Search

Herein, we report two different adsorbents from spherical nanocellulose (SNC) in successive steps, for the adsorption of Hg2+ ions and Congo red (CR). Cellulose extracted from pine needles was subsequently converted to SNC through mixed acidic hydrolysis. As-obtained SNC was esterified with methionine at C6 of the anhydroglucose unit to produce SNC-methionine ester (SNC-ME). The amino group of methionine residue in SNC-ME was protonated to SNC-PME with positive surface charge. The SNC-ME and SNC-PME were evaluated as Hg2+ ions and CR adsorbents, respectively. The SNC, SNC-ME, SNC-PME, Hg2+-loaded SNC-ME, and CR-loaded SNC-PME were characterized by FTIR, XRD, XPS, Zeta potential, BET, FESEM, EDS, and surface charge analysis. SNC-ME showed Hg2+ ions removal efficiency of 94.8 ± 1.9 % in 40 min, while SNC-PME showed CR removal efficiency of 96.1 ± 3.8 % in 90 min. The adsorption data of both the adsorbents fitted best into pseudo-second order kinetic and Langmuir isotherm. The maximum adsorption capacity of SNC-ME for Hg2+ ions was 211.5 ± 3.1 mg/g and that of SNC-PME for CR was 281.1 ± 7.1 mg/g. The astounding recyclability of the adsorbents for ten repeat cycles with significant cumulative adsorption capacity of 760.9 ± 12.8 mg/g for Hg2+ ions and 758.8 ± 12.7 mg/g for CR endorses their spectacular potentiality for wastewater treatment. SNC was prepared by mixed acidic hydrolysis of cellulose, sourced from vastly available forest biomass, pine needles, and esterified with methionine to get SNC-ME which was later protonated to get SNC-PME. These adsorbents were respectively used to remove Hg2+ ions and anionic dye, Congo red from their sample solutions. [Display omitted] [ABSTRACT FROM AUTHOR]

We applied a holistic, sustainable, and green approach to develop an effective multipurpose adsorbent from whole pine needles (PNs), a forest waste lignocellulosic biomass. The PNs were oxidized and modified with phenylhydrazine-4-sulphonic acid (ɸHSO 3 H) to OPN-ɸHSO 3 H. The latter was characterized and tested as an adsorbent for cationic dyes, malachite green (MG), methylene blue (MB), crystal violet (CV), and metal ions (Hg2⁺ and Pb2⁺). The adsorption followed different kinetic models: Elovich for MG and MB, pseudo-second-order for CV, and pseudo-first-order for Hg2⁺ and Pb2⁺. Langmuir isotherm indicated maximum adsorption capacities of 303.4 ± 8.91 mgg−1 (MG), 331.4 ± 17.50 mgg−1 (MB), 376.6 ± 22.47 mgg−1 (CV), 210.8 ± 28.86 mgg−1 (Hg2⁺), and 172.9 ± 20.93 mgg−1 (Pb2⁺) within 30 min. Maximum removal efficiencies were 99.0% (MG), 98.0% (MB), 96.04% (CV), 95.5% (Hg2⁺), and 89.8% (Pb2⁺). The adsorbent demonstrated significant regeneration and reusability over ten cycles, proving highly efficient for both cationic dyes and metal ions, with wide potential for practical applications where more than one adsorbate is present. [Display omitted] • Pine needles (PN) were oxidized in two steps with TEMPO, and NaIO 4. • -CHO of OPN reacted with phenylhydrazine-4-sulphonic acid to form Schiff-base. • Schiff-base proved selective adsorbent for MB, CV, MG, Hg2+, and Pb2+ ions. • Adsorption was highly rapid and efficient with high adsorption capacity. • High adsorption capacity even after ten cycles of regeneration and reusability. [ABSTRACT FROM AUTHOR]

Cancer is a complex disease that starts with genetic alterations and mutations in healthy cells. The past decade has witnessed a huge demand for new biocompatibility and high-performance intelligent drug delivery systems. Curcumin (CUR) is a bioactive stimulant with numerous medical benefits. However, because of its hydrophobic nature, it has low bioavailability. The utilization of many biobased materials has been found to improve the loading of hydrophobic drugs. Cellulose nanocrystals (CNCs) with exceptional qualities and a wide range of applications, feature strong hydrophilicity and lipophilicity, great emulsification stability, high crystallinity and outstanding mechanical attributes. In this review, numerous CNCs-based composites have been evaluated for involvement in the controlled release of CUR. The first part of the review deals with recent advancements in the extraction of CNCs from lignocellulose biomass. The second elaborates some recent developments in the post-processing of CNCs in conjunction with other materials like natural polymers, synthetic polymers, β-CD, and surfactants for CUR loading/encapsulation and controlled release. Furthermore, numerous CUR drug delivery systems, challenges, and techniques for effective loading/encapsulation of CUR on CNCs-based composites have been presented. Finally, conclusions and future outlooks are also explored. [Display omitted] [ABSTRACT FROM AUTHOR]

Diabetes is a chronic metabolic disease that lasts a person's life and the estimation of blood glucose concentration is one of the main diagnostic criteria for this disease. The past decade has witnessed a huge demand for new biocompatibility and high-performance glucose biosensors. Non-enzymatic optical glucose sensing using nano/microscaled materials has surged significantly as it provides a direct visualized and cost-effective way to measure glucose concentrations. This review, in a non-exhaustive way, considers some of the recent most important achievements in the glucose-sensitive optical biosensors based upon nano/microscaled materials. Such materials are capable of mimicking the activities of the enzymes which oxidize glucose to release H 2 O 2. The overall framework of the review can be divided into three parts. The first part describes the colorimetric glucose sensing using nano/microscaled materials as enzyme mimics for the oxidation of different chromogenic substrates. In the second part, some recent developments in chromogenic substrate-free fluorescence glucose sensing facilitated by nano/microscaled materials are elaborated. The third part reviews the glucose-sensing through Förster resonance energy transfer (FRET) based assays. Finally, some current challenges, gaps in fundamental understanding and future improvements in the field of optical glucose biosensors are discussed. [Display omitted] ▪ [ABSTRACT FROM AUTHOR]

