bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Ultrasound Guided Single Injection Infraclavicular Brachial Plexus Block Using Bupivacaine Alone and Bupivacaine Combined with Dexmedetomidine for Pain Control in Upper Limb Surgeries
Authors:   Assistant professor, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore 560002, Karnataka, India., Nagappa Saraswathi , Patil Pooja ,   Post Graduate, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore 560002, Karnataka, India., Yasmeen Mohsina ,   Assistant professor, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore 560002, Karnataka, India., Sabreen Sumaiya ,   Assistant professor, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore 560002, Karnataka, India.
Published: January 2024

Background: Infraclavicular brachial plexus blockade provides anesthesia for surgeries of upper limb. In contrast to interscalene and supraclavicular block, infraclavicular blockade has the advantage of minimal risk to intravertebral, intrathecal or epidural injection, as well as reduced incidence of phrenic nerve and stellate ganglion block. Aim: To evaluate the effect of dexmedetomidine with bupivacaine on the onset and duration of sensory and motor block and duration of analgesia in infraclavicular blocks. Methodology: A prospective, double blind, randomized control trial was conducted among 50 patients under going elective surgery of hand, for earm, elbow and distal humerus. Patients were randomly divided into two groups based on random numbers generated by a computer program (www.randomwqqqizer.org). Group A consisted 25 patients received block with bupivacaine + dexmedetomidine Group A and Group B consisted 25 patients received block with bupivacaine + 20 ml normal saline. This study compared Onset and duration of sensory and motor blockade, duration of analgesia, post-operative pain score and hemodynamic parameters between the two groups. Results: There was significant difference in mean onset of sensory block between two groups, (Group A 9.20 ± 0.98 vs Group B 11.06 ± 1.24 min p value < 0.001. Similarly there was significant difference in mean onset of Motor blockade between two groups (Group A 10.66 ± 1.06 min vs Group B 11.80 ± 1.10 min p value < 0.001). There was a statistically significant longer duration of sensory block (Group A was 8.88 ± 1.04 hrs and in Group B was 7.60 ± 0.78 hrs, p value <0.001), longer duration of motor block (Group A was 7.79 ± 0.82 Hrs vs Group B was 6.62 ± 0.49 hrs p value < 0.001). Statistically significant longer duration of motor block (Group A was 9.78 ± 0.73 vs Group B 6.99 ± 1.10 hrs p value < 0.001. Conclusion: Dexmedetomidine as an adjuvant hastens the onset and prolongs the duration of both sensory and motor block and has better analgesia when compared to bupivacaine alone.
Comparison of 0.5% Hyperbaric Bupivacaine with Midazolam Versus 0.5% Hyperbaric Bupivacaine Alone Intrathecally: Prospective Observational Study
Authors:   Senior resident, Department of Anesthesia, Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum 695504, Kerala, India., Varghese Mariam Joan , Fernandez Jenifer Joab ,   Junior resident, Department of Anesthesia, Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum 695504, Kerala, India., R Buena. ,   Assistant professor, Department of Anesthesia, Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum 695504, Kerala, India., Wilson M.Paul ,   Head of Department and Professor, Department of Anesthesia, Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum 695504, Kerala, India.
Published: January 2024

Context: Neuraxial anesthesia is the preferred choice for infraumbilical surgeries due to its advantages. The incorporation of midazolam alongside local anesthetic drugs in spinal anesthesia has demonstrated positive outcomes. This study was undertaken to assess the effectiveness of midazolam in terms of analgesic and anesthetic efficacy, as well as potential adverse effects, in patients undergoing infraumbilical surgeries. Aims: To compare the analgesic and anaesthetic effect of mixture of midazolam - bupivacaine as compared to bupivacaine alone in patients undergoing infra-umbilical surgeries under spinal anaesthesia. Settings and Design: The present study is a prospective, observational study. Methods and Material: Fifty patients posted for elective infra-umbilical surgery were randomly divided into two groups of 25 each for intrathecal drug administration. (n=25). After administration of block, patients were assessed for analgesic and anesthetic effect of the drug. Statistical Analysis used: The study analyzed through the statistical programming software SPSS-22 and it involved the application of the student’s t-test, with a significance threshold set at a P value of <0.05. Results: Analgesic duration of patients in Midazolam Group was signiÞcantly longer compared to Bupivacaine Group for sensory block. More patients in the midazolam group were sedated and easily arousable. Conclusions: This study concludes that the addition of intrathecal preservative-free midazolam to hyperbaric bupivacaine improved intra - operative anaesthesia and prolonged duration of analgesia. Also, it was observed that there was a significant reduction in the consumption of analgesics during the postoperative period in patients undergoing infra-umbilical surgeries without causing any significant haemodynamic changes.
Recreational Exposure of Liquified Petroleum Gas: Case report and Review of the Literature
Authors:   Junior resident, Anesthesiology, Sri Devaraj URS Medical College, Tamaka, Kolar 563101, Karnataka, India., Ushasree Jala , Sindhu Jagadeesan ,   Assistant professor, Anesthesiology, Sri Devaraj URS Medical College, Tamaka, Kolar 563101, Karnataka, India., Ravi Madhusudhana ,   Professor, Anesthesiology, Sri Devaraj URS Medical College, Tamaka, Kolar 563101, Karnataka, India., Kumar Nagaiah Suresh ,   Professor and HOD, Anesthesiology, Sri Devaraj URS Medical College, Tamaka, Kolar 563101, Karnataka, India.
Published: January 2024

