How Did We Deal with the Pandemic? - Experience from a Tertiary Health Institute in Eastern India.

With the introduction of the novel coronavirus in late 2019, the healthcare system of every country in the world experienced many challenges. In India, every healthcare organization has prepared itself to fight against these global challenges. This study aims to describe the challenges faced during the COVID-19 pandemic and how we dealt with the pandemic successfully. This narrative analysis study was made in a 960-bedded teaching hospital during the pandemic. The challenges were identified from the minutes of meetings, circulars issued, and various strategic decisions made to combat the pandemic. The challenges faced by the institute were categorized into nine different categories: infrastructural, human resource, hospital operations, and others. Lack of knowledge during the initial days of the pandemic, need for round-theclock situational management, and day-to-day operation needed aggressive training and adherence to the guidelines. Gaps identified in areas like inventory, infection control, logistics, etc., were quickly addressed, and processes were created as per the nation's changing guidelines. This study revealed strategies to manage the pandemic by optimally utilizing available resources with good teamwork and situational leadership.

Radiological Patterns of Lung Injury on HRCT in COVID-19 Patients: An Experience From Tertiary Care Centre in India.

INTRODUCTION: During the outbreak of the COVID-19 pandemic, radiological examinations became crucial in assessing the severity and progression of lung injuries in COVID-19 patients. AIM: This study was done to identify radiological patterns of lung injuries in COVID-19 patients, assess lobar involvement, and perform CT severity scoring on symptomatic patients on a baseline scan. METHODS AND MATERIAL: All the RT-PCR-positive patients were retrospectively enrolled in the study from August 16, 2020 to October 12, 2020. The final heart-resolution computed tomographic (HRCT) thorax data of a total of 119 COVID-19 patients was analyzed using simple statistical methods. A p-value of less than 0.05 (p < 0.05) was considered statistically significant. RESULTS: A total of 119 HRCT thorax scans of symptomatic indoor RT-PCR-positive patients were reviewed. Over 50% of the patients were under 50 (n = 66; 25 = 5; 25-50 = 61). Males > females: 3.25:1 (M = 91; F = 28). Peripheral involvement dominated (n = 90). Both lungs were affected equally, but the right lower lobe was more involved (n = 103) than the left (n = 98). Inpatient care was needed for 64.70% of CT severity score (CTSS) 10 COVID-19 patients (n = 77). Most positive CT scans (n = 115) revealed ground glass opacities (n = 112; 97.39%). Vascular dilatation or vasculitis (n = 65; 56.62%) and organizing pneumonia-like changes (n = 61; 53.04%) were also common. Vascular enlargement (56.53 percent, n = 65) and reverse halo (52.17%, n = 60) were the most common CT signs. CONCLUSION:  The most common chest CT finding in COVID-19 was ground-glass opacity in peripheral distribution with extensive lung involvement. These ground glass opacities may coalesce into consolidations. Vascular dilatation, organizing pneumonia, interlobular septal thickening, and crazy paving were other important imaging characteristics.

Highly Efficient Intramolecular Excimer Formation in a Disulfide-Linked Dipyrenyl Compound: Proton Recognition and Fluidity Assessment.

Intramolecular excimer formation has been utilized extensively in chemical sciences, especially to probe solvation within complex media as well as to assess physicochemical properties of the solubilizing milieu. Pyrene has been employed extensively as a fluorescence probe for this purpose due to its favorable multidimensional fluorescence properties. Termini-capped dipyrenyl scaffolds possessing various functionalities comprise the majority of such compounds. A new both end-tagged dipyrenyl compound DTP is designed and synthesized, which exhibits significantly high intramolecular excimer formation efficiency in polar solvents. The presence of a -NH-(CO)- and/or -S-S- functionality on the chain linking the two pyrenyl groups facilitates intramolecular excimer formation. Excited-state emission intensity decay reveals that the excimer formation exclusively takes place in the excited state with only one excimer conformation. The rate constant of excimer formation is found to be higher for DTP as compared to a similar compound with an alkyl backbone. The dependence of the excimer formation on the solvent (protic versus aprotic) as well as on temperature reveals further insights into the excimer formation process. The excimer formation by DTP is found to be highly sensitive to the presence of H+: the relative excimer formation efficiency decreases drastically in the presence of a small amount of H+ (∼10-5 M). Further, the recognition of protons by DTP via intramolecular excimer formation is also observed to be highly selective in nature. Based on the observation that both the excimer formation efficiency and kinetics depend on the viscosity of the solubilizing milieu, fluidity assessment of the (dimethyl sulfoxide + acetonitrile) mixture was carried out using DTP. Further, DTP is found to be an effective probe for the assessment of the amount of water in the ionic liquid 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl) imide as well as in a deep eutectic solvent composed of choline chloride and urea in a 1:2 mol ratio. Highly efficient and rapid intramolecular excimer formation not only establishes DTP as a useful and versatile probe but also offers strategic pathways for designing effective excimer-forming compounds.

