Laparoscopic surgery for Crohn’s disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery

BACKGROUND: Previous meta-analyses have had conflicting conclusions regarding the differences between laparoscopic and open techniques in patients with Crohn’s Disease. The objective of this meta-analysis was to compare outcomes in patients with Crohn’s disease undergoing laparoscopic or open surgical resection. METHODS: A literature search of EMBASE, MEDLINE, The Cochrane Central Register of Controlled Trials and the US National Institute of Health’s Clinical Trials Registry was completed. Randomized clinical trials and non-randomized comparative studies were included if laparoscopic and open surgical resections were compared. Primary outcomes assessed included perioperative complications, recurrence requiring surgery, small bowel obstruction and incisional hernia. RESULTS: 34 studies were included in the analysis, and represented 2,519 patients. Pooled analysis showed reduced perioperative complications in patients undergoing laparoscopic resection vs. open resection (Risk Ratio 0.71, 95% CI 0.58 – 0.86, P = 0.001). There was no evidence of a difference in the rate of surgical recurrence (Rate Ratio 0.78, 95% CI 0.54 – 1.11, P = 0.17) or small bowel obstruction (Rate Ratio 0.63, 95% CI 0.28 – 1.45, P = 0.28) between techniques. There was evidence of a decrease in incisional hernia following laparoscopic surgery (Rate Ratio 0.24, 95% CI 0.07 – 0.82, P = 0.02). CONCLUSIONS: This is the largest review in this topic. The results of this analysis are based primarily on non-randomized studies and thus have significant limitations in regards to selection bias, confounding, lack of blinding and potential publication bias. Although we found evidence of decreased perioperative complications and incisional hernia in the laparoscopic group, further randomized controlled trials, with adequate follow up, are needed before strong recommendations can be made

Ectopic pregnancy in a case of congenital mullerian anomaly: a diagnostic dilemma

Ectopic or extrauterine pregnancy occurring in a case with mullerian defect is very rare and poses diagnostic challenges. Undescended and non-communicating fallopian tubes are extremely rare mullerian anomalies. Here authors present a case of ectopic pregnancy occurring in an undescended non-communicating fallopian tube in a patient with unicornuate uterus with absent horn, which was managed laparoscopically. A 32-year-old lady, diagnosed case of left unicornuate uterus with absent right horn, was referred to us with the suspicion of ruptured ectopic pregnancy. The abdominopelvic ultrasound showed a soft tissue lesion of size 32×24 mm, towards the right lateral pelvic wall near the iliac vessels, with increased vascularity on colour flow doppler.  The patient underwent laparoscopy which showed left sided unicornuate uterus with normal left tube and ovary. The right uterine horn was absent.  An undescended right ovary and tube were found attached to the peritoneum at the level of pelvic brim along the right lateral pelvic wall.  Right sided tubal ectopic pregnancy with rupture was present along with 300-350 cc of hemoperitoneum. The patient was treated with laparoscopic right sided total salpingectomy. In patients with unicornuate uterus and atypical presentation, ectopic pregnancy should be ruled out in an undescended non-communicating fallopian tube. Salpingectomy of incidentally diagnosed non-communicating fallopian tubes is recommended to prevent future ectopic pregnancy

Clinical and endoscopic features of pill-induced esophagitis

Background: Medication can cause an injury in the esophagus by local and systemic effect, leading to esophagitis. Many such medications have been identified as a cause of pill-induced esophagitis. This study was performed to evaluate the clinical and endoscopic findings of pill-induced esophagitis.Methods: This was retrospective observational study, conducted among patients diagnosed endoscopically with pill-induced esophagitis at Ansh gastroenterology clinic, Ahmedabad, India, from April 2017 to March 2021. The data of these patients were recorded in pre-designed case record form by evaluating their past medical records.Results: Total 90 patients were diagnosed with pill-induced esophagitis. Retrosternal chest pain (68.9%), odynophagia (41.1%), dysphagia (25.6%), and epigastric pain (14.4%) were common clinical findings. The major culprit medications were antibiotics, and NSAIDs (non-steroidal anti-inflammatory drugs). Common esophageal endoscopic findings were ulcer (84.4%), erosion (17.8%), and active ulcer bleeding (12.2%). Kissing ulcers were observed in the majority (46.7%) of cases. The majority of ulcer and erosion were located in middle third of the esophagus. All the patients were recovered within 6 to 10 days after treatment with PPIs (proton pump inhibitors) and/or antacids, and withdrawal of the causative medication.Conclusions: Pill-induced esophagitis commonly manifests as retrosternal chest pain, odynophagia and dysphagia, and endoscopy reveals kissing ulcer and erosion in the majority of cases. The condition can be treated with PPIs and/or antacids, and withdrawal of the offending medication.

