bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Biofilm Formation and Antibiotic Resistance Pattern in Extended-Spectrum β-Lactamase-Producing Escherichia coli Strains
Authors: Jomehzadeh Nabi , Ahmadi Khadijeh , Nasiri Zahra
Published: August 2023

Background:

The increasing prevalence of multidrug-resistant (MDR) Escherichia coli strains, especially extended-spectrum beta-lactamase (ESBL)-producing strains, has become a global health concern. This study was aimed to determine the frequency of bla
CTX-M, bla
TEM, and bla
SHV genes among E. coli isolates from urinary tract infection (UTI) and evaluate their antibiotic resistance pattern.

Methods:

Totally 98 E. coli isolates were recovered from urine samples of UTI-diagnosed patients. Antibiotic resistance and ESBL production were evaluated by disk diffusion and combined disk methods according to the Clinical Laboratory Standards Institute guidelines. The biofilm formation ability of isolates was assessed using the tube adherence method. ESBL-positive isolates were screened for bla
TEM, bla
CTX-M, and bla
SHV genes by polymerase chain reaction.

Results:

Among the examined isolates, 25 (25.5%) were detected as ESBL producers and harbored at least one of the studied genes. The bla
CTX-M was the predominant (44%) gene, followed by bla
TEM (24%) and bla
SHV (8%). The isolates revealed variable resistance levels to all antimicrobials, out of which 55.1% were conferred a high resistance rate to different antibiotic classes and considered MDR. Phenotypically, 42.85% of the isolates were biofilm formers, of which the majority (38%) formed moderate biofilms.

Conclusions:

This study showed that the ESBL-positive isolates were more resistant to some first-line antibiotics, and this highlights the necessity to control and monitor the prescribed antibiotics used for empirical treatment for UTI patients.
Screening the in-vitro Antibacterial Activity of Different Naturally Produced Coal and Coal Mediated Commercial Products on Clinically Isolated Pathogens
Authors: Shreya Shawda Shafiq , Islam Tamanna , Ishma Touhida , Polin Irin Sultana , Nazia Fahim Monwar , Acharjee Mrityunjoy
Published: August 2023

Background:

The rise of microbial illnesses caused by drug-resistant microflora is one of the most serious public health concerns, therefore identifying novel antimicrobial agents is crucial in combating multidrug-resistant bacterial strains.

Methods:

Present Investigation designated to assess the microbiological status of some naturally produced coal and coal mediated commercial products collected from Barapukuria Coal Mine Dinajpur and different retailer in Dhaka city, respectively through conventional cultural and biochemical tests. Moreover, the anti-bacterial potential of both categories of coal samples was also aimed to be checked by the agar well diffusion method and minimal inhibitory concentration (MIC) assay.

Results:

Out of 10 samples, total viable bacteria was estimated at high range in all the samples excluding the charcoal. In case of specific bacteria, only Staphylococcus spp. was found in both types of samples while Klebsiella spp. was found in coal mediated commercial products. Both categories of samples showed their anti-bacterial activity with satisfactory range of zone diameter (9 mm–26 mm). However, the naturally produced coal was unable to show their anti-bacterial activity against Bacillus spp., Shigella spp. and Vibrio spp. through agar well diffusion methods. Meanwhile, the minimal concentration of all the samples was successfully quantified as MIC value at which the bacterial growth was retarded. In case of naturally produced coal, the lowest concentration 4 mg/ml was recorded for wooden coal powder against Escherichia coli while the maximum concentration was estimated at 34 mg/ml. Conversely, the MIC value was varied between 4 mg/ml to 24 mg/ml in case of coal mediated commercial products.

Conclusion:

The results of this study suggest that the naturally produced coal and coal-mediated products have excellent antibacterial characteristics which indicating their economic potential for treating various infectious disorders.
Antibiotic Susceptibility Profile and Plasmid Analysis of Micro-Organisms Associated with Ocular Infections
Authors: Unegbu Valentine Nnachetam , Anyamene Chris , Odibo Frederick
Published: August 2023

Background:

This study was undertaken to determine the antimicrobial susceptibility profile and plasmid analysis of micro-organisms associated with ocular infections.

Methods:

Ocular specimens were collected from 500 patients. Subsequent identification was done based on morphology and biochemical tests. Susceptibility pattern of the isolates was done using the disk diffusion method. The presence of plasmids was determined using the agar gel electrophoresis technique. Plasmid curing was carried out by treating the MAR isolates with sodium dodecyl sulfate at concentration of 10%.

Results:

Conjunctivitis was the most prevalent ocular infection of 105 (39.8%). S. aureus was the most prevalent pathogen 63 (23.9%) followed by CoNS 36 (13.6%). S. aureus was 100% sensitive to vancomycin and chloramphenicol. CoNS was also 100% sensitive to ciprofloxacin, vancomycin, and chloramphenicol. K pneumoniae was 100% sensitive to gentamicin and amoxicillin-clavulanic acid while N. gonorrhoeae was 100% sensitive to gentamicin, ciprofloxacin, ceftriaxone, amoxicillin-clavulanic acid, and cefotaxime. The overall MAR bacteria was 38 (16.2%). Plasmid analysis revealed the presence of 1–3 plasmid bands of sizes 6.21–16.22 Kbp from the MAR isolates. Plasmid curing revealed that the gene coding for resistant seen in this study was plasmid mediated.

