The best position of the fibreoptic view through the SAD, that is Grade 4 also has the epiglottis visible through the SAD aperture. ...in Grade 1 (worst view), despite the epiglottis completely ...covering the glottis, the SAD has adequate function. In our study, we also assessed the ventilation score with SAD and majority of children in our study had the ventilation score 3. ...we feel that although the suggestion by Van Zundert seems very valid, we can apply it in children only after defining the optimal position of the SAD and the optimal view of the glottis aperture through the SAD in the paediatric population.
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Background and Aims: Fasting guidelines have been recommended in the paediatric population to minimise the risk of pulmonary aspiration. The present study was planned to assess the compliance with ...fasting instructions in children undergoing ambulatory surgery and identify the factors affecting it. Methods: A total of 1,050 ASA I and II children aged 1-12 years, scheduled for day care surgery were enrolled. Parents of these children were given a questionnaire with specific questions like fasting instructions, source of instructions, actual fasting times and reasons for not following instructions. Results: Only 90 (8.5%) parents followed fasting instructions as advised. Of the 960 non-compliant patients, 31 (2.9) inadequately fasted while 929 (88.4%) fasted more than advised. While only 5.2% mentioned aspiration, 25% cited vomiting as the reason for fasting. Younger parents (OR = 0.853, 95% CI-0.796 to 0.915), fasting instructions in writing (OR = 10.808, 95% CI-1.459 to 80.059) and separate instruction for solids and liquids (OR = 6.016, 95% CI- 3.663 to 9.883) were found to affect compliance with fasting instructions. Conclusion: To avoid risks of prolonged or inadequate fasting in day care surgical patients, good coordination between the anaesthetist and the surgeon and an updated knowledge about the preoperative fasting instructions among the health-care providers is essential. Separate written fasting instructions for liquids and solids should be given to the parents according to their order in the operating list to ensure better compliance with fasting instructions.
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N-nitroso compounds (NOC) are produced by the acid catalyzed reaction of nitrite with certain nitrogen compounds. The gastrointestinal tract (GI) is the main site for the formation of reactive ...nitrogen species (RNS). Bacteria present on the GI tract surface reduced the dietary nitrate or nitrite into Nitric oxide NO and other related compounds. The clinical sign of NOC carcinogenicity varies according to species, dose, and route of administration. Humans are exposed to preformed N-nitroso compounds and endogenous NOC via the environmental food chain. Several NOC are potential human carcinogens, including DENA and NDMA, but evidence from population studies is inconsistent.
Aim: A study was conducted to explore the characteristics of the videos on pediatric inguinal hernia repair on YouTube and compare the most popular videos (MPV) with the least popular ones in terms ...of educative value vis-a-vis their popularity.
Materials and Methods: The term "Pediatric inguinal hernia repair" was searched for on YouTube on August 15, 2021, with the filter set to "view rate." Pertinent data were collected from the 50 MPV and the 50 least popular videos (LPV) and then compared. The h-index and affiliation of the surgeon were obtained from the Scopus database, and their affiliation was further categorized as academic or nonacademic.
Results: One hundred and seventy-five videos were found with median views of MPV: LPV being 9270 (interquartile range IQR - 12099):127 (IQR - 194), respectively (P < 0.0001). Most of the videos in the MPV and LPV groups were uploaded from the United States of America (USA) (MPV - 17 and LPV - 13) and India (MPV - 15 and LPV - 15). The MPV were on YouTube for a median duration of 3.1 (IQR - 5.5) years as compared to 1.2 (IQR - 2.3) years for the LPV (P < 0.0001). Ninety-two surgeons were identified. The median h-index of the surgeons of MPV was 3 (IQR - 12) in comparison to 1 (IQR - 10) of LPV (P = 0.13). The ratio of academic versus nonacademic affiliation among MPV and LPV was almost equal in both the groups.
Conclusions: On either end of the spectrum of popularity, the majority of the pediatric inguinal hernia videos on YouTube were surgical videos uploaded from the USA and India. The educative value of these videos was found to be low and widely dispersed. Surgeons from both academic and nonacademic affiliations had contributed similarly.
