Comparison of functional outcomes and patient satisfaction in patients with lumbar canal stenosis with and without concomitant obesity following lumbar decompression surgery and their correlation with BMI.

BACKGROUND: Obesity is an important predictor of development of Lumbar canal stenosis (LCS) and its symptoms. LCS further restricts the mobility of the patient and a vicious cycle develops. The operative decision on patients with LCS and obesity is a matter of debate. Hence, we attempted to compare changes in body mass index and patient satisfaction in patients with LCS with and without concomitant obesity, undergoing spinal decompression surgery. METHODS: Patients undergoing decompression for LCS between 1st June 2019 to 31st May 2020 were included. Baseline characteristics including age, sex, co-morbidities, BMI, self-recorded maximal walking distance (SR-MWD) and Oswestry disability index score (ODI) were recorded. All patients were followed up prospectively at 1 year post surgery. Satisfaction was recorded on a five-point Likert scale. Participants were classified into non obesity (group 1) and obesity (group 2) groups according to JAPI and WHO classification and compared. RESULTS: 55 patients met the inclusion criteria, 23 in group 1 and 32 in group 2. Group 2 showed a mean decrease in BMI of 0.95 ± 1.32 kg/m2 while other group had an increase of 0.14 ± 1.31 kg/m2 (p = 0.021). Significant weight change was seen in 31.3 % group 2 vs 8.7 % group 1 patients which was significant (p = 0.046). Pre operative BMI positively correlated with change in BMI after surgery (r = 0.406, p = 0.001) and with percentage weight reduction (r = 0.321, p = 0.017). Both the groups were comparable in improvement in ODI and SR-MWD scores and patient satisfaction. CONCLUSION: Patients with obesity achieve significant reduction in weight and BMI following decompression surgery for LCS. It will further prevent other health conditions attributed to obesity. Both the groups were comparable in ODI, SR-MWD and satisfactory outcome following surgery. Hence obesity should not be a deterring factor for surgical consideration for patients with lumbar canal stenosis.

Use of emergency departments by children and young people following telephone triage: a large database study.

BACKGROUND: Although one objective of NHS 111 is to ease the strain on urgent and emergency care services, studies suggest the telephone triage service may be contributing to increased demand. Moreover, while parents and caregivers generally find NHS 111 satisfactory, concerns exist about its integration with the healthcare system and the appropriateness of advice. This study aimed to analyse the advice provided in NHS 111 calls, the duration between the call and ED attendance, and the outcomes of such attendances made by children and young people (C&YP). METHODS: A retrospective cohort study was carried out of C&YP (≤17) attending an ED in the Yorkshire and Humber region of the UK following contact with NHS 111 between 1 April 2016 and 31 March 2017. This linked-data study examined NHS 111 calls and ED outcomes. Lognormal mixture distributions were fit to compare the time taken to attend ED following calls. Logistic mixed effects regression models were used to identify predictors of low-acuity NHS 111-related ED attendances. RESULTS: Our study of 348 401 NHS 111 calls found they were primarily concerning children aged 0-4 years. Overall, 13.1% of calls were followed by an ED attendance, with a median arrival time of 51 minutes. Of the 34 664 calls advising ED attendance 41% complied, arriving with a median of 38 minutes-27% of which defined as low-acuity. Although most calls advising primary care were not followed by an ED attendance (93%), those seen in an ED generally attended later (median 102 minutes) with 23% defined as low-acuity. Younger age (<1) was a statistically significant predictor of low-acuity ED attendance following all call dispositions apart from home care. CONCLUSION: More tailored options for unscheduled healthcare may be needed for younger children. Both early low-acuity attendance and late high-acuity attendance following contact with NHS 111 could act as useful entry points for clinical audits of the telephone triage service.

The need for prosthetic and orthotic rehabilitation inclusion in early pediatric intervention centers in India: A viewpoint.

The article focuses on the need for prosthetic and orthotic services in India to improve the quality of life of children with disabilities through early identification and intervention. Early intervention is the earliest identification and comprehensive service and support for children with developmental delays and disabilities ranging from 0 to 6 years to improve their ability to adapt to society. A practical early intervention delays or prevents future complications and prepares the child for functional adult life. It may positively affect the quality of life of the differently abled and their family members, and they can lead an active personal and social life. Also, such interventions promote the well-being and dignity of the differently abled and their parents, which may result in national economic progress. Prosthetic and orthotic rehabilitation facilities under the leadership of qualified professionals are needed in India's government and private setups.