Krishi Vigyan Kendra is a district level institution work as a centre of knowledge for farming community. In the year 2014-15, Krishi Vigyan Kendra adopted three villages in District-Sehore (M.P.) and imparted activities like on Farm Trials; Front Line Demonstrations; Training to Farm Women and rural youth along with income generation activities; training to extension personal and other extension activities for extension of latest technologies. Krishi Vigyan Kendra is also developing and need based literature on latest technologies in local language and same are distributed to farming community for impact study, Krishi Vigyan Kendra were selected 25 farmers on random bases in each adopted village (Village- Gloukhedi in block Ichhawar; village Bichhiya inb block – Bafapur in block-Asta) and collect the feedback about adoption of technologies. [ABSTRACT FROM AUTHOR]

We present two rare cases of children who presented with progressive exertional breathlessness and dry cough. They also had history of bluish discoloration of mucous membranes, hands and feet on exertion. Both were diagnosed to have pulmonary alveolar proteinosis after a high-resolution computed tomography and bronchoalveolar lavage. They were subjected to bilateral whole lung lavage (WLL) as a salvage therapy. Bilateral WLL was performed in a single sitting with the help of a modified endotracheal tube. The anesthetic technique included a modified cuffed endotracheal tube for accomplishing WLL. After the procedure, both children improved clinically and functionally. [ABSTRACT FROM AUTHOR]

In this paper, a low-cost and room temperature flexible carbon monoxide (CO) gas sensor is presented using multi-walled carbon nanotubes coated cotton fabric. A dip and drying method is used to fabricate a lightweight, and high-performance fabric based CO gas sensor using different concentrations of multi-walled carbon nanotubes (MWCNTs). Transmission electron microscopy (TEM) is utilized for examining the deagglomeration of MWCNTs in the presence of a sufficient amount of surfactant. The field-emission scanning electron microscopy (FESEM) is used to evaluate the formation of a uniform network of MWCNTs on the cotton fabric. Fourier transform infrared (FTIR) spectroscopy is used to confirm the presence of functional groups which plays an important role in CO gas sensing. The fabricated cotton fabric coated with MWCNTs (CCM) sensors are tested with different concentrations of CO gas ranging from 25 ppm to 100 ppm at room temperature. It is found that in comparison to all other sensors, the CCM sensor coated with the higher concentration of MWCNTs (0.5 mg/ml) shows a maximum response of 9.11 % at 25 ppm and 15.2 % at 100 ppm concentration of CO gas respectively. The CCM 4 sensor shows the fastest response and recovery within 49s for 25–100 ppm of CO gas. Moreover, the fabricated CCM sensor exhibited good repeatability, reproducibility, and selectivity. These sensors are suitable for low-cost smart textile applications. [Display omitted] • Biodegradable cotton fabric-based room temperature CO gas sensors are fabricated. • Flexible cotton fabric sensors are fabricated using CNT with a low-cost process. • The fabricated sensors are highly-sensitive for the detection of CO gas. • The CO gas sensor has a quick response and recovery time at room temperature. • High potential uses in biomedical sensors, intelligent packaging, and e-textile. [ABSTRACT FROM AUTHOR]

Background: Blood transfusion requirement during neonatal open heart surgeries is universal. Homologous blood transfusion (HBT) in pediatric cardiac surgery is used most commonly for priming of cardiopulmonary bypass (CPB) system and for postoperative transfusion. To avoid the risks associated with HBT in neonates undergoing cardiac surgery, use of autologous umbilical cord blood (AUCB) transfusion has been described. We present our experience with the use of AUCB for neonatal cardiac surgery.Designs and Methods: Consecutive neonates scheduled to undergo cardiac surgery for various cardiac diseases who had a prenatal diagnosis made on the basis of a fetal echocardiography were included in this prospective observational study. After a vaginal delivery or a cesarean section, UCB was collected from the placenta in a 150-mL bag containing 5 mL of citrate-phosphate-dextrose-adenine-1 solution. The collected bag with 70-75 mL cord blood was stored at 2°C-6°C and tested for blood grouping and infections after proper labeling. The neonate's autologous cord blood was used for postcardiac surgery blood transfusion to replace postoperative blood loss.Results: AUCB has been used so far at our institute in 10 neonates undergoing cardiac surgery. The donor exposure in age and type of cardiac surgery-matched controls showed that the neonates not receiving autologous cord blood had a donor exposure to 5 donors (2 packed red blood cells [PRBCs], including 1 for CPB prime and 1 for postoperative loss, 1 fresh frozen plasma, 1 cryoprecipitate, and 1 platelet concentrate) compared to 1 donor for the AUCB neonate (1 PRBC for the CPB prime). Postoperative blood loss was similar in both the groups of matched controls and study group. Values of hemoglobin, total leukocyte count, platelet counts, and blood gas parameters were also similar.Conclusions: Use of AUCB for replacement of postoperative blood loss after neonatal cardiac surgery is feasible and reduces donor exposure to the neonate. Its use, however, requires a prenatal diagnosis of a cardiac defect by fetal echo and adequate logistic and psychological support from involved clinicians and the blood bank. [ABSTRACT FROM AUTHOR]

