Effect of Intravenous Calcium Gluconate on Prevention of Post Spinal Hypotension during Spinal Anaesthesia for Caesarean Section: A Randomized Double-Blind Controlled Study.

BACKGROUND: Calcium, a physiological ion, causes vasoconstriction and has a positive ionotropic action on heart. Its use to prevent post-spinal hypotension has been suggested but never formally evaluated for patients undergoing caesarean section. This study investigated the hemodynamic effects of calcium administration in parturients with the primary aim of comparing the incidence of post-spinal hypotension. METHODS: Sixty healthy full-term pregnant patients scheduled for caesarean section were randomly allocated to two equal groups to receive either calcium gluconate or normal Saline bolus over 20min by syringe infusion pump under electrocardiography monitoring immediately after the patient was turned supine following spinal anaesthesia. Blood pressure and heart rate were recorded at baseline, and at regular intervals following spinal. Maternal calcium levels were estimated before and after infusion. Neonatal blood gas analysis and calcium level were analyzed. Total mephentermine requirement was recorded in both groups. RESULTS: The heart rate values remained comparable to baseline value in group calcium gluconate while in group normal Saline, it decreased significantly at 8,12 and 16min. Blood pressure decreased significantly as compared to the baseline value from 4min onwards in both the groups. However, it was comparable in the two groups at all time points(0.622). Nineteen patients(63.33%) required mephentermine infusion in group calcium gluconate as compared to 23 patients(76.6%) in group normal Saline for maintenance of systolic blood pressure.(p=0.791) Umbilical venous pH (p=0.038) and partial pressure of carbon dioxide(p=0.038) were significantly better in group calcium gluconate. CONCLUSIONS: Calcium used for prophylaxis of hypotension in healthy parturients undergoing caesarean section reduced the vasopressor requirements and total mephenteramine dose, but the difference did not attain statistical significance.

Cryoprotectant with a mitochondrial derived peptide, humanin, improves post-thaw quality of buffalo spermatozoa.

BACKGROUND: Semen cryopreservation results in deleterious effects on spermatozoa, including lipid peroxidation and a reduction in the total antioxidant components of seminal plasma. The ultimate outcome of these changes is a reduction in post-thaw semen quality. A mitochondrial derived peptide, humanin, a potent cytoprotective and antioxidant agent was used in the present study. OBJECTIVE: To evaluate the efficacy of a mitochondrial-derived peptide, humanin to improve the post-thaw quality of buffalo spermatozoa. MATERIALS AND METHODS: A total of 18 ejaculates from three Murrah buffalo bulls (n=6 each) were collected. Each ejaculate was divided into four aliquots. The first aliquot was diluted with standard EYTG dilutor (Group I, control), whereas the other three aliquots were diluted with EYTG supplemented with 2 µM (Group II), 5 µM (Group III) and 10 µM humanin (Group IV), respectively. Semen was evaluated for physico-morphological and functional attributes such as progressive motility, viability, abnormality, acrosome integrity, plasmamembrane integrity of fresh samples, pre-freeze and post-thaw stages. Oxidative stress parameters [lipid peroxidation (LPO) and total antioxidant capacity (TAC)] were also measured at the pre-freeze and post-thaw stages. RESULTS: Humanin supplementation resulted in significantly higher (p < 0.05) post-thaw motility in all treatment groups and, higher (p < 0.05) viability in Groups III and IV in comparison to the control at the post-thaw stage. Spermatozoa with intact acrosome and plasma membrane were higher (p < 0.05) in Groups III and IV as compared to Groups I and II. The LPO levels at the post-thaw stage were found to be lower (p < 0.05) in all treatment groups versus the control group, whereas, higher (p≤0.05) TAC values were recorded in Groups III and IV in comparison to the control and Group II. CONCLUSION: Humanin supplementation in the extender improved the freezabilty of buffalo spermatozoa.

Correlates of In-Hospital COVID-19 Deaths: A Competing Risks Survival Time Analysis of Retrospective Mortality Data.

