Evaluation of Open (Hasson's) and Closed (Veress) Technique of Intraperitoneal Access for Creation of Pneumoperitoneum in Laparoscopic Surgery.

Background The creation of pneumoperitoneum is the first step in any laparoscopic surgery. There are various methods of creating pneumoperitoneum which can be divided into open or closed methods. The closed method involves the blind insertion of the Veress needle into the peritoneal cavity. The open technique involves making an incision and then dissecting the fascia to the peritoneal cavity to introduce the cannula under direct vision. This study was conducted to evaluate the safety and efficacy of open (Hasson's) and closed (Veress) techniques of intraperitoneal access for the creation of pneumoperitoneum in laparoscopic surgery. Material and methods The study was conducted in the Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. This was a prospective observational study and a total of 100 patients of laparoscopic surgeries fulfilling inclusion criteria were included in the study - 50 patients in group A undergoing the open method of creating pneumoperitoneum and 50 patients in group B undergoing the closed method of creating pneumoperitoneum were evaluated for the study period of 18 months from October 2020 through June 2022. Results The mean time to create pneumoperitoneum was 5.3 ± 1.41 minutes in the open method and 6.21 ± 1.36 minutes in the closed method. The mean time for umbilical port closure in our study was 7.33 ± 1.66 in the open group and 8.86 ± 2.19 in the closed group. In our study, there was no vascular or visceral injury noted in either of the methods used for the creation of pneumoperitoneum. Post-operative complications were almost equal in both the groups. Conclusions Both open and closed methods of intraperitoneal access are safe and effective for the creation of pneumoperitoneum during abdominal laparoscopy. The open method of creating pneumoperitoneum in laparoscopic surgery is a quicker method for the creation of pneumoperitoneum as compared to the closed method of intraperitoneal access.

Using mobile health technology to assess childhood autism in low-resource community settings in India: An innovation to address the detection gap.

LAY ABSTRACT: Autism is diagnosed by highly trained professionals- but most autistic people live in parts of the world that harbour few or no such autism specialists and little autism awareness. So many autistic people go undiagnosed, misdiagnosed, and misunderstood. We designed an app (START) to identify autism and related conditions in such places, in an attempt to address this global gap in access to specialists. START uses computerised games and activities for children and a questionnaire for parents to measure social, sensory, and motor skills. To check whether START can flag undiagnosed children likely to have neurodevelopmental conditions, we tested START with children whose diagnoses already were known: Non-specialist health workers with just a high-school education took START to family homes in poor neighbourhoods of Delhi, India to work with 131 two-to-seven-year-olds. Differences between typically and atypically developing children were highlighted in all three types of skills that START assesses: children with neurodevelopmental conditions preferred looking at geometric patterns rather than social scenes, were fascinated by predictable, repetitive sensory stimuli, and had more trouble with precise hand movements. Parents' responses to surveys further distinguished autistic from non-autistic children. An artificial-intelligence technique combining all these measures demonstrated that START can fairly accurately flag atypically developing children. Health workers and families endorsed START as attractive to most children, understandable to health workers, and adaptable within sometimes chaotic home and family environments. This study provides a proof of principle for START in digital screening of autism and related conditions in community settings.

Social anxiety is more likely to influence reputation management decisions than autistic traits.

People manage their social reputation by selectively sharing achievements, thereby shaping the way others think about them. Autistic traits and social anxiety may have opposing impacts on reputation management. This study aimed to identify the influence of autistic traits and social anxiety on reputation management behavior, independently and in co-occurrence with one another. Seventy-seven adults with varying levels of autistic and social anxiety traits completed a novel self-disclosure task that required them to complete a computerized game and decide whether to disclose their scores to another participant. This design provided a safe social environment for sharing performance outcomes and allowed us to manipulate performance outcomes for participants and set a perceived 'norm' of high self-disclosure. Results showed that participants were more likely to disclose their high than low scores to the other player. Social anxiety reliably predicted the likelihood of disclosing their scores while high autistic traits predicted the likelihood of disclosure only in combination with high social anxiety. Additionally, establishing the norm of high disclosure facilitated self-disclosure in all the participants. This study shows that social anxiety may influence reputation management via selective self-disclosure more when co-occurring with high autistic traits. People with varying levels of autistic traits may not behave differently to maintain a social reputation.

