Search

Despite its ambitious "economic sustainability" objectives, the China-Pakistan Economic Corridor (CPEC) has been the subject of growing environmental anxiety. Considering the CPEC developments, it is clear that Pakistan is ready to fully embrace this new industrial chapter and take advantage of its major benefits to solve social, energy, infrastructure, and economic problems. However, it should also seriously commit to undertaking proper environmental impact assessments and upgrading system resilience. Data was collected from 400 respondents from Pakistan, and structural equation modeling was applied with the help of AMOS. Factor analysis and structural equation modeling techniques were used to estimate the results and test the study's hypothesis. The results indicate a strong socio-economic impact across perceived economic, infrastructure, social, and total impacts, but they identify a negative association between infrastructure innovation and environmental sustainability. Moreover, results revealed that infrastructure supports social and economic growth, but it might have a substantial negative impact on biodiversity. According to findings, Pakistan may be more vulnerable to climate change due to three potential environmental issues: coal-fired power plants, CO2 concentration along the CPEC route, and increased traffic on the Karakorum Highway. Furthermore, future international trade will be significantly impacted by the corridor. It may, however, also accelerate the destruction of the ecosystem over time due to the industrial revolution., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background and Aims: Videolaryngoscopes with varying characteristics with regard to angulation of blades and video configurations are now available. However, the contribution of each of these in improving ease of intubation is quite different. We evaluated the role of video camera in the performance of laryngoscopy by using the universal serial bus (USB) videolaryngoscope in patients with predicted difficult airway., Methods: Sixty patients in the age group of 25 to 65 years having Mallampati grade III or IV were randomly allocated to two groups. All patients were American Society of Anesthesiologists physical status grade I or II and planned for elective surgical procedure under general anesthesia. USB videolaryngoscope or Macintosh laryngoscope was used for intubation as per group allotted. Comparison of time of endotracheal intubation was our primary outcome measure and it was calculated from the time the laryngoscope tip passes the incisors to the initial appearance of capnography wave. Rate of successful intubation, number of attempts needed for successful tube placement, optimisation manoeuvres used, changes in haemodynamic parameters and airway injuries were evaluated as secondary outcomes., Results: Time for intubation was shorter in the Macintosh group than the USB group ( P = 0.024). The incidence of successful intubation was similar in both groups ( P = 0.079). USB group required lesser number of attempts for tube placement ( P = 0.047). The incidence of airway injuries was similar in both the groups., Conclusion: USB videolaryngoscope reduces the number of attempts required for successful endotracheal intubation compared to Macintosh laryngoscope though it increases the time for intubation in patients with predicted difficult airway., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Anaesthesia.)

Background and Aims: Studies on simulated difficult airway provide an opportunity to evaluate the performance of intubation devices for use in limited neck mobility. We did a comparative study between Split Type Postman videolaryngoscope and Macintosh laryngoscope, evaluating their efficacy for tracheal intubation in a simulated difficult airway., Methods: Sixty American Society of Anesthesiologists (ASA) physical status I and II patients aged between 20 and 60 years, having body mass index <30 kg m -2 , posted for elective surgery under general anaesthesia were allocated to two groups. Endotracheal intubation was done with either Split Type Postman videolaryngoscope or Macintosh laryngoscope after placing a rigid cervical collar around the neck to simulate a difficult airway. The primary outcome measure was time for tracheal intubation as assessed from the time of introduction of laryngoscope between incisors till visual confirmation of passage of endotracheal tube through the vocal cords by the anaesthesiologist. Success rate of intubation, number of attempts required for successful intubation, haemodynamic alterations and airway complications were measured as secondary outcomes., Results: Time taken for endotracheal intubation was significantly shorter in Postman group (26.23 ± 7.18 vs. 31.43 ± 9.83 s) ( P = 0.012) compared to Macintosh group. The groups were comparable in terms of incidence ( P = 0.491) of successful intubation, with significantly lesser number of attempts required for intubation in Postman group ( P = 0.022). The incidence of airway trauma and postoperative sore throat was comparable between the groups., Conclusion: Split Type Postman videolaryngoscope was superior with respect to intubation characteristics when compared to conventional laryngoscope., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Anaesthesia.)

