Next-generation sequencing-based genetic testing and phenotype correlation in retinitis pigmentosa patients from India

Purpose: Inherited retinal dystrophies (IRD) are a heterogeneous group of retinal diseases leading to progressive loss of photoreceptors through apoptosis. Retinitis pigmentosa (RP) is considered the most common form of IRD. Panel?based testing in RP has proven effective in identifying the causative genetic mutations in 70% and 80% of the patients. This is a retrospective, observational, single?center study of 107 RP patients who had undergone next?generation sequencing?based targeted gene panel testing for IRD genes. These patients were inspected for common phenotypic features to arrive at meaningful genotype–phenotype correlation. Methods: Patients underwent complete ophthalmic examination, and blood was collected from the proband for DNA extraction after documenting the pedigree. Targeted Next Generation Sequencing (NGS) was done by panel?based testing for IRD genes followed by co?segregation analysis wherever applicable. Results: Of the 107 patients, 72 patients had pathogenic mutations. The mean age of onset of symptoms was 14 ± 12 years (range: 5–55). Mean (Best Corrected Visual Acuity) BCVA was 6/48 (0.9 logMAR) (range 0.0–3.0). At presentation, over one?third of eyes had BCVA worse than 6/60 (<1 logMAR). Phenotype analysis with the gene defects showed overlapping features, such as peripheral well?defined chorioretinal atrophic patches in patients with CERKL, PROM1, and RPE65 gene mutations and large macular lesions in patients with RDH12 and CRX gene mutations, respectively. Nummular or clump?like pigmentation was noted in CRB1, TTC8, PDE6A, and PDE6B. Conclusion: NGS?based genetic testing can help clinicians to diagnose RP more accurately, and phenotypic correlations can also help in better patient counselling with respect to prognosis and guidance regarding ongoing newer gene?based therapies.

Anatomical and surgical considerations and outcomes in infantile Terson syndrome

Purpose: To study the presentation and outcomes of infantile Terson syndrome (TS). Methods: This was a retrospective analysis of 18 eyes of nine infants diagnosed to have TS?related intraocular hemorrhage (IOH). Results: Nine infants (seven males) were diagnosed to have IOH secondary to TS, of which eight infants had imaging features suggestive of intracranial bleed meeting our definite criteria. Median age at presentation was 5 months. In 11 eyes of six infants with suspected birth trauma, the median age of presentation was 4.5 months (range 1–5 months) of which one baby had a history of suction cup?aided delivery and four babies had a history of seizures. Vitreous hemorrhage (VH) was noted in 15 eyes (extensive in 11 eyes). Ten of these eyes showed membranous vitreous echoes, or triangular hyperechoic space with apex at the optic nerve head (ONH) posteriorly and base at the posterior lens capsule anteriorly, with or without dot echoes in the rest of the vitreous cavity, with a configuration of “tornado?like hemorrhage” suggestive of Cloquet’s canal hemorrhage (CCH). Eight eyes underwent lens?sparing vitrectomy (LSV) and one eye underwent lensectomy with vitrectomy (LV). On follow?up, disc pallor and retinal atrophy were noted in 11 and 10 eyes, respectively. The mean follow?up was 62 months (1.5 month–16 years). Visual acuity/behavior improved in all cases at the final follow?up. Developmental delay was noted in four children. Conclusion: Unexplained and altered vitreous hemorrhage with typical ultrasonography (USG) features should raise the suspicion of CCH in TS. Despite early intervention to clear visual axis, anatomical and visual behavior may remain subnormal.

Corneal manifestations and treatment among patients with COVID-19-associated rhino-orbito-cerebral mucormycosis

