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Background:Measurement of biomarkers representing sympathetic tone and the surgical stress response are helpful for objective comparison of anesthetic protocols. Aims: The primary aim was to compare changes in chromogranin A levels following pump pediatric cardiac surgery between children who received bolus caudal morphine and those who received a conventional intravenous narcotic?based anesthesia regime. The secondary objectives were to compare hemodynamic responses to skin incision and the magnitude of the rise in blood sugar values between the groups. Settings and Design: A prospective observational study at a tertiary cardiac center. Measurements and Methods: Sixty pediatric cardiac surgical patients were randomized to Group I [n = 30] to receive intravenous narcotic?based anesthesia and Group II [n = 30] to receive single?shot caudal morphine. Baseline and postoperative chromogranin A levels, the hemodynamic response to skin incision, changes in blood sugar levels, and the total intravenous narcotic dose administered were recorded for each participant. Statistical Analysis: Pearson’s Chi?squared test was used for comparison of categorized variables, and Mann–Whitney test was used for the analysis of continuous data. Results: Changes in chromogranin A levels and blood sugar levels were comparable in both groups. Group II received a lower narcotic dosage (P ? 0.001), and the response to skin incision as reflected by systolic pressure rise was less (P = 0.006). Conclusions: Surgical stress response attenuation was similar to caudal morphine as compared with intravenous narcotic?based anesthesia techniques as reflected by a similar increase in chromogranin A levels
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Background: The primary objective was to compare the effect of a low-dose dexamethasone as against a saline placebo on extravascular lung water index (EVLWI) in patients undergoing elective primary coronary artery bypass surgery. The secondary endpoints were to assess the effect of dexamethasone on other volumetric parameters (pulmonary vascular permeability index, global end diastolic volume index, and intrathoracic blood volume index), Vasoactive Inotrope Scores, hemodynamic parameters and serum osmolality in both groups. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Materials and Methods: Twenty patients were randomized to receive either dexamethasone (steroid group, n = 10) or placebo (nonsteroid group, n = 10) twice before the institution of cardiopulmonary bypass (CPB). EVLWI and other volumetric parameters were obtained with the help of VolumeView™ Combo Kit connected to EV 1000 clinical platform at predetermined intervals. Hemodynamic parameters, vasoactive-inotropic Scores, hematocrit values were recorded at the predetermined time intervals. Baseline and 1st postoperative day serum osmolality values were also obtained. Results: The two groups were evenly matched in terms of demographic and CPB data. Intra- and inter-group comparison of the baseline EVLWI including other volumetric and hemodynamic parameters with those recorded at subsequent intervals revealed no statistical difference and was similar. Generalized estimating equation model was obtained to compare the changes between the groups over the entire study period which showed that on an average the changes between the steroid and nonsteroid group in terms of all volumetric parameters were not statistically significant. Conclusions: There were no beneficial effects of low-dose dexamethasone on EVLWI or other volumetric parameters in patients subjected to on-pump primary coronary bypass surgery. Hemodynamic parameters were also not affected. Probably, the advanced hemodynamic monitoring aided in optimal fluid management in the nonsteroidal group impacting EVLW accumulation.
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Background: The primary objective of this study was to identify pre-anesthetic airway assessment parameters that would predict Cormack and Lehane grade III and IV laryngoscopy views in pediatric patients undergoing cardiac catheterization procedures. The secondary end points were to identify factors that would contribute to difficult laryngoscope views in this subset of patients. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Materials and Methods: 199 children below 5 years of age undergoing elective cardiac catheterization were included. Pre-anesthetic airway assessment was done by modified Mallampati grading, lower lip to chin distance [LCD], tragus to mouth angle [TMA], thyromental distance [TMD], neck circumference [NC], and the ratio of height to thyromental distance [RHTMD]. Demographic data including American Society of Anesthesiologists physical status [ASA PS] were recorded for each child. Receiver Operating Characteristic curves were plotted and Areas Under the Curve were measured to identify the best cut off values for each of the airway evaluation method that would predict poor laryngoscopy views as well as assess their accuracy in doing so. Results: LCD, TMD and low body mass index were found to have good sensitivity, specificity and accuracy in predicting Grade III and IV laryngoscope views. ASA PS grade III and above patients had a significantly higher incidence of poor laryngoscope visualization. Conclusions: LCD, TMA, TMD, NC, RHTMD and BMI could all be used combinedly as screening tools during pre-anesthetic airway evaluation for predicting difficult laryngoscope views in children. Among these, LCD, TMD along with low body mass index might have better accuracy.
