Multi Degree of Freedom Hinge Joints Embedded on Tubes for Miniature Steerable Medical Devices

With the proliferation of successful minimally invasive surgical techniques, comes the challenge of shrinking the size of surgical instruments further to facilitate use in applications such as neurosurgery, pediatric surgery, and needle procedures. The present thesis introduces laser machined, multi-degree-of-freedom (DoF) hinge joints embedded on tubes, as a possible means to realize such miniature instruments without the need for any assembly. A method to design such a joint for an estimated range of motion is explored by using geometric principles. A geometric model is developed to characterize the joint and relate it to the laser machining parameters, design parameters, and the workpiece parameters. The extent of interference between the moving parts of the joint can be used to predict the range of motion of the joint for rigid tubes and for future design optimization. The total usable workspace is estimated using kinematic principles for joints in series and for two sets of orthogonal joints. The predicted range of motion was compared to the measured values for fabricated samples of different hinge sizes and kerf dimensions, and it was shown that the predicted values are close to the measured ranges across samples. The embedded hinge joints described in this thesis could be used for micro-robotic applications and minimally invasive surgical devices for neurosurgery and pediatric surgery. Our work can open up avenues to a new class of miniature robotic medical devices with hinge joints and a usable channel for drug delivery

Early exposure of laparoscopic anatomy to first year medical undergraduate students: is it necessary?

The teaching of undergraduate anatomy is particularly based on cadaveric dissection. Currently, medical curriculum is continually evolving and focusing on clinical application, especially for first year medical undergraduate students. Recently, surgical educators defined a role for laparoscopy in teaching anatomy. This study was conducted to know the opinion by first year medical undergraduate students, of current teaching practices and which teaching modalities should be emphasized. In this study a total of 200 first-year medical undergraduate students were exposed to a Diagnostic Laparoscopy with appendectomy video, with explanation/commentary by a laparoscopic surgeon. A pre-test and a post-test questionnaire were given before and after exposure to the video. The objective of the study was to collect students’ opinion by answering the questions in the questionnaire. All pre-test and post-test questionnaire results were analysed. The results were quantified in terms of percentage. The knowledge of anatomy of abdominal wall and peritoneal cavity improved from 62% to 91% of students after exposure to surgical video. Similarly, knowledge regarding laparoscopy improved from 37% to 85% and awareness about surgical video as an additional method of learning improved from 46% to 89%. Almost 93% of students were able to appreciate the organs and structures within intraperitoneal cavity. Hence, the clinicians/surgeons need to try their best and put in their maximum efforts to make the training of future medical graduates more efficient and knowledgeable in anatomy subject, by creating interest in learning of the subject by using such additional method (surgical videos) learning tool

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Comparative study of the outcome of pediatric femur diaphyseal fractures treated with titanium elastic nails vs. compression plates

Background: A variety of methods have been described for the management of femur diaphyseal fractures in children between ages of 5 to 12 years. Some of the techniques include closed reduction and internal fixation (CRIF) with elastic nails, open reduction and internal fixation (ORIF) with compression plates, external fixators and skeletal traction with spica casting. This study was done to compare the outcome and complications of diaphyseal femur fractures in pediatric age treated with CRIF with Titanium elastic nails vs. ORIF with compression plates.Methods: The study was a prospective, clinical study.  A total of 60 patients were studied. 30 patients were treated with CRIF with titanium nails and 30 patients were treated with ORIF with compression plates. Every patient operated was followed up at 3 weeks, 6 weeks, 3 months, 6 months and 3 monthly thereafter until implant removal.Results: Only 1 wound healing complication was noted in the TENS nail group which was skin irritation at the site of pin insertion. In the compression plating group, 6 patients developed wound complications, including superficial infections, deep infections and keloids. The range of movements at knee joint in the two groups was compared.  Only 1 patient had a significant loss of flexion with ROM of less than 100 degrees in the TENS nail group. In the plating group 4 patients had a significant loss of flexion with ROM of less than 100 degrees. Limb length discrepancies were seen in 3 patients in the TENS nail group whereas the compression plating group showed 1 patient. 2 patients in the TENS group developed an angular deformity due to premature weight bearing.  3 patients in the compression plating group developed deformities at the fracture site. The average time for fracture union in the compression plate group was 10.7 weeks and was 14.7 weeks in the patients treated with TENS nail. Conclusions: No single fixation method can be considered superior in all types and patterns of pediatric diaphyseal femur fractures. Titanium elastic nails can be considered a better implant for treating pediatric femur fractures when compared to compression plates due to the lesser rates of surgical wound complications, better range of movements at knee joint and overall lesser complication rate as was recorded in this study

