Comparison of Outcomes following Vaginal Natural Orifice Transluminal Endoscopic Surgery and Laparoendoscopic Single-site Surgery in Benign Hysterectomy: A Systematic Review and Meta-analysis.

Gradually increasing interest in laparoscopic surgeries has led to the advent of various lesser invasive techniques in the form of vaginal natural orifice transluminal endoscopic surgery (vNOTES) and laparoendoscopic single-site (LESS) surgery. Very few studies have analyzed the advantages and disadvantages of vNOTES over LESS surgeries in hysterectomy. After a comprehensive search, full texts of relevant manuscripts were obtained to assess eligibility for recruitment. A comprehensive meta-analysis was subsequently performed to compare the outcomes of vNOTES and LESS in hysterectomy, and forest plots were constructed. Four articles were rendered for review (three retrospective cohort studies and one randomized controlled trial). Three studies showed lesser postoperative pain in vNOTES compared to LESS. In one study, postoperative vaginal pain was higher in vNOTES due to additional suture between uterine artery and vaginal wall. The meta-analysis concluded that vNOTES could be better alternative to LESS hysterectomies. However, further large multicentric randomized trials are required for the standardization of the surgical method.

Distal enteral feeding can replace total parenteral feeding to support nutrition in patients with high output stoma (jejunostomy) - A case series.

BACKGROUND: Ostomy/Stoma is a common entity in patients operated for small bowel perforation in developing countries. Delay in presentation, poor general condition, malnutrition and lack of health infrastructure in peripheral areas are some of the causes leading to severe sepsis at presentation. Exteriorising the perforation site as stoma/ostomy is the preferred salvage procedure. Proximal stoma/ostomy is high output and cause fluid and electrolyte imbalance. Also it is difficult to maintain nutrition with oral feeds, as partially digested food along with digestive enzymes gets lost through the stoma. Parenteral nutrition (PN) is widely used in these patients, which is expensive requires hospitalisation, also not without risks e.g. liver dysfunction and associated with complications of central line insertion. AIM: We hereby report our experience of managing three patients of high output jejunostomy with distal enteral feeding provided by feeding chyme and partially digested food into the distal stoma. METHOD: After confirming the distal patency of the bowel, we started feeding through distal lumen of stoma (known as distal enteral feeding) in our 3 patients with jejunostomies immediately in postoperative period along with PN. After few days we started decreasing PN, we gradually switched to complete enteral nutrition; and increasing distal feeding and then totally stopping the PN in few days only. We kept a watch on the different parameters of the patient like calories and protein intake, weight, electrolytes, liver function, etc. RESULTS: Distal enteral feeding improved their body weight, maintained their serum electrolytes and liver function tests including serum albumin. After achieving the good nutritional status, we were able to do successful surgical closure of stomas in all the three patients. CONCLUSION: In our experience, patients with high-output stomas can be nutritionally maintained with distal enteral feeding without the need of long term PN. Use of distal enteral feeding, if used appropriately and with proper monitoring, can nutritionally build up the patient avoiding the complications of PN.

Chrononutrition-When We Eat Is of the Essence in Tackling Obesity.

Obesity is a chronic and relapsing public health problem with an extensive list of associated comorbidities. The worldwide prevalence of obesity has nearly tripled over the last five decades and continues to pose a serious threat to wider society and the wellbeing of future generations. The pathogenesis of obesity is complex but diet plays a key role in the onset and progression of the disease. The human diet has changed drastically across the globe, with an estimate that approximately 72% of the calories consumed today come from foods that were not part of our ancestral diets and are not compatible with our metabolism. Additionally, multiple nutrient-independent factors, e.g., cost, accessibility, behaviours, culture, education, work commitments, knowledge and societal set-up, influence our food choices and eating patterns. Much research has been focused on 'what to eat' or 'how much to eat' to reduce the obesity burden, but increasingly evidence indicates that 'when to eat' is fundamental to human metabolism. Aligning feeding patterns to the 24-h circadian clock that regulates a wide range of physiological and behavioural processes has multiple health-promoting effects with anti-obesity being a major part. This article explores the current understanding of the interactions between the body clocks, bioactive dietary components and the less appreciated role of meal timings in energy homeostasis and obesity.

Factors affecting the outcome of fractional carbon dioxide laser resurfacing of various types of scars in skin of color.

BACKGROUND: Fractional laser resurfacing has been used widely in management of scars. However, data for post-traumatic and post-burn scar are limited in skin of color. AIMS: This retrospective study assessed the efficacy of fractional ablative carbon dioxide laser in treatment of various types of scars other than acne scars. We also tried to find out the effect of different factors like skin type, duration, shape, location, and color of the scars on the outcome. MATERIALS AND METHODS: Forty-two patients with 67 scars including post-traumatic (43), post-burn (15), post-surgical (5), and post-folliculitis (5) scars treated during 2019-2020 were analyzed. The improvement was graded according to investigator and patient global assessment (IGA & PGA) through percentage improvement and quartile scale. RESULTS: Overall, there was 45.4% and 32.7% of improvement according to PGA and IGA, respectively. Scars with >50% improvement were recorded in 13.43% of the scars with IGA and 41.78% with PGA. Early scars, scars without hyperpigmentation, lighter skin type, post-traumatic scars had better results. There was no significant difference for other parameters like atrophic versus hypertrophic, facial versus extra facial, linear versus non-linear, or the number of sessions. CONCLUSION: Fractional carbon dioxide laser efficacious for non-acne facial and extra facial scars in the skin of color. Early intervention could yield more satisfactory results.

