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Abstract Domain-specific vocabulary, which is crucial in fields such as Information Retrieval and Natural Language Processing, requires continuous updates to remain effective. Incremental Learning, unlike conventional methods, updates existing knowledge without retraining from scratch. This paper presents an incremental learning algorithm for updating domain-specific vocabularies. It introduces DocLib, an archive used to capture a compact footprint of previously seen data and vocabulary terms. Task-based evaluation measures the effectiveness of the updated vocabulary by using vocabulary terms to perform a downstream task of text classification. The classification accuracy gauges the effectiveness of the vocabulary in discerning unseen documents related to the domain. Experiments illustrate that multiple incremental updates maintain vocabulary relevance without compromising its effectiveness. The proposed algorithm ensures bounded memory and processing requirements, distinguishing it from conventional approaches. Novel algorithms are introduced to assess the stability and plasticity of the proposed approach, demonstrating its ability to assimilate new knowledge while retaining old insights. The generalizability of the vocabulary is tested across datasets, achieving 97.89% accuracy in identifying domain-related data. A comparison with state-of-the-art techniques using a benchmark dataset confirms the effectiveness of the proposed approach. Importantly, this approach extends beyond classification tasks, potentially benefiting other research fields.

IntroductionThis study was undertaken to find the clinical correlation of resistive index (RI) in the anterior cerebral artery (ACA) of preterm neonates admitted to the Neonatal Intensive care unit (NICU) with comorbidities such as perinatal asphyxia, neonatal sepsis, and necrotizing enterocolitis (NEC).MethodsAn observational analytical study was conducted, including preterm neonates (

Postoperative visual loss (POVL) is an infrequent yet consequential complication that can follow cardiac surgical interventions. This systematic review aims to provide a comprehensive analysis of the incidence of POVL after cardiac surgery and to delineate the associated risk factors. A comprehensive search was conducted in major medical databases for relevant studies published up to September 2022. Eligible studies reporting on the incidence of POVL and identifying risk factors in patients undergoing cardiac surgery were included. Data extraction was performed independently by two reviewers. The pooled incidence rates and the identified risk factors were synthesized qualitatively. POVL after cardiac surgery has an overall incidence of 0.015%, that is, 15 cases per 100,000 cardiac surgical procedures. Risk factors for POVL include patient characteristics (advanced age, diabetes, hypertension, and preexisting ocular conditions), procedural factors (prolonged surgery duration, cardiopulmonary bypass time, and aortic cross-clamping), anesthetic considerations (hypotension, blood pressure fluctuations, and specific techniques), and postoperative complications (stroke, hypotension, and systemic hypoperfusion). Ischemic optic neuropathy (ION) is an uncommon complication, associated with factors like prolonged cardiopulmonary bypass, low hematocrit levels, excessive body weight gain, specific medications, hypothermia, anemia, raised intraocular pressure, and micro-embolization. Diabetic patients with severe postoperative anemia are at increased risk for anterior ischemic optic neuropathy (AION). Posterior ischemic optic neuropathy (PION) can occur with factors like hypertension, postoperative edema, prolonged mechanical ventilation, micro-embolization, inflammation, hemodilution, and hypothermia. While the overall incidence of POVL postcardiac surgery remains modest, its potential impact is substantial, necessitating meticulous consideration of modifiable risk factors. Notably, prolonged surgical duration, intraoperative hypotension, anemia, and reduced hematocrit levels remain salient contributors. Vigilance is indispensable to promptly detect this infrequent yet visually debilitating phenomenon in the context of postcardiac surgical care.

Background and Aims: A Key Performance Indicator (KPI) is a critical metric measuring organizational success or specific activities, reflecting the periodic achievement of operational goals aligned with strategic objectives. Material and Methods: A retrospective cross-sectional study of key quality performance indicators, (CQI-NABH) concerning anesthesia and surgical services was conducted at a tertiary care hospital after taking institutional ethical clearance (AIIMS/IEC/21/150). It was as per COP 13, COP 14, and COP 15 standards of NABH 4th edition published in 2015. The study was conducted at the department of anesthesiology at a tertiary care hospital, and data were retrospectively analyzed from 01 October 2019, till November 2020. All patients undergoing elective or emergency surgical procedures under monitored anesthesia care and regional or general anesthesia during the study period were considered.The primary objective was to analyze Continuous Quality Improvement (CQI) in perioperative services, with secondary goals including gap identification, suggesting corrective actions, and examining quality indicators during the COVID-19 pandemic in 2020. Results: Out of 8574 patients operated during the study, 6705 were in the four months before the pandemic, and 1869 were operated during the COVID-19 scenario. In the pre-COVID era, many of the cases were performed on an elective basis (71.23%), and emergencies constituted 16.9% of the total number of cases. In the COVID era, most of the cases were emergencies (45.4%) and semi-emergencies (40.25%), and elective cases were only 14.05% of the total cases performed. The percentage of modification of anaesthesia plans ranged from 0-3.34%. Adverse anaesthesia events were observed in 0-2.1%, primarily related to cardiovascular, respiratory, and airway issues. No anaesthesia-related mortality was reported. Prophylactic antibiotic administration within one hour of surgery ranged from 88-100%. Conclusions: Monitoring and evaluating healthcare performance, specifically through KPIs, is vital for optimizing care and resource utilization. These indicators provide an overview of hospital service efficiency, aiding in key areas such as patient treatment, satisfaction, healthcare quality improvement, cost reduction, and optimal resource utilization. Addressing identified issues ensures effective and sustainable quality improvement in anaesthesia services, emphasizing ongoing monitoring as a foundation for hospital quality assurance.