Feasibility of laparoscopic cholecystectomy for symptomatic gallstone disease with portal cavernoma: Can prior portal vein decompression be avoided?

Backgrounds/Aims: Biliary surgery in patients with extrahepatic portal vein obstruction with portal cavernoma (PC) is technically challenging, and associated with the risk of bleeding. Therefore, prior portal vein decompression is usually recommended before definitive biliary surgery. Only a few studies have so far reported the safety of isolated laparoscopic cholecystectomy. We aimed to evaluate our experience of laparoscopic cholecystectomy in patients with PC without prior portal decompression. Methods: Prospectively maintained data for patients with PC who underwent laparoscopic cholecystectomy for symptomatic gallstone disease without portal decompression were analyzed. Clinical features, imaging, intraoperative factors, conversion rate, complications of surgery, and long-term outcomes were assessed. Results: Sixteen patients underwent cholecystectomy without portal decompression from 2012 to 2021, of which interventions 14 were laparoscopic cholecystectomies. One patient required conversion (7.1%) to open surgery. Jaundice was present in 5 patients (35.7%), and underwent endoscopic stone clearance before surgery. Median intraoperative blood loss, operative time, and hospital stay were 100 mL (20-400 mL), 105 min (60-220 min), and 2 days (1-7 days), respectively. Blood transfusion was required in two patients (14.2%). Prior endoscopic or percutaneous intervention was associated with significant blood loss and prolonged intraoperative time. Conclusions: In centers with experience, prior portal decompression can be avoided in patients with PC requiring isolated cholecystectomy to treat gallstones or their complications. Laparoscopic surgery is safe and feasible for these patients, and gives excellent outcomes in the selected group.

Management of COVID-19 during the second wave at a tertiary care public hospital in Eastern India: An experience from the administrative control room.

Context: Though many arrangements had been made during the first wave, multiple complaints were reported regarding the arrangements made for COVID patients. The control room was set up as a 24 × 7 administrative coordination center to attend to issues after the initial setup of COVID units. Aim: To identify the major problems reported to the control room during the second wave of COVID-19 and find the related cause for the same. Methods and Materials: Issues reported to the control room were recorded from April to June (2021). The control room residents were asked to allocate each problem into six categories. Next, the residents allotted a frequency score to each of the problems depending on how regularly it was reported. Secondary data from various reports were also considered. Statistical Analysis Used: Data were analyzed using MS Excel software. Results: Various administrative issues were identified to be due to issues in communication and coordination (23%), policy and procedures (22%), human resource and training (16%), administration and implementation (15%), infrastructure (14%), and HMIS and IT (10%). Conclusion: Most frequent problems reported to the control room were related to infrastructure, policy implementation, and manpower training. After the initial implementation of new processes, there was a requirement for regular follow-up and coordination. This model of setting up an administrative control room and evidence-based approach will serve as a template for public hospitals to ensure coordination of hospital operations.

Translucency characteristics of permanent maxillary central incisor in Indian population: An analytical cross-sectional study.

Background: Understanding the optical characteristics, especially the translucency patterns (TPs) in teeth can assist clinicians in creating biomimetic restorations. Aim: This study assessed the differences in enamel TPs and the area of translucency (AOT) in the most dominant teeth of an individual's smile according to their age and gender. Materials and Methods: This cross-sectional study was conducted on 140 consented individuals. Based on the age, there were four groups with 35 subjects in each. The digital imaging method is used to classify and differentiate different TPs. The AOT was measured with the assistance of ImageJ 1.51j8 software. Statistical Analysis Used: One-way ANOVA with a post hoc test was used to test the statistical significance difference among the various age groups, and an independent t-test was used to test the variations between genders. Results: The outcome of this study showed that the AOT was the highest for the 50 and above age group as compared to other age groups (P = 0.003). Although there were variations in the TPs between the two genders, the AOT showed no significant difference. Conclusion: The area of incisal third translucency in the upper central incisors varied between different age groups. However, gender had no influence in the area of incisal translucency. Wide variations in the TPs were seen based on age and gender.

COVID 19 Pandemic and biomedical waste management practices in healthcare system.