Conclusions:

The prevalence of ocular infection was high with conjunctivitis being the dominant. The dominant bacteria species were S. aureus and CoNS. The overall MAR bacteria proportion was relatively high. The presence of plasmids was responsible for the resistance of the isolates to antibiotics.
Her2neu Expression of Gastric and Lower Esophageal Carcinoma and its Correlation with Clinicopathological Findings in Tertiary Care Hospital in Eastern India
Authors: Chakraborty Dipsikha , Ghosh Sanchita , Jain Bhawna Bhutoria , Ghosh Saurav Kumar , Nandi Ayandip
Published: August 2023

Background:

Gastric carcinomas are the fifth most common cancer worldwide and cause the second most common cancer-related deaths. Human epidermal growth factor receptor 2 (HER-2/Neu)(c-erbB2) protein overexpression in gastric cancer has been correlated to poor outcomes and a more aggressive disease. Targeted therapy against HER-2/Neu has attracted much attention recently. Comprehensive data regarding Her2neu expression in gastric carcinoma in Southeast Asia shows highly variable results and often lacks standardization.

Aim/Objective:

In this study, we study the expression of HER-2/Neu marker in lower esophageal and gastric carcinoma and compare it with various clinicopathological parameters and are known to have prognostic significance.

Methods:

One hundred and fifty cases of gastric/gastroesophageal adenocarcinomas (intestinal type) were included in the study over 2 years, and immunohistochemistry was done to evaluate Her2neu expression. Scoring was done according to the American Society of Clinical Oncology/College of American Pathologists guideline, and the finding was correlated with clinicopathological parameters.

Results:

The age of patients ranged from 41 years to 80 years. Gastric tumors were more common in the age group 61–70 years with mean age of 65.5 years. Gastric tumors are more common in males than females. (M:F = 3.16:1) Most common type of specimen received was partial gastrectomy (38%). Anorexia (46%) and pain abdomen (46%) were the most common presenting symptoms. Gastric tumors were common in tubular subtypes (76%) followed by mucinous subtypes (16%). Most common histopathological grading was moderately differentiated gastric adenocarcinoma (64%). Most gastric tumors were located at antropyloric area of the stomach (42%). The highest frequency of cases presented at an tumor, node, metastasis (TNM) stage that is pT2N2Mx (32.3%). Her2neu expression was found to be score 0 in most (62%) cases, only 10% of cancers were positive (3+), 14% were equivocal (2+), and another 14% were 1+ (negative). When we correlated clinicopathological parameters such as age, sex, tumour site, gross appearance, size, depth of invasion, TNM stage, Lymphovascular invasion, perineural invasion etc. with HEr2neu expression; no statistically significant correlation was found.

Conclusion:

Overexpression of HER-2/Neu in gastric carcinoma can help to identify patients with reduced survival and to identify eligible candidates for targeted therapy. A larger sample size and follow-up for a longer period might shed more light on the role of the above markers in gastric carcinoma.
Comparing Pili Producing Gene (mtp-flp) in Susceptible and Resistant Dormant Mycobacterium Tuberculosis Strains with Active Clinical Isolates
Authors: Nasirzadeh Zahra , Farnia Parissa , Nowroozi Jamileh , Farnia Poopak , Velayati Ali Akbar
Published: August 2023

Background:

Pili producing genes in different life cycles of Mycobacterium tuberculosis (M. tuberculosis) were assessed. M. tuberculosis has two life cycles: dormant and active states. We aimed to assess the pili producing genes such as curli pili of M. tuberculosis (mtp) encoded by the mtp gene (Rv3312A) and fimbrial low-molecular-weight protein encoded by flp gene (Rv3656c) which were compared and analyzed.

Methods:

Two hundred M. tuberculosis isolates were investigated both at active and dormant states for production and expression of pili. The dormant M. tuberculosis was achieved by incubation in a sealed tube (modified Wayne method). The susceptibility of M. tuberculosis was evaluated on genes, rpob, inh, katg, and gyra by using multiplex polymerase chain reaction (PCR) and single-strand conformational polymorphism methods. The PCR–restriction fragment length polymorphism was used to express pili genes mtp and flp and then the PCR products was digested using restriction enzyme Fnu4HI, XmaI, and MspJI and AciI, TagII, and HaeII, respectively. The transmission electron microscopy was also used to detect pili in different isolates. The result was compared and analyzed using H37RV as a gold standard.

Results:

The mtp and flp PCR products were 263 and 122 bp in the studied strains irrespective of M. tuberculosis different life cycles, respectively. The PCR products were analyzed on 8% Polyacrylamide gel electrophoresis (PAGE), and in the 180/200 (20%), producing five fragments of 25,40,45,63,90 bp with the Fun4HI and two fragments of 126,138 bp with the XmaI and uncut with the MspJI for mtp gen were obtained at the dormant and active states of M. tuberculosis (P < 0.05). Similarly in flp gene producing three fragments of 22,35,65 bp with AciI and two fragments of 35.87 bp with TagII and two fragments of 38.84 bp with HaeII were obtained (P < 0.05). In contrast to genotyping analysis, the electron microscopy examination showed protruding of pili from M. tuberculosis, especially in dormant mycobacterium (15/100; 15%), that was multidrug resistance and extensive drug resistance isolates (P > 0.05).

