Uncomplicated Procedure Research Articles

Ultrasound‐assisted and landmark‐based nusinersen delivery in spinal muscular atrophy adults: A retrospective analysis

AbstractIntroduction/PurposeNusinersen, the first treatment approved for all spinal muscular atrophy (SMA) types, is administered intrathecally through lumbar puncture. We used ultrasound assistance or a landmark‐based technique to access the lumbar intrathecal space in adult SMA patients. This study aimed to evaluate the technical success and adverse events (AEs) in such patients using either technique over a long observation period.MethodsFifty‐one adult patients received 507 consecutive interlaminar nusinersen administrations. Patients presented with both ‘uncomplicated spines’ or ‘complicated spines’; two patients had previous back surgery. Technical success and AEs were recorded using either technique. A generalised linear mixed model was applied to evaluate predictors of technical success and complications.ResultsAn overall success rate of 99.6%, with only two procedures failing to reach the intrathecal space, and an overall optimal procedure rate of 90.3% have been reported. A total of 455 procedures (89.7%) were uneventfully performed. One (0.2%) case of severe AE (puncture of a bulky abdominal annexal cyst) was recorded. Twenty‐seven episodes (5.3%) of post‐dural puncture headache (PDPH) and 24 episodes (4.7%) of radicular or back pain, both successfully treated with medical therapy, have also been reported. Technical success was significantly associated with ‘complicated spines’ (P = 0.022) and the use of ultrasound assistance (P = 0.01), and the use of ultrasound was the only independent predictor of uncomplicated procedures (P = 0.007).DiscussionIn adult patients with SMA both landmark‐based and ultrasound‐assisted techniques are safe and effective even in the long term. The use of assistance is associated with technical success and can predict uncomplicated procedures.ConclusionOur results support the use of ultrasonography in order to improve the success and reduce the burden of nusinersen intrathecal administration.

Green synthesis of novel cyclopentapyridines: One‐pot multicomponent reactions of vinilydene Meldrum's acid

AbstractThis study focused on the investigation of synthesizing new derivatives of cyclopentapyridines with high yields employing multicomponent reaction that involved vinilydene Meldrum's acid, ethyl 2‐amino‐4‐dioxo‐4‐arylbutanoates, hydrazonoyl chlorides, and activated acetylenic compounds. The reaction was conducted in water at room temperature, resulting in the synthesis of new compounds. Also, the reaction of synthesized cyclopentapyridines with dimethyl acetylenedicarboxylate was performed in water at room temperature which produced other cyclopentapyridine derivatives by elimination of N2. The advantages of this technology encompass rapid response times, high product yields, and facile product separation via uncomplicated procedures.

A Novel ultrasensitive nitrite ion detection using tungsten trioxide-modified gold electrode

A novel ultrasensitive nitrite ion detection using tungsten trioxide/carbon (WO3/C) modified gold electrode has been studied. The WO3 was synthesized from tungsten metal through chemical methods with selective precipitation techniques. The visual color of the material obtained is bright yellow, indicating WO3 compound. The X-ray diffraction (XRD) diffractogram confirms WO3 compound in monoclinic shaped by showing of the 2θ at 23.205, 23.723, 24.384, 33.426, and 33.911. The characterization using Field Emission Scanning Electron Microscopy (FESEM) showed that the material obtained was a disk-shaped with diameter 150–250 nm and a thickness of 50 nm. The Energy Dispersive X-ray spectroscopy (EDX) also confirms WO3 compound with no impurities. The gold electrode was modified by dip immersion technique where the gold electrode was dipped in a mixture of WO3-carbon paste. The measurement of surface area by cyclic voltammetry shows that the WO3/C modified gold electrode has the highest surface area compared to unmodified gold and C-modified gold electrode, indicating it has more active electron transfer sites. The WO3/C modified gold electrode worked well at pH 7 for the detection of nitrite ion and gave the highest peak current (0.875 V) than the others. The measurement ranges from 1–200 mg/L with no interference from NO3−, SO42−, Zn2+, Fe2+, Pb2+, Cl−, Ca2+, and NH4+ ions. The sensitivity and the LOD of the electrode are 8.86 μA.L.mg−1.cm−2 and 0.8 µg/L, respectively. The proposed method not only exhibits identical precision and accuracy to the standard method in detecting nitrite ions in real samples but also offers the advantages of rapid analysis, uncomplicated pretreatment procedures, environmental friendliness, and economical operation. This performance indicates that the WO3/C modified gold electrode is feasible as an alternative electrode for nitrite ion detection.

Continuous Enantioselective α-Alkylation of Ketones via Direct Photoexcitation.

Motivated by the scarcity of enantioselective direct intermolecular α-alkylation reactions of ketones with simple alkyl halides, we report a photo-organocatalytic process to access diethyl 2-(2-oxocyclohexyl)malonate and derivatives in good yield and enantioselectivity. The reaction design is based on highly abundant and nature-derived 9-amino-9-deoxy-epi-cinchona alkaloids to activate ketones as transient secondary enamines, which exist unfavorably in equilibrium with imines. These condensed species can serve as powerful photoinitiators via direct photoexcitation. This concept provides access to both enantiomeric antipodes. In addition to introducing an uncomplicated batch-optimized procedure, we investigated the feasibility and limitations of implementing the reaction in continuous flow, thus enabling to obtain diethyl 2-(2-oxocyclohexyl)malonate with a productivity of 47 μmol/h and 84% enantioselectivity.

Cardiology department versus intensive care unit admission after successful uncomplicated transcatheter aortic valve replacement (TAVR)

BackgroundMost patients after transcatheter aortic valve replacement (TAVR) are admitted directly to the cardiac intensive care unit (CICU) despite low complication rates. Reducing unnecessary CICU hospitalization reduces healthcare costs. This study aimed to compare the outcomes between patients admitted directly to the cardiology department (CD) and those admitted to CICU based on prespecified protocols. MethodsHistorical cohort study of all patients who underwent TAVR and were admitted directly to the CD according to a prespecified protocol (uncomplicated procedure, hemodynamically stable, without new conduction abnormalities) in 2017–2018, and the same number of patients meeting the same criteria who were admitted to the CICU in 2015–2016 before direct CD admission was initiated. Pacemaker implantation during the procedure was not considered a new conduction abnormality. In-hospital outcomes and 30-day post-discharge outcomes were compared. ResultsOverall, 260 patients (130 CICU + 130 CD) were included in the study. There was no in-hospital mortality in either group, and the post-procedure length of stay was shorter for patients admitted to CD (median and IQR: 2, 2–4 vs. 4, 3–5 days, p <0.001). There was no significant difference in 30-day emergency department visits between groups (CICU:13.9% vs. CD:16.2%, p = 0.602), rehospitalization rate (9.3%) was the same in both groups, and one patient from the CICU group died. Similar results were observed in multivariable analysis and after matching. ConclusionDirect admission to the CD after TAVR, according to the proposed criteria, may be considered as a safe and less expensive alternative for stable patients after an uncomplicated TAVR procedure.

Successful Application of a Hemoperfusion Machine in Separated System CRRT: Evaluating Effectiveness and Safety in Critically Ill Patients With AKI in Resource-Limited Settings.

It is imperative to note that integrated system continuous renal replacement therapy (CRRT) necessitates a sophisticated and costly apparatus, potentially limiting its availability within resource-limited settings. The introduction of a separated system for continuous veno-venous hemofiltration (CVVH), characterized by uncomplicated setup procedures with a hemoperfusion machine, holds promise as a feasible alternative to CRRT for critically ill patients with acute kidney injury (AKI). We aimed to retrospectively analyze the effectiveness and safety of separated CRRT applied from a hemoperfusion machine in critically ill patients with AKI during the January 2015 to December 2021 period. We also examine the in-hospital mortality rate and multivariate logistic regression analysis to uncover the factors that affect mortality. We included a total of 129 critically ill patients who received separated system CRRT. The SOFA score at CRRT initiation was 12.6 ± 3.8. The fluid accumulation at the day of CRRT initiation was 3900 mL (622-8172 mL) All patients received pre- and postdilution CVVH. The mean prescribed CRRT dose was 22.4 ± 3.1 mL/kg/h. We found no serious complications including circuit explosion and air embolism. The in-hospital mortality rate was 68.9%. High SOFA score and positive fluid accumulation at CRRT initiation serve as predictors of survival. Separated system CRRT using a hemoperfusion machine provides a simplified system to operate and is proven to be effective and safe in real-life practice, especially in resource-limited areas.

