Study of factors associated with incisional hernia in female

Background: Incisional hernia is still relatively common in our practice. The aim of the study was to identify risk factors associated with incisional hernia in females in our region.Methods: All the women who presented with incisional hernia between 2010 and 2012 were retrospectively studied using records and preparing a standard form to obtain information on pre-hernia (index) operations and possible predisposing factors. They all had open surgical repair and were followed up for 12-36 months.Results: Fifty two women were treated during study period. The index surgeries leading to the hernias were emergency caesarian section 26/52 (50%), emergency exploratory laparotomy 6/52 (11.6%), and elective surgeries 20/52 (38.5%). Major associated risk factors were the use of wrong suture materials for fascia repair, midline incisions, wound sepsis, and overweight.Conclusions: For elective surgeries, reduction of weight should be encouraged when appropriate, and transverse incisions are preferred. Absorbable sutures should be avoided in fascia closure. Antibiotics should be used for complicated cases

Comparison of the Clinical Profile and Complications of Mixed Malarial Infections of Plasmodium Falciparum and Plasmodium Vivax versus Plasmodium Falciparum Mono-infection

Objectives: This study aimed to compare the clinical presentations and complications in patients having mixed malaria infection of Plasmodium falciparum and Plasmodium vivax with those of patients with malaria due to a P. falciparum mono-infection. Methods: The medical records of malaria patients admitted to Kasturba Medical College, Manipal, India, during the years 2008–10 were analysed. Inclusion criteria were patients in whom P. falciparum and P. vivax coinfection or P. falciparum mono-infection alone was confirmed on peripheral smear examination. Exclusion criteria were patients in whom P. vivax infection alone was diagnosed on peripheral smear examination. The sample size was twenty patients diagnosed with mixed infection of P. falciparum and P. vivax and 60 patients diagnosed with P. falciparum mono-infection. Results: 35% of mixed infections had thrombocytopenia as compared to 51.7% of P. falciparum mono-infections. A total of 5% of the mixed infections had renal failure as compared to 16.7% of the falciparum mono-infections. Total bilirubin was raised in 15.8% of mixed infections and in 46.6% of falciparum mono-infections. Abnormal liver enzymes were seen in 36.8% of mixed infections and in 66.6% of falciparum mono-infections. None of the mixed infections had a parasite index over 2% while it was present in 28% of the falciparum mono-infections. Conclusion: Patients with mixed infections were found to have a lower incidence of severe complications such as anaemia, thrombocytopenia, liver and renal dysfunction and a lower parasite index. Thus mixed malaria tends to have a more benign course as compared to malaria due to P. falciparum mono-infection

Plasmacytoma of clavicle bone: a case report

Plasmacytoma refers to a malignant tumor composed of plasma cells, which grows within soft tissue or axial skeleton. These are identical to those in plasma cell myeloma, which appears as a solitary lytic lesion on radiological examination. Primary bone tumor of clavicle are uncommon and likely to be malignant. Systemic issues in multiple myeloma are absent in plasmacytoma which makes it a formidable diagnostic challenge. Authors report a case of sixty-two years old female with progressive swelling around medial end of right clavicle associated with pain and restriction in arm movements. X-ray revealed lytic lesion in medial one-third of clavicle. FNAB revealed small to large plasmacytoid cells. CT Angiography revealed ill-defined heterogenous soft tissue density lesion. Since the mass was near the vascular structure, adjuvant chemoradiotherapy was given. Solitary plasmacytoma of bone (SPB) of medial end of clavicle is rare. Surgery is the mainstay treatment but in inoperable cases, adjuvant therapy may be considered. SPB of clavicle is a unique surgical entity with diagnostic and management challenges.

