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.

Fungal endocarditis in neonate

Neonatal endocarditis is a rare but usually fatal disease. Fungal endocarditis is an uncommon complication of invasive fungal infections and is associated with a high burden of morbidity and mortality. It frequently occurs in premature infants. The majority of these infections are caused by Candida (60-70%) and Aspergillus species (20-25%). The diagnosis is difficult because the criteria that have suggested and used in adults are not readily applicable for neonates. The incidence of fungal endocarditis in a neonate is on the rise, reported in the last decade secondary to use of central venous lines, frequent use of broad-spectrum antibiotics and neonatal surgical interventions.

Role of procalcitonin in diagnosis of neonatal sepsis and procalcitonin guided duration of antibiotic therapy

Background: Neonatal sepsis is one of the important causes of neonatal morbidity and mortality particularly in the developing countries. Accurate and quick diagnosis is difficult because clinical presentation is non-specific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. Procalcitonin (PCT) is often reported to be more superior to C-reactive protein (CRP), being more sensitive and specific, starts to rise earlier and returns to normal concentration more rapidly than CRP.Methods: It is a hospital based prospective observational study. Blood samples were obtained and analyzed for blood culture, septic screen including serum CRP and PCT. Neonates were categorized into proven sepsis (n=39), probable sepsis (n=21) and clinical sepsis (n=40) groups on the basis of laboratory findings and risk factors. Data was analyzed by using standard statistical tests using SPSS 16.Results: Out of 100 cases, elevated PCT level >0.5 ng/dl was detected in 75 and >2 ng/dl was detected in 51 whereas CRP was positive only in 61 cases. Among the 39 culture positive cases, elevated serum PCT level was noticed in 39 (100%) cases whereas CRP level was noticed in 30 (76.9%) cases. Mean PCT levels were significantly high according to infection severity (P<0.01). Procalcitonin (sensitivity 87.2%, specificity 72.13%, positive predictive value 66.7% and negative predictive value 89.8% and with p value of <0.001) is more superior than CRP to predict sepsis in neonate. The mean duration of antibiotic therapy was 12.46±4.62 days in definite sepsis, 4.53±1.78 days in probable sepsis group and in clinical sepsis group 3.75±1.33 days by serial PCT measurement.Conclusions: Serum PCT levels >2 ng/dl has got a better sensitivity and NPV, which help us not only in the early diagnosis but also in the prognosis and duration of antibiotic therapy.

Fetal transverse cerebellar diameter measurement in intrauterine growth restriction: a more accurate parameter for gestational age assessment at term

Background: Assessment of fetal gestational age (GA) is an essential part of obstetric USG. Accurate knowledge of fetal GA is important to facilitate the best possible prenatal care and successful pregnancy outcome.  For the estimation of GA the commonly used parameters in third trimester are:- BPD, HC, AC and FL. As all these parameters are affected by fetal growth disorders and fetal position. TCD can be used as another parameter for the estimation of GA in growth restricted fetuses.Methods: This study was conducted at Mahila Chikitsalaya Sanganeri Gate; SMS Medical College Jaipur from July 2005 to September 2006. A total of 80 pregnant women in third trimester with singleton pregnancy including 40 pregnant women with known cases of IUGR and 40 AGA fetuses were studied for TCD measure.Results: Correlation coefficient between TCD and gestational age was highly significant and no significant difference was found in TCD of AGA and IUGR fetuses.Conclusions: TCD measurement can be used as more reliable parameter for accurate estimation of gestational age in IUGR fetuses in third trimester.

Assessment of Depression in Cancer Patients receiving Chemotherapy in a Tertiary Care Hospital

Introduction: Cancer patients usually have variouspsychological complications, depression being the mostcommon among them. Depression poses difficulties incontinuing the prescribed treatment within the scheduledtime frame, ultimately affecting outcome. Study aimed todetermine the magnitude of depression and various factorsassociated with it, so as to initiate the timely intervention.Material and methods: Brief Edinburgh Depression Scale(BEDS) was used to major depression in 203 cancer patientsreceiving chemotherapy at Day Care Centre of the Departmentof Radiotherapy, SMS Medical College and attached groupof hospitals, Jaipur, Rajasthan, and VCSG GovernmentInstitute of Medical Science and Research, Srinagar, Garhwal,Uttarakhand, India during 1-30 August, 2018, who wereabove 18 years of age, and could read, understand, and write,were selected. Association of depression with various factorslike name, age, sex, contact details, education and occupationdetails, income, marital status, history of other co-morbiddisease, type and site of cancer, presence of metastases,number of chemotherapy cycle going on, source of cost oftherapy, was also computed.Results: Out of 203 patients, depression was present in130 (64%) patients. Statistically significant association ofdepression was found with both extremes of the age (P = 0.04),paid treatment (P = 0.03) and less than four chemotherapycycle (P = 0.04). No significant association was seen betweendepression and gender, occupation, performance status, site ofcancer, presence of co-existing disease and metastases.Conclusions: BEDS is a easy and reliable method to measuredepression. Depression was present in 64% of patients, andwas significantly associated with both extremes of age,paid treatment, and less than four chemotherapy cyclesadministered.