Comparative study of CURB-65 and expanded CURB-65 score in community acquired pneumonia in a tertiary care hospital of Assam

Background:Community acquired pneumonia is one of the leading causesof morbidityand mortality in developing countries like India. The presentation of CAP may range from mild pneumonia characterized only by fever and productive cough to severe pneumonia leading to respiratory distress and sepsis syndrome requiring management in ICU. Any delay in ICU admission has been shown to be associated with increased mortality. This study was conducted to compare Expanded CURB-65 with CURB-65 scoring system in a tertiary care centre in Assam for early stratification of patients with CAP based of severity and expected prognosis.Methods: This hospital based prospective study was conducted between September 2020 to August 2021, and a total of 100 patients were taken and followed up form admission to up to30 days. CURB65 and expanded CURB 65 score was calculated for each patientand the accuracy of each score was statistically compared.Results:In our study out of 100 patients mean age of 60�.97 with Mortality rate of 16%. Total 29% patients were need ICU care. The Sensitivity, Specificity, PPV and NPV for predicting mortality and for ICU admission of Expanded CURB-65 score is found to be superior to CURB-65 Score. Conclusions:In comparison to the CURB-65 score system, the expanded CURB-65 score prioritises both clinical and laboratory criteria and is a more reliable marker for evaluating CAP severity and may improve the effectiveness of forecasting death in CAP patients.

Dexmedetomidine improves surgical field in cochlear implant surgery: a randomized, double-blind, placebo-controlled trial

Objectives: Sympatholytic properties of dexmedetomidine have many advantages to use in general anesthesia especially in pediatric age group undergoing cochlear implant surgeries. This study is designed to compare the effects of bolus dose of dexmedetomidine followed by infusion with placebo in cochlear implant surgeries for quality of hypotensive anesthesia with hemodynamic stability and incidence of complications in pediatric age group particularly emergence delirium with sevoflurane

Methodology: 60 pediatric patient of ASA grade I or II with congenital or acquired deafness of age ranging from 2 to 8 years scheduled for cochlear implant surgery were included in this study. Group D were administered dexmedetomidine 0.5 micro g/kg in 100 ml 0.9% NaCI over 10 min followed by infusion of dexmedetomidine at 0.5 micro g/kghr[-1] and Group P was given placebo only i.e. 0.9% NaCl 100 ml over 10 min followed by infusion at 2 ml.hr[-1]. Heart rate [HR] and mean arterial pressure [MAP] at different time interval, intraoperative fentanyl and propofol consumption, surgeons' satisfaction score and complications, particularly incidences of emergence delirium were recorded

Statistical analysis: Mean with standard deviation of various parameters of both groups was compared using student's t test were analyzed

Result: statistical significant lowering of MAP, HR, opioid consumption and rate of complications were lower in dexmedetomidine group compared to placebo group

Conclusion: Intraoperative administration of dexmedetomidine provides better surgical field and subsequently higher surgeon's satisfaction score leading to reduced surgery time with better recovery profile

Effect of sevoflurane versus propofol-based anesthesia on the hemodynamic response and recovery characteristics in patients undergoing microlaryngeal surgery

This randomized study was conducted to compare the hemodynamic changes and emergence characteristics of sevoflurane versus propofol anesthesia for microlaryngeal surgery. Forty adult patients undergoing microlaryngoscopy were randomly allocated into two groups. In propofol group, anesthesia was induced with 2-3 mg/kg propofol and maintained with propofol infusion 50-200 microg/kg/h. In sevoflurane group induction was carried out with 5-8% sevoflurane and maintained with sevoflurane in nitrous oxide and oxygen. The propofol and sevoflurane concentrations were adjusted to maintain the bispectral index of 40-60. All patients received fentanyl 2 microg/kg before induction and succinylcholine 2 mg/kg to facilitate tracheal intubation. The hemodynamic changes during induction and suspension laryngoscopy were compared. In addition, the emergence time, time to extubation, and recovery were assessed. The changes in heart rate were comparable. The mean arterial pressure was significantly lower after induction and higher at insertion of operating laryngoscope in propofol group as compared to sevoflurane group. More patients in propofol group had episodes of hypotension and hypertension than sevoflurane group. The emergence time, extubation times, and recovery time were similar in both groups. We found that sevoflurane showed advantage over propofol in respect of intraoperative cardiovascular stability without increasing recovery time