Sandeep Kumar

OBJECTIVE: There is a lack of consensus among surgeons over interrupted versus continuous methods of abdominal wound closure. The objective of this study was to perform a meta-analysis to estimate the pooled odds ratio (OR) for dehiscence and incisional hernia in the interrupted technique of laparotomy wound closure as compared to the continuous technique. METHODS: All randomized, controlled trials comparing continuous and interrupted methods of laparotomy wound closure, with burst abdomen and/or incisional hernia as the outcomes, were included in the meta-analysis. MEDLINE, Clinical Evidence and the Cochrane Library were searched. Burst abdomen and incisional hernia were the two primary outcomes. RESULTS: Twenty-three studies were identified, with a total of 10,900 patients. The interrupted method of closure was associated with significantly less dehiscence as compared with the continuous method (OR, 0.576; p = 0.014; relative risk reduction, 39.8%; number needed to treat, 143). The interrupted technique was also found to be better in the nonabsorbable suture, vertical incision and mass closure subgroups. However, no difference in the hernia risk was found between the two methods. CONCLUSION: Interrupted laparotomy wound closure reduces the odds of dehiscence by half compared with continuous wound closure. [Asian J Surg 2008;31(3):104–14]

BACKGROUND: Interleukins and cytokines are important regulator of the aetio-pathogenesis of majority of cancers. Mechanistic role of IL-1RN and IL-4 particularly in breast carcinogenesis is well documented. However, the role of polymorphisms of IL-1RN and IL-4 combinations associated with risk of breast cancer not reported. METHODS: The IL-1RN and IL-4 gene polymorphism were genotyped with VNTR-PCR in 100 patients (benign tumor, n=32 and breast cancer, n=68) and 200 normal healthy control subjects with normal mammogram. Genotype distribution and allelic frequencies between patients and controls were compared and odds ratio (ORs) with 95% confidence intervals (CI) were calculated using SPSS software (version-12.0) RESULTS: There were no significant differences in the genotype distributions of both IL-1RN and IL-4 polymorphisms between cases and controls. Similarly, subgroup analysis showed that there is no significant association for pre and postmenopausal women. However, BB genotype of IL-1RN is significantly differs among benign and malignant stages of breast cancer. CONCLUSIONS: IL-1RN and IL-4 polymorphism alone or in combination are not associated with risk of breast cancer in Indian patients. The association of IL-1RN with malignant stages may indicate its possible role in progression of breast cancer. Further studies in other population are needed to confirm our findings and to elucidate the role of IL-1RN in progression of breast cancer.

Background Burden of death and disability resulting from lack of emergency medical system (EMS) and emergency care is very high in low and middle income countries (LMIC).
Aim To study the knowledge, attitudes and practices of pre-hospital care and emergency services among health care providers of Lucknow
Setting and Design Cross-sectional survey, 200 residents, 104 hospital consultants and 108 private practitioners
Material and Methods A close ended, self administered questionnaire based on 5-point Likert scale with 30 items of knowledge, attitude and practice of pre-hospital and emergency care
Results Median scores of knowledge (26/50), attitude (41/50) and practices (27/50) showed less than adequate knowledge and practices. However, a positive attitude was seen in all the 3 group of respondents i.e. resident doctors, hospital consultants and private practitioners.
Conclusion Lucknow is the capital city of Indian largest state – Uttar Pradesh with over 100 years of established medical education. The results of the study in this town are applicable to most developed cities in India. Lack of adequate knowledge and practices in emergency medical system (EMS) at Lucknow represent a dismal situation and require continuing medical education in this area.
Keywords Emergency medical system . Cross-sectional survery . Health care

Background Trained doctors and para-medical personnel in accident and emergency services are scant in India. Teaching and training in trauma and emergency medical system (EMS) as a specialty accredited by the Medical Council of India is yet to be started as a postgraduate medical education program. The MI and CMO (casualty medical offi cer) rooms at military and civilian hospitals in India that practice triage, fi rst-aid, medico-legal formalities, reference and organize transport to respective departments leads to undue delays and lack multidisciplinary approach. Comprehensive trauma and emergency infrastructure were created only at a few cities and none in the rural areas of India in last few years.

Aim: A case series analysis of 52 consequent subjects of immediate man-dibular reconstruction after tumour resection using non-vascularised methods, undertaken at U.P. King George's University of Dental Sciences and King George's Medical University, is being reported. To assess the success of reconstruction on subjective and objective evaluation based upon Mandibular Reconstruction Assessment Scale (MRAS) questionnaire. Methods: Patients with benign mandibular tumours irrespective of age, sex, site and socioeconomic status were included. Primary reconstruction was carried out after resection in two surgical units on surgeon's choice using stainless steel wire (6/52; 12%), stainless steel reconstruction plate (10/52; 19%) or titanium reconstruction plate (36/52; 69%) without bone graft (23/52; 44%) or with bone graft (29/52; 56%). Bone grafts were harvested from iliac crest (21/52; 40%), rib (2/52; 4%) and an additional pec-toralis major myocutaneous flap with iliac crest bone graft (6/52; 12%) to provide cover to the reconstruction plate was also used. Results: The primary outcome measurements were wound healing, mouth opening, chewing efficiency, jaw movements, cosmetic achievement and speech on a five-point scale, all of which improved significantly after surgery. The overall complication rate was 17%. Three patients (6%) had loosening of the screw, two (4%) showed dehiscence of the plate, two (4%) showed tumour recurrence and one (2%) had infection of the graft that was subsequently removed. Conclusion: Titanium reconstruction plates with iliac crest graft provided good result in the absence of microvascular reconstruction because of unavailable long operating time and lack of expertise. Long-term satisfactory rehabilitation can be achieved using removable dentures or prosthesis on dental implants on the contraption provided by the non-vascularised tissue despite non-calcified bone visible on the skiagram.

Ramakant. Detection of new amino acid markers of liver trauma by proton nuclear magnetic resonance spectroscopy. Abstract: Objective: We examined serum in patients of liver injury to explore the possible clinical application of abnormal micrometabolites as a marker of liver injury and severity in cases of traumatic liver damage. Methods: Serum were screened by proton nuclear magnetic resonance spectroscopy in 96 patients with varying degree of liver injury and compared with concentrations in healthy control volunteers. Results: Large quantities of phenylalanine and tyrosine were detected by spectroscopic analysis in patients with liver injury but not in those without liver injury (Po0.001). Proton nuclear magnetic resonance spectroscopy revealed two unique amino acids, phenylalanine and tyrosine, in the sera of the subjects with liver injury, irrespective of the extent and type of injury gauged by radiology or laparotomy. Phenylalanine spectrum was obtained in all 84 patients with liver injury (100% sensitivity) whereas tyrosine spectrum was present in 83 out of 84 patients (98.8% sensitivity) suggesting that these amino acids were specifically released in the patients of liver injury. Significant correlations were observed between phenylalanine and tyrosine concentrations and total bilirubin levels and albumin levels. Serum phenylalanine and tyrosine concentrations correlated well with imaging and laparotomy findings of liver injury. Conclusion: Phenylanaline and tyrosine appear to be specific and new markers of liver injury.

Background Trained doctors and para-medical personnel in accident and emergency services are scant in India. Teaching and training in trauma and emergency medical system (EMS) as a specialty accredited by the Medical Council of India is yet to be started as a postgraduate medical education program. The MI and CMO (casualty medical offi cer) rooms at military and civilian hospitals in India that practice triage, fi rst-aid, medico-legal formalities, reference and organize transport to respective departments leads to undue delays and lack multidisciplinary approach. Comprehensive trauma and emergency infrastructure were created only at a few cities and none in the rural areas of India in last few years.

A new non-aqueous method for electrodeposition of copper, indium and copper indium alloy films, ethylene glycol has been used as the solvent which is non-toxic and non-hazard bath. All the source materials are readily soluble in this bath and they have higher working temperature (≥160°C). The copper films prepared in ethylene glycol based bath are preferred (111) oriented with grains