Quantifying preference for social stimuli in young children using two tasks on a mobile platform.

Children typically prefer to attend to social stimuli (e.g. faces, smiles) over non-social stimuli (e.g. natural scene, household objects). This preference for social stimuli is believed to be an essential building block for later social skills and healthy social development. Preference for social stimuli are typically measured using either passive viewing or instrumental choice paradigms, but not both. Since these paradigms likely tap into different mechanisms, the current study addresses this gap by administering both of these paradigms on an overlapping sample. In this study, we use a preferential looking task and an instrumental choice task to measure preference for social stimuli in 3-9 year old typically developing children. Children spent longer looking at social stimuli in the preferential looking task but did not show a similar preference for social rewards on the instrumental choice task. Task performance in these two paradigms were not correlated. Social skills were found to be positively related to the preference for social rewards on the choice task. This study points to putatively different mechanisms underlying the preference for social stimuli, and highlights the importance of choice of paradigms in measuring this construct.

Social orienting and social seeking behaviors in ASD. A meta analytic investigation.

Social motivation accounts of autism spectrum disorder (ASD) posit that individuals with ASD find social stimuli less rewarding than neurotypical (NT) individuals. Behaviorally, this is proposed to manifest in reduced social orienting (individuals with ASD direct less attention towards social stimuli) and reduced social seeking (individuals with ASD invest less effort to receive social stimuli). In two meta-analyses, involving data from over 6000 participants, we review the available behavioral studies that assess social orienting and social seeking behaviors in ASD. We found robust evidence for reduced social orienting in ASD, across a range of paradigms, demographic variables and stimulus contexts. The most robust predictor of this effect was interactive content - effects were larger when the stimulus involved an interaction between people. By contrast, the evidence for reduced social seeking indicated weaker evidence for group differences, observed only under specific experimental conditions. The insights gained from this meta-analysis can inform design of relevant task measures for social reward responsivity and promote directions for further study on the ASD phenotype.

Distinct neural correlates of social and object reward seeking motivation.

The "Choose-a-Movie-CAM" is an established task to quantify the motivation for seeking social rewards. It allows participants to directly assess both the stimulus value and the effort required to obtain it. In the present study, we aimed to identify the neural mechanisms of such cost-benefit decision-making. To this end, functional Magnetic Resonance Imaging data were collected from 24 typical adults while they completed the CAM task. We partly replicated the results from our previous behavioural studies showing that typical adults prefer social over object stimuli and low effort over higher effort stimuli but found no interaction between the two. Results from neuroimaging data suggest that there are distinct neural correlates for social and object preferences. The precuneus and medial orbitofrontal cortex, two key areas involved in social processing are engaged when participants make a social choice. Areas of the ventral and dorsal stream pathways associated with object recognition are engaged when making an object choice. These activations can be seen during the decision phase even before the rewards have been consumed, indicating a transfer the hedonic properties of social stimuli to its cues. We also found that the left insula and bilateral clusters in the inferior occipital gyrus and the inferior parietal lobule were recruited for increasing effort investment. We discuss limitations and implications of this study which reveals the distinct neural correlates for social and object rewards, using a robust behavioural measure of social motivation.

Lower P300 amplitudes for internally-generated events in patients with schizophrenia.

BACKGROUND: Patients with schizophrenia demonstrate difficulty differentiating internally-generated from externally-generated events. An excessive deployment of attention to external events as well as poor processing of self-generated events has been proposed to explain this misattribution. This study was done to understand the neurophysiological basis of source monitoring bias in schizophrenia. METHODS: Seventeen patients and fourteen healthy controls completed a two-stage source monitoring task involving solving a three-letter jumbled word either by the participant or a computer following which they had to identify the correct source of the word - solved by self (internal source monitoring, ISM) or by computer (external source monitoring, ESM) - while EEG was recorded. P300 amplitude and latency were computed separately for ISM and ESM conditions. RESULTS: P300 amplitude for ISM condition was lower in patients with schizophrenia compared to controls over right and left parietal regions. Additionally, P300 amplitude for ISM condition was lower compared to ESM condition in patients over right and left parietal regions. However, P300 amplitude for ESM condition did not differ significantly between the groups. In contrast to P300 amplitude, there was no significant difference in P300 latency in ISM or ESM condition within or between the groups. CONCLUSION: P300 amplitude was lower for internally-generated but not externally-generated events in patients with schizophrenia. These findings suggest that patients allocate less attentional resources to internally generated events resulting in poorer processing and consequent misattribution of their source of origin. This study provides the first specific electrophysiological evidence of impaired source monitoring in schizophrenia.

