Comparision of Cardiac Output Measured by Transthoracic Echocardiography with Continuous Cardiac Output Measured by Pressure Recording Analytical Method

Background: Low cardiac output is a common complication following cardiac surgery and it is associated with higher mortality in the pediatric population. A gold standard method for cardiac output (CO) monitoring in the pediatric population is lacking. The present study was conducted to validate cardiac output and cardiac index measured by transthoracic echocardiography and Pressure recording analytical method, a continuous pulse contour method, MostCare Up in postoperative pediatric cardiac surgical patients. Materials and Methods: This was a prospective observational clinical study conducted at a tertiary care hospital. A total of 23 pediatric patients weighed between 2 and 20 kg who had undergone elective cardiac surgery were included in the study. Results: Spearman抯 correlation coefficient of CO between transthoracic echocardiography (TTE) and Pressure Recording Analytical Method (PRAM) showed of positive correlation (r = 0.69, 95% Confidence interval 0.59?0.77, P < 0.0001) Linear regression equations for CO between TTE and PRAM were y = 0.55 + 0.88x (R2 = 0.46, P < 0.0001). (y = PRAM, x = TTE), respectively. Bland? Altman plot for CO between TTE and PRAM showed a bias of ?0.397 with limits of the agreement being ?2.01 to 1.22. Polar plot analysis showed an angular bias of 6.55� with radial limits of the agreement being ?21.46 to 34.58 for CO and angular bias of 6.22� with radial limits of the agreement being ?22.4 to 34.84 for CI. Conclusion: PRAM has shown good trending ability for cardiac output. However, values measured by PRAM are not interchangeable with the values measured by transthoracic echocardiography.

Inadequate Response to Adenosine Infusion During Cardiac Stress Magnetic Resonance Imaging

Aim:To determine the factors associated with an inadequate response to adenosine infusion during cardiac stress magnetic resonance imaging (MRI). Study Design: It is a retrospective cohort study. Introduction: Stress cardiac MRI is a highly accurate and non?invasive method to diagnose coronary artery disease (CAD). Stress MRI is performed by inducing stress with adenosine infusion.There is an increase in systemic andmyocardial blood flow (MBF) with vasodilator agents. Capillaries are maximally dilated in a diseased artery and cannot sustain increased myocardial oxygen demand. It results in delayed delivery of contrast, which leads to an area of perfusion defect in the myocardium. These perfusion defects can be accurately seen by cardiovascular magnetic resonance (CMR) and help in the prognosis of patients. Methods: A retrospective study on patients subjected to cardiac stress MRI was conducted in a Tertiary Care Cardiac Center from January 2019 to January 2022. In total, 99 patients underwent adenosine stress perfusion cardiac MRI. All patients received an adenosine infusion of 140 mcg/kg/min for 2 min. Subsequently, the dosage was increased by 20 mcg/kg/min every 2 min to a maximum of 210 mcg/kg/min until an adequate stress response was achieved. Adequate stress was defined as two or more of the following criteria: 1) Increase in heart rate >/= 10 beats perminute. 2) Decrease in systolic blood pressure SBP by >/= 10mmHg Symptoms like chest discomfort, breathlessness, and headache. Patients who satisfied two or more of the above criteria were labeled as responders and the patients who did not satisfy the above criteria with the maximum dose of 210 mcg/kg/min of adenosine infusion were labeled as non?responders. Multivariable logistic regression analysis with forward and backward stepwise selection was used to identify predictors in non?responders. Basic demographic variables with P value </= 0.2 were examined for inclusion in the model. A P value </= 0.05 was considered significant. Results: Nine patients (9.1%) showed inadequate stress response to adenosine infusion even with a maximum dose of 210 mcg/kg/min. Multivariate logistic regression analysis showed that left ventricular end?diastolic volume (LVEDV) was a predictor of inadequate response to adenosine infusion. Conclusion: Inadequate stress response to adenosine occurred in 9.1% of subjects with an infusion of 140–210 ug/kg/min. LVEDV is an independent and strong predictor in non?responders.

