Bhagwan Mahaveer Cancer Hospital and Research Centre

Parkinson's disease (PD) is a neurodegenerative disease. It is not curable and treatment revolves around controlling the symptoms. The most preferable approach is medicating with levodopa drug. One of the major concerns in treating with this drug is its conversion to dopamine within the gut and 1%−10% of dopamine becomes available to the brain, thus compromising the effectiveness of the treatment. Other dominant concerns are γ-amino butyric acid (GABA) collapse and serotonergic dysfunction that leads to secondary symptoms. To counter-balance its appalling repercussions reversal of gut bacterial dysbiosis, gut modulation by supportive bacteria is the new uproar, uncovering potent applications. In this study, gut bacteria were focused on having the ability to overcome the drug interference possibility. Samples were collected from PD patients, prone to PD, and healthy individuals for isolation of gut bacteria and were screened for criteria like tyrosine decarboxylase, GABA, short chain fatty acids (SCFAs), and serotonin production. Thin layer chromatography (TLC), Fourier transform infrared spectroscopy (FTIR), and spectrophotometric analysis were used to test bacteria for the production of GABA and serotonin. A total of 855 isolates were screened and 23 isolates were further evaluated for their probiotic properties. Out of which 6 isolates namely HFS 2.1 TM, HFS 10.2 TM, FS 9.2 SA, HFS 6.2 NA, HFS 11.1 TM, and HFS 11.1 PDA were identified by 16S rRNA sequencing and were screened positive to be prospective psychobiotic agents that could be employed as adjuvant therapy for PD.

This study investigates whether cancer-related stigma and pain among patients with advanced cancer influences their perceptions of receiving responsive care. We surveyed 2138 advanced cancer patients from 11 hospitals in eight Asian countries. Participants rated their most recent healthcare visit and a hypothetical patient's experience described in vignettes concerning dignity, clarity of information, and involvement in decision-making. We used the vignettes to correct for differences in patients' reporting behaviors. Overall, 39% of patients perceived cancer-related stigma, and 66% reported moderate or severe pain. While most patients rated their own experience of being treated with dignity (89%), receiving clear information (82%), and involvement in decision-making (79%) as "good" or "very good," they generally rated the vignettes less favorably compared to their own care experience. The negative relationship between perceived stigma and severe pain and health system responsiveness was established through the ordered probit models (p < 0.05 for all domains). Correcting for reporting heterogeneity amplified the negative association for all three domains of health system responsiveness for both moderate and severe pain and perceived stigma (p ≤ 0.01 for all domains). The widespread prevalence of cancer-related stigma and pain documented in this study across a diverse sample of patients with advanced cancer is concerning. Moreover, perceived stigma and pain pervade patients' interactions with the healthcare system, diminishing their experience of being treated with dignity, receiving clear information, and participating in decision-making. Our findings underscore the importance of addressing stigma and pain to ensure responsive care for advanced cancer patients in Asia.

