STELA (Smart TV and smartphone-basEd Laparoscopy TrAiner): a no-cost home-based trainer for beginners.

BACKGROUND: Proficiency in laparoscopy is gradually achieved. After initial simulation, it is safe to move to real patients. Simulation improves the basic attributes of laparoscopy, and its non-availability hampers training. Virtual reality and commercial simulators are exorbitantly expensive. Cheaper non-commercial latest, mobile phone-based simulators appear ergonomically unsuitable. A need for a no-cost, home-based laparoscopic endotrainer was felt by authors. METHODS: The authors proposed the concept of smart TV and smart phone-based laparoscopy trainer (STELA), an almost zero cost, lightweight indigenous, cable-less box-type endotrainer, with a smart phone housed on the model, projecting to smart TV via Wi-fi direct. The simulation timings on STELA were compared with Universal Beetel endotrainer by a group of surgeons and residents using identical tasks like object transfer (OT) and knot making (KM). RESULTS: Data were analysed using SPSS, version 23.There was no significant difference in the mean timings of the residents (p > 0.05) on two endotrainers, for both tasks, and of surgeons for OT. Surgeons took significantly longer time (p < 0.05) in KM on STELA. Highest correlation (r = +.848) (<.05) was seen for KM on both devices by residents. CONCLUSION: STELA is a viable, technologically advanced, no cost alternative to the non-commercial cumbersome simulators especially for beginners.

Safety and efficacy of total intraluminal topical anaesthesia for ureteroscopy. Is success worth the pain?

BACKGROUND: Ureteroscopic management of ureteral calculi using topical anaesthesia has been described. Most studies topically anaesthetized the urethra or urinary bladder by instilling 2% of plain lignocaine. In addition to the success rate, the pain perception in these studies was reported subjectively using non-standard criteria. Topical anaesthesia of the ipsilateral ureter and the pelvicalyceal system (PCS), in addition to urethra and urinary bladder, and use of alkalinised lignocaine, for enhanced effect, has not been reported for ureteroscopy. Using these conceptual alterations, we tested the safety and efficacy of performing ureteroscopy and laser lithotripsy under our technique of total intraluminal topical anaesthesia (TILTA). METHODS: One hundred sixty-eight patients underwent ureteroscopic laser lithotripsy by topical instillation of alkalinised lignocaine into the urinary bladder and ipsilateral ureter and PCS. Self-assessed pain perception and changes in vital parameters were objectively scored at various times. The success rate, reasons for failure, maximum pain scores, complications, and willingness to undergo repeat procedure were recorded. RESULTS: The success rate was 91.3% with a mean duration of 14.7 minutes Double J Stent (DJS) was placed in 38.1%. 61.3% patients did not need any postoperative injectable analgesic, with 11.3% requiring more than a single dose. The intraoperative changes in vitals initially and at the height of pain were not statistically significant (p>0.05). Self-assessed median pain scores between intravenous access placement and ureteroscopy were significantly different (p<0.05). CONCLUSIONS: Ureteroscopy, effectively performed under TILTA, is safe with a high success rate. The acceptable pain tolerance and the shortened convalescence in addition makes the procedure's success worth the pain.

Effect of Hemodialysis on Corrected QT Interval and QTc Dispersion.

Hemodialysis patients are at higher risk of cardiovascular disease due to traditional and dialysis-related risk factors. Our aim was to study the effects of hemodialysis on the corrected QT interval (QTc) and QTc dispersion in chronic kidney disease (CKD) without clinically manifest heart disease. Two hundred cases of CKD on chronic intermittent hemodialysis of >3 months' duration were included in the study. Twelve-lead electrocardiography and samples for serum creatinine, potassium, calcium, and magnesium were taken before and after dialysis. The mean age of patients was 52.4 ± 17 years with male-to-female ratio of 3:1. QTc interval and QTc dispersion were prolonged in 47% and 59% before and 50% and 89% of patients after hemodialysis, respectively. The mean values of QTc were 433.4 ± 36.9 ms before and 451.4 ± 39.6 ms after hemodialysis (p = 0.001) and the mean values of QTc dispersion were 60.5 ± 19.3 ms before and 81.5 ± 24.4 ms after hemodialysis (p = 0.001). Similar pattern was observed in all etiological groups of CKD, except for QTc dispersion in malignancy-related CKD (p = 0.216). After hemodialysis, there was a significant fall in the mean values of serum potassium (p = 0.001), rise in serum calcium (p = 0.001), and no change in magnesium (p = 0.424). Patients with post hemodialysis QTc dispersion >74 ms had significantly low mean values of serum potassium and calcium as compared to <74 ms group. Large numbers of hemodialysis patients have a prolonged QTc interval and QTc dispersion with a significant increase in the mean values after hemodialysis. There is a significant fall in serum potassium and rise in serum calcium after dialysis.

