Aerosol-generating procedures, how best did anesthesiologists use available personal protective equipment during early COVID-19 pandemic in a tertiary care center of southern India? A prospective cross-sectional study.

Background and Aims: Anesthesiologists are involved in high-risk procedures for transmission of SARS-CoV-2 like aerosol-generating procedures (AGPs). The present study was conducted to assess the compliance toward the use of personal protective equipment (PPE) and proposed modifications in anesthesia techniques to prevent dissemination of the virus among healthcare workers. Material and Methods: This prospective cross-sectional study was conducted during the first wave of the COVID-19 pandemic and included all elective surgeries involving AGPs inside operation theatres and remote areas. Participants were anesthesia consultants and trainees. Trained anesthesia technicians observed and documented all the AGPs and data entry with analysis was done using EPI Data 3.1, SPSS 21.0. Descriptive statistics were reported using mean ± SD for continuous variables. Results: Preoperative COVID-19 test was done in 96.3% of patients. Most (74.8%) of the AGPs were performed by consultants. In our study, compliance for N95 masks usage and hand hygiene was found to be 99.2% and 55.9%, respectively. Avoidance of crowding was followed in only 38.9% during intubation. To contain the aerosol-based spread of virus, modification of anesthesia practices like acrylic boxes (6.4%), plastic sheets (5.5%), video laryngoscopy (39%), rapid sequence intubation (RSI) (42.7%), and 59.3% of deep extubation were incorporated. Conclusion: In our study, we found satisfactory compliance toward usage of N95 masks alone, whereas compliance toward other available PPE and modification in anesthesia practice was found to be unsatisfactory.

Comparison of a single intraoperative posterior sub-Tenon's capsule triamcinolone acetonide injection versus topical steroids for treatment of postcataract surgery inflammation in children.

BACKGROUND: The aim of this study is to compare the clinical efficacy of a single intraoperative posterior sub-Tenon's capsule triamcinolone acetonide injection with postoperative topical steroids in controlling intraocular inflammation in uncomplicated pediatric cataract surgery. MATERIALS AND METHODS: A prospective comparative study of children (<13 years of age) undergoing cataract surgery in a tertiary care eye center in South India. Preoperative evaluation was similar in both groups. The surgical procedure was the same for both groups except at the end of surgery only Group 1 (right eye of bilateral cataracts and all unilateral cataracts) received intraoperative 0.5 ml (40 mg/ml) posterior sub-Tenon's injection of triamcinolone acetonide. Postoperatively, Group 1 was administered only topical antibiotic and Group 2 was put on topical antibiotic, mydriatic, and steroids. Intraocular inflammation and intraocular pressure (IOP) were assessed clinically on day 1, 1st week, 1st month, and 3 months, postoperatively. RESULTS: A total of 30 eyes were included in the study. Age ranged between 1 month and 132 months, with 18 eyes included in Group 1 and 12 eyes in Group 2. The mean postoperative IOP at the 3 months follow-up was not significantly different between groups (P = 0.4). The presence of intraocular lens had no role in postoperative inflammation (P = 1). Group 2 showed more anterior segment inflammation with six eyes (50%) developing posterior synechiae and distortion of the pupil 3 months postoperatively. CONCLUSION: In pediatric cataracts, a single intraoperative sub-Tenon's capsule injection of triamcinolone acetonide appears to be safe and effective in controlling postcataract surgery inflammation.

Predictors of renal recovery in renal failure secondary to bilateral obstructive urolithiasis.

OBJECTIVES: To identify factors predicting renal recovery in patients presenting with renal failure secondary to bilateral obstructing urolithiasis. PATIENTS AND METHODS: Data from electronic records of consecutive adult patients presenting with bilateral obstructing urolithiasis between January 2007 and April 2011 were retrieved. Ultrasonography of the abdomen, and kidney, ureter, bladder (KUB study) X-ray or abdominal non-contrast computed tomography confirmed the diagnosis. Interventional radiologists placed bilateral nephrostomies. Definitive intervention was planned after reaching nadir creatinine. Renal recovery was defined as nadir creatinine of ⩽2 mg/dL. RESULTS: In all, 53 patients were assessed, 50 (94.3%) were male, and 18 (33.9%) were aged ⩽40 years. Renal recovery was achieved in 20 patients (37.7%). A symptom duration of ⩽25 days (P < 0.01), absence of hypertension (P = 0.018), maximum renal parenchymal thickness of >16.5 mm (P = 0.001), and haemoglobin >9.85 g/dL (P < 0.01) were significant on unadjusted analysis. Symptom duration of ⩽25 days alone remained significant after adjusted analysis. Symptom duration of ⩽25 days (hazard ratio (HR) 13.83, 95% confidence interval (CI) 4.52-42.26; P < 0.01), parenchymal thickness of ⩾16.5 mm (HR 5.91, 95% CI 1.94-17.99; P = 0.002), and absence of hypertension (HR 9.99, CI 95% 1.32-75.37; P = 0.026) were significantly related to time to nadir creatinine. Symptom duration of ⩽25 days (HR 17.44, 95% CI 2.48-122.79; P = 0.004) alone remained significant after adjusted analysis. A symptom duration of ⩽25 days (P = 0.007) was 22-times more likely to indicate renal recovery. CONCLUSIONS: Shorter symptom duration (⩽25 days) is predictive of renal recovery in renal failure secondary to bilateral obstructive urolithiasis.