ASSOCIATION BETWEEN THE WEIGHT LOSS AND ANXIETY, DEPRESSION AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY: A NEED FOR PRE-DISCHARGED COUNSELING

Objectives: To see the association between weight loss and anxiety, depression after percutaneous transluminal coronary angioplasty (PTCA) for coronary artery disease patients. (1) To see the severity of anxiety and depression 1 month after PTCA, (2) to evaluate the relationship between the weight changes and major adverse cardiac events (MACE) in 1 month follow-up.Methods: A total 1001 patients who underwent PTCA for acute coronary syndrome and coronary heart disease were included. Data were collected at baseline and 1 month after PTCA. A validated Euro 5Q-5D-5L questionnaire was used to assess the level of anxiety and depression. Chi-square test was applied to find out the association between weight loss status and anxiety, depression.Results: There was a significant decrease in mean weight 1 month after coronary angioplasty (64.18±11.022 vs. 61.96±11.17, p<0.001). No association was observed between weight loss status and anxiety, depression in PTCA patients (p=0.5) and there is no significant association between weight changes and MACE 1 month after PTCA (p=0.92).Conclusion: Data show that anxiety and depression were observed in 64.9% of the study population after coronary angioplasty but anxiety and depression are not associated with weight loss after PTCA. Loss of weight may be due to the modified post angioplasty lifestyles such as adherent to Mediterranean diet, physical exercise, cessation of smoking, optimum control of blood pressure, blood sugar, and blood cholesterol along with prescribed medications. Anxiety and depression may turn into chronic stage if not treated wisely could lead to significant MACE. Proper pre-hospital discharge counseling is necessary for all post PTCA patients to sustain their quality of life

Relevance of tumor angiogenesis patterns as a diagnostic value and prognostic indicator in oral precancer and cancer

Tumor angiogenesis occurs by recruitment of endothelial cell precursors or by sprouting of existing capillaries, which differ from the normal vasculature by having an altered morphology that can be exploited for diagnosis and as a prognostic indicator. Improved technologies have propelled diagnosis into a new era. These technologies have to be used with great precision. The diagnosis of a dysplastic premalignant lesion of the oral mucosa cannot be based solely on clinical findings. Therefore histologic evaluation of a representative biopsy specimen is necessary. Accurate judgment of the proper site for biopsy is essential for reaching a correct diagnosis. The aim of this report is to analyze the vascular patterns with the help of direct oral microscopy and the technique of stereo-optical microscopy in the oral cavity to select biopsy sites, and compare the outcome of a directed biopsy with that of biopsy specimens obtained from sites selected solely on the basis of clinical criteria. The study sample comprised 50 oral mucosal lesions. A statistically significant difference was noted between samples judged to be microscopically representative sites. We conclude that this method would aid in early and better diagnosis and treatment planning of oral premalignant and malignant lesions by assessing the various vascular patterns in the mucosa

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

MS-CheXNet: An Explainable and Lightweight Multi-Scale Dilated Network with Depthwise Separable Convolution for Prediction of Pulmonary Abnormalities in Chest Radiographs

Pulmonary diseases are life-threatening diseases commonly observed worldwide, and timely diagnosis of these diseases is essential. Meanwhile, increased use of Convolution Neural Networks has promoted the advancement of computer-assisted clinical recommendation systems for diagnosing diseases using chest radiographs. The texture and shape of the tissues in the diagnostic images are essential aspects of prognosis. Therefore, in the latest studies, the vast set of images with a larger resolution is paired with deep learning techniques to enhance the performance of the disease diagnosis in chest radiographs. Moreover, pulmonary diseases have irregular and different sizes; therefore, several studies sought to add new components to existing deep learning techniques for acquiring multi-scale imaging features from diagnostic chest X-rays. However, most of the attempts do not consider the computation overhead and lose the spatial details in an effort to capture the larger receptive field for obtaining the discriminative features from high-resolution chest X-rays. In this paper, we propose an explainable and lightweight Multi-Scale Chest X-ray Network (MS-CheXNet) to predict abnormal diseases from the diagnostic chest X-rays. The MS-CheXNet consists of four following main subnetworks: (1) Multi-Scale Dilation Layer (MSDL), which includes multiple and stacked dilation convolution channels that consider the larger receptive field and captures the variable sizes of pulmonary diseases by obtaining more discriminative spatial features from the input chest X-rays; (2) Depthwise Separable Convolution Neural Network (DS-CNN) is used to learn imaging features by adjusting lesser parameters compared to the conventional CNN, making the overall network lightweight and computationally inexpensive, making it suitable for mobile vision tasks; (3) a fully connected Deep Neural Network module is used for predicting abnormalities from the chest X-rays; and (4) Gradient-weighted Class Activation Mapping (Grad-CAM) technique is employed to check the decision models’ transparency and understand their ability to arrive at a decision by visualizing the discriminative image regions and localizing the chest diseases. The proposed work is compared with existing disease prediction models on chest X-rays and state-of-the-art deep learning strategies to assess the effectiveness of the proposed model. The proposed model is tested with a publicly available Open-I Dataset and data collected from a private hospital. After the comprehensive assessment, it is observed that the performance of the designed approach showcased a 7% to 18% increase in accuracy compared to the existing method

