Utilizing indocyanine green video angiography to bridge intracranial aneurysm treatment gaps in low- and middle-income countries: a mini-review

Intracranial aneurysms, affecting 2%–5% of the population, pose a significant challenge to neurosurgeons due to their potential to cause subarachnoid haemorrhage and high mortality rates. Intraoperative angiography is necessary for effective surgical planning and indocyanine green video angiography (ICG-VA) has emerged as a useful tool for real-time visualization of aneurysmal blood flow, aiding in better planning for potential blood flow and detection of aneurysm remnants. This mini narrative review explores the application of ICG-VA in intracranial aneurysm surgery. Compared with conventional dye-based angiography, ICG-VA is safer, more effective and more cost-effective. It can assess haemodynamic parameters, cerebral flow during temporary artery occlusion, completeness of clipping and patency of branch vessels. However, implementing ICG-VA in low- and middle-income countries presents challenges such as financial constraints, limited access to training and expertise, patient selection and consent issues. Addressing these obstacles requires capacity-building, training programmes for neurosurgeons and multidisciplinary teams, technology transfer, equipment donations, public–private partnerships, continued research and development, reducing conventional dye usage, reducing ICG wastage, exploring mechanisms to reuse ICG dyes and advocating for increased government funding and healthcare budgets

A reflection of Africa's cardiac surgery capacity to manage congenital heart defects: a perspective

Congenital heart defects (CHDs) are birth abnormalities that may drastically alter the structure and functionality of the heart. For 70% of infants with congenital disorders to survive or maintain a better quality of life, surgery is necessary. Over 500 000 of the 1.5 million CHD cases reported annually, or 1% of all live births, occur in Africa, according to the WHO. A surmounted 90% of these patients are from Africa, and as a consequence, 300 000 infants die annually as a result of poor care or difficulty accessing adequate healthcare. However, the high prevalence of CHDs, precipitated by a plethora of aetiologies worldwide, is particularly pronounced in Africa due to maternal infectious diseases like syphilis and rubella amongst the pregnant populace. In low- and middle-income countries, especially in Africa, where foreign missions and organizations care for the majority of complicated cardiac surgical patients, access to secure and affordable cardiac surgical therapy is a substantial issue. Interventions for CHDs are very expensive in Africa as many of the continent’s domiciles possess low expenditures and funding, thereby cannot afford the costs indicated by associated surgical treatments. Access to management and healthcare for CHDs is further hampered by a lack of trained surgical personnel, specialized tools, infrastructure, and diagnostic facilities in Africa

Biportal endoscopic surgery for lumbar spine herniated discs: a narrative review of its clinical application and outcomes

Lumbar disk herniation (LDH) is a common condition affecting millions worldwide. The management of LDH has evolved over the years, with the development of newer surgical techniques that aim to provide better outcomes with minimal invasiveness. One promising emerging technique is biportal endoscopic spinal surgery (BESS), which utilizes specialized endoscopic equipment to treat LDH through two small incisions. This review aims to assess the effectiveness of BESS as a management option for LDH by analyzing the available literature on surgical outcomes and potential complications associated with the technique. Our review shows that BESS is associated with favorable postoperative results as judged by clinical scoring systems, such as visual analog scale, Oswestry disability index, and MacNab criteria. BESS has several advantages over traditional open surgery, including minimized blood loss, a shorter duration of hospitalization, and an expedited healing process. However, the technique has limitations, such as a steep learning curve and practical challenges for surgeons. Our review offers recommendations for the optimal use of BESS in clinical practice, and provides a foundation for future research and development in this field, aiming to improve patient outcomes and quality of life

Estimating Children’s Weight and Comparison of Paediatric Weight Estimation Methods in an Indian Tertiary Hospital

