Alcoholic vs. non-alcoholic chronic pancreatitis: surgeons' perspective from a tertiary centre in india / Perspectiva dos cirurgiões sobre pancreatite crônica alcoólica vs. não-alcoólica de um centro terciário na índia

ABSTRACT Background: Although alcohol is the most common cause for chronic pancreatitis worldwide, idiopathic type is prevalent in India. Natural history and disease progression are different between these two groups. There is paucity of data comparing surgical outcome and quality of life in these patients. Aim: To evaluate clinical features, surgical outcome and quality of life between these two groups of patients. Method: All patients with chronic pancreatitis who underwent surgery were prospectively reviewed. Results: From 98 patients, 42 were alcoholic. Number of male and the mean age at the time of operation was significantly more in alcoholic patients. Smoking, preoperative hospital admission rate and the prevalence of local complications like inflammatory pancreatic head mass, biliary stricture and left sided portal hypertension were distinctly more common in alcoholic group. Frey procedure was required more commonly in alcoholic group. Mean postoperative hospital stay and overall postoperative complication rate were comparable between the two groups. Over a median follow up of 18 months there was significant improvement in quality of life and pain score in both the groups. Improvement of physical functioning score at follow-up was significantly more in alcoholic group but the requirement for analgesic medications were significantly more in alcoholic group. However, appetite loss was more perceived by non-alcoholic group. Conclusion: Alcoholic chronic pancreatitis presents with more local complications associated with chronic pancreatitis. Frey procedure is a safe and well accepted surgery in this group. Though they required more analgesic requirement in short term follow up, other aspects of quality of life are similar to non-alcoholic group.

RESUMO Racional: Embora o álcool seja a causa mais comum de pancreatite crônica em todo o mundo, a forma idiopática é prevalente na Índia. A história natural e a progressão da doença são diferentes entre esses dois grupos. Há escassez de dados comparando o resultado cirúrgico e a qualidade de vida entre eles. Objetivo: Avaliar as características clínicas, o resultado cirúrgico e a qualidade de vida entre esses dois grupos de pacientes. Método: Todos os pacientes com pancreatite crônica operados foram revisados ​​retrospectivamente. Resultados: Do total de 98 pacientes, 42 eram alcoolistas. O número de homens e a idade média no momento da operação foi significativamente maior nos alcoolistas. Tabagismo, taxa de internação pré-operatória e prevalência de complicações locais como massa inflamatória da cabeça do pâncreas, estenose biliar e hipertensão portal do lado esquerdo foram distintamente mais comuns no grupo de alcoolistas e o procedimento de Frey foi exigido mais comumente neste grupo. A média de internação pós-operatória e a taxa geral de complicações pós-operatórias foram comparáveis ​​entre os dois grupos. Ao longo de acompanhamento médio de 18 meses houve melhora significativa na qualidade de vida e pontuação de dor em ambos os grupos. A melhora no escore de funcionamento físico foi significativamente maior no grupo de alcoolistas, mas a necessidade de medicamentos analgésicos foi significativamente maior nos alcoolistas. No entanto, a perda de apetite foi mais percebida pelo grupo não alcoólico. Conclusão: A pancreatite crônica alcoólica se apresenta com mais complicações locais associadas à pancreatite crônica. O procedimento de Frey é operação segura e bem aceita neste grupo. Embora exigissem mais necessidade de analgésicos no acompanhamento em curto prazo, outros aspectos da qualidade de vida são semelhantes ao grupo não alcoólico.

Outcome analysis in patients with multi vessel coronary artery disease and left ventricular ejection fraction after percutaneous coronary intervention: single center experience

Background: The present study evaluated the changes in baseline left ventricular function and clinical symptoms in multi-vessel coronary artery disease patients after multi-vessel percutaneous coronary intervention.Methods: This was a prospective, observational study conducted at Medical Super-speciality Hospital, Kolkata, India, between August 2017 and August 2019. The study included 48 patients who were diagnosed with ≥2 coronary artery stenosis of ≥50% in native coronary arteries with left ventricular ejection fraction (LVEF) <40%. Echocardiography was performed before and after 3 months of the procedure to observe LVEF. Canadian Cardiovascular Society (CCS) score was calculated before and after 3 months after PCI.Results: Mean age of the patients was 61.89±9.96 years and 89.6% patients were male. Mean LVEF before and after angioplasty was 34.9±4.95% and 42.06±8.78%, respectively (p=0.001). CCS score before and after angioplasty was 2.89 and 1.83, respectively (p=0.001).Conclusions: The results displayed significant improvement in clinical symptoms as well as LVEF after PCI in patients with multi-vessel disease with LVEF <40%. These results will be helpful to conduct larger randomized trials with long term follow-up in order to prove the safety and effectiveness of PCI in such patients over coronary artery bypass grafting.

Viability of Mycobacterium leprae in the environment and its role in leprosy dissemination.

