Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study.

Background: The goal was to measure the piriform sinus, epiglottis, and thyroid cartilage in our sample population. Methods: This study included 22 adult embalmed cadavers available in the Department of Anatomy. Dimensions were measured using a digital Vernier caliper. Results: The mean height of the thyroid laminae was 27 ± 1.4 mm at the right side and 25.5 ± 1.4 mm at the left side. Mean width of the thyroid lamina was 27.1 ± 1.3 mm at the right side and 27.4 ± 0.9 mm at the left side. The mean thickness of thyroid cartilage was found to be 4.4 ± 0.4 mm and 3.9 ± 0.5 mm over the right and left sides. The mean length, width and thickness of the epiglottis were 29.1 ± 0.5 mm, 22.2 ± 0.6 mm and 2.6 ± 0.3 mm correspondingly. The height, width and thickness of the right piriform sinus were 25 ± 0.5 mm, 14.2 ± 0.5 mm and 12.6 ± 0.5 mm, the same parameters were 25.3 ± 1.3 mm, 15.1 ± 0.7 mm and 13.3 ± 0.4 mm for the left side. Conclusions: The height and thickness of the thyroid cartilage were greater on the right side than on the left side (p<0.05). It was statistically observed that the width and thickness were greater on the left side than on the right side (p < 0.05). The data about the height, width and thickness of the thyroid cartilage, epiglottis and piriform sinus are essential during the laryngeal and other neck surgeries. They guide in the preoperative positioning, predicting the difficulty of intraoperative exposure and retractor pulling.

Unveiling childhood asthma: Exploring biomarkers, zinc, and beyond.

This editorial discusses a case-control study by Ibrahim et al, published in the recent issue of the World Journal of Clinical Pediatrics. Childhood bronchial asthma is a chronic inflammatory respiratory disease. It was found that an increase in oxidative stress leads to a decrease in antioxidants causing oxidative damage to mitochondrial respiratory chain complexes resulting in the inflammation of the airway, hypersecretion of mucus causing a cascade of clinical manifestations ranging from recurrent episodes of coughing, wheezing, and breathlessness to shortness of breath. Since oxidative stress mediates the inflammatory response in asthma, the supplementation of anti-oxidants can be one strategy to manage this disease. Zinc is one such antioxidant that has attracted much attention about asthma and airway inflammation. Zinc is a crucial trace element for human metabolism that helps to regulate gene expression, enzyme activity, and protein structure. Apart from zinc, free serum ferritin levels are also elevated in case of inflammation. Several previous studies found that ferritin levels may also help determine the pathology of disease and predict prognosis in addition to tracking disease activity. However, this study's results were different from the findings of the previous studies and the zinc levels did not show a significant difference between asthmatic children and non-asthmatic children but ferritin levels were significantly high in asthmatic children as compared to the controls. Hence, the possible role of the biochemical nutritional assessment including zinc and ferritin as biomarkers for asthma severity should be assessed in the future.

Pioneers of Neurosurgery in the South Asian Association for Regional Cooperation (SAARC) region: A Historical Vignette and beyond.

South Asia, consisting of Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka spreads between the Himalayan base and the Indian ocean, and shares identical geophysical characteristics. With the inclusion of its newest member Afghanistan, these 8 member-nations of the South Asian Association for Regional Cooperation (SAARC) share more or less a homogenous geographical, political, and historical background and cultural heritage, with a significant role in shaping the world. This densely populated area is home to around a quarter of the world's total population. From the ancient ages, the neurosurgical practice has paced relentlessly and in the last 100 years, it has reached its zenith. With modern advancements, neurosurgery has developed in its diagnostic and treatment modalities along with facilities for training and education. Despite falling behind owing to economic, educational, and geopolitical constraints the pioneers of the SAARC region have established the fields of neurosurgery in their respective countries with command. No constraint could stop them from educating and training young physicians to make competent neurosurgeons to evolve the field of neurosurgery in their countries. Their firm determination and hard work paved the way to keep this field striving and thriving, to serve a substantial volume of the world population with their neurosurgical insight and skill. However, this region needs to go a long way as the number of neurosurgeons and facilities is still insufficient. This can be achieved with the guidance and collaboration among the neurosurgeons of the SAARC region as the youth here are talented and hard-working.

