Retraction-Related Liver Lobe Necrosis After Laparoscopic Gastric Surgery

Reviewed are various types of retractor-related liver injuries during laparoscopic surgery. Highlighted is the importance of intermittent release of retraction during prolonged operative procedures

Comparing dexmedetomidine and propofol for sedation and hemodynamic stability in cardio-thoracic intensive care unit for patients following off-pump coronary artery bypass graft surgery

Background: Most patients in intensive care unit (ICU) require both sedation and analgesia to encourage natural sleep, facilitate assisted ventilation and modulate physiologic response to stress. The ideal sedative after Coronary artery bypass grafting (CABG) should have rapid onset, immediate resolution of both pain and anxiety, promote cardiac and respiratory stability, maintain a reusability during sedation, allow rapid recovery after discontinuation, and attenuate the cardiovascular, neuroendocrine, and inflammatory response. All these properties may improve outcome in cardiac patients after CABG.Methods: Setting-cardiac ICU. A prospective, randomised, single blind study including 60 patients divided into 2 groups. Data collection tools-study proforma and Ramsay sedation scale (RSS). Data analysed using science and statistical packaged (SPSS) version 20, independent sample `t` test, chi-square test, analysis of variance (ANOVA) and p value ≤0.05 was considered statistically significant.Results: Sedation levels and length of stay of patients on ventilator were comparable in both groups, however, analgesic requirement was significantly less in dexmedetomidine group. Dexmedetomidine group showed significantly lower heart rates compared to propofol group.Conclusions: Dexmedetomidine and propofol are safe sedative agents during mechanical ventilation in ICU for patients undergoing off pump coronary artery bypass (OPCAB). There is more than 50% reduction in analgesic requirement and a significant reduction in heart rate in dexmedetomidine sedated patients.

Silica nano particles synthesized from boiler spent ash: Value addition to an industrial waste

Large quantities of biomass ash are generated everyday by the spice industries and are currently disposed off as landfill. However, this could transform into an environmental pollutant unless alternative techniques are developed for its disposal or value addition. Here in this study, the waste ash from biomass combustion wassuccessfully converted into silica nanoparticles with potential for application in several fields. The highly alkaline nature of the ash and presence of unburned carbon warrants a pretreatment which includes digestion and acid treatment. The synthesized silica was characterized in terms of morphology, specific surface area, crystallinity, surface functional groups and size. Alkaline extraction of the pretreated ash followed by acid precipitation yielded an amorphous structure with minimum mineral contaminants, high surface area, and a narrow size distribution (8-10 nm range) characteristic of nano silica. Studies thus indicate that the waste ash and the extraction process could be fine tuned for the large scale production of amorphous silica and could be of use to solve the problem of boiler ash pollution. Keywords: biomass ash, boiler ash, nano silica, value addition to waste, amorphous silic

Herpes encephalitis in an elderly immunocompetent lady – A case report

Herpes zoster encephalitis is a rare complication of varicella zoster virus infection. As its clinical presentation is usually non-specific, it often goes unrecognized. Advent of polymerase chain reaction test for detecting viral particles in the cerebrospinal fluid has enabled rapid and accurate diagnosis

Prevalence of elevated alanine transaminase in Australia and its relationship to metabolic risk factors: A cross-sectional study of 9,447 people

BACKGROUND AND AIM: Elevated alanine transaminase (ALT) is a strong predictor of metabolic syndrome, but there are few data from the Australian population. We aimed to determine the prevalence of elevated ALT and association with metabolic risk factors. METHODS: In this cross-sectional study including adult participants (N = 9,447) from a nationwide, population-based survey, we assessed the prevalence of elevated ALT [defined as ≥ 40 IU/L (men) and ≥ 30 IU/L (women) as baseline, and ALT as ≥ 30 IU/L (men) and ≥ 19 IU/L (women) as lower threshold], distribution of metabolic risk factors, and independent predictors of elevated ALT in logistic regression models. Analyses were weighted to the population with population weights. RESULTS: Elevated ALT levels were found in 11.2% of the Australian population. People with elevated ALT were younger (43 vs 46 yrs) with more truncal adiposity (100 vs 91 cm), higher pro-atherogenic lipids and glucose and exercised less (120 vs 160 min per week, P < 0.05 for all analyses). Regression analyses indicated that younger age, male sex, diabetes, triglycerides, apolipoprotein B, and waist circumference were independent predictors of elevated ALT. The population attributable fraction of elevated ALT due to truncal obesity was estimated at 47%. CONCLUSION: These data demonstrate a high prevalence of elevated ALT in the general population that is closely associated with metabolic risk factors. Individuals with elevated ALT should be evaluated for co-existent metabolic disorders

Prevalence of goitre and its associated factors in a coastal district of Karnataka