Abstract This study employed subtractive proteomics and immunoinformatics to analyze the Wuchereria bancrofti proteome and identify potential therapeutic targets, with a focus on designing a vaccine against the parasite species. A comprehensive bioinformatics analysis of the parasite's proteome identified 51 probable therapeutic targets, among which "Kunitz/bovine pancreatic trypsin inhibitor domain-containing protein" was identified as the most promising vaccine candidate. The candidate protein was used to design a multi-epitope vaccine, incorporating B-cell and T-cell epitopes identified through various tools. The vaccine construct underwent extensive analysis of its antigenic, physical, and chemical features, including the determination of secondary and tertiary structures. Docking and molecular dynamics simulations were performed with HLA alleles, Toll-like receptor 4 (TLR4), and TLR3 to assess its potential to elicit the human immune response. Immune simulation analysis confirmed the predicted vaccine’s strong binding affinity with immunoglobulins, indicating its potential efficacy in generating an immune response. However, experimental validation and testing of this multi-epitope vaccine construct would be needed to assess its potential against W. bancrofti and even for a broader range of lymphatic filarial infections given the similarities between W. bancrofti and Brugia.

Reciprocal Recommender Systems (RRS) use bilateral preferences to satisfy the needs of both the parties involved. Popularity bias is a critical problem in RRS, which arises when the RRS tend to prefer few popular users over others and thus exhibit biased behavior towards popular users. It can have adverse effect on both the parties involved. Popular users may become swamped by the requests received from a large number of users and cease to acknowledge, which can make it difficult for other users to make contact. To address this challenge, we propose Popularity-aware Siamese Bi-directional Gated Recurrent Units (PSBiGRU) with the proposed popularity-aware reciprocal score (ParS)-based re-ranking that uses semantic similarity between explicit user profiles. The proposed model is evaluated on two reciprocal environments, namely, online recruitment and online dating. Experimental findings demonstrate that PSBiGRU surpasses the compared state-of-the-art methodologies and illustrate its viability.

Background Dynamic parameters used for predicting fluid responsiveness require special equipment and are minimally invasive. Therefore, recent interest in the use of carotid artery ultrasound parameters, such as carotid corrected flow time (FTc) and peak velocity variation (ΔVpeak) has grown. Therefore, we performed this systematic review and meta-analysis to assess the ability of carotid FTc and/or ΔVpeak to accurately predict fluid responsiveness. Methods We searched the PubMed and Embase databases for articles evaluating the diagnostic accuracy of carotid FTc or ΔVpeak for predicting fluid responsiveness. Two independent authors performed the search and selected studies published until May 2022. The studies were assessed for the inclusion and exclusion criteria using Rayyan (Rayyan Systems Inc., 2022). Results Ten studies (n=438) that fulfilled the inclusion criteria were selected. Studies were divided into those assessing carotid FTc and those assessing carotid ΔVpeak. Five studies (six datasets) assessed FTc. The pooled sensitivity and specificity of carotid FTc were 0.76 and 0.88, respectively. The summary receiver operating characteristic (SROC) curve for carotid FTc had an area under the curve (AUC) of 0.9092, with a Q value of 0.8412. Seven studies calculated carotid ΔVpeak. The pooled sensitivity and specificity for ΔVpeak were 0.83 and 0.81, respectively. The SROC curve had an AUC of 0.8941 and a Q value of 0.8250. Conclusions Our meta-analysis showed that both carotid FTc and ΔVpeak are useful for predicting fluid responsiveness in anesthesia and critical care settings with good specificity and sensitivity.

Fast-scan cyclic voltammetry (FSCV) is an electrochemical sensing technique that can be used for neurochemical sensing with high spatiotemporal resolution. Carbon fiber microelectrodes (CFMEs) are traditionally used as FSCV sensors. However, CFMEs are prone to electrochemical fouling caused by oxidative byproducts of repeated serotonin (5-HT) exposure, which makes them less suitable as chronic 5-HT sensors. Our team is developing a boron-doped diamond microelectrode (BDDME) that has previously been shown to be relatively resistant to fouling caused by protein adsorption (biofouling). We sought to determine if this BDDME exhibits resistance to electrochemical fouling, which we explored on electrodes fabricated with either femtosecond laser cutting or physical cleaving. We recorded the oxidation current response after 25 repeated injections of 5-HT in a flow-injection cell and compared the current drop from the first with the last injection. The 5-HT responses were compared with dopamine (DA), a neurochemical that is known to produce minimal fouling oxidative byproducts and has a stable repeated response. Physical cleaving of the BDDME yielded a reduction in fouling due to 5-HT compared with the CFME and the femtosecond laser cut BDDME. However, the femtosecond laser cut BDDME exhibited a large increase in sensitivity over the cleaved BDDME. An extended stability analysis was conducted for all device types following 5-HT fouling tests. This analysis demonstrated an improvement in the long-term stability of boron-doped diamond over CFMEs, as well as a diminishing sensitivity of the laser-cut BDDME over time. This work reports the electrochemical fouling performance of the BDDME when it is repeatedly exposed to DA or 5-HT, which informs the development of a chronic, diamond-based electrochemical sensor for long-term neurotransmitter measurements in vivo.

Advances in artificial intelligence, telemedicine, block-chain technology and electronic medical records are paving the way for a new era in anaesthetic care through automation, non-invasive monitoring, system management and decision support systems. Their utility has been demonstrated in a variety of contexts in the peri-operative setting, including but not limited to, monitoring anaesthesia depth, maintaining drug infusion, predicting hypotension, critical incident evaluation, risk management strategies, antibiotic administration, haemodynamic monitoring, precise ultrasound-guided nerve blocks and a future where possibilities are entirely dependent on how we decide to embrace this progression. The main objective of this article is to provide up-to-date and valuable knowledge about the recent advances in anaesthesia technology during the past few years.