INTRODUCTION: Several aspects of the coronavirus disease 2019 (COVID-19) pandemic remain ambiguous, including its transmission, severity, geographic, and racial differences in mortality. These variations merit elaboration of local patterns to inform wider national policies. METHODS: In a retrospective analysis, data of patients treated at a dedicated COVID hospital with moderate and severe illness during 8 wk of the pandemic were reviewed with attention to mortality in a competing risks framework. RESULTS: A total of 1147 patients were hospitalized, and 312 (27.2%) died in hospital. Those who died were older (56.5 vs 47.6 y; P < 0.0001). Of these, 885 (77.2%) had tested positive on reverse transcriptase polymerase chain reaction (RT-PCR), with 219 (24.2%) deaths (incidence rate, 1.9 per 100 person-days). Median time from onset of symptoms to death was 11 days. A competing risks analysis for in-hospital death revealed an adjusted cause-specific hazard ratio of 1.4 for each decade increase in age. CONCLUSIONS: This retrospective analysis provides broad patterns of disease presentation and mortality. Even COVID test-negative patients will receive treatment at dedicated facilities, and 33% presenting cases may die within the first 72 h, most with comorbid illness. This should be considered while planning distribution of services for effective health-care delivery.

Effect of oral gabapentin premedication on hemodynamic parameters and postoperative pain in patients of laparoscopic cholecystectomy: A randomized double-blind controlled study.

BACKGROUND AND AIMS: Carbon dioxide (CO2) pneumoperitoneum created during laparoscopic cholecystectomy causes adverse hemodynamic changes such as rise in arterial pressure. The aim of this study was to assess the effect of oral gabapentin premedication on hemodynamic parameters in addition to postoperative nausea and vomiting (PONV) and pain in patients of laparoscopic cholecystectomy conducted under general anesthesia. MATERIAL AND METHODS: Randomly selected 60 American Society of Anesthesiologists (ASA) class I patients scheduled for laparoscopic cholecystectomy were premedicated with either gabapentin 1200 mg (Group GB) or placebo (Group PL) 2 h prior to induction of anesthesia. Anesthesia was induced with fentanyl, propofol, and vecuronium; and maintained with oxygen (33%), nitrous oxide (66%), and isoflurane (1%) with controlled ventilation. Hemodynamic parameters were recorded at various time intervals intraoperatively and during pneumoperitoneum every 10 min till 50 min. Postoperatively visual analog score (VAS) for pain, incidence of PONV, and sedation score were recorded for 6 h. The collected data were analyzed statistically by using repeated measures analysis of variance (ANOVA), Student's t test, Chi-square test, and Mann-Whitney U test. RESULTS: Changes in mean BP, systolic BP, and diastolic BP from prepneumoperitoneum values were significantly less in group GB during pneumoperitoneum (P < 0.05) with no significant change in HR in both groups (>0.05). VAS score was significantly lower in group GB. The duration of analgesia and PONV free period were significantly higher in group GB (P < 0.01). CONCLUSION: Oral gabapentin premedication may be used to control hemodynamic parameters during pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.

Effect of Cryopreservation on Semen Quality Parameters in Relation to Lipid Peroxidation and Antioxidant Profile in Indian Buffalo.

BACKGROUND: Lipid peroxidation (LPO) due to oxidative stress leads to structural and functional changes in spermatozoa. OBJECTIVE: To evaluate any association of various seminal characteristics at the pre- and post-cryopreservation stages with LPO and total antioxidant capacity (TAC) in Murrah buffalo semen samples. MATERIALS AND METHODS: Sixty-five ejaculates from seven bulls were processed for cryopreservation in liquid nitrogen. RESULTS: Only 31 (47.7%) samples were found satisfactory for inclusion in the further artificial insemination. A strong negative correlation was observed between LPO and individual progressive motility, TAC, viability, plasma membrane integrity as well as acrosome integrity of fresh spermatozoa. At the post-thaw stage, post-thaw motility, viability, plasma membrane integrity and acrosome integrity had strong positive correlation with TAC. CONCLUSION: The effort to minimize LPO and enhance TAC shall play a pivotal role in improving buffalo semen quality upon cryopreservation.

Effect of Mito-TEMPO Incorporated Semen Extender on Physico-morphological Attributes and Functional Membrane Integrity of Frozen Thawed Buffalo Spermatozoa.

