bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary retroperitoneal mucinous cystadenocarcinoma: a rare surgico-pathological entity
Authors: K. Sangeetha , Patel Shilpa M. , Arora Ruchi S. , Shah Mona N.
Published: August 2020

Ovarian cancer (OC) is the seventh most common cancer for females in the world. Epithelial OC is the most predominant pathologic subtype (85%-90%), with five major histotypes- serous, mucinous, endometrioid, brenner and clear cell tumour. Each have three pathological subtypes ie benign, borderline and malignant. Mucinous cystadenomas and carcinomas of the ovary are well-established and common tumors. Primary retroperitoneal mucinous cystadenomas and carcinomas are being very rare and histopathogenesis of which is still uncertain. Most pathologists suggest their origin through mucinous metaplasia in a pre-existing mesothelium-lined cyst. An accurate preoperative diagnosis of these tumors is challenging due to lack of established effective diagnostic measures. Hereby presenting a 50-year-old woman, who visited to the hospital with abdominal distension and discomfort since two months. Sonography and computed tomography scans were performed and showed large predominantly cystic lesion arising from right adnexa. Patient underwent exploratory laparotomy for removal of the tumor. Histology and immunohistochemistry revealed primary retroperitoneal mucinous cystadenocarcinoma.
A rare case of vaginal sarcoma in pregnancy
Authors: Kujur Avinashi , Roy Archana , Ekka Suma Velgin , Gupta Divya
Published: August 2020

Vaginal Sarcoma is an extremely rare tumour in pregnancy. Authors are presenting a case report of a pregnant woman who presented with vaginal mass and urinary retention at 32 weeks of gestational age. USG confirmed a live baby with possibility of cervical fibroid. Before further investigations for diagnosis of the mass her emergency LSCS has to be done. Histopathology and immunohistochemistry then confirmed sarcoma.
Tuberculous mastitis: a rare case report
Authors: Ennasser Hind , Raoudi Jamal Eddine , Taheri Hafsa , Saadi Hanane , Mimouni Ahmed
Published: August 2020

Tuberculous mastitis is a granulomatous mastitis due to infection by mycobacterium tuberculosis. It’s a rare entity witch is often confused with breast carcinoma or pyogenic breast abscess because of its clinical and radiological aspect. The diagnosis is histological with identification of an epithelioid cell granulomas and necrosis. The treatment is based on anti-tuberculous therapy with a good clinical issue. Authors report a case of tubercular mastitis in a post-menopausal female diagnosed on adenectomy.
Role of neo-adjuvant chemotherapy followed by surgery in cervical cancer: a review
Authors: Bharaswadkar Ganesh
Published: August 2020

Incidence of cervical cancer is predominantly found in developing countries. In Indian set up, it is most commonly found in rural locations in younger population. Chemotherapy was initially introduced for the treatment of recurrent/metastatic cervix cancer and has subsequently been explored in primary treatment either as neo-adjuvant prior to radiation or surgery in an attempt to reduce the incidence of loco-regional recurrence. The review study tries to evaluate the role of neoadjuvant chemotherapy (NACT) followed by surgery in cervical cancer management. Randomized trials and meta-analysis were analysed. Most of them used short course chemotherapy course of 4-6 weeks followed by surgery. patients with high risk pathological features received postoperative RT. The results of trials indicated significant reduction in the risk of death with NACT, but there were few differences between the trials. NACT followed by surgery is found to be associated with an improved response rate and progression-free survival. However, the impact on overall survival remains to be confirmed.
COVID-19 during pregnancy: vertical transmission, diagnosis and maternal-fetal complications
Authors: Moukit Mounir , Ouardi Assia El , Babahabib Abdellah , Hassani El Mehdi El , Kouach Jaouad
Published: August 2020

The current pneumonia outbreak of COVID-19 has been declared a pandemic by the World Health Organization on March 11, 2020. With its indiscriminate spread across continents, authors are likely to see women with COVID-19 canvassed across all trimesters of pregnancy. To date, few reports have provided information about this disease in pregnant patients. Authors conducted a literature review to summarize the results concerning intrauterine transmission, diagnostic challenges and maternal-fetal outcomes of pregnant women with COVID-19 pneumonia.
Safe pregnancy and delivery in COVID-19 time
Authors: Agarwal Sakshi
Published: August 2020

The impact of COVID-19 on pregnant women is yet not defined. There is no clear evidence that they are more susceptible to COVID-19. Clinical features and diagnostic workup are similar as in non-pregnant women. This virus has been reported to cause complications like premature rupture of membranes, preterm birth and fetal distress in the last trimester but effects in first and second trimester are not apparent. This infection is a supportive indication for delivery if pregnant patient requires improvement in oxygen saturation. Treating doctor has to make individualized decision regarding mode of delivery considering maternal and fetal clinical conditions. Its vertical transmission from mother to baby and presence in breast milk and vaginal secretions has not been reported. So mother can feed breast milk to babies or it can be given in form of expressed milk. Further research and data collection are required for unanswered questions.
Assessment of independent risk factors of acute pancreatitis
Authors: Bada Vijaykumar C.
Published: August 2020

