Comparative Study of Gabapentin, Clonidine and Placebo in Alleviating the Hemodynamic Changes Due to Tracheal Intubation and Laryngoscopy.

INTRODUCTION: Hemodynamic changes during laryngoscopy and tracheal intubation must be reduced for safe and effective anesthesia. The present study was conducted to compare the efficacy of oral clonidine, gabapentin and placebo in alleviating the hemodynamic changes due to tracheal intubation and laryngoscopy. METHODS: This was a double-blinded randomized controlled trial conducted on 90 patients who were undergoing elective surgery and were randomized into three groups. Group I (n=30) received a placebo, group II (n=30) received gabapentin and group III (n=30) received clonidine as premedication before anesthesia induction. Patient heart rate and pressor response were recorded periodically and compared between the groups. RESULTS: There was no significant difference in the baseline heart rate (HR) and mean arterial pressure (MAP) between the groups. HR elevation was observed in all three groups and found to be significant (p=0.0001) but the increase was higher in the placebo (15 min: 80.80± 15.41) and lower in the clonidine group (15 min: 65.53± 12.43). The elevation in systolic and diastolic blood pressure was least and transient in the gabapentin group, as compared to placebo and clonidine group. Intra-operatively, the requirement of opioids was higher in the placebo as compared to clonidine and gabapentin (p < .001). CONCLUSION: Clonidine and gabapentin were effective in reducing the hemodynamic changes during laryngoscopy and intubation.

Prognostic Role of Catecholamine in Moderate-to-Severe Traumatic Brain Injury: A Prospective Observational Cohort Study.

Objective Traumatic brain injury leads to the activation of sympathetic nervous system and elevation in serum catecholamine levels. The aim of this study was to determine whether catecholamine level obtained within 24 hours of traumatic brain injury provides a reliable prognostic marker for outcome. Materials and Methods This study was a prospective observational cohort study on 36 moderate-to-severe traumatic brain injury. Plasma epinephrine (E), norepinephrine (NE), and dopamine (DA) levels were measured by using computed tomography enzyme-linked immunosorbent assay test and compared with Glasgow coma scale (GCS) that was obtained concurrently. Neurological outcome was determined by GCS at day 7 of treatment and by Glasgow outcome scale at mean follow-up of 9.73 ± 2.26 months. Results Patients with GCS 3 to 4 had markedly increase in baseline mean E (771.5 ± 126.0), NE (2,225.0 ± 215.4), and DA (590.2 ± 38.8) levels as compared with control, while patients with better GCS (11-12) had mildly elevated levels. Patients with GCS 5 to 10 had intermediate values. Cases with markedly elevated baseline E, NE, and DA level were either died or remained in poor GCS (3 or 4) at day 7 of treatment and remained in persistent vegetative state at mean follow-up of 9.73 ± 2.26 months. Cases with only mildly elevated E, NE, and DA level were improved to better GCS on treatment and had good recovery on follow-up. Conclusion These data indicate that a markedly elevated catecholamine level was an excellent endogenous and readily quantifiable marker that appears to reflect the extent of brain injury and predict the likelihood of recovery.

A Randomised Controlled Trial to Compare the Effect of Ramosetron and Ondansetron in Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Gynaecological Procedures.

Background and objective The antiemetic drug is one of the most common armamentariums in an anaesthesiologist's pharmacopoeia to prevent postoperative nausea and vomiting (PONV). PONV is one of the usual side effects after general anaesthesia, especially in female patients (21%) and after laparoscopic surgery (60%). This study aimed to compare the efficacy of ondansetron with ramosetron. Methodology After institutional ethical clearance and informed written consent, one hundred female patients scheduled for laparoscopic gynaecological surgeries were selected for this prospective, double-blinded, randomised interventional study. These patients were further subdivided into two equal groups (50 in groups R and O). Group R received ramosteron 0.3mg, and group O received ondansetron 8mg 30 minutes before the end of surgery. Patients were assessed between 0-2, 2-6, 6-12 and 12-24 hrs in the postoperative period. The primary objective of this study was to compare the effect of a single dose of ramosetron (0.3mg) with a single dose of ondansetron (8mg) for the prevention of PONV after general anaesthesia in laparoscopic surgeries. The secondary goal was to record the time of occurrence of the first episode of PONV, the need for rescue antiemetics, patient satisfaction scores, and to look for any side effects. Results This study shows no significant difference in the reduction of PONV incidence between group O and group R in the first 24 hours of the postoperative period. The overall incidence of PONV was significantly higher in the early postoperative (0-6 hrs) than in the late postoperative period (6-24 hrs), i.e., 51% and 13%, respectively. The requirement of rescue antiemetic was higher in group O than in group R but not statistically significant. In our study, both groups had similar patient satisfaction scores. Headache was the most common side effect and was noted in 9% of the patient population. Conclusion We conclude that ramosetron is as effective as ondansetron in preventing the incidence and severity of PONV up to 24 hours postoperatively.

