Management and pattern of pellet gun injuries in war conflicted Kashmir Valley, India

AbstractBackground: The pellet gun is a shot gun weapon which is used by law enforcement agencies to maintain law and order in conflict zones whenever need arises. Sometimes these minute sized pellets may lead to grave injuries to vital structures of the body which may sometimes led to permanent disability. The objective of this study was to investigations and manages these fatal injuries in war conflicted valley. Methods: The prospective study conducted in a tertiary care hospital of Government Medical College Srinagar at the time of civilian unrest in 2016 and onwards when thousands of people were injured with pellets by security agencies. Results: Maximum number (67.1%) of patients had injuries to eyes and face, among the total number of patients 69 (17.2%) of patients had abdominal injuries. CECT abdomen showed pellets in all 69 (100%) of patients, pellets in gut lumen in 48 (69.5%) of patients. In the abdominal group 40 patients underwent laparotomy which showed hemoperitoneum in 49 (71.01%), pneumoperitoneum in 6 (8.69%) of patients. Conclusion: Pellet gun weapon has become a common arsenal to suppress the unarmed civilian agitation which may lead to fatal injuries to vital structures of body, where prognosis remained poor despite of best available treatment

Role of colonoscopy in haemorrhoids with other colorectal disorders

Background: Haemorrhoids are the enlargement or engorgement of the normal fibrovascular anal cushions. These fibrovascular cushions lose their attachment to the underlying rectal wall and lead to prolapse with repeated straining over time, thinning of rectal mucosa and subsequent bleeding. The objective of the present endeavour was to study the prevalence of associated colorectal lesions like colonic carcinoma, diverticular disease, inflammatory bowel disease which present the rectal bleeding and role of colonoscopy in these lesionsMethods: This study was conducted in hundred fifty patients presenting with bleeding and haemorrhoids were analyzed. All patients were examined locally and endoscopically. All significant endoscopic findings (diverticuli, polyps, cancer, angiodysplasia and varices or colitis) were recorded.Results: Majority of patients were males (102), accounting for (68 percent). The main symptom at the time of presentation was rectal bleeding (90 percent). The digital rectal examination was normal in 114 patients. The commonest finding on proctoscopy examination was haemorrhoids. Colonoscopy showed haemorrhoids in maximum patients (147 percent). The associate lesions with altered bowel habits were growth in 12, worm in 6, solitary rectal ulcer in 3, pancolitis in 3.Conclusions: It can be concluded that in the present study colonoscopy revealed a high proportion of colorectal pathologies with haemorrhoids presenting with bleeding per rectum.  Colonoscopy thus proved to be very useful procedure in patients with haemorrhoids especially in elderly

Comparative study of harmonic scalpel haemorrhoidectomy versus conventional (milligan and morgan) haemorrhoidectomy

Background: Haemorrhoids are dilated veins occurring in relation to the anus. There are various treatment modalities for haemorrhoids and among them surgical treatment is considered to be most effective one. Harmonic scalpel hemorrhoidectomy was compared with conventional in terms of symptomatic relief and complications.Methods: The aim of our study was to compare harmonic scalpel haemorrhoidectomy with conventional in terms of various intraoperative and postoperative factors for the treatment of grade III and IV haemorrhoids.Results: In our case study of 25 patients average time taken was 17.68 ± 2.84 minutes, while it was 28.44 ±3.69 minutes in control group. The mean blood loss was 8.96 ± 2.15 ml, 31.72 ± 3.28 ml in the case and control group respectively. Postoperative pain with VAS in case group on the first postoperative day was 5.92 ± 0.72, while it was 8.52 ± 0 in the control group. The dose of analgesia was less in case group. The postoperative wound site soakage was less in case study, early ambulation and return to normal work was faster in case study group.Conclusions: Harmonic scalpel haemorrhoidectomy is a simple, bloodless, safe and effective procedure in terms of blood loss, postoperative pain early return to routine work because of less lateral thermal injury

Role of laparoscopic surgery in cancer of stomach: Our early experience

Purpose: To study the clinical outcome and scope of laparoscopic management in patients of cancer stomach. Methods: This is a prospective study of our first 25 patients of cancer stomach managed laparoscopically. Following procedures were undertaken: 1) Gastric resection in resectable cases; 2) Palliative bypass; 3) Tumor/ nodal/ peritoneal/ any other/ biopsy in cases of unresectable tumors. Results: Growth was resectable in 10 (40%) patients, and unresectable in 15 (60%) patients. Diagnostic laparoscopy had sensitivity of 100%, while other modalities of investigation were not totally useful in 1/3 to ½ of cases. Laparoscopic gastrojejunostomy was done in 5 (20%) patients, laparoscopy assisted distal partial gastrectomy was performed in 8 (32%) patients while totally laparoscopic gastrectomy was possible in 1 (4%) patient. Long term follow up was observed. Conclusion: In cancer stomach laparoscopy is a safe, effective, and cost effective means of directing appropriate therapy especially in patients requiring diagnostic, staging and palliative procedures

