Endoscopic management of high-grade biliary strictures complicating living donor liver transplantation using soehendra stent retrievers.

BACKGROUND: Biliary strictures following living donor liver transplantation (LDLT) are usually managed by endoscopic retrograde cholangiography (ERC) with stricture dilation and stent placement. While current endoscopic techniques are successful in most cases, high-grade biliary strictures (HGBS) pose a challenge using currently employed techniques which have a low rate of technical success. AIMS: In this study, we have explored the safety and efficacy of Soehendra stent retrievers (SSR) for the dilation of HGBS complicating LDLT. METHODS: This was a prospective cohort study where all patients with anastomotic biliary strictures following LDLT from January 2016 till February 2018 were included. Patients with HGBS defined as the exclusive passage of 0.018-inch guidewire, were included in Group 1. In these patients, 5 Fr Soehendra stent retrievers were used to dilate HGBS over guidewire, using torsional movements. Technical success, safety and clinical response was compared with patients who required Per-cutaneous transhepatic cholangiography (PTC) with rendezvous procedure due to a failed ERC, before the commencement of the study (Group 2). RESULTS: Ten patients with HGBS were included into Group 1. Technical success defined as successful placement of a biliary stent across the stricture was achieved in all the patients in group 1. Favorable response to endotherapy was higher in group 1(8/10 patients (80%)) as compared to group 2(6/14 patients (42.8%)). There were no post procedure complications in patients of group 1, while 3 patients developed cholangitis in group 2. CONCLUSIONS: HGBS can be successfully treated with SSR for stricture dilation. It is safe with no significant complications and requires fewer procedures.

Patient-Centered Foodservice Model Improves Body Weight, Nutritional Intake and Patient Satisfaction in Patients Undergoing Cancer Treatment.

Hospital malnutrition is a multi-factorial and complex problem seen in cancer patients receiving treatment, which is associated with poorer outcomes. Appropriate foodservice interventions may be required to improve nutritional status, prevent malnutrition and promote patient satisfaction. We introduced and implemented a patient-centered foodservice model with the aim of improving patient's overall nutritional care and enhancing patient experience. A cross-sectional analysis was done to evaluate outcomes between the traditional foodservice model and the newly implemented patient-centered foodservice model. A meal intake observation tool using a five-point visual scale along with a patient satisfaction survey was used to understand nutritional intake and patient satisfaction, respectively. The findings suggest increased nutritional intake and improved patient satisfaction with the patient-centered foodservice model. Comparison of weight change and nutritional intake between a traditional foodservice model (n = 60) and the patient-centered foodservice model (n = 100) showed a significant weight gain and increase in energy and protein intake (P < 0.01) in the patient-centered foodservice model. Higher patient satisfaction ratings indicated improvement with foodservice across domains in quality and flavor of food, timeliness of delivery, diet education and overall satisfaction. The study concludes that the patient-centered foodservice model can increase the nutritional intake in oncology patients and improve overall patient satisfaction.

Cephalometry as an aid in the diagnosis of pediatric obstructive sleep apnoea: A systematic review and meta-analysis.

Background: Obstructive sleep apnoea (OSA) is part of a spectrum of sleep disorders causing snoring, gasping, and choking while sleeping. In children, OSA can also lead to behavioural issues, hyperactivity, and poor academic performance. Thus, early identification and management of OSA in children is crucial in preventing long-term health problems. The gold standard test for diagnosis is an overnight in-lab polysomnography (PSG). However, due to certain constraints associated with PSG, such as lack of accessibility, high expenses incurred, as well as the need for hospitalization, alternative diagnostic tools are needed. Cephalometry is a non-invasive, affordable diagnostic tool that may offer useful information in the evaluation of OSA. The present systematic review and meta-analysis aimed to evaluate the various cephalometric parameters associated with the diagnosis of OSA in children. Methods: A structured literature search was performed using the search engines PubMed, Scopus, Web of Science, Cochrane, and Google scholar from inception till July 2022. The weighted mean difference (z-test) was calculated using a random effects method (REM). Results: 16 studies were included in the review and meta-analysis was executed for each cephalometric parameter. The parameters of significance (p < 0.05) in Pediatric OSA with lower heterogeneity were associated with McNamara's and Linder-Aronson's analysis, the hyoid bone position, a retrognathic mandible, and an acute cranial base angle. Conclusions: Certain parameters in craniofacial morphology may be reliable diagnostic parameters. Further long-term studies are needed in order to shed more light in this area.

Case Report: Holistic dental care for a child with Hunter syndrome: Addressing dental ramifications, overcoming challenges, and enhancing quality of life.

Hunter syndrome (MPS II), an X-linked recessive lysosomal storage disorder, is a result of deficiency of the iduronate 2-sulfatase enzyme (IDS), leading to cognitive impairment, systemic organ involvement, and increased dental problems. This case report describes the management of a child with Hunter syndrome who was referred to the Department of Paediatric and Preventive Dentistry for pain in the upper front teeth. Intraoral examination revealed severe early childhood caries, prompting planning for full-mouth rehabilitation under general anaesthesia due to the child's uncooperative behaviour. In response to recommendations from the Department of Otolaryngology and the Department of Paediatric Surgery, a comprehensive treatment plan consolidated full-mouth rehabilitation in addition to adenoidectomy and inguinal and umbilical herniotomy procedures during a single session of general anaesthesia. Successful interventions were reflected in the uneventful one-month follow-up of the patient, highlighting the efficacy of the interdisciplinary approach. The key takeaway underscores the importance of collaborative interventions, emphasising singular intubation for patients requiring recurrent hospitalisations, providing both monetary relief and reducing post operative healing time. Designed to address global developmental delay in the child, a personalised home care plan was also implemented. Evaluation of plaque and gingival indices before and after the home care regimen demonstrated a notable improvement, indicating an enhanced oral quality of life.

