Study of profile of cases and complications of ileal perforation at KMCH, Katihar

Background: Bowel perforation is an important cause of acute abdomen. It carries high morbidity and mortality. Materials and methods: The present descriptive study included 48 patients with ileal perforation admitted at the department of surgery. Data regarding clinical features, management and complications was noted. Results: Mean age of the patients was 34.4 ± 8.8 years with male preponderance. Abdominal pain and distension (100%) and constipation (87.5%) were the common symptoms seen. Single perforation was commoner (64.6%) than multiple perforations. It was caused by typhoid in 39.6% cases, due to tuberculosis in 16.7%, due to injury in 10.4% and other causes in 33.3% cases. Surgical site infection was the commonest complication. Conclusion: Ileal perforation is caused by typhoid or tuberculosis in majority of the cases and presents with pain abdomen and distension. Rates of infection are high in these cases.

Comparative Study on Delayed versus Early Appendicectomy in cases of Acute Appendicitis

Background: Acute appendicitis is the commonest abdominal emergency. It can be managed as emergency or the surgery can be delayed for some time. Materials and methods: The present comparative study included 128 patients with acute appendicitis admitted at the department of surgery. Data regarding clinical features, management and complications was noted and compared between the two groups. Results: Mean age of patients, sex, BMI, initial total leucocyte count and associated comorbidities were similar in the two groups. Incidence of wound infection in the two groups did not differ as well as the chances of complications. Conclusion: Appendicectomy can be delayed in the selected patients without the risk of increased morbidity

Expression of Toll-like Receptors, Pro-, and Anti-inflammatory Cytokines in Relation to Gut Microbiota in Irritable Bowel Syndrome: The Evidence for Its Micro-organic Basis

BACKGROUND/AIMS: A Subset of patients with irritable bowel syndrome (IBS) may have mild inflammation due to immune activation. Toll-like receptors (TLRs) and cytokines may cause intestinal inflammation. We studied their expression in relation to gut microbiota. METHODS: Expression of TLRs and cytokines was assessed in 47 IBS patients (Rome III) and 25 controls using quantitative real-time polymerase chain reaction. Immunohistochemistry was further performed to confirm the expression of TLR-4 and TLR-5. RESULTS: Of 47 patients with IBS, 20 had constipation (IBS-C), 20 diarrhea (IBS-D), and 7 unclassified (IBS-U). The mRNA levels of TLR-4 and TLR-5 were up-regulated in IBS patients than controls (P = 0.013 and P < 0.001, respectively). Expression of TLR-4 and TLR-5 at protein level was 4.2-folds and 6.6-folds higher in IBS-D than controls. The mRNA levels of IL-6 (P = 0.003), C-X-C motif chemokine ligand 11 (CXCL-11) (P < 0.001) and C-X-C motif chemokine receptor 3 (CXCR-3) (P < 0.001) were higher among IBS patients than controls. Expression of IL-6 (P = 0.002), CXCL-11 (P < 0.001), and CXCR-3 (P < 0.001) were up-regulated and IL-10 (P = 0.012) was down-regulated in IBS-D patients than controls. Positive correlation was seen between TLR-4 and IL-6 (P = 0.043), CXCR-3, and CXCL-11 (P = 0.047), and IL-6 and CXCR-3 (P = 0.003). Stool frequency per week showed positive correlation with mRNA levels of TLR-4 (P = 0.016) and CXCR-3 (P = 0.005), but inversely correlated with IL-10 (P = 0.002). Copy number of Lactobacillus (P = 0.045) and Bifidobacterium (P = 0.011) showed correlation with IL-10 in IBS-C, while Gram-positive (P = 0.031) and Gram-negative bacteria (P = 0.010) showed correlation with CXCL-11 in IBS-D patients. CONCLUSIONS: Altered immune activation in response to dysbiotic microbiota may promote intestinal inflammation in a subset of patients with IBS.