Thoracoscopic management of posterior mediastinal neurogenic tumours.

Background: This study describes the surgical technique of thoracoscopic resection of posterior mediastinal neurogenic tumours and reporting the surgical outcomes. Methods: This is a retrospective analysis of 21 patients operated over 7 years in a dedicated thoracic surgery centre. The demographic and post-operative parameters along with complications were recorded and analysed. Results: Twelve patients had right-sided tumours, while 9 had left-sided lesions, and 9 were on the left side. The most common diagnosis was schwannoma (n = 15, 71.42%), followed by neurofibroma (n = 4, 19.04%). The average surgery duration was 104 min (85-135 min), and the mean blood loss was 120 ml (25 ml-250 ml). The average lesion size was 4.8 cm (2 cm-7 cm). Conversion to open procedure was required in one patient. Two patients (14.2%) developed complications. One patient developed Horner's Syndrome and the other developed post-operative lung atelectasis. The median follow-up was 36 months (6-90 months). No recurrence was observed during the follow-up period. Conclusions: Thoracoscopic approach to posterior mediastinal neurogenic tumours is feasible and allows for low morbidity, short hospital stay and superior cosmesis.

Comparative Evaluation of Nemoceph and Foxit PDF Reader for Steiner's Cephalometric Analysis.

AIM: The aim of this study was to evaluate and compare the values of Steiner's cephalometric analysis using Nemoceph and Foxit PDF Reader. No significant difference between the two methods will result in that Foxit PDF Reader can be used as a cost-effective alternative. MATERIALS AND METHODS: This study was conducted on 100 digital lateral cephalograms taken from the same machine. The samples were collected by nonprobability convenience sampling procedures. These images were analyzed for Steiner's cephalometric analysis using two software packages. RESULTS: The skeletal and dental values showed no statistically significant difference in the majority, except for the L1-NA (linear) and L1-NB (linear). CONCLUSION: Results showed that there is a high agreement between the two methods. CLINICAL SIGNIFICANCE: This article provides a simple and cost-effective method of onscreen cephalometric analysis. This technique uses the inbuilt measurement tools in the tool bar of our daily use software. The method can be used independently anywhere without any internet connection and software subscription.

Comparison of Frictional Resistance in Conventional Brackets with Different Stainless Steel Wires.

AIM: The aim of the study was to evaluate and compare static and kinetic friction of round (0.018") and rectangular (0.019 × 0.025") stainless steel (SS) wires of different brands with conventional preadjusted edgewise brackets. MATERIALS AND METHODS: Maxillary canine and two bicuspids of 0.022 × 0.028" slot sized MBT prescription (Gemini, 3M Unitek, Monrovia, California) brackets were chosen. The wires selected were 0.018" SS (3M Unitek); 0.018" Australian wire (AJ Wilcock, UK), and 0.019 × 0.025" SS (3M Unitek). The testing was done on Instron 3382. A total of 30 test combinations with three wires were repeated 10 times. The static and kinetic friction was recorded in Newton. The kinetic friction was also recorded in Newton at 3, 5, 7, and 9 mm of movement. One-way analysis of variance (ANOVA) and descriptive statistics were used for comparing the friction. To test the level of significance, multiple comparisons were used within wire in bracket by using post hoc test. RESULTS: Static friction was found to be greater than kinetic in all wires; 0.018" SS (3M) wire exhibited minimum static and kinetic friction; while 0.019 × 0.025" SS (3M) exhibited maximum static friction. Kinetic friction was similar in both 0.018" AJ Wilcock and 0.019 × 0.025" SS but greater than 0.018" SS (3M). CONCLUSION: Least static and kinetic friction was exhibited by 0.018" SS (3M). Kinetic friction was similar in both 0.018" AJ Wilcock and 0.019 × 0.025" SS. CLINICAL SIGNIFICANCE: The study concluded that 0.018" SS (3M) is better for individual canine retraction than the other wires used in the study because it has the least frictional resistance; 0.019 × 0.025" SS (3M) is a better wire for canine retraction than 0.018" AJ Wilcock as we can have a three-dimensional control over tooth movement. When torque control is not a prime requisite, then 0.018" SS (3M) can be used for retraction of incisors instead of 0.018" AJ Wilcock in severely proclined incisor cases.

