Objective: Pharmacognostic Screening and evaluate the in-vitro free radical scavenging activity of roots Acacia leucophloea. Methods: Pharmacognostic Standardization, Physico-chemical evaluation of the roots of Acacia leucophloea was carried out to determine its macro-and microscopical characters and also some of its quantitative standards. Microscopical studies were done by using trinocular microscope. Microscopically, root showed cork, cortex, stellar region and calcium oxalate crystals. Petroleum ether, ethanol, aqueous extracts of Acacia leucophloea were prepared, with successive extraction in soxhlet apparatus. Each extract was selected to study the free radical scavenging activity by superoxide scavenging assay method. Results: It was found that aqueous extract contained carbohydrates, glycosides amino acids flavonoids, tannins, alkaloids, steroids; ethanolic extract contained glycosides amino acids flavonoids, tannins, alkaloids, steroids. Ethanolic extract of Acacia leucophloea shows maximam inhibition in superoxide scavenging model. Aqueous extract also showed almost similar activity compared to ethanolic extract), while Petroleum ether extract showed poor inhibition of superoxide scavenging activity. Conclusion: The present study on pharmacognostic standardization, physico and phytochemical evaluation of Acacia leucophloea root might be useful to supplement information about its identification parameters assumed significantly in the way of acceptability of herbal drugs in present scenario lacking regulatory laws to control quality of herbal drugs.

Background: Predicting difficult intubation (DI) is a key challenge, as no single clinical predictor is sufficiently valid to predict the outcome. We evaluated the effectiveness of four upper airway ultrasonographic parameters in predicting DI. The validity of the models using combinations of ultrasonography-based parameters was also investigated. Methods: This prospective, observational, double-blinded cohort trial enrolled 1,043 surgical patients classified as American Society of Anesthesiologists physical status I–III without anticipated difficult airway. Preoperatively, their tongue thickness (TT), invisibility of hyoid bone (VH), and anterior neck soft tissue thickness from the skin to thyrohyoid membrane (ST) and hyoid bone (SH) were measured by sublingual and submandibular ultrasonography. The logistic regression, Youden index, and receiver operator characteristic analysis results were reported. Results: Overall, 58 (5.6%) patients were classified as DI. The TT, SH, ST, and VH had accuracies of 78.4%, 85.0%, 84.7%, and 84.9%, respectively. The optimal values of TT, SH, and ST for predicting DI were > 5.8 cm (sensitivity, 84.5%; specificity; 78.1%; AUC, 0.880), > 1.4 cm (sensitivity, 81%; specificity, 85.2%; AUC, 0.898), and > 2.4 cm (sensitivity, 75.9%; specificity, 85.2%; AUC, 0.885), respectively. VH had a sensitivity and specificity of 72.4% and 85.6% (AUC, 0.790. The AUC values of the five models (with combinations of three or four parameters) ranged from 0.975–0.992. ST and VH had a significant impact on the individual models. Conclusions SH had the best accuracy. Individual parameters showed limited validity. The model including all four parameters offered the best diagnostic value.

Background: Predicting difficult intubation (DI) is a key challenge, as no single clinical predictor is sufficiently valid to predict the outcome. We evaluated the effectiveness of four upper airway ultrasonographic parameters in predicting DI. The validity of the models using combinations of ultrasonography-based parameters was also investigated. Methods: This prospective, observational, double-blinded cohort trial enrolled 1,043 surgical patients classified as American Society of Anesthesiologists physical status I–III without anticipated difficult airway. Preoperatively, their tongue thickness (TT), invisibility of hyoid bone (VH), and anterior neck soft tissue thickness from the skin to thyrohyoid membrane (ST) and hyoid bone (SH) were measured by sublingual and submandibular ultrasonography. The logistic regression, Youden index, and receiver operator characteristic analysis results were reported. Results: Overall, 58 (5.6%) patients were classified as DI. The TT, SH, ST, and VH had accuracies of 78.4%, 85.0%, 84.7%, and 84.9%, respectively. The optimal values of TT, SH, and ST for predicting DI were > 5.8 cm (sensitivity, 84.5%; specificity; 78.1%; AUC, 0.880), > 1.4 cm (sensitivity, 81%; specificity, 85.2%; AUC, 0.898), and > 2.4 cm (sensitivity, 75.9%; specificity, 85.2%; AUC, 0.885), respectively. VH had a sensitivity and specificity of 72.4% and 85.6% (AUC, 0.790. The AUC values of the five models (with combinations of three or four parameters) ranged from 0.975–0.992. ST and VH had a significant impact on the individual models. Conclusions SH had the best accuracy. Individual parameters showed limited validity. The model including all four parameters offered the best diagnostic value.

