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Background and Aim: Sevoflurane, a preferred anaesthetic for children, exhibits a dose‑dependent reduction in intraocular pressure (IOP). However, consensus is lacking regarding optimal end‑tidal sevoflurane concentration for safe IOP measurement. This study aimed to identify the concentration at which IOP measurement could be attempted without inducing movements in paediatric patients after inhalational induction. Methods: Two paediatric groups (1–12 months and 12–36 months) with glaucoma undergoing examination under anaesthesia were recruited. After induction with 8% sevoflurane and 100% oxygen, the first child had an end‑tidal sevoflurane concentration maintained at 2% for 4 min, followed by IOP measurement. Success was defined as ‘no movement’, and subsequent concentrations (adjusted in 0.2% steps) were determined using the Dixon and Massey method based on the previous patient’s responses. Results: The study included 75 children. The effective concentration of sevoflurane causing ‘no movement’ during IOP measurement in 50% of the study population for successful IOP measurement was 1.98% (95% confidence interval [CI] 1.63, 2.17, P = 0.017) for 1–12 months group and 0.55% (95% CI 0.39, 0.66, P = 0.002) for 12–36 months group. Probit regression analysis yielded effective concentration of sevoflurane causing ‘no movement’ during IOP measurement in 95% of the study population values of 2.47% (95% CI 2.24, 4.58, P = 0.017) for 1–12 months group and 0.94% (95% CI 0.78, 1.57, P = 0.002) for 12–36 months group. Conclusion: In paediatric patients, a higher end‑tidal sevoflurane concentration of 2% is needed for IOP measurement in 1–12 months age group compared to 0.5% required in 12–36 months age group, achieving success in 50% of the study population. [ABSTRACT FROM AUTHOR]

Introduction: Sedation and analgesia are integral parts of patient care in intensive care units. These medications are routinely administered to mechanically ventilated patients to reduce pain, anxiety, improve patient comfort, to allow the patient to tolerate the physical environment and unpleasant procedures, avoiding awareness during ICU stay, reduce the requirement for the use of neuromuscular blocking agents and to contribute in maintaining metabolic and haemodynamic homeostasis. Materials and Methods: After approval by the Institutional ethical committee the study was conducted in the Main ICU of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. All the patients who were admitted in the main ICU were eligible for the study. After taking informed written consent, 70 adult patients who were haemodynamically stable and require sedation were studied. Patients were stabilized after admitting in the ICU. The demographic data including the admission diagnosis, admitting unit were collected. APACHE IIscore was calculated in first 24 hours. BIS electrodes were applied to the forehead of each patient after skin preparation to ensure low impedance and a good quality of signal. BIS offers continuous monitoring of sedation for 24 hours. Baseline BIS score and RSS, RASS scores were collected. Results: Seventy critically ill sedated patients were studied prospectively in MICU, PGIMER, Chandigarh. From January to December 2014. The mean patient age was 38.8 ± 16.5 years (range: 18- 92 years). 35 (50%) patients were male and 35 (50%) were female patients. The median APACHE score of the 70 patients was 11 with IQR of 8-13. Parameters like SBP, DBP, HR, SpO2, temperature; blood gases and electrolytes were assessed for normality by Shapiro Francia test. However, none of them showed normal distribution. The BIS, RSS, RASS of the patients during the study period are given in the table 1, and figures 1, 2, 3. Conclusion: We found significantly better correlation between RSS & RASS compared to RSS & BIS and RASS & BIS. This concludes that RSS and RASS are not a good substitute for BIS. Whereas RSS and RASS can be substituted each other. We found negligible correlation between BIS and clinical scores to APACHE. Hence we can conclude no influence of change in APACHE on BIS and clinical sedation scores (RSS and RASS). [ABSTRACT FROM AUTHOR]

