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India is seeing a rapid epidemiological transition from underweight to overweight, with an overall prevalence of obesity reported to be 40.3%. Anesthesiology concerns in an obese patient are well known. We elaborate on the anesthesia management in a 68-year-old male patient with a body mass index of 66.3 kg/m2 who underwent spine surgery in prone position. Challenges faced ranged from the size of the table to the difficult airway, difficulty in positioning, maintenance of airway and ventilation, maintaining a free abdomen, and anesthesia management with meticulous use of anesthetic drugs for an uneventful recovery.
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A difficult airway poses a challenge to attending anaesthesiologist. Fibreoptic intubation (FOI) to secure airway can be a valuable option in such a scenario. Steep Trendelenberg’s position with pneumoperitoneum in robotic surgery causes respiratory changes with airway oedema and congestion. We are describing here a case report of 56-year male patient with a large congenital oral cavity hemangioma with primary urothelial neoplasm of bladder posted for robotic radical cystectomy with ileal conduit with urethrectomy. We emphasize the importance of difficult airway management by using fibre optic technique in such cases complicated by steep Trendelenburg’s position required during robotic surgeries.
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Non compaction cardiomyopathy (NCM) is a rare, primary genetically derived cardiomyopathy with a variable clinical presentation ranging from absence of symptoms to congestive heart failure, systemic thromboembolism, arrythmias and sudden cardiac death. Being an uncommon condition, the perioperative concerns in a patient with NCM have not been studied much. With increasing awareness and improved diagnostic tools including high resolution echocardiography and cardiac MRI, there has been an increase in the reporting of cases which stresses on the need for a complete understanding of this form of cardiomyopathy and its perioperative anaesthetic management. Authors report the case of a 24 years old female, with NCM who underwent prophylactic Implantable cardioverter defibrillator (ICD) insertion 5 years ago and was now posted for ICD removal and replacement in view of inappropriate ICD functioning.
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Doukky Rand colleagues acknowledged that Transcutaneous Cardiac Pacing is a temporary method of pacing which may be indicated in patients with symptoms of severe or hemodynamically unstable bradyarrhythmias. It is found to be extremely helpful in patients with reversible or transient conditions, such as digoxin toxicity and in atrioventricular block in the case of inferior wall myocardial infarction, or when transvenous pacing is not available or there are high chances of complications. Widened QRS complex indicates successful attempt followed by a distinct ST segment and broad T wave. The hemodynamic response to pacing is to be confirmed by the assessment of patient’s arterial pulse waveforms. Trancutaneous pacing is a boon to manage and treat intra op dangerous bradycardia.
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Pulmonary endarterectomy (PEA) is a potentially curative procedure for chronic thromboembolic pulmonary hypertension. A 34-year Indian male presented with supra-systemic pulmonary pressure was taken for PEA after achievable optimization. A successful PEA was performed with the help of total cardiac arrest. Patient developed reperfusion pulmonary edema post operatively, which was managed medically. The problems encountered by anesthesiologists in this case were preoperative pulmonary hypertension with chronic hypoxia and postoperative management of reperfusion pulmonary edema.
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Takotsubo cardiomyopathy or stress-induced cardiomyopathy is a cardiac syndrome of a reversible, transient left ventricular dysfunction that is caused by emotional and/or physical stress and surgery. Its clinical manifestations are similar to acute myocardial ischemia in absence of coronary artery lesion. It is more common in middle-aged women, and the prognosis is favourable. We report the case of a 32-year-old male patient who underwent a total colectomy, developed stress-induced cardiomyopathy and had poor outcome despite extracorporeal membrane oxygenation (ECMO).
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Goldman and colleagues identified severe aortic stenosis (AS) as a risk factor for perioperative cardiac complications in non-cardiac surgery. Although patients with aortic stenosis are at an increased risk of perioperative cardiac events, they can undergo non-cardiac surgery relatively safely provided that the condition is recognized and appropriate monitoring and management put in place. The early detection and treatment of hypotension and arrhythmias are essential. We present a case of severe aortic stenosis posted for emergency open cholecystectomy which was successfully managed under epidural anaesthesia and had an uneventful recovery.
