Sathasivam Sureshkumar

Sequential versus concomitant therapy for eradication of Helicobacter Pylori in patients with perforated duodenal ulcer: A randomized trial

Objectives: Comparison of Helicobacter pylori eradication rates, side effects, compliance, cost, and ulcer recurrence of sequential therapy (ST) with that of concomitant therapy (CT) in patients with perforated duodenal ulcer following simple omental patch closure. Methods: Sixty-eight patients with perforated duodenal ulcer treated with simple closure and found to be H. pylori positive on three months follow-up were randomized to receive either ST or CT for H. pylori eradication. Urease test and Giemsa stain were used to assess for H. pylori eradication status. Follow-up endoscopies were done after 3 months, 6 months, and 1 year to evaluate the ulcer recurrence. Results: H. pylori eradication rates were similar in ST and CT groups on intention-to-treat (ITT) analysis (71.43% vs 81.80%,P = 0.40). Similar eradication rates were also found in per-protocol (PP) analysis (86.20% vs 90%,P = 0.71). Ulcer recurrence rate in ST groups and CT groups at 3 months (17.14% vs 6.06%,P = 0.26), 6 months (22.86% vs 9.09%,P = 0.19), and at 1 year (25.71% vs 15.15%,P = 0.37) of follow-up was also similar by ITT analysis. Compliance and side effects to therapies were comparable between the groups. The most common side effects were diarrhoea and metallic taste in ST and CT groups, respectively. A complete course of ST costs Indian Rupees (INR) 570.00, whereas CT costs INR 1080.00. Conclusion: H. pylori eradication rates, side effects, compliance, cost, and ulcer recurrences were similar between the two groups. The ST was more economical compared with CT.

Hybrid therapy versus sequential therapy for eradication of Helicobacter pylori: A randomized controlled trial

Objective: To compare the sequential therapy (ST) with the hybrid therapy (HT) for the eradication of Helicobacter pylori. Materials and Methods: Patients with peptic ulcer disease and gastritis found to be H. pylori positive were randomized to HT group who received omeprazole (20 mg bid) and amoxicillin (1 g bid) for 7 days followed by omeprazole (20 mg bid), amoxicillin (1 g bid), clarithromycin (500 mg bid), and metronidazole (400 mg tid) for the next 7 days and ST group who received omeprazole and amoxicillin for 5 days followed by omeprazole, clarithromycin, and metronidazole for the next 5 days. Eradication rate, compliance, and complications were compared. Results: A total of 120 patients were included, sixty in each group. H. pylori eradication rate was significantly higher in HT group on intention-to-treat analysis (88.3% [confidence interval (CI) 78.3%–94.8%] vs. 73.3% [CI 61.1%–83.3%]; P= 0.037). Per-protocol analysis showed higher eradication rate with HT (93% [CI 83.9%–93.7%] vs. 81.5% [CI 69.5%–90.2%]; P= 0.068); however, the difference was insignificant. Compliance and side effects were similar. A complete course of HT costs

Efficacy and Feasibility of Objective Structured Clinical Examination in the Internal Assessment for Surgery Postgraduates

10.77, while ST costs only

Effect of exercise on shoulder function and morbidity following mastectomy with axillary dissection in patients with breast cancer: a prospective randomized clinical study

6.347. Conclusions: HT achieves significantly higher H. pylori eradication rate than ST with comparable patient compliance and side effects but at an higher price. However, it can be used in places where ST is ineffective.

Contrast-enhanced computed tomography – an effective tool in identifying pancreatic duct disruption in acute pancreatitis: A case series

INTRODUCTION Traditionally assessment in medical training programs has been through subjective faculty evaluations or multiple choice questions. Conventional examinations provide assessment of the global performance rather than individual competencies thus making the final feedback less meaningful. The objective structured clinical examination (OSCE) is a relatively new multidimensional tool for evaluating training. This study was carried out to determine the efficacy and feasibility of OSCE as a tool for the internal assessment of surgery residents. METHODS This study was carried out on the marks obtained by surgery residents at different levels of training in a single tertiary center in India over the 4 OSCEs conducted in the years 2015 and 2016. The marks of the OSCE were collected from the departmental records and analyzed. Reliability was calculated using internal consistency using Cronbachs α. Validity was calculated by item total correlation. Content validation was done by obtaining expert reviews from 5 experts using a proforma, to assess the content and checklist of each station of the OSCE. RESULTS A total of 49 surgery residents were assessed in small batches during the above mentioned period. Of the 4 OSCEs conducted by us, 3 had a high value of Cronbachs α of greater than 0.9, as opposed to the set standard of 0.7. Out of 23 stations used in the 4 examinations separately, only 3 stations were found to have a low correlation coefficient (item total correlation), and hence, a low validity. The remaining 20 stations were found to have a high validity. Expert review showed unanimous validation of the content of 17 out of the 23 stations, with few suggestions for change in the remaining 6 stations. The material and manpower used was minimal and easy to obtain, thus making the OSCE feasible to conduct. CONCLUSION OSCE is a reliable, valid. and feasible method for evaluating surgery residents at various levels of training.

