Most Viewed Articles

Background: Macitentan significantly improves pulmonary hemodynamics and survival in patients with primary pulmonary hypertension (PPH). Its beneficial effect, however, may be blunted due to the adverse impacts such as anemia and peripheral edema. Pulmonary arterial hypertension (PAH) is a significant consequence of congenital heart disease (CHD). Its presence and severity are associated with increased morbidity and mortality. We tried to evaluate that the effectiveness of the macitentan in patients with late-onset pulmonary hypertension after atrial septal defect operation in our center. Methods: The effect of a single dose of macitentan (10 mg) on pulmonary hemodynamics, functional capacity was examined in four patients with late-onset pulmonary hypertension after atrial septal defect operation. Results: The macitentan significantly improved mean pulmonary artery pressure (MPAP), cardiac output (CO), tricuspid annular plane systolic excursion (TAPSE), right ventricle systolic wave(RVS’), 6-minute walking test and NT-proBNP levels compared with before treatment. Conclusions: Macitentan can be used in patients with late-onset pulmonary hypertension after shunt operation especially atrial septal defect.

It is planned to carry out a comprehensive experimental and theoretical study on the high temperature of low calorific gas combustion with oxygen-deficient oxidizers. The experimental research will be performed using the experimental facility with a combustion chamber. The oxygen concentration in combustion oxidizers will be varied from 21% by volume (normal) air to 2%. The test combustion chamber will be fed with propane or methane as the reference fuel, then with low calorific fuels as test gases obtained by mixing various combustible components, e.g. H2, CH4, CO, and neutral gases, e.g. N2, CO2. Gaseous fuels prepared in this way will be burned in the atmosphere of a deficient oxidizer with a temperature changing from 800 °C to 1100 °C. Oxidizers will be heated up to a certain temperature using two methods: by flue gas heat exchanger and kanthal rod electric preheater. Different burner geometry will be used. The burner will be equipped with annular swirl vanes for co-axial or under different angles, fuel, and oxidizers flow to have a high swirl number achieved by flow aerodynamics and mixing. Experimental data will be verified with numerical simulations with the use of ANSYS CFD Fluent code.

A study of palm lines, various landmarks on the hand, and their correlation with the hand's anthropometric dimensions may sometimes help predict various future events in the life of an individual. We try to find out any correlation between these appearances and the sudden death of an individual. In the present study, we collected data from an individual’s hand after carefully breaking the rigor mortis in the deceased brought for medicolegal postmortem examination and measured the different dimensions. The data were then subjected to statistical analysis. The article may help rule out the cultural belief about the study of the lifeline and age at the time of death. Palmistry is a self-interpretation of changes in or around the lifeline by an individual, and it varies from person to person. There is no concrete literature proof available that suggests its importance in ascertaining the age of the individual.We also observed that there is no close relation between the age interpreted by the lifeline and the biological age of the individual. Our study shows that the individual either lives too long or too short compared to age by the lifeline.We observed that unnatural deaths are more common in young individuals, and males outnumber females. According to the cause of death, hanging, accident, and poisoning are the most common, followed by sudden death and homicide. In our study, we observed that there is no correlation between unnatural death and the lifeline of an individual and age at the time of death.

Background: Repair of a large ventral hernia is a challenge for surgeons. Component Separation Technique (CST) is a novel technique for closure of the midline with live tissues without undue tension. This can further be reinforced by a prosthesis. We wanted to see the outcome of mesh-reinforced open Anterior Component Separation (ACS) for large complex ventral hernia repair. We aimed to see the duration of surgery, hospital stay, Surgical Site Occurrence (SSO), and recurrence within the first year after surgery.Materials and methods: We analyzed data of patients operated from January 2014 to January 2024 for a period of 10 years in three centers. There were 13 patients with divarication of recti without any previous surgery. Rest 44 patients had either incisional hernia or port site hernia. All patients had defect sizes more than 8 cm. Open bilateral anterior component separations were done to achieve midline closure. Medium-pore soft Prolene mesh was used to reinforce the midline closure by an on-lay technique. Patients were followed up to 1 year after surgery to assess efficacy and complications of the procedure.Results: The average operating time was 73 ± 12 min. Hospital stay was 3 to 7 days, mean was 5.3 days. Surgical site occurrence was 14%. These include seroma formation, major wound infection, and abscess formation. There was no flap necrosis nor mesh removal. There was no recurrence within one year of follow-up after surgery. Conclusion: Open mesh Anterior Component Separation (mACS) is an easy and effective way of treating large and complex ventral hernia. Operating time is substantially less than posterior component separation. Reinforcement with mesh reduces recurrence.