Polymorphous Low-Grade Neuroepithelial Tumor of the Young (PLNTY): Scoping Review of Case Reports and Case Series.

Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is considered one of the low-grade neuroepithelial tumors, as per the World Health Organization 2021 classification of brain tumors. First described in 2016, these morphologically variable tumors are characterized by oligodendroglioma-like cellular components, infiltrative growth patterns, and cluster of differentiation 34 immunopositivity. A literature search of the PubMed/MEDLINE, SCOPUS, ScienceDirect, and COCHRANE databases (from inception to 20th June 2022) was carried out to identify relevant studies. To identify additional studies, we performed a recursive search of the bibliographies of the selected articles and published systematic reviews on this topic. The search yielded a total of 64 results. After removing duplicates, 26 articles were eligible for the review. The diagnostic criteria for these glioneuronal variants, representing a broad neuropathological spectrum, are not distinct and hence impede proper diagnosis and prognosis. Frequent genetic abnormalities involving mitogen-activated protein kinase pathway constituents, such as B-Raf proto-oncogene or fibroblast growth receptor 2/3, are harbored by PLNTYs. Recent advances in molecular diagnostics have resulted in more accurate tumor classification systems, based on gene expression profiles and DNA methylation patterns. Gross total resection seems curative, with a low recurrence rate. Malignant transformation is rare; however, adjuvant radiation therapy and chemotherapy may be beneficial in selected cases.

Patient-centric periodontal research: A pioneering application of patient-reported outcome measures.

Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes. Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient. In this context, patient-centric periodontal research (PCPR) is an approach that considers the patient´s feedback concerning their functional status, experience, clinical outcomes, and accessibility to their treatments. It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief, cultural background, and social and economic factors. However, literature has shown that the incorporation of "patient-centric outcome" components considerably enhances the validity and applicability of research findings. Variations in the results of different studies might be due to the use of different and non-standardized assessment tools. To overcome this problem, this editorial enlists various reliable tools available in the literature. In conclusion, we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.

Trial Sequential Analysis and Meta-Analysis of Olanzapine in Pediatric Patients for Chemotherapy-Induced Nausea and Vomiting (CINV).

Background and Objective: Olanzapine (OLZ) containing regimens are approved in adults for chemotherapy-induced nausea and vomiting (CINV) receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC), and the same has not been approved in the pediatric population. In order to generate data regarding the efficacy and safety of OLZ as an adjunct to the standard of care (SoC) for CINV in pediatric patients receiving HEC/MEC, the review authors performed this systematic review and meta-analysis. Methods: A systematic literature search was performed through the databases Cochrane Library, Pub Med, and clinicaltrials.gov, from inception to September 2023, using keywords: "chemotherapy" and "olanzapine," "nausea" and "vomiting." Randomized clinical trials published in English that analyzed the efficacy and safety of olanzapine as an adjunct to SoC were included. The essential outcomes included in this study were the proportion of patients with no emesis in the acute and delayed phase, patients with no nausea in the acute and delayed phase, the proportion of patients requiring rescue medication, and the proportion of patients with reduced CNS arousal. Results: In the OLZ group, a greater number of patients had no emesis both in the acute and delayed phase (RR = 1.22; 95% CI = 1.09-1.37; P = .0004); and (RR = 1.23; 95% CI = 0.92-1.63; P = .16) respectively. Similarly, a higher number of patients showed no nausea both in the acute and delayed phase (RR = 1.08; 95% CI = 0.78-1.48; P = .66) and (RR = 1.12; 95% CI = 0.79-1.61; P = .52) respectively. The use of rescue medication was significantly less in the OLZ group (RR = 0.62; 95% CI = 0.42-0.91; P = .01). More patients experienced reduced CNS arousal in the OLZ group (RR = 2.97; 95% CI = 2.02-4.38; P < .0001). Conclusions: Olanzapine as an adjunct to the SoC may be effective in acute emesis, which may also reduce the use of rescue medication. Reduced CNS alertness was the significant adverse effect observed. For other endpoints, more studies are required to substantiate its role in CINV.

