The challenges of obesity and obstetric anaesthesia

PURPOSE OF REVIEW: The aim of this article is to review the clinical challenges of obesity in obstetrics from the anaesthetist's viewpoint. RECENT FINDINGS: The prevalence of obesity continues to increase both in the community and on the labour ward. Women who have undergone bariatric surgery are also on rise. During pregnancy, obesity is associated with hypertensive disease (chronic hypertension and preeclampsia), diabetes mellitus (pregestational and gestational), respiratory disorders (asthma and sleep apnoea), thromboembolic disease, caesarean section and infections (primarily urinary tract infections, wound infections and endometritis). Obesity is a risk factor for anaesthesia-related maternal mortality. Obese women are not only at high-risk of airway complications, cardiopulmonary dysfunction, perioperative morbidity and mortality but also pose technical challenges. Obesity also influences the fetal outcomes. Increasing use of regional techniques contributes to the reduced anaesthesia-related maternal mortality. Preconception counselling, antenatal screening and anaesthetic assessment are strongly encouraged. SUMMARY: Effective communication and good teamwork between an anaesthetist and an obstetrician are essential for the care of obese parturients. A more liberalized use of regional techniques may be a means of further reducing the anaesthesia-related maternal mortality.     

Spontaneous coronary artery dissection in a young woman precipitated by retching

Spontaneous coronary artery dissection as a cause of acute myocardial ischemia is a rare entity that has been associated with several different clinical profiles and precipitating events. The recognition of this entity as the cause of acute ischemia is important because the therapeutic considerations may be different than that for ischemia due to a ruptured atherosclerotic plaque. We report a case of spontaneous coronary artery dissection in a 31-year-old female that was induced by prolonged, forceful retching. To our knowledge, this is the first reported case of such an association. Prolonged retching should be added to the list of causes of spontaneous coronary artery dissection.     

Enhanced SARS-CoV-2-Specific CD4+ T Cell Activation and Multifunctionality in Late Convalescent COVID-19 Individuals

Background: Examination of CD4⁺ T cell responses during the natural course of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection offers useful information for the improvement of vaccination strategies against this virus and the protective effect of these T cells. Methods: We characterized the SARS-CoV-2-specific CD4⁺ T cell activation marker, multifunctional cytokine and cytotoxic marker expression in recovered coronavirus disease 2019 (COVID-19) individuals. Results: CD4⁺ T-cell responses in late convalescent (>6 months of diagnosis) individuals are characterized by elevated frequencies of activated as well as mono, dual- and multi-functional Th1 and Th17 CD4⁺ T cells in comparison to early convalescent (<1 month of diagnosis) individuals following stimulation with SARS-CoV-2-specific antigens. Similarly, the frequencies of cytotoxic marker expressing CD4⁺ T cells were also enhanced in late convalescent compared to early convalescent individuals. Conclusion: Our findings from a low-to middle-income country suggest protective adaptive immune responses following natural infection of SARS-CoV-2 are elevated even at six months following initial symptoms, indicating the CD4⁺ T cell mediated immune protection lasts for six months or more in natural infection.     

Benzothiazole appended 2,2′-(1,4-phenylene)diacetonitrile for the colorimetric and fluorescence detection of cyanide ions

A benzothiazole appended 2,2′-(1,4-phenylene)diacetonitrile derivative (2Z,2′Z)-2,2′-(1,4-phenylene)bis(3-(3-(benzo[d]thiazol-2-yl)-4-hydroxyphenyl)acrylonitrile) (PDBT) has been synthesized and investigated as a novel sensor, capable of showing high selectivity and sensitivity towards CN⁻ over a wide range of other interfering anions. After reaction with CN⁻, PDBT shows a new absorption peak at 451 nm with a color transformation from colorless to reddish-brown. When yellow fluorescent PDBT is exposed to CN⁻, it displays a significant increase in fluorescence at 445 nm, resulting in strong sky-blue fluorescence emission. The nucleophilic addition reaction of CN⁻ plays a role in the sensing mechanism of PDBT to CN⁻. PDBT can distinguish between a broad variety of interfering anions and CN⁻ with remarkable selectivity and sensitivity. Furthermore, the detection limit of the PDBT probe for CN⁻ is 0.62 μM, which is significantly lower than the WHO standard of 1.9 μM for drinking water. Density functional theory simulations corroborated the observed fluorescence changes and the internal charge transfer process that occurs after cyanide ion addition. In addition, real-time applications of PDBT, such as cell imaging investigations and the detection of CN⁻ in water samples, were successfully carried out.

(2Z,2′Z)-2,2′-(1,4-Phenylene)bis(3-(3-(benzo[d]thiazol-2-yl)-4-hydroxyphenyl)acrylonitrile) (PDBT) has been synthesized and investigated as a novel PDBT, capable of showing high selectivity and sensitivity towards CN⁻ over a wide range of other interfering anions.     

Enhancing the stability and efficiency of MAPbI3 perovskite solar cells by theophylline-BF4− alkaloid derivatives,a theoretical-experimental approach

Perovskite solar cells (PSCs) are an evolving photovoltaic field with the potential to disrupt the established silicon solar cell market. However, the presence of many transport barriers and defect trap states at the interfaces and grain boundaries has negative effects on PSCs; it decreases their efficiency and stability. The purpose of this work was to investigate the effects on efficiency and stability achieved by quaternary theophylline additives in MAPbI₃ PSCs with the structure FTO/TiO₂/perovskite/spiro-OMeTAD/Ag. The X-ray photoelectron spectroscopy (XPS) and theoretical calculation strategies were applied to study the additive''s interaction in the layer. The tetrafluoroborinated additive results in an increase in device current density (J_SC) (23.99 mA cm⁻¹), fill factor (FF) (65.7%), and open-circuit voltage (V_OC) (0.95 V), leading to significant improvement of the power conversion efficiency (PCE) to 15.04% compared to control devices (13.6%). Notably, films exposed to controlled humidity of 30% using the tetrafluoroborinated additive maintained their stability for more than 600 hours (h), while the control films were stable for less than 240 hours (h).