A case of inferior lumbar hernia

In this article we report a case of inferior lumbar hernia. The patient underwent preperitoneal meshplasty. The patient is well on follow up with no recurrence. The relevant literature has been reviewed and management discussed in brief

Opioid Free Anesthesia in Laparoscopic Surgery: A New Emerging Technique

Background: Opioid-free anesthesia (OFA) is a new anesthesiological technique where opioid is avoided intra and post-operative due to side effects. Hence, this study compared opioid-free with opioid-based anesthesia for postoperative analgesia in laparoscopic surgeries. The primary objective was to assess pain scores in the postoperative period with the Numerical rating scale (NRS) for 24 hours, and the secondary objective was to compare intraoperative vitals, postoperative analgesia period, and utilization of total analgesics in the first 24 hours. Materials and Methods: Prospective randomized control trial, 100 patients aged 20-70 years, American Society of Anaesthesiologists physical class I and II posted for elective upper and lower abdominal laparoscopic surgeries. Patients were divided into two groups (n=50 in each group): opioid-free (Group A) and opioid (Group B). Group A received anesthetic doses of lidocaine, magnesium, and paracetamol in combination with Erector spinae plane block for post-operative pain relief, while group B received intermittent doses of fentanyl. Postoperatively, NRS was observed at 0, 2, 4, and 6 hours during rest and at 0, 2, 4, 6, and 24 hours during movement. Data were analyzed by independent t-test. Results: Group A showed a significant decrease in NRS score at rest at 0, 2, 4, and 6 hours, whereas there was a significant decrease in NRS score at movement in group A at 0, 2, 6, and 24 hours compared to group B (P< 0.05). Total duration of analgesia (hour) was significantly more in group A (17.86 ± 7.85) as compared to group B (7.76 ± 3.98) (P<0.001). Intraoperative vitals were comparable. The total rescue analgesia (milligram) requirement was significantly low in group A (0.92 ± 0.8) as compared to group B (2.02 ± 0.38). Conclusion: For patients undergoing elective upper and lower abdominal laparoscopic surgeries, multimodal analgesia was safe in unwanted opioid side-effects cases and unavailability of opioids

Crystal structure of isobutyl 4-(2-chloro-phenyl)-5-cyano-6-{(E)-[(dimethylamino)-methylidene]amino}-2-methyl-4H-pyran-3-carboxylate

The authors thank Dr Babu Varghese, Senior Scientific Officer SAIF, IIT Madras, India, for carrying out the data collection.Peer reviewedPublisher PD

Performance Analysis And Experimental Investigation On Exhaust Gas Heat Recovery For IC Engines Using Shell And Tube Heat Exchanger

Increase in energy demand results in shortage of energy. Many effective means were under research to overcome shortage of energy. Recent trend researchers focussing on cogeneration and waste heat recovery in order to improve the efficiency of existing system as well as to avoid energy wastage. In this work waste heat from the exhaust gas is recovered by means of shell and tube heat exchanger to convert cold fluid in to hot fluid. In this system water is used as a working fluid. Water extracts thermal energy to estimate the exhaust heat obtainable from the engine exhaust gases. The exhaust gases which is passed through the tube side of the heat exchanger is obtained from the existing four stroke single cylinder diesel engine whereas water is passed through the shell side of the heat exchanger. The counter flow type heat exchanger arrangement is considered for the analysis. Therefore, the heat transfer characteristics of a system combining compression ignition engine and heat exchanger which recover waste heat from exhaust gas. Performance improvement in this type heat exchanger gives the better USAbility of low grade heat energy.nbs

Giant cell tumor of the breast masquerading as a malignant breast tumor: a case report

Introduction: Giant cell tumours of the soft tissue (GCT-ST) are usually found in the superficial and deep soft tissues of the extremities but have been described in the pancreas, lung, thyroid gland, urothelial tract, skin, larynx, heart and very rarely, in the breast. At present, according to the World Health Organization's classification of soft tissue tumors, GCT-ST is categorized as an intermediate grade (rarely metastasizing) fibrohistiocytic tumour. GCT of the breast is extremely rare and to date, only eleven cases have been reported. We report a case of GCT of the breast, which was clinically suspected as a malignant tumor and discuss the different treatment modalities with the importance of close follow-up of the same after a thorough review of the literature. Case Presentation: We report a case of a 45-year-old woman who noticed a tender lump in her left breast. A malignant tumour was suspected on clinical examination and imaging. Histological evaluation revealed a tumour composed of a mixture of round and oval mononuclear cells with minimal atypia and uniformly distributed multinucleated osteoclast-like giant cells (OGCs) with a stroma rich in blood vessels. IHC was done in which the OGCs stained positively for CD68 and CD45, mononuclear stromal cells were positive for vimentin whereas the tumour was negative for breast markers Progesterone Receptor (PR), Estrogen Receptor (ER), GATA 3, epithelial marker EMA, S-100 and Desmin; hence the definitive diagnosis of GCT of the breast was made. Discussion: GCT of the breast, due to its rareness and the malignant-mimicking clinical presentation, causes difficulty in diagnosis. Other giant cell-rich lesions including breast cancer with OGCs, pleomorphic leiomyosarcoma, osteosarcoma, undifferentiated pleomorphic sarcoma and metastatic GCT-B are to be considered in the differential diagnosis. Conclusion: GCT of the breast is an extremely rare tumour and pretends a breast malignant tumours. For the correct diagnosis of this rare tumour, combining the results of histological and immunohistochemical analyses helps in ruling out differential diagnosis

