Are Gynaecologists underutilising the open access technique for laparoscopic surgery?

Background: Open access technique for laparoscopic surgery is used by the surgeons routinely, for gaining intraabdominal access safely, but is somehow underutilised by gynaecologists. The most important and dangerous part of laparoscopic surgery is while gaining access to the abdominal cavity, especially in the obese, thin and in patients with previous abdominal scars. Various access techniques have been described including Hasson and Fielding technique, transvaginal or transuterine insufflation, alternative sites for introducing Veress needle abdominally and insufflations with an optical trocar. Open access technique can minimize visceral and vascular injuries and ensures quick and easy intra-abdominal access.Methods: 250 patients were taken up for laparoscopic surgery at tertiary care service hospitals for open access technique for laparoscopic surgery for a variety of indications. The spectrum of patients ranged from thin, obese, single and multiple transverse scarsResults: A total of 250 patients, were taken up for laparoscopic surgery with the open access method successfully. The median age of the patients was 32 years, there were 77 patients (31%), with previous transverse laparotomy incisions. Median time for access was 100 seconds, and in 102 patients, there was prolonged access time ranging from 150-300 seconds, 37 (36%) of these patients were those with previous multiple transverse laparotomies and 65 (64%), patients were obese. There were no intra-abdominal organ or vascular injuries. Skin incisions healed well.Conclusions: This study describes the open access technique in patients, with transverse laparotomy scars and especially useful in thin and obese women, and where the chances of vascular and visceral injuries can be high while gaining intra - abdominal access. It is safe, effective, easy to learn and requires minimal instrumentation and can be used in the vast majority of the gynaecological cases

Ceasarean scar pregnancies, diagnosis and management

Background: Objective of present study was to describe evaluation and management of pregnancies implanted into uterine Cesarean section scars, Ceasarean scar pregnancies (CSP), is defined as gestational sac implanted in the myometrium at the site of a previous ceasarean scar. Also known as Ceasarean ectopic pregnancy.Methods: In all antenatal patients attending the antenatal outpatient department of a tertiary care service hospital a transvaginal sonography was done for determining the gestational age as well as the viability of the pregnancy. In all patients with a history of previous Cesarean section(s), special effort was made to assess the possibility of implantation into the uterine scar by means of an early transvaginal and colour doppler ultrasound.Results: Twelve Cesarean section scar pregnancies were diagnosed in a five-year period, of a tertiary care service hospital. Five (42%) patients with Cesarean scar pregnancies were treated surgically, four patients medically (33%), and two patients expectantly (17%) and one patient opted to continue the pregnancy. Surgical management was successful in all cases, although two of five (40%) women suffered bleeding (300-500ml). In the group of women who were managed medically the success rate was 3/4(75%). Expectant management was successful in one of two cases (50%). One patient who opted to continue pregnancy, underwent a ceasarean hysterectomy at 33 weeks of gestation for placenta accreta.Conclusions: Incidence of ceasarean section scar pregnancies is increasing as is the increasing rate of ceasarean deliveries. A high index of suspicion in all cases of post ceasarean pregnancies, coupled with early transvaginal ultrasonography along with colour doppler confirmation and institution of early and individualized treatment, optimizes the clinical outcome. Although rare, the patient and her relatives must be made aware of the possibility of recurrent CSP

Lipophilic profiling of Sorghum bicolor (L.) Moench seedlings vis-à-vis Chilo partellus (Swinhoe) larvae reveals involvement of biomarkers in sorghum-stem borer interactions

