045728   GUPTA I, SARMAL A (Pathology Dep, GMC Jammu, J&K) : Histopathological assessment of cases of hepatoblastoma. J Adv Med Dent Sci Res 2020, 8(1), 296-9.

Primary hepatic malignancies in children comprise about 0.5–2 % of all solid tumors in children. The present study was conducted to assess cases of hepatoblastoma histopathologically. 48 cases of hepatoblastoma of both genders were recorded. PRETEXT staging was assigned using contrast computed tomography (CT). Out of 48 cases, males were 28 and females were 20. Common complaints of patients was vomiting in 20, abdominal distension in 38, jaundice in 16 and abdomen mass in 14 cases. Out of 48 cases, epithelial type was seen in 32 and mixed epithelial and mesenchymal in 16. Epithelial type 8 was pure fetal in 18, fetal mitotically active in 6, embryonal in 4 and mixed epithelial in 4 cases. The difference was significant (P< 0.05). Maximum cases were epithelial type as compared to mixed epithelial and mesenchymal and females predominance was observed.

3 tables, 12 ref

045728   GUPTA I, SARMAL A (Pathology Dep, GMC Jammu, J&K) : Histopathological assessment of cases of hepatoblastoma. J Adv Med Dent Sci Res 2020, 8(1), 296-9.

Primary hepatic malignancies in children comprise about 0.5–2 % of all solid tumors in children. The present study was conducted to assess cases of hepatoblastoma histopathologically. 48 cases of hepatoblastoma of both genders were recorded. PRETEXT staging was assigned using contrast computed tomography (CT). Out of 48 cases, males were 28 and females were 20. Common complaints of patients was vomiting in 20, abdominal distension in 38, jaundice in 16 and abdomen mass in 14 cases. Out of 48 cases, epithelial type was seen in 32 and mixed epithelial and mesenchymal in 16. Epithelial type 8 was pure fetal in 18, fetal mitotically active in 6, embryonal in 4 and mixed epithelial in 4 cases. The difference was significant (P< 0.05). Maximum cases were epithelial type as compared to mixed epithelial and mesenchymal and females predominance was observed.

3 tables, 12 ref

045727   THAKUR S, SINGH D P, ABROL T, MAHAJAN V (Orthodontics and Dentofacial Orthopedics Dep, Himachal Dental Coll, Sunder nagar) : Assessment of prevalence of midline diastema in a known population. J Adv Med Dent Sci Res 2020, 8, 293-5.

The present study was conducted to assess midline diastema in known population. 148 young adults age ranged 12- 18 years of both genders were enrolled subjects. A thorough oral examination was done. The prevalence of midline diastema was recorded.Age group 12-13 years had 38, 14-15 years had 68 and 16-18 years had 42 patients. The difference was significant (P< 0.05). Midline diastema in age group 12-13 years had 10, 14- 15 years had 15 and 16-18 years had 4. The difference was significant (P< 0.05).  The prevalence of midline diastema was 19.6%. Highest rate was observed in age group 14-15 years old.

2 tables, 12 ref

045726   BINDAL S (Pathology Dep, Government Medical Coll, Badaun, Uttar Pradesh) : Evaluation of histopathological spectrum of lymphadenectomies. J Adv Med Dent Sci Res 2020, 8(1), 289-92.

The present study was conducted to evaluate histopathological spectrum of lymphadenectomies. 114 lymph node biopsies of both genders were included. Sections from formalin fixed, paraffin embedded blocks and stained with H and E, stains were studied in all cases.  Hodgkin lymphoma was seen in 32, non-hodgkin lymphoma in 46, follicular hyperplasia in 16, sinus histiocytosis in 10, paracortical hyperplasia in 18 and tuberculosis in 2 cases. The clinical features was cough in 72, fever in 45, weight loss in 80, night sweat in 32, lymph node pain in 58 and splenomegaly in 15 patients. The difference was significant (P< 0.05). Lymph node biopsies were found to be hodgkin lymphoma, nonhodgkin lymphoma, follicular hyperplasia and sinus histiocytosis.

3 illus, 12 ref

045725   SRIVASTAVA A K, PANDEY S (Medicine Dep, Hind Institute of Medical Sciences, Ataria Sitapur U.P) : Relationship between thyroid dysfunction and Diabetes mellitus. J Adv Med Dent Sci Res 2020, 8(1), 244-6.

Diabetes mellitus is a common metabolic disease and the prevalence is increasing rapidly. Thyroid disorders including subclinical hypothyroidism are frequently observed in diabetic patients. We conducted a study to explore Present study was conducted to know the spectrum of thyroid dysfunction in diabetes mellitus. A total of 60 candidates were enrolled in this study. 30 patients with a history of diabetes for less than 5 years were taken as cases and rest 30 patients were normal healthy candidates taken as control. Venous blood was withdrawn from anticubital vein and various parameters like TSH, T3, T3, FBS, PPBS etc were estimated. Thyroid disorders were present in 43.33%. Hypothyroidism was present in 1, hyperthyroidism in 5 and subclinical hypothyroidism in 7 cases. There was significant difference between levels of TSH and T3. Prevalence of thyroid disorders in Diabetics was 43.33%. Hence regular screening of diabetic patients should be done.

2 tables, 13 ref

045724   CHANDEL N, MANDHOTRA P, THAKUR T, DOGRA A, PATIYAL A, SHARMA A K (Conservative Dentistry and Endodontics Dep, Himachal Dental Coll, Sundernagar, Himachal Pradesh) : Assessment of levels of TNF-α in patients undergoing fixed orthodontic treatment. J Adv Med Dent Sci Res 2020, 8(1), 273-5.

Orthodontic forces cause an initial inflammatory response followed by alterations in the vascular and neural envelope and perpetual bone and tissue remodelling accompanied by paracrine release of bioactive mediators. The pro-inflammatory cytokines include Interleukin 1b (IL-1 b), IL-2, IL-5, IL-6, IL-8, interferon γ (IFN γ), tumor necrosis factor alpha (TNFα) and granulocyte macrophage colony stimulating factor (GM-CSF), which induce classic inflammation markers. Hence; the present study was conducted for assessing the levels of TNF-α in patients undergoing fixed orthodontic treatment. A total of 20 patients scheduled to undergo fixed orthodontic treatment were enrolled in the present study. Complete demographic details of all the patients were obtained. During the pre-treatment phase, all the patients were recalled in the morning and GCF samples were obtained. All the samples were sent to laboratory where auto-analyser was used for assessing TNF-α level. Assessment of TNF-α levels was done one month after starting of the fixed orthodontic treatment and six months after starting of the fixed orthodontic treatment. Mean TNF- α level at pretreatment, one month post-treatment and six months post-treatment were found to be 6.72 pg/mL, 6.51 pg/mL and 6.59 pg/mL respectively. In the present study, while comparing the mean TNF- αs at different time intervals, non-significant results were obtained. Fixed orthodontic treatment doesn’t alter the TNF-α levels.

3 illus, 12 ref

045723   KUMAR V, MITTAL P (Paediatrics Dep, Santosh Medical Coll and Hospital, Ghaziabad, UP) : A comparative study of levetiracetam and fosphenytoin in the treatment of benzodiazepine- refractory status epilepticus in pediatric patients. J Adv Med Dent Sci Res 2020, 8(1), 273-6.

Status epilepticus (SE) is one of the most important neurological emergencies of pediatric age group. The present study was conducted to compare levetiracetam and fosphenytoin in the treatment of benzodiazepine refractory status epilepticus (BRSE) in pediatric patients. The present study was conducted on 84 pediatric cases of status epilepticus who were divided into 2 groups of 42 each. Group I patients received fosphenytoin at 20 mg/kg phenytoin equivalents (PE) dose and group II patients received levetiracetam at 40 mg/kg over 10 min. Time to terminate seizure (response latency) was measured. Primary and secondary outcome measures were recorded in all cases. Type of seizures was GTCS 30 in group I and 32 in group II, focal seizure 7 in group I and 5 in group II, generalized tonic seizures 4 in group I and 3 in group II and myoclonic seizure 1 in group I and 2 in group II. Neuro-developmental status was normal seen in 34 in group I and 35 in group II, development delay 4 in group I and 2 in group II, static encephalopathy 3 in group I and 4 in group II, progressive encephalopathy 1 in group I. The need of additional anti-seizure medication was seen in 11 in group I and 5 in group II, time to termination of clinical seizure was 15.2 hours in group I and 13.4 hours in group II, duration of primary illness was 2.8 days in group I and 1.7 days in group II, number needing mechanical ventilation was 4 in group I and 3 in group II. Authors found that levetiracetam is an effective alternative to fosphenytoin in management of BRSE in pediatric population.

3 tables, 12 ref

045722   SHAILAT P, SINGH A (General medicine Dep, Noida International Institute of Medical Sciences, Greater Noida, U.P) : Assessment of clinical profile of typhoid fever patients- A clinical study. J Adv Med Dent Sci Res 2020, 8(1), 285-8.