Conclusion:

Pili were shown by electron microscopy, although at the gene expression, the insignificant difference was observed at the dormant strains in comparison to active states. Therefore, we may conclude that other genes might be involved in pili production of M. tuberculosis that needs further investigation. Although, the resistance phenomena might influence the pili producing gene expression that showed in our results.
Alpha-Pinene Preserves Human Dopaminergic SH-SY5Y Cells against 6-Hydroxydopamine-Induced Toxicity through its Antioxidant and Antiapoptotic Properties and Gamma-Aminobutyric Acid Type A Signaling
Authors: Moshrefi Mandana , Pourrahimi Ali Mohammad , Abbasnejad Mehdi , Farjoo Mohammad Hadi , Esmaeili-Mahani Saeed
Published: August 2023

Background:

Parkinson's disease (PD) is one of the most common neurodegenerative disorders which is characterized by progressive loss of dopaminergic neurons in substantia nigra. Therefore, drugs or natural agents that have suppressive effects on dopaminergic cell death may reduce the progression of such disorder. Here, the effect of natural product alpha-pinene was evaluated on 6-hydroxydopamine (6-OHDA)-induced damage in SH-SY5Y human dopaminergic cell line as an in vitro model of PD.

Methods:

The cells were incubated by 150 μM 6-OHDA alone or accompanied with different concentration of alpha-pinene (10–180 μM). Cell viability was determined by MTT assay. The amount of intracellular reactive oxygen species (ROS) and mitochondrial membrane potential were measured by fluorescence spectrophotometry. In addition, the components of molecular apoptotic pathway such as cytochrome c release, Bax, Bcl-2, and caspase-3 levels were measured by immunoblotting. Gamma-aminobutyric acid (GABA) antagonist, bicuculline, was used to find the role of GABA Type A (GABAA) receptors in the signaling of alpha-pinene.

Results:

The data showed that 6-OHDA produced cell damage, decreased mitochondrial membrane potential, increased intracellular ROS and cytochrome c release, as well as increased Bax/Bcl-2 ratio and caspase-3 activity. Moreover, alpha-pinene (70 μM) significantly inhibited cellular and molecular abnormalities. Blockage of GABAA receptor significantly suppressed the protective effect of alpha-pinene.

Conclusion:

The results suggest that alpha-pinene has a protective effect against dopaminergic toxicity, and at least in part, its antioxidant and antiapoptotic properties are probably involved in such protection.
Comparison of Microalbuminuria, Creatinine, and Glomerular Filtration Rate between Sickle Cell Disease Patients and Healthy Individuals
Authors: Ismail Abazar Mahmoud , Abakar Adam Dawoud , Elkarsany Mubarak Elsaeed Mustafa , Almugadam Babiker Saad
Published: August 2023

Background:

Sickle cell disease is related to many health issues (such as stroke, severe infections, and sickle cell crisis) and elevated risk of death. This study was aimed to investigate and compare microalbuminuria (MAU), creatinine, and glomerular filtration rate (GFR) between sickle cell disease (SCD) patients and healthy individuals.

Methods:

A total of 156 cases and 156 control subjects were included. MAU, creatinine, GFR, and body mass index (BMI) were measured.

Results:

The estimated levels of MAU and creatinine were significantly higher in cases than controls, but the mean of BMI and GFR was significantly lower in cases than the control group. In patients of sickle cell disease, the mean MAU, GFR, creatinine, and BMI levels in females, rural area residents, and subjects aged 2–13 years were higher than controls, P < 0.05. MAU and GFR were also higher (P < 0.05) in males and subjects aged 14–25 years of study cases than controls.

Conclusion:

Accordingly, this study indicated the impact of SCD in MAU, creatinine, GFR, and BMI, which are significant in the diagnosis of nephropathy.
Detection, Clinical Features, and Laboratory Markers of H.pylori Infection in Individuals attended Kosti Teaching Hospital, Sudan
Authors: Azoz Mohammed Eltoum , Almugadam Babiker Saad , Ibrahim Omer Mohammed Ali , Ahmed Yousif Mousa Alobaid , Tayeb Amna Ahmed Al , Eshagg Noor Hussin , Hassan Roaa Azhari
Published: August 2023

Background:

Helicobacter pylori infections are associated with significant morbidity. The study intended to screen H. pylori among symptomatic patients and assess the performance of anti-H. pylori immunoglobulin G (IgG) test compared to stool Ag test as well as to investigate some clinical and hematology findings in H. pylori-seropositive persons.

Methods:

One hundred individuals with the clinical suspicion of infection by H. pylori and 100 control subjects matched for gender (χ
2 = 0.026, P = 0.873) and age groups (χ
2 = 5.303, P = 0.151) were recruited. Clinical assessment, endoscopy, anti-H. pylori IgG test, and stool for cagA Ag were performed to investigate H. pylori infection. White blood cells, red blood cells (RBCs), hemoglobin (Hb), and mean corpuscular hemoglobin (MCH) were also analyzed.

Results:

Vomiting and hematemesis were reported in 44% and 8% of the study group, respectively. Whereas, nausea, epigastric pain, and weight loss were observed in all (100%). Notably, gastritis and duodenal ulcer were detected in 100% and 80% of cases, respectively. Based on Immunochromatographic test (ICT), 75% and 78% of the study group were positive for anti-H. pylori Ab and cagA Ag of H. pylori, respectively. The odd of reported a positive result for H. pylori was less likely in females than males as determined by anti-H. pylori (odds ratio [OR]: 0.529, 95% confidence interval [CI]: 0.142–1.970, P: 0.343) and stool cagA Ag test (OR: 0.364, 95% CI: 0.087–1.532, P: 0.168). Compared to the cagA Ag test, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of anti-H. pylori test were 77.2%, 85.3%, 78.7%, 84.1%, and 81.9%, respectively. Interestingly, RBCs count, MCH, and Hb were significantly higher in the control compared to study cases, P < 0.05.

