Intraoperative aerosol box use: does an educational visual aid reduce contamination? / 대한마취과학회지

Background@#The aerosol box was rapidly developed and disseminated to minimize viral exposure during aerosolizing procedures during the COVID-19 pandemic, yet users may not understand how to use and clean the device. This could potentially lead to increased viral exposure to subsequent patients and practitioners. We evaluated intraoperative contamination and aerosol box decontamination and the impact of a preoperative educational visual aid. @*Methods@#Using a double-blinded randomized design, forty-four anesthesiology trainees and faculty completed a simulated anesthetic case using an aerosol box contaminated with a fluorescent marker; half of the subjects received a visual aid prior to the simulation. Intraoperative contamination was evaluated at 10 standardized locations using an ultraviolet (UV) light. Next, subjects were instructed to clean the aerosol box for use on the next patient. Following cleaning, the box was evaluated for decontamination using an UV light. @*Results@#Median total contamination score was significantly reduced in the experimental group (5.0 vs. 10.0, P < 0.001). The aerosol box was completely cleaned by 36.4% of subjects in the experimental group compared to 4.5% in the control group (P = 0.009). @*Conclusions@#The use of a visual aid significantly decreased intraoperative contamination and improved box cleaning. Despite these findings, a potentially clinically significant amount of viral exposure may exist. Thorough evaluation of the risks and benefits of the aerosol box should be completed prior to use. If an aerosol box is used, a visual aid should be considered to remind practitioners how to best use and clean the box.

Celastrus paniculatus oil ameliorates synaptic plasticity in a rat model of attention deficit hyperactivity disorder

Objective: To explore the effect and mechanism of action of Celastrus paniculatus oil on the treatment of perinatal rats with attention deficit hyperactivity disorder. Methods: In the perinatal stage, the rats were either isolated or administered with lead acetate to establish an animal model of attention deficit hyperactivity disorder. Atomoxetine served as the reference standard. Animals' behaviours were assessed through Y-maze, novel object preference, fear conditioning and residentintruder aggression tests. Oxidative stress parameters, bioamine concentration (dopamine, noradrenaline and 5-hydroxytryptamine), nerve growth factor, interleukin-6, nuclear factor-κB, and tumour necrosis factor (TNF)-α were estimated. Synaptophysin immunohistochemical assay was performed. Results: Celastrus paniculatus oil significantly improved behavioural parameters in Y maze, novel object preference, discrimination index, fear conditioning and resident intruder aggressive tests. The treatment groups showed a decrease in malondialdehyde level. Changes in the levels of dopamine, noradrenaline, and serotonin were restored by Celastrus paniculatus oil. Celastrus paniculatus oil increased nerve growth factor and decreased interleukin-6, nuclear factor-κB, and TNF-α. Synaptophysin immunoreactivity was also improved by Celastrus paniculatus oil with alleviated reactive gliosis, degeneration, and vascular proliferation. Conclusions: This research shows the therapeutic potential of Celastrus paniculatus oil for the treatment of attention deficit hyperactivity disorder.

Celastrus paniculatus oil ameliorates synaptic plasticity in a rat model of attention deficit hyperactivity disorder

Objective: To explore the effect and mechanism of action of Celastrus paniculatus oil on the treatment of perinatal rats with attention deficit hyperactivity disorder. Methods: In the perinatal stage, the rats were either isolated or administered with lead acetate to establish an animal model of attention deficit hyperactivity disorder. Atomoxetine served as the reference standard. Animals' behaviours were assessed through Y-maze, novel object preference, fear conditioning and residentintruder aggression tests. Oxidative stress parameters, bioamine concentration (dopamine, noradrenaline and 5-hydroxytryptamine), nerve growth factor, interleukin-6, nuclear factor-κB, and tumour necrosis factor (TNF)-α were estimated. Synaptophysin immunohistochemical assay was performed. Results: Celastrus paniculatus oil significantly improved behavioural parameters in Y maze, novel object preference, discrimination index, fear conditioning and resident intruder aggressive tests. The treatment groups showed a decrease in malondialdehyde level. Changes in the levels of dopamine, noradrenaline, and serotonin were restored by Celastrus paniculatus oil. Celastrus paniculatus oil increased nerve growth factor and decreased interleukin-6, nuclear factor-κB, and TNF-α. Synaptophysin immunoreactivity was also improved by Celastrus paniculatus oil with alleviated reactive gliosis, degeneration, and vascular proliferation. Conclusions: This research shows the therapeutic potential of Celastrus paniculatus oil for the treatment of attention deficit hyperactivity disorder.

