epigastric fullness after intake of food. Diagnosis was confirmed with contrast enhanced CT scan of the abdomen. He successfully underwent laparoscopic gastrojejunostomy with uneventful postoperative recovery. Though rare, annular pancreas should be considered as differential diagnosis in patient presenting as gastric outlet obstruction after excluding common causes.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 35-36

Post operative diagnosis of early gastric cancer in a low risk population and the possibility of risk stratified screening

BACKGROUND

Gastric cancer is the second commonest cause of cancer related mortality worldwide. Though its incidence is more in Eastern Asia, it is increasing in the South Asian subcontinent. The diagnosis of early gastric cancer (EGC) confined to the mucosa or submucosa, is an important concern due to a better outcome at this stage where five year survival rates could increase by 90 percent. Though mass screening is done in few countries, it has not been applied in developing countries like Nepal. Preoperative diagnosis of EGC is rare in Nepal. The aim of this study is to analyze the clinicopathological features of postoperative cases of gastric cancer managed in a tertiary care university hospital of Nepal.

METHODS

All patients with histological diagnosis of gastric cancer admitted in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal during the three year period (September 2010 to August 2013) were analyzed retrospectively.

RESULTS

Ninety two patients with endoscopic diagnosis of gastric cancers were admitted during the past three years. The mean age was 60 years ranging from 28 years to 85 years with the male to female ratio of 2.8:1. Five patients were younger than 40 years and all were in advanced stage. Thirty five percent of the patients belonged to Janajatis (Hill) community though they comprise only 23% of the population and about 65% of them belonged to an area involving 25% of the country. Seventy six cases were operated. Out of 92 patients, 4 patients were diagnosed as early gastric cancer postoperatively. All patients with early gastric cancer were above 50 years with CT Scan abdomen revealing focal thickening without lymphadenopathy.

CONCLUSION

Over the years, the incidence of gastric cancer is increasing in Nepal. Though 92% are advance gastric cancers, few have been diagnosed and treated early. A screening program in a country like Nepal with diverse ethnicity and difficult terrain might be helpful if it targets high risk people in high risk areas.

Accuracy of triple test score in the diagnosis of palpable breast lump

Breast lump is a very sensitive issue for the patient so a reliable, non invasive and prompt diagnosis helps to lessen the associated anxiety and leads to early definitive treatment. The aim of this study was to evaluate the accuracy of Triple Test Score (TTS) as a clinical tool for the diagnosis of a palpable breast lump. This diagnostic test study was carried out in the Department of Surgery of Tribhuvan University Teaching Hospital. Of the 117 patients admitted with breast diseases from the breast clinic over thirteen months, 87 had breast lump. Fifty patients underwent Triple Test Score ( physical examination, mammography and fine needle aspiration cytology) and were categorized into benign, suspicious and malignant. This was later correlated with the histopathological findings. Nineteen patients with breast lumps interpreted by TTS as benign correlated with the histopathological findings whereas of 31 malignant lumps, 30 turned out to be malignant and one benign. This gives TTS an over all accuracy of 98% with 100% sensitivity, 95.2% specificity and positive predictive value of 96.7%. Carcinoma was seen in 29 (58%) cases in the age group of 35 to 70 years. The mean age at diagnosis of benign and malignant disease was 41.8 and 45.1 years respectively. In conclusion, TTS is an accurate and least invasive diagnostic test based on which definitive treatment can be initiated.