Introduction: LPG, a combination of aliphatic hydrocarbon gases, is utilized as a source of fuel for cooking appliances and vehicles. LPG mainly comprises butane (80%) and propane (20%), which are combustible gases, along with small concentrations of propylene and butylene. Mercaptans are included in the mixture to enable easy detection of any gas leakage due to their unpleasant smell. Because propane gas is heavier than air, it tends to settle at floor level. Due to the non-specific and diverse nature of its signs and symptoms, the timely and accurate diagnosis of LPG poisoning remains challenging. Due to easy access to LPG, there has been an increase incidence of its use for suicidal purposes and abuse. The current case report focuses on the effects of the abuse potential of LPG and its toxic effects. Case Report: In this case report, four individuals of same family (19 yrs, 23 yrs, 24 yrs, 25 yrs old brothers) who have abused LPG for recreational purpose under alcoholic intoxication and subsequently, of four of them three individuals showed acute toxic myocarditis with ECG changes and elevated cardiac biomarkers, hypoxia, neurological manifestations such as generalized weakness, unconsciousness. The fourth person was brought dead to casualty and it was determined that approximately 22% of the people who used inhalants died during their first use. Sudden deaths are usually caused by abuse of butane, propane, or butane/propane mixture and it is due to cardiac arrhythmia. Conclusion: The gas mixture of propane butane is among the most lethal inhalant substances. The substance abuse is increasing especially in adolescents and young adults. The public population must be educated about dangers of this gas abuse and its bad outcomes and should be recommended to stay away from it.
Effect of Intraoperative Esmolol Infusion on Haemodynamics and Surgical Field in FESS Under General Anaesthesia
Authors:   Associte professor, Department of Anesthesia, Dr M K Shah Hospital and Research Centre, Ahmedabad, Gujarat 382424, India., Mattoo Juhi , Shah Parth M ,   Assistant professor, Department of Anesthesia, Dr M K Shah Hospital and Research Centre, Ahmedabad, Gujarat 382424, India., Thakur Dinesh ,   Professor and Head, Department of Anesthesia, Dr M K Shah Hospital and Research Centre, Ahmedabad, Gujarat 382424, India.
Published: January 2024

Introduction: Functional endoscopic sinus surgery (FESS) is a commonly performed operation. Endoscopic sinus surgery allows enhanced illumination and visualization and it has dramatically improved surgical dissection. However major complications such as excess bleeding and poor visibility can arise do to work in a confined space.Due to poor visibility longer time to perform the surgery may arise. Material and Methods: This study was performed on randomly selected 60 patients, in a randomized placebo controlled double blind prospective study. We evaluated the hypotensive efficacy of intravenous Esmolol in FESS, reduction in blood pressure and Quality of surgical field and complications under general anaesthesia. Conclusions: Esmolol produces a lower surgical bleeding scores and better quality of operative field for the surgeon as well as less adverse effects.
Hemodynamic Stability of Dexmedetomidine in Laparoscopic Cholecystectomy Cases
Authors:   Assistant Professor, Department of Anesthesia, Pacific Institute of Medical Sciences, Udaipur, Rajasthan 313015, India., Tyagi Naresh Kumar , Ranawat Pinu ,   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.
Published: January 2024

The advent of minimally invasive surgeries has heralded a new field in surgical practice. The procedure of laparoscopy has been most beneficial to the clinician and patient alike however, it has also been responsible for newer complications. The present study was conducted with a view to ascertain if the hemodynamic instability brought about by pneumoperitoneum be effectively counteracted by using dexmedetomidine in cases of elective laparoscopic cholecystectomy. The study employed 30 subjects and who were evaluated in pre, intra and post operative stages for HR and BP. The results showed a significant difference between parameters of subjects who were administered the study drug and a corresponding control sample. The study concluded that the benefits of dexmedetomidine are accurate and the drug must be considered as a necessary adjuvant in all minimally invasive surgeries.
Caudal Epidural Block for Transurethral Resection of Prostate in Patients with Comorbidities: An Observational Study
Authors:   Assistant Professor, Department of Anesthesia, Great Eastern Medical School and Hospital, Srikakulam, Ragolu, Andhra Pradesh 532484, India., Appalaraju Nellimarala , Krishna Karri Bala ,   Assistant Professor, Department of Anesthesia, Great Eastern Medical School and Hospital, Srikakulam, Ragolu, Andhra Pradesh 532484, India.
Published: January 2024