Background and Aims : This study aimed to compare manual infusion versus target-controlled infusion (TCI) in total intravenous anaesthesia (TIVA) utilising laryngeal mask airway (LMA)-gastro during endoscopic retrograde cholangio-pancreatography (ERCP) procedures. Methods: This was a single-blind randomised trial. Patients were randomly allocated into two groups. TCI group included 27 patients, where TCI of propofol was implemented with the Schnider pharmacokinetic model driven by a computer-controlled syringe pump. The TIVA group included 27 patients with a loading dose of 2 mg/kg of propofol, followed by manual infusion of 15 mg/kg/h for the first 15 min, 13 mg/kg/h for the next 15 min, then 11 mg/kg/h for 30 min and 10 mg/kg/h for 60 min and finally maintained at 9 mg/kg/h. The primary objective was to compare recovery time following cessation of propofol infusion in both groups. The difference in the total dose of propofol, time to achieve anaesthesia induction, first attempt success rate, ease of LMA-gastro insertion, ease of insertion, success rate of endoscope device and post-anaesthesia care unit (PACU) discharge time were the secondary objectives. T-test and Chi-square test were used for statistical analysis. Results: The time required for the recovery was significantly less in the TCI group than in the TIVA group (mean ± standard deviation; 11.60 ± 2.27 versus 15.4 ± 3.25 minutes, P < 0.001). The duration of ERCP, ease of LMA and endoscope insertion were comparable between the groups. There was no post-operative recall of intra-operative events in the groups. Conclusion: TCI offers earlier recovery than TIVA in patients undergoing ERCP procedures using LMA-gastro.

The study aims to present an overview of the extent of insecticide resistance in the dengue vector Aedes aegypti in India. Published data on insecticide resistance in this species were systematically searched through online databases like PubMed, Google, and Google Scholar. From each study, data were extracted and analyzed to understand the spatial and temporal patterns. Particular emphasis was given to the commonly used insecticides for mosquito control. Forty-three studies met the inclusion criteria, of which 13 had adult bioassay data, 13 larval bioassay data and 17 contained both. Data demonstrated high resistance to DDT and resistance is also widespread against carbamates. There is mounting evidence of increased tolerance to pyrethroids and organophosphorus compounds, viz permethrin, deltamethrin, lambda-cyhalothrin, malathion, and temephos. The emergence of resistance to all the insecticide classes further justifies the need for annual resistance monitoring and to maintain a nationwide database that can provide a reference for formulating effective control strategies.

Background: An individual's health and overall well-being are strongly correlated with their oral health. Parents' knowledge, attitude, and practice have a great impact on the maintenance of child's oral health. Objective and Aim: The aim of the study is to assess the knowledge, attitude, and practice of parents about child's oral health in Faridabad and its correlation with prevalence of dental caries in children through a questionnaire survey in 3–6-year-old children. Materials and Methods: A cross-sectional study was conducted in Faridabad. The data were collected from the parents and their children 3–6 years old. A total sample of 400 parents and their children 3–6 years old residing in Faridabad was included. A questionnaire regarding knowledge, attitude, and practice about child's oral health was given to the parents. The parents who volunteer to participate in the study their children were taken for the study examination. Results: Parental perception of early childhood oral health is critical for developing effective preventive measures. Parents play an important role in making decisions about their child's oral health. The parents were given a self-administered questionnaire. The study included 400 parents and children aged 3–6 years. There was no significant difference in perception of their child's oral health care between mothers and fathers. The majority of parents/caretakers had good knowledge about children's oral hygiene, particularly fathers, but this knowledge did not appear to reflect in their attitude and practice. Conclusion: The current study concludes that parents are not well aware about dental disease prevention measures. As a result, it is the responsibility of the government and health-care providers to teach parents about oral health because they are role models for their children.

The Anatomage table represents a significant advancement in the field of medical education by offering an interactive and immersive learning experience for medical students studying human anatomy. This digital technology enables virtual dissection, allowing students to explore and visualize the internal structures of the human body in a detailed and realistic manner. This provides several advantages by the elimination of need for physical specimens or cadavers, offering a safe and controlled learning environment, including repeated practices, critical thinking, and inculcation of problem-solving skills. It can enhance their knowledge, improve procedural skills, and ensure patient safety in various clinical scenarios. Additionally, the 3D anatomy and virtual dissection platforms like Anatomage table can facilitate preoperative planning and can aid in regional anesthesia procedures, airway management, and understanding anatomical variations. Anesthesiologists can benefit from the high anatomical accuracy, virtual dissection, chemical-free lab experience, environmental and safety benefits, and cost-effectiveness of the Anatomage table.

Background and Aims: The venous excess ultrasound (VExUS) score presents a prospect of valuable clinical utility. The study aimed to systematically review the effectiveness of the VExUS score in detecting venous congestion across emergency, critical care, and peri-operative contexts; assessing its utility in improved patient outcomes; and exploring its relationship with established parameters. Methods: This systematic review was registered in the International Prospective Register of Systematic Reviews (CRD42023421034). A comprehensive literature search, employing pre-defined search terms related to the VExUS score in diverse clinical contexts, was conducted on articles published between 2000 and 15 May 2023 across databases- PubMed, PubMed Central, Cochrane, Scopus, Elsevier Clinical Key, and Google Scholar. Bias risk assessment was carried out using the Risk of Bias in Non-Randomised Studies tool. Given the significant heterogeneity across studies concerning participants, interventions, outcomes, and study designs, data pooling for a meaningful meta-analysis was not feasible. Results: The review included 15 articles comprising observational studies, case series, and case reports. Most patients exhibited moderate-to-severe venous congestion based on their baseline VExUS scores. Higher VExUS scores correlated with a greater risk of acute kidney injury (AKI) in post-operative patients. The VExUS score strongly correlated with central venous pressure; specific components, such as the intra-renal monophasic pattern, portal-pulsatility, and inferior vena cava diameter, exhibited robust predictive value for venous congestion. Conclusion: VExUS score is valuable in assessing and predicting venous congestion, especially regarding AKI prediction risk and guiding interventions. However, its utility in predicting outcomes in acute heart failure patients appears less certain.

