Efficacy of staplers in comparison with conventional (Hand-Sewn) anastomosis in gastrointestinal surgery – A prospective and randomized study

Background: Gastrointestinal anastomosis is a regularly carried out surgical technique to set up communication between two distant portions of the intestine since the era of Sushruta. There exist different methods of intestinal anastomosis. The newer techniques are Stapling devices over to conventional hand-sewn method of anastomosis. It is proved that a key to a successful anastomosis is accurate anastomosis of two viable ends of the bowel maintaining good vascularity and less tension. Due to consistency, stapler’s can be used at difficult locations. Aims and Objectives: The objective of present study was to compare the outcome of hand-sewn versus stapler anastomosis in elective gastrointestinal surgeries. Materials and Methods: We conducted a prospective and randomized study including 30 study participants each in stapler’s method and hand-sewn method at surgery outpatient department of Kempegouda Institute of Medical Sciences Hospital and Research Center. Results: Stapling procedure took less days to get restored, less time to return of bowel sounds, shorter duration of hospital stays, and less time to resume for oral feeds compared to hand-sewn method and which were statistically significant (P<0.05). Complications such as anastomotic leaks accounted for 3.3% in stapler group and 13.3% in hand-sewn anastomosis, which was not significant statistically. Conclusion: We concluded that time for anastomosis during the procedure, restoration of the gastrointestinal function, oral feeding resumption, and post-operative hospital stay took significantly less time in stapling technique than hand-sewn anastomosis and the staplers looked technically easy compared to hand-sewn method. Complications related to procedure did not show significant differences which helped us to conclude that one can use staplers with similar safety and accuracy as hand suturing method

Cognitive and Socio-Emotional Deficits in Platelet-Derived Growth Factor Receptor-β Gene Knockout Mice

Platelet-derived growth factor (PDGF) is a potent mitogen. Extensive in vivo studies of PDGF and its receptor (PDGFR) genes have reported that PDGF plays an important role in embryogenesis and development of the central nervous system (CNS). Furthermore, PDGF and the β subunit of the PDGF receptor (PDGFR-β) have been reported to be associated with schizophrenia and autism. However, no study has reported on the effects of PDGF deletion on mice behavior. Here we generated novel mutant mice (PDGFR-β KO) in which PDGFR-β was conditionally deleted in CNS neurons using the Cre/loxP system. Mice without the Cre transgene but with floxed PDGFR-β were used as controls. Both groups of mice reached adulthood without any apparent anatomical defects. These mice were further examined by conducting several behavioral tests for spatial memory, social interaction, conditioning, prepulse inhibition, and forced swimming. The test results indicated that the PDGFR-β KO mice show deficits in all of these areas. Furthermore, an immunohistochemical study of the PDGFR-β KO mice brain indicated that the number of parvalbumin (calcium-binding protein)-positive (i.e., putatively γ-aminobutyric acid-ergic) neurons was low in the amygdala, hippocampus, and medial prefrontal cortex. Neurophysiological studies indicated that sensory-evoked gamma oscillation was low in the PDGFR-β KO mice, consistent with the observed reduction in the number of parvalbumin-positive neurons. These results suggest that PDGFR-β plays an important role in cognitive and socioemotional functions, and that deficits in this receptor may partly underlie the cognitive and socioemotional deficits observed in schizophrenic and autistic patients

A two-year retrospective study of maternal mortality in tertiary care hospitals in South India

Background: The death of a woman during pregnancy or within 42 completed days after delivery of the baby, irrespective of the duration or site of pregnancy, from any cause related to or aggravated by pregnancy, but not from accidental or incidental causes is labelled as maternal mortality. The study was conducted with the objectives to assess the existing MMR and the causes of maternal mortality over 2 years in a tertiary care hospital. Methods: Retrospective study done from March 2021 to February 2023 at RIMS Raichur. The medical records of all maternal death over 2 years were reviewed and analysed. The data of all the maternal deaths during the study period at the department of Obstetrics & Gynecology, RIMS Raichur were recorded using a predesigned and semistructured questionnaire. Results: A total of 75 deaths were assessed over 2 years and MMR was calculated to be 726.5/1 lakh live births. Most of the maternal deaths occurred in the age group of 21-30 years (73.3%), most maternal deaths were observed in primipara (30.7%), 32% of deaths occurred within 24 hours of admission. Hypertensive disorders in pregnancy (32%) were the leading direct cause followed by non-obstetric complications (17%), and haemorrhage (16%). Conclusion: To reduce maternal mortality, the crucial work starts at the grassroots level. Most deaths could have been prevented with the help of early referral, quick efficient transport facilities and the availability of blood and its products

A Rare Case of Reversible Encephalopathy Syndrome Accompanying Late Postpartum Eclampsia or Hypertensive Encephalopathy-A Clinical Dilemma

Posterior Reversible Encephalopathy Syndrome (PRES) refers to a clinic-radiologic diagnosis. Clinically it is characterized by non specific symptoms such as headache, confusion, visual disturbances and seizures. The radiological findings in PRES are thought to be due to vasogenic oedema, predominantly in the posterior cerebral hemispheres, and are reversible with appropriate management. We report a case of reversible encephalopathy diagnosed by MRI scan occurring in atypical areas like the caudate and lentiform nuclei of the brain following an uneventful lower segment caesarean section in a normotensive patient, who was successfully treated with antihypertensives, anticonvulsants and supportive treatment. The differential diagnosis of convulsions in the post-partum period is discussed