The present study was conducted to assess clinical profile of typhoid patients.  74 patients diagnosed with typhoid fever of both genders were enrolled. Clinical features were recorded in all patients. Widal testing was also done.  Out of 74, males were 30 and females were 44. Stain O+ was seen in 36, AH+in 15, H+ in 16 and BH+ in 7 patients. The difference was significant (P< 0.05). Common clinical features were fever seen in 68, fatigue in 34, loss of appetite in 50, abdominal pain in 62, constipation in 15, diarrhea in 24, cough in 38 and skin rashes in 17 patients. The difference was significant (P< 0.05). Common clinical features were fever, fatigue, loss of appetite, abdominal pain, constipation, diarrhea, cough and skin rashes.

3 tables, 12 ref

045721   SINGH S K (Community Medicine Dep, Mulayam Singh Yadav Medical Coll, Meerut, U.P) : Determination of risk factors of infertility in village women- An epidemiological survey. J Adv Med Dent Sci Res 2020, 8(1), 281-4.

The present study was conducted to determine infertility and risk factors in village population. 370 village population were enrolled. Socioeconomic status, education, duration of marriage, age at marriage, occupation status, type of family, menstruation pattern, age of menarche, first child born after marriage, family history of infertility etc. was recorded. Age group 20-25 years had 25 subjects, 25-30 years had 190, 30-35 years had 110, 35-40 years had 35 and 40-50 years had 10 subjects. Out of 370 women, 40 were infertile. Under infertile women, age at marriage time >25 were 35 and 14 years was seen in 24 and in 20 regular menstruation cycle was seen. The difference was significant (P< 0.05). Risk factors associated with infertility was nuclear family, low education status and obesity.

3 tables, 11 ref

045720   AGGARWAL A, ARORA S, CHAWLA M P S (Medicine Dep, Dr Ram Manohar Lohia Hospital, New Delhi- 110 001, Email: amitaggarwal@doctor.com) : Clinical update on Covid-19. J Acad Clin Med 2020, 21(1-2), 46-59.

The rapid spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Wuhan, China prompted an increased surveillance in India since early January 2020. The first laboratory confirmed case of COVID-19 in India was reported from Kerala on 30th January 2020. Since then the novel coronavirus infected pneumonia (NCIP) cases have been presenting to the hospital emergencies as severe acute respiratory illness (SARI) or influenza like illness (ILI). As on 4th June, 2020, about 2,10,000 confirmed cases have been detected in India with around 6,100 reported deaths. The major mode of transmission has been via close contact with infected individuals through respiratory droplets and fomites. The clinical spectrum varies from asymptomatic to mildly symptomatic (fever, myalgia, and sore throat) to acute respiratory distress syndrome as a part of cytokine release syndrome. The diagnosis depends on nucleic acid detection by rRT-PCR for SARS-CoV-2, IgM/IgG antibodies detection and typical radiological appearance in high suspects. Social distancing, isolation precautions, and proper hand hygiene with good cough etiquettes are all very important infection prevention and control (IPC) measures in mitigating the spread of the contagion. Repurposing of old and existing drugs like hydroxychloroquine, lopinavir/ritonavir, favipiravir, remdesivir, interferons have been found to be useful in various trials. Role of convalescent plasma and anti-inflammatory/immune-suppressive therapy is also being tried to some effect in cases with cytokine release syndrome. Personal protective equipments form a crucial part of the management of the affected individuals. Vaccine development and trials are being pursued with aggressive vigor worldwide.

6 illus, 49 ref

045719   CHATURVEDI M, PAL K, VERMA R, PARAMJEET (Medicine Dep, Sarojini Naidu Medical Coll, Agra- 282 002, Uttar Pradesh, Email: drmridul@gmail.com) : Prevalance of non-alcoholic fatty liver disease in hypothyroid patients and its correlation with seruml ferritin levels. J Acad Clin Med 2020, 21(1-2), 43-5.

NAFLD is a relatively newly recognised entity among clinicians, presented with vague symptoms and upper quadrant abdominal pain. With growing epidemic of obesity, more and more cases of NAFLD are seen in clinical practises due to better availability of ultrasonographic facilities. The disease has an unpredictable course, may remain stationary through out life or may progress to hepatic cirrhosis. Search of a biomarker like serum ferritin may be useful in routine clinical practise to predict the natural history of NAFLD. In this small study, 100 patients were included which shows raised TSH in 33 % patients of NAFLD, and out of 33 patient 20 patients has raised serum ferritin. To prove that it has more of a prognostic as compared to diagnostic value, a larger sample size is needed.

4 tables, 11 ref

045718   SALUJA M, SEN P, CHITTORA S, BHARGAVA G, SHARMA P (Medicine Dep, Govt Medical Coll, Kota- 324 010, Rajasthan, Email: pawan.sen26@gmail.com) : Study of prevalence of retinopathy, it’s awareness and associated risk factors in type 2 DM patients in Hadoti region, Kota. J Acad Clin Med 2020, 21(1-2), 29-32.

DM is one of the major systemic causes of blindness throughout the world. Diabetic retinopathy can be defined as damage to microvasculature in the retina by prolonged hyperglycaemia. Though multiple studies have been conducted to find out prevalence of DR and its awareness in various parts of India, it remains less explored in Hadoti region, Kota, Rajasthan, India. Study design and material: This is a hospital-based cross-sectional study conducted on patients attending the diabetic clinic in New Medical College Hospital, Kota. A total of 248 type 2 diabetes mellitus patients were screened with Carl Zeiss Retinoscope after taking informed and written consent. Anthropometric data of each subject was collected. Urine albumin and HbA1C levels were also noted. Furthermore, a special questionnaire was designed to assess awareness about diabetes-related eye disease among the patients. The overall prevalence of diabetic retinopathy was 8.87 %, out of which 54.54 % patients had NPDR and 45.45 % patients had PDR. Out of the 22 patients with diabetic retinopathy, 16 had albuminuria, and 14 of them have had diabetes for more than 10 years. Out of 248 patients, 178 patients (71.77 %) were aware about ophthalmological side-effects of DM, though only 74 of them (41.57 %) visited an ophthalmologist for further check-up. Out of the 70 patients unaware about ophthalmological s/e, 26 patients (37.14 %) were illiterate. This study concluded that prevalence of diabetic retinopathy in Hadoti region was 8.87 %. and awareness about the illness was seen in 71.77 % of the population. Furthermore, in our study educated patients were more aware (94.38 %) about diabetic eye disease suggesting an association between the two. Early diagnosis via screening programme may help in formulation and implementation of effective intervention at the earliest. It will also help in reducing the economic burden on the government and society.

10 tables, 9 ref

045717   KUMAR P, BHARATH G, SONEJA M, RANJAN P, BISWAS A, WIG N (Medicine Dep, Dr Ram Manohar Lohia Hospital, New Delhi- 110 001, Email: drkumar.prabhat@gmail.com) : Spectrum of infection among admitted systemic lupus erythematosus patients. J Acad Clin Med 2020, 21(1-2), 25-8.

Patients of Systemic Lupus Erythematosus (SLE) often require hospitalisation due to infections, which remains a major cause of mortality and morbidity in these patients. This study was intended to study the spectrum of infection and clinical profile of SLE patients getting admitted at a tertiary centre in north India. This was a cross-sectional observational study done over a period of one year on SLE patients’ getting admitted under the department of medicine with suspected infection. The demographic, presenting complaints, duration of SLE, treatment history, clinical parameters, laboratory investigations, SLE-related organ involvement, systemic lupus erythematosus disease activity score (SLEDAI) at admission, type of infection, duration of hospital stay, treatment received, and outcome were recorded. A total of 27 patients were included in the study and the mean age of the patients was 29.7 ± 10.7 years. The most common symptom at the time of admission in the hospital was fever (74 %), followed by cough (55 %), dyspnoea (55 %), oral ulcers (51 %), arthralgia (37 %), photosensitivity (33 %), oliguria (15 %), and psychosis (11 %). The common risk factors for infection seen in this study were steroid intake in the last 3 months (51.8 %), previous antibiotic intake (18.5 %), other immunosuppressant therapy (18.5 %), recent hospital stay (7.4 %) and past history of tuberculosis (7.4 %). Acute phase reactants were significantly elevated and mean SLEDAI score was 11.1 ± 6.8. The most common infection was bacterial pneumonia (44.4 %), followed by tuberculosis (33.3 %), fungal pneumonia (7.4 %), MRSA bacteraemia (7.4 %), acute gastroenteritis (7.4 %), urinary tract infection (7.4 %), skin infection (3.7 %), HIV (3.7%) and infective endocarditis (3.7 %). E.coli, Methicillin resistant Staphylococcus aureus (MRSA), A.baumannii and Candida were isolated from various specimens. There were four deaths due to infection. Conclusion: Bacterial pneumonia and tuberculosis are the leading cause of infection among hospitalised SLE patients.

4 tables, 20 ref

045716   AGGARWAL H K, JAIN D, KUNDU M, BISHNO A (Medicine Dep, Pandit B.D. Sharma Univ of Health Sciences, Rohtak- 124 001, Haryana, Email: jaindeepakdr@gmail.com) : Evaluation of renal functions in tropical acute febrile illness. J Acad Clin Med 2020, 21(1-2), 20-4.