Background: The most important goal of anaesthesia for geriatric patients with comorbid diseases is to maintain normal homoeostasis of different systems during and after surgery. This prospective study was conducted to evaluate the success rate and associated complications of the caudal epidural block for transurethral resection of prostate in elderly patients with comorbid diseases. Methods: This is a prospective study of a cohort of 110 elderly patients posted for transurethral resection of prostate with comorbid diseases belonging to American Society of anaesthesiologist’s physical status II, III and IV over a period of 1 year from November 2018 to November 2019. Standard recommended technique for caudal epidural block was followed. Time of onset, spread, duration of analgesia, intensity of block, complications, and unwanted effects were noted. Results: The average age was 72. Eighty percent patients belonged to ASAIII and IV grade. The majority had excellent to a good quality of anaesthesia with no motor block. 80% of patients had the onset of analgesia between 5–15 minutes and 71% had a duration between 90–130 minutes. four patients had patchy analgesia and they were considered as a failure. No death was encountered in the study. Conclusion: Caudal epidural block is a safe, effective anaesthetic technique for transurethral resection of the prostate in elderly with comorbid diseases of other systems.
Absent Gastric Bubble: It’s Implications on Intra and Post-op Recovery in CABG Patients
Authors:   Consultant, Department of Cardiac Anesthesiologist, Ashoka Medicover Hospital, Nashik, Maharashtra 422209, India., Kaiche Rupinder Kaur , Shinde Amol ,   Consultant, Department of Cardiothoracic and Vascular Surgeon, Ashoka Medicover Hospital, Nashik, Maharashtra 422209, India., Kaiche Rahul ,   Consultant, Department of Medicine, Ashoka Medicover Hospital, Nashik, Maharashtra 422209, India., Jagtap Amogh ,   Consultant, Department of Radiodiagnosis, Ashoka Medicover Hospital, Nashik, Maharashtra 422209, India.
Published: January 2024

Background: Absent gastric bubble was an X-ray chest finding preoperatively of a 68 year old gentleman posted for CABG. Apart from symptoms of unstable angina consistent with his angiographic findings, he complained of chest pain at night and lump in throat which we could attribute to gastroesophageal reflux disease. The aim of this study was to find the causes of absent gastric air bubble, so as to understand its implications and prevent the possible complications in patients undergoing CABG. Methods: All patients undergoing cardiac surgery underwent prescribed blood investigation, ECG, X-ray chest (PAview ) PFT, carotid doppler, 2D ECHO and coronary angiography. Over a period of 6 months we had 5 patients whose X-ray chest showed absent gastric air bubble. All of the 5 patients were evaluated and managed preoperative,intra and postoperative keeping in mind the possible complications. Results: Cause of absent gastric bubble in our patients: 1. Hiatus hernia -1 2. Achalesia cardia -1 3. Gastro-esophegael reflux disease -3 Conclusion: Absent gastric bubble is a sign which needs to be investigated pre-operatively for its cause. Gastro-esophageal reflux disease is a common disease which mimics heart attack.1. and is common in patients coming for CABG and can be a cause for concern for patient due to persistent chest pain post surgery. Adequate precautions like duration of fasting preop-operatively, prevention of micro aspiration post-operatively with head end elevation and low fat diet, abstinence from smoking, tea, coffee intake, weightloss will help in relieving symptoms of GERD and improve patient satisfaction post CABG. Confirmation and explanation of the observed relation between the presence of hiatal hernia and infarction requires further research .
Potassium Chloride as an Adjuvant to Lignocaine and Bupivacaine in Brachial Block for Orthopedic Surgeries
Authors:   Tutor, Department of Anesthesiology, B J Medical College and Civil Hospital, Ahmedabad, Gujarat 380016, India., Dave Alka , Chandnani Anup ,   Tutor, Department of Anesthesiology, Shri M P Shah Government Medical College, Jamnagar, Gujarat 361008, India., Shah Mitesh ,   Tutor, Department of Anesthesiology, B J Medical College and Civil Hospital, Ahmedabad, Gujarat 380016, India.
Published: January 2024

Background: Brachial Plexus block is the easiest and simplest form of providing anesthesia for upper limb surgeries. It is known that potassium added to local anesthetics can increase the extracellular concentration, time of depolarization and prolongation of action of the local anesthetics. With this in background, this study was designed to observe the effect of potassium chloride as adjuvant to local anesthetics on onset of sensory and motor blockade and qualitative block for analgesia. Materials and Methods: Forty patients of ASA I and II of either sex, aged 17 to 61 years posted for upper limb orthopaedic surgeries received either plain Inj. Xylocaine 1.5% (A1), Inj. Xylocaine 1.5% with Inj. Potassium Chloride 0.2 mmol (A2), plain Inj. Bupivacaine 0.375% (B1) or Inj. Bupivacaine 0.375% with Inj. Potassium Chloride 0.2 mmol (B2) in Brachial Plexus block through Supraclavicular approach. Patients were assessed for the onset of sensory and motor blockade, duration of anaesthesia and post-operative analgesia. Result: Groups A2 and B2 (potassium added groups) had faster onset of sensory and motor blockade, and prolonged duration of action than A1 and B1 (plain Xylocaine and Bupivacaine) groups. The quality of blockade was better in groups with added potassium, more so with Bupivacaine than with Xylocaine. Conclusion: Addition of Potassium chloride to Xylocaine and Bupivacaine had significant clinical advantage over Plain drugs specially Bupivacaine on onset time, duration and quality of sensory and motor blockade in Brachial Plexus block.
Comparison of Effect of Norepinephrine Versus Phenylephrine Prophylactic Boluses on Spinal Anesthesia-Induced Hypotension During Elective Cesarean Delivery: A Double-Blind, Randomized, Clinical Study
Authors:   Postgraduate Resident, Department of Anesthesiology, Krishna Institute of Medical Sciences ", . Pratiksha ,   Deemed to be",   University, Karad, Maharashtra 415110, India., Jamale P B ,   2Professor,  Department of Anesthesiology, Krishna Institute of Medical Sciences "Deemed to be" University, Karad, Maharashtra 415110, India., Dhulkhed V K ,   Head of Department and Professor, Krishna Institute of Medical Sciences "Deemed to be" University, Karad, Maharashtra 415110, India.
Published: January 2024