Introduction: Managing pediatric emergencies is a challenging task as parameters like drug doses and equipment sizes are based on body weight. Inaccurate estimation of weight can lead to increased adverse drug reactions or non-responsiveness. However, measuring weight in emergency situations is not always feasible, especially in low and middle-income countries where weighing scales may be unavailable. Age-based formulae are available to estimate weight rapidly, but these have been created and validated using data from high-income countries, leaving a gap in formulae for low- and middle-income countries. This study aims to create and validate similar formulae for these countries to improve the accuracy of pediatric weight estimation in emergency situations. Objective: To determine which weight estimate provides the most accurate reading for the Indian population. This will allow us to provide recommendations for similar populations. Methodology: Study design: a cross-sectional study Inclusion criteria: Children between the ages of 1 and 18 years whose parents give consent. Exclusion criteria: Children who need immediate resuscitation, have conditions that could affect their weight, like oedema, or were on medications that could affect their weight, including long-term steroids. Children who have limb deformities. Study site: Tertiary Hospital in India Study duration: 2 Months Population Recruitment Children who visit hospitals for- Out-patient treatment In-patient treatment Immunization Sample Size Estimation We require at least 75 observations required for BlandAltman analysis to calculate the sample size for a multiple regression study keeping significance of 0.05 and power of study of 0.80. Data Collection • Target data: Age- (in years- depending on nearest birthday) Sex-(Male or Female) Height-(in cm- to nearest 0.1cm) - please mention the name of instrument, company, model number, country of manufacture Weight-(in kg- to nearest 0.1kg) - please mention the name of instrument, company, model number, country of manufacture Body habitus - Body habitus shall be measured by using a figural reference image adapted from the PAWPER study[ https://www.sciencedirect.com/science/article/pii/S0736467917309794#fig1 ] Instruments Measuring tape Weighing machine Record Handling and Data Keeping We would maintain records in a structured format in a Microsoft Excel spreadsheet. Outcome Measures Primary- The proportion of children whose weight would be estimated within 10%-20% of their actual weight by each weight estimation method to measure the accuracy. Secondary-The precision of the weight estimation methods in the form of Bland-Altman limits of agreement. Plan of Statistical Analysis We would use a multiple linear regression model to derive a new age-based formula with age, sex and length as variables. We would use Bland-Altman analysis to compare the different weight estimation methods. The statistical analysis would be conducted in SATA BE Application and Microsoft Excel software. Limitations We would only include children presenting at the time of our study. We would have to depend on the parents’ knowledge to record the age of the children. There could be a degree of error while recording the anthropometric variables based on the reliability of the machine and the measuring technique of the assessor. Our study would also be limited by the general restrictions of a multiple linear regression model. ETHICAL CONSIDERATION Study will be initiated only after getting clearance from IRC & IEC. No cost will be incurred from the participants for the purpose of the study. REFERENCES: Greig A, Ryan J, Glucksman E. How good are doctors at estimating children’s weight? J Accid Emerg Med. 1997 Mar;14(2):101–3. Harris M, Patterson J, Morse J. Doctors, nurses, and parents are equally poor at estimating pediatric weights. Pediatr Emerg Care. 1999 Feb;15(1):17–8. Ramarajan N, Krishnamoorthi R, Strehlow M, Quinn J, Mahadevan SV. Internationalizing the Broselow tape: how reliable is weight estimation in Indian children. Acad Emerg Med Off J Soc Acad Emerg Med. 2008 May;15(5):431–6. Wells M, Goldstein LN, Bentley A. A systematic review and meta-analysis of the accuracy of weight estimation systems used in paediatric emergency care in developing countries. Afr J Emerg Med Rev Afr Med Urgence. 2017;7(Suppl):S36–54. Sharma S, Arlappa N, Balakrishna N, Misra A, Laxmaiah A. Validation of APLS, Argall and Luscombe Formulae for Estimating Weight among Indian Children. Indian J Pediatr. 2019 Jul;86(7):648–50. Varghese A, Vasudevan VK, Lewin S, Indumathi CK, Dinakar C, Rao SDS. Do the length-based (Broselow) Tape, APLS, Argall and Nelson’s formulae accurately estimate weight of Indian children? Indian Pediatr. 2006 Oct;43(10):889–94. Shah V, Bavdekar SB. Validity of Broselow tape for estimating weight of Indian children. Indian J Med Res [Internet]. 2017 Mar [cited 2021 Mar 12];145(3):339–46. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555062/ Mishra DG, Kole T, Nagpal R, Smith JP. A correlation analysis of BroselowTM Pediatric Emergency Tape-determined pediatric weight with actual pediatric weight in India. World J Emerg Med [Internet]. 2016 [cited 2021 Mar 12];7(1):40–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786497/ Altman DG. Practical Statistics for Medical Research. CRC Press; 1990. 630 p

