040174   BHATT M M, SHAH D, VAISHNAV K, PATEL P, HARSOLIA Z, DANGI R ( Prosthodontics Dep, Karnavati School of Dentistry, Gandhinagar, Gujarat, Email: bhattmiloni.mb@gmail.com) : Correlation of inter occlusal distance and gonial angle in dentate and edentulous patients in Gujarati population. Adv Hum Biol 2020, 10(3), 166-70.

The amount of interocclusal distance in any individual is mainly an expression of muscle function, its equilibrium, and gravity. In some medically compromised patients, it is difficult to determine the interocclusal distance. This study aims to evaluate the correlation of interocclusal distance and corresponding gonial angle on the lateral profile of dentulous individuals in lateral cephalograms in Gujarati population and correlation of these values for edentulous individuals. A total of 100 individuals were involved in this study within age group of 20-35 years. Interocclusal distance was determined by the difference between the readings of vertical dimension of rest and vertical dimension of occlusion in dentulous individuals. Gonial angle was calculated with the help of cephalometric radiographs and the two were correlated. Range of gonial angle and interocclusal distance were obtained and the mean of the values was derived. A strong correlation was found to exist. By applying the processes of linear regression to the paired results, a formula was obtained which may be used to predict the best value of one variable for any given value of the other. Thus, in an edentulous case, where the value of the interocclusal distance measurement is unknown and difficult to determine, a method is provided for predicting its best value by the determination of the patient’s gonial angle through cephalometric analysis.

3 illus, 1 table, 10 ref

040173   KALYAN P, DAVE B , DESHPANDE N , PANCHAL D (Public Health Dentistry Dep, Sumandeep Vidyapeeth, Vadodara, Gujarat, Email: drpulkitkalyan@gmail.com) : A study to assess the periodontal status of eunuchs residing in central Gujarat, India: A cross sectional study. Adv Hum Biol 2020, 10(3), 162-5.

The extent of periodontal tissue destruction can be assessed using pocket depth which also indicates the condition of the extent of the local inflammation. There are so many social stigmas associated with eunuchs community that these people do not come out in open and even if they come out in open, they often resort to various debilitating lifestyle habits that affect their general well‑being and oral health in a negative sense. The objective of the present study is to assess the periodontal status among the eunuchs residing in Central Gujarat and to analyse the association between the periodontal status of eunuchs residing in Central Gujarat and various demographic variables. The survey was conducted in Central Gujarat, and data were collected through primary source using the WHO Oral Health Assessment Form for Adults (2013) to assess the periodontal status and loss of attachment. Clinical examination was performed by using a plane mouth mirror and Community Periodontal Index Probe (WHO probe) (CPI) probe under adequate natural/artificial light. Out of 384 eunuchs, the mean value of periodontal pocket depth among the eunuchs is 3.12 ± 0.89; clinical attachment loss is 2.88 ± 0.74. The difference in the periodontal pocket depth and clinical loss of attachment was statistically insignificant indicating that there is no difference in periodontal pocket depth and clinical loss of attachment across all the age groups and education status of eunuchs. The results of the current study showed poor periodontal status among eunuch population in Central Gujarat. The periodontal condition helps estimate the oral condition of this population. These estimates are important for the future planning of dental services among eunuch community.

4 tables, 18 ref

040172   MERAVI A, KUSHWAHA P, KHARE I (Obstetrics and Gynaecology Dep, Peoples Medical Coll and Hospital, Bhopal, Madhya Pradesh, Email: prachikushwah40@gmail.com) : Analytical study to evaluate maternal morbidity and perinatal outcome among pregnant women with severe anaemia at tertiary care centre: A hospital based study. Adv Hum Biol 2020, 10(3), 158-6.

Anaemia during pregnancy is a global public health challenge facing the world today. It is estimated that around 2 billion people, 30% of the world population, are affected with the majority coming from the developing world. The present study was conducted to assess perinatal outcomes and associated morbidity factors among anaemic pregnant women. The present study was a hospital-based observational study that was conducted in the Department of Obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh, India and included all the pregnant women in the third trimester of pregnancy with haemoglobin level <7 who were admitted between January 2016 to December 2017. A total of 500 cases were enrolled for the study. The present study revealed that anaemia was significantly associated with co‑morbidities, 25.4 % women had pre‑eclampsia, 7.6 % had jaundice, 3.6 % had heart disease and 4.8 % had the intercurrent infection. Out of 500 anaemic women 216 women had severe maternal morbidity this was found to be significant (P = 0.016), 59 women had eclampsia in their antenatal period, septicaemia was found in 63 women, 32 had a pulmonary embolism. In this study, maternal morbidity among anaemic pregnant women (ICD‑10) were found to be significant in the puerperal period, among 500 study participants, 41 women had puerperal pyrexia. 319 (63.8 %) delivered the baby with low birthweight, 144 (28.8 %) had full‑term delivery, 34 (6.8 %) were stillborn and 03 (0.6 %) patients were undelivered. There was a statistically significant difference found in fetal outcome according to the urban or rural locality (P = 0.001). Low education level, gravidity and inter-pregnancy intervals are the main risk factor. We recommend educational awareness programme to be conducted amongst pregnant women to improve their knowledge regarding the causes and prevention of anaemia for a better antenatal and perinatal outcome.

5 tables, 15 ref

040171   TIWARI R, KUSHWAHA P, MERAVI A (Obstetrics and Gynaecology Dep, PCMS, Bhopal, Madhya Pradesh, Email: prachikushwah40@gmail.com) : Analytical study to determine the impact of jaundice in pregnancy on maternal and perinatal outcome. Adv Hum Biol 2020, 10(3), 153-7.

Jaundice in pregnancy carries a grave prognosis for both the foetus and the mother, and is responsible for 12% of maternal deaths. Liver disease is a rare complication of pregnancy, but when it occurs it may do so in a dramatic and tragic fashion for both the mother and infant. Data were collected as prospective Hospital based observational study at tertiary care centre. After the preliminary assessment with regard to the inclusion and exclusion criteria, informed consent was obtained from all patients. Thorough history was taken and physical examination was done. Demographic details of each patient were obtained. Relative investigations were done. Out of 300 patients, 287 were healthy and alive and 13 patients died. The maternal mortality was 4.33 %. Out of the total 13 maternal deaths, 4 cases died due to hepatic encephalopathy, 3 due to disseminated-intravascular coagulation and 3 due to sepsis with multiorgan failure. Mortality was due to HELLP- Hemolysis Elevated Liver enzymes and Platelet count in two cases and due to acute fatty liver in one case. In 126 (42 %) cases, the mode of delivery was lower segment caesarean section, 138 (46 %) cases had normal vaginal delivery, while 36 (12 %) cases had undergone abortion. A total of 114 (38 %) cases delivered full‑term live baby and 78 (26 %) cases delivered preterm live baby. Full‑term intrauterine foetal death (IUFD) was seen in 15 (5 %) cases and preterm IUFD was seen in 69 cases (23 %). There was neodeath in 24 (8 %) babies. The total perinatal mortality was 36.0 %. The present study shows that although liver dysfunction is infrequently seen in pregnancy, it can result in severe maternal and foetal compromise. Jaundice in pregnancy should be managed as a team with the collaboration of the department of obstetrics, internal medicine, gastroenterology, anaesthesia and critical care so that early diagnosis and aggressive management can prevent and reduce foeto–maternal morbidity and mortality.

8 tables, 15 ref

040170   BHATI B S, MIRZA N, CHOUDHARY P K (Obstetrics and Gynaecology Dep, Government Medical Coll, Pali, Rajasthan, Email: drbsbhati@gmail.com) : Correlation of lactate dehydrogenase levels with outcome in patients with pre eclampsia. Adv Hum Biol 2020, 10(3), 149-52.

Pregnancy causes profound anatomical, physiological and metabolic changes in maternal tissues. Lactate dehydrogenase (LDH) is an intracellular enzyme. Hence, the present study was undertaken for assessing and correlating LDH levels with outcome in patients with preeclampsia. A total of 60 pregnant women with pre‑eclampsia (PE) were included in the present study. Among these 60 patients, 30 patients were mild PE while the remaining 30 patients were of severe PE. Another set of 30 subjects of normotensive pregnancy were included as controlled group. Blood samples were obtained from all the subjects and were sent to laboratory where auto-analyser was used for the evaluation of serum LDH levels. Follow-up was done and outcome was recorded in all the patients. All the results were recorded into Microsoft excel sheet and were analysed by SPSS software. Mean LDH levels amongst subjects of normotensive group, mild PE group and severe PE group was found to be 169.2 IU/L, 338.4 IU/L and 629.7 IU/L, respectively. Non‑significant results were obtained while comparing the mean gestational age of the patients divided on the basis of mean LDH levels. Significant results were obtained while comparing the neonatal complications and neonatal mortality amongst patients divided on the basis of LDH levels.  Significant alteration of LDH levels occurs in PE patients. In addition, higher levels of LDH levels are significantly associated with worse outcome in PE patients.

3 tables, 14 ref

040169   DHAKA N, KOOLWAL A , AGARWAL A , AWASTHI A , KOOLWAL G D (Psychiatry Dep, Government Medical Coll, Rajasthan, Email: drankit1983@gmail.com) : Cognitive impairment in patients with schizophrenia: A comparative study from western Rajasthan. Adv Hum Biol 2020, 10(3), 144-8.

Cognitive impairment is the core feature of schizophrenia (SCZ). The affected individuals exhibit wide‑ranging deficits involving multiple domains of cognitive functioning. These deficits are associated with poor functional outcome and residual disability in patients. Substantial literature exists on cognition in SCZ; however, few studies have been carried out on this subject in India and in particular in Rajasthan. The objective was to evaluate cognitive functions in SCZ patients and to compare these with healthy controls. This cross‑sectional study was conducted at the psychiatry department of a tertiary care institution on fifty schizophrenic patients and matched healthy controls who fulfilled the inclusion criteria. Diagnosis was made by DSM‑V criteria, and symptom severity was determined by the Positive and Negative Symptom Scale. After seeking sociodemographic details, all participants were administered Postgraduate Institute Battery of Brain Dysfunction to assess their cognitive functioning. Data collected were subjected to suitable statistical analysis (mean, standard deviation and Chi-square test). Majority of the schizophrenic patients (56 %) were under 35 years of age, were males (70 %), were from urban background (66 %) and were married (70 %). Schizophrenic patients performed poorly on all domains of cognitive functioning, including memory, performance and verbal intelligence and perceptuo-motor skills. The present study reiterated the previous findings of wide‑spread, multidomain cognitive impairment in schizophrenic patients. The resultant cognitive profile has important implications for the aetiology and treatment of this major psychiatric disorder.

3 tables, 27 ref

040168   BHATT N N, PATEL R, PATEL J, CHHABRAT, SETHURAMAN R , PATEL S (Prosthodontics and Crown and Bridge Dep, Sumandeep Vidyapeeth, Waghodia ? 391 760, Email: drninadbhatt@gmail.com) : Comparative evaluation of the masticatory efficiency of complete dentures with bio engineered teeth and conventional denture teeth using electromyography ? A randomised crossover clinical study. Adv Hum Biol 2020, 10(3), 139-43.

