A Retrospective Study of Mechanical Hepaticojejunostomy: Can We Use a Circular Stapler as a Viable and Safe Alternative?

Background: Some writers have described the use of mechanical staplers to establish anastomosis in biliary surgery since the early 1980s. However, in the following decades, the usage of these devices did not proliferate, and most centres still perform hand-sewn anastomosis. Methods: We used medical records, surgical registries, and computer-assisted databases to acquire information about the use of mechanical circular staplers for the establishment of hepaticojejunostomy at our institution. Results: Between 2012 and 2020, our hospital performed 11 stapled hepaticojejunostomies for both neoplastic and non-neoplastic illnesses. The patients were on average 74 years old, with 5 men and 6 women in the group. Prior to surgery, the average bile duct diameter was 19 mm. In preoperative blood samples, total bilirubin was 6.95 mg/dL. There were no issues. Throughout the treatment Two patients (18%) experienced minor postoperative problems (1 wound dehiscence and 1 episode of melena requiring blood transfusions), but no serious complications occurred. In none of the patients were there any biliary fistulas or anastomotic dehiscence. No one dies within 30 days of surgery. After surgery, the average length of stay was 13 days. Conclusions: Based on our limited experience, stapled hepaticojejunostomy appears to be a safe and successful operation in chosen individuals.

Author(s) Details

Nicolò Fabbri
Unit of General Surgery, Azienda USL di Ferrara, Ferrara, Italy

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Radiotherapy in Elderly Patients with Low-Risk Breast Cancer

Few studies on the treatment of older women with low-risk breast cancer have been conducted. Despite the fact that their clinical behaviour is identical to that of younger patients, they are frequently undertreated, which increases the likelihood of local relapses and shortens their survival. The rate of local recurrences after breast conserving surgery without adjuvant treatment (tamoxifen or radiation) is significant, approaching 20% in low-risk individuals, which is unacceptable. Despite the fact that tamoxifen and irradiation appear to have equal effects in terms of preventing local recurrence, The combination of the two produces the best overall survival rates, with local relapses of less than 2%. In recent years, two trials that were specially tailored for older patients were published. These trials propose avoiding radiotherapy in patients with low-risk tumours treated with breast conserving surgery and tamoxifen based on equal survival, but with a 10% increase in local relapses at 10 years vs. 2% when radiotherapy is skipped. There is no proof that taking tamoxifen can help you lose weight. is less toxic in this group of patients who are typically poly-treated, and treatment compliance appears to be much lower than expected. This recommendation is highly contentious due to the reduction in the number of sessions in external radiotherapy with hypofractionation and the acceleration of partial breast irradiation, especially intraoperative radiotherapy with a single session. After breast conserving surgery, elderly patients may benefit from radiation therapy.

Author (s) Details

Claudio Fuentes-Sánchez
Hospital Universitario Candelaria, Santa Cruz de Tenerife, Spain.

María Elena García-Morales
Hospital Universitario Candelaria, Santa Cruz de Tenerife, Spain.

Carmen González-San Segundo
Hospital Universitario Gregorio Marañón, Madrid, Spain.

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Influence of Abnormal Thyroid Hormone Changes on Lipid Peroxidation and Antioxidant Imbalance in Hypothyroid and Hyperthyroid Patients

The thyroid gland is the body’s main metabolic regulator. Normal organ development necessitates thyroid hormones. Thyroid hormones in high doses have been shown to change oxygen metabolism in cells and accelerate the formation of free radicals. When compared to normal and hypothyroidism, thyroid hormone has a pro-oxidant action and increases the generation of oxygen free radicals, resulting in a drop in antioxidant status in hyperthyroidism. Oxidative stress is also caused by thyroxin administration. Oxidative stress and hypothyroidism both impair the immune system. The thyroid gland appears to play a key role in the generation of widespread oxidative stress in pathological states. Thyroid hormones are essential regulators of mitochondrial oxidative metabolism. The goal of this research is to examine at free radical scavenging activity, lipid peroxidation, and other related topics. and antioxidant levels in hyperthyroidism and hypothyroidism patients In conclusion, our findings imply that individuals with hypothyroidism and hyperthyroidism have a high generation of ROS and oxidative stress, as well as increased lipid peroxidation and a failure of antioxidant defence mechanisms.

