Early bladder dysfunction after vesicovaginal fistula repair: A prospective comparative analysis of transvaginal, open, and laparoscopic abdominal approaches.

INTRODUCTION: We aim to compare the clinical and urodynamic profile of lower urinary tract symptoms (LUTS) in patients undergoing laparoscopic, open transabdominal, and laparoscopic transabdominal vesicovaginal fistulae (VVF) repair at 3 months of repair, that is, in early postoperative period. MATERIALS AND METHODS: Fifty-one consecutive patients with endoscopically confirmed VVF were enrolled in our study over 2 years. Malignant fistulae, radiation-induced, and complex fistulae were excluded after cross-sectional imaging. All patients underwent a postoperative assessment for the success of the repair. Then at 3 months, they completed the American Urological Association Symptom Score questionnaire and underwent a dual channel pressure-flow urodynamic study. The results of transvaginal, laparoscopic, and open transabdominal repairs were compared. RESULTS: All patients belonged to the Indian Caucasian race. The mean age was 35.43 ± 6.63 years. Thirty-two patients had supratrigonal and 19 had trigonal fistulae. Laparoscopic transabdominal repair was done in 15 patients, open transabdominal repair in 22 patients, and transvaginal repair in 14 patients. Forty-six patients reported some LUTS at a median follow-up of 5.83 ± 2.37 months postoperatively. Only 18 (35.2%) of these patients had moderate to severe symptoms The postoperative bladder dysfunction rates in open transabdominal, transvaginal and laparoscopic transabdominal groups were 36.4%, 28.6%, and 20%, respectively. Twenty-seven patients (52.9%) had some urodynamic abnormality, that is, small capacity (5), high voiding pressures (14), genuine stress incontinence (3), and poor compliance (3). Bladder capacity was a significant predictor of bladder dysfunction in our patients. CONCLUSIONS: In our study, all three surgical approaches were associated with bladder dysfunction, however, it was the least in the laparoscopic transabdominal approach. Postoperative bladder capacity is a significant predictor of bladder dysfunction.

Circularly Recyclable Polymers Featuring Topochemically Weakened Carbon-Carbon Bonds.

Closed-loop circular utilization of plastics is of manifold significance, yet energy-intensive and poorly selective scission of the ubiquitous carbon-carbon (C-C) bonds in contemporary commercial polymers pose tremendous challenges to envisioned recycling and upcycling scenarios. Here, we demonstrate a topochemical approach for creating elongated C-C bonds with a bond length of 1.57∼1.63 Å between repeating units in the solid state with decreased bond dissociation energies. Elongated bonds were introduced between the repeating units of 12 distinct polymers from three classes. In all cases, the materials exhibit rapid depolymerization via breakage of the elongated bond within a desirable temperature range (140∼260 °C) while otherwise remaining remarkably stable under harsh conditions. Furthermore, the topochemically prepared polymers are processable and 3D-printable while maintaining a high depolymerization yield and tunable mechanical properties. These results suggest that the crystalline polymers synthesized from simple photochemistry and without expensive catalysts are promising for practical applications with complete materials' circularity.

Association of severity and mortality of Covid-19 cases among acute kidney injury and sexual dimorphism.

INTRODUCTION: The outbreak of coronavirus disease 2019 (Covid-19) severely impacted global health and economic status. The native receptor-ligand interaction of Angiotensin-converting enzyme 2 (ACE2) and S protein induces host cell pathogenesis via immunosuppression. MATERIAL AND METHODS: The emerging evidence reports the sex disparity in Covid-19 induced mortality rate which affects abundantly men population. Although the biological interaction of Covid-19 with receptor upregulates the viral genome protein interactions and initiates the predictive multiorgan failure followed by acute kidney injury (AKI) in Covid-19 infected male population. CONCLUSION: Besides, the knowledge and lessons learned from the study depict that cellular and molecular links may explain the risk and severity of Covid-19 and AKI in the male population and lead to management of Covid-19 induced AKI. Therefore, this review explored the pathways associated with the pathogenesis of two diseased conditions with sex disparity.

Long-term yogic intervention decreases serum interleukins IL-10 and IL-1ß and improves cancer-related fatigue and functional scale during radiotherapy/chemotherapy in breast cancer patients: a randomized control study.

PURPOSE: Yoga improved fatigue and immunological profile in cancer survivors and has been a promising alternative therapy. Breast cancer treatments are rapidly improving, along with their side effects. This article investigated the effect of the yogic intervention at a different time interval during radiotherapy/chemotherapy on the pro- and anti-inflammatory interleukins along with the cancer-related fatigue and functional scale among patients with stage II/III breast cancer. METHODS: A total of 96 stage II/III breast cancer patients were enrolled in this study and randomly divided into two different groups. Group I (non-Yoga) received chemotherapy and/or radiotherapy and group II (Yoga) received an additional yogic intervention. Both groups were followed up for a period of 48 weeks and blood was collected at the time of enrollment, 16, 32, and 48 weeks, and serum was isolated to measure the pro- and anti-inflammatory interleukins, fatigue, and functional scale questionnaire obtained at each time point. RESULTS: Breast cancer patients in group II showed a significant improvement (p < 0.05) in the functional scale and fatigue from baseline to 48 weeks compared to group I. The yogic intervention significantly decreased (p < 0.05) the level of pro-inflammatory interleukin IL-1ß and pleiotropic interleukin IL-10 in group II compared to group I. CONCLUSION: These finding suggested that improved fatigue and functional scale is associated with a lower level of IL-1ß and IL-10. Yoga may be an important additional therapy along with the cancer treatment to help the patients with cancer-related fatigue and improve their overall immunological profile.

Comparison of extended totally extra peritoneal (eTEP) vs intra peritoneal onlay mesh (IPOM) repair for management of primary and incisional hernia in terms of early outcomes and cost effectiveness-a randomized controlled trial.

BACKGROUND: There are no randomized controlled trials comparing the eTEP with IPOM repair and this randomized study was designed to compare the two techniques in terms of early pain, cost effectiveness, and quality of life. METHOD: This was a prospective randomized trial with intention to treat analysis. The primary outcome was immediate post-operative pain scores. Operative time, conversions, peri operative morbidity, hospital stay, return to daily activities, incremental cost effectiveness ratio and quality of life (WHO-QOL BREF) were secondary outcomes. RESULTS: Sixty patients were randomized equally. Early post-operative pain scores and seroma rates were significantly lower and with a significantly earlier return to activity in eTEP group (p value < 0.05). With negative costs and positive effects, eTEP group was 2.4 times more cost effective. CONCLUSION: eTEP repair is better in terms of lesser early post-operative pain, earlier return to activities and cost effectiveness in small and medium size defects.

Tailored one anastomosis gastric bypass - Subgroup analysis of a randomised control trial based on bilio-pancreatic limb length with long-term results of 101 patients.

Background: : Ideal bilio-pancreatic limb (BPL) length is a highly debatable issue in one anastomosis gastric bypass (OAGB). Whether to use a tailored BPL or a fixed-length BPL needs to be answered. Materials and Methods: : One-hundred and one patients who have undergone tailored OAGB based on basal metabolic index (BMI) and type 2 diabetes mellitus (T2DM) were analysed. Sixty-three patients had BPL of 150 cm and 38 patients had BPL of 180 cm. Mean pre-operative BMI of BPL 150 and 180 cm groups were 39.73 and 51.92 kg/m2, respectively. Results: There was a significant drop in mean total body weight, BMI and excess body weight of both the groups at 1 year which persisted for 5 years post-operatively. The mean BMI of BPL 150 and BPL 180 cm group at 5 years was 29.17 and 32.88 kg/m2, respectively. Although mean percentage excess weight loss (%EWL) and percentage of excess BMI loss in the two groups was similar, the mean percentage total weight loss (%TWL) was significantly higher for the BPL 180 cm group. There was no difference between the two groups in the number of patients who had >50% EWL and >20% TWL. At 5 years of follow-up, the mean serum iron level was significantly low in BPL 180 cm group. There was a significant drop in mean haemoglobin A1c values postoperatively, with no difference between the two groups. Conclusions: Tailored BPL of 150 and 180 cm do not show any difference in the number of patients achieving >50% EWL or >20% TWL and so increasing limb length may not increase the number of good responders for weight loss. Although the resolution of T2DM and improvement of QoL score do not change significantly with increase in BPL length, mean serum iron levels may be lower with longer BPL.

