Enhanced Recovery After Surgery: Exploring the Advances and Strategies.

Enhanced recovery after surgery (ERAS) has emerged as a paradigm-shifting approach in perioperative care, aimed at optimizing patient outcomes, accelerating recovery, and minimizing hospital stays. This review delves into the latest advances and strategies within the field of ERAS, encompassing a comprehensive examination of preoperative, intraoperative, and postoperative interventions. By analyzing an array of clinical studies, meta-analyses, and implementation experiences, this review highlights the multifaceted elements contributing to the success of ERAS programs. Key components such as preoperative patient education, minimally invasive surgical techniques, tailored anesthesia protocols, judicious fluid management, optimized pain control, early ambulation, and structured nutritional support are thoroughly explored. Furthermore, the review delves into the intricacies of ERAS implementation across diverse surgical specialties, emphasizing the significance of multidisciplinary collaboration, protocol customization, and sustained quality improvement initiatives. The analysis not only showcases the tangible benefits of ERAS, including reduced complication rates, shortened hospital stays, and enhanced patient satisfaction, but also underscores the challenges and barriers that medical professionals encounter during program adoption. By synthesizing the current state of ERAS research and practice, this review provides clinicians, administrators, and researchers with valuable insights into the evolving landscape of perioperative care, fostering a deeper understanding of ERAS as a holistic approach that transcends traditional surgical pathways.

Prospective audit of the phenotype, causes and correlates of trachomatous and non- trachomatous trichiasis in a peri-elimination setting.

PURPOSE: To explore the burden, clinical features and associations of trichiasis due to trachomatous and non-trachomatous aetiologies. METHODS: Consenting patients presenting with trichiasis of either eyelid (of one or both eyes) attending the outpatient department, cornea and oculoplasty clinics of a tertiary eye care hospital in New Delhi between August 2018 to March 2020 were included. A comprehensive examination including visual acuity and anterior segment evaluation and photography was performed. Grade of trichiasis, laterality, presence and grade of entropion, and information on corneal opacity, conjunctival scarring, Herbert's pits, and pannus, if present, were recorded in the case record form. RESULTS: Overall, 302 patients (454 eyes) with trichiasis were recruited. The most common attributed cause of upper eyelid trichiasis (276 patients, 405 eyes) was trachoma (26% of patients), followed by Stevens-Johnson syndrome (23%), blepharokeratoconjunctivitis (17%) and old age (10%). A total of 296/405 eyes (73%) had some form of corneal involvement. Trachoma was not identified as the cause of trichiasis in any eye with lower eyelid-only disease. CONCLUSION: Only about a quarter of upper eyelid trichiasis in this peri-elimination setting was attributed to trachoma. A distinction between trachomatous and non-trachomatous trichiasis is imperative to meaningfully determine whether elimination of trachoma as a public health problem has occurred. These data may have implications for population-based estimates of TT prevalence in India and other peri-elimination settings.

A Review on Umbilical Cord Milking and Its Implications in Neonatal Health.

In India, there is an extreme lack of advancement in techniques concerning the care of infants during labor and post-pregnancy, i.e., the postnatal period. India projected an Infant Mortality Rate of 28.771 deaths per 1000 live births for the year 2021. Such a high death rate in infants arises a dire need to discover and launch new techniques and increase the application of the existing lesser-known techniques. One less well-known technique is the milking of the infant's umbilical cord. Transfusion of placental blood has recently been considered definitive in the care of newborns with the boon to the infant of declined death rate in preterm neonates and the enhanced consequences of growth in term infants. The chief goal of this descriptive review article is to examine all the studies relating to umbilical cord milking (UCM) in late-preterm and term infants and to evaluate every achievable outcome and restriction of a given process in clinical application, mainly when compared to rapid and late umbilical cord clamping. Application of milking of the umbilical cord can be seen to improve the health of hypoxic neonates, weight parameters, blood volume, hematocrit, hemoglobin, iron levels in the blood, red blood cell count, blood pressure, right ventricular output, left ventricular functions, cerebral oxygenation, urine output regulation, cognitive abilities, antioxidant levels, better outcomes in the resuscitation of infant and above all helps in lowering Infant Mortality Rates.

Atypical Corneal Phenotype in Patients With Trachoma and Secondary Amyloidosis.