Author(s) Details

Babu Kandasamy
Department of Biochemistry, Kongunadu Arts and Science College, G. N. Mills, Coimbatore, Tamil Nadu, India.

Indira A. Jayaraaj
Department of Biochemistry, Kongunadu Arts and Science College, G. N. Mills, Coimbatore, Tamil Nadu, India.

Jeganathan Prabhakar
J. P. Thyroid Clinic, Coimbatore, Tamilnadu, India.

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Left Atrial Appendage Occlusion as an Alternative to Anticoagulation

Because blood clots form largely in the left atrial appendage in non-valvular atrial fibrillation, there is a greatly increased risk of embolic stroke (LAA). Anticoagulant therapy on a long-term basis or interventional LAA blockage are two ways to avert embolic occurrences. Physical LAA occlusion used to necessitate surgical excision or suture or stapler exclusion. Various clinical investigations now show that LAA occlusion utilising various interventional occluder devices is safe, efficacious, and therapeutically successful. After demonstrating the safety, therapeutic value, and cost-effectiveness of LAA occlusion, the use of such implants has become a valuable alternative for stroke prevention in patients who cannot take anticoagulants.

Author (s) Details

Ibrahim Akin
First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.

Christian Fastner
First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.

Christoph A. Nienaber
Royal Brompton Hospital and Harefield Trust, London SW3 6NP, United Kingdom.

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Self-Assessment of Dental Anxiety in Patients Visiting Comprehensive Rural Health Service Project, Ballabgarh

The goal of this study was to determine the prevalence, severity, and relationships of dental anxiety in a sample of adults visiting the Ballabgarh, Haryana, Comprehensive Rural Health Service Department. Dental anxiety is a prevalent issue among both dental professionals and patients. The purpose of this study was to assess the prevalence, intensity, and connections of dental anxiety in people visiting the Comprehensive Rural Health Service Department in Ballabgarh, Haryana. Dental anxiety is a common occurrence among both dentists and patients. Analytical Statistics The percentage, means, and standard deviation were calculated using SSP version 16 software. Females were shown to be more apprehensive than males, according to the findings. According to the distribution of anxiety by age group, males aged 15 to 23 and 24 to 33 were fairly apprehensive, whereas those aged 35 and older experienced relatively minor anxiety (44 to 53 yr). Females, on the other hand, were shown to be extremely nervous in the age groups of 24-33 and 34-43. Conclusions: To combat the fear and anxiety component, it is suggested that dental education and health care services be increased.

Author(s) Details

Anindya Bhalla
Department of Public Health Dentistry & Nims Dental College Shobha Nagar, N.H.11-C Jaipur – 303121 Rajasthan, India.

Sukriti Bhalla Singh
Department of Internal Medicine & Shri Dada Dev Matriavum Shishu Chikitsalya, Dabri, Delhi -110045 New Delhi, India.

Department of Oral Diagnosis & KG Chopra Dental Clinic, Jaipur,-302004, Rajasthan, India.

Ashish Singh
Department of Family Medicine & Room 10, community Health centre (CHC) District Shyamli, -251319 Uttar Pradesh, India.

Ajay Choudhary
Department of Conservative & Endotics Dentistry& Nims Dental College Shobha Nagar, N.H.11-C Jaipur – 303121 Rajasthan, India.

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Secure Automated In-home Patient Monitoring

Early detection and prevention of diseases rely heavily on in-home patient monitoring. The construction of a wireless sensor network to monitor a patient in his or her home is presented in this study. Various body sensors are attached to the patient’s body in order to collect data such as temperature, blood pressure, ECG, and pulse rate. Most monitoring systems currently employ a personal computer (PC) as a local database to store patient body parameters prior to transferring them to the hospital. In this case, a cell phone replaces the requirement for a computer. The body parameters recorded by sensors are kept private and sent to the hospital in a secure manner. To accomplish security, a variant of Ciphertext Policy Attribute-Based Encryption (CP-ABE) with a double encryption approach is utilised. Because the patient always has his or her phone with them when they leave the house, outside monitoring is also enabled by the mobile phone. As a result, the mobile phone serves as a local database, obviating the need for a computer and allowing for outdoor surveillance. Finally, a temperature sensor is used to implement real-time monitoring. A temperature sensor, an analogue to digital converter (ADC), a microcontroller, an LCD, and a Bluetooth device make up the sensing circuit. A variation of Ciphertext Policy Attribute-Based Encryption (CP-ABE) with a twofold encryption technique is used to provide security. Outside monitoring is also possible because the patient always has his or her phone with them when they leave the house. As a result, the cell phone acts as a local database, removing the need for a computer and enabling outside surveillance. Finally, real-time monitoring is implemented using a temperature sensor. The sensing circuit consists of a temperature sensor, an analogue to digital converter (ADC), a microcontroller, an LCD, and a Bluetooth device.

Author (s) Details

Dr. R. Suji Pramila
Department of Computer Science and Engineering, Noorul Islam Centre for Higher Education Kumaracoil, Tamilnadu, India.

Dr. A. Shajin Nargunam
Department of Computer Science and Engineering, Noorul Islam Centre for Higher Education Kumaracoil, Tamilnadu, India.

Dr. V. A. Tibbie Pon Symon
Department of Computer Science and Engineering, Noorul Islam Centre for Higher Education Kumaracoil, Tamilnadu, India.

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Transmesenteric Hernia in a Peripartum Patient: A Case Report

 Adult intestinal obstruction due to a congenital transmesenteric hernia is a rather uncommon occurrence. The intestinal loops are strangulated once they protrude through the defects in the mesentery in this type of internal hernia. Following computed CT findings and increased pancreatic enzymes, a patient who presented to the emergency department with persistent stomach pain after an emergency caesarean section was diagnosed with acute pancreatitis. Her pain was out of proportion to her diagnosis of pancreatitis, and her health swiftly deteriorated, demanding multiorgan treatment. After reimaging, a blocked transmesenteric hernia was identified. The patient required immediate surgical intervention. Internal hernia should be one of the differential diagnoses for any abnormal acute abdomen, and early management can save lives.

Author (s) Details

Gopala Krishnan Ravi

Department of Critical Care Medicine, Manipal Hospital, Bengaluru, Karnataka, India.

Dr. A. K. Ajith Kumar
Department of Critical Care Medicine, Manipal Hospital, Bengaluru, Karnataka, India.

Sunil Karanth
Department of Critical Care Medicine, Manipal Hospital, Bengaluru, Karnataka, India.

Nagaraj Palankar
Department of Surgical Gastroenterology, Manipal Hospital, Bengaluru, Karnataka, India.

Shilpa Ramachandra
Department of Radiodiagnosis, Manipal Hospital, Bengaluru, Karnataka, India.

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Empty Sella [Presenting as Hypopituitarism] and Platybasia Secondary to Essential Fatty Acids Deprived Diet: A Retrospective Analysis

Background: An increased prevalence of morbidity and mortality is a global concern; due to a lack of understanding, the world has implemented non-evidence-based medical practise, without therapeutic indication, therapeutic protocols, policies-contraception, abortion, annihilating the human race through therapy, destroying germ cells with subsequent systemic inflammatory response syndrome, linked to death. For the past >40 years, cholesterol has been blamed for neoplasms, resulting in essential fatty acids deficiency, promoting sunflower seed oil, refined oil, lipid-lowering agents prescription like water; the tragedy of this false concept of refined oil, essential fatty acids deficiency, [against God-ordained marvellous cell metabolism, from cholesterol] resulting in essential fatty acids deficiency, promoting sunflower seed oil, refined oil, lipid-lowering agents prescription like water sandrogen Case 1: A 76-year-old vegetarian man with lethargy, hypotension, and unexplained hyponatremia who had been on fludrocortisone for two years arrived with lethargy, hypotension, and unexplained hyponatremia. After an MRI revealed an empty sella, hypopituitarism with cortisol deficit, resulting in hyponatremia, was evaluated, and the patient improved with hydrocortisone replacement. Low values of LDL and HDL suggested that a degenerative—empty sella state with hypopituitarism had occurred from a long [>40 years] restriction of a diet rich in essential fatty acids.

