Study compares Blind and Miller Laryngoscope-guided Insertion of LMA Blockbuster in Paediatric Patients

The research paper compared blind insertion versus Miller laryngoscope-guided insertion of the LMA Blockbuster® in children aged 1-4 years undergoing general anesthesia. The primary objective of the study was to compare the oropharyngeal leak pressure (OPLP) between blind insertion and Miller laryngoscope-guided insertion. Secondary outcomes included insertion time, haemodynamic changes, and postoperative complications. The study revealed that Miller laryngoscope-guided insertion provided significantly higher mean OPLP compared to blind insertion. Although the insertion time was longer with the Miller laryngoscope-guided method, it was not clinically relevant. The study concluded that Miller laryngoscope-guided under-vision insertion of LMA Blockbuster® improves alignment with epiglottic structures compared to blind insertion. The research study involved 100 pediatric patients aged 1-4 years. The patients were randomly assigned to either blind insertion or Miller laryngoscope-guided insertion of the LMA Blockbuster®. The results revealed that the mean OPLP was significantly higher in the Miller laryngoscope-guided insertion group compared to the blind insertion group. Additionally, the insertion time was longer with the Miller laryngoscope-guided insertion method. However, this difference was not clinically relevant. There were no significant differences in the number of insertion attempts, haemodynamic stability, and postoperative complications between the two insertion methods.

Background and Aims of the Research

The study also discussed the background and aims of the research, highlighting the importance of effective airway management in pediatric anesthesia. It discussed the advantages of supraglottic airway devices over endotracheal intubation and emphasized the significance of proper alignment and positioning of the LMA Blockbuster® for efficient ventilation.

Limitations of the Study

The paper also addressed the limitations of the study, including the inability to grade the malposition of the LMA Blockbuster® and the lack of measuring the leak volume, which could provide insights into the effectiveness of the airway seal. The study acknowledged the need for further investigation to explore the applicability of guided insertion techniques in pediatric anesthesia practice.

Overall Study Conclusion

In conclusion, the study demonstrated that Miller laryngoscope-guided under-vision insertion of the LMA Blockbuster® in pediatric patients improves alignment with epiglottic structures and provides a significantly higher OPLP compared to blind insertion. While the insertion time was longer with the Miller laryngoscope-guided method, the study did not find any clinically relevant differences in terms of insertion attempts, haemodynamic stability, and postoperative complications between the two insertion methods.

Key Points

– The research paper compared blind insertion and Miller laryngoscope-guided insertion of the LMA Blockbuster® in children aged 1-4 years undergoing general anesthesia. The primary objective was to compare the oropharyngeal leak pressure (OPLP) between the two insertion methods.

– Results revealed that Miller laryngoscope-guided insertion provided significantly higher mean OPLP compared to blind insertion. Although the insertion time was longer with the Miller laryngoscope-guided method, it was not clinically relevant. – The study involved 100 pediatric patients who were randomly assigned to either blind insertion or Miller laryngoscope-guided insertion. The mean OPLP was significantly higher in the Miller laryngoscope-guided insertion group, and the insertion time was longer with this method. But there were no significant differences in the number of insertion attempts, haemodynamic stability, and postoperative complications between the two insertion methods.

– The background and aims of the research emphasized the importance of effective airway management in pediatric anesthesia, the advantages of supraglottic airway devices over endotracheal intubation, and the significance of proper alignment and positioning of the LMA Blockbuster® for efficient ventilation.

– The limitations of the study included the inability to grade the malposition of the LMA Blockbuster® and the lack of measuring the leak volume. The study also acknowledged the need for further investigation to explore the applicability of guided insertion techniques in pediatric anesthesia practice.

– In conclusion, the study demonstrated that Miller laryngoscope-guided under-vision insertion of the LMA Blockbuster® in pediatric patients improves alignment with epiglottic structures and provides a significantly higher OPLP compared to blind insertion. No clinically relevant differences were found in terms of insertion attempts, haemodynamic stability, and postoperative complications between the two insertion methods.

Reference –

Bihani P, Shivanand, Jaju R, Paliwal N,  Janweja S, Vyas A. Comparative analysis of LMA Blockbuster®  clinical performance: Blind versus Miller laryngoscope‑guided insertion in paediatric general anaesthesia – A double‑blinded,  randomised controlled trial. Indian J Anaesth 2024;68:875‑81

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Combination 5-FU/Calcipotriene Cream Shows Promise in Treating Cutaneous Squamous Cell Carcinoma: Study

USA: A recent pilot study, published in the Journal of the American Academy of Dermatology has shown that a combination topical cream containing 5% 5-fluorouracil and 0.005% calcipotriene is significantly more effective in treating cutaneous squamous cell carcinoma in situ (SCC) than a placebo. This innovative treatment approach could offer new hope for patients facing this common form of skin cancer.

