Impact of Socio-demographic Variables, Surgical Techniques and Risk Factors on the Outcome of Coronary Artery Bypass Graft Surgery among Bangladeshi Population.

This study was intended to evaluate the pathological outcome of cardiopulmonary bypass whilst considering socio-demographic variables and surgical technique on early postoperative results following coronary artery bypass graft (CABG) surgery in patients at a tertiary level hospital in Bangladesh. This observational study evaluated a total of 880 patients with ischemic heart disease in Bangabandhu Sheikh Mujib Medical University, Bangladesh from 2011 to 2019 who were undergoing an isolated CABG surgery. In this current study, the population divided into two groups- Group A: Off-pump CABG (n=440) and Group B: On-pump CABG (n=440). The mean age of the patients was 55.25±5.0 years in off-pump and 50.75±5.2 years in the on-pump group. Risk factors, including smoking, hypertension, and hyperlipidemia, were predominant in both study groups. Total operative time was notably higher in the on-pump CABG group. However, grafting time was more in the off-pump CABG procedures. Postoperative neurological deficits were higher amongst the on-pump CABG population. The mean time of mechanical ventilation, intensive care unit (ICU) stay, total hospital stay, and mortality was notably higher in the on-pump CABG group. Moreover, the number of mortalities in on-pump CABG patients was primarily due to the low output syndrome, failure of weaning from cardiopulmonary bypass (CPB) and sudden cardiac arrest. Off-pump CABG is now more acceptable due to its potentiality to avoid CPB induced complications, aortic cannulation, and cross-clamping. Cardiac arrest in on-pump CABG induces global ischemia and reperfusion injury to the cardiac muscle. Besides, the Off-pump CABG provides a conspicuous survival advantage compared to the on-pump CABG, in association with a notable reduction in postoperative morbidity and mortality.

Bolstering Buck Fertility: The Impact of Asparagus racemosus Aqueous Extract on Semen Cryopreservation and Antioxidant Defense System.

Importance of Study: Semen cryopreservation results in sperm damage due to lipid peroxidation or oxidative stress, leading to a decrease in conception rate. The sperm damage during cryopreservation can be minimized with the use of suitable antioxidant supplements in semen diluent. Some herbs have potent antioxidant potential and can be used in semen diluent to protect the spermatozoa. Objective: Hence, the investigation was planned to evaluate the effect of Asparagus racemosus (A. racemosus) aqueous extract on buck semen quality during cryopreservation. Methodology: In the current study, semen was collected from eight Sirohi bucks, and from each buck, 8 ejaculates were collected. Good-quality semen samples were pooled during each collection. Pooled semen samples were then divided into four equal parts and diluted in TRIS buffer containing different concentrations of A. racemosus aqueous extract (different groups, i.e., G I -5 mg, G II -2.5 mg, G III -1.25 mg, and G IV -0 mg of A. racemosus aqueous extract in 1 mL TRIS buffer). All the diluted semen samples were kept at equilibration temperature (5°C) for 2 hours and then cryopreserved by the manual method. Semen samples were evaluated for various sperm characteristics and antioxidant status before and after cryopreservation. Results: Asparagus racemosus aqueous extract showed significant (p < 0.05) enhancement of sperm viability, sperm motility, acrosomal integrity, and plasma membrane integrity, whereas it reduced sperm abnormality. Furthermore, in the experimental groups, the antioxidant gene expression was found to be increased compared to that of the treatment group. G III (p < 0.05) showed significantly better results in terms of sperm viability, sperm motility, acrosomal integrity, and plasma membrane integrity. Conclusion: Asparagus racemosus aqueous extract has the antioxidant potential to protect buck spermatozoa during semen cryopreservation.

Expert panel recommendations for topical hemostatic agent use in varied bleeding sites and situations during neuro-spine surgeries.

