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Systematic reviews and meta-analyses synthesise existing evidence for clinical and scientific decision-making. Clinicians and researchers need to understand how to interpret the evidence with the bias involved, as well as the various available tools and how to use them when performing a systematic review. The validity of systematic reviews and meta-analyses depends on comprehensive assessment and mitigation of biases. Biases have the potential to compromise the validity and reliability of results. By being aware of and addressing these different biases, researchers and clinicians can more confidently interpret findings and increase the impact and dependability of their conclusions. The article discusses the biases involved in systematic reviews and meta-analyses and various ways to assess them.

Background and Aims: Obese patients undergoing bariatric and metabolic surgeries have a high chance of respiratory depression and could need admission to an intensive care unit or a high-dependency unit. Several studies have compared remifentanil to other opioids or non-opioids in these patients. This review investigated the efficacy and safety of remifentanil in bariatric and metabolic surgeries. Methods: After registering with PROSPERO, we searched PubMed/Medline, Ovid, CINAHL and the Cochrane Library with relevant keywords to find studies in which remifentanil was compared to other opioids or non-opioids in adult patients undergoing bariatric and metabolic surgeries. We used the risk of bias-2 tool to assess bias and Grading of Recommendation, Assessment, Development and Evaluation to determine the level of evidence. RevMan 5.4 was used to perform a quantitative meta-analysis. Results: Of the 121 articles retrieved from the database search, seven articles fulfilled the inclusion criteria. The overall bias was low in five studies and high in two studies. There was significant heterogeneity in the control group, which comprised opioids and also non-opioids like labetalol, dexmedetomidine and lignocaine. A quantitative meta-analysis was not reported due to a lack of comparable data for a meaningful quantitative meta-analysis. Conclusion: The results of this systematic review neither support nor refute the use of remifentanil in patients undergoing bariatric and metabolic surgeries, compared to other medications. Further studies are needed to investigate its efficacy and safety in these patients.

Introduction: Laparoscopic Cholecystectomy (LC) and Intraperitoneal Onlay Meshplasty (IPOM) have established themselves as standard and popular surgeries for gallstone disease and ventral hernia, respectively. However, their concurrent performance for co-existing gallstone disease and ventral hernia has never been studied. Aim: To determine the outcomes of the concurrent performance of LC and IPOM in patients with co-existing gallstone disease and ventral hernia. Materials and Methods: This retrospective observational study was conducted at the Department of General and Laparoscopic Surgery, Dr. L H Hiranandani Hospital, Mumbai, India from August 2005 to July 2024. Over 19 years, 15 patients with coexisting gallstone disease and ventral hernia (primary/recurrent) were operated upon in a single sitting. The following outcomes were studied: duration of surgery, intra and postoperative complications including mesh infection, duration of hospital stay, recurrence of hernia, time taken to resume normal activity, and cost of treatment. Proportions, percentages, and means were calculated. Results: The mean age of the patients was 55±12.36 years (range 35-77 years). The average duration of surgery was 62 minutes (range 48-70 minutes). There was no conversion to open surgery. The mean postoperative stay was 2.5 days. Total 3 (20%) patients developed seromas, which were identified on day 10. All three seromas were small in size, managed conservatively, and resolved by six weeks. No patient experienced any significant intra- or postoperative haemorrhage. There was no superficial or deep surgical site infection, and there was not a single case of mesh infection. There was no recurrence of the hernia. Patients resumed normal activity in an average of seven days. The total cost of concurrent treatment for both conditions was reduced by 28% compared to the sum of costs, if both operations had been done separately in two separate hospital stays at present Institution. Conclusion: Concurrent LC and IPOM is a safe, practical, and cost-effective procedure in carefully selected patients.

Sublingual (SL) buprenorphine has been used as a modality of managing acute postoperative pain in many studies. This systematic review aimed to investigate the safety and efficacy of SL buprenorphine as an analgesic for various surgeries. After registering the protocol with PROSPERO, we searched PubMed, Cochrane Library, and Ovid databases with relevant keywords. The primary outcomes were 24-hour pain scores, and the secondary outcomes were postoperative nausea and vomiting, sedation scores, pruritus, rescue analgesia, and urinary retention. The risk of bias scale was used to identify the quality of evidence. From the 103 articles identified, four randomized-controlled trials fulfilled the inclusion criteria for qualitative analysis. The overall risk of bias was low. Most of the studies showed that the use of SL buprenorphine led to either better or comparable pain scores when compared to a control group with lesser or tolerable adverse events. There was a lot of heterogeneity across the studies in this systematic review in terms of the type of surgery performed, the comparison groups, doses of buprenorphine, and the outcomes that were assessed. Therefore, a quantitative meta-analysis was not performed. The results of this systematic review should be interpreted with caution due to heterogeneity in the methodology. Adequately powered studies with robust methodology should investigate the safety and efficacy of SL buprenorphine when used for postoperative analgesia.

