bluuebunny/crossref_metadata_2025 huggingface dataset:
Propofol vs Sevoflurane for Laryngeal Mask Airway Insertion Under General Anaesthesia in Day Care Surgeries
Authors:   Professor, Department of Anaesthesia, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab 151203, India., Singh Gurpreet , Kaur Haramritpal ,   Associate professor, Department of Anaesthesia,Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab 151203, India., Bansal Deepali ,   Senior resident, Department of Anaesthesia, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab 151203, India., Kavita Divya ,   Assistant professor, Department of Anaesthesia, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab 151203, India., Singh Amandeep ,   Assoicate Professor, Department of Surgury, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab 151203, India., Gupta Shashank ,   Junior Resident Department of Anaesthesia, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab 151203, India.
Published: January 2024

Background: Laryngeal mask airway (LMA) is an excellent airway device used in day care surgeries. We aimed to compare two induction anaesthetic agents, propofol and sevoflurane for LMA insertion conditions in day care surgeries. Patients and Methods: This prospective, randomized study was conducted on 80 adult, ASA grade I and II patients, of either gender, undergoing elective day care surgical procedures. Patients were randomly divided in two groups of 40 each. Group P received intravenous propofol infusion at the rate of 800ml/ hour for induction followed by LMA insertion. Group S received 8% sevoflurane for induction followed by LMA insertion. Both groups were compared for LMA insertion conditions in terms of time taken from the start of induction to loss of verbal contact, loss of eyelash reflex, jaw relaxation, successful LMA insertion conditions, number of attempts of LMA insertion and effective airway establishment time. Unpaired student – t test and Chi square test were used for statistical analysis. Results: Patients in Group P achieved earlier LMA insertion conditions as compared to Group S i.e. shorter time to loss of verbal contact (33.48 ± 6.55 seconds vs 41.30 ± 4.12 seconds), loss of eye lash reflex (36.50 ± 6.67 seconds vs 44.40 ± 4.06 seconds), adequate jaw relaxation (40.35 ± 7.64 seconds vs 49.02 ± 4.45 seconds), and effective airway establishment time (44.88 ± 8.86 vs 54.65 ± 4.28 seconds) (P value <0.001). Conclusion: We concluded that both the agents can be used for insertion of LMA however induction and insertion of LMA is faster with propofol.
Dexmedetomidine versus MgSo4 in Hemodynamic Stability in Laparoscopic Cholecystectomy Cases
Authors:   Assistant Professor, Department of Anesthesia, Pacific Institute of Medical Sciences, Udaipur, Rajasthan, 313015, India., Ranawat Pinu , Tyagi Naresh Kumar ,   Assistant Professor, Department of Anesthesia, Pacific Institute of Medical Sciences, Udaipur, Rajasthan, 313015, India., Gupta Arvind Kumar ,   Assistant Professor, Department of Anesthesia, Pacific Institute of Medical Sciences, Udaipur, Rajasthan, 313015, India., Jangir Amit ,   Assistant Professor, Department of Anesthesia, Pacific Institute of Medical Sciences, Udaipur, Rajasthan, 313015, India.
Published: January 2024

Laparoscopic surgery is associated with an elevation of cardiac parameters as well an elevation in blood pressure due to effects of catecholamine activity and vaso constriction. Due to the widespread use of laparoscopic techniques in modern day surgical practice it has become imperative for the anaesthetist to maintain a stable hemodynamic environment in the patient in the operative and post operative period. The use of dexmedetomidine and magnesium sulphate has been done with successfully in practice. The present study aimed to ascertain whether the comparative efficacy of both these drugs is equal or different. The study employed a subject pool of 60 subjects. The study found that there were no statistically significant differences between the two drugs when used in the corresponding sample population.
Comparative Study of Oral Clonidine, IV Fentanyl and IV Butorphanol in Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation
Authors:   Assistant Professor, Department of Anaesthesiology, Shri M P Shah Medical College, Jamnagar, Gujarat 361008, India., C Sorathiya Prashant , Souza Rashmi D ,   Assistant Professor, Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka 560002, India.
Published: January 2024

Introduction: Laryngoscopy and endotracheal intubation is invariably associated with haemodynamic stress response which may have severe consequences in patients with comorbidities. Various drugs have been tried to attenuate this response. Ease of use, cost effectiveness and minimal side effects are some important considerations while choosing an agent. In this study we have compared the efficacy of oral clonidine with IV fentanyl and IV butorphanol in attenuating the stress response to laryngoscopy and intubation. Materials and Methods: This is a prospective, randomised, comparative study carried out on 75 patients aged 20–60 years, ASA I/II physical status, scheduled for elective surgery. These patients were randomly allocated into three groups- GROUP A received IV Fentanyl 2mcg/kg and GROUP B received IV Butorphanol 40 mcg/kg five mins prior to induction respectively. GROUP C received Oral Clonidine 4 mcg/kg 90 mins prior to induction. All thepatients were assessed for heart rate, systolic blood pressure and diastolic blood pressure before induction, during laryngoscopy, after intubation at 1 min, 2 min, 3 min and 5 minrespectively. Statistical analysis: The data was compared and analysed using Kruskal-Wallis test. Results: There was an increase in the hemodynamic parameters post laryngoscopy and intubation in all the groups.Astatistically significant difference in the mean heart rate, systolic blood pressure and diastolic blood pressure was observed; the increase being significantly lower and short-lived in the oral clonidine group compared to the other two groups. Although all the three drugs were effective in attenuating the pressor response, oral clonidine was moreeffective and consistent compared to IV fentanyl and IV butorphanol. Conclusion: Oral clonidine 4mcg/kg given 90 mins prior to induction is more effective than IV fentanyl and IV butorphanol in blunting the hemodynamic response to direct laryngoscopy and intubation without causing any significant side effects.
Efficacy of Varying Doses of Dexamethasone with Lignocaine in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries
Authors:   Associate professor, Department of Anesthesiology, Rangaraya Medical College, Kakinada, Andhra Pradesh 533001, India., Sree M Santhi , Sowbhagyalakshmi B ,   Professor and HOD, Department of Anesthesiology, Rangaraya Medical College, Kakinada, Andhra Pradesh 533001, India., Archana M ,   Senior Resident, Department of Anesthesiology, Rangaraya Medical College, Kakinada, Andhra Pradesh 533001, India.
Published: January 2024

