Attenuation of hypotension using phenylephrine during induction of anaesthesia with propofol

Objective: To observe if phenylephrine mixed with propofol can attenuate hypotensive effects of propofol during induction of anaesthesia. Methods: A total number of 135 adult ASA-I and ASA-II patients were divided into three groups. (Group A, B and C). All patients were induced with propofol 2.5 mg per kg. In Group A (control group) patients received propofol mixed with 2cc of 0.9% normal saline. Group B (study group) patients received propofol mixed with 2cc of a solution containing phenylephrine 25µg/cc (total 50µg); Group C (study group) patients received propofol mixed with 2cc of a solution containing phenylephrine 50µg/cc (total 100µg). Haemodynamic variables like systolic, diastolic, mean arterial blood pressure and heart rate were noted. Hypotension was defined as 20% decrease in baseline systolic blood pressure recorded before induction of anaesthesia. Results: Phenylephrine in a dose of 100 micrograms attenuated the drop in systolic blood pressure. However phenylephrine in a dose 50 micrograms did not effectively prevent anticipated drop in SBP. Conclusion: Phenylephrine in doses of 100 micrograms effectively attenuates anticipated hypotension upon induction of general anaesthesia with propofo

Perceived Social Support and Mental Health among Caregivers of Patients with Chronic Illnesses in Pediatric Departments: An Observational Study

AbstractObjective: The objective of the study was to assess the perceived social support and mental health ofcare givers of children suffering from chronic medical conditions.Methodology: The research design of current study was cross-sectional in nature. Data was collectedfrom Pediatric Departments of one public and one private sector hospitals. Sampling technique waspurposive sampling comprising of 151 mothers of children with chronic medical conditions. Forassessment purpose demographic form, Depression Anxiety Stress Scale (DASS-21) for evaluation ofgeneral mental health and Multidimensional Scale of Perceived Social Support Scale (MSPSS) forassessment of perceived social support were used. P value≤0.05 was considered as significant.Results: Regression analysis showed social support measured by MSPSS to be a significant predictorof stress (p<0.000), anxiety (p<0.000) and depression (p<0.000) in mothers of children with chronicillnesses which were inpatients in pediatric departments.Conclusion: In conclusion, the mental health of mothers taking care of their children who weresuffering from chronic illnesses in the pediatric departments was influenced by various factors, withperceived social support playing a pivotal role in the current study.Keywords: caregivers, social support, mental health, pediatric department

Grown up congenital heart disease patient presenting for non cardiac surgery: anaesthetic implications

Congenital heart disease patients surviving to adulthood have increased over the years due to various reasons. These patients are admitted in the hospital for non cardiac surgeries and other procedures more often than normal adult population. Management of grown up congenital heart disease patient presents a challenge during perioperative period for cardiologists, surgeons, intensivists and particularly for the anaesthetist. Management issues include psychological and physiological impact on the patient, complexity of defects, presence of previous palliative procedure, impact of anaesthetic agents on shunting and myocardium, endocarditis prophylaxis and associated extra cardiac anamolies

SmartSIM - a virtual reality simulator for laparoscopy training using a generic physics engine

International audienceVirtual reality (VR) training simulators have started playing a vital role in enhancing surgical skills, such as hand–eye coordination in laparoscopy, and practicing surgical scenarios that cannot be easily created using physical models. We describe a new VR simulator for basic training in lapa-roscopy, i.e. SmartSIM, which has been developed using a generic open‐source physics engine called the simulation open framework architecture (SOFA). This paper describes the systems perspective of SmartSIM including design details of both hardware and software components, while highlighting the critical design decisions. Some of the distinguishing features of SmartSIM include: (i) an easy‐to‐fabricate custom‐built hardware interface; (ii) use of a generic physics engine to facilitate wider accessibility of our work and flexibility in terms of using various graph-ical modelling algorithms and their implementations; and (iii) an intelligent and smart evaluation mechanism that facilitates unsupervised and independent learning

Cytotoxicity against A549 Human Lung Cancer Cell Line via the Mitochondrial Membrane Potential and Nuclear Condensation Effects of Nepeta paulsenii Briq., a Perennial Herb

