bluuebunny/crossref_metadata_2025 huggingface dataset:
Pantallas y prejuicios: estereotipos mediáticos sobre las mujeres indígenas en Perú y Guatemala
Authors: Celigueta Gemma , Viola Andreu
Published: January 2022

Este artículo analiza la difusión mediática de imágenes estereotipadas referidas a poblaciones indígenas, y a las mujeres indígenas en particular, a partir de dos casos polémicos: el programa televisivo de humor La Paisana Jacinta en Perú, y el uso de la imagen de la mujer y la indumentaria Maya en una revista de moda guatemalteca. Esta investigación sugiere que el uso mediático de dichos estereotipos ejerce un efecto amplificador, especialmente a través de las redes sociales, sobre los prejuicios contra la población indígena.
Fragmentos para una etnografía de las radios comunitarias e indígenas en América Latina
Authors: Gil García Francisco M. , Pérez Galán Beatriz , Pitarch Pedro
Published: January 2022

En este artículo nos interesa resaltar la existencia de comunidades ampliadas a partir del uso social, político y cultural que los actores implicados en las radios comunitarias e indígenas de América Latina hacen de estos medios. Para ello recurrimos a la presentación de tres casos etnográficos. Desde Chiapas (México), nos fijamos en el proceso dialógico de la comunicación indígena y en el valor de la palabra para generar comunidad. Por otra parte, analizamos las distintas estrategias que en la búsqueda y expresión de las identidades siguen las radios indígenas y comunitarias en la Quebrada de Humahuaca y la Puna de Jujuy (Noroeste argentino). Por último, abordamos el cuestionamiento de las relaciones de género planteado por mujeres comunicadoras de Bolivia. En todos los casos, nuestro propósito es el de interpretar cómo la experiencia de la radio es capaz de crear nuevas comunidades.
Mediaciones indígenas en el espacio audiovisual: películas, series y videoclips
Authors: Izard Martínez Gabriel , Flores Martos Juan Antonio , Martínez Mauri Mònica
Published: January 2022

En este artículo presentamos tres casos de jóvenes artistas indígenas de México y Panamá que, desde el cine, la televisión y el rap, y combinando su poética con la agencia política, crean contenidos novedosos para audiencias indígenas y no indígenas globales. Argumentamos que estos comunicadores de la era digital pueden ser considerados nuevos mediadores que, a través de un espacio intermedio audiovisual, visibilizan ante sus comunidades y el mundo una nueva realidad indígena.
Las hogueras de la noche de Sant Joan y la desactivación de la cultura infantil de calle en Barcelona
Authors: Delgado Ruíz Manuel , Contijoch Torres Marta , Fabré Nadal Helena
Published: January 2022

A mediados de la década de los 60 del siglo pasado, cada noche del 23 de junio se encendían sin permiso cientos de hogueras en todos los barrios de Barcelona. Esos fuegos eran el resultado de la actividad de una chiquillería autoorganizada que se encargaba de recoger la madera días antes, custodiarla y montar con ella las piras. En la actualidad apenas quedan menos de dos decenas de fuegos de Sant Joan en la capital catalana, todos preparados por adultos y con la debida autorización. Los factores que han motivado la práctica desaparición de una costumbre con más de dos siglos de historia y que había llegado a ser masiva, han sido varios. A partir de una investigación sobre la memoria de quienes fueron preadolescentes hace décadas, se pone el acento en una de esas razones: la que pone en relación el declive de la cultura popular infantil de calle con la implantación con éxito de una importante oferta de educación en el tiempo libre, que fue suprimiendo la presencia de pandillas de niños y niñas en las calles, concebidas cada vez más como lugares de riesgo y depravación.
El papel de las mujeres en la transición cultural de Cuentepec, Morelos
Authors: Orihuela Gallardo María del Carmen
Published: January 2022

En este artículo se desarrolla la forma en que los diversos factores socioculturales y económicos, que caracterizan la dinámica cultural de la comunidad nahua de Cuentepec, Morelos, definen el papel de las mujeres. Esta comunidad mantiene una identidad apegada a la tradición cultural de los pueblos indígenas que practican la agricultura; sin embargo, en las últimas décadas su dinámica organizacional ha experimentado cambios que muestran una transición socioeconómica. Esto, a partir de la introducción y adaptación de la población a nuevos conectores con el exterior a la comunidad se generó una fluida interacción con la población mestiza. Por ejemplo, con la intensa migración pendular se incrementó la actividad laboral, la profesionalización escolar y la capacidad económica. Si bien, todo esto ha provocado cambios en la interacción comunitaria de las mujeres, es precisamente su actuar social lo que ha permitido mantener la continuidad cultural y la cohesión social interna. Se trata, entonces, de una investigación realizada con metodología etnográfica, con observación participante e interacción directa con la comunidad. Así como de una revisión documental y etnográfica previa.
El «lugar» de los campamentos de refugiados en la consideración antropológica
Authors: Aris Escarcena Juan Pablo
Published: January 2022

En su célebre obra «Los no lugares. Espacios del Anonimato.», el antropólogo francés Marc Augé define los campamentos de refugiados como no lugares (Augé 1998 [1992]). Sin cuestionar la validez de la categoría para definir los otros espacios característicos de la «sobremodernidad», analizaremos la aplicabilidad de la misma para los campamentos de refugiados sobre la base del trabajo de campo empírico en los campamentos existentes en varios contextos europeos actuales. Nuestras conclusiones contradicen esta propuesta teórica. En un momento histórico, llamado la «crisis de los refugiados en Europa», es necesaria la reflexión sobre la interpretación desde la antropología cultural de estos espacios.
Subjetividad o miedo. Los modos de ser y hacer de las brujas en los Andes
Authors: Muñoz Morán Óscar
Published: January 2022