An Observational Study for Causes of Surgical Jaundice at Tertiary Care Hospital

Background: The etiological pattern of obstructive jaundice varies from one region to another due to higher incidence being noticed in the Northern region of India. Very limited studies have been carried out in the western regions of Uttar Pradesh. The various etiological parameters ranges from malignant biliary stricture, stone in the CBD and even secondaries lymph node compression at porta hepatis. Due to the transition from open surgery to the minimum invasive laproscopic surgery. The etiology related to surgical jaundice also become more common in relation to procedure related complications like CBD injury that leads to surgical jaundice.Material & Methods:This present study has been conducted in the department of general surgery in TMMC and RC of a Tertiary Care hospital. In this observatory study the patients having clinical records of surgical jaundice who had attended the surgical Out Patient Department are going to be included. The time period of the study was from 1 jan 2020 to 30 sept 2021 . Overall, 44 patients were being considered. The selection of subject was done randomly and any type of special consideration regarding the gender of the patients was not being considered while selecting for the study.Results:In our study from 44 patients according to frequency distribution of etiology maximum of the subjects were having choledocholitheasis along with cholelitheasis that are 34.5 % and choledocholitheasis with obstructive jaundice was the 2ndmost common cause with 31.78%.The 3rdmost common etiology was found carcinoma of gall bladder with 11.35%.Conclusions:It can be concluded that for the cases of malignant surgical jaundice good survival benefit usually depends upon the detection of the disease early during the course period. It has also been found that in malignant cases the stage of disease with jaundice were advanced. As per our study results it has been observed that there are various etiological factors contributing to development of surgical jaundice which needs multiple modes of precise investigations and further evaluations further studies and research needed to cover various factor responsible for surgical jaundice.

Comparison of Epidural Analgesia with Ultrasound?Guided Bilateral Erector Spinae Plane Block in Aorto?Femoral Arterial Bypass Surgery

Objective:Thoracic Epidural Analgesia (TEA) was compared with ultrasound?guided bilateral erector spinae plane (ESP) block in aorto?femoral arterial bypass surgery for analgesic efficacy, hemodynamic effects, and pulmonary rehabilitation. Design: Prospective randomized. Setting: Tertiary care centre. Participants: Adult patients, who were scheduled for elective aorto?femoral arterial bypass surgery. Interventions: It was a prospective pilot study enrolling 20 adult patients who were randomized to group A (ESP block = 10) and group B (TEA = 10). Monitoring of heart rate (HR) and mean arterial pressure (MAP) and pain assessment at rest and deep breathing using visual analog scale (VAS) were done till 48?h post?extubation. Rescue analgesic requirement, Incentive spirometry, oxygenation, duration of ventilation and stay in Intensive Care Unit (ICU) were reported as outcome measures. Statistical analysis was performed using unpaired Student T?test or Mann?Whitney U test. A value of P < 0.05 was considered significant. Results: HR was lower in group B than group A at 1 and 2 h post? surgery and at 0.5, 16, 20, and 32 h post?extubation (P < 0.05). MAP were lower in group B than A at 60, 90, 120, 150, 180, 210, 240, 270 minutes and at 0 hour post?surgery and at 4 hours, every 4 hours till 32 hours post?extubation (P < 0.05). Intraoperative midazolam and fentanyl consumption, ventilatory hours, VAS at rest, incentive spirometry, oxygenation, and ICU stay were comparable between the two groups. VAS during deep breathing was more in group A than B at 0.5, 4 hours and every 4 hours till 44 hours post?extubation. The time to receive the first rescue analgesia was shorter in group A than B (P < 0.05). Conclusion: Both ESP block and TEA provided comparable analgesia at rest. Further studies with larger sample size are required to evaluate whether ESP block could be an alternative to TEA in aorto?femoral arterial bypass surgery

A Comparative Study of Operative Management of Intraarticular Fracture Distal end of Radius (External Fixator Versus ORIF with Buttress Plating)

Background: Intraarticular fracture distal end of the radius isone of the most common fracture of upper extremities. Here israndomised comparative study of the most effective treatmentmodality to deal with such fracture by external fixator vsbuttress plating.Method: Patients were randomly allocated into two groups of30 each (group A and group B). Patients treated with externalfixator was put in group A while those treated with buttressplating was kept in group B. At the end of 8 months of follow-upfinal assessment was done for fracture union and patients wereassessed for pain, wrist range of motion (ROM), grip strengthand activity and scored according to the Modified Green OBrien Scoring System. The mean duration of treatment and theoutcome were comparable.Results: In group A (external fixator) only 7 patients hadexcellent and 18 had good results while patient in group B(ORIF with plating) 14 patients had excellent and 11 had goodresult.Conclusion: We found that plating predominantly providesmore excellent results as long as the radiological parametersare met and fixation achieved as early as possible along withvigorous physiotherapy.Level of Evidence: Level II randomised comparative series.

