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Background: Ileosigmoid knotting (ISK) is one of the rare causes of acute intestinal obstruction. It has a rapid course for forming gangrene. In this condition, the ileum and sigmoid colon wrap around each other, causing a knot and strangulation of both structures. ISK is extremely rare in North America most cases are reported in Asia and Africa. This is a surgical emergency and an attempt to relieve the obstruction must be done promptly. The management may range from a resection and anastomosis of the ileum and Sigmoid Colon, ileostomy and Hartmann's procedure depending on patients condition and gangrenous bowel segment. Method: It is a retrospective study. Data collection was done for three years from September 2018 to August 2021 in Bankura Sammilani Medical College and Hospital in the Department of General Surgery. Result: In our study 26 patients (M: F ratio 3:1) was identified with ileosigmoid knotting. The mean age of the patients are 43 years (SD+/- 13) in the study population. It more commonly affects males (76.92%) who are in the fourth decade of life. About fifty percent patients (53.84%) presented with shock (chi square test p value

Low strength and rapid biodegradability of Acellular Dermal Matrix (ADM) restrict wider clinical application as rapid cell delivery platform in situ, for management of burn wounds. Herein, extracted ADM was modified by dual cross-linking approach with ionic crosslinking using chitosan (CTS) and covalent cross-linking using an iodine modified 2, 5-dihydro-2,5-dimethoxy-furan (DHF-I) cross-linker; termed as CsADM-Cl. In addition, inherent growth factors and cytokines were found to be preserved in the CsADM-Cl, irrespective of ionic/covalent crosslinking. CsADM-Cl demonstrated improvement in post crosslinking stiffness with decreased biodegradation rate. This hybrid crosslinked hydrogel supported adhesion, proliferation, and migration of human foreskin derived fibroblasts (HFCs) and keratinocytes (HKC). Also, the angiogenic potential of CsADM-Cl was manifested by chick chorioallantoic membrane (CAM) assay. CsADM-Cl showed excellent antibacterial activity against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). Moreover, CsADM-Cl treated full thickness (FT) burn wounds demonstrated rapid healing marked with superior angiogenesis, well-defined dermal-epidermal junctions (DEJ), mature basket weave collagen deposition, and development of more pronounced secondary appendages. Altogether, the bioactive CsADM-Cl hydrogel established significant clinical potential to support wound healing as an apt injectable antibacterial matrix to encounter unmet challenges concerning critical burn wounds.

Background: Since inception hernia surgery evolved a lot and achieved the gold standard of Lichtenstein hernioplasty. Chronic post-surgical inguinal pain and mesh related wound complications are still issues of concern for surgeons. To minimize these problems different modifications are being evaluated worldwide. OBJECTIVE: To compare the incidence of post-surgical chronic inguinal pain duration of surgery between two different techniques of mesh placement, one is placing the mesh anterior to Fascia Transversalis and other is placing the mesh posterior to Fascia Transversalis. STUDY DESIGN: Randomized superiority trial done among patients selected from opd and divided in two groups undergone hernioplasty by two different techniques of mesh placement. MATERIALS AND METHODS: Each group of patients contained fifty patients of 18 to 65 years of age with unilateral inguinal hernia. Duration of surgery recorded and post-surgical chronic inguinal pain evaluated at 2 weeks 2 months 4 months and 6 months after surgery. CONCLUSION: The study showed that placement of mesh posterior to fascia tranversalis gave better result than placing it anterior to FT in respect of post operative chronic pain but with a longer operative duration.

Electrospun nanofibrous scaffold has long been studied as skin substitutes for their structural resemblance to the dermal extracellular matrix. However, packed fibrous architecture with small pore size restricts cellular infiltration into nanofibrous mat. In this article, we report highly porous, nano-/microfibrous 3D structure using polycaprolactone-chitosan emulsion and its application in skin regeneration. Under the influence of electric field, the emulsion containing encapsulated charged chitosan droplets enhances charge of the spinning solution and residual charge in the core of the deposited fiber, thereby creating core-shell, cotton-like fluffy structure with average pore size 62 μm, fiber diameter ∼1.62 μm, contact angle of 72° and 80% water uptake capacity of the scaffold. Further, differential stirring period of the specific emulsion developed compact nanofibrous membrane with nanometer ranged pore size emphasizing the role played by emulsion droplet size and the charge carried thereafter. Presence of nanofibers with high-interconnected porosity promoted efficient cellular infiltration and proliferation from initial days of cell seeding. The scaffold supported extracellular matrix protein expression and stratified epithelialization

Mimicking skin extracellular matrix hierarchy, the present work aims to develop a bilayer skin graft comprising a porous cotton-wool-like 3D layer with membranous structure of PCL-chitosan nanofibers. Emulsion electrospinning with differential stirring periods of PCL-chitosan emulsion results in development of a bilayer 3D structure with varied morphology. The electrospun membrane has fiber diameter ∼274 nm and pore size ∼1.16 μm while fluffy 3D layer has fiber diameter ∼1.62 μm and pore size ∼62 μm. The 3D layer was further coated with collagen I isolated from Cirrhinus cirrhosus fish scales to improve biofunctionality. Surface coating with collagen I resulted in bundling the fibers together, thereby increasing their average diameter to 2.80 μm and decreasing pore size to ∼45 μm. The architecture and composition of the scaffold promotes efficient cellular activity where interconnected porosity with ECM resembling collagen I coating assists cellular adhesion, infiltration, and proliferation from initial days of fibroblast seeding, while keratinocytes migrate on the surface only without infiltrating in the membranous nanofiber layer. Anatomy of the scaffold arising due to variation in pore size distribution at different layers thereby facilitates compartmentalization and prevents initial cellular transmigration. The scaffold also assists in extracellular matrix protein synthesis and keratinocyte stratification in vitro. Further, the scaffold effectively integrates and attaches with third-degree burn wound margins created in rat models and accelerates healing in comparison to standard Tegaderm dressing™. The bilayer scaffold is thus a promising, readily available, cost-effective, off-the-shelf matrix as a skin substitute.