Background & objectives: Accurate mosquito species identification is the basis of entomological surveys and effective vector control. Mosquito identification is either done morphologically using diagnostic features mentioned in taxonomic keys or by molecular methods using cytochrome oxidase subunit 1 (coxI) and Internal transcribed spacer 2 (ITS2). Methods: We performed a larval survey for Aedes mosquitoes from eight different geographical regions in Tamil Nadu, India. The mosquitoes collected during the survey were characterized using both morphological and molecular markers. Results: During an entomological survey from eight different geographical regions in Southern India, a morphological variety named Aedes aegypti var. luciensis was observed. The variant mosquitoes were characterized using both morphological and molecular markers. The variant mosquitoes differed only in the dark scaling of 5th segment of hind-tarsi. Around one third to two third of the 5th segment in variant mosquitoes was dark which has been described as white in identification keys. No other significant difference was observed in adults or immature stages. The variation was heritable and coexisting in the field with the type form mosquitoes. Comparison of the genetic profile of coxI and ITS2 were similar in variant and the type form indicating both of them to be conspecific. Interpretation & conclusion: The morphological variant mosquitoes were found genetically similar to the Ae. aegypti type form. However, considering its high prevalence and coexistence with Ae. aegypti type form in different geographical regions, detailed studies on bionomics, ecology, genetics, behavior as well as its plausible role in disease transmission are warranted.

Background: Dental fear and anxiety remains the most common emotions experienced by the child who visit the pediatric dentist. The success of pedodontics is determined by the odontologist's capability to gain the confidence and maintain the cooperation of the child. Objective/Aim: The aim of the study was to assess the behavior and anxiety levels of school-going children in a dental setting using a Miniature Pediatric Dental Office Model during the first dental visit of the child. Study Design: This cross-sectional research was carried out in a dental institute in the department of pediatrics and preventive dentistry. The study protocol was explained to the parents of 3–9-year-old children. Demographics were elicited from the parents and their correlation with the placement of the doll in the pediatric dental office model and a modified Frankl's behavior rating scale was used to assess the child's behavior. Results: Of 84 participants, 47 children were under the age of 6 years and 37 children were ≥6 years of age. In the doll placement test, the majority (36.9%) of the children preferred pattern 2 (the child is on the chair, the dentist is inside the operatory, the mother is inside the operatory, and the father is outside the operatory) in the doll placement test, and the least (8.3%) preferred pattern 1 (the child is on the chair, the dentist is inside the operatory, the father is inside the operatory, the mother is outside the operatory). Thirty-four percent children up to the age of 6 years exhibited a mix of negative-positive behavior, and 43.2% of children aged 6 years showed a positive behavior according to the modified Frankl's rating scale. Conclusion: The doll placement test using a miniature pediatric office aided us in determining the child's anxiety level during their first dental visit. To achieve emotional support and avoid the impact of traumatic separation, especially in younger children, our study showed that mothers should be present in the dental office to remove behavior-related problems.

Anatomical differences in the airway in pediatric patients, compared to adults pose many challenges during endotracheal intubation, such as selecting the proper sized endotracheal tube (ETT) during intubation. Our primary objective was to assess how accurate is ultrasound (US) co-relation in comparison to standard age-based formulas in pediatric patients. Meta-analysis was registered in PROSPERO 2020, CRD42020220041. Online literature available in PubMed, Cochrane, and Embase, Goggle scholar was searched from year 2000 till November 30, 2020, using relevant Mesh terms, ('airway US' OR (('airway'/exp OR airway) AND ('US'/exp OR US))) AND ('endotracheal intubation'/exp OR 'endotracheal intubation') AND ('pediatric'/exp OR pediatric)” to Predict endotracheal tube size/placement in pediatric age (neonate till 18 years) by the US. Bibliographic cross-references of selected publications were further manually screened. The full texts of each article were studied, once the abstract was found appropriate independently by two reviewers. A total of 48 papers published between 2010 and 2020 were identified as relevant and read in detail. Average numbers of patients were 86 and total numbers of patients were 1978. Most of the studies included pediatric patients posted for elective surgeries under general anesthesia and excluded emergency procedures, known laryngeal or tracheal pathology, high-risk patients, recent upper respiratory tract infections or allergy to ultrasound gel. A total of 18 independent correlations were analyzed. Final combined r value calculated from all the included articles was 0.824 (95% CI 0.677, 0.908) with a P < 0.00001 {strong co-relation (r > 0.80)}. Q statistic of 756.484, and I2 statistics of 97.53% showed a large degree of heterogeneity in the effect size across the studies. Use of US for upper airway in pediatric patients is an effective modality and can effectively predict endotracheal tube size estimations in comparison to standard age-based or height-based formulae in the pediatric age group. US is a non-invasive, cost-effective, portable, and reproducible technique as compared to CT and MRI. It also takes less time with increasing expertise and experience.

