Operating Room Waste Generated From Corneal and Conjunctival Surgeries.

PURPOSE: The purposes of this study were to bring awareness to the surgical waste generated from corneal and conjunctival surgeries and to compare those findings with the waste generated from cataract surgeries. METHODS: This was an observational prospective pilot cohort study at a tertiary corneal/anterior segment private practice. All waste related to cataract, cornea, and conjunctival surgical procedures (including anesthesia waste and corneal tissue storage) was weighed. The primary outcome was total waste generated while other outcomes included surgical setting (ambulatory surgical center, hospital, and minor operating room) and comparison of corneal/conjunctival surgeries with cataract surgery. RESULTS: Surgical waste data were collected from 119 surgeries (82 corneal/conjunctival surgeries and 37 cataract surgeries). Hospital surgeries produced more waste than ambulatory surgical center and minor operating room surgeries. Penetrating keratoplasty (2.22 kg, P = 0.483) and Descemet stripping only (2.11 kg, P = 0.326) procedures generated comparable mean waste with cataract surgery (2.07 kg) while endothelial keratoplasties produced more (P < 0.001, 0.002). (Deep) anterior lamellar keratoplasty results depended on the surgical setting. All conjunctival surgeries produced less waste than cataract surgery. CONCLUSIONS: In comparison with cataract surgery, keratoplasties overall produced comparable or more waste while conjunctival surgeries produced less waste. The surgical setting and type of anesthesia played a substantial role in the amount of waste generated. Assessing waste production from different ophthalmic surgeries may increase awareness of the negative environmental impact of surgical waste and promote practice or legal changes to improve environmental sustainability.

Retrospective Study of Normal Variations in Vertebral Artery on Computed Tomography Angiography With Special Emphasis on Relevant Embryology.

Background The vertebral arteries (VA) nourish the posterior cerebral circulation. Planning neck and cervical interventions like drilling and instrumentation, which involves VA manipulation, require an in-depth acquaintance with the normal and variant patterns encountered in the origin and course of the VA. Embryological events involved in forming these variant patterns can be correlated to their prior disposition in the lower vertebrate's understanding which becomes crucial while planning cervical interventions.  Study design This is a single-center, retrospective study.  Materials and methods The study involved 70 patients of both sexes and was done from September 2021 to February 2022 in the Department of Radiodiagnosis and Imaging at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Meghalaya, India. The CT angiographies were studied for variations of VA under V1 - from origin to entrance into the foramen transversarium (FT), V2 - part inside FT, V3 - from its exit from FT till it pierces the cranial dura mater, and V4 - intracranial part. Further, VA was observed for its origin, dominance, level of entry in FT, and any associated anomalies.  Results The VA was found mostly to be codominant. There was an opposite directional relationship between the basilar artery curvature and the dominance of VA. The association of ischemic events with hypoplastic VA was more on the left side (66.67%). Left VA originated from the aorta in 4.3% of subjects. One case presented a dual origin of VA. The abnormal origin of the LVA from the aorta showed a higher rate of abnormal entry into FT which was also found to be statistically significant.  Conclusion Our study identifies and documents the anatomical variations present in VA specific to the population of northeast India by CT angiography and thus provides a much-needed reference for the healthcare professionals working in the field of Head and Neck interventions by providing opportunities further to understand these patterns for better diagnostic and therapeutic outcomes.

Effect of lockdown amid second wave of COVID-19 on environmental noise scenario of the megacity Delhi, India.

