Redox-Sensitive Poly(lactic-co-glycolic acid) Nanoparticles of Palbociclib: Development, Ultrasound/Photoacoustic Imaging, and Smart Breast Cancer Therapy.

Breast cancer is one of the leading causes of mortality in women globally. The efficacy of breast cancer treatments, notably chemotherapy, is hampered by inadequate localized delivery of anticancer agents to the tumor site, resulting in compromised efficacy and increased systemic toxicity. In this study, we have developed redox-sensitive poly(lactic-co-glycolic acid) (PLGA) nanoparticles for the smart delivery of palbociclib (PLB) to breast cancer. The particle size of formulated PLB@PLGA-NPs (nonredox-sensitive) and RS-PLB@PLGA-NPs (redox-sensitive) NPs were 187.1 ± 1.8 nm and 193.7 ± 1.5 nm, respectively. The zeta potentials of nonredox-sensitive and redox-sensitive NPs were +24.99 ± 2.67 mV and +9.095 ± 1.87 mV, respectively. The developed NPs were characterized for morphological and various physicochemical parameters such as SEM, TEM, XRD, DSC, TGA, XPS, etc. The % entrapment efficiency of PLB@PLGA-NPs and RS-PLB@PLGA-NPs was found to be 85.48 ± 1.29% and 87.72 ± 1.55%, respectively. RS-PLB@PLGA-NPs displayed a rapid drug release at acidic pH and a higher GSH concentration compared to PLB@PLGA-NPs. The cytotoxicity assay in MCF-7 cells suggested that PLB@PLGA-NPs and RS-PLB@PLGA-NPs were 5.24-fold and 14.53-fold higher cytotoxic compared to the free PLB, respectively. Further, the cellular uptake study demonstrated that redox-sensitive NPs had significantly higher cellular uptake compared to nonredox-sensitive NPs and free Coumarin 6 dye. Additionally, AO/EtBr assay and reactive oxygen species analysis confirmed the superior activity of RS-PLB@PLGA-NPs over PLB@PLGA-NPs and free PLB. In vivo anticancer activity in dimethyl-benz(a)anthracene-induced breast cancer rats depicted that RS-PLB@PLGA-NPs was highly effective in reducing the tumor size, hypoxic tumor, and tumor vascularity compared to PLB@PLGA-NPs and free PLB. Further, hemocompatibility study reveals that the developed NPs were nonhemolytic to human blood. Moreover, an in vivo histopathology study confirmed that both nanoparticles were safe and nontoxic to the vital organs.

DKCNN: Improving deep kernel convolutional neural network-based COVID-19 identification from CT images of the chest.

BACKGROUND: An efficient deep convolutional neural network (DeepCNN) is proposed in this article for the classification of Covid-19 disease. OBJECTIVE: A novel structure known as the Pointwise-Temporal-pointwise convolution unit is developed incorporated with the varying kernel-based depth wise temporal convolution before and after the pointwise convolution operations. METHODS: The outcome is optimized by the Slap Swarm algorithm (SSA). The proposed Deep CNN is composed of depth wise temporal convolution and end-to-end automatic detection of disease. First, the datasets SARS-COV-2 Ct-Scan Dataset and CT scan COVID Prediction dataset are preprocessed using the min-max approach and the features are extracted for further processing. RESULTS: The experimental analysis is conducted between the proposed and some state-of-art works and stated that the proposed work effectively classifies the disease than the other approaches. CONCLUSION: The proposed structural unit is used to design the deep CNN with the increasing kernel sizes. The classification process is improved by the inclusion of depth wise temporal convolutions along with the kernel variation. The computational complexity is reduced by the introduction of stride convolutions are used in the residual linkage among the adjacent structural units.

Ultrastructural study confirms the formation of single and heterotypic syncytial cells in bronchoalveolar fluids of COVID-19 patients.

