Biomedical subjects

V Datta

Publications and source records attributed to V Datta.

At least 19 recordsLinked to original sources

PubMed2006

Objective assessment comparing hand-assisted and conventional laparoscopic surgery.

BACKGROUND: Although several reports have subjectively highlighted the benefits of hand-assisted as compared with conventional laparoscopic surgery, there has been little objective analysis comparing these two techniques. METHODS: For this study, 12 trained laparoscopic surgeons completed standardized knot-tying and dissection tasks in a laparoscopic trainer using both hand-assisted (HandPort) and traditional laparoscopic techniques. Motion analysis with the Imperial College Surgical Assessment Device was used to assess performance, measuring the number of movements made, the path length of hand travel, and the time taken. Mann-Whitney U tests were used to compare hand-assisted (HA) and conventional laparoscopic (L) performance. A p value less than 0.05 was deemed significant. Means and standard deviations are shown in the results. RESULTS: In knot tying, for both the dominant and nondominant hands, hand-assisted rather than conventional laparoscopic techniques resulted in reduced movements (dominant: HA [114 +/- 50] vs L [321 +/- 118, p < 0.001], nondominant: HA [89 +/- 36] vs L [296 +/- 96, p < 0.001]); path length (dominant: HA [1,083 +/- 680 mm] vs L [3,637 +/- 1,852 mm, p < 0.001], nondominant: HA [549 +/- 339 mm] vs L [2,556 +/- 1,042 mm, p < 0.001]); and time taken (HA [162 +/- 50 s] vs L [460 +/- 179 s, p < 0.001]). However, there was no statistical difference for any measured variable with respect to the dissection task. CONCLUSION: Hand-assisted surgery significantly improves the knot-tying ability among trained laparoscopic surgeons. However, there appears to be no improvement in performance for this specific dissection task.

Dissection↗

PubMed2006

Technical skills examination for general surgical trainees.

BACKGROUND: The technical skills of surgical trainees are difficult to assess and compare objectively. This study involved a structured, multistation, technical skills examination that enables the stratification of surgical trainees. METHODS: Twenty-two surgeons (five basic surgical trainees, eight junior specialist trainees, four senior specialist trainees and five consultants) participated in the study. All undertook a five-station technical skills examination consisting of three synthetic simulations (bowel anastomosis, vascular anastomosis, saphenofemoral dissection) and two virtual reality-based (flexible sigmoidoscopy and laparoscopy) assessment stations. Video-based analyses and in-built computer scoring were used to measure each surgeon's performance. The mean rank was determined for each variable, and the sum of the mean ranks produced a total score. RESULTS: There was a significant improvement in overall performance with increasing seniority (P<0.001). Significant differences were observed between basic surgical trainees and junior specialist trainees (P=0.019), and between junior and senior specialist trainees (P=0.048), but not between senior trainees and consultants. CONCLUSION: This examination successfully differentiated surgical skill, both between surgeons with different grades of experience and within the target study group of specialist trainees. The examination is feasible in terms of the timeframe needed to complete tasks, cost, and efficiency in performing video-based assessments.

Clinical Competence↗

PubMed2004

Qualitative and quantitative analysis of the learning curve of a simulated surgical task on the da Vinci system.

BACKGROUND: Robotic telemanipulation systems provide solutions to the problems of less dexterity and visual constraints of minimally invasive surgery (MIS). However, their influence over surgeons' dexterity and learning curve needs to be assessed. We present motion analysis as an objective method to measure performance and learning progress.METHODS. Thirteen surgeons completed five synthetic small bowel anastomoses using the da Vinci system. Objective Structured Assessment of Technical Skills (OSATS) allowed qualitative analysis. Quantitative analysis used API software of the system to retrieve real-time robotic signal data of time, path length, and number of movements. Wilcoxon signed ranks test was used for statistical analysis. A p value <0.05 was considered significant.RESULTS. OSATS global scores were 18.6 points for the first attempt and 26 for the fifth attempt ( p < 0.02, Cronbach's alpha = 0.894). Paired data of motion analysis for attempts 1 vs 5 showed significant change: time taken 3507 sec and 2287 sec ( p < 0.008), total number of movements 2411 and 1387 ( p = 0.01), total path length 21,630 cm and 13,941 cm ( p = 0.01).CONCLUSIONS. A rapid learning curve to a competent level using the da Vinci system is possible aided by the system's intuitive motion. Motion analysis is a useful tool to measure performance in the da Vinci system compared to OSATS and time alone.

