Management of hepatic hydatidosis by open versus laparoscopic surgery

Background:Aim of current study was to compare between laparoscopic versus open management of the hydatid cyst of liver regarding complication rate, post-operative recovery course with different modality of treatment and hospital stay. This study shows our results of surgical treatment of liver hydatid cysts during a 2.5 years period.Methods:A prospective study of 30 patients operated on in a 2.5 year period (April 2011 to October 2013) in department of general surgery of J.N. medical college, Sawangi (Meghe), Wardha, Maharashtra, with hepatic hydatid cyst. All patients were preoperatively treated with albendazole. 15 patients were tackled by laparoscopic technique (using Palanivelu hydatid system) and rest 15 underwent Open procedure as surgical approach.Results:Patients operated by laparoscopic surgery shown a better post-operative recovery course, required less analgesia, mobilized and started on oral feed early, intra-abdominal drain was removed at a much earlier period as compared to open group patient, this not only reduced morbidity but also because of this patient could be discharged earlier.Conclusion:Minimal invasive management, using Palanivelu hydatid system for aspiration and laparoscopic intervention, is an alternative to open surgery because of its ability to prevent spillage and thus minimize recurrences. It is better and safe to use laparoscopy in treatment of hydatid liver with less morbidity, mortality and recurrence rate in comparison with open technique.

Abdominal tuberculosis: a study of 50 cases

Background: The main type of tuberculosis of interest to any hospital- based surgeon is intestinal, the clinical presentation of which varies from one of an acute abdomen to one of a protracted cause of ill health and morbidity with a notorious reputation for poor response to therapy, both conservative as well as surgical. Low socio- economic status and malnutrition in our country are very important causes of the high prevalence of pulmonary tuberculosis, and with superadded problems of overcrowding and poor access to good sanitation and neglect for medical attention, extra pulmonary forms of tuberculosis also form a sizeable proportion of the case load of tuberculosis. The major source of infection is the open untreated case of pulmonary tuberculosis.Methods: Presented here is a brief account of hospital- based study of the presentation of 50 cases of abdominal tuberculosis and its management in both the acute as well as chronic setting, carried out at the B. Y. L. Nair Municipal Hospital Mumbai.Results: In our study 40% patients presented with signs of intestinal obstruction, 6% with perforative peritonitis, 34% with diffuse or well defined lump and 54% with ascites. All these patients underwent biochemical, radiological and endoscopic investigations.All the cases in this study were put on antitubercular four drug regime. Isoniazid (5mg / kg), Rifampicin (5-10mg/kg), Ethambutol (15mg/kg) and Pyrazinamide (20-25mg/kg) for two months followed by Isoniazid and Rifampicin for seven months. None of the patients developed drug toxicity during treatment. In our study out of 50 patients, 24 patients were treated conservatively. These includes 12 with tuberculous peritonitis (2 of the 12 had associated paraortic lymphadenopathy), 6 with subacute intestinal obstruction, 4 with RIF lump and 2 with colonic pathology) were treated conservatively. 26 patients underwent surgical treatment. Out of these 26 patients, 14 were operated in emergency and 12 were operated electively. Emergency surgeries were performed after correction of fluid electrolyte imbalance. Of the 14 emergency cases, 3 patients underwent resection anastomosis of small bowel, 6 patients underwent right hemicolectomy for iieocaecal tuberculosis. One patient had a stricturoplasty for ileal stricture in addition to right hemicolectomy. One patient underwent a stricturoplasty for ileal stricture and one unstable patient underwent drain insertion under local anaesthesia to drain out contaminated peritoneal fluid. Remaining two patients underwent adhesiolysis.Conclusions: In this study 60% patients had an acute and subacute presentation and 40% patients had a chronic presentation.

Development and evaluation of one step single tube multiplex RT-PCR for rapid detection and typing of dengue viruses

<p>Abstract</p> <p>Background</p> <p>Dengue is emerging as a major public health concern in many parts of the world. The development of a one-step, single tube, rapid, and multiplex reverse transcription polymerase chain reaction (M-RT-PCR) for simultaneous detection and typing of dengue virus using serotype specific primers during acute phase of illness is reported.</p> <p>Results</p> <p>An optimal assay condition with zero background was established having no cross-reaction with closely related members of flavivirus (Japanese encephalitis, West Nile, Yellow fever) and alphavirus (Chikungunya). The feasibility of M-RT-PCR assay for clinical diagnosis was validated with 620 acute phase dengue patient sera samples of recent epidemics in India. The comparative evaluation <it>vis a vis </it>conventional virus isolation revealed higher sensitivity. None of the forty healthy serum samples screened in the present study revealed any amplification, thereby establishing specificity of the reported assay for dengue virus only.</p> <p>Conclusion</p> <p>These findings clearly suggested that M-RT-PCR assay reported in the present study is the rapid and cost-effective method for simultaneous detection as well as typing of the dengue virus in acute phase patient serum samples. Thus, the M-RT-PCR assay developed in this study will serve as a very useful tool for rapid diagnosis and typing of dengue infections in endemic areas.</p