Conclusions:

Our results highlight the epidemiology of into H. pylori, assess the performance of anti H. pylori test compared to cagA Ag test, and demonstrate the direct link between some hematologic indices and H. pylori. Further studies are necessary to verify these findings.
Evaluation of Adnexal Masses – Correlation of Clinical and Radiologic Features with Histopathologic Findings
Authors: Dasgupta Senjuti , Mangal Srishtidhar , Naskar Kalyani
Published: August 2023

Background:

Ovarian carcinoma is the seventh most common cause of carcinoma-induced deaths among women of the world. Adnexal masses often pose a diagnostic challenge to a treating physician. The aim of the present study was to find out the incidence of various categories of ovarian tumors and their correlation with clinicopathologic parameters among patients attending a tertiary care center of Eastern India. Another aim was the evaluation of diagnostic accuracy of clinical, laboratory, and radiological findings.

Methods:

A prospective, observational study was carried out for a period of 1 year. Female patients with adnexal masses were included in the study. Clinical, laboratory, and sonographic findings of each patient were recorded along with their histopathological reports.

Results:

The median age of 59 patients included in the study was 36 years. Most patients (32, 54.2%) were between 30 and 50 years of age. Thirty-six (61%) ovarian tumors were found to be benign and the rest (23, 39%) malignant. Surface epithelial tumors were the most common type (35, 59.3%), followed by germ cell tumors (11, 18.6%) and sex cord stromal tumors (9, 15.3%). A statistically significant association was noted between parity, menstrual status, laterality, size, gross appearance of tumor, and nature (benign/malignant) of the mass. Sensitivity (57%) and specificity (86%) of the clinical diagnosis were good, but diagnostic accuracy (88%) of sonographic findings was better. While serum CA125 level measurement had a diagnostic accuracy of 78%, the risk of malignancy index (RMI) 2 score, with an accuracy of 86%, has the potential to guide further management in a patient with adnexal mass.

Conclusion:

Increased incidence of malignancy was noted with postmenopause, nulliparity, bilaterality of tumors, and complex tumor morphology. All these risk factors were found to be statistically significant. RMI 2 score may be used routinely for diagnosis and guidance of further management of adnexal masses.
Biological Implications of Deletion P53 by Fluorescence In Situ Hybridization in Multiple Myeloma
Authors: Shetty Vijith Vittal , Arumugam Meenakshi , Shetty Reshma Arun , Kalal Akanksha Ashok , Kulkarni Nagaraj Venkatesh , Shetty Deyyenthody Prashanth
Published: August 2023

Background:

Multiple myeloma (MM) is a clonal plasma cell disorder characterized by heterogeneous complex genetic abnormalities. Due to the low proliferative index of plasma cells, conventional cytogenetic (CC) analysis is hampered in MM. Interphase fluorescence in situ hybridization (FISH) along with CC enhances the sensitivity of detection. The study aims to investigate the diagnostic yield and prevalence of P53 deletion in patients with MM.

Materials and Methods:

Cytogenetic analysis and FISH were performed on 41 MM patients.

Results:

Our study showed that 55–65 years of age range among all individuals, predominantly affected by the disease. The cytogenetic analysis detected abnormal karyotype in 12% (5/41), normal karyotype in 66% (27/41), and culture failure in 22% (9/41). Abnormal karyotype showed numerical abnormalities such as hyperdiploidy 5% (n = 2) and hypodiploidy 7% (n = 3%). Chromosomes 5, 9, 11, and 21 were common gains among hyperdiploid cases. Chromosome 7, 17, 22 and Y were the common missing chromosome in hypodiploid cases. P53 gene deletion is a rare genetic event and difficult to identify using CC. FISH analysis of deletion 17p was detected in 15% (6/41). Out of six cases, two cases showed deletion of 17p region, three cases showed monosomy 17, and one case showed amplification signals for chromosome 17. Conclusion: CC along with FISH increases the rate of detection of abnormality in MM cases. P53 being less frequent is uncommon at initial diagnosis; increasing its incidence with advanced stage is considered one of the important prognostic factors in MM.
Dimensional Accuracy and Surface Detail Reproduction of Hydrophilic Polyvinylsiloxane Impression Material Tested under Dry and Moist Salivary Conditions
Authors: Nayyar Abhishek Singh
Published: August 2023

Background:

The dimensional accuracy and surface detail reproduction of impression materials play a major role in determining the extent to which indirectly produced prostheses and restorations have an acceptable fit. The purpose of the present study was to compare the dimensional accuracy and surface detail reproduction of hydrophilic polyvinylsiloxane (PVS) impression material tested under dry and moist salivary conditions.

Methods:

The study samples were assigned two groups based on the condition in which they were made. One group consisted of casts obtained from impressions made in dry condition (n = 12), while the other group consisted of casts obtained from impressions made in moist salivary conditions (n = 12). Impressions of the master model were made using hydrophilic PVS impression material by two-step putty-wash technique and working casts were obtained. Dimensional accuracy was measured by comparing the inter-abutment distance in each cast to the master model using a profile projector with an accuracy of 0.001 mm, while surface detail reproduction was evaluated using the American Dental Association specification No. 19 criteria of continuous replication of at least two of the three horizontal lines. Descriptive statistics such as mean and standard deviation were calculated for both the groups. Differences from the master model were analyzed by paired t–test, while one-way analysis of variance (ANOVA) was used for intergroup comparisons. P ≤ 0.05 was considered statistically significant.