Objectives: To compare the effectiveness of inj. Dexamethasone 4mg added to 1.5% lignocaine with adrenaline with inj Dexamethasone 8mg added to 1.5% lignocaine with adrenaline in Supraclavicular Brachial Plexus Block in terms of onset of sensory and motor blockade andduration of sensory and motor blockade. Materials and Methods: The study was carried out as a Prospective, randomized clinical trial among 150 patients who underwent different surgical procedures under supraclavicular brachial plexus block. They were randomized into three groups. GROUP A: Patients belonging to this group are given supraclavicular brachial plexus block with 4 mg dexamethasone as adjuvant to 1.5 %lignocaine with adrenaline (7mg/kg). GROUP B: Patients belonging to this group received supraclavicular brachial plexus block with 8 mg dexamethasone as adjuvant to 1.5 % lignocaine with adrenaline (7mg/kg). GROUP C: Patients belonging to this group received supraclavicular brachial plexus block with 2ml of normal saline added to 1.5 % lignocaine with adrenaline (7mg/kg). The three groups were compared with regard to onset of sensory and motor blockade andduration of sensory and motor blockade. Results: No statistically significant difference was reported between the three groups in demographic variables. The mean time required for onset of sensory block in Group A and Group B is 11.2 minutes and in Group–C is 14.26, onset of motor block Group A and Group B is 13.0 minutes and in Group–C is 17.0 min. The average duration of sensory block in Group B>A>C. The average duration of Motor block in Group B is 242min, and in Group A with 192 min and with Group C is 153min. Conclusion: In conclusion, addition of dexamethasone to local anaesthetics in supraclavicular brachial plexus block results in a faster onset and prolonged duration of sensory and motor blockade. Higher dose (8mg) of dexamethasone is more efficacious than lower dose (4mg) of dexamethasone as an adjuvant with local anaesthetics in terms of duration of sensory block, motor block and analgesia but equally efficacious in onset of sensory and motor blockade.
Study to Evaluate Usefulness of Magnesium Sulphate and Dexmedetomidine as Adjuvant to Bupivacaine for Lower Limb and Abdominal Surgeries Under Epidural Anaesthesia
Authors:   Postgraduate Resident, Sri Devaraj Urs Academy of Higher Education and Research, R L Jalappa Hospital, Kolar, Karnataka 563103, India., Devi S Manjula , Madhusudhana Ravi ,   Professor and Head of Department, Department of Anaesthesiology, Sri Devaraj Urs Academy of Higher Education and Research, R L Jalappa Hospital, Kolar, Karnataka 563103, India., Krishnamurthy Dinesh ,   Professor and Head of Department, Department of Emergency Medicine, Sri Devaraj Urs Academy of Higher Education and Research, R L Jalappa Hospital, Kolar, Karnataka 563103, India.
Published: January 2024

Objective: Central neuraxial blockade not only provides good anaestheti Background andcand surgical conditions but it has also advantages over general anaesthesia. To compare time of onset and duration of motor and sensory blockade, duration of analgesia, hemodynamic stability, adverse effects if any and number of rescue analgesia in first 24hours after surgery. Materials and Methods: After ethical committee permission and patient consent, study was conducted on 90 patients aged 18 to 65 years belonging to ASA- I and II undergoing lower limb and lower abdominal surgeries, were randomly divided into 3 groups. GROUP A received epidural bupivacaine 0.5 % (17 ml) + 1ml 0.9% normal saline. GROUP B received epidural Bupivacaine 0.5 %( 17 ml) + 1ml 0.5mcg per kg dexmedetomidine. GROUP C received epidural Bupivacaine 0.5 % (17 ml) + 1ml 50mg magnesium sulphate. Exclusion criteria include patient’s with bradyarrythmias, cerebrovascular diseases, neurodegenerative diseases, renal and hepatic diseases, uncontrolled hypertension, bronchial asthma, ischemic heart disease, drug and alcohol abuse and uncontrolled diabetes mellitus.The Statistical software SPSS 22.0, and R environment ver.3.2.2 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc. Test of significance were ANOVA and chisquare test. P value <0.05 statistically significant. Results: Analgesia in postoperative period and less number of rescue analgesia was better in Group C, Duration of sensory and motor blockade was prolonged and better hemodynamic stability in Group B Conclusion: Hence addition of magnesium sulphate to epidural bupivacaine provides better post-operative analgesia and dexmedetomidine to epidural bupivacaine increases duration of motor and sensory blockade with better hemodynamic stability.
Comparison between Ultrasound Guided Peritubular Infiltration and Paravertebral Block for Postoperative Pain Relief in Percutaneous Nephrolithotomy
Authors:   Associate Professor, Department of Anaesthesiology, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu 603319, India., Barathi Karunanithi Vino , Sathappan Kumaresan ,   Associate Professor, Department of Anaesthesiology, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu 603319, India., Murugaraj Annamalai Anbu ,   Associate Professor, Department of Anaesthesiology, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu 603319, India.
Published: January 2024

