Objective-: Simultaneous bilateral carotid artery stenting (SBCAS) is a complicated and challenging procedure. Final outcome depends upon selective criteria. The purpose of study was to determine the efcacy and safety of the SBCAS retrospectively patients with signicant bilateral carotid artery disease vs staged bilateral carotid stenting. Patients Method: with symptomatic stenosis of 50% or asymptomatic stenosis of 60% of bilateral carotid arteries are included for bilateral carotid artery stenting (BCAS). Procedure time, stent thrombosis,dissection,bradycardia ,hypotension,ischemia, presence of high-intensity spots on postoperative dwi image, duration of postprocedure stays and one month outcome of patients performed with simultaneous BCAS (group A, 11 patients with 22 stenotic lesions (11 procedures)) were compared with those of staged BCAS (group B, 14 patients with 28 stenotic lesions (28 procedures))out of total 205 patients during march 2017 to January 2021. In Results: groups A and B, median procedure time was 166.0 and 115 min; intraprocedure hypotension was observed in 52% and 40%; postprocedure hypotension occurred in 40% and 42%; dwi image showed high intensity spots in 25% and 12.5%; and median duration of postprocedural hospital stays was 5.1 and 6.3 days.One patient suffered ischemic complications and recoverd. Procedure time was longer in simultaneous BCAS, but there was no increase in symptomatic ischemic complications and duration of hospital stays compared to staged BCAS. Safety of Conclusions: simultaneous BCAS may be noninferior to staged BCAS. In terms of cost and duration of hospitalization,simultaneous BCAS are often superior to staged BCAS for patients with bilateral carotid artery stenosis

Purpose Genitofemoral neuralgia (GFN) is a chronic pain condition that may be refractory to commonly employed treatment modalities. Implantation of a peripheral nerve stimulator (PNS) may provide significant pain relief; however, few reports have described placement of and response to a GFN PNS implant. Clinical features We implanted a StimRouter® PNS in a 42-yr-old male with severe GFN that did not respond to pharmacologic and interventional pain management modalities and impaired all aspects of his function and quality of life. The often-challenging sonographic visualization of the genitofemoral nerve was aided by intraprocedural sensory mapping using a stimulating probe. Preoperatively, the patient’s average pain was rated as 7 on a 0 to 10 numeric rating scale. Following the procedure, the patient experienced over 90% pain relief after one week. At one and five months post implantation, the patient’s average pain scores were 1 and 0.5, respectively. The patient also reported substantial improvement in the physical component scores on the 12-Item Short Form Survey (SF-12), which remained similar at the five-month follow-up (from 26.1 preop to 57.2 at one month and 49.7 at five months). Conclusions Peripheral nerve stimulator implantation may be a promising intervention when other analgesic modalities fail to manage refractory GFN. Further research to verify the effectiveness of this intervention and evaluate for appropriate integration in patient care is required.

Acute brain infarction due to carotid artery occlusion has been associated with poor outcome in the absence of cerebral collaterals. The incipient development of collaterals does not guarantee their persistence while available data are strongly indicative that good collateral flow is key in cerebral perfusion, and in reducing infarct size, this knowledge has resulted in only limited therapeutic applications.

Intracranial stenting and angioplasty have been used widely to treat atherosclerotic symptomatic vascular stenosis when conventional medical therapy fails to eliminate ischemic symptoms. We describe a case report of middle-age diabetic male with endovascular stent deployment for the treatment of atherosclerotic vertebrobasilar artery stenosis with acute recurrent medial medullary ischemic stroke. Application of a drug-eluting stent coronary stent without previous balloon dilatation resulted in vessel reopening and good clinical improvement. Emergency primary intracranial stent deployment can be technically feasible and improve the outcome in acute vertebrobasilar artery occlusion whenever indicated.

