bluuebunny/crossref_metadata_2025 huggingface dataset:
Direct, non-Vitamin K antagonist oral anticoagulants compared with warfarin for stroke with atrial fibrillation and cerebral small vessel disease
Authors: Cai Lipeng , Duan Honglian , Saymuah Sara , Xin Ruiqiang , Geng Xiaokun , Ding Yuchuan
Published: July 2021

Background:

Cerebral small vessel disease (CSVD) is not only associated with an increased risk of intracranial hemorrhage (ICH) in patients on oral anticoagulation, but also associated with an increased risk of ischemic stroke. Limited data support the benefits of direct, non-Vitamin K antagonist oral anticoagulants (direct oral anticoagulants [DOACs]) in acute ischemic stroke (AIS) or transient ischemic attack (TIA) patients with nonvalvular atrial fibrillation (AF) and CSVD. We aimed to evaluate the effectiveness and safety of DOACs in AIS or TIA with AF and CSVD.

Patients and Methods:

We conducted a retrospective study with consecutive patients who experienced AIS or TIA with AF and CSVD from January 1, 2017 to December 31, 2019 in the Stroke Center at Beijing Luhe Hospital, Capital Medical University. Patients are followed for 12 months by outpatient visits or telephone interviews. The safety endpoint of this study was symptomatic ICH (sICH), while the efficacy endpoint was recurrent ischemic events (AIS or TIA). Patients in the DOACs group were compared with patients in the warfarin group using Chi-square tests or the continuity correction Chi-square tests. The safety and efficacy endpoint was progression-free survival assessed by the log-rank test.

Results:

A total of 542 patients were finally included in this study (353 in the DOACs group and 189 in the warfarin group). There were no significant differences in vascular risk factors, NIH Stroke Scale score at baseline, and CHA2DS2-VASc score between the two groups. There were no significant differences in recurrent events between the two groups (P = 0.68). Patients in the DOACs group showed lower risks of sICH (P = 0.03) and a shorter hospital stay (P = 0.03) compared to patients in the warfarin group followed over 12 months.

Conclusion:

DOACs were associated with lower risks of sICH and similar risks of the recurrent ischemic event as compared to the warfarin group with AF and CSVD. Patients in the DOACs group had shorter hospital stay when compared to patients in the warfarin group. DOACs may be a better option than warfarin for AIS or TIA patients with AF and CSVD for secondary prevention.
Data Analysis of Autism Disorder and Micronutrition using PubMed Abstracts
Authors: Choe Seo-Yeong , Lee Dong-Wook , Jeong Hwee-Soo
Published: July 2021

Aim:

This study was conducted to identify the notable nutrients mentioned in abstracts of articles about autism disorder using the big data analysis method.

Methods and Materials:

Abstracts of articles on nutrients related to autism disorder were extracted from MEDLINE using PubMed. Text mining was performed to extract nutrient-related words from collected research abstracts. Network analysis was performed using nutrients keywords and showed more than 100 occurrences among extracted words.

Results:

As a result of text mining 932 abstracts, the top 10 Nutrients that appeared more than 100 times were vitamin D omega 3, zinc, iron, copper, vitamin B6, vitamin B12, folate, calcium, and probiotics, in decreasing order. Folate and copper were central nutrients in the central analysis of the network made by 10 nutrients. Grouping the 10 nutrients showed folic acid, vitamin B6, vitamin B12, calcium, iron, zinc, copper, omega 3 in group 1, probiotics in group 2, and vitamin D in group 3.

Conclusions:

A variety of nutrients, including vitamin D, folate, and copper, were found to be related to autism disorder by big data analysis of abstracts of nutrition research studies related to this disorder.
Stem Cells Therapy
Authors: Gorantla Vasavi Rakesh , Bhat Abid , Ghosh Abhinav Raj , Bolla Srinivasa Rao , Bhojaraj Saravanan , Mohan Surapaneni Krishna , Veeraraghavan Vishnu Priya , Chidambaram Saravana Babu , Essa Musthafa Mohamed , Qoronfleh M. Walid
Published: July 2021

Huntington disease is an autosomal neurodegenerative disease that is induced by a repeated trinucleotide sequence of a gene that encodes Huntingtin and is characterized by motor, behavioral, and cognitive manifestations. It is a progressive disorder with symptoms worsening over time. The prevalence of this disease is predominant in the United States as well as the UK. The five main progression stages of this disease are Early stage, Early intermediate stage, Late intermediate stages, Early advanced stage, and Advanced stage. The risk factors at the molecular level are CAG is trinucleotide repeat, CAG instability, and genetic modification. The drugs currently used for this disease are useful only in treating the symptoms of the disease but not as useful long-term therapies. Stem cells remedy on the other hand are much more versatile and might prove effective in the treatment of neurodegeneration. Stem cells, which may be employed in Huntington research, are pluripotent stem cells, embryonic stem cells, neural stem cells, adipose stem cells, and mesenchymal stem cells. Each type of cell line has its essential properties for combating this disease. Although extensive investigations have been carried out for this disease, there is no successful therapy as of today. This review provides comprehensive information on novel stem cell therapy research that has been channeled out for the treatment of this genetic neurodegenerative disorder.
Effect of Methanol Extract of Polygonum minus on Neuropathic Pain and Cognitive Dysfunction in Rats
Authors: Christapher Parayil Varghese , Muthuraman Arunachalam , Zhang Liew Shi , Jordon Koh Sing Yap , Jonathan Koay Hean Huat
Published: July 2021

Introduction:

Polygonum minus is one of the traditional medicinal plants. It contains various bioactive ingredients such as flavonoids and essential oil. It possesses the potential pharmacological actions, cytotoxicity, and antiproliferative actions. The role of Polygonum minus on neuropathic pain and cognitive functions remains to be explored. The present study was designed to evaluate the role of methanolic extract of Polygonum minus (PM) in paclitaxel (PT) and scopolamine (SCO) induced neuropathic pain and cognitive dysfunction in rats respectively.