Phytomediated Copper Oxide Nanoparticles Derived from the Fronds of Adiantum venustum D.Don: Evaluation of their Biomedical Potential.

The green synthesis of copper oxide nanoparticles (CuO) mediated by crude ethanolic extract and the n-butanol fraction of Adiantum venustum represents a groundbreaking approach in nanotechnology, combining ecological sustainability with advanced functionality. This innovative method leverages the natural bioactive compounds present in A. venustum to produce CuO nanoparticles, which exhibit remarkable antioxidant, anti-inflammatory, antimicrobial, and anti-proliferative properties. The green synthesized nanoparticles were characterized using a variety of techniques, as XRD confirmed the crystalline nature of the CuO nanoparticles, with a crystallite size of 14.65 nm for CuO-C and 18.73 nm for CuO-B. The grain sizes of CuO-C (14.09 ± 0.17 nm) and CuO-B (67.88 ± 2.08 nm) were determined using transmission electron microscopy micrographs. Furthermore, the synthesized nanomaterial and the crude ethanolic extract, n-butanol fraction, were examined for their biological potentials namely antioxidant, anti-inflammatory, antimicrobial, and anti-proliferative activity against HeLa cancer cells. Among the synthesized nanomaterials, copper oxide nanoparticles synthesized by utilizing the n-butanol fraction have appeared as a potential biomedical agent. CuO-B has arisen as an antioxidant agent with IC50 values of 44.63 ± 0.49 µg/mL, 48.49 ± 0.17 µg/mL, and 35.39 ± 0.61 µg/mL for DPPH, FRAP, and reducing power assay, respectively. Furthermore, the significant antibacterial potential of CuO-B against gram-positive (S. aureus MIC 46.88 µg/mL) and gram-negative (K. pneumonia MIC 23.48 µg/mL) bacterial strains cannot be neglected either. Along with this, the IC50 value (138.07 µg/mL) of CuO-B against HeLa cells proved it to be a potential anticancerous agent. Hence, this novel approach emphasized that these synthesized nanoparticles have tremendous biological potential and can be applied to various fields of agriculture and biomedicine.

Performing median arcuate ligament release surgery in celiac artery compression syndrome: Insights from a tertiary care hospital.

BACKGROUND: Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome or celiac artery (CA) compression syndrome, is a rare condition characterized by persistent post-meal or post-exercise abdominal discomfort, often more pronounced during expiration. Additional symptoms include nausea, vomiting, and weight loss. AIMS AND OBJECTIVES: To document the clinical presentation, diagnostic process, and treatment outcomes of seven patients diagnosed with MALS and to evaluate the effectiveness of surgical release of the median arcuate ligament (MAL) over a follow-up period of at least six months. MATERIALS AND METHODS: The study included seven patients diagnosed with MALS from 2019 to 2021. Diagnosis was based on the presence of chronic abdominal pain and associated symptoms, absence of alternative diagnoses after various clinical assessments, and angiographic evidence of CA compression. The primary treatment involved surgical decompression of the CA by releasing the MAL through either open or laparoscopic techniques. RESULTS: All seven patients underwent successful surgical release of the MAL. The patients were followed up for at least six months post-surgery. The study evaluated the persistence of symptoms and the need for additional interventions such as revascularization techniques. CONCLUSION: Surgical release of the MAL is the primary treatment for MALS, providing relief for many patients. However, long-term follow-up is essential as some patients may continue to experience symptoms post-surgery, necessitating further interventions.

Beyond Traditional Training: Exploring the Benefits of Virtual Reality Simulator in Lumbar Pedicle Screw Insertion - A Randomized Controlled Trial.

INTRODUCTION: This study compares the effectiveness of virtual reality simulators (VRS) and a saw bone model for learning lumbar pedicle screw insertion (LPSI) in neurosurgery. METHODS: A single-center, cross-sectional, randomized controlled laboratory investigation was conducted involving residents and fellows from a tertiary care referral hospital. Participants were divided into two groups (A and B). Group A performed 3 LPSI tasks: the first on a saw bone model, the second on VRS, and the third on another saw bone model. Group B completed 2 LPSI tasks: the first on a saw bone model and the second on another saw bone model. The accuracy of LPSI was evaluated through noncontrast computed tomography scans for the saw bone models, while the in-built application of VRS was utilized to check for accuracy of screw placement using the simulator. RESULTS: The study included 38 participants (19 in each group). Group A participants showed reduced mean entry point error (0.11 mm, P 0.024), increased mean purchase length (4.66 cm, P 0.007), and no cortical breaches (P 0.031) when placing the second saw bone model screw. Similar improvements were observed among group A participants in PGY 1-3 while placing the second saw bone model screws. CONCLUSIONS: Virtual reality simulators (VRS) prove to be an invaluable tool for teaching complex neurosurgical skills, such as LPSI, to trainees. This technology investment can enhance the learning curve while maintaining patient safety.