Intraoperative aerosol box use: does an educational visual aid reduce contamination? / 대한마취과학회지

Background@#The aerosol box was rapidly developed and disseminated to minimize viral exposure during aerosolizing procedures during the COVID-19 pandemic, yet users may not understand how to use and clean the device. This could potentially lead to increased viral exposure to subsequent patients and practitioners. We evaluated intraoperative contamination and aerosol box decontamination and the impact of a preoperative educational visual aid. @*Methods@#Using a double-blinded randomized design, forty-four anesthesiology trainees and faculty completed a simulated anesthetic case using an aerosol box contaminated with a fluorescent marker; half of the subjects received a visual aid prior to the simulation. Intraoperative contamination was evaluated at 10 standardized locations using an ultraviolet (UV) light. Next, subjects were instructed to clean the aerosol box for use on the next patient. Following cleaning, the box was evaluated for decontamination using an UV light. @*Results@#Median total contamination score was significantly reduced in the experimental group (5.0 vs. 10.0, P < 0.001). The aerosol box was completely cleaned by 36.4% of subjects in the experimental group compared to 4.5% in the control group (P = 0.009). @*Conclusions@#The use of a visual aid significantly decreased intraoperative contamination and improved box cleaning. Despite these findings, a potentially clinically significant amount of viral exposure may exist. Thorough evaluation of the risks and benefits of the aerosol box should be completed prior to use. If an aerosol box is used, a visual aid should be considered to remind practitioners how to best use and clean the box.

Reproductive counseling and pregnancy outcomes after radical trachelectomy for early stage cervical cancer / 부인종양

OBJECTIVE: To evaluate patient perceptions of preoperative reproductive counseling and to evaluate complications and pregnancy outcomes in women who had radical trachelectomy (RT) for early stage cervical cancer. METHODS: Patients who underwent RT from January 1, 2004, through July 31, 2017, and had been cancer free for more than 1 year after RT were eligible; consented patients were sent a 16-item online survey. RESULTS: Of the 58 eligible patients, 39 patients (67%) completed the questionnaire. Eighteen patients (46%) reported receiving reproductive counseling and 26 (68%) reported receiving counseling about pregnancy risks and complications prior to RT, mainly delivered by gynecologic oncologists. Twenty-nine patients (74%) reported having a complication after RT, and cervical stenosis was the most common complication, occurring in 13 patients (33%). Twenty-four patients actively attempted to conceive after RT, and 20 pregnancies were achieved in 13 patients for a pregnancy rate of 54%. Eight pregnancies were spontaneous and 12 required a fertility treatment. There were 5 spontaneous first-trimester miscarriages; 14 of the 20 pregnancies (70%) resulted in live births. The median time to conception was 13.5 months (range, 1–120). CONCLUSION: A significant proportion of women with early stage cervical cancer do not receive adequate reproductive counseling before RT, and many women undergoing RT experience complications that can negatively impact their fertility. We recommend a preoperative consultation with a reproductive endocrinologist for all patients considering RT.

AAA syndrome, case report of a rare disease

Triple A [Allgrove] syndrome, an autosomal recessive disease is characterized by achalasia, alacrimia and ACTH-resistant adrenal failure with progressive neurological syndrome including central, peripheral and autonomic nervous system impairment, and mild mental retardation. The triple A syndrome gene, designated AAAS, localized on chromosome 12q 13 encodes for a 546 amino acid protein called ALADIN [Alacrimia-Achlasia-Adrenal Insufficiency and Neurologic disorder]. This report relates to two sisters, aged 8 and 12 years, who had vomiting, muscle weakness, alacrimia, excessive fatigue and dysphagia. Abdominal sonography, esophago-gastroduodenoscopy, barium swallow, esophageal manometry, CT scan abdomen and brain, biochemical profiles, as well as neurologic and ophthalmic evaluations were consistent with Allgrove's syndrome. Management consisted of pneumatic balloon dilatation for achalasia and initiation of cortisone therapy with successful resolution of dysphagia and other symptoms

Pneumatic Balloon Dilatation for Achalasia Cardia; Early and late results, a single center study

Objective: Achalasia Cardia is treated by Pneumatic balloon dilatation, Heller's Myotomy and recently, by Peroral Esophagaeal Myotomy. This study reports the efficacy of pneumatic balloon dilatation as a non-surgical motility in achieving relief of dysphagia, clinical improvement and recurrence. Long-term complications were reported