The genus Nepeta belongs to the largest Lamiaceae family, with 300 species, which are distributed throughout the various regions of Africa, Asia, India, and America. Along with other plant families distinguished by their medicinal and therapeutic values, the Nepeta genus of Lameaceae remains relatively valuable. Hence, the phytochemicals of N. paulsenii Briq. were extracted using different plant parts, i.e., leaves, stem, roots, flowers, and the whole plant by using various solvents (ethanol, water, and ethyl acetate), obtaining 15 fractions. Each extract of dried plant material was analyzed by FT-IR and GC-MS to identify the chemical constituents. The cytotoxicity of each fraction was analyzed by MTT assay and mitochondrial membrane potential and nuclear condensation assays against lung cancer cells. Among the ethyl acetate and ethanolic extracts, the flowers showed the best results, with IC50 values of 51.57 μg/mL and 50.58 μg/mL, respectively. In contrast, among the water extracts of the various plant segments, the stem showed the best results, with an IC50 value of 123.80 μg/mL. 5-flourouracil was used as the standard drug, providing an IC50 value of 83.62 μg/mL. The Hoechst 33342 stain results indicated apoptotic features, i.e., chromatin dissolution and broken down, fragmented, and crescent-shaped nuclei. The ethanolic extracts of the flowers showed more pronounced apoptotic effects on the cells. The mitochondrial membrane potential indicated that rhodamine 123 fluorescence signals suppressed mitochondrial potential due to the treatment with the extracts. Again, the apoptotic index of the ethanolic extract of the flowers remained the highest. Hence it can be concluded that the flower part of N. paulsenii Briq. was found to be the most active against the A459 human lung cancer cell line

A prospective cohort study on cognitive and psychological outcomes in COVID-19 ICU survivors at 3 months of follow up

ObjectiveThe Outcomes – Short and Long term in ICU patient with COVID-19 “OUTSTRIP COVID-19” study was initiated to assess overall mortality, physical and psychiatric co-morbidities, reduction in lung function, and the ability to return to work post-ICU discharge with a follow-up period of 2 years in COVID-19 patients admitted to ICUs in Qatar. This paper focuses on the prevalence of cognitive impairment, depression, anxiety, and stress at baseline and 3 months after ICU discharge.MethodsThis prospective cohort study included 100 ICU survivors reviewed at baseline within 7 weeks of ICU discharge, with a 3-month follow-up. Demographics, clinical characteristics, and relevant medical history were collected at baseline. Cognitive outcomes were assessed using the Montreal Cognitive Assessment-Basic (MoCA-B) tool, while psychological outcomes were evaluated using the Depression Anxiety and Stress Scale-21 (DASS-21).ResultsAt baseline, 72% of ICU survivors exhibited mild cognitive impairment, which significantly improved to 56% at 3 months. However, severe cognitive impairment persisted in 20% of survivors at 3 months.For psychological outcomes, the mean depression score remained below 9 (5.64 ± 6.90) at both time points, with no significant change. At baseline, 25% of survivors had clinical depression, which reduced to 16% at 3 months.The mean anxiety score at baseline (9.35 ± 8.50) significantly decreased to 6.51 ± 7.74 (p = 0.002) at 3 months. Anxiety was not reported by 48% of survivors at baseline and this increased to 66% at 3 months. Severe to extremely severe anxiety decreased from 19% to 12% during the same period.The mean stress score at baseline (8.34 ± 8.07) did not significantly change at 3 months. At baseline, 18% experienced stress, which decreased to 12% at 3 months, with 5.3% facing severe to extremely severe stress.ConclusionCOVID-19 ICU survivors experience significant cognitive impairment, anxiety, and stress. While cognitive impairment and anxiety showed improvements at 3 months, depression and stress remained unchanged. These outcomes strongly emphasize the requirement for thorough post-ICU care and comprehensive mental health assistance for individuals recovering from COVID-19. Customized interventions and additional research endeavors are crucial to effectively manage the cognitive and psychological consequences faced by these patients. The exploration of telemonitoring and innovative approaches can offer avenues to enhance the overall quality of life for survivors. Further investigation should encompass extended timeframes to analyze prolonged effects and consider the broader socioeconomic impact

