Perioperative Anxiolysis and Analgesic Effect after Premedication with Melatonin and Pregabalin in Total Hip Arthroplasty under Spinal Anaesthesia: A Prospective Comparative Trial.

Background: Preoperative anxiety plays a critical role in post-operative pain response and other outcomes. Melatonin is a naturally secreted hormone which has anxiolytic, sedative, and analgesic properties. Pregabalin, analogue of gabapentin which has property of anxiolytic and analgesic effects. Materials and Methods: Total 96 patients undergoing total hip arthroplasty, divided into 3 groups of 32 each and were given placebo (group I), melatonin 6 mg (group II), and pregabalin 150 mg (group III). Anxiety level, postoperative pain score, sedation level and duration as well as characteristics of spinal anaesthesia were assessed with other vital parameters. Results: Group I showed an increment in the anxiety score from baseline whereas in group II and group III, there was a decline in pre-operative anxiety score from baseline at all the periods of observation and more significantly in group III. Visual analogue scale (VAS) score and total dose of rescue analgesia were highest in group I, but group II and group III were comparable to each other. However, the durations of spinal anaesthesia and motor blockade showed a statistically significant difference with maximum duration in group III followed by II and then I. The level of sedation among the three groups were comparable at all the periods of observation. Conclusions: Pregabalin was found better for perioperative anxiolysis, post-operative analgesia and for prolongation of duration of spinal anaesthesia when compared to melatonin.

Recovery and post-operative analgesic efficacy from fentanyl- versus dexmedetomidine-based anesthesia in head and neck cancer surgery: A prospective comparative trial.

Background: Opioids such as fentanyl are being used frequently in the management of postoperative period, whereas non-opioid drugs such as dexmedetomidine are now commonly being used as adjuvants during the perioperative period to hasten the fast recovery and better outcome in the post-operative period because of their anesthetic and analgesic property. The recovery profile was measured by the emergence of anesthesia and pain characteristics. We aimed to evaluate and compare the efficacy of dexmedetomidine and fentanyl in the surgery of head and neck cancer patients. Methods: Prospective double-blind study on 60 patients with the American Society Anesthesiologists (ASA) grade I and II were randomly divided into two groups. Group DM received a loading dose of dexmedetomidine 1 µg/kg over 10 min followed by a maintenance dose of 0.5 µg/kg/h and Group FM received a loading dose of fentanyl 2 µg/kg/h for over 10 min followed by 1 µg/kg/h maintenance dose. Data were analyzed using a Chi-square test or Student's 't' test. Results: The group DM was hemodynamic stable as compared to group FM. The perturbation during extubation emergence was significantly lower in group DM as compared to that in group FM. A total of four patients were severely agitated in group FM, whereas it was absent in group DM. Severe agitation was significantly different between Group FM and Group DM. The visual analog scale (VAS) was lower among patients of Group DM as compared to Group FM at all times except at 4 h. Conclusions: The infusion of dexmedetomidine was better in controlling emergence agitation, postoperative pain, and achieving peri-operative hemodynamic stability as compared to fentanyl.

Improvements in Essential Newborn Care and Newborn Resuscitation Services Following a Capacity Building and Quality Improvement Program in Three Districts of Uttar Pradesh, India.

BACKGROUND: Neonatal death remains a global challenge contributing to 45% of underfive deaths. With rising institutional delivery, to accelerate decline in neonatal mortality rate (NMR) improvement in the quality of perinatal care requires attention. OBJECTIVES: This implementation research targeted improving service delivery readiness for quality of newborn care at public health facilities in three districts of Uttar Pradesh, India, with high NMR. MATERIALS AND METHODS: This before-after study assessed the facility readiness and quality of newborn services at 42 health facilities. The changes in 26 signal functions for routine and emergency obstetric and newborn care were tracked. RESULTS: There was marked improvement in newborn service availability: skilled birth attendants (51%), resuscitation (30%), and kangaroo mother care (27%) at these facilities. A multifold rise in newborn resuscitation efforts and documentation (n = 4431 vs. n = 144 in preintervention period) with high success rate (98.6%) was observed. There was also improvement in obstetric care services including partograph use (31%) and active management of third stage of labor (46%). However, several infrastructural indicators (electricity, water supply, toilets, and sanitation) remained unchanged. CONCLUSION: Overall improvements were observed in the majority of the signal functions for perinatal care and newborn resuscitation efforts. There was a limited impact on the infrastructural and supervision components.

Intraventricular haemorrhage as a complication of sub mucosal infiltration of adrenaline.

Adrenaline infiltration is a widely used technique in head-neck and ENT surgeries to provide bloodless surgical field. However, use of adrenaline has been associated with hemodynamic changes which can be life threatening at times. Therefore, use of higher concentrations of adrenaline should be avoided and a close hemodynamic monitoring is required with use of other vasopressors. In the present case report, a young male died because of intraventricular bleeding caused by adrenaline infiltration during rhinoplasty.

Serum zinc levels and its association with vitamin A levels among tuberculosis patients.

