Comparison of pre-operative and post-operative liver function tests in patients undergoing laparoscopic cholecystectomy at different intra-peritoneal pressures

Background: Establishing pneumoperitoneum is a pre-requisite for any laparoscopic procedure. However, its adverse effects are not uncommon. Increased intra-peritoneal pressure during laparoscopic cholecystectomy is expected to alter the liver function test (LFT) in immediate post-operative period, which may raise concerns in surgeons’ mind regarding integrity of biliary tract. The aim of our study was to compare the post-operative LFT with pre-operative values in patients undergoing laparoscopic cholecystectomy at different pneumoperitoneal pressures and to assess its clinical significance. Methods: It was a prospective observational study in which the enrolled patients were divided into 2 groups. Group 1 patients underwent laparoscopic cholecystectomy at 12 mm Hg pressure and group 2 underwent the surgery at 15 mmHg pressure. Pre-operative LFT was compared with post-operative LFT done 24 hours and 2 weeks after surgery. Results: Among 73 included patients, 41 constituted group 1 and 32 were included in group 2. Statistically significant difference was observed in hepatic transaminases between pre-operative and post-operative (1st POD) values. Mean AST in group 1: 34.7 versus 51.4 U/l; in group 2, the values were 35.1 versus 50.9 U/l respectively. Mean ALT in group 1: 36.3 versus 50.1 U/l; in group 2, values were 32.9 versus 45.6 U/l respectively. However, the enzymes normalized in all patients in 2 weeks without any adverse clinical outcome. Conclusions: Early post-operative transient elevation of hepatic transaminases after laparoscopic cholecystectomy is not associated with any adverse clinical outcome.

Traumatic Atrial Septal Defect with Tricuspid Regurgitation Following Blunt Chest Trauma Presenting as Hypoxemia: A Case Report

Introduction: Although myocardial injury is common after blunt chest trauma, tricuspid valve injury associated with traumatic atrial septal defect resulting in acute hypoxia is an infrequent event. We report an unusual case of blunt chest trauma referred to us for unexplained hypoxemia, emphasizing the unusual nature of injury and the importance of comprehensive cardiac evaluation in such cases.   Case Report: A 35-year-old male presented to the emergency department after falling from a tree from an approximate height of 15 feet. He sustained multiple rib fractures and a left hemopneumothorax. Examination revealed decreased air entry over the left hemithorax and a systolic murmur over the left sternal border. Electrocardiography showed a junctional rhythm, and troponin levels were significantly elevated. Despite tube thoracostomy, the patient remained hypoxemic. Cardiology evaluation revealed a flail tricuspid valve with severe regurgitation and a traumatic atrial septal defect (ASD). Bidirectional shunting across the atrial septal defect was causing hypoxemia. The patient underwent surgical repair of the ASD and tricuspid valve, which resulted in a successful outcome.    Conclusion: Our case highlights the need for comprehensive cardiac evaluation in such patients. In addition to sonography for trauma, point-of-care echocardiographic examination should be a part of the focused assessment

A look into augmented reality multimodal interaction designs for industrial logistics control centres of the future.

