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Background: The incidence of postoperative nausea and vomiting (PONV) is quite high after laparoscopic surgeries. This study endeavors to compare the efficacy of the combination of palonosetron and dexamethasone with that of either drug alone in the prevention of PONV in patients undergoing laparoscopic surgeries. Methods: This randomized, parallel-group trial was done on ninety adults of American Society of Anesthesiologists Grade I and II patients aged 18–60 years undergoing laparoscopic surgeries under general anesthesia. The patients were randomly divided into three groups of thirty patients each. Group P (n = 30) received palonosetron 0.075 mg intravenously (iv), Group D (n = 30) received dexamethasone 8 mg iv and Group P + D (n = 30) received palonosetron 0.075 mg and dexamethasone 8 mg iv. The primary outcome was incidence of PONV in 24 h, and the secondary outcome was a number of rescue antiemetics required. To compare the proportions in the groups, unpaired t-test, Mann–Whitney U-test, Chi-square test, or Fisher's exact test was applied. Results: We found that the overall incidence of PONV was 46.7% in Group P, 50% in Group D, and 43.3% in Group P + D during the first 24 h. Rescue antiemetic was required in 27% of the patients in Group P and Group D compared to 23% of the patients in Group P + D and twice in 3% of the patients in Group P, 7% of the patients in Group D, and none in Group P + D which were not significant. Conclusions: The combination therapy of palonosetron plus dexamethasone did not significantly reduce the incidence of PONV when compared with either drug alone. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) on heavy menstrual bleeding in perimenopausal women. Methods: This was a prospective, observational clinical study conducted on 42 perimenopausal women with heavy menstrual bleeding who met the study eligibility criteria. LNG-IUS was inserted in the postmenstrual phase following baseline evaluation. The patients were followed up at the 4, 12, and 24 weeks. Pictorial blood assessment chart (PBAC) score, hemoglobin and serum ferritin levels, and endometrial thickness were assessed before insertion and during the follow-up visits. Results: Two patients (4.8%) were lost to follow-up, three patients (7.1%) opted for hysterectomy, two women (4.8%) experienced spontaneous expulsion and 35 (83.3%) women continued the usage. Menstrual blood loss assessed using the median PBAC score (interquartile range) significantly reduced (P < 0.001) from the pre-insertion level of 280 (246-306) to 124 (60-200) at 4 weeks to 45 (34-76) at 12 weeks and further to 32 (20-50) at the end of 24 weeks. Simultaneously, a significant (P < 0.001) improvement in the mean hemoglobin and serum ferritin levels and a significant (P < 0.001) decrease in endometrial thickness were observed. The most common side effect was spotting (50.0%) and vaginal discharge (38.1%). Conclusions: LNG-IUS causes a remarkable reduction in menstrual blood loss and marked improvement in dysmenorrhea. It also reduces anemia by improving the hemoglobin and ferritin levels. Thus, it can serve as an effective treatment option for heavy menstrual bleeding in perimenopausal women and prevent the need for a hysterectomy. [ABSTRACT FROM AUTHOR]

Background: Emergency authorization and approval were given for the coronavirus disease-19 (COVID-19) vaccines. The efficacy reported after phase III trials were 70.4% and 78% for Covishield and Covaxin, respectively. In this study, we aim to analyze the risk factors, which were associated with mortality in critically ill COVID-19-vaccinated patients admitted into intensive care unit (ICU). Materials and methods: This study was conducted from April 1, 2021 to December 31, 2021 across five centers in India. Patients who had received either one or two doses of any of the COVID vaccines and developed COVID-19 were included. The ICU mortality was a primary outcome. Results: A total of 174 patients with COVID-19 illness were included in the study. The mean age was 57 years standard deviation (SD 15). Acute physiology, age and chronic health evaluation (APACHE II) score and the sequential organ failure assessment (SOFA) score were 14 (8-24.5) and 6 (4-8), respectively. Multiple variable logistic regression showed patients who have received a single dose [odds ratio (OR): 2.89, confidence interval (CI): 1.18, 7.08], neutrophil:lymphocyte (NL) ratio (OR: 1.07, CI: 1.02,1.11), and SOFA score (OR: 1.18, CI: 1.03,1.36) were associated with higher mortality. Conclusion: The mortality in the vaccinated patients admitted to the ICU was 43.68% due to COVID illness. The mortality was lower in patients who had received two doses. [ABSTRACT FROM AUTHOR]

