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Journal of Anaesthesiology, Clinical... 2024The objective of the study was to evaluate the performances of qCON and qNOX indices in pediatric populations undergoing surgery under general anesthesia (GA), focusing...
BACKGROUND AND AIMS
The objective of the study was to evaluate the performances of qCON and qNOX indices in pediatric populations undergoing surgery under general anesthesia (GA), focusing on the induction and recovery periods. Both the indices are derived from electroencephalogram (EEG) and implemented in the CONOX monitor (Fresenius Kabi, Germany).
MATERIAL AND METHODS
After approval of the institutional ethics committee, this prospective observational study was conducted in pediatric patients of either sex in the age group of 1-12 years belonging to the American Society of Anesthesiology (ASA) grade I and II undergoing elective surgery under GA. Anesthetic technique was GA with or without regional analgesia (RA). All patients underwent inhalation induction and maintenance using sevoflurane. Patients were monitored with the use of a CONOX monitoring system (Fresenius Kabi, Germany), connected via a set of electrodes placed over the forehead. qCON and qNOX scores were recorded during awake (on operating table premedicated with oral midazolam 0.5 mg/kg), at induction, at loss of eyelash reflex, intubation/laryngeal mask airway (LMA) insertion, before and after regional anesthesia, surgical incision, at cessation of anesthesia, emergence, extubation, and eye-opening. Registered results were also analyzed compared with the minimum alveolar concentration of sevoflurane (MAC).
RESULTS
A total of 46 pediatric patients were enrolled in the study with a mean age of 5.6 years. All the patients were either ASA I or II. There was a simultaneous fall and rise of qCON and qNOX upon induction and recovery, respectively. There was a rise in qNOX with surgical incision irrespective of RA. However, there was a greater rise in qNOX following surgical incision in those who did not receive RA ( = 0.33) Also both qCON ( = 0.06) and qNOX ( = 0.41) were poorly correlated with MAC values of sevoflurane during GA in the pediatric population.
CONCLUSIONS
Both qCON and qNOX values change predictably with changes in the conscious level and with different noxious stimuli. Further studies are required to confirm the findings taking into account the postoperative assessment of delirium and recall of intraoperative events.
PubMed: 38919439
DOI: 10.4103/joacp.joacp_453_22 -
Journal of Anaesthesiology, Clinical... 2024Intra-cuff pressure of Air-Q self-pressurized laryngeal airways (Air-Q SP) balances airway pressure and adapts to patient's pharyngeal and periglottic structures, thus...
BACKGROUND AND AIMS
Intra-cuff pressure of Air-Q self-pressurized laryngeal airways (Air-Q SP) balances airway pressure and adapts to patient's pharyngeal and periglottic structures, thus improves oropharyngeal leak pressure (OLP).This study was performed to compare efficacy of Air-Q SP with Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery.
MATERIAL AND METHODS
The study design was prospective, randomized and controlled. Ninety patients were randomly assigned to Air-Q SP or PLMA group. All patients were premedicated and shifted to operation theatre. Monitoring was instituted. After securing IV-line, induction with inj. Morphine + Propofol, relaxation with inj. Vecuronium was done. Supraglottic was inserted according to group allocation. Outcome measures were OLP, fibreoptic view of larynx, success rate, device insertion parameters, haemodynamic and respiratory parameters and post-operative laryngopharyngeal complications. Neostigmine + glycopyrrolate were given, device was extubated.
RESULTS
All supraglottic airway devices (SADs) were successfully placed in two attempts. The mean initial OLP, OLP at 10 minutes, and device insertion time were significantly lower in Air-Q SP group. Fiber-optic laryngeal view grading was significantly better with Air-Q SP. No significant difference was observed with respect to rate of successful insertion in first attempt, ease of insertion, and manipulations required. The hemodynamic/respiratory parameters and post-operative sore throat in the two both groups were similar.
CONCLUSIONS
Proseal LMA has a higher OLP than Air-Q SP but average insertion time was better, and fiber-optic grading of laryngeal view was shorter with Air-Q SP. However, Air-Q SP and Proseal LMA were both effective for lung ventilation.
