A Comparative Clinical Study on the effect of Tankana Ksharasutra and Apamarga Ksharasutra in the management of Bhagandara (Fistula In Ano)

Fistula in Ano is very common surgical condition necessitating safe treatment modality as open surgery may result anal incontinence in most of the time. Fistula-in-Ano is one such disease where ideal care delivery is still a challenge. It may be because of nature of disease, regional anatomy, hygiene, etc. Though in this disease many Ksharasutras are tried, Apamarga Ksharasutra is widely being practiced. When we go through the classics, we get reference regarding Tankana grouped into Kshara Dravyas. This Tankana is not widely practiced. Apamarga Kshara is very effective but preparation of this Apamarga Kshara is not at all a easy process. It needs burning of lot of Apamarga plants, then process including boiling etc, and at the end we get very little quantity of final product. In the other hand Tankana, as per reference, is also Kshara, cost effective and abundantly available hence this study is planned to evaluate the efficacy of Tankana Ksharasutra in the management of Fistula in Ano which is referred as Bhagandara in Ayurveda

Advancement in Reperfusion Injury Awareness and Mitigation

Understanding reperfusion damage, raising knowledge of its underlying processes, and creating measures to lessen its negative consequences have all seen significant progress over time. The developing knowledge of the pathophysiological processes, such as oxidative stress, inflammation, calcium excess, and mitochondrial dysfunction, that lead to reperfusion damage. Clinicians may now identify biomarkers and use modern imaging techniques to identify reperfusion damage in its early phases, allowing for prompt treatment and better patient outcomes. Real-time evaluation of tissue viability during reperfusion is now possible thanks to the development of non-invasive monitoring techniques, which supports clinical judgment. The use of pharmaceutical substances that target certain pathways, such as antioxidants, anti-inflammatory substances, and calcium homeostasis regulators. Additionally, cutting-edge approaches like therapeutic hypothermia and remote ischemia conditioning have demonstrated promise in lowering reperfusion damage and enhancing patient prognosis. Our knowledge of the underlying processes has considerably increased thanks to improvements in reperfusion injury recognition and mitigation, which have also created new opportunities for therapeutic intervention. These developments are anticipated to result in more efficient methods for reducing reperfusion damage and eventually enhance patient outcomes in a variety of therapeutic situations via continuing study and cooperation

Open appendicectomy stump: invaginate or not to invaginate?

Acute appendicitis remains the most common abdominal surgical emergency. Appendicectomy is the standard treatment of acute appendicitis, which performed by open or laparoscopic approach. During open method, after removal of appendix, stump simple ligation or simple ligation and invagination. A prospective randomized study conducted at Smt SCL General Hospital, Smt NHL municipal Medical College, Ahmedabad between October 2009 to September 2011 to evaluate the necessity of appendicular stump invagination during appendicectomy. A total 110 patients were studied and randomized into two group, Group I stump simple ligation, transfixation and invagination and Group II stump simple ligation and transfixation only. There was no statically significant difference in the rate of postoperative complication and post operative hospital stay between the two groups. The mean operating time was significantly shorter in group without invagination. The rate of postoperative paralytic ileus was more in group I. We conclude that simple ligation of the appendicular stump during appendicectomy is safe, simple and shortens operating time

Short pediatric Crohnʼs disease activity index for quality improvement and observational research:

Practical and objective instruments to assess pediatric Crohn’s disease (CD) activity are required for observational research and quality improvement

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Spatial Organization and Molecular Correlation of Tumor-Infiltrating Lymphocytes Using Deep Learning on Pathology Images

Beyond sample curation and basic pathologic characterization, the digitized H&E-stained images of TCGA samples remain underutilized. To highlight this resource, we present mappings of tumorinfiltrating lymphocytes (TILs) based on H&E images from 13 TCGA tumor types. These TIL maps are derived through computational staining using a convolutional neural network trained to classify patches of images. Affinity propagation revealed local spatial structure in TIL patterns and correlation with overall survival. TIL map structural patterns were grouped using standard histopathological parameters. These patterns are enriched in particular T cell subpopulations derived from molecular measures. TIL densities and spatial structure were differentially enriched among tumor types, immune subtypes, and tumor molecular subtypes, implying that spatial infiltrate state could reflect particular tumor cell aberration states. Obtaining spatial lymphocytic patterns linked to the rich genomic characterization of TCGA samples demonstrates one use for the TCGA image archives with insights into the tumor-immune microenvironment

Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease 12:

Obesity is a significant public health threat to children in the United States

Derivation and validation of a novel risk assessment tool to identify children aged 2-59 months at risk of hospitalised pneumonia-related mortality in 20 countries

INTRODUCTION: Existing risk assessment tools to identify children at risk of hospitalised pneumonia-related mortality have shown suboptimal discriminatory value during external validation. Our objective was to derive and validate a novel risk assessment tool to identify children aged 2-59 months at risk of hospitalised pneumonia-related mortality across various settings. METHODS: We used primary, baseline, patient-level data from 11 studies, including children evaluated for pneumonia in 20 low-income and middle-income countries. Patients with complete data were included in a logistic regression model to assess the association of candidate variables with the outcome hospitalised pneumonia-related mortality. Adjusted log coefficients were calculated for each candidate variable and assigned weighted points to derive the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) risk assessment tool. We used bootstrapped selection with 200 repetitions to internally validate the PREPARE risk assessment tool. RESULTS: A total of 27 388 children were included in the analysis (mean age 14.0 months, pneumonia-related case fatality ratio 3.1%). The PREPARE risk assessment tool included patient age, sex, weight-for-age z-score, body temperature, respiratory rate, unconsciousness or decreased level of consciousness, convulsions, cyanosis and hypoxaemia at baseline. The PREPARE risk assessment tool had good discriminatory value when internally validated (area under the curve 0.83, 95% CI 0.81 to 0.84). CONCLUSIONS: The PREPARE risk assessment tool had good discriminatory ability for identifying children at risk of hospitalised pneumonia-related mortality in a large, geographically diverse dataset. After external validation, this tool may be implemented in various settings to identify children at risk of hospitalised pneumonia-related mortality

Prediction of complicated disease course for children newly diagnosed with Crohn's disease: a multicentre inception cohort study

Stricturing and penetrating complications account for substantial morbidity and health-care costs in paediatric and adult onset Crohn’s disease. Validated models to predict risk for complications are not available, and the effect of treatment on risk is unknown

Analysis of Using the Total White Blood Cell Count to Define Severe New-onset Ulcerative Colitis in Children

Objectives: The aim of this study was to assess common laboratory tests in identifying severe ulcerative colitis in children at diagnosis. Methods: A cohort of 427 children 4 to 17 years of age newly diagnosed with ulcerative colitis (UC) was prospectively enrolled. Boosted classification trees were used to characterize predictive ability of disease attributes based on clinical disease severity using Pediatric Ulcerative Colitis Activity Index (PUCAI), severe (65+) versus not severe (<65) and total Mayo score, severe (10-12) versus not severe (<10); mucosal disease by Mayo endoscopic subscore, severe (3) versus not severe (<3); and extensive disease versus not extensive (left-sided and proctosigmoiditis). Results: Mean age was 12.7 years; 49.6% (n = 212) were girls, and 83% (n = 351) were Caucasian. Severe total Mayo score was present in 28% (n = 120), mean PUCAI score was 49.8 ± 20.1, and 33% (n = 142) had severe mucosal disease with extensive involvement in 82% (n = 353). Classification and regression trees identified white blood cell count, erythrocyte sedimentation rate, and platelet count (PLT) as the set of 3 best blood laboratory tests to predict disease extent and severity. For mucosal severity, albumin (Alb) replaced PLT. Classification models for PUCAI and total Mayo provided sensitivity of at least 0.65 using standard clinical cut-points with misclassification rates of approximately 30%. Conclusions: A combination of the white blood cell count, erythrocyte sedimentation rate, and either PLT or albumin is the best predictive subset of standard laboratory tests to identify severe from nonsevere clinical or mucosal disease at diagnosis in relation to objective clinical scores