Práticas coletivas e individuais associadas à dificuldade dos enfermeiros da atenção primária à saúde / Collective and individual practices associated with the difficulty of primary health care nurses / Prácticas coletivas e individuais asociadas a la dificultad de las enfermeras de atención primaria de salud

Objetivo: analisar as práticas individuais e coletivas que estão associadas as dificuldades dos enfermeiros que atuam na Atenção Primária à Saúde da região Norte. Métodos: observacional de prevalência e analítico. Foram incluídos enfermeiros da atenção básica. A coleta ocorreu entre novembro de 2019 a agosto de 2021, nos sete estados do Norte, através de um formulário eletrônico, analisados pelos testes binomial, quiquadrado e G no programa Bioestat. Resultados: Entre os 626 enfermeiros do estudo, 15,7% (98/626) afirmaram ter dificuldade no exercício de suas práticas, quanto à autonomia das suas responsabilidades normativas legais. O Amapá teve menor proporção (8,3%; 9/108) de enfermeiros com dificuldade em relação a região. As práticas associadas a dificuldade foram: a não participação do enfermeiro no gerenciamento dos insumos (p=0,03), realizar consulta eventualmente (p=0,03) e nunca prescrever medicamentos (p=0,02); resolutividade insuficiente na consulta pré-natal (p=0,000), acompanhamento de crescimento e desenvolvimento infantil (p=0,001); planejamento familiar (p=0,000); hanseníase (p=0,005); tuberculose (p=0,031); hipertensão arterial (p<0,0001); diabetes (p<0,0001). Conclusão: As dificuldades quanto à autonomia das responsabilidades normativas legais estão associadas a práticas individuais e coletivas que são privativas do enfermeiro e estão regulamentadas nos programas de saúde pública. (AU)

Objective: to analyze the individual and collective practices that are associated with the difficulties of nurses who work in Primary Health Care in the North region. Methods: observational of prevalence and analytical. Primary care nurses were included. The collection took place between November 2019 and August 2021, in the seven states of the North, through an electronic form, analyzed by the binomial, chi-square and G tests in the Bioestat program. Results: Among the 626 nurses in the study, 15.7% (98/626) stated that they had difficulty in exercising their practices, regarding the autonomy of their legal normative responsibilities. Amapá had a lower proportion (8.3%; 9/108) of nurses with difficulties in relation to the region. The practices associated with the difficulty were: the non-participation of nurses in the management of supplies (p=0.03), occasional consultations (p=0.03) and never prescribing medication (p=0.02); insufficient resolution in the prenatal consultation (p=0.000), monitoring of child growth and development (p=0.001); family planning (p=0.000); leprosy (p=0.005); tuberculosis (p=0.031); arterial hypertension (p<0.0001); diabetes (p<0.0001). Conclusion: Difficulties regarding the autonomy of legal normative responsibilities are associated with individual and collective practices that are exclusive to nurses and are regulated in public health programs. (AU)

Objetivo: analizar las prácticas individuales y colectivas que están asociadas a las dificultades de los enfermeros que actúan en la Atención Primaria de Salud de la región Norte. Métodos: observacional de prevalencia y analítico. Se incluyeron enfermeras de atención primaria. La colecta se realizó entre noviembre de 2019 y agosto de 2021, en los siete estados del Norte, a través de un formulario electrónico, analizado por las pruebas binomial, chi-cuadrado y G en el programa Bioestat. Resultados: Entre los 626 enfermeros del estudio, 15,7% (98/626) afirmaron tener dificultad en el ejercicio de sus prácticas, en cuanto a la autonomía de sus responsabilidades normativas legales. Amapá tuvo menor proporción (8,3%; 9/108) de enfermeros con dificultades en relación a la región. Las prácticas asociadas a la dificultad fueron: la no participación de los enfermeros en la gestión de los insumos (p=0,03), consultas ocasionales (p=0,03) y nunca recetar medicamentos (p=0,02); resolución insuficiente en la consulta prenatal (p=0,000), seguimiento del crecimiento y desarrollo infantil (p=0,001); planificación familiar (p=0,000); lepra (p=0,005); tuberculosis (p=0,031); hipertensión arterial (p<0,0001); diabetes (p<0,0001). Conclusión: Las dificultades en cuanto a la autonomía de las responsabilidades normativas legales están asociadas a las prácticas individuales y colectivas, exclusivas de los enfermeros y reguladas em los programas de salud pública. (AU)

