Carotenoids from marine bacteria: A natural antioxidant and UV protectant

For the cosmetics and pharmaceutical sectors, marine resources are a promising supply of organic substances. Marine organisms have evolved particular metabolites to combat threats to their survival, reproduction, and the easier storage, movement, and turnover of essential biological materials in habitats with extreme conditions like high salinity, low temperature, or intense pressure.Several newly conducted research studies on pigments, such as violacein, astaxanthin, canthaxanthin, zeaxanthin, rubrolone, and carotenoid derivatives of bacteria from marine sources, confirm their effective radical scavenging activity. Carotenoids are tetraterpene, lipophilic bioactive pigments synthesized by archaea, algae, photosynthetic bacteria, and plants. Carotenoids are divided into two categories, oxygenated carotenoids (xanthophylls) having oxygen as a functional group, and hydrocarbon carotenoids (carotene) made of carbon and hydrogen atoms Carotenoids are important because of their functional properties, which include their usage in the food industry as color additives and natural antioxidants, as well as chemotaxonomic markers and pharmaceuticals. The present review aims to describe 1) carotenoids from marine bacteria 2) the antioxidant properties of carotenoids 3) the Exposure consequences of ultraviolet radiation 4) the protective role of carotenoids. Photoaging, sunburn, and skin cancer are all possible side effects of excessive UV exposure. Carotenoids have potential use in the pharmaceuticals and cosmetic industry as anti-aging, photoprotective, skin-whitening, anticancer, and immunity boosters because of their antioxidant and UV protection properties.

Secondary amyloidosis with concomitant gastric GIST and gastric adenocarcinoma - A case report

Secondary amyloidosis is a well-established entity and has been described in association with chronic inflammatory conditions such as rheumatoid arthritis, ankylosing spondylitis, bronchiectasis, tuberculosis, etc., It has also been reported in association with neoplasms such as Hodgkin's lymphoma, Waldenstrom's macroglobulinemia, renal cell carcinoma, lung carcinoma, etc. However, only a few case reports documenting the association of amyloidosis with gastrointestinal tumor (GIST) and gastric adenocarcinoma are available in the literature. Hereby, we report a case of a 74-year-old male who presented with colicky abdominal pain and vomiting. Ultrasonography revealed a common bile duct (CBD) stone and a small extra-luminal gastric mass. Endoscopic retrograde cholangiopancreatography (ERCP) was performed to remove the CBD stone which revealed an incidental finding of gastric ulcer. A biopsy was taken from the gastric ulcer which on histopathological examination was confirmed as adenocarcinoma leading onto total gastrectomy. During total gastrectomy, an inadvertent injury to the spleen led to simultaneous splenectomy. Multiple samples from the gastric ulcer, the extra-luminal gastric mass, and the spleen were subjected to histopathological examination. Gastric ulcer was confirmed as adenocarcinoma, gastric extra-luminal mass was confirmed as GIST, and splenic examination revealed widespread deposition of amyloid which on Congo-red stain imparted an apple-green birefringence on polarizing microscopy. To the best of our knowledge, this is the first-ever case of such an association where gastric adenocarcinoma occurred with concomitant gastric GIST and secondary amyloidosis of the spleen.

Prevalence and spectrum of haemoglobinopathies in females of reproductive age group- A first tertiary care center experience in Punjab, North India