A curious case of hemoptysis.

Paragonimiasis is a crustacean-borne parasitic zoonosis caused by lung fluke or Paragonimus. Several endemic foci of paragonimiasis have been discovered in Northeastern India. Chronic pulmonary infection with Paragonimus is characterized by hemoptysis, which is usually mistaken for Tuberculosis (TB). Paragonimiasis is acquired by eating raw, undercooked, or pickled crabs or crayfish containing encysted metacercariae of Paragonimus. Infection can usually be confirmed by finding Paragonimus eggs in sputum or bronchoalveolar lavage. We present a rare case of paragonimiasis masquerading as hypereosinophilia, asthma, and intracerebral hemorrhage for the last three years. Paragonimiasis is a rare cause of hemoptysis outside endemic regions. A strong index of suspicion is required to diagnose paragonimiasis outside the endemic areas. Diagnosis is usually delayed because of similarity of presentation to TB. Our patient was symptomatic with hemoptysis for three years. He gave history of eating raw crayfish and crabs while on leave to his native village in Nagaland. Diagnosis was confirmed on microscopy by detection of Paragonimus ova in sputum and bronchoalveolar lavage specimens. Symptoms resolved on treatment with praziquantel (25 mg/kg TDS for three days). Patient became symptom-free after a week of treatment.

Influence of Parental Awareness Drive on Preoperative Fasting Compliance in Pediatric Day Care Surgery.

Context: Optimum preoperative fasting is imperative for the prevention of aspiration in pediatric patients. The current guidelines advocate 2-4-6 rule for the same. However, direct supervision is lacking in large volume centers. Aims: Thus, we aimed to determine the fasting compliance of children preoperatively and to ascertain whether parents understood the significance and purpose of optimum fasting. Materials and Methods: Design - A prospective questionnaire-based study regarding preoperative fasting was performed in pediatric patients aged 1-10 years scheduled for "day care surgery" or "same day admission surgery" over 12 weeks. Thereafter, parental awareness drive was carried out, and a re-audit was performed with a questionnaire in the next cohort of patients. Results: The number of patients in the pre and postcounseling groups were 98 and 99. Thirteen percent of the patients were optimally fasted for solids initially. Re-audit confirmed compliance increased to 46%. Patients fasting adequately (2-3 h) for clear fluids increased from 22.4% to 51.5% postcounseling. The number for optimally breast-fed children increased postaudit (23.1%-39.1%). Consequent to the drive, parental awareness increased and 49.5% parents knew that only plain water was permitted during fasting. Number of parents considering preoperative fasting important increased from 39.8% to 79.7%. Initially, 27.6% of the parents did not know the reason for fasting, which reduced to 3% postaudit. Conclusion: Parents are misinformed and ignorant about optimum preoperative fasting. Adequate education and awareness to improve their knowledge was associated with increased compliance for optimal fasting.

Development of a Machine learning image segmentation-based algorithm for the determination of the adequacy of Gram-stained sputum smear images.

