A Prospective Study Comparing No Antibiotic versus Antibiotic Prophylaxis in Patients Undergoing Elective Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is one of the most common operations performed in general surgery. Elective laparoscopiccholecystectomy has a low risk for infective complications, and standard guidelines do not recommend prophylactic antibioticuse for low-risk cases. However, the use of antibiotic prophylaxis is very prevalent and the duration and dosage are inconsistentand varies widely among surgeons. This study is being done to assess the role of no antibiotic prophylaxis in the prevention ofwound infection in a patient undergoing elective laparoscopic cholecystectomy.Study Design and Period: The study was conducted in the Department of General Surgery at Christian Medical College,Ludhiana. This was an open labeled study conducted from the period of January 1, 2014, to December 31, 2014.Results: 92 patients suffering from chronic calculous cholecystitis undergoing elective laparoscopic cholecystectomy wereincluded in the study. Group A with 23 cases without prophylactic antibiotic. Group B with 69 cases with two doses of prophylacticantibiotics Inj. cefuroxime 1.5 gram 30 min prior to induction and after 6 h. The majority of our 81patients (88.04%) were females.The male to female ratio was 1:8. 3 patients (3.27%) in Group B had associated comorbidities except for diabetes mellitus. Themajority of patients 14 (60.86%) in Group A had taken 1-2 h of operative time while 58 patients (84.05%) patients in Group Bwith statistical insignificant P = 0.05. There was no fever in Group A patients while in Group B 2 patients (2.89%) had fever onsecond post-operative day which was not related to surgical site infection and that was due to superficial thrombophlebitis. InGroup A 18 patients (78.26%) were discharged on second postoperative days while 46 patients (66.67%) patients in Group Bwere discharged on second postoperative day. 8 patients (11.59%) in Group B were discharged on third postoperative days.There was no statistical difference in the duration of hospitalization between the two groups with P = 0.22. The overall incidenceof postoperative infective complications were nil in both groups either with patients having no prophylactic antibiotic or thosehaving prophylactic antibiotics

Comparison of Wound Closure using Octylcyanoacrylate Tissue Adhesive versus Subcuticular Suture in Inguinal Hernia Surgery

In our study, we have compared inguinal hernia skin closure with octylcyanoacrylate tissue adhesive and subcuticular suturewith 4-0 Monocryl. We found that time require for closure is significantly less with using glue. Hospital stay are less in glue groupcompare to subcuticular group but not significant. Incidence of infection is more in subcuticular group. Cosmetic outcome of scaris equally good in glue as compared to sutures. Post op pain is less in glue group. Inguinal hernia is a common surgical problemand the usual treatment is Lichtenstein mesh hernioplasty. Wound closure is usually done by interrupted sutures, subcuticularsutures, or staples. Tissue adhesive octylcyanoacrylate is an alternative method for skin closure, which is a new generation longchain tissue adhesive. In this study, we will be comparing the outcome of tissue adhesive octylcyanoacrylate with subcuticularsuture for closure of inguinal hernia surgery in adults in terms of time efficiency, cosmesis, pain, and wound complications

Clostridium difficile infections in HIV-positive patients with diarrhoea.

Background. Patients with HIV/AIDS are at a high risk of being infected with toxin-producing strains of Clostridium difficile (C. difficile) because of frequent hospitalization, exposure to antibiotics and antibiotic prophylaxis for opportunistic infections. There are little data from India on the prevalence of C. difficile infection in such patients. Methods. We assessed the occurrence of C. difficile infections in HIV-positive patients with diarrhoea by looking for the presence of its toxin as well as by culturing. Enzyme immunoassay (EIA, Premier toxins A and B; Meridian Diagnostic Inc.) was used to detect toxin from 237 fresh stool samples collected from HIV-positive patients with diarrhoea. Culture was done on cycloserine–cefoxitin–fructose agar and brain– heart infusion agar. Results. C. difficile was found in 12 of 237 (5.1%, 95% CI 2.64%–8.68%) HIV-positive patients with diarrhoea (9 patients were positive by EIA and 3 by culture). The presence of C. difficile in patients who had received antiretroviral therapy (7/66 [10.6%]) was significantly higher (p<0.016) compared with those who had not (5/171 [3%]). Of the 12 patients positive for C. difficile, 7 were on antiretroviral therapy for a mean (SD) of 34.4 months with mean CD4+ count of 186 (98.81) cells/cmm and 5 patients were anti-retroviral-naïve with mean CD4+ count of 181 (68.7) cells/cmm. All the 12 patients were on antibiotics for previous 2 months and 4 of 12 had been hospitalized in the previous 30 days. Conclusion. C. difficile infections occurred more frequently in patients who had received antiretroviral therapy. Our study population had a lower frequency of C. difficile infections compared to previous studies.

Paroxysmal kinesigenic dyskinesia manifestation of hyperthyroidism.

Sporadic paroxysmal kinesigenic dyskinesia (PKD) secondary to thyrotoxicosis is an extremely rare entity. A 36-year-old female presented with the features of PKD. Her investigations revealed thyrotoxicosis. Her dyskinesia did not respond to carbamazepine but remitted with the anti-thyroid drug, neomercazole. Perhaps hyperthyroidism-related PKD is a result of a metabolic disturbance of the basal ganglia circuits rather than a permanent and irreversible change.