Background: Thalassemia and hemoglobinopathies are a group of inherited conditions characterized by abnormalities in the synthesis or structure of hemoglobin (Hb). According to estimates, approximately 7% of the world population is a carrier of Hb disorders, leading to high morbidity and mortality. To reduce the burden of these highly prevalent monogenic disorders, detecting them in the carrier stage is crucial to prevent disease progression. Aim: We aimed to estimate the prevalence and spectrum of hemoglobinopathies in females in the reproductive (20–40 years) age group. Settings and Design: It was a retrospective observational study carried out for 2.5 years (from January 2018 till June 2020). Materials and Methods: All the females in the age group of 20–40 years age whose blood samples were received in the department for High-Performance Liquid Chromatography (HPLC) were included. The cases with abnormal HPLC findings were analyzed for hematological parameters including hemoglobin, RBC count, and RBC indices [mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), & red cell distribution width - coefficient of variation (RDW-CV)]. Statistical Analysis: Statistical package for social science (SPSS) statistics 21 version for Microsoft Windows (Chicago, USA) was used for statistical analysis of data. The data were described in terms of range, mean ± standard deviation (SD), frequencies (number of cases), and relative frequencies (percentage) as appropriate. Results: During the study period, 72.2% of the females were affected with ?-thalassemia trait, followed by HbD Punjab trait (17.8%), HbQ India trait (2.9%), ?-thalassemia major (1.8%), and two cases (1.2%) each of HbS trait, HbD Iran trait, and compound heterozygous of HbD Punjab and ?-thalassaemia, whereas HbE trait, compound heterozygous of HbQ and ?-thalassemia, compound heterozygous of HbJ-variant and ?-thalassemia had one case each (0.6%). Conclusion: Preventive strategies are cost-effective and include population screening, premarital screening, screening of spouses, genetic counseling, and prenatal diagnosis. Educating the carrier females about the potential risk and various screening methods may help in controlling the disease.

COVID-19 in Children with West Syndrome: An Ambispective Study

Objectives To study the course of West syndrome (WS) and coronavirus disease-19 (COVID-19) in children with WS who contracted SARS-CoV-2 infection. Methods This ambispective study was conducted at a tertiary-care center in North India between December 2020 and August 2021 after approval from the Institute Ethics Committee. Five children with WS, positive for COVID-19 based on RT-PCR, fulflled the inclusion criteria. Results One child with COVID-19 during the frst wave was retrospectively included while four children (of the 70 children screened) were prospectively enrolled. The median age at onset of epileptic spasms was 7 mo (2 boys), and that at presentation with COVID-19 was 18.5 mo. Three had underlying acquired structural etiology. Three were in remission following standard therapy, while two had ongoing spasms at the time of COVID-19 illness. During the illness, two of those in remission continued to be in remission while one child had a relapse. The children with ongoing epileptic spasms had variable course [one had persistent spasms and other had transient cessation lasting 3 wk from day 2 of COVID-19 illness, but electroencephalography (on day 8 of COVID-19 illness) continued to show hypsarrhythmia]. Fever was the most typical symptom (and sometimes the only symptom) of COVID-19, with a duration ranging from 1–8 d. Two children had moderate COVID-19 illness requiring hospitalization, while the rest had a mild illness. All the afected children had complete recovery from COVID-19. Conclusion The severity of COVID-19 illness in children with WS is often mild, while the subsequent course of WS is variable.

Age-related cataract - Prevalence, epidemiological pattern and emerging risk factors in a cross-sectional study from Central India

Purpose: To study the epidemiological pattern, prevalence, types, and correlates of age?related cataracts in a tertiary care center in central India. Methods: This hospital?based single?center cross?sectional study was conducted on 2,621 patients diagnosed with cataracts for 3 years. Data pertaining to demography, socio?economic profile, cataract grading, cataract types, and associated risk factors were evaluated. Statistical analysis using unadjusted odds ratio (OR) and multivariate logistic regression was performed, with P-value <0.05 considered significant with the power of the study being 95%. Results: The commonest age group affected was 60–79 years, closely followed by the 40–59 years age group. The prevalence of nuclear sclerosis (NS), cortical (CC), and posterior subcapsular cataract (PSC) was found to be 65.2% (3,418), 24.6% (1,289), and 43.4% (2,276), respectively. Among mixed cataracts, (NS + PSC) had the highest prevalence of 39.8%. Smokers were found to have 1.17 times higher odds of developing NS than non?smokers. Diabetics had 1.12 times higher odds of developing NS cataracts and 1.04 times higher odds of developing CC. Patients with hypertension showed 1.27 times higher odds of developing NS and 1.32 times higher odds of developing CC. Conclusion: The prevalence of cataracts in the pre?senile age group (<60 years) was found to have increased significantly (35.7%). A higher prevalence of PSC (43.4%) was found in studied subjects, as compared to the data of previous studies. Smoking, diabetes, and hypertension were found to have a positive association with a higher prevalence of cataracts.

