Bloodless Cardiac Surgery- Comparison of Outcomes between Two Groups in Post Cardiac Surgery Patients with and without Blood Transfusions

Blood transfusion is an integral part of cardiac surgery; however, transfusion of blood and blood products has inherent hazards. Avoidance of blood transfusion during cardiac surgery eliminates the hazards of blood transfusion and improves the outcome. This study compares the post-operative outcome of patients who underwent cardiac surgery without blood transfusion with those who required multiple blood transfusions.METHODSPatients who underwent cardiac surgery in a unit in Department of Cardiothoracic and Vascular Surgery (CTVS), SSKM Hospital, between January 2017 to December 2018 were studied retrospectively. The study population was divided into 2 groups. Those patients who underwent cardiac surgery and did not receive blood transfusion were included in Group A (n=68) and those who received multiple blood transfusion were included in Group B (n=340). Statistical data was analysed.RESULTSThe recovery of patients in terms of mechanical ventilation time (mean, 8.2 vs 12.5 hrs.), length of Intensive Care Unit (ICU) stay (mean, 1.5 vs 3.3 days) was significantly shorter in group A patients than group B. The length of hospital stay also was significantly less in group A patients (mean 5.2 vs 7.3 days, p=<0.0001). Patients with history of smoking, chronic obstructive pulmonary disease (COPD), had higher incidences of blood transfusions (p-0.003, 0.001 respectively). There was lesser incidence of surgical site infection and respiratory complications in Group A patients, but it was not statistically significant. However, incidence of haematuria was more in Group B patients which was clinically significant (p = 0.011). There was no incidence of renal failure, mediastinal bleeding requiring re-exploration, jaundice and mortality in Group A patients.CONCLUSIONSCareful surgical and perfusion techniques, with meticulous haemostasis should be performed in all patients of cardiac surgery. Elimination of blood during cardiac surgery augments faster recovery of patients.

Fiber-Reinforced Composite Resin Fixed Partial Denture To Restore Missing Anterior Teeth: A Case Report

Prosthetic dentistry constantly evolving as a result of innovative treatment solution based on new material, treatment technique,and technologies. The advent of fiber reinforced has further increased the potential uses of composite material within prostheticdentistry. As we know that, missing anterior teeth are serious concern in the social life of a patient. To restore the missing anteriorteeth, we are having several treatment options such as conventional fixed partial denture and implant-supported restoration allthese are may the treatment of choice, but fiber-reinforced composite (FRC) resin offers a conservative, fast, and cost-effectivealternative for single or multiple teeth replacement. In this paper, we are presenting how to use FRC technology to restoreanterior edentulous area in terms of esthetic values and functionality.

Inhibition of protein kinases by anticancer DNA intercalator, 4-butylaminopyrimido4',5':4,5thieno(2,3-)quinoline

Targeting protein kinases (PKs) has been a promising strategy in treating cancer, as PKs are key regulators of cell survival and proliferation. Here in this study, we studied the ability of pyrimido[4',5':4,5]thieno(2,3-)quinolines (PTQ) to inhibit different PKs by performing computational docking andscreening. Docking studies revealed that 4-butylaminopyrimido[4',5':4,5]thieno(2,3-)quinoline (BPTQ) has a higher order of interaction with the kinase receptors than other PTQ derivatives.screening confirms that BPTQ inhibits VEGFR1 and CHK2, with the ICvalues of 0.54 and 1.70 µmol/L, respectively. Further, cytotoxicity of BPTQ was measured by trypan blue assay. Treatment with BPTQ decreased the proliferation of HL-60 cells with an ICvalue of 12 µmol/L and induces apoptosis, as explicated by the fall in the mitochondrial membrane potential, annexin V labeling and increased expression of caspase-3. Taken together, these data suggest that BPTQ possess ability to inhibit PKs and to induce cell death in human promyelocytic leukemia cells.

A Double Blind Randomized, Placebo Controlled Study Evaluating the Effect of Ondansetron in Reducing Spinal- Induced Hypotension Using Low Dose Bupivacaine in Parturients Undergoing Caesarean Section.