Características sociodemográficas associadas ao baixo peso e ao excesso de peso em adultos com 50 anos ou mais (ELSI-Brasil): diferenças entre sexos / Sociodemographic characteristics associated with underweight and overweight in adults aged 50 years and over (ELSI-Brasil): differences between sexes / Características sociodemográficas asociadas al bajo peso y al sobrepeso en adultos de 50 años o más (ELSI-Brasil): diferencias entre sexos

Os objetivos foram descrever a prevalência de baixo peso e excesso de peso, avaliados pelo índice de massa corporal (IMC), estratificada por sexo e faixa etária, e analisar as características sociodemográficas associadas ao IMC em mulheres e homens mais velhos. Trata-se de uma análise transversal de 8.974 participantes com ≥ 50 anos da linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil, 2015-16). O IMC foi classificado em baixo peso, eutrofia e excesso de peso de acordo com a idade do participante. Foi utilizado modelo de regressão logística multinominal, considerando-se as características sociodemográficas de mulheres e homens. Os resultados evidenciaram maior prevalência de excesso de peso nas mulheres em comparação aos homens (64,1% vs. 57,3%). Em ambos os sexos, a prevalência de baixo peso foi maior nos mais longevos, enquanto que o excesso de peso foi menor. Nas mulheres, a chance de baixo peso foi maior do que a chance de eutrofia naquelas solteiras/viúvas/divorciadas (OR = 1,95; IC95%: 1,42-2,66) e nas residentes na área rural (OR = 1,58; IC95%: 1,01-2,49), ao passo que a chance de excesso de peso foi menor do que a chance de eutrofia nas residentes na área rural (OR = 0,78; IC95%: 0,62-0,97) e em todas as macrorregiões geográficas relativas à Região Sul. Para os homens, a chance de excesso de peso foi menor do que a chance de eutrofia entre solteiros/viúvos/divorciados (OR = 0,58; IC95%: 0,48-0,69). Os mais ricos apresentaram menor chance de baixo peso (OR = 0,59; IC95%: 0,38-0,90), bem como maior chance de excesso de peso (OR = 1,52; IC95%: 1,20-1,92). Em conclusão, as características sociodemográficas associadas ao IMC diferiram entre os sexos.

The objective were to describe the prevalence of underweight and overweight, assessed by body mass index (BMI), stratified by sex and age group, and to analyze the sociodemographic characteristics associated with BMI in older women and men. This is a cross-sectional analysis of 8,974 participants aged ≥ 50 years from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brasil, 2015-2016). BMI was classified as underweight, eutrophy, and overweight according to the participant's age. A multinomial logistic regression model was used, considering the sociodemographic characteristics of women and men. The results showed a higher prevalence of overweight in women compared to men (64.1% vs. 57.3%). In both sexes, the prevalence of underweight was higher in the longest-lived individuals, while overweight was lower. In women, the chance of underweight was higher than the chance of eutrophy in those who were single/widowed/divorced (OR = 1.95; 95%CI: 1.42-2.66) and in those living in rural areas (OR = 1.58; 95%CI: 1.01-2.49), while the chance of being overweight was lower than the chance of being eutrophy in those living in rural areas (OR = 0.78; 95%CI: 0.62-0.97) and in all geographic macro-regions related to the South Region. For men, the chance of being overweight was lower than the chance of being eutrophy among single/widowed/divorced individuals (OR = 0.58; 95%CI: 0.48-0.69). The richest had a lower chance of being underweight (OR = 0.59; 95%CI: 0.38-0.90), as well as a higher chance of being overweight (OR = 1.52; 95%CI: 1.20-1.92). In conclusion, the sociodemographic characteristics associated with BMI differed between the sexes.