A three-arm randomized study to compare sexual functions and fertility indices following open mesh hernioplasty (OMH), laparoscopic totally extra peritoneal (TEP) and transabdominal preperitoneal (TAPP) repair of groin hernia.

BACKGROUND: With evolving technology, the focus of groin hernia repair has shifted to sexual function and fertility outcomes. METHODS: This three-arm randomized study was conducted in tertiary care hospital from 1st July 2017 to 30th March 2019. Consecutive patients of groin hernia were randomized into 3 groups, TAPP (Group 1), TEP (Group 2), and OMH (Group 3). Demographic profile and hernia characteristics were assessed preoperatively. Sexual functions (using BMSFI) and fertility (using surrogate fertility indices, viz., semen analysis and anti-sperm antibodies (ASA)) were assessed preoperatively at 3 months after the surgery. RESULTS: A total of 121 patients were included in the study with 41 patients in TAPP (Group 1) and 40 each in TEP (Group 2) and OMH (Group3) group. All the 3 groups were comparable in terms of demographic profile, hernia characteristics, intra-operative and early post-operative outcomes. Significant improvement was found in most of the domains of BMSFI score in the study population (p value < 0.001) with no intergroup difference. There was significant increase of anti-sperm antibody level in OMH group as compared to TAPP and TEP (p = 0.001), however, the levels were within normal limit. CONCLUSIONS: In conclusion, this study has shown that inguinal hernia repair whether open or laparoscopic (TEP or TAPP) leads on to improvement in sexual functions and fertility indices and can have a significant impact on pre-op counseling of the patient in terms of choice of repair, depending on the available expertise in a given center.

Inflammatory bowel disease: An Indian perspective.

Inflammatory bowel disease (IBD) in recent times is causing a significant healthcare burden as both ulcerative colitis and Crohn's disease (CD) require lifelong therapy and constant monitoring. The current review highlights the concerns in a country like India with special reference to the changing trends of IBD, risk attribution and the financial issues. Indian immigrants behave like residential Indians, whereas their children show IBD prevalence similar to the West, highlighting the role of environmental triggers. However, the environmental and genetic factors in Indians with IBD are not well understood. Men appear to be more frequently affected than women in India. The disease severity is milder in the patients, both males and females, but the risk for colorectal cancer (CRC) is similar to the West. The incidence of paediatric IBD is on the rise. The major burden of IBD in the Indian subcontinent at present is in children, adolescents and teens. Cost towards the management of complications, non-adherence to treatment, differentiating tuberculosis from CD and finally screening for CRC in patients with IBD are the points to ponder in the Indian scenario.

Defaecation disorders among information technology personnel: A cross-sectional study.

Background Individuals working in the information technology (IT) industry are likely to develop lifestyle disorders. We aimed to determine the presence of defaecation-related disorders in IT personnel in Chennai. Methods This cross-sectional, questionnaire-based study was done from June to December 2018. We included employees between 18 and 60 years of age and excluded those with <1 year stay in Chennai, pregnancy and those who sent incomplete responses. The cohort was classified as normal, irritable bowel syndrome (IBS), faecal evacuation disorder (FED) and a combination of the latter two. Results The overall response rate was 95.6%. The study included 54.7% of men, and the median age was 31 years. The majority of respondents used an Indian toilet (554; 58%). Almost all (96.2%) passed stools daily, and stool consistency was soft in 59%. Based on the study criteria, 180 (18.8%) had FED, 56 (5.9%) had IBS and a small group had a combination of symptoms of IBS and FED (20; 2.1%). Respondents with symptoms of IBS had a higher proportion of comorbid states (p<0.0001), lesser stool frequency (p<0.0001) and required more toilet time (p<0.00001). Conclusion Over one-fourth (26.7%) of the respondents had defaecation-related issues, 18.8% had symptoms suggestive of FED and 5.6% that of IBS, often above 30 years of age.

"Misra's appendicular hitch" stich - Innovative technique for simplifying endo-suturing during laparoscopic appendectomy.

Laparoscopic suture transfixation and free tie ligation are the most commonly used cost-effective technique of managing the base of the appendix during laparoscopic appendectomy in low resource settings such as India. This becomes technically cumbersome especially in the presence of the long friable appendix and for novice surgeons. We hereby describe an innovative technique of suspending the appendix using a transfacial suture to ease the placement of suture at the base of the appendix during laparoscopic appendectomy.

Scoring Systems that Predict Mortality at Admission in End-stage Liver Disease.

BACKGROUND: Various scoring systems have been developed to assess the severity and survival in end-stage liver disease. AIM OF THE STUDY: Prospective study to compare and analyze the efficacy of scoring systems in predicting mortality in ESLD patients who present with cirrhosis specific complications to the emergency room. MATERIALS AND METHODS: This prospective, single point study was conducted over a two year period from September 2014 to August 2016 among 162 ESLD patients seeking admission to the emergency unit of Gleneagles Global Health City, Chennai. Baseline investigations incorporated hemogram, liver biochemical parameters, coagulation parameters (PT/INR), serum creatinine, serum electrolytes and blood gas analysis, to calculate the CTP score, MELD, MELD-Na, MESO, iMELD, Updated MELD, UKELD, SOFA and APACHE II. Comparison of MELD snd non MELD scores were done between survivors and nonsurvivors. The mortality rate for the same admission was calculated. RESULTS: Of the 162 patients requiring emergency admision, 148 were men (91.4%). The median age of patients was 56 years (range 25-75 years). The cause for liver cirrhosis was alcohol followed by nonalcoholic steatohepatitis and hepatitis B. The indications for emergency admissions were fever, tense ascites, reduced urine output and altered sensorium. Thirty patients (18.5%) expired during the same admission. The predictive accuracy of all scores for predicting mortality by ROC curves was between 0.7 and 0.8 (p < 0.05). CONCLUSION: Although, all scores appear to be equally good, simple scores like CTP and MELD is all that is required to ascertain the prognosis of patients seeking emergency admission. HOW TO CITE THIS ARTICLE: Mangla N, Bokarvadia R, Jain M, Varghese J, Venkataraman J. Scoring Systems that Predict Mortality at Admission in End-stage Liver Disease. Indian J Crit Care Med 2019;23(10):445-448.

von Willebrand Factor: A Tool to Predict Severity and Prognosis in Liver Disease.

Von Willebrand factor (vWF) is an adhesive and multimeric glycoprotein that has a central role in primary hemostasis. v W F levels correlate with thrombosis risk and inversely with bleeding risk within the apparently healthy population. Recently, numerous publications in Indian and western literature have focussed to its role in liver diseases like acute liver failure, chronic liver disease, non cirrhotic portal hypertension and tropical infections eg. dengue. The present review encapsulates the recent advances in this aspect.

Nocardia liver abscess post liver transplantation-A rare presentation.

Nocardiosis is usually a disseminated disease seen in immunocompromised individuals. We herein present a rare case of isolated Nocardia liver abscess post liver transplantation. The patient responded well to treatment and is on long-term antibiotics for Nocardia infection.

Evaluation of Maxillary Sinus Septa Using Cone Beam Computed Tomography (CBCT): A Retrospective Study.