Comparison of recurrence rate of primary pterygium using conjunctival autograft with sutures versus suture-free approach.

Objective: To compare the recurrence rate of primary pterygium treated with conjunctival autograft (CAG) using sutures versus a suture-free approach. Methodology: From July 2022 to December 2022, a quasi-experimental study was carried out at the Institute of Ophthalmology, Liaquat University of Medical &amp; Health Sciences Jamshoro. A total of 110 patients with primary pterygium underwent treatment with conjunctival autograft using sutures or a suture-less/glue-free approach, under local anaesthesia. The patients were monitored for 12 months after surgery to assess recurrence and complications, and all procedures were performed by a single surgeon. Data was collected and analyzed on SPSS version 22. Result: The study included 110 patients with pterygium, mostly males (71.81%) and from rural areas, with the nasal location being the most common. Group A had 3 recurrences at 3 and 6 months, while Group B had 4 recurrences at similar intervals. Group A had fewer complications, including graft oedema, retraction, granuloma, and giant papillary conjunctivitis, while Group B had three cases of retraction. The recurrence rate was found to be 5.08% and 7.70% with and without sutures (P value ≥ 0.53) respectively. Conclusion: The excision of primary pterygium using conjunctival autograft with sutures or suture-free/glue-free methods are safe and uncomplicated procedure that results in lower levels of induced astigmatism, improved cosmetic appearance, no tissue loss, reduced recurrence of pterygium, and decreased risk of, scleral thinning, granuloma formation. Suture-free conjunctival autograft results in less postoperative manifestation like discomfort foreign body sensation, shorter surgery time, and high levels of patient satisfaction compared to conjunctival autograft with sutures. Key words: Primary pterygium, autograft and pterygium. recurrence rate of pterygium, suture with pterygium.

In-situ lignin regeneration facilitated corn straw-based photothermal evaporator with high cost-effectiveness

Solar evaporators are one of the most efficient and sustainable water purification strategies, but it requires the use of expensive photothermal materials. Herein, the surface of waste corn straw was modified with condensed lignin by means of in-situ lignin regeneration. The resulting material was composited with hydrophilic chitosan and then applied as a sustainable and cost-effective photothermal material to construct a solar evaporator. The non-radiative transport was conferred by π-π stacking between conjugated aromatic rings of lignin, allowing the composites to demonstrate promising photothermal conversion ability. The composites presented a max evaporation rate of ∼1.44 kg m−2 h−1 under 1 sun, plus they consistently produced clean water in aqueous organic dye solutions (100 ppm RhB dye and 100 ppm MB dye) and seawater. Due to the ultra-low cost of raw materials and uncomplicated manufacturing procedure, these composites displayed a cost-effectiveness of ∼475 g h−1 $−1. Thus, this work provides a green and sustainable method for converting agricultural waste into functional photothermal evaporators, which is meaningful for both materials and environmental science.

Snowball Sampling and Its Non-Trivial Nature

Snowball sampling (SS) is one of the popular methods of sampling in social research. The history of the development and implementation of this sampling model sheds light on the conditions of the evolution of the idea of sampling from hidden or hard-to-reach human populations. The seemingly uncomplicated procedure is the source of the method's popularity but also leads to its caricatured forms. This article presents selected elements of the theoretical basis of snowball sampling in its original version and its role in the development of theory related to sampling hard-to-reach populations based on chains of relationships. Special attention is given to the issue of sample representativeness and the conditions for determining the sample size obtained through snowball sampling. The aim of the presentation is to highlight the rational possibilities that the snowball sampling model offers for observational studies on education.

A Standardized Interrupted Parachute Suture Technique in Hepaticojejunostomy for Patients With Perihilar Cholangiocarcinoma.

