Efficacy and outcome of indocyanine green-based intraoperative cholangiography using near-infrared fluorescence imaging: A prospective study.

INTRODUCTION: The most dreaded complication during laparoscopic cholecystectomy still remains to be injury to the common bile duct. The primary cause for bile duct injury during LC is misinterpretation of the biliary anatomy. Intra-operative cholangiography was introduced as a means of reducing the chances of biliary injury, done using Fluoroscopic imaging or Near-infrared fluorescence imaging method. NIRF is one of the most popular imaging methods in biomedical sciences. Indocyanine Green is sterile and water soluble which completely binds to albumin and is excreted in bile. PATIENTS AND METHODS: This prospective study was conducted among 70 patients between July 2020 and December 2021. Subjects were administered 5mg of ICG dye pre-operatively and procedure performed using Karl Storz HD image S1 system with a D-light P light source for NIRF imaging. RESULTS: The average duration of surgery was 58.10 minutes. After calot's dissection, the CBD was visualized in 88.71 % patients, with a mean time to visualization at 26.33 minutes. The cystic duct was visualized in 87.3% cases with a mean time of visualization of 32.10 minutes. The hepatic duct was visualized in 28.57% and the hepatic duct-CBD confluence was visualized in 34.28% patients. CONCLUSION: Near infrared imaging based intra-operative cholangiography, using Indocyanine Green dye, during Lap. Cholecystectomy is an easy, useful and inexpensive method of visualizing the biliary ductal anatomy.

Inflammatory Bowel Disease and X (Formerly Twitter) Influencers: Who Are They and What Do They Say?

Background and objective More than half of the population suffering from inflammatory bowel disease (IBD) use the internet as a primary source of information on their condition. X (formerly Twitter) has been increasingly used to disseminate healthcare-related information. In this study, we aimed to identify top influencers on the topic of IBD on X and correlate the relevance of their social media engagements with their professional expertise or academic productivity. Methods X (formerly Twitter) influence scores for the search topic IBD were obtained using Cronycle API, a proprietary software employing multiple algorithms to rank influencers. Data regarding gender, profession, location, and research productivity represented as h-index was collected. Results We collected information on the top 100 IBD influencers on X. The majority of influencers were gastroenterologists, followed by IBD advocates. Of note, 62% of the IBD influencers were from the US followed by the UK and Canada. A positive correlation was observed between the X topic score and the h-index of the influencer (r=+0.488, p<0.001) Conclusions The strong correlation observed between the X topic score and h-index suggests that social media is a viable platform for gaining information regarding IBD. Further research aimed at counteracting misleading information by providing facts and data in a succinct manner about IBD on social media is required to improve disease awareness.

A nationwide survey on the preference of Indian undergraduate medical students to go abroad for higher studies and residency.

Context: Getting residency training abroad is a critical motivator in the emigration of Indian medical students. Brain drain is an emerging issue, especially for developing countries as it causes a shortage of trained staff in the donor country. Aim: We aimed to survey Indian medical students to know about their intentions to get trained abroad and to understand the factors influencing their decision. Materials and Methods: In this cross-sectional observational study, we surveyed Indian undergraduate medical students of all professional years, including internship. A validated questionnaire collected data on students' demographics and educational characteristics, intention to study overseas or stay back in India, and factors influencing their decision. Results: Out of a total of 1199 responses (51.1% males, 48.9% females), 45.0% partakers had planned to pursue their residency abroad, while 33.8% wanted to stay in India and 21.2% were undecided. Better lifestyle and higher pay grades overseas were viewed as the most significant barriers to staying back in India and a key influencer in decision-making among the maximum number of students (412; 76.3%). On the other hand, a whopping 58.2% of participants opined that they wanted to stay back in India for taking care of their parents. Conclusions: Source countries with better healthcare facilities and better incomes tend to attract medical students. Awareness among medical educators regarding constantly changing curricula, a shift to a competency-based education system, better pay grades, limited working hours, and interventions to mitigate workplace violence could help prevent brain drain among Indian medical students and graduates.