Methods:

The PT (2 mg/kg; i.p. for 10 days) and SCO (1 mg/kg; i.p. for 4 days) were used for the induction of neuropathic pain and cognitive dysfunction in rats. The PM (200 and 400 mg/kg; for 10 days) was used for testing neuro-analgesic effect and the PM (150 mg/kg; for 4 days) was used for cognitive function study. The neuropathic pain was assessed by plantar, tail immersion, and pinprick tests. The cognitive function was assessed by the Morris water maze test. The reference drugs, that is, pregabalin (10 mg/kg) and donepezil (1 mg/kg) used for the assessment of neuropathic pain and cognitive function. Besides, the hippocampal tissue samples were used for the estimation of acetylcholinesterase activity, thiobarbituric acid reactive substances, reduced glutathione, and total protein levels.

Results:

The administration of PM ameliorated the PT- and SCO-induced neuropathic pain and cognitive dysfunctions in a dose-dependent manner.

Conclusion:

The PM possesses the potential neuroprotective actions due to its potential antioxidant, lipid peroxidation inhibition, and regulation of cholinergic neurotransmitter functions.
A Hidden Gem in the World of Natural Syrup Market
Authors: Al-Belushi Maha Khamis , Butt Irfan , Ali Amanat , Bhuian Shahid
Published: July 2021

Background:

Understanding consumer’s preferences in the development and marketing of date syrup is crucial for developing its global market. Limited studies have attempted to understand the issues related to consumer’s preferences for date syrup, even though such understandings are essentials for its effective marketing as a promising alternative natural syrup. The present study was therefore conducted to investigate the sensory properties, purchase attributes, and usages of date-syrup among the consumers in Pakistan.

Design, Methodology, and Approach:

A total of 135 consumers, comprising students, faculty, and staff from three different universities in Pakistan, participated in this study. The study questionnaire included sensory tests, rank order of brands tests, and rating of purchase-related attribute tests to evaluate the consumer preferences for date-syrup.

Findings and Implications:

The results showed that consumers prefer a great taste, least sweet, least thick, smoothest, most soluble, medium dark in color, and mouthfeel date syrup. Additionally, a reasonable price, good packaging, and no added sugar were the purchase-important attributes of date syrup. The purchase attributes did not differ across varying demographics. These findings indicate that the enterprises striving to promote date syrup as an alternative sweetener should pay greater attention to customer-preferred sensory properties, usages, and purchase-related attributes.

Conclusion:

This is the first study that evaluated the consumer’s preferences for date syrup in Pakistan. The results suggest that consumers prefer the great taste, smoothness, reasonable price, good packaging, and no added sugar as purchase-important attributes for date syrup. Therefore, enterprises promoting the use of date syrup as an alternate sweetener must concentrate on these aspects for its effective marketing.
A Prospective Observational Study of the Outcome of Treatment with Kabasura Kudineer among Patients with SARS-nCOV-2 Infection
Authors: Ramya J. Ezhil , Chandran G. Subash , Alagesan S. , Ravichandran M. , Victoria S. , Devi M. Rathi , Antony S. Justus , Shantaraman K.
Published: July 2021

Introduction:

The novel Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2), has been considered a major life-threatening danger to the human population worldwide. The traditional Indian medicines also play an important role as possible novel therapeutic approaches, exclusively targeting SARS-CoV-2 and its pathways. Among the Siddha medicines, Kabasura kudineer is a formulation composed of 15 ingredients used against fever caused by respiratory infections.

Aim:

To determine the outcome of Kabasura kudineer, among SARS CoV-2 patients admitted in a tertiary care hospital of Tamil Nadu with mild to moderate symptoms or asymptomatic patients.

Methods:

A prospective observational study was carried out in Covid care Hospital, Tirunelveli Medical College Hospital, Tirunelveli after the approval of Institutional Ethics Committee. Written informed consent forms were obtained from the patients. A total of 100 patients with positive Real Time Polymerase Chain Reaction (RT-PCR) for SARS-nCov-2 with asymptomatic and mild to moderate symptoms were included in this study. Among them, 50 patients were included in the control group and the other 50 patients were provided with 60 mL Kabasura kudineer for 5 days. Again on the sixth day, RT-PCR was repeated.

Results:

Among 50 participants in each group, by the sixth day, RT-PCR converted into negative for 27 patients in group B, by 10th day 25 in group A and 22 in group B, by 14th day 25 in group A and remaining 1 in group B became negative.

Conclusion:

The present study showed Kabasura kudineer was effective when compared with the control group against SARS-nCoV-2 patients with no symptoms and mild symptoms and also the conversion of RT-PCR.
Identification and Prevalence of Food Colors in Candies Commonly Consumed by Children in Muscat, Oman
Authors: AbuKhader Majed , UM Dhanalekshmi , Nazmi Abdulsalam
Published: July 2021

Background:

A food color, or a color additive, is any dye, pigment, or a chemical substance that imparts colors to food. There have been several concerns about the safety of food colors reported in the literature that require further evaluation.

