Frey’s procedure: short term follow up results in terms of pain, endocrine and exocrine status, a tertiary care centre experience

Background: Chronic pancreatitis, a debilitating disease which affects the patient to an extent to render him bedridden sometimes and often make him/her unable to perform daily work, leading to poor quality of life, severe emotional stress and financial burden. Frey’s procedure one of the most commonly performed surgery in patient of chronic pancreatitis with stones in pancreatic duct and small inflammatory head mass. This procedure had shown promising results in terms of pain control with unclear outcome with respect to exocrine and endocrine status.Methods: Study was conducted in Government Kilpauk Medical College, Chennai during March 2016 to December 2019. Total 21 patients were followed up for 18 months and Post-operative pain was analysed using pain scoring system used by Bloechle et al. Exocrine status in terms of diarrhea, bloating sensation and Fecal Elastase level(preoperative and postoperative) were analysed. Patient glycaemic status were also analysed and compared. Patient Nutritional status was analysed in terms of weight gain.Results: In this study there was significant improvement in pain after surgery in terms of VAS pain Score (Preop Mean-82.14, Post-op Mean- 9.76, p<0.001) , frequency of pain (Preop Mean-78.57, Post-op Mean- 14.29, p<0.001), analgesia required (Preop Mean-15, Post-op Mean- 3.10, p<0.001), and inability to work due to pain (Preop Mean-80.95, Post-op Mean- 11.90, p<0.001). Overall total Pain score was significantly improved after surgery (Preop Mean-256.67, Post-op Mean- 39.05, p<0.001). There was significant weight gain and significant improvement in Fecal Elastase level in patients following surgery, however there was no significant difference in pancreatic exocrine status on the basis of symptoms.Conclusions: Frey’s procedure is very effective in pain control in properly selected patients of chronic calcific pancreatitis, and it also improves nutritional status of patient. Frey’s procedure might improve patient exocrine and endocrine status but further  multicentre studies are needed to come to a conclusion.

Management of Choledocholithiasis with special reference to use of Choledochoscopy.

INTRODUCTION : Gall stone disease affects people from every society, race, gender and age group. More than 95% of biliary tract disorders are related to gallstone. Most bile duct stones are stones that have passed into bile duct from the gallbladder. Choledocholithiasis means stones in the bile duct. Stones are non crumbling concretions larger than 2mm in diameter and biliary microlithiasis are particles 2mm or less in diameter although there is no universally accepted definition. Sludge is suspension of cholesterol monohydrate crystals, calcium bilurubinate granules, and or other calcium salts with or without microlithiasis of gall bladder mucus. Sludge is a form of gall stone disease and may predispose to macroscopic stones or directly cause pancreatitis and other morbidity. Despite good surgical techniques,about 8% to 16% of patients have retained stones in common bile duct after conventional choledocholithotomy. Common bile duct stone is defined as retained if they are discovered within two years of cholecystectomy or recurrence if they are detected more than two years after cholecystectomy. To reduce the incidence of retained stones in the common bile duct, operative flexible choledochoscopy was introduced into clinical practice in 1970’s. Moreover surgery has been associated with a discouragingly high incidence of residual stones .Many studies since then have confirmed the value of flexible choledochoscopy as a reliable method of reducing the incidence of retained biliary tract stones.The reported incidence varied between 0% to 7% . In India, limited study is available regarding the use of operative choledochoscopy in the management of choledocholithiasis. ERCP facilities are not available in many centres and requires the expertise of a medical gastroenterologist. In contrast, operative choledochoscopy is a simpler procedure that can easily be learnt and practised by many surgeons at the time of exploration of common bile duct. This study was undertaken with an aim to investigate how flexible choledochoscopy lowered the incidence of retained stones in the common bile duct after the exploration. AIM : 1. To evaluate the role of operative flexible choledochoscopy after choledocholithothomy / transcystic choledochoscopy in reducing the incidence of retained stones in the common bile duct. 2. To study the epidemiology and clinical features of choledocholithiasis. 3. To study the surgical modes of management of common bile duct stone. 4. To study the operative finding in terms of gall bladder / common bile duct stone 5. To study the complications of surgical procedures 6. To study the role of T tube cholangiogram, ultrasound, magnetic resonance cholangio pancreatogram in detecting any retained stones in the common bile duct. MATERIALS AND METHODS : The patients who had their common bile duct explored for proven common bile duct stones during three years period from 2004 to 2007 were reviewed prospectively at Government General Hospital, Chennai in Department of Surgical Gastroenterology. During this period forty four patients with confirmed common bile duct stone with or without gallstones were chosen. Initial decision to explore the common bile duct was made by ultrasound in 20patients(45%), ERCP in 8 patients(18%), CT in 10 patients (23%), MRCP in 6 patients (14%) is given in Figure1. In addition, inclusion criteria and exclusion criteria were used to select the patients for common bile duct exploration using flexible choledochoscopy. CONCLUSION : It is now well established that choledochoscopy reduces the incidence of retained common bile duct stones in patients with choledocholithiasis. Hence we recommend that operative choledochoscopy should always be done after exploration of the common bile duct stones to reduce the incidence of retained stone. Surgical exploration of CBD with conventional method without the use of choledochoscopy have shown 8 to 16% of patients with retained stones . With the use of choledochoscopy, the incidence is reduced to 2% as quoted in various studies. In our study percentage of retained stone after flexible choledochoscopy was (2.27%) . Females were commonly affected by choledocholithiasis. The commonest age group was between 51-60yrs. Commonest complaint was pain or jaundice Though the gold standard in the management of choledocholithiasis is precholecystectomy or postcholecystectomy ERCP and sphincterotomy and retrieval of stones. Conventional use of choledochoscopy gives equivalent results as that of ERCP in the diagnostic and management of CBD stones. Hence in centers where ERCP facilities are lacking, flexible choledochoscopy plays a major role in reducing the retained stones in CBD. Since patients with choledocholithiasis may be completely asymptomatic, choledochoscopy should be done as a routine in suspected patients. Choledochoduodenostomy, Choledochojejunostomy, T tube drainage & primary closure of CBD after CBD exploration with flexible choledochoscopy has a definitive role in the management of choledocholithiasis. Post operative MRCP has played a major role in detecting stones even smaller than 4mm. Hence MRCP should be used as a preoperative and post operative evaluation of choledocholithiasis