BACKGROUND: Sperm mitochondria are the major site of reactive oxygen species (ROS) production and excess production during freezing-thawing process inflicts oxidative damages to spermatozoa. Buffalo spermatozoa are more prone to oxidative damage due to inherently more polyunsaturated fatty acids and low cholesterol to phospholipids ratio in the plasma membrane. A mitochondrial targeted antioxidant, Mito-TEMPO was used in this study. OBJECTIVE: To study the effect of Mito-TEMPO incorporated semen extender on the post-thaw semen quality in buffalo. MATERIALS AND METHODS: A total of 18 ejaculates from three murrah buffalo bulls with ≥70% individual progressive motility were utilized for the study. Each semen sample was equally divided and extended with five groups: Group I (Control, without Mito-TEMPO addition); Group II (10 µM Mito-TEMPO); Group III (50 µM Mito-TEMPO); Group IV (100 µM Mito-TEMPO); Group V (500 µM Mito-TEMPO) to have 80×106 progressive motile sperm/mL of extender, filled and sealed in French mini straws (0.25 mL) and frozen following equilibration. The effect of Mito-TEMPO was assessed at fresh/post-dilution and post-thaw stages by evaluating physico-morphological attributes and functional membrane integrity such as hypo-osmotic swelling test (HOST). RESULTS: Initial progressive motility, viability, acrosomal integrity and HOS response was significantly (p<0.05) improved and sperm abnormality was significantly (p<0.05) reduced in extended semen with Mito-TEMPO (50 µM) compared to control at post-thaw stage, although improvement was also observed at 10 and 100 µM in post-thaw samples. CONCLUSION: Mito-TEMPO incorporated semen extender at 50 µM concentration, could be part of a rationale for improving post-thaw semen quality in buffalo.

Incubation with Cholesterol-loaded Cyclodextrin and Subsequent Dilution in Partially Deoxygenated Extender Improves the Freezability of Cross-bred Bull Sperm.

BACKGROUND: The cryopreservation process induces osmotic stress, membrane changes and production of reactive oxygen species resulting in damage to the spermatozoa. Together, the presence of oxygen in the extender aggravates the oxidative stress that further reduces the cryosurvival rate of sperm cells. OBJECTIVE: To study the combined effect of cholesterol loaded cyclodextrin (CLC) and partial deoxygenation on post-thaw semen quality in crossbred bulls. MATERIALS AND METHODS: A total of 18 ejaculates from three crossbred bulls with >3+ mass motility and >70% individual progressive motility were utilized for the study. Each semen sample was divided into four groups: Group I (containing extender without partial deoxygenation or CLC addition); Group II (extender containing 3 mg CLC/120X106 spermatozoa); Group III (extender containing 3 mg CLC/120X106 spermatozoa and 4 ppm dissolved oxygen (DO) level); Group IV (extender containing 3 mg CLC/120X106 spermatozoa and 6 ppm DO level). The samples in each group were finally extended to have 80×106 progressive motile sperm/mL of extender, filled and sealed in French mini straws (0.25 mL) and frozen following equilibration. The effect of CLC addition and partial deoxygenation was assessed at fresh (post-dilution), pre-freeze and post-thaw stages by evaluating various variables [sperm motility, viability, hypo-osmotic swelling (HOS) response, acrosomal integrity, capacitation status and mitochondrial membrane potential (MMP)]. RESULTS: The sperm population was significantly more positive for motility, viability, HOS response, acrosome intactness, high MMP and had less capacitation-like changes in groups supplemented with CLC and partially deoxygenation. However, the positive effect was most pronounced in the group that had extender with CLC+4 ppm DO. CONCLUSION: Partial deoxygenation of extender, and CLC addition in combination, could be part of a rationale for improving post-thaw semen quality in cross-bred bulls.

Anesthetic management for bronchoscopy and debulking of obstructing intratracheal tumor.

Primary tracheal tumors comprise a rare group of benign and malignant tumors. Bronchoscopy is required for diagnosis and staging of tracheal neoplasms as well as debulking of the tumor. The management of anesthesia for rigid bronchoscopy in a patient with tracheal neoplasm presents with many challenges to the anesthetist. We present anesthetic management of an 18-year-old female who presented with orthopnea. Computed tomography scan of the thorax revealed a polypoidal lesion in the trachea proximal to carina and consolidation in the right middle lobe. The patient was scheduled for rigid bronchoscopy and debulking of the tumor. Case was successfully managed by providing positive pressure ventilation and oxygenation during rigid bronchoscopy using manual ventilation through the side port of the rigid bronchoscope. The procedure was uneventful, and patient improved symptomatically in the immediate postoperative period. The successful management of this case demonstrates the airway management in a patient with tracheal tumor for rigid bronchoscopy.

Effect of intravenous magnesium sulphate on postoperative pain following spinal anesthesia. A randomized double blind controlled study.