Comparison of choose-a-movie and approach-avoidance paradigms to measure social motivation.

Social motivation is a subjective state which is rather difficult to quantify. It has sometimes been conceptualised as "behavioural effort" to seek social contact. Two paradigms: approach-avoidance (AA) and choose a movie (CAM), based on the same conceptualisation, have been used to measure social motivation in people with and without autism. However, in absence of a direct comparison, it is hard to know which of these paradigms has higher sensitivity in estimating preference for social over non-social stimuli. Here we compare these two tasks for their utility in (1) evaluating social seeking in typical people and (2) identifying the influence of autistic traits on social motivation. Our results suggest that CAM reveals a clear preference for social stimuli over non-social in typical adults but AA fails to do so. Also, social seeking measured with CAM but not AA has a negative relationship between autistic traits.

Social seeking declines in young adolescents.

The desire to engage with others is an important motivational force throughout our lifespan. It is known that social behaviour and preferences change from childhood to adulthood, but whether this change is linked with any changes in social motivation is not known. We evaluated 255 typically developing participants from ages 4-20 years on a behavioural paradigm 'Choose a Movie' (CAM). On every trial, participants had a choice between viewing social or non-social movies presented with different levels of effort (key presses/screen touch required). Hence, participants chose not only the movie they would watch but also how much effort they would make. The difference between the effort levels of the chosen and not chosen stimuli helps in quantifying the motivation to seek it. This task could be used with all the age groups with minimal adaptations, allowing comparison between the groups. Results showed that children (4-8 years), older adolescents (12-16 years) and young adults (17-20 years) made more effort to look at social movies. Counterintuitively, this preference was not seen in young adolescents (around 9-12 years), giving a U-shaped developmental trajectory over the population. We present the first evidence for non-monotonic developmental change in social motivation in typical participants.

Brief Report: A Comparison of the Preference for Viewing Social and Non-social Movies in Typical and Autistic Adolescents.

The recently proposed Social Motivation theory (Chevallier et al., Trends in cognitive sciences 16(4):231-239, 2012) suggests that social difficulties in Autism Spectrum Condition (ASC) might be caused by a difference in the motivation to engage with other people. Here we compared adolescents with (N = 31) and without (N = 37) ASC on the Choose-a-Movie paradigm that measures the social seeking. The results showed a preference for viewing objects over smiling faces in ASC, which is in line with the theory of low social motivation. However, typical adolescents did not show any stimuli preferences, raising questions about developmental changes in social motivation. Age was found to play a significant role in moderating the choice behaviour of the participants. We discuss the implications of these findings in detail.

The Latent Structure of Autistic Traits: A Taxometric, Latent Class and Latent Profile Analysis of the Adult Autism Spectrum Quotient.

Autistic traits are widely thought to operate along a continuum. A taxometric analysis of Adult Autism Spectrum Quotient data was conducted to test this assumption, finding little support but identifying a high severity taxon. To understand this further, latent class and latent profile models were estimated that indicated the presence of six distinct subtypes: one with little probability of endorsing any autistic traits, one engaging in 'systemising' behaviours, three groups endorsing multiple components of Wing and Gould's autistic triad, and a group similar in size and profile to the taxon previously identified. These analyses suggest the AQ (and potentially by extension autistic traits) have a categorical structure. These findings have important implications for the analysis and interpretation of AQ data.

Measuring the value of social engagement in adults with and without autism.