Purpose:

The aim of this study was to identify the type, synthetic and natural, frequency, and prevalence of food colors in candy confectionary items commonly consumed by children.

Methods:

A random cross-sectional product survey approach was followed in selected supermarkets and convenience stores in Muscat, Oman. The ingredient label was utilized as a reliable source of information about food colors used in the selected candy confectionery items.

Results:

A greater variety of natural food colors were used in candy confectionery when compared with the synthetic ones. It seems, however, that synthetic food colors were more frequently used. Brilliant Blue FCF (E133) and Allura Red AC (E129) are synthetic food colors used more frequently in the studied sample. Although a general observation of the collected data highlights some variation in the frequency of food colors used in candy confectionery sold in supermarkets and convenience stores, statistical analysis has revealed an insignificant correlation.

Conclusion:

Both synthetic and natural food colors were found to be used in the studied sample. There was no correlation between the type of food colors used in candies and the outlets where these items were sold. This research encourages further exploration of consumption patterns among young children and the actual levels of food colors in food items including candy confectionery marketed in Oman.
Machine Learning Approaches for Prognostication of Newly Diagnosed Glioblastoma
Authors: Tunthanathip Thara , Oearsakul Thakul
Published: July 2021

Background:

Glioblastoma (GBM) is the poorest prognosis in glioma. Although Temozolomide (TMZ) with radiotherapy following tumor resection is currently the standard treatment, the high cost has become an economic burden in a limited-resource setting. In an era of disruptive innovation, machine learning (ML) has been recently performed to be the clinical prediction tool for prognostication, especially GBM. The aim of the study was to assess the predictability of ML algorithms for 2-year survival in patients with GBM.

Methods:

A retrospective cohort study was performed in patients with GBM. Various clinical, radiological, and treatment variables were collected, and the outcome was a 2-year living status as bi-classifiers. The candidate variables, which had a P<0.1, were performed to train the ML model. For training the ML model, random forest (RF), logistic regression (LR), and support vector machines were used for training the model and testing the predictive performance.

Results:

There were 190 GBM patients in the cohort. Four candidate variables were used for building the ML model and testing the performance of each algorithm. The LR and RF algorithms had an acceptable performance for predicting a 2-year survival with an area under the receiver operating characteristic curve at 0.82 and 0.81, respectively.

Conclusion:

ML-based algorithms had an acceptable performance for the prognostication of 2-year survival in GBM patients that could be implicated in real-world practice for selecting patients with a favorable prognosis and developing treatment strategies for resource allocation in a limited-resource setting.
Biosimilars
Authors: Bhojaraj Saravanan , Kumar Thirumoorthy Durai Ananda , Ghosh Abhinav Raj , Sushmitha BS , Ramamurthy Srinivasan , Velusamy Thirunavukkarasu , Ramesh Thiyagarajan , Jayanthi MK , Essa Musthafa Mohammed , Chidambaram Saravana Babu , Qoronfleh M. Walid
Published: July 2021

Biologics are medicines primarily derived from living systems and produced through recombinant DNA (rDNA) and monoclonal technologies. Generic version of biologics with improved efficacy and safety is called biosimilar. Patent and copyright expiration of biological products permits the entry of biosimilars. Synthesis of biosimilars involves two main processes, such as monoclonal antibodies and rDNA technology, and characterized by various methods such as posttranslational modification, mass spectrometry, peptide mapping, three-dimensional (high-order) structure, X-ray crystallography, ion mobility spectrometry, and hydrogen deuterium exchange mass spectrometry. Though both generic and biosimilar products follow the same regulatory approval, the requirements are not the same due to the variability in composition and instability. Hence, it is essential to develop pharmacokinetic and pharmacodynamic data to support the efficacy and safety data on biosimilars. This review summarizes the recent updates on biosimilars, synthesis, characterization, and current market status. Brief information on the role of biosimilars in multiple sclerosis is also provided in the review.
Scoliosis Associated with HGPPS Syndrome
Authors: Menon Venugopal , Tahasildar Naveen S. , Sivaraman Thirunavukkarasu , Venkateshappa Bhaskar M.
Published: July 2021

Horizontal gaze palsy with progressive scoliosis (HGPPS) syndrome is a rare genetic abnormality causing cranial dysinnervation manifesting as absence of conjugate lateral eye movements, nystagmus, and scoliosis. While the genetics, imaging abnormalities, and ocular manifestations have been well described in literature, the spinal deformity has not been addressed adequately. An 11-year-old girl presented with progressive thoracic scoliosis who on evaluation was detected to have all the features of HGPPS syndrome. The patient underwent posterior correction of scoliosis uneventfully. A thorough literature search was performed to understand the descriptors of spinal deformity and its surgery in HGPPS syndrome. The spinal deformity in HGPPS resembles adolescent idiopathic scoliosis. Rapidly progressive right thoracic scoliosis was the usual pattern. Surgical and anesthetic considerations during surgery are similar to idiopathic scoliosis. These children tolerate surgery and anesthesia well. Neuromonitoring changes during surgery need to be interpreted correctly in the background of uncrossed sensory and motor tracts.
An Atypical Presentation of Metastatic Ewing Sarcoma to the Spine
Authors: Tan Wei Jie , Lee Hwei Yee , Yap Wayne Ming Quan , Nolan Colum Patrick , Oh Jacob Yoong-Leong
Published: July 2021

