Our Experience in Comparing Laparoscopic and Open Herniotomy For Pediatric Inguinal Hernia Repair: Revisiting the Debate

Introduction: Traditionally, open groin exploration has been done for congenital inguinal hernia and hydrocele, but recently, laparoscopic herniotomy has gained popularity and has become a successful alternative to open herniotomy. This study compares Laparoscopic herniotomy [LH] and Open herniotomy [OH] regarding operative time, patency of contralateral internal ring, post-op complications, recurrence rates, and parental satisfaction. Materials and Methods: A multicentric randomized prospective comparative study was done at two tertiary care centers in North India. A total of 180 patients (newborn to 12 years) with congenital inguinal hernia and congenital hydrocele were included based on the inclusion criteria and were randomized using computer-generated numbers to assign to open and laparoscopic herniotomy surgery groups. Various parameters were evaluated during the pre-op, intra-op, and post-op periods. Results: The study was carried out from Nov 2014 to April 2019. The majority of the patients operated on had a right inguinal hernia in both groups (50% in each group). For bilateral inguinal hernia or hydrocele mean time taken by open technique was 41.16 minutes, and by laparoscopy was 37.75 minutes. In the case of unilateral hernia/hydrocele, it was 20.24 minutes by open technique compared to 24.3 minutes by laparoscopy. But the difference in operative time was statistically not significant. Conclusion: Based on our observation and results, we conclude that both laparoscopic and open techniques are equally effective and comparable in managing inguinal hernia and hydrocele, with advantages and disadvantages. Claims of one procedure being better than the other and counterclaims of one being more complicated than the other are ill-founded, and the efficacy of each procedure must be viewed with an unbiased approach

Isolation and preliminary characterization of a bacteriocin-producer Bacillus strain inhibiting methicillin resistant Staphylococcus aureus

In a multivalent approach to discover new antimicrobial substance, a total of 160 Bacilli were isolated from termitarium soil, characterized on the basis of their morphological and physiological characters and screened for their antimicrobial activity by agar well diffusion method against certain drug resistant pathogenic bacteria such as Staphylococcus aureus, Methicillin resistant Staphylococcus aureus and common food contaminating bacteria Listeria monocytogenes. After preliminary screening, sixteen isolates showed inhibitory activity against test pathogens. Among them Bacillus isolate TSH58 exhibited maximum inhibitory activity against MRSA, Staphylococcus aureus and Listeria monocytogenes. Based on morphological, physiological, biochemical and 16S rDNA characteristics isolate TSH58 was identified as a member of the Bacillus cereus species group. Various nutrient sources and culture conditions were optimized, the partially purified antimicrobial metabolite was subjected to various treatments such as heat, pH and proteolytic enzymes. Complete loss in the activity observed when the crude metabolite was treated with proteolytic enzymes suggesting its proteinaceous nature and termed as bacteriocin like inhibitory substance (BLIS). Minimal inhibitory concentration of the partially purified bacteriocin determined by microtiter plate assay was 80 μg/ml for MRSA and 40 μg/ml for L. monocytogenes. Tricine SDS PAGE analysis revealed that the partially purified bacteriocin produced by the Bacillus strain TSH58 had an apparent molecular weight of about 4.0 KDa

Design and Organization of the Dexamethasone, Light Anesthesia and Tight Glucose Control (DeLiT) Trial: a factorial trial evaluating the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery

<p>Abstract</p> <p>Background</p> <p>The perioperative period is characterized by an intense inflammatory response. Perioperative inflammation promotes postoperative morbidity and increases mortality. Blunting the inflammatory response to surgical trauma might thus improve perioperative outcomes. We are studying three interventions that potentially modulate perioperative inflammation: corticosteroids, tight glucose control, and light anesthesia.</p> <p>Methods/Design</p> <p>The DeLiT Trial is a factorial randomized single-center trial of dexamethasone vs placebo, intraoperative tight vs. conventional glucose control, and light vs deep anesthesia in patients undergoing major non-cardiac surgery. Anesthetic depth will be estimated with Bispectral Index (BIS) monitoring (Aspect medical, Newton, MA). The primary outcome is a composite of major postoperative morbidity including myocardial infarction, stroke, sepsis, and 30-day mortality. C-reactive protein, a measure of the inflammatory response, will be evaluated as a secondary outcome. One-year all-cause mortality as well as post-operative delirium will be additional secondary outcomes. We will enroll up to 970 patients which will provide 90% power to detect a 40% reduction in the primary outcome, including interim analyses for efficacy and futility at 25%, 50% and 75% enrollment.</p> <p>Discussion</p> <p>The DeLiT trial started in February 2007. We expect to reach our second interim analysis point in 2010. This large randomized controlled trial will provide a reliable assessment of the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery. The factorial design will enable us to simultaneously study the effects of the three interventions in the same population, both individually and in different combinations. Such a design is an economically efficient way to study the three interventions in one clinical trial vs three.</p> <p>Trial registration</p> <p><b>This trial is registered at </b>Clinicaltrials.gov <b>#</b>: NTC00433251</p

Refining Prediction Of Atrial Fibrillation-Related Stroke Using The P2-Cha2Ds2-Vasc Score

University of Minnesota M.S. thesis. February 2018. Major: Epidemiology. Advisor: Lin Chen. 1 computer file (PDF); viii, 34 pages.Introduction: In people with atrial fibrillation (AF), periods of sinus rhythm present an opportunity to detect pro-thrombotic atrial remodeling through measurement of P-wave indices (PWIs)—prolonged P-wave duration, abnormal P-wave axis, advanced inter-atrial block, and abnormal P-wave terminal force in lead V1. We hypothesized that addition of PWIs to the CHA2DS2-VASc score would improve its ability to predict AF-related ischemic stroke. Methods: We included 2229 Atherosclerosis Risk in Communities (ARIC) study and 700 Multi-Ethnic Study of Atherosclerosis (MESA) participants with incident AF and without anticoagulant use within 1 year of AF diagnosis. PWIs were obtained from study visit ECGs before development of AF. AF was ascertained using study visit ECGs and hospital records. Ischemic stroke cases were based on physician adjudication of hospital records. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of PWIs for ischemic stroke. Improvement in 1-year stroke prediction was assessed by C-statistic, categorical net reclassification improvement (NRI), and relative integrated discrimination improvement (IDI). Results: Abnormal P-wave axis was the only PWI associated with increased ischemic stroke risk (HR, 1.84; 95% CI, 1.33-2.55) independent of CHA2DS2-VASc variables and that resulted in meaningful improvement in stroke prediction. The beta estimate was approximately twice that of the CHA2DS2-VASc variables, thus abnormal P-wave axis was assigned 2 points to create the P2-CHA2DS2-VASc score. This improved the C-statistic (95% CI) from 0.60 (0.51-0.69) to 0.67 (0.60-0.75) in ARIC and 0.68 (0.52-0.84) to 0.75 (0.60-0.91) in MESA (validation cohort). In ARIC and MESA, the categorical NRI (95% CI) were 0.25 (0.13-0.39) and 0.51 (0.18-0.86), respectively, and the relative IDI (95% CI) were 1.19 (0.96-1.44) and 0.82 (0.36-1.39), respectively. Conclusions: Abnormal P-wave axis—an ECG correlate of left atrial abnormality— improves ischemic stroke prediction in AF. Compared with CHA2DS2-VASc, the P2-CHA2DS2-VASc is a better prediction tool for AF-related ischemic stroke