Background: Machine learning (ML) prepares and trains a model through supervised or unsupervised learning methods. Sputum, a respiratory tract secretion, is a common laboratory specimen that aids in diagnosing respiratory diseases, including pulmonary tuberculosis (TB). Gram stain is an easy, cost-effective stain, which may be applied to sputum smears to screen out an unsatisfactory sample. ML model may help in screening sputum smears. Methods: This collaborative project was carried out from June 2020-July 2021. In this study, a color-based segmentation ML algorithm using K-Means clustering was developed. A library of stained sputum smears was built. The Bartletts criteria (based on neutrophil and squamous cell count) for screening and selecting satisfactory sputum smears were used. A smartphone camera was used to take several photographs of satisfactory, as well as unsatisfactory, smears. The image segmentation algorithm was applied to medical image analysis, color-segmentation of sputum images was done. The hue saturation value (HSV) color ranges were defined on a prototype image. Then, all connected pixels were identified as a single object, and morphological operations were applied. Results: Usage of AI-driven model on the slide-image revealed the slide adequacy as the cell count was acceptable based on Bartlett's criteria. Both the manual cell counts (Range: 126-203 neutrophils, 14-47 squamous cells) and the model counts (Range: 117-242 neutrophils, 14-37 squamous cells) are within acceptable limits. Conclusion: The use of a model to screen a large number of sputum slides may be a boon in resource-limited settings where trained microscopists may not be easily available.

EduNet: A New Video Dataset for Understanding Human Activity in the Classroom Environment.

Human action recognition in videos has become a popular research area in artificial intelligence (AI) technology. In the past few years, this research has accelerated in areas such as sports, daily activities, kitchen activities, etc., due to developments in the benchmarks proposed for human action recognition datasets in these areas. However, there is little research in the benchmarking datasets for human activity recognition in educational environments. Therefore, we developed a dataset of teacher and student activities to expand the research in the education domain. This paper proposes a new dataset, called EduNet, for a novel approach towards developing human action recognition datasets in classroom environments. EduNet has 20 action classes, containing around 7851 manually annotated clips extracted from YouTube videos, and recorded in an actual classroom environment. Each action category has a minimum of 200 clips, and the total duration is approximately 12 h. To the best of our knowledge, EduNet is the first dataset specially prepared for classroom monitoring for both teacher and student activities. It is also a challenging dataset of actions as it has many clips (and due to the unconstrained nature of the clips). We compared the performance of the EduNet dataset with benchmark video datasets UCF101 and HMDB51 on a standard I3D-ResNet-50 model, which resulted in 72.3% accuracy. The development of a new benchmark dataset for the education domain will benefit future research concerning classroom monitoring systems. The EduNet dataset is a collection of classroom activities from 1 to 12 standard schools.

Observation of ion acceleration in nanosecond laser generated plasma on a nickel thin film under rear ablation geometry.

In this article we report acceleration observed for the ions produced in a 50-nm-thick nickel film coated on a quartz substrate, under nanosecond laser ablation, in the rear ablation geometry. A detailed study with varying background pressure and laser energy is done. Spectroscopic study including spectroscopic time of flight (STOF) measurements of ionic and other neutral transitions from the plasma has been undertaken. The STOF spectra recorded for ionic transition clearly show an enhancement in the velocity of the slow component as the background pressure increases. In addition, a large asymmetric spectral broadening in the 712.22-nm neutral line is observed, which increases with background pressure. While these observations have similarity to some of the reported studies on the acceleration of ionic species through double-layer formation, the electric fields calculated from the measured acceleration appear to be anomalously higher, and a double-layer concept seems to be inadequate. Moreover, the large asymmetry observed in the neutral line profile is indicative of microelectric fields present inside the laser produced plasma plume, which may play a role in the continuous acceleration of the ions. Interestingly, this asymmetry in spectral broadening exhibits temporal and spatial dependence, which indicates that significant electric field is present in the plasma plume even for longer duration and larger distance from the target. These spectroscopic observations of acceleration have also been complemented by triple Langmuir probe measurements. To the best of our information, such observations regarding large ion acceleration for the rather low laser intensities as used in this experiment have not been reported in literature so far.

Spectroscopic investigation of molecular formation in laterally colliding laser-produced carbon plasmas: publisher's note.

This publisher's note corrects errors in Appl. Opt.58, 561 (2019)APOPAI0003-693510.1364/AO.58.000561.

Spectroscopic investigation of molecular formation in laterally colliding laser-produced carbon plasmas.