Background: Acute pancreatitis (AP) is a sudden inflammatory condition of the pancreas. The present study recorded independent risk factors of acute pancreatitis.Methods: The present study was conducted on 50 patients of acute pancreatitis of both genders. A detailed general and systemic examination was done in all patients. History of smoking, alcoholism, hypertension, weight, obesity and diabetes was taken.Results: Out of 50 patients, males were 45 and females were 5. There was history of smoking in 20 patients, alcoholism in 15, weight >70 kg in 38, hypertension in 10, diabetes in 24 patients and obesity in 12 patients. The difference found to be significant (p<0.05).Conclusions: Authors found that smoking, alcoholism, hypertension, diabetes, weight >70 kg and obesity as independent risk factors of acute pancreatitis.
Efficacy of foam sclerotherapy in treatment of grade I and grade II bleeding hemorrhoids at Nalanda Medical College and Hospital, Patna
Authors: Shekhar Raj , Gupta V. K.
Published: August 2020

Background: Sclerotherapy is the treatment of choice for first and second grade haemorrhoidal disease. The aim of this study is to assess the efficacy and safety of polidocanol foam for haemorrhoidal disease.Methods: A total of 50 patients were treated with foam sclerotherapy (polidocanol 3%). Patients who presented with complain of bleeding per anum and diagnosed with first and second grade hemorrhoidal disease were included. Patients without bleeding per anum were not included. The primary objective was the stopping of perianal bleeding after one sclerotherapy session. Sclerotherapy was repeated at 2-week intervals until patients were free of bleeding. The final follow-up was 12 weeks after the last sclerotherapy session.Results: After one foam sclerotherapy session, 82% of patients (41 out of 50) were treated successfully. After second sclerotherapy, 98% of the patients (46 out of 50) were treated successfully. 2% of the patients received third sclerotherapy.Conclusions: In the treatment of first and second grade haemorrhoidal disease, polidocanol 3% foam is very effective and safe. The results of this study show that foam sclerotherapy is a new, innovative, effective and safe non-surgical treatment option for haemorrhoidal disease.
Improvement in semen parameters after varicocoelectomy
Authors: Kumar Sandeep , Singh Sakshi
Published: August 2020

Background: Varicoceles are associated with abnormal sperm parameters. The difference is more marked in cases with infertility and higher grades of varicocele. Following ligation of varicocele, there is a significant improvement in the sperm counts.Methods: The study was conducted in the department of general surgery at Maulana Azad Medical College and associated Lok Nayak Hospital from September 2012 to April 2014. The study was conducted on 40 numbers of patients. These were divided into 2 groups, group 1 (n=20) constituted of patients with varicocele who are symptomatic. Group 2 (n=20) constituted of patients with varicocele who are asymptomatic (infertile). All patients were evaluated by clinical examination and Doppler to grade the varicocele. All patients underwent detailed semen analysis. Patients of both the groups underwent FNAC of bilateral testes. The patients with clinical or Doppler detectable varicocele were taken up for low ligation of varicocele. Patients were followed up and all above parameters were repeated about 3 months after surgery.Results: The sperm morphology, counts and motility increase significantly in group 2 patients and sperm counts and morphology increased significantly in group 1 while motility not increased significantly.Conclusions: Most of the patients who presented to us were in the age group of 25-35 years. Longer duration of disease in patient with infertility is also suggestive of the fact that varicocele is a progressive disease and leads to testicular dysfunction over time leading to infertility. Most of the varicoceles were either left sided or bilateral
Modalities in the management of splenic trauma
Authors: M. Swetha B. , Erabati Santosh Raja , Majji V. V. Harika
Published: August 2020

Background: The aim of the study to study the modalities in the management of splenic trauma. Factors affecting non operative management in order to improve the outcome of conservative management, and the factors responsible for conversion to operative management.Methods: 30 patients were admitted in the Department of Surgery, NRI Institute of Medical Sciences, Visakhapatnam, satisfying the inclusion criteria between 01 June 2016 to 31 August 2018.Results: A cross-sectional type of study was performed. Among the 30 patients, 21 were male and 9 were female. It was seen that in 80% of patients the mode of injury was road traffic accident. Human assault, animal attack and fall from height contributed to 6.66% each. The most common reason for conversion to operative management was fragile hemodynamic status of the patient. 20% of the cases were grade I, 40% grade II, 26.66% grade III, 6.66% each of grade IV and grade V, all cases of grade IV and grade V were managed operatively. In this study 60% of the cases could be managed conservatively, 1 case (3.33%) splenorraphy was done. 33.3% (1/3rd) patients required splenectomy, and 1 (3.33%) patient expired who presented late and with hemodynamic instability, belonged to grade V splenic injury.Conclusions: Conservative management has replaced splenectomy as the most common method of splenic trauma management in patients with stable hemodynamic status. Higher grades of splenic injuries have been managed conservatively. As a result, 60% of all blunt splenic injuries can be managed non-operatively with a success rate of 98%. Operative management associated with stringent intensive care unit (ICU), transfusions are restricted to higher grades of splenic injuries.
A prospective study to analyze the etiology, prevalence, clinical presentation, age and sex wise distribution of thyrotoxicosis among thyroid disorders in a tertiary care hospital
Authors: Nirmalanandan Manoj Kumar , Balachandran Kavitha Jayanthi
Published: August 2020