Expression, purification and characterization of a biologically active and thermally stable human lysyl oxidase

Lysyl oxidase (LOX), a promising therapeutic target for the progression of cancer and fibrosis, has not been well characterized yet. A major difficulty faced in LOX characterization is its lack of solubility in common buffers. In this study, mature LOX (mLOX) was cloned, purified and its purity was ascertained by mass spectroscopy. Through screening various buffers, 0.2 M glycine-NaOH buffer with 10% glycerol pH 8.0 was identified to maintain mLOX in its soluble state. About 67% of the refolded mLOX was found to be in copper bound state after His-tag removal. Catalytic properties Km and kcat were found to be 3.72 × 10−4 M and 7.29 ×103s−1. In addition, collagen cross-linking in ARPE-19 cells was augmented on exposure to mLOX, endorsing its biological activity. Circular Dichroism revealed that mLOX comprises 8.43% of α-helix and 22% of β-strand and it was thermally stable up to 90°C. Disulfide linkage imparts the structural stability in LOX which was experimentally ascertained with intrinsic and extrinsic fluorescence studies.

ANSiscope™: Can it be the crystal ball of cardiac anesthesia?

Background: Autonomic dysfunction (AD) is infrequently evaluated preoperatively despite having profound perioperative implications. The ANSiscope™ is a monitoring device that quantifies AD. This study aims to determine the potential of the device to predict hypotension following anesthetic induction, occurrence of arrhythmias, and inotrope requirement for patients undergoing off-pump coronary artery bypass surgery (OPCAB). Study Design: Prospective observational double-blinded study. Materials and Methodology: Seventy-five patients undergoing OPCAB had their autonomic function assessed by ANSiscope™. They were classified into four groups based on their AD and compared to perioperative adverse events. Results: Patients with diabetes had a higher ANSindex (P = 0.0263). They had a greater decrease in systolic blood pressure (P = 0.001) and mean arterial pressure (P = 0.004) postinduction, had an increased incidence of arrhythmias (P = 0.009), required higher inotropic support immediately (P = 0.010) and at 24 h after surgery (P = 0.018), and longer duration of postoperative ventilation (P < 0.001). They also had a higher incidence of emergency conversion of OPCAB to on-pump surgery (P = 0.009). Conclusions: An increased association between AD as quantified by the ANSiscope™ and perioperative adverse outcomes was observed. An increased rate of emergency conversion of OPCAB to on-pump surgery with higher dysfunction was noted. The authors opine that the threshold for conversion must be lower in patients deemed to be at a higher risk. Proper evaluation of the autonomic nervous system empowers the anesthesiologist to anticipate and adequately prepare for complications.

Evaluation of risk scores in predicting perioperative blood transfusions in adult cardiac surgery

Objective: Allogeneic blood product transfusions are associated with an increased morbidity and mortality risk in cardiac surgery. At present, a few transfusion risk scores have been proposed for cardiac surgery patients. The present study is aimed to develop a new score and to compare with preexisting scores – Transfusion Risk and Clinical Knowledge (TRACK) and Transfusion Risk Understanding Scoring Tool (TRUST) score. Methodology: A total of 1014 adult patients undergoing cardiac surgery were enrolled in the retrospective study. Independent predictors of allogeneic blood transfusions were selected from TRACK and TRUST scores. A predictive score was developed from six variables using logistic regression analysis, and new score was compared to the other existing scores – TRACK and TRUST. Results: The new score had following predictors: age >58 years, weight <63 kg for males and <49 kg for females, gender (female), complex surgery, hemoglobin <13.5 g/dl, and creatinine >1.36 mg/dl. Validation of new score demonstrated an acceptable predictive power (area under the curve [AUC] 0.749) and a good calibration at the Hosmer–Lemeshow test. New score was comparable with TRACK score with P = 0.578 (AUC of TRACK 0.756 and AUC of new score 0.749). There was a significant difference between new score and TRUST score, P = 0.01 (AUC of TRUST 0.72 and AUC of new score 0.749). Conclusion: New score is a simple risk model based on six predictors having a similar accuracy and calibration in predicting the transfusion rate in cardiac surgery as compared to TRACK score.