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INTRODUCTION: India leads the world with the largest number of diabetic subjects (nearly 40 million) and it is predicted that this number would reach almost 80 million by the year 2030. There are research works those indicate towards the genetic liability of Indians towards the insulin resistance, diabetes & obesity. The constellation of insulin resistance, impaired glucose tolerance, atherogenic dyslipidaemia, hypertension and intra-abdominal adiposity (IAA) is called metabolic syndrome. This all factors contribute to high cardiovascular risk, morbidity & mortality in population. Identification of cardiovascular risk in nondiabetic subjects at early stage might be a game changer. OBJECTIVE: The aims of our study were to evaluate the prevalence of QTc prolongation in nondiabetic subjects with impaired fasting serum glucose and hyperinsulinemia & identify the subjects with cardiovascular risks at early stage. METHOD: We estimated fasting serum glucose & insulin in multiple subjects till we found 50 nondiabetic subjects with impaired fasting serum glucose and hyperinsulinemia. For each case we matched 50 control without insulin resistance. Subjects’ heart beats were recorded on the resting ECG tracing. QTc was calculated according to Bazett’s formula. Insulin Resistance& hyperinsulinemia was defined as homeostasis model assessment of IR (HOMA-IR). RESULTS: We observed that there was significant difference in QTc interval between case & control group.CONCLUSION: This study has concluded that Insulin resistance, estimated by HOMA-IR, was strongly correlated with prolonged QTc. Prolonged QTc identifies metabolic syndrome patients with an elevated risk of cardiovascular events
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Background: Biophysical parameters of skin such as trans-epidermal water loss (TEWL), hydration, elasticity, pH, and sebum reflects it functional integrity. Advances in technology have made it possible to measure these parameters by non-invasive methods. These parameters are useful for the prediction of disease and its prognosis. It also helps in developing new skin care products according to various skin types, and to evaluate, modify, or compare the effects of existing products. Aim: The aim of the study was to measure, evaluate, and analyze variations in biophysical parameters at pre-selected skin sites in healthy Indian volunteers, across different age groups and gender. Methods: The study was conducted among 500 healthy Indian volunteers, between 5 and 70 years of age, in the outpatient department of dermatology at Sir T. Hospital, Bhavnagar. Biophysical parameters such as TEWL, hydration, elasticity, and sebum content was measured on four pre-selected body sites by a Dermalab instrument (Cortex Technology, Denmark). The skin pH was measured with a sensitive pH probe (BEPL 2100). Results: All parameters were higher in males compared to females, except for sebum content, which was equal in both genders. Transepidermal water loss and hydration was lower in middle and older age groups. The skin pH showed no statistically significant difference with age. Sebum content was higher in middle and older age groups. The nose had the highest sebum content across all age groups. The forehead showed higher median values of TEWL and hydration compared to other sites. Though elasticity has highest value on forearm, only leg region showed statistically significant value. Limitations: The present study was confined to a single geographical area, so the effect of environment changes could not be judged accurately. Seasonal variations were not studied as it was a cross-sectional study. Conclusion: Skin properties vary with age, gender, and location on the body. This knowledge will help to create a database of these parameters in the Indian population. It would assist in the diagnosis of various clinical conditions and monitor therapeutic response.
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Background: Biophysical parameters of skin such as trans-epidermal water loss (TEWL), hydration, elasticity, pH, and sebum reflects it functional integrity. Advances in technology have made it possible to measure these parameters by non-invasive methods. These parameters are useful for the prediction of disease and its prognosis. It also helps in developing new skin care products according to various skin types, and to evaluate, modify, or compare the effects of existing products. Aim: The aim of the study was to measure, evaluate, and analyze variations in biophysical parameters at pre-selected skin sites in healthy Indian volunteers, across different age groups and gender. Methods: The study was conducted among 500 healthy Indian volunteers, between 5 and 70 years of age, in the outpatient department of dermatology at Sir T. Hospital, Bhavnagar. Biophysical parameters such as TEWL, hydration, elasticity, and sebum content was measured on four pre-selected body sites by a Dermalab instrument (Cortex Technology, Denmark). The skin pH was measured with a sensitive pH probe (BEPL 2100). Results: All parameters were higher in males compared to females, except for sebum content, which was equal in both genders. Transepidermal water loss and hydration was lower in middle and older age groups. The skin pH showed no statistically significant difference with age. Sebum content was higher in middle and older age groups. The nose had the highest sebum content across all age groups. The forehead showed higher median values of TEWL and hydration compared to other sites. Though elasticity has highest value on forearm, only leg region showed statistically significant value. Limitations: The present study was confined to a single geographical area, so the effect of environment changes could not be judged accurately. Seasonal variations were not studied as it was a cross-sectional study. Conclusion: Skin properties vary with age, gender, and location on the body. This knowledge will help to create a database of these parameters in the Indian population. It would assist in the diagnosis of various clinical conditions and monitor therapeutic response.
