Neurology India 2018 66(1):268-268
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Πέμπτη 11 Ιανουαρίου 2018
Reversible symptoms present in a patient with Balo's concentric sclerosis
Neurology India 2018 66(1):268-268
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Sertraline-induced reversible myopathy with rhabdomyolysis and trismus
Neurology India 2018 66(1):235-237
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Changing trends in surgery for suprasellar lesions
Neurology India 2018 66(1):4-8
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Russel Brain: Some reflections on genius and other essays
Neurology India 2018 66(1):290-293
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Evolution of concepts in the management of vestibular schwannomas: Lessons learnt from Prof B Ramamurthi's article published in 1970
Neurology India 2018 66(1):9-19
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Dirofilariasis mimicking an osteoma
Neurology India 2018 66(1):255-256
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A medical-legal perspective on overlapping surgery
Neurology India 2018 66(1):20-23
In the U.S., there has recently been increased scrutiny on the appropriateness of surgeons performing overlapping cases and the potential for adverse consequences. This article describes the current literature on overlapping surgery and the ethics that guide behavior by performing a review of the PUBMED literature on overlapping surgery and analysis. Although the literature on overlapping surgery supports it as a safe practice, some public opinion runs contrary to the data, which is driving changes in policy. Surgeons should become familiar with the overlapping surgery policy in the hospital(s) in which they practice and be mindful of the potential consequences of performing overlapping surgeries.
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Authors' Reply: Magnesium supplementation in intracerebral hematoma: The hope and the hype!
Neurology India 2018 66(1):282-283
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Cerebrospinal fluid shunts – How they work: The basics
Neurology India 2018 66(1):24-35
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Association of hemolysis, elevated liver enzymes, low platelets syndrome with posterior reversible encephalopathy and intracranial hypotension
Zahide Yılmaz, Nuray Voyvoda, Pinar Bekdik Şirinocak, Hasan Terzi
Neurology India 2018 66(1):226-227
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Neurology India 2018 66(1):226-227
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Current status of dystonias including Meige's syndrome
Neurology India 2018 66(1):36-37
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Lumber nerve root cavernous angioma
Neurology India 2018 66(1):244-245
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Botulinum toxin in patients with Meige's syndrome
Neurology India 2018 66(1):38-39
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Nasu–Hakola Disease
Neurology India 2018 66(1):263-263
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Management of intracranial arterial dissection
Neurology India 2018 66(1):40-42
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The Indo-US Collaborative Stroke Registry and infrastructure development project
Neurology India 2018 66(1):276-278
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Endovascular management of vertebral artery dissecting aneurysms
Neurology India 2018 66(1):43-45
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Subgaleoatrial or subgaleopleural shunt?
Neurology India 2018 66(1):285-286
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Dissecting aneurysms of the vertebrobasilar system with non-traumatic subarachnoid haemorrhage: Therapeutic considerations
Neurology India 2018 66(1):46-48
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Supplementing dietary rosemary ( Rosmarinus officinalis L.) powder and vitamin E in broiler chickens: evaluation of humoral immune response, lymphoid organs, and blood proteins
Abstract
The aim of the present study was to evaluate the effect rosemary (Rosmarinus officinalis L.) powder (RP) and vitamin E (VE) at different levels on humoral immunity of broilers during a 42-day production cycle. A total of 270 1-day-old male chicks were assigned to nine groups with three replicates of ten birds each, and diets were supplemented with 0, 0.5, or 1.0% RP and 0, 100, or 200 mg/kg VE, respectively. Commercial-inactivated vaccines against avian influenza (AI) and Newcastle disease (ND) viruses, and living infectious bronchitis virus (IBV) vaccine were administered by spray method. Sheep red blood cells (SRBC) were administered subcutaneously. Blood samples were collected from birds 1 week after each vaccination to determine antibody titers. At the 42nd day, blood samples were also assessed for globulin level, and lymphoid tissues (thymus, spleen, and bursa) were weighed. Neither antibody titers against viruses nor lymphoid tissues weight were affected by RP and/or VE (P > 0.05) treatments. However, broilers supplemented with 0 mg/kg of VE had lower antibody titers against SRBC than those fed 100 mg/kg of VE (P < 0.05) at the 24th day. A significant RP × VE interaction effect (P < 0.05) on plasma globulin level was observed. The findings of our study suggest that dietary RP and VE additives can interact and modulate the humoral immunity of broilers, but not sufficiently to improve antibody titers against specific virus during a 42-day production cycle.
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Testing the role of external debt in environmental degradation: empirical evidence from Turkey
Abstract
This study investigates the role of external debt stock in Turkey, which has suffered from heavy (external and domestic) debt stock for many years. Annual data from 1960 to 2013 was analyzed using time series analysis in order to study this. The results confirm the validity of the conventional environmental Kuznets curve (EKC) in the case of Turkey. However, this study also found that Turkey's external debt stock did not influence the Turkish economy's long-term EKC behavior. Fortunately, the results suggest that there are important interactions among external debt stock, CO2 emissions, energy consumption, and real income; that is, changes in external debt volume precede changes in these aggregates' volumes.
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Contrasting effects of alkaline amendments on the bioavailability and uptake of Cd in rice plants in a Cd-contaminated acid paddy soil
Abstract
Reducing cadmium (Cd) concentrations in rice grains is important for food safety, particularly in acid paddy fields in South China where the soils have been previously contaminated with Cd. A field experiment was conducted to evaluate the effects of four alkaline amendments, i.e., lime, compost, biochar, and carbide slag on soil bioavailability and uptake of Cd in plants of two rice cultivars (Oryza sativa L.) in a Cd-contaminated acid paddy soil. The addition of these amendments significantly decreased the concentrations of CaCl2-extractable Cd by 13–41%. Cd in the acid-soluble fraction was decreased in these amended soils while it increased in the residual fraction. The amendments also decreased the uptake of Cd in the plants at the tillering and mature growth stages. The concentrations of Cd in plant tissues at maturity were in the order: root > shoot > bran > polished rice > husk. The amendment of carbide slag decreased Cd concentration in rice grains the most, followed by lime, biochar, and compost. The increases in soil pH and the decreases in the acid-soluble fraction of Cd (F1-Cd) indicated that these amendments can directly transform the highly availability fraction of Cd to a more stable fraction (residual Cd fraction) in soils. Furthermore, the Cd concentrations in polished rice grains of the two rice cultivars used were reduced by 66–67% by treatment with carbide slag. Our study suggests that carbide slag has a great potential to reduce the bioavailability and uptake of Cd in rice plants in Cd-contaminated acid paddy field soils.