A deep neural network and transfer learning combined method for cross-task classification of error-related potentials.

Background: Error-related potentials (ErrPs) are electrophysiological responses that naturally occur when humans perceive wrongdoing or encounter unexpected events. It offers a distinctive means of comprehending the error-processing mechanisms within the brain. A method for detecting ErrPs with high accuracy holds significant importance for various ErrPs-based applications, such as human-in-the-loop Brain-Computer Interface (BCI) systems. Nevertheless, current methods fail to fulfill the generalization requirements for detecting such ErrPs due to the high non-stationarity of EEG signals across different tasks and the limited availability of ErrPs datasets. Methods: This study introduces a deep learning-based model that integrates convolutional layers and transformer encoders for the classification of ErrPs. Subsequently, a model training strategy, grounded in transfer learning, is proposed for the effective training of the model. The datasets utilized in this study are available for download from the publicly accessible databases. Results: In cross-task classification, an average accuracy of about 78% was achieved, exceeding the baseline. Furthermore, in the leave-one-subject-out, within-session, and cross-session classification scenarios, the proposed model outperformed the existing techniques with an average accuracy of 71.81, 78.74, and 77.01%, respectively. Conclusions: Our approach contributes to mitigating the challenge posed by limited datasets in the ErrPs field, achieving this by reducing the requirement for extensive training data for specific target tasks. This may serve as inspiration for future studies that concentrate on ErrPs and their applications.

Reconsidering red blood cells as the diagnostic potential for neurodegenerative disorders.

BACKGROUND: Red blood cells (RBCs) are usually considered simple cells and transporters of gases to tissues. HYPOTHESIS: However, recent research has suggested that RBCs may have diagnostic potential in major neurodegenerative disorders (NDDs). RESULTS: This review summarizes the current knowledge on changes in RBC in Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and other NDDs. It discusses the deposition of neuronal proteins like amyloid-ß, tau, and α-synuclein, polyamines, changes in the proteins of RBCs like band-3, membrane transporter proteins, heat shock proteins, oxidative stress biomarkers, and altered metabolic pathways in RBCs during neurodegeneration. It also highlights the comparison of RBC diagnostic markers to other in-market diagnoses and discusses the challenges in utilizing RBCs as diagnostic tools, such as the need for standardized protocols and further validation studies. SIGNIFICANCE STATEMENT: The evidence suggests that RBCs have diagnostic potential in neurodegenerative disorders, and this study can pave the foundation for further research which may lead to the development of novel diagnostic approaches and treatments.

Design and evaluation of fluorescent chitosan-starch hydrogel for drug delivery and sensing applications.

Composite bio-based hydrogels have been obtaining a significant attention in recent years as one of the most promising drug delivery systems. In the present study, the preparation of composite chitosan-starch hydrogel using maleic acid as a cross-linker was optimized with the help of response surface methodology. The synthesized hydrogel was fluorescent owing to clustering of large number of functional groups. Different analytical techniques, including XRD, FTIR, SEM, XPS, fluorescence and BET were utilized to characterize the prepared hydrogel. XRD analysis confirmed the formation of non-crystalline hydrogel with random arrangement of macromolecular chains. The composite hydrogel exhibited good swelling percentage with pH sensitivity, hemocompatibility and degradability. BET analysis confirmed that the variation in concentration of crosslinker significantly influences the pore volume of the hydrogel. The synthesized composite chitosan-starch hydrogel was utilized as a prospective candidate for controlling drug release. Cefixime as a model drug was loaded onto the synthesized hydrogel utilizing the swelling diffusion method. SEM micrographs showed uniform distribution of drug molecules in the drug loaded hydrogel. In vitro drug release experiments indicated the swelling dependent drug release behaviour of chitosan-starch hydrogel with higher drug release at pH 7.4 (93.08 %) compared to pH 1.2 (67.85 %). The composite chitosan-starch hydrogel was able to prolong and control the drug release up to 12 h. The drug release from the hydrogel followed Korsmeyer-Peppas and Makoid-Banakar model with Fickian diffusion mechanism. Further, the composite hydrogel displayed excitation dependent fluorescence emission with most intense blue emission band at 425 nm with an excitation wavelength of 350 nm. The inclusion of cefixime drug in the hydrogel matrix significantly reduced the fluorescence intensity; the decrease was linearly correlated to the concentration of the drug. Moreover, the fluorescence emission the chitosan-starch hydrogel was found to be dependent upon pH. The synthesized hydrogel is expected to be a potential candidate for controlled drug release as well as for fluorescent sensing applications.

