Transient Horner's Syndrome: An Unusual Complication of Pneumothorax Treatment.

Horner's syndrome is a rare condition that results when there is an interruption of the sympathetic fibers that run from the stellate ganglion to the eye. The classic triad of Horner's syndrome includes unilateral ptosis, miosis, and anhidrosis. Spontaneous pneumothorax is a rare condition that occurs when there is a sudden collapsed lung without any direct cause. A few cases have been reported of spontaneous pneumothorax associated with iatrogenic Horner's syndrome. A chest thoracostomy is a procedure that can lead to iatrogenic Horner's syndrome. Here, we present the case of a 25-year-old male with a left-sided spontaneous pneumothorax complicated by iatrogenic Horner's syndrome secondary to chest thoracostomy.

A Rare Case of Elevated Transaminases With Incomplete Abortion Due to Cytomegalovirus Infection: An Experience From a Resource-Limited Setting.

Cytomegalovirus (CMV) infection during pregnancy may cause spontaneous abortion, stillbirth, and death of newborns. CMV is the most common congenital infection in newborns. It generally has a benign course in immunocompetent individuals, while the severe disease is usually seen in immunocompromised patients. Most of the published studies about CMV infection describe congenital abnormalities in newborns. Only a handful of case reports mention CMV infection associated with elevated transaminases during pregnancy. Here, we present a case of incomplete abortion with elevated liver enzymes in a 26-year-old female caused by CMV infection. Our case report illustrates the importance of considering CMV infection as a differential in an incomplete abortion associated with elevated liver enzymes.

Checkpoint Inhibitor-Associated Scleroderma and Scleroderma Mimics.

Immune checkpoint inhibitors (ICI) are the standard of care for various malignancies and have been associated with a wide spectrum of complications that are phenotypically akin to primary autoimmune diseases. While the literature on these toxicities is growing, there is a paucity of data regarding ICI-associated scleroderma which can carry significant morbidity and limit the ability to continue effective ICI therapy. Our review aimed to analyze the current literature on ICI-associated systemic scleroderma (ICI-SSc) and key scleroderma mimics. Cases of ICI-SSc had notable differences from primary SSc, such as fewer vascular features and less seropositivity (such as scleroderma-specific antibodies and antinuclear antibodies). We found that patients with a diagnosis of SSc prior to the start of ICI can also experience flares of pre-existing disease after ICI treatment used for their cancer. Regarding scleroderma mimics, several cases of ICI-eosinophilic fasciitis have also been described with variable clinical presentations and courses. We found no cases of scleroderma mimics: ICI-scleromyxedema or ICI-scleroedema. There is a critical need for multi-institutional efforts to collaborate on developing a patient database and conducting robust, prospective research on ICI-scleroderma. This will ultimately facilitate more effective clinical evaluations and management for ICI-scleroderma.

Barriers in biogas production from the organic fraction of municipal solid waste: A circular bioeconomy perspective.

Biogas-based circular bioeconomy can provide a long-term way out of the organic fraction of municipal solid waste. The barriers to biogas production are obstructing the growth of the biogas-based circular bioeconomy. This study provides a comprehensive analysis of the barriers to biogas in developing countries for the wider implementation of biogastechnology. Twenty barriers are identified and categorized into technical, logistical, institutional, and social dimensions. The analytical hierarchy process is applied to rank the barriers. The result of barrier ranking shows that the lack of appropriate segregation facilities is the most crucial barrier, followed by waste characteristics variation, and inconsistent supply. This study will provide an outline for rational decision-making in the sustainable organic fraction of municipal waste management.

An analytical hierarchy process based decision support system for the selection of biogas up-gradation technologies.

