Sphincter of Oddi disorder (SOD): Is it necessary to investigate and treat?

Sphincter of Oddi disorder (SOD) is a part of functional gastrointestinal disorder which is a non-calculous obstructive disorder. This disease is more common in middle-aged women with a prevalence of around 1.5% but in patients with post-cholecystectomy syndrome (PCS) the prevalence rate is markedly higher (9-55%). This high variability maybe attributed to lack of uniformity in patient selection criteria, definition of SOD, and the diagnostic method used. Abdominal pain is the most common symptom occurring due to obstruction at the SO leading to ductal hypertension, ischemia from spastic contraction and hypersensitivity of papilla. Clinical diagnosis of SOD can be achieved by Rome III criteria. Various classifications are used (Milwaukee billiary and modified Milwaukee group classification) for billiary and pancreatic SOD. Not a single non-invasive method is diagnostic. Sphincter of Oddimanometry (SOM) is the gold standard method for evaluating and deciding the management of an SOD patient. The symptomatic relief rate varies from 55% to 95%, so risk-benefit ratio should be evaluated with each patient.

Chromosomal structural analysis in carcinoma of the gallbladder.

BACKGROUND: The etiopathogenesis of gallbladder cancer is still unknown. Both environmental and patient factors have been incriminated in its cause. That it is found in pockets of epidemiological distribution raises an issue of genetic changes associated with it. The aim of this study was to find out the chromosomal changes in gallbladder cancer. METHODS: Lymphocyte cell culture was carried out on blood of gallbladder cancer patients to determine chromosomal banding abnormalities. Native PAGE was also evaluated to analyze lactate dehydrogenase (LDH), superoxide dismutase (SOD) and catalase enzyme activity from the same blood of gallbladder cancer patients. RESULTS: Out of 30 gallbladder cancer patients, 4 male showed breakage on the long arm of chromosome 1 while only one male patient showed the translocation from the long arm of chromosome 4 to the long arm of chromosome 6 in a male patient. CONCLUSION: The aberrations found in our study may suggest underlying genetic predisposition for the development of gallbladder cancer. They can act as a marker for gallbladder cancer, which needs further study.

Intravenous catheter associated complications.

Two cases of intravenous catheter associated complications are reported herewith.

Impact of Shutdown due to COVID-19 Pandemic on Aerosol Characteristics in Kanpur, India.

BACKGROUND: Since March 2020, the number of confirmed COVID-19 positive cases have steadily risen in India. Various preventive measures have been taken to contain the spread of COVID-19. With restrictions on human activities, anthropogenic emissions driving air pollution levels have seen a reduction since March 23, 2020, when the government imposed the first nationwide shutdown. The landlocked Indo-Gangetic Plain (IGP) has many densely-populated cities, witnessing high levels of particulate matter due to both nature-driven and anthropogenic elements. Kanpur is an urban metropolis in the IGP with high aerosol loading, and this paper explores the impact of restricted anthropogenic activities on aerosol characteristics in Kanpur. OBJECTIVES: This study aims to investigate the change in aerosol optical depth level and its related parameters during the shutdown phases in Kanpur city compared to the same time periods in 2017-2019. METHODS: Aerosol optical properties such as aerosol optical depth (AOD) at 500 nm, Angstrom exponent (AE), fine mode fraction (FMF) of AOD at 500 nm and single scattering albedo (SSA) at 440 nm were obtained from the Aerosol Robotic Network (AERONET) station operating in Kanpur from the 1st March to the 30th April for 2017-2020. RESULTS: A significant decrease in aerosol loading was observed during the shutdown period compared to the pre-and partial shutdown periods in 2020 as well as during the same time periods of 2017-2019. Mean AOD, FMF and SSA were 0.37, 0.43 and 0.89, respectively, during the shutdown period in 2020. A 20-35% reduction in mean AOD levels was observed during the shutdown period in 2020 as compared to the same period in 2017-2019. CONCLUSIONS: The shutdown led to an improvement in air quality due to decreases in anthropogenic emissions. As fine particles, typically from urban and industrial emissions, dominate episodic air pollution events, this study can be further utilized by the scientific community and regulators to strengthen the emergency response action plan to check high pollution episodes in Kanpur city until cleaner technologies are in place. COMPETING INTERESTS: The authors declare no completing financial interests.