Intraoperative bleeding poses a substantial challenge, particularly in neuro-spine surgeries leading to complications such as hematomas, infections, and hemodynamic instability. Despite their proven efficacy, use of topical hemostatic agents (THAs) lacks comprehensive published literature and guidelines particularly in the Indian setting. The present study provides the first-ever Indian expert panel recommendations for effective adjunct THA use in different intraoperative bleeding sites and situations in neuro-spine surgeries. A comprehensive approach, encompassing a literature review, followed by experience sharing in a meeting using a survey helped integrate expert opinions in the form of practical algorithms to guide THA selection. Our survey results revealed a strong inclination towards specific THAs, flowable gelatin + thrombin being choice of THA for difficult to access and problematic bleeding situations during tumor removal/resection, transsphenoidal hypophysectomy and skull-based procedures. Both oxidized regenerated cellulose (ORC)/Fibrillar and flowable gelatin + thrombin were recommended for continuous oozing. ORC/Fibrillar was preferred for arteriovenous and cavernous malformations. This expert-panel guidance on THA use aims to optimize hemostat use practices and improve surgical outcomes in neuro-spine surgery.

Automated classification of hidradenitis suppurativa disease severity by convolutional neural network analyses using calibrated clinical images.

BACKGROUND: The assessment of hidradenitis suppurativa (HS) severity requires detailed, and error-prone lesion counts. This proof-of-concept study aimed to automatically classify HS disease severity using machine learning of clinical smartphone images. METHODS: 777 ambient-light and size-controlled images were used to build a class-balanced synthetic dataset (n = 7675). Convolutional neural networks (CNN) were used for automated severity classification (scale 0-3), and to assess disease-dynamics. International Hidradenitis Suppurativa Severity Score System (IHS4) served as reference. A U-NET algorithm was implemented for automated localization of diseased skin. RESULTS: CNNs were able to distinguish no/mild from moderate/severe disease with an overall prediction accuracy of 78% [receiver operating curve (AUC) 0.85]. Correct IHS4 classification was achieved with an overall accuracy of 72% (AUC 0.84-0.89). In addition, disease dynamics using IHS4 numerical values aligned with CNN outputs (NRMSE 0.262). The UNET algorithm localized lesions with a pixel accuracy of 88.1% and test loss of 0.42. LIMITATIONS: Limitations in assessing tattooed and hairy skin. Limited number of patients with dark skin colour and Hurley I. CONCLUSION: CNNs were able to distinguish no/mild from moderate/severe disease, classify disease severity over time, and automatically identify diseased skin areas and the skin phototype. This study breaks new grounds for fast, reliable, reproducible and easy-to-use HS severity assessments using clinical images.

Single parent adoption in India: Mental health and legal perspectives and the way forward.

Single parent adoption (SPA) is a relatively new construct worldwide and in India. The Ministry of Women and Child Development, Government of India, has laid down criteria for adoption in general and SPA in particular, in conjunction with the Juvenile Justice Act (Care and Protection of Children), 2015. There is scant literature on this topic of SPA, more so in India, that looks into the various psychological nuances of SPA from a mental health professional's (MHP) perspective. This review paper aims to assess SPA from the perspective of a MHP that will focus on its various legal nuances as well as the psychological connotations attached to it. For this, a search strategy was employed that included a thorough literature search from two databases (PubMed and Google Scholar) with relevant keywords related to the topic. The various legal issues pertaining to SPA in the current scenario, the psychological issues and challenges faced by single parents, the behavioral outcomes of adoptees who are adopted by single parents, and ways to deal with the various obstacles of SPA are discussed.

Diagnostic Dilemma of Frozen Shoulder in Post CABG Patient: A Case Report.

Frozen shoulder, also known as adhesive capsulitis, is a condition featured by stiffness and pain in shoulder joint. In this report, we present a case of 58 years old diabetic male patient with the history of coronary artery bypass grafting (CABG) 06 months back. He presented with persistent right shoulder pain for 05 months. Clinical examinations reveal restriction of the right shoulder joint movement in all directions and wasting of the right supraspinatus, infraspinatus and trapezius muscles. Both active and passive range of motions was restricted with painful right shoulder joint. Pain free abduction range was about 40 degrees in right shoulder. Plain X-ray of right shoulder joint and other relevant investigations show normal findings. Considering the clinical and laboratory findings decision was taken to treat the patient with exercise, pain killer and ultrasound therapy which were found to be optimistic.

IGF-1 stabilizes goat sperm mitochondrial transmembrane potential and reduces dna fragmentation.