BACKGROUND: Magnesium sulphate (MgSO4), NMDA receptor antagonist, is known to reduce perioperative requirement of anesthetics and analgesics. However, no studies assessed the effect of MgSO4 on onset and recovery from spinal anesthesia. A prospective, randomised, double blind study was designed to assess the effect of intravenous (IV) MgSO4 on onset and recovery from spinal anesthesia and post operative analgesic requirement following below umbilical surgery. METHODS: Sixty patients (ASA class I & II) were selected randomly and divided into two groups. Patients were given either MgSO4 50 mg kg(-1) in 10 mL within 10 min, followed by an infusion of MgSO4 10 mg kg(-1) hr(-1) IV in 4mL (MG group) for 12 hrs or normal saline in same volume and rate for 12 hrs as used in MG group (NS group). After initiating the infusion, spinal anesthesia was given with 0.5% bupivacaine (Hyperbaric) 2.5 mL at L3/4 or L4/5 space. Time taken for sensory block at the level of T-10 and motor block (modified Bromage Score-1) was noted. Postoperatively, time taken for recovery from spinal anesthesia, pain score and requirement of postoperative analgesic in 24 hours were observed and compared between the two groups. RESULTS: The first rescue analgesia was required after 334 +/- 202 min in MG group and after 233 +/- 141 min in NS group with significant difference (p < 0.05). The morphine required over 24 hours for analgesia was significantly less in MG group (3.99 +/- 1.25 mg) as compared to NS group (7.13 +/- 2.68 mg) (p < 0.000). CONCLUSION: Intravenous MgSO4 improves postoperative analgesia without affecting the onset and recovery from spinal anesthesia.

Development of TaqMan real-time polymerase chain reaction for the detection of the newly emerging form of carbapenem resistance gene in clinical isolates of Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii.

PURPOSE: The newly emerging form of the so-called New Delhi Metallo-beta-lactamases (NDM-1) has been reported recently from patients worldwide and broadly thought as a potential source for the major global health problem. Thus, it is important to study the epidemiology of the so-called NDM-1 harbouring bacteria to prevent its further spread and to place effective control measures. The present study describes the use of the real-time polymerase chain reaction (PCR) assay for the detection of the bla NDM-1 gene using TaqMan probes among clinical isolates. MATERIALS AND METHODS: Clinical isolates of Escherichia coli (11 strains), Klebsiella pneumoniae (17 strains) and Acinetobacter baumannii (six strains) that were resistant to either of the carbapenems (meropenem or imipenem) were included in the study. The presence of carbapenemases in such strains was confirmed using the modified Hodge test. A real-time PCR assay was optimized for the detection of NDM-1 using a cloned synthetic gene fragment followed by testing of the clinical isolates. The findings were further confirmed using PCR and gene sequencing. RESULTS: TaqMan probe assay displayed a good detection limit with analytical sensitivity of the assay up to 10 copies of bla NDM-1 gene per reaction. The isolates of E. coli and K. pneumoniae revealed narrow range crossing point values (Cp values) between (12-17) cycles (mean Cp value 14), indicating number of bla NDM-1 gene copies of 106-108. The wider range of Cp values (15-34) cycles with a higher mean Cp value (23.6) was observed in A. baumannii with number of bla NDM-1 gene copies of 103-108. CONCLUSIONS: The study demonstrates that real-time PCR assay based on TaqMan chemistry is a useful technique for the detection of bla NDM-1 harbouring clinical isolates of E. coli, K. pneumoniae and A. baumannii. The assay has great precision in measuring the number of bla NDM-1 gene copies per specimen of DNA.

Phylogenetic studies reveal existence of multiple lineages of a single genotype of DENV-1 (genotype III) in India during 1956-2007.

BACKGROUND: Dengue virus type 1 (DENV-1) have been mostly circulating silently with dominant serotypes DENV-2 and DENV-3 in India. However recent times have marked an increase in DENV-1 circulation in yearly outbreaks. Many studies have not been carried out on this virus type, leaving a lacunae pertaining to the circulating genotypes, since its earliest report in India. In the present study, we sequenced CprM gene junction of 13 DENV-1 isolated from Delhi and Gwalior (North India) between 2001-2007 and one 1956 Vellore isolate as reference. For comparison, we retrieved 11 other Indian and 70 global reference sequences from NCBI database, making sure that Indian and global isolates from all decades are available for comparative analysis. RESULTS: The region was found to be AT rich with no insertion or deletion. Majority of the nucleotide substitutions were silent, except 3 non-conservative amino acid changes (I --> T, A --> T and L --> S at amino acid positions 59,114 and 155 respectively) in the Indian DENV-1 sequences, sequenced in this study. Except two 1997-98 Delhi isolates, which group in genotype I; all other Indian isolates group in genotype III. All Indian genotype III DENV-1 exhibited diversity among them, giving rise to at least 4 distinct lineages (India 1-4) showing proximity to isolates from diverse geographic locations. CONCLUSION: The extensive phylogenetic analysis revealed consistent existence of multiple lineages of DENV-1 genotype III during the last 5 decades in India.

