Nasogastric tube insertion using conventional versus bubble technique for its confirmation in anesthetized patients: a prospective randomized study

Abstract Background: Nasogastric tube insertion and confirmation of its position can be difficult in the anesthetized patient. The purpose of the present study was to compare the bubble technique with the conventional method for confirmation of nasogastric tube placement in these patients. Methods: Two hundred sixty adult patients, aged between 20-70 years, posted for surgeries requiring general anesthesia, tracheal intubation, and a nasogastric tube were enrolled in this study. Patients were randomized into 2 groups: Group B (Bubble group) and Group C (Control group). In Group C, a conventional technique using a lubricated nasogastric tube was positioned through the nostril with head remained neutral. In Group B, 2% lidocaine jelly was added to the proximal end to form a single bubble. The correct placement of the nasogastric tube in the stomach was confirmed by fluoroscopy by an independent observer intraoperatively. Results: The duration of nasogastric tube insertion was 57.2 ± 13.3seconds in Group B and 59.8 ± 11.9seconds in Group C (p = 0.111). The confirmation rate of the bubble technique was 76.8% (95% CI: 68.7-83.3), which was significantly better than the conventional method where the confirmation rate was 59.7% (95% CI 50.9-67.9), p< 0.001. When compared to fluoroscopy, bubble technique was found to have a sensitivity of 92.3% (95% CI: 85.6-96.1) with specificity of 81.0% (95% CI: 60.0-92.3), positive predictive value of 96.0% (95% CI: 90.2-98.4), and a moderate negative predictive value of 68.0% (95% CI: 48.4-82.8). Conclusions: The bubble technique of nasogastric tube insertion has a higher confirmation rate in comparison to the conventional technique. Trial Registry Number: Clinical Trial Registry of India (CTRI/2018/09/015864).

Preoperative assessment of inferior vena cava collapsibility index by ultrasound is not a reliable predictor of post-spinal anesthesia hypotension

Abstract Background Post-spinal anesthesia hypotension is of common occurrence, and it hampers tissue perfusion. Several preoperative factors determine patient susceptibility to hypotension. This study aimed to assess the effectiveness of the Inferior Vena Cava Collapsibility Index (IVCCI) for predicting intraoperative hypotension. Methods One hundred twenty-nine adult patients who were scheduled for elective surgical procedures after administration of spinal (intrathecal) anesthesia were included in the study. Ultrasound evaluation of the Inferior Vena Cava (IVC) was done in the preoperative area, and the patients were shifted to the Operating Room (OR) for spinal anesthesia. An independent observer recorded the change in blood pressure after spinal anesthesia inside the OR. Results Twenty-five patients developed hypotension (19.37%). Baseline systolic blood pressure and mean blood pressures were statistically higher in those patients who developed hypotension (p= 0.001). The logistic regression analysis for IVCCI and the incidence of hypotension showed r2 of 0.025. Receiver Operating Characteristic (ROC) curve analysis demonstrated the Area Under the Curve (AUC) of 0.467 (95% Confidence Interval, 0.338 to 0.597; p= 0.615). Conclusions Preoperative evaluation of IVCCI is not a good predictor for the occurrence of hypotension after spinal anesthesia.

Role of melatonin in attenuation of hemodynamic response to intubation and anesthetic requirements: a randomized, controlled, double-blind study

Abstract Background Melatonin has been studied to have anxiolytic, sedative, and analgesic effects. However, there is limited data on the effect of melatonin in the attenuation of hemodynamic response to intubation. We aimed to study whether preanesthetic oral melatonin attenuates hemodynamic responses to intubation and anesthetic requirements. Methods Sixty-four patients scheduled for laparoscopic cholecystectomy were randomized into melatonin or placebo group (n = 32 each). Melatonin group received two tablets (3 mg each) of melatonin, and the placebo group received two tablets of vitamin D3 120 min before induction. Hemodynamic parameters were recorded during induction and postintubation for 15 minutes. Total induction dose of propofol, total intraoperative fentanyl consumption, and adverse effects of melatonin were also noted. Results Postintubation rise in heart rate (HR) was less in the melatonin group compared to the placebo group (10.59% vs. 37.08% at 1 min, respectively) (p< 0.0001). Maximum percentage increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) was lesser in melatonin group than placebo group (SBP 9.25% vs. 37.73%, DBP 10.58% vs. 35.51%, MBP 9.99% vs. 36.45% at 1 min postintubation. respectively) (p< 0.0001). Induction dose of propofol (1.42 mg.kg-1 vs. 2.01 mg.kg-1) and the number of patients requiring additional fentanyl intraoperatively (3 vs. 11) were also significantly reduced in the melatonin group. Conclusion Premedication with 6 mg of oral melatonin resulted in significant attenuation of postintubation rise in HR, SBP, DBP, and MBP. It also reduced the induction dose of propofol, total intraoperative fentanyl consumption without any adverse effects.

