The most frequent cause of infectious disease-related mortality globally is tuberculosis (TB), a ... more The most frequent cause of infectious disease-related mortality globally is tuberculosis (TB), a multisystemic disease with a wide range of presentations and symptoms. Around 12% of extrapulmonary TB cases and 1–3% of all TB cases are caused by abdominal TB. The issue of antituberculosis drug-induced liver injury (ATLI), which has long been a challenge in the management of TB infection, is one of increased significance. The major steps to reduce the occurrence of ATLI are to identify the possible risk factors of hepatotoxicity and to provide an appropriate weight-based anti-tuberculosis treatment (ATT). This case report clarifies the significance of appropriate weight-based dosing of ATT, particularly in a post-operative environment as evidenced in this instance where the patient experienced considerable post-operative weight loss.
Background: Minimally invasive surgery has recently become the approach of choice for surgeons fo... more Background: Minimally invasive surgery has recently become the approach of choice for surgeons for inguinal hernia repair. Subsequent to excellent visualisation of the preperitoneal space by high definition and 4K systems during laparoscopy and robotic surgery, as well as increasing use of multi detector CT scans to visualise abdomen, our knowledge of the anatomy of the posterior view of inguinal region has been enhanced. However, recurrence after surgery for groin hernia continues to be an issue during its learning curve especially for laparoscopic repair. One cause for recurrence is the infolding of the mesh after its placement in the preperitoneal space. A reason for this is inadequate dissection of the peritoneal fold especially inferomedially. The peritoneum has to be dissected inferomedially till the point where the vas deferens turns medially. During the course of a randomised study done to compare Transabdominal preperitoneal mesh repair with Totally extraperitoneal mesh rep...
International Journal for Scientific Research and Development, 2016
Data security and privacy are crucial issues to be addressed for assuring a successful deployment... more Data security and privacy are crucial issues to be addressed for assuring a successful deployment of biometrics-based recognition systems in real life applications. In this paper, we present a highly efficient and secured authentication scheme by online verification of signature. This authentication scheme is very simple and can be used for securing the applications and various elements which can be accessed and interfaced by touch panel’s inputs. This authentication scheme is very simple and can be used for securing the applications and various elements which can be accessed and interfaced by touch panel’s inputs.
Background: After decades of debate and controversy, the short-term benefits and at least equival... more Background: After decades of debate and controversy, the short-term benefits and at least equivalent long-term outcomes of laparoscopic colon surgery compared to open surgery has now been well established. Methods: In this article, short- and medium -term outcomes of patients undergoing laparoscopic colorectal surgery for cancer in a tertiary care hospital is analysed. A retrospective analysis of prospectively collected data of all patients who had laparoscopic management of colorectal cancer (CRC) for 3 years was done. Patients were followed up for 2 years after treatment. The prospectively collected data was analysed to find out the incidence of complications, local or distant metastases and the survival rates. Results: There were 65 patients who underwent laparoscopic surgery among 120 patients who had treatment for colorectal carcinoma in the study period. The 26 patients underwent low anterior resection followed by 14 patients and 13 patients undergoing left colonic and right...
Although colorectal cancer (CRC) may not be uncommon in India, accurate data regarding its demogr... more Although colorectal cancer (CRC) may not be uncommon in India, accurate data regarding its demographics and surgical outcomes is sparse. With an aim to assess demographics and perioperative outcomes of CRC in Kerala, all members of Association of Surgical Gastroenterologists of Kerala (ASGK) were invited to participate in a registry. Data of operated cases of CRC were entered on a web-based questionnaire by participating members from January 2016. Analysis of accrued data until March 2018 was performed. From 25 gastrointestinal surgical centers in Kerala, 15 ASGK member hospitals contributed 1018 CRC cases to the database (M:F 621:397; median age–63.5 years [15–95 years]). Rectum (39.88%) and rectosigmoid (20.33%) cancers comprised the majority of the patients. Among them, preoperative bowel preparation was given to 37.68%, minimally invasive surgery (MIS) was performed in 73%, covering stoma in 47% and had an overall leak rate of 3.58%. In colonic malignancies, MIS was performed in...
BACKGROUND. The role of Early Cholecystectomy (EC) in Acute Cholecystitis(AC) is well established... more BACKGROUND. The role of Early Cholecystectomy (EC) in Acute Cholecystitis(AC) is well established. However it may not be feasible in many situations because of various compounding factors. AIM. To study the outcome after different management strategies for AC and includes EC, Cholecystectomy after Cholecystostomy (CC) and Interval Cholecystectomy after conservative management(IC). MATERIALS AND METHODS. Primary and Secondary analysis of data of patients who were admitted with AC was done. The management strategy was based on the clinical,hematological and radiological findings. The quantitative data pertaining to the 3 groups were analysed using one-way ANOVA technique with unequal number of observations. Qualitative data were subjected to Chi square test . RESULTS The mean age of the patients who underwent IC, CC and EC were 54yrs, 63yrs and 50 yrs respectively (27- 80) and was significantly higher for CC group(p<0.05) .There was no significant difference between the three group...
