Intraoperative thoracic interfascial plane block with levobupivacaine versus levobupivacaine with dexmedetomidine for postoperative analgesia after modified radical mastectomy: A randomised controlled double-blinded trial.

Background and Aims: Nearly half of the patients following breast cancer surgery experience postoperative pain. The interfascial plane for the pectoral nerve (PECS) block, along with dexmedetomidine, can alleviate this pain. Methods: After institutional ethics committee clearance and written informed consent, this randomised, double-blind study was conducted on 60, 18-60 years female patients, who were scheduled for modified radical mastectomy (MRM) under general anaesthesia. Patients were randomised into Group L (20 ml of 0.25% levobupivacaine) and Group DL (20 ml of 0.25% levobupivacaine with 0.5 µg/kg of dexmedetomidine). After resection of the tumour and securing haemostasis, under strict aseptic precaution, 10 ml of the study drug was injected under direct vision between the pectoralis major and pectoralis minor and 10 ml between pectoralis minor and serratus anterior muscles by the operating surgeon (direct PECS block). The primary outcome was to compare the duration of analgesia. Normally distributed variables were compared using Student's t-test, and non-normally distributed variables were compared using the Mann-Whitney U-test. Qualitative data were analysed using Chi-square/Fisher's exact test. Statistical significance was kept at P < 0.05. Results: The median time of the first analgesic requirement was 8 [inter-quartile range (IQR): 6-8] h in Group L and 18 (IQR: 16-20) h in Group DL (W = 17.000, P < 0.001). The mean total opioid consumption of Group L was 12.53 [standard deviation (SD): 2.29] mg in the first 24 h and 6.93 (SD: 1.89) mg in Group DL. Conclusion: Adding 0.5 µg/kg dexmedetomidine to 20 ml of levobupivacaine enhances the duration of analgesia of direct PECS block in patients undergoing MRM.

Health care needs and barriers to care among the transgender population: a study from western Rajasthan.

BACKGROUND: Transgender people comprise an estimated 0.3-0.5% (25 million) of the global population. The public health agenda focuses on understanding and improving the health and well-being of gender minorities. Transgender (TG) persons often have complex healthcare needs and suffer significant health disparities in multiple arenas. The international literature suggests that this community is at a higher risk of depression, and other mental health problems, including HIV. Many transgender people experience gender dysphoria and seek specific medical needs such as sex reassignment surgeries, implants, hormonal therapies, etc., but are unable to access these services due to financial or social reasons. The objective of this study was to assess the healthcare needs and associated barriers experienced by transgender people in Western Rajasthan. METHODOLOGY: A qualitative study was carried out in which multilevel stakeholder interviews were conducted using interview and focus group discussion guides. Data was analyzed using the qualitative thematic analysis technique. RESULTS: Findings reveal that transgender people have expressed their need to access health services for general health needs, including but not limited to mental health, non-communicable diseases, and infectious diseases. Barriers to healthcare services were identified on 3 levels: health system, social and personal. Health system barriers include policy, accessibility, affordability, and acceptability issues. Social factors such as inadequate housing, education, and job opportunities also play an important role in affecting the individual's health-seeking behavior. The knowledge of healthcare providers in this context was also limited in context of health insurance schemes, package of services available for transgenders and the importance of gender sensitive healthcare. CONCLUSION: Transgender people expressed the need for mental health services, programs targeting nutritional improvement, gender-affirmation procedures besides regular screening of non-communicable diseases as operational for males and females. Levels of barriers have been identified at various levels ranging from absence of targeted policies to individual behavior.

Innovative cascade reaction for 2H-indazole derivative synthesis.

In the realm of synthetic organic chemistry, by using a one-pot sequential combination of MCR, it is possible to manufacture chemical commodities (fine chemicals, agrochemicals, and pharmaceutical substances) that enhance our quality of life while generating less waste materials and increasing economic advantages. With this motivation, using a "one-pot" method with multiple components, we present a relatively simple way to make stereoselective substitute 2H-indazole analogues for this study. Firstly, functionalised 3-bromo-4-((methylthio)methyl) derivatives were produced using DMSO as both a carbon source and a solvent, in conjunction with TMSOTf as the Lewis acid promoter. These derivatives were then utilised in the synthesis of 2-H-indazole derivatives with an up to 80% yield using t-Bu3PHBF4 as the ligand and Cs2CO3 as the base, in the presence of a Pd catalyst at 100°C in an airtight tube. The phenyl ring is endowed with an electron-releasing group situated at position C-6, which efficiently synthesises several 2-H-indazol derivatives with cost-efficient and noteworthy yields by using this method. A comparative analysis of a number of halogen derivatives was also undertaken, using a variety of solvents that were classified according to their halogen group. To confirm the structures of the synthesised target compounds, spectrometric analysis (1H NMR, 13C NMR, and LCMS) was performed.