INTRODUCTION: One-third of the total human population is infected with the Mycobacterium tuberculosis. This bacterium causes illness in up to 9 million people annually and is responsible for three deaths every minute world-wide. OBJECTIVE: To determine the association of serum zinc level with vitamin A level in active pulmonary tuberculosis (TB) cases. MATERIALS AND METHODS: It was a cross-sectional study of 208 active pulmonary TB patients aged 18-55 years. Blood samples were obtained from these patients to determine the serum zinc and serum retinol levels. RESULTS: The mean age of the patients was 30.56 (±11.38) years ranging from 18 years to 55 years. More than half (54.3%) of the patients were males and 63% were married. Body mass index of the patients was 18.40 ± 3.10. The serum zinc and vitamin A levels among the patients were 9.60 (±0.86) µmol/l and 0.77 (±0.22) µmol/l respectively. However, haemoglobin, white blood cell, erythrocyte sedimentation rate, and serum albumin were 10.02 (±1.33) g/dl, 10076.01 (±1822.67) cell/mm3, 14.50 (±2.95) mm/h and 3.40 (±0.32) g/dl respectively. There was a strong correlation between serum zinc and vitamin A levels (r = 0.86, P < 0.01). Vitamin A levels were not significantly different among the different age groups; however, this was significantly (P = 0.001) higher in male (0.82 ± 0.23, 95% confidence interval [CI] =0.77-0.86) patients as compared to females (0.71 ± 0.20, 95% CI = 0.67-0.75). CONCLUSION: Zinc deficiency may indirectly influence the metabolism of Vitamin A via reduction of the levels of circulating proteins.

Successful low-dose spinal anaesthesia for lower segment caesarean section in a patient with Takayasu arteritis.

Takayasu arteritis is a rare, chronic idiopathic, occlusive inflammation of the aorta and its major branches. It is a rare form of non-specific obliterative panarteritis of unknown aetiology. Anaesthesia for the patient with Takayasu arteritis is complicated by severe uncontrolled hypertension leading to end organ dysfunction, stenosis of major blood vessel affecting regional circulation and difficulties in the monitoring of arterial blood pressure. We report a 26-year-old woman multigravida who was diagnosed with Takayasu arteritis who underwent an emergency caesarean section under spinal anaesthesia. In this case study, the whole course of anaesthesia and operation was uneventful due to thorough systemic evaluation and planned anaesthetic management.

Oral iron supplementation leads to oxidative imbalance in anemic women: a prospective study.

BACKGROUND & AIMS: This study was aimed to assess the desirable and undesirable effects of iron (100 mg/day as ferrous sulphate) and folic acid (500 µg/day) supplementation in iron deficient anemic women. METHODS: Iron and folic acid supplementations were given to 117 anemic women (mild = 55, moderate = 40, and severe = 22) and 60 age matched placebo treated (100 mg cane sugar) non-anemic controls for 100 days. Blood index values, oxidative stress parameters, antioxidant enzymes and vitamins were estimated as per standard protocols. RESULTS: Haemoglobin (Hb) levels along with antioxidant enzymes, namely catalase, superoxide dismutase (SOD), glutathione reductase (GSH-Rd), reduced glutathione (GSH) and total antioxidant capacity (TAC) were found significantly increased (P < 0.01) in anemic women after treatment. However, the glutathione peroxidase (GSH-Px) and antioxidant vitamins A, C and E were found significantly decreased (P < 0.01) in all treated groups. Lipid peroxide levels (LPO), protein carbonyl (PC), conjugated dienes (CD), lipid hydroperoxide (LOOH) and oxidized glutathione (GSSG) levels were found significantly increased (P < 0.01) after oral iron supplementation groups. Moreover, undesirable side effects of iron supplementation were observed maximally in mild as compared with moderate and severe anemic groups, whereas nausea, vomiting, systemic reactions were negligible in all treated subjects. CONCLUSION: Study found recommended dose of iron effective for improving Hb, but at the cost of increased oxidative stress (mild > moderate > severe). It is suggested that blind iron supplementation should be avoided and shall be provided on need basis.

Intraventricular hydatid cyst causing entrapped temporal horn syndrome: Case report and review of literature.

Entrapped temporal horn is due to obstruction of one lateral ventricle in the region of trigone causing dilatation of the temporal horn. The isolated temporal horn presents itself as mass lesion. Intraventricular hydatid cyst presenting as an entrapped temporal horn has not been reported in literature till now. We report two cases of intraventricular hydatid cyst causing entrapped temporal horn.

Dermoid cyst in brain.

The authors are presenting here a case of dermoid cyst in 50-year-male who presented with 3 months history of headache.

Cerebellar haemangioblastoma: a rare entity.

A 45-year-old female presented with headache, nausea, vomiting and ataxia of 4-month duration. CT head showed a posterior fossa tumour which was diagnosed as a case of haemangioblastoma on microscopic examination.

Intracranial chondroma: a rare entity.

Intracranial chondroma is a rare benign cartilaginous tumour with an incidence of less than 1% of all primary intracranial tumours. The authors are reporting here a case of intracranial chondroma in a 40-year-old man who presented with 5-month history of headache and gradual diminution of vision. A tentative diagnosis of chondroma was made on imprint cytology which was confirmed on histopathological examination.

Evaluation of oxidative stress and antioxidant status in pregnant anemic women.

The present study was conducted to investigate the oxidant-antioxidant status in iron deficient pregnant anemic women. One hundred thirty pregnant women with iron deficiency anemia (IDA) were divided into three groups, namely mild (50), moderate (50) and severe (30) anemic along with pregnant healthy women as controls (50). The complete blood count, plasma lipid peroxidation products, enzymatic and non-enzymatic antioxidants were measured according to respective protocols. The levels of complete blood count, iron, ferritin along with antioxidant enzymes namely catalase, superoxide dismutase, glutathione peroxidase, glutathione reductase and reduced glutathione were significantly reduced in all IDA groups. However, the level of oxidized glutathione, lipid peroxides, protein carbonyls, conjugated dienes were found significantly increased in all anemic patients. Antioxidant vitamins, namely C, E and A were also found significantly decreased in IDA patients. On the basis of our results, it may be concluded that IDA tends to increase the pro-oxidant components, which may result in various complications including peroxidation of vital body molecules resulting in increased risk for pregnant women as well as fetus.