Purpose: TO report the corneal manifestations in patients with COVID?19?associated rhino?orbito?cerebral mucormycosis (ROCM). Methods: This study was a retrospective, observational, and record?based analysis of patients of ROCM with corneal involvement. Results: A total of 220 patients were diagnosed with ROCM over a period of 3 months. Thirty?two patients had developed corneal manifestations. The mean age at diagnosis was 52.84 ± 12.8 years. The associated risk factors were systemic mucormycosis, uncontrolled diabetes, recent COVID?19 infection, and injudicious use of systemic steroids. Twenty?nine patients were known diabetics, 32 had recent COVID?19 infection, and 13 gave a history of injudicious use of steroids. The right eye (RE) was affected in nine patients, the left eye (LE) in 20 patients, and both eyes in three patients. Nine patients had a round?oval corneal ulcer. One patient each had a perforated corneal ulcer with uveal prolapse, sealed perforated corneal ulcer, spontaneously healed limbal perforation, diffuse corneal haze with hyphemia, panophthalmitis, diffuse corneal stromal abscess, limbal ischemia, anterior uveitis with posterior synechiae, inferior corneal facet, and filamentary keratitis. Three patients each had a corneal melt and inferior conjunctival xerosis with chemosis. Orbital exenteration was performed in six patients. Five patients with corneal ulcers healed. Topical eye drops of amphotericin (0.5 mg/ ml) cycloplegic, antiglaucoma medications, and lubricant eye drops were started along with systemic antifungals. Conclusion: Central corneal ulcer was the most common manifestation of mucormycosis. A concentration as low as 0.5 mg/ml of amphotericin eye drops was effective in the treatment.

An institution-based study on Hematological profile of Dengue patients at a tertiary care hospital in Konkan region of Maharashtra

Background: Dengue is the most rapidly spreading mosquito-borne viral fever especially in coastal regions due to heavy rainfalls. It is important to understand the hemato-pathological changes associated with dengue infections to avoid dreaded hematological complications. These hematological changes can be used as diagnostic aid in remote rural set-ups wherein rapid dengue diagnostic kits are not available. Objective: This retrospective study was carried out from 1st January 2018 to 31st August 2021 with an objective to analyze the hematological profile of serologically diagnosed dengue patients. Materials and Methods: A cross sectional, observational, retrospective study was carried out at a tertiary care center at Dervan, Konkan region of Maharashtra over a period of three years and eight months. Commercially available ‘Dengue Day 1 test kit’ was used to detect NS1 antigen and IgM and IgG antibodies. Patients with positive NS1 antigen and/or IgM or IgG antibody were included while patients with other febrile illnesses like typhoid, malaria were excluded from this study. Patient’s venous blood was collected in plain bulb for serology and in EDTA bulb for hematological profile (CBC/blood smear). This profile included hemoglobin, hematocrit (HCT), RBC indices like MCV, MCH And MCHC, total leucocyte count (TLC), Differential leucocyte count (DLC) and platelet count (PC). Results: A total of 330 patients were diagnosed as dengue cases based on rapid card test. Majority of the patients were positive for NS1 antigen (60%) followed by IgM antibody (27.87%). Male: female ratio was 1.8:1. Age of the patients were in the range of 10-65 years whereas majority of NS1 positivity was seen in the age group of 21-30 years. Hemoglobin levels among these patients ranged from 3.1-19.9 g/dl. 27.47% cases had hemoglobin level of more than 15 g/dl and 16.96% patients had hemoglobin level <10 g/dl. 225 out of 330 patients showed hematocrit (HCT) >35% above the average reference value. HCT ranging from 20-35% was seen in 72/330 (21.82%) patients. 143/330 (43.34%) cases showed TLC <4000/cumm (leukopenia). 51.07% patients showed relative lymphocytosis with 15.15% of these cases showing reactive lymphocytosis. Maximum cases showed thrombocytopenia (69.32%). 31.21% showed grade 1 thrombocytopenia that is, platelets between 75000-150000/cumm. This grade was followed sequentially by Grade III, II and IV thrombocytopenia cases. Conclusion: This study highlights important hematological parameters on different serological dengue diagnosis made on rapid card test. This study will help diagnose dengue disease in remote, rural set-ups wherein rapid diagnostic kits are not available.

Prevention Strategies to De-escalate Workplace Violence against Doctors…

Workplace violence is something we can discuss it, tolerating it but we can’t prevent it even we can’t accept it that it belongs to us, we are initiating it against people like us only. Nothing can solve violence, neither two wrong can make anything right. Though every sector is afflicted by it but healthcare sector is majorly affected by it because patients family is in great trauma of facing their people’s death and no one have been able to do anything to stop it. Accepting loved ones especially death has always been painful to everyone. But blaming some sector and taking revenge is big NO NO. As we all know prevention is better than cure so via this paper I am trying to address some prevention Strategies that may be helpful to de-escalate this issue on ground level.