We report detailed spectroscopic investigation of carbon dimer production in the stagnation layer formed due to laterally colliding plasma plumes under vacuum and N2 ambience. Two spatially separated Nd:YAG laser pulses are used to generate plasma plumes in close proximity to a solid graphite target. A comparative optical emission spectroscopic study of a stagnation layer and a single carbon plasma plume is carried out in order to find the optimum experimental conditions for carbon dimer (C2) production. Significant enhancement in the C2 production is observed in the stagnation layer as compared to that observed in the single plume. Further, a substantial increase in carbon dimer formation is monitored by introducing N2 gas. Along with carbon dimer, carbon nitride (CN) band emission is also observed in the emission spectra. Spatiotemporal evolution of C2 and CN emission reveals that the yield of carbon dimer production is at a maximum close to the target surface, and decreases with an increase in time as well as spatial position. On the contrary, CN emission increases with the target distance. The dominant pathways for CN formation are suggested, and it is demonstrated that C2 acts as a precursor to CN formation. The above observation is correlated with cooling of ejected carbon species in the collisional regime and the estimated vibrational temperature of C2.

Trojan horse anaesthesia: A novel method of anaesthesia for pars plana vitrectomy.

CONTEXT: Topical anesthesia has been used for pars plana vitrectomy (PPV) with limited patient comfort. Thus, augmenting topical anesthesia with intracameral anesthesia (Trojan horse anesthesia) will provide pain-free experience during PPV. AIMS: This study was undertaken to evaluate the patient comfort and surgical safety using 2% lignocaine jelly augmented with intracameral 1.0% lignocaine solution for anesthetizing the eyes undergoing PPV. SETTINGS AND DESIGN: This was a prospective interventional case series at tertiary care hospital. SUBJECTS AND METHODS: Patients planned for PPV for indications other than retinal detachment were included in the study. The pain perception of the participants undergoing PPV under Trojan horse anesthesia was evaluated using visual analog scale (VAS). STATISTICAL ANALYSIS USED: Data analysis was done using descriptive statistics and nonparametric analysis with level of significance at P < 0.05. RESULTS: There were 114 eyes of 114 patients in the study out of which 68.4% (n = 78) were males. The mean age was 42.31 years (range 14-80 years, standard deviation [SD] 18.7). The mean surgical time was 34.0 min (range 13-80 min, SD 14.2). The pain perception on VAS scale averaged 3.0 (range 0-8, SD 1.59, median 3.0). Pain scores were not affected by the age (Pearson correlation = 0.098, P = 0.3), gender (P = 0.44), or the educational status of the participant (P = 0.28). The pain scores were not affected by the indications of surgery (P = 0.58) or the use of silicone oil (P = 0.07). CONCLUSIONS: Trojan horse anesthesia provides adequate analgesia for comfortable and safe 23-gauge PPV with high patient acceptability.

Screening of over 1000 Indian patients with breast and/or ovarian cancer with a multi-gene panel: prevalence of BRCA1/2 and non-BRCA mutations.

PURPOSE: Breast and/or ovarian cancers are among the most common cancers in women across the world. In the Indian population, the healthcare burden of breast and/or ovarian cancers has been steadily rising, thus stressing the need for early detection, surveillance, and disease management measures. However, the burden attributable to inherited mutations is not well characterized. METHODS: We sequenced 1010 unrelated patients and families from across India with an indication of breast and/or ovarian cancers, using the TruSight Cancer panel which includes 14 genes, strongly associated with risk of hereditary breast and/or ovarian cancers. Genetic variations were identified using the StrandNGS software and interpreted using the StrandOmics platform. RESULTS: We were able to detect mutations in 304 (30.1%) cases, of which, 56 mutations were novel. A majority (84.9%) of the mutations were detected in the BRCA1/2 genes as compared to non-BRCA genes (15.1%). When the cases were stratified on the basis of age at diagnosis and family history of cancer, the high rate of 75% of detection of hereditary variants was observed in patients whose age at diagnosis was below 40 years and had first-degree family member(s) affected by breast and/or ovarian cancers. Our findings indicate that in the Indian population, there is a high prevalence of mutations in the high-risk breast cancer genes: BRCA1, BRCA2, TP53, and PALB2. CONCLUSION: In India, socioeconomic inequality limiting access to treatment is a major factor towards increased cancer burden; therefore, incorporation of a cost-effective and comprehensive multi-gene test will be helpful in ensuring widespread implementation of genetic screening in the clinical practice for hereditary breast and/or ovarian cancers.