Intratympanic steroid use for idiopathic sudden sensorineural hearing loss: current otolaryngology practice in Germany and Austria.

AIMS: The frequency of the use of intratympanic steroids (ITS) as a treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) in Europe is still unknown and remains a contentious issue amongst otolaryngologists. We undertook a survey of otolaryngologists in Germany and Austria to establish if there is any professional consensus with which to form a protocol for its use. METHODS: A survey of 21 questions was distributed electronically to otolaryngologists in Germany and Austria and data on demographics, indications for intratympanic treatment, procedure, follow-up, and outcomes were analysed. RESULTS: We received 908 responses. 49.1% of otolaryngologists used ITS for ISSNHL. Of those otolaryngologists who use ITS, 73.7% do not use it as primary treatment. 20.6% use ITS in conjunction with oral steroids for primary treatment and only 5.8% use ITS as monotherapy for primary treatment. 90.5% use ITS as salvage therapy. 81.1% do not consider the use of ITS after 2 weeks from the onset of symptoms. 8.3% used a tympanostomy tube and while the most commonly used steroid was dexamethasone at a concentration of 4 mg/ml (61%), a wide variety or other steroids and concentrations were used. CONCLUSIONS: This survey illustrates wide variation of current practice of intratympanic corticosteroid injection for ISSHL in Germany and Austria. In the absence of high-level evidence, knowing what current practice is allows clinicians to assess what they do against what their colleagues are doing, and if they do something very different, make them question their practice. Moreover, the obtained data will help to direct future clinical trials with the aim to compare the outcomes of more commonly used protocols.

To evaluate the safety and efficacy of the TVT-Secur procedure in the treatment of stress urinary incontinence in women.

BACKGROUND: The prevalence of stress urinary incontinence (SUI) in the middle-aged Indian women is around 16%. The use of transvaginal tapes (TVTs) has revolutionised the surgical management of SUI. Patients who undergo placement of the tape via the transobturator route often complain of persistent thigh pain at the site of trocar insertion. The use of minimally invasive tapes with a single suburethral incision reduces surgical trauma by eliminating thigh incisions, while maintaining the cure achieved by conventional TVTs. The study was conducted to test the efficacy and safety of minimally invasive TVT-Secur tape placement for treatment of SUI in women. METHODS: 20 women with stress incontinence were implanted with TVT-Secur tapes and followed up for a year. RESULTS: The objective cure rate of SUI was 85% at the end of a year. The improvement in the patient satisfaction and Incontinence-specific QOL scores, of both Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7), was statistically significant at 95% and 99% confidence levels. There were no complaints of thigh pain; however, there were intraoperative complications in the form of bladder perforation in 5% (n = 1), urethral injury in 5% (n = 1) and urethral tape exposure in 10% (n = 2), at 3 months requiring tape sectioning. CONCLUSIONS: These cure rates and complications are comparable to the standard TVT implantations at the end of a year, without thigh pain; however, a greater number of patients and a longer follow-up is required to see whether the long-term cure is maintained or not, before recommending the same as a standard of treatment.

Midurethral sling is the dominant procedure for female stress urinary incontinence: analysis of case logs from certifying American Urologists.

OBJECTIVE: To investigate contemporary trends in the use of midurethral sling procedures for the surgical correction of female stress urinary incontinence over the past decade. METHODS: Annualized case log data for female incontinence surgeries from certifying and recertifying urologists were obtained from the American Board of Urology. Descriptive analysis of the number and type of cases per year was performed. Associations between surgeon characteristics and the use of female incontinence procedures were evaluated. RESULTS: A total of 6355 nonpediatric urologists applied for certification or recertification between 2003 and 2012. Two-thirds (4185) reported performing any procedures for female incontinence. Procedures sharply increased from 4632 in 2003 to 7548 in 2004, then remained relatively stable between 2005 and 2012 (range, 8014-10,238 cases). Traditional procedures decreased from 17% of female incontinence procedures in 2003 to 5% in 2004 to <1% since 2010 (P <.0005). Midurethral sling procedures have risen sharply from 3210 procedures in 2003 to 7200 in 2012 (P <.0005). Endoscopic injection treatments have remained stable. CONCLUSION: Midurethral slings have been widely adopted by urologists over the last decade. Increase in sling usage coincided with a drastic decline in traditional repairs, implying that the newer midurethral slings were replacing these traditional procedures for the treatment of female incontinence. In addition, the fact that the use of periurethral injections did not change significantly during this time period indicates that increased sling usage is responsible for most of the decline in traditional repairs.

