A comparative study of supraclavicular versus infraclavicular approach for central venous catheterization in neurosurgical patients

Background: Central venous cannulation is a commonly performed procedure in neurosurgical patients to maintain the hemodynamic stability in the intraoperative period. It is used for infusion of intravenous fluids, vasopressors central venous pressure monitoring and detection of air embolism. Subclavian vein is commonly performed as there are minimal effects of positioning on it. Supraclavicular approach to subclavian vein cannulation is not as frequently employed as the infraclavicular approach. The purpose of this study was to compare the supraclavicular approach versus the infraclavicular approach in terms of number of attempts, success rate of catheterization and complications associated with the procedure.Methods: About 150 patients undergoing various neurosurgical procedures were enrolled in the study. They were divided into two groups. 75 patients underwent right supraclavicular catheterization of subclavian vein while as 75 patients underwent right infraclavicular catheterisation of the subclavian vein. The number of attempts for cannulation, success or failure of catheterization and any complications associated with the procedure or in the postoperative period were noted in each group. The data was compared between the two groups by using Chi-square test and Student’s Independent Samples T-test.Results: The right supraclavicular vein was successfully cannulated in 90.66% while as the right infraclaviclar vein was successfully cannulated in 96% of the patients (p >0.05). Malpositioning of catheter (threaded in contralateral subclavian) was noted in 4 patients in Group S and ipsilateral internal jugular vein in 2 patients. Pneumothorax was encountered in 1 patient in the group S undergoing supraclavicular subclavian vein cannulations while as subclavian arterial puncture was seen in 4 patients who underwent infraclavicular arterial puncture.Conclusions: There was no difference in successive cannulations between right the supraclavicular and right infraclaviclar veins. The rate of complications between the two approaches was comparable.

Morphological diversity of Morus spp. (Mulberry accessions) grown in Muzaffarabad, Azad Jammu & Kashmir, Pakistan / La diversidad morfológica de Morus spp. (accesiones de mora) cultivados en Muzaffarabad, Azad Jammu y Cachemira, Pakistán

Genetic diversity of thirty mulberry accessions was determined by using the eleven different phenotypic characters. The study was conducted in field areas of Azad Jammu and Kashmir. The main objective of this study was to find out the diversity in morphological characters of Mulberry accessions found in Azad Jammu and Kashmir and Pakistan. The results showed that there is a significant difference in quantitative parameters among the thirty accessions (p≤0.001). The cluster analysis showed that the data is divided into two main groups at near 80 dissimilarity level. This study suggests that the Morus germplasm is quite diverse.

Se determinó la diversidad genética de treinta accesiones de mora utilizando once caracteres fenotípicos diferentes. El estudio se realizó en áreas de campo de Azad Jammu y Cachemira. El objetivo principal de este estudio fue conocer la diversidad en los caracteres morfológicos de lss accesiones de mora encontrados en Azad Jammu, Cachemira y Pakistán. Los resultados mostraron que hay una diferencia significativa en los parámetros cuantitativos entre las treinta accesiones de mora (p≤0.001). El análisis de conglomerados mostró que los datos se dividen en dos grupos principales a un nivel de disimilitud cercano a 80. Este estudio sugiere que el germoplasma de Morus es muy diverso.