BACKGROUND: SARS-CoV-2 was reported to induce cell fusions to form multinuclear syncytia that might facilitate viral replication, dissemination, immune evasion, and inflammatory responses. In this study, we have reported the types of cells involved in syncytia formation at different stages of COVID-19 disease through electron microscopy. METHODS: Bronchoalveolar fluids from the mild (n = 8, SpO2 > 95%, no hypoxia, within 2-8 days of infection), moderate (n = 8, SpO2 90% to ≤ 93% on room air, respiratory rate ≥ 24/min, breathlessness, within 9-16 days of infection), and severe (n = 8, SpO2 < 90%, respiratory rate > 30/min, external oxygen support, after 17th days of infection) COVID-19 patients were examined by PAP (cell type identification), immunofluorescence (for the level of viral infection), scanning (SEM), and transmission (TEM) electron microscopy to identify the syncytia. RESULTS: Immunofluorescence studies (S protein-specific antibodies) from each syncytium indicate a very high infection level. We could not find any syncytial cells in mildly infected patients. However, identical (neutrophils or type 2 pneumocytes) and heterotypic (neutrophils-monocytes) plasma membrane initial fusion (indicating initiation of fusion) was observed under TEM in moderately infected patients. Fully matured large-size (20-100 µm) syncytial cells were found in severe acute respiratory distress syndrome (ARDS-like) patients of neutrophils, monocytes, and macrophage origin under SEM. CONCLUSIONS: This ultrastructural study on the syncytial cells from COVID-19 patients sheds light on the disease's stages and types of cells involved in the syncytia formations. Syncytia formation was first induced in type II pneumocytes by homotypic fusion and later with haematopoetic cells (monocyte and neutrophils) by heterotypic fusion in the moderate stage (9-16 days) of the disease. Matured syncytia were reported in the late phase of the disease and formed large giant cells of 20 to 100 µm.

Impact of intravenous dexamethasone on the initiation and recovery of atracurium in children: A double-blinded randomized controlled trial.

BACKGROUND: Chronic steroid intake has been associated with attenuation of neuromuscular block. Despite some promising animal and adult studies, the effect of a single dose of intravenous dexamethasone on neuromuscular blockers is not well established. Thus, the present study aimed to demonstrate the effect of dexamethasone given at the time of induction for the prevention of PONV on the action of neuromuscular blockers in children undergoing elective surgery. METHOD: After obtaining approval from the Institute Ethics Committee and written informed parental consent, 100 ASA I and II children aged 4-15 years undergoing elective surgery randomized to receive either: 0.15 mg/kg (maximum of 5 mg) of dexamethasone diluted to a total volume of 2 ml with 0.9% saline (n = 50) or 2 ml of 0.9% saline (n = 50) at the time of induction. The time interval between application of atracurium and maximum T1 depression, 25% twitch height recovery of T1, amid 25% and 75% twitch height recovery of T1, amid the 25% twitch height recovery of T1 and recovery of the neuromuscular block to a TOF ratio of 0.9, and in between the initiation of atracurium injection till the recovery of the neuromuscular block to a TOF ratio of 0.9 was defined as onset time, clinical duration, recovery index, recovery time, and total recovery period, respectively, and recorded. RESULTS: The onset time and recovery index time were lower (1.96 ± 0.39, 8.04 ± 2.14, respectively) with dexamethasone in comparison with saline (2.01 ± 0.51, 8.9 ± 3.4, respectively) but not statistically significant. The clinical duration, recovery time, and total recovery period were similar. CONCLUSION: Application of a single bolus dose (0.15 mg/kg) of dexamethasone during induction does not attenuate atracurium-induced neuromuscular blockade in children.

Association of severity and mortality of Covid-19 cases among acute kidney injury and sexual dimorphism.