95-108Lipophilic metabolites play important role in the developmental process of insects, however, still there is no clarity on their involvement in plant resistance. Therefore, we carried out the lipophilic profile of host sorghum genotype seedlings and the Chilo partellus (Swinhoe) larvae, to understand the role and contribution of certain lipophilic metabolites in sorghum plant defense against the dreaded pest, spotted stem borer, C. partellus. There were variations in the form of presence or absence, along with significant differences in lipophilic metabolites across sorghum genotypes and the C. partellus larvae. The significantly higher contents of myristic acid, palmitic acid, linoleic acid, linolenic acid, eicosanoic acid and behenic acid in resistant sorghum genotypes; and linolenic acid, methyl 3-methoxytetradecanoate, myristic acid, oleic acid, palmitic acid, palmitoleic acid, lathosterol and squalene in C. partellus larvae were significantly lower than those fed on susceptible genotype, indicating their role in insect-plant biochemical disruptions. Myristic acid, methyl 3-methoxy-tetradecanoate, stearic acid, squalene, fucosterol, hexacontane, tetrapentacontane, palmitic acid, l-(+)-ascorbic acid 2,6-dihexa-decanoate, 2-pentadecanone, 6,10,14-trimethyl, lignoceric acid and stigmasterol in sorghum seedlings contributed to 60 to 100% variability in various biological and resistance parameters of C. partellus. However, myristic acid, linoleic acid, margaric acid, methyl 14-methylhexadecanoate, methyl 3-methoxytetradecanoate, stearic acid, palmitic acid, palmitoleic acid, eicosanoic acid, gamma-ergostenol, cholesterol, lathosterol, squalene, 1-triacontanol and n-pentadecanol in C. partellus larvae contributed to 64 to 100% variability in various biological and resistance parameters of C. partellus. The myristic acid, methyl 3-methoxytetradecanoate, palmitic acid, stearic acid and squalene present in both host plant and the test insect, contributed significantly to explain variability in resistance against C. partellus, thus could be used as biomarkers for sorghum-stem borer interactions

INTRODUCTION TO CAMBER CONTROL, PRESTRESSED CONCRETE BRIDGE GIRDERS

When designing a bridge, serviceability usually controls and is a more important factor than the ultimate capacity of the bridge or the allowable stresses. Therefore, the behaviour of the bridge girder deflection and camber must be predicted as accurately as possible. Therefore, excessive camber has become one of the most common problems when constructing concrete bridges. Different methods have been developed to overcome this problem. The most common and widely used is using haunch with adjustable pedestals to overcome the excessive camber. However, this method has limitations that must be considered. Therefore, this study is evaluating the effectiveness of using post tensioning jacking strands at the top flange of simply supported bridge girders to reduce the excessive camber and make it equal to the design camber

Non-ischemic Cardiomyopathy Patients Derive Superior Mortality Benefit from Cardiac Resynchronization Therapy

Background: Cardiac Resynchronization Therapy (CRT) is indicated for the treatment of advanced heart failure with severe systolic dysfunction and intraventricular conduction delay. Patient selection for this technology is vital, though it remains unclear which patients benefit most from CRT. We tested the hypothesis that patients with non-ischemic cardiomyopathy have a superior mortality benefit from CRT than ischemic cardiomyopathy patients. Methods: We evaluated 95 CRT patients to determine which factors predict mortality.Results: Patients with non-ischemic cardiomyopathy had a significantly better prognosis than patients with ischemic cardiomyopathy.Conclusion: Larger prospective studies can substantiate this finding and better delineate which patients benefit most from CRT

Hysteroscopic evaluation of postmenopausal bleeding patients and its correlation with histopathological examination

Background: Menopause is defined according to WHO as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. It is defined as uterine bleeding occurring after at least 1 year of amenorrhoea. Considering the high accuracy of hysteroscopy in evaluation of postmenopausal bleeding, the present study was carried out with an aim to evaluate hysteroscopic findings in women with postmenopausal bleeding in order to assess the causes of PMB and to determine their prevalence in our population.Methods: This was a prospective observation study, comprising of total number of 50 postmenopausal women attending gynae OPD at department of obstetrics and gynecology, Command Hospital (CH), Lucknow, Uttar Pradesh. The data obtained for the purpose of study was fed into computer using Microsoft excel 2013 software.Results: A total of 50 women with complaints of postmenopausal bleeding were enrolled in the study. Maximum number of women had achieved menopause between age 46 and 50 years. Hysteroscopy had an accuracy of 94% for detection of polyps. Hysteroscopy had an accuracy of 90% for detection of atrophy. For fibroid, hysteroscopy had an absolute sensitivity, specificity, positive predictive, negative predictive and accuracy value (100%).Conclusions: The findings of present study suggested that hysteroscopy has a useful role in evaluation of postmenopausal bleeding especially in the diagnosis of polyps and fibroids. Given fewer number of cases, the usefulness of hysteroscopy in evaluation of endometrial cancer and hyperplasia could not be established adequately. Further studies on larger number of sample size will help in providing more useful and confirmatory information

Utility of three-dimensional printing in the surgical management of intra-articular distal humerus fractures: a systematic review and meta-analysis of randomized controlled trials

