Anaesthesia-related morbidity associated with recumbent, low-field magnetic resonance imaging of horses

CASE HISTORY

Medical records from 2009 to 2021 from a private equine referral hospital in Rochester, NH, USA were analysed for cases that underwent general anaesthesia for low-field MRI of the distal limb. These were used to determine peri-anaesthetic morbidity and mortality.

CLINICAL FINDINGS AND OUTCOME

Two hundred and forty-three anaesthetic episodes were recorded in horses undergoing low-field MRI. The peri-anaesthetic complication rate prior to discharge was 6.2% (15/243). No patients experienced a fatal complication. Ninety two of the 243 patients had multiple sites imaged, 90/243 received pre-anaesthetic dantrolene, 134/243 received intra-anaesthetic dobutamine, and 15/243 were positioned in dorsal recumbency. Complications included: abdominal discomfort ("colic"; 9/243), myopathy (4/243), hyphaema (1/243) and carpal fracture (1/243). At the time of discharge, 14/15 complications had resolved. Of 135 horses for which data were available 55 became hypotensive during the procedure (lowest mean arterial pressure < 65 mmHg). Median body weight was 553 (min 363, max 771) kg. Horses were anaesthetised for a median of 150 (min 45, max 210) minutes. There was no evidence of an association between higher body weight (p = 0.051) or longer duration of anaesthesia (p = 0.421) and development of an anaesthetic complication. For categorical variables (dantrolene administration pre-anaesthesia, dobutamine administration during anaesthesia, hypotension (mean < 65 mmHg) during anaesthesia, dorsal vs. lateral recumbency, and imaging of single vs. multiple sites), the 95% CI for the OR included 1, indicating a lack of effect of the variable on the odds of complication.

CLINICAL RELEVANCE

The cases included in this series suggest that low-field MRI under general anaesthesia is a viable option for diagnostic imaging in otherwise healthy horses. Complications occur, but most resolve before discharge.

Evaluation of Immunohistochemistry Technique for Diagnosis of Extrapulmonary Tuberculosis in Biopsy Tissue Specimen as Compared to Composite Diagnostic Criteria

Introduction

Diagnosis of extrapulmonary tuberculosis (EPTB) has been challenging owing to its paucibacillary nature and diverse clinical manifestations. Immunohistochemistry (IHC) on biopsy specimens has presented a new perspective toward improving tuberculosis diagnosis. MPT64 is a unique antigen that has shown high sensitivity and specificity compared to other conventional techniques in its ability to diagnose tuberculosis as well as differentiate it from nontubercular mycobacteria. In this study, we aimed to analyze the utility of anti-MPT64 in the diagnosis of EPTB.

Methods

In this cross-sectional study, conducted over a period of 1 year, 52 nonrepetitive samples from 52 participants with a presumptive diagnosis of EPTB were collected and processed. The specimens were subjected to Ziehl-Neelsen staining, GeneXpert, tissue culture by mycobacterium growth indicator tube, H and E staining, and IHC with anti-MPT64. The sensitivity and specificity of anti-MPT64 was computed against a composite diagnostic criterion.

Results

Fifty-two consecutive participants satisfying the study criteria were recruited. The mean age of the study population was 37.35 ± 18.71 years. Lymph node specimen accounted for majority of the specimen processed (n = 20, 38.5%). The sensitivity of anti-MPT64 in the diagnosis of EPTB was 68.29%, specificity was 90.90%, positive predictive value was 96.55%, and negative predictive value was 43.47%, when composite criteria were considered standard for diagnosis.

Conclusion

Immunohistochemical staining by anti-MPT64 is useful in establishing microbiological diagnosis of EPTB on biopsy specimens.

Stimulant induced Dermatological and Vascular Complications in patients with ADHD: A literature review

Introduction

Methylphenidate and amphetamine are the two most widely used stimulants in managing Attention Deficit Hyperactivity Disorder (ADHD)¹. Reynaud’s phenomenon (RP) is a reversible distal vasoconstriction presenting with various dermatological symptoms. RP can secondarily develop after certain medications as well².

Objectives

The review was undertaken to synthesize the incidence of RP within ADHD population treated with stimulants, and any causal relation of RP and stimulant-use.

