bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of effect of diabetes mellitus on classical risk factors for coronary artery disease
Authors: Garhwal Suchitra , Poonia Anil Kumar , Agarwal Veeha
Published: November 2020

Background: Diabetes mellitus (DM) is increasingly prevalent in general population and is associated with increased risk for coronary artery disease (CAD). DM both directly and indirectly increases risk of CAD. Quantum of DM associated increase in classical risk factor for CAD is not exactly described. In present study, association of traditional risk for CAD and DM was analyzed.Methods: Total 150 patients with CAD were enrolled and divided into two group: group 1 with DM (84 patients) and group 2 without DM (66 patients). These two were compared and analyzed for classical risk factors for DM.Results: CAD with DM group had higher prevalence for traditional risk for CAD than CAD alone group: for Hypertension relative prevalence was 67.8 and 36.3% respectively (p<0.05); for Obesity it was 79.7 and 40.9% respectively (p<0.05) and for Dyslipidemia relative prevalence was 75 and 37.8% respectively (p<0.05).Conclusions: DM is major risk for CAD and it is also associated with increased prevalence for hypertension, obesity and dyslipidemia in affected population.
Outcome of management of intracapsular fracture neck of femur in young adult patients
Authors: Arfee Sakib , Jabeen Asma , Arfee Akib , Arfee Adnan Aadil
Published: November 2020

Background: Almost four centuries back fracture neck of femur was described, but till today this fracture is unsolved, though situation has largely improved from the days of Sir Astley Cooper, who had said “I have never met one in whom union had taken place”. High incidence of complications with this fracture even in modern day show that we still have not found way to treat this fracture appropriately and its treatment remains a challenging problem. The objective of the study was to assess the final outcome of management of intracapsular fracture neck of femur in young adult patients after internal fixation.Methods: This study has been conducted at Orthopedic Department of Government Medical College and hospital, Jammu from 2018 to 2020. 30 young adult patients with fractures neck of femur treated with CCS (27 patients) and DHS (3 patients) after taking informed consent were selected for the study.Results: 30 young adult patients in age group of 18-60 years, constituted this study. 27 patients were treated with closed reduction and internal fixation with CCS (group A) and 3 patients were treated with DHS (group B). 3 patients were lost to the follow up, all of them from group A.Conclusions: DHS appears to be more forgiving implant than CCS in fracture neck of femur in young adult patients. However number in this group is very small and hence larger studies are needed. In fixation with CCS anatomical reduction of fracture, proper screw placement is the most important criterion for achieving better results.
Protocol of sterile personal protective equipment for surgical personnel against SARS-CoV-2 during the COVID-19 pandemic
Authors: Guevara Valmana Osvaldo I. , Quero Maria M. Cavazos , Loaeza Elias Gil , Sandoval Jesus C. Lopez , Molina Jose A. Pereyra , Ceballos Mario A. Rebolledo , Chavez Chantal Gonzalez , Gachuz Omar D. Gonzalez
Published: November 2020

Background: COVID-19 represents the major pandemic seen the last years generating morbidity and mortality around the world. It is well known the propagation of the virus occurs by air mostly, so it is needed a barrier when the medic personal is treating suspect or confirm patients. Personal protective equipment represents a barrier between the health personnel and the patient during the COVID-19 pandemic. The surgical team during a COVID-19 confirmed o suspicious case procedure requires using PPE to be protected and keep the sterility for the patient safety.Methods: A team of surgeons from a 100% COVID-19 hospital of the Mexican institute of social security developed an inner protocol of safe use PPE maintaining sterility for the surgery.Conclusions: The protocol described provides safety to surgical team and the patient minimizing risk of surgical infections.
Occurrence of the metabolic syndrome in newly diagnosed hypertensive adult Gujarati patients in G. K. General Hospital, Bhuj
Authors: Dodhiya Aalisha U. , Patel Darshan
Published: November 2020

Background: A study of 30 newly diagnosed hypertensive Gujarati patients visiting the OPD of G. K. General Hospital, Bhuj, Gujarat, India was carried out. The main aim of the study was to estimate the occurrence of metabolic syndrome in newly diagnosed hypertensive patientsMethods: The study was carried out in a period of 2 months and data was collected after obtaining prior consent of patients and IEC approval. Blood pressure, waist circumference and BMI (body mass index) of the selected patients were measured while blood sample was collected for the laboratory investigations. The data collected was analysed using appropriate softwareResults: On observation, out of 30 hypertensive patients 22 (73.33%) patients suffered from metabolic syndrome. Also in patients suffering from metabolic syndrome, along with hypertension 63.63% (n=14) patients suffered from hypertriglyceridemia, 68.18% (n=15) patients had low HDL cholesterol, 77.27% (n=17) patients had high FBS, 72.72% (n=16) patients had abnormal BMI and 63.63% (n=14) patients had abnormal waist circumference.Conclusions: This very high occurrence values signifies the need of study with larger sample size based on region for further evaluation to treat the high risk patients on early diagnosis.
Arthroscopy pull through for management of eminentia tibia fracture in 15 years old adolescent: a case report
Authors: Maha Putra Anak Agung Gde Duta , Maharjana Made Agus
Published: November 2020