Wide Local Excision of Complex or Infected Pilonidal Sinus Followed by Negative Pressure Wound Therapy: Does It Enhance Wound Healing?

Background Pilonidal sinus disease (PSD) is a chronic skin condition caused by hair retention that affects the sacrococcygeal cleft. The purpose of this study is to compare the efficacy of negative pressure wound therapy (NPWT) to routine daily dressings (DDs) in wound healing after complex or infected pilonidal sinus tract excision. Materials and methods The study included 81 individuals who had extensive local excisions for pilonidal sinuses that were complex or infected. Randomly selected participants were given either NPWT or the usual dressing. Between the two groups, the length of hospitalization, the amount of time needed to resume daily activities, and the amount of time needed for full wound closure were compared. Results Forty-two patients received NPWT, while 39 patients received DDs as usual. There was no discernible difference between the two groups in terms of operating time or hospital stay. However, patients who underwent NPWT experienced a quicker final wound closure (59.24 ± 10.21 days compared to routine DD with a mean time of 75.31 ± 14.68 days, P = 0.001) and returned to normal activities earlier (17.36 versus 21.75 days in NPWT and routine DD, respectively). Conclusion Compared to patients who received standard DDs, those who were postoperatively managed with NPWT showed faster wound healing and return to normal activities. Whenever feasible, this strategy may be employed to improve patient recovery.

Digital impact of world hepatitis day: Formulating evidence-based recommendations for promoting healthcare awareness events.

BACKGROUND: Social media applications provide room for public interaction and forming communities, thus helping disseminate health-related information. Since 2010, World Hepatitis Day has been observed on July 28 with endorsement from the World Health Organization. This study aimed to ascertain the global digital impact of World Hepatitis Day on Twitter (an online microblogging social network) and on the web (web searches and news) to formulate evidence-based recommendations for promoting future policy development. MATERIALS AND METHODS: We analyzed publicly available data from Twitter, a popular microblogging social network on the internet (data accessed from India). Three social media assessment tools (Sprout social, SocioViz and Symplur) and Google Trends were used to obtain data about the tweets and global impressions worldwide about World Hepatitis Day. A time frame from July 27th, 2022 to July 29th, 2022 was taken into account for all the tweets in various time zones around the world. RESULTS: "#WorldHepatitisDay" and "#Hepatitis" received 519.16 million and 412.37 million impressions in the defined timeframe, respectively. A total of 39,069 tweets were posted about World Hepatitis Day, an increase of 24.1% compared to the previous year. On social network analysis, 93 of the top 100 influencers collaborated among themselves, which helped in the wider dissemination of awareness. CONCLUSIONS: World Hepatitis Day 2022 was an impactful healthcare awareness event on Twitter for the global audience and sets forth an example of the effective utilization of resources. Future policies shall inculcate constructive feedback from our findings and must be inclusive of all the underrepresented communities.

Role of Artificial Intelligence in Global Surgery: A Review of Opportunities and Challenges.

Global surgery broadly refers to a rapidly expanding multidisciplinary field concerned with providing better and equitable surgical care across international health systems. Global surgery initiatives primarily focus on capacity building, advocacy, education, research, and policy development in low- and middle-income countries (LMICs). The inadequate surgical, anesthetic, and obstetric care currently contributes to 18 million preventable deaths each year. Hence, there is a growing interest in the rapid growth of artificial intelligence (AI) that provides a distinctive opportunity to enhance surgical services in LMICs. AI modalities have been used for personalizing surgical education, automating administrative tasks, and developing realistic and cost-effective simulation-training programs with provisions for people with special needs. Furthermore, AI may assist with providing insights for governance, infrastructure development, and monitoring/predicting stock take or logistics failure that can help in strengthening global surgery pillars. Numerous AI-assisted telemedicine-based platforms have allowed healthcare professionals to virtually assist in complex surgeries that may help to improve surgical accessibility across LMICs. Challenges in implementing AI technology include the misrepresentation of minority populations in the datasets leading to discriminatory bias. Human hesitancy, employment uncertainty, automation bias, and role of confounding factors need to be further studied for equitable utilization of AI. With a focused and evidence-based approach, AI could help several LMICs overcome bureaucratic inefficiency and develop more efficient surgical systems.