Early prediction of acute kidney injury using serum phosphorus as a biomarker in pediatric cardiac surgical patients

Background: Acute kidney injury (AKI) is a strong predictor of morbidity and mortality after cardiac surgery. Lack of valid early biomarkers for predicting AKI has hampered the ability to take therapeutic measures for preventive cause. Hyperphosphatemia that occurs in AKI due to renal excretion defect was not studied in this context and could be simple marker of AKI. Therefore, we tested role of serum phosphorus in prediction of AKI as a biomarker after cardiac surgery in children. Methodology: We prospectively evaluated 51 children aged between 3 weeks and 12 years undergoing elective cardiac surgery. Serum creatinine and phosphorus were measured preoperatively and postoperatively at 24 and 48 h. As per the Kidney Disease Improving Global Outcomes criteria, patients were grouped into AKI and non-AKI on the basis of the development of AKI within 48 h postsurgery. The postoperative diagnostic performance of phosphorus thresholds was analyzed by the area under receiver operating characteristic curves (AUC-ROC). Results: From 51 children included, 10 developed AKI. In AKI group, serum phosphorus increased significantly from 4.47 ± 0.43 baseline to 6.29 ± 0.32 at 24 h postsurgery (P = 0.01) while serum creatinine increased from baseline 0.33 (0.24–0.46) to 0.49 (0.26–0.91) at 24 h which is statistically insignificant (P = 0.16). ROC analysis showed that serum phosphorus at 24 h, the AUC was 0.84 with sensitivity 0.75 and specificity 0.93 for a cutoff value of 6.4 mg/dl. Whereas serum phosphorus at 48 h, the AUC was 0.86 with sensitivity 66.67% and specificity 97.62% for a cutoff value of 5.4 mg/dl. Conclusion: Serum phosphorus can be an alternative biomarker as early as 24 h for early prediction of AKI in pediatric cardiac surgery.

Standardization of screening techniques for resistance to Lipaphis erysimi (Kalt.) in rapeseed-mustard under field conditions

The population and damage by aphid, Lipaphis erysimi (Kalt.) in Brassica spp. is highly variable across seasons and regions, wherein screening of rapeseed-mustard genotypes under natural infestation conditions has not been rewarding for aphid resistance. Since no reliable screening technique is in place, we developed and evaluated various screening techniques to differentiate diverse mustard genotypes for resistance to L. erysimi under field conditions. Artificial infestation at bud formation stage with 20 mixed stage aphids pinned with bell pins on the top third branch near inflorescence was found most appropriate and effective for establishment of aphids at inoculation site. Evaluation of mustard genotypes under multi-choice natural infestation revealed maximum variability in L. erysimi resistance indices, but plot cage artificial screening technique was found appropriate over natural infestation for multi-choice assays. Genotypes Heera and PDZM 31 showed susceptible to highly susceptible reaction against L. erysimi under all the artificial infestation screening techniques. However, PM 30, PM 21, Pusa Bold and Pusa Vijay displayed variable resistance reactions under different screening techniques. Although no-choice twig cage and plant cage techniques showed significant differences in test mustard genotypes for various aphid resistance indices, the twig cage technique revealed maximum variability and could differentiate them at slightest variation in levels of tolerance/susceptibility to L. erysimi. The rate of L. erysimi multiplication on test mustard genotypes was highly variable under plant cage as compared to twig cage. The twig cage technique also successfully differentiated the double low erucic acid and total glucosinolate, single low erucic acid, and conventional varieties with high erucic acid and total glucosinolate groups of mustard genotypes for L. erysimi resistance. The multiplication rate and ease in scouting of aphids, easy handling and cost of the cage, and natural plant growth conditions are some of the most favourable factors, suggesting twig cage technique more précised, realistic, economical, and efficient for artificial screening of rapeseed-mustard for resistance against the aphid L. erysimi infestation

Efficacy of bilateral pectoralis nerve block for ultrafast tracking and postoperative pain management in cardiac surgery