Background: Literature search reveals that postoperative atrial fibrillation (POAF) occurs in 15%-40% of coronary artery bypass graft (CABG) patients. Although several risk models exist for predicting the development of POAF, few have studied left atrial appendage (LAA) velocity. We hypothesize that an association between LAA velocity and development of POAF exists.Design and Methods: Single institution university hospital prospective observational clinical study performed between May 2016 and November 2016 in 96 adult patients undergoing CABG surgery utilizing cardiopulmonary bypass (CPB). Transesophageal echocardiography was performed perioperatively to measure LAA velocity and left atrial (LA) size after anesthetic induction, post-CPB and during the postoperative period before extubation. Student's t-test was used for inter-group comparisons. Data are expressed as mean ± (standard deviation). The value of P < 0.05 was considered statistically significant.Results: A total of 95 patients (69 males and 26 females) completed the study and were included in the final analysis. Of these, 21 (22%) (15 males and 5 females) developed POAF. The patient group which developed POAF was compared with the group that did not develop POAF. On comparing mean age of patients in each group (59 years in patients with no POAF and 63.71 years in patients with POAF, P = 0.04). LA volume indexed in POAF group (34.13 ml/m2) compared with that in group with no POAF (34.82 ml/m2) resulted in P = 0.04. Mean LAA velocities (pre-CPB, post-CPB, postoperative Intensive Care Unit) in group with no POAF were 41.06, 56.33, and 60.44 cm/s, respectively, whereas in the other group with POAF the values were 39.68, 55.04, and 58.09 cm/s, respectively. No statistical significance was noted (P > 0.05). Comparison of comorbidities also did not yield any significant results (P > 0.05).Conclusions: Decreasing LAA velocity does not appear to independently predict the development of POAF in patients undergoing CABG surgery with the use of CPB. There is, however, a positive correlation of POAF with age and LA volume. [ABSTRACT FROM AUTHOR]

Background: Conduct of stable inhalational anesthetic induction in children with congenital heart disease (CHD) presents special challenges. It requires in-depth understanding of the effect of congenital shunt lesions on the uptake, delivery, and equilibration of anesthetic drugs. Intracardiac shunts can alter the induction time and if delivery of anesthetic agent is not carefully titrated, can lead to overdosing and undesirable myocardial depression.Aims: To study the effect of congenital shunt lesions on the speed of inhalational induction and also the impact of inhalational induction on hemodynamics in the presence of congenital shunt lesions.Setting: Tertiary care hospital.Design: A prospective, single-center clinical study.Materials and Methods: Ninety-three pediatric patients undergoing elective surgery were segregated into three equal groups, namely, Group 1: no CHD, Group 2: acyanotic CHD, and Group 3: cyanotic CHD. General anesthesia was induced with 8% sevoflurane in 6 L/min air-oxygen. The time to induction was noted at loss of eyelash reflex and decrease in bispectral index (BIS) value below 60. End-tidal sevoflurane concentration, minimum alveolar concentration, and BIS were recorded at 15 s intervals for the 1 st min followed by 30 s interval for another 1 min during induction. Hemodynamic data were recorded before and after induction.Results: Patients in Group 3 had significantly prolonged induction time (99 ± 12.3 s; P < 0.001), almost twice that of the patients in other two groups (51 ± 11.3 s in Group 1 and 53 ± 12.0 s in Group 2). Hypotension occurred after induction in Group 1. No other adverse hemodynamic perturbations were observed.Conclusion: The time to inhalational induction of anesthesia is significantly prolonged in patients with right-to-left shunt, compared to patients without CHD or those with left-to-right shunt, in whom it is similar. Sevoflurane is safe and maintains stable hemodynamics in the presence of CHD. [ABSTRACT FROM AUTHOR]

Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by accumulation of excessive lung surfactant in the alveoli leading to restrictive lung functions and impaired gas exchange. Whole lung lavage (WLL) is the treatment modality of choice, which is usually performed using double lumen endobronchial tube insertion under general anesthesia and alternating unilateral lung ventilation and washing with normal saline. It may be difficult to perform WLL in patients with severe hypoxemia wherein patients do not tolerate single lung ventilation. Extracorporeal membrane oxygenation support (ECMO) has been used in such patients. We report a patient with autoimmune PAP following renal transplant who presented with marked hypoxemia and was managed by WLL under ECMO support. [ABSTRACT FROM AUTHOR]

We hereby report a child with transposition of great arteries and regressed ventricle who underwent arterial switch operation (ASO) with the aid of cardiopulmonary bypass and "integrated" extracorporeal membrane oxygenation (ECMO) circuit. The significance of lactate clearance as a guide to initiate and terminate veno-arterial ECMO in a post ASO child with regressed left ventricle is discussed. [ABSTRACT FROM AUTHOR]

Objective(s): This study aimed to determine the prevalence of carotid artery stenosis (CAS) due to atherosclerosis in neurologically asymptomatic patients undergoing coronary artery bypass grafting (CABG) for coronary artery disease (CAD). It contemplated a greater role for the cardiac anesthesiologist in the perioperative management of such patients with either previously undiagnosed carotid artery disease or towards re-assessment of severity of CAS.Design: Prospective, observational clinical study.Setting: Operation room of a cardiac surgery centre of a tertiary teaching hospital.Participants: A hundred adult patients with New York Heart Association (NYHA) classification I to III presenting electively for CABG.Interventions: All patients included in this study were subjected to ultrasonic examination by means of acarotid doppler scan to access for presence of CAS just prior to induction of general anesthesia.Measurements and Main Results: Based on parameters measured using carotid doppler, the presence of CAS was defined using standard criteria. The prevalence of CAS was found to be as high as 38% amongst the patients included in our study. The risk factors for CAS were identified to be advanced age, history of smoking, diabetes mellitus, dyslipidaemia and presence of a carotid bruit.Conclusion: This study points towards the relatively wide prevalence of carotid artery disease in neurologically asymptomatic patients undergoing CABG for CAD in the elective setting. It highlights the need to routinely incorporate carotid ultrasonography in the armamentarium of the cardiac anesthesiologist as standard of care for all patients presenting for CABG. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses reports published in the issue which include the atrioventricular septal defect (AVSD) disorder, the surgical correction of children with congenital heart disease, and the review on perioperative and intensive care of children with AVSD.