BACKGROUND: Differences in social communication are commonly reported in autism spectrum condition (ASC). A recent theory attributes this to a reduced motivation to engage with others, that is, deficits in social motivation. However, there are currently few simple, direct, behavioural ways to test this claim. This study uses a new behavioural measure of social motivation to test if preferences for direct gaze and face stimuli are linked to autistic traits or an ASC diagnosis. Our novel choose-a-movie (CAM) paradigm measures the effort participants invest to see particular stimuli. This aspect of social motivation is also known as social seeking. METHODS: In experiment 1, 80 typical adults completed the CAM task and a measure of autistic traits. In experiment 2, 30 adults with ASC and 24 age/IQ-matched typical adults completed the CAM paradigm. RESULTS: The results from study one showed that typical adults prefer social stimuli over non-social, but this preference is weaker in those with higher levels of autistic traits. In study two, adults with ASC showed a significant reduction in their preference for direct gaze but little difference in their preference for faces without direct gaze. CONCLUSIONS: These data show that social motivation can be measured in a simple, direct, behavioural paradigm. Furthermore, adults with ASC prefer direct gaze less than typical adults but may not avoid faces without direct gaze. This data advance our understanding of how social motivation may differ between those with and without autism.

Socio-emotional factors in alcohol dependence.

BACKGROUND: Alcohol-dependent patients are traditionally believed to have insecure attachment styles, higher anger expression, and lower self-esteem. There is a need to study them together. AIM: To understand the relationships amongst various of the socio-emotional factors. MATERIALS AND METHODS: Forty male patients with Alcohol dependence syndrome and 40 matched healthy controls (General Health Questionnaire-12 score <3) were compared on attachment styles (on Relationship Scale Questionnaire), anger domains (on State Trait Anger Expression Inventory), and self-esteem (on Rosenberg Self-esteem Scale). STATISTICS AND ANALYSIS: Comparison using independent samples t test and chi square test; correlation using Pearson's correlation coefficient. RESULTS: Patients had significantly higher anger expression, 'anger in' and 'anger out,' and lower self-esteem than healthy controls. Severity of alcohol dependence had significant correlation with 'anger out,' and self-esteem had significant negative correlation with anger expression. CONCLUSION: The present study suggests that the socio-emotional factors studied are developmentally linked to each other.

Subacute intestinal obstruction: an enigma revisited.

Sixty-three patients presenting with subacute intestinal obstruction (SAIO) were studied. Thirty (47.6%) reported recurrent symptoms. Exaggerated bowel sound, visible/palpable bowel loops, distention of abdomen and abdominal lumps were observed in 60.3%, 28.5%, 25.3% and 19.0% patients, respectively. Thirty (47.6%) required emergency laparotomy. Investigations revealed lesions requiring surgery in 14 of 33 patients which were relieved with conservative treatment. The accuracy of ultrasonography, contrast enhanced computed tomography (CECT) scan and diagnostic laparoscopy was 57.1%, 100% and 100%, respectively. Ileum was the most common site of obstruction (79.5%). Adhesions and small intestinal strictures were the two most frequent cause of obstruction seen in 31.8% and 27.2%, respectively. Tuberculous pathology was demonstrated in 23 (52.2%). Previous abdominal surgery was found to be the only predictor of the success of conservative treatment (13/19 versus 7/44). All patients of SAIO, whose symptoms were relieved with conservative treatment, and who do not have history of abdominal surgery, should be subjected to CECT and/or diagnostic laparoscopy in order to discover the underlying cause of the obstruction. When these diagnostic modalities are not available, laparotomy is an effective alternative for this group of patients.

Emphysematous pyelonephritis in a non-diabetic patient with non-obstructed kidney: an unknown entity.

Emphysematous pyelonephritis (EPN) is an acute necrotizing infection with evidence of gas inside the kidney, perinephric space, and/or urinary collecting system. This condition is usually encountered in an obstructed urinary system of diabetics or immunocompromised patients and carries poor prognosis. The gold standard for early diagnosis is computed tomography (CT) of the abdomen. Percutaneous/surgical drainage and urgent or delayed nephrectomy are the available treatment options. We report one case of EPN, which was diagnosed in an immunocompetent non-diabetic man with a non-obstructed urinary system.

Long-term concentrative meditation and cognitive performance among older adults.

BACKGROUND: The general consensus that cognitive abilities decline with advancing age is supported by several studies that have reported that older adults perform more poorly on multiple tests of cognitive performance as compared to younger adults. To date, preventive measures against this cognitive decline have been mainly focused on dietary, physical, and lifestyle behaviors which could allow older adults to maintain their cognitive abilities into late life. However, much less stress has been laid on evaluating meditation as a preventive measure in such cases in spite of the fact that the role of meditation on attention has been proved in several studies. In the current study, we extend this preliminary idea, examining the practice of concentrative meditation and the differences in the cognitive performance of older adults who have or have not employed this practice long term. METHODOLOGY: This was a cross-sectional study comparing the cognitive performance of meditators and non-meditators in the geriatric age group. Twenty (age > 55 years) long-term practitioners of Vihangam Yoga meditation (>10 years of practice) were recruited in the present study and were applied six paper-pencil neuropsychological tests for assessment of short-term memory, perceptual speed, attention, and executive functioning. The tests used were: (1) the Digit Span test, (2) the Stroop Color Word test, (3) the Trailmaking test, (4) the Letter Cancellation Task, (5) the digit symbol substitution test, and (6) the Rule Shift Card Test. All the tests were also applied to 20 age- and education-matched geriatric adults who have not practiced the meditation technique. RESULTS: Vihangam Yogis showed significantly better performances in all these tests of attention (p < .05) except for the digit backward test, where a trend (p = .08) was found in favor of meditators. CONCLUSION: Long-term Vihangam Yoga meditators have superior cognitive abilities than non-meditators in the old age group. This technique should be studied further for its ability to prevent age-related cognitive decline.

Diverse presentation of spontaneous rupture of urinary bladder: review of two cases and literature.

The objective of the study was to highlight diagnostic dilemmas and suggest pointers toward early diagnosis of spontaneous rupture of urinary bladder based on case study of 2 patients diagnosed as a case of spontaneous rupture of urinary bladder. A 26-year-old man presented with painless progressive abdominal distension of 1-week duration. In absence of acute abdominal symptoms and signs, the diagnosis of chronic liver disease with ascites was entertained. Peritoneal fluid aspirate demonstrated high urea and creatinine levels. Computed tomographic (CT) scan of abdomen suggested urinary bladder rupture, which was further confirmed by CT cystogram. Another 34-year-old man presented with acute abdominal pain, hematuria, and features of peritonitis. There was no history of trauma. Foley catheterization revealed blood-stained urine. Ultrasonography abdomen suggested urinary bladder rupture, which was again confirmed by CT cystogram. Both patients made uneventful recovery after repair of bladder perforation. Spontaneous rupture of urinary bladder is extremely rare with only very few reports available in literature. High creatinine levels in the peritoneal fluid aspirate of the first patient and the blood-stained urine in the second patient were pointers toward possibility of urinary bladder rupture. Rupture of urinary bladder should always be considered in differential diagnosis of patients presenting with free fluid in abdomen/peritonitis, decreased urine output, hematuria and in whom increased level of urea/creatinine are detected in serum and/ or peitoneal fluid aspirate.

Retroperitoneal vascular malformation mimicking incarcerated inguinal hernia.

A 30-year-old man presented to the Department of Surgery with a painful groin swelling on right side. Exploration revealed a reddish-blue hemangiomatous mass in the scrotum extending through inguinal canal into the retroperitoneum. On further dissection swelling was found to be originating from right external iliac vein. The swelling was excised after ligating all vascular connections. The histopathological examination of excised mass confirmed the diagnosis of venous variety of vascular malformation. This is the first reported case of vascular malformation arising from retroperitoneum and extending into inguinoscrotal region, presenting as incarcerated inguinal hernia.

Nephrobronchial fistula complicating neglected nephrolithiasis and xanthogranulomatous pyelonephritis.

Nephrobronchial fistula is a rare complication seen in association with renal infections, trauma or stone disease. Xanthogranulomatous pyelonephritis (XGP) is an infectious disease with a potential for fistulization to lung, skin, colon and other organs. We present a case of nephrolithiasis complicated by obstruction leading to pyonephrosis and nephrobronchial fistula, treated successfully by nephrectomy and excision of fistulous tracts. Nephrobronchial fistula, although a rare complication of longstanding renal stone, should be considered when a patient presents with perirenal suppurative process. This clinical case illustrates the natural history of nephro-bronchial fistula and the relevance of early treatment of nephrolithiasis.