Survey of incidence of various surface defects in goat and sheep skin in Madras

23,429 goat skins and 37,026 sheep skins were examined to find out the incidence of various surface defects in them. 33.44 percent of goat skins and 14.6 per cent of sheep skins were found to be affected in quality. Major defects common to both goat and sheep skins were abscess, fire-mark and psoroptosis. In addition to the above common defects demodecosis and sheep pox appreciably deteriorated the quality of goat and sheep skins respectively. Seasonal variation in the incidence of the major defects were also studied

Sea turtle nesting grounds identification and its conservation status of Southern Tamil Nadu

581-589Five non reported new nesting grounds of Olive ridley turtles were recognized by beach surveying along the coast of southern Tamil Nadu covering 201.75 km. The survey indicates that the study areas have apposite beaches for turtle nesting however; the nesting incidences were declined due to predation and habitat alterations. The observed nest site temperature; perpendicular distance from high tide line; egg diameter and weight at Kanyakumari was well suited than the other study sites. The conservation awareness among stakeholders was found to be 41.7 % and mass awareness program has been created through 16 field visits to various fish landing centers and folders and booklets were distributed to 150 stakeholders. Similarly, 650 students belonging to eight schools were enlightened about the importance of sea turtles and their conservation awareness through audio visual aids. From the study it could be concluded that the turtle nesting grounds are found along the southern coast of Tamil Nadu and conservation initiatives need to be strengthened to protect them

