Intravenous dexamethasone along with caudal block improves analgesic efficacy following day-case inguinal hernia repair in children: A randomized controlled trial.

OBJECTIVE: To assess the effectiveness of intravenous dexamethasone along with caudal block in improving analgesia following inguinal hernia repair in children. METHODS: The double-blind randomised controlled trial was conducted over a 6-month period from June 01, 2016 to November 30, 2016 at the Aga Khan University Hospital, Karachi, and comprised patients aged 1-5 years, scheduled for elective inguinal hernia repair. The subjects were randomised into two groups using the sealed envelope technique. Group D patients received 0.5mg/kg dexamethasone intravenous in 5ml, and group P was given placebo (5ml 0.9% saline). Assessment of postoperative pain was made through the faces, legs, activity, cry and consolability tool at 30 minutes and hourly for 4 hours. Rescue analgesia was given at pain score 3 or more with intravenous pethidine 0.5 mg/kg. SPSS 19 was used for data analysis. RESULTS: Of the 64 patients, there were 55(85.9%) boys and 9(14.1%) girls. The overall mean age was 29.8}13.8 months. The mean postoperative pain score was significantly higher in group P (p<0.05). At 30 minutes and two hours postoperatively, need for analgesia was also significantly higher in group P (p<0.05). CONCLUSIONS: In paediatric day-care inguinal hernia repair, dexamethasone could be used effectively for improving pain relief.

Hypertension as a reason for cancellation of elective surgical cases on day of surgery: A five year audit report from The Aga Khan University Hospital Karachi.

OBJECTIVE: To assess the controllable factors in preventing undue cancellation of elective surgical cases and to suggest measures to address the issue. METHODS: The retrospective audit was conducted at the Aga Khan University Hospital, Karachi, and comprised all cancellations of elective surgery from 2011 to 2015. The cases reviewed had been cancelled primarily due to hypertension. A three-member committee regularly reviewed files regarding case cancellations and data was gathered. RESULTS: Of the 42,242 surgical cases scheduled during the period, 2903 (6.8%) were cancelled. In 11(0.37%) of these cases, hypertension was the primary reason. Of them, 10(91%) were men and 1(9%) woman. Overall age range was 30-77 years. Among the cancelled cases, 3(27.3%) each belonged to neurosurgery and general surgery, 2(18%) each to orthopaedic and urology, and 1(9%) to ear, nose and throat surgery. CONCLUSIONS: Hypertension as the primary reason for cancellation was low. Further reductions in these cancellations can be done by emphasis on following guidelines and their dissemination through continuing medical education.

Dealing a Neonate with CHARGE Syndrome:Anaesthesia perspective of perioperative care.

CHARGE syndrome is a condition that can disturb numerous areas of human body. As an abbreviation CHARGE stands for: coloboma, heart defects, atresia choanae, and retardation of growth, genital, and ear abnormalities. The configuration of malformations differs among individuals with this disorder, and the various health issues can be life-threatening during infancy and childhood. Affected individuals typically have several main features or a combination of major and minor appearances. Here we are presenting a case report of a neonate with CHARGE syndrome who underwent successful repair of choanal atresia under general anaesthesia with invasive monitoring.

The impact of epidural analgesia for acute pancreatitis on maternal and fetal outcome: a cohort study.

It is anticipated that between 1 in 10, 000 and 1 in 30, 000 pregnancies will be affected by acute pancreatitis (AP). The authors wanted to evaluate the impact of epidural analgesia on maternal and fetal outcomes and its effectiveness in the pain treatment of obstetric patients with AP. Methodology: The period for this cohort research was from January 2022 to September 2022. Fifty pregnant women with AP symptoms were enrolled in the study. Conservative medical management was done using intravenous (i.v.) analgesics, including fentanyl and tramadol. Fentanyl was infused i.v. at a rate of 1 µg/kg every hour, while tramadol was bolused i.v. at 100 mg/kg every 8 h. Boluses of 10-15 ml of 0.1% ropivacaine were injected into the L1-L2 interspace at 2-3-h intervals to provide high lumbar epidural analgesia. Results: In this study, 10 patients were given an i.v. infusion of fentanyl, and 20 patients were given tramadol boluses. Epidural analgesia showed the most promising results decreasing the visual analog scale score from 9 to 2 in half of the patients. Most fetal complications were noticed in the tramadol group, including prematurity, respiratory distress, and babies requiring noninvasive ventilation. Conclusion: Patients with AP during pregnancy may benefit from a new technique for simultaneous analgesia during labor and cesarean section administered via a single catheter. When AP is detected and treated during pregnancy, the mother and child benefit from pain control and recovery.

Biochemical Profiling and Elucidation of Biological Activities of Beta vulgaris L. Leaves and Roots Extracts.

RESEARCH BACKGROUND: Red beet (Beta vulgaris L.) is commercially grown in Punjab and Khyber Pakhtunkhwa (KPK) regions while cultivated as vegetable in Baluchistan and Sindh regions of Pakistan. It is well known for its health-promoting role in several clinical and pathologic outcome due to abundance of betalains and other bioactive compounds. The purpose of study was to interpret bioactivity of of B. vulgaris leaves (BvLM) and roots (BvRM) extracts for finding natural cure of neurodegenerative diseases (NDs). EXPERIMENTAL APPROACH: BvLM and BvRM extracts were evaluated for phytochemical composition, antioxidant, anti-inflammatory and anticholinesterase potential using standard protocols with modifications. RESULTS: Phytochemicals analysis of BvLM and BvRM extracts depicted the presence of flavonoids, phenols, alkaloids, saponins and glycosides. The IC50 values for free radical scavenging activity for BvRM and BvLM showed that BvLM (DPPH: 2.20 ± 0.72 µg/mL, H 2 O 2 : 0.0519 ± 1.02 µg/mL) is more significant as compared to BvRM (DPPH: 2.312 ± 0.72 µg/mL, H 2 O 2 : 2.668 ± 0.49 µg/mL). BvLM showed significant protection against heat induced hemolysis of HRBCs and protein denaturation (2.322 ± 0.1 > 2.324 ± 0.06 µg/mL) as compared to BvRM (8.572 ± 0.2 > 50.18 ± 1.0 µg/mL). Both extracts found to exhibit strong inhibitory potential against acetylcholinesterase enzyme. DISCUSSION/CONCLUSION: Our study highlighted B. vulagris extracts as rich and nutritious source of antioxidants, anti-inflammatory and cholinesterase inhibitors that could be helpful in preventing and treating neurodegenerative disorders (NDs). In consideration of multifactorial and complex etiology of NDs, BvLM and BvRM extracts would be apt candidates for development of therapeutic strategy for management of multiple cognitive disorders.