The Digital Impact of Neurosurgery Awareness Month: Retrospective Infodemiology Study.

BACKGROUND: Neurosurgery Awareness Month (August) was initiated by the American Association of Neurological Surgeons with the aim of bringing neurological conditions to the forefront and educating the public about these conditions. Digital media is an important tool for disseminating information and connecting with influencers, general public, and other stakeholders. Hence, it is crucial to understand the impact of awareness campaigns such as Neurosurgery Awareness Month to optimize resource allocation, quantify the efficiency and reach of these initiatives, and identify areas for improvement. OBJECTIVE: The purpose of our study was to examine the digital impact of Neurosurgery Awareness Month globally and identify areas for further improvement. METHODS: We used 4 social media (Twitter) assessment tools (Sprout Social, SocioViz, Sentiment Viz, and Symplur) and Google Trends to extract data using various search queries. Using regression analysis, trends were studied in the total number of tweets posted in August between 2014 and 2022. Two search queries were used in this analysis: one specifically targeting tweets related to Neurosurgery Awareness Month and the other isolating all neurosurgery-related posts. Total impressions and top influencers for #neurosurgery were calculated using Symplur's machine learning algorithm. To study the context of the tweets, we used SocioViz to isolate the top 100 popular hashtags, keywords, and collaborations between influencers. Network analysis was performed to illustrate the interactions and connections within the digital media environment using ForceAtlas2 model. Sentiment analysis was done to study the underlying emotion of the tweets. Google Trends was used to study the global search interest by studying relative search volume data. RESULTS: A total of 10,007 users were identified as tweeting about neurosurgery during Neurosurgery Awareness Month using the "#neurosurgery" hashtag. These tweets generated over 29.14 million impressions globally. Of the top 10 most influential users, 5 were faculty neurosurgeons at US university hospitals. Other influential users included notable organizations and journals in the field of neurosurgery. The network analysis of the top 100 influencers showed a collaboration rate of 81%. However, only 1.6% of the total neurosurgery tweets were advocating about neurosurgery awareness during Neurosurgery Awareness Month, and only 13 tweets were posted by verified users using the #neurosurgeryawarenessmonth hashtag. The sentiment analysis revealed that the majority of the tweets about Neurosurgery Awareness Month were pleasant with subdued emotion. CONCLUSIONS: The global digital impact of Neurosurgery Awareness Month is nascent, and support from other international organizations and neurosurgical influencers is needed to yield a significant digital reach. Increasing collaboration and involvement from underrepresented communities may help to increase the global reach. By better understanding the digital impact of Neurosurgery Awareness Month, future health care awareness campaigns can be optimized to increase global awareness of neurosurgery and the challenges facing the field.

Contact Tracing of Healthcare Workers Exposed to COVID-19 Infection in a Tertiary-Care Hospital: Containing the Contagion.