The present study reported the temperature dependent properties of tin oxide (SnO2) thin films deposited by using conventional, cost effective and non-vacuum-based spray pyrolysis technique (SPT). The as deposited films were characterized by various characterization techniques such as X ray diffraction (XRD), UV-Vis spectroscopy and Scanning electron microscopy (SEM) to study their structural, optical and morphological properties respectively. XRD analysis revealed tetragonal rutile crystal structure of SnO2 with preferred orientation along (200) plane. The refinement of XRD data was also carried out by Rietveld refinement to obtain the fitting parameters, crystallite size and lattice parameters. UV-Vis study showed considerable change in optical absorbance and transmittance with change in substrate temperature. Effect of substrate temperature on film thickness, refractive index and band gap energy were determined by Swanepoel method and by Tauc’s plot respectively. The Urbach energy was also calculated and were correlated to the defects in SnO2 films. SEM micrograph showed the transformation from granules to nanospheres as a function of substrate temperature. Electrical properties were determined by Hall effect measurements which gives carrier concentration, electrical resistivity and mobility in the order of 1019-1020 /cm3, 10−2-10−3 Ω.cm and 4–23 cm2/Vs respectively.

Corona virus disease (COVID-19) initially appeared to be an exclusively respiratory ailment. While that is true in a vast majority of the cases, its evolution and later evidence have shown that it can afflict virtually any organ system in the human body after first gaining entry through the respiratory tract. The COVID-19 vaccines were one of the turning points in the campaign to control the COVID-19 pandemic. However, after their extensive use all over the world, it has emerged that they can cause some dangerous collateral damage. We, herein, report the case of a 58-year-old woman who presented to us with signs and symptoms of acute intestinal obstruction 4 months after receiving her first dose of Covishield® vaccination for COVID-19. Her blood tests showed a high D-dimer and normal platelet count. She was previously admitted to the hospital with an acute abdomen 3 months back. A contrast-enhanced computed tomography (CECT) scan of the abdomen done then had revealed thrombi in the aorta and inferior mesenteric and splenic arteries. She was started on low-molecular-weight heparin and discharged on tablet Warfarin after clinical improvement. CECT abdomen done during her present admission revealed a proximal small bowel stricture with dilated proximal and collapsed distal loops. She underwent a laparoscopic jejuno-ileal resection anastomosis. During the post-operative period, a repeat CECT abdomen done to evaluate multiple episodes of vomiting revealed pulmonary embolism in the lower chest cuts. A venous Doppler revealed extensive deep venous thrombosis of the left lower limb. A thrombophilia profile diagnosed anti-phospholipid antibody syndrome, an exacerbation of which was likely precipitated by the COVID-19 vaccine.

Rationale & Objective: The effect of apolipoprotein L1(APOL1) genotype on future risk of kidney disease among middle-aged individuals with good kidney function is not well established. Study Design: Longitudinal cohort study. Setting & Participants: In total, 5,886 healthy individuals (45-64 years old) enrolled in the Atherosclerosis Risk in Communities study with creatinine-based estimated glomerular filtration rate ≥ 80 mL/min who would be suitable kidney donors. Exposures: Race and APOL1 genotype. Outcomes: Creatinine- and cystatin C-based estimated glomerular filtration rate (eGFRcr-cys) using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) 2021 equation, urinary albumin-creatinine ratio (UACR), proportion with chronic kidney disease (CKD) 3a or worse, end-stage kidney disease (ESKD), and death. Analytical Approach: Participants grouped based on race and APOL1 genotype. Compared eGFRcr-cys and UACR across groups. Multinomial logistic regression models were used compare odds of CKD. Kaplan–Meier survival curves were created to compare rates of ESKD and death at last follow-up. Results: There were 5,075 Whites (86%), 701 Blacks carrying the low-risk APOL1 genotype (12%), and 110 Blacks carrying the high-risk APOL1 genotype (2%). The mean age at baseline was 53 ± 6 years. At 10 years, White participants had lower eGFRcr-cys than low-risk and high-risk groups (89 ± 16 vs 91 ± 16 and 92 ± 15 mL/min/1.73 m2, respectively; P

