Health-related quality of life following cranioplasty - a systematic review.

Cranioplasty is a neurosurgical procedure that repairs a defect in the skull Coupled with the underlying pathology cranioplasty associated morbidity can have a large impact on patient quality of life, which is often poorly explored. The objective of this systematic review was to identify patient-reported outcomes evaluating health-related quality of life following cranioplasty. The review protocol was registered on PROSPERO (CRD42021251543) and a systematic review was conducted in accordance with the PRISMA statement. PubMed, Embase, CINAHL Plus, and the Cochrane databases were searched from inception to 1 May 2022. All studies reporting HRQoL following cranioplasty were included. Reporting was assessed using the ISOQOL checklist and risk of bias was assessed using the Newcastle-Ottawa Scale or the Johanna-Briggs Institute Scale, as appropriate. A total of 25 studies were included of which 20 were cross-sectional and 2 longitudinal. Most studies utilized study specific questionnaires and Likert scales to assess HRQoL. The studies found a significant improvement in physical functioning, social functioning, cosmetic outcome, and overall HRQoL following cranioplasty. Further longitudinal studies utilising validated measurement tools are required to better understand the effect of cranioplasty at a patient level.

Meningioma systematic reviews and meta-analyses: an assessment of reporting and methodological quality.

INTRODUCTION: Systematic reviews (SR) and systematic reviews with meta-analysis (SRMA) can constitute the highest level of research evidence. Such evidence syntheses are relied upon heavily to inform the clinical knowledge base and to guide clinical practice for meningioma. This review evaluates the reporting and methodological quality of published meningioma evidence syntheses to date. METHODS: Eight electronic databases/registries were searched to identify eligible meningioma SRs with and without meta-analysis published between January 1990 and December 2020. Articles concerning spinal meningioma were excluded. Reporting and methodological quality were assessed against the following tools: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2), and Risk Of Bias in Systematic reviews (ROBIS). RESULTS: 116 SRs were identified, of which 57 were SRMAs (49.1%). The mean PRISMA score for SRMA was 20.9 out of 27 (SD 3.9, 77.0% PRISMA adherence) and for SR without meta-analysis was 13.8 out of 22 (SD 3.4, 63% PRISMA adherence). Thirty-eight studies (32.8%) achieved greater than 80% adherence to PRISMA. Methodological quality assessment against AMSTAR 2 revealed that 110 (94.8%) studies were of critically low quality. Only 21 studies (18.1%) were judged to have a low risk of bias against ROBIS. CONCLUSION: The reporting and methodological quality of meningioma evidence syntheses was poor. Established guidelines and critical appraisal tools may be used as an adjunct to aid methodological conduct and reporting of such reviews, in order to improve the validity and transparency of research which may influence clinical practice.

Statins as antiepileptogenic drugs: Analyzing the evidence and identifying the most promising statin.

Many brain insults and injuries are "epileptogenic": they increase the risk of developing epilepsy. It is desirable to identify treatments that are "antiepileptogenic": treatments that prevent the development of epilepsy, if administered after the occurrence of an epileptogenic insult. Current antiepileptic drugs are not antiepileptogenic, but evidence of antiepileptogenic efficacy is accumulating for a growing number of other compounds. From among these candidate compounds, statins are deserving of particular attention because statins are reported to be antiepileptogenic in more published studies and in a wider range of brain insults than any other individual or class of compounds. Although many studies report the antiepileptogenic effect of statins, it is unclear how many studies provide evidence that statins exhibit the following two essential features of a clinically viable antiepileptogenic drug: the drug must exert an antiepileptogenic effect even if it is initiated after the epileptogenic brain insult has already occurred, and the antiepileptogenic effect must endure even after the drug has been discontinued. In the current work, we interrogate published preclinical and clinical studies, to determine if statins fulfill these essential requirements. There are eight different statins in clinical use. To enable the clinical use of one of these statins for antiepileptogenesis, its antiepileptogenic effect will have to be established through future time- and resource-intensive clinical trials. Therefore, it is desirable to review the published literature to determine which of the statins emerges as the most promising candidate for antiepileptogenic therapy. Hence, in the current work, we also collate and analyze published data-clinical and pre-clinical, direct and indirect-that help to answer the question: Which statin is the most promising candidate to take forward into an antiepileptogenesis clinical trial?

Optimized hybrid machine learning approach for smartphone based diabetic retinopathy detection.

