Laparoscopic versus open appendicectomy-a comparative study of clinical outcomes in an institutional centre

Background: Appendicectomy remains to be one of the most common procedures performed by the general surgeon. Laparoscopic appendicectomy is likely to have less postoperative pain, less use of analgesics, early discharge, decreased wound infection, better cosmetics and also diagnostic and early return to routine work. Method: This is a comparative study of 50 cases of appendicitis divided equally into two groups 25 in open and 25 in the laparoscopic which were randomly selected and operated in the department of general surgery at PMCH, Patna. Results: In present study pain score was 2.97±0.7 for open group as compared to 1.56±0.7 in lap group (p<0.05) because of longer incision stretch of muscles and wound infection. Post operative complications like vomiting was lower in laparoscopic group with 12% as compared with 40% in open group (p<0.05) and ileus was lower in lap group with 27±4.6 and for open group 31±5.4 with p<0.05 which were significant. There is significant reduction in incidence of post operative wound infection in lap group 0% as compared to open group 32% (p<0.05). Duration of postoperative hospital stay was significantly low for lap group 2±0.78 as compared to open group 8±0.89. The return to normal activity was low for lap group 14±2.11 days as compared to open group 21.7±3.7days. Duration of surgery for open appendicectomy was 48±19 mins and for lap appendicectomy was 46±15 mins. Conclusions: Overall laparoscopic appendicectomy is better than open appendectomy in selected patients with acute or recurrent appendicitis.

Laparoscopic versus open appendicectomy-a comparative study of clinical outcomes in an institutional centre

Background: Appendicectomy remains to be one of the most common procedures performed by the general surgeon. Laparoscopic appendicectomy is likely to have less postoperative pain, less use of analgesics, early discharge, decreased wound infection, better cosmetics and also diagnostic and early return to routine work. Method: This is a comparative study of 50 cases of appendicitis divided equally into two groups 25 in open and 25 in the laparoscopic which were randomly selected and operated in the department of general surgery at PMCH, Patna. Results: In present study pain score was 2.97±0.7 for open group as compared to 1.56±0.7 in lap group (p<0.05) because of longer incision stretch of muscles and wound infection. Post operative complications like vomiting was lower in laparoscopic group with 12% as compared with 40% in open group (p<0.05) and ileus was lower in lap group with 27±4.6 and for open group 31±5.4 with p<0.05 which were significant. There is significant reduction in incidence of post operative wound infection in lap group 0% as compared to open group 32% (p<0.05). Duration of postoperative hospital stay was significantly low for lap group 2±0.78 as compared to open group 8±0.89. The return to normal activity was low for lap group 14±2.11 days as compared to open group 21.7±3.7days. Duration of surgery for open appendicectomy was 48±19 mins and for lap appendicectomy was 46±15 mins. Conclusions: Overall laparoscopic appendicectomy is better than open appendectomy in selected patients with acute or recurrent appendicitis.

Abordaje del desarrollo en la primera infancia y sus dificultades en Turquía: programa de capacitación para las unidades de pediatría del desarrollo / Addressing early childhood development and developmental difficulties in Turkey: a training program for developmental pediatrics units

Introducción. El abordaje del desarrollo en la primera infancia (DPI) y las dificultades del desarrollo (DD) en los países de ingresos bajos o medios (PIBM) requiere de programas aplicables y sostenibles. Se evaluó el programa de capacitación para las unidades de pediatría del desarrollo (UPD) en los centros de referencia tras siete años. Población y métodos. Diseño transversal con métodos cualicuantitativos para evaluar los servicios, la capacitación, la investigación y la promoción de las UPD. Resultados. Se mantuvieron los servicios clínicos, la capacitación, investigación y promoción. En total, 23710 niños fueron derivados. La motivación y resistencia del personal, el respaldo de los administradores y la satisfacción del paciente facilitaron el programa, aunque la invisibilidad dentro del sistema de salud fue un obstáculo. Conclusiones. En Turquía, y posiblemente otros PIBM, el programa de capacitación para las UPD es aplicable y sostenible si se abordan los obstáculos del sistema de salud.