Background: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract (GIT) that represent approximately 1 to 2 percent of primary gastrointestinal (GI) cancers. Owing to their rarity, very little is known about their overall epidemiology, and the prognostic factors of their pathology. The current study aimed to evaluate the independent determinants of mortality in patients diagnosed with GISTs over the past decade. Methods: Our study comprised 2374 patients diagnosed with GISTs from 2000 to 2017 from the Surveillance, Epidemiology, and End Results (SEER) database. We analyzed the baseline characteristics, and overall mortality (OM), as well as the cancer-specific mortality (CSM) of GISTs. Variables with a p value < 0.01 in the univariate Cox regression were incorporated into the multivariate Cox model, to determine the independent prognostic factors. Results: Multivariate Cox proportional hazard regression analyses of factors affecting the all-cause mortality and GIST-related mortality among US patients between 2010 and 2017 revealed a higher overall mortality in non-Hispanic Black patients (HR = 1.516, 95% CI 1.172–1.961, p = 0.002), patients aged 80+ (HR = 9.783, 95% CI 4.185–22.868, p = 0), followed by those aged 60–79 (HR = 3.408, 95% CI 1.488–7.807, p = 0.004); male patients (HR = 1.795, 95% CI 1.461–2.206, p < 0.001); patients with advanced disease with distant metastasis (HR = 3.865, 95% CI 2.977–5.019, p < 0.001), followed by cases with regional involvement via both direct extension and lymph node involvement (HR = 3.853, 95% CI 1.551–9.57, p = 0.004); and widowed patients (HR = 1.975, 95% CI 1.494–2.61, p < 0.001), followed by single patients (HR = 1.53, 95% CI 1.154–2.028, p = 0.003). The highest CSM was observed in the same groups, except widowed patients and patients aged 60–79. The highest CSM was also observed among patients that underwent chemotherapy (HR = 1.687, 95% CI 1.19–2.392, p = 0.003). Conclusion: In this updated study on the outcomes of patients with GISTs, we found that non-Hispanic Black patients, male patients, and patients older than 60 years have a higher mortality with GISTs. Furthermore, patients who have received chemotherapy have a higher GIST-specific mortality, and married patients have a lower mortality. However, we do not know to what extent these independent prognostic factors interact with each other to influence mortality. This study paves the way for future studies addressing these interactions. The results of this study may help treating clinicians to identify patient populations associated with a dismal prognosis, as those may require closer follow-up and more intensive therapy; furthermore, with married patients having a better survival rate, we hope to encourage clinicians to involve family members of the affected patients early in the disease course, as the social support might impact the prognosis.

Abstract Use of succinylcholine in neonates is surrounded by many controversies. The need to review this topic stems from the fact that though there is an abundance of information, but there are divergent views regarding its use in neonates. We have analyzed the incidence of intubation attempts, bradycardia, and hemodynamic changes in clinical settings. The authors conducted a meta-analysis and systematic literature search to ascertain the risks and benefits of using succinylcholine in neonatal intubation by conducting a review in the online databases of PubMed, Cochrane, Scopus, Embase, Elsevier, and Google scholar. The combination of keywords used for the search included “Succinylcholine,” “succinylcholine” AND “neonates,” “neonates” AND “difficult airway,” “neuromuscular blockers” AND “neonates,” and “non-depolarizing neuromuscular blockers” AND “neonates”. The severe adverse reactions associated with use of succinylcholine include bradycardia, asystole, hyperkalemia, and apnea. The number of attempts required for intubation was significantly lower in the patients receiving succinylcholine as compared to those who did not receive succinylcholine. Evidence suggests that conscious awake intubation leads to adverse physiological responses in neonates. The main recommended indications for using succinylcholine include emergency intubation in laryngospasm, full stomach, difficult airway, absent intravenous access, and controlled endotracheal intubation in the neonatal intensive care unit. Hence, the use of succinylcholine can be rationally accepted after considerations of the pre-operative clinical status of the neonate and risk-benefit ratio with more research further to build up strong evidence for the most appropriate agents for use in neonatal patients.

Background: The utility of Neuromuscular monitoring (NMT) has not been studied in Indian scenario till date. We did a survey to evaluate the knowledge, attitude, practices of NMT among Indian anesthesiologists. Methods: A questionnaire-based google form was sent to 350 anesthesiologists over 3-months. Demographic data was collected in initial questions, followed by data on their concepts, practices, and knowledge of NMT and postoperative residual nerve block (PRNB). Data were descriptively analysed using frequencies and percentages. Descriptive statistical testing was done using software package IBM SPSS 23. Results: 88.9% of participants reported the use of clinical assessment. Though majority used clinical parameters, they were well-versed about Train-of-Four criteria. 75.9% stated the use of objective NMT in < 25 % of patients. The reasons for not using objective monitoring were scarcity of neuromuscular monitors, non-familiarity, and complexity of monitors. In regards to PRNB, 79.6 % participants considered PRNB to be an important clinical issue. Although in their clinical practice they rarely encountered PRNB, 74% responded that routine NMT can decrease PRNB. The cross-tabulation table reflected that the use of objective tools (P= 0.014), knowledge about the essentiality of NMT (p=0.003), correctly stating PRNB as an important clinical issue (p=0.006), and their understanding about unreliability of clinical tests (p=0.001) showed significant improvement with increasing anesthesia experience. Conclusion: Participants showed great understanding of clinical and qualitative tests but not of quantitative tests, with low rate of usage of objective NMT. A lacuna in understanding of quantitative parameters must be addressed considering high incidence of PRNB and lack of sensitivity of clinical parameters.

Rickettsia is an important pathogenic entity among tick-borne diseases (TBD), which are considered serious emerging public health problems globally. In India, though the widespread distribution of ticks and TBD has been documented, its real burden remains underreported. In a preliminary attempt, rickettsial surveillance was carried out in ticks collected from Sirumalai, Eastern Ghats in Tamil Nadu, India by using pathogen genome-based phylogenetic inferences generated through multi-locus sequence typing (MLST), targeting the genes 16s rRNA, OmpA, OmpB, and gltA by nested PCR. The laboratory evidence confirms the circulation of Rickettsia in Haemaphysalis intermedia species collected from this area. Analysis of the four gene sequences detected demonstrates their closest identity to the spotted fever group (SFG) available in the GenBank database. Further, multiple sequence alignment with other sequences derived from the GenBank database showed close relatedness to Rickettsia conorii subsp. raoultii (16s rDNA-99.32%, OmpA-93.38%, OmpB-97.39%, and gltA-98.57%) and Rickettsia felis (16s rDNA 99.54%, OmpA-100%, OmpB-100% and gltA-99.41%). With this genomic evidence, the circulation of rickettsial pathogens in the pools of H. intermedia ticks infesting livestock in the Sirumalai foothill area has been demonstrated and to complement the microscopic identification of the tick species, DNA barcodes were generated for H. intermedia using the mitochondrial cytochrome c oxidase subunit I gene (COI). Nevertheless, R. raoultii and R. felis were found to be the aetiological agents of tick-borne lymphadenopathy and flea-borne spotted fever in human cases, respectively, further study on the determination of their diversity, distribution, clinical relevance, and potential risk to the local community in these areas is highly warranted.

