Isolated liver tuberculosis

Isolated liver tuberculosis is still considered a rare condition and its atypical clinical presentation challenges the clinical acumen of the treating physician. There is difficulty in reaching the correct preoperative diagnosis of nodular hepatic tuberculosis that presents as a space-occupying lesion. It is usually unsuspected and confused with primary or metastatic carcinoma of the liver. In this report, we describe a rare case of isolated liver tuberculosis

Duct-to-mucosa pancreatojejunostomy is a safe technique of reconstruction after pancreatoduodenectomy

Background: A duct-to-mucosa pancreatojejunostomy is technically difficult to perform than Dunking procedure after pancreatoduodenectomy. In contrast, the incidence of anastomotic dehiscence is more in Dunking than duct-to-mucosa procedure. Duct-to-mucosa technique is rarely practiced in our country because of technical difficulties and lack of experiences. Objectives: This study was undertaken to evaluate the safety of duct-to-mucosa procedure in our patients with pancreatoduodenectomy. Methods: We have performed pancreatojejunostomy in 14 consecutive patients using a duct-to-mucosa technique and the result was assessed. Results: No patients developed pancreato-jejunal leakage; however, 6 of 14 patients developed complications not related to operative techniques (wound infections; 3,jejunal fistula following removal of jejunal feeding tube; 1, renal dysfunction; 1, delayed gastric emptying; 1) which were managed conservatively. There were no postoperative deaths in the present series and the median postoperative hospital stay was 20.3 days. The follow-up period ranged from 1 to 12 months and all patients are surviving with good health during this period. Conclusion: Pancreatojejunostomy by duct-to-mucosal technique is a safe method of pancreatojejunostomy after pancreatoduodenecytomy

Change in serum interleukin-6 levels in patients after pancreatoduodenectomy for periampullary cancer

This study was undertaken to elucidate the changes in interleukin-6 concentrations in the systemic circulation of 20 patients following pancreatoduodenectomy and whether it had any predictive value for postoperative complications. Blood was drawn on the day before surgery, at fixed intervals immediately after closure of the abdomen, and on day 1, 3, 5 after surgery for the measurement of interleukin-6. Change in the serum interleukin-6 levels was observed before and after pancreatoduodenectomy and between patients with and without complications. There was no mortality, but morbidity occurred in 5 patients. Serum interleukin-6 levels peaked immediately after surgery and gradually declined to preoperative level on postoperative day 5, but it remained persistently higher in a patient who developed postoperative complication. The peak level of interleukin-6 was significantly correlated with body mass index, duration of jaundice, biliary decompression prior to surgery, operation time and hospital stay, but not with operative blood loss. In conclusion, interleukin-6 is an important stress marker for predicting the complications after pancreatoduodenectomy operation. Patient with good body mass index status, short duration of jaundice and without preoperative biliary decompression provides less operative stress, less chance of complications and shorter hospital stay

Port site Infection in laparoscopic cholecystectomy in a teriary care hospital – a retrospective study

Port site infection(PSI) in laparoscopic surgery is not very uncommon. The main aim of this study was to assess the causes of port site infection and its management. This retrospective descriptive study was conducted on 48 patients from March 2019 to December 2020 who develop port site infection after laparoscopic cholecystectomies. Operation notes were analyzed; and swabs were taken for culture & sensitivity. Exploration and wound debride- ment with excisional biopsies were done under local anesthesia for all patients. All patients were followed-up for one year postoperatively. Factors as gender, site of infected port, types of microorganism, acute versus chronic cholecystitis, type of infection (superficial or deep infection) and intraoperative spillage of stones, bile or pus were analyzed . Age of the patients ranged from 15 years to 60 years and the mean age was 32.4 years. The female to male ratio is 2.2:1. Among the subjects, 56.25% patients suffered from acute and 43.75% suffered from chronic cholecystitis. 35.42% had a history of spillage of bile or stones in the abdomen. Considering the site of infection, 33.33% had only umbilical port site infection, 18.75% had only epigastric port infection and 47.92% had multiple port infection. 58.33% suffered from superficial infection and others had deep site infections. Histopathology reports showed granulomatous infection in case of 37.5% patients. So, special consideration should be taken in chronic deep surgical site infection as Mycobacterium tuberculosis could be the cause. BSMMU J 2021; 14(4): 99-10

A Short Review: Divulge on Growth Heritage of Biochemically Isolated Adipose-Derived Mesenchymal Stem Cells, Types, Risks, and Therapeutics Roles

Tissue engineering and regenerative medicine’s progression and benefits are based on harvesting healthy stem cells for their remarkable therapeutic effects. In context with tissue rehabilitation and repair, stem cells are a key vehicle for cellular therapies. This review paper aims to report a protocol for the isolation of a homogenous population of murine Adipose-derived Mesenchymal Stem cells (mAd-MSCs) their identification, growth characteristics, proliferation, types, risk factors as well as their therapeutic roles. Various assays are discussed here to check the properties, proliferation, and differentiation of ad-MSCs. Ad-MSCs are found to be associated with angiogenesis, regenerative abilities (wound healing and tissue repairing), suppressing the immune system during autoimmune disorders, cardiovascular illness, cartilage repair, and potential therapeutic cellular carriers for targeted and specific drug delivery particularly in the treatment of cancer. Hence, ad-MSCs due to their vast purposes could be utilized to achieve therapeutic goals in the field of medicin

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Duct-to-mucosa pancreatojejunostomy is a safe technique of reconstruction after pancreatoduodenectomy

Background: A duct-to-mucosa pancreatojejunostomy is technically difficult to perform than Dunking procedure after pancreatoduodenectomy. In contrast, the incidence of anastomotic dehiscence is more in Dunking than duct-to-mucosa procedure. Duct-to-mucosa technique is rarely practiced in our country because of technical difficulties and lack of experiences. Objectives: This study was undertaken to evaluate the safety of duct-to-mucosa procedure in our patients with pancreatoduodenectomy. Methods: We have performed pancreatojejunostomy in 14 consecutive patients using a duct-to-mucosa technique and the result was assessed. Results: No patients developed pancreato-jejunal leakage; however, 6 of 14 patients developed complications not related to operative techniques (wound infections; 3,jejunal fistula following removal of jejunal feeding tube; 1, renal dysfunction; 1, delayed gastric emptying; 1) which were managed conservatively. There were no postoperative deaths in the present series and the median postoperative hospital stay was 20.3 days. The follow-up period ranged from 1 to 12 months and all patients are surviving with good health during this period. Conclusion: Pancreatojejunostomy by duct-to-mucosal technique is a safe method of pancreatojejunostomy after pancreatoduodenecytomy