Comparison of three different techniques of endotracheal tube cuff inflation: just seal, stethoscope guided and pressure volume loop: a prospective randomized study

Background: Cuffed endotracheal tubes not only ensure a proper seal during positive pressure ventilation, but at the same time also prevent aspiration of gastric secretions. The aim of this prospective, randomized study was to compare three methods of ETT cuff inflation-- palpation of the leak in suprasternal notch (Just seal), a stethoscope guided method of tracheal tube cuff inflation and PVL guided cuff inflation.Methods: After approval by institutional ethical committee, 192 patients of either sex in age group of 18-50 years belonging to ASA physical status I or II were enrolled. Each patient was randomly allocated into one of three groups: one group received standard 'just seal' method of tracheal cuff inflation (JS), the second group, the stethoscope-guided method (SG) and in third group cuff was inflated using Pressure Volume Loop (PVL). Volume of air introduced into the cuff and pressure within the cuff was recorded.Results: A total of 192 patients were recruited to the study. The median (IQR [range]) tracheal cuff pressure was 12 (10-22 [6-28]) cm H2O, 16 (12-24[6-38]) and 14 (10-22[8-32]) cmH2O in JS, SG and PVL group respectively. Cuff pressures within the recommended range of 20-30 cm H2O fell in 25% of the patients in both JS and SG group and 31% patients in PVL group. The mean volumes of air introduced in the cuff and the resultant mean cuff pressure in all groups was found to be statistically insignificant (p= 0.4, 0.18 respectively). Tidal volume discrepancy was more and 75% of cuff pressures were less than the recommended range in JS than the other two groups.Conclusions: Real time PVL displayed on most modern anaesthesia machine is a good alternative to check for proper ETT cuff inflation, avoid high cuff pressure and monitor air leak

A Systematic Review and Comparative Meta-analysis of Non-destructive Fruit Maturity Detection Techniques

The global fruit industry is growing rapidly due to increased awareness of the health benefits associated with fruit consumption. Fruit maturity detection plays a crucial role in fruit logistics and maintenance, enabling farmers and fruit industries to grade fruits and develop sustainable policies for enhanced profitability and service quality. Non-destructive fruit maturity detection methods have gained significant attention, especially with advancements in machine vision and spectroscopic techniques. This systematic review provides a concise overview of the techniques and algorithms used in fruit quality grading by farmers and industries. The study reviewed 63 full-text articles published between 2012 and 2023 along with their bibliometric analysis. Qualitative analysis revealed that researchers from various disciplines contributed to this field, with techniques falling into 3 categories: machine vision (mathematical modelling or deep learning), spectroscopy and other miscellaneous approaches. There was a high level of diversity among these categories, as indicated by an I-square value of 88.37% in the heterogeneity analysis. Meta-analysis, using odds ratios as the effect measure, established the relationship between techniques and their accuracy. Machine vision showed a positive correlation with accuracy across different categories. Additionally, Egger's and Begg's tests were used to assess publication bias and no strong evidence of its occurrence was found. This study offers valuable insights into the advantages and limitations of various fruit maturity detection techniques. For employing statistical and meta-analytical methods, key factors such as accuracy and sample size have been considered. These findings will aid in the development of effective strategies for fruit quality assessment

Methylmalonic aciduria as a biochemical marker for mitochondrial DNA depletion syndrome in patients with developmental delay and movement disorders: a case series