Resorption of residual ridge is common problem related to edentulous mandible. One of the main causes of resorption of denture-supporting structures is traumatic or excessive force transmitted through the prosthesis. The resilient-layer and occlusal-reactive dentures are clinical attempts developed for impact reduction and distribution of the masticatory load to the edentulous ridge. Bio-engineered posterior denture teeth which was used in this study have resilient silicone material lining which lead to cushioning effect and reduced the force transmitted to the basal bone. This study was done to assess and compare the masticatory efficiency of complete dentures with bio-engineered teeth and conventional denture teeth using electromyography (EMG) analysis. The present study was conducted on 09 completely edentulous patients who reported to the department of prosthodontics and crown and bridge. Group A - conventional denture and Group B - denture with bio-engineered teeth. All the patients were randomly allotted to Group A or B using random allocation software, after 3 months EMG recording was done, and then, all the patients were provided another set of denture, other than the group in which they had allocated previously. EMG recording was done again after 3 months of providing the denture of other group. Paired t‑test showed no statistically significant difference in EMG reading of left masseter (P = 0.514), right masseter (P = 0.545), left temporalis (P = 0.954), and right temporalis (0.944) between both the groups. Both the dentures did not show any statistically significant difference in terms of EMG activity, which indicates that the masticatory efficiency of bio‑engineered teeth denture is comparable to that of conventional denture.

6 illus, 1 table, 14 ref

040167   KHAZAEI Z, MOAYED L, SHARIFNIA G , GOODARZI E , ZARGHI A (Sabzevar Univ of Medical Sciences, Sabzevar, Iran, Email: a.zarghi59@gmail.com) : Prebiotic prophylaxis of abdominal bloating in mechanically ventilated patients fed through nasogastric tubes: A randomised clinical trial. Adv Hum Biol 2020, 10(3), 134-8.

Enteral nutrition is the first choice of nutritional support of patients undergoing mechanical ventilation. Gastrointestinal disorders, especially abdominal bloating, are commonly seen in this group of patients. Given the prevalence of bloating and its perceived severity, the lack of an effective method for the control or treatment of this problem during mechanical ventilation is urgently felt.  This double‑blind, randomised, controlled clinical trial was conducted on 60 mechanically ventilated patients divided in two groups (n = 30). The study group received fenugreek seed (FS) powder by gavage twice a day besides the routine care. The control group only received routine care. Abdominal bloating, consisting of abdominal pain intensity, abdominal circumference, vomiting, frequency deification, bowel sounds and gastric residual volume, was measured at the baseline and every day for 5 days. By the end of study, abdominal bloating decreased significantly in the study group compared to controls (P < 0.05). Given that even a slight reduction in symptoms can produce positive public health consequences, daily diet with FSs is recommended for critically ill patients.

4 tables, 23 ref

040166   KHANDELWAL J R, BARGALE S, DAVE B H, POONACHA K S, KARIYA P B, VAIDYA S (Pediatric and Preventive Dentistry Dep, K M Shah Dental Coll and Hospital, Vadodara, Gujarat, Email: drseemabargale@gmail.com) : Comparative evaluation of remineralising efficacy of bioactive glass agent and nano hydroxyapatite dentifrices on artificial carious lesion in primary teeth: An in vitro study. Adv Hum Biol 2020, 10(3), 129-33.

The phenomenon of reversal of incipient or early enamel caries forms an important part of prevention leading to apparent repair of the lesion. Recently, novel biomaterials such as the bioactive glass(BAGs) and nano-hydroxyapatite (n-HAP) crystal have been introduced as remineralising agents. This study aimed to evaluate and compare the remineralising efficacy of BAG agent and nano‑hydroxyapatite (NHA) dentifrices on artificial carious lesion in primary teeth. Thirty human extracted primary teeth were selected for the study, and the specimens were randomly divided into Group A: BAGs agent toothpaste group and Group B: n-HAP toothpaste group. The surface microhardness of the teeth was measured using a Vickers microhardness tester at the baseline and after demineralisation and remineralisation. The statistical analysis was done using independent t-test for intergroup comparison and paired t-test for intragroup comparison. On intergroup comparison, microhardness differences of baseline to exposure to dentifrice between the two groups showed that microhardness differences of baseline to exposure to dentifrice were higher in Group B with a t value of −2.158 and was statistically significant (P < 0.001). On intragroup comparison of the mean values of baseline microhardness and microhardness after exposure to dentifrices, the mean values of baseline microhardness were higher in both the groups with a difference of 14.3 and 20.45 in Group A and Group B, respectively. Both BAG and NHA toothpastes were considered to be effective for the remineralisation of caries‑like lesions of primary teeth. The remineralising efficacy of n‑HAP toothpastes was found to be slightly higher than that of BAGs toothpastes, which was statistically significant.  

3 illus, 2 tables,17 ref

040165   NADIG P, SHAH M (Periodontology Dep, K M Shah Dental Coll and Hospital, Vadodara, Gujarat, Email: drprasadnadig@gmail.com) : Awareness about yoga and its benefits among undergraduate and post graduate dental students. Adv Hum Biol 2020, 10(3), 125-8.

Students of all professional courses are under stress amongst which dental and medical curriculum is rated as highest. Many studies have indicated that the students experienced a reduction in stress and anxiety levels after inclusion of regular practice of yoga and can have a significant change in the lifestyle of a dentist by allowing them to maintain their health as well as relieving them from their day‑to‑day stress. Considering the long‑term effects of the dental profession on one’s health, it is crucial to know the awareness levels about yoga and its benefits amongst dental undergraduate and post‑graduate students towards ensuring physical, mental and psychological well‑being. Google Forms were created where section one was for informed consent; the section two consisted of the questionnaire. It consisted of four items to assess the student’s knowledge about awareness and benefits about yoga. The statistical analysis was done after collecting all the responses. The total number of students participated was 206. Among 206 students, 35 % had the habit of doing yoga and 65 % did not have the habit of doing yoga. Ninety‑two percent of the students had the knowledge of benefits of yoga; 6 % had no knowledge of benefits of yoga. Ninety‑two percent of the students had the knowledge of benefits of yoga, but only 35% had the habit of doing yoga. Based on the findings of the study, a sensitisation program on benefits of yoga shall be planned in small groups and the students should be motivated to take up yoga in their daily life.

4 illus, 4 tables, 14 ref

040164   RAIKWAR S (Anaesthesiology Dep, Gandhi Medical Coll, Bhopal, Madhya Pradesh, Email: drskraikwar@gmail.com) : Comparative clinical evaluation of intrathecal bupivacaine heavy, bupivacaine with magnesium sulphate and bupivacaine with neostigmine for infraumbilical surgeries ? A clinical study. Adv Hum Biol 2020, 10(3), 120-4.

This study aims to assess the anaesthetic effects of adjuvant therapies with neostigmine or magnesium sulphate compared with bupivacaine intrathecally, alone in patients undergoing infraumbilical surgeries under subarachnoid block. After approval from the Institutional Ethics Committee and informed written consent from patients, the present study was carried out in 90 patients of ASA Class I and II, aged between 18 and 50 years, of either sex (M and F), scheduled for elective infraumbilical surgeries. The selected patients were randomly divided into three equal groups of 30 patients. Group I patients received bupivacaine heavy (0.5%) 3 ml (15 mg) +0.5 ml normal saline. Group II patients received bupivacaine 3 ml (5 mg) with preservative‑free magnesium sulphate 0.5 ml (50 mg). Group III patients received bupivacaine (3 ml) with neostigmine 0.5 ml (25 µg). The parameters assessed were the duration of sensory and motor blockade, quality of block, perioperative haemodynamic effects and duration of post‑operative analgesia. Addition of 50 mg of magnesium sulphate significantly increases the duration of sensory block in Group II (397.67 ± 14.003) as compared to Group III (188.67 ± 23.887) and Group I (183.10 ± 8.185), duration of motor block in Group II (213.67 ± 13.767) as compared to Group III (164.67 ± 23.154) and Group I (177.30 ± 7.312), duration of analgesia in Group II (349.00 ± 22.453) as compared to Group III (327.83 ± 31.61) and Group I (241.33 ± 16.399). Haemodynamic parameters were stable in both Groups I and II. Quality of block was much better in Group II (3.83 ± 0.40) as compared to Group III (3.49 ± 0.68) and Group I (2.83 ± 0.79). According to the results obtained from the present study, it is concluded that addition of 50 mg of magnesium sulphate as an adjuvant to intrathecal bupivacaine is better in view of the duration of sensory and motor blockade, quality of block and duration of analgesia (requirement of rescue analgesia) without any significant increase in adverse effects.

3 tables, 21 ref

040163   KHAN K, PARVATHI B K L, YADAV G S, KOOLWAL S (Respiratory Medicine Dep, SMS Medical Coll, Jaipur, Rajasthan, Email: drskoolwal@gmail.com) : Prognostic role of pre chemotherapy platelet counts in patients with non small cell lung cancer treated with first line chemotherapy at IRD SMS Medical College Jaipur. Adv Hum Biol 2020, 10(3), 115-9.

Lung cancer remains the most common cause of cancer death worldwide. The difference in outcome among patients with same clinical stage of disease suggests that advanced non-small cell lung carcinoma (NSCLC) is heterogeneous disease. The patient’s heterogeneity is leading to need for identification of prognostic factors for survival. The analysis of these factors will be helpful in advising individuals, choosing treatment, understanding disease and optimising results of chemotherapy. To study the relationship between pre-chemotherapy platelet count and tumour response in NSCLC patients. This was a hospital-based descriptive study. All patients are cytological and/or histological confirmed NSCLC. We divided patients in two group, patients with normal platelet count and patients with thrombocytosis. Platinum-based chemotherapy was started to patients after pre-chemotherapeutic evaluation. After 3rd and 6th cycles of chemotherapy, patients were evaluated for radiological response as per RECIST criteria. Total 70 patients were enrolled in the study. Those patients who showed progressive disease after 3rd cycle and 6th cycle had higher mean platelet count (4.33 ± 1.21 lakh and 4.14 ± 0.30 lakh, respectively) compared to those patients who showed complete response and partial response. In this study, 78.57 % patients with thromboytosis died, while 35.71 % patients with normal platelet count died after 6 months of follow‑up. The study suggests that pre-chemotherapy thrombocytosis can be considered as a potential negative independent factor for survival and tumour response in patients of NSCLC. Awareness of association between prognostic factor including pre‑chemotherapy platelet count and NSCLC may benefit disease outcome.

2 tables, 27 ref

040162   KHADEMI N, ABBASSINYA H, HESHMAT F, NAAFE M, MOHAMMADBEIGI A (Tehran Univ of Medical Science, Tehran, Iran, Email: hani.abbassinya@gmail.com) : Evaluation of the effect of Perforan (Hypericum perforatum) on premenstrual syndrome severity of physical and behavioural symptoms in patients with premenstrual syndrome: A clinical randomised trial. Adv Hum Biol 2020, 10(3), 110-4.

