bluuebunny/crossref_metadata_2025 huggingface dataset:
Design and Analysis of Blast Resistant RC Beams for Concrete Structures at Off-Site Oil and Gas Plants
Authors: Al-Jasmi Salah , Ariffin Nur Farhayu , Seman Mazlan Abu
Published: March 2023

The impact resistance of Reinforced Concrete (RC) beams, as the major structural load-bearing member, is an integral consideration in the design of concrete structures at the off-site of oil and gas pants against powerful dynamic loads. As a result, impact-resistant design is crucial for the maintenance, preservation, and safety of such structures. The RC beams' impact performance, on the other hand, remain unclear, and approaches for reinforcing RC structures at oil and gas plants to withstand impact loads are currently limited. This paper presents the Finite Element Analysis (FEA) used to simulate the behavior of Reinforced Concrete (RC) beams strengthened with Carbon Fiber Reinforced Polymer (CFRP) laminates. Five beams were modelled in FEA software. In those five beams, one beam was used as control beam without CFRP reinforcement, two beams were reinforced with single CFRP sheet, and the other two were reinforced with two CFRP sheets. Total deformation, von Misses stress, shear stress and principal strain were obtained and compared with the experimental results. The numerical simulation results agree well with the test findings reported in Neagoe's experimental study. The simulation results demonstrated that CFRP could indeed relieve high stress in impact unstable concrete, decrease beam body deformation, constrain crack development, and offer additional impact resistance. Under various impact load scenarios, CFRP can successfully restrain deformation. As a result, strengthening RC beams with CFRP is an efficient way to improve impact load resistance. Using computer software to design and simulate these elements was also much quicker and less costly. As a result, ANSYS can be used to model experimental beams. Finite element ANSYS software can also be used to validate experimental results.
Operating procedures - flame tests on rigid ducts used for mine ventilation
Authors: Sarin N K
Published: March 2023

Flammability tests are carried out on a variety of flexible and rigid duct materials used for mine ventilation in order to evaluate their fire-resistance and their suitability in a mining environment. Several tests are available for this purpose, however, CEAL
has been using CSA standard C22.2 No. 30 for at least 10 years as part of its program for certification of various mining products. An interim large scale gallery test has been introduced since July, 1985 in order to determine if better repeatability of test results can be obtained. The aim is to
eliminate threats to health and safety resulting from the use of such products in the mines. Special attention has been given to the safety precautions and sequence of operations necessary while conducting tests. A standard test recording sheet and test layout diagrams are also
presented.
Installation and use of a quantimet 720 image analyzer for particle characterization
Authors: Judge K J
Published: March 2023

The size and shape of particles, in a dust, can affect the explosion hazards posed by the dust. Dust explosion work at the Canadian Explosive Atmospheres Laboratory (CEAL) now involves the use of an image analyzer. The analyzer is being used to characterize the
shape and size of grains involved in explosion tests at this laboratory. It is hoped that this information will indicate the relationships between these parameters and that a more comprehensive prediction of dust explosion phenomena will result. The system configuration, operating procedures and
supporting hardware and software are detailed in this report.
Utility and futility of central venous catheterization
Authors: Phulli Roopali , Arora Prateek , Neema Praveen Kumar
Published: March 2023

Central venous access is useful for monitoring central venous pressure, inserting pulmonary artery catheter and administering vasoactive drugs in hemodynamically unstable patients. Central venous catheter (CVC) insertion through internal jugular vein may cause major vessel injury, inadvertent arterial catheterization, brachial plexus injury, phrenic nerve injury, pneumothorax, and haemothorax. We describe unusual presentation of hemothorax following CVC placement in a patient undergoing vestibular schwannoma excision. The patients’ trachea intubated after several attempts during which thiopentone up to 600 mg administered. Thereafter, under ultrasound guidance, an 18G introducer needle placed in the right internal jugular vein but guide-wire did not advance. Meanwhile, the patient became hemodynamically unstable and a CVC placed in right subclavian vein and norepinephrine infused at 0.05 μg/kg/min; simultaneously, 1000 ml normal saline administered through CVC. The hemodynamic instability attributed to thiopentone administered during endotracheal intubation. The surgical procedure cancelled, and the patient shifted to critical care unit (CCU). Mechanical ventilation continued. In CCU, hemodynamic parameters further deteriorated and 0.1 μg/kg/min epinephrine started. Bedside lung ultrasound showed a large collection in pleural space on the right side. Chest radiograph showed a homogenous opacity obliterating costophrenic angle on the right side. A possibility of hemothorax considered, chest tube inserted and 1000 ml sanguineous fluid drained. Blood sample drawn through CVC showed air from proximal and middle lumen but distal lumen drained blood. Another CVC placed in the femoral vein and subclavian vein CVC removed. The vasoactive drug infusion transferred to CVC in femoral vein and 2 units pRBCs transfused. Hemodynamic parameters gradually stabilized and the patient recovered completely.
Comparative evaluation of stroke volume variation and inferior vena cava distensibility index for prediction of fluid responsiveness in mechanically ventilated patients
Authors: Kaur Kaminder Bir , Nakra Monish , Mangal Vishal , Singh Shalendra , Taank Priya , Marwah Vikas
Published: March 2023

Objectives:

To evaluate the correlation between stroke volume variation (SVV) and inferior vena cava distensibility index (dIVC) as a marker for fluid responsiveness in mechanically ventilated hypotensive intensive care unit (ICU) patients.