INTRODUCTION: The outbreak of coronavirus disease 2019 (Covid-19) severely impacted global health and economic status. The native receptor-ligand interaction of Angiotensin-converting enzyme 2 (ACE2) and S protein induces host cell pathogenesis via immunosuppression. MATERIAL AND METHODS: The emerging evidence reports the sex disparity in Covid-19 induced mortality rate which affects abundantly men population. Although the biological interaction of Covid-19 with receptor upregulates the viral genome protein interactions and initiates the predictive multiorgan failure followed by acute kidney injury (AKI) in Covid-19 infected male population. CONCLUSION: Besides, the knowledge and lessons learned from the study depict that cellular and molecular links may explain the risk and severity of Covid-19 and AKI in the male population and lead to management of Covid-19 induced AKI. Therefore, this review explored the pathways associated with the pathogenesis of two diseased conditions with sex disparity.

Long-term yogic intervention decreases serum interleukins IL-10 and IL-1ß and improves cancer-related fatigue and functional scale during radiotherapy/chemotherapy in breast cancer patients: a randomized control study.

PURPOSE: Yoga improved fatigue and immunological profile in cancer survivors and has been a promising alternative therapy. Breast cancer treatments are rapidly improving, along with their side effects. This article investigated the effect of the yogic intervention at a different time interval during radiotherapy/chemotherapy on the pro- and anti-inflammatory interleukins along with the cancer-related fatigue and functional scale among patients with stage II/III breast cancer. METHODS: A total of 96 stage II/III breast cancer patients were enrolled in this study and randomly divided into two different groups. Group I (non-Yoga) received chemotherapy and/or radiotherapy and group II (Yoga) received an additional yogic intervention. Both groups were followed up for a period of 48 weeks and blood was collected at the time of enrollment, 16, 32, and 48 weeks, and serum was isolated to measure the pro- and anti-inflammatory interleukins, fatigue, and functional scale questionnaire obtained at each time point. RESULTS: Breast cancer patients in group II showed a significant improvement (p < 0.05) in the functional scale and fatigue from baseline to 48 weeks compared to group I. The yogic intervention significantly decreased (p < 0.05) the level of pro-inflammatory interleukin IL-1ß and pleiotropic interleukin IL-10 in group II compared to group I. CONCLUSION: These finding suggested that improved fatigue and functional scale is associated with a lower level of IL-1ß and IL-10. Yoga may be an important additional therapy along with the cancer treatment to help the patients with cancer-related fatigue and improve their overall immunological profile.

Ultracellular Imaging of Bronchoalveolar Lavage from Young COVID-19 Patients with Comorbidities Showed Greater SARS-COV-2 Infection but Lesser Ultrastructural Damage Than the Older Patients.

In this study, we examined the cellular infectivity and ultrastructural changes due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the various cells of bronchoalveolar fluid (BALF) from intubated patients of different age groups (≥60 years and <60 years) and with common comorbidities such as diabetes, liver and kidney diseases, and malignancies. BALF of 79 patients (38 cases >60 and 41 cases <60 years) were studied by light microscopy, immunofluorescence, scanning, and transmission electron microscopy to evaluate the ultrastructural changes in the ciliated epithelium, type II pneumocytes, macrophages, neutrophils, eosinophils, lymphocytes, and anucleated granulocytes. This study demonstrated relatively a greater infection and better preservation of subcellular structures in these cells from BALF of younger patients (<60 years compared with the older patients (≥60 years). The different cells of BALF from the patients without comorbidities showed higher viral load compared with the patients with comorbidities. Diabetic patients showed maximum ultrastructural damage in BALF cells in the comorbid group. This study highlights the comparative effect of SARS-CoV-2 infection on the different airway and inflammatory cells of BALF at the subcellular levels among older and younger patients and in patients with comorbid conditions.

Comparison of Serum Nucleosomes and Tissue Inhibitor of Metalloproteinase1 (TIMP1) in Predicting Mortality in Adult Critically Ill Patients in Sepsis: Prospective Observational Study.

