7 research outputs found
Author Commitment and Social Power: Automatic Belief Tagging to Infer the Social Context of Interactions
No full textPosterior reversible encephalopathy syndrome due to spinal pathologies or interventions
No full textPosterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity characterized by headache, seizures, visual deterioration, motor and cognitive deficits, and decreased level of consciousness among other symptoms and signs with imaging findings suggestive of vasogenic edema preferentially affecting the occipital and posterior temporal and parietal lobes. As the name suggests in the vast majority of cases, the syndrome is self-limiting and the deficits are reversible to a large extent. It is seen most commonly in periparturient patients and multiple theories have been proposed regarding its pathogenesis. It is widely thought to occur due to intermittent high blood pressures overwhelming the myogenic arm of cerebral autoregulation and in the setting of weaker neurogenic autoregulation in the posterior cerebral circulation being due to sparse innervation; the resulting hyperperfusion creates vasogenic edema. This can be compounded by deranged overcompensation causing hypoperfusion and endothelial dysfunction precipitating vasogenic edema through increased permeability. Various spinal pathologies and interventions can create pathophysiologic cascades that can combine to result in PRES; thus leading to often unforeseen morbidity. This review seeks to present in a narrative form (systematically searched literature) on PRES as a sequel to spinal pathologies or interventions
Impact of frailty on surgery for glioblastoma: a critical evaluation of patient outcomes and caregivers’ perceptions in a developing country
No full textOBJECTIVE
The authors aimed to evaluate the impact of age and frailty on the surgical outcomes of patients with glioblastoma (GBM) and to assess caregivers’ perceptions regarding postdischarge care and challenges faced in the developing country of India.
METHODS
This was a retrospective study of patients with histopathologically proven GBM from 2009 to 2018. Data regarding the clinical and radiological characteristics as well as surgical outcomes were collected from the institute’s electronic database. Taking Indian demographics into account, the authors used the cutoff age of 60 years to define patients as elderly. Frailty was estimated using the 11-point modified frailty index (mFI-11). Patients were divided into three groups: robust, with an mFI score of 0; moderately frail, with an mFI score of 1 or 2; and severely frail, with an mFI score ≥ 3. A questionnaire-based survey was done to assess caregivers’ perceptions about postdischarge care.
RESULTS
Of the 276 patients, there were 93 (33.7%) elderly patients and 183 (66.3%) young or middle-aged patients. The proportion of severely frail patients was significantly more in the elderly group (38.7%) than in the young or middle-aged group (28.4%) (p < 0.001). The authors performed univariate and multivariate analysis of associations of different short-term outcomes with age, sex, frailty, and Charlson Comorbidity Index. On the multivariate analysis, only frailty was found to be a significant predictor for in-hospital mortality, postoperative complications, and length of hospital and ICU stay (p < 0.001). On Cox regression analysis, the severely frail group was found to have a significantly lower overall survival rate compared with the moderately frail (p = 0.001) and robust groups (p < 0.001). With the increase in frailty, there was a concomitant increase in the requirement for readmissions (p = 0.003), postdischarge specialist care (p = 0.001), and help from extrafamilial sources (p < 0.001). Greater dissatisfaction with psychosocial and financial support among the caregivers of severely frail patients was seen as they found themselves ill-equipped to provide postdischarge care at home (p < 0.001).
CONCLUSIONS
Frailty is a better predictor of poorer surgical outcomes than chronological age in terms of duration of hospital and ICU stay, postoperative complications, and in-hospital mortality. It also adds to the psychosocial and financial burdens of the caregivers, making postdischarge care challenging
Frailty and Neutrophil Lymphocyte Ratio as Predictors of Mortality in Patients with Catheter-Associated Urinary Tract Infections or Central Line–Associated Bloodstream Infections in the Neurosurgical Intensive Care Unit: Insights from a Retrospective Study in a Developing Country
No full textObjective
We aim to evaluate the role of frailty and inflammatory markers in predicting the short-term outcomes after catheter-associated urinary tract infections (CAUTI) and central line–associated bloodstream infections (CLABSI).
Methods
Data regarding the patients’ characteristics, isolates on CAUTI and CLABSI, antibiotic susceptibility, frailty (11-point Modified Frailty Index), and inflammatory markers were retrospectively collected. Their impact on the short-term outcomes was assessed using regression modeling response.
Results
One hundred and one patients with CAUTI (n = 71) and CLABSI (n = 30) between January 2018 and December 2019 were included in this study. The pooled incidence rates for CAUTI were 5.50 and for CLABSI 3.58 episodes/1000 catheter-days. We observed 74.7% drug resistance in our CAUTI isolates and 93.3% in CLABSI. In the multivariate analysis, frailty (P = 0.006), neutrophil/lymphocyte ratio (NLR) (P = 0.007) and the presence of sepsis (P = 0.029) were found to be significant predictors of in-hospital mortality in CAUTI. In patients with CLABSI, frailty (P = 0.029) and NLR (P = 0.029) were found significant and along with sepsis (P = 0.069) resulted in a regression model with good accuracy in predicting mortality. The receiver operating characteristic curve showed that 11-point Modified Frailty Index and NLR as well as the regression model significantly predicted mortality with an area under the curve of 86.1%, 81.4%, and 95.4%, respectively, in CAUTI, and 70.9%, 77.8%, and 95.2%, respectively, in CLABSI
SimSpine: A Cost-Effective Spinal Endoscopy Training Prototype for Neurosurgical Residents Skills Training
No full textObjective
To compare the SimSpine (indigenously developed, low-cost model) and EasyGO! (Karl Storz, Tuttlingen, Germany) systems for simulation of endoscopic discectomy.
