Prevention of post spinal hypotension; comparison between preloading with and without intramuscular ephedrine in elderly patients undergoing inguinal hernia surgery

Objective of the study is to evaluate the efficacy of intramuscular ephedrine along with preloading in prevention of post spinal hypotension in elderly patients undergoing inguinal hernia surgery. This is a quasi experimental study. The study was conducted at the department of Anaesthesia and Intensive Care Combined Military Hospital, Peshawar over a period of one year. In a double-blind, randomized study, 80 elderly patients undergoing inguinal hernia surgery under spinal anaesthesia divided into two equal groups of A and B. Forty patients received i/m inj of ephedrine 45mg deep in the paravertebral muscles immediately after injection of bupivacaine, and 40 received an equal volume of saline. Patients in both groups were given the same volumes of fluid before anaesthesia. The incidence of hypotension [Systolic arterial pressure <90mmHg or <80% of baseline] were recorded. and incidence of fall in the heart rate was recorded. Systolic arterial pressure during the first 60 min after anaesthesia remained significantly more stable in the ephedrine-treated group, and there was also a significantly smaller number of patients in this group who had decreases in pressure of more than 30% of pre-block levels and fewer required rescue i.v. Ephedrine. An increase in heart rate or systolic pressure of > 20% from baseline was found in two patients in the ephedrine group and in one patient in the placebo group. We conclude that ephedrine 45mg administered in the paravertebral muscles immediately after plain bupivacaine spinal anaesthesia is a simple and effective means of reducing the incidence of hypotensive episodes in the elderly patient

Experience with polyclonal immunoglobulin therapy in poly trauma patients with severe sepsis

To evaluate the effects of intravenous immunoglobulin therapy on progression of severe sepsis in patients of poly trauma. Quasi-experimental study. Combined Military Hospital Peshawar from June 2008 to Dec 2009. Forty six patients of poly trauma with severe sepsis were included. Along with the standard management i.e., surgical management, fluid resuscitation, antibiotics, analgesics, ionotropic, ventilatory and nutritional support, IVIG 5% [intravenous immunoglobulin] was infused over a period of 6 hours and repeated for three consecutive day. Sequential Organ Failure Assessment [SOFA] score was used to assess the progress in all the patients. At the time of enrolment mean SOFA score was 5.41 +/- 1.127 and on the 15th day it was 1.62 +/- 2.24, mean age was 39.21 +/- 10.26 years. Thirty four patients [73.91%] developed gram negative sepsis and eighteen patients [39.13%] developed septic shock. Mean duration of stay in ICU and on of these patients was 30.43%. The IVIG administration, when used along with the standard management appears to improve significantly the prognosis in patients of poly trauma with severe sepsis

Biological control of potato black scurf by rhizosphere associated bacteria

The present work was carried out to study the potential of plant rhizosphere associated bacteria for the biocontrol of potato black scurf disease caused by Rhizoctonia solani Khun AG-3. A total of twenty-eight bacteria isolated from diseased and healthy potato plants grown in the soil of Naran and Faisalabad, Pakistan were evaluated for their antagonistic potential. Nine bacterial strains were found to be antagonistic in vitro, reduced the fungal growth and caused the lysis of sclerotia of R. solani in dual culture assay as well as in extracellular metabolite efficacy test. The selected antagonistic strains were further tested for the production and efficacy of volatile and diffusible antibiotics, lytic enzymes and siderophores against R. solani. Selected antagonistic bacteria were also characterized for growth promoting attributes i.e., phosphate solubilization, nitrogen fixation and indole acetic acid production. Biocontrol efficacy and percent yield increase by these antagonists was estimated in greenhouse experiment. Statistical analysis showed that two Pseudomonas spp. StT2 and StS3 were the most effective with 65.1 and 73.9 percent biocontrol efficacy, as well as 87.3 and 98.3 percent yield increase, respectively. Potential antagonistic bacterial strain StS3 showed maximum homology to Pseudomonas sp. as determined by 16S rRNA gene sequencing. These results suggest that bacterial isolates StS3 and StT2 have excellent potential to be used as effective biocontrol agents promoting plant growth with reduced disease incidence.