Tumor Educated Platelets as a Biomarker for Diagnosis of Lung cancer: A Systematic Review.

INTRODUCTION: Lung cancer is one of the commonest cause of cancer associated mortality worldwide. Platelets have emerged as key players in cancer development and progression by supporting tumor growth, and dissemination. In the present systematic review, we analyzed RNA transfer between cancer cells and platelets and explored potential role of different platelet RNA profiles as onco-signature in diagnosis, subtyping, disease progression and treatment monitoring in carcinoma lung carcinoma. MATERIALS AND METHODS: The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Cochrane Manual of Systematic Reviews and Meta-analysis that included seven studies on patients with lung cancer, with data on tumor-educated platelets, and control group. The outcome measured was based on sensitivity, specificity, and ROC. PUBMED, SCOPUS, Central Cochrane Registry of Controlled Trials and Science Direct databases were searched using specific search terms until October 2023. QUADAS - 2 tool was used to assess quality, risk of bias and applicability concerns. RESULTS: The analysis revealed AUC > 70% for different platelet mRNAs, with sensitivity and specificity of more than 60 %. AUC and sensitivity were highest for ITGA2B (AUC 0.922; sensitivity 92.8%). lncRNA GTF2H2-1 was the most specific platelet RNA. On QUADAS-2 tool, 3/7 articles were unclear in reference standards, patient flow timing, and 1/7 had high bias in both aspects. For applicability, 1/7 studies were unclear in reference standards, and 2/7 in index tests. CONCLUSION: TEP RNA can aid in early diagnosis of lung cancer and of proven utility in its early-stage detection. TEP RNA can also monitor disease progression and treatment response.

The spectrum of microvascular patterns in adult diffuse glioma and their correlation with tumor grade.

BACKGROUND: Primary brain tumors constitute the leading cause of cancer-related mortality. Among them, adult diffuse gliomas are the most common type, affecting the cerebral hemispheres and displaying a diffuse infiltrative pattern of growth in the surrounding neuropil that accounts for about 80% of all primary intracranial tumors. The hallmark feature of gliomas is blood vessel proliferation, which plays an important role in tumor growth, tumor biological behavior, and disease outcome. High-grade gliomas exhibit increased vascularity, the worst prognosis, and lower survival rates. Several angiogenic receptors and factors are upregulated in glioblastomas and stimulate angiogenesis signaling pathways by means of activating oncogenes and/or down-regulating tumor-suppressor genes. Existing literature has emphasized that different microvascular patterns (MVPs) are displayed in different subtypes of adult diffuse gliomas. METHODS: We examined the distribution and biological characteristics of different MVPs in 50 patients with adult diffuse gliomas. Haematoxylin and eosin staining results, along with periodic acid-Schiff and CD34 dual-stained sections, were examined to assess the vascular patterns and correlate with different grades of diffuse glioma. RESULTS: The present observational study on adult diffuse glioma evaluated tumor grade and MVPs. Microvascular sprouting was the most common pattern, while a bizarre pattern (type 2) was associated with the presence of a high-grade glioma. Vascular mimicry was observed in 6% of cases, all of which were grade 4 gliomas. CONCLUSIONS: This study supplements the role of neo-angiogenesis and aberrant vasculature patterns in the grading and progression of adult diffuse gliomas, which can be future targets for planning treatment strategies.

Assessment of memory deficits in psychiatric disorders: A systematic literature review.

Memory deficits are observed across psychiatric disorders ranging from the prodrome of psychosis to common mental disorders such as anxiety, depression, and dissociative disorders. Memory deficits among patients recovering from psychiatric disorders could be directly related to the primary illness or secondary to the adverse effect of a treatment such as Electroconvulsive Therapy (ECT). The trouble in the meaningful integration of working-memory and episodic memory is the most commonly affected domain that requires routine assessments. An update on the recent trends of methods of assessment of memory deficits is the first step towards understanding and correcting these deficits to target optimum recovery. A systematic literature search was conducted from October 2018 to October 2022 to review the recent methods of assessment of memory deficits in psychiatric disorders. The definition of 'Memory deficit' was operationalized as 'selective processes of memory, commonly required for activities of daily living, and affected among psychiatric disorders resulting in subjective distress and dysfunction'. We included 110 studies, most of them being conducted in western countries on patients with schizophrenia. Other disorders included dementia and mild cognitive impairment. Brief Assessment of Cognition in Schizophrenia, Cambridge Automated Neuropsychological Test Battery, California Verbal Learning Test, Trail Making Test Part A and B, Rey Auditory Verbal Learning Test, Wechsler Memory Scale, Wechsler Adults Intelligence Scale-IV were the most common neuropsychological assessments used. Mini-Mental State Examination and Montreal Cognitive Assessment were the most common bedside assessment tools used while Squire Subjective Memory Questionnaire was commonly used to measure ECT-related memory deficits. The review highlights the recent developments in the field of assessment of memory deficits in psychiatric disorders. Findings recommend and emphasize routine assessment of memory deficits among psychiatric disorders in developing countries especially severe mental illnesses. It remains interesting to see the role of standardized assessments in diagnostic systems given more than a decade of research on memory deficits in psychiatric disorders.

Three dimensional convolutional neural network-based automated detection of midline shift in traumatic brain injury cases from head computed tomography scans.

Objectives: Midline shift (MLS) is a critical indicator of the severity of brain trauma and is even suggestive of changes in intracranial pressure. At present, radiologists have to manually measure the MLS using laborious techniques. Automatic detection of MLS using artificial intelligence can be a cutting-edge solution for emergency health-care personnel to help in prompt diagnosis and treatment. In this study, we sought to determine the accuracy and the prognostic value of our screening tool that automatically detects MLS on computed tomography (CT) images in patients with traumatic brain injuries (TBIs). Materials and Methods: The study enrolled TBI cases, who presented at the Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi. Institutional ethics committee permission was taken before starting the study. The data collection was carried out for over nine months, i.e., from January 2020 to September 2020. The data collection included head CT scans, patient demographics, clinical details as well as radiologist's reports. The radiologist's reports were considered the "gold standard" for evaluating the MLS. A deep learning-based three dimensional (3D) convolutional neural network (CNN) model was developed using 176 head CT scans. Results: The developed 3D CNN model was trained using 156 scans and was tested on 20 head CTs to determine the accuracy and sensitivity of the model. The screening tool was correctly able to detect 7/10 MLS cases and 4/10 non-MLS cases. The model showed an accuracy of 55% with high specificity (70%) and moderate sensitivity of 40%. Conclusion: An automated solution for screening the MLS can prove useful for neurosurgeons. The results are strong evidence that 3D CNN can assist clinicians in screening MLS cases in an emergency setting.

Preoperative topical estrogen application in the management of hypospadias: a systematic review.

Local estrogen therapy has been explored as an alternative to conventional testosterone therapy in children requiring urethroplasty for hypospadias. Our objective is to evaluate if preoperative estrogen stimulation reduces post-urethroplasty complications and enhances penile dimensions. A systematic search was conducted on various databases, selecting only randomized controlled trials (RCTs) that tested estrogen on hypospadias patients under 18 years. Articles underwent sorting following PRISMA guidelines and bias risk was assessed using the JBI clinical appraisal tool for RCTs. Out of 607 screened records, 10 underwent full-text review, and 4 randomized controlled trials (RCTs) were selected for analysis. The total patient cohort across studies was 387 with 174 in the estrogen group. All studies utilized topical estrogen, but in different formulations and timings. Prudence is necessary for interpreting results due to variations in formulation, timing, and hypospadias type across studies. Limited by a small number of studies and outcome presentation non-uniformity, the review suggests no change in penile dimensions or postoperative complications with topical estrogen. Further research is needed to explore wound-healing properties of estrogen in hypospadias through animal and human studies.Registration and protocol: Registered in Prospero CRD42024502183.