Tibial eminence fractures are rare injuries. Multiple treatment techniques are described and there is a lack of consensus with regard to the choice of treatment. In this case, we present the left eminentia tibia fracture which stabilized using arthroscopy pull through technique in a 15 years old male adolescent. A male 15 years old adolescent complained of pain on his left knee after climbing a tree and jumped with his left knee in hyperextention. On physical examination, tenderness was felt around the apex of patella. Left knee X-Ray confirmed a fracture of eminentia tibia. On arthroscopic evaluation, there was a fracture of medial eminentia tibia meyers and mckeever IIIA. The fractures were treated by using 1 mm ethibond which was inserted through the anterior cruciate ligament and pull through the tibia plateau. 10 weeks evaluation after the procedure, patient was able to walk independently with full weight bearing and was able to flex his knee in 130˚ and full extension without any pain. Management of displaced fracture of eminentia tibia is somewhat controversial and the ideal method of ﬁxation has not been deﬁned. In this patient, there were perfect anatomic and functional outcome without any serious complication. Arthroscopic reduction and internal fixation by pull through suture provide perfect anatomic and functional outcome for displaced type II and type III tibial eminence fracture.
Radical radiotherapy in epidermoid cancer in the orbitary region: ideal scheme of hypo-fractionation in times of COVID-19: a case report
Authors: Romero Ruben A. Lara , Jimenez Karilu Muñoz , Puch Amelia E-Sarricolea , Lopez Fernando H. Castillo
Published: November 2020

There are adverse events in the patient's environment that impact on therapeutic decisions and become a medical challenge, as is currently the management of cancer patients with radiotherapy, particularly the elderly in times of a COVID-19 pandemic, due the high risk of infection and fatal complications from non-cancer causes. Here we present the case of an 84-year-old woman with voluminous squamous cell cancer in the left orbital region, which caused intense pain, stench, and persistent bleeding. And due to persistence and time, it impacted with deterioration in the patient’s quality of life. In the end, of hypo fractionated radiotherapy management as the only modality, it evolves with a complete clinical response and total palliation of initial symptoms. The reasons for the decision to manage radiotherapy and the excellent clinical results that reinforce the idea of personalized medicine and the importance of evaluating the biopsychosocial environment of the cancer patient will be discussed.
Limited fasciotomy in dupuytren contracture: a case report
Authors: Giri Kadek Gede Bakta , Karna Made Bramantya , Asmara Anak Agung Gde Yuda , Meregawa Putu Feryawan
Published: November 2020

Dupuytren's disease is a benign fibroproliferative disorder usually isolated affects the palmar fascia. The condition usually has a progressive course, from the appearance of a nodule, to the formation of a fibrous cord which pulls the finger in a flexion posture. Management from dupuytren's disease has developed, from conservatifly, surgery, and minimal invasive. One of the conventional treatments that can be done is fasciotomy. A man, 72 years old, an Australian patient with Dupuytren's disease that affects his 4th MCP joint. From the history it was found that the complaint had been felt since 8 years ago. Patients were do limited fasciotomy and get recovered his hand function with good result. Dupuytren's disease is a disorder of the palmar and digital fascia that can decrease the function of patient hands. Many therapies have been developed for the treatment of this disease. From conventional treatments such as fasciotomy, to minimal invasive such as the injection of clostridium histolyticum collagenase. All of these therapies give different results and side effects. We would like to say that conventional management, especially limited fasciotomy, is still a good choice in view of the return of hand function and the minimum side effects. Limited fasciotomy gives good results, fast recovery of hand function, with minimal side effects.
Neuropathy in the setting of alcoholism-an entity less thought of
Authors: Paneyala Shasthara , C. Nemichandra S. , Sundaramurthy Harsha , Colaco K. Vimala Christina
Published: November 2020

Disulfiram is a commonly used adjunctive treatment in the management of alcohol dependency.  It has been noted that disulfiram can induce peripheral neuropathy, the mechanism of which has not been clearly determined. A 35-year-old patient, reformed alcoholic, on disulfiram presented with complaints of painful distal dysesthesias and foot drop. Clinical examination revealed bilateral foot drop without any objective sensory loss. Patient was evaluated for the same and routine blood investigations including vitamin B-12, inflammatory and virological markers were found to be normal. Nerve conductions studies revealed in excitable bilateral common peroneal and tibial nerves. Possibility of disulfiram induced peripheral neuropathy was thought of and drug was withdrawn. Patient was followed up and after two months improvement in motor power and reduction in paraesthesia’s was noted. Disulfiram is a commonly used drug, the uncommon side effect of which is distal predominant axonal neuropathy. This must be kept be kept in mind when evaluating a patient presenting with features of peripheral neuropathy, on a background of alcohol abuse.
Total elbow arthroplasty surgery in neglected elbow stiffness post open reduction and internal fixation with plate and screw: a case report
Authors: Putra I. Gede Mahardika , Karna Made Bramantya
Published: November 2020