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Rhythmic Spontaneous Activity Mediates the Age-Related Decline in Somatosensory Function
Abstract
Sensory gating is a neurophysiological process whereby the response to a second stimulus in a pair of identical stimuli is attenuated, and it is thought to reflect the capacity of the CNS to preserve neural resources for behaviorally relevant stimuli. Such gating is observed across multiple sensory modalities and is modulated by age, but the mechanisms involved are not understood. In this study, we examined somatosensory gating in 68 healthy adults using magnetoencephalography (MEG) and advanced oscillatory and time-domain analysis methods. MEG data underwent source reconstruction and peak voxel time series data were extracted to evaluate the dynamics of somatosensory gating, and the impact of spontaneous neural activity immediately preceding the stimulation. We found that gating declined with increasing age and that older adults had significantly reduced gating relative to younger adults, suggesting impaired local inhibitory function. Most importantly, older adults had significantly elevated spontaneous activity preceding the stimulation, and this effect fully mediated the impact of aging on sensory gating. In conclusion, gating in the somatosensory system declines with advancing age and this effect is directly tied to increased spontaneous neural activity in the primary somatosensory cortices, which is likely secondary to age-related declines in local GABA inhibitory function.http://ift.tt/2mkuT3f
Gli2 Rescues Delays in Brain Development Induced by Kif3a Dysfunction
Abstract
The primary cilium in neural stem cells plays distinct roles in different stages during cortical development. Ciliary dysfunctions in human (i.e., ciliopathy) cause developmental defects in multiple organs, including brain developmental delays, which lead to intellectual disabilities and cognitive deficits. However, effective treatment to this devastating developmental disorder is still lacking. Here, we first investigated the effects of ciliopathy on neural stem cells by knocking down Kif3a, a kinesin II motor required for ciliogenesis, in the neurogenic stage of cortical development by in utero electroporation of mouse embryos. Brains electroporated with Kif3a shRNA showed defects in neuronal migration and differentiation, delays in neural stem cell cycle progression, and failures in interkinetic nuclear migration. Interestingly, introduction of Gli1 and Gli2 both can restore the cell cycle progression by elevating cyclin D1 in neural stem cells. Remarkably, enforced Gli2 expression, but not Gli1, partially restored the ability of Kif3a-knockdown neurons to differentiate and move from the germinal ventricular zone to the cortical plate. Moreover, Cyclin D1 knockdown abolished Gli2's rescue effect. These findings suggest Gli2 may rescue neural stem cell proliferation, differentiation and migration through Cyclin D1 pathway and may serve as a potential therapeutic target for human ciliopathy syndromes through modulating the progression of neural stem cell cycle.http://ift.tt/2D3tUPn
The Roles of Subdivisions of Human Insula in Emotion Perception and Auditory Processing
Abstract
Previous studies have shown insular activations involving sensory, motor, and affective processing. However, the functional roles of subdivisions within the human insula are still not well understood. In the present study, we used intracranial electroencephalography and electrical cortical stimulation to investigate the causal roles of subdivisions of the insula in auditory emotion perception in epilepsy patients implanted with depth electrodes in this brain region. The posterior and the anterior subdivisions of the human insula, identified based on structural and functional analyses, showed distinct response properties to auditory emotional stimuli. The posterior insula showed auditory responses that resemble those observed in Heschl's gyrus, whereas the anterior insula (AI) responded to the emotional contents of the auditory stimuli in a similar way as observed in the amygdala. Furthermore, the degree of the differentiation between various emotion types increased from the posterior to the AI. Our findings suggest different roles played by the two regions of the human insula and a transformation from sensory to affective representations in auditory modality along the posterior-to-anterior axis in the human insula.http://ift.tt/2mkcQKE
Streptococcus oralis maintains homeostasis in supragingival biofilms by antagonizing cariogenic pathogen Streptococcus mutans
Summary
Bacteria residing in oral biofilms live in a state of dynamic equilibrium with one another. The intricate synergistic or antagonistic interactions between them are crucial for determining this balance. Using the 6-species Zürich "supragingival" biofilm model, this study aimed to investigate interactions regarding growth and localization of the constituent species. As control, an inoculum containing all six strains was used, whereas in each of the further five inocula one of the bacterial species was absent, and in the last both streptococci were absent. Biofilms were grown anaerobically on hydroxyapatite discs, and after 64 h they were harvested and quantified by culture analyses. For visualization, fluorescence in situ hybridization and confocal laser scanning microscopy was used. Compared to the control, no statistically significant difference of total CFU was observed in the absence of any of the biofilm species, except for F. nucleatum whose absence caused a significant decrease in total bacterial numbers. Absence of S. oralis resulted in a significant decrease in A. oris, and increase in S. mutans (p<0.001). Absence of A. oris, V. dispar or S. mutans did not cause any changes. The structure of the biofilm with regards to the localization of the species did not result in observable changes. In summary, the most striking observation was that absence of S. oralis resulted in limited growth of commensal A. oris and overgrowth of S. mutans. This data establishes S. oralis as commensal keeper of homeostasis in the biofilm by antagonizing S. mutans, thus preventing a caries-favoring dysbiotic state.
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Long-term variations of the riverine input of potentially toxic dissolved elements and the impacts on their distribution in Jiaozhou Bay, China
Abstract
The concentrations of the potentially toxic dissolved elements (PTEs) As, Hg, Cr, Pb, Cd, and Cu in the main rivers into Jiaozhou Bay (JZB) during 1981–2006 were measured, and the impact of the fluvial PTE fluxes on their distributions in the bay was investigated. The overall average concentration in the rivers into JZB ranged from 8.8 to 39.6 μg L−1 for As, 10.1 to 632.6 ng L−1 for Hg, 4.1 to 3003.6 μg L−1 for Cr, 8.5 to 141.9 μg L−1 for Pb, 1.1 to 34.2 μg L−1 for Cd, and 13.2 to 1042.8 μg L−1 for Cu. The interannual average concentration variations of the PTEs in these rivers were enormous, with maximum differences of 41–21,680 times, while their relative seasonal changes were far smaller with maximum differences of 3–12 times. The total annual fluvial fluxes for As, Hg, and Cr into JZB exhibited the inverse "U" pattern, while those for Pb and Cd showed the "N" pattern. As a whole, the total annual Cu flux presented a growing tendency from 1998 to 2006. In general, the changing trends of the PTE concentrations in JZB were similar to those of their annual fluxes from the rivers, indicating a great impact of their fluvial fluxes on their distributions in JZB. The annual concentration of Cd in the bay almost remained constant and differed from the fluvial flux of Cd. The diversified pattern of the environmental Kuznets curve (EKC) represented China's approach to industrialization as "improving while developing."