Bispectral index-guided comparison of dexmedetomidine and fentanyl as an adjuvant with propofol to achieve an adequate depth for endotracheal intubation - A double-blind randomised controlled trial.

Background and Aims: Laryngoscopy and tracheal intubation require an adequate depth of anaesthesia. The study's primary objective was to compare the time needed to achieve the bispectral index (BIS)-guided adequate depth of anaesthesia for endotracheal intubation using fentanyl and dexmedetomidine. Methods: After institutional ethics committee clearance and written informed consent, this randomised study was conducted on 140 patients of either gender between 18 and 60 years who were scheduled for elective surgeries under general anaesthesia. Patients were randomised to intravenous dexmedetomidine 1 µg/kg (Group D) or fentanyl 2 µg/kg (Group F). The drugs were given as an intravenous infusion over 10 min before induction of anaesthesia. The primary outcome was the time required to achieve BIS 50. Normally distributed variables were compared using Student's t-test, and non-normally distributed variables were compared using the Mann-Whitney U test. Qualitative data were analysed using Chi-square/Fisher's exact test. A P value <0.05 was considered significant. Results: The time to achieve BIS 50 was lesser in Group F, 1546 (27) as compared to Group D, 1558 (11) s [mean difference (95% confidence interval (CI) 12[5.11, 18.89]), P < 0.001]. Haemodynamic parameters were comparable at all time points between both the groups, except heart rate, which was significantly lower. Propofol consumption was significantly less in group D than in group F [125.9 (25.36) versus 157.3 (42.80) mg, respectively, mean difference (95% CI) 31.4 (-44.16 to -20.63) P < 0.001)]. Conclusion: Dexmedetomidine achieves BIS 50 faster and has a propofol-sparing effect as compared to fentanyl.

A Cross-Sectional Survey to Assess the Preparedness of Healthcare Workers of Isolation Intensive Care Units for Anticipated Another Wave of the COVID-19 Pandemic in a Tertiary Care Center.

BACKGROUND: Our fight against coronavirus disease 2019 (COVID-19) has not ended yet. Another wave, possibly due to another variant, can put the healthcare system on its toes again. The outcome of the intensive care unit (ICU) depends on the teamwork of doctors, nursing staff, and care assistants (CAs). AIM: This survey was conducted to assess the level of preparedness of healthcare workers (HCWs) in isolation ICUs by recording and calculating the score of their responses, using a validated pre-formed questionnaire. METHODS: A cross-sectional survey was conducted on 200 HCWs in isolation ICUs by using a pre-validated questionnaire form as an assessment tool. HCWs in isolation ICUs included doctors, nurses, and CAs who have worked in ICUs dedicated to COVID-19 patients. The response was documented and scores as per the response were assessed by analog scale. RESULTS: Most of the HCWs were anxious (53%) and 96.5% were either bothered or scared. HCWs with adequate knowledge have higher generalized anxiety disorder scores (χ2 = 15.287, p = 0.015). Despite having adequate/average knowledge, most of the HCWs have insufficient knowledge of the correct steps of donning and doffing. CONCLUSION: HCWs were aware of the COVID-19 pandemic but were not prepared for the anticipated second wave.

Advancing the one health approach through integration of Ayush systems: Opportunities and way forward.

