COVID-19 vaccine – Knowledge, Attitude and practices among medical students in Hyderabad

Today as a lot of COVID 19 vaccines are available and are currently used, we conducted a study to assess the knowledge, a?tudes and percep?ons of medical students in our college. An online survey was conducted through GOOGLE forms. In this study total par?cipants are 155 medical students of which 28.4% (n=44) males and 71.6% (n=111) are females. Effec?veness of vaccine as perceived by par?cipants in our study is 65.2%. The safety of the vaccine as considered by par?cipants in this study is 55.5% In this study it was also no?ced that when gender is compared with effec?veness and safety of vaccine both males and females felt equally it is effec?ve as well as safe to take vaccine. There is a need to increase trust among our medical students. The elements that define and build trust must be understood and interven?ons like health awareness programs as role plays, talks on social media involving known personali?es can be undertaken and cra?ed accordingly to improve the knowledge regarding COVID 19. Most of the seniors shared their readiness to take the vaccine than junior students. It was also found that seniors felt that they do not get enough informa?on about vaccines when compared to juniors. The main source of informa?on regarding COVID 19 vaccine for majority of the par?cipants i.e., 71% (n=110) was through internet and social media and 16.8% (n=26) get from health care workers and the least number of par?cipants got informa?on from family and friends. Hence social media and internet can be used in a more appropriate way to remove vaccine hesitancy.

Comparison between cyanoacrylate, sutureless and polypropylene sutures in mesh fixation on lichtenstein tension free in repair of open inguinal hernia

Background: inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become gold standard in open inguinal hernia repair. Despite the low recurrence rates; postoperative pain and discomfort remain a problem for a large number of patients

Aim of the work: the aim of this study is to compare between cyanoacrylate, sutureless and polypropylene sutures in mesh fixation on lichtenstein tension free in repair of open inguinal hernia regard as postoperative pain, infection, recurrence,and cost benefit

Methods: a total of thirty patients with primary unilateral uncomplicated inguinal hernia were randomized to undergo lichtenstein tension free hernioplasty, and were randomized using close envelope into three groups: Group A: Inguinal hernioplasty with mesh fixation using polypropylene sutures [10 patients], Group B: Inguinal hernioplasty with mesh fixation using cyanoacrylate glue [10 patients] and Group C: Inguinal hernioplasty with mesh placement without sutures [10 patients]. Primary outcome was early and late postoperative pain. Secondary endpoints were use of painkillers after 24 hours, morbidity rate and recurrence rate. Follow-up time was 6 months

Results: significantly, less postoperative pain was reported in group B compared to the other two groups [A and C]. Additionally, trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay and earlier return to daily activities were seen in patients within group[B].Clinical recurrence was reported in only one patient in Group C after a period of four months follow up postoperatively

Conclusion: cyanoacrylate glue seemed to be a simple, original, reasonable, feasible, reproducible technique and competitive alternative to the standard tissue-penetrating meshfixation devices in open inguinal hernioplasty. It is accompanied by a reduction in chronic inguinal pain, with no increase in the early recurrence rate

Uterine and subendometrial arteries doppler in patients with recurrent first trimestric abortion

Background: Unexplained Recurrent miscarriage remains a frustrating problem for the clinician and a distressing condition for the affected couple. Recurrent pregnancy loss is defined as three or more successive spontaneous abortion. The incidence of recurrent pregnancy loss is 1-2% in the fertile population

Aim of the Work: This study aimed to find out any difference in uterine artery pulsitility index [PI] between women with history of recurrent unexplained first trimestric abortion and women without this history

Patients and Methods: One hundred cases from Al-Azhar University Hospitals [Al-Hussein and Sayed Galal] were included in the study and classified into two groups: Recurrent pregnancy loss [RPL] group: 50 cases with history of recurrent unexplained abortion. Control group: 50 cases with no history of abortion and one full term child at least. Uterine artery Doppler [Pulsatility Index [PI]] assessment was done to all patients in the study during the luteal phase of spontaneous menstrual cycle

Results: PI in the RPL group was found to be elevated compared to the control group

Conclusion: Assessment of uterine perfusion through measurement of uterine artery Doppler [PI] could be of value in cases with recurrent unexplained first trimestric abortion

Recent therapeutic alternative methods for burst abdomen and its relation to development of incisional hernia

Background: Burst abdomen is considered one of the most challenging obstacles that facing general surgery. Studying the layers of the abdominal wall, and knowing the anatomy of the anterior abdominal wall, its arterial and nerve supply is the corner stone in management of that surgical problem, and in finding the best way how to close that defect

Objective: The aims of the study were to evaluate and compare between recent therapeutic methods of burst abdomen after elective and emergency laparotomy as regard technical, function and to prevent its complication with its later development of incisional hernia

Patients and Methods: This randomized prospective study was carried out at Al-Azhar University Hospitals and Military production hospital on 20 patients with post-lapraotomy burst abdomen in the period from January 2016 to October 2017. The patients were randomly classified according to the method of abdomen closure into 5 groups; 4 patients each: Group A: Closure with TI, TIE, TIES incisions and component separation technique. Group B: Simple mass closure with continuous sutures. Group C: Closure using a Pedicled Tensor Fascia LataFlap. Group D: Vacuum assisted closure. Group E: Closure with gradual skin stretching by tension relief system[TRS]

Results: By the use of TI, TIE, TIES incisions and component separation technique, complete fascial closure was achieved in 3 patients [75%].By the use of mass closure, complete fascial closure was achieved in all patients [100%].By the use of the vacuum assisted closure, complete fascial closure was achieved in all patients [100%] but enterocutaneous fistula was encountered in one patient [25%]. By the use of the pedicled tensor fascia lata to close the abdomen, complete fascial closure was achieved in all patients [100%] but recurrence occurred in one patient [25%].By the use of the TRS, complete fascial closure was achieved in 2 patients [50%]

Conclusion: Mass closure with continous suture seems to be the best method as the abdominal wall defect is not large as its simple ,easy and cost effective

the bispectral index a sensitive monitor for survival after living donor liver transplantation?

Bispectral index [BIS] monitoring has been established as a standard monitoring method for the assessment of the depth of anesthesia during living donor liver transplantation [LDLT]. We tested the sensitivity and specificity of BIS readings during LDLT in predicting the postoperative 3-month survival. After receiving ethical approval, 42 patients who had undergone LDLT under sevoflurane-fentanyl-rocuronium anesthesia were studied. Correlations between BIS readings and extubation time, postoperative liver function tests, intensive care unit stay, and 3-month mortality were tested. Receiver operating characteristic curves were generated to determine the sensitivity and specificity of the BIS readings during different phases of surgery in predicting the survival outcome. The extubation time, liver function tests, coagulation factors V and VII, and intensive care unit stay were not statistically correlated with the BIS values. Receiver operating characteristic curve analyses showed reasonable sensitivity and specificity of mean BIS values during hepatic resection and neohepatic periods for predicting the 3-month mortality, with an unweighted accuracy of 76 and 73%, respectively. The nonsurvivors had significantly higher mean BIS values during the neohepatic phase [P<0.05]. The researchers concluded that the BIS monitoring during hepatic resection and neohepatic phases seems to be a suitable noninvasive monitoring tool with reasonable sensitivity and specificity for predicting the 3-month mortality after LDLT under sevoflurane-fentanyl anesthesia

Outcome of pouch surgery for ulcerative colitis: Single center experience

The purpose of the present study is to present the experience of our center in surgical management of ulcerative colitis [UC], stressing on evaluating the outcome of pouch surgery. Fifty eight patients underwent surgery for UC between 1996 and 2007 at Mansoura Gastroenterology Center. A retrospective analysis has been done of all patients with UC undergoing surgery which includes details of the patient's history, indication of surgery, type of operation, postoperative morbidity, and functional outcome. The main indication for operation was failed medical treatment [n=42, 72.4%]. Pouch surgery was performed in 25/58 patients [43.1%]. The majority of patients, 23/25 [92%] had J-shaped pouch. Twenty patients [80%] had a defunctioning ileostomy. There was one postoperative death after pouch surgery. Early complications after pouch surgery included pelvic sepsis [n=4], small bowel obstruction [n=2], pouch hemorrhage [n=1], wound sepsis [n=3]. The most common long-term complication after pouch surgery [n=14] was anastomotic stricture [n=9, 42.6%]. Five patients [35.7%] presented with pouchitis. Median daytime stool frequency was 5.1. Three patients [21.4%] presented with fecal incontinence. Pouch surgery is a major one that attains many complications. However, the long term results and patient's satisfaction are reasonable

Post-gastrojejunostomy entero-gastric reflux: is it always Symptomatic?