En este artículo me gustaría proponer un nuevo acercamiento a la figura de las brujas y sus modos de actuar en los Andes. Al mismo tiempo, utilizo la percepción que de estos personajes se tiene para plantear un modelo de análisis de la noción de miedo en los Andes. Lo que sugiero es que en la comunidad quechua hablante de Coipasi las brujas son reconocidas como sujetos y, por tanto, queda normalizada la relación que con ellas se pueda tener. Así, el miedo no aparece como factor de esta relación.
Réflexions sur la relation entre littérature et nourriture dans l’œuvre de Yoko Tawada
Authors: Meyer Anne-Rose
Published: January 2022

Après avoir rappelé la place que la thématique de la nourriture a de tout temps occupée dans la littérature et inventorié différents aspects et différentes approches de la relation entre littérature et nourriture, l’auteure de cet article illustre sa réflexion par des exemples empruntés aux récits de l’écrivaine germano-japonaise Yoko Tawada : Les aliments, leur préparation, consommation et absorption y servent de marqueurs ou de révélateurs des différences culturelles entre Extrême-Orient et Occident.
Sensorless Control of Induction Motor Based on Differential Flatness Theory and Reduced MRAS Observer
Authors: Louanasse Laggoun , Yassine Beddiaf
Published: January 2022

In this paper, we propose a hybrid sensorless control method of IM, This method consists of using the differential flatness theory and reduced MRAS observer. The control design proceeds by showing that each input of the motor model stands for a differentially flat system, where the flat output is chosen to be the associated state variable. Next for each regulation loop is a virtual control input is computed, that can invert the loop’s dynamics and can eliminate the system’s tracking error. The reduced MRAS observer is used to estimate the rotor speed and flux. Simulation and experimental results are presented to illustrate the effectiveness of the proposed approach for sensorless control of induction motor.
New Technology Introduction Into an Existing Production Line Viewed From the Lens of a Sociotechnical Framework
Authors: Lemon Todd , McLeod Alister
Published: January 2022

Process changes, in manufacturing environments, can have a critical impact on the interface between social dynamics and technical systems if usability and performance are not factored into the project. Socio-technical frameworks allow us to analyze the introduction of new technology and the adaptation of social systems in manufacturing environments, where technological change is constant and is in direct competition for social, technical and capital resources within the organization. A case study method was chosen in an endeavor to collect, present, and analyze data that is being derived from the introduction of new machinery into an existing production line. The main overarching factor identified was organizational ‘fit’. This paper proposes that fit be used as a gauge for new technology introduction in existing production lines. If change can be designed and managed through a socio-technical framework, future expansion and intended improvements can be smoother and more effective.
The Protective Role of IL-36/IL-36R Signal in Con A–Induced Acute Hepatitis
Authors: Wang Xiaofang , Liang Yuejin , Wang Hui , Zhang Biao , Soong Lynn , Cai Jiyang , Yi Panpan , Fan Xuegong , Sun Jiaren
Published: January 2022

The IL-36 family, including IL-36α, IL-36β, IL-36γ, and IL-36R antagonist, belong to the IL-1 superfamily. It was reported that IL-36 plays a role in immune diseases. However, it remains unclear how IL-36 regulates inflammation. To determine the role of IL-36/IL-36R signaling pathways, we established an acute hepatitis mouse model (C57BL/6) by i.v. injection of the plant lectin Con A. We found that the levels of IL-36 were increased in the liver after Con A injection. Our results demonstrated the infiltrated neutrophils, but not the hepatocytes, were the main source of IL-36 in the liver. Using the IL-36R−/− mouse model (H-2b), we surprisingly found that the absence of IL-36 signals led to aggravated liver injury, as evidenced by increased mortality, elevated serum alanine aminotransferase and aspartate aminotransferase levels, and severe liver pathological changes. Further investigations demonstrated that a lack of IL-36 signaling induced intrahepatic activation of CD4+ and CD8+ T lymphocytes and increased the production of inflammatory cytokines. In addition, IL-36R−/− mice had reduced T regulatory cell numbers and chemokines in the liver. Together, our results from the mouse model suggested a vital role of IL-36 in regulating T cell function and homeostasis during liver inflammation.
Bidirectional Transport of IgE by CD23 in the Inner Ear of Patients with Meniere’s Disease
Authors: Zhang Na , Lyu Yafeng , Guo Jia , Liu Jiahui , Song Yongdong , Fan Zhaomin , Li Xiaofei , Li Na , Zhang Daogong , Wang Haibo
Published: January 2022

Meniere’s disease (MD) is a disorder of the inner ear characterized by episodes of spontaneous vertigo, fluctuating hearing loss, and tinnitus. Recent studies have demonstrated that IgE may play a role in the pathogenesis of MD. Patients with MD (n = 103), acoustic neuroma (n = 5), and healthy subjects (n = 72) were recruited into the study. Serum from the participants was analyzed for IgE and type 2–related cytokines. IgE and CD23 expression levels in vestibular end organs of patients, C57BL/6 mice, or mouse HEI-OC1 cells were analyzed. Finally, the role of CD23 in IgE transcytosis was assessed using HEI-OC1 cells. Serum IgE was elevated in patients with MD and positively correlated with clinical symptoms. IL-4, IL-5, IL-10, IL-13, and CD23 levels were increased in patients with MD compared with the control group. In the transcytosis assay, mouse IgE was found to be bidirectionally transported across the HEI-OC1 cell monolayer. Additionally, CD23 downregulation using a small interfering RNA approach significantly reduced the efficiency of IgE transcytosis, suggesting that IgE is transported by CD23. Furthermore, exposure to IL-4 increased CD23 expression and enhanced IgE transcytosis in the HEI-OC1 cells and primary vestibular end organs. Our study indicated that IgE may play a role in the pathophysiology of MD. In addition, CD23-mediated IgE transcytosis in the hair cells may play a critical role in initiating inflammation in the inner ear. Thus, reducing the level of IgE may be a potentially effective approach for MD treatment.
Concussion Nondisclosure in Youth Sports
Authors: Bretzin Abigail C. , Anderson Morgan , Bhandari Neha , Schmitt Ara J. , Beidler Erica
Published: January 2022

