Acute abdomen in pregnancy: a case series on clinical presentation and diagnostic dilemma

Acute abdomen in pregnancy remains one of the most challenging situation in regard with the diagnosis and management. Pregnancy is a unique state in which the female body undergoes both anatomical and physiological changes which can pose a challenge in diagnosis. This may result in delay in management and increase in maternal and fetal morbidity and mortality. This study was to identify the spectrum of causes, the clinical presentation and diagnostic dilemma of acute abdomen in pregnancy. It was an observational study was done over a period of 3 years which included all the pregnant women who presented with acute abdomen. In this study, eighteen pregnant women presented with acute abdomen. Among the study group, 5.5%, 50% and 44.5% presented in first, second and third trimester respectively. The diagnosis included acute appendicitis in 11.1%, acute cholecystitis in 16.6%, acute pancreatitis in 16.6%, malrotation in 11.1%, uterine rupture 11.1%, rudimentary horn rupture in 22.4% and ovarian cyst torsion in 11.1%. The clinical presentation included pain abdomen (16.6%), pain abdomen and vomiting (44.4%), pain abdomen in shock (39%) and abdominal tenderness (33.3%). The diagnosis was confirmed with ultrasonography in 55.6%, 11.1% women required higher imaging like magnetic resonance imaging (MRI) and 33.3% women were diagnosed on table. Majority of them had good outcome, but there was one maternal mortality (6%). Diagnosis and treatment of acute abdomen in pregnancy should be individualized. Good clinical acumen is essential for ordering early diagnostic test in acute abdomen in pregnancy. Appropriate intervention should be undertaken at the earliest to reduce the maternal and fetal complications.

Zoonotic Tuberculosis: A Concern and Strategies to Combat

Mycobacterium bovis is the main causal agent of bovine tuberculosis that causes zoonotic tuberculosis in humans. The most common routes of transmission of the agent to human are airborne transmission, consumption of unpasteurized milk, direct contact with infected animals or untreated animal products. Conventional diagnostic methods in combination with modern molecular and immunological techniques should be used for early and accurate diagnosis of the disease. Some of the challenges to tackle and eradicate zoonotic TB in developing countries are having many hosts, absence of early diagnosis, presence of other acute diseases, being economically unable to implement control strategies, and other social and cultural issues. Usually treatment is not recommended in animals but vaccination is carried out in some countries as a preventive measure. Due to the grave consequences of M. bovis infection on animal and human health, it is necessary to introduce accurate control measures to reduce the risk of disease in human and animal populations. Proper food hygiene practices, slaughter of the affected animals in developed countries, and segregation of the suspected animals in developing countries along with stronger intersectoral collaboration between the veterinary and medical professions are important for the control of the disease

Antioxidant, antimicrobial and cytotoxic activity of Curkolin® (Curcuma longa and Coleus forskohlii formulation)

The aim of this study was to screen the in vitro antimicrobial, antioxidant and cytotoxicity effect of Curkolin®, a combination of curcumin and C. forskolin in the ratio 4:1. Curcuma longa L. is the source of curcumin while C. forskohlii has been used in traditional ayurvedic medicine for curing various disorders and therefore the forskolin is the source of the diterpenoids. The medicinal properties of plants are investigated throughout the world for scientific advancement for their important pharmacological activities, user convenient, economically viable with low toxicity. The antioxidant property of Curkolin® was determined to be 55.42 µg/ml using (Diphenyl picryl hydrazine) DPPH assay and was then compared with standard Butylated hydroxytoluene (BHT). The antimicrobial activity was assessed by calculating the MIC and MBC using microplate serial dilution technique. It exhibited 250 µg/ml, the least MIC value of Bacillus cereus as compared to the rest Gram-positive (Streptococcus mutans and Staphylococcus aureus) and Gram-negative (Escherichia coli and Salmonella typhi) bacteria. Further, it was analyzed for cytotoxic screening on MCF-7 breast cancer cell line by MTT assay, which has shown a strong anti-proliferative activity. The IC50 values of Curkolin® were found 135.8 μg/ml. Together these results suggest the combination to be an effective antioxidant, antimicrobial and cytotoxic agent

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Anomalous Peak Effect in CeRu2 and NbSe2 : Fracturing of a Flux Line Lattice?

CeRu2 and 2H-NbSe2 display remarkable similarities in their magnetic response, reflecting the manner in which the weakly pinned flux line lattice (FLL) loses spatial order in the Peak Effect (PE) regime. The discontinuous change in screening response near the onset of PE and the history dependence in it are attributed to a disorder-induced fracturing transition of the FLL, as an alternative to the scenario involving the appearance of a spatial modulation in superconducting order parameter in CeRu2.Comment: 4 pages of text and figures in ps for

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Recurrent PTPRB and PLCG1 mutations in angiosarcoma

Angiosarcoma is an aggressive malignancy that arises spontaneously or secondarily to ionizing radiation or chronic lymphoedema. Previous work has identified aberrant angiogenesis, including occasional somatic mutations in angiogenesis signaling genes, as a key driver of angiosarcoma. Here we employed whole-genome, whole-exome and targeted sequencing to study the somatic changes underpinning primary and secondary angiosarcoma. We identified recurrent mutations in two genes, PTPRB and PLCG1, which are intimately linked to angiogenesis. The endothelial phosphatase PTPRB, a negative regulator of vascular growth factor tyrosine kinases, harbored predominantly truncating mutations in 10 of 39 tumors (26%). PLCG1, a signal transducer of tyrosine kinases, encoded a recurrent, likely activating p.Arg707Gln missense variant in 3 of 34 cases (9%). Overall, 15 of 39 tumors (38%) harbored at least one driver mutation in angiogenesis signaling genes. Our findings inform and reinforce current therapeutic efforts to target angiogenesis signaling in angiosarcoma