Anastomosis, Surgical↗

PubMed2004

Graves' disease in DiGeorge syndrome: patient report with a review of endocrine autoimmunity associated with 22q11.2 deletion.

DiGeorge syndrome, which falls within a wider phenotypic spectrum associated with deletions of 22q11.2, is associated with a number of endocrine disorders. These include hypoparathyroidism, hypothyroidism and growth hormone deficiency. We report an unusual case of autoimmune hyperthyroidism (Graves' disease) presenting in a 3 year-old male with DiGeorge syndrome. The development of endocrine specific autoimmune disease in a syndrome associated with immune deficiency and the spectrum of endocrine autoimmunity associated with deletions of 22q11.2 are described. Paediatricians and patients with 22q11.2 deletions should be particularly aware of the risks of developing disorders of thyroid function.

Antithyroid Agents↗

PubMed2003

Suppression of TSH in congenital hypothyroidism is significantly related to serum levels and dosage of thyroxine.

AIM: To assess thyrotropin (thyroid-stimulating hormone; TSH) suppression and serum thyroxine (T(4)) concentrations in infants with congenital hypothyroidism in relation to T(4) dose and pretreatment parameters. METHOD: A retrospective study of all cases treated in a single centre since neonatal screening began was performed. RESULTS: In 54 infants treated with a mean daily T(4) dose of 9.8 microg/kg, the TSH concentration was suppressed (<6 mU/l) in 65% of the cases by 6 months with the serum T(4) level at the upper end of the infant reference range. Infants who suppressed their TSH later did not differ in pretreatment serum TSH or T(4) concentration. T(4) dose and serum T(4) level were lower in infants whose TSH was not suppressed. CONCLUSIONS: TSH suppression in congenital hypothyroidism is significantly related to serum levels and dosage of T(4). We suggest that a delay in TSH suppression is mainly due to undertreatment.

Aging↗

PubMed2002

The PreOp flexible sigmoidoscopy trainer. Validation and early evaluation of a virtual reality based system.

AIM: To demonstrate face and construct validity of a computer based flexible sigmoidoscopy trainer. METHODS: The PreOp (Immersion Medical, USA) system is a virtual reality based flexible sigmoidoscopy simulator. The system records several performance parameters, such as percentage of colonic mucosa visualized, time taken, and pathlength of endoscope travel. Forty-five subjects were divided into three groups: novice (never performed a lower GI endoscopy), intermediate (5-50 examinations), and trained (greater than 200 examinations). After initial familiarization subjects were assessed three times on a case module. Results showed a nonparametric distribution. RESULTS: There was a significant difference between all three groups with respect to percentage of mucosa visualized (novice 71.0 +/- 3.7%, intermediate 77.3 +/- 5.6%, expert 84.8 +/- 4.6%, Kruskal-Wallis p <0.001) and efficiency ratio (%mucosa/time, novice 0.163 +/- 0.055, intermediate 0.259 +/- 0.07, expert 0.306 +/- 0.058, p <0.001). The novice group was also slower and had a lower pathlength of instrument travel compared to the others. CONCLUSION: PreOp virtual reality simulator is a valid discriminator of flexible sigmoidoscopic experience. Its effect on training needs to be explored.

Clinical Competence↗

PubMed2002

Practice distribution in procedural skills training: a randomized controlled trial.