Background: Prophylactic use of intra-aortic balloon pump (IABP) mainly depends on left ventricular (LV) systolic function. Global longitudinal strain (GLS) is a robust prognostic parameter for LV strain. It has proved to be more sensitive than LV ejection fraction (EF) as a measure of LV systolic function and is a strong predictor of outcome. Aim: To determine whether GLS can be used as a reliable marker and its cut-off value for IABP insertion in patients undergoing elective off-pump coronary artery bypass grafting (OPCABG). Settings and Design: A prospective observational clinical study which included 100 adult patients scheduled for elective OPCABG. Materials and Methods: Two-dimensional (2D) speckle tracking echocardiography (STE)-estimated GLS was computed and compared with LV EF measured by three dimensional (3D) echocardiography for the insertion of IABP. The intensive care unit (ICU) parameters were correlated with echocardiographic parameters to predict early post-operative outcome. Results: IABP insertion correlates better with GLS (post-revascularization > pre-revascularization) than with 3D LV EF. Receiver operating characteristic (ROC) curve analysis revealed the highest area under the curve (AUC, 0.972) with a cut-off value of > -9.8% for GLS compared to 3D LV EF (AUC, 0.938) with a cut-off value of = 44%. ICU parameters show better correlation with E/e'> GLS > WMSI than 3D LV EF. Conclusion: GLS is a better predictor of IABP insertion compared to 3D LV EF in patients undergoing OPCABG. [ABSTRACT FROM AUTHOR]

Objective: The aim was to compare various pre-and post-operative parameters and to identify the predictors of mortality in neonates, infants, and older children undergoing Modified Blalock Taussig shunt (MBTS). Materials and Methods: Medical records of 134 children who underwent MBTS over a period of 2 years through thoracotomy were reviewed. Children were divided into three groups-neonates, infants, and older children. For analysis, various pre-and post-operative variables were recorded, including complications and mortality. Results: The increase in PaO2 and SaO2 levels after surgery was similar and statistically significant in all the three groups. The requirement of adrenaline, duration of ventilation and mortality was significantly higher in neonates. The overall mortality and infant mortality was 4.5% and 8%, respectively. Conclusion: Neonates are at increased risk of complications and mortality compared with older children. Age (<30 days), weight (<3 kg), packed red blood cells transfusion >6 ml/kg, mechanical ventilation >24 h and post shunt increase in PaO2(PDiff) <25% of baseline PaO2 are independent predictors of mortality in children undergoing MBTS. [ABSTRACT FROM AUTHOR]

Although the concept of extracorporeal membrane oxygenation (ECMO) has remained unchanged, component technology has evolved considerably over the past three decades. Presently the clinical conditions requiring ECMO support have been updated with input from the outcome data of patient registries. Modern circuit configuration has become less cumbersome, safer, and more efficient. Technological advances now allow prolonged support with fewer complications compared to the past eras and facilitate transition to a single bedside caregiver model, similar to hemofiltration or ventricular-assist devices. The clinical considerations and indicators for placing the patient on ECMO, the various circuit configurations, clinical and technical issues, and management aspects are considered in this article. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) is an adaptation of conventional cardiopulmonary bypass techniques to provide cardiopulmonary support. ECMO provides physiologic cardiopulmonary support to aid reversible aspects of the disease process and to allow recovery. ECMO does not provide treatment of the underlying disease. The indications for ECMO support have expanded from acute respiratory failure to acute cardiac failure refractory to conventional treatments from wide patient subsets involving neonates to adults. Vascular access for ECMO support is either percutaneous through a single-site, dual-lumen bicaval cannula or transthoracic via separate cannulas. The modes of support are either veno-venous or veno-arterial ECMO. In this article, the physiologic aspects of ECMO support are outlined. [ABSTRACT FROM AUTHOR]

Indications for extra corporeal membrane oxygenation (ECMO) after pediatric cardiac surgery have been increasing despite the absence of encouraging survival statistics. Modification of ECMO circuit led to the development of integrated ECMO cardiopulmonary bypass (CPB) circuit at the author's institute, for children undergoing repair of transposition of great arteries among other congenital heart diseases (CHD). In this report, they analyzed the outcome of children with CHD, undergoing surgical repair and administered ECMO support in the last 10 years. The outcome was analyzed with reference to the timing of intervention, use of integrated ECMO--CPB circuit, indication for ECMO support, duration of ECMO run and the underlying CHD. The results reveal a significantly improved survival rate with the use of integrated ECMO--CPB circuit and early time of intervention rather than using ECMO as a last resort in the management. The patients with reactive pulmonary artery hypertension respond favorably to ECMO support. In all scenarios, early intervention is the key to survival. [ABSTRACT FROM AUTHOR]

Leprosy, a chronic granulomatous infection caused by Mycobacterium leprae, classically presents with cutaneous and neurological manifestations. Musculoskeletal involvement though third most common is underdiagnosed and underreported. It may manifest in the form of Charcot’s arthropathy, acute symmetrical polyarthritis or swollen hands and feet syndrome during lepra reactions, insidious-onset chronic symmetrical polyarthritis mimicking RA or as isolated tenosynovitis or tenosynovitis associated with arthritis or neuropathy. At times, articular involvement may be the sole presenting manifestation even without cutaneous lesions. Other rheumatological manifestations occasionally reported are enthesitis, sacroiliitis, cryoglobulinaemic vasculitis and DM. With increasing travel of population between tropical and temperate zones, it is likely that rheumatology clinics in countries free of leprosy may come across cases of leprosy with rheumatological manifestations. Delay in diagnosis and management may be detrimental and may result in deformities and loss of function. Not only this, but recent reports of leprosy being diagnosed in native white populations following anti-TNF-α therapy should alert rheumatologists across the globe to be more familiar with this disease. This review is aimed at presenting a comprehensive clinical scenario of various rheumatological manifestations of leprosy to sensitize rheumatologists and physicians across the continents. [ABSTRACT FROM PUBLISHER]

