Pleural fluid pseudocholinesterase and its ratio to serum pseudocholinesterase: For differentiating pleural transudates from exudates

BACK GROUNND: The lights criteria is the system that has stood the test of time in classifying pleural effusions into transudates and exudates. But studies have shown that there is significant number of misclassification with the lights criteria. Several newer parameters are being postulated as an alternative to lights criteria for classifying effusions. Pleural fluid pseudocholinesterase and its ratio to serum pseudocholinesterase is one such parameter. AIMS AND OBJECTIVES: To evaluate the usefulness of pleural fluid pseudocholinesterase(PChE) level and its ratio with serum pseudocholinesterase in order to differentiate between transudates and exudates. To compare the diagnostic efficacy of: (1) pleural fluid PChE value and (2) pleural fluid PChE to serum PChE ratio; with the efficacy of Light’s criteria. MATERIALS AND METHODS: 60 patients with pleural effusion with known etiology were selected and divided into transudates and exudates based on the etiology. lights criteria was applied to all patients. Pleural fluid PChE level and its ratio to serum PChE were estimated in all patients. ROC analysis and unpaired t test was done. RESULTS: There was significant difference between the values of both Pleural fluid PChE level and pleral fluid to serum PChE ratio between exudates and transudates. Misclassification was less with the new parameters compaired to lights criteria. Sensitivity,specificity,PPV,NPV of Pleural fluid PChE level(96.2%,85.36%,89.36%,97.6% respectively)and pleral fluid to serum PChE ratio(97.14%,91.6%,94.2%,98.3%) were better than that of lights criteria (93.3%,77.7%,83.3%,95.6%). CONCLUSION: Both pleural fluid PChE and P/S PChE ratio are reliable parameters in differentiating transudates and exudates. PChE and P/S PChE ratio are more efficient than lights criteria in differentiating transudates and exudates. P/S PChE ratio is the most sensitive and specific parameter among the parameters studied

Internet-based interventions to support recovery in youth: A systematic review

Personal recovery represents a paradigm shift in how individuals are seen to benefit from mental health interventions, from a narrow view of symptom reduction to a holistic, multi-dimensional view of well-being, functional gains and rehabilitation. Although there is a large body of evidence supporting the use of recovery-oriented care in adults, research on personal recovery amongst youth with mental health concerns is an emerging area of research. Efforts to promote youth mental health have also focussed on the use of digital applications and platforms as a means of overcoming barriers related to factors including stigma and lack of available services. This systematic review aims to review the literature on existing internet-based, youth mental health interventions with regard to (a) identifying elements of the programs that align with the personal recovery and (b) outcome measures utilised in assessing personal recovery. Eleven papers were identified that met the inclusion criteria. Five of the programs reviewed from these eleven papers showed efficacy for recovery processes. The results offer preliminary support and guidance for the use of internet-based mental health interventions in the promotion of personal recovery amongst youth. Future research and practice are suggested to further develop understanding in this area

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Evolution of Hierarchical Hexagonal Stacked Plates of CuS from Liquid-Liquid Interface and its Photocatalytic Application for Oxidative Degradation of Different Dyes under Indoor Lighting

Blue solution of copper(II) acetylacetonate complex, [Cu(acac)2] in dichloromethane (DCM) and an aqueous alkaline solution of thioacetamide (TAA) constitute a biphasic system. The system in a screw cap test tube under a modified hydrothermal (MHT) reaction condition produces a greenish black solid at the liquid-liquid interface. It has been characterized that the solid mass is an assembly of hexagonal copper sulfide (CuS) nanoplates representing a hierarchical structure. The assynthesized CuS nanoplates are well characterized by several physical techniques. An ethanolic dispersion of CuS presents a high band gap energy (2.2 eV) which assists visible light photocatalytic mineralization of different dye molecules. Thus a cleanup measure of dye contaminated water body even under indoor light comes true

Lung to Lung Cannon Ball Metastases: A Case Series on Primary Lung Malignancy

Cannon ball metastases refer to large, well circumscribed, round pulmonary nodules like cannon balls that are scattered over both lungs, being a classical presentation of haematogenous tumour spread.Cannon ball pulmonary metastases are typically seen in the patients with choriocarcinoma or renal cell carcinoma. Rarely, pulmonary metastases with the same appearance may be secondary from prostate cancer, synovial sarcoma, endometrial carcinoma or haepatocellular carcinoma.The present case series is about six patients diagnosed with cannon ball metastases which occurred from primary lung carcinoma. Out of these six cases, three were of small cell carcinoma, two of squamous cell carcinoma and one of adenocarcinoma.The histopathology of all the cases was established by biopsy from the tumour site and appropriate treatment was started in the form of chemotherapy and radiotherapy as needed. Clinicians must investigate thoroughly for primary origin of cannon ball metastasis, though rare but lung cancer can present as this kind of metastasis

Utilisation of Digital Applications for Personal Recovery Amongst Youth with Mental Health Concerns

There is an increasing population of youths that report mental health issues. Research has shown that youths are reluctant to seek help for various reasons. A majority of those who do seek help are using digital mental health supports. Subsequently, efforts to promote youth mental health have focused on the use of digital applications as a means of overcoming barriers related to factors including stigma and lack of available services. The worldwide move toward recovery-oriented care led to emerging research on personal recovery amongst youths with mental health concerns. This study sought to address the need for recovery-oriented digital resources for youths. It utilised a qualitative design methodology to develop a rich interpretation of how youths are using digital interventions to support their mental health recovery journey. It sought to understand how existing digital applications are useful for youth recovery and identified characteristics associated with recovery and engagement. The content analysis generated five categories that represent facilitators of youth recovery and the thematic analysis identified key elements of digital applications that support youth recovery. The results offer complimentary support and guidance for recovery-oriented care and the use of digital mental health interventions in the promotion of personal recovery amongst youths