Laparoscopic management of rare smoked dry pork bezoar in the stomach.

Medical literature recognise only 4 types of bezoar - phytobezoar, trichobezoar, lactobezoar and pharmacobezoar. Here, we discuss a new unique type of bezoar composed of undigested dry pork. A 58-year-old male patient from Nagaland, India, presented with intermittent symptoms of gastric outlet obstruction and pain abdomen. On clinical examination, he was found to have an epigastric lump. Upper gastrointestinal endoscopy showed an undigested ball of swallowed meat at the pylorus and later at the fundus on repeat endoscopy just before the surgical intervention. Endoscopic mechanical fragmentation was tried, but owing to the large size and hard sticky consistency of the bezoar, fragmentation was not feasible. Due to persistent pain abdomen and clinical gastric outlet obstruction, a decision for operative intervention was taken. He finally underwent laparoscopic anterior gastrotomy and evacuation of the bezoar. The post-operative course was uneventful, and the patient went home symptom free on the 5th post-operative day.

Study on impact of flexible endoscopy training course for surgeons in India.

Context: Competence in flexible endoscopy is essential for all surgeons during this era of minimal access surgery. However, fewer surgeons have expertise in endoscopy due to a lack of training and interest. The Indian Association of Gastrointestinal Endo Surgeons devised a short-structured training course in the art and science of endoscopy. Aims: This study aimed to find the impact of the endoscopy training course (Endoscopic Fellowship of Indian Association of Gastrointestinal Endo Surgeons [EFIAGES]) in improving the endoscopic skill of surgeons. Settings and Design: Twenty-two-part electronic survey forms were sent to all 375 candidates who took the course between 2016 and 2019 for this retrospective observational study. Subjects and Methods: The following outcome measures were noted, namely technical competence in endoscopy before the course, delegate feedback about the course modules, volume of endoscopies before and after the course and quality indicators such as reaching up to duodenum (D2) and caecum before and after the course. Statistical Analysis Used: Statistical analysis of the impact of the course was done using Chi-square test. Results: Responses from 262 out of a total of 375 candidates were received. Seventy-seven per cent of trainees were pleased with content and mode of conduct of the course. The quality indicator of gastroscopy with the ability to reach D2 in 90% of the caseload was achieved by only 28% of trainees before the EFIAGES. This increased to 72% of candidates after the course and similar results were seen with colonoscopy also. Most of the candidates noted a distinct improvement in their endoscopic navigation skills subsequent to the course. Conclusions: Endoscopy skill transfer was possible with a short-structured endoscopy course. The surgical fraternity should realise the importance of endoscopy skills in the current era of surgical practice.

Robotic-assisted excision of splenic epidermoid cyst in an adolescent patient in a new robotic platform: A case report.

Laparoscopic management of non-parasitic cysts (NSCs) of the spleen is currently the standard of care. There is a paucity of data of robotic management of NSCs. Here, we report a case of a NSC in a 13-year-old male. The patient presented to us with the chief complaints of pain in abdomen and feeling of a left upper abdomen lump for the last 3 months. The spleen being an important organ for immunity, we decided to opt for splenic preservation. Since minimal access methods offer the best outcome and we wanted to go with a safe option, we settled for near-total cystectomy of the splenic cyst. Here, we review the literature regarding the surgical management of NSCs and discuss the robotic technique for the accomplishment of the surgery.

Diversity of edible insects in a Natural World Heritage Site of India: entomophagy attitudes and implications for food security in the region.

Insects not only play a significant role in the ecological process of nature but since pre-historic times have also formed a part of the human diet. With a still growing population and skewed demographic structures across most societies of the world, their role as nutrient-rich food has been increasingly advocated by researchers and policymakers globally. In this study, we examine the edible insect diversity and entomophagy attitudes of ethnic people in Manas National Park, a UNESCO Natural World Heritage Site, located in Assam (India). The study involved a field investigation through which the pattern of entomophagy and the attitude towards insect-eating was studied. Following this, we examined the edible insect diversity and abundance at different sampling points. A total of 22 species of edible insects belonging to fifteen families and eight orders were recorded from different habitat types. Out of these 22 species, Orthopterans showed a maximum number of eight species followed by Hymenoptera (four), Hemiptera (three), Lepidoptera (two), Blattodea (two) and one species each from Coleoptera, Odonata, and Mantodea. Dominance, diversity, and equitability indices were computed along with the relative abundance of the insects concerning four habitat types. Aspects of the economic significance of entomophagy were also observed during the field investigation. To manage insects in the interest of food security, more attention should be given to sustainable collecting and rearing methods emphasizing their economic, nutritional, and ecological advantages.

All India survey for analyses of colors in sweets and savories: exposure risk in Indian population.

