Spatial distribution of groundwater quality indices using decision support system in Cheyyeru Watershed, YSR District, India

Gorantla Shanmukha Srinivas,Pradeep Kumar G N 대한공간정보학회 2021 Spatial Information Research Vol.29 No.3

Due to industrialization and overblown population, the quality of groundwater has become an issue of major concern at global level. Groundwater Quality Index (GWQI), a technique of rating water quality, is an effective tool to assess spatial and temporal changes. Water samples collected from fourteen well locations and analyzed for physico-chemical parameters viz., pH, Alkalinity, Calcium (Ca2?), Magnesium (Mg2?), Total Hardness (TH), Chlorides (Cl-), Nitrates (No3 -), Sulphates (So4 2-), Total Dissolved Solids (TDS). In this study, methodology based on Multi Criterion Decision Making analysis is developed to create a GWQI, with the aim of identifying places with best quality for drinking within the Cheyyeru Watershed, YSR District. Weights proposed through Analytical Hierarchical Process are applied using National Sanitation Foundation method for determining GWQI. Indices revealed that GWQI varied from 117.02 to 408.74. The impact of land use changes has favored the deterioration of groundwater quality in the basin. Overall assessment of the basin reveals that almost all the parameters analyzed are above the desirable limits. The higher concentration of Mg2? during post-monsoon samples exhibits poor quality of water as compared to summer season. Sample test results were cross-correlated and significant influence on GWQI is observed from Mg2?, TH, and TDS. An interpolation technique Inverse Distance Weighted was used to obtain the spatial distribution of GWQI. The analysis revealed that the groundwater in the basin needs some degree of treatment before consumption, and it also needs to be protected from the perils of contamination.

Decompression Surgery versus Interspinous Devices for Lumbar Spinal Stenosis: A Systematic Review of the Literature

Tram Jennifer,Srinivas Shanmukha,Wali Arvin R.,Lewis Courtney S.,Pham Martin H. 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4

In this retrospective review study, the authors systematically reviewed the literature to elucidate the efficacy and complications associated with decompression and interspinous devices (ISDs) used in surgeries for lumbar spinal stenosis (LSS). LSS is a debilitating condition that affects the lumbar spinal cord and spinal nerve roots. However, a comprehensive report on the relative efficacy and complication rate of ISDs as they compare to traditional decompression procedures is currently lacking. The PubMed database was queried to identify clinical studies that exclusively investigated decompression, those that exclusively investigated ISDs, and those that compared decompression with ISDs. Only prospective cohort studies, case series, and randomized controlled trials that evaluated outcomes using the Visual Analog Scale (VAS), Oswestry Disability Index, or Japanese Orthopedic Association scores were included. A random-effects model was established to assess the difference between preoperative and the 1–2-year postoperative VAS scores between ISD surgery and lumbar decompression. This study included 40 papers that matched our criteria. Twenty-five decompression-exclusive clinical trials with 3,386 patients and a mean age of 68.7 years (range, 31–88 years) reported a 2.2% incidence rate of dural tears and a 2.6% incidence rate of postoperative infections. Eight ISD-exclusive clinical trials with 1,496 patients and a mean age of 65.1 (range, 19–89 years) reported a 5.3% incidence rate of postoperative leg pain and a 3.7% incidence rate of spinous process fractures. Seven studies that compared ISDs and decompression in 624 patients found a reoperation rate of 8.3% in ISD patients vs. 3.9% in decompression patients; they also reported dural tears in 0.32% of ISD patients vs. 5.2% in decompression patients. A meta-analysis of the randomized controlled trials found that the differences in preoperative and postoperative VAS scores between the two groups were not significant. Both decompression and ISD interventions are unique surgical interventions with different therapeutic efficacies and complications. The collected studies do not consistently demonstrate superiority of either procedure over the other but understanding the differences between the two techniques can help tailor treatment regimens for patients with LSS.

