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We revisit the well-known Gilbert–Varshamov (GV) bound for constrained systems. In 1991, Kolesnik and Krachkovsky showed that the GV bound can be determined via the solution of an optimization problem. Later, in 1992, Marcus and Roth modified the optimization problem and improved the GV bound in many instances. In this work, we provide explicit numerical procedures to solve these two optimization problems and, hence, compute the bounds. We then show that the procedures can be further simplified when we plot the respective curves. In the case where the graph presentation comprises a single state, we provide explicit formulas for both bounds.

Background and Aims: There are two approaches for ultrasound (US)-guided vessel cannulation: the short axis (SA) approach and the long axis (LA) approach. However, it remains to be seen which approach is better. Therefore, we performed the present updated systematic review and meta-analysis to assess the effectiveness and safety of US-guided vascular cannulation between the SA and LA techniques. Methods: We performed a comprehensive electronic database search in PubMed, Embase, Cochrane Library and Web of Science for the relevant studies from inception to June 2022. Randomised controlled trials comparing the SA approach and the LA approach for US-guided vascular access were incorporated in this updated meta-analysis. The first-attempt success rate was the primary outcome. The secondary outcomes were the overall success rate, cannulation time, number of attempts and the incidence of complications. The statistical analysis was conducted using RevMan software (version 5.4; the Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark). The Cochrane risk of bias tool was used to evaluate each study's potential risk for bias. Results: In total, 16 studies consisting of 1885 participants were incorporated in this updated meta-analysis. No statistically significant difference was found between the SA and LA vascular access techniques for first-pass success rate (risk ratio = 1.07, 95% confidence interval: 0.94-1.22). The overall cannulation success rate, complication rate, average cannulation time and average number of attempts were not significantly different between the SA and LA groups. Conclusion: This updated meta-analysis demonstrated that the SA and LA approaches of US-guided vessel cannulation are similar regarding first-pass success, overall cannulation success rate, total complication rate, cannulation time and the number of attempts.

Background Catheter-associated urinary tract infections (CAUTIs) are a major healthcare-associated infection (HAI) in trauma care settings, contributing to morbidity, mortality and antimicrobial resistance. In this study we characterize the epidemiology, microbiological profile, antimicrobial resistance patterns, and clinical outcomes of CAUTIs and non-CAUTI urinary tract infections (UTIs) at a Level 1 Trauma Centre in India from 2017 to 2024, using a modified CDC-NHSN definition and digital surveillance. Methods A retrospective analysis of 723 UTI events was conducted using Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC-NHSN) definitions, modified to include Candida spp. at ≥ 10 5 CFU/mL. Surveillance was performed by dedicated Hospital Infection Control Nurses (HICNs) using a digital system. Microbiological identification and antimicrobial susceptibility testing (AST) were conducted via the conventional manual methods and automated systems. Results of 723 UTI events, 608 (84.0%) were CAUTIs. The cohort had a median age of 34 years (IQR:22–45) and was 76% male. Pseudomonas aeruginosa (18%), Klebsiella pneumoniae (17.9%), and Escherichia coli (15%) were predominant pathogens. Antimicrobial resistance was high, with 100% resistance to ceftazidime in Acinetobacter baumannii and 93.6–94.1% resistance to ciprofloxacin in Klebsiella spp. and Enterococcus spp. Mortality was 25.5% (28.2% in CAUTI, 12.9% in non-CAUTI). Conclusion This large-scale, trauma specific study with modified fungal criteria and digital surveillance highlights the importance of CAUTI burden and the high resistance in pathogens causing this infection. Clinical trial number Not applicable.

Background: In traumatic brain injuries (TBI), cerebral microdialysis (CMD)-derived parameters, especially the lactate to pyruvate ratio (LP ratio), have been utilized for cerebral perfusion optimization. The objectives were to identify cerebral ischemia as measured by CMD in TBI patients requiring decompressive craniectomy and to observe the correlation between cerebral perfusion pressure (CPP), intracranial pressure (ICP), and CMD variables in these patients. Our secondary aim was to observe the effect of CPP augmentation on ischemia biomarkers. Methods: After the Institute Ethics Committee approvals, seven adult patients requiring decompressive craniectomy following TBI were enrolled and CMD data were obtained prospectively for 72 h. CPP was augmented by 20% with noradrenaline infusion if LP ratio >40. Correlations were done with bootstrapping (n = 500) to obtain the confidence intervals (CI) due to the small sample size. Results: One patient had cerebral ischemia (median LP ratio of 265.5 and median pyruvate of 38 μmol/L), while another patient had non-ischemic mitochondrial dysfunction (median LP ratio 40.7 and median pyruvate 278.5). The coefficients of correlation between the LP ratio with CPP and ICP were r = −0.05 (CI = −0.14-0.03) and r = 0.09 (CI = −0.03-0.24), respectively. The coefficient of correlation between cerebral and blood glucose was r = 0.38, (CI − 0.35-0.14). Only two patients needed CPP augmentation, however, postaugmentation cerebral biochemistry did not change appreciably. Conclusion: CMD can identify cerebral ischemia, however, no correlations were observed between the LP ratio and CPP or ICP. CPP augmentation did not improve cerebral biochemistry. More studies are required to understand and treat cerebral metabolism in TBI.