Los objetivos fueron describir la prevalencia de bajo peso y sobrepeso, evaluados a través del índice de masa corporal (IMC), estratificada por sexo y grupo de edad, y analizar las características sociodemográficas asociadas al IMC en mujeres y hombres mayores. Se trata de un análisis transversal de 8.974 participantes con ≥ 50 años de la línea de base del Estudio Longitudinal Brasileño sobre el Envejecimiento (ELSI-Brasil, 2015-2016). Se clasificó el IMC en bajo peso, eutrofia y sobrepeso conforme la edad del participante. Se utilizó el modelo de regresión logística multinomial, teniendo en cuenta las características sociodemográficas de mujeres y hombres. Los resultados evidenciaron una prevalencia más alta de sobrepeso en las mujeres en comparación con los hombres (64,1% vs. 57,3%). En ambos sexos, la prevalencia de bajo peso fue más alta en los grupos de mayor edad, mientras que la prevalencia del sobrepeso fue menor. La chance de bajo peso fue más alta que la chance de eutrofia en las mujeres solteras/viudas/divorciadas (OR = 1,95; IC95%: 1,42-2,66) y en las que viven en el área rural (OR = 1,58; IC95%: 1,01-2,49), mientras que la chance de sobrepeso fue menor que la chance de eutrofia en las que viven en el área rural (OR = 0,78; IC95%: 0,62-0,97) y en todas las macrorregiones geográficas relacionadas a la región Sur. La chance de sobrepeso fue menor que la chance de eutrofia entre los hombres solteros/viudos/divorciados (OR = 0,58; IC95%: 0,48-0,69). Los más ricos presentaron una chance menor de bajo peso (OR = 0,59; IC95%: 0,38-0,90), así como una chance más alta de sobrepeso (OR = 1,52; IC95%: 1,20-1,92). En conclusión, las características sociodemográficas asociadas al IMC difirieron entre los sexos.

Anatomic barriers to paraspinal blocks: a cadaver case series

Abstract The paraspinal space is intriguing in nature. There are several needle tip placements described in compact anatomical spaces. This has led to an incertitude regarding the appropriate anatomic locations for needle tip positions. Through our cadaver models we try to resolve the issues surrounding needle tip positions clarifying anatomical spaces and barriers. Further we propose an anatomical classification based on our findings in cadaveric open dissections and cross and sagittal sections.

Habilidades sociais na especialidade da enfermagem em oncologia: estudo qualitativo / Social skills in the nursing specialty in oncology: qualitative study / Habilidades sociales en la especialidad de enfermería en oncología: estudio cualitativo

Objetivo: compreender o significado das habilidades sociais atribuído por enfermeiros especialistas em enfermagem em oncologia. Método: estudo qualitativo, exploratório, que aplicou a Teoria Fundamentada nos Dados e o Interacionismo Simbólico. Participaram 14 enfermeiros de um dos grupos amostrais, especialistas em oncologia, de hospital oncológico. Aplicamos a entrevista semiestruturada, on-line, de maio de 2021 a dezembro de 2022. A análise seguiu a codificação aberta, axial e integração, e aplicamos o paradigma da codificação. Resultados: a categoria paradigmática 'condição do fenômeno' é apresentada face o aspecto semântico e de reconhecimento da aplicação das habilidades sociais. A categoria Percepções e significados das habilidades sociais para enfermeiros oncologistas alicerçou-se nas subcategorias: reagindo ao termo, e atribuindo significados e valores às habilidades sociais na especialidade da enfermagem em oncologia. Conclusão: os enfermeiros reconhecem as habilidades sociais e sua importância na oncologia. Desse modo, reitera-se a importância da articulação teórico-prático para qualificar a prática na oncologia.

Objective: to understand the meaning of social skills attributed by specialist nurses in oncology nursing. Method: a qualitative, exploratory study, which applied Grounded Theory and Symbolic Interactionism. The participants were 14 nurses from one of the sample groups, specialists in oncology, from an oncological hospital. We applied semi-structured interviews, online, from May 2021 to December 2022. The analysis followed open, axial, and integration coding, and the coding paradigm. Results: we present the paradigm condition category, given the semantic aspect and recognition of the application of social skills. The category Perceptions and meanings of social skills for oncology nurses was based on the subcategories: reacting to the term, and attributing meanings and values to social skills in the specialty of nursing in oncology. Conclusion: nurses recognize social skills and their importance in oncology. We reinforce the importance of theoretical-practical articulation to qualify the practice in oncology.

