Extended-duration thromboprophylaxis after ventral hernia repair: a risk model to predict venous thrombotic events after hospital discharge

BACKGROUND

Venous thromboembolism (VTE) is a major source of morbidity and mortality after ventral hernia surgery, but the risk of VTE after discharge has not been reported.

STUDY DESIGN

Data from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) were used to investigate the risk of post-discharge VTE. Current procedural terminology (CPT) codes identified all reported patients who underwent ventral hernia repair from 2011 to 2017. We created a multivariable regression model for post-discharge VTE, using the 2011-2016 dataset to develop the model and 2017 as a validation set. The prediction model was used to create a risk calculator as a mobile application.

RESULTS

The rate of VTE after surgery was 0.62% (878 of 141,065) with 48% occurring after discharge from the hospital. The final predictor model consisted of eight variables: age > 60 years, male sex, body mass index (BMI) ≥ 35 kg/m2), operative time > 2 h, concurrent panniculectomy, post-operative hospitalization > 1 day, presence of bleeding disorder, and emergency operation. The model had good calibration and discrimination (Hosmer-Lemeshow goodness-of-fit test, p = 0.71; c-statistic = 0.71). Threshold analysis showed a strategy of extended-duration thromboprophylaxis was optimized when the risk of post-discharge VTE was > 0.3%.

CONCLUSION

Forty-eight percent of VTEs after ventral hernia repair occur after discharge, particularly in older, male, obese patients undergoing longer and complex operations that require hospitalization > 1 day. Post-discharge thromboprophylaxis should be considered in these patients, particularly when risk of VTE exceeds 0.3%.

Two cases of non-parasitic splenic cysts and spleen-preserving therapy

We review two different presentations of non-parasitic splenic cysts, both of which are post-traumatic in aetiology. The first case was of slower onset and was managed electively. The second case was of acute onset and was managed as an emergency. Non-parasitic splenic cysts are uncommon and the optimal management strategy for them is not well defined. Historically, treatment has been with open splenectomy; however, infection rates following this surgery have been high, making it an unattractive management option. Both cases were managed successfully with laparoscopic fenestration with no recurrence at subsequent follow-up.

Efficacy of Itraconazole in the Prevention of Recurrence of Tinea Versicolor: A Three Year Follow Up

Pityriasis versicolor (PV) also known as tinea versicolor, which is chronic and superficial fungal skin disease caused by Malassezia yeasts. A permanent cure may difficult to achieve and this may explain the long-term nature of the disease. Consequently, a preventive treatment regimen may help to prevent the recurrence of pityriasis versicolor. Whether, the recurrence of tinea versicolor could be prevented by monthly itraconazole treatment regimen after a short course of itraconazole therapy. Open treatment followed by a randomized, single blind placebo control trial. Multi-center trial was characterized by an open, active treatment phase with itraconazole followed by a randomized placebo controlled treatment for prevention of recurrence. A total 200 patients (150 male and 50 female) were included in this study and was given 200mg itraconazole daily for 7 days (treatment phase). Patients in whom tinea versicolor was mycologically cured divided into Group A and Group B. Active open treatment was followed by preventive itraconazole treatment 200mg twice daily in Group A and placebo in Group B monthly for 6 consecutive months. The patients were diagnosed clinically and confirmed by Wood's lamp examination and KOH microscopy. Clinical improvement in 90%, negative Wood's lamp examination in 86.5% and Mycological cure in 85.5% were found at the end of open treatment. The mycological cure, 171 subjects were taken into this study for preventive treatment phase and divided into two groups- Group A & Group B. Preventive treatment was given in Group A and placebo in Group B. After the preventive treatment, the end point (After 6 months), clinical improvement, negative Wood's lamp examination and mycological cure were found in 81(90%), 76(84.4%) and 75(83.3%) in Group A and 44(55%), 41(51.3%) and 42(52.5%) in Group B respectively. In preventive treatment phase, 1 patient in Group A did not complete the study. No patient experienced any serious adverse effects. Prevention of recurrence of Pityriasis versicolor with itraconazole is as effective as treatment.

