Does pre-procedure ultrasound increase the success and safety of right internal jugular venous catheterization? An intervention study.

BACKGROUND: Real-time ultrasound (US) in central venous catheterization is superior to pre-procedure US. However, ensuring real-time US into routine practice is impeded by its perceived expense and difficulty. This expertise requires hand-eye coordination and learning curve. Moreover, availability of multiple US machines and probes for multiple operation theatres may not be possible even at the tertiary level care set-up. Currently, pre-procedure US and landmark methods are most widely used. We investigated both the techniques with application of skin markings in the pre-procedure group to ascertain efficacy and safety with a view to incorporate pre-procedure US in our practice. METHODS: In this randomized study, we investigated 66 patients. Thirty-three patients in the pre-procedure ultrasound group and 33 patients in the landmark group were included for right internal jugular vein (RIJV) cannulation. We recorded the first needle pass success rate, cannulation time and complications. RESULTS: Pre-procedure US was associated with more successful attempts, shorter cannulation times and less complications. Under pre-procedure US, 75.76% of first attempts were successful with a cannulation time of 50 (25-180) seconds. Under landmark technique, 27.27% of first attempts were successful with a cannulation time of 85 (20-200) seconds. First puncture success rates were higher in pre-procedure US than landmark technique, 66.67% vs 27.27%, respectively. CONCLUSION: Pre-procedure US for RIJV catheterization is safer, quicker and superior to landmark technique.

Aqueous ozone controls decay and maintains quality attributes of strawberry (Fragaria × ananassa Duch.).

Investigations were made on the changes in physical and biochemical attributes, fruit decay and storage life of 'Winter Dawn' strawberry fruits in response to aqueous ozone dip treatment for different exposure times. Fruits were subjected to 0.1 ppm aqueous ozone for different time intervals (1-4 min). The treated strawberries were air dried and stored under ambient (25 ± 2 °C and 45-50% RH) and low temperature (2 ± 1 °C and 90% RH) conditions. Results revealed that treatment of strawberry fruits with aqueous ozone @ 0.1 ppm for 2 min resulted in 21% lower weight loss, 16% higher firmness and 15% lesser change in fruit colour during 2 days in ambient storage. Under low temperature storage, 2 min ozone treated fruits exhibited ~ 21% lower PLW, 19% higher firmness and 46% lesser colour change as compared to control fruits during 14 days of storage. Fruit decay reduced significantly under both low and cold storage conditions. Thus, it can be concluded that application of aqueous ozone for 2 min was able to retain the strawberry fruit quality and extend its storage life till 14 days under low temperature storage and 2 days under ambient storage conditions.

Control of hospital acquired infections in the ICU: A service perspective.

BACKGROUND: The service setting has some unique strengths and weaknesses that must be kept in mind when organizing Hospital acquired infections (HAI) prevention interventions. METHODS: Following an initial study to gather data regarding HAI in the Surgical intensive care unit (ICU) we put into place various infection control interventions. The present study was carried out to analyse the effect of these interventions on the incidence of HAI in the ICU. RESULTS: The total admissions to the ICU were 253 patients. Eighty eight patients (34.78%) were admitted for more than 48 hr, 165 patients stayed for less than 48 h. The frequency of HAI was 7.95% (95% CI 3.54, 15). Hospital acquired pneumonia was observed in 2 of the 88 patients (2.27%) (95% CI 0.38, 7.30) which amounted to 9.70 infections per 1000 ventilator days. Bloodstream infection was detected in 3 out of 88 patients (3.4%) (95% CI 0.87, 8.99) amounting to 6.54 fresh infections per 1000 Central Venous Catheter days. Urinary tract infection was observed in 2 (2.27%) (95% CI 0.38, 7.30) at 2.86 fresh infections per 1000 catheter days. As compared to the previous study we found that there was a decline of HAI ranging from 60 to 70%. CONCLUSION: Our study demonstrated that by meticulously following infection control protocols especially tailored to the service setting the incidence of HAI's can be reduced. However, the challenge is in maintaining the gains achieved since there is a rapid turnover of manpower in the ICU and a lack of a structured ICU design model.

Diagnosis of central venous catheter-related bloodstream infection without catheter removal: A prospective observational study.

BACKGROUND: Catheter-related bloodstream infections (CRBSI) resulting from bacterial colonisation of an intravascular catheter are the leading cause of nosocomially acquired sepsis contributing significantly towards in-hospital morbidity and mortality. Suspicion of central venous CRBSI leads frequently to catheter withdrawal but not all infection requires the catheter to be withdrawn; therefore, diagnosis of central venous CRBSI without catheter withdrawal is a necessity. METHODS: The study was prospectively performed in a cohort of adult patients who had short term central venous catheter use. The samples collected from each patients included, skin swab from insertion site, swab from catheter hub, paired blood samples from catheter and from the peripheral vein for quantitative blood culture collected within 15 min of each other and catheter-tip sample by cutting off the tip (distal 5-cm segment). All samples were processed immediately. RESULTS: 50 episodes of clinical sepsis involving 100 patients occurred in the study population. 28 of the episodes were confirmed as CR-BSI (56%). Blood culture from the central venous catheter had the highest sensitivity (71.43%) and the greatest negative predictive value (86.67%). However, the peripheral blood culture was most specific and had the highest positive predictive value (specificity75%; positive predictive value 50%). The most accurate technique was differential quantitative blood cultures (accuracy 72%), followed by semiquantitative superficial cultures (accuracy 68%), although there were no statistically significant differences between values. CONCLUSION: We recommend combining semiquantitative cultures and peripheral blood cultures to screen for CR-BSI, leaving differential quantitative blood cultures as a confirmatory and more specific technique.

Evaluation of mannitol as an osmotherapeutic agent in traumatic brain injuries by measuring serum osmolality.

BACKGROUND: The effectiveness of mannitol as an osmotherapeutic agent has never been subjected to a controlled clinical trial against placebo. Excessive use of mannitol in brain trauma patients can result in hyperosmolar states, hypernatremia and renal failure. This prospective study was conducted to evaluate the institutional protocol of using mannitol and assess its effects on serum osmolality. METHOD: Thirty patients with brain injury were included in the study. All the patients were given 100 mL of 20% mannitol three times a day as bolus infusion over 20-30 minutes. Serum osmolality was measured at 12 hourly intervals using Fiske osmometer. Mannitol administration was stopped whenever serum osmolality reached ≥ 320 mOsmol/Kg H2O. The total dose and duration of mannitol used to reach target osmolality of ≥ 320 mOsmol/Kg H2O was recorded. RESULTS: On 33% of all occasions, the patients had a serum osmolality which was in excess of the desired values (i.e. ≥ 320 mOsmol/Kg H2O). This indicates that the standard protocol of administering 20% mannitol 100 mL three times a day for more than 48 hours is perhaps excessive. CONCLUSION: The mannitol therapy should be guided by 12 hourly measurement of serum osmolality. Mannitol should be used for 48 hours only if facilities for measuring serum osmolality are not available.

Effects of Low Dose Vasopressin in Catecholamine Resistant Septic Shock.

BACKGROUND: Septic shock commonly leads to death in critically ill patients. Severe hypotension resistant to conventional catecholamine leads to multiorgan failure. We studied the effectiveness of low dose vasopressin in resistant septic shock. METHODS: Thirty critically ill patients with catecholamine resistant hypotension were included in the study. After adequate fluid resuscitation, infusion of norepinephrine and dobutamine was started. If the patient remained hypotensive, vasopressin was infused at a fixed rate of 0.04 unit/minute for 24 hours. Haemodynamic parameters and mortality rates were recorded. RESULT: There was a significant improvement in systolic and mean arterial pressure within four hours of starting vasopressin. This improvement continued throughout the 24-hour period. In addition, it was possible to withdraw dopamine in all the patients and significantly reduce infusion rates of dobutamine and norepinephrine. No significant complication was noted. CONCLUSION: Low dose vasopressin at the rate of 0.04 unit/minute is an effective vasopressor in adult patients with catecholamine resistant septic shock.

