Comparison Between Closed and Open Methods for Creating Pneumoperitoneum in Laparoscopic Cholecystectomy.

Background: To study the efficacy of closed and open methods for creating pneumoperitoneum in laparoscopic cholecystectomy by comparing the two in terms of their outcome and complication. Study Design: Single-centre, prospective, observational study. Materials and study: Purposive sampling method where the inclusion criteria were all patients with cholelithiasis who were advised and consented to laparoscopic cholecystectomy of age 18-70 years were included in the study group. Exclusion criteria include patients with a paraumbilical hernia, a history of upper abdominal surgery, uncontrolled systemic illness, and local skin infection. Sixty cases of cholelithiasis satisfying exclusion and inclusion criteria who underwent elective cholecystectomy during the study period were included. Thirty-one of these cases underwent the closed method, while in the remaining 29 patients open method was adopted. Cases in which pneumoperitoneum created by closed technique were grouped as group A and those by open technique as group B. Parameters comparing the safety and efficacy of the two methods were studied. The parameters were access time, gas leak, visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia. Patients were assessed on the first postoperative day, the seventh postoperative day, and then two months after surgery. Some follow-ups were done telephonically. Results: Out of 60 patients, 31 underwent the closed method, while 29 underwent the open method. Minor complications like gas leak during the procedure was observed more in the open method. The mean access time in the open-method group was less than in the closed-method group. Other complications like visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia were not observed in either group during the allocated follow-up period in the study. Conclusion: Open technique for pneumoperitoneum is as safe and effective as the closed technique.

Our Experience with Nasolabial Flaps in Soft Tissue Reconstruction of Oral Malignancy; Feasible Option in Rural Set Up.

In this era of microvascular expertise, free flaps are the preferred option by reconstructive surgeons but has technical limitation in rural set up. Nasolabial flaps has been widely mentioned in literature for smaller defect reconstruction with minimal morbidity. It is a robust flap for soft tissue reconstruction in early stage lesion of oral cavity. We present a series of single stage oral cavity reconstruction using inferiorly based islanded nasolabial flaps in small to moderate soft tissue defects. This is a retrospective study which included biopsy proven 10 patients diagnosed with early stage oral cavity malignancy. All the patients underwent single stage islanded nasolabial flap for small to moderate oral defects. Follow up of all patients were recorded with respect to clinical photographs, mouth opening, tongue mobility, deglutition, speech and patient satisfaction. All operated patients had good functional outcome in terms of swallowing, speech and tongue mobility. All patients were satisfactory with the postoperative results. In early stage oral malignancy patients, this option justifies a reliable and cost effective approach. Inferiorly based islanded nasolabial flaps provides a single stage, safer, faster and reliable option for small to moderate oral cavity defects.

Clinical and economic outcomes of continuous glucose monitoring system (CGMS) in patients with diabetes mellitus: A systematic literature review.

OBJECTIVE: Poor glycemic management increases the risk of cardiac, microvascular, and other complications. Therefore, timely assessment and control of glycemic levels is paramount in diabetes. Recent advancements in automated management methods is the use of a continuous glucose monitoring system (CGMS). The objective was to study its clinical and economic impact in the glucose level monitoring and how it can be effectively used or reimbursed for wider population. METHODS: Comprehensive search was done using multiple databases to capture relevant and most recent evidence. All steps were conducted by two independent researchers and discrepancies resolved by a third reviewer. Quality appraisal was performed by relevant scale depending on study design. RESULTS: Twenty-six and 12 studies were included for clinical and economic outcomes, respectively. Clinical outcomes like HbA1c and glucose variation, time in range, accuracy, etc. were captured. Comparison of different CGMS types was also reported. Major economic outcomes were direct cost, healthcare resource utilization, and work absenteeism. CONCLUSIONS: CGMS in patients with diabetes is associated with a valuable clinical implications in reducing hypoglycemic events, glucose and HbA1c level. Additionally, it has an impact on direct and indirect costs of management. Further, quantitative analysis would be required to produce concrete evidence.

Extramedullary Hematopoiesis Presenting with Thoracic Spinal Cord Compression in a Young Adult with Thalassemia Major: A Case Report.

Background: Extramedullary hematopoiesis (EMH) refers to the production of blood cellular components at sites other than the bone marrow, namely liver, spleen, and lymph nodes. The common sites associated with this condition are the liver, spleen, and lymph nodes whereas the common conditions associated with it are myelofibrosis, myelodysplasia, thalassemia, sickle cell anemia, and polycythemia vera. Case Description: This report describes a young male with thalassemia major, who presented with symptomatic cord compression due to a thoracic intraspinal lesion. It was surgically excised and diagnosed as a case of EMH. The boy recovered fully and has been asymptomatic for six months now. Conclusion: The occurrence of EMH in the thoracic spine is uncommon, whereas symptomatic cord compression as a result of it is even more unusual. Magnetic resonance imaging (MRI) is the diagnostic imaging of choice and treatment options that can be offered are surgical decompression, radiotherapy, hydroxyurea, and transfusion of packed red blood cells (RBCs).

Construction of a Genetic Linkage Map and Identification of QTLs for Seed Weight and Seed Size Traits in Lentil (Lens culinaris Medik.).

Seed weight and seed size both are quantitative traits and have been considered as important components of grain yield, thus identification of quantitative trait loci (QTL) for seed traits in lentil (Lens culinaris) would be beneficial for the improvement of grain yield. Hence the main objective of this study was to identify QTLs for seed traits using an intraspecific mapping population derived from a cross between L. culinaris cv. Precoz (seed weight-5.1g, seed size-5.7mm) and L. culinaris cv. L830 (seed weight-2.2g, seed size-4mm) comprising 126 F8-RILs. For this, two microsatellite genomic libraries enriched for (GA/CT) and (GAA/CTT) motif were constructed which resulted in the development of 501 new genomic SSR markers. Six hundred forty seven SSR markers (including 146 previously published) were screened for parental polymorphism and 219 (33.8%) were found to be polymorphic among the parents. Of these 216 were mapped on seven linkage groups at LOD4.0 spanning 1183.7cM with an average marker density of 5.48cM. Phenotypic data from the RILs was used to identify QTLs for the seed weight and seed size traits by single marker analysis (SMA) followed by composite interval mapping (CIM) which resulted in one QTL each for the 2 traits (qSW and qSS) that were co-localized on LG4 and explained 48.4% and 27.5% of phenotypic variance respectively. The current study would serve as a strong foundation for further validation and fine mapping for utilization in lentil breeding programs.

Pancreatic extra-gastrointestinal stromal tumour with documentation of C-kit mutation: a case report.

Gastrointestinal stromal tumours (GIST) are the most common mesenchymal neoplasms located in the alimentary tract. Stromal tumours that arise outside the gastrointestinal tract as primary tumour are designated as extra-gastrointestinal stromal tumours (EGIST). The EGIST are located in mesentry, omentum, retroperitoneum and rarely in pancreas. Only 19 cases of pancreatic EGIST (pEGIST) have been reported in the literature. Of these, there were only two cases of pEGIST with documentation of molecular alteration in C-Kit gene. We here report a third case of primary pEGIST with documentation of C-kit mutation.

Biosequestration of lead using Bacillus strains isolated from seleniferous soils and sediments of Punjab.

The present study was conducted to isolate and explore bacterial strains with a potential to sequester lead (Pb) and tolerate other heavy metals from industrial effluents and sediments. Out of the six bacterial strains isolated from seleniferous sites of Punjab, three isolates (RS-1, RS-2, and RS-3) were screened out for further growth-associated lead sequestration and molecular characterization on the basis of their tolerance toward lead and other heavy metals. Biomass and cell-free supernatant were analyzed for lead contents using ICP-MS after growth-associated lead sequestration studies in tryptone soya broth (pH = 7.2 ± 0.2) under aerobic conditions at 37 °C temperature. Almost 82 % and 70 % divalent lead was sequestered in cell pellets of RS-1 and RS-3, respectively while only 45 % of lead was found in cell pellet of RS-2 in the first 24 h. However, significant biosequestration of lead was observed in RS-2 after 48 h of incubation with concomitant increase in biomass. Simultaneously, morphological, biochemical, and physiological characterization of selected strains was carried out. 16S rRNA gene sequence of these isolates revealed their phylogenetic relationship with class Bacillaceae, a low G + C firmicutes showing 98 % homology with Bacillus sp.