Journal of The Academy of Clinical Microbiologists, 2020
Non-typhoidal Salmonella are important food-borne pathogens that are associated with gastroenteri... more Non-typhoidal Salmonella are important food-borne pathogens that are associated with gastroenteritis, bacteraemia and focal infections. Salmonella enterica subspecies enterica serovar bareilly has been implicated in gastroenteritis and nosocomial infections. There are not much literature available on the hepatobiliary involvement by S. bareilly. We report a case of acute pancreatitis with pseudocyst. S. bareilly was isolated from blood and pseudocyst aspirate.
International Journal of Contemporary Medical Research [IJCMR], 2019
Introduction: Gastrinoma is a rare gastrin secreting neuroendocrine tumor. Clinical manifestation... more Introduction: Gastrinoma is a rare gastrin secreting neuroendocrine tumor. Clinical manifestations are nonspecific gastrointestinal (GI) symptoms or as Zollinger Ellison Syndrome(ZES) which often delays the diagnosis in majority of patients. Hence a high clinical index of suspicion is warranted in patients who present with nonspecific GI symptoms to rule out gastrinoma. Case report: We report a case of 55 year old female who presented with long standing dyspepsia and chronic diarrhoea and was diagnosed with Sporadic Duodenal Gastrinoma on detailed evaluation. She was treated with surgical resection and pathologically diagnosed as well differentiated neuroendocrine tumor, Gastrinoma-grade I after IHC analysis. Patient was relieved of her symptoms and became eugastrinemic after surgery. Conclusion: Any patient with refractory dyspepsia associated with long standing non specific abdominal symptoms should be evaluated for Gastrinoma and treated accordingly to avoid misdiagnosis and complications in the long run.
Laparoscopic repair of duodenal ulcer perforation has certain advantages over open repair. Howeve... more Laparoscopic repair of duodenal ulcer perforation has certain advantages over open repair. However, the conversion rate to open surgery is still high. The most common reason for conversion is inadequate localization of the ulcer perforation site during laparoscopy. Here, a technique is described which will aid in localizing the perforation, make suturing and repair easier, and helps in checking the integrity of the repair at the end of the procedure. This is done by compressing the gall bladder with an instrument like a laparoscopic fan retractor and simultaneously depressing the first part of the duodenum with another instrument. This results in bile flowing out through the perforation and simultaneously depressing the duodenum downward, making it more easily visible and making identification easier. Suturing is easier due to the liver also getting retracted simultaneously and more space being available consequently. Integrity of the anastomoses is also easily ascertained by this maneuver.
were involved in collecting and analyzing the data; Hussain M and Barreto SG were also involved i... more were involved in collecting and analyzing the data; Hussain M and Barreto SG were also involved in editing the manuscript; Doctor N designed and wrote the manuscript.
We report a 6-year-old girl who received a left-lobe live-related liver transplant for decompensa... more We report a 6-year-old girl who received a left-lobe live-related liver transplant for decompensated liver disease after a failed Kasai's surgery for biliary atresia. Preoperatively, her nails were white, dystrophic, brittle with severe onycholysis, clubbing and watch-glass deformities. Nail scrapings were negative for fungus. Five months after transplantation, her nails had become near normal. There is only one such documented case in literature on reversal of nail changes in an adult.
Background: Hepatic vein thrombosis (Budd-Chiari Syndrome) is a rare disorder resulting from an o... more Background: Hepatic vein thrombosis (Budd-Chiari Syndrome) is a rare disorder resulting from an obstruction to the outflow of blood from the liver. Early decompression is needed to prevent liver dysfunction and death. Radiological intervention includes angioplasty of stenosis and webs and the placement of transjugular intrahepatic portosystemic shunts (TIPPS). Side-to-side portacaval shunt (SSPCS) remains the gold standard for achieving good long-term results. Case presentation: A 37-year old lady underwent side-to-side portacaval shunt for Budd Chiari syndrome. She had early shunt blockage and this was successfully treated with the placement of a metallic stent across the shunt. Conclusion: At five years, she remains asymptomatic, with normal liver functions, no ascites, and normal flow through the stent on Colour Doppler examination.
