Endovascular Stenting - Novel Technique in the Management of Acute Stanford Type B Aortic Dissection Involving Right-sided Aortic Arch: Is This the Way Forward? Systematic Literature Review with Case Study

The occurrence of aortic dissection involving a right-sided aortic arch (RAA) is extremely rare. Majority of the symptomatic cases have been managed with open surgical treatment. However, middle-aged and elderly patients with coexistent comorbidities have higher postoperative risks if managed by surgery. The purpose of this case study is to review the literature for occurrence and treatment modalities for RAA with dissection, to review the various literature studies which have helped establish a consensus and guidelines in the management of aortic dissections, to review previous reported cases of successful endovascular management of RAA dissections, and to report our experience of treating a case of Stanford Type B right-sided aortic dissection managed by complete endovascular approach, the first of its kind in India. Our search in the databases revealed around 32 cases of RAA with aortic dissection published in the literature, most of which have been treated with open surgical approach; however, very few cases are managed with endovascular approach only like in our case

Ceelen-Gellerstedt syndrome in an elderly Indian man: Case report of an unusual case

Ceelen-Gellerstedt syndrome, also known as idiopathic pulmonary hemosiderosis (IPH), is a rare disease characterized by recurrent pulmonary alveolar hemorrhages associated with a classical clinical triad of hemoptysis, unexplained iron deficiency anemia, and diffuse pulmonary infiltrates on imaging. We present a case report of Ceelen-Gellerstedt syndrome in an elderly 69-year-old Indian male patient, which is an unusual case as the condition is more common in children and young adults. Diagnosis was suspected on high-resolution computed tomography (HRCT) scan, which revealed diffuse areas of consolidation, ground glass opacities, and septal thickening with perihilar and basal predominance and further workup with bronchoscopy and bronchoalveolar lavage helped to confirm the diagnosis

Knowledge, Attitude, and Practice of Physiotherapists in COVID-19 ICUs: A National Survey

Background. COVID-19 belongs to the beta-corona cluster that spreads enormously via aerosols. Physiotherapists must be knowledgeable about the symptoms, mode of transmission, risk mitigation strategies, and practice guidelines for COVID-19. Objective. This study aimed to assess physiotherapists’ knowledge of COVID-19 guidelines, their attitude toward this new evolving field, and their practice routines in India’s COVID-19 ICUs. Methods. It was a cross-sectional study. A total of 600 questionnaires were distributed through e-mail and WhatsApp to physiotherapists using Google Forms between February 2022 and January 2023. The questionnaires consisted of demographics and 23 questions in three sections about the knowledge, attitude, and practice of physiotherapists working in the COVID-19 ICU. Data analysis was carried out using Jamovi. Results. A total of 136 responses were obtained from 18 states of India. Of 136 participants, 89 were female (65.4%) and 47 were male (34.6%). The highest level of qualification was BPT (n = 69 (50.7%)), followed by MPT (n = 62 (45.6%)) and Ph.D. (3 (3.7%)). The knowledge about COVID-19 guidelines is fair. Only 21.3% of the physiotherapists received training before being deployed in COVID-19 ICUs, and the CARP protocol was well known by only as few as 10.3%. The criteria advised for close monitoring of patients during treatment was aware by 29.4%. Most physiotherapists have a good attitude toward treating COVID-19 patients; 70.63% strongly agree that physiotherapy is vital in these patients despite the risk of self-exposure, and 64.7% agree that physiotherapy should be initiated during all phases of COVID-19. Physiotherapists follow good practices for COVID-19 patients in the ICU, which is as per the guideline recommendation. Conclusion. Physiotherapists working in COVID-19 ICUs have a fair knowledge of the existing physiotherapy guidelines for COVID-19, and they exhibit good attitudes and practice patterns

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Not AvailableThe National Agricultural Research System (NARS) is playing a pivotal role in enabling food security by continuous generation of technologies in agriculture and allied sectors in the country. The Indian farming mostly characterized with diversified agro-ecologies, water scarcity, unpredicted rains due to vagaries of monsoon and high cost of technological inputs. Based on the changing scenario of agriculture year by year, it requires promotion of proper management of natural resources like soil, water and micro environment, besides wellbeing of all stakeholders involved in the food production and consumption chain. This is primarily possible by technological empowerment of farmers. As part of such a strategy, the Indian Council of Agricultural Research (ICAR) is playing a crucial role in providing technologies generated by NARS after its assessment, refinement, demonstration in the micro farming situations, in addition to updating the knowledge and skill of farmers and extension personnel by taking up innovative approaches through its network of 589 Krishi Vigyan Kendras (KVKs), which act as knowledge and resource centers for empowering all the partners in the agricultural development process. Over the years, there is a change in agrarian structure, though 80% of farmers are operating small and marginal land holdings and having a weak access to critical production resources. It is expected that India will have the largest agricultural manpower dominated by youths under 30 years of age by 2020. Majority of the Indian youth live in villages and are engaged in agricultural activities. Keeping in view such a situation, the KVKs are effectively addressing the felt needs of farming community especially rural youth by following plough to plate approach and creating an enterprising environment. In order to reach the farmers efficiently, a number of activities are carried out by the entire KVK system to bring out location specific technology modules and appropriate extension approaches. It is therefore very important to review and analyze the input, output, outcome and impact of technological interventions implemented by KVKs by documenting the success achieved and to reorient the strategies for effective functioning of KVKs for fulfilling its mandate. In this direction, the Division of Agricultural Extension of ICAR has made a critical review of success stories emerged from KVKs through a rigorous process followed by the Programme Coordinators at district level, the Zonal Project Directorates at Zonal level and by the Division at national level. Altogether 101 salient technological interventions which proved success have been chosen as a testimony of hard work put in by KVK system and are presented in the form of this document. There is no denying the fact that until the full potential of technology modules tested and demonstrated by KVKs are harvested by the millions of farmers in the country, success cannot be truly translated into production gains at the field level. It is hoped that this attempt may direct the KVKs and the farming community for up-scaling and replication of successful enterprising interventions for teaching the untaught and reaching the unreached.Not Availabl

Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study

Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60-1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14-1.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely