Intraarterial papaverine for relief of catheter-induced peripheral arterial vasospasm during pediatric cardiac surgery: A randomized double-blind controlled trial.

BACKGROUND: Maintaining the patency of peripheral arterial lines in pediatric patients during surgery can be challenging due to multiple factors, and catheter-related arterial vasospasm is a potentially modifiable cause. Papaverine, a potent vasodilator, improves arterial line patency when used as a continuous infusion in the pediatric intensive care setting, but this method is not convenient during surgery. AIM: Extrapolating from the benefit seen in the intensive care unit, the authors hypothesize that a small-volume intraarterial bolus of papaverine immediately after arterial line placement will reduce vasospasm-related arterial line malfunction. METHODS: This was a prospective, randomized, double-blind study. Patients less than 17 years of age undergoing cardiac surgery were enrolled. Patients were randomized into the heparin or papaverine groups. Immediately after arterial line insertion, an intraarterial bolus of heparin (2 units/ml, 1 ml) or papaverine (0.12 mg/ml, 1 ml) was administered (T1, Figure 1). An optimal waveform was defined as the ease of aspirating a standardized blood sample within 30 s, absence of cavitation when sampling, absence of color change at the catheter site during injection, and presence of a dicrotic notch. The primary outcome evaluated was the presence of an optimal arterial waveform at 5 min after the first randomized dose (T1 + 5 min). The secondary outcomes were the presence of optimal arterial waveform an hour after the first dose and the ability of papaverine to rescue suboptimal waveforms. RESULTS: A total of 100 patients were enrolled in the study. Twelve patients were excluded from the analysis. Complete datasets after randomization were available in 88 patients (heparin group, n = 46; papaverine group, n = 42). At baseline, groups were similar for age, weight, arterial vessel size, and arterial line patency. At T1 + 5 min, an improvement in the waveform characteristics was observed in the papaverine group (heparin,39% [8/46] vs. papaverine, 64% [27/42]; p = .02; odds ratio, 2.8; 95% CI, 1.2 to 6.6, Figure 3, Table 2). At the end of 1 h, both groups showed continued improvement in arterial line patency. After the second dose, a higher number of patients in the heparin group had suboptimal waveforms and were treated with papaverine (heparin,37% [17/46] vs. papaverine,17% [7/42], p = .05). Patients in the heparin group treated with papaverine showed significant improvement in patency (13/17 vs. 3/7, p = .01). No serious adverse events were reported. CONCLUSIONS: In pediatric patients, papaverine injection immediately after peripheral arterial catheter placement was associated with relief of vasospasm and improved initial arterial line patency. Further, papaverine can be used as a rescue to improve and maintain arterial line patency.

Rheumatoid Arthritis Veiled by Sickle Beta-Thalassemia: A Rare Immunological Association Delaying Diagnosis.

Sickle beta-thalassemia is a rare variant of sickle cell disease (SCD) that manifests with milder symptoms. Musculoskeletal complications arising from this condition can mimic inflammatory arthritis and hence delay the diagnosis of rheumatoid arthritis (RA) until irreversible damage has been done. RA has been reported to occur with SCD but there is no documented literature thus far on its co-occurrence with sickle beta-thalassemia.  This case report elucidates the etiopathogenesis, clinical manifestations, and challenges encountered with the diagnosis and management of RA in a patient with sickle beta thalassemia.

Knowledge, attitude, and practice of breast self-examination amongst female IT professionals in Silicon Valley of India.

INTRODUCTION: Breast cancer is one of the leading causes of cancer deaths among women in India today. Overall outcome of this disease is largely dependent on early detection and medical intervention. Breast self-examination (BSE) is an easy, cost effective, and safe method of screening for the same. MATERIALS AND METHODS: A cross-sectional descriptive questionnaire-based study was conducted among female IT professionals and their scores in the fields of knowledge, attitude, and practice were calculated. The scores were categorized linearly as good, fair, and poor, then analyzed in detail. The correlation between knowledge and attitude, attitude and practice, and knowledge and practice were ascertained using the Spearman's rank correlation coefficient. RESULTS: About 356 women spanning from 18 to 55 years of age were included in the study, out of which 44 women (12.35%) gave family history of breast cancer. The mean scores in knowledge, attitude, and practice fields were 18.17 ± 2.90, 27.07 ± 8.14, and 19.11 ± 5.08, respectively. Spearman's rank correlation coefficient revealed that knowledge and attitude were not correlated, attitude and practice were not correlated; but knowledge and practice were extremely correlated. CONCLUSION: Educational programs to create awareness regarding breast cancer and its occurrence, risk factors, screening including BSE, symptoms, need for early help-seeking practices, diagnosis, and treatment modalities are the need of the hour.

Adverse Drug Reactions Attributed to Fondaparinux and Unfractionated Heparin in Cardiovascular Care Unit: An Observational Prospective Pilot Study in a Tertiary Care Hospital.

INTRODUCTION: This study was carried out to collect and analyze the adverse drug reactions (ADRs) reported with use of anticoagulants, heparin and fondaparinux. These drugs are vital in the treatment of unstable coronary artery diseases and emergencies. MATERIALS AND METHODS: A cross-sectional study with active reporting of ADRs from cardiology and medicine department was conducted. The type of reaction was assessed by Rawlins and Thomson criteria, causality by Naranjo probability scale, severity by modified Hartwig criteria, and preventability by Schumock and Thornton criteria. RESULT: Of the 67 patients observed, 16 showed ADRs. Fifteen reactions were attributable to unfractionated heparin and one to fondaparinux following assessment by the Naranjo causality scale. Severity of the ADRs assessed by modified Hartwig criteria showed that although 12 of 16 (75%) were mild, 4 (25%) were moderate in severity. Modified Schumock and Thornton criteria showed that 9 of 16 (56.25%) reactions could not have been prevented whereas 5 (31.25%) were probably preventable and 2 (12.5%) were definitely preventable. CONCLUSION: Incidence of ADRs with fondaparinux was lower than with heparin, hence emphasizing its better safety profile. The study also highlights the need for nurses and other caretakers in the coronary care unit to enquire for and report ADRs, particularly with high-potency medicines that are associated with an equally high potential to induce ADRs.