Telemedicine-based new patient consultations for hernia repair and advanced abdominal wall reconstruction.

PURPOSE: Telemedicine has emerged as a viable option to in-person visits for the evaluation and management of surgical patients. Increased integration of telemedicine has allowed for greater access to care for specific patient populations but relative outcomes are unstudied. Given these limitations, we sought to evaluate the efficacy of telemedicine-based new patient preoperative encounters in comparison to in-person encounters. METHODS: We performed a retrospective analysis of adult patients undergoing new patient evaluations from April 2020 to October 2021. Telemedicine visits consist of both video and telephone-based encounters. Visit types, patient demographics, preoperative diagnosis, travel time to the hospital, and prior imaging availability were reviewed. RESULTS: A total of 276 new patient encounters were conducted (n = 108, 39% telemedicine). Indications for evaluation included inguinal hernia (n = 81, 30%), ventral hernia (n = 149, 54%) and groin or abdominal pain (n = 30, 11%). Patients undergoing telehealth evaluations were more likely to have greater travel distance to the hospital (91 km vs 29 km, p = 0.002) and have CT image-confirmed diagnoses at the initial visit (73 vs 47%, p < 0.001). Patients who were evaluated for a recurrent or incisional hernia were more likely to be seen through a telemedicine encounter (69 vs 45%, p < 0.001). CONCLUSIONS: We report the efficacy of telemedicine-based consultations for new patient preoperative evaluations related to hernia repair and abdominal wall reconstruction. Telemedicine is a useful modality for preoperative evaluation of new patients with hernia and advanced abdominal wall reconstruction needs. Understanding this patient population will allow us to optimize telemedicine encounters for new patients and improve access to care for patients in remote locations.

Leprosy patients with deformities at post-elimination stage: The Bangladesh experience.

Background: Disability assessment in leprosy patients is a very important factor in the evaluation of the effectiveness of a leprosy elimination program. Little information exists on deformities in leprosy patients in Bangladesh. Objectives: To describe the pattern and prevalence of deformities in leprosy patients after leprosy has been declared eliminated from Bangladesh in 1998. Methods: A descriptive retrospective cross-sectional study was carried out in Chittagong Medical College Hospital using the registered records of patients for the period 2004-2013. Results: Out of 670 leprosy patients, 213 (31.79%) had deformities. The prevalence of deformity was for grade 1: 92 (43.20%), for grade 2: 121 (56.80%). Among the patients with deformity, males 144 (67.60%) outnumbered females 69 (32.40%). Four age groups were considered. The calculated age-specific cumulative detection rates showed the highest case detection in >40 years group at 81 (38.02%). The rate of children (<14 years) was less at 7 (3.29%). Of the 213 patients with deformity, the borderline tuberculoid patients were totalled 79 (37.08%), which was higher than other forms of leprosy. Among the 121 patients with limb deformity, 57 (8.50%) had claw hand followed by wrist drop 31 (4.63%), foot drop 30 (4.48%). Three (0.45%) had a nerve abscess, 27 (4.02%) had a trophic ulcer and 7 (1.05%) patients had ocular complications. Conclusion: The grade 2 deformities among newly detected leprosy patients were still high. Claw hand was the most common deformity in the upper limbs, whereas foot drop and trophic ulcer were the most common deformities in the lower limbs. Although leprosy according to the World Health Organization has been eliminated globally, the disease continues to be a significant cause of peripheral neuropathy, deformity, disability and disfigurement in some developing countries like Bangladesh.

Genetic Diversity Based on Coat Protein of Papaya ringspot virus (Pathotype P) Isolates from Bangladesh.

The coat protein (CP) sequences of twelve Papaya ringspot virus (PRSV) (pathotype-P) isolates from six major papaya growing areas were determined and compared with those of published PRSV. The CP coding region varied in size from 846-852 nucleotides, encoding a protein of 282-284 amino acids. Comparative CP sequence analysis revealed that the PRSV-P isolates originating from Bangladesh were divergent up to 14 % at amino acids level. Further, the isolates from Bangladesh shared 86-95 % amino acid sequence identity with those reported from rest 21 of the Asia and 83-93 % amino acid sequence identity with isolates from the other parts of the world. A number of KE repeats were observed in the N terminus of the CP coding region of all Bangladesh isolates. Phylogenetic branching pattern revealed that the PRSV-P isolates originating from Bangladesh formed a distinct clade from those from the rest of the world. This forms the first report on the genetic diversity of PRSV-P isolates from Bangladesh.

First Report of Groundnut bud necrosis virus in Tomato in Bangladesh.