PubMed: 38919429
DOI: 10.4103/joacp.joacp_248_22 -
Journal of Anaesthesiology, Clinical... 2024Coronavirus disease (COVID-19)-related pneumonia is proposed to be an inflammatory process. The treatment currently includes supportive therapy and low-dose steroids....
BACKGROUND AND AIMS
Coronavirus disease (COVID-19)-related pneumonia is proposed to be an inflammatory process. The treatment currently includes supportive therapy and low-dose steroids. Anti-inflammatory drugs have been proposed to prevent cytokine storms and improve oxygenation in such cases. The study aimed to assess the efficacy of nebulized lignocaine in COVID-19 patients with pneumonia.
MATERIAL AND METHODS
This was an exploratory randomized double-blinded control trial conducted in COVID-19 patients with respiratory failure requiring oxygen therapy either by face mask or non-invasive mechanical ventilation. Patients included were of the age of more than 18 years of either gender. The patients were randomized to receive either lignocaine or distilled water nebulization. The outcomes assessed were PaO/FiO ratio, hemodynamics, respiratory parameters, and sequential organ failure score (SOFA).
RESULTS
The two groups were comparable concerning demographic variables. The PaO/FiO were significantly higher in the lignocaine group from day 2 onward. The SPO was significantly higher on day 3 in the lignocaine group and thereafter there was no significant difference. Other hemodynamic, respiratory parameters, and SOFA scores showed no difference in both the groups.
CONCLUSION
Lignocaine nebulization improved oxygenation in COVID-19 patients and can be used as adjunctive therapy along with other supportive medications.
PubMed: 38919418
DOI: 10.4103/joacp.joacp_205_22 -
Indian Journal of Thoracic and... Jul 2024Tracheobronchial foreign body (TFB) aspiration is an uncommon but potentially life-threatening event. This case report discusses the successful extraction of a metallic...
Tracheobronchial foreign body (TFB) aspiration is an uncommon but potentially life-threatening event. This case report discusses the successful extraction of a metallic screw aspirated by a 48-year-old woman with intellectual disability, using flexible bronchoscopy through the i-gel® laryngeal mask under general anesthesia. The i-gel® device proved effective in maintaining airway access and facilitating bronchoscopy, emphasizing its utility in challenging cases. The report underscores the significance of careful assessment, skillful intervention, and multidisciplinary teamwork in managing TFB aspirations, especially in uncooperative patients with comorbidities.
PubMed: 38919200
DOI: 10.1007/s12055-023-01676-4 -
Microsystems & Nanoengineering 2024With the increasing demand for multifunctional optoelectronic devices, flexible electrochromic energy storage devices are being widely recognized as promising platforms...
With the increasing demand for multifunctional optoelectronic devices, flexible electrochromic energy storage devices are being widely recognized as promising platforms for diverse applications. However, simultaneously achieving high capacitance, fast color switching and large optical modulation range is very challenging. In this study, the MXene-based flexible in-plane microsupercapacitor was fabricated via a mask-assisted spray coating approach. By adding electrochromic ethyl viologen dibromide (EVB) into the electrolyte, the device showed a reversible color change during the charge/discharge process. Due to the high electronic conductivity of the MXene flakes and the fast response kinetics of EVB, the device exhibited a fast coloration/bleaching time of 2.6 s/2.5 s, a large optical contrast of 60%, and exceptional coloration efficiency. In addition, EVB acted as a redox additive to reinforce the energy storage performance; as a result, the working voltage window of the TiC-based symmetric aqueous microsupercapacitor was extended to 1 V. Moreover, the device had a high areal capacitance of 12.5 mF cm with superior flexibility and mechanical stability and showed almost 100% capacitance retention after 100 bending cycles. The as-prepared device has significant potential for a wide range of applications in flexible and wearable electronics, particularly in the fields of camouflage, anticounterfeiting, and displays.
PubMed: 38919161
DOI: 10.1038/s41378-024-00720-6 -
Radiotherapy and Oncology : Journal of... Jun 2024To promote the development of auto-segmentation methods for head and neck (HaN) radiation treatment (RT) planning that exploit the information of computed tomography...
BACKGROUND AND PURPOSE
To promote the development of auto-segmentation methods for head and neck (HaN) radiation treatment (RT) planning that exploit the information of computed tomography (CT) and magnetic resonance (MR) imaging modalities, we organized HaN-Seg: The Head and Neck Organ-at-Risk CT and MR Segmentation Challenge.
