Surgical outcomes of laparoscopic total extraperitoneal (TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study.

Inguinal hernia repair is one of the most frequently performed surgery. The ideal procedure for inguinal hernia repair remains controversial. Open Lichtenstein tension-free mesh repair (LMR) is one of the most preferred open techniques with satisfactory outcomes. Laparoscopic approach in inguinal hernia surgery remains controversial, especially in comparison with open procedures. In this study, we have reported a comparison of laparoscopic total extraperitoneal (TEP) inguinal hernia repair with LMR. Postoperative pain, operative time, complications like seroma, wound infection, chronic groin pain, and recurrence rate were parameters to evaluate the outcome. One hundred seventy-four patients were included in the study by consecutive randomized prospective sampling. The patients were divided into 2 groups: group A, laparoscopic TEP inguinal hernia repair, and group B, LMR. The procedures were performed by experienced surgeons. The primary outcomes were evaluated based on postoperative pain and recurrence rate. Secondary outcomes considered for evaluation were operative time, complications like seroma, infection, and chronic groin pain. Severe pain was reported in group A (7.9%) compared to group B (15.1%), which was statistically significant (P < .001). Moderate pain was reported more in group B (70.9%) compared to group A (29.5%) (P < .001). The mean operative time in group A was 84.6 ± 32.2, which was significantly higher than that in group B, 59.2 ± 14.8. There was no major complication in both groups. The chronic pain postoperatively was significantly in higher number of patients in group B vs group A (22.09% vs 3.4%). The postoperative hospital stay period was significantly lesser for group A vs for group B (2.68 ± 1.52 vs 3.86 ± 6.16). Time duration taken to resume normal activities was significantly lower in group A (13.6 ± 6.8) vs (19.8 ± 4.6) in group B (P < .001). Although there is definite evidence of longer operative time and learning curve, laparoscopic TEP has added advantages like less postoperative pain, early resumption of normal activities, less chronic groin pain, and comparable recurrence rate compared to open Lichtenstein repair. Laparoscopic TEP can be performed with acceptable outcomes and less postoperative complications if performed by experienced hands.

Chediak-Higashi Syndrome With Epstein-Barr Virus Triggered Hemophagocytic Lymphohistiocytosis: A Case Report.

Chediak-Higashi syndrome (CHS) is a rare, autosomal-recessive disorder characterized by oculocutaneous albinism, recurrent bacterial infections, progressive neurologic abnormalities, coagulation defects and a high risk of developing hemophagocytic lymphohistiocytosis characterized by pancytopenia, high fever, and lymphohistiocytic infiltration of liver, spleen, and lymph nodes. Treatment of accelerated-phase CHS is difficult with poor prognosis. Here, we report a two-and-a-half-year-old male child who was diagnosed with Chediak-Higashi Syndrome based on silvery hair, pathognomonic hair microscopy and giant azurophilic granules in granulocytes. The patient was in advanced stage of HLH induced by an Epstein-Barr virus (EBV) infection and given etoposide, cyclosporine and dexamethasone according to hemophagocytic lymphohistiocytosis (HLH)-2004 protocol but did not survive.

Clinical profile and predictors of Severe Dengue disease: A study from South India.

BACKGROUND: Dengue is endemic and prevalent in tropical and sub-tropical countries including India and can cause significant mortality and morbidity. There are limited studies available on factors associated with severe dengue from India, to investigate the predictors of severe dengue in south Indian patients. METHODS: We recruited 334 patients with dengue admitted in Yashoda Hospital, Hyderabad. Study period was between March 2015 and February 2017. Based on clinical symptoms, we divided patients into severe dengue and non-severe dengue. Univariate and multivariate analysis was performed for prognostic factors of severe dengue. RESULTS: Out of 334 patients, there were 186(55.6%) males with mean age 30.3±14.3 39 years (age range: 10-73 years), severe dengue was seen in 117(35%) and non-severe dengue in 217(65%). Clinical symptoms of diabetes, low platelet count (<50,000mm3), melena, skin rash, delayed admission (>5days after onset) elevated hematocrit, lymphadenopathy, hepatomegaly, splenomegaly, convulsions and mortality were significantly associated with severe dengue. After multivariate analysis, diabetes (OR: 2.12; 95% CI:1.34-4.65) (<0.0001), elevated hematocrit (OR: 3.14; 95% CI:2.17-6.14) (<0.0001), skin rashes (OR: 1.99; 95% CI: 1.11-3.55) (<0.0001), melena (OR: 2.59; 95% CI:1.40-4.93) (<0.0001), low platelet count (OR: 6.71; 95% CI:4.12-13.6) (<0.0001), lymphadenopathy (OR: 3.12 95% CI: 1.91-7.85) (<0.0001) and delayed admission (OR: 2.40; 95% CI:1.31-3.41) (<0.0001) were significantly associated with severe dengue disease. CONCLUSIONS: In our study, it was established that low platelet count, elevated hematocrit, diabetes, skin rash, melena, lymphadenopathy and delayed in admission (>5days) were independently associated with severe dengue.

Nutritional enrichment of broiler breast meat through dietary supplementation of Indian ginseng Withania somnifera and synbiotic substances under semi-arid climatic conditions.

AIM: The present study was conducted to explore the effect of supplementation of Withania somnifera and synbiotics alone or in combination on the composition of broiler breast meat under heat stress conditions. MATERIALS AND METHODS: A 42-day feeding trial was conducted on 360 broiler chicks randomly allotted into eight treatment groups with three replicates each under completely randomized design. The T1 group was kept as control whereas T2-T4 were supplemented with 0.5%, 1%, and 1.5% W. somnifera root powder; T5 and T6 were supplemented with 0.025% and 0.050% synbiotic and T7 and T8 were fed on diet containing 0.25% W. somnifera+0.025% synbiotic and 0.50% W. somnifera+0.05% synbiotic, respectively. Three broilers from each replicate were sacrificed at the end of the trial to estimate crude protein (CP), ether extract and ash content of the breast muscle on dry matter basis. RESULTS: Significantly higher CP values and lower ether extract values were observed in 1.5% W. somnifera supplemented group (T4) or in group supplemented with 0.50% W. somnifera and 0.05% synbiotic (T8). The ash content of breast meat was observed non-significant in T1-T4 groups however the inclusion of synbiotics in T5-T8 groups significantly raised the ash contents. CONCLUSION: The study concluded that inclusion of 0.5% W. somnifera with 0.05% synbiotic substance enriches the total protein content and reduces the total lipids content of broiler breast meat under heat stress conditions.

Study on Steroid Induced Ocular Findings in Children with Nephrotic Syndrome.

INTRODUCTION: Long term use of corticosteroids in Nephrotic Syndrome (NS) is associated with ocular complications such as Posterior Subcapsular Cataract (PSC), glaucoma, increased intra-ocular pressure, ptosis, mydriasis, eyelid skin atrophy, keratisis, thinning of cornea and sclera, repeated hordeolum exacerbations. AIM: To determine ocular abnormalities in children with NS and their association with steroid dosing and duration. MATERIALS AND METHODS: Hundred patients with NS in the age group of 2-18 years, with no evidence of other systemic disease, were considered for the study. Group I included cases (66) who took standard steroid regimen for first episode of NS. Group II included cases (34) who took steroid irrationally (daily basis for long time) other than standard regimen. Steroid induced ocular complications were compared in both groups after detailed ophthalmological examination. Statistical analysis was done using Statistical Package for Social Science (SPSS-20.0). RESULTS: Ocular abnormalities were found in 12 patients out of 66 in Group I (18%) and 16 patients out of 34 patients in Group II (47%). Out of 12 patients of Group I who had ocular problems, three had myopic astigmatism, eight patients had PSC and one had temporal disc pallor. While in Group II, out of 16 patients who had ocular complications, two patients had raised intra ocular pressure and two patients had myopic astigmatism and 12 patients had posterior sub capsular cataract. The difference in mean cumulative steroid doses in both groups was statistically significant but no such difference was there between duration of steroid intake in both group. CONCLUSION: Our study concluded that ocular complications were more common in patients with irrationally steroid intake and cumulative steroid dose intake was also significantly higher in same patients.