Context

Researchers conducting studies about sport-related concussion (SRC) reporting behaviors and reasons for nondisclosure primarily focus on older athletic populations. Youth athletes participating in contact sports are also at risk for SRC; however, little is known about their SRC disclosure patterns and reasons for nondisclosure.

Objective

To examine the self-reported SRC history and reasons for SRC nondisclosure of youth athletes aged 8–14 years.

Design

Cross-sectional study.

Setting

Youth athletes in organized football, ice hockey, lacrosse, or soccer.

Patients or Other Participants

A total of 411 youth athletes (boys = 70.0% [n = 287/410]; median age = 11 [interquartile range = 10–13] years).

Main Outcome Measure(s)

A 15-minute survey including self-reported demographics, diagnosed and nondisclosed SRC history, and reasons for nondisclosure of suspected SRCs.

Results

Ten percent of respondents (n = 41/411) recounted ≥1 diagnosed SRC, 12.7% (n = 52/411) did not report a suspected SRC, 13.1% (n = 53/404) indicated they continued to practice, and 12.3% (n = 50/406) reported they continued to play in a game after a suspected SRC. Significant associations between sport and nondisclosure existed (P values < .001) but not with self-reported concussion history (P = .14). In sex-comparable analyses, boys' lacrosse players had a higher frequency of nondisclosure than girls (P = .05). The most common reasons for nondisclosure were not wanting to lose playing time (66.7%, n = 32/48), miss a game (56.3%, n = 27/48), and let the team down (43.8%, n = 21/48) and uncertainty over injury severity and the presence of SRC (43.8%, n = 21/48).

Conclusions

Ten percent of youth athletes self-reported at least 1 diagnosed SRC. However, they also described continuing to practice or play in a game after a suspected SRC. Reasons for nondisclosure at this age were similar to those reported in high school and collegiate athletes. Recent researchers suggested negative consequences of continued play with SRC, especially in the acute stages. Anyone conducting future educational initiatives should emphasize these risks and focus on reasons why athletes of both sexes withhold reporting.
Resuscitation of hemorrhagic shock using normal saline does not damage the glycocalyx in the immediate resuscitation phase
Authors: Pudjiadi Antonius Hocky , Firmansyah Agus , M. Gunanti Soeyono D. V. , Bardosono Saptawati , Jusman Sri Widia , Siagian Minarma , Lubis Munar
Published: January 2022

OBJECTIVES:

The objectives were to study the effect of aggressive resuscitation using normal saline on hemodynamics, serum atrial natriuretic peptide (ANP), syndecan-1 (marker of endothelial glycocalyx shedding), and extravascular lung water index (ELWI) following hemorrhagic shock.

METHODS:

Eleven male piglets (Sus scrofa) underwent blood drawing to create 20% drop in mean arterial pressure (MAP). Two-phase resuscitation was performed: Phase 1 using normal saline of an equal volume of blood drawn to create shock and Phase 2 using 40 ml/kg BW of normal saline to simulate hypervolemia and hemodilution. Heart rate, MAP, cardiac index (CI), systemic vascular resistance index, oxygen delivery (DO2), global end-diastolic volume index, ELWI, hemoglobin (Hb), lactate, ANP, and syndecan-1 at each phase and up to 60 min following Phase 2 resuscitation were recorded.

RESULTS:

Phase 2 resuscitation significantly decreased Hb concentration (P = 0.006), however, DO2 was maintained (P = 1.000). CI increased from shock to Phase 1 (P = 0.029) and further increase in Phase 2 resuscitation (P = 0.001). Overall, there was a transient increase of ANP following Phase 1 resuscitation, from 85.20 ± 40.86 ng/L at baseline to 106.42 ± 33.71 ng/L (P = 0.260). Serum syndecan-1 and ELWI change at all phases were not significant.

CONCLUSIONS:

We demonstrate compensatory protective mechanism despite overzealous fluid resuscitation. Compensatory increased CI despite decreased Hb maintained DO2. In the absence of inflammation, serum ANP did not increase significantly, no glycocalyx shedding occurred, subsequently no change in ELWI. We show that factors other than volume overload are more dominant in causing glycocalyx shedding.
Bilateral continuous serratus anterior plane block
Authors: Gupta Anju , Ahmed Aasim , Malviya Amit Kumar
Published: January 2022

Pain due to rib fracture leads to respiratory impairment and bilateral fractures impact respiratory mechanics in the worst manner. Thoracic epidural analgesia is the gold standard for bilateral rib fractures but is technically difficult, entails potentially serious complications, and necessitates patient repositioning. Ultrasound-guided serratus anterior plane block (SAPB) has recently gained favor for alleviating thoracic pain and can be performed in patients lying supine, rendering it particularly useful in polytrauma patients who are unable to sit up or turn lateral for regional blocks on the back. Use of continuous bilateral SAPB for rib fractures has been underutilized. We report a case of a polytrauma patient who had bilateral multiple rib fracture along with vertebral and pelvic fractures due to which she was in severe pain and was unable to move to provide any kind of positioning for the blocks. Bilateral SAPB provided effective pain relief and facilitated early recovery and pulmonary rehabilitation of the patient.
Development of a nomogram to predict the outcome of moderate or severe pediatric traumatic brain injury
Authors: Oearsakul Thakul , Tunthanathip Thara
Published: January 2022

OBJECTIVES:

Traumatic brain injury (TBI) in children has become the major cause of mortality and morbidity in Thailand that has had an impact with economic consequences. This study aimed to develop and internally validate a nomogram for a 6-month follow-up outcome prediction in moderate or severe pediatric TBI.