Objetivo: comprender el significado de las habilidades sociales atribuido por enfermeros especialistas en enfermería oncológica. Método: estudio cualitativo, exploratorio, que aplicó la Teoría Fundamentada y el Interaccionismo Simbólico. 14 enfermeros, expertos en oncología, participaron en uno de los grupos de muestreo de un hospital oncológico. Aplicamos entrevistas semiestructuradas, en línea, de mayo de 2021 a diciembre de 2022. El análisis siguió la codificación abierta, axial y de integración, y aplicamos el paradigma de la codificación. Resultados: se presentó la categoría paradigmática 'condición del fenómeno' ante el aspecto semántico y de reconocimiento de la aplicación de habilidades sociales. La categoría 'Percepciones y significados de las habilidades sociales para enfermeros de oncología' se basó en las subcategorías: reaccionando al término y atribuyendo significados y valores a las habilidades sociales en la especialidad de enfermería en oncología. Conclusión: los enfermeros reconocen las habilidades sociales y su importancia en la oncología. Siendo así, reforzamos la importancia de la articulación teórico-práctica para cualificar la práctica en oncología.

Identification of rare atypical BCR-ABL1 transcript: A case report

CML is characterized by the presence of a BCR-ABL1 fusion transcript. Several guidelines have been published for its detection and molecular monitoring. Here, a case is described of chronic myeloid leukemia presenting in the blast phase with a rare variant transcript, with a discussion on possible red flags in its detection and genetic testing and description of the patient's clinical characteristics. This case highlights the pitfalls of using real-time quantitative reverse-transcription polymerase chain reaction (RQ-PCR) for diagnosis of CML, especially when the clinical picture and the test results are discordant.

Evaluation of contact angle and mechanical properties of resin monomers filled with graphene oxide nanofibers

Abstract This in vitro study synthesized hybrid nanofibers embedded in graphene oxide (GO) and incorporated them into experimental resin composite monomers to evaluate their physical-mechanical properties. Inorganic-organic hybrid nanofibers were produced with precursor solutions of 1% wt. GO-filled Poly (d,l-lactide, PLA) fibers and scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) characterized the morphology and chemical composition of the spun fibers. Resin composite monomers were developed and a total of 5% nanofibers were incorporated into the experimental materials. Three groups were developed: G1 (control resin monomers), G2 (resin monomers/PLA nanofibers), and G3 (resin monomers/inorganic-organic hybrid nanofibers). Contact angle (n=3), flexural strength (n=22), elastic modulus (n=22), and Knoop hardness (n=6) were evaluated. The mean of the three indentations was obtained for each sample. The normality of data was assessed by QQ Plot with simulated envelopes and analyzed by Welch's method (p<0.05). Overall, SEM images showed the regular shape of nanofibers but were non-aligned. Compositional analysis from EDS (n=6) revealed the presence of carbon and oxygen (present in GO composition) and Si from the functionalization process. The results of contact angle (°) and hardness (Kg/mm2) for each group were as follow, respectively: G1 (59.65±2.90; 37.48±1.86a), G2 (67.99±3.93; 50.56±1.03b) and G3 (62.52±7.40; 67.83±1.01c). The group G3 showed the highest Knoop hardness values (67.83 kg/mm2), and the flexural strength of all groups was adversely affected. The experimental resin composite composed of hybrid nanofibers with GO presented increased hardness values and hydrophilic behavior.

Resumo Este estudo in vitro sintetizou nanofibras híbridas embebidas em óxido de grafeno (GO), incorporando-as à uma resina composta experimental de monômeros para avaliar suas propriedades físico-mecânicas. Nanofibras híbridas inorgânica-orgânicas foram produzidas com soluções precursoras de fibras poli (d, l-lactídeo, PLA) preenchidas com GO a 1% em peso e microscopia eletrônica de varredura (MEV) e espectroscopia de raio-X de energia dispersiva (EDS) caracterizaram a morfologia e composição química das fibras. Monômeros de resina composta foram desenvolvidos e um total de 5% de nanofibras foi incorporado aos materiais experimentais. Três grupos foram desenvolvidos: G1 (monômeros de resina controle), G2 (monômeros de resina/ nanofibras de PLA) e G3 (monômeros de resina/nanofibras híbridas inorgânico-orgânicas). Ângulo de contato (n=3), resistência à flexão (n=22), módulo de elasticidade (n=22) e dureza Knoop (n=6) foram avaliados. A média das três endentações foi obtida para cada amostra. A normalidade dos dados foi avaliada pelo QQ Plot com envelopes simulados e analisada pelo método de Welch (p<0,05). No geral, as imagens de MEV mostraram forma regular de nanofibras, mas não alinhadas. A análise composicional de EDS (n=6) revelou a presença de carbono e oxigênio (presentes na composição do GO) e Si resultante do processo de funcionalização. Os resultados do ângulo de contato (°) e dureza (Kg/mm2) para cada grupo foram os seguintes, respectivamente: G1 (59,65±2,90; 37,48±1,86a), G2 (67,99±3,93; 50,56±1,03b) e G3 (62,52±7,40; 67,83±1,01c). G3 apresentou os maiores valores de dureza Knoop (67,83 kg/mm2), e a resistência à flexão de todos os grupos foi prejudicada. A resina composta experimental composta por nanofibras híbridas com GO apresentou maiores valores de dureza e comportamento hidrofílico.

THE IMPACT OF SUPPLY CHAIN MANAGEMENT PRACTICES ON PRODUCTIVITY

The purpose of the study is to test the impact of supply chain management practices on productivity of the organisation. Additionally, investigated the relationship between supply chain management practices and organisational productivity. The type of research used is descriptive in nature.. The study was conducted on the basis of various factors like risk management, process, delivery and planning and how organisational productivity can be improved through these factors of supply chain management practices. The paper revealed that there is a relationship between supply chain management practices and organisational productivity. It also revealed that there is an impact of supply chain management practices on organisational productivity. As far as the researcher is aware,this paper is rst to investigate the impact of supply chain management practices on organisational productivity with factors like quality management, inventory management and transportation and the researcher has done the study on different factors like risk management, planning, process and delivery

Food consumption is associated with frailty in edentulous older adults: evidence from the ELSI-Brazil study / Consumo alimentar está associado à fragilidade em adultos mais velhos edêntulos: evidências do estudo ELSI-Brasil

Abstract This cross-sectional study aimed to evaluate the association between food consumption (meat, fish, and fruits and vegetables), anthropometric indicators (body mass index, waist circumference, and waist-to-height ratio), and frailty; and to verify whether these associations vary with edentulism. We used data from 8,629 participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) (2015-16). Frailty was defined by unintentional weight loss, weakness, slow walking speed, exhaustion, and low physical activity. Statistical analyses included multinomial logistic regression. Of the participants, 9% were frail and 54% pre-frail. Non-regular meat consumption was positively associated with pre-frailty and frailty. Non-regular fish consumption, and underweight were associated only with frailty. Models with interactions reveled a marginal interaction between meat consumption and edentulism (p-value = 0.051). After stratification, non-regular meat consumption remained associated with frailty only in edentulous individuals (OR = 1.97; 95%CI 1.27-3.04). Our results highlight the importance of nutritional assessment, oral health, and public health-promoting policies to avoid, delay and/or reverse frailty in older adults.

Resumo Este estudo transversal teve como objetivo avaliar a associação entre consumo alimentar (carnes, peixe e frutas e hortaliças), indicadores antropométricos (índice de massa corporal, circunferência da cintura e relação cintura/estatura) e fragilidade; e verificar se essas associações variam com o edentulismo. Usamos dados de 8.629 participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil) (2015-16). A fragilidade foi definida por perda de peso não intencional, fraqueza, baixa velocidade da marcha, exaustão e baixa atividade física. As análises estatísticas incluíram regressão logística multinomial. Dos participantes, 9% eram frágeis e 54% pré-frágeis. O consumo não regular de carnes foi positivamente associado à pré-fragilidade e fragilidade. O consumo não regular de peixe e o baixo peso foram associados apenas à fragilidade. Modelos com interações revelaram uma interação marginal entre consumo de carnes e edentulismo (p-valor = 0,051). Após estratificação, o consumo não regular de carnes permaneceu associado à fragilidade apenas em indivíduos edêntulos (OR = 1,97; IC95% 1,27-3,04). Nossos resultados destacam a importância da avaliação nutricional, saúde bucal e políticas públicas de promoção da saúde para evitar, retardar e/ou reverter a fragilidade em adultos mais velhos.