Background: Thrombocytopenia may result from mechanisms such as marrow hypoplasia, increased destruction of platelets, and splenic sequestration. The gold standard method for discriminating the causes of thrombocytopenia is bone marrow examination, but it is invasive and expensive. Therefore, an alternative method should be introduced as a first-line diagnostic procedure. Of late, the automated blood cell analyzer has made it possible to assess the cause of thrombocytopenia through various machine-derived parameters, known as platelet indices, which include the mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), which are provided as a part of routine complete blood count. Objectives: The objectives of the present study are to study the variation and effectiveness of platelet indices in establishing the etiology of thrombocytopenia. Method: An observational, prospective, and comparative study was conducted on 134 patients with thrombocytopenia, and 67 cases were taken as the normal group. The study group was classified into two groups: hypo-productive and hyper-destructive. Platelet indices were recorded and compared in the two groups along with the normal group. Results: The mean platelet count (10^3 µL) in the normal, hypo-productive, and hyper-destructive groups was 232.03 ± 74.84, 73.00 ± 36.52, and 68.28 ± 38.24, respectively. The MPV and mean PCT in the normal, hypo-productive, and hyper-destructive groups were 9.46 ± 1.68fL, 8.99 ± 1.49fL, and 11.35 ± 1.35fL and 0.22 ± 0.06%, 0.07 ± 0.04%, and 0.08 ± 0.05%, respectively. The mean PDW in the normal, hypo-productive, and hyper-destructive groups was 15.66 ± 1.76fL, 17.63 ± 1.01fL, and 18.32 ± 1.10fL, respectively. Conclusion: In the present study, platelet indices such as MPV, PCT, and PDW are higher in the hyper-destructive group and may discriminate hyper-destructive from hypo-productive causes of thrombocytopenia. [ABSTRACT FROM AUTHOR]

Byline: Jay. Prakash, Radhika. Dhanpal, Natesh. Rao, Sarayu. Ramamurthy Sir, The article by Venugopal et al . made for an interesting reading and an informative case series.[1] We agree with [...]

Image processing fields, such as separating data from healthcare images, can benefit greatly from using deep learning algorithms. This can be extremely beneficial. For the treatment of someone with a brain tumour, discovering the tumour as soon as possible is critical. The patient's life expectancy would increase if the tumour was discovered sooner rather than later. Medical images typically lack contrast because of noise or because there aren't enough diffusive boundaries in the image. This is because of noise. In order to better understand tumours in medical image segmentation, MRI was used to diagnose the tumour, but it also played a beneficial role in clinical image analysis. Why did an MRI need to be done? This paper will examine how bad a brain tumour is using the hybrid deep learning algorithm, which is what this paper is about. Algorithms help us get the correct answer. Based on the direction of the images taken by MR, there will be a lot of information about how to divide up the pictures. In this way, three separate networks are trained to improve their segmentation results. [ABSTRACT FROM AUTHOR]

Objective: Due to the lack of resources for culture and antibiotic susceptibility testing in most underdeveloped countries, puerperal sepsis is treated empirically with a wide range of antibiotics. Empirical treatment, on the other hand, does not ensure treatment effectiveness and may even contribute to antibiotic resistance. So, we studied cases of puerperal sepsis, its socio-demographic factors, bacterial isolates, and antibiotic sensitivity in a tertiary health center. Material and Methods: This was a cross-sectional study conducted at the obstetrics and gynecology department of a tertiary health center in India from April 2019 to September 2020. During this time, all patients with sepsis who met the criteria for inclusion were included. After granting an informed written consent, the subjects were registered on a pre-designed proforma. Results: There were 2,049 obstetrical admissions throughout this period, with 106 (5.1%) of these having puerperal sepsis. The majority of these women (58.7%) were between the ages of 21 and 30, were multiparous (96.5%), and unbooked. Fever 104 (98.1%) was the most prevalent clinical characteristic, whereas wound gape was the most common consequence (47.1%). Klebsiella aerogens was the most common organism found in various cultures. Many organisms were shown to be multidrug-resistant and sensitive to gentamycin and amikacin. Conclusion: Klebsiella aerogens wasthe most common cause of puerperal sepsis in this investigation. Because the causal agents of puerperal sepsis and their antibiotic sensitivity patterns change over time, positive blood culture and antibiotic susceptibility of the isolates are the best guides for selecting the optimum antimicrobial therapy for treating sepsis. [ABSTRACT FROM AUTHOR]

