An observational study on the effect of laparoscopic cholecystectomy over pulmonary function test

Background: Inflammation of gallbladder bed, CO2 pneumoperitoneum, and intraoperative patient posture all plays a role in the etiology of pulmonary dysfunction during laparoscopic cholecystectomy. Aims and Objectives: The goal of this study was to detect any changes in pulmonary function following laparoscopic cholecystectomy using a portable spirometry instrument, as well as to determine the degree of pulmonary function impairment and complications. Materials and Methods: The pre-operative and post-operative spirometry of 150 patients undergoing laparoscopic cholecystectomy under general anesthesia were compared in this prospective observational study conducted at JLN medical college and attached group of hospitals after obtaining due permission from the Institutional Ethics Committee. Spirometry was performed preoperatively to determine baseline values forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow rate (PEFR). Those who were unable to complete the required maneuvers were not included in the study. Pulmonary function testing was performed thrice after surgery, on days 1, 2, and 3 after surgery. To achieve a VAS score of <4, enough pain alleviation was provided. The paired t-test was used to compare spirometry values. Results: Between the preoperative and immediate post-operative periods, significant changes in FVC, FEV1, and PEFR were detected, indicating restrictive ventilator dysfunction. Conclusion: After laparoscopic cholecystectomy, light restrictive respiratory disturbances were noted with quick recovery of pulmonary function, potentially lowering post-operative pulmonary morbidity and mortality.

Prospective study of acute intestinal obstruction in adults based on etiology and severity indicators

Background: Intestinal obstruction is a common clinical entity in surgeons practice. In a large number of patient, therapeutic options are surgery versus conservative treatment; the choice of the treatment, that is, surgical versus conservative depends mainly on the surgeon’s assessment and therefore, is a clinical challenge to decide. Aims and Objectives: The purpose of our study is early detection of strangulated bowel obstruction based on a clinical, laboratory, and radiological parameters, a severity indicator score developed by combining these parameters. Materials and Methods: It was a hospital-based prospective observational study of 100 patients between April 2019 and October 2020 who presented with intestinal obstruction. Clinical, laboratory, and radiological parameters were noted and scoring was done as per severity scores. Results: Common cause of obstruction in this study was adhesions 41%, tuberculosis 13%, malignance 8%, and mesenteric ischemia 6% followed by intussusception and volvulus. Patients who had score <3 were managed conservatively, while 90.9% of patients having a score of three or more where operated on, which was statistically significant. Conclusion: Evaluation of the patient is not only to confirm the diagnosis but also timely management of strangulation and prevention of ischemia of gut to improve morbidity and mortality. This study used a severity scoring system of clinical parameters, laboratory and radiological investigation to help in the decision-making of treatment in a case of intestinal obstruction.

Effectiveness Of The Lacey Assessment Of Preterm Infants To Predict Neuromotor Outcomes For Premature Babies At Twelve Months Corrected Age

Background: The Lacey Assessment of Preterm Infants (LAPI) is used in clinical practice to identify premature babies at risk of neuromotor impairments, especially cerebral palsy. There is a shortage of studies on the Lacey assessment despite its wide clinical use. This study attempted to find the diagnostic accuracy of the Lacey assessment of preterm infants to predict neuromotor outcomes of premature babies at 12 months corrected age and to compare their predictive ability with brain ultrasound. Methods: This prospective cohort study included 89 preterm infants (45 females & 44 males) born below 35 weeks gestation. An initial assessment was done using the Lacey Assessment of Preterm Infants (LAPI) after babies reached 33 weeks postmenstrual age. Follow up assessment on neuromotor outcomes was done at 12 months (±1 week) corrected age using two standardized outcome measures, i.e., Infant Neurological International Battery and Alberta Infant Motor Scale. Brain ultrasound data were collected retrospectively. Data were statistically analyzed, and the diagnostic accuracy of the Lacey Assessment of Preterm Infants (LAPI) alone and in combination with brain ultrasound was calculated. Results: Fisher's exact test showed p<.01, indicating that there is an association between the Lacey Assessment of Preterm Infants (LAPI) and the neuromotor outcomes at one year corrected age. A combination of Lacey Assessment (LAPI) and brain ultrasound results showed higher sensitivity in predicting abnormal neuromotor outcomes than Lacey Assessment alone (80% vs. 66.7%, respectively). Lacey Assessment also showed high specificity (96.3%) and negative predictive value (97.5%). Conclusion: Results of this study suggest that the Lacey Assessment of Preterm Infants (LAPI) can be used as a supplementary assessment tool for premature babies to identify those at risk of abnormal neuromotor outcomes. These findings have applications to identify premature babies eligible for early intervention services.