Background: Thyrotoxicosis is a clinical syndrome characterized by an excess of free thyroxine and triiodothyronine or both. One of the major and usual causes of thyrotoxicosis is Graves’ disease. Morbidity associated with the situation is very high and it demands early diagnosis and treatment. This can reduce the burden of the disease it imparts on the society. The aim of the study is to analyse the etiology, prevalence, clinical presentation, age, and sex-wise distribution of thyrotoxicosis among thyroid disorders presenting to Government Medical College, Thiruvananthapuram.Methods: It is a prospective study undertaken in tertiary care and teaching hospital over a period of one year. 2401 patients admitted in the general ward with thyroid disorders were included in the study. Definite inclusion and exclusion criteria were followed. Relevant blood tests were done in all cases.Results: On analysis of the data which were entered in excel format the prevalence of thyrotoxicosis was 2.5%. The majority of the study population was in the twenties and forties. Incidences in females were more mainly due to increased prevalence.Conclusions: By studying the etiology, prevalence, clinical presentation, age, and sex-wise distribution of Thyrotoxicosis, the disease burden in the population can be understood and early diagnosis and proper treatment can be instituted. Our study prevalence was comparable with similar studies done in other institutions.
Evaluation of surgical Apgar score in predicting post-laparotomy complications
Authors: Shah Nimish J. , Choudhary Ram Singh , Jangir Shish Ram , Patel Divyang
Published: August 2020

Background: Surgical Apgar score is a simple, objective and economical ten point post-operative prognostic scoring system based on three readily recorded intra operative variables. Aim is to evaluate the applicability and accuracy of the surgical Apgar score in predicting post-operative complications and objectives are to identify patients at risk of developing post-operative complications based on intra-operative data, to study the incidence of post-operative complications and morbidity and mortality in patients undergoing elective and emergency laparotomy.Methods: This was a prospective analytical study carried out at SSG Hospital from November 2018 to October 2019 and achieved sample size was 160 patients. Surgical Apgar score was calculated at the end of the operation from these three parameters: heart rate, mean arterial pressure and expected blood loss.Results: Out of 160 patients, 77 patients were in group 0-5 and complications occurred in 45 patients (58.4%), 54 patients in group 6-7 in which 18 patients (33.3%) suffered a complication and 29 patients in 8-10 surgical Apgar score, rate of complications was 17.3% in category 8-10 Apgar score.Conclusions: Complications are more in low Apgar score patients compared to high Apgar score and in emergency cases compared to elective surgeries, would require more intensive monitoring in the postoperative period.
Analysis of etiology of loss of skin in lower limb and its reconstructive options
Authors: Devare Abhishek , Bhatnagar Arun
Published: August 2020

Background: The goal of lower extremity reconstruction in cases of skin loss is the coverage of defects and open wounds of the leg, so that they resume their life and prevent the deformity or amputation. Skin loss is either managed by dressings or surgically providing skin cover in the form of skin graft or flap.Methods: This was a prospective, observational hospital based study which involved 100 patients who were admitted in the ward with a diagnosis of skin loss in lower limb in Department of General Surgery and Department of Plastic surgery, Gandhi medical college and associated Hamidia Hospital, Bhopal, Madhya Pradesh from October 2017 to July 2019. Based upon history, clinical and local examination of the wound, necessary investigations, the plan of management, reconstructive procedure was done. The results were compared after one follow up.Results: The patients suffering were commonly males between 18-29 years and mostly due to trauma. Initial management of wounds with skin loss in lower limb was debridement and dressings. Commonly involved anatomical area was below knee area upto both malleoli. Reconstructive measures were commonly undertaken between 3-7 days. The commonest reconstructive option was split skin grafting. Commonly flap used was perforator based flap and local transposition flap.Conclusions: It can be concluded that the most common etiology responsible for the loss of skin in lower limb is trauma and the most used reconstructive measure in skin loss of lower limb is split skin grafting. Flap coverage acts as the best modality of reconstruction.
Single layer versus double layer intestinal anastomoses: a comparative study
Authors: Kumar Ajit , Kumar Vinod
Published: August 2020

Background: There are still conflicting views regarding suitability of single layer and double layer anastomotic technique. This prospective single blinded randomized comparative study conducted at Rajendra Institute of Medical Sciences to assess various aspects viz. safety, efficacy, duration of hospital stays and chances of perforation in single- and double-layer anastomotic surgery.Methods: 26 patients each in single layer and double layer anastomosis group were included in the study.  Single layer intestinal anastomosis was carried using extramucosal technique with 2-0 vicryl suture (round body). Double layer anastomosis was carried out using interrupted 3-0 silk lembert sutures for the outer layer and a continuous 2-0 vicryl for the inner layer. End to end colocolic, end to end ileocolic, end to side ileocolic, end to end ileoileal, side to side ileoileal, end to end jejunoileal and end to end jejunojejunal anastomosis were performed. Each group was compared for anastomotic leak, time required to construct the anastomosis, cost incurred, and length of hospital stay.Results: Findings of the study indicated that single layer is economical in comparison to double layer anastomosis and took significant less time to operate. There was no significant difference in hospital stay of the patients in two groups. There was no anastomotic leak in group-S (single layer) while one (3.8%) patient in group-D (double layer) suffered from anastomotic leak.Conclusions: It was concluded that single layer anastomosis method is beneficial and safe as it required less operative time, suturing material and no leak took place after surgery.
Comparison between the composite heavy weight prolene mesh versus the prolene soft mesh for the reduction in post-operative pain in patients undergoing lichensteins mesh repair for inguinal hernias
Authors: Medikeri Abhijit , Kamatagi Praveeen
Published: August 2020

Background: Globally, inguinal hernia is the most common type of hernia, comprising of approximately 75% of all abdominal wall hernias.Aim of the study was to compare the heavyweight composite polypropylene mesh versus the prolene soft mesh for the reduction of post-operative pain in patients undergoing lichensteins mesh repair for inguinal hernia.Methods: This study was conducted in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum attached to KLE University’s J.N.M.C Belgaum.Results: Male preponderance was seen with 96.67% of patients in group SP and all (100%) patients in group RP were males. The mean age in group SP was 51.93±18.73 years compared to 49.50±14.03 years in group RP (p=0.571). The mean duration of the disease was 12.67±9.85 months in group SP whereas in group RP it was 15.10±8.98 months (p=0.321). The mean pulse rate in group SP and RP (79.60±5.64 vs 82.37±5.46 /min; p=0.059), systolic blood pressure (120.33±9.99 vs 124.33±11.94 mmHg; p=0.165) and diastolic blood pressure (73.73±6.76 vs 75.80±8.59 mmHg; p=0.305) were comparable. Right position was noted in 56.67% of patients in group SP compared to 50% of patients in group RP (p=0.673).Conclusions: Prolene soft mesh (lightweight macro-porous polypropylene mesh) significantly reduced the post-operative pain in patients undergoing lichensteins mesh repair for inguinal hernia as compared to heavyweight composite polypropylene mesh.
Role of pre-operative serum albumin level in predicting the post-operative outcomes in gastrointestinal surgery
Authors: S. Nagesh N. , Siddiraju Venkata Kapil Kishor , V. Ashok Kumar K.
Published: August 2020

Background: The prevalence of protein-energy malnutrition in surgical patients is seen in 30-50% of surgical patients with gastrointestinal disease. Malnutrition and hypalbuminaemia contribute to increased morbidity and mortality. Serum albumin level is a low-cost key element in nutritional assessment. Clavien-Dindo classification of post-operative complications enables stratification of post-operative complication.Methods: We retrospectively analysed the prospectively maintained data of 136 patients who underwent major gastro intestinal procedures from October 2019 to March 2020. We assessed the pre-operative; intra operative parameters, outcome variables and the postoperative complications were graded according to Clavien-Dindo severity, length of ICU stay, length of hospitalization and mortality.Results: Out of the 136 patients (M: F=3:2), the procedures were hepatopancreaticobiliary (n=40), colorectal (n=39), small bowel (n=36) and esophago-gastric (n=19). Pre-operative serum albumin was identified to be single most statistically significant pre-operative variable predicting post-operative complication of Clavien-Dindo severity grade III and above. The ROC curve of the serum albumin level predicting the severe post-operative complication suggested optimal cut off value of 3.1 gm/dl (AUC=0.76; 5% CI=0.64-0.87; p<0.001). Linear regression analysis of serum albumin level predicting the severe post-operative complication suggested good correlation with (r2=0.133; b=0.689; p<0.001). Further analysis of serum albumin level in predicting the length of ICU and the hospital stays suggested a significant negative correlation with both of these dependent outcome variables. The serum albumin level correlated inversely with the length of ICU stay and hospitalization.Conclusions: Low pre-operative albumin (serum level <3.1 gm/dl) in patients undergoing major gastrointestinal surgery predicts severe post-operative complications, prolonged ICU and hospital stays.
Prospective evaluation of early local complications of stoma and their risk factors
Authors: Jana Koustav , Bera Pritin , Mukhopadhyay Arunima , Bhattacharya Ujjwal
Published: August 2020

Background: Bowel stoma namely ileostomy and colostomy are frequently performed procedure and often associated with complications. Aim of this study was to assess early local complications and association with any risk factors.Methods: A total of 99 patients undergoing ileostomy or colostomy were analysed prospectively over a period 18 months. Comorbidity, preoperative clinical data, operative time, local complications within 12 weeks and hospital stay were documented. Univariate and multivariate analysis were used to find out any association.Results: Sixty-four ileostomies and 35 colostomies were analysed in our study. Median age was 55 years in both groups. Nontraumatic bowel perforation (42%) and colorectal malignancy (48.6%) were most common etiology for ileostomy and colostomy formation respectively.  64% of ileostomy and 68% of colostomy had one or more complications. Skin excoriation (31%) was most common complication in ileostomy group and it was stomal prolapse (17%) in colostomy group. Poor stoma care was prevalent in both groups. We found diabetes to have significant association with skin excoriation (p=0.002).Conclusions: Diabetes was identified as significant risk factor for skin excoriation in ileostomy group. Further long term data and larger population are needed for better evaluation of stomal complication and their risk factors.
Self-gripping mesh versus polypropylene mesh in ventral hernia repair: an observational study
Authors: Kumar V. Om , Subbiah Venkatesh
Published: August 2020

