bluuebunny/crossref_metadata_2025 huggingface dataset:
Erythrocyte profile in cordblood of newborns to diabetic and non-diabetic mothers
Authors: Thaseen Nazima , Veeraiah Shivakumar
Published: January 2021

Background: Diabetes, an endocrinal disorder causing morbidity and mortality has its effect on gestational diabetes. Intrapartum stress, maternal hyperglycemia leads to fetal hyperglycemia. The maternal glycaemic status has influence on neonates erythrocyte profile.Methods: Cord blood of neonates born to 40 diabetic (known to be diabetic at pregnancy) and 40 non-diabetic mothers were selected. A fully automated hematology analyzer ABXMICROsot was used to analyze whole blood collected in EDTA tubes. The diabetic group was subdivided into D1 and D2. D1 as 100-150 mg/dcl, D2 as above 150 mg/dcl.Results: Hemoglobin, hematocrit, MCV, MCH, RDW were significantly higher, RBC count were comparatively insignificant. Hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), Mean corpuscular hemoglobin concentration (MCHC) were significantly higher in D2 than D1 group. The prognosis for the child of a pregnant diabetic is related to the degree of control of mother’s glycemic status, reflected as higher indices in D2 than D1.Conclusions: Neonatal immune system depends on maternal immune system i.e, all the immunological properties are practically under the control of interleukin-1 and interleukin-6. Interleukin-6 potentiates the action of interleukin-1 synergistically, such action of interleukin converts noncommitted stem cells to committed stem cells. Immunosuppressant status in diabetic mother (i.e., non-priming of neonatal interleukin-6 by immunosuppressant diabetic mother`s interleukin-6, the main cause for these altered count). By modulating neonatal interleukin-6 it decreases hematopoietic potential in the neonates, on the other hand ECF in infants of diabetic mother is reduced leading to hemoconcentration and increase in cell counts. Giving a picture as if polycythemia at birth in neonates of diabetic mothers.
Early diagnosis HFpEF, heart failure with preserved ejection fraction in cardiomyopathy, a chance to treat and reduce morbidity and mortality
Authors: Gokhale Vijayashree S. , Malik Atiulla I. , Malik Atiulla I. , Yadav Ponvijaya M. , Yadav Ponvijaya M. , Garg Kunal , Garg Kunal
Published: January 2021

Background: Cardiomyopathy as a diagnosis almost signifies a kind of end stage disease of the myocardium. With conditions like hypertension, diabetes and ischemic heart disease on the rise, we are seeing a large number of cases diagnosed as cardiomyopathy, most common presenting feature being Heart failure. Echocardiography (ECG), is non-invasive and easily available and can pick up early signs of failure in the form of diastolic and systolic dysfunction. To study patients with cardiac symptoms, by clinical, ECG, and Echocardiography parameters.Methods: A cross-sectional, observational study of 50 patients aged 18-80 years with cardiac symptoms (dyspnoea, palpitations, pedal odema) was carried out over a period of 3 years in a semi-urban Medical College Hospital in Western Maharashtra. Patients of Acute coronary disease, valvular and congenital heart disease and chronic obstructive pulmonary disease (COPD) were excluded from the study. Data collected, tabulated and subjected to statistical analysis.Results: Our study of 50 patients had 50% Diabetic and 42% Hypertensive patients. 2D echo findings were clinically significant in the form of diastolic dysfunction (36%), systolic dysfunction (12%). Ejection fraction (EF) was significantly reduced, in most patients, but 4% patients had HFpEF, i.e. EF=55% and 24% had EF between 30-55%Conclusions: Our study of 50 patients of Cardiomyopathy had more hypertensives and diabetics, and most of them less than 60 years of age and mostly male. HFpEF was detected in 4% and 76% had EF30-60% and 24% had EF<30%. Diastolic dysfunction was diagnosed in more than half and systolic dysfunction in few on ECG.
Human leptospirosis in patients with undifferentiated acute febrile illness in a tertiary care hospital in New Delhi
Authors: Gautam Garima , Jais Manoj B. , Kaur Ravinder , Dhakkad Megh Singh
Published: January 2021

Background: Leptospirosis is an important cause of febrile illness with a widespread global distribution. Although endemic in the southern and western states of India, its true incidence in the northern states of the country remains underreported. The main objective of this study was to estimate the seropositivity of infections by Leptospira in patients presenting with undifferentiated acute fever, in a tertiary care hospital in New Delhi.Methods: This prospective observational study was conducted from November 2016 to March 2018 in a tertiary care hospital in New Delhi. Blood samples of the patients (n=370) having fever for more than one week and seronegative for typhoid, dengue, chikungunya and malaria were subjected to Leptospira IgM ELISA (DRG International Inc., USA). Data was analyzed using statistical software SPSS version 21.Results: Out of 370 patients, 142 (38.4%) were males and 228 (61.6%) were females; the mean age was 32.18 years. The most common symptom was headache (55.5%) and icterus (55.55%) whereas increased ALT/AST was the most common laboratory finding (88.8%) followed by anaemia (77.7%). On employing Leptospira IgM ELISA, 2.43% (9 cases, n=370) were strongly reactive (>1.0 OD) whereas 15.1% (56 cases) were weakly reactive (1.15-1.00 OD).Conclusions: There is a need to increase awareness and suspicion regarding diagnosis of leptospirosis. A positive IgM ELISA when correlated with patient’s clinical profile and epidemiological factors can aid in the timely diagnosis and treatment of these infections.
Challenges faced by blood transfusion services in a tertiary care centre for recruitment of convalescent plasma donors for COVID-19
Authors: Handa Anjali , Bundas Sunita , Pal Ashok
Published: January 2021

