Search

Peripartum cardiomyopathy and hypertensive disorders of pregnancy are not very uncommon in routine practice, but when associated with abruptio placentae and significant hypotension, survival of both child and mother becomes challenging. We report a case of a 20-year-old primigravida who presented in the gynecology emergency unit of our hospital with an ejection fraction of < 20%, severe preeclampsia with abruptio placentae leading to fetal demise, and renal failure in the immediate postoperative period. Challenges faced during decision making regarding the mode of delivery and grave concerns during intraoperative and postoperative periods are discussed. In this case, prompt termination of pregnancy, various point-of-care sonographic measurements, and post-operative emergency dialysis played vital roles in the complete recovery of this patient with a failing heart and grossly jeopardized hemodynamics. Hence, multidisciplinary team-based management is crucial for managing such cases to prevent maternal mortality and morbidity. [ABSTRACT FROM AUTHOR]

Introduction: The blood--brain barrier (BBB) is a semipermeable border that is responsible for maintaining central nervous system (CNS) homeostasis in the brain. Screening compounds based on their BBB permeability is an important consideration for CNS-acting drug development. Several studies have attempted to link physicochemical properties to specific BBB permeability; however, there is no widely accepted rule that can determine how and to what extent molecular properties affect the BBB permeability of compounds. To understand the complex phenomenon of BBB permeability, we explored the vast molecular space of the compounds to determine whether some features could differentiate the compounds based on their BBB permeability. Materials and Methods: A dataset of 1951 compounds containing 1246 BBB-permeable and 705 BBB-nonpermeable molecules was used in the study. Each compound encoded 499 molecular features. Feature selection was performed using feature selection algorithms, feature-to-feature, and feature-to-permeability correlation analysis. The findings of the feature selection algorithms were merged to select the best set of 53 features. Results: The descriptive analysis of the molecular features suggests that nCXr (number of X on ring C[sp3]) feature values for BBB nonpermeable compounds are zero for all considered compounds except for compounds with PubChem ID 71260, Flurithromycin. In addition, the majority of compounds were found to have nCrq (number of ring quaternary C[sp3]) feature values of zero for BBB nonpermeable compounds. For BBB-permeable compounds, MACCS fingerprints 8 feature values for all 1951 compounds were found to be zero except for the compound with PubChem ID 146291, Dezinamide. Conclusion: The descriptive and nonparametric tests confirm that molecular feature distributions are significantly different for BBB permeable and BBB nonpermeable compounds. [ABSTRACT FROM AUTHOR]

Background: Postoperative nausea and vomiting (PONV) are one of the common distressing conditions after anesthesia. The PONV are related to several potential risk factors are patient related, anesthesia related, and surgery related. In surgery-related risk, middle ear surgery is associated with a high incidence of PONV. Aims: This study aimed to compare the efficiency of palonosetron versus palonosetron with dexamethasone in the prevention of PONV in middle ear surgeries. Settings and Design: This was a prospective, randomized, double-blind study. Methods: A prospective randomized double-blind study was conducted for the prevention of nausea and vomiting in patients with middle ear surgeries. The study comprised 50 patients of Group A (palonosetron 0.075 mg) and patients of Group B (palonosetron 0.075 mg and dexamethasone 4 mg). Statistical Analysis: The data were presented as descriptive statistics for continuous variables and percentages for categorical variables and were subjected to Z-test/Chi-square test/Fisher's exact test. The value of P < 0.05 was considered statistically significant. Results: Demographic parts in comparison to age, duration of surgery, and duration of anesthesia were similar in both the groups. Our study showed that the incidence of PONV during 0–6 h was 38% (n = 19) in Group A and 12% (n = 6) in Group B and the incidence during 6–12 h postoperatively was 14% (n = 7) in Group A and 8% (n = 4) in Group B. During 12–24 h, the incidence was 8% (n = 4) and 6% (n = 3) in Group A and B, respectively. Hence, the difference of total early PONV in Group A was 60% (n = 30) and in Group B, it was 26% (n = 13) which was statistically significant (P < 0.03). Conclusions: The above result proves that palonosetron and dexamethasone group is superior in the prevention of PONV in middle ear surgery. [ABSTRACT FROM AUTHOR]

This article discusses the case of a 24-year-old female with Susac syndrome who underwent laparoscopic cholecystectomy. Susac syndrome is a disease characterized by encephalopathy, sensorineural hearing loss, and visual disturbance. The patient was managed with oral cyclophosphamide and prednisolone and had thinning of the inner retinal nerve fiber layer. The article describes the anesthetic considerations for the surgery, including the use of an i-gel to maintain the airway and the monitoring of optic nerve sheath diameter to assess intracranial pressure. The surgery was successful, and the patient's oral steroid was resumed postoperatively. [Extracted from the article]

