Intralobar pulmonary sequestration: a rare cause of hemoptysis: a case report.

Overview and significance: Pulmonary sequestration (PS) is a rare congenital anomaly characterized by aberrant formation of nonfunctional lung tissue with anomalous systemic blood supply. Despite its rarity, PS presents significant diagnostic and management challenges, often necessitating a multidisciplinary approach for optimal patient outcomes. This case report provides insights into the clinical presentation, diagnostic modalities, and management strategies for PS. Case summary: The authors present a case of a 30-year-old male who complained of chronic cough and hemoptysis and was eventually diagnosed with intralobar PS by computed tomography (CT) imaging. The patient underwent a surgical procedure, specifically a lobectomy, to address the lung tissue. Clinical discussion: The diagnosis of intralobar PS is confirmed by CT imaging, showing features of abnormalities, including irregular cystic communication. A large area with abnormal systemic arterial supply and variable venous fluid. This patient presented with symptoms consistent with PS, including chronic cough and hemoptysis, highlighting the importance of timely diagnosis and intervention to prevent life-threatening complications. Conclusion: Lung sequestration has diagnostic challenges due to its variable clinical presentation and potential for misdiagnosis. However, advances in technology, such as CT angiography, make accurate diagnosis and precise surgical planning easier. Prompt intervention via lobectomy or transarterial embolization is important to reduce the risk of life-threatening complications associated with PS. These data highlight the importance of multidisciplinary collaboration between physicians, radiologists, and surgeons to effectively manage PS and improve patient outcomes.

Case Report: Successful Treatment of Aberrant Left Subclavian Artery With a Right-Sided Aortic Arch.

Right sided aortic arches with concomitant aberrant left subclavian arteries are exceedingly rare anatomical variants. We present a case of a 45 year old male that presented with symptoms consistent with dysphagia and known right sided aortic arch with an aberrant left subclavian artery. Though previous reports of repair have indeed been reported, we confirm that a hybrid approach to these anatomic variants remain feasible and with symptom resolution for patients.

Imbrication of Anterior Digastric with Advancement of the Posterior Digastric and Its Implications in Neck Aesthetics.

Background: To describe a novel technique to modify the proportional length of the anterior-to-posterior digastric muscles to improve neck aesthetics. Objective: To provide an objective measure to quantify neck rejuvenation and a novel technique to adjust the digastric ratio. Design: We retrospectively compared 52 patients who had neck rejuvenation with or without digastric manipulation. Preoperative and postoperative images were analyzed and compared with computer software using a novel analysis technique to measure the digastric ratio and neck height. Distances between the menton, cervical point (CP), and gonion were measured. Results: The anterior-to-posterior digastric ratio improved an average of 26.5% (p < 0.01) in the new technique group, 15.9% in the control group. Distance of the CP to the inferior edge of the mandible decreased an average of 13.9% using the new technique. Conclusion: The ratio of anterior-to-posterior digastric muscle appears to improve as well as the neck height with manipulation of the digastric muscles.

Snare assisted manual small-incision cataract surgery: Single solution for any grade of cataract.

Cataract surgery is constantly evolving with new techniques, machines, and procedures entering the lexicon. With the modernization, the cost of surgery is increasing with respect to the surgeon, patient, and the society. Early rehabilitation with modern minimal access techniques reduces the societal cost of intervention. Manual small-incision surgery is simple, safer, and cheaper when contrasted with the cost and steep learning curve of machine-driven surgeries. A nucleus of a normal size is 6 mm, which can be bisected; 3 mm longitudinal fragments can be removed through 3.5 to 4.5 mm incision, and a large nucleus of 9.0 mm can trisected and removed through 3.5 to 4.5 mm. The limbal tunnel incision is 3.5 mm, which is close to 2.8 mm phacoincision, so it gives all the advantages of modern phacosurgery. The search of an ideal technique for manual phaco-fragmentation leads us to this specially designed snare (designed by the first author AS) which can tackle any grade nucleus. The nucleus can be bisected or trisected with ease. The technique has been around for 2 decades. There is a small learning curve. The complications are few and can be minimized with practice and simulation. It is a safe, valid, repeatable, and generalizable surgical procedure.

Sustainable management of municipal solid waste through waste-to-energy technologies.

