Background: Traditionally laparoscopic common bile duct exploration is followed by T-tube placement because of which patients suffer problems related to T-tube thereby increasing the morbidity of patients. Primary closure of CBD following laparoscopic choledocholithotomy is now being considered as an alternative superior to the traditional method. This study is designed to analyse the outcome of primary CBD repair in terms of mean operation time, duration of hospital stay and post-operative morbidity.Methods: A prospective randomized study was done in which 40 patients at our institute and associated hospitals were divided into two groups to compare the results of primary closure to T-tube placement following laparoscopic choledocholithotomy.Results: 40 patients were included in this study. The mean operating time was observed to be 65±14.05 mins in Group A (primary closure) patients while that in case of Group B (T-tube drainage) patients was 95.25±9.66 mins with a p-value 0.0001 which is considered statistically significant. The average duration of hospital stay in Group A (primary closure) was 8.2 days which was much shorter than that of Group B (T-tube drainage) patients which was of 15.7 days. The post-operative complication was observed in 1 patient of Group A (primary closure) while post-operative complication occurred in 3 patients of Group B (T-tube drainage).Conclusions: This study indicates that primary repair following laparoscopic choledocholithotomy is a safer and more effective method than T-tube drainage and we strongly recommend this procedure in clinical practice.

Elizabethkingia meningoseptica is Gram-negative, rod-shaped opportunistic bacterial pathogen increasingly reported in hospital-acquired outbreaks. This bacterium is well known to thrive in the hospital environment. One of the leading causes of meningitis in pediatric and immune-compromised patients, E. meningoseptica has been noted as a ''pathogen of interest'' in the context of nosocomial diseases associated with device-related infections in particular. This pathogen's multidrug-resistant phenotype and attendant lack of adequate molecular mechanistic data limit the current approaches for its effective management in hospitals and public health settings. This study provides the global proteome of E. meningoseptica. The reference strain E. meningoseptica ATCC 13253 was used for proteomic analysis using high-resolution Fourier transform mass spectrometry. The study provided translational evidence for 2506 proteins of E. meningoseptica. We identified multiple metallo-b-lactamases, transcriptional regulators, and efflux transporter proteins associated with multidrug resistance. A protein Car D, which is an enzyme of the carbapenem synthesis pathway, was also discovered in E. meningoseptica. Further, the proteomics data were harnessed for refining the genome annotation. We discovered 39 novel protein-coding genes and corrected four existing translations using proteogenomic workflow. Novel translations reported in this study enhance the molecular data on this organism, thus improving current databases. We believe that the in-depth proteomic data presented in this study offer a platform for accelerated research on this pathogen. The identification of multiple proteins, particularly those involved in drug resistance, offers new future opportunities to design novel and specific antibiotics against infections caused by E. meningoseptica.

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Iron deficiency anemia (IDA) is the most common nutritional deficiency disorder in children and is worldwide in distribution. In fact, iron deficiency is the only micronutrient deficiency that is prevalent in virtually all developed countries. An infant is predominantly fed on milk, bioavailability of breast milk is much better than cow’s milk; although both are deficient in iron content. The peak prevalence of nutritional IDA occurs in late infancy and very rarely seen before the age of 6 months in a term baby who is exclusively breastfed. We report a case of severe IDA in a 6-month-old child in whom no other obvious cause was found.

Enterococci are normal inhabitants of the human gastrointestinal tract, increasingly becoming important human pathogen posing therapeutic challenges for long. The unique natural resistance of enterococci to several types of antibiotics and their inherent capacity to survive in different environments allows them to survive, proliferate, and fill the void when antibiotic-susceptible organisms are eliminated, contributing to the frequency of enterococci in nosocomial infections and unusual clinical consequence. 1 A three and a half year old girl child from low socioeconomic status weighed 12 kg (<-2 zscore), height 92 cm (<-2 score) moderately malnourished as per WHO criteria presented with complaints of fever moderate to high grade, cough for 8 days, and breathing difficulty 1 day. She was receiving some oral antibiotic 1 day prior to admission; next pleurocentesis was done for respiratory distress, 200 mL pus was removed and referred immediately. She had no significant past, family history, child was sick looking, febrile, had respiratory distress, features of parapneumonic effusion. Cardiac and abdominal examination was unexceptional except mild nontender hepatomegaly. She was put on supportive treatment, broad spectrum antibiotics after sending cultures and other investigations. Immediate ICD was placed and 400 mL pus was drained out. Laboratory analysis of pus revealed TLC 220,000/mm with 98% neutrophis, sugar 20 mg/dL, protein 5 gm/dL, ADA 452 IU/L and AFB +ve, so ATT was started. Hematological analysis showed HB 10 gm%, TLC 20200/mm 3 with 86% polymorphs. Blood culture was sterile at 72 hours; LFT, RFT normal. Her serology was negative for HIV. Her USG abdomen was not significant other than mild hepatomegaly. She continued to have fever spikes although her toxicity was decreased. On day 4, pus culture grew vancomycin-resistant Enteroccus faecalis (VRE) and antibiotics were changed to linezolid and ciprofloxacin as per sensitivity report. She became afebrile by day 6, her ICD was removed on day 10 and was discharged after completion of 2 weeks of antibiotics on ATT, hematinics. X-ray chest showed lung expansion; CT chest not done due to financial constraint but USG abdomen and chest did not show any other abnormality. Family screen for TB was negative. DiscussionEnterococci is an important cause of nosocomial infection, infective endocarditis, wound infections, and urinary tract infections but very rarely causes spontaneous pleural empyema. The infection sometimes occurs in the presence of peritonitis, possibly because of a dysfunctional reticuloendothelial system, but cases of E. faecalis empyema in the absence of peritonitis have been reported as well. 2 They are uncommon but emerging agents of upper and lower airway diseases, in particular, pneumonia and thoracic empyema and may jeopardize the clinical outcome of compromised, hospitalized hosts, as well as affect outpatients. 3,4 In Indian scenario pertaining to children etiological profile of empyema mainly remains staphylococci and streptococci, Gram-nega...