Background: The transfusion of convalescent blood products is an age old therapy in emerging infectious disease outbreaks. Convalescent plasma works on the principle of passive immunotherapy and Viral Neutralization. In the Current pandemic of corona virus disease (COVID-19), convalescent plasma transfusions can have therapeutic role as there is no specific preventative and therapeutic options. This study was done to see the challenges faced by blood transfusion services for recruitment of plasma donors.Methods: The retrospective study included challenges faced by blood transfusion services in recruiting Donors for convalescent plasma for COVID-19 and strategies followed for improving the donation at SMS Medical College and Hospital from April 2020 to October 2020.Results: This study evaluated challenges faced to recruit the recently recovered COVID-19 patients as donors, Setting up of plasmapheresis capacity, Role of social media in recruitment of Convalescent plasma donors, Financial aspects associated with Convalescent plasma donation, Role of NGOs in recruitment of donors and Success achieved in organization of donor mobilization and plasma collection.Conclusions: Recruitment of Convalescent Plasma donor from COVID-19 recovered patients is a big challenge for blood transfusion services. Different strategies to motivate donors should be implemented such as personnel communication, advertisement via classical mass media like radio, poster, newspaper and online media.
Use of topical nasal steroid spray in the treatment of non-speciﬁc chronic pharyngitis- our experience
Authors: Gul Naveed , Manhas Monica , Kalsotra Parmod , Deva Faizah , Mir Mehak Taban
Published: January 2021

Background: The present study was done to find the effectiveness of nasal steroid spray in the treatment of non-speciﬁc chronic pharyngitis.Methods: The present prospective study was carried out in department of Otorhinolaryngology and Head and Neck surgery, Government Medical College Jammu from July 2017 to March 2020. Patients were selected randomly from the ENT OPD, a detailed history was taken, thorough clinical examination was done to conﬁrm the diagnosis and exclude all other existing illnesses and associated problems. Fluticasone nasal spray was used to see the relief of symptoms. Persistent relief was central to be considered proof of effectiveness of the treatment.Results: 40 patients were taken up for the present study, out of which only 32 patients showed relief in symptoms. 25 patients showed relief of symptoms with only 1-2 sprays. 8 patients did not report any relief of symptoms even after continues use of steroid nasal spray for 3-4 weeks. No significant side effect was noticed in any patient.Conclusions: In the present study, it is concluded that use of steroid (fluticasone) nasal spray in well selected cases of non-specific chronic pharyngitis is very effective, safe and cheap.
Clinico-haematological profile of adult pancytopenia patients at a tertiary care institute in South India
Authors: Chikan Nadia Shafi , Iqbal Qazi Mohammad , Mir Altaf Hussain
Published: January 2021

Background: Pancytopenia is not a disease by itself; rather it describes simultaneous presence of anemia, leukopenia and thrombocytopenia resulting from a number of disease processes. Varieties of hematological and non-hematological disorders may affect bone marrow either primarily or secondarily, resulting in the manifestation of pancytopenia. The incidence of various hematological disorders causing pancytopenia varies due to geographical distribution and genetic predisposition. This study highlights the spectrum of causes, clinical presentation and bone marrow morphology of pancytopenia.Methods: This prospective observational study was conducted for a period of two years at Al-Ameen Medical College, Bijapur, Bangalore. During this period, fifty patients with a hematological diagnosis of pancytopenia were studied during period in the department of pathology.Results: Among the 50 cases studied, 35 were males and 15 were females. Most of the patients presented with generalized weakness and fever. The commonest physical finding was pallor, followed by splenomegaly and hepatomegaly. Dimorphic anemia was predominant blood picture. Bone marrow study showed 72% hypercellular marrow, 12% normocellular and 16% hypocellular marrow. The commonest cause for pancytopenia was megaloblastic anemia followed by iron deficiency anaemia and malaria.Conclusions: The present study concludes that detailed hematological investigations along with bone marrow examination in pancytopenic patients is helpful to diagnose or rule out the causes of pancytopenia.
Glove balloon uterine tamponade for post-partum haemorrhage: indigenous, readily available, cheap, easy to learn and practice, yet effective
Authors: Tasneem Fasiha , Sharma Vinutha M.
Published: January 2021

