Laparoscopic Cholecystectomy Versus Open Cholecystectomy in Acute Cholecystitis: A Literature Review.

Cholecystectomy is a common surgical procedure performed worldwide for acute cholecystitis. Acute cholecystitis occurs when the cystic duct is obstructed by a gallstone, which causes gallbladder distension and subsequent inflammation of the gallbladder. Acute cholecystitis is characterized by pain in the right upper quadrant, anorexia, nausea, fever, and vomiting. Cholecystectomy is the treatment of choice for acute cholecystitis. The two commonly performed types of cholecystectomies are open cholecystectomy and laparoscopic cholecystectomy. However, the approach of choice widely fluctuates with regard to various factors such as patient history and surgeon preference. It is imperative to understand the variations in outcomes of different approaches and how best they fit an individual patient when deciding the technique to be undertaken. This article reviews several studies and compares the two techniques in terms of procedure, mortality rate, complication rate, bile leak/injury rate, conversion rate, and bleeding rate.

Digesting the Impact of Diet on Irritable Bowel Syndrome (IBS): Exploring Solutions for Controlling IBS.

Irritable bowel syndrome (IBS) plagues nearly a fifth of the general population. It is a chronic illness that can significantly lower quality of life (QoL) and work productivity. The relationship between diet and the functional gastrointestinal (GI) symptoms present in IBS is gaining more and more attention. In addition to being a factor in the pathophysiology of IBS, diet also has a significant impact on symptoms and overall well-being. Recent research has also shown that short-chain fermentable carbohydrates increase colonic gas production and small intestine water volume, which in turn causes functional GI symptoms in those with visceral hypersensitivity. This review article has consolidated various studies highlighting the association between certain foods and the pathophysiology of IBS. It has also talked about how restricting certain food items from the diet of affected individuals can relieve symptoms and in some cases can be more effective than pharmacotherapy. Although the low reduced fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet (LFD) is a well-known method of treating IBS symptoms, over a third of individuals do not benefit from it. This article has also discussed the effectiveness and applicability of the LFD compared to other dietary therapies for the long-term management of IBS.

The Impact of Hypothyroidism on Diabetes Mellitus and Its Complications: A Comprehensive Review.

Diabetes mellitus (DM) is one of the most prevalent metabolic disorders in the world and is characterized by excessive blood glucose levels, which lead to deranged carbohydrate, protein, and lipid metabolisms. At its core, DM is an impairment of insulin metabolism, leading to a plethora of clinical features. The thyroid gland is another vital cog in the wheel of the endocrine system, and the hormones synthesized by it are heavily involved in the control of the body's metabolism. Hypothyroidism is a state in which thyroid hormones are deficient due to various factors and is characterized by a metabolically hypoactive state. Together, insulin, implicated in DM, and thyroid hormones engage in an intricate dance and serve to regulate the body's metabolism. It is imperative to explore the relationship between these two common endocrine disorders to understand their clinical association and mold treatments specific to patients in which they coexist. Both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) have been shown to have an increased association with hypothyroidism, especially in patients with risk factors including female sex, hyperlipidemia, obesity, and anemia. This review also explores DM's macrovascular and microvascular complications and their association with hypothyroidism. It is of great use to screen for hypothyroidism in diabetic patients. Specific protocols, especially for patients at an elevated risk, provide improved quality of life to patients affected by this highly prevalent disease.

The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management.

An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta above 3 cm or 50% greater than the segment above. It is a dangerous condition accounting for a substantial number of deaths per year and increasing at an alarming rate. Various factors come into play in the development of AAAs, which this study has elaborated on, including smoking and old age, demographics, and comorbid conditions. Endovascular aneurysm repair (EVAR) is a newer treatment modality used for AAAs in which an endograft device is placed into the aorta, thereby creating a bypass tract from the aneurysm and generating flow mimicking that of the natural aorta. It is minimally invasive and associated with less postoperative mortality and reduced hospital stay. However, EVAR is also associated with significant postoperative complications, including endoleaks, which were reviewed in depth. Endoleaks are postprocedural leaks into the aneurysm sac that are usually identified immediately after graft placement and indicate treatment failure. They are of five subtypes, categorized according to their mechanism of development. The most common type is type II endoleaks, and the most dangerous is type I endoleaks. Each subtype has multiple management options with varying rates of success. Prompt identification along with appropriate treatment of endoleaks can lead to better postoperative outcomes and improved quality of life for patients.

