Comparison of analgesic efficacy of combined external oblique intercostal and rectus sheath block with local infiltration analgesia at port site in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial.

BACKGROUND: Conventional fascial plane block approaches for upper abdominal surgeries spare the lateral cutaneous nerve. An external oblique intercostal block (EOIB) may be suitable for upper abdominal incisions as it blocks the lateral and anterior branches of the intercostal nerves T6-T10. However, there is a paucity of studies evaluating this block in clinical settings. The study aimed to compare the analgesic efficacy of combined EOIB and rectus sheath block with local infiltration analgesia (LIA) in laparoscopic cholecystectomy (LC). METHODS: After obtaining written informed consent, 70 patients were randomly allocated to undergo right-sided EOIB with 20 ml and left-sided RSB with 10 ml of 0.25% bupivacaine at the end of surgery (group ER, n = 35). Patients in the LIA group (n = 35) underwent local infiltration at the port site using 20 ml of the same solution (group LIA, n=35). RESULTS: The visual analog scale scores with combined EOI and RSB were significantly lower than those with LIA at 1, 2, 4, 8, and 12 h (P < 0.001). Rescue analgesics were required by 65.7% and 14.3% of the patients in the LIA and block groups, respectively (P < 0.001). The time to first rescue analgesic was significantly greater in the ER group than that in the LIA group (2.8 ± 1.10 vs. 1.6 ± 0.50 h; P = 0.012). The number of times rescue analgesia was required was significantly lower in the ER group than that in the LIA group (1.00 ± 0.00 vs. 1.83 ± 0.72; P = 0.015). Nausea and vomiting scores were higher in the LIA group than those in the ER group (P < 0.001). Patient satisfaction scores were higher in the ER group than those in the LIA group. CONCLUSIONS: EOIB combined with RSB provides superior analgesia compared with LIA and should be considered for LC.

The diagnostic conundrum of hyper eosinophilia-Sheer tenacity of a parasite.

We present an interesting and rare case of Capillaria hepatica infection in a 2-year-old boy, who presented with fever, rash, hepatomegaly and peripheral eosinophilia. FNAC of hepatic lesion showed parasitic eggs and PCR from the aspirate confirmed the diagnosis. We describe the cytomorphological features and provide educational multiple-choice questions related to the topic.

Investigating Permselectivity in PVDF Mixed Matrix Membranes Using Experimental Optimization, Machine Learning Segmentation, and Statistical Forecasting.

This research examines the correlation between interfacial characteristics and membrane distillation (MD) performance of copper oxide (Cu) nanoparticle-decorated electrospun carbon nanofibers (CNFs) polyvinylidene fluoride (PVDF) mixed matrix membranes. The membranes were fabricated by a bottom-up phase inversion method to incorporate a range of concentrations of CNF and Cu + CNF particles in the polymer matrix to tune the porosity, crystallinity, and wettability of the membranes. The resultant membranes were tested for their application in desalination by comparing the water vapor transport and salt rejection rates in the presence of Cu and CNF. Our results demonstrated a 64% increase in water vapor flux and a salt rejection rate of over 99.8% with just 1 wt % loading of Cu + CNF in the PVDF matrix. This was attributed to enhanced chemical heterogeneity, porosity, hydrophobicity, and crystallinity that was confirmed by electron microscopy, tensiometry, and scattering techniques. A machine learning segmentation model was trained on electron microscopy images to obtain the spatial distribution of pores in the membrane. An Autoregressive Integrated Moving Average with Explanatory Variable (ARIMAX) statistical time series model was trained on MD experimental data obtained for various membranes to forecast the membrane performance over an extended duration.

A rare manifestation of serum sickness after common krait envenomation in a patient treated with polyvalent anti-snake venom in India: Presentation and challenges.