This paper analyzes the impact of second wave of COVID-19 lockdown on environmental noise levels of 25 sites in Delhi city and compares the noise scenario during pre-lockdown, lockdown, and post-lockdown periods. The study utilized the noise monitoring data acquired from 25 real-time ambient noise monitoring stations, installed by the Delhi Pollution Control Committee, Delhi, at various sites throughout Delhi city. A significant reduction of up to 10 and 3 dB(A) in day and night equivalent noise levels, respectively, had been observed during the lockdown period as compared to the pre-lockdown and post-lockdown periods. The study also revealed that only nine sites, including four industrial and five commercial zone sites, complied with the ambient noise standards during lockdown period, and no silence or residential zone sites complied with the ambient noise standards even during the lockdown period. A roadmap for environmental noise management and control is suggested. The study also reports the community's perception toward the change in acoustic environment of Delhi city during the lockdown period by conducting an environmental noise perception survey. The present study should be helpful in devising noise control action plans and policy interventions for environmental noise management and control in the metropolitan city Delhi, India.

An Anatomical Study on the Measurement of Stature From Ulnar Length in the Adult Ethnic Khasi Tribal Population of the North Eastern Region of India.

Introduction The stature of an individual is an important parameter for establishing identification. The height of an individual can be indirectly estimated from different parts of the skeleton and such measurements are of great use in forensic science, anatomy, and anthropometry. This study was an attempt to formulate a linear regression equation for estimation of stature by measuring the ulnar length in the living adult Khasi population. Methods The study population consists of 164 subjects (Male: 118; Female: 46) between 25 and 45 years of age. The left and right ulnar lengths were measured from the tip of the olecranon process to the tip of the styloid process with the elbow flexed and palm spread over the opposite shoulder by a spreading caliper. The measurements of the stature of the volunteers were done in the standard anatomical standing position with a bared foot with the head in the Frankfort plane. The documented data were calculated by the standard statistical software. Results The height and ulnar length in males (160.85 ± 6.34 cm and 24.41 ± 1.10 cm, respectively) were found to be significantly (p < 0.001) higher than females (149.56 ± 2.95 cm and 22.58 ± 0.47 cm, respectively). Significant positive correlation coefficient (r) between height (cm) and ulnar length (cm) were observed in both males (r = 0.955, P < 0.001) and females (r = 0.915, P < 0.001), respectively. Conclusion The length of the ulna provides an accurate and reliable means in estimating the height of an individual; being almost a percutaneous bone, its length can be measured easily. The regression formulae that were derived in this study will be useful for clinicians, human anatomists, archeologists, anthropologists, and forensic experts.

L-cysteine whether a nutritional booster or a radical scavenger for Plasmodium.

INTRODUCTION: Plasmodium falciparum is the most noxious species among other Plasmodium species that cause malaria. Attention is required to understand more about the pathophysiology and parasite biology to obscure this disease. The fact is, very little is known about the nutritional requirement in sense of carbohydrate, lipid, nucleic acid, and amino acid metabolism that regulate the growth of parasite and out of this, studies related to the metabolism of amino acid are exceptionally limited. Out of several amino acids, L-cysteine is essential for the continuous erythrocytic growth of Plasmodium. However, the exact role of L-cysteine in regulating the growth of Plasmodium is unknown. Here, we tried to investigate how does L-cysteine affects the growth of Plasmodium in in vitro culture, and also the study was aimed to find whether there is a synergism with chloroquine on the Plasmodium growth in vitro. MATERIALS AND METHODS: Parasite inhibition assay based on schizont maturation inhibition following WHO protocol on P. falciparum chloroquine-sensitive strain (MRC-2) was employed to determine IC50 value and drug interaction pattern was shown through fractional inhibitory concentration index. RESULTS: Inhibitory effect of L-cysteine hydrochloride on Plasmodium growth was depicted with IC50 1.152 ± 0.287 µg/mL and the most synergistic pattern of interaction was shown with chloroquine. CONCLUSIONS: The present study anticipates two important findings, firstly inconsistent results from previous findings and secondly, synergistic effect with chloroquine suggests its potency that may be used as an add-on therapy along with chloroquine. However, further study is needed to validate the above findings in vivo models.

Concomitant use of dexamethasone and tetracyclines: a potential therapeutic option for the management of severe COVID-19 infection?

