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Organic amendments have emerged as a pivotal component in the trajectory of sustainable agriculture, given their multifaceted contributions to soil health, crop yield, and environmental conservation. This comprehensive review delves into the intricacies of organic amendments, spanning their historical context, types, sources, nutrient profiles, and their interplay with soil and plant health. Special emphasis is laid on the integration of modern technological advancements with traditional amendment practices, exploring the synergistic potential of digital agriculture and precision farming in enhancing the efficacy of organic inputs. The review also sheds light on the economic, social, and environmental ramifications, emphasizing the role of organic amendments in smallholder versus large-scale agricultural systems and their influence on farmer resilience and consumer perceptions. Crucially, this review addresses the challenges and limitations inherent in organic amendment practices, including concerns related to quality variation, scalability, over-application, and regulatory nuances. Concomitantly, the work culminates with a forward-looking perspective, highlighting emergent trends and innovations that portend the future of organic amendments in global agriculture. The findings underscore the significance of organic amendments not merely as soil additives but as integral elements in the blueprint for a sustainable, resilient, and food-secure future.
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Purpose: To evaluate and compare endothelial cell changes in phacoemulsification and manual small- incision cataract surgery (MSICS) in patients with uncomplicated senile cataracts. Methods: This was a prospective, tertiary care hospital-based, randomized, double-blinded interventional study. In total, 152 patients with an uncomplicated senile cataract of nuclear grade III and above were recruited. Exclusion criteria included patients with preoperative endothelial cell density (ECD) less than 1500 cells/mm3, a history of previous ocular surgery, any other coexisting ocular disease, and intraoperative or postoperative surgical complications. Preoperative and postoperative values of ECD and central corneal thickness (CCT) were measured, analyzed, and correlated with various factors. Results: Patients were randomized into two interventional groups-MSICS and phacoemulsification. Factors associated with significant drop in postoperative ECD following phacoemulsification were patients with advanced age (P = 0.01), higher grades of cataract (P = 0.01), and longer effective phacoemulsification time (P = 0.007). Shallow anterior chamber depth (ACD) was strongly associated with greater ECD loss in both groups (P < 0.0001). A threshold value of 2.86 mm of ACD was defined for minimal endothelial cell loss following phacoemulsification. CCT was observed to slightly increase postoperatively in both groups but was insignificant (P > 0.05). Conclusion: Both MSICS and phacoemulsification have similar postoperative visual outcomes. An increase in postoperative CCT is insignificant following surgery. Greater postoperative ECD loss is associated with phacoemulsification with advanced age, hard nuclear cataracts, and longer effective phacoemulsification time. ACD can be used as an essential parameter preoperatively to determine the choice of surgical technique between MSICS and phacoemulsification
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Background & objectives: An. annularis van der Wulp (1884) is the secondary malaria vector of importance in India. In Jharkhand state it is present in almost all the districts abundantly and transmits malaria. The development of resistance to Dichlorodiphenyltrichloroethane (DDT) in An. annularis was reported from various parts of India. The main objective of this study was to generate information on insecticide susceptibility status of An. annularis to DDT, malathion, deltamethrin and permethrin in different districts of Jharkhand state. Methods: Adult An. annularis female mosquitoes were collected form villages of six tribal districts Simdega (Kurdeg and Simdega CHC), Khunti (Murhu and Khunti CHCs), Gumla (Bharno and Gumla CHCs), West Singhbhum (Chaibasa and Bada Jamda CHCs), Godda (Poraiyahat and Sunderpahari (CHCs) and Sahibganj (Borio and Rajmahal CHCs). Insecticide susceptibility status was determined by using WHO tube test method against prescribed discriminatory dosages of insecticides, DDT - 4.0%, malathion - 5.0%, deltamethrin - 0.05% and permethrin - 0.75%. Results: An. annularis was reported resistant to DDT in six districts, possible resistant to malathion in districts Gumla, Khuntiand Sahibganj and susceptible to deltamehrin (98% to100% mortality) and permethrin (100% mortality). Interpretation & conclusion: An. annularis, the secondary vector species is associated with the transmission of malaria reported resistant to DDT and susceptible to pyrerthroids deltamethrin and permethrin. In view of large-scale distribution of long-lasting insecticidal nets (LLINs) in all the districts, the response to synthetic pyrethroid needs to be periodically monitored to assess the effectiveness.