Background: Sepsis is a life-threatening organ dysfunction due to dysregulated host response to infection. Timely identification is important for risk reduction and better outcomes in critically ill patients. Nucleosomes and tissue inhibitors of metalloproteinase1 (TIMP1) are the biomarkers whose validity and utility in predicting organ dysfunction and mortality in sepsis have been proven. However, which biomarker among these two has better predictive value in elucidating disease severity, organ dysfunction, and mortality in sepsis is yet to be answered, and further studies are needed. Methods: Eighty patients with sepsis/septic shock, aged between 18 and 75 years admitted in intensive care unit (ICU) were recruited in this prospective observational trial. Quantification of serum nucleosomes and TIMP1 was done using enzyme linked immunosorbent assay (ELISA) within 24 hours of diagnosis of sepsis/septic shock. The primary outcome was to compare the predictability of nucleosomes and TIMP1 in estimating sepsis mortality. Results: The area under the receiver operating characteristic curve (AUROC) for TIMP1 and nucleosomes to discriminate between survivors and non-survivors were 0.70 [95% Confidence interval (CI), 0.58-0.81] and 0.68 (0.56-0.80), respectively. Although independent, TIMP1 and nucleosomes have statistically significant capacity to discriminate between survivors and non-survivors (p = 0.002 and p = 0.004, respectively), superiority of one biomarker over the other in discriminating between survivors and non-survivors was not observed. Conclusion: The median values of each biomarker showed statistically significant differences between survivors and non-survivors, superiority of one biomarker over other in predicting mortality was not observed. However, this was an observational study and larger studies are needed in the future to validate the findings of this study. How to cite this article: Rai N, Khanna P, Kashyap S, Kashyap L, Anand RK, Kumar S. Comparison of Serum Nucleosomes and Tissue Inhibitor of Metalloproteinase1 (TIMP1) in Predicting Mortality in Adult Critically Ill Patients in Sepsis: Prospective Observational Study. Indian J Crit Care Med 2022;26(7):804-810.

Effect of germanium auto-diffusion on the bond lengths of Ga and P atoms in GaP/Ge(111) investigated by using X-ray absorption spectroscopy.

The germanium auto-diffusion effects on the inter-atomic distance between the nearest neighbors of the Ga atom in GaP epilayers are investigated using high-resolution X-ray diffraction (HRXRD) and X-ray absorption spectroscopy. The GaP layers grown on Ge (111) are structurally coherent and relaxed but they show the presence of residual strain which is attributed to the auto-diffusion of Ge from the results of secondary ion mass spectrometry and electrochemical capacitance voltage measurements. Subsequently, the inter-atomic distances between the nearest neighbors of Ga atom in GaP are determined from X-ray absorption fine-structure spectra performed at the Ga K-edge. The estimated local bond lengths of Ga with its first and second nearest neighbors show asymmetric variation for the in-plane and out-of-plane direction of GaP/Ge(111). The magnitude and direction of in-plane and out-of-plane microscopic residual strain present in the GaP/Ge are calculated from the difference in bond lengths which explains the presence of macroscopic residual tensile strain estimated from HRXRD. Modified nearest neighbor configurations of Ga in the auto-diffused GaP epilayer are proposed for new possibilities within the GaP/Ge hetero-structure, such as the conversion from indirect to direct band structures and engineering the tensile strain quantum dot structures on (111) surfaces.

Role of chromatin modification and remodeling in stem cell regulation and meristem maintenance in Arabidopsis.

In higher plants, pluripotent stem cells reside in the specialized microenvironment called stem cell niches (SCNs) harbored at the shoot apical meristem (SAM) and root apical meristem (RAM), which give rise to the aerial and underground parts of a plant, respectively. The model plant Arabidopsis thaliana (Arabidopsis) has been extensively studied to decipher the intricate regulatory mechanisms involving some key transcriptions factors and phytohormones that play pivotal roles in stem cell homeostasis, meristem maintenance, and organ formation. However, there is increasing evidence to show the epigenetic regulation of the chromatin architecture, gene expression exerting an influence on an innate balance between the self-renewal of stem cells, and differentiation of the progeny cells to a specific tissue type or organ. Post-translational histone modifications, ATP-dependent chromatin remodeling, and chromatin assembly/disassembly are some of the key features involved in the modulation of chromatin architecture. Here, we discuss the major epigenetic regulators and illustrate their roles in the regulation of stem cell activity, meristem maintenance, and related organ patterning in Arabidopsis.

