Congenital Absence of Pericardium: A Case Report and Technical Considerations in Cardiac Surgery

This case report describes a rare instance of left-sided congenital pericardial agenesis (CPA) encountered during coronary artery bypass grafting (CABG) in a 77-year-old male. In this unique case, the presence of an unusual strip of left pericardium containing the phrenic nerve posed significant surgical challenges. Special attention was required for the graft lay, ensuring adequate filling of the heart during assessment before closure, as well as emphasis on the need for generous graft length. Additionally, the evaluation of graft positioning prior to cardiopulmonary bypass was crucial. Despite these complexities, CABG was successfully performed with no complications to note. This case underscores the importance of adaptability in surgical technique to manage the unique challenges posed by CPA, leading to a positive outcome despite the atypical cardiac anatomy.

Examining the Efficacy of Drain Tip Cultures in Predicting Postoperative Surgical Site Infections in Hip Arthroplasty: A 15-Year Retrospective Study

Background Postoperative surgical site infections (SSIs) are a significant complication of surgical procedures, leading to increased morbidity, prolonged hospital stays, and substantial healthcare costs; however, the use of drain tip cultures to diagnose SSIs in patients is controversial. The objective of this study was to evaluate the efficacy of drain tip cultures for the prediction of postoperative SSIs in patients recovering from hip arthroplasty. Methodology The data were collected from 1204 patients who underwent hip arthroplasty procedures over 15 years, and statistical analysis was performed to evaluate the diagnostic value of drain tip culture in determining surgical site infection. We also used these data to evaluate whether preexisting conditions such as hypertension or diabetes affected the probability of a patient getting an SSI. Results Drain tip cultures were positive in 12 of 1,112 cases of primary hip arthroplasty, but only one of these 12 patients was ultimately diagnosed with an SSI (sensitivity, 12.5%; specificity, 99.0%; p = 0.0834). Results from postoperative drain tip cultures performed in patients undergoing revision arthroplasty included two false positives and three false negatives; interestingly, no true positives were detected in any of the revision arthroplasty cases we evaluated (sensitivity, 0％; specificity, 97.8％; p = 0.9355). Conclusion Our results indicate that drain tip cultures have no statistically significant predictive value for the diagnosis of postoperative SSIs and thus should not be used as a primary diagnostic or predictive tool for SSIs. We recommend exploring other diagnostic tools for the postoperative diagnosis of SSIs. Standardized guidelines should therefore be established to improve the predictive value of the different methods.

Fat mass: a novel digital biomarker for remote monitoring that may indicate risk for malnutrition and new complications in decompensated cirrhosis

BACKGROUND

Cirrhosis is associated with sarcopaenia and fat wasting, which drive decompensation and mortality. Currently, nutritional status, through body composition assessment, is not routinely monitored in outpatients. Given the deleterious outcomes associated with poor nutrition in decompensated cirrhosis, there is a need for remotely monitoring this to optimise community care.

METHODS

A retrospective analysis was conducted on patients monitored remotely with digital sensors post hospital discharge, to assess outcomes and indicators of new cirrhosis complications. 15 patients had daily fat mass measurements as part of monitoring over a median 10 weeks, using a Withing's bioimpedance scale. The Clinical Frailty Score (CFS) was used to assess frailty and several liver disease severity scores were assessed.

RESULTS

73.3% (11/15) patients were male with a median age of 63 (52-68). There was a trend towards more severe liver disease based on CLIF-Consortium Acute Decompensation (CLIF-C AD) scores in frail patients vs. those not frail (53 vs 46, p = 0.072). When the cohort was split into patients who gained fat mass over 8 weeks vs. those that lost fat mass, the baseline CLIF-C AD scores and WBC were significantly higher in those that lost fat (58 vs 48, p = 0.048 and 11.2 × 109 vs 4.7 × 109, p = 0.031).

CONCLUSIONS

This proof-of-principle study shows feasibility for remote monitoring of fat mass and nutritional reserve in decompensated cirrhosis. Our results suggest fat mass is associated with greater severity of acute decompensation and may serve as an indicator of systemic inflammatory response. Further prospective studies are required to validate this digital biomarker.