PURPOSE: To report clinical presentation, in vivo confocal microscopic features, and corneal phenotype in patients with trachomatous keratopathy (TK) and secondary amyloidosis. METHODS: Histopathological records of all patients undergoing keratoplasty at the Dr. Rajendra Prasad Centre for Ophthalmic Sciences over a 3-year period were scanned retrospectively for a diagnosis of TK and amyloidosis. Demographic profile and details of preoperative comprehensive ophthalmic assessment were extracted. The histopathology was freshly reviewed. RESULTS: Fifteen patients (29 eyes) with TK and atypical corneal involvement due to amyloid deposition were identified. Herbert's pits and upper palpebral conjunctival scarring were present in all cases. Central or total diffuse corneal scarring was present involving the anterior stroma in 5 (31%) and the full thickness of the cornea in 11 (69%) of the eyes. Eight (73%) of 11 patients with deep stromal amyloid deposits revealed bilateral, discrete, blue-white opacities at the level of deep stroma and Descemet membrane (DM). Endothelial cells were atrophic and flattened with gutta formation. Confoscans revealed hyperreflective, needle-shaped crystalline deposits of extracellular amyloid at various depths of the corneal stroma up to DM. All host corneal buttons demonstrated Congo red-positive amyloid deposits on histopathological examination. CONCLUSIONS: We describe a distinct form of TK unlike the usual presentation of dense, leucomatous, vascularized corneal scarring in trachoma. We believe that amyloid deposits in DM and the corneal endothelium have not previously been reported in patients with trachoma.

Tuning macrocycles to design 'turn-on' fluorescence probes for manganese(II) sensing in live cells.

We tune the coordination environment of macrocyclic ligands to design two novel fluorescence sensors for Mn(2+). The BODIPY-based Mn(2+) sensor M1 affords an excellent, 52 fold, fluorescence 'turn-on' response despite the paramagnetic nature of Mn(2+). The lipophilic probe is cell-permeable and confocal imaging demonstrates that the sensor distinctly detects Mn(2+) within live cells.

Synthesis of some thiophene, imidazole and pyridine derivatives exhibiting good anti-inflammatory and analgesic activities.

A series of thiophene derivatives 1a-d & 2a-c were synthesized by condensation of 5-nitro-2-thiophene carboxaldehyde with mono and diamines respectively. Various imidazole derivatives 3a-c were obtained by condensing 4-(2-ethylamino)-1H-imidazole with 4-acetylpyridine, 2-acetylpyridine and 4-acetylbenzonitrile respectively. Pyridine derivatives 4a-e were synthesized by condensing 2-hydrazino-pyridine with various carbonyl compounds; 5a-c by condensing 2, 6-pyridine dicarbonyl dichloride with various aryl sulfonylhydrazides; 6, 7 by condensing 2, 6-dialdehyde pyridine with 2-hydrazinopyridine and anthranilonitrile respectively and compound 8 by condensing 2, 5-thiophene dialdehyde with hydrazinopyridine. All the compounds were characterized by IR, (1)HNMR, Mass spectra and elemental analysis. Compounds 1a-d; 2a-c; 3a-c; 4a-e; 5a-c, 6, 7 and 8 were screened for anti-inflammatory and analgesic activities. Compounds 1b and 2c exhibited good anti-inflammatory (26.5% and 33.4% at 50mg/kg p.o. respectively) and 3a, 3c good analgesic (100% and 75% at 100 mg/kg p.o. respectively) activities.

Synthesis of biologically active N-methyl derivatives of amidines and cyclized five-membered products of amidines with oxalyl chloride.

A series of substituted N-methylisonicotinamidine (2a-f), N-methylpyrazine-2-carboxamidine (2g-i) derivatives were synthesized by reaction of amidine derivatives (1a-i) with methyl iodide in presence of triethylamine. Five-membered condensed dihydroimidazolylbenzenesulfonamide derivatives (3a-i) were obtained by the reaction of amidine derivatives (1a-i) with acylating agent oxalyl chloride. All the compounds, i.e. 2a-i and 3a-i were purified by crystallization. Structures of all the synthesized compounds are supported by correct IR, (1)H NMR, mass spectral and analytical data. Anti-inflammatory activity evaluation was carried out using carrageenan-induced paw oedema assay and compounds 2e, 3a and 3d exhibited good anti-inflammatory activity (44%, 31% and 37% activity at 50 mg/kg p.o., respectively). Analgesic activity evaluation was carried out using acetic acid writhing assay and compounds 2a and 3f gave 75% activity each at 100 mg/kg p.o.; on the other hand compounds 3a and 3d exhibited 60% analgesic activity each at 50 mg/kg p.o. Compounds 3a and 3d exhibited good anti-inflammatory and analgesic activities.

One pot synthesis of pyrimidine and bispyrimidine derivatives and their evaluation for anti-inflammatory and analgesic activities.

A number of pyrimidine derivatives (1-10) have been synthesized by condensation of 4-isothiocyanato-4-methylpentan-2-one with furfurylamine, histamine, 1-(3-aminopropyl)imidazole, 1-(3-aminopropyl)-2-pyrrolidinone, 2-aminobenzonitrile and 3-isothiocyanatobutanal with 1-(3-aminopropyl)-2-pyrrolidinone and 2-hydrazinopyridine under different reaction conditions. Various bispyrimidine derivatives (11-15) were obtained by condensation of 4-isothiocyanato-4-methylpentan-2-one with 2,4,8,10-tetraoxaspiro[5,5]undecane3,9-dipropamine (11'), 1,4-bis(3-aminopropyl)piperazine (13'), 3,5-diamino 1,2,4-triazole (15') and 3-isothiocyanatobutanal with 2,4,8,10-tetraoxaspiro[5,5]undecane 3,9-dipropamine, 1,4-bis(3-aminopropyl)piperazine. All these compounds were characterized by correct FT-IR, (1)H NMR, MS and elemental analysis. These compounds were screened for anti-inflammatory and analgesic activities. Anti-inflammatory activity of 3 is comparable while analgesic activity was found to be better than that of standard drug.

Removal of 2-fluoro and 2-iodophenol from aqueous solutions using industrial wastes.

A comparative study of the adsorbents prepared from several industrial wastes for the removal of 2-fluorophenol and 2-iodophenol has been carried out. The results show that maximum adsorption on carbonaceous adsorbent prepared from fertilizer industry waste has been found to be 35.3 and 235.3 mg g(-1) for 2-fluorophenol and 2-iodophenol, respectively. Compared to carbonaceous adsorbent, the other three adsorbents (viz., blast furnace sludge, dust, and slag) adsorb phenols to a much smaller extent. This has been attributed to the carbonaceous adsorbent having a larger porosity and consequently higher surface area. The adsorption of phenols on this adsorbent has been studied as a function of contact time, concentration and temperature. The adsorption has been found to be endothermic, and the data conform to the Langmuir equation. The further analysis of data indicates that adsorption is a first order process and pore diffusion controlled. A comparative study of adsorption results with those obtained on standard activated charcoal sample shows that prepared adsorbent is about 45% as efficient as standard activated charcoal and therefore, can be fruitfully employed for the removal of phenolic pollutants from wastewaters.

Removal of chlorophenols using industrial wastes.

Development of inexpensive adsorbents from industrial wastes for the treatment of wastewaters is an important area in environmental sciences. Blast furnace slag, dust and sludge from steel plants, and carbon slurry from fertilizer plants after their treatment have been utilized as inexpensive adsorbents for the removal of phenols, which are an important class of pollutants as they are highly toxic. The characterization of the four adsorbents prepared has shown that the carbonaceous adsorbent prepared from carbon slurry possesses high porosity and maximum surface area (380 m2/g) as compared to the other three adsorbents (4-28 m2/g). The adsorption of four phenols (phenol, 2-chlorophenol, 4-chlorophenol, and 2,4-dichlorophenol) on these adsorbents is parallel to their porosity and surface area order. The uptake of the phenols on carbonaceous adsorbent is substantial and found to be 17.2, 50.3, 57.4, and 132.5 mg/g for phenol, 2-chlorophenol, 4-chlorophenol, and 2,4-dichlorophenol, respectively. The detailed adsorption studies on carbonaceous adsorbent have indicated that the adsorption process follows the Langmuir isotherm, is first order, and is pore diffusion controlled. As adsorption of phenols on prepared carbonaceous adsorbent is significant, its performance has been evaluated with respect to standard activated charcoal. The results indicate that the phenols removal efficiency of carbonaceous adsorbent is about 45% to that of a standard activated charcoal sample. Thus, the carbonaceous adsorbent can be used for the removal of phenols as a low-cost alternative (approximately 0.1 U.S. dollars/kg) to activated charcoal.