Effect of intraoperative alveolar recruitment maneuver on intraoperative oxygenation and postoperative pulmonary function tests in patients undergoing robotic-assisted hysterectomy: a single-blind randomized study

Abstract Background Robotic-Assisted Hysterectomies (RAH) require Trendelenburg positioning and pneumoperitoneum, which further accentuate alteration in respiratory mechanics induced by general anesthesia. The role of Recruitment Maneuver (RM) as a lung-protective strategy during intraoperative surgical settings has not been much studied. We planned this study to evaluate the effect of RM on perioperative oxygenation and postoperative spirometry using PaO2/FiO2 and FEV1/FVC, respectively in patients undergoing RAH. Methods Sixty-six ASA I‒II female patients scheduled for elective RAH were randomized into group R (recruitment maneuver, n = 33) or group C (control, n = 33). Portable spirometry was done one day before surgery. Patients were induced with general anesthesia, and mechanical ventilation started with volume control mode, with Tidal Volume (TV) of 6-8 mL.kg−1, Respiratory Rate (RR) of 12 min, inspiratory-expiratory ratio (I: E ratio) of 1:2, FiO2 of 0.4, and Positive End-Expiratory Pressure (PEEP) of 5 cmH2O. Patients in group R received recruitment maneuvers of 30 cmH2O every 30 minutes following tracheal intubation. The primary objectives were comparison of oxygenation and ventilation between two groups intraoperatively and portable spirometry postoperatively. Postoperative pulmonary complications, like desaturation, pulmonary edema, pneumonia, were monitored. Results Patients who received RM had significantly higher PaO2 (mmHg) (203.2+-24.3 vs. 167.8+-27.3, p < 0.001) at T2 (30 min after the pneumoperitoneum). However, there was no significant difference in portable spirometry between the groups in the postoperative period (FVC, 1.40 ± 0.5 L vs. 1.32 ± 0.46 L, p= 0.55). Conclusion This study concluded that intraoperative recruitment did not prevent deterioration of postoperative spirometry values; however, it led to improved oxygenation intraoperatively.

VacPred: Sequence-based prediction of plant vacuole proteins using machine-learning techniques

Subcellular localization prediction of the proteome is one of major goals of large-scale genome or proteomesequencing projects to define the gene functions that could be possible with the help of computationalmodeling techniques. Previously, different methods have been developed for this purpose using multi-labelclassification system and achieved a high level of accuracy. However, during the validation of our blind datasetof plant vacuole proteins, we observed that they have poor performance with accuracy value range from*1.3% to 48.5%. The results showed that the previously developed methods are not very accurate for the plantvacuole protein prediction and thus emphasize the need to develop a more accurate and reliable algorithm. Inthis study, we have developed various compositions as well as PSSM-based models and achieved a highaccuracy than previously developed methods. We have shown that our best model achieved *63% accuracyon blind dataset, which is far better than currently available tools. Furthermore, we have implemented our bestmodels in the form of GUI-based free software called ‘VacPred’ which is compatible with both Linux andWindow platform. This software is freely available for download at www.deepaklab.com/vacpred.

Aerosol, a health hazard during ultrasonic scaling: A clinico‑microbiological study.

Context: Ultrasonic scaling is a routinely used treatment to remove plaque and calculus from tooth surfaces. These scalers use water as a coolant which is splattered during the vibration of the tip. The splatter when mixed with saliva and plaque of the patients causes the aerosol highly infectious and acts as a major risk factor for transmission of the disease. In spite of necessary protection, sometimes, the operator might get infected because of the infectious nature of the splatter. Aim: To evaluate the aerosol contamination produced during ultrasonic scaling by the help of microbiological analysis. Materials and Methods: This clinico‑microbiological study consisted of twenty patients. Two agar plates were used for each patient; the first was kept at the center of the operatory room 20 min before the treatment while the second agar plate was kept 40 cm away from the patient’s chest during the treatment. Both the agar plates were sent for microbiological analysis. Statistical Analysis: The statistical analysis was done with the help of STATA 11.0 (StataCorp. 2013. Stata Statistical Software, Release 13. College Station, TX: StataCorp LP, 4905 Lakeway Drive College Station, Texas, USA). Statistical software was used for data analysis and the P < 0.001 was considered to be statistically significant. Results: The results for bacterial count were highly significant when compared before and during the treatment. The Gram staining showed the presence of Staphylococcus and Streptococcus species in high numbers. Conclusions: The aerosols and splatters produced during dental procedures have the potential to spread infection to dental personnel. Therefore, proper precautions should be taken to minimize the risk of infection to the operator.

Comparison of Two Different Doses of Dexmedetomidine as an Adjuvant to Intrathecal Bupivacaine in Patients Undergoing Femur Surgery.

Background: Duration of action of local anaesthetic is an important limiting factor in spinal anaesthesia. Dexmedetomidine, selective α 2- agonist has been recently used in addition to other adjuvants to prolong the duration of intrathecal local anaesthetics. Aim: To compare two different doses of dexmedetomidine added to heavy bupivacaine 0.5% intrathecally for femur surgeries. Methods: In this prospective double blind trial, one hundred and twenty patients were randomly allocated into two groups, D1 and D2. Group D1 received 12.5 mg 0.5% hyperbaric bupivacaine and 5 μg dexmedetomidine. Group D2 received 12.5 mg 0.5% hyperbaric bupivacaine and 10 μg dexmedetomidine. Results: Sensory and motor block were comparable in both groups in terms of characteristics like the highest level of sensory block achieved, time to achieve maximum sensory block and time of two segment regression, time to achieve maximal motor block and duration of regression to Bromage scale 0. However time of first analgesic request and total analgesic requirement were significantly reduced by increasing intrathecal dose of dexmedetomidine to 10 μg without any undesirable effects. Conclusion: Intrathecal dose of 10 μg dexmedetomidine provided an increased duration of sensory compared to 5μg dosing, with no significant increase in duration of motor blockade or the incidence of hypotension, bradycardia and any other undesirable side-effects.

To compare intrapartum cardiotocographic (CTG) recording with conventional intermittent auscultation during labor.

Standard evaluation of fetal well-being during labor includes the periodic assessment of the fetal heart rate (FHR), its pattern and response to intrapartum stimuli and events. Effective methods of evaluation and meaningful interpretation of FHR data range from non-invasive techniques like Intermittent Auscultation, continuous electronic fetal heart rate (FHR) monitoring to invasive techniques of fetal blood gas analysis and fetal ECG.

Idiopathic granulomatous mastitis: a great diagnostic challenge.

Idiopathic granulomatous mastitis is a rare chronic inflammatory lesion of breast which presents as a spectrum of diseases and is diagnosed only histological. It is often a diagnosis of exclusion in most of the cases. Medical and surgical treatments have been tried with varied success rates and till today no standard protocol could be made in its management though excision remains the treatment of choice in refractory cases which is associated with morbidity more due to psychological factors. In the present case, medical treatment was tried in the initial phase followed by wide excision.