An Unusual Case of Urinary Tract Infection in a Pregnant Woman With Photobacterium damsela

We describe a case of a urinary tract infection with an unusual pathogen, Photobacterium damsela, in a pregnant female. This pathogen has been described as having a virulent life threatening nature, so a detailed history and prompt treatment is needed

COMPARISON OF PREDICTORS OF DIFFICULT INTUBATION

Context: Unanticipated difficult laryngoscopy and tracheal intubation always remain a primary concern for an anaesthesiologist as the failure to maintain a patent airway during induction of anaesthesia may lead to anaesthesia related morbidity and mortality. Aims: The aim of our study was to predict difficult intubation and to identify best predictor(s) among them and also to compare the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of various airway parameters.Airway parameters taken in our study were Modified Mallampati Classification (MMT), Thyromental Distance (TMD), Sternomental Distance (SMD), Interincisor Gap (IIG), Upper Lip Bite Test (ULBT), Degree of Neck Extension (DNE), Anterior Subluxation of Mandible (ASM) and Protruding Teeth (PT). Methods and Material: 350 patients of ASA Grade 1 and 2 scheduled for various elective surgeries under general anaesthesia were included in our study and were assessed preoperatively for different airway parameters. Intraoperatively all patients were classified as difficult and easy intubation group according to Cormack and Lehane laryngoscopic view. Clinical data of each test was collected, tabulated and analyzed to obtain the sensitivity, specificity, positive predictive value and negative predictive value. Results: The upper lip bite test had the highest sensitivity (80%); Anterior subluxation of mandible had highest specificity (99.06%) and both of above were most accurate tests. The overall incidence of difficult intubation was 8.57%. Conclusion: Upper lip bite test was the best predictor of difficult intubation and it should be included as a routine test along with Modified mallampati test in preanaesthetic evaluation

COMPARISON OF PREDICTORS OF DIFFICULT INTUBATION

Context: Unanticipated difficult laryngoscopy and tracheal intubation always remain a primary concern for an anaesthesiologist as the failure to maintain a patent airway during induction of anaesthesia may lead to anaesthesia related morbidity and mortality. Aims: The aim of our study was to predict difficult intubation and to identify best predictor(s) among them and also to compare the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of various airway parameters.Airway parameters taken in our study were Modified Mallampati Classification (MMT), Thyromental Distance (TMD), Sternomental Distance (SMD), Interincisor Gap (IIG), Upper Lip Bite Test (ULBT), Degree of Neck Extension (DNE), Anterior Subluxation of Mandible (ASM) and Protruding Teeth (PT). Methods and Material: 350 patients of ASA Grade 1 and 2 scheduled for various elective surgeries under general anaesthesia were included in our study and were assessed preoperatively for different airway parameters. Intraoperatively all patients were classified as difficult and easy intubation group according to Cormack and Lehane laryngoscopic view. Clinical data of each test was collected, tabulated and analyzed to obtain the sensitivity, specificity, positive predictive value and negative predictive value. Results: The upper lip bite test had the highest sensitivity (80%); Anterior subluxation of mandible had highest specificity (99.06%) and both of above were most accurate tests. The overall incidence of difficult intubation was 8.57%. Conclusion: Upper lip bite test was the best predictor of difficult intubation and it should be included as a routine test along with Modified mallampati test in preanaesthetic evaluation

Feasibility of an Assessment Tool as a Data-Driven Approach to Reducing Racial Bias in Biomedical Publications.

The editorial independence of biomedical journals allows flexibility to meet a wide range of research interests. However, it also is a barrier for coordination between journals to solve challenging issues such as racial bias in the scientific literature. A standardized tool to screen for racial bias could prevent the publication of racially biased papers. Biomedical journals would maintain editorial autonomy while still allowing comparable data to be collected and analyzed across journals. A racially diverse research team carried out a three-phase study to generate and test a racial bias assessment tool for biomedical research. Phase 1, an in-depth, structured literature search to identify recommendations, found near complete agreement in the literature on addressing race in biomedical research. Phase 2, construction of a framework from those recommendations, provides the major innovation of this paper. The framework includes three dimensions of race: 1) context, 2) tone and terminology, and 3) analysis, which are the basis for the Race Equity Vetting Instrument for Editorial Workflow (REVIEW) tool. Phase 3, pilot testing the assessment tool, showed that the REVIEW tool was effective at flagging multiple concerns in widely criticized articles. This study demonstrates the feasibility of the proposed REVIEW tool to reduce racial bias in research. Next steps include testing this tool on a broader sample of biomedical research to determine how the tool performs on more subtle examples of racial bias. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10916-021-01777-w