Background: Postpartum haemorrhage (PPH) is still a nightmare in obstetrics. It is the leading cause of maternal mortality and morbidity accounting for one quarter of the maternal mortality worldwide. In a simple language, we can say PPH is allowing the delivered woman to bleed till death. Uterine atony is the cause in 80% of cases.Methods: This study is conducted in a tertiary care and teaching hospital between May 2019-2020. There were 5400 vaginal and 2100 caesarean sections conducted in our institute in the study period. 20 patients who underwent vaginal delivery and 12 patients of caesarean section had PPH. Only one patient had unsuccessful glove tamponade who underwent stepwise devascularisation for her survival. Hence the success rate of glove tamponade in our institute is found to be 95% (n=19).Results: We chose glove as it is simple, safe, least invasive, rapidly made without any expertise, non-irritant, doesn’t rupture easily, doesn’t slip and cost effective. We have manually tried out the capacity of the glove and found to be enormous, of 10 litres. After a successful insertion of glove tamponade, it is left in situ for 24 hours in our study.Conclusions: In this era of advanced medical services, it is annoying to say women still die of postpartum haemorrhage. Timely intervention (medical or surgical) in the golden hour can bring back many mothers back to life.
Diagnostic yield of bronchoalveolar fluid/bronchoscopy among sputum AFB and CBNAAT negative presumptive tuberculosis patients: an observational study
Authors: Dubey Sakshi , Gaikwad Nitin , Meshram Shailesh , Bagrecha Mahavir
Published: January 2021

Background: Tuberculosis is one of the most common chronic infections globally, especially in developing countries like India and is a leading cause of morbidity and mortality. Therefore, early diagnosis, and microbiological confirmation of pulmonary TB is important to break the chain of transmission. This study was carried out to study usefulness of fiberoptic bronchoscopy in sputum smear negative and CBNAAT negative patient of presumptive tuberculosis.Methods: It was an observational study in the Department of Respiratory medicine for duration of 2 years (Sept 2018- Aug 2020) among 100 adults cases of presumptive tuberculosis whose sputum were negative on sputum AFB and CBNAAT. Cases with relative or absolute contraindication for bronchoscopy were excluded from study.Results: Mean age of study subjects was 47.31±12.29 years; M:F was 1.2:1 and 5% had past history of tuberculosis. Most common findings on chest X-ray was alveolar opacities (40%), inhomogeneous opacity (24%), cavitary lesions (20%), cystic lesion (8%) and fibrosis (6%) in different zones of lung. BAL sent for CBNAAT testing detected 15% mycobacterial TB, 2% mycobacterial TB with Rif resistance. Zn staining testing detected 10% AFB, on culture 14% showed AFB growth,4% had malignant cell findings. Diagnostic efficacy of Zn staining of BAL showed 42.86% sensitivity, 95.35% specificity, 60% PPV, 91.11% NPV and 88% diagnostic accuracy. BAL CBNAAT testing had 78.57% sensitivity, 93.02% specificity, 64.71% PPV, 96.39% NPV and 91% diagnostic accuracy. Most common complication was bronchospasm and hypoxia.Conclusions: Fiberoptic bronchoscopy is useful investigation in establishing accurate and early diagnosis of lower respiratory tract infection.
Environmental and water, sanitation and hygiene conditions in schools: a community-based cross-sectional study from North India
Authors: Aniruddh Ranga , J. P. Majra
Published: January 2021

Background: Schools environment is essential for children to achieve optimal health and development. Faulty construction leads to inadequate ventilation and moisture accumulation which increase the levels of morbidities. Schools should also serve as demonstration centres of good sanitation to the community hence healthful environment and functional toilets and WASH facilities are of utmost importance for school children.Methods: A community-based cross-sectional study includes randomly selected 50 schools of Sonepat district which were functional for more than 5 years. Schools were recruited by PPS. A schedule was used to assess the environment and WASH conditions. Percentage, proportion and Chi-square test were used as statistical methods. The p-value <0.05 was considered statistically significant.Results: 68.4% government schools and 51.6% private schools were located in a rural area. 68% schools were having multi-storied building, 72% schools were located at appropriate land. Ventilation was inadequate in 58% schools while all schools were having adequate lighting. Ergonomically sitting facilities were observed in one school only. Water treatment was done in 68% schools. Toilets were adequate in 58% schools but cleaning was done daily in 46% schools. Handwashing points were available in 96% schools but soap was observed in 10.4% schools only. Garbage disposal was observed to be sanitary in 52% schools while liquid waste disposal was sanitary in 44% schools.Conclusions: The study points towards deficiency of environment and WASH conditions in schools and recommends the school authorities to take corrective measures.
Analysis of posterior segment findings in acute encephalitic syndrome in a tertiary care institute
Authors: Dutta Parmita , Deuri Arup
Published: January 2021

Background: Objective of the study was to determine the posterior segment findings in cases of Acute Encephalitic Syndrome(AES) in patients attending the paediatrics department of Assam Medical College.Methods: A prospective study of 36 cases of AES attending the paediatrics department of Assam Medical College during a period of 6 months was taken into consideration.Results: 36 cases of AES were studied during a period of 6 months. The maximum number of cases was around 5 years (41.6%).The number of cases in males were more than in females (63.8%vs 36.1%) .The posterior segment findings were papilledema (44.4%), optic disc hyperemia (52.7%),and retinal hemorrhages(3%).Conclusions: Analysis of posterior segment findings helps in early detection and preventing the sequalae and complications and therefore helps in saving the eye.
Case series: eruptive xanthomas and hyperlipdaemia
Authors: Anaba Ehiaghe L. , Cole-Adeife Olufolakemi M. , Oaku Ruth I.
Published: January 2021