The whole world was shaken with the pandemic of Coronavirus Disease (COVID-19) in end of the year 2019. Due to its novel origin, it was required to follow all precautions possible. Dealing with the massive amount of infectious healthcare waste became an enormous challenge. This review identifies the impacts of the pandemic on biomedical waste management. This systematic review was made by using keywords "biomedical waste" and "COVID 19" in open access databases like PubMed, Science Direct, Scopus, Google Scholers etc. 2124 articles downloaded and 765 found duplicate and 634 not related to the topic. after scrutiny with inclusion criteria 102 articles were considered to analyze the practices related to biomedical waste management during pandemic using PRISMA guideline.. The COVID-19 waste segregation, collection, storage, transportation, and disposal are a big challenge with all stakeholders. In order to control the virus spread, strict monitoring of the complete waste management cycle is required. Adoption of appropriate guidelines is paramount to worker safety and containment of infection. Sustainable recycling methods are needed to deal with the ever-increasing plastic waste resulting from mandatory personal protective equipment (PPE) usage. The situation also demands a rethinking of the healthcare system. Overall, there was an increase in BMW generation, and municipal waste had increased globally. Pandemic preparedness requires a global public health strategy and long-term investments. This will be vital for making a robust community capable enough to fight against any public health pressures in the future, as well as the pandemic tremors. Systematized efforts from all stakeholders, at all levels, not only refines epidemic preparation but also helps to attain a sustainable development of health for a healthier future.

Thoracoscopic enucleation of oesophageal submucosal tumours in prone position gives excellent long-term outcome: A single-centre experience.

Background: Thoracoscopic enucleation of oesophageal leiomyomas has been adopted by many centres. The procedure when performed in prone position gives good results. The long-term outcome has not been reported earlier. This single-centre study establishes the role of this particular technique. Methods: A retrospective analysis of a prospectively maintained hospital database was performed and after following the study criteria eleven cases of oesophageal submucosal tumours were included in the study. All patients underwent thoracoscopic enucleation in the prone position by a single surgeon. Peri-operative data were recorded and patients followed up for a mean period of 78 months (range = 24-120 months). Results: Thoracoscopic enucleation in prone position was done for all patients with no conversions to an open procedure. Two patients had a mucosal rent during dissection that was repaired. There was no post-operative morbidity greater than Clavien-Dindo Grade 2. Long-term follow-up is available for eight patients (73%) with no recurrence of disease or symptoms. Conclusion: Oesophageal submucosal tumours (predominantly leiomyomas) are benign neoplasms with an indolent biological behaviour and deserve a procedure that would serve the purpose of minimal post-operative morbidity coupled with excellent outcome. Thoracoscopic enucleation in the prone position provides a physiological benefit that translates into better peri-operative outcomes without compromising the long-term outcome and should be the preferred form of treatment for oesophageal submucosal tumours.

ECG Paper Record Digitization and Diagnosis Using Deep Learning.

PURPOSE: Electrocardiogram (ECG) is one of the most essential tools for detecting heart problems. Till today most of the ECG records are available in paper form. It can be challenging and time-consuming to manually assess the ECG paper records. Hence, automated diagnosis and analysis are possible if we digitize such paper ECG records. METHODS: The proposed work aims to convert ECG paper records into a 1-D signal and generate an accurate diagnosis of heart-related problems using deep learning. Camera-captured ECG images or scanned ECG paper records are used for the proposed work. Effective pre-processing techniques are used for the removal of shadow from the images. A deep learning model is used to get a threshold value that separates ECG signal from its background and after applying various image processing techniques threshold ECG image gets converted into digital ECG. These digitized 1-D ECG signals are then passed to another deep learning model for the automated diagnosis of heart diseases into different classes such as ST-segment elevation myocardial infarction (STEMI), Left Bundle Branch Block (LBBB), Right Bundle Branch Block (RBBB), and T-wave abnormality. RESULTS: The accuracy of deep learning-based binarization is 97%. Further deep learning-based diagnosis approach of such digitized paper ECG records was having an accuracy of 94.4%. CONCLUSIONS: The digitized ECG signals can be useful to various research organizations because the trends in heart problems can be determined and diagnosed from preserved paper ECG records. This approach can be easily implemented in areas where such expertise is not available. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40846-021-00632-0.

Creating a Competency-Based Medical Education Curriculum for Canadian Diagnostic Radiology Residency (Queen's Fundamental Innovations in Residency Education)-Part 2: Core of Discipline Stage.