The Ayush systems in India, specifically Ayurveda, have a large pool of infrastructure, human resources, and unique modalities for disease prevention, wellness, and management. These systems have seen significant growth in recent years, with the budget allocation for the Ayush Ministry increasing fourfold from INR 691 crore to INR 3050 crore over the last seven years. The Ayush systems can contribute significantly to the One Health approach, which addresses the interconnectedness of human, animal, and environmental health. The current commentary explores the areas of work related to the One Health approach, the potential role of the Ayush system in addressing these existing policies that support the integration of Ayush in the One Health approach, and future perspectives on the role of Ayush in One Health. Ayush systems advocate preventive measures, such as daily and seasonal regimens and the use of rejuvenating herbs and drugs, as well as therapeutic interventions for a range of health issues. Ayurveda also addresses environmental, animal, and plant health issues and promotes the creation of a healthy ecosystem between humans, animals, and the environment. In addition, Ayush can play a role in addressing zoonotic diseases, noncommunicable diseases, antimicrobial resistance, food safety and health of the elderly, children, and environment. To fully utilize the potential of Ayush in the One Health approach, these systems should be integrated into the healthcare infrastructure and network. Furthermore, initiation of collaborative projects, focused research, training and sensitization of Ayush human resources, and promotion of Ayush-based lifestyles and practices are some of the critical steps required to be taken.

A Randomized Double-Blind Comparative Study of the Intubating Conditions and Hemodynamic Effects of Rocuronium and Succinylcholine in Pediatric Patients.

BACKGROUND: The incidence of unanticipated difficult airways is higher in pediatric age groups than in adults due to the different airway anatomy, difficulty in airway examination, and congenital malformations. Rocuronium bromide has a comparable onset time to succinylcholine at its proportionate dose. Hence, we compared rocuronium bromide with succinylcholine to assess intubating conditions and their side effects, if any. METHOD: A total of 200 pediatric patients of American Society of Anesthesiologists (ASA) grades I and II between one and 14 years of age of either sex posted for elective surgery were included in the study. After randomization, group R (n = 100) received 1.2 mg/kg rocuronium, and group S (n = 100) received 2 mg/kg succinylcholine intravenously. After confirming the mask ventilation, the study drugs were administered, and intubating conditions were assessed as excellent, good, poor, or impossible. Hemodynamic changes post-intubation were recorded as our secondary outcome. RESULT: Intubating conditions were excellent( 65%), good( 25%) and fair (10%) in patients of group R, while results in group S were excellent( 60%), good( 20%), fair (15%), and poor (5%) (p = 0.010). The heart rate was significantly increased post-intubation in group S, while there was no significant increase in systolic or diastolic blood pressure in either group. CONCLUSION: At a dose of 1.2 mg/kg body weight, rocuronium was a better alternative to succinylcholine for providing rapid intubating conditions and stable hemodynamics without associated adverse effects.

Comparative Study of Intranasal Dexmedetomidine Versus Intranasal Ketamine as Premedicant in Children.

BACKGROUND:  Pre-operative anxiety in children not only makes induction difficult but it is also associated with an increase in the requirement of analgesics, the incidence of post-operative nausea and vomiting (PONV), emergence delirium (ED), and postoperative maladaptive behavioral changes. It can be reduced effectively by pharmacological interventions. In a quest to find the ideal premedicant and non-invasive way of its administration, we decided to compare intranasal (IN) dexmedetomidine with IN ketamine as a premedicant in pediatric patients. AIMS AND OBJECTIVES:  To compare sedation score, mask acceptance score (MAS) during induction, the incidence of ED, and other adverse events in both groups. MATERIAL AND METHODS:  Some 60 children, between 1 and 8 years of age of either sex undergoing surgical procedures were included in this study and randomly divided into two groups (Group D and Group K). Thirty minutes prior to induction of anesthesia, patients of Group D received dexmedetomidine 1 mcg kg-1 in 1 mL of 0.9% saline intranasally and patients of Group K received ketamine 5 mg kg-1 in 1 mL of 0.9% saline intranasally through calibrated dropper (0.5 mL in each nostril) in a recumbent position. Incidences of sneezing or coughing after IN administration of study drugs were recorded. The subsequent sedation scores were assessed using MOASS at 15 min, then at 30 min following premedication at the time of parental separation. After shifting patients to operation theater inhalation induction was done. MAS at induction and any adverse effects were recorded. RESULTS:  Children in Group K were found to be significantly more sedated at 30 min after administration of premedication and mask acceptance was also better (p value < 0.0001 with a confidence interval, CI=95%). But the incidence of ED and PONV was high. CONCLUSION:  Intranasal dexmedetomidine (1 mcg kg-1) is clinically less effective as a premedicant in terms of sedation and mask acceptance in older children as compared to ketamine (5 mg kg-1), but associated with fewer incidence of ED and PONV. We recommend the usage of IN dexmedetomidine in a higher dose (1.5-2 mcg kg-1), through nebulization/atomizer for the desired level of sedation and mask acceptance.