5-fluorouracil (5-FU) is a well-established chemotherapeutic agent commonly used for various types of skin cancer due to its ability to inhibit cellular proliferation. Calcipotriene, a synthetic derivative of vitamin D3, is known for regulating skin cell growth and differentiation. The synergistic effect of these two agents in a topical formulation offers a novel therapeutic strategy for addressing cutaneous malignancies.

Currently, there are no Food and Drug Administration (FDA)-approved topical treatments specifically for squamous carcinoma in situ. Given that the combination of topical 5-FU and calcipotriene is effective for treating actinic keratoses, Riya T. Patel, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, and colleagues investigated its potential application for SCCIS.

This randomized single-blinded study evaluated the outcomes in 24 patients with biopsy-confirmed squamous cell carcinoma in situ. Participants were treated with either a placebo cream applied twice daily or cream containing 5-fluorouracil 5.0% and calcipotriene 0.005%, also applied twice daily, for 7 or 14 days.

The study led to the following findings:

  • After tumor excision, the proportion of patients with histological clearance was significantly higher in the 7-day (83.3%) and 14-day (87.5%) treatment groups than in the placebo group.
  • Two patients receiving treatment developed eruptive squamous atypia within the scar 2 to 3 months after excision, whereas none of those receiving placebo experienced any adverse events.

Overall, the pilot study presents encouraging evidence for using a combination of topical 5-fluorouracil and calcipotriene in treating cutaneous SCC in situ. As further research is conducted, this innovative approach could lead to more effective and safer treatment options for patients, ultimately improving outcomes in managing skin cancer. The findings underscore the need for continued exploration of combination therapies in dermatologic oncology.

Reference:

Patel, R. T., Fagan, K. K., Quan, E. Y., Johnson, N. M., Tegge, A. N., Holliday, A. C., Grider, D. J., Rush, P. S., Prickett, K. A., Eikenberg, J. D., & Phillips, M. A. (2024). Combination topical 5-fluorouracil 5%/calcipotriene 0.005% cream for the treatment of cutaneous in situ squamous cell carcinoma: A pilot study. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2024.08.039

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Low Vitamin D levels linked to slow healing process in pediatric patients: Study

Low levels of Vitamin D can impact the healing of fractures in children, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. .

The study, “Low Vitamin D Levels Are Associated with Longer Healing Times in Pediatric Fracture Patients,” examined 186 extremity fracture cases in children from 2015 to 2022 and found that low levels of Vitamin D correlated with longer healing times.

This result was found in fractures that did and did not require surgery as well as when comparing clinical healing times to radiographic healing times.

Leg fractures in children with low Vitamin D levels that did not require surgery took an extra 20 days to heal clinically and two months longer to show signs the fracture was disappearing in x-rays. As for those cases where surgery was needed, healing took an extra month to heal clinically and nearly four months for fractures to fade on x-rays.

“Previous studies have focused more on how Vitamin D can help prevent fractures but now we are seeing a link between low vitamin D levels and longer fracture healing times,” said Jessica McQuerry, MD, senior author on the study. “Children need to be given well-balanced diets that include Vitamin D for overall health and to make sure when accidents do happen, they can heal appropriately.”

Vitamin D is primarily found in dairy products such as milk, cheese and yogurt but can also be found in fish and other foods fortified with Vitamin D such as breakfast cereal. Moderate exposure to sunlight can also help the body absorb Vitamin D.

Study authors recommended checking vitamin D levels if your child has a fracture that is taking longer to heal than typical.

“Getting outside and enjoying the fresh air can do wonders for your health while also upping Vitamin D absorption,” Dr. McQuerry said. “What a great excuse to get outside and explore nature!”

Reference:

Low Vitamin D levels in pediatric patients linked to slow healing process, American Academy of Pediatrics, Meeting: American Academy of Pediatrics 2024 National Conference & Exhibition.

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Cervical ripening using dinoprostone may lead to vaginal delivery in small gestational age pregnancies: Study

Cervical ripening using dinoprostone may lead to vaginal delivery in pregnancies complicated by early gestational age suggests a study published in The Journal of Maternal-Fetal & Neonatal Medicine.