This article discusses a case series of four pediatric patients with difficult airways who were successfully intubated using a rhino-laryngoscope, I-gel, and a bougie. The authors describe their technique of inserting a larger diameter bronchoscope through the I-gel to visualize the vocal cords and then inserting the bougie alongside the bronchoscope to guide the endotracheal tube into the trachea. They emphasize that this method can be used in resource-limited settings and may be a safe alternative to traditional fiber optic intubation. The authors obtained appropriate patient consent and declare no conflicts of interest. [Extracted from the article]

Aim: The aim of the study was to compare the effectiveness of ropivacaine (0.5%) and bupivacaine (0.5%) in epidural neuraxial blockade for elective lower abdominal surgeries. Methods: The present study was conducted in sixty patients undergoing elective lower abdominal surgeries under epidural anesthesia who were included after satisfying the eligibility criteria. The patients were randomly divided into two groups. An epidural catheter was inserted in cephalad direction using Tuohy epidural needle at L2–L3 or L3–L4 with the help of loss of resistance to air technique. Twenty milliliter of the study drug was given, sensory blockade was tested using the pinprick method, and quality of motor blockade was assessed by the modified Bromage scale. Results: In our study, demographic data comparing age and sex show no statistically significant difference among both the groups. In our study, the mean time for the onset of sensory block consider at T10 in Group B was 10.05 ± 2.1 min and in Group R was 9.8 ± 1.8 min. Moreover, the mean time duration of sensory block in Group B was 5.56 ± 0.059 h and in Group R was 5.34 ± 0.073 h. The onset of motor block in Group B was 4.98 ± 1.07 min and in Group R was 5.28 ± 1.2 min, but the duration of motor block for Group B was 4.63 ± 0.39 h and for Group R was 3.53 ± 0.23 h, which is clinically and statistically significant. The maximum level of sensory blockade for Group B was T4 and for Group R was T5. The range of block in Group B was T10–T4 and in Group R was T10–T35. Conclusion: The onset of sensory block was comparable in both the group, but the duration of sensory block is shorter with ropivacaine compared to bupivacaine. The onset of motor blockade was comparable in both the groups, but the duration of motor blockade was also shorter and the degree of motor block was less intense with ropivacaine compared to bupivacaine. [ABSTRACT FROM AUTHOR]

Background: Cytological evaluation of specimens from respiratory tract is the initial investigation in patients suspected to have pulmonary diseases. The various cytological specimens submitted for analysis include bronchoalveolar lavage, bronchial wash, brush smears, transbronchial needle aspiration, guided fine needle aspiration cytology (FNAC) smears and pleural fluid. Present study was undertaken to study the spectrum of lesions diagnosed by cytomorphological analysis of various cytological specimens. Materials and Methods: Centrifuged and direct smears from received samples were stained with MGG and PAP stain. Special stains (ZN and PAS) were used wherever required. Cytohistological correlation was done wherever biopsy was available. Results: This study included 671 samples from 583 patients suspected clinicoradiologically of having a respiratory pathology. A male preponderance (65.87%) was noted with 73.59% of patients in age group 40–80 years. Cytological diagnoses were classified as non-diagnostic (14.90%), negative for malignancy (59.76%), specific benign lesions (5.22%), positive for atypical cells (3.87%) and malignant (16.25%). Tuberculosis (TB) was found in 17 cases. Adenocarcinoma (both primary and metastatic) was the commonest malignancy of the 99 cases positive for malignancy. Incidence of primary lung adenocarcinoma and squamous cell carcinoma were found to be equal. Conclusion: Lung carcinoma is presently the leading cause of cancer deaths while TB is still a common cause of death in developing countries. Cytopathology has a definite role in diagnosis of malignant lesions and also contributes in diagnosis of unsuspected chronic infections. Cytological diagnosis is fairly accurate if the specimen obtained is adequate and representative. [ABSTRACT FROM AUTHOR]

Braz J Anesthesiol 2021;71:429-42. 3 Singh U, Agarwal R, Dhar M, Biswas S. Emergency surgery for a ruptured ovarian cyst in an anticoagulated patient with artificial mitral valve and massive haemorrhage: Maintaining a delicate balance. The major gynecological complications are rare in patients receiving anticoagulants and the incidence of hemorrhagic ovarian cysts is 1%.[[1]] We present a case report of a 25-year-old female admitted to the emergency department with complaints of abdomen pain and vomiting for 3 days. [Extracted from the article]