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Background Postcholecystectomy bile duct injury (BDI) is a management challenge with significant morbidity, mortality, and effects on long-term quality of life. Early referral to a specialized ...hepatobiliary center and appropriate early management are crucial to improving outcomes and overall quality of life. In this retrospective analysis, we examined patients who were managed at our center over the past 10 years and proposed a triage and management algorithm for BDI in acute settings. Methods Patients referred to our center with BDI from January 2011 to December 2020 were reviewed retrospectively. The primary objective of initial management is to control sepsis and minimize BDI-related morbidity and mortality. All the patients were resuscitated with intravenous fluid, antibiotics (preferably culture-based), correction of electrolyte deficiencies, and organ support if required. A triage module and management algorithm were framed based on our experience. All the patients were triaged based on the presence or absence of bile leaks. Each group was further subdivided into red, yellow, and green zones (depending on the presence of sepsis, organ failure, and associated injuries), and the results were analyzed as per the proposed algorithm. Results One hundred twenty-eight patients with acute BDI were referred to us during the study period, and 116 patients had BDI with a bile leak and 12 patients were without a bile leak. Out of bile leak patients, 106 patients (91.38%) had sepsis with or without organ failure (red and yellow zone) and required invasive intervention in the form of PCD insertion (n=99, 85.34%) and/or laparotomy, lavage, and drainage (n=7, 6.03%). Another 10 patients (8.62%) had controlled external biliary fistula (green zone), of which four were managed with antibiotics, four underwent endoscopic retrograde cholangiopancreatography stenting, and only two (1.7%) patients could undergo Roux-en-Y hepaticojejunostomy upfront due to late referral. Among patients with BDI without bile leaks, nine (75%) had cholangitis (red and yellow zones). Out of these, five required PTBD along with antibiotics and four were managed with antibiotics alone. Only three (25%) patients in this group could undergo definitive repair without any restriction on the timing of referral and were sepsis-free at presentation (green zone). A total of nine patients had a vascular injury, and four of them required digital subtraction angiography and coil embolization. There were three (2.34%) mortalities; all were in the red zone of rest and had successful initial management. In total, five patients were managed with early repair in the acute setting, and the rest underwent definitive intervention at subsequent admissions after being converted to green zone patients with initial management. Conclusion The presented categorization, triaging, and management algorithm provides optimum insight to understand the severity, simplify these complex scenarios, expedite the decision-making process, and thus enhance patient outcomes in early acute settings following BDI.
Background and Aims: Head and neck movements alter the shape of the pharynx, resulting in changes in the oropharyngeal leaking pressures and ventilation with supragottic airway devices. We compared ...the effect of the different head-and-neck positions on the oropharyngeal leak pressures and ventilation with the I-Gel™ and ProSeal™ laryngeal mask airway (PLMA) in anaesthetised paralysed children. Methods: A total of 70 children were randomly assigned to receive PLMA (n = 35) or I-Gel™ (n = 35) for airway management. Oropharyngeal leak pressure in maximum flexion, maximum extension and the neutral position was taken as the primary outcome. Peak inspiratory pressures (PIPs), expired tidal volume, ventilation score and fibreoptic grading were also assessed. Results: No significant difference was noted in oropharyngeal leak pressures of PLMA and I-Gel™ during neutral (P = 0.34), flexion (P = 0.46) or extension (P = 0.18). PIPs mean (standard deviation SD) were significantly higher (17.7 4.03 vs. 14.6 2.4 cm H2O, P = 0.002) and expired tidal volume mean SD was significantly lower (5.5 1.6 vs. 6.9 2 ml/kg, P = 0.0017) with I-Gel™ compared to PLMA. Fibreoptic grading and ventilation score were comparable in both the groups in all the three head-and-neck positions. Conclusion: PLMA and I-Gel™, both recorded similar oropharyngeal leaking pressures in all the three head-and-neck positions. However, higher peak pressures and lower expired tidal volume in maximum flexion of the neck while ventilating with I-Gel may warrant caution and future evaluation.