Anemia is the most common haematological disorder in pregnancy. Anemia increases maternal morbidity and mortality. It is a condition that can be diagnosed and treated during antenatal period, preventing the serious complications of anemia during pregnancy and labour. Aims: This study investigated the prevalence of types of anemia during pregnancy and fetomaternal outcomes among pregnant women. Study Design: This was a cross-sectional study that enrolled 1100 pregnant women who were in the third trimester of pregnancy with haemoglobin level <11.0 gm/dl between March 2019 and August 2020. Methods and Material: Participants were selected by consecutive sampling and baseline data were collected by using a predesigned and pretested structured questionnaire. Data Analysis: Data were entered and analysed by using SPSS version 20. Results: The prevalence of anemia in third-trimester pregnancy in this study was 91.05%. Iron deficiency anemia was most common (69.18%) among pregnant women followed by megaloblastic anemia (2.5%). Most of pregnant women (45.90%) were mildly anemic. Mean ± SD of haematological parameters among the anemic pregnant women during third trimester of pregnancy were haemoglobin (8.08±2.24 gm/dl), haematocrit (28.92±7.78%), mean corpuscular volume (MCV) (93.02±11.32fl), mean corpuscular haemoglobin (MCH) (26.03±2.90 pg), mean corpuscular haemoglobin concentration(MCHC) (27.99 ± 2.01 gm/dl), RBC count (3.05 ± 0.67million/mm3). Most common maternal complications due to anemia in pregnancy was preterm labour (30%). Fetal outcome in the form of an alive term, most commonly seen in mild anemia (34.7%), fetal complications like Preterm alive (11.3%), preterm intrauterine fetal death (IUFD) (2.7%) most commonly associated with severe anemia. Conclusion: The present study concludes that the prevalence of anemia among pregnant women in third trimester of pregnancy was 91.05% which is a serious public health problem. Proper counselling to the patients and their family members regarding cause of anemia, effect of anemia and complications of anemia. So, that such preventable condition can be prevented. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease-2019 (COVID-19) is prone to acute hypoxemic respiratory failure (AHRF). Because tracheal intubation is associated with a higher risk of death in these patients, AHRF employs high-flow nasal oxygen therapy (HFNOT). The goal of this study was to assess the effect of HFNOT on oxygenation status as well as different predictors of HFNOT failure. Methods: A prospective observational cohort study was conducted in COVID-positive critically ill adult patients (age >18 years) with AHRF, who were unable to maintain SpO2 >90% on a non-rebreathing face mask at an oxygen flow ≥15 L/minute. Respiratory variables (PaO2/FiO2, SpO2, and RR) before HFNOT (baseline) and then at 1 hour, 6 hours, 7th day, and 14th day after HFNOT application were recorded. Borg CR10 scale and visual analogue scale were used to evaluate the subjective sensation of dyspnea and comfort level, respectively. As needed, Student's t, Mann--Whitney U, or Wilcoxon signed-rank tests were performed. To find parameters linked to HFNOT failure, multivariate logistic regression and receiver-operating characteristic (ROC) analysis were employed. Results: A total of 114 patients were enrolled in the study, with an HFNOT failure rate of 29%. The median PaO2/FiO2 ratio at baseline (before the initiation of HFNOT) was 99.5 (80--110) which significantly increased at various time points (1 hour, 6 hours, 7th day, and 14th day) after HFNOT initiation in the successful group. Patients reported significant improvement in sensation of breathlessness [9 (8--10), 3 (2--4); p <0.001] as well as in comfort level [2 (1--2), 8 (4--9); p <0.001]. Multivariate logistic regression analysis, sequential organ failure assessment (SOFA) score >7, acute physiology and chronic health evaluation (APACHE) II score >20, admission P/F ratio <100, D-dimer >2 mg/L, IL-6 >40 pg/mL, random blood sugar (RBS) >250 mg/dL, and 6 hours ROX Index <3.5 were independent prognostic factors of HFNOT failure. Conclusion: The use of HFNOT significantly increased the oxygenation levels in COVID-19 patients with AHRF at various time periods after HFNOT beginning. Age, SOFA score, APACHE II score, ROX score, admission P/F ratio, IL-6, D-dimer, and RBS were independent prognostic factors of HFNOT failure in this cohort. [ABSTRACT FROM AUTHOR]