Dear Editor, We report our experience using serratus posterior superior intercostal plane block (SPSIPB) for analgesia in a 69-year-old male patient, American Society of Anesthesiologists (ASA) physical status II, scheduled for the excision of a large, lobulated fungating mass (measuring 116 mm × 74 mm × 53 mm) on the right shoulder, along with axillary lymph node dissection and reconstruction. The mass extended from the right shoulder to the ipsilateral supraclavicular region, abutting the sternocleidomastoid muscle superiorly, the pectoral muscles inferolaterally, and the trapezius muscle posteriorly [Figure 1a and b]. Due to the location of the tumour, an interscalene brachial plexus block was not feasible, and other blocks, such as the serratus anterior plane block, erector spinae plane block, and rhomboid intercostal and subserratus plane block, would not have provided sufficient analgesia from the shoulder to the neck.Figure 1: (a) Location of the large ulceroproliferative mass. (b) The scope of dissection includes the neck, shoulder, and chest wall. (c) Diagram showing the anatomy of the serratus posterior superior muscle and the position of the transducer. (d, e) Post-block ultrasound images displaying sono-anatomy, reverse sono-anatomy, and the distribution of local anaesthetic (the blue star indicates the spread of local anaesthetic, a red triangle denotes the needle path)In the operating room, after standard monitoring, the patient was positioned sitting, with the affected side arm touching the opposite shoulder to displace the overlying scapula for SPSIPB laterally. After ensuring a sterile field, a high-frequency (7–12 MHz) linear transducer (Fujifilm Sonosite M Turbo Edition, USA) was placed over the base of the neck in a parasagittal orientation and traced downwards to identify the 1st–3rd ribs, the overlying serratus posterior superior muscle (SPSM), the rhomboid major, and the trapezius muscles along the upper medial border of the scapula. A 22-gauge Stimuplex A (B Braun, Melsungen, Germany) was advanced in-plane (caudal to cephalad) towards the interfascial plane between the SPSM and the intercostal muscles. Following negative aspiration, 1–2 mL of saline was injected to confirm correct placement, and 30 mL of 0.375% ropivacaine with 6 mg dexamethasone was administered into the space between the SPSM and the intercostal muscles [Figure 1c–e]. The craniocaudal spread of the anaesthetic was monitored in real time using ultrasound. The sensory assessment confirmed successful analgesia in the neck, lateral chest wall, axilla, and shoulder 20 minutes post-block, using spirit-soaked gauze. General anaesthesia was induced with intravenous fentanyl (2 µg/kg), propofol (2 mg/kg), and rocuronium (0.9 mg/kg), followed by tracheal intubation with an 8-mm cuffed tracheal tube. Mechanical ventilation was maintained using an oxygen-air mix at 1.5 L/min and isoflurane (1%–1.5%). The surgery included wide local excision with axillary lymph node dissection and regional pedicle flap reconstruction. No additional analgesic was required intraoperatively. At extubation, the patient was comfortable and breathing well. Postoperative pain management included intravenous paracetamol 1 g every 8 hours, and intravenous tramadol 50 mg reserved for rescue analgesia if the Numeric Rating Scale for either dynamic or resting pain exceeded 3 out of 10. Pain was assessed by the acute pain service team in the post-anaesthesia care unit immediately after shifting (0 hours) of the patient and at various intervals: 1, 4, 8, 16, and 24 hours postoperatively. Pain scores remained below 3/10 during the first 24 hours. The patient received a total of 3 g intravenous paracetamol postoperatively as a part of a multimodal analgesia regimen. After 24 hours, the patient was transitioned to oral analgesics. The SPSM, located in the posterior thorax, originates from the nuchal ligament and spinous processes of C7–T3, inserting obliquely onto the upper borders of the 2nd–5th ribs. This muscle lies deep into the scapula, creating a plane through which local anaesthetic can spread from the neck to the shoulder. Administering a local anaesthetic in this plane allows the drug to bathe both the dorsal rami and lateral cutaneous branches of the intercostal nerves at the C3–T7 levels, providing analgesia to the ipsilateral neck, shoulder, and hemithorax. Initially, SPSIPB was studied through cadaveric examination and a retrospective evaluation of patients with thoracic pain.[1] Subsequently, the analgesic efficacy of this block has been evaluated in video-assisted thoracoscopic surgery, minimally invasive cardiac surgery, and breast surgery.[2,3] Declaration of patient consent We certify that we have obtained all appropriate patient consent forms. In the form, the patient has given his consent for images and other clinical information to be reported in the journal. The patient understands that names and initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Introduction : Oligohydramnios, dened as when the Amniotic uid index is less than 5. Denition of increased or decreased amniotic uid volume or based on sonographic criteria. Oligohydramnios complicates 1-2 % of pregnancies. Amniotic uid provides the cushion effect against the constricting connes of the gravid uterus. It creates space and help in musculoskeletal development of fetus, helps in normal fetal lung development and prevents compression of umbilical cord, placenta and hence protects the fetus from vascular and nutritional compromises. Oligohydramnios is associated with high-risk adverse perinatal outcome like fetal distress, meconium aspiration, low APGAR, joint contracture, pulmonary hypoplasia etc., and associated with maternal morbidity in the form of increased rates of induction and/or operative interference. Materials &amp; Methods : This is the prospective observational study of parturient with oligohydramnios admitted in the department of OBG, BMCRC Ballari, study conducted for a period of 6 months August 2023 to January 2024 consist of 70 subjects. This study is conducted on all singleton, non-anomalous, low risk pregnant women with AFI less than or equal to 5 with intact membranes and gestational age between 37-42 weeks. After obtaining approval and clearance from the institutional ethical committee, the pregnant woman meeting the inclusion and exclusion criteria was enrolled in the study after obtaining informed consent. Detailed clinical history including obstetric, menstrual, past and personal history was taken and detailed examination was done. Basic routine blood investigations were done. Liquor volume was estimated by ultrasonography by measuring the AFI by four quadrant technique of Phelan or when the single deepest vertical pocket measures less than 2cms. Delivery was optimized depending on antepartum fetal surveillance. The mean age of mothers at time o Results: f delivery was lower (25.84 yrs) in the oligohydramnios group. Most of the patients were primiparous, this difference was found to be non-signicant. Out of 70 cases, majority of cases were between 39-39.6 weeks of gestation 31 cases (44.28%). Comparison of pregnancy outcome between the two groups is represented in Table 2. Low birth weight, NICU admission, fetal distress, fetal death, APGAR score, preterm delivery, and neonatal death. However, meconium staining, mode of delivery and postpartum hemorrhage were almost equal in the two groups (p&gt;.05). The average and standard deviation of AFI were in 6.14±1.08 cm in oligohydramnios group. APGAR score was above 7 in 80% patients in oligohydramnios group. The table and graph show the distribution of cases based on admission NST. It was reactive in 37 cases (52.85%) at the time of admission. Augmentation was done for 23 cases (32.8%). : Our present study shows that even though there is an increased rate of caesarean se Conclusion ction, NICU admission and observation, meconium stained liquor and NST changes there is no signicant increase in the perinatal morbidity and mortality.

