The association between prior appendicectomy and/ or tonsillectomy in females and subsequent pregnancy rate: A cohort study

OBJECTIVE: To study pregnancy rates after appendectomy and/or tonsillectomy. DESIGN: Population-based cohort study using the United Kingdom (U.K.) primary health care–based Clinical Practice Research Datalink (CPRD). SETTING: Not applicable. PATIENT(S): Female patients who underwent appendectomy, tonsillectomy, or both from 1987 to 2012 and appropriate comparators. INTERVENTION(S): Timed follow-up until first pregnancy after surgery. The association between prior surgery and subsequent pregnancy was determined with the use of Cox regression models. MAIN OUTCOMES AND MEASURE(S): Pregnancy rate and time to first pregnancy after surgery. RESULT(S): The analyses included 54,675 appendectomy-only patients, 112,607 tonsillectomy-only patients, 10,340 patients who had both appendectomy and tonsillectomy, and 355,244 comparators matched for exact age and practice from the rest of female patients in the database. There were 29,732 (54.4%), 60,078 (53.4%), and 6,169 (59.7%) pregnancies in the appendectomy-only, tonsillectomy-only, and both appendectomy tonsillectomy cohorts, respectively versus 155,079 (43.7%) in the comparator cohort during a mean follow-up of 14.7 ± 9.7 years. Adjusted hazard ratios (HRs) for subsequent birth rates were 1.34 (95% confidence interval [CI] 1.32–1.35), 1.49 (95% CI 1.48–1.51), and 1.43 (95% CI 1.39–1.47), respectively. Time to pregnancy was shortest after both appendectomy and tonsillectomy followed by appendectomy only and then tonsillectomy only compared with the rest of the population. CONCLUSIONS(S): Appendectomy and/or tonsillectomy was associated with increased subsequent pregnancy rates and shorter time to pregnancy. The effect of the surgical procedures on the pregnancy outcome was cumulative

Diaphragmatic hernia following oesophagectomy for oesophageal cancer – Are we too radical?

Background: Diaphragmatic herniation (DH) of abdominal contents into the thorax after oesophageal resection is a recognised and serious complication of surgery. While differences in pressure between the abdominal and thoracic cavities are important, the size of the hiatal defect is something that can be influenced surgically. As with all oncological surgery, safe resection margins are essential without adversely affecting necessary anatomical structure and function. However very little has been published looking at the extent of the hiatal resection. We aim to present a case series of patients who developed DH herniation post operatively in order to raise discussion about the ideal extent of surgical resection required. Methods: We present a series of cases of two male and one female who had oesophagectomies for moderately and poorly differentiated adenocarcinomas of the lower oesophagus who developed post-operative DH. We then conducted a detailed literature review using Medline, Pubmed and Google Scholar to identify existing guidance to avoid this complication with particular emphasis on the extent of hiatal resection. Discussion: Extended incision and partial resection of the diaphragm are associated with an increased risk of postoperative DH formation. However, these more extensive excisions can ensure clear surgical margins. Post-operative herniation can be an early or late complication of surgery and despite the clear importance of hiatal resection only one paper has been published on this subject which recommends a more limited resection than was carried out in our cases. Conclusion: This case series investigated the recommended extent of hiatal dissection in oesophageal surgery. Currently there is no clear guidance available on this subject and further studies are needed to ascertain the optimum resection margin that results in the best balance of oncological parameters vs. post operative morbidity

PRELIMINARY ANALYTICAL STUDY OF SAINDHAVADYA GHRUTA

Ghruta is considered best among the Snehas. Its usage is being highlighted by our Acharyas in the disorders of brain like Unmada, Apasmara etc. This study focuses on one such preparation Saindhayadya ghruta mentioned in Yogaratnaka Apasmara chikitsa. Literary review done through various sources like books, journals and internet revealed that, no studies have been carried out on this formulation yet. Hence an attempt was made to study Saindhayadya ghruta through qualitative and quantitative analysis of Physico-chemical parameters and to develop fingerprints of High-Performance Thin Layer chromatography study (HPTLC). HPTLC densitometric scan of chloroform extract of unsaponifiable matter of Saindhvadhya Ghruta showed 9 and 6 spots at 254nm and 366nm respectively. To interpret the results, there are no previous standard markers established for Saindhavadya ghruta. This analytical profile may help in the identification of Saindhavadya ghruta in future and to maintain the standard quality of the formulation