METHODS:

This retrospective cohort study involved 104 children with moderate or severe TBI. Various clinical variables were reviewed. The functional outcome was assessed at the hospital discharge and at a 6-month follow-up based on the King's Outcome Scale for Childhood Head Injury classification. Predictors associated with the 6-month follow-up outcome were developed from the predictive model using multivariable binary logistic regression to estimate the performance and internal validation. A nomogram was developed and presented as a predictive model.

RESULTS:

The mean age of the samples was 99.75 months (standard deviation 59.65). Road traffic accidents were the highest injury mechanism at 84.6%. The predictive model comprised Glasgow Coma Scale of 3–8 (odds ratio [OR]: 16.07; 95% confidence interval [CI]: 1.27–202.42), pupillary response in one eye (OR 7.74; 95% CI 1.26–47.29), pupillary nonresponse in both eyes (OR: 57.74; 95% CI: 2.28–145.81), hypotension (OR: 19.54; 95%: CI 3.23–117.96), and subarachnoid hemorrhage (OR: 9.01, 95% CI: 1.33–60.80). The concordance statistic index (C-index) of the model's discrimination was 0.931, while the C-index following the bootstrapping and 5-cross validation were 0.920 and 0.924, respectively.

CONCLUSIONS:

The performance of a clinical nomogram for predicting 6-month follow-up outcomes in pediatric TBI patients was assessed at an excellent level. However, further external validation would be required for the confirmation of the tool's performance.
Intravenous morphine plus ibuprofen or ketorolac versus intravenous morphine alone in reducing renal colic pain intensity in emergency department
Authors: Safaie Arash , Tavoli Maryam , Babaniamansour Sepideh , Aliniagerdroudbari Ehsan , Mousavi Amirabbas , Sotoodehnia Mehran , Bahreini Maryam
Published: January 2022

OBJECTIVES:

This study aimed to compare the efficacy of intravenous (IV) morphine plus ibuprofen or ketorolac versus IV morphine alone in controlling renal colic pain in the emergency department.

METHODS:

This double-blind, randomized clinical trial was conducted during November 2018 and March 2019 in Iran. Patients aged 18–65 years with acute renal colic and numerical rating scale (NRS) score of higher than 6 of 10 were enrolled to the study. They were randomly assigned to I, K, and control groups receiving 5 mg morphine with 800 mg ibuprofen (n = 65), 5 mg morphine with 30 mg ketorolac (n = 65), or only 5 mg morphine (n = 65) intravenously, respectively. NRS was evaluated 0, 15, 30, 60, and 120 min after injection.

RESULTS:

A total of 195 participants took part in the study. The presence of stone in pelvis area was higher in I group (P = 0.027). The mean rescue analgesic dose was higher in the control group and lower in K group (P = 0.031). From the 15th min, the NRS reduction in I and K group was higher than the control group (P < 0.001), but the difference between I and K group was not statistically significant in total (P = 1.0) or in the all follow-up time intervals (15th
P = 0.864, 30th
P = 0.493, 60th
P = 0.493, and 120th min P = 1.0). The largest difference in pain reduction was observed in 120th min and mean of NRS was 2.9 (95% confidence interval [CI]: 2.6–3.3), 2.9 (95% CI: 2.6–3.3) and 7.0 (95% CI: 6.7–7.4) in I, K and control group, respectively. The adverse effects showed in 18.5%, 20.0%, and 13.8% of I, K, and control group, respectively.

CONCLUSION:

IV ibuprofen plus morphine and IV ketorolac plus morphine had similar effects in reducing renal colic pain but were more effective than IV morphine alone.
The Effects of Comprehensive Home-Based Cardiac Rehabilitation versus Usual Care in Patients with Ischemic Heart Disease in Iran
Authors: Okati-Aliabad Hassan , Ansari- Moghaddam Alireza , Roohafza Hamidreza , Mohammadi Mahdi , Vakili Leila , Abbasi Mohammad Hadi , Heidari Hossein , Masoudy Gholamreza , Yazdekhasti Safoura , Sadeghi Masoumeh
Published: January 2022

Background:

Cardiovascular diseases are the leading causes of mortality all around the world. Patients with Ischemic heart disease (IHD) are at an increased risk of ischemic events; therefore, secondary prevention measures should continue for these patients. Although Cardiac rehabilitation (CR) is one of the secondary prevention measures for IHD patients which has favorable clinical outcomes, only 50% of patients are referred and among them, a small percentage attends CR. Therefore, other strategies should be considered, one of which is home-based cardiac rehabilitation.

Methods:

A multicenter, parallel-group randomized controlled trial has been conducting in three hospitals in Isfahan and patients have been assigned into a 1:1 ratio for the evaluation of the effectiveness of home-based cardiac rehabilitation versus usual care. Psycho-educational consultation based on the Health Action Process Approach including heart-healthy diet, stress management, lifestyle changes, smoking cessation, and physical activity has been performed. Primary outcomes, including the quality of life, psychological and smoking status, body mass index, blood pressure, blood cholesterol level, and physical activity level have been measured at 6 months after the randomization and intervention. One year after the intervention, primary and secondary outcomes, including cardiovascular events, the frequency of hospital admissions, and the death rates due to cardiovascular reasons will be assessed.