Background: Given the evolving nature of COVID-19, for better understanding of its effect on antimicrobial resistance of Staphylococcus aureus (S. aureus), it becomes crucial that we follow the resistance patterns across different surges of COVID-19 cases. Methods: This prospective surveillance study extended over two years from January 2020-March 2022 and was conducted in a healthcare center of North India. Susceptibility patterns of Staphylococcus aureus during January-March 2020 were considered as prepandemic patterns. Processing of clinical specimens, identification of S. aureus, and in-vitro antibiotic susceptibility testing were performed in accordance with standard microbiological testing procedures and Clinical Laboratory Standard Institute guidelines. Results: Lowest prevalence (38.9%) of Methicillinresistant S. aureus was reported during January-March 2021 and July-September 2021. More than 50% S. aureus isolates were susceptible to linezolid, cotrimoxazole, tetracycline, and gentamicin in January-March 2020. In January-March 2021, =50% of S. aureus isolates from clinical specimens were additionally susceptible to clindamycin and erythromycin. Antibiotic agents of linezolid, tetracycline, clindamycin, and cotrimoxazole were susceptible in =50% of S. aureus isolates in January-March 2022. Conclusions: This study reveals a sharp decline in overall resistance to commonly prescribed antibiotic agents for S. aureus isolates after first peak of COVID-19 cases. However, same trend was not observed in subsequent peaks and probably we are approaching the same resistance levels that were seen prior to COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background The current available literature is not unanimous in reporting the utility of short-axis and long-axis techniques for radial artery cannulation in both adults and children. This study was designed to compare short-axis out-of-plane (SA-OOP) and long-axis in-plane (LA-IP) techniques in ultrasound-guided radial artery cannulation in adults. Methods In this prospective randomized controlled trial, 150 adult patients of American Society of Anesthesiologists physical status I-III aged between 18 and 70 years were included. All patients were randomized into two groups (group SA-OOP) and (group LA-IP) of 75 each undergoing ultrasound-guided radial artery cannulation. The primary outcome was successful cannulation in the first attempt. Secondary outcomes included antero-posterior arterial diameter, skin-to-artery distance, ultrasonic localization time, cannulation time, no of attempts to cannulate artery, cannula insertion failure, and vascular complications. Results First-attempt arterial cannulation was successful in 80 % of patients in the SA-OOP group as opposed to 82.6 % patients in the LA-IP group (p = 0.67). The time to cannulate the artery was similar between the two groups, but the time to localize artery was significantly higher in the long-axis technique (p < 0.001). Conclusions The first-attempt cannulation success rate and cannulation time in adult patients are similar in ultrasound-guided radial artery cannulation with both short-axis as well as long-axis techniques. Trial registration Clinical Trial Registry of India (CTRI/2015/02/005552)., Author(s): Sameer Sethi [sup.1] , Souvik Maitra [sup.1] , Vikas Saini [sup.1] , Tanvir Samra [sup.1] , S. K. Malhotra [sup.1] Author Affiliations: (1) 0000 0004 1767 2903grid.415131.3Anesthesia Department, Post [...]

Byline: Aditi. Jain, Aditi. Mehta, Usha. Singh, Vikas. Saini Sir, Oculocardiac reflex (OCR) is one of the most notorious complications associated with ophthalmic surgeries. We would like to report a [...]

Every year, approximately 0.4 million women suffer from endometrial cancer (EC) worldwide and it has become the most common gynecological malignancy. Almost 66% of EC cases are diagnosed at an early stage and can be cured by performing surgery while those at an advanced stage turns out to be fatal. Biomarkers of endometrial cancer would be very valuable for screening of women who are at high risk and in detecting the chance of recurrence of disease. The current article has reviewed studies published on expression of biomarkers and susceptibility to EC. Google Scholar and PubMed were used as searching platforms and we have majorly considered the literature from last 10 years. Potential biomarkers of EC identified from various studies were summarised. [ABSTRACT FROM AUTHOR]

Byline: B. Naik, Venkata. Ganesh, Vikas. Saini, Tanvir. Samra Sir, We describe a case in which a suction catheter inserted through the gastric drain channel of an i-gel™ (size 3) [...]

