Analysis of human thermoregulatory mechanisms using 2-D computational model.

A numerical investigation is reported comparing various human thermoregulation mechanisms under hot and cold stress. The passive system of the developed model consists of 12 spherical/cylindrical segments and is modeled using the Pennes bioheat equation and finite difference method. The active system accounts for all regulatory responses, including the counter current heat exchange between veins and arteries; the respiratory heat loss; and threshold, gain, and maximum intensity of response mechanisms. The developed code analyzes various thermoregulatory defense mechanisms under hot and cold environments. Results indicate that shivering and sweating are more effective than other defense mechanisms under cold and hot conditions, respectively. Suppressing shivering will be more effective than the stoppage of vasoconstriction for inducing therapeutic hypothermia. The normal basal metabolic heat generation is essential to maintain a constant body temperature. It is seen that the changes in threshold temperatures of thermoregulatory mechanisms significantly affect the core more than the peripheral regions. The result may be helpful for better management of therapeutic hypothermia, hot/cold stress management, and design of drug protocols.

Assessing the readiness of hospitals in Riyadh Province for efficient and timely stroke management: A pilot study.

OBJECTIVES: To assess the readiness of hospitals in Riyadh to establish acute stroke centers by following the Australian Clinical Guidelines for Stroke Management. METHODS: This study was a quantitative cross-sectional observational study conducted among hospitals in the central region of Saudi Arabia (Jan 2018 - April 2018). A self-administered questionnaire/survey tool was adapted from an Australian survey developed by the Stroke Foundation in Melbourne, Australia.The data were analyzed using SPSS version 21.0. Appropriate statistical tests (chi-square and Fisher's exact test) were used for bivariate analyses. RESULTS: A total of 3932 stroke patient visits were recorded in 37 hospitals in the central region of Saudi Arabia. The most common limitations of acute stroke services were that 25 (67.57%) of the hospitals had no stroke unit and 21 (56.76%) had inadequate clinical staff. Magnetic resonance imaging and computed tomography were available in 32 (86.49%) and 36 (97.30%) hospitals, respectively. Only two-thirds of hospitals 25 (67.57%) followed protocols for rapid Emergency Department (ED) triage. CONCLUSION: We found that most of our hospitals were not fully prepared to address acute stroke management in a manner that was reasonably consistent with international guidelines. We recommend raising the hospital's requirements a higher level to be in line with the stroke guidelines.

An Integrated Quantitative Index for Measuring Chronic Multisite Pain: The Multiple Areas of Pain (MAP) Study.

OBJECTIVE: Despite the high prevalence of chronic multisite pain, there is little consensus on methods to characterize it. Commonly used assessments report only one dimension of pain, that is, intensity, thus ignoring the spatial aspect of pain. We developed a novel pain quantification index, the Integrated Pain Quantification Index (IPQI), on a scale of 0 to 1 that integrates multiple distinct pain measures into a single value, thus representing multidimensional pain information with a single value. DESIGN: Single-visit, noninterventional, epidemiological study. SETTING: Fourteen outpatient multidisciplinary pain management programs. PATIENTS: Patients with chronic pain of the trunk and/or limbs for at least six months with average overall pain intensity of at least 5 on the numeric rating scale. METHODS: Development of IPQI was performed in a large population (N = 810) of chronic pain patients from the Multiple Areas of Pain (MAP) study. RESULTS: Prevalence of two or more noncontiguous painful areas was at 88.3% (95% confidence interval [CI] = 0.86-0.90), with a mean of 6.3 areas (SD = 5.57 areas). Prevalence of more than 10% body area in pain was at 52.8% (95% CI = 0.49-0.56), with a mean at 16.1% (17.16%). On average, IPQI values were near the middle of the scale, with mean and median IPQI at 0.52 (SD = 0.13) and 0.55, respectively. The IPQI was generalizable and clinically relevant across all domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. CONCLUSIONS: IPQI provided a single pain score for representing complex, multidimensional pain information on one scale and has implications for comparing pain populations across longitudinal clinical trials.

Trends in childhood immunisation amongst Muslim children of Punjab (India): An empirical study.