In the present study, an attempt has been made to understand the exposure assessment of food colors through 2 major groups, sweets and savories, at a national level so as to evolve a scientific yardstick to fix levels of colors in commodities based on technological and safety requirement. A vast majority of colored food commodities (83.6%) were found to employ permitted colors and confirmed a marked decline in the trend of use of nonpermitted colors (NPCs). Of the 4 zones of India, East zone showed the maximum adulteration (80.3%) both by exceeding the prescribed limits of permitted colors (72.3%) and the use of NPCs (28.7%). Tartrazine was the most popular color among the permitted list, which ranged from 12.5 to 1091 mg/kg. Rhodamine B was the most prevalent dye in the NPCs group. On the basis of average consumption of food commodities and average levels of detected colors, the intake of Sunset Yellow FCF saturates the acceptable daily intake limit to a maximum of 47.8% in children, which is a cause of concern. The uniform maximum permissible limit of synthetic colors at 100 mg/kg under the Indian rules thus needs to be reviewed and should rather be governed by the technological necessity and the consumption profiles of food commodities so that the vulnerable population should not unnecessary be exposed to excessive amounts of synthetic colors to pose health risks.

A simple method for simultaneous determination of basic dyes encountered in food preparations by reversed-phase HPLC.

The present method utilizes a simple pretreatment step, cleanup on polyamide SPE cartridges, and HPLC resolution on reversed-phase C18 for the detection of the three basic nonpermitted dyes encountered in food matrixes. Polyamide cartridges were chosen because both acidic and basic dyes can be cleaned up due to their amphoteric nature. Analysis was performed on a reversed-phase C18 micro-Bondapak column using the isocratic mixture of acetonitrile-sodium acetate with a flow rate of 1.5 mL/min and a programmable lambda(max) specific visible detection to monitor colors, achieving higher sensitivity and expanded scope to test multicolor blends. All the colors showed linearity with the regression coefficient, from 0.9983 to 0.9995. The LOD and LOQ ranged between 0.107 and 0.754 mg/L and 0.371 and 2.27 mg/L or mg/kg, respectively. The intraday and interday precision gave good RSDs, and percentage recoveries in different food matrixes ranged from 75 to 96.5%. The study demonstrates that the use of a combination of a simple SPE cleanup and HPLC resolution with UV-Vis end point detection was successful in screening the presence of these three basic nonpermitted dyes individually or in blend, in a variety of food matrixes.

Simultaneous determination of eight synthetic permitted and five commonly encountered nonpermitted food colors in various food matrixes by high-performance liquid chromatography.

A simple and sensitive HPLC method has been developed for the simultaneous determination of eight permitted food colors and five commonly encountered nonpermitted colors in various food commodities, including sugar-, fat-, and starch-based food matrixes. The method uses a specific food category-based cleanup/treatment procedure before color extraction to avoid the interference of food matrixes, and to obtain the optimal color extraction. Analysis was performed on a reversed-phase C18 micro-Bondapak column with ammonium acetate and acetonitrile gradient elution as the mobile phase; a programmable lamda max-specific visible detection was used to monitor colors to obtain the higher sensitivity and expanded scope needed for multicolor blends having diverse absorption maxima. All colors showed good linearity, with regression coefficients of 0.9974-0.9999. The LOD and LOQ values ranged from 0.01 to 0.12 mg/L, and from 0.04 to 0.83 mg/L or mg/kg, respectively. The intraday and interday precision tests produced good RSD values, and the recoveries from different food matrixes ranged from 82 to 104%. The method offers high sensitivity for analysis of a wide variety of food matrixes containing a broad scope of multicolor blends. Two nonpermitted colors, orange II and metanil yellow, were found. Also, a number of samples contained permitted colors at levels two- to seven-fold higher than those prescribed.

Potentiation of neurotoxicity of Lathyrus sativus by manganese: alterations in blood-brain barrier permeability.

Environmental factors have been speculated to play an important role in potentiating the neurotoxicity of Lathyrus sativus (LS). Hence, blood-brain barrier permeability and neurotoxicity studies were carried out in manganese- and LS-exposed animals. Dietary feeding of LS (80%) plus Mn (0.4 mg/100 g diet) for 90 days to guinea pigs showed significant (p < 0.05) decrease in brain nucleotidase and ATPase activities when compared to control or LS alone treated groups. Combined treatment of LS and Mn showed a significant (p < 0.05) decrease in neuronal aryl hydrocarbon hydroxylase (36-40%), ethoxyresorufin-O-deethylase (40-45%), glutathione-S-transferase (27-31%), and quinone reductase (24-25%) activities when compared to control and LS alone treated animals. Lipid peroxidation, a marker for membrane damage, was found to be relatively more enhanced (58-141%) along with significant (p < 0.05) depletion of GSH levels in LS+Mn-treated animals when compared to control, Mn alone, and LS alone treated groups. The neuronal catalase activity of lathyrus plus Mn-treated animals showed a pronounced decrease (37-49%) when compared to control, Mn, and lathyrus alone treated groups. On the contrary, glutathione peroxidase in brain of Mn and lathyrus alone treated animals indicated a respective increase (p < 0.05) of 18% and 20%, while the combined effect of lathyrus plus Mn exhibited an increase of almost 50% when compared to control guinea pigs. Single parenteral administration of Mn (15 mg/kg b.wt) to guinea pigs followed by single oral intubation of beta-N-oxalyl-L-alpha, beta-diamino propionic acid (ODAP, 75 mg/guinea pig) resulted in a significant increase (143%) in neuronal ODAP content. ODAP (50 mg/kg,iv) treatment to mice pretreated with MnCl2 (10 mg/kg b.wt for 3 days or 40 mg/kg b.wt for 1 day), caused an enhancement in blood-brain barrier (BBB) permeability (129-196%), while ODAP and Mn alone showed relatively less enhancement (66-87%). The lumbar region of LS+Mn showed a number of vacuolated areas of variegated size and chromatolytic neurons, along with a few degenerated neurons. These results suggest that Mn may potentiate the neurotoxicity of lathyrus/ODAP by altering the BBB permeability.

Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial.

BACKGROUND: Preoperative or postoperative radiotherapy reduces the risk of local recurrence in patients with operable rectal cancer. However, improvements in surgery and histopathological assessment mean that the role of radiotherapy needs to be reassessed. We compared short-course preoperative radiotherapy versus initial surgery with selective postoperative chemoradiotherapy. METHODS: We undertook a randomised trial in 80 centres in four countries. 1350 patients with operable adenocarcinoma of the rectum were randomly assigned, by a minimisation procedure, to short-course preoperative radiotherapy (25 Gy in five fractions; n=674) or to initial surgery with selective postoperative chemoradiotherapy (45 Gy in 25 fractions with concurrent 5-fluorouracil) restricted to patients with involvement of the circumferential resection margin (n=676). The primary outcome measure was local recurrence. Analysis was by intention to treat. This study is registered, number ISRCTN 28785842. FINDINGS: At the time of analysis, which included all participants, 330 patients had died (157 preoperative radiotherapy group vs 173 selective postoperative chemoradiotherapy), and median follow-up of surviving patients was 4 years. 99 patients had developed local recurrence (27 preoperative radiotherapy vs 72 selective postoperative chemoradiotherapy). We noted a reduction of 61% in the relative risk of local recurrence for patients receiving preoperative radiotherapy (hazard ratio [HR] 0.39, 95% CI 0.27-0.58, p<0.0001), and an absolute difference at 3 years of 6.2% (95% CI 5.3-7.1) (4.4% preoperative radiotherapy vs 10.6% selective postoperative chemoradiotherapy). We recorded a relative improvement in disease-free survival of 24% for patients receiving preoperative radiotherapy (HR 0.76, 95% CI 0.62-0.94, p=0.013), and an absolute difference at 3 years of 6.0% (95% CI 5.3-6.8) (77.5%vs 71.5%). Overall survival did not differ between the groups (HR 0.91, 95% CI 0.73-1.13, p=0.40). INTERPRETATION: Taken with results from other randomised trials, our findings provide convincing and consistent evidence that short-course preoperative radiotherapy is an effective treatment for patients with operable rectal cancer.

Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial.

BACKGROUND: Local recurrence rates in operable rectal cancer are improved by radiotherapy (with or without chemotherapy) and surgical techniques such as total mesorectal excision. However, the contributions of surgery and radiotherapy to outcomes are unclear. We assessed the effect of the involvement of the circumferential resection margin and the plane of surgery achieved. METHODS: In this prospective study, the plane of surgery achieved and the involvement of the circumferential resection margin were assessed by local pathologists, using a standard pathological protocol in 1156 patients with operable rectal cancer from the CR07 and NCIC-CTG CO16 trial, which compared short-course (5 days) preoperative radiotherapy and selective postoperative chemoradiotherapy, between March, 1998, and August, 2005. All analyses were by intention to treat. This trial is registered, number ISRCTN 28785842. FINDINGS: 128 patients (11%) had involvement of the circumferential resection margin, and the plane of surgery achieved was classified as good (mesorectal) in 604 (52%), intermediate (intramesorectal) in 398 (34%), and poor (muscularis propria plane) in 154 (13%). We found that both a negative circumferential resection margin and a superior plane of surgery achieved were associated with low local recurrence rates. Hazard ratio (HR) was 0.32 (95% CI 0.16-0.63, p=0.0011) with 3-year local recurrence rates of 6% (5-8%) and 17% (10-26%) for patients who were negative and positive for circumferential resection margin, respectively. For plane of surgery achieved, HRs for mesorectal and intramesorectal groups compared with the muscularis propria group were 0.32 (0.16-0.64) and 0.48 (0.25-0.93), respectively. At 3 years, the estimated local recurrence rates were 4% (3-6%) for mesorectal, 7% (5-11%) for intramesorectal, and 13% (8-21%) for muscularis propria groups. The benefit of short-course preoperative radiotherapy did not differ in the three plane of surgery groups (p=0.30 for trend). Patients in the short-course preoperative radiotherapy group who had a resection in the mesorectal plane had a 3-year local recurrence rate of only 1%. INTERPRETATION: In rectal cancer, the plane of surgery achieved is an important prognostic factor for local recurrence. Short-course preoperative radiotherapy reduced the rate of local recurrence for all three plane of surgery groups, almost abolishing local recurrence in short-course preoperative radiotherapy patients who had a resection in the mesorectal plane. The plane of surgery achieved should therefore be assessed and reported routinely.