Background: Leprosy, a chronic disease caused by Mycobacterium leprae, is a public health concern in certain countries, including India. Although the prevalence of the disease has fallen drastically over time, new cases continue to occur at nearly the same rate in many regions. Several endemic pockets have been observed in India and elsewhere. The precise dynamics of leprosy transmission are still not clearly understood. Both live bacilli as well as M. leprae DNA have been detected in the soil and water of endemic areas; they possibly play an important role in disease transmission. Aims: To study the occurrence of viable M. leprae in environmental samples collected from areas of residence of patients with active leprosy. Methods: The study was conducted on 169 newly diagnosed leprosy patients in Ghatampur, Uttar Pradesh, India. Soil and water samples were collected from their areas of residence using a standardized protocol. An equal number of soil and water samples were also collected from non-patient areas of the same or adjoining villages. The environmental samples collected from the patients surroundings were subjected to 16S ribosomal RNA gene analysis after obtaining informed consent. Results: About a quarter of the environmental samples collected from patient areas, (25.4% of soil samples and 24.2% of water samples) were found to be positive for specifi c 16S ribosomal RNA genes of M. leprae. Environmental samples collected from non-patient areas were all found negative for M. leprae 16S ribosomal RNA genes. Limitations: The major limitation of the study was that the sample size was small. Conclusion: The study demonstrated the presence of viable strains of M. leprae in skin smear samples of paucibacillary patients and multibacillary patients, as well as in the environmental samples obtained from around their houses. This could play an important role in the continued transmission of leprosy.

Assessment of nutritional status in pre-school children in Teetardi village near Geetanjali hospital, Udaipur (Rajasthan).

Background: The pre-school age group (2-5 years) was evaluated for nutritional status at Teetardi village near Geetanjali hospital Udaipur. Objectives: To study the nutritional status in pre-school children. Methods: Cross sectional study carried out during February 2014 to June 2014 with 300 children at Teetardi village near Geetanjali hospital Udaipur. Body weight, height recorded with age, gender and also interviewing the mother. Results: The age and sex distribution of 300 children in present study was 52% males and 48% females. The nutritional status in the children was determined as per World Health Organization child growth standards. Result reveals that out of total male children 4.5% were severely stunted and out of total female children 4.2% were severely stunted. Out of total 10.3% of male children and 11.1% of female children were found stunted. Whereas out of total children 3.2% of male children and 4.9% of female children were severely wasted. Out of total children 10.9% of male children and 12.5% of female children were found wasted. Also 7.1% of male children and 5.5% of female children were overweight also found that 1.9% of male children and 0.7% of female children are obese. Conclusions: There is necessity of more education in reference to nutrition and dietary habits including proper antenatal care and postnatal care of mother to reduce the prevalence of nutrition related abnormalities in children.

Analysis of phytochemical profile of Terminalia arjuna bark extract with antioxidative and antimicrobial properties

Objective: To investigate phytochemical screening, antimicrobial activity and qualitative thin layer chromatographic separation of flavonoid components, antioxidant activity and total flavonoid compound of Terminalia arjuna. Methods:For phytochemical screening, some common and available standard tests were done. Antimicrobial bioassay was done through agar well diffusion method. Detection of antioxidant activity and flavonoid compounds were done through thin layer chromatography. Total antioxidant activity was measured by 2, 2-diphenyl-1-picrylhydrazyl (DPPH) in colorimetric method. Aluminum chloride colorimetric method was used for total flavonoid determination. Results:Phytochemical screening showed the active compounds presence in high concentration, such as phytosterol, lactones, flavonoids, phenolic compounds and tannins and glycosides. The antimicrobial activity of extract showed that greater inhibition zone against Gram negative bacteria than Gram positive bacteria. This methanolic extract showed a promising antioxidant activity, as absorption of DPPH redicles decreased in DPPH free radical scavenging assay. Flavonoids components having antioxidant property present in the methanol extract at a level of 199.00 mg quercetin equivalent/g of dried methanol extract in colorimetric method. Conclusions: The Terminalia arjuna bark extract revealed the presence of bio-active constituents which are known to exhibit medicinal as well as physiological activities.

Child abuse and its detection in the Dental Office.

Child abuse is a major public health problem all over the world. There are four major types of abuse: physical abuse, sexual abuse, emotional abuse and neglect. Although the injuries of child abuse are many and varied, several types of injuries are common to abuse. Many of these injuries are within the scope of dentistry or easily observed by the dental professional in the course of routine dental treatment. It is important to realize that all members of the dental team have a unique opportunity and a legal obligation to assist in the struggle against child abuse. This requires clinical significance because a high proportion of abused children suffer injuries to the face and head, including the oral and perioral regions. These injuries may be observed during the course of dental treatment and in some cases even before the child is seated in the dental chair.

Tadalafil in the management of severe pulmonary artery hypertension.

Severe oyknibart arterial hypertension is a life-threatening disease with a poor prognosis. Continuous intravenous infusion of prostacyclin has proved effective in this condition. However, it carries the risk of serious complications arising from the complex delivery system along with a high cost. Prostacyclin analogs, endothelin antagonists, and the phophodiesterase-5 inhibitor sildenafil are emerging and promisinge therapies. Tadalafil, like sildenafil, is a selective phosphodiesterase-5 inhibitor with a longer duration of action. We repport the use of tadalafil in two patients of severe pulmonary arterial hypertension who could not afford expensive treatment.