Introduction: The global coronavirus disease-2019 (COVID-19) pandemic has posed a critical challenge to the research community as well as to the healthcare systems. Severe COVID-19 patients are at a higher risk of developing serious complications and mortality. There is a dire need for safe and effective pharmacotherapy for addressing unmet needs of these patients. Concomitant use of dexamethasone and tetracyclines, by virtue of their immunomodulatory and other relevant pharmacological properties, offers a potential strategy for synergy aimed at improving clinical outcomes.Areas covered: Here we review the potential benefits of combining dexamethasone and tetracyclines (minocycline or doxycycline) for the management of severe COVID-19 patients. We have critically examined the evidence obtained from in silico, experimental, and clinical research. We have also discussed the plausible mechanisms, advantages, and drawbacks of this proposed combination therapy for managing severe COVID-19.Expert opinion: The concomitant use of dexamethasone and one of the tetracyclines among severe COVID-19 patients offers several advantages in terms of additive immunomodulatory effects, cost-effectiveness, wide-availability, and well-known pharmacological properties including adverse-effect profile and contraindications. There is an urgent need to facilitate pilot studies followed by well-designed and adequately-powered multicentric clinical trials to generate conclusive evidence related to utility of this approach.

Tafenoquine for Plasmodium vivax malaria: Concerns regarding efficacy & safety.

Plasmodium vivax (P. vivax) malaria is a major problem in various countries such as America, Southeast Asia, Africa and the Eastern Mediterranean. The major barrier in controlling P. vivax malaria is its ability to remain in the liver as a hypnozoite form which is responsible for relapse of P. vivax malaria; hence it is necessary to target both the blood (schizont) as well as the liver (hypnozoite) stages of P. vivax to prevent its relapse. A number of factors limit the use of primaquine (PQ), the currently available therapy for P. vivax (hypnozoite stage), such as haemolysis in glucose-6-phosphate dehydrogenase-deficient patients and being contraindicated in pregnant women. Another problem associated with PQ is the poor adherence rate to the 14-day treatment regimen. Single-dose tafenoquine (TQ), an 8-aminoquinoline, has recently been approved by the U.S. FDA for the treatment of P. vivax malaria along with a blood schizonticidal. TQ is active against all stages of P. vivax lifecycle. In published studies, TQ is considered a better alternative to PQ in terms of adherence, but there are some concerns regarding its safety, efficacy and study designs of trials conducted on TQ. In this context, this review, discusses the potential safety concerns, efficacy data, summary and an appraisal of findings of the important published trials of TQ.

Potential Role of Dexamphetamine in the Treatment of Non-alcoholic Fatty Liver Disease: Hopes and Pitfalls.

Non-alcoholic fatty liver disease (NAFLD) is one of most frequent causes of chronic liver disease. Global prevalence of NAFLD and nonalcoholic steatohepatitis (NASH) with advanced fibrosis is increasing day by day. Patients with NAFLD are more susceptible to encounter cardiovascular morbidity and mortality. Apart from lifestyle changes and dietary modifications, no effective pharmacotherapy is available to prevent the progression of NAFLD to NASH and advanced stages of hepatic fibrosis and cirrhosis. Dexamphetamine is the d-isomer of amphetamine, which acts by inhibiting monoamine reuptake and direct stimulation of dopamine and noradrenaline release. Presently, dexamphetamine is indicated for the treatment of attention deficit hyperactivity disorder and narcolepsy, but since its use was found to be associated with weight loss, it is also now used as an off-label drug for the treatment of obesity. Direct or indirect evidence is present in the form case reports, case series and from effects of related drugs to support the potential role of dexamphetamine in NAFLD. There is an urgent need to initiate preclinical and clinical studies involving robust methodology and adequate sample sizes to explore the potential of dexamphetamine in patients with NAFLD. In this review, we will discuss the therapeutic potential of dexamphetamine for the treatment of NAFLD.

Minocycline for the management of multiple sclerosis: repositioning potential, opportunities, and challenges.