Polypoidal choroidal vasculopathy (PCV) is characterized by a branching vascular network (BVN) of choroid that terminates in polypoidal dilations. We have previously reported the generation of the first PCV model by transgenically expressing human HTRA1 (hHTRA1(+)), a multifunctional serine protease, in mouse RPE. The purpose of this study was to perform a comprehensive examination of the PCV phenotypes (e.g., lesion type and distribution) of hHTRA1(+) mice by a variety of in vivo imaging techniques. We generated improved hHTRA1(+) mice with a more consistent phenotype. Transgenic mice were examined by indocyanine green angiography (ICGA), fluorescein angiography, funduscopy, and spectral-domain optical coherence tomography. In particular, we performed ICGA by tail vein injection of ICG to obtain high-quality ICGA comparable to human studies in terms of the three phases (early, middle, and late) of angiography. The polyps can be detected in the early "fill-in" phase of ICGA, and most lesions become visible in the middle phase and are more distinct in the late phase with the fading of surrounding vessels. In addition to the two key features of PCV (polypoidal dilations and BVNs), hHTRA1(+) mice exhibit other features of PCV (i.e., late geographic hyperfluorescence, pigment epithelial detachment, and hyperfluorescent plaque). Polypoidal lesions appear as reddish orange nodules on funduscopy. Transgenic hHTRA1(+) mice exhibit a rich spectrum of "clinical" features that closely mimic human PCV. This animal model will serve as an invaluable tool for future mechanistic and translational studies of PCV and other forms of choroidal vasculopathies.

Indocyanine Green Angiography (or ICGA) is a technique performed by ophthalmologists to diagnose abnormalities of the choroidal and retinal vasculature of various eye diseases such as age-related macular degeneration (AMD). ICGA is especially useful to image the posterior choroidal vasculature of the eye due to its capability of penetrating through the pigmented layer with its infrared spectrum. ICGA time course can be divided into early, middle, and late phases. The three phases provide valuable information on the pathology of eye problems. Although time-course ICGA by intravenous (IV) injection is widely used in the clinic for the diagnosis and management of choroid problems, ICGA by intraperitoneal injection (IP) is commonly used in animal research. Here we demonstrated the technique to obtain high-resolution ICGA time-course images in mice by tail-vein injection and confocal scanning laser ophthalmoscopy. We used this technique to image the choroidal lesions in a mouse model of ...

The clinical picture of viral encephalitis is determined by the affinity and persistence of the virus to different brain regions. Therefore, the present study was aimed to investigate the neuropathological changes following Japanese encephalitis virus (JEV) infection in rat at different time points. Twelve days old Wistar rats were infected by intracerebral inoculation of JEV. Presence of JEV antigen was detected in thalamus, striatum, cortex and mid brain on 3, 6, 10 and 20 days post inoculation (d.p.i.). Histopathological changes were also studied in different brain regions at different time points. The highest expression of JEV antigen was found on 6 dpi in all the brain regions studied. JEV antigen was maximum in thalamus on 6 d.p.i. and mid brain on 10 d.p.i. JEV antigen, however, was almost undetectable on 20 d.p.i. in all the regions. The classical pathological changes such as cellular infiltration, perivascular cuffing, meningeal disruption, neuronal damage, neuronal shrinka...

Trained doctors and para-medical personnel in accident and emergency services are scant in India. Teaching and training in trauma and emergency medical system (EMS) as a specialty accredited by the Medical Council of India is yet to be started as a postgraduate medical education program. The MI and CMO (casualty medical officer) rooms at military and civilian hospitals in India that practice triage, first-aid, medico-legal formalities, reference and organize transport to respective departments leads to undue delays and lack multidisciplinary approach. Comprehensive trauma and emergency infrastructure were created only at a few cities and none in the rural areas of India in last few years. To study the infrastructure, human resource allocation, working, future plans and vision of the established trauma centers at the 3 capital cities of India - Delhi (2 centres), Lucknow and Mumbai. Participant observer structured open ended qualitative research by 7 days direct observation of the fa...

Adipose tissue secretes various kinds of adipokines that controls the glucose and lipid metabolism in humans. The abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) both are associated with metabolic syndrome and insulin resistance. IL-6 is one of the adipokines, which promotes insulin resistance and dyslipidemia in humans. The association of adipokines with metabolic syndrome at protein levels are well documented. However, their association at gene expression level are lacking. The present study was design to investigate IL-6 mRNA expression in adipose tissues (VAT and SAT) and its correlation with metabolic risk factors and insulin resistance (HOMA) in post menopausal women. A total of 108 Asian North Indian post menopausal women, 54 without metabolic syndrome (controls) and 54 with metabolic syndrome (cases) were recruited and evaluated. Overnight fasting blood samples were collected at admission and abdominal visceral and subcutaneous adipose tissues were collected during open abdomen surgery. The results showed significantly (p < 0.05 or p < 0.01 or…

Results: Large quantities of phenylalanine and tyrosine were detected by spectroscopic analysis in patients with liver injury but not in those without liver injury (P<0.001). Proton nuclear magnetic resonance spectroscopy revealed two unique amino acids, phenylalanine and tyrosine, ...

THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 14, NO.1, 2001 ... Delay in presentation of oral cancer: A multifactor ... SANDEEP KUMAR, RF HELLER, UPENDRA PANDEY, VARSHA TEWARI, NIDHI BALA, KHUAT THI HAl OANH ... ABSTRACT Background. Patients with ...

Breast pain or mastalgia is the common symptom in the breast. The two most common concerns of patients presenting with mastalgia are: the fear that breast pain is a symptom of breast cancer and the presence of severe pain that affects a woman's quality of life. Breast pain requires thorough assessment and should be investigated in the same manner as any other breast symptom. We conducted a systematic review of treatment for breast pain. We searched various reviews, randomized controlled trial, and observational studies over Pubmed and Medline via internet. Searches were carried out on MEDLINE (1950-present), EMBASE (1980-present), and CINAHL (1981-present) using the NHS Evidence Healthcare Databases Advanced Search interface. A further search was also carried out on Cochrane Database of Systematic Reviews (issue 12 of 12, Dec 2011) and Central Register of Controlled Trials (issue 4 of 4, Oct 2011). If no abnormality is found in the breast on assessment, then a combination of reassurance, breast support brassiere, and topical NSAID gel massage are usually effective. Antiestrogen (centchroman/tamoxifen) therapy for 3 to 6 months is the second-line treatment of choice. Danazol may be used in resistant cases. Gamma-linolenic acid or evening primrose oil though commonly prescribed is not effective.

The prevalence and frequency distribution patterns of 10 phthirapteran species infesting house sparrows, Indian parakeets, common mynas, and white breasted kingfishers were recorded in the district of Rampur, India, during 2004–05. The sample mean abundances, mean ...

There is a lack of consensus among surgeons over interrupted versus continuous methods of abdominal wound closure. The objective of this study was to perform a meta-analysis to estimate the pooled odds ratio (OR) for dehiscence and incisional hernia in the interrupted ...

Background Burden of death and disability resulting from lack of emergency medical system (EMS) and emer-gency care is very high in low and middle income countries (LMIC). ... Aim To study the knowledge, attitudes and practices of pre-hospital care and emergency ...

To study tobacco consumption practices in north-Indian population, a community-based, stratified sampling survey using validated interview schedule was performed in rural/urban areas of Lucknow, Uttar Pradesh. There were 432 tobacco users (385 men, 47 women; 276 urban, 156 rural) taken as subjects. Tobacco use practices ie, chewing/smoking/rubbing/snuffing, frequency, starting age, supply, place/context of use, quid habit, affect, facilitating conditions/barriers, tobacco users' opinion on control measures were all taken into consideration. Single mode of tobacco use was reported by 277 subjects (64.1%) and the rest had a plethora of tobacco practices. Chewing was prevalent in 322(74.5%), smoking in 256(59.3%), rubbing in 32(7.4%) and snuffing in 4 subjects (0.9%). Of the 10 preparations in the questionnaire, the "top 5" preferences ranked as tobacco-betel, gutka, cigarette, bidi and khaini that remained unchanged between sexes, rural/urban people and age groups. Women significantly (p<0.00001) preferred smokeless tobacco and perceived social barrier for smoking. Gutka consumption was significantly higher in youngsters (<25 yeans;…

The field experiments were conducted at the Indian Agricultural Research Institute, New Delhi, India for 3 years from 2001–2002 to 2003–2004 to study the relative efficiency of diammonium phosphate (DAP) and Mussoorie rock phosphate along with phosphorus solubilizing bacteria inoculation (MRP + PSB) at different rates of application on productivity and phosphorus balance in a rice-rapeseed-mungbean cropping system. Phosphorus application significantly increased the