Background: Transurethral resection of bladder tumors (TURBT) surgeries requires post‐resection catheterization for continuous irrigation of the bladder. This indwelling catheter is associated with distressing catheter‐related bladder discomfort (CRBD) and increases postoperative pain and agitation. Objectives: To prove the hypothesis that transurethral 100 mg lidocaine irrigation at the end of TURBT can reduce the frequency of moderate‐to‐severe postoperative CRBD. Methods: 116 patients scheduled for TURBT were screened, 94 were recruited and completed the study. American Society of Anesthesiologists Physical Status I–II adult patients, 20–75 years of age undergoing elective TURBT surgery under general anesthesia were included. Transurethral normal saline with 0.01% lidocaine (100 mg in 1 L NS) was used for irrigation 30 min before the completion of surgery in group L, while only normal saline was used for transurethral irrigation in group N. The main outcomes were frequency of CRBD, pain and patient satisfaction at 0, 1, 2, and 6 h postoperatively. Results: A total of 94 patients were analyzed in the study. The incidence of moderate–severe CRBD was significantly lower in group L as compared to group C at 0, 1, and 2 h (65.9% vs. 31.9%, p = 0.01; 31.9% vs. 10.6%, p = 0.012; 21.3% vs. 2.1%, p = 0.004, respectively). At the 6‐h mark, the incidence of CRBD was lower in group L, although this did not achieve statistical significance (6.38% vs. 2.1%; p = 0.613). Conclusion: Irrigation with 0.01% lidocaine (100 mg) towards the end of TURBT reduces the incidence of moderate–severe CRBD by 52% and increases patient satisfaction. [ABSTRACT FROM AUTHOR]

Salmonella serotypes, including Salmonella Typhi, S. Paratyphi A, S. Paratyphi B, and S. Paratyphi C, are responsible for the systemic, protracted febrile sickness known as typhoid fever. Various antibody-based tests are being used for diagnosing typhoid fever. This study was carried out to assess the performance of the widal test and blood culture for the diagnosis of typhoid fever among malaria-negative patients in a tertiary care hospital in east Delhi, India. The study was conducted from July 2021 to June 2022 in the Department of Microbiology of a tertiary care hospital in Delhi. Patients, including the adult and pediatric population, were evaluated for typhoid fever and participated in an observational, prospective study on febrile patients that was malaria-negative. Venous blood samples were obtained under strict aseptic conditions and further processed for widal serology and blood culture tests for typhoid fever. In our study, the prevalence of blood culture-positive Salmonella species was 0.3% (30/10,000 = 0.3%) Among antimicrobial susceptibility patterns, S. Typhi revealed the highest resistance rates for Ciprofloxacin (43.33%), Azithromycin (36.66%), and third-generation cephalosporins. Out of 30 blood culture-positive Salmonella Typhi of typhoid fever patients, 5 (17%) samples were negative for the Widal test. Among 30 samples, all were blood culture positive, but only 25 samples show Widal titer above the baseline i.e. >1:64. Although blood culture is the gold standard for the diagnosis of typhoid fever, the Widal test does play a role in the diagnosis and management of typhoid fever, especially in suspected cases when blood culture is negative, especially in government tertiary care hospitals. [ABSTRACT FROM AUTHOR]

All clinicians should provide high-quality, safe, and equitable care to every patient and community. Yet, in practice, health care delivery systems are designed and organized to exacerbate inequity in access and outcomes, and clinicians are incentivized to deliver unequal and inequitable care in deeply segregated academic health centers that are structured to reify white supremacy. This article investigates the nature and scope of health professions educators' obligations to acknowledge harms of segregation in health care as widespread, unjust, iatrogenic, and preventable. [ABSTRACT FROM AUTHOR]

Byline: Vikas. Saini, Tanvir. Samra, Nitin. Ahuja, Sameer. SethiOBJECTIVES: Thrombosis and thrombophlebitis of the superficial venous system are common in hospitalized patients. Efficacy and safety of topical quick penetrating solution [...]

Byline: Deepanshu. Dhiman, Vikas. Saini, Sameer. Sethi, Tanvir. Samra Sir, Central venous cannulation (CVC) is a commonly performed procedure in emergency, critical care and perioperative period. The use of ultrasound [...]