BACKGROUND: "Massed" and "distributed" practice are important concepts in the acquisition of fine motor skills, and may be important in training in procedural skills. METHODS: A total of 41 novice subjects were recruited and randomized to three groups to receive training on the MIST VR surgical trainer. There were 14 subjects in each of groups A and B and 13 subjects in group C. Training comprised 20 min of massed practice for group A, 20 min of distributed practice in 5 min blocks for group B, and 15 min of distributed practice in 5-min blocks for group C. Following the training period, all groups had a 5-min rest period, followed by a 5-min retention test. Comparisons were made between groups A and B, and groups A and C. RESULTS: There was a statistically significant difference between groups A and B (p = 0.023) on the retention test, with group B performing better. The increment between the groups was 19% for the overall score on MIST VR. There were also significant differences in the time taken to complete the task during the training phase (p = 0.023, training blocks 3 and 4). Graphical representation suggests no effect between groups A and C, and statistical analysis confirms that the observed difference in median score is not significant. CONCLUSION: This study demonstrates a benefit for distributed practice over massed practice in learning laparoscopic surgical skills on the MIST VR surgical trainer. This finding has potential implications for skills training in all areas of medicine.

Adult↗

PubMed2001

Maternal knowledge, attitude and practices towards diarrhea and oral rehydration therapy in rural Maharashtra.

OBJECTIVE: A cross sectional hospital based survey was undertaken in rural area of Wardha District of Maharashtra, to assess the knowledge, attitude and practices of mothers regarding diarrhea and oral rehydration therapy. METHODS: 75 mothers of under-five children participated [corrected] in the study. They were interviewed by an interviewer using a pre-designed and pre-tested questionnaire. RESULTS: 69.3% of them had a per-capita income of less than rupees 500 [corrected]. 68% of mothers knew the correct definition of diarrhea but only 5.3% of them were aware that diarrhea leads to dehydration [corrected]. 90.7% of mothers were aware of ORT and ORS was easily available to the majority, but only 60% of mothers [corrected] practiced ORT. Nearly 1/3rd of mothers were mixing ORS in the wrong fluid. Nearly half of the mothers were not practicing adequate hand washing, 32% were using feeding bottles [corrected]. CONCLUSION: The maternal knowledge towards diarrhea and ORS was inadequate in the population studied [corrected] and there was a big gap between actual and desired practices.

Child, Preschool↗

PubMed2001

The challenge of objective assessment of surgical skill.

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Clinical Competence↗

PubMed2001

The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model.

BACKGROUND: Technical performance has traditionally been assessed subjectively within the operating theater, with few successful attempts at objective analysis. The Imperial College Surgical Assessment Device (ICSAD) has already been shown to be a valid quantitative measure of dexterity in laparoscopic surgical simulation. We describe its application to the assessment of open surgical procedures. STUDY DESIGN: Fifty-one participants were recruited from four different levels of general surgical experience: basic surgical trainees (n = 12), junior specialist registrars (n = 13), senior specialist registrars (n = 13), and consultants (n = 13). They completed two tasks: a small bowel anastomosis and a vein patch insertion into an artery. Surgical performance was measured with the Imperial College Surgical Assessment Device, a motion analysis system that measures the number of hand movements made and time taken to complete a task. The four groups were compared statistically using the Kruskal-Wallis test (K-W). Pairwise group comparisons used the Mann-Whitney U test and p values were adjusted for multiple comparisons to determine the statistical significance of these comparisons. RESULTS: Mean values for number of movements and time (secs) for small bowel anastomosis were 2,080/1,236 (basic surgical trainees), 1,673/1,016 (junior specialist registrars), 1,375/862 (senior specialist registrars), and 1,337/782 (consultants), respectively. Comparison of the medians by K-W revealed a p < 0.001 for each variable (No. of movements, time), respectively. Mean vein patch insertion results were 1,653/1,258, 1,297/1,006, 1,090/912, and 925/736 for each of the four groups. Again, comparison of the medians by K-W revealed a p < 0.001 for each variable. CONCLUSIONS: These findings suggest that hand motion analysis may be an effective objective measure of dexterity in open surgical simulation.

Anastomosis, Surgical↗

PubMed2001

Hyperinsulinism in short-chain L-3-hydroxyacyl-CoA dehydrogenase deficiency reveals the importance of beta-oxidation in insulin secretion.