Association Of Risk Factors Of Cerebral Palsy – A Matched Case Control Study

Background: Cerebral palsy (CP) is one of the leading causes of childhood disability worldwide. The exact etiology of CP is poorly understood, but many risk factors are related to problems during pregnancy, labor, and delivery. The age and sex-matched control study were done to evaluate the association of perinatal risk factors with the development of CP among children in a rural area. Methods: The study was conducted in the Division of Physical Medicine and Rehabilitation (PMR). Seventy clinically diagnosed CP children as cases and 70 children without CP as controls were included. Information regarding perinatal risk factors was collected from the parents of the children. Data were collected and statistically analyzed by using the Mc-Nemar chi-square test. Results: The study results suggested that children with male sex (53%) had a higher incidence of CP compared to female (47%) children. Spastic diplegia (60%) was the most common subtype of CP. The significant ‘p’ value (< 0.01) reveals that all the perinatal risk factors are associated with the development of CP. Conclusion: This study concluded that spastic diplegia was the most common subtype of CP. The perinatal risk factors such as preterm, low birth weight, birth asphyxia, and neonatal seizures had a significant association with the development of CP.

Vaginal stenosis with cervical intraepithelial neoplasia in a postmenopausal patient with pyometra: a diagnostic dilemma

Postmenopausal patient presenting with pain and lump in abdomen should be considered as a complication caused by gynaecological malignancy unless proved otherwise pyometra is most common in postmenopausal women but it can affect women of child bearing age as well. Usually it is caused by impairment of natural drainage of the cervix due to malignant diseases of genital tract and consequences of their treatment with radiotherapy. Authors report one such case with cervical intraepithelial neoplasia with uterus markedly enlarged to 26-28 weeks size with Vaginal stenosis in an eighty-year-old postmenopausal patient.

Successful management of a near miss case of eclampsia with intracranial haemorrhage requiring craniotomy

Large population-based studies on stroke report that intracerebral haemorrhage is rare in young women however it is a grave and disturbing complication of pregnancy. Preeclampsia is usually clinically silent, but may cause symptoms of neurological dysfunction such as headache, visual disturbances and impairment of consciousness. Eclampsia is in the occurrence of seizures in the context of preeclampsia and is often, but not always, preceded by the above neurological symptoms. Most published data support the view that preeclampsia and eclampsia are important causative factors for pregnancy related ICH. Sparse data is available with respect to the management of such cases. Identification of near miss cases is an important step in reducing mortality. Herein we report a near miss case of eclampsia with intracranial haemorrhage requiring craniotomy.

Maternal and fetal outcome of heart disease in pregnancy: an audit in a tertiary hospital in India

Background: There has been a rising incidence of pregnancy complicated by heart disease in India. The importance of heart disease in pregnancy lies in its high morbidity and mortality in both maternal and fetal outcomes combined with lack of enough established guidelines in its management.Methods: A study was done in department of obstetrics and gynaecology, KEM hospital, Mumbai from January 2016 to April 2017 retro prospectively studying the different manifestations of heart disease in pregnancy and the maternal and fetal outcomes.Results: During the study period, there were 6500 deliveries in the study center and of them 135 presented with heart disease. Of the 135 cases observed, 100 cases came under the inclusion criteria and were included in the study. The incidence of heart disease in pregnancy in the current institute is 2%. In the 100 cases, 55% were seen to have Rheumatic heart disease, 32% with cyanotic and acyanotic congenital heart disease and 13% with other conditions such as peripartum cardiomyopathy and mitral valve prolapse. Maternal outcome shows 44 patients delivered vaginally, 21 by assisted vaginal delivery and 35 required caesarean section. Maternal adverse cardiac events comprised of heart failure seen in 11 cases, ICU admissions required in 14 patients and maternal mortality in one case. Neonatal outcome comprised of 31 preterm births, still births 2, low birth weight seen in 41 and 16 needing NICU admissions.Conclusions: Early diagnosis and prompt management with a multidisciplinary approach is fundamental in managing a case of heart disease in pregnancy.

The evaluation of the amount and sustain release of antifungal agent clotrimazole incorporated in different polymer matrix in artificial saliva at a pH of 6.2.

Background: Candidiasis in the oral cavity is an opportunistic infections, the most common species involved is Candida albicans. Clotrimazole (CTZ) is the first line broad-spectrum antifungal drug that has been widely used for the prophylaxis and treatment of oral and vaginal candidiasis. It is seen that the effect of drug is better locally as compared to oral intake. The aim of the present study is to find out the quantum release of clotrimazole from the incorporated materials in the artificial salivary medium at the pH of 6.2 and to access the physical properties of the clotrimazole incorporated reliner and tissue conditioner. Methods: The antifungal clotrimazole is incorporated in two types of denture base material used for this study at 2%, 5% and 10% concentration by weight. The release of clotrimazole out of polymer matrix was studied at various pH. The main property of tensile strength of the specimen before and after the chemical release of the clotrimazole was tested. Result: Concentration was maximum on 8th day and uniformly decreased thereafter. The maximum amount of release upto 8th day was 2.52, 4.23, 9.84 mg for 2%, 5% and 10% respectively. Conclusion: Topical release of antifungal agents is more effective than systemic intake, which has adverse effect like renal toxicity and CNS toxicity.