Application of 3D Printing Technology in the Treatment of Hoffa's Fracture Nonunion / Aplicação da tecnologia de impressão 3D no tratamento da pseudartrose da fratura de Hoffa

Abstract Objective To evaluate a proposed three-dimensional (3D) printing process of a biomodel developed with the aid of fused deposition modeling (FDM) technology based on computed tomography (CT) scans of an individual with nonunion of a coronal femoral condyle fracture (Hoffa's fracture). Materials and Methods Thus, we used CT scans, which enable the evaluation of the 3D volumetric reconstruction of the anatomical model, as well as of the architecture and bone geometry of sites with complex anatomy, such as the joints. In addition, it enables the development of the virtual surgical planning (VSP) in a computer-aided design (CAD) software. This technology makes it possible to print full-scale anatomical models that can be used in surgical simulations for training and in the choice of the best placement of the implant according to the VSP. In the radiographic evaluation of the osteosynthesis of the Hoffa's fracture nonunion, we assessed the position of the implant in the 3D-printed anatomical model and in the patient's knee. Results The 3D-printed anatomical model showed geometric and morphological characteristics similar to those of the actual bone. The position of the implants in relation to the nonunion line and anatomical landmarks showed great accuracy in the comparison of the patient's knee with the 3D-printed anatomical model. Conclusion The use of the virtual anatomical model and the 3D-printed anatomical model with the additive manufacturing (AM) technology proved to be effective and useful in planning and performing the surgical treatment of Hoffa's fracture nonunion. Thus, it showed great accuracy in the reproducibility of the virtual surgical planning and the 3D-printed anatomical model.

Resumo Objetivo Avaliar uma proposta de processo de impressão tridimensional (3D) de um biomodelo preparado com o auxílio da tecnologia de modelagem por deposição de material fundido (fused deposition modeling, FDM, em inglês) a partir de imagens de tomografia computadorizada (TC) de um indivíduo com pseudartrose de fratura coronal do côndilo femoral (fratura de Hoffa). Materiais e Métodos Para tanto, utilizamos imagens de TC, que permitem estudar a reconstrução volumétrica 3D do modelo anatômico, além da arquitetura e geometria óssea de sítios de anatomia complexa, como as articulações. Também permite o planejamento cirúrgico virtual (PCV) em um programa de desenho assistido por computador (computer-aided design, CAD, em inglês). Essa tecnologia possibilita a impressão de modelos anatômicos em escala real que podem ser utilizados em simulações cirúrgicas para o treinamento e a escolha do melhor posicionamento do implante de acordo com o PCV. Na avaliação radiográfica da osteossíntese da pseudartrose de Hoffa, verificou-se a posição do implante no modelo anatômico impresso em 3D e no joelho do paciente. Resultados O modelo anatômico impresso em 3D apresentou características geométricas e morfológicas semelhantes às do osso real. O posicionamento dos implantes em relação à linha de pseudartrose e pontos anatômicos foram bastante precisos na comparação do joelho do paciente com o modelo anatômico impresso em 3D. Conclusão A utilização do modelo anatômico virtual e do modelo anatômico impresso em 3D com a tecnologia de manufatura aditiva (MA) foi eficaz e auxiliou o planejamento e a realização do tratamento cirúrgico da pseudartrose da fratura de Hoffa. Desta forma, foi bastante preciso na reprodutibilidade do planejamento cirúrgico tanto virtual quanto no modelo anatômico impresso em 3D.

