A clinical study of the factors affecting the outcome of intestinal resection and anastomosis

INTRODUCTION: Resection and anastomosis is the surgical procedure involving excision of a diseased organ with adequate margins and joining the cut ends so as to maintain anatomical continuity. Most commonly performed resection and anastomosis is that involving the intestines. The above mentioned study is a humble attempt to understand the various factors which influence the outcome of an intestinal anastomosis in order to bring forth successful anastomosis healing. BODY: The above mentioned study has been conducted under the Department of General Surgery, Tirunelveli Medical College, with Institutional Ethical Committee approval. 50 cases of intestinal resection and anastomosis due various causes have been studied. Various factors – patient related, surgery related and post operative were analysed and compared. Patient related factors include Age, Cause for resection, Diabetes, Hypertension, biochemical parameters. Surgery related includes presence of gangrene, volume of bowel resected, type of anastomosis, and contamination of peritoneum. Post operative includes transfusion of blood and blood products, TPN. The presence or absence of these factors in the 50 patients were followed and analysed. Outcomes taken into consideration were a successful anastomotic healing, anastomotic leak and death. Factors which were found to directly influence the outcomes were age, sex, cause of resection, diabetes, low serum proteins, anaemia, presence of gangrene and TPN. CONCLUSION: Outcome of intestinal resection and anastomosis is multi-factorial. A successful anastomosis healing is an outcome of a wholesome approach. Correction of metabolic abnormalities and supplementation of nutrients goes a long way in proper healing of the anastomotic site

A Multi-Method Examination of Partitioned Pricing

This dissertation investigates the relationship between partitioned pricing (Morwitz, Greenleaf, and Johnson 1998) and dependent variables such as demand, preference, and attention. The first essay proposes a theoretical framework to examine extant and new moderators of partitioned pricing, classifying moderators based on the source of their impact as presentational, evaluative, or attentional. A meta-analysis of 17 years of research on partitioned pricing examines 149 observations from 43 studies in 27 papers (N = 12,878). The perceived benefit of the surcharge and the typicality of partitioning the surcharge in the category emerge as robust moderators of the effect of partitioned pricing on consumer demand. Surcharges for components perceived to provide high benefit and highly typical surcharges make partitioned prices more attractive. Replicating the meta-analytic effects of typicality, a follow-up experiment shows a more positive effect of partitioning on preference for typical surcharges than for atypical surcharges, and an eye-tracking experiment offers insight into the underlying mechanism by showing that people pay more attention to atypical surcharges than to typical surcharges. Different pricing strategies in the same market suggest different beliefs about the efficacy of partitioning prices on consumers' preferences. The second essay in this dissertation explores the impact of two countervailing theoretical influences that may predict how the numerical magnitude of surcharges can affect preferences. "Base price anchoring" suggests that as the magnitude of the surcharge increases (holding the total price constant), consumers may anchor on a lower base price, leading them to evaluate partitioned prices more favorably. In contrast, "surcharge salience" suggests that as the magnitude of the surcharge increases, attention to the surcharge increases, and evaluations of partitioned prices decrease. An analysis of eBay auction data reveals support for the influence of base price anchoring, and a follow-up experiment suggests that this mechanism dominates at lower levels of surcharge magnitude whereas surcharge salience dominates at higher levels of surcharge magnitude. Finally, an eye-tracking study demonstrates the influence of surcharge salience on preference and attention

Lifecourse influences on osteoarthritis of the knees, hips and hands as defined by musculoskeletal ultrasound

PhD ThesisAims: There has been very little lifecourse research looking at the risk of osteoarthritis (OA). A lifecourse analysis of risk factors for knee, hip and hand OA (defined using features on ultrasound) acting at different stages of life, including early life factors, was performed among members of the Newcastle Thousand Families birth cohort. Methods: Potential risk factors for OA (including birth weight, breast feeding data and socioeconomic status) have been collected prospectively in this birth cohort of subjects aged 63 (born in May-June 1947) and an a priori conceptual framework was developed. Subjects had both knees, hips and the dominant hand scanned with ultrasound. These data were analysed in relation to a range of factors from across the lifecourse using logistic and linear regression models. Results: Among 316 participants, duration of exclusive breast feeding showed a significant inverse association with knee osteophytes while BMI and total hip bone mineral density at age 50 increased the risk of knee osteophytes. The univariate effect of social class at birth on knee osteophytes was found to be mediated by its subsequent effect on breast feeding and total hip bone mineral density. The multivariate model for hip OA had three risk factors; BMI, physical activity and pack years of smoking at age 50. Smoking at age 50 and increased infections in childhood appeared to confer protection from hand OA. Conclusions: This is the first study to perform a lifecourse analysis of OA risk using prospectively collected data. The majority of the risk of OA at the three joint sites seemed to occur through factors acting in adulthood. However, breast feeding protected subjects from knee OA while infections in childhood decreased hand OA risk. These results suggest that modification of OA risk factors acting in adulthood would probably be more beneficial than intervening in early life.Northumbria Healthcare NHS Foundation Trus