Background and Aims: Healthcare workers (HCWs), which include surgeons, anaesthesiologists, nurses, technicians, and other non-medical staff working in the operation theatre (OT), change to surgical scrubs for providing designated services. This study was intended to investigate the association of moving in and out of OT to other hospital areas without changing scrubs and its impact on bacterial infection. Methods: After PROSPERO registration, we performed a systematic review to compare the occurrence of surgical site infections (SSIs) with or without the movement of HCWs outside OT. We searched PubMed, Scopus, and Cochrane Library using relevant keywords. RoB-2 and ROBINS-E tools were used to assess the risk of bias in randomised controlled trials (RCTs) and observational studies, respectively. Results: We identified six articles that fulfilled the inclusion criteria: three RCTs and three observational studies. A risk of bias assessment revealed an overall low bias in the RCTs and an overall high bias in the observational studies. The analysis revealed a comparable incidence of bacterial infection in terms of colony-forming units when scrubs when HCWs moved in and out of OT with the same scrubs. A meta-analysis was not performed due to heterogeneity in participants and the OT set-up, as well as fewer studies and sample size. Conclusion: The evidence is insufficient to suggest that wearing scrubs outside the OT could increase the incidence of SSI in surgical patients or transmit the organisms to patients, causing infection. The present review neither supports nor is against wearing surgical scrubs outside OT premises.

Purpose: To compare the accuracy of nine conventional and newer-generation formulae in calculating intraocular lens power in eyes with axial myopia. Setting: Tertiary eye care center, Bengaluru, India. Design: Retrospective cross-sectional, comparative study conducted in India. Methods: Patients undergoing uneventful phacoemulsification in eyes with axial length >26 mm were included. Preoperative biometry was done using Lenstar LS 900 (Haag-Streit AG, Switzerland). Single eye of patients undergoing bilateral implantation was randomly selected. Optimized lens constants were used to calculate the predicted postoperative refraction of each formula, which was then compared with the actual refractive outcomes to give the prediction errors, following which subgroup analysis was performed. The Kane formula, Barrett universal II, Emmetropia Verifying Optical (EVO) 2.0, Hill Radial Basis Function (Hill RBF) 3.0, Olsen formula, along with Wang Koch–adjusted four formulae, that is, Sanders Retzlaff Kraff/Theoretical (SRK/T), Holladay 1, Haigis, and Hoffer Q formula, were compared for intraocular lens power calculations. Results: One hundred and sixty-five eyes that fulfilled all the inclusion criteria were studied. Hill RBF 3.0 had the lowest mean and median absolute prediction errors (0.355 and 0.275, respectively) compared to all formulas. In subgroup analysis (26–28, >28–30, and >30 mm), significant difference was seen only in extremely long eyes (>30 mm). The Hill RBF 3.0 formula generated the maximum percentage of eyes with refractive errors within ±0.25, ±0.5, ±0.75, and ±1 D (46%, 76.2%, 89.9%, and 95.8%, respectively). Conclusion: This is the first study evaluating all the formulas exclusively in the myopic eyes. Hill RBF 3 was found to be superior in accuracy to all other formulas.

Dermatomal analgesia achieved with quadratus lumborum blocks is site-dependent and inconsistent. Cadaveric and clinical studies reveal multiple mechanisms of action. We dissected six fresh human cadavers bilaterally and thoroughly studied their neurological linkages to the quadratus lumborum muscle (QLM) to identify neural structures and block targets. At the end of the investigation, only the subcostal nerve (anterolateral) and the ilioinguinal nerves were found near the QLM in all specimens. The iliohypogastric nerve was found in only two specimens. No further neural targets were found in the fascial planes before and posterior to the QLM.