A logistics centre, or control centre, is a major component for many industries, especially those that participate in activities related to transport vehicles and logistics, for instance, the mining industry. Previous research has shown that the capabilities of humans to process a large amount of information are limited. As the flow of information continues to increase in the future, Situation Awareness (SA) and task performance can decrease. Moreover, currently, an operator is dependent and restricted to their workstation to perform any necessary task, which is also a major hindrance that is being faced. This thesis project used Augmented Reality (AR) to tackle these problems and look at how the user experience of logistics operators working in these control centres could look like and improve in the next few decades. An augmented reality multimodal prototype was developed using a variety of technologies during this thesis project. The prototype was evaluated through both qualitative and quantitative methods. Six subject matter experts (SMEs) were selected as participants and completed a small quantitative survey, after which they were interviewed for more in-depth feedback. Results show a positive approval rating for the prototype, both in terms of usability and learnability. Additionally, a number of further solutions and possible applications emerged from interviews with the participants. Finally, it became apparent that one of the research sub-questions, about the overflow of information, could not be fully addressed by this prototype. However, possible solutions to that problem emerged from the project. Ett logistikcenter eller kontrollcenter är en viktig komponent för många industrier, särskilt de som deltar i aktiviteter relaterade till transportfordon och logistik, till exempel gruvindustrin. Tidigare forskning har visat att människors förmåga att bearbeta en stor mängd information är begränsad. Eftersom informationsflödet fortsätter att öka i framtiden kan Situation Awareness (SA) och uppgiftsprestanda minska. Dessutom är en operatör för närvarande beroende och begränsad till sin arbetsstation för att utföra alla nödvändiga uppgifter, vilket också är ett stort hinder som står inför. Detta avhandlingsprojekt använde Augmented Reality (AR) för att ta itu med dessa problem och titta på hur användarupplevelsen för logistikoperatörer som arbetar i dessa kontrollcentra kan se ut och förbättras under de närmaste decennierna. En förstärkt verklighet multimodal prototyp utvecklades med hjälp av en mängd olika tekniker under detta avhandlingsprojekt. Prototypen utvärderades genom både kvalitativa och kvantitativa metoder. Sex ämnesexperter (SMF) valdes ut som deltagare och genomförde en liten kvantitativ undersökning, varefter de intervjuades för mer ingående feedback. Resultaten visar ett positivt godkännandebetyg för prototypen, både när det gäller användbarhet och lärbarhet. Dessutom framkom ett antal ytterligare lösningar och möjliga tillämpningar från intervjuer med deltagarna. Slutligen blev det uppenbart att en av forskningsundersökningarna, om överflöd av information, inte helt kunde behandlas av denna prototyp. Men möjliga lösningar på det problemet framkom ur projektet

A look into augmented reality multimodal interaction designs for industrial logistics control centres of the future.

A logistics centre, or control centre, is a major component for many industries, especially those that participate in activities related to transport vehicles and logistics, for instance, the mining industry. Previous research has shown that the capabilities of humans to process a large amount of information are limited. As the flow of information continues to increase in the future, Situation Awareness (SA) and task performance can decrease. Moreover, currently, an operator is dependent and restricted to their workstation to perform any necessary task, which is also a major hindrance that is being faced. This thesis project used Augmented Reality (AR) to tackle these problems and look at how the user experience of logistics operators working in these control centres could look like and improve in the next few decades. An augmented reality multimodal prototype was developed using a variety of technologies during this thesis project. The prototype was evaluated through both qualitative and quantitative methods. Six subject matter experts (SMEs) were selected as participants and completed a small quantitative survey, after which they were interviewed for more in-depth feedback. Results show a positive approval rating for the prototype, both in terms of usability and learnability. Additionally, a number of further solutions and possible applications emerged from interviews with the participants. Finally, it became apparent that one of the research sub-questions, about the overflow of information, could not be fully addressed by this prototype. However, possible solutions to that problem emerged from the project. Ett logistikcenter eller kontrollcenter är en viktig komponent för många industrier, särskilt de som deltar i aktiviteter relaterade till transportfordon och logistik, till exempel gruvindustrin. Tidigare forskning har visat att människors förmåga att bearbeta en stor mängd information är begränsad. Eftersom informationsflödet fortsätter att öka i framtiden kan Situation Awareness (SA) och uppgiftsprestanda minska. Dessutom är en operatör för närvarande beroende och begränsad till sin arbetsstation för att utföra alla nödvändiga uppgifter, vilket också är ett stort hinder som står inför. Detta avhandlingsprojekt använde Augmented Reality (AR) för att ta itu med dessa problem och titta på hur användarupplevelsen för logistikoperatörer som arbetar i dessa kontrollcentra kan se ut och förbättras under de närmaste decennierna. En förstärkt verklighet multimodal prototyp utvecklades med hjälp av en mängd olika tekniker under detta avhandlingsprojekt. Prototypen utvärderades genom både kvalitativa och kvantitativa metoder. Sex ämnesexperter (SMF) valdes ut som deltagare och genomförde en liten kvantitativ undersökning, varefter de intervjuades för mer ingående feedback. Resultaten visar ett positivt godkännandebetyg för prototypen, både när det gäller användbarhet och lärbarhet. Dessutom framkom ett antal ytterligare lösningar och möjliga tillämpningar från intervjuer med deltagarna. Slutligen blev det uppenbart att en av forskningsundersökningarna, om överflöd av information, inte helt kunde behandlas av denna prototyp. Men möjliga lösningar på det problemet framkom ur projektet

