relationship between uterine artery two-dimensional color Doppler measurement and pregnancy outcome: a prospective observational study

Background: the purpose of the study was to evaluate the role of uterine blood flow parameters measured by uterine artery two-dimensional [2D]-power color Doppler [PCD] ultrasound in predicting fertility outcomes in women undergoing IVF-ET cycles

Methods: in this prospective observational study, a total of 188 infertile women who underwent IVF-ET cycles were investigated. Uterine artery 2D-PD measurements were taken during early follicular phase and on day of trigger. Pulsatility Index [PI], Resistant Index [RI], Peak Systolic Velocity [PSV], and Systolic/Diastolic ratio [S/D] were measured. Statistical correlation was sought between the doppler parameters and fertility outcomes

Results: the pregnancy rate was 40.43% [76/188]. The women who conceived [n= 76] [Group A] were found to have mean age of 31.2+/-3.9 years whereas the nonpregnant group of women [n=112] [Group B] had mean age of 31.45+/-4.25 years. The mean PI measurements subsequently during early follicular phase and on the day of hCG trigger between group A and group B were comparable [2.09+/-1.15 versus 1.9+/-0.95; p=0.385 and 1.86+/-1.12 versus 2.03+/-1.0; p=0.192, respectively]. No significant changes in the uterine artery PSV values and S/D values and RI were noted during the cycle

Conclusion: uterine artery doppler evaluation in women undergoing IVF cycles was not predictive of the pregnancy outcomes

Emergence of non-albicans Candida species and antifungal resistance in intensive care unit patients

Objective: To evaluate the epidemiology of candidiasis and the antifungal susceptibility profile of Candida species isolated from the intensive care unit (ICU) patients. Methods: The study used a qualitative descriptive design. Relevant samples depending on organ system involvement from 100 ICU patients were collected and processed. Identification and speciation of the isolates was conducted by the biochemical tests. Antifungal susceptibility testing was carried out as per CLSI-M27-A3 document. Results: Ninety Candida isolates were isolated from the different clinical samples: urine (43.3%), tracheal aspirate (31.1%), urinary catheter (12.2%), endotracheal tube (7.8%), abdominal drains (3.3%), sputum (2.2%). The incidence of candidiasis caused by non-albicans Candida (NAC) species (63.3%) was higher than Candida albicans (36.7%). The various NAC species were isolated as: Candida tropicalis (41.1%), Candida glabrata (10%), Candida parapsilosis (6.7%), Candida krusei (3.3%) and Candida kefyr (2.2%). The overall isolation rate of Candida species from samples was 53.3%. Antifungal susceptibility indicated that 37.8% and 7.8% of the Candida isolates were resistant to fluconazole and amphotericin B, respectively. Conclusions: Predominance of NAC species in ICU patients along with the increasing resistance being recorded to fluconazole which has a major bearing on the morbidity and management of these patients and needs to be further worked upon.

double blind, randomized, controlled study of the effect of addition of butorphanol to 0.25% bupivacaine for bilateral ilioinguinal nerve blocks in post-caesarean patients

Ilioinguinal nerve block [IIB] is highly effective in controlling postoperative pain following inguinal herniorrhaphy, orchidopexy and caesarean sections. Butorphanol has been claimed to increase the duration and quality of analgesia in various nerve blocks. This prospective, randomized, double blind study was designed to compare the effect of butorphanol when added to bupivacaine [0.25%] with plainbupivacaine [0.25%] in bilateral IIBs in post-caesarean patients. This prospective, double blind, randomized, controlled study was conducted at University College of Medical Sciences / GTB Hospital, Delhi, which is a tertiary care healthcare centre, from March 2006 to December 2008. Sixty ASA 1 or 2 patients, scheduled for elective caesarean section via Pfannensteil incision under general anaesthesia, were selected for the study. The patients who had a known allergy to any of the drugs used; or had placenta previa, eclampsia or severe preeclampsia were excluded from the study. The patients were randomly divided into two groups of 30 each; Group A, to receive bilateral IIB with 0.25% bupivacaine [to a volume of 10 ml on each side], and Group B to receive bilateral IIB with 0.25% bupivacaine plus 1 mg butorphanol. The randomization was clone using computer generated random number tables. All the patients completed the study. After administering appropriate antacid prophylaxis, routine general anaesthetic technique was used with rapid sequence intubation. At delivery of baby, all patients received oxytocin infusion followed by inj. morphine [0.1 mg/kg] intravenously. Just after the last stitch, bilateral IIB was performed using the prefilled syringes with the block solution. Neuromuscular blockade was reversed and inj. diclofenac sodium [1.5 mg/kg i.m.] was selected as a rescue analgesic. Numeric pain scale [marked 0-10] and simple descriptive pain scoring were used for assessment of pain intensity at 1 st, 2nd, 3rd and 4th hours postoperatively and then after 24 hours. The time to first rescue analgesic was noted and the study was terminated with that. The adverse effects, if any, were also noted. More than 86% of Group B and 70% of Group A complained of no pain in immediate 4 hours of postoperative period. In Group B, six patients felt no pain even after 4 hours of postoperative period. In Group A, all patients developed pain after 2 hours. Maximum analgesic effect was observed in Group B [18 hours]. Bilateral IIB with 0.25% bupivacaine and 2 mg of butorphanol is more effective and safe post-operative analgesic technique in patients undergoing caesarean section