Safety and Efficacy of Paracetamol + Lignocaine Injection in Patients with High-grade Fever:A Prospective Analysis

Paracetamol is frequently used as an analgesic and antipyretic across the world. However, there is no data on Indian patients regarding the safety and efficacy of paracetamol + lignocaine injection in patients with high-grade fever. Hence, a prospective analysis was conducted to assess the safety and efficacy of paracetamol and lignocaine injection in patients with high-grade fever and mild-to-moderate body pain. The study is a real-world prospective study. The results showed that following intervention with paracetamol and lignocaine injection, 98% patients showed resolution of fever and 58% patients showed improvement in pain symptoms. The authors suggest that clinicians should consider paracetamol and lignocaine injection in patients with high-grade fever and associated pain and discomfort

Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial

Background Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. Methods In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH,non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2–F3, or F1 with at least oneaccompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpointsfor the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2–F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. Findings Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1–F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2–F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1–F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). Interpretation Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A Novel Laser-Aided Machining and Polishing Process for Additive Manufacturing Materials with Multiple Endmill Emulating Scan Patterns

In additive manufacturing (AM), the surface roughness of the deposited parts remains significantly higher than the admissible range for most applications. Additionally, the surface topography of AM parts exhibits waviness profiles between tracks and layers. Therefore, post-processing is indispensable to improve surface quality. Laser-aided machining and polishing can be effective surface improvement processes that can be used due to their availability as the primary energy sources in many metal AM processes. While the initial roughness and waviness of the surface of most AM parts are very high, to achieve dimensional accuracy and minimize roughness, a high input energy density is required during machining and polishing processes although such high energy density may induce process defects and escalate the phenomenon of wavelength asperities. In this paper, we propose a systematic approach to eliminate waviness and reduce surface roughness with the combination of laser-aided machining, macro-polishing, and micro-polishing processes. While machining reduces the initial waviness, low energy density during polishing can minimize this further. The average roughness (Ra = 1.11 µm) achieved in this study with optimized process parameters for both machining and polishing demonstrates a greater than 97% reduction in roughness when compared to the as-built part

Subsurface imaging of brown coal bearing Tertiary sedimentaries Deccan Trap interface using microtremor method

We propose an application of the microtremor (ambient noise) H/V spectral ratio technique to identify significant rheological boundaries at shallow depths, estimate thickness of both lignite bearing Tertiary sedimentary sequence and late Cretaceous Deccan basalt flows and comprehend basinal geometry of Umarsar Basin (Babia syncline). Forty-six stations were gauged in a grid format at similar to 250 m resolution during the microtremor survey. The microtremor H/V spectral ratio technique takes into account the frequency of the ratio between the horizontal (NS + EW) and vertical components of persistent Rayleigh waves in the area. Depth estimates are made using Mean_VS (433.69 m/s) from three borehole records (MMA_Vs (431.6 m/s), MMB_Vs (406.86 m/s) and MMC_Vs (462.6 m/s) using standard relationship between depth and velocity. In the present study, we recognize three rheological interfaces viz., L-1 interface (0.2328 Hz to 0.3862 Hz), L-2 interface (0.7843 Hz to 2.5123 Hz) and L-3 interface (6.2477 Hz to 27.1119 Hz). The geology and stratigraphic records supplement correlation for L1,L2 and L-3 interfaces with Mesozoic-Deccan Trap (M-DT) boundary, Deccan Trap-Tertiary (DT-T) boundary, and boundaries between shale-carbonate hardpans within sediment sequence belonging to Naredi Formation respectively. The estimated depth range for M-DT boundary (L-1) is 281-466 m and for DT-T boundary (L-2)is 43-138 m. The subsurface image acquired from the frequency records advocates for a palaeo high in SE portion that retains its entity over the present landscape. The frequency records advocate for 369 m to 206 m thick Deccan basalt and 85 m to 18 m thick lignite bearing Naredi Formation. The ambient noise seismic study further suggests NW-SE trending basin geometry of Babia syncline comprising three distinct depressions having six local depocenters. Finally, we propose the microtremor H/V spectral ratio technique as a tool to develop economical borehole plan with realistic reserve estimate and a step forward towards rapid economical assessment covering large mining lease areas complementary to local geological studies. (C) 2018 Elsevier B.V. All rights reserved

Fontan procedure on deep hypothermic circulatory arrest: Short-term results and technique

Background : Various operative strategies are described for the Fontan procedure. In this study, we describe our short-term results and technique of Fontan procedure on cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). Methods : This was a retrospective study of 32 patients, median age of 6 years (4–19 years) and median weight of 20 kg (13–51 kg), who underwent Fontan procedure on CPB and DHCA from July 2016 to July 2021. Results : The median CPB time was 125 min (77–186 min), the median DHCA time was 42 min (27–50 min), and the median Fontan pressure was 14 mmHg (10–18 mmHg). The median time to extubation was 4 h (1–20 h), the duration of chest tube drainage was 8 days (5–24 days), and the median intensive care unit stay was 4 days (3–8 days). The presence of heterotaxy was associated with longer duration of pleural drainage (P = 0.01). There was no operative mortality and no major adverse events such as seizures, gross neurological deficits, or arrhythmias in the postoperative period. Conclusions : Fontan procedure can be safely performed on CPB and DHCA with good operative results. This operative strategy may be used in special circumstances like in patients with situs and systemic venous anomalies and those requiring repair of a complex intracardiac defect. Long-term follow-up will be required to evaluate if this strategy has any impact on the neurodevelopmental outcome and the long-term sequelae of Fontan

Subsurface profiling along Banni Plains and bounding faults, Kachchh, Western India using microtremors method

The present article is a maiden attempt to map shallow subsurface rheological interfaces laterally across the Banni Plains and to decode geometry of the antecedent faults associated with the Kachchh Mainland Fault using the microtremor method. We conducted microtremor data acquisition for thirty-one sites along N-S transect from Loriya in Mainland Kachchh to Bhirandiara towards Patcham Island. Results from H/V spectral ratio technique show presence of two distinct rheological interfaces characterised by the resonant frequency (f(r)) ranges 0.23-0.27 Hz and 0.8252-1.5931 Hz respectively. The above frequency ranges are correlated with the depths of the Mesozoic-Basement (M-B) interface and the Quaternary-Tertiary (Q-T) interface. Using either the velocity (Vs) of seismic waves at the M-B and Q-T interfaces (calculated as 1830 m/s and 411 m/s respectively) or the standard non-linear regression relationship derived for the Banni Plains (h = 110.18f(r)(-1.97)) we estimate the depth range for M-B interface to be 1442-1965 m and for Q-T interface to be 44-160 in. The subsurface profile across the Banni Plains educe cluster of four faults that develop an array of imbricate faults at the forefront of the Kachchh Mainland Fault within the Banni Footwall Syncline. The geometry of the faults suggests a `positive flower structure' indicating step-overs and strain restraining bends displaying push-ups resulting from localized shortening between converging bends of Kachchh Mainland Fault and the South Wagad Fault. The Banni Footwall Syncline preserves evidence of two episodes of deformations. The initial deformation event led to subsidence within the Kachchh Mainland Fault Zone bringing Mesozoic sequence juxtaposed to the basement rocks, whereas the later event is dominated by an uplift developing a positive flower structure in the Kachchh Mainland Fault Zone. Finally, the present study provides a mechanism to investigate faults and fault geometries correlating surface structural grains with subsurface structures