Increasing municipal solid waste (MSW) generation and environmental concerns have sparked global interest in waste valorization through various waste-to-energy (WtE) to generate renewable energy sources and reduce dependency on fossil-derived fuels and chemicals. These technologies are vital for implementing the envisioned global "bioeconomy" through biorefineries. In light of that, a detailed overview of WtE technologies with their benefits and drawbacks is provided in this paper. Additionally, the biorefinery concept for waste management and sustainable energy generation is discussed. The identification of appropriate WtE technology for energy recovery continues to be a significant challenge. So, in order to effectively apply WtE technologies in the burgeoning bioeconomy, this review provides a comprehensive overview of the existing scenario for sustainable MSW management along with the bottlenecks and perspectives.

Organic solid waste: Biorefinery approach as a sustainable strategy in circular bioeconomy.

Waste generation is associated with numerous environmental consequences, making it a point of discussion in the environmental arena. Efforts have been made around the world to develop a systematic management approach coupled with a sustainable treatment technology to maximize resource utilization of organic solid waste. Biorefineries and bio-based products play a critical role in lowering total emissions and supporting energy systems. However, economic viability of biorefineries, on the other hand, is a stumbling hurdle to their commercialization. This communication provides a thorough study of the concept of biorefinery in waste management, as well as technological advancements in this field. In addition, the notion of techno-economic assessment, as well as challenges and future prospects have been covered. To find the most technologically and economically viable solution, further techno-economic study to the new context is required. Overall, this communication would assist decision-makers in identifying environmentally appropriate biorefinery solutions ahead of time.

Municipal solid waste management: Dynamics, risk assessment, ecological influence, advancements, constraints and perspectives.

Global energy consumption has been increasing in tandem with economic growth, putting pressure on the world's supply of renewable energy sources. Municipal Solid waste (MSW) has been reported contributing immensely to the improvement of a secure environment and renewable sources. Energy scarcity and conventional MSW disposal methods in developing countries lead towards many environmental and economic issues. Scientists have been able to experiment with various waste-to-energy conversion technologies in light of this situation. This communication highlights and reviews WtE technologies to convert MSW and other feedstocks into electricity, hydrogen gas, bioethanol along with other value added products like fertilizer(s), platform chemicals as an environmentally friendly products. This review comprehensively summarized the dynamics, risk assessment, ecological influence, advancements, constraints and perspectives altogether in field of municipal solid waste management and treatment. Stare-of-the-art information on ecological influence and risk assessment in handling and transportation of municipal solid waste has been provided. Advanced trends involved in remediation of emerging pollutants and resources obtained from municipal solid wastes have been uncovered. Lastly, this paper comprises constraints and perspectives for uncovering MSW based circular bioeconomy aspects.

In-office Endonasal Minor Revision Rhinoplasty.

The revision rhinoplasty presents many unique challenges to the facial plastic surgeon. While many cases will require a full revision in the operating room, there are several isolated deformities which may be repaired in the office via an endonasal approach. This provides many benefits to the patient and surgeon including decreased cost, shorter recovery time, avoidance of general anesthesia, and less discomfort. It is critical to identify defects appropriate for endonasal repair, establish clear expectations with the patient, and work within one's skill set and level of experience. The surgeon who can comfortably navigate both open and endonasal techniques can offer their patients a comprehensive set of solutions for revision rhinoplasty. In this article we outline the defects amenable to this type of repair as well as technical considerations for each defect addressed. We hope it serves as a useful framework for the range of deformities the rhinoplasty surgeon may take on for in-office repair.

Quantitative Analysis of Tranexamic Acid Effects on Ecchymosis in Rhinoplasty.

Background: Many methods have been described to reduce postoperative ecchymosis in rhinoplasty with tranexamic acid (TXA) remaining controversial. TXA remains a consideration for surgeons, however, may have serious side effects, including seizures, blood clots, and vision changes. Methods: A prospective study of primary rhinoplasty patients was performed from March 2019 to June 2019. TXA was used in 50 patients and postoperative ecchymosis was compared with 50 control patients. Adobe Photoshop was used to quantitate postoperative ecchymosis using multiple objective color scales. Results: One hundred subjects were enrolled in the study. Eighty-four females and 16 males were included. Photographs were taken on postoperative day 7. There were no significant differences among any of the Red, Green, Blue (RGB) and L*a*b* color subgroups with p > 0.05. There were no adverse events with TXA. Conclusions: In this study, TXA did not reduce postoperative ecchymosis in rhinoplasty when used both through intravenous and intraoperative injections.

Wastewater surveillance-based city zonation for effective COVID-19 pandemic preparedness powered by early warning: A perspectives of temporal variations in SARS-CoV-2-RNA in Ahmedabad, India.