A modified technique to extract fractured femoral stem in revision total hip arthroplasty: A report of two cases

AbstractINTRODUCTIONThe removal of well-fixed broken femoral component and cement mantle can be extremely demanding, time consuming and potentially damaging to the host bone. Different methods have been described to extract broken femoral stem yet this remains one of the most challenging prospect to the revision hip surgeon.PRESENTATION OF CASEThe authors present two cases underwent a modified sliding cortical window technique utilising a tungsten carbide drill, Charnley pin retractor and an orthopaedic mallet to aid extraction of a fractured cemented femoral stem in revision total hip arthroplasty.DISCUSSIONThe modified technique offers a simple and controlled method in extracting a well fixed fractured cemented femoral stem. It has the advantage of retaining the cement mantle with subsequent good seal of the femoral cortical window secured with cable ready system. Furthermore, tungsten carbide drill bit and Charnley pin retractor are relatively readily available to aid the extraction of the broken stem. Finally, it yields the option of implanting a standard femoral stem and obviates the need for bypassing the cortical window with long revision femoral component.CONCLUSIONFractured femoral stem is a rare yet a complex and very demanding prospect to both patients and hip surgeons. The sliding cortical window technique utilising tungsten carbide drill and Charnley pin retractor is technically easy and most importantly; preserves host bone stock with cement-in-cement revision hip arthroplasty. We believe this technique can be added to the armamentarium of revision hip surgeon when faced with the challenge of extracting a fractured cemented femoral stem

Neurilemmoma of Retromolar Region in the Oral Cavity

Neurilemmoma also known as schwannoma is benign nerve sheath tumor rarely occurring in the oral cavity. Only 1% of all extracranial schwannomas show that intraoral occurrence with tongue is the commonest site and retromolar region is the least common site. It presents as encapsulated, slow growing, solitary, smooth-surfaced, usually asymptomatic tumor. We report a case of 70-year-old male with well-defined mass on left retromolar region which was painless and slow growing. Diagnosis is made by histological examination and immunohistochemistry analysis to confirm the neural tissue origin of the lesion. The treatment is complete surgical excision of the lesion without recurrence

Manipal lifestyle modification score to predict major adverse cardiac events in postcoronary angioplasty patients

Background: Lifestyle modification (LSM) such as prudent diet, physical activity, avoidance of smoking, and maintaining a healthy weight may considerably decrease the risk for coronary artery disease. Objective: The primary objective of this study was to develop a new LSM scoring system and investigate the correlation between adherence to LSM and incidence of major adverse cardiac events (MACEs) at 12-month follow-up. Method: A total of 1000 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA) were included in this prospective single-center study. Manipal lifestyle modification score (MLSMS) was developed by using five lifestyle-related factors. Adherence to LSM at the baseline and subsequent follow-ups was determined by using MLSMS. The MACE at 1-, 6-, and 12-month follow-up were analyzed. Results: There was a significant reduction in overall adherence to LSM (p < 0.001) at 12-month follow-up. Nonadherence to LSM [hazard ratio (HR) 0.575; 95% confidence interval (CI) 0.334–0.990; p < 0.046] and noncompliance to medication (HR 2.09; 95% CI 1.425–3.072; p < 0.001) were independent predictors of MACEs after PTCA. The cumulative MACE was 15.4%, which includes 4.9% of all-cause death, 5.2% of nonfatal myocardial infarction, 2.0% of target lesion revascularization, 1.8% of target vessel revascularization, and 1.3% of stroke at 12 months. The incidence of MACEs at 12 months was significantly (p = 0.03) higher in LSM nonadherent compared with LSM adherent patients. Conclusion: There is an overall reduction in adherence to LSM on successive follow-ups and a significant association between the incidence of MACEs and the lack of adherence to LSM. MLSMS is a simple and effective evaluation tool in predicting MACEs in this group of patients. Keywords: Coronary heart disease, Lifestyle modification, Percutaneous coronary intervention