Background: Spinal anesthesia (SA) onset induces maternal hypotension, which can be managed by vasopressors like phenylephrine (PE). However, PE (α-adrenergic agonist) tends to reflexively decrease the heart rate (HR) and cardiac output (CO). Norepinephrine (NE), being an α-agonist with weak β-adrenergic activity, maintains the blood pressure (BP) with less tendency to decrease the HR and CO, and hence, may be a more useful alternative to PE. Objectives: To compare the effects of prophylactic boluses of NE and PE on SA-induced hypotension during elective cesarean section, as well as assess the neonatal outcomes and adverse reactions. Methods: Sixty parturient belonging to ASA class I and II, scheduled for elective cesarean section, were randomly allocated between 2 groups: (i) Group NE (n=30) which received 5 µg intravenous (IV) NE, and (ii) Group PE (n=30) which received 50 µg IV PE as prophylactic boluses immediately after patient repositioning. Rescue bolus interventions using 5 µg NE or 25 µg PE were given for hypotension, respectively. Maternal hemodynamic variables were measured non-invasively. Neonatal outcomes and adverse effects, if any, were also noted and compared. Results: Pre-operative and post-operative hemodynamic parameters (HR, SBP, DBP, MAP, SpO2), adverse incidences (of hypotension, bradycardia, and nausea) as well as neonatal outcomes were comparable between the two groups (P>0.05). However, the number of patients who required additional rescue vasopressor boluses was significantly greater in Group PE than in Group NE (OR for 2 vs 0 bolus = 9.75; OR for 2 vs. 1 bolus = 11.1428). Conclusion: NE was more efficacious in preventing SA-induced hypotension with better preservation of maternal HR than PE, and hence, can be considered as an alternative to PE.
A Comparative Study of Recovery and Postoperative Cognitive Functions after General Anesthesia with Sevoflurane or Desflurane Based Techniques in Elderly Patients
Authors:   Senior Resident, Krishna Institute of Medical Sciences Hospital, Kondapur, Hyderabad, Andhra Pradesh 500095., Ajay Pesala , Paidipally Harsha Vardhan ,   Associate Professor, Department of Anesthesiology, Dr. Patnam Mahender Reddy Institute of Medical Sciences, Chevella, Rangareddy, Telangana 501503, India.
Published: January 2024

Context: It is clear that the number of elderly is going to rise in coming days. Hence, number of elderly requiring surgery and anesthesia is also on increase. At the same time, there are newer developments in the field of anesthesia. Hence, operation theatre staff and doctors should know which agent is better when given the choice. Aim: To compare recovery and postoperative cognitive functions after general anesthesia with sevoflurane or desflurane based technique in elderly patients. Settings and Design: Prospective Randomized Controlled Comparative Interventional study was conducted at KIMS Hospital, Kondapur, Hyderabad. Methods: 120 patients undergoing surgeries under general anesthesia were included. They were randomly assigned in two groups of 60 each; with one group receiving Sevoflurane and the other desflurane. Two groups were compared for different parameters. Statistical Analysis: Chi Square Test was applied for categorical data and t test for the continuous data. Results: Both the groups were comparable in terms of age and sex. Mean BMI was significantly higher in desflurane group compared to sevoflurane group (p < 0.05). Mean duration was significantly higher in desflurane group cases. The recovery indices were significantly better in desflurane group cases (p<0.05). MMSE scores were not significantly different in two groups (p>0.05). Incidence of POCD in two groups was comparable (p>0.05). Conclusion: Both the drugs i.e. desflurane and sevoflurane are equally effective among elderly cases undergoing surgery under general anesthesia in preventing POCD.
A Comparative Study of Intrathecal Magnesium Sulphate with or without Intrathecal Fentanyl to 0.5% Hyperbaric Bupivacaine in Parturients Undergoing Elective Lower Segment Caesarean Section
Authors:   Assistant professor, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka 560002., HE Kantharaja , S Geetha ,   Assistant Professor, Department of Pharmacology, East Point College of Medical Sciences and Research Centre, Bengaluru, Karnataka 560049, India., HY Kiran Kumar ,   Post-graduate Student, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka 560002.
Published: January 2024

Background: Prolongation of analgesia in Neuraxial anaesthesia is achieved by adding various adjuvants intrathecally along with local anaesthetic agent. Using two adjuvants together in lower doses will prolong the duration of analgesia without causing much side effects. Aims: To compare the efficacy and safety of Intrathecal Magnesium v/s Fentanyl with Magnesium sulphate as an adjuvant to 0.5% Bupivacaine in terms of onset and duration of Sensory and Motor Blockade and Duration of Postoperative analgesia. Material and Methods: Prospective randomized double blinded study was conducted on 70 ASA 1 & 2 patients undergoing elective caesarean section. They were randomly divided into two groups (35 each). All patients received spinal anaesthesia. Group M received 1.7 ml of 0.5% bupivacaine, 0.1 ml (50 mg) magnesium sulphate and 0.2 ml of normal saline intrathecally. Group FM received 1.7 ml of 0.5% bupivacaine, 0.1 ml (50 mg) magnesium sulphate and 0.2 ml (10microgram) of fentanyl intrathecally. Results: Onset of sensory block was similar in Group M and Group FM. Duration of sensory block was prolonged in group FM (191±45.60) compared to Group M (178.12±38.06). Duration of analgesia was significantly prolonged. Conclusion: We conclude that, the addition of both intrathecal magnesium sulphate and fentanyl to bupivacaine for spinal anesthesia, in parturients undergoing elective LSCS results in prolonged duration of analgesia.
The Use of Intravenous Sodium Bicarbonate in the Treatment of Metabolic Acidosis with Septic Shock
Authors:   Associate professor, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka 560002, India., HN Vijaya Kumar , Madabhavi Satish Kumar ,   Junior Resident, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka 560002, India.
Published: January 2024

Background: Acute metabolic acidemia, defined as a decrease in blood pH originating from a primary reduction in bicarbonate concentration that is accompanied by an appropriate secondary reduction in PaCO2 and is present for up to a few days, can impair hemodynamics and increase mortality, particularly when severe (arterial blood pH<7.20). Septic shock constitutes an important cause of morbidity and mortality in the critically ill patient. The Surviving Sepsis Campaign recommends against treatment with bicarbonate in patients with lactic acidosis due to hypo perfusion when pH is >7.15 but does not explicate what should be done in cases with lower pH. Methodology: Prospective randomized, Double-blind controlled study was conducted in ICU of Bangalore Medical College and Research Institute, Bangalore for a period of 4 months (November 2020 to February 2021). Sample size calculation was based on previous prospective, randomized double bind, controlled study by Jung B et al, calculated to be 27 in each group. Results: Mean age of subjects in Study group was 43.7 ± 14.0 years and in control group was 43.3 ± 17.1 years. A statistically significant difference was found in mean final pH and HCO3 levels and with respect to need for ventilation and Multi Organ Dysfunction Syndrome among the groups. Conclusion: Metabolic acidosis is a common acid-base disorder and its management should be directed by the current guidelines of therapy. Rational treatment of metabolic acidosis in sepsis is directed towards addressing the underlying causes of acidosis and optimizing tissue oxygen delivery through optimization of cardiopulmonary parameters. Limitations of the previous studies prevent reaching definite conclusions and further investigations are required in order to ensure the validity of this therapeutic approach.
Over View of Oliceridine Newer Opioid Analgesic
Authors:   Postgraduate, Department of Anesthesiology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, 560060, India., Konnur Anurita , N Yoganarasimha ,   Professor, Department of Anesthesiology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, 560060, India., Anand Kripa ,   Senior Resident, Department of Anesthesiology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, 560060, India.
Published: January 2024

Pain relief requires a balance between adequate analgesia and risk of adverse effects. Opioids remain the cornerstone for managing moderate to severe pain, but are associated with opioid-induced respiratory depression (OIRD) and gastrointestinal complications. Opioids exert their analgesic effects predominantly via G-protein signaling, however, adverse effects including OIRD are mediated by the β-arrestin pathway. Oliceridine is the first of a new class of biased opioid agonists that preferentially activate G-protein signaling over β-arrestin, which would theoretically improve analgesia and reduce the risk of adverse effects. Oliceridine is approved by the Food and Drug Administration (FDA) for the treatment of moderate to severe acute pain. The efficacy of Oliceridine was mainly established in two randomized controlled Phase III clinical trials of patients experiencing moderate to severe pain after bunionectomy (APOLLO-1) and abdominoplasty (APOLLO-2). The results of the APOLLO studies demonstrate that Oliceridine, when administered via patient-controlled analgesia (PCA) demand boluses of 0.35mg and 0.5mg, provides superior analgesia compared to placebo, and is equianalgesic to PCA morphine 1mg demand boluses, without significant difference in the incidence of respiratory complications. However, these studies were designed to evaluate analgesic efficacy, and it is still uncertain if Oliceridine has a better safety profile than conventional opioids. Although several post hoc analyses of pooled data from the trials reported that Oliceridine was associated with lower OIRD and gastrointestinal complications compared to morphine, prospective studies are needed to elucidate if biased agonists such as Oliceridine reduce the risk of adverse effects compared to conventional opioids
Comparative Evaluation of Effect, Onset & Duration of Intranasal Dexmedetomidine Vs Midazolam for Paediatric Sedation During Diagnostic CT Scan
Authors:   Senior Resident, Department of Anesthesia & Critical Care, Grant Government Medical College & Sir J J Group of Hospitals, Mumbai 400008, Maharashtra, India., Gautam Somiya , Sonkamble Ashwin ,   Associate Professor, Department of Anesthesia & Critical Care, Grant Government Medical College & Sir J J Group of Hospitals, Mumbai 400008, Maharashtra, India., Sonkamble Poornima ,   Associate Professor, Department of Anesthesia & Critical Care, Grant Government Medical College & Sir J J Group of Hospitals, Mumbai 400008, Maharashtra, India., Badole Usha ,   Professor and Head, Department of Anesthesia & Critical Care, Grant Government Medical College & Sir J J Group of Hospitals, Mumbai 400008, Maharashtra, India.
Published: January 2024

Background: Separation anxiety among children is common and normal.Children undergoing radiological imaging studies often require sedation to avoid panic episodes & severe anxiety for induction of Anaesthesia. It is important for the child to lie still during the scanning procedure & mostly we find it difficult for the children to keep still during a CT scan, which is usually about 10–15 minutes. This study aimed at comparing and evaluating the efficacy of use of intranasally administered Dexmedetomidine Vs intranasal midazolam for paediatric sedation undergoing diagnostic CT scan studies. Methods: 100 paediatric patients within age group 1-10 years were divided into 2 groups of 50 patients each, Group I & II respectively, were given either intranasal Dexmedetomidine or Intranasal Midazolam. The depth of sedation was assessed by using University of Michigan sedation scale. Results: This study concluded that Intranasal Dexmedetomidine is superior & more effective than Midazolam for pediatric sedation.
Anesthetic Management of Achondroplastic Dwarf with Bronchial Asthma and Hypothyroidism Posted for Abdominal Hysterectomy
Authors:   Junior resident, Department of Anesthesiology, Sri Devaraj URS Medical College, SDUAHER, Kolar, Karnataka 563101, India., C Vidya Shree , Madhusudhana Ravi ,   Professor and HOD, Department of Anesthesiology, Sri Devaraj URS Medical College, SDUAHER, Kolar, Karnataka 563101, India., Vasantha Nagaseshu Kumari ,   Assistant professor,Department of Anesthesiology, Sri Devaraj URS Medical College, SDUAHER, Kolar, Karnataka 563101, India., B Sinchana ,   Senior Resident, Department of Anesthesiology, Sri Devaraj URS Medical College, SDUAHER, Kolar, Karnataka 563101, India.
Published: January 2024

Introduction: Achondroplasia is most common cause of dwarfism caused by FGFR-3 gene mutation. It possess anesthetic challenges due to multiorgan system involvement, spine abnormality, difficulty in mask ventilation and endotracheal intubation. Case Report: A 38yr old, female, case of achondroplastic dwarfism with history of bronchial asthma and hypothyroidism was posted for abdominal hysterectomy. She weighed 30 kgs and 43 cm in height. Spine examination showed thoracolumbar kyphoscoliosis. Airway assessment revealed large tongue, receding mandible, Mallampatti class IV. Pulmonary function test suggested mild restrictive disease. Difficult intubation trolley was kept ready. Routine monitoring, radial artery cannulation done for invasive blood pressure monitoring. Patient was given general anesthesia. On laryngoscopy, CL grade III view was obtained, with the aid of bougie endotracheal tube was placed. Delayed recovery time from general anesthesia was encountered, neuromuscular monitoring was doneandreversed and extubated uneventfully. Conclusion: we present a successful anesthetic management of a dwarf patient with bronchial asthma and hypothyroidism who underwent hysterectomy. We emphasize the risk of neurological injury while extending the neck during laryngoscopy for tracheal intubation due to anatomical abnormalities in these patients. A detailed pre anesthetic evaluation evaluation and planning is utmost important and the anesthetic technique has to be individualized based on the patients anatomical characterstics and associated co-morbidities. Keywords: Dwarf, Asthma, Hypothyroidism. Key Messages: A 38 yrs old female patient with achondroplastic dwarfism (43cm tall) with associated comorbidities like bronchial asthma and hypothyroidism, thoracolumbar kyphoscoliosis and mild restrictive lung disease posted for abdominal hysterectomy possesses various anesthetic challenges. Since multiple systems are involved preanesthetic evaluation, preoperative optimization of the patient and planning of anesthesia is important. As the spread of drug in regional anesthesia is unpredictable, we planned general anesthesia. A successful management of major abdominal surgery in such patients, with anesthetic challenges and implications in these patients are reviewed in this case report.
A Study on Pregnancy Outcomes in Patients with First Trimester Vaginal Bleeding
Authors:   3rd Year Resident, Department of Obstetrics and Gynecology, Bharati Vidyapeeth Deemed University, Kothrud, Pune 411038, Maharashtra, India., Yadav Sakshi , Kulkarni Y S ,   Associate Professor, Department of Obstetrics and Gynecology, Bharati Vidyapeeth Deemed University, Kothrud, Pune 411038, Maharashtra, India.
Published: January 2024

Bleeding in first trimester of pregnancy poses a risk to embryo. It can be a natural symptom of implantation, sign of spontaneous abortion, or of pathologic condition like ectopic pregnancy/ gestational trophoblastic illness.4 Aim: To assess the etiology and outcome of first trimester bleeding. Objectives: (1) To study the etiology for first trimester bleeding. (2) To study the incidence of various etiological factors. Settings and design: This is the prospective observational study carried out in a tertiary health care centre over 2 years from October 2019 to october 2021. Materials and methods: This study was conducted on women with complaints of vaginal bleeding in first trimester of pregnancy. The methodology were explained to the women and valid informed written consent was recorded. The ethical clearance was obtained from ethical review committee of the tertiary care centre. After taking a detailed history and physical examination, the patient will undergo a urine pregnancy test, on confirmation she will be sent for a TVS scan depending upon the USG report further management and follow-up will be decided. Conclusion: Bleeding in first trimester doesn’t necessarily lead to miscarriage, but causes anxiety to the patient. Women and obstetricians should consider the outcome of continued pregnancies after the first trimester bleeding when planning antenatal care and clinical interventions. We need more researches on this to improve our better understanding and knowledge so that we can better plan the continued pregnancy as well as council the patient in better way.
Prospective Observational study of Etiological Spectrum of Febrile Illinessess in Pregnancy and Association with Outcomes
Authors:   Junior Resident (Jr-3),  Department of Obstetric and Gynaecology, Bharati Vidyapeeth, Hospital and Medical College, Pune-416414, Maharashtra, India., Mali Vishal
Published: January 2024