Premenstrual syndrome (PMS) is an extensive group of emotional, behavioural and physical symptoms that occur before menstruation. It has a negative impact on activities of daily living, social activities, sexual functioning and quality of life. This study aimed to evaluate the effect of perforan (Hypericum perforatum) on the severity of physical and behavioural symptoms associated with PMS. In a triple-blind clinical trial, 93 students with PMS were randomly divided into two groups, including perforan and control (placebo) groups, and followed for three subsequent cycles. They took capsules daily in the first cycle for 1 month, and in the second and third cycles, they took capsules from 8 days pre-menstruation to 2 days post-menstruation and recorded the severity of physical and behavioural symptoms using a PMS questionnaire. Statistical analyses were performed using SPSS version 20. Repeated measures ANOVA, Chi-squared tests and independent t-tests were used to compare the mean scores of the two groups. The data showed that there were no significant differences between the two groups before the intervention (P > 0.05). Nevertheless, the severity of physical and behavioural symptoms of PMS was significantly lower in the perforan group than the control group. This was the case 1, 2 and 3 months after consumption of perforan (P < 0.001). Moreover, a significant difference between the two groups in the decrease of PMS scores was observed by repeated measurement tests (P < 0.001). Perforan significantly reduces the severity of physical and behavioural symptoms of PMS. Therefore, perforan could be effective in the treatment of physical and behavioural symptoms of patients with PMS. Nevertheless, future studies are necessary to confirm these results.

2 illus, 4 tables, 31 ref

040160   RAZZAQUE M S (Pathology Dep, Lake Erie Coll of Osteopathic Medicine, Pennsylvania-165 09, USA, Email: mrazzaque@lecom.edu) : Covid 19 pandemic: Can boosting immune responses by maintaining adequate nutritional balance reduce viral insults?. Adv Hum Biol 2020, 10(3), 99-102.

The impact of nutrition on immunity is an intense area of research. Malnutrition is linked to a higher risk of microbial infections, while severe infections usually lead to a nutritional imbalance in affected patients. The nutritional status has an impact on the severity of the ongoing SARS‑CoV‑2 infection. Studies conducted on small number of patients have shown the benefits of maintaining optimal Vitamin (B12 and D) and mineral (zinc and magnesium) balance in reducing the intensity of COVID-19. Although consuming a balanced diet with a healthy lifestyle is always desirable, the importance of such practice is even more meaningful during the COVID-19 pandemic. Keeping an optimal balance of vitamins and minerals through healthy dietary habits helps to maintain a robust immune system that is essential to combat invading microbial pathogens, including SARS-CoV-2. 

1 illus, 1 table, 57 ref

040159   KRISHNATREYA M, KATAK A C (Cancer Epidemiology and Biostatistics Dep, Dr. B Borooah Cancer Institute, Guwahati-781 016, Email: manigreeva@gmail.com) : Environmental pollution and cancers in India. Adv Hum Biol 2020, 10(3), 95-8.

Environmental pollution poses a risk of cancer to the vulnerable population. With more and more industrialisation and migration of people to the cities, a large number of Indian people are at an increased risk of developing cancer. Pollution in many places and cities across the country are reaching hazardous levels. Thus, there is a need to review the rising cancer incidences, changing cancer trends and environmental pollution in the country. The issue of environmental pollution must be addressed sooner than later to mitigate the risk of cancer to India’s vulnerable individuals. This brief review summarises the environmental pollution trends, most recent evidences of changing cancer burden and types in the country highlighting the underlying pollution trends in India, since economic liberalisation which began in early 1990s and its impact on cancer risk two and half decades later.

1 table, 23 ref

040158   SINGH K, GAUR U, HALL K, MASCOLL K, COHALL D, MAJUMDER M A A (The Univ of the West Indies, Bridgetown, Barbados, Email: azim.majumder@cavehill.uwi.edu) : Teaching anatomy and dissection in an era of social distancing and remote learning. Adv Hum Biol 2020, 10(3), 90-4.

Anatomy is one of the fundamental and core basic medical sciences in medical education. It forms the basis for physiology and subsequently pathophysiology to understand the aetiology of diseases, followed by the treatment in medical curricula. The traditional mechanism and gold standard for teaching anatomy in the medical curricula is cadaveric dissection in a small-group teaching environment. This type of teaching also develops compassion and empathy in training medical professionals. The onset of COVID-19 pandemic has limited the ability of faculty and students to function in this educational space as social/physical distancing guidelines, and the halting of cadaveric donation programmes has been implemented as safeguard measures against the transmission of the virus. Anatomists and other teaching staff within the discipline have been limited significantly to the use of technology‑enhanced learning (TEL). TEL has been used in teaching environments prior and subsequent to the onset of COVID-19 to supplement cadaveric dissection, especially in medical programmes with limited cadaveric resources. While TEL is not interchangeable with cadaveric dissection, it appears to be a near and potentially medium–long‑term solution to remote anatomy teaching during the COVID-19 pandemic. A blended hands-on approach with virtual reality three-dimensional experience can also be adopted in anatomy teaching during the neo-normal period.

27 ref

040149   ZIGANSHIN A M, KARKHANI H M H, SHARMA B (Facultative Surgery Dep, Bashkir State Medical Univ, Russia, Email: hewa.karkhani@yandex.ru) : Optimization of diagnosis of acute appendicitis in pregnant women. Indian J Surg 2020, 82(5), 941–6.

One of the most common diseases of abdominal surgery is acute appendicitis (AA). The urgency of the problem of early diagnosis of AA is justified by the fact that this pathology may occur during pregnancy, parturition, and the postpartum period, hiding acute surgical pathology under the mask of gynecological diseases. The review presents the main diagnostic techniques used by doctors of various specialties, since the diagnosis of AA in pregnant women presents significant difficulties and also analyzes the existing methods for diagnosing acute appendicitis for timely surgical treatment and preservation of pregnancy. Thus, despite a significant number of ways and methods, the diagnosis of appendicitis in pregnant women presents with different kind of challenges, especially with an increase in the duration of pregnancy. In timely combined diagnosis including various ways and methods which can prevent the development of severe complications, without harming the fetus, especially in the third trimester, the method of gradual compression is recommended, which consists the gradual compression of the muscles of the anterior abdominal wall on the right side. Overall, MRI technique is having the least side effects with best diagnostics results following with properly assessment of clinical and laboratorial findings.

2 tables, 22 ref

040148   YADAV S K, AGRAWAL V , AGARWAL P, SHARMA D (Surgery Dep, Netaji Subhash Chandra Bose Government Medical Coll, Jabalpur- 482 002, Email: drvikeshagrawal@gmail.com) : Rapid scoping review of laparoscopic surgery guidelines during the covid-19 pandemic and appraisal using a simple quality appraisal tool ?emerge?. Indian J Surg 2020, 82(5), 930–40.

The theoretical danger of virus transmission during laparoscopic surgery (LS) via surgical smoke and laparoscopy gas has led to the formulation of many guidelines during the COVID-19 pandemic. This rapid scoping review of these guidelines was done to assess the quality of their evidence and appraise them for their impact on surgical services from the global south. A simple quality appraisal tool was constructed which can be used to evaluate rapidly emerging guidelines for evidence as well as for the needs of the global south. This rapid scoping review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol. Electronic databases were searched with predefined strategy and retrieved papers were screened according to relevant criteria. A simple objective tool to assess the quality of rapidly emerging guidelines including evidence, methodology, ease, resource optimization, geography, and the economy was constructed. Twenty studies met the inclusion criteria. None of the guidelines qualified to be evidence-based clinical practice guidelines as the level of evidence was uniformly rated “low”. A newly constructed tool showed good validation, reliability, and internal consistency. This rapid scoping review found two major research gaps: lack of systematic review of evidence during their development and insufficient weightage of their impact on surgical services from the global south. These significant issues were addressed by constructing a simple and more representative tool for evaluating rapidly emerging guidelines which also gives the rightful importance of their impact on surgical services from the global south.

1 illus, 4 tables, 50 ref

040147   KRIGER A G, BERELAVICHUS S V, KALDAROV A R, GORIN D S, SMIRNOV A V, YUR’EVNA Z V (A.V. Vishnevsky Institute of Surgery, Moscow-115 093, Email: ayratikus@gmai.com) : Robot-assisted pancreatic surgery- the Russian experience. Indian J Surg 2020, 82(5), 912–7.

Surgical procedures that involve working in small anatomical spaces can be successfully performed using robot-assisted surgery. We did a retrospective study of the results of 86 robot-assisted pancreatic operations performed in the Abdominal Department No.1 of the A.V. Vishnevsky Institute of Surgery, Moscow. Seventy (81.4 %) patients were female, and 16 (18.6 %) were male; the average age was 49 (37; 59). The following robot-assisted surgeries were performed: 17 pancreaticoduodenectomies, 45 distal pancreatectomies, 16 tumor enucleations, 6 median resections, and 2 total duodenopancreatectomies. The duration of robot-assisted surgical operations varied depending on the extent of the surgery: for a pancreaticoduodenectomy (PD), it was 400 (360–550) min; for a distal pancreatectomy, it was 210 (180–250) min. Estimated blood loss in a PD was 200 (150–500) ml; in a distal pancreatectomy, it was 100 (50–300) ml. Conversions happened in 6 cases: 2 of them in PD and 4 in distal pancreatectomies. The postoperative length of stay was 15 ± 9 days and depended on the extent of the surgery. The maximum length (16 days) was after robot-assisted pancreaticoduodenectomies (14–25), the minimum (12 days) after organ-preservation surgery (8; 15). Pancreatic fistula А and В occurred in 35 (40.7 %) patients and hemorrhages in 6 (7.0 %) cases; there were 2 cases of 30-day mortality (2.3 %). Robotic assistance can be successfully used in pancreatic surgery. Robot-assisted procedures ensure the precision of lymphadenectomy and anastomoses formation, and the postoperative lengths of stay are more comfortable for patients due to minimal tissue injury. The use of the robot-assisted approach in pancreatic surgery does not guarantee that specific postoperative complications will not occur. 

3 tables, 18 ref

040146   AGGARWAL R, PRANAVI A R, SUBAIR M, KUMAR S S, SREENATH G S, SISTLA S, MAHALAKSHMY T, KATE V (Surgery Dep, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry- 605 006, Email: drvikramkate@gmail.com) : Bacteriological profile of patients with intra-abdominal sepsis and superficial surgical site infection following emergency abdominal surgery- Is it concordant?. Indian J Surg 2020, 82(5), 905–11.