Externe Schlauchdrainage oder Omentumplastik bei der Behandlung von Echinococcus-Zysten (Finnenblasen): eine prospektive randomisierte Studie

Background: Surgical procedures advocated for management of residual hepatic hydatid cyst cavity have been a subject of controversy. The aim of this study was to compare omentoplasty (OP) and external tube drainage (ETD).Material and methods: This was a prospective randomized controlled study conducted on radiologically documented cases of hepatic hydatidosis (n=50) in a tertiary care hospital of Kashmir. Patients were divided into two groups; in one group ETD was performed and in another OP was done.Results: Twenty-eight patients were offered ETD and 22 OP. There was no statistically significant difference in mean operative time. The overall complication rate was higher in ETD (42.86%) as compared to OP (22.73%). In ETD group two patients had bile leak and infection of residual cavity each; whereas no such complication was seen in OP. The mean pain scores were elevated in ETD (p<0.0016).The mean hospital stay was more in ETD as compared to OP (p<0.0031). Also time for resumption of activities of daily life was more in ETD (p<0.0026). The recurrence of disease was seen in three patients in ETD as compared to none in OP. Conclusion: Omentoplasty offers a number of advantages over external tube drainage and should remain the preferred option whenever possible.Einleitung: Die chirurgischen Verfahren zur Behandlung von vorhandenen Echinococcus-Zysten in der Leber werden kontrovers beurteilt. Das Ziel dieser Studie war es, die Omentumplastik (OP) mit dem externen Schlauch-Drainageverfahren (ETD) zu vergleichen.Material und Methoden: Eine prospektive randomisierte, kontrollierte Studie an radiologisch nachgewiesenen Fällen von Leberechinococcose (n=50) wurde in einem Krankenhaus der Maximalversorgung von Kashmir durchgeführt. Die Patienten wurden in zwei Gruppen eingeteilt: Bei der einen Gruppe wurde die externe Schlauchdrainage (ETD) durchgeführt, die andere Gruppe wurde operativ mit Omentumplastik (OP) behandelt.Ergebnisse: 28 Patienten erhielten das ETD-Verfahren und 22 wurden operativ mit Omentumplastik (OP) behandelt. Die gesamte Komplikationsrate war bei ETD höher (42,86 %), verglichen mit dem OP-Verfahren (22,73 %). In den ETD-Gruppen entstanden bei zwei Patienten Gallenfisteln und Infektionen der Zysten, während in der Kontrollgruppe keine Komplikationen beobachtet wurden. Bei der ETD-Gruppe waren die durchschnittlichen Schmerzskalen (pain scores) erhöht (p<0,0016). Der mittlere Krankenhausaufenthalt war bei ETD länger als bei dem OP-Verfahren (p<0,0031). Die Zeit bis zur Wiederaufnahme des täglichen Lebens war bei ETD länger (p<0,0026). Rückfälle wurden bei drei ETD-Patienten gesehen, keine Rückfälle bei OP.Folgerung: Omentumplastik bietet eine Reihe von Vorteilen gegenüber dem ETD-Verfahren und sollte - wenn möglich - die bevorzugte Therapie sein