BACKGROUND: Maxillary sinus septa, which are bony structures dividing the sinus cavity, can pose challenges during sinus lift or implant surgeries by potentially causing perforation of the Schneiderian membrane. This study aimed to estimate the prevalence, height, location, orientation, and risk of perforation of the maxillary sinus septa using cone beam computed tomography (CBCT). MATERIALS AND METHODS: This retrospective, cross-sectional study utilized CBCT (NewTom CBCT machine, of which the scan parameters were 90 KvP, 8 mAs, and 14 s exposure with a field of view (FOV) of 8×8 cm and a 0.2 mm3 voxel size) images of 300 maxillary sinuses from patients aged >18 years, obtained from Swami Devi Dyal Hospital and Dental College in Panchkula, India. Scans were analyzed for the presence, height, location, orientation, and risk of septal perforation. The data were categorized based on age, sex, and dentition status. Statistical analyses were performed to assess the prevalence, configuration, and risk factors. RESULTS: The prevalence of maxillary sinus septa was 21.33%, with the majority showing a single septum (90.63%). Septa were predominantly found in the middle region (48.44%), with bucco-palatal orientation (93.75%) being more common than anteroposterior. The mean septa height was 6.16 mm. The perforation was classified as moderate (48.4%), low (46.8%), or high (4.6%). Class III septa were associated with the highest risk of perforation. CONCLUSION: This study highlights a significant prevalence of maxillary sinus septa with variations in height, orientation, and location. The risk of perforation varies with the septa configuration and orientation. CBCT is essential for identifying these anatomical features to minimize surgical complications and to guide preoperative planning.

Mapping the Multiscale Proteomic Organization of Cellular and Disease Phenotypes.

While the primary sequences of human proteins have been cataloged for over a decade, determining how these are organized into a dynamic collection of multiprotein assemblies, with structures and functions spanning biological scales, is an ongoing venture. Systematic and data-driven analyses of these higher-order structures are emerging, facilitating the discovery and understanding of cellular phenotypes. At present, knowledge of protein localization and function has been primarily derived from manual annotation and curation in resources such as the Gene Ontology, which are biased toward richly annotated genes in the literature. Here, we envision a future powered by data-driven mapping of protein assemblies. These maps can capture and decode cellular functions through the integration of protein expression, localization, and interaction data across length scales and timescales. In this review, we focus on progress toward constructing integrated cell maps that accelerate the life sciences and translational research.

LSG vs OAGB: 7-Year Follow-up Data of a Randomised Control Trial and Comparative Outcome Based on BAROS Score.

BACKGROUND: This study aims to evaluate and compare long-term results of laparoscopic sleeve gastrectomy (LSG) and one anastomosis gastric bypass (OAGB) based on bariatric analysis reporting and outcome system (BAROS) score. MATERIALS AND METHODS: Patients operated for morbid obesity between 2013 and 2015 were randomised to LSG and OAGB groups. Based on inclusion and exclusion criteria, 201 patients (100 LSG and 101 OAGB) were analysed for changes in total body weight (TBW), body mass index (BMI), percent excess weight loss (%EWL), percent total weight loss (%TWL), QoL (quality of life) scores, comorbidity resolution and outcome based on BAROS at 7 years. RESULTS: Sixty-six LSG and 64 OAGB patients were followed up at 7 years. Mean pre-operative TBW and BMI were 119 ± 28.2 and 44.87 ± 7.71 for LSG group and 113.25 ± 23.74 and 44.71 ± 8.75 for OAGB group respectively. At 7 years after surgery, there was significant drop in mean TBW and BMI in both groups. Mean %EWL for LSG and OAGB patients was 50.78 ± 28.48 and 59.99 ± 23.32 and mean %TWL for LSG and OAGB patients was 23.22 ± 12.66 and 27.71 ± 12.27 respectively. Mean QoL scores at 7 years were significantly higher than the pre-operative scores and most of the patients in both groups had remission or improvement in their comorbidities. 68.76% OAGB patients had very good or excellent outcome on BAROS score while only 36.37% LSG patients had similar outcome. CONCLUSIONS: LSG and OAGB are successful bariatric procedures over the long term. OAGB outperforms LSG and has significantly higher %EWL and %TWL over the long term.