Isolated cavitary lung disease in a renal allograft recipient: A rare manifestation of cryptococcus.

Although lungs are the portal of entry for cryptococcus, pulmonary disease is relatively uncommon. Cavitary pulmonary disease is even less common. We report a rare case of cryptococcosis with an isolated cavitary lung lesion in a renal allograft recipient.

Long latency reflex response of superficial trunk musculature in athletes with chronic low back pain.

BACKGROUND AND OBJECTIVES: Incidence of Low Back Pain (LBP) in athletes is as high as 30%. Patients with LBP show altered postural and neuromuscular responses to various functional tasks. The objective of the study was to compare long latency reflex response (occurring between 40 to ∼ 100 ms duration) in athletes with chronic LBP with asymptomatic athletes. METHODS: Surface electromyography (EMG) of superficial trunk muscles - Rectus Abdominis (RA) and Erector Spinae (ES) were studied in athletes with chronic LBP (n=24) and asymptomatic athletes (n=25). Perturbations were introduced in standing both expectedly and unexpectedly. The latency of onset and the Root Mean Square (RMS) amplitudes within the reaction duration were compared between the two groups. RESULTS: The latency of onset was delayed in Unexpected perturbations but no change was observed in Expected tasks. The mean RMS amplitudes were significantly lower in both tasks for RA and in the Expected task for ES (p< 0.05). CONCLUSION: Chronic LBP athletes exhibit a delay in onset latency to Unexpected perturbations and reduced long latency response amplitudes to perturbation tasks compared to asymptomatic athletes. These changes could predispose athletes to recurrent low back pain and further injury.

Aflatoxin contamination in stored rice variety PAU 201 collected from Punjab, India.

BACKGROUND & OBJECTIVES: The present study was carried out on stored rice variety PAU 201 in Punjab that was not permitted for milling and public distribution due to the presence of damaged grains at levels exceeding the regulatory limits of 4.75 per cent. The aim of the study was to determine fungal and aflatoxin contamination in the rice samples to assess hazard from the presence of damaged grains. Presence of iron in discoloured rice grains was also assessed. METHODS: Stored samples of paddy of PAU 201 rice variety were collected from six districts of Punjab, milled and analysed for presence of fungal and aflatoxin contamination. Scanning electron microscopy (SEM), energy dispersive X-ray (EDX) analysis and Prussian blue staining was used to determine fungal spores and presence of iron, respectively. RESULTS: Aflatoxin analysis of rice samples indicated that none exceeded the Food Safety and Standards (Contaminants, Toxins and Residues) Regulations, 2011 tolerance limit of 30 µg/kg and majority of the samples had levels <15 µg/kg. The proportion of damaged grains exceeding the limit of 5 per cent was observed in 85.7 per cent of the samples. SEM and Prussian blue staining and EDX analysis of black tipped and pin point damaged rice grains did not show presence of fungal structures and presence of iron. INTERPRETATION & CONCLUSIONS: The results of the study indicated that the stored rice samples did not pose any health concern with respect to aflatoxin contamination as per the criteria laid down by the Food Safety and Standards Authority of India.

Anterior pelvic exenteration with total vaginectomy for recurrent or persistent genitourinary malignancies: review of surgical technique, complications, and outcome.

OBJECTIVE: To describe the surgical technique, complications, and outcomes after anterior pelvic exenteration with total vaginectomy (AETV) for recurrent or persistent genitourinary malignancies. METHODS: We reviewed the medical records of all patients who underwent AETV between 12/2002 and 07/2011. Relevant demographic, clinical, and pathological information was collected. Postoperative complications and rates of readmission and reoperation (up to 180 days after surgery) were examined, and preliminary survival data were obtained. RESULTS: We identified 11 patients who underwent AETV. The median age at the time of the surgery was 55 years (range, 36-71). The median tumor size was 0.9 cm (range, microscopic - 4). Primary tumor sites included: cervix, 6; uterus, 3; vagina, 1; and urethra, 1. Complete surgical resection with negative pathologic margins was achieved in all 11 patients. Major postoperative complications occurred in 4 patients (36%). Six patients (55%) required readmission to the hospital. No operative mortalities were observed, and none of the patients required a re-operation. With a median follow-up after the procedure of 25 months (range, 6-95), none of the patients developed a pelvic recurrence. Ten patients (91%) were alive without evidence of disease and one patient (9%) developed a pancreatic recurrence. CONCLUSION: AETV sparing the rectosigmoid and anus is feasible in highly selected patients with central pelvic recurrences. Compared to previously reported studies on total pelvic exenteration, data from this case series suggest that AETV may be associated with a lower rate of complications without compromising the oncologic outcome, while also preserving rectal function.