Air quality forecasting using artificial neural networks with real time dynamic error correction in highly polluted regions.

Air pollution is an important issue, especially in megacities across the world. There are emission sources within and also in the regions around these cities, which cause fluctuations in air quality based on prevailing meteorological conditions. Short term air quality forecasting is used not to just possibly mitigate forthcoming high air pollution episodes, but also to plan for reduced exposures of residents. In this study, a model using Artificial Neural Networks (ANN) has been developed to forecast pollutant concentration of PM10, PM2.5, NO2, and O3 for the current day and subsequent 4 days in a highly polluted region (32 different locations in Delhi). The model has been trained using meteorological parameters and hourly pollution concentration data for the year 2018 and then used for generating air quality forecasts in real-time. It has also been equipped with Real Time Correction (RTC), to improve the quality of the forecasts by dynamically adjusting the forecasts based on the model performance during the past few days. The model without RTC performs decently, but with RTC the errors are further reduced in forecasted values. The utility of the model has been demonstrated in real-time and model validations were performed for the whole year of 2018 and also independently for 2019. The model shows very good performance for all the pollutants on several evaluation metrics. Coefficient of correlations for various pollutants varies from 0.79-0.88 to 0.49-0.68 between the Day0 to Day4 forecasts. Lowest deterioration of performance was observed for ozone over the four days of forecasts. Use of RTC further improves the model performance for all pollutants.

Activation tagging of the floral inducer FT.

FLOWERING LOCUS T (FT), which acts in parallel with the meristem-identity gene LEAFY (LFY) to induce flowering of Arabidopsis, was isolated by activation tagging. Like LFY, FT acts partially downstream of CONSTANS (CO), which promotes flowering in response to long days. Unlike many other floral regulators, the deduced sequence of the FT protein does not suggest that it directly controls transcription or transcript processing. Instead, it is similar to the sequence of TERMINAL FLOWER 1 (TFL1), an inhibitor of flowering that also shares sequence similarity with membrane-associated mammalian proteins.

Targeting connexin 43 in diabetic wound healing: future perspectives.

The unknown mechanisms of impaired tissue repair in diabetes mellitus are making this disease a serious clinical problem for the physicians worldwide. The lacuna in the knowledge of the etiology of diabetic wounds necessitates more focused research in order to develop new targeting tools with higher efficacy for their effective management. Gap-junction proteins, connexins, have shown some promising results in the process of diabetic wound healing. Till now the role of connexins has been implicated in peripheral neuropathy, deafness, skin disorders, cataract, germ cell development and treatment of cancer. Recent findings have revealed that gap junctions play a key role in normal as well as diabetic wound healing. The purpose of this review is to provide the information related to etiology, epidemiology, clinical presentation of diabetic wounds and to analyze the role of connexin 43 (Cx43) in the diabetic wound healing process. The current control strategies and the future research challenges have also been discussed briefly in this review.

Long-term fertilization and manuring with different organics alter stability of carbon in colloidal organo-mineral fraction in soils of varying clay mineralogy.