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Background & objectives: The state of Himachal Pradesh is one of the hilly forested states of India. Warming of climate has been evidenced in the state due to the ongoing climate change which may cause the upsurge/introduction of mosquito-borne diseases. To curb disease transmission, an effective vector control strategy will be required. Methods: Insecticide susceptibility status of available malaria vectors was determined using the standard WHO method in six districts Kangra, Una, Mandi, Bilaspur, Solan and Mandi of the state. An. culicifacies and An. fluviatilis were tested against DDT (4%), malathion (5%) and deltamethrin (0.05%) using WHO insecticide susceptibility kits. Results: Overall, An. culicifacies was found resistant to DDT in all the six districts, susceptible to malathion in all districts except Bilaspur and Solan where it showed possible resistance. It was susceptible to deltamethrin in all the study districts. An. fluviatilis was resistant to DDT and susceptible to malathion and deltamethrin in Kangra and Una districts. Interpretation & conclusion: At present, indoor residual spraying (IRS) is not being undertaken in Himachal Pradesh. However, with the information generated through the present study, the state government can plan evidence-based IRS at least for focal spray in limited foci reporting malaria incidence.
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Background & objectives: Attractive toxic sugar baits (ATSB) is a novel tool which employs mosquito sugar feeding behaviour to kill them. The potential of ATSB against mosquito vectors has been demonstrated in limited scope around the world including Israel, some of the African countries and USA. But their efficacy against mosquito vectors of India is yet to be ascertained. Therefore, current study was planned to evaluate the efficacy of TSB (without attractant) against two important malaria vectors Anopheles culicifacies and An. stephensi along with major dengue vector Aedes aegypti. Methods: TSB solution was prepared by dissolving different concentrations of boric acid in glucose and tested against each of the mosquito species. Another experiment was done by spraying this boric acid sugar solution on to Calendula officinalis plant. It served as a sole source of mosquito feed and mortality of mosquitoes was counted after 24 hours. Results: The TSB resulted in 100% mortality of Ae. aegypti and An. stephensi at 4% concentration of boric acid while in An. culicifacies 100% mortality was achieved at 3% concentration TSB solution. TSB solution with 2% boric acid, resulted in 99.1% mortality in An. culicifacies while ~95 % mortality of An. stephensi and Ae. aegypti. When TSB solution with 2% boric acid was sprayed on plant, ~89-94% mortality was observed in both An. stephensi and An. culicifacies. Interpretation & conclusion: Based on the results, boric acid based toxic sugar bait solution could be a promising tool for vector control. Further studies are needed to find out its toxicity of TSB against non-target organisms and residual efficacy in field trials in different ecotypes.
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Background: Non-ST elevation acute coronary syndrome (NSTE-ACS) patients are complex and varied population. Primarily thrombolysis in myocardial infarction (TIMI) risk score was developed to guide therapy and assess the short term (14 days) prognosis of these patients. However, few studies have evaluated the long term prognostic significance of TIMI risk score after revascularization. This study aims at assessing the long term prognostic significance of TIMI risk score, 36 months after revascularization in NSTE-ACS.Methods: This was a retrospective observational cohort study of consecutive NSTE-ACS patients (n=150) treated by percutaneous coronary intervention between January 2017 to June 2017 in a tertiary care center. TIMI risk score was calculated for each patient at admission. The primary endpoint was a composite of MACE (death, repeat target-vessel revascularization, and non-fatal recurrent MI) at the end of 36 months of follow up. Clinical secondary endpoints included the individual components of the primary endpoint, death, nonfatal recurrent MI, and repeat target vessel revascularization.Results: Baseline characteristics for 150 participants were as follows, age 56±9.5 years, 78.7% male, 25% diabetics, 82% hypertensives, and 36% had hypercholesterolemia. The event rates of the primary endpoint and its components after 36 months were 26.6%. Event rates increased significantly as the TIMI risk score increased as determined by regression analysis (p=0.004). The relative risk increased by 66% as the TIMI risk score increased from low risk category (TIMI score 0-2) to high risk (TIMI score 5-6).Conclusions: TIMI risk score can be used for long term prognostication of NSTE-ACS patients after revascularization, and thus can be used by clinicians for therapeutic decision making.
