Factors affecting reintubations after cardiac and thoracic surgeries in cardiac intensive care unit of a tertiary care hospital

Background: Reintubation and readmission after cardiothoracic surgeries are not uncommon, and its reasons are multifactorial. The study goal was to identify the factors that contribute reintubation after cardiac and thoracic surgery in tertiary care hospital and to compare the outcome with international benchmark.Methodology: A prospective, observational study was planned in Cardiac Intensive Care Unit (CICU). The study included all those patients who required readmission in CICU due to endotracheal intubation following cardiac and thoracic surgeries. The study was conducted from January to December 2016. The primary focus was to identify the reasons for reintubation within 72 h of extubation after CICU discharge and its association with outcome.Results: Out of 750 patients who shifted out from CICU following successful extubation, only 32 were readmitted and among them in 25 patients (3.33%) were reintubated and their reasons reintubation were noted. Patients underwent a coronary artery bypass grafting (CABG) with valve replacement had a higher incidence of reintubation 3/39 (7.69%) when compared with CABG 13/517 (2.51%) and 4/135 (2.96%) valve procedure alone. Single cause of endotracheal reintubation was observed in 7 patients (28%), in which 5 patients (20%) had respiratory and 2 patients had (8%) cardiac reason while 18 patients (72%) were observed with multisystem involvement, in which 7 patients (28%) had both respiratory and cardiovascular causes, and 2 (8%) had both respiratory and neurological causes. More than 70% cause of endotracheal reintubation was both respiratory and cardiovascular. The CICU stay after reintubations was 12.88 ± 16.88 days and the hospital stay prolonged to 23.84 ± 21.61 days.Conclusion: Reasons of reintubation were mainly respiratory and cardiac. The rate of reintubations is high when multisystem involvement is there. CICU, hospital stay, and mortality are increases after reintubation

Germ Cell Tumor and Takotsubo Cardiomyopathy: A Treatment Dilemma

Germ cell tumors (GCT) are uncommon malignancies in adult males and comprise less than 1% of male cancers. Due to highly curative nature and productive life years gained after treatment; reduction of chemotherapy related toxicities becomes vital. Cisplatin is the backbone of GCT chemotherapy, & is related to myocardial injury, thromboembolism & vasculitis. Though it should not be replaced with Carboplatin, however in certain circumstances, its use maybe unsafe; especially in cases when patient have prior myocardial infarction. We report a case of Takotsubo cardiomyopathy (TCM)secondary to GCT diagnosis in a young male. This patient presented withsymptoms of myocardial infarction however, coronary angiography was normal and a diagnosis of TCM was made. Though, it is rare but a unique challenge, as whether Cisplatin use would be safe in this particular scenario? On one hand patient had stress related myocardial injurywhile he was also at risk of further Cisplatin induced complications.There are no clear cut guidelines, so after informed consent his treatment regimen was modified to EC (Etoposide/Carboplatin) instead of EP (Etoposide/Cisplatin). Patient has completed 4.6 years of follow-up without any evidence of relapse. We suggest informed decisions and to weigh the pros and cons of using an inferior regimen, in order to achieve same long term prognosis while preventing any acute complications,in younger patients with curable cancers

Fluid choice during perioperative care in children: A survey of present‑day proposing practice by anesthesiologists in a intertiary care hospital

Background: Perioperative fluid therapy in pediatrics has always been a challenging avenue for anesthesiologists. Inappropriate choice of fluid leads to multiple side effects, for instance iatrogenic hyponatremia. Our aim was to observe the current practice of perioperative fluid therapy in pediatric population undergoing surgery in a tertiary care hospital. Methods: After obtaining approval from the Departmental Research Review Committee, a survey form including questions was emailed to anesthesiologists from January 2015 to June 2015. Individual responses were recorded and analyzed. Results: Overall response was 100% from consultant and resident, and total 55 anesthesiologists were participated in this survey. Majority of anesthesiologist have used, 1/2 dextrose saline (52.7%) as fluid of choice in routine intraoperative maintenance, while Hartmann’s solution (41.8%) and normal saline 0.9% (5.5%) were used for rest of the them. The Holliday‑Segar method for maintenance fluid was mentioned by 92.7% of anesthesiologists. Conclusion: The use of hypotonic fluid in perioperative care in pediatric population is still being practiced despite the current guidelines. These results point to a considerable gap between the available evidence and practic

Comparison between Tramadol and Pethidine in Patient Controlled Intravenous Analgesia

Objective: To compare the efficacy and side effects related to Tramadol with Pethidine in patient controlled intravenous analgesia (PCIA) after total abdominal hysterectomies. Methods: A total of 60 patients were randomized to receive either Tramadol or Pethidine by PCIA (30 in each group) after total abdominal hysterectomy. Pain assessments were recorded one hour after starting the PCIA and then at 6, 12, and 24 hours by using visual analogue scale (VAS). Nausea vomiting score and sedation score were also recorded. Good attempts, total attempts and total drug consumption was noted from PCIA pump at the end of the study period. Results: The analgesia achieved in Tramadol group was comparable to Pethidine. The incidence of nausea and vomiting was similar in both groups. Tramadol causes significantly less sedation than Pethidine (p \u3c 0.05). Mean drug consumption, total attempts and good attempts were also significantly less in Tramadol group than Pethidine group (p \u3c 0.05). Conclusion: Tramadol produces equivalent analgesia and less sedation and can be used as an alternative to Pethidine in Patient Controlled Intravenous Analgesia for postoperative pain relief after Total Abdominal Hysterectomy (TAH

Table Structure Extraction with Bi-directional Gated Recurrent Unit Networks

Tables present summarized and structured information to the reader, which makes table structure extraction an important part of document understanding applications. However, table structure identification is a hard problem not only because of the large variation in the table layouts and styles, but also owing to the variations in the page layouts and the noise contamination levels. A lot of research has been done to identify table structure, most of which is based on applying heuristics with the aid of optical character recognition (OCR) to hand pick layout features of the tables. These methods fail to generalize well because of the variations in the table layouts and the errors generated by OCR. In this paper, we have proposed a robust deep learning based approach to extract rows and columns from a detected table in document images with a high precision. In the proposed solution, the table images are first pre-processed and then fed to a bi-directional Recurrent Neural Network with Gated Recurrent Units (GRU) followed by a fully-connected layer with soft max activation. The network scans the images from top-to-bottom as well as left-to-right and classifies each input as either a row-separator or a column-separator. We have benchmarked our system on publicly available UNLV as well as ICDAR 2013 datasets on which it outperformed the state-of-the-art table structure extraction systems by a significant margin.Comment: Proceedings of the 15th International Conference on Document Analysis and Recognition (ICDAR) 2019, Sydney, Australi