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Background First degree relatives (FDR) of type 2 diabetic (T2D) are predisposed for type 2 diabetes mellitus (T2DM) which accelerates cardiovascular aging. Pulse wave analysis (PWA) gives non-invasive measurement of central hemodynamics like central blood pressure (cBP), cardiac output (CO), stroke work (SW) and vascular stiffness like pulse wave velocity (PWV) and augmentation index at heart rate 75 (AIx@75). Objective To study PWA derived cardiovascular parameters in FDRs of T2D as compared to controls. Materials and methods We enrolled 117 FDRs of T2D and 117 matched controls for a cross-sectional study. We performed PWA using Mobil-o-Graph (IEM, Germany) by oscillometric method to derive cardiovascular parameters which were compared and correlated for significance. P value less than 0.05 was considered statistically significant. Results Gender, age, height, weight, body mass index (BMI), physical activity were comparable between groups. FDRs of T2D had significantly higher blood pressure (brachial-systolic 125 vs 118, diastolic 80 vs 77, mean 100 vs 96 mmHg and central- systolic 113 vs 105, diastolic 82 vs 79, pulse pressure 31 vs 28 mmHg), SW (98 vs 90 g m/bt), rate pressure product (RPP- 113 vs 107), PWV (5.14 vs 4.89 m/s), AIx@75 (30 vs 27) than control. Dependant variables correlated with brachial BP more than age or anthropometric variables. Result did not differ by maternal or paternal inheritance in case group. Conclusions Young, sedentary, non-obese FDRs of T2D have adverse cardiovascular profile which is suggested to worsen before or with onset of T2DM and definitely need attention for life style modification as primary prevention.
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Introduction: Hypertension represents a multifactorial disease of blood pressure (BP) regulation with persistently elevated systolic and/or diastolic BP over 140/90mmHg. 90% cases of hypertension have to be assigned as essential hypertension. Research has proven that patients with essential hypertension, especially at an early stage without any medication, display autonomic disturbance in the form of increase in sympathetic and a reduction in parasympathetic activity of the ANS. The heart rate variability analysis is a powerful tool in assessment of the cardiac autonomic nerve function. It is non-invasive, an accurate, reliable, reproducible, yet simple to measure and to process and It is indicative of neuro-cardiac fitness and overall health. Objective – The aim of the present study was to (1) measure Heart rate variability (HRV) in Essential Hypertension (2) effect of different drugs on Heart rate variability in hypertension among hypertensive subjects. Materials and Methods: This study was conducted On 100 Hypertension subjects & 100 Normal subjects after obtaining informed written consent by use of Heart rate variability Analysis System Variowin-HR Medical System. Results: The mean values of Very low frequency (VLF), Low frequency (LF), High frequency (HF), Normalized High Frequency (HF (nu) & all time domain parameters were found to be reduced significantly in hypertensive subjects as compared to control subjects. The mean values of LF (nu), LF / HF ratio were significantly high in hypertensive subjects as compared to control subjects. Conclusion: observations in our study demonstrate that hypertensive subjects had markedly reduced heart rate variability (HRV) in comparison with normal subjects which indicate cardiac autonomic disturbances in hypertension subjects in causation of essential hypertension.
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Background: In today’s era of technology, intelligence and success are not viewed the same way they were before. New theories of intelligence have been introduced and are gradually replacing the traditional theory. Academic achievement is based on creativity, emotions, and interpersonal skills. Methods: The aim of this study was to see whether there is a relationship between emotional intelligence and academic success. Study was done on 1st MBBS students of Govt. Medical College, Bhavnagar. The sample size was 75 students (boys and girls). The emotional intelligence questionnaire from Institute for Health and Human Potential was given to the students, Depending on the EQ score we divided the students in to five groups and compared with their academic performance. Results: Study showed inverse relationship between emotional intelligence and academic achievement. Conclusion: There is a negative relation among emotional intelligence and academic achievement of the participants.