Case 2: 17-year-old girl presented with headache, vomiting, and a weak pulse; platybasia had been diagnosed 6 months prior, and she had undergone corrective neurosurgery to widen bi-laterally narrowed base of skull foramina to prevent compression on the exiting neurovascular bundles; an urgent CT scan of the brain revealed significant narrowing of the foramen magnum, compressing the brainstem; she died shortly after. Low HDL, LDL verified, long-term [16 years] deficiency in necessary fatty acids intake, resulting in decreased steroid hormone synthesis—including oestrogen—the surveilling hormone for cell metabolism, including skull base, having resulted in prostatic hyperplasia.

Conclusion: Despite the fact that both patients were from affluent families, the cause and effect phenomenon of degenerative empty sella syndrome, ineffective cell-bone metabolism, and platybasia was the honest adherence to the incorrect damaging notion of essential fatty acids denied diet. It’s worth repeating that cholesterol esters, which are produced from necessary fatty acids in the diet, are the basic component of cell metabolism, new cell creation, steroid hormone synthesis, and genomic repertory.

Author (s) Details

Elizabeth JeyaVardhini Samuel
Karpagam Faculty of Medical Sciences and Research, Madras University, Coimbatore, India.

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Neurovascular Syndrome—Secondary to Endemic Subacute (Fruits Borne) Viral Infection, Consequent to Global Aborted Blood, Contraceptives Menstrual Blood Pollution and Consumption of Waterliving Toxinous Mammals: A Retrospective Demographic Analysis

After the initial onset of the identified Nipah viral infection (fruits borne virus) epidemic in adjacent state in the middle of 2018, 15 patients with fever, acute coma, delirium, and movement disorders required referral to the district headquarters hospital for virology confirmation and management. Over the past 14 months, 135 mostly afebrile patients who refused referral to a government hospital for virology confirmation presented with symptoms of mostly subacute pan encephalitis; 90% of them had vertigo, staring, personality changes, imbalance in gait, difficulty walking, bilateral saliva drooling, tremors, confusion, altered sensorium, nausea, and vomiting. 4.6 percent had impaired vision, 58 percent had myoclonic jerks, and 8% had choreoathetosis. They couldn’t afford the INR 10,000 for virology proof because they couldn’t afford it. Fruits-borne viral subacute pan encephalitis can present as subacute neurovascular syndrome, mimicking ischemic stroke, mediated by Hapten-triggered autoimmune angiopathy (blood-borne) with resultant bilateral, asymmetrical multifocal infarcts, cerebritis, and edoema, requiring recognition and successful treatment with acyclovir, antiedema, antiepileptic measures, but not antiplatelets, s Educating people on how to steam cook, pressure cook, and cook with coconut oil (pie) fruits, as well as how to steam fresh fruits. Before eating, wash your hands to avoid fruit transmitted illness, tobacco leaf transmitted illness, and endemic viral infection. Early identification, authentic notification, and treatment of subacute pan encephalitis manifesting as neurovascular disease, simulating ischemic stroke, will be made possible by inexpensive screening card testing for Nipah fruits borne virus. Aborted blood pollution, contraceptive menstrual blood pollution, as evidenced by increased ambient oestrogen, beta human chorionic gonadotropins, and alpha fetoprotein, favours microorganism development, virulence, and medication resistance. including the recent fruits-borne virus; global eradication of contraception and abortion (—non-evidence-based medical practise, without therapeutic indication, therapeutic protocols, therapeutic policies), to be replaced by a global baby boom (promoting childbirth >10 – 20 children per family) will prevent further emergence, virulence of microbial infections, including Ni-pah, the oncoming Ebola corona Consumption of water life without scales, gills, fins, or toxin-containing mammals has increased dramatically during the last five years. In 3.5 percent of cases, cortical venous, sigmoid sinus thrombosis, choreoathetosis in 12.5 percent, unresponsive but restless in 12.5 percent, quadriparesis, hemiparesis in 37.5 percent, simulating neurovascular disease, ischemic stroke; therapy with methylprednisolone, immunoglobulin reverted As a differential diagnosis to ischemic stroke, this retrospective analysis includes water intake while living without scales, presenting as neurovascular illness.

