ABSTRACT
Angiotensin II receptor blockers (ARBs) are the antihypertensive drugs associated with side effects, majorly such ascough and electrolyte disturbance. Azilsartan is a newly marketed ARB in India, not even having a well-establishedadverse effect profile. Here, we present a 58-year-old female who was admitted to the emergency department showingsigns and symptoms of delirium, disorientation, and vomiting for 4 days. The patient is known to have coronaryartery disease so that she underwent coronary artery bypass grafting. She was recently started on azilsartan for herchronic hypertension, along with other drugs. The presence of electrolyte imbalance in laboratory reports and currentsymptoms suggested azilsartan-induced encephalopathy. The patient was recovered after discontinuation of azilsartan.This case enlightens the clinical characteristics, possible mechanism, and treatment strategy opted to correct thecondition.
ABSTRACT
Background: A caudal block is commonly performed block for postoperative analgesia pediatric surgeries. Duration can be enhanced by addition drugs like fentanyl, tramadol, clonidine midazolam etc to local anesthetics helps in decreasing the requirement of postoperative analgesics. This study was conducted to assess the analgesic efficacy of tramadol or fentanyl when mixed with bupivacaine in pediatric patients for surgeries below the umbilicus.Methods: Fifty children of ASA I and ASA status, between 2 to 12 years of age, of both sexes underwent elective surgeries below umbilicus were selected and randomly divided into groups of 25 each. One Group, T (n = 25) received 0.75 ml/kg of 0.25% bupivacaine with tramadol 1mg/ kg and other Group F (n = 25) received 0.75 ml/kg of 0.25% bupivacaine with Inj fentanyl 1μg/kg. Assessment of analgesia and any side effects after caudal injection to the first administration of analgesia were recorded for both the groups in next 24 hours following objective pain scores. Duration of analgesia and requirement of additional rescue analgesics was noted.Results: The Mean duration of analgesia recorded longer in Group T (18.26±6.1 hours) as compared to Group F (10.0+/- 2.68 hrs.) and no significant haemodynamic changes or adverse effect noted between 2 groups.Conclusions: Addition of tramadol, 1mg/kg to bupivacaine 0.25% for caudal anesthesia in children undergoing surgeries below umbilicus, enhances and prolongs postoperative analgesia compared to caudal fentanyl 1μg/kg and bupivacaine 0.25% alone.
ABSTRACT
Heart failure (HF) is responsible for 1.8 million admissions annually in India with an additional burden of mortalityand re-hospitalizations. Positive inotropes with multiple mechanisms, such as dopamine and levosimendan, are beingused for more than three decades to treat the patients of acute HF with reduced ejection fraction (HFrEF). This studycompared the outcomes of the dopamine and the levosimendan up to 180 days. We have selected the patients fromManipal Heart Failure Registry who were diagnosed to have HFrEF (left ventricular EF less than 50%) and wereinitiated on either dopamine or levosimendan in first 6 hours of hospitalization. The study included a total of 187patients; among them, 120 patients were analyzed in the dopamine group, and 67 patients in the levosimendan group.Dopamine was initiated as intravenous infusion with the dose of 2.5 microgram/kilogram/minute (mcg/kg/minute)and up-titrated up to 10 mcg/kg/minute. Levosimendan was also administered intravenously with a dose of 0.1 mcg/kg/minute and up-titrated up to 0.4 mcg/kg/minute. The primary outcomes include a composite of all-cause mortalityand re-hospitalization at 30-days and 180-days follow-ups. The in-hospital mortality, 30-days mortality and 180-daysmortality, and composite outcomes were noted higher in levosimendan treated patients even after matched demographicparameters (age and gender) and comparable comorbidities and risk factors, i.e., smoking, alcohol consumption,hypertension, diabetes mellitus, and atrial fibrillation. However, reduced EF, raised serum creatinine, procalcitonin,and N-terminal pro b-type natriuretic peptide levels and high use of digoxin were noticed in levosimendan groupduring the initial period of index-hospitalization and these can be considered as confounding factors for future studies.
ABSTRACT
The evaluation of coronary artery disease (CAD) concerning the metabolic status and body mass index (BMI) is poorlystudied. This study was designed to observe the relationship between insulin resistance (IR) and the severity of CADon the basis of the metabolic and phenotypic status in stable-angina patients. A cross-sectional study was conductedon 532 patients with stable angina and coronary angiogram was done to diagnose the CAD for all. Determination ofmetabolic obesity was done using the National Cholesterol Education Program-Adult Treatment Panel III criteria.Phenotypic obesity was defined as BMI ≥ 25 kg/m2. Homeostasis model assessment IR in correlation with the severityof CAD was measured using SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for theTreatment of Narrowed Arteries) Score. The average age of the patients was 57.58 ± 10.40 years, and 69.4% weremales. Out of 532 subjects, 51.3% were hypertensive, 14.5% were smokers, 29.1% consumed alcohol, 49.3% weremetabolically obese, and 50% were phenotypically obese. Increase in IR increased the risk of severity of CAD inmetabolically obese subjects (OR = 2.51, p = 0.048). In the phenotypically obese group, the relationship between IRand the severity of CAD was not statistically significant (OR = −2.19, p = 0.08). The study concludes that the increasedIR increases the risk of severity of CAD in metabolically obese subjects.
ABSTRACT
Background: Emissary sphenoidal foramen also named as foramen Vesalius is a rare opening found near the scaphoid fossa and located exteriorly on the base of skull, antero-medial to foramen ovale, spinosum and carotid canal whereas postero-medial to the foramen rotundum. Methods: A total 28 dry adult human skulls were observed & studied for the presence of emissary sphenoidal foramen (ESF) in the department of anatomy at Desh Bhagat Dental College & Hospital, Sri Muktsar Sahib, Punjab.Unilateral and bilateral presence of ESF were noted. Results: Total 56 sides of 28 skulls were studied and it was found that 08 ESF were observed on right side and 02 on left side with an incidence of 28.5% and 7.1% respectively. Conclusion: Present study highlights the incidence of ESF and describes its neuro-anatomic importance.
ABSTRACT
Marfan syndrome rarely presents with peripheral artery and pulmonary artery aneurysms. We are presenting a case of a fifteen-year-old boy who presented to us with progressive lower abdominal pulsatile swelling with bruit in the right inguinal region for one month. He had typical marfanoid habitus, though there was no history of similar illness in family. CT angiogram revealed the presence having giant right common iliac aneurysm along with interlobar pulmonary artery aneurysm. He had spontaneous rupture of aneurysm in right common iliac artery.
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Left femur was osteotomized and fixed with K wire in 21 rabbits. One group was fed simvastatin (120 mg/kg body wt/day) orally, whereas another group without medication served as control. Both groups were assessed radiologically, morphologically, histologically and biomechanically at 4, 8 and 12 weeks. An analysis of various parameters of study showed that simvastatin treated group had improved bone healing at 4 and 8 weeks of follow up, however, the difference was not significant statistically at 12 weeks. So it is concluded that Simvastatin favourably hastened the process of fracture healing in the rabbits at earlier phases.