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Background: VO2MAX is the sole major criterion for endurance assessment. By using the regression equation the necessity of the sophisticated gas analyzer is eliminated. The usability and applicability of such equations are questioned due to non-uniformity, standardization and other variables. Methods: 100 healthy young male subjects were recruited and each performed all the four selected treadmill protocol viz. Bruce, Modified Bruce, Ellestad and Balke. VO2MAX was calculated for each person for each protocol by using regression equation. Results: Mean and SD values of VO2MAX of each protocol were, Balke (41.94 ± 2.15), Bruce (64.55 ± 6.7), Ellestad (61.17 ± 7.5), Modified Bruce (64.36 ± 5.4). There was difference among different protocols (p<0.05), except between Bruce and Modified Bruce (p>0.05). These were compared with ACSM predicted equation based on age and height (51.5+7.4). Later Paired t-test was applied. There is no statistically significant difference between the Bruce and Modified Bruce protocols. Highest difference was observed between the Balke and Bruce protocol and between Balke and Modified Bruce, as was the difference between Balke and Ellestad protocol. Conclusion: For endurance testing Ellestad protocol can be a suitable option in resource crunch settings as the Balke protocol underestimates and Bruce overestimates the VO2MAX. Devising a ramp protocol for the population subset’s need can be the best option.
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Background: Diabetes is an iceberg disease with many complications like cardiovascular disease & diabetic neuropathy. Diabetic autonomic neuropathy is least recognized & most frequent complication. Cardiac autonomic neuropathy is associated with fatal outcome like silent myocardial ischemia & intra-operative liability. With this background we have evaluated the cardiac autonomic neuropathy in diabetic patients using resting blood pressure measurement & isometric hand grip test. Aim:Aim of the study is to analyze the role of handgrip test of & resting blood pressure in diagnosing Cardiac Autonomic Neuropathy. Materials And Methods: A Present cross sectional study was carried out in 50 diabetic patients & 50 controls(age and sex matched) at Sir T. Hospital Bhavnagar. Each subject was evaluated for cardiovascular autonomic neuropathy by isometric hand grip test & resting blood pressure.Diabetic patients were divided in 3 groups according to duration of disease(groupI-< 5 year, II-6 to 10 year, III- > 10 year) to evaluate the impact of duration of disease on autonomic nervous system.We have used student’s T test for comparisons of result between 2 groups. Result:The mean value of resting systolic blood pressure(RSBP) & resting diastolic blood pressure (RDBP)is comparatively higher in diabetic patients compared to controls &the mean value of BP is increasing with duration of diabetes. Isometric hand grip test failure rate was higher in diabetic group than controls. Conclusion: outcome of the study indicates that cardiac autonomic neuropathy is seen in diabetic patients which progresses with duration. Implication of study: isometric hand grip test & resting BP measurement is effective diagnostic tool for cardiac autonomic neuropathy & it also show association with duration of disease.
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Background: The learning habit of a learner is the way he handles new information and experiences, and determines its outcomes. Various types of learning habits are adopted by students, including visual (V; learning from graphs, charts, and flow diagrams), auditory (A; learning from speech), read-write(R; learning from reading and writing), and kinesthetic (K; learning from touch, hearing, smell, taste, and sight).Understanding their preferred learning habits as visual, auditory, read-write or kinesthetic learners will help to improve the teaching methods adopted. Facilitators and supporters themselves may need guidance and training in how to identify feedback and adapt learning to individual's habits. Objective: To assess different learning habits of medical students and hence provide student oriented education, producing efficient doctors. Materials and Methods: This study was performed at Department of physiology in Govt. Medical College, Bhavnagar in March 2011.Eighty four (84) medical students of first MBBS were participated in the study. By using the English version of the visual, auditory, reading or writing, kinesthetic (VARK) questionnaire, we measured the difference in learning habits of First year medical students. Results: In Unimodal learning habit highest preference was given to auditory mode (48.57%), then to Kinesthetic (28.57%) & then to read (14.29%) & visual (8.57%). Among Multimodal learning habit students (n=44), 64.29% students preferred bimodal, 2.38% students preferred trimodal and 33.33% students preferred quadrimodal learning habit. Conclusion: Knowing that students have different preferred learning modes, will help medical instructors in our faculty develop appropriate learning approaches and explore opportunities so that they will be able to make the educational experience more productive. The results will help faculty to develop appropriate learning approaches and explore opportunities, so that they will able to make the educational experience more productive.
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Present study was carried out on 50 textile workers (34 males and 16 females) of Kumbharwada, Bhavnagar. All were exposed to high intensity industrial noise in plastic weaving Textile industry. Other causes of Hearing loss apart from Occupational Noise Induced Hearing Loss (ONIHL) were ruled out. Detailed occupational history and complaints related to hearing were inquired. Each subject was evaluated by Pure Tone Audiometry. Hearing thresholds at speech frequencies and high frequency were tested in silent room after 16 hours from termination to last exposure. The result was compared by statistical analysis that revealed more hearing loss at high frequency as compared to speech frequencies. The magnitude and degree of hearing loss seemed to increase with duration of exposure.