Efficacy of Variable Doses of Prophylactic Intravenous Ondansetron in Attenuating Spinal Induced Hypotension in Parturients Undergoing Caesarean Delivery: A Randomised Control Trial.

Introduction Spinal anaesthesia is frequently associated with adverse effects like maternal hypotension and bradycardia. This effect is due to a decrease in systemic vascular resistance, a decrease in central venous pressure or Bezold-Jarisch Reflex (mediated by 5-HT3 receptors). We aimed to measure the effect of three different doses of prophylactic intravenous ondansetron (5-HT3 antagonists) with a placebo on maternal haemodynamics. Methods A prospective randomised control study was done over 240 parturients, aged 19-35 years. They were randomly allocated into four groups (n=60) Group O4, Group O6, Group O8 and Group S to receive either intravenous ondansetron 4 mg, 6 mg, 8 mg or 0.9% normal saline respectively. Haemodynamic variables (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], heart rate [HR]) were recorded at 2-minute intervals for the first 20 minutes and at 5-minute intervals for further 30 minutes. Results A significant decrease in haemodynamic parameters was observed in group S when compared with ondansetron groups at various time intervals (p<0.05). The difference was most significant in groups O6 and O8. Development of nausea and vomiting was significantly higher in Group S compared to ondansetron groups (p< 0.005). The requirement for ephedrine was more in Group S in comparison to ondansetron groups (p<0.0001). Conclusion All three groups of ondansetron showed a decrease in the incidence of hypotension and use of vasopressor but Group O6 and O8 were more effective in attenuating spinal-induced hypotension in parturients undergoing caesarean section.

Comparison of conventional with Parker flex-tip tracheal tube for intubation through air-Q intubating laryngeal airway.

BACKGROUND AND AIMS: The problem of difficult and failed intubation led to increased development of equipment for airway management. A number of supraglottic airways have now been developed to facilitate the passage of tracheal tubes. Conventional PVC tracheal tubes are recommended for intubation through the air-Q ILA. No study has compared different PVC tubes for blind intubation through air-Q ILA. Thus, we undertook this prospective, randomised, single blind study to compare two PVC tracheal tubes with different designs viz. conventional PVC tracheal tube (TT) and Parker flex-tip TT with regards to success rate, ease of intubation and total time required for successful intubation through air-Q ILA. MATERIAL AND METHODS: One hundred patients of either sex, aged 18-60 years, belonging to American Society of Anesthesiologists (ASA) physical status class I and II scheduled for elective surgery under general anesthesia requiring endotracheal intubation were included in the study. Blind intubation using conventional PVC TT and Parker flex-tip tube was done in group A (n = 50) and group B (n = 50), respectively. RESULTS: The first attempt success rate in Parker flex-tip TT was significantly more as compared to conventional PVC TT (P = 0.002). Success rate of intubation was significantly more in Parker flex-tip TT as compared to conventional PVC TT (P = 0.004). The intubation was significantly easy in Parker flex-tip tube as compared to conventional PVC TT (P = 0.002). Total time of intubation was less in Parker flex-tip tube as compared to PVC TT (P = 0.043). CONCLUSION: Unique design of the Parker Flex-tip TT resulted in increase in success rate, first attempt success rate and ease of intubation in group B in present study.

Emergence of ciprofloxacin resistant Neisseria gonorrhoeae in north India.

BACKGROUND AND OBJECTIVES: Though quinolones have been recommended as a single dose treatment for uncomplicated gonorrhoea, there have been reports of treatment failure with fluoroquinolones. In this study we determined the antimicrobial susceptibility levels of consecutive isolates of Neisseria gonorrhoeae to examine the emergence of ciprofloxacin resistance N. gonorrhoeae. METHODS: Minimum inhibitory concentration (MIC) of ciprofloxacin and other drugs (penicillin, tetracycline, ciprofloxacin and ceftriaxone) was determined by agar dilution method. MIC was interpreted according to the NCCLS guidelines. beta lactamase production was detected by iodometric method and chromogenic cephalosporin method using nitrocefin disc. RESULTS: A total of 45 consecutive isolates of N. gonorrhoeae were obtained from patients with suspected acute gonococcal uretheritis. Of the 45 isolates, 35 (77.7%) were resistant to ciprofloxacin, 16 (35.5%) showed MIC value greater than 8 microg/ml. All isolates were sensitive to ceftriaxone while 21 isolates (46.6%) were resistant to penicillin and 23 (51%) to tetracycline. Ten isolates (22%) were found to be beta-lactamase producers. INTERPRETATION AND CONCLUSION: Ciprofloxacin resistant N. gonorrhoeae is on the rise in and around Chandigarh (north India). Thus, periodic surveillance of susceptibility levels of N. gonorrhoeae is essential to prevent the dissemination of drug resistant strains in the community.

Anaerobiosis-induced virulence of Salmonella enterica subsp. enterica serovar Typhimurium: role of phospholipase Cgamma signalling cascade.

Salmonella enterica subsp. enterica serovar Typhimurium (S. Typhimurium) can initiate entry into non-phagocytic epithelial cells by triggering certain signal transduction pathways, thereby allowing the pathogen to invade and establish a niche within host cells. Anaerobiosis has been shown to be an important inducer of the invasion process of S. Typhimurium. However, the effect of anaerobiosis on modulation of cell signalling cascades by S. Typhimurium is not known. In the present study, the phospholipase Cgamma signalling cascade was investigated in mice enterocytes, following interaction with S. Typhimurium grown under aerobic and anaerobic growth conditions. Significant increases in enterocyte intracellular calcium and inositol 1,4,5-triphosphate levels were observed on interaction with S. Typhimurium grown anaerobically compared with S. Typhimurium grown aerobically. An increased membrane/cytosolic ratio of protein kinase C was also seen with anaerobic S. Typhimurium in enterocytes compared with aerobic S. Typhimurium. These data suggest that anaerobically grown organisms are more efficient in initiating cell-signalling events than are aerobically grown bacteria. These enhanced cell signals may contribute to the increased virulence of S. Typhimurium grown anaerobically.