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Biochar amendment with fertilizers increases peanut N uptake, alleviates soil N 2 O emissions without affecting NH 3 volatilization in field experiments
Abstract
Biochar application to soil is currently widely advocated for a variety of reasons related to sustainability. However, the synergistic effects of biochar combined with mineral or organic fertilizer on soil N2O emissions, NH3 volatilization, and plant N uptake are poorly documented. Field plot experiments planted with peanut were conducted under the application of biochar (derived from rice husk and cottonseed husk, 50 t ha−1) with organic or mineral fertilizer. It was found that biochar increased soil nutrient availability and decreased surface soil bulk density, demonstrating that biochar could improve the soil quality especially in the 0–20-cm profile. The total N content of the plant changed little with treatments, but the kernel N concentration increased significantly when biochar was applied with organic fertilizer. Peanut yield increased with biochar amendment while no significant difference was observed in plant biomass, suggesting biochar had a positive effect on belowground biomass. Peanut N uptake was also increased following biochar amendment with either organic or mineral fertilizers. While biochar amendment had no significant effect on soil NH3 volatilization, it did decrease the cumulative N2O emission by 36.3% on average with organic fertilizer, and by 32.6% with mineral fertilizer, respectively (p < 0.05). The copy numbers of 16S rDNA, nifH, nirK, and nirS were not influenced by the application of biochar; however, the copy number of nosZ was significantly increased under biochar plus mineral fertilizer treatment. The results imply that biochar application can suppress N2O emissions, as a result of abiotic factors and enhanced peanut N uptake rather than changes of denitrification genes.
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Agro-industrial waste recycling by Trichosporon fermentans : conversion of waste sweetpotato vines alone into lipid
Abstract
Agro-industrial waste can be used to replace traditional carbohydrates, such as sucrose, starch, and glucose in many industrial fermentation processes. This study investigated the conversion of pre-treated waste sweetpotato vines (SV) into lipid by Trichosporon fermentans under the separate hydrolysis and fermentation (SHF) and the simultaneous saccharification and fermentation (SSF) processes. The results showed that SV autoclaving significantly increased the lipid accumulation of T. fermentans compared with acid or alkaline hydrolysis. The effects of different pre-treatments on SV were also studied by scanning electron microscopy and Fourier transform infrared spectroscopy, which showed the partial removal of the aliphatic fractions, hemicelluloses, and lignin during pre-treatment. Moreover, the lipid yield of T. fermentans in SSF was 6.98 g L−1, which was threefold higher than that (2.79 g L−1) in SHF, and the lipid contents of yeast in SSF and SHF were 36 and 25%, respectively. Overall, this study indicated that SSF using autoclaved SV could increase the growth and lipid production of T. fermentans and provided an efficient way to realize the resource utilization of waste SV.
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Investigation of the effect of rapid and slow external pH increases on Enterococcus faecalis biofilm grown on dentine
Abstract
Background
Calcium hydroxide is a common endodontic medicament and has an anti-microbial effect by increasing the localized pH within the root canal. However, Enterococcus faecalis has shown some resistance to calcium hydroxide.
Method
A flow cell apparatus was used to grow an E. faecalis biofilm on dentine discs. Following 4 weeks growth in Todd Hewitt Broth, flow cells were exposed to either a rapid or slow increase to pH 11.5 or 12.5. Cellular viability was determined using serial plating and the number of colony forming units was normalised against the cellular protein content. Scanning electron microscopy was carried out to qualitatively observe the effects of the different rates of pH increase.
Results
A significant difference in viability between the pH rapid and slow groups was not shown in this study. Compared to pH 11.5 solutions, pH 12.5 solutions were more effective at killing bacteria although some E. faecalis still survived.
Conclusion
E. faecalis did not adapt and develop a greater resistance to high pH following a slow rise in pH compared with a rapid rise in pH. As expected, pH 12.5 was more effective in reducing bacterial numbers compared to pH 11.5 although E. faecalis was not completely eliminated.
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An ultrasensitive detection of miRNA-155 in breast cancer via direct hybridization assay using two-dimensional molybdenum disulfide field-effect transistor biosensor
Publication date: 15 May 2018
Source:Biosensors and Bioelectronics, Volume 105
Author(s): Samira Mansouri Majd, Abdollah Salimi, Foad Ghasemi
MicroRNAs (miRNAs), critical biomarkers of acute and chronic diseases, play key regulatory roles in many biological processes. As a result, robust assay platforms to enable an accurate and efficient detection of low-level miRNAs in complex biological samples are of great significance. In this work, a label-free and direct hybridization assay using molybdenum disulfide (MoS2) field-effect transistor (FET) biosensor has been developed for ultrasensitive detection of miRNA-155 as a breast cancer biomarker in human serum and cell-line samples. MoS2, the novel 2D layered material with excellent physical and chemical properties, was prepared through sequential solvent exchange method and was used as an active channel material. MoS2 was comprehensively characterized by spectroscopic and microscopic methods and it was applied for fabrication of FET device by drop-casting MoS2 flacks suspension onto the FET surface. MoS2 FET device showed a relatively low subthreshold swing of 48.10mV/decade and a high mobility of 1.98 × 103cm2V−1s−1. Subsequently, probe miRNA-155 strands were immobilized on the surface of the MoS2 FET device. Under optimized conditions detection limit of 0.03fM and concentration range 0.1fM to 10nM were achieved. The developed biosensor not only was capable to identification of fully matched versus one-base mismatch miRNA-155 sequence, but also it could detect target miRNA-155 in spiked real human serum and extracts from human breast cancer cell-line samples. This approach paves a way for label-free, early detection of miRNA as a biomarker in cancer diagnostics with very high sensitivity and good specificity, thus offering a significant potential for clinical application.