Following the proven concept, capabilities, and limitations of detecting the RNA of Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) in wastewater, it is pertinent to understand the utility of wastewater surveillance data on various scale. In the present work, we put forward the first wastewater surveillance-based city zonation for effective COVID-19 pandemic preparedness. A three-month data of Surveillance of Wastewater for Early Epidemic Prediction (SWEEP) was generated for the world heritage city of Ahmedabad, Gujarat, India. In this expedition, 116 wastewater samples were analyzed to detect SARS-CoV-2 RNA, from September 3rd to November 26th, 2020. A total of 111 samples were detected with at least two out of three SARS-CoV-2 genes (N, ORF 1ab, and S). Monthly variation depicted a significant decline in all three gene copies in October compared to September 2020, followed by a sharp increment in November 2020. Correspondingly, the descending order of average effective gene concentration was: November (~10,729 copies/L) > September (~3047 copies/L) > October (~454 copies/L). Monthly variation of SARS-CoV-2 RNA in the wastewater samples may be ascribed to a decline of 20.48% in the total number of active cases in October 2020 and a rise of 1.82% in November 2020. Also, the monthly recovered new cases were found to be 16.61, 20.03, and 15.58% in September, October, and November 2020, respectively. The percentage change in the gene concentration was observed in the lead of 1-2 weeks with respect to the percentage change in the provisional figures of confirmed cases. SWEEP data-based city zonation was matched with the heat map of the overall COVID-19 infected population in Ahmedabad city, and month-wise effective gene concentration variations are shown on the map. The results expound on the potential of WBE surveillance of COVID-19 as a city zonation tool that can be meaningfully interpreted, predicted, and propagated for community preparedness through advanced identification of COVID-19 hotspots within a given city.

Detection of NDM-1 and VIM Genes in Carbapenem-Resistant Klebsiella pneumoniae Isolates from a Tertiary Health-Care Center in Kathmandu, Nepal.

BACKGROUND: Klebsiella pneumoniae is one of the leading causes of nosocomial infections. Carbapenems are used as the last resort for the treatment of multidrug resistant Gram-negative bacterial infections. In recent years, resistance to these lifesaving drugs has been increasingly reported due to the production of carbapenemase. The main objective of this study was to detect the carbapenem-resistant genes blaNDM-1 and blaVIM in K. pneumoniae isolated from different clinical specimens. METHODS: A total of 585 clinical specimens (urine, pus, sputum, blood, catheter tips, and others) from human subjects attended at Annapurna Neurological Institute and Allied Sciences, Kathmandu were obtained in the period between July 2018 and January 2019. The specimens were isolated and identified for K. pneumoniae. All K. pneumoniae isolates were processed for antimicrobial susceptibility testing (AST) using the disk diffusion method. The isolates were further phenotypically confirmed for carbapenemase production by the modified Hodge test (MHT) using imipenem (10 µg) and meropenem (10 µg) discs. Thus, confirmed carbapenemase-producing isolates were further screened for the production of blaNDM-1 and blaVIM using conventional polymerase chain reaction (PCR). RESULTS: Among the clinical isolates tested, culture positivity was 38.29% (224/585), and the prevalence of K. pneumoniae was 25.89% (58/224). On AST, K. pneumoniae exhibited resistance toward carbapenems including ertapenem, meropenem, and imipenem, while it showed the highest susceptibility rate against to tigecycline (93.1%; 54/58). Overall, AST detected 60.34% (35/58) carbapenem-resistant isolates, while the MHT phenotypically confirmed 51.72% (30/58) isolates as carbapenemase-producers and 48.28% (28/58) as carbapenemase nonproducers. On subsequent screening for resistant genes among carbapenemase-producers by PCR assay, 80% (24/30) and 3.33% (1/30) isolates were found to be positive for blaNDM-1 and blaVIM, respectively. In the same assay among 28 carbapenem nonproducing isolates, 9 (32.14%) isolates were positive for blaNDM-1 gene while none of them were tested positive for blaVIM gene. CONCLUSIONS: Molecular detection of resistant genes provides greater specificity and sensitivity than those with conventional techniques, thus aiding in accurate identification of antimicrobial resistance and clinical management of the disease.

Processes and prospects on valorizing solid waste for the production of valuable products employing bio-routes: A systematic review.