Author (s) Details

Elizabeth JeyaVardhini Samuel
Karpagam Faculty of Medical Sciences and Research, Madras University, India.

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Complex Physical Prevention and Rehabilitation of Cervical Myofascial Pain and Headache, Due to Spine Malposition in Users (Abusers) of Smart Phones

Introduction: The introduction of portable gadgets into everyday life necessitated an assessment of the potential implications (of misuse) on the spine and central nervous system, as well as the development of programmes to prevent these consequences. The purpose of this study is to assess the influence of various physical modalities (such as physiotherapy, ergotherapy, and massage therapy). In the prevention and complex rehabilitation of the beginning of cervical myofascial pain and headache owing to spinal malposition in users (abusers) of smart phones, manual therapy, deep oscillation, lasertherapy, and magnetic field were used. Methods and Materials: A total of 165 patients with cervical myofascial pain and headache were observed and placed into five groups (of 33 patients each). The patients ranged in age from 19 to 50 years old, with cervical spine posture (position) changes but no major cervical disease. For at least 6 months, all patients used a mobile device in their daily activities (at least 2 hours per day). a month after the recovery is completed We used a complex physical-therapeutic programme (PT) in all of the patients, which included analytic exercises for paravertebral muscles and soft tissue techniques [massages, post-isometric relaxation (PIR) for the respective upper trapezius and sterno-cleidomastoideus muscles] as well as encouraging patients’ active participation in the prevention process (education in principles of back-school, self-massage, auto-PIR). The first group of patients Only these procedures were carried out. We included manual treatment elements in the second group (MT – tractions, mobilizations, manipulations; and auto-mobilizations). A paravertebral application of a prepared modality was added to the PT and the MT in patients in the following groups: group 3 – Deep Oscillation (DO); group 4 – lasertherapy (LT); group 5 – magnetic field (MF). The statistical analysis was carried out with the SPSS programme, version 17, and the t-test (analysis of variances ANOVA) and Wilcoxon rank test were used (non-parametrical correlation analysis). All patients reported a considerable reduction in the severity of their neck discomfort and headaches (evaluated by Visual analogue scale of pain and by pressure dolorimetry). The static position of the cervical spine was improved in all patients, as was the amount of paravertebral muscle spasm and the sensitivity of trigger and tender points, as well as the range of active motion of the cervical region of the spine. The second group (with manual treatment) had the best results during the recovery period, but there were no statistical differences between the two groups one month afterwards. Conclusion and Discussion: PT and MT techniques are extremely beneficial in the prevention and rehabilitation of cervical myofascial pain and headache. Active (analytic) exercises, PIR and stretching techniques, tractions and mobilizations, patient education, and (in some situations) manipulations are all part of the treatment plan. The use of prefabricated modalities (DO, LT, MF) in a sophisticated preventative and rehabilitation programme promotes pain relief and spine mobility. as well as improving the results’ stability. Every medical practitioner who specialises in physical and rehabilitation medicine, as well as every physiotherapist and ergotherapist, must, in our opinion, modify the basic algorithm to the specific demands of the patient.

Author (s) Details

Ivet B. Koleva
Medical University of Sofia, Bulgaria

Radoslav D. Yoshinov
Bulgarian Academy of Sciences, Laboratory of Telematics – Sofia, Bulgaria.

Mr. Borislav R. Yoshinov
Medical Faculty of Sofia University, Bulgaria.

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