Graphical abstract
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A catalytic and dual recycling amplification ATP sensor based on target-driven allosteric structure switching of aptamer beacons
Source:Biosensors and Bioelectronics, Volume 105
Author(s): Ying Peng, Daxiu Li, Ruo Yuan, Yun Xiang
Abnormal concentrations of ATP are associated with many diseases and cancers, and quantitative detection of ATP is thus of great importance for disease diagnosis and prognosis. In the present work, we report a new dual recycling amplification sensor integrated with catalytic hairpin assembly (CHA) to achieve high sensitivity for fluorescent detection of ATP. The association of the target ATP with the aptamer beacons causes the allosteric structure switching of the aptamer beacons to expose the toehold regions, which hybridize with and unfold the fluorescently quenched hairpin signal probes (HP1) to recycle the target ATP and to trigger CHA between HP1 and the secondary hairpin probes (HP2) to form HP1/HP2 duplexes. Due to the recycling amplification, the presence of ATP leads to the formation of many HP1/HP2 duplexes, generating dramatically amplified fluorescent signals for sensitive detection of ATP. Under optimal experimental conditions, our sensor linearly responds to ATP in the range from 25 to 600nM with a calculated detection limit of 8.2nM. Furthermore, the sensor shows a high selectivity and can also be used to detect ATP in human serums to realize its application for real samples. With the distinct advantage of significant signal amplification without the involvement of any nanomaterial and enzyme, the developed sensor thus holds great potential for simple and sensitive detection of different small molecules and proteins.
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Editorial Board
Source:Biosensors and Bioelectronics, Volume 102
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A quantitative CT imaging signature predicts survival and complements established prognosticators in stage I non-small cell lung cancer
Publication date: Available online 10 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Juheon Lee, Bailiang Li, Yi Cui, Xiaoli Sun, Jia Wu, Hui Zhu, Jinming Yu, Michael F. Gensheimer, Billy W. Loo, Maximilian Diehn, Ruijiang Li
BackgroundPrognostic biomarkers are needed to guide the management of early stage non-small cell lung cancer (NSCLC). This work aims to develop an image-based prognostic signature and assess its complementary value to existing biomarkers.MethodsWe retrospectively analyzed outcomes of stage I NSCLC in seven cohorts. Based on an analysis of 39 CT features characterizing tumor and its relation to neighboring pleura, we developed a prognostic signature in an institutional cohort (n=117) and tested it in an external cohort (n=88). A third cohort of 89 patients with CT and gene expression data was employed to create a surrogate genomic signature of the imaging signature. We conducted further validation using data from five gene expression cohorts (n=639), and built a composite signature by integrating with the cell-cycle progression (CCP) score and clinical variables.ResultsAn imaging signature consisting of pleural contact index and normalized inverse difference was significantly associated with overall survival in both imaging cohorts (p=0.0005 and 0.0009). Functional enrichment analysis revealed that genes highly correlated with the imaging signature were related to immune response, such as lymphocyte activation and chemotaxis (false discovery rate<0.05). A genomic surrogate of the imaging signature remained a significant predictor of survival adjusting for known prognostic factors (hazard ratio: 1.81, 95% CI: 1.34-2.44, p<0.0001), and stratified patients within subgroups as defined by stage, histology, or CCP score. A composite signature outperformed the genomic surrogate, CCP score, and clinical model alone (p<0.01) regarding concordance index (0.70 vs 0.62-0.63).ConclusionThe proposed CT imaging signature reflects fundamental biologic differences in tumors and predicts overall survival in patients with stage I NSCLC. When combined with established prognosticators, the imaging signature improves survival prediction.
Teaser
We identified a CT imaging signature that predicts overall survival in stage I NSCLC. The imaging signature is associated with immune response and may serve as a noninvasive prognostic biomarker in stage I NSCLC.http://ift.tt/2mlNE6r
Maternal thyroid hormone insufficiency during pregnancy and risk of neurodevelopmental disorders in offspring: A systematic review and meta-analysis
Abstract
Background
In the last two decades, several studies have examined the association between maternal thyroid hormone insufficiency during pregnancy and neurodevelopmental disorders in children and shown conflicting results.
Aim
This systematic review aimed to assess the evidence for an association between maternal thyroid hormone insufficiency during pregnancy and neurodevelopmental disorders in children. We also sought to assess whether levothyroxine treatment for maternal thyroid hormone insufficiency improves child neurodevelopment outcomes.
Methods
We performed systematic literature searches in MEDLINE, EMBASE, PSYCinfo, CINAHL, AMED, BNI, Cochrane, Scopus, Web of Science, GreyLit, Grey Source and Open Grey (latest search: March 2017). We also conducted targeted web searching and performed forwards and backwards citation chasing. Meta-analyses of eligible studies were carried out using the random-effects model.
Results
We identified 39 eligible articles (37 observational studies and 2 randomised controlled trials (RCT)). Meta-analysis showed that maternal subclinical hypothyroidism and hypothyroxinaemia are associated with indicators of intellectual disability in offspring (odds ratio (OR) 2.14, 95% confidence interval (CI) 1.20 to 3.83, p= 0.01, and OR 1.63, 95% CI 1.03 to 2.56, p=0.04, respectively). Maternal subclinical hypothyroidism and hypothyroxinaemia were not associated with attention deficit hyperactivity disorder, and their effect on the risk of autism in offspring was unclear. Meta-analysis of RCTs showed no evidence that levothyroxine treatment for maternal hypothyroxinaemia or subclinical hypothyroidism reduces the incidence of low intelligence quotient in offspring.
Limitations
Although studies were generally of good quality, there was evidence of heterogeneity between the included observational studies (I2 72-79%).
Conclusion
Maternal hypothyroxinaemia and subclinical hypothyroidism may be associated with intellectual disability in offspring. Currently there is no evidence that levothyroxine treatment, when initiated 8 to 20 weeks gestation (mostly between 12-17 weeks), for mild maternal thyroid hormone insufficiency during pregnancy reduces intellectual disability in offspring.