Factors Influencing Postoperative Urinary Retention Following Elective Posterior Lumbar Spine Surgery: A Prospective Study

Study Design Prospective observational study. Purpose To determine the incidence of postoperative urinary retention (POUR) in patients undergoing elective posterior lumbar spine surgery and identify the risk factors associated with the development of POUR. Overview of Literature POUR following surgery can lead to detrusor dysfunction, urinary tract infections, prolonged hospital stay, and a higher treatment cost; however, the risk factors for POUR in spine surgery remain unclear. Methods A prospective, consecutive analysis was conducted on patients undergoing elective posterior lumbar surgery in the form of lumbar discectomy, lumbar decompression, and single-level lumbar fusions during a 6-month period. Patients with spine trauma, preoperative neurological deficit, previous urinary disturbance/symptoms, multiple-level fusion, and preoperative catheterization were excluded from the study. Potential patient- and surgery-dependent risk factors for the development of POUR were assessed. Univariate analysis and a multiple logistical regression analysis were performed. Results A total of 687 patients underwent posterior lumbar spine surgery during the study period; among these, 370 patients were included in the final analysis. Sixty-one patients developed POUR, with an incidence of 16.48%. Significant risk factors for POUR were older age, higher body mass index (BMI), surgery duration, intraoperative fluid administration, lumbar fusion versus discectomy/ decompression, and higher postoperative pain scores (p<0.05 for all). Sex, diabetes, and the type of inhalational agent used during anesthesia were not significantly associated with POUR. Multiple logistical regression analysis, including age, BMI, surgery duration, intraoperative fluid administration, fusion surgery, and postoperative pain scores demonstrated a predictive value of 92% for the study population and 97% for the POUR group. Conclusions POUR was associated with older age, higher BMI, longer surgery duration, a larger volume of intraoperative fluid administration, and higher postoperative pain scores. The contribution of postoperative pain scores in the multiple regression analysis was a significant predictor of POUR

Utility of DNA-specific stains in micronuclei assay as a marker of genotoxicity in oral potentially malignant disorders and oral squamous cell carcinoma

Background: The term oral potentially malignant disorder (OPMD) was recommended to refer to precancer as it conveys that not all disorders described under this term may transform into cancer. Oral squamous cell carcinoma (OSCC) arises through an accumulation of genetic alterations, deoxy ribonucleic acid (DNA) changes, and epigenetic alterations. Thus, a simple yet a sensitive and specific test for early diagnosis is the need of an hour. The micronuclei (MN) assay in exfoliated epithelial cells is potentially an excellent biomarker to detect chromosome loss or malfunction of mitotic spindle. Aim of the Study: To compare the frequency of MN in exfoliated cells from oral mucosa exposed to genotoxic agents using different staining procedures and to observe the incidence of micronucleus in potentially malignant and malignant lesions. Materials and Methods: The study was undertaken to observe the cytogenetic damage in the exfoliated buccal cells of 75 cases of tobacco-related PMDs, OSCC and control subjects (25 cases from each group) and were evaluated with nonspecific May-Grünwald Giemsa stain and DNA-specific Feulgen stain. The results were statistically determined using SPSS version 17.0. Results: Correlation analyses in the present study depicted that MN frequency was significantly more in oral squamous cell carcinoma than OPMDs and normal group (P < 0.05). Giemsa-stained slides correlated significantly with karyorrhexis, karyolysis, condensed chromatin, and binucleates, whereas no such correlations were found with DNA-specific stains. Conclusion: Malignant transformation is accompanied by loss of cell capacity to evolve to death in situations of DNA damage. These findings indicate that nuclear anomalies may be misinterpreted as MN with nonspecific DNA stains and lead to false-positive results in studies with cells of epithelial origin