Perception of HIV Testing and Counseling among Integrated Counseling and Testing Center Clients of Tertiary Level Hospitals

BACKGROUND

The purpose of establishing integrated counseling and testing center (ICTC) is to detect HIV at the earliest time, providing information on modes of transmission and prevention of HIV by promoting behavioral change and reducing vulnerability, and informing individuals on HIV prevention, care, and treatment services.

OBJECTIVE

To know the awareness of the clients about ICTC before pretest counseling.

METHODS

This facility-based cross-sectional study was conducted among 105 pretest counseling clients who visited ICTC for the first time in 3 ICTCs of tertiary care hospitals attached to a medical college in Mangalore.

RESULT

Majority of the clients were pregnant women (n = 57, 54.30%), and most of the clients were referred by the treating doctor (n = 91, 86.7%). Most of the clients, being unaware of ICTC, are not aware of its functions and activities.

CONCLUSION

Although ICTCs have been functional for nearly a decade, the awareness of ICTC and its functions among the people is poor.

Tuberculosis in chronic kidney disease

BACKGROUND

The incidence of tuberculosis is high in chronic kidney disease (CKD) which needs a high index of suspicion, early diagnosis and management for gratifying outcome.

MATERIALS

The clinical, laboratory profile, management and outcome of tuberculosis in 36 patients with chronic kidney disease between 2000 and 2005 constitute the material of this study.

RESULTS

During this study period, over 900 chronic renal failure patients were evaluated in our unit and 36 of them were found to have tuberculosis, the incidence being 4%. In majority (69.4%), tuberculosis was observed in association with CKD Stage V. Age range was 25 - 77 years, male : female ratio was 33 : 3. Fever, malaise and weight loss were the commonest symptoms observed at presentation. Extrapulmonary tuberculosis (23 patients, 63.8%) predominated over pulmonary tuberculosis (10 patients, 36.1%). Tuberculin skin test was negative in 23 patients (63.8%). The diagnosis of tuberculosis was confirmed by tissue or specimen examination in 17 patients (47.2%) and in the rest it was empirical basing on clinical picture, pleural fluid analysis and radiological tests. All the patients were planned for a minimum period of 9-month antituberculous therapy (ATT). Of them, 17 patients (47.2%) were cured from tuberculosis and did not relapse, 9 patients (25%) died during treatment and 10 patients were lost for follow-up. Two patients were managed for anti-tuberculous therapy-related side effects: hepatotoxicity and psychosis.

CONCLUSIONS

We observed a 4% incidence of tuberculosis in CKD. Extrapulmonary form of tuberculosis predominated over pulmonary form. Fever and malaise were important clues for suspicion of tuberculosis. Tuberculin skin test was negative in the majority. Diagnostic confirmation was possible in 47.2% of patients and in the rest it was based on clinical suspicion, pleural fluid analysis and radiological findings. Cure from tuberculosis was observed in 47.2% of patients with antituberculous therapy.

Dielectric properties of certain biological materials at microwave frequencies

In the medical field, microwaves play a larger role for treatment than diagnosis. For the detection of diseases by microwave methods, it is essential to know the dielectric properties of biological materials. For the present study, a cavity perturbation technique was employed to determine the dielectric properties of these materials. Rectangular cavity resonators were used to measure the complex permittivity of human bile, bile stones, gastric juice and saliva. The measurements were carried out in the S and J bands. It is observed that normal and infected bile have different dielectric constant and loss tangent. Dielectric constant of infected bile and gastric juice varies from patient to patient. Detection and extraction of bile stone with possible method of treatment is also discussed.