Extended pelvic resections for recurrent or persistent uterine and cervical malignancies: an update on out of the box surgery.

OBJECTIVE: To update our report on the outcome of patients who underwent extended pelvic resection (EPR) for recurrent or persistent uterine and cervical malignancies. METHODS: We reviewed the records of all patients who underwent EPR between 6/2000 and 07/2011. EPR was defined as an en-bloc resection of a pelvic tumor with sidewall muscle, bone, major nerve, and/or major vascular structure. Complications up to 180 days post surgery were analyzed. Survivals were estimated using the Kaplan-Meier method. RESULTS: We identified 22 patients. Median age at the time of EPR was 58 years (range, 36-74). Median tumor diameter was 5.4 cm (range, 1.5-11.2). Primary tumor sites included: uterus, 13; cervix, 7; synchronous uterus/cervix, 1; and synchronous uterus/ovary, 1. The EPR structures were: muscle, 13; nerve, 10; bone, 8; vessel, 5. Complete gross resection with microscopically negative margins (R0 resection) was achieved in 17 patients (77%). There were no perioperative mortalities. Major postoperative complications occurred in 14 patients (64%). The two most common morbidities were pelvic abscesses and peripheral neuropathies. Median follow-up time was 28 months (range, 6-99). The 5-year overall survival (OS) for the entire cohort was 34% (95% CI, 13-57). For the 17 patients who had an R0 resection, the 5-year OS was 48% (95% CI, 19-73). In patients with positive pathologic margins (n=5), the 5-year OS was 0%. CONCLUSION: EPR was associated with prolonged survival when an R0 resection was achieved. The high rate of postoperative complications remains a hallmark of these procedures and properly selected patients should be extensively counseled preoperatively.

Effects of resistance training on metabolic profile of adults with type 2 diabetes.

BACKGROUND & OBJECTIVE: The number of diabetes in India is increasing at an alarming rate. The effects of physical activity in the form of resistance training or aerobic exercises on type 2 diabetes have not been studied in Indian population. The objective of this study was to analyse the effects of eight weeks of progressive resistance training (PRT) compared with aerobic exercise (AE) on glycaemic control, metabolic profile, cardiovascular fitness parameters and general well being in adults with type 2 diabetes. METHODS: Thirty adults (14 females and 16 males mean; age 53.8 +/- 8.8 yr) with type 2 diabetes were randomly assigned to 8 wk supervised PRT (n=10) or AE (n=10) or control group (n=10). Glycosylated haemoglobin (HbA1c), lipid profile, blood pressure, heart rate, body mass index (BMI) and general well being were measured before training (i.e. 0 wk) and after 8 wk of training period. RESULTS: Plasma glycosylated haemoglobin levels decreased significantly (P<0.05) both in the PRT group (7.57 +/- 2.4% to 6.23 +/- 0.8%) and in AE group (8.11+/-0.9% to 6.66 +/- 0.9%).Total cholesterol levels decreased significantly (P<0.05) by 13.3 per cent in PRT group and by 6.1 per cent in AE group. Both exercise groups showed significantly reduction in systolic blood pressure (P<0.05). General well being improvement was much more in PRT (8.6%) as compared to AE group (2.7%). INTERPRETATION & CONCLUSION: Our findings showed that both PRT and AE were effective in improving metabolic profile of adults with type 2 diabetes but the percentage improvement in triglycerides, total cholesterol levels and general well being with PRT was more compared to AE. Further studies on a larger sample need to be done to confirm these findings.

Full-field acoustomammography using an acousto-optic sensor.

