Effectiveness of high flow nasal cannula (HFNC) versus bilevel positive airway pressure (BiPAP) in preventing tracheal reintubation in patients with high risk of extubation failure in intensive care unit - A randomised comparative trial.

Background and Aims: The incidence of tracheal extubation failure in high-risk patients is higher, and non-invasive ventilation is suggested to avoid tracheal reintubation. This study compares the effectiveness of bilevel positive airway pressure (BiPAP) and high flow nasal cannula (HFNC) to reduce the rate of reintubation in intensive care unit (ICU) patients with increased risk of extubation failure. Methods: This randomised comparative trial was conducted on 60 high-risk patients on mechanical ventilators admitted to the ICU, ready for weaning after a spontaneous breathing trial. They were randomised to Group H for HFNC and Group B for BiPAP therapy. Designated therapy was administered in these high-risk patients for up to 48 hours after tracheal extubation. Haemodynamic parameters [mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), a saturation of peripheral oxygen (SpO2), electrocardiogram (ECG)], arterial blood gas analysis (ABG) parameter [potential of hydrogen (pH), partial pressure of carbon dioxide (pCO2), partial pressure of oxygen/fraction of inspired oxygen (paO2/FiO2) ratio], the effectiveness of cough, comfort level was recorded and continuous monitoring for signs of respiratory distress and failure was done. Results: Most of the patients were obese and had more than two risk factors for extubation failure. Several patients in Group B have significantly higher successful extubation than in Group H (P = 0.044). Most of the reintubation took place within 24 hours. The HFNC therapy was more comfortable and acceptable to patients. Conclusion: BiPAP therapy was more efficient than HFNC in preventing tracheal reintubation among patients with a high risk of extubation failure.

Recent advancements in toxicology, modern technology for detection, and remedial measures for arsenic exposure: review.

Arsenic toxicity has become a major global health concern for humans and animals due to extensive environmental and occupational exposure to arsenic-contaminated water, air, soil, and plant and animal origin food. It has a wide range of detrimental effects on animals, humans, and the environment. As a result, various experimental and clinical studies were undertaken and are undergoing to understand its source of exposures, pathogenesis, identify key biomarkers, the medical and economic impact on affected populations and ecosystems, and their timely detection and control measures. Despite these extensive studies, no conclusive information for the prevention and control of arsenic toxicity is available, owing to complex epidemiology and pathogenesis, including an imprecise approach and repetitive work. As a result, there is a need for literature that focuses on recent studies on the epidemiology, pathogenesis, detection, and ameliorative measures of arsenic toxicity to assist researchers and policymakers in the practical future planning of research and community control programs. According to the preceding viewpoint, this review article provides an extensive analysis of the recent progress on arsenic exposure to humans through the environment, livestock, and fish, arsenic toxicopathology, nano-biotechnology-based detection, and current remedial measures for the benefit of researchers, academicians, and policymakers in controlling arsenic eco-toxicology and directing future research. Arsenic epidemiology should therefore place the greatest emphasis on the prevalence of different direct and indirect sources in the afflicted areas, followed by control strategies.

Comparison of Palonosetron Versus Palonosetron and Dexamethasone for Prevention of Postoperative Nausea and Vomiting After Middle Ear Surgeries: A Randomized Controlled Study.

Background: Postoperative nausea and vomiting (PONV) are one of the common distressing conditions after anesthesia. The PONV are related to several potential risk factors are patient related, anesthesia related, and surgery related. In surgery-related risk, middle ear surgery is associated with a high incidence of PONV. Aims: This study aimed to compare the efficiency of palonosetron versus palonosetron with dexamethasone in the prevention of PONV in middle ear surgeries. Settings and Design: This was a prospective, randomized, double-blind study. Statistical Analysis: The data were presented as descriptive statistics for continuous variables and percentages for categorical variables and were subjected to Z-test/Chi-square test/Fisher's exact test. The value of P < 0.05 was considered statistically significant. Results: Demographic parts in comparison to age, duration of surgery, and duration of anesthesia were similar in both the groups. Our study showed that the incidence of PONV during 0-6 h was 38% (n = 19) in Group A and 12% (n = 6) in Group B and the incidence during 6-12 h postoperatively was 14% (n = 7) in Group A and 8% (n = 4) in Group B. During 12-24 h, the incidence was 8% (n = 4) and 6% (n = 3) in Group A and B, respectively. Hence, the difference of total early PONV in Group A was 60% (n = 30) and in Group B, it was 26% (n = 13) which was statistically significant (P < 0.03). Conclusions: The above result proves that palonosetron and dexamethasone group is superior in the prevention of PONV in middle ear surgery.

Antibiotic sensitivity trends of pseudomonas endophthalmitis in a tertiary eye care center in South India: A 12-year retrospective study.