Neurotrophic actions of a novel molluscan epidermal growth factor

The mammalian epidermal growth factor (EGF) is expressed in the developing and adult CNS, and it has been implicated in the control of cell proliferation, differentiation, and neurotrophic events. Despite extensive evolutionary conservation of the EGF motif in a range of different types of proteins, secreted EGF homologs with neurotrophic actions have not been reported in invertebrates. In this study, we present a novel member of the family of EGF-like growth factors, an EGF homolog from the mollusc Lymnaea stagnalis (L-EGF), and we demonstrate that this protein has neurotrophic activity. Purified L-EGF is a 43-residue peptide and retains the typical structural characteristics of the EGF motif. The L-EGF cDNA reveals a unique precursor organization. In contrast to the multidomain mammalian EGFs, it consists of only two domains, a signal peptide and a single EGF motif. Conspicuously, the L-EGF precursor lacks a transmembrane domain, setting it apart from all other members of the EGF-family. L-EGF mRNA is expressed throughout embryonic development, in the juvenile CNS, but not in the normal adult CNS. However, expression in the adult CNS is upregulated after injury, suggesting a role of L-EGF in repair functions. This notion is supported by the observation that L-EGF evokes neurite outgrowth in specific adult Lymnaea neurons in vitro, which could be inhibited by an EGF receptor tyrosine kinase inhibitor. In conclusion, our findings further substantiate the notion that the EGF family has an early phylogenetic origin, and our data support a neurotrophic role for L-EGF during development and injury repair.

Primary structure of a new neuropeptide, cerebral peptide 2, purified from cerebral ganglia of Aplysia

We report the purification and characterization of a novel neuropeptide from Aplysia nervous tissue. The peptide was termed cerebral peptide 2 (CP2) because it was the larger of two peptides predominantly synthesized in the cerebral ganglia and transported to other regions of the central nervous system. The purification of CP2 from extracts of cerebral ganglia using three sequential modes of high-pressure liquid chromatography (HPLC) was followed using the [35S]methionine-labeled peptide obtained from transport experiments. The primary structure of CP2 was determined by automated Edman degradation of native CP2 and its proteolytic fragments in conjunction with mass spectrometry. CP2 is a 41 amino acid peptide with an amidated carboxyl terminal. A peptide with the proposed sequence of CP2 was synthetized and compared by HPLC with the native peptide. Chromatographic properties of the synthetic and native peptide labeled in vivo were found to be identical. CP2 does not appear to be a member of any previously identified peptide family.

Molecular mimicry: histone H3 and mycobacterial protein epitopes

A 15-kDa protein detected initially in amyloidotic ileum from a transgenic mouse and subsequently in control (nontransgenic) ileum by various polyclonal rabbit antiserums applied to electroblots of extracts derived from these tissues was identified by partial sequence analysis as histone H3. Antiserums were made against immunogens unrelated to the histone, but they recognized calf thymus histone H3 (14.7 kDa) on Western blots. The bacterial component of the Freund's medium used as an adjuvant for the immunogens was either Mycobacterium butyricum or Mycobacterium smegmatis. Absorption tests with histone H3 and sonicated M. butyricum substantiated the presence of anti-histone H3 activity in the antiserums. These findings indicate that the two mycobacterium species make a protein with epitopes perceived as nonself by recipient rabbits but sufficiently similar to epitopes of mammalian histone H3 that the rabbits produced antibodies cross-reactive with the histone.

Platelet-derived growth factor-BB accelerates wound closure in a new mesentery culture model without macrophages

Platelet-derived growth factor-BB has multiple effects in vitro and has been demonstrated to accelerate wound healing in several animal models, but its precise mechanisms of action in vivo have not been fully explained. A rat mesentery culture model was developed, and platelet-derived growth factor-BB (100 ng/ml) was added to the medium containing 2% fetal calf serum for examining its closure effects. The mesentery specimens were stained by routine hematoxylin and eosin and immunohistochemical staining for macrophages. A significant improvement in closure rate and complete closure rate was seen when platelet-derived growth factor-BB was added to the medium compared with the controls (p < 0.05). There are significantly fewer macrophages in the in vitro specimen than in the in vivo specimen. In conclusion, platelet-derived growth factor-BB can contribute to wound closure of a mesenteric defect even without macrophages, suggesting a second mechanism in which it can act directly on mesenchymal cells during wound healing. This tissue-culture model is useful for gaining further insights into growth factor interactions and wound healing.