This study explores cutting-edge computational technologies and intelligent methods to create realistic synthetic data, focusing on dementia-centric Magnetic Resonance Imaging (MRI) scans related to Alzheimer’s and Parkinson’s diseases. The research delves into Generative Adversarial Networks (GANs), Variational Autoencoders, and Diffusion Models, comparing their efficacy in generating synthetic MRI scans. Using datasets from Alzheimer’s and Parkinson’s patients, the study reveals intriguing findings. In the Alzheimer dataset, diffusion models produced non-dementia images with the lowest Frechet Inception Distance (FID) score at 92.46, while data-efficient GANs excelled in generating dementia images with an FID score of 178.53. In the Parkinson dataset, data-efficient GANs achieved remarkable FID scores of 102.71 for dementia images and 129.77 for non-dementia images. The study also introduces a novel aspect by incorporating a classification study, validating the generative metrics. DenseNets, a deep learning architecture, exhibited superior performance in disease detection compared to ResNets. Training both models on images generated by diffusion models further improved results, with DenseNet achieving accuracies of 80.84% and 92.42% in Alzheimer’s and Parkinson’s disease detection, respectively. The research not only presents innovative generative architectures but also emphasizes the importance of classification metrics, providing valuable insights into the synthesis and detection of neurodegenerative diseases through advanced computational techniques.

Good quality activated charcoals were prepared from areca nutshell and coconut shell using phosphoric acid as a chemical activating agent at 400oC. Physico-chemical properties like iodine number, methylene blue number, and surface area of two activated charcoals were measured to assess the porous nature. A special test called acetic acid number was devised to understand the quality of functional groups on charcoal surfaces. Proximate analysis and physical properties of the two activated charcoals closely matched those of a commercial sample, confirming the good quality of samples prepared in the laboratory. Adsorption of isolated caramel from waste stream obeyed Freundlich isotherm, and the data could be explained based on the physisorption of large size molecules on the walls of mesoporous solid surface. Adsorption of methylene blue involving Coulombic attraction towards the areca nut shell-derived activated charcoal could be predicted and confirmed based on the acetic acid number for the first time.

In this study, zinc oxide (ZnO) and zinc oxide-zirconium dioxide nanocomposites (ZnO@ZrO2) were synthesized by a low-cost solution combustion route to study their structural, morphological, optical, and photocatalytic performance. The properties of synthesized nanocomposites were characterized by x-ray diffraction (XRD), UV–vis absorption spectroscopy, Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and energy dispersive spectroscopy (EDS). Phase formation and purity were confirmed using XRD and EDS. Optical absorption spectra revealed that the addition of ZrO2 significantly affected optical absorption and band gap energy. The band gap energy increased from 3.01 to 3.24 eV with addition of ZrO2 in ZnO. FTIR spectra confirmed the formation of ZnO and ZnO@ZrO2. SEM micrographs showed a significant change in the morphology of the ZrO2 addition in ZnO. BET analysis showed surface area for sample P3 (ZnO@0.4ZrO2) was 28.9 m2/g while for sample P1 (ZnO) was 22.5 m2/g. In addition, the photocatalytic performance of ZnO and ZnO@ZrO2 for the decomposition of methylene blue (MB) dye was studied for all samples exposed to solar light. The effect of different contents of ZrO2 in ZnO@ZrO2 in terms of degradation efficiency and degradation time are described in detail. The sample P3 showed highest photodegradation efficiency of 84.52 % at degradation time of 240 minutes.

The relationship between historical climate change and past agricultural production contributes to a better understanding of the impacts of projected climate change by providing empirical data for resilient human responses. This study explores the periods of dynastic transitions and crop production at the urban site of Vadnagar, in semi-arid northwest India through several climate events, generally characterised by weakening summer monsoon precipitation during the Late Holocene. Artefacts from the site present an unbroken sequence of seven successive cultures from the first century BCE to the nineteenth century CE. Archaeobotanical data indicate the sufficient water availability during the Historic and Medieval periods, allowing crop production dominated large-grained cereals (C3 plants). However, during the Post-Medieval period (ca.1300−1850 CE) a resilient crop economy based on small-grained cereals (C4 plants) dominated, representing a human adaptation to prolonged weakening of monsoonal precipitation. Isotopic and phytolith data at the site present a clear signal of changing local environmental conditions over two millennia, consistent with regional palaeoclimate records, providing and interpretive context for agricultural evidence at Vadnagar. Despite long-term reduction in summer humidity, we argue that an adaptable agricultural package coupled with suitable water management systems allowed for the resilience of the urban settlement at Vadnagar.