Conclusion:

HBCR program can increase patient accessibility to CR services its implantation can be reduce burden IHD.
Preoperative Factors Influencing Functional Rehabilitation after Major Lower Limb Amputation and Validation of a Preoperative Scoring Tool
Authors: Premnath Sivaram , Cox Michael , Hostalery Aurelien , Kuhan Ganesh , Rowlands Timothy , Quarmby John , Singh Sanjay
Published: January 2022

Introduction:

The ability to walk with prosthesis is a major determinant of functional independence after major lower limb (MLL) amputation. The Blatchford Leicester Allman-Russell Tool (BLARt) score is a potentially valuable tool that can predict the functional outcome after MLL amputation. The study aimed to identify preoperative factors that influence functional rehabilitation after MLL amputation and validation of BLARt score.

Methods:

This retrospective study analyzed 71 patients referred for rehabilitation postamputation. The level of functional outcome at 6 and 12 months were recorded using Special Interest Group in Amputee Medicine grading. Preoperative factors and BLARt score were analyzed for association with functional outcome.

Results:

BLARt score was found to have a significant correlation with functional outcome in 6 and 12 months. BLARt showed a fair to good predictive ability with an area under the receiver operating characteristic curve of 0.713 (SE 0.61, 95% confidence intervals 0.593–0.832) and 0.705 (SE 0.061, 95% confidence intervals 0.585–0.825) for the nonfunctional outcome at 6 and 12 months, respectively. Preoperative mobility was the only significant risk factor that was associated with functional mobility (P = 0.02).

Conclusion:

With the validation analysis showing a fair to good predictive ability, BLARt score does serve its proposed role in risk stratification.
Four Limb Gangrene - A Rare Presentation
Authors: Niveda BR , Karegoudar Jyoti S , Vijayanath V
Published: January 2022

We report a case of a 73-year-old male, who presented with acute gangrene of the left thumb which then progressed to symmetrical peripheral gangrene of digits of all four limbs, with no comorbid diseases. On investigation, there was high D-dimer, normal lipid profile, and two-dimensional Echo. Computed tomography and magnetic resonance angiogram of all limbs revealed atherosclerotic changes. The patient underwent disarticulation of digits under the wrist block. Symmetrical peripheral gangrene, seen in a wide variety of medical conditions presents as symmetrical gangrene of two or more extremities without large vessel obstruction or vasculitis. The fingers and toes (rarely nose, ear lobes, or genitalia) are affected. It may manifest unpredictably in conditions associated with sepsis, diabetes mellitus, low-output states, vasospastic conditions, myeloproliferative disorders, or hyperviscosity syndrome. It carries a high mortality rate with a very high frequency of multiple limb amputations in survivors.
Applied Features of Perforasomes in the Revascularization and Reconstruction of Chronic Limb-Threatening Ischemia in the Diabetic Foot
Authors: Paramasivam Ilayakumar , Margabandu Balakrishnan Thalaivirithan , Palanisamy Poorani , Christabel Prethee Martina , Sritharan Narayanan , Janardhanan Jaganmohan
Published: January 2022

Chronic limb-threatening ischemia in the diabetic foot is a spectrum disease characterized by the failure of wound healing and increased risk of amputation. The interspecialty consolidating services between the vascular and plastic surgeon with applied perforasome approaches both in the timely revascularization and early reconstruction culminate in the stable and shoeable foot or foot residuum.
Guidewire Complications During Central Vein Cannulation
Authors: Darbari Anshuman , Lahiri Raja
Published: January 2022

Medical intervention procedures are never complication-free. Even after years of refinement in techniques and laying out protocols and checklists, errors do occur. Most of them are preventable, but not all of them. In such cases, efficient and timely diagnosis and management of complications is a key to a successful outcome. In this case series, we describe three situations of complications due to guidewire used in central venous cannulations and different approaches toward their successful management.
Acute-on-Chronic Mesenteric Ischemia Successfully Managed by Superior and Inferior Mesenteric Artery Reimplantation and Cholecystectomy for Gangrenous Gallbladder
Authors: Savlania Ajay , Sriharsha B , Kaman Lileshwar
Published: January 2022

Acute-on-chronic mesenteric ischemia (CMI) leading to gallbladder gangrene is a rare event, and successful use of mesenteric arterial reimplantation with regard to contaminated field is not reported. In contaminated field from gangrenous gallbladder due to acute-on-CMI, reimplantation of the superior and inferior mesenteric artery (SMA and IMA, respectively) for revascularization is a feasible option, and was used to revascularize in this patient. SMA and IMA require one anastomosis at the aorta, and it was successfully used in contaminated field to revascularize the threatened bowel. In acute-on-CMI, with contaminated field, reimplantation of SMA makes one of an option in surgical armamentarium of using autologous tissue and it reduces number of anastomosis in infected field. Acalculous gangrenous cholecystitis is a rare pathology associated with acute-on-CMI.
Lack of influence of dexmedetomidine on rat glomus cell response to hypoxia, and on mouse acute hypoxic ventilatory response
Authors: O’Donohoe Peadar B. , Turner Philip J. , Huskens Nicky , Buckler Keith J. , Pandit Jaideep J.
Published: January 2022

Background and Aims:

There is a lack of basic science data on the effect of dexmedetomidine on the hypoxic chemosensory reflex with both depression and stimulation suggested. The primary aim of this study was to assess if dexmedetomidine inhibited the cellular response to hypoxia in rat carotid body glomus cells, the cells of the organs mediating acute hypoxic ventilatory response (AHVR). Additionally, we used a small sample of mice to assess if there was any large influence of subsedative doses of dexmedetomidine on AHVR.