Adaptive Energy-Optimized Consolidation Algorithm

We have been hearing about cloud computing for quite a long time now. This type of computing is booming and emerging as a popular computing paradigm for its scalability and flexibility in nature. Cloud computing provides the provision of service on-demand, on-demand resources supply and services to end-users. However, energy consumption and energy wastage are becoming a major concern for cloud providers due to its direct impression on costs required for operations and carbon emissions. To tackle this issue, Adaptive Energy-Optimized Consolidation Algorithm has been proposed to efficiently manage energy consumption in cloud environments. This algorithm involves sharing by dividing, in this process resource allocation is done into two different phases, those are, consolidation of tasks and consolidation of resources. Compared to single-task consolidation algorithms, the proposed two-phase Adaptive energy optimized consolidation algorithm shows improved performance in terms of energy efficiency and resource utilization. The results of experiments conducted using a cloud-sim show the effectiveness of the proposed algorithm in decreasing energy consumption while maintaining the quality-of-service requirements of computing in cloud.  The need for an hour is to automate things without human intervention. Thus, using Autonomous computing refers to a type of computing system that is capable of performing tasks and making decisions without the intervention of humans. This type of system typically relies on Artificial.Intelligence, Machine.Learning, and other futuristic technologies to study the data, identify patterns, and make decisions based on that data. Cloud computing can certainly be incorporated into an autonomous computing system. The performance of an automated computing environment depends on a various factor, considering the quality of the different algorithms used, also the amount and quality of various data available to the system, the computational resources available, and the system's ability to learn and adapt over time. However, by incorporating cloud computing, an autonomous computing system can potentially access more resources and process data more quickly, which can improve its overall performance

Gaining insights into chronic obstructive pulmonary disease exacerbation through emerging biomarkers and the chronic obstructive pulmonary disease assessment test score

Chronic obstructive pulmonary disease (COPD), a leading cause of mortality and morbidity, presents significant challenges, particularly with exacerbations, which drastically impact patients' health and healthcare costs. The Global Initiative for Chronic Obstructive Lung Disease guidelines recommend comprehensive assessments beyond spirometry, with the COPD assessment test (CAT) emerging as a pivotal tool. Despite its utility, the relationship between CAT scores and specific biomarkers during exacerbations remains unclear. Hence, this study aims to assess the correlation between the CAT score and specific circulating biomarkers. A cross-sectional study from August 2023 to January 2024 included 59 COPD patients with exacerbations who underwent pulmonary function tests and completed the CAT score assessment. The CAT score cut-off point was set at 20, where a CAT score <20 indicated a low impact on health status and a CAT score ≥20 indicated a high impact on health status. On the same day, measurements of neutrophils, leukocytes, eosinophils, C-reactive protein, and procalcitonin were conducted. Patients with CAT scores ≥20 had significantly higher levels of neutrophils (p=0.001), leukocytes (p=0.006), procalcitonin (p=0.010), and forced expiratory volume in the first second/forced vital capacity (p=0.002), but lower eosinophil levels (p=0.025). A positive correlation existed between total CAT score and neutrophils (p=0.001), leukocytes (p=0.000), and procalcitonin (p=0.010), while eosinophil levels showed a negative correlation (p=0.025). The spirometry parameters showed no correlation with the total CAT score. This study highlights the link between CAT and key inflammatory biomarkers, supporting the use of blood biomarkers to identify COPD patients at risk of exacerbations

Spontaneous retroperitoneal hematoma with deep venous thrombosis of left lower limb managed conservatively

Deep vein thrombosis (DVT) of iliac and femoral veins is a common condition in our clinical practice. Spontaneous retroperitoneal hematoma (SRH) is a relatively rare condition. The occurrence of both DVT and SRH concomitantly is very rare. Many of the times the exact pathology leading to SRH with DVT is unknown. Both conditions being fatal in nature, the management remains very challenging. Here we report a similar case with review of the literature