An unusual disease of tomato characterized by leaf mottling and necrotic streaks on veins, shortened internodes, necrosis of terminal buds, and concentric rings on fruits was observed during 2010 to 2011 surveys in tomato growing regions of Godagari Upzila, Rajshahi district, Bangladesh. Disease incidence in popularly grown F1 hybrid cultivars, which include Sobal, Abhiruchi, Salamat, Bangobir, and BARI hybrid tomato-5 and -6 in about 40 commercial fields, ranged from 40 to 90%. Extracts from the field samples (n = 10) reacted with polyclonal antiserum to Groundnut bud necrosis virus (GBNV) in direct antigen coated ELISA, suggesting the association of a tospovirus antigenically related to serogroup IV topsovirus (1). To identify whether the tospovirus was a distinct virus species, ELISA-positive samples were subjected to total RNA extraction with an RNeasy Plant Mini Kit (Qiagen, Chatsworth, CA) followed by reverse transcription (RT)-PCR with tospovirus-specific primers (5'-ATGGTTGAAAAGAGCAAGAATGATGC-3') and degenerate primer (5'-CTTCTTATGAAGTGTACTCACCATAAGTCATCC-3') derived from the conserved sequences of GBNV, Watermelon bud necrosis virus (WBNV), and Capsicum chlorosis virus (CaCV) (2). The RT-PCR product was cloned into pGEM-T Easy vector (Promega, Madison, WI) and sequenced at Department of Biochemistry, University of Delhi, South Campus, Delhi, India (GenBank Accession No. JQ692083). The sequences of cloned fragments were assembled. Analysis of the 477-bp region of the nucleocapsid protein (N) gene revealed that the tomato tospovirus shared maximum identity both at the nucleotide (96%) and amino acid (97%) levels with the corresponding region of GBNV. In contrast, only 78 to 81% and 85 to 87% identity at nucleotide and amino acid levels, respectively, was observed with the corresponding region of the N genes of CaCV, WBNV, and Watermelon silver mottle virus. These results suggested the association of GBNV with the diseased tomato samples. To our knowledge, this is the first report of GBNV infecting tomato in Bangladesh and regular surveys are necessary to ascertain the prevalence and incidence of GBNV in other crops. References: (1) R. K. Jain et al. J. Virol. Methods 130:162, 2005. (2) M. Tsompana and J. W. Moyer. Tospovirus. Page 157 in: Encyclopedia of Virology. Academic Press, New York, 2009.

Epilepsy in children with cerebral palsy.

This was a prospective analytical study done from October'99 through December 2000 to observe the clinical profile of epilepsy in children with cerebral palsy. Sixty epileptic children with cerebral palsy were studied and their results were compared with the results of epilepsy in 30 developmentally normal children. Ages of all children studied were 1-15 years. Majority were below five years of age and male out numbered female. Spastic quadriplegia (60%) was the commonest type of cerebral palsy. Generalized tonic-clonic seizure (66%) was the commonest seizure type in both groups. Second most common type of seizure was partial (13%) and myoclonic (29%) in developmentally normal and cerebral palsy children respectively. Mental retardation (63%) and speech delay (58%) were the two common associated problems in cerebral palsy patients. Ventriculomegaly (55%) was the commonest computed tomographic findings in cerebral palsy patients. In electro encephalography generalized epileptiform activity was the commonest finding in both groups. Clinical pattern is different in many ways when epilepsy is associated with cerebral palsy.

Effect of cimetidine, ranitidine and tiotidine on plasma testosterone and luteinizing hormone levels in rats.

This investigation was carried out to study the comparative effects of cimetidine, ranitidine and tiotidine on the plasma levels of testosterone and luetinizing hormone under local conditions. The three H(2)-blocking drugs were injected to the adult male albino rats twice daily at the recommended therapeutic dose levels for six weeks. The data obtained showed that only tiotidine caused a significant (<0.05) increase in the level of testosterone. However, all the three drugs caused a significant rise in the levels of luteinizing hormone with the most active ranitidine administration.

Fetal exsanguination associated with antepartum hemorrhage.

Fetal bleeding in utero is infrequent. It is usually life-threatening but can be treated successfully in most cases if recognized early. Four cases are described and it is suggested that screening for fetal blood be done in all instances of antepartum hemorrhage.

Respiratory distress syndrome and the value of amniotic fluid phospholipids in predicting such complications before birth.

The amniotic fluid study of 80 samples from 40 patients, obtained by amniocentesis between 28 and 40 weeks of pregnancy, was carried out. It was noted that L/S (Lecithin/Sphingomyelin) ratio was significantly different at 36-38 weeks of pregnancy when compared with values in pregnancies of less than 36 weeks gestation (P less than 0001). No cases of RDS occurred when the L/S ratio was mature 4 or more. A brief review of recent developments in etiology of RDS are also presented.

The use of ultrasound in obstetrics and gynecology.

Advantages of ultrasound as a diagnostic tool are many. The patient experiences no discomfort, nor does she feel any sensation. The patient can be examined without moving from her bed. Unlike x-ray, there is no danger of exposing the fetus and the mother to adverse effects of radiation. Its application in determination of fetal death, early in pregnancy, diagnosis of hydatidiform mole and localization of the placenta in cases of antepartum hemorrhage are only some of the obvious applications of this method.

Vaginal versus abdominal tubal ligation. Study at Victoria General Hospital.

PIP: Comparisons of two methods of sterilization on 250 patients at Victoria General Hospital, Nova Scotia, Canada between January 1968 and December 1970. There were 85 vaginal procedures and 165 abdominal procedures; 50 cases were lost to follow-up. Average age of the women was 35 years, average parity was 3.5 children. Average hospital stay was 4.0 days with the vaginal approach and 6.5 days with the abdominal approach. Hydrosalpinx was discovered in 3 women who had vaginal ligations, and in 2 who had abdominal ligations. Menstrual changes were reported by 15 women; 8 had vaginal ligation, 7 abdominal ligation. Dysmenorrhea was experienced by 5 women; 3 undergoing vaginal ligation and 2 abdominal ligation. Morbidity rate with abdominal ligation was 3.2% and 8.3% with vaginal ligation. Operative failure was 1.17% with the vaginal approach. Menstrual irregularities, dysmenorrhea, dyspareunia, and hydrosalpinx seemed more frequent in the vaginal ligations. Cost-wise the vaginal approach has the advantage but should be carried out on selected patients using a skilled staff.^ieng