India is endemic for dengue, malaria, typhoid and scrub typhus infections. Acute kidney injury (AKI) is one of the most challenging problems faced by clinicians in tropical acute febrile illness. Due to emerging and re-emerging diseases, population growth, urbanisation, migration, international travel, pandemics, and global warming, the incidence of tropical acute febrile illness is continuously increasing. The spectrum of tropical acute febrile illness is also changing. While some infections like malaria are contained because of effective implementation of national programmes, various febrile illnesses like scrub typhus and dengue have shown a resurgence. There is a scarcity of literature available from developing countries like India. This study was planned to know the spectrum of tropical acute febrile illness and its association with AKI. The present study is a prospective observational study conducted on 100 adult patients of tropical acute febrile illness who reported to the medicine department at Pt. B.D. Sharma PGIMS Rohtak, Haryana. A detailed history and clinical examination was done in all subjects included in the study. Patients who fulfilled case definition criteria were evaluated for AKI as per definitions of KDIGO classification on day of admission and then subsequently on day 3, 7, and 14 with laboratory investigations, i.e., serum creatinine, blood urea, urine output, and eGFR. The most common tropical acute febrile illness (TAFI) diagnosed in the current study was dengue in 43 % cases. The spectrum of TAFI was dengue (43 %), followed by malaria (23 %), scrub typhus (19 %), enteric fever (9 %), and mixed pattern (6 %). The febrile illnesses causing AKI in decreasing trend in present study was malaria (40.6 %), scrub typhus (31.2 %), dengue (12.5 %), mixed disease pattern (9.4 %) and enteric fever (6.3 %). The proportion of AKI was highest among the subgroup with malaria (56.5 %), followed by scrub typhus (52.63 %), mixed infections (50 %), enteric fever (22.22 %), and dengue fever (9.30 %). Among the subtypes of malaria, 64.7 % of Plasmodium vivax cases and 50 % of falciparum cases had AKI; but none of the mixed cases had AKI. In the present study; none of the patients with Dengue, enteric fever, or mixed disease pattern had undergone dialysis. Only one patient of Scrub Typhus with AKI underwent dialysis. 38.46 % cases required dialysis of malaria subgroup. Total cases of AKI were 32, out of these 18.75 % were dialysed and in-hospital mortality was none. In the present study, the proportion of AKI in tropical fever was 32%. Serum blood urea, serum creatinine, urine output, eGFR and hospital stay were statistically significantly different between AKI and non AKI. The most common cause of AKI in TAFI was malaria followed by scrub typhus and mixed infection. Long-term studies are needed to know the exact spectrum of AKI in TAFI, so that an effective strategy can be implemented to prevent this recoverable complication.

5 illus, 21 ref

045715   SINGH O P, SINGH R, TANEJA R S, TANEJA A, CHAWLA M P S ( Medicine Dep, Dr Ram Manohar Lohia Hospital, New Delhi- 110 001, Email: docrajnish11@gmail.com) : Assessment of fracture risk and its predictors in patients with axial spondyloarthritis using the fracture risk assessment (frax) algorithm. J Acad Clin Med 2020, 21(1-2), 16-9.

Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the axial skeleton. Increased prevalence of low bone mineral density in patients with AS has been reported by studies but data on fracture risk in these patients is scarce. The present study was undertaken to find the risk of fracture and predictors of fracture risk in patients with Axial spondyloarthritis (AxSpA) using FRAX algorithm. 40 consecutive adult patients with AxSpA attending the Rheumatology clinic of our Institute were included in this crosssectional observational study. Bone Mineral Density (BMD) was measured at femur neck, lumbar spine and forearm, and T-scores were taken. FRAX score was calculated using FRAX calculator for Indian cohort and results showed 10-year probability of major osteoporotic and hip fractures in percentage. Out of total 40 patients, 34 (85 %) were males, and 6 (15 %) were females with a mean age of 34.98 ± 9.29 years and a mean disease duration of 5.14 ± 4.47 years. Osteoporosis was found in 17 patients (42.5 %) at lumbar spine, 10 (25 %) at forearm, and 6 (15 %) at femur. Overall prevalence of OP in the study population was 55 %. The mean FRAX score for major osteoporotic fracture was 1.53 ± 1.04 % and for hip fracture 0.54 ± 0.82 %. On multivariate analysis, femur BMD showed independent association with risk of major osteoporotic fracture; while age, BASDAI and femur BMD with the risk of hip fracture. Prevalence of osteoporosis was high in AxSpA patients. Though a trend of higher FRAX score was seen with loss of BMD, its absolute values did not exceed prescribed cut-off for intervention. The independent predictors for the risk of fracture in AxSpA patients were age, BASDAI and low BMD at femur neck.

3 tables, 17 ref

045714   PAUL R, SOM K, BANDYOPADHYAY D (Medicine Dep, Desun Hospital, Kolkata- 700 107, Email: kunalsom8@gmail.com) : The new scandinavian five-point classification of diabetes applied to an Indian population: A pilot study from eastern India. J Acad Clin Med 2020, 21(1-2), 12-5.

Diabetes is a major public health problem all over the world. It is a heterogeneous disease and the patients have different degrees of metabolic control and other complications. Recently, there have been attempts to classify diabetes into further sub-groups which can give better prognostic information. The present study is aimed to test one such classification in a sample Indian population.  Diabetic adult patients coming to medicine department were the subjects for this cross-sectional pilot study. Parameters like HbA1C %, Body Mass Index (BMI), HOMA-2 IR and HOMA-2B scores were collected. Then, the patients were classified into clusters according to the scheme proposed by Ahlqvist et al in 2018. Appropriate India/South Asia specific cut-offs were used to define obesity and insulin resistance. Presence of specific complications like fatty liver and microalbuminuria in different clusters was studied.  There were 64 diabetic patients with male: female ratio 41: 23. According to this classification system, 10.9% of the subjects had SIDD, 26.6 % had SIRD, 31.3 % had MOD and 4.7 % had MARD. 26 % of the patients remained unclassified and there was no SAID. Average HbA1C of SIDD and SIRD groups were higher than study average. In the unclassified group, HbA1C was lower (p = 0.013). Urine ACR was higher in the MOD group. This study gives an idea of the relative percentage of different clusters in Indian diabetic subjects. A higher percentage of MOD was found in this study, compared to other European data. However, the classification may need some modification in the Indian context to account for the unclassified section.

1 illus, 14 ref

045713   DAVE M, POSWAL L, BEDI V, REGAR L, VIJAYVARGIYA R, SHARMA M, DEVAL N (Medicine and Anaesthesia Dep, RNT Medical Coll, Udaipur- 313 001, Rajasthan, Email: rahul.sanwaria1990@gmail.com) : Study of antibody-based rapid card test in covid-19 patients admitted in a tertiary care covid hospital in southern Rajasthan. J Acad Clin Med 2020, 21(1-2), 7-11.

COVID-19 also known as SARS C0V-2, is now a pandemic which started in December 2019 in China. RT-PCR based nucleic acid detection is currently the standard diagnostic method for COVID-19, but certain shortcomings make it unfeasible for use as a screening test.  To study the dynamics of IgM and IgG antibody, establish its role in diagnosis and prognosis of COVID19 patients. It was a cross-sectional study conducted over 100 RT PCR confirmed COVID-19 patients admitted in various wards of a dedicated Corona hospital, RNT Medical College, Udaipur, Rajasthan, India over a period of 2 months – from April 2020 to May 2020. We performed an anti-SARS-CoV-2 IgG/IgM test on 100 confirmed COVID-19 patients and found that 61% patients had antibody positivity. Dynamics of antibody show that seroconversion, peaking, and disappearance of IgM antibody occur at end of 1st week, 2nd week, and 3rd week respectively, while for IgG seroconversion was seen at the end of 2nd week, and was persistently positive up to 32nd day of illness in our study. Patients with development of anti-SARS-CoV-2 antibodies had a mild degree of illness with positive outcome and vice versa. Our study concludes that serological responses have been observed in COVID-19 patients, and the dynamic pattern of these responses is consistent with acute viral infection which is useful to see the immune status of these patients and diagnosis of COVID -19.

3 illus, 4 tables, 15 ref

045712   ARCHIBONG M S, AYEGBUSI O E (Obstetrics and Gynaecology Dep, Obafemi Awolowo Univ Teaching Hospital, ILE-IFE, Nigeria, Email: beracah4@ yahoo.com) : Minimal access, optimal dryness: A review of laparoscopic repair of vesicovaginal fistula. World J Lap Surg 2020, 13(3), 130-2.

Vesicovaginal fistula (VVF) is an embarrassing condition for women. Various routes of surgical intervention exist for the management of VVF. Laparoscopic repair is safe and effective. Aim and objective: To review the success rate of laparoscopic repair of VVF and to highlight the benefits/advantages of the laparoscopic approach. Using various databases, previous studies of patients who underwent laparoscopic VVF repair between 2008 and 2018 were reviewed. Outcome measures from these studies were success rate, mean blood loss, mean operating time, length of hospital stay, major intraoperative complications, and conversion to open surgery. Fourteen retrospective studies (full-text articles) were retrieved and reviewed. Two hundred and sixty-nine patients had a laparoscopic repair. The pooled success rate was 96.7 %. Mean blood loss ranged from 30 to 400 mL, length of hospital stay ranged from 1.1 to 7.8 days while the mean operating time ranged from 54 to 229 minutes. There was only one major intraoperative complication. Only four patients had to be converted to open surgery. Laparoscopic repair of VVF has a high success rate and is a safe, patient-friendly, and cost-effective route for surgical management of VVF.