Incremental innovations in operation theaters

Background: The field of ophthalmology has been built upon continuous innovations. COVID?19 pandemic has been an important driving force behind many innovations in ophthalmology and other branches of medicine. Innovations in ophthalmology has been a key to surgical progress. The process of promoting innovation in surgery is imperative in the evolving practice of ophthalmology. Purpose: In this video we demonstrate some incremental innovations in operation theaters which help in increasing the efficiency and improving the performance of a surgeon. These innovations also provide a more comfortable environment for the patient undergoing the surgery. Synopsis: A few incremental innovations that are described in our video also help in preventing the spread of COVID infection during surgery. This video also showcases a few wet lab innovations that help train residents in their surgical skills. Highlights: Use and reuse of simple materials make it cost effective and ecofriendly. These incremental innovations help in the smooth running of operation theaters. Thus, they are small improvements in the existing setup and help in creating a smooth and error free OT flow

Chop and tumble nucleotomy – A technique for safe nuclear emulsification in posterior polar cataract

A modified phaco chop technique for nuclear emulsification in posterior polar cataracts with nuclear sclerosis that avoids hydrodissection or nuclear rotation has been described. After performing a vertical chop maneuver to divide the nucleus, two pie-shaped nuclear fragments are removed from either side of the initial chop. The remaining nuclear fragments are then sequentially tumbled toward the center using the second instrument and emulsified while maintaining an intact epinuclear shell, which safeguards the fragile posterior capsule. The technique was successfully performed in 62 eyes of 54 patients with posterior polar cataract and grade II–IV nuclear sclerosis. The Chop and Tumble nucleotomy is a safe and effective technique for phacoemulsification in posterior polar cataracts with nuclear sclerosis, where hydrodissection and nuclear rotation are typically avoided

A Case Series of Histoid Leprosy with a Brief Comparison of the Clinical Features with that of Lepromatous Leprosy

Histoid leprosy (HL) is a rare highly bacilliferous variant of lepromatous leprosy (LL). We are describing here a case series of HL in a tertiary care centre along with a comparison of the clinical features with cases of LL encountered in the same centre. There were 6 cases of HL in our centre for the past 10 years accounting for 1.86% of the total number of leprosy cases. HL constituted 11.54% of the total LL cases. 4 cases were de novo HL and 2 cases due to relapse. Papules, plaques and nodules were the commonest primary skin lesions. The distribution was localised in HL, mainly confined to the upper and lower limbs, while in LL it was symmetrical and generalised and mainly localised to the trunk. Superciliary madarosis, ear lobe infiltration, glove and stocking type of anaesthesia were found in the majority of LL, while lacking in HL patients. Type 2 lepra reaction and Grade 2 disability was much more common in LL, than HL. A very important finding in this case series is that the mean BI and MI of HL was more than in LL. All the patients were given of MB-MDT for 12 months and in patients who had initial BI of 4+ or more were given 24 months treatment and there were no cases of relapse after release from treatment

Post mastectomy pain syndrome at an Indian tertiary cancer centre and its impact on quality of life

Background: Literature on Post mastectomy pain in the Indian population is scarce. Most literature is from the West. The current study aimed to identify the incidence of post?mastectomy pain syndrome (PMPS), pain severity, and its impact on quality of life in Indian patients. Method: Prospective observational study of 120 women undergoing mastectomy between March and December 2017, followed until 6 months after surgery. The Brief Pain Inventory (BPI) questionnaire and the quality of life questionnaire (QLQ) by the European Organization for Research and Treatment of Cancer (EORTC) and known as (EORTC?QLQ 30) were used to identify the impact on function and quality of life. Results: A 35.8% PMPS incidence was identified at 6 months after mastectomy. Pain was located in the anterior chest wall (41.8%), axilla (32.6%), and medial upper arm (25.6%). Most (48.8%) patients described it as dull aching and of mild intensity (55.8%). No significant association of age, BMI, surgery, Intercostobrachial nerve (ICBN) dissection, postoperative pain severity, pain history {dysmenorrhea, headache}, and postoperative radiotherapy with PMPS was found. Pain interfered with daily activities and quality of life in those with PMPS, as deduced from BPI and EORTC?QLQ. Conclusion: PMPS is very much a problem affecting the quality of life in our set of patients. Most women tried to cope and accept the pain as part of the treatment process. This shows the need for creating awareness about PMPS among healthcare providers and patients alike. Early identification and treatment of post mastectomy pain should be an essential aspect of patient care