Post-traumatic and post-operative stiffness of the elbow joint constitutes a significant problem since the elbow is prone to develop soft-tissue contractures and heterotopic bone formation especially if happened in dominant arm. Total elbow replacement is considered as an ultimate treatment in salvaging a stiff elbow which has failed conservative and operative therapeutic procedures to overcome the stiffness and return the elbow to an effective functional arc. A 35-year-old female came to orthopaedic outpatient clinic in Sanglah Hospital, complaining on stiffness in her right elbow since one year prior to admission. This complain was felt after she underwent internal fixation on July 19th 2016, for closed fracture right monteggia bado type-3 post internal fixation. After the surgery, she couldn’t move her elbow because of inappropriate physiotheraphy. Neglected elbow stiffness in this patient was treated surgically with total elbow arthroplasty after physiotherapy has failed to improve her range of motion over 1-year period postoperatively. This decision stated when nonsurgical treatment fails, the patient who has realistic expectations of eventual outcome and who can comply with the arduous postoperative rehabilitation program may be a surgical candidate. Total elbow arthroplasty conducted for these patients resulted in satisfying functional outcome with using quick disabilities of the arm, shoulder and hand (DASH) score improved from 81.8 to 43.2 postoperatively and no complication was reported.
Glucose-6 phosphate dehydrogenase deficiency and newborn screening
Authors: Bhaumik Samapika , Patel Suprava , Padhi Phalguni
Published: November 2020

Glucose-6 phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive disorder causing breakdown of RBCs. It affects over 400 million people, making it the most common enzymopathy in the world. It leads to hereditary predisposition to hemolysis. In India, various study results reveal an incidence ranging from 2 to 27.9% in different communities. It is known globally for its genetic and phenotypic heterogeneity with 13 biochemically characterized variants have been reported from India, G6PD Mediterranean being the most common. It is mostly asymptomatic but certain triggers like infections, some medications, chemicals, stress or food may precipitate hemolysis. It is important to understand the epidemiology and distribution pattern in India because of its higher prevalence in tribal population who are more prone for malaria. Irrational use of drugs for malaria treatment has attributed high mortality especially neonatal mortality, in this community. Newborn screening is one of the best options to diagnose the case at neonatal age. Implementation of newborn screening would aid in identifying the genetic disorders in order to provide comprehensive care along with parental counselling to reduce the complications associated with it.
Immune boosting and anti-influenza effects of an Unani decoction in influenza like illness and COVID-19 like epidemics: a rationale approach
Authors: Ansari Athar P. , N. Zaheer Ahmed , Rather Shameem A. , Rafeeqi Towseef A. , Beigh Bharat Saleem
Published: November 2020

The Unani system of medicine is one of the traditional systems of medicine practised since centuries in many parts of the world including India. At a time when the coronavirus disease 2019 (COVID-19) pandemic is still raging across the globe and there is still no appreciable satisfactory management available with vaccination being the only panacea in the near future, unani medicine chiefly composed of herbal drugs is replete with many classical references for the management of influenza like illness and COVID-19 like epidemics. In Unani medicine, nazla-i-wabāi is referred as influenza for which a decoction containing Behidana (Cydonia oblonga), Unnab (Ziziphus jujuba) and Sapistan (Cordia myxa) are recommended to relieve the clinical features of nazla-i-wabāi and other COVID-19 like epidemics. All the three ingredients of this formulation are also individually used for the treatment of sore throat, cough, septicaemia, fever, dyspnoea, pharyngitis, chest pain etc. Certain scientific studies have validated various pharmacological actions of these drugs as claimed by unani physicians. A concerted rational approach has been attempted to highlight the effect of the unani decoction as to its immune boosting property both as prophylactic and therapeutic use in the treatment of influenza like illness and COVID-19 like epidemics in the light of ancient Unani classics and recent scientific studies.
Laparoscopic subtotal cholecystectomy in severe cholecystitis with unclear anatomy
Authors: Rihan Maged
Published: November 2020

Background: Aim of the study was to determine the differences between laparoscopic cholecystectomy and laparoscopic subtotal cholecystectomy as regards bile duct injury and post-operative complications rates in patients with severe cholecystitis and obscure anatomy.Methods: We retrospectively reviewed the charts and postoperative outcomes of 293 patients with severe cholecystitis who underwent either laparoscopic cholecystectomy or laparoscopic subtotal cholecystectomy between September 2011 and January 2020. Patients with intraoperative altered anatomy which leaded to difficult dissection were defined as having severe cholecystitis.Results: There were 304 cholecystectomies done for patients with severe cholecystitis. Of those, 203 underwent laparoscopic cholecystectomy (LC group), 90 underwent laparoscopic subtotal cholecystectomy (LSC group). There was no significant difference in male to female ratio, age, cases performed on an elective or emergency basis, hospital length of stay or initial operative findings. There were 5 patients with detected intraoperative biliary injury in LC group only. Postoperative bile leaks were significantly higher in the LSC (11.1%) than in the LC group (3.9%). Postoperative collections which needed percutaneous aspiration were also significantly higher in the LSC group (18.9%) than in the LC group (7.4%). Reoperation for collection was required in 8 patients in LC group and in 5 patients in LSC group. The rates of retained common bile duct stones, port site hernia, wound infections, and total complications were not significantly different between the two groups (28.1% v. 45.6%).Conclusions: Our study demonstrated that laparoscopic subtotal cholecystectomy is a safe procedure which reduces the risk of bile duct injury and is comparable to laparoscopic cholecystectomy in patients with severe cholecystitis with unclear anatomy.
Preperitoneal mesh repair in incisional hernia: a prospective study
Authors: Dhanasekaran Uma , Arumugam Ramesh
Published: November 2020

