The major goals of anesthesia in patients with severe traumatic brain injury (TBI) are—maintenance of hemodynamic stability, optimal cerebral perfusion pressure, lowering of ICP, and providing a relaxed brain. Although both inhalational and intravenous anesthetics are commonly employed, there is no clear consensus on which technique is better for the anesthetic management of severe TBI. Ninety patients, 18–60 years of age, of either gender, with GCS < 8, posted for emergency evacuation of acute subdural hematoma were enrolled in this prospective trial, and they were randomized into two groups of 45 each. Patients in group P received propofol infusion at 100–150 mg/kg/min for maintenance of anesthesia and those in group I received ≤ 1 MAC of isoflurane. Hemodynamic parameters were monitored in all patients. ICP was measured at the dural opening and brain relaxation was assessed by the operating surgeon on a four-point scale (1-perfectly relaxed, 2-satisfactorily relaxed, 3-firm brain, and 4-bulging brain) at the dural opening. It was reassessed at dural closure. Brain relaxation, both at dural opening and closure, was significantly better in patients who received propofol compared to those who received isoflurane. ICP was significantly lower (25.47 ± 3.72 mmHg vs. 23.41 ± 3.97 mmHg) in the TIVA group. Hemodynamic parameters were well maintained in both groups. In patients with severe TBI, total intravenous (Propofol)-based anesthesia provided better brain relaxation, maintained a lower ICP along with better hemodynamics when compared to inhalational anesthesia. Clinical trials registry (NCT03146104).
Introduction: Embryology, a complex and three-dimensional (3D) field of anatomy, requires a multifaceted approach to learning. Traditional lectures often result in short-term retention, while visual aids such as videos can improve recall. However, creating models of embryological concepts and congenital anomalies facilitates a deeper understanding of the material. Building on this, the current study investigates the impact of combining two innovative methods - 3D model-making and jigsaw peer teaching - on both short-term and long-term knowledge retention in learning embryology. By engaging students actively and promoting peer-to-peer learning, this approach aims to enhance the learning experience and improve comprehension of this intricate subject. Materials and Methods: Sixty-two 1(st)-year MBBS students learned systemic embryology topics and participated in a model-making competition, followed by jigsaw grouping. Short-term retention was assessed through pre- and posttests, analyzed using paired t-tests. Long-term retention was evaluated by correlating posttest scores with performance in the Common Internal Assessment Test (CIAT). Student feedback was also collected after the model-making and jigsaw activities. Results: The intervention yielded a significant 14.2-point increase in mean test scores (P < 0.001). Posttest scores strongly correlated with scores in the CIAT (r = 0.68) and embryology (r = 0.62). Regression analysis confirmed a significant independent association between posttest scores and IA/embryology scores, controlling for confounding variables. Conclusion: Students found model-making and jigsaw learning to be valuable, time-consuming but effective methods for retaining long-term memory and learning embryology. Both approaches, being student-centered, fostered a dynamic learning environment, promoting teamwork, communication, leadership, and motivation, beyond just academic knowledge.
The magnitude of the problem of sickle cell disease (SCD) in India is very large and diverse. For people living with SCD there are several unmet health care needs making it pertinent to focus on recognizing the important public health burden of SCD in the country. In a bid to achieve this goal, the Indian College of Hematology (ICH) of the Indian Society of Hematology and Blood Transfusion (ISHBT) in collaboration with Indian Council of Medical Research (ICMR) has formulated a Guideline on Management and Control of Sickle Cell Disease in India. This was achieved by a national taskforce comprising top experts from the field who held multiple sessions to deliberate on different aspects and form consensus on preparing a comprehensive document on SCD care in India. The taskforce has presented its recommendations on various aspects of SCD in India, all of which have been evaluated based on the best evidence. Where the evidence was weak, the recommendations have been based on consensus among the experts. This review which is adapted from the comprehensive guideline document gives a concise treatise on various aspects of sickle cell disease in India along with specific recommendations. The section on screening and diagnosis provides an evidence-based background to scientifically select the most appropriate and feasible test option(s) in various Indian practice settings. The other aspects covered in this review are management of SCD in stable condition, iron overload and chelation therapy, vaso-occlusive crisis, management of other complications of SCD, blood transfusion in SCD, haematopoietic stem cell transplant and gene therapy in SCD, immunization and antibiotic prophylaxis in SCD and monitoring of patients with SCD. It also gives guidance on special circumstances such as pregnancy and surgery in SCD. It concludes with a note on prevention and control of SCD in India with an outline of a defined roadmap to make this possible.
Senescent cells have been implicated in the pathogenesis of metabolic dysfunction-associated liver disease (MASLD), which can negatively affect female fertility. Senolytic drugs are reported to eliminate senescent cells in various tissues, including the ovary. However, the efficacy of senolytic drugs in reducing liver damage and preserving fertility in female mice with MASLD remains unclear. Therefore, this study aimed to evaluate the protective effect of senolytic drugs on liver damage and fertility in reproductive-aged female mice with MASLD. Three-month-old female mice were fed a standard diet (SD) or Western diet (WD) to induce MASLD until 9 months of age. Starting at 6 months of age, mice were also randomized to receive senolytic treatment (dasatinib + quercetin, D + Q) or vehicle within each diet. We observed that mice fed the WD exhibited liver damage characteristic of MASLD, with increased liver size, triglyceride accumulation, and fibrosis. These mice also exhibited increased liver senescence and inflammation. Senolytic treatment slightly reduced liver mass and modulated some liver senescence and inflammation-related genes, suggesting limited efficacy in controlling WD-induced liver damage. Pregnancy rates were reduced in mice with MASLD and improved by senolytic treatment. Mice with MASLD had increased ovarian senescence, inflammation, and fibrosis, which was attenuated by senolytic treatment, despite having no effect on the ovarian follicle reserve. We conclude that senolytic treatment has potential for improving reproductive function in aged female mice with MASLD, despite limited impact in liver and systemic indicators.
INTRODUCTION AND OBJECTIVES:Curative resection of type IV hilar cholangiocarcinoma typically requires trisectionectomy, a procedure associated with high morbidity. The Taj Mahal hepatectomy, involving resection of segment IVb, V, and the caudate lobe, offers a parenchyma-preserving alternative.1 Since complete resection of segment IV facilitates caudate lobectomy, and inclusion of segment V provides no added benefit, a modified approach-removing only segment IV (IVa and IVb) with the caudate lobe-has been developed.2 The robotic performance of this modified procedure has not been reported previously in the English literature. This video demonstrates the standardized technique of robotic-modified Taj Mahal hepatectomy for type IV hilar cholangiocarcinoma. METHODS:Patients with type IV hilar cholangiocarcinoma without vascular involvement are suitable candidates. A 59-year-old male with jaundice and 1-month weight loss underwent sequential percutaneous transhepatic biliary drainage (segment III and right posterior ducts) for elevated bilirubin (>30 mg/dL). Key steps included hepatoduodenal lymphadenectomy, distal bile duct division with frozen section, caudate mobilization via a left-sided approach, indocyanine green-guided segment IV resection with en bloc caudate lobectomy, and three separate cholangiojejunostomies. RESULTS:Operative time was 560 minutes with 300 mL blood loss. The postoperative course was uneventful, and the patient was discharged on day 8. Histopathology showed T2 moderately differentiated adenocarcinoma with negative margins and 14 tumor-free lymph nodes. At 11-month follow-up, the patient remained disease free. Four patients underwent this procedure over 12 months. CONCLUSION:Robotic-modified Taj Mahal hepatectomy is a safe, feasible, parenchyma-preserving option for selected patients with type IV hilar cholangiocarcinoma.