Background: The clinical outcomes (time to ambulation, length of stay, and home discharge) after proximal femoral nail (PFN) for proximal femoral fractures (PFF) is dependent on successful pain management. Currently, the lumbar erector spinae plane block (LESPB) is in vogue and is associated with favorable outcomes in the postoperative period. Our study aimed to evaluate whether a LESPB provided equivalent analgesia and clinical outcomes as compared to LPB in PFN for PFF. Material and Methods: We compared LPBs [L] with LESPBs [E], with 30 patients in each group, performed from June 2020 to June 2021 for PFN in PFF's. The primary outcome of this study was the average NRS pain scores over 24 hours postoperatively. Secondary outcomes included pain scores at different time points over 24 hours, opioid consumption between the groups at 24 hours postoperatively, time for request of first parenteral analgesia, quadriceps weakness and adverse events. Results: The average pain scores over 24 hours were better in the LESPB group as compared to the LPB group (p = 0.02). Further, only n = 5 (30%) of patients in the LESPB group required opioids, while n = 13 (43.333%) of patients in the LPB group required opioids. Moreover, the median time for request of first parenteral analgesia was 615 (480–975) minutes, weakness of quadriceps function occurred in 2 patients in the L group, which recovered at 3rd and 5th month, respectively, with no incidences of hemodynamic instability and respiratory complications. Conclusions: This trial demonstrated that single bolus LESPB is superior to LPB in terms of analgesic outcomes, has low adverse events, and is an agreeable substitute for patients with PFF undergoing a PFN.

Every year, the Western Ghats region experiences devastating landslides, resulting in significant loss of life and damage to both private and public assets. To mitigate these losses, it is essential to identify the areas most susceptible to landslides. This research aims to create an accurate landslide susceptibility map for a section of the Western Ghats region by employing a comprehensive approach that combines remote sensing and geographical information systems (GIS). The Landslide Numerical Risk Factor (LNRF) method is utilized to determine landslide susceptibility zones. The LNRF model incorporates a landslide inventory based on geographic object-based image analysis and influencing factors. The resulting LNRF model generates a landslide susceptibility map, classifying over 35% of the study region's land area as having a high probability of landslides. The model's accuracy is assessed using the receiver operating characteristic (ROC) method, which yields an area under the curve (AUC) value of 0.77. This indicates that the LNRF model exhibits good predictive performance, resulting in a reliable landslide susceptibility map.

Abstract Banana is an important fruit crop in the tropics and subtropics; however, limited information on biomarkers and signature volatiles is available for selecting commercial cultivars. Clonal fidelity is a major contributor to banana yield and aroma; however, there are no useful biomarkers available to validate clonal fidelity. In this study, we performed the molecular profiling of 20 banana cultivars consisting of diploid (AA or AB) and triploid (AAA or AAB or ABB) genomic groups. We screened 200 molecular markers, of which 34 markers (11 RAPD, 11 ISSR, and 12 SSR) yielded unequivocally scorable biomarker profiles. About 75, 69, and 24 allelic loci per marker were detected for RAPD, ISSR, and SSR markers, respectively. The statistical analysis of molecular variance (AMOVA) exhibited a high genetic difference of 77% with a significant FST value of 0.23 (p

The molecular mechanisms of sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) remain incompletely understood. Single-cell RNA sequencing and morphometric data were collected from research kidney biopsies donated by young persons with type 2 diabetes (T2D), aged 12 to 21 years, and healthy controls (HCs). Participants with T2D were obese and had higher estimated glomerular filtration rates and mesangial and glomerular volumes than HCs. Ten T2D participants had been prescribed SGLT2i (T2Di[+]) and 6 not (T2Di[–]). Transcriptional profiles showed SGLT2 expression exclusively in the proximal tubular (PT) cluster with highest expression in T2Di(–) patients. However, transcriptional alterations with SGLT2i treatment were seen across nephron segments, particularly in the distal nephron. SGLT2i treatment was associated with suppression of transcripts in the glycolysis, gluconeogenesis, and tricarboxylic acid cycle pathways in PT, but had the opposite effect in thick ascending limb. Transcripts in the energy-sensitive mTORC1-signaling pathway returned toward HC levels in all tubular segments in T2Di(+), consistent with a diabetes mouse model treated with SGLT2i. Decreased levels of phosphorylated S6 protein in proximal and distal tubules in T2Di(+) patients confirmed changes in mTORC1 pathway activity. We propose that SGLT2i treatment benefits the kidneys by mitigating diabetes-induced metabolic perturbations via suppression of mTORC1 signaling in kidney tubules.