Calorie restriction has been shown to slow the aging process in numerous organisms including primates. Caloric excess states, such as type 2 diabetes, are associated with accelerated aging and the incidence and severity of chronic diseases. The nutrient-sensing pathways and intestinal microbiome are important systems that affect aging and chronic disease development. This manuscript reviews the various pathways involved with aging and chronic disease development and examines the pharmacological manipulation of these systems which appear to slow aging and the chronic diseases of aging in experimental model organisms and collaborating human data when available. Finally, the abundance of experimental and human data suggesting the newer diabetic medications, the sodium-glucose transport inhibitors, are potent anti-aging agents is provided.

In the realm of dental surgery, implants are essential for replacing missing teeth. To facilitate implant placement, techniques such as bone grafting and sinus lifts are utilized to augment the volume of atrophied alveolar bone in candidates for dental implants. Typically, patients undergo a period of recovery following bone grafts before proceeding with implant placement. This study investigates the efficacy of Cone Beam Computed Tomography (CBCT) in measuring the residual bone volume and assessing bone quality after the healing phase. A texture analysis was conducted on CBCT scans from 42 patients requiring maxillary sinus lift reconstruction. These patients were categorized into two groups based on the type of grafting material used: Xenograft or allograft. The study analyzed the distribution of various texture parameters and conducted a Mann-Whitney U test to identify significant statistical differences between the groups. Results indicated non-normal distributions for specific variables such as Area_S(1,0) and S(1,0)SumOfSqs, while others like S(1,0)Entropy displayed normal distributions. The findings revealed no significant statistical differences in the primary outcomes between the xenograft and allograft groups. However, the average values of the gray shades of pixels in the allograft group were statistically significantly higher compared to the xenograft group, suggesting differences in bone texture post-procedure.

Introduction: A gastric outlet obstruction secondary to a gallstone ileus is known as Bouveret syndrome. Herein we present a case of an elderly woman with an impacted gallstone in duodenum and discuss its’ management. Patient description: A 96-year-old woman was admitted to our department due to a gastric outlet obstruction. Initial gastroscopy revealed a gastric bezoar. An attempt for its extraction failed. She underwent a laparotomy in which a cholecystoduodenal fistula and a large impacted stone were found. Separation of the fistula, including closure of the duodenum side, cholecystectomy and removal of the obstructing gallstone were performed. Additional stones were found and retrieved during common bile duct (CBD) exploration. Surgery was finalized by duodenoplasty, closure and T-tube drainage of the CBD. Post-operative course was prolonged and uneventful. Discussion and Conclusions: Bouveret syndrome is a rare cause of gastric outlet obstructions. In this case, unsuccessful endoscopic treatment necessitated surgery for removal of impacted gallstone in the duodenum.

43-year-old lady presented with incidentally discovered liver lesions while she was being managed for her complaints of menorrhagia. CT and MRI showed hepatomegaly with multiple lesions in both lobes of the liver with vascular element in the background of diffuse fatty infiltration. Patient underwent laparoscopic core biopsy. Histopathology showed extensive steatosis, intracytoplasmic giant mitochondria and absence of portal tracts, features highly suggestive of hepatic adenomatosis. IHC staining showed membranous and cytoplasmic positivity in hepatocytes for B-catenin consistent with multiple hepatic adenomatosis. Hepatic adenomatosis is a new clinical entity in the hepatological practice characterized by the presence of 10 or more nodules in the liver known for its major complication of bleeding. Hepatic adenomatosis is managed by regular imaging and resection of large (> 5cm) superficial and painful adenomas along with liver function tests and tumor markers to rule out malignant transformation. However, the potential cure being the liver transplantation.

