Context:Gliomas are the most common brain tumors. In addition to conventional magnetic resonance imaging (MRI) techniques, a variety of new techniques offers more than the anatomic information. The new MRI techniques include perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI).Aims:The aim of this study is to assess the sensitivity, specificity, predictive value, and accuracy of diffusion- and perfusion-weighted MRI in the preoperative grading of gliomas.Setting/Design:The study was conducted in the Department of Neurosurgery, Pathology, and Radiodiagnosis, Sher-e-Kashmir Institute of Medical Sciences, Kashmir, India, which is the only tertiary care neurosurgical center in the state. It was a prospective study.Patients and Methods:Thirty-one consecutive patients with gliomas were included in the study. All the patients were evaluated by a standard conventional contrast-enhanced study on Siemens 1.5 Tesla MRI. In addition to the standard MRI, diffusion- and perfusion-weighted MRI were also performed. The histopathological grading of the tumor was done as per the WHO classification of 2007. The sensitivity, specificity, predictive value, and accuracy of diffusion- and perfusion-weighted MRI in determining tumor grade were calculated. Comparison was done between PWI, DWI findings, and WHO histopathological grading.Analysis Method:The statistical analysis was done using the Statistical Package for the Social Sciences, and receiver operating characteristic curves were used to estimate sensitivity, specificity, and accuracy.Results:The overall sensitivity of PWI (with regional cerebral blood volume cutoff of 1.7) in the preoperative assessment of high-grade gliomas was 82.6% and specificity was 75%, the positive predictive value (PPV) was 90.48%, and the negative predictive value (NPV) was 60%. The overall accuracy was 80.65%. In case of DWI, the sensitivity was 69.57% and the specificity was 75%, and the PPV and NPVs were 88.8% and 46.15%, respectively. The overall accuracy was 71%.Conclusion:Our results clearly show higher accuracy of diffusion- and perfusion-weighted MRI in assessment of glioma grade as compared to conventional MRI. This information can prove very useful for the operating neurosurgeon in preoperative assessment and surgical planning. Postoperatively, the neuropathologist can also benefit from such information.

BACKGROUNDIntraoperative awareness occurs when a patient becomes conscious during a surgical procedure performed under general anaesthesia and subsequently has recall of these events. The experience can be quite disturbing and traumatic, and some patients may even need counselling after their surgery to help lessen feelings of confusion, stress, or trauma associated with the experience. For this reason, anaesthesia professionals are seriously committed to minimising the risk of intraoperative awareness under general anaesthesia. Objectives-The purpose of this study was to evaluate the incidence of awareness with recall after surgery, which is an infrequent occurrence but of significant concern with significant adverse psychological sequelae and medicolegal implications. MATERIALS AND METHODS300 patients were enrolled for three different subsets of surgical patients undergoing general anaesthesia. An acknowledged and well-established method of detecting awareness involved the use of a structured Brice et al interview, 1970 and correlation with intraoperative Entropy monitoring. RESULTSOur study found that among these 300 patients, 2 patients reported remembering something between going to sleep and waking up from anaesthesia, thus 2 cases of awareness were identified. 7 patients reported dreaming and 4 cases of possible awareness were identified. CONCLUSIONAwareness occurs despite the usual clinical monitoring of anaesthetic depth like BP, HR and even with the use of entropy. There is currently no evidence that awareness and recall could be prevented by monitoring consciousness with sophisticated methods such as BIS or entropy. If a patient has suffered from awareness and recalls this postoperatively, psychiatric consultation and followup is recommended.

OBJECTIVES:The purpose of present study was to evaluate the reliability of central venous blood gas monitoring as an alternative to arterial blood gas monitoring and to assess that the central venous catheter is convenient and reliable source of blood for repetitive measurement of pH bicarbonate and PCO2 in critically ill patients admitted in surgical intensive care unit (SICU). METHODS:We took one hundred patients who required ABG analysis between 20-60 years of age. The cases were divided in four groups which constituted major admissions in SICU in one year. Out of one hundred patients for the study there were 19 Poisoning patients, 15 Trauma patients, 40 Major abdominal surgery patients, 26 Hypovolemic shock patients and others. Central Venous blood drawn within 5 min of an ABG measurement and the samples analyzed immediately on automated ABG analyzer were compared. RESULTS: Bland Altman plots demonstrated a high degree of agreement between the two corresponding sets of measurements of arterial and venous blood with coefficient of correlation 0.979 for pH. The coefficient of correlation was highly positive i.e. 0.926 for PCO2 and 0.955 for HCO3 -which is statistically significant. There was also positive correlation for saturation between arterial and venous blood i.e. 0.57 with clinically acceptable difference and is statistically significant. The difference in pO2 measurements was however higher with correlation coefficient of 0.259 although the arterial saturation and finger oximetry reveals a good degree of agreement with clinically acceptable bias. CONCLUSION: Venous blood gas (VBG) analysis clearly does not replace ABG analysis in determining exact pO2 status and arterial puncture may still be required for invasive arterial BP monitoring. With positive correlation and regression plots obtained, venous samples can be used as an alternative to arterial samples depending on the significant positive correlation values obtained for each parameter separately. Given the well accepted accuracy of pulse oximetry, VBG analysis may be a safer alternative to ABG analysis for determining acid-base status.

There is widespread misinformation, taboos, and a lack of scientific analysis about vitiligo. In Bangladesh, there is a scarcity of research on vitiligo, though advanced treatments are widely available. This study aimed to investigate the treatment efficacy of vitiligo in a selected dermatology clinic and analyze the factors that impact the efficacy level. This was an analytical cross-sectional study among vitiligo patients who attended a dermatology clinic for treatment and were followed up for at least six months. Patients were treated by experienced physicians through a holistic treatment approach. An interviewer-administered questionnaire was used to collect information after obtaining informed consent. The data was processed by Microsoft Excel 2013 and analyzed by SPSS 25.0. The mean age of the study participants was 25.14 ± 13.32 years, where 60% were female. Acrofacial (33%), focal (27%), and acral (14%) are the most common types of vitiligo, and the face (n=73) is the most common body part. We have seen excellent treatment efficacy as proven by 94% of patients' lesion sizes decreased and 96% gained repigmentation at six months' follow-up. Our study revealed there is a negative impact of the presence of systemic disease and co-morbidities on vitiligo. The efficacy of the treatment was significantly affected by advanced age, body surface area, hypertension, diabetes, and anemia (P<0.05). Our analysis revealed a good treatment efficacy of holistic treatment for vitiligo in selected clinic. For more effective treatment, control of co-morbidities is essential. The findings of this study will help clinicians in their decision making during the treatment process of vitiligo. Asian J. Med. Biol. Res. 2023, 9 (2), 51-58