Objective: We determined whether an exercise regime comprising high-intensity training, multiplanar trunk movements, and dual-task practice could improve trunk control, balance, functional mobility, and reduce fall risk in patients with hemiplegic stroke., Methods: In this randomized controlled trial, 74 patients (mean age 61.71 years) were randomly assigned to the experimental and comparison groups. Primary outcome was trunk impairment scale (TIS) scores. Secondary outcomes were scores on the Berg balance scale, 10-meter walk test, Timed-up-and-go test, timed-Up-Go-cognitive, and Stroke Impact Scale-16 to measure between-group changes from baseline. We used linear mixed modeling to identify changes over time within and between groups on each scale and whether changes persisted at 6- and 12-month follow-ups., Results: We observed significantly increased mean TIS scores from baseline to 3 months post-treatment (7.74); the increased scores were maintained at 6- and 12-month follow-ups (8.60 and 8.43, respectively). In the experimental group, all secondary outcomes showed significant and clinically meaningful results. Fall risk between groups was significantly reduced at 6 and 12 months., Conclusions: Intensive multiplanar trunk movements coupled with dual-task practice promoted trunk control, balance, and functional recovery in patients with stroke, reduced fall risk, and improved independent mobility. Trial registration: # IRCT20200127046275N1.

Background: Naphthalene is widely used in households as an insect repellent, but its poisoning is rare, especially in adults. Naphthalene is a strong oxidant with a pungent smell., Case Report: We report a case of a 16-year-old female who ingested three naphthalene mothballs 3 days prior to admission and presented with history of recurrent vomiting, severe pallor, jaundice, and hemoglobinuria. Investigation found severe hemolytic anemia, indirect hyperbilirubinemia, acute kidney injury, and evidence of intravascular hemolysis. Her urine output was normal throughout the course of illness. She was managed conservatively with i.v. fluid, oral ascorbic acid, and blood transfusion. With treatment our patient improved completely and was discharged in hemodynamically stable condition. She is doing fine after further follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physician should keep the possibility of poisoning by an oxidizing agent, such as naphthalene, when a patient presents to the emergency department with rapid onset pallor, jaundice, and hemoglobinuria., (Copyright © 2019 Elsevier Inc. All rights reserved.)

In ferromagnetic (FM) metal/organic semiconductor (OSC) heterostructures charge transfer can occur which leads to induction of magnetism in the non-magnetic OSC. This phenomenon has been described by the change in the density of states in the OSC which leads to a finite magnetic moment at the OSC interface and it is called the 'spinterface'. One of the main motivations in this field of organic spintronics is how to control the magnetic moment in the spinterface. In this regard, there are several open questions such as (i) which combination of FM and OSC can lead to more moment at the spinterface? (ii) Is the thickness of OSC also important? (iii) How does the spinterface moment vary with the FM thickness? (iv) Does the crystalline quality of the FM matter? (v) What is the effect of spinterface on magnetization reversal, domain structure and anisotropy? In this context, we have tried to answer the last four issues in this paper by studying Fe/C 60 bilayers of variable Fe thickness deposited on Si substrates. We find that both the induced moment and thickness of the spinterface vary proportionally with the Fe thickness. Such behavior is explained in terms of the growth quality of the Fe layer on the native oxide of the Si (100) substrate. The magnetization reversal, domain structure and anisotropy of these bilayer samples were studied and compared with their respective reference samples without the C 60 layer. It is observed that the formation of spinterface leads to a reduction in uniaxial anisotropy in Fe/C 60 on Si (100) in comparison to their reference samples.

Background and Objectives: Managing the airway of post burn contracture of the neck has always been challenging to anesthesiologists as it limits the alignment of oro-pharyngo-laryngeal axes because of functional and anatomical deformities that occur as a result of long standing contractures. Here the role of the King Vision video laryngoscope which is the latest in the series of video laryngoscope has been evaluated for such patients., Case Report: A 35 year old male patient with post burn contracture of neck was scheduled for release of the contracture. As the patient had had fixed flexion deformity of the neck we did not attempt the conventional laryngoscopy. Instead we opted for King Vision video laryngoscope., Conclusion: We therefore conclude that King Vision videolaryngoscope can be used for difficult airway situations like post burn contracture of neck., (Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background and Aims: Video Stylet (VS) is a new intubating modality that provides real-time video of endotracheal intubation (ETI). This device does not need alignment of the oral, pharyngeal and tracheal axes to view glottis and can be used in patients with limited mouth opening. The aim of this study was to compare flexible fibre-optic (FO) bronchoscope with VS in elective surgical patients in apparently normal airway patients requiring oral ETI., Methods: Sixty patients undergoing elective surgery under general anaesthesia of age group 20-60 years, weight 40-70 kg, American Society of Anesthesiologist 1 and 2 and modified Mallampatti I and II were included in the study. Patients in group FO ( n = 30) were intubated by flexible FO bronchoscope, whereas patients in group VS ( n = 30) were intubated by VS. Primary outcome measure was time taken for intubation (TTI). Secondary outcome measures were successful intubation, haemodynamic response and post-operative complications if any., Results: Average TTI in cases of FO group was 38.2 s (95% confidence interval [CI] 36-41) and in VS group was 19.7 s (95% CI 19-21; P = 0.0001). Three patients required a second attempt for successful intubation in FO group compared to eight in VS group ( P = 0.2), with no failures in any group. Haemodynamic response and complications rate were greater in VS group; however, the differences were not statistically significant., Conclusion: VS takes lesser time to intubate than flexible FO bronchoscope., Competing Interests: There are no conflicts of interest.