Morgagni hernia represents 2-4% of congenital diaphragmatic hernias. Only one-third of them are symptomatic, due to the hernia of abdominal viscera in the thoracic cavity, causing respiratory and digestive problems, some of them serious ones, such as intestinal obstruction. Acute presentation with incarceration of the contents is rare; there are only 7 cases described in the literature. We are presenting a case of diaphragmatic hernia that began with obstruction of the colon and secondary ischemia, requiring emergency surgery in two phases: first surgery to control the damage, with an open right hemicolectomy, and then later surgery to repair the hernia and perform bowel transit reconstruction, with proper postoperative evolution and no evidence of relapse. The treatment of Morgagni diaphragmatic hernia is surgical. Also in asymptomatic cases, due to the risk of incarceration, the most appropriate way to enter is abdominally, whether by way of laparotomy or laparoscopy, for the reduction of the contents of the hernia sac, the repair of the defect, as well as the performing of associated techniques on herniated viscera, as occurred in our case. A complicated congenital hernia is an infrequent pathology, and there is little experience in handling it. Acute presentation requires a combined treatment of the abdominal symptoms and repair of the hernia defect. The carrying over of surgical techniques for damage control into non-traumatic surgery in the face of serious hemodynamic instability is a widespread, accepted practice with the benefits of reducing mortality in critical patients and at times allowing the avoidance of ostomies.

Acute pancreatitis forms a major bulk of our inpatient admission due to gall stone disease. Diagnosis of acute pancreatitis remains a challenge even now. Serum amylase remains the most commonly used biochemical marker for its diagnosis but its sensitivity can be reduced by late presentation, hyper-triglyceridemia and chronic alcoholism. We conducted a study to determine the levels of serum and urinary amylase in patients with acute pancreatitis and compared their sensitivity and correlation with CT findings vis-à-vis the severity of the disease. The study was taken as a post graduate research model in the Post graduate Department of General and Minimal Access Surgery, Govt. Medical College Srinagar, J&K, India 2014-2016 and submitted for the award of masters in General Surgery. A total number of 150 patients were enrolled in the studies which were admitted in our unit as acute pancreatitis. 73 (48.7%) belonged to the age group of 30-44 years, 15(10%) patients aged >60 years with 86 (57.3%) males and 64 (42.7%) females. We had 81 (54%) patients with biliary tract diseases, followed by 21 (14%) patients with worm induced, 20 (13.3%) had hyperlipidaemia and only 4 (2.7%) patients had post ERCP etiology. Tenderness in epigastrium was the presenting sign in 111 (74%), followed by chest signs in 25 (16.7%) patients, diffuse tenderness in 19 (12.7%), icterus in 11 (7.3%), low grade fever in 9 (6%) patients, shock in 5 (3.3%). Diabetes mellitus as a comorbidity was observed in 48 (32%) patients followed by hypothyroidism 37 (24.7%) patients. Hypertension was seen in 31 (20.7%) patients, COPD in 19 (12.7%) patients and obesity in 13 (8.7%) patients. Twenty two (14.7%) needed ICU admission; while as 128 (85.3%) were managed in the general ward. All the enrolled patients in our study were managed conservatively. Out of a total of 150 patients, 148 (98.7%) survived while as only 2 (1.3%) of our patients expired. At the time of admission in the hospital, 120 (80%) patients had serum amylase level of >450 U/L, 19 (12.7%) patients had 150-450 U/L levels while as 11 (7.3%) patients had <150 U/L serum amylase levels. CT has been shown to yield an early overall detection rate of 90% with close to 100% sensitivity after 4 days for pancreatic gland necrosis. The correlation of urinary amylase with the CECT Severity Scoring in a patient of acute pancreatitis is still ambiguous.