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Objectives: Haemolytic disease of the fetus and newborn [HDFN] causes hydrops fetalis. The successful treatment of HDFN has been reported with intrauterine blood transfusion [IUT]. This study aimed to describe the initial experience with IUT procedures in Oman
Methods: This retrospective observational study took place at the Royal Hospital and Sultan Qaboos University Hospital Blood Bank, Muscat, Oman, and included all women who underwent IUT procedures in Oman between March 2012 and March 2016. Gestational and neonatal outcomes were assessed, including complications, morbidity, neurodevelopmental sequelae and mortality
Results: A total of 28 IUT procedures for 13 fetuses carried by 11 women were performed. Gestational age at the time of referral ranged from 13-30 weeks, while the median gestational age at first IUT procedure was 26 weeks [range: 19-30 weeks]. Indications for the procedure included HDFN caused by anti-D [n = 6], a combination of anti-D and anti-C [n = 4], anti-K [n = 1] and anti-Jsb [n = 1] antibodies and nonimmune hydrops fetalis due to a congenital parvovirus infection [n = 1]. Median fetal haemoglobin levels at the beginning and end of the procedure were 4.6 g/dL and 12.8 g/dL, respectively. Most procedures were transplacental intravascular transfusions through the placental umbilical cord root [71.4%], followed by transamniotic intravascular transfusions [14.3%]. The overall survival rate was 61.5%, with five deaths; of these, four were intrauterine and one was an early neonatal death due to non-resolved hydrops and severe cardiac dysfunction
Conclusion: As a relatively novel obstetric procedure in Oman, IUT seems to result in a favourable outcome for hydropic fetuses
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Objectives: The role of personality in occupational specialty choices has been explored in many parts of the world. To our knowledge, there is a dearth of such studies in the Arab/Islamic population and Oman is no exception. This study aimed to explore the relationship between personality traits and specialty choice among residents of Oman Medical Specialty Board [OMSB]
Methods: A cross-sectional study was carried out among Omani resident physicians working under OMSB. The Eysenck Personality Questionnaire-Revised was employed to quantify personality subtypes [e.g., psychoticism, extraversion, and neuroticism]. Specialties were categorized as surgical, medical, and diagnostics as per standard of North American medical specialties. A total of 255 residents in 17 medical specialties participated in the study [m = 40.4%; f = 59.6%] of 300 eligible subjects giving a response rate of 85.0%. Results: Respondents who had chosen surgical specialties scored significantly higher on the psychoticism subscale than those who had opted for medical and diagnostic specialties
As for individual specialties, orthopedic respondents had statistically significant higher mean scores on psychoticism and neuroticism compared to radiologists and psychiatrists who scored the lowest in the two personality traits, respectively. Conclusions: This study found statistically significant associations between personality traits and choices of specialty by young Omani doctors. We recommend more detailed studies that examine further psychological and cultural variables that are likely to affect the choices of specializations by young Omani professionals in both medical and non-medical fields
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Humans , Female , Male , Adult , Internship and Residency , Cross-Sectional Studies , Surveys and Questionnaires , SpecializationABSTRACT
Objective: To identify a potential bacterium which produces antimicrobial peptide (vibriocin), and its purification, characterization and production optimization. The bacteria subjected in the study were isolated from a highly competitive ecological niche of mangrove ecosystem. Methods:The bacterium was characterized by phenotype besides 16S rRNA gene sequence analysis.The antibacterial activity was recognised by using agar well diffusion method. The vibriocin was purified using ammonium sulphate precipitation, butanol extraction, gel filtration chromatography, ion-exchange chromatography and subsequently, by HPLC. Molecular weight of the substance identified in SDS-PAGE. Production optimization performed according to Taguchi’s mathematical model using 6 different nutritional parameters as variables. Results:The objective bacterium was identified as Vibrio parahaemolyticus. The vibriocin showed 18 KDa of molecular mass with mono peptide in nature and highest activity against pathogenic Vibrio harveyi. The peptide act stable in a wide range of pH, temperature, UV radiation, solvents and chemicals utilized. An overall ~20% of vibriocin production was improved, and was noticed that NaCl and agitation speed played a vital role in secretion of vibriocin. Conclusion: The vibriocin identified here would be an effective alternative for chemically synthesized drugs for the management of Vibrio infections in mariculture industry.
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<p><b>OBJECTIVE</b>To identify a potential bacterium which produces antimicrobial peptide (vibriocin), and its purification, characterization and production optimization. The bacteria subjected in the study were isolated from a highly competitive ecological niche of mangrove ecosystem.</p><p><b>METHODS</b>The bacterium was characterized by phenotype besides 16S rRNA gene sequence analysis. The antibacterial activity was recognised by using agar well diffusion method. The vibriocin was purified using ammonium sulphate precipitation, butanol extraction, gel filtration chromatography, ion-exchange chromatography and subsequently, by HPLC. Molecular weight of the substance identified in SDS-PAGE. Production optimization performed according to Taguchi's mathematical model using 6 different nutritional parameters as variables.</p><p><b>RESULTS</b>The objective bacterium was identified as Vibrio parahaemolyticus. The vibriocin showed 18 KDa of molecular mass with mono peptide in nature and highest activity against pathogenic Vibrio harveyi. The peptide act stable in a wide range of pH, temperature, UV radiation, solvents and chemicals utilized. An overall ∼20% of vibriocin production was improved, and was noticed that NaCl and agitation speed played a vital role in secretion of vibriocin.</p><p><b>CONCLUSION</b>The vibriocin identified here would be an effective alternative for chemically synthesized drugs for the management of Vibrio infections in mariculture industry.</p>