Background: Peripheral arterial disease (PAD) involves arterial blockages in the body, except those serving the heart and brain. We explore the relationship of functional limitation and PAD symptoms obtained from a quality-of-life questionnaire about the severity of the disease. We used a supervised artificial intelligence-based method of data analyses known as machine learning (ML) to demonstrate a nonlinear relationship between symptoms and functional limitation amongst patients with and without PAD. Objectives: This paper will demonstrate the use of machine learning to explore the relationship between functional limitation and symptom severity to PAD severity. Methods: We performed supervised machine learning and graphical analysis, analyzing 703 patients from an administrative database with data comprising the toe–brachial index (TBI), baseline demographics and symptom score(s) derived from a modified vascular quality-of-life questionnaire, calf circumference in centimeters and a six-minute walk (distance in meters). Results: Graphical analysis upon categorizing patients into critical limb ischemia (CLI), severe PAD, moderate PAD and no PAD demonstrated a decrease in walking distance as symptoms worsened and the relationship appeared nonlinear. A supervised ML ensemble (random forest, neural network, generalized linear model) found symptom score, calf circumference (cm), age in years, and six-minute walk (distance in meters) to be important variables to predict PAD. Graphical analysis of a six-minute walk distance against each of the other variables categorized by PAD status showed nonlinear relationships. For low symptom scores, a six-minute walk test (6MWT) demonstrated high specificity for PAD. Conclusions: PAD patients with the greatest functional limitation may sometimes be asymptomatic. Patients without PAD show no relationship between functional limitation and symptoms. Machine learning allows exploration of nonlinear relationships. A simple linear model alone would have overlooked or considered such a nonlinear relationship unimportant.

The objective of this work is to ascertain whether reliable prediction of Global Horizontal Irradiance (GHI) is attainable using predictor variables: wind speed, wind direction, temperature, relative humidity, solar zenith angle, date of year and time. Multivariate backward stepwise linear regressions was utilized to determine significant attributes for GHI estimation. The model was then used to predict value of GHI. The performance of models was investigated using model residuals. The resulting model could explain 67% of variation in data. The model was further tested for multicollinearity and heteroscedasticity. The model gives satisfactory VIF and MAPE values and nominal heterosdasticity. R computation platform was used for modeling and computation.

This study attempts to analyze state of air quality in India from both long term and short term perspectives. Annual mean value of particulate matter concentration (PM) at one hundred thirty two locations in India reported by World health Organization (WHO) was analyzed. These locations were grouped in seven clusters according to severity of concentration of PM10 and PM2.5. Heuristic clustering (HC) was employed as clustering algorithm with Euclidian distance measure. Locations having worst concentration of PM concentration were identified using cluster profile summary. In second part of study, Air quality index of forty-two locations reported by Central Pollution Control Board (CPCB) was observed on monthly basis for a period of twelve months. The study resulted in three observations. First, no location under the study was able to satisfy WHO recommendation of annual mean value of PM. Second, majority of regions having worse air quality are located in northern part of India. Third, condition of air quality deteriorates in months between Novembers to February and May to June at several locations in India.

Mathematical models which can aid academic assessment of students have the potential to improve the delivery of education and learning. Such models can be utilized to find out the quality of learning and influencing factors. These insights enable stakeholders to take effective measures for the attainment of educational objectives. Present work attempts to formulate two mathematical models for assessment: a predictor model for final grade predictions of students and a classifier model to identify academically weak students. Linear regression was employed for predictions while logistic regression was used for the classification. The Computation was performed in R environment. The study dealt with a dataset containing a record of three hundred ninety-five students with thirty-three attributes. Predictor model was tested with statistical metrics like VIF value, fit chart, and residual plots. Performance of classifier was investigated by using confusion matrix and kappa value. Predictor model gave a very low average error in score prediction of final grades. Classifier model demonstrated high accuracy of eighty-eight percent in identifying weak students on the test sample.

Introduction Despite sterile barrier precautions and vigorous skin antisepsis, percutaneous insertion of intravenous catheters has been shown to result in attachment to the catheter surface of bacteria residing in the deep structures of the skin. Such attachment poses the risk of biofilm formation and eventual catheter-related bloodstream infection (CRBSI). This study was undertaken to assess whether the non-coated surface treatment of a unique catheter material (ChronoFlex C® with BioGUARD™) could inhibit bacterial attachment and biofilm formation. Methods A novel in vitro model and fluorescence microscopy were used to compare two intravascular catheter materials with respect to bacterial attachment and biofilm formation. The control material was a commonly used polyurethane. The study material was a unique copolymer, treated so as to remove surface additives, alter hydrophobicity and create surface micro-patterning. Outcomes were assessed using both a membrane potential indicator and a cell death reporter with appropriate fluorescent channels. Thus, bacterial cells attached to the catheter surface (living and dead) were imaged without mechanical disruption. Results Both bacterial attachment and biofilm formation are significantly inhibited by the study catheter material. In fact, over 5 times more bacteria were able to attach and grow on the control polyurethane material than on the study material (P=0.0020). Moreover, those few bacteria that were able to attach to the study material had a 1.5 times greater likelihood of dying. Conclusion Using a novel in vitro percutaneous catheter insertion model, ChronoFlex C with BioGUARD is proven to significantly inhibit bacterial attachment and biofilm formation as compared with a commonly used polyurethane catheter material.