Nutrigenetics and nutrigenomics-A personalized approach to nutrition.

The prevalence of non-communicable diseases has been on an upward trajectory for some time and this puts an enormous burden on the healthcare expenditure. Lifestyle modifications including dietary interventions hold an immense promise to manage and prevent these diseases. Recent advances in genomic research provide evidence that focussing these efforts on individual variations in abilities to metabolize nutrients (nutrigenetics) and exploring the role of dietary compounds on gene expression (nutrigenomics and nutri-epigenomics) can lead to more meaningful personalized dietary strategies to promote optimal health. This chapter aims to provide examples on these gene-diet interactions at multiple levels to support the need of embedding targeted dietary interventions as a way forward to prevent, avoid and manage diseases.

New fluid therapy protocol in acute burn from a tertiary burn care centre.

BACKGROUND: Ringer lactate is the main fluid for resuscitation of acute burns. However it is not a complete fluid alone, as it does not take care of sugar and electrolyte balance adequately. This study has been carried out to compare the use of Ringer lactate (RL) alone and combination of RL with Dextrose Normal Saline (DNS) as fluid replacement therapy in acute burn. OBJECTIVE: To assess the biochemical parameters with the use of DNS as maintenance fluid in combination with Ringer lactate as resuscitation fluid in acute burns resuscitation. METHOD: A prospective randomized control study has been carried out by enrolling 200 patients into 2 groups, treated in ICU and resuscitated by using Modification of Brooke's formula (2mL/kg/% TBSA for resuscitation plus 2500mL maintenance). Group A received RL for resuscitation and DNS as maintenance in 1st 72h of burns. Group B received RL only for 1st 72h. The effects of this on various blood parameters were studied. RESULTS: Mean value of sodium at 24h was 137.79±3.89 in group A and was 133.2±4.57 (p<.0001) in group B. The sodium levels remained in range of 137-138 (p<.0001) in group A with only 22% patients showing lower range of sodium levels, whereas, there was a falling trend (p<.0001) of sodium levels in group B on subsequent days with 54.00% (p<.0001) showing hyponatremia on 1st day which increased to 76% on 3rd day. Mean values of early morning random blood sugar (RBS) levels in group A remained between 165.5±65.51mg/dL-115.82±32.52mg/dL on all 3days but in group B there was a falling trend from 127.49±46.11mg/dL to 102.84±22.92mg/dL by 3rd day. Thus, there was significant difference in levels of sodium and RBS in patients receiving DNS as maintenance fluid in addition to RL in acute phase. CONCLUSION: RL is not an ideal fluid for maintenance as it is low in sodium (130mEq/L) as well as potassium (4mEq/L) in view of daily electrolyte requirement. There is no glucose content in it to provide calories. Therefore, DNS should be added as daily maintenance fluid with RL as replacement for evaporative losses following burns.

Household air pollution from various types of rural kitchens and its exposure assessment.

Exposure to household air pollutants has become a leading environmental health risk in developing countries. Considering this, real-time temporal variation in fine particulate matter (PM2.5) and carbon monoxide (CO) concentrations were measured in various types of rural household kitchens. Observed average concentrations of PM2.5, CO, percent relative humidity (%RH) and temperature (T) in five different kitchen types were 549.6µg/m3, 4.2ppm, 70.2% and 20°C respectively. Highest CO and PM2.5 concentration were found in household performing cooking in indoor kitchens (CO: 9.3ppm; PM2.5: 696.5µg/m3) followed by outdoor kitchens (CO: 5.8ppm; PM2.5: 539.5µg/m3). The concentration of PM2.5 and CO varied according to the fuel type and highest concentration was observed in kitchens using cowdung cakes followed by agricultural residue>firewood>biogas>Liquefied Petroleum Gas (LPG). Results revealed that the pollutants concentration varied with kitchen type, fuel type and the location of kitchen. An exposure index was developed to calculate the exposure of cook, non-cook and children below 5years. Analysis of exposure index values shows that cooks, who use solid biomass fuel (SBF) in indoor kitchen, are four times more exposed to the harmful pollutants than the cooks using clean fuel. Further, using indoor PM2.5 concentrations, hazard quotient was calculated based on evaluation of intake concentration and toxicological risk, which also shows that SBF users have higher health risks (hazard quotient>1) than the clean fuel (LPG) users.