INTRODUCTION: Multiple sclerosis (MS) is a chronic demyelinating inflammatory disorder with variable clinical and pathologic characteristics reflecting multiple underlying pathophysiologic mechanisms. Repositioning of existing drugs for the new indications offers several advantages including significant reduction in the cost and time of drug development and exemption from early phase clinical trials. Minocycline has been reported to exhibit immunomodulation in several pre-clinical and clinical studies through suppression of migratory inflammatory cells, modulation of peripheral immune response, and inhibition of microglial activation within the CNS. AREAS COVERED: Here, the authors review the repositioning potential of minocycline for the treatment of MS along with appraisal of the evidence obtained from preclinical and clinical research. The authors also discuss the advantages and potential safety concerns related to the use of minocycline for the management of MS. EXPERT OPINION: Minocycline offers several distinct advantages in terms of well-known safety profile, lower cost of therapy, widespread availability, and being available as an oral formulation. The authors call upon the public and private funders to facilitate well designed and adequately powered randomized clinical trials that can provide conclusive evidence regarding the safety and efficacy of minocycline in patients with MS.

Combining hydroxychloroquine and minocycline: potential role in moderate to severe COVID-19 infection.

INTRODUCTION: Patients with moderate to severe COVID-19 infection require specific drugs to prevent the morbidity and mortality. Hydroxychloroquine (HCQ) has shown some promise in the management of COVID 19. Minocycline, because of its anticytokine and other useful properties can be an ideal candidate for combining with HCQ. AREAS COVERED: Here we review the need and mechanisms and reasons for combining HCQ and minocycline moderate to severe COVID-19 infection. We also reviewed the advantages, potential safety concerns and precautions to be taken, while combining HCQ and minocycline. EXPERT OPINION: Combining HCQ and minocycline offers many advantages in the management of moderate to severe COVID-19 infection. Both drugs are cheaper, widely available and long-term safety data and contraindications are well known. We do not recommend this combination for prophylaxis or use in asymptomatic or mild disease patients as this can lead to unnecessary safety concerns. Additive antimicrobial and anticytokine effects of both drugs may reduce the morbidity and mortality among patients with COVID-19 and may act as a cheaper alternative to the costlier drugs, however, thorough clinical research is warranted. We call upon public and private healthcare bodies to come up with large well-designed clinical studies for generating evidence-based recommendations.

Repurposing Potential of Ketamine: Opportunities and Challenges.

Ketamine is a noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptor which also interacts with various other receptors that account for its myriad actions. Originally approved as a general anesthetic, it is being explored to be repurposed for numerous other indications such as depressive disorders, suicidal ideation, substance-use disorders, anxiety disorders, chronic pain, refractory status epilepticus, and bronchial asthma exacerbations. Numerous trials are ongoing for the same. The nasal spray of esketamine, a more potent S (+) enantiomer of ketamine, has been approved by the United States Food and Drug Administration (USFDA) for treatment-resistant depression along with the oral antidepressants. However, there are concerns about its safety on long term use, given its psychedelic effects and potential abuse. In this review, we discuss repurposing ketamine for potential therapeutic use and about the safety concerns related to ketamine and esketamine.

Correlation between the arm-span and the standing height among males and females of the Khasi tribal population of Meghalaya state of North-Eastern India.