Methods

PubMed, Psych-Info and Google Scholar were searched using these keywords: skin change, Raynaud, stimulants and methylphenidate. All relevant study types were included. Results were synthesized narratively.

Results

Initial search yielded 240 articles with 5 articles fulfilling our inclusion criteria. One was retrospective case-controlled study while remaining 4 were case reports. Six cases were identified with an age of 12-19 years, who presented with RP after being treated with methylphenidate-or-dextroamphetamine. In one case, multiple clinical signs of RP were seen with cold distal fingers, transient color changes and even frank ulceration^3–6. In two cases, it was seen that RP was dose-dependent with stimulant use and got resolved after decreasing the dosage respectively. In case-control study, 32 cases with RP and 32 controls were enrolled. The results showed a statistically significant association (χ² =5, p=0.01) between RP and past-or-current stimulant usage.⁷

Conclusions

The literature review suggests weak evidence of the association between RP and stimulant use but no evidence of any causal link. Further studies are needed to identify characters that can predict this adverse effect in vulnerable ADHD individuals.

Disclosure

No significant relationships.

Evaluation of Protective Action of Selenium Against Hepatotoxicity Caused by Methotrexate In Mice

Drug induced liver injury has been regarded as the main cause of acute liver injury in many countries. Objectives: To evaluate the protective action of selenium against hepatotoxicity caused by methotrexate in mice. Study Design: Randomized, single blinded study. Methodology: Present study was done on 18 mice (n = 18) after taking approval from Ethical Review Committee. Administration of methotrexate induced hepatotoxicity. Selenium was administered along with methotrexate in order to evaluate the protective effects. The extent of hepatotoxicity and protective effects were analyzed by measuring levels of serum liver enzymes and histological examination of liver samples. Statistical analysis: One way ANOVA test was applied for comparison of biochemical markers between groups. Chi Square test was also applied for histopathological results. Results: In present study, results showed that significant hepatotoxicity was observed (p < 0.05) with elevated levels of serum liver enzymes with methotrexate. Selenium was found to significantly reduce the hepatotoxicity (p < 0.05). Histological examination revealed steatosis, which was found to be markedly decreased after treatment with selenium along with methotrexate. Conclusion: We concluded that selenium helped to protect against hepatotoxicity induced by methotrexate in mice. Keywords: Drug induced liver injury, Hepatotoxicity, Methotrexate and Selenium.

Real-time harmonics analysis of digital substation equipment based on IEC-61850 using hybrid intelligent approach

This paper proposed a hybrid intelligent approach based on empirical mode decomposition (EMD), artificial neural network (ANN) and J48 algorithm of machine learning for real-time harmonics analysis of digital substation’s equipment based on IEC-61850 using explanatory input variables based on laboratory proto-type real-time recorded database. In the proposed hybrid model, these variables are first extracted then diagnostic of power transformer harmonics of digital substation is evaluated/analyzed to perform the long term as well as the short term goal and planning in the electrical power network. In this paper, firstly, experimental analysis is performed to validate the laboratory prototype setup using FFT (fast Fourier transform), STFT (short-time Fourier transform) and CWT (continuous wavelet transform). Then, features are extracted from experimental dataset using EMD (empirical mode decomposition) method. The IMFs (intrinsic mode functions) have generated from EMD, which are used as an input variable to the two different diagnostic models, i.e., ANN and J48 algorithm. In order to validate the performance and accuracy of the proposed hybrid model, a comparative analysis is performed by using ANN and J48 method (with and without EMD method) and the results are compared. Obtained results shows that the proposed hybrid diagnostics approach for harmonics analysis has outperformance characteristics.

Era of TB elimination: Growing need to understand diversities of Mycobacterium tuberculosis lineages!

INTRODUCTION

The mycobacterium tuberculosis complex (MTBC) has highly clonal population structure which made the organism spread globally mirroring human migration out of Africa and resulted in the formation of seven lineages. We conducted this study to determine the proportion of spoligotype lineages and drug susceptibility profile of Mycobacterium tuberculosis isolates among smear positive TB patients attending a tertiary care hospital in Mysore, Karnataka, India.

METHODS

It is a descriptive study conducted at JSS Hospital a tertiary care centre at Mysore, India during 2018-19. The sputum smear positive samples were subjected to solid culture and drug susceptibility testing and spoligotyping for identification of lineages.