Prevalence and Associated Risk Factors of Osteoporosis in Post-Menopausal Women in North India

Introduction: Osteoporosis is a global health problem contributing to increased functional limitations (mortality, morbidity, disability) and economic costs. The study aimed at assessing the prevalence and risk factors of osteoporosis in a sample of post-menopausal women from the states of Punjab, Haryana and Chandigarh in North India. Methods: A total of 250 post-menopausal women, ranging in age from 45 to 80 years, were selected by purposive sampling from three states in North India. Information was collected on height, weight, waist and hip circumferences, grip strength, dietary intake, physical activity, and exposure to sunlight. Bone mineral density (BMD) was evaluated by using Dual Energy X-ray Absorptiometry (DXA) at lumbar spine (L1-L4). Results: The prevalence of osteoporosis at lumbar spine (L1-L4) was found in 26.4% of the post-menopausal women. Osteoporotic women were significantly shorter (155.17 vs. 157.57,p

Methane emission from rice fields in relation to management of irrigation water.

A field experiment was conducted for two years to find out best water management practice to mitigate methane emission from the rice-fields. Continuously flooded conditions yielded two major flushes of methane emission and on an average resulted in relatively higher rate of methane emission (2.20 and 1.30 mg m(-2) hr(-1), respectively in 2005 and 2006) during the kharif season. The methane flux was reduced to half (1.02 and 0.47 mg m(-2) hr(-1), respectively in 2005 and 2006) when rice fields were irrigated 2-3 days after infiltration of flood water into the soil. Irrigating the field at 0.15 bar matric potential reduced seasonal methane flux by 60% (0.99 and 0.41 mg m(-2) hr(-1), respectively in 2005 and 2006) as compared to completely flooded conditions, without any decline in grain yield (60 q ha(-1)).

Effect of organic materials and rice cultivars on methane emission from rice field.

A field experiment was conducted for two years on a sandy loam (Typic Ustochrept) soil of Punjab to study the effect of organic materials and rice cultivars on methane emission from rice fields. The methane flux varied between 0.04 and 0.93 mg m(-2) hr(-1) in bare soil and transplanting of rice crop doubled the methane flux (0.07 to 2.06 mg m(-2) hr(-1)). Among rice cultivars, significantly (p < 0.05) higher amount of methane was emitted from Pusa 44 compared to PR 118 and PR 111. Application of organic materials enhanced methane emission from rice fields and resulted in increased soil organic carbon content. The greatest seasonal methane flux was observed in wheat straw amended plots (229.6 kg ha(-1)) followed by farmyard manure (111.6 kg ha(-1)), green manure (85.4 kg ha(-1)) and the least from rice straw compost amended plots (36.9 kg ha(-1)) as compared to control (21.5 kg ha(-1)). The differential effect of organic materials in enhancing methane flux was related to total carbon or C:N ratio of the material. The results showed that incorporation of humified organic matter such as rice straw compost could minimize methane emission from rice fields with co-benefits of increased soil fertility and crop productivity.

Burden of anaemia in rural and urban jat women in haryana state, India.

A cross-sectional study was undertaken on 600 Jat women (rural=300, urban=300), aged 40 to 70 years from Haryana state in North India. The aim of the study was to determine the prevalence of anaemia and the dietary intake of rural and urban middle-aged (40-59 years) and older (60 and above) Jat women. The findings indicated that all the subjects exhibited a decline in the mean values of haemoglobin (Hb) concentration with advancement in age. The mean blood Hb concentration of urban middle-aged and older women was 10.1±1.3g/dl and 9.91.4g/dl respectively, which was higher than their rural counterparts at all age groups, although the differences were statistically non-significant (p>0.05). The overall prevalence of anaemia reached 88.7% (rural women= 91.3%, urban women =86%). Daily dietary intake of rural and urban subjects was below the recommended dietary allowances. Physical performance of both groups of the women showed a decline with a decrease in Hb concentration. A significant and positive correlation of Hb status was observed with grip strength and vital capacity while a negative association was witnessed with blood pressure and pulse rate in both the rural and urban women. Anaemia among these women may be attributed to inadequate dietary intake, illiteracy, and poor access to health services.

Burden of Anaemia in Rural and Urban Jat Women in Haryana State, India

A cross-sectional study was undertaken on 600 Jat women (rural=300, urban=300), aged 40 to 70 years from Haryana state in North India. The aim of the study was to determine the prevalence of anaemia and the dietary intake of rural and urban middle-aged (40-59 years) and older (60 & above) Jat women. The findings indicated that all the subjects exhibited a decline in the mean values of haemoglobin (Hb) concentration with advancement in age. The mean blood Hb concentration of urban middle-aged and older women was 10.1±1.3g/dl and 9.91.4g/dl respectively, which was higher than their rural counterparts at all age groups, although the differences were statistically non-significant (p>0.05). The overall prevalence of anaemia reached 88.7% (rural women= 91.3%, urban women =86%). Daily dietary intake of rural and urban subjects was below the recommended dietary allowances. Physical performance of both groups of the women showed a decline with a decrease in Hb concentration. A significant and positive correlation of Hb status was observed with grip strength and vital capacity while a negative association was witnessed with blood pressure and pulse rate in both the rural and urban women. Anaemia among these women may be attributed to inadequate dietary intake, illiteracy, and poor access to health services.