A prospective study of USG guided pigtail catheter drainage in management of liver abscess

Background: Treatment of the liver abscess of any etiology has evolved in the recent years. Percutaneous drainage of liver abscess has been an important advancement in the treatment of pyogenic liver abscesses. Aim: to evaluate and assess response, morbidity and complication rates of percutaneous pig tail catheter drainage in treatment of liver abscess.  Methods: During a period of 27 months, 25 patients with liquefied liver abscess ≥5x5 cm underwent percutaneous drainage under sonographic guidance.Results: 18 had solitary abscess, while 7 had multiple abscesses. Pigtail catheters of various sizes (10 F or 12 F) were introduced in these patients using the Seldinger technique. The volume of pus drained ranged from 150 to 400 ml, while the period of catheter drainage ranged from 6 to 17 days. Complications were minor and included catheter blockage in 2 patients and tract pain in 8 patients. There was no mortality associated with this procedure. This study shows a success rate of 96% (successful treatment in 24 out of 25 patients).Conclusion: Percutaneous catheter drainage of liver abscesses is successful with a low morbidity and mortality and should be the first line of management in liquefied moderate to large sized liver abscesses.

Triple mesh technique in repair of recurrent lumbar incisional hernia

Lumbar hernias occur infrequently and can be congenital, primary (inferior or Petit type, and superior or Grynfeltt type), post-traumatic, or incisional. They are bounded by the 12th rib, the iliac crest, the erector spinae, and the external oblique muscle. Most postoperative incisional hernias occur in nephrectomy or aortic aneurysm repair incisions for which various surgical method in context of meshplasty are available. In this case 60 yr. male hypertensive patient presented to the outpatient clinic of institute with recurrent left side lumbar incisional hernia, patient was previously operated for left side nephrolithiasis 15 years back and onlay meshplasty 2 years back for incisional hernia. The patient was operated under high risk for recurrent incisional hernia repair by triple layered meshplasties in the same sitting. Lumbar incisional hernias are often diffuse with fascial defects that are usually hard to appreciate. Computed tomography scan is the diagnostic modality of choice with adjuvant clinical findings, which allows differentiating them from abdominal wall musculature denervation atrophy complicating flank incisions. Repairing these hernias is difficult due to the surrounding structures for which our surgical approach included a triple mesh repair consisting of underlay, inlay and onlay meshplasty thereby anticipating further such incidences of incisional hernia

A prospective comparative study of intestinal anastomosis, single layer extramucosal versus double layer

Background: Intestinal anastomosis is an operative procedure that is of central importance in the practice of surgery. Intestinal anastomosis after resection of bowel may be of various types and techniques. This prospective comparative study is performed to evaluate the safety in term of anastomotic leak of single layer interrupted extramucosal technique as compared to conventional double layer technique.Methods: The patients selected for this study are those who were admitted with various clinical conditions requiring resection and anastomosis of small or large bowel presented to P.D.U. Medical College & Hospital, Rajkot between a period of August 2012 to December 2014. A total of 50 patients were included in the study. All the patients above the age of 18 years and less than 60 years, requiring intestinal anastomosis on emergency or electively, were included in the study and those requiring anastomosis to esophageal, gastric and duodenal anastomosis were excluded and randomly allotted single layer and double layer groups and results such as anastomotic leak rate, duration for anastomosis, number of suture material required noted.Results: Mean duration required for single layer anastomosis was 19.6 minutes and for double layer anastomosis was 29.5 minutes and double number of suture material used in double layer anastomosis with equal anastomotic leak rate (6%) in each group.Conclusions: Single layer interrupted extramucosal technique required significantly less duration for anastomosis, is cost effective with no significant difference in anastomotic leak rate and  as safe as conventional double layer technique.

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Local structure order around Ni in Hf‒Cu‒Ni glassy ribbons: XANES and EXAFS study at Ni K‒edge

This work has investigated the formation of the local structure order around Ni in Hf‒Cu‒Ni glassy ribbons by employing X‒ray absorption near edge structure (XANES) and extended X‒ray absorption fine structure (EXAFS) spectroscopy at Ni K‒edge. XANES probed 1s to 4p transition at the shoulder of the spectra. The main peak of the spectra corresponds to the 1s to 4p dipole selection rule. The magnitude of the first peak of the EXAFS signal, belonging to the first coordination shell of Ni, decreased with an increase in Ni concentration. The coordination number (CN) of Ni/Cu atoms increases, whereas that of Hf atoms decreases with increasing Ni concentration. The first peak of Hf$_{57}$Cu$_{11}$Ni$_{32}$ (Hf$_{57}$), Hf$_{59}$Cu$_{18}$Ni$_{23}$ (Hf$_{59}$), and Hf$_{60}$Cu$_{21}$Ni$_{19}$ (Hf$_{60}$) is dominated by Ni–Ni and Ni–Cu pair. A nearly linear decrease in atomic distances of Ni‒Hf pair is observed with an increase in CN of Ni/Cu, thereby indicating atomic re‒arrangement around the central absorbing atom. Hf$_{57}$ with large CN of Ni/Cu atoms has shown the most negative (product of enthalpy of chemical mixing and normalized mismatch entropy) and large supercooled liquid region. This work reflects that the CN of an element strongly influences the glass formation ability of an alloy