Short-term outcome of polytetrafluoroethylene membrane valve versus transannular pericardial patch reconstruction of right ventricular outflow tract in tetralogy of fallot: a randomized controlled trial

Abstract Introduction: Reconstruction of right ventricular outflow tract during primary repair of tetralogy of Fallot often requires the placement of a transannular patch which results in pulmonary regurgitation (PR). We compared the short-term outcomes of bicuspid polytetrafluoroethylene membrane valve versus transannular pericardial patch reconstruction of the right ventricular outflow tract. Methods: Thirty consecutive patients undergoing primary repair of tetralogy of Fallot were randomly allocated to two groups - polytetrafluoroethylene valve (PTFEV) group (n=15) and transannular pericardial patch (TAP) group (n=15). The two groups had similar preoperative demographic characteristics. We compared the short-term clinical and echocardiographic outcomes between these groups. The transthoracic echocardiographic follow-up was performed at one week, one month and six months after surgery. Results: The PTFEV group had significantly lower central venous pressure in the immediate postoperative period compared to the TAP group (7.60±2.06 vs. 10.13±1.73, P=0.002). Extubation time was significantly shorter in the PTFEV group compared to the TAP group (12.93±7.55 hrs vs. 22.23±15.11 hrs, P=0.04). PR in the PTFEV group was absent in five patients at 24 hours post-surgery. At the study endpoint, PR was absent in six, trivial in one and mild in eight patients in the PTFEV group compared to TAP group, where all 15 patients had severe PR. Conclusion: The bicuspid polytetrafluoroethylene membrane valves significantly decrease the central venous pressure in the immediate postoperative period, facilitate early extubation and, thus, prevent ventilator-related comorbidities. They achieve a high degree of pulmonary competence and do not increase the right ventricular outflow tract gradient in short-term follow-up.

Hyperbilirubinemia and appendicular perforation peritonitis

Background: This study aims to assess the relationship between appendiceal perforation peritonitis and serum bilirubin levels, as has been reported previously in the literature.Methods: A retrospective observational study was conducted at tertiary care hospital of India, namely Government Medical College-Srinagar, Maulana Azad Medical College-Delhi and Government Medical College-Jammu over a period of five years (January 2014 to December 2018). Authors collected and analysed the data of 306 patients, who had reported to the surgery emergency of the afore mentioned hospitals with complaints of acute abdominal pain and were later confirmed and managed as appendiceal perforation peritonitis (localized or generalized). Also, liver function tests of these 306 patients had been sent at the time of admission.Results: Authors had 202 males and 104 females with an average age of 35 years in this study group. Hyperbilirubinemia was noted in 226 patients, with an average serum bilirubin level 1.8 mg/dl. In patients having total leucocyte counts higher than 11000 cells/cumm, the average serum bilirubin level was 2 mg/dl.Conclusions: It may be safely concluded that a pre-operative evaluation of serum bilirubin levels may help us in better diagnosing appendiceal perforation when used in conjunction with other routine and advanced diagnostic modalities.

Evaluating serum bilirubin levels in acute appendicitis and appendiceal perforation

Background: Acute appendicitis is one of the commonest surgical emergencies. Authors undertook this study to evaluate serum bilirubin levels in acute appendicitis and appendiceal perforation.Methods: A retrospective study evaluating the serum bilirubin levels in acute appendicitis and appendiceal perforation was carried out for 6 years at three tertiary care hospitals at India from 2014 to 2019. Patients having acute appendicitis and appendiceal perforation, confirmed on histopathology, with no other medical or surgical comorbidity were included in the study.Results: The total number of our study subjects was 927. 306 patients had appendiceal perforation, amongst these, 226 (74%) had hyperbilirubinemia. Out of the 621 patients having acute appendicitis only 186 (30%) had hyperbilirubinemia. The lowest and the highest serum bilirubin levels of this study group were 0.6 and 3.1 mg/dl, respectively, with an average of 1.6 mg/dl. In patients diagnosed to be having acute appendicitis, the lowest and highest serum bilirubin levels were 0.6 and 2.4 mg/dl, respectively, with an average of 1.3 mg/dl. As for the patients having appendiceal perforation the lowest and highest serum bilirubin levels were 0.8 and 3.1 mg/dl, respectively, with an average of 1.8 mg/dl.Conclusions: Hyperbilirubinemia is seen in acute appendicitis but predominantly in appendiceal perforation, so serum bilirubin estimation may help us in diagnosing appendiceal perforation pre-operatively if and when used in conjunction with other available diagnostic modalities.