IntroductionBone morphogenetic proteins (BMPs) are used as key therapeutic agents for the treatment of difficult fractures. While their effects on osteoprogenitors are known, little is known about their effects on the immune system.MethodsWe used permutations of BMP-6 (B), vascular endothelial growth factor (V), and Hedgehog signaling pathway activator smoothened agonist (S), to treat a rat mandibular defect and investigated healing outcomes at week 8, in correlation with the cellular landscape of the immune cells in the fracture callus at week 2.ResultsMaximum recruitment of immune cells to the fracture callus is known to occur at week 2. While the control, S, V, and VS groups remained as nonunions at week 8; all BMP-6 containing groups - B, BV, BS and BVS, showed near-complete to complete healing. This healing pattern was strongly associated with significantly higher ratios of CD4 T (CD45+CD3+CD4+) to putative CD8 T cells (CD45+CD3+CD4-), in groups treated with any permutation of BMP-6. Although, the numbers of putative M1 macrophages (CD45+CD3-CD11b/c+CD38high) were significantly lower in BMP-6 containing groups in comparison with S and VS groups, percentages of putative - Th1 cells or M1 macrophages (CD45+CD4+IFN-γ+) and putative – NK, NKT or cytotoxic CD8T cells (CD45+CD4-IFN-γ+) were similar in control and all treatment groups. Further interrogation revealed that the BMP-6 treatment promoted type 2 immune response by significantly increasing the numbers of CD45+CD3-CD11b/c+CD38low putative M2 macrophages, putative - Th2 cells or M2 macrophages (CD45+CD4+IL-4+) cells and putative – mast cells, eosinophils or basophils (CD45+CD4-IL-4+ cells). CD45- non-haematopoietic fractions of cells which encompass all known osteoprogenitor stem cells populations, were similar in control and treatment groups.DiscussionThis study uncovers previously unidentified regulatory functions of BMP-6 and shows that BMP-6 enhances fracture healing by not only acting on osteoprogenitor stem cells but also by promoting type 2 immune response.

Introduction: Pathologic remodeling of the brain following ischemic stroke results in neuronal loss, increased inflammation, oxidative stress, astrogliosis, and a progressive decrease in brain function. We recently demonstrated that stimulation of steroid receptor coactivator 3 with the small-molecule stimulator MCB-613 improves cardiac function in a mouse model of myocardial ischemia. Since steroid receptor coactivators are ubiquitously expressed in the brain, we reasoned that an MCB-613 derivative (MCB-10-1), could protect the brain following ischemic injury. To test this, we administered MCB-10-1 to rats following middle cerebral artery occlusion and reperfusion.Methods: Neurologic impairment and tissue damage responses were evaluated on day 1 and day 4 following injury in rats treated with control or 10-1.Results: We show that 10-1 attenuates injury post-stroke. 10-1 decreases infarct size and mitigates neurologic impairment. When given within 30 min post middle cerebral artery occlusion and reperfusion, 10-1 induces lasting protection from tissue damage in the ischemic penumbra concomitant with: (1) promotion of reparative microglia; (2) an increase in astrocyte NRF2 and GLT-1 expression; (3) early microglia activation; and (4) attenuation of astrogliosis.Discussion: Steroid receptor coactivator stimulation with MCB-10-1 is a potential therapeutic strategy for reducing inflammation and oxidative damage that cause neurologic impairment following an acute ischemic stroke.

Abstract Increasing evidence suggests that single in kidney states (e.g., kidney transplantation and living donation) progressive glomerulosclerosis limits kidney lifespan. Modeling shows that post-nephrectomy compensatory glomerular volume (GV) increase drives podocyte depletion and hypertrophic stress resulting in proteinuria and glomerulosclerosis, implying that GV increase could serve as a therapeutic target to prevent progression. In this report we examine how Angiotensin Converting Enzyme inhibition (ACEi), started before uninephrectomy can reduce compensatory GV increase in wild-type Fischer344 rats. An unbiased computer-assisted method was used for morphometric analysis. Urine Insulin-like growth factor-1 (IGF-1), the major diver of body and kidney growth, was used as a readout. In long-term (40-week) studies of uni-nephrectomized versus sham-nephrectomized rats a 2.2-fold increase in GV was associated with reduced podocyte density, increased proteinuria and glomerulosclerosis. Compensatory GV increase was largely prevented by ACEi started a week before but not after uni-nephrectomy with no measurable impact on long-term eGFR. Similarly, in short-term (14-day) studies, ACEi started a week before uni-nephrectomy reduced both GV increase and urine IGF-1 excretion. Thus, timing of ACEi in relation to uni-nephrectomy had significant impact on post-nephrectomy “compensatory” glomerular growth and outcomes that could potentially be used to improve kidney transplantation and live kidney donation outcomes.

