Background: s/Aims: Hepatic artery pseudoaneurysm (HAP) is a condition associated with high mortality rates when untreated. Current literature lacks comprehensive understanding of complication rates and optimal treatment strategies. This study aims to analyze the etiology, technical success, and complication rates associated with endovascular and percutaneous management of HAP. Methods: A retrospective analysis was conducted, examining data on demographics, comorbidities, etiology, and embolic agents. A comparative analysis of hemoglobin levels, liver function tests, and renal function tests was performed before and 24–48 hours after the procedure. Results: The study included 49 patients (71% males) with a mean age of 46.44 (± 15.88) years. The common etiologies were post-operative complications (36.7%) and blunt abdominal trauma (26.5%). The right hepatic artery (RHA) was the most frequently involved site (57%). Endovascular embolization involved the use of coils, glue, and stent grafts, while percutaneous embolization was performed in six cases. The technical success rate for the endovascular approach was 97.6%, compared to 33% for the percutaneous approach. Hemoglobin levels stabilized post-procedure (mean post-procedure 8.9 g/dL vs. 7.9 g/dL at presentation), indicating effective hemostasis.Post-procedural complications included transient elevation of liver enzymes (22.4%), hepatic abscess (4.1%), and cholangitis (2.0%). Conclusions HAP is primarily caused by iatrogenic injury or blunt abdominal trauma, with a predilection for the RHA. Endovascular therapy proves to be a safe and effective treatment for this life-threatening condition. Although high technical success rates are achievable, the potential for ischemic complications necessitates a tailored treatment approach and the implementation of prophylactic measures when indicated.

Background: Guillain-Barré syndrome (GBS) is an acute acquired autoimmune inflammatory disorder of the peripheral nerves and roots. Respiratory insufficiency is an important predictor of a poor prognosis in patients with GBS. Phrenic nerve assessment is an area of interest in GBS with respiratory failure. We aimed to analyze the characteristics of the phrenic nerve conduction study (NCS) in GBS and assess its value in predicting respiratory failure requiring ventilatory support, along with outcome assessment at 6 months as per the Hughes score. Methods: A total of 135 patients with GBS admitted to our hospital over 3 years were thoroughly evaluated by clinical examination, blood laboratory tests, and phrenic NCS. Results: Phrenic NCS abnormality was observed in 48 patients (35.6%) with statistically significant increases in phrenic sum compound muscle action potential (CMAP) latency (18.91±7.82 ms) and sum CMAP duration (44.65±6.84 ms), along with reduced sum CMAP amplitude (0.3246±0.132 mV) and sum CMAP area (3.56±2.62 mV·ms) occurring in those requiring ventilatory assistance. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of the phrenic NCS for predicting respiratory failure in patients with GBS were 90.7%, 90.2%, 81.3%, 95.4%, 9.27, and 0.10, respectively. The results showed a statistically significant association between abnormal initial phrenic NCS scores and outcomes at 6 months. Conclusion Phrenic NCS can predict respiratory failure requiring ventilator assistance in patients with GBS. Phrenic NCS can be incorporated into routine NCS protocols to predict impending respiratory failure in patients with GBS.

Objective: To report a new species of sandfly, Sergentomyia (Neophlebotomus) ashwanii sp. nov. (Diptera: Psychodidae) from Western Ghats, India. Methods: A systematic sandfly survey was conducted in the Thrissur and Kollam districts of Kerala, India using mechanical aspirators, light and sticky traps, both indoor and outdoor habitats, for a period of one year. Deoxyribonucleic acid barcoding of samples was performed targeting mitochondrial cytochrome oxidase I (COI) gene and sequence generated was subjected to phylogenetic analysis. Results: Sergentomyia (Neophlebotomus) ashwanii, a new sandfly species is recorded and described in this communication. A single row of 10-12 pointed teeth in the cibarium with 4-6 small denticles or fore-teeth are the key characteristics that is distinctive from other members of the subgenus Neophlebotomus. Mitochondrial COI barcode followed by phylogenetic analysis of the nucleotide sequence confirms that specimens of the species belong to the same taxonomic group while the genetic distance (14.2%) with the congeners established it to be a different species. Conclusions: The Western Ghats' being an important biodiversity hotspot and has dearth of systematic entomological surveys on sandflies. The current study tried to fill the void and also report a new sandfly species.