MATERIALS AND METHODS
The challenge task was to automatically segment 30 organs-at-risk (OARs) of the HaN region in 14 withheld test cases given the availability of 42 publicly available training cases. Each case consisted of one contrast-enhanced CT and one T1-weighted MR image of the HaN region of the same patient, with up to 30 corresponding reference OAR delineation masks. The performance was evaluated in terms of the Dice similarity coefficient (DSC) and 95-percentile Hausdorff distance (HD), and statistical ranking was applied for each metric by pairwise comparison of the submitted methods using the Wilcoxon signed-rank test.
RESULTS
While 23 teams registered for the challenge, only seven submitted their methods for the final phase. The top-performing team achieved a DSC of 76.9 % and a HD of 3.5 mm. All participating teams utilized architectures based on U-Net, with the winning team leveraging rigid MR to CT registration combined with network entry-level concatenation of both modalities.
CONCLUSION
This challenge simulated a real-world clinical scenario by providing non-registered MR and CT images with varying fields-of-view and voxel sizes. Remarkably, the top-performing teams achieved segmentation performance surpassing the inter-observer agreement on the same dataset. These results set a benchmark for future research on this publicly available dataset and on paired multi-modal image segmentation in general.
PubMed: 38917883
DOI: 10.1016/j.radonc.2024.110410 -
International Journal of Surgery Case... Jun 2024Vitamin B12 deficiency can manifest through various oral manifestations such as glossitis, glossodynia, recurrent ulcers, cheilitis, dysgeusia, lingual paresthesia,...
INTRODUCTION AND IMPORTANCE
Vitamin B12 deficiency can manifest through various oral manifestations such as glossitis, glossodynia, recurrent ulcers, cheilitis, dysgeusia, lingual paresthesia, burning sensations, and pruritus. These oral signs can serve as early indicators of systemic conditions such pernicious anemia.
CASE PRESENTATION
A 67 year old northern African female presented at the oral surgery service with complaints of a sore mouth and difficulty eating certain types of food. Her medical history revealed hypothyroidism and no history of gastrectomy. She was diagnosed with pernicious anemia in 2014 and is under hydroxocobalamin injection 5000μg/month since then. Dental history indicated extraction of all teeth, and in 2014, the patient was diagnosed with oral lichen planus. There were no contributory oral habits. Intraoral examination revealed a band like erythematous lesion on the palate with two superficial ulcerations, diagnosed as related to her pernicious anemia. The patient was prescribed a mouthwash containing sodium bicarbonate and corticosteroid to reduce inflammation and alleviate pain. A low level laser therapy was also considered to reduce the burning sensations.
CLINICAL DISCUSSION
Pernicious anemia (PA) is an autoimmune disease characterized by the gradual atrophy of the gastric mucosa, predominantly affecting the body and fundus of the stomach, leading to vitamin B12 deficiency. Its insidious onset often masks its presence. Patients have no anemic symptoms. However, they can present with oral manifestations related to vitamin B12 deficiency. Those oral signs can precede hematological symptoms helping in early diagnosis of PA.
CONCLUSION
Dentists and other oral health care providers must be aware of this condition and its oral manifestations. Investigating vitamin B12 levels should be considered in patients presenting with oral ulcers, oral erythema or burning sensations without an apparent origin.
PubMed: 38917702
DOI: 10.1016/j.ijscr.2024.109931 -
Advances in Colloid and Interface... Jun 2024As the potential applications of electrospinning in healthcare continue to be explored, along with advancements in industrial-scale solutions and the emergence of... (Review)
Review
As the potential applications of electrospinning in healthcare continue to be explored, along with advancements in industrial-scale solutions and the emergence of portable electrospinning devices, some researchers have explored electrospinning technology in topical products, including its application in skincare, such as facial masks, beauty patches, sunscreen, and dermatological treatments for conditions like atopic dermatitis, psoriasis, acne, skin cancer, etc. In this review, we first outline the fundamental principles of electrospinning and provide an overview of existing solutions for large-scale production and the components and functionalities of portable spinning devices. Based on the essential functionalities required for skincare products and the mechanisms and treatment methods for the aforementioned dermatological diseases, we summarize the potential advantages of electrospinning technology in these areas, including encapsulation, sustained release, large surface area, and biocompatibility, among others. Furthermore, considering the further commercialization and clinical development of electrospinning technology, we offer our insights on current challenges and future perspectives in these areas, including issues such as ingredients, functionality, residue concerns, environmental impact, and efficiency issues.
