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Byline: Jyoti. Sharma, Ajay. Goila, Rajesh. Sood Sir, Recently, during lumbar subarachnoid block with bupivacaine (heavy), we experienced problems such as delayed onset, early regression and patchy block. As clinicians [...]

Byline: Rakesh. Garg, Ajay. Goila, Mridula. Pawar Sir, The episodes of haemodynamic disturbances may lead to activation of various protective physiological reflexes. Clinical occurrences of Bezold-Jarisch reflex (BJR) is not [...]

Byline: Nishkarsh. Gupta, Sarbjot. Kaur, Ajay. Goila, Mridula. Pawar We describe for the first time, the perioperative care of a patient with a rare combination of Eisenmenger syndrome with ß-thalassemia [...]

Byline: Ajay. Goila, Mridula. Pawar Physicians, health care workers, members of the clergy, and laypeople throughout the world have accepted fully that a person is dead when his or her [...]

Background: The diagnosis of ventilator-associated pneumonia (VAP) is a challenge because the clinical signs and symptoms lack both sensitivity and specificity. Further confirmation of the diagnosis of VAP can be done by other diagnostic procedures such as bronchoscopic and blind endotracheal aspiration, but the selection of either diagnostic procedure is debatable. Aims: The aim is to study and compare the role of bronchoscopic protected specimen brush biopsy (PSBB) and blind endotracheal aspiration for diagnosis of VAP. Settings and Design: This prospective comparative study was conducted in multidisciplinary Intensive Care Unit of a tertiary care hospital. Materials and Methods: Thirty patients clinically diagnosed to have VAP were further evaluated by bronchoscopic and blind endotracheal aspiration. The P value of PSBB and blind aspiration techniques was calculated, taking clinical pulmonary infection score of ≥6 as reference standard. Statistical Analysis Used: Statistical analysis was done using Chi-square and t-test. Results and Conclusions: Our study shows that for the diagnosis of VAP, PSBB and blind aspiration had Chi-square value of 0.83 with degree of freedom 1 which showed P = 0.3623 which is not significant. t-test value is 0.402 with degree of freedom 1 and P = 0.7567 which is still not significant. There was a good microbiologic concordance among bronchoscopic and nonbronchoscopic distal airway sampling techniques. Blind endotracheal aspiration is a comparable technique for bacteriological diagnosis of VAP. [ABSTRACT FROM AUTHOR]

Leptospirosis is a rare infection in pregnancy and is often misdiagnosed and underreported. Liver disease specific to pregnancy include intrahepatic cholestasis of pregnancy, HELLP syndrome, and acute fatty liver of pregnancy. Multivisceral organ failure related to leptospirosis in pregnant patient. [Extracted from the article]

We describe for the first time, the perioperative care of a patient with a rare combination of Eisenmenger syndrome with β-thalassemia major presenting for splenectomy. Patients with Eisenmenger syndrome have polycythemia because of chronic hypoxia but our patient was anaemic and had thrombocytopenia because of thalassemia major. The management of such a case can be challenging for any anaesthesiologist because of severe V/Q mismatch (high shunt fraction and restrictive lung disease because of hypersplenism), decreased oxygen carrying capacity (anaemia) and increased risk of haemorrhage (thrombocytopenia), along with the potential increase in intracardiac shunt during anaesthesia. [ABSTRACT FROM AUTHOR]