Flexible piezo-resistive strain sensors using all-polydimethylsiloxane based hybrid nanocomposites for wearable electronics.

We report flexible piezo-resistive strain sensors composed of silver nanoparticle (Ag NP), graphene nanoplatelet (GNP), and multi walled carbon nanotube (MWCNT)-based ternary conductive hybrid nanocomposites as an active sensing layer fabricated using a simple solution processing method on flexible polydimethylsiloxane (PDMS) substrates. The electrical characteristics have been studied in PDMS-based flexible devices having three different kinds of structures, namely Ag NPs/MWCNT/PDMS, GNP/PDMS and Ag NPs/GNP/PDMS. The microscopic analysis of the hybrid nanocomposites is undertaken using field emission scanning electron microscopy. The diameter of the CNTs is found to be in the range of 20-40 nm, whereas the length is determined to be 100-800 nm. The average diameter and length of the GNPs are observed to be 30-50 nm and 100-500 nm, respectively. The crystallite size of the silver nanoparticles in the Ag NPs/MWCNT/PDMS and Ag NPs/GNP/PDMS-based nanocomposites is determined to be 22.8 nm and 29.1 nm, respectively. The prepared sample of Ag NPs shows four distinct peaks in the X-ray diffraction pattern, which correspond to the (111), (200), (220), and (311) face-centered cubic (FCC) crystalline planes. Raman spectroscopy is undertaken to study the fundamental physical properties and chemical analysis of the nanocomposites. Ag NPs/GNP/PDMS-based sensors exhibit superior performance in terms of sensitivity, response and recovery time during breathing/unbreathing analysis. The large surface area of the Ag NPs and GNPs promotes uniform distribution of Ag NPs to fill into the porous GNP surface, thereby facilitating high contact area along with better electron transport in the Ag NPs/GNP/PDMS hybrid nanocomposite-based sensors. The gauge factor (GF), response and recovery time of the Ag NPs/GNP/PDMS hybrid nanocomposite-based sensors are determined to be 221, 130 ms and 119 ms, respectively. The ternary conductive nanocomposite-based sensors are free from the drawbacks of binary nanocomposite-based sensors where the high percolation threshold and poor mechanical behaviour lead to the degradation of the device performance.

Assessment of head and neck position for optimal ultrasonographic visualisation of the internal jugular vein and its relation to the common carotid artery: A prospective observational study.

BACKGROUND AND AIMS: There is a wide variation in the anatomical relationship of the Internal Jugular Vein (IJV) to the Common Carotid Artery (CCA). This makes landmark based techniques of IJV cannulation and head rotation questionable and may lead to accidental arterial puncture. We conducted this study to determine the anatomical relation of the IJV to the CCA using (USG) in patients undergoing IJV cannulation for central venous access, and to analyse the effect of head rotation on this relationship. MATERIAL AND METHODS: A prospective observational study was conducted on 100 patients requiring central venous access, in the operation theatre or the intensive care unit. Anatomical relationship of the IJV to CCA at the level of the cricoid cartilage was analysed by noting the segment position (1-12) around the CCA using a high frequency linear USG probe on patients in neutral head position, on both sides and also with the head rotated to the contra lateral side by 15° and 45°. RESULTS: Antero-lateral segments 1 and 2 were the most common positions (50% on the right and 73% on the left side). Change in segment causing increase in overlap of IJV and CCA with 15° head rotation was seen in 44% subjects on the right and 39% on the left. Statistically, a higher number of subjects showed overlap with 45° rotation (99% on right and 97% on left, P < 0.05). CONCLUSION: There is a wide variation in anatomical location of the IJV in relation to the CCA as seen by USG. Excessive head rotation causes overlap of IJV over CCA which may cause inadvertent arterial puncture, even under USG guidance. Thus, it is preferable to cannulate the IJV in neutral or near neutral head and neck position.

Functional compared to anatomical imaging in the initial evaluation of patients with suspected coronary artery disease: An international, multi-center, randomized controlled trial (IAEA-SPECT/CTA study).