Recent developments in biogas upgradation have opened new horizons for its utilisation because upgradation technologies are fully developed and commercially available. However, the implementation of biogas upgrading technologies is not at the scale required to harness the full potential of biogas. Therefore, it is requisite to adopt a multicriteria decision-making methodology (MCDM) to select the most appropriate biogas up-gradation technology as each technology has its own set of benefits and downside. In this multifaceted scenario, the analytical hierarchy Process (AHP), one of the most preferred MCDM methods in rational decision-making, is applied in this study to select the most appropriate biogas upgrading technology. The broader recognition of AHP is its provision for converting multifaceted problems into a simple hierarchy. The research results reveal that biogas up-gradation technologies based on water scrubbing and membrane separation rank first and second among the alternatives. This research will show a direction to researchers and the MCDM community involved in biogas upgradation technologies on a broader scale.

Sustainable rural waste management using biogas technology: An analytical hierarchy process decision framework.

Biomass is present in ample amounts in rural areas, mainly in agriculture residue and animal wastes. Biogas can be produced from rural solid waste, providing affordable clean energy for rural households and a prominent solution to solid waste management. Despite having several benefits of using biogas, the contribution of biogas in rural areas is not as much as expected. Several technical and non-technical barriers are accountable for the slow rate of biogas technology adoption in rural households. Nineteen barriers to household biogas plant adoption in four dimensions of technical, economic, market, and awareness are identified and ranked with the analytical hierarchy process (AHP) in the perspective of rural India. The outcome of the barrier dimension reveals that the economic dimension gets the highest weight of (0.350), followed by the market with a weight of (0.322). At the same time, high installation cost with a weight of (0.141) dominates in the category of barriers, followed by competition from freely available fuel with a weight of 0.105). The gap in capital cost and capital subsidy, lack of paying capacity, and lack of easy credit have positioned respectively third, fourth, and fifth in the overall ranking of barriers with weights of (0.094), (0.084), and (0.08). This paper may contribute significantly to creating greater awareness, evaluating numerous barriers, and adopting biogas technology in India more effectively and efficiently.

Highly efficient bio-adsorption of Malachite green using Chinese Fan-Palm Biochar (Livistona chinensis).

The discharge of effluents from the textile industry is a multidimensional problem that affects the ecosystem in many ways. Though many new technologies are being developed, it remains to be seen which of those can be practiced in a real scenario. The current investigation attempts to absorb the Malachite Green, an effluent from textile dye using Chinese Fan Palm Seed Biochar. Accordingly, biochar was prepared using fruits of Chinese Fan Palm (Livistona chinensis) tree. The fruit also yielded a significant amount of biochar and bio-oil. 1.346 kg of fresh and cleaned fruit was fast pyrolyzed at 500 °C in a laboratory-scale Pyrolyzer resulting in 0.487 kg of biochar and 0.803 L of bio-oil. The remaining fruit matter was converted to gaseous products. The kinetics of dye removal were studied and the parameters were determined. The study advocates that the Langmuir isotherm model simulates the adsorption experiment, to a good extent. From the plot, the maximum (monolayer) adsorption capacity, Qm was determined to be 21.4 mg/g. The suitability of the Langmuir isotherm model onto biochar was established by the high correlation coefficient, R2 that was higher than 0.97.

Acid-Base Disorder in the Patients Visiting the Emergency Department of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: An acid-base disorder is a change in the normal value of extracellular pH that may result when renal or respiratory function is abnormal or when an acid or base load overwhelms their excretory capacity. Clinical acid-base disorders are conventionally defined from the vantage point of their impact on carbonic-acid-bicarbonate buffer system. The aim of the study is to find out the prevalence of acid-base disorder among patients visiting the emergency department of a tertiary care hospital. METHODS: This is a descriptive cross-sectional study conducted among 370 patients who underwent arterial gas analysis at the emergency department of a tertiary care hospital. The study was carried out from 15th July 2016 to 15th July 2017 after receiving ethical approval from Institutional Review Committee. Convenient sampling was done. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Data were entered in Microsoft-Excel. Statistical Package for Social Sciences version 17 was used for analysis. RESULTS: Out of 370 patients analyzed, 329 (88.91%) (84.68-91.311 at 95% Confidence Interval) had acid-base disorder. The mixed disorder was the most common finding 80 (21.6%), followed by compensated Respiratory Acidosis 56 (17.8%). The mean age group of male patients studied was 50.72±20.586 and among females, it was 49.95±20.908 Among those most common symptoms were shortness of breath 151 (40.81%) followed by vomiting 91 (24.59%). CONCLUSIONS: Most common acid-base disorder was mixed disorder presenting with prominent symptoms of shortness of breathe in non-geriatric patients wherein the geriatric patient, the most common disorder was compensated respiratory acidosis with the prominent symptom of shortness of breath.

Punch Incision with Secondary Healing (PISH) Technique for Benign Facial Lesions: An Institutional Experience in 307 Patients.

Background Multiple or solitary facial lesions pose a unique challenge to the attending surgeon in terms of delivering the best cosmetic outcome. There are various methods in dealing with them and the preference of using them is based on the surgeon's experience, patient expectations, and availability of instruments. One such tool, skin-punch, primarily designed for a biopsy can play a very important therapeutic role in this era of keyhole surgery. In this paper, we assess the technique of punch incision with its combination of secondary healing for various facial lesion. Methods This observational study, a total of 307 patients with solitary or multiple benign facial lesions were treated with punch incision technique using 2 to 6 mm sterile, disposable skin biopsy punches. Subsequently, the wounds were managed with healing with secondary intention. Results In our series all superficial wounds epithelized by 7 to 14 days while the deeper lesions epithelized by 14 to 28 days. We had three recurrences which were managed by fusiform excision and one patient had surgical site infection which was managed conservatively. On application of our self-devised facial scar scoring system (SCAR or Scar Cosmesis Assessment and Rating) 3 on all the scars, the mean score was 6 at 1 year followup. Conclusion Punch incision with healing by secondary intention is a relatively easy, effective, single-stage office procedure. This method can be considered as an alternative method for the removal of various skin lesions, especially on face, thus providing a simple solution to complex problems.

Reusability of brilliant green dye contaminated wastewater using corncob biochar and Brevibacillus parabrevis: hybrid treatment and kinetic studies.

This work highlights the potential of corncob biochar (CCBC) and Brevibacillus parabrevis for the decolorization of brilliant green (BG) dye from synthetically prepared contaminated wastewater. The CCBC was characterized by proximate, Fourier-transform infrared spectroscopy, scanning electron microscopy, X-ray diffraction, and Brunauer-Emmett-Teller analysis, respectively. Different parameters affecting the adsorption process were evaluated. The experimental results were analyzed by the Langmuir and Freundlich isotherm models. Kinetic results were examined by different models; pseudo-second-order model has shown the best fit to the experimental data. Anew positive values of ΔHo (172.58 kJ/mol) and ΔSo (569.97 J/K/mol) in the temperature range of 303-318 K revealed that the adsorption process was spontaneous and endothermic. The present investigation showed that the bacteria immobilized with CCBC showed better BG dye degradation. The kinetic parameters, µmax, Ks, and µ max, were found to be 0.5 per day, 39.4 mg/day, and 0.012 L/mg/day using Monod model, respectively. The adsorbent with bacteria showed good potential for the removal of cationic BG dye and can be considered for the remediation of industrial effluent.

Transvaginal laparoscopic appendectomy using innovative submucosal tunnels: a conducive modification for improving hybrid NOTES access and its critical appraisal.