Emergency Department Healthcare Providers’ Knowledge of Ischemic Stroke

Introduction: Stroke is one of the leading causes of death and disability in the United States. Nationally, only 3-8% of patients with Acute Ischemic Stroke (AIS) who are eligible for thrombolysis currently receive recombinant tissue plasminogen factor (r-TPA). Lack of knowledge and familiarity with thrombolytics in stroke therapy are major impediments. We investigated the baseline stroke management concepts and knowledge of AIS therapy in Emergency Department (ED) healthcare providers and then assessed the impact of a brief educational intervention. Method: An anonymous 14-item (11 multiple choice and 3 open-ended) questionnaire was administered to a convenience sample of 58 healthcare providers in the ED of a Level-1, tertiary care, academic, urban hospital. The survey was collected and a 15-minute lecture was provided to the group. A post-test was administered immediately and six months after the intervention. Data collected were analyzed with chi-square, analysis of variance and Kruskal-Wallis analysis using SAS 9.1.3. Results: Of the 58 respondents 77% (45/58) identified r-TPA as the thrombolytic agent, but only 56% (33/58) knew the therapeutic window and 29% (17/58) knew the “Door-to-CT” time. Sixty-two percent (36/58) of the respondents reported unfamiliarity with the National Institute of Health’s Stroke Scale and the eligibility criteria of r-TPA. Median score pre-education was 5/14 which improved to 11/14 (CI 8-12, p<0.0001) and six months later was 8/14 (best score was 12, p<0.0001). Only 8% (5/58) of the respondents expressed a special interest in stroke. Conclusion: Few medical personnel express a special interest in stroke and many misunderstand basic management concepts as well as eligibility criteria for thrombolysis in AIS. A brief targeted intervention improves knowledge and familiarizes ED healthcare providers about the use of r-TPA in AIS. Improvement in knowledge was demonstrated on testing immediately and at six month follow-up

Cyto-histopathological correlation of skin adnexal tumors: A short series

Background: Skin adnexal neoplasms are relatively rare and thus uncommonly encountered in routine pathology practice. Aims: The present study was conducted with the aim to diagnose various skin adnexal tumors on fine-needle aspiration cytology (FNAC) followed by confirmation on histopathology and immunohistochemistry of the excised tumor. Materials and Methods: A total of 11 cases of superficial nodular swellings of the skin were studied over a period of 2 years from 2015 to 2016. FNAC of the swelling was performed and slides were stained with Giemsa stain. Following FNAC, the swelling was excised and subjected to histopathological examination. Immunohistochemistry was performed in some cases for confirmation. Results: It was observed that overall incidence of adnexal tumors (ATs) encountered on FNAC was very low. Typing of ATs on cytology was possible in 82% cases (9/11 cases) with diagnostic accuracy of 88% (8/9 cases). Most common tumor encountered in the study was nodular hidradenoma followed by pilomatrixoma, trichoepithelioma, cylindroma, chondroid syringoma, and trichilemmal cyst. Majority of the cases were benign except one case, which subsequently turned malignant. Conclusion: FNAC is a simple, safe, and cost-effective tool in diagnosing skin ATs. Cytological diagnosis of these lesions is depends on clinical correlation and cytomorphological features. FNAC in lesions suspected to be malignant can guide the surgeon regarding extent of excision

A rare case of ganglion cyst of sternoclavicular joint diagnosed and treated by fine-needle aspiration cytology