OBJECTIVE: To test the hypothesis that, in the initial evaluation of patients with suspected coronary artery disease (CAD), stress myocardial perfusion imaging (MPI) would result in less downstream testing than coronary computed tomographic angiography (CCTA). METHODS: In this international, randomized trial, mildly symptomatic patients with an intermediate likelihood of having CAD, and asymptomatic patients at intermediate risk of cardiac events, underwent either initial stress-rest MPI or CCTA. The primary outcome was downstream noninvasive or invasive testing at 6 months. Secondary outcomes included cumulative effective radiation dose (ERD) and costs at 12 months. RESULTS: We recruited 303 patients (151 MPI and 152 CTA) from 6 centers in 6 countries. The initial MPI was abnormal in 29% (41/143) and CCTA in 56% (79/141) of patients. Fewer patients undergoing initial stress-rest MPI had further downstream testing at 6 months (adjusted OR 0.51, 95% CI 0.28-0.91, P = 0.023). There was a small increase in the median cumulative ERD with MPI (9.6 vs. 8.8 mSv, P = 0.04), but no difference in costs between the two strategies at 12 months. CONCLUSION: In the management of patients with suspected CAD, a strategy of initial stress MPI is substantially less likely to require further downstream testing than initial testing with CCTA. TRIAL REGISTRATION: clinicaltrials.gov identification number NCT01368770.

Assessment of Anticarcinogenic Potential of Vitex trifolia and Triticum aestivum Linn by In Vitro Rat Liver Microsomal Degranulation.

OBJECTIVE: The main objective of this preliminary study is to confirm the synergistic anticarcinogenic potential of Vitex trifolia and Triticum aestivum ethanolic extracts. MATERIALS AND METHODS: Rat hepatic microsomal degranulation is a short - term technique that has been used for the detection of potential chemical carcinogens, in vitro. The present study has been carried out to study the inhibition of ribosome- membrane disruption against 3, 8-Diamino-5-ethyl-6-pheylphenanthridinium bromide (EB), as the degranulating agent, by measuring the RNA/protein ratios of microsomal membranes in the presence or absence of V.trifolia and T. aestivum extracts. These two extracts were further evaluated for cytotoxic effect in HCT 116 and A549 cell lines. RESULTS: V. trifolia and T. aestivum protects hepatic microsomes against the degranulatory attack by the carcinogen EB showed a significant reduction in the proliferation of the HCT 116 and A549 cancer cell lines. CONCLUSION: The ethanolic extracts of the plants, V. trifolia and T. aestivum individually possessed anti-degranulatory potential. Importantly they act synergistically, possess appreciable anticarcinogenic properties, based on their ability to inhibit EB induced liver microsomal degranulation. Further these extracts inhibit cell proliferation of cancer cell lines.

Analgesic efficacy of stellate ganglion block in head and neck cancer pain: A case series.

Patients with head and neck cancer (HNC) have ongoing pain but Stellate ganglion block which is a sympatholytic block may be a viable therapy for treating it. The data were retrospectively collected from five histopathologically confirmed HNC patients who had completed chemotherapy and radiation doses. Stellate ganglion block was given to these patients and was subsequently monitored for 3 months to assess pain alleviation and overall satisfaction. Over a 3-month period, there was a decrease in the pain levels with a better quality of life so the stellate ganglion block can be a promising modality for reducing the pain of HNC.

Surgery compared to fibrinolytic therapy for symptomatic left-sided prosthetic heart valve thrombosis (SAFE-PVT): Rationale and design of a randomized controlled trial.

BACKGROUND: Left-sided mechanical prosthetic heart valve thrombosis (PVT) occurs because of suboptimal anticoagulation and is common in low-resource settings. Urgent surgery and fibrinolytic therapy (FT) are the two treatment options available for this condition. Urgent surgery is a high-risk procedure but results in successful restoration of valve function more often and is the treatment of choice in developed countries. In low-resource countries, FT is used as the default treatment strategy, though it is associated with lower success rates and a higher rate of bleeding and embolic complications. There are no randomized trials comparing the two modalities. METHODS: We performed a single center randomized controlled trial comparing urgent surgery (valve replacement or thrombectomy) with FT (low-dose, slow infusion tissue plasminogen activator, tPA) in patients with symptomatic left-sided PVT. The primary outcome was the occurrence of a complete clinical response, defined as discharge from hospital with completely restored valve function, in the absence of stroke, major bleeding or non-CNS systemic embolism. Outcome assessment was done by investigators blinded to treatment allocation. The principal safety outcome was the occurrence of a composite of in-hospital death, non-fatal stroke, non-fatal major bleed or non-CNS systemic embolism. Outcomes will be assessed both in the intention-to-treat, and in the as-treated population. We will also report outcomes at one year of follow-up. The trial has completed recruitment. CONCLUSION: This is the first randomized trial to compare urgent surgery with FT for the treatment of left-sided PVT. The results will provide evidence to help clinicians make treatment choices for these patients. (Clinical trial registration: CTRI/2017/10/010159).