Methods: Eight hundred ninety two adult achalasia patients of both genders were treated from January 1988 till December 2011, with pneumatic balloon [Rigiflex Microvasive] dilatation, under fluoroscopy Barium swallow was obtained prior to and five minutes after dilatation to evaluate for efficacy of dilatation as well as for complications. Patients not responding to 30 mm balloon had repeat dilatation with 35 mm balloon after 8 weeks. All patients were enrolled in regular follow up at one, six months and yearly intervals up to a period of five years. Recurrence was defined as an increase in symptom score at 8 weeks greater than 50% of their baseline value. These patients were treated with 35 mm balloon or referred for surgical intervention

Results: Of 892 patients, follow up was obtained in 50% for 5 years, 9.2% for 4-years, 9.3% for 3-years, 10% for 2-years and 21.5% for 1-year of patients. One patient died after repeat dilatation. Eighty-eight patients were excluded from this analysis [20 died due to non-procedure related causes and another 68 were lost during follow up]. Statistically significant improvement was noted in reduction in height and width of barium column and symptom score coupled with weight gain during follow up. Forty-eight patients were subjected to repeat dilatation with 35 mm balloon, two of these developed post-procedure perforations with one mortality. Three non-responsive patients required surgical laparoscopic myotomy. No carcinoma of esophagus was reported during follow up. One patient post dilatation, developed esophageal bezoar. A single pneumatic dilatation achieved a remission rate of 93% at four years, 90% at three years, 95% at two years and 92% at one year post dilatation

Conclusion: Achalasia of esophagus can be effectively and safely treated with balloon dilatation to achieve adequate short and long-term symptomatic relief with a low complication rate

Treatment of Cerebral Vasospasm in an Infant Using a Modified Dotter Technique

An 8-month old female presented with spontaneous subarachnoid hemorrhage and was treated successfully with endovascular coil embolization of the ruptured aneurysm. Transcranial Doppler ultrasound performed four days later demonstrated middle cerebral artery (MCA) velocities greater than 350 cm/sec on the right and greater than 200 cm/sec on the left, despite medical management. The patient demonstrated no focal neurological deficits, though examination was limited by our patient's sedation and intubation. Angiography revealed severe vasospasm of the supraclinoid internal carotid and MCA territories, bilaterally. The vasospasm was refractory to the administration of intra-arterial verapamil. Balloon angioplasty was attempted, but the device could not be advanced safely due to the small size of the patient's vessels and the stiffness of the device. A microcatheter (0.0165" diameter) was advanced over a J-shaped soft microwire (0.014" diameter) to perform mechanical angioplasty in the internal carotid artery and MCA vessels bilaterally. Dramatic improvement was seen angiographically and on transcranial Doppler, and no complications were seen.

Burden and associated factors for caregivers of the elderly in a developing country

The elderly population in South Asia is growing. In Pakistan trained caregivers are scarce and culturally not acceptable. This study assessed the level of stress experienced by caregivers of the elderly and determined the association of care giving burden with different characteristics of the elderly. A cross-sectional, questionnaire based study was conducted using nonprobability purposive sampling. All consenting participants aged 60 years and above needing help with at least one activity of daily living or two instrumental activities of daily living were included. 350 participants were assessed for perceived care giver burden. Care providers were mostly female [68.9%]. Half [50.3%] of the caregivers had a positive score on a perceived care burden scale. Financial impact had a strong correlation [0.79] with perceived caregiver burden. Higher dependency levels of a physical and cognitive nature posed greater burden on caregivers. Behavioural issues of the elderly such as verbal abuse and difficulty sleeping were predictors of a higher caregiver burden. Caregiver burden is a significant issue for those caring for elderly family members in Karachi, Pakistan

Radiation doses from [131]I treated hyperthyroidism patients versus life style: - a survey

Radioactive iodine is widely used for the treatment of various thyroid disorders. Safety issues are often a source of worry and anxiety for the patients, their families and comforters. The patients are advised to restrict their social and work related activities. The work presented in this study describes the results of a structured survey conducted on patients visiting our hospital. The total number of patients inducted was 419. The patients were asked about their housing conditions, family set up, number of children, travelling modes and travelling time back to home. The hospital leaving exposure rates from the patients were measured and radiation doses to others were estimated. Patients residing in joint family system were 93%. The measured dose rate at one meter were 5.7, 11.0, 15.7, 18.7, 23.0 and 28.0 micro Svh-1 for the administered [131]I activity of 185, 370, 555, 740, 925 and 1100 MBq respectively. The corresponding radiation doses to others from the patient were estimated as 0.76, 1.53, 2.29, 3.06, 3.82 and 4.58 mSv. The patients using public transport were 78.04% whereas 21.96% used private transport. There were 11.93% of the patients with no children and 88.07% of the patients had children residing with them. It was observed that 1.67% of the patients had no toilets at home and 98.33% had multiple toilets available. The radiation protection advice and regulatory requirements need to be formulated keeping in view the individual patient life styles and other living conditions