In this Letter the authors introduce a wide-field transmission ultrasound approach to breast imaging based on the use of a large area acousto-optic (AO) sensor. Accompanied by a suitable acoustic source, such a detector could be mounted on a traditional mammography system and provide a mammographylike ultrasound projection image of the compressed breast in registration with the x-ray mammogram. The authors call the approach acoustography. The hope is that this additional information could improve the sensitivity and specificity of screening mammography. The AO sensor converts ultrasound directly into a visual image by virtue of the acousto-optic effect of the liquid crystal layer contained in the AO sensor. The image is captured with a digital video camera for processing, analysis, and storage. In this Letter, the authors perform a geometrical resolution analysis and also present images of a multimodality breast phantom imaged with both mammography and acoustography to demonstrate the feasibility of the approach. The geometric resolution analysis suggests that the technique could readily detect tumors of diameter of 3 mm using 8.5 MHz ultrasound, with smaller tumors detectable with higher frequency ultrasound, though depth penetration might then become a limiting factor. The preliminary phantom images show high contrast and compare favorably to digital mammograms of the same phantom. The authors have introduced and established, through phantom imaging, the feasibility of a full-field transmission ultrasound detector for breast imaging based on the use of a large area AO sensor. Of course variations in attenuation of connective, glandular, and fatty tissues will lead to images with more cluttered anatomical background than those of the phantom imaged here. Acoustic coupling to the mammographically compressed breast, particularly at the margins, will also have to be addressed.

Effects of eye position on the vestibular evoked myogenic potential.

CONCLUSION: The position of a subject's eyes during vestibular evoked myogenic potential (VEMP) recording significantly alters the magnitude of the response. This change is largely due to an alteration in the tonicity of the sternocleidomastoid muscle (SCM) caused by variations in the position of the eye. However, even if electromyographic (EMG) normalization is conducted effects of eye position remain. OBJECTIVE: To determine if eye position has a significant effect on the magnitude of the VEMP. SUBJECTS AND METHODS: VEMPs were collected from 32 ears measured on 16 healthy subjects. The recordings were made unilaterally using the head turn method. The acoustic stimuli were 500 Hz air-conduction short tone bursts. VEMPs were measured in three recording conditions: (i) eyes in the same direction as head turn, (ii) eyes straight ahead, (iii) eyes in the opposite direction to head turn. RESULTS: All 32 ears tested showed a VEMP response with eyes in all three positions. Repeated measures analysis of variance (RM-ANOVA) verified an overall significant effect of eye position (p<0.001). Post hoc paired t tests revealed statistically significant differences between the eyes opposite and the other two conditions (p<0.001). Normalization of the VEMP magnitude using pre-stimulus EMG reduced the effect; however, some variability remained.

Evaluation of the efficacy of pulsed electromagnetic field in the management of patients with diabetic polyneuropathy.

AIM: The study was carried out to evaluate and compare the effect of low power, low frequency pulsed electromagnetic field (PEMF) of 600 and 800 Hz, respectively, in management of patients with diabetic polyneuropathy. SETTINGS AND DESIGNS: The study was a randomized controlled trial performed in Guru Nanak Dev University and Medical College, Amritsar, India with different subject experimental design. MATERIALS AND METHODS: Thirty subjects within an age group of 40-68 years with diabetic polyneuropathy stages N1a, N1b, N2a were randomly allocated to groups 1, 2, 3 with 10 subjects in each. Group 1 and 2 were treated with low power 600 and 800-Hz PEMF for 30 min for 12 consecutive days. Group 3 served as control on usual medical treatment of diabetic polyneuropathy (DPN). The subjects with neuropathy due to any cause other than diabetes were excluded. The pain and motor nerve conduction parameters (distal latency, amplitude, nerve conduction velocity) were assessed before and after treatment. STATISTICAL ANALYSIS: Related t-test and unrelated t-test were used for data analysis. RESULTS: Significant reduction in pain and statistically significant (P<0.05) improvement in distal latency and nerve conduction velocity were seen in experimental group 1 and 2. CONCLUSIONS: Low-frequency PEMF can be used as an adjunct in reducing neuropathic pain as well as for retarding the progression of neuropathy in a short span of time.

A study of changes in the body composition components in the patients with pulmonary tuberculosis.

The present study deals with the analysis of body composition components of 86 randomly selected patients with confirmed pulmonary tuberculosis aged 16- 70 years collected from the District Tuberculosis Centre and Hospital, Amritsar. An adequate number of controls were also taken for comparison. The findings of the present study showed highly significant differences (p < or = 0.001) in all the twelve kinanthropometric variables except height. When the data was further analyzed between sputum negative and sputum positive patients with pulmonary tuberculosis, highly significant differences (p < or = 0.001) were found only in total body fat and statistically significant differences (p < or = 0.05) were observed in weight, chest circumference in normal position, abdominal circumference, right calf and buttock circumferences. It may be concluded that TB patients were more malnourished than normal people. Thus, special nutritional care should be taken to the TB patients to give them a better quality of life.