Eruptive xanthomas are uncommon with only case reports documented making it difficult to have a prevalence figure. These asymptomatic eruptions are usually a clue to an underlying metabolic disorder with associated cardiovascular risk. Early diagnosis and treatment prevent its associated morbidity and mortality. We present a case series of 2 males (29 and 40 years) and 3 females (14, 28 and 40 years old). They presented with lesions clinically consistent with eruptive xanthomas.  Laboratory and histologic investigations revealed dyslipidemia and lipid laden macrophages. They were placed on statins with an improvement of skin lesions and improvement in lipid levels. Dermatologists should be aware of skin lesions as a marker of severe dyslipidemia and its attendant cardiovascular risk. Early treatment leads to resolution of xanthomas and prevention of cardiac related morbidity and mortality.
Irreducible second and third metatarsophalangeal dislocation: a rare case report
Authors: Arnaya Agung K. , Karna Made B. , Asmara Anak A. G. Y. , Meregawa Putu F.
Published: January 2021

Metatarsophalangeal (MTP) articulations are complex structures that are prone to sprains, subluxations, and dislocations. MTP dislocations are an uncommon but well documented and problematic orthopaedic injury. Once the diagnosis is certain, the dislocation should be reduced as soon as possible. Immediate reduction of the dislocation can limit numerous complications. A 24-year-old male patients came to emergency department of Sanglah Hospital with 2nd and 3rd MTP joint dislocation. Patient treated with open reduction and immobilization with pinning for 2nd and 3rd metatarsal. After several attempt of closed reduction, the dislocation can be reduce with open reduction and immobilization with k wire, after 4 weeks k wire was removed without any complication and patient can walk normally. Irreducible metatarsophalangeal dislocation of the lesser toes is unusual with third toe was the most commonly affected, followed by the second, fourth, and fifth toes. Radiographs are very useful for diagnose. Multiple procedures have been created to attempt to reduce and stabilize the MP joint. According to other studies, Kirschner wires were also only used in unstable dislocations. In this case, dorsal surgical approach is the most commonly chosen method to reduce the irreducible metatarsophalangeal joint dislocations of the lesser toes. When irreducible dislocation found and closed reduction is initially unsuccessful, we recommend a dorsal surgical approach to open reduction and using Kirschner wires for unstable dislocations.
Actinomycosis of the appendix mimicking appendiceal tumor: a case report and review of the literature
Authors: Fuentes Huber Díaz , Cocom Quijano Carlos De Jesús , Moguel Héctor Omar Márquez , Estévez Marianne González
Published: January 2021

Actinomycosis is an uncommon entity caused by an anaerobic bacterium, Actinomyces Israeli, a component of the human oral and gastrointestinal flora. However, it can cause clinical disease, usually consisting of chronic inflammation and sinus tract formation. Abdominal actinomycosis, a rare entity itself, most commonly occurs at the appendix and in the ileocecal valve area. Authors present the case of a 24-year-old patient in which this disease presented as acute appendicitis resolved with a simple appendicectomy, and the etiology, actinomycosis was proved only in the histopathological report.
Wunderlich syndrome (spontaneous renal hematoma) as a cause of acute abdomen: a case report
Authors: Miranda Militza Cerrillo , Pereyra Molina Jose A. , Gonzalez Flavio Hernandez , Vazquez Barrios Carlos E. , Valmana Osvaldo I. Guevara , Lara Becerra Jose A.
Published: January 2021

Spontaneous renal hemorrhage, also known as Wünderlich syndrome, is a rare condition that can be life-threatening and consists of the onset of sudden hemorrhage into the subcapsular and perirenal spaces. It can be lethal as it goes unnoticed and requires aggressive treatment. The entity lies mainly in neoplasms, the malignant ones being the most common. We present the case of a 63-year-old female patient with acute abdomen clinic, a diagnostic laparoscopy was performed and renal hematoma was evidenced as the cause of the symptoms. It was managed conservatively without any complications. We emphasize the importance of keeping in mind Wünderlich syndrome as a differential diagnosis to instigate early treatment for a better outcome.
Synchronous phyllodes tumor and invasive breast carcinoma in contralateral breasts- a rare case report
Authors: Mathias Michelle , Joshi Divya , H. L. Kishan Prasad , K. Sajitha , Lobo Lancet , Hidangmayum Abena
Published: January 2021

Phyllodes tumours are rare breast tumours, accounting for 0.3-1% of all breast cancers and 2.5% of fibroepithelial tumours. They occur in younger age women in Asian countries. These can be classified into benign, borderline and malignant based on stromal hypercellularity, mitotic figures, cellular pleomorphism, stromal overgrowth and nature of the tumour borders. Synchronous coexistence of phyllodes tumour and invasive breast carcinoma in the contralateral breast is very rare, and probably the second one reported in the literature. Hereby, we report a case of a middle-aged woman presenting with a lump in the bilateral breast, diagnosed to have benign phyllodes of one breast and Invasive carcinoma of the contralateral breast.
Nasal intubation with bronchial blocker in a patient with difficult airway for thoracoscopic surgery
Authors: Koli Deepak C. , Kadakia Aditi P. , Latkar Prajakta D. , Mehta Hemant H.
Published: January 2021