Corporate Social Responsibility: The Efficacy of Matched Between Not-For-Profits and Multinational Enterprises in Developed and Emerging Markets

Responding to Pope Francis’s appeals in Laudato si’ and to societal pressures, multinational enterprises (MNEs; Dunning, 1977) are increasingly searching for ways to structure demands for corporate social responsibility (CSR). Previous literature, however, suggests that the positive effects of CSR initiatives are not certain; moreover, alliance-based CSR remains an understudied area. Therefore, we propose a model based on a “matched” alliance approach to increase the efficacy of, and positive response to, CSR initiatives. We argue that MNEs increase the legitimacy and/or business-process efficiency of CSR initiatives by partnering with not-for-profit (NFP; Schwenk, 1990) organizations in alliances that “match” common objectives with complementary capabilities, which in turn results in positive responses to CSR initiatives. We propose that CSR activities from the following matched alliances will result in more positive media coverage: between MNEs and NFPs, between a local MNE and local NFPs (vs. a foreign MNE and local NFPs), and between local MNEs and NFPs in an emerging (vs. developed) market. Our case and media-intensity analyses for Walmart’s Katrina Assistance, Infosys’s Campus Connect, and Unilever’s Project Shakti span matched alliances between local and foreign MNEs in emerging and developed markets. Our findings document positive media coverage surrounding CSR initiatives whenever MNEs partner with matched local NFPs. In addition, positive media coverage is more for local rather than foreign MNEs, and for CSR initiatives in emerging, rather than developed, markets

Review of clinical profile, risk factors, and outcome in patients with Tuberculosis and COVID -19

Coronavirus disease (COVID 19) has involved millions of people all over the world. Tuberculosis (TB) continues to affect millions of people every year with high mortality. There is limited literature on the occurrence of COVID 19 in patients with TB. We reviewed the available data on various clinical details, management, and outcome among patients with COVID-19 and TB. 8 studies reported a total of 80 patients with this coinfection. These patients were reported from ten different countries, with Italy reporting the largest number of cases. Migrant, males constituted a major proportion of cases. Most reported patients were symptomatic. Fever, dry cough, and dyspnea were the most commonly reported symptoms. Bilateral ground glass opacities were more common in COVID 19 infection and cavitary lesions were more common in patients with TB. Most reported TB patients had been found to have mycobacterium tuberculosis from sputum culture in the background of pulmonary TB. Most patients of TB were treated with multidrug regimen antitubercular therapy. In all 8 studies, COVID 19 was treated as per the local protocol. Mortality was reported in more than 10% of patients. Mortality was higher in elderly patients ( \u3e 70 years) and amongst patient with multiple medical comorbidities

Comparison of Surface Area across the Allograft-Host Junction Site Using Conventional and Navigated Osteotomy Technique.

Bulk allograft reconstruction plays an important role in limb-salvage surgery; however, non-union has been reported in up to 27% of cases. The purpose of this study is to quantify average surface contact areas across simulated intraoperative osteotomies using both free-hand and computer-assisted navigation techniques. Pressure-sensitive paper was positioned between two cut ends of a validated composite sawbone and compression was applied using an eight-hole large fragment dynamic compression plate. Thirty-two samples were analyzed for surface area contact to determine osteotomy congruity. Mean contact area using the free-hand osteotomy technique was equal to 0.21 square inches. Compared with a control of 0.69 square inches, average contact area was found to be 30.5% of optimal surface contact. Mean contact area using computer-assisted navigation was equal to 0.33 square inches. Compared with a control of 0.76 square inches, average contact area was found to be 43.7% of optimal surface contact. Limited contact achieved using standard techniques may play a role in the high rate of observed non-union, and an increase in contact area using computer-assisted navigation may improve rates of bone healing. The development of an oncology software package and navigation hardware may serve an important role in decreasing non-union rates in limb salvage surgery

Minimal hepatic encephalopathy: consensus statement of a working party of the Indian National Association for study of the liver

Hepatic encephalopathy (HE) is a major complication that develops in some form and at some stage in a majority of patients with liver cirrhosis. Overt HE occurs in approximately 30-45% of cirrhotic patients. Minimal HE (MHE), the mildest form of HE, is characterized by subtle motor and cognitive deficits and impairs health-related quality of life. The Indian National Association for Study of the Liver (INASL) set up a Working Party on MHE in 2008 with a mandate to develop consensus guidelines on various aspects of MHE relevant to clinical practice. Questions related to the definition of MHE, its prevalence, diagnosis, clinical characteristics, pathogenesis, natural history and treatment were addressed by the members of the Working Party