Indian patients undergoing cardiac surgery have different demographics, clinical profile as well as risk profile, compared to the western population. The purpose of this study was to validate the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification model in Indian patients undergoing cardiac surgery in a single cardiac center. Data from 1000 consecutive adult patients undergoing cardiac surgery (coronary artery bypass grafting or valve surgery) were prospectively collected as per the EuroSCORE model. The model's validity was assessed on the basis of its calibration power (Hosmer-Lemeshow test) and discriminatory power [area under receiver operating characteristic curve]. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow test revealed a good calibration power (P = 0.73) and the area under the ROC curve was 0.8278, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients (15.6%) was double that of predicted mortality (7.5%). The risk factors prevalent in European population were not observed in Indian population. EuroSCORE accurately predicts mortality in low and moderate-risk Indian patients undergoing cardiac surgery but is less predictive for high- risk Indian patients. Updating and improvisation of EuroSCORE by incorporation of risk factors associated with rheumatic valvular heart disease which is more prevalent in India, may enable it to accurately predict mortality in high-risk patients also. [ABSTRACT FROM AUTHOR]

The surgical procedures performed with robtic assitance and the scope for its future assistance is endless. To keep pace with the developing technologies in this field it is imperative for the cardiac anesthesiologists to have a working knowledge of these systems, recognize potential complications and formulate an anesthetic plan to provide safe patient care. Challenges posed by the use of robotic systems include, long surgical times, problems with one lung anesthesia in presence of coronary artery disease, minimally invasive percutaneous cardiopulmonary bypass management and expertise in Trans-Esophageal Echocardiography. A long list of cardiac surgeries are performed with the use of robotic assistance, and the list is continuously growing as surgical innovation crosses new boundaries. Current research in robotic cardiac surgery like beating heart off pump intracardic repair, prototype epicardial crawling device, robotic fetal techniques etc. are in the stage of animal experimentation, but holds a lot of promise in future. [ABSTRACT FROM AUTHOR]

To determine the most effective dose regimen of aprotinin for infants undergoing arterial switch operation for transposition of the great arteries in reducing blood loss and postoperative packed red blood cell (PRBC) requirements. A total of 24 infants scheduled for arterial switch operation for transposition of the great arteries were included in the study. The infants were randomly assigned to one of the three groups. Group I (n = 8) patients received aprotinin in a dose of 20,000 kallikrein inhibiting units (KIU)/kg after induction of anesthesia, 20,000 KIU/kg was added to the pump prime, and 20,000 KIU/kg/hour infusion for three hours after weaning from bypass; group II (n = 8) patients received aprotinin 30,000 KIU/kg after induction of anesthesia, 30,000 KIU/kg was added to the pump prime and 30,000 KIU/Kg/hour infusion for three hours after weaning from bypass; group III patients (n = 8) received aprotinin 40,000 KIU/kg after induction of anesthesia, 40,000 KIU/kg was added to the pump prime and 40,000 KIU/kg/hour infusion for three hours after weaning from bypass. Postoperatively, the cumulative hourly blood loss and PRBC requirements were noted up to 24 hours from the time of admission in the intensive care unit (ICU). Use of blood and blood products were noted. Coagulation parameters such as hematocrit, activated clotting time (ACT), fibrinogen, prothrombin time (PT), international normalized ratio (INR), platelet count, and fibrin degradation products (FDP) were investigated before cardiopulmonary bypass (CPB), after protamine administration, and at four hours postoperatively in the ICU. The number of infants reexplored for increased mediastinal drainage was recorded. Renal functions were monitored by measuring urine output (hourly) and serum urea (mg%) and serum creatinine (mg%) at 24 hours. The sternal closure time was comparable in all the three groups. Cumulative blood loss (ml/kg/24 hours) was greatest in group I (17.30 ± 7.7), least in group III (8.14 ± 3.17), whereas in group II, it was 16.45 ± 6.33 (P = 0.019 group I versus group III; (P = 0.036 group II versus group III). Postoperative PRBC requirements were significantly less in high dose group III (P = 0.008, group I versus III; p = 0.116, group II versus group III). Tests for coagulation performed at four hours postoperatively, viz. ACT, PT, INR, FDP, and platelets were comparable in the three groups. Urine output on CPB was comparable in all the groups. Serum urea and creatinine showed no significant difference between the three groups twenty four hours postoperatively. Aprotinin dosage regimen of 40,000 KIU/kg at induction, in CPB prime and postoperatively for three hours was most effective in reducing postoperative blood loss and PRBC transfusion requirements. Aprotinin does not have any adverse effect on renal function. [ABSTRACT FROM AUTHOR]

Abstract: Two series of novel hydrogels consisting of different molar ratios of monomers were prepared for specialty applications as sorbents for some common metal ions. The hydrogels, comprising acrylamide (AAm) and 2-hydroxyethyl methacrylate (HEMA), were prepared in a 1:1 water–acetone solvent system using fixed concentration of the initiator system comprising ammonium persulphate (APS) and N,N,N,N-tetramethylethylene diamine (TEMED) and were in situ crosslinked using two different crosslinkers [ethylene glycol dimethacrylate (EGDMA) and N,N-methylene bisacrylamide (N,N-MBAAm)]. In the reaction scheme employed to prepare hydrogels, only [HEMA] was changed over five concentrations. Hydrogels were further functionalized by partial saponification with 0.5 M NaOH. The hydrogels were characterized by FTIR, SEM and water uptake, and were used as adsorbents for Cu2+, Fe2+ and Cr6+ ions. The metal ion sorption was observed in the order: Fe2+ >Cu2+ >Cr6+. From the results obtained we can tailor some hydrogels for specific metal ion separation and enrichment, as the selectivity for these ions is significantly different. [Copyright &y& Elsevier]