SEMICONDUCTOR INDUSTRY IN INDIA- USHERING ITS WAY INTO A NEW ERA

This paper focuses on the current state of the semiconductor industry at the global level as well as in India. With semiconductor chips emerging as the new gold, its demand is highest now than it was ever before. The demand for semiconductor chips in India is said to reach a gure of whopping US 110 billion dollars by 2030. In recent years, this industry has witnessed a crunch in its supply due to supply-side and demand-side constraints. This paper sheds light on the causes of these limits. Moreover, many countries are acquainted with this industry's scope in the future. India recognizes its dependence on countries like China for semiconductors. So, it aims to become a manufacturing hub for this industry and not just remain a fabless industry. However, India is encountering hurdles in this process. With this perception, this study has tried to explore India's initiatives in this direction. Keeping in mind India's vision of Aatmanirbhar Bharat, it seems like it's a long and rough road ahead to make the semiconductor industry in India, a self-reliant industry. This analytical study infers that overcoming these obstacles is going to become increasingly onerous.

Pancycle Aortic Incompetence and Double Alternans in Pediatric Heart Failure

A 12?year?old boy presented with bicuspid aortic valve, severe aortic regurgitation, and dilated dysfunctional left ventricle in heart failure. He underwent aortic valve replacement with a 23 mm TTK Chitra heart valve prosthesis (tilting disk). He was gradually weaned off milrinone and noradrenaline in the intensive care. Echocardiography showed severe left ventricular dysfunction with an ejection fraction of 24%. The radial pulse was regular and of normal volume but exactly half that of the heart rate. Evaluation of the rhythm and echocardiography revealed an interesting hemodynamic phenomenon with double alternans.

Cardiopulmonary Bypass Surgery?Cold Alert!

The term 揷old agglutinin (CA)� refers to a group of disorders caused by anti?erythrocyte autoantibodies that preferentially bind RBCs at cold temperatures (4癈�癈). CAs contribute to 10 to 15% of autoimmune hemolytic anemia. We report a case of CAs diagnosed intraoperatively during emergency mitral valve replacement.

Evaluation of the effects of Albizia lebbeck bark extracts on the cariogenic properties of Streptococcus mutans

Introduction: Oral diseases continue to be a major and common health problem worldwide and affect the quality of life by causing considerable pain and discomfort. While the mechanistic methods of caries prevention and treatment are in vogue, the concern about adverse effects of the constituents of these methods persists. Thus, there has always existed a need to develop effective and safe strategies to combat oral pathogens such as Streptococcus mutans (S. mutans). Aim: To examine the action of Albizia lebbeck (A. lebbeck) bark extracts on the growth and virulence factors of S. mutans such as- biofilm formation, surface adherence, cell surface hydrophobicity and acid production. Materials and Methods: Ethyl acetate, hexane, and chloroform extracts of the bark of A. lebbeck was prepared and tested for their activity against the ATCC 25175 S. mutans. The phytochemical constituents of the extracts were determined by biochemical assays and the MIC (Minimum Inhibitory Concentration) and MBC (Minimum Bactericidal Concentration) were obtained using the well diffusion assay. The effect of the sub-MIC concentrations of extracts on biofilm formation & eradication, microbial growth, adherence of the strain to glass surfaces, cell surface hydrophobicity and acid production were also determined. Results: All extracts inhibited the organism’s growth, and MIC was determined as 25 mg/ml. the sub-MIC concentrations of the extracts were found to- inhibit the formation of biofilms, eradicate formed biofilms and interfere with the adherence and acid production of S. mutans. Conclusion: The ethyl acetate and ethanolic extracts were found to be active at low concentrations (0.02mg/ml) and demonstrate a potential to be used in the formulation of anti-caries preparations.

PERIOPERATIVE CONCERNS OF VENTRICULOATRIAL SHUNT-A RETROSPECTIVE ANALYSIS OF 40 CASES.