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Background and objectiveSeveral studies have indicated an escalation in the stress and anxiety levels among all sections of the population at large during the ongoing coronavirus disease 2019 ...(COVID-19) pandemic. In this challenging environment, meditation or yoga can help in maintaining the quality of life. This pilot study aimed to assess the willingness to practice meditation as a tool to manage anxiety, perceived stress levels, and psychological well-being (quality of life) during the COVID-19 pandemic in India.Materials and methodsBivariate and multivariate logistic regression models were employed to characterize the attitude of healthy Indian adults toward meditation as a stress management tool and its impact on psychological well-being. Primary data of 241 participants were collected using Google Forms circulated via email and social media platforms through the snowball sampling technique. The self-reported data on four different psychosocial scales, viz., for anxiety measurement the Seven-Item Generalized Anxiety Disorder Scale (GAD-7) and Coronavirus Anxiety Scale (CAS), for stress measurement Perceived Stress Scale (PSS), and to quantify well-being levels the Five-Item World Health Organization Well-Being Index (WHO-5), along with those on their perception toward meditation were obtained.ResultsOur findings suggest that the anxiety and perceived stress scores are lower among those practicing some form of relaxation or meditation than those not practicing it, along with those who already report better psychological well-being and perceived stress. The bivariate results indicated that willingness to meditate among those who were practicing some form of meditation and those not mediating significantly differed based on their age, presence of comorbidities, and GAD and PSS levels. The multivariate logistic regression showed that only those individuals aged 35 years and above and those who have some comorbidity symptoms showed a significant level of willingness to opt for meditation.ConclusionsIn order to attain proper relief from psychological issues during a pandemic situation such as the current one, a more specific remedial module for meditation procedure needs to be devised as an intervention, and it should be kept in mind that age and comorbidity status also play a significant role with respect to individuals' attitude toward meditation as a tool for psychological relief.
Background:
Repeated head impacts sustained by athletes have been linked to short-term neurophysiologic deficits; thus, there is growing concern about the number of head impacts sustained in sports. ...Accurate head impact exposure data obtained via head impact sensors may help identify appropriate strategies across sports and between genders to mitigate repetitive head impacts.
Purpose:
To quantify sport- and gender-based differences in head impact rate and mechanism for adolescents.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
High school female and male varsity soccer, basketball, lacrosse, and field hockey (female only) teams were instrumented with headband-mounted impact sensors during games over 2 seasons of soccer and 1 season of basketball, lacrosse, and field hockey. Video review was used to remove false-positive sensor-recorded events, and the head impact rate per athlete-exposure (AE) was calculated. Impact mechanism was categorized as equipment to head, fall, player to head, or head to ball (soccer only).
Results:
Male players had significantly higher head impact rates as compared with female players in soccer (3.08 vs 1.41 impacts/AE; rate ratio, 2.2 95% CI, 1.8-2.6), basketball (0.90 vs 0.25; 3.6 2.6-4.6), and lacrosse (0.83 vs 0.06; 12.9 10.1-15.8). Impact mechanism distributions were similar within sports between boys and girls. In soccer, head to ball represented 78% of impacts, whereas at least 88% in basketball were player-to-player contact.
Conclusion:
Across sports for boys and girls, soccer had the highest impact rate. Male high school soccer, basketball, and lacrosse teams had significantly higher head impact rates than did female teams of the same sport. For girls, basketball had a higher head impact rate than did lacrosse and field hockey, and for boys, basketball had a similar impact rate to lacrosse, a collision sport. Sport differences in the distribution of impact mechanisms create sport-specific targets for reducing head impact exposure.
Depressive disorder is a recurrent illness that affects large numbers of the general population worldwide. In recent years, the goal of depression treatment has moved from symptomatic response to ...that of full remission. However, treatment-resistant depression is a major challenge in the treatment of depression or depression-related disorders. Consensus opinion, therefore, suggests that effective combined aggressive initial treatment is the most appropriate strategy. This study aimed to evaluate the effects of quercetin (QUR) and/or ascorbic acid (AA) on Phenobarbital-induced sleeping mice. QUR (50 mg/kg) and/or AA (25 mg/kg) with or without intraperitoneally pre-treated with GABA receptor agonist (diazepam: 2 mg/kg, i.p.) or antagonist (Flumazenil: 2.5 mg/kg, i.p.) to underscore the effects, as well as the possible involvement of the GABA receptor in the modulatory action of QUR and AA in sleeping mice. Additionally, an in silico study was undertaken to predict the involvement of GABA receptors in the sleep mechanism. Findings suggest that the pretreatment of QUR and AA modulated the onset and duration of action of the standard drugs in experimental animals. The acute administration of QUR and/or AA significantly (p < 0.05) reversed the DZP-mediated onset of action and slightly reversed the duration of sleep time in comparison to the vehicle (control) group. A further combination of QUR or AA with the FLU resulted in an enhancement of the onset of action while reducing the duration of action, suggesting a FLU-like effect on the test animals. In in silico studies, AA and QUR showed good to moderate binding affinities with GABAA and GABAB receptors. Both QUR and AA produced a stimulatory-like effect on mice, possibly through the GABAA and GABAB receptor interaction pathways. Further studies are necessary to verify this activity and clarify the exact mechanism of action(s) involved.
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