Methodology and Design:

This study is designed as prospective observational study conducted in patients admitted to an ICU who were mechanically ventilated and experienced a hypotensive episode.

Intervention:

A fluid challenge of 10 mL/kg ringer’s lactate was given over 20 min.

Measurements:

Hemodynamic parameters as well as SVV, IVCmax, IVCmin, dIVC, and cardiac output (CO), were recorded at a different time interval. An increase in ≥15% of CO was taken as fluid responsiveness.

Results:

Out of 67 patients, 67.2% responded to fluid challenge. Pearson’s correlation graph at baseline showed a strong positive correlation between dIVC and SVV with r = 0.453, (P < 0.002). Non-responders also had a strong positive correlation (r = 0.474) at the baseline. Bland Altman’s analysis of the correlation between dIVC and SVV post-fluid challenge showed a mean difference of – 4.444, with 1.49% of the values falling outside the limits of agreement (18.418 and -27.306). This difference was clinically significant. Pearson’s correlation graph post-fluid challenge showed a moderately strong positive correlation between dIVC and SVV with r = 0.298 and P value = 0.047, which was statistically significant. Also, non-responders had a weak correlation as compared to the responder’s group, r = 0.364 and P value = 0.095, which was not clinically significant. There was no significant difference in the trend of dIVC and SVV values between the non-surgical and surgical groups, nor was there any gender difference analyzed in the study.

Conclusion:

This study ascertains the positive correlation between dIVC and SVV and justifies its use in a clinical setting of hypotension suspected to be due to hypovolemia.
Left Ventricle Pseudoaneurysm-Recurrence following Surgical Repair
Authors: Garg Vinit , Arora Dheeraj , Mishra Manisha
Published: March 2023

Left ventricular (LV) pseudoaneurysm is a rare complication following free wall rupture post transmural myocardial infarction or left ventricular surgery. A lot of imaging modalities like echocardiography, computerised tomography and cardiac magnetic resonance imaging are available to diagnose it. Echocardiography plays a significant role in delineating the cavity, orifice and impact on the surrounding structures. We present a case of LV pseudoaneurysm recurrence following surgical repair.
Noninvasive continuous arterial pressure monitoring during anesthesia induction in patients undergoing cardiac surgery
Authors: Frank Paul , Logemann Frank , Gras Clemens , Palmaers Thomas
Published: March 2023

Objective:

In this study we compared noninvasive arterial pressure measurement using ClearSight™ vascular-unloading-technique (Edwards Lifesciences Corp, Irvine, CA) with invasive arterial pressure measurement during induction of anesthesia undergoing mayor cardiac surgery.

Design:

Prospective, monocentric.

Setting:

University hospital.

Participants:

54 patients undergoing mayor cardiac surgery.

Interventions:

During induction all patients were simultaneously monitored with invasive (reference method) and noninvasive arterial pressure measurement (test-method) over a mean time period of 27 minutes.

Measurements and Main Results:

We observed slightly lower systolic and mean arterial pressures noninvasive than invasive. For systolic arterial pressure the mean of the differences was -18,05 mmHg (p < 0,05, SD ±16,78 mmHg), the mean arterial pressure MAP -5,47 mmHg (p < 0,05, SD ±11,08 mmHg) and for diastolic pressure -1,09 mmHg (p < 0,05, SD±11,15 mmHg),. The mean of the differences in heartrate was 1,15 (p < 0,05, SD±6,9 mmHg). When considering all measured values of the invasively measured MAP and the ClearSight ™ -MAP at the same timestamp over the recording interval, an almost identical progress can be seen that indicates a sufficient mapping of the hemodynamic changes. The percentage error for mean arterial, systolic and diastolic pressure measured by ClearSight™ amounts to 25,95 %, 26,77 % and 34,16 %, respectively.

Conclusions:

We conclude that ClearSight ™ is a good option for hemodynamic monitoring during induction of anesthesia. Taking into account the limitations, non-invasive arterial blood pressure measurement offers sufficient security to safely initiate anesthesia, especially when MAP is of particular interest. The use of non-invasive arterial blood pressure measurement with ClearSight ™ during induction of anesthesia in patients scheduled for major cardiac surgery is reliable and easy to use.
A right para-tracheal mass extending into the anterior mediastinum
Authors: Landa Andres Bacigalupo , Krishnamurthy Kritika , Goldman Howard S.
Published: March 2023

The anesthetic management of patients with a mediastinal mass represent a challenge due to the potential for difficult ventilation and intubation, as well as the risk of cardiovascular collapse upon induction of general anesthesia. Different strategies and alternatives have been described. We present the case of a 70-year-old man with a right para-tracheal mass extending into the anterior mediastinum with 90% mid-tracheal lumen obstruction who was successfully managed with venous-venous extra-corporeal membrane oxygenation (ECMO) during mass debulking and tracheal stent placement.
When Echocardiography Fails, Intravascular Ultrasound as an Alternative for Adequate Graft Patency in Hybrid Elephant Trunk Surgery
Authors: Thida Fnu , Carvajal Tomas , Unai Shinya , Bustamante Sergio E
Published: March 2023