Diabetic Retinopathy (DR) is defined as the Diabetes Mellitus difficulty that harms the blood vessels in the retina. It is also known as a silent disease and cause mild vision issues or no symptoms. In order to enhance the chances of effective treatment, yearly eye tests are vital for premature discovery. Hence, it uses fundus cameras for capturing retinal images, but due to its size and cost, it is a troublesome for extensive screening. Therefore, the smartphones are utilized for scheming low-power, small-sized, and reasonable retinal imaging schemes to activate automated DR detection and DR screening. In this article, the new DIY (do it yourself) smartphone enabled camera is used for smartphone based DR detection. Initially, the preprocessing like green channel transformation and CLAHE (Contrast Limited Adaptive Histogram Equalization) are performed. Further, the segmentation process starts with optic disc segmentation by WT (watershed transform) and abnormality segmentation (Exudates, microaneurysms, haemorrhages, and IRMA) by Triplet half band filter bank (THFB). Then the different features are extracted by Haralick and ADTCWT (Anisotropic Dual Tree Complex Wavelet Transform) methods. Using life choice-based optimizer (LCBO) algorithm, the optimal features are chosen from the mined features. Then the selected features are applied to the optimized hybrid ML (machine learning) classifier with the combination of NN and DCNN (Deep Convolutional Neural Network) in which the SSD (Social Ski-Driver) is utilized for the best weight values of hybrid classifier to categorize the severity level as mild DR, severe DR, normal, moderate DR, and Proliferative DR. The proposed work is simulated in python environment and to test the efficiency of the proposed scheme the datasets like APTOS-2019-Blindness-Detection, and EyePacs are used. The model has been evaluated using different performance metrics. The simulation results verified that the suggested scheme is provides well accuracy for each dataset than other current approaches.

Enhancement of hydrocarbons and phenols in catalytic pyrolysis bio-oil by employing aluminum hydroxide nanoparticle based spent adsorbent derived catalysts.

The present study investigated the effects of metal loaded spent adsorbent as catalyst for the catalytic pyrolysis of pine needle biomass. Metal active sites (Ni, Fe, Cu, Zn and Mo) were introduced in alumina matrix by wet impregnation process. Non-catalytic and catalytic semi-batch pyrolysis study was carried out at conditions: 550 °C temperature, 50 °C min-1 heating rate and 200 mL min-1 N2 flow rate. Results indicated significant deoxygenation potential 3.33-35.57% of the applied catalysts towards oxygenated compounds by converting them into their corresponding hydrocarbon (27.70-36.41%) and phenolic (40.41-46.04%) derivatives. Among all the catalysts, Ni/Al and Fe/Al produced the highest quality bio-oil by enriching their carbon content to 62.93 and 60.14% and heating value to 31.41 and 26.86 MJ kg-1, respectively. Moreover, significant enhancement in their hydrocarbons (36.41 and 36.01% for Ni/Al and Fe/Al, respectively) and phenolic compounds (46.04 and 41.67% for Ni/Al and Fe/Al, respectively) from 9.15% hydrocarbons and 13.32% phenols in non-catalytic bio-oil had also been observed. Presence of CO and CO2 in the evolved gases also represented the occurrence of deoxygenation reactions during catalytic breakdown. Hydrocarbon and phenol-rich bio-oil can find its application either as a replacement for petroleum fuel or an industrial-grade chemical. Thus, catalysts derived from spent aluminum hydroxide nanoparticle adsorbent can act as an effective substitute for the currently utilized high-cost catalysts in catalytic pyrolysis of biomass.

Pregnancy and cardiac interventions: What are the optimal management options?

Cardiac disease is the leading cause of maternal mortality in the United Kingdom. Major causes of cardiac death in pregnant women include cardiomyopathies, myocardial infarction, ischemic heart disease, and aortic dissection. Uncorrected congenital heart disease and women who have had corrective or palliative surgery may have complicated pregnancies as well. Some women with significant cardiac disease are unable to meet the increased physiological demands of pregnancy. Of these, those who do not respond to medical treatment may require surgical correction such as coronary artery bypass grafting. The risk of cardiac operations for pregnant women is similar to that for nonpregnant women but the fetal mortality rate remains high. Contributing factors to high fetal mortality rates include timing, urgency of operation, and the fetal/fetoplacental response to cardiopulmonary bypass. The aim of this review is to summarize current evidence in utilizing the different management approaches of cardiac issues during pregnancy.

Acute Kidney Injury Associated with Cardiac Surgery: a Comprehensive Literature Review.

OBJECTIVE: To comprehensively understand cardiac surgeryassociated acute kidney injury (CSA-AKI) and methods of prevention of such complication in cardiac surgery patients. METHODS: A comprehensive literature search was performed using the electronic database to identify articles describing acute kidney injury (AKI) in patients that undergone cardiac surgery. There was neither time limit nor language limit on the search. The results were narratively summarized. RESULTS: All the relevant articles have been extracted; results have been summarized in each related section. CSA-AKI is a serious postoperative complication and it can contribute to a significant increase in perioperative morbidity and mortality rates. Optimization of factors that can reduce CSA-AKI, therefore, contributes to a better postoperative outcome. CONCLUSION: Several factors can significantly increase the rate of AKI; identification and minimization of such factors can lead to lower rates of CSA-AKI and lower perioperative morbidity and mortality rates.

Predicting likelihood of psychological disorders in PlayerUnknown's Battlegrounds (PUBG) players from Asian countries using supervised machine learning.