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Percutaneous nephrolithotomy (PCNL) has gradually become a preferred method of treatment modality for kidney stones in adults as well as in paediatric patients. The primary objective of this study was to evaluate the outcomes and complications in patients having multiple and staghorn calculi and of different sizes, who underwent tubeless PCNL at a single, tertiary care hospital.METHODSA retrospective study was conducted at IGIMS, Patna from January 2017 to February 2018. Patients who underwent conventional PCNL with one or two access for single, multiple or staghorn calculus without nephrostomy tube were included in the study. Patients having solitary kidney with stones are excluded from this study. The primary outcomes of the study were haemoglobin, pain score, and duration of hospital stay.RESULTSA total of 96 patients underwent conventional PCNL with a mean age of 34 years and male:female ratio of 1.3:1. Majority of the patients had a single stone (n=54) followed by 28 patients with multiple stones. Medical comorbidities including hypertension, diabetes mellitus and chronic obstructive pulmonary disease were observed in patients of single (n=8), multiple (n=3) and staghorn (n=2) groups, respectively. Postoperative complications such as haematuria and pleural effusion were developed by the patients. Seventy-six patients were treated with single-tract and 20 by double tract PCNL.CONCLUSIONSPCNL is safe and efficient with limited post-operative complications. The number of residual stones were nil in single stone group while in multiple and staghorn groups insignificant number of renal stones was seen.
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A 48-year-old obese gentleman with mild pain over abdomen for 10 days followed by pain and swelling in the right side of scrotum with skin discolouration for 2 days. Clinically necrotic patch with pus discharge was noted on the right side of scrotum. Extensive debridement over scrotum was done following which inflamed omentum and fecal contents were noticed from the inguinal canal. Patient underwent laparotomy and an ascending colonic perforation was found. A loop colostomy with partial omentectomy and inguinal hernia repair along with serial debridement of scrotal wound was done. Although uncommon, gastrointestinal perforations should be considered as a potential etiology in Fournier’s gangrene.
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The nucleotide derivatives (p)ppGpp, comprising ppGpp and pppGpp, are important signalling molecules thatcontrol various facets of gene regulation and protein synthesis in Escherichia coli. Their synthesis is catalysedby RelA (in response to amino acid limitation) and by SpoT (in response to the limitation of carbon source orfatty acids). SpoT is also a hydrolase for degradation of both ppGpp and pppGpp, while GppA catalyses theconversion of pppGpp to ppGpp. Here we provide evidence to show that pppGpp exerts heightened toxicitycompared to that by ppGpp. Thus, gppA spoT double mutants exhibited lethality under conditions in which thesingle mutants were viable. The extent of RelA-catalysed (p)ppGpp accumulation in the gppA spoT strain wassubstantially greater than that in its isogenic gppA? derivative. The data is interpreted in terms of a model inwhich toxicity of pppGpp in the gppA spoT mutants is mediated by its activation of RelA so as to result in avicious cycle of (p)ppGpp synthesis.
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Background: High blood pressure is one of the most importantrisk factor for cardiovascular disease. CVD are the number onecause of death globally. The present study was conducted toassess the correlation between Anthropometric parametersand Cardiovascular reactivity in normotensive students.Materials and Methods: This cross-sectional study wasconducted among 100 MBBS students in the age group of 19to 22 years at KD Medical College, Hospital and ResearchCentre, Mathura subjects over the period of 2 months wereselected for the study. The subject will be asked to had a lightbreakfast then in the sitting position we will take theCardiovascular parameters and Anthropometric data of thesubject. This study will be significant if the calculated ‘p’ valueis < 0.5. Data was analyzed using SPSS version 20.Correlation between Cardiovascular Reactivity andAnthropometric parameters will be accessed by Pearson’sCorrelation method.Results: In the present study the mean age of the subjectswas 21 years, mean height was 1.65, mean weight was 67.24kg and mean BMI was 23.37. P value found to be statisticallynon-significant for BMI and heart rate, BMI and DBP, BMI andTransit time, BMI and Velocity. And P value found to bestatistically significant for BMI and SBP, BMI and MAP.Conclusion: Our findings in the study showed the existingpositive correlation between the BMI and the various reactivitymeasures of the heart such as heart rate, systolic bloodpressure, diastolic blood pressure, mean arterial pressure,pulse transit time and pulse velocity.
