Overview and Clinical Applications of Artificial Intelligence and Machine Learning in Cardiac Anesthesiology.

Artificial intelligence- (AI) and machine learning (ML)-based applications are becoming increasingly pervasive in the healthcare setting. This has in turn challenged clinicians, hospital administrators, and health policymakers to understand such technologies and develop frameworks for safe and sustained clinical implementation. Within cardiac anesthesiology, challenges and opportunities for AI/ML to support patient care are presented by the vast amounts of electronic health data, which are collected rapidly, interpreted, and acted upon within the periprocedural area. To address such challenges and opportunities, in this article, the authors review 3 recent applications relevant to cardiac anesthesiology, including depth of anesthesia monitoring, operating room resource optimization, and transthoracic/transesophageal echocardiography, as conceptual examples to explore strengths and limitations of AI/ML within healthcare, and characterize this evolving landscape. Through reviewing such applications, the authors introduce basic AI/ML concepts and methodologies, as well as practical considerations and ethical concerns for initiating and maintaining safe clinical implementation of AI/ML-based algorithms for cardiac anesthesia patient care.

Premarital health counseling: A must.

Premarital Health Counseling (PMHC) is emerging as a growing trend worldwide. The couples are provided with accurate and unbiased information and assistance, who are planning to get marry with the aim of screening, educating, and counseling about nutritional disorders, communicable diseases, medical conditions, hereditary/genetic disorders, and guiding for a healthy pregnancy. Premarital screening and adequate counseling are essential for changing attitudes toward consanguineous marriage particularly in places where consanguineous and "tribal" marriages are common, resulting in a high incidence of genetic disorders. Although making PMHC obligatory in India may appear to be a very exciting and promising proposal, its implementation still has various ethical issues and other barriers that need to be addressed.

Intrathoracic Extension of a Giant Cell Tumour of the Medial End of Clavicle: A Case Report with Review of Literature.

Introduction: The clavicle is a very rare site for primary bone tumours, and Giant cell tumours of the clavicle are even rarer. Very few cases have been reported in the literature. Method: The authors report a rare presentation of intrathoracic extension of a giant cell tumour of the medial end of the clavicle, in an 18-year-old female. The patient had painful swelling at the sternal end of the clavicle associated with a painful shoulder range of motion. Complete resection of the mass was done, preserving the lateral half of the clavicle. Result and Discussion: At a 3-year follow-up, the patient has a good clinical outcome with no signs of recurrence. Being a very rare entity, no clear guidelines are available for the management of GCT of Clavicle. Adequate resection of the tumour mass remains the mainstay of treatment and has shown promising results. Denosumab has been proved to be effective in some studies, but the high cost of treatment is a major limitation in the Indian scenario. Conclusion: Resection of the tumour mass with partial cleidectomy provided good results in this patient.

Total Hip Replacement and Distal Femur Shaft Non-union in a Case of Below-knee Amputation - A Case Report.

INTRODUCTION: Primary total hip replacement (THR) surgery for the neck of femur (NOF) fracture in a case of below-knee amputation with distal femur shaft non-union is rare. CASE REPORT: This case describes the traumatic right NOF fracture in a 49-year-old male patient with distal femur shaft non-union. The patient has a history of ipsilateral below the knee amputation along with right distal femur shaft fracture managed with retrograde femur nailing 10 months back following a road traffic accident. The NOF fracture was managed by primary THR as the definitive procedure after distal femur nail removal and distal femur plating with allograft for non-union. CONCLUSION: Primary THR with distal femur plating and allogenic bone grafting in such cases provides satisfactory outcomes. It allows for early ambulation and rehabilitation of the patient.

Wedge Osteotomy with Tens Nailing in Monostotic Fibrous Dysplasia of Tibia - A Case Report.

INTRODUCTION: Titanium elastic nailing (TENS) with wedge osteotomy for the management of monostotic fibrous dysplasia (FD) of tibia is done in a 6-year-old male patient. CASE REPORT: This is a case describing monostotic FD of right tibia in a 6-year-old male patient. The patient's parents noticed a diffuse swelling in the right leg a few days after birth. It was managed conservatively till 3 years of age when the patient started complaining of pain in his right leg and difficulty in walking and running. The patient developed gradual and progressive anterior bowing in the right leg in the next 3 years. The patient was diagnosed with monostotic FD of the right tibia based on clinical and radiological findings. Wedge osteotomies were done in the tibia and fibula with TENS nailing as a definitive procedure for this patient. DISCUSSION: Management of monostotic FD of the right tibia with TENS nailing and wedge osteotomy can be a possible modality of definitive management with complete pain relief and deformity correction. CONCLUSION: Correction of deformities secondary to FD requires meticulous pre-operative planning and execution. But with proper planning, even major deformities as in our case, procedures as simple as wedge osteotomy and TENS nailing can give excellent outcomes.