The most frequent cause of infectious disease-related mortality globally is tuberculosis (TB), a ... more The most frequent cause of infectious disease-related mortality globally is tuberculosis (TB), a multisystemic disease with a wide range of presentations and symptoms. Around 12% of extrapulmonary TB cases and 1–3% of all TB cases are caused by abdominal TB. The issue of antituberculosis drug-induced liver injury (ATLI), which has long been a challenge in the management of TB infection, is one of increased significance. The major steps to reduce the occurrence of ATLI are to identify the possible risk factors of hepatotoxicity and to provide an appropriate weight-based anti-tuberculosis treatment (ATT). This case report clarifies the significance of appropriate weight-based dosing of ATT, particularly in a post-operative environment as evidenced in this instance where the patient experienced considerable post-operative weight loss.
Background: Minimally invasive surgery has recently become the approach of choice for surgeons fo... more Background: Minimally invasive surgery has recently become the approach of choice for surgeons for inguinal hernia repair. Subsequent to excellent visualisation of the preperitoneal space by high definition and 4K systems during laparoscopy and robotic surgery, as well as increasing use of multi detector CT scans to visualise abdomen, our knowledge of the anatomy of the posterior view of inguinal region has been enhanced. However, recurrence after surgery for groin hernia continues to be an issue during its learning curve especially for laparoscopic repair. One cause for recurrence is the infolding of the mesh after its placement in the preperitoneal space. A reason for this is inadequate dissection of the peritoneal fold especially inferomedially. The peritoneum has to be dissected inferomedially till the point where the vas deferens turns medially. During the course of a randomised study done to compare Transabdominal preperitoneal mesh repair with Totally extraperitoneal mesh rep...
International Journal for Scientific Research and Development, 2016
Data security and privacy are crucial issues to be addressed for assuring a successful deployment... more Data security and privacy are crucial issues to be addressed for assuring a successful deployment of biometrics-based recognition systems in real life applications. In this paper, we present a highly efficient and secured authentication scheme by online verification of signature. This authentication scheme is very simple and can be used for securing the applications and various elements which can be accessed and interfaced by touch panel’s inputs. This authentication scheme is very simple and can be used for securing the applications and various elements which can be accessed and interfaced by touch panel’s inputs.
Background: After decades of debate and controversy, the short-term benefits and at least equival... more Background: After decades of debate and controversy, the short-term benefits and at least equivalent long-term outcomes of laparoscopic colon surgery compared to open surgery has now been well established. Methods: In this article, short- and medium -term outcomes of patients undergoing laparoscopic colorectal surgery for cancer in a tertiary care hospital is analysed. A retrospective analysis of prospectively collected data of all patients who had laparoscopic management of colorectal cancer (CRC) for 3 years was done. Patients were followed up for 2 years after treatment. The prospectively collected data was analysed to find out the incidence of complications, local or distant metastases and the survival rates. Results: There were 65 patients who underwent laparoscopic surgery among 120 patients who had treatment for colorectal carcinoma in the study period. The 26 patients underwent low anterior resection followed by 14 patients and 13 patients undergoing left colonic and right...
Although colorectal cancer (CRC) may not be uncommon in India, accurate data regarding its demogr... more Although colorectal cancer (CRC) may not be uncommon in India, accurate data regarding its demographics and surgical outcomes is sparse. With an aim to assess demographics and perioperative outcomes of CRC in Kerala, all members of Association of Surgical Gastroenterologists of Kerala (ASGK) were invited to participate in a registry. Data of operated cases of CRC were entered on a web-based questionnaire by participating members from January 2016. Analysis of accrued data until March 2018 was performed. From 25 gastrointestinal surgical centers in Kerala, 15 ASGK member hospitals contributed 1018 CRC cases to the database (M:F 621:397; median age–63.5 years [15–95 years]). Rectum (39.88%) and rectosigmoid (20.33%) cancers comprised the majority of the patients. Among them, preoperative bowel preparation was given to 37.68%, minimally invasive surgery (MIS) was performed in 73%, covering stoma in 47% and had an overall leak rate of 3.58%. In colonic malignancies, MIS was performed in...
BACKGROUND. The role of Early Cholecystectomy (EC) in Acute Cholecystitis(AC) is well established... more BACKGROUND. The role of Early Cholecystectomy (EC) in Acute Cholecystitis(AC) is well established. However it may not be feasible in many situations because of various compounding factors. AIM. To study the outcome after different management strategies for AC and includes EC, Cholecystectomy after Cholecystostomy (CC) and Interval Cholecystectomy after conservative management(IC). MATERIALS AND METHODS. Primary and Secondary analysis of data of patients who were admitted with AC was done. The management strategy was based on the clinical,hematological and radiological findings. The quantitative data pertaining to the 3 groups were analysed using one-way ANOVA technique with unequal number of observations. Qualitative data were subjected to Chi square test . RESULTS The mean age of the patients who underwent IC, CC and EC were 54yrs, 63yrs and 50 yrs respectively (27- 80) and was significantly higher for CC group(p<0.05) .There was no significant difference between the three group...