Lingzhi or Reishi Medicinal Mushroom, Ganoderma lucidum (Agaricomycetes), Inhibits Candida Biofilms: A Metabolomic Approach.

This article presents a comparative gas chromatography (GC)-mass spectrometry (MS)-based metabolomic analysis of mycelia and fruiting bodies of the medicinal mushroom Ganoderma lucidum. Three aqueous extracts-mycelia, fruiting bodies, and a mixture of them-and their sequential fractions (methanolic and ethyl acetate), prepared using an accelerated solvent extractor, were characterized by GC-MS to determine volatile organic compounds and by high-performance thin-layer chromatography to quantify ascorbic acid, a potent antioxidant. In addition, these extracts and fractions were assessed against Candida albicans and C. glabrata biofilms via the XTT reduction assay, and their antioxidant potential was evaluated. Application of chemometrics (hierarchical cluster analysis and principal component analysis) to GC data revealed variability in volatile organic compound profiles among G. lucidum extracts and fractions. The mycelial aqueous extract demonstrated higher anti-Candida activity and ascorbic acid content among all the extracts and fractions. Thus, this study illustrates the preventive effect of G. lucidum against C. albicans and C. glabrata biofilms along with its nutritional value.

Comparative Inhibition Study of Compounds Identified in the Methanolic Extract of Apamarga Kshara Against Trichomonas vaginalis Carbamate Kinase (TvCK): An Enzoinformatics Approach.

In the present study, we have identified ten compounds, namely dodecanol acid, myristic acid, neophytadiene, palmitic acid, heptadecanoic acid, linoleic acid, elaidic acid, 3-7-dimethyl acid, stearic acid and methyl eicos acid, of the methanolic extract of Apamarga Kshara by GC-MS analysis. Apamarga Kshara has been reported to be active against cervical erosion. Major causal organism for cervical erosion is Trichomonas vaginalis. However, there is a paucity of information about the mechanism of action and inhibitory effect of the biologically active natural compounds presented in A. Kshara against this organism (T. vaginalis). Therefore, present investigation was conducted to observe possible interactions of these compounds on T. vaginalis carbamate kinase using molecular docking software 'AutoDock 4.2.' Identification of the amino acid residues crucial for the interaction between T. vaginalis carbamate kinase and these natural compounds is of due scientific interest. The study will aid in efficacious and safe clinical use of the above-mentioned compounds.

Trabeculectomy Under Augmented Topical Anesthesia: Study on Pain Evaluation and Surgical Feasibility.

PURPOSE: Performing trabeculectomy under topical anesthesia using lignocaine jelly with intracameral anesthesia may offer painless surgery with immediate visual gain and avoid the increase in intraocular pressure associated with locally injected anesthesia. In this context, we evaluated topical anesthesia using 2% lignocaine jelly with intracameral 1.0% lignocaine for trabeculectomy in terms of pain during surgery and the surgeon's experience. DESIGN: This was a tertiary care center-based interventional case series. METHODS: Patients scheduled for trabeculectomy as the first surgery for medically controlled glaucoma underwent standard ab externo trabeculectomy under topical anesthesia. Pain evaluation was done using a visual analog scale with the modified Wong-Baker FACES Pain Rating Scale, within 1 hour after surgery. RESULTS: Fifteen eyes of 14 patients were included in the study with a mean (SD, range) age of 61.3 (17.54, 40-90, distributed normally) years. Patients' pain score analysis showed a mean (SD, range) visual analog scale score of 0.73 (0.59, 0-2) on a scale of 0 to 10. The mean (SD, range) surgeon's satisfaction score was 3.2 (0.4, 3-4) on a scale of 3 to 9. The intraocular pressure of all patients was well controlled at 2 weeks [mean (SD, range), 9.2 (2.9, 4-16)] and at 4 weeks [mean (SD, range), 13.2 (1.2, 11-15)] postoperatively without any topical or systemic antiglaucoma medications. CONCLUSIONS: Trabeculectomy can be done under augmented topical anesthesia, which provides adequate analgesia for acceptable patient and surgeon comfort with favorable outcomes. Anesthesia provided by topical application of lignocaine 2% jelly and intracameral 1.0% lignocaine is sufficient for safe trabeculectomy surgery with acceptable discomfort to the patient.

