Laparoscopic management of left paraduodenal hernia: a rare case report

An internal hernia is any protrusion of a solid organ or a hollow viscus through a defect within the abdominal cavity. Paraduodenal hernias are rare, but are the most common variety of internal hernias. We present a rare case of a left sided paraduodenal hernia in a 26 years old otherwise healthy male who presented in emergency department with intermittent colicky upper abdominal pain. Left paraduodenal hernia was diagnosed pre operatively in a computer tomography scan. Hence patient was offered a laparoscopic repair. Our search via online search engines revealed very few case reports of Paraduodenal hernias which were repaired laparoscopically. We believe that in expert hands, paraduodenal hernias should be managed with laparoscopic technique as it significantly reduces morbidity and hospital stay.

A prospective observational study on feasibility of laparoscopic perforation repair in patients presenting with intestinal perforation at a tertiary care superspeciality hospital in Chhattisgarh

Background: Bowel perforation is one of the common emergencies faced by the surgeons in the developing world. It carries a high morbidity and mortality rate even today. In the present era, laparoscopy is being used as a better treatment alternative across the world. Various reports in literature are now available regarding the feasibility of laparoscopic repair of bowel perforation. The purpose of this study was to assess the feasibility of laparoscopic primary suture repair as the initial modality in treating a bowel perforation and to analyze the pattern of bowel perforation in relation to age, sex and etiology in Chhattisgarh state.Methods: This study included the data of relevant patients who got admitted in Ramkrishna Care Hospital Raipur from 1st October 2017 to 31st September 2019 (24 months).Results: Most commonly affected mean age group in this study was 39±15.82 years with male predominance. Statistically  significant findings in favour of laparoscopic repair in our study were early return of bowel activity, less incidence of surgical site infection, early return to work (less hospital stay), less post-operative pain as compared to open surgery (p<0.05).Conclusions: In this study it was found that laparoscopy in patients with bowel perforation who are hemodynamically stable and present early (<72 hours) to the hospital is feasible and safe and gives many benefits including reduction in perioperative morbidity and mortality.

A prospective observational study on prevention of contractures of upper limb following burn

Background: Over 1 lakh people are affected by burn every year in India and 20 thousands of them die per year. Post burn contracture is a common sequele occurring after burn. Upper limb contractures are also occurring more commonly because it is most mobile part of body and likely to be involved in burn. There are many studies on management of post burn contractures but literature about prevention of contracture is little, hence this study was conducted. The aim of this study was to recognise various preventive measures to prevent post burn contractures of upper extremity.Methods: This study was conducted in NSCBM Subharti Medical College and Hospital located in Meerut (North India) from October 2012 to October 2014 in Department of Surgery. It was a prospective observational study consisted of 80 cases who presented as acute burn of upper limb admitted in the hospital.Results: In our study early excision with skin grafting was done in 20 patients (25%) while delayed skin grafting was done in 25 patients (31%) while 35 patients (44%) were managed conservatively. In our study 20 patients reported back with a post burn contracture. The reason found was non-compliance to antideformity splint and physiotherapy.Conclusions: Early surgical management of deep burns, physiotherapy, anti-deformity position and proper splintage can significantly reduce the development of post burn contracture.

Spectrum of Cyanotic Heart Defects and Their Modes of Presentation at Cardiology Clinic in a Tertiary Care Hospital.

Background: Cyanotic Congenital heart defect (CHD) is the high risk group which requires prompt medical attention. Immediate management can drastically alter the natural history otherwise most of the children will succumb to their defect very early in infancy. It is thus important to have reliable information of the profile of various cyanotic CHDs as well as their mode of presentation for the early detection. Methods: The study was carried out in Department of Pediatrics and Center of Cardiology, Jawaharlal Nehru Medical College, Aligarh. All patients referred with complaints or clinical examination suggestive of congenital heart defects were further evaluated with echocardiography. On echocardiography patients having congenital heart defects were included as cases which were further divided into cyanotic and acyanotic heart defects, preterms having PDA and PFO and those with acquired heart defects were excluded. The profile and mode of presentation of various cyanotic CHDs was further described in detail. Results: Acyanotic heart defects were 290(72.50%) of the total heart defects, while the contribution of cyanotic heart defects was 110 (27.50%). Out of all CHDs, VSD was the most common lesion with contribution of 152 (38.00%) cases, while among the cyanotic heart defect, Tetralogy of Fallot (TOF) was the most common lesion (18% of total cases). Spectrum of various cyanotic lesions were TOF 65.45%, Single Ventricle 12.72%, TAPVC (Total Anomalous Pulmonary Venous Connection) 8.18%, TGA(Transposition of Great Arteries) 7.27%, Tricuspid Atresia 3.63%, Ebsteins malformation 1.81% and Truncus Arteriosus 0.90%. Conclusion: Profile of various cyanotic CHDs was similar to the previous studies, however spectrum of various CHDs was quite wide, a large number of cases were missed in infancy and presented late.