Neurotransmitter release is important to study in order to better understand neurological diseases and treatment approaches. Serotonin is a neurotransmitter known to play key roles in the etiology of neuropsychiatric disorders. Fast-scan cyclic voltammetry (FSCV) has enabled the detection of neurochemicals, including serotonin, on a sub-second timescale via the well-established carbon fiber microelectrode (CFME). However, poor chronic stability and biofouling, i.e., the adsorption of interferent proteins to the electrode surface upon implantation, pose challenges in the natural physiological environment. We have recently developed a uniquely designed, freestanding, all-diamond boron-doped diamond microelectrode (BDDME) for electrochemical measurements. Key potential advantages of the device include customizable electrode site layouts, a wider working potential window, improved stability, and resistance to biofouling. Here, we present a first report on the electrochemical behavior of the BDDME in comparison with CFME by investigating in vitro serotonin (5-HT) responses with varying FSCV waveform parameters and biofouling conditions. While the CFME delivered lower limits of detection, we also found that BDDMEs showed more sustained 5-HT responses to increasing or changing FSCV waveform-switching potential and frequency, as well as to higher analyte concentrations. Biofouling-induced current reductions were significantly less pronounced at the BDDME when using a “Jackson” waveform compared to CFMEs. These findings are important steps towards the development and optimization of the BDDME as a chronically implanted biosensor for in vivo neurotransmitter detection.

Background: Primary cardiac sarcomas (PCS) are extremely rare malignant tumors involving the heart. Only isolated case reports have been described in the literature over different periods of time. This pathology has been associated with a dismal prognosis and given its rarity; treatment options are very limited. Furthermore, there are contrasting data about the effectiveness of current treatment modalities in improving the survival of patients with PCS, including surgical resection which is the mainstay of therapy. There is a paucity of data on the epidemiological characteristics of PCS. This study has the objective of investigating the epidemiologic characteristics, survival outcomes, and independent prognostic factors of PCS. Methods: A total of 362 patients were ultimately registered in our study from the Surveillance, Epidemiology, and End Results (SEER) database. The study period was from 2000 to 2017. Demographics such as clinical characteristics, overall mortality (OM), and PCS-specific mortality (CSM) were taken into account. A p value of p < 0.001), followed by age 60–79 (HR = 1.429, 95% CI 1.028–1.986, p = 0.033); and PCS with distant metastases (HR = 1.888, 95% CI 1.389–2.566, p < 0.001). Patients that underwent surgical resection of the primary tumor and patients with malignant fibrous histiocytomas (HR = 0.657, 95% CI 0.455–0.95, p = 0.025) had a better OM (HR = 0.606, 95% CI 0.465–0.791, p < 0.001). The highest cancer-specific mortality was observed in age 80+ (HR = 5.037, 95% CI 2.606–9.736, p < 0.001) and patients with distant metastases (HR = 1.953, 95% CI 1.396–2.733, p < 0.001). Patients with malignant fibrous histiocytomas (HR = 0.572, 95% CI 0.378–0.865, p = 0.008) and those who underwent surgery (HR = 0.581, 95% CI 0.436–0.774, p < 0.001) had a lower CSM. Patients in the age range 80+ (HR = 13.261, 95% CI 5.839–30.119, p < 0.001) and advanced disease with distant metastases (HR = 2.013, 95% CI 1.355–2.99, p = 0.001) were found to have a higher OM in the multivariate analyses adjusting for covariates). Lower OM was found in patients with rhabdomyosarcoma (HR = 0.364, 95% CI 0.154–0.86, p = 0.021) and widowed patients (HR = 0.506, 95% CI 0.263–0.977, p = 0.042). Multivariate cox proportional hazard regression analyses of CSM also revealed higher mortality of the same groups, and lower mortality in patients with Rhabdomyosarcoma. Conclusion: In this United States population-based retrospective cohort study using the SEER database, we found that cardiac rhabdomyosarcoma was associated with the lowest CSM and OM. Furthermore, as expected, age and advanced disease at diagnosis were independent factors predicting poor prognosis. Surgical resection of the primary tumor showed lower CSM and OM in the crude analysis but when adjusted for covariates in the multivariate analysis, it did not significantly impact the overall mortality or the cancer-specific mortality. These findings allow for treating clinicians to recognize patients that should be referred to palliative/hospice care at the time of diagnosis and avoid any surgical interventions as they did not show any differences in mortality. Surgical resection, adjuvant chemotherapy, and/or radiation in patients with poor prognoses should be reserved as palliative measures rather than an attempt to cure the disease.

Background Due to the risk of viral transmission during in-person training, a shift toward online platforms is imperative in the current pandemic. Therefore, we compared the effectiveness of an in-person interactive course with a structurally similar online course designed to improve cognitive skills among clinical health professionals in arterial blood gas analysis, management of electrolyte imbalances, and approaches to mechanical ventilation in critically ill patients. Methods In an observational, outcome assessor-blinded, cohort trial, group A included participants enrolled prospectively in an online course, while group B included those who took part in an in-person course (retrospective arm). The primary objective was comparison of cognitive skills through a pre and post-test questionnaire. Statistical analysis was performed using Student t-test. Results In total, 435 participants were analyzed in group A, while 99 participants were evaluated in group B. The mean pre-test score was 9.48±2.75 and 10.76±2.42, while the mean post-test score was 11.94±1.90 (passing rate, 64.6%) and 12.53±1.63 (passing rate, 73.3%) in groups A and B, respectively. Group B scored significantly higher in both pre-test (P=0.001) and post-test evaluations (P=0.004). The improvement in post-test score was significantly greater (P=0.001) in group A (2.46±2.22) compared to group B (1.77±1.76). The medical specialties fared better in group B, while surgical specialties scored higher in group A. The pre-test vs. post-test scores exhibited a moderate correlation in both groups (P3.5 for most points in both groups. Conclusions The online teaching module exhibited a significant benefit in terms of participant sensitization and knowledge sharing.