Background Clinical outcomes after fixation of distal humerus intraarticular fractures are directly related to the quality of reduction. The use of three-dimensional (3D)-printed fracture models can benefit preoperative planning to ensure good reduction. This review aims to determine if surgery performed with 3D printing assistance are faster and result in fewer complications and improved clinical outcomes than conventional methods. We also outline the benefits and drawbacks of this novel technique in surgical management of distal humerus fractures. Methods A systematic literature search was carried out in various electronic databases. Search results were screened based on title and abstract. Data from eligible studies were extracted into spreadsheets. Meta-analysis was performed using appropriate computer software. Results Three randomized controlled trials with 144 cases were included in the final analysis. The 3D-printed group had significantly shorter mean operating time (mean difference, 16.25 minutes; 95% confidence interval [CI], 12.74–19.76 minutes; P<0.001) and mean intraoperative blood loss (30.40 mL; 95% CI, 10.45–60.36 mL; P=0.005) compared with the conventional group. The 3D-printed group also tended to have fewer complications and a better likelihood of good or excellent outcomes as per the Mayo elbow performance score, but this did not reach statistical significance. Conclusions Three-dimensional-printing-assisted surgery in distal humerus fractures has several benefits in reduced operating time and lower blood loss, indirectly decreasing other complications such as infection and anemia-related issues. Future good-quality studies are required to conclusively demonstrate the benefits of 3D printing in improving clinical outcomes. Level of evidence I

Higher Activity of the Inducible Nitric Oxide Synthase Contributes to Very Early Onset Inflammatory Bowel Disease

OBJECTIVES: The NOS2 gene encodes for the inducible nitric oxide synthase (iNOS), responsible for nitric oxide (NO) production, which contributes to antimicrobial and antipathogenic activities. Higher levels of both iNOS and NO-induced damage have been observed in inflammatory bowel disease (IBD) patients. NOS2 may have a role in a specific subset of IBD patients with severe and/or extensive colitis. Therefore, the aim of this study is to examine the role of NOS2 in such a subset, very early onset IBD (VEO-IBD). METHODS: Seventeen tag single nucleotide polymorphisms (SNPs) in the NOS2 gene were successfully genotyped in VEO-IBD patients. Genetic associations were replicated in an independent VEO-IBD cohort. Functional analysis for iNOS activity was performed on the most significantly associated functional variant. RESULTS: The NOS2 rs2297518 SNP was found to be associated in VEO-IBD in two independent cohorts. Upon combined analysis, a coding variant (S608L) showed the strongest association with VEO-IBD (Pcombined=1.13 × 10−6, OR (odds ratio)=3.398 (95% CI (confidence interval) 2.02–5.717)) as well as associations with VEO-Crohn's disease and VEO-ulcerative colitis (UC). This variant also showed an association with UC diagnosed between 11 and 17 years of age but not with adult-onset IBD (>17 years). B-cell lymphoblastoid cell lines genotyped for the risk variant as well as Henle-407 cells transfected with a plasmid construct with the risk variant showed higher NO production. Colonic biopsies of VEO-IBD patients showed higher immunohistochemical staining of nitrotyrosine, indicating more nitrosative stress and tissue damage. CONCLUSIONS: These studies suggest the importance of iNOS in genetic susceptibility to younger IBD presentation due to higher NO production

Dietary Patterns and Breast Cancer Risk: A Multi-Centre Case Control Study among North Indian Women.

Evidence from India, a country with unique and distinct food intake patterns often characterized by lifelong adherence, may offer important insight into the role of diet in breast cancer etiology. We evaluated the association between Indian dietary patterns and breast cancer risk in a multi-centre case-control study conducted in the North Indian states of Punjab and Haryana. Eligible cases were women 30⁻69 years of age, with newly diagnosed, biopsy-confirmed breast cancer recruited from hospitals or population-based cancer registries. Controls (hospital- or population-based) were frequency matched to the cases on age and region (Punjab or Haryana). Information about diet, lifestyle, reproductive and socio-demographic factors was collected using a structured interviewer-administered questionnaire. All participants were characterized as non-vegetarians, lacto-vegetarians (those who consumed no animal products except dairy) or lacto-ovo-vegetarians (persons whose diet also included eggs). The study population included 400 breast cancer cases and 354 controls. Most (62%) were lacto-ovo-vegetarians. Breast cancer risk was lower in lacto-ovo-vegetarians compared to both non-vegetarians and lacto-vegetarians with odds ratios (95% confidence intervals) of 0.6 (0.3⁻0.9) and 0.4 (0.3⁻0.7), respectively. The unexpected difference between lacto-ovo-vegetarian and lacto-vegetarian dietary patterns could be due to egg-consumption patterns which requires confirmation and further investigation