Abstract: Objective: Hypothermia conventionally used in cardiopulmonary bypass necessitates rewarming to normothermic temperatures, which has been shown to be associated with neuropsychological injury. We studied the effects of two different rewarming strategies on postoperative neuropsychological function in cyanotic paediatric patients undergoing elective primary intracardiac repair of tetralogy of Fallot with the aid of cardiopulmonary bypass. Methods: This was a randomised clinical study undertaken in the cardiothoracic centre of a tertiary level referral and teaching hospital. Eighty children, aged 6–15 years undergoing elective primary intracardiac repair of tetralogy of Fallot using cardiopulmonary bypass under moderate hypothermia at 28°C were included in this study. The patients were randomly allocated into two groups of 40 each. Group 1 patients were rewarmed to a nasopharyngeal temperature of 33°C while group 2 patients were rewarmed to a nasopharyngeal temperature of 37°C before weaning them off cardiopulmonary bypass. The anaesthetic and bypass management was standardised for both the groups. All patients were assessed for neuropsychological function preoperatively and on the fifth postoperative day using the MISIC tests. The amount of blood loss and need for blood and blood product transfusion postoperatively, need for pacing, increased inotropes or vasodilator use and time to extubation were also noted. Serum s-100β levels were measured post anaesthetic induction and at 24h postoperatively. Results: There was a significant deterioration in neuropsychological function postoperatively in the patients in group 2 (37°C) as compared to their preoperative function. This was associated with higher s-100β levels 24h postoperatively in group 2 (37°C) compared to group 1 (33°C) patients. The time to extubation was longer in group 1 (33°C). No significant differences were noted in the amount of postoperative blood loss, blood and blood product use, inotrope or vasodilator use and the need for pacing. Conclusion: Weaning off bypass at 33°C is associated with lesser postoperative neuropsychological dysfunction compared to rewarming to 37°C before weaning off bypass. This may be used as a tool to decrease neurologic morbidity following cardiac surgery in children with congenital cyanotic heart disease. [Copyright &y& Elsevier]

Novel supports for use as cation and anion adsorbents were prepared from lignocellulosics using pine needles and their carboxymethylated forms by network/hydrogel formation with acrylamide and N,N-methylene bisacrylamide. The hydrogels thus prepared were further functionalized by partial alkaline hydrolysis with 0.5N NaOH and were characterized by FTIR, SEM and nitrogen analysis. Adsorption of Fe2+ on these hydrogels was carried as a function of time, temperature, pH and ionic strength. The hydrogel having the maximum adsorption capacity was loaded with Fe2+ at the conditions those afforded maximum uptake and was used as novel anionic adsorbent for . The water uptake capacities and biodegradability of the hydrogels before and after the ion loading was studied to evaluate the possible end-uses of these hydrogels as alternate materials in the removal of ionic species from water. [Copyright &y& Elsevier]

Treatment of tuberculosis (TB) infection (TBI) to prevent active TB disease is a key component of the National Strategic Plan to end TB in India, without which the strategies to end TB would be futile. There is a need to rapidly scale up access to effective shorter regimens for tuberculosis preventive treatment (TPT) to a wider set of risk groups. This applies for identifying high-risk groups for TPT expansion. Thus, our aim with this review is to determine the TBI prevalence in different risk groups in India. We searched databases like Embase, Medline, Scopus, and CINAHL for studies published between 2012 and 2023 to estimate TBI in different risk groups in India. The PRISMA guidelines were followed when reviewing the publications, and a predetermined search strategy was used to find relevant sources across various databases. Using MetaXL (MS excel) software, we pooled data based on a random-effects model, along with heterogeneity testing using Cochrane's Q and I2 statistic. A total of 68 studies were included from 10,521 records. TBI pooled prevalence was estimated using the IGRA data, while in the absence of IGRA data, TST data were utilized. The key findings revealed a total of 36% pooled TBI prevalence for all risk factors, 59% among smokers, 53% among diabetics and alcoholics, 48% among malnourished, 47% among contacts of TB patients, 44% among HIV, 36% among pregnant women, 35% among COVID-19 patients, 31% among healthcare workers, 18% among sarcoidosis patients, and 15% among rheumatoid arthritis patients in India. Our review depicted a high TBI burden among groups such as diabetes mellitus, smokers, malnourished, and alcoholics. WHO has yet to recommend for systematic screening and treatment for TBI among these groups for want of evidence which this study provides, highlighting the need to reprioritize the risk groups for tailored TPT strategies. [ABSTRACT FROM AUTHOR]

Background: Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss.Aims: The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation.Settings and Design: A prospective, matched case-control study which included sixty women of reproductive age group undergoing OHS.Patients and Methods: The surgical blood loss was compared between women who were menstruating (group-M; n = 25) and their matched controls, i.e., women who were not menstruating (group-NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup-P) and perioperative period (subgroup-PO) was compared to determine the effect of OHS on menstrual blood loss.Results: The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr-M = 245.6 ± 120.1 ml vs gr-NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr-P = 36.8 ± 4.8 ml vs gr-PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr-P = 4.2 ± 0.6 days vs gr-PO = 4.4 ± 0.6 days, P value = 0.10).Conclusion: Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation. [ABSTRACT FROM AUTHOR]

An alternative technique of coronary button transfer and Lecompte maneuver for anomalous left coronary artery (ALCAPA) arising from left lateral pulmonary sinus is described. This technique was used by us successfully in four patients aged 6 months to 3.5 years, weighing from 4.7 to 16 kg. The importance of trapdoor technique and Lecompte maneuver is discussed. (J Card Surg 2010;25:225-227) [ABSTRACT FROM AUTHOR]

This editorial discusses the occurrence of neurological complications after cardiopulmonary bypass (CPB). It highlights mortality and decreased postoperative quality of life caused by neurological dysfunction after cardiac surgery. It suggests some techniques to reduce or prevent the occurrence of stroke and encephalopathy. In addition, this article identifies the risks posed by postoperative hypothermia as a consequence of inadequate rewarming, including coagulopathy, shivering and arrhythmias.