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In response to: Unsolved enigma of atrial myxoma with biventricular dysfunction
Annals of Cardiac Anaesthesia 2018 21(1):107-107
Thanks to Raut et al.[1] for appreciating our efforts in managing the case of biatrial myxomas. A brief discussion is warranted here on the types, size of cardiac myxomas, interleukin 6 (IL-6) levels, left ventricle (LV) dysfunction, and their relation. IL-6 is a pleiotropic cytokine with a variety of biologic activities, including differentiation of B cell, thymocytes, and T cells; activation of macrophages; and stimulation of hepatocyte to produce acute-phase proteins such as C-reactive protein.[2],[3] It is also said to have paracrine, endocrine, and autocrine growth functions.[3]
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Role of transesophageal echocardiography during left atrial appendage occlusion device closure in a patient with non-valvular atrial fibrillation and angiodysplasia of the colon
Annals of Cardiac Anaesthesia 2018 21(1):88-91
Atrial fibrillation is the most common arrhythmia associated with significant mortality and morbidity secondary to thrombo-embolism. To prevent this thrombo-embolism oral anticoagulation therapy is the recommended treatment. In patients with contraindications to oral anticoagulation therapy, percutaneous left atrial appendage occlusion device is indicated. TEE is essential to guide in all the stages of LAA device deployment. Right from pre-procedure screening, to guiding during deployment, to rule out any complications and post-procedure surveillance and monitoring long term outcomes.
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Perioperative renal protection during cardiac surgery: A choice between dopamine and dexmedetomidine
Annals of Cardiac Anaesthesia 2018 21(1):4-5
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Successful resolution with apixaban of a massive left atrial appendage thrombus due to nonrheumatic atrial fibrillation: A case report and review
Annals of Cardiac Anaesthesia 2018 21(1):76-77
A 32-year-old woman with a past medical history of paroxysmal atrial fibrillation, long QT syndrome, and implantation of an automatic iimplantable cardioverter-defibrillator (AICD) following cardiac arrest presented with disabling symptoms of paroxysmal atrial fibrillation due to recurrent AICD shocks. Before curative ablation, transesophageal echocardiography was performed to assess for existing thrombi. This is a rare case of successful resolution with apixaban of a massive left atrial appendage thrombus due to non-rheumatic atrial fibrillation that was successfully treated with apixaban.
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Noninvasive ventilation using bipap: Expanding indications to post cardiac surgery care
Annals of Cardiac Anaesthesia 2018 21(1):6-7
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Pneumopericardium after minimally invasive atrial septal defect closure
Annals of Cardiac Anaesthesia 2018 21(1):99-100
Minimally invasive atrial septal defect (ASD) closure is a commonly performed cardiac surgical procedure and has good outcome. We report an interesting chest X-ray showing pneumopericardium in a patient who underwent ASD closure using a minimally invasive approach.
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Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study
Annals of Cardiac Anaesthesia 2018 21(1):8-14
Context: The role of prophylaxis for postoperative nausea and vomiting (PONV) in cardiac surgery is under debate. Aims: To study the risk factors for PONV after cardiac surgery and the role of betamethasone with or without droperidol for its prevention. Setting and Design: Randomized open-label controlled study comparing standard care with PONV prophylaxis from February to November 2016. Methods: Five hundred and two patients with planned nonemergent cardiac surgery were included. Interventions: In the intervention arm, PONV prophylaxis (4 mg betamethasone with/without 0.625 mg droperidol) was administered in high-risk patients (two or more risk factors). Patients in the control arm were treated as per routine hospital practices. Results: Female sex, past history of PONV, and migraines were associated with a significantly increased risk of PONV, while motion sickness, smoking status, and volatile anesthetics were not. Pain and treatment with nefopam or ketoprofen were associated with an increased risk of PONV. PONV was less frequent in the active arm compared to controls (45.5% vs. 54.0%, P = 0.063; visual analogic scale 10.9 vs. 15.3 mm, P = 0.043). Among the 180 patients (35.6%) with ≥2 risk factors, prophylaxis was associated with reduced PONV (intention-to-treat: 46.8% vs. 67.8%, P = 0.0061; per-protocol: 39.2% vs. 69%, P = 0.0002). In multivariate analysis, prophylaxis was independently associated with PONV (odds ratio [OR]: 0.324, 95% confidence interval: 0.167–0.629, P = 0.0009), as were female sex, past history of PONV, and migraines (OR: 3.027, 3.031, and 2.160 respectively). No drug-related side effects were reported. Conclusion: Betamethasone with/without droperidol was effective in decreasing PONV in high risk cardiac surgical patients without any side effect.
http://ift.tt/2DoIVsI
Concomitant neurogenic and vascular thoracic outlet syndrome due to multiple exostoses
Annals of Cardiac Anaesthesia 2018 21(1):71-73
We report a rare case of multiple hereditary exostosis where patient presented with bilateral base of neck exostoses with concurrent compression of brachial plexus and subclavian artery and vein. The patient was a young 26-year-old woman with chief complaints of pain in the left upper extremity, paresthesia in the left ring and little finger, and weakness in hand movement and grip. On referral, history, physical examination, radiological imaging, and electrodiagnostic tests evaluated the patient. Due to severe pain and disability in performing routine activities, surgical intervention was necessary. In the current case, the patient had thoracic outlet syndrome with concomitant venous, arterial, and neurogenic sub types. Radial pulse returned and pain associated with brachial plexus compression was resolved after the surgery.
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Retrospective study of complete atrioventricular canal defects: Anesthetic and perioperative challenges
Annals of Cardiac Anaesthesia 2018 21(1):15-21
Objective: The objective of this study was to highlight anesthetic and perioperative management and the outcomes of infants with complete atrioventricular (AV) canal defects. Design: This retrospective descriptive study included children who underwent staged and primary biventricular repair for complete AV canal defects from 1999 to 2013. Setting: A single-center study at a university affiliated heart center. Participants: One hundred and fifty-seven patients with a mean age at surgery of 125 ± 56.9 days were included in the study. About 63.6% of them were diagnosed as Down syndrome. Mean body weight at surgery was 5.6 ± 6.3 kg. Methods: Primary and staged biventricular repair of complete AV canal defects. Measurements and main results: A predefined protocol including timing of surgery, management of induction and maintenance of anesthesia, cardiopulmonary bypass, and perioperative intensive care treatment was used throughout the study. Demographic data as well as intraoperative and perioperative Intensive Care Unit (ICU) data, such as length of stay in ICU, total duration of ventilation including reintubations, and total length of stay in hospital and in hospital mortality, were collected from the clinical information system. Pulmonary hypertension was noted in 60% of patients from which 30% needed nitric oxide therapy. Nearly 2.5% of patients needed permanent pacemaker implantation. Thorax was closed secondarily in 7% of patients. In 3.8% of patients, reoperations due to residual defects were undertaken. Duration of hospital stay was 14.5 ± 4.7 days. The in-hospital mortality was 0%. Conclusion: Protocolized perioperative management leads to excellent outcome in AV canal defect repair surgery.