Introduction: Healthcare workers (HCWs) are at higher risk of getting infected with COVID-19 infection due to their close proximity to COVID-19-positive patients. We studied the risk stratification and positivity rate in HCWs at risk of getting COVID-19 infection as well as the possible factors responsible for their being at risk of COVID-19 infection during the study period. Material and Methods: This prospective study was conducted after approval by the institutional ethics committee. The data regarding demographic variables, risk stratification, COVID-19 (reverse-transcription polymerase chain reaction) report, and possible sources of exposure for HCWs were recorded in a proforma by personal/telephonic interviews as well as from hospital records from March 2020 to June 2021. The data generated were entered into Microsoft Excel® software and analyzed using percentages, proportions, and Chi-square tests for qualitative variables. Results: COVID-19 infection's positivity rate was 19.5% among high-risk and 0.6% among low-risk HCW contacts. HCWs working in non-COVID-19 areas (67.9%) were more at risk than those working in COVID-19 areas (32.1%). In contrast, the COVID-19 positivity rate was significantly higher among high-risk contact HCWs from COVID-19 areas (34.2%) than in non-COVID-19 areas (12.6%). The maximum COVID-19 positivity rate was seen in high-risk contacts with body fluid exposure (21%), performing aerosol-generating procedures (20%), and close exposure in operation theaters (18%). Conclusions: Risk stratification is an important tool to contain infection among HCWs who had unprotected close contact with a COVID-19-positive case. With appropriate contact tracing, we were able to avoid over- and under-quarantine, save many man-hours as well as contain the spread of infection. HCWs should not only wear appropriate personal protective equipment (PPE) during work hours but should also practice mask-wearing and social distancing while they are in the community.

Appendix Playing Hide and Seek: A Variation to Amyand's Hernia.

Amyand's hernia is a rare condition where the appendix becomes trapped in the inguinal hernia sac, leading to severe complications if left untreated. Treatment typically involves surgical repair of the hernia, with the removal of the appendix if necessary. This case report presents a 65-year-old male with compromised cardiac status and a right inguinal hernia, confirmed by ultrasound. The surgery was performed under local anesthesia, and the appendix was normal and reduced back. The patient was discharged on the next day of surgery after an uneventful course in the hospital. There is a difference of opinion regarding the need for an appendectomy in an Amyand's hernia with a normal appendix, with the appendix dancing in and out of the inguinal canal while coughing on the table. The decision to remove or leave a normal appendix in this situation should be based on several factors, including the patient's age, appendix anatomy, and extent of intraoperative inflammation. In conclusion, local anesthesia can be a safe and effective option for patients who are not fit for general or spinal anesthesia. The decision to remove or leave a normal appendix in Amyand's hernia should be based on several factors.

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.

Understanding the digital impact of World Hypertension Day: key takeaways.

Aim: To understand the global digital impact of World Hypertension Day and identify areas for further improvement to steer future policy development. Methods and results: We used three social media assessment tools (Sprout Social, SocioViz, and Symplur) and Google Trends to obtain data about the total tweets and global impressions from countries worldwide about World Hypertension Day. Social network analysis of top influencers, associated hashtags, and keywords was performed to understand the context of the posts. With over 60 000 tweets reaching more than 250 million impressions, World Hypertension Day was a highly impactful event. A large spike of over 800% yearly increase was seen in 2021 that has greatly facilitated wider dissemination. However, there was limited collaboration among the top influencers and negligible participation from several African and non-English-speaking European countries. Conclusion: With support from several governmental bodies, organizations and media outlets, World Hypertension Day is a highly impactful healthcare awareness day and presents a global case study of effectively utilizing digital resources for creating awareness among the global audience. Prioritizing equitable involvement from underrepresented and underprivileged communities must be focused. Future policy development of other awareness events shall extract the constructive feedback from these findings to promote global and public health.

Routine Histopathological Evaluation After Appendectomy: Is It Necessary? A Systematic Review.

Acute appendicitis is one of the most common reasons for acute abdominal pain. Fecaliths and lymphoid hyperplasia are the usual etiology of acute appendicitis, however, other unusual causes can also not be neglected which can be parasitic infections, benign or malignant lesions. Due to substantial lab costs and limited resources, the policy of routine histopathological examination (HPE) of appendectomy samples is being questioned. PubMed, PubMed Central (PMC), and Google Scholar were used to look for relevant published studies. The following keywords were used both alone and in combination: "Acute appendicitis" and "routine histopathological examination". Fifteen articles were selected for final review that collectively had 57,524 cases. All these studies included in this systematic review are peer-reviewed. Based on the reviewed articles, it was found that though the probability of unusual findings in a patient of acute appendicitis is less but it is still significant and if found, often results in a change of management plan of the patient. Therefore, it is recommended to perform a routine histopathological examination of all appendectomy specimens to rule out unusual pathologies.