A letter to the editor is presented which discusses the treatment of Behçet's syndrome and plasmacytoma in a patient with peripheral blood stem cell transplantation.

There is increased interest in flexible substrate-based piezoelectric energy harvester (PEH) for self-powered wireless sensor nodes, due to their low-cost and environmental friendliness. However, it presents fabrication challenges due to the low-temperature process and formation of a highly polar β-phase of a polymer film on a flexible substrate. In this work, first, we optimize the deposition parameters to grow the polar β-phase of poly vinylidene fluoride trifluoroethylene (PVDF-TrFE) film on Polyethylene terephthalate (PET) substrate. Using optimized PVDF-TrFE film, rectangular shape PEH is fabricated on a flexible Mo/PET substrate and characterized for voltage and power. It is found that the maximum measured power is 6.83 μW with input acceleration of 1.0 g. Further, we develop a novel analytical approach using a mass-spring damper model of PEH to predict the resonance frequency and output power. The fabricated and model results are shown to match well with mechanical and induced electrical damping as fitting parameters. The maximum measured power density from the flexible substrate based PEH is found to be 312.85 μW/cm3. The obtained power density is better than similar reported devices, with the advantage of low-cost material and fabrication. The optimized and low frequency PEHs reported in this work have a high potential for the wireless sensor node applications, such as monitoring of water bodies and plant health monitoring in agriculture, etc. [ABSTRACT FROM AUTHOR]

Objective To identify literature on health literacy levels and examine its association with tuberculosis treatment adherence and treatment outcomes. Methods Two authors independently searched Pubmed®, Embase, CINAHL, PsycINFO, Scopus, LILACS, Global Health Medicus and ScienceDirect for articles reporting on health literacy levels and tuberculosis that were published between January 2000 and September 2023. We defined limited health literacy as a person's inability to understand, process, and make decisions from information obtained concerning their own health. Methodological quality and the risk of bias was assessed using the JBI critical appraisal tools. We used a random effects model to assess the pooled proportion of limited health literacy, the association between health literacy and treatment adherence, and the relationship between health literacy and tuberculosis-related knowledge. Findings Among 5813 records reviewed, 22 studies met the inclusion criteria. The meta-analysis revealed that 51.2% (95% confidence interval, CI: 48.0--54.3) of tuberculosis patients exhibit limited health literacy. Based on four studies, patients with lower health literacy levels were less likely to adhere to tuberculosis treatment regimens (pooled odds ratio: 1.95; 95% CI: 1.37--2.78). Three studies showed a significant relationship between low health literacy and inadequate knowledge about tuberculosis (pooled correlation coefficient: 0.79; 95% CI: 0.32--0.94). Conclusion Health literacy is associated with tuberculosis treatment adherence and care quality. Lower health literacy might hamper patients' ability to follow treatment protocols. Improving health literacy is crucial for enhancing treatment outcomes and is a key strategy in the fight against tuberculosis. [ABSTRACT FROM AUTHOR]

The design and development of a novel approach for the administration of a drug to the targeted area within the therapeutic dosage have been an ongoing progression for the last few decades. Developing biopolymer-based hydrogels as site-specific drug delivery devices is one such strategy gaining lots of attention. Herein, the present study reports the synthesis of novel, pH-responsive hydrogel using whole barley grain (Hordeum vulgare L.) and a biocompatible monomer, 2-acrylamido-2-methylpropanesulfonic acid through copolymerization method. The synthesized polymeric material has been characterized using various characterization methods and detailed swelling studies. After exploring the pH-responsive behavior and appreciable swelling at pH 7.4 (3925%) and pH 4.0 (3033%), suitable for blood-related ailments and anticancer studies, respectively. The synthesized superabsorbent has been explored as a drug delivery device using methylene blue (MB) as a drug against methemoglobinemia. MB dosage has been regulated within the therapeutic dosage (1–2 mg/kg) using synthesized material loaded at varied initial MB concentrations (50–500 ppm). The release mechanism has been determined using various kinetic models: zero-order, first-order, Higuchi, Korsmeyer–Peppas, and Hixson–Crowell. It was found that the release mechanism followed the Korsmeyer–Peppas model with 'n' values of 0.78 (500 ppm), 0.84 (300 ppm), 0.77 (100 ppm), 0.34 (50 ppm) at pH 7.4 and 0.69 (500 ppm), 0.86 (300 ppm), 0.73 (100 ppm) and 0.31 (50 ppm) at pH 4.0, respectively, at 37 °C in 7 h, which significantly depicted non-Fickian diffusion with controlled release of MB. [ABSTRACT FROM AUTHOR]