Background: Incisional hernia is a common surgical condition encountered in day to day practice. Based on national operative statistics, incisional hernias account for 15 to 20% of all abdominal wall hernias. Of all hernias encountered incisional hernias can be the most frustrating and challenging to treat. This prospective study aims to assess the efficacy of preperitoneal mesh repair technique using polypropylene mesh in the management of incisional hernia.Methods: A total of 40 patients with incisional hernia undergone open preperitoneal polypropylene mesh repair. It had evaluated for post-operative complications and recurrence for six months to one-year post-surgery. The results had tabulated statistically analysed and compared with other published reports in the literature.Results: Out of 40 patients, the size of the defect, 10 patients had less than 2 cm, 28 patients had between 2.1-4 cm, 1 patient between 4.1-6 cm and 1 patient between 6.1-8 cm. The type of hernia, 32 patients had infra umbilical hernia, and 8 patients had a supraumbilical hernia. Post-operative complication 3 patients had seroma, 1 patient had edge necrosis, 1 patient had post-op ileus, and 1 patient had chronic pain. Based on follow up, 4 patients had followed until 6 months, 10 patients till 9 months and 26 patients till one year.Conclusions: Post-operative complications following open preperitoneal polypropylene mesh repair are considerably less compared to other techniques of mesh repair and showed no recurrence among its subjects during the follow-up period, and longer follow-up is required to draw a definitive conclusion.
Diagnostic efficacy of Fenyo-Lindberg scoring system in patients of acute appendicitis a one-year cross sectional study
Authors: Sahu Kartik , Bellad Anil P.
Published: November 2020

Background: Diagnostic scores have been found to be very efficient. The present study was taken up to calculate diagnostic efficacy of Fenyo-Lindberg (FL) scoring system in patients of acute appendicitis.Methods: A one-year cross sectional study was done on 100 patients in patients with right lower quadrant pain. Group I had patients with score of -2 and above and group II with score below -2. The groups were compared with histopathological diagnosis. Then, the sensitivity, specificity, positive predictable value (PPV) and negative predictable value (NPV) were calculated.Results: In this study, the males were 52 and females were 48.15 patients, Total leucocyte count (TLC) had more than 14,000 whereas 16 patients had onset of pain in less than 24 hours. 47 patients had vomiting. Tenderness was present in all cases, while rebound tenderness was present in 54% of cases. 98% of patients had progression of pain, whereas migration was seen in 76%. 56% patients had increased pain on coughing. 54 patients had acute appendicitis on histopathology. The study shows that this scoring system has sensitivity of 72% and specificity of 71% in diagnosing acute appendicitis. The PPV was 75% and NPV was 68%.Conclusions: The FL score is an inexpensive clinical tool that may help the diagnosis of acute appendicitis. The results are comparable to previous studies but as the sample size is small, study has to be done in higher sample size to get the data necessary to generalize the findings and the fact that this study was first on this scoring system in India should also be considered.
Role of pre-operative ultrasonography in assessment of technical difficulties during laparoscopic cholecystectomy requiring conversion to open procedure
Authors: Chatterjee Debarghya , Vakil Rakesh , Sharma Rajeev , Mohanty Arnab , Patras Elisheba
Published: November 2020

Background: Cholecystectomy is the most common major abdominal surgery of the biliary tract and the second most common abdominal surgery performed in recent times. Today, laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones. Ultrasound is a non-invasive, painless investigation that will show stones in the gallbladder with sensitivity and specificity of more than 90%. The study aims at evaluating the accuracy of certain ultrasound parameters to predict a difficult laparoscopic cholecystectomy.  Methods: Prospective observational study. The selected patients were explained about the procedures of ultrasonography and laparoscopic cholecystectomy, and about the advantages and disadvantages of laparoscopic cholecystectomy, along with the possibility of conversion to open procedure. Informed consent was taken. General particulars of patients, relevant history & findings on physical examination, laboratory investigations, ultrasonographic features and operative findings were noted in the study proforma. For data analysis, categorical variables were expressed as frequencies and percentages. Sensitivity, specificity and p values were calculated. P value<0.05 was considered to be statistically significant.Results: Significant association was found between all the independent ultrasound parameters and a difficult laparoscopic cholecystectomy. Presence of contracted gall bladder was found to be significantly associated with conversion to open cholecystectomy.Conclusions: It was found that ultrasonography can be a useful tool in predicting a difficult laparoscopic cholecystectomy.
Comparison of ultrasound and serum amylase in the diagnosis of acute pancreatitis
Authors: V. Manoharan G. , P. Maharaja
Published: November 2020

