Clinical Assessment of the Ambu® Aura-i™ as an Independent Ventilatory Device and Conduit for Fiberoptic-Guided Endotracheal Intubation in Adults.

Background and aim A novel supraglottic airway device of the second generation is the Ambu® Aura-i™. It is designed to accommodate standard cuffed tracheal tubes and is phthalate-free and compatible with MRI. The primary objectives of the research were to examine the properties and efficiency of Ambu® Aura-i™ as a means of enabling fiberoptic-guided intubation, the view of the glottis during fiber optic examination, the duration of intubation in fiber optic bronchoscopy, the ease of intubation, the success rate of intubation, and the duration for device removal from the tracheal tube. Methodology A hospital-based descriptive observational study was conducted with 80 patients. An adequately sized Ambu® Aura-i™ was placed after general anesthesia was induced. Following a fiberoptic examination of the view of the glottis through the Ambu® Aura-i™, the trachea was intubated under fiberoptic guidance. The Ambu® Aura-i™ insertion time, glottic view grading, ease of intubation, and time required for fiberoptic-guided intubation were recorded. Also, the time taken to remove the Ambu® Aura-i™ was documented. Results Similar levels of ease were experienced by both groups after inserting the Ambu® Aura-i™, being easy in both group 1 (37/40) and in group 2 (38/40). In group 1, the average time taken to insert the Ambu® Aura-i™ was 13.53±1.91 seconds, while in group 2, it was 13.98±2.4 seconds. The average time required for fiberoptic-guided intubation was found to be 14.95±1.85 seconds in group 1 and 14.15±1.37 seconds in group 2, indicating a statistically negligible variation. Conclusion The low cost of Ambu® Aura-i™, size suitability and availability for almost all age groups, compatibility with MRI machines, and availability in phthalate-free versions contribute to it being a more appealing and useful ventilatory device, as well as an intubation tool for both normal and emergency airway management.

The Efficacy of Transverse Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Hysterectomy: A Randomized Prospective Study.

BACKGROUND AND AIM: Postoperative pain is an inevitable acute pain for which a multimodal analgesic approach is required. The aim of this study was to quantify and compare the efficacy of transverse abdominis plane (TAP) block as a postoperative analgesic for patients undergoing laparoscopic hysterectomies versus intravenous opioid analgesics. METHOD: Sixty female patients were enrolled and randomized into two groups following a computer-generated sequence of numbers. In group T (n=30) patients received an ultrasound-guided bilateral TAP block with 20 of 0.375% levobupivacaine on each side immediately after surgery. Patients in group O (opioid group, n = 30) received intravenous (i.v.) tramadol (100mg) immediately after surgery. Rescue analgesic (inj. tramadol 50mg) i.v. bolus given in both groups if visual analog scale (VAS) >4. In the postanesthesia care unit (PACU), the vital signs, episodes of nausea, vomiting, and VAS score of each patient were recorded every two hours for the first 24 hours. RESULT: Total consumption of rescue analgesic (inj. tramadol 50 mg i.v.) during the first 24 hours was significantly higher in group O (186.47+37.48mg) than in group T (107.28+26.34mg). No significant difference was observed in intraoperative vital parameters (HR, NIBP, SPO2). The VAS scores were significantly low in group T. Incidence of postoperative nausea and vomiting (PONV) was significantly higher in group O (13 out of 28 patients) than in group T (five out of 28 patients) with P value =0.043. CONCLUSION: Our study indicated bilateral ultrasound-guided TAP block is a good alternative to opioids for postoperative analgesia.

Can training over phone calls help improve outcomes for COVID-19 positive patients under home isolation? An analysis of the COVID-19 Care Companion Program in Punjab, India.

Background: Phone-supported recovery of COVID-19 patients in home isolation could be an effective way of addressing COVID-19 in contexts with limited resources. The COVID-19 Care Companion Program (CCP) is one such intervention, designed to support patients and their caregivers in remote, evidence-based management of COVID-19 symptoms. Objective: To estimate the effect of providing phone-based training to COVID-19 patients and their caregivers on the likelihood of hospitalizations and mortality. Methods: A pragmatic randomized trial was conducted to assess the effect of a novel phone-based training program on COVID-19 home-isolated patient outcomes. The analysis compared the outcomes of death and hospitalizations in the teletraining intervention group (CCP) to those receiving standard of care (SoC). Results: Logistic regression models adjusted for age, gender, education, occupation, and poverty, as measured by family possession of Below Poverty Line (BPL) card, were used to look at the effect of intervention on hospitalization and mortality. While the CCP intervention had no effect on 21-day mortality (OR 0.64; 95% CI, 0.19 to 2.12), it was associated with a 48% reduction in 21-day hospitalization (OR 0.52; 95% CI, 0.31 to 0.90). Conclusion: COVID-19 CCP teletraining intervention reduced the rate of hospitalization, potentially reducing the burden on hospitals.