Dual venous anastomosis in radial forearm free flap surgery increases chances of flap survival as compared to anastomosing only the superficial system. A 48-year-old male patient who had received three previous microsurgical reconstructions and radiotherapy presented with recurrent oral cavity carcinoma. Two of these reconstructions were anastomosed to the left side neck vessels. The recurrence was in the left half of the soft palate. The left neck and underlying vessels were severely scarred and fibrotic, and only 2 cm of the left internal jugular vein (IJV) could be circumferentially mobilized for anastomosis, allowing for only one venous anastomosis. The radial forearm free flap was harvested and a tributary of the cephalic vein was preserved in the proximal part to act as a conduit for drainage of one of the venae comitantes. The cephalic vein was anastomosed end-to-side to the IJV and one venae comitantes to the preserved tributary in end-to-end fashion. The flap survived and the patient was discharged in a week. This novel method helps to drain both venous systems through one available neck vein.

Dual venous anastomosis in radial forearm free flap surgery increases chances of flap survival as compared to anastomosing only the superficial system. A 48-year-old male patient who had received three previous microsurgical reconstructions and radiotherapy presented with recurrent oral cavity carcinoma. Two of these reconstructions were anastomosed to the left side neck vessels. The recurrence was in the left half of the soft palate. The left neck and underlying vessels were severely scarred and fibrotic, and only 2 cm of the left internal jugular vein (IJV) could be circumferentially mobilized for anastomosis, allowing for only one venous anastomosis. The radial forearm free flap was harvested and a tributary of the cephalic vein was preserved in the proximal part to act as a conduit for drainage of one of the venae comitantes. The cephalic vein was anastomosed end-to-side to the IJV and one venae comitantes to the preserved tributary in end-to-end fashion. The flap survived and the patient was discharged in a week. This novel method helps to drain both venous systems through one available neck vein.

Dual venous anastomosis in radial forearm free flap surgery increases chances of flap survival as compared to anastomosing only the superficial system. A 48-year-old male patient who had received three previous microsurgical reconstructions and radiotherapy presented with recurrent oral cavity carcinoma. Two of these reconstructions were anastomosed to the left side neck vessels. The recurrence was in the left half of the soft palate. The left neck and underlying vessels were severely scarred and fibrotic, and only 2 cm of the left internal jugular vein (IJV) could be circumferentially mobilized for anastomosis, allowing for only one venous anastomosis. The radial forearm free flap was harvested and a tributary of the cephalic vein was preserved in the proximal part to act as a conduit for drainage of one of the venae comitantes. The cephalic vein was anastomosed end-to-side to the IJV and one venae comitantes to the preserved tributary in end-to-end fashion. The flap survived and the patient was discharged in a week. This novel method helps to drain both venous systems through one available neck vein.

Dual venous anastomosis in radial forearm free flap surgery increases chances of flap survival as compared to anastomosing only the superficial system. A 48-year-old male patient who had received three previous microsurgical reconstructions and radiotherapy presented with recurrent oral cavity carcinoma. Two of these reconstructions were anastomosed to the left side neck vessels. The recurrence was in the left half of the soft palate. The left neck and underlying vessels were severely scarred and fibrotic, and only 2 cm of the left internal jugular vein (IJV) could be circumferentially mobilized for anastomosis, allowing for only one venous anastomosis. The radial forearm free flap was harvested and a tributary of the cephalic vein was preserved in the proximal part to act as a conduit for drainage of one of the venae comitantes. The cephalic vein was anastomosed end-to-side to the IJV and one venae comitantes to the preserved tributary in end-to-end fashion. The flap survived and the patient was discharged in a week. This novel method helps to drain both venous systems through one available neck vein.

Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity. In our review, we have discussed nine original studies describing endoscopic sleeve gastroplasty (ESG). A total of 172 subjects successfully underwent ESG. Of 65 subjects with follow up data, 95.4% (62/65) had intact gastric sleeve confirmed via esophagogastroduodenoscopy or oral contrast study at the end of study specific follow up interval (the longest being 6 months). Individual studies reported a technical success rate for intact gastric sleeve from as low as 50% to as high as 100%. A statistically significant p < 0.05) weight loss was reported in seven of the eight studies with available data. None of the patients experienced any intra-procedure complications, and approximately 2.3% (4/172) of patients experienced major post-procedure complications; however, no mortality was reported. Majority of the studies reported relatively high incidence of minor post-procedure complications, which improved with symptomatic treatment alone. Good patient tolerance with comparable clinical efficacy in achieving and sustaining desired weight loss makes ESG an attractive option to consider among other bariatric therapies.
Bariatric Surgery ; Behavior Therapy ; Body Mass Index ; Endoscopy, Digestive System ; Follow-Up Studies ; Gastroplasty* ; Humans ; Incidence ; Mortality ; Obesity* ; Pandemics ; Treatment Outcome ; Weight Loss

The histologic analysis of gastrointestinal stromal tumors (GISTs) is a common method to detect the mitotic activity and to subsequently determine the risk of GISTs for malignancy. The potential false negative error due to inadequate yield of specimens and actual determination of malignancy risk requires analysis of the whole tumor. We aimed to assess the role of contrast enhanced endoscopic ultrasound (CE-EUS) in the management of GISTs. Two authors individually did review of English literatures to identify nine peer-reviewed original articles using keywords- contrast endoscopic ultrasound, GIST and submucosal tumor. Studies were heterogeneous in their aims looking either at differentiating submucosal lesions from GISTs, estimating malignant potential of GISTs with histologic correlation or studying the role of angiogenesis in malignant risk stratification. CE-EUS had moderate to high efficacy in differentiating GISTs from alternative submucosal tumors. CE-EUS had a higher sensitivity than EUS-guided fine needle aspiration, contrast computed tomography and Doppler EUS for detection of neo-vascularity within the GISTs. However, the evidence of abnormal angiogenesis within GIST as a prognostic factor needs further validation. CE-EUS is a non-invasive modality, which can help differentiate GISTs and provide valuable assessment of their perfusion patterns to allow better prediction of their malignant potential but more experience is needed.
Biopsy, Fine-Needle ; Diagnosis* ; Gastrointestinal Stromal Tumors* ; Methods ; Perfusion ; Ultrasonography*

Gastric outlet obstruction, afferent or efferent limb obstruction, and biliary obstruction among patients with altered anatomy often require surgical intervention which is associated with significant morbidity and mortality. Endoscopic dilation for benign etiologies requires multiple sessions, whereas self-expandable metal stents used for malignant etiologies often fail due to tumor in-growth. Lumen apposing metal stents, placed endoscopically with the intent of creating a de-novo gastrointestinal anastomosis bypassing the site of obstruction, can potentially achieve similar efficacy, with a much lower complication rate. In our study cohort (n=79), the composite technical success rate and clinical success rate was 91.1% (72/79) and 97.2% (70/72), respectively. Five different techniques were used: 43% (34/79) underwent the balloon-assisted method, 27.9% (22/79) underwent endoscopic ultrasound-guided balloon occluded gastro-jejunostomy bypass, 20.3% (16/79) underwent the direct technique, 6.3% (5/79) underwent the hybrid rendezvous technique, and 2.5% (2/79) underwent natural orifice transluminal endoscopic surgery (NOTES)-assisted procedure. All techniques required an echoendoscope except NOTES. In all, 53.2% (42/79) had non-cautery enhanced Axios stent, 44.3% (35/79) had hot Axios stent, and 2.5% (2/79) had Niti-S spaxus stent. Symptom-recurrence was seen in 2.8%, and 6.3% had a complication (bleeding, abdominal pain or peritonitis). All procedures were performed by experts at centers of excellence with adequate surgical back up.
Abdominal Pain ; Cohort Studies ; Endosonography ; Extremities ; Gastric Outlet Obstruction ; Humans ; Methods ; Mortality ; Natural Orifice Endoscopic Surgery ; Stents*