Isolation of bovine coronavirus (bcoV) in vero cell line and its confirmation by direct FAT and RT-PCR.

Bovine Coronavirus (BCoV) is widespread both in dairy and beef cattle throughout the world. The virus is one of the largest RNA virus and has specific tropism for intestinal and pulmonary epithelial cells. It is responsible for huge economic losses by causing winter dysentery in adult dairy cattle and respiratory and intestinal tract infections leading to pneumo-enteritis in young calves. Isolation of BCoV has been reported to be difficult. Studies regarding epidemiology, virus isolation and molecular detection from India are very few. In the present study Vero cell line was used for isolation of the BCoV from Enzyme Linked Immunosorbent Assay (ELISA) positive samples. Direct florescent antibody technique (dFAT) and reverse transcriptase-polymerase chain reaction (RT-PCR) were used to confirm the isolated virus strains at antigenic and genomic levels, respectively. Out of the 15 positive fecal samples, virus from only seven was able to infect vero cell line. Subsequently BCoV got adapted to the vero cell line upto three passages, which was confirmed both at genomic and antigenic levels by dFAT and RT-PCR testing. It can be concluded that vero cell line can be used for isolation of BCoV, however due to the enormous stain diversity of the virus it is possible that many stains can't grow and get adapt in this cell line. Further studies are required for isolation of different viral strains, finding the susceptible cell lines and also to confirm the variations among the BCoV isolates at antigenic/genomic levels.

Small lateral access--an alternative approach to appendicitis in paediatric patients: a randomised controlled trial.

BACKGROUND: Conventionally the appendix is removed through a right lower quadrant transverse incision or a gridiron incision approximately 5 cm in length. In this modern era of minimally invasive surgery, there is a lot of emphasis on cosmesis and early recovery. We performed a prospective, double blind, randomised trial to evaluate a new incision for appendectomy to compare with conventional appendectomy. METHODS: One hundred and twenty patients, aged between 3 and 18 years, were randomized to receive either small access appendectomy (SAA) (n=60, 53 acute appendicitis and 7 interval appendectomy) or conventional appendectomy (CAP) (n=60, 55 acute appendicitis and 5 interval appendectomy). SAA was performed through an incision in the lateral 1/3 of the spino-umbilical line, lateral to McBurney's point. The caecum along with the appendix could be delivered through this small incision easily as the ileal loops did not interfere with the delivery. All patients suspected of acute appendicitis were evaluated by the modified Alvarado's system to reduce the rate of negative appendectomies. Patients with diffuse peritonitis were excluded. RESULTS: The demographic data for the two groups were similar. The SAA group required less analgesics (p<0.001), had earlier ambulation and shorter hospital stay (p<0.001), and better cosmetic score (p<0.001), but the operation took longer (p<0.001) compared to the CAP group. CONCLUSION: We conclude that SAA can be done safely without the need for any special equipment, with definite advantages over conventional appendectomy.

Management of hepatobiliary and pancreatic ascariasis in children of an endemic area.

Ascariasis is the most common parasitic infestation in endemic areas and accounts for 50-60% of pediatric admissions in the surgical emergency department. Hepatobiliary and pancreatic ascariasis accounts for about 10% of such admissions. The present study was undertaken to evaluate the clinical features, investigations, and management of hepatobiliary and pancreatic ascariasis. The study was conducted in the endemic areas of Kashmir in northern India over a period of 3 years. During the study period (May 2001 to April 2004), 214 children with hepatobiliary and pancreatic ascariasis were admitted in the department. These children underwent complete clinical evaluation, investigation including ultrasound, and ERCP when required. Surgical intervention was done in patients who failed to settle with medical treatment. Ninety percent of our admissions were from rural areas and 86% of the children presented with pain in the right hypochondrium. Twenty-two percent of patients presented with cholangitis, whereas 39% of the children had mild icterus at presentation. Thirty-eight percent of the children had vomited worms during the episode of illness. Ultrasound was the diagnostic method of choice, which revealed the worms in the CBD in 80% of the patients, and in gall bladder in 16% of the children. Eight patients had worms in the main pancreatic duct while seven (4%) had multiple small liver abscesses. Serum alkaline phosphatase was raised in majority of children (80%). Twenty (9%) children were referred for ERCP. Medical treatment including endoscopic management was successful in 97% of the children. Seven (4%) children had to be operated upon due to complications of the disease. We conclude that the majority of the children with hepatobiliary and pancreatic ascariasis respond to conservative treatment, and surgical treatment is rarely needed.