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Background: Students usually prefer to play games on theirmobile phones to avoid stress which is a major cause of CVDnowadays. CVR to stress can be assessed throughcardiovascular parameters such as blood pressure, heart rateand pulse transit time. The present study was conducted tocompare the Cardiovascular Reactivity (Heart rate, bloodpressure, pulse transit time) before, during and after playingmobile games and to compare cardiovascular parameters onthe 1st day and last day of study.Materials and Methods: This cross-sectional study wasconducted among 100 MBBS students in the age group of 19to 22 years at KD Medical College, Hospital and ResearchCentre, Mathura. Subjects over the period of 2 months wereselected for the study. The subjects were asked to have a lightbreakfast. Then in the sitting position; cardiovascularparameters and anthropometric data of the subjects weretaken 10 minutes before the game. All the rules of(CRASHLAND) mobile game were explained to the subjectsbefore letting him/her to start the game. After taking theseparameters the subject were asked to play the mobile game for30 minutes. Then the game was withdrawal and within 10minutes of interval; all these parameters were taken again. Ifany discomfort was reported by the subject then he/she wasexcluded from this study. Data was analyzed using SPSSversion 20. Variation of Cardiovascular Reactivity before,during and after playing mobile games were accessed byRepeated Measure ANOVA. Comparison of cardiovascularparameters on the 1st day and last day of study of a subjectwas accessed by Paired “t” Test.Results: A positive correlation was found between the BMIand various CVR parameters such as heart rate, SBP, DBP,MAP, pulse transit time, pulse wave velocity during and afterplaying the game. Repeated measure ANOVA analysed thatthere was no significant increase in pulse wave velocity of thesubject before, during and after playing mobile game. One wayANOVA analysed that there was significant increase in SBPand DBP of the subject, suggesting increased stressassociated with playing mobile games.Conclusion: Our study concluded that a positive correlationwas found between the BMI and various CVR parameters suchas heart rate, SBP, DBP, MAP, pulse transit time, pulse wavevelocity during and after playing the game.
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MRSA is a major nosocomial pathogen. It causes severe morbidity and mortality all over the world. MRSA strains are prevalent around the world. In India it is responsible for 25%–50%. Methods: The study included 379 samples from various critical care units. The study was conducted in the Department of Microbiology at Prasad Institute Of Medical Sciences, Lucknow. The duration of study was over a period of three months. Results: In our study, we found that out of total 379 samples ,200 were isolated as Staphylococcus aureus . The prevalence of MRSA cases in ICU was 10.2%. Conclusion: MRSA is an important pathogen for nosocomial infections so studying prevalence of this pathogen in various clinical samples and screening for MRSA colonization in health care workers will help in hospital infection control practices
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Enterotoxigenic Staphylococcus aureus can be isolated from various sources and are responsible for food poisoning in addition to many suppurative infections. In the present study, from 82 physically normal milk samples from cattle subclinical mastitis 33(40.24%) were isolated to S. aureus. Out of these, 22 (66.66%) S. aureus isolates had either one or more enterotoxin genes. Both seg and sei enterotoxin genes were carried by 19 (57.5%) S.aureus isolates while only three (9.09%) isolates were positive for seh gene. This study showed the evidence of presence of enterotoxin genes seg, seh, and sei in S. aureus isolates from subclinical mastitis. The presence of these enterotoxigenic S. aureus strains in milk indicates potential public health concern
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Introduction: Regional anaesthesia is seldom used forclavicle fractures considering the anatomical location of thebone. We aim to compare the efficacy of two techniques ofregional anaesthesia as sole anaesthesia technique for fixationsof clavicular fractures.Material and methods: 60 Adult patients with claviclefractures were divided randomly in two groups (1 and 2) andwere administered interscalene block (ISB) only or interscaleneblock and superficial cervical plexus block(ISB+SCPB) assole anaesthetic, respectively. Patients were monitored forefficacy of block and adequacy of anaesthesia and analgesiaat the surgical site. Side effects and hemodynamic parameterswere also monitored.Results:. ISB+SCPB provides excellent anaesthesia forclavicle fixation. Only 1 patient in group 2 required GeneralAnaesthesia(GA) whereas in Group 1, 8 patients required someform of supplemental anaesthesia. There was no statisticallysignificant difference in side-effects and hemodynamic profilein both the groups.Conclusion: ISB+SCPB is significantly better than ISB onlyfor anaesthesia for fixation of clavicular surgeries.