Background: Percutaneous Nephrolithotomy is most advanced and preferred technique for Renal calculi but associated with pain and discomfort in postoperative period. Aim of our study is to compare analgesic efficacy of peritubular infiltration with paravertebral block under Ultrasound guidance for postoperative pain relief. Methods: In this prospective randomised study total 60 adult patients were allocated in two equal groups (A, B). After undergoing surgery under general anaesthesia group A patients received peritubular infiltration of 15ml of 0.25% inj.bupivacaine with inj. Dexmeditomidine 1ug/kg and group B patients received 15ml of 0.25% inj.bupivacaine with inj. Dexmeditomidine 1ug/kg in Paravertebral space T11, T12, L1 under ultrasound guidance. Postoperatively hemodynamic variables, VAS, Dynamic VAS, mean time for 1st demand of analgesia and total consumption of inj.tramadol were noted in both groups. Results: At 4, 8, 12 hrs VAS, Dynamic VAS scores were lower in group B compared to group A(p<0.005). Hemodynamic variables were comparable between groupsand demand for first rescue analgesia time were higher in paravertebral block group compared to peritubular infiltration group and total consumption of tramadol were low in paravertebral block. Conclusion: Paravertebral block under ultrasound guidance is an effective analgesia for PCNL in postoperative period compared to peritubular infiltration.
Comparative Evaluation of Bupivacaine and Bupivacaine with Dextmedetomidine in Subarachnoid Block
Authors:   Associate Professor, Department of Anaesthesiology, Vilasrao Deshmukh Government Institute of Medical Sciences, Latur, Maharashtra 413512, India., M Kokane Deepak , Ingle Nitin ,   Professor, Department of Anaesthesiology, Swami Ramanand Teerth Rural Medical College, Ambajogai, Beed, Maharashtra 413512, India., Deshpande Satish ,   Professor, Department of Anaesthesiology, Swami Ramanand Teerth Rural Medical College, Ambajogai, Beed, Maharashtra 413512, India.
Published: January 2024

ntroduction: Since the introduction of spinal anaesthesia in 1898 by Dr. August Bier, who described the intrathecal administration of cocaine, spinal anaesthesia is preferred over general anaesthesia, particularly in surgical procedures of lower abdomen and lower limbs1 (D C Simon et al 2008). The aim of intrathecal local anaesthetic is to provide adequate sensory and motor block necessary for all below umbilical surgeries. Hyperbaric Bupivacaine is the most commonly used intrathecal local anaesthetic. Various adjuvants have been added to Bupivacaine to shorten the onset of block and prolong the duration of block. A number of adjuvants such as clonidine, Midazolam, opioids have been studied to prolong the effect of spinal anaesthesia3,4 (Elia N.et al 2008, Boussofara et al 2006). Clonidine has side effects like bradycardia, hypotension, dryness of mouth, nausea, respiratory depression, itching, and neurological toxicity. Dexmedetomidine is a new highly selective α2 agonist. It is α2 agonist drug, when given intrathecally, significantly prolongs the duration of spinal block. Intrathecal α2 receptor agonists have been found to have antinociceptive action for both somatic and visceral pain5 (Al Ghanem SM et al 2009). It is hypothesized that intrathecal 5 µg Dexmedetomidine would produce more postoperative analgesic effect with hyperbaric Bupivacaine in spinal anaesthesia with minimal side effects5-7 (Al Ghanem, Al Mustafa et al 2009 & Kanazi GE). To see whether the Dexmedetomidine alleviates the side effects of clonidine & Midazolam, we decided to study the efficacy and safety profile of Dexmedetomidine in combination with local anaesthetic in subarachnoid block for below umbilical surgeries.
Comparing Dexamethasone and Dexmedetomidine as Adjuvants for Tap Block After Abdominal Hysterectomy Under Spinal Anaesthesia
Authors:   Associate Professor,  Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka 560002, India., Kumar J Vasantha , S Kori Rachana ,   Post Graduate Student, Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka 560002, India.
Published: January 2024