1 table, 21 ref

045711   AGARWAL V, SHARMA A, ANDANKAR M, PATHAK H (Urology Dep, All India Institute of Medical Sciences, Raipur, Chhattisgarh, Email: dramiturology@gmail.com) : Factors predicting success of laparoscopic adrenalectomy: Our experience. World J Lap Surg 2020, 13(3), 125-7.

Adrenal is one of the most feared organs owing to its anatomical position. However, adrenalectomy by laparoscopic means has now been adopted as the procedure of choice to treat benign and malignant functioning and nonfunctioning adrenal tumors. We describe our experience with laparoscopic adrenalectomy (LA) in 37 patients at a tertiary institute and try to predict factors for open conversion. Thirty-seven patients who underwent LA from August 2013 to February 2018 were retrospectively analyzed and factors leading to conversion to open adrenalectomy assessed. Among 37 patients, 31 had pheochromocytoma on histopathology and 1 patient had adrenal hyperplasia leading to Cushing’s syndrome. Five out of 37 patients had to be converted to open technique—multiple adhesions with the bowel, retrocaval tumor extensions, difficult dissection, and prolonged operative time due to large tumor size (in two patients) and severe hepatomegaly were the reasons for conversion to open.  Laparoscopic adrenalectomy is safe and feasible for large adrenal lesions.

1 illus, 2 tables, 16 ref

045710   TALWAR P, VELAYUDAM L, KUKREJA H P, PATIL S R (Obstetrics and Gynaecology Dep, JSS Medical Coll and Research Institute, Mysuru, Karnataka, Email: soumyarpatil999@ gmail.com) : Barbed vs polyglactin 910: A comparative study of the efficacy in laparoscopic vaginal cuff closure. World J Lap Surg 2020, 13(3), 113-6.

Total laparoscopic hysterectomy (TLH) is a popular mode of hysterectomy in the recent times. One of the principal steps is vaginal cuff closure, with many variations in surgical technique and materials. Intracorporeal suturing and knot-tying are crucial steps and are considered to be the most technically difficult skills. To overcome these challenges and learning curve, various measures have been emerging. One among them is the introduction of barbed suture, a new class of suture material. To evaluate whether the use of barbed suture for vaginal cuff closure during TLH reduced the surgical difficulty and suturing time when compared to polyglactin 910 suture. This randomized comparative study included 100 patients divided into two groups of 50 each, who underwent TLH with vault closure using either barbed sutures or polyglactin 910. Demographic details, indication for surgery, intraoperative complications, mean suturing time, surgeon difficulty, and average hospital stay were compared between the two groups. Student t test for continuous variables and Fischer exact test for categorical variables. p values ≤ 0.05 were considered significant. Use of barbed suture has significantly reduced the suturing time for vaginal vault closure (5.39 vs 6.9 minutes, p value < 0.0001) as well as the technical difficulty in laparoscopic suturing (p value < 0.0001) when compared to that with polyglactin 910. The introduction of barbed sutures for vault closure during TLH not just reduces the suturing time but is also technically less demanding, making it a potential asset in laparoscopic hysterectomies.

3 tables, 21 ref

045709   FEHINTOLA A O, AWOTUNDE O T, OGUNLAJA O A, AKINOLA S E, OLADEJI S A, AARON O I, FEHINTOLA F O (Obstetrics and Gynaecology Dep, Obafemi Awolowo Univ, Osun, Nigeria, Email: akintunds@yahoo.com) : The outcome of laparoscopic ovarian drilling in patients with clomiphene-resistant polycystic ovarian syndrome in ogbmoso, Nigeria: A prospective evaluation. World J Lap Surg 2020, 13(3), 101-7.

Polycystic ovary syndrome (PCOS) is commonly encountered in women with anovulatory infertility. The surgical ovarian drilling procedure aims to restore spontaneous ovulatory cycles. This function is similar to the goal of clomiphene citrate and/or metformin. We conducted this study to determine the outcome of laparoscopic ovarian drilling (LOD) among patients who presented with clomiphene-resistant PCOS. The study was prospective in design. We studied 43 patients with clomiphene-resistant PCOS who had laparoscopic ovarian drilling (LOD) using monopolar diathermy at the Bowen University Teaching Hospital, Ogbomoso. The study took place between January 2014 and June 2016. Clinical data recorded at different intervals of follow-up included the menstrual pattern and reproductive history.  We successfully performed laparoscopic ovarian drilling without any complication. Four (9.3 %) of the patients were lost to follow-up. Thirty (76.9 %) of the remaining 39 patients resumed regular menstrual cycles with spontaneous ovulation, while 23 (59.1 %) patients achieved spontaneous pregnancy within 6 and 18 months following LOD. No record of multiple pregnancies. Factors associated with failed LOD treatment included obesity and a long duration of infertility. LOD is a feasible and effective first-line treatment option in patients with clomiphene-resistant PCOS in sub-Saharan Africa. Emphasis should be on weight reduction with early application of LOD to treat patients with clomiphene-resistant PCOS. This will reduce the time to achieve pregnancy and the need for gonadotropins to induce ovulation.

4 tables, 44 ref

045708   SAFTA Y B, TOUNSI N, MAATOUK M, MABROUK A, DHAOU A B, MOUSSA M B (Surgery Dep, Tunis El Manar Univ, Tunis, Tunisia, Email: neserine.tounsi@gmail.com) : Mortality and morbidity in peptic ulcer perforation: A comparison between radical open repair vs conservative laparoscopic repair. World J Lap Surg 2020, 13(3), 97-100.

Currently, in the era of robotic surgery and advancement of laparoscopic technology, the place of open surgery has been reduced. However, the use of laparoscopic surgery for peptic ulcer disease is not yet a consensus. All patients who had been operated for perforated peptic ulcer (PPU) disease from January 2005 to December 2014 in our hospital were reviewed retrospectively. Patient demographics, perioperative and intraoperative details, and surgical outcomes were evaluated. The objective of our study is to compare the clinical and surgical outcomes of patients who underwent either laparoscopic or open procedure as well as to demonstrate if laparoscopic repair (LR) technique has advantages to open repair (OR) in terms of morbidity and mortality.  We diagnosed 159 patients with PPU during the study period. LR was performed for 65 (41 %) patients, and the remaining patients underwent OR. Morbidity of medical and surgical complication was higher in open groups (21 vs 2) (p value = 0.0001). The most frequent complication in both groups was medical complication. Overall, 16 patients in the OR group had medical complications vs 2 patients in the LR group (p value = 0.009). Surgical complication was higher in open groups (7 vs 0) (p value = 0.04). Mortality was statistically higher in the open group. We did not report any death in the laparoscopic group. However, six deaths were identified in the OR group (p value = 0.04). Our results indicate that LR for PPU was a safety option with fewer rates of morbidity, reoperation, and mortality compared to OR.

3 tables, 14 ref

045707   TIWARI C, SHAH H, SANDLAS G, SHENOY N S, GANDHI S (Paediatric Surgery Dep, BYL Nair Hospital, Mumbai, Maharashtra, Email: hemanshisshah@gmail.com) : Single-incision laparoscopy-assisted appendectomy in the pediatric age group: Our experience. World J Lap Surg 2020, 13(2), 77-9.

Various methods of laparoscopic appendectomy have been described in children. We present the data of 50 children who underwent interval appendectomy at our institution by transumbilical single-incision laparoscopy-assisted appendectomy (SILAA). Fifty patients 24–48 hours’ duration; had abdominal ultrasound (USG) with appendicular diameter of >10 mm and good clinical response to initial management by intravenous antibiotics within 24–48 hours of admission were retrospectively analyzed. They underwent SILAA after 6 weeks. Under general anesthesia, an infraumbilical incision was made and umbilical tube was identified. A 5 mm camera port was inserted by open Hassan’s technique. After visualizing the appendix, another incision was made adjacent to the port site on the left and a 5 mm instrument was introduced through this. The appendix was freed, mobilized, and delivered through the incision. Appendectomy was completed extracorporeally. The average age at presentation was 9.3 years. There were 18 females and 32 males. Two patients required conversion to open procedure in view of extensive adhesions and a short retrocecal appendix which was difficult to mobilize and exteriorize through umbilicus. The mean operating time was 30 minutes. There were no complications.  Single-incision laparoscopy-assisted appendectomy combines the advantages of both laparoscopic and open appendectomy and offers reduced operative time and less complications and reduced surgical costs in pediatric age group.

2 illus, 20 ref

045706   WINARTO H, SASPRIYANA K Y, KEKALIH A (Obstetrics and Gynecology Dep, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, Email: hariyono.winarto@ui.ac.id) : Comparison objective structured assessment of camera navigation skills score—pre- and post-training intervention. World J Lap Surg 2020, 13(2), 69-73.