Dry eye disease in head and neck cancer patients undergoing radiotherapy

Purpose: To study the incidence of dry eye disease (DED) in head and neck cancer (HNC) patients undergoing external beam radiotherapy (EBRT), to find a correlation between tumor location and total radiation dose with DED, and to report various radiotherapy (RT) induced acute toxic effects on ocular and adnexal structures. Methods: A prospective cohort study was conducted at a tertiary eye?care center on 90 patients of HNC undergoing EBRT from March 2021 to May 2022. All underwent a thorough clinical history and complete ophthalmological examination including an ocular surface disease index (OSDI) questionnaire, visual acuity, anterior segment, angle and posterior segment examination, dry eye workup including the Schirmer test, tear meniscus height, tear break?up time, corneal fluorescein staining and grading, and meibography by auto?refractometer and its scoring at each visit. Patients were evaluated before the start of RT and then at 1 week, 4 weeks, and 12 weeks post?RT. Radiation records of all patients were noted. Data were analyzed using percentage and Microsoft Excel. Results: Of the 90 patients, 66 were male and 24 female (M: F ratio of 2.75) with a median age of 52.5 years (range 24 to 80 years). The most common HNC was the carcinoma oral cavity and lip. Most patients received a total radiation dose between 46 to 55 Gy. DED developed in 48 (53.3%) patients. The incidence of DED increased with the increase in total radiation dose (r = 0.987). DED was also found to be correlated with tumor location (r = 0.983). Conclusion: The incidence of DED positively correlated with the total radiation dose and tumor location.

Does left atrial appendage morphology and dimension differ amongst etiological stroke subtypes in patients without known atrial fibrillation? Results from the left atrial appendage morphology and dimension assessment by TEE in patients with stroke without known atrial fibrillation (LAMDA-STROKE) study

Context: Complex left atrial appendage (LAA) morphology is increasingly associated with cryptogenic ischemic stroke as compared to cardioembolic stroke due to atrial fibrillation (AF). However, data on such an association in patients with other etiological stroke subtypes in the absence of AF is limited. Aim: The study aimed to assess the LAA morphology, dimension and other echocardiographic parameters by transesophageal echocardiography (TEE) in patients with embolic stroke of undetermined source (ESUS) and compare it with other etiological stroke subtypes without known AF. Methods: This was a single-Centre, observational study involving comparison of echocardiographic parameters including LAA morphology and dimension in ESUS patients (group A; n ¼ 30) with other etiological stroke subtypes i.e., TOAST (Trial of Org 10172 in Acute Stroke Treatment) class I-IV without AF (group B; n ¼ 30). Results: Complex LAA morphology was predominant in group A (18 patients in group A versus 5 patients in group B, p-Value ¼ 0.001). Mean LAA orifice diameter (15.3 þ 3.5 mm in group A versus 17 þ 2.0 mm in group B, p-Value ¼ 0.027) and LAA depth were significantly lower in group A (28.4 þ 6.6 mm in group A versus 31.7 þ 4.3 mm in group B, p-Value ¼ 0.026). Out of these three parameters only complex LAA morphology was found to be independently associated with ESUS [OR ¼ 6.003, 95% CI {1.225e29.417}, p ¼ 0.027]. Conclusion: Complex LAA morphology is a predominant feature in ischemic stroke patients with ESUS and may contribute to an increased risk of stroke in these patients.

CORRELATION OF SERUM FERRITIN AND LDH ON CRITICALLY ILL PATIENTS OF COVID-19 DISEASE DURING 1ST AND 2ND WAVE OF COVID 19 PANDEMIC IN TERTIARY CARE HOSPITAL, INDIA