Pulsed radiofrequency to stellate ganglion for brachial plexus injury-induced complex regional pain syndrome: A case series.

Brachial plexus injury (BPI) occurs commonly in young adults following trauma. This may result in the development of complex regional pain syndrome (CRPS) following injury, which is difficult to treat. We present a group of patients with CRPS secondary to BPI. These patients were managed with neuromodulation of the stellate ganglion (SG) with pulsed radiofrequency (PRF) and followed up for a period of 3 months to assess for pain relief and a decrease in the intake of medications after the intervention. PRF to SG was found to have significant pain relief lasting around three months.

Efficacy of stellate ganglion interventions for complex regional pain syndrome in the upper limb-A systematic review and meta-analysis.

Background and Aims: Stellate ganglion (SG) interventions for treating upper limb complex regional pain syndrome (CRPS) have been reported in studies. However, more substantial evidence is required to reach a consensus on its analgesic efficacy. To the best of our knowledge, no systematic review demonstrating the effectiveness of SG intervention for upper limb CRPS has been reported. Hence, this meta-analysis was done to ascertain the efficacy of SG intervention in managing patients with upper limb CRPS. Methods: A database search of PubMed, Cochrane, Embase, Scopus and Google Scholar was done for articles published between January 2001 and December 2021. Two independent reviewers extracted data from the included studies, and the studies were evaluated for any potential risk of bias, and a meta-analysis was performed. Results: Eight studies were included in the qualitative synthesis, four were randomised controlled trials (RCTs), and the rest were non-RCTs. Six studies were assessed quantitatively. A significant reduction in pain scores post-intervention, up to two weeks, and four to 28 weeks after the procedure was observed, although the included studies exhibited marked heterogeneity. Qualitative analysis of these studies revealed an overall improvement in disability scores and functionality as assessed by an improved range of motion. Most studies reported no complications or only short-term minor complications after the procedure. Conclusion: Stellate ganglion interventions improve pain and disability scores with self-limiting short-term complications and no long-term complications. However, further studies with a large sample size are required to validate this treatment modality.

Stellate Ganglion Blocks for Refractory Central Poststroke Pain: A Case Series.

Central poststroke pain (CPSP) is a neuropathic pain secondary to cerebrovascular accidents. This is characterized by pain and other sensory abnormalities, which correspond with the area of the injured brain. Despite advancements in therapeutic options, this clinical entity is still challenging to treat. We present 5 patients with CPSP, who were refractory to pharmacotherapy and were successfully managed with stellate ganglion blocks. A significant decrease in pain scores and improvement in functional disabilities were noted in all patients following the intervention.

Effect of autologous platelet-rich plasma (PRP) on low back pain in patients with prolapsed intervertebral disc: A randomised controlled trial.

Background and Aims: Prolapsed intervertebral disc (IVDP) is a major cause of low back pain. Platelet-rich plasma (PRP) has emerged as a viable option for these patients, with fewer adverse effects and long-term sustainability of pain relief. This double-blinded, randomised study aimed to evaluate the effect of autologous PRP on low back pain in patients with IVDP. Methods: A total of 42 patients with IVDP were randomised either to the autologous PRP (n = 21) group or control (epidural local anaesthetics with steroids; n = 21) group. Change in pain was assessed using the Numeric Rating Scale (NRS). Impact of treatment was assessed using the Global Perceived Effect (GPE) scale. All the patients were followed up for six months. Data was compared using Chi-square, independent sample t, and Mann-Whitney U tests. Results: The two groups were similar in their demographic and clinical profile. The baseline mean NRS ± standard deviation (SD) was 6.91 ± 0.94 in the PRP group and 7.38 ± 1.16 in the control group (P = 0.099). At six months, the mean NRS ± SD was 1.43 ± 0.75 in the PRP group compared to 5.43 ± 0.75 in the control group (P < 0.001). The GPE score was also found to be significantly higher in the PRP group, compared to the control group in the final assessment (P < 0.001). During the course of the study, the PRP group showed a consistent decline in NRS, whereas the control group showed an initial decline followed by consistent increase in NRS. Conclusion: PRP provided sustained relief from low back pain due to IVDP and can be recommended as a safe and promising alternative to epidural local anaesthetics and steroids.