Colorectal malakoplakia in a child presenting as multiple polyposis coli.

Malakoplakia of the gastrointestinal tract is a rare chronic infl ammatory disorder, usually affecting the descending colon, sigmoid colon and rectum. It is commonly seen in adults. Only few cases have been reported in children. We report a case of malakoplakia of colon and rectum in a 7-year-old child who presented with multiple polyposis coli.

The efficiency of root canal disinfection using a diode laser: In vitro study.

Aims: The aim of this study is to verify the disinfection of diode laser, following chemo-mechanical procedures against Enterococcus fecalis. Materials and Methods: Crowns of 30 extracted premolar teeth were sectioned at the cemento- enamel junction. The canals were shaped using step-back technique to K-file #40. The teeth were randomly assigned to three groups and placed into nutrient broth containing bacterial suspension of Enterococcus fecalis. Group A received no laser radiation. Specimens of group B and C were treated with diode laser (Sirona) with energy set at 1.5 and 3 W, respectively. After laser irradiation, the teeth were placed in vials, which contained 2 mL of the nutrient broth. The vials were incubated at 37°C for 24 h. Grown colonies were identified by standard methods. Statistical Analysis Used: Statistical analysis used was the nonparametric Kruskal-Wallis test, with comparison using the Bonferroni methods of means. Results: Higher mean CFU/mL is recorded in Group A (without laser disinfection) followed by Group B (with 1.5 W laser disinfection) and Group C (with 3 W laser disinfection), respectively. The difference in CFU/mL between the three groups is found to be statistically significant ( P < 0.001). Conclusions: The results of this research show that the 980 nm diode laser can eliminate bacteria that has immigrated into dentin, thus being able to increase the success rate in endodontic therapy.

An Insight Into Neurophysiology of Pulpal Pain: Facts and Hypotheses

Pain and pain control are important to the dental profession because the general perception of the public is that dental treatment and pain go hand in hand. Successful dental treatment requires that the source of pain be detected. If the origin of pain is not found, inappropriate dental care and, ultimately, extraction may result. Pain experienced before, during, or after endodontic therapy is a serious concern to both patients and endodontists, and the variability of discomfort presents a challenge in terms of diagnostic methods, endodontic therapy, and endodontic knowledge. This review will help clinicians understand the basic neurophysiology of pulpal pain and other painful conditions of the dental pulp that are not well understood.

Asymptomatic bacteriuria in diabetic women.

Objectives:- To study the prevalence of ASB in diabetic women and to compare microbiological profile among diabetic and non- diabetic women. Material and methods:- In this prospective study, 100 midstream urine samples were collected from diabetic women without any signs and symptoms of urinary tract infection. Routine standard laboratory methods were used for isolation and identification of uropathogens. Antibiotic sensitivity test was done on MHA media by using Kirby Bauers disk diffusion method. Result: Prevalence of ASB was 13% in diabetic and 6% in non-diabetic women.E-coli found to be leading pathogen among diabetic and in non-diabetic women. Nitrofurantoin and Amikacin were found to be the most effective drugs against large types of bacteria. Conclusion:- The initial choice of empirical antimicrobial therapy should be based on Gram stain and urine culture. Choice of antimicrobial therapy should integrate local sensitivity patterns of infecting organisms.

Epithelioid angiomyolipoma of the kidney: a case report.

Renal angiomyolipoma is a distinctive benign neoplasm that occurs either sporadically or in patients with tuberous sclerosis complex. A 45-year-old woman was admitted with history offlank pain and vomiting. There were no signs suggestive of tuberous sclerosis either in the patient or her family. At operation, she had a left renal mass with nephrolithiasis and hydronephrosis. Histopathology revealed epithelioid angiomyolipoma of the left kidney with chronic pyelonephritis. Immunohistochemistry confirmed the diagnosis of angiomyolipoma. This case is presented to highlight the epithelioid variant of angiomyolipoma which may behave in an aggressive manner.

Gonadoblastoma with contralateral dysgerminoma in a young female--a case report.

Gonadoblastomas are rare germ cell and sex cord stromal tumours, often associated with dysgerminomas. They occur almost entirely in patients with pure or mixed gonadal dysgenesis and in male pseudohermaphroditism. A 19 year old female was admitted in our hospital for evaluation of primary amenorrhoea. She had poor secondary sexual characters, left sided streak gonad and right sided ovarian tumour. Histopathology showed gonadoblastoma in streak gonad with contralateral dysgerminoma. This case is presented because of its rarity and clinical importance of recognizing such cases because of excellent prognosis.