The purpose of this study is to determine whetheraccurate prediction of birth weight is possible using predictor variables: ethnicity, education level, smoking habit and duration of gestation. Multivariate linear regressions is deployed to determine which of these variables are significant for prediction. The model is then used to predict weight of babies at birth. Theefficacy of the predication models are assessed and compared on basis of errors in the predicted weights.Theresulting modelcan explain 65% of weight variation in data. The model was further tested for multicollinearity and heteroscedasticity. The model gives satisfactory VIF and MAPE values and nominal heterosdasticity. R computation platform was used for modeling and computation.

Background We propose that substituting central lines with midlines can help reduce the total number of central line catheter-days as well as central line-associated bloodstream infections (CLABSIs), thereby reducing the associated costs and the resulting increased length of stay. A midline or vascular access program in a community hospital can bring about these positive changes. Objectives Our objective is to evaluate whether the institution of a midline program for vascular access at a community hospital can reduce the number of central line catheter-days and the associated CLABSI rate, incidence, and cost. Materials and methods We collected data on the number of central line catheter-days per year starting from 2012. We also collected data on the total number of patient-days during this period and the number of CLABSIs. We started Centers for Disease Control and Prevention (CDC)-based recommendations to help decrease CLABSIs in June 2014; this included the use of the central venous catheters (CVC) insertion bundles and CVC maintenance bundle. Chlorhexidine baths were also given to all patients with central lines. In June 2015, we started a midline program and tracked data till June 2017. We then compared the infection rates during these periods. Results We conclude that instituting CDC recommendations to decrease CLABSIs did bring down the CLABSI rate; this decrease was not statistically significant. However, the addition of the midline program to replace central lines whenever possible, combined with universal CDC recommendations, did result in a significant decrease in both the number of central line days per patient-day and the CLABSI rate. Conclusion We recommend hospitals to develop a midline program to help reduce the use of central line catheters when possible to reduce the total number of catheter-days and the CLABSI rate associated with them.

HYPOTHESIS:Our objective was to evaluate whether the use of midline venous catheters in place of central line venous catheters, when appropriate, decreased the overall incidence of central line-associated bacteremia in a ventilator unit.METHODS:The time interval between February 2012 and February 2013 was divided into 2 periods. Group A was the first half of the year, before the introduction of midline catheters, and group B was the second half of the year, 6 months after their introduction. Central line-associated bloodstream infection (CLABSI) was calculated using the equation: (total number of CLABSI/total number of catheter days) × 1000. The Z test was used for proportions between independent groups to compare the significance in the difference in CLABSI between groups A and B.RESULTS:There was a significant decrease in the total number of catheter days on the ventilator unit in group A from 2408 catheter days in 1 year (August 1, 2011, to July 31, 2012) before the introduction of midline catheters to 1521 catheter days in group B in the following year (November 1, 2012, to October 31, 2013; P < 0.05 for both groups).CONCLUSIONS:Midline catheters in place of central lines decrease the rate of CLABSI in a ventilator unit. In addition, no bloodstream infections were associated with midline catheters.

Radiation proctopathy is a complication of pelvic radiotherapy, which occurs in patients treated for carcinoma of the prostate, rectum, urinary bladder, cervix, uterus, and testes. If it presents within 6 weeks to 9 months after therapy, it is called acute radiation proctitis/proctopathy (ARP), and if it occurs 9 months to a year after treatment, it is classified as chronic radiation proctitis/proctopathy (CRP). CRP occurs in 5%-20% of patients receiving pelvic radiation, depending on the radiation dose and the presence or absence of chemotherapy. In many cases, CRP resolves spontaneously, but in some, it can lead to persistent rectal bleeding. Other symptoms of CRP include diarrhea, mucoid discharge, urgency, tenesmus, rectal pain, and fecal incontinence. Despite the availability of several therapies, many patients fail to respond, and continue to suffer in their quality of life. Radiofrequency ablation (RFA) is a newer endoscopic technique that uses radiofrequency energy to ablate tissue. This is an emerging way to treat radiation proctopathy and other mucosal telangiectasia. We present three cases of radiation proctopathy treated with RFA at our institute and review the literature on treatment modalities for CRP. We were also able to find 16 other cases of CRP that used RFA, and review their literature as well as literature on other treatment modalities.