We describe a case report of a 49 years old male, a case of Carcinoma tongue with one finger mouth opening operated multiple times, currently presented with pleural based soft tissue lesion in lower lobe of left lung with query metastasis posted for video assisted thoracoscopy surgery (VATS) SOS open thoracotomy and wedge resection of the lesion. Considering difficult airway due to restricted mouth opening we opted for an awake nasal fiberoptic intubation followed by general anaesthesia. One lung ventilation was achieved with CoopdechTM bronchial blocker type A with standard cuff size in left main stem bronchus. Postoperative course of patient was uneventful. In this case report we highlight the importance of use of fiberoptic bronchoscope and bronchial blocker for lung deflation in the management of difficult airway in VATS, as incomplete deflation of the nondependent lung during VATS can lead to poor surgical exposure and inadequate space for surgical manipulation which in turn can compromise the success of the procedure, and may possibly lead to conversion into an open approach.
Case study successful use of stent graft in post-catherization massive pseudoaneurysm of femoral artery with wide neck
Authors: Kunwar Brajesh Kumar , Ingle Farah , Ingle Atul , Tulasigeri Chandrasekhar
Published: January 2021

Pseudoaneurysms are not rare and can occur due to varied reasons including percutaneous vascular access. If left untreated, pseudoaneurysms can be fatal. Here, we have presented a classic case study where a large pseudoaneurysm of left femoral artery with very wide neck was closed using stent graft.  A 55 years old male was presented with severe painful large mass in left groin.  The mass was soft tissue swelling with severe tenderness and pulsatile in nature. The doppler suggested it to be filled with blood and communicating with femoral artery hence diagnosed as pseudoaneurysm. Attempt was made to compress the neck which was large not clearly defined, hence failed. Multiple interventional and surgical options of closure of pseudoaneurysm was discussed.  Patient was taken for stent graft deployment in cath lab. Check angiogram showed nicely flowing femoral artery with no signs of pseudoaneurysm. The patient immediately improved with decrease in pain and swelling.
Students’ feedback on exclusive 6-months online teaching during COVID-19 lockdown: a cross-sectional survey
Authors: Khilnani Ajeet Kumar , Thaddanee Rekha , Khilnani Gurudas
Published: January 2021

The corona virus pandemic has disrupted the human activities all across the globe and teaching-learning activity is no exception. In India, the nation-wide lockdown was announced in late March, and since then the main mode of undergraduate (UG) medical teaching has been through online classes. This is an unprecedented situation, both for medical teachers and students. Our institute initiated online classes for UG students from as early as mid-March, 2020. It has been more than 6 months of exclusive online teaching now and it was imperative to get overall feedback from students regarding its impact on their learning. It would provide useful inputs regarding utility, efficacy and opportunities to improvise further.
Impact of COVID-19 on surgical services in a District General Hospital in the United Kingdom: benefits versus drawbacks
Authors: El-Abbassy Islam H. , El-Hakim Hesham , Wong Mei Kei , McIntyre Robert
Published: January 2021

Background: COVID-19 outbreak led to significant changes in health services worldwide. This study aimed to assess the impact of this outbreak on the surgical services in a small District General Hospital and to highlight any benefits that we can take forward.Methods: Data were collected retrospectively comparing the surgical service activity during the two months (April and May 2020) around the peak of COVID-19 first wave in the UK and the similar two-month period the year before when activity was at its usual pre-COVID level. A short questionnaire on the use and satisfaction of remote consultation was circulated to all hospital consultants.Results: The total number of patients presenting to the emergency department in all specialities almost halved during the COVID-19 crisis. The number of emergency surgical admissions decreased. All elective lists were cancelled and more patients were managed conservatively. In April and May 2020, 156 patients had outpatient surgical consultations. Only 14 of them were face-to-face, whereas the rest were done either by telephone or video calls. This is compared to 472 patients who had face-to-face consultations in April and May 2019. The results of the questionnaire showed that over 90% of the consultants felt telemedicine consultations were satisfactory and that they would have an important role in the future.Conclusions: COVID-19 had serious impacts on surgical services regarding cancellation of elective lists and prolongation of waiting time. Despite these drawbacks, the increased confidence with telemedicine services was a significant benefit.
Current experience with emphysematous cholecystitis
Authors: Iqbal Ramiz , Wiadji Elvina
Published: January 2021

