Short term results of endoscopic discectomy in lumbar spine

A recent modification to lumbar discectomy involves the use of a micro-endoscope instead of an operating microscope for visualization. Percutaneous endoscopic lumbar discectomy (PELD) uses a rigid operating spinal endoscope that allows direct visualization and excision of contained and non-contained herniated disc fragments. The advantages of Endoscopic lumbar discectomy are remarkable due to minimal bone resection, no damage to paravertebral muscles, rapid recovery, minimally procedure related morbidity, cost-effectiveness and high patient satisfaction rate. Aims and objectives is to study and evaluate clinical and radiological outcomes of endoscopic lumbar discectomy over a period of 6 months.24 patients underwent endoscopic lumbar discectomy proven with MRI in a span of 3 years from 2018 to 2021. Every patient was followed up for 6 months in an observational, retrospective and prospective type of study and assessed on the basis of MacNab criteria, VAS pain score, Oswestry low back pain questionnaire. Mean preoperative Oswestry disability score (ODS) was 74.38 while mean postoperative ODS was found to be 29.25. Preoperative, while analyzing through Macnab criteria, poor results were seen in 95.83% of patients while fair results were seen in 4.17% of patients. Postoperatively excellent results were seen in 16.67% of patients while good results were seen in 83.34% of patients. Mean preoperative VAS was 7.33 while mean postoperative VAS was found to be 2.91. Endoscopic discectomy is a safe and effective procedure where patient satisfaction and pain relief are not compromised. It may be an effective and alternative treatment option for the upward migration of disc herniation in the upper lumbar area and offers additional advantage for early mobilization and faster improvement

New classification of S1 pedicle morphometry impacting pedicle screw insertion technique

Background: The conventional entry point for the S1 pedicle screw insertion has been described as ‘at the base of and lateral to the superior S1 superior facet’. However, many orthopaedic surgeons complain that this technique is extremely demanding and is faced with many challenges in execution. Therefore, alternative entry points and modifications of existing techniques are explored for a greater convenience.Methods: We conducted a survey amongst 136 spine surgeons on the technical difficulties faced during insertion of the S1 pedicle screw. We also classified the S1 pedicles based by measuring their geometric parameters on 100 random computed tomography (CT) images.Results: The S1 pedicle entry technique was considered to be the most difficult and challenging by the orthopaedic surgeons in our survey due to an inadequate medial angulation due to paraspinal muscle mass tension and an overhanging iliac crest. This could be explained by the hourglass shaped pedicle (type 3) with a desired medial angle more 50 degrees (type III) observed as the most common S1 pedicle in the study population. To overcome this limitation, most of them preferred a tri-corticate approach.Conclusions: A more lateral entry point and a longer screw might be considered as solutions for a better and safer S1 pedicle entry. Also, the use of pre-operative CT can be considered to visualize the type of S1 pedicle and hence, decide on the most appropriate technique of screw insertion.

Efficacy and safety of anti-malarial drugs (chloroquine and hydroxy-chloroquine) in treatment of COVID-19 infection: a systematic review and meta-analysis

Background: Anti-malarial drugs inhibit coronaviruses in-vitro. Few published studies have evaluated the safety and efficacy of these drugs in the treatment of COVID-19 infection. Materials and Methods: This is a systematic review and meta-analysis of clinical trials and observational studies. Major database searches were carried out up until June 5, 2020. Participants admitted with RT-PCR-confirmed SARS Cov-2 (COVID-19) infection were included. The “Intervention group” received anti-malarial drugs with or without other drugs (Azithromycin) administered as an adjunct to the standard treatment/care. The “Control group” received treatment except anti-malarial drugs. The primary outcome is “all-cause mortality.” Secondary outcome measures were effects on clinical and laboratory parameters and adverse events. Results: Of 3,472 citations, 17 (six clinical trials and 11 observational studies) studies provided data of 8,071 participants. Compared to the control, Hydroxy-chloroquine (HCQ) has no significant effect on mortality [(OR 0.87; 95% CI 0.46–1.64); eight observational studies; N = 5,944]. Data from a single, small non-randomized trial (N = 42) also reached a similar conclusion (OR 1.94; 95% CI 0.07–50.57; p = 0.69). Compared to the control, HCQ plus Azithromycin (AZM) significantly increased mortality [(OR 2.84; 95% CI 2.19–3.69); four observational studies; N = 2,310]. Compared to the control, risk of any adverse event was significantly increased in HCQ group [(OR 3.35; 95% CI 1.58–7.13); four clinical trials; N = 263]. Compared to control, risk of adverse cardiac events (abnormal ECG, arrhythmia, or QT prolongation) were not significantly increased in HCQ group (but significantly increased in the HCQ plus AZM group). The GRADE evidence generated for all the outcomes was of “very low-quality.” Conclusions: As very low quality evidence suggests an increased risk of mortality and adverse event with HCQ plus Azithromycin combination (not HCQ alone), caution should be exercised while prescribing this combination for treatment of hospitalized adults with COVID-19 infection. Good quality, multi-centric RCTs (including both hospitalized and non-hospitalized patients) are required for any firm recommendation to be made during the ongoing pandemic. OSF Protocol Registration Link: https://osf.io/6zxsu