Ewing sarcoma (ES) is a rare malignancy of the young, primarily arising from the bones. Uncommonly, it can arise extraskeletally and, among the rarest cases, from the spinal extradural tissues. The patient is a previously well 26-year-old male who presented with radicular low back pain. Magnetic resonance imaging revealed an L5-S1 spinal canal mass with possible metastases to the vertebral and pelvic bones. The initial diagnosis was challenging, with differentials of an intradural tumor, infection, solid organ tumor metastasis, and lymphoma. The patient subsequently underwent decompression and debulking of his spinal tumor, which was found to be extradural. Histological and pathological studies supported the diagnosis of metastatic ES. This case report highlights an atypical presentation of ES. Although exceedingly rare, young patients can still present with metastatic spinal disease. Clinicians should always consider more sinister diagnoses and investigate further, especially if red flag symptoms are present.
In-vivo Clinical Validation of Perpendicular to Superior Articular Process as Thoracic Pedicle Trajectory
Authors: Ahmad Aziz , Ali Chadi , Stokes Oliver
Published: July 2021

Study Design:

This is a retrospective case series study.

Objective:

Thoracic pedicle screw insertion can be technically challenging because of narrow pedicles. Placement of thoracic pedicle screws in pediatric scoliosis and adult deformity surgeries, due to three-dimensional rotation of vertebrae, is even more challenging because the usual landmarks are less evident, and the sagittal trajectory is more difficult to correctly orientate due to the vertebral rotation. We describe a variation of freehand technique to guide sagittal trajectory of thoracic pedicle screw.

Materials and Methods:

The inferior articular process of cranially adjacent vertebrae is osteotomized using a Capener Gouge to expose the superior articular process (SAP) of the thoracic vertebrae to be instrumented. An O’Connell dissector is then placed flush on the SAP. The main shaft of the dissector is at right angle to the base plate; pedicle finder is placed parallel to the shaft and follows the same sagittal trajectory as the shaft.

Results:

A total of 390 pedicle screws were identified in a consecutive series of 60 scoliosis patients inserted using this technique. Only one screw was revised for lateral breach. There was no intra-operative complication or neurological sequelae in any of our patients.

Conclusion:

Freehand pedicle screw placement remains a very common technique, used particularly by pediatric scoliosis surgeons. One of the drawbacks of previous reports of the freehand technique is that the sagittal trajectory is not clearly defined. Our technique fills this gap, and this series demonstrates that the technique produces a reliable and consistent result.
A Rare Case of Primary High Cervical Intramedullary Cysticercosis
Authors: Mediratta Sunit
Published: July 2021

Neurocysticercosis (NCC) is the most common parasitic infection involving the central nervous system. The involvement of spine by this disease is extremely uncommon. When the spine does get affected, it generally develops as a synchronous infection with an existing cerebral cysticercosis and usually involves the intradural extramedullary space. Primary intramedullary involvement is rare. A case of primary high cervical intramedullary cysticercosis with non-progressive symptoms is described. In this case, a pre-operative diagnosis could not be ascertained. The patient underwent total surgical resection of the lesion and made excellent recovery. Post-operative evaluation did not reveal disease at other sites. This case highlights the safety and ease of surgical resection in intramedullary NCC.
Paradoxical Reactions in Spinal Tuberculosis
Authors: Zaveri Gautam R. , Jaiswal Nitin P.
Published: July 2021

Introduction:

Clinical or radiological worsening of pre-existing tubercular lesions or appearance of new lesions in patients who have shown initial improvement following antitubercular chemotherapy (ATT) is termed as a paradoxical reaction (PR). The appearance of these lesions after spine surgery raises the possibilities of drug resistance, treatment failure, and surgical site infection. This retrospective case series aims to describe the presentation of PRs in spinal tuberculosis (TB), identify risk factors, and propose a treatment plan for PRs within the spine.

Materials and Methods:

Nine patients (2 males and 7 females; mean age 31.2 years), who underwent posterior transpedicular decompression and instrumented fusion for spinal TB, presented 4–7 weeks later with a soft, large swelling at the surgical site. In one patient, the swelling had burst through the skin resulting in a discharging wound. Two patients had screw pullout with local kyphosis. All patients had been started on ATT only after index surgery and had experienced improvement in constitutional symptoms, pain, and neurology. Magnetic resonance imaging showed large fluid collection at the surgical site without any new bony lesions.

Results:

All patients underwent surgical debridement with two patients requiring revision instrumentation. Examination of tissue and fluid revealed caseating granulomas and mycobacteria. Continuation of the same ATT led to uneventful healing.

Conclusion:

PRs in patients with spinal TB presented with a cold abscess at the surgical site between 4 and 7 weeks after starting ATT. Surgical drainage with debridement and continuation of ATT without changes to the regimen led to uneventful healing in all patients. Young age, female sex, thoracic lesions, and patients virgin to ATT prior to surgery were risk factors.
Early Experiences in the Management of Traumatic Spinal Injuries at a Level 1 Trauma Center in India During the COVID-19 Pandemic
Authors: Farooque Kamran M. , Nayak Tushar R. , Siamwala Burhan S. , Aryal Aayush
Published: July 2021

Context:

Overwhelmed by COVID-19 patients requiring urgent medical attention and intensive care beds, majority of our medical resources are allocated for the management of the current pandemic. Other urgent cases requiring surgical attention also need to be optimally addressed.

Aims:

The aim of this article is to report the early results and organizational protocol in the management of traumatic spinal fractures at a level-1 trauma center during the current pandemic.