Majority of organic matter is bound to clay minerals to form stable colloidal organo-mineral fraction (COMF) in soil. Stability of carbon (C) in COMF is crucial for long-term C sequestration in soil. However, information on the effect of long-term fertilization and manuring with various organic sources on C stability in such fraction in soils with varying clay mineralogy is scarce. The present study was, therefore, carried out to assess the effect of thirty-one years of continuous fertilization and manuring with different organics on C-stability in COMF extracted from an Inceptisol, a Vertisol, a Mollisol, and an Alfisol. The treatments comprised of control (no fertilization), 100% NPK (100% of recommended N, P and K through fertilizer), 50% NPK+ 50% of recommended N supplied through either farm yard manure (FYM) or cereal residue (CR) or green manure (GM). The stability of C (1/k) in COMF was determined from desorption rate constant (k) of humus-C by sequential extraction and correlated with extractable amorphous Fe-Al-Si-oxides, and crystallite size of illite minerals. Long-term fertilization and manuring with the above sources of organic altered the contents of amorphous Fe-Al-Si-oxides, and decreased the crystallite size of illite in all the soil orders. Fifty percent substitution of fertilizer N by various organics significantly increased C-stability in COMF by 27-221% (mean 111%) over full dose of NPK (100% NPK). Smectite dominating Vertisol exhibited highest stability of C followed by the Mollisol, the Inceptisol and the Alfisol. Stability of such C in soil was correlated positively with the amount of amorphous Fe and Al oxides but negatively with crystallite size of illite (r = -0.46, P < 0.01). Application of NPK + GM or NPK + FYM in Inceptisol, Vertisol and Mollisol and NPK + GM or NPK + CR in Alfisol emerged as the best management practices for higher stabilization of C in COMF for long-term C sequestration.

Risk assessment for pressure ulcer: a hospital-based study.

AIM: To identify patients at risk for developing pressure ulcer among hospitalized patients and the prevalence of pressure ulcer in this group. PATIENTS AND METHOD: A prospective study included 100 patients from medical and surgical wards. Data were collected on admission, and subjects were followed up at regular intervals. The Waterlow pressure ulcer risk assessment tool was completed and patients were stratified "as not at risk," "at risk", "high risk", and "very high risk". Subjects were then monitored for 2 weeks and the actual incidence of pressure ulcer formation was analyzed in the various risk groups. RESULTS: Of 100 patients studied, 20% were at risk, 10% were assessed at high risk, and 7% were classified as at very high risk for developing a pressure ulcer. Necessary preventive measures were taken (posture change, specialized beds/mattresses, nursing care, nutritional input, etc) for those patients at risk of development of pressure ulcer. Four of 7 patients (57.1%) who were at very high-risk developed pressure ulcer as compared with 2 of 10 patients (20%) categorized in the high-risk category within a period of 2 weeks. No patient who was classified as not at risk on the Waterlow pressure ulcer risk assessment tool developed a pressure ulcer within the observation period. CONCLUSION: Pressure ulcers developed in identified risk groups despite adequate available preventive measure being taken to prevent their development. It is of extreme importance to identify patients at risk for the development of pressure ulcers so that preventive measures can be instituted to reduce the incidence of hospital-acquired pressure ulcers.

Expression Analysis of Survivin and XIAP in Gallbladder Cancer: a Case-control Study in Indo-Gangetic Plain.

PURPOSE: Gallbladder cancer is a highly mortal disease with poor prognosis because of late presentation of disease. Survivin and X-linked inhibitor of apoptosis (XIAP) are one of the two important members of inhibitors of apoptosis. Thus, this study aimed to look at the expression of Survivin and XIAP in gallbladder cancer patients. METHODS: Survivin and XIAP expression were investigated in tissues of gallbladder cancer patients (40 cases) and compared with cholelithiasis as control (40 cases) by using immunohistochemistry. Their expression was correlated with clinicopathological parameters. RESULTS: Significantly higher (p < 0.05), Survivin protein was expressed in gallbladder cancer (n = 67.5%) than control (n = 35%). But it did not show any significant association with any of the clinicopathological parameter while XIAP was not expressed in the GBC patients (p > 0.05). CONCLUSION: Overexpression of Survivin in gallbladder cancer suggests its possible role and association with poor prognosis. But XIAP has not been found to be associated with gallbladder carcinogenesis.

Evaluation of pH measurement as a method of wound assessment.

OBJECTIVE: To assess variations in wound pH levels and explore the relationship between wound pH and the state of wound healing. METHOD: Fifty patients with acute or chronic wounds attending the wound clinic at University Hospital,Varanasi, India were included. Wound pH was measured using litmus paper strips and recorded weekly. Other parameters recorded were the wound condition, exudate level and culture. RESULTS: The baseline pH of most of the wounds was greater than 8.5. As the wound condition improved and exudate levels decreased, the pH reduced to less than 8.0. Fifty-eight per cent of the wounds were culture positive, and an association was observed between the type of organism present and the wound pH. CONCLUSION: Wound pH measurements can be performed efficiently and are non-invasive, causing no discomfort to the patient. As the wounds healed, the pH reduced. This change in pH can help predict the likelihood of wound healing.

Abdominal compartment syndrome--an old syndrome, a new perspective.

The abdominal compartment syndrome is a life threatening condition resulting from pathologic elevation of the intraabdominal pressure. Prompt diagnosis is required to avoid significant sequelae. Diagnosis of this syndrome is based on clinical findings and intra abdominal pressure monitoring. Treatment consists of decompressive laparotomy, which corrects the pathology. Various surgical techniques are described to manage the open abdomen. Despite considerable attention accorded to this disorder, it is still associated with high morbidity and mortality. This review article deals with the identification of risk factors, pathophysiology, diagnostic criteria and treatment of critically ill patients with the abdominal compartment syndrome.

Leiomyosarcoma of kidney: a case report with long term result after radiotherapy and chemotherapy.

Leiomyosarcoma of the kidney is a rare entity with poor prognosis. Among renal sarcomas, it is the most common histologic subtype amounting to 50-60% of all cases. The tumors usually arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall. We describe a case of renal leiomyosarcoma that presented with history of left flank pain. Physical examination was normal. Abdominal ultrasound showed a solid lesion of 38 x 36 mm arising from the left kidney. Intravenous urography showed cut off of both major and minor calyces of the left kidney from its pelvis with a normal right kidney. Exploratory laparotomy revealed a well-encapsulated mass confined to the renal parenchyma for which radical nephrectomy was performed. Histopathology showed a Grade I leiomyosarcoma arising from the renal capsule. Adjuvant chemotherapy and sandwich radiotherapy was given and he is disease free after six and half years of follow up. The rarity of this disease, its severity and poor prognosis, uncommon form of presentation, resulting delay in diagnosis and difficulty in management is highlighted and reported.

Dietary intake of metals by Mumbai adult population.

Daily intake of 12 metals (Na, K, Ca, Cu, Zn, Fe, Mn, Mg, Pb, Cd, Co and Ni) by Mumbai adult population were assessed by analysing duplicate diet samples. These metals were determined by flame atomic absorption spectrophotometry (AAS) and stripping voltammetric techniques. A total of 250 diet samples containing 170 vegetarian diet and 80 non-vegetarian diet collected during April 2003 to March 2004 were analysed during this study. Daily dietary intakes of 2.4 g Na and 1.2 g K were observed for Mumbai adults. Daily dietary intakes of Ca, Cu, Zn, Fe, Mn and Mg were 367, 1.0, 6.3, 6.7, 2.0 and 304 mg, respectively. Pb, Cd, Co and Ni intakes by Mumbai adults were 32.3, 2.2, 2.2 and 108 microg/day, respectively. From this study it has been observed that the intake of toxic metals such as Pb, Cd and Ni is much lower than the tolerable daily intake derived from PTWI given by FAO/WHO and could not be considered harmful in this group of subjects. Daily intake of the studied 12 metals was found to be higher in non-vegetarian diet compared to the vegetarian diet (P<0.02, 0.01).

Conservative debridement of postoperative Meleney's gangrene following a caesarean section.

Meleney's gangrene is almost exclusively postoperative and is caused by multiple bacteria. This case review describes the conservative management of Meleney's gangrene in a young patient following a Caesarean section.

Effect of placental-extract gel and cream on non-healing wounds.