BACKGROUND: Antioxidant present in sperm cells protects them from oxidative damage. However, sperm are more susceptible to peroxidative damages due to the loss of these enzymes during cryopreservation and their survival and fertility may be compromised. Insulin like growth factor-1 (IGF-1) has an antioxidant effect and could maintain sperm motility. OBJECTIVE: To improve seminal parameters, mitochondrial membrane potential (MMP), oxidative status and DNA integrity of buck semen after freeze-thawing by fortification of goat semen diluent with various concentrations of IGF-1. MATERIALS AND METHODS: Fifty ejaculates were collected and were extended with tris- citric acid- fructose diluent with 10% egg yolk and 6% glycerol with sperm concentrations of 1×108 mL-1. Post-cryopreserved sperm were assessed for motility and a range of other functional parameters. RESULTS: In post-thaw semen sperm motility, live sperm count, acrosome integrity, hypo-osmotic swelling positive spermatozoa, malondialdehyde (MDA), protein carbonyl content (PCC), TUNEL positive sperm differed significantly (P<0.05) with the various concentrations of IGF-1 used. Sperm functional parameters post-thawing were significantly (P<0.05) better in 250 ng/mL IGF-1. IGF-1 protects against lipid peroxidation by lowering MDA and PCC production, thus reducing the harmful effect of reactive oxygen species. The kidding percentage using the artificial insemination technique was significantly higher ( i.e., 40%) in the group supplemented with 250 ng/mL of IGF-1 than in the non-supplemented group (i.e., 30%). CONCLUSION: IGF-1 may be used to improve post-thaw semen quality and fertility as measured by actual kidding rate. Doi.org/10.54680/fr23610110312.

An Unusual Complication of a Usual Guidewire during Central Venous Cannulation.

How to cite this article: Palanisamy S, Arish BT, Segaran S, Ranjan RV. An Unusual Complication of a Usual Guidewire during Central Venous Cannulation. Indian J Crit Care Med 2022;26(6):761-762.

Comparative Evaluation of Frictional Resistance Between Different Types of Ceramic Brackets and Stainless Steel Brackets With Teflon-Coated Stainless Steel and Stainless Steel Archwires: An In-Vitro Study.

Background Orthodontic tooth movement relies on sliding mechanics usually achieved by sliding the archwire through brackets. Sliding causes friction which is a force resisting the relative motion of two contacting objects. Frictional resistance is undesirable in orthodontic tooth movement because the archwire might bind with the bracket and prevent tooth movement. In addition, friction causes bending of the archwire leading to unwanted tooth movement or space loss through anchorage interference, prolonging the treatment time and root resorption. This study was performed to compare the frictional resistance produced by different types of ceramic brackets and stainless steel brackets with Teflon-coated stainless steel and stainless steel archwires. The surface texture of the wire before and after friction test was also evaluated using a scanning electron microscope (SEM). Methodology A total of 48 samples were tested. In total, 12 premolar brackets each of stainless steel (Ortho technology, Carlsbad, CA, USA), monocrystalline ceramic (Ortho technology, Carlsbad, CA, USA), polycrystalline ceramic (Ortho technology, Carlsbad, CA, USA), and ceramic bracket with a metal slot (Ortho technology, Carlsbad, CA, USA) having an 0.022-inch slot were coupled with 0.019 × 0.025-inch stainless steel and Teflon-coated stainless steel wires. Each bracket-wire assembly was vertically mounted and clamped to the jaws of the universal testing machine. The wire was pulled across the bracket with a cross head speed of 10 mm per minute. The readings obtained were recorded. To evaluate the surface roughness, wires were examined using an SEM (in four magnifications 250×, 500×, 1,000×, and 5,000×) before and after testing. Results Under the testing conditions, the stainless steel bracket-stainless steel wire combination produced the least frictional resistance, and the polycrystalline ceramic bracket-stainless steel wire combination produced the highest frictional resistance. Ceramic brackets with a metal slot generated lesser friction than other types of ceramic brackets but more friction than stainless steel brackets. Moreover, for all bracket-archwire combinations, Teflon-coated wires generated reduced frictional resistance compared to stainless steel wires. The surface examination of Teflon-coated stainless steel wire and conventional uncoated stainless steel wire revealed that Teflon-coated wire had a smoother surface compared to uncoated stainless steel wire. Conclusions Within the limitations of this study, it was concluded that the stainless steel bracket produced the lowest frictional resistance and the polycrystalline ceramic bracket produced the highest frictional resistance. Ceramic brackets with a metal slot showed a coefficient of friction that was more than but comparable to that of stainless steel brackets. Monocrystalline ceramic brackets generated lesser friction compared to polycrystalline ceramic brackets. Further, Teflon coating of stainless steel archwires can reduce frictional resistance compared to conventional uncoated stainless steel archwires. The surface of Teflon-coated stainless steel wires was found to be smoother than uncoated stainless steel wires.

