Acute Kidney Injury among Post Cardiac Surgery Patients : A Retrospective Study

Background : Acute Kidney Injury (AKI) is a common complication Post Cardiac Surgery with reported incidence of 20-70%. Various studies have been conducted worldwide on risk factors contributing to the etiology of AKI in Cardiac surgery patients. We undertook similar study to understand the etiology and risk factors associated with AKI at Goa Medical College hence we undertook this study. Methodology : A retrospective record based observational study was conducted at Goa Medical College; wherein records of 419 patients who underwent Cardiac Surgery during the study period were analyzed for pre-operative, intra-operative and postoperative variables. Kidney Disease Improving Global Outcomes criteria were used to study the incidence of AKI. The Data was entered in Microsoft Excel and analysed using SPSS version 22.0. Chi-square test and Student t test were used as a test of significance. Results : Out of 419 patient records reviewed; 40.3% patients developed AKI after Cardiac Surgery. Age, Sex, h/o previous Cardiac Surgery, CPB duration, Aortic Cross Clamp Time, addition of vasopressor etc. were some of the significant risk factors associated. AKI associated with Cardiac Surgery was associated with a mortality of 8.3%. Mean duration of ventilation 38.48�.27 hrs. and ICU stay 6.12�15 days was comparatively longer than patients without AKI (P<0.001). Conclusion : We concur that AKI is a serious complication in patients undergoing Cardiac Surgery and has significant impact on the outcome of the patients in terms of duration of ICU stay, duration of ventilation and mortality. There is need to identify modifiable risk factors at the earliest and develop approaches to improve the outcome and decrease the AKI associated morbidity and mortality

Echocardiographic detection of free‑floating thrombus in left ventricle during coronary artery bypass grafting.

We report an incident of detection of a free‑floating thrombus in the left ventricle (LV) using intraoperative two‑dimensional (2D) and three‑dimensional (3D) transesophageal echocardiography (TEE) during proximal coronary artery bypass graft anastomosis. A 58‑year‑old man presented to us with a 6‑month history of chest pain without any history suggestive of myocardial infarction or transient ischemic attacks. His preoperative echocardiography revealed the systolic dysfunction of LV, mild hypokinesia of basal and mid‑anterior wall, and the absence of an aneurysm. He was scheduled for on‑pump coronary artery bypass surgery. On intraoperative TEE before establishing cardiopulmonary bypass (CPB), a small immobile mass was found attached to LV apical area. After completion of distal coronary artery grafting, when the aortic cross‑clamp was removed, the heart was filled partially and beating spontaneously. TEE examination using 2D mode revealed a free‑floating mass in the LV, which was suspected to be a thrombus. Additional navigation using biplane and 3D modes confirmed the presence of the thrombus and distinguished it from papillary muscles and artifact. The surgeon opened the left atrium after re‑establishing electromechanical quiescence and removed a thrombus measuring 1.5 cm × 1 cm from the LV. The LV mass in the apical region was no longer seen after discontinuation of CPB. Accurate TEE‑detection and timely removal of the thrombus averted disastrous embolic complications. Intraoperative 2D and recent biplane and 3D echocardiography modes are useful monitoring tools during the conduct of CPB.

Sex verification tests: ethical, legal and social aspects.

Lay people often wonder at all the fuss about identifying the biological sex of an individual. They may recall a granny or midwife, immediately after a delivery, even in the dim light, declaring with ease that it’s a girl, or a boy, to the rejoicing crowd waiting eagerly outside the delivery room. When it is so simple, why are doctors, sports administrators and investigators making such a hue and cry about this? How do you identify the biological sex of an individual? What is this fuss about sex verification tests? Are they the same as gender verification tests? What are the ethical, legal and social aspects of these sex verification tests? I will try to answer some of these questions.

Legal changes towards justice for sexual assault victims.

The crime of rape is a major problem in India, evident from the reports in the press as well as official statistics. The accused has often gone free, because the victim did not file a complaint, or because of poor evidence gathering and well as lacunae in the law. This paper presents an overview of the laws applicable to sexual assault cases and amendments in these laws, specifically in terms of the roles and responsibilities of healthcare providers to bridge the gap in providing medical evidence to the courts.