Assessment of Serum Electrolytes and Glycated Hemoglobin Level in Non-diabetic Iron-Deficient Anaemic Patients.

INTRODUCTION: The WHO has recognised iron deficiency anaemia (IDA) as the most common nutritional deficiency in the world, with 30% of the population being affected by this condition. The patient's glycemic status during the past three months is shown by the glycated haemoglobin A1C (HbA1c) test. According to several studies, iron deficiency can increase HbA1C levels without affecting blood sugar levels. HbA1C levels of ≥ 6.5% have been approved by the American Diabetes Association (ADA) as a diagnostic indicator for diabetes mellitus (DM). An imbalance in serum electrolyte levels and anaemia have been linked by several studies.  Aim: To analyze the effect of iron deficiency anaemia on HbA1c levels and serum electrolytes in an adult non-diabetic population. METHODS: This was a descriptive cross-sectional study conducted in Shri BM Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India from January 2021 to June 2022. A total of 65 moderate to severe normoglycemic iron deficiency anemia patients between 18 to 75 years were enrolled in the study after fulfilling inclusion and exclusion criteria. A detailed history, clinical and biochemical examination was performed including HbA1c levels. The results were pooled and statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY, USA). RESULTS: We found elevated HbA1c levels (5.67±1.1%) in non-diabetic iron-deficient anaemia individuals, and elevation was more in women of reproductive age group (30.8%). There was a statistically significant Spearman negative correlation between hemoglobin and HbA1C levels. Also, 16 patients had hyponatremia with a mean haemoglobin (Hb) of 4.8 g/dL and one patient had hyperkalemia with a mean Hb of 3.2 g/dL which was statistically non-significant. CONCLUSION: In this study haemoglobin and HbA1c had a statistically significant positive correlation with serum sodium and a negative correlation with serum potassium in moderate to severely iron-deficient anaemic patients, especially females of the reproductive age group.

Efficacy of BAINS Circuit in Treating Critically Ill Hypoxemic COVID-19 Patients During the Second Wave of the Pandemic in India.

BACKGROUND: The COVID-19 pandemic has encouraged doctors to look for novel ways of treating patients with respiratory failure due to the limited availability of ventilators and highflow nasal cannula. The study aims to assess the efficacy of using the Bains circuit as an alternative to HFNC and NIV as life-saving tools in patients with respiratory failure during the second wave of the COVID-19 pandemic in India. METHODS: This is a prospective interventional study carried out in the intensive care unit of Shri B.M Patil Medical College Hospital and Research Centre, Vijayapur, India, from May 2021 to June 2021. All patients (n=90) with respiratory failure not responding to therapy with an oxygen mask were included. Patients were placed on Bain circuits, one end connected to a non-invasive ventilation mask fitted to the face of the patients, and the other end connected to a central oxygen port. Patients' vital parameters were assessed on an hourly basis. The blood gas analyses were done before and after using Bains. RESULTS: The study showed diabetes (33.4%), hypertension (22.2%), and diabetes with hypertension (11.1%) as comorbid factors among the ICU admitted patients. The results from the arterial blood gas analyses showed a statistically significant increase in Sp02 (%) and a decrease in respiratory rate (cycles/min) in the patients after being kept on Bains (p<0.05). Further, it showed that 72% of ICU patients with 70-79% Sp02 had a recovery by using Bains. The overall outcome of ICU admitted COVID-19 patients on Bains showed that 38.9% of patients improved and were shifted to 02/NRBM masks. CONCLUSION: The study highlights a novel concept of using the Bains circuit as an effective alternative to HFNC and NIV for oxygenation in critically ill COVID-19 patients during scarcity of NIV and HFNC at the peak of the pandemic.

Ratios of Height-to-Thyromental Distance and Height-to-Sternomental Distance as Predictors of Difficult Airway in Patients Posted for General Anaesthesia.