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Mechanical discordance between left atrium and left atrial appendage
Annals of Cardiac Anaesthesia 2018 21(1):82-84
During standard transesophageal echocardiographic examinations in sinus rhythm (SR) patients, the left atrial appendage (LAA) is not routinely assessed with Doppler. Despite having a SR, it is still possible to have irregular activity in the LAA. This situation is even more important for SR patients where assessment of the left atrium is often foregone. We describe a case where we encountered this situation and briefly review how to assess the left atrium and its appendage in such a case scenario.
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Dexmedetomidine for prevention of skeletal muscle ischaemia-reperfusion injury in patients with chronic limb ischaemia undergoing aortobifemoral bypass surgery: A prospective double-blind randomized controlled study
Annals of Cardiac Anaesthesia 2018 21(1):22-25
Background: Dexmedetomidine is a selective α-2 agonist used for sedation. It has also been shown to have myocardial protective effect and prevent ischemia-reperfusion injury in off-pump coronary artery bypass patients. The aim of our study was to assess the effect of dexmedetomidine for prevention of skeletal muscle ischemia-reperfusion injury in patients undergoing aortobifemoral bypass surgery. Methodology: Sixty adult patients (Group dexmedetomidine n = 30, Group normal saline n = 30) undergoing aortobifemoral bypass surgery were recruited over 3 months. Randomization was done using a computer-generated random table. The attending anesthesiologist would be blinded to whether the drug/normal saline was being administered. He would consider each unlabeled syringe as containing dexmedetomidine and calculate the volume to be infused via a syringe pump accordingly. Dexmedetomidine infusion (1 mcg/kg) over 15 minutes was given as a loading dose, followed by maintenance infusion of 0.5 mcg/kg/h till 2 h postprocedure in Group dexmedetomidine (D) while the same volume of normal saline was given in the control Group C till 2 h postprocedure. Creatine phosphokinase (CPK) values were noted at baseline (T0), 6 h (T1), 12 h (T2), and 24 h (T3) after the procedure. Hemodynamic variables (heart rate [HR] and mean blood pressure [MAP]) were recorded at T0, T1, T2, and T3. Results were analyzed using unpaired Student's t-test, P < 0.05 was considered statistically significant. Results: MAP and HR significantly decreased in Group D as compared to control group (P < 0.05). However, the decrease was never <20% of the baseline. The CPK values at 6, 12, and 24 h were statistically significant between the two groups. Conclusion: Dexmedetomidine prevents skeletal muscle ischemia-reperfusion injury in patients undergoing aortobifemoral bypass surgery.
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Quadricuspid aortic valve: A rare intraoperative diagnosis by transesophageal echocardiography
Annals of Cardiac Anaesthesia 2018 21(1):95-96
Quadricuspid aortic valve (QAV) is a rare congenital anomaly frequently associated with other anomalies particularly coronary anomalies. It may be detected on transthoracic or transesophageal echocardiography. We present here a case report of a 27-year-old male patient with a QAV, the valve being regurgitant and requiring aortic valve replacement. It has been reported as isolated case reports in the literature and various theories exist to the development of QAV. The diagnosis requires a high degree of suspicion and a detailed assessment, and if asymptomatic, then patients need to be carefully followed up for the development of aortic regurgitation.
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Assessment the effect of dexmedetomidine on incidence of paradoxical hypertension after surgical repair of aortic coarctation in pediatric patients
Annals of Cardiac Anaesthesia 2018 21(1):26-33
Objective: The aim of the study was to assess the effect of dexmedetomidine on the incidence of paradoxical hypertension in patients undergoing aortic coarctation repair. Design: Randomized observational study. Setting: University hospital and cardiac center. Patients: The study included 108 pediatric patients with isolated aortic coarctation. Methods: The patients were classified into two groups (each = 54): Group D: the patients received dexmedetomidine as a loading dose of 0.5 μg/kg over 10 min followed by infusion 0.3 μg/kg/h during surgery and continued for the first 48 postoperative hours. Group C: The patients received an equal amount of normal saline. The medication was prepared by the nursing staff and given to anesthetist blindly. The collected data included the heart rate, systolic and diastolic arterial blood pressure, incidence, onset, severity and treatment of paradoxical hypertension, fentanyl dose and end-tidal sevoflurane concentration, amount of blood loss and urine output. Main Results: The heart rate, systolic and diastolic blood pressure decreased significantly with dexmedetomidine than Group C (P < 0.05). The incidence and severity of the paradoxical hypertension was lower with dexmedetomidine than Group C (P = 0.011, P = 0.017, respectively). The onset the paradoxical hypertension was earlier in Group C than dexmedetomidine (P = 0.026). The dose of fentanyl and sevoflurane concentration decreased significantly with dexmedetomidine (P = 0.034, P = 0.026, respectively). The blood loss decreased with dexmedetomidine (P = 0.020) and the urine output increased with dexmedetomidine (P = 0.024). The incidence of hypotension and bradycardia was more with dexmedetomidine (P < 0.05). Conclusion: Dexmedetomidine is safe in pediatric patients undergoing aortic coarctation repair. It minimized the incidence and severity of paradoxical hypertension. It decreased the required antihypertensive medications.