PURPOSE: All postgraduate residency programs in Canada are transitioning to a competency-based medical education (CBME) model divided into 4 stages of training. Queen's University has been the first Canadian institution to mandate transitioning to CBME across all residency programs, including Diagnostic Radiology. This study describes the implementation of CBME with a focus on the third developmental stage, Core of Discipline, in the Diagnostic Radiology residency program at Queen's University. We describe strategies applied and challenges encountered during the adoption and implementation process in order to inform the development of other CBME residency programs in Diagnostic Radiology. METHODS: At Queen's University, the Core of Discipline stage was developed using the Royal College of Physicians and Surgeons of Canada's (RCPSC) competence continuum guidelines and the CanMEDS framework to create radiology-specific entrustable professional activities (EPAs) and milestones for assessment. New committees, administrative positions, and assessment strategies were created to develop these assessment guidelines. Currently, 2 cohorts of residents (n = 6) are enrolled in the Core of Discipline stage. RESULTS: EPAs, milestones, and methods of evaluation for the Core of Discipline stage are described. Opportunities during implementation included tracking progress toward educational objectives and increased mentorship. Challenges included difficulty meeting procedural volume requirements, inconsistent procedural tracking, improving feedback mechanisms, and administrative burden. CONCLUSION: The transition to a competency-based curriculum in an academic Diagnostic Radiology residency program is significantly resource and time intensive. This report describes challenges faced in developing the Core of Discipline stage and potential solutions to facilitate this process.

SMA syndrome: management perspective with laparoscopic duodenojejunostomy and long-term results.

BACKGROUND: Superior mesentery artery syndrome (SMAS) is a rare vasculo-anatomic occlusive pathologic entity for which a period of conservative medical management is advocated with surgery reserved for nonresponsive cases. We present our management plan that entails a single admission approach and complete rendering of medical and surgical treatment to the patient on a background of the socioeconomic and cultural trends prevalent in this geographic region. METHODS: A retrospective analysis of 22 cases of SMAS admitted in our health care system who underwent a period of preoperative conditioning followed by laparoscopic duodenojejunostomy from September 2009 to June 2019 was performed. Patients were followed up at regular intervals. RESULTS: The mean follow-up of the cohort was 41.2 months (2-108 months). The median length of stay was 6 days. The mean postoperative stay was 4.13 days. A subgroup of six patients who had severe physiological depletion required a period of preoperative optimisation. Five of the 22 (22.7%) patients suffered from postoperative complications in the form of delayed return of bowel functions. None of the patients had complications more than Clavien-Dindo grade 2 with no mortality. Long-term data are available for 19 patients (86.3%) which showed no symptom recurrence. CONCLUSION: Management of SMAS that entails an antecedent medical therapy followed by surgery can be accomplished in a single admission with good to excellent results in the intermediate and long-term follow-up. Physiologically depleted patients do require a period of intensive preconditioning but on long-term follow-up, they have excellent results.

Duodenal neuroendocrine tumours in morbidly obese: Amalgamated strategy to optimise outcome.

The association of gastroenteropancreatic neuroendocrine tumours (GEP-NETs) with obesity has been reported and researched on. Rendering of a laparoscopic treatment treating these concurring pathologies in unison has not been described. Two morbidly obese patients with duodenal NETs underwent a resectional procedure, with curative intent, in the form of laparoscopic subtotal gastrectomy with roux-en-y gastrojejunostomy with partial duodenectomy and a laparoscopic one-anastomosis gastric bypass-mini gastric bypass with remnant gastrectomy and partial duodenectomy. Both patients had an uneventful convalescence with acceptable weight loss and no evidence of tumour recurrence on follow-up. The indolent nature of NETs, as compared to the morbidity of obesity provides the rationale for treating this particular cohort of patients with a surgical procedure that would serve to remove the tumour and also provide therapeutic benefit for obesity. With experience in advanced laparoscopic procedures, this can be accomplished safely with acceptable results.

Inventory management practices in the blood bank of an institute of national importance in India.

Background: The demand and supply gap in blood and components has always existed in healthcare facilities. Blood inventory management is crucial to meet the demand and to minimize wastage. This study explores the blood inventory management practices at the blood bank of an institute of national importance in India. Methods: The technicians of the blood bank were interviewed on the practices they followed on blood inventory management and records were reviewed where required. Results: Simple rule of thumb practices, the experience of staff, training, clear policy on stock keeping and allocation, daily stock review, record-keeping, monthly performance review, automation, adoption of information system, regular communications, and leadership emerged as factors contributing to inventory management. Conclusion: The blood bank follows simple procedures and relies on the experience of its staff to manage its inventory. Rigorous training, strict oldest-unit-first-out (OUFO)/first-in-first-out (FIFO) principle for stock management, stringent allocation policy, diligent record-keeping, daily stock review, and monthly performance reports were identified as the key drivers for inventory management. Other measures like regular preventive maintenance of equipment, robust blood bank information system, communication with stakeholders, and effective leadership were found to contribute indirectly to inventory management practices.