Combined Femoral Osteotomy and Contralateral Hip Arthroplasty to Correct Limb Alignment and Arthritis in a Scoliosis and Polio Patient: A Case Report

We describe the first case of a 62-year-old female symptomatic patient with multiple comorbidities presenting with coronal limb malalignment due to scoliosis and osteoarthritis who underwent a combined total hip arthroplasty and biplane opening wedge osteotomy of the distal femur in one procedure. It is essential to realize that in patients who present with multiple comorbidities, combining different established procedures should be considered as a therapeutic option. We detail the operative procedure, preoperative considerations, and postoperative rehabilitation. By reviewing the literature on operative techniques, we highlight how our findings can be applied to similar cases with multiple comorbidities. Our report underscores the importance of considering combined procedures as a viable therapeutic option for patients with complex medical histories.

Non-surgical organ preservation in laryngeal and hypopharyngeal cancers: an audit from the clinic

BACKGROUND

There is increasing concern regarding efficacy of organ preservation protocol in laryngeal and hypopharyngeal cancers.

METHOD

This study retrospectively assessed disease-related and functional outcomes of 191 patients with non-metastatic laryngeal or hypopharyngeal squamous cell carcinoma treated with curative intent (radiotherapy with or without chemotherapy).

RESULTS

Seventy-six patients (39.8 per cent) had a primary cancer in the larynx, and 115 patients (60.2 per cent) had a primary cancer in the hypopharynx. The median follow up was 39 months. The 3-year time to progression, overall survival, local control and laryngectomy free survival was 56.2 per cent, 76.3 per cent, 73.2 per cent and 67.2 per cent, respectively. At the time of analysis, 83 patients (43.5 per cent) were alive and disease free at their last follow up and did not require tube feeding or tracheostomy. The laryngo-oesophageal dysfunction-free survival was 61 per cent at 3 years.

CONCLUSION

Organ conservation protocols remain the standard of treatment in appropriately selected patients with laryngeal and hypopharyngeal cancers.

Unicompartmental Knee Arthroplasty for Severe Osteoarthritis and Pseudarthrosis in a Patient with Neurofibromatosis

We describe the case of a 76-year-old Asian female patient who presented with severe pain and a valgus deformity of the right knee. Her past medical history included neurofibromatosis, which resulted in a severe anterior slope of the right knee, limb shortening, and congenital pseudarthrosis. She was diagnosed with severe anterolateral osteoarthritis and eburnation of the right knee that was treated surgically with a lateral unicompartmental knee arthroplasty (UKA). Bone and cartilage fragments were removed from the joint space and a UKA implant (Zimmer®) with dimensions of 29 mm × 50 mm was inserted. Perioperative imaging revealed that the procedure resulted in the correction of the valgus deformity. Pain was reduced and the patient was able to walk for 10 meters with support during the immediate postoperative period. One week post-surgery, the patient sustained an oblique tibial fracture that extended from the medial edge of the implant to the medial slope of the proximal tibia. This complication may have been attributed to large implant size or sagittal overcutting. The fracture was treated surgically with a rotated anterolateral locking plate (A.L.P.S®) inserted into the distal tibia. The patient was capable of ambulation at full weight load at two months after the second procedure. It is critical to recognize that there are no standard protocols that can be used to guide the treatment of neurofibromatosis-induced osteoarthritis. The specific preoperative condition of the individual patient plays a large role in determining the appropriate treatment option. In this case, the availability of custom-fitted UKA implants might have improved outlook, we understand that these devices are costly and may not be available at all hospitals. However, we strongly believe that the "gold standard" in these cases is patient-specific treatment that addresses the issues of the highest concern using the resources that are available at that time.

Flexor Tendon Entrapment of the Index Finger After Monteggia Fracture in a Pediatric Patient

The present case report describes a pediatric patient who presented with flexor digitorum profundus (FDP) entrapment after a forearm fracture. The patient was diagnosed with a Bado type I Monteggia fracture. The fracture was reduced using closed reduction under fluoroscopy followed by Kirschner’s wire fixation. This case is unique because the FDP was found entrapped in the fracture site 2 weeks post-operation and was managed using conservative therapy. FDP entrapment is typically managed by surgical intervention, and there have been no previous reports of conservative management. The FDP was released using passive extension of the index finger under general anesthesia, and no irreversible damage to the tendon or muscle was found. This case report demonstrates the potential for conservative therapy in the management of FDP entrapment after forearm fractures.