Lessons from 151 ureteral reimplantations for postcystectomy ureteroenteric strictures: A single-center experience over a decade.

OBJECTIVES: Ureteroenteric anastomotic strictures are common after cystectomy with urinary diversion. Endoscopic treatments have poor long-term success, although ureteral reimplantation is associated with morbidity. Predictors of successful open repair are poorly defined. Our objective was to characterize outcomes of ureteral reimplantation after cystectomy and identify risk factors for stricture recurrence. PATIENTS AND METHODS: We performed a retrospective review of 124 consecutive patients with a total of 151 open ureteral reimplantations for postcystectomy ureteroenteric strictures between January 2006 and December 2015. Baseline clinicopathologic characteristics and perioperative outcomes were examined. Predictors for stricture recurrence were assessed by univariable testing and univariate Cox proportional hazards regression. RESULTS: Most patients underwent preoperative drainage by percutaneous nephrostomy (PCN; 43%) or percutaneous nephroureterostomy (PCNU; 44%). Major iatrogenic injuries included enterotomies requiring bowel anastomosis (3.2%) and major vascular injuries (2.4%). Overall, 60 (48%) patients suffered 90-day complications, of which 15 (12%) patients had high-grade complications. Median length of stay was 6 days [interquartile range: 5, 8] and median follow-up was 21 months [interquartile range: 5, 43]. The overall success rate per ureter was 93.4%. On univariate analysis, the only significant predictor of stricture recurrence was preoperative PCNU placement compared with PCN placement or no drainage (success rates: 85.5% vs. 98.9%, respectively, P = 0.002). Cox proportional hazards regression demonstrated that preoperative PCNU placement yielded a hazard ratio of 10.2 (95% CI: 1.27-82.6) for stricture recurrence (P<0.005). Stricture recurrence was independent of previous endoscopic interventions (P = 0.42). Stricture length was unable to be assessed. CONCLUSIONS: Postcystectomy ureteral reimplantation was associated with relatively low rates of major iatrogenic injuries and high-grade complications. Preoperative PCN placement rather than PCNU may yield better results.

Redefining the implications of nasogastric tube placement following radical cystectomy in the alvimopan era.

PURPOSE: Alvimopan has decreased ileus and need for nasogastric tube (NGT) after radical cystectomy (RC). However, the natural history of ileus versus intestinal obstruction in patients receiving alvimopan is not well defined. We sought to examine the implications of NGT placement before and after the introduction of alvimopan for RC patients. METHODS: Retrospective review identified 278 and 293 consecutive patients who underwent RC before and after instituting alvimopan between June 2009 and May 2014. Baseline characteristics and postoperative outcomes were compared by alvimopan status. Multivariate logistic regression was performed to assess the impact of alvimopan on rates of NGT placement and reoperation for bowel complications. RESULTS: The cohorts had similar age, stage, approach, and BMI. Patients receiving alvimopan had decreased ileus (16 vs 32 %, p < 0.01) but similar rates of reoperation for bowel complications (2.8 vs 2.7 %). On multivariate analysis, alvimopan was associated with lower risk of NGT placement (OR 0.30, p < 0.01). For patients requiring NGT placement, there was an increased rate of reoperation among patients receiving alvimopan compared with those who did not (28 vs 11 %, p = 0.03). Patients receiving alvimopan who needed NGT had significantly increased median length of stay (22 vs 7 days), need for TPN (66 vs 5.3 %), and readmission for ileus (10.3 vs 2.3 %) compared with those who did not require NGT. CONCLUSIONS: Alvimopan significantly reduced the incidence of ileus and NGT placement following RC. NGT placement was associated with an increased need for reoperation for bowel complications in the setting of alvimopan.