A study was done to explore the complications and pregnancy outcomes of vaginal dinoprostone vs. Cook’s double balloon for the induction of labor among pregnancies complicated by small-for-gestational-age (SGA) at term. This retrospective study included consecutive singleton pregnancies complicated by SGA treated at Fujian Maternity and Child Health Hospital between January 2017 and December 2021. The patients were divided into the Cook’s double balloon and dinoprostone groups according to the induction method they received. The primary outcome was vaginal delivery. Results: This study included 318 women [165 (aged 30.25 ± 4.72 years) and 153 (aged 28.80 ± 3.91 years) in the dinoprostone and Cook’s balloon groups]. The dinoprostone group had a higher vaginal delivery rate than the Cook’s balloon group (83.6% vs. 71.9%, p = .012). The cervical ripening duration (9.73 ± 4.82 vs. 17.50 ± 8.77 h, p < .001) and induction to delivery duration (22.11 ± 8.13 vs. 30.27 ± 12.28, p < .001) were significantly shorter in the dinoprostone group compared with the Cook’s balloon group. Less women needed oxytocin infusion in the dinoprostone group compared with that in the Cook’s balloon group (32.7% vs. 86.3%, p < .001). Dinoprostone was independently associated with vaginal delivery (HR = 1.756, 95%CI: 1.286–2.399, p = .000). The rates of uterine tachysystole and spontaneous rupture of the fetal membrane were significantly higher in the dinoprostone group than that in the Cook’s balloon group (10.3% vs. 0.7%, p < .001; 7.3% vs. 1.3%, p = .012). There were no differences in maternal complications and neonatal outcomes between the two groups. In pregnant woman with pregnancies complicated by SGA, cervical ripening using dinoprostone were more likely to achieve vaginal delivery than those with Cook’s balloon, and with a favorable complication profile.

Reference:

Yan, M., Li, L., & Wang, J. (2024). Impact of dinoprostone versus cook cervical ripening balloon on induction in pregnancies complicated by small-for-gestational-age fetuses at term. The Journal of Maternal-Fetal & Neonatal Medicine, 37(1). https://doi.org/10.1080/14767058.2024.2381584

Keywords:

Cervical ripening, dinoprostone, vaginal, delivery, pregnancies, complicate, small gestational age, study, The Journal of Maternal-Fetal & Neonatal Medicine, Yan, M., Li, L., & Wang, J.

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Both direct and indirect psychotherapies equally effective inReducing Suicidal Ideation and Suicide Attempts: JAMA

Researchers have found that both direct and indirect modes of psychotherapy have significantly reduced suicidal ideation and attempts. Suicidal ideation and attempts are serious mental health issues that affect millions around the world. Traditionally, psychotherapy indirectly addresses such issues through an approach to reducing the underlying mental health problems, such as depression or personality disorders. A recent study was published in the journal JAMA Psychiatry by Wouter and colleagues.

Most successful suicide prevention interventions are indirect mental health interventions targeted toward depression or personality disorders, as opposed to directly targeting suicidal thoughts or behaviors themselves. Although indirect intervention methods have been found to be efficacious, compared with direct intervention methods, in which actual suicidal ideation has actually been targeted, no previous study has conducted a comprehensive comparison of the efficacy of direct and indirect intervention methods.

The main aim is to identify the effect sizes of direct and indirect psychotherapy for lessened suicidal ideation and attempts. The analysis will be based on the data retrieved from the six major databases: PubMed, Embase, PsycInfo, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials, as of April 1, 2023.

The researchers did a systematic search of six databases for randomized clinical trials comparing psychotherapy for any mental disorder with control groups and reporting outcomes that included suicidal ideation or suicide attempts. Only any setting trial was included if it was psychotherapy-based and reported using validated scales on suicidal behaviors or ideation; those conducted with single-item measures of suicidal ideation were left out. Two independent researchers extracted the data and pooled it with 3-level meta-analyses according to the PRISMA guidelines. Summary of the Effect Sizes Used The effect sizes for suicidal ideation were Hedges g, while relative risk (RR) was used for suicide attempts.

The meta-analysis consisted of 147 studies involving 193 comparisons from a total number of 11,001 participants.

The studies found that direct and indirect psychotherapy reduced suicidal ideation and attempts.

Direct psychotherapy also had a medium-sized effect, with a Hedges g of -0.39 (95% CI, -0.53 to -0.24; I2, 83.2), indicating a moderate reduction in suicidal ideation.

Indirect psychotherapy was once more equivalent, with a Hedges g of -0.30 (95% CI, -0.42 to -0.18; I2, 52.2).

Relative risk for direct psychotherapy was at 0.72 (95% CI, 0.62 to 0.84; I2, 40.5), showing that individuals exposed to direct psychotherapy were 28% less likely to attempt suicide than the control groups.

The relative risk for indirect psychotherapy was at 0.68 (95% CI, 0.48 to 0.95; I2, 0), showing that individuals who received indirect psychotherapy would be 32% less likely to attempt suicide.

In conclusion, the meta-analysis confirmed that both direct and indirect psychotherapy effectively reduce suicidal ideation and the incidence of attempts to commit suicide. Such findings go on to support the provision of both therapeutic strategies in efforts towards prevention of suicide. The outcomes further suggest indirect treatment could provide an essential alternative for people who do not seek explicit help for suicidal thoughts or behaviors. If mental health services can offer a variety of intervention pathways, then it would indeed be possible to reach at-risk individuals and support them in the prevention of suicide.

Reference:

van Ballegooijen, W., Rawee, J., Palantza, C., Miguel, C., Harrer, M., Cristea, I., de Winter, R., Gilissen, R., Eikelenboom, M., Beekman, A., & Cuijpers, P. (2024). Suicidal ideation and suicide attempts after direct or indirect psychotherapy: A systematic review and meta-analysis. JAMA Psychiatry (Chicago, Ill.). https://doi.org/10.1001/jamapsychiatry.2024.2854

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Serum human pregnancy specific glycoprotein 1 in pregnant women with preeclampsia vs normal pregnancy

Preeclampsia [PE] is a multiple system pathology of
pregnancy defined previously as hypertension associated with proteinuria after
20 weeks of pregnancy.

Pregnancy-specific glycoproteins (PSGs), known as
Schwangerschafts Protein and pregnancy-specific beta 1 glycoproteins, are a
family of soluble proteins released by the placental syncytiotrophoblasts
during pregnancy. PSGs have been detected as early as 3 days post fertilization
in the maternal serum, with the attachment of the blastocyst to the uterine wall,
and then the level increases gradually and reaches to the level of 200 400
µg/mL in the third trimester, while in the fetal serum, its level does not
exceed 1-2 µg/L. PSGs can control the secretion of proangiogenic factors,
TGF-β1 and VEGF A, by various types of cell included in placental development. The
provision of an immunomodulator environment and The stimulation of angiogenesis
in the maternal–foetal interface indicate that PSGs are effective in progress
of pregnancy and successful outcomes.

Studies Previously have revealed that the level of PSG is
abnormal in complicated pregnancies and illustrate the role of this protein for
protect healthy pregnancies so, it is clear that the PSG level in serum
diminished with complicated pregnancy outcome abortion, ectopic pregnancy,
fetal hypoxia and intrauterine growth retardation. This study aimed to detect
the relationship between PSG levels and preeclampsia by comparing serum PSG
levels between pregnant with preeclampsia and normotensive healthy pregnants,
and since the PSG1 mRNA is fairly expressed highly compared with other PSGs in
the pregnancy first trimester and in the term placenta.

A total of 90 pregnant women, whom were recruited during
their antenatal care visits to the obstetrical department in Hospital, were
included. They were divided into two groups: 45 women with diagnosis of
preeclampsia and 45 controls who were the women with healthy pregnancy. Blood
samples were collected from both groups and the measurement of pregnancy
specific glycoprotein 1 was done using an enzyme immunometric assay.

The groups of preeclampsia pregnant women had markedly lower
pregnancy specific glycoprotein 1 than the women with the uneventful pregnancies
(p value < 0.001). Pregnancy specific glycoprotein 1 can significantly
predict preeclampsia (P value < 0.001) with an odds ratio of 0.839 and 95%
confidence interval of 0.763 – 0.924. By application of receiver operating
characteristic curve analysis, it was observed that the cut-off value of
pregnancy specific glycoprotien1 for predicting preeclampsia was 10.4 ng/ml
with 77% sensitivity and 60% specificity, the area under the curve 0.728 with
95% confidence interval between 0.622 and 0.835, P value < 0.001).

This study had found that women with PE had significantly
lower PSG1 levels than the women with the uneventful pregnancies (9.8 vs 14.3
ng/ml; p value < 0.001).

From the results of the present study, it could be concluded
that pregnancies complicated by PE are associated with decreased serum maternal
level of PSG1, and values <10.4 ng/ml can predict the development of PE with
77% sensitivity and 60% specificity. The abnormally decreased levels of PSG1 in
pregnant women with PE might be a reflection of stressed or dysfunctional
syncytiotrophoblasts, which is related to the pathogenesis of this placental
disorder.

Source: Murad et al. / Indian Journal of Obstetrics and
Gynecology Research 2024;11(3):388–392;

https://doi.org/10.18231/j.ijogr.2024.070

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Detection of LAM in Non-Sputum Specimens Achieves High Accuracy for TB Diagnosis, reveals study

Lipoarabinomannan (LAM) can be detected in non-sputum samples, such as urine, plasma, and serum, in the diagnosis of pulmonary tuberculosis (TB) among patients with HIV. TB is primarily caused by a bacterium known as Mycobacterium tuberculosis, of which sputum is the most common sample taken. A recent study was published in the journal The Lancet eBioMedicine by Paul K. and colleagues.