Background: Acute pancreatitis is an inflammatory disease of the pancreas. Though, severe acute pancreatitis constitutes 15-20% of all cases of pancreatitis, in recent times, mortality rate of severe acute pancreatitis has reduced from 30-80% to 15-20%. Ultrasound is the first imaging modality in most centres for the preliminary screening of an acute abdomen.Methods: In this prospective study between October 2017 to March 2019, 113 patients with clinical signs and symptoms of acute pancreatitis were screened with an ultrasonogram of the abdomen and serum amylase in the emergency room. Patients also underwent a complete physical exam.Results: In our study 38.9% of patients were in the age group of 45-55 years, 25% in the 35-45 age group and 20.4% in the 55 to 70 age group. 92.9% of the patients were men. 89.4% of the participants had a history of alcoholism. Only 37.2% of the participants who were clinically positive for acute pancreatitis, also showed USG findings for acute pancreatitis while 69% of the clinically positive patients showed serum amylase level positive for acute pancreatitis.Conclusions: Ultrasonogram though cheap and easily available is not ideal for the diagnosis of acute pancreatitis. As shown in the study serum amylase is able to detect nearly twice as many cases of pancreatitis compared to ultrasonogram. The sensitivity and specificity of ultrasonography to detect acute pancreatitis is too low to use as a diagnostic test but it is a valuable tool in the evaluation of an acute abdomen.
Effect of antibiotic prophylaxis in open inguinal hernioplasty (Lichtenstein hernia repair): a study in tertiary care center
Authors: Yadav Sitaram , Kchhawa Devi Singh , Meena Jaswant
Published: November 2020

Background: Inguinal hernia is one of the most common presenting surgical problems of abdomen and open inguinal hernioplasty (Lichtenstein hernia repair) is one of the most commonly performed general surgeries. Many time hernia repairs may lead to surgical site complication. There are many strong and effective antibiotics available for prophylaxis from these infections. Aims and objectives of the study were to compare rate of wound infection in post-operative cases among antibiotics prophylaxis group and placebo group.Methods: A prospective study was conducted in tertiary care centres with 200 patients enrolled in study. These patients were equally divided in both groups that is antibiotics arm and placebo group. The patients were in between age group of 18-70 years. The study duration was one and half years. Patients were included as per inclusion criteria. Data was entered and analysed using appropriate software.Results: There were total 200 patients recruited in the study with 100 patients in each group. Mean age of patients was 47.92±8.32 years in antibiotic group and 48.09±9.12 years in placebo group. All patients were males and most of th patients belong to rural area. A total of 12 patients develop surgical site infection out of which 6 patients were from antibiotics group and 8 patients from placebo group. Differences between these groups were not significant (0.426).Conclusions: This study showed that there was no clear acceptable benefit of antibiotics in prevention of post-operative wound infection in open inguinal hernioplasty (Lichtenstein hernia repair). Antibiotics administration did not reduce the incidence of wound infections in significant way.
Retrospective analysis of laparoscopic versus open appendectomy for the treatment of acute appendicitis
Authors: Resutra Ritvik , Salaria Haroon , Gupta Rajive
Published: November 2020

Background: Acute appendicitis is one of the most commonly encountered emergency by the general surgeons and appendectomy is the most common surgery performed in the world. Although open appendectomy is preferred by many surgeons, yet the laparoscopic approach is gradually replacing open surgery for treatment of acute appendicitis.Methods: A total of 400 patients of acute appendicitis were operated, 200 by laparoscopic appendectomy and 200 by open method by a single surgeon at various private hospitals in Jammu (Jammu and Kashmir), India over a period of three years from July 2017 to July 2020. The two groups were compared with respect to operative time, duration of hospital stay, post-operative pain, complication rate and time taken to resume routine activity and cosmetic satisfaction of the patients.Results: Results were found to be better with the laparoscopic technique. There was significantly less pain in the postoperative period with faster recovery, early resumption to work, reduced postoperative complications and better cosmetic satisfaction of the patients operated by the laparoscopic appendectomy technique as compared to open surgery.Conclusions: Laparoscopic appendectomy is safe and feasible technique in expert hands, for treatment of acute appendicitis with results comparable to the open appendectomy, with no obvious increase in complications and is definitely a procedure of choice for the management of acute appendicitis.
The utility of serum 25-hydroxyvitamin D in predicting post-thyroidectomy hypocalcemia in thyrotoxic subjects: a single-center cohort study
Authors: Karunakaran Poongkodi , Abraham Deepak Thomas
Published: November 2020

Background: The role of preoperative vitamin D deficiency as a predictor of post-thyroidectomy hypocalcemia in thyrotoxic subjects is controversially reported. This prospective cohort study determined the utility of serum 25-hydroxyvitamin D (25OHD) levels in predicting transient hypocalcemia in thyrotoxic and euthyroid patients undergoing total thyroidectomy (TT).Methods: Subjects with new-onset hyperthyroidism (n=97; age=median (Inter-Quartile Range); 38 (18) years; M:F=25:72) and age; sex-matched euthyroid cohorts (n=231; age=37 (18) years; M:F=40:191) undergoing TT were evaluated for serum corrected-calcium, intact parathormone and 25OHD levels at baseline, 48-hour and 6-months post-TT, p value <0.05 was considered significant.Results: The incidence of transient hypocalcemia in thyrotoxic subjects was 58.8% (57/97) versus 22.5% (52/179) in euthyroid cohorts. In receiver operating characteristic analysis predicting transient hypocalcemia for the test-variable preoperative 25OHD, the area under curve (AUC) among euthyroid subjects was 0.725 (95% CI: 0.641-0.809; p<0.001) with a threshold of 17.6 ng/mL with sensitivity and specificity of 65.4% and 64.2% respectively. In thyrotoxic subjects, the AUC was 0.573 (95% CI; 0.452-0.694; p=0.222) with poorer predictability and was less than that of euthyroid subjects.Conclusions: Preoperative 25OHD below 17.6 ng/ml was reliable in predicting transient postoperative hypocalcemia in euthyroid subjects though with a limited sensitivity and specificity but unreliable in thyrotoxic subjects undergoing TT.
Tetralogy of fallot repair at a new centre in North India: our growing experience
Authors: Yadav Mayank , Singh Sumit Pratap , Haseen Mohd Azam , Abqari Shaad , Kamran Mirza M.
Published: November 2020

Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease with complete surgical repair being its most appropriate treatment currently. Although in a developing country, pediatric cardiac surgery is not being practiced as frequently as the adult cardiac surgery either due to limited resources centres or surgeon reluctance. The aim of this study is to evaluate and compare the operative and postoperative outcome of the initial 50 patients with the subsequent 50 patients undergoing corrective surgery of TOF in a new cardiac centre.Methods: This is a comparative descriptive study performed at a single centre comprising of two groups of initial 50 and subsequent 50 patients who underwent complete surgical correction of TOF and compare their operative and postoperative outcomes.Results: The mean age of patients in group I and II were 82.4 and 74.3 months respectively. There was no significant difference in the preoperative characteristics of the patients of both groups. Among operative parameters there was significant improvement in the cardiopulmonary bypass time and aortic cross clamp time in group 2 with p value of 0.0017 and 0.0324 respectively. The requirement for transannular patch also came down in group 2 (p=0.016). Mortality in group 1 and 2 were 6 and 2 respectively (p=0.14), other postoperative characteristics were similar in both groups.Conclusions: With growing experience, proper planning and perseverance pediatric cardiac surgery too can be performed with acceptable results in a new centre.
An observational comparative study of single layer continuous extramucosal anastomosis versus conventional double layer intestinal anastomosis
Authors: Dhamnaskar Suchin S. , Baid Anil , Gobbur Nishant , Patil Pratik
Published: November 2020

Background: Conventional double layered technique of intestinal anastomosis are widely in practise. Some surgeons also practice single layer technique either continuous or interrupted. This was a prospective observational study to compare safety, efiicacy and feasibility of single versus double layered continuous techniques.Methods: Patients undergoing intestinal anastomosis with either of these two techniques were observed prospectively for various outcome parameters like length of suture material used, time taken for anastomosis, and that for entire surgery, postoperative complications, return of bowel activity etc. Data such obtained was analysed for statistical significance by applying chi-square test and unpaired ‘t’ test.Results: Length of suture used for single layer (mean of 15.06 cm) was statistically significantly lesser than that for double layer (mean 19.90 cm) (p.0.001). Time taken for anastomosis and overall surgical time too was significantly less for single layer group (p.0.001 and 0.022 respectively). Complications including anastomotic dehiscence were not significantly different between two groups. Postoperative recovery of bowel function was earlier in single layer group with marginal statistical significance (p=0.048).Conclusions: Thus in our study, single layer continuous method of intestinal anastomosis resulted in significant reduction in time, suture material length and cost; without any difference in complications and it marginally hastens the postoperative recovery of bowel function. So single layer continuous method can be recommended for intestinal anastomosis.
Outcome and management of postoperative enterocutaneous fistula
Authors: Sharma Dinesh Chandra , Jalendra Gaurav , M. Pugazhenthi , Kumar Amit
Published: November 2020

Background: Approximately 75% of enterocutaneous fistula (ECF) occur following surgery. Due to the high morbidity and mortality associated with ECF, prompt and effective treatment is important. This study was conducted to study the outcome and management of patients with enterocutaneous fistula.Methods: Total 40 patients developing the enterocutaneous fistula following surgery were included. All patients were treated either conservatively or operatively by various means and varying period of time. Treatment was focused on the correction of dehydration, controlling sepsis, management of electrolyte imbalance and nutritional support.Results: Overall 40 patients were included in this observational study, comprising 26 were males and 14 were females. About 97.5% of ECF were postoperative. Ileum was found to be the most common site of ECF. Also, 42.5% of fistulas were high output and 57.5% were low output. Serum albumin levels correlated significantly with fistula healing and mortality. Surgical intervention was required in 37.5% of patients.Conclusions: Conservative management with emphasis on improvement of nutrition, control of sepsis, management of fluid and electrolyte balance and control of fistula output is first line of management. Operative intervention must be done in selectively after cases after aggressive and targeted measures for improvement of nutritional status and control of infection.
Clinicoepidemiology and treatment outcome of acute intestinal obstruction in adult in KIMS Amalapuram: a retrospective observational study
Authors: Lakshmi Y. Anantha , Narasimha Reddy K. V.
Published: November 2020