Persistent poststernotomy pain (PSP) is a well-known entity following cardiac surgery done with midline strenotomy. The severity of pain is usually mild to moderate in the majority of the patients. However, a small percentage of patients develop severe and persistent pain and need aggressive treatment. Our patient, a 63-year-old lady developed chronic severe parasternal pain following coronary artery bypass graft surgery. As multiple medications did not relieve her pain effectively, we did an ultrasound-guided pectoral-intercostal fascial plane block to which she responded with excellent and long-lasting pain relief. This is the first such case report of the use of this novel block technique for treating PSP.

Incidence of breast malignancies has been rising. Any breast lump needs to differentiated as surgery may not be required in all cases. The National Health Services Breast Screening Program recommends Fine Needle aspiration cytology (FNAC) as a non-operative diagnostic tool. FNAC is a cheap, readily available, relatively painless, repeatable and patient-friendly investigation with good sensitivity and specificity. FNAC does not yield a tissue diagnosis as opposed to core biopsy, however, a well-performed FNAC and reporting by an expert pathologist help to avoid unnecessary surgeries in benign lesions where only conservative management or elective surgery is needed. Aims: To study the correlation between FNAC and histopathological reports of palpable breast lumps. Materials and method: We conducted an observational study at a tertiary care hospital. The study included 237 patients of palpable breast lumps who had undergone FNAC, excisional biopsy and histopathology in the same institution. The results of FNAC and histopathology reports were correlated into benign and malignant categories. Results: There were 225 women and 12 men in this study. FNAC had reported 20 malignant (C4+C5) cases and 217 benign cases. Histopathology revealed 21 malignant cases and 216 benign cases. We observed a sensitivity of 90.48%, specificity of 99.54%, a positive predictive value of 95%, a negative predictive value of 99.08%, a concordance of 92.41%, a diagnostic accuracy of 98.73% and a negative likelihood ratio of 0.1 for FNAC. Conclusions: Besides other advantages, FNAC of a breast lesion is reliable enough to rule out malignancy.

Context: Ambuja Cement Foundation (ACF) started replicating the famous “Gadchiroli” model to reduce neonatal mortality in Chandrapur in 2005. ACF conducted the Home-Based Newborn Care (HBNC) model through trained female health workers, viz., “SAKHIs.” In 2008, Government of India introduced community health worker, viz., Accredited Social Health Activist (ASHA). ACF withdrew its services steadily and few SAKHIs were hired as ASHAs. Aims: We assessed and compared the knowledge level and skills of trained ASHA workers with SAKHIs in providing HBNC. Methods and Material: A cross-sectional study was conducted in three blocks of Chandrapur district of Maharashtra, India. A structured questionnaire consisting of 34 questions was used for knowledge assessment and checklists assessed hand washing, weight recording, temperature recording, kangaroo mother care (KMC) position, suction and bag and mask ventilation (BMV) skills on manikins. Results: 135 healthcare workers participated. The mean (SD) score of current SAKHIs (23.89 (1.9) was significantly higher than former SAKHIs (currently ASHAs) (17.97 (2.92), former SAKHIs (currently not engaged in HBNC) (16.73 (2.95) and ASHAs not worked as SAKHIs in the past (16.19 (3.19) [all P < 0.001]. Similar trend was seen in all skill sets. The skills of ASHAs not worked as SAKHIs previously were abysmal, with no ASHA being able to perform BMV and KMC skills, and only 4 (7.5%) who could perform suctioning. A typical trend was observed with current SAKHIs faring best followed by former SAKHIS (currently ASHAs), former SAKHIs (currently not in HBNC), and ASHAs not worked as SAKHIs faring worst. Conclusion: The skills and knowledge of ASHA workers are far deficient compared to SAKHIs despite similar training components, potentially hampering neonatal mortality reduction. Quality of training and supportive supervision mechanism of ASHAs should be explored.