Although hepaticojejunostomy is a relatively uncomplicated surgical procedure, its postoperative complications can range from a prolonged hospital stay to death. In hepatectomy, including resection of the perihilar bile duct for perihilar cholangiocarcinoma, the difficulty of performing hepaticojejunostomy and the complication rate increase due to the characteristics of surgery required for perihilar cholangiocarcinoma. In this study, we standardized the interrupted parachute suture technique and examined its safety and efficacy. The greatest advantage of our technique is the use of interrupted sutures, and the anterior bile duct is threaded prior to completing the posterior anastomosis. Therefore, the field of vision is better when threading the bile duct and intestinal tract, and the needle handling procedure can be performed relatively stress-free regardless of the type of hepatectomy. In patients who underwent hepaticojejunostomy, postoperative biliary complications, such as anastomotic leakage, biliary stricture, hemobilia, and jejunal bleeding, were not observed. The interrupted suture is easy to implement in biliary reconstruction and can facilitate any type of hepatic resection. In addition, the standardized technique was efficient and safe and did not increase the incidence of postoperative complications.

Cubosomes as versatile lipid nanocarriers for neurological disorder therapeutics: a comprehensive review.

Cubosomes are novel vesicular drug delivery systems with lipidic liquid crystal nanoparticles formed of predetermined proportions of amphiphilic lipids. They have a honeycomb-like structure and are thermodynamically stable. These bicontinuous lipid layers are separated into two water-based channels internally that can be used by various bioactive substances, including drugs, proteins, and peptides. This complex structure is responsible for its high drug-loading capacity. Cubosomes are thought to be promising vehicles for various routes of administration because of their extraordinary characteristics, including bioadhesion, the capacity to encapsulate hydrophilic, and hydrophobic, as well as amphiphilic substances, high resistance to environmental stress, and their ability to achieve controlled release through modification. One of the essential elements for improving patient compliance is the ability of these well-defined nano-drug delivery systems to boost the effectiveness of targeting while lowering the side effects/toxicities of payloads. The large internal surface area, a sufficiently uncomplicated fabrication procedure, and biodegradability make it an attractive nano lipid carrier for drug delivery. This review outlines the recent advancement of cubosomes for managing various neurological disorders, highlighting their potential in this field.

Benign High Prevalence Antibody Yta

Abstract Introduction/Objective The Yt system, also known as the Cartwright system, discovered in 1964, consists of five antigens encoded by the ACHE gene on chromosome 7. Yta and Ytb are antithetical antigens on the GPI – linked red cell glycoprotein, acetylcholinesterase (AChE). About 8-10% of individuals of European ancestry are Yt(b+); Yta is highly prevalent in all populations. The other three high-prevalence antigens, YTEG, YTLI, and YTOT, were added to this system in 2018. Yta is not affected by trypsin but is destroyed by α-chymotrypsin treatment of reagent red cells. Yta and Ytb are sensitive to disulfide bond-reducing agents 2-aminoethylisothiouronium bromide (AET) and dithiothreitol (DTT). Yt antibodies are mostly IgG and require Indirect Antiglobulin Test (IAT) for detection. Yt antibodies are not clinically significant, although anti-Yta may cause accelerated destruction of Yt(a+) transfused red cells. Monocyte Monolayer Assay (MMA) is often used to determine whether the anti-Yta is predicted to cause destruction of transfused Yt(a+) red cells. Methods/Case Report A 50 year old female of Hispanic/Latino descent with a BRCA2 mutationand a history of scoliosis and severe migraineswas admitted for robotic-assisted bilateral salpingo-oophorectomy, cystoscopy, and dilation and curettage. A type and screen was ordered preoperatively, and her antibody screen was positive. In her profile, the origin of anti-Yta was identified from an outside facility since 2008, but written documentation of anti-Yta identification could not be located. On antibody identification, the patient’s plasma was reactive with all cells (1+ AHG in PEG) except the auto control. Rare frozen anti-Yta antisera were used for phenotyping the patient for Yta and she was found to be Yta negative. Yta antigens are sensitive or weakened by DTT, so DTT-treated panel screen cells were used to rule out all clinically significant alloantibodies except for the Kell system. Anti-K and anti-k were ruled out by testing the patient’s plasma against SCARF (Serum, Cells, and Rare Fluid Exchange) Yta negative with homozygous K positive and homozygous k positive cells. Anti-Yta was reconfirmed at our facility. Results (if a Case Study enter NA) NA Conclusion Yta-negative blood is so rare that anti-Yta reacts &amp;gt; 99.8% of most populations. In some cases, autologous transfusion may be recommended for a patient. However, anti-Yta is often benign, and antigen-negative blood may not need to be transfused. The patient had uncomplicated procedures, and blood transfusion was not indicated at that time.