Bridge to Transplantation: Policies Impact Practices.

Since the development of the first heart allocation system in 1988 to the most recent heart allocation system in 2018, the road to heart transplantation has continued to evolve. Policies were shaped with advances in temporary and durable left ventricular assist devices as well as prioritization of patients based on degree of illness. Herein, we review the changes in the heart allocation system over the past several decades and the impact of practice patterns across the United States.

Nanofabrication of citronellal with chitosan biopolymer to boost its efficacy against aflatoxin B1 and Aspergillus flavus mediated biodeterioration of active ingredient of Piper longum.

The study reports the efficacy of nanofabricated citronellal inside the chitosan biopolymer (NeCn) against Aspergillus flavus growth, aflatoxin B1 (AFB1) production, and active ingredient biodeterioration (Piperine) in Piper longum L. The prepared NeCn was characterized by Scanning Electron Microscopy (SEM), Dynamic Light Scattering (DLS), and Fourier Transform Infrared Spectroscopy (FTIR). The results revealed that the NeCn exhibited distantly improved antifungal (1.25 µL/mL) and AFB1 inhibition (1.0 µL/mL) compared to free Cn. The perturbances in membrane function, mitochondrial membrane potential, antioxidant defense system, and regulatory genes (Ver-1 and Nor-1) of AFB1 biosynthesis were reported as probable modes of action of NeCn. The NeCn (1.25 µL/mL) effectively protects the P. longum from A. flavus (78.8%), AFB1 contamination (100%), and deterioration of Piperine (62.39%), thus demonstrating its potential as a promising novel antifungal agent for food preservation.

Reconstruction of Partial Defect of Ear in a Tertiary Care Institute.

Auricle is the outward visible part of ear and composed of skin and cartilage. Auricle due to its standout and projected position is more vulnerable to get injured and cause distortion of the facial aesthetics. Reconstruction of the ear defect should be individualized depending on the defect size, location, nearby skin, patient requirement and surgeon experience. To present the results of various reconstructive options for partial ear defect which will aid in decision making among reconstructive options available. Reconstruction was individualized considering the defect size, depth, location, surrounding skin. In upper 1/3 defect reconstructive options include Antia-Buch chondrocutaneous advancement flap, autogenous cartilage with temporoparietal fascial flap, for middle 1/3 defect options include retroauricular soft tissue tube flap, diefenbach procedure, Autogenous cartilage graft and temporoparietal fascial flap, for lower 1/3 defect reconstructive options include pre auricular flap, triangular repair method, Zenteno Alanis technique. Reconstruction with various techniques results in aesthetically good outcomes. There is no major complication seen in any patient. Reconstruction of ear defect with various options available has good outcome. Planning is important part in reconstruction process. Reconstructive option chosen for a ear defect should be individualized depending on patient characteristics, surgeon experience.

Impact of new allocation policy on waitlist and transplant outcomes of adult congenital heart patients supported with ECMO.

BACKGROUND: The use of ECMO as a bridge to heart transplantation has been growing rapidly in all heart transplant recipients since the implementation of the new UNOS allocation policy; however, the impact on adult congenital heart disease (ACHD) patients is not known. METHODS: We analyzed the UNOS data (2015-2021) for ACHD patients supported with extracorporeal membrane oxygenation (ECMO) during the waitlist, before and after October 2018, to assess the impact on the waitlist and posttransplant outcomes. We compared the characteristics and outcomes of ACHD patients with or without ECMO use during the waitlist and pre- and postpolicy changes. RESULTS: A total of 23 821 patients underwent heart transplantation, and only 918 (4%) had ACHD. Out of all ACHD patients undergoing heart transplants, 6% of patients in the prepolicy era and 7.6% in the postpolicy era were on ECMO at the time of listing. Those on ECMO were younger and sicker compared to the rest of the ACHD cohort. Those on ECMO had similar profiles pre- and postpolicy change; however, there was a very significant decrease in the waitlist time [136 days (IQR 29-384) vs. 38 days (IQR 11-108), p = 0.01]. There was no difference in waitlist mortality; however, competing risk analyses showed a higher likelihood of transplantation (51% vs. 29%) and a lower likelihood of death or deterioration (31% vs. 42%) postpolicy change. Long-term outcomes posttransplant for those supported with ECMO compared to the non-ECMO cohort are similar for ACHD patients, although there was higher attrition in the first year for the ECMO cohort. CONCLUSION: The new allocation policy has resulted in shorter waitlist times and a higher likelihood of transplantation for ACHD patients supported by ECMO. However, the appropriate use of ECMO and the underuse of durable circulatory support devices in this population need further exploration.