Background and Aim: Ultrasound guided transversus abdominis plane (TAP) block is a safe, effective analgesic technique for lower abdominal surgeries .This study is designed to compare dexamethasone and dexmedetomidine as adjuvants for TAP block in patients undergoing abdominal hysterectomy under spinal anaesthesia. Materials and methods: After ethics committee approval and informed written consent ,30 Patients were allocated into 2 groups each by randomized double-blind design using a computer generated randomization posted for abdominal hysterectomy under spinal anaesthesia . Group D1 received Inj Bupivacaine 0.25% 20ml + Inj Dexamethasone 4mg + 1ml normal saline in TAP Block on each side. Group D2 received Inj Bupivacaine 0.25% 20ml + Dexmedetomidine 25mcg+ 1ml normal saline in TAP Block on each side at the end of surgery under ultrasound guidance. Assessment parameters included hemodynamic, post operative VAS score, duration of post operative analgesia, total dose of post operative rescue analgesia and side effects. Results: There was no significant difference in Heart rate and Mean arterial blood pressure in both the groups. In the first 8 hr post operative VAS score was lower in GROUP D1compared to GROUPD2 (p < 0.05).Duration of post operative analgesia was longer in GROUP D1 compared to GROUP D2 (p<0.05).Total dose of post operative rescue analgesia consumption in 24hrs was lower in GROUP DI than in GROUP D2 (p<0.05) . No significant side effects were noted. Conclusion: Dexamethasone as an adjuvant to bupivacaine in TAP block has prolonged postoperative analgesia and has reduced requirement of rescue analgesia than dexmedetomidine following abdominal hysterectomy under spinal anesthesia
Perioperative Management of a Patient with Prosthetic Mitral Valve Posted for Ankle Surgery
Authors:   Post Graduate Resident,  Department of Anaesthesiology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka 563101, India., Sravanthi G N S , Madhusudhana Ravi ,   Professor and HOD, Department of Anaesthesiology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka 563101, India.
Published: January 2024

Introduction: Patients with prosthetic valves pose a specific challenge to the anesthesiologist due to their increased predisposition to thrombo embolic events, infective endocarditis and hemolysis. Case Report: Here we describe the anaesthetic management of a 50 year old female with prosthetic mitral valve posted for wound debridement and external fixation for open type III right ankle bone fracture. She is a known case of Rheumatic heart disease and has underwent mitral valve replacement with tricuspid annuloplasty 5years back and is on oral anticoagualtion which was stopped 7days prior to surgery. Pre operative ECG showed AF with recent ECHO finding of concentric LVH with EF of 60%. Pre operative coagulation profile was normal. Antibiotic prophylaxis was given 2hours prior to incision. Case was done under general anaesthesia. Patient was induced with etomidate and maintained with intermittent doses of propofol and isoflurane with adequate analgesics. Intra operative blood loss was around 100ml.Patient was extubated and shifted to ICU for observation. Conclusion: In patients with prosthetic heart valves the most common complication is thromboembolism therefore optimising the coagulation profile before the surgery and subsequent restarting of anticoagulation therapy immediately after surgery is of utmost importance.
Comparison of Median and Paramedian Approach in Spinal Anaesthesia Using Whitacre Spinal Needle in Cesarean Surgery
Authors:   Senior Resident, Department of Anaesthesiology, Bharati Vidyapeeth Deemed to be University, Pune, Maharashtra 411030, India., Sai Balaji Areti , Ladi Sushma ,   Professor, Department of Anaesthesiology, Bharati Vidyapeeth Deemed to be University, Pune, Maharashtra 411030, India.
Published: January 2024

Background: Spinal anaesthesia is the most common anaesthesia techniques used for Caesarean surgeries, median and paramedian approaches are two common techniques used for spinal anaesthesia. The present study was conducted to compare both median and paramedian approach in spinal anaesthesia in pregnant patients undergoing caesarean surgery in terms of incidence of PDPH, ease of each approach and skin to subarachnoid distance in both the approaches. Materials and Methods: A total of 100 obstetric patients, undergoing cesarean surgery were included in the study. Patients were randomly allocated into two groups. Group M (n=50)- median approach and Group PM (n=50)- Paramedian approach. Results: Mean number of attempts for successful spinal anesthesia were higher in Group PM (paramedian 1.90+0.65) as compared to Group M (median 1.54+0.68). Mean skin to subarachnoid distance was higher in Group PM (5.97 ± 0.13cms) as compared to Group M (5.05 ±0.19cms). Nine patients presented with Post dural puncture headache out of total 100 patients. In Group M, six patients (12%) developed PDPH out of 50 patients while in group PM, three patients (6%) developed PDPH, however, the difference was not statistically significant. Conclusion: Paramedian approach is better than median approach in terms of reduction in the frequency of PDPH, though the results were statistically insignificant. Skin to subarachnoid distance (SSD) is significantly higher in paramedian approach as compared to median group.
COVID 19 Patients with Pregnancy Anesthetic Management Case Series
Authors:   Postgraduate Student, Department of Anesthesia, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka, India., George Mathew , Madhusudhana Ravi ,   Professor & HOD, Department of Anesthesia, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka, India., Kumari Vasantha Naga Seshu ,   Assistant professor, Department of Anesthesia, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka, India., Nelamangala Kiran ,   Professor, Department of Anesthesia, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka, India.
Published: January 2024

Introduction: Case series helps us to evaluate management and safety of spinal anesthesia for caesarean delivery in pregnant women with COVID-19 infection. Case Series: We hereby report the management of three COVID-19 positive pregnant women undergoing caesarean section in our hospital. Patients presented with mild symptoms of COVID 19. Routine investigations and COVID -19 markers were evaluated. Anesthesia and operation went uneventfully. Conclusion: Health care providers and babies were not infected with virus. Precautionary measures and strategies were of utmost importance to lower virus contagion risk. Spinal anesthesia was preferred over GA.
A Case Report of Pseudocholinesterase Fergse Deficiency
Authors:   Junior Resident, Department of Internal Medicine, NLC India, City Neyveli T.S 607801, Tamil Nadu, India., Premchand Kaushika
Published: January 2024