Ganglion cyst although a common swelling observed near joints of hands and feet, it is extremely rare in the sternoclavicular joint. Diagnosis is usually based on clinical examination, radiological investigations, or fine-needle aspiration cytology (FNAC). We hereby report a case of an 8-year-old girl who presented to the surgical outpatient department with a nontender, nonerythematous swelling over the right sternoclavicular joint for 3 months. Ultrasonography revealed a cystic swelling measuring 0.4 cm × 0.3 cm × 0.3 cm. The diagnosis of ganglion cyst was finally confirmed on FNAC. The aspiration acted both as diagnostic and therapeutic modality thus avoiding surgery. The patient is under follow-up for the chance of recurrence

Structured Communication: Teaching Delivery of Difficult News with Simulated Resuscitations in an Emergency Medicine Clerkship

Introduction: The objective is to describe the implementation and outcomes of a structured communication module used to supplement case-based simulated resuscitation training in an emergency medicine (EM) clerkship. Methods: We supplemented two case-based simulated resuscitation scenarios (cardiac arrest and blunt trauma) with role-play in order to teach medical students how to deliver news of death and poor prognosis to family of the critically ill or injured simulated patient. Quantitative outcomes were assessed with pre and post-clerkship surveys. Secondarily, students completed a written self-reflection (things that went well and why; things that did not go well and why) to further explore learner experiences with communication around resuscitation. Qualitative analysis identified themes from written self-reflections. Results: A total of 120 medical students completed the pre and post-clerkship surveys. Majority of respondents reported that they had witnessed or role-played the delivery of difficult news, but only few had real-life experience of delivering news of death (20/120, 17%) and poor prognosis (34/120, 29%). This communication module led to statistically significant increased scores for comfort, confidence, and knowledge with communicating difficult news of death and poor prognosis. Pre-post scores increased for those agreeing with statements (somewhat/very much) for delivery of news of poor prognosis: comfort 69% to 81%, confidence 66% to 81% and knowledge 76% to 90% as well as for statements regarding delivery of news of death: comfort 52% to 68%, confidence 57% to 76% and knowledge 76% to 90%. Respondents report that patient resuscitations (simulated and/or real) generated a variety of strong emotional responses such as anxiety, stress, grief and feelings of loss and failure. Conclusion: A structured communication module supplements simulated resuscitation training in an EM clerkship and leads to a self-reported increase in knowledge, comfort, and competence in communicating difficult news of death and poor prognosis to family. Educators may need to seek ways to address the strong emotions generated in learners with real and simulated patient resuscitations. [West J Emerg Med. 2015;16(2):344–352.

Catalytic synthesis of fatty acid methyl esters from Madhuca indica oil in supercritical methanol

Fatty acid methyl esters (FAMEs) that are used as biodiesel can be synthesized in supercritical methylating agents such as supercritical methanol. While the synthesis can be conducted both non-catalytically and catalytically, the synthesis in the presence of oxides is significantly faster. In this study, FAMEs were synthesized by transesterification of a non-edible oil (Mahua, Madhuca indica) in supercritical methanol with a wide variety of oxides. The reaction was extensively studied with eleven different oxides, synthesized using the solution combustion method, as catalysts. In addition, the best two catalysts, namely MgO and Mn3O4, were synthesized using four different fuels in the combustion synthesis. The catalytic effect of all these oxides was investigated and conversions ranging from 5% to 100% were obtained over the investigated range of temperature from 503 K to 583 K, and with reaction time varying between 2 min and 80 min. Among all the catalysts, MgO synthesized with ascorbic acid as the fuel for the solution combustion gave the best results. Therefore, this catalyst was chosen and the influence of operating temperature for the transesterification reaction (503-583 K) on the rate of the reaction was studied. A pseudo first order kinetic model was obtained based on the proposed Eley-Rideal reaction mechanism and, the rate constants were obtained. The rate constants varied between 1.61 x 10(-3) s(-1) to 4.93 x 10(-3) s(-1) with an activation energy of 36 kJ/mol and a pre-exponential factor of 9.33 s(-1). The rate constant obtained for the non-catalytic supercritical transesterification with oxide as catalyst was significantly higher than the rate constant of 9.9 x 10(-5) s(-1) obtained for the non-catalytic reaction at 523 K. The activation energy for the catalyzed reaction (36 kJ/mol) was notably lower than the activation energy (75 kJ/mol) for the uncatalyzed reaction indicating the efficacy of the catalyst