Efficacy of splanchnic nerve neurolysis in the management of upper abdominal cancer pain: A systematic review and meta-analysis.

Background and Aims: Neurolytic splanchnic nerve block (NSNB) is practised in intractable abdominal pain secondary to intra-abdominal malignancies. This review evaluated the efficacy of NSNB. Methods: PubMed, Embase, Scopus, and Cochrane databases were searched for articles published from January 2001 to October 2023. Two independent reviewers extracted the data from the included studies. The quality of randomised controlled trials (RCTs) was assessed using the revised Cochrane risk-of-bias tool (RoB 2), and the Newcastle-Ottawa scale was used for cohort studies. Results: Fourteen articles (4 RCTs, 3 non-randomised prospective, and 7 retrospectives) were included. Ten articles were quantitatively assessed and demonstrated significant pain relief at 1 week (standardised mean difference (SMD): 3.46 [2.09, 4.83], P < 0.001, I2 = 95%), 2 weeks (SMD: 4.45 [2.61, 6.29], P < 0.001, I2 = 95%), 4 weeks (SMD: 3.35 [2.23, 4.47], P < 0.001, I2 = 97%), 8 weeks (SMD: 3.7 [2.71, 4.7], P < 0.001, I2 = 86%), 12 weeks (SMD: 4.01 [2.66, 5.36], P < 0.001, I2 = 95%), and 24 weeks (SMD: 2.54 [1.71,3.37], P < 0.001, I2 = 84%). Daily narcotic consumption and quality of life (QOL) significantly improved post neurolysis, but survival rates showed controversial results. Significant heterogeneity was reported, and sub-group analysis revealed a moderate level of variability [I2 = 47.3%] pertaining to study design as a source of heterogeneity. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Pro GDT recommendation for the primary objective was 'high' for the analysis of RCTs and 'very low' evidence quality for observational studies. Only transient minor complications were reported. Conclusion: NSNB appears to be an efficacious technique that provides substantial pain relief, reduces opioid consumption, and ameliorates QOL.

Use of Artificial Intelligence for the Development of Predictive Model to Help in Decision-Making for Patients with Degenerative Lumbar Spine Disease.

Context The aim of the study was to develop a prognostic model using artificial intelligence for patients undergoing lumbar spine surgery for degenerative spine disease for change in pain, functional status, and patient satisfaction based on preoperative variables included in following categories-sociodemographic, clinical, and radiological. Methods and Materials A prospective cohort of 180 patients with lumbar degenerative spine disease was included and divided into three classes of management-conservative, decompressive surgery, and decompression with fixation. Preoperative variables, change in outcome measures (visual analog scale-VAS, Modified Oswestry Disability Index-MODI, and Neurogenic Claudication Outcome Score-NCOS), and type of management were assessed using Machine Learning models. These were used for creating a predictive tool for deciding the type of management that a patient should undergo to achieve the best results. Multivariate logistic regression was also used to identify prognostic factors of significance. Results The area under the curve (AUC) was calculated from the receiver-operating characteristic (ROC) analysis to evaluate the discrimination capability of various machine learning models. Random Forest Classifier gave the best ROC-AUC score in all three classes (0.863 for VAS, 0.831 for MODI, and 0.869 for NCOS), and the macroaverage AUC score was found to be 0.842 suggesting moderate discriminatory power. A graphical user interface (GUI) tool was built using the machine learning algorithm thus defined to take input details of patients and predict change in outcome measures. Conclusion This study demonstrates that machine learning can be used as a tool to help tailor the decision-making process for a patient to achieve the best outcome. The GUI tool helps to incorporate the study results into active decision-making.

Sexual Dysfunction in Male Patients with Idiopathic Generalized Tonic Clonic Seizures.

