Background: Gallstone disease (GSD) is a prevalent health problem around the globe and the treatment of choice for symptomatic GSD is laparoscopic cholecystectomy (LC). There are many factors that influence the operative findings, conversion rates and the outcome of surgery. Male gender has been considered by some to be an adverse factor in this regard. Through this study we intend to find out the role of gender in the operative findings and outcome of laparoscopic cholecystectomy.Methods: All the patients undergoing laparoscopic cholecystectomy at SMI Hospital, Dehradun during one year period were included in the study with certain exceptions. The details of clinical presentation, operative findings and conversion rates, duration of surgery and peri-operative complications were recorded separately for male and female patients and compared.Results: A total of 402 patients were included in the study. 72 (17.9%) were male and 330 (82%) were female. The mean duration of surgery was significantly greater in the male group (66 min) as compared to female group (60.5 min). The rate of conversion to open surgery was not significantly different in the two groups. There was no significant difference in frequencies of complications in the two groups.Conclusions: Gender has little role as far as overall morbidity and conversion to open surgery are concerned in patients undergoing laparoscopic cholecystectomy.
Autism spectrum disorder is an emerging public health issue. The core features of autism spectrum disorder are persistent impairment in reciprocal social communication and interaction and restricted, repetitive patterns of behavior or interests. We now know that it encompasses disorders previously referred to as early infantile autism, childhood autism, Kanner autism, high-functioning autism, atypical autism, Asperger disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. While it is agreed that the etiology of autism spectrum disorder is largely unknown, certain environmental and genetic factors may be responsible for the disease. In particular, emerging evidence has suggested the role of C677T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene as a possible risk factor. We present the case of a two-year-old boy with high risk for autism who was found on advanced investigation to have heterozygous polymorphism for MTHFR. This prompted us to add folic acid to his therapeutic regime. He was treated with high-dose folic acid along with conventional intervention, and went on to make excellent recovery. We conclude that pharmacological intervention has the potential to improve outcome in a subgroup of autistic children.
Cirrhosis carries high morbidity and mortality due to various complications and decompensation, which can be decreased by following various practice guidelines, which are variedly followed in actual practice. This multicentric prospective/retrospective study was conducted over a 3 month period to assess actual care of patients with cirrhosis. 416 patients with cirrhosis (median age 53 years, 316 males) were included in the study. A comprehensive protocol was devised taking into account various practice guidelines. Patients were divided into 3 groups. Group 1: Newly diagnosed patients evaluated as per protocol. Group 2: Patients previously diagnosed at the study centers, past practices assessed. Group 3: patients diagnosed previously at non-study centers, their surveillance practices were assessed. Patients in the 3 groups were similar in terms of age and gender ratio. There was significant difference between varices screening practices amongst 3 groups, however there was similar nonselective beta blockers (NSBB)/endoscopic variceal ligation (EVL) prophylaxis practices. Ultrasound surveillance for ascites varied significantly amongst 3 groups. There was significant difference between antibiotic prophylaxis practice in high risk ascites patients between groups 1 and 2. Evaluation of renal function at baseline and ultrasound surveillance for hepatocellular carcinoma was significantly different in 3 groups. All patients in group 1 underwent SpO2 monitoring, however none in groups 2 or 3 previously had SpO2 monitoring. Surveillance and treatment practices for various complications of cirrhosis vary widely in real life and falls well short of goals. Presence of dedicated protocols helps in improving the way we care for our patients with cirrhosis.
BACKGROUNDThe goal of enteric anastomosis is to prevent leakage, to promote healing, to preserve bowel length, and to prevent stricture formation. An effective anastomosis requires adequate mobilization, perfusion, apposition, and inversion of the mucosal edges into the bowel lumen. METHODSAfter taking the institutional ethical committee approval for the study, the study was conducted at SVRRGG Hospital (a tertiary care centre of about 950 bed size), Tirupati. All patients were above 18 years and were admitted for undergoing gastrointestinal anastomoses electively. Patients who underwent gastrointestinal anastomoses as an emergency procedure in SVRRGG Hospital, Dept. of General Surgery, Tirupati from October 2017 to September 2018 were included in this study. RESULTSOut of the 60 cases in this study, 49 cases were done electively, and 11 cases were done on an emergency basis. The overall leak rate was 11.7%. The p-value is more than the significance level 0.05; the difference in leak rate between elective and emergency cases is not significant. CONCLUSIONSThis study is an attempt to evaluate various factors involved in bowel anastomotic leaks, various presentations of anastomotic leaks, and morbidity and mortality associated with them. With the observations and analysis, we concluded that various preoperative factors like haemoglobin %, nutritional status, serum albumin levels, intraoperative factors like degree of contamination, type of anastomosis and pathology involved have significant impact on outcome of bowel anastomosis.
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