Molecular characterization of exon 3 of caprine myostatin gene in Marwari goat.

AIM: To estimate genetic variability in exon 3 of caprine myostatin gene in Marwari goats. MATERIALS AND METHODS: A total of 120 blood samples from unrelated Marwari goats were randomly collected from different villages of Bikaner (Rajasthan), India. Genomic DNA was extracted from whole blood using blood DNA isolation kit (Himedia Ltd.) as per manufacturer's protocol. The quality of extracted genomic DNA was checked on 0.8% agarose gel. Specifically designed a primer set for caprine myostatin (MSTN) gene (Genebank accession no. DQ167575) was used to amplify the exon 3 region of MSTN gene in Marwari goat. The genetic variability in exon 3 of MSTN gene in Marwari goat was assessed on 8% polyacrylamide gel electrophoresis to detect single strand conformation polymorphism (SSCP) pattern. RESULTS: The exon 3 of MSTN gene in Marwari goat showed two types of conformation patterns on 8% polyacrylamide gel. One of the patterns showed only two bands and was considered as genotype AA, whereas another pattern having an extra band was designated as genotype AB. The frequencies of AA and AB genotype for exon 3 region of MSTN gene were calculated as 0.90 and 0.10, respectively. CONCLUSION: Low level of polymorphism was observed at exon 3 region of MSTN gene in Marwari goat through SSCP analysis. This information could be utilized in future breeding plan to exploit the unique characteristics of Marwari goat of Rajasthan.

Nested PCR Assay for Eight Pathogens: A Rapid Tool for Diagnosis of Bacterial Meningitis.

PURPOSE: Bacterial meningitis is a dreadful infectious disease with a high mortality and morbidity if remained undiagnosed. Traditional diagnostic methods for bacterial meningitis pose a challenge in accurate identification of pathogen, making prognosis difficult. The present study is therefore aimed to design and evaluate a specific and sensitive nested 16S rDNA genus-based polymerase chain reaction (PCR) assay using clinical cerebrospinal fluid (CSF) for rapid diagnosis of eight pathogens causing the disease. METHODS: The present work was dedicated to development of an in-house genus specific 16S rDNA nested PCR covering pathogens of eight genera responsible for causing bacterial meningitis using newly designed as well as literature based primers for respective genus. A total 150 suspected meningitis CSF obtained from the patients admitted to Central India Institute of Medical Sciences (CIIMS), India during the period from August 2011 to May 2014, were used to evaluate clinical sensitivity and clinical specificity of optimized PCR assays. RESULTS: The analytical sensitivity and specificity of our newly designed genus-specific 16S rDNA PCR were found to be ≥92%. With such a high sensitivity and specificity, our in-house nested PCR was able to give 100% sensitivity in clinically confirmed positive cases and 100% specificity in clinically confirmed negative cases indicating its applicability in clinical diagnosis. CONCLUSIONS: Our in-house nested PCR system therefore can diagnose the accurate pathogen causing bacterial meningitis and therefore be useful in selecting a specific treatment line to minimize morbidity. Results are obtained within 24 h and high sensitivity makes this nested PCR assay a rapid and accurate diagnostic tool compared to traditional culture-based methods.

Prediction of (13)C NMR Chemical Shift Sum Using Topological Indices: Role of Recently Introduced Balaban F and G Indices.

Present paper deals with the examination of Balaban F and G indices for estimating (13)C NMR chemical shift sums of alkanes. Set of 66 alkanes were used for this purpose, which have been divided into training set (50 compounds) and test set (16 compounds). The results have shown that Balaban G Index along with connectivity indices yields the best model. The model is analyzed for the defect due to colinearity using Ridge parameters. The most appropriate model is a three-parametric model found containing [Formula: see text], [Formula: see text], and G as correlating parameters. The results have been critically examined based on variety of statistical parameters.

A rare case of leptospirosis with isolated lung involvement.