Journal of The Academy of Clinical Microbiologists, 2020
Non-typhoidal Salmonella are important food-borne pathogens that are associated with gastroenteri... more Non-typhoidal Salmonella are important food-borne pathogens that are associated with gastroenteritis, bacteraemia and focal infections. Salmonella enterica subspecies enterica serovar bareilly has been implicated in gastroenteritis and nosocomial infections. There are not much literature available on the hepatobiliary involvement by S. bareilly. We report a case of acute pancreatitis with pseudocyst. S. bareilly was isolated from blood and pseudocyst aspirate.
International Journal of Contemporary Medical Research [IJCMR], 2019
Introduction: Gastrinoma is a rare gastrin secreting neuroendocrine tumor. Clinical manifestation... more Introduction: Gastrinoma is a rare gastrin secreting neuroendocrine tumor. Clinical manifestations are nonspecific gastrointestinal (GI) symptoms or as Zollinger Ellison Syndrome(ZES) which often delays the diagnosis in majority of patients. Hence a high clinical index of suspicion is warranted in patients who present with nonspecific GI symptoms to rule out gastrinoma. Case report: We report a case of 55 year old female who presented with long standing dyspepsia and chronic diarrhoea and was diagnosed with Sporadic Duodenal Gastrinoma on detailed evaluation. She was treated with surgical resection and pathologically diagnosed as well differentiated neuroendocrine tumor, Gastrinoma-grade I after IHC analysis. Patient was relieved of her symptoms and became eugastrinemic after surgery. Conclusion: Any patient with refractory dyspepsia associated with long standing non specific abdominal symptoms should be evaluated for Gastrinoma and treated accordingly to avoid misdiagnosis and complications in the long run.
Laparoscopic repair of duodenal ulcer perforation has certain advantages over open repair. Howeve... more Laparoscopic repair of duodenal ulcer perforation has certain advantages over open repair. However, the conversion rate to open surgery is still high. The most common reason for conversion is inadequate localization of the ulcer perforation site during laparoscopy. Here, a technique is described which will aid in localizing the perforation, make suturing and repair easier, and helps in checking the integrity of the repair at the end of the procedure. This is done by compressing the gall bladder with an instrument like a laparoscopic fan retractor and simultaneously depressing the first part of the duodenum with another instrument. This results in bile flowing out through the perforation and simultaneously depressing the duodenum downward, making it more easily visible and making identification easier. Suturing is easier due to the liver also getting retracted simultaneously and more space being available consequently. Integrity of the anastomoses is also easily ascertained by this maneuver.
were involved in collecting and analyzing the data; Hussain M and Barreto SG were also involved i... more were involved in collecting and analyzing the data; Hussain M and Barreto SG were also involved in editing the manuscript; Doctor N designed and wrote the manuscript.
We report a 6-year-old girl who received a left-lobe live-related liver transplant for decompensa... more We report a 6-year-old girl who received a left-lobe live-related liver transplant for decompensated liver disease after a failed Kasai's surgery for biliary atresia. Preoperatively, her nails were white, dystrophic, brittle with severe onycholysis, clubbing and watch-glass deformities. Nail scrapings were negative for fungus. Five months after transplantation, her nails had become near normal. There is only one such documented case in literature on reversal of nail changes in an adult.
Background: Hepatic vein thrombosis (Budd-Chiari Syndrome) is a rare disorder resulting from an o... more Background: Hepatic vein thrombosis (Budd-Chiari Syndrome) is a rare disorder resulting from an obstruction to the outflow of blood from the liver. Early decompression is needed to prevent liver dysfunction and death. Radiological intervention includes angioplasty of stenosis and webs and the placement of transjugular intrahepatic portosystemic shunts (TIPPS). Side-to-side portacaval shunt (SSPCS) remains the gold standard for achieving good long-term results. Case presentation: A 37-year old lady underwent side-to-side portacaval shunt for Budd Chiari syndrome. She had early shunt blockage and this was successfully treated with the placement of a metallic stent across the shunt. Conclusion: At five years, she remains asymptomatic, with normal liver functions, no ascites, and normal flow through the stent on Colour Doppler examination.
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Papers by Sujith Philip