Comparison of Efficacy of Laryngeal Mask Airway and Intersurgical-Gel Supraglottic Airway Device During General Anesthesia in a Tertiary Care Hospital

Background: Upper airways collapse during anesthesia is a common issue faced by anesthetists. Air way maintenance is an essential component of general anesthesia. Laryngeal mask airway and Intersurgical-gel (i-gel) air way devices are new advances in general anesthesia. Present study aims to compare the ease of insertion and hemodynamic response of i-gel supraglottic and laryngeal mask airway (LMA). Material and Methods: A Randomized Clinical trial was conducted at the Department of Anesthesia, Shaikh Zayed Hospital, Lahore. Study duration was 6 months (June 2014- December 2014). A total of 60 patients were selected through non-probability consecutive sampling. Ethical approval was taken from ethical review board of Sheikh Zayed Hospital and informed written consents were taken from all the participants. Patients were randomly divided into two groups using lottery method. Group A was given laryngeal mask airway device while group B patients were provided with i-gel supraglottic device during anesthesia. Patients were compared for ease of insertion and hemodynamic parameters. Data was analyzed using SPSS version 24. Chi-square and t-test were applied and p-value ≤0.05 was considered statistically significant. Results: A total of 60 patients were included in study. Mean age of patients was 35.2±11.7 years in LMA group and 36.7±13 years in i-gel group. Group B had lower number of insertion attempts (p=0.01) and high insertion satisfaction (p=0.4) as compared to group A. However, process failure and bleeding rate was found to be slightly higher in group B (16% and 13% respectively) as compared to group A (p>0.05). Conclusion: i-gel supraglottic device is a successful alternative option in terms of ease of insertion and less hemodynamic response as compared to laryngeal mask airway during general anesthesia. Key words: , ,&nbsp

Immunomodulatory interventions in myocardial infarction and heart failure: a systematic review of clinical trials and meta-analysis of IL-1 inhibition

Following a myocardial infarction (MI), the immune system helps to repair ischaemic damage and restore tissue integrity, but excessive inflammation has been implicated in adverse cardiac remodelling and development towards heart failure (HF). Pre-clinical studies suggest that timely resolution of inflammation may help prevent HF development and progression. Therapeutic attempts to prevent excessive post-MI inflammation in patients have included pharmacological interventions ranging from broad immunosuppression to immunomodulatory approaches targeting specific cell types or factors with the aim to maintain beneficial aspects of the early post-MI immune response. These include the blockade of early initiators of inflammation including reactive oxygen species and complement, inhibition of mast cell degranulation and leucocyte infiltration, blockade of inflammatory cytokines, and inhibition of adaptive B and T-lymphocytes. Herein, we provide a systematic review on post-MI immunomodulation trials and a meta-analysis of studies targeting the inflammatory cytokine Interleukin-1. Despite an enormous effort into a significant number of clinical trials on a variety of targets, a striking heterogeneity in study population, timing and type of treatment, and highly variable endpoints limits the possibility for meaningful meta-analyses. To conclude, we highlight critical considerations for future studies including (i) the therapeutic window of opportunity, (ii) immunological effects of routine post-MI medication, (iii) stratification of the highly diverse post-MI patient population, (iv) the potential benefits of combining immunomodulatory with regenerative therapies, and at last (v) the potential side effects of immunotherapies

Efficacy of Five Days Nitrofurantoin Therapy versus Fosfomycin Stat Dose in Clinical Resolution of Uncomplicated Urinary Tract Infections

Objective: To compare the efficacy of 5-days Nitrofurantoin therapy versus Fosfomycin stat dose in clinical resolution of uncomplicated urinary tract infections in females of reproductive age group. Study Design: Comparative prospective study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2019 to Mar 2020. Methodology: A total of 498 females of reproductive age (18 years to 40 years) with lower urinary tract infection symptoms(increased urinary hesitancy, frequent micturition, tenderness at suprapubic region) and positive urine dipstick test for nitrates/leukocyte esterase test were incorporated in the study. Patients were randomly assigned to Group-A and Group-B,comprising 249 patients. Group-A was given tablet Nitrofurantoin 100mg every six hourly. Group-B was given Fosfomycin 3gstat dose. Patients were advised to follow up on days 14 and 28 of treatment to observe the clinical resolution of urinary tractinfection symptoms and bacteriologic response. Results: Clinical resolution of urinary tract infection on the 28th day of treatment was attained in 172(69.1%) patients of the Nitrofurantoin-Group versus 140(56.2%) patients receiving Fosfomycin (p-value 0.003). Baseline urine cultures were positive in 286(57.4%) patients. Microbiologic resolution was achieved in 109 of 140(77.9%) and 100 of 146(68.4%) (p- value=0.026). Conclusion: Among the females of reproductive age, five days of Nitrofurantoin therapy is superior to stat dose Fosfomycin in the clinical and microbiologic resolution of uncomplicated urinary tract infections

Immunomodulatory interventions in myocardial infarction and heart failure: a systematic review of clinical trials and meta-analysis of IL-1 inhibition.

Following a myocardial infarction (MI), the immune system helps to repair ischaemic damage and restore tissue integrity, but excessive inflammation has been implicated in adverse cardiac remodelling and development towards heart failure (HF). Pre-clinical studies suggest that timely resolution of inflammation may help prevent HF development and progression. Therapeutic attempts to prevent excessive post-MI inflammation in patients have included pharmacological interventions ranging from broad immunosuppression to immunomodulatory approaches targeting specific cell types or factors with the aim to maintain beneficial aspects of the early post-MI immune response. These include the blockade of early initiators of inflammation including reactive oxygen species and complement, inhibition of mast cell degranulation and leucocyte infiltration, blockade of inflammatory cytokines, and inhibition of adaptive B and T-lymphocytes. Herein, we provide a systematic review on post-MI immunomodulation trials and a meta-analysis of studies targeting the inflammatory cytokine Interleukin-1. Despite an enormous effort into a significant number of clinical trials on a variety of targets, a striking heterogeneity in study population, timing and type of treatment, and highly variable endpoints limits the possibility for meaningful meta-analyses. To conclude, we highlight critical considerations for future studies including (i) the therapeutic window of opportunity, (ii) immunological effects of routine post-MI medication, (iii) stratification of the highly diverse post-MI patient population, (iv) the potential benefits of combining immunomodulatory with regenerative therapies, and at last (v) the potential side effects of immunotherapies

Sonographic Evaluation of Cholelithiasis and Its Correlation with Normal/Fatty Liver

Cholelithiasis and Fatty Liver disease are usually observed to coexist. Patients who have gallstones also have Fatty Liver as both of the conditions have same associated risk factors I.e., diabetes mellitus, gender, age, obesity, metabolic syndrome, insulin resistance and high lipids level. Non-Alcoholic Fatty Liver Disease (NAFLD) is also an independent accountable risk factor for the formation of gallstones. We aimed to determine whether there is any correlation between cholelithiasis and fatty liver disease. The study was conducted in Lahore General Hospital, Lahore, Pakistan. The data was collected from March 24,2021 to May 24,2021. Informed consent was taken from all the participants. We did a cohort study comprising the data of 51 patients undergoing physical checkup. The data gathered included age, gender and whether they had normal or fatty liver. Cholelithiasis was diagnosed by confirming the presence of gallstones on abdominal ultrasonography after fasting for approximately 8hrs. it was an observational study for the assessment of correlation between cholelithiasis and fatty liver in the participants. A Total of 51 patients with cholelithiasis were included in our study. Most of the patients were 29 to 70 years of age. The average age of the patients was 42.3 ± 10.1 years. Out of 51 patients, there were 60.8% (P=31) females and 39.2%(P=20) males. Out of 51 cholelithiasis patients there were 31.4%(P=16) had Normal Liver and 68.6%(P=35) were positive with Fatty liver disease. Patients with stone size ranges from 1.90mm to 4.6mm hade Grade 1 Fatty liver as shown in table-5.4, Grade 2 Fatty liver was seen in patients with stone size ranges from 4.5mm to 5.8mm. Fatty liver Grade 3 was not observed in any included patient with cholelithiasis. Results of our study showed that both cholelithiasis and Fatty Liver disease are correlated with each other. Females are at higher risk to be affected by these with diseases. Early detection of Fatty liver in patients of cholelithiasis can help patients to prevent them further complications regarded to fatty liver and cholelithiasis and can play important role in health care of society. Keywords: Non-Alcoholic Fatty Liver Disease, Cholelithiasis, Fatty liver, Ultrasonography. DOI: 10.7176/JHMN/91-07 Publication date:July 31st 202

Impact Of Multidisciplinary Team Approach To The Management Of Otalgia Patients

Background: Otalgia, one of the most common complain reported in OPD of otorhinolaryngologist, is agonizing and affects all age groups. The objective of the study was to highlight the use of Multidisciplinary team approach to the management of otalgia patients for speedy recovery. Methods: A cross sectional study was conducted on patients having ear pain. These patients presented to the out-patient department (OPD) of otolaryngology of a tertiary care hospital. Data was collected through questionnaire prepared in advance. Informed oral consent was taken from participants before administration of the questionnaire. Results: A total of 216 patients were included in the study. Out of these only 33(15.2%) were less than 18 years of age. Majority [139(64.35%)] of subjects belonged to a low socioeconomic class. Out of these patients 119(55.1%) had ear infections who has to be seen by otolaryngologists. 63(29.2%) of patients had temporomandibular joint pain, referred to the Maxillofacial Surgeons and 34(15.7%) of patients suffering from neck pain, referred to Orthopaedic Surgeon. Conclusion: Multidisciplinary team approach was found effective in treating otalgia patients visiting the otorhinolaryngology clinics for the symptom, should be closely examined and referred to concerned departments if required for complete recovery

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570