Profile of Acyanotic Congenital Heart Defects

Background: Acyanotic CHD constitute majority of heart defect with significant morbidity, Profile of various defects is essential for identifying children who need urgent intervention and who need to be medically followed. Methods: The study was carried out in Department of Pediatrics and Center of Cardiology, Jawaharlal Nehru Medical College, Aligarh. All patients referred with complaints or clinical examination suggestive of congenital heart defects were further evaluated with echocardiography. On echocardiography patients having congenital heart defects were included as cases which were further divided into cyanotic and acyanotic heart defects, preterms having PDA and PFO and those with acquired heart defects were excluded. The profile and mode of presentation of various acyanotic CHDs was further described in detail. Results: Acyanotic heart defects were 290(72.50%) of the total heart defects, while the contribution of cyanotic heart defects was 110 (27.50%). Out of all CHDs, VSD was the most common lesion with contribution of 152 (38.00%) cases, followed by ASD (20.34%) , PDA (13.10%), PS (6.90%), Subaortic Membrane (2.00%), AV Canal valve defect (1.00%), RSOV (1.00%), Bicuspid Aortic Valve (1.00%), PAPVC (0.66%), Cortriatriatum (0.33%), Coarctation of Aorta(0.33%), ALCAPA(0.33%) and Aortic stenosis (0.33%). Age of presentation for most of the children was between 1 to 5 years. Conclusions: The profile and mode of presentation of various acyanotic heart defects was similar to other studies but diagnosis was delayed in majority of cases. The prevelance of various obstructive lesions like AS, coarctation and bicuspid aortic valve was much lower.

Profile and Clinical Spectrum of Congenital Heart Defects in NICU

Introduction: Congenital heart defects are commonest birth defects and is an important cause of mortality and morbidity in newborns. The current study was done aiming at determining profile and clinical spectrum of various congenital heart diseases (CHD) in neonatal period. Methodology: An observational study was carried out in the NICU, Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh from Feb 2014 to Aug 2015 with the objective to determine profile of various congenital heart defects. All patients with clinical suspicion of congenital heart defect were further evaluated with echocardiography.  Patients who were preterm having PDA and PFO were excluded from cases. Prevalence of various congenital heart defects was calculated. Clinical Spectrum of various congenital heart defects was observed. Observations: Total newborns screened 238 and 52 congenital hearts defect were detected. Acyanotic heart defect contributed 67% while cyanotic heart defect contributed 23%. VSD was the most common lesion while TOF (11.5%) was commonest among cyanotic heart defects. Most of the cyanotic heart defects were detected on screening as murmur on auscultation while PDA of bigger size presented as fast breathing. In cyanotic heart, defect classical TOF presented with only murmur while TOF with PA presented as cyanosis. Conclusion: VSD was the most common congenital heart defect detected while Tetralogy of Fallot was commonest among the cyanotic heart defects.

Polycystic ovarian syndrome and insulin resistance: a North Indian study.

Background: Polycystic ovarian syndrome (PCOS) is most common form of chronic anovulation associated with androgen excess. Insulin resistance (IR) is characterized by impaired glucose response to specific amount of insulin. The objective of the study was to find an association between PCOS and IR in North Indian patients. Methods: A total of 50 PCOS cases diagnosed according to Rotterdam criteria, 2003, i.e. at least two of the following three features: oligomenorrhea or amenorrhea, clinical or biochemical hyperandrogenism and polycystic ovaries on ultrasound. Serum glucose levels were measured spectrophotometrically by glucose oxidase-peroxidase method. Insulin levels in serum were estimated by using ELISA based kit procured form Diasorin Ltd, Germany. Homeostatic Model Assessment- Insulin Resistance (HOMA-IR) and Body Mass Index (BMI) were calculated by their formulas. Results: PCOS patients had significantly higher values of BMI, fasting serum glucose, fasting serum insulin and HOMA-IR. Fasting serum glucose was however in the normal range in both cases and control. Conclusion: Our study suggested a strong association of PCOS with insulin resistance in this part of the country.