The combination of lithography and ion implantation is demonstrated to be a suitable method to prepare lateral multilayers. A laterally, compositionally, and magnetically modulated microscale pattern consisting of alternating Co (1.6 µm wide) and Co-CoO (2.4 µm wide) lines has been obtained by oxygen ion implantation into a lithographically masked Au-sandwiched Co thin film. Magnetoresistance along the lines (i.e., current and applied magnetic field are parallel to the lines) reveals an effective positive giant magnetoresistance (GMR) behavior at room temperature. Conversely, anisotropic magnetoresistance and GMR contributions are distinguished at low temperature (i.e., 10 K) since the O-implanted areas become exchange coupled. This planar GMR is principally ascribed to the spatial modulation of coercivity in a spring-magnet-type configuration, which results in 180° Néel extrinsic domain walls at the Co/Co-CoO interfaces. The versatility, in terms of pattern size, morphology, and composition adjustment, of this method offers a unique route to fabricate planar systems for, among others, spintronic research and applications., (© 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Study Objective: Anticipated and unanticipated difficult airways are often encountered by anesthesiologists in their clinical practice. There are various devices available in such situations. We aim to compare King Vision video laryngoscope and Lightwand for their performance as an intubating device in predicted difficult intubation., Design: Prospective, randomized, single blind study., Setting: Jawaharlal Nehru Medical College., Patients: Sixty ASA 1 and 2 with Mallampati grade III and IV., Interventions: Patients were divided into 2 groups of 30 patients each. Patients of King Vision group [n=30] and Lightwand group [n=30] were intubated using respective devices. Primary outcome measure was time taken to intubate whereas secondary outcome measure ware number of attempts for intubation, no of adjustment maneuvers, changes in heart rate and mean arterial pressure and airway trauma., Measurements and Main Results: Mean intubation time using King Vision video laryngoscope (19.50±6.73 seconds was lower than the intubation time using Lightwand 25.40±7.42 s, P=.00). The difference between number of attempts, success of intubation, numbers of adjustment maneuvers were comparable. There was a significant rise in heart rate within the groups from the pre-induction values. However inter group variations were similar. In addition, there was a significant rise in mean arterial pressure within the groups from the pre-induction values. Inter group variations show less increase in mean arterial pressure with Lightwand at immediate post intubation (P=.0234) and at 3 min and 5 min post intubation anesthesia., (Copyright © 2016. Published by Elsevier Inc.)

Tissue composition of the atria plays a critical role in the pathology of cardiovascular disease, tissue remodeling, and arrhythmogenic substrates. Optical coherence tomography (OCT) has the ability to capture the tissue composition information of the human atria. In this study, we developed a region-based automated method to classify tissue compositions within human atria samples within OCT images. We segmented regional information without prior information about the tissue architecture and subsequently extracted features within each segmented region. A relevance vector machine model was used to perform automated classification. Segmentation of human atrial ex vivo datasets was correlated with trichrome histology and our classification algorithm had an average accuracy of 80.41% for identifying adipose, myocardium, fibrotic myocardium, and collagen tissue compositions.

Breast cancer is the second leading cause of death in women in the United States due to cancer. Early detection of breast cancerous regions will aid the diagnosis, staging, and treatment of breast cancer. Optical coherence tomography (OCT), a non-invasive imaging modality with high resolution, has been widely used to visualize various tissue types within the human breast and has demonstrated great potential for assessing tumor margins. Imaging large resected samples with a fast imaging speed can be accomplished by under-sampling in the spatial domain, resulting in a large image scale. However, it is unclear whether there is an impact on the ability to classify tissue types based on the selected imaging scale. Our objective is to evaluate how the scale at which the images are acquired impacts texture features and the accuracy of an automated classification algorithm. To this end, we present a comparative study of texture features in OCT images at two image scales for human breast tissue classification. Texture features and attenuation coefficients were inputs to a statistical classification model, relevance vector machine. The automated classification results from the two image scales were compared. We found that more informative tissue features are preserved in small image scale and accordingly, small image scale leads to more accurate tissue type classification.

Airtraq has been shown to improve ease of intubation in patients with normal and difficult airway. King Vision video laryngoscope is a newly introduced intubating device with an attached monitor. We here hypothesized that the King Vision video laryngoscope with channeled blade performs better during intubation as compared to Airtraq. In this study, we performed a comparison between the King Vision video laryngoscope and the Airtraq with regard to time needed for intubation, number of attempts required to intubate, and complications. Fifty ASA grade I and II adult patients posted for a routine surgical procedure were randomly divided into two groups of 25 patients each. All patients were anesthetized using similar techniques. The time required to intubate patients was significantly shorter when the King Vision video laryngoscope with channeled blade was used as compared to the Airtraq (p < 0.05). The number of attempts to successfully intubate patients was also significantly lower (p < 0.05) for the King Vision video laryngoscope than for the Airtraq. The use of the Kings Vision video laryngoscope with channeled blade should be encouraged in difficult intubation situations in adult patients with a mouth opening of more than 18 mm.