Association of bull semen protein estimates and SDS-PAGE profiles on semen freezability

It is vital to identify the ejaculate with good freezability by determining the biochemical makeup of the ejaculate at the pre-freeze stage. The present study targeted to assess the use of the protein estimates and profiles at the pre-freeze stage as markers of freezability in Frieswal populations. Storing the proteins for proteomic studies is always tricky in the case of animal studies, where accessibility to liquid nitrogen is limited. Hence alternative storing approaches need to be optimized. The second part of this study examined the protein concentration and protein profiles of RNALater and frozen stored sperm cells to assess the use of RNALater preservation in sperm proteomic studies. Sperm and seminal plasma protein concentrations were quantified using Bradford assay, and total protein quantities were derived. The seminal plasma and sperm protein profiles were generated with SDS-PAGE. The protein estimates and SDS-PAGE profiles of good and poor freeze-groups were similar. Also, sperm and seminal plasma protein concentration were not correlated with the semen volume and sperm count. Even though the yield was comparatively less, the protein profiles of sperm preserved by RNALater were similar to that of frozen sperms. The present study results indicate that the protein estimates and qualitative profiles of sperm and seminal plasma proteins may not be sufficient to reveal the differences in the proteome of good and poor freezable bulls at the macro level. Hence, the protein estimates and profiles of neat semen may not be helpful for the prediction of freezability at the pre-freeze stage. Secondly, this study indicates that RNALater preservation helps store sperms for proteome analysis studies.

First Record of Molecular Confirmation, Phylogeny and Haplotype Diversity of Haemonchus contortus from Gaddi (breed) Goats of North India

Abstract: In the present study, molecular identification and genotypic characterization of H. contortus was carried out targeting 28S-18S rRNA intergenic spacer. Faecal samples of Gaddi goats were collected and subjected to qualitative screening. The samples exhibiting the presence of strongyle type eggs were introduced to faecal culturing. The larvae retrieved were molecularly confirmed as of H. contortus species and the phylogenetics was performed. For the estimation of evolutionary divergence in between the present study isolates with the GenBank archived sequences, maximum composite likelihood model was employed. Nucleotide and haplotype diversity indices and Fu's Fs were also estimated. Approximately 260 bp size amplicons retrieved were confirmatory for the presence of H. contortus species. Phylogenetic analysis also accentuated that present parasite isolates were of H. contortus only. The nucleotide diversity (π) obtained was 0.06696, whereas, haplotype diversity was 0.92549 [95% CI: 0.77778-1.0000]. In between the isolates, Fu's Fs statistic value was positive (1.566), evidencing a deficiency of alleles, which would have happened due to recent population bottleneck. The recovered representative sequences were deposited in GenBank under the accession numbers LC600315-LC600317.To the best of our knowledge, the present study is the first report of phylogeny and haplotype diversity of H. contortus isolated from Gaddi goats of North India. The present study would also serve the basis for future detailed molecular epidemiological studies using discriminative markers for the assessment of genetic diversity in different populations of H. contortus in different hosts of the study area.

Clinical Evaluation of Demineralized Bone Matrix Allograft in Femur Fracture in Dogs

Eight clinical cases of dogs having femur fracture, were divided into two groups, A and B with four dogs (n=4) in each group. Group A animals were treated with intramedullary pinning (IMP) alone and group B were treated using IMP alongwith demineralized bone matrix (DBM) implantation at the fracture site. The efficacy of healing was evaluated on the basis of clinical evaluation, haemato-biochemical and radiographic parameters on the day of admission (day 0), followed by 7th, 15th, 30th, 45th and 60th post-operative days. The weight bearing was observed to be better in dogs of group A. Swelling was completely absent after 15th post-operative day in dogs of both the groups. The mean values of Hb, PCV, TLC and DLC showed a non-significant variation on subsequent post-operative days in both the groups. There was a significant increase in serum calcium up to 30th post-operative day and thereafter, followed a decreasing trend. The serum alkaline phosphatase values showed non-significant variation in group A while in group B animals significant increase observed on 15th, 30th and 45th post-operative day. Radiographically, the dogs of group B showed better radiographic union of fracture evidenced by early disappearance of fracture line than those of group A

Bacterial Investigation and Antibiogram in Corneal Ulcers in Dogs

Corneal ulcers in dogs usually have a traumatic origin. They cause a break in the continuity of underlying corneal stroma and become rapidly contaminated with bacteria. Twenty eight clinical samples were obtained from corneal ulcer affected dogs for bacterial isolation and anti-microbial susceptibility. Bacterial growth was observed in 100% of the samples (n=28) and Staphylococcus spp. was isolated and characterized by culture, gram staining and various biochemical tests. Antibiogram pattern revealed that gatifloxacin and moxifloxacin antibiotics were found to be highly effective in the treatment of corneal ulcers in dogs. Corneal culture and sensitivity testing provided useful information for the diagnosis, determination of appropriate treatment and antimicrobial therapy for corneal diseases in dogs