Background: To compare clinical outcomes following sutureless Parietex ProGrip™ mesh in ventral hernia repair to traditional lightweight polypropylene mesh secured with sutures.Methods: This was a study conducted at the Department of General Surgery in Velammal medical college from August 2019 to February 2020. This prospective observational study involved, 60 patients, 30 each undergoing ventral hernia repair with polypropylene mesh with suture fixation and Parietex ProGrip™ precut mesh (P group) without fixation. The primary outcome measure was postoperative pain using the visual analog scale were assessed prior to surgery and up to 3 months postoperatively (VAS, 0-150 mm); other outcomes (duration of surgery, wound infection and recurrence of hernia) were assessed up to 3 months postoperatively.Results: Compared to baseline (preoperative), pain score below four on the visual analogue scale was higher in the test group at discharge (76.7%) and 24 hours (96.7%), while the pain was more in the study group at discharge (43.3%) and seven days (70%). The difference between groups was significant at both time points. In the test group, patients without fixation suffered less pain compared to those with single-suture fixation (48 hours: 100% versus 86.6%, p=0.038; 3 months: 100% versus 100%, p≤0.001). Surgery duration was significantly shorter in the test group (<60 minutes) (66.7% versus 40%; p<0.038). No recurrence was observed at three months in both groups.Conclusions: A self-gripping mesh for ventral hernia repair may result in less pain in the early postoperative phase. Recurrence rates reduce as well as the patient’s quality of life improves.
Mannheim’s peritonitis index a more simpler prognostic index than APACHE II score
Authors: Maran Jyoti S. , Shukla Archana , Parmar Bhupendra Singh
Published: August 2020

Background: The study was done with the aim to determine the clinical profile of patients with hollow viscous perforation and to compare MPI and APACHE II scoreMethods: This study was a prospective and retrospective observational study conducted in the department of General Surgery, Gandhi Medical College and associated Hamidia Hospital from the June 2017 to August 2019The possible score ranges from 0-47. All necessary preoperative data was recorded. Blood sample was taken and relevant blood investigations were done. Patients were resuscitated with iv fluids. Nasogastric tube and urinary cather insertion were done. The parameters of modified APACHE II score and Manheim’s peritonitis index were recorded at the time of admission. Patients underwent emergency laprotomy and correction of pathology was done.Results: Out of total 100 patients 79% were males, 21% were females, majority 45% belonged to the age group 26-35 years.  To calculate the cut off point for mortality ROC curve was constructed. ROC curve analysis predicted that Manheim’s score of 22 or more would predict mortality. Out of total 16 deaths, 14 cases had Manheim’s score of 22 or more thus, giving the score a sensitivity of 87.5% and specificity of 77.38% and overall accuracy of 79% in our study. ROC also predicted that APACHE II score of 15 or more would predict mortality. Thus, giving APACHE II score a sensitivity of 93.75%, specificity of 100% and accuracy of 99%.Conclusions: We consider MPI to be a more simpler prognostic indicator than APACHE II score.
Determination of severity of acute pancreatitis
Authors: Bada Vijaykumar C.
Published: August 2020

Background: Acute pancreatitis is an inflammatory process with a highly variable clinical course. The present study was conducted to assess severity of acute pancreatitis.Methods: The present study was conducted on 53 patients of acute pancreatitis of both genders. A thorough clinical examination was performed. Ranson’s score (RS), Glasgow score (GS), acute physiology and chronic health evaluation (APACHE-II) score, APACHE-O score and Balthazar’s computed tomography severity index (CTSI) score was recorded.Results: Out of 53 patients, males were 47 and females were 6. Patients were divided into acute pancreatitis (32) and severe pancreatitis (21). Results of the bivariate analysis of Ranson scoring system in mild periodontitis was 0.84 in severe was 2.95, Glasgow score was 0.66 in mild and 2.48 in severe, APACHE-II had 6.94 in mild and 10.33 in severe, APACHE-O had 7.34 in mild and 11 in severe and CTSI had 1.9 in mild and 6.15 in severe.Conclusions: Authors found that all the scoring systems are useful in assessing the severity of acute pancreatitis.
Perforation of a Meckel’s diverticulum secondary to chronic NSAID use: case report and review of the literature
Authors: Espitia Francisco Terrazas , Davila David Molina , Ramirez Luis Villalobos , Trujillo Bruno Salazar , Moyron Lucio Santos , Salgado Ariadna Mondragon
Published: August 2020

Meckel´s diverticulum is an abnormality in the development of the gastrointestinal system, its origin and clinical significance was first described by Johan Friedrich Meckel in 1809. It is a remnant of the omphalomesenteric duct which is usually observed following the rule of 2’s, located 2 feet proximal to the ileocecal valve, before 2 years of age in approximately 2% of the population, and is twice as common in male population. It is considered a true diverticulum because it presents all the histopathological layers of the bowel; 6% of the cases present with heterotopic tissue, mainly pancreatic, gastric, colonic or jejunal. We present the case of a 37-year-old patient who presented with acute onset epigastric pain which migrated to the right iliac fossa, he had a history of chronic non-steroidal anti-inflammatory drugs (NSAIDs) usage for articular pain. He underwent abdominal contrast tomography (CT) scan with double iodine contrast enhancement, which revealed the presence of a perforated Meckel´s diverticulum in the antimesenteric portion of the terminal ileum. The patient underwent laparoscopic diverticulectomy with no complications and was discharged 72 hours after the procedure. Histopathological confirmation of a perforated meckel’s diverticulum with heterotopic gastric mucosa confirmed the clinical suspicion of perforation secondary to chronic NSAIDs usage.
An eventful course of a routine laparoscopic appendectomy: case report
Authors: Khalifa Aiden , Devanabanda Bhavana , Louis Martine
Published: August 2020

