Patterns of complications and outcome of laparoscopic cholecystectomy

Background: Cholelithiasis is known to be one of the most common biliary pathologies. Laparoscopic cholecystectomy is the gold standard for the removal of the gallbladder, because of its cosmetic benefit, short stay, cost-effective and lesser side effects. But no procedure is immune to complications and other procedure-related side effects. The present study was conducted to study the patterns of complications and outcome of laparoscopic cholecystectomy.Methods: the present study was conducted prospectively on patients undergoing laparoscopic cholecystectomy for symptomatic gall bladder pathology. the patients undergoing laparoscopic cholecystectomy were distributed and analysed on various parameters i.e. age, sex, ultrasound abdomen findings, complications related to access, per-operative condition of gallbladder, per-operative and postoperative complication.Results: In our study cases major complication rate 1% leading to biliary stricture for which hepaticojejunostomy was done, minor complication rate 11% and conversion to open cholecystectomy rate 2%.Conclusions: It is concluded that laparoscopic cholecystectomy is the safe and standard procedure for the laparoscopic cholecystectomy and its major complication are preventable by strictly following the basic principles of laparoscopic cholecystectomy and keeping a low level of the threshold for converting to open cholecystectomy.

Electrolyte Changes in the Term Neonates Following Phototherapy in Neonatal Hyperbilirubinemia

Hyperbilirubinemia is one of the most prevalent problems in neonates. Jaundice is observed during first week of life in approximately 60% of term neonates and 80% of preterm neonates. Phototherapy is the most common therapeutic modality used in the treatment of uncomplicated neonatal hyperbilirubinemia. Objective: To study electrolyte (Ca, Na, K, Cl) changes in the term neonates following phototherapy in neonatal hyperbilirubinemia. Methods: This study was performed on 100 term neonates (65 males, 35 females) admitted to the Department of Pediatrics, Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar, Punjab with unconjugated hyperbilirubinemia and were managed with phototherapy. These neonates were completely normal on physical examination. Electrolytes were checked at 0 hr (at the time of admission) and after 48 hours of phototherapy or at discontinuation of phototherapy (second sample) whichever was earlier. The first sample was considered as control. Results: After phototherapy, among electrolytes (Ca, Na, K ,Cl) there was significant fall in serum calcium (ionized) level. 16 neonates developed hypocalcemia after 48 hr or less of phototherapy and 11 neonates developed hypocalcemia after 48 hr or up to 96 hr of phototherapy. The difference between pre and post phototherapy serum calcium (ionized) levels was found to be statistically significant (p <0.005). Of the 27 term neonates who developed hypocalcemia, 7 (26%) developed jitteriness and none of them developed irritability, seizures and aponea. No statistically significant fall/rise in levels of Na, K, Cl were observed in term neonates after phototherapy. The incidence of potassium, sodium and chloride changes following phototherapy was found to be nonsignificant irrespective of gestational age, birth weight and duration of phototherapy. Conclusion: The study concluded that among electrolytes (Ca, Na, K, Cl), phototherapy induced hypocalcemia is a significant problem. Thus calcium supplementation should be considered.

To Study Nutritional Factors and Postnatal Growth as Predictors of Retinopathy of Prematurity in Neonates Weighing <1750g and/ or Gestation <34 Weeks

Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the developing retinal vessels of premature infants. ROP remains one of the leading causes of childhood blindness worldwide. India and other developing countries are facing the third epidemic of ROP. Various risk factors for development of ROP include low gestational age, low birth weight, hyaline membrane disease, sepsis, shock, prolonged oxygen therapy, poor nutrition and weight gain and blood transfusions. Objective: To study nutritional factors and postnatal growth as predictors of ROP in neonates weighing <1750g and/ gestation <34 weeks. Methods: It is a prospective observational study conducted over one year (May 2017 to April 2018) in NICU, Department of Pediatrics, Govt. Medical College Amritsar, in collaboration with Department of Ophthalmology. All antenatal, perinatal and neonatal factors along with nutritional factors and postnatal growth mointoring were recorded. Screening for ROP was done by indirect opthalmoscopy at 4 weeks of postnatal age and followed up till retinal vascularization was complete. Data was analysed using univariate and multivariate regression analysis to evaluate risk factors. Results: Out of 79 babies screened 44 were found to have ROP of which 4 required treatment. Important risk factors found significant on univariate analysis were low birth weight (p=0.023) gestational age (p=0.003), duration of i/v fluid therapy (p=0.004), day of start of feed (p=0.032), day of attainment of full feed (p=0.005), relative weight gain at 4 weeks (p=0.041) and 6 weeks of life (p=0.04). On mutivariate logistic analysis, relative weight gain (g/kg/day) at 4 weeks of life was found to be an independent risk factor. Conclusion: Relative weight gain (g/kg/day) at 4 weeks of life was found to be an independent risk factor for development of ROP. This result may be regarded as providing emphasis on the importance of weight gain at an earlier postnatal age.