The potential of phosphorylated α-synuclein as a biomarker for the diagnosis and monitoring of multiple system atrophy.

Publication status: PublishedINTRODUCTION: Multiple system atrophy (MSA) is a rapidly progressive neurodegenerative disorder characterized by the presence of glial cytoplasmic inclusions (GCIs) containing aggregated α-synuclein (α-Syn). Accurate diagnosis and monitoring of MSA present significant challenges, which can lead to potential misdiagnosis and inappropriate treatment. Biomarkers play a crucial role in improving the accuracy of MSA diagnosis, and phosphorylated α-synuclein (p-syn) has emerged as a promising biomarker for aiding in diagnosis and disease monitoring. METHODS: A literature search was conducted on PubMed, Scopus, and Google Scholar using specific keywords and MeSH terms without imposing a time limit. Inclusion criteria comprised various study designs including experimental studies, case-control studies, and cohort studies published only in English, while conference abstracts and unpublished sources were excluded. RESULTS: Increased levels of p-syn have been observed in various samples from MSA patients, such as red blood cells, cerebrospinal fluid, oral mucosal cells, skin, and colon biopsies, highlighting their diagnostic potential. The α-Syn RT-QuIC assay has shown sensitivity in diagnosing MSA and tracking its progression. Meta-analyses and multicenter investigations have confirmed the diagnostic value of p-syn in cerebrospinal fluid, demonstrating high specificity and sensitivity in distinguishing MSA from other neurodegenerative diseases. Moreover, combining p-syn with other biomarkers has further improved the diagnostic accuracy of MSA. CONCLUSION: The p-syn stands out as a promising biomarker for MSA. It is found in oligodendrocytes and shows a correlation with disease severity and progression. However, further research and validation studies are necessary to establish p-syn as a reliable biomarker for MSA. If proven, p-syn could significantly contribute to early diagnosis, disease monitoring, and assessing treatment response

The paradoxical role of cytokines and chemokines at the tumor microenvironment: a comprehensive review

Abstract Tumor progression and eradication have long piqued the scientific community's interest. Recent discoveries about the role of chemokines and cytokines in these processes have fueled renewed interest in related research. These roles are frequently viewed as contentious due to their ability to both suppress and promote cancer progression. As a result, this review critically appraised existing literature to discuss the unique roles of cytokines and chemokines in the tumor microenvironment, as well as the existing challenges and future opportunities for exploiting these roles to develop novel and targeted treatments. While these modulatory molecules play an important role in tumor suppression via enhanced cancer-cell identification by cytotoxic effector cells and directly recruiting immunological effector cells and stromal cells in the TME, we observed that they also promote tumor proliferation. Many cytokines, including GM-CSF, IL-7, IL-12, IL-15, IL-18, and IL-21, have entered clinical trials for people with advanced cancer, while the FDA has approved interferon-alpha and IL-2. Nonetheless, low efficacy and dose-limiting toxicity limit these agents' full potential. Conversely, Chemokines have tremendous potential for increasing cancer immune-cell penetration of the tumor microenvironment and promoting beneficial immunological interactions. When chemokines are combined with cytokines, they activate lymphocytes, producing IL-2, CD80, and IL-12, all of which have a strong anticancer effect. This phenomenon opens the door to the development of effective anticancer combination therapies, such as therapies that can reverse cancer escape, and chemotaxis of immunosuppressive cells like Tregs, MDSCs, and TAMs