India's immunisation programme is one of the largest in the world and achieved great success over the years, however, some significant gaps are still observable in terms of achieving universal immunisation of children. Religion has emerged as a strong correlate for immunisation rates at national, state and global level. It has been observed that the rate of immunisation among children from Muslim families is comparatively less at global as well as at national level. Therefore, the paper attempts to understand immunisation trends among Muslims children from the north-western Indian state of Punjab. Based on the cross-sectional study of 400 households from district Sangrur of Punjab, results of the study show that rate of full immunisation among children from Muslim families was 88 per cent and none of the children were non-immunised. Reasons stated for partial immunisation of children included distrust of the government and belief that it would cause infertility amongst children. The present study reveals that religion per se does not appear to be influence rates of full immunisation. Geographical location, embeddedness of the community in the larger political and social milieu of their area, reach and acceptance of health workers at grassroots level emerge as strong factors contributing to higher rates of immunisation amongst Muslim children of Malerkotla.

Pancreatic tuberculosis mimicking as pancreatic malignancy: Surgeon's dilemma.

Pancreatic tuberculosis is a rare form of Tuberculosis (TB) which requires a high index of suspicion to diagnose. Here, we report a case of middle-aged gentleman presenting with abdominal pain and constitutional symptoms who was diagnosed with pancreatic tuberculosis on imaging, which was confirmed by Fine Needle Aspiration (FNA) from the lesion. The patient was given Anti-Tubercular Treatment (ATT) as per conventional protocol. Follow-up showed recovery from the entity. A review of patient presentation, patho-physiology, diagnosis, and management of pancreatic tuberculosis is mentioned in this article.

Density of Bismuth Boro Zinc Glasses Using Machine Learning Techniques.

Machine learning techniques have been employed to predict the glass densities of xBi2O3-(70 - x)B2O3-20Li2O-5Sb2O3-5ZnO glasses using a data set of 2000 various B2O3 rich glasses using their chemical composition and ionic radius. The experimental density of present glasses strongly depends on Bi2O3 content which is increasing with bismuth content. The increasing density in bismuth doped glasses because the BO3 are converted into BO4 units, and besides BO3 units are less heavy than the BO4 units. The FTIR studies also confirm that the intensity of B-O-B bond decreasing with increasing Bi2O3 content which suggested that B-O-B bond in bond ring isolated to BO3 units transformed into BO4 units. In Raman Spectra the stretching vibrations of BO4 units shifting towards higher wavelengths with increasing Bi2O3 content. This shifting conforms that there is a structural changes in the glass-matrix and borate units converting from BO3 to BO4 units. The prepared glasses along with B2O3 rich glass data set train on various AI model such as gradient descent, Random Forest regression and Neural Networks to predict present density of glasses. Among the various models RF regression analysis model is successfully acceptable for the glass data with the highest R2 value 0.983 which end result conform that the predicted and experimental values correlated. ANNs stood the effective technique in prediction of glass density with the optimum performance resulting with Tanh as the activation function (R2 = 0.950). The minimum cost 0.018 obtained in the case of gradient decent function which also shows the better performance of regression model.

Artificial intelligence: A new tool in surgeon's hand.

Artificial intelligence (AI) is the future of surgery. Technological advancements are taking place at an incredible pace, largely due to AI or AI-backed systems. It is likely that there will be a massive explosion or "Cambrian explosion" of AI in our everyday life, largely aided by increased funding and resources spent on research and development. AI has also significantly revolutionized the medical field. The concept of machine learning and deep learning in AI is the crux of its success. In surgical practice, AI has numerous applications in the diagnosis of disease, preoperative planning, intraoperative assistance, surgical training and assessment, and robotics. The potential automation of surgery is also a possibility in the next few decades. However, at present, augmentation rather than automation should be the priority. In spite of the allure of AI, it comes with its own price. A robot lacks the "sixth sense" or intuition that is crucial in the practice of surgery and medicine. Empathy and human touch are also inimitable characteristics that cannot be replaced by an AI system. Other limitations include the financial burden and the feasibility of using such technology on a wide scale. Ethical and legal dilemmas such as those involving privacy laws are other issues that should be taken under consideration. Despite all these limitations, with the way technology is progressing, it is inevitable that AI and automation will completely change the way we practice surgery in the near future. Thus, this narrative review article aims to highlight the various applications and pitfalls of AI in the field of surgery.

Stentolith in Bile Duct: A Neglected Entity-Case Report with Review of Literature.

