Comparison of clinical safety of minimal access surgery/laparoscopy versus open surgery in terms of patient outcomes and risk to theatre staff during the COVID-19 pandemic

Background: The COVID-19 pandemic has greatly affected surgical practice in all parts of the world because the safety of minimal access surgery (MAS) was questioned during the COVID-19 pandemic due to increased concern with regard to disease spread. This study assessed the available evidence on the safety of laparoscopy as compared to open surgery during the COVID-19, explored the possible precautions to be taken to prevent exposure of the operating team to the viral infection. The objective of this study was to access the clinical safety of laparoscopy as compared to open surgery during the COVID-19 pandemic.Methods: This study was a retrospective study conducted during the COVID-19 pandemic in the Department of Surgery, GMC, India, from January 2020 to January 2021. The various outcomes assessed included: burden of covid-19 infection among the patients, deaths due to COVID-19, infection acquired by staff, length of hospital stay and post-discharge symptomatology among patients.Results: There was no statistically significant difference in terms of median age of patients (p=0.853), gender (p=0.835), American Society of Anesthesiologists (ASA) status (p=0.876), urgency of operation (p=0.074), total time in theatre complex (p=0.163) or total number of theatre staff involved (p=0.831). The length of stay in the hospital was significantly shorter in the laparoscopic as compared the open group (3.5 versus 9 days; p=0.011).Conclusions: Based on our review, we concluded that if recommended guidelines are followed and proper precautions are taken, laparoscopic surgery is safe for patients and theatre staff during the COVID-19 pandemic. Only on the basis of COVID-19, laparoscopy should not be replaced by laparotomy. If laparoscopy is strongly indicated in patients, it can be used with precautions because of its benefits over open surgery

An audit of trauma related mortality in Government Medical College, Jammu

Background: Surgical audit is defined as a systematic, critical analysis of the quality of surgical care that is reviewed by peers against explicit criteria or recognized standards, and then used to further inform and improve surgical practice with the ultimate goal of improving the quality of care for patients. Aims and objectives were to study the profile of patients who died due to trauma and to identify factors involved in both pre-hospital and hospital care.Methods: This study was conducted in the department of surgery, GMC Jammu during over a period of one year. The profile of all traumatic deaths was studied to evaluate the various causes of trauma related mortality, age and sex relationship, mortality rate, prognostic indicators and also to identify factors involved in both pre-hospital and hospital care.Results: A total of 414 deaths occurred due to trauma. Out of these 317 patients were males and 97 patients were females comprising male to female ratio of 3.3:1. Road traffic accidents accounted for majority of the deaths (57%) followed by falls (35.5%), assaults (5.07%) and miscellaneous causes (2.43%). In children less than 15 years of age, traumatic deaths were more due to falls, whereas in adults it was more due to road traffic accidents. In our study there was steady rise of fatalities during weekend days with a peak on Saturday. Cranio-cerebral injuries were responsible for majority of the traumatic deaths (85.9%) followed by limb injuries including fractures (38.4%), thoracic injuries (27.7%), abdominal injuries (24.6%), pelvic injuries (20.7%) and spine injuries (14.2%).Conclusions: This study can be the impetus to motivate committed professionals in the trauma specialty to help in the organization of available facilities and to upgrade existing facilities for a better response to injury, which should not be different from other public health responses

Comparative study of transabdominal preperitoneal versus open Lichtenstein hernia repair in primary inguinal hernia