A study to assess the knowledge on hypoglycemia among the diabetic patient in selected hospital, Siliguri

Background:The prevalence of diabetes mellitus, is a major health concern that affects people around the world, and is increasing yearly. When blood glucose levels go below normal, a condition known as hypoglycemia, an immediate consequence of diabetes mellitus, occurs. The International Diabetes Federation reported thatthere were 451 million diabetics globally in 2017 and by 2045, it is anticipated that there will be 693 million. The objective of this study was to assess the level of knowledge of diabetic patient regarding hypoglycaemia and to find out the association between the levels of knowledge of diabetic patient on hypoglycaemia with their selected demographic variable.Methods:A descriptive cross-sectional study, was carried out in the month of June 2022. A semi-structured questionnaire was used to interview 100 study participants who were diabetes patients who had been admitted to the medical ward and who had visited the endocrinology outpatient department.Results:52% of the samples had fair knowledge on hypoglycemia, while 23% of them had poor knowledge. Demographic variable such as age, income, treatment, frequency of taking medicine, experience of symptoms of hypoglycemia and dietary habit were statistically significant with the level of knowledge, p<0.05.Conclusions:The study's findings highlighted the fact that most diabetes mellitus patients had a fair understanding of hypoglycemia. The health care personnel should also take time and efforts to educate patients about the sign of hypoglycemia. So that hypoglycemic episodes and morbidity could be reduced or prevented at primordial level.

Revisión Sistemática: Aromaterapia versus Meditación en ansiedad por temor a la soledad en personas mayores / Systematic Review: Aromatherapy versus Meditationin anxiety due to fear of loneliness in the elderly

El objetivo de este estudio es demostrar de forma retrospectiva que el uso de aromaterapia tendría un efecto significativamente mayor en la reducción de la ansiedad por temor a la soledad en comparación con la meditación. Metodología: El estudio actual corresponde a una revisión sistemática rápida de tipo descriptiva. Resultados: Se realizaron dos sintaxis, una para Aromaterapia y una para Meditación. A través de criterios de inclusión y exclusión se seleccionaron 10 artículos para análisis profundo, de los cuales 8 corresponden a Aromaterapia y 2 a Meditación, obteniéndose resultados significativos por parte de la aromaterapia para la reducción de la ansiedad en personas mayores. Conclusión: A través de la evidencia científica, se recomienda la terapia complementaria de aromaterapia por sobre la meditación en personas adultas mayores para la reducción de ansiedad por temor a la soledad, siempre y cuando la soledad como tal aún no esté presente como problemática[AU]

The aim of this study is to retrospectively demonstrate that aromatherapy has a significantly greater effect in reducing anxiety due to fear of loneliness compared to meditation. Methodology: The current study is a rapid descriptive systematic review. Results: Two syntaxes were performed for this study, one for aromatherapy and one for meditation. Through the exclusion criteria 10 articles were selected for depth analysis, which 8 correspond to aromatherapy and 2 for meditation, obtaining significant results from aromatherapy because of its reduction of anxiety in older people. Conclusion: Through scientific evidence, aromatherapy is recommended over meditation to reduce anxiety due to fear of loneliness as long as the loneliness is not a problem itself yet[AU]

O objectivo deste estudo é demonstrar retrospectivamente que o uso da aromaterapia teria um efeito significativamente maior na redução da ansiedade devido ao medo da solidão em comparação com a meditação. Metodologia: O estudo actual corresponde a uma rápida revisão sistemática descritiva. Resultados: Foram realizadas duas sintaxes, uma para Aromaterapia e outra para Meditação. Através de critérios de inclusão e exclusão, foram seleccionados 10 artigos para análise aprofundada, dos quais 8 correspondem à Aromaterapia e 2 à Meditação, obtendo resultados significativos para a aromaterapia para a redução da ansiedade nas pessoas idosas. Conclusão: Através de provas científicas, a terapia complementar da aromaterapia é recomendada sobre a meditação em adultos idosos para a redução da ansiedade devido ao medo da solidão, desde que a solidão enquanto tal ainda não esteja presente como um problema[AU]