Functional and health promoting inherent attributes of Enterococcus hirae F2 as a novel probiotic isolated from the digestive tract of the freshwater fish Catla catla

Probiotic microorganisms are gaining global importance because of their use in the preparation of a nutraceutical or in the treatment of infections. As per the health industry demand, there is an urgent need for exploring new indigenous probiotic strains with its specific origin due to variation in gut microflora, different food habits and specific host-microbial interactions. The main objective of the present study was to isolate and identify a novel probiotic Enterococcus strain from the gut of Catla catla fish and evaluate its potentiality as a potent probiotic. The whole study was designed with the isolation of novel lactic acid bacterial strain from the gut of Catla catla fish with their biochemical and molecular identifications. The potentiality of the isolated strain as a potent probiotic was carried out according to the parameters described in FAD/WHO guidelines for the evaluation of probiotics in food. The isolated strain was confirmed as Enterococcus hirae F2 on the basis of various biochemical and 16s rRNA gene sequencing methods. Enterococcus hirae F2 was able to survive under highly acidic and bile salt concentration with the ability for the production of lipase and Bsh enzyme. It was also able to survive under simulated gastrointestinal conditions with the inhibition ability of various pathogens. The antioxidant potentiality with the cell surface hydrophobicity and cell aggregation ability confirms its potentiality as a potent probiotic. All the results detail the potency of Enterococcus hirae F2 as a novel probiotic for a safer use. The isolation of Enterococcus hirae with probiotic potential from the gut of fish is a new approach and done for the first time. However, the whole study concluded that the isolated strain might be used as a novel probiotic in the food industry for the production of new probiotic products which imparts health benefits to the host

A Rapid Decision Sampling Plan for Implementing Area—Wide Management of the Red Palm Weevil, Rhynchophorus ferrugineus, in Coconut Plantations of India

The red palm weevil Rhynchophorus ferrugineus Olivier (Curculionidae/Rhynchophoridae/Dryophthoridae) is a lethal pest of young coconut palms, Cocos nucifera L. (Arecales: Arecaceae), with a highly aggregated population distribution pattern. R. ferrugineus is managed in several coconut growing countries using area-wide pheromone based programmes that need a substantial commitment of funds over a period of time. Often, decisions to implement area-wide management of R. ferrugineus are based on pheromone trap captures in surveillance traps and or infestation reports. Implementing area-wide management of this pest on the basis of such data can be inaccurate, as it may either under or over estimate the pest intensity in the field. This study presents sampling plans for rapid and accurate classification of R. ferrugineus infestation in coconut plantations of India by inspecting palms to detect infestation in a sequence until a decision to either implement or not to initiate area-wide management of R. ferrugineus can be made. The sampling plans are based on a common aggregation index of 3.45, assumed action threshold values of either 1.0 (plan A) or 0.5 (plan B) per cent infested palms and a risk factor of making the wrong decision set at 0.05. Using plans A and B, if the cummulative number of infested palms in a young 1 hectare coconut plantation is zero out of 150 palms for both plans, then area-wide management is not required, while on the other hand, if the cummulative number of infested palms for the same area is 6 (plan A), or 5 (plan B), then area-wide management of R. ferrugineus is essential. The proposed sampling plans are efficient tools in decision making, particularly at very low and high levels of infestation and can also be used to assess the performance of R. ferrugineus IPM programmes that are in progress. These plans not only save time and money as only a small area needs to be sampled to arrive at a correct decision, but are also efficient in rating the infestation level accurately