Inoculation With Azospirillum spp. Acts as the Liming Source for Improving Growth and Nitrogen Use Efficiency of Potato

Nitrogen (N) is one of the limiting factors for plant growth, and it is mainly supplied exogenously by fertilizer application. It is well documented that diazotrophic rhizobacteria improve plant growth by fixing atmospheric N in the soil. The present study investigates the nitrogen-fixing potential of two Azospirillum spp. strains using the 15N isotope-dilution method. The two diazotrophic strains (TN03 and TN09) native to the rhizosphere of potato belong to the genus Azospirillum (16S rRNA gene accession numbers LN833443 and LN833448, respectively). Both strains were able to grow on an N-free medium with N-fixation potential (138–143 nmol mg−1 protein h−1) and contained the nifH gene. Strain TN03 showed highest indole acetic acid (IAA) production (30.43 μg/mL), while TN09 showed highest phosphate solubilization activity (249.38 μg/mL) while both diazotrophs showed the production of organic acids. A 15N dilution experiment was conducted with different fertilizer inputs to evaluate the N-fixing potential of both diazotrophs in pots. The results showed that plant growth parameters and N contents increased significantly by the inoculations. Moreover, reduced 15N enrichment was found compared to uninoculated controls that received similar N fertilizer levels. This validates the occurrence of N-fixation through isotopic dilution. Strain TN09 showed higher N-fixing potential than TN03 and the uninoculated controls. Inoculation with either strain also showed a remarkable increase in plant growth under field conditions. Thus, there were remarkable increases in N use efficiency, N uptake and N utilization levels. Confocal laser scanning and transmission electron microscopy showed that TN03 is an ectophyte, i.e., present outside root cells or within the grooves of root hairs, while TN09 is an endophyte, i.e., present within root cells, forming a strong association withroot it. This study confirms that diazotrophic Azospirillum spp. added to potato systems can improve plant growth and N use efficiency, opening avenues for improvement of potato crop growth with reduced input of N fertilizer

Structural modifications in Bermuda grass [Cynodon dactylon (L.) Pers.] ecotypes for adaptation to environmental heterogeneity

IntroductionIt is well known that different ecotypes adopt different mechanisms to survive under environmental stress conditions. In this regard, each ecotype showed different type of modifications for their existence in a specific habitat that reflects to their ecological success.MethodsHere, differently adapted ecotypes of Bermuda grass [Cynodon dactylon (L.) Pers.] were collected to evaluate their differential structural and functional modifications that are specific to cope with environmental stress conditions. The soil that adheres ecotypes roots were highly saline in case of DF-SD (Derawar Fort-Saline Desert), UL-HS (Ucchali Lake-Hyper Saline) and G-SSA (Gatwala-Saline Semiarid) ecotypes. Soils of S- HS (Sahianwala-Hyper Saline), S-SW (Sahianwala-Saline Wetland) and PA-RF (Pakka Anna-Reclaimed Field) were basic (pH 9 to 10). Soils of UL-HS and PA- HS (Pakka Anna-Hyper Saline), KKL-S (Kalar Kahar Lake-Saline), BG-NS (Botanic Garden-Non Saline) and G-SSA were rich in organic matter, and soil of BG-NS and DF-SD were rich in minerals. Anatomical modifications were performed by using the free hand sectioning technique and light microscopy.Results and DiscussionDF-SD is one of the best ecotypes which showed anatomical modifications to cope with environmental changes. These modifications included stem cross-sectional area and leaf sheath thickness that contribute towards water storage, vascular tissues for proficient translocation of solutes and trichomes that provide resistance to water loss. On the other hand, sclerification in root is the only notable modification in the Gatwala Saline Semiarid (G-SSA) ecotype from saline arid habitat where rainfall is not as low as in the Cholistan Desert. Two ecotypes from hyper-saline wetlands, UL-HS and KL-HS showed increased number and size of vascular tissue, central cavity and sclerification in stem which are important for solutes conduction, water loss and salts bulk movement, respectively. The ecotype from reclaimed site was not much different from its counterpart from hyper-saline dryland. Overall, anatomical modifications to maintain water conservation are key mechanisms that have been identified as mediating stress tolerance in C. dactylon ecotypes

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial