Giant choledochal cyst: The largest reported!

Choledochal cyst (CC) is an atypical congenital abnormality of the biliary system. CC more than 10 cm is rare and only a few cases are reported. Herein, we reported a 25 × 18 cm CC and highlighted how definitive treatment after a timely diagnosis provides good prognosis irrespective of the size.

Factors affecting depression and anxiety in diabetic patients: A cross sectional study from a tertiary care hospital in Eastern India.

Background: Diabetes is one of the most common chronic disease in the world and its prevalence in India is rising day by day. Diabetic patients often suffer from depression and anxiety which has a negative impact on patients resulting in non-adherence to medication, rapid disease progression and overall poor prognosis. India is the land of diversity and so are the causes of depression and anxiety in the people from different parts of the country. The study done in the current population has revealed certain indicators of both depression and anxiety that were not significant in previous studies. These new findings point towards the changing scenario and the need for more precise steps for improving the quality of life of diabetics. Aims: The study aims to determine the prevalence of depressive symptoms and anxiety among diabetic patients and the factors associated with them. Methods: A prospective cohort study was conducted with 305 participants among which 152 were diabetic while 153 were non diabetic patients. Depression and anxiety of the patients was measured through PHQ-9 scale and GAD-7 scale respectively. Factors associated with prevalence of depression and anxiety in the diabetic population was analysed. Results: The prevalence of depressive symptoms (39.5% versus 12.4%) and anxiety (36.2% versus 14.4%) were significantly higher in diabetic patients as compared to non-diabetic participants. Low-income, urban residence, unmarried status, insulin therapy, presence of retinopathy, and ischemic heart disease were significantly associated with depression among diabetic group of patients. Similarly the major predictors of anxiety were marital status, literacy and diabetic complications like neuropathy, retinopathy and ischemic heart disease. Conclusion: Our study shows depression and anxiety are highly prevalent among diabetic patients. All diabetic patients while seeking clinical contact should be screened for depression and anxiety especially those patients with predisposing risk factors.

Effect of Hypodermic Needle Versus Safety Lancet on the Fear and Anxiety of Needle Prick Among Undergraduate Medical Students During Hematology Practical: A Cohort Study From a Resource-Limited Setting.

Background Most of the government-sponsored medical teaching institutions in India do not provide safety lancets, and hence, the students are compelled to use hypodermic needles. These needles are widely unpopular among students due to the potential hazards (pain, fear, anxiety) associated with them. This study aims to compare any difference in fear and anxiety associated with finger pricking with a hypodermic needle and a safety lancet. Methods This is a prospective cohort study. The current study included data from first-year undergraduate medical students for academic sessions 2021-22. Results A total of 121 students participated in the study. Eighty-two (67.8%) participants were male. 41/82 male participants and 20/39 female participants were allocated to the intervention cohort. 111 (91.7%) pricked their fingers by themselves. The sight of others pricking during the experiment (17 versus 5, p=0.004) and the thought of pain while pricking (36 versus 16, p<0.001) was significantly associated more with the use of a hypodermic needle compared to a safety lancet. There was no significant difference in students perceiving the smell of the hematology laboratory (4 versus 1, p=0.165) and the sight of blood (9 versus 3, p=0.064) as a factor influencing their fear and anxiety in both cohorts. There was no gender difference in the perception of these factors. Symptoms were significantly lower in the intervention cohort compared to the control cohort (8 versus 20, odds ratio 0.302, p=0.008). The most common symptom experienced was excessive sweating (n=22, 18.18%), followed by drying of the mouth (n=12, 9.91%). There was a significant difference in pain scores between the intervention and the control cohorts. There was no significant difference in pain scores among male and female subjects. Conclusion A considerable difference between the two cohorts was found. The use of lancets can be proposed to medical teaching institutions for psychological advantage, pain reduction, and overall better quality of the process.

Solid Pseudopapillary Neoplasm of the Pancreas Presenting With Gastric Outlet Obstruction.

Solid pseudopapillary neoplasm (SPN) of the pancreas are rare tumors accounting for a minor portion of all exocrine pancreatic tumors. It usually occurs in young women. It has a very low malignant potential with a relatively indolent clinical course. A small subset of patients exhibits pathological features of malignancy. Herein, we present a rare case of pancreatic SPN that presented with gastric outlet obstruction. Despite the characteristic computed tomography (CT) findings, due to its rarity, it was missed in more common conditions such as gastrointestinal stromal tumors. In our case, we found that the tumor was causing extrinsic duodenal compression leading to gastric outlet obstruction, creating a diagnostic dilemma.

Enhancement of antibacterial activity of synthesized ligand-free CdS nanocrystals due to silver doping.

Recently, different nanocrystals have been reported to be the alternative, optimistic, and novel antimicrobial agent against the many antibiotic-resistant bacteria. Here, ligand-free CdS and Ag-doped CdS (Ag/CdS) nanocrystals have been synthesized by chemical methods for the study of the antimicrobial activity on Escherichia coli and Staphylococcus aureus by Kirby-Bauer diffusion method to see the effect against Gram-positive and Gram-negative bacteria. These prepared nanocrystals have been characterized by transmission electron microscopy (TEM), scanning electron microscopy (SEM), and X-ray diffraction (XRD). TEM and SEM images confirm the spherical morphology of both the sample and the respective XRD patterns indicate polycrystalline nature having a cubic zinc blende structure. Antibacterial activities have been tested with CdS and Ag/CdS, considering concentrations ranging from 10 to 200 µg/ml. After 24 h of incubation, the zone of inhibition (ZOI) is measured for each concentration, which shows that both the nanocrystals are ineffective against E. coli but much effective against S. aureus at this low concentration range. Furthermore, Ag/CdS nanocrystals have been found to show much more ZOI than CdS. Differences in the antibacterial activity can be due to the presence of different cell wall in E. coli and S. aureus.

Automated stratification of liver disease in ultrasound: An online accurate feature classification paradigm.

PURPOSE: Fatty liver disease (FLD) is one of the most common diseases in liver. Early detection can improve the prognosis considerably. Using ultrasound for FLD detection is highly desirable due to its non-radiation nature, low cost and easy use. However, the results can be slow and ambiguous due to manual detection. The lack of computer trained systems leads to low image quality and inefficient disease classification. Thus, the current study proposes novel, accurate and reliable detection system for the FLD using computer-based training system. MATERIALS AND METHODS: One hundred twenty-four ultrasound sample images were selected retrospectively from a database of 62 patients consisting of normal and cancerous. The proposed training system was generated offline parameters using training liver image database. The classifier applied transformation parameters to an online system in order to facilitate real-time detection during the ultrasound scan. The system utilized six sets of features (a total of 128 features), namely Haralick, basic geometric, Fourier transform, discrete cosine transform, Gupta transform and Gabor transform. These features were extracted for both offline training and online testing. Levenberg-Marquardt back propagation network (BPN) classifier was used to classify the liver disease into normal and abnormal categories. RESULTS: Random partitioning approach was adapted to evaluate the classifier performance and compute its accuracy. Utilizing all the six sets of 128 features, the computer aided diagnosis (CAD) system achieved classification accuracy of 97.58%. Furthermore, the four performance metrics consisting of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) realized 98.08%, 97.22%, 96.23%, and 98.59%, respectively. CONCLUSION: The proposed system was successfully able to detect and classify the FLD. Furthermore, the proposed system was benchmarked against previous methods. The comparison established an advanced set of features in the Levenberg-Marquardt back propagation network reports a significant improvement compared to the existing techniques.