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Spontaneous coronary artery dissection in anabolic steroid misuse
Annals of Cardiac Anaesthesia 2018 21(1):103-104
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A randomized controlled trial comparing the myocardial protective effects of isoflurane with propofol in patients undergoing elective coronary artery bypass surgery on cardiopulmonary bypass, assessed by changes in N-terminal brain natriuretic peptide
Annals of Cardiac Anaesthesia 2018 21(1):34-40
Objective: The objective of the study is to compare the myocardial protective effects of isoflurane with propofol in patients undergoing elective coronary artery bypass surgery on cardiopulmonary bypass (CPB), the cardio protection been assessed by changes in N-terminal brain natriuretic peptide (NT proBNP). Methodology and Design: This study is designed as a participant blinded, prospective randomized clinical trial. Setting: Christian Medical College Hospital, Vellore, India. Participants: Patients undergoing elective coronary artery bypass surgery on CPB. Intervention: Anesthesia was maintained with 0.8–1.2 end tidal concentrations of isoflurane in the isoflurane group and in the propofol group, anesthesia was maintained with propofol infusion as described by Roberts et al. Measurements: Hemodynamic data were recorded at frequent intervals during the surgery and up to 24 h in the Intensive Care Unit (ICU). The other variables that were measured include duration of mechanical ventilation, dose and duration of inotropes in ICU, (inotrope score), duration of ICU stay, NT proBNP levels before induction and 24 h postoperatively, creatine kinase-MB levels in the immediate postoperative, first and second day. Results: Mean heart rate was significantly higher in propofol group during sternotomy, (P = 0.021). Propofol group had a significantly more number of patients requiring nitroglycerine in the prebypass period (P = 0.01). The increase in NT proBNP from preoperative to postoperative value was lesser in the isoflurane group compared to propofol even though the difference was not statistically significant. The requirement of phenylephrine to maintain mean arterial pressure within 20% of baseline, mechanical ventilation duration, inotrope use, duration of ICU stay and hospital stay were found to be similar in both groups. Conclusion: Propofol exhibit comparable myocardial protective effect like that of isoflurane in patients undergoing coronary artery bypass graft surgery. Considering the unproven mortality benefit of isoflurane and the improved awareness of green OT concept, propofol may be the ideal alternative to volatile anesthetics, at least in patients with good left ventricular function.
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Atrioventricular septal defects
Annals of Cardiac Anaesthesia 2018 21(1):1-3
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Long-term quality of life postacute kidney injury in cardiac surgery patients
Annals of Cardiac Anaesthesia 2018 21(1):41-45
Background: Acute renal failure after cardiac surgery is known to be associated with significant short-term morbidity and mortality. There have as yet been no major reports on long-term quality of life (QOL). This study assessed the impact of acute kidney injury (AKI) and renal replacement therapy (RRT) on long-term survival and QOL after cardiac surgery. The need for long-term RRT is also assessed. Materials and Methods: Patients who underwent cardiac surgery between 2005 and 2011 (n = 6087) and developed AKI (RIFLE criteria, n = 570) were included. They were propensity-matched 1:1 to patients without renal impairment (control). Data were prospectively collected, and health-related QOL questionnaire was sent to patients who were alive at least 1-year postoperatively at the time of the study. Results: There was no significant difference in the preoperative characteristics between the two groups (age, gender, left ventricular ejection fraction, procedure, urgency, logistic Euroscore), respectively. Median follow-up was 52 months. Survival data were available in all patients. Questionnaires were returned in 64% of eligible patients. Long-term survival was significantly lower, and QOL, in particular the physical aspect, was significantly worse for the AKI group as compared to non-AKI group (38.8 vs. 44.2, P = 0.002), especially so in patients who required RRT. In alive respondents, despite an 18% (66/359) incidence of ongoing renal follow-up, the need for late RRT was only in 1.1% (4/359). Conclusion: AKI and especially the need for RRT following cardiac surgery are associated with increased long-term mortality as well as worse quality of life in a propensity-matched control group.
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Commentary: Comments on thoracic outlet syndrome
Annals of Cardiac Anaesthesia 2018 21(1):74-75
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Design and standardization of tools for assessing the perceived heart risk and heart health literacy in Iran
Annals of Cardiac Anaesthesia 2018 21(1):46-52
Objectives: The aim is to achieve the standard tools for heart health, the present study aimed to design, develop, and standardize the two questionnaires of perceived heart risk scale (PHRS) and heart health literacy scale (HHLS). Methods: The present study was a methodological research conducted on the residents of Kermanshah Province, Iran, using the multi-stage cluster sampling. Further, considering the scientific methods in the psychometric field, the design of the research questionnaires was conducted. In addition, the viewpoints of experts in different domains were qualitatively and quantitatively included to assess the validity of the questionnaires. To assess the reliability of the questionnaires, a sample including 31 subjects was first selected and studied within a fortnight's interval. Then, the reliability and validity of the scales were assessed using factor analysis and Cronbach's alpha in a sample of 771 subjects. Results: After reviewing the viewpoints of experts, the items were adjusted and implemented in the first sample at two stages. The results were indicative of the stability and acceptability of the Cronbach's alpha. In addition, the validity and reliability of the questionnaires were confirmed in the second sample too. Conclusion: According to the results of the present study, it can be concluded that the two questionnaires of PHRS and HHLS had acceptable reliability and validity.
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Bleeding in the lung complicates a routine intracardiac repair: What went wrong!!!
Annals of Cardiac Anaesthesia 2018 21(1):78-81
Cyanotic congenital heart disease presents an increased tendency to bleed in view of subtle coagulation defects. Airway bleeding can be particularly difficult to manage while maintaining an adequate ventilation. An isolated lung bleed with the exclusion of possible traumatic, medical and surgical causes of bleeding, should alert the attending anesthesiologist to the possibility of the collateral-related bleeding. Preoperative coil embolization remains an important initial management step in a case of tetralogy of Fallot (TOF) with major aortopulmonary collaterals. Nevertheless, the coiling of the collaterals in certain specific case scenarios is not feasible, rendering the management of a lung bleed, all the more challenging. We, hereby discuss a case of a 7-year-old girl with a massive endotracheal bleed at the time of weaning from cardiopulmonary bypass after corrective surgery for TOF. The subsequent approach and management are discussed. The optimal management of tetralogy with collaterals mandates an effective communication among the cardiologist, radiologist, anesthesiologist, and the surgeon.