Delayed pulmonary oedema following attempted suicidal hanging-a case report.

SUMMARY: During suicidal hanging, death takes few minutes to occur. Patient, if rescued, may develop respiratory distress, pulmonary oedema, convulsions, raised intra cranial pressure and unconsciousness immediately after incidence. We report a young male of suicidal hanging, brought to hospital in unconscious state with decerebrating movements. He developed pulmonary oedema after two hours of incidence. He was resuscitated and treated successfully.

Emergence of an independent lineage of dengue virus type 1 (DENV-1) and its co-circulation with predominant DENV-3 during the 2006 dengue fever outbreak in Delhi.

OBJECTIVES: The sudden emergence of dengue virus type 1 (DENV-1) and its co-circulation with predominant DENV-3 was the hallmark of the 2006 dengue fever outbreak in Delhi. Viruses that circulated between 1996 and 2005 in the City have been well characterized, but the genomic diversity in 2006 strains is not known. The present study was undertaken to reveal the emerging molecular genotype(s) and evolutionary trend of the viruses responsible for the dengue fever outbreak in Delhi during 2006. STUDY DESIGN: The CprM gene junction of the DENV isolates from the 2006 Delhi dengue fever outbreak were subjected to nucleotide sequencing. Comparative phylogenetic analysis was done using DENV-1 and DENV-3 sequences retrieved from the global database. RESULTS: Multiple sequence alignment revealed only substitutions, with no insertions or deletions. A dendrogram indicated emergence of a distinct lineage of DENV-1 (having similarity with the Comoros/Singapore 1993 and Delhi 1982 strains, but quite different from the Delhi 2005 lineage) and microevolution of the pre-circulating DENV-3. These findings point towards the circulation of two independent lineages of DENV-1 in Delhi during 2005 and 2006. CONCLUSIONS: It is feared that the introduction of an independent lineage of the outbreak-associated strain of DENV-1 and its co-circulation with the deeply-rooted strain of DENV-3 in Delhi may result in yet another, possibly more severe outbreak in the near future.

Serum lipids, lipoproteins and sex-hormone binding globulin in breast cancer.

Serum levels of various lipid parameters, i.e., triglycerides, total cholesterol, alpha lipoprotein or high density lipoprotein (HDL)-cholesterol and beta lipoprotein or low density lipoprotein (LDL)-cholesterol were measured in a total of 138 histologically proven cases of breast cancer along with 146 control women. The mean levels of serum triglycerides, total cholesterol and LDL-cholesterol were found to be significantly higher in breast cancer cases as compared to controls. However, lower mean levels of serum HDL-cholesterol and sex-hormone binding glubulin (SHBG) were observed in breast cancer patients than the control subjects. The results indicate a probable relation between serum lipids and the activity of sex-hormones. Moreover, the study reflects an overall disturbance of lipid metabolism in the pathological process of breast cancer.

A rare case of two malignancies: Carcinoma of the breast and uterine cervix.

A female patient who had two primary cancers was investigated. Biochemical analysis of patient's serum for different parameters indicated an alteration in the metabolic process. Prognostically, the patient has shown favourable clinical features.

Analgesia for acute musculoskeletal trauma: low-dose subcutaneous infusion of ketamine.

Low-dose ketamine by subcutaneous infusion (0.1 mg/kg/h) was compared in double-blind fashion with intermittent morphine (0.1 mg/kg intravenously, four-hourly) as analgesic regimen in 40 ASA-I adults after acute musculoskeletal trauma. Pain was assessed using visual analogue scales and sedation was graded on a four point rank drowsiness score. Objective cardiovascular and respiratory parameters and patient acceptability in terms of supplementary analgesia and early mobilization were also recorded. Pain relief was better with the ketamine infusion than with intermittent morphine (P < 0.001). Patients were more awake and alert with ketamine infusion as evidenced by the drowsiness score (P < 0.001). Peak expiratory flow rate improved significantly with the ketamine infusion (P < 0.05). None of the patients in ketamine group required supplementary analgesia (P < 0.001) and the patients could be easily mobilized for traction/splintage as compared with patients in the control group (P < 0.001). The incidence of nausea and vomiting in the morphine group was high (P < 0.01). The study shows that subcutaneous infusion of ketamine provides safe and effective analgesia in acute musculoskeletal trauma.