RESULTS

Of the 100 samples which were culture positive, 94 isolates were clustered into five spoligotype international types with SIT-126 (EAI-5) being the largest cluster of 46 (46%) isolates, followed by SIT-62 (H1) with 24 (24%), SIT -26 (CAS 1-DELHI) with 20 (20%), SIT-53 (T1) with 03 (3%) and SIT-482 (BOV-1) with 01 (1%). Among the remaining six isolates, two had unique Cameroon spoligotypes and four were orphans CONCLUSION: The study finding reveals that a diverse pattern of genotypes is circulating in the region of which EAI-5, Harleem (H1) and CAS-DELHI pattern forms the majority (88%). It is evident that there is a wide range of MTB genetic lineages in circulation and further research is needed to understand the diversity across the country.

Hepato curative effects of Silymarin and Cymbopogoncitratus stem infusion: RCT

People all around the world suffer from liver diseases, which is a serious health problem. Purpose: To observe the synergistic effects of Silymarin and Cymbopogoncitratus stem infusion on liver in acetaminophen induced hepatotoxicity in rats. Study Design: Laboratory-Based Randomized Control Trial. Methodology: Total forty adult rats were divided into four groups (10 each). Group 1 was taken as control group. After initial sampling at day 0, Acetaminophen (300 mg/kg) was injected to 30 rats via intra-peritoneal route. At day 8, rats were further divided into three groups. Group 2 was a disease control group. Group 3 was given Silymarin (100 mg/kg) and group 4 was treated with Silymarin (100 mg/kg) plus Cymbopogoncitratus stem infusion (130 mg/kg) through gavage method for fourteen days. At day 21, rats were sacrificed for histological examination after terminal sampling. Statistical Analysis: Mean± SEM was calculated and analyzed through SPSS 20. P-value less than 0.05 was considered statistically significant. Results: Rats from group 2 showed marked elevation (p<0.05) in serum markers. There was marked sinusoidal dilatation and necrosis present in group 2 rats.Silymarinin group 3 and Silymarin plus Cymbopogoncitratus stem infusion in group 4 significantly lowered the biochemical enzymes as well as considerably reversed the histological changes in comparison to group 2 rats. Conclusion: We concluded in present study that synergism was observed in group 4 rats. There was more reversal of hepatic injury in group 4 rats. Key words: Cymbopogoncitratus, Silymarin and Synergism.

Upfront Xpert MTB/RIF for diagnosis of pediatric TB-Does it work? Experience from India

Background

Diagnosis of TB in pediatric population poses several challenges. A novel initiative was implemented in several major cities of India aimed at providing upfront access to free-of-cost Xpert MTB/RIF to presumptive pediatric TB cases. This paper aims to describe the experience of implementing this large initiative and assess feasibility of the intervention in high TB burden settings.

Methods

Data were drawn from the pediatric TB project implemented in 10 major cities of India between April 2014 and March 2018. In each city, providers, both public and private, were engaged and linked with a high throughput Xpert MTB/RIF lab (established in that city) through rapid specimen transportation and electronic reporting system. Rates and proportions were estimated to describe the characteristics of this cohort.

Results

Of the total 94,415 presumptive pediatric TB cases tested in the project, 6,270 were diagnosed positive for MTB (6.6%) on Xpert MTB/RIF (vs 2% on smear microscopy). Among MTB positives, 545 cases were rifampicin resistant (8.7%). The median duration between collection of specimens and reporting of results was 0 days (same day) and >89% cases were initiated on treatment. Approximately 50% of the specimens tested were non-sputum. The number of providers/facilities engaged under the project increased >10-fold (from 124 in Q2’14 to 1416 in Q1’18).

Conclusion

This project, which was one of the largest initiatives globally among pediatric population, demonstrated the feasibility of sustaining rapid and upfront access to free-of-cost Xpert MTB/RIF testing. The project underscores the efficiency of this rapid diagnostic assay in tackling several challenges in pediatric TB diagnosis, identifies opportunities for further interventions as well as brings to light scope for effective engagement with healthcare providers. The findings have facilitated a policy decision by National TB Programme mandating the use of Xpert MTB/RIF as a primary diagnostic tool for TB diagnosis in children, which is being scaled-up.