Surgical revascularization for Moyamoya disease in the United States: A cost-effectiveness analysis

Wali Arvin R.,Santiago-Dieppa David. R.,Srinivas Shanmukha,Brandel Michael G.,Steinberg Jeffrey A.,Rennert Robert C,Mandeville Ross,Murphy James D.,Olson Scott,Pannell J. Scott,Khalessi Alexander A. 대한뇌혈관외과학회 2021 Journal of Cerebrovascular and Endovascular Neuros Vol.23 No.1

Objective Moyamoya disease (MMD) is a vasculopathy of the internal carotid arteries with ischemic and hemorrhagic sequelae. Surgical revascularization confers upfront peri-procedural risk and costs in exchange for long-term protective benefit against hemorrhagic disease. The authors present a cost-effectiveness analysis (CEA) of surgical versus non-surgical management of MMD. Methods A Markov Model was used to simulate a 41-year-old suffering a transient ischemic attack (TIA) secondary to MMD and now faced with operative versus nonoperative treatment options. Health utilities, costs, and outcome probabilities were obtained from the CEA registry and the published literature. The primary outcome was incremental cost-effectiveness ratio which compared the quality adjusted life years (QALYs) and costs of surgical and nonsurgical treatments. Base-case, one-way sensitivity, two-way sensitivity, and probabilistic sensitivity analyses were performed with a willingness to pay threshold of $50,000. Results The base case model yielded 3.81 QALYs with a cost of $99,500 for surgery, and 3.76 QALYs with a cost of $106,500 for nonsurgical management. One-way sensitivity analysis demonstrated the greatest sensitivity in assumptions to cost of surgery and cost of admission for hemorrhagic stroke, and probabilities of stroke with no surgery, stroke after surgery, poor surgical outcome, and death after surgery. Probabilistic sensitivity analyses demonstrated that surgical revascularization was the cost-effective strategy in over 87.4% of simulations. Conclusions Considering both direct and indirect costs and the postoperative QALY, surgery is considerably more cost-effective than non-surgical management for adults with MMD.

Cervical Arthroplasty in the Treatment of Cervical Angina: Case Report and Review of the Literature

Omar M. Al Jammal,Luis Daniel Daz-Aguilar,Shanmukha Srinivas,Jillian Plonsker,Ronald Sahyouni,Martin H. Pham 대한척추신경외과학회 2020 Neurospine Vol.17 No.4

Cervical angina is an often-overlooked etiology of noncardiac chest pain that may mimic true angina pectoris but is due to cervical spine disease. Diagnosis can be difficult, and treatment ranges from conservative therapy to surgical management. However, of patient’s refractory to conservative therapy, approximately ninety percent experience postoperative relief of angina symptoms. Here, we present a case report on cervical angina and performed a systematic review of the literature. A 34-year-old male with prior surgery for thoracic outlet syndrome presented with persistent anterior neck and chest pain as well as posterior left scapular and upper lateral arm pain. The pain was refractory to 12 months of conservative therapy. Cardiac workup was negative and cervical spine imaging revealed a C6–7 herniation with neuroforaminal stenosis. A systematic literature search was conducted in PubMed, Web of Science, and Cochrane databases from database inception to April 2020. Studies reporting cervical level, average symptom duration, location of pain, and postoperative pain improvement were included. The patient's atypical symptoms were completely resolved after C6–7 anterior cervical discectomy and arthroplasty. To our knowledge, this is the first study which reports on the use of arthroplasty in the treatment of cervical angina. The systematic review included 11 articles from 1989–2020 consisting of 1,186 total patients and 109 patients (age range, 36–84 years; 60.7% male) meeting inclusion criteria. Symptom duration range was 2 days to 90 months, with the most common location of pain being localized to the anterior chest wall (66.7% of patients). All patients (100%) had postoperative resolution of their pain symptoms. The most common herniation level was C6–7 (87.3% of patients). We conclude that a broad and multidisciplinary approach is necessary for the diagnosis and management of noncardiac chest pain. When cervical disease is identified as the underlying cause for the angina-like pain, conservative therapy should be sought. Refractory cases should be treated surgically depending on the cervical pathology.