To the Editor, We read the original study by De Michele et al. titled “Post severe COVID-19 infection lung damages study. The experience of early three months multidisciplinary follow-up” with great interest...

Across the world, choledocholithiasis is presently treated by a two staged approach of Endoscopic Retrograde CholangioPancreatography (ERCP) followed by Laparoscopic Cholecystectomy (LC); in a vast majority of the situations. Modern day literature abounds with comparative outcomes studies between ERCP and Laparoscopic Common Bile Duct Exploration (LCBDE), as therapeutic modalities for Common Bile Duct (CBD) stones. There are strong arguments both in favour and against both these treatment options, in literature. As per literature, the advantage of LCBDE is that it is a single stage procedure, but requires advanced laparoscopic expertise and a choledochoscope in the setup. The advantage of ERCP is that it is a highly standardised procedure. In expert hands and well equipped setups, it rarely ever fails to deliver. However, ERCP is also a highly operator dependant procedure. Also, in the best of hands, sometimes, local factors such as abnormal anatomy, stone morphology can lead to failures or suboptimal results. As per literature, ERCP to extract CBD stones can fail for various reasons such as failed cannulation, previous Billroth II gastrectomy, large CBD stones, large number of CBD stones etc. The failure in retrieving CBD stones by ERCP is an absolute indication for performing CBDE. Here, authors present a case report of a 73-year-old male with failed ERCP (inspite of two attempts) due to a large, solitary but tightly impacted terminal CBD stone. It hopes to convey the message that in similar situations, LCBDE, tactically using some endoscopy accessories, is a sound backup therapeautic option, inspite of non availability of a choledochoscope in the setup. The novelty of this case was that instead of the standard use of choledochoscope to directly visually confirm the completeness of stone clearance during the LCBDE, intraoperative fluoroscopy has been used effectively for the same; by obtaining good quality proximal and distal occlusion cholangiograms at the end of the procedure.

Background: The aim of this study is to understand the effect of ultrasound (US) guided erector spinae plane block (ESPB) in improving the intraoperative and postoperative analgesia in patients undergoing mastectomies, decreasing the use of opioids and in reducing postoperative nausea and vomiting. Methods: After local ethics committee approval, 100 patients were divided randomly into two groups. Group A with 50 patients received US guided ESPB with 30 ml of 0.25% of bupivacaine under US guidance. Group B with 50 patients received no block. Visual analogue scale (VAS) was used to assess pain postoperatively. All patients received 1 g intravenous intravenous paracetamol 8th hourly and morphine was used as rescue analgesia if VAS score is more than 4. Patients were monitored for VAS scores, postoperative nausea/ vomiting and total morphine consumption for a 24-hour period in a high dependency unit. Results: Postoperative morphine consumption was found to be significantly less in patients who received US-guided ESPB compared to control group (0.12 mg ± 0.59 mg in ESPB group compared to 1.70 ± 2.29 mg which was statistically significant, p =0.000). Only 3 patients in ESP group received rescue analgesia in the form of morphine whereas 22 patients in the control group received morphine. There was no difference in PONV score in either groups. There were no complications like vascular puncture, pneumothorax, or respiratory depression in both groups. Conclusion: US guided ESPB is quite effective in reducing perioperative pain in patients undergoing mastectomy. The trial was registered prospectively with CTRI with registration number: CTRI/2018/09/015668.

Peripherally inserted central catheter (PICC) placement can be extremely challenging and difficult in certain situations. In this case report, we have described PICC placement in right femoral vein in a patient who had thrombosis of arm veins and great veins in neck. We have described a unique way of tunneling the catheter in lower abdominal wall so as to use it for long term and avoid infections which is common with groin lines.

Anaesthesia induction and meticulous airway management is important in a patient with anterior mediastinal mass. It is all the more challenging if this is encountered in infants. We report a comrehensive successful management of an infant with huge anterior mediastinal mass who was anaesthesized for diagnosis initially followed by surgical resection of the tumor.

An 81-year-old woman with a history of malignant melanoma who presented with dyspnea and fatigue was found to have metastases to the stomach detected on endoscopy. Primary cutaneous malignant melanoma with gastric metastases is a rare occurrence, and it is often not detected until autopsy because of its non-specific manifestations.

[This corrects the article DOI: 10.1371/journal.pone.0103060.].