The rates of surgical site infections (SSI) continue to be reported with great variability, even for the same operation, from different geographical areas. Hence, a hospital-based surveillance of SSI can help in designing effective preventive strategies. This study was done to assess the risk factors, characteristics, and incidence of SSI in patients undergoing emergency gastrointestinal surgery. The study was a case series analysis, enrolling all consecutive patients undergoing emergency gastrointestinal surgery. The patients were examined daily for SSI using ASEPSIS score and during the post-operative period up to 30 days. For patients with SSI, wound swab was taken for culture and sensitivity. Patient and operative characteristics were analyzed for identifying risk factors, and the bacteriological profile and sensitivity pattern of intra-abdominal specimens were analyzed and compared with microbiological profile of SSI. A total of 100 patients were studied. The incidence of SSI was 33 %. Age (44.33 ± 18.277 vs. 39.43 ± 16.158; p 0.015) and pre-operative blood transfusion (61.1 vs. 38.9; p 0.012) were found to be significant risk factors for SSI. On multivariate analysis, blood transfusion (p 0.027) and the duration of operation (p 0.005) were found to be independent risk factors. In cases where the isolated organisms were Escherichia coli, Enterococcus faecalis, and Klebsiella pneumoniae, concordance was noted between the intra-abdominal pathogens and the organisms isolated from the SSI. Risk factors for SSI in patients undergoing emergency abdominal surgeries include increasing age, pre-operative blood transfusion, prolonged operating time, intra-operative blood loss, and operative procedures involving bowel resection. Concordance exists between intraabdominal and SSI pathogens.

3 tables, 15 ref

040145   BILGEN F, DUMAN Y, URAL A, BEKERECIOGLU M (Sutcu Imam Univ, Kahramanmaras, Turkey, Email: fatmabilgen81@gmail.com) : Determining anatomical position of the umbilicus in turkish population. Indian J Surg 2020, 82(5), 899–904.

The umbilicus is essential to the aesthetic appearance of the abdomen. However, very little has been written about the exact location of the aesthetically pleasing umbilicus as far as the Turkish population is concerned. Although a variety of reconstructive methods are available, no real standards define the location and shape of the umbilicus. This is a single cross-sectional cohort study focused on the morphometric analysis of the umbilicus in 300 adults between 18 and 65 years old. All data, including standardized measures and pictures, were determined. A total of 150 women and 150 men are incorporated into the study who referred to Kahramanmaraş Sütçü İmam University Hospital between January and July 2018. In this study, the authors observed that the umbilicus is situated around the midline plane such that the ratio of the distance between the xiphisternum and the umbilicus and the distance between the pubic symphysis and the umbilicus is 1.45. Also, the ratio of the distance between the umbilicus and anterior superior iliac spine and the between anterior superior iliac spine is approximately 0.6/1. Most umbilicus was found to be oval shape in males while round shape in females. Umbilical hood orientation was with an inferior hood in males while superior–inferior hood in females in my study at Turkish population. The present study was performed to determine the normal anatomical position of the umbilicus and umbilicus shapes in a sample of Turkish people and to obtain ideal ranges for repositioning neo-umbilicus during abdominoplasty.

3 illus, 2 tables, 18 ref

040144   OZMEN I, GUNAL Y D, ATASOY P, KISA U, YORUBULUT S, ASLAN M K, BOYBEYI-TURER O (Pediatric Surgery Dep, Hacettepe Univ, Ankara, Turkey, Email: ozlemboy80@yahoo.com) : The effect of extractum cepae, heparin sodium, and allantoin in experimental peritoneal adhesion. Indian J Surg 2020, 82(5), 892–8.

The purpose of the study is to investigate the effects of extractum cepae (EC), heparin sodium (HS), and allantoin (AA) on postoperative peritoneal adhesion (PPA) prevention. Forty-eight rats were allocated into six groups (n = 8). PPA was performed by Harris method. In group 1, no additional procedure was done. Abdominal cavity was washed with normal saline in group 2, EC in group 3, HS in group 4, AA in group 5, and EC-HS-AA mixture (EHA-m) in group 6. On the 21st postoperative day, PPA was scored with Nair adhesion score and examined for fibrosis histopathologically and hydroxy-proline levels (OHP) biochemically. Macroscopically, PPAwas decreased in groups 2, 4, and 6 compared to groups 1, 3, and 5 (p < 0.05) and decreased in group 2 compared to other groups (p < 0.05). Histopathologically, fibrosis was decreased in groups 2, 4, and 6 compared to other groups and decreased in group 2 compared to other groups (p < 0.05). Tissue OHP level was decreased in groups 2, 3, 4, and 5 compared to groups 1 and 6 (p < 0.05). Tissue OHP level was decreased in group 6 compared to group 1, but the difference was not statistically significant. PPA formation decreases with normal saline, HS and EHA-m, whereas increases with EC and AA both macroscopically and microscopically. Although HS and EHA-m seem to have adhesion prevention effect, washing the intestines with saline seems to be more effective.

2 illus, 3 tables, 20 ref

040143   UCAROGLU E R, KORKMAZ U T K, YUKSEL A, VELIOGLU Y, UNAL O, ERDEM K (Cardiovascular Surgery Dep, Bolu Abant Izzet Baysal Univ, Bolu, Turkey, Email: ahmetyuksel1982@mynet.com) : A novel modified technique with a combination of percutaneous embolization with N-Butyl cyanoacrylate and high ligation of saphenous vein: A preliminary report. Indian J Surg 2020, 82(5), 886–91.

Chronic venous insufficiency (CVI) is defined as a condition affecting the venous system of lower extremities. Different treatment options are used for the treatment of this pathological condition, which impairs quality of life, especially in later stages. Surgical options are used in the case of failure with conservative treatment and pharmacological methods. There are numerous surgical techniques used in the treatment of venous insufficiency. Each of these techniques has its advantages and disadvantages. New hybrid methods are being developed to overcome adverse effects and possible complications such as deep vein thrombosis, phlebitis, and infections. In the present study, we aimed to present the preliminary results of a combination of percutaneous embolization of SV with n-butyl cyanoacrylate (NBCA) and high ligation, which is a novel modified method that we have developed. A total of 47 patients, aged between 28 and 62 years and diagnosed with chronic venous insufficiency, were included in the study. The patients were evaluated with a Comprehensive Classification System For Chronic Venous Disorders, and Venous Clinical Severity Score (VCSS). Patients’ demographic features such as age and gender, and clinical features such as CEAP classes, VCSSs, and vena saphena magna VSM diameters were recorded. All patients were treated with a novel modified hybrid technique including Venablock embolization system (Invamed RD, Ankara, Turkey) and surgical high ligation of the greater SV. In addition, patients’ preprocedural, intraprocedural, and postprocedural period follow-up data were recorded and retrospectively analyzed. According to the CEAP classification, 38 patients (80.8 %) were classified as C3, six patients (12.8 %) as C4, and three patients (6.4 %) as C2. CEAP class was C3 in majority (38/47) of the patients, with 22 (46.8 %) female and 22 (53.2 %) male patients in C3 class. The mean preoperative VCSS of the patients was calculated as 8.83 ± 1.31 and the mean postoperative VCSS was calculated as 2.85 ± 0.71. The mean postoperative VCSS was statistically significantly lower than the mean preoperative VCSS (p < 0.05). The technical success rate was found as 100 %. None of the patients developed complications or side effects. We suggest that this novel method is efficient and safe in the treatment of chronic venous insufficiency because it eliminates the need for general anesthesia with short operation time and adhesion of all branches of the saphenous vein, thus preventing possible complications.

3 tables, 28 ref

040142   TOSUN S, GUNDUZ N (General Surgery Dep, Medeniyet Univ, Istanbul, Turkey, Email: drsalihtosun@yahoo.com) : Anterior component separation technique is efficient enough in loss of domain hernia treatment. Indian J Surg 2020, 82(5), 879–85.

Repair of loss of domain hernia (LODH) has many related postoperative complications and abdominal separation techniques are well-accepted methods for avoiding abdominal compartment syndrome. The purpose of our study was to evaluate the effectiveness of anterior component separation technique and method of the patient selection for this technique in LODH. Between 2016 and 2019, 40 consecutive patients operated for LODH with over 10-cm fascial defect were analyzed prospectively. Patients were divided into two groups according to the hernia volume/abdominal volume ratio. Group 1 included patients less than 0.25 ratio and group 2 over 0.25. Bladder pressure, length of hospital stay, pain, bleeding, wound infection, and the duration of drainage tube were compared between groups. Average operation time, hospital stay, and wound drainage time was similar in both groups. In group 1, postoperative intra-abdominal hypertension was detected in 5 patients, whereas there was none in group 2. The rating of the individual measurement and sum of the defects will give proper results in multiple hernia defects. The properly performed anterior component separation alone would be an effective method on patients with LODH in order to avoid abdominal compartment syndrome.

3 illus, 2 tables, 29 ref

040141   TSURUTA A, WATANABE Y, MINETA S, TANIOKA NAGASAKA T, FUJIWARA Y, UENO T (Digestive Surgery Dep, Kawasaki Medical School, Okayama 701-0192, Japan, Email: atsuatsu@apost.plala.or.jp) : Prognostic nutritional index as a predictor of postoperative outcome in patients aged 85 years or older after colorectal cancer surgery. Indian J Surg 2020, 82(5), 874–8.

The preoperative prognostic nutritional index (PNI) calculated based on the serum albumin concentration and peripheral blood lymphocyte count has been reported to correlate with the prognosis in patients undergoing cancer surgery. However, in case of very old patients over 85 years old, the value of preoperative PNI in colorectal cancer has not been studied in any detail. The aim of this study was to assess the PNI as a predictor of postoperative outcome in elderly patients over 85 years old with colorectal cancer. We performed a retrospective review in forty-five patients over 85 years old who underwent colorectal tumor resection at our hospital from April 2013 to March 2018. The correlations between preoperative PNI and postoperative complications were examined. The incidence rate of postoperative complications was 31.1 % (14/45). All of cases with postoperative complications were improved conservatively. The median preoperative PNI was 43.20 (range 24.05–57.05) in the validation study. According to the receiver operating characteristic (ROC) curve, cutoff value of PNI was set at 45.0 in the validation study. An univariate analysis demonstrated that PNI (p = 0.0006), operation style (elective/emergency) (p = 0.03), operation approach (open/laparoscopy) (p = 0.03), and T factor (p = 0.04). A multivariate analysis showed that PNI was independent predictive factor of postoperative complications. Moreover 3-year overall survival rates of patients in the PNI ≧ 45 and PNI < 45 were 100 % and 63.8 %, respectively (p = 0.009). This study suggested that PNI is a pivotal independent predictor of the postoperative outcome among elderly patients over 85 years old after colorectal cancer surgery

1 illus, 4 tables, 21 ref

040140   DOUGAZ M W, CHAOUCH M A, CHERNI S, KHALFALLAH M, JERRAYA H, BOUASKER I, NOUIRA R, DZIRI C (General Surgery Dep, Charles Nicolle Hospital, Tunis, Tunisia, Email: docmedalichaouch@gmail.com) : Preperitoneal versus retromuscular mesh repair for ventral abdominal hernias: A propensity matched analysis. Indian J Surg 2020, 82(5), 868–73.