Evaluation of the problem of enterogastric reflux in duodenal ulcer patients managed by anterior and posterior truncal vagotomy and simple loop gastrojejunostorny. Between September 1976 and May 1996, 709 duodenal ulcer patients were managed by different surgical techniques. Anterior and posterior truncal vagotomy with simple loop gastrojejunostomy were done for 372 patients [52.5%]. Of the last group, 75 random patients were studied for enterogastric reflux. The mean postoperative period was 6.5 years, the mean age was 43 years, 64 were men and 11 were women. Careful clinical examination, barium meal study and esophagogastroscopy with histological examination of multiple gastric biopsies were done for all patients. Dual channel simultaneous esophageal and gastric 24h pH monitoring was done for 28 patients. Patients were classified into 2 groups, group 1 included 44 patients [58.7%] free of symptoms and group 2 included 30 patients [40%] who complained of one or more symptom of gastritis, however, the classic symptoms of alkaline refiux gastritis were found only in 8 patients [10.7%]. One patient [1.3%] was excluded due to proved ulcer recurrence. Endoscopic evidence of gastritis was found in 50% in group I versus 73.3% in group 2 [P<0.05]. Histopathologic evidence of gastritis was found in 77.3% in group 1 versus 46.7% in group 2 [P=0.007]. PH monitoring revealed alkaline gastric reflux in 50% in group I versus 75% in group 2 [P>0.05] alkaline esophageal reflux in 33.3% in group 1 versus 50% in group 2 [P<0.05] and mixed esophageal reflux [i.e alkaline and acidic] in 16.7% in group 1 versus 18.8% in group 2 [P> 0.05]. Enterogastric refiux is not an infrequent problem after trurcal vagotomy and loop gas trogejunostory. Pathologic alkaline gastric reflux should be proved by endoscopy, histopathology and pH metry before deciding remedial surgery

Laparoscopic cholecystectomy: a recent experience

A long the period from October 1992 to July 1993, 162 consecutive patients with gall stones were considered for laparoscopic cholecystectomy in the Gastroenterology Center of Mansoura. 106 females and 56 males, their ages ranged from 23 to 65 years. All the patients underwent ultrasonic abdominal examination, complete laboratory, chest and cardiac assessment. E.R.C.P., papillotomy and stone extraction when needed was done in cases with history [or] of jaundice before the procedure. Cardiac and hypertensive patients were excluded from the study. Laparoscopic cholecystectomy was successful in 135 out of the 262 cases [83.3%]. 27 cases failed to be completed by laparoscopy [16.7%], 5 cases were due to uncontrollable bleeding, 3 from injured cystic artery and 2 from cirrhotic liver. The other failures were due to marked dense adhesions with acutely inflammed gall bladder in 9 cases, injury of common bile duct in 2 cases, injury of gall bladder with escape of multiple small stones intra-abdominally in 2 cases, 5 cases gall bladder masses, failure to grasp or manipulate thick walled gall bladders that were packed with multiple small stones in 2 cases, presence of cholecysto-duodenal fistula in one case and injury of the right common iliac vessels by the trochar in one case. There were no deathes, but post-operative major complications occured in 4 cases that needed laparotomy, 2 cases of internal haemorrhage and 2 cases of biliary peritonitis. There were 6 minor complications, 3 surgical emphysema, and 3 small collections in gall bladder bed, that all passed conservatively. The shortest time of the procedure was 20 minutes and the longest was 3 hours. The median post-operative stay was 2 days and all the patients could start oral diet in the morning of the second day. In Conclusion, from this recent experience and results. We could suggest what are the possible difficulties and complications that could be met with laparoscopic cholecystectomy and we suggest that it should tried in most of patients who require elective or urgent cholecystectomy specially if radiological and endoscopic support are available