Femoroacetabular impingement treatment using the arthroscopic extracapsular outside-in approach: Does capsular suture affect functional outcome?

BACKGROUND

Over the last decades, the arthroscopic treatment of hip pathology has highly grown thanks to the evolution of surgical techniques and instrumentation development. An alternative approach consisting in making a first outside-in longitudinal capsulotomy was described by Laude at the end of the 2000s and is experiencing significant development in France. The clinical results of this technique have rarely been reported and in particular the influence of the repair of the capsule is unknown. Therefore we performed a retrospective case control study aiming to asses: (1) the clinical outcomes and complication rates of the outside-in extracapsular approach for the treatment of FemoroAcetabular Impingement (FAI) and (2) the effect of capsular closure on the functional outcome.

HYPOTHESIS

We hypothesize that the outside-in extracapsular approach is a safe and efficient technique and the capsular closure at the end of the procedure positively affects the functional outcome.

METHODS

A retrospective study was conducted on prospectively collected data of a consecutive series of hip arthroscopies performed for surgical treatment of FAI using the outside-in extracapsular approach. Any complications during follow-up were identified and recorded. Linear regression models were used to estimate the influence of capsular closure on the functional outcome. Functional outcome was assessed using modified Harris Hip Score (mHHS) and Non-arthritic Hip Score (NAHS).

RESULTS

Sixty-four hips in 57 patients operated by a single surgeon between October 2013 and December 2016 were analyzed at the time of final follow-up of 34.17 months (range 24 to 53). As the surgical technique evolved over time, a side-to-side capsular closure was performed at the end of the procedure for 25 hips and the capsule was left open for the remaining 39 patients. Functional outcome measurements showed an improvement from the preoperative to the last follow-up: 63.5±11.0 to 88.1±11.2 for mHHS, 63.1±13.8 to 86.4±13.4 for NAHS. Capsular closure leads to a significantly improved clinical outcome: gain in mHHS: 25.8±2.3 vs. 20.6±1.9 (p≤0.044), gain in NAHS: 26.1±2.5 vs. 19.6±2.1, (p=0.023). No major complications occurred. One case of postoperative tensor fascia latae atrophy was documented in the group "capsule left open".

CONCLUSION

Hip arthroscopy in the management of FAI with an extraarticular starting point (outside-in) is a safe technique with functional results and postoperative morbidity comparable to previously reported techniques. Side-to-side capsular closure at the end of the procedure might positively affect the final functional outcome.

LEVELS OF EVIDENCE

III, case control retrospective study.

Understanding Constipation: A Cross-sectional Study from a Developing Country Setting

A cross-sectional study was conducted in the Gastroenterology Clinics of The Aga Khan Hospital and Jinnah Postgraduate Medical Centre in Karachi. All patients complaining of constipation were included. Patients with alarm features were excluded. Interviews were conducted by trained doctors using a structured Rome III based pre-tested questionnaire and Bristol Stool Form Scale. Out of 396 participants, 186 (47.0%) had FC and 209 (52.7%) had IBS-C. Based upon Bristol Stool Form Scale, only 214 (54%) reported to have slow transit constipation (BSS <2). A higher proportion of women reported severe form of constipation as compared to men (81.5%, n=150 vs. 65.1%, n=138 p<0.001). However, a higher percentage of men reported using medications to treat their symptoms (71.2%, n=151 vs. 57.1%, n=105 p=0.003). Proper understanding of patient's symptoms is essential for optimizing individual patient management.

Structural and luminescent studies of erbium-doped CaZrO3 green-emitting nanophosphors

Erbium (Er) (0.5, 1.0 and 1.5 wt%)-doped CaZrO₃ nanophosphors were synthesized by the sol-gel method using poly(vinyl alcohol) as the chelating agent. Their structural and photoluminescence properties were studied using X-ray diffraction (XRD), field emission scanning electron microscopy-energy dispersive spectroscopy (FESEM-EDS), transmission electron microscopy (TEM), photoluminescence and Fourier transform infrared spectroscopy (FTIR). The XRD patterns of the samples confirm that nanoscale crystallite sizes. Agglomeration of the samples was observed using field emission scanning electron microscopy images. Energy dispersive spectroscopy measurements confirmed the existence of Ca, Zr, O and Er in the samples. Average particle sizes for the samples were calculated from transmission electron microscopy images. FTIR spectra clearly show characteristic absorption bands related to the metal oxides, as well as some other organic molecules. The photoluminescence spectra show bands in the green region. The Commission International de l'Eclairage coordinates were calculated and found to be in green region.