To compare retromuscular and preperitoneal mesh positioning in open ventral hernia mesh repair, we performed a retrospective and comparative study of patients who underwent retromuscular mesh repair (RMMR) and preperitoneal mesh repair (PPMR) for ventral abdominal hernias between January 2012 and December 2016. We used propensity score matching to adjust for potential baseline confounders between two groups. After propensity score matching, 68 patients who underwent RMMR were compared with 92 patients treated with PPMR. There was no difference between RMMR and PPMR regarding operative time (85.24 vs 65.34 min, p = 0.120), drainage duration, hospital stay (3.12 vs 1.7 days, p = 0.226), morbidity (20.5 % vs 11.9 %, p = 0.129), superficial abscess (p = 0.056), deep abscess (p = 0.188), hematoma (p = 0.220), and seroma (p = 0.593). PPMR was superior to RMMR in term of drainage rate, drainage quantity (128 ml vs 36 ml, p = 0.001), drainage duration (3.6 vs 4.14 days, p = 0.068), and re-hospitalisation rate (7 vs 1 patient, p = 0.011). The mean follow-up in RMMR group was 42.6 months and 35.9 months in PPMR group. Nineteen patients were lost in follow-up (10.3 %). Median delay of recurrence was 20.3 months in RMMR group and 11.1 months in PPMR group. At 3-year follow-up, there was no statistically difference between the two groups regarding the recurrence (11 vs 9 patients, p = 0.33) and delay of recurrence (20.3 vs 11.1 months, p = 0.175). RMMR and PPMR present a good alternative for open sublay mesh repair. They are safe, efficient, and associated with comparable complication and recurrence rates.

3 illus, 2 tables, 20 ref

040139   SREEKANTH N S (Daya General Hospital and Specialty Surgical Centre, Kerala- 680 022, Email: sreekanth.mmc@gmail.com) : Study of effectiveness of serum phosphate as a predictor of temporary hypocalcaemia following total thyroidectomy. Indian J Surg 2020, 82(5), 861–7.

Hypocalcaemia is the commonest complication following total thyroidectomy and is mainly due to parathyroid insufficiency. Measurement of serum calcium and PTH levels, post-thyroidectomy, is being used for predicting hypocalcaemia. PTH is an expensive test, not easily available in all hospitals. Since serum phosphate responds quickly to the change in PTH levels and is inexpensive and easily available, the effectiveness of serum phosphate in predicting the post-thyroidectomy hypocalcaemia was studied. To find out if the serum phosphate levels help in predicting temporary hypocalcaemia developing in patients undergoing total thyroidectomy. This was a prospective cross-sectional study of 118 patients who underwent total thyroidectomy, at Amrita Institute of Medical Sciences, Kochi, from June 2014 to June 2016. Patients had serum calcium and phosphate measured pre-operatively, on the evening of surgery (day 0), on the morning of day 1 and over the following week until discharge. Out of 118 patients, 104 (88.1 %) were females and 14 (11.9 %) were males. Thirty-seven (31.4 %) patients developed biochemical hypocalcaemia (< 7.8 mg/dL) out of whom, 31 were symptomatic. Thirty-six patients (30.5 %) developed treatment requiring symptomatic hypocalcaemia, out of whom, 5 did not have a drop in serum calcium levels. Temporary hypocalcaemia was seen in 42 (35.6%) patients. Out of 118 patients, 46 (38.9 %) had a rise in serum phosphate. Early hyperphosphataemia was seen in 44 patients. Out of the 42 patients who developed temporary hypocalcaemia, 29 of them had a day 1 hyperphosphataemia and 33 had early hyperphosphataemia. Most of the patients who developed hypocalcaemia (15 patients) did so on the second post-operative day. The change in mean values of serum phosphate from baseline pre-operative value to day 0 and to day 1 was found to be significant in those patients who developed hypocalcaemia on day 2.  Serum phosphate can be used as a reliable predictor of post-thyroidectomy hypocalcaemia which would help in the safe early discharge of patients.

4 tables, 30 ref

040138   CANO-VALDERRAMA O, CUÑARRO-LÓPEZ Y, LAIZ B, JIMÉNEZ-FUERTES M, TORRES A J, DURAN-POVEDA M (Surgery Dep, Hospital Clínico San Carlos, Madrid, Spain, Email: oscarcanovalderrama@hotmail.com) : Inappropriate venous thromboembolism prophylaxis in a general surgery department: Risk factors and improvement with a simple educational program. Indian J Surg 2020, 82(5), 855–60.

The aim of this study was to describe the rate of patients with an inappropriate venous thromboembolism (VTE) prophylaxis in a Department of Surgery, study the risk factors associated with an inappropriate VTE prophylaxis, and analyze the effect of a simple educational program to improve these results. A quasi-experimental study was performed. VTE prophylaxis was studied in a Department of Surgery. The results of this analysis were presented to the Staff of the Department. Then, prophylaxis was again studied to analyze if this simple educational program improved these results. Inappropriate prophylaxis was seen in nearly 40 % of the patients, mainly due to a lack of prescription. Inappropriate prophylaxis was associated with advanced age, ASA, surgical patient, no same-day surgery, no discharged patients, and high VTE risk. In the multivariate analysis, only no same-day surgery was related to inappropriate prophylaxis. The educational program achieved a non-significant reduction of inappropriate prophylaxis (31.7 % vs. 40.5 %, p = 0.070). A high percentage of patients in the Department of Surgery had an inappropriate VTE prophylaxis, mainly due to the lack of prescription. A simple educational program improved VTE prophylaxis prescription, although this improvement was not statistically significant.

1 illus, 4 tables, 24 ref

040137   SRICHARAN R, CHAWLA A S, KUMAR S, SANDHYA P A (General Surgery Dep, VMMC & SJH, New Delhi- 110 029, Email: sricharan34@yahoo.com) : Reinfusion enteroclysis can successfully replace parenteral feeding in patients with high-output enteral fistula or ostomy awaiting definitive surgery. Indian J Surg 2020, 82(5), 848–54.

Distal bowel reinfusion enteroclysis or fistuloclysis or mucous fistula re-feeding is described as the method of collecting proximal bowel effluents and re-infusing the same into the distal viable bowel with or without effluent processing. Patients with anatomical or functional short bowel syndrome (SBS) are very difficult to manage with great risk of fluid electrolyte imbalance and protein calorie malnutrition. We describe our experience with reinfusion of stoma effluent in these patients, whether it can be used as a stand-alone modality after an initial bridging period of total parenteral nutrition therapy (TPN). Reinfusion enteroclysis was attempted in 30 patients with functional SBS but with distal viable continuous bowel. After an initial bridging period of TPN therapy, gradually increasing quantities of chyme reinfusion was done with a Foley’s catheter in the distal bowel until the whole of daily requirements was met by oral feeds and reinfusion enteroclysis. Gradually, the parenteral nutrition (PN) was withdrawn. Daily assessment of patient’s oral nutritional adequacy, fluid, and electrolyte balance was done while in the hospital. Patients who were nutritionally stable on exclusive enteroclysis were discharged and were kept on standalone “home enteroclysis.” The patients were followed until definitive surgery. Even though median length of proximal bowel was just 40 cm from duodeno-jejunal junction, PN could be completely withdrawn in 24 patients; they sustained only on reinfusion enteroclysis. Eighteen patients were discharged and sustained independently on “home enteroclysis.” All 30 attained a positive nitrogen balance with weight gain and increasing albumin titers. There were no complications associated to reinfusion and no associated mortality. Successful definitive surgery was carried out in 16 patients, within the 3-month study period. However, 14 patients required more than 3 months for their definitive surgery. During this period, 8 of them continued to be on “exclusive re infusion enteroclysis” and 6 on a combination of PN and reinfusion enteroclysis until the second stage of definitive operative intervention. Reinfusion enteroclysis/fistuloclysis can act as effective stand-alone nutritional therapy in selected patients and adjunctive therapy in all patients of functional SBS with distal viable continuous bowel.

3 illus, 2 tables, 20 ref

040136   SRICHARAN R, CHAWLA A S, KUMAR S , SANDHYA P A (General surgery Dep, VMMC, New Delhi- 110 029, Email: sricharan34@yahoo.com) : Reinfusion enteroclysis can successfully replace parenteral feeding in patients with high-output enteral fistula or ostomy awaiting definitive surgery. Indian J Surg 2020, 82(5), 848–54.

Distal bowel reinfusion enteroclysis or fistuloclysis or mucous fistula re-feeding is described as the method of collecting proximal bowel effluents and re-infusing the same into the distal viable bowel with or without effluent processing. Patients with anatomical or functional short bowel syndrome (SBS) are very difficult to manage with great risk of fluid electrolyte imbalance and protein calorie malnutrition. We describe our experience with reinfusion of stoma effluent in these patients, whether it can be used as a stand-alone modality after an initial bridging period of total parenteral nutrition therapy (TPN). Reinfusion enteroclysis was attempted in 30 patients with functional SBS but with distal viable continuous bowel. After an initial bridging period of TPN therapy, gradually increasing quantities of chyme reinfusion was done with a Foley’s catheter in the distal bowel until the whole of daily requirements was met by oral feeds and reinfusion enteroclysis. Gradually, the parenteral nutrition (PN) was withdrawn. Daily assessment of patient’s oral nutritional adequacy, fluid, and electrolyte balance was done while in the hospital. Patients who were nutritionally stable on exclusive enteroclysis were discharged and were kept on standalone “home enteroclysis.” The patients were followed until definitive surgery. Even though median length of proximal bowel was just 40 cm from duodeno-jejunal junction, PN could be completely withdrawn in 24 patients; they sustained only on reinfusion enteroclysis. Eighteen patients were discharged and sustained independently on “home enteroclysis.” All 30 attained a positive nitrogen balance with weight gain and increasing albumin titers. There were no complications associated to reinfusion and no associated mortality. Successful definitive surgery was carried out in 16 patients, within the 3-month study period. However, 14 patients required more than 3 months for their definitive surgery. During this period, 8 of them continued to be on “exclusive re infusion enteroclysis” and 6 on a combination of PN and reinfusion enteroclysis until the second stage of definitive operative intervention. Reinfusion enteroclysis/fistuloclysis can act as effective stand-alone nutritional therapy in selected patients and adjunctive therapy in all patients of functional SBS with distal viable continuous bowel.

3 illus, 2 tables, 20 ref

040135   HIYOSHI M, WADA T, TSUCHIMOCHI Y, HAMADA T , YANO K, IMAMURA N , FUJII Y, NANASHIMA A (Surgery Dep, Miyazaki Univ, Miyazaki, Japan, Email: mhiyoshi@med.miyazaki-u.ac.jp) : Usefulness of drain lipase to predict postoperative pancreatic fistula after distal pancreatectomy. Indian J Surg 2020, 82(5), 841–7.

Postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) is a worrisome and life-threatening complication. The aim of this study was to clarify the risk factors and to find the early detective method of POPF after DP. From January 2010 through December 2014, 37 patients underwent DP and were enrolled in this study to examine the factors predictive of clinical POPF after DP. POPF was defined and classified according to the International Study Group of Pancreatic Surgery guideline 2016. Biochemical leakage occurred in 14 (37.8 %) patients, grade B POPF in 16 (43.2 %) patients, and no grade C POPF in any patient. Clinical POPF (grade B/C) occurred in 43.2 % of patients. Multivariate analysis revealed pancreatic thickness ≥ 14 mm to be the independent preoperative risk factors predictive of POPF. Receiver operating characteristic curves showed that the drain lipase ≥ 800 IU/L on postoperative day 4 could distinguish clinical POPF from non-clinical POPF effectively. Sensitivity, specificity, and accuracy were 93.8 %, 70.0 %, and 80.6 % respectively. Pancreatic thickness ≥ 14 mm was the independent preoperative predictive risk factors for POPF. A drain lipase level of ≥ 800 IU/L on POD 4 was useful to find clinical POPF after DP.

4 illus, 1 table, 30 ref

040134   GUAN H, CHEN R, LI D, HOOSEN R, XIE S, CHEN C, JIN S (Gastroenterology Dep, The First Affiliated Hospital of Wenzhou Medical Univ, Wenzhou-325 000, China, Email: ssjdoc@163.com) : Potential risk factors and prognostic evaluation of malignant changes following congenital choledochal cyst: A retrospective analysis. Indian J Surg 2020, 82(5), 835–40.

Congenital choledochal cyst (CCC) is a congenital anomaly of the biliary duct with a tendency for malignant evolution. This study aimed to investigate the potential risk factors involved in the malignant transformation of these cysts and to elucidate the survival status of patients who subsequently developed malignancy. One hundred and fifty patients were involved in the study. They were divided into two groups; people in group A had malignancy, while people in group B did not. Of the total 150 patients, 15 (10 %) developed malignancy. On univariate analysis, significant differences were found between the two groups, showing an increasing risk with older age (p = 0.003), presence of jaundice (p = 0.000) and biliary calculi (p = 0.000), and elevated conjugated bilirubin (CB), alkaline phosphatase (ALP), and γ-glutamyl transpeptidase levels (p = 0.005, 0.020, 0.021). On logistic regression analysis, only older age (p = 0.036), presence of biliary calculi (p = 0.003), and elevated levels of CB and ALP were identified as significant factors (p = 0.000, 0.039). In group A, the median overall survival time was 28.8 ± 8.1 months (95 % confidence interval 12.9–44.7). In summary, older age, presence of biliary calculi, and elevated levels of CB and ALP are important indicators of the potential malignant transformation of CCC. Actively treating patients with biliary obstruction and impaired liver function are effective management methods for patients diagnosed with CCC.

2 illus, 4 tables, 25 ref

040133   YEGEN S F, KAFADAR M T, GOK M A (Health Sciences Univ, Sanlurfa, Turkey, Email: drtolgakafadar@hotmail.com) : Comparison of perioperative standard and immunomodulating enteral nutrition in patients received major abdominal cancer surgery: A prospective, randomized, controlled clinical trial. Indian J Surg 2020, 82(5), 828–34.

The aim of this study was to compare the effects of standard and immunomodulating enteral nutrition on the clinical outcomes of the patients undergoing major abdominal cancer surgery. Patients who underwent a major elective abdominal cancer surgery in our clinic were randomly assigned preoperatively to two groups according to enteral nutritional intervention; Standard (ST) or Immunomodulating (IM) group. The patients who were randomized to ST and IM groups received Resource® 2.0 fiber and OraI Impact® RTD 7 days prior to surgery and 30 days after surgery, respectively. The outcome variables were as follows; infections (surgical site infection, pneumonia, abdominal abscess or septicemia), non-infectious complications (wound dehiscence, anastomotic leak, adult respiratory distress syndrome (ARDS), multi-organ failure), need for intensive care unit admission, need for re-operation, length of hospital stay, and hospital mortality. A total of 78 patients were randomized (n = 39 in each group). Fortyfive (58 %) of patients were male and mean age was 62.9 ± 13.4 (25–85). The mean pre-operative Body Mass Index (BMI) and Nutritional Risk Screening (NRS-2002) scores were 26.5 ± 5.4 and 2.3 ± 1.1, respectively. There were no significant differences in gender, age, BMI, and NRS-2002 scores between groups (p ≥ 0.05). ASA scores, surgical interventions also were similar in two groups. Rate of surgical site infection in groups ST and IM was 72 % (n = 28) and 15 % (n = 6), (p < 0.001). Rate of pneumonia in groups ST and IM was 25 % (n = 10) and 0 % (n = 0), (p < 0.001). Rate of urinary tract infection in groups ST and IM was 33.3 % (n = 13) and 5.1 % (n = 2), (p < 0.03). Length of hospital stay in groups ST and IM was 8.4 ± 4.8 and 6.1 ± 1.4, respectively (p < 0,003). There were no significant differences in other outcome variables between groups (p ≥ 0.05, for all comparisons). Perioperative immunomodulating enteral nutrition may reduce the incidence of surgical site infection, pneumonia, urinary tract infection and length of hospital stays in patients who received abdominal cancer surgery.

4 tables, 22 ref

040132   AZHOUGH R, JALALI P, GOLZARI S E J, HASHEMZADEH S, SAVARAN R (Tabriz Univ of Medical Sciences, Tabriz, Iran, Email: pooya.jalali1995@gmail.com) : Pilonidal sinus surgery with mechanical drilling technique. Indian J Surg 2020, 82(5), 824–7.

Pilonidal sinus disease (PSD) is a common condition affecting young and middle-aged adults. Most commonly seen in men, it has significant economic implications and is associated with discomfort and inability to work. Men are thought to be at higher risk because of their more hirsute nature. The aim of this study was to evaluate the efficacy of “Mechanical drilling technique” as a new approach in pilonidal sinus disease treatment. From January 2017 to February 2019, 30 patients were treated for PSD in our center. All patients referred to our center with chronic pilonidal disease in the natal cleft were enrolled with no age or sex limitations and operation previously. After spinal anesthesia, all patients underwent operation in the prone position. Mechanical drilling was performed using drilling trephine apparatus number 368. Smaller pits were distracted using trephine number 859. Thirty patients were operated using this technique. The mean operating time was 15 min. Recurrence was observed in only one patient (3.33 %). Wound healing time varied from 7 to 21 days. All patients were operated under spinal anesthesia and discharged after 4 h. The maximum cosmetic satisfaction rate was 90 %. Mechanical drilling technique is an effective minimally invasive technique for the treatment of PSD with very low recurrence and comparable rate, and hospital stay compared with excision and primary closure techniques.

1 illus, 3 tables, 29 ref

040131   MISHRA K G, AHMAD A, SINGH G, TIWARI R (Urology Dep, Indira Gandhi Institute of Medical Sciences, Bihar- 800 014, Email: ahsanahmad6@gmail.com) : Current status of genitourinary tuberculosis: Presentation, diagnostic approach and management-single centre experience at IGIMS (Patna, Bihar, India). Indian J Surg 2020, 82(5), 817–23.

Genitourinary tuberculosis (GUTB) is associated with significant morbidity and mortality. As patients with GUTB have no specific symptoms or clinical features, early diagnosis and treatment of GUTB is clinically challenging. The present study assessed the current spectrum of clinical presentation, urinary findings and radiological signs of patients with GUTB. Patients with confirmed GUTB (n = 53) were analysed for clinical presentation, diagnostic tests and management. Data about demographic details, clinical presentation, urine routine examination, urine acid-fast bacillus (AFB) smear test, urine Mycobacterium tuberculosis culture, routine blood investigations, radiological, cystoscopic and histopathological examinations were recorded for all study patients. Various surgical interventions were performed on the basis of the site involved. After surgical procedure, patients were treated with chemotherapy and followed up for one year to till date. The present study patients were from the age range of 19–75 years with female preponderance. The most common clinical presentation was irritative voiding symptoms (69.81 %), haematuria and flank pain (56.60 %, each). The most commonly affected organ was kidney (62.26 %) following ureter (30.19 %), urinary bladder (24.53 %), prostate (9.43 %) and epididymis (1.89 %). The urine AFB smear and urine culture for M. tuberculosis tests were positive in 13.18 % and 54.71 % of patients, respectively. Surgical interventions were done in majority (75.47 %) of patients. Accurate and early diagnosis is vital for the better management of patients with GUTB. Apart from the available course of chemotherapy, surgical intervention is also required for complete management.

2 illus, 3 tables, 24 ref

040130   GANNI S, LI M, BOTDEN S M B I, NAYAK S R, GANNI B R, RUTKOWSKI A-F, GOOSSENS R H M, JAKIMOWICZ J (Delft Univ of Technology, Delft, The Netherlands, Email: s.ganni@tudelft.n) : Virtual operating room simulation setup (vorss) for procedural training in minimally invasive surgery- A pilot study. Indian J Surg 2020, 82(5), 810–6.

Virtual reality (VR) training is widely used in several minimal invasive surgery (MIS) training curricula for procedural training. However, VR training in its current state lack immersive training environments, such as using head-mounted displays that is implemented in military or aviation training and even entertainment. The virtual operating room simulation setup (VORSS) is explored in this study to determine the effectiveness of immersive training in MIS. Twenty-eight surgeons and surgical trainees performed a laparoscopic cholecystectomy on the VORSS comprising of a head-mounted 360-degree realistic OR surrounding on a VR laparoscopic simulator. The VORSS replicated a full setup of instruments and surgical team-members as well as some of the distractions occurring during surgical procedures. Questionnaires were followed by semi-structured interviews to collect the data. Experts and novices found the VORSS to be intuitive and easy to use (p = 0.001). The outcome of the usability test, applying QUESI and NASA-TLX, reflected the usability of the VORSS (p < 0.05), at the cognitive level, which indicates a good sense of immersion and satisfaction, when performing the procedure within VORSS. The need for personalized experience within the setup was strongly noted from most of the participants. The VORSS for procedural training has the potential to become a useful tool to provide immersive training in MIS surgery. Further optimizing of the VORSS realism and introduction of distractors in the OR should result in an improvement of the system.

1 illus, 4 tables, 30 ref

040129   DUTTA H K , BARUAH M (Pediatric Surgery Dep, Assam Medical Coll & Hospital, Assam- 786 002, Email: hemontdut@gmail.com) : Pediatric surgery in undergraduate curriculum: A survey. Indian J Surg 2020, 82(5), 806–9.

Pediatric surgical topics are not generally covered in undergraduate (UG) curriculum in India. However, incorporating pediatric surgery in UG curriculum will help in improving the total surgical care of infants and children, and will also motivate students to choose pediatric surgery as a career option. The purpose of the study was to identify the main objectives of pediatric surgery in UG curriculum and to evaluate the input of specialist, non-specialist, and students to these objectives. The survey was conducted among various stakeholders in three medical colleges in the state using a pre-designed questionnaire to identify the needs to incorporate pediatric surgery in UG curriculum. Twenty-five common topics of pediatric surgery were enlisted for the survey. All the topics were considered essential by pediatric surgeons and pediatricians, whereas general surgeons regarded 21 and general practitioners had identified 16 as essential (mean score > 2.0). The UG and post graduate medical students and interns considered all the items as essential. The study laid emphasis for having a unified, standardized pediatric surgery curriculum in the undergraduate teaching program.

2 illus, 3 tables, 11 ref

040128   AYSAN E, PIRALIYEV E, YIGMAN S (General Surgery Dep, Yeditepe Univ, Istanbul, Turkey, Email: erhanaysan@hotmail.com) : Results of 150 subtotal parathyroidectomies for secondary hyperparathyroidism. Indian J Surg 2020, 82(5), 801–5.