Settings and Design:

This is a retrospective study of patients with vertebral fractures operated by a single surgeon between April and October 2020. All patients were tested for the SARS-CoV-2 virus, and the tests were repeated every 72 h. We modified our institutional protocol to aid the early management of emergency traumatic spine cases during this pandemic. Descriptive analysis of data collected from hospital records was carried out using Statistical Package for Social Sciences, Virginia, USA, Version 20.

Results:

A total of 44 patients were operated. Burst fracture was the most common fracture with a fall from height being the most common mechanism of injury. Two patients tested positive for the novel corona virus. There were no complications and none of the healthcare staff involved in the patient care or patients reported symptoms of COVID-19 during a 30-day follow‐up period.

Conclusion:

Surgical treatment of patients with vertebral fractures, with strict adherence to personal protective measures and local guidelines, did not increase the risk of contracting SARS‐CoV2 to either healthcare workers or patients during the lockdown period.
Techno-Innovations and Molecular Methods for Diagnosis of COVID-19
Authors: Gairolla Jitender , Gupta Pratima , Gupta Prakamya , Mathuria Yogendra Pratap , Chauhan Chandarkanta , Kaur Maninder , Naithani Priyanka , Naithani Manisha , Nagar Pramod Kumar
Published: July 2021

The rapid diagnosis of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection relies on the availability of a robust method. The demand for SARS-CoV-2 diagnostic kits and other desirable consumables for timely diagnosis have increased drastically after the current pandemic. The cumulative efforts by scientists, funding agencies, regulatory authorities, and corporates have accelerated the process of kit development. Worldwide, rapid molecular techno progression to characterize the biology of any pathogen witnessed during this pandemic faster than ever. Moreover, a paradigm shift from real-time polymerase chain reaction technique to highly sensitive novel CRISPR technology has been observed. India, second most populous country actively leveraged molecular technologies for rapid diagnosis of SARS-CoV-2. This paper focuses on paradigm shift in the methods for diagnosis of SARS-CoV-2 infection with a focus on molecular innovations carried out in India indigenously.
Reactivation of a 35-year-old Scar!
Authors: Ranjan Eeshaan , Arora Sandeep , Donaparthi Navya , Ahmed Safia , Pemmaraju Arpitha
Published: July 2021

Sarcoidosis is a systemic inflammatory disorder of unknown etiology characterized by the presence of noncaseating granulomas. Scar sarcoidosis refers to the infiltration of old scars with noncaseating epithelioid cell granulomas. This reactivation of old scars, manifesting as cutaneous sarcoidosis, is highly specific for sarcoidosis and very unusual. This report describes an old scar with an unusually long history of quiescence and its reactivation after 35 years along with manifestations of pulmonary sarcoidosis.
Wall-to-wall heart – The largest left atrium ever reported
Authors: Bhattacharjee Saikat , Awasthi Shikha , Jambunathan Prashant , Sinha Preema , Prateek
Published: July 2021

A 59-year-old male patient presented with a history of dyspnea on exertion for the past 10 years, which was gradually progressive in nature. The patient had orthopnea and paroxysmal nocturnal dyspnea for the past few months. On evaluation, he was found to have cardiomegaly and a giant left atrium. Contrast-enhanced computed tomography of the heart showed the left atrium to be enlarged to a dimension of 20.7 cm which, as of the time of writing, is the largest ever reported.
Desmopressin nasal spray reduces blood loss and improves the quality of the surgical field during functional endoscopic sinus surgery
Authors: Safaeian Reza , Hassani Valiollah , Ghandi Arman , Mohseni Masood
Published: July 2021

Background and Aims:

Making a dry surgical field during functional endoscopic sinus surgery (FESS) is a challenge for anesthetists. This study was conducted to evaluate the pre-emptive hemostatic effects of a single dose of an intranasal spray of desmopressin (DDAVP) in sinus surgery.

Material and Methods:

Sixty consecutive patient's as first-time candidates for FESS due to chronic sinusitis were enrolled. They were randomly allocated to receive either a nasal spray of DDAVP 20 μg or sterile water before induction of anesthesia. Management of anesthesia was achieved with propofol and remifentanil infusions. Blood loss, quality of the surgical field, and surgeon's satisfaction were compared between the two groups.

Results:

Blood loss in the DDAVP group was 147 ± 43 mL and in the placebo group 212 ± 64 mL (mean ± SD, P < 0.01). The quality of the surgical field in the DDAVP group was better than the placebo group. (median score, 1 (1–2) vs. 2 (1–3), P = 0.017). Surgeons were more satisfied with the surgical field in the DDAVP group than in the control group (median score, 4 (2.8–5) vs. 3 (2-3), P = 0.04).

Conclusion:

Premedication with nasal spray DDAVP 20 μg effectively reduces bleeding and improves the surgical field during FESS.
Comparative evaluation of dexmedetomidine and fentanyl in total intravenous anesthesia for laparoscopic cholecystectomy
Authors: Siddiqui Tabish Husnain , Choudhary Nitin , Kumar Abhijit , Kohli Amit , Wadhawan Sonia , Bhadoria Poonam
Published: July 2021

Background and Aims:

Laparoscopic cholecystectomy is one of the commonly performed ambulatory surgeries. The selection of anesthetic agents for ambulatory surgeries should be done bearing in mind the need for early discharge. Opioids form an integral component of total intravenous anesthesia (TIVA) but their associated side effects may result in an increased hospital stay. Hence, we planned a study to compare the opioid (fentanyl) and non-opioid (dexmedetomidine) based technique of TIVA for laparoscopic surgery.