Congenital pulmonary adenomatoid malformation (CPAM) is a rare entity. The authors searched the US National Library of Medicine Database, EMBASE, Google Scholar, PubMed Central for anesthetic management in CPAM. The search was performed using the terms: congenital cystic adenomatoid malformation, congenital pulmonary adenomatoid malformation, CCAM, CPAM, anesthetic management. The prognosis of CPAM depends on timely diagnosis, presence of hydrops, degree of hypoplasia of remaining lung, and the size of the lesion. Symptomatic patients must be treated surgically and lobectomy is considered the gold standard. Anesthetic management of such cases is challenging as it involves thoracotomy or thoracoscopic lobectomy or cystectomy and can lead to sudden hemodynamic Collapse. Early extubation should be considered to avoid iatrogenic ventilator-induced bronchial stump dehiscence resulting from positive pressure ventilation.

Enhanced electrical activity, ventricular arrhythmia (VA), and cardiac instability due to increased sympathetic tone may be refractory to standard medical treatment and ablation procedures. Stellate ganglion block (SGB) has been used to treat refractory VA; however, there is insufficient information in the literature on its long-term outcome. Herein, we described three patients that were successfully treated with ultrasound-guided left SGB (LSGB) and chemical neurolysis. Ultrasound-guided LSGB may be considered as rescue or bridge therapy for stabilizing ventricular rhythm before a definitive procedure is planned.

Background: There has been considerable interest in mobile and tablet technology in the field of health care. This interest has brought the area of mobile health apps, described as providing health care and health-related services through communications devices, into-sharp focus. This study aimed to assess the status of contemporary apps targeted at chronic pain assessment and management with a particular focus on patient-centered approach, criterion for pain assessment, medication assessment, targeted system, and pain management/guidance. Methodology: We searched for pain apps specific for chronic pain on the App Store for iOS devices and Google Play for Android devices. Each app store was searched using terms related to “pain,” “chronic pain,” “pain scale,” and “pain management.” Various parameters such as the name of the app, availability in operating systems (iOS or Android), download cost, creation dates, date of latest update, language, type of pathology, user rating, number of downloads, reviews, type of target population, the objective of the app and target population were explored. To explore the downloaded apps, an Excel® tool was designed for data extraction. Observations: Two hundred and fifty-four numbers of apps were identified after excluding duplicates. Forty-seven apps were included in the study that had a rating of above 4 in Google play store for further analysis. Eight out of 47 apps only did extensive pain assessment, and pain rating score was available in 14 apps. Most of the apps targeted exercise as a primary modality of management, and provided knowledge about the disease process. Few apps were based on the patients' hospital-based management and very few apps targeted yoga, integrative therapy, and trigger point as the primary modalities of management. 75% of apps targeted general pain, and only 25% were specific to an organ system. Majority of the apps were neither designed nor edited by licensed health-care providers, and there was little direct involvement by health-care professionals. Conclusion: The use of mobile devices can offer many advantages and opportunities for enhancing medical care. At present, due to the lack of evidence supporting their use, caution should be taken in the use of smartphones apps. These applications should also be assessed and regularly analyzed, and integrated with pain assessment and pain management and incorporate various integrative therapies based on available recommendations.

Background: Comprehensive preoperative geriatric evaluations, including frailty, diet, mobility aid use, physical activity, cognitive testing, and mood state assessment, help predict perioperative outcomes in elderly patients. Material and Methods: An online questionnaire-based Google survey was prepared to assess preanesthetic checkup (PAC) in elderly patients by practicing anesthesiologists over 3 months. Data about respondent demographics, knowledge about preoperative investigations, and utilization of validated tools for risk assessment in geriatric patients were collected and analyzed descriptively using different percentages and frequencies. Results: The invitation was sent to 500 anesthesiologists. One hundred and fifty-six recipients responded to the e-mail invitation producing an overall response rate of 31.2%. About 47.4% and 42.4% of anesthesiologists had an equal preference for regional/general anesthesia in conducting elderly elective cases for surgeries, the choice of anesthesia was mainly regional anesthesia in cognitively impaired elderly patients. Nearly 88.5% and 78.2% of practicing anesthesiologists were well aware and conducted the functional assessment and mini—mental state examination in geriatric patients, but only 48.7% were aware of frailty scoring, 30.8% were aware of Charlson comorbidity scoring index, and 24.4% were about Elderly Mobility Scale (EMS). Conclusion: Surgical results are strongly influenced by the general health, work, and life expectancy of patients. A comprehensive preoperative geriatric evaluation of patients must be extended beyond an organ-based or disease-based evaluation. We support the inclusion in the PAC of geriatric patients of validated score systems, including frailty score, Charlson comorbidity score index, EMS, functional assessment, and mini—mental state assessment.

BackgroundAnopheles stephensi, an invasive malaria vector, has been reported to have three biological forms identifiable mainly based on the number of ridges present on the egg's floats. Recently, the first intron of the odorant-binding protein-1 (AsteObp1) has been introduced as a molecular marker for the identification of these forms, and based on this marker, the presence of three putative sibling species (designated as species A, B and C) has been proposed. However, there is no data on the association of proposed markers with biological form or putative species on field populations.MethodsField collected and laboratory-reared An. stephensi were characterized for biological forms based on the number of ridges on the egg's float. DNA sequencing of the partial AsteObp1 gene of An. stephensi individuals were performed by Sanger's method, either directly or after cloning with a plasmid vector. Additionally, AsteObp1 sequences of various laboratory lines of An. stephensi were retrieved from a public sequence database.ResultsAsteObp1 intron-1 in Indian An. stephensi populations are highly polymorphic with the presence of more than 13 haplotypes exhibiting nucleotides as well as length-polymorphism (90-to-121 bp). No specific haplotype or a group of closely related haplotypes of intron-1 was found associated with any biological form identified morphologically. High heterozygosity for this marker with a low inbreeding coefficient in field and laboratory populations indicates that this marker is not suitable for the delimitation of putative sibling species, at least in Indian populations.ConclusionsAsteObp1 cannot serve as a marker for identifying biological forms of An. stephensi or putative sibling species in Indian populations.