Robotic lobectomy: The first Indian report.

INTRODUCTION: Even today, open lobectomy involves significant morbidity. Video-assisted thoracic surgery (VATS) lobectomy results in lesser blood loss, pain, and hospital stay compared to lobectomy by thoracotomy. Despite being an excellent procedure in expert hands, VATS lobectomy is associated with a longer learning curve because of its inherent basic limitations. The da Vinci surgical system was developed essentially to overcome these limitations. In this study, we report our initial experience with robotic pulmonary resections using the Completely Portal approach with four arms. To the best of our knowledge this is the first series of robotic lobectomy reported from India. MATERIAL AND METHODS: Data on patient characteristics, operative details, complications, and postoperative recovery were collected in a prospective manner for patients who underwent Robotic Lung resection at our institution between March 2012 and April 2014 for various indications including both benign and malignant cases. RESULTS: Between March 2012 to April 2014, a total of 13 patients were taken up for Robotic Lobectomy with a median age of 57 years. The median operative time was 210 min with a blood loss of 33 ml. R0 clearance was achieved in all patients with malignant disease. The median lymph node yield in nine patients with malignant disease was 19 (range 11-40). There was one intra-operative complication and two postoperative complications. The median hospital stay was 7 days with median duration to chest tube removal being 3 days. CONCLUSION: Robotic lobectomy is feasible and safe. It appears to be oncologically sound surgical treatment for early-stage lung cancer. Comparable benefits over VATS needs to be further evaluated by long-term studies.

Does Structured Patient Education Reduce the Peri-Operative Anxiety and Depression Levels in Elective Chest Surgery Patients? A Double-Blinded Randomized Trial of 300 Patients.

Psychological distress associated with surgery is an emerging issue. The study was conducted to assess the impact of structured patient education viz-a-viz routine patient education on anxiety and depression levels in patients undergoing elective chest surgery. It is a prospective, double-blind randomized study, conducted from February 2019 to February 2020 at a tertiary care center in India, on patients who underwent elective chest surgeries. A total of 300 patients were randomized using a computer-generated randomization sequence, into 2 equal groups (150 subjects each). Study group included patients who underwent structured patient education (Group A), whereas control group included patients who underwent routine patient education (Group B). The 2 groups were compared for anxiety and depression levels at admission as well as discharge using Hospital Anxiety and Depression Scale. Also, at the time of discharge, the groups were compared for the effectiveness of patient education using a validated Questionnaire B. In comparison to routine education, patients receiving structured education showed significantly lesser scores for anxiety and depression at discharge (P < .001). Also, structured patient education proved to be effective in comparison to the routine education in educating the patients in all parameters as determined by the Questionnaire B (P < .05). It can be concluded that structured educational intervention is strongly recommended in patients undergoing chest surgery which can help alleviate perioperative anxiety and depression. Such intervention helps patient get an understanding of the surgical procedure and assist them in facing the condition in a better way.

Mood Disorders in Youth: Complementary and Integrative Medicine.

Omega-3 polyunsaturated fatty acids, probiotics, vitamin C, vitamin D, folic acid and L-methyl folate, broad-spectrum micronutrients, N-acetylcysteine, physical activity, herbs, bright light therapy, melatonin, saffron, meditation, school-based interventions, and transcranial photobiomodulation are reviewed, with a focus on their use for treating mood disorders in children and adolescents. For each treatment, all published randomized controlled trials are summarized.

A cross-sectional study of SARS-CoV-2 seroprevalence among asymptomatic healthcare workers in a tertiary healthcare centre: Assessing the impact of PPE guidelines.

