Anterior Communicating Artery Aneurysms: Surgical Strategy and Outcome based on Proposed Newer Classification.

BACKGROUND: The ruptured anterior communicating artery aneurysm is the most frequent intra-cranial aneurysm treated at any neurosurgical department. These aneurysms arise from either the A1-A2-Acom artery junction or Acom artery. The surgical outcome depends on the age of the patient, time duration between ictus and surgery, and Hunt and Hess grade at admission. In this article, we intend to analyze the surgical outcome based on our proposed classification with our overall experience of Acom aneurysm. METHODS: A retrospective review of our surgical database with 250 patients of ruptured Acom was done, and the location, morphology, and direction of aneurysm, along with other clinical parameters including the demographic profile, radiological findings, and intra-operative details, were studied. We classified the Acom based on both site of origin and morphology (Type I, junctional on the dominant side; Type II, fusiform with an ill-defined neck and branching pattern; Type III, saccular true Acom A) and secondarily as described in the literature on the basis of the direction of fundus (Type A-E). The clinical parameters were compared among the above groups using Fischer-exact and one-way analysis of variance test. RESULTS: A total of 250 patients (M: F =113:137) were included (mean age 52.1 ± 11.5 standard deviation years). 55.2% patients had left A1 dominance. Type I Acom A was commonly found on the left dominant circulation (P = 0.00). The difference in aspect ratio of Type I (2.0 ± 0.8) and Type II (1.8 ± 0.52) aneurysms was insignificant (P = 0.28). However, a significant difference in post-operative vasospasm among different types of aneurysms was found (P < 0.05). The Type I Acom A were anteriorly directed, while Type II and III were posteriorly directed (P = 0.001). The mean follow-up of the study was 44.4 ± 25.7 months, with age (P = 0.007) and Hunt and Hess grade (P = 0.001) at admission correlating with surgical outcome. CONCLUSION: Classifying the Acom A pre-operatively based on site and morphology, location, and direction of fundus helps in surgical planning and prognosis. The junctional 'Type IA aneurysms' are most common and possess a high intra-operative rupture rate. The anteriorly directed aneurysms have a better prognosis, and visual complaints are usually associated with anterior-inferiorly directed aneurysms.

Clinical Characteristics of Migraine and Their Association With the Retinal Nerve Fiber Layer Thickness.

BACKGROUND: Migraine is characterized by recurrent episodes of unilateral, pulsating headaches. At the cerebral and ocular levels, it is recognized that the vascular narrowing and loss of blood flow are transient; however, the chronic nature of migraine may result in long-term functional and structural changes in these structures. It could result in axonal loss and an alteration in the thickness of the retinal nerve fiber layers (RNFL). This study aimed to measure the RNFL thickness, which provides a useful indication of the state of the axons and the loss of ganglion cells in migraine patients, and to find out if RNFL thickness and the clinical features of migraine are correlated. MATERIALS AND METHODS: Sixty patients with migraine and 60 age-gender-matched controls were recruited. A complete neurological and ophthalmological examination was performed, and spectral-domain optical coherence tomography (SD-OCT) was done to measure RNFL. RESULTS: All quadrants of the retina on both sides showed non-statistically significant differences in RNFL thickness between migraine patients and controls (p-value >0.05). Furthermore, in all retinal quadrants on both sides, there was no statistically significant difference in RNFL thickness between migraine patients with aura and those without aura (p-value >0.05). Significant correlations were found between the duration of migraine disease and the superior RNFL thickness of both eyes, as well as the inferior RNFL in the right eye. There was also a significant correlation between the headache attack duration and RNFL thickness of the superior retina (p<0.05), Conclusion: Our key finding was that when comparing migraine patients to controls, RNFL thickness did not significantly change; however, the duration of migraine disease did significantly affect RNFL thickness.

Commencement and Monitoring: Microbiological Surveillance in Operation Theaters at a Tertiary Care Center in North India.