Inexperienced operating assistants are often tasked with the important role of handling camera navigation during laparoscopic surgery. Incorrect handling can lead to poor visualization and increased operating time. The objective of this research was to examine benefit of camera navigation training in laparoscopic used pelvic box based on Objective Structured Assessment of Camera Navigation Skills (OSA CNS) assessment and explore factors correlated to difference skill after training.  An experimental study (pre–post interventional study) was conducted at the training room of Indonesia Clinical Training and Education Centre (ICTEC) Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital (CMH), on December 2018 to January 2019. Participants were Obstetrics and Gynecology resident Medical Faculty of Universitas Indonesia. We did evaluation before training and 1, 2, 3 weeks after training used OSA CNS. Data analysis used paired-t test. There were significant increasing OSA CNS score after camera navigation training used pelvic box. Average OSA CNS score before training and 1, 2, 3 weeks after training were 15.00 ± 2.03, 17.60 ± 2.69, 16.36 ± 1.84, 17.80 ± 2.26, respectively. Optimum duration of OSA CNS evaluation was 3 weeks after the training. Female gender and low experience were two factors influence camera navigation skill after the training. Laparoscopy camera navigation training used pelvic box could be applied to support residency program curriculum and there were increasing camera navigation skills after training used pelvic box. Female gender and low experience were factors significant correlate to training outcome of camera navigation skill used pelvic box. Clinical significance: Camera navigation training used pelvic box is a critical component for teaching safe endoscopic practices in our Ob/Gyn residency training program.

3 illus, 4 tables, 19 ref

045705   SINGH N, KENWAR D B, SINGH S, DASGUPTA S, KAPOOR K, KUMAR S, SHARMA A (Renal Transplant Surgery Dep, Postgraduate Institute of Medical Education and Research, Chandigarh, Email: ashishpgi@gmail.com) : Retroperitoneal single-port donor nephrectomy through lumbotomy incision: An experience of 30 cases. World J Lap Surg 2020, 13(2), 61-4.

Over the years, laparoscopic donor nephrectomy (LDN) has evolved as a preferred alternative to open-donor nephrectomy (ODN). Laparoscopic donor nephrectomy can be performed either by transperitoneal or retroperitoneal route. Retroperitoneoscopic live donor nephrectomy (RPLDN) results in less analgesic requirement, decreased hospital stay, and better cosmetic acceptance by the donors. Lumbotomy incision has been thought to be an ideal approach without any muscle being cut but is limited by the amount of space in open surgery. Between November 2014 and September 2016, 350 donor nephrectomies were performed at our department. All the surgeries were performed by a single surgeon. Thirty patients consented for translumbar RPLDN out of the 82 donor nephrectomies assigned to that particular surgeon. Visual analog scale (VAS) was used to evaluate the severity of pain on postoperative day (POD)0 and POD1. Mean age of donors was 44.7 ± 11.4 years, M:F ratio 9:21. Average duration of surgery was 170.33 ± 52 minutes. Four patients (13.3 %) had double renal arteries and one patient had double renal vein. In one patient, retrieval was performed by an open approach. No patient had surgical site infection. Most patients (28/30) had a VAS score of <4, and did not require any additional analgesics beyond POD0. Single-site translumbar RPLDN is a feasible alternative approach to the donor surgery.

1 table, 30 ref

045704   YADAV A K, KANKARIA J (Surgery Dep, SMS Hospital, Jaipur, Rajasthan, Email: ashok.yadavmd@gmail.com) : Ten-point strategy for safe laparoscopic cholecystectomy: A prospective study. World J Lap Surg 2020, 13(2), 55-60.

To devise a 10-point strategy for performing safe laparoscopic cholecystectomy (LC), share experience of 8,000 patients without any conversion to open procedure by adopting the strategy, and assess its effectiveness.  A total of 8,000 patients were prospectively analyzed during 2007 to 2017. A point was assigned to a specific finding intraoperatively. Patients were divided into three groups based on the points. Anatomical variations, time of surgery, intraoperative/postoperative complications were plotted for three groups, and statistical significance was calculated. In this study, 63.5 % of patients were female. No case of conversion to open cholecystectomy (OC) was found. The youngest and oldest patients were 2 and 109 years old, respectively. Mortality, negligible morbidity, or significant complications were not observed. Group I (1–4 points) had high-risk patients, and lowest safety, and group III (8–10 points) had low-risk patients, and highest safety, and group II (5–7 points) had with equivocal numbers. Laparoscopic cholecystectomy was performed keeping these 10 points in mind with patience and precautions. Chances of conversion to open surgery can be reduced to zero, with minimal complications. The study suggests that in case of difficult anatomy, go gentle and slow to safeguard from injuries.

2 illus, 8 tables, 37 ref

045703   RAD M T, BOGDANYOVA S, WILHELM L M, KONCZALLA J, RAIMANN F J, WALLWIENER M, BECKER S (Obstetrics and Gynecology Dep, Frankfurt Univ, Germany, Email: Morva.TahmasbiRad@kgu.de) : Laparoscopic intervention after ventriculoperitoneal shunt: A case report, systematic review, and recommendations. World J Lap Surg 2020, 13(1), 35-42.

In patients presenting pelvic pathology and a placed ventriculoperitoneal (VP) shunt, there is uncertainty regarding the decision whether to use laparoscopy. The aim of the article is to examine the available literature as well as sharing our own experiences operating on a patient with a VP shunt using laparoscopy. We searched online libraries (PubMed, EMBASE, and Google Scholar) for all publications published between January 1975 and December 2018 on our topic. We performed a systematic review and shared our experience with laparoscopy in a patient with shunt and ovarian cancer. The age of the patients ranged from 1 to 79 years. The operations were performed by the departments of general surgery, gynecology, and urology. The time from the shunt operation to laparoscopy ranged from 5 days to 28 years. In different articles, four important points were considered and discussed: the risk of a shunt infection or complication, technical difficulties carrying out laparoscopy in patients with a VP shunt, the necessity of routine monitoring of the intracranial pressure (ICP) intraoperatively, and perioperative strategies to avoid complications. It seems that a laparoscopic surgery in adults with a VP shunt appears to be a safe option. Based on the results of our case and the review of literature, we consider it necessary to have a neurosurgical consult performed prior to surgery, to have the procedure be carried out by an experienced surgeon, and to avoid complications by implementing recommended precautions.

3 illus, 46 ref

045702   KANANI E (General Surgery Dep, Khoula Hospital, Muscat, Oman, Email: mutazkanani313@hotmail.com) : Laparoscopic ventral hernia repair with polypropylene mesh: A literature review. World J Lap Surg 2020, 13(1), 31-4.

Laparoscopic ventral hernia repair (LVHR) is currently considered the gold standard. However, the mesh selection is still controversial. The aim of this review is to look for evidence that supports the use of polypropylene mesh (PPM) in the intraperitoneal position in LVHR. The literature was searched systematically using Google Scholar and PubMed for controlled studies, prospective descriptive series, and retrospective case series.  A total of 11 studies were retrieved. All the studies were either retrospective or animal experiments. Their outcomes are heterogeneous and they have multiple weaknesses. The literature clearly lacks data from controlled randomized trials in humans that can give strong evidence. The use of intraperitoneal PPM in LVHR remains an individual surgeon preference decision until well-designed prospective double-blind randomized controlled clinical trials are available.

2 tables, 16 ref

045702   KANANI E (General Surgery Dep, Khoula Hospital, Muscat, Oman, Email: mutazkanani313@hotmail.com) : Laparoscopic ventral hernia repair with polypropylene mesh: A literature review. World J Lap Surg 2020, 13(1), 31-4.

Laparoscopic ventral hernia repair (LVHR) is currently considered the gold standard. However, the mesh selection is still controversial. The aim of this review is to look for evidence that supports the use of polypropylene mesh (PPM) in the intraperitoneal position in LVHR. The literature was searched systematically using Google Scholar and PubMed for controlled studies, prospective descriptive series, and retrospective case series.  A total of 11 studies were retrieved. All the studies were either retrospective or animal experiments. Their outcomes are heterogeneous and they have multiple weaknesses. The literature clearly lacks data from controlled randomized trials in humans that can give strong evidence. The use of intraperitoneal PPM in LVHR remains an individual surgeon preference decision until well-designed prospective double-blind randomized controlled clinical trials are available.

2 tables, 16 ref

045701   SANKPAL J T, TAYADE M B, BHANDARWAR A H, SAHA P, CHATNALKAR S, SANKPAL S, GADKARI A (General and Laparoscopic Surgery Dep, Sir JJ Government Hospitals, Mumbai, Maharashtra, Email: drjts_ palmbeach@yahoo.co.in) : Mini two-port laparoscopic appendicectomy with novel knotting technique. World J Lap Surg 2020, 13(1), 21-5.

In pursuit of minimizing surgical trauma and achieving better esthetics by reducing the size and number of ports, this mini two-port technique was devised to offer an easier and safe alternative in comparison to conventional three-port technique. An easy and costeffective mini two-port appendicectomy is made possible with a unique intracorporeal surgical knotting through a single 5-mm port with a single instrument, thus reducing number and size of ports and with a better cosmetic result. Total 200 patients underwent laparoscopic appendicectomy out of which, mini two-port appendicectomy (TPA) with novel knotting technique could be successfully performed on 168 patients (84 %) and remaining 32 patients (16 %) required conventional threeport technique (CLA). None of the cases were converted to open.  Patient undergoing two-port laparoscopic appendicectomy had shorter operative time with better cosmetic result with no incidence of port-site hernia. There was no difficulty in adhesiolysis and intraoperative bleeding control. Infection rate was 0.59 % and 3.12 % for TPA and CLA, respectively. Incidence of intraoperative bleeding and intraoperative rupture of appendix was less in TPA (1.19 % and 0 %) as compared to CLA (6.25 % and 3.125 %). Mean hospital stay was less in TPA (1.7 days) compared to CLA (2.1 days). This mini two-port technique with novel knotting technique is easy to learn and helps to overcome the challenges and limitations faced during two laparoscopic appendicectomies; however conversion to conventional approach in complicated cases is still advisable. It is safe and effective intermediate option from conventional three-port to SILS/NOTES/Endo GIA staplers.

4 illus, 1 table, 30 ref

045700   MOGAHED M M, ZYTOON A A, EYSA B, MANAA M, ABDELLATIF W (Radiodiagnosis Dep, Menoufia Univ, Menoufia, Egypt, Email: ashradio@gmail.com) : Laparoscopic vs open drainage of complex pyogenic liver abscess. World J Lap Surg 2020, 13(1), 11-5.

Complex pyogenic liver abscess (CPLA) is a rare fatal disease if untreated. Complex pyogenic liver abscess is a multilocular abscess more than 5 cm in diameter. Pyogenic liver abscess (PLA) is mainly treated by percutaneous aspiration or drainage under antibiotic cover. Surgical drainage is indicated if interventional radiology fails, if ruptured, or if associated with biliary or intra-abdominal pathology. Laparoscopic drainage is a promising management option.  To evaluate the safety and efficacy of laparoscopic drainage as a management of complex pyogenic liver abscesses in comparison to open surgical drainage. Combined retrospective and prospective comparative study of 48 patients having complex PLA who were admitted to NHTMRI and managed by either laparoscopic drainage or open surgical drainage from January 2012 to January 2020 as regards results, complications, perioperative morbidity, mortality, and possible recurrence. Twenty-six patients were managed by open drainage, and 22 patients by laparoscopic drainage. Culture sensitivity of pus was done for all patients. Patients having small, solitary, and unilocular PLA that responded to antibiotic treatment or/and percutaneous drainage were excluded. All patients were subjected to full clinical assessment, laboratory investigations, ultrasonography, computed tomography, or magnetic resonance images for the abdomen and pelvis. Forty-eight patients having complex PLA with a median age of 54.5 years were managed by either laparoscopic drainage (22 patients) or open surgical drainage (26 patients). The operation time and hospital stay were less, and oral feeding was started earlier in laparoscopic group. Wound infection was higher in open drainage group. Abscess recurrence occurred once in laparoscopic group and once in open surgery group, and both were successfully treated with percutaneous drainage. One laparoscopic operation was converted to open.  Both laparoscopic and open surgical drainage of PLA are safe and effective. Laparoscopic drainage has less operative time, morbidity, and hospital stay; however, open drainage is considered the management of choice for patients with severe sepsis or failed percutaneous drainage.

5 illus, 2 tables, 17 ref

045699   PEDRAZA-CIRO M, CABRERA L F, GOMEZ D A, MENDOZA-ZUCHINI A C, PULIDO J A, JIMÉNEZ M C, VILLARREAL R A, SANCHEZ-USSA S (Surgery Dep, El Bosque Univ, Bogota, Colombia, Email: mpedraza93@gmail.com) : Laparoscopic cholecystectomy and common bile duct exploration using choledochotomy and primary closure following failed endoscopic retrograde cholangiopancreatography: A multicentric comparative study using three-port vs multiport. World J Lap Surg 2020, 13(1), 4-10.

Laparoscopic surgery has changed many ways in which we as surgeons manage patients, offering better results, quicker recovery, and fewer complications using minimally invasive techniques, especially in common bile duct (CBD) surgery. Not only can laparoscopic techniques be applied to programed surgery but also emergencies and those following failed endoscopic retrograde cholangiopancreatography (ERCP).  Describe and compare clinical and surgical results of the laparoscopic CBD exploration with primary closure using a 3-port vs multiport approach. Materials and methods: We present a multicentric comparative study of 197 consecutive patients who underwent a laparoscopic gallbladder removal along with CBD exploration with primary closure following failed (ERCP to extract CBD stones; 104 patients were managed by threeport vs 93 multiport laparoscopic surgery in five centers of Bogotá, Colombia, between 2013 and 2017 with follow-up of 1 year. A total of 197 patients were taken to laparoscopic gallbladder removal along with CBD exploration with primary closure, 104 patients via three-port technique and 93 patients via multiport. All (100 %) the patients had previously failed ERCP. The average surgical time on the three-port approach was 106 minutes vs 123 minutes on multiport. Only in the multiport technique we had an average conversion of 2 %. Mean hospital stay of 2.5 days, less for the three-port approach vs multiport in 5–7 days. There was a need of reintervention in 1 % of the patients who underwent three-port exploration. Postoperative pain, use of an additional port, complication rates, operation time, and cost of the three-port technique were similar to those of the conventional approach. Large randomized controlled trials are needed to examine the true benefits of the three-port technique.

6 illus, 3 tables, 35 ref

045698   OBONNA G C, OBONNA M C, MISHRA R K (Surgery Dep, Medical Sciences Teaching Hospital Univ, Nigeria, Email: obogeo2009@yahoo.com) : Role of indocyanine green in laparoscopic cholecystectomy. World J Lap Surg 2020, 13(1), 1-3.

The most feared complication during laparoscopic cholecystectomy (LC) is bile duct injury. Real-time intraoperative imaging using indocyanine green (ICG) reduces the risk of bile duct injury by improving visualization of the biliary tree during laparoscopy. This effect will also shorten operative time and hence reduce the dangers of prolonged operation time. It also subserves the diagnostic value in its use in the liver function test. This study was aimed to elucidate the role of ICG as an investigative tool that aids the operative procedure of laparoscopic cholecystectomy. The analysis of case series of ICG laparoscopic cholecystectomy in our hospital—the World Laparoscopic Hospital, Gurgaon, India. In all the cases, fluorescent cholangiography using intravenous injection of ICG has become the optimal tool to confirm the biliary tract anatomy during LC because it has potential advantages over radiographic cholangiography in that it does not require irradiation or dissection of the triangle of Calot. This early visualization of the cystic duct and additional imaging of the common bile duct (CBD) may increase safety in LC and offers an alternative to the intraoperative cholangiogram in patients with increased risk of CBD injury. Laparoscopic cholecystectomy with real-time ICG fluorescence cholangiography enables a better visualization and identification of the biliary tree and therefore should be considered as a means of increasing the safety of LC.

3 illus, 11 ref

044271   VAYYA M , ABBULU K (Pharmaceutics Dep, CMR Coll of Pharmacy, Medchal - 501 401, Hyderabad) : Formulation and evaluation of mouth dissolving films for cardiovascular disease. Int J Res Pharm Chem 2020, 10(1), 42-9.

The main aim of the current study is to develop Mouth dissolving films (MDFs) of Ramipril which is an anti-hypertensive agent used to cardiovascular diseases. Five formulations (E1, E2, E3, E4, E5) were prepared by using HPMC E15 and PVA as polymers, PEG 400 as plasticizer, aspartame as sweetening agent, citric acid as saliva stimulatingz agent and orange as flavoring agent by following solvent casting method. The films prepared shows quick onset of action, increases bioavailability by avoiding hepatic first pass metabolism and is administered without the help of water. Formulation E2 showed drug release of 98.2 % within 3 minutes and was found to be stable under suitable stability conditions. From the results of evaluation parameters of films suggest that mouth dissolving films of Ramipril can be an impressive and innovative approach for the treatment of cardiovascular disease like heart failure, heart attack and myocardial infarction.

5 illus, 9 tables, 9 ref

044270   KUMAR S , GAUTAM D, TALWAN P (Gautam Coll of Pharmacy Hamirpur, Himachal Pradesh-177 001) : Formulation and evaluation of mirtazapine oral thin film. Int J Res Pharm Chem 2020, 10(1), 35-41.

The aim of this present investigation was to develop a rapid dissolving oral polymeric film, using the solvent casting method, having good mechanical properties, instant disintegration and dissolution, an acceptable taste in the oral cavity. Mirtazapine is a tetracyclic antidepressant drug mainly in patients affected by depression The present investigation was undertaken with the objective of formulating of the Mirtazapine rapid dissolving oral thin films allowing fast reproducible drug dissolution in oral cavity thus bypassing first pass metabolism, to enhance the convenience and compliance by the elderly and pediatric patients .Nine formulation of films with drug were prepared using both natural and synthetic polymers like HPMC E6 and Sodium Alginate. Propylene glycol was used as plasticizers. Citric acid was used as a saliva stimulating agent. Synthetic Aspertame was used as sweetening agent. The resultant films were evaluated for weight variation, assay, content uniformity, folding endurance, thickness, tensile strength, percent elongation, surface pH, in vitro disintegration and in vitro dissolution. The F4 formulation showing the best results. the disintegration time is only 3.5 second. and was releasing upto 100.8 % of drug within 20 minutes.

4 illus, 3 tables, 12 ref

044265   CHOUDHARY S (Physical Education Dep, Delhi Univ, Ashok Vihar, Delhi) : Sports and language: Innovative in approach. Int J Phys Educ Sports Health 2020, 7(1), 43-4.