Mannose-binding lectin deficiency in preterm neonates

Background: Mannose-binding lectin (MBL) is a collagenous protein that plays a role in innate immunity. MBL deficiency is associated with an opsonization defect and has been associated with recurrent infections, especially in immunocompromised individuals. Neonates are considered to be immunocompromised because adaptive immunity has not yet been developed. Objective: This study was done to evaluate the levels of MBL in premature neonates and to determine the relation between MBL deficiency and development of sepsis. Methods: This case- control study was conducted on 64 neonates classified into 2 groups; 39 preterm neonates with gestational age (G.A) <36 weeks and 25 healthy full term neonates. Measurement of mannose-binding lectin (MBL) serum level was done on the first day of life using ELISA technique. Results: Mean MBL plasma level was found to be lower in preterm than full term neonates, yet this difference did not reach statistical significance. There was a negative correlation albeit an insignificant one, between MBL level and GA. The deficient group (those with MBL level ≤0.7μg/ml) had higher incidence of sepsis, albeit an insignificant one, than the non deficient group. A highly significant positive correlation was demonstrated between MBL plasma level in neonatal and umbilical cord blood samples. Conclusion: Premature neonates have low MBL serum levels which could be measured in either their venous or umbilical cord blood efficiently. Further studies are needed to investigate the relationship between MBL deficiency and neonatal sepsis and whether measuring MBL levels might be used to identify which neonates are prone to infections.Keywords: Mannose binding lectin, neonates, preterm, sepsisEgypt J Pediatr Allergy Immunol 2010;8(2):75-8

Planting methods, subsurface drip fertigation and bioinoculants on growth and productivity of vetiver [Vetiveria zizanioides (L.) Nash]

A field experiment was conducted to study the effect of three planting methods, (planting in coconut husk mulched trenches, planting in coconut husk lined trenches and planting on the ridges), two levels of fertigation (subsurface drip fertigation and without fertigation) and two levels of bioinoculants (combined application of bioinoculants and without bioinoculant) on growth and productivity of vetiver. The study revealed that planting vetiver slips in coconut husk lined trenches could considerably increase vegetative growth, root yield, net returns and B: C ratio. Subsurface drip fertigation and combined application of bioinoculants with Azospirillum, Fluorescent pseudomonads and AM fungi showed positive effect on growth characters and root yield. However, subsurface drip fertigation was not effective in increasing net income. &nbsp

Serum zinc and copper levels: a marker of disease activity in senile cataract patients

Background: The present study was aimed to study alterations in levels of zinc and copper in senile cataract patients.Methods: 25 senile cataract patients in age group of 50 to 80 years and 25 control group were included in the study. Serum zinc and copper levels were determined by colorimetric method.Results: Significantly increased levels of serum zinc in cataract patients (199.8±24.32 µg/dl) were found as compared to controls (85.80±3.6 µg/dl) (p<0.0001). Serum copper concentration in cataract patients (249.5±34.59 µg/dl) were significantly (<0.0001) increased when compared to controls (125.7±4.66 µg/dl).Conclusions: Copper and zinc are involved in the pathogenesis of cataracts by different mechanisms such as damaging lipid membranes and lens capsule, crosslinking and in solubilization of lens proteins, leakage of beta and gamma crystalline into the aqueous humour through the production of hydroxyl radicals and peroxyl radicals. So, abnormal elevation of serum copper and zinc can be used as a marker in the opacification of the lens cortex in age-related human cataract

Oxidative stress versus inflammation, a better predictor of cardiovascular disease risk in polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is also known as hyperandrogenic anovulation (HA) or Stein-Leventhal syndrome. PCOS has a diverse range of causes that are not entirely understood, but there is evidence that it is largely a genetic disease. Aim of the study was to evaluate better predictor of cardiovascular disease risk in women with polycystic ovary syndrome.Methods: 50 diagnosed patients of PCOS and 50 age matched healthy females were included in this study. Cases were diagnosed based on new Rotterdam criteria formulated by the American Society for Reproductive Medicine (ASRM). Fasting Blood samples were collected. Serum High sensitivity-C reactive protein (hs-CRP) and Malondialdehyde (MDA) were estimated.Results: Results were analyzed using unpaired t-test and p-value was calculated. Statistically non-significant increased levels of serum hs-CRP in PCOS cases as compared with controls were observed. MDA was found to be significantly increased in cases as compared to controls. ROC curve analysis shows MDA as a more specific predictor of cardiovascular disease risk in PCOS compared to hs-CRP.Conclusions: Increase in the serum MDA level indicates increased formation of reactive oxygen species and lipid peroxidation which leads to increased oxidative stress and this may increase cardiovascular disease risk in PCOS. hs-CRP a marker of chronic inflammation was not significantly increased in PCOS

Soft-tissue metastasis revealing a pancreatic adenocarcinoma: One case report and a review of literature

Soft tissue metastases from pancreatic adenocarcinoma are rare lesions and can be the source of diagnostic confusion both clinically and pathologically. To our knowledge, one patient has been reported on with soft tissue lesions that ultimately disclose a pancreatic adenocarcinoma. We report here on a patient who presented with a metastatic soft tissue lesion in the trochanter, and the buttocks, as the initial manifestation of pancreatic adenocarcinoma. Soft tissue metastasis from pancreatic carcinoma is a rare finding. Clinicians should be aware that metastatic soft tissue lesions could be the initial presenting sign for pancreatic cancer. Also, the immunohistochemical staining for CK 7 and 19 may be helpful for the diagnosis of metastatic pancreatic adenocarcinoma