Evaluation of Shear Bond Strength of a Primer Incorporated Orthodontic Composite Resin: An In-Vitro Study.

Introduction Newer adhesive systems are available eliminating the separate priming step during the bonding procedure thereby reducing the chances of introduction of error during bonding. The purpose of this study was to compare the shear bond strength of a primer-incorporated adhesive with that of a self-etching primer system and conventional bonding system. Materials and method Sixty-six extracted human premolars were cleaned, mounted, and randomly divided into three groups. In group A (control), 22 teeth were bonded with stainless steel orthodontic brackets using the conventional bonding system; in group B, 22 teeth were bonded using a self-etching primer system (Transbond Plus SEP, 3M Unitek, Monrovia, CA) and in group C, 22 teeth were bonded using the new primer-incorporated adhesive system (GC Ortho Connect, GC Orthodontics, Breckerfeld, Germany). After bonding, the teeth were stored in artificial saliva at 37ºC for 24 hours and debonded with a universal testing machine. The adhesive remnant index (ARI) was also evaluated. Statistical analysis was done using one-way ANOVA to compare the shear bond strength values among the three groups and Kruskal Wallis test was used for comparison of ARI scores. Results The SBS values in group A (11.60 ± 2.95 MPa), group B (9.44 ± 4.46 MPa) and group C (12.68 ± 6.25 MPa) were found to be comparable with no statistically significant difference. The ARI scores were also similar among the tested groups with the predominant site of bond failure being the bracket-adhesive interface indicating a safe bond-failure site. Conclusion GC Ortho Connect was found have clinically acceptable shear bond strength values that are comparable with that of self-etching primer and conventional bonding system. Therefore, it can be used effectively for saving the clinician's chairside time by reduction in the number of steps during bonding without compromising on the bond strength.

Comparison of dexmedetomidine in two different doses on emergence agitation in children under sevoflurane anaesthesia: A double-blind randomised controlled trial.

BACKGROUND AND AIMS: Emergence agitation (EA) in children is one of the most common postoperative problems encountered in the recovery room. Sevoflurane has been strongly associated with EA owing to its lower solubility and rapid recovery. Dexmedetomidine has been found to reduce the incidence of EA. This study was designed to evaluate the effectiveness of dexmedetomidine in two doses in reducing EA in children. METHODS: This was a prospective double-blinded randomised study done on eighty children aged 5-14 years undergoing adenotonsillectomy/tonsillectomy under sevoflurane anaesthesia. Patients in Group A (n = 40) received 0.3 µg/kg/h and patients in group B (n = 40) received 0.5 µg/kg/h infusion after a bolus dose of 0.5 µg/kg of dexmedetomidine. The primary objective was to compare two different doses of dexmedetomidine on EA in the postoperative period. The secondary objectives were to assess the pain and perioperative haemodynamics in the recovery room. The anaesthesiologist blinded to the study charted the paediatric anaesthesia emergence delirium score (PAED), perioperative haemodynamic parameters, objective pain score and rescue medications if given. The data were analysed using Student's unpaired t-test, Chi-square test, repeated measures Analysis of Variance (ANOVA) and Mann-Whitney U test wherever appropriate. RESULTS: The incidence of EA was comparable between both groups (P = 0.960). The haemodynamic parameters (P > 0.05) and the objective pain score (P = 0.810) also did not show a statistically significant difference. CONCLUSION: A lower dose of dexmedetomidine (0.3 µg/kg/h) is equally effective as a higher dose (0.5 µg/kg/h) after a bolus dose of 0.5 µg/kg in decreasing EA.