PURPOSE: The present study estimates the seroprevalence of SARS-COV-2 among asymptomatic HCWs and assess the impact of various categories of PPE. METHODS: A cross-sectional study of asymptomatic HCW using different levels of PPE as per their risk profile was undertaken between 18th and 24th September 2020. Participant demographics and other relevant details including the levels of PPE used were recorded using a customized questionnaire. IgG antibodies against SARS-COV-2 were detected by chemiluminescence method & used as a surrogate marker for incomplete protection. RESULTS: Out of 1033 HCWs tested, overall SARS-COV-2 sero-prevalence was 25.8%. Univariate and multivariate analysis both demonstrated that ancillary workers including security staff (OR 5.589, P â€‹< â€‹0.001) and sanitary workers (OR 3.946, P â€‹< â€‹0.001) were at significantly higher risk of seropositivity irrespective of the PPE used as per guidelines, whereas doctors were at significantly lower risk of seropositivity (OR 0.307, P â€‹= â€‹0.005). Staff working in office areas was associated with reduced risk of seropositivity (OR 0.21, P â€‹= â€‹0.045). CONCLUSIONS: We document high seroprevalence of SARS-COV-2 antibodies in asymptomatic HCWs. Doctors who are at the highest risk had the lowest seropositivity and seroprevalence among office staff having a risk level comparable to the general community was lower than that reported in general population, supporting the efficacy of PPE practices as per guidelines in these groups. In contrast, much higher rates of seropositivity were seen among ancillary workers despite the availability of adequate PPE. Active screening, proper PPE use as per guidelines, and regular infection control trainings including Covid appropriate behaviour are therefore essential to contain COVID-19 spread among HCW & preventing them to transfer infection to the patients.

An International Survey of Female Dental Students' Perceptions About Gender Bias and Sexual Misconduct at Four Dental Schools.

As women enter the dental profession in increasing numbers in North America and around the world, the questions of how they perceive their environment and what kind of barriers they face are important subjects to be addressed. The aim of this study was to assess and compare women dental students' perceptions of bias in their environment and experiences of sexual misconduct at one dental school in each of four countries. In spring 2017, 1,293 female students at four dental schools in the U.S., Bulgaria, Brazil, and India were invited to participate in a 24-item survey developed by researchers from the four countries; 990 students responded (response rate 76.6%). The overall majority of the respondents reported thinking the admissions process at their school was fair (79.7%); but a fifth of U.S. and Brazilian students perceived their school was not fully embracing of females, with most Bulgarian students agreeing (87.2%) and all Indian students disagreeing. Most respondents overall perceived that male faculty members did not favor male students (79.5%) and did not think there was discrimination against female students by faculty (87.1%), but half of the U.S. respondents reported feeling discriminated against by both male faculty and male students. When the responses "I've been verbally harassed" and "I've been somewhat verbally harassed" were combined, 10.1% of the U.S. respondents reported verbal harassment, compared to 20% of Brazilian, 15% of Bulgarian, and 2% of Indian respondents. When the responses "I've been sexually assaulted" and "I've been somewhat sexually assaulted" were combined, 6% of U.S. respondents reported being sexually assaulted, compared to 6.2% of Brazilian, 2.5% of Bulgarian, and none of the Indian respondents. Almost half (46.9%) of these students overall perceived their school was not or only somewhat vigilant about issues of sexual misconduct, and only 54% said they would feel comfortable or very comfortable reporting misconduct. These results suggest that academic dental institutions in all four countries need improvements to make their environments more equitable and free of bias and sexual misconduct.

A global probe into dental student perceptions about philanthropy, global dentistry and international student exchanges.