Context:&nbsp;Iodine deficiency Disorders (IDDs) are a major public health problem globally. In India more than 200 million are at risk for this disorder. It affects people of all ages and both sexes. The mental impairment caused by IDD especially in children is an important consequence of IDD.&nbsp;Aim:&nbsp;To find the prevalence of IDDs and the associated factors with it.&nbsp;Settings and Design:&nbsp;A school based cross – sectional study.&nbsp;Methods and Material: The study was done in Udupi district of Karnataka using a pretested, semistructured questionnaire. The villages of the three talukas (Udupi, Kundapur and Karkala) of Udupi district were sampled according to Probability Proportionate to Size (PPS).One school was chosen for the study from each of the 30 selected villages. Minimum of 90 students were selected from each school. Salt and urine samples were collected for Iodine estimation from a sub sample. Goitre was graded according to WHO/UNICEF/ICCIDD criteria.&nbsp;Results:&nbsp;A total of 3023 children were examined (M = 49.1%, F = 50.9%). The prevalence of goitre in Udupi district was 19.8%. The prevalence of goitre was found to be more amongst females compared to males (p = 0.021) and also was found to be increasing with the increasing age (p = 0.003). Of the 539 salt samples analyzed 23.7 % were inadequately iodized. Education of the father, fish consumption and occupation of the mother were found to be significant predictors of goitre.&nbsp;Conclusions:&nbsp;Goitre is a public health problem in Udupi district of Karnataka. The adequately Iodized salt coverage which should have been more than 90 % is not fulfilled. More awareness is required amongst the people about IDDs and its predictors

The Role of Diet in the Treatment of Pulmonary Tuberculosis: An Evaluation in a Controlled Chemotherapy Study in Home and Sanatorium Patients in South India

Before the advent of antituberculosis chemotherapy, a diet rich in calories, proteins, fats, minerals and vitamins was generally considered to be an important, if not essential, factor in the treatment of tuberculosis. The introduction of specific antituberculosis drugs, however, has so radically altered the management of the disease that the role of diet has to be reconsidered in the light of the recent advances in treatment. An evaluation of the influence of diet in the treatment of pulmonary tuberculosis with isoniazid plus p-aminosalicylic acid was recently undertaken by the Tuberculosis Chemotherapy Centre, Madras, in the course of a controlled comparison of home and sanatorium chemotherapy for tuberculous patients from a poverty-stricken community in Madras City. Despite the fact that during the year of treatment the home patients subsisted on a markedly poorer diet, were physically more active and, on the average, gained less weight than the sanatorium patients, the overall response to treatment in the home series closely approached that in the sanatorium series, although there was a tendency for tubercle bacilli to disappear earlier in the latter. Direct evidence has been presented that none of the dietary factors studied (calories, carbohydrates, total and animal proteins, fats, minerals and vitamins) appears to influence the attainment of quiescent disease among tuberculous patients treated for one year with an effective combination of antimicrobial drugs, and that initial chemotherapy of patients at home can be successful even if the dietary intake is low throughout the period of treatment

Elevated Liver Enzymes and Mortality in Older Individuals: A Prospective Cohort Study

Aim of the study: The aim of the study was to determine the excess risk of all-cause and cardiovascular mortality in older people with elevated liver enzymes [alanine transaminase (ALT) and gamma glutamyltransferase (GGT)]. Methods: We utilized data from a large, prospective, population based study of 2061 people aged 50 to 99 years with linkage to a National Death Registry. Participants were categorized as having elevated liver enzymes using standard thresholds (for males, GGT>51 and ALT>40 IU/L, and GGT>33 and ALT>31 IU/L for females). Adjusted Cox proportional hazards models assessed the association of elevated liver enzymes and mortality with long duration follow-up. Results: Over a median follow-up of 10 years (20,145 person years), 701 people died, including 203 (34%) from cardiovascular disease. Cox regression models adjusted for sex, age, smoking, and alcohol intake indicated that people with elevated liver enzymes had an increased risk of all-cause mortality that was modified by age (test for interaction P=0.01). Age-stratified analyses demonstrated no increased risk at younger ages [age 59 y and below; hazard ratio (HR): 0.46; 95% confidence interval, 0.06-3.49], but increased risk with age; age 60 to 69, HR: 1.05 (0.53-2.07), age 70 to 79 years, HR: 1.54 (0.81 to 2.93), and age 80 years and above, HR: 3.53 (1.55 to 8.04). Similarly, the risk of cardiovascular mortality with elevated liver enzymes was also modified by, and increased with age (test for interaction P=0.02); age 70 to 79, HR: 3.15 (1.37 to 7.23), age 80 years and above, HR: 6.86 (2.44 to 19.30). Conclusions: In community-dwelling elderly persons, an elevation in both ALT and GGT are associated with an excess risk of all-cause and cardiovascular mortality which increases with age