Hypoglycemia in Neonates More than 1500 Gram Weight with No Secondary Cause – Its Effects and Outcome

Aim: 1) To study the outcome of hypoglycemia in neonates weighing >1500gram both symptomatic and asymptomatic having exclusively hypoglycemia with no any other medical condition known to cause brain damage , till 9 months of corrected gestational age(CGA).2) To study the clinical profile of hypoglycemia in neonates weighing >1500gram. Methods: 35 neonates weighing >1500gram with hypoglycemia (<40 mg/dl), both symptomatic and asymptomatic without any other medical condition known to cause brain damage were enrolled in the study. Hypoglycemia was confirmed with venous sample laboratory value. Both neonatal and maternal history was taken in detail, clinical examination, anthropometry was done. Follow up was done at 3, 6, 9 months of CGA for assessing neurodevelopmental outcome (motor developmental quotient i.e. MoDQ and mental developmental quotient i.e. MeDQ using DASII6 i.e. development assessment scale for Indian infants) and we did anthropometry and clinical examination, ultrasonography at discharge, electroencephalogram (EEG) done in patients with seizure, Magnetic Resonance Imaging (MRI) at 3 months, Brainstem evoked response audiometry (BERA) at 6 months, vision assessment at 9 months of CGA. Appropriate statistical analysis was done to calculate results. Results: Out of 35 enrolled cases follow up was possible in 30 cases. In our study, the prevalence of abnormal neurodevelopmental outcome according to DASII6 was 53.33% (n=16) cases with abnormal MoDQ (<70%) and 56.66% (n=17) cases with abnormal MeDQ (<70%) at 3, 6, 9 months of CGA respectively. There was statistically significant difference in the mean values of MoDQ (p value 0.014, 0.011, 0.02) and mean MeDQ (p value 0.019, 0.008, 0.02) on follow up at 3, 6, 9 months of corrected gestational age respectively between symptomatic and asymptomatic hypoglycemic cases. 8 (57.14%) symptomatic cases and 6 (37.5%) asymptomatic cases had microcephaly on follow up and the difference was not statistically significant. MRI was abnormal in 10 (71.4%) symptomatic cases and 6 (37.5%) asymptomatic cases and the difference was not statistically significant. Ultrasonography was done in all cases at discharge and it was found abnormal in 2(5.7%) cases. BERA, vision assessment and EEG was normal in all cases. Conclusion: Both symptomatic and asymptomatic hypoglycemia leads to abnormal neurodevelopmental outcome but it is more poor in symptomatic neonates as compared to asymptomatic hypoglycemia.

Digital forensics: A technological revolution in forensic sciences.

Computer Forensics World is a growing community of professionals involved in the digital forensics industry. It is an open resource, free for all to access and to use. Digital investigations and crime regularly cross international and language borders today. Open database connectivity technology is now providing access to a wide range of database technologies, such as neural networks and pattern recognition databases, which are being used to analyze shoe prints and tool marks. These new computer-aided analysis tools can link and chart case information, allowing the investigator to question the data and pose scenarios as well as suggest and follow possible investigative paths. As a result, connections that often took weeks or months to come to light are revealed in a fraction of the time. Forensics is just beginning to get looked at, but the problems are cost and government is slow to adopt new technology. In this paper we discussed about the kingdom of Digital Forensics and Computer Forensic World. The study consists of Computer Forensic World, Digital Forensics (MEK, AFF, and Keyword Search etc.), and the Future Forensics Labs.