AUDIT OF EVOLVING ROLES OF LAPAROSCOPY IN THE CURRENT SURGICAL PRACTICE AT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL: A 5 YEAR REVIEW

Background: Laparoscopic surgery (LS) is gaining momentum and has revolutionised the practice of surgery. Over the past thirty years, LS has been used to manage a wide range of surgical pathologies and has become a recognised and generally accepted standard of care. Aim: The aim of this study is to describe the evolution of LS in selected procedures.. Methods: Data were collected from theatre registries. Statistical analysis was performed using the software IMB SPSS. The data were analysed using descriptive statistics of mean and standard deviation for age, and percentage and frequencies for categories of variables . Results: Of the 3745 patients involved in the study, 59.1% were males and 40.9% were females. The mean age of the patients was 35.17±17.30 years. Laparoscopic surgery was represented in 43.2% of the procedures, with laparoscopic appendicectomy (46.73%) and laparoscopic cholecystectomy (32.69%) being the most commonly performed procedures.. Twenty-five adrenalectomies were performed over the study period, and of those 12 (52%) were performed laparoscopically. All the thymectomies (12) were performed thoracoscopically, with one conversion. Conclusion: The findings of this study suggest that there has been an increase in the overall incidence of laparoscopic surgery in selected procedures at CHBAH.

5 DAY CONTINUOUS DOSING WITH ORAL NANO VIT.D3 – A CASE SERIES

Vitamin D is highly essential for various functions of human body including proper immunity. Deficiency of vitamin D is mostly undetected and also a major underlying cause for various diseases and disorders .The Prevalence of Vitamin D deficiency in India is very high, detection and immediate management of severe vitamin D deficiency is an essential step especially given the current situation of the COVID 19 Pandemic where proper immunity is an important factor for survival. This case series is an update on the impact of 5 day continuous dosing with oral Nano Vit.D3 on serum vitamin D levels in individuals with severe vitamin D deficiency without co-morbidities

MICROSATELLITE INSTABILITY TESTING'S BENEFITS IN A VARIETY OF CANCERS

The accumulation of mutations across the genome, notably in microsatellite (MS) DNA repeat sequences, is a hallmark of MSI/dMMR tumors. Microsatellite instability (MSI) is a genetic change in which microsatellites, which typically have one to six nucleotide repetitions, acquire mutations corresponding to small nucleotide deletions or insertions. Immunohistochemistry or a PCR-based test directed against a set of five MS areas were used to create an MSI detection method. MSI is a significant biomarker for cancer diagnosis, prognosis, and treatment options.

SURGICAL MANAGEMENT AND BACTERIOLOGICAL OUTCOME OF INFRARENAL ABDOMINAL AORTIC GRAFT INFECTION AT A SINGLE CENTRE

Aim: Primary outcome measures was to analyze the clinical consequence of patients who treated for infrarenal aorta synthetic graft infection ( SGI) with extra-anatomical bypass (axillobifemoral (AXF)) or in situ reconstruction (ISR). Secondary outcome measure was to show bacteriological analysis of abdominal aorta graft infection. Method: Analysis of medical records of 24 patients treated for SGI at Jordanian Royal Medical Services between June 2010 and Aug 2020 were retrospectively reviewed. For all patients, we recorded clinical features , morbidity and mortality , as well as bacteriology results, and antibiotic treatment . Result: We identified 24(3%) patients with SGI .The median follow up duration was 22 months range (8-84months). The median age was 52 years and 18 were males. An in situ prosthetic graft replacement, using rifampin-soaked polyester graft was performed in 10 patients(42%) and AXF in 14 patients((58%). The early hospital mortality rate was 4 (17 %.) owing to bowel ischemia 1 patient, 2 patients with septicemia and one patient with aortic stump blowout . There were no late procedure-related deaths during follow up period Primary patency and limb salvage rates at 3 years were 80 %(2 patients ) for ISR and 90%( 2 patients) for AXF. The incidence of graft reinfection was 10% (1 patient) for ISR and 8 %(2 patients) for AXF. Graft reinfection occurred in 3 patients (12.5%) was not associated with procedure-related death .Microbiology specimens obtained from the graft and the tissues were positive in 21 patients(88%). Poly microbial Gram-positive organisms were the most dominant bacteria found in 10 patients (42%). The mean length of hospital stay was 17 days . Conclusion: According to our study ISR and AXF is a safe and effective in treatment of aortic graft infection. Graft reinfection occurred in 12.5% of the patients. The graft patency and limb salvages rates were considered satisfactory.

