Role of early contrast enhanced CT scan in severity prediction of acute pancreatitis.

Severe pancreatitis occurs in approximately 15-25% of patients with acute pancreatitis. The objective of our study was to compare the CT Severity Index (CTSI) with a clinical score (BISAP score) to predict severity of acute pancreatitis. Forty-eight consecutive patients with acute pancreatitis who underwent contrast enhanced CT scan within 72 hours of presentation were included. Results of our study showed that both CTSI and BISAP score were reliable predictors of mortality (p value = 0.019 and <0.001 respectively) and need for mechanical ventilation (p value = .002 and .006 respectively). Positive predictive value of CTSI to predict recovery without intervention was 91.4% as compared to 78% for that of BISAP score. Receiver Operating Characteristics (ROC) Curves showed CT scan was superior to BISAP Score in predicting need of percutaneous or surgical intervention. Early CT scan may be utilized for prediction of clinical course of patients with acute pancreatitis.

Portal hypertensive biliopathy: review of pathophysiology and management.

Portal hypertensive biliopathy is described as abnormalities of the walls of the biliary tree secondary to portal hypertension. In literature it has also been named as "Cholangiopathy associated with portal hypertension", "Portal biliopathy" and "Portal cavernoma associated cholangiopathy". It is usually asymptomatic and found incidentally, but rarely patients do present with symptoms of abdominal pain, jaundice, asthenia and fever. Treatment is warranted in symptomatic cases only, and is dictated by the clinical manifestations and complications of the disease process. Due to presence of underlying severe portal hypertension, endoscopic biliary intervention is usually the first line of management, and is relatively safe and often sufficient. When surgery is resorted to, a porto-systemic shunt prior to biliary bypass procedure provides early relief of obstructive biliary symptoms and often precludes the need for a biliary bypass surgery. This review describes the pathophysiology, presentation, progression and management approaches to portal biliopathy.

Effectiveness of Laparoscopic Skills Workshop on Enhancing Knowledge and Skills of Surgical Residents and Its Comparison with DOPS (Direct Observation of Procedural Skills) Scores: Prospective Cohort Study.

INTRODUCTION: Simulation-based surgical skills workshops are commonly used in the surgical training programs to enhance the knowledge and psychomotor skills of the residents, but there is scarcity of objective data on their effectiveness. The aim of our study was to explore if a 1-day laparoscopic skills workshop enhanced the knowledge and skills of surgical residents in minimal access surgery and if it had any correlation with the Direct Observation of Procedural Skills (DOPS) scores. METHODS: This was a quasi-experimental, single-arm, repeat measure, prospective cohort study design. Thirty-three residents from general surgery and obstetrics/gynecology programs of Aga Khan University participated in the study. A daylong laparoscopic skills workshop consisting of lectures, videos, and hands-on practice was offered. The pre-workshop knowledge and skills scores of residents were assessed and compared with immediate post-workshop scores and scores of repeat assessment at 2 months. The scores of DOPS on laparoscopic procedures before and after the workshop were also compared. RESULTS: The results of our study indicated that mean post-workshop (p < 0.001) and interval scores (p < 0.001) for both cognitive and psychomotor skills were significantly higher compared with mean pre-workshop scores. Similarly, post-workshop DOPS scores were significantly higher (p < 0.011) compared with pre-workshop DOPS scores. CONCLUSIONS: One-day laparoscopic skills workshop resulted in significant improvement in knowledge and psychomotor skills of the surgical residents. The skills gained from the workshop also resulted in improvement of DOPS scores reflecting the transfer of skills to real-life performance. TRIAL REGISTRATION: ClinicalTrials.gov registration number: NCT03982927.

Surgical grand rounds at a University Hospital. Applying "publication presentation index" to evaluate outcomes.

BACKGROUND AND OBJECTIVE: Surgical grand rounds (SGR) are an important educational activity in all teaching hospitals however each institute has its own way of conducting them. At our institute, grand rounds in the Department of Surgery include an original research presentation by residents. The publication of the research work acts as a measure of its success. In this study we analyzed the outcome of this activity and review factors affecting their progression to publication. METHODOLOGY: We conducted a retrospective review of a prospectively maintained database of all presentations made at the Surgical Grand Round at a University Hospital from January 2001 to December 2010. Presentations with incomplete follow up records were excluded from analysis. A Publication-Presentation Index (PPI) was used to evaluate outcomes of SGRs and to study factors influencing outcomes. Differences in PPI in each category were calculated using the chi square test. RESULTS: Total of 470 presentations were made. Majority presented retrospective studies (73%). Majority of the presentations were made by junior residents (year 1-3, 62%). Following presentation, 279 (59.4%) studies were presented at a national conference, 80 (17%) were presented at an international forum while only 99 (21.1%) studies were published. Mean presentation to publication time was 34.8 months. Study design, level of resident, section of surgery, sample size and national/international presentation were associated with conversion to a publication (all p < 0.05). Overall PPI was 0.32. Randomized controlled trials had the highest PPI (0.67). CONCLUSION: The proportion of SGR presentations converted into national/international presentations and/or publications was found to be low. The PPI has a potential to be used as a tool to study the association of presentation to publication.

Localised fungal infection in a prosthetic mesh treated conservatively.

Infection remains one of the most challenging complications of mesh hernioplasty. The authors report a case of a 28-year-old male with no known comorbidities who underwent reversal of ileostomy and prolene mesh hernioplasty. His wound was left open for delayed primary closure, although daily dressing started from second postoperative day. He developed fungal infection of prolene mesh on fifth postoperative day which was successfully treated with irrigation and daily wound dressing with amphotericin B avoiding the complications associated with mesh excision. He made an uneventful recovery and on last follow-up his wound was granulating well with no signs of infection.