Analgesia after ACL reconstruction: Hamstring donor-site injection versus intra-articular local anaesthetic injection

BACKGROUND

The purpose of this study was to compare hamstring donor-site injection versus intra-articular injection of a local anaesthetic for analgesia after anterior cruciate ligament (ACL) reconstruction.

HYPOTHESIS

The two methods provide similar pain relief.

MATERIAL AND METHODS

158 consecutive patients undergoing ACL hamstring tendon graft reconstruction (semi-tendinosus/gracilis [STG] or four-stranded semi-tendinosus [ST4]) during two periods in 2015 were included. Peripheral nerve block was not performed. At the end of surgery, 20mL of ropivacaine 7.5mg/mL was injected, intra-articularly during the early period (n=79) and into the hamstring donor site during the second period (n=79). Post-operative pain was evaluated subjectively by the patients using a visual analogue scale (VAS). We recorded patient demographics, concomitant surgical procedures, VAS pain scores, rescue analgesic use, time to discharge, and patient satisfaction. VAS pain score, side effects, and patient satisfaction were also recorded during a phone interview on the day after surgery (D1).

RESULTS

Mean VAS pain scores were not significantly different between the two groups immediately after surgery (D0) or on D1 (D0: intra-articular, 2.08 and donor site, 1.88; Mann-Whitney P=0.6). Neither were the groups significantly different for rescue analgesic use, patient satisfaction, or quadriceps activation.

CONCLUSION

The same local anaesthetic provides similar pain relief when injected intra-articularly or into the hamstring donor site after hamstring tendon ACL reconstruction (STG or ST4).

LEVEL OF EVIDENCE

III, prospective case-control study.

Composite split cord malformation associated with a dermal sinus tract, dermoid cyst, and epidural abscess: A case report and review of literature

Background:

Split cord malformation (SCM) is typically present at a single level but rarely, may be present at multiple levels in the spinal cord and can be associated with a wide array of lesions such as myelomeningoceles, lipomas, teratomas, and dermal sinus tracts (DSTs).

Case Description:

We describe a case of a 15-month-old female child who presented with high-grade fever and progressive motor weakness in the lower limbs. Magnetic resonance imaging revealed the presence of SCM along with an epidural abscess, DST, and dermoid cyst. The child underwent surgery for excision of DST along with removal of the dermoid cyst and drainage of epidural abscess. The postoperative course was uneventful. Elective repair of the SCM was performed 4 weeks later. The postoperative course was uneventful again.

Conclusion:

To the best of our knowledge, the combination of a composite SCM with a DST and dermoid cyst with associated epidural abscess has rarely been reported in literature.

Aneurysm in the anterior inferior cerebellar artery-posterior inferior cerebellar artery variant: Case report and review of literature

•

We reported a case of an aneurysm in the AICA-PICA variant which was subsequently excised.

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Considerable variation exists in the anatomy of the vertebrobasilar system.

•

Understanding the variations and the aneurysms that may arise from them is an important aspect of neurosurgical practice.

Introduction

There are variations in the anatomy of the vertebrobasilar system amongst which the Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) variant is thought to have a prevalence of 20–24% (based on retrospective studies). Despite this, aneurysms of the AICA-PICA variant are rare. We present a case of an AICA-PICA aneurysm and discuss its presentation and management, along with a review of literature.

Presentation of case

We describe the case of a 35 year old female who presented with signs of meningismus. On the basis of radiological imaging it was initially misdiagnosed as a thrombosed arteriovenous malformation (AVM). The patient was eventually discharged with a plan of interval imaging and interventional radiology (if required). The patient presented again with similar signs and symptoms. Re-evaluation of imaging revealed an aneurysm of the AICA-PICA variant which was managed surgically.

Discussion

Aneurysms of the AICA-PICA variant are rare. The radiological features and surgical management represent a unique clinical entity and are discussed below.