Currently, transvaginal natural orifice transluminal endoscopic surgery (NOTES), the most minimally invasive option for laparoscopic surgery, suffers various technological restraints limiting its implementation. We discuss a simple modification for vaginal access to improve the existing hybrid NOTES technique. We retrospectively studied 18 women at our rural hospital in central India, who, under defined criteria, underwent transvaginal appendicectomy using innovative strategically designed submucosal tunnels. The procedure was successfully completed in all but the first three cases. None required additional abdominal trocar or analgesia beyond the first 6 h. The mean operative and hospitalisation times were 27.5 min and 18.5 h, respectively. We had no intraoperative complications and only one patient experienced postoperative self-limiting vaginal spotting. All patients were very pleased with the cosmetic results and sexual life as assessed by locally devised scales. On regular follow-up, all were progressing well. We recommend the method presented, as it is not only feasible and safe but has the potential to improve overall results. Clearly, a larger volume randomised trial would be optimal to confirm our conclusion.

Application of Arjuna (Terminalia arjuna) seed biochar in hybrid treatment system for the bioremediation of Congo red dye.

In the present study, a hybrid treatment system (biological and ozonation) was developed and used in the decolorization of Congo red (CR) dye. The biological treatment was performed in packed bed bioreactor (PBBR) containing Arjuna (Terminalia Arjuna) seeds biochar immobilized with Providencia stuartii, whereas ozonation was carried out in an ozone reactor. The process variables such as temperature, process time, and inoculum size were optimized and found to be 30 °C, 2 48 h, and 3 × 105 CFU/mL, respectively with 92.0 ± 5.0% of dye decolorization. Furthermore, biologically treated effluent was subject to ozone treatment for the decolorization of the remaining CR dye. The hybrid approach reveals almost complete decolorization of Congo red (CR) dye. The kinetic study of microbial growth was examined by Monod model. In addition, the cost analysis estimation for the removal of CR dye was done, and removal per liter was found to be economic.

A Simple Bed-side Method of Enteral Feeding through Distal Mucous Fistula in Patients with Short Bowel Syndrome to overcome Parenteral Dependency: The Jategaonkar Technique.

Today, massive proximal small bowel resection with diverting stoma formation is a relatively common occurrence, especially in an emergency setting. However, the resultant short bowel syndrome remains difficult to manage on various nutritional fronts and commencing total parenteral nutrition, along with plethora of its associated complications, becomes almost obligatory for these unfortunate patients. In this context, the authors describe an innovative, yet, handy method of enteral feeding through distal mucous fistula using two commonly available tubes in the ward, with the aim to maximise the usage of the available gut and to outwit the ensuing need of parenteral supplementation, and name it the Jategaonkar technique. Backed with successful experience of 18 cases, it is especially useful in low-income countries and can be mastered readily even by junior doctors, paramedic staff, and stoma therapists or by patient's kin, alike. Such a procedure is yet to be reported in the available literature.

Tensionless Purely Laparoscopic Intra-Gastric Surgery using an Innovative Mucosal Flap-Valve Mechanism: The Jategaonkar Technique.

Cooperative laparoscopic endoscopic intra-gastric surgery, with its ability to acquire advantages of both these technologies, is a recent development in the field of minimally invasive surgery. However, the pre-requisition of its multi-disciplinary approach together with several technical constraints have, plausibly, limited its widespread acceptance. The ever-increasing number of modifications being reported in today's literature largely underscores the inability of any one to be the best. We illustrate a novel, simple-to-learn, rapid and potentially cost-effective technique of intra-gastric surgery using just the routine laparoscopic instruments, and name it the 'Jategaonkar technique'. We have practised it in seven consecutive patients without any complications; and hence, recommend it for regular application. Such a method is yet to be described in the literature.

Amending Umbilical Porting in Laparoscopic Totally Extra-peritoneal Hernioplasty: A Simplified Way.

An unambiguous identification of anterior rectus sheath (ARS) is a crucial initial step required for precise umbilical porting in order to achieve successful execution of laparoscopic totally extra-peritoneal (TEP) hernioplasty. However, it is scarcely discussed in the present-day literature. Backed with the experience of 1100 cases, we present an easy and rapid technique of exposing the anterior rectus sheath with the aim to save operative time without compromising the safety. Such a method is yet to be described in the literature.