Background:- Fever in pregnancy is a common clinical problem worldwide. The risk to the mother and fetus is significantly increased in pregnancy complicated by infection and fever. Aim and objective:- To determine etiological spectrum of febrile illnesses in pregnancy and its association with maternal & fetal outcomes. Methodology :- Prospective observational study was conducted in the Department of obstetrics and gynecology in a tertiary care center in western Maharashtra. A total 105 pregnant women reported with fever during the study periods, out of which 37 were followed up longitudinally till delivery and were included in the study analysis. Results:- In the present study, Fever of unknown origin(32.43%), Dengue(24.32%), COVID-19 (24.32%), Urinary tract infections(16.21%) Malaria(2.7%) were the common cause of febrile illness. Out of 37 pregnant women with febrile illness, 31 (83.8%) had live births, 5 (13.5%) had intrauterine death (IUD) and there was one case of abortion. In 10 (27%) patients, there was a requirement for NICU admission. It was observed that more is the number of febrile episodes higher is the chance of neonatal morbidity and mortality. Conclusion :- High grade fever with multiple febrile episodes due to any underlying etiology in pregnancy is harmful to the fetal-maternal health.
An Observational Study of Evaluation of Caesarean Section Rate by Robson’s Ten Group Classification System
Authors:   Resident, Department of Obstetrics and Gynecology, GMERS Medical College and General Hospital, Gotri 390021, Vadodra, Gujarat, India., Madhukar Shinde Shweta , Sharad Pitre Dipa ,   Associate Professor, Department of Obstetrics and Gynecology, GMERS Medical College and General Hospital, Gotri 390021, Vadodra, Gujarat, India.
Published: January 2024

Aims and objectives: • To use Robson’s Ten Group Classification System to evaluate caesarean sections in present institution. • To understand the reasons behind the CS rates for different groups of Ten Group Classification System specific to present institution. Study Design and Settings: The prospective observational study conducted for a period of one year from 15th July 2020 to 15th July 2021 which included all women admitted in the labour room of GMERS medical college and general hospital, Gotri, Vadodara, Gujarat for delivery over in the analysis. Methods and Material: The data compilation and statistical analysis was performed according to Robson’s Ten Group Classification using Microsoft excel version 2011 and Med Calc software. For each group, we have calculated the caesarean section rate within the group and its absolute and relative contribution to the overall caes arean rate. Results: A total 1768 patients delivered in the present institute and out of which 1069 were vaginal deliveries and 699 were caesarean section over this study period of one year. The overall caesarean section rate (CSR) was 39.54%, maximum contribution to total CS was from group 5, followed by group 1, group 2, group 10, and group 3. Less contribution from group 4, group 7, group 6, group 8 and least from group 9. Group 1, 2, 3 & 4 were low risk group.
A brief inventory of bruchids (Chrysomelidae, Bruchinae) and similar pest beetles occurring on peas in the Republic of Congo: barcoding and prospects
Authors: Okassa Mireille Belle Mbou , Mabika Matito Mavanga , Dibangou Valentin , Lenga Arsène
Published: January 2024

The seed beetles of the family Chrysomelidae, subfamily Bruchinae, are pest species that cause substantial damage to legume crops, affecting supply for human and animal consumption. Legumes are a staple of the Congolese population due to their protein-rich seeds, productivity, and ability to improve soil fertility when combined with cereals. In this study, we focused on bruchids that attack two varieties of peas, Cajanus cajan and Vigna unguiculata subsp. cylindrica, in the Republic of Congo. 80 individuals of bruchids were considered from the two main pea-growing departments: Bouenza and Niari. Specimens were collected using baited traps placed in the field and by manually selecting affected seeds from the storage areas. Individuals were categorised at the species level based on morphological traits and molecular barcode analyses. This is the second time that 12S rRNA sequences of bruchids from the Republic of Congo have been deposited in the GenBank database. This study emphasises the need to enrich the GenBank database with DNA sequences originating from areas where the technical means to carry out quality morphological analyses are limited.
Development of a model based on Support Vector Machines to predict the degradation of pesticides in biobeds systems
Authors: Molina-Chuc Ahreel , Aceves-Lara César Arturo , De Lille Marisela Vega , Quintal-Franco Carlos , Ponce-Caballero Carmen
Published: January 2024