Material and Methods:

In the primary study, glomus cells isolated from neonatal rats were used to study the effect of 0.1 nM (n = 9) and 1 nM (n = 13) dexmedetomidine on hypoxia-elicited intracellular calcium [Ca2+]i influx using ratiometric fluorimetry. Secondarily, whole animal unrestrained plethysmography was used to study AHVR in a total of 8 age-matched C57BL6 mice, divided on successive days into two groups of four mice randomly assigned to receive sub-sedative doses of 5, 50, or 500 μg.kg-1 dexmedetomidine versus control in a crossover study design (total n = 12 exposures to drug with n = 12 controls).

Results:

There was no effect of dexmedetomidine on the hypoxia-elicited increase in [Ca2+]i in glomus cells (a mean ± SEM increase of 95 ± 32 nM from baseline with control hypoxia, 124 ± 41 nM with 0.1 nM dexmedetomidine; P = 0.514). In intact mice, dexmedetomidine had no effect on baseline ventilation during air-breathing (4.01 ± 0.3 ml.g-1.min-1 in control and 2.99 ± 0.5 ml.g-1.min-1 with 500 μg.kg-1 dexmedetomidine, the highest dose; P = 0.081) or on AHVR (136 ± 19% increase from baseline in control, 152 ± 46% with 500 μg.kg-1 dexmedetomidine, the highest dose; P = 0.536).

Conclusion:

Dexmedetomidine had no effect on the cellular responses to hypoxia. We conclude that it unlikely acts via inhibition of oxygen sensing at the glomus cell. The respiratory chemoreflex effects of this drug remain an open question. In our small sample of intact mice, hypoxic chemoreflex responses and basal breathing were preserved.
Comparative evaluation of glidescope videolaryngosocope and conventional macintosh laryngoscope for nasotracheal intubation in patients undergoing oropharyngeal cancer surgeries: A prospective randomized study
Authors: Kumar Abhishek , Gupta Nishkarsh , Kumar Vinod , Bharti Sachidanand Jee , Garg Rakesh , Kumar Rajeev , Bhatnagar Sushma
Published: January 2022

Background and Aims:

Nasotracheal intubation in oropharyngeal cancer patients is challenging owing to anatomical alterations. Various videolaryngoscopes have been compared to conventional laryngoscope and also amongst each other in different clinical scenarios; the supremacy of videolaryngoscopes over conventional laryngoscope in oropharyngeal cancer patients is yet to be established. We compared the efficacy of glidescope videolaryngoscopes and Macintosh laryngoscope for nasotracheal intubation in patients posted for routine oropharyngeal cancer.

Material and Methods:

120 ASA I and II oropharyngeal cancer patients scheduled for elective surgery were randomized to undergo nasotracheal intubation after induction of general anesthesia with glide scope video laryngoscope (Group GVL, N = 60) or Macintosh laryngoscope (Group L, N = 60) as per group allocation. Time to glottic view, total intubation time (primary objective), hemodynamic fluctuations, and additional manoeuvres to aid intubation were recorded.

Results:

Time to visualize the glottic opening (9.20 ± 4.6 sec vs 14.8 ± 6.3 sec) (P = 0.000) and the total intubation time was significantly less in group GVL (35.6 ± 9.57 sec vs 42.2 ± 11 sec) (P = 0.001). Glidescope videolaryngosocpe provided better glottic views and resulted in significantly fewer manoeuvres to facilitate NTI (P = 0.009). The median numeric rating scale (NRS), hemodynamic parameters and complications were similar in both the groups.

Conclusion:

Glidescope videolaryngosocpe is better than conventional Macintosh laryngoscope for intubation times and need of manoeuvres to facilitate intubation and should be a preferred device for NTI in patients with oropharyngeal cancer.
C5 ventral ramus block for clavicle surgery: How low concerning the volume can we go?
Authors: Diwan Sandeep , Feigl Georg , Nair Abhijit
Published: January 2022

Background and Aims:

Clinical case reports mention 3-5 ml of local anesthetic (LA) at the cervical root 5 (C5) for surgical anesthesia essential for clavicle surgeries with reasonable success. A volume of 5 ml LA has been shown to cause hemidiaphragmatic paresis.

Material and Methods:

We implement the 3–5 ml LA for awake clavicle surgeries along with a supraclavicular nerve (SCN) block with another 2 ml. To understand the spread of injectate, we conducted anatomic macroscopic dissection on Theil based cadavers. Post ultrasound injection of 3 ml of blue latex in one cadaver and green latex in the other, we dissected one cadaver and the other cadaver underwent a cross-section.

Results:

Dissection confirmed a vertical spread of dye more caudad than cephalad. There was no neuraxial spread visualized in the cross-section. The phrenic nerve (PN) was not stained in both cadavers, but a possibility exists depending on its course.

Conclusion:

Based on this limited study we recommend a volume of LA of 3 ml at the level of C5 and another 2 ml at the level SCN of LA for clavicle surgeries.
Preoperative oral carbohydrate loading: Effects on intraoperative blood glucose levels, post-operative nausea and vomiting, and intensive care unit stay
Authors: Rajan Sunil , Rahman Ahlam Abdul , Kumar Lakshmi
Published: January 2022

Background and Aims:

Preoperative fasting imparts safety to patients from aspiration of gastric contents, but undue fasting may predispose to hypoglycemia and dehydration. Preoperative carbohydrate drink reduces postoperative nausea and vomiting (PONV). Primary objective of the present study was to assess effect of carbohydrate drink given 2h before surgery on intraoperative blood glucose levels as compared to those who did not receive it. Secondary objectives included assessment of incidence and severity of PONV and duration of Intensive Care Unit (ICU) stay.