Role of Amylase and Lipase Levels in Diagnosis of Blunt Trauma Abdomen.

INTRODUCTION: Blunt Trauma Abdomen (BTA) is the leading cause of morbidity and mortality amongst all age groups. Spectrum of injury may vary from simple to life threatening multi organ involvement and therefore proper assessment and diagnosis becomes very important. AIM: To evaluate the role of serum amylase and lipase in diagnosis of blunt trauma abdomen. MATERIALS AND METHODS: This study was done on 50 patients with diagnosis of BTA admitted in Dayanand Medical College and Hospital, Ludhiana. Serum amylase and lipase levels were estimated on days 1, 3 and 5 of admission. RESULTS: Road side accident was the most common aetiology accounting for 40 patients. Thirty one patients were less than 35 years of age and 42 patients were males. Abdominal tenderness was the most common per abdomen finding, found in 31 patients, followed by distension, found in 21 patients. The most common organ injured was liver, seen in 27 patients. Fifteen patients underwent laparotomy while 35 patients were managed conservatively. There was statistically significant rise in serum amylase levels on days 1, 3 and 5 in patients with small and large intestinal injury. There was statistically significant rise in serum lipase levels on days 1, 3 and 5 in patients with stomach injury. Raised levels of serum amylase and lipase had a statistically significant prediction for the need of surgery in these patients. CONCLUSION: Serum amylase and lipase levels, when coupled with other laboratory tests and imaging modalities, may have significant role in predicting the site of injury as well as the surgical outcome in patients of BTA.

Role of routine intraoperative cholangiography during laparoscopic cholecystectomy.

BACKGROUND: Routine intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC), a radiologic contrast-based examination of the bile duct, can represent a systemic approach to avoiding common bile duct injury MATERIAL AND METHOD: This was a prospective study, conducted in the Department of General Surgery, Government Medical College/Rajindra Hospital, Patiala. 100 consecutive patients suffering from symptomatic gall stones undergoing LC were included in the study. The intraoperative cholangiograms were obtained. Two films were taken in addition to a preoperative scout film. The films were immediately interpreted. The catheter was taken out and the gall bladder was removed as usual, and ports were taken out after putting drain in the abdominal cavity. RESULTS: A total of 100 patients were included in the study. Average age was 43.7 years and majority of them were females (80%). 60% of patients presented with pain abdomen while 40% presented with dyspepsia along with pain abdomen. Out of the 100, successful cannulation of the cystic duct was achieved in 92 patients. There was significant additional operating time ranging from 17 to 42 min with mean time of 24.82 min. There was no intraoperative complication. Total additional cost of IOC was in range of Rs. 2200-2500. No patient re-presented to us with biliary symptoms within 18 months of surgery. CONCLUSION: In our study, we conclude that routine IOC was successful and safe, yields information that was not useful to alter operative management. The operating time was significantly longer but there was no significant difference in the hospital stay. Routine IOC decreases the readmission rate with post cholecystectomy syndrome, which occurs in 10-40% of the post cholecystectomy patients.

Role of diagnostic laparoscopy in chronic abdominal conditions with uncertain diagnosis.

INTRODUCTION: Laparoscopy has proved to be an important tool in the minimally invasive exploration of selected patients with chronic abdominal disorders, whose diagnosis remains uncertain, despite exploring the requisite laboratory and imaging investigations like ultrasonography, computed tomography (CT) scan, and the like. MATERIALS AND METHODS: Diagnostic Laparoscopy was conducted on 120 patients, admitted to the Departments of Surgery and Gynecology, Dayanand Medical College and Hospital, Ludhiana, with an uncertain diagnosis after four weeks of onset of symptoms. CONCLUSION: With laparoscopy providing tissue diagnosis, and helping to achieve the final diagnosis without any significant complication and less operative time, it can be safely concluded that diagnostic laparoscopy is a safe, quick, and effective adjunct to non-surgical diagnostic modalities, for establishing a conclusive diagnosis, but whether it will replace imaging studies as a primary modality for diagnosis needs more evidence.