Humanity is struggling against a major problem for a proper management of generated municipal solid waste. The collected waste causes natural issues like uncontrollable emission of greenhouse gases and others. Even though, escalation of waste results in minimizing the areas accessible for disposing the waste. Creating awareness in the society to use organic products like biofuels, biofertilizers and biogas is a need of an hour. Biochemical processes such as composting, vermicomposting, anaerobic digestion, and landfilling play important role in valorizing biomass and solid waste for production of biofuels, biosurfactants and biopolymer. This paper covers the details of biomass and solid waste characteristics and its composition. It is also focused to provide updated information about reutilization of biomass for value creation. Technologies and products obtained through bio-routes are discussed in current review paper together with the integrated system of solid waste management. It also covers challenges, innovations and perspectives in this field.

First proof of the capability of wastewater surveillance for COVID-19 in India through detection of genetic material of SARS-CoV-2.

We made the first ever successful effort in India to detect the genetic material of SARS-CoV-2 viruses to understand the capability and application of wastewater-based epidemiology (WBE) surveillance in India. Sampling was carried out on 8 and 27 May 2020 at the Old Pirana Waste Water Treatment Plant (WWTP) at Ahmedabad, Gujarat that receives effluent from Civil Hospital treating COVID-19 patients. All three, i.e. ORF1ab, N and S genes of SARS-CoV-2, were found in the influent with no genes detected in effluent collected on 8 and 27 May 2020. Increase in SARS-CoV-2 genetic loading in the wastewater between 8 and 27 May 2020 samples concurred with corresponding increase in the number of active COVID-19 patients in the city. The number of gene copies was comparable to that reported in untreated wastewaters of Australia, China and Turkey and lower than that of the USA, France and Spain. However, temporal changes in SARS-CoV-2 RNA concentrations need to be substantiated further from the perspectives of daily and short-term changes of SARS-CoV-2 in wastewater through long-term monitoring. The study results SARS-CoV-2 will assist concerned authorities and policymakers to formulate and/or upgrade COVID-19 surveillance to have a more explicit picture of the pandemic curve. While infectivity of SARS-CoV-2 through the excreted viral genetic material in the aquatic environment is still being debated, the presence and detection of genes in wastewater systems makes a strong case for the environmental surveillance of the COVID-19 pandemic.

Prevalence of Colistin-resistant Gram-negative Isolates Carrying the mcr-1 Gene among Patients Visiting a Tertiary Care Center.

INTRODUCTION: Gram-negative isolates harboring mobilized colistin resistance (mcr-1) gene are a great threat to human health. They have been reported worldwide among various bacterial isolates. This work aimed to study the prevalence of colistin resistance among Gram-negative bacteria and the incidence of mcr-1 gene among these isolates. METHODS: A descriptive cross-sectional study was done at a tertiary care center from June 2016 to February 2017. An ethical approval was taken from review board of the Nepal Health Research Council (Reg. no: 274/2016). Convenience sampling was used. The data was collected and analyzed using Microsoft Excel 2010 and Statistical Package for Social Sciences (SPSS) Version 16 . Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Among 485 gram-negative isolates, only 13 (2.68%) (1.26-6.62 at 95% Confidence Interval) isolates were colistin-resistant and mcr-1 was present in two isolates. Predominant colistin-resistant isolates were E. coli 6 (4.1%), Enterobacter spp 2 (2.81%), and Acinetobacter spp 2 (2.81%). A high level of colistin-resistance was noted in 4 (30.7%) isolates as indicated by the very high value of colistin MIC (>256 µg/ml). ICU was the major site of isolation of colistin-resistant and mcr-1 positive pathogens. The majority of colistin-resistant isolates were highly drug-resistant and were sensitive only to polymyxin B. Antibiotics like imipenem, amikacin, gentamicin, aztreonam, ciprofloxacin, and piperacillin-tazobactam were effective for few of these isolates. CONCLUSIONS: Though the prevalence of mcr-1 gene was low among colistin-resistant gram-negative isolates, the resistant pattern was quite alarming as these isolates were highly drug-resistant.

Frontier review on the propensity and repercussion of SARS-CoV-2 migration to aquatic environment.

Increased concern has recently emerged pertaining to the occurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in aquatic environment during the current coronavirus disease 2019 (COVID-19) pandemic. While infectious SARS-CoV-2 has yet to be identified in the aquatic environment, the virus potentially enters the wastewater stream from patient excretions and a precautionary approach dictates evaluating transmission pathways to ensure public health and safety. Although enveloped viruses have presumed low persistence in water and are generally susceptible to inactivation by environmental stressors, previously identified enveloped viruses persist in the aqueous environment from days to several weeks. Our analysis suggests that not only the surface water, but also groundwater, represent SARS-CoV-2 control points through possible leaching and infiltrations of effluents from health care facilities, sewage, and drainage water. Most fecally transmitted viruses are highly persistent in the aquatic environment, and therefore, the persistence of SARS-CoV-2 in water is essential to inform its fate in water, wastewater and groundwater and subsequent human exposure.