A Comprehensive Review: Development of Electrochemical Biosensors for Detection of Cyanotoxins in Freshwater.

Cyanobacteria harmful algal blooms are increasing in frequency and cyanotoxins have become an environmental and public concern in the U.S. and worldwide. In this Review, the majority of reported studies and developments of electrochemical affinity biosensors for cyanotoxins are critically reviewed and discussed. Essential background information about cyanobacterial toxins and electrochemical biosensors is combined with the rapidly moving development of electrochemical biosensors for these toxins. Current issues and future challenges for the development of useful electrochemical biosensors for cyanotoxin detection that meet the demands for applications in field freshwater samples are discussed. The major aspects of the entire review article in a prescribed sequence include (i) the state-of-the-art knowledge of the toxicity of cyanotoxins, (ii) important harmful algal bloom events, (iii) advisories, guidelines, and regulations, (iv) conventional analytical methods for determination of cyanotoxins, (v) electrochemical transduction, (vi) recognition receptors, (vii) reported electrochemical biosensors for cyanotoxins, (viii) summary of analytical performance, and (ix) recent advances and future trends. Discussion includes electrochemical techniques and devices, biomolecules with high affinity, numerous array designs, various detection approaches, and research strategies in tailoring the properties of the transducer-biomolecule interface. Scientific and engineering aspects are presented in depth. This review aims to serve as a valuable source to scientists and engineers entering the interdisciplinary field of electrochemical biosensors for detection of cyanotoxins in freshwaters.

Open flap versus flapless placement of dental implants. A randomized controlled pilot trial.

The aim of this study was to compare the immediate postoperative period of participants rehabilitated with dental implants placed with a conventional technique or with a minimally invasive technique, without a mucoperiosteal flap elevation (flapless). Participants who needed implant placement were divided into two groups: one group was operated using a mucoperiosteal flap elevation (G_A), and the other with a flapless surgical technique (G_B). Objective clinical parameters including oral hygiene, mouth opening, inflammation (facial perimeter), surgical time and analgesic consumption, as well as subjective parameters of pain and degree of satisfaction with the procedure, were evaluated. 48 implants were placed in 30 participants (15 participants per group). Oral hygiene index, maximum interincisal opening, pain and analgesic consumption values had a significant difference between groups favoring the flapless technique at 24 h and 7 days but at the 15 days' follow-up the differences were only significant for oral hygiene and pain (P < 0.05); there were no statistically significant differences between groups in terms of facial perimeter values and surgical time (P > 0.05). Average on the degree of satisfaction was of 2.6 (SD 0.8) for G_A and 3.6 (SD 1.02) for G_B (P = 0.06). One implant placed in G_A (2.0%) failed before prosthetic loading due to mobility and pain at 3 months' follow-up. Participants operated for implant placement with flapless surgical technique go through less postoperative discomfort. Both techniques show high success rates, but to perform a flapless technique patients must be properly selected.

Intraoral lipomas: Review of literature and report of two clinical cases.

BACKGROUND: Lipomas are benign mesenchymal tumors composed of mature adipocytes. They are classified according to their histological pattern and their etiology remains unclear. Objectives: To present two cases and review the literature. MATERIAL AND METHODS: A search was conducted in the Medline / PubMed and Scielo data bases of the last 10 years (2004-2014) with the keywords " intraoral lipoma OR oral cavity lipoma". RESULTS: 46 articles with 95 cases (56 women and 39 men) were reviewed. The average age was found to be 52.28 years (52.28 ± 18.55); and most of them occurred between the 4th and 6th decade of life. Lipomas occur mostly in the buccal mucosa (n = 36, 37.9%), followed by the tongue (n = 23, 24.2%) and other locations (n = 36, 37.9%). The most common histologic pattern was simple lipomas (n = 40, 42%), followed by fibrolipomas (n = 18, 18.9%) and other types (n = 37, 39.1%). The average tumor size was 19.77 ± 16.26mm. CONCLUSIONS: Lipomas are a relatively rare finding in the oral cavity. Surgical excision is the treatment of choice and recurrence is not expected. Key words:Benign oral tumor, oral lipoma, lipoma, oral cavity.