Aortic pathology is a common cardiovascular disease in the US. Transesophageal Echocardiogram is an invaluable imaging modality in the management of aortic pathology in perioperative setting. Intravascular ultrasound can assess coronary obstruction during coronary interventions and can be used in endovascular aneurysm repair. A 54-year-old male underwent Hybrid Elephant Trunk Surgery, for complex open aorta repair. There was functional confirmation graft patency via the femoral arterial line tracing, there was surgical confirmation via visual and physical inspection of graft, but there was lacking anatomical confirmation. Epiaortic ultrasound reassured the graft patency at level of the arch. However, transesophageal echocardiogram was not reassuring for adequate anatomical confirmation of patency. Intravascular ultrasound was used for anatomical confirmation of graft patency and position. This technology provides real time graft patency and is a great tool in open aorta reconstruction surgery.
Preoperative screening for obstructive sleep apnea in cardiovascular patients – How useful is STOP-BANG questionnaire in the Indian context?
Authors: Sreedharan Sapna Erat , Mitta Nandini , KP Unnikrishnan , Paul Rejith , Pillai Vivek
Published: March 2023

Background:

Obstructive sleep apnea (OSA) is reported in a high proportion of cardiac surgical patients, up to 73%. STOP-BANG is a validated questionnaire for screening of outpatients for OSA with high sensitivity. There is sparse literature from India regarding the prevalence of OSA in preoperative cardiovascular patients and the utility of screening tools.

Aims:

We sought to study the utility of the STOP-BANG questionnaire as a screening tool for OSA in cardiovascular patients validating it with ambulatory level 3 polysomnography.

Materials and Methods:

It was a prospective study where consecutive patients getting admitted for coronary artery bypass surgery (CABG) from August 2017–February 2019 were recruited. All the patients were screened with the STOP-BANG questionnaire. 53 patients underwent overnight level 3 polysomnography using Apnea-Link. Correlations were made between clinical symptoms, STOP-BANG score, and OSA severity, measured using Apnea hypopnea index (AHI).

Results:

We had 120 patients(103 males) with a mean age 60 years. Snoring was the most common sleep complaint. Our cohort had a high prevalence of vascular risk factors (DM 72.3%, hypertension 59.2%, dyslipidemia 60%) and 11.7% were obese (BMI >30). The median STOP-BANG score was 3 (IQR 2) with 83 having scores ≥3. Median AHI was 5.6 with AHI ≥5 in 28 patients and AHI 15 or above in 14 patients. Among the clinical parameters, arousals with respiratory difficulty at night, higher neck circumference, and tonsillar hypertrophy showed a significant association with PSG-proven OSA.STOP-BANG scores 3 or above had a sensitivity of 75% in predicting OSA.

Conclusions:

Our study shows that in cardiovascular patients less symptomatic for sleep complaints, the STOP-BANG questionnaire is a useful screening tool for OSA in outpatient settings. Among clinical parameters, airway narrowing and neck circumference can predict OSA.
Massive Intrathoracic Solitary Fibrous Tumor of the Right Hemithorax
Authors: Boswell Michael R. , Smith Bradford B. , Wigle Dennis , Rowse Phillip G. , Smith Mark M.
Published: March 2023

Solitary fibrous tumors of the pleura (SFTP) are rare mesenchymal tumors that arise from visceral or parietal tissue. Surgical resection of massive SFTP can be complicated by airway collapse, vascular compression/hemodynamic instability, and hemorrhage. Patients with SFTP may also present with metabolic derangements secondary to paraneoplastic processes. We present a case of successful removal of massive right-sided SFTP via clamshell sternotomy and discuss the perioperative considerations for which providers should be familiar.
Percutaneous paravalvular leak closure with their outcomes
Authors: Garg Ankit , Azad Sushil , Radhakrishnan Sitaraman
Published: March 2023

Background:

Transcatheter paravalvular leak (PVL) closure in recent times has emerged as a safe and effective alternate to redo-surgical repair. We sought to examine the clinical efficacy and safety of percutaneous PVL closure at our center.

Methods and Results:

A retrospective study from August 2012 to December 2019 of 19 patients who underwent 21 procedures for PVL closure. The mean age was 49.25 ± 14.72 years. The target valve was mitral in 11 (57%) and aortic in 7 (36%) cases. One (5%) patient had prosthetic valve in left atrioventricular valve with congenitally corrected transposition of great arteries. Majority of the cohort presented with heart failure without hemolysis (89%), with most of them being in NYHA functional class III (57%) or class IV (21%). A procedural success of 85% was achieved. Post procedure severity of regurgitation reduced from severe in thirteen patients and moderate in six patients to moderate in two patients and mild in fourteen patients. Symptomatic improvement was observed in all cases who had successful closure with NYHA function class improving from 3 ± 0.64 to 1.6 ± 0.94. The mean follow-up duration was 21 ± 13 months (median 24 months). There was one (4.7%) mortality with cumulative survival from all-cause mortality of 95%.