Auricular acupuncture for adult tonsillectomy.

OBJECTIVES: Adult tonsillectomy causes significant postoperative pain that can last over 14 days, but narcotic regimens only provide a modest reduction in pain. Auricular acupuncture has been demonstrated to improve pain with minimal complications. This study compared acupuncture versus control for pain, opioid consumption, nausea, and return of diet and activity following tonsillectomy. METHODS: A prospective, single-blinded randomized controlled trial was performed on 134 adults undergoing tonsillectomy at a tertiary care teaching hospital. Each patient was randomized to receive either auricular (Battlefield protocol) acupuncture with auricular bandages or bandages alone while under general anesthesia. Subjects journaled daily postoperative pain, diet, activity, and opioid consumption, then returned to the clinic on postoperative day 14 for a final questionnaire and evaluation. RESULTS: Ninety-nine patients completed the study with 50 patients in the acupuncture group and 49 patients in the control group. Pain scores for the acupuncture group following tonsillectomy were significantly lower than the control group on the day of surgery (2.9, 4.3; P = .01), but there was no statistically significant difference in pain thereafter. There was an equivalent level of postoperative narcotic usage, nausea, emesis, functional activity and diet between the two groups. The main complication following tonsillectomy was secondary hemorrhage and there was no significant difference between the two groups (20%, 10%; P = .13). CONCLUSION: Auricular acupuncture provides increased pain relief on the day of surgery, an effect that seems to diminish after 24 hours. LEVEL OF EVIDENCE: 1b Laryngoscope, 130: 1907-1912, 2020.

The Aging Face.

The aging face is a popular topic in modern medicine. To understand and treat unwanted signs of aging, it is imperative to understand the biological and physical causes and contributing factors to facial aging, preventative measures to avoid advanced facial aging, and current treatment options. Changes to the human face are progressive with time; however, there are many methods, both surgical and nonsurgical, to reduce the stigmata of aging and provide patients with the appearance they desire. The process of aging is discussed in this article, as well as the multiple treatment options, both surgical and nonsurgical.

Combined carotid endarterectomy and transcatheter aortic valve replacement: Technique and outcomes.

BACKGROUND: Stroke and transient ischemic attack after transcatheter aortic valve replacement results in significantly higher morbidity and mortality. Severe carotid artery disease may be a contributing factor to this increased risk. We report our technique and outcomes of combined carotid endarterectomy (CEA) with transcatheter aortic valve replacement (TAVR). METHODS: From March 2013 to November 2017 a total of 753 TAVRs were performed at our institution for symptomatic severe aortic stenosis. Of this group, 16 patients underwent concomitant TAVR and CEA. A retrospective review was performed to assess risk, outcomes, and short-term survival. RESULTS: Sixteen patients underwent concomitant CEA/TAVR procedures for severe carotid and severe aortic stenosis. The mean Society of Thoracic Surgeons (STS) Risk Score was 7.0 ± 4.7. All patients had severe carotid artery stenosis and aortic stenosis. Nine patients had a transfemoral TAVR approach and eight patients had a transapical TAVR approach. The mean length of stay was 6.4 ± 3.7 days. At 30 days there were no cerebrovascular events and no mortalities. CONCLUSIONS: The use of concomitant CEA and TAVR in patients with severe aortic stenosis and severe carotid stenosis can be done safely without increased risk of complications. This approach may reduce the risk of stroke associated with TAVR in appropriately selected patients.

Golden roots to golden fruits of mental health in Gujarat.

Through the behavioral descriptions in age-old texts it is obvious that Mental Health problems exist since the existence of Homo Sapiens and humanity, with ever changing norms, contexts, definitions and hence their management. Gujarat state of India is one of the oldest land plateaus existing. It has been inhabited, ruled and governed by many different people, races, kings; and invaded through its longest sea-coast by Dutch, Portuguese, British. Even after freedom of India in 1947, Gujarat emerged as a separate state in 1960 only. The history of Mental Health, before being a separate state, could be summed up in 2 Mental Hospitals started by British governance and 2 very unique institutions. Post NMHP, there has been a tremendous growth in the sector, supported by many leaders in the governance. This is an attempt to review some documented and some gathered information from dependable sources, from pre-independence colonial era, post-independence and post-statehood contemporary period.