Simplified Technique of Conventional Cholecystectomy in a Patient with Situs Inversus Totalis: A Case Report from Nepal

Introduction: Situs inversus is a rare autosomal recessive disorder occurring in 1:5,000 to 1:20,000 indiviuals. Cholecystectomy is a standard treatment for symptomatic gallbladder stone. We report a case of cholelithiasis in patient with inversus totalis who underwent cholecystectomy. Case presentation: A 48 years old obese female patient with dextrocardia and hypertention presented with a recurrent left upper abdominal pain for two years. Ultrasound abdomen showed gallbladder stone. Conventional cholecystectomy was done with a small left subcostal incision. The postoperative period was uneventful and the patient was discharged on 3rd post operative day. Conclusion: Cholecystectomy is the treatment of choice in patients with a left sided gallbladder stone, like in normal gallbladder and it is safe.

VOLLEYBALL AS AN EXERCISE PROGRAM FOR OVERWEIGHT AND OBESE FEMALE ADOLESCENTS

ABSTRACT Introduction: Sport is very important in the lives of children and adolescents, as it brings countless benefits at the physical, psychological and social levels. Objective: The aim of the study was to investigate the effects on physical fitness of an exercise program for overweight and obese female adolescents, with an emphasis on teaching volleyball. Methods: Twenty-five volunteers participated, aged between 13 and 14 years, of which 11 were overweight or obese for statistical analysis. Anthropometric and physical capacity assessments were performed, before and after 12 weeks, through activities related to volleyball. Results: There was an increase in height and span and a reduction in waist circumference, with no significant differences in body weight, BMI, arm circumference and triceps skinfold thickness; there was an increase in the sit-and-reach test, in the number of sit-ups and in the distance of the horizontal jump. There was a decrease in the time in the square test and the 20-meter run, with no significant differences in the medicine ball throw and in the 6-minute run test. Conclusion: It is concluded that the volleyball teaching program provided benefits for the physical fitness of overweight and obese adolescents. Level of evidence II; Lower quality RCT (example, <80% follow-up, no randomization code masking or inadequate randomization).

Abdominal wall skin lesions in adult morbid obese women

Objective: To present only skin lesions in the abdominal wall that we detected in morbidly obese patients and to examine them in the light of the literature. Material and Method: Patients who applied to the general surgery outpatient clinic for bariatric surgery and who also had dermatological complaints and were referred to the dermatology outpatient clinic with the detection of skin-related complaints were retrospectively evaluated in terms of age and breast skin findings. Normal skin findings were separated into intertrigo, chronic recurrent folliculitis, eczemas, acanthosis nigricans and striae. Results: A total of 60 obese female patients were included in the study. The mean age of the patients was 32.4 ± 8.8 years (19-53), and the mean body mass index was 42.6 ± 2.4 (40-49). Normal skin findings were present in 28.3% of the patients (17 patients). The most common finding was striae, and 60% (36 patients) had it. Then respectively, intertrigo was detected in 14 patients (23%), chronic recurrent folliculitis in 12 patients (20%), eczema in 5 patients (8.3%), and acanthosis nigricans in 2 patients (3.3%). Conclusion: The most common findings on the abdominal wall skin of obese individuals are striae and intertrigo, and similar findings have been found in many studies in the literature.

The differences of glycodelin and uterus NK cell expression in obese and non-obese rats (Rattus norvegicus)

HIGHLIGHTS1. Obesity increases the risk of comorbidities especially for the pregnancy.2. The study analyzed glycodelin levels and uterine NK cell expression using Rattus norvegicus as animal model.3. uNK cell expression of the obese rats group was higher as the marker of chronic inflammation for obesity.4. Although there was increasing uNK cells in obese rats group, this result was not followed by the level of gycodelin.ABSTRACTObjectives: To prove the existence of differences in glycodelin levels and uterine NK cell expression in obese and non-obese female white rats of Wistar strain (Rattus norvegicus).Materials and Methods: . This study used a randomized post-test only controlled group design. This in vivo study used two groups of female rats (Rattus norvegicus). Group 1 was treated with the high obese diet for eight weeks, and group 2 was not treated with the high obese diet. After eight weeks, the rats were weighed, the proestrus phase was synchronized, and then the rats were terminated.Results: In this study, there was no significant difference in glycodelin levels between the obese and non-obese groups with a p= 0.821 (p >0.05). Significant differences were found in uterine NK cell expression between obese dan non-obese groups with p=0.001 (p <0.05). The correlation test of glycodelin levels and uterine NK cell expression showed insignificant results with a correlation coefficient of 0.120 and p=0.513. This proved that there was no significant correlation between glycodelin levels and uterine NK cell expression.Conclusion: There was no significant difference between glycodelin levels and uterine NK cell expression in obese and non-obese female white rats of Wistar strain (Rattus norvegicus).

Obesity Enhances Disease Severity in Female Mice Following West Nile Virus Infection

A rise in adiposity in the United States has resulted in more than 70% of adults being overweight or obese, and global obesity rates have tripled since 1975. Following the 2009 H1N1 pandemic, obesity was characterized as a risk factor that could predict severe infection outcomes to viral infection. Amidst the SARS-CoV-2 pandemic, obesity has remained a significant risk factor for severe viral disease as obese patients have a higher likelihood for developing severe symptoms and requiring hospitalization. However, the mechanism by which obesity enhances viral disease is unknown. In this study, we utilized a diet-induced obesity mouse model of West Nile virus (WNV) infection, a flavivirus that cycles between birds and mosquitoes and incidentally infects both humans and mice. Likelihood for severe WNV disease is associated with risk factors such as diabetes that are comorbidities also linked to obesity. Utilizing this model, we showed that obesity-associated chronic inflammation increased viral disease severity as obese female mice displayed higher mortality rates and elevated viral titers in the central nervous system. In addition, our studies highlighted that obesity also dysregulates host acute adaptive immune responses, as obese female mice displayed significant dysfunction in neutralizing antibody function. These studies highlight that obesity-induced immunological dysfunction begins at early time points post infection and is sustained through memory phase, thus illuminating a potential for obesity to alter the differentiation landscape of adaptive immune cells.

Newer Airway Gadgets: Rescuers in Difficult Airway Scenarios

Background: As anaesthetists, we may constantly be in the learning curve of the management of difficult airway scenario. It can have a disastrous outcome if one is not adequately prepared with the right equipment. Over time there has been multiple ways to tackle difficult airway scenarios. Needless to say, appropriate airway gadgets are carefully chosen according to the surgery and patient characteristics. But what if these certain techniques fail? Then, what next? The inability to efficiently manage a difficult airway is the major cause of morbidity and mortality in anaesthetic practice. Here, we discuss 4 different case scenarios of difficult airway management. case reports:Case 1 was a pediatric patient with TMJ ankylosis, with mouth opening 4mm, in whom we used the fibreoptic technique. Case 2- A failed fibreoptic attempt in a case of recurrent Ca oral cavity where we secured the airway using Airtraq videolaryngoscope. Case 3- A patient with post burn contracture over front of neck and anterior shoulder where we decided to use intubating laryngeal mask airway for securing airway and Case 4- An obese female patient posted for hysterolaparoscopy where we used the Laryngeal Mask Airway Supreme. Conclusion: Effective usage of newer drugs, equipment and airway gadgets by technically skilled personnel, with sound clinical judgement are essential factors in reducing airway related adverse scenario and it is of utmost importance to keep these alternate gadgets handy and to be proficient with its usage.