Clinico - pathological profile of Adenoid Cystic Carcinoma of the Lacrimal gland - A Retrospective Study at Tertiary Cancer Care Hospital, Punjab

Background: A retrospective study conducted in the department of radiation oncology to review the management aspects of the adenoid cystic carcinoma of the lacrimal gland and identify the outcome and corelation of the recurrence pattern with pathological and clinical findings. Methods: Data of 10 patients of adenoid cystic carcinoma of the lacrimal gland treated over a period of six years were reviewed with respect to presentation, treatment received , end points and outcome. Results: All of the 10 patients underwent surgery followed by adjuvant radiation therapy. Five patients received adjuvant chemotherapy . Eight (80%) patients were alive at a median follow up of 2 years. Five ( 50%) patients withou t evidence of disease and 3 patients with the disease. One patient developed scalp metastasis during the course of radiation therapy and another one developed lung metastasis. Conclusion: Ad enoid cystic carcinoma of the lacrimal gland is a rare neoplasm wi th aggressive outcome. It is often treated with surgery and adjuvant radiotherapy and needs long follow up.

Building self-esteem by prosthetic rehabilitation in a child with hypohidrotic ectodermal dysplasia, role of pediatric dentist: A case report

Ectodermal dysplasia (ED) is a congenital disorder exhibiting multiple disorders that affect ectodermal tissues. Over 150 different presentations of the syndrome have been reported, of which the most commonly encountered are hidrotic and hypohidrotic variants. In the present paper, we report the case of an 8-year-old male who was diagnosed with hypohidrotic ED by a physician. The extraoral and intraoral findings were recorded and found in accordance with the diagnosed variant. A comprehensive therapy was initiated which included child and parent counseling, familiarizing the child with dental setup, and delivery of a removable partial denture for the upper arch and a removable complete denture for the lower arch. The importance of follow-up and newer dentures as per the growth of the patient was also explained to the parents. The article highlights the key role of a pediatric dentist in managing the child and parents in syndromes as such

Humanitarian approach in medicine: A study on clinical empathy among medical students and graduates using the Jefferson Scale of Empathy

BACKGROUND Empathy is one of the pillars of professionalism in the medical field associated with better patient satisfaction and outcome. This study aimed to assess and compare the empathy score with other institutes within and outside India using the Jefferson Scale of Empathy-Student version (JSE-S). METHODS We did a cross-sectional study for undergraduate medical students and interns of Pramukhswami Medical College, Karamsad, for 4 months from October 2019. Voluntary participants completed the JSE-S, an internationally validated 20-item survey questionnaire. RESULTS The mean empathy score of 575 voluntary participants out of 631 was 100.75, with women having higher and significant scores than men (F 102.1 [11.5]; M 98.3 [12.5]; p<0.001). The highest empathy score was observed in the first year (102 [10.8]), which increased and decreased in different years of medical education with a maximum dip in the second year (99.4 [11.5]). The choice of specialty of participants showed a lower significant difference as per the JSE-S score. A lower empathy score was identified among participants compared to medical students studying in international medical institutes. CONCLUSION There is a need to organize workshops with training modules to cater to the empathy aspect of professional care, as a continuous process, starting from the first year till the completion of internship.

Effect of 4.7% Stevia Solution Mouth Rinsing on Salivary pH: An In Vivo Randomized Controlled Trial

Background: Stevia is a natural, non-caloric sweetener with antimicrobial, antioxidant and anti-cariogenic properties. Aim was to assess and compare the effect of 4.7% stevia solution, 4.7% sucrose solution and distilled water mouth rinsing on salivary pH. Methods: Randomized controlled trial with latin square design was followed involving 15 female participants aged 20-23 years. Participants were randomly allocated to three interventional groups; Group A: 4.7% stevia mouth rinse, Group B: 4.7% sucrose mouth rinse and Group C: distilled water mouth rinse. Salivary pH assessments were done at baseline and 1, 20 and 60 minutes post intervention using salivary pH indicator strips. For statistical analysis, significance level was fixed at p<0.05. One way and repeated measures ANOVA followed by Tukey’s post Hoc tests were used for data analysis Results: There was a significant (p<0.05) increase in salivary pH post rinsing with stevia solution (at 1, 20 and 60 minutes respectively) compared to sucrose solution and distilled water mouth rinsing Conclusion: Stevia solution mouth rinsing showed significant increase in salivary pH at one hour from baseline compared to sucrose and distilled water mouth rinsing. Hence, it may serve as an anti-cariogenic sugar substitute.