Background: Good postoperative analgesia in cardiac surgical patients helps in early recovery and ambulation. An alternative to parenteral, paravertebral, and thoracic epidural analgesia can be pectoralis nerve (Pecs) block, which is novel, less invasive regional analgesic technique. Aims: We hypothesized that Pecs block would provide superior postoperative analgesia for patients undergoing cardiac surgery through midline sternotomy compared to parenteral analgesia. Materials and Methods: Forty adult patients between the age groups of 25 and 65 years undergoing coronary artery bypass grafting or valve surgeries through midline sternotomy under general anesthesia were enrolled in the study. Patients were randomly allocated into two groups with 20 in each group. Group 1 patients did not receive Pecs block, whereas Group 2 patients received bilateral Pecs block postoperatively. Patients were extubated once they fulfilled extubation criteria. Ventilator duration was recorded. Patients were interrogated for pain by visual analog scale (VAS) scoring at rest and cough. Inspiratory flow rate was assessed using incentive spirometry. Results: Pecs group patients required lesser duration of ventilator support (P < 0.0001) in comparison to control group. Pain scores at rest and cough were significantly low in Pecs group at 0, 3, 6, 12, and 18 h from extubation (P < 0.05). At 24 h, VAS scores were comparable between two groups. Peak inspiratory flow rates were higher in Pecs group as compared to control group at 0, 3, 6, 12, 18, and 24 h (P < 0.05). Thirty-four episodes of rescue analgesia were given in control group, whereas in Pecs group, there were only four episodes of rescue analgesia. Conclusion: Pecs block is technically simple and effective technique and can be used as part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and outcome.

Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery

Objective: Continuous thoracic epidural analgesia (TEA) is compared with erector spinae plane (ESP) block for the perioperative pain management in patients undergoing cardiac surgery for the quality of analgesia, incentive spirometry, ventilator duration, and intensive care unit (ICU) duration. Methodology: A prospective, randomized comparative clinical study was conducted. A total of 50 patients were enrolled, who were randomized to either Group A: TEA (n = 25) or Group B: ESP block (n = 25). Visual analog scale (VAS) was recorded in both the groups during rest and cough at the various time intervals postextubation. Both the groups were also compared for incentive spirometry, ventilator, and ICU duration. Statistical analysis was performed using the independent Student's t-test. A value of P < 0.05 was considered statistically significant. Results: C omparable VAS scores were revealed at 0 h, 3 h, 6 h, and 12 h (P > 0.05) at rest and during cough in both the groups. Group A had a statistically significant VAS score than Group B (P ≤ 0.05) at 24 h, 36 h, and 48 h but mean VAS in either of the Group was ≤4 both at rest and during cough. Incentive spirometry, ventilator, and ICU duration were comparable between the groups. Conclusion: ESP block is easy to perform and can serve as a promising alternative to TEA in optimal perioperative pain management in cardiac surgery.

Prevalence of Thyroid Disorders in Patients of Gall Bladder Stones: A Prospective Study

Background: Gall bladder stones are one of the commonest abdominal disorder requiring hospitalization and surgery in India. In Europian countries more than 10% prevalence of gall bladder stone has been recorded. Different studies suggested that sluggish movement of bile during hypothyroidism may induce formation of stone in gall bladder. Moreover, use of thyroxine for dissolving gall bladder stone has been suggested in studies. However, relation of thyroid hormones and gall bladder stone is still unclear. Therefore, present study was designed to assess if there is any relation between thyroid hormones disorders and gall bladder stones. Methods: It was cross sectional type of study which was conducted in departments of general surgery of TMMC & RC, Moradabad. This study was carried out from April 2017 to December 2017. Study population included 100 patients of cholelithiasis undergoing for cholecystectomy. Surgical profile along with full history including name, age, sex etc was recorded in the study. Similarly, full history of control group subjects was taken. Thyroid hormones in serum total tri iodothyronine (T3), free thyroxine (FT4), and TSH were measured by Enzyme Linked Immunosorbent Assay (ELISA) method. Results: Gall bladder stone were more common in female patients (60) in comparison of male patients (40). Hypothyroid disorder was found in 20% male gall bladder patients. Whereas, 7.5% hyperthyroid disease in male cholelethiais patients. Euthyroid status was observed in 72.5% male gall bladder patients. Hypothyroid disorder was found in 14% female gall bladder patients. Whereas, 7% hyperthyroid disease in female cholelethiais patients. Euthyroid status was observed in 65% female gall bladder patients. Conclusion: Findings of the current study suggest that female population suffers more in comparison of male population. Further, prevalence of gall bladder stones were more in 51 to 60 years age group population. Further, no definite relation was observed between thyroid hormones disorders either hypothyroid or hyperthyroid and gall bladder stones. However, more studies of on larger populations are required to assess if there is any relation between thyroid disorders and gall bladder stones