Introduction. Addressing early childhood development (ECD) and developmental difficulties (DDs) in low and middle-income countries (LMICs) requires applicable and sustainable programs. Seven years after its implementation in 2010, we evaluated the Developmental Pediatrics Unit (DPU) Training Program in pediatric referral centers in Turkey. Population and methods. We applied crosssectional design and quantitative/qualitative methods to assess services, training, research and advocacy of the DPUs. Results. Five of six established DPUs sustained clinical services, training, research, and advocacy. A total of 23,710 children (9085 new cases in 2017) had been referred mainly for perinatal risks and chronic illness, all centers contributed with similar proportions of children. Staff motivation and endurance, hospital administrator support, and client satisfaction facilitated the program; whereas invisibility within the performance based healthcare system was a barrier. Conclusions. In Turkey and possibly other LMICs, the DPU Training Program is applicable and sustainable if health system barriers are addressed

Dolor y variabilidad de la frecuencia cardíaca en recién nacidos prematuros que recibieron surfactante: un estudio piloto / Neonatal pain and heart rate variability in preterm infants treated with surfactant: a pilot study

Objetivo. Evaluar la percepción del dolor de recién nacidos prematuros a quienes se les administró surfactante mediante diferentes técnicas, utilizando la variabilidad de la frecuencia cardíaca (VFC).Métodos. Se aleatorizó a los recién nacidos que requirieron tratamiento con surfactante por SDR a los grupos INSURE o MIST. El análisis de la VFC se realizó con la tecnología NIPE para evaluar el componente parasimpático del sistema nervioso autónomo de los recién nacidos. Se registró la VFC antes, durante y después de administrar el surfactante. La evaluación del dolor se determinó con la escala PIPP. Resultados. Se incluyó a 14 recién nacidos en el estudio. Los grupos tenían características demográficas similares. Los puntajes de la escala PIPP no difirieron entre los grupos INSURE y MIST (p = 0,05). Se observó una diferencia estadísticamente significativa en la mediana de la VFC durante la administración del surfactante entre los grupos INSURE y MIST (52 frente a 56, p = 0,03). El análisis de la VFC fue similar entre los grupos antes y después de administrar el surfactante.Conclusión. La administración de surfactante mediante la técnica MIST podría ser más cómoda para los recién nacidos prematuros con SDR. No obstante, es necesario realizar otros estudios con series más importantes.

Objective. We aimed to assess the pain perception of preterm infants treated with different surfactant administration techniques by using heart rate variability (HRV).Methods. Preterm infants who required surfactant therapy for RDS were randomized to INSURE or MIST groups. HRV analysis was performed by Newborn Infant Parasympathetic Evaluation monitor. HRV was recorded before, during and after surfactant administration. Pain assessment was determined by Premature Infant Pain Profile (PIPP) score.Results. Fourteen infants were enrolled in the study. Demographic characteristics of the groups were similar. PIPP scores did not differ between INSURE and MIST groups (p = 0.05). Statistically significant difference in median HRV during surfactant administration was observed between INSURE and MIST groups (52 vs. 56, p = 0.03). HRV analysis was similar between groups before and after surfactant administration. Conclusion. Surfactant administration with MIST technique might be more comfortable for preterm infants with RDS. However further studies with larger series are needed.

case of brucellosis mimicking Crimean-Congo hemorrhagic fever

Brucellosis is a zoonotic disease caused by Brucella spp. that is transmitted to humans by the ingestion of unpasteurized milk and other dairy products from infected animals or through close contact with secretions. Crimean-Congo hemorrhagic fever [CCHF] is a tick-borne disease caused by a virus that is transmitted to humans by ixoid tick bites, contact with blood and tissue of infected animals or contact with infected humans. The symptoms of brucellosis are non-specific; it can mimic other diseases. In this paper, we present a case of brucellosis that was initially evaluated as CCHF. We emphasize that brucellosis should be considered in the differential diagnosis of CCHF, especially in endemic countries