Status of Beta Defensin-1 and its Effect on Post-thaw Semen Fertility Gene Expression in Indian Goat Breed.

BACKGROUND: Defensins are antimicrobial peptides and uniformly spans the entire sperm surface and is not exclusive to a specific domain. Goat ß-defensin-1 helps in initiation of motility and capacitation of sperm. OBJECTIVE: To know the status of ß-defensin-1 in blood, semen and its effect on post thaw fertility gene expression in Indian goat breeds. MATERIALS AND METHODS: Semen was extended and divided for estimation of ß-defensin-1 and cryopreserved having different concentrations of ß-defensin-1. RESULTS: Bet defensin-1 concentration (pg/mL) in neat semen, sperm pellet and seminal plasma was significantly higher (P< 0.05) in goat breed Barbari followed by Jamunapari and Jakhrana. ß-defensing-1 was also high in Jakhrana blood followed by Barbari and Jamunapari. The post thaw motility, live sperm, acrosome intactness and hypo osmotic swelled sperms were significantly higher (P< 0.05) with 10 ng/mL ß-defensin in the semen dilutor. CONCLUSION: Beta defensin (10 ng/mL) in semen dilutor may be used as immuno-modulator to get better post thaw quality suitable for artificial insemination.

Cauda Equina Syndrome: A Review of 15 Patients Who Underwent Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD) Under Local Anaesthesia.

INTRODUCTION: To analyse the results of Cauda Equina Syndrome (CES) operated by Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD). MATERIAL AND METHODS: The study is a retrospective series of 15 patients operated by PTELD. Bladder dysfunction was classified as incomplete CES (CESI) and complete CES retention (CESR). Bladder / motor recovery rate and its timing, Oswestry Disability Index (ODI), Visual Analogue Score (VAS), patient satisfaction index, and sexual dysfunction were used to measure the outcome objectively. Additionally, in CESR patients, post-void residual (PVR) urine was measured by sonography. Complications and technical problems were noted. RESULTS: There were ten patients of CESI and five patients of CESR. The average follow-up was 20.33(12.05) months. Bladder symptoms recovery was 100%, and motor recovery was 80%. VAS for back pain recovered to 0.53(0.52) from 8(2.39). VAS for leg pain recovered to 0.13(0.35) from 9.20(1.32). ODI improved to 6.07(2.85) from 77.52(13.20). The time to the recovery of bladder function was 1.47(1.55) days. All CESR patient's abnormal PVR urine was normalised at five weeks post-operative. No complications were reported. However, five technical executional problems occurred. CONCLUSION: PTELD can be considered for CES treatment due to its substantial and quick recovery advantages. However, more evidence support is needed to make it a practice recommendation.

A 15 Year's Experience with Minimally Invasive Mitral Valve Replacement in Bangladesh.

This study was aimed to compare the long-term outcomes and survival rate among mitral valve replacement using thoracotomy and standard median sternotomy in a single surgeon's practice. Total 250 patients were evaluated; Group I (n=65) patients had anterolateral thoracotomy and Group II (n=185) had standard median sternotomy for valve replacement. Mean age was 25.1±5 years in Group I and 41.8±10.5 years in Group II. Female was predominant in Group I. Total operative time and bypass time was statistically significant in Group I (235.5±25.8 minutes; 84.2±12.75 minutes) in contrast to Group II (203.8±15.5 minutes; 71.5±10.5 minutes). Incision scar was not visible in females in Group I but full incision scar was visible in Group II. Post-operative ICU stay duration was significant high in Group II. Though, wound infection incidence was 0% in Group I; however, 9.73% patient had wound infection in Group II. Only 1.62% patient developed unstable sternum in Group II. Most of the patients from both study group were in regular follow up and 1-year mortality rate was 4.62% and 5.94% in Group I and Group II respectively. Mitral valve replacement through a right anterolateral thoracotomy is easy and safe to perform; while getting maximum benefits for the patients. Besides satisfactory cosmetic outcome especially in female, this approach provides better exposure to mitral apparatus even in patients with small left atrium, cost effectiveness, less duration of hospital stays and absence of the risk for unstable sternum.

A randomised double-blind trial of minimal bolus doses of oxytocin for elective caesarean section under spinal anaesthesia: Optimal or not?