Introduction: The CDC estimates an average of around 5 central line associated blood stream infections(CLABSIs) per 1000 catheter-days in the United States. As more patients with central lines are located outside the ICU, CLABSI rates for non-ICU patients have been on the rise. There are approximate

BACKGROUND:Clostridium difficile infection (CDI) has become a global concern over the last decade. In the United States, CDI escalated in incidence from 1996 to 2005 from 31 to 64/100,000. In 2010, there were 500,000 cases of CDI with an estimated mortality up to 20,000 cases a year. The significance of this problem is evident from the hospital costs of over 3 billion dollars annually. Fecal microbiota transplant (FMT) was first described in 1958 and since then about 500 cases have been published in literature in various small series and case reports. This procedure has been reported mainly from centers outside of the United States and acceptance of the practice has been difficult. Recently the US Food and Drug Administration (FDA) labeled FMT as a biological drug; as a result, guidelines will soon be required to help establish it as a mainstream treatment. More US experience needs to be reported to popularize this procedure here and form guidelines.METHOD:We did a retrospective review of our series of patients with relapsing CDI who were treated with FMT over a 3-year period. We present our experience with FMT at a community hospital as a retrospective review and describe our procedure.RESULTS:There were a total of 12 patients who underwent FMT for relapsing C. difficile. Only one patient failed to respond and required a second FMT. There were no complications associated with the transplant and all patients had resolution of symptoms within 48 hours of FMT.CONCLUSION:FMT is a cheap, easily available, effective therapy for recurrent CDI; it can be safely performed in a community hospital setting with similar results.

OBJECTIVES:Organochlorine pesticides (OCPs) and oxidative stress are reported to be associated with adverse reproductive outcomes. Glutathione S-transferase (GST) is a polymorphic supergene family involved in the detoxification of numerous toxins including OCPs. OCPs are endocrine disrupter and prenatal exposure to them may be associated with fetal growth restriction (FGR). The objectives of the present study were (i) to determine the frequencies of polymorphic alleles of GSTM1 and GSTT1 genes in women with idiopathic FGR, (ii) to analyze the maternal and cord blood levels of the OCPs, and (iii) to identify the gene environment interaction that increases the risk of FGR. STUDY DESIGN:Maternal and cord blood samples of 50 FGR cases (birth weight <10 percentile for gestational age as per Lubchenco's growth chart) and equal number of normal pregnancies who were occupationally non exposed to OCPs and excluding all the known high risk factors such as anemia, hypertension, antiphospholipid antibody syndrome, medical disease, dietary habit, living style, parity, and BMI. The collected samples at the time of delivery/after delivery were analyzed for OCPs levels by gas chromatography and polymorphic analysis for GSTM1/GSTT1 gene using multiplex PCR. RESULTS:Significantly higher levels of α,β,γ-HCH and p,p'-DDT were found in maternal blood and significantly higher levels of β and γ-HCH and p,p'-DDT were found in cord blood of FGR cases as compared to controls. The genotypic distribution of GSTM1/GSTT1 was almost similar in both the groups, but the frequency of GSTM1-/GSTT1- (null) genotype was significantly higher in FGR cases as compared to controls (p<0.05, OR=6.42). When interaction between GSTM1/GSTT1 genes polymorphism-OCPs levels and birth weight (gene-environment interaction) was ascertained, a significant association was seen between β-HCH and GSTM1- genotype with reduction in birth weight of 213g. CONCLUSION:Higher levels of OCPs in pregnant women may be considered as an important aetiological factor in 'idiopathic' FGR. GST polymorphism can influence the relationship between prenatal exposure to pesticides and FGR. The present study provides evidence that polymorphism in xenobiotic metabolising genes may modify the effect of environmental health hazards and increase the risk of FGR.

Abdominal pain is a frequent presenting complaint in pediatric patients seeking acute medical care. We report the case of an adolescent female who presented with nonspecific complaints of chest pain, faintness, and weight loss and whose diagnosis was determined only after the disclosure of trichophagia.