Methods
Twelve neurosurgery residents, 6 in postgraduate years 1–4 or equivalent (junior) and 6 in postgraduate years 5–6 or equivalent (senior), were randomly allocated (1:1) to either EasyGO! or SimSpine endoscopic visualization systems for endoscopic lumbar discectomy simulation on the same physical simulator. After the first exercise, the participants switched over to the other system, and the exercise was repeated. Time taken to dock the system, time to reach annulus, time required for task completion, dural violation, and volume of disc material removed were used for calculating objective efficiency score. Subjective scoring (Neurosurgery Education and Training School [NETS] criteria) was performed by 4 blinded mentors based on recorded video on 2 separate occasions 2 weeks apart. Cumulative score was calculated based on efficiency and Neurosurgery Education and Training School scores.
Results
Performance metrics were similar across the 2 platforms, regardless of participant seniority (P > 0.05). Time to reach disc space and discectomy time improved for both EasyGO! (P = 0.07 and P = 0.03, respectively) and SimSpine (P = 0.01 and P = 0.04, respectively) between first and second exercises. Efficiency and cumulative scores were better (P = 0.04 and P = 0.03 respectively) when EasyGO! was used as the first device compared with SimSpine.
Conclusions
SimSpine is a cost-effective viable alternative to EasyGO for endoscopic lumbar discectomy simulation-based training
Investigation on topology-optimized compressor piston by metal additive manufacturing technique: Analytical and numeric computational modeling using finite element analysis in ANSYS
No full textAir compressors are widely used in factories to power automation systems and store energy. Several studies have been conducted on the performance of reciprocating and screw compressors. Advancements in design and manufacturing techniques, such as generative design and topology optimization, are leading to improved performance and turbomachinery growth. This work presents a methodology to design and manufacture air compressor pistons using topology optimization and metal additive manufacturing. The existing piston is converted to 3D CAD data and topology optimization is conducted to reduce material in stress concentration regions. Thermal and mechanical loads are considered in boundary conditions. The results show reduced material and improved efficiency, which is validated using ANSYS fluent. The optimized 3D model of the piston is too complex for conventional subtractive manufacturing, so laser sintering 3D printing is proposed. Honeycomb pattern infill patterns are used in 3D printing. This investigation is a step toward researching similar methods in other reciprocating compressor components such as cylinder, cylinder head, piston pins, crankshaft, and connecting rods, which will ultimately lead to improved compressor efficiency. © 2023 the author(s), published by De Gruyter.Khon Kaen University, KKU: R.G.P.1/349/43; Deanship of Scientific Research, King Khalid UniversityFunding information: This research was funded by the Deanship of Scientific Research at King Khalid University (KKU) through the Research Group Program Under the Grant Number: (R.G.P.1/349/43).The authors extend their appreciation to the Deanship of Scientific Research at King Khalid University (KKU) for funding this research through the Research Group Program Under the Grant Number: (R.G.P.1/349/43)
Community Control of Hypertension and Diabetes (CoCo-HD) program in the Indian states of Kerala and Tamil Nadu: a study protocol for a type 3 hybrid trial
No full textIntroduction: India grapples with a formidable health challenge, with an estimated 315 million adults afflicted with hypertension and 100 million living with diabetes mellitus. Alarming statistics reveal rates for poor treatment and control of hypertension and diabetes. In response to these pressing needs, the Community Control of Hypertension and Diabetes (CoCo-HD) program aims to implement structured lifestyle interventions at scale in the southern Indian states of Kerala and Tamil Nadu. Aims: This research is designed to evaluate the implementation outcomes of peer support programs and community mobilisation strategies in overcoming barriers and maximising enablers for effective diabetes and hypertension prevention and control. Furthermore, it will identify contextual factors that influence intervention scalability and it will also evaluate the program’s value and return on investment through economic evaluation. Methods: The CoCo-HD program is underpinned by a longstanding collaborative effort, engaging stakeholders to co-design comprehensive solutions that will be scalable in the two states. This entails equipping community health workers with tailored training and fostering community engagement, with a primary focus on leveraging peer supportat scale in these communities. The evaluation will undertake a hybrid type III trial in, Kerala and Tamil Nadu states, guided by the Institute for Health Improvement framework. The evaluation framework is underpinned by the application of three frameworks, RE-AIM, Normalisation Process Theory, and the Consolidated Framework for Implementation Research. Evaluation metrics include clinical outcomes: diabetes and hypertension control rates, as well as behavioural, physical, and biochemical measurements and treatment adherence. Discussion: The anticipated outcomes of this study hold immense promise, offering important learnings into effective scaling up of lifestyle interventions for hypertension and diabetes control in low- and middle-income countries (LMICs). By identifying effective implementation strategies and contextual determinants, this research has the potential to lead to important changes in healthcare delivery systems. Conclusions: The project will provide valuable evidence for the scaling-up of structured lifestyle interventions within the healthcare systems of Kerala and Tamil Nadu, thus facilitating their future adaptation to diverse settings in India and other LMICs.Peer reviewe