Surviving Pulmonary Tuberculosis: Navigating the Long Term Respiratory Effects.

Tuberculosis is a transmissible disease caused by the bacteria Mycobacterium tuberculosis, which is a cause of significant morbidity and mortality all over the world. Tuberculosis has a number of risk factors, such as living in a developing country, poor ventilation, smoking, male sex, etc., which not only increase the chance of infection but may be independent factors for impairment in pulmonary function as well. In this review article, we have compiled several studies to learn how tuberculosis causes impaired lung function and further explored the long-term effects of tuberculosis on the same. We studied tuberculosis's effect on the lungs even after appropriate treatment and its relationship with obstructive and restrictive lung disorders. A significant relationship exists between chronic respiratory disorders and tuberculosis even after treatment; hence, we believe prevention is far superior to cure.

Neuroimaging in Alzheimer's Disease for Early Diagnosis: A Comprehensive Review.

Alzheimer's disease (AD) is the most common cause of dementia in the elderly, affecting roughly half of those over the age of 85. We briefly discussed the risk factors, epidemiology, and treatment options for AD. The development of therapeutic therapies operating very early in the disease cascade has been spurred by the realization that the disease process begins at least a decade or more before the manifestation of symptoms. Thus, the clinical significance of early diagnosis was emphasized. Using various keywords, a literature search was carried out using PubMed and other databases. For inclusion, pertinent articles were chosen and reviewed. This article has reviewed different neuroimaging techniques that are considered advanced tools to aid in establishing a diagnosis and highlighted the advantages as well as disadvantages of those techniques. Besides, the prevalence of several in vivo biomarkers aided in discriminating affected individuals from healthy controls in the early stages of the disease. Each imaging method has its advantages and disadvantages, hence no single imaging approach can be the optimum modality for diagnosis. This article also commented on a better approach to using these techniques to increase the likelihood of an early diagnosis.

Atrial Fibrillation in Obstructive Sleep Apnea Patients: Mechanisms, Risk Factors, and Management Strategies.

Obstructive sleep apnea (OSA) is identified by apnea or hypopnea of the upper respiratory tract, which is associated with decreased oxygen saturation or awakening from sleep. A severe and prevalent association with OSA is atrial fibrillation (AF). This review article outlined numerous studies to understand the pathogenic pathways linked with developing OSA-associated AF and the therapeutic and preventive options available to reduce AF. The article looked for multiple risk factors common to OSA and AF. In addition, it has reviewed several therapeutic modalities such as continuous positive air pressure (CPAP), weight loss, upper airway stimulation (UAS), and other novel treatment options to find their efficiency in decreasing the outcome of AF in OSA patients. Since OSA often goes undiagnosed, this article emphasizes the importance of early screening in patients with AF and other comorbid conditions such as obesity, advanced age, diabetes, hypertension, and many more. The article focuses on the importance of preventive approaches that can be easily implemented, such as behavioral modifications.

Probabilistic computations of virial coefficients of polymeric structures described by rigid configurations of spherical particles: A fundamental extension of the ZENO program.

We describe an extension of the ZENO program for polymer and nanoparticle characterization that allows for precise calculation of the virial coefficients, with uncertainty estimates, of polymeric structures described by arbitrary rigid configurations of hard spheres. The probabilistic method of virial computation used for this extension employs a previously developed Mayer-sampling Monte Carlo method with overlap sampling that allows for a reduction of bias in the Monte Carlo averaging. This capability is an extension of ZENO in the sense that the existing program is also based on probabilistic sampling methods and involves the same input file formats describing polymer and nanoparticle structures. We illustrate the extension's capabilities, demonstrate its accuracy, and quantify the efficiency of this extension of ZENO by computing the second, third, and fourth virial coefficients and metrics quantifying the difficulty of their calculation, for model polymeric structures having several different shapes. We obtain good agreement with literature estimates available for some of the model structures considered.

Differences in Knowledge and Perspectives on the Usage of Artificial Intelligence Among Doctors and Medical Students of a Developing Country: A Cross-Sectional Study.