INTRODUCTION: Preserving sterility and safety in hospital operation theaters (OTs) is vital. We have implemented a comprehensive microbiological surveillance program for OTs, encompassing both commencement and ongoing monitoring. This study assesses the prevalence of microorganisms, identifies their types, and detects contamination on surfaces and in the air. METHODS: Commencement and monitoring samples were collected from October 2021 to July 2023, from nine OTs. OTs were cleaned with soap and water, disinfected, and fogged with quaternary ammonium compounds. After sealing the OTs overnight, samples were collected aseptically. Air was sampled using the settle plate method, and surfaces were swabbed. Six surfaces, namely, the floor, wall, table, light, anesthesia workstation, and door handle, were swabbed. Samples were transported immediately to the institution's microbiology laboratory. RESULTS: During OT commencement, 247 swabs from nine OTs yielded 19 (7.29%) positives for bacterial growth. These microorganisms were primarily non-pathogenic, including aerobic spore-forming bacilli and Micrococcus, with an average bioload of 9.5 colony-forming units (CFU)/m3 of air. During OT monitoring, swab positivity was 10.79% (23/213). The General Surgery OT and Obstetrics and Gynecology OT showed the highest bacterial growth (5/23). Surface sampling revealed prevalent methicillin-resistant coagulase-negative staphylococci (MRCoNS) (9/23), followed by methicillin-sensitive Staphylococcus aureus (MSSA) (4/23) and methicillin-sensitive coagulase-negative staphylococci (MSCoNS) and aerobic spore-forming bacilli (ASB) (3/10). The General Surgery, Obstetrics and Gynecology, and ENT OTs displayed elevated air bioloads of 53, 49, and 47 CFU/m3, respectively. CONCLUSION: In newly constructed non-operational OTs, non-pathogenic organisms prevailed. However, as the OTs became functional, pathogenic organisms became more prevalent. Sampling emphasized contamination in areas with high patient loads, such as General Surgery, Obstetrics and Gynecology, and ENT OTs. Notably, OT tables and OT walls exhibited higher pathogenic microorganism presence. By combining both initial commencement and ongoing monitoring, the institution has effectively managed the microbial environment within its OTs.

Perception of robotic-assisted surgery (RAS) among medical students: a systematic review and meta-analysis.

INTRODUCTION: Robotic surgery, also known as robotic-assisted surgery (RAS), involves a camera and a small surgical instrument attached to a robotic arm. A trained surgeon operates the robot from a viewing screen while being in the same room. METHODOLOGY: This review was prepared following Cochrane collaboration guidelines and reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. Two authors independently searched and appraised the studies published in PubMed, cumulative index to nursing and allied health literature (CINAHL), Embase, Clinical Key, and Google Scholar. Pooled data analyzed and reported in RevMan software version-5.4. RESULTS: This systematic review and meta-analysis comprised 1400 medical students, from 8 studies. The participants' age ranged from 23 to 49 years. Similarly, the sample size ranged from 25 and 300. The pooled prevalence of the existing studies revealed that 29.8% of medical students, were favorable towards RAS. Effect size (ES), 95% confidence intervals (CI) and heterogeneity (I2) [ES = 29.8, 95% CI 16.4-43.2, I2 = 95.1%, P < 0.00]. About 40% of Australian medical students' positive opinion on RAS [ES = 40.4, 95% CI 25.7-55.2]. Similarly, 34.2% of students from Saudi Arabia [ES = 29.8, 95% CI 22.4-90.8, I2 = 99.3%, P < 0.00], 27.8% students from Canada [ES = 27.8, 95% CI 15.9-39.6], 24.8% from USA [ES = 24.8, 95% CI 6.9-42.7, I2 = 77.3%, P < 0.00] and 24% [ES = 24, 95% CI 18-30] from India favorable towards RAS. DISCUSSION: Medical students from developed nations display favorable attitudes towards RAS. However, implementing of revised curriculum at the beginning of the graduation level sparks medical students' attitude towards robotic surgery.