A Soft Wearable Microfluidic Patch with Finger-Actuated Pumps and Valves for On-Demand, Longitudinal, and Multianalyte Sweat Sensing.

Easy sample collection, physiological relevance, and ability to noninvasively and longitudinally monitor the human body are some of the key attributes of wearable sweat sensors. Examples typically include reversible sensors or an array of single-use sensors embedded in specialized microfluidics for temporal analysis of sweat. However, evolving this field to a level that truly represents "lab-on-skin" technology will require the incorporation of advanced functionalities that give the user the freedom to (1) choose the precise time for performing sample analysis and (2) select sensors from an array embedded within the device for performing condition-specific sample analysis. Here, we introduce new concepts in wearable microfluidic platforms that offer such capabilities. The described technology involves a series of finger-actuated pumps, valves, and sensors incorporated within soft, wearable microfluidics. The incoming sweat collects in the inlet chamber and can be analyzed by the user at the time of their choosing. On-demand sweat analyte assessment is achieved by pulling a thin tab to activate a pump which opens a valve and allows the pooled sweat to enter a chamber embedded with sensors for the desired analytes. The article describes a thorough characterization of the platform that demonstrates the robustness of the pumping, valving, and sensing aspects of the device under conditions mimicking real-life scenarios. A two-day-long human pilot study validates the system and illustrates the device's ability to offer on-demand, longitudinal, and multianalyte sensing. Our work represents the first example of a wearable system with such on-demand sensing capabilities and opens exciting avenues in sweat sensing for acquiring new insights into human physiology.

Use of Paravertebral Block as an Alternative to General Anesthesia for Breast Surgeries: A Randomized Control Study.

BACKGROUND: General anaesthesia (GA) is the conventional technique used for surgical treatment of breast lumps. However, various side effects and complications of GA, such as postoperative pain, nausea, vomiting, and increased hospital stay increase morbidity in patients. Regional anaesthesia using multiple injection paravertebral block is an ideal alternative to GA for breast surgeries. METHODS: Sixty female patients posted for unilateral breast surgery were randomly divided into two groups, Group P for paravertebral block and group G for GA, and compared on the basis of time taken for induction of anaesthesia, postoperative pain relief on basis of Visual Analogue Scale (VAS) score, postoperative nausea and vomiting (PONV) and duration of hospital stay. RESULTS: Duration of surgery in group P was 64.75±18.07 and 67.32±17.64 in group G respectively (P>0.05). Time for inducing anaesthesia was significantly longer in group P (17.15±3.92min) compared to group G (5.90±1.75min) with P<0.05. Significant difference (P<0.001) was observed in the mean duration of postoperative analgesia of group P (298.34±67.02min) and group G (107.68±27.28min). The VAS scores in immediate postoperative period and after two and four hours in the postoperative period were significantly higher in group G (P<0.05). The incidence of postoperative nausea and vomiting was significantly higher in group G (13 out of 30 patients) than group P (four out of 28 patients) with P<0.05. CONCLUSION: The efficacy and safety of paravertebral block for operative treatment of breast tumors, excellent analgesia in early postoperative period, requirement of significantly lesser amount of postoperative analgesics, decreased incidence of PONV and negligible complications along with early ambulation and hospital discharge makes it an afferent cost-effective block of choice for unilateral breast surgeries.

Comparison of Fiberoptic-Guided Tracheal Intubation Through Intubating Laryngeal Mask Airway (ILMA) FastrachTM and Ambu® Aura-i™: A Randomized Clinical Study.

Background and aim The primary aim of the study was to compare the intubation characteristics and effectiveness of intubating laryngeal mask airway (ILMA) and Ambu® Aura-i™ as a conduit for facilitating fiberoptic-guided intubation. Methods Eighty patients were enrolled in the randomized-controlled hospital-based study. After inducing general anesthesia, an appropriately sized ILMA (group 1)/Ambu Aura-I (group 2) was placed. Fiberoptic assessment of the glottic view was done followed by fiberoptic-guided tracheal intubation. The time taken for the insertion of ILMA/Ambu Aura-i, glottic view grading, time taken for fiberoptic-guided intubation, ease of intubation, time taken for the removal of ILMA/Ambu Aura-i were recorded. Data analysis was done using the two-tailed independent t-test, paired t-test, and Fisher's exact probability test. Result Anthropometric and airway parameters were similar in both groups. The success rate of the insertion of both devices was 100%. In group 1, the mean time taken for the insertion was 20.53±1.91, and it was 13.98±2.4 in group 2 (P<0.001S). Fiberoptic assessment of the glottic view in group 1 (ILMA group) was grade 1 in 80% of the patients, whereas it was 92% in group 2 (Ambu Aura-i) (P=0.54). The mean time taken for fiberoptic-guided intubation was 14.95±1.85 in group 1 and 14.15±1.37 in group 2 (P>0.001). No significant difference was observed according to the number of attempts in intubating through ILMA/Ambu Aura-i. Seventy-five percent (75%) in group 1 and 87.5% in group 2 were successfully inserted on the first attempt (𝑝 = 0.33). The time taken for the removal of the device was 11.87 +1.265 seconds in group 1 and 11.25±1.58 seconds in group 2 (P=0.054). Conclusion The Ambu Aura-i scores superiorly over ILMA in requiring less time for successful insertion on the basis of statistical analysis and hence appears to be a better independent ventilatory device.

