ICAR: endoscopic skull‐base surgery

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Looking beyond protected areas: Identifying conservation compatible landscapes in agro-forest mosaics in north-eastern India

Small-sized protected areas face increasing pressures from developmental activities and are often rendered inadequate and isolated to conserve wide-ranging species. However, in situations where wildlife persists outside protected areas, conservation goals may be met by aligning the ecological needs of wildlife with the socio-economic needs of local communities and offsetting losses arising due to shared spaces. We explore the potential of a tea-plantation dominated landscape of multiple land-use in north-eastern India to conserve the Asian elephant and the Indian leopard. We assess conservation potential by identifying predictors of species use of particular habitats using species distribution models and identify challenges by reviewing the available literature. Elephants used ~680 km2 of this 1200 km2 non-forested landscape; within this area, habitats with a higher proportion of deciduous forest patches were favored. Leopards were found to be ubiquitous in tea-plantation and used ~950 km2 of the study area, with the proportion of tea cover being the single best predictor of leopard habitat-use. With more than 30 human deaths and 100 injuries per year caused by these two species in the study area alone, the high frequency of human casualties and economic losses remain the prime hurdles to long-term conservation efforts. We discuss specific mitigation measures to reduce human casualties and call for the inclusion of important stakeholders in the mitigation process. The study provides a template for identifying conservation-compatible landscapes outside protected areas and a framework for identifying challenges and potential to mitigate current or future conservation conflicts

Complementary Alternative Medical Therapies for Heart Surgery Patients: Feasibility, Safety, and Impact

BACKGROUND: Complementary therapies (touch, music) are used as successful adjuncts in treatment of pain in chronic conditions. Little is known about their effectiveness in care of heart surgery patients. Our objective is to evaluate feasibility, safety, and impact of a complementary alternative medical therapies package for heart surgery patients. METHODS: One hundred four patients undergoing open heart surgery were prospectively randomized to receive either complementary therapy (preoperative guided imagery training with gentle touch or light massage and postoperative music with gentle touch or light massage and guided imagery) or standard care. Heart rate, systolic and diastolic blood pressure, and pain and tension were measured preoperatively and as pre-tests and post-tests during the postoperative period. Complications were abstracted from the hospital record. RESULTS: Virtually all patients in the complementary therapy group (95%) and 86% in standard care completed the study. Heart rate and blood pressure patterns were similar. Decreases in heart rate and systolic blood pressure in the complementary therapies group were judged within the range of normal values. Complication rates were very low and occurred with similar frequency in both groups. Pretreatment and posttreatment pain and tension scores decreased significantly in the complementary alternative medical therapies group on postoperative days 1 (p \u3c 0.01) and 2 (p \u3c 0.038). CONCLUSIONS: The complementary medical therapies protocol was implemented with ease in a busy critical care setting and was acceptable to the vast majority of patients studied. Complementary medical therapy was not associated with safety concerns and appeared to reduce pain and tension during early recovery from open heart surgery

The effect of postoperative medical treatment on left ventricular mass regression after aortic valve replacement.

OBJECTIVE: The study objective was to analyze factors associated with left ventricular mass regression in patients undergoing aortic valve replacement with a newer bioprosthesis, the Trifecta valve pericardial bioprosthesis (St Jude Medical Inc, St Paul, Minn). METHODS: A total of 444 patients underwent aortic valve replacement with the Trifecta bioprosthesis from 2007 to 2009 at 6 US institutions. The clinical and echocardiographic data of 200 of these patients who had left ventricular hypertrophy and follow-up studies 1 year postoperatively were reviewed and compared to analyze factors affecting left ventricular mass regression. RESULTS: Mean (standard deviation) age of the 200 study patients was 73 (9) years, 66% were men, and 92% had pure or predominant aortic valve stenosis. Complete left ventricular mass regression was observed in 102 patients (51%) by 1 year postoperatively. In univariate analysis, male sex, implantation of larger valves, larger left ventricular end-diastolic volume, and beta-blocker or calcium-channel blocker treatment at dismissal were significantly associated with complete mass regression. In the multivariate model, odds ratios (95% confidence intervals) indicated that male sex (3.38 [1.39-8.26]) and beta-blocker or calcium-channel blocker treatment at dismissal (3.41 [1.40-8.34]) were associated with increased probability of complete left ventricular mass regression. Patients with higher preoperative systolic blood pressure were less likely to have complete left ventricular mass regression (0.98 [0.97-0.99]). CONCLUSIONS: Among patients with left ventricular hypertrophy, postoperative treatment with beta-blockers or calcium-channel blockers may enhance mass regression. This highlights the need for close medical follow-up after operation. Labeled valve size was not predictive of left ventricular mass regression