Iron Profile and Glycaemic Control in Patients with Type 2 Diabetes Mellitus.

Iron overload is increasingly being connected to insulin resistance in Type 2 Diabetes Mellitus (T2DM) patients. Free iron causes the assembly of reactive oxygen species that invariably steer the body's homeostasis towards oxidative stress-mediated diabetic complications. This study aims to assess the serum iron, total iron binding capacity (TIBC), and percentage transferrin saturation (Tsat) of 150 subjects divided into three groups (I,II,III) of 50. Healthy individuals (controls) constituted Group I. Group II consisted of T2DM patients with optimal glycaemic control. T2DM patients with suboptimal glycaemic control formed group III. Mean serum free iron concentration was 105.34 ± 3.5, 107.33 ± 3.45, and 125.58 ± 3.45 µg/dL in Group I, Group II, and Group III, respectively. Mean serum TIBC concentration in Group I, Group II, and Group III was 311.39 ± 5.47, 309.63 ± 6.1, and 284.2 ± 3.18 µg/dL, respectively. Mean serum transferrin saturation (%) in Group I, Group II, and Group III was 34.17 ± 1.21, 35.02 ± 1.2, and 44.39 ± 1.07, respectively. The difference between TIBC, mean serum free iron concentration, and transferrin saturation between Group I and Group III (for all, p values <0.001), as well as between Group II and Group III (p values 0.0012, 0.0015, and <0.0001, respectively) was statistically significant. The fasting plasma glucose values of Groups II and III were significantly higher than those of Group I, (p < 0.0001). Glycated haemoglobin (HbA1c) values were also shown to increase from Group I to II and then III, and the increase was highly significant (all p values <0.0001). Thus, decreased glycaemic control and an increase in the glycation of haemoglobin was the key to elevation in serum iron values and alterations in other parameters. However, a significant correlation was absent between serum iron and HbA1c (r = 0.05) and transferrin saturation (r = 0.0496) in Group III.

Diamagnetic cavitization of laser-produced barium plasma in transverse magnetic field.

Influence of uniform transverse magnetic field and ambient Ar pressure on the plasma plume produced by Nd:YAG laser ablation of barium has been investigated by time-of-flight optical emission spectroscopy. Experiments were carried out with laser pulse energy of 150 mJ and 0.45 Tesla magnetic field. The time-of-flight profiles showed ambient pressure independent behavior at 6-mm distance from the target, which is attributed to the diamagnetic behavior of the laser plasma. A theoretical model is proposed that may explain the compression of temporal profiles of the ionic lines.

Emission analysis of a laser-produced barium plasma plume.

In the present work we report the characteristic emission features of a laser-produced barium plasma plume. The time-resolved analysis for the different spectral lines of neutral and singly charged ionic barium has been carried out. It has been observed that the temporal evolution of electron temperature and density shows a peculiar behavior which is significantly different from the reported results of laser ablation of materials. The electron density increases with increase in delay time but the temperature does not change to any significant extent. Strong self-reversal in the emission of a resonant singly charged barium ionic line (455.4 nm) with time delay indicates the increase of population of singly charged barium ion with time. The results are explained on the basis of the increased population of barium metastables and subsequent ionization (Penning type).

Proof-of-concept experiment for on-line laser induced breakdown spectroscopy analysis of impurity layer deposited on optical window and other plasma facing components of Aditya tokamak.

In the present manuscript, we demonstrate the design of an experimental setup for on-line laser induced breakdown spectroscopy (LIBS) analysis of impurity layers deposited on specimens of interest for fusion technology, namely, plasma-facing components (PFCs) of a tokamak. For investigation of impurities deposited on PFCs, LIBS spectra of a tokamak wall material like a stainless steel sample (SS304) have been recorded through contaminated and cleaned optical windows. To address the problem of identification of dust and gases present inside the tokamak, we have shown the capability of the apparatus to record LIBS spectra of gases. A new approach known as "back collection method" to record LIBS spectra of impurities deposited on the inner surface of optical window is presented.