Vijayanagara Institute of Medical Sciences

We describe a technique of Umbilical hernioplasty, where the mesh is placed in the Preperitoneal or retro-muscular plane. An adequate incision helps in a good exposure and repair. At the end of surgery, the incision is brought inside the area of the umbilicus with a purse-string effect of the subcuticular sutures, making the scar nearly merge with the umbilicus.

The concept of selective photothermolysis, introduced by Anderson and Parrish, revolutionized the use of lasers in dermatology by enabling targeted thermal damage to tissues based on wavelength, pulse width, and thermal relaxation time (TRT). However, the principle of thermal kinetic selectivity, which involves heat diffusion and selective destruction of non-homogeneous tissues, has received limited attention in literature. This paper explores thermal kinetic selectivity as a key factor in laser-mediated tissue destruction, especially in cases where the target tissue and chromophore are spatially separated or have varying sizes and properties. Selective photothermolysis functions through confined heat generation, where the pulse duration is shorter than the TRT of the target tissue, preventing damage to surrounding structures. However, in non-homogeneous targets, heat diffusion becomes a critical factor in tissue destruction. The extended theory of selective photothermolysis emphasized this heat diffusion through the concept of thermal damage time (TDT). TDT varies with the geometry and dimensionality of the target, with planar structures dissipating heat more efficiently than cylindrical or spherical ones. The theory of thermal kinetic selectivity is particularly useful when treating tissues with different TRTs, such as larger blood vessels and smaller capillaries, by adjusting the pulse duration to selectively damage the desired target without affecting the surrounding tissues. This concept also applies to non-ablative treatments, such as skin rejuvenation and body contouring, where homogenous heating of the dermis is achieved through extended pulse durations. In conclusion, the integration of thermal kinetic selectivity enhances our understanding of laser-tissue interactions, in a range of dermatological and esthetic applications. In addition to the concept of TRT, light-absorption profiles, tissue geometry, heat conduction from the absorber to target tissues, and the light device output temporal profiles all have an effect on the thermolysis.

Background: Coffee's global popularity arises from its stimulating effects on the central nervous system, taste, and aroma, making it one of the most widely consumed beverages. Numerous studies have explored the potential link between coffee consumption and diseases, particularly coronary heart disease (CHD), yet this association remains debatable. Purpose: This study aims to assess the risks and benefits of coffee consumption concerning CHD, compared to individuals who do not drink coffee. Methods: An umbrella meta-analysis incorporating existing meta-analyses was conducted. A systematic search was performed on the PubMed database from 2006 to 2023 using the PRISMA protocol. MeSH terms "coffee consumption," "coronary artery disease," and "myocardial infarction" were used. The study included 3.28 million participants from cohort studies across four prospective meta-analyses. Additionally, subgroup analysis based on varying levels of coffee intake (very-heavy, moderate, and light) was performed. Analysis was conducted using RevMan to derive a summarised risk ratio (RR) of CHD/MI associated with coffee consumption and a 95% Confidence Interval. Risk bias was incorporated using RoBANS integrated with RevMan. Sensitivity analysis was conducted by excluding one study at a time to derive Heterogeneity Index (I 2 ) scores. Forest plots were generated, with statistical significance set at p<0.05. Results: The study comprised four meta-analyses meeting the inclusion criteria, incorporating 80 studies involving 3.28 million individuals worldwide. Compared to non-coffee drinkers, coffee consumers had a summarized risk ratio of 1.08 (95%CI: 1.01-1.14, I2: 76%, p<0.00001). Subgroup analysis, with one study omitted, revealed that very-heavy coffee drinkers had a risk ratio of 1.14 (0.99-1.29, 73%, p<0.00001), moderate coffee drinkers had a risk ratio of 1.02 (0.89-1.14, 77%, p<0.00001), and light coffee drinkers had a risk ratio of 1.00 (0.94-1.06, 0%, p<0.00001). Conclusion: Based on our umbrella meta-analysis, very-heavy coffee consumption is associated with a borderline increased risk of CHD. However, no significant difference was found between moderate and light coffee drinkers regarding CHD risk.

BackgroundIndia accounts for 25% of incidence and mortality of cervical cancer when compared to world's burden. Carcinoma cervix is preventable. In developing countries like India, the ideal screening test should be inexpensive, have a high sensitivity, specificity, PPV and be relatively easy to evaluate and should provide immediate results. Papanicalaou (PAP) smear, though popular and reliable requires huge infrastructure, medical personnel, counseling and follow-up and have logistic problems. Visual inspection of acetic acid (VIA) has potential advantage over PAP smear being simple, provides results immediately and even can be done by trained medical personnel and suits better in poor resource settings. Hence, there is a need to find an ideal screening test which overcome the logistic problems of PAP smear and give results immediately with same accuracy.ObjectivesTo evaluate the sensitivity, specificity, PPV of cervical cytology and VIA as screening method for premalignant and malignant lesions of cervix. To compare accuracy of VIA & cervical cytology in predicting premalignant and malignant lesions of cervix.MethodsThis was hospital based prospective non randomized study done at department of OBG, VIMS Ballari. 500 patients were selected from OPD. All study population were subjected for PAP smear followed by VIA with 5% acetic acid. Abnormal Pap smear (Bethesda system) was subjected to biopsy. VIA-positive patients were subjected to biopsy from abnormal areas. Biopsy considered positive if CIN 1 and above lesions. Biopsy reports were taken as reference standards for statistical analysis in predicting sensitivity, specificity and accuracy.ResultsIn our study of 500 women, 105 showed positive cervical cytology (21%) and among them 83.8% patients showed precancerous and cancerous lesions. 265 were VIA positive (53%) out of which 172 (64.9%) patients showed precancerous and cancerous lesions on biopsy. The sensitivity of VIA was 93.9% with 70.6% specificity and PPV 64.9%. The sensitivity of PAP smear was 48% with 94.6% specificity and PPV 83.8%. The accuracy of PAP smear was 77.6% and VIA is 79.2% which is comparable.ConclusionSince diagnostic values of VIA is comparable to PAP smear, accuracy of both procedures are comparable, VIA can be used as an alternative to PAP smear in low-resource settings.