Genetic Modifiers of Hereditary Neuromuscular Disorders and Cardiomyopathy

Novel genetic variants exist in patients with hereditary neuromuscular disorders (NMD), including muscular dystrophy. These patients also develop cardiac manifestations. However, the association between these gene variants and cardiac abnormalities is understudied. To determine genetic modifiers and features of cardiac disease in NMD patients, we have reviewed electronic medical records of 651 patients referred to the Muscular Dystrophy Association Care Center at the University of Cincinnati and characterized the clinical phenotype of 14 patients correlating with their next-generation sequencing data. The data were retrieved from the electronic medical records of the 14 patients included in the current study and comprised neurologic and cardiac phenotype and genetic reports which included comparative genomic hybridization array and NGS. Novel associations were uncovered in the following eight patients diagnosed with Limb-girdle Muscular Dystrophy, Bethlem Myopathy, Necrotizing Myopathy, Charcot-Marie-Tooth Disease, Peripheral Polyneuropathy, and Valosin-containing Protein-related Myopathy. Mutations in COL6A1, COL6A3, SGCA, SYNE1, FKTN, PLEKHG5, ANO5, and SMCHD1 genes were the most common, and the associated cardiac features included bundle branch blocks, ventricular chamber dilation, septal thickening, and increased outflow track gradients. Our observations suggest that features of cardiac disease and modifying gene mutations in patients with NMD require further investigation to better characterize genotype–phenotype relationships

Barium Enema in the Diagnosis of Hirschsprung's Disease: A Comparison with Rectal Biopsy

Aim: The aim of the present study was to compare the diagnostic accuracy of a barium enema in Hirschsprung's disease with respect to a rectal biopsy. Materials And Methods: This study was conducted on 60 consecutive patients of clinically suspected cases of Hirschsprung's disease admitted to a tertiary care hospital in Kashmir over a period of three and a half years. All the patients were subjected to a barium enema and a full-thickness rectal biopsy. Results: The mean age was 3.5 + 0.5 years. A rectal biopsy revealed absence of ganglion cells in 36 (60%) patients, absence of ganglion cells with nerve hypertrophy in 4 (6.66%) patients and ruled out Hirschsprung's disease in 20 (33.33%) patients. A barium enema was compatible with Hirschsprung's disease in 20 (33.33%), suggestive in 14 (23.33%) and unremarkable in 26 (43.33%) patients. A barium enema had a diagnostic accuracy of 76.67% with a positive predictive value of 88.23%, a negative predictive value of 61.53%, specificity of 80% and a sensitivity of 75%, and a rectal biopsy had a diagnostic accuracy of 100% (P value < 0.0001). Conclusion: Barium enema is a valuable diagnostic tool for the diagnosis of patients with Hirschsprung's disease. We recommend a barium enema as a routine initial workup in the management of patients of suspected Hirschsprung's disease. [Arch Clin Exp Surg 2013; 2(4.000): 224-228

Development of solid polymer electrolytes based on poly (ethylene oxide) complexed with 2-trifluoromethyl-4, 5-dicyanoimidazole lithium salt and 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide ionic liquid for Li-ion batteries

Ion conducting solid polymer electrolyte films based on polymer poly (ethylene oxide) (PEO) complexed with 2-trifluoromethyl-4, 5-dicyanoimidazole lithium salt and ionic liquid (IL) 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide are synthesized using anhydrous acetonitrile as solvent. Prepared electrolyte films are characterized by X-ray diffraction (XRD), differential scanning calorimetry (DSC), complex impedance spectroscopy and cyclic voltammetry techniques. Incorporation of IL into the PEO20-LiTDI polymer electrolyte changes different physicochemical properties of these materials. By characterizations, particularly XRD, DSC and ionic conductivity studies, the synthesized SPEs showed decreased crystallinity, melting points and increased ionic conductivity by the introduction of ionic liquid. The 40 wt% of IL doped polymer electrolyte showed an ionic conductivity of the order of 1.78 × 10−4 S/cm at 60°C with better thermal stability. The optimum conducting composition showed very good electrochemical stability window at ambient temperature. These results suggested that the IL-doped polymer electrolyte would be a potential separator in Li-ion batteries