Feasibility of a peer-led, school-based asthma education programme for adolescents in Jordan

The Adolescent Asthma Action programme [Triple A] has been used successfully to promote asthma knowledge, awareness and quality of life in adolescents with asthma in Australia. We describe the feasibility and acceptability of an adaptation of this English-language, peer-led, asthma education programme in a girls' high school in Northern Jordan. The pilot was conducted by bilingual health workers. Feasibility, acceptability and adaptability were measured through participation rates, open-ended questionnaires completed by peer leaders, a focus group for junior students and reflective journal notes. The programme was well-received by staff and students, with high levels of participation. The peer-led approach was viewed positively. Students reported that they enjoyed the interactive learning activities and the opportunity to practise English. The students reported increased asthma knowledge and awareness, with students with asthma reporting receiving more support from peers. A peer-led asthma education programme is feasible and acceptable in the Jordanian school context

Heated Moisture Exchanger (HME) and dead space ventilation. Is Isocapnic conditions unachievable in children? / 대한마취과학회지

No abstract available.

[Assessment of serum vit E levels in patients with recurrent aphtous stomatitis]

Recurrent aphthous stomatitis [RAS] is a common oral mucosal disorder characterized by recurrent and painful oral aphtous ulcers. Although the exact cause of RAS is not known, but local trauma, nutritional deficiencies, hormonal changes, genetics, and immunologic factors have been suggested to contribute to its pathogenesis. The aim of this study was to assess the serum level of vitamin E in patients with RAU and normal subjects. This case-control study was conducted on19 patients with RAU and 17 healthy controls with same age and sex. Serum level of vitamin E was measured in both groups by liquid chromatography technique. Data were analyzed by Mann-u-Whitney test. The mean serum level of vitamin E was 14.89 +/- 2.3 micro g/ml in RAU patients and 22. 53 +/- 3.7 micro g/ml in normal group. This level was significantly lower in patients with RAU than in healthy control subjects [p<0.05]. The present study demonstrated that serum level of vitamin E significantly decreased in patients with aphtous ulceration

clinical profile of benign tumours of nose and paranasal sinuses

To analyse the sex and age incidences, clinical presentations and histopathological picture of the benign tumours of nose and paranasal sinuses. Prospective, Longitudinal, Descriptive. GMS Memorial Academy of ENT and HNS,TUTH, Kathmandu, Nepal. 2 years, September 2008 to August 2010. All cases of benign masses of nose and paranasal sinuses who visited the Outpatient department and were undergoing surgical intervention were included. The histological proven malignant masses were excluded from the study. Out of 49 patients, majority of the patients were between 13-20 years [34.69%]. Male:female ratio was 3.9:l.The most common presenting symptoms were unilateral nasal obstruction and nasal bleeding [65.29%]. Inverted papilloma and angiofibroma were the most common tumours [42.84%]. All masses of nose and paranasal sinuses should be subjected to histopathological examination and followed up for two years for assessment of outcome of treatment and monitoring recurrences

Comparison of body mass index and waist circumference in predicting incident diabetes

The objective of the present investigation is to confirm that central obesity which is measured by waist circumference [WC] is more informative than general obesity determined by body mass index [BMI] in the prediction of diabetes mellitus [DM]. The study was conducted at Khyber Medical College, Peshawar during 2008 to 2009. A total of 475 adult male and female volunteers were the subject of present research and were categorized in terms of their BMI. The BMI was determined from weight and height; the subjects were grouped as normal, overweight and obese. WC was determined by measuring the waist between the lower rib and iliac crest. The results show a consistence relation between BMI and WC with diabetes mellitus. The Chi-square test for 95% confidence interval showed 2-sided asymptomatic significance of diabetes mellitus with WC to be 0.016 and BMI 0.082. The results showed a higher trend of diabetes mellitus in males having WC greater then 40 inches [100 cm] and for female WC greater than 35 inches [87.5 cm] as compare to higher BMI

Deep Brain Stimulation: Technology at the Cutting Edge

Deep brain stimulation (DBS) surgery has been performed in over 75,000 people worldwide, and has been shown to be an effective treatment for Parkinson's disease, tremor, dystonia, epilepsy, depression, Tourette's syndrome, and obsessive compulsive disorder. We review current and emerging evidence for the role of DBS in the management of a range of neurological and psychiatric conditions, and discuss the technical and practical aspects of performing DBS surgery. In the future, evolution of DBS technology may depend on several key areas, including better scientific understanding of its underlying mechanism of action, advances in high-spatial resolution imaging and development of novel electrophysiological and neurotransmitter microsensor systems. Such developments could form the basis of an intelligent closed-loop DBS system with feedback-guided neuromodulation to optimize both electrode placement and therapeutic efficacy.