Prevalence of Mobile Phone Dependence (MPD) among Medical Students: An Observational study

Today, we live in an era of Information and technology, where everything is available at the touch of a finger, and the speed of an electron. With the advent of the smartphone, new unbounded possibilities have opened up, bringing with them an array of mental, behavioural, and psychological problems. Aim Evaluation of the Prevalence of Mobile Phone dependence in Medical Students. A secondary aim involves finding out association of a factor, like age, sex, or years of usage with aforementioned dependence. Materials and Methods An observational survey was conducted, with an questionnaire for the students of a Medical College in Navi Mumbai (New Bombay), India. 340 students, from each of the 4 years from a Medical College in Navi Mumbai were selected for the sample. The students were randomly included, and criteria of having a mobile phone was applied. Participant information like age, gender, family type, phone type, duration of use per day and years of mobile phone usage was recorded. They were administered an MPD questionnaire based upon the dependence syndrome criteria as per ICD-10 criteria. According to their responses, participants who fulfilled three or more of the diagnostic criteria were rated as having MPD. Results The sample of 340 students was analyzed and the following results were obtained. ● Out of 340, 51 students matched the ICD-10 criteria, while 289 did not. At 95% Confidence Interval (CI), the prevalence was 15.04 ± 3.8 %. ● The mean age of all the students was calculated to be around 20.156 years. At 95% CI, we can say the mean age is 20.15 ± 0.15 years. Alternatively, it can be stated around 20 to 20.3 years. ● The percentage of males dependent were 17.30 ± 7.76 %, while for females they were 12.80 ± 7.36 %. ● Smartphone users were at 14.90 ±1.15 %, with the mean years of use sitting around 3.43 ± 0.27.

IS THAT THE R171Q AMINO ACID VARIANT IN EXON 3 OF THE MEN1 GENE IS RELATED TO AGE, TO PLAY A MUTATING ROLE?

Background/aim: Several studies demonstrated that the R171Q amino acid variant in exon 3 of MEN1 gene is a polymorphism, and in some new studies it is probably a mutation. We found in our study of twelve cases, two young cases have this variant and developed multiple endocrine neoplasia type1. Materials and methods: twelve MEN1 young patients (7 female, 5 male) aged between 20 and 40 years old, were included in our study. After investigating each patient, biochemical and molecular researches is done. We sequenced exon 3 of the MEN1 gene of patients and some members of their families. Results: Ten patients have MEN1 syndrome and they have no mutation in MEN1 gene. Two patients from separated families have a c.512G>A heterozygote variant. Phenotypically the two cases have hyperparathyroidism in young age. One of them developed others tumors later. Conclusion: The R171Q variant is a mutation in some cases; causes hyperparathyroidism and will develop further MEN1 lesions later, and it is just a polymorphism in other cases. We believe that when this polymorphism combines with young age in severe depression, it will lead to MEN1 syndrome, which will make this polymorphism considered a genetic mutation

COMPARISON OF 0.5% LEVOBUPIVACAINE AND 0.5% BUPIVACAINE WITH FENTANYL FOR SPINAL ANAESTHESIA FOR TRANSURETHRAL RESECTION OF PROSTATE / BLADDER TUMOUR: A PROSPECTIVE RANDOMIZED AND CONTROLLED CLINICAL STUDY.

Background – The aim of this study is to compare safety and efficacy of bupivacaine 0.5% of 2ml (10mg) with 25mcg fentanyl and levobupivacaine 0.5% of 2ml with 25mcg fentanyl when given intrathecally in patients of Transurethral Resection of Prostate/Bladder Tumor Surgeries Methods–After local ethics committee approval,60 patients were selected according to eligibility criteria and a written informed consent was obtained from each patient after explaining the technique prior to inclusion in this study in their own vernacular language and randomly allocated in two groups of 30 each. GROUP I: patients received 2 ml(10 mg) 0.5% bupivacaine with 25 mcg fentanyl intrathecally to achieve an adequate level of anaesthesia.GROUP II: patients received 2 ml(10 mg) 0.5% bupivacaine with 25 mcg fentanyl inrathecally to achieve adequate level of anaesthesia.Spinal block was performed by an anaesthesiologist consultant. Patients were monitored for sensory blockade,motor blockade,Ramsay sedation score,VAS score and complications. Hemodynamics were compared in both the groups. Observations –In this study we evaluated and compared 0.5% bupivacaine and fentanyl with 0.5% levobupivacaine and fentanyl in terms of intraoperative hemodynamic changes, onset & duration of sensory block, onset of motor block, level of sedation and occurance of complications when given intrathecally for transurethral resection of prostate/bladder tumors.It was observed that sensory blockade qualities were comparable in both the groups. However, motor blockade was significantly reduced in group-II(Levobupivacaine) as compared to groupI(Bupivacaine). Patients in Group II had better hemodynamic stability,good patient and surgeon satisfaction and fewer side effects as compared to Group I. Conclusion –0.5% Levobupivacaine plus fentanyl provides less motor blockade,better hemodynamic stability and fewer side effects in patients undergoing TURP/TURBT compared to 0.5% bupivacaine plus fentanyl.