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Introduction: Urinary tract infections (UTIs) are morecommon in geriatrics due to physiological alterations/pathological conditions. The main objective of this studywas to analyze the prevalence, causative organisms, types ofantimicrobials used, drug interactions and its outcome.Material and methods:- This study was conducted in thedepartment of Microbiology in TSM Medical College. 106total numbers of cases were involved in this study. Each wasbelong to elderly group. The duration of study was conductedover a period of six month. Early Morning clean catchmid-stream urine were collected and sent to Microbiologylaboratory for culture and sensitivity.Results: In this study, 65.3% of gram positive bacteria, 28.5%of gram negative bacteria and 2.8% fungus were isolated. E.coli and Enterococcus were most prevalent gram positivebacteria and gram negative bacteria respectively.Conclusion: About one-fourth patients have UTIs and halfof them were affected by E. coli. Urinary tract infections aremainly caused by Gram negative bacteria mainly Escherichiacoli followed by Gram positive bacteria. UTI can beminimized by proper use of antimicrobial agents and healthhygiene.
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Soul is an eternal, noble and everlasting presence of energy in human body, represents bestcreation of nature. The combination of five dhatus (Air, Water, Earth, Agni, Akasha) with Soul is called‘Shad Dhatu’ purusha. When the Soul leaves the body, all biological and physiological activities are notfunctional and body declared as dead body. The sharira (body), indriya (sense organs), Mann (mind),and Soul (atma) are connected together in the living human body, this is called as Ayu (life). Mann,Soul, and Sharira are just like the tri-unity. The world is self-sustained by their combination and theyconstitute the sol stratum for physical, mental, psychological activities along with spiritual knowledgegrowth in human life. The soul is non-physical and non-materials. Science does all experiments forconfirming and understanding the events and action. This initiate an effort to provide and develop aconcept to hypothesize this relationship among Soul, Mann and body. They all are connected togetherand cannot be separated till death. The separation mechanism is not clearly understood for theirinternal survival in the human body and even after death also. We never find any kind of method,techniques and technology to identify soul and mann individually in the living body even after death.The whole body functions and their operational mechanism have been witnessed by the soul. It is akind of a divine battery that never exhausts its power or capacity during individual life and re-birth ascompared to manmade battery which loses its strength with time in working of instruments/devices.The battery has to be replaced in order to make the device in working condition. We hope that presentstudy will provide the scientific basis in understanding the embedded relationship of soul, mann in thefunctioning of human and body.
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Introduction: Ban on gutka/smokeless tobacco (SLT) in India beginning in 2011 raised apprehension of its users switching to smoking and thereby increased second-hand smoke (SHS) exposure to non-users. Delhi Government issued notification banning gutka and pan-masala containing tobacco and/or nicotine in 2012. To address circumvention of ban by SLT manufacturers, ban was revised and reissued in 2015 to explicitly ban all SLT products. Objectives: To assess change in second hand smoke (SHS) exposure in Delhi three years after gutka ban and one year after explicit ban on all SLT products. Method: Cross-sectional household survey was conducted in Delhi during March-December 2016 to assess SHS exposure at home, workplace and public places. Males aged 15 years and above living in urban Delhi were asked questions similar to Global Adult Tobacco Survey (GATS)-India, 2010. Survey data were compared with 2010 records to assess change in SHS exposure between 2010 and 2016. Results: As compared to 2010, 12.0% less non-smokers reported SHS exposure at home. Among those working outside home, 13.7% non-smokers reported SHS exposure at indoor workplace as compared to 19.3% in 2010. Less educated people are more likely to face SHS exposure at work. Chance of exposure at any public place during last one month has also decreased by 6.5%. Conclusion : Probability of coming across SHS exposure has decreased in urban Delhi at all places in 2016 as compared to 2010. Efforts to enforce SLT ban must sustain without fear of increase in SHS exposure.