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Spectroscopic investigation on the production of clay bricks with SCBA waste

In this paper, the effect of sugarcane bagasse ash (SCBA) addition to the brick making clay has been analyzed using spectroscopic techniques. For that, mixtures of brick making clay (BMC) with sugarcane bagasse ash (SCBA) in proportions of 0-20 wt.% were hydraulic uniaxially pressed and sintered at temperatures of 800-1100 °C. The partial replacement of the brick making clay with SCBA was studied with chemical and mineralogical analyzes (XRF and X-ray diffraction). The quantitative estimation of minerals was made by FTIR analysis. The results of FT-IR reveal that kaolinite, quartz, and lignin are predominant, whereas, cellulose and calcite are in moderate levels. In addition, magnetite and hematite are found in trace level. The overall results reveal that the brick making clay substituted with 15 wt.% of SCBA can open up a new path for the fabrication of quality bricks at low cost.

An insight on electrospun-nanofibers-inspired modern drug delivery system in the treatment of deadly cancers

This review gives an insight into the process of electrospinning, its essential parameters, the types of drug incorporation and the works reported on common dreadful cancers.

Review: physico-chemical modification as a versatile strategy for the biocompatibility enhancement of biomaterials

Physico-chemical modification induced improvement in biocompatibility of materials.

Gallic acid: prospects and molecular mechanisms of its anticancer activity

Gallic acid (GA) is a phenolic acid found in many dietary substances. It is a natural compound found in gallnuts, sumac, witch-hazel, clove, tealeaves, oak bark, sundew and other plants. Edibles like blackberry, hot chocolate, common walnut and Indian gooseberry contain GA.

Prospects of common biomolecules as coating substances for polymeric biomaterials

The concept of using common biomolecules like proteins, carbohydrates,etc., for improving the biocompatibility seems rational and effective because of the bio-friendly surface that they present, remains closer in mimicking the innate environment.

Synthesis of Some New Isoxazoline Derivatives of Chalconised Indoline 2-one as a Potential Analgesic, Antibacterial and Anthelmimtic Agents

A series of novel 1[5”-(2”’-substituted phenyl)-4”,5”’-dihydro isoxazole-3”-yl]-3-[(4 substituted phenyl)imino]1-3-dihydro-2H-indole-2-one were synthesized from different substituted chalconised indole-2,3-dione was prepared from the different chalconised Isatin. The structures of the compounds were elucidated by elemental and spectral (IR, ¹H NMR, and MS) analysis. The synthesized compounds were screened for their analgesic activity by the acetic acid induced Writhing method and in vitro antimicrobial activity against the Gram-positive bacteria—Staphylococcus aureus and the Gram-negative bacteria—Pseudomonas auroginosa, Pseudomonas mirabilis, and E. coli by the cup plate agar diffusion method. Compounds 6a₁, 6a₃, 6b₃, and 6b₂ were found to be active against bacteria. The compounds 6a₁, 6b₃, and 6a₃ show a significant analgesic activity. Synthesized compounds also screened for anthelmintic activity against Pheretima posthuma. Compounds 6a₁, 6b₁, and 6b₃ show significant anthelmintic activity.

Quality of care among type 2 diabetes mellitus patients residing in an urban slum of Chennai Corporation -- a community-based cross-sectional study

Despite the high prevalence, serious long term complications and established evidence based guidelines for management of diabetes mellitus the quality of care is still deficient in developed and developing countries. So a study of these factors and their influence on the quality of care is necessary to tackle diabetes in the community. The objectives of the study were to assess the quality of care in type 2 diabetes patients of 35 years and above age group and to identify the factors associated with it. It is a community-based cross-sectional study done among urban slum people of Chennai, in which 323 adults with type 2 diabetes were interviewed in the above said age group. Variables like age, sex, income, duration of diabetes, healthcare delivery of choice, treatment prescribed, compliance to treatment, family history of diabetes, presence of comorbid illnesses and quality of care indicators were studied and appropriate statistical analysis was carried out. Only 26 adults (8%) received good quality of care in this study. The adults who received good quality of care were among male sex (p < 0.005), high income group (p < 0.001), patients with good compliance to treatment (p < 0.001) and those who preferred private health facility for treatment (p < 0.001). The present current study indicates very low quality of care among this community. The management of diabetes in our setting was suboptimal and even the minimum achievable goals were not reached.