Insilico Analysis of Phytoconstituents from Allium sativum as Potential Inhibitors of Inha in Mycobacterium tuberculosis

ABSTRACT Tuberculosis is leading cause of death among the global bacterial infections. The main causative for tuberculosis is Mycobacterium tuberculosis, which will survive in its host human being for decades in latent or chronic levels. In addition, the late multidrug resistance at a disturbing rate accompanies the appearance of tuberculosis. The quick spread of resistance to initial stage treatment medications has redirected the focus of the medical community in the creation of an array of new drug against Mycobacterium tuberculosis. The InhA protein is a component of Fatty acid synthetase (FAS) II and exhibits an NADH reliant enoyl-ACP reductase activity. InhA is a vital enzyme of M.tuberculosis in control of cell wall synthesis, which can turn out to be a great focus for the synthesis of anti-tubercular treatment. Inspired from the offering biological actions of phytoconstituents from Allium sativum, the current research concentrates on looking at novel lead compounds from the plant. Molecular docking studies were carried out employing specific phytoconstituents from A.sativum with the protein InhA target. Ajoene shows much more encouragingresults with a Mol Dock rating of 80.6047Kcal/mol, as opposed to the typical initial line drug isoniazid (Moldock score: -58.7028 Kcal/mol). Molecular docking prediction indicate that Ajoene could be formulated into a possible treatment drug for Mycobacterium tuberculosis.

A sustained release of tablet granules associated with ZnS nanocrystals using Tamarind seed polysaccharide.

Tamarind seed polysaccharide (TSP) isolated from tamarind kernel powder was investigated for sustained release manners of salicylic acid drug. Tablet granules of salicylic acid were prepared, with two different grades of TSP and Cross linked TSP and embedded with chemically synthesized ZnS nanocrystals. Five different formulations made and the drug excipient mixtures were subjected to pre-formulation studies such as physicochemical studies, in vitro dissolution test, disintegration test, angle of repose and drug content. The physicochemical properties of tablets were found within the limits. Formulation F1 and F5 containing TSP and Cross linked were found to release the drug in sustained manner up to 24 hour and were stable under accelerated conditions of temperature for 6 months since there were no significant changes in drug content and physical parameters. This formulation was more comfortable to the user due to less erosion, faster and optimum pH of surrounding medium.

Diagnosis of adult chronic rhinosinusitis: can nasal endoscopy predict intrasinus disease?

To define the role of endoscopic evaluation of middle meatus in adult patients clinically diagnosed to have chronic rhinosinusitis and its ability to predict intra-sinus mucosal involvement as compared to CT scan. This prospective analytical study was conducted on consecutive patients with diagnosis of chronic rhino-sinusitis who were symptomatic and fulfilled the American Academy of Otolaryngology - Head and Neck Surgery Task Force criteria. The patients were enrolled prospectively and were subjected to rigid diagnostic nasal endoscopy and classified as defined by the revised Sinus Allergy Health Partnership Task Force criteria. The patients then underwent non contrast CT sinuses on the same day. Results were analyzed as a diagnostic test evaluation using CT as a gold standard. Among the 75 study patients with symptom based chronic rhino-sinusitis, nasal endoscopy was abnormal in 65 patients [87%]. Of these patients, 60/65 [92%] showed positive findings on CT scan. Ten patients had normal endoscopy, of these 6/10 [60%] had abnormal CT scan. Sensitivity and specificity of diagnostic nasal endoscopy against CT scan were 91% [95% CI: 81-97] and 44% [95% CI: 14-79], respectively. The likelihood ratio for positive nasal endoscopy to diagnose chronic rhino-sinusitis was 1.6 and the likelihood ratio to rule out chronic rhino-sinusitis when endoscopy was negative was 0.2. Nasal endoscopy is a valid and objective diagnostic tool in the work up of patients with symptomatic chronic rhinosinusitis. When clinical suspicion is low [<50%] and endoscopy is negative, the probability of rhino-sinusitis is very low [<17%] and there is no need to perform a CT scan to reconfirm this finding routinely. Endoscopy alone is able to diagnose chronic rhinosinusitis in >90% of patients when clinical suspicion is high [88%] as defined in this study by AAO-HNS Task Force criteria. Negative endoscopy, however, does not totally exclude the sinus disease in patients fulfilling task force criteria. CT scan may be needed on follow-up if there is clinical suspicion in 10% of these patients who are negative on endoscopy if symptoms persists. It is thus possible to reduce the number of CT scans if patients are carefully selected based on clinical criteria and endoscopy is done initially as part of their evaluation.

Evaluation of Role of Anterior Debridement and Decompression of Spinal Cord and Instrumentation in Treatment of Tubercular Spondylitis

STUDY DESIGN: Prospective study with simple randomization. PURPOSE: To evaluate the results of anterior spinal instrumentation, debridement and decompression of cord and compare it with results of a similar procedure done without the use of anterior instrumentation. OVERVIEW OF LITERATURE: Use of anterior spinal instrumentation in treatment of tubercular spondylitis is still an infrequently followed modality of treatment and data regarding its usefulness are still emerging. METHODS: Thirty-two patients of tubercular paraplegia with involvement of dorsal and dorso-lumbar vertebrae were operated with anterior spinal cord decompression, autofibular strut grafting with anterior instrumentation in 18 patients and no implant in 14 patients. Results were compared on the basis of improvement in Frankel grade, correction of local kyphosis, decrease in canal compromise and further progression of kyphosis. RESULTS: The mean local kyphosis correction in the immediate postoperative period was 24.1degrees in the instrumented group and was 6.1degrees in the non instrumented group. The mean late loss of correction of local kyphosis at 3 years follow-up was 1.7degrees in the instrumented and 6.7degrees in the non instrumented group. The mean improvement in canal compression was 39.5% in the instrumented group and 34.8% in the non instrumented group. CONCLUSIONS: In treatment of tubercular spondylitis by anterior debridement and decompression of the spinal cord and autofibular strut grafting, the use of instrumentation has no relation with the improvement in neurological status, however the correction of local kyphosis and prevention of further progression of local kyphosis was better with the use anterior spinal instrumentation.

