ABSTRACT
Background: Postoperative analgesia is of utmost importance in the treatment of patients undergoing surgery. Good postoperative pain management reduces hospital stay and improves early ambulation. This study compared the efficacy of epidural bupivacaine with buprenorphine to butorphanol in lower limb orthopedic surgery. Objectives: This study was carried out to investigate the onset of analgesia, the extent of analgesia, sedation score, and side effects of butorphanol with bupivacaine versus buprenorphine with bupivacaine. Methods: In a clinical trial study, 100 patients who underwent elective orthopedic lower limb surgery were randomly allocated to two groups. A total of 100 patients with American Society of anesthesiologists grades I and II posted for lower limb orthopedic surgery were enrolled in this randomized, double-blind study. The patients were divided into groups A and B. Subarachnoid block was achieved with 3.4 mL of 0.5% bupivacaine. The pain was monitored by the visual analog scale postoperatively. The patients in group A received bupivacaine with buprenorphine, and group B received bupivacaine with butorphanol when they complained of pain in the postoperative period. The onset of analgesia, duration of analgesia, sedation score, and side effects were compared between the two groups. Results: The onset of analgesia was observed earlier in group A than in group B (7.7 ± 1.6 vs. 12.6 ± 1.7 minutes, P < 0.001). The duration of analgesia was longer in group A than in group B (590 ± 40 vs. 480 ± 54 minutes, P < 0.001). Pulse rates and mean arterial pressures were significantly different (P < 0.001). Side effects were common in both groups. Conclusions: Buprenorphine added to bupivacaine provides earlier onset and longer postoperative epidural analgesia than epidural butorphanol with bupivacaine.
ABSTRACT
Acute kidney injury (AKI) is common in coronavirus disease 2019 (COVID-19), and its severity is linked to the adverse outcomes of multiorgan involvement. We attempted to assess the clinical outcomes and determinants of mortality in patients admitted to our COVID-19 care center from May to November 2020 who developed AKI through a retrospective examination of their case records. The data of those who developed AKI were analyzed for their clinical parameters, clinical presentation, history, laboratory parameters, urine output measurements, requirements for dialysis, treatment, and treatment outcomes (discharge or death). These outcomes were correlated to the comorbidities, laboratory parameters, the Kidney Disease Improving Global Outcomes (KDIGO) AKI stage, sequential organ failure assessment score, and need for dialysis or renal replacement therapy. Of 1890 patients admitted, 132 (6.98%) patients developed AKI. Of 450 deaths from all causes, 67 (14%) were in AKI patients. There were 100 (75.8%) males and 32 (24.8%) females. The mean age was 62.05 ± 11.48 years. The median duration of stay was 7 days (interquartile range: 4--11.75 days). The number of patients in AKI Stages 1, 2, and 3 was 1 (0.75%), 64 (48.48%), and 67 (50.75%), respectively. The most common symptoms were breathlessness (85.6%), fever (84.5%), myalgia (81.19%), and weakness (76.5%). Multivariate analysis showed that the determinants of mortality were a partial pressure of oxygen saturation (pO2) of <75% and of 76%-85% compared with a pO2 of >85%, not receiving remdesivir, and KDIGO Stage >2.
Subject(s)
Acute Kidney Injury , COVID-19 , Male , Female , Humans , Middle Aged , Aged , COVID-19/complications , COVID-19/therapy , Retrospective Studies , Tertiary Care Centers , Treatment Outcome , Acute Kidney Injury/diagnosis , Acute Kidney Injury/therapy , Acute Kidney Injury/etiology , Hospital Mortality , Risk FactorsABSTRACT
BACKGROUND: Monitoring of hepatitis B virus (HBV) viral load has become an essential phase in the treatment of HBV. There are many commercial assays available for HBV viral load quantification. In this study, we have evaluated the performance characteristics of Amplisure® HBV Kit in comparison with the Qiagen artus HBV QS-RGQ kit for HBV DNA quantitation. METHODS: Comparison of 2 methods was carried out on 200 clinical samples, 150 HBV DNA positive and 50 HBV DNA negative, by a reference method. Results obtained with Amplisure® HBV Kit (Amplisure HBV) were compared using the Qiagen artus HBV QS-RGQ assay results as the comparator method. RESULT: The overall performance of the Amplisure HBV compared with the comparator method shows positive and negative clinical agreement of 100 and 76%, respectively. Among the 12 qualitative discrepant samples, all positive with Amplisure HBV were sequenced and 10 were below comparator method's LOD. For 5 weak positives (-0.22 to 0.98 log IU/mL), the sequencing failed. The 7 other positives (0.48 to 1.89 log IU/mL) were confirmed positive by sequencing. Quantitative comparison gave an r2 of 0.967 with a mean log difference of 0.09 log10 IU/mL. CONCLUSION: This study shows that Amplisure® HBV Quantitative Kit shows comparable performance with artus HBV QS-RGQ assays and can be useful in management and therapeutic monitoring of HBV in a clinical practice.