Background: The intestinal obstruction is a common potentially risky surgical emergency in all age group globally. This is responsible for 12% to 15% of surgical admission due to acute abdomen. Obstruction to gastrointestinal tract can occur at all labels but it is small intestine which more commonly involved. To improve the outcome early diagnosis and management is essential. Present study has been designed to study the epidemiology, demography and clinical presentation of acute intestinal obstruction and to study the complications and outcome of surgical management of acute intestinal obstruction.Methods: In present study patients admitted with diagnosis of acute intestinal obstruction during study period were enrolled for this study as per inclusion and exclusion criteria. As per that 126 patients were enrolled for this study. Case record of all patients were closely reviewed and analysed thoroughly.Results: The mean age of the patients was 54.64±12.93 years. The acute intestinal obstruction was more common in 41 to 60 years of age group that is (44.45%). Regarding etiology of acute intestinal obstruction 44.45% patient adhesion was the etiology of obstruction. Resection of adhesion was most common procedure done for removal of obstruction (42.85%).Conclusions: Adhesion was most common etiology and pain abdomen and tachycardia was common presentation. Regarding management of obstruction resection of adhesion was most common procedure done for removal of obstruction. Infection of wound was common complication.
Pancreatic metastasis of mesenchymal chondrosarcoma
Authors: Camacho Cristina P. , Fraga Emília C. , Almeida Ana , Amaral Maria J. , Sergio Mario
Published: November 2020

Mesenchymal chondrosarcoma is an aggressive tumor with chondrogenic differentiation that typically develops in skeletal sites, such as craniofacial bones, ribs, ilium, femur, and the vertebrae. It counts less than 3% of primary chondrosarcomas, and about a third of these tumors develop extraskeletal sites such as the meninges, and soft tissue. We present a case of a 53-year-old female, that was diagnosed with mesenchymal chondrosarcoma in the left thigh and submitted to surgical excision. The patient's case was evaluated by a multidisciplinary team, and it was decided to maintain vigilance. In the 5 years, follow-up presented several pulmonary metastases that were submitted to pulmonary resections. Two years later, during imaging control, an abdominal computed tomography (CT) scan was performed and revealed a pancreatic mass of 3 centimeters, located in the pancreatic tail. The patient was submitted to an explorative laparoscopy and a distal pancreatectomy was performed. The biopsy gave the definitive result of the metastasis of mesenchymal chondrosarcoma.
Thymic cyst as a differential diagnosis of a lateral cervical mass: case report and review of literature
Authors: Goncalves Ines C. , Ventura Nuno , Valente Tania , Ferreira Gonçalo , Coelho Maria I. , Inacio Ana , Cunha Fernanda , Santos Miguel C.
Published: November 2020

Thymic cysts are a rare cause of benign neck mass in adults and are usually diagnosed after surgery. Their prevalence is less than 1% of all cervical masses, and they are generally noted in the first decade. We report a case of a 34 year old female with a lateral cervical mass, describing ultrasound and CT features, intraoperative findings and histopathology. Thymic cysts are uncommon lesions causing neck swelling, often misdiagnosed preoperatively and should be included in the differential diagnosis of cervical cystic masses.
Acute paraoesophageal hiatal hernia following laparoscopic sleeve gastrectomy
Authors: Alobaid Omar M. , Alzahrani Abdullah S. , Ali Bander I.
Published: November 2020

Anti-obesity surgery is the most effective therapy available for significant weight loss in patients with morbid obesity. Obesity in consider a major independent risk factor for Hiatal hernia (HH) and it is present in about 37%-50% of morbidly obese patients undergoing bariatric surgery.1,2,3 It might be overlooked or under looked especially if the patient was asymptomatic and no pre-operative endoscopy or radiological workup. Denovo closure of the hiatal defect in case of an intraoperative finding of HH strongly recommended preventing such acute postoperative complications. Herein we report a rare and acute post laparoscopic sleeve gastrectomy with gastric herniation were uneventfully diagnosed and interfered early to prevent a catastrophic outcome.
Multiple cystic lesions in the abdominopelvic cavity one and a half years after resection of presacral neurogenic tumor: tumor recurrence or other?
Authors: Khan Umar Zeb , Masroor Matiullah , Liu Hai
Published: November 2020

Cystic lesions of abdominopelvic cavity include a variety of pathologies and diagnosis can sometimes be challenging. Urinoma can be caused by iatrogenic injury, spontaneous rupture of ureters or by various causes of ureteral obstruction. It needs to be differentiated from abdominopelvic cystic diseases including tumors that can undergo cystic degeneration. Here we report a case of a 41 years old female underwent a presacral neurogenic tumor resection at a local hospital 5 years ago. The tumor recurred three and a half years after the first surgery and removed at another hospital. She experienced abdominal distension and difficulty in urination from the last 2 months and was diagnosed as having a recurrence of tumor once again at both hospitals on separate CT scans. They believed that the tumor was too large and encroaching on adjacent organs to be surgically resected, she was finally diagnosed as infected urinoma during surgery in our hospital. Even though spontaneous rupture of ureters and urinoma formation is a rare disease but it should be considered as a main differential diagnosis of recurrence of neurogenic tumors especially in post abdominopelvic surgeries patient.
A case of elevated carbohydrate antigen 19-9 with a benign cause
Authors: Parikh Jayesh V. , Dalal Parth R. , Baraiya Piyush N. , Vishwakarma Sachin R.
Published: November 2020

Serum carbohydrate antigen 19-9 (CA 19-9), a marker of malignant tumors, is generally slightly elevated in benign conditions. We report a case of cholecystitis with perforated gall bladder with significantly elevated level of serum CA 19-9 based on abdomen computed tomography and intra operative findings. A 70 years diabetic and hypertensive female presented with right hypochondriac pain associated with occasional itching and nausea without vomiting with markedly raised CA 19-9 (1554 U/ml) with CECT abdomen suggestive of perforated gall bladder with cholecystitis.  Patient electively operated for open cholecystectomy and per operative findings were distended gall bladder with multiple calculi within with edematous gall bladder wall and adhesions between gall bladder and omentum and colon. Gall bladder removed and biopsy suggestive of chronic calculus cholecystitis. On post-operative day 5th and 7th CA 19-9 was repeated twice and drastic fall to 5 U/ml and 12 U/ml respectively. Chronic calculus cholecystitis with high elevation of CA 19-9 is rare.
Use of pectoralis major myocutaneous flap cover in a case of electric burn
Authors: Balraj Dharmesh Jothilakshmi , Singh Manmohan , Sood Pranav , Reehal Dil Preet
Published: November 2020

Reconstructive flap surgery is commonly done in patients that have tissue loss from trauma or burns. It involves transporting live healthy tissue from one part of the body to the area with tissue loss or loss of skeletal support. Myocutaneous flaps are often used when the area to be covered needs more bulk and increased blood supply. Since its development in 1947 for repairing cardiothoracic tissue defects, the pectoralis major myocutaneous flap has been widely utilized in head and neck reconstructive procedures. This flap offers a one-stage reconstruction and provides a large cutaneous space that can be navigated to fix defects involving two epithelial surfaces. Though done as salvage flap nowadays after failure of a free vascularized flap, PMMC flaps are continually performed in developing countries with limited medical sources. Primarily implemented to repair head and neck defects, the PMMC flap can be executed at other sites as well. In this case report, we present the application of PMMC flap to cover exposed acromion in high voltage electrical burn patient.
Strategies to prevent extinction of plastic surgery
Authors: Agrawal Neeraj K.
Published: November 2020

“What we need is not the will to believe, but the wish to find out.”  William WordsworthPlastic surgery is a rare combination of carpentry and aesthetics. These skills are so judgmental that the perception of the ideal form varies radically between the surgeons. Plastic surgery being surface surgery is unique as the results are obvious and almost instantaneous. Younger surgeons usually face difficulties in satisfying the patients because of the visibility of surgical results. Litigation and compensation issues may also dissuade medical students to join the revered specialty. Many other issues related to the specialty merit due attention.
Cannulated cancellous screws versus dynamic hip screw in femoral neck fractures: a comparison in productive age group at tertiary care hospital of North India
Authors: Arfee Sakib , Arfee Akib , Arfee Adnan Aadil
Published: November 2020

Background: Since intracapsular fracture neck femur was recognized by Ambrose Pare almost 4 centuries back, the management of intracapsular neck femur fracture has undergone many changes. The multitude of various implants designed and techniques available for its treatment themselves indicate the inadequacy of the various methods of treatment.  Objective was to compare cannulated cancellous screws (CCS) versus dynamic hip screw (DHS) in femoral neck fractures in productive age group.

Methods: This observational study with both prospective and retrospective data analysis of patients operated by different surgeons in same hospital setup has been conducted from March, 2018 to February, 2020 at the department of Orthopedics, Government Medical College (GMC), Jammu. 105 cases satisfying the inclusion criteria admitted in GMC Jammu were included clinically and radiologically. Total number of patients included in the study was 97 patients as 8 patients were lost to follow-up. Functional outcome was evaluated by using Harris hip scoring.

Results: In our study 8 CCS cases were lost to follow up. Total 97 of cases were followed up till one year both radiologically and clinically after a given time intervals and final assessment done on the basis of Harris hip score. Among 97 cases 71 were males most of them in age group of 41-45 years and 26 were females with 46-50 years age group predominance. 47.42% fractures were classified as type III in garden’s staging.  

Conclusions: DHS is a better implant than CCS in hands of doctors who lack of expertise and precision i.e. required for CCS in fracture neck femur in young adult patients.
Desafios da In(ex)clusão no Espaço da Educação Superior à Distância no Brasil
Authors: Di Gesú Viviane Spadaro , Gimenez Roberto
Published: November 2020

O presente artigo se propõe a discutir o tema inclusão no ensino superior brasileiro, em especial, sob o contexto da educação à distância (EAD). Considerando a função social das instituições de ensino superior (IES), identificou-se como se deu o tratamento dos alunos com deficiência em nível de graduação no Brasil, adentrando ao campo da acessibilidade nos ambientes virtuais de aprendizagem (AVA) utilizados em cursos superiores na modalidade à distância. O estudo apontou que a inclusão no espaço acadêmico de nível superior é um desafio, agravado quando submetido ao contexto da formação à distância. A legislação tímida acerca da inclusão e as ações, sobretudo tecnológicas, voltadas à provisão de acessibilidade no ensino superior à distância ainda estão longe da garantia do direito à educação para todos.
Palavras chave: Inclusão. Alunos com deficiência. Educação à distância. Educação superior.