Structural, photoluminescence and dielectric investigations of phosphatic shale.

In the current study, the structural and spectroscopic properties of phosphatic shale samples obtained from the Atomic Minerals Directorate for Exploration and Research were probed for potential use as a phosphor material. X-ray diffraction and Raman and Fourier transform infrared spectroscopy revealed that the beneficiated phosphatic shale samples were primarily monophasic consisting of fluorapatite [Ca5 (PO4 )3 F, (FAP)] with minor traces of haematite (α-Fe2 O3 ) and calcite (CaCO3 ). Energy dispersive X-ray fluorescence revealed the presence of U, Eu, Dy and Tb in the FAP matrix substituted at Ca(I) and Ca(II) sites of FAP. A reduced optical direct band gap of 4.46 eV was calculated from the Tauc plot. Photoluminescence spectral studies revealed multicolour emissions (red, yellow, green and blue) on ultraviolet light excitation that were attributed to luminescence spectra from rare earth ions Eu3+ , Tb3+ , U4+ and U6+ in the FAP matrix. The overall emissions for the rare earth and actinide-doped FAP were obtained in the cool white region and the corresponding Commission Internationale de l'Eclairage chromaticity coordinates were calculated to be (0.274, 0.317). The corresponding colour correlated temperature obtained was 9342 K. Furthermore, phosphatic shale had a high room temperature dielectric constant of 11 at a frequency of 1 kHz that demonstrated its suitability for use in biological sensors. The study showed that natural phosphatic shale could be a potential material for optical, biological and dielectric applications.

Thermostability of Well-Ordered HIV Spikes Correlates with the Elicitation of Autologous Tier 2 Neutralizing Antibodies.

In the context of HIV vaccine design and development, HIV-1 spike mimetics displaying a range of stabilities were evaluated to determine whether more stable, well-ordered trimers would more efficiently elicit neutralizing antibodies. To begin, in vitro analysis of trimers derived from the cysteine-stabilized SOSIP platform or the uncleaved, covalently linked NFL platform were evaluated. These native-like trimers, derived from HIV subtypes A, B, and C, displayed a range of thermostabilities, and were "stress-tested" at varying temperatures as a prelude to in vivo immunogenicity. Analysis was performed both in the absence and in the presence of two different adjuvants. Since partial trimer degradation was detected at 37°C before or after formulation with adjuvant, we sought to remedy such an undesirable outcome. Cross-linking (fixing) of the well-ordered trimers with glutaraldehyde increased overall thermostability, maintenance of well-ordered trimer integrity without or with adjuvant, and increased resistance to solid phase-associated trimer unfolding. Immunization of unfixed and fixed well-ordered trimers into animals revealed that the elicited tier 2 autologous neutralizing activity correlated with overall trimer thermostability, or melting temperature (Tm). Glutaraldehyde fixation also led to higher tier 2 autologous neutralization titers. These results link retention of trimer quaternary packing with elicitation of tier 2 autologous neutralizing activity, providing important insights for HIV-1 vaccine design.

Correlation between duration of preoperative fasting and emergence delirium in pediatric patients undergoing ophthalmic examination under anesthesia: A prospective observational study.