Biosynthesis and Response of Zinc Oxide Nanoparticles against Periimplantitis Triggering Pathogens.

Periimplantitis due to pathogenic bacteria is considered as a major cause for dental implants failures. Biogenic zinc oxide nanoparticles (ZnPs) are known to inhibit periimplantitis triggering pathogens. The current investigation intended to perform ZnPs biosynthesis and evaluation against periimplantitis triggering bacteria. The current study involved ZnPs biosynthesis using Andrographis paniculata leaves aqueous extract (APLAE), followed by optimization, stability, characterization, and in vitro evaluation against periimplantitis triggering bacteria. The experimental results indicated the success of ZnPs biosynthesis based on the optimization of zinc acetate (1.5 g), plant extract (5 mL), pH 12, and temperature (25 °C), and using the stability study (absorbance between 365-370 nm) and characterization data exhibiting broad and shifted bands (in FTIR spectrum), the size was found to be below 98.61 nm (determined by FESEM and XRD spectra) and 71.54% zinc was observed in the EDX spectrum. Biogenic ZnPs exhibited a high inhibitory activity against periimplantitis-triggering pathogens (E. coli and S. aureus). Based on the experimental results, the present study concludes that biogenic ZnPs possess a high inhibitory potential against periimplantitis-triggering bacteria, and it is established that the biosynthesis of ZnPs using APLAE is a useful method.

Combined Parietal-Insular-Striatal Cortex Stroke with New-Onset Hallucinations: Supporting the Salience Network Model of Schizophrenia.

Brain imaging studies have identified multiple neuronal networks and circuits in the brain with altered functioning in patients with schizophrenia. These include the hippocampo-cerebello-cortical circuit, the prefrontal-thalamic-cerebellar circuit, functional integration in the bilateral caudate nucleus, and the salience network consisting of the insular cortex, parietal anterior cingulate cortex, and striatum, as well as limbic structures. Attributing psychotic symptoms to any of these networks in schizophrenia is confounded by the disruption of these networks in schizophrenic patients. Such attribution can be done with isolated dysfunction in any of these networks with concurrent psychotic symptoms. We present the case of a patient who presents with new-onset hallucinations and a stroke in brain regions similar to the salience network (insular cortex, parietal cortex, and striatum). The implication of these findings in isolating psychotic symptoms of the salience network is discussed.

Profile of trauma patients in the emergency department of a tertiary care hospital in South India.

BACKGROUND: Trauma is an increasing cause of morbidity and mortality in India. This study was done to improve the understanding of the mode of trauma, severity of injuries, and outcome of trauma victims in our hospital. MATERIALS AND METHODS: This was a retrospective observational study of all adult trauma patients more than 18-year-old presenting to our emergency department (ED). Details of the incident, injuries, and outcome were noted. RESULTS: The ED attended to 16,169 patients during the 3-month study period with 10% (1624/16,169) being adult trauma incidents. The gender distribution was 73.6% males and 26.4% females. The mean age was 40.2 ± 16.7 years. The median duration from time of incident to time of arrival to the ED was 3 h (interquartile range [IQR]: 1.5-6.5) for priority one patients, 3 h (IQR: 1.5-7.7) for priority two patients, and 1.5 h (IQR: 1-7) for priority three patients. The average number of trauma incidents increased by 28% during the weekends. Road traffic accident (RTA) (65%) was the most common mode of injury, followed by fall on level ground (13.5%), fall from height (6.3%), work place injuries (6.3%), and others. Traumatic brain injury was seen in 17% of patients while 13.3% had polytrauma with two-wheeler accidents contributing to the majority. The ED team alone managed 23.4% of patients while the remaining 76.6% required evaluation and treatment by the trauma, surgical teams. The in-hospital mortality rate was 2.3%. Multivariate analysis showed low Glasgow coma score (odds ratio [OR]: 0.65, 95% confidence interval [CI]: 0.55-0.76, P < 0.001) and high respiratory rate (OR: 1.15, 95% CI: 1.07-1.24, P < 0.001) to be independent predictors of mortality among polytrauma victims. CONCLUSIONS: RTA and falls are the predominant causes of trauma. A simple physiological variable-based scoring system such as the revised trauma score may be used to prioritize patients with polytrauma.

A case of vasculitis, retinitis and macular neurosensory detachment presenting post typhoid fever.

BACKGROUND: Ocular and extraocular immune-mediated phenomena are known to occur following febrile illness. Vasculitis, retinitis and neurosensory detachment are not well-recognized sequelae of typhoid fever. FINDINGS: We report a case of vasculitis, retinitis and macular neurosensory detachment presenting post typhoid fever. A 27-year-old female presented with decreased vision in right eye with history of typhoid fever (treated adequately 6 weeks prior). Her best corrected visual acuity in right eye was 20/125, N36. Fundus showed a patch of vasculitis and retinitis superior to the disc associated with macular neurosensory detachment and disc pallor. With oral steroids, the inflammation resolved and visual acuity improved to 20/20 at 6 weeks. CONCLUSIONS: Immune-mediated vasculitis and retinitis following typhoid fever may respond well to systemic steroids.