Conclusion

The prevalence of the AICA-PICA variant might be high but aneurysms in this vessel are rare. The scant knowledge available on this subject makes it a diagnostic difficulty.

From conception to birth - how endometriosis affects the development of each stage of reproductive life

Increasing evidence suggests that female infertility is associated with endometriosis. Indeed, 40% of women with this disease are infertile. However, a causal relationship has not yet been established, and the possible pathophysiology of infertility in this disease also has not been completely elucidated. In this article, we analyze the mechanisms necessary to achieve a successful live birth in patients with this disease as well as the important steps of fertility, pregnancy and birth that can be impaired in these women. Specifically, we will review new advances in research on folliculogenesis, oocyte quality and sperm quality, egg fertilization, embryo quality, transport through fallopian tube and utero-tubal transport sperm, implantation defects, risk of miscarriage, risk during pregnancy and pre-term delivery. The physiopathology of these alterations and the clinical results of the studies are still very controversial. For these reasons, we can conclude that more research is needed to study the biological pathways of the fertility impairment caused by this disease.

Preferential cell response to anisotropic electro-spun fibrous scaffolds under tension-free conditions

Anisotropic alignment of collagen fibres in musculoskeletal tissues is responsible for the resistance to mechanical loading, whilst in cornea is responsible for transparency. Herein, we evaluated the response of tenocytes, osteoblasts and corneal fibroblasts to the topographies created through electro-spinning and solvent casting. We also evaluated the influence of topography on mechanical properties. At day 14, human osteoblasts seeded on aligned orientated electro-spun mats exhibited the lowest metabolic activity (P < 0.001). At day 5 and at day 7, no significant difference was observed in metabolic activity of human corneal fibroblasts and bovine tenocytes respectively seeded on different scaffold conformations (P > 0.05). Osteoblasts and corneal fibroblasts aligned parallel to the direction of the aligned orientated electro-spun mats, whilst tenocytes aligned perpendicular to the aligned orientated electro-spun mats. Mechanical evaluation demonstrated that aligned orientated electro-spun fibres exhibited significant higher stress at break values than their random aligned counterparts (P < 0.006) and random orientated electro-spun fibres exhibited significant higher strain at break values than the aligned orientated scaffolds (P < 0.006). While maintaining fibre structure, we also developed a co-deposition method of spraying and electro-spinning, which enables the incorporation of microspheres within the three-dimensional structure of the scaffold.

Exploration of skin permeation mechanism of frusemide with proniosomes

The present study explored the transdermal permeation enhancing mechanism of non-ionic surfactant vesicles (proniosomes) of frusemide across rat skin. Fourier Transform Infrared Spectroscopy (FT-IR), Differential Scanning Calorimetry (DSC), activation energy and histological examination were carried out to study the mode of action of the optimized proniosome formulations PGS [Span 40:soyalecithin:cholesterol (4.5:4.5:1)] and PGD [Span 40:dicetylphosphate:cholesterol (4.5:4.5:1)]. The IR spectra showed a prominent decrease in peak areas and heights of CH2 stretchings but did not show shift of these peaks and shift in amide bands. DSC studies also confirmed the IR findings. It was concluded that the proniosomes disrupted the lipid bilayer by extracting the lipids thereby creating pathways for drug penetration. The significant decrease in activation energy for frusemide permeation across rat skin indicated the SC lipid bilayers were significantly disrupted (p<0.05). Histological investigations were carried out. Disruption and extraction of lipid bilayers as distinct voids and empty spaces were visible in the epidermal region. Overall, our findings suggested that proniosomal formulations offer a promising means for non-invasive delivery of frusemide, especially due to their ability to modulate drug transfer and serve as non-toxic permeation enhancers.

Biotechnological production of oil: fatty acid composition of microbial oil

The fatty acid profile and the fatty acid composition of microbial lipids obtained from molds revealed that oil from Aspergillus sydowii, Fusarium oxysporum and F. equisetti had a high percentage of unsaturated fatty acids, particularly oleic acid, and had a similarity to the edible oils, groundnut and palm oil. This study sheds light on the possibilities of exploring the use of these oils as supplement to other edible fats and for other non-edible industrial purposes.