Premise and Objective:Elective laparoscopic cholecystectomy (LC) has low risk for post-operative infectious complications; still most clinicians use persistent post-operative prophylactic antibiotics out of habit, tradition, or simply as defensive practice due to evolving medicolegal implications of a large number of surgeries being showcased as daycare or next day discharge procedures. This randomised prospective trial was done to test the need for such prophylaxis in cases of elective LC in a rural/semi-urban setting.Materials and Methods:Two hundred and ten successive patients undergoing elective LC were randomised into groups receiving single dose of injection ceftriaxone at the time of induction of anaesthesia, (Group A = 112 cases) and those who in addition to above received injection ceftriaxone twice daily for 2 days postoperatively (Group B = 98 cases). Post-operative infectious complications between two groups were compared for variables such as age, sex, body mass index and bile/stone spillage.Results:There was no significant difference in surgical site infection rates between the groups for variables such as age, sex, body mass index, duration of symptoms, American Society of Anesthesiologists grade, duration of surgery and hospital stay. Intraoperative spillage of stones (9.8% [A]: 5.1% [B]) did not increase infectious complications even in the presence of positive bile culture (Group A, N = 7 vs. Group B, N = 3). An operative time of greater than 60 min was found to be associated with increased surgical site infection (P = 0. 0006).Conclusion:Single dose of ceftriaxone at the time of induction is adequate prophylaxis following elective LC even in the rural/semi-urban Indian setting and routine continued administration of antibiotic should be abandoned as it contributes to adverse reactions, drug resistance and unnecessary financial burden.

Aims:To investigate the association between Vitamin D receptor gene polymorphisms (BsmI, TaqI and FokI) and type 2 diabetes mellitus in patients in north eastern India.Settings and Design:This was a case control study with 40 cases of type 2 diabetes and 20 controls.Materials and Methods:Genomic DNA was extracted from blood and genotyped for the single nucleotide polymorphism (SNPs) of BsmI [rs1544410], TaqI [rs731236] and FokI [rs2228570] by polymerase chain reaction and gene sequencing. Genotype distribution and allelic frequencies were compared between patients and controls. Data was expressed as mean ±standard deviation. Chi square test and t test were used to compare groups. Statistical analysis was done using SAS version 9.3 software. P value of <0.05 was considered significant.Results:Body weight and BMI were significantly associated with VDR polymorphisms BsmI and TaqI while BsmI was significantly associated with HbA1C. Vitamin D deficiency was significantly greater in cases than controls. The frequency of the heterozygous genotype of the BsmI polymorphism was significantly greater in type 2 diabetics than in controls.Conclusions:Vitamin D receptor polymorphisms are associated with type 2 diabetes in our population and require larger scale studies to be considered as possible risk factors or type 2 diabetes mellitus.

The involvement of proximal humerus by Osteosarcoma is quite common, with the survival rates highly dependent on the staging of the tumor. Numerous salvage methods have been described but without any consensus. We present a case of a 17-year-old patient who had a wide excision of the tumor and underwent a mega prosthesis fixation, which underwent implant failure with the revised prosthesis subluxing. Finally, Reverse Shoulder Arthroplasty was done. Ten years follow up shows the success of the above. Salvage surgery in young patients yields good functional and cosmetic results. However, an insight into the complications associated with extended use of the mega prosthesis is needed. Prolonged survival after bone tumors is associated with surgical, medical and psychological challenges.

Objectives:To evaluate the efficacy of shortduration, open-ended ureteral catheter drainage as a replacement to indwelling stent, and to study the effect of tamsulosin on stent-induced pain and storage symptoms following uncomplicated ureteroscopic removal of stones.Design: Prospective randomised study.Setting: School of Medical Sciences and Research, Sharda University, Greater Noida, India. Patients:Patients who underwent ureteroscopic removal of stones for lower ureteral stones between November 2011 and January 2014 were randomly assigned into three groups. Patients in group 1 (n=33) were stented with 5-French double J stent for 2 weeks. Patients in group 2 (n=35) were administered tablet tamsulosin 0.4 mg once daily for 2 weeks in addition to stenting, and those in group 3 (n=31) underwent 5-French open-ended ureteral catheter drainage for 48 hours. Main outcome measures:All patients were evaluated for flank pain using visual analogue scale scores at days 1, 2, 7, and 14, and for storage (irritative) bladder symptoms using International Prostate Symptom Score on days 7 and 14, and for quality-of-life score (using International Prostate Symptom Score) on day 14.Comparison of efficacy and tolerance of shortduration open-ended ureteral catheter drainage and tamsulosin administration to indwelling double J stents following ureteroscopic removal of stones New knowledge added by this study • This study shows that short-duration (up to 48 hours) ureteral drainage following ureteroscopic removal of stones (URS) has better efficacy and tolerance than indwelling stent placement with respect to the need for postoperative drainage. Hence, this can be a replacement for double J stenting.• Routine tamsulosin administration in patients with indwelling stents following URS has beneficial effects not only on irritative bladder symptoms but also on flank pain (both persistent and voiding). Implications for clinical practice or policy • Replacement of stents with short-duration open-ended ureteral catheter drainage provides early and more rehabilitation to the patients following URS. This is a viable option because there is no need for follow-up for stent-related symptoms, or maintaining records for planning its removal (no lost or retained stents).• It avoids a second invasive endoscopic procedure of stent removal, thereby reducing the medical and financial burden on the patient (especially important in developing countries). Patients are more likely to undergo URS again if required in the future (with stone recurrence) than opt for less effective or expensive choices like medical management, shock wave lithotripsy, or alternative forms of medicine.• In stented patients, tamsulosin administration improves the overall quality of life, and makes the period with stent in situ more bearable and asymptomatic.