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Introduction: Worldwide antibiotic prescription in surgical practices are inappropriate quite often, reasons being inappropriate indication, inappropriate antibiotic prophylaxis, continuation of empiric therapy despite negative cultures in a stable patient, and a lack of awareness of susceptibility patterns of common pathogens. Extended-spectrum b-lactamase, Carbapenemase resistant and multidrug-resistant strains of organisms causing intrabdominal infections, have developed. The occurrence of MRSA surgical site infection (SSI) has a significant impact on clinical and economic outcomes, notably an increase in postoperative mortality. Opportunities: There is an array of web of factors which affect the occurrence of SSI and antibiotics should not be answer or replacement to any of those factors. Narrow spectrum antibiotic active against the most probable pathogen to be encountered during operation, for a short period of time in adequate doses should be utilized. Broad-spectrum antimicrobial agents don’t result in lower rates of postoperative SSI compared to narrower spectrum. Elective laparoscopic cholecystectomy, parotidectomy, chest tube insertion and other clean procedures don’t warrant use of prophylaxis. For most patients who have had their wounds opened and adequately drained, antibiotic therapy is unnecessary. Antibiotics should be discontinued at time of incision closure (exceptions include implant-based breast reconstruction, joint arthroplasty, and cardiac procedures and liver transplantation. Hospital-specific antibiograms are important to guide the usage of diverse antibiotic agents to decrease resistance among pathogens. In intrabdominal infections source control is still integral and most important to the treatment of most patients. Routine use of antimicrobial therapy is not appropriate for all patients with intra-abdominal infections e.g. Patients with uncomplicated diverticulitis. In uncomplicated IAIs, when the focus of infection is treated effectively, the administration of antibiotics is unnecessary beyond prophylaxis e.g. Acute unperforated appendicitis removed surgically. In case of intraabdominal infections selection of empirical antimicrobial therapy depends on various factors which include probable contaminating pathogen/s, individual risk assessment and possibility of resistant pathogens. Higher risk patients are those, with severe sepsis/septic shock, elevated APACHE II score (>10), multiple medical comorbidities, problematic or delayed source control. The possibility of resistant pathogens is low in community acquired infections (CAI) in contrast to healthcare or hospital-associated infection (HAI). In Lower risk patients with community-acquired IAI, narrower-spectrum therapy ( coli, Bacteroides) is recommended and there is no need for anti-enterococcal or antifungal therapy. In Higher risk patients with community-acquired IAI, broader-spectrum therapy is recommended with selective use of anti-enterococcal and antifungal therapy. In Patients with healthcare/hospital-associated IAI, broader-spectrum therapy is recommended with additional agents for resistant pathogens. Do not use clindamycin as an anti-anaerobic agent in combination regimens for the empiric treatment in adults and children unless metronidazole cannot be used. Duration of antimicrobial therapy can be significantly shortened to 4-7 days under most of the circumstances. Routine addition of an aminoglycoside to other agents having broad spectrum gram negative coverage provides no additional benefit in intrabdominal infections. Conclusion: Antibiotics are a treasure but not unlimited. Appropriate use is the need of the hour to save our present and future generations from the menace of antimicrobial resistance. JMS 2018;21(1):54-60

The well-established molecular pathogenesis of chronic myelogenous leukemia (CML) and its consequences for laboratory testing and clinical management illustrate a classic paradigm for the importance of molecular diagnostics in targeted drug therapy. The success of the tyrosine kinase inhibitor (TKI), Imatinib, as the currently recommended first-line treatment of early chronic phase CMLhas both fueled the need for timely and reproducible molecular testing of the BCR-ABL fusion transcript in diagnosis and monitoring. As ongoing research continues to refine guidelines for monitoring residual disease in patients undergoing TKI therapy, an understanding of molecular technologies and their interpretation is critical. In this regard, we at Cancer Diagnostic and Research Centre, Immunology and Molecular Medicine established a gold standard RT-PCR and RQ-PCR technique to diagnose and monitor residual disease in CMLpatients. JMS 2016; 19(2):82-84

The techniques of single-incision laparoscopic surgery (SILS) is developed and based on that of conventional laparo-endoscopic surgery. At first, surgeons wanted to devise a method for visceral surgery with no incision on body’s surface, which is called natural orifice transluminal endoscopic surgery (NOTES). As early as the 1970s, Dr. Raimund Wittmoser, the “father” of modern thoracoscopic surgery of the autonomic nervous system, used a single-intercostal incision through which he inserted a multifunctional port which contained all the instruments and optics. Another example of SILS in early times is the application of laparoscopic instrumentation to resect lesions in the rectum or sigmoid colon. Using the anus as the portal of entry, trans- anal endoscopic microsurgery (TEMS) employs a specialized multichannel trocar to reach lesions located 8 to 18 cm away from the anal verge. Compared to NOTES, SILS is easier, safer, more applicable and convenient for surgeons to master and the main reason is that physicians, but not surgeons always use endoscopes. However, laparoscope has been a tool for surgeons for a long time.

A 35-year-old male patient presented to the General Surgery Out Patient Department with a history of swelling on the left lateral chest since birth. The swelling appeared during inspiration and disappeared during expiration. JMS 2018;21(1):48