A female infant of nonconsanguineous Indian parents presented at 4 months with a hypoglycemic convulsion. Further episodes of hypoketotic hypoglycemia were associated with inappropriately elevated plasma insulin concentrations. However, unlike other children with hyperinsulinism, this patient had a persistently elevated blood spot hydroxybutyrylcarnitine concentration when fed, as well as when fasted. Measurement of the activity of L-3-hydroxyacyl-CoA dehydrogenase in cultured skin fibroblasts with acetoacetyl-CoA substrate showed reduced activity. In fibroblast mitochondria, the activity was less than 5% that of controls. Sequencing of the short-chain L-3-hydroxyacyl-CoA dehydrogenase (SCHAD) genomic DNA from the fibroblasts showed a homozygous mutation (C773T) changing proline to leucine at amino acid 258. Analysis of blood from the parents showed they were heterozygous for this mutation. Western blot studies showed undetectable levels of immunoreactive SCHAD protein in the child's fibroblasts. Expression studies showed that the P258L enzyme had no catalytic activity. We conclude that C773T is a disease-causing SCHAD mutation. This is the first defect in fatty acid beta-oxidation that has been associated with hyperinsulinism and raises interesting questions about the ways in which changes in fatty acid and ketone body metabolism modulate insulin secretion by the beta cell. The patient's hyperinsulinism was easily controlled with diazoxide and chlorothiazide.

3-Hydroxyacyl CoA Dehydrogenases↗

PubMed2000

Ellis-Van Creveld syndrome associated with nodular sclerosing Hodgkin's disease and nephrotic syndrome.

An 11-year-old male child presented with multiple congenital anomalies, gradually increasing swelling on the left side of neck for one month along with generalized swelling of body and passage of scanty urine for fifteen days. On examination, the child had multiple congenital anomalies and cervical lymphadenopathy. Cardiac examination revealed a pansystolic murmur grade III/VI in left lower parasternal area. Laboratory evaluation revealed significant hypoalbuminemia and hypercholesterolemia, 24 hours urinary protein was 116 mg/hour/m2. Histopathological examination of left cervical lymphnode revealed Hodgkin's disease (Nodular Sclerosing type), 2D echocardiography revealed presence of a single atrium. A diagnosis of Ellis-van Creveld syndrome with nodular sclerosing Hodgkin's disease and nephrotic syndrome was kept. This association, to the best of our knowledge has not been previously reported.

Child↗

PubMed2000

Genetic locus for streptolysin S production by group A streptococcus.

Group A streptococcus (GAS) is an important human pathogen that causes pharyngitis and invasive infections, including necrotizing fasciitis. Streptolysin S (SLS) is the cytolytic factor that creates the zone of beta-hemolysis surrounding GAS colonies grown on blood agar. We recently reported the discovery of a potential genetic determinant involved in SLS production, sagA, encoding a small peptide of 53 amino acids (S. D. Betschel, S. M. Borgia, N. L. Barg, D. E. Low, and J. C. De Azavedo, Infect. Immun. 66:1671-1679, 1998). Using transposon mutagenesis, chromosomal walking steps, and data from the GAS genome sequencing project (www.genome.ou.edu/strep. html), we have now identified a contiguous nine-gene locus (sagA to sagI) involved in SLS production. The sag locus is conserved among GAS strains regardless of M protein type. Targeted plasmid integrational mutagenesis of each gene in the sag operon resulted in an SLS-negative phenotype. Targeted integrations (i) upstream of the sagA promoter and (ii) downstream of a terminator sequence after sagI did not affect SLS production, establishing the functional boundaries of the operon. A rho-independent terminator sequence between sagA and sagB appears to regulate the amount of sagA transcript produced versus transcript for the entire operon. Reintroduction of the nine-gene sag locus on a plasmid vector restored SLS activity to the nonhemolytic sagA knockout mutant. Finally, heterologous expression of the intact sag operon conferred the SLS beta-hemolytic phenotype to the nonhemolytic Lactococcus lactis. We conclude that gene products of the GAS sag operon are both necessary and sufficient for SLS production. Sequence homologies of sag operon gene products suggest that SLS is related to the bacteriocin family of microbial toxins.

Amino Acid Sequence↗

PubMed2000