We evaluated our experience of subtotal parathyroidectomy (SP) for secondary hyperparathyroidism (SHP) cases. We evaluated retrospectively our 150 SP operations due to SHP. Serious hypocalcemia (< 6.5 mg/dL) developed in 23 (15.3 %) patients, and we performed cryopreserved parathyroid cell autotransplantation in four cases with successful results. Recurrent hyperparathyroidism developed in 3 (2 %) cases, and persistent hyperparathyroidism was observed in 22 (14.6 %) cases. Upon reoperation in nine persistent hyperparathyroidism cases, we found supernumerary parathyroid glands in three cases, remnant tissue hyperplasia in four cases, and ectopic parathyroid glands in two cases. Among cases in which four glands cannot be found during surgery, the permanent HP rate is high. Serious hypocalcemia may develop postoperatively, and cryopreserved parathyroid autotransplantation may be inevitable in some of these cases. 

2 tables, 27 ref

040127   RAVICHANDRAN A, BALASUBRAMANIAN A (Government Theni Medical Coll, Madurai- 625 002, Email: aravind95@outlook.com) : Palpae potami: A novel method of palpating dorsalis pedis artery. Indian J Surg 2020, 82(5), 796–800.

The peripheral pulse examination of the foot is the preliminary yet important step in diagnosing peripheral vascular diseases. It has been reported that locating the dorsalis pedis pulse is difficult with existing variability among examiners when compared with other distal foot pulse examination. Ill-defined landmark and a high rate of aberrant course of the artery have been attributed for its difficulty (Mowlavi et al. Postgrad Med J 78(926):746–747, 2002; Vijayalakshmi et al. J Clin Diagn Res 5(2):287–290, 2011). Here, we present a new method for examination of dorsalis pedis pulse. About 102 patients admitted in a tertiary care centre were enrolled for the study, and their dorsalis pedis pulse were examined by a portable Doppler and clinical methods. Two examiners, double-blinded, examined the dorsalis pedis artery using the conventional method and the new method independently, and documented their findings. Dorsalis pedis pulse was impalpable in 2.9 % of cases by both methods. The palpae potami method located the dorsalis pedis pulse in 90 % of cases, while the conventional method located dorsalis pedis pulse in 83.3 % of cases. The palpae potami method has better sensitivity and specificity of 96.8 % and 75 %, respectively, while the conventional method had sensitivity and specificity of 86 % and 50 %, respectively. The mean duration taken by conventional method to locate the pulse was 4.7 s, while palpae potami took 31 s. The absence of dorsalis pulse was seen in 7.2 % (8/102). The presence of systemic hypertension in patients lower the dorsalis pedis pulse detection in the conventional method (p = 0.0023), while no significant difference in pulse detection was found by the palpae potami method. The difficulties encountered by the conventional method in locating dorsalis pedis pulse could be reduced by this method. The new proposed method increased the chance of locating the dorsalis pedis artery significantly than by conventional method, which could be translated to higher case pickup of peripheral vascular diseases in a resource limited settings.

3 tables,14 ref

040126   YILMAZ F, BAS K (Anaesthesiology and Reanimation Dep, Health Science Univ, Izmir, Turkey, Email: fulya.dr@gmail.com) : An analysis of publications on cervical plexus blocks. Indian J Surg 2020, 82(5), 792–5.

Bibliometric analysis provides measures of the quality and quantity of researches undertaken by departments/individuals and indicates countries’ contribution toward scientific development. The aim of this bibliometric study is to analyze scientific publications on cervical plexus blocks. Institute for Scientific Information (ISI)/Web of Knowledge Science was used for the analysis. A retrospective search was performed using the terms “cervical plexus block (CPB),” “superficial-CPB,” “intermediate-CPB,” “deep-CPB,” “regional anesthesia in CPB,” and “loco-regional anesthesia in CPB”. We further analyzed these results by the “analyze” function of the software in terms of number of papers from each country, type of documentation, number of publications per year, name of journals, and authors. The number of citations to published works was also calculated by using the citation function of the same software. Two hundred sixty papers were found related to cervical plexus block. The biggest contribution was from the USA (14.61 %). The acceleration of the publications began in 2004. But there were three sharp declines in 2007, 2014, and 2016, respectively, after the acceleration in publications. CPBs were most frequently employed for carotid endarterectomy. Other indications for CPB application were otoplasty, thyroid, and parathyroid surgery (for analgesia and/or anesthesia) and recently perioperative analgesia during cervical spine surgery; but the number of publications on these topics is very limited.

3 illus, 2 tables, 12 ref

040125   SINGLA V, CHUMBER S, DAMLE N A, RATHORE Y S, SINGH K J, VYAS S, NAYER J, RANJAN P (Surgical Disciplines Dep, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Email: dryashvant.r@gmail.com) : The utility of metabolic imaging in patients with obscure abdominal pain: Is it required?. Indian J Surg 2020, 82(5), 786–91.

Abdominal pain is one of the most frequent and worrisome complaints that brings a patient to the hospital. Patients with undiagnosed abdominal pain usually undergo a battery of investigations, while remaining dissatisfied. Since glucose metabolic imaging with FDG PET has been shown to detect infection, inflammation and malignancies earlier than structural imaging, we planned a pilot study to assess the causes of undiagnosed pain abdomen. The study was carried out at our tertiary care academic institution, from December 2016 to July 2018. A total of 30 patients with no aetiology found on clinical evaluation, laboratory investigations, ultrasound and computerized tomography scan underwent FDG PET CT. PET findings were correlated with clinical parameters to reach a final diagnosis. The results were analysed prospectively to find the utility of PET scan. The mean age was 33.33 years, and 66.67 % were females. The number of patients in whom a final diagnosis (relating to pain abdomen) was made with the help of FDG PET was 6; therefore, the yield was calculated as 6/30 = 20.0 %. A positive correlation was seen between duration and intensity of pain, raised ESR/positive or borderline Mantoux and presence of findings on PET. The negative predictive value of PET was 100 %. Three patients were diagnosed to have tuberculosis, one had aorto-arteritis, one patient had infective foci in lung and one patient had subacute appendicitis. FDG PET scan might be indicated in undiagnosed pain abdomen, especially in patients with chronic pain with raised ESR or positive Mantoux.

3 illus, 2 tables, 26 ref

040124   BOLAT I, BITEKER M (Cardiology Dep, Fethiye Government Hospital, Fethiye, Turkey, Email: drismail_bolat@hotmail.com) : Prognostic nutritional index predicts perioperative adverse events in patients undergoing noncardiac surgery. Indian J Surg 2020, 82(5), 780–5.

Although the relation of preoperative prognostic nutritional index (PNI) with perioperative adverse events has been investigated in patients undergoing cardiac surgery and various solid organ cancer surgeries, it has never been investigated in patients undergoing noncardiac surgery as a distinct group. A retrospective analysis of 811 consecutive patients, older than 18 years old and undergoing an elective, noncardiac, and nonvascular surgery between November 2015 and February 2019 was performed. Patients’ information, including demographic data, routine preoperative laboratory tests, and PNI were collected to assess the association between these factors and the perioperative complications. PNI was calculated from the following formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm³ ). The outcomes of interest were perioperative complications during hospitalization. The perioperative adverse event rate was 9.0 % (73 patients). Older patients and those with more comorbid conditions such as atrial fibrillation, history of malignancy, and diabetes mellitus tended to have a higher rate of perioperative complications. Patients with complicated hospital course had lower albumin (3.1 ± 0.41 vs. 3.7 ± 0.62 g/dL; p < 0.001) and PNI levels (45.1 ± 4.4 vs. 51.8 ± 5.8; p < 0.001) at admission compared to patients without complications. Multivariate analysis showed that age (OR, 2.13; 95 % CI, 1.14–4.45; p < 0.01), PNI < 47.5 (OR, 2.51; 95 % CI, 1.19–5.46; p = 0.005), and history of malignancy (OR, 3.11; 95 % CI, 1.14–5.33; p < 0.01) were significant and independent predictors of perioperative complications. This study demonstrated that the lower preoperative PNI is associated with increased rate of perioperative complications in patients undergoing noncardiac surgery.

1 illus, 2 tables, 23 ref

040123   CAI M, WENG Y, WANG Z, ZHU J, YOU Q (Cardiothoracic Surgery Dep, Affiliated Hospital of Jiangnan Univ, Wuxi- 214 000, China, Email: cai_doctor@163.com) : Prevention of esophageal-stomach anastomosis leakage after esophagectomy-an analysis of 1243 patients. Indian J Surg 2020, 82(5), 775–9.

To summarize the tips for the prevention of esophageal anastomosis leakage. Improvement in clinical techniques and treatments has decreased anastomotic leakage occurrence, but it remains one of the main causes of death after esophageal and gastric surgery. After efforts to improve outcomes in the past 7 years, we observed only four cases of anastomotic leakage. Thus, here we summarize the technical details for peer reference. The tips for preventing esophageal-stomach anastomosis fistula include preoperative general nutrition improvement and esophageal edema-reducing measures. During surgery, technical prevention measures include protection and improvement of anastomosis technology. Postoperative measures include maintaining cervical anteflexion position, reduced anastomotic tension, and circulation-invigorating medicines to improve anastomotic circulation. Between January 2006 and December 2012, 1243 patients with esophageal cancer underwent resection of the esophagus and esophagogastrostomy. There were 885 male patients and 358 female patients, aged 40 to 78 years old, with an average age of 63.4 ± 5.6 years. The esophageal-stomach anastomotic leakage occurred in four cases, for an incidence rate of only 0.32 % (4/1243). In these four detected cases, three patients recovered and were discharged from the hospital. One patient died. The application of improved technical measures may reduce postoperative esophageal anastomotic leakage incidence.

1 illus, 20 ref

040122   GONG L, SHU B, HUANG X, FENG X (Tsinghua Univ, Beijing, China, Email: gonglei1262@126.com) : Characteristics of subcutaneous drainage fluid in patients after Hepatopancreatobiliary surgery. Indian J Surg 2020, 82(5), 769–74.

The beneficial effect of subcutaneous drainage has been challenged. Here, we evaluated subcutaneous drainage fluid characteristics in patients without complications after hepatopancreatobiliary surgery. We aimed to provide useful information for addressing this issue. We included 59 patients that underwent hepatopancreatobiliary surgery for hepatic (n = 33), biliary (n = 12), and pancreatic (n = 14) disorders. We recorded the total volume of drainage liquid. We analyzed drainage fluid characteristics (biochemical test, cells, etc.) and patient demographic and clinical characteristics. Differences in characteristics were assessed among hepatic, biliary, and pancreatic surgery groups. Pearson correlation coefficient analyses were performed to assess associations between preoperative parameters and drainage volume. The median body mass index was 24.01 kg/m². The mean blood loss and operation time were 371 ml and 406 min, respectively. Three (5.1 %) patients required transfusions. The median drainage fluid volume was 37.34 ml, and the median density was 1.0217. The total numbers of white and red blood cells were 4.38*105/L and 30.5*103/L, respectively. The protein, glucose, and adenosine deaminase contents were 34.41 g/L, 1.22 mmol/L, and 103.09 U/L, respectively. The Rivalta test and lactate dehydrogenase were positive in 14 (77.8 %) and 16 (88.9 %) patients, respectively. All parameters were similar between the three surgical groups. Preoperative erythrocyte and hemoglobin levels were weakly positively correlated with subcutaneous drainage fluid volumes. We found a substantial amount of protein in subcutaneous drainage fluid. Removing the fluid might reduce the risks of incision fat liquefaction and infection. At minimum, subcutaneous drainage reduced the frequency of incisional dressing changes.