Background: Since the pilot study in 2002, many studies have evaluated the feasibility of an Early Ileostomy takedown by 2 weeks, thus decreasing the stoma related morbidity. However, in a developing country like India, this paradigm shift is still debatable. Our study from a tertiary teaching rural hospital in Bengal evaluates the feasibility of Early takedown by 2 weeks and compares it to a more accepted concept of Ileostomy takedown by 8-10 weeks.Methods: This prospective longitudinal comparative study conducted from February 2018 to July 2019, in our institute. Sample size was calculated to be 30 in each group. The early closure went a takedown at 2 weeks and the delayed closure underwent a takedown by 8-10 weeks. Data was analysed with Fischer’s exact or Chi square test, student’s t test. A p value of 0.05 was significant.Results: Our set of rural patients, had more stoma related complications due to lack of stoma care (13.33% vs 3.33%, EC vs DC). Intraoperative adhesions (26 vs 12, p=0.0004) significantly increased operative time (126.1667±27.5895 vs 86.0000±34.2506, EC vs DC, p

Background: Gallstone disease (GSD) is a common health problem throughout the world and majority of this burden occurs in developing countries. Most of the gallbladder carcinoma (GBC) is associated with GSD but there is till deficit of information on this association. Beside this, there is no study on the spectrum of histopathological pattern of cholecystectomy specimens from GSD patients in rural areas of West Bengal of India. Methods: The study was carried out on GSD patients who were undergone for cholecystectomy at B.S. Medical College & Hospital of West Bengal over a period of three years from January 2013 to December 2015. Histopathological reports of cholecystectomy specimens were analyzed. Results: In the present study, total 786 GSD patients were included where 635 were female and 151 were male. Histopathological findings depicted that chronic cholecystitis was the most prevalent (79.8%) followed by acute-on-chronic cholecystitis (6.1%), cholesterolosis (2.9%) and xanthogranulomatous cholecystitis (1.7%) among the patients. Beside these, hyperplasia, metaplasia, dysplasia and GBC were observed in 2.0%, 4.7%, 2.2% and 0.6% of the patients respectively. The mean ages for patients with chronic cholecystitis, hyperplasia, metaplasia, dysplasia and carcinoma were 34.5, 37.2, 42.9, 43.9 and 53 years respectively. Study also showed that male GSD patients were more prone to pre-malignancy and malignancy (significant at 95% confidence limit). Conclusions: The study revealed that different types of histopathological features were present in the gallbladder of GSD patients where pre-malignant (hyperplasia, metaplasia and dysplasia) and malignant types were remarkable percentages though chronic cholecystitis was the commonest histopathological feature. Study also demonstrated that males with GSD were more prone to pre-malignancy and malignancy. Gradient ages may suggest that GBC was developed from cholecystitis to carcinoma via hyperplasia, metaplasia and dysplasia.

Gallstone is a high-risk factor for gallbladder pre-malignancy or malignancy (GB PM-M) but which substances of gallstones definitely assist to turn out in to GB PM-M, remains unclear. This study aimed to find out the presence of carcinogenic heavy metals in gallstones and to explore the aetiopathogenesis of gallbladder pre-malignancy and malignancy. Presence of elements in gallstones was detected by energy dispersive X-ray spectroscopy (EDS) with scanning electron microscopy (SEM) and then level of carcinogenic heavy metals was estimated in gallstones using atomic absorption spectroscopy (AAS). The experiment was carried out in gallstone samples of 46 patients with gallbladder pre-malignant and malignant condition (PM-M group) and 65 sex and age-matched patients with chronic cholecystitis (C-C group). Gallstones were also classified in to three types such as cholesterol stone, mixed stone, and black pigment stone. EDS analysis detected presence of mercury, lead, and cobalt elements in all types of gallstones of both PM-M and C-C groups. AAS analysis revealed significantly higher amount of mercury (p

Purpose Benign phyllodes and fibroadenoma are two well-known breast tumors with remarkable diagnostic ambiguity. The present study is aimed at determining an optimum set of immuno-histochemical features to distinguish them by analyzing important observations on expressions of important genes in fibro-glandular tissue. Methods Immuno-histochemically, the expressions of p63 and α-SMA in myoepithelial cells and collagen I, III and CD105 in stroma of tumors and their normal counterpart were studied. Semi-quantified features were analyzed primarily by ANOVA and ranked through F -scores for understanding relative importance of group of features in discriminating three classes followed by reduction in F -score arranged feature space dimension and application of inter-class Bhattacharyya distances to distinguish tumors with an optimum set of features. Results Among thirteen studied features except one all differed significantly in three study classes. F -Ranking of features revealed highest discriminative potential of collagen III (initial region). F -Score arranged feature space dimension and application of Bhattacharyya distance gave rise to a feature set of lower dimension which can discriminate benign phyllodes and fibroadenoma effectively. Conclusions The work definitely separated normal breast, fibroadenoma and benign phyllodes, through an optimal set of immuno-histochemical features which are not only useful to address diagnostic ambiguity of the tumors but also to spell about malignant potentiality.