Background and Aims: Bupivacaine has been the most frequently used local anaesthetic in brachial plexus block, but ropivacaine has also been successfully tried in the recent past. It is less cardiotoxic, less arrhythmogenic, less toxic to the central nervous system than bupivacaine, and it has intrinsic vasoconstrictor property. The effects of clonidine have been studied in peripheral nerve blockade. The purpose of this study was to evaluate the effects of clonidine on nerve blockade during brachial plexus block with ropivacaine using peripheral nerve stimulator., Methods: Sixty patients were randomly divided into two groups, Group A and B. Group A received 30 ml of 0.5% of ropivacaine with 0.5 ml normal saline while Group B received same amount of ropivacaine with 0.5 ml (equivalent to 75 μg) of clonidine for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post-operative analgesia and intra and post-operative complications., Results: There was a significant increase in duration of motor and sensory block and analgesia in Group B as compared to Group A patients (P < 0.0001). There was no significant difference in onset time in either group (P = 0.304). No significant side effects were noted., Conclusion: The addition of 75 μg of clonidine to ropivacaine for brachial plexus block prolongs motor and sensory block and analgesia without significant side effects.

Study Objective: To determine the efficacy of the Airtraq versus the McCoy laryngoscope as intubation devices with the neck stabilized by a rigid cervical collar., Design: Prospective, randomized, double-blinded study., Setting: Jawaharlal Nehru Medical College., Patients: 60 ASA physical status 1, 2, and 3 patients, aged 18-70 years, scheduled for various surgical procedures requiring tracheal intubation for surgical anesthesia., Interventions: Patients were randomly allocated to undergo intubation with the McCoy (n = 30) or Airtraq (n = 30) laryngoscope., Measurements and Main Results: Differences in intubation times between the Airtraq and the McCoy laryngoscope, modified Cormack-Lehane score, percentage of glottic opening (POGO) score, and airway trauma were compared. Overall intubation success rates were 100% with both devices and a similar number of intubation attempts were required. However, the mean (SD) time required for successful intubation was shorter with the Airtraq (28.73 ± 6.39 sec) than the McCoy laryngoscope (39.11 ± 14.01 sec; P < 0.0001). The frequencies of intubation complications were similar. Esophageal intubation occurred in 4 cases but only with the McCoy laryngoscope., Conclusion: Intubation time was shorter with the Airtraq than the McCoy laryngoscope, even though the overall success rates between the two devices were similar., (Copyright © 2014 Elsevier Inc. All rights reserved.)

A mixture of carbon black powder, polar organo salt and a pressure sensitive adhesive (PSA) has shown to be able to collect skin bio potentials. Such PSA electrodes do not dehydrate even after a prolonged period of storage, which leads to a theoretically infinite shelf life. The PSA electrodes need to be electrically activated through electrophoresis. ECG data were simultaneously collected with PSA and Ag-AgCl electrodes from 5 healthy subjects. ECG morphology was almost identical for both media. Hence, given that PSA electrodes have an infinite shelf-life, potentially with less cost associated with their fabrication, and have ECG signal dynamics nearly identical to those of Ag-AgCl, the new electrodes provide an attractive alternative for ECG measurements.

Background and Objectives: Lipoma is a progressively increasing disease which may appear anywhere in the body. Its appearance at the back of the neck, especially when it is large enough to cause restriction of neck extension, poses challenges to anesthesiologists in airway management whenever needed. This paper evaluates the role of Airtraq® in restricted neck movement., Case Report: Case with a huge lipoma of 14×12cm at the nape, and its surgical removal during an elective operation theatre posed difficulty in securing the airway by conventional laryngoscopy. To overcome the problem we successfully used a newly developed device, the Airtraq®, which is an optical laryngoscope for securing the airway., Conclusion: Airtraq® can be used for elective intubation in patients with restricted neck movements., (Copyright © 2012 Elsevier Editora Ltda. All rights reserved.)

Airway management in patients of ankylosing spondylitis remains a challenge for anaesthesiologists. Many new airway devices have been used for securing airway in these patients. The Airtraq(®) optical laryngoscope is one of the new rigid laryngoscopes with a proximal view finder that reflects an image transferred from the distal tip of the blade through a series of lenses, prisms and mirrors. We report two cases of ankylosing spondylitis who were scheduled for total hip replacement and subtotal thyroidectomy and were successfully intubated using the Airtraq(®) laryngoscope.