Introduction: The drug metabolising enzyme pseudocholinesterase (butyrylcholinesterase) is responsible for the breakdown of the muscle relaxant medicines mivacurium and succinylcholine. Following infusion of mivacurium and succinylcholine, a deficiency of any kind might produce protracted paralysis and apnoea. Case presentation: It's a case study of a patient who developed long-term apnea after taking mivacurium. Conclusion: Prolonged blocks may be encountered due to mivacurium use. The diagnosis of pseudocholinesterase enzyme deficiency can be given after a careful clinic supervision and peripheral nerve stimulator monitoring. A decrease in the activity of pseudocholinesterase enzyme and improvement in neuromuscular function will help verifying our diagnosis. Instead of pharmacological applications that may further complicate the situation, what should be done in such patients is to wait until the block-effect goes down by the help of sedation and mechanical ventilation.
Anesthetic Management of Dilated Cardiomyopathy for Cesarean Section
Authors:   Junior Resident, Department of Anesthesiology, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka,, Yashwanth Paidmuddala , V Vishnuvardhan ,   Associate Professor, Department of Anesthesiology, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka,, GNS Sravanthi ,   Senior Resident, Department of Anesthesiology, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka,
Published: January 2024

Introduction:Dilated cardiomyopathy(DCM) is one of the most common types of non ischemic heart muscle disease among the adult population, and it is associated with a high perioperative mortality. Case Report: A 33-year-old female, G2P1L1+1 at 37 weeks of gestation admitted electively for cesarean section who is a known case of DCM with an ejection fraction of 40%. In the preoperative evaluation, patient has a history of shortness of breath on mild to moderate physical exercise, 12-lead electrocardiography (ECG) showed sinus rhythm with occasional premature ventricular complexes and other parameters are normal. Echocardiogram (Echo) showed severely dilated left ventricle with moderately to severely reduced systolic function due to global hypokinesia and indeterminate filling pressures, and no thrombi were present. All monitoring parameters were connected and an awake arterial line was inserted first followed by epidural in the sitting position. Inj. bupivacaine 0.25% 20 mL + 40 μgn fentanyl was given into the epidural space. The depth of the epidural space was 9.5 cm, while the depth of the catheter was 5.5 cm. The epidural was uneventful, and we changed the patient position into a supine position. Intravenous fluids were maintained at 60–80 mL/h. Intra operative vitals are stable and baby was extracted and blood loss around 700ml.Patient shifted to ICU for close monitoring. Conclusion: Dilated cardiomyopathy is associated with high mortality and persistewnt decrease in quality of mother. Careful selection of drugs and best anesthetic techniques is important for good maternal and fetal outcome.
Comparison of Efficacy of Trans-Cervical Foleys Catheter and PGE2 Gel for Induction of Labour
Authors:   Junior resident, Department of Obstetrics and Gynecology, Bharati Vidyapeeth Deemed to be University, Pune, Maharashtra 411043 ,India., Joshi Ishita , Barsode Salil ,   Professor, Department of Obstetrics and Gynecology, Bharati Vidyapeeth Deemed to be University, Pune, Maharashtra 411043 ,India., Taralekar Vaishali ,   Professor and Head, Department of Obstetrics and Gynecology, Bharati Vidyapeeth Deemed to be University, Pune, Maharashtra 411043 ,India.
Published: January 2024

Background: Induction of labour is initiation of uterine contractions before the onset in order to vaginally deliver the fetoplacental unit. Common reasons for induction of labour (IOL) are post-term and hypertensive disorders of pregnancy. Many women who undergo induction do not have a favourable cervix, so some methods of cervical ripening either pharmaceutical or mechanical are used. Aim & Objective: To compare the effectiveness of the transcervical Foley catheter and the prostaglandin E2 (PGE2) gel for the induction of labour. Methodology: The clinical trial was conducted for a period of two years OBGY department of Bharati Vidyapeeth University, Pune. 196 pregnant women which included and randomly via block randomization divided into two groups. Group A had 98 women in whom the transcervical Foley catheter was inserted and Group B included 98 women in whom the PGE2 gel was inserted vaginally for IOL. Bishop’s score and duration from induction to onset of labour was calculated. Data analysis was done and appropriate statistical tests were used. Results: In Group A (37.8%) as well as in Group B (41.8%) most of the pregnancies were primigravida. The most common indication for induction in both groups was postdatism. The adjuvant therapy was required in 66.3% and 54.1% of women in Group A & B respectively. Significant higher median values were observed in Bishop’s score at 12 hours as compared to 0 hour in both the groups. No significant association was observed between mode of induction and need of adjuvant therapy and induction to onset hours in both groups. Conclusion: The study shows that both Foley's catheter and PGE2 gel are equally effective in pre induction cervical ripening.
A Rare Report of Vaginal Rhabdomyosarcoma
Authors:   Associate professor, Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong 793018, Meghalaya, India., Das Ananya , Panda Subrat ,   Additional professor, Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong 793018, Meghalaya, India., Sarma Anusuya ,   Senior Resident, Department of Obstetrics and Gynecology,North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong 793018, Meghalaya, India., Dey Biswajit ,   Assistant Professor, Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong 793018, Meghalaya, India.
Published: January 2024