Gastrointestinal Stromal Tumour of Meckel's Diverticulum Causing Perforation and Peritonitis: A Case Report.

A 23-year-old man presented with history of fever and pain in the right lower abdomen. He was diagnosed to have acute appendicitis with perforation and was taken up for emergency laparotomy after resuscitation. There was pus in the right iliac fossa and a tumor at the fundus of Meckel's diverticulum, which had perforated. Appendix was found to be normal. The histopathology examination showed it to be gastrointestinal stromal tumor of Meckel's diverticulum. The gastrointestinal stromal tumor causing Meckel's diverticulum perforation and peritonitis is very rare, and prior to this indexed case, only two such cases have been reported in the literature.

Biosequestration, transformation, and volatilization of mercury by Lysinibacillus fusiformis isolated from industrial effluent.

In the present study, an efficient mercury-tolerant bacterial strain (RS-5) was isolated from heavy-metalcontaminated industrial effluent. Under shake flask conditions, 97% of the supplemented mercuric chloride was sequestered by the biomass of RS-5 grown in a tryptone soy broth. The sequestered mercuric ions were transformed inside the bacterial cells, as an XRD analysis of the biomass confirmed the formation of mercurous chloride, which is only feasible following the reaction of the elemental mercury and the residual mercuric chloride present within the cells. Besides the sequestration and intracellular transformation, a significant fraction of the mercury (63%) was also volatilized. The 16S rRNA gene sequence of RS-5 revealed its phylogenetic relationship with the family Bacillaceae, and a 98% homology with Lysinibacillus fusiformis, a Gram-positive bacterium with swollen sporangia. This is the first observation of the sequestration and volatilization of mercuric ions by Lysinibacillus sp.

Healing of solitary rectal ulcers with multiple sessions of argon plasma coagulation.

BACKGROUND: Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of evacuation. Management of bleeding ulcers is usually unsatisfactory with conventional treatment. Argon plasma coagulation (APC) has been reported to control bleeding; however, it has not been shown to result in ulcer healing. The aim of the present study was to: (i) to investigate the efficacy and safety of APC in controlling bleeding from SRUS; and (ii) to study its efficacy in the healing of ulcer/s. METHODS: Twenty-four patients with bleeding SRUS diagnosed on clinical, colonoscopic, and histological findings were randomized to receive either standard care alone (12 patients) or to undergo multiple sessions of APC in addition (12 patients). All patients were followed up to determine ulcer healing. RESULTS: Twenty-four patients with a mean duration of symptoms of 12.6 +/- 4.8 months were included. Bleeding was controlled with one (n = 5) or two sessions (n = 7) of APC. Reduction in size and depth of ulcer was noted. Eight out of 12 patients who received APC had complete healing of ulcers after four to eight sessions, carried out 2-4 weeks apart. The remaining four patients had a reduction in size and depth of ulcers compared to their pretreatment appearance. All patients were advised to have a high intake of fluids, fiber and laxatives, and to undergo biofeedback and behavior modification therapy in addition to the treatment. CONCLUSIONS: APC controls bleeding in patients with SRUS and it also improves the healing of these ulcers.

High pharyngoesophageal strictures after laryngopharyngectomy can also be treated by self-expandable plastic stents.

BACKGROUND: Permanent dysphagia occurring after laryngectomy or laryngopharyngectomy can usually be treated by periodic dilation. Occasionally, however, conservative treatment is insufficient, and patients require long-term tube feeding. We describe 4 cases with stricture after laryngopharyngectomy who underwent insertion of self-expandable plastic stents (SEPSs) across the stricture for treatment of dysphagia. OBJECTIVE: The aim of this study was to evaluate the role of SEPSs in postlaryngopharyngectomy strictures. DESIGN: An interventional study of management of 4 patients of dysphagia after laryngopharyngectomy with SEPSs. SETTING: Medical gastroenterology unit in a tertiary care hospital. PATIENTS: Four patients with dysphagia after laryngopharyngectomy. INTERVENTIONS: SEPS placement and removal after 3 months. MAIN OUTCOME MEASUREMENTS: Improvement in dysphagia. METHODS: Four patients with dysphagia after laryngopharyngectomy underwent dilation of stricture followed by SEPS placement for 3 months. RESULTS: Three patients had grade IV, and 1 grade III dysphagia. Endoscopy showed stricture at 10 to 14 cm from the incisors. Stricture was dilated up to 15 mm on 3 occasions, 2 weeks apart. A silicone Polyflex stent was placed across the stricture and removed after 3 months. No dysphagia recurred after 2 months. No significant complications were noted. LIMITATIONS: Small sample size. CONCLUSIONS: SEPSs dilate postlaryngopharyngectomy strictures and prevent restenosis even after removal.