The outcome of transforaminal epidural steroidal injection in patients with lumbar canal stenosis: a study of 49 patients

Background: Lumbar canal stenosis is a disease of advanced age, commonly seen in individuals >60 years of age. The disease begins with neurogenic claudication and is progressively associated with weakness in the lower limbs. Often, these patients also have radiculopathy, which may be due to a contribution of foraminal stenosis and facet arthropathy. Methods: This research has been conducted on a sample of patients presenting to our tertiary care center with lumbar canal stenosis to evaluate the outcome of transforaminal epidural steroidal injection and to determine the therapeutic response of the patient in response to the epidural steroidal injection. A sample of 49 patients presenting with neurogenic claudication of 6 weeks duration (minimum) in correspondence with MRI finding suggestive of lumbar canal stenosis were chosen after obtaining informed consent for the procedure transforaminal epidural steroidal injection under fluoroscopy. Pre- and post-NRS scores were recorded at 2 instances. Results: The mean and standard deviation of pre-procedural and immediate post-procedural NRS scores were found to be 7.02±1.62 and 3.12±1.2 respectively. The mean and standard deviation of the 1-month post-procedure NRS was found to be 3.27±1.56. Considering successful treatment as more than 50% reduction in the NRS score at 1 month when compared to the pre-treatment NRS score, the successful outcome of the study was 63.26%. Conclusions: In our study, we have evaluated the effect of TEFSI in patients with lumbar canal stenosis presenting with neurogenic claudication and radiculopathy. Our study assessed pre-procedure, immediate post-procedure, and 1-month post-procedure NRS score following TEFSI. NRS score was assessed based on a questionnaire. The reduction of NRS score was equally seen in all patients irrespective of age, sex, and complaints

Magnesium sulphate for treating acute bronchiolitis in children up to two years of age

Background: Acute bronchiolitis is a significant burden on children, their families and healthcare facilities. It mostly affects children younger than two years of age. Treatment involves adequate hydration, humidified oxygen supplementation, and nebulisation of medications, such as salbutamol, epinephrine, and hypertonic saline. The effectiveness of magnesium sulphate for acute bronchiolitis is unclear. Objectives: To assess the effects of magnesium sulphate in acute bronchiolitis in children up to two years of age. Search methods: We searched CENTRAL, MEDLINE, Embase, LILACS, CINAHL, and two trials registries to 30 April 2020. We contacted trial authors to identify additional studies. We searched conference proceedings and reference lists of retrieved articles. Unpublished and published studies were eligible for inclusion. Selection criteria: Randomised controlled trials (RCTs) and quasi‐RCTs, comparing magnesium sulphate, alone or with another treatment, with placebo or another treatment, in children up to two years old with acute bronchiolitis. Primary outcomes were time to recovery, mortality, and adverse events. Secondary outcomes were duration of hospital stay, clinical severity score at 0 to 24 hours and 25 to 48 hours after treatment, pulmonary function test, hospital readmission within 30 days, duration of mechanical ventilation, and duration of intensive care unit stay. Data collection and analysis: We used standard methodological procedures expected by Cochrane. We used GRADE methods to assess the certainty of the evidence

Application of Handheld Tele-ECG for Health Care Delivery in Rural India

Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. The purpose of our study was to use handheld tele-electrocardiogram (ECG) developed by Bhabha Atomic Research Center (BARC) to identify heart conditions in the rural underserved population where the doctor-patient ratio is low and access to health care is difficult. The objective of our study was clinical validation of handheld tele-ECG as a screening tool for evaluation of cardiac diseases in the rural population. ECG was obtained in 450 individuals (mean age 31.49 ± 20.058) residing in the periphery of Chandigarh, India, from April 2011 to March 2013, using the handheld tele-ECG machine. The data were then transmitted to physicians in Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, for their expert opinion. ECG was interpreted as normal in 70% individuals. Left ventricular hypertrophy (9.3%) was the commonest abnormality followed closely by old myocardial infarction (5.3%). Patient satisfaction was reported to be ~95%. Thus, it can be safely concluded that tele-ECG is a portable, cost-effective, and convenient tool for diagnosis and monitoring of heart diseases and thus improves quality and accessibility, especially in rural areas