Acute appendicitis is one of the most common surgical emergencies in the world. Appendectomy can be done through an open technique, but the laparoscopic approach has become the gold standard for surgical treatment of acute appendicitis. This technique has been found to be associated with decreased postoperative pain, morbidity and length of stay when compared to open appendectomy. However, complications from laparoscopic appendectomy can still occur. We present a case of an internal hernia causing a small bowel obstruction, from adhesions due to loose staples after a laparoscopic appendectomy. Laparoscopic linear cutting staples and automatic clip applier are commonly fired across the appendiceal stump. At the end of the laparoscopy, if the free intraperitoneal staples are not removed with grasper or suction, it can lead to bowel obstruction. We report the clinical presentation, diagnostic work up, treatment and management of mechanical small bowel obstruction caused by loose staples in a pediatric patient.
Solitary intratracheal neurofibroma: a rare tracheal tumor
Authors: Mazcuri Misauq , Abid Ambreen , Ahmad Tanveer
Published: August 2020

Intratracheal neurofibromas are rare benign tumors with a tendency to transform into malignant form. Intratracheal neurofibroma remain asymptomatic and are incidentally found during routine radiography or may present with wheeze, cough and lower respiratory tract infection. We recently operated a 38 year old gentleman, who presented with progressive shortness of breath and chronic cough for two years. Examination was normal. CT identified a supracarinal, intratracheal mass. Rigid bronchoscopy revealed a hyper vascular mass, attached to membranous trachea. We performed resection anastomosis via right posterolateral thoracotomy. Histopathology revealed neurofibroma. Patient recovered well and was discharged after eight days.
Unique position of a pancreatic head insulinoma during laparoscopic enucleation: case report
Authors: Alshamrani Abdullah M. , Ghabbani Hisham M. , Alobaid Omar M. , AlShehri Abdullah J. , Alzaraa Khalid M. , Alshurafa Haider A.
Published: August 2020

Insulinomas are benign pancreatic neuroendocrine tumors that require surgical intervention as a therapeutic measure. We describe an 18-year-old male patient who presented to the emergency department with a history of syncope, blurred vision, and diaphoresis. His blood sugar level was low upon admission, and a 72-hour fasting plasma glucose test showed low serum glucose, high serum insulin, and high C-peptide. An abdominal computed tomography scan and magnetic resonant imaging revealed a solitary tumor in the pancreatic head with no sign of ductal dilatation. Laparoscopic enucleation was performed, and a histopathological examination revealed findings consistent with insulinoma. The patient’s postoperative course was uneventful, and his follow-up examination was unremarkable. In conclusion, physicians should have a high clinical suspicion index for insulinomas, especially in young patients with a history of syncope, blurred vision, and diaphoresis, in order to avoid delayed diagnosis.
A case of spleen hydatid cyst
Authors: El Brahmi Yasser , Anajjar Mohamed , Rebbani Mohammed , Ehirchiou Abdelkader , Ait Ali Abdelmounaim
Published: August 2020

The hydatid cyst of the spleen results from the development of the hydatid worm Echinococcus granulosus, in the splenic parenchyma. Humans are the accidental intermediate host in the development cycle of hydatid disease. Splenic involvement is the third most common location after the liver and lung. Echography and sometimes tomography are needed to confirm the diagnosis. In the absence of truly effective medical treatment, splenic hydatidosis often leads to surgery. Resection of the protruding dome is the treatment of choice due to low morbidity and absence of mortality. We report the case of 27 years old, with no particular medico-surgical history, referred to our hospital for the treatment of a splenic hydatid cyst discovered fortuitously during a radiological assessment. The patient was operated by laparoscopy. The treatment consisted of sterilization of the contents of the cyst with hydrogen peroxide, removal of the contents and resection of the salient dome, the results were unremarkable.
Management of the patient with fibromatosis of the left anterior chest wall
Authors: Subbaraj Saravanakumar , Manohar Sandeep
Published: August 2020

Desmoid fibromatosis is a rare but locally aggressive tumour comprised of myofibroblasts. It is histologically benign but can behave aggressively. They do not have the ability to metastasize but can cause significant morbidity and mortality by local invasion. These tumours may occur anywhere on the body, but are commonly found on the abdominal wall and within the intestinal mesentery. Mutations in either the β-catenin or the adenomatous polyposis coli (APC) genes are usually the cause for the development of desmoid tumours with the former comprising the sporadic development of tumours and the latter being associated with familial adenomatous polyposis syndrome. Surgical resection with histologically negative margins has been the cornerstone of therapy for this disease, but this paradigm has begun to shift. It is now common to accept a microscopically positive margin after resection as recurrence rates may not be significantly affected. This case report intends to describe the clinical, diagnostic and pathologic features of a post-traumatic fibromatosis involving left side chest wall in a 45 years old female and causing worsening pain. The surgical management was successfully undertaken.
Multiple submucosal lipomas of small intestine: a case report
Authors: Tiwari Kritika , Raghuvanshi Rhishikesh J. , Athale Anuja , Deshpande Suresh G.
Published: August 2020