Pregabalin in Chronic Post-thoracotomy Pain.

INTRODUCTION: Chronic post-thoracotomy pain (CPP) has very high incidence and therefore it needs attention. Usually, it is burning, dysaesthetic and aching in nature and it displays many features of neuropathic pain. No one technique of thoracotomy has been shown to reduce the incidence of chronic post thoracotomy pain. OBJECTIVES: To evaluate the efficacy and safety of pregabalin in patients with chronic post-thoracotomy pain. METHODS: This prospective, randomized study was conducted on 50 consenting patients who underwent posterolateral thoracotomy. 25 patients were given pregabalin for 21 days (Group A). Another 25 were given diclofenac sodium (Group B) on demand and they escaped treatment. Visual Analogue Scale (VAS) scoring was performed on days 0, 1 and 7, then follow up was done at 3, 6, 12 and 24 weeks. The data was analyzed by using t-test and Chi- square test for various variables. RESULTS: The pain VAS scores in Group A were significantly low at all observation points except on day 0, day 1 and day 7 post-operatively, when the difference in pain scores in both the groups were comparable. The overall pain scores of Group A were comparable at day 0, day 1 and at day 7 as compared to those of Group B (p>0.9). Pain was significantly low at three weeks (p<0.05). Pain scores of Group A were significantly low at 6 weeks,12 weeks and 24 weeks as compared to those of Group B (p<0.001) and the difference was statistically significant. No significant adverse reactions were observed during study period. CONCLUSION: Pregabalin is a safe and an effective adjuvant which is used for reducing the chronic post thoracotomy pain, which has no side effects and a high patient compliance. These results should be supported with multidisciplinary studies with larger sample sizes and longer follow-ups.

The role of fibrin glue in the treatment of high and low fistulas in ano.

AIM: The aim of this study was to assess the outcome of fibrin glue in high and low anal fistulas. METHODS: A prospective, non-randomized trial was carried out on 30 patients who were diagnosed to have fistulas in ano. They were evaluated by categorizing them into high (with the internal opening above the anorectal ring)(14/30) and low anal fistulas (with the internal opening below the anorectal ring)(16/30). The fibrin glue was instilled in their anal tracts. The character of the anal tract, whether it was single or multiple and primary or recurrent, was analyzed. The outcome in terms of a postoperative discharge (failure), the incidence of a postoperative perianal pain/abscess and the glue reaction, was noted at 1 week, 1 month, 3 months and 6 months. A success was defined as the absence of any discharge at 6 months. RESULTS: Fourteen patients with high anal fistulas and 16 with low anal fistulas (with a mean age of 48.5yrs) were treated with fibrin glue. 19 patients had primary tracts (7- high group and 12- low group) and 11 had recurrent tracts (7- high group and 4- low group). 20 fistulas were single tracted (8- high and 12- low) and ten were multiple tracted (6- high and 4-low). The success rate at 6 months was 57.14% in the high group and it was 81.25% in the low group. The failure rate was 85.71% in the recurrent high fistula group as compared to 25% in the recurrent low fistula group (p=0.049). 25% of the single tracted high fistulas failed to heal as compared to a 100% healing rate in the single low fistulas group (p=0.90). CONCLUSION: This procedure is thus, superior to the conventional surgical treatment, in terms of the patient comfort, an undisturbed sphincter function, a reduced overall hospital stay, wound pain and the complications and adverse reactions. It showed the best results in the primary, single tracted and the low anal fistulas.