Helicobacter pylori eradication in complicated peptic ulcer: Beneficial in most?

Background: There are no guidelines for the exercises performed in physical rehabilitation after breast cancer surgery and, specifically, for how to minimize these postoperative complications. Hence this study was conducted to study the effect of exercise intervention on upper extremity range of motion, strength, lymphedema, pain and activities of daily living (ADL). Methods: A total of 75 patients were included in the study in accordance to inclusion criteria. They were randomized into exercise group (n=38) and no exercise group (n=37). Patients in the exercise group were given a set of 19 active or active assisted range of motion exercises and strengthening exercises with frequent follow up. The other group were did not receive any strict exercise, they were given a few free hand exercise when they had some shoulder complaints based on treating physician discretion. Apart from demographic data other parameters studied were pain, numbness, active shoulder range of motion, muscle strength, lymphedema and ADL. These were evaluated before surgery, 24 hours after drain removal and 3 weeks /6 weeks/ 3 months of post-surgery. Results: Demographic parameters were comparable between the groups. Pain score, shoulder ROM were better in the exercise group compared to no exercise group and this difference was found to be significant (p <0.001). More patients in no exercise group experienced numbness. There was no statistically significant difference in the grip strength between the two groups. The incidence of lymphedema was higher in no exercise group compared to exercise group and this was extremely significant. (p < 0.001). Patients in no exercise group had higher disability scores for ADL which was significant compared to exercise group. Conclusions: Exercise interventions resulted in significantly reduced pain, improved shoulder ROM and lowered ADL impairment. Exercise intervention significantly reduced the incidence of lymphedema, but there was no effect on strength.

Assessing the risk for development of Venous Thromboembolism (VTE) in surgical patients using Adapted Caprini scoring system.

Pancreatic duct disruption may follow acute pancreatitis, chronic pancreatitis, pancreatic surgery, and trauma. Diagnosis in these patients is usually made by endoscopic retrograde cholangiopancreaticogram or secretin-stimulated magnetic resonance cholangiopancreaticogram. We report five cases where pancreatic duct disruption was diagnosed by contrast-enhanced computed tomography (CECT). Five patients with acute pancreatitis were studied; three were secondary to alcohol and two were posttraumatic. Three patients developed pancreatic ascites, one developed pancreatico-pleural effusion, and the other had pancreatic pseudocyst. CECT of the abdomen revealed pancreatic ductal injury in all the patients. In one patient with pancreatic ascites, multiple peripancreatic collections and dilated and disrupted pancreatic duct communicating with the peritoneal cavity were noted. The patient of traumatic pancreatitis had a fracture of the head of the pancreas, with peripancreatic collection communicating with the main pancreatic duct (MPD). In the other traumatic pancreatitis, there was a pseudocyst near the head of pancreas communicating with the MPD. CECT can provide a comprehensive assessment in acute pancreatitis including duct integrity, type and location of pancreatic ductal injury and can be an effective noninvasive alternative imaging modality in diagnosing pancreatic duct disruption.

Adapted ERAS Pathway vs. Standard Care in Patients with Perforated Duodenal Ulcer—a Randomized Controlled Trial

Helicobacter pylori eradication therapy has a role in minimizing the complications of peptic ulcer disease, namely, bleeding, perforation, and obstruction. However, the precise role of H. pylori eradication therapy in the complicated ulcers remains inconclusive, especially in perforation and gastric outlet obstruction. The prevalence of H. pylori in peptic ulcer bleeding patients has been widely underestimated owing to the differences in diagnostic tests and patient characteristics, and hence, it is recommended that an initial negative test should be followed up by a delayed repeat testing to rule out false negativity. It is well established now that eradication of H. pylori in patients with bleeding ulcers reduces rebleeding and ulcer recurrence. Multiple studies have attributed high recurrence rates of duodenal ulcer following simple closure to a high prevalence of H. pylori infection. Eradication therapy decreases the recurrence rate of perforated ulcers, thus justifying the role of H. pylori eradication therapy following the primary surgical management of perforated ulcers. The role of H. pylori in duodenal ulcer with gastric outlet obstruction is yet to be evaluated clearly. There are some reports of resolution of gastric outlet obstruction following therapy for H. pylori, obviating the need for surgery. Clarithromycin-containing regimens are recommended as first-line in areas of low resistance, whereas bismuth-containing quadruple therapy is the first-line empirical treatment in areas of high clarithromycin resistance. Treatment of H. pylori is beneficial in most of the patients with complicated peptic ulcer disease, especially in reducing recurrence of ulcer with or without complications.