Safety and Efficacy Report for the Use of Poly-4-Hydroxybutyrate as a Retropubic Mid-Urethral Sling (MUS) for Stress Urinary Incontinence: A Prospective 24 Months Follow-Up of New Poly-4-Hydroxybutyrate TephaFlex SUI Bioresorbable MUS

To investigate the feasibility and safety of the retropubic mid-urethral sling (MUS) procedure with a resorbable mesh implant made of poly-4-hydroxybutyrate (P4HB). A prospective clinical cohort study with 24 months follow-up. A tertiary academic hospital. Seventeen women with moderate to severe stress urinary incontinence (SUI). A retropubic MUS procedure with P4HB sling. Seventeen women underwent an uncomplicated MUS procedure with a new sling made of resorbable P4HB. Following safety criteria, there has been no need to stop the study before 24 months' end point. Three serious adverse events were reported during follow-up: (1) inability to void urine after 1 week postsurgery, (2) a hysterectomy and bilateral oophorectomy performed due to a precancerous endometrial lesion at 16 months after initial MUS procedure and (3) exposed mesh with a part of device sheath left behind. These participants underwent an uncomplicated reintervention with no additional and/or permanent harm. Reinterventions because of failure of cure contained 3 second MUS procedures and one admission of urethral bulking agent. Seventy-six percent and 47 percent of patients were objectively cured of SUI at 12 and 24 months, respectively. Preliminary evidence suggests that a sling made of P4HB can be safely used for MUS procedures and could be an alternative for permanent polypropylene slings in patients that prefer the use of nonpermanent material.

The clinical utility of immediate post-operative PACU plain film radiographs following uncomplicated open Latarjet procedure – An institutional series of consecutive patients

BackgroundImmediate post-operative plain film radiograph x-rays in PACU following open Latarjet procedure are often ordered as routine. However, such radiographs utilize institutional cost and time, whilst potentially exposing patients to often-unnecessary additional radiation. This study sought to evaluate whether routine immediate post-operative radiographs following uncomplicated open Latarjet procedures impacted clinical decision-making in our institution. MethodsFrom 2017 to 2020, patients who underwent open Latarjet procedure by one of four fellowship-trained upper limb surgeons at a single institution were included in this study. Post-operative radiographs taken immediately in PACU were reviewed to determine if any reported radiographic findings impacted on clinical decision-making in the immediate post-operative setting. SPSS was used for descriptive statistics. ResultsA total of 337 patients underwent an X-ray in PACU immediate after uncomplicated open Latarjet procedure. Overall, 98.5% were male (n = 332), the mean patient age of included patients was 22.9 ± 4.2 years. No patient had an abnormal finding on their post-operative x-ray. Two patients returned to the operating room in the immediate post-operative period, both requiring washout and debridement due to haemtoma or superficial wound infection. ConclusionThe findings of this study suggest that the use of post-operative plain films in PACU following open Latarjet procedure remains a costly use of resources, with little ultimate impact on clinical decision making in the short-term post-operatively. Level of EvidenceIV – Institutional Case Series of Consecutive Patients.

Abnormal release of cardiac biomarkers in the presence of myocardial oedema evaluated by cardiac magnetic resonance after uncomplicated revascularization procedures.

To analyse the association of myocardial oedema (ME), observed as high T2 signal intensity (HT2) in cardiac magnetic resonance imaging, with the release of cardiac biomarkers, ventricular ejection, and clinical outcomes after revascularization. Patients with stable coronary artery disease with the indication for revascularization were included. Biomarker levels [troponin I (cTnI) and creatine kinase MB (CK-MB)] and T2-weighted and late gadolinium enhancement (LGE) images were obtained before and after the percutaneous or surgical revascularization procedures. The association of HT2 with the levels of biomarkers, with and without LGE, evolution of left ventricular ejection fraction (LVEF), and 5-year clinical outcomes were assessed. A total of 196 patients were divided into 2 groups: Group 1 (HT2, 40) and Group 2 (no HT2, 156). Both peak cTnI (8.9 and 1.6 ng/mL) and peak CK-MB values (44.7 and 12.1 ng/mL) were significantly higher in Group 1. Based on the presence of new LGE, patients were stratified into Groups A (no HT2/LGE, 149), B (HT2, 9), C (LGE, 7), and D (both HT2/LGE, 31). The peak cTnI and CK-MB values were 1.5 and 12.0, 5.4 and 44.7, 5.0 and 18.3, and 9.8 and 42.8 ng/mL in Groups A, B, C, and D, respectively, and were significantly different. The average LVEF decreased by 4.4% in Group 1 and increased by 2.2% in Group 2 (P = 0.057). ME after revascularization procedures was associated with increased release of cardiac necrosis biomarkers, and a trend towards a difference in LVEF, indicating a role of ME in cardiac injury after interventions.