Recent Developments in Recombinant Protein–Based Dengue Vaccines

Recombinant proteins are gaining enormous importance these days due to their wide application as biopharmaceutical products and proven safety record. Various recombinant proteins of therapeutic and prophylactic importance have been successfully produced in microbial and higher expression host systems. Since there is no specific antiviral therapy available against dengue, the prevention by vaccination is the mainstay in reducing the disease burden. Therefore, efficacious vaccines are needed to control the spread of dengue worldwide. Dengue is an emerging viral disease caused by any of dengue virus 1–4 serotypes that affects the human population around the globe. Dengue virus is a single stranded RNA virus encoding three structural proteins (capsid protein, pre-membrane protein, and envelope protein) and seven non-structural proteins (NS1, NS2a, NS2b, NS3, NS4a, NS4b, NS5). As the only licensed dengue vaccine (Dengvaxia) is unable to confer balanced protection against all the serotypes, therefore various approaches for development of dengue vaccines including tetravalent live attenuated, inactivated, plasmid DNA, virus-vectored, virus-like particles, and recombinant subunit vaccines are being explored. These candidates are at different stages of vaccine development and have their own merits and demerits. The promising subunit vaccines are mainly based on envelope or its domain and non-structural proteins of dengue virus. These proteins have been produced in different hosts and are being investigated for development of a successful dengue vaccine. Novel immunogens have been designed employing various strategies like protein engineering and fusion of antigen with various immunostimulatory motif to work as self-adjuvant. Moreover, recombinant proteins can be formulated with novel adjuvants to enhance the immunogenicity and thus conferring better protection to the vaccinees. With the advent of newer and safer host systems, these recombinant proteins can be produced in a cost effective manner at large scale for vaccine studies. In this review, we summarize recent developments in recombinant protein based dengue vaccines that could lead to a good number of efficacious vaccine candidates for future human use and ultimately alternative dengue vaccine candidates

Colloid Cyst Presenting as Head Injury

Colloid cysts are mucous- or hyaloid-filled lesions with an outer fibrous layer. These are rare developmental and nonneoplastic malformation. They may be found incidentally, while some cases may present with intermittent headache, rapid neurologic deterioration, drop attacks, and even sudden death. Early recognition of this disease may result in lesser mortality. Here, we present a 22-year-old male with a history of fall while driving his two-wheeler. A diagnosis of colloid cyst of the third ventricle with a head injury was made. Colloid cyst presenting with a head injury is exceedingly rare with only five case reports in the literature. This report may help to support surgical intervention in an asymptomatic patient, as the cyst can predispose head injury with serious consequences. It also stresses the importance of a high degree of suspicion when there is any well-defined radiological abnormality in the region of the third ventricle. A colloid cyst may easily be confused with intracranial hemorrhage due to hyperdensity in head trauma. It can be distinguished by the presence of an accompanying traumatic lesion. The cyst usually has well-defined round margins, and the morphologic appearance and density do not change on a follow-up computed tomography (CT) scan, whereas in hemorrhage the density usually regresses with clinical improvement on serial imaging

Awake focussed craniotomy for oedematous/large brain lesions: A pilot study for safety and feasibility

Aim: Awake craniotomy has been proven to be safe and effective. It has generally been used for non-edematous conditions. If done in edematous states, large craniotomies are advised. Here, we report the combined use of techniques of awake anaesthesia and focussed craniotomy for dealing with large/edematous brain lesions. Materials and Methods: This was a prospective single-centre study from May to October 2019. Included were adult cooperative patients presenting with edematous brain lesions. A completely awake cycle was used using ring scalp block, Dexmedetomidine loading, and maintenance infusion, and use of Midazolam and Fentanyl. The dural flap was lifted limited to the lesion, and sometimes in stages to tackle the bulging brain. Data was collected for resection volume, pain scores using visual analogue scale (VAS) during the surgery, seizures, complications, new deficits, blood loss, duration of surgery, ICU, and postoperative hospital stay. Results: Fifteen patients underwent the procedure. Pathologies were high-grade gliomas (7), low-grade gliomas (3), tuberculoma (2), metastasis (1), ependymoma (1), and meningioma (1). Fourteen patients underwent total, and one underwent subtotal excision. Brain bulge could be handled with the staged opening of the dura and intratumoral decompression. No patient required postoperative ventilatory support. Intraoperative pain scores ranged from 2-3. The duration of surgery ranged from 60-280min. Blood loss ranged from 75-300ml. Postoperative stay varied from 3-20 days. There were two intraoperative seizures (managed), two CSF leaks, and two infections. Two patients developed transitory motor deficits. Conclusion: Awake focussed craniotomy was found safe and effective for large/edematous brain lesions in appropriately selected patients