Isospectral orbifold lens spaces

Spectral theory is the study of Mark Kac's famous question [K], "can one hear the shape of a drum?" That is, can we determine the geometrical or topological properties of a manifold by using its Laplace Spectrum? In recent years, the problem has been extended to include the study of Riemannian orbifolds within the same context. In this thesis, on the one hand, we answer Kac's question in the negative for orbifolds that are spherical space forms of dimension higher than eight. On the other hand, for the three-dimensional and four-dimensional cases, we answer Kac's question in the affirmative for orbifold lens spaces, which are spherical space forms with cyclic fundamental groups. We also show that the isotropy types and the topology of the singularities of Riemannian orbifolds are not determined by the Laplace spectrum. This is done in a joint work with E. Stanhope and D. Webb by using P. Berard's generalization of T. Sunada's theorem to obtain isospectral orbifolds. Finally, we construct a technique to get examples of orbifold lens spaces that are not isospectral, but have the same asymptotic expansion of the heat kernel. There are several examples of such pairs in the manifold setting, but to the author's knowledge, the examples developed in this thesis are among the first such examples in the orbifold setting

Clinical presentations of colorectal cancer at initial presentation to hospital and its site specific correlation

Background: Colorectal cancer is one of the leading cause of death all over the world. It progresses slowly and may be asymptomatic for as many as 5 years. Aim of this study was to find the incidence and the initial clinical presentations of patients with colorectal cancer and its site specific correlationMethods: This was a prospective hospital-based study conducted over a period of two years from August 2015 to September 2017 in the postgraduate department of surgery, Government medical college, Srinagar. Total of fifty three patients in the age group of 10 years to 80 years were included in the study. Colorectal tumors were divided into right colon growths (caecum, ascending colon and hepatic flexure), left colon growths (splenic flexure, descending colon and sigmoid colon) and rectal growths. Data was collected from their hospital records and analysed using SPSS computer program.Results: In present study incidence of colorectal cancer was 0.2 per 100,000 people. Thirty percent of our patients were found to be in the sixth decade of their life with male preponderance in almost every age group. Mean age of presentation being 46.44 years (males= 48.5years, females= 43.76years). Out of 53 patients, rectal growths constituted 36%, left colonic growths 36% followed by 28% cases of right colonic growths. More than one symptom was present in several patients. Maximum number of patients (43%) presented with anemia (microcytic hypochromic) with Hb of <9gm% followed by constipation 38% and bleeding per rectum 28%. Pain abdomen was present in 23% of patients. Loss of weight and diarrhoea was equally seen in 19% of patients. Diarrhoea was seen in 6 males and 4 females and was statistically significant (p<0.05).Conclusions: Colorectal cancer was found to affect the Kashmiri patients at younger age (38% were 40 years or less) with peak incidence at sixth decade. Males were affected more than females. Anaemia, constipation and bleeding per rectum were the most common predominant clinical features in right colon, left colon and rectal growths respectively

Three port versus four port laparoscopic cholecystectomy: a prospective comparative clinical study

Background: Although, traditional laparoscopic cholecystectomy is performed using four-port technique, various modifications were made to further enhance the advantages of laparoscopic cholecystectomy. Aim of the study is to compare the results of three-port and four-port laparoscopic cholecystectomy at single center in terms of technical feasibility, safety of the procedure, operative time, intra-operative complications, postoperative pain and post-operative analgesia requirementMethods: It was a  prospective comparative study conducted  in the department of surgery Skims Medical college Srinagar, India from July 2015 to March 2017. The study was performed on all adult patients with ultrasound documented cholelithiasis and gall bladder Polyposis. The total number of patients studied was 100 which were divided into two groups of 50 each.Results: The average operative time in three port group was 29.2 minutes (range, 15-37) compared to 30.66 minutes (range, 15-42) in four port group, which was statistically insignificant. The final visual analog scores for pain in the postoperative period was 2.30 vs 2.86 in three port and four port group respectively, with a P value=0.008, which was statistically significant.Conclusions: The three-port technique is as safe as the standard four-port technique and can be a viable alternative to four port cholecystectomy with an advantage of less pain and less analgesic requirement and better cosmetic results

Outcome of albendazole therapy in the management of hepatic hydatid disease

Background: The treatment modalities for managing patients with hepatic hydatidosis include surgical treatment and non-surgical treatments. The non-surgical methods include albendazole therapy and percutaneous management. Use of albendazole as an adjuvant therapy to surgery has been found to significantly reduce the viability of daughter cyst and recurrence of hydatid disease. The aim of the study was to understand the effect of albendazole therapy on the viability of protoscoleces and recurrence rate of hydatid disease of liver.Methods: The study was conducted at Sher-i-Kashmir Institute of Medical Sciences and Medical College, Srinagar, Kashmir India, from March 2010 to February 2012 with further follow up of 3-4 years and the total of 64 patients were studied. ; Patients were divided into two groups, Group A and Group B, each comprising of 32 patients. In group A, patients were given albendazole for 12 weeks preoperatively followed by further postoperative course for 12 weeks. In group B, patients were first taken for surgery followed by postoperative course of albendazole for 12 weeks. The two main outcome measures studied and compared during present study were the viability of the hydatid cysts and the recurrence rate in two groups.Results: Out of those, patients who received preoperative albendazole, 9.37% had viable cysts at the time of surgery as compared to 96.87% of patients who did not receive any preoperative albendazole. In those patients who received only postoperative albendazole therapy, recurrence rate was 18.75% while as there was no recurrence was in patients who received both preoperative and postoperative albendazole therapy.Conclusions: Study concludes that albendazole is safe and effective adjuvant therapy in the treatment of hydatid liver disease.

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Meckel&#x2032;s diverticulum-Revisited

Meckel&#x2032;s diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development. In about 50&#x0025; cases, it contains ectopic or heterotopic tissue which can be the cause of complications. A systematic review of literature was undertaken to study the history, incidence, embryoanatomy, clinical presentation, complication and management of Meckel&#x2032;s diverticulum. Although Meckel&#x2032;s diverticulum is the most common congenital abnormality of the gastrointestinal tract, it is often difficult to diagnose. It may remain asymptomatic or it may mimic disorders such as Crohn&#x2032;s disease, appendicitis and peptic ulcer disease

Short-term results of Limberg flap in the management of Pilonidal sinus disease

Background: Although several treatment options have been used for management of pilonidal sinus disease, no optimal treatment method has been defined as yet due to high complication and recurrence rates. Aim: To study the short term results of Rhomboid excision with Limberg flap closure in the management of Pilonidal sinus disease. Material and Methods: The study entitled, “Short-term results of Limberg flap in the management of pilonidal sinus disease” was conducted prospectively in the department of surgery Skims Medical College Srinagar for a period of three years from January 2017 to February 2020 and total of 41 patients with primary or recurrent pilonidal sinus disease were studied.Results: The study included 34 males and 7 females with a male to female ratio of 5;1. The average operative time was 60 minutes. Postoperative stay of patients in the hospital was 4-5 days and the patients returned to their normal activity between 21 and 24 days. The complications were seen in total of three patients which included prolonged drainage in one , Seroma in one and wound dehiscence in one patient. Recurrence was not seen in any of the patients in our study.Conclusions: Rhomboid excision with Limberg flap transposition is an ideal and efficient surgical technique for management of pilonidal sinus