Sarcomas are connective tissue cancers and Rhabdomyosarcomas are cancers originating from the skeletal muscle cells of the body. A 23 year old female unmarried, nulligravida presented in our emergency with the complaint of bleeding per vagina on and off since last 4 months. The lesion measured 9.2 (cc) x8.7 (cs)x7.8 (ap) cm. The lesion displaced the uterus superiorly distended the vaginal canal compressed the urinary bladder and urethra anteriorly but with no evidence of infiltration into the pelvic side wall and with maintained fat plane. Rest all pelvic organs as well as abdominal organs were within normal limit. The HPE report on microscopic examination of the tissue showed features suggestive of malignant spindle cell neoplasm. Immunohistochemistry was done and IHC report showed: Positive for Desmin, Myogenin predominantly cytoplasmic positive. Correlating the morphologic and IHC markers the report came to be Embryonal Rhabdomyosarcoma (Botryoid Rhabdomyosarcoma). As soon as the final diagnosis was made patient was referred to Department of Oncology and chemotherapy with Cyclophosphamide was started. She has been on regular follow up since then and is keeping well. The presence of a cervical polyp in an adolescent is a gynecologic oddity and must necessarily be examined histologically because it might be a rhabdomyosarcoma. This is extremely important because diagnosis at an early stage of the disease is a highly favorable prognostic factor.
Acute Fatty Liver of Pregnancy: A Case Series
Authors:   Fellow in High Risk Obstetrics and Critical Care, Department of Obstetrics and Gynecology, Bharati Vidyapeeth, Pune 411030, Maharashtra, India., Agarwal Neha , Dabhadkar Suchita ,   Professor, Department of Obstetrics and Gynecology, Bharati Vidyapeeth, Pune 411030, Maharashtra, India.
Published: January 2024

Introduction: Acute fatty liver of pregnancy (AFLP), a rare but recognized obstetric and medical emergency, is a catastrophic illness for both the mother and unborn offspring. It develops rapidly in the last trimester of pregnancy and contributes to significant maternal and perinatal mortality. Its demands early diagnosis, immediate delivery of fetus, systematic approach for anticipating complications and dealing with them. Aim and Objective: To enlighten the varied presentations of this rare entity which help in early diagnosis, prompt delivery and highlighting the importance of supportive care to reduce maternal morbidity and mortality. Materials and Methods: The authors report an observational case series of patients who developed AFLP and were managed in critical care in a period of 3 months. Results: A total of three cases of AFLP were diagnosed in a period of 3 months. Nausea, vomiting and anorexia were the most common symptoms. Jaundice was seen in all. Anticipation of the complications like postpartum haemorrhage, DIC, hepatorenal syndrome and sepsis and providing prophylactic treatment in that view can reduce the morbidity and in-hospital days for the patient. Conclusions: AFLP has significant perioperative mortality and morbidity secondary to renal dysfunction, coagulopathy and massive transfusion related complications. Clinical outcome can be improved by early diagnosis, urgent delivery of fetus and supportive care from multidisciplinary team.
Perinatal Outcome in Twin Pregnancy According to Chorionicity
Authors:   Professor, Department of Obstetrics and Gynecology, Sri Muthukumaran Medical Collage, Hospital & Resarch, Shikkaraya 600069, Chennai, Tamil Nadu, India., Oswal Kiran , H Rathod Lakshman ,   Professor, Department of Obstetrics and Gynecology, Sri Muthukumaran Medical Collage, Hospital & Resarch, Shikkaraya 600069, Chennai, Tamil Nadu, India.
Published: January 2024

Background: Multiple pregnancy is defined as pregnancy with 2 or more fetuses. It is termed as twins for 2 fetuses, triplets for 3 fetuses, Quadruplets for 4 fetuses, Quintuplets for 5 fetuses, Sextuplets for 6 fetuses and Septuplets for 7 fetuses and so on. The incidence of multiple pregnancies varies significantly. In several overview studies (since the early 1970) it was found that natural twinning rates were less than 8 twin births per 1000 births in East Asia and Oceania, 9-16 per 1000 births in Europe, USA and India and 17 and more per 1000 births in African countries. Methods: This prospective observational study was conducted by the department of OBG at Sri muthukumaran medical college hospital and research institute, Shikkarayapuram, Chennai from December 2019 to May 2020. Results: Primigravidas constituted for 43% of pregnancies and multigravidas constituted for 57% of pregnancies. The maximum cases 42 (42%) were in the age of 25-29 yrs followed by 31(31%) in the age group 21-24 years. The mean age of the patients was 26.87 (SD 9.67) years. The discordant growth constituted for 12% of pregnancies in both monochorionic and dichorionic twins where as it was absent in 88% of cases.
Evaluation of CRP as Predictor of Chorioamnionitis in Premature Rupture of Membranes
Authors:   Junior Resident (Jr3), Department of Obstetrics and Gynecology, Bharati Vidyapeeth Hospital and Medical College, Pune 411043, Maharashtra, India., Sai Aparna Pentala , Taralekar Vaishali ,   Professor, Department of Obstetrics and Gynecology, Bharati Vidyapeeth Hospital and Medical College, Pune 411043, Maharashtra, India., Dabhadkar Suchita ,   Professor, Department of Obstetrics and Gynecology, Bharati Vidyapeeth Hospital and Medical College, Pune 411043, Maharashtra, India.
Published: January 2024