Background: Emphysematous cholecystitis (EC) is a rare variant of acute cholecystitis with a reported 15-25% mortality rate. Conventionally, EC is managed with an early open cholecystectomy. However, recent advancement in percutaneous intervention and laparoscopic techniques have influenced our management of this biliary pathology. This study reviews the management and outcomes of EC in a regional centre.Methods: Retrospective analysis of a clinical database constituting all patients diagnosed with EC at a regional Australian hospital in NSW from Jan 2010 to July 2019. Inclusion criteria: sepsis, abdominal pain and radiological evidence of gas in the gallbladder wall, lumen, and pericholecystic tissue in the absence of an abnormal connection between the gallbladder and gastrointestinal tract. We investigated patient risk factors, management and outcomes.Results: 16 patients with EC were identified. The mean age of the cohort was 73 years old. The majority of patients had co-morbidity including type 2 diabetes and ischemic heart disease (56 and 62% respectively). Laparoscopic cholecystectomies were performed in 9 patients during their index admissions and 7 patients were managed with PTC. 5 patients required ICU admission for septic shock, and all were managed with PTC drain placement. The overall mortality rate was 6%.Conclusions: Laparoscopic cholecystectomy on index admission is the treatment of choice for EC. Although more technically challenging, adverse clinical event including major complication and open conversion was avoided in our cohort while percutaneous cholecystostomy was reserved for unstable and poor surgical candidate.
Laparoscopic cholecystectomy: do upper GI and lower GI surgeons have similar outcomes?
Authors: Chidambaranath Rajesh , Thomas Pradeep F. , Zhen Siu Mei , Reynolds Tim
Published: January 2021

Background: Laparoscopic cholecystectomy is operation performed on a regular basis, regardless of surgeon’s primary specialty. Common complications include bile duct injury, bile leaks, bleeding, and bowel injury. In Tier 2 Hospitals, upper GI surgeons will manage patients with non-complex OG and HPB disease including laparoscopic cholecystectomy. The AUGSGBI proposed that laparoscopic cholecystectomy (LC) be performed by surgeons trained in upper GI surgery. NICE guidelines recommend similarly. Concentration of surgical expertise and volumes led to lesser conversions and complications. The aim was to compare the complication rates of consecutive patients undergoing laparoscopic cholecystectomy by upper and lower GI consultants in one hospital.  Methods: This was a retrospective observational study. We collected 100 consecutive patients from a list of laparoscopic cholecystectomies performed by upper GI surgeons (UGI) and lower GI (LGI) surgeons. All complications were identified from electronic patient records. Complications were recorded according to the Clavien and Dindo system. Median length of stay (LOS) was recorded and compared between the two groups. Results: There was no difference in between groups with respect to sex, age, length of stay or ASA grade, nor a significant difference in complication rates between surgeons of upper and lower GI surgeons.  Conclusions: In this study in a selected group, we did not find any difference in procedure related complications between operations conducted by upper GI and lower GI surgeon groups. However, there appeared to be a higher rate of port closure related complication at the umbilicus in operations performed by the lower GI team.
Effect of vitamin C on liver regeneration after partial hepatectomy and acetaminophen-induced liver injury in Wistar rats
Authors: Rudiman Reno , Wing Handy , Usman Nurhayat
Published: January 2021

Background: The aim of this study is to evaluate the potential effect of vitamin C as an antioxidant on liver regeneration after partial hepatectomy and acetaminophen-induced liver injury in Wistar rats.Methods: A total of 24 male Wistar rats were divided into four groups, each group consisted of 6 rats: group A (control, partial hepatectomy/PHx alone), group B (PHx and vitamin C 250 mg/kg BW), group C (acetaminophen 500 mg/kg BW and PHx), and group D (acetaminophen 500 mg/kg BW with PHx and vitamin C 250 mg/kg BW). Subtoxic dose of acetaminophen was given 24 hours before partial hepatectomy. Vitamin C was given orally via oral gavage for 6 consecutive days after partial hepatectomy. POD 7, all animals were terminated and performed laparotomy to obtain liver tissue for measurement of liver weight and regeneration rate, blood samples for malondialdehyde (MDA) as a lipid peroxidation measurement and histopathological investigation.Results: The means of regeneration rate in vitamin C groups were significantly higher compared to non-vitamin C group (p<0.05). Similar result, the means of MDA values in vitamin C groups were significantly lower compared to non-vitamin C group (p<0.05). This result suggests a protective effect of vitamin C against lipid peroxidation. Histopathological changes in liver cells were statistically difference between vitamin C groups and non-vitamin C groups (p<0.05).Conclusions: Our results indicate that vitamin C administration promotes liver regeneration and inhibits lipid peroxidation after partial hepatectomy and acetaminophen-induced liver injury in Wistar rats.
Comparative study of unilateral subcutaneous internal anal sphincterotomy and 02% diltiazem local application in acute fissure in ano: a study of 40 patients over 01 year
Authors: Varshney Priyanshu M. , Ray Mriganko S. , Nagyan Tushar , Malhi Sarvpreet S. , Thakore Digpal H. , Modi Naresh A. , Gupta Sandhya
Published: January 2021

Background: Two most demoralizing things in life are physical pain and bad body odour. A counted few body pains are as terrible, as oppressive and as tormenting, almost on daily basis as the pain of fresh acute fissure in ano. It pins your whole being, your awareness of life and focus of living on to your painful anus. Anal fissures are commonly encountered in routine colorectal practice. Fissure has traditionally been treated surgically. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment.Methods: 40 patients with acute fissure in ano were divided into 02% diltiazem gel and unilateral subcutaneous internal anal sphincterotomy (USIAS) groups. Patients in the two groups were followed up subsequently.Results: Anal fissures were found completely healed in 14 (70%) out of 20 patients treated with 02% diltiazem gel between 4-8 weeks. Healing was 100% with “USIAS” group. The mean healing duration of fissure was 04.45 weeks in diltiazem gel group and 03.45 weeks in “USIAS” group. 65% patients were free from pain after treatment with diltiazem gel whereas 95% patients were free from pain after treatment with “USIAS”.Conclusions: This prospective study, demonstrates that “USIAS” is superior to pharmacological treatment of anal fissure with good symptomatic relief, high rate of healing with very low rate of complication. Patients who are not willing to undergo surgery may be managed by 02% diltiazem as pharmacological line of management for fissure in ano.
The study of the prognostic outcome of necrotizing fasciitis patients with and without diabetes mellitus
Authors: Kaur Navjot , Mittal Seema , Kapoor Sudershan , Gupta Arun
Published: January 2021