Material and Methods:

It was a prospective randomized study done in 52 non-diabetic patients undergoing thyroidectomy. Group A received 39gm of carbohydrate in 250 mL of apple juice (tetrapack) and Group B patients were given equivalent volume of plain water 2 h prior to surgery. Random blood glucose (RBS) levels were checked before fluid administration, preinduction, 1 h postinduction, and at the end of surgery. PONV was assessed using PONV Impact Scale Score (ISS) and rescue drugs, if needed, were noted. Paired t-test, sample t-test, Mann–Whitney U test, and Fisher’s exact test were used as applicable.

Results:

The fasting, preinduction, and postoperative RBS values were comparable in both groups. Group B had significantly higher RBS at 1h intraoperatively. Group A patients had less vomiting, dry retching, or nausea and required less rescue therapy compared to Group B.

Conclusion:

Compared to patients who received carbohydrate drink 2 h before surgery, those who did not receive it had significantly higher blood glucose values intraoperatively with a higher incidence and severity of PONV and comparable ICU stay.
Does cerebral oximetry always measure brain tissue oxygen saturation? An anatomical study utilizing computed tomography
Authors: Naftalovich Rotem , Chyu Darrick , Denny John T. , Hasan Aysha , Pantin Enrique J.
Published: January 2022

Background and Aims:

to quantify the scalp-cortex distance and determine its variation among patients. We hypothesized that in a significant number of patients, this distance is greater than the maximum penetration depth of current cerebral oximeters.

Material and Methods:

A retrospective anatomic study using transverse head CT images selected randomly from 102 patients over the age of 18 years without brain swelling, intracranial mass effect, or brain hemorrhage. Scalp-cortex distances were determined at two separate locations along the craniocaudal axis; most cephalad to the frontal sinus (I0) and also 2 cm cephalad to that location (I2). Multiple measurements were obtained bilaterally at 1, 3, 5, 7, and 9 cm from midline.

Results:

The average scalp-cortex distance was 14.3 mm and 15 mm at I0 and I2 respectively. Distances varied more in I2 than in I0; from the measurements, 12.8% vs. 6.8% were over 20 mm, 4.4% vs. 2.2% over 25 mm, 1.1% vs. 0.6% over 35 mm and 0.6% vs. none over 40 mm at I2 and I0, respectively. 1.5% of the measurements at I2 were over 30 mm.

Conclusion:

Cerebral oximetry manufacturers all claim to measure cerebral tissue up to a depth of 20-25 mm; 20 mm with the EQUANOX and INVOS compared with 25 mm with the FORE-SIGHT. Scalp-cortex distance is within 25 mm in more than 95% of patients. However, even with the probe placed as per the manufacturer’s recommendations, in a small but significant subset of patients, this distance is greater than the maximum penetration depth of current cerebral oximeters and hence may not reflect actual brain tissue oxygen saturation.
Assessment of communication skill during process of preoperative visit and informed consent by anesthesiology residents
Authors: Salgaonkar Sweta V. , Kulkarni Aarti D. , Chapane Sunil P.
Published: January 2022

Background and Aims:

Anaesthesiologists have few opportunities to communicate with patients especially in preoperative period for various reasons. If these opportunities are not well utilized, anesthesiologists may not be able to educate patients about anaesthesia related issues. The aim of this study was to assess communication skill (CS) exhibited by the anesthesiology residents during the process of preoperative visit and informed consent.

Material and Methods:

This was a pre and post intervention questionnaire based study carried out in a presurgical ward of a tertiary hospital. During the process of preoperative visit and informed consent, fourteen of the second year anesthesia residents were assessed by faculty members for various aspects of CS using validated questionnaire on 3-point Likert’s scale, before and after CS workshop. Residents’ perception about workshop and patient satisfaction with regards to the preoperative visit and process of informed consent was assessed. Results were described in percentage value and a qualitative analysis was carried out.

Results:

While none of the residents exhibited ‘excellent CS score’ in the pre-workshop phase, six (42.86%) achieved the same after the workshop. One resident, who had ‘poor CS score’ moved to higher category score post workshop. The behavioural traits of professionalism, empathy, risk explanation and written consent showed statistically significant improvements post intervention by Wilcoxon Signed Rank Test, with P value < 0.05. All residents felt that good communication can improve patient satisfaction and CS training should be part of the post graduate curriculum.

Conclusion:

Conduct of CS workshop for anesthesia residents improved certain behavioral traits during anaesthesia preoperative visit and informed consent process. This important nontechnical skill of CS, may not be uniformly acquired during clinical training and should be specifically taught and evaluated as part of post graduate curriculum.
Comparison of the efficacy of erector spinae plane block and peritubal infiltration of levobupivacaine for postoperative analgesia following percutaneous nephrolithotomy
Authors: Lomate Prashant , Jadhav Vasudha R. , Yadav Arvind
Published: January 2022

Background and Aims:

Erector spinae plane (ESP) block is a simple and safe interfascial plane block reported to provide good analgesia after thoracolumbar surgeries. We compared its efficacy with conventional peritubal local anesthetic infiltration following percutaneous nephrolithotomy (PCNL).