Total Hip Arthroplasty after McMurray's Osteotomy - A Case Report and Review of Literature.

INTRODUCTION: Total hip arthroplasty after McMurray's osteotomy increases the operative difficulties and decreases the chances of better outcome. With the advent of modular femoral stems, minute changes can be done to individual joints, which allow intraoperative flexibility and better post-operative outcome. Thus, it should be considered as an option for complicated cases. CASE REPORT: We report a case of a 35-year-old female with chief complain of pain in the left hip while walking for the past 2 years. The patient also had difficulty in squatting and sitting cross legged. History of fracture in the left hip at 4 years of age for which McMurray's osteotomy was done. The patient was operated with total hip arthroplasty using modular Sivash range of motion (S-ROM) stem. CONCLUSION: Modular S-ROM total hip arthroplasty is a good option for treatment in cases with previous osteotomy in femur.

Solitary Osteochondroma of Posterior Elements of the Spine: A Rare Case Report.

INTRODUCTION: Osteochondromas are the most common benign tumors of the bone accounting for 35% to 40% of all benign bone tumors. They present in two distinct clinical forms - solitary osteochondroma and multiple osteochondromas. Solitary osteochondroma accounts for 85% of all osteochondroma and is commonly seen in childhood and adolescence. They more frequently affect the appendicular skeleton and are rarely found in spine. Biopsy and imaging help in diagnosis and en bloc resection is the treatment of choice in symptomatic patients. CASE REPORT: We present a case of a 6-year-old girl who presented with swelling over back for 4 years. Radiological evaluation and biopsy were done and the patient was diagnosed with osteochondroma of the left lamina and spinous process of dorsal 12th vertebral body which was managed with extraperiosteal en bloc excision. CONCLUSION: Osteochondroma of the lamina and spinous process of vertebrae is rare and can be effectively treated by extraperiosteal en bloc resection and has a good post-operative outcome.

Tuberculous Dactylitis in Adult - A Case Report and Review of Literature.

INTRODUCTION: Tubercular dactylitis is an uncommon form of musculoskeletal tuberculosis (TB), especially after the age of 5 years without any risk factors. CASE REPORT: A case of 49-year-old male presented with pain, swelling, and discharging sinus of proximal phalanx of third digit of the right hand with no constitutional symptoms for 2 years, with multiple failed treatment in form of antibiotic therapy. There were no risk factors such as immunodeficiency or any co-morbidities. The plain radiograph was suggestive of increased bone density with mild periosteal reaction; magnetic resonance imaging was suggestive of tubercular osteomyelitis. A biopsy was performed, the gene expert of the sample revealed TB with no drug resistance. The patient was managed with anti-tubercular drugs with complete resolution of clinical and radiological symptoms at 1-year follow-up. CONCLUSION: TB should be considered a differential in patients with chronic soft-tissue or skeletal lesions even in the absence of the usual risk factors because with treatment it still carries a good prognosis.

Management of Forearm Deformity by Limb Reconstruction System in Children with Multiple Exostosis - A case Report.

INTRODUCTION: Osteochondroma is the group of benign bone tumours, which are composed of spongy bone covered by a cartilaginous cap. Patients with distal ulnar osteochondromas frequently cause forearm deformities with relative ulnar shortening, wrist joint deviation, and varus bowing. Surgical ulnar lengthening is necessary to restore the carpal balance. CASE REPORT: We report the case of multiple exostosis in a 13-year-old male with the right distal ulna osteochondroma with long-standing and progressive ulnar shortening and radial bowing treated with a limb reconstruction system. Our case is Type I Masada managed with excision of distal ulna osteochondroma and gradual ulnar lengthening without osteotomy of the radius. CONCLUSION: Progressive ulna deformity can lead to increasing pain, joint instability, limited motion, and functional decline. For Type I, Masada ulnar lengthening is necessary, but over correction is inadvisable due to possible ulnocarpal impaction syndrome. As significant remodeling effects on the radius were observed, simultaneous radial correction can be delayed.