Current surgical treatment of obstructed defecation among selected European opinion leaders in pelvic floor surgery.

BACKGROUND: The aim of this study was to perform a survey on the surgical management of obstructed defecation (OD) across advocated selected coloproctological experts across Europe. METHODS: Surgeons from 42 centers of coloproctology in Europe were asked to complete a questionnaire, including seven questions about their past and present operative treatment strategy for patients with OD. RESULTS: The questionnaire was completed by 32 experts of pelvic floor surgery in 13 European countries. All but one indicated that they consider surgical treatment for OD. Seventy-four percent of these have been using transanal stapled rectal resection (STARR) and 96 % transabdominal rectopexy. While only 65 %, who have begun performing STARR are still using transanal resection, the technique is still being used by all surgeons performing abdominal procedures. Rectopexy only, STARR only, or both approaches are offered by 52, 3, and 45 % of surgeons, respectively. CONCLUSIONS: The use of STARR in the treatment of OD is decreasing among European opinion leaders in the field of pelvic floor surgery, while the application of transabdominal procedures continues.

Carcinoma arising in enteric diversion or rectal neobladder for bladder exstrophy.

Bladder exstrophy is a rare malformation. Ureteral diversion, such as ureterosigmoidostomy or a neorectal bladder, has been described. When the patients reach adulthood, cancer may arise in these reconstructions. Our aim was to perform a systematic review (all languages) of the published literature on neoplasia after urinary diversion and suggested management in cases of cancer. PubMed and Cochrane library were searched for relevant articles published within the last 20 years. All identified articles were reviewed for inclusion. Carcinoma occurring in the bladder and unreconstructed exstrophy were excluded. Out of 47 articles found, 12 matched our search criteria. The outcomes of 23 patients (including 2 from the authors' institution) were reported. Twenty-two patients with adenocarcinoma and 1 with carcinoid tumour were identified. Median age at urinary diversion was 3 (range 1-13) years. There were 20 ureterosigmoidostomies and 2 neorectal bladders. Cancer was diagnosed subsequently at a median of 31 (range 5-55) years after urinary diversion still in place (n = 18) or 21 years (range 1-30) after incomplete excision of ureteric stump when re-diverted (n = 5). The long-term outcomes of 15 patients were available. Ten died due to colorectal adenocarcinoma, and 5 were disease-free at 3 years. Patients with enteric diversion for bladder exstrophy, including those with subsequent reconstruction, are at risk of adenocarcinoma during adulthood. It is important to provide adequate surveillance. If lesions suggestive of carcinoma are seen, complete excision of the receptive bowel and urinary diversion are mandatory.

Kimura's Disease of the Parotid: A Complete Clinical-Radiological-Pathology Report.

Kimura's disease is rare chronic inflammatory disease with a distinct clinicopathological entity. It has three major components; inflammatory, vascular and fibrosis. It has to be considered as a differential diagnosis in young patient presenting with head and neck swelling. Although of unknown aetiology many hypothesis has been postulated. Inflammation is the most prominent and predominating characteristic in this disease. Although reported to be predominant in Asian literature regarding this disease is scanty. We report a complete clinical-radiological and pathological picture of this disease.

Assessment of soil microbial diversity and soil enzyme activities under inorganic input sources on maize and rice ecosystems.

Background: To increase crop productivity, modern agricultural practices comprises fertilizers, algaecides, herbicides and fungicides. Objective: The purpose of this study was to evaluate the effects of soil microbial population and soil enzyme activity by the use of fertilizer in maize and inorganic input in the rice ecosystem. Methods: A field experiment (2021 to 2023) was carried out using synthetic fertilizer doses with maize crops followed by rice crops using inorganic inputs. Soil microbial population and enzyme activities were examined. Results: Maize field experiment revealed that the plots treated with 75 % Standardized Dose of Fertilizer (SDF) of NPK had the highest populations of diazotrophs (124 × 105cfu / g), Phosphobacteria (66.33 × 105cfu / g), and Azospirillum (0.409 × 105 MPN / g) than 100 % and 150 % SDF of NPK. The soil enzyme activity was higher in the unfertilized control plot than fertilized plot. These experimental results revealed that a low amount of fertilizer and no fertilizers favour the growth of soil microorganisms and soil enzyme activities, respectively. Followed by the rice field experiment, revealed that the soil microbial population was decreased by the application of inorganic inputs viz., fertilizer, algaecide, herbicide and fungicide. However, the maximum soil microbial population was found in algaecide application followed by herbicide and fungicide. Conclusion: The field experiment concluded that soil microbial population and enzyme activity were affected by inorganic amendments. Less inorganic fertilizers and no fertilizers improve soil microbial activities and soil enzyme activities.

Exploring the influence of varying pH on structural, electro-optical, magnetic and photo-Fenton properties of mesoporous ZnFe2O4 nanocrystals.