Material and Methods:

Ninety ASA I and II patients between 18-60 years of either sex posted for laparoscopic cholecystectomy were randomly allocated into two groups namely group D (Dexmedetomidine) and group F (Fentanyl). Patients received propofol infusion along with group specific drug infusion, after which an appropriate size proseal laryngeal mask airway was placed. The patients were assessed for discharge time from post-anesthesia care unit (PACU), on table recovery time, time to first rescue analgesia, hemodynamic parameters, incidence of postoperative nausea and vomiting (PONV) and any other complication.

Results:

Demographic profile of both the groups was comparable. Group D had longer on table recovery time (13.00 ± 2.34 min vs 6.29 ± 2.46 min; P < 0.001) and time to discharge from PACU (6.80 ± 3.96 min vs 2.36 ± 1.67 min; P < 0.001) compared to group F. Group F had better hemodynamic stability compared to group D. In group D, 77% patients required rescue analgesia in first one hour post surgery, unlike 22% in group F. No patient in group D had PONV.

Conclusion:

Opioid based technique (Fentanyl) of TIVA is superior over non-opioid based (dexmedetomidine) technique with faster recovery, early discharge, decreased postoperative pain scores and better hemodynamic stability. PONV is observed with opioids which can be treated successfully with antiemetics.
A randomized comparison of epidural, dural puncture epidural, and combined spinal-epidural without intrathecal opioids for labor analgesia
Authors: Bakhet Wahba Z.
Published: July 2021

Background and Aims:

Dural puncture epidural (DPE) has been shown to improve labor analgesia over epidural (EPL), with fewer side effects than a combined spinal-epidural (CSE). However, there is some debate regarding the superiority of DPE over EPL and CSE. Therefore, we aimed to compare the effects of EPL, DPE, and CSE without intrathecal opioids on the epidural local anesthetic (LA) consumption and occurrence of side effects in early labor.

Material and Methods:

We randomly assigned parturient to one of the 3 groups; EPL, DPE, or CSE. EPL and DPE groups received a 10 mL loading dose of 0.1% bupivacaine with fentanyl 2 μg/mL. CSE group received intrathecal 2.5 mg bupivacaine (without opioids). Labor analgesia was maintained in all patients via patient-controlled epidural analgesia (PCEA). The primary outcome was the mean hourly consumption of epidural LA.

Results:

The mean hourly consumption of epidural LA anesthetic was significantly lower in CSE (9.55 mL), compared with the EPL (11 mL), and DPE (10.5 mL), P < 0.01; but no significant difference was seen between EPL and DPE. Compared with EPL and DPE, CSE achieved faster time to complete analgesia defined as a numeric rating pain scale (NRPS) ≤1 and sensory block, lower NRPS in the first hour and higher frequencies of complete analgesia. There were no differences between groups in terms of physician top-up boluses, the occurrence of side-effects, mode of delivery, Apgar scores, and maternal satisfaction.

Conclusion:

Compared with EPL and DPE, CSE without intrathecal opioids, had a less epidural LA consumption, faster onset of analgesia, with no difference in the incidence of side effects.

Trial Registration:

This study was registered at www.clinicaltrials.gov (NCT03980951).
Comparative evaluation of analgesic efficacy of buprenorphine transdermal patch and fentanyl patch in management of postoperative pain after arthroscopic lower limb surgery
Authors: Khandelwal Hariom , Negi Anoop , Govil Nishith , Singh Ashutosh , Parag Kumar , Bhardwaj Bharat Bhushan
Published: July 2021

Background and Aims:

Transdermal opioids are newer modality in use for the control of postoperative pain, because of its noninvasiveness, longer duration of action, sustained blood levels, and with minimal side effects. The study was aimed to evaluate the efficacy of analgesia of buprenorphine patch 10, 20 μg·h-1 and fentanyl patch 25 μg·h-1 for relief of pain in the postoperative period in patients undergoing arthroscopic lower limb surgeries.

Materials and Methods:

It was a randomized, double-blinded, prospective study in which adult patients undergoing lower limb arthroscopic surgery were randomly segregated into three groups. In Group 1 (fentanyl patch 25 μg·h-1), Group 2 (buprenorphine patch 10 μg·h-1), and Group 3 (buprenorphine patch 20 μg·h-1), transdermal patches were applied 12 h prior to surgery. Mean NRS score, total rescue analgesic requirement, drug-related adverse effects, and hemodynamic status were evaluated till 72 h in the postoperative period.

Results:

Out of 175 screened patients, 150 patients were finally analyzed. Baseline characteristics were the same among all the three groups. Median NRS score was lowest in Group 3 [P value < 0.05 at 2, 4, 8, 12, and 24 h after surgery (Kruskal Wallis test). The total consumption of postoperative rescue analgesic diclofenac was the lowest in Group 3 as compared to other groups without any significant increase in adverse events.