Conclusion:

The results of percutaneous PVL closure appear encouraging in our series with modest number of patients and offers a promising alternative to redo-surgery in this high-risk cohort.
Stellate ganglion block as rescue therapy in drug-resistant electrical storm
Authors: Sahoo Rajendra K , Kar Rajesh , Dev Indranil , Kumar Mukesh , Parida Ashok Kumar , Ganguly Arunangshu
Published: March 2023

Electrical storm or incessant ventricular tachycardia is a life-threatening condition and is associated with high morbidity and mortality. Often patients respond to traditional anti-arrhythmia treatment. However, some patients are resistant to the drug therapy and thus, pose huge challenges in effective management. Though stellate ganglion block has been found to be effective in treating patients with electrical storm, it is still under-utilized. In this case report, we successfully managed to revert the drug-resistant arrhythmia to sinus rhythm after ultrasound-guided stellate ganglion block. Earlier utilization of the block can possibly provide effective treatment in drug-resistant ventricular arrhythmias and prevent morbidity and mortality.
A prospective study on use of thrive (transnasal humidified rapid insufflation ventilatory exchange) versus conventional nasal oxygenation following extubation of adult cardiac surgical patients
Authors: Burra Vijitha , Putta Gnapika , Prasad S.R. , Manjunatha N.
Published: March 2023

Background:

Postoperative pulmonary complications in cardiac surgery increase mortality and morbidity. High flow nasal cannula oxygen therapy (HFNC) is one of the preventive measures to reduce the incidence of lung complications. HFNC can decrease dyspnea and improve physiologic parameters after extubation, including respiratory rate and heart rate, compared with conventional oxygen therapy. In this study, we evaluated the role of THRIVE (Transnasal Humidified Rapid Insufflation Ventilatory Exchange) after extubation.

Methodology:

We prospectively randomized 60 adults aged between 18 and 65 years undergoing elective cardiac surgery to either High flow oxygen therapy using THRIVE (Group A) or conventional nasal cannula (group B). Arterial paO2, paCO2, pH at three points of time i.e., 1, 2, 4 hrs after extubation were evaluated using arterial blood gas analysis. Ventilation duration, the incidence of reintubation, sedation score, mortality, and other complications were also assessed.

Results:

Thirty adults in each group had comparable patient characteristics. There was a statistically significant decline in paCO2 in group A at 1, 2, 4 hrs post extubation (P = 0.022, 0.02, <0.001) with a significant increase in oxygenation (P < 0.001) when compared to group B.ICU stay duration was similar between two groups. No complications were noted in both groups.

Conclusion:

THRIVE is safe to use following extubation in adult cardiac surgical patients.
Intraoperative Cardiac Arrest due to Allergic Acute Coronary Syndrome (Kounis syndrome) Triggered by Cephalosporin
Authors: Kumaran Thiruthani , Damodaran Srinath , Singh Akshaya Pratap , Kanchi Muralidhar
Published: March 2023

An acute coronary syndrome due to mast-cell activation in the presence of an allergen is known as Kounis Syndrome (KS). This relatively new entity of KS is being increasingly recognized among allergists, cardiologists, and emergency physicians; however, it is not well-known among anesthesiologists. We report here, a case of type 2 KS due to antibiotic administration causing sudden perioperative cardiac arrest.
Postoperative Atrial Fibrillation in Coronary Artery Bypass Grafting Herald Poor Outcome
Authors: Malhotra Pulkit , Pande Shantanu , Mahindru Supaksh , Thukral Ankit , Kotwal Ankush Singh , Gupta Rajan Prasad , Tewari Prabhat , Agarwal Surendra Kumar
Published: March 2023

Introduction:

Atrial fibrillation in postoperative period is common. Although the event of atrial fibrillation is associated with reduced cardiac output and its consequences and cerebrovascular events, its effect on outcome is not clearly documented. This study is done to evaluate the effect of atrial fibrillation on outcome of the operation.

Materials and Methods:

This is a retrospective case-control study. A total of 263 patients received coronary artery bypass grafting during this period. The data for demographics, comorbidities, preoperative medications, operative details, and echocardiographic parameters of left ventricular functions were acquired. A total of 24 patients had atrial fibrillation (Group I), while 239 remained in normal sinus rhythm (Group II). The outcome is measured as combined of death and postoperative myocardial infarction (MI).

Results:

The groups are comparable in demographic, preoperative medications, operative, and left ventricular parameters. Of the 24 (9.12%) patients who had postoperative atrial fibrillation, 11 were discharged on medical management. Nine patients reverted to sinus rhythm at discharge. Atrial fibrillation persisted in 8 patients 1 week after discharge and 3 patients after 1 month. The requirement of intraaortic balloon pump (IABP) was statistically significant in group I (5 in group I vs. 10 in group II, n = 0.001). There were 4 deaths in group 1 and 7 in group 2 (P = 0.002), however, the combined end point was achieved in 4 (16.6%) vs. 22 (9.2%), respectively, P = 0.1.

Conclusion:

The appearance of atrial fibrillation heralds increased requirement of IABP, MI, and death in patients undergoing coronary artery bypass grafting.
New Combined Risk Score to Predict Atrial Fibrillation after Cardiac Surgery
Authors: Burgos Lucrecia M , Ramírez Andreína Gil , Seoane Leonardo , Furmento Juan F , Costabel Juan P , Diez Mirta , Navia Daniel
Published: March 2023

Background and Aims:

Atrial fibrillation frequently occurs in the postoperative period of cardiac surgery, associated with an increase in morbidity and mortality. The scores POAF, CHA2DS2-VASc and HATCH demonstrated a validated ability to predict atrial fibrillation after cardiac surgery (AFCS). The objective is to develop and validate a risk score to predict AFCS from the combination of the variables with highest predictive value of POAF, CHA2DS2-VASc and HATCH models.

Methods:

We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data. The study included consecutive patients undergoing cardiac surgery in 2010-2016. The primary outcome was the development of new-onset AFCS. The variables of the POAF, CHA2DS2-VASc and HATCH scores were evaluated in a multivariate regression model to determine the predictive impact. Those variables that were independently associated with AFCS were included in the final model.