Results:

One-way ANOVA revealed a highly significant difference in the dimensional accuracy of impressions made under moist conditions as against those which were made under dry condition (P < 0.001). The percentage change in dimension of 0.6% in Group A casts and 0.3% in Group B casts, also, showed a high clinical significance. Under dry condition, the impression material satisfactorily replicated the surface details in 100% of the cases, while under moist conditions, only 58% of the impressions were found to be satisfactory.

Conclusion:

The presence of moisture caused a significant adverse impact on the dimensional accuracy and surface detail reproduction of hydrophilic PVS impression material underlying the clinical significance of moisture control for successful impressions.
Antimycobacterial Properties and Metabolite Profiling of Fish Gut-Associated Streptomyces sp. MCA2
Authors: Nekkanti Deepa Sudeeshna , Sasikumar Ushanandhini , Baskaran Abirami , Kaari Manigundan , Venugopal Gopikrishnan , Radhakrishnan Manikkam
Published: August 2023

Background:

Infectious diseases such as tuberculosis and other opportunistic diseases affecting the lungs are major threats concerning public health. These pathogens have gained resistance to the currently available drugs which has prompted the discovery of novel antibiotics to fight against such pathogenic organisms. With unique pharmaceutical and biotechnological applications, Actinobacteria are considered possessing rich source of natural products. Biodiscovery of actinobacterial metabolites depends on the identification and recovery from unexplored environments and effective assessment of their metabolites. Literature states that among various ecosystems, fish are promising yet understudied source.

Methods:

Potential strain was screened from 13 fish gut-associated actinobacterial strains for their antimycobacterial and antitubercular properties. Ideal fermentation methodology has opted for bioactive metabolite production. Optimization procedures, minimum inhibitory concentration determination, characterization studies, and metabolite profiling through gas chromatography mass spectrometry were performed.

Results:

Potential strain MCA2 was selected for their antagonistic activity against Mycobacterium smegmatis. Bioactive metabolite of potential strain was produced through agar surface fermentation and extracted using ethyl acetate. Antitubercular activity was confirmed by >50% reduction in relative light unit against Mycobacterium tuberculosis H37Rv. The potential strain MCA2 was identified as Streptomyces sp. based on its phenotypic characteristics.

Conclusion:

The outcome of this study outlined the antimycobacterial potential of isolated fish gut-associated Streptomyces sp. strain confirming that fish guts are promising sources for isolating metabolites active against tuberculosis and other nontuberculous mycobacterial diseases.
Metastatic Adenoid Cystic Carcinoma – An Unusual Neoplastic Lesion of the Liver
Authors: Tapadia Ashish , Mouleeswaran Karattupalayam Sampath , Thomas Jacob Nikhil , Varghese Joy
Published: August 2023

Adenoid cystic carcinoma (ACC) is an uncommon tumor of the salivary glands and is known for its delayed presentation of distant metastasis. However, delayed presentation of metastatic ACC in the liver without primary recurrence is rare, and literature is limited. In this case report, we present a case of metastatic ACC involving the liver without primary recurrence 6 years after radical excision of submandibular ACC.
Norovirus Infection in Renal Transplant Patients with Chronic Diarrhea
Authors: Parameswaran Sarojini Ashok , Rao B. Subba , Balasubramaniam S. , Parameswaran Ashok , Tarigopula Anil
Published: August 2023

Diarrhea is not uncommon in immunocompromised patients We report here four renal transplant patients in whom a molecular testing panel for gastrointestinal pathogens revealed positive test for norovirus.
Endoscopic Management of Failed Surgical Repair of Boerhaave's Syndrome
Authors: Zanwar Shankar , Gupta Vikas , Patle Nirmal , Ganjare Ashish , Rajput Anantsingh , Chaware Shailesh
Published: August 2023

We present a case of failed surgical repair of Boerhaave's syndrome managed with minimally invasive care and first of its kind use of Padlock Clip for Boerhaave's syndrome.
Pseudomembranous Colitis Due to Cytomegalovirus Infection During SARS COVID-19 Convalescence
Authors: Yewale Rohan , Ramakrishna Banumathi , Chand Naveen , Ramakrishna Balakrishnan S.
Published: August 2023

Pseudomembranous colitis (PMC) is a well-known entity with an increasing prevalence in the current post antibiotic era. Its endoscopic and histological morphology is often considered synonymous with Clostridioides difficile-associated colitis. Cytomegalovirus (CMV) infection is a less commonly reported cause of PMC. We report an interesting case of a 61-year-old gentleman with an acute-onset, inflammatory diarrhea during SARS COVID-19 convalescence who was found to have features consistent with PMC on colonoscopy. However, histological and immunohistochemistry analysis of colonic biopsies revealed the presence of CMV infection in the absence of C. difficile toxins on stool assay.
Cryptogenic Multifocal Ulcerous Stenosing Enteritis
Authors: Vinish Doraiswami Babu , Balasundaram Partheeban , Ramakrishna Banumathi , Palaniappan Alagu Balaji , Sarangapani Arulprakash , Ramakrishna Balakrishna Siddhartha
Published: August 2023

Crytpogenic multifocal ulcerous setnosing enteritis is an unusual cause of gastrointestinal bleed. The objective of this report is to highlight small bowel ulcerations as a cause of anemia and the role of wireless capsule endoscopy in the diagnosis of CMUSE. We present here two young women who had been evaluated for anemia with normal gastroscopy, colonoscopy and contrast CT's and requiring multiple blood transfusions over the years. Both patients had wireless capsule endoscopy which showed multiple ulcerations with stenosis in the small intestine, resulting in capsule retention in the small intestine which was retrieved. Both patients improved with steroids and azathioprine. To summarize CMUSE could be cause of obscure GI bleed, when CMUSE is a consideration as the cause of GI bleed wireless capsule endoscopy should be used in caution.
Cap Polyposis in a Child
Authors: Arulprakash S. , George Tarun , Sathiyasekaran Malathi
Published: August 2023