BACKGROUND: Epilepsy is the second most common neurological disorder, and it may have a significant effect on sexual functions in epileptic patients. MATERIALS AND METHODS: Sexual dysfunctions were assessed in 146 male patients suffering from generalized tonic-clonic seizure (GTCS) with a seizure-free interval of at least 1 year. Out of 146 patients enrolled, 46 patients had a psychiatric impairment and were excluded from the study, after applying the General Health questionnaire12 (GHQ12) scale and detailed psychiatric evaluation. The remaining patients were evaluated for the presence of sexual dysfunction by applying Arizona Sexual Experience scale (ASEX). Sixty-six patients scoring more than 19 as a cutoff score on the ASEX scale were further interviewed by a psychiatrist, and a diagnosis of sexual dysfunction was made as per ICD 10 Diagnostic criteria. RESULTS: Sexual dysfunction was diagnosed in 66% (n = 66) of the patients. Erectile dysfunction was the most common sexual disorder diagnosed in 36% of the patients (n = 36) followed by premature ejaculation in 26% (n = 26) and decreased libido (hypoactive sexual desire) seen in 4% (n = 4) of the patients. In patients with sexual dysfunction, a significant association was observed with the duration of epilepsy and type of therapy (mono/polytherapy) (P value < 0.05). Erectile dysfunction and hypoactive desire were more common in patients taking polytherapy, whereas premature ejaculation was more common in patients on monotherapy. CONCLUSION: Significant impairment of sexual functions was observed in male epileptics with GTCS. A high index of suspicion should be kept in mind by the practicing clinician on diagnosing and treating sexual dysfunction in them.

Management of Obstetric Analgesia in the Developing Countries during the Coronavirus Disease Pandemic: A Narrative Review.

Coronavirus disease (COVID), also known as COVID-19, has brought the immense challenges for the health-care system globally. All the branches of medicine are equally involved in managing these patients. During this pandemic, care of obstetric patients in terms of obstetric analgesia becomes crucial. Hence, the purpose of this review was to draft a basic model of strategies related to the provision of safe obstetric analgesia during this coronavirus pandemic, which will assist the health-care providers across the developing countries to formulate their own protocols depending upon the resource availability. All research articles related to obstetric analgesia during the COVID-19 pandemic from January 2020 to December 01, 2020 available on PubMed, Cochrane, Google scholar, and Embase are included in this study. The keywords used for data search were "obstetric analgesia during COVID-19," "coronavirus pandemic," "Labor pain," "obstetric pain management guidelines," and "regional anesthesia during COVID-19." Eventually, our review yielded the most recentmodel for the provision of safe and effective obstetric analgesia practices during the COVID-19 pandemic across the developing countries.

Development of macaronic Hindi-English 'Hinglish' text message content for a coronary heart disease secondary prevention programme.

BACKGROUND: Coronary heart disease (CHD) is a leading cause of morbidity and mortality in India. Text message based prevention programs have demonstrated reduction in cardiovascular risk factors among patients with CHD in selected populations. Customisation is important as behaviour change is influenced by culture and linguistic context. OBJECTIVES: To customise a mobile phone text message program supporting behaviour and treatment adherence in CHD for delivery in North India. METHODS: We used an iterative process with mixed methods involving three phases: (1) Initial translation, (2) Review and incorporation of feedback including review by cardiologists in India to assess alignment with local guidelines and by consumers on perceived utility and clarity and (3) Pilot testing of message management software. RESULTS: Messages were translated in three ways: symmetrical translation, asymmetrical translation and substitution. Feedback from cardiologists and 25 patients was incorporated to develop the final bank. Patients reported Hinglish messages were easy to understand (93%) and useful (78%). The software located in Australia successfully delivered messages to participants based in Delhi-surrounds (India). CONCLUSIONS: Our process for customisation of a text message program considered cultural, linguistic and the medical context of potential participants. This is important in optimising intervention fidelity across populations enabling examination of the generalisability of text message programs across populations. We also demonstrated the customised program was acceptable to patients in India and that a centralised cross-country delivery model was feasible. This process could be used as a guide for other groups seeking to customise their programs. TRIAL REGISTRATION NUMBER: TEXTMEDS Australia (Parent study)-ACTRN 12613000793718.