Background: This prospective, randomized, double-blind trial was done to compare intranasal dexmedetomidine and intranasal midazolam as premedication for sedation and ease of child-parent separation in pediatric patients of tetralogy of Fallot (TOF) undergoing corrective cardiac surgery. Materials and Methods : Forty children with TOF, between 1 and 10 years, undergoing corrective cardiac surgery were included in the study and, after randomization, were given intranasal midazolam (0.2 mg/kg) or intranasal dexmedetomidine (1 µg/kg), 30 min before shifting to the operation room (OR). Patients were assessed for sedation and child-parent separation, along with hemodynamic parameters, respiratory rate, and oxygen saturation (SpO2) 30 min after drug administration, at the time of shifting inside the OR, and at the time of induction of anesthesia. Results: Both groups had comparable child-parent scores, hemodynamic parameters, SpO2, and respiratory rate. However, the dexmedetomidine group had significantly better sedation levels than the midazolam group patients at the time of shifting inside the OR (dexmedetomidine group: 3.55 ± 0.82 vs. midazolam group: 2.80 ± 0.83; P = 0.007) and at the time of induction of anesthesia (dexmedetomidine group: 3.40 ± 0.75 vs. midazolam group: 2.70 ± 0.86; P = 0.009). Conclusion: Intranasal dexmedetomidine provides better sedation than midazolam, with similar child-parent separation scores and hemodynamic parameters, respiratory rate, and SpO2. No adverse events were observed in both groups. A study on a larger population will help in further establishing the safety and superiority of dexmedetomidine and will further its regular use as an intranasal premedication. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Transesophageal echocardiography probe shutdown in a patient with hyperthermia" by V. Saluja, published in the previous issue of the periodical.

Background and Aims: Enhanced recovery after cardiac surgery is centred around multimodal analgesia which is becoming increasingly feasible with the advent of safer regional analgesic techniques such as fascial plane blocks. We designed this prospective, single-blind, randomised controlled study to compare the efficacy of serratus anterior plane block (SAPB), pectoral nerves (Pecs) II block, and intercostal nerve block (ICNB) for post-thoracotomy analgesia in cardiac surgery. Methods: 100 adults posted for cardiac surgery through a thoracotomy were randomly allocated to one of the three groups: SAPB, Pecs II or, ICNB wherein the patients received 2.5 mg/kg of 0.5% ropivacaine for ultrasound-guided block after completion of surgery. Postoperatively, intravenous (IV) paracetamol was used for multimodal and fentanyl was employed as rescue analgesia. Visual analogue scale (VAS) was evaluated at 2, 4, 6, 8, 10 and 12 hours post-extubation. Results: The early mean VAS scores at 2, 4 and 6 hours were comparable in the 3 groups. The late mean VAS (8, 10 and 12 hours) was significantly lower in the SAPB and Pecs II group compared with that of the ICNB group (P value <0.05). The cumulative rescue fentanyl dose was significantly higher in ICNB group compared to SAPB and Pecs II group (P value <0.001). The SAPB group had the highest time to 1st rescue analgesic requirement in contrast to the other groups. Conclusion: SAPB and Pecs II blocks are simple single-shot effective alternatives to ICNB with a prolonged analgesic duration following thoracotomy and can potentially enhance pain-free recovery after cardiac surgery. [ABSTRACT FROM AUTHOR]

The author reviews the traditional systems of medicine with respect to rheumatological disorders. Topics discussed include the ayurveda where practitioners believe in holistic health such as eating nutritious food, yoga and medication, the traditional Chinese medicine (TCM) which is a broad range of medicine practices like acupuncture that have been developed and practised in China for at least 5,000 years and the Unani system where diagnosis is based on pulse and urine.

The article comments on a study that compared the tranexamic acid (TA) and aprotinin in pediatric cardiac surgery. Topics discussed include the risk of bleeding by pediatric patients after cardiac surgery on cardiopulmonary bypass (CPB), epsilon aamino caproic acid and TA as analogs of the amino acid lysine and the loading dose of TA after protamine reserval as the best of the doses compared.

In the present study, we report the chemical modification of the dried and fallen pine needles (PNs) via a simple protocol using KMnO4 oxidation. The oxidized PNs (OPNs) were evaluated as adsorbents using some cationic and anionic dyes. The successful synthesis of OPNs adsorbent was characterized by various techniques to ascertain its structural attributes. The adsorbent showed selectivity for the cationic dyes with 96.11% removal (Pr) for malachite green (MG) and 89.68% Pr for methylene blue (MB) in 120 min. Kinetic models namely, pseudo-first order, pseudo-second order, and Elovich were applied to have insight into adsorption. Additionally, three adsorption isotherms, i.e., Langmuir, Freundlich, and Temkin were also applied. The dye adsorption followed a pseudo-second-order kinetic model with R² > 0.99912 for MG and R² > 0.9998 for MB. The adsorbent followed the Langmuir model with a maximum adsorption capacity (qm) of 223.2 mg/g and 156.9mg/g for MG and MB, respectively. Furthermore, the OPNs showed remarkable regeneration and recyclability up to nine adsorption-desorption cycles with appreciable adsorption for both the dyes. The use of OPNs as an adsorbent for the removal of dyes from wastewater, therefore, provides an ecologically benign, low-cost, and sustainable solution. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The application of European system for cardiac operative risk evaluation II (EuroSCORE II) and Society of Thoracic Surgeons risk score for risk stratification in Indian patients undergoing cardiac surgery," by D. Borde and colleagues, published in volume 16, 2013.

The article describes the case of a 45-year old woman with congestive heart failure. She presented to the emergency department with complaints of fever, weight loss and dyspnea. She was taken up for surgery, and after induction of anesthesia, a transesophageal echocardiographic (TEE) examination was performed. The TEE revealed a pedunculated, solid, ovoid tumor, which was later identified as cardiac myxoma.

A letter to the editor is presented about a case of a five-year-old boy who was diagnosed with sinous venosus atrial septal defect following an intracardiac repair of Tetralogy of Fallot.

A letter to the editor is presented about the EuroSCORE 2010 initiative for cardiac surgical patients.