Inflammatory cap polyposis (CP) is a uncommon, non-malignant condition characterized by the presence of sessile and pedunculated polyps in the colon and rectum. The histology of these polyps reveals a “cap” of inflammatory granulation tissue with fibrinopurulent exudate that covers the polyps, hence the name “inflammatory cap polyposis”. The pathogenesis of this non-malignant condition is poorly understood and while several associations have been made, causality has yet to be elucidated. The mainstay of initial treatment is conservative, however complicated and refractory cases usually benefit from endoscopic or surgical intervention followed by close surveillance for disease recurrence and progression. We present a 12 yr old girl with a large cap polyposis which was resected successfully by EMR and literature review.
Dual or Single Risk Factor in Acute Liver Failure
Authors: Varanasi Bhargav Yugandar , Kedarishetty Chandan Kumar , Mu Karthikeyan , Selvan Thamarai S. , Venkataraman Jayanthi
Published: August 2023

Acute liver failure (ALF) is a medical emergency. We report a case of ALF due to paracetamol overdose in a patient with pregnancy-related transient hepatic venous outflow obstruction, managed conservatively. The patient made a complete recovery 6 months later.
Dynamic Scoring of Appetite Predicts Inpatient Survival in Patients with Acute-on-Chronic Liver Failure
Authors: Jaleel Rajeeb , Sharma Anand , Selvaraj Vimala , Aaron Rekha , Muliyil Jayaprakash , Vijayalekshmi Balakrishnan , Balasubramanian Kunnisery Ananthsubramanian , Antonisamy Balavendra , Goel Ashish , Zachariah Uday George , Eapen Chundamannil Eapen
Published: August 2023

Background and Aim:

Decreased appetite is common in patients with liver disease and may be mediated by inflammatory cytokines. Acute-on-chronic liver failure (ACLF) is associated with raised inflammatory cytokines. The aim of this study was to evaluate appetite scoring as a predictor of inhospital survival in patients with ACLF.

Methods:

In a prospective observational study, consecutive hospitalized patients with ACLF were recruited. Appetite was assessed daily using Simplified Nutritional Appetite Questionnaire (SNAQ). The total SNAQ score ranged from 4 to 20, and a change in SNAQ score ≥1 was considered significant. Patients received standard medical care. Outcome was defined as good when patient was discharged in a stable condition and as poor if patient died or was discharged in terminal state.

Results:

Seventy-five ACLF patients (mean age 44 years; 66 males) were recruited. The median length of hospital stay was 5 (range: 1–20) days. Outcome was good in 50 and poor in 25 patients. Patients with good outcome had higher Day 1 SNAQ score (median: 12, range: 7–16) than patients with poor outcome (median: 10, range: 5–16) (P < 0.001). The area under receiver operating characteristic curve to predict poor outcome was 0.71 (95% confidence interval [CI]: 0.56–0.86) for Day 1 SNAQ score and 0.90 (95% CI: 0.82–0.98) for SNAQ δ. When divided into tertiles based on Day 1 SNAQ score, the outcome was good for all patients whose appetite improved and poor for all patients whose appetite worsened on Day 3.

Conclusion:

Appetite (SNAQ) scores on Day 1 and change on Day 3 predict inhospital survival in ACLF patients. SNAQ is a simple bedside tool which may help in guiding therapeutic decisions in ACLF patients. Further larger studies are required to validate these findings.
Renal Dysfunction in Chronic Liver Disease
Authors: Yewale Rohan , Ramakrishna Balakrishnan S.
Published: August 2023

Renal dysfunction is not uncommon in patients with cirrhosis, particularly as disease advances and the liver function decompensates. This review discusses the various types of renal dysfunction that may occur, the current classification of these kinds of kidney injury, and the rational management of these disorders based on the pathophysiology of these conditions.
Use of a Small-Diameter Resectoscope on a Patient with Extensive Urethral Strictures for Transurethral Resection
Authors: Georgios Moustakas , Graikos Konstantinos , Athanasios Klampatsas , Valerios Tsochataridis , Melina Milou , Stergios Gatzos
Published: August 2023

This case refers to a 60-year-old male suffering from an extensive circular urethral stricture throughout the whole length of the urethra, with the coexistence of a papillomatous tumor of the urinary bladder. The insertion of the resectoscope through the urethra was impossible, despite previous dilations with Benique. Therefore, an internal urethrotomy was performed. From May 2020 to September 2022, the patient was submitted to three TUR-BTs with the use of a smaller diameter resectoscope (22ch). The histology report resulted in TCC (Transitional Cell Carcinoma) stage pT1 high grade. The patient was then administered intravesical bacillus Calmette-Guerin installations. The last TUR-BT took place in October 2022. It was impossible to insert the conventional 22ch resectoscope through the urethra, so the Delmont gynecological resectoscope was used instead. This resectoscope by the French company Delmont has the same length as the conventional urological resectoscopes, but the important fact is its smaller diameter (18, 5 ch), allowing the surgeon to pass through the urethra and approach the papillomatous lesion in the bladder. The lesion was resected transurethrally, and the histological examination resulted in TCC with focal infiltration of the muscle layer, stage pT2 high grade. In this way, it was possible to complete the surgical procedure in a case that the conventional resectoscope could not enter the urethra, and the outcome was exceptional. In November 2022, following the Oncology–Urology Council of the hospital, it was decided for the patient to receive neoadjuvant chemotherapy followed by radical cystoprostatectomy.
The Early Experience of a Novel Robotic Platform: A Pilot Study
Authors: Peteinaris Angelis , Tatanis Vasileios , Vagionis Athanasios , Pagonis Konstantinos , Natsos Anastasios , Obaidat Mohammed , Faitatziadis Solon , Anaplioti Eirini , Gkeka Kristiana , Michalopoulos Fotios , Vrettos Theofanis , Liatsikos Evangelos , Kallidonis Panagiotis
Published: August 2023

Introduction:

Robotic platforms have been gradually adopted in the current surgical status quo. The aim of the pilot study is the presentation of our initial experience, using the newly introduced avatera robotic system.

