Clinical utility of ultrasonography, pulse oximetry and arterial line derived hemodynamic parameters for predicting post-induction hypotension in patients undergoing elective craniotomy for excision of brain tumors - A prospective observational study.

Background: Hypotension, which is a common adverse effect of induction of anesthesia, may be especially detrimental in neurosurgical patients. Hence, it is important to investigate hemodynamic parameters which may be useful in identifying patients at risk of hypotension, following induction. Our study was designed to assess the utility of parameters derived from ultrasonography, pulse oximeter and arterial line for predicting post-induction hypotension. Methods: The study was designed as a prospective, observational trial. Written informed consent was obtained from 100 American Society of Anesthesiologists (ASA) 1 and 2 patients, between 18-60 years of age, scheduled for elective craniotomy for brain tumors. Arterial cannula was inserted before induction of anesthesia and connected to Vigileo cardiac output monitor. Baseline stroke volume variation (SVV), stroke volume (SV), cardiac index (Ci), cardiac output (CO) and pulse pressure variation (PPV) were recorded. Plethysmography variability index (PVI) and perfusion index (PI) were obtained from the Masimo rainbow SET® Radical-7® pulse oximeter. Ultrasonographic assessment of the inferior vena cava (IVC) was performed before induction of anesthesia and again within 15 min after induction. Maximum and minimum IVC diameters (dIVCmax and dIVCmin) and collapsibility index (CI) were measured. All the other aforementioned parameters were recorded every minute starting at induction, until the 15th minute following induction. Results: PI, CI and dIVCmax were found to have the largest AUCROC for the prediction of post-induction hypotension (AUCROC 0.852, 0.823 and 0.781 respectively). Multiple logistic regression analysis revealed CI to be the most significant independent factor for the prediction of post-induction hypotension. Conclusion: Non-invasively derived hemodynamic parameters like dIVCmax, CI and PI were more accurate for the prediction of post-induction hypotension, compared to invasively derived parameters.

Correlation of Antenatal Ultrasound Parameters with the Postnatal Outcome of Bilateral Fetal Hydronephrosis.

AIM: To determine the role of antenatal parameters in predicting the outcome of bilateral fetal hydronephrosis. METHODOLOGY: Total 50 antenatal women with bilateral antenatal fetal hydronephrosis (ANH) were included. On ultrasound, amount of liquor, kidney size, pelvic anteroposterior diameter, degree of caliectasis, bladder size, and thickness were observed at 28 and 32 weeks of gestation. For 3 months post-delivery, the babies were evaluated in terms of ultrasound renal parameters, serum creatinine levels, and need for surgery. RESULTS: The mean gestational age at delivery was 37.4 ± 1.7. All babies were alive at birth, 48 were alive after 3 months. Surgery was done in 10/50 cases; cystoscopic fulguration was the most common procedure. There was a resolution of bilateral ANH in 27/50 cases, in 5/50 cases there was pylectasis with normal serum creatinine, and in 18/50 cases there was adverse outcome. Most of the parameters had better sensitivity and specificity at 32 weeks than at 28 weeks. At 32-week gestation, the renal pylectasis between 10 and 15 mm had the highest sensitivity (88.9%), and the presence of caliectasis had the highest specificity (90.6%) for adverse outcome. CONCLUSION: Resolution of hydronephrosis took place in the majority of cases, and there was an adverse outcome in only one-third of them. Renal caliectasis was the best marker for the prediction of adverse outcome.

Prevalence of Anaemia and Its Associated Risk Factors Among Adolescent Girls of Central Kerala.

INTRODUCTION: Adolescent age group is the window of opportunity to correct nutritional status of children. If we intervene correctly during this period we can prevent future consequences of nutritional deficiencies. Very few studies have been conducted in kerala regarding adolescent anaemia. AIM: To estimate prevalence of anaemia and its associated factors among adolescent girls of central Kerala, India. MATERIALS AND METHODS: A cross-sectional study was conducted among 257 adolescent girls of ettumanoor panchayat, the field practice area of Government Medical College, Kottayam. A pre-designed and pre-tested proforma was used to obtain data regarding socio-demographic details and factors associated with anaemia. Relevant clinical examination of participants were done. Blood samples were analysed using an auto-analyser and stool examination for ova or cyst was done under microscopy. Diagnosis of anaemia was established when haemoglobin was less than 12gm/dl. Data analysis was done using SPSS 16.0. Association between Categorical variables were tested with Chi-square test and continuous variables independent t-test was used. Logistic regression was used to find out independent risk factors. The level of significance was fixed at p-value of < 0.05. RESULTS: The prevalence of anaemia was 21%. Risk factors associated with anaemia in the univariate analysis were presence of ova or cyst in stool (p = 0.003, OR = 2.94) and number of pads per day during menstruation (p = 0.004). Protective factors were hand washing after toileting (p = 0.021, OR = 0.311), hand washing before food intake (p = 0.026, OR = 0.5), foot wear usage (p = 0.022, OR = 0.25) and jaggery consumption (0.042). The factors which were significant in logistic regression were worm infestation, number of pads per day, washing hands before food intake and foot wear usage. CONCLUSION: Worm infestation and number of pads per day during menstruation were found to be risk factors for anaemia. Personal hygiene practices like hand washing and foot wear usage were found to be protective factors.