Pesticides are chemical compounds used to mitigate, reduce, or eliminate the impact of pests on agricultural production. Due to their nature, pesticides are potentially toxic to many organisms, including humans. Among the various methods used to decontaminate pesticides in soils, the use of biological beds (biobeds) is a feasible option to minimize their contamination. The main problematic to use biobeds is the difficult to predict their behavior due biotic and abiotic factors. This study focuses on the use of the support vector machine (SVM), for the generation of predictive models of pesticide degradation in biobeds systems. The results show that the Gaussian and polynomial kernel has the best performance to model experimental data. The statistical parameters of R-Squared were 0.93 for Gaussian kernel and polynomial, 0.83 for cubic, 0.76 for quadratic and 0.52 for lineal. The Gaussian model could be used to provide the characteristics to improve of pesticide degradation.
Preference and performance of thrips, Megalurothrips distalis Karny on selected greengram accessions
Authors: M REVATHI , V Selvanarayanan
Published: January 2024

Many studies conducted in the last few decades focused solely on the field screening of greengram against thrips. There has not been much research done on the interaction between thrips, Megalurothrips distalis and greengram. So, in the current study, several laboratory experiments were carried out to determine the feeding and oviposition preferences of M. distalis on terminal leaves and flowers of selected greengram accessions, as well as to compare the biological preferences of M. distalis on terminal leaves and flowers of selected greengram accessions. In the free choice tests, when compared to accession IC-39380, IC-39430, and IC-103862, the M. distalis population showed a lower feeding preference for accession IC-329039-1, followed by accession IC-325782. Furthermore, under laboratory conditions, the M. distalis population reared on accession IC-329039-1 showed significantly slower development, shorter lifespan and lower survival and fecundity rate than the other four accessions. Overall, the current study could help us to understand how M. distalis interacts with its selected greengram accessions. As a result, these findings indicate that the abundance of thrips populations varies among the selected accessions and is heavily influenced by the identity and condition of the respective accessions. These contributions may help us develop a better IPM control programme for thrips in the future.
Protein structure-based organic chemistry-driven ligand design from ultra-large chemical spaces
Authors: Rognan Didier , Sindt François , SEYLLER Anthony , Eguida Merveille
Published: January 2024

Ultra-large chemical spaces describing several billion compounds are revolutionizing hit identification in early drug discovery. Because of their size, such chemical spaces cannot be fully enumerated and requires ad-hoc computational tools to navigate them and pick potentially interesting hits. We here propose a structure-based approach to ultra-large chemical space screening in which commercial chemical reagents are first docked to the target of interest and then directly connected according to organic chemistry and topological rules, to enumerate drug-like compounds under three-dimensional constraints of the target. When applied to bespoke chemical spaces of different sizes and chemical complexity targeting two receptors of pharmaceutical interest, the computational method was able to quickly enumerate hits that were either known ligands (or very close analogs) of targeted receptors as well as chemically novel candidates that could be experimentally confirmed by in vitro binding assays. The proposed approach is generic, can be applied to any docking algorithm and requires few computational resources to prioritize easily synthesizable hits from billion-sized chemical spaces.
Northward shift of pre-monsoon winds exacerbating heatwaves over India
Authors: Mondal Arpita , Jha Roshan , Ghosh Subimal , Murtugudde Raghu
Published: January 2024

India has observed increasingly persistent heat extremes in recent decades, that pose environmental, agricultural, and human health challenges. North-Central India, a highly populated region prone to heatwaves, has experienced record maximum temperatures (>48°C) during the pre-monsoon season. While studies have shown positive trends in heatwaves due to rising air temperature during pre-monsoon season, we identify a shift in pre-monsoon mean daily maximum temperature over North-Central India, resulting in an increase in seasonal mean maximum temperature by 0.7°C post-1998. The jump in temperature is associated with a weakening of mid-tropospheric zonal winds as a result of a northward migration of the subtropical jet since 1998. Further, comparing the two regimes before and after the shift, we find that the frequency and duration of heatwaves have accelerated in the latter regime. We also observe that the recent increase in heatwaves is associated with an increase in negative vorticity indicating increasing anticyclonic circulations over North-Central India. These findings highlight that the exacerbation of heatwaves in North-Central India is primarily driven by atmospheric dynamical changes triggered by a regime shift, further compounded by global warming.
Nowcasting methods to improve the performance of Respiratory Sentinel Surveillance: Lessons from the COVID-19 Pandemic
Authors: Flores-Alvarado Sandra , Olivares María Fernanda , Vergara Natalia , García Christian , Canals Mauricio , Cuadrado Cristóbal
Published: January 2024

Respiratory diseases, including influenza and coronaviruses, pose recurrent global threats. This study delves into the respiratory surveillance systems, focusing on the effectiveness of SARI sentinel surveillance for total and severe cases incidence estimation. Leveraging data from the COVID-19 pandemic in Chile, we examined a 159-week period comparing census surveillance results of confirmed cases and hospitalizations, with sentinel surveillance carried out during the same period. Our analyses revealed a consistent underestimation of total cases and an overestimation of severe cases of sentinel surveillance. To address these limitations, we introduce a nowcasting model, improving the precision and accuracy of incidence estimates. Our findings are applicable beyond COVID-19, with implications for respiratory virus surveillance and early detection of respiratory epidemics. The nowcasting model offers real-time insights into an outbreak for public health decision-making, using the same surveillance data that is routinely collected. This approach enhances global preparedness for emerging respiratory diseases by the development of practical solutions with wide-ranging applications in public health.