Type II diabetes mellitus (T2DM) is a chronic disease that develops due to defective insulin secretion and is frequently associated with insulin resistance. It is also characterized by progressively decreasing beta-cell function over time. As a manifestation of symptoms is not always the case, DM is primarily diagnosed on the basis of some form of measurement of blood glucose. Sodium-glucose cotransporter 2 (SGLT2) inhibitors enhance urinary glucose excretion, which consequently reduces hyperglycemia. They exert favorable effects on various biomarkers, including blood glucose, body weight, blood pressure, albuminuria, and fatty liver. In contrast, dipeptidyl peptidase-4 (DPP-4) inhibitors decrease glycaemic variability by stimulating glucose-dependent insulin secretion. Material and Methods: This is a Prospective, randomized, Open-label was conducted in Type 2 DM patients attending the outpatient department of Medicine in Index Medical College and Hospital over a period of 2 years. All the Type 2 DM patients attending outpatient department (OPD) of Medicine were randomly divided into Dapagliflozin Group and Sitagliptin Group. The treatment drug (dapagliflozin 5.0 mg/day and sitagliptin 50 mg/day) was administered for 12 weeks. Follow-up visits were scheduled at the end of every month for 12 weeks for assessment, including measurement of weight and general and systemic examination. The following laboratory investigation was performed on sample of Type 2 DM patients before and after Dapagliflozin and Sitagliptin therapy. Results The changes in glycemic and metabolic parameters from baseline to week 12 in the two study groups. The mean ± SD change in HbA1c from baseline to 12 weeks were 1.95 ± 0.94% and 2.71 ± 0.54 in the dapagliflozin and sitagliptin groups, respectively. The changes in the time courses of Fasting plasma glucose at baseline and at week 12 in the two study groups are shown in Table 3. The mean ± SD change in Fasting plasma glucose from baseline to week 12 were 123.9 ± 3.4 and 45.0 ± 6.4 in the dapagliflozin and sitagliptin groups, respectively. The changes in glycemic and metabolic parameters from baseline to week 12 in the two study groups. The mean ± SD change in Fasting plasma insulin from baseline to 12 weeks were 2.08 ± 0.76 and 2.37 ± 0.44 in the dapagliflozin and sitagliptin groups, respectively. Conclusion Although dapagliflozin and sitagliptin provided similar effects on glycemic control with avoidance of hypoglycemic episodes, adequate loss in body weight occurred significantly more frequently in the dapagliflozin group. Additionally, various cardiometabolic indices improved to a significantly greater extent in the dapagliflozin group than in the sitagliptin group
Laparoscopic cholecystectomy (LC) has emerged as the gold standard for the surgical management of symptomatic gallstone disease and cholecystitis, offering advantages such as reduced postoperative pain, shorter hospital stays, and faster recovery times when compared to open cholecystectomy (OC)[1],[2]. Despite these benefits, the procedure is not without challenges, notably the risk of conversion from laparoscopic to open surgery due to various intraoperative difficulties[3]. The decision to convert is multifactorial, influenced by factors such as the severity of inflammation, anatomical variations, and the presence of complications like gallbladder perforation or injury to the biliary tree[4]. Therefore, a reliable and standardized method for grading the operative findings at LC could provide significant benefits in predicting the likelihood of conversion, enhancing surgical planning, and improving patient outcomes.
The complexity of operative findings in laparoscopic cholecystectomy varies widely, ranging from mild, chronic cholecystitis to acute, gangrenous forms of the disease, each presenting its unique set of challenges[5]. Historically, the assessment of these findings has been subjective, with significant variability in reporting and decision-making among surgeons[6]. This lack of standardization complicates the ability to accurately predict surgical outcomes, including the risk of conversion to OC and postoperative complications. Furthermore, the absence of a universally accepted grading systemhampers the comparison of surgical data across studies and institutions, limiting the advancement of surgical techniques and patient care protocols[7].
Recognizing these challenges, the present study aims to develop and validate a new scoring system for grading operative findings at laparoscopic cholecystectomy. This system seeks to quantify the severity of cholecystitis observed during surgery, providing a standardized method for assessing operative difficulties. The objectives of this study are twofold: firstly, to establish a scoring system that accurately reflects the complexity of operative findings, facilitating a more standardized approach to reporting and decision-making in laparoscopic cholecystectomy; and secondly, to evaluate the utility of this scoring system in predicting the need for conversion to open cholecystectomy, thereby enhancing preoperative planning and patient counseling.
The proposed scoring system is based on a comprehensive review of the literature, identifying key factors that influence operative difficulty and the likelihood of conversion. These factors include the degree of gallbladder inflammation, the presence of adhesions, gallbladder wall thickness, and the visibility of critical anatomical landmarks[8],[9]. By grading these elements, the scoring system aims to provide a quantitative measure of operative complexity, offering a predictive tool for surgeons to assess the risk of conversion and potentially reduce the incidence of intraoperative complications.
To validate the proposed scoring system, a prospective study will be conducted, applying the scoring system to a cohort of patients undergoing laparoscopic cholecystectomy. The outcomes of this study will include the accuracy of the scoring system in predicting conversion to open surgery, its correlation with operative time, and its association with postoperative complications. Through this rigorous evaluation, the study aims to demonstrate the clinical utility of the scoring system, supporting its adoption as a standard tool in the preoperative assessment for laparoscopic cholecystectomy.
The development of a standardized scoring system for operative findings at laparoscopic cholecystectomy represents a significant advance in the field of minimally invasive surgery. By providing a quantitative method for grading the severity of cholecystitis, this system has the potential to improve surgical planning, enhance patient safety, and facilitate the comparison of surgical outcomes across different settings. Ultimately, the adoption of such a system could lead to better surgical decision-making, reduced rates of conversion to open cholecystectomy, and improved patient outcomes in the management of gallstone disease.
Aims and Objectives
The primary aim of the study was to meticulously analyze the efficacy of a novel scoring system designed for the operative findings observed during laparoscopic cholecystectomy procedures. This scoring system sought to standardize the grading of cholecystitis by categorizing the severity of operative findings, thereby facilitating a more systematic approach to predicting the need for conversion from laparoscopic to open cholecystectomy. The general objective was to scrutinize this scoring system to standardize the degree of cholecystitis observed during surgery, while the specific objective focused on utilizing this system to anticipate the likelihood of converting laparoscopic procedures to open surgery.
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