Deep vein thrombosis (DVT) is the formation of a blood clot typically in the deep veins of the extremities. The risk factors for venous thrombosis are primarily related to hypercoagulability, which can be genetic, acquired, or due to immobilization and venous stasis. The Johnson and Johnson (J&J) vaccine developed against the novel SARS-CoV-2 has been linked to more specific cases of thrombosis, associated with low platelet levels similar to that seen in heparin-induced thrombocytopenia. In this case report, we present a female who developed a DVT four days after receiving the J&J vaccine. We propose that the administration of this vaccine may further increase the risk of developing DVTs in patients with previous risk factors, and we hope to use this case to support screening all patients for previous risk factors for thrombosis before administration of the J&J vaccine.

Background: Anaesthesiologists undergo shear stress during the perioperative period, which was further increased during the COVID 19 pandemic. Many observational studies were done to find out the stress levels of the residents. Methods: This was a prospective observational cohort study of Anaesthesiology residents in a tertiary care academic institution. We have measured the minute to minute heart rate variability which can be an indirect measure of stress level with the help of wrist band MI 4 which works on the principle of PPG. Results: The difference between baseline HR and resting HR was observed to be substantial (p value 0.115 and 0.000 respectively). The percentage rise in heart rate during intubation from resting heart rate was 42.79 ± 25.54 percentage points. Conclusion: Users can use this type of ongoing information as a feedback option to increase their work efficacy. Understanding how to use these smart devices will assist us in balancing our stress-free day-to-day activities.

Acute myeloid leukaemia (AML) is a highly heterogeneous disorder and is characterised by the proliferation of poorly differentiated myeloid cells due to underlying mutation, eventually causing bone marrow failure. Accounting for approximately 25% of cases, AML is the most frequent form of leukaemia in the world yet has the lowest survival rate among all leukaemias. Patients with haematological malignancy are more susceptible to severe acute respiratory syndrome coronavirus-2 infection and further development of severe infection, including pneumonia with poor blood oxygenation. The management of such patients is more challenging than expected. Successful management of one such case is discussed in this report. COVID-19 infection can cause great harm to a patient with underlying leukaemia and increase the mortality risk. It has a major impact on the physical and psychological health of the patient. Therefore, these patients need special care and attention. The authors emphasise the importance of supportive management (oxygen with bilevel positive airway pressure, prone positioning, and physiotherapy) to prevent complications.

Incentive spirometer (IS) is a popular choice for chest physiotherapy. It is used to optimize preoperative respiratory status and prevent postoperative pulmonary complications. However, the use of conventional forms of IS pose a challenging task in children due to the lack of cooperation, compliance, and submaximal effort on the part of pediatric patients. To tackle this problem, we describe an innovative and fascinating technique of spirometry. It employs a toy as a better acceptable incentive spirometry device in pediatric population. This toy has a mouthpiece and a long inflatable plastic strip at the other end. As the child blows into the mouthpiece, a captivating sound from the toy keeps buzzing progressively till the air is being blown during exhalation and is accompanied with inflation of the strip in an elongated fashion. Hence, this device incorporates the two best enjoyed incentives for children, namely, visual and audio to ensure patient compliance and participation.

Anaesthesia is a medical speciality that is pertinent to safety of patients who are undergoing surgical procedures. The type of anaesthesia, critical care and pain services is considered as a benchmark of quality of care provided in any tertiary care institute. This is prerequisite in order to provide quality of care based on sound organisation, good clinical practice and adequate communication with other healthcare workers involved. Several important efforts have been undertaken especially in an integrated manner in developing countries, where anaesthesia services are often provided by unqualified personnel at remote places. The principal reasons in the resource poor areas are critical shortage of trained anaesthesia providers. The patient safety plan must provide a systematic, coordinated and continuous approach to the reduction of medical errors. This includes quality of care, development of guidelines, clinical audits, education and training. In addition, importance of other tools like critical incident reporting, use of simulation for training of residents and staffs and use of checklists are also growing. This article highlights the development of department of anaesthesia in a remote location of India and it focuses on the important elements of safe anaesthesia practice, use of advanced model of teaching by the faculty members and how the anaesthesiologist being expert in critical care and airway management have provided par excellence services in the current challenging times of COVID-19 pandemic crisis situation.

Total intravenous anaesthesia (TIVA) is a technique of general anaesthesia (GA) given via intravenous route exclusively. In perspective of COVID-19, TIVA is far more advantageous than inhalational anaesthesia. It avoids the deleterious effects of immunosuppression and lacks any respiratory irritation, thus providing an edge in the current situation. Many peripheral surgeries can be done with the patient breathing spontaneously without any airway device, thus avoiding airway instrumentation leading to droplet and aerosol generation. Intravenous agents can be utilized to provide sedation during regional anaesthesia (RA), which can easily be escalated to contain pain due to sparing of blocks or receding neuraxial anaesthesia. The present narrative review focuses on the merits of adopting TIVA technique during this pandemic so as to decrease the risk and morbidity arising from anaesthetizing COVID-19 patients.

The world has changed due to COVID-19 pandemic. Global spread of COVID-19 has overwhelmed all health systems and has incurred widespread social and economic disruption. The authorities are struggling to ramp up the healthcare systems to overcome it. Anaesthesiologists are facing long duty hours, have fear of bringing disease home to their families, being companion to critically ill patients on long term life support, being on front line of this pandemic crisis, may take toll on all aspects of health of corona warriors- physical, mental, social as well as the emotional.At this juncture, we must pause and ask this question to ourselves, “Buried under stress, are we okay?”