Correlation between Transcranial Ultrasound and CT Head to Detect Clinically Significant Conditions in Post-craniectomy Patients Performed by Emergency Physician: A Pilot Study.

Background: The main objective is to detect clinically significant conditions by transcranial ultrasound (TCS) in post-decompressive craniectomy (DC) patients who come to the emergency department. Materials and methods: This was a cross-sectional observational study. We studied 40 post-DC patients. After primary stabilization, TCS was done. Computer tomography of head was done within 2 hours of performing TCS. The correlation between both modalities were assessed by the measurement of lateral ventricle (LV) (Bland-Altman plot), Midline shift and mass lesion. Additionally, normal cerebral anatomy, 3rd and 4th ventricles and external ventricular drainage (EVD) catheter visualization were also done. Results: About 14/40 patients came with non-neurosurgical complaints and 26/40 patients came with neurosurgical complaints. Patients with non-neurosurgical complaints (4/14) had mass lesions and 1/14 had MLS. Patients with neurosurgical complaints (11/26) had mass lesions and about 5 patients had MLS. A good correlation was found between TCS and CT of head in measuring LV right (CT head = 17.4 ± 13.8 mm and TCS = 17.1 ± 14.8 mm. The mean difference (95% CI) = [0.28 (-1.9 to 1.33), ICC 0.93 (0.88-0.96)], Left [CT head = 17.8 ± 14.4 mm and TCS = 17.1 ± 14.2 mm, the mean difference (95% CI) 0.63 (-1.8 to 0.61), ICC 0.96 (0.93-0.98)], MLS [CT head = 6.16 ± 3.59 (n = 7) and TCS = 7.883 ± 4.17 (n = 6)] and mass lesions (kappa 0.84 [0.72-0.89] [95% CI] p-value < 0.001). The agreement between both modalities for detecting mass lesions is 93.75%. Conclusion: Point of care ultrasound (POCUS) is a bedside, easily operable, non-radiation hazard and dynamic imaging tool that can be used for TCS as a supplement to CT head in post-DC patients in emergency as well as in ICU. However, assessment of the ventricular system (pre/post-EVD insertion), monitoring of regression/progression of mass lesion, etc. can be done with TCS. Repeated scans are possible in less time which can decrease the frequency of CT head. How to cite this article: Chouhan R, Sinha TP, Bhoi S, Kumar A, Agrawal D, Nayer J, et al. Correlation between Transcranial Ultrasound and CT Head to Detect Clinically Significant Conditions in Post-craniectomy Patients Performed by Emergency Physician: A Pilot Study. Indian J Crit Care Med 2024;28(3):299-306.

Stellate ganglion block & ventricular arrhythmias.

An electrical or ventricular storm is a life-threatening condition that must be treated as soon as possible. Here we have successfully saved a 32-year-old male patient with ventricular storm by going beyond the conventional treatment of ACLS. The ultrasound-guided stellate ganglion block terminates sympathetic over discharge thus terminates electrical storm. The emergency physicians need to be aware of the right timing, indication & ultrasound-guided nerve block technique as it is time a sensitive & final rescue technique to save the patient. Lack of expertise can lead to treatment failure or delay which can lead to poor resuscitation outcomes.

Effectiveness of Plyometrics Along With Pilates Exercises in Increasing Vertical Jump Performance Among Basketball Players.

Introduction Basketball is an athletic court game sport played by five players from two sports teams each. Therefore, the objective of this study is aimed at gauging the potential impact of the combination of plyometrics and Pilates training along with the efficacy of these exercise regimes individually on raising vertical jump performance in basketball players. Methodology For this study, 45 subjects were enrolled and assigned into groups A, B, and C. Group A was given a plyometric program, group B was given a Pilates program, and group C was given a combination of plyometrics and Pilates program. All were tested for vertical jump and muscle endurance prior to starting the plyometric and Pilates training and plyometrics with Pilates program. All the subjects passed through six weeks of the training program and were retested. The program was given three days a week for six weeks. Result The data collected were statistically analyzed by applying the Wilcoxon signed-rank test and the one-way analysis of variance test. The analysis of variance in vertical jump ability among three groups was assessed. The average value of vertical jump ability before training was 260.60 for group A, 243.47 for group B, and 263 for group C. Training group C had a higher mean vertical jump value. All groups showed improvement in vertical jump, but group C (plyometrics with Pilates) showed greater improvement in the vertical jump height and trunk flexor and trunk extensor endurance test. Conclusion The finding suggested that group C (plyometrics with Pilates) is more effective than group A (plyometrics) and B (Pilates) in improving the vertical jump height.

Decreased Expression of BRCA2 Accelerates Sporadic Breast Cancer Progression.

Human tumor suppressor BRCA2 has been known to function in the repair of DNA double strand break. Germ line mutation in BRCA genes predisposes individuals to familial breast and ovarian cancer. The aim of present study was to characterize the implication of BRCA2 expression in cases of non - hereditary (sporadic) breast cancer. Female breast cancer patients aged between 20 and 75 years who underwent surgery were randomly selected. Patients with Stage IV disease at time of primary diagnosis or previous history of any other malignancy other than breast carcinoma or undergoing neoadjuvant chemotherapy were excluded from the study. Total 48 patients full filled these criteria. Patients were treated with either modified radical mastectomy or breast conservation therapy. Concentration of BRCA2 was measured by Sandwiched method of ELISA. Immunohistochemistry was used to determine the hormonal receptor status. Stage of the disease was not found to have any significant correlation on the BRCA2 expression. In patients with higher grade of tumors the level of BRCA2 expression was found to be low. Decreased expression of BRCA2 was found to be triple negative, had aggressive features and associated with higher chances of axillary metastasis. Genetic instability caused by decreased expression of BRCA2 could trigger mutations in sporadic breast cancer cases and mutations in turn leads to uncontrolled proliferation and invasive growth.