Stentolith is a forgotten stent that acts as a nidus for stone formation leading to a stone-stent complex. Once the planned procedure is completed, these stents should be removed within 4 to 6 weeks, but if they are required for a longer period, then they should be replaced every 3 to 6 months. Devastating complications may ensue -such as cholangitis, biliary stricture, or secondary biliary cirrhosis. Management primarily comprises surgical intervention with common bile duct exploration or endoscopic clearance. The majority of patients eventually develop symptoms that lead to their diagnosis and subsequent management. This article, however, details the case of a silent stentolith and how it may have led to disastrous complications if surgical intervention was not done promptly.

Fabrication of Decellularized Amnion and Chorion Scaffolds to Develop Bioengineered Cell-Laden Constructs.

INTRODUCTION: Human mesenchymal stem cells (hMSCs) holds great promise for managing several clinical conditions. However, the low engraftment efficiency and obscurity to harvest these cells without compromising the cellular viability, structural and functional properties from the culture niche still remain major obstacles for preparing intact regenerative constructs. Although few studies have demonstrate different methods for generating cell-liberated amniotic scaffolds, a common method for producing completely cell-liberated amnion (D-HAM) and chorion (D-HCM) scaffolds and their cytocompatibility with hMSCs yet to be demonstrated. METHODS: A common process was developed for preparing D-HAM and D-HCM scaffolds for assessing hMSCs engraftment efficiency, proliferation and molecular shifts to generate cell-laden biological discs. The structural and functional integrity of D-HAM and D-HCM was evaluated using different parameters. The compatibility and proliferation efficiency of hMSCs with D-HAM and D-HCM was evaluated. RESULTS: Histological analysis revealed completely nucleic acid-free D-HAM and D-HCM scaffolds with intact extracellular matrix, mechanical and biological properties almost similar to the native membranes. Human MSCs were able to adhere and engraft on D-HCM better than D-HAM and expanded faster. Ultrastructural observations, crystal violet staining and expression studies showed better structural and functional integrity of hMSCs on D-HCM than D-HAM and control conditions. CONCLUSION: A common, simple and reliable process of decellularization can generate large number of cell-liberated amniotic scaffolds in lesser time. D-HCM has better efficiency for hMSCs engraftment and proliferation and can be utilized for preparing suitable cell-laden constructs for tissue engineering applications.

Knowledge and Behavior toward Venous Thromboembolism Event Prophylaxis and Treatment Protocols among Medical Interns in Riyadh.

Objective: This study was aimed at evaluating the knowledge and behavior toward venous thromboembolism (VTE) prophylaxis among medical interns. Methods: This is a questionnaire-based cross-sectional observational cohort study of medical interns that used a validated questionnaire. The questionnaire comprised of items that assessed behavior, knowledge, and self-assessment of VTE risk factors, diagnosis, and prophylaxis. The study was conducted in Riyadh, Saudi Arabia, from October 2020 till September 2021. Results: The respondents were 246 medical interns. The overall rate of correct responses to behavior items was 41.82%. The overall rate of correct responses to knowledge items was 47.35%. A total of 61.8% responded negatively to the use of VTE risk assessment guidelines (p < 0.0001). For the self-assessment of knowledge of VTE, more than 70% believed they did not have appropriate knowledge, were not prepared to establish the risk of VTE, and were not prepared to provide adequate prophylaxis for VTE (p < 0.0001). A high proportion of medical interns (83.3%, p < 0.0001) believed they needed further training on this topic. Conclusion: Participants in this study showed poor knowledge and negative behavior regarding the assessment of risk factors, diagnosis, and prophylaxis of VTE. The majority of participants reported they needed training on this topic. These findings underscore the need for educational programs during undergraduate training and orientation of medical interns for VTE risk assessment, diagnosis, and prophylaxis at the beginning of their internship.

Biofabrication of allogenic bone grafts using cellularized amniotic scaffolds for application in efficient bone healing.

INTRODUCTION: The reconstruction/regeneration of human bone injuries/defects represents a crucial challenge due to the lack of suitable bio/immune compatible and implantable biological grafts. The available strategies represent implications of several types of grafting materials in the form of metals, synthetic, and various kinds of biological scaffolds; however, the lack of appropriate biological components required for activating and enhancing repair mechanisms at the lesion-site limits their wider applicability. METHODS: In this study, a unique approach for generating human osteogenic implantable grafts was developed using biofabrication technology. Using a gradient change of detergents and continuous agitation, developed a unique technique to generate completely cell-free amnion and chorion scaffolds. The absence of cellular components and integrity of biological and mechanical cues within decellularized human amnion (D-HAM) and chorion (D-HCM) were evaluated and compared with fresh membranes. Allogenic bone grafts were prepared through induction of human mesenchymal stem cells (hMSCs) into osteogenic cells on D-HAM and D-HCM and evaluated for their comparative behavior at the cellular, histological and molecular levels. RESULTS: The common decellularization process resulted in an efficient way to generate D-HAM and D-HCM while retaining their intact gross-anatomical architecture, surface morphology, extracellular matrix components, and mechanical properties. Both these scaffolds supported better growth of human umbilical cord blood derived MSCs as well as osteogenic differentiation. Comparative investigation revealed better growth rate and differentiation on D-HCM compared to D-HAM and control conditions. CONCLUSION: D-HCM could be used as a better choice for producing suitable allogenic bone grafts for efficient bone healing applications.

Impact of Sense of Coherence on Oral Health among Bus Drivers: A Cross-Sectional Study.

AIM AND OBJECTIVES: To assess the sense of coherence (SOC) and the impact of SOC on oral hygiene behaviors and oral health status among bus drivers in Nellore district, Andhra Pradesh. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted during August-September 2017. Cluster random sampling methodology was used for the selection of drivers. Five depots were randomly selected from the list of various Andhra Pradesh State Road Transport Corporation depots in Nellore district. The estimated sample size was proportionately divided among these five depots of Nellore district (n = 120). The SOC-related data were obtained using short version of Antonovsky's SOC scale. Every item was scored on a Likert scale ranging from 1 to 7. The sum of the scores for SOC was 13-91. A high score indicates a strong SOC. Clinical examination was done for recording oral health status using Oral Hygiene Index-simplified (OHI-S), dental caries, periodontal status, and oral mucosal lesions were recorded according to the WHO criteria 1997. Data were entered and analyzed using SPSS ver. 22 (SPSS Inc., Chicago, IL, USA). RESULTS: Majority of the bus drivers who participated in the study had a low SOC (60%). A significant (P < 0.05) positive correlation was observed with age (r = 0.1420), socioeconomic status (r = 0.1467), and visit to dentist (r = 0.1912). A nonsignificant negative correlation was observed with habits (r = -0.0681), OHI-S (r = -0.0772), dental caries (r = -0.0874), Community Periodontal Index (r = -0.0642), loss of attachment (r = -0.0650), and oral mucosal lesions (r = -0.0542). CONCLUSION: Strong SOC was associated with increase in age, better socioeconomic status, good habits, increased frequency of dental visits, and a good oral health.

Lumbar Epidural Blood Patch via a Caudal Catheter After Surgical Dural Tear and Failed Repair: A Case Report.

We report a patient who developed a positional headache and pseudomeningocele after multiple lumbar surgeries for low back and radicular pain. An epidural blood patch via a lumbar approach was not feasible as a result of distorted lumbar anatomy after multiple back surgeries. An epidural blood patch was performed via catheter-threaded cephalad from a caudal approach. The patient had immediate relief after the procedure and at 1 year was still symptom-free. This combination technique may be considered as an alternative approach when a percutaneous lumbar epidural blood patch is disadvantageous.

Spinal Cord Stimulation for Complex Regional Pain Syndrome: A Case Study of a Pregnant Female.