Innovative approach in language learning extends its application in sports activities which are also considered the best and the easiest way to learn the language. Through our interaction with other players we encounter new words, new expressions and pronunciation as we integrate these tools of the language in our speech. The purpose of this paper is to understand and demonstrate the integration of language in sports which promotes and encourages innovative ideals and experiences in communication systems. Therefore, there are growing indications of a link between linguistic skills and physical training. As globalization, mobility and communications are bringing the world together; ever more urgent is the need to be competent in linguistic skills. Using games and sports is a good way of integrating most complex language skills. Physical Education Teachers are in a unique position to provide good language skills. Idiomatic expressions can make students to put the things in an impressive and succinct manner.

4 ref

044264   KAUR N (Arts and Sports Coll, Jalandhar, Punjab) : Sports training. Int J Phys Educ Sports Health 2020, 7(1), 41-2.

Sports Training refers to engaging in activity to improve performance and /or fitness. It is understood as a process of systematic development of each component in dependence on the duration of preparation which leads to achieving maximum efficiency in senior age within the selected sports discipline. Sports training is an integral part of every player. Training can be best accomplished by understanding general sports training principles. Principles are generally agreed upon guidelines that are grounded in the sport sciences and hold true in practice and competition. Wisdom from experience and good judgment are essential for optimizing the benefits of these guidelines. Apart from this skill learning, movement mechanics and other aspects of sport performance must be included in programs of players at respective level of competition. Tasks of sports training focus on systematic development of the components of sports training. Development of individual component of training is influenced by the structure of sports performance.

4 ref

044263   RAJAN K M, NEETHU PR (Alagappa Univ, Karaikudi, Tamil Nadu) : Effect of yogic practice on blood pressure among female IT professionals. Int J Phys Educ Sports Health 2020, 7(1), 37-40.

This study was designed to investigate blood pressure using Yogic Practices on female IT Professionals. An empirical study was performed on female IT Professionals (n = 30), aged 25–35 years. The subjects were categorized into treatment group I (n =15) (yogic practice), and group II acted as control group (n =15). All the subjects were tested before and after twelve weeks of yogic practice on blood pressure. There are significant differences in blood pressure for working women group. This empirical study indicated that regular yogic practices on IT female professionals will be beneficial for blood pressure.

3 tables, 9 ref

044262   SUNADI D, APRIANTONO T, KUSNAEDI , IHSANI S I, JUNIARSYAH A D (School of Pharmacy, Jawa Barat, Indonesia) : Measuring student interests in following sports lectures in ITB joint preparation stage. Int J Phys Educ Sports Health 2020, 7(1), 33-6.

Interest is the relationship between oneself and something outside oneself. The stronger or closer the relationship. The measurement of Joint Preparation Stage student interest in taking a sports course has never been measured in research among students. The purpose of this study was to find out how high the students' interest in participating in the Sports Lecture was and how general the fitness of Sports Lecture students was, especially the Sports Lecture lecturers in Semester II 2017/2018. Subjects in this study were 172 second semester students of ITB 2017/2018 academic year consisting of 90 male groups and 82 female groups. The instrument of interest research used a questionnaire with a validity value> 0.361 and Cronbach's Alpha reliability value of 0.968. The data analysis technique used is quantitative descriptive with a percentage. The mean score of the female and male groups was quite large. The female group had a mean score of 71.01 greater than the male group of 64.80. Interest in research subjects in the category of Very Good 23.8 %, Good category 18.02 %, Fair category 31.9 % and category Less 26.16 %. Students' interest in joining Sports Lecture is divided into 4 categories, namely very good, good, sufficient and less. This category provides an overview of the research subject's interest in Sports Lecture.

1 table, 14 ref

044261   MAMGAIN R (Physical Education Dep, H.N.B. Garhwal Univ, Srinagar, Garhwal, Uttarakhand) : Modern warriors: The pro kabaddi. Int J Phys Educ Sports Health 2020, 7(1), 31-2.

Pro Kabaddi, a first significant initiative of Mashal Sports, takes our truly indigenous sport of Kabaddi to levels of new professionalism, which will benefit all stakeholders involved in the ecosystem of the game, Kabaddi, most of all, the players themselves, who will become the new role models for the youth of India. This bold step will highlight the new, modern, international and competitive face of Kabaddi throughout the length and breadth of the country, and beyond. From villages, from cities, from all walks of life, these warriors have emerged and made a name for them in this brutal sport. And now they are leading entire teams in the most thrilling kabaddi format yet. Meet the warriors leading the charge- The Pro Kabaddi high-octane Kabaddi action.

5 ref

044260   YURTAYDIN Y, AFYON Y A (Coaching Education Dep, Mugla Sitki Kocman Univ, Mugla, Turkey) : Investigation of the effects of hatha-yoga exercises on some physiological and motoric parameters in sedentary women. Int J Phys Educ Sports Health 2020, 7(1), 26-30.

The aim of this study was to investigate the effects of 8 weeks of Hatha Yoga exercises on some physiological and motor parameters in sedentary women. The descriptive characteristics of 30 sedentary women living in Ula district of Mugla province; Experimental Group (DG) (n = 15) (age X = 48.27 ± 3.51 years, height X = 160.26 ± 3.47 cm, Body Weight X = 62.78 ± 4.60 kg.), Control Group (KG) (n = 15) (age X = 46.07 ± 5.75 years, height X = 149.66 ± 41.71 cm, body weight X = 62.68 ± 299.59 kg). For the effects of 8 weeks of hatha yoga exercises on some physiological and motoric parameters (body fat, strength, balance, flexibility), pre-test and post-test comparisons were made between the control and experimental groups. In addition to their normal programs, they performed ath ‘’hatha yoga’’ 2 twice a week for 8 weeks. The control group continued their weekly schedule. Pre-tests (body weight, flexibility, body fat ratio, strength and balance) of the 2 groups were taken before the studies. At the end of 8 weeks, posttest measurements were taken. The measurements were taken in a yoga hall in Ula by a trainer with a yoga coaching certificate from Mugla Sitki Kocman University School of Physical Education and Sports. In the research, arithmetic means (X) standard deviations, independent samples t-Test (Indepented Samples t-Test), and difference between pre-test and post-test t-Test (Paired Samples t-Test) were examined at 0.05 significance level. As a result; It was observed that hatha yoga exercises applied to sedentary women for 8 weeks provided positive improvement on all physiological and motor parameters (p<0.05). Hatha Yoga program can be recommended to coaches to develop physiological and motoric features in different sports and age groups.

5 tables, 17 ref

044259   HERYANTO M, LUBIS J, SUKUR A (Jakarta State Univ, Indonesia) : Influence of teaching style and learning motivation towards free style capability. Int J Phys Educ Sports Health 2020, 7(1), 22-5.

This study aims to determine the effect of teaching style and learning motivation on freestyle swimming ability. The sample of this research is 48 people who are students at SMK Pasundan 3 Cimahi City using a treatment design by 2x2 level. Data were analyzed using analysis of variance (ANAVA) and continued with the Tukey test at a significance level of a = 0.05. The results showed (1) There was a significant difference between the ability of free-style swimming students who were taught with inclusive teaching styles and students who were taught with reciprocal teaching styles. (2) T erdapat interaction between teaching style and motivation towards freestyle swimming ability. (3) There is a difference in the ability of freestyle swimming in highly motivated students using reciprocal teaching styles and inclusive teaching styles. (4) There is a difference in the ability of free style swimming in students with low motivation using reciprocal teaching styles and inclusive teaching styles.

5 tables, 42 ref

044258   SHEIKH L UZ Z, PATHAK M K (Physical Education Dep, Rabindranath Tagore Univ, Bhopal, Madhya Pradesh) : A comparative study of speed among football and hockey players of Kashmir province. Int J Phys Educ Sports Health 2020, 7(1), 19-21.

The aim of the present study is to compare the speed among Football and Hockey of Kashmir province. For the present study 60 male Football and Hockey players were selected during the school level competition, between the age group of 15-18 years. i.e. 30 Football and 30 Hockey players who have taken part in the district sports events during the year of 2018-2019 were taken for study. The test was used to assess the speed among Football and Hockey of Kashmir province. The result of the study show that the football players of Kashmir provinces having very good speed of compare to hockey players of Kashmir province. It is recommended that Football and Hockey players of Kashmir province must be given good speed, speed training to enhance performance.

1 illus, 1 table, 6 ref

044257   KAKADE P (Krishna institute of medical sciences “Deemed To Be Univ'', Karad, Maharashtra) : The study of flat foot and inferior heel pain in sub elite basketball players. Int J Phys Educ Sports Health 2020, 7(1), 16-8.

The aim of this study was to find the relation between flatfoot and inferior heel pain in sub elite basketball players. The arches of foot supports the body weight and absorbs ground reaction force during physical activities or sports. Many studies have been done on BMI and flat foot, ankle injuries, knee injuries and etc in basketball players but there is lack of research on relation between flatfoot and inferior heel pain which can also occur in basketball players. This was an observational study. Total 80 players were taken, 40 players with flatfoot and 40 players with normal foot arches with age group of 18-25. This candidates were assessed for flatfoot and VISA-A questionnaire was asked, answers were recorded and data was analysed. The 80 % of basketball players with flatfoot has inferior heel pain while the 37.5 % of basketball players with normal foot arch has inferior heel. On the basis of result it can be concluded that basketball players having flatfoot and less experience in playing are more prone to get inferior heel pain.