INTRODUCTION: The estimation of relationship between the arm span and the standing height has been an important tool in anthropometric measurements especially in cases where direct measurement of stature is not possible. OBJECTIVE: To find the relationship between the arm-span and the standing height of both males and females in the population of Khasi tribal population of Meghalaya. MATERIALS AND METHODS: The study involved 400 numbers (272 males and 128 females) of healthy human volunteer subjects belonging to Khasi tribe of Meghalaya. The standing height and arm-span were measured for each individual and analyzed. RESULT: Of the 400 healthy volunteers, 272 (68%) were males and 128 (32%) were females with age ranged from 25 to 45 years. Height and arm span in males (159.68 ± 4.12 cm and 166.30 ± 4.27 cm, respectively) werefound to be significantly (p < 0.001) higher than females (149.96 ± 3.04 cm and 155.77 ± 3.13 cm respectively). The Pearson correlation coefficient (r) between height (cm) and arm span (cm) showed significant positive correlation in both male (r = 0.988, P < 0.001) and female (r = 0.991, P < 0.001) study subjects. The regression equation was Height = 1.060 + 0.954 (Arm span); R2 = 0.976; SEE = 0.646 for male. For female subjects the regression equation was found as Height = 0.150 + 0.962 (Arm span); R2 = 0.983; SEE = 0.400. CONCLUSION: Arm-span can be used as one of the most reliable parameter in both males and females for obtaining the stature of an individual in alternative to the height.

Lack of Awareness of Pharmacovigilance among Young Health-care Professionals in India: An Issue Requiring Urgent Intervention.

BACKGROUND: Young healthcare professionals (HCPs) are the pillar of healthcare system. The objective of the present study was to assess the knowledge, attitude, and practices of young HCPs regarding adverse drug reactions (ADRs) reporting. METHODS: This cross-sectional questionnaire-based study was conducted on young HCPs in a tertiary care teaching hospital of North India. The study instrument was semi-structured, prevalidated questionnaire. The responses obtained were compared among doctors and nursing professionals. RESULTS: We obtained response from 84 HCPs (61 doctors and 23 nurses). The mean age of the doctors and nurses was 25.0 ± 2.4 versus 26.3 ± 3.4 years, respectively. No significant difference was observed in questions related to definition of ADR, components of pharmacovigilance (PV), who can report ADRs and medications for which ADRs are to be reported. Only 9.8% doctors and 26.1% nurses were aware of ADR reporting system in India, of which 6 (26%) nurses and none of the doctors were aware of its name. About 16.4% doctors as compared to 61% nurses admitted to have reported an ADR (P < 0.001). The main discouraging factor in ADR reporting was time constraint while lack of knowledge was also highlighted by the HCPs. More nurses as compared to doctors (78.3% vs. 49.2%, P = 0.01) were of the opinion that holding continuing medical education/workshop could encourage reporting. CONCLUSION: There is an urgent need to increase awareness about PV among young HCPs, and adequate interventions should be instituted to encourage PV practices.

Effluent Treatment Technologies in the Iron and Steel Industry - A State of the Art Review.

Iron and steel industry is the principal driving force propelling economic and technological growth of a nation. However, since its inception this industry is associated with widespread environmental pollution and enormous water consumption. Different units of a steel plant discharge effluents loaded with toxic, hazardous pollutants, and unutilized components which necessitates mitigation. In this paper, pollutant removal efficiency, effluent volume product quality, and economic feasibility of existing treatments are studied vis-à-vis their merits, demerits, and innovations to access their shortcomings which can be overcome with new technology to identify future research directions. While conventional methods are inadequate for complete remediation and water reclamation, the potential of advanced treatments, like membrane separation, remains relatively untapped. It is concluded that integrated systems combining membrane separation with chemical treatments can guarantee a high degree of contaminant removal, reusability of effluents concurrently leading to process intensification ensuring ecofriendliness and commercial viability.

Experimental observation of extreme multistability in an electronic system of two coupled Rössler oscillators.

We report the first experimental observation of extreme multistability in a controlled laboratory investigation. Extreme multistability arises when infinitely many attractors coexist for the same set of system parameters. The behavior was predicted earlier on theoretical grounds, supported by numerical studies of models of two coupled identical or nearly identical systems. We construct and couple two analog circuits based on a modified coupled Rössler system and demonstrate the occurrence of extreme multistability through a controlled switching to different attractor states purely through a change in initial conditions for a fixed set of system parameters. Numerical studies of the coupled model equations are in agreement with our experimental findings.

Chimera states: the existence criteria revisited.