Conclusions:

In arthroscopic lower limb surgery, buprenorphine patch (20 μg·h-1) applied 12 h prior to surgery is an effective postoperative analgesic and it is not associated with any significant adverse effects.
The barrier techniques for airway management in covid-19 patients - review of literature
Authors: Yadav Pratishtha , Garg Rakesh
Published: July 2021

The coronavirus disease 2019 (COVID-19) has emerged as a pandemic and shall prevail for some time around the globe. The disease can manifest from asymptomatic to severe respiratory compromise requiring airway intervention. Transmission of COVID-19 has been reported to be by droplets, fomites, and aerosols, and airway management is an aerosol-generating procedure. The high viral load in the patient's airway puts the clinician performing intubation at a very high risk of viral load exposure. So, the need for barrier devices was considered and led to reporting of various such devices. All these devices have been reported individually and have not been compared. We present a review of all the information on these devices based on the reported literature.
COVID-19 pandemic and preparedness of anesthesia team in a stand-alone cancer centre in Eastern India
Authors: Goswami Jyotsna , Sarkar Anshuman , Mukherjee Sudipta , Ghosh Pralay S. , Pal Angshuman R. , Barman Suparna M. , Banerjee Sumantra S. , Nandi Rudranil , Bhattacharyya Sanjay
Published: July 2021

India came under the grip of the coronavirus disease-2019 (COVID-19) pandemic and is now seeing rising graph. Cancer patients are specially in the high-risk group because of their immunocompromised status on one hand and progressive disease on the other hand. Hence, cancer care facility needs to prepare a clear strategy to manage their space, staff and supplies so that optimum patient care can be continued in the face of COVID-19 pandemic. In addition, infection prevention measures need to be robust to reduce in-hospital transmission. The working area of anesthesia and Critical Care is spread over the whole hospital such as operating room, ICU, isolation area, out-patient dept (OPD) area, various diagnostic areas and in-patient dept (IPD) to attend code blue calls. In this article, we describe the preparedness and initial response measures of the anesthesia and Critical Care department of a stand-alone tertiary level cancer care centre in eastern part of India. These include engineering controls such as identification and preparation of an isolation operating room, administrative measures such as modification of workflow, introduction and adequate supply of personal protective equipment for staff and formulation of clinical guidelines for anesthetic management. These containment measures are necessary to continue care of cancer patients, optimize the quality of care provided to COVID-19 positive cancer patients and to reduce the risk of viral transmission to other patients or healthcare providers.
Common anti-COVID-19 drugs and their anticipated interaction with anesthetic agents
Authors: Shah Shagun B. , Hariharan Uma , Chawla Rajiv
Published: July 2021

The corona virus disease 2019 (COVID-19) pandemic has till date (26/7/20) affected 1crore 62 lac 73 thousand 638 people globally with almost 6.5 lakh mortalities. COVID-19 has invaded the operation theatre and intensive care unit (ICU) in a short span of 6 months. It appears inevitable that all of us, as anesthesiologists, have to treat COVID-positive patients, either in the ICU or the operation theatre. Many asymptomatic, presumably noninfected people including frontline health care workers are also consuming potential anticorona viral drugs (such as hydroxychloroquine) prophylactically and may present for surgery. Detailed knowledge of which anesthetic and perioperative care drugs can interact with anti-COVID drugs would be very valuable for pre, intra-, and postoperative management of such patients and COVID-19 positive patients requiring intubation, mechanical ventilation, and ICU-sedation. Powered with this knowledge, anesthesiologists and intensivists can minimize the adverse effects of drug interactions. An extensive literature search using different search engines including Cochrane, Embase, Google Scholar, Scopus, and PubMed for all indexed review articles, original articles, case reports, and referenced webpages was performed to extract the most current and relevant literature on drug-drug interactions for clinicians.
Effect of airway device and depth of anesthesia on intra-ocular pressure measurement during general anesthesia in children
Authors: Darlong Vanlal , Kalaiyarasan Ramkumar , Baidya Dalim K. , Pandey Ravindra , Sinha Renu , Punj Jyotsna , Dada Tanuj
Published: July 2021

Background and Aims:

Accurate measurement of intraocular pressure (IOP) under anaesthesia is essential for diagnosis and further management of pediatric glaucoma patients. However, depth of anaesthesia and use of airway device like laryngeal mask airway (LMA) or endotracheal tube can influence IOP values measured. We planned this study to compare change of IOP with facemask or LMA. Change of IOP at varying depth of anaesthesia was also assessed.

Material and Methods:

After Institutional ethical clearance and informed parental consent, 89 children of glaucoma aged 0-12 years were included in this prospective randomized controlled trial. The children were randomized to facemask (Group M) and LMA (Group L). Sevoflurane was the sole general anaesthetic used in both the groups and IOP were recorded after induction, at BIS 40-60, after LMA insertion (Group L), at BIS 60-80 and BIS more than 80.

Results:

The IOP values did not differ significantly between the groups at BIS 40-60 and at BIS 60-80. Moreover, pre and post LMA insertion IOP values were also comparable in Gr L (p = 0.11). However, significant increase in IOP values were observed with increasing BIS values within each group. The mean IOP in Group M at BIS 40-60 was 13.41 ± 4.04 as compared to 14.18 ± 3.64 at BIS 60-80 (p = 0.003). There was a similar pattern observed in Group L, where mean IOP at BIS 40-60 & BIS 60-80 was 14.13 ± 4.90 and 15.52 ± 4.57 respectively (p < 0.001).

Conclusion:

Either facemask or classic LMA can be safely used as per anaesthesiologist's preference without any significant effect on IOP. BIS monitoring may be used during IOP measurement in paediatric glaucoma suspects for accurate assessment of IOP.
Investigation of the Lower Punctum Parameters
Authors: Sabermoghaddam Aliakbar , Golestani Shahin , Hassanpour Kiana , Bakhtiari Elham
Published: July 2021

Purpose:

To evaluate the dimensions of lower punctum in a sample of Iranian normal population using spectral domain anterior segment optical coherence tomography (OCT).