Multiplayer Online Battle Arena (MOBA) has become one of the most popular genre of online video games played by gamers worldwide. Previous studies have exhibited that excessive engagement in games can lead to Internet Gaming Disorder (IGD). Internet Gaming Disorder has been associated with psychological disorders like impulsivity, anxiety and Attention Deficit Hyperactivity Disorder (ADHD). In this study, we propose an approach to use the game and player statistics along with self-esteem measure of a PlayerUnknown's Battlegrounds (PUBG, a MOBA game) player to predict whether he/she suffers from IGD and psychological disorders namely ADHD and Generalized Anxiety Disorder (GAD). We extract the game and player statistics of PUBG players from Asian countries and then run several state of the art supervised machine learning models to predict the occurrence of IGD, ADHD, and GAD. Initial experiments and results show that we are able to predict IGD, ADHD, and GAD with an accuracy of 93.18%, 81.81% and 84.9% respectively. Game statistics of PUBG players show strong positive correlation with IGD and ADHD indicating detrimental effects of MOBA games.

Acute kidney injury associated with cardiac surgery: a comprehensive literature review

Abstract Objective: To comprehensively understand cardiac surgeryassociated acute kidney injury (CSA-AKI) and methods of prevention of such complication in cardiac surgery patients. Methods: A comprehensive literature search was performed using the electronic database to identify articles describing acute kidney injury (AKI) in patients that undergone cardiac surgery. There was neither time limit nor language limit on the search. The results were narratively summarized. Results: All the relevant articles have been extracted; results have been summarized in each related section. CSA-AKI is a serious postoperative complication and it can contribute to a significant increase in perioperative morbidity and mortality rates. Optimization of factors that can reduce CSA-AKI, therefore, contributes to a better postoperative outcome. Conclusion: Several factors can significantly increase the rate of AKI; identification and minimization of such factors can lead to lower rates of CSA-AKI and lower perioperative morbidity and mortality rates.

Maternal and Neonatal Outcomes in Patients of Gestational Diabetes Mellitus on Metformin Therapy.

BACKGROUND: Present study carried out in a tertiary referral hospital in North India attempts to determine the maternal and neonatal outcomes of metformin therapy in patients of gestational diabetes mellitus. OBJECTIVES: To evaluate maternal and neonatal outcomes in patients of GDM on metformin therapy and to study its adverse effects. METHOD: In this prospective observational study, all women diagnosed with GDM not controlled by medical nutrition therapy were started on metformin therapy and the maternal and neonatal outcomes were studied. RESULTS: A total of 104 patients of GDM, not controlled on MNT and requiring pharmacotherapy, were enrolled for the study. An important clinical data from the study were that in 63.5% of patients there was no family history of diabetes mellitus. Average weight gain during pregnancy ranged from 6 to 10 kg. Glycemic control was achieved in 96.2% of patients with varying doses of metformin therapy, and it reached statistical significance. Duration of metformin therapy ranged from a minimum of 2 months to a maximum of 6 months. No serious side effects were noted except for hypoglycemia in one patient. Patient acceptability toward metformin intake was good. Mean birth weight of newborns was 2972 ± 280 g, and no case of fetal macrosomia was seen. Neonatal hypoglycemia was seen in 3.8% of the babies and 6.7% required NICU admission. No case of congenital malformation was reported. CONCLUSIONS: Metformin is a clinically effective, inexpensive and safe drug for treating gestational diabetes mellitus.

Oral Health Knowledge, Attitude, and Practice among Nursing Students in the North-Eastern Part of Rajasthan, India.

BACKGROUND: Professional and paramedical students have a key role in oral health promotion. The aim of this study was to assess oral health-related Knowledge, Attitude, and Practice (KAP) among the nursing students in Rajasthan. MATERIALS AND METHODS: A cross-sectional, questionnaire-based study was carried out among 409 nursing students from five different institutes who were selected by simple random sampling. A 27-item questionnaire was used to assess KAP. The resulting data were analyzed using frequency distribution. RESULTS: Over 50% of the students used toothbrush and toothpaste twice a day to maintain their oral hygiene. Besides, 41% recognized the importance of dental visit in case of gingival bleeding and knew that poor oral hygiene is responsible for bad breath. CONCLUSIONS: Oral health-related behavior among the nursing students needs improvement. More educational and preventive programs should be organized to achieve better results.

Proximal arterial cannulation in thoracic aortic surgery-Literature review.

Surgery on thoracic aorta is complex with a number of approaches being required depending on the pathology and anatomy that is specific to each patient and therefore, careful planning is required to ensure successful outcomes. Among the key factors that determine a satisfactory and safe operation is the choice of arterial cannulation site to establish cardiopulmonary bypass and deliver brain protection adequately. Direct proximal aortic cannulation is the gold-standard method for elective aortic root surgery and traditionally femoral arterial cannulation has been used in complex aortic surgeries such as redo or acute pathologies; however, axillary and innominate artery (IA) cannulation has evolved dramatically and several centers are currently using proximal cannulation sites as the default cannulation choice in elective and emergency settings of complex thoracic aortic surgeries. The evidence behind cannulating the IA is growing; however, it is yet to be well established through large studies or trial to confirm its superiority to other methods of central cannulation techniques.