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Alok D. Gandhi Rohit A. Patel Robert E. Brolin 《Surgery for obesity and related diseases》2009,5(2):144-149
BackgroundMesenteric internal hernia (MIH) is the most common cause of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass. Because MIH is a potentially life-threatening complication, we hypothesized that elective repair of MIH before developing acute SBO could decrease morbidity in this population.MethodsThe records of 702 consecutive patients undergoing primary laparoscopic Roux-en-Y gastric bypass from January 2002 and August 2007 were retrospectively reviewed to determine the incidence and etiology of SBO. During the last 9 months of the study, we offered elective laparoscopy to any patient who presented to us with symptoms of intermittent SBO.ResultsOf the 702 patients, 27 (3.8%) developed acute SBO. Of these 27 patients, 15 (55%) had obstruction related to an MIH. Nearly all patients had a typical history of intermittent abdominal pain, nausea, and bloating before developing acute SBO. Elective laparoscopy was offered to 11 patients with symptoms of intermittent SBO. Two patients who refused subsequently underwent operations for acute SBO. MIH was found at elective laparoscopic exploration in all cases. Of the 9 patients undergoing elective surgery, 3 (33%) had small bowel volvulus.ConclusionSBO due to MIH after laparoscopic Roux-en-Y gastric bypass is typically preceded by symptoms of intermittent obstruction. Patients who have these herald symptoms should promptly be offered elective laparoscopic exploration. Elective repair of MIH can be performed safely and expeditiously. 相似文献
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Alok Bhargava Matthew Jukes Damaris Ngorosho Charles Khilma Donald A P Bundy 《American journal of human biology》2005,17(3):280-292
This paper models the proximate determinants of school attendance and scores on cognitive and educational achievement tests and on school examinations of over 600 schoolchildren from the Control group of a randomized trial in Tanzania, where children in the Intervention group heavily infected with hookworm and schistosomiasis received treatment. The modeling approach used a random effects framework and incorporated the inter-relationships between school attendance and performance on various tests, controlling for children's health status, socioeconomic variables, grade level, and the educational infrastructure. The empirical results showed the importance of variables such as children's height and hemoglobin concentration for the scores, especially on educational achievement tests that are easy to implement in developing countries. Also, teacher experience and work assignments were significant predictors of the scores on educational achievement tests, and there was some evidence of multiplicative effects of children's heights and work assignments on the test scores. Lastly, some comparisons were made for changes in test scores of treated children in the Intervention group with the untreated children in the Control group. 相似文献
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Lasers in Medical Science - Antimicrobial photodynamic therapy (APDT) is a promising approach for treatment of wounds infected with antibiotic-resistant bacteria. In this approach, delivery of... 相似文献
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Shrikala Acharya Maninder Singh Setia Amol Palkar Dandu Chandra Sekar Reddy Padmaja Keskar Pramod Deoraj Mugundu Ramien Parthasarthy Padum Narayan Shobhini Rajan Alok Saxena 《The International journal of health planning and management》2021,36(1):71-82
A key recommendation of the National AIDS Control Programme‐IV of India was to develop new strategies for geo‐prioritization of the human immunodeficiency virus (HIV) epidemic. We conducted this study to categorize the districts in Maharashtra (India) based on a multidimensional framework for geo‐prioritization of services. Programmatic data on trends of HIV prevalence, coverage of marginalized populations and vulnerability factors were included. A composite indicator based on these was developed, and the cumulative score was calculated for each district. HIV prevalence among general population has declined steadily from 0.60% in 2007 to 0.33% in 2017. The programme coverage was stable but inadequate for men who have sex with men (MSM). The coverage for female sex workers (FSWs) was inadequate and reduced over time. Nine districts were categorized as high priority, 13 as moderate priority and 11 were classified as low‐priority districts based on burden and vulnerability for HIV. The high‐priority districts were Pune, Solapur and Yavatmal for FSW interventions and Pune, Thane and Latur for MSM interventions. This multidimensional indicator is based on existing programmatic data, dynamic and can be made state‐specific. It is useful to categorize and prioritize districts for allocation of resources and geo‐prioritization of services in resource limited settings. 相似文献
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D. S. Grewal Bachi T. Hathiram Alok V. Moliorikar Santhosli Davis T. Rajeevan 《Indian journal of otolaryngology and head and neck surgery》2003,55(2):107-112
Retractions of the tympanic membrane constitute a large proportion of ear diseases causing concern to the otologist. The clinical
features in a case of retraction pocket are varied and cholesteatoma. Also, that a retraction pocket in the posterosuperior
region and pars ftaccida is a precursor of cholesteatoma is now well recognized. We have studied 60 cases of retraction pockets
during a period of 5 years and have attempted to find out the etiology as well as the most effective treatment in such cases.
Though over the years along with a dysfunctional eustachian tube, a sclerotic mastoid has been implicated as one of the causes
of Retraction Pockets, we in our study have seen a large sized mastoid antrum (beyond 2 mm vf Lateral Semicircular Canal)
as a consistent feature in most of our cases. This was subjectively assessed as a surgical finding in tympanomastoidectomy
and objectively assessed by a high Resolution Computed Tomography of the temporal bone. We have found that a canal wall down
mastoidectomy was the most effective in preventing the recurrence of retraction pockets. In a coutry like India, canal wall
down mastoidectomy offers an acceptable solution to the problem of retraction pocket as not only is the follow up of patients
poor but also the “Second- Look” procedure is not always possible. The use of 1- 0 chromic catgut in the middle ear instead
of the more conventionally used silastic in preventing recurrent retractions can be considered as an effective single-staged
procedure. 相似文献
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