In both the earlier waves of COVID-19 variants, severe and fatal respiratory disease like acute respiratory distress syndrome (ARDS) became more fatal in population with comorbid conditions. Therefore, early identi?cation of severe COVID-19 is very important for individual's precise management, including antiviral, oxygen support and intensive care unit (ICU) management. First case of COVID-19 got reported in the medical record of India on 30th January 2020 in a student who had returned from Wuhan, China. In 2020 and 2021 it was found that individuals with increased serum ferritin and LDH level landed up with severe and very severe COVID-19 if not treated timely and correctly. So correlation between S. Ferritin and LDH in 1st and 2nd wave was required to evaluate the condition of patients who remained admitted in critical care unit with or without comorbid conditions. This is hospital based cross- sectional observational study on 50-50 (total-100) critically ill patients admitted during 2020 and 2021 respectively. We found that In 2020 during the 1st wave serum LDH and serum Ferritin levels were signi?cantly high with the mean value of 481.65 U/L and 532.56 ng/ml respectively and in 2021 during 2nd wave serum LDH and serum Ferritin levels were again signi?cantly high with the mean value of 488.43 U/L and 667.27 ng/ml respectively. In 2020 patients with comorbid conditions showed S. LDH and Ferritin mean value of 543.47 U/L and 582.63 ng/ml respectively and in 2021 during 2nd wave it showed S.LDH and Ferritin levels mean value of 672.72 U/L and 727.38 ng/ml respectively. Both in?ammatory markers were signi?cantly more increased in the critically ill patients who presented with co-morbidities. This study will provide improved con?dence to health workers working in remote areas and COVID-19 hospitals in predicting transfer of COVID-19 patients to tertiary care hospitals for critical care management at the earliest.

Management of Diabetic Macular Edema Through Ayurveda: A Single Case Study

Diabetic macular edema is one of the leading causes of visual acuity loss in people with diabetes. It produces blurry vision, particularly in the centre of the vision field, floaters and black spots in front of the eyes etc. The treatment recommended by modern science is laser photocoagulation and anti-VEGF injection, which is pricey and does not ensure visual reversal in the patient. In Ayurveda text, diabetic retinopathy and diabetic macular edema are not directly described but etiopathogenesis of eye diseases and Prameha gives an idea of possible correlation between these two diseases. So, DME resembles Timira (Pramehajanya). In Ayurveda, Timira has been explained in detail by our Acharyas. Clinical manifestations of Timira are Vihwal Drishti (blurred vision), Makshika Mashaka Kesha Jaala Pashyati (floaters), Tamasa Darshanam (Scotoma- black spots in front of eyes) and Nasa Akshi Yuktani Vipritani Vikshate (Metamorphopsia or distorted vision) which has similarity with features of DME. Material & Methods: In the present study, a female patient aged 51 years, visited the Shalakya Tantra OPD of National Institute of Ayurveda, Jaipur, with complaining of Blurriness of vision since 6 months and uncontrolled blood sugar level. Result: Blood sugar level was controlled and saw reduction in subjective and objective parameters. Discussion: Following an Ayurvedic drugs and routine will assist to slow the advancement of the condition, prevent further diabetes complications, and improve quality of life.

Role of Sthanik Chikitsa in Shweta Pradara Associated with Madhumeha (DM Type- II): A Case Study

Shweta Pradara or excessive vaginal discharge is one of the commonest complaints among women of reproductive age group. An increase in the normal vaginal secretion develops physiologically at puberty, at ovulation, premenstrual phase and during pregnancy. Excessive discharge causes irritation and itching in the genetalia. Ayurveda explained this condition as Shweta Pradara. Shweta Pradara is a symptom which is present in most of the diseases or present as a complication. Shweta Pradara is not a disease it produces as a symptom, hence etiopathogenesis of principal disease and Shweta Pradara would be same. It is a Kaphaja disorder at the place of Apana Vayu. A 47 years old female patient suffering from intermittent Yonigata Shwet Strava since two years with aggravation of symptoms from one week presented to Prasuti Tantra Evam Stree Roga OPD. Yonigat Shwet Strava was associated with Yoni Kandu, Katishool, Yoni Daha. On enquiry, it was found that she was the known case of Type II Diabetes Mellitus since 10 years. She was taking medication for the same but her blood sugar levels were uncontrolled in spite of taking medication as per her recent investigations. In this case Shwet Pradar was the Updrava of Madhumeh, thus line of management was planned to control her sugar level by supplementing Ayurvedic drugs along with allopathic medicine for DM II (Madhumeh) and treated her with Yoniprakshalan with Triphala Kwath followed by Cutis ointment tamponing per vaginum for 14 days. She had followed the schedule of Yoni Prakshalana, oral medicines and Pathya-Apathya properly. It was observed that, symptoms were started to reduce gradually which has been depicted by documentation of investigations and local examination in this case study.

Optical coherence tomography-based assessment of macular vessel density, retinal layer metrics and sub-foveal choroidal thickness in COVID-19 recovered patients

Purpose: The primary objective of the study was to assess the macular retinal vessel density, subfoveal choroidal thickness, and retinal layer metrics by optical coherence tomography angiography (OCTA), enhanced?depth imaging optical coherence tomography (EDI?OCT), and spectral domain optical coherence tomography (SD?OCT), respectively, in recovered COVID?19 patients and its comparison with the same in control subjects. The secondary objective was to evaluate differences in OCTA parameters in relation with the severity of COVID?19 disease and administration of corticosteroids. Methods: A case–control study was performed that included patients who had recovered from COVID?19 and age?matched healthy controls. Complete ocular examination including OCTA, SD?OCT, and EDI?OCT were performed three months following the diagnosis. Results: Three hundred sixty eyes of 180 subjects were enrolled between the two groups. A decreased mean foveal avascular zone area in both superficial capillary plexuses (P = 0.03) and deep capillary plexuses (P < 0.01), reduced average ganglion cell layer?inner plexiform layer thickness (P = 0.04), and increased subfoveal choroidal thickness (P < 0.001) were observed among cases in comparison to the control group. A significant correlation was found between sectoral macular vessel density in relation to disease severity and a decrease in vessel density with greater severity of the disease. Conclusion: OCTA detected retinal microvascular alterations following SARS?CoV?2 infection in subjects with the absence of any clinical ocular manifestation or systemic thrombotic events. These parameters could be used to help identify patients with a higher incidence of systemic thromboembolism on longer follow?ups and identify the impact of corticosteroids on retinal architecture.

SARS-CoV-2 antigen detection in deceased bodies: implications for infection prevention

Background & objectives: High transmissibility of the SARS-CoV-2 has significant implications on healthcare workers’ safety, preservation, handling, transportation and disposal of the deceased bodies. The objective of this study was to detect SARS-CoV-2 antigen in nasopharyngeal samples and its implications in handling and care of COVID-19 deceased bodies. Methods: A study was conducted at a dedicated COVID-19 centre on deceased individuals from April to December 2020. Rapid antigen test (RAT) and reverse transcription (RT)-PCR was compared on all the SARS-CoV-2 positive cadavers recruited in the study. Results: A total of 115 deceased individuals were included in the study. Of these, 79 (68.7%) were male and 36 (31.3%) were female and majority were in the age group of 51-60 yr [31 (27%)]. SARS-CoV-2 antigen test was positive in 32 (27.8%) and negative in 83 (72.1%) individuals. The mean time interval between deaths to the sample collection was 13.2 h with interquartile range of eight to 20 h. Reverse transcription (RT)-PCR was used as the reference test and 24 (20.9%) cases were true positive; 93.6 per cent [95% confidence interval (CI) 88.8-98.4%] sensitivity, 45.2 per cent (95% CI 35.5-55%) specificity, 60.2 per cent (95% CI 50.6-69.8%) positive predictive value and 88.8 per cent (95% CI 82.7-95%) negative predictive value of antigen test was computed. Interpretation & conclusions: SARS-CoV-2 antigen test was positive beyond 19 h in COVID-19 deceased individuals. Antigen test was found to be highly sensitive in the deceased. Patients, suspected of having died due to COVID-19, can be screened by this method. As infectiousness of the virus in the deceased bodies cannot be directly concluded from either the antigen or RT-PCR test, yet possible transmission cannot be completely ruled out. Strict infection control measures need to be followed during the handling and clearance of COVID-19 cadavers.