Healing of a bleeding solitary rectal ulcer with multiple sessions of argon plasma.

BACKGROUND: Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of evacuation. Management of bleeding ulcers is usually unsatisfactory with conventional treatments. Argon plasma coagulation (APC) has been reported in case reports to control bleeding; however, it has not been shown to result in ulcer healing. OBJECTIVE: To investigate the efficacy and safety of APC in controlling bleeding from SRUS and to study its efficacy in eventual healing of ulcers. DESIGN: A randomized, controlled trial of the management of 24 consecutive patients with SRUS. SETTING: The gastroenterology unit at 2 tertiary care hospitals. PATIENTS: Twenty-four patients with bleeding SRUS. MAIN OUTCOME MEASUREMENTS: Control of bleeding and endoscopic healing of SRUS. METHODS: Twenty-four patients with bleeding SRUS, whose diagnoses were based on clinical, colonoscopic, and histologic findings, were randomized to receive either standard care only (12 patients, biofeedback therapy [BT] group) or multiple sessions of APC in addition to BT (12 patients, APC group). All patients were advised to intake a high level of fluids and fibers, laxatives, biofeedback, and behavior modification therapy in addition to the treatment. Patients were followed to determine whether ulcers healed. RESULTS: Twenty-four patients with symptoms that lasted 12.6 +/- 4.8 months were included. Bleeding was controlled in all 12 patients in the APC group, but only in 5 of 12 patients in BT group. We also made the following observations about healing of the ulcers: 8 of 12 patients in the APC group had complete healing of their ulcers after 4 to 8 sessions, whereas in the BT group, ulcers healed in only 2 of 12 patients. CONCLUSIONS: APC controls the bleeding in patients with SRUS and also improves the healing of these ulcers.

Duodenal mucosal nodularity in Strongyloides stercoralis infection.

A 22-year-old man presented with a two-year history of colicky upper abdominal and dyspnoea. His absolute eosinophil count (AEC) was 980/mm3. Chest x-ray revealed hilar prominence. An upper gastrointestinal endoscopy showed marked oedema and nodularity of duodenal mucosal folds. Duodenal biopsy disclosed heavy lymphoplasmacytic infiltrates in the lamina propria and sheets of eosinophils and rhabdtiform larvae of Strongyloides stercoralis in the crypts. The patient was not on steroids and his HIV ELISA was nonreactive. His IgG ELISA for Strongyloides stercoralis was positive. Nodular duodenal mucosa may thus be seen with Strongyloides stercoralis infection.

Possible GABAergic mechanism in the protective effect of allopregnenolone against immobilization stress.

Acute stress may be experienced in response to an immediate physical, emotional or psychological stimulus. Stress is known to promote long-term changes in multiple neural systems. Present study was conducted with an aim to elucidate the possible role of GABAergic system in the protective effect of allopregnenolone against immobilization stress induced behavioral and biochemical alterations. Mice were immobilized for periods of 6 h. Animals were divided into different groups, consisting of six in each. Various behavioral tests (mirror chamber, actophotometer) followed by oxidative parameters (malondialdehyde level, glutathione, catalase, nitrite and protein) were assessed in animals. 6 h immobilization significantly caused antinociceptive, locomotor activity impairment, anxiety-like behavior and oxidative damage as compared to unstressed animals. Allopregnenolone (10 and 20 mg/kg, i.p.) treatment significantly reduced tail flick latency, improved ambulation, anti-anxiety like effect and attenuated oxidative damage as compared to stressed mice. Protective effect of allopregnenolone (10 mg/kg, i.p.) was further antagonized by picrotoxin (1.0 mg/kg) and potentiated by muscimol (0.05 mg/kg) pretreatments (P<0.05). Present study suggests that allopregnenolone's protective effect could be due its interaction with gamma-amino butyric acid receptor complex.

