Social and Cultural Factors Leading to Suicide Attempt via Organophosphate Poisoning in Nepal.

Organophosphates are commonly used in rural, agricultural communities worldwide. Poisoning in Nepal is commonly a result of suicide attempt via ingestion with a mortality rate of 41 times higher than in the United States even after appropriate treatment. The patient discussed in this case is a 46-year-old Nepalese female with a complicated psychosocial history that presented with a suicide attempt via organophosphate ingestion. She required higher doses and greater lengths of treatment of atropine and pralidoxime to resolve symptoms of toxicity that resulted in atropine-induced psychosis, a side effect rarely cited in the literature. This patient was one of many who attempt suicide in Nepal, where suicide is the leading cause of death for young to middle aged women in the country.

Pneumopericardium after minimally invasive atrial septal defect closure.

Minimally invasive atrial septal defect (ASD) closure is a commonly performed cardiac surgical procedure and has good outcome. We report an interesting chest X-ray showing pneumopericardium in a patient who underwent ASD closure using a minimally invasive approach.

Cardiac output monitoring: comparison of a new arterial pressure waveform analysis to the bolus thermodilution technique in patients undergoing off-pump coronary artery bypass surgery.

OBJECTIVE: To analyze the clinical agreement between the conventional intermittent bolus thermodilution (TD) technique and a new arterial pressure waveform analysis (APCO) technique (FloTrac; Edward Lifesciences, Irvine, CA) for cardiac output (CO) estimation. DESIGN: Prospective observational clinical study. SETTING: Cardiac surgery operating room of a tertiary care cardiac center. PARTICIPANTS: Twelve patients undergoing elective off-pump coronary artery bypass (OPCAB) surgery. MEASUREMENTS AND MAIN RESULTS: CO was determined by 2 different methods: TD and APCO at 8 time points (preinduction, postinduction, poststernotomy, left internal mammary artery to left anterior descending artery anastomosis, left [obtuse marginal/diagonal] anastomosis, right [right coronary/posterior descending coronary artery] anastomosis, postprotamine administration, and poststernal closure) in 12 patients undergoing elective OPCAB surgery. The mean bias and limits of agreement (2 standard deviations) expressed in liters per minute at respective points of measurement were -0.54 +/- 1.12, -0.37 +/- 1.0, -0.42 +/- 1.50, -0.25 +/- 1.18, -0.31 + 1.28, +/-0.41 +/- 1.0, 0.06 +/- 1.50, and 0.09 +/- 1.40. CONCLUSION: Good agreement was found between the CO values obtained by the APCO and TD techniques throughout the intraoperative period including the period of coronary artery graft surgery.

Cardiac output estimation after off-pump coronary artery bypass: a comparison of two different techniques.

The present study compares the cardiac output (CO) estimated by a new, non-invsive continuous Doppler device (Ultrasonic cardiac output monitor-USCOM) with that by bolus thermodilution technique (TD). Thirty post off-pump coronary artery bypass graft surgery patients were studied in this prospective nonrandomized study. Right heart CO estimation by USCOM and TD was performed and measured in quadruplet. A total of 120 paired observations were made. The mean CO was 4.63 and 4.76 Llmin as estimated by TD and USCOM respectively. For TD and USCOM, the CO had a mean bias (tendency of one technique to differ from other) of -0.13 L/min and limits of agreement (mean bias +/- 2SD) at -0.86 and 0.59 L/min. The study reveals very good agreement between the values of CO estimated by USCOM and TD.

An observational study to know the association of leukocytosis and fever with infection in post cardiac surgery patients.

BACKGROUND: Leukocytosis and fever in the absence of infection are common phenomena in post surgical period. The systemic inflammatory response syndrome induced by surgical trauma is a well-known entity, with resultant release of variety of inflammatory cytokines leading to fever and/or leukocytosis in spite of the absence of infection. AIMS AND OBJECTIVE: To know the association of leukocytosis and fever with infection in immediate post cardiac surgical period. METHODS: It was a retrospective, observational study including 569 patients, who underwent cardiac surgeries in our institute. All demographic data, comorbidities and other factors associated with fever and/or leukocytosis were analyzed. The sensitivity and specificity of fever and/or leukocytosis were analyzed for the diagnosis of infection. RESULTS: Out of 569 patients; 49 patients (9%) had evidence of infection on microbiological culture. Mean total leukocyte counts (TLC) on zero and 1st postoperative days were associated with infection with a sensitivity (75.5% and 63.3%) and specificity (15.8% and 24.0%) respectively. Mean maximum temperature (Tmax) on zero and 1st postoperative days were associated with infection with a sensitivity (20.4% and 24.5%) and specificity of (82.5% and 83.3%) respectively. The combined sensitivity and specificity of leukocytosis and fever for the diagnosis of infection on 2nd postoperative day was 14.3% and 91.5% respectively. CONCLUSION: Fever and leukocytosis are poor predictors of diagnosing infection on the first two postoperative days. However, fever and leukocytosis combined together have low sensitivity (14.3%) with high specificity (91.5%) for the diagnosis of infection on the 2nd and subsequent postoperative days.

Cardiac output estimation with a new Doppler device after off-pump coronary artery bypass surgery.

OBJECTIVE: To compare cardiac output (CO), stroke volume (SV), and cardiac index (CI) as estimated with a new, noninvasive Doppler device (Ultrasonic Cardiac Output Monitor [USCOM]; USCOM Ltd, Sydney, Australia) with those measured with the bolus thermodilution (TD) technique. DESIGN: Prospective nonrandomized study. SETTING: Postcardiac surgery recovery unit of a tertiary cardiac center. PARTICIPANTS: Fifty patients after off-pump coronary artery bypass (OPCAB) surgery. MEASUREMENT AND MAIN RESULTS: Both right-sided and left-sided CO were estimated with a USCOM continuous-wave (CW) Doppler device, and CO was determined with the bolus TD technique performed in triplicate. On comparing the right-sided CO, SV, and CI with those of TD, the mean bias was 0.03 L/min, 1.6 mL, and 0.02 L/min/m(2), respectively. The comparison of left-sided CO, SV, and CI with those of TD revealed a means bias of 0.14 L/min, 1.0 mL, and 0.08 L/min/m(2), respectively. CONCLUSION: This study showed excellent agreement between the values for CO, SV, and CI as determined with USCOM and TD. Since there was only 1 time period for CO estimation in each patient with both methods, the stability of this correlation needs to be further investigated over time.