An economically viable and superficial technique was indorsed to yield ZnFe2O4 nanocrystals in the system to investigate the impact of pH variation on the optical, structural, electrical, and magnetic properties of as-prepared nanocrystals. The as-synthesized ZnFe2O4 nanocrystals were premeditated with the application protracted to degradation of Methylene blue organic dye. The results specify that the pH plays the utmost decisive facet in photo-Fenton recital. From XRD (X-Ray diffraction) analyses, it was confirmed that as-synthesized nanocrystals belong to a cubic Fd3m crystal phase. The crystallite size was also determined by the Scherrer formula and it was noticed that as the pH rises the crystallite size also increased. FT-IR (Fourier Transform Infrared) analysis depicts two absorption peaks âˆ¼ 500 and ∼600 cm-1 that represents tetrahedral (Td) and octahedral (Oh) sites. Using TEM (Transmission Electron Microscopy), the morphology was observed to be spherical particles with some agglomeration. Photoluminescence and UV-visible spectral studies were performed to investigate the optical properties. The bandgap energy was seen to decrease as the pH increased. Using BET analysis, the surface area for the as-synthesized samples was found to decrease on increasing the pH. The reaction results showed that the ZnFe2O4 has good photocatalytic activity, which can be attributed to high surface area and pore volume, and large pore size. The ZnFe2O4 produced by the co-precipitation route exhibited promising photocatalytic activity for the removal of textile dye, reaching nearly 99.2% of decolorization at 100 min. Therefore, ZnFe2O4 particles rapidly prepared by the co-precipitation route have the potential for use in treatment of textile wastewater by the heterogeneous photo-Fenton process. With the help of VSM analysis, the coercivity and other magnetic properties were determined for the as-synthesized nanocrystal with plays a significant role in photocatalytic recyclability, which intends to premediate that the prepared nanocrystals can be used in industrial persistence.

Clinico-pathological features in fatal Covid-19 Infection: A Preliminary Experience of a Tertiary Care Centre in North India using Post-Mortem Minimally Invasive Tissue Biopsies

BackgroundThe Covid-19 pandemic began in China in December 2019. India is the second most affected country, as of November 2020 with more than 8.5million cases. Covid-19 infection primarily involves the lung with severity of illness varying from influenza-like illness to acute respiratory distress syndrome. Other organs have also found to be variably affected. Studies evaluating the histopathological changes of Covid-19 are critical in providing a better understanding of the disease pathophysiology and guiding treatment. Minimally invasive biopsy techniques (MITS/B) provide an easy and suitable alternative to complete autopsies. In this prospective single center study we present the histopathological examination of 37 patients who died with complications of Covid-19. MethodsThis was an observational study conducted in the Intensive Care Unit of JPN Trauma Centre AIIMS. A total of 37 patients who died of Covid-19 were enrolled in the study. Post-mortem percutaneous biopsies were taken by the help of surface landmarking/ultrasonography guidance from lung, heart, liver, and kidneys; after obtaining ethical consent. The biopsy samples were then stained with haematoxylin and eosin stain. Immunohistochemistry (IHC) was performed using CD61 and CD163 in all lung cores. SARS-CoV-2 virus was detected using IHC with primary antibodies in selected samples. Details regarding demographics, clinical parameters, hospital course, treatment details, and laboratory investigations were also collected for clinical correlation. ResultsA total of 37 patients underwent post-mortem minimally invasive tissue sampling. Mean age of the patients was 48.7years and 59.5% of them were males. Respiratory failure was the most common complication seen in 97.3%. Lung histopathology showed acute lung injury and diffuse alveolar damage in 78% patients. Associated bronchopneumonia was seen in 37.5% patients and scattered microthrombi were visualised in 21% patients. Immunostaining with CD61 and CD163 highlighted megakaryocytes, and increased macrophages in all samples. Immunopositivity for SARS-CoV-2 was observed in Type II pneumocytes. Acute tubular injury with epithelial vacuolization was seen in 46% of the renal biopsies but none of them showed evidence of microvascular thrombosis. 71% of the liver tissue cores showed evidence of Kupfer cell hyperplasia. 27.5% had evidence of submassive hepatic necrosis and 14% had features of acute on chronic liver failure. All the heart biopsies showed non-specific features such as hypertrophy with nucleomegaly with no evidence of myocardial necrosis in any of the samples. ConclusionsThe most common finding in this cohort is the diffuse alveolar damage with demonstration of SARS-CoV-2 protein in the acute phase of DAD. Microvascular thrombi were rarely identified in the lung, liver and kidney. Substantial hepatocyte necrosis, hepatocyte degeneration, Kupffer cell hypertrophy, micro, and macrovesicular steatosis unrelated to microvascular thrombi suggests that liver might be a primary target of Covid-19. This study highlights the importance of MITS/B in better understanding the pathological changes associated with Covid-19.