Effect of temperature and time delay in centrifugation on stability of select biomarkers of nutrition and non-communicable diseases in blood samples

Introduction: Preanalytical conditions are critical for blood sample integrity and poses challenge in surveys involving biochemical measurements. A cross sectional study was conducted to assess the stability of select biomarkers at conditions that mimic field situations in surveys. Material and methods: Blood from 420 volunteers was exposed to 2 – 8 °C, room temperature (RT), 22 – 30 °C and > 30 °C for 30 min, 6 hours, 12 hours and 24 hours prior to centrifugation. After different exposures, whole blood (N = 35) was used to assess stability of haemoglobin, HbA1c and erythrocyte folate; serum (N = 35) for assessing stability of ferritin, C-reactive protein (CRP), vitamins B12, A and D, zinc, soluble transferrin receptor (sTfR), total cholesterol, high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), tryglicerides, albumin, total protein and creatinine; and plasma (N = 35) was used for glucose. The mean % deviation of the analytes was compared with the total change limit (TCL), computed from analytical and intra-individual imprecision. Values that were within the TCL were deemed to be stable. Result: Creatinine (mean % deviation 14.6, TCL 5.9), haemoglobin (16.4%, TCL 4.4) and folate (33.6%, TCL 22.6) were unstable after 12 hours at 22- 30°C, a temperature at which other analytes were stable. Creatinine was unstable even at RT for 12 hours (mean % deviation: 10.4). Albumin, CRP, glucose, cholesterol, LDL, triglycerides, vitamins B12 and A, sTfR and HbA1c were stable at all studied conditions. Conclusion: All analytes other than creatinine, folate and haemoglobin can be reliably estimated in blood samples exposed to 22-30°C for 12 hours in community-based studies

Osteoarthritis: 119. The Effectiveness of Exercise Therapy with and without Manual Therapy for Hip Osteoarthritis: A Multicentre Randomised Controlled Trial

Background: Current evidence indicates that exercise therapy (ET) has a short and medium-term benefit for hip osteoarthritis (OA), but evidence is inconclusive regarding the effect of manual therapy (MT). The primary aim of this randomised controlled trial was to determine the effectiveness of ET with and without MT on clinical outcomes for individuals with hip OA. A secondary aim was to ascertain the effect of an 8-week waiting period on outcomes. Methods: 131 men and women with hip OA recruited in four hospitals were initially randomised to one of three groups: ET (n = 45), a combination of ET and MT (n = 43) and wait-list control (n = 43). The two intervention groups underwent individualised ET or ET/MT for 8 weeks. Patients in the control group waited 8 weeks and were randomised to receive either ET or ET/MT after 9 week follow-up, and pooled with original treatment group data: ET (n = 66) and ET/ MT (n = 65). All participants were followed up at 9 and 18 weeks and the control group was reassessed at 27 weeks (18 weeks post-treatment) by the same blinded assessor. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Other outcomes included sit-to-stand, 50-foot walk test, pain severity, hip range of motion (ROM), anxiety, depression, quality of life (QOL), analgesic usage, physical activity, patient-perceived change and patient satisfaction. Intention-to-treat analysis was performed to determine within-group change and between-group differences for the three groups at baseline and 9 weeks, and the two treatment groups at baseline, 9 and 18 weeks. Results: Eight patients (6.1%) were lost to follow-up at 9 weeks and 19 (14.5%) were lost to follow-up by 18 weeks. Both ET (n = 66) and ET/MT groups (n = 65) showed significant within-group improvements in WOMAC, pain severity, sit-to-stand and HROM measures at 9 weeks, which were still evident at 18 weeks. There was no significant within-group change in anxiety, depression, QOL, analgesic usage, 50-foot walk test or physical activity. There was no significant difference between the two intervention groups for any of the outcomes. Regarding the results of the original ET, ET/MT and control group allocation, there was a significant improvement in one or both ET and ET/MT groups compared with the control group in the same outcomes, as well as patient perceived improvement at 9 weeks. There was no significant difference between the three groups in analgesic usage, WOMAC stiffness subscale, sit-to-stand and 50 foot walk tests, QOL and physical activity. There was an overall deterioration in anxiety and depression scores. Conclusions: The addition of MT to an 8 week programme of ET for hip OA resulted in similar improvements in pain, function and ROM at 9 and 18 weeks. The significant improvement which occurred in the same outcomes in the two treatment groups compared with a wait-list control of 8 weeks has implications for waiting list management Disclosure statement: The authors have declared no conflicts of interes