Psychological distress and suicidal tendency of depressed patients

This study aimed at identifying the relationship between psychological distress and suicidal tendency of depressed patients. A descriptive correlational design was utilized in this study. A sample of convenience of 100 depressed patients was recruited from the Out-patient Clinic of Tahnasha Psychiatric Hospital in El Minia Governorate. A socio-demographic data sheet, Suicidal Tendency Scale, Depression, Anxiety, Stress Scale [DASS] were used to achieve the purpose of the study. A semi-structured interview method was used to collect data from patients. Results of this study revealed that, almost two third of the subjects were females, married, illiterate, unemployed, residing rural areas, and most of them were in the age group ranged from 20-39 years old. More than one third of the subjects were attempting suicide from one to three times or more. A statistically significant correlation was detected between suicidal tendency and psychological distress. In conclusion, depressed patients are having multiple stressors, social, environmental, and interpersonal factors that with their personality character can aggravate the symptom of depression and interfere with their productivity, initiation, and prevent the interaction with others. It was recommended that, a training program should be designed for nurses who are dealing with depressed patients and specially those who are at risk for suicide to provide them with knowledge about how to assess those patients, evaluate their needs, and prevent the risk of suicide

Antifilarial activity of Caesalpinia bonducella against experimental filarial infections.

BACKGROUND & OBJECTIVE: Lymphatic filariasis is a disabling disease that continues to cripple population in tropical countries. Currently available antifilarial drugs are not able to control the disease. Therefore, a better antifilarial is urgently required for proper management of the disease. We undertook this study to assess the antifilarial activity of Caesalpinia bonducella-seed kernel against rodent filarial parasite in experimental model. METHODS: Microfilaraemic cotton rats and Mastomys coucha harbouring Litomosoides sigmodontis and Brugia malayi respectively, were treated with crude extract or fractions of the seed kernel C. bonducella through oral route for 5 consecutive days. Microfilaricidal, macrofilaricidal and female worm sterilizing efficacy was assessed. RESULTS: Crude extract showed gradual fall in microfilariae (mf) count in L. sigmodontis-cotton rat model from day 8 post-treatment attaining more than 95 per cent fall by the end of observation period. It also exhibited 96 per cent macrofilaricidal and 100 per cent female sterilizing efficacy. The butanol fraction F018 caused 73.7 per cent reduction in mf count and 82.5 per cent mortality in adult worms with 100 per cent female sterilization. The aqueous fraction F019 exerted more than 90 per cent microfilaricidal activity and 100 per cent worm sterilization. Two chromatographic fractions, F024 and F025 of hexane soluble fraction exhibited 64 and 95 per cent macrofilaricidal activity, respectively. Both the fractions caused gradual fall in microfilaraemia and 100 per cent worm sterilization. In B. malayi-M. coucha model F025 showed gradual reduction in microfilaraemia and caused 80 per cent sterilization of female parasites INTERPRETATION & CONCLUSION: In conclusion, C. bonducella- seed kernel extract and fractions showed microfilaricidal, macrofilaricidal and female-sterilizing efficacy against L. sigmodontis and microfilaricidal and female-sterilizing efficacy against B. malayi in animal models, indicating the potential of this plant in providing a lead for new antifilarial drug development.

Intra-strain crossing in trichoma harzianum via protoplast fusion to enhance chitinase productivity and biocontrol activity

Protoplasts were isolated from Trichoderma harzianum fungus using Novozyme 234 with 0.7 M KCl as osmotic stabilizer. Intra-strain T. harzianum protoplast fusion has been carried out using polyethylene glycol with STC [sorbitol, Tris - HCl, CaCl[2]] buffer. The fused protoplasts were regenerated on colloidal chitin agar selective medium. Eighteen self-fusant strains were selected to study the chitinase production and biocontrol activity. Most of the fusants exhibited fast and vigorous mycelial growth on 2% colloidal chitin agar compared to non-fusant and parent strains. High chitinase activity was measured in the culture filtrates of the self-fusant strains than the parent. Among the fusants, four [ATh1/9, ATh1/12, ATh1/14 and ATh1/17] produced maximum chitinase with a two - fold increase compared to the parent strain. Moreover, fusant AThl/7 produced 94.3% more chitinase activity than the original strain. Most self - fusant strains exhibited increased antagonistic activity against Cephalosporium acremonium, Aspergillus niger and Rhizoctonia solani than the parent strain. The crude chitinase preparations of fusants ATh1/9, ATh1/12, ATh1/14 and ATh1/17 lysed the mycelia of T. reesei, T. viride and A. niger and released the protoplasts in higher numbers than the crude chitinase preparation of parent strain. Results demonstrated the significance of the protoplast fusion approach, as a technique to develop superior hybrid strains of filamentous fungi lacking inherent sexual reproduction

