Comparison of Low Pressure and High Pressure Pneumoperitoneum in Patients Undergoing Laparoscopic Cholecystectomy-A Randomized Prospective Study

Pneumoperitoneum of 12-16mmHg is created by instillation of carbon dioxide during laparoscopic cholecystectomy .Nowadays low pressure pneumoperitoneum of 8-10 mmHg is used to decrease the side effects. In our study we have compared the two methods. Methods: Eighty patients with gallstones admitted in Government Hospital Gandhinagar (district hospital Jammu) for laparoscopic cholecystectomy were divided into two groups of forty each. Forty patients were subjected to standard pressure pneumoperitoneum during the procedure and forty patients to low pressure pneumoperitoneum. Results: Very slight difference in operating time of two groups was seen. No significant change in postoperative blood pressure and heart rate seen. Only two patients had shoulder tip pain and required more analgesics. Conclusion: High pressure pneumoperitoneum has no effect on intra operative and post operative hemodynamics but can lead to increase in post operative pain.

Short Term Visual Prognosis After Retinal Laser Photocoagulation for Diabetic Retinopathy.

To assess the outcome of laser photocoagulation treatment for diabetic retinopathy in relation to various risk factors. Method: The change in visual acuity shortly after laser photocoagulation for diabetic retinopathy was assessed in 50 eyes of 25 patients and was compared to the age of onset of diabetes, type of retinopathy, pre treatment duration of diabetes, hypertension, microalbuminuria, smoking, dyslipedemia, associated complications of diabetes and type of treatment of diabetes. Results: Visual improvement was good in young diabetics, short duration of diabetes and parents having mild diabetic retinopathy. Factors having adverse effect on prognosis were longer duration of diabetes, hypertension, dyslipedemia, nephropathy and severe diabetic retinopathy. There was no significant influence of smoking, glycemic control, type of treatment, age of onset and sex of patients on visual outcome. Conclusion: Early diagnosis of retinopathy and initiation of specific treatment by laser photocoagulation at earlier stages with proper control of risk factors viz hypertension, dyslipidemia and nephropathy lead to a favourable visual outcome.

Isoniazid preventive therapy programmes for healthcare workers in India: Translating evidence into policy.

Background. Occupational tuberculosis (TB) among healthcare workers (HCWs) is an important public health issue, especially in India where HCWs are exposed to a high burden of TB and infrastructural infection control procedures are inadequate. We examined the need for implementing isoniazid preventive therapy (IPT) programmes to protect Indian HCWs from occupational TB. Methods. Bardach’s 8-fold path was followed to analyse and formulate the policy for introducing IPT programmes for HCWs in India. The results of surveillance with tuberculin skin testing (TST) and treatment of latent TB infection with isoniazid (INH) for HCWs belonging to two different age groups (<30 years and >30 years) were compared with each other and with the alternative of maintaining status quo, i.e. no surveillance and no therapy, under various parameters such as the lifetime risks of active TB, deaths due to TB, benefit–risk ratios, costsavings to the health system and relative risk reductions. Results. The lifetime risk of TB was found to be higher among HCWs in the age group of <30 years. IPT for HCWs reduced the lifetime risks of TB and death due to TB in both age groups, with better results in the age group of <30 years. The relative lifetime risk reduction of active TB was 24.04% for the age group of <30 years and 19.92% for the age group of >30 years. The relative lifetime risk reduction of death due to TB by administration of IPT was from 13.96% to 19.62% in the two age groups. The benefit–risk ratio of IPT was 11.24 for the age group of <30 years and 2.88 for the age group of >30 years. IPT was associated with an approximate savings of `4000–8000 for each case prevented. Conclusion. TB is a major occupational hazard for Indian HCWs. The inclusion of IPT programmes in the national policy to combat TB, along with infrastructural infection control measures, can contribute to reduction in workplace TB. IPT programmes for HCWs in the younger age group have better results in terms of prevention of active TB, TB-related mortality and INHinduced hepatitis as compared to the older age group. There is an urgent need for a mechanism of targeted testing and treatment of latent TB infection to minimize the risk of occupational exposure for TB among HCWs in all age groups.

A Long Standing Foreign Body in Bronchus in An Adult:A Diagnostic Dilemma.

Foreign body in bronchus is a surgical emergency requiring prompt action. In adults, it usually is associated with specific history or risk factors. We here present a case of 57 years old otherwise healthy male who presented with productive cough of 6 months duration before foreign body (vegetative) was visualized by fibreoptic bronchoscopy. Modalities of diagnosis, management and outcome are discussed.

A Long Standing Foreign Body in Bronchus in An Adult:A Diagnostic Dilemma.

Foreign body in bronchus is a surgical emergency requiring prompt action. In adults, it usually is associated with specific history or risk factors. We here present a case of 57 years old otherwise healthy male who presented with productive cough of 6 months duration before foreign body (vegetative) was visualized by fibreoptic bronchoscopy. Modalities of diagnosis, management and outcome are discussed.