Methods:

In this cross-sectional study, 102 eyes of 102 healthy volunteers were enrolled. All participants underwent a detailed history and complete ophthalmic examination. Lower punctum metrics were measured using OCT (Spectralis, Heidelberg) with the anterior segment module. External punctal diameter was defined as the largest diameter at the surface of the punctum. Internal punctal diameter was measured at two different depths of 100 μm and 500 μm from the external surface. Measurements were repeated for 30% of data by another grader. The agreement was measured using intraclass correlation coefficient (ICC).

Results:

The mean age of the participants was 61.5 ± 7.9 years. The mean external punctal diameter was 425.6 ± 124.3 μm. The mean internal punctal diameter at 100 μm and 500 μm was 183 ± 97.5 μm and 77.7 ± 51.4 μm, respectively. The agreement between the graders was high in assessing all punctal characteristics (ICC >0.9 for all measurements).

Conclusion:

The spectral domain OCT can be used for measuring lower punctum diameter with acceptable reproducibility.
Tolosa–Hunt Syndrome
Authors: Dutta Paromita , Anand Kamlesh
Published: July 2021

Purpose:

To review the diagnostic criteria for Tolosa–Hunt syndrome (THS) and utility of recent modifications.

Methods:

We searched PubMed for keywords Tolosa Hunt and magnetic resonance imaging. We compared the three editions of International Classification of Headache Disorders and isolated case reports and case series with the assessment of cavernous internal carotid artery (ICA) caliber to find the prevalence of vascular anomalies. We also evaluated cases of THS with the involvement of extracavernous structures and the possible role of idiopathic hypertrophic pachymeningitis (HP). Cases diagnosed falsely as THS were also reviewed for the presence of atypical features and relevance of criterion D. We assessed nonconforming cases (those with normal neuroimaging benign THS) and idiopathic inflammatory orbital pseudotumor (IIPO).

Results:

Vascular abnormalities were found in 36.36% of THS cases. Benign THS may also show changes in ICA caliber. Evidence suggestive of idiopathic HP could be found in 57% of cases with the involvement of extracavernous structures, such as facial nerve and pituitary gland. Both THS and IIPO are steroid-responsive pathologies with similar clinical and radiological features. False-positive diagnosis of THS results from early labeling, based solely on clinical features and symptom resolution after steroid therapy.

Conclusions:

Benign THS may be a result of limitation of resolution of available neuroimaging technique or early testing. Early and late vascular changes can be seen in both THS and its benign variant; some of them are not innocuous. THS may be considered a type of focal idiopathic HP. IIPO may represent an anterior variant of THS. In the absence of histopathological diagnosis, steroid-induced resolution of symptoms should be confirmed radiologically and followed-up.
Tonometry by Ocular Response Analyzer in Keratoconic and Warpage Eyes in Comparison with Normal Eyes
Authors: Alipour Fateme , Hassanpoor Narges , Letafatnejad Moggan , Beheshtnejad Amir-Hooshang , Mohammadi Seyed-Farzad
Published: July 2021

Purpose:

To compare intraocular pressure (IOP) values measured by ocular response analyzer (ORA) in contact lens-induced corneal warpage, normal, and keratoconic eyes.

Methods:

In a prospective, observational case–control study, 94 eyes of 47 warpage-suspected cases and 46 eyes of 23 keratoconic patients were enrolled. Warpage-suspected cases were followed until a definite diagnosis was made (warpage, nonwarpage normal, or keratoconus). ORA tonometry and corneal biomechanics testing were performed for all cases in each visit. We had 2–3 measured corneal-compensated IOP (IOPcc) and Goldmann-correlated IOP (IOPg) for each patient (based on group) with at least 2-week interval.

Results:

After following up of warpage-suspected patients, finally 44 eyes of 22 patients had confirmed soft contact lens-related corneal warpage. Forty-six eyes of 23 people were finally diagnosed as nonwarpage normal eyes. Forty-six eyes of 23 known keratoconus patients were also included for comparison. The demographic and refractive data were not different between the warpage and nonwarpage normal groups but were different in the keratoconus group. Both IOPcc and IOPg were statistically different with the highest value in the warpage group followed by normal and keratoconus groups; the same trend was observed in central corneal thickness (CCT). The mean of IOPg was 14.94 ± 2.65, 13.7 ± 2.33, and 10.86 ± 3 and IOPcc was 15.73 ± 2.4, 15.28 ± 2.43, and 14.08 ± 2.55 in the warpage, normal, and keratoconus groups, respectively. IOPg and IOPcc in the warpage group (based on baseline diagnosis) did not regress to become closer to IOP of normal eyes after discontinuation of contact lens in their follow-up visits (P value for IOPg and IOPcc trends in the warpage group was 0.07 and 0.09 controlling for CCT, respectively). Both IOPcc and IOPg were significantly lower in keratoconic eyes in comparison with normal eyes. After correction for the confounding effect of CCT, a lower IOPcc in keratoconus versus warpage remained significant (P = 0.02).

Conclusion:

Both IOPcc and IOPg were statistically different with the highest value in the warpage group followed by normal and keratoconus groups, just like their CCT. After correction for the confounding effect of CCT, there was no statistically significant difference between the three groups in their measured IOPcc and IOPg except for IOPcc in keratoconus versus warpage (P = 0.02).