Introduction: Catheter-associated urinary tract infections (CAUTIs) are one of the most common device-associated infections acquired in a hospital. Trauma patients are highly susceptible to CAUTI, as catheterization is a lifesaving measure often required for their management. This study focuses on the profile of CAUTI, the organism profile with antibiotic susceptibility patterns, and the clinical outcomes in the ICUs of a trauma care center. Methodology: A retrospective analysis of prospective surveillance data of patients in ICUs was done over a period of ten years (2010-2019) in a level 1 trauma center. A modified NHSN definition of CAUTI was used. Microbiological processing and antibiotic susceptibility profile was done based on standard guidelines. Clinical outcomes were considered for analysis. Results: A total of 10,732 patients were included in the study, accounting for 98,131 patient days and 78,126 urinary catheter days (UCD). Among 546 patients, 577 episodes of CAUTI were recorded, giving a CAUTI rate of 7.4/1,000 catheter days. The average length of stay (LOS) of patients was 19.9 days. There was a significant relationship between UCD and the development of CAUTI. Orthopedic and spinal injuries (91%) accounted for the maximum device utilization ratio, followed by polytrauma (90%), miscellaneous injuries (88%), and head injuries (69%). CAUTI episodes were the highest in head injury patients. Gram-negative organisms (53.4%) dominated the pathogen profile. The crude mortality was 25.1%. Conclusions: Surveillance of CAUTI with analysis of the organisms and the antibiotic susceptibility trend will help improve infection prevention practices and antibiotic stewardship programs in local hospital settings.

Introduction The current research sets out to assess implant early survival rates and identify relevant parameters. Methods The research spanned the years 2021 and 2022 and included all individuals who had dental implants. Various criteria, such as age, sex, maxilla/mandible, implant location, immediate implant, implant diameter, implant length, and others, were used to determine the implant survival rate in the research. A multiple logistic regression model was used to show the risk variables for early survival rates of implants, and components with p < 0.05 were further included after the Chi-square test was employed to filter them. Results The current research included 128 patients who had a single implant procedure, including 70 males and 58 females. The early survival rate was 91.40%, and 117 implants were retained after implantation. Risk variables that were shown to be associated with early survival rates were patients aged 30-60 years (OR: 2.542), immediate implant placement (OR: 3.742), and implant length less than 10 mm (OR: 3.972). Conclusions Age, tooth location, implant length, and immediate implantation were risk variables that contributed to our subjects' above 91% early survival rate of implants.

Study designDescriptive retrospective.ObjectivesTo evaluate the burden of respiratory morbidity in terms of ventilator dependence (VD) days and length of stay in neurotrauma ICU (NICU) and hospital, and to determine mortality in patients with traumatic cervical spinal cord injury (CSCI) in a low middle-income country (LMIC).SettingJai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India.MethodsA total of 135 patients admitted with CSCI in the NICU between January 2017 to December 2018 were screened. Information regarding age, gender, American Spinal Injury Association (ASIA) impairment scale (AIS), level of injury, duration of VD, length of NICU, hospital stay, and outcome in terms of mortality or discharge from the hospital were obtained from the medical records.ResultsA total of 106 CSCI patients were analyzed. The mean (SD) age of patients was 40 (±16) years and male: female ratio was 5:1. The duration of VD, duration of NICU, and hospital stay was a median of 8 days (IQR 1127), 6 days (IQR 1118), and 15 days (IQR 3127) respectively. Mortality was 19% (20/106). The mortality was significantly associated with poorer AIS score, VD, and duration of ICU and hospital stay. All patients were discharged to home only after they became ventilator-free.ConclusionsThe ventilator burden, hospital stay, and mortality are high in patients with CSCI in LMICs. Poor AIS scores, prolonged VD, ICU and hospital stay are associated with mortality. There is a need for comprehensive CSCI rehabilitation programs in LMICs to improve outcome.

Diffuse leptomeningeal glioneuronal tumor (DL-GNT) is a newly introduced tumor entity of uncertain prognosis characterised by a primary diffuse leptomeningeal growth pattern, oligodendroglial-like morphology and dual glial/neuronal differentiation. Predominantly occurring in children, these tumors present as chronic meningitis and mimic infectious/inflammatory diseases. They are surgically challenging tumors with a high incidence of delayed morbidity and mortality despite low-grade histology. Their molecular genetic profile is not fully elucidated and few reports have identified chromosome 1p and 19q deletions, and BRAF alterations. We present a rare instance of a DL-GNT in a 13-year-old female who presented with slowly progressive and sequential neurological deficits over a 12-month duration. Imaging showed leptomeningeal thickening and spinal lesions. Biopsy from the spinal mass showed histomorphological features characteristic of DL-GNT. Further molecular analysis revealed 1p and 19q co-deletion and H3K27M mutation, while no mutation were identified in IDH, TERT , or BRAF genes. Patient died 4 months after diagnosis. Only one previous case of DL-GNT has been reported to harbour H3K27M mutation. Although H3K27M mutations have been described in rare examples of low-grade glial and glioneuronal tumors, whether DL-GNTs with H3K27M represent a rare growth pattern of the aggressive H3K27M -mutant diffuse midline gliomas needs further clarification.

[1] ECG artifacts caused by electromagnetic fields of the magnetic resonance system can make detection of any arrhythmia or new onset morphologic changes very difficult. [...]I-gel™ is a helpful airway device for MRI in children in routine as well as emergency scenario. [...]sevoflurane was opted which preserves systemic arterial pressure. [2] We preferred dexmedetomidine infusion in low dose as maintenance drug with gaseous mixture (O2: Air) because of its central sympatholytic activity which would have helped in condition of congestive heart failure if arisen as untoward event during the procedure unlike any inhalational agent.