BACKGROUND: Spinal cord stimulation (SCS) is a form of neuromodulation, used to treat chronic neuropathic pain refractory to conventional medical management. Spinal cord stimulators are treatment options when intractable chronic pain has not responded to more conventional treatment modalities. Currently, the use of SCS is contraindicated in pregnancy. Nevertheless, many SCS/neuromodulation recipients are women of child bearing age who may become pregnant. There are no published reports that focus on the possible side effects of SCS or neuromodulation therapy on human fertility, fetal development, pregnancy, delivery, or lactation. OBJECTIVES: The purpose of this current report is to present a case study on the use of SCS/neuromodulation during pregnancy. STUDY DESIGN: Presentation of the case of a 24 year old female who became pregnant after receiving an SCS implantation for pain control secondary to complex regional pain syndrome (CRPS). The SCS was in use at the time of conception but deactivated when patient became aware of her pregnancy and intermittently reactivated for five minute intervals throughout the entire pregnancy. RESULTS: Currently very little documented evidence is available regarding the safety of using a SCS/neuromodulator during pregnancy; therefore its use during pregnancy is contraindicated. Available literature suggests that, women who have chosen to keep the SCS/neuromodulator activated during pregnancy have delivered healthy babies without any life threatening complications. LIMITATIONS: Case presentations do not provide conclusive evidence of treatment effectiveness. This data is only preliminary and future studies should be used to assess outcomes and measures to provide quantification of the SCS implantation during pregnancy. CONCLUSIONS: Women of child bearing age who are recipients of SCS/neuromodulation implantation should be informed of the limited knowledge available regarding the impact of SCS/neuromodulation use during pregnancy. For current recipients, decisions about ongoing use during pregnancy should be an individual decision based on the potential risks and benefits.

Dexmedetomidine versus esmolol to attenuate the hemodynamic response to laryngoscopy and tracheal intubation: A randomized double-blind clinical study.

CONTEXT: Sympathoadrenal response to laryngoscopy and tracheal intubation manifests as transient, but distinct tachycardia and hypertension. AIMS: The objective of this study is to compare the clinical effects of dexmedetomidine with esmolol and control in attenuating the presser response during laryngoscopy. SETTINGS AND DESIGN: A randomized, prospective, double-blind, controlled study. SUBJECTS AND METHODS: We studied consented, 90 adult, American Society of Anesthesiologists physical status I and II patients of either sex, scheduled for non-cardiac surgery requiring intubation. The patients were randomly divided into three groups (n = 30). Group C received placebo, Group E received 2.0 mg/kg of esmolol and Group D received 1.0 µg/kg of dexmedetomidine, intravenously over 10 min and 3 min before induction of general anesthesia. All patients were uniformly pre-medicated, induced and intubated using thiopentone and succinylcholine as per standard protocol. Heart rate (HR), systemic arterial pressures were recorded at baseline, after study drug infusion, after induction, immediately and 3, 5, 7, 10 min after intubation. STATISTICAL ANALYSIS: Analysis of variance and t-test as appropriate. RESULTS: The mean arterial pressure was significantly increased in patients receiving placebo (P < 0.0001) and esmolol (P < 0.0001) after laryngoscopy and intubation compared with baseline value and Group D (P = 0.6294). The rise in HR (P = 0.08481) and rate pressure product (P = 0.0666) at the time of intubation were minimal and was statistically significant up to 15 min in Group D. CONCLUSIONS: Both the drugs attenuated the pressure response. Of the two drugs administered, dexmedetomidine 1.0 µg/kg provides a consistent, reliable and effective attenuation of pressure responses when compared to esmolol 2.0 mg/kg.

Benzopyran derivatives as cardio-selective ATP-sensitive potassium channel openers: a review.

Benzopyran derivatives are the potassium channel openers (KCOs) having antihypertensive, cardio-protective, myocardial protectors, powerful peripheral vasodilators and anti-ischemic activity. Their usage as anti-ischemic including angina, hypertension and diabetes is thought to be due to the stimulation of KATP channels which are contemplated to produce vasorelaxation and myocardial protection. It is observed that potassium channels are involved in mediating the cardio-protective effects of pre-conditioning in animal models and man. KCOs protect heart from an ischemic insult without contribution from vasodilatation. This review provides an overview of the characteristics of KCOs and their actions on subtypes used widely for the treatments of various diseases including hypertension, cardiac ischemia, arrhythmia, smooth muscle relaxation, diabetes, cardio-protective and anti-angiogenic activities.

Antidiabetic Activity of Vinca rosea Extracts in Alloxan-Induced Diabetic Rats.

The present study was carried out to evaluate the antidiabetic activity of Vinca rosea methanolic whole plant extracts in alloxan induced diabetic rats for 14 days. The methanolic whole plant extract at high dose (500 mg/kg) exhibited significant anti-hyperglycemic activity than whole plant extract at low dose (300 mg/kg) in diabetic rats. The methanolic extracts also showed improvement in parameters like body weight and lipid profile as well as regeneration of beta-cells of pancreas in diabetic rats. Histopathological studies reinforce the healing of pancreas, by methanolic Vinca rosea extracts, as a possible mechanism of their antidiabetic activity.