Bullous Drug Reaction with Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

Hypoglycemic drugs in the dipeptidyl peptidase-4 (DPP-4) inhibitor class are used as a second-line treatment for type 2 diabetes mellitus. With DPP-4 inhibitors, there have been a few reports of cutaneous side effects such as bullous response, fixed drug eruption, and photosensitivity. There is no definitive pathophysiology for the above mentioned allergic reactions. Sitagliptin phosphate belongs to the DPP-4 inhibitor class. This is a case report of a sitagliptin-induced bullous drug reaction manifesting three weeks after starting therapy. He had bullous pemphigoid-like eruptions all over the body. The patient showed improvement once sitagliptin was discontinued alon with oral and topical steroid treatment.

National exit test: The medical faculty perspective—A pilot study

BACKGROUND Implementation of the exit examination for medical graduates in India has been debated for many years. The national exit test (NEXT), under the construct of the National Medical Commission Act, would serve two purposes: first, it will be a common exit/licentiate examination for all Indian medical graduates, and second, it will be a test for postgraduate selections for all specialties. There has been no research or evidence on stakeholders’ opinion on this test. We aimed to assess the perspective of medical faculties, nationwide, regarding the implementation of NEXT. METHODS We conducted a nationwide, cross-sectional, questionnaire-based pilot survey. The Google survey form with close- and open-ended questions was forwarded via email and WhatsApp to various groups. RESULTS Two hundred and forty-five medical teachers participated, of which 35.9% were from Gujarat, 44.9% were working in government colleges, 91.43% had MD/MS as the highest professional degree, 50% had >15 years of experience and were from different medical specialties. The majority felt that the NEXT examination was a positive step, 82.5% suggested that a national selection/testing authority should conduct it, 36.3% suggested having the test after internship while 32.7% expected some weightage for each year of the medical programme, and 84.1% agreed that all the learning domains should be assessed by various strategies. DISCUSSION Faculties welcomed the NEXT examination under a national testing authority. The necessity of this examination is to have uniform standards and quality for medical graduates irrespective of their institutes. Assessment of all the domains will make the Indian medical graduate more competent for the job or residency programmes.

Efficacy of laser photobiomodulation pulpotomy in human primary teeth A randomized controlled trial

Background: Laser photobiomodulation (LPBM), also called Low Level Laser Therapy (LLLT), has shown potential to reduce the pulpal inflammation and to preserve the dental pulp vitality, thereby improving healing. Lasers being minimally invasive, safe, and patient friendly prompt its application in pediatric dentistry. Aim: The aim of this study was to evaluate and compare the clinical and radiographic success rates of LPBM and formocresol pulpotomy at 9 months post intervention in human primary molars. Materials and Methods: A randomized controlled, split-mouth study design was followed involving children aged 4–7 years with at least two primary molars indicated for pulpotomy. Sixty-eight eligible primary molars were randomly allocated to two interventions – formocresol pulpotomy (Group I) and LPBM pulpotomy (Group II). Statistical Analyses: Chi-square test was used for statistical analysis fixing significance level at P ? 0.05. Results: There was no statistically significant difference in the clinical success rates between the formocresol group (97.05%) and the photobiomodulation group (94.1%) (?2 = 0.34, P = 0.55); however, the radiographic success rate was significantly high in the laser group (94.1%) compared to the formocresol group (58.82%) (?2 = 11.76, P = 0.001). Conclusion: LPBM could be a viable nonpharmaceutical alternative for formocresol pulpotomy in human primary teeth

Epstein-Barr Virus-associated Mixed Lymphoepithelioma-like Carcinoma and Adenocarcinoma of the Gall Bladder: An Unusual Entity / 대한소화기학회지