BackgroundMitochondrial DNA (mtDNA) depletion syndromes (MDDS) are genetically and clinically variable disorders resulting from a reduction in mtDNA content in the cells, tissues, and organ systems, leading to symptoms related to energy deficits. Deficiency of the mitochondrial succinyl-CoA ligase/synthetase enzyme secondary to pathogenic variations in the SUCLG1 and SUCLA2 genes is a subtype of MDDS that presents with neurological manifestations and a specific biochemical profile.MethodsThis cross-sectional series describes five patients with MDDS secondary to pathogenic variations in the SUCLG1 and SUCLA2 genes from two tertiary care centers in Canada and India. Clinical data concerning the course, investigations, and outcome were gathered through chart reviews.ResultsAll subjects presented in early infancy with neurological manifestations, including movement disorder, psychomotor regression, developmental delay, hearing loss, behavioral issues, or a combination thereof. Elevated methylmalonic acid metabolites, an abnormal acylcarnitine profile, and lactic acidemia were noted in the biochemical profile of each patient (n = 5/5, 100%). Molecular genetic testing disclosed the presence of pathogenic homozygous mutations in four subjects and compound heterozygosity in one subject.ConclusionMDDS associated with SUCLG1 and SUCLA2 genes can be detected biochemically by the presence of methylmalonic aciduria besides the elevation of lactate, C3, C4DC, and C5-OH acylcarnitine. Conducting metabolic workups including MMA and acylcarnitine profiles in patients with heterogeneity of clinical symptoms associated with the presence of this biochemical marker may potentially reduce the time to diagnosis and management

A survey of multivitamin supplement knowledge, attitude, and use in the urban community of Bikaner, Rajasthan

Background and Objective: Over the last two decades, there has been a trend for people to supplement their nutritional intake with dietary supplements including multivitamins, which are also commonly prescribed as a concomitant medication. We conducted a community-based survey in an urban population to assess consumers' knowledge, practices, and attitudes regarding multivitamin supplements. Materials and Methods: A cross-sectional questionnaire-based survey was conducted from November 2013 to April 2014 among 500 participants residing in urban areas of Bikaner (Rajasthan). The data were collected in a predesigned questionnaire after obtaining written informed consent from each participant. Results: The survey results showed that the taking of multivitamin supplements is quite prevalent (64.2%) in the community of urban areas of Bikaner. Physicians were found to be the most common source of information regarding multivitamins; however, consumers do get the information from the internet, newspaper, and relatives also. Multiple reasons were quoted for the practice of multivitamins such as maintenance of general health, compensation for the deficiencies, etc. The majority of the respondents were unaware of the correct indications for use of vitamin supplements and had little knowledge of harmful effects. Conclusion: This survey in an urban population highlights that the multivitamin supplements are commonly taken on a daily basis. Most consumers are unaware of any possible side-effects or drug-supplement interactions. There is a continuing need to adopt certain educational interventions for physicians to update and disseminate knowledge of vitamin supplements to their patients and also to increase awareness regarding their correct usage

Edward’s syndrome: A rare cause of difficult intubation-utility of left molar approach

Edward’s syndrome (trisomy 18) is an autosomal abnormality with dysmorphic face, visceral deformities and delayed mental and motor development including congenital heart disease. Challenges may arise during mask ventilation, laryngoscopy and/or intubation of the trachea due to dysmorphic face. Difficult airway cart should be kept ready. Left molar approach using a standard Macintosh blade improves the laryngoscopic view in patients with difficult midline laryngoscopy. We hereby present a case report of a 2 year old male child with Edward’s syndrome posted for evacuation and drainage of brain abscess, intubated successfully using left molar approach

Gene therapy: Current status and future perspectives

Abstract The concept of transferring genes to tissues for clinical applications has been discussed for nearly half a century. Advances in molecular biology and biotechnology have helped to understand the genetic basis of inherited diseases and have brought gene therapy to the forefront of medical research. Gene therapy is the process of introducing foreign genomic materials into host cells to elicit a therapeutic benefit. While originally conceived as a way to treat life-threatening disorders refractory to conventional treatment, gene therapy now is considered for many non-life -threatening conditions, including those adversely affecting a patient's quality of life. Although gene therapy is still at a fairly primitive stage, however, the possibility of success of gene therapy now appears much closer. This is a consequence of the significant improvements made in the development of both in vivo and ex vivo systems for gene delivery and the identification of novel classes of therapeutic genes. Although as of now, gene therapy has not offered any permanent cure to any human patients, a breakthrough may come anytime. The recent results obtained by gene therapy of inherited blindness and of some neurodegenerative disorders encourage firm optimism on the eventual success of this discipline