Observation of spatiotemporal optical vortices enabled by symmetry-breaking slanted nanograting.

Providing additional degrees of freedom to manipulate light, spatiotemporal optical vortex (STOV) beams carrying transverse orbital angular momentum are of fundamental importance for spatiotemporal control of light-matter interactions. Unfortunately, existing methods to generate STOV are plagued by various limitations such as inefficiency, bulkiness, and complexity. Here, we theoretically propose and experimentally demonstrate a microscale singlet platform composed of a slanted nanograting to generate STOV. Leveraging the intrinsic topological singularity induced by C2 symmetry and z-mirror symmetry breaking of the slanted nanograting, STOV is generated through the Fourier transform of the spiral phase in the momentum-frequency space to the spatiotemporal domain. In experiments, we observe the space-time evolution of STOV carried by femtosecond pulses using a time-resolved interferometry technique and achieve a generation efficiency exceeding 40%. Our work sheds light on a compact and versatile platform for light pulse shaping, and paves the way towards a fully integrated system for spatiotemporal light manipulation.

Systematic review and meta-analysis of studies comparing baseline D-dimer level in stroke patients with or without cancer: Strength of current evidence.

Objectives: D-dimer levels are increased in stroke and cancer. Cancer patients are at a higher risk of stroke. However, the evidence is unclear if high D-dimer in stroke patients can suggest the diagnosis of concomitant cancer or the development of stroke in a cancer patient. The objective is to assess the evidence available on the baseline D-dimer level in stroke patients with and without cancer. Materials and Methods: We conducted the systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We searched PUBMED, Cochrane, ScienceDirect, and Scopus for potentially eligible articles published till June 2023. All the review steps were iterative and done independently by two reviewers. The Newcastle-Ottawa scale tool was used to assess the quality of included studies for case control and cohort studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. The qualitative synthesis is presented narratively, and quantitative synthesis is shown in the forest plot using the random effects model. I2 of more than 60% was considered as high heterogeneity. Results: The searches from all the databases yielded 495 articles. After the study selection process, six papers were found eligible for inclusion in the qualitative and quantitative synthesis. In the present systematic review, 2651 patients with ischemic infarcts are included of which 404 (13.97%) patients had active cancer while 2247 (86.02%) did not. The studies included were of high quality and low risk of bias. There were significantly higher baseline D-dimer levels in stroke patients with cancer than in non-cancer patients with a mean difference of 4.84 (3.07-6.60) P < 0.00001. Conclusion: D-dimer is a simple and relatively non-expensive biomarker that is increased to significant levels in stroke patients, who have cancer and therefore may be a tool to predict through screening for active or occult cancer in stroke patients.

Calvarial hemangiomas: Series of 6 cases and review of literature.

Calvarial haemangiomas are benign, vascular tumours of the skull involving parietal and frontal bones. Mostly these lesions remain asymptomatic, and present with cosmetic deformity, headache, uncommon neurological symptoms and reported as case reports and case series. The radiological appearance can range from sessile growing intradiploically to globular and the lesions may extend outwards or inwards after eroding the outer and inner tables of the skull. "Sunburst appearance" and "Wagon-wheel sign" are classical radiological findings but the lesions may present simply as a lytic expansile or even sclerotic calvarial mass. Because of varied clinical presentation and atypical radiological characteristics, the final diagnosis can be clinched by histology only. In selected cases where these lesions are not cosmetically acceptable, en bloc resection with tumour free margins followed by cranioplasty is the treatment of choice. Most reports of calvarial haemangiomas in literature are in the form of case reports.

Tantalum pentoxide: a new material platform for high-performance dielectric metasurface optics in the ultraviolet and visible region.