Tuberculosis continues to be one of the significant challenges globally and remains one of the most serious global health concerns, predominantly in areas of high prevalence rates for HIV. Sputum samples are the most common presentation of TB, though often less easily obtained, especially in HIV patients or non-productors. A simple detection product for LAM – a cell wall component of Mycobacterium tuberculosis can be screened from all other bodily fluids, providing alternative methods for diagnosis.

This was a prospective diagnostic research conducted on adult patients presenting with TB symptoms in South Africa. A total of 684 participants were enrolled, and 210 participants were randomly selected for comprehensive testing, with a case-to-control ratio of 2:1. Concentrations of LAM were detected in time-matched urine, plasma, and serum samples using an electrochemiluminescence immunoassay that used two capture antibodies: FIND 28 and S4–20, to measure the concentration of LAM. The diagnostic performance was assessed by comparing the concentrations of LAM with microbiological reference standards.

  • 41% of the TB-positive participants were female with the co-infection of HIV.

  • In TB-positive adults, the median urine LAM concentration was 137 pg/mL using FIND 28 and 52 pg/mL using S4–20.

  • LAM levels were the highest among HIV-positive participants with CD4+ T cell counts less than 200 cells/mm³.

  • Urine LAM had a sensitivity of 62% (95% CI: 53–70%) with a specificity of 99% (95% CI: 96–100%) for the S4–20 antibody.

  • In contrast, the sensitivity of plasma and serum LAM levels measured by FIND 28 was 70% (95% CI: 62–78%), with specificities of 90% (95% CI: 82–97%) for plasma and 94% (95% CI: 88–99%) for serum.

  • The mean concentration of the average LAM in HIV-positive participants with CD4+ T cell counts below 200 cells/mm³ was significantly higher, indicating that the subgroup performed better in the diagnostics.

  • The diagnostic sensitivity of urine LAM (S4–20) was more in the non-HIV participants at 41 % (95 % CI: 24 %–61 %) when compared to 20 % (95 % CI: 8 %–39 %) in HIV-positive participants whose CD4 counts ≥200 cells/mm³.

It was thus concluded that LAM could be identified in specimens other than sputum to help diagnose pulmonary TB, especially among HIV-positive individuals with low CD4+ T cell counts. Further work is required in order to enhance the sensitivity in broader populations. LAM testing both in urine and blood samples can represent an important contribution towards TB diagnostics, especially in areas where availability of sputum samples is challenging.

Reference:

Drain, P. K., Niu, X., Shapiro, A. E., Magcaba, Z. P., Ngcobo, Z., Ngwane, M. W., Thomas, K. K., Dalmat, R. R., Morton, J. F., Budiawan, E., Pinter, A., Cantera, J., Anderson, C., Buchmann, R., Wilson, D., & Grant, B. (2024). Real-world diagnostic accuracy of lipoarabinomannan in three non-sputum biospecimens for pulmonary tuberculosis disease. EBioMedicine, 108(105353), 105353. https://doi.org/10.1016/j.ebiom.2024.105353

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AI-Powered CT Scan Analysis Enhances Prognostic Accuracy for Idiopathic Pulmonary Fibrosis, Study Finds

UK: Researchers have reported that deep-learning algorithms can accurately segment computed tomography (CT) scans of patients with idiopathic pulmonary fibrosis (IPF), providing valuable prognostic information for clinicians.

The new data, published in the American Journal of Respiratory and Critical Care Medicine, has the potential to enhance the monitoring and treatment of IPF patients.

Although evidence exists to support the prognostic value of computed tomography (CT) scans in idiopathic pulmonary fibrosis, image-based biomarkers are not commonly employed in clinical practice or trials. Considering this, Muhunthan Thillai, Royal Papworth Hospital, Cambridge, United Kingdom, and colleagues aimed to develop automated imaging biomarkers using deep learning–based segmentation of CT scans.

For this purpose, the researchers developed segmentation processes for four anatomical biomarkers, which were then applied to a unique cohort of treatment-naive patients with IPF from the PROFILE (Prospective Observation of Fibrosis in the Lung Clinical Endpoints) study. These processes were also tested against a separate cohort from the United Kingdom. The study evaluated the relationships among CT biomarkers, lung function, disease progression, and mortality.

The analysis included data from 446 PROFILE patients, with a median follow-up duration of 39.1 months (interquartile range, 18.1–66.4 months). Over five years, the cumulative incidence of death was 277 patients (62.1%).