Altered high density lipoprotein (HDL), triglyceride (TG) and anthropometric measurements in normal, overweight and obese under graduate medical students.

Background: Obesity has reached epidemic proportions in India, affecting 5% of the country’s population. Urbanization and modernization has been associated with obesity in population of younger generation. The aim of the study was to find out variation in metabolic indicators (HDL, TG and anthropometric measurements) of normal overweight and obese undergraduate medical students. Methods: Total of 194 students took part in this study. Their height, weight and waist circumference were measured by standard methods. Their serum was estimated for HDL, TG and, fasting sugar on fully automatic Vitros 250 dry chemistry analyser from Orthoclinical diagnostics from Johnson & Johnson USA. Results: Over all females students were more overweight (Females 16% and Males 8%) and obese (F 18%, M 9%) as compared to males. Blood pressure, weight, waist circumference, HDL, and TG levels were more in overweight and obese group as compared to normal group. Conclusion: The results of the current study have shown an increasing trend of obesity and derangement of metabolic indicators among under graduate medical students.

Comparative study of electrolytes and metabolic changes during percutaneous nephrolithotomy: spinal vs. general anaesthesia.

Percutaneous nephrolithotomy (PCNL) is a common surgery for renal stones and it can be performed under spinal and general anaesthesia. There is always a debate upon the superiority of one of the above technique over other. This study was undertaken to study the metabolic changes associated with the use of above techniques. We also studied the blood loss associated with them. Methods: 60 patients of either sex, aged between 25 to 60 years belonging to ASA physical status I or II undergoing PCNL were divided randomly into two groups and they received spinal (SA) and general anaesthesia (GA) as per standard protocol and study parameters were evaluated. Results: Blood pressure was lower and heart rate was higher in SA group compared to GA group. Changes in pH, bicarbonate, serum sodium, serum potassium and serum lactate were insignificant. Blood loss was report to be lower in SA group. Conclusions: In both the groups, patients were haemodynamically stable throughout the surgery and both the techniques were safe regarding hemodynamic changes and no significant advantage or disadvantage exists between the two. In both the groups there was a trend towards metabolic acidosis with increased lactate levels but it was not clinically significant with any of the anaesthetic technique. No changes were seen in electrolytes levels (Na and K) in any of the groups. Spinal anaesthesia was associated with lesser amount of blood loss and need for post-operative blood transfusion as compared to general anaesthesia.

Prevalence of hypothyroidism among patients of Meerut, Uttar Pradesh - A hospital based study.

Background: Hypothyroidism is a widespread thyroid problem, but there are no reports on the incidence and prevalence of hypothyroidism in this part of our country, that is western UP. Aims & Objective: The aim of the present study was to assess the prevalence of hypothyroidism in Meerut and nearby areas. Material and Methods: This retrospective hospital based study involved 4739 patients having undergone thyroid function assay, in the central clinical biochemistry laboratory of Subharti Medical College and its associated hospital. These patients were evaluated for thyroid hormonal assay-tri iodo thyronine (T3), tetra iodo thyronine (T4) and thyroid stimulating hormone (TSH) by Mini Vidas auto analyzer using enzyme linked fluorescent assay technique. Statistical analysis was performed by SPSS version 17 software. Results: Our study shows high prevalence of abnormal thyroid hormone levels (hypothyroidism was 8.2% & subclinical hypothyroidism was 8.4%) with female preponderance. Conclusion: The study has defined thyroid function status in thyroid patients of Meerut, Uttar Pradesh (U.P). Higher prevalence of hypothyroidism was observed in patients (especially females) in their second & third decade of life. The findings also supports the usefulness of screening of thyroid function compulsory after age of 30 years, for early detection and treatment to reduce the ill effects of thyroid dysfunctions.