In individuals with diabetes, the occurrence of heart failure varies from 9% to 22%, marking a fourfold rise compared to the general population. This heightened prevalence is particularly pronounced in diabetic patients aged 60 years or older. Recent studies highlight a rapid increase in mortalities related to cardiomyopathies, attributed to the alarming surge in cases of type 2 diabetes mellitus. Global epidemics like diabetes and heart failure (HF) often referred to as the “deadly duo,” pose a significant burden on society due to heightened hospitalization costs and a grim prognosis. Therefore, it is necessary to implement new strategies for improving the diagnosis and treatment of diabetes and heart failure. Early diagnosis of diabetes and heart failure may have results in keeping patients healthy and it helps in reducing the risk factors of such serious complications. Currently, the application of artificial intelligence (AI) and Machine Learning (ML) in the field of diabetes has increased which may help improve the classification system and may have the possibility to solve this problem at an early stage. In this article, our aim is to examine the multifaceted relationship between diabetes and heart failure using (AI/ML). The application of AI and ML in diabetes and heart failure research has been widely explored in basic biomedical research. Therefore, in this review, we highlighted the impactful use of AI/ML in underlying mechanisms of diabetic cardiomyopathy by using various therapeutic drugs to explore the risk factors and consider their implications on patient response. By unraveling this intricate relationship, we can strive to enhance our knowledge to pave the way for improved preventive measures, early detection, and more effective management of these intertwined titans.

Abstract Neural tube defects are common pediatric surgical conditions. Among them, encephalocele represents the protrusion of the brain component through the cranial defect. Double encephalocele is a rare entity, with only five cases reported in literature.We report a case of congenital double encephalocele with review of literature.