POD1 Stent Removal after PCNL

Introduction: Percutaneous nephrolithotomy (PCNL) is the gold standard for treating large or complex renal stones. Renal drainage after the procedure is most commonly via nephrostomy tube or indwelling ureteral stent, but the optimal duration of ureteral stents after PCNL is unknown. This study describes the post-operative events occurring with early stent removal on postoperative day one (POD1) in patients undergoing uncomplicated PCNL. Methods: We identified 336 patients from a single institution that underwent PCNL between 1/1/2020 and 6/1/2021. Of these, 106 patients with uncomplicated procedures that met inclusion criteria for early stent removal on POD1 were included. In addition, a retrospective chart review was performed to collect demographic information, operative data, and to identify adverse outcomes including additional procedures, patient telephone calls for symptoms, complications and emergency department (ED) visits. Results: Mean (SD) patient age was 54 (15.1) years and 56% of patients were morbidly obese (Body Mass Index [BMI] &gt; 30). Overall post-operative complication rate was low (18.8%) and limited primarily to Clavien I/II complications with only two Clavien III (1.9%) complications. Telephone calls or electronic messages were received from 37.7% of patients, with 16% requiring a visit to the ED or clinic. The most common reason for an ED visit was flank pain (11.1%). Conclusions: Early stent removal on POD1 may lead to pain-related telephone calls but appears to be a generally safe and effective management option in carefully selected patients undergoing uncomplicated PCNL.

Major drivers of healthcare system costs and cost variability for routine atrial fibrillation ablation.

Catheter ablation is an effective treatment for atrial fibrillation (AF) but incurs significant financial costs to payers. Reducing variability may improve cost effectiveness. We aimed to measure (1) the components of direct and indirect costs for routine AF ablation procedures, (2) the variability of those costs, and (3) the main factors driving ablation cost variability. Using data from the University of Utah Health Value Driven Outcomes system, we were able to measure direct, inflation-adjusted costs of uncomplicated, routine AF ablation to the healthcare system. Direct costs were considered costs incurred by pharmacy, disposable supplies, patient labs, implants, and other services categories (primarily anesthesia support) and indirect costs were considered within imaging, facility, and electrophysiology lab management categories. A total of 910 patients with 1060 outpatient ablation encounters were included from January 1, 2013, to December 31, 2020. Disposable supplies accounted for the largest component of cost with 44.8 ± 9.7%, followed by other services (primarily anesthesia support) with 30.4 ± 7.7% and facility costs with 16.1 ± 5.6%; pharmacy, imaging, and implant costs each contributed <5%. Direct costs were larger than indirect costs (82.4 ± 5.6% vs 17.6 ± 5.6%). Multivariable regression showed that procedure operator was the primary factor associated with AF ablation overall cost (up to 12% differences depending on operator). Direct costs and other services (primarily anesthesia) drive the majority costs associated with AF ablations. There is significant variability in costs for these routine, uncomplicated AF ablation procedures. The procedure operator, and not patient characteristic, is the main driver for cost variability.

Analysis of the 3D printing open-source video laryngoscope for orotracheal intubation

