Effect Of Dexmedetomidine On Capillary Blood Glucose And Sevoflurane Requirement During Laparoscopy In Diabetic Patient

Background: Dexmedetomidine has been shown to blunt the stress response to surgery. Hence a study was designed to evaluate the effect of intravenous (IV) dexmedetomidine infusion during general anaesthesia for abdominal surgeries on blood glucose levels and on sevoflurane requirements during anaesthesia. Materials and Methods: Thirty four patients scheduled for laparoscopic surgery under general anaesthesia were divided into dexmedetomidine (D) group and Placebo (P) group of 17 each. Group D received a loading dose of dexmedetomidine at 1 μg/kg/10 min diluted to 20 mL, followed by maintenance with 0.5 μg/kg/h., till the end of surgery. Group P received similar volume of IV normal saline. Anaesthesia was maintained with nitrous oxide in oxygen and sevoflurane keeping BIS between 40 and 60. Data were analyzed using students t test, chi square test and Fisher Exact test as applicable. Results: 90min after intubation, dexmedetomidine group showed blood glucose levels of 127.24 ± 6.14 mg/dL, compared to placebo group which was 146.88± 3.56mg/dL and it was statistically significant (P< 0.05). After 60min sevoflurane requirement in Group D was 12.65 ± 2.06 mL, compared to 19.82 ± 1.77 mL in placebo group. In peri–operative period, the heart rate and MAP were stable. Conclusion: Intravenous Dexmedetomidine was effective in blunting stress response to surgical trauma as indicated by lower blood glucose levels, and reduced Sevoflurane requirements during BIS guided general anaesthesia for laparoscopy surgery.

Evidence Based Medicine: Assessing Knowledge, Attitudes and Barriers in Post-graduate Training.

Aims: To assess the knowledge and attitude of post- graduate medical students regarding evidence based medicine (EBM) and to find out the barriers against its implementation, if any. Study Design: Medical college based cross-sectional survey. Place and Duration of Study: The study was carried out between October 2013 to March 2014, at a medical college in Kolkata, West Bengal, India. Methodology: Altogether 145 post-graduate medical students of clinical disciplines filled up a predesigned, pre-tested, structured questionnaire and data were analyzed by standard statistical procedures. Results: The mean knowledge score was found to be 13.46±3.10. The score was arbitrary, ranged from 0 to 20 and higher score corresponded to higher knowledge. The distribution of the mean knowledge score among <30 years (13.34±3.28) and ≥30 years (13.67±2.62) was the same across these two categories (P =.62). Large proportions of the respondents were not familiar with reputed EBM resources such as Cochrane data base (66.9%) and Best Evidence (67.6%). Use of Medline was also quite poor (35.9%). Nearly half of them did not think that EBM was focused on patient’s values and preferences and many believed that EBM would place another demand on the already overburdened residents and doctors. Quite a large proportion thought that EBM would be of limited value in clinical practice. However the mean attitude score (21.23±4.06) showed an overall favorable attitude towards EBM. There was a positive correlation between the mean knowledge and attitude scores (P =.008). The common barriers against the implementation of evidence-based medicine were “no ready access to resources” (68.3) and “never taught on the subject” (56.6%). Conclusion: Although many of the respondents were not adequately knowledgeable about evidence-based medicine and also quite a few had a negative attitude towards its practicality, the positive correlation between knowledge attitude scores suggested that imparting proper knowledge could bring about a positive change in this attitude.

In vitro Studies of Iron Chelation Activity of Purified Active Ingredients Extracted from Triticum aestivum Linn. (Wheat Grass).

Objective: Seven to eight days germinated plants of Triticum aestivum (wheat grass) are a rich source of vitamin A, C, calcium, magnesium, phosphorus, potassium, sodium, sulphur, cobalt, zinc and protein. Traditionally the aqueous extract of T. aestivum was reported to be used as a health tonic in folk and ayurvedic medicine. We previously reported that aqueous extract of T. aestivum was found to reduce the blood transfusion requirement in iron overloaded Thalassemia and Myelodysplastic syndrome patients. Our objective was to extract and purify active ingredients from wheat grass and study their mode of action in stabilizing hemoglobin level in those patients. Design and Method: Active ingredients of wheat grass were extracted and purified by cation exchange column chromatography followed by High Performance Liquid Chromatography. In vitro experiments with phenylhydrazine treated red blood cell hemolysate were carried out before and after treatment of purified fraction of T. aestivum to study iron chelating activity. Result: Purified fraction of T. aestivum treated red blood cell showed significant inhibition of free reactive iron production and formation of thio-barbituric acid reactive substances when compared to desferrioxamine treated hemolysate. Conclusion: Iron chelating activity of purified fraction of T. aestivum, an inexpensive, easily available source, is very promising for further clinical trial and development of oral iron chelator drug for Thalassemia, Myelodysplastic syndrome and other iron overloaded diseases.