Intraoperative embolism or type I hypersensitivity reaction to gelofusine®

Despite rare reports of Type I Hypersensitivity reactions (anaphylaxis) to colloid plasma expanders, they find wide application during resuscitation and major surgeries. We present the case of a possible Type I hypersensitivity reaction to Gelofusine® in a 42-year-old female patient during oncological surgery. The delayed manifestation caused some diagnostic confusion with an embolic event. The patient was symptomatically treated and the rest of the surgery was completed uneventfully. A high index of suspicion is vital for prompt identification and treatment of anaphylaxis

Preliminary Screening of Antimicrobial Properties of Few Medicinal Plants

Crude extracts were prepared from the leaves of ten medicinal plants viz., Alpinia galanga, Artabotrys uncinatus, Commelina benghalensis, Costus igneus, Euphorbia cyathopora, Justicia gendarussa, Kalanchoe pinnata, Panicum antidotale, Sauropus androgynous and Hibiscus using methanol as solvent and screened for their antibacterial activity against ten bacterial pathogens. The tested gram positive bacterial strains were Bacillus cerus, Bacillus megaterium, Micrococcus leuteus, Staphylococcus aureus, Streptococcus lactis, and gram negative strains were Pseudomonas aeruginosa, Escherichia coli, Enterobacter aerogenes, Klebsiella pneumoniae and Salmonella typhimurium. Among the ten plants tested, the methanol extracts of Alpinia galanga, Artabotrys uncinatus, Costus igneus and Yellow Hibiscus exhibited higher antibacterial activity when compared to the other plant extracts. These four plant extracts were further used for the phytochemical analysis. Results of the phytochemical analysis indicated the presence of alkaloids, phenolic compounds and flavanoids. The antibacterial activities of the leaves were due to the presence of various secondary metabolite

Sleep duration in school-age children with epilepsy: A cross-sectional study

Background: Normal sleep is required for the optimal growth and development of the children. Ineffective or inadequate sleep is common in children with epilepsy. Objectives: The objectives of this study were to study the sleep duration and describe the factors affecting it in school-aged children with epilepsy attending the seizure clinic of a pediatric tertiary care hospital. Materials and Methods: 6–12-year-old children with epilepsy, attending the seizure clinic formed the study subjects. They were assessed for inclusion in the study using INCLEN diagnostic tool for epilepsy (INDT-Epi) to achieve a sample size of 139. Informed written consent was obtained from parents. Background sociodemographic information, seizure type and treatment details, and duration of sleep of the child were collected from the parents. The proportion of children with epilepsy who had sleep problems were expressed as percentage. Results: The mean age of study population was 9.07±2.09 years. The average sleep duration of the study population was 9.41±1.41 h. The mean nap time of the study population was 68.51±33.88 min. No significant association was seen among the factors that determine sleep duration. Conclusion: Children with epilepsy tend to sleep for lesser hours when compared to historic controls of normal school-age children reported in literature

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Revolutionizing connectivity: Unleashing the power of 5G wireless networks enhanced by artificial intelligence for a smarter future

In the context of 5G wireless networks, this paper addresses a crucial concern—data loss in Analog-to-Digital Converters (ADCs) embedded within Multiple Input Multiple Output (MIMO) channels, a prevalent challenge in modern wireless communication systems. Despite the integration of ADCs in MIMO configurations to mitigate this issue, their implementation introduces significant complexities. In response to this, the paper introduces an innovative and efficient approach aimed at enhancing channel estimation in 5G MIMO systems. The proposed methodology relies on a heuristic-based optimization technique within a channel prediction framework. The framework uses feedback information collected through a Cascade Fusion Serial Network (CFSN) to analyze the receiver-side error ratio and estimate the channel coefficients of MIMO systems at the transmitter. An attention mechanism is incorporated into the model design through the use of a Convolutional Neural Networks - Gated Recurrent Units (CNN-GRU) and a Multi-Scaled Stacked Auto encoder. Parameters of Attention CNN-GRU, Stacked Auto encoder, and CFSN are refined using the Whale Optimization method. The optimization objective is to minimize key metrics, including Root Mean Squared Error (RMSE), Bit Error Rate (BER), and Mean Squared Error (MSE) associated with the estimated channel. Experimental evaluations underscore the efficacy of the proposed MIMO model in the context of 5G networks. The results demonstrate improved convergence rates, heightened prediction performance, and reduced computational costs compared to existing methods. This research contributes valuable insights into addressing data loss challenges specific to 5G MIMO systems, providing a pioneering solution that integrates heuristic optimization, advanced neural network architectures, and nature-inspired algorithms for parameter tuning

Virological and cytological changes in tears and conjunctiva of patients with COVID-19