Results:

A total of 3113 patients underwent cardiac surgery, of which 21% presented AFCS. The variables included in the new score COM-AF were: age (≥75: 2 points, 65-74: 1 point), heart failure (2 points), female sex (1 point), hypertension (1 point), diabetes (1 point), previous stroke (2 points). For the prediction of AFCS, COM-AF presented an AUC of 0.78 (95% CI 0.76-0.80), the rest of the scores presented lower discrimination ability (P < 0.001): CHA2DS2-VASc AUC 0.76 (95% CI 0.74-0.78), POAF 0.71 (95% CI 0.69-0.73) and HATCH 0.70 (95% CI: 0, 67-0.72). Multivariable analysis demonstrated that COM-AF score was an independent predictor of AFCS: OR 1,91 (IC 95% 1,63-2,23).

Conclusion:

From the combination of variables with higher predictive value included in the POAF, CHA2DS2-VASc, and HATCH scores, a new risk model system called COM-AF was created to predict AFCS, presenting a greater predictive ability than the original ones. Being necessary future prospective validations.
Recurrent Cardiac Myxoma
Authors: Mahavar Ravi K , Arora Dheeraj , Singh Ajmer , Mishra Manisha
Published: March 2023

Cardiac myxomas are the most common benign tumors of the heart. They are most commonly found in the left atrium, followed by a right atrium and rarely in the left ventricle. Herein, we report a rare case of left ventricular myxoma in a patient who had twice undergone removal of left atrial myxoma. Complete removal of the tumor through aortotomy, without causing fragmentation led to the uneventful recovery of the patient.
Inhaled Nitric Oxide before Induction of Anesthesia in Patients with Pulmonary Hypertension
Authors: Eljezi Vedat , Rochette Laetitia , Dualé Christian , Pereira Bruno , Boby Henri , Constantin Jean Michel
Published: March 2023

Background:

The aim of this study was to examine the action of inhaled nitric oxide in the patients with pulmonary hypertension administered with a face mask before anesthesia induction.

Methods:

Ten adult patients scheduled for heart surgery with sternotomy were included in this prospective, interventional, single centre study. The inclusion criteria were patients scheduled for heart surgery with sternotomy with cardiopulmonary bypass (CPB), aged >18 years which presents a pulmonary hypertension (PH) (class 2 or 3 according to the Dana Point classification) with systolic pulmonary arterial pressure (PAPS) >40 mmHg diagnosed by preoperative right cardiac catheterization or by transthoracic echocardiography. The exclusion criteria were: heart transplant, PH of type 1, 4, 5, according to the Dana Point classification, methemoglobin reductase deficit, incapacity to understand the protocol and sign the consent.

Results:

The administration of iNO decrease pulmonary hypertension (P < 0,001 compared to room air; P = 0,01 compared to pure oxygen administration). The iNO administration did not improve arterial blood oxygenation. The hyperoxia, decrease the cardiac index even with right ventricular post charge decrease. The increased blood oxygenation content cause systemic vascular vasoconstriction and decrease the peripheral oxygen extraction showed with VO2 linear increase (P < 0,001).

Conclusions:

The administration of inhaled nitric oxide with a face mask before anaesthesia induction is safe and effective method to reduce pulmonary hypertension. The oxygen and hyperoxia influences the systemic vascular resistance and peripheral oxygen consumption.
Unusual delay in Kidney Transplant due to COVID-19 Pandemic Just Before Transplant Surgery
Authors: Krishna Amresh , Singh Prit Pal , Kumar Chandan , Kumar Om
Published: March 2023

The extended lockdown and COVID-19-related restrictions severely affected the care of patients with noncommunicable diseases as well as communicable diseases. Kidney transplant services were suspended throughout the country as a part of the suspension of all nonessential surgeries. Many tertiary care centers, like ours, were designated as dedicated COVID-19 hospitals and were catering patients only with COVID-19. Here, we are to discuss a case of a 29-year-old male who underwent live-related ABO-compatible kidney transplant at our center and the problems he encountered due to this pandemic situation. Due to COVID-19 pandemic, he had to wait for more than one year after obtaining a no-objection certificate for kidney transplant from the competent authority. In our case, both donor and recipient were COVID-19 positive 45 days before kidney transplant operation. The patient and the donor both had an uneventful posttransplant course.
Subcapsular Hematoma in Postrenal Transplant Patients: A Report of Three Cases
Authors: Mandwar Milind , Thakur Vivek , Kenwar Deepesh Benjamin , Patil Shivakumar S.
Published: March 2023

Subcapsular hematomas are not uncommon after renal transplantation but they rarely cause parenchymal compression or graft dysfunction. They occur following trauma during kidney retrieval or benching, and appear soon after reperfusing the graft kidney. Significant subcapsular hematoma may present with flank pain and tenderness, hypertension, increased drain output and decreased urine output. Duplex ultrasonography and computed tomography help in diagnosis. Early recognition and surgical intervention are important to restore graft function. We report successful outcome after hematoma evacuation in three patients with post-transplant subcapsular hematomas that caused renal allograft dysfunction.
Curbing Proteastasis to Combat Antibody-Mediated Rejection Post Lung Transplant
Authors: Sharma Dhruva , Sharma Neha , Subramaniam Krishnan Ganapathy
Published: March 2023

Lung transplantation (LTx) has emerged as the treatment of choice for patients suffering from end-stage lung disease all over the past 35 years. Despite ameliorated early survival with a median survival of 6.5 years, its long-term outcomes are dissatisfactory. Although antibody-mediated rejection (AMR) remained “the Achilles heel of LTx,” yet we have not attained consensus on the optimal therapeutic approach. The aim of this review article is to address the upcoming role of proteasome inhibitor drugs in managing AMR post-LTx.
Treating Parvovirus Triggered Refractory Hemolytic Anemia with Rituximab in Renal Transplant Recipients – A Report of Two Cases
Authors: Rajesh Chilaka , Mishra Utkarsh , Valsan Anna , John Elenjickal Elias , Eapen Jeethu Joseph , Thomas Athul , Yusuf Sabina , Alexander Suceena , David Vinoi George , Varughese Santosh
Published: March 2023

Parvovirus B19 is a small (26 nm), nonenveloped, single-stranded DNA (5.6-kb) virus. The only known host for parvovirus B19 is humans. Parvovirus B19 is directly cytotoxic to erythroid precursor cells of the colony- and burst-forming units. Human parvovirus B19 is the etiologic agent of erythema infectiosum and chronic pure red cell aplasia in immunocompromised individuals. Acute parvovirus B19 infection should be suspected in immunocompromised patients, who present with reticulocytopenic hemolytic anemia and thrombocytopenia. Intravenous immunoglobulin (IVIg) is the standard treatment for parvovirus-induced cytopenias. We report two cases of postrenal transplant who presented with reticulocytopenic anemia and were found to have parvovirus infection. They did not respond to conventional treatment with intravenous gamma globulin. Both patients were treated with rituximab with which they had improvement in clinical and hematological parameters. There was no previous documentation of using rituximab in the treatment of parvovirus-triggered autoimmune hemolytic anemia postrenal transplant patients. This article illustrates how rituximab will be helpful in this setting, of course, it is a new thought but requires further studies and validation.
Utility of Protocol Biopsy in the Management of Renal Allograft Recipients
Authors: Kumar K. Vinod , Sathyan Jeena J. , Prasannan Minnu , Urs Vishnu Dev , Prasannan Bipi , Unni V. Narayanan
Published: March 2023

Background:

Many studies suggest that early rejection episodes and chronic changes in the allograft kidneys were often subclinical without a concomitant rise in the serum creatinine or proteinuria. Early identification of subclinical pathology by doing protocol biopsy and appropriate intervention is likely to improve long-term graft outcomes. However, it is often not done, out of concern about the procedure-related complications.

Methods:

All patients who underwent live donor kidney transplantation at Aster Medcity from September 2019 to August 2021 with stable graft function were included in the study. Stable graft function is defined as variation in the creatinine values of <25% from the nadir creatinine. Protocol biopsies were taken at 3 months after transplant surgery. Biopsies were done using spring-loaded biopsy guns percutaneously under ultrasound guidance, and patients were observed for 24 h in the hospital for any complication. Biopsies were analyzed by light microscopy and C4d staining and scored based on the Banff classification 2017 update.

Results:

Seventy patients underwent protocol kidney biopsy at a prespecified time of 3 months. Majority of our patients (74.3%) received a kidney from the first-degree blood relatives, and the rest (25.7%) of the patients received kidneys from spouses. Induction therapy was given in 57% of the patients, and the rest (43%) were transplanted without an induction agent. Of 70 specimens studied, 44 (62.9%) had normal histology and 26 (37.1%) had varying degrees of histological abnormalities. Thirteen (18.6%) had evidence of subclinical rejection, of which 12 (17.2%) showed borderline rejection and 1 (1.4%) had acute T-cell-mediated rejection (acute TCMR). Other histological findings include chronic active TCMR in 1 (1.4%), varying degrees of interstitial fibrosis and tubular atrophy in 5 (7.1%), evidence of BK virus nephropathy in 2 (2.8%), features of tacrolimus toxicity in 2 (2.8%), and acute interstitial nephritis in one patient. None of the patients developed any complication after the procedure. With appropriate treatment interventions, all patients had stable graft functions at 6-month follow-up.

Conclusions:

Protocol graft biopsy under real-time ultrasound guidance has a very good safety profile and can help the clinician optimize the immunosuppression with more precision, and on a long term, it might prove cost effective to the patient.
Comparative Evaluation of Titer Estimation of ABO Isoagglutinins using Three Different Methods
Authors: Ranjan Shweta , Pandey Prashant , Setya Divya , Kumari Supriya
Published: March 2023

Background and Aims:

While automation has the advantage of objectivity, ease of use, and reproducibility with well-defined end points of agglutination reaction, standardization of these methods has still not been possible. The aim of the present study was to compare results obtained by manual conventional test tube technique (CTT) with semi-automated, column agglutination technique (CAT), and fully automated hemagglutination/solid-phase red cell adherence (HA/SPRCA) by calculating and comparing correlation and median immunoglobulin M (IgM) and immunoglobulin G (IgG) titer.

Materials and Methods:

This was a prospective, observational study conducted from October 2019 to March 2020. All consecutive A, B, and O group donors who consented to participate were included in the study. All samples were consecutively tested by CTT, CAT, and HA/SPRCA.

Results:

A total of 300 (100 each from A, B, and O blood groups) donors were included. IgG titers were higher than IgM titers in most group O individuals. This difference was more evident with the use of CAT. The correlation between CTT and CAT was found to be strong, whereas the correlation between CTT and HA/SPRCA was found to be variable for anti-A and anti-B IgG and IgM titers. When measured by CTT and CAT, median anti-A and anti-B titer results for group O individuals were similar. Anti-A and anti-B median titer results obtained by CTT and CAT for group A and B individuals were also similar.