Arthroscopy ; Follow-Up Studies ; Humans ; Rotator Cuff/surgery* ; Treatment Outcome

To determine the effect of inspiratory muscle training (IMT) on pulmonary function, respiratory muscle strength (RMS), and functional capacity in patients undergoing cardiac surgery. The PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to June 2020. Randomized controlled trials (RCTs) that evaluated patients who underwent cardiac surgery were included in this review. Meta-analysis performed using a random-effects model showed that the mean difference in forced vital capacity, forced expiratory volume in 1 second, 6-minute walk distance, and RMS was 3.47% (95% confidence interval [CI], 0.57 to 6.36), 5.80% (95% CI, 2.03 to 9.56), 78.05 m (95% CI, 60.92 to 95.18), and 4.8 cmH2O (95% CI, -4.00 to 13.4), respectively. There is strong evidence that IMT improves inspiratory muscle strength, pulmonary function, and functional capacity, and reduces the length of hospital stay in patients undergoing cardiac surgery.

To determine the effect of inspiratory muscle training (IMT) on pulmonary function, respiratory muscle strength (RMS), and functional capacity in patients undergoing cardiac surgery. The PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to June 2020. Randomized controlled trials (RCTs) that evaluated patients who underwent cardiac surgery were included in this review. Meta-analysis performed using a random-effects model showed that the mean difference in forced vital capacity, forced expiratory volume in 1 second, 6-minute walk distance, and RMS was 3.47% (95% confidence interval [CI], 0.57 to 6.36), 5.80% (95% CI, 2.03 to 9.56), 78.05 m (95% CI, 60.92 to 95.18), and 4.8 cmH2O (95% CI, -4.00 to 13.4), respectively. There is strong evidence that IMT improves inspiratory muscle strength, pulmonary function, and functional capacity, and reduces the length of hospital stay in patients undergoing cardiac surgery.

Background/Aims: Bile leak is a common complication of cholecystectomy, and it is also observed in other conditions such as ruptured liver abscess, hydatid cyst, and trauma. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line management for such conditions. However, studies on the outcomes of endoscopic management for bile leaks with etiologies other than post-cholecystectomy injury are extremely limited. Methods: We conducted a retrospective review of patients with symptomatic bile leak who were referred to a tertiary care center and who underwent ERCP between April 2016 and April 2019. The primary outcome was complete symptomatic resolution without extravasation of the contrast medium during the second ERCP conducted after 6 weeks. Results: In total, 71 patients presented with symptomatic bile leak. The etiologies of bile leak were post-cholecystectomy injury in 34 (47.8%), liver abscess in 20 (28.1%), and post-hydatid cyst surgery in 11 (15.4%) patients. All patients were managed with ERCP, sphincterotomy, and stent placement for 6 weeks, except for one who underwent surgery. The primary outcome was achieved in 65 (91.5%) of 71 patients. There was no significant difference in terms of outcome in relation to the interval between the diagnosis of bile leak and ERCP. Conclusions Most patients with bile leak can be successfully managed with ERCP even when performed on an elective basis.

Adult ; Anticoagulants ; therapeutic use ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Male ; Upper Extremity Deep Vein Thrombosis ; diagnosis ; drug therapy

PURPOSEIlizarov ring fixator and limb reconstruction system (LRS) fixators have been used in the management of complex tibial fractures with severe soft tissue injuries, compound tibial fractures, and infected tibial nonunion for which conventional internal fixation cannot be contemplated. Fracture union and distraction osteogenesis can be done simultaneously with these external fixators, allowing early weight bearing. Several previous studies have shown almost equal results of rail and ring fixators for the compound tibial shaft fractures. Thus we performed a prospective study to evaluate the union rate, functional outcome and amount of limb lengthening after the treatment of compound tibial shaft fractures with or without infected nonunion by ring or LRS fixators.

METHODSThis prospective study was done at Sarojini Naidu Medical College and Hospital, Agra, India and included 32 patients of compound tibial shaft fractures with or without infected nonunion. There were 26 males and 6 females and the average age was 40 years. Patients were randomly divided into two groups (n=16 for each): one underwent Ilizarov fixation and the other received LRS fixation. Cases were followed up for 3-24 months, 6 months on average from September 2012 to October 2014. Functional and radiological outcomes were assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria for both rail and ring fixators.

RESULTSUnion was achieved in all cases. Radiological outcome was found excellent in 68.75%, good in 18.75% and fair in 12.50% of cases treated by rail fixators whereas it was excellent in 56.25%, good in 18.75%, fair in 12.50% and poor in 12.50% of cases treated by ring fixators. Functional result was satis- factory in 75.00% of cases treated by rail fixator and 68.75% of cases treated by ring fixators whereas the corresponding rate of unsatisfactory was 25.00% vs. 31.25%.

CONCLUSIONIn our short-term assessment, LRS fixators show a better result than Ilizarov fixators in terms of fracture union and functional outcome with soft tissue care and limb length.

Adult ; Aged ; External Fixators ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Ilizarov Technique ; instrumentation ; Male ; Middle Aged ; Prospective Studies ; Tibial Fractures ; diagnostic imaging ; surgery ; Treatment Outcome