Background: Ventriculo -peritoneal [VP] shunt is the most commonly used cerebrospinal ?uid (CSF) diversion procedure for the management of hydrocephalus. However, when the absorption of CSF from the peritoneum is defective, it results in abdominal distension with CSF ascites. In such cases, an alternate diversion procedure - the ventriculo-atrial [VA] shunt – may be performed. However, this procedure is also associated with several perioperative problems like arrhythmias, air embolism and infection. Materials and methods: A retrospective analysis of 40 cases on the perioperative concerns of VA shunt procedures, performed in our institute, was done. Indication of the shunt, preoperative status & work -up, intraoperative adverse events & management and immediate post-operative complications were assessed. Out of the 40 patients, there were 25 male Results: s and 15 females and there were a total of 12 paediatric patients. Blocked shunt, abdominal infection and CSF ascites were common indications for VA shunt. All patients received general endotracheal anaesthesia with preoperative hypovolemia correction. Intraoperative tachycardia and arrhythmia were noted. Various Conclusion : preoperative concerns like distended abdomen and compromised respiration increase risk of VA shunt procedures. A better understanding of the underlying disease pathology and anticipation of related complications along with cautious and meticulous management can help prevent most of the complications of VA shunt procedure and thereby improve outcome

Clinico-laboratory Profile and Outcomes of Megaloblastic Anemia presenting as Severe Pyrexial Illness mimicking Tropical Infection

Background: Anemia-causing fever has been described in patients with megaloblastic anemia. Although the exact mechanism of this is unknown, high-grade fever is relatively less reported. Materials and methods: This prospective observational study included all new cases of megaloblastic anemia presenting with febrile illness (>101°F) during a 3-year period. Patients with existing anemia, comorbidities, and other causes of macrocytosis were excluded. A detailed evaluation for megaloblastic anemia and workup for excluding tropical infections was done. The patients were treated with parenteral vitamin B12, folic acid, and other hematinics. Results: Around 24 cases of megaloblastic anemia presenting with high-grade fever were included, with 14 (58.3%) males, mean duration of fever 7.7 days (4–18 days), and 09 (37.5%) having temperature >103°F. The mean hemoglobin (Hb) was 8.15 g/dL (3.7–11.1 g/dL), the mean corpuscular volume (MCV) was 111 ± 7.8 fL, 18 (75%) had unconjugated hyperbilirubinemia, the mean lactate dehydrogenase (LDH) was 814 ± 24 IU/L, and 21 (87.5%) had low B12 or folate levels. Most showed good therapeutic response to B12 or folic acid with defervescence in 1–5 days (mean 2.6 days) and improvement in lab parameters in 1 week. The study population was divided into those with temperature ?103°F, and temperature <103°F it was seen that there was a significant association (p < 0.05) with leucocyte count of ?3000/cumm, and MCV ?110 fL, in patients with temperature ?103°F Conclusion: Megaloblastic anemia should be considered in the differentials of a patient presenting with a febrile illness with no clinical localization and a negative initial fever workup. Early identification and prompt therapy of this easily treatable disorder are very essential.

Ultrasound-guided continuous costoclavicular block through retrograde stimulating catheter technique for postoperative analgesia in shoulder surgery: a case series

Abstract In five patient undergoing surgery for proximal humerus fracture we investigated into postoperative analgesia provided by continuous costoclavicular block using continuous stimulating catheter. The postoperative pain scores were less than 4 in all patients except in two patients who required intravenous tramadol 50 mg as a rescue analgesic. The radiocontrast dye study executed in two patients revealed contiguous contrast spread through the brachial plexus sheath with the catheter tip in the interscalene space. We propose that a continuous costoclavicular block with a retrograde stimulating catheter is a feasible alternative regional anesthesia technique for postoperative analgesia in shoulder surgery.

Consensus Statement of the Neurodevelopmental Pediatrics Chapter of Indian Academy of Pediatrics (IAP) on the Management of Children With Down Syndrome

Justification: The diagnosis of Down syndrome (DS) is easily made clinically but the management is multi-disciplinary and life-long. There is no standard protocol available for its management in India. Process: A committee was formed under the Indian Academy of Pediatrics (IAP) chapter of Neuro developmental pediatrics consisting of 20 experts working in the related field. The various aspects of the condition were discussed and allotted to the concerned experts related for preparing the guidelines. The material received was collated to form a set of guidelines, which were reviewed by the committee, and a consensus statement made. The guidelines were then approved by the chapter, and by the IAP. Objectives: To define the condition and to look into the various aspects of antenatal and postnatal diagnosis. To explain briefly about the involvement of the various systems that are involved and formulate recommendations for management. To recommend early and sustained interventional therapies to enable children with DS lead an independent life. Recommendations: The stress on bio-psycho-social strategy for the management of children with DS is reiterated, and the need for a medical, social and rights model is recommended after each section. The age-wise recommendations are also highlighted in addition to the recommendations under each system.