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.

Low-Cost Scalable PCB-Based 2-D Transducer Arrays for Volumetric Photoacoustic Imaging.

Photoacoustic (PA) imaging provides deep tissue molecular imaging of chromophores with optical absorption contrast and ultrasonic resolution. Present PA imaging techniques are predominantly limited to one 2D plane per acquisition. 2D ultrasound transducers, required for real-time 3D PA imaging, are high-cost, complex to fabricate and have limited scalability in design. We present novel PCB-based 2D matrix ultrasound transducer arrays that are capable of being bulk manufactured at low-cost without using laborious ultrasound fabrication tools. The 2D ultrasound array specifications are easily scalable with respect to widely available PCB design and fabrication tools at low cost. To demonstrate scalability, we fabricated low (11 MHz) frequency 8x8 matrix array and high (40 MHz) frequency 4x4 matrix array by directly bonding an undiced polyvinylidene fluoride (PVDF) piezoelectric material of desired thickness to the custom designed PCB substrate. Characterization results demonstrate wideband PA receive sensitivity for both low (87%) and high (188%) frequency arrays. Volumetric PA imaging results of light absorbing targets inside optical scattering medium demonstrate improved spatial resolution and field of view with increase in aperture size.

An integrative ayurvedic approach in management of breast abscess - A case report.

A focus has been placed particularly on the description of breast abscesses (sthana vidradhi in Ayurveda terms). Breast inflammation known as mastitis has the potential to develop into a breastabscess in the future. The term "stana roga," refers to breast disorders and describes breast abscesses, is mentioned in the ancient works Sushruta Samhita, Madhava Nidana, and Bhavaprakasha. Breast abscesses are typically treated surgically by making an incision over the area of greatest fluctuation (or pain) and breaking the abscess septa with digits. For a few days, the abscess chamber is left untreated or gauze-packed, with dressing changes made as needed to facilitate wound granulation. The current report was aimed at management of the breast abscess through an integrated approach comprising surgical and medicinal intervetions as mentioned in Ayurveda classics. A 32-year-old female patient with pain and swelling in right breast was diagnosed with breast abscess in Shalya (Surgery) OPD and managed primarily by incision and drainage which was followed by regular dressing and ayurvedic medications which encouraged appreciable granulation in a short period of time with complete healing of the abscess. This case study presents the successful management of breast abscesses with both surgical & Ayurvedic management.

Assessment of Trachyspermum ammi essential oil against Aspergillus flavus, aflatoxin B1 contamination, and post-harvest quality of Sorghum bicolor.

The present investigation explored the antifungal effectiveness of Trachyspermum ammi essential oil (TAEO) against Aspergillus flavus, aflatoxin B1 (AFB1) contamination, and its mechanism of action using biochemical and computational approaches. The GC-MS result revealed the chemical diversity of TAEO with the highest percentage of γ-terpinene (39 %). The TAEO exhibited minimum inhibitory concentration against A. flavus growth (0.5 µL/mL) and AFB1 (0.4 µL/mL) with radical scavenging activity (IC50 = 2.13 µL/mL). The mechanism of action of TAEO was associated with the alteration in plasma membrane functioning, antioxidative defense, and carbon source catabolism. The molecular dynamic result shows the multi-regime binding of γ-terpinene with the target proteins (Nor1, Omt1, and Vbs) of AFB1 biosynthesis. Furthermore, TAEO exhibited remarkable in-situ protection of Sorghum bicolor seed samples against A. flavus and AFB1 contamination and protected the nutritional deterioration. Hence, the study recommends TAEO as a natural antifungal agent for food protection against A. flavus mediated biodeterioration.