Conclusion:

Semi-automated method (CAT) shows higher ability in detecting ABO isoagglutinins than the manual method (CTT) and automated method (HA/SPRCA). These methods cannot be used interchangeably.
Renal Transplant Outcomes in Allografts with Multiple versus Single Renal Arteries
Authors: Rathi Deepak Kumar , Bansal Somendra , Zafar Feroz Amir , Ghosh Prasun , Khera Rakesh , Ahlawat Rajesh
Published: March 2023

Context:

Anatomical variations of the grafts are one of the challenging problems in renal transplantation. Among these anatomical variations, multiple renal arteries (MRAs) are considered the most common.

Aims:

The aim of the study was to find out the outcome of recipient’s receiving multiple artery renal allografts.

Settings and Method:

This was a single-institutional, prospective, observational study of 212 patients who underwent open live renal allografting after exclusion criteria. All patients were followed up for a minimum of 12 months, and serum creatinine was done at 1 month, 3 months, 6 months, and at 12 months of follow-up.

Statistical Analysis Used:

Quantitative data have been presented in terms of means and standard deviation. Categorical data have been presented in terms of proportions and percentages. Student’s t-test has been used for the comparison of individual quantitative parameters. Value of P < 0.05 was considered statistically significant.

Results:

Serum creatinine on the postoperative day-1 was found to be higher in the MRAs group compared to single renal artery (SRA) group (2.25 mg/dl vs. 2.02 mg/dl, P = 0.178). During follow-up of the recipients, there was no statistically significant difference in serum creatinine between the two groups when measured at 1, 3, and 6 months and at 1 year.

Conclusions:

Outcomes in recipients receiving multiple artery renal allografts were similar compared to the cohort of allografts with SRA. Hence, transplantation of renal allograft with MRAs is safe, and the recipient in need should not be denied of a graft with multiple vessels.
Rare diagnosis of an Epstein-Barr virus-positive extracavitary/solid variant of primary effusion lymphoma by duodenal endoscopic biopsy in a human immunodeficiency virus-seronegative and immunocompetent patient: A case report
Authors: Guler Beril , Cetin Guven
Published: March 2023

Primary effusion lymphoma and its tissue-based subtype extracavitary/solid variant was first described in human immunodeficiency virus (HIV)-seropositive patients. We report the case of a 50-year-old HIV-seronegative male patient who presented with icterus and cholestasis. Computed tomography revealed a 80 × 56 mm abdominal mass. Fine-needle aspiration biopsy was performed from the celiac lymph nodes and pancreatic head, under endoscopic ultrasonography guidance. A duodenal endoscopic biopsy was taken from the infiltration area, and a core biopsy was performed for the portal hilar mass. All biopsies showed similar cytohistopathological features. LCA-positive lymphoid neoplasia had a plasmacytoid/anaplastic morphology and null cell phenotype. HHV-8 and Epstein-Barr virus-encoded small RNAs (EBER) were diffuse positive. The patient, who did not have an effusion, was diagnosed with an extracavitary/solid variant of primary effusion lymphoma. Virus-associated lymphoproliferative disorders should be considered in the differential diagnosis of patients without a history of immunosuppression or HIV infection.
Comparative Evaluation of Remineralization Potential of Shelcal, Calcium Sandoz and Shelcal with Vitamin C on Artificially Induced Carious Lesions in Permanent Teeth: An in vitro Study
Authors: Shrienitha DN , Prasad V , Iyer K , Jagadeson M , Priyadharshini KI , Gomathi MS
Published: March 2023

Background:

The invitro study was done to find out the efficacy of shelcal, shelcal with Vitamin C and calcium sandoz in remineralizing enamel surfaces on which artificial carious lesions had been created. The changes were analyzed using Vickers Hardness Testing Machine.

Materials and Methods:

A total of 45 permanent teeth were selected and divided into three groups: Group I – Shelcal, Group II – Shelcal with Vitamin C, and Group III – Calcium sandoz tablets. All samples were subjected to deminralization and assessed using Vickers Hardness Testing Machine. Each demineralized sample was randomly divided into three groups: Group I – Shelcal, Group II – Shelcal with Vitamin C, and Group III – Calcium sandoz tablets. After the 10 days of remineralization, the obtained data were analyzed statistically. The significance of mean difference between the groups was done by post
hoc Bonferroni test and repeated measures ANOVA. All analyses were performed on SPSS software (Windows version 20.0).

Results:

Statistical analysis showed that shelcal remineralizes artificially induced carious lesions in permanent teeth.

Conclusion:

Shelcal (Group I) exhibited superior remineralization potential.
Knowledge, Attitude, and Practice of Oral Hygiene Aids and its Role in the Prevention of COVID-19 Transmission: A Hospital-Based Questionnaire Study
Authors: Penmetsa GS , Vundavalli S , Boddeda A , Sruthima NV , Veluri SV , Praveen G
Published: March 2023

Introduction:

The novel coronavirus disease has brought to the forefront the importance of oral hygiene aids and its role in the prevention of COVID-19 transmission.

Objectives:

The objective is to assess knowledge, attitude, and practice of oral hygiene aids and its role in COVID-19 transmission.

Materials and Methods:

This was a cross-sectional study conducted on 385 patients visiting Vishnu dental college. The questionnaire included demographic data, history of COVID, and vaccination status. The second part included questions regarding knowledge, attitude, and practice of oral hygiene aids and its role in COVID-19 transmission.