Leptospirosis is a zoonosis caused by a pathogenic spirochete "leptospira interrogans." Severe form of leprospira infection is usually associated with jaundice and renal involvement, leading to major hemorrhagic complications. Lung involvement can vary from subtle clinical features to deadly pulmonary hemorrhage and acute respiratory distress syndrome (ARDS). We recently managed a case of leptospirosis with isolated lung involvement as alveolar hemorrhage and ARDS. Our patient had acute febrile illness with respiratory symptoms associated with radiological picture of pulmonary hemorrhage. Patient was managed with noninvasive ventilation with high flow oxygen, antibiotic and pulse steroids therapy. In conclusion, leptospirosis can present with predominant pulmonary involvement, instead of the classical triad of Weil disease. High index of suspicion should be kept in acute febrile illness patients with respiratory symptoms and alveolar hemorrhage. Early diagnosis and management with oxygenation, antibiotics and immunosuppresents can prevent complications and mortality.

Aluminum phosphide poisoning: Possible role of supportive measures in the absence of specific antidote.

Aluminum phosphide (ALP) poisoning is one of the major causes of suicidal deaths. Toxicity by ALP is caused by the liberation of phosphine gas, which rapidly causes cell hypoxia due to inhibition of oxidative phosphorylation, leading to circulatory failure. Treatment of ALP toxicity is mainly supportive as there is no specific antidote. We recently managed 7 cases of ALP poisoning with severe hemodynamic effects. Patients were treated with supportive measures including gastric lavage with diluted potassium permanganate, coconut oil and sodium-bicarbonate first person account should be avoided in a scientific paper. Intravenous magnesium sulfate, proper hemodynamic monitoring and vasopressors. Four out of 7 survived thus suggesting a role of such supportive measures in the absence of specific antidote for ALP poisoning.

Obstructed Umbilical Hernia: A Normal Presentation with Abnormal Contents.

Umbilical hernia is a common problem encountered in children. The rarity of finding cecum and appendix is probably due to the fact that the appendix is seldom found in the proximity of the umbilicus. It would, therefore, appear worthwhile to report the occurrence of cecum and an inflamed appendix with Ladd's bands in an umbilical hernia of a child. The last case with similar presentation was presented in 1950s. HOW TO CITE THIS ARTICLE: Agrawal VP, Shetty NS, Narasimhaprasad A. Obstructed Umbilical Hernia: A Normal Presentation with Abnormal Contents. Euroasian J Hepato-Gastroenterol 2015;5(2):110-111.

Potassium permanganate toxicity: A rare case with difficult airway management and hepatic damage.

Potassium permanganate (KMnO4) is rarely used for suicidal attempt. Its ingestion can lead to local as well as systemic toxicities due to coagulation necrosis and damage, caused by free radicals of permanganate. We recently managed a case of suicidal ingestion of KMnO4 in a lethal dose. She had significant narrowing of upper airway leading to difficult intubation as well as hepatic dysfunction and coagulopathy as systemic manifestation. We suggest to keep ourselves ready to handle difficult airway with the aid of fiber optic bronchoscope or surgical airway management in such patients. Upper gastrointestinal (GI) endoscopy should be done at the earliest to determine the extent of upper GI injury and further nutrition planning.

Prediction of human volume of distribution values for drugs using linear and nonlinear quantitative structure pharmacokinetic relationship models.

In the present study the volume of distribution values in humans of 121 drugs was estimated using quantitative structure pharmacokinetic relationship analysis. The multiple linear regression (MLR) method and nonlinear artificial neural network (ANN) and support vector machines (SVM) were employed for modeling. The theoretically calculated molecular descriptors were used for modeling and best set of descriptors selected by correlation based feature selection (CFS) method. The performance and predictive capability of linear method was investigated and compared with nonlinear method. The ANN gave better model with an average fold error of 1.66. The test set prediction accuracy shows human volume of distribution values could be predicted, on average, within 2-fold of the actual value.

Exploring QSARs of the interaction of flavonoids with GABA (A) receptor using MLR, ANN and SVM techniques.