Comparison between noninvasive measurement of central venous pressure using near infrared spectroscopy with an invasive central venous pressure monitoring in cardiac surgical Intensive Care Unit.

Introduction: Central venous pressure (CVP) measurement is essential in the management of certain clinical situations, including cardiac failure, volume overload and sepsis. CVP measurement requires catheterization of the central vein which is invasive and may lead to complications. The aim of this study was to evaluate the accuracy of measurement of CVP using a new noninvasive method based on near infrared spectroscopy (NIRS) in a group of cardiac surgical Intensive Care Unit (ICU) patients. Methodology: Thirty patients in cardiac surgical ICU were enrolled in the study who had an in situ central venous catheter (CVC). Sixty measurements were recorded in 1 h for each patient. A total of 1800 values were compared between noninvasive CVP (CVPn) obtained from Mespere VENUS 2000 CVP system and invasive CVP (CVPi) obtained from CVC. Results: Strong positive correlation was found between CVPi and CVPn (R = 0.9272, P < 0.0001). Linear regression equation ‑ CVPi = 0.5404 + 0.8875 × CVPn (r2 = 0.86, P < 0.001), Bland–Altman bias plots showed mean difference ± standard deviation and limits of agreement: −0.31 ± 1.36 and − 2.99 to + 2.37 (CVPi–CVPn). Conclusion: Noninvasive assessment of the CVP based on NIRS yields readings consistently close to those measured invasively. CVPn may be a clinically useful substitute for CVPi measurements with an advantage of being simple and continuous. It is a promising tool for early management of acute state wherein knowledge of CVP is helpful.

Feasibility of measuring superior mesenteric artery blood flow during cardiac surgery under hypothermic cardiopulmonary bypass using transesophageal echocardiography: An observational study.

Background: Abdominal complications being rare but results in high mortality, commonly due to splanchnic organ hypoperfusion during the perioperative period of cardiac surgery. There are no feasible methods to monitor intraoperative superior mesenteric artery blood flow (SMABF). Hence, the aim of this study was to evaluate the feasibility and to measure SMABF using transesophageal echocardiography (TEE) during cardiac surgery under hypothermic cardiopulmonary bypass (CPB). Methodology: Thirty‑five patients undergoing elective cardiac surgery under CPB were enrolled. Heart rate, mean arterial pressure (MAP), cardiac output (CO), SMABF, superior mesenteric artery (SMA) diameter, superior mesentric artery blood flow over cardiac output (SMA/CO) ratio and arterial blood lactates were recorded at three time intervals. T0: before sternotomy, T1: 30 min after initiation of CPB and T2: after sternal closure. Results: SMA was demonstrated in 32 patients. SMABF, SMA diameter, SMA/CO, MAP and CO-decreased significantly (P < 0.0001) between T0 and T1, increased significantly (P ≤ 0.001) between T1 and T2 and no significant change (P > 0.05) between T0 and T2. Lactates increased progressively from T0 to T2. Conclusion: Study shows that there is decrease in SMABF during CPB and returns to baseline after CPB. Hence, it is feasible to measure SMABF using TEE in patients undergoing cardiac surgery under hypothermic CPB. TEE can be a promising tool in detecting and preventing splanchnic hypoperfusion during perioperative period.

Effect of dexmedetomidine on diseased coronary vessel diameter and myocardial protection in percutaneous coronary interventional patients.