Introduction Rapid advancements are being made in the field of Artificial Intelligence (AI) to support digital healthcare transformation and provide evidence-based care. The aim of this cross-sectional study was to evaluate the knowledge of basic principles, limitations, and applications of AI in healthcare among medical students and doctors of a developing country. Methods Two free webinars were hosted for doctors and medical students in northern India (Punjab state) to create awareness about the role of AI in healthcare and the recent advancements made in various medical specialties. The delegates' perceptions about their knowledge and interest in AI were ascertained using the Likert scale (1 = low, 5 = high) in the post-event questionnaire. Using Chi-square and cross-tabulation analysis, associations were examined between knowledge of AI, gender, medical experience, and other variables. Results Out of the total of 621 registrants, 367 filled the post-event questionnaire and were included in the analysis. Although the majority felt that AI will play an important role in delivering healthcare services in the future (74.4%), they did not feel knowledgeable about the applications (79.6%) and limitations of AI (82.8%). A relatively lesser proportion of doctors (51.6%) felt interested to learn more about AI than medical students (69.3%). Furthermore, a lesser proportion of doctors (65.2%) felt that AI will be beneficial for their career as a doctor as compared with medical students (84.4%). The majority of medical students (83.5%) had never attended any webinar/lecture or course on AI in healthcare and felt that they have received minimal advice (80.7%) from their medical school on teaching about AI and its applications. A significantly (P = 0.001) higher proportion of female medical students were unknowledgeable about the principles and applications of AI than male respondents. However, female medical students were significantly (P = 0.004) more interested than male medical students to learn about AI. Conclusions Formal training courses to teach about AI should be focused on to facilitate coherent and scientifically supported dissemination of knowledge in medical schools and hospitals. Further large-scale studies are needed to understand the perception and attitude of medical students and doctors regarding AI to steer policy development and medical education curriculum changes to spark an interest in emerging technologies and drive innovation.

Evaluation of Osmotic Virial Coefficients via Restricted Gibbs Ensemble Simulations, with Support from Gas-Phase Mixture Coefficients.

We present a method for computing osmotic virial coefficients in explicit solvent via simulation in a restricted Gibbs ensemble. Two equivalent phases are simulated at once, each in a separate box at constant volume and temperature and each in equilibrium with a solvent reservoir. For osmotic coefficient BN, a total of N solutes are individually exchanged back and forth between the boxes, and the average distribution of solute numbers between the boxes provides the key information needed to compute BN. Separately, expressions are developed for BN as a series in solvent reservoir density ρ1, with the coefficients of the series expressed in terms of the usual gas-phase mixture coefficients Bij. Normally, the Bij are defined for an infinite volume, but we suggest that the observed dependence of Bij on system size L can be used to estimate L dependence of the BN, allowing them to be computed accurately at L → ∞ while simulating much smaller system sizes than otherwise possible. The methods for N = 2 and 3 are demonstrated for two-component mixtures of size-asymmetric additive hard spheres. The proposed methods are demonstrated to have greater precision than established techniques, for a given amount of computational effort. The ρ1 series for BN when applied by itself is (for this noncondensing model) found to be the most efficient in computing accurate osmotic coefficients for the solvent densities considered here.

Technical Feasibility and Short-Term Outcome of Intracorporeal Hand-Sewn Esophagojejunostomy After Laparoscopic Total Gastrectomy: Our Experience.

The purpose of this study was to demonstrate the safety and technical feasibility of intracorporeal hand-sewn esophagojejunostomy after laparoscopic total gastrectomy. Laparoscopic total gastrectomy (LTG) is a technically challenging procedure, especially for esophagojejunal anastomosis (EJA). Various techniques have been described to overcome these difficulties using staplers with variable results. We report successfully performed complete intracorporeal hand-sewn EJA after LTG. The perioperative clinical data and short-term outcomes for 30 patients who underwent LTG using hand-sewn EJA for gastric cancer between 2013 and 2015 have been retrospectively reviewed. The mean age was 49.9 years; 64 % of patients were male and 36 % were female. The mean body mass index (kg/m2) was 22.4, and the mean American Society of Anesthesiologists (ASA) score was 1.4. Eleven patients had co-morbidities, and six patients had previous abdominal operations. The mean operative time, time for EJA, and blood loss was 136.9 min, 13.25 min, and 166 ml, respectively. The conversion rate was nil. The mean time for the first oral feeding and mean hospital stay was 8.3 and 9.8 days respectively. The postoperative complications were found in 16 % of patients with one case of 30-day mortality because of lobar pneumonia. There were three cases of anastomotic stenosis; however, no leakage was identified both clinically and radiologically. Complete intracorporeal hand-sewn EJA is a safe and feasible technique in the hands of experienced surgeons that can be considered as an alternative cost-effective method when performing LTG.