Introduction Orotracheal intubation becomes a challenge for the anesthesiologist when the glottis is not visualized with direct laryngoscopy. Videolaryngoscopes emerged as an alternative in these situations, but the costs of these devices restrict their popularization. Doubts remain as to whether low-cost devices would be safe and effective, such as the 3D printing Open-Source video laryngoscope. Aim To analyze the 3D printing Open-Source video laryngoscope for orotracheal intubation for general anesthesia in its the rate of achieving, glottis visualization time, intubation time and its correlation with the order of execution. Methods Clinical, prospective, analytical study of a questionnaire carried out after the procedure. Statistical analysis was performed using Spearman’s correlation, Kruskal-Wallis test, and chi-square test. Results There was a total of 64 uncomplicated orotracheal intubation procedures with an overall success rate of 93.8%. Mean time for viewing the glottis (16.4”), mean times of endotracheal intubation with Mallampati I (26.5”), ll (33.7”), lll (57.3”), lV (38.5”) were obtained with no statistical significance (P 0.170) and overall mean time of orotracheal intubation (36.4”) with a moderate negative correlation of –0.36 across the orotracheal intubation execution order. Conclusion In the analysis of endotracheal intubation with the 3D printing Open-Source video laryngoscope a high success rate was demonstrated without any complications. The time to obtain endotracheal intubation tends to reduce with subsequent experiences and learning, but it is more than twice the time required to adequately visualize the glottis and the Mallampati classification was not a relevant time predictor. Keywords Orotracheal intubation; Videolaryngoscopy, Airway management

Patient and caregiver experience with telehealth for surgical cancer care: A qualitative study

The COVID-19 pandemic led to telemedicine adoption for many medical specialties, including surgical cancer care. To date, the evidence for patient experience of telemedicine among patients with cancer undergoing surgery is limited to quantitative surveys. Thus, this study qualitatively assessed the patient and caregiver experience of telehealth visits for surgical cancer care. We conducted semistructured interviews with 25 patients with cancer and three caregivers who had completed a telehealth visit for preanesthesia or postoperative visits. Interviews covered visit descriptions, overall satisfaction, system experience, visit quality, what roles caregivers had, and thoughts on what types of surgery-related visits would be appropriate through telehealth versus in-person. Telehealth delivery for surgical cancer care was generally viewed positively. Multiple factors influenced the patient experience, including prior experience with telemedicine, ease of scheduling visits, smooth connection experiences, having access to technical support, high communication quality, and visit thoroughness. Participants identified use cases on telehealth for surgical cancer care, including postoperative visits for uncomplicated surgical procedures and educational visits. Patient experiences with telehealth for surgical care are influenced by smooth system experiences, high-quality patient-clinician communications, and a patient-centered focus. Interventions are needed to optimize telehealth delivery (e.g., improve telemedicine platform usability).

Multicomponent spectrophotometric determination of a ternary mixture of widely-prescribed cardiovascular drugs by four different methods

Four accurate, green, uncomplicated, and fast spectrophotometric procedures were established for the purpose of resolving as well as quantifying a ternary combination prescribed for cardiovascular patients, such as aspirin, atorvastatin, and ramipril. Method (A) is based on the first derivative zero-crossing spectrophotometry for the determination of aspirin and atorvastatin at 247.4 nm and 302.6 nm, respectively. Ramipril was determined using the second derivative at 211 nm. Method (B) depends on the ratio spectra first derivative (RDS) where the absorption spectrum of the ternary combination was divided by the spectrum of one of the analytes. When treated similarly, the concentrations of the other two analytes were measured using their corresponding calibration graphs. For the determination of ASP and RAM, ATR was used as a divisor with a concentration of 26 µg/mL, and the RDS values at 272.0 and 225.8 nm, respectively, were plotted against the ASP and RAM concentrations. Using 40 µg/mL ASP as a divisor, ATR was analyzed, and the RDS values at 295 nm were plotted versus the ATR concentration. Method (C) is based on the double divisor-ratio spectra derivative technique. In this technique, the derivative of the ratio spectrum is computed by dividing the absorption spectra of the studied combination by the standard spectrum of abinary combination of two of the three analytes being studied. The concentrations of the three analytes in the mixture were assayed by determining the absorbance either at the positive or the negative amplitude. For the determination of ASP, ATR, and RAM, the wavelengths used were 244, 295, and 220 nm, respectively. Method (D) was a hybrid double divisor-ratio spectra technique based on convolving the double divisor-ratio spectra with trigonometric Fourier functions. The magnitudes of the Fourier function coefficients at either maximum or minimum points were correlated to the concentration of each drug in the mixture. The specificity of the suggested methods was tested by analyzing synthetic laboratory-prepared combinations and laboratory-made tablets. Furthermore, the accuracy and precision were ensured by statistically comparing the obtained results with those obtained from comparison method using Bartlett's Test for Equality of Variances and ANOVA test.