BACKGROUND: Preoperative fasting in children can cause anxiety, which may ultimately lead to postoperative emergence delirium. However, no data are available whether duration of preoperative fasting correlates with postoperative emergence delirium. AIMS: The aim of this study was to identify if there is any correlation between the duration of preoperative fasting and emergence delirium in children undergoing ophthalmic examination under anesthesia. METHODS: In this prospective observational study, 100 children between the age group 2-6 years of American Society of Anesthesiologists physical status I or II, scheduled for examination of the eye under general anesthesia with sevoflurane were recruited. Data regarding preoperative fasting was recorded and presence of emergence delirium was assessed by the Pediatric Anesthesia Emergence Delirium (PAED) scale at 5 minute interval till 30 minutes from the time of leaving the operation theater. No premedication was used in any patients but parental presence was allowed in all of them. RESULTS: Mean (standard deviation) duration of fasting to clear liquid was 6.3 (1.7) hrs. Twenty-four children (24%) had at least 1 recorded PAED score >10 at any time point in the postoperative period. PAED scores at 15 and 25 minutes were significantly correlated with duration of fasting (r2 [95% CI] = .24 [0.04, 0.41], P = .02, Pearsons's correlation and r2 [95% CI] = .23 [0.04, 0.41], P = .02, Pearsons's correlation, respectively). No correlation has been found between duration of fasting and blood glucose level (r2 [95% CI] = -.05 [-0.24, 0.15], P = .65, Pearsons's correlation) between fasting blood glucose and PAED score at any time point. CONCLUSION: Increased preoperative fasting duration may be a risk factor for postoperative emergence delirium in children undergoing ophthalmic examination under general anesthesia.

From the bench to the field in low-cost diagnostics: two case studies.

Despite the growth of research in universities on point-of-care (POC) diagnostics for global health, most devices never leave the laboratory. The processes that move diagnostic technology from the laboratory to the field--the processes intended to evaluate operation and performance under realistic conditions--are more complicated than they might seem. Two case studies illustrate this process: the development of a paper-based device to measure liver function, and the development of a device to identify sickle cell disease based on aqueous multiphase systems (AMPS) and differences in the densities of normal and sickled cells. Details of developing these devices provide strategies for forming partnerships, prototyping devices, designing studies, and evaluating POC diagnostics. Technical and procedural lessons drawn from these experiences may be useful to those designing diagnostic tests for developing countries, and more generally, technologies for use in resource-limited environments.

Expanding the analytical toolbox: pharmaceutical application of quantitative NMR.

In response to the changing market pressures being applied to the pharmaceutical industry, a greater emphasis is being made to advance new drugs to market with minimal investment in early development stages. The use of quantitative NMR (q-NMR) has been shown to be a single point replacement for routine early development testing which previously combined elements of identity testing, chromatographic assay, moisture analysis, residual solvent analysis, and elemental analysis. This Feature will highlight the applications of q-NMR to early phase drug development testing and its efficient potency, solvent quantification, and relative response factor determinations.

Regioselective C(sp3) Carboboration of 1,3-Diynes: A Direct Route to Fully Substituted Enyne Boronates.

Here, we report a general copper-catalyzed C(sp3) carboboration of 1,3-diynes, providing access to an array of tetra-substituted boryl enynes in a regioselective manner. All four positions of enyne can be efficiently manipulated using this methodology. The reaction was smoothly applied in the conjugation of complex bioactive molecules to the enyne scaffold. Cross-coupling reactions were carried out with boron end groups on densely substituted 1,3-enynes, opening avenues for the modular synthesis of highly functionalized enynes. Control experiments and density functional theory studies supported the proposed mechanism.

Design and development of a horizontal contact separated (HCS) test setup for measuring the performance of triboelectric nanogenerator for sustainable energy harvesting applications.

Triboelectric nanogenerators (TENGs) can play a pivotal role in harnessing non-utilized reciprocating motion and convert it into electrical energy that can later be stored in a battery or capacitor to power various Internet of Things-based smart electronic and wearable devices. Herein, we designed a cost-effective instrumental test bed focused on investigating the output performance of a horizontal contact separation mode triboelectric nanogenerator by varying the input parameters, such as applied force, motor speed, triboplate separation, and frequency of instrumental setup. The test bed mainly consists of three major parts: (i) application of force, (ii) tapping of TENG sample, and (iii) output parameters measurement. The output performance in terms of open circuit output voltage (VOC), short circuit current (ISC), and power density of polydimethylsiloxane-based TENG was monitored and optimized by varying the input parameters. A low-cost current measuring circuitry using an operational amplifier integrated circuit has been proposed with 92% accuracy. The maximum value of VOC and ISC was observed to be 254 V and 31.8 µA at a motor speed of 600 rpm, the distance between both the plates was 6 mm, the input applied force of 40 N, and the striking frequency of 3 Hz. The maximum power density of 2.1 W/m2 was obtained at an input impedance of 8 kΩ. The durability of the test bed as well as the TENG sample was also measured for 25 h. The degree of uncertainty was measured for VOC, ISC, and applied force and calculated to be 1.62%, 7.45%, and 6.27%, respectively.