Background: Early identification of sepsis is essential as the mother has a risk of chorioamnionitis. C-reactive protein levels are done along with placental histopathology to detect chorioamnionitis. It is one of the most significant causes of high perinatal morbidity and mortality. Aim and Objective: To determine c-reactive protein levels and placental histopathology in premature rupture of membranes for maternal chorioamnionitis. Methodology: A prospective study was conducted in a tertiary care university medical college hospital and research center in western Maharashtra. A total of 250 pregnant women were reported per vaginal leak during the study period and CRP levels were sent along with urine culture sensitivity and high vaginal swab, post-delivery the placenta was sent for histopathology and were included in the study analysis. Results: The histopathology was done in all 250 pregnant women, and chorioamnionitis was evident in 46 pregnant women. This gives the incidence of 18.4% of chorioamnionitis in the study population. The sensitivity for CRP was calculated to be 15.22%, with a specificity of 99.02%, positive and negative predictive values of 77.78% and 83.82%, respectively, with an accuracy of 83.60%. Conclusion: Normal CRP level has good predictive values to rule out maternal chorioamnionitis. A raised single CRP level has low sensitivity to predict histological chorioamnionitis prior to its clinical expression.
NOTA DOS EDITORES
Authors: Costa Silva Ricardo Gilson da , Vidal da Silva Viviane , Oliveira Neto Thiago
Published: January 2024

Esperamos que o conjunto dos textos possa contribuir com o conhecimento e reflexões sobre a Amazônia em suas múltiplas territorialidades. Os textos desse dossiê correspondem em um desdobramento de reflexões realizado no “Simpósio Territorialidades Amazônicas”,  com temáticas que nos ajudam a compreender a complexidade da Amazônia, região em que muitos nasceram, escolheram, sendo acolhidos para viver. 
Boa leitura!
FORMAÇÃO ESPACIAL E TERRITORIAL DO MUNICÍPIO DE ACRELÂNDIA
Authors: Pedroso da silva Elias , Ferreira Castelo Carlos estevão
Published: January 2024

Neste artigo, os autores trabalham com o conceito de espaço e território de Claude Raffestin, para compreender, a formação espacial e territorial do município de Acrelândia, a partir do Projeto de Assentamento Redenção, eles percorrem o caminho que levou um simples projeto de assentamento criado pelo governo militar brasileiro a se tornar um município com características singulares. Utilizam de pesquisa bibliográfica como fonte de informações, mas também lançam mão da história oral através de entrevistas com alguns atores sociais que participaram do processo de formação da localidade. Discorrem sobre a importância da luta política e da participação da população local no processo de criação do Município. Encontram, através de relatos, alguns elementos que preenchem lacunas na história oficial, tentando vencer a carência de informações sistematizadas sobre o tema. O trabalho coloca à luz, um embate político que culminou com a criação de um novo município para o estado do Acre e suas implicações no aspecto geográfico em razão da secessão do território de dois municípios mais antigos, Plácido de Castro e Senador Guiomard. Por fim este é um trabalho de geografia histórica, elaborado com a intenção de apresentar algumas páginas ainda desconhecidas da formação histórica do Acre.
A genetic algorithm - based vehicle routing for transportation cost optimization with time-capacity-penalty constraints
Authors: Nguyen Trung-Tuan , Vu Thi-Huong-Giang , Huynh Quyet-Thang , Pham Minh-Hoan , Tong Thi-Minh-Ngoc
Published: January 2024

Optimizing transportation costs regarding many constraints on depots, customers, vehicles, and time windows is an urgent need of logistic businesses to get the highest profit and customer satisfaction. In this paper, we propose a genetic algorithm for optimizing the transportation cost in vehicle routing problem, comprising the penalty cost while constraints are violated. The considered constraints are: goods must be picked up from or delivered to different depots or customers at their requested time windows; vehicles are subject to a capacity limit, an operation time limit, a distance limit, and a type of goods limit.
Three experiment scenarios with real-world locations on Google maps were conducted, showing significant results on transportation costs in terms of traveled distance and number of used vehicles. The experimental results, compared to other methods, show the effectiveness and practical applicability of the proposed algorithm.
Size-Dependent Effects of Silver Nanoparticles in Colorectal Cancer Treatment: Apoptosis Activation, Anti-Metastatic Properties, and Tissue Accumulation
Authors: Karakurt Serdar , BILGISEVEN Irem Mukaddes , CINAR Sumeyya , BILECEN Deniz SEZLEV , KANDIR Sinan
Published: January 2024

Nanoparticles possess unique characteristics due to their small size and high surface area-to-volume ratios, enabling facile interactions with biomolecules, cells, and tissues upon entry into the body. This study investigates the size-related effects of silver nanoparticles (AgNPs) in the context of colorectal cancer treatment. The proposed mechanism, resembling “Trojan horses”, elucidates the toxicity of AgNPs; AgNPs transport metallic silver across cell membranes and then dissolve intracellularly to release Ag2+ ions. To explore the impact of AgNP size, a range of AgNPs with varying sizes was synthesized. The cytotoxic effects of synthesized AgNPs (5 nm, 10 nm, 40 nm, and 100 nm) in colorectal cancer cell lines; CaCo-2, SW-620, DLD-1, HT-29, and healthy colon epithelial cell line CCD-18Co were determined in vitro. The distribution and amount of different-sized AgNPs in rat tissues at 24-hour and 48-hour post-administration were determined by ICP-MS method. Experimental findings revealed that the apoptotic pathway in DLD-1 and HT-29 cells was activated by AgNPs, and this activation exhibited a positive correlation with increasing AgNP size. Furthermore, an increase in size was associated with decreased metastatic properties, resulting in a reduced ability to form colonies. AgNP therapy induced the activation of proteins and genes involved in various pathways, including TGFβ, WNT, MAPK, PI3K-Akt, and p53. In vivo studies demonstrated the effective penetration of AgNPs into the circulatory system following intraperitoneal (IP) administration. These nanoparticles were found to accumulate extensively in the lungs, liver, heart, kidneys, and colon. 5 nm AgNPs were rapidly cleared from the kidney at 48 h, while 40 nm AgNPs exhibited the highest concentration in the lung at 24 h. Notably, different-sized AgNP nanoparticles exhibited distinct accumulation sites, suggesting a potential passive targeting approach for specific tissues. In conclusion, this study highlights the size-dependent effects of AgNPs in colorectal cancer treatment. The findings underscore the ability of AgNPs to activate apoptosis and modulate metastatic properties in colorectal cancer cells, with larger AgNPs exhibiting more pronounced effects. Moreover, the differential accumulation of AgNPs in various tissues offers a promising alternative strategy for passive targeting based on nanoparticle size. These insights contribute to the development of targeted therapies utilizing AgNPs in the field of cancer treatment.
Irradiated red blood cell transfusion is associated with an increased risk of deep vein thrombosis in trauma patients: a case control study
Authors: Lu Hua , Wu Li-Fang , Li Jing-Jing , Gao Qi , Xu Gui-Ping
Published: January 2024

