A Randomised Controlled Trial Comparing Ketamine versus Fentanyl for Procedural Sedation in the Emergency Department for Adults with Isolated Extremity Injury.

Introduction: Alleviating pain and anxiety of patients during procedures is an essential skill for an Emergency Physician (EP). Several sedatives and dissociative agents are used for PSA (Procedural Sedation and Analgesia). In this study, we aimed to compare two drugs that is, ketamine and fentanyl for procedural sedation in adults with isolated limb injuries in the Emergency Department (ED). Materials and methods: In this prospective, randomised controlled interventional trial, patients aged between 18 to 65 years with isolated extremity injury requiring PSA in the ED were recruited. A total of 200 subjects were included in the study and randomly allocated to either the fentanyl (n=100) or the ketamine (n=100) group. Patients were blinded to the intervention and subsequently premedicated with Midazolam. Following this, they received either ketamine or fentanyl based on the group they were allocated to. Vital signs, including but not limited to the level of sedation, were measured at predetermined time intervals. A Modified Aldrete Score of >8 was used as a criterion for disposition from the ED. Data were collected in a pre-designed proforma. We aimed to compare the effectiveness as well as ascertain the safety profile of the two drugs for PSA in the ED. Results: There was no significant difference between the two groups when age, gender, mechanism of injury and comorbidities were compared. We found that there was no statistically significant difference between the two groups when blood pressure, respiratory rate and depth of sedation were compared. In both groups, there was a significant decrease in pain on the Numerical Rating Scale (NRS) following drug administration from 8 to 3 (p<0.001). Patients in the fentanyl group had an increased incidence of transient oxygen desaturation (p<0.001). Vomiting was more common in the ketamine group (p<0.001). Conclusion: PSA is a safe and efficacious procedure for patients undergoing painful procedures in ED. Patients in both the groups maintained hemodynamic stability throughout the procedure. From our study, we were able to conclude that both ketamine and fentanyl are similar in efficacy for PSA in the ED for adults with isolated limb injuries. In addition, no significant cardiovascular adverse events were noted in either group in our study.

A rare tumour of pancreas-Case report.

INTRODUCTION: Pancreatic schwannomas are very rare neoplasm arising from Schwann cells that present in the nerve sheath. Schwannoma usually occur in the extremities but can also be found in the trunk, head and neck, retroperitoneum, mediastinum, pelvis and rectum. PRESENTATION OF CASE: We briefly describe a 30-year-old female patient with upper abdominal pain and on examination by ultrasound and Computed tomography of abdomen revealed a solid tumor arising from body of the pancreas. A laparoscopic splenic vessel preserving distal pancreatectomy (kimura) was performed. DISCUSSION: Approximately only 50 cases reported in the literature and none of these cases were diagnosed as schwannoma preoperatively. CT scan is often useful to establish pancreatic lesion which usually demonstrate hypodense lesion with encapsulation CONCLUSION: Although the incidence of pancreatic schwannoma is low, it must be considered as one possibility in the differential diagnosis of mass lesions in the pancreas and whenever possible especially in large tumors surgical resections should be considered due to increased chance of transformation to malignancy.

Improved lead recovery and sulphate removal from used lead acid battery through electrokinetic technique.

This paper presents improvement in lead (Pb) recovery and sulphate removal from used Pb acid battery (ULAB) through Electrokinetic technique, a process aimed to eliminate environmental pollution that arises due to emission of gases and metal particles from the existing high temperature pyrometallurgical process. Two different cell configurations, (1) one with Nafion membrane placed between anode and middle compartments and Agar membrane between cathode and middle compartments and (2) another with only Agar membrane placed between both sides of the middle compartments were designed for the Pb and sulphate separation from ULAB. This paper concludes that the cell with only Agar membranes performed better than the cell with Nafion and Agar membranes in combinations and also explains the mechanism underlying the chemical and electrochemical processes in the cell.