Introduction: Dexmedetomidine is an alpha‑2 agonist used for conscious sedation. It has also been shown to have a myocardial protective effect in off‑pump coronary artery bypass patients. The aim of the study was to assess the effect of dexmedetomidine for myocardial protection in percutaneous coronary interventional patients. Methodology: A total of 60 patients (group dexmedetomidine, n = 30 and group normal saline, n = 30) were enrolled in the study. Dexmedetomidine infusion (1 mcg/kg) over 15 min was given as a loading dose after coronary angiography in group dexmedetomidine (D) while normal saline was given in the control group (C) and later maintenance infusion was started at 0.5 mcg/kg/h in both the groups. Coronary vessel diameter was noted before (T0) and after (T1) loading dose of dexmedetomidine/saline in each group. Troponin T (Trop T) values were noted at baseline (T0), 6 h (T2), 12 h (T3) and 24 h (T4) after starting the loading dose. Hemodynamic variables (heart rate [HR] and blood pressure) were monitored at T0, T1, and at regular intervals till 2 h postprocedure. Results: Coronary vessel diameter and HR significantly decreased in group D as compared to control group (P < 0.05) whereas the decrease in Trop T at 6 h, 12 h, and 24 h were not statistically significant between the two groups. Conclusion: Dexmedetomidine decreases the coronary vessel diameter, but maintains the myocardial oxygen demand‑supply ratio by decreasing the HR. The decrease in Trop T is statistically insignificant at the doses used.

Transesophageal echocardiography estimation of coronary sinus blood flow for the adequacy of revascularization in patients undergoing off-pump coronary artery bypass graft.

Aims and Objectives: Physiologically coronary sinus (CS) drains the left coronary artery (LCA) territory. Stenosis of the branches of LCA may decrease the coronary sinus blood flow (CSBF). Any intervention that aims at restoring the flow of the stenosed vessel increases coronary artery flow that should consequently increase the CSBF. Hence, this study was undertaken to assess the CSBF before and after each branch of LCA to determine the adequacy of surgical revascularization in patients undergoing elective off pump coronary artery bypass grafting (OPCAB) using transesophageal echocardiography (TEE). Materials and Methods: Thirty consecutive patients scheduled for elective OPCAB were enrolled. CSBF was assessed before and after each branch of LCA revascularization using TEE. Left internal mammary artery (LIMA) Doppler was also obtained post LIMA to left anterior descending (LAD) grafting. Results: Hemodynamic and echocardiographic variables were compared by means of Student’s t-test for paired data before and after revascularization. The CSBF per beat (1.28 ± 0.71), CSBF per minute (92.59 ± 59.32) and total velocity time integral (VTI) (8.93 ± 4.29) before LAD grafting showed statistically significant increase to CSBF per beat (1.70 ± 0.89), CSBF per minute (130.72 ± 74.22) and total VTI (11.96 ± 5.68) after LAD revascularization. The CSBF per beat (1.67 ± 1.03), CSBF per minute (131.91 ± 86.59) and total VTI (11.00 ± 5.53) before obtuse marginal (OM) grafting showed statistically significant increase to CSBF per beat (1.91 ± 1.03), CSBF per min (155.20 ± 88.70) and total VTI (12.09 ± 5.43) after OM revascularization. In 9 patients, color flow Doppler of LIMA could be demonstrated which showed diastolic predominant blood flow after LIMA to LAD grafting. Conclusion: Demonstration of CSBF was simple and monitoring the trend of CSBF values before and after each graft of LCA territory will guide to determine the adequacy of surgical revascularization.

Role of perioperative transesophageal echocardiography in the management of adolescent truncus arteriosus: Rare case report.

Truncus arteriosus (TA) is a rare congenital heart disease defined as a single arterial vessel arising from the heart that gives origin to the systemic, pulmonary and coronary circulations. The truncal valve in majority of the cases is tricuspid though quadricuspid and bicuspid valves have been reported. Patients with TA typically have a large nonrestrictive sub truncal ventricular septal defect. Survival of these infants beyond 1‑year is uncommon. Here, we report a unique case of 12‑year‑old female patient with persistent TA who underwent surgical repair by using transesophageal echocardiography as a monitoring device during the perioperative management.