3 tables, 9 ref

044256   HERDIAWAN G G S, ASMAWI M, HANIF A S (Jakarta State Univ, Indonesia) : The effect of current power, arm strength and coordination on jump shoot skill basketball skills. Int J Phys Educ Sports Health 2020, 7(1), 11-5.

The purpose of the study to determine whether or not the direct influence of the explosive power leg muscle (X1), arm muscle strength (X2) and k oordinasi hand eye (X3) on skill jump shoot (Y) basketball SMEs basketball UNINUS. The research method used is a sociative quantitative approach, the analysis technique uses the path analysis approach (Path analysis). The sample included in this study amounted to 50 students. The results of the analysis that there menunjkkan contributions influence of X1 and X2 to Y 75.2 % (ε 1 = 0.4979); contributions influence of X1, X2, X3 to Y 87.7 % while the remaining 12.3 % is contributed by other variables not researched (ε 2 = 0.3507). The conclusion of this experiment is the leg muscle power, k ekuatan arm muscles, hand-eye coordination are equally affect the skills of the jump shot. P ower muscle and strength of arm muscles directly influence the hand-eye coordination on SME UNINUS basketball.

2 illus, 6 tables, 8 ref

044255   SZTEJNBERG A, JASI?SKI T L (Professor Emeritus at the Opole Univ, Opole, Poland) : Physical education students’ expectation towards the teachers’ nonverbal and verbal behaviors during classes. Int J Phys Educ Sports Health 2020, 7(1), 04-10.

This study presents the results of research aimed at recognizing the first and second year students’ expectations for the teachers’ nonverbal and verbal behaviors during classes. Data were gathered from 214 students of the Physical Education Faculty at Gdansk Academy of Physical Education and Sport in Gdansk. Anonymous “Teachers’ Communication Behavior – TCB” questionnaire was used in this study. Its first part enabled to know the students expectancy for teachers’ both nonverbal immediacy and nonverbal non-immediacy. The second part of this questionnaire contains questions enabling to rate the students’ expectation for verbal teachers’ behaviors. An analysis of the obtained results revealed four significant differences in the degree of the students’ expectations for nonverbal behaviors of the teachers. It was also found that the students want their teachers to show seven attitudes being indicators of their nonverbal immediacy. The obtained results revealed also that the students rather do not accept touching them by the teachers. In case of verbal behaviors, the students want to see teachers’ verbal immediacy and clarity of teaching the students expect from their teachers some behaviors pointing their nonverbal immediacy. They more accept the teachers who are smiling to the whole group, and not to the particular person. On the other side, the students do not accept touching. Students also expect for their teachers verbal immediacy, clarity and matter-of-factness. Differences between mean degrees of intensity the first and second year student’s expectation proved to be statistically significant for four behaviors.

1 illus, 3 tables, 37 ref

045697   KISMIATI S , WAHYUNI H I, MURYANI R, SUNARTI D, SUMARSIH S (Animal Science Dep, Diponegoro Univ, Central of Java, Indonesia, Email: kismiati59@gmail.com) : Addition of binahong (Anredera cordifolia) leaf powder to diets to produce eggs with low cholesterol. Vet World 2020, 13(3), 604-8.

The aim of this study was to evaluate the effect of the addition of binahong leaf powder to quail rations on the production and quality of eggs.  The study involved the use of two hundred 7-week-old quails housed evenly in 20 wire cages with a body weight of 123.77±0.72 g. The quails were treated as follows: Ration without binahong leaf powder (T0), addition 2 % of binahong leaf powder (T1), addition 4% of binahong leaf powder (T2), and addition 6 % of binahong leaf powder (T3). The study used a completely randomized design. The parameters measured were the production, weight, and characteristics of the eggs, as well as the cholesterol, triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and egg protein content in the yolk. The addition of 2-6 % binahong powder did not significantly affect egg production, egg characteristics, or egg protein content, but significantly (p<0.05) affected the cholesterol, triglyceride, HDL, and LDL contents in yolk. The cholesterol, triglyceride, and LDL contents decreased significantly in T1, whereas HDL increased significantly in T2 and T3. The addition of 2 % binahong was enough to obtain healthy quail eggs with low levels of cholesterol, triglyceride, and LDL.

5 tables, 37 ref

044254   ALMAL N Y B, MEKAL F H, ALI H M, ALI M S (Zoology Dep, Omar El-Mukhtar Univ, Box 919, Al -Bayda-Libya) : Prevalence of human cystic echinococcosis: A clinico-epidemiological study in Northeast of Libya. Int J Pharm & Life Sci 2020, 11(1), 0976-7126.

Cystic echinococcosis (CE) or hydatid cyst is the most important zoonotic disease that causes significant economic losses and public health problems worldwide. It is an endemic disease in the Mediterranean area that has not yet been fully documented in eastern Libya. This study was conducted to evaluate retrospectively 79 patients diagnosed with the CE disease at three hospitals in Benghazi and the main hospital in El-Beyda. Medical records were surveyed of infected patients with CE who had been operating in four hospitals from 2000 till end of 2002. Several parameters were studied, including age, sex, place of habitation, and the location of cysts. Of the 79 cases, 60.2 % (n=48), 39.8 % (n=31) were female and male respectively, with the mean age of 46 years (1– 90). The most affected age group was 1-10 years old (30.4 % of the cases). A Single organ involvement was seen in the majority of patients. The cysts were most frequently found in the liver (55.7 %), followed by the lungs (22.8 %), then other organs (16.4 %). Among patients, 5.1 % had cysts in 2 organs (lungs and liver). The distribution of residence of patients showed that 44 (55.7 %) of them were Benghazi residents, followed by El-Beyda residents by 12 (15.2 %). Conclusion: The population in northeast of Libya is suspected to be at high risk for CE infection because many inhabitants have flocks of sheep or goats that are kept around dogs for protection.

1 illus, 3 tables, 22 ref

044253   SALEH B (Molecular Biology and Biotechnology Dep, Atomic Energy Commission of Syria (AECS), P.O. Box 6091, Damascus, Syria) : FT-IR, FT-Raman and GC-MS analyses of biochemical compounds in Ophrys apifera Huds (Orchidaceae) species. Int J Pharm & Life Sci 2020, 11(1), 0976-7126.

Fourier-transform infrared spectroscopy (FT-IR), fourier transform raman spectroscopy (FT-Raman) and gas chromatography-mass spectrometry (GC-MS) techniques were employed for biochemical characterization of acetonic, methanolic and ethanolic flowers of Ophrys apifera Huds species extracts, as a new Ophrys species in Syria. FT-IR spectra 1100 cm-1 peak assigned to C–O secondary alcohol stretch C–O stretch (Ethers) and 3000 cm-1 peak assigned =C-H stretch (aromatics) groups were mainly detected as a common peaks with the three examined extracts. As for FT-Raman spectra, 1500 cm-1 peak assigned to C=C stretch aromatic (aromatics) group was mainly detected as a common peak with the three examined extracts. Whereas, in GC-MS assay, 9-Octadecenamide (Z)- compound (oleamide) was mainly presented as a major and common compound 67.76 SALEH B%, 85.87 % and 87.49 % with acetonic, methanolic and ethanolic extracts, respectively. All the above mentioned components exhibited a potential role in pharmaceutical and medicine researches and applications. Thereby, more attention should be given to these components to be handled in the future work.

48 ref

045696   AL-SHAELI S J J, ETHAEB A M, GHARBAN H A J (Anatomy and Histology Dep, Wasit Univ, Wasit, Iraq, Email: salshaeli@uowasit.edu.iq) : Molecular and histopathological identification of ovine neosporosis (Neospora caninum) in aborted ewes in Iraq. Vet World 2020, 13(3), 597-603.

The objective of the present study was to detect Neospora caninum DNA in the placenta of sheep and evaluate the association of risk factors to polymerase chain reaction (PCR) positive and histopathological analysis of the placenta and fetal tissue samples of aborted fetuses. Fresh placenta from 51 aborted ewes was collected for PCR assay. Placental and fetal tissues of aborted fetuses, including brain, heart, liver, lung, and thymus, were collected for histopathological analysis, besides the risk factor data were obtained during the time of sampling.  From 51 placentas examined by PCR, 13.73 % appeared positive to N. caninum DNA. The relationship between PCR positive and the risk factors revealed a significant difference (p0.05). Histopathological investigation of placental and fetal tissues of positive samples showed tissue cyst-like structure, necrotic foci, and infiltration of mononuclear cells. Other lesions were thickening in chorionic plate in placenta, severe vacuolization and death of neurons, microgliosis, demyelination, edema, and proliferation of astrocytes in brain. In addition, fibrous and fat deposition with stenosis in the heart, parenchymal necrosis, severe atrophy, vacuolization and hyalinization of hepatocytes, megakaryocyte, portal fibrosis in the liver, and interlobular septal thickening in lung without obvious lesions is seen in the thymus tissue samples. This is a unique study that confirmed N. caninum DNA in the placenta of aborted ewes in Iraq using PCR assay. Histopathological analysis of some aborted fetuses organs could provide a more confirmatory and reliable data for a significant role of neosporosis in increasing the rate of abortion in sheep, while the clinical data of risk factors could be used to control the transmission of N. caninum infection.

6 illus, 1 table, 38 ref