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The effect of acceptance and commitment therapy on the mental health of women patients with type II diabetes
Annals of Tropical Medicine and Public Health 2017 10(6):1709-1713
Background: Diagnosis of diabetes will have a significant impact on patients' psychosocial functioning and patients should devote sufficient time and energy to self-manage the disease. This study aimed to evaluate the effectiveness of treatment based on acceptance and commitment model on the mental health of women with diabetes type II. Methods: The present study is an experimental study with pretest-posttest control group design. The sample consisted of 26 women with diabetes from Kermanshah who were recruited using convenience (availability) sampling and were randomly divided into experimental and control groups. All patients completed the 28-item general health questionnaire before and after the intervention. Data were analyzed using univariate analysis of covariance and applying SPSS version 23. Results: The results clearly showed that the posttest scores of mental health in the experimental group were significant compared to the control group (P
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Advocating for the implementation of recommended measures to improve infant and young child feeding
Annals of Tropical Medicine and Public Health 2017 10(6):1835-1836
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World Health Organization calls for the adoption of updated guidelines for the management of chlamydial, gonococcal, and syphilitic infections
Annals of Tropical Medicine and Public Health 2017 10(6):1403-1404
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Prevalence and pattern of parasitic infestations among nomadic Fulani children in a grazing reserve in Northwestern Nigeria
Annals of Tropical Medicine and Public Health 2017 10(6):1799-1804
Background: Nomadic pastoralists lack access to basic sanitary and health-care facilities mainly because their mode of life makes them a hard to reach group. In the Nigerian context, there is dearth of knowledge about the interplay between their lifestyle and health indices.Therefore, this study is aimed at determining the association between the prevalence of parasitic infestation among nomadic Fulani children in Ladduga grazing reserve, Kaduna, Northwestern Nigeria. Aim: The aim of this study was to assess the prevalence and pattern of parasitic infestation among nomadic Fulani children in Ladduga grazing reserve, Kaduna, Northwestern Nigeria. Materials and Methods: A cross-sectional descriptive study was conducted using questionnaires, physical examination, automated hemocytometry, enzyme-linked immunosorbent assay-based serum ferritin assay, and formol-ether concentration-based stool tests on 337 children (5–15 years) at Ladduga grazing reserve, Northwestern Nigeria. Data were analyzed using SPSS version 20.0. Results: The prevalence of parasitic infestation was 14.4% (49/337). The predominant parasites found were hookworm species, i.e., Necator americanus and Ancylostoma duodenale (46.9%) and Schistosoma mansoni (26.6%) while Ascaris lumbricoides, Hymenolepis nana, and Enterobius vermicularis accounted for 26.6%. Anemia was found in 40.4% (137/340) of the children with a statistically significant difference between younger (5–9 years) and older children (10–15 years; P
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Saving lives of mothers and newborns from infections around the time of childbirth by strengthening health sector response to the public health concern of antibiotic resistance
Annals of Tropical Medicine and Public Health 2017 10(6):1405-1406
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Identifying and investigating exercise activity on the factors of physical fitness and well-being of the staff at the Isfahan University of Technology
Annals of Tropical Medicine and Public Health 2017 10(6):1661-1667
Objective: The results of the conducted studies investigating the prevalence of machinery life and increase of cardiovascular diseases imply that motor poverty and especially low aerobic power and increase in blood fat are among primary risk factors in cardiovascular diseases. To prevent these discomforts, doing regular physical and exercise activities are recommended; hence, people's participation in physical activities and their awareness of physical status and well-being factors, especially blood fat and cardiovascular profile are of utmost importance. The general purpose of this study, besides awareness of the participants' physical well-being, is to investigate the effect of exercise activities on physical fitness and blood fat profile in the staff of Isfahan University of Technology. Methods: A semi-experimental method with clinical experiments was used in this research, and the effect of 8 weeks of 45–50-min sessions of exercise, twice a week, and on the staff's physical performance was investigated. An experimental and a control group were randomly selected from volunteer male staff. The research variables were measured from the participants, and the results were addressed through SPSS software and statistical formulas and considering research hypotheses regarding the degree of variable changes. Results: The results of this study showed that comparing the degree of changes of the variables of body weight, body mass index, 1600-meter race, sit-ups 94-meter race, Swedish swimming, and blood cholesterol was significantly changed at P < 0.05 level after training period compared to before-training, and there was no significant change at P < 0.05 level in other research variables. Moreover, it was observed that the degree of changes of the variables of 1600-meter race, sit-up, stretch board, Swedish swimming, low-density lipoprotein (LDL), high-density lipoprotein, and the experimental group was significantly different at P < 0.05 level compared to the control group, and there was no significant difference at P < 0.05 level. Conclusion: It was observed from the results of this study that aerobic exercise trainings cause the increase of power, cardiovascular endurance, muscular endurance, and suitable changes in blood fat and the degree of the staff's flexibility. Therefore, attending program to increase the staff's physical activity level and physical fitness seems necessary. Furthermore, to control body fat, it is advised that men regularly measure their blood cholesterol after the age of 35, and LDL should be lower than 130 mg/dl but better to be lower than 100 mg/dl in the patients suffering from cardiovascular disease.
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World Health Organization raises concern over the urgent need to respond to the multiple outbreaks of infectious diseases reported in South Sudan amidst the ongoing conflict
Annals of Tropical Medicine and Public Health 2017 10(6):1407-1408
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An investigation of the impact of Kelussia odoratissima extract on mice with secondary hyperlipidemia
Annals of Tropical Medicine and Public Health 2017 10(6):1752-1755
Introduction: For many years, human beings have applied plants as medicine and their healing impact has been proved for many years. Kelussia odoratissima is a biennial, edible, and fragrant plant with medicinal and food applications. This plant is dedicated to some pastures of Iran and this plant is not reported in other regions around the world. Flavonoids are the most important ingredient of this plant. Materials and Methods: In this study, to evaluate the effect of feeding mice with secondary hyperlipidemia with K. odoratissima, we used thirty mice with secondary hyperlipidemia of similar weight and divided them into three equal groups. For 3 weeks, the first and second groups were fed with the extract of K. odoratissima with doses of 600 mg/kg weight of mice and 1200 mg/kg weight of mice, respectively, and triglyceride, low-density lipoprotein (LDL), total cholesterol, and weight of mice were evaluated. Results: The results showed that, at the end of the 1st week, there was no significant change in any of the groups, but at the end of the 2nd week, in the first group, there was a reduction of LDL; in the second group total cholesterol and triglyceride without any weight change were reduced and LDL factors, total cholesterol, and triglyceride had low weight change; and in the third group, there was an increase of LDL factors, total cholesterol, and triglyceride and an increase of weight. At the end of the 3rd week, in the first group, there was a reduction of LDL factors, total cholesterol, and triglyceride and a little weight reduction; in the second group there was a reduction of LDL factors, total cholesterol, and triglyceride and a considerable reduction of the weight; and in the third group, LDL factors and total cholesterol, triglycerides, and weight of mice were increased. Conclusion and Discussion: Hydroalcoholic extract of the plant reduced total cholesterol, triglyceride, LDL, and weight of mice using K. odoratissima. Except two groups that were administered K. odoratissima, the weight of the other animals was increased. The increase in the activity of lipoprotein lipase as the mediator of hydrolysis of triglyceride in chylomicron causes free fatty acids to generate energy or be stored as fat.
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