1 illus, 3 tables, 26 ref.

040121   SRIVASTAVA V, PANDEY V, TIWARI P, PATEL S, ANSARI M A, SHUKLA V K (General Surgery Dep, Banaras Hindu Univ, Varanasi, Uttar Pradesh, Email: vkshuklabhu@gmail.com) : Utility of real-time online teaching during Covid era among surgery postgraduates. Indian J Surg 2020, 82(5), 762–8.

A cross-sectional study was conducted to assess the utility of online teaching for general surgery postgraduate residents at the end of 1 month of online teaching during the COVID-19 lockdown. A questionnaire related to different aspects of online teaching was developed on a 5-point Likert scale from “strongly agree” to “strongly disagree”. Following a pilot study, the questionnaire was shared among surgery residents, and response collection was done. The residents who did not attend at least 90 % of scheduled classes were excluded. A total of 55 resident doctors without prior experience of online teaching program were enrolled in the study. All the participants responded to all questions and submitted their responses within stipulated time. On the basis of validity testing, questions 1 and 2 were found invalid and hence deleted. The median value for the total cohort was 4 indicating that majority of residents gave affirmative response. On segregating the result with the year of residency program, similar results were found in the 1st year and 2nd year group; however, the 3rd year group showed a median of 3, thus eliciting that only 50 % of 3rd year residents liked online teaching. From the present study, it can be concluded that the online teaching is a feasible alternative to the physical class among surgical postgraduates. The questionnaire utilized in the present study can be used for assessing similar online teaching protocols.

2 illus, 3 tables, 24 ref

040120   GUMAA D, GORDON-WEEKS A , SILVA M (East Kent Hospital Univ, Canterbury, UK, Email: duaa.gumaa1@nhs.net) : Small bowel tumors- Case series analysis: prognostic factors and survivals. Indian J Surg 2020, 82(4), 662–8.

Small intestinal malignancy is uncommon. The clinical characteristics vary with histologic subtype, and factors predictive of outcome are not well studied. A case series analysis of clinicopathologic data from patients undergoing small intestinal malignancy resection in our institution was used over a 6-year period. Kaplan Meier survival estimates were compared using Log-rank and survival curves constructed. Multivariate analysis enabled determination of factors predictive of outcome. Eighty-seven patients were included; 24 required emergency surgery and neuroendocrine (NET) was the most common histological subtype. NETs were significantly smaller than adenocarcinomas or gastrointestinal stromal tumors (GISTs); however, a greater proportion of NETS had metastatic disease, perineural invasion and underwent R1 resection. Despite their advanced stage at presentation, NETs demonstrated favorable outcome compared with other histologic subtypes. Tumor grade, neuroendocrine histology and nodal metastasis were all independently associated with overall survival. Despite the advanced stage of NETs at presentation, these tumors demonstrated better overall survival than adenocarcinomas or GISTs. De-bulking with R1 resection is an acceptable approach for NET as compared to adenocarcinoma or GIST. Future work needs to focus on the development of targeted therapies for small intestinal adenocarcinoma to improve long-term outcome.

1 illus, 3 tables, 29 ref

040119   MIRIJANYAN A A, GRIGORYAN K H, MIRIJANYAN M M (Surgery Dep, Yerevan State Medical Univ, Yerevan, Armenia, Email: armirijanyan@gmail.com) : Comparative analysis of efficacy of intraoperative decompression with nasogastric and nasojejunal tubes in patients with malignant small bowel obstruction. Indian J Surg 2020, 82(4), 656-61.

Nasointestinal decompression was implemented into clinical practice in 1930s. Earlier clinical trials have confirmed the efficacy of nasointestinal tubes in treating adhesive small bowel obstructions. A recent study showed controversial results: efficacy after nasogastric intervention was not less efficient compared to nasointestinal decompression. Hydrophilic silicon triple lumen tubes used for intestinal decompression were introduced in 2003. A variety of modifications were introduced and applied in clinical practice. Our study attempts to compare the decompression efficacy between the modern ileus tube and nasogastric tubes used for decompression in patients with malignant bowel obstruction. A total of 132 consecutive patients with intestinal obstruction were included in this study. There was no significant difference between the two groups with regard to clinical characteristics and laboratory variables documented on admission. The endoscopically inserted intestinal tube was used for gastrointestinal decompression in 64 patients, and nasogastric tube was applied in 68 patients. The therapeutic efficacy of applied strategies was compared between the two groups using Chi-squared test. Compared with the strategy applying nasogastric tubes, the group of patients treated with intestinal tube showed significantly shorter time for surgical rehabilitation (4.8 ± 2.2 d vs 9.6 ± 4.8 d). Significant difference was registered in laboratory test results (P < 0.01). In the study group, the output of drainage and the length of hospital stay were significantly shorter compared to the control (P < 0.05). Nasointestinal decompression used in the surgical management of small intestinal obstruction with malignancy has significantly higher efficacy compared to nasogastric decompression.

2 illus, 1 table, 30 ref

040118   AGRAWAL K S, SHROTRIYA R, GARALE M (Plastic Surgery Dep, Seth GS Medical Coll, Maharashtra- 400 012, Email: drkapilps@gmail.com) : Dermo-peritoneal flap: A novel, safe and effective technique to manage abdominal defects in complicated recurrent incisional hernia. Indian J Surg 2020, 82(4), 651–5.

Recurrences after open surgical or laparoscopic repair of abdominal wall defects are not uncommon. No technique is the “best” solution, and a wide variety of surgical options are being used by surgeons for specific defects or locations with variable results. We describe a new technique “dermo-peritoneal flap,” which can easily be used to manage such difficult incisional hernias. Three patients having difficult recurrent incisional hernia were operated from April 2014 to May 2016 using the “dermo-peritoneal flap” technique. Detailed pre-operative assessment was done by structured questionnaire and ultrasonography (USG) scan to rule out co-existing intraabdominal pathology and subacute/blind loop obstruction. Also, the approximate size and location of defect were estimated clinically and confirmed by pre-operative USG scan. A vertical ellipse in midline was marked, and the area was de-epithelialized. Bilateral abdominal flaps were elevated, leaving the de-epithelized dermo-fat patch over sac. After reaching the defect, blunt separation of the sac was done from edges of the defect. The sac was reduced into the abdominal cavity without opening. Edges of dermal tissue were sutured to edges of the defect. Onlay prolene mesh-plasty was done, and abdomen was closed with suction drains. Patients were aged 48, 52, and 57 years, and all patients were women. The patients had undergone 6, 5, and 6 surgeries, and duration of hernia was 6, 6.5, and 4.5 years respectively. Two of the patients had undergone resection anastomosis of gangrenous bowel previously. All patients have shown no signs of recurrence. Mild discharge from the suture line was seen in two patients, which resolved spontaneously on dressings. One of them has developed a midline scar similar to natural umbilicus. The concept of de-epithelialization of thinned-out skin over sac makes surgery easier and safe and also provides tough and vascular tissue which plugs the defect. It can also be used universally with any technique of repair for any location and size of defect. This is a case series of 3 lady patients, all of whom had ventral/incisional hernias operated earlier by this new technique of isolated de-epithelialized overlying skin used as a flap strengthened with overlay mesh.

4 illus, 1 table, 7 ref

040117   SIMSEK G, TEKIN A, KARTAL A (Konya Research and Training Hospital, Konya, Turkey, Email: gurcansimsek@gmail.com) : Comparison of results of dual mesh hernioplasty and omental interposition polypropylene mesh hernioplasty in incisional hernias. Indian J Surg 2020, 82(4), 646–50.

Recently, with the improvement of dual meshes, that has no harm when in touch with the intraabdominal organs, intraperitoneal mesh hernioplasty techniques became more popular. Intraperitoneal repair can also be done by polypropylene mesh with interpositioning of the omentum. This study aims to compare the results of omental interposition mesh hernioplasty and intraperitoneal mesh hernioplasty. The study was conducted as a prospective observational study. In between January 2008 and January 2012, patients with incisional hernia were divided into two groups according to the suitability of the greater omentum as omental interposition mesh hernioplasty and intraperitoneal dual mesh hernioplasty. The median follow-up periods of all 49 patients were 17 (4–48) months. Operation time was significantly longer in the omental interposition mesh hernioplasty group (p < 0.05). Length of hospital stay, drain take off time, and the complication rates were similar in between the groups. The recurrence rates were also similar; however, in omental interposition mesh hernioplasty group, the cost was significantly lower (p < 0.05). Although omental interposition mesh hernioplasty technique takes more time, in cases that great omentum is suitable; this technique can be used safely with lower cost.

4 illus, 1 table, 13 ref

040116   SAYAN M, VALIYEV E, BAS A, GOKCE A, CELIK A, KURUL I C, ARIBAS O K, TASTEPE A I (Thoracic Surgery Dep, Gazi Univ, Ankara, Turkey, Email: drsayann@gmail.com) : Outcomes of surgically treated patients with stage IIB non-small cell lung cancer, a single center experience. Indian J Surg 2020, 82(4), 639–45.

Stage IIB lung cancers according to TNM8 staging include T1-2N1M0 and T3N0M0 groups. It has been emphasized that the most important prognostic factor of lung cancer is of tumor in many studies. In this study, we investigated the prognostic effect of some variables including tumor diameter, visceral pleural invasion, lymph node invasion, type of surgery, etc. in same tumorstage. After the approval of the local ethics committee, a total of 139 patients who were surgically treated for non-smallcell lung cancer in our department and whose pathological staging was reported as stage IIB were included in the study. The 15 patients were female and 124 were male, and the mean age was 61.5 (Range, 39–81; SD, 7.9). The overall survival and diseasefree survival of patients were analyzed according to N1 presence, tumor diameter, histopathological type, visceral pleural invasion, age, and gender. The 5-year survival rate was 50.4 %, and the 5-year diseases free survival rate was 54.9 %. The survival of N1 (+) group was worse than the T3 group. Pneumonectomy, big tumor diameter, and squamous cell carcinoma histopathology were negative prognostic factors for survival, whereas visceral pleural invasion and adenocarcinoma histopathology were found as statistically significant to negative effect disease-free survival. Furthermore the 5-year survival rate of T2bN1M0 group was found worst than others. According to the TNM system adopted in 2016, the stage IIB lung cancers are a heterogeneous group, and as the survival studies related to this group increase, a separate tumor stage formation or separation of T2bN1 group from stage IIB may be considered.

4 illus, 1 table, 24 ref