Envenomation from snakebites is a significant public health concern in the Southeast Asian region resulting in considerable mortality and morbidity. Anti-snake venom (ASV) despite being the only rescue can bring forth several acute and delayed adverse effects. Among them, serum sickness is a late manifestation after treatment with ASV that presents after 5-14 days of treatment. However, there is no specific definition to diagnose serum sickness or proven treatment. Here, we present a case of serum sickness to provide an insight into this unventured zone, briefing the presentation, treatment and probable reason for serum sickness and its prevention after common krait envenomation and treatment with polyvalent ASV in India.

Prediabetes in children and adolescents: A ticking bomb!

Prediabetes in children and adolescents is on the rise which has drawn significant attention over the past decade. It is an early warning sign of the underlying pathophysiological changes which in due course of time might compound into type II diabetes mellitus. The incidence of prediabetes in adolescents ranges from 4%-23% which is alarmingly high and requires active intervention from the system. We have discussed early identification of high-risk patients, prompt screening and active intervention to manage this growing problem.

Techniques of detecting recurrent laryngeal nerve palsy in patients undergoing thyroid surgery: Pearls and pitfalls.

Though permanent vocal cord palsy consequent to recurrent laryngeal nerve (RLN) injury is rare following thyroidectomies, its consequences are grave enough for it to be the most feared complication postoperatively. Anesthesiologists and surgeons take various precautions to prevent its occurrence and employ various methods for its early detection. They include direct visualization of the nerve intraoperatively, use of intraoperative nerve monitoring, and post-extubation visualization of vocal cord mobility by use of direct or indirect methods. In the present narrative review, we aim to discuss the clinical evidence pertaining to the various methods adopted for the prevention and early detection of RLN palsy during thyroidectomy.

Analysis of the Characteristics and Intricacies of Arrangement of Neural Elements in the Costoclavicular Block Using Ultrasound: A Retrospective Qualitative Study.

Background: Ultrasound (US)-guided costoclavicular block (CCB) is a promising new approach to brachial plexus (BP) block which is increasingly being utilized. Conventionally, the costoclavicular space (CCS) has been described to contain three cords. However, there may be variations in the neural pattern of the BP which is important to know to prevent inadvertent injury. We intend to describe the variations in neural patterns from retrospective scans of patients receiving costoclavicular BP block. Methods: The stored US images of patients who had received BP block using the CCB for surgery at the level of the elbow or below in the last year (from March 2021 to March 2022) were analyzed by two investigators independently. The clinical data were retrieved from the records of the same patients for the study outcomes. We collated the variations of the neural pattern, the number of neural structures seen, and the echogenicity of the structures in the costoclavicular BP space. Results: In the CCS, the median number of neural structures was 4.5 (minimum of 3 to maximum of 8). With the BP lateral to the axillary artery and sandwiched between the subclavius-pectoralis minor superiorly and the serratus anteriorly inferiorly, numerous variations in the neural structures were noted. The most common arrangement was caterpillar-like (28.6%) and pecker-like (20.3%). The neural structures were found to be hypoechoic in the majority (66%). Conclusion: The CCS hosts several mostly hypoechoic neural structures which may be the variations of the cords or the extension of BP divisions. These new findings have been unreported in the recent past.

Speleothem-Inspired Copper/Nickel Interfaces for Enhanced Liquid-Vapor Transport by Marangoni and Soret Effects.

Geological formations have superior wickability and support the absorption of water and oils into narrow spaces of Earth's crust without external assistance. In this study, we present speleothem inspired heterogeneous porous and wicked copper (Cu)/nickel (Ni) interfaces for enhanced nucleate boiling of water/ethanol mixtures for energy-efficient separation processes. The incorporation of Ni strands within the copper particle matrix significantly enhanced heat transfer. Compared to plain copper, the Cu/Ni speleothem surfaces exhibited a 61% increase in the heat transfer coefficient for water/ethanol mixtures and a 332% increase for water, with a 58% faster onset of nucleate boiling. This enhancement was attributed to Marangoni and Soret effects at the Cu/Ni interfaces, driven by surface tension and concentration gradients. Furthermore, the synergistic wicking action of the Ni strands facilitated rewetting of the surface, replenishing liquid to the porous nucleation sites and preventing surface dry-out, thereby improving the overall heat transfer performance.