Background: Inguinal hernia repair is one of the most commonly performed surgery in surgical practice and has evolved through various techniques. However, which technique is gold standard is still a topic of debate and the clinical studies are not adequate to show clear benefits of one technique over another. Objective was to compare the outcome of transabdominal preperitoneal repair (TAPP) versus open Lichtenstein tension free mesh repair in primary inguinal hernia.Methods: This retrospective cohort study was conducted in a tertiary care hospital with sample size of 80 patients (40 cases in each group) and these patients were compared in terms of operative time, complications, duration of hospital stay, postoperative recovery, postoperative pain and timing of return to normal activity and work.Results: On comparing the results of our study we found that in unilateral cases the operating time was greater in the TAPP group than the Lichtenstein group; however, in the bilateral cases, the operating time was significantly greater in the Lichtenstein repair group than the laparoscopic TAPP group. The incidence of post operative complications was lower in TAPP group (8.2%) then in open hernia repair group (21.6%). The time to return to normal activity was also lower for laparoscopic group in both unilateral and bilateral cases.Conclusions: It can be concluded that laparoscopic TAPP repair offers significant advantage over open tension free mesh hernioplasty in terms of lesser post operative pain, lesser complications and early return to normal activity, better cosmetic outcomes, and less persisting pain but it is associated with a higher operative time depending on surgeon’s expertise, more costly for the patient and there is no significant difference in early post operative complications

Aggregatibacter Actinomycetemcomitans Leukotoxin Causes Activation of Lymphocyte Function-Associated Antigen 1

Repeats-in-toxin leukotoxin (LtxA) produced by the oral bacterium Aggregatibacter actinomycetemcomitans kills human leukocytes in a lymphocyte function-associated antigen 1 (LFA-1, integrin α L /β 2 )-dependent manner, although the mechanism for this interaction has not been identified. The LtxA internalisation by LFA-1-expressing cells was explored with florescence resonance energy transfer (FRET) microscopy using a cell line that expresses LFA-1 with a cyan fluorescent protein-tagged cytosolic α L domain and a yellow fluorescent protein-tagged β 2 domain. Phorbol 12-myristate 13-acetate activation of LFA-1 caused transient cytosolic domain separation. However, addition of LtxA resulted in an increase in FRET, indicating that LtxA brings the cytosolic domains closer together, compared with the inactive state. Unlike activation, this effect was not transient, lasting more than 30 min. Equilibrium constants of LtxA binding to the cytoplasmic domains of both α L and β 2 were determined using surface plasmon resonance. LtxA has a strong affinity for the cytosolic domains of both the α L and β 2 subunits (K d = 15 and 4.2 nM, respectively) and a significantly lower affinity for the cytoplasmic domains of other integrin α M , α X , and β 3 subunits (K d = 400, 180, and 230 nM, respectively), used as controls. Peptide fragments of α L and β 2 show that LtxA binds membrane-proximal domain of α L and intermediate domain of β 2 . © 2018 John Wiley & Sons Lt

In vitro selection of yellow passion fruit genotypes for resistance to Fusarium vascular wilt.

Fusarium vascular wilt (caused by Fusarium oxysporum f. sp. passiflorae) is a limiting factor in the cultivation of yellow passion fruit (Passiflora edulis). Since there is no effective and economically viable control available, development of resistant or at least tolerant cultivars are in demand. A number of procedures have been used for the initial selection of plant genotypes resistant to various fungal pathogens by means of a fungal culture filtrate or purified toxin. In this study, seeds and in vitro-grown plantlets of passion fruit were screened with different concentrations of either Fusarium oxysporum f. sp. passiflorae (FOP) culture filtrate (0, 20, 30, 40 or 50%, v/v) or fusaric acid (0.10, 0.20, 0.30 or 0.40 mM) supplemented in Murashige and Skoog (MS) basal media. Subsequently, selected plants were inoculated with a conidial suspension of FOP to assess correlation between in vivo and in vitro responses. In vitro sensitivity to the selective agents and the resistance response to the pathogen were also compared. Root growth was markedly influenced by FA, culture filtrate, and conidial suspension culture treatments. Observations indicated that roots were primary targets for attack by F. oxysporum. Successful in vitro selection of resistant genotypes by both FA and culture filtrate treatments suggested that this strategy was viable for accelerating breeding of passion fruit for resistance to the Fusarium vascular wilt