BACKGROUND: Training culturally competent graduates who can practice effectively in a multicultural environment is a goal of contemporary dental education. The Global Oral Health Initiative is a network of dental schools seeking to promote global dentistry as a component of cultural competency training. OBJECTIVE: Before initiating international student exchanges, a survey was conducted to assess students' awareness of global dentistry and interest in cross-national clerkships. METHODS: A 22-question, YES/NO survey was distributed to 3,487 dental students at eight schools in seven countries. The questions probed students about their school's commitment to enhance their education by promoting global dentistry, volunteerism and philanthropy. The data were analysed using Vassarstats statistical software. RESULTS: In total, 2,371 students (67.9%) completed the survey. Cultural diversity was seen as an important component of dental education by 72.8% of the students, with two-thirds (66.9%) acknowledging that their training provided preparation for understanding the oral health care needs of disparate peoples. A high proportion (87.9%) agreed that volunteerism and philanthropy are important qualities of a well-rounded dentist, but only about one-third felt that their school supported these behaviours (36.2%) or demonstrated a commitment to promote global dentistry (35.5%). In addition, 87.4% felt that dental schools are morally bound to improve oral health care in marginalised global communities and should provide students with international exchange missions (91%), which would enhance their cultural competency (88.9%) and encourage their participation in charitable missions after graduation (67.6%). CONCLUSION: The study suggests that dental students would value international exchanges, which may enhance students' knowledge and self-awareness related to cultural competence.

Knowledge, attitude and practices towards HIV among nurses in a tertiary care teaching hospital: two decades after the discovery.

Accidental transmission of HIV infection to health care workers during occupational exposure is a real threat today. The first such case in India has been documented by NACO recently. Adequate knowledge about the disease and practice of safety measures are our best bet to reduce such transmission. A survey was carried out amongst over 500 nurses in a tertiary care referral hospital in Delhi to assess their knowledge, attitude and practices towards HIV/AIDS. While overall knowledge was satisfactory, there were gaping holes in vital areas. The conversion of their theoretical knowledge into safe practices was shockingly poor. It was due to attitude problems as much as inadequate supplies. High incidence of accidental exposures in the near past and complete ignorance of post-exposure prophylaxis guidelines was another highlight of this study. Despite tremendous efforts put in by the Government as well as various Non-Governmental Organizations, we are completely ill equipped to fight the menace of occupational HIV transmission. In order to fight this menace, "safe practices" have to be made a "way of life" for HCWs. Our health care planners need to take note of it and our teaching and training programmes need complete re-orientation to achieve this goal.

Biodegradation and bioaccumulation of fenitrothion in rat liver.

The biodegradation of fenitrothion O,O-dimethyl-O-(3-methyl-4-nitro phenyl) phosphorothioate was investigated in rat liver after administration of various doses (5 mg/100 g body weight and 20 mg/100 g body weight) in acute treatment and 1 mg/100 g body weight in chronic treatment. High performance liquid chromatography of the pesticide and its metabolites formed in liver in acute treatment showed time-dependent sequential conversion of pesticide into three major metabolites within 24 h. These metabolites were separated and purified to homogenity by HPLC and characterized by IR spectroscopy as O,O-dimethyl-O-(3-methyl-4-amino phenyl) phsophorothioate (metabolite 1), O,O-dimethyl phosphorothioate (metabolite II) and O,O-dimethyl phosphate (metabolite III) in the fi rst dose (5 mg/100 g body weight). Metabolite II was found to be different in the second dose (20 mg/100 g body weight) and identified as O,O-dimethyl O-3-methyl-4-amino phenyl phosphate. The results with the fi rst dose indicated reduction of the nitro group in fenitrothion as step I followed by hydrolytic clevage of the P-O-aryl bond in metabolite I and oxidative desulphurylation of metabolite II. At higher dose (20 mg/100 g body weight) oxidative desulphurylation takes place as step II followed by hydrolysis of metabolite II. The bioaccumulation of fenitrothion within 60 days during chronic treatment showed no metabolite but continuous reduction in fenitrothion concentration, indicating excretion of pesticide and its products in urine and in faeces.