Background Gamma ray irradiation accelerates the release of red blood cell (RBC)-derived microparticles with procoagulant function, and further promotes the formation of microthrombosis. The use of irradiated RBCs in nontransplant patients is usually not prohibited, except in patients with renal dysfunction and hyperkalemia. At present, the possibility that irradiated RBC transfusion promotes the occurrence of deep vein thrombosis (DVT) remains unclear.
Methods This retrospective cohort study was conducted on 251 trauma patients enrolled between January 2021 and April 2023 at the Second Affiliated Hospital of Chongqing Medical University. The cohort included 147 patients who were only transfused with nonirradiated RBCs (nonirradiation group) and 104 patients who were transfused with irradiated RBCs with or without nonirradiated RBCs (irradiation group). Multivariate logistic regression was used to analyze the risk factors for DVT in this population.
Results The incidence of DVT was higher in the irradiation group than in the nonirradiation group (38.5% vs 22.4%, P<0.01). After adjusting for inconsistent variables, the results showed that irradiated RBC transfusion was a significant risk factor for DVT (odds ratio =2.16, 95% confidence interval=1.24 to 3.76; P<0.01). The incidence of DVT increased from 22.4% to 43.8% with the rising percentage of irradiated RBCs in total transfused RBCs (P =0.0248). The median storage days and total units of irradiated RBCs were not associated with an increased risk of DVT (odds ratio <1, P>0.05). Further subgroup analysis showed that the total volume, median storage days, and maximum storage days of transfused RBCs were not associated with the occurrence of DVT in this cohort, regardless of whether the irradiation group was included (all, P>0.05).
Conclusions Irradiated RBC transfusion was associated with an increased risk of DVT in trauma patients in a percentage-dependent manner, and the total volume and longer storage duration of transfused RBCs were not associated with the incidence of DVT. The transfusion indications for irradiated RBCs should be strictly controlled to avoid unnecessary transfusion of irradiated RBCs to trauma patients.
WITHDRAWN: Linking Manufacturing Firms with Environment: Role of Green Manufacturing and Environmental Management on Firm's Environmental Performance with Moderating Effect of External Environmental Regulations
Authors: Nazir Samera , Mehmood Saqib , Nazir Zarish , Zhaolei Li
Published: January 2024

Purpose: The relationship between manufacturing firms and the environment became critical in contemporary business research and sustainability efforts. This study explored the complex interconnections and relationships among various factors, specifically focusing on manufacturing firms. It sought to understand how these firms' environmental performance was influenced by a combination of environmental management practices they adopted and the regulatory environment they operated in.
Design: Data were collected through a structured questionnaire from employees working in manufacturing firms in Pakistan. Random sampling was used to select the participants. The hypotheses were tested using partial least squares (PLS) analysis.
Findings: The findings of this study had significant implications for both manufacturing firms and policymakers. They provided insights into the strategies that manufacturing companies could adopt to enhance their environmental performance through green manufacturing practices and proactive environmental management. Furthermore, the research shed light on the role of external environmental regulations in moderating these processes.
Practical Implications: The practical implications offered valuable insights and guidance for manufacturing companies seeking to improve their environmental responsibility and performance. Additionally, policymakers gained insights into how regulatory frameworks could be designed or modified to better support sustainability efforts within the manufacturing sector.
Originality or Value: It emphasized the novelty and significance of the research in offering a comprehensive understanding of how manufacturing firms could navigate the complex landscape of environmental responsibility, compliance with regulations, and the simultaneous enhancement of their environmental performance. In essence, it underscored the study's role in advancing knowledge and practices related to sustainability in manufacturing.
Can green finance improve eco-efficiency? New Insights from China
Authors: Lee Chien-Chiang , Du Lixia
Published: January 2024

Achieving economic development and ecological protection simultaneously is an inevitable selection for sustainable development in today's world, so it is crucial to improve eco-efficiency (EE). According to Chinese panel data at the provincial level between 2010 and 2020, this research explores the nexus between green finance (GF) and EE. The results denote that GF can significantly improve EE, and the higher the level of EE, the stronger the effect of improvement. The upgrading of industrial structure, optimization of energy structure, enterprises' concern for environmental protection and the public's attention to the environment are all favorable factors that can enhance the promotion effect of GF on EE. Additionally, this facilitation can only be played under a good external environment and mature internal conditions. Our findings can provide new insights for improving EE by developing GF.