Assessment of genetic diversity in Brassica juncea Brassicaceae genotypes using phenotypic differences and SSR markers / Evaluación de la diversidad genética en genotipos de Brassica juncea Brassicaceae utilizando diferencias fenotípicas y marcadores SSR

Brassica mustard species represent one of the most important oilseed crops in India, nevertheless, their genetic diversity is barely known. A better understanding on this topic is essential for the proper utilization of genotypes in breeding programmes. We evaluated the genetic diversity among 44 Indian mustard Brassica juncea genotypes including varieties/purelines from different agro-climatic zones of India and few exotic genotypes Australia, Poland and China. For this, we used A and B genome specific SSR markers and phenotypic data on 12 yield and yield contributing traits. Out of the 143 primers tested, 134 reported polymorphism and a total of 355 alleles were amplified. Dendrograms based on Jaccards similarity coefficients and Manhattan dissimilarity coefficients were generated based on an average linkage algorithm UPGMA using marker data and phenotypic data. Genotypes were grouped into four clusters based on genetic distances. Both the clustering patterns based on Jaccards similarity and Manhattan dissimilarity coefficients, independently, discriminated the genotypes effectively as per their pedigree and origin. PCoA revealed that, the grouping of genotypes based on SSR marker data is more convincing than phenotypic data, however, the correlation between phenotypic and genetic distance matrices was observed to be very low r=0.11. Hence, for diversity studies reliability on molecular markers is worth proving and SSR markers are the stronger tools than quantitative traits in discriminating B. juncea genotypes.

Las especies de mostaza del género Brassica representan uno de los cultivos de semillas oleaginosas más importantes en India, sin embargo, su diversidad genética es poco conocida. Para la utilización de genotipos en programas de cultivos resulta esencial un mayor conocimiento sobre este tema. Debido a ello, se evaluó la diversidad genética entre 44 genotipos de mostaza de la India Brassica juncea incluyendo variedades y líneas puras de diferentes zonas agro-climáticas de la India y algunos genotipos exóticos Australia, Polonia y China. Para ello, se utilizaron marcadores SSR específicos del genoma A y B y datos fenotípicos del rendimiento de 12 cosechas y sus características. De los 143 primers evaluados, 134 reportaron polimorfismo y un total de 355 alelos fueron amplificados. Se generaron dendrogramas a partir de los coeficientes de similitud de Jaccard y de disimilitud Manhattan, basados en un algoritmo de vinculación promedio UPGMA. Se utilizaron datos de marcadores genéticos y datos fenotípicos. Los genotipos se agruparon en cuatro grupos basados en las distancias genéticas. Ambos patrones de agrupamiento, tanto los basados en los coeficientes de similitud de Jaccard como los basados en los de disimilitud Manhattan, separaron independientemente los genotipos por su genealogía y origen, de una manera efectiva. El PCoA reveló que la agrupación de genotipos basada en datos de marcadores SSR, es más convincente que los datos fenotípicos, sin embargo, se observó que la correlación entre las matrices de distancia fenotípica y genética resultó muy baja r=0.11. Por lo tanto, para estudios de diversidad basados en marcadores moleculares es necesario realizar más pruebas. Los marcadores SSR constituyen herramientas más eficientes para discriminar entre genotipos de B. juncea, que las características cuantitativas.

Comparison of left internal mammary artery diameter before and after left stellate ganglion block.

Aims and Objectives: Left internal mammary artery (LIMA) is the preferred arterial conduit for coronary artery bypass grafting. Various pharmacological agents are known to increase LIMA blood flow. Sympathetic blockade mediated by stellate ganglion block (SGB) has been used to provide vasodilatation in the upper extremities and in the treatment of refractory angina. We investigated effect of left stellate ganglion block (LSGB) on LIMA diameter. Materials and Methods: In 30 diagnosed patients of triple vessel coronary artery disease, LSGB was given under fluoroscopic guidance by C6 transverse process approach using 10 ml of 1% lignocaine. LIMA diameter was measured before and 20 min after the block at 2nd, 3rd, 4th and at 5th rib level. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded before and 20 min after the block. Results: The LIMA diameter increased significantly at 2nd (2.56 ± 0.39 vs. 2.99 ± 0.40; P < 0.0001), 3rd (2.46 ± 0.38 vs. 2.90 ± 0.40; P < 0.0001), 4th (2.39 ± 0.38 vs. 2.84 ± 0.41; P < 0.0001) and 5th rib level (2.35 ± 0.38 vs. 2.78 ± 0.40; P < 0.0001). No statistically significant change occurred in HR, SBP, DBP and MAP before and 20 min after LSGB. Conclusions: LSGB significantly increased the LIMA diameter. The LSGB can be considered as an alternative to topical and systemic vasodilators for reducing vasospasm of LIMA.