Deep Brain Stimulation: Technology at the Cutting Edge

Deep brain stimulation (DBS) surgery has been performed in over 75,000 people worldwide, and has been shown to be an effective treatment for Parkinson's disease, tremor, dystonia, epilepsy, depression, Tourette's syndrome, and obsessive compulsive disorder. We review current and emerging evidence for the role of DBS in the management of a range of neurological and psychiatric conditions, and discuss the technical and practical aspects of performing DBS surgery. In the future, evolution of DBS technology may depend on several key areas, including better scientific understanding of its underlying mechanism of action, advances in high-spatial resolution imaging and development of novel electrophysiological and neurotransmitter microsensor systems. Such developments could form the basis of an intelligent closed-loop DBS system with feedback-guided neuromodulation to optimize both electrode placement and therapeutic efficacy.

Relation of hypertension with body mass index and age in male and female population of Peshawar, Pakistan

Hypertension, a condition developed as a result of high blood pressure is strongly correlated with body mass index [BMI]. Obesity was noted to be a single best predictor of hypertension incidence, and was regarded as a major controllable contributor to hypertension. Overweight and obesity is conveniently determined from BMI. Present study was conducted in Khyber Medical College [KMC] Peshawar to investigate the relation of hypertension with BMI and age. The objective of the present investigation is to establish a relationship between hypertension and BMI in male and female population of Peshawar with consideration of age. This study was conducted at KMC, Peshawar during 2008-2009. A total of 1006 adult male and female volunteers were the subject of present research and were categorized in terms of their ages. BMI was determined from weight and height; the subjects were grouped as normal, overweight and obese. Hypertension was determined from the measure of blood pressure. The results show a consistence relation between BMI and hypertension within age groups in both male and females. The figures exhibited a relation of age with BMI and hypertension in both males and females subjects. The results showed a higher trend of hypertension with increasing BMI. In young females it was noted that with a shift from normal BMI the incidence of hypertension was very high

Surgical site infection in lumbar surgeries, pre and postoperative antibiotics and length of stay: a case study

Postoperative wound infection also called as surgical site infection [SSI], is a troublesome complications of lumbar spine surgeries and they can be associated with serious morbidities, mortalities and increase resource utilization. With the improvement in diagnostic modalities, proper surgical techniques, antibiotic therapy and postoperative care, infectious complications can result in various compromises afterwards. The objective was to study the relation of surgical site infection in clean lumbar surgeries with the doses of antibiotics. This retrospective study was conducted at Shifa International Hospital, from January 2006 to March 2008. Hundred post operated cases of lumber disc prolapse, lumber stenosis or both studied retrospectively by tracing their operated data from hospital record section for the development of surgical site infection [SSI]. The patients were divided into three groups depending upon whether they received single, three or more than three doses of antibiotics respectively. Complete data analyses and cross tabulation done with SPSS version 16. Of 100 cases, only 6% had superficial surgical site infection; only 1 case with co morbidity of hypertension was detected. Twenty-one cases had single dose of antibiotic [Group-I], 59 cases had 3 doses [Group II] and 20 cases received multiple doses [Group III]. There was no infection in Group-I. Only one patient in Group-II and 5 patients in Group III developed superficial SSI. While 4 in Group-II, 3 in Group-III, and none of Group-I had >6 days length of stay [LOS]. The dose of antibiotic directly correlates with the surgical site infection in clean lumbar surgeries. When compared with multiple doses of antibiotics a single preoperative shot of antibiotic is equally effective for patients with SSI

Retinal examination of diabetic patients: knowledge, attitudes and practices of physicians in Oman

Knowledge, attitudes and practices of 40 randomly selected physicians was assessed in the North Sharqiya region of Oman in 2003. We evaluated non-ophthalmologist physicians' knowledge of techniques of eye examination of diabetic patients, attitudes towards fundus examination and practices of detailed eye examination. Knowledge about different parts of the eye was satisfactory in only 58% of physicians and knowledge about method of fundus examination for diabetic retinopathy was poor in 40%. Attitudes towards eye examination by nonophthalmologists at primary level were positive. In practice 20 physicians had attempted to use an ophthalmoscope and only 9 could see details of the retina. Our general physicians would need detailed training if they are to be involved in early detection of diabetic retinopathy