Introduction: The world is experiencing a pandemic of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2. The prescription of a superfluity of unnecessary antibiotics without regard for the potential for increased antimicrobial resistances is extensive and unimpeded during the COVID-19 pandemic. Aims: To compare the microorganisms and the pattern of antimicrobial resistance of bacteremia during the first and second waves of the COVID-19 pandemic in a tertiary care hospital. Methods and Material: This retrospective observational study, to compared the blood culture of the COVID-19 pandemic during the first wave (April 2020 to September 2020) and the second wave (April 2021 to September 2021). All the blood culture isolates were identified and the antimicrobial susceptibility testing was done according to standard guidelines. Results: Out of 1470 blood culture samples, 259 (17.6%) blood bacterial isolates were grown in the first wave and, out of 4200 blood culture samples, 711 (16.9%) bacterial isolated during the second wave of the COVID-19 pandemic. Coagulase-negative staphylococcus (CONS) was 32.8% followed by Staphylococcus aureus 29.7% in COVID first wave and staphylococcus aureus (48.9%) followed by Klebsiella pneumoniae (11.6%) during COVID second wave were the most prevalent isolates. Conclusions: This study shows that coagulase-negative staphylococcus aureus and multidrug-resistant Klebsiella spp. are the leading causes of bloodstream coagulase-negative infections during both the first and second wave in the bloodstream COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Byline: Rohan. Magoon, Surender. Malhotra, Vikas. Saini, Ridhima. Sharma, Jasleen. Kaur Background and Aims: The external jugular vein (EJV), often used for resuscitation, has been underutilised for central venous catheterisation [...]

Byline: Neeru. Sahni, Manisha. Biswal, Komal. Gandhi, Kulbeer. Kaur, Vikas. Saini, Lakshminarayana. Yaddanapudi Objective: The aim was to analyze the impact of education and training of nurses on the incidence [...]

Background and Aims: Ultrasound-guided subclavian vein cannulation has two approaches: supraclavicular and infraclavicular. The aim of this study was to compare the ease of cannulation by recording the puncture time of the subclavian vein with the two approaches in adult patients. Material and Methods: This study was approved by our institutional ethics committee, and a written informed consent was obtained from the patients. This prospective randomized trial recruited patients aged 18 to 80 years with definite indications of subclavian vein cannulation. Real-time in-plane ultrasound-guided technique was used, and the subclavian vein was punctured at the junction of the brachiocephalic and IJV in supraclavicular approach (SC) and in oblique axis below the border of the clavicle in infraclavicular approach (IC). Results: A total of 96 patients were randomly allocated equally into two groups of 48 each, but only 45 patients in each group could be successfully cannulated. Median puncture times were comparable; 15 (9–39) s in SC and 21 (5–80) s in IC group. The first attempt success rate was 82.2% and 62.2%, and the mean total access time was 99.11 ± 34.66 s and 103.44 ± 50.27 s in SC and IC approaches, respectively and were comparable. The attempts of needle puncture were significantly higher in IC approach (1.40 ± 0.54 vs 1.20 ± 0.46 in SC approach; P = 0.04). The complication rates were comparable and less than 5%. Conclusion: Ease of cannulation of the subclavian vein using ultrasound-guided supraclavicular and infraclavicular approach is comparable as no statistically significant difference is noted in the puncture time and first-attempt success rate. The increased number of needle punctures reported in our study with the IC approach did not translate to an increased complication rate. [ABSTRACT FROM AUTHOR]

Objectives: We conducted this study with an objective to compare the diagnostic accuracy of rapid antigen and antibody kits for early detection (<5 days of fever) and late detection (>5 days of fever) of S.Typhi and S.Paratyphi in relation to the Widal test. Methods: A cross-sectional observational study was conducted over 15 months, during which 180 cases of documented fever were enrolled. Paired samples (at <5 and >5 days of fever) were processed for rapid antigen test (RAg), rapid antibody test (RAb) and Widal test. Blood culture (BacT/Alert system) was considered as the gold standard for confirmation. Results: The mean (SD) age of patients with enteric fever was 16.42 (12.53) years, with a slight male preponderance (58.33% males vs. 41.67% females). Positive blood culture was reported in 58 (32.22%) cases. For RAg, RAb and Widal tests, the diagnostic accuracy was 45.56%, 42.22% and 41.11%, respectively, which was comparable for diagnosing enteric fever in cases with <5 days of fever (P = 0.675). For fever >5 days, RAg showed a significantly lower diagnostic accuracy (15%) as compared to RAb (61.11%) and Widal test (66.11%) (P < 0.0001). Conclusion: The study concludes that RAg marks a high sensitivity of accurate diagnosis in the initial five days of typhoid fever while RAb (with or without Widal tests), hold a superior sensitivity for diagnosis after five days of onset of enteric fever. [ABSTRACT FROM AUTHOR]