Extralobar Pulmonary Sequestration: A Rare Entity.

Lung sequestration is a rare congenital anomaly characterized by non-functional lung tissue that lacks normal bronchial communication and receives blood supply from an aberrant systemic artery. Extralobar sequestration (ELS) is less common and usually found in the lower thoracic or upper abdominal regions. It is often diagnosed in infancy or early childhood due to associated congenital anomalies or respiratory symptoms. The complexity of highly variable anatomy and the involvement of multiple systemic arteries pose significant diagnostic and therapeutic challenges. Patients may present with a variety of nonspecific symptoms, such as recurrent respiratory infections, chronic coughs, or unexplained abdominal pain, which often leads to delayed diagnosis. This case report details the unique presentation of extrapulmonary lung sequestration in a 32-year-old male who presented with persistent respiratory symptoms and intermittent abdominal discomfort. Through comprehensive imaging studies and surgical intervention, the diagnosis was confirmed, and the sequestered tissues were successfully resected. This report aims to highlight the importance of considering bilateral extrapulmonary sequestration in differential diagnoses of recurrent respiratory and abdominal symptoms and to discuss the diagnostic approach and management strategies for this rare condition with highly variable anatomy.

Isolated Pyomyositis of the Thigh With a Sinus Tract: A Rare Presentation of Tuberculosis.

Muscular tuberculosis as a primary focal lesion in an immunocompetent individual without any underlying bone involvement is a rare finding. The authors present a case of a young female in her 30s who presented with complaints of recurrent discharging sinus in the posteromedial aspect of the proximal right thigh for eight months. The patient was treated by surgical debridement followed by antitubercular therapy (ATT) and has shown full recovery during the post-eight-month treatment period. Such a presentation of primary tubercular pyomyositis imposes a diagnostic as well as a therapeutic challenge.

Comparison of the classical approach and costoclavicular approach of ultrasound-guided infraclavicular block: A systematic review and meta-analysis.

Background and Aims: The infraclavicular brachial plexus block (ICB) provides analgesia and anaesthesia of the upper limb. It is given using the classical or the more recently described costoclavicular (CC) approach at the level of cords. This systematic review aimed to assess which approach is better for the ICB in terms of onset, performance, and safety. Methods: This PROSPERO (vide registration number CRD42022361636) registered meta-analysis included randomised trials of patients undergoing upper limb surgery in ultrasound-guided ICB from MEDLINE, EMBASE, SCOPUS, and IRCTP from inception to March 2023. The quality of evidence was assessed using GradePro software. The primary outcomes were sensory and motor block onset time and the number of patients having complete block at 30 minutes. Secondary outcomes included block performance time (BPT), number of attempts, duration of the block, and any incidence of complications. Results: Five trials with 374 adult patients (classic = 185, CC = 189) were included. No significant difference was found in the sensory (Mean difference (MD): 1.44 minutes [95% confidence interval (CI): 3.06, 5.95]; I2 = 95%; very low level of evidence (LOE); P = 0.53) and motor block onset times (MD: 0.83 minutes [95% CI: 0.96, 2.62]; I2 = 84%; very low LOE P = 0.36) and BPT (MD: 5.06 seconds [95% CI: 38.50, 48.63]; I2 = 98%; very low LOE; P = 0.82) in classic and CC approach of ICB. Trial sequential analysis revealed our sample size to be 0.65% of the required sample size to achieve 80% power, deeming our study underpowered. Conclusion: Costoclavicular approach was not superior or inferior to the classical technique for infraclavicular brachial plexus block. However, the quality of evidence is low and further studies are needed to corroborate the findings.