Quercetin protects against acute immobilization stress-induced behaviors and biochemical alterations in mice.

Oxidative stress is a major contributor to the alterations of various pathological conditions, including neurodegenerative and neuropsychiatric problems. Antioxidative flavonoids, ubiquitously included in vegetables, fruits, and teas, are expected to prevent degenerative diseases. Recently, flavonoids have been characterized as neuroprotectants in the treatment of various neurological disorders. The present study was designed to investigate protective effects of quercetin, a bioflavonoid, against acute immobilization-induced behavioral and biochemical alterations in mice. Mice were immobilized for a period of 6 hours. Quercetin (20 and 40 mg/kg, i.p.) was administered 30 minutes before subjecting the animals to acute stress. Behavioral tests (mirror chamber, actophotometer, and tail flick test) and biochemical analysis (malondialdehyde, reduced glutathione, catalase, nitrite, and protein levels) were subsequently performed. Acute immobilization stress for a period of 6 hours caused severe anxiety, analgesia, and impaired motor activity in mice. Biochemical analyses revealed an increase in malondialdehyde and nitrite levels as well as partial depletion of reduced glutathione and catalase activity in immobilization-stressed brain. Behavioral and biochemical parameters were significantly altered as compared to naive mice. Pretreatment with quercetin (20 and 40 mg/kg, i.p.) significantly reversed immobilized stress-induced anxiety and analgesia and reduced locomotor activity. Biochemically, quercetin treatment attenuated malondialdehyde accumulation and nitrite activity and restored the depleted reduced glutathione and catalase activity. Neuroprotective effects of quercetin were significantly improved as compared to control (immobilized stressed) animals. Results suggest that neuroprotective properties of quercetin can be used in the treatment and management of stress and related disorders.

Serum transferrin receptor-ferritin index shows concomitant iron deficiency anemia and anemia of chronic disease is common in patients with rheumatoid arthritis in north India.

Anemia is a frequent cause of morbidity in patients with rheumatoid arthritis (RA). We studied the prevalence of anemia of chronic disorders (ACD) and ACD with coexistent iron deficiency anemia (IDA) in patients with RA using sTfR/log ferritin ratio (sTfR - F index). Complete blood counts, percent transferrin saturation, serum ferritin, sTfR, sTfR-F index measurements were carried out in 100 anemic RA patients. Twenty-five IDA subjects without any other illness and 25 age- and sex-matched normal controls were studied. Prevalence of anemia in RA patients was 50.5%. Patients with sTfR-F index value < 1.5 were classified as pure ACD and patients with sTfR-F index value> 1.5 were classified as ACD with coexistent IDA. Using these criteria, 20% patients were found to have pure ACD and 80% patients had coexistent ACD and IDA. In the normal control group, sTfR-F index was found to be 0.16-1.8. We found that sTfR-F index can clearly distinguish IDA control cases and normal subjects with no overlap in the range of sTfR-F index.

Gabapentin attenuates acute hypoxic stress-induced behavioral alterations and oxidative damage in mice: possible involvement of GABAergic mechanism.

The effect of gabapentin has been investigated on acute hypoxic stress-induced behavioral alterations and oxidative damage in mice. Mice were subjected to hypoxia for 2 hr. Treatment with gabapentin (50 and 100 mg/kg) significantly increased ambulatory movements, exerted anti-anxiety like effect and reduced oxidative damage in mice subjected to acute hypoxic stress. Treatment with picrotoxin (1.0 mg/kg) per se had no significant effect on behavioral and biochemical parameters of stressed mice. Treatment with muscimol (0.05 mg/kg) per se significantly increased the locomotor activity of stressed mice, exerted significant anti anxiety effect and significantly reduced the oxidative damage. Further, pretreatment with picrotoxin (1.0 mg/kg) significantly blocked whereas pretreatment with muscimol (0.05 mg/kg) significantly potentiated the neuroprotective effect of gabapentin. These results suggest that gabapentin produces its neuroprotective effect in mice subjected to acute hypoxic stress through GABA(A) receptor mechanism.