Walking Epidural : An Effective Method of Labour Pain Relief.

BACKGROUND: Labour pain can be deleterious for mother and baby. Epidural analgesia relieves labour pains effectively with minimal maternal and foetal side effects. A prospective open label study was undertaken to ascertain effective dosing regime for walking epidural in labour. METHODS: Fifty women with singleton foetus in vertex position were included. Epidural catheter was inserted in L2-3 / L3-4 interspinous space. Initial bolus of 10 ml (0.1% bupivacaine and 0.0002% fentanyl) solution was injected and after the efficacy of block was established, an epidural infusion of the same drug solution was started at the rate of 5 ml/hour. RESULTS: In first stage of labour 80% of the parturient had excellent to good pain relief (visual analogue scale 1 to 3) with standard protocol while 20% parturient required one or more additional boluses. For the second stage, pain relief was good to fair (VAS 4-6) for most of the parturient. The incidence of caesarian section was 4% and 6% needed assisted delivery. No major side effects were observed. CONCLUSION: 0.1% bupivacaine with 0.0002% fentanyl maximizes labour pain relief and minimizes side effects.

Uptake and distribution of natural radioactivity in wheat plants from soil.

The uptake of naturally occurring uranium, thorium, radium and potassium by wheat plant from two morphologically different soils of India was studied under natural field conditions. The soil to wheat grain transfer factors (TF) were calculated and observed to be in the range of 4.0 x 10(-4) to 2.1 x 10(-3) for 238U, 6.0 x 10(-3) to 2.4 x 10(-2) for 232Th, 9.0 x 10(-3) to 1.6 x 10(-2) for 226Ra and 0.14-3.1 for 40K. Observed ratios (OR) of radionuclides with respect to calcium have been calculated to explain nearly comparable TF values in spite of differences in soil concentration of the different fields. They also give an idea about the discrimination exhibited by the plant in uptake of essential and nonessential elements. The availability of calcium and potassium in soil for uptake affects the uranium, thorium and radium content of the plant. The other soil factors such as illite clays of alluvial soil which trap potassium in its crystal lattice and phosphates which form insoluble compounds with thorium are seen to reduce their availability to plants. A major percentage (54-75%) of total 238U, 232Th and 226Ra activity in the plant is concentrated in the roots and only about 1-2% was distributed in the grains, whereas about 57% of 40K activity accumulated in the shoots and 16% in the grains. The intake of radionuclides by consumption of wheat grains from the fields studied contributes a small fraction to the total annual ingestion dose received by man due to naturally existing radioactivity in the environment.

Trigonella foenum graecum (fenugreek) seed extract as an antineoplastic agent.

The antineoplastic effect of Trigonella foenum graecum seed extract has been evaluated in the Ehrlich ascites carcinoma (EAC) model in Balb-C mice. Intra-peritoneal administration of the alcohol extract of the seed both before and after inoculation of EAC cell in mice produced more than 70% inhibition of tumour cell growth with respect to the control. Treatment with the extract was found to enhance both the peritoneal exudate cell and macrophage cell counts. The extract also produced a significant antiinflammatory effect. We report here the antiinflammatory and antineoplastic effects, of Trigonella foenum graecum seed extract.

Antiinflammatory effect of petroleum ether extract of leaves of Litchi chinensis Gaertn. (Sapindaceae).

Pharmacological studies were conducted with the petroleum ether extract of leaves of the plant Litchi chinensis Gaertn. (Sapindaceae) on experimental animals. The extract was found to possess antiinflammatory, analgesic and antipyretic activity. Acute toxicity studies revealed that the extract, up to a dose of 1 g/kg intraperitoneally, was nontoxic. The extract did not inhibit arachidonic acid-induced paw inflammation thus indicating that it may inhibit the cyclooxygenase pathway of arachidonic acid metabolism. The extract also enhanced peritoneal cell exudate along with macrophage significantly.