Methods:

Two patients were included in the current study. One male patient underwent a robot-assisted radical prostatectomy and one female patient underwent a right radical nephrectomy.

Results:

Both of the surgeries were completed successfully, without major complications. The mean operative time was calculated to be 174 min.

Conclusion:

Radical procedures can be safely and effectively conducted, using the avatera robot platform.
A Cross-Sectional Study on Factors Determining the Current Practice of Prostate Biopsy among Government and Private Urologists in Malaysia
Authors: Jagwani Arvind Vashdev , Fairuz M. S. Mohammad , Yusof M. R. , Lee Fei Yee , Illias Aizat Sabri , Lee C. K. S. , Fahmy Omar , Asri M. G. Khairul
Published: August 2023

Background:

Prostate Biopsy remains a gold standard among urologist to diagnose prostate cancer. It is a field that is undergoing massive change. Our study allows us to have a glimpse into the current practice of prostate biopsies in Malaysia and would allow us to make improvements in the right direction.

Methods:

A 34 set multiple choice question was created using a web based programme and posed to all doctors in the Urology Field under the Malaysia Urological Association. The questions targeted various aspects of the practice of prostate biopsies. Data’s were then collected and analysed using a validated statistical manner.

Results:

94 responses were returned with a standard deviation of 18.15.

Conclusion:

This study provides an insight into the current practice of prostate biopsy among members of the Malaysian Urological Association (MUA). Although TRUS biopsy without additional imaging was still the most typical approach, MRI and TPT biopsy were commonly used. These two diagnostic methods are likely to increase in the future. Quinolone prophylaxis was widely used, but selective use of prophylactic carbapenems was also common, indicating concerns about quinolone-resistant pathogens and their infectious complications.
An Adult Patient with Bladder Exstrophy
Authors: Peteinaris Angelis , Kallidonis Panagiotis , Liatsikos Evangelos , Fokaefs Eleftherios
Published: August 2023

Bladder exstrophy is a rare congenital malformation. The incidence of this rare condition is calculated between 1 in 10,000 and 1 in 50,000 live births. The reconstruction of this malformation is one of the most challenging conditions managed by pediatric urologists. The exact incidence of patients with bladder exstrophy seeking treatment in adulthood is not documented adequately in the literature. The aim of this study is to present a 24-year-old female with bladder exstrophy who was referred to the emergency department of our hospital due to a high fever. The diagnosis of acute right pyelonephritis was determined after physical examination and computed tomography. The patient was hospitalized for intravenous antibiotics. She decided that she did not want any reconstructive intervention besides the opposite consultation.
Early small bowel obstruction following abdominal wall hernia repair: Report of four cases and systematic review of the literature
Authors: Martínez-Hoed Jesús , Ortiz-Cubero José Ángel , Montagné-Bonilla Nicole , Bueno-Lledó José A , Pous-Serrano Salvador
Published: August 2023

CONTEXT:

Early small bowel obstruction (ESBO) is a recognized condition, but its treatment remains poorly defined. Conservative management may be attempted during abdominal wall reconstruction (AWR), but this approach can result in complications such as intra-abdominal hypertension (IAH). Considering recent cases, we conducted a systematic review of the literature and screened our database for diagnoses and treatments.

MATERIALS AND METHODS:

We conducted a retrospective review of our database from 2018 to 2022, searching for cases of ESBO following hernia repair. We also included international literature in English and Spanish, according to PRISMA criteria, from 2010 to 2022, using the keywords “intestinal obstruction” and “hernia repair.”

RESULTS:

We identified four cases in total, with three involving incisional hernias and one involving a parastomal hernia. ESBO developed in a mean of 6 days due to adhesions. Emergency surgery was required in three cases due to IAH, which was resolved with an open abdomen. One patient died, and only two patients ultimately underwent hernia repair. In our systematic review, we found 26 articles describing 54 patients with ESBO, mostly due to adhesions following laparoendoscopic inguinal repairs. Obstruction occurred on average within 6.7 days, and 65% of patients were treated with surgery, with no mortality.