Chimera states, representing a spontaneous breakup of a population of identical oscillators that are identically coupled, into subpopulations displaying synchronized and desynchronized behavior, have traditionally been found to exist in weakly coupled systems and with some form of nonlocal coupling between the oscillators. Here we show that neither the weak-coupling approximation nor nonlocal coupling are essential conditions for their existence. We obtain, for the first time, amplitude-mediated chimera states in a system of globally coupled complex Ginzburg-Landau oscillators. We delineate the dynamical origins for the formation of such states from a bifurcation analysis of a reduced model equation and also discuss the practical implications of our discovery of this broader class of chimera states.

Amplitude-mediated chimera states.

We investigate the possibility of obtaining chimera state solutions of the nonlocal complex Ginzburg-Landau equation (NLCGLE) in the strong coupling limit when it is important to retain amplitude variations. Our numerical studies reveal the existence of a variety of amplitude-mediated chimera states (including stationary and nonstationary two-cluster chimera states) that display intermittent emergence and decay of amplitude dips in their phase incoherent regions. The existence regions of the single-cluster chimera state and both types of two-cluster chimera states are mapped numerically in the parameter space of C(1) and C(2), the linear and nonlinear dispersion coefficients, respectively, of the NLCGLE. They represent a new domain of dynamical behavior in the well-explored rich phase diagram of this system. The amplitude-mediated chimera states may find useful applications in understanding spatiotemporal patterns found in fluid flow experiments and other strongly coupled systems.

Amplitude death in networks of delay-coupled delay oscillators.

Amplitude death is a dynamical phenomenon in which a network of oscillators settles to a stable state as a result of coupling. Here, we study amplitude death in a generalized model of delay-coupled delay oscillators. We derive analytical results for degree homogeneous networks which show that amplitude death is governed by certain eigenvalues of the network's adjacency matrix. In particular, these results demonstrate that in delay-coupled delay oscillators amplitude death can occur for arbitrarily large coupling strength k. In this limit, we find a region of amplitude death which already occurs at small coupling delays that scale with 1/k. We show numerically that these results remain valid in random networks with heterogeneous degree distribution.

Characteristics of spontaneously formed nanoemulsions in octane/AOT/brine systems.

Nanoemulsions were formed spontaneously by diluting water-in-oil (W/O) or brine-in-oil (B/O) microemulsions of a hydrocarbon (octane), anionic surfactant (Aerosol-OT or AOT) and water or NaCl brine in varying levels of excess brine. The water-continuous nanoemulsions were characterized by interfacial tension, dynamic light scattering, electrophoresis, optical microscopy and phase-behavior studies. The mechanism of emulsification was local supersaturation and resulting nucleation of oil during inversion. For nanoemulsions formed at low salinities with Winsor I phase behavior, octane drops grew from initial diameters of 150-250 nm to 480-1000 nm over 24h, depending on salinity. Growth was caused by mass transfer but seemed to approach the asymptotic stage of Ostwald ripening described by the Lifshitz-Slyozov-Wagner (LSW) theory only for dilution with salt-free water. Near the higher cross-over salinity (Winsor III), the nanoemulsions showed much slower growth with droplet size consistently remaining below 200 nm over 24h and reaching 250 nm after 1 week. Birefringence indicated the presence of liquid crystal for these conditions, which could have contributed to the slow growth rate. At even higher salinity levels in the Winsor II domain, W/O/W multiple emulsions having drops greater than 1 µm in diameter were consistently recorded for the first 5-7h, after which size decreased to values below 1 µm. The number and size of internal water droplets in multiple emulsion drops was found to decrease over time, suggesting coalescence of internal droplets with the continuous water phase and mass transfer of water from internal droplets to continuous phase as possible mechanisms of the observed drop shrinkage. Electrophoresis studies showed the nanoemulsions to be highly negatively charged (zeta potentials of -60 mV to -120 mV). The high charge on octane droplets helped assure stability to flocculation and coalescence, thereby allowing mass transfer to control growth in the Winsor I and III regions.