Results:

Mean age of the population was 40.11 years, and had almost equal proportions of males and females. About 22.6% of the population had suffered from COVID-19 and 92.7% of men got fully vaccinated. Knowledge of COVID-19 transmission through oral hygiene aids was found in 57.4% of the population. No difference in knowledge of occupational health advisor (OHA) and its role in COVID transmission was found between gender, COVID, and vaccination status (P > 0.05). About 22.9% of graduates had higher knowledge than others (P = 0.00).

Conclusions:

The use of appropriate oral hygiene aids and practices could prevent the transmission of COVID-19.
Attitude towards Learning Communication Skill among Dental Interns in Davanagere City: A Cross-sectional Survey
Authors: Yavagal PC , Raj R , Kateel P , Mrunal SP , Diwakar NR , Lokapur RM
Published: March 2023

Background:

Current education systems including dental education are focusing on communication, leadership, and team-building skills; hence, it is imperative to understand the students’ perspectives and willingness to learn communication skills during their professional course.

Aim:

The aim of the study was to assess the attitude towards learning communication skill among dental interns in Davanagere city.

Methods:

A cross-sectional questionnaire survey in a dental college setting was conducted among 125 dental interns of Davanagere city. Data were collected pertaining to age, gender, academic performance in the final-year BDS, self-perceived level of communicating skill, and attitude towards learning communication skill using a pretested study pro forma and Dental Communication Skills, Attitude Scale questionnaire.

Statistical Analysis:

Descriptive statistics were generated in terms of percentages and mean attitude scores. Student’s unpaired t-test, one-way ANOVA test, and Pearson’s correlation test were used for the analysis of data. The significant level was set at P < 0.05.

Results:

The mean positive attitude score of the interns was 51.71 ± 5.10, and the mean negative attitude score was 28.15 ± 4.67. There was no significant difference (P > 0.05) in the mean attitude scores between males and females. Dental interns’ attitude towards learning communication skill was not related to their self-reported communication skill and academic performance (P > 0.05).

Conclusion:

Dental interns had a high positive attitude towards learning communication skill which were not related with their self-reported communication skill and academic performance.
Impact of the COVID-19 pandemic lockdown on physical activity, physiological function, and psychological well-being among community-dwelling older people
Authors: Ganvir Shyam Devidas , Nikhade Nitin S. , Sidhaye Aishwarya S. , Vate Chetana N. , Shastri Kshipra R.
Published: March 2023

Background:

Old age is an important period in the development stage of a human being, and the older persons become more vulnerable and are prone to develop physical and psychological ailments. Psychological well-being has been examined as an indicator of successful adaptation during old and really adulthood. Regular physical activity improves mental health reducing the risk of depression, cognitive decline, and delaying the physiological changes during aging.

Purpose:

The purpose of this study was to find out the impact of coronavirus disease 2019 pandemic lockdown on selected physical, physiological, and psychological variables among community-dwelling older people.

Materials and Methods:

One hundred and thirty participants were evaluated using the sit and reach test, 30-s chair-rise test, pulmonary function test, 2-min step test, and Ryff's psychological well-being scale.

Results:

Data were analyzed using GraphPad In Stat version 3.10, 32 bit for Windows. When compared with normative values, a significant difference was found in all the variables (P = 0.005).

Conclusion:

The patients have changes/alterations in all the physical, physiological, and psychological variables.
Validity and reliability of the Persian version of greenspan social-emotional growth chart
Authors: Soleimani Farin , Azari Nadia , Sajedi Firoozeh , Kraskian Adis , Rahmani Nahid , Rassafiani Mehdi , Nobakht Zahra
Published: March 2023

Background:

The estimated prevalence of mental health disorders in children and adolescents is between 10% and 20%. Furthermore, a quarter of very premature infants exhibit socioemotional delays in infancy and childhood. The objective of this study was to determine the validity and reliability of Greenspan social-emotional growth chart (GSEGC) in Persian children aged 1–42 months.

Materials and Methods:

After translation procedures, the face validity, content validity, construct validity, test–retest reliability, and internal consistency of the GSEGC questionnaire were evaluated. The quality of translating items was obtained using the suggestions of the research group. The face validity of the GSEGC was performed by interviewing with 10 mothers in the target group. To evaluate content validity quantitatively, content validity ratio (CVR) and content validity index (CVI) were used after reviewing the face and content validity and pilot study, 264 parents of children aged 1–42 months completed the GSEGC questionnaire to assess the construct validity and internal consistency. In order to determine the test-retest reliability, after 2 weeks, 18 parents completed the questionnaire again.

Results:

Eleven questions were changed according to the interviews (questions 1–6, 9–11, and 15–16). The lowest CVR was related to items 30 and 20 (0.636), and other items had an acceptable CVR. The lowest CVI value was related to item 1 of clarity and simplicity (0.818), and other items had an acceptable CVI. Intra-class correlation coefficient was 0.988 for all items of questionnaire. Furthermore, Cronbach's alpha coefficient was 0.952 for all items. In factor analysis, two factors were extracted from the items in questionnaire.

Conclusion:

The Persian version of GSEGC questionnaire has acceptable face, content and, constructs validity, test-retest reliability and high internal consistency in the target population. Therefore, the Persian version of the GSEGC can be used as a tool to assess 1–42 months sensory processing and socio-emotional development.