Prevalence of Health Problems, Professional and Financial Satisfaction among Doctors Working Across Vadodara City: A Cross-sectional Study

Background: The present study was conducted to know the distribution of various health problems among doctors and to assess professional and financial satisfaction levels among doctors. Methods: A Google Form questionnaire-based cross-sectional study was conducted among 122 doctors in Vadodara selected purposively after taking consent. Google form was circulated by email and WhatsApp groups. The form consisted of questions related to demographic details, health problems, financial and job satisfaction. All the responses were recorded and analyzed in MS Excel 2019. Results: Among the 122 doctors, 89 (72.95%) were male and 33 (27.04%) were female and 101 (82.78%) doctors were taking treatment for some ailment. Around 86.9% of doctors regularly opt for a health check-up. Among the health problems reported by doctors, the most common were musculoskeletal ailments (72.13%) followed by hypertension (28.9%), diabetes (17.2), cardiac (12.3%), endocrinal (10.65%), eye (9.01), mental (6.55) problems. Approximately 37.70% of doctors answered that health problems temporarily affect their work; 5.73% of doctors felt the need to modify their work pattern. About 91.80% of doctors were satisfied by their profession, while 108 (88.52%) doctors were financially satisfied with their work. Conclusion: More than half of the professionals complained of musculoskeletal problems. The majority of health care professionals were professionally and financially satisfied

Adsorptive column studies for removal of acid orange 7 dye using bagasse fly ash

319-327Increasing industrialization creates a large scale of pollution and affects the availability of usable water. Dyes in wastewater are a visible pollutant, difficult to treat, and are toxic in nature. Amongst all the physicochemical methods, adsorption is the extensively applied process for the aqueous removal of dye. In the present study; the Bagasse Fly Ash (BFA) is used as an adsorbent for aqueous removal of Acid Orange dye in packed bed adsorption technique. The packed bed studies for different bed heights, influent concentration and flow rate are performed. The efficacy of packed columns is investigated using different models namely Bed depth service time, Thomas, Wolborsaka, Yoon-Nelson, and Bohart-Adams Models. The maximum adsorption capacity of BFA for 50% saturation of column is calculated to be 38 (mg/g) which shows BFA as a good adsorbent for dye removal

MicroRNAs as prognostic markers in acute coronary syndrome patients : a systematic review

Background: The potential utility of microRNAs (miRNAs) in the diagnosis, prognosis, and treatment of multiple disease states has been an area of great interest since their discovery. In patients with cardiovascular disease, there is a large pool of literature amassed from the last decade assessing their diagnostic and prognostic potential. This systematic review sought to determine whether existing literature supports the use of miRNAs as prognostic markers after an Acute Coronary Syndrome (ACS) presentation. Methods: A systematic review of published articles from 2005-2019 using MEDLINE and EMBASE databases was undertaken independently by two reviewers. Studies addressing prognosis in an ACS population yielded 32 studies and 2 systematic reviews. Results/conclusion: 23 prospective studies reported significant differences in miRNA levels and 16 compared the predictive power of miRNAs. The most common miRNAs assessed included miR-133a, -208b, -21, -1, -34a, -150, and -423, shown to be involved in cell differentiation, apoptosis, and angiogenesis. Barriers to the use of miRNAs as prognostic markers include bias in miRNA selection, small sample size, variable normalization of data, and adjustment for confounders. Therefore, findings from this systematic review do not support the use of miRNAs for prognostication post-ACS beyond traditional cardiovascular risk factors, existing risk scores, and stratifications tools

Role of diagnostic hysterolaparoscopy in the evaluation of infertility

Background: Infertility has become nowadays not only a medical, but a social problem as well. None of the laboratory findings alone is conclusive in diagnosing infertility. Diagnostic hysterolaparoscopy is an accurate method of assessing and treating infertility. Direct visualization of abdominal and pelvic organs in hysteroscopy and laparoscopy allows a definite diagnosis where clinical examination and less invasive techniques such as ultrasound, SSG and HSG fail to identify the problem. The main objective of study was to determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centers.Methods: A prospective hospital based study was carried out in two tertiary care centers (Sheth V.S. General Hospital and Smt. S.C.L. Municipal Hospital) over a period of 2 years from July 2013 to June 2015. Hysterolaparoscopy was done in 300 patients. Women aged 20-40 years with normal hormone profile without male factor infertility were included.Results: Out of 300 cases, 206 (69%) patients had primary infertility. While laparoscopy detected abnormalities in 35% of the cases, significant hysteroscopy findings were noted in 17% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14%) and adnexal adhesions (12%) in primary and secondary infertile patients respectively, on hysteroscopy, intrauterine septum was found as the commonest abnormality in both the groups.Conclusions: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions and subseptate uterus, which are usually missed by other imaging modalities

EFFECTIVENESS OF TRIPLE DRUG FIXED DOSE COMBINATION INHALED THERAPY IN SEVERE COPD PATIENTS

Rationale: According to GOLD 2018 guidelines, inhaled corticosteroids are recommended along with long acting muscarinic antagonist (LAMA) and long acting beta-2 agonist (LABA) inhaler medications in Group D COPD patients who show frequent exacerbations and symptom severity. Therefore, the use of triple drug inhaled medication in such severe COPD patients become necessary. Objectives: To know the effectiveness of inhaled triple drug medication in relation to spirometry, exercise tolerance, symptom control and prevention of exacerbations in severe COPD patients. Method: 25 severe COPD patients were included in this hospital based study. Before initiating the triple drug inhaled medication the baseline parameters such as spirometry ( FEV1), exercise tolerance (6 minute walking distance) and symptom control(CAT score, MMRC dyspnoea grading) are measured. 2 monthly follow-up till 6months of the study period is done. At each visit all the baseline parameters are reassessed. Result: There is statistically significant (p=<0.01) improvement in the FEV1, CAT scoring, MMRC grading, 6 Minute Walking Distance in the 25 subjects following initiation of treatment with the triple drug inhaler medication over 6months observation period. Conclusion: Triple drug inhaler medication in severe COPD patients is effective in improving airflow obstruction, symptom control, exercise tolerance and prevention of exacerbations

Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries.

BACKGROUND: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. METHODS: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. RESULTS: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. CONCLUSIONS: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care