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It is an acute phase protein, which rises due to inflammation, infection and injury. It is synthesized by liver in response to IL-6 secreted by activated macrophages and T cells in acute and chronic inflammatory conditions. Changes in serum CRP concentration occur more quickly than ESR and therefore CRP may be a better reflection of current inflammation. Methods: Blood was collected by vene-puncture from the patients and separated sera were obtained from individuals elderly as well as young person’s were tested by quantitative & qualitative method. Results: In our study, two groups were included in this study, i.e. elderly group & young group.108 & 40 total cases were included in elderly group & young group respectively. In the elderly group out of 108 cases 35.2% were positive rest were negative for C - reactive protein as well as in young group 35% positive & 65% were negative found in the present study. Conclusion: In cases of joint pains CRP tests can give a better picture before going for higher and more expensive investigations.
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Objective: To prospectively assess safety outcome of TRUS guided prostate biopsy in patients taking low dose aspirin. Materials and methods: Consecutive patients, who were planned for 12 core TRUS guided prostate biopsy and satisfied eligibility criteria, were included in the study and divided into two Groups: Group A: patients on aspirin during biopsy, Group B: patients not on aspirin during biopsy, including patients in whom aspirin was stopped prior to the biopsy. Parameters included for statistical analysis were: age, serum prostate specific antigen (PSA), prostate volume, hemoglobin (Hb %), number of hematuria episodes, number of patient reporting hematuria, hematuria requiring intervention, number of patient reporting hematospermia and number of patient reporting rectal bleeding. Results: Of 681 eligible patients, Group A and B had 191 and 490 patients respectively. The mean age, prostate volume, serum PSA and pre-biopsy hemoglobin were similar in both Groups with no significant differences noted between them. None of the post-biopsy complications, including number of hematuria episodes (p=0.83), number of patients reporting hematuria (p=0.55), number of patients reporting hematospermia (p=0.36) and number of patients reporting rectal bleeding (p=0.65), were significantly different between Groups A and B respectively. None of the hemorrhagic complication in either group required intervention and were self limiting. Conclusion: Continuing low dose aspirin during TRUS guided prostate biopsy neither alters the minor bleeding episodes nor causes major bleeding complication. So, discontinuation of low dose aspirin prior to TRUS guided prostate biopsy is not required.
Sujet(s)
Sujet âgé , Humains , Mâle , Adulte d'âge moyen , Acide acétylsalicylique/administration et posologie , Biopsie au trocart/méthodes , Hémorragie/prévention et contrôle , Antiagrégants plaquettaires/administration et posologie , Prostate/anatomopathologie , Échographie interventionnelle/méthodes , Biopsie au trocart/effets indésirables , Hémorragie/étiologie , Numération des plaquettes , Études prospectives , Complications postopératoires/étiologie , Complications postopératoires/prévention et contrôle , Antigène spécifique de la prostate/sang , Tumeurs de la prostate/anatomopathologie , Reproductibilité des résultats , Facteurs de risque , Rectum , Échographie interventionnelle/effets indésirablesRÉSUMÉ
Background: Pulmonary hypertension (PHT), if present, can be a significant cause of increased morbidity and mortality in children undergoing surgery for congenital heart diseases (CHD). Various techniques and drugs have been used perioperatively to alleviate the effects of PHT. Intravenous (IV) sildenafil is one of them and not many studies validate its clinical use. Aims and Objectives: To compare perioperative PaO2 – FiO2 ratio peak filling rate (PFR), systolic pulmonary artery pressure (PAP) – systolic aortic pressure (AoP) ratio, extubation time, and Intensive Care Unit (ICU) stay between two groups of children when one of them is administered IV sildenafil perioperatively during surgery for CHDs. Materials and Methods: Patients with ventricular septal defects and proven PHT, <14 years of age, all American Society of Anesthesiologists physical status III, undergoing cardiac surgery, were enrolled into two groups – Group S (IV sildenafil) and Group C (control) – over a period of 14 months, starting from October 2013. Independent t‑test and Mann–Whitney U‑test were used to compare the various parameters between two groups. Results: PFR was higher throughout, perioperatively, in Group S. PAP/AoP was 0.3 and 0.4 in Group S and Group C, respectively. In Group S, mean group extubation time was 7 ± 7.34 h, whereas in Group C it was 22.1 ± 10.6. Postoperative ICU stay in Group S and Group C were 42.3 ± 8.8 h and 64.4 ± 15.9 h, respectively. Conclusion: IV sildenafil, when used perioperatively, in children with CHD having PHT undergoing corrective surgery, improves not only PaO2 – FiO2 ratio and PAP – AoP ratio but also reduces extubation time and postoperative ICU stay.