Material and Methods:

A total of 60 adult patients posted for elective PCNL were randomly allocated into two groups. Postoperatively, Group I received ultrasound (US) guided peritubular infiltration block with 20 ml of 0.25% levobupivacaine and Group II received US guided ESP block with 20 ml of 0.25% levobupivacaine. The two groups were compared for the time to first rescue analgesic (Injection tramadol), number of rescue analgesic demands, total analgesic consumption in first 24 hours, VAS (rest and dynamic) scores and the adverse effects. The data were analyzed by unpaired t-test and Mann Whitney U test.

Results:

The time to first rescue analgesic demand was significantly longer in Group II (6.93 ± 2.15 h vs. 16.21 ± 7.53 h). The VAS scores (rest and dynamic) at eight and twelve hours of measurement were significantly lower in Group II (P < 0.05). The number of analgesic demands were less in group II (2.97 ± 0.49 vs. 1.00 ± 1.05). The total analgesic consumption in first 24 hours was less in Group II (148.33 ± 24.51 mg vs. 51.92 ± 45.78 mg).

Conclusion:

ESP block is a very effective and safe technique to provide prolonged duration of postoperative analgesia following PCNL. Peritubal local anesthetic infiltration is also a reliable technique for postoperative analgesia.
Ultrasound-guided costoclavicular vs. axillary brachial plexus block: A randomized clinical study
Authors: Nalini Kadirehally Bheemanna , Bevinaguddaiah Yatish , Thiyagarajan Balaji , Shivasankar Archana , Pujari Vinayak Seenappa
Published: January 2022

Background and Aims:

Brachial plexus is in a very compact state at the costoclavicular space (CCS) when compared to the axilla, where the individual nerves are separate. This study aimed to test the hypothesis that brachial plexus block (BPB) at the CCS would result in a faster onset of block as compared to the axillary approach of BPB.

Material and Methods:

Fifty patients who underwent surgeries below the level of mid-arm under ultrasound-guided BPB were randomly allocated to any one of the two study groups. Thirty milliliters of local anesthetic (LA), a mixture of 10-mL 2% lidocaine with 5-μg/mL adrenaline and 20-mL 0.5% bupivacaine, was deposited around the axillary artery (25-mL LA) and the musculocutaneous nerve (5-mL LA) or at the CCS, and performance time was noted. Observer blinded to the block procedure recorded the block onset time and success rate.

Results:

The mean (SD) onset times were comparable between the costoclavicular (CC) and axillary (AX) groups (12.0 ± 3.2 vs. 11.2 ± 2.9 min, respectively; P = 0.367). Group CC demonstrated a reduction in performance time compared to group AX (5.3 ± 1.9 vs. 8.0 ± 3 min, respectively; P < 0.05). All blocks were successful in both groups without any complications except for one patient in group AX who required a rescue block for radial nerve.

Conclusion:

Costoclavicular and axillary ultrasound-guided BPBs resulted in similar onset times. However, the block performance time was longer for AX group compared to CC group. There were no intergroup differences found in terms of success rates.
Flow dynamics of ultrasound-guided lumbar plexus block in adults
Authors: Diwan Sandeep , Nair Abhijit , Gawai Nitin , Sancheti Parag
Published: January 2022

Background and Aims:

The outcomes of plexus and peripheral nerve blocks depend on needle-nerve contact and the spread of local anesthetic (LA) around the plexus or nerve. Needle-nerve distance and spread of LA could be visualized during US-guided lumbar plexus block (LPB).

Material and Methods:

After Institutional Ethics Committee approval and after obtaining informed consent, 24 American Society of Anesthesiologists’-physical status I–III patients who underwent surgical fixation of fractures of proximal femur were enrolled. Spinal anesthesia was a primary anesthetic in all patients. At the end of the surgery, all patients received US and neurostimulation-aided LPB at the third lumbar nerve root (LNr). The primary aim was to determine the spread of LA in the lumbar plexus area with the relation of the needle tip and LNr contact. The secondary aim was to understand block efficacy in terms of pain scores monitored at regular intervals and 100 mg intravenous tramadol was administered as a rescue analgesic if VAS >4.

Results:

In all 24 patients, we observed an oval and antegrade LA spread after lumbar plexus was identified with neurostimulation at L3. With the needle closer to intervertebral foramina (IVF), a retrograde spread was visualized. Only 2/24 patients received rescue analgesia in the first 24 h.

Conclusion:

The type of spread after the US-guided LPB could predict block success of block and a possible epidural spread.
Perioperative anesthesia management for brachytherapy in cancer patients: A retrospective observational study
Authors: Kumar Vinod , Gulia Abhity , Garg Rakesh , Gupta Nishkarsh , Bharati Sachidanand J. , Mishra Seema , Bhatnagar Sushma
Published: January 2022

Background and Aims:

Anesthetic management for brachytherapy require repeated exposure to anesthesia in elderly patients with comorbidities. The varying locations provide an anesthesiologist with further challenges.

Material and Methods:

We studied retrospectively anesthesia type, details of anesthetic techniques and complications that occurred in patients having received anesthesia for brachytherapy in our institute in the last 6 years. Categorical variables were described as frequency and percentage, and continuous variables described as median and interquartile range. For continuous variables, mean values compared using two sample t tests for independent samples.

Results:

The majority of patients were females who received brachytherapy for carcinoma cervix. A higher percentage of carcinoma breast and male genitourinary malignancies had comorbidities. Predominant side effects included 22 (1.85%) had hypotension, 19 (1.59%) had difficulty in putting spinal, 13 (1.09%) patients had tachycardia and 11 (0.92%) had headache in the postoperative period.

Conclusion:

Neuraxial block as anesthetic technique in pelvic brachytherapy using fentanyl as additive helped reduce the dose of local anesthetic and avoided the complications of high spinal. The choice of anesthesia can vary depending on the duration and site of brachytherapy keeping in consideration the patient’s factors.