Purpose: To analyze the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in tears/conjunctival epithelium and assess the cytomorphological changes in the conjunctival epithelium of coronavirus disease 2019 (COVID-19) patients. Methods: In this pilot study, patients with moderate to severe COVID-19 were recruited from the COVID ward/intensive care unit of the institute. Tears and conjunctival swabs were collected from COVID-19 patients and sent to the virology laboratory for reverse transcription polymerase chain reaction (RT-PCR) testing. Conjunctival swabs were used to prepare smears, which underwent cytological evaluation and immunocytochemistry for SARS-CoV-2 nucleocapsid protein. Results: Forty-two patients were included. The mean age of participants was 48.61 (range: 5–75) years. Seven (16.6%) patients tested positive for SARS-CoV-2 ribonucleic acid in tears samples, four (9.5%) of which were positive on conjunctival swab by RT-PCR in the first test. Cytomorphological changes were observed significantly more in smears from patients with positive RT-PCR on tear samples, including bi-/multi-nucleation (p = 0.01), chromatin clearing (p = 0.02), and intra-nuclear inclusions (p < 0.001). One case (3.2%) showed immunopositivity for SARS-CoV-2; this patient had severe disease and the lowest Ct values for tear and conjunctival samples among all positive cases. Conclusion: Conjunctival smears from patients with COVID-19 revealed cytomorphological alterations, even in the absence of clinically significant ocular infection. However, viral proteins were demonstrated within epithelial cells only rarely, suggesting that although the conjunctival epithelium may serve as a portal for entry, viral replication is possibly rare or short-lived

Adaptive exhaustion during prolonged intermittent hypoxia causes dysregulated skeletal muscle protein homeostasis

KEY POINTS: Sarcopenia or skeletal muscle loss is one of the most frequent complications that contributes to mortality and morbidity in patients with chronic obstructive pulmonary disease (COPD). Unlike chronic hypoxia, prolonged intermittent hypoxia is a frequent, underappreciated and clinically relevant model of hypoxia in patients with COPD. We developed a novel, in vitro myotube model of prolonged intermittent hypoxia with molecular and metabolic perturbations, mitochondrial oxidative dysfunction and consequent sarcopenic phenotype. In vivo studies in skeletal muscle from a mouse model of COPD shared responses with our myotube model establishing pathophysiological relevance of our studies. These data lay the foundation for translational studies in human COPD to target prolonged, nocturnal hypoxemia to prevent sarcopenia in these patients. ABSTRACT: Nocturnal hypoxemia that is common in chronic obstructive pulmonary disease (COPD) patients is associated with skeletal muscle loss or sarcopenia, which contributes to adverse clinical outcomes. In COPD, we have defined this as prolonged intermittent hypoxia (PIH) because the duration of hypoxia in skeletal muscle occurs through the duration of sleep followed by normoxia during the day in contrast to recurrent brief hypoxic episodes during obstructive sleep apnea (OSA). Adaptive cellular responses to PIH are not known. Responses to PIH induced by 3-cycles of 8h hypoxia followed by 16h normoxia were compared to those during chronic hypoxia (CH) or normoxia for 72h in murine C2C12 and human inducible pluripotent stem cell-derived differentiated myotubes. RNA sequencing followed by downstream analyses were complemented by experimental validation of responses that included both unique and shared perturbations in ribosomal and mitochondrial function during PIH and CH. A sarcopenic phenotype characterized by decreased myotube diameter and protein synthesis, and increased phosphorylation of eIF2α (Ser51) by eIF2α kinase, GCN-2 (general controlled non-derepressed-2), occurred during both PIH and CH. Mitochondrial oxidative dysfunction, disrupted supercomplex assembly, lower activity of Complexes I, III, IV and V, and reduced intermediary metabolite concentrations occurred during PIH and CH. Decreased mitochondrial fission occurred during CH. Physiological relevance was established in skeletal muscle of mice with COPD that had increased phosphorylation of eIF2α, lower protein synthesis, and mitochondrial oxidative dysfunction. Molecular and metabolic responses with PIH suggests an adaptive exhaustion with failure to restore homeostasis during normoxia. Abstract figure legend Prolonged intermittent hypoxia (PIH) is commonly demonstrated in patients with COPD (chronic obstructive pulmonary disease); however, the effects of PIH on skeletal muscle are unclear. We tested the hypothesis that PIH causes skeletal muscle loss or sarcopenia in vitro by down-regulating protein synthesis and causing mitochondrial oxidative dysfunction associated with dysregulation of hypoxia inducible factors (HIF1α and HIF2α). α-ketoglutarate (αKG), a critical TCA cycle intermediate and co-factor for the degradation of HIF1α, was reduced due to PIH. Physiological relevance was established in skeletal muscle of mice with COPD. Our findings suggest that PIH causes sarcopenia through adaptive exhaustion and failure to restore homeostasis during normoxia. This article is protected by copyright. All rights reserved