Achromobacter Spp.: A retrospective review of rare and emerging pathogen

Background: Achromobacter spp. is a rare nosocomial pathogen known to cause many serious infections like bloodstream infection, osteomyelitis, meningitis, urinary tract infections, corneal ulceration, peritonitis, and endocarditis. Materials and Methods: In this study, we retrospectively analyzed all the bacteriological sample records from the bacteriology database from January 2021 to December 2021 to determine the prevalence of Achromobacter spp. Result: Nine patients with Achromobacter xylosoxidans causing bacterial infection were identified, from whom five blood samples, two pus, one respiratory sample, one central venous pressure (CVP), and one cerebrospinal fluid were found positive for Achromobacter spp., among whom one was a 6-year-old patient having the same organism from two different body sites—CVP line and cerebrospinal fluid. Five patients had coinfection with another organism, whereas acute kidney injury was the most common comorbidity. Conclusion: In our single-center experience, approximately 50% of the cases with Achromobacter denitrificans bacteremia suffered from chronic kidney disease and had a history of antibiotic therapy, hospitalization, and the presence of devices. Active research on rising trends of Achromobacter spp. needs to be promoted.

Laparoscopic Witzel feeding jejunostomy: a procedure overlooked!

Purpose@#Feeding jejunostomy (FJ) is a critical procedure to establish a source of enteral nutrition for upper gastrointestinal disorders. Minimally invasive surgery has the inherent benefit of better patient outcomes, less postoperative pain, and early discharge. This study aims to describe our total laparoscopic technique of Witzel FJ and to compare its outcome with its open counterpart. @*Methods@#A retrospective database analysis was performed in patients who underwent laparoscopic (n = 20) and open (n = 21) FJ as a stand-alone procedure from July 2018 to July 2022. A readily available nasogastric tube (Ryles tube) and routine laparoscopic instruments were used to perform laparoscopic FJ. Perioperative data and postoperative outcomes were analyzed. @*Results@#Baseline preoperative variables were comparable in both groups. The median operative duration in the laparoscopic FJ group was 180 minutes vs. 60 minutes in the open FJ group (p = 0.01). Postoperative length of hospital stay was 3 days vs. 4 days in the laparoscopic and open FJ groups, respectively (p = 0.08). Four patients in the open FJ group suffered from an immediate postoperative complication (none in the laparoscopic FJ group). After a median follow-up of 10 months, fewer patients in the laparoscopic FJ group had complications such as tube clogging, tube dislodgement, surgical-site infection, and small bowel obstruction. @*Conclusion@#Laparoscopic FJ with the Witzel technique is a safe and feasible procedure with a comparable outcome to the open technique. Patient selection is vital to overcome the initial learning curve.

Cystic Lymphangioma of Rectum-A Case Report and Review of Literature / 대한소화기학회지

Colorectal cystic lymphangiomas are rare benign lesions. They are characterized by the presence of either single or multi-cystic spaces lined by endothelium. Though there are multiple case reports of right and transverse colonic lymphangioma; only around 10 cases of lymphangioma of the rectum have been reported. We present a case report of rectal lymphangioma with the relevant literature review.

Development of orthopedic simulator to practice closed reduction of pediatric fractures of the middle third of forearm / Desenvolvimento de um simulador ortopédico para prática de redução incruenta de fraturas pediátricas do terço médio do antebraço

ABSTRACT In the current scenario of medical education, a trend of using models and simulators to train operational skills, especially in the practice of basic orthopedic techniques, is growing. This form of teaching allows academics to maximize learning opportunities and contributes to improving the quality of care for their future patients. However, the realistic simulation has high costs as a major limitation. Objective: To develop a low-cost orthopedic simulator for practicing pediatric forearm reduction skills in the preclinical setting. Methods: A model of an arm and forearm with a fracture in the middle third was developed. Orthopedists, residents, and medical students evaluated the simulator's ability to reproduce fracture reduction. Results: The simulator had a significantly lower cost than the others in the literature. The participants agreed that the model had a good performance, and that the manipulation was consistent with the reality of reducing closed pediatric forearm fracture. Conclusion: The results suggest that this model can be used to teach orthopedic residents and medical students the skill of closed reduction of fractures in the middle third of the forearm. Level of Evidence III, Case Control Study.