Schmincke described lymphoepithelioma as an undifferentiated carcinoma with abundant lymphoid stroma in the nasopharynx. Tumors with a similar histomorphology in extrapharyngeal areas have been referred to as lymphoepithelioma-like carcinoma (LELC). The association of an Ebstein-Barr virus (EBV) infection with lymphoepithelioma is well established in the nasopharynx but not so well at the extrapharyngeal sites. Only four cases of LELC have been reported in the gall bladder, of which all were negative for the EBV. This paper reports the first case of an EBV-associated mixed gall bladder carcinoma exhibiting a distinct phenotype of LELC and adenocarcinoma with mucinous differentiation. The EBV was confirmed by the strong granular membranous and cytoplasmic expression of LMP-1 (latent membrane protein-1) on immunohistochemistry and nuclear EBER RNA on chromogen in-situ hybridization in the tumor. This is the first case of LELC positive for EBV in the gall bladder. LELC has a more favorable prognosis than conventional adenocarcinoma or squamous cell carcinoma, irrespective of the site. Although a higher T stage and nodal metastasis were exceptional in the present case in contrast to the previous cases, the EBV-associated lymphocytic response might limit the disease spread and confer better overall survival and prognosis in these patients. Nevertheless, more prospective studies with a larger cohort will be needed to understand the pathogenesis, biological behavior, and prognosis of this rare entity.

Epstein-Barr Virus-associated Mixed Lymphoepithelioma-like Carcinoma and Adenocarcinoma of the Gall Bladder: An Unusual Entity / 대한소화기학회지

Schmincke described lymphoepithelioma as an undifferentiated carcinoma with abundant lymphoid stroma in the nasopharynx. Tumors with a similar histomorphology in extrapharyngeal areas have been referred to as lymphoepithelioma-like carcinoma (LELC). The association of an Ebstein-Barr virus (EBV) infection with lymphoepithelioma is well established in the nasopharynx but not so well at the extrapharyngeal sites. Only four cases of LELC have been reported in the gall bladder, of which all were negative for the EBV. This paper reports the first case of an EBV-associated mixed gall bladder carcinoma exhibiting a distinct phenotype of LELC and adenocarcinoma with mucinous differentiation. The EBV was confirmed by the strong granular membranous and cytoplasmic expression of LMP-1 (latent membrane protein-1) on immunohistochemistry and nuclear EBER RNA on chromogen in-situ hybridization in the tumor. This is the first case of LELC positive for EBV in the gall bladder. LELC has a more favorable prognosis than conventional adenocarcinoma or squamous cell carcinoma, irrespective of the site. Although a higher T stage and nodal metastasis were exceptional in the present case in contrast to the previous cases, the EBV-associated lymphocytic response might limit the disease spread and confer better overall survival and prognosis in these patients. Nevertheless, more prospective studies with a larger cohort will be needed to understand the pathogenesis, biological behavior, and prognosis of this rare entity.

Relationship between subjective and objective measures of anticipatory anxiety prior to extraction procedures in 8- to 12-year-old children

Background@#This study assessed anticipatory dental anxiety levels among 8- to 12-year-old children based on subjective and physiological measures and their correlation. The variations in anxiety based on sex, age, temperament, and academic performance were evaluated. @*Methods@#An observational study was conducted in 60 children recruited from the waiting room over a 6-month period. The operator recorded subjective anxiety in the children using a novel visual facial anxiety scale. The operator also noted the demographic details and child’s temperament using the nine dimensions of the Thomas and Chess criteria, and graded children as “easy,” “slow to warm-up,” and “difficult.” The academic performance of the children was graded (parental ratings) on a five-point Likert scale. Physiological variables (heartrate [HR], oxygen saturation[SpO2 ], and blood pressure [BP]) were recorded by another evaluator. The correlation between anxiety levels and physiological variables was also assessed. The effects of age, sex, temperament, and academic performance on anxiety were evaluated. @*Results@#The study included 60 children aged 8–12 years, including 36 boys and 24 girls. Seventy percent of children had mild to moderate levels of pre-extraction anxiety, while 30% of children demonstrated high anxiety.A significant positive correlation was noted between anxiety levels and HR (rs = 0.477, P < 0.001*) and systolic BP (rs = 0.294, P < 0.05), while a significant but inverse correlation was observed with SpO2 (rs = −0.40, P < 0.05). Anxiety did not influence diastolic BP. Children with difficult temperament and poor academic performance had significantly higher anxiety. @*Conclusion@#A high percentage (70%) of children aged 8–12 years had mild to moderate anxiety prior to the extraction procedure. Increased HR, systolic BP, and reduced SpO2 were significantly associated with high levels of anticipatory dental anxiety. Pre-extraction anxiety was significantly related to the temperament and scholastic performance.