The study led to the following findings:

  • Segmentation was successful on 97.8% of all scans across multiple imaging vendors at slice thicknesses of 0.5–5 mm.
  • Lung volume showed the strongest correlation with FVC (r = 0.82) of the four segmentations.
  • Lung, vascular, and fibrosis volumes were consistently associated across cohorts with differential 5-year survival, which persisted after adjustment for baseline gender, age, and physiology score.
  • Lower lung volume (hazard ratio [HR], 0.98), increased vascular volume (HR, 1.30), and increased fibrosis volume (HR, 1.17) were associated with reduced 2-year progression-free survival in the pooled PROFILE cohort.
  • Longitudinally, decreasing lung volume (HR, 3.41) and increasing fibrosis volume (HR, 2.23) were associated with differential survival.

The findings showed that automated models can quickly segment CT scans of IPF, offering both near-term and long-term prognostic information. This capability could be integrated into routine clinical practice or used as critical endpoints in clinical trials.

The team believes these findings could enhance the monitoring of patients with idiopathic pulmonary fibrosis (IPF).

“We show that CT scans from IPF patients can be utilized to train models capable of rapidly and extensively segmenting images to generate data on fibrosis, vessel, airway, and lung volumes. These models can also predict disease progression and mortality,” the researchers concluded.

Reference:

Thillai M, Oldham JM, Ruggiero A, Kanavati F, McLellan T, Saini G, Johnson SR, Ble FX, Azim A, Ostridge K, Platt A, Belvisi M, Maher TM, Molyneaux PL. Deep Learning-based Segmentation of Computed Tomography Scans Predicts Disease Progression and Mortality in Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med. 2024 Aug 15;210(4):465-472. doi: 10.1164/rccm.202311-2185OC. PMID: 38452227.

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Liposomal bupivacaine fails to decrease pain after hip fracture surgery: Study

 For older adults undergoing hemiarthroplasty for hip fracture, intraoperative use of liposomal bupivacaine does not improve pain scores or other relevant outcomes, compared to conventional bupivacaine, reports a study in The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio by Wolters Kluwer.

“[U]se of liposomal bupivacaine is not associated with substantially improved postoperative pain or function or with a shorter hospital course following hip hemiarthroplasty for a femoral neck fracture,” according to the clinical trial report by Mitchell K. Ng, MD, and colleagues of Maimonides Medical Center, Brooklyn, New York.

Randomized trial of liposomal bupivacaine for hip fracture surgery

Liposomal bupivacaine is a long-acting local anesthetic developed for use in relieving postoperative pain, allowing drug release over up to 72 hours. Studies have shown that liposomal bupivacaine can reduce pain after various surgical procedures, including total knee or hip arthroplasty. Few studies have assessed its use following hip fracture surgery.

The new clinical trial enrolled 50 older adults undergoing hip hemiarthroplasty for isolated intracapsular femoral neck fractures. Patients were randomly assigned to intraoperative injection of either liposomal bupivacaine or standard bupivacaine hydrochloride. In both groups, a series of injections were made around the reconstructed joint toward the end of the procedure.

Pain scores, total opioid dose, and time to ambulate were assessed in blinded fashion. Time to hospital discharge, safety, and a range of secondary outcomes were evaluated as well.

The results showed no significant difference in pain scores with liposomal bupivacaine (2.3) versus standard bupivacaine (2.7), with scores remaining comparable throughout the first 48 hours postoperatively. The two groups also required similar total opioid doses (morphine milligram equivalents) for pain relief. Liposomal bupivacaine is marketed as an alternative to reduce the need for postoperative opioids.

‘Worth questioning’ liposomal bupivacaine in geriatric hip fracture

In both groups, time to ambulation was about one day and time to hospital discharge was about four days. Delirium and other postoperative adverse events were comparable as well.

The new study – the first randomized controlled trial of liposomal bupivacaine for hip fracture surgery in elderly patients – showed no significant difference in pain scores and other relevant outcomes, as compared with standard intraoperative bupivacaine administration.

The researchers point out some limitations of their study, including possible variations in injection technique. Dr. Ng notes: “Our study specifically focused on hip fractures, and does not contradict the growing body of evidence that liposomal bupivacaine is indeed beneficial to reduce pain scores in context of primary total joint arthroplasty.”

Citing a previous report, the authors note the high cost of liposomal bupivacaine: 11 times higher than standard bupivacaine or other postoperative pain modalities. “Given the increased costs associated with liposomal bupivacaine, it is worth questioning its use in the setting of geriatric patients with a hip fracture undergoing hemiarthroplasty,” Dr. Ng and coauthors conclude. 