CONCLUSIONS:

ESBO following AWRs can result in severe complications, with adhesions being the most common cause and surgical re-intervention being frequent. Our cases revealed that difficulty in expanding the abdomen during ESBO after AWR may trigger postoperative IAH, which has not been described in the literature and can lead to significant morbidity and mortality.
The use of intraoperative fascial traction in W3-incisional hernia repair: A revolution or an emergency exit (two case reports)
Authors: Gorjanc Jurij , Dreschl Christiane , Trieb Sigrid , Greiner Maria , Grün Andreas , Zanchi Pero , Kuschnig Manfred , Müller May Cathleen , Engels Alexander , Tschmelitsch Jörg
Published: August 2023

In the modern era of tension-free hernia repairs, any tissue tension seems to be counterproductive. It was believed to cause tissue damage, hemorrhage, and chronic pain, and lead to higher early or late recurrence rates. Surprisingly, recently published data on intraoperative fascial traction do not confirm this harmful effect of tissue tension in the cases of sufficiently wide mesh augmentation. On the contrary, the traction was reported to be beneficial in order to approximate large hernia defects and at the same time avoid the wide tissue preparation of component separation (CS) techniques. Below is presented our initial and positive experience regarding this after intraoperative fascial traction was used in two patients, each of them with a large incisional hernia (W3). Without intraoperative traction, the linea alba could not have been approximated in patient 1 without CS, and a large bridging of the linea alba would have been necessary in patient 2. The duration of hospitalization in both patients was short and there were no negative long-term results. It seems that intraoperative fascial traction facilitates the closure of hernia defects. It can serve as a useful adjunct tool in the surgery of large midline incisional hernias (W3) in the future. However, more data are needed to better evaluate this method.
A rare case of a concomitant inguinal and obturator hernia and their laparoscopic transabdominal repair: A case report
Authors: Pillay Yagan
Published: August 2023

An obturator hernia remains a rare occurrence and accounts for less than 1% of all abdominal wall hernias. To have a concomitant presentation with a direct inguinal hernia makes this an extremely rare case report. This patient did not fit the usual epidemiological profile of an elderly female with small intestinal obstruction. This was a male patient with an asymptomatic obturator hernia. There are no concise guidelines for obturator hernia management and the primary repair is often undertaken in the presence of bowel incarceration or strangulation. The use of overlapping mesh herniorrhaphy is a controversial one. Two self-gripping polypropylene meshes with a 2-cm overlap were used to provide adequate coverage of the two hernial necks. We did not have access to a large-size mesh at our institution to cover both hernial defects effectively with one mesh. The patient made an uneventful recovery, and it is our intent to follow this patient for a minimum of 2 years to document any hernia recurrence or inguinodynia. Any clinical signs of pain or discomfort will necessitate a computerised tomography scan as an obturator hernia remains difficult to assess clinically.
Enhancing safety in ventral patch repair for umbilical hernia by utilizing a hybrid technique
Authors: Jhaveri Ruchir , Kalikar Vishakha , Modi Rajan , Patankar Roy
Published: August 2023

BACKGROUND:

Both suture and mesh repairs are used for smaller (1-3 cm) umbilical hernias. But primary repair has a higher recurrence rate in literature. The use of mesh repairs has become the way to go for small and medium sized ventral hernias. Ventral patch placement is a simple and effective procedure for the repair of umbilical hernias of 1–3 cm size. We demonstrate the safety and efficacy of the ventral patch for the same with our modification of the technique in 100 consecutive patients. We would initially insert the patch as described by the company, but had one patient presenting with intestinal obstruction, who on diagnostic laparoscopy had a small bowel loop entrapped between the patch and the anterior abdominal wall. This brought about a change in the original technique at our institute, which we adopted for all patients thereafter.

MATERIALS AND METHODS:

A single centre retrospective analysis of prospectively collected data was done. Our modified technique was done in 100 consecutive patients with umbilical hernia defect size ranging from 1 cm to 2.5 cm, from January 2017 to January 2021. Demographics, post-operative pain, duration of hospital stay, surgical site occurrences (early and late), post-operative complications and recurrences were noted.

RESULTS:

A total of 100 patients were included in the study. Two patients had superficial surgical site infection which was managed conservatively. We did not record any other major complications or recurrence. Visual analogue scale for pain was recorded at 24 hours. Majority (95%) of the patients had none to mild pain and were discharged at 24 hours. Five patients experienced moderate pain and were discharged at 36–48 hours. No patient experienced chronic pain at follow up.

CONCLUSION:

The hybrid technique of the ventral patch placement is a safe way for optimum visualization for the correct mesh placement and may improve results, decrease complications and recurrences.
Laparoscopic inguinal hernia repair: A comparison of transabdominal preperitoneal and total extraperitoneal techniques—Results of initial experiences
Authors: Ergenç Muhammer , Gülşen Taygun
Published: August 2023

Aims:

This study aimed to analyze the results of transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) repairs performed by two authors and to compare two laparoscopic methods.

Materials and Methods:

Patients who underwent inguinal hernia surgery in a secondary-care hospital between 2019 and 2022 were evaluated retrospectively. Demographics, hernia side and type, primary or recurrent hernia situation, size of hernia orifice, operation type, postoperative complications, duration of operation, length of hospital stay, recurrence, and follow-up time were examined. Perioperative outcomes were compared between the two groups.

Results:

One hundred and eleven patients were analyzed. The mean age was 49.4 ± 13 years, with a male/female ratio of 106/5. About 82% of hernias were unilateral, and 18% were bilateral. Sixty-four TAPP and 47 TEP repairs were performed. Follow-up time (months, mean ± standard deviation) (range) was 14.2 ± 10 (1–37). About 42.3% of the hernias were direct, 49.5% were indirect, and 8.1% were pantaloon hernias. The recurrence rate was 1.8%. The operation time was significantly lower in the TEP than in TAPP (64.4 ± 23.5, 96.7 ± 31.9, respectively, P < 0.001). TAPP was preferred in patients with larger hernia orifices (P = 0.01). The two groups had no significant difference regarding postoperative complications and recurrence rate.

Conclusion:

Our study did not detect any significant difference between TAPP and TEP repair regarding recurrence rate and postoperative complication. Laparoscopic inguinal hernia repair, which has advantages such as short hospital stay and less pain, can be safely performed in a secondary-care hospital.