The incorporation of new quaternized theophylline and BF₄ additives in MAPbI₃ perovskite solar cells increases efficiency and stability in controlled humidity.     

Management of pancreatic pseudocyst in the era of laparoscopic surgery – Experience from a tertiary centre

Background In the era of minimally invasive surgery, laparoscopy has a great role to play in the management of pseudocyst of pancreas. We present our surgical experience over the past 12 years (May 1994 to April 2006) in the management of pancreatic pseudocysts. Materials and Methods The total number of cases was 108, with 76 male and 32 female patients. Age ranged from 18 to 70 years. Duration of symptoms ranged from 45 days to 7 months. Fifty-nine patients presented with pain abdomen. Sixty-one patients had co-morbid illness. Ten patients had abdominal mass on clinical examination. Predisposing factors were gallstones in 58 cases, alcohol in 20 cases, trauma in eight cases and post-pancreatectomy in one case. In 21 cases there are no predisposing factors. Results All the cases were successfully operated without any significant intraoperative complication. Laparoscopic cystogastrostomy was done in 90 cases (83.4%), laparoscopic cystojejunostomy in eight cases (7.4%), open cystogastrostomy in two cases (1.8%), and laparoscopic external drainage in eight cases (7.4%). Laparoscopic cholecystectomy was done in 47 cases along with the drainage procedure. The mean operating time was 95 minutes. Mean blood loss was 69 ml. Mean hospital stay was 5.6 days. Percutaneous tube drain to assist decompression of the cyst was kept in all the laparoscopic cystojejunostomy (LCJ) group. Two patients were re-operated for bleeding and gastric outlet obstruction. We had no mortality in the postoperative period. With mean follow up of 54 months (range 3–145 months); only one patient who underwent laparoscopic cystogastrostomy (LCG) earlier in this series had recurrence due to inadequate stoma size. This patient later underwent OCG Conclusion Laparoscopy has a significant role to play in the surgical management of pseudocysts with excellent outcome. It offers all the benefits of minimally invasive surgery to the patients.     

Laparoscopic management of symptomatic multiple hepatic cysts: a combination of deroofing and radical excision.

BACKGROUND: Liver cysts have been estimated to occur in 5% of the population. Multiple liver cysts can also be part of the polycystic disease complex. Only symptomatic or complicated cysts need surgery. Traditionally, laparotomy is the procedure of choice. We present our experiences with laparoscopic management of both symptomatic multiple liver cysts and polycystic liver disease. METHODS: Between 1995 and 2006, we treated 12 patients with large, multiple liver cysts, including 4 cases of polycystic liver disease. Most of the patients were elderly males. The lung and other organs were not involved in any case. Laparoscopic deroofing or radical excision with omentoplasty was successfully performed in these patients. RESULTS: Postoperatively, 4 patients had fluid draining through the drainage tube for an average of 10 days. One patient had ascites that resolved spontaneously. Cysts recurred in 5 patients. DISCUSSION: There are not many reports in the literature regarding large series of patients, further confirming the rarity of the disease. Liver cysts can occur as a part of polycystic renal and lung disease or isolated to the liver alone. Laparoscopic deroofing is the ideal treatment for nonpolycystic liver disease, and laparoscopic radical excision is ideal for polycystic liver disease. Simple needle aspiration or sclerotherapy is inadequate as recurrence is almost 100%. CONCLUSION: Currently, laparoscopy scores over laparotomy for the treatment of nonparasitic liver cysts as evidenced by this and other studies.     

Laparoscopic Internal Marsupializaton for Large Nonparasitic Splenic Cysts: Effective Organ-Preserving Technique

Background Primary splenic cyst is a rare disease, and therefore there is no information regarding its optimal management. Most such cysts are classified as epithelial cysts. During the last few years, the laparoscopic approach has gained increasing acceptance in splenic surgery. We present our experience with the laparoscopic (organ-preserving) management of splenic cysts. Methods We managed 11 patients with large symptomatic nonparasitic splenic cysts from 1996 to 2006. All the patients had fullness in the left upper abdomen and a palpable mass. Preoperative diagnosis was established with ultrasonography and computed tomography. All patients were treated with either laparoscopic partial cystectomy or marsupialization. Results Seven patients had mesothelial cysts, two had epidermoid cysts, and two had pseudocysts. Nine patients did not have any problems or recurrence during an average follow-up of 29.5 months. Two patients had cyst recurrence after 14 months. Conclusion Laparoscopic organ-preserving surgery should be the goal of therapy in most cases. Total splenectomy is reserved for cases in which cyst excision cannot be done or most of the splenic tissue is replaced by the cyst. Plication of the cyst wall edges prevents the cyst walls from adhering and causing recurrence, as well as helping to control hemorrhage. Laparoscopic partial cystectomy/marsupialization is an acceptable procedure for the treatment of splenic cysts; and after short to mid-term follow-up, it seems that a reasonable rate of success is possible.