Reference:

Kang, Kevin K. MD1; Voyvodic, Lucas BS1; Komlos, Daniel MD1; Swiggett, Samuel MD1; Ng, Mitchell K. MD1,a. Liposomal Bupivacaine Does Not Decrease Postoperative Pain in Patients with Intracapsular Femoral Neck Fracture Treated with Hemiarthroplasty: HEAT-A Randomized, Controlled Trial. The Journal of Bone and Joint Surgery ():10.2106/JBJS.23.01344, September 18, 2024. | DOI: 10.2106/JBJS.23.01344.

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RG Kar Case: ‘Why Progress on safety measures so tardy?’ SC pulls up WB Govt, seeks National Task Force’s Report

New Delhi: The Supreme Court, while considering the suo-motu matter regarding the rape and murder of a PG trainee doctor at Kolkata-based RG Kar Medical College and Hospital, criticised the West Bengal Government today over its “tardiness” in installing CCTVs, and building toilets to ensure the safety of resident doctors at their workplace.

Taking note of the submission of the West Bengal Government’s counsel that the works would be completed by 31st October, the Apex Court bench comprising the Chief Justice of India DY Chandrachud, Justices JB Pardiwala and Manoj Misra observed, “…the status report submitted by WB indicates the ongoing work ….thought the state has indicated that remaining work will be completed by 31st October, but state has assured that it will make all endeavours to complete the work by 15th October 2024.”

Listing the matter for further hearing on October 14, 2024, the Apex Court bench directed the counsel for the Union Government Tushar Mehta to submit the report on the progress of the National Task Force on the next day.

What Happened at the Supreme Court Hearing today? 

Photographs & Name of Deceased Still Being Used on Social Media Posts:

During the hearing of the matter, the counsel for the deceased’s parents highlighted that there were still a lot of social media posts disclosing her name and photos.

However, CJI Chandrachud that an order in this regard has already been passed and now it is only upon law enforcement to enforce the order. Responding to this, the counsel asked if there could be a nodal officer and email ID provided by the Union for the taking down of the posts according to the law.

Meanwhile, Advocate Nandy for the senior doctors pointed out that reels were also being made with hindi songs in it. At this outset, the CJI observed that the West Bengal Government should immediately contact all the media posts.

Advocate Vrinda Grover, appearing for the victim’s family, pointed out that there is also a YouTube movie that is slated for release tomorrow which says that it is based on the victim. However, the CJI pointed out that to stop the film, legal recourse needed to be taken. Again, Advocate Grover urged the Court to appoint a nodal counsel to whom the victim’s family could pass the information.

After the counsels highlighted that the last order of the Apex Court was regarding Wikipedia only, the CJI noted that “The parents of the deceased are disconcerted by repeated clips in social media referring to photographs and the name of the deceased. Besides these, videos have also proliferated. Earlier order is clarified to apply in relation to all intermediaries and to reiterate no intermediate shall be allowed to carry the name or pics of her identity.” Further, the CJI asked MEITI to notify a nodal officer in relation to any uploading or unauthorized publication which be taken away.

Meanwhile, Senior Advocate Mahesh Jethmalani pointed out that till death no FIR has been lodged against the Police Commissioner who revealed the name of the victim and the High Court had said that the Supreme Court would look into this.

After perusing the status report submitted by the Central Bureau of Investigation (CBI), the CJI observed that very substantial leads have come up in the CBI investigation. Asking CBI to continue with the investigation, the CJI noted that the CBI has given statements on both aspects- the rape and murder case and the financial irregularities.

Referring to the report, which mentioned that the injury was accelerated because of braces and glasses she was wearing, the CJI asked “how can that happen if you are lying for sleep?” 

On this, one of the counsels asked if the person who conducted the Forensic Examination was examined. To this, Solicitor General Mehta informed that he was examined before hospitalisation.

Counsels Highlight Possibility of Accused Persons Still Being in Power: 

During the proceedings, Advocate Jaisingh, appearing for the junior doctors in Bengal, informed the Court that the Junior Doctors have already gone back to work. She also submitted that she had 4 names, who arrived at the place of crime and some were elected members of the Council. 

Advocate Nandy also submitted that a lot of people mentioned in the CBI wrt in the financial irregularities case and who were also present at the crime scene, are still in power. She urged the Court that they should be suspended temporarily until the investigation is over. Advocate Jaisingh pointed out that 7 people in investigation are still in employment at RG Kar and argued that they only needed to be suspended temporarily so that the doctors can go back to work with confidence. She urged the Court to issue directions to let the alleged persons go on leave.

Also Read: RG Kar Case: Supreme Court tells protesting doctors to resume work from tomorrow, state to ensure Safety

The CJI asked the Solicitor General to inform the Court why the people under investigation are still employed in RG Kar against whom financial irregularities are alleged. 