Role of laparoscopic surgery in cancer of stomach: Our early experience

Purpose: To study the clinical outcome and scope of laparoscopic management in patients of cancer stomach. Methods: This is a prospective study of our first 25 patients of cancer stomach managed laparoscopically. Following procedures were undertaken: 1) Gastric resection in resectable cases; 2) Palliative bypass; 3) Tumor/ nodal/ peritoneal/ any other/ biopsy in cases of unresectable tumors. Results: Growth was resectable in 10 (40%) patients, and unresectable in 15 (60%) patients. Diagnostic laparoscopy had sensitivity of 100%, while other modalities of investigation were not totally useful in 1/3 to ½ of cases. Laparoscopic gastrojejunostomy was done in 5 (20%) patients, laparoscopy assisted distal partial gastrectomy was performed in 8 (32%) patients while totally laparoscopic gastrectomy was possible in 1 (4%) patient. Long term follow up was observed. Conclusion: In cancer stomach laparoscopy is a safe, effective, and cost effective means of directing appropriate therapy especially in patients requiring diagnostic, staging and palliative procedures.</p

Comparative study of harmonic scalpel haemorrhoidectomy versus conventional (milligan and morgan) haemorrhoidectomy

Background: Haemorrhoids are dilated veins occurring in relation to the anus. There are various treatment modalities for haemorrhoids and among them surgical treatment is considered to be most effective one. Harmonic scalpel hemorrhoidectomy was compared with conventional in terms of symptomatic relief and complications.Methods: The aim of our study was to compare harmonic scalpel haemorrhoidectomy with conventional in terms of various intraoperative and postoperative factors for the treatment of grade III and IV haemorrhoids.Results: In our case study of 25 patients average time taken was 17.68 ± 2.84 minutes, while it was 28.44 ±3.69 minutes in control group. The mean blood loss was 8.96 ± 2.15 ml, 31.72 ± 3.28 ml in the case and control group respectively. Postoperative pain with VAS in case group on the first postoperative day was 5.92 ± 0.72, while it was 8.52 ± 0 in the control group. The dose of analgesia was less in case group. The postoperative wound site soakage was less in case study, early ambulation and return to normal work was faster in case study group.Conclusions: Harmonic scalpel haemorrhoidectomy is a simple, bloodless, safe and effective procedure in terms of blood loss, postoperative pain early return to routine work because of less lateral thermal injury

Importance of Blue Carbon in Mitigating Climate Change and Plastic/Microplastic Pollution and Promoting Circular Economy

Blue carbon has made significant contributions to climate change adaptation and mitigation while assisting in achieving co-benefits such as aquaculture development and coastal restoration, winning international recognition. Climate change mitigation and co-benefits from blue carbon ecosystems are highlighted in the recent Intergovernmental Panel on Climate Change Special Report on Ocean and Cryosphere in a Changing Climate. Its diverse nature has resulted in unprecedented collaboration across disciplines, with conservationists, academics, and politicians working together to achieve common goals such as climate change mitigation and adaptation, which need proper policy regulations, funding, and multi-prong and multi-dimensional strategies to deal with. An overview of blue carbon habitats such as seagrass beds, mangrove forests, and salt marshes, the critical role of blue carbon ecosystems in mitigating plastic/micro-plastic pollution, as well as the utilization of the above-mentioned blue carbon resources for biofuel production, are critically presented in this research. It also highlights the concerns about blue carbon habitats. Identifying and addressing these issues might help preserve and enhance the ocean&rsquo;s ability to store carbon and combat climate change and mitigate plastic/micro-plastic pollution. Checking out their role in carbon sequestration and how they act as the major carbon sinks of the world are integral parts of this study. In light of the global frameworks for blue carbon and the inclusion of microalgae in blue carbon, blue carbon ecosystems must be protected and restored as part of carbon stock conservation efforts and the mitigation of plastic/micro-plastic pollution. When compared to the ecosystem services offered by terrestrial ecosystems, the ecosystem services provided by coastal ecosystems, such as the sequestration of carbon, the production of biofuels, and the remediation of pollution, among other things, are enormous. The primary purpose of this research is to bring awareness to the extensive range of beneficial effects that can be traced back to ecosystems found in coastal environments