Background: Spinal induced hypotension is the most common intraoperative complication after spinal anesthesia during cesarean delivery. Various adjuvant techniques/drugs had been used in the past to minimize the haemodynamic effects of spinal anaesthesia. Five-hydroxytriptamine (5-HT), a serotonergic receptor, may be an important factor associated with inducing the Bezold Jarish reflex (BJR) that may lead to the bradycardia and hypotension in the setting of decreased blood volume. Some animal and human studies further supported that BJR can be decreased by 5-HT3 antagonists. Aim: The present study work is to assess the effects of Inj. Ondansetron (a selective 5‑HT3 receptor antagonist) in preventing spinal induced hypotension in patient undergoing elective Caesarean section. Methods: Sixty parturients scheduled for elective caesarean section were randomly allocated into two groups. Group O (30 patients): Inj. Ondansetron (4 mg IV) diluted in 10 mL of normal saline, administered 5 minutes before spinal anaesthesia and Group N (30 patients): Normal saline 10 mL given 5 minutes before spinal anaesthesia. We observed the haemodynamic parameters as our primary outcome and neonatal outcome in terms of APGAR scoring as secondary outcome. Results: Both the groups were comparable in terms of demographic characteristics. The decrease in mean arterial pressure in Group O was significantly lesser than Group N from 6 min until 30 min. The requirement of vasopressor (Inj. Phenylephrine) was significantly less in Group O than Group N (P = 0.015). Neonatal outcome in terms of APGAR Score and gas analysis were comparable between the groups. Conclusion: Inj. Ondansetron (4 mg IV), given intravenously 5 min before subarachnoid block reduced hypotension and vasopressor use in parturients undergoing elective caesarean section.

prospective randomised double blind study comparing the efficacy of peri-articular injection with bupivacaine and levobupivacaine for postoperative pain control in total knee arthroplasty

Objective: Adequate control of postoperative pain management after total knee arthroplasty [TKA] remains a big challenge for the clinicians, as if left unrelieved, it might cause a delayed recovery of the patient and a prolonged hospital stay. Not much literature is found regarding the peri-articular use of levobupivacaine in patients undergoing TKA. So, we aimed to compare the efficacy of peri-articular infiltration of bupivacaine and levobupivacaine for postoperative pain control in TKA

Methodology: We organised a randomised, prospective, double blind study and enrolled sixty patients undergoing TKA by a single surgeon. Group L [Levobupivacaine] received peri-articular injections with 0.20% levobupivacaine before wound closure and Group B [Bupivacaine] patients received a 0.25% bupivacaine injection. All the cases were performed by a standardized anesthetic technique, postoperative pain control and rehabilitation protocol

Results: Postoperative morphine consumption within first twelve hours was observed to be significantly reduced in Group L [P < 0.05]. However, no significant difference was observed in the two groups on comparing postoperative morphine consumption between 12-96 hours. VAS scores were also found to be comparable between the groups

Conclusion: Administration of peri-articular injection with levobupivacaine before the wound closure was shown to be an effective method for postoperative analgesia after TKA with minimal side effects

Adenocarcinoma of sweat gland: case report and review of literature.

Sweat gland carcinoma is a rare malignant tumour, first described in 1865, with approximately 220 cases reported in last 30 years. Lower limbs are the most common site of involvement, followed by the upper extremities, and the head. Trunk is rarely involved. Five histological types have been described, most common being porocarcinomas followed by ductal carcinomas, adenoid cystic carcinomas, syringomatous carcinomas and mucinous carcinomas. These are aggressive tumours with potential for distant metastasis. Wide surgical excision is the treatment of choice and the overall prognosis is poor. Here we report another case of sweat gland adenocarcinoma with no evidence of metastasis

Pacing Indications and Modes in Bradyarrhythmia Patients: Gender Related Differences.