RESUMO No cenário atual de ensino médico existe uma tendência crescente do uso de modelos e simuladores para o treino de habilidades operacionais, principalmente na prática de técnicas ortopédicas básicas, que permite aos acadêmicos maximizarem as oportunidades de aprendizado e contribui para melhorar a qualidade de atendimento dos futuros pacientes atendidos. A simulação realística, no entanto, tem como grande limitação os altos custos. Objetivo: Desenvolver um simulador ortopédico de baixo custo para a prática de habilidades de redução incruenta do antebraço pediátrico no cenário pré-clínico. Métodos: Desenvolveu-se um modelo de braço e antebraço com fratura no terço médio, que foi avaliado por médicos ortopedistas, residentes e acadêmicos de medicina quanto à capacidade do simulador de reproduzir a redução da fratura. Resultados: O simulador desenvolvido teve custo significativamente inferior aos existentes na literatura. Os participantes concordaram que o modelo teve um bom desempenho e que a manipulação foi condizente com a realidade de redução de fratura incruenta do antebraço pediátrico. Conclusão: Os resultados levam a crer que esse modelo pode ser usado para ensinar a redução incruenta de fratura no terço médio do antebraço para residentes de ortopedia e acadêmicos de medicina. Nível de Evidência III, Estudo de Caso-Controle.

Skeletal changes of the axial axis and lower limbs in overweight children and adolescents / Alterações esqueléticas do eixo axial e de membros inferiores em crianças e adolescentes com excesso de peso

Abstract Objective: To evaluate the presence of axial skeletal deviations in children and adolescents and to relate them to body mass index (BMI), age and sex. Methods: 101 patients aged 7 to 17 years old were included in this study; exclusion criteria were primary orthopedic diseases and syndromes or treatments that affect growth. Patients were grouped according to their BMI Z-score: eutrophic (n=29), overweight (n=18) and obese (n=54). They underwent static clinical inspection was made by simetrographic technique. Intermaleolar distance was obtained, Adam's forward bend and tiptoe tests were performed. Results: When comparing obese and eutrophic patients, changes in the cervical spine (p<0.01), spine (p<0.001), hip (p<0.01) and shoulders (p<0.001) were present in more than half of the obese patients (62.5%, 62.2%, 79.9% and 55.4%, respectively). Changes in the knees were more frequent among obese (p<0.001) when compared to eutrophic patients. There was no variation regarding age or sex (p>0.05). Conclusions: being overweight influences skeletal deviations in children and adolescents.

RESUMO Objetivo: Avaliar a presença de desvios do esqueleto axial em crianças e adolescentes e relacioná-los com índice de massa corpórea, idade e sexo. Métodos: Fizeram parte deste estudo 101 pacientes de sete a 17 anos, os quais não possuíam doenças ortopédicas primárias, síndromes ou tratamentos que afetassem o crescimento. Os pacientes foram agrupados conforme os escores Z do índice de massa corpórea em: eutróficos (n=29), com sobrepeso (n=18) e obesos (n=54). Foram avaliados por meio da inspeção clínica estática, com simetrógrafo de parede, medida da distância intermaleolar, manobra de Adams e teste da ponta dos pés. Resultados: Quando comparados os pacientes obesos com os eutróficos, alterações de coluna cervical (p<0,01), coluna (p<0,001), quadril (p<0,01) e ombros (p<0,001) ocorreram em mais da metade dos obesos (62,5, 62,2, 79,9 e 55,4%, respectivamente). Alterações nos joelhos foram mais frequentes entre os obesos (p<0,001) quando comparados aos eutróficos. Não houve variação com a idade ou o sexo (p>0,05). Conclusões: Conclui-se que o excesso de peso exerce influência sobre desvios do esqueleto em crianças e adolescentes.