Quantitative Structure-Activity Relationship (QSAR) models for binding affinity constants (log Ki) of 78 flavonoid ligands towards the benzodiazepine site of GABA (A) receptor complex were calculated using the machine learning methods: artificial neural network (ANN) and support vector machine (SVM) techniques. The models obtained were compared with those obtained using multiple linear regression (MLR) analysis. The descriptor selection and model building were performed with 10-fold cross-validation using the training data set. The SVM and MLR coefficient of determination values are 0.944 and 0.879, respectively, for the training set and are higher than those of ANN models. Though the SVM model shows improvement of training set fitting, the ANN model was superior to SVM and MLR in predicting the test set. Randomization test is employed to check the suitability of the models.

The Shear Bond Strengths of Metal and Ceramic Brackets: An in-Vitro Comparative Study.

AIM: This study has compared the Shear Bond Strengths (SBSs) of ceramic brackets and metal brackets. MATERIALS AND METHOD: Forty freshly extracted, human maxillary first premolars were selected for bonding. They were equally bonded with ceramic brackets (Transcend series 6000) and metal brackets (Mini Dynalock Straight wire brackets). A no - mix orthodontic adhesive system was used. Their shear bond strengths were measured by using the Instron universal machine. RESULTS: The mean bond strength of the ceramic brackets was 20.68 ± 3.89 Mpa and that of the metal brackets was 12.15 ± 1.32 MPa. CONCLUSION: The shear bond strength of the ceramic brackets was found to be superior than that of the metal brackets.

Estimation of Anti-HIV Activity of HEPT Analogues Using MLR, ANN, and SVM Techniques.

The present study deals with the estimation of the anti-HIV activity (log1/C) of a large set of 107 HEPT analogues using molecular descriptors which are responsible for the anti-HIV activity. The study has been undertaken by three techniques MLR, ANN, and SVM. The MLR model fits the train set with R (2)=0.856 while in ANN and SVM with higher values of R (2) = 0.850, 0.874, respectively. SVM model shows improvement to estimate the anti-HIV activity of trained data, while in test set ANN have higher R (2) value than those of MLR and SVM techniques. R m (2) = metrics and ridge regression analysis indicated that the proposed four-variable model MATS5e, RDF080u, T(O⋯O), and MATS5m as correlating descriptors is the best for estimating the anti-HIV activity (log 1/C) present set of compounds.

Quantitative structure-pharmacokinetic relationship (QSPkP) analysis of the volume of distribution values of anti-infective agents from J group of the ATC classification in humans.

In this study, a quantitative structure-pharmacokinetic relationship (QSPkR) model for the volume of distribution (Vd) values of 126 anti-infective drugs in humans was developed employing multiple linear regression (MLR), artificial neural network (ANN) and support vector regression (SVM) using theoretical molecular structural descriptors. A correlation-based feature selection (CFS) was employed to select the relevant descriptors for modeling. The model results show that the main factors governing Vd of anti-infective drugs are 3D molecular representations of atomic van der Waals volumes and Sanderson electronegativities, number of aliphatic and aromatic amino groups, number of beta-lactam rings and topological 2D shape of the molecule. Model predictivity was evaluated by external validation, using a variety of statistical tests and the SVM model demonstrated better performance compared to other models. The developed models can be used to predict the Vd values of anti-infective drugs.

SAR studies on ß-cell K(ATP) channel openers.

Recently Balaban has introduced a J-type G index for modeling those properties/activities where not only the "shape" but also size of the graph influences the property/activity of organic compounds acting as drugs. Here, for the first time G index has been used for modeling the pancreatic ß-cell K(ATP) channel openers viz R/S-3,4-dihydro-2,2-dimethyl-6-halo-4-(substituted phenylaminocarbonylamino)-2H-1-benzopyrans. Modeling technology used in this paper has established that the referred activity is excellently modeled by using G as one of the correlating descriptors. The results are critically discussed using Ridge statistics.