Comparison of antibiotic susceotibility tests, plasmid profiles and restriction enzyme analysis of plasmid DNA of methicillin susceptible and resistant-staphylococcus aureus strains isolated from intensive care units

To differentiate methicillin-resistant Staphylococcus aureus [S. aureus] [MRSA] and methicillin-sensitive S. aureus [MSSA] strains and detect the source of epidemic strains and prevent their access to patients. All the procedures were carried out in the Department of Microbiology, Medical Faculty Hospital, Dokuz Eylul University, Izmir, Turkey from 1996-1998, and antibiotic susceptibility tests continued in the laboratory of King Fahad Hospital, Al-Baha, Kingdom of Saudi Arabia [KSA], from 2001-2004. A total of 81 S. aureus strains [71 MRSA, 10 MSSA] from Turkey were isolated from different sites of patients in Intensive Care Unit's [ICU's], evaluated by plasmid profile, Restriction Endonuclease Analysis of Plasmids [REAP], and antibiotic sensitivity tests. A total of 117 S. aureus strains [24 MRSA, 93 MSSA] from KSA were isolated from different sites of patients in ICU's, evaluated by antibiotic sensitivity tests as recommended by National Committee for Clinical Laboratory Standards [NCCLS]. Seventy-one MRSA from Turkey were divided into 13 groups by antibiotic sensitivity tests and into 4 groups by plasmid profiles, in which 3rd and 4th groups subdivided into 2 subgroups, and into 5 groups by REAP. The 1st, 2nd, 3rd and 5th groups were subdivided into 2 subgroups. Ten MSSA were divided into 4 groups by antibiotic sensitivity tests, 3 in plasmid profiles and 2 in REAP tests. Twenty-four MRSA strains from KSA were divided into 9 groups by antibiotic sensitivity tests while 93 MSSA strains were divided into 7 groups. In respect to epidemiological survey, plasmids profiles and REAP seems to discriminate more respect to antibiotic sensitivity tests but at the same time neither of them were 100% accurately differential. According to the plasmid profile of the 3rd MSSA [Turkey] group, a multi-drug resistance by antibiotic susceptibility tests were noticed and showed the same plasmid profile in MRSA first subgroup of the 3rd group, but the same groups were different in REAP tests. In order to distinguish the discriminatory power of the strains, where REAP is better than plasmid profile and antibiotic sensitivity tests, we may formulate the statement into the following; REAP > plasmid profile > antibiotic sensitivity tests. For typing and gathering of epidemiological data, it is suggested that all 3 methods should be employed in clinical laboratories as they are cheap, practical and easily interpreted

Genetic improvement of trichoderma reesei for cellulose Enzymes production through mutation breeding

The possibility of inducing genetic variability in the fungus Trichoderma reesei which produces cellulases upon treatment with different mutagenesis was investigated. The fungal strain NRRL-12368 was treated with UV-light, NTG, and combined treatment with both of them or combined treatment with UV-lightNaNO2. The results indicated that the treatment with UV-light induced 183colonies, 48 of them are morphological variants and 6 are auxotrophic mutants. When the NTG mutagen was applied, 48 colonies were isolated, 20 of them are morphological variants and only one is auxotrophic mutant. Using the combination between UV and NTG, 64 colonies were obtained, 24 of them are morphological variants and only one is auxotrophic. The combination between UV and NaNO2 gave 49 colonies, 11 of them are morphological variants and one is auxotrophic mutant. These mutants were evaluated for their productivity concerning the three cellulase enzymes FPase, CMCase and beta-glucosidase. Some mutants overyielded the parental strain in the cellulases production. The mutant S26 produced 180%, 102% and 31.6% FPase, CMCase and beta-glucosidase more than the original strain, respectively. No relationship can be found between the requirements of auxotrophic mutants and their cellulase activities, since some mutants lost their enzymes activity, some others produced one or more of these enzymes, whereas two mutants produced the three enzymes more than their parental strain