Dielectric metasurfaces, composed of planar arrays of subwavelength dielectric structures that collectively mimic the operation of conventional bulk optical elements, have revolutionized the field of optics by their potential in constructing high-efficiency and multi-functional optoelectronic systems on chip. The performance of a dielectric metasurface is largely determined by its constituent material, which is highly desired to have a high refractive index, low optical loss and wide bandgap, and at the same time, be fabrication friendly. Here, we present a new material platform based on tantalum pentoxide (Ta2O5) for implementing high-performance dielectric metasurface optics over the ultraviolet and visible spectral region. This wide-bandgap dielectric, exhibiting a high refractive index exceeding 2.1 and negligible extinction coefficient across a broad spectrum, can be easily deposited over large areas with good quality using straightforward physical vapor deposition, and patterned into high-aspect-ratio subwavelength nanostructures through commonly-available fluorine-gas-based reactive ion etching. We implement a series of high-efficiency ultraviolet and visible metasurfaces with representative light-field modulation functionalities including polarization-independent high-numerical-aperture lensing, spin-selective hologram projection, and vivid structural color generation, and the devices exhibit operational efficiencies up to 80%. Our work overcomes limitations faced by scalability of commonly-employed metasurface dielectrics and their operation into the visible and ultraviolet spectral range, and provides a novel route towards realization of high-performance, robust and foundry-manufacturable metasurface optics.

Stress Levels in Mothers of Admitted Newborns in NICU and Effect of Counseling.

OBJECTIVES: To examine the effect of counseling on stress levels in mothers of neonates admitted to the Neonatal Intensive Care Unit (NICU). METHODS: This prospective research was carried out from January 2020 to December 2020 in a central India teaching hospital providing tertiary care. Parental Stressor Scale (PSS):NICU questionnaire was used to measure maternal stress among mothers of 540 admitted infants between 3 and 7 d of admission. Counseling was done at the time of recruitment and its effect was measured after 72 h and re-counseling was done. This cycle of stress assessment and counseling was repeated every 72 h till the baby was admitted in the NICU. Overall stress levels for each subscale were determined, and pre- and post-counseling stress was compared. RESULTS: For the subscales of sight and sound, appearance and behavior, change in the parental role, and staff behavior and communication, the median scores were 1.5 (IQR-1.2-1.88), 2.5 (2.3-2.9), 3.3 (3.0-3.6) and 1.3 (1.1-1.62), respectively indicating high stress in the parental role alteration. Counseling was effective in reducing stress levels among all mothers irrespective of various maternal factors (p <0.01). Stress reduces more with increasing number of counseling, as suggested by higher change in the stress score with increased number of counseling. CONCLUSIONS: This study shows that NICU mothers are under remarkable stress and repeated counseling sessions targeted at particular concerns might assist.

Heart failure in children and adolescents: an update on diagnostic approaches and management.

Cardiac failure is a clinical syndrome that may develop in children owing to cardiac dysfunction or underlying structural heart diseases. Considering the differences in diagnostic and therapeutic approaches for pediatric heart failure (PHF) and adult heart failure, we have reviewed the current literature on PHF. Relevant studies were extracted from MEDLINE/PubMed, Google Scholar, and Clinical Trial Registries using the terms "pediatric heart failure" or "heart failure in children" and "management" or "decongestive therapy." Recent advances in diagnostic approaches, such as cardiac magnetic resonance, speckle-tracking echocardiography, tissue Doppler imaging, and molecular diagnostic techniques, have increased our under -standing of PHF. It is imperative that clinicians evaluate the interrelated factors responsible for the develop ment of PHF, including myocardial function, pulmonary and systemic blood flow, heart rhythm, valve function, and nutritional status. Although recent advances have demon strated the efficacy of many new drugs in adult heart failure trials, it cannot be concluded that these drugs will show similar efficacy in children, considering the heterogeneous nature of the underlying mechanisms and variable pharmacody-namics and pharmacokinetics. Therefore, the underlying pathophysiology of PHF and the mechanisms of action of different drugs should be considered when selecting appropriate therapies. Further trials are needed to establi sh the efficacy and safety of these drugs, and a combined mul-ti disciplinary strategy will help enhance PHF outcomes.