Background: Necrotizing fasciitis is highly lethal infection. It can be defined as infection of any layers within the soft tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia or muscle). Early diagnosis and management with identification of co morbidities and treating them brings down the morbidity and mortality rate. To make a full assessment of the cause, all patients require a detailed history, examination and, investigations.Methods: This is a cross sectional comparative study of 50 patients having symptoms of necrotizing fasciitis to be divided into two groups of 25 patients each where one group is having diabetes mellitus and other group without diabetes mellitus.Results: Diabetes mellitus patients have more morbidity and mortality in term of more days of hospital stay, rate of amputations and number of debridements. Early diagnosis and early aggressive debridement is the mainstay of management. Aggressive surgical debridement at initial stages of presentation can halt the clinical process and patient can have better prognosis. In neglected diabetic patient’s debridement alone is not sufficient and amputation may be required in some cases.  Conclusions: Early diagnosis and aggressive debridement in necrotizing fasciitis patients results in better outcomes.
A study on the effectiveness of wells criteria for diagnosing deep vein thrombosis: a prospective observational study
Authors: Palanisamy Dhanaraj , Omkumar Akshay
Published: January 2021

Background: Wells score which takes into account various aspects in the history as well as various clinical signs which can help the clinician to arrive at a diagnosis of deep vein thrombosis (DVT). This helps to save time and money that is wasted in doing many unnecessary investigations. Aim of the study was to test the application of the Wells score in our clinical set up and to see how effectively we can diagnose DVT.Methods: This was a prospective diagnostic validation study of the wells rule for DVT in our setup, ultrasound (USG) being the gold standard comparison and will be conducted over a duration of 12 months. Wells score for each patient was calculated and the results were evaluated.Results: Among the 50 cases suspected DVT, the wells score was able to predict DVT in 46 of the cases thus proving to be a very efficient diagnostic indicator. The average wells score among the various cases was 4/8. Complications noted in the study group were 2 cases of cortical vein thrombosis in the post-partum period which fully recovered. Mortality rate in the study group was 4.3% in which a single case of diagnosed myocardial infarction died of heart failure.Conclusions: Wells score is indeed a very good predictive criteria for DVT and can be applied with ease as it required only clinical assessment and thus avoids unnecessary delays in waiting for scans thereby allowing us to start anticoagulants as early as possible.
Role of intralesional bleomycin in recurrent or residual keloids and hypertrophic scars
Authors: Mishra Bharat , Arora Chetna
Published: January 2021

Background: Keloids and hypertrophic scars are difficult to treat. There are many modalities available with variable success rate. Triamcinolone is still the most commonly used drug but recurrence and partial response to this conventional treatment is still a major concern. Many studies have proved the role and efficacy of intralesional bleomycin and this study was done to assess the role of intralesional bleomycin in recurrent and residual lesions.Methods: The patients with recurrent lesion or residual lesions after the injection of triamcinolone were enrolled in the study. Patients received local infiltration of bleomycin. The injections were scheduled at monthly intervals for three consecutive months. They were followed at 1st, 2nd, 3rd, and 12th months. Scar assessment was done by calculating its volume, Vancouver scar scale (VSS) and visual analogue score (pain and pruritis). Side effects were also recorded. Final assessment was done at 1year for any recurrence.Results: Twenty-five patients completed the study. The most common location of scars was presternal (52%) and trauma was the most common cause in scars (20%). We observed the decrease of volume of 75.85% which was highly significant on statistical analysis (p=0.001). Similarly, statistically significant difference was noticed in VSS, VAS for pain and pruritis. No systemic side effects were noticed. No recurrence was noted at the end of 12 months.Conclusion: Intralesional bleomycin is found to be useful in management of recurrent or residual lesions. It can be a potential option in the management of recurrent and residual hypertrophic scars and keloids.
Evaluation of clinical profile of acute pancreatitis in a tertiary centre
Authors: Goel Kanwar Singh , Garg Gulshan , Singla Sham L.
Published: January 2021

Background: Acute pancreatitis is a disease for which patients are in large numbers, etiology, clinical presentation and examinations are varied. Disease may be mild or severe, may lead to multi organ failures and death. Most common cause is biliary tract diseases. Other causes are alcohol consumption, post ERCP, trauma, idiopathic and drugs, viral infections, genetic mutations and connective tissue disorders.Methods: This is a prospective observational study conducted at SGT medical college, Budhera, Gurugram, Haryana, from January 2017 to June 2019 in 100 consecutive patients. Data collection included detailed recording of demography of patient, clinical presentation, any history of biliary tract disease, alcohol consumption, trauma, ERCP, comorbidities. Data was also collected about investigations done, treatment, recovery, complications and any intervention. Results: Most of the patients were from age group 41-55 years. Female patients were more than male patients. Etiology was mostly gall stone, alcohol, idiopathic, post ERCP and trauma. Pain, distention abdomen, vomiting, fever and jaundice were presenting features. Serum amylase, serum lipase, USG abdomen and CECT abdomen were diagnostic investigations. Complications included local and systemic. Mortality was 7%.  Conclusions: Acute pancreatitis is mild in most of the cases and recovery is good. Severe cases should be meticulously treated as mortality rates are higher. They should be treated in ICU under the guidance of intensivist. Our study results show that patients with severe diseases should be meticulously monitored clinically, biochemically, haemodynamically and radiologically.
Pre-operative serum albumin and body mass index as predictors of post-operative morbidity and mortality in perforation peritonitis secondary to peptic ulcer disease
Authors: K. R. Bhanu Prakash , Mohan Manasa , Patil Subhas
Published: January 2021

Background: Peptic ulcer disease (PUD) affects 4 million people worldwide annually. Perforated peptic ulcer is a serious complication of PUD and patients often present with acute abdomen that carries high risk for morbidity and mortality. This is worsened in patients who are malnourished. The incidence of malnutrition is around 30% in patients with gastrointestinal disease and is frequently unrecognized. Albumin or prealbumin levels may help identify these patients. Obesity is also another cause for morbidity and has deleterious effects on wound healing. Therefore this study was carried out to assess if preoperative serum albumin and body mass index can be used as predictors of morbidity and mortality in patients with perforated peptic ulcers.Methods: 70 patients with peptic perforation peritonitis presented to the hospitals attached to Bangalore Medical College and Research Institute from November 2018 to May 2020 and were included in the study. Pre-operative Serum Albumin and BMI was noted and the patients were followed up for 30 days.Results: Mean albumin level in our study was 3.01. The patients with Serum Albumin <3.5 g/dl have more complications compared to patients with >3.5 g/dl. Morbidity and mortality increases with severity of hypoalbuminemia. This study was statistically significant with a p value <0.05. In our study, we also found that patients with abnormal BMI have more complications than patients with normal BMI but it is statistically insignificant with a p value >0.05.Conclusions: Serum albumin is a good indicator for predicting postoperative morbidity and mortality in peritonitis secondary to peptic ulcer disease.
Pancreaticogastrostomy as a choice of reconstruction after pancreaticoduodenectomy: a hospital based observational study
Authors: Reddy Hetish M. , Bagree Rajendra , Panwar Pradeep , Jalendra Gaurav
Published: January 2021

Background: The aim of this study was to compare the rate of occurrence of post-operative pancreatic fistulae (POPF) and other complications with pancreaticogastrostomy (PG) or pancreatojejunostomy (PJ) as a choice of reconstruction in classic Whipple’s Procedure.Methods: A hospital based prospective observational study collected data of 60 patients who underwent Whipple’s procedure from June 2018 to august 2019, in two different surgical units, where one-unit preferred PG as routine while the other unit preferred PJ.Results: Two out of 30 patients who underwent PG (Group A) developed POPF while Nine out of 30 patients who underwent PJ (Group B) developed POPF (p-value = 0.04) indicating a significant difference in outcome. The duration of hospital stay (DOHS) in our study in Group A was 12.82±1.74 days when compared to Group B was 13.88±2.01 days (p-value = 0.042).Conclusions: Our results indicate that the preferred reconstruction after classic Pancreaticoduodenectomy should be Pancreaticogastrostomy, but further validation with randomized control trials or multicenter studies with larger sample size are required.
A study of upper gastrointestinal endoscopy in management of acute upper gastrointestinal bleed
Authors: Bansod Atish N. , Shingade Amarsingh , Mishra Sarvagya
Published: January 2021

Background: Upper gastrointestinal bleeding (UGIB) is life threatening emergency that remains a common cause of hospitalization worldwide. In spite of tremendous advancement in management of upper gastrointestinal bleeding (UGIB) over past two decades, it carries considerable mortality, morbidity. The present study was undertaken to know the clinical profile, endoscopic profile, intervention, outcome and mortality of upper GI bleed.Methods: A total of 110 patients of UGIB were evaluated over a period of 30 months for etiology of UGIB like peptic ulcer, variceal bleeding, gastritis, Barrett’s esophagus and malignancy. Therapeutic Intervention (Band ligation, glue injection, clipping etc.) was done as required on case to case basis.Results: Hematemesis was the most common symptom with 62(56.36%) patients. 85(77.27%) patients were presented during first episode of their bleeding. Esophageal varices 50 (45.45%) was the most common diagnosis and the most common past history was alcohol intake 48 (43.63%). 55 (50%) patients required only medical (Pharmacological) management and 50 (44.54%) patients require endoscopic management. 102 (92.72%) were improved and subsequently discharged while 8 (7.27%) patients expired during the course of treatment.Conclusions: Endoscopic examination is an important modality in both diagnosis and managing UGIB and helps to reduce morbidity, mortality and also need for surgery of the disease significantly.