Calculation of the efficacy of vaccines against tick infestations on cattle

Articles in International JournalsCattle ticks are responsible for great economic losses in cattle farming worldwide, and their main control method, chemicals, has been showing problems, whether resulting from the development of resistant strains of ticks or environmental contamination. Research studies directed toward developing vaccines against ticks are emerging. One way to evaluate those vaccines is to calculate the percentage of efficacy. The aim of this study was to analyze scientific publications archived in PubMed that used this method of assessment and discuss the main factors that may affect its calculation. Thus, 25 articles addressing this subject were selected. The percentage of efficacy was usually calculated in one of two ways, with one considering the reduced fertility of eggs and the other not. The latter method may underestimate the vaccine efficacy, and the most complete formula for calculating the efficacy reflects how much the vaccine actually affects the infestation. In our view, the use of the complete formula for calculating the percentage of efficacy is broader and more representative of the vaccine effect on the tick population.RESUMO - Carrapatos de bovinos são responsáveis por grandes perdas econômicas para a pecuária bovina mundial e seu principal método de controle, o químico, vem apresentando problemas, seja pelo desenvolvimento de amostras de carrapatos resistentes ou pela contaminação ambiental. Na tentativa de diminuir a utilização dos acaricidas, surgem pesquisas direcionadas ao desenvolvimento de vacinas contra carrapatos. Uma maneira de avaliar essas vacinas é pelo cálculo de percentagem de eficácia. O objetivo deste trabalho foi analisar as publicações científicas indexadas no PubMed que utilizaram este método de avaliação e discutir os principais fatores que podem interferir no seu cálculo. Dessa maneira, selecionaram-se 25 artigos que tratavam desse assunto. A percentagem de eficácia apareceu sendo calculada de duas formas, uma considerando a redução da fertilidade dos ovos e a outra não. Essa última pode subestimar a eficiência da vacina, e a fórmula de cálculo da eficácia mais completa representa o quanto da infestação a vacina realmente reduziu. Em nosso entendimento, a utilização da fórmula completa para o cálculo da percentagem de eficácia é mais abrangente e representativa do efeito da vacina na população de carrapatos

Absence of the common Insulin-like growth factor-1 19-repeat allele is associated with early age at breast cancer diagnosis in multiparous women

Multiparity decreases the risk of breast cancer in white women, whereas it is a risk factor in black women <50 years. Early-onset breast cancer (<50 years) has been associated with high insulin-like growth factor-1 (IGF-1) levels. Absence of the common IGF1 19 cytosine-adenine (CA)-repeat allele (IGF1-19/-19) inverts the effect of several non-genetic factors on breast cancer risk but the interaction between IGF1-19/-19 and multiparity on breast cancer risk is unknown. As IGF1-19/-19, multiparity and early-onset breast cancer are more common in black than in white women, we aimed to study whether multiparity combined with IGF1-19/-19 increases the risk of early-onset breast cancer. Four hundred and three breast cancer patients diagnosed in Lund, Sweden, at age 25–99 years were genotyped for the IGF1 CA-repeat length using fragment analysis. Overall, 12.9% carried the IGF1-19/-19 genotype. There was a highly significant interaction between multiparity and IGF1-19/-19 on age at breast cancer diagnosis (P=0.007). Among IGF1-19/-19 patients, multiparity was associated with a 9.2 year earlier age at diagnosis compared with uniparity or nulliparity (P=0.006). Multiparity combined with IGF1-19/-19 was associated with an early age at breast cancer diagnosis. If confirmed, IGF1-19/-19 may help identify a subgroup of women for earlier breast cancer screening

Challenges in machine learning based approaches for real-time anomaly detection in industrial control systems

Data-centric approaches are becoming increasingly common in the creation of defense mechanisms for critical infrastructure such as the electric power grid and water treatment plants. Such approaches often use well-known methods from machine learning and system identification, i.e., the Multi-Layer Perceptron, Convolutional Neural Network, and Deep Auto Encoders to create process anomaly detectors. Such detectors are then evaluated using data generated from an operational plant or a simulator; rarely is the assessment conducted in real time on a live plant. Regardless of the method to create an anomaly detector, and the data used for performance evaluation, there remain significant challenges that ought to be overcome before such detectors can be deployed with confidence in city-scale plants or large electric power grids. This position paper enumerates such challenges that the authors have faced when creating data-centric anomaly detectors and using them in a live plant

Socially and biologically inspired computing for self-organizing communications networks

The design and development of future communications networks call for a careful examination of biological and social systems. New technological developments like self-driving cars, wireless sensor networks, drones swarm, Internet of Things, Big Data, and Blockchain are promoting an integration process that will bring together all those technologies in a large-scale heterogeneous network. Most of the challenges related to these new developments cannot be faced using traditional approaches, and require to explore novel paradigms for building computational mechanisms that allow us to deal with the emergent complexity of these new applications. In this article, we show that it is possible to use biologically and socially inspired computing for designing and implementing self-organizing communication systems. We argue that an abstract analysis of biological and social phenomena can be made to develop computational models that provide a suitable conceptual framework for building new networking technologies: biologically inspired computing for achieving efficient and scalable networking under uncertain environments; socially inspired computing for increasing the capacity of a system for solving problems through collective actions. We aim to enhance the state-of-the-art of these approaches and encourage other researchers to use these models in their future work