Intra uterine growth retardation (IUGR) is a major complication of pregnancy, affecting ∼5% to 10% of newborns. Hexachlorocyclohexane (HCH) is an organochlorine pesticide that consists of eight stereoisomers and γ-isomer is the only isomer that possesses insecticidal activity. The aim of the present study was to analyze the OCP residues in maternal and cord blood of women and to assess the level of oxidative stress markers as well as to establish correlation with OCP levels. Fifty women delivering neonates with low birth weight (IUGR) and equal number of women delivering normal birth weight babies (control) were recruited. We have observed higher levels of γ-HCH and T-HCH and increased oxidative stress markers in IUGR subjects versus control subjects. Significant correlations were also found between HCH isomers and oxidative stress markers in IUGR subjects. In conclusion, our results suggest that higher levels of HCH isomers may be associated with IUGR and increased oxidative stress.

BACKGROUND AND OBJECTIVE:Glutathione S-transferases (GSTs) belong to a family of ubiquitous and multifunctional enzymes that work as one of the endogenous antioxidants in our body. This study was designed to look into the association of GST polymorphism with oxidative stress in both diabetic and nondiabetic chronic kidney disease (CKD). DESIGN AND METHODS:Three groups of patients (50 in each): diabetics without CKD (DM), diabetic CKD (DM-CKD), and nondiabetic CKD (NDM-CKD) and 50 age- and sex-matched healthy controls were recruited. Genotyping was done for GSTM1 and GSTT1 genes using a multiplex polymerase chain reaction. Serum GST and malondialdehyde (MDA) as a marker of oxidative stress were measured spectrophotometrically. RESULTS:Based on genotyping, subjects were categorized as GSTM1+/GSTT1+, GSTM1-/GSTT1+, GSTM1+/GSTT1-, and GSTM1-/GSTT1-. Serum GST levels were lower among subjects with deletion in one/both GST genes, whereas MDA levels were found to be correspondingly raised. A negative correlation for MDA versus GST levels was observed among genotypes with one/both gene deletions. Presence of GSTM1+/GSTT1- and GSTM1-/GSTT1- was significantly higher among patients with CKD in both diabetics and nondiabetics. INTERPRETATIONS AND CONCLUSIONS:GSTM1 and GSTT1 deletions singly or together were associated with lower GST levels and higher oxidative stress in both diabetic and nondiabetic CKD. Interestingly, GSTT1 deletion appears to be associated with both diabetic and nondiabetic CKD irrespective of the GSTM1 status.

A number of studies have focused attention on various biochemical abnormalities evoked due to exposure to organochlorine pesticides (OCPs). The aim of the present study was to analyze the OCP residues in maternal and cord blood of women and assess the levels of different non-enzymatic oxidative stress markers as well as to establish correlation with OCP levels, if any. Thirty women in each group of full-term delivery (FTD; > or =37 weeks of gestation) and preterm delivery (PTD; <37 weeks of gestation) were enrolled in this study. Levels of OCPs like Hexachlorocyclohexane (HCH), endosulfan, p,p(') Dichlorodiphenyldichloroethylene (DDE) and p,p' Dichlorodiphenyltrichloroethane (DDT) were analyzed by gas chromatography. Non-enzymatic oxidative stress was measured by the quantification of malondialhyde (MDA), protein carbonyl, reduced glutathione (GSH) and ferric-reducing ability of plasma (FRAP). MDA and protein carbonyl levels were increased significantly, while the levels of GSH and FRAP were decreased in PTD in comparison to FTD cases. We have observed higher levels of beta-HCH and alpha-endosulfan and increased oxidative stress in PTD than FTD cases. In PTD cases, a significant positive correlation was observed between maternal blood levels of beta-HCH and MDA (r = .78), beta-HCH and GSH (r = -.65), gamma-HCH and MDA (r = .89), gamma-HCH and GSH (r = -.74) and alpha-endosulfan and MDA (r = .54) in PTD cases. We also found significant correlations between cord blood levels of beta-HCH and MDA (r = .59), beta-HCH and GSH (r = -.69), gamma-HCH and MDA (r = .62) and alpha-endosulfan and MDA (r = .54) in PTD cases. In conclusion, our results suggest that higher levels of some of the OCP residues may be associated with PTD and increased oxidative stress.