Comparative study of propofol and etomidate as intravenous induction agents for general anesthesia: hemodynamic effects, adrenal suppression, and blood glucose response in controlled hypertensive patients

Background: General anesthesia induces unconsciousness and loss of reflexes, facilitating complex medical treatments. The induction of anesthesia is crucial for patient comfort and procedural success, with propofol and etomidate being common intravenous induction agents. Propofol offers a rapid onset and short duration, while etomidate is known for cardiovascular stability. Methods: A prospective randomized controlled trial involving 100 controlled hypertensive patients compared propofol and etomidate for induction. Hemodynamic parameters and biochemical responses were monitored at various intervals. Injection site discomfort and myoclonus were assessed, and cortisol and glucose levels were measured. Results: Baseline hemodynamic values were similar. Etomidate resulted in stable hemodynamics as compared to propofol. Blood sugars were comparable. Though serum cortisol levels were reduced after etomidate was given. But it came back to normal range 24 hours after surgery. Injection site pain was reported by 20% of etomidate patients and 10% of propofol patients. No myoclonus occurred. Conclusions: Etomidate is an effective induction agent for controlled hypertensive individuals, causing transient adrenal suppression without affecting blood sugar levels

Optic nerve sheath diameter as a non-invasive indicator of intracranial hypertension in traumatic brain injury: correlation with CT head and prognostic implications

Background: Ultrasound guided measurement of optic nerve sheath diameter (ONSD) is an emerging non invasive bedside tool that is being used to detect raised intracranial pressure (ICP) in patients with traumatic brain injury(TBI). Early detection of raised ICP can guide in the timely management of such patients with raised ICP due to TBI. Methods: A prospective, observational, open labelled study planned with a 30 patients of TBI of both genders, aged between 18 to 70 years. ONSD readings were taken 3 times a day for three days from the time of admission with portable SonoSite ultrasound machine. Data was expressed as mean ±standard deviation. Values were compared using T test and P value was calculated. Results: Highest reading recorded in patients with GCS <8 was 6.26±0.73 in comparison to 5.38±0.56 (p=0.001) in patients with GCS >8. Highest reading of ONSD  correlating  with a positive CT finding at admission was 6.22±.81 and was 5.46±.57 (p=0.006)  in patients with negative findings on CT. ROC curve with average cut off of 6 mm  correlated with positive CT findings with sensitivity of 80%, specificity of 70%  and negative predictive value of 87% was found. Conclusions: Ultrasound-guided ONSD monitoring shows promise for diagnosing intracranial hypertension in traumatic brain injury. Correlations with CT, GCS, and outcomes emphasize its clinical relevance, warranting further validatio

Evaluation of flexural strength and color stability of different denture base materials including flexible material after using different denture cleansers

Aims: Present study aimed at evaluating the colour stability and flexural strength of flexible denture base materials (Valplast) and Polymethyl methacrylate (PMMA) denture base material (Meliodent) processed by two different methods (Injection moulding and compression moulding) after immersing them in three different denture cleansers with acidic, basic and neutral PH. Methods and Materials: Total 120 specimens (65 × 10 × 3 mm3), 40 specimens of each material (Valplast, Meliodent compression moulding and injection moulding) were immersed in denture cleansers having different PH; Valclean (Acidic), Clinsodent (Basic) and Polident (Neutral) as well as Distilled Water. Color changes were measured with a spectrophotometer after 1 month, 3 months and 6 months of immersion cycle. A flexural 3-point bending test was carried out by using an Instron universal testing machine after 6 months of soaking.Data were analyzed using SPSS software Results: Maximum effect on colour stability was noted with Clinsodent followed by Valclean. Least color changes were observed after immersion in Polident. Colour difference was increased significantly as the immersion time increased. For both Meliodent and Nylon resins, statistically significant change in flexural strength occurred with immersion in all denture cleansers. Clinsodent has greater effect as compared to Valclean and Polident. Conclusions: Polident and Valclean can be safely used as denture cleanser for both nylon and acrylic resin denture base materials as far as colour stability and flexural strength both are concerned

Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015–2020

Objectives We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.Design A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.Setting National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.Participants Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measures We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015.Results The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra.Conclusion TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020