Gender differences are increasingly recognized in cardiology. It is also well known that women have higher complications and a higher mortality related to coronary procedures. In arrhythmias, gender-specific variations in the electrophysiological structure of the heart or hormonal effects may explain some of the gender differences. The aim of this study was to evaluate gender differences according to their risk factors, indications and modes of pacing. A total of 267 patients who had pacemaker implantation for bradyarrhythmia indications were enrolled in our study. A pre-designed questionnaire was filled to record their baseline characteristics, clinical indications and mode of pacing. Out of 267 patients 190 were male and 77 were female. Data was analyzed with SPSS 16.0 software (SPSS, Chicago, IL, USA) The pacemaker implantation requirement was 31% significantly lower among males compared with females who were hypertensive (RR=0.69, 95%CI=0.58-0.82, p=0.0001) and 1.57 times (RR=1.57, 95%CI=1.32-1.87, p=0.0001) significantly higher among male patients than females who were the tobacco user in any form. The single chamber requirement was 1.41 times significantly (RR=1.41, 95%CI=1.16-1.71, p=0.0001) higher in males than females. The risk analysis showed that complete heart blockage (p= 0.02) and sick sinus syndrome (p= 0.01) were significantly higher in males as compared with females. In conclusion male patients had more CHB, sick sinus syndrome and syncope as primary pacemaker indication, compared with female patients. Smoking was the most prominent risk factor in male and hypertension in female and most importantly there were significant gender differences in indications leading to pacing.

Anatomical parameters of Neck; Predictors for Laryngoscopy and Intubation.

One of the common problems encountered by anaesthetists is difficult airway. Proper laryngoscopy and intubation is required by the anaesthetists for securing the airway by endotracheal tube. Anatomic parameters of the neck may prove to be a better predictors of airway particularly in difficult airway scenarios.

Influence of APOA5 (rs662799 and rs3135506) gene polymorphism in acute myocardial infarction patients and its association with basic coronary artery disease risk factors.

The aim of this study was to examine the allele and genotype of APOA5 -1131T/C (rs662799) and APOA5-56C/G (rs3135506) gene in acute myocardial (AMI) case and control subjects. 304 case and 304 controls were enrolled in this study. DNA was extracted using salting out method followed by polymerase chain reaction amplification and restriction endonuclease digestion (using MseI for -1131T/C and Taq1 for -56C/G). Digested PCR products were identified using agarose gel electrophoresis and stained with ethidium bromide. There was a strong association between APOA5 -1131T/C (TC vs. TT, OR= 1.58 and CC vs. TT OR= 2.43) and APOA5 -56C/G (CG vs. CC, OR= 1.64 and GG vs. CC, OR= 2.44) polymorphisms with AMI. Out of the six potential risk factors for coronary artery disease, only smoking, diabetes and hypertension were found to be associated with APOA5 gene and increased the risk of AMI. Smoking was the most prominent risk factor for both the genes. Other risk factors like history of dyslipidemia, obesity and family history of coronary artery disease did not reveal any potential association with the candidate gene. Our data demonstrate that both the SNPs in the APOA5 gene (-1131T/C, and -56C/G) were strongly associated with AMI in north Indian population.

Indian E-Banking Scenario.

Now a days most of the banking happens while you are sipping coffee or taking an important call. ATMs are at your doorstep. Banking services are accessible 24x7. There are more plastic cards in your wallet than currency notes. A huge part of this change is due to advent of IT. Banks today operate in a highly globalized, liberalized, privatized and a competitive environment. In order to survive in this environment banks have to use IT. Indian banking industry has witnessed tremendous developments due to sweeping changes that are taking place in the information technology. Electronic banking has emerged from such an innovative development. The objective of the present paper is to study and analyze the progress made by Indian banking industry in adoption of technology. The study is secondary based and analytical in nature. The progress in e-banking in Indian banking industry is measured through various parameters such as Computerization of branches, Automated Teller Machines, Transactions through Retail Electronic Payment Methods etc. Statistical and mathematical tools such as simple growth rate, percentages and averages etc. are used. The paper also highlights the challenges faced by Indian banks in adoption of technology and recommendations are made to tackle these challenges. The paper concludes that in years to come e-banking will not only be acceptable mode of banking but preferred mode of banking.

In vitro assessment of Ag and TiO2 nanoparticles cytotoxicity.