Purpose: To assess trends in antibiotic sensitivity of pseudomonas and compare multidrug resistance (MDR) between Pseudomonas endophthalmitis cases presenting in two consecutive 6-year time frames in a tertiary center in South India. Methods: This is a retrospective comparative series of all Pseudomonas endophthalmitis cases treated from June 2004 to May 2016. Microbiological culture results in all endophthalmitis patients were screened for pseudomonas. Positive cases in the initial 6 and final 6 years were compared for sensitivity to antibiotics and the proportion of MDR. MDR was defined as resistance to at least two different classes of antibiotics. Results: Pseudomonas accounted for 74 of 389 endophthalmitis cases (19%), 42 in initial 6 and 32 in final 6 years. Sensitivity to ciprofloxacin, ofloxacin, gatifloxacin, moxifloxacin, and ceftazidime was 85.7%, 82.9%, 76.5%, 76.9%, 88.1% up to 2010 which reduced to 75%, 59.4%, 68.8%, 56.3%, 56.3%, respectively, after 2010, being significant for ofloxacin (P = 0.0349) and ceftazidime (P = 0.0028). Susceptibility to amikacin, gentamicin, and tobramycin changed non-significantly from 83.3%, 43.9%, 47.6% to 71.9%, 61.3%, 61.3%, respectively. Twenty of 74 cases (27%) were MDR with 16.7% in first 6 years versus 40.6% in final 6 years. Postoperative MDR cases rose from 10.3% to 50% (P = 0.0048). Conclusion: This study shows rising resistance of Pseudomonas to fluoroquinolones, amikacin, and ceftazidime in endophthalmitis. MDR also showed an upward trend, particularly in postsurgical cases.

Anesthesia in a Child with Newly Diagnosed Hypertrophic Cardiomyopathy for Placement of Implantable Cardioverter Defibrillator.

Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease usually characterized by asymmetric ventricular septal hypertrophy. HCM is an important cause of sudden cardiac death in adolescents and young adults. We are presenting a case report, ten years boy came in emergency with sudden loss of consciousness (witness cardiac arrest). Child was revived after cardiopulmonary resuscitation and send to coronary care unit. Echocardiography findings were suggestive of HCM. There was history of sudden death of her mother and maternal uncle. After stabilization ICD was implanted under total intravenous anesthesia. Post procedure his hospital stay was uneventful.

Predictive Value of Baseline Biochemical Parameters for Clinical Response of Macular Edema to Bevacizumab in Eyes With Central Retinal Vein Occlusion: A Retrospective Analysis.

PURPOSE: To evaluate the influence of baseline biochemical parameters on the improvement in best corrected visual acuity (BCVA) and reduction in central foveal thickness (CFT) in patients treated with intravitreal bevacizumab (IVB; Avastin, Genentech, Inc) for macular edema (ME) secondary to central retinal vein occlusion (CRVO). DESIGN: A retrospective study. METHODS: Seventy eyes of 70 participants with CRVO who underwent IVB for ME and had at least 1 month of follow-up after the last injection were studied. Demographic variables, systolic and diastolic blood pressure (SBP and DBP), BCVA, CFT measured by optical coherence tomography (OCT), and biochemical investigations [hemoglobin, fasting and postprandial blood sugar (FBS and PPBS), lipid profile, blood urea (BU), serum creatinine (SC), glycosylated hemoglobin (HbA1c)] at baseline were noted. IVB need at every visit was based on clinical and OCT parameters. Changes in BCVA (ΔBCVA) and CFT (ΔCFT) from baseline to last injection were estimated. RESULTS: After IVB, there was a statistically significant reduction in mean CFT (P < 0.01). The group of patients with normal BU and SC had more than 2 lines of improvement compared with those with elevated values (P = 0.043 and 0.009, respectively). Other parameters like FBS, PPBS, hemoglobin, HbA1c, and serum lipids were not associated with improvement of BCVA and reduction of CFT. CONCLUSIONS: Normal baseline renal parameters (BU and SC) predict better visual outcome after treatment for ME in CRVO and offer additional benefit over and above that obtained with ME reduction.

Acute exposure of arsenic tri-oxide produces hyperglycemia in both sexes of an Indian teleost, Clarias batrachus (Linn.).

The present investigation has been conducted to study of the effect of acute exposure of sublethal doses of arsenic tri-oxide (As(2)O(3)) on blood glucose level in an Indian teleost, Clarias batrachus, during their post-breeding season (October to January). The effect was correlated with the sex and doses used with time. Acute exposure of As(2)O(3) of 5, 10 and 15 mg/l for six consecutive days (i.e., 144 h) has been conducted on both sexes of C. batrachus. During the present investigation, it was noticed that the females were more reactive to arsenic in producing hyperglycemia compared to their male counterparts. The difference between males and females to produce hyperglycemia on exposure to arsenic appears to be dose dependent, as lower doses of 5 and 10 mg/l exhibit less difference between the two sexes compared to the highest dose order of 15 mg/l. After 96 h of treatment, a normoglycemic condition was observed in both sexes. However, no significant differences in average normal blood glucose levels were noticed in male and female C. batrachus during the post-breeding season.

Study of muscle glycogen content in both sexes of an Indian teleost Clarias batrachus (Linn.) exposed to different concentrations of arsenic.

The present investigation has been conducted to study the effect of different sublethal concentrations of arsenic (5, 10 and 15 mg/L) on the muscle glycogen content in an Indian teleost, Clarias batrachus, during their post-spawning period (October to January).The species were exposed to various arsenic concentrations for six consecutive days i.e.,144 h. Significant differences in average muscle glycogen content were found in the treated male and female C. batrachus specimens. However, significantly higher (P < 0.01) muscle glycogen content was observed in male fish when compared to females in the untreated specimens. Arsenic caused muscle glycogenolysis in both sexes of C. batrachus. The depletions were not always dose (arsenic concentration) and time dependent, although higher concentrations were more glycogenolytic than the lower concentrations. After 96 h of treatment with arsenic, less depletion of muscle glycogen content was recorded in both sexes of fish.