Recent development in the strategies projected for chikungunya vaccine in humans

The unprecedented epidemic spread of chikungunya worldwide illustrates the critical need for potent vaccines and therapeutic interventions. The morbidity and mortality associated with this arboviral infection has become a major public health problem in many countries across different continents. Increasing public–private partnerships have opened new avenues in research and development of vaccines. This review mainly focuses on the recent advances in patented approaches for chikungunya vaccine development and the forthcoming challenges

Central venous access devices for the delivery of systemic anticancer therapy: an economic evaluation

Objectives: Patients undergoing long-term anti-cancer therapy typically require one of three venous access devices (VADs): HICK, PICC, or PORT. Recent evidence has shown PORT is safer and improves patient satisfaction. However, PORT did not show improvement in quality-adjusted life years (QALYs) and was more expensive. Decisions regarding cost-effectiveness in the UK are typically informed by a cost-per-QALY metric. However, this approach is limited in its ability to capture the full range of relevant outcomes, especially in the context of medical devices. This study assessed the potential cost-effectiveness of HICK, PICC and PORT in routine clinical practice. Methods: Cost-consequence analysis to determine the trade-offs between the following outcomes: complication, infection, non-infection, chemotherapy interruption, unplanned device removals, health utilities, device insertion cost, follow-up cost, and total cost, using data from the CAVA clinical trial. We conducted Value of Implementation analysis of a PORT service. Results: PORT was superior in terms of overall complication rate, compared with both HICK (IRR: 0.422 (95% CI: 0.286 to 0.622)) and PICC (IRR: 0.295 (95% CI: 0.189 to 0.458)) and less likely to lead to an unplanned device removal. There was no difference in chemotherapy interruption or health utilities. Total cost with device in situ was lower on PORT, compared with HICK (£-98.86 (95% CI: -189.20 to -8.53)) and comparable with PICC -£48.57 (95% CI: -164.99 to 67.86)). Value of Implementation analysis found that PORT was likely to be considered cost-effective within the NHS. Conclusion: Decision makers should consider including PORT within the suite of VADs available within in the NHS

Deep learning based methodology for identification of windthrows in forestry data

Post-storm management is necessary after a storm has occurred. Post-storm management helps maintain the ecosystem of the forests. For post-storm management to start a rapid survey, a reliable estimation of the damage that happened must be acquired. Wind damage to forests has significant economic, ecological, and social impacts. In the case of managed forests, storms lead to increased risk of forest fires, loss of timer, damage to soil, insect and fungal damage, and damage to civil infrastructure. Along with these disadvantages, dead wood in controlled quantity is essential for the forest ecosystem. Thus, it is vital to recognize wind-damaged areas, specifically fallen trees due to winds/ windthrows, for proper management and restoration of forests. Change detection has been previously used for windthrow detection, which requires two images before and after the storm, which may be challenging to acquire due to atmospheric conditions and revisit times of remote platforms like satellites or Unmanned Aerial Vehicle (UAV). Hence, there is a push for single-image identification of windthrows. While deep learning has already been studied for summer storms, winter storms have not been the research focus. In this master thesis, single post-storm imagery is used. Data is from winter storms from the forests of Lower Saxony, Germany, and the task of windthrow identification is studied using deep learning methods. The dataset used has four channels, RGB-Near-Infrared (NIR). The post-storm images had a detailed prediction map consisting of four classes: no forest, forest with no windthrows, forest with windthrows, and cleared areas. Two deep learning models have been compared: DeepLabv3+ and U-Net. We study different channel combinations and input image tile sizes to obtain the best configuration for windthrow detection. DeepLabv3+ model outperforms the U-Net model with a prediction accuracy of 86.27% for windthrows, with the best accuracy of 95.03% across all classes, and a class IoU of 0.7440 for windthrow compared to a prediction accuracy of 80.97% for windthrows and class IoU of 0.6944 for windthrows for the U-Net model. DeepLabv3+ and U-Net models were able to process 2048 × 2048 mosaics with an input image tile size of 512 × 512 in nearly 889ms and 875ms, respectively. As a result, a fast and well-performing windthrow detection model based on DeepLabv3+ is developed