Background: Regional anesthesia using paravertebral block has been suggested as an ideal adjunct to general anesthesia for modified radical mastectomy. Paravertebral block is an effective management of peri-operative pain for Modified radical mastectomy, however, there are no established guidelines regarding what is the most suitable strategy when varying drugs and dosages between different groups. Aim: To evaluate the effectiveness of paravertebral block comparing the most frequently employed drugs in this procedure (bupivacaine vs ropivacaine). Study Design: Prospective randomized double blind study. Methods: A total 70 ASA I and II adult female patients undergoing Modified radical mastectomy under paravertebral block followed by general anesthesia were randomly divided into two groups. The first group was administered 0.375% Ropivacaine in a dose 0.25 ml /kg in paravertebral block. The second group was administered bupivacaine 0.375% in dose 0.25 ml /kg in paravertebral block. Standard induction technique followed. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), were recorded pre block, post block 5 min, post block 10 min, at skin incision,post skin incision initially at 5 interval for first 15 min till one hour, and every 30 min till end of surgery. Post-operative visual analogue score for pain was recorded at 1 hr, 6 hr and 24 hr. Statistical Analysis: Chi-square test (Fisher's exact test) for qualitative variables. Independent sample t-test for quantitative data. Results: Ropivacaine and Bupivacaine had no difference in intraoperative analgesia as shown by intraoperative hemodynamic parameters. Bupivacaine got better post-operative VAS scores (P < 0.05) in mean and after first, 6 h and 24 h. [ABSTRACT FROM AUTHOR]

True hermaphrodites have characteristics tissue both sex in the form of presence of vagina uterus, fallopian tubes and ovaries as in female and presence of testis seminiferous tubules but penis as in penoscrotal hypospadias and bifid scrotal sac confuses as well developed labia majora. Determination of sex as per parents view in our social set up. The case was provisionally diagnosed as intersex. Total abdominal hysterectomy, bilateral salphingo-oophorectomy and colpectomy were conducted. A 3-year-old child referred by a pediatrician to Nalanda Medical College, child surgical department for investigation and management of his ambiguous genitalia having following features like, urine was not passing from the tip of penis; penis along with apparently looking female genitalia was taken under treatment. Examination under general anesthesia showed a presence of both male/female internal genitalia and gonads with features of external genitalia of both sexes. After total abdominal hysterectomy and human chorionic gonadotrophin treatment growth of phallus and testicle was noted. The child was made male after extirpation of female genitals. This case illustrates that gender correction can be made as per patients consent in adult but at this stage social customs and parents consent dictated the treatment. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) scans revealed a pneumomediastinum, pneumopericardium, subcutaneous emphysema, pneumothorax with collapsed right lower and a hyper-inflated right upper lobe [Figure 1]. Sir, Foreign body aspiration is a common cause of mortality and morbidity in children.[[1]] We present a 2-year-old, 12-kg female admitted to our emergency with fever, difficulty in breathing and repeated episodes of vomiting for last 16 hours. Child was successfully extubated on the next day.{Figure 1}{Figure 2} Children less than 3 years of age are at risk for foreign body aspirations.[[2]] Pneumomediastinum, pneumo pericardium, pneumothorax and subcutaneous emphysema together constitute what is called the "air leak syndrome". [Extracted from the article]

Difficult Airway Society intubation guidelines working group, Difficult Airway Society 2015 guide lines for management of unanticipated difficult intubation in adults. It would buy us time; however, definitive management in such children is still a tracheostomy.[[2]] With competent surgeons available for tracheostomy, it was important to give them time to perform tracheostomy without disturbing the surgical anatomy. Sir, Managing a child with severe respiratory distress due to near-complete airway obstruction without the option of bag-mask ventilation, supraglottic device placement, or intubation poses serious challenges even when attempting an emergency front of neck access. [Extracted from the article]

There are more than 1.15 million cases of breast cancer diagnosed worldwide annually. At present, only small numbers of accurate prognostic and predictive factors are used clinically for managing the patients with breast cancer. DNA microarrays have the potential to assess the expression of thousands of genes simultaneously. Recent preliminary researches indicate that gene expression profiling based on DNA microarray can offer potential and independent prognostic information in patients with newly diagnosed breast cancer. In this paper, an overview upon the applications of microarray techniques in breast cancer is presented. [ABSTRACT FROM AUTHOR]

The article discusses the recommendation of awake fiberoptic intubation (AFOI) for patients with complaint of anticipated difficult airway, cervical spine injury. It notes the bradycardia and hypotension during nebulization, the local action of dexmedetomidine and its analgesic effect, not reversed by adrenoceptor antagonist.

Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease usually characterized by asymmetric ventricular septal hypertrophy. HCM is an important cause of sudden cardiac death in adolescents and young adults. We are presenting a case report, ten years boy came in emergency with sudden loss of consciousness (witness cardiac arrest). Child was revived after cardiopulmonary resuscitation and send to coronary care unit. Echocardiography findings were suggestive of HCM. There was history of sudden death of her mother and maternal uncle. After stabilization ICD was implanted under total intravenous anesthesia. Post procedure his hospital stay was uneventful. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article titled "Hard Palate Tumour: A Nightmare for the Anaesthesiologists: Role of Modified Molar Approach" published in a previous issue of the journal is presented.

A letter to the editor is presented in response to the article on iatrogenic superior vena cava syndrome.

A letter to the editor is presented in response to the article "Dexmedetomidine versus midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography: An open-label randomised controlled trial" by P. Sethi and coworkers, in the 2014 issue.