“…ultimately any action has to be taken by the state govt…it would be appropriate at this stage for sharing of information with the State Govt,” observed the CJI, further seeking information about the 5 doctors in RG Kar who were suspended.

“presently we are seeing is Rape and financial irregularities ….we are focusing on RG KAR but rest assured we can see other things, we can look at the IA, if there is need for broadening the investigation…this is part of the broader nexus (alleged mafia mentioned by the adv),” the CJI was quoted noting by Live Law.

Meanwhile, Advocate Dwivedi appearing for the State of West Bengal informed that when the doctors met the CM, they requested the transfers of police officials, they were transferred. However, Advocate Nandy pointed out that they had asked for resignation.

In response to this, Advocate Dwivedi pointed out that furthermore any information is given by the CBI on any person, action will be taken without any difficulty. 

Taking note of these submissions, the CJI pointed out that CBI has submitted the 4th status report dated 30 September indicating the leads and steps taken in the investigation. Referring to this, the CJI observed, “…at this stage , when investigation is in progress, it would not be appropriate to set down the details of leads ….CBI is conducting investigation on (1) the rape and murder and (2) allegation on financial irregularities – whether there is relationship between the two is a matter of investigation by the CBI.”

“…several persons against whom serious allegations of misdemeanor are there are occupying positions in the college…the submissions of the doctor is that such persons should either be suspended or directed to be on leave is matter to be decided by the state govt ….” the Court further observed.

The CJI referred to the West Bengal Government’s submission stating that if the CBI shares any information of such person, the State will take action consistent with the law. Referring to this, the bench ordered, “…counsels submit that the financial irregularities would extent to outside the state, the CBI may be informed along with the modalities prescribed, the court may be informed what other directions maybe required to be given.”

Court Seeks Details of Work Done to Ensure Safety of Doctors: 

After issuing directions that the details of the IA may be shared with the CBI, the CJI questioned the West Bengal Government regarding the steps taken for CCTV cameras and the construction of toilets and separate resting rooms etc.

In response to this, Advocate Dwivedi requested for more time to complete the constructions as there are logistical delays, flood situation etc. He submitted that 36% CCTVs have been installed and the remaining likely to be completed by 10 October. 

At this outset, the CJI noted that no part of the work is above 50%. “why is the process so tardy? we have been monitoring since 9 August…” questioned the CJI. However, Advocate Dwivedi assured to complete the work by 31st October, by 15th most work will be done.

Meanwhile, the Apex Court bench recorded that 2 officers were brought in as Principal and VP of the College- Dr. Manas Banerjee and Dr. Saptarshee Chatterjee.

“…the status report submitted by WB indicates the ongoing work ….thought the state has indicated that remaining work will be completed by 31st October, but state has assured that it will make all endeavours to complete the work by 15th October 2024,” observed the CJI.

One of the advocates brought allegations against the current principal at RG Hospital. However, the CJI asked him not to just throw allegations without any basis. 

Allegations Against Junior Doctors Not Performing OPD Works: 

During the hearing, the counsel for West Bengal Government pointed out that doctors were not performing OPD services. However, CJI recorded the submission of Advocate Jaisingh stating that the doctors were performing all duties and services.

Advocate Jaisingh submitted that they were performing all essential services including IPD and OPD services and insisted the Court to record categorically that they were providing all essential and emergency services.

The CJI noted, “Jaisingh has categorically stated that all doctors shall perform essential services including IPD and OPD.”

Meanwhile, Advocate Nandy pointed out that there have been several other attacks including the recent incident at Sagar Dutta Medical College. At this outset, even though Advocate Dwivedi alleged that a patient had died because no beds were provided and no doctor attended, Advocate Nandy vehemently argued that such allegations could not be made.

Court Asks Solicitor General to Submit National Task Force’s Report on Next Date: 

When Advocate Jethmalai reiterated the case of the Police Commissioner revealing the victim’s name. the CJI observed, “we are not staying the proceedings before HC …HC seasoned enough to know which areas to enter upon. SG can I we have report of the NTF on next date? SG shall place on record of the progress of the NTF on the next date.”

Even though Advocate Jaisingh urged the Court to include one member from the State of West Bengal in the National Task Force, the Court clarified that the Task Force was not State specific and its report would have pan-India implications.

“the cabinet secretary are coordinating, they will take into account what the WB has to say …..please write an email, request an urgent appointment and give them inputs, it will be a welcomed suggestion, the SG can communicate,” observed the Court.

While Advocate Jaisingh pressed for making a sub-taskforce for West Bengal, the CJI noted, “all that you have to do is address an email, they will ensure that representation of the residential doctors will be heard.”

Also Read: Conditions of Women Doctors not Working at Night Will Prejudice their Careers: Supreme Court Criticises Bengal Govt’s Policy

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