OBJECTIVE:To assess the value of single-dose, intravenous, prophylactic antibiotic in the prevention of wound infections during tension free inguinal hernia mesh repair by a double-blind, prospective, randomized trial. BACKGROUND: Hernia repair is considered as one of the so-called 'clean' operations which may not require antibiotic coverage. Many surgeons, however, continue to give antibiotics empirically, as prophylaxis. This practice was more widely used after the establishment of the tension-free mesh repair technique as the method of choice for hernia repair, because of the fear of infection of the introduced foreign body. Several controlled randomised trials have been published on this topic, even before the introduction of the mesh repair techniques, however results are conflicting. METHODS AND MATERIALS: 200 patients were included in the study and the study population was randomized in two groups. The study group was administered parenteral cefazolin while the control group received placebo preoperatively. Follow up was done for 30 days post-surgery which included 180patients.The study was a double-blind randomized controlled trial, the results of which were analyzed statistically. RESULT: The overall infection rate was 8.3% (15 out of 180). The incidence of wound infection in antibiotic group was 7.4% and 9.3% in control group. There was no statistically significant difference in the infection rates between the two groups. CONCLUSION: Antibiotics showed a protective effect in preventing SSI after mesh inguinal hernia repair. However significant values cannot be obtained and cost effectiveness of antibiotic prophylaxis needs further evaluation. Therefore routine use is not recommended.

Basal cell carcinoma (BCC) of the breast is a rare occurrence. To the best of our knowledge, only 34 cases of this rare malignancy have been reported worldwide. We report the case of a 48 year old lady who presented with history of rapid enlargement of a nevus over breast since three months. On initial examination a diagnosis of melanoma was considered. However the histopathology showed features suggestive of BCC. This case report highlights an atypical presentation of BCC.

A saturated health care system with a lack of evidence-based antiviral medicine and ignorance of antimicrobial stewardship during pandemics has prompted clinicians to prescribe a broad-spectrum antibiotic more often. A prospective, cross-sectional study of COVID-infected patients was conducted to gain insight into antibiotic prescribing practices and their impact on antimicrobial resistance. The antibiotic susceptibility test was performed using the disc diffusion method. 318 patients met the study’s inclusion criteria, with a mean age of 46 years and 55% (175) of them being males. Antibiotics were prescribed for 93.72% (209) of mild cases, 92.45% (49) of moderate cases, 96.15% (25) of severe cases, and 100% (16) of critical cases of COVID-19. A total of 95 samples were sent in for culture and antibiotic sensitivity testing, with 58.95% (56) confirming growth. The majority of the growth was found to contain E. coli (14). In 54.9% of cases, antibiotics with less than 50% sensitivity to curing bacterial infection were detected. In the study, we found that antibiotics were being used unnecessarily in excessive quantities and that more than half of the antibiotics were less sensitive to isolated bacteria.

BACKGROUND: The VHWG recommend synthetic mesh in Grade I, biologic mesh in Grade III and Grade IV. The use of synthetic mesh in Grade II comrbid patient is matter of consideration and debate. Our aim was to examine the outcome of synthetic mesh repair in open incisional ventral hernia repair in patients with comorbidities. METHODS: Retrospective review of all open, grade II VHR performed by single surgeon over 5 years was evaluated. RESULTS: Seventysix patients with grade II ventral hernia underwent open hernia repair with synthetic mesh during the study period. There were 40 males and 36 females in our study with mean age of 53 years (range 30-85). Comorbidities associated with these patients included obesity in 43 (56%), smoking in 25 (32%), COPD in 19 (25%), diabetes milletus in 32 (42%), and immunosuppression in 2 (2.6%). Surgical site occurrence as defined by VHWG was identified in 12 (16%) patients which included 8 (10%) surgical site infection (SSIs), 3 (4%) seroma and 1 (1%) wound dehiscence. One patient developed recurrence during the follow-up period. CONCLUSION: Synthetic macroporous mesh can be used in co morbid patients with no long term complications with recurrence of less than 1.3%. although surgical site occurrence in this cohort of patients is high (16%), they can be managed conservatively with antibiotics.

BACKGROUND: Follicular variant of papillary thyroid carcinoma is relatively common variant of papillary thyroid carcinoma. Fine needle aspiration cytology (FNAC) is an important investigation in preoperative diagnosis of thyroid lesions. The diagnosis of follicular variant of papillary thyroid carcinoma in FNAC is usually missed and is challenging compared to classic papillary thyroid carcinoma. OBJECTIVES: To assess the clinical and histopathological features of subtypes of follicular variant of papillary thyroid carcinoma and to document the features that would improve the sensitivity of FNAC in the preoperative diagnosis. METHODS: Retrospective study of histologically confirmed follicular variant of papillary thyroid carcinoma in our institution over 5 years from 2009 to 2013.RESULTS: Of 26 cases of FVPTC, 21 cases were encapsulated and 5 cases were non-encapsulated, with male: female ratio was 1:18. The median age was 33.5 years. The most frequent microscopic pattern on FNA was micro follicular (23 cases). The p value for monolayered sheets, papillary fronds, nuclear grooves, pseudo inclusions, nucleomegaly and irregular nuclear membrane were found to be significant. Non-encapsulated variant had significantly higher rate of intra tumoral fibrosis (80% vs. 14% compared to encapsulated variant), extra thyroidal extension (60% vs. 5% respectively), positive margins (60% vs. 5% respectively) and lymph node metastases (60% vs. 9% respectively). CONCLUSION: FVPTC appeared to be a heterogeneous disease composed of 2 distinct groups: an infiltrative/diffuse (non-encapsulated) subvariant, which resembles classic papillary carcinoma in its metastatic lymph node pattern and invasive growth, and an encapsulated form, which behaves more like FTA/FTC. The sensitivity of FNA in preoperative diagnosis of FVPTC can be increased by carefully looking for specific features like nuclear grooving and nuclear pseudo inclusions in suspected smears. Further studies with large sample size and long term follow up in required to document the prognosis of FVPTC.