Diabetes with multiple abscesses disseminated in time and place

We report the course of a 29 year old diabetic and alcoholic with multiple visceral and muculoskeletal abscesses that occurred sequentially over a span of 4 months that was caused by repeated interruptions in his treatment due to poor compliance and premature discharges from hospital.

Perforation Peritonitis:A Two Year Experience.

Four hundred patients who presented in the emergency of GMC Jammu as a case of perforation peritonitis over a period of two years were studied. In most of the cases diagnosis was made by clinical examination supplemented by investigations in the form of standing X-ray chest PA view with domes of diaphragm, Ultrasound abdomen and abdominal paracentesis. Contrast enhanced CT scans of abdomen were conducted on patients where the diagnosis of perforation peritonitis was doubtful. After resuscitation, Laparotomy was done in all the patients and thorough peritoneal lavage was done. A note of the site, size, type, number of perforations was made and biopsy was taken from the edge of the perforation whenever indicated. The most common cause of gastrointestinal perforation in our study was duodenal ulcer perforation, followed by appendicitis, typhoid perforation, blunt/penetrating trauma, gastric perforation, obstruction, iatrogenic, malignancy, and recurrent perforation. Primary closure of the perforation was most commonly done procedure, followed by appendectomy, resection anastomosis of the gut and exteriorization of the gut. The overall mortality was 6 % and morbidity in the form of wound infection, fever, respiratory complications, residual abscess, dyselectrolytemia, burst abdomen, jaundice, sepsis, cardiac complications, anastomotic disruption was present

Comparison of needle biopsy with pleural fluid analysis for the evaluation of pleural lesions.

A total of 60 pleural biopsies were received at Nidaan Clinic, Kathmandu during the period of two years from January 2000 to December 2002. The age of the patient ranged from 8 years to 82 years. Male: female ratio seen was 3:1. The most common lesion was found to be chronic nonspecific; pleuritis seen in 50.0% cases followed by tuberculous pleuritis in 36.7% cases, metastatic adenocarcinoma in 8.3% cases, metastatic small cell carcinoma in 3.3% cases and anaplastic large cell carcinoma in 1.7% cases. 63.3% cases of chronic nonspecific pleuritis showed transudative pleural fluid effusion. None of the cases of tuberculous pleuritis had transudative pleural effusion. 2 cases (40.0%) of metastatic adenocarcinoma had transudative pleural fluid effusion which suggests the need to perform pleural biopsy in all the cases of transudative pleural effusion whether encountered for malignancy or not.

Histomorphologic pattern of skin lesions in Kathmandu Valley: a retrospective study.

A total of 85 skin biopsies were analyzed to see the pattern of skin disorders in Kathmandu Valley. Clinico-histopathological correlation was done to see for the inconsistency between clinical and histopathological diagnosis and also to analyse for the false positive diagnosis of melanoma in such lesions. The age of the patients ranged from 10 to 88 years. No gender predominance was observed. Five percent of the lesions were located on head and neck region and rest were distributed over chest, back and extremities. Clinically 21 (24.7%) out of 85 cases showed hyperpigmentation and were diagnosed as melanocytic lesions. Intradermal nevus emerged as the single largest disorder with a total of 11 cases (12.9%). Capillary hemangioma cases constituted the second largest group with a total of 9 cases (10.6%). Seborrhoeic Keratosis (8.2%), Verrucous vulgaris (8.2%) Neurofibroma (7.1%), Nonspecific granulomatous lesions (4.7%) and melanoma (3.5%) formed the other major groups of disorders. Morphea (1.2%), Psoriasis (1.2%) and fungal lesions (1.2%) commonly seen in other studies were not found to be common among the skin disorders in the present study.

Enthesopathy: clinical recognition and significance.

Enthesopathy is a common clinical finding denoting pathology at the 'entheses', i.e. attachment sites of muscles, tendons, joint capsules, ligaments and fascia to the bone. Inflammatory enthesopathy or enthesitis is a sine qua non of seronegative spondyloarthropathies (SSA). It can also be occupational, metabolic, drug induced, infective or degenerative. Bursitis closely mimics enthesitis. Ultrasound with high frequency transducers is a simple, cost-effective and feasible test to detect enthesopathy which is amenable to treatment with local steroid injections, physiotherapy and non-steroidal anti-inflammatory drugs, in addition to treatment of the primary disease. Unrecognized and untreated, it can lead to considerable morbidity.