Small bowel obstruction can be due to benign or malignant pathologies. Gastro intestinal lipomas are one of the benign subepithelial tumours causing obstruction. These are usually detected incidentally if asymptomatic. Adult intussusception due to intestinal lipoma is a very rare cause. We are presenting a case of male hypertensive patient with features of multiple subacute obstruction due to multiple submucosal lipomas in ileum. Exploratory laparotomy with intra-operative enteroscopy was performed and resection-anastomosis of affected segment was done.
Delayed presentation of enterocutaneous fistula after tubal ligation: a case report
Authors: Munnamgi Sinduja , Singh Sudhir Kumar , Huda Farhanul , Ravikumar Arundev , Gajula Bhargav
Published: August 2020

A 50-year-old woman with a history of tubal ligation nine years earlier, presented with a complaint of discharge from the scar site. She was found to have an enterocutaneous fistula. The patient underwent an exploratory laparoscopy. The tract excised and primary repair of bowel done. A unique feature of the case is the formation of an enterocutaneous fistula after an extremely long latency due to gauze threads, which has not been previously reported in the literature.
Urachal fistula in a 22 year male: a case report
Authors: Srivastava Vipul Kumar , Roy Shilpi , Meena Ram Niwas , Khanna Rahul
Published: August 2020

A patent urachus is one of the spectrums of congenital urachal anomalies. It has been termed as "urachal fistula" when the lumen of intra-embryonic portion of allantois persist abnormally.  Persisting urachal fistula is a rare condition mostly diagnosed during childhood or in autopsies. Here we report a very rare case of urachal fistula of a young male. We present a case of 22 years male with intermittent periumbilical pain and sero-purulent discharge from umbilicus since birth. On examination sero-purulent discharging umbilical sinus with granuloma was present. Surgical excision of whole of the urachal fistulous tract was done with repair of bladder. Patient did well during post-operative period. Persisting urachal fistula in adult is rare entity and difficult to diagnose because of low incidence and non-specific symptoms. So a high index of suspicion is required in order to make the early diagnosis of urachal anomalies.
Non-clostridial gas gangrene of a diabetic foot with COVID-19 infection
Authors: Bakhshi Girish D. , Patel Owais Ahmed , Pawar Dinesh , Shah Jessicka
Published: August 2020

Gas gangrene is a manifestation of soft tissue infection by clostridial group of bacteria. Non-clostridial gas gangrene is uncommon and seen rarely in diabetics. In the era of COVID-19 pandemic where COVID-19 itself induces hyperglycemia non clostridial gas gangrene may arise due to altered immunity. We present a case of non clostridial gas gangrene of lower limb in a middle aged person who was not a known diabetic. A brief case report with review of literature is presented.
Appendicular abscess: as a masquerader and pheochromocytoma as an incidentaloma in a 12 year old male child
Authors: Suresh Jayasurya , Mathew P. John , Chandran R. Nidheesh
Published: August 2020

A 12 year old boy presented initially with symptoms suggestive of urinary tract infection (UTI). Later, it turned out to be acute appendicitis with appendicular abscess. Pre-operative investigations revealed co-presentation of pheochromocytoma. Although this child was having no symptoms of pheochromocytoma, the presentation of phaechromocytoma with appendicular abscess needs to be dealt with extreme vigil as pheochromocytoma can result in severe sympathetic outburst storm. Laparoscopic appendicectomy was done and the child was discharged after complete recovery.
A curious case of electric wire in urethra
Authors: Thangarasu Mathisekaran , Prakash Sanjay J. , Jain Nitesh
Published: August 2020

We present a case of discharging urethral fistula in a sexually active young male, who was found to have an impacted electrical wire in the urethra. Polyembolokoilamania is a condition, where one inserts foreign bodies via natural orifices, either for autoerotism, in inebriated states or due to psychological conditions. A wire was inserted into the patient’s urethra and it remained impacted for a year, leading to pain, dysuria and discharging urethral fistula. The wire was removed and the fistulous tract was excised. Patients, if diagnosed with autoerotism needs follow up with psychiatrist to address the underlying condition.
Emergency surgery amid ongoing pandemic in suspected COVID-19 with D1 perforation
Authors: Shankar Mrinal , Chaudhary Manoj Kumar , Samal Shubham , Ramchandani Radhakrishna
Published: August 2020

The COVID-19 pandemic has affected working patterns of all emergency and regular surgical services. We report a case of emergency surgery amid this ongoing pandemic, in a suspected COVID-19 patient with D1 (duodenal) perforation. We did not wait for the real time polymerase chain reaction (RT-PCR) report for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to come, and proceeded with surgery with all safety protocols. We intend not to delay, for the better outcome of patient’s condition, the life-saving response alike we follow routinely. The pandemic scenario is expected to sustain for longer time. We assume, patients requiring acute care surgery with COVID-19 like symptoms (suspected or confirmed), should definitely be proceeded with surgery as earliest, following all safety protocols, and prevent undue and added morbidity and mortality during this pandemic crisis.
Antibodies to SARS-CoV2 detectable for less than 50 days in polymerase chain reaction confirmed COVID-19 patients
Authors: Kumar Nishant , Bhartiya Shibal , Singh Tarundeep
Published: August 2020