PubMed: 38917594
DOI: 10.1016/j.cis.2024.103236 -
PloS One 2024This paper investigates the association between several mental health indicators (depression, anxiety, stress, and loneliness) and the overall tendency to follow...
This paper investigates the association between several mental health indicators (depression, anxiety, stress, and loneliness) and the overall tendency to follow official recommendations regarding self-protection against COVID-19 (i.e., overall compliance). We employ panel data from the COME-HERE survey, collected over four waves, on 7,766 individuals (22,878 observations) from France, Germany, Italy, Spain, and Sweden. Employing a flexible specification that allows the association to be non-monotonic, we find a U-shaped relationship, in which transitions to low and high levels of mental health are associated with higher overall compliance, while transitions to medium levels of mental health are associated with less overall compliance. Moreover, anxiety, stress, and loneliness levels at baseline (i.e., at wave 1) also have a U-shaped effect on overall compliance later (i.e., recommendations are followed best by those with lowest and highest levels of anxiety, stress, and loneliness at baseline, while following the recommendations is lowest for those with moderate levels of these variables). These U shapes, which are robust to several specifications, may explain some of the ambiguous results reported in the previous literature. Additionally, we observe a U-shaped association between the mental health indicators and a number of specific health behaviours (including washing hands and mask wearing). Importantly, most of these specific behaviours play a role in overall compliance. Finally, we uncover the role of gender composition effects in some of the results. While variations in depression and stress are negatively associated with variations in overall compliance for men, the association is positive for women. The U-shaped relation in the full sample (composed of males and females) will reflect first the negative slope for males and then the positive slope for females.
Topics: Humans; COVID-19; Male; Female; Mental Health; Anxiety; Middle Aged; Adult; Depression; Loneliness; Stress, Psychological; SARS-CoV-2; Aged; Surveys and Questionnaires; Health Behavior; Young Adult
PubMed: 38917072
DOI: 10.1371/journal.pone.0305833 -
PloS One 2024When combating a respiratory disease outbreak, the effectiveness of protective measures hinges on spontaneous shifts in human behavior driven by risk perception and...
When combating a respiratory disease outbreak, the effectiveness of protective measures hinges on spontaneous shifts in human behavior driven by risk perception and careful cost-benefit analysis. In this study, a novel concept has been introduced, integrating social distancing and mask-wearing strategies into a unified framework that combines evolutionary game theory with an extended classical epidemic model. To yield deeper insights into human decision-making during COVID-19, we integrate both the prevalent dilemma faced at the epidemic's onset regarding mask-wearing and social distancing practices, along with a comprehensive cost-benefit analysis. We explore the often-overlooked aspect of effective mask adoption among undetected infectious individuals to evaluate the significance of source control. Both undetected and detected infectious individuals can significantly reduce the risk of infection for non-masked individuals by wearing effective facemasks. When the economical burden of mask usage becomes unsustainable in the community, promoting affordable and safe social distancing becomes vital in slowing the epidemic's progress, allowing crucial time for public health preparedness. In contrast, as the indirect expenses associated with safe social distancing escalate, affordable and effective facemask usage could be a feasible option. In our analysis, it was observed that during periods of heightened infection risk, there is a noticeable surge in public interest and dedication to complying with social distancing measures. However, its impact diminishes beyond a certain disease transmission threshold, as this strategy cannot completely eliminate the disease burden in the community. Maximum public compliance with social distancing and mask-wearing strategies can be achieved when they are affordable for the community. While implementing both strategies together could ultimately reduce the epidemic's effective reproduction number ([Formula: see text]) to below one, countries still have the flexibility to prioritize either of them, easing strictness on the other based on their socio-economic conditions.
Topics: Humans; Masks; COVID-19; Game Theory; Physical Distancing; SARS-CoV-2; Cost-Benefit Analysis
PubMed: 38917069
DOI: 10.1371/journal.pone.0301915