A Comparison of the Postoperative Analgesic Efficacy of Two Different Doses of Caudal Clonidine as Adjunct to Caudal Bupivacaine in Infraumbilical Surgeries in Younger Children.

Managing peri operative pain in smaller children is challenging but beneficial. Caudal epidural block with local anaesthetic and adjuvant in proper dose can significantly prolong the duration of analgesia while avoiding dose related side effects of both the drugs. We selected clonidine as adjuvant to bupivacaine in caudal blocks for perioperative pain management in 80 children during infra umbilical surgeries performed under general anaesthesia. MethodsThe children were randomly allocated into two groups, Group A (n=40) and Group B (n=40). Group A received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 1 μg/Kg in 1 mL normal saline and Group B received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 0.5 μg/Kg in 1 mL normal saline, after inhalational anaesthesia. Heart rate, blood pressure, respiratory rate, oxygen saturation, sedation score, Bromage score and pain score were monitored and recorded peri-operatively. Time to first rescue analgesic at pain score of 12, total number of rescue analgesic doses required, and side effects were also recorded. Data was analysed using appropriate statistical tests. ResultsGroup B patients had significantly higher heart rates, systolic and diastolic blood pressures, respiratory rates and pain scores compared to Group A patients at 50 mins post operatively. The requirement of rescue analgesics in Group B was earlier and higher than Group A. Group A patients remained haemodynamically stable and pain free for longer period. There was no significant difference in side effects between the groups. ConclusionsAddition of 1 μg/Kg clonidine to caudal epidural bupivacaine improves the quality and prolongs the duration of postoperative analgesia compared to addition of 0.5 μg/Kg clonidine without causing significant side effects.

Antimicrobial Resistance Pattern of Bacterial Isolates among Nosocomial Infections (Urinary Tract Infection and Blood Stream Infection) from the Intensive Care Unit of a Tertiary Care Government Hospital in India.

Development of antimicrobial resistance (AMR) to different generations of common antibiotics by various organisms is rising alarmingly. A nationwide standard antibiotic policy is needed. We wanted to study the resistant organisms, the drug class to which organisms are becoming resistant and identify factors favoring the development of AMR for formulating an effective antibiotic policy. MethodsWe conducted this observational study from January 2018 to May 2019 in a tertiary care hospital in India. Sample (urine, blood from ICU patients) processing, organism identification and antibiotic susceptibility tests were carried out as per the institutional guidelines in the Microbiology Department from where data collection was done. ResultsOut of 500 samples, 145 (29%) showed significant growth of organisms exhibiting resistance to either single or multiple drugs. Acinetobacter spp. was the most common organism isolated with a total of 40 (27.58%), followed by Klebsiella spp. 23 (15.83%), MRSA 20 (13.79%), E. coli 15 (10.34%), Pseudomonas 12 (8.27%), Enterococci 12 (8.27%), and CoNS 7 (4.82%). Among GNB, Klebsiella and E. coli showed minimal resistance to polymyxins, fosfomycin, minocycline and tigecycline. Among Staphylococcus spp. maximum sensitivity was seen to teicoplanin, tobramycin, tigecycline and minocycline. Acinetobacter spp. showed high sensitivity to polymyxins, tobramycin, tetracycline, tigecycline and minocycline. ConclusionsAMR was highly prevalent with hospital acquired organisms, and against commonly used antibiotics. Variation of resistance and sensitivity pattern with time and local microflora necessitates periodic AMR monitoring and rotation of antibiotics is suggested to restrict further emergence of resistance. Focusing on the organisms causing UTI and BSI and their resistance pattern, helps in selecting proper antibiotic therapy and in strengthening general sepsis measures.