Low lung function in the developing world is analogous to stunting: a review of the evidence.

Background: Low vital capacity, one of the consequences of restricted lung growth, is a strong predictor of cardiovascular mortality. Vital capacity is lower in the developing world than the developed world, even after adjusting for height, weight and gender. This difference is typically dismissed as ethnic variation, adjusted for by redefining normal. Whether this is a consequence of stunted lung growth, rather than genetically smaller lungs, has not been investigated in detail. Therefore, we sought to compare factors implicated in both stunting and lung development, particularly in the developing world. Methods: We conducted a manual screen of articles identified through Google Scholar and assessed risk of bias. No language restrictions were applied, so long as there was an associated English abstract. We queried VizHub (Global Burden of Disease Visualization Tool) and Google Dataset search engines for disease burden and genome wide association studies.  The scope of the article and the heterogeneity of the outcome measures reported required a narrative review of available evidence. To the extent possible, the review follows PRISMA reporting guidelines. Results: Early life influences operate in synergism with environmental and nutritional factors to influence lung growth and development in children.  Low lung function and stunting have common anthropometric, environmental and nutritional correlates originating during early development. Similar anthropometric correlates and shared chronic inflammatory pathways indicated that the two conditions were analogous. Conclusion: The analogy between poor lung function and stunting is conspicuous in the developing world, where malnutrition lies at the center of non -achievement of growth potential, susceptibility to infectious diseases and intrauterine programming for metabolic syndrome. The common pathological mechanisms governing stunting and lung function deficits counter the idea of redefining the normal for lung function measurements.

A meta-analysis of blood lead levels in India and the attributable burden of disease.

Multiple studies in India have found elevated blood lead levels (BLLs) in target populations. However the data have not yet been evaluated to understand population-wide exposure levels. We used arithmetic mean blood lead data published from 2010 to 2018 on Indian populations to calculate the average BLLs for multiple subgroups. We then calculated the attributable disease burden in IQ decrement and Disability Adjusted Life Years (DALYs). Our Pubmed search yielded 1066 articles. Of these, 31 studies representing the BLLs of 5472 people in 9 states met our study criteria. Evaluating these, we found a mean BLL of 6.86 µg/dL (95% CI: 4.38-9.35) in children and 7.52 µg/dL (95% CI: 5.28-9.76) in non-occupationally exposed adults. We calculated that these exposures resulted in 4.9 million DALYs (95% CI: 3.9-5.6) in the states we evaluated. Population-wide BLLs in India remain elevated despite regulatory action to eliminate leaded petrol, the most significant historical source. The estimated attributable disease burden is larger than previously calculated, particularly with regard to associated intellectual disability outcomes in children. Larger population-wide BLL studies are required to inform future calculations. Policy responses need to be developed to mitigate the worst exposures.

Mitochondrial Function in Allergic Disease.

PURPOSE OF THE REVIEW: The connections between allergy, asthma and metabolic syndrome are becoming increasingly clear. Recent research suggests a unifying mitochondrial link between the diverse phenotypes of these interlinked morbidities. The scope of this review is to highlight cellular mechanisms, epidemiology and environmental allergens influencing mitochondrial function and its importance in allergy and asthma. We briefly also consider the potential of mitochondria-targeted therapies in prevention and cure. RECENT FINDINGS: Recent research has shown allergy, asthma and metabolic syndrome to be linked to mitochondrial dysfunction. Environmental pollutants and allergens are observed to cause mitochondrial dysfunction, primarily by inducing oxidative stress and ROS production. Malfunctioning mitochondria change the bioenergetics of the cell and its metabolic profile to favour systemic inflammation, which drives all three types of morbidities. Given the existing experimental evidence, approaches targeting mitochondria (e.g. antioxidant therapy and mitochondrial replacement) are being conducted in relevant disease models-with some progressing towards clinical trials, making mitochondrial function the focus of translational therapy research in asthma, allergy and linked metabolic syndrome.