Background: A seroprevalence study for COVID-19 antibodies was conducted amongst health workers in Mumbai, India, in June 2020.Methods: Healthcare workers (n=801) underwent a cross sectional survey through electrochemiluminescence immunoassay (Roche diagnostics’ Elecsys anti-SARS-CoV-2 assay, Roche diagnostics, Rotkreuz, Switzerland).Results: Of the 801 healthcare workers, 62 who had been previously diagnosed with a real time-polymerase chain reaction (RT-PCR) proven SARS-CoV-2 infection, 45 (73.6%) were found to be seronegative during the study. The duration between the positive RT-PCR test and the serological testing ranged from 15 to 49 days for 34 (54.8%), and was >50 days in 28 subjects. Up to 28 days after a positive PCR test, 90% of the subjects were found to be seropositive, but this reduced to less than half over the next two weeks (38.5% between 29 and 42 days).Conclusions: Our findings are in agreement with previous reports that demonstrate a peak antibody formation after 3 weeks, and also an early antibody decay that is almost exponential. This may also have a significant effect on the protection vaccines are able to provide considering that a natural infection has such a transient antibody response.
Trends of leptospirosis cases in a tertiary care center in Northern Kerala during January 2013 to October 2019
Authors: Sanya Rameela , Kumaran Jayasree Anandabhavan
Published: August 2020

Background: Leptospirosis is a zoonosis endemic in tropical climates. Though overall incidence of leptospirosis has decreased during recent years, it continues to be a major public health problem, highly underreported in India. Various trends such as seasonal, geographical, mortality have to be studied in detail for proper planning of prevention and control programs. The objective of this study was to assess geographical, seasonal, mortality trends of leptospirosis cases attending a tertiary care centre in Northern Kerala, from January 2013 to October 2019.Methods: A record-based retrospective study was conducted where leptospirosis cases attending tertiary care centre were included. Data was entered into Microsoft Excel 2007, analysed using Epi Info 7. Results were expressed as frequencies, percentages.Results: Among 647 leptospirosis cases, 141 were confirmed and 506 were probable. Maximum number of cases were reported in 2014 and maximum deaths were reported in 2019. Majority belonged to 51-60 years age category; males outnumbered females. Maximum cases were reported during September, August. Major hotspots for leptospirosis were Kannur and Taliparamba Municipalities and Koothuparamba.Conclusions: During rainy season, probably younger individuals are at risk as they indulge in leisure like swimming, playing while post rainy season older individuals are at risk due to occupational exposure. The number of deaths showed a declining trend from 2013 to 2018, but increased in 2019. Few of the previous hotspots reported decline in cases probably due to improved surveillance and control activities.
Investigation of hepatitis A outbreak in a municipality in Northern Kerala
Authors: Nizar Abdul , Haveri Sheela P. , Binub Kanniyan , Ishaque Sherin , Sasi Shilpa T. , Venugopal Aishwarya K.
Published: August 2020

Background: Viral hepatitis A is a contagious viral disease affecting liver that can result in mild to severe illness. It can occur sporadically and in epidemics with a tendency of cyclical recurrence. India is considered to be hyper endemic region for HAV infection with very high infection rate in early years of life.Methods: An outbreak investigation was conducted in a municipality in Northern Kerala were a sudden rise in hepatitis A cases was reported by health authority to describe the outbreak in terms of person, place and time. Different sources were also inspected to identify probable cause for an outbreak in the area.Results: A total of 267 households were surveyed which included 84 households with at least one hepatitis A case and 183 household without cases. Individuals with hepatitis A counted up to 157. Mean age of the cases were 14.09±7.34 years. 89.1% took allopathic treatment and 7% took Ayurveda treatment. The total attack rate of the population was 0.29% and attack rate of ward 31 was 4.96%.Conclusions: Results of the outbreak investigation indicates that there is a need for establishment of an efficient water quality surveillance system and bringing about intervention for behavioural change in the population.
Knowledge, attitude and practice among health care professionals regarding COVID-19 and barriers faced by health care professionals in South India
Authors: Nallani Venkata Rama Rao , Nadendla Rama Rao , Kavuri Naga Swathi Sree
Published: August 2020

Background: Corona virus disease or SARS-CoV-2 is the rapidly emerging pandemic in the present world. It has become a major concern for the front liners (health care professionals) globally. Aim of the study to assess the knowledge, attitude and practice among health care professionals regarding COVID-19 and barriers faced by HCP’s during practicing in south India.Methods: A cross sectional online survey was conducted during the month of May. The questionnaire was designed and validated and it was administered among participants. The statistical significance was calculated for collected data.Results: Total 658 subjects were responded. Gender distribution, females (64%) and males (36%). The questions included about profession, geographical distribution, age, source of information. Out of 658 samples, 418 (63.49%) with good knowledge and 240 (36.51%) with poor knowledge. Regarding attitude findings showed only few have positive attitude. Regarding practice 74.9% have good practice and 25.1% have poor practicing. By calculated the Chi-square test gives the statistical significance p<0.0001 at 95% CI. Logistic regression analysis was done using gender versus knowledge (p<0.0001), age versus knowledge (p<0.0001) and area of residence versus knowledge (p<0.438) hence. Whereas gender versus practice (p<0.0001), age versus practice (p<0.402) and area of residence versus practice (p<0.0001) at 95% CI.Conclusions: In the present pandemic situation HCP’s were the front liners so, they must have proper knowledge, attitude and practicing skills. Our results showed positive outcome still the awareness should be created by conducting educational campaigns, journal clubs and continuous professionals programs for more positive outcome.