Background: Silver (Ag) and titanium dioxide (TiO2) nanoparticles are the most eminent nanoproducts. Due to their antimicrobial and antifungal activity, they have been the well commercialized nanosubstances. The hazards associated with human exposure to Ag and TiO2 nanoparticles should be investigated, and hence both the nanoparticles were synthesized to facilitate the risk assessment process. Methods: Prior to the cytotoxic studies, Dynamic Light Scattering (DLS) and Transmission Electron Microscopy (TEM) were carried out to ensure the particle size. Glutathione (GSH), Nitric Oxide (NO) and superoxide dismutase (SOD) estimated by ELISA method. Results: In the present study, the cytotoxicity of Ag and TiO2 were investigated by using the glutathione (GSH), Nitric Oxide (NO) and superoxide dismutase (SOD) by incubating various concentration of silver (0.25 to 76 mg/mL) and titanium dioxide (0.25 to 2 mg/mL) nanoparticles in different incubation periods (24, 48 and 74 hours at 37°C) in plasma. Results observed that significant decrease (P <0.0001) in the concentration of GSH associated with increased concentration of NO (P <0.0001) and SOD (P <0.0001) after incubation with silver and titanium dioxide nanoparticles at 24hrs at 37°C, however at 48 hours and 74 hours there is not much change. Conclusion: The results indicate that silver and titanium dioxide nanoparticles exhibits, nanoparticles mediated cytotoxicity by induction of Reactive Oxygen Species (ROS).

An Assessment of the Level of Awareness, Attitudes, Opinions of Pharmacy Students Concerning HIV and AIDS in Malaysia.

Aims: HIV and AIDS spreading wide and causing serious threats and deaths among Malaysian residents. A nationwide cross-sectional survey was conducted to assess the awareness, attitudes and opinions about HIV and AIDS among pharmacy students. Methods: A total of 316 pharmacy students of year three and onwards took part in the survey. Students were asked to fill in questionnaires with consent forms. The results were analyzed by using SPSS version 17. Results: The data indicated that awareness about HIV and AIDS was moderate. High level of awareness was seen for major routes of HIV transmissions, but lower level of awareness was seen for other modes of transmission like circumcision, visiting barbers, and blood splashes on outer body surface. Only 19.3% and 13.3% of respondents were aware about HIV prevention by sex abstinence and by staying faithful to one partner respectively. The respondents had doubts in keeping HIV and AIDS patients in close vicinity to them and their family. Conclusion: According to the findings, the respondents had a few misconceptions about HIV transmission and prevention. Data from this survey may be useful to hold programs and campaigns designed to convey accurate information about HIV transmission and prevention. Talks and media campaigns should also be carried out to change their attitudes and opinions about HIV and AIDS.

Effects of Erythropoietin on Memory Deficits and Brain Oxidative Stress in the Mouse Models of Dementia

The present study was undertaken to explore the potential of erythropoietin in memory deficits of mice. Memory impairment was produced by scopolamine (0.5 mg/kg, i.p.) and intracerebroventricular streptozotocin (i.c.v STZ, 3 mg/kg, 10 microliter, 1st and 3rd day) in separate groups of animals. Morris water-maze test was employed to assess learning and memory. The levels of brain thio-barbituric acid reactive species (TBARS) and reduced glutathione (GSH) were estimated to assess degree of oxidative stress. Brain acetylcholinesterase enzyme (AChE) activity was also measured. Scopolamine/streptozotocin administration induced significant impairment of learning and memory in mice as indicated by marked decrease in Morris water-maze performance. Scopolamine/streptozotocin administration also produced a significant enhancement of brain AChE activity and brain oxidative stress (an increase in TBARS and a decrease in GSH) levels. Treatment of erythropoietin (500 and 1,000 IU/Kg i.p.) significantly reversed scopolamine- as well as streptozotocin-induced learning and memory deficits along with attenuation of those-induced rise in brain AChE activity and brain oxidative stress levels. It may be concluded that erythropoietin exerts a beneficial effect in memory deficits of mice possibly through its multiple actions including potential anti-oxidative effect.

Phytochemical and pharmacological investigations on some medicinally important zizyphus species

Species of Zizyphus are regarded as useful plants in indigenous system of medicine. Extensive research has been carried out on this species and mentioned by almost all authors of authentic texts and manuscripts of the sub-continent. Regarded as a medicinal plant in the traditional medicine, it is attributed to exert sedative, anti-histaminic, 'antimicrobial and dental cleansing activities. The authors present a comprehensive review of its utility in the light of contemporary researches