OBJECTIVE: To compare the effects of topical placental-extract gel and cream in the treatment of chronic non-healing wounds with regard to wound healing and discomfort during dressing change. METHODS: A sample of 120 patients attending the wound clinic at University Hospital, Varanasi, India, with wounds of more than six weeks' duration were enrolled into the study. They were alternately allocated to group A (topical application of placental-extract gel) or group B (placental-extract cream). Wound biopsy was performed, and swab culture and sensitivity were taken. Wound size was measured, and visual analogue scale (VAS) scores for pain and discomfort at dressing change were recorded at weekly follow-up in both groups. Biopsy was repeated after two weeks of treatment and sent for histopathological examination for assessment of angiogenesis in 25 cases from each group. RESULTS: One hundred patients completed the study. More than 50% wound healing was observed after eight weeks in 72% of group A patients and 74% of group B patients (p = 0.75). Microscopic angiogenesis grading system (MAGS) scores were similar in both groups (not statistically significant, p = 0.92). The VAS scores for pain and discomfort were lower in group B (statistically significant, p < 0.02). CONCLUSION: Placental-extract gel and cream are both effective topical agents for chronic non-healing wounds. However, there is less pain and discomfort during dressing change with the placental-extract cream, which we thus recommend for topical application in chronic non-healing wounds.

Congenital thyroid hemiagenesis with thyroid nodules-Role of TI-RADS to prevent long term thyroid replacement therapy.

BACKGROUND: Hemi-agenesis of thyroid is a rare congenital condition with the clinical significance lying only in cases where the remnant tissue is affected by a pathology mandating removal of the gland. Henceforth, the hemi-thyroidectomy technically becomes a total thyroidectomy with a need for long term thyroid replacement therapy. CASE SUMMARY: We present a series of three cases noted over a period of two years where preoperative imaging evaluation confirmed the developmental abnormality. Further presence of a thyroid nodule in each of these cases posed a specific clinical situation whereby characterization of nodule appeared mandatory for a rational management involving life-long thyroid replacement therapy due to an 'apparent total thyroidectomy', if the remnant gland is removed. Ultrasound TI-RADS is a new system for evidence based sub-classification of thyroid nodules enabling both the surgeon and patient to take a streamlined decision about the overall approach for management. CONCLUSION: Prospective nodule characterization based on the thyroid image reporting and data system (TI-RADS), enables the surgeon to decide the treatment strategy sparing the patient of the cost and morbidity associated with long term thyroid replacement therapy.

The longest tumor diameter in one dimension as a predictor for skeletal metastasis in renal cell carcinoma.

INTRODUCTION: Renal cell carcinoma (RCC) comprises a diverse group of malignant neoplasms that have multifarious histopathological features and biological behavior. One-third of RCC patients develops skeletal metastasis with a poor 5-year survival rate. Data explaining how some of these tumors show sooner bony metastasis than expected is sparse. The objective of this study was to identify whether tumor size can act as a predictor of bony metastases among patients of RCC. MATERIALS AND METHODS: We retrospectively reviewed contrast enhanced computed tomography (CECT) scan and clinical records of 66 patients with RCC, who fulfilled specified inclusion criteria. Patients who had bony metastasis at the time of presentation were selected as case and those without skeletal metastasis were referred to as controls. Receiver operating characteristic (ROC) curve analysis was used to determine the appropriate cut-off value for tumor size, which was measured as the longest tumor diameter (LTD) in one-dimensional (1D). RESULTS: Of the 66 patients selected, 30% developed bone metastasis. The tumor size of RCCs significantly correlated with the presence of skeletal metastasis in our study. None of the patients with 1D LTD <4.8 cm on CECT were found to have skeletal metastasis. ROC analysis revealed that the accuracy of the LTD in predicting bone metastasis was high with an area under ROC curve of 0.823. A cut-off value of 7.5 cm had a sensitivity of 78.9% and specificity of 80.9%. CONCLUSION: The 1D LTD with a cut-off value of 7.5 cm, at the time of presentation is an important predictor of skeletal metastasis. The result of this study may have role in triage of patients into a subgroup which mandates more aggressive treatment and monitoring.