BACKGROUND: Oxytocin administration regimens are arbitrary and highly subjective. Hence, it is essential to reinvestigate the appropriate dose for effective uterine contraction with minimal bleeding and adverse effects. AIM: To determine the optimal dose of bolus oxytocin for uterine contractions for elective caesarean section under spinal anaesthesia. METHODS: Ninety term mothers (37 to 41 weeks) undergoing caesarean section electively under spinal anaesthesia were considered for the trial and divided into three groups to receive oxytocin bolus of one, two or three units. The uterine tone was assessed at 2 min after oxytocin administration. Intraoperative blood loss, mean arterial pressure, heart rate and possible side effects were also compared. Paired t-test, Kruskal-Wallis test, Chi-square test and analysis of variance (ANOVA) test with Scheffe multiple comparisons were used as inferential statistics. RESULTS: Adequate uterine contraction was seen in 66% of participants who received one unit of oxytocin, and in 83.3% of participants who received two units of oxytocin. All those who received three units of oxytocin had an adequate uterine contraction. Blood loss was inversely related to the bolus dose of oxytocin. CONCLUSIONS: Lower bolus oxytocin doses of one and two units were inadequate for uterine contraction at elective caeserean section, while three units appeared to be effective in terms of adequate uterine contraction, reduced blood loss and stable haemodynamic system and absent side effects.

Extending Horizon of Robotic Surgery to Bladder-Preserving Approach for Vesical Paraganglioma: Rare Case with Unusual Presentation.

Background: Vesical paraganglioma is rare and accounts for <0.1% of all urinary bladder tumors. They are mostly functional because of secretion of catecholamines and clinical presentation may mimic like a hyperfunctioning adrenal pheochromocytoma. They are easily misdiagnosed as urothelial malignancy and adequate perioperative attention is not provided. Case presentation: We hereby report a case of 55-year-old Indian lady with silent vesical paraganglioma at anatomically difficult location of bladder neck managed with robot-assisted excision of mass and bladder preservation. Conclusion: Surgery is the mainstay of the treatment that requires total excision of mass. However, minimally invasive bladder-preserving approach should be always kept as an option, if feasible. Robot assistance can help in bladder preservation even in difficult anatomic locations.

Cigarette smoking promotes cancer-related transformation of oral epithelial cells through activation of Wnt and MAPK pathway.

Aim: Study aims to investigate the effect of cigarette smoking on cancer-related transformation in oral epithelial cells of smokers through evaluating the alteration in Wnt/ß-catenin and MAPK pathways. Materials & methods: Exfoliated oral epithelial cells were collected from 138 subjects and categorized into nonsmokers, smokers and clinically diagnosed precancer and cancer patients. Real-time quantitative PCR was performed to detect the fold changes of related genes. Expressions of biomarkers were assessed using immunofluorescence and western blot. Results: Study shows significant (p < 0.001) alteration in mRNA level of TNF-α, NF-κß, FZD1, ß-catenin, PARD 3, MAPK1 and vimentin genes under cigarette smoking. Conclusion: Results suggested the progression of oral cancer under cigarette smoking occurs through multiple events and activation of canonical Wnt/MAPK pathways.

Fast Tract Anesthesia Using Isoflurane and Propofol During Off-pump Coronary Artery Bypass Graft Surgery.

This study aimed to evaluate myocardial protective effect of isoflurane and propofol as a fast tract anesthesia in off pump coronary artery bypass graft surgery by measuring postoperative cardiac enzyme Troponin-I, and liver enzyme. The study was conducted on 260 patients scheduled to undergo elective off pump coronary artery bypass graft surgery. Patients were randomly allocated to receive either isoflurane or propofol anesthesia and was aimed to extubated within 6 hours. Troponin-I levels were measured preoperatively, at arrival in postoperative intensive care unit, at 12, 24, 48, 72 hours and 4 weeks following surgery. Liver function was also assessed and compared between preoperative and postoperative values. There is no difference in Troponin-I levels between the two studies groups at observed pre and post-operative time intervals. Fast tract anesthesia using isoflurane and propofol provides same myocardial protection during and after OPCABG and overall outcome was excellent.