BACKGROUND: Preoperative airway assessment and anticipation of a difficult airway is of utmost critical value in anesthesiology as failure to secure airway can lead to morbidity and mortality. The study evaluated ratio of height-to-thyromental distance (RHTMD) and ratio of height-to-sternomental distance (RHSMD) as predictors of a difficult airway. METHODS: The prospective observational study evaluated 131 adult participants scheduled for elective surgery under general anesthesia. In addition to the preoperative airway assessment, RHTMD and RHSMD were calculated. Correlation of these ratios with the Cormack-Lehane grading of glottis visualisation on direct laryngoscopic view following induction of anesthesia was analyzed. The optimal cut-off point for RHTMD and RHSMD were identified using receiver operating characteristic curve analysis. RESULTS: The incidence of difficult intubation was 14.50%. The cut-off values for RHTMD and RHSMD were ＜ 21.50 (sensitivity 85.25%, specificity 100.00%) and ＜ 10.50 (sensitivity 84.21%, specificity 96.42%) respectively for predicting difficult airway. The area under the curve with 95% confidence interval for RHTMD was 0.875 (0.730-1.000) and that for RHSMD was 0.890 (0.777-1.000). CONCLUSION: RHTMD was found to be a better predictor of difficult intubation and restricted laryngoscopic view compared to RHSMD.

Comparative Study of the Efficacy of Dexmedetomidine and Fentanyl as Adjuvants to Ropivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block.

OBJECTIVE: Supraclavicular brachial plexus block is preferable to general anaesthesia in upper limb surgeries. Various adjuvants have been added to improve the quality of the block and prolong postoperative analgesia. The aim of the present study was to compare the onset and duration of sensory and motor blockade with the quality of perioperative analgesia and postoperative complications provided by dexmedetomidine and fentanyl as adjuvants to ropivacaine under ultrasound (USG) guidance in supraclavicular block. METHODS: A total of 80 patients with American Society of Anesthesiologists grade I/II scheduled for elective upper limb surgeries were randomly allocated into two groups. Group A received 30 mL of 0.5% ropivacaine with 1 µg kg-1 dexmedetomidine, and group B received 30 mL of 0.5% ropivacaine with 1 µg kg-1 fentanyl for supraclavicular brachial block using USG guidance. The onset and duration of sensory and motor block, time for requirement of rescue analgesia and adverse events during the perioperative period were noted. RESULTS: The onset of sensory blockade was 13.95±1.34 min in the dexmedetomidine group and 14.18±1.41 min in the fentanyl group. There was a highly significant statistical difference in terms of the duration of the sensory blockade, i.e. 801.75±46.07 min with dexmedetomidine compared to 590.25±40.41 min with fentanyl (p<0.0001). The duration of motor blockade was highly statistically significant with 649.56±42.73 min in group A compared to 456.75±32.93 min in group B. CONCLUSION: Dexmedetomidine prolongs the duration of sensory and motor block and postoperative analgesia as compared to fentanyl when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block and is not associated with any major adverse events.

Purpura Fulminans Secondary to Rickettsial Infection: A Case Report.

Purpura fulminans is an acute life threatening disorder characterized by cutaneous haemorrhagic manifestations and necrosis caused by disseminated intravascular coagulation and dermal vascular thrombosis. In this case a 60-year-old male presented with purpuric lesions over both upper and lower limbs and consumption coagulopathy following rickettsial infection. It was diagnosed as purpura fulminans secondary to rickettsial infection with disseminated intravascular coagulation and treated with replacement of platelets and coagulation factors along with antibiotics and doxycycline.

Anaesthetic Management of a Geriatric Patient with Parkinson's Disease, who was Posted for Emergency Laparotomy- A Case Report.

Parkinson's Disease (PD) is a relatively common neuro degenerative disorder in the geriatric age group. The pathophysiological changes in these patients predispose to major systemic complications like aspiration pneumonitis, respiratory depression, myocardial depression and postural hypotension. Anaesthetic agents interact with the anti-Parkinsonian medication and this may lead to adverse effects. Here, we are presenting a case report of the anaesthetic management of a patient with a history of Parkinson's disease, who was posted for emergency laparotomy.

Anesthetic management of a patient with bicuspid aortic valve and Hashimoto's thyroiditis posted for abdominal hysterectomy.

Bicuspid aortic valve is the most common birth defect affecting the heart and is present in 1-2% of the population. The abnormal valve structure leads to turbulent flow, fibrosis, calcification, and aortic stenosis. Aortic stenosis increases perioperative morbidity and mortality. Anesthetic techniques that reduce systemic vascular resistance (regional neuraxial techniques) must be used with extreme caution. Hashimoto's disease or chronic thyroiditis or autoimmune thyroiditis is the most common cause of hypothyroidism in adults. Regional anesthesia is preferred in patients with hypothyroidism as recovery from general anesthesia may be delayed by hypothermia, respiratory depression, or slow drug biotransformation. This is a case report of anesthetic management of a middle-aged female with co-existing aortic stenosis, hypothyroidism, and fibroid uterus posted for abdominal hysterectomy.