A randomised clinical study to compare the haemodynamic effects of etomidate with propofol during induction of general anaesthesia

Background: Induction agents are frequently associated with changes in heart rate and blood pressure and various adverse effects. Since the introduction of general anaesthesia, no ideal induction agent has yet been discovered in term of providing a stable hemodynamic with fewer adverse effects. This prospective randomized clinical study was conducted to compare propofol and etomidate for their effect on hemodynamic and various adverse effects on patients scheduled for elective surgeries during the induction of general anesthesia.Methods: 50 patients of ASA I and II of age group 18-60 years scheduled for elective surgeries under general anaesthesia were randomly assigned in two groups (n=25) receiving etomidate (0.3 mg/kg) in group E and propofol (2.5 mg/kg) in group P as an induction agent. Hemodynamic parameters were recorded at various time intervals. Any adverse effect pain on injection and myoclonus was carefully watched. VAS score was recorded for pain on injection. Statistical analysis was done using software (SPSS IBM version 20). P value was considered significant if (p0.05). Patients in propofol group showed significant fall of  systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and compared to etomidate (P<0.05).) Pain on injection was more in propofol group (P=0.021), While incidence of myoclonus activity was higher in etomidate group (P=0.0027).Conclusions: Etomidate is a better induction agent over propofol as it provides more hemodynamic stability and less pain on injection as compared to propofol

Leaf Concentrate Fortification of Antenatal Protein- Calorie Snacks Improves Pregnancy Outcomes

Ready-to-eat (RTE) snacks are routinely distributed to pregnant women in India. These provide protein and calories but are low in micronutrients. We investigated whether RTE snacks fortified with leaf concentrate (LC) could improve pregnancy outcomes, including maternal haemoglobin (Hb) concentrations and infants\u2019 birthweight. This randomized controlled two-arm trial was conducted over 18 months: control (sRTE) group received standard 120 g RTE snack (102 g wheat flour, 18 g soya flour); intervention (lcRTE) group received the same snack fortified with 7 g LC. The study was conducted in Jaipur, Rajasthan, India. One hundred and five pregnant women aged 18-35 years were studied. Among the 105 women randomized to the two arms of the trial, 2 (1.9%) were severely anaemic (Hb 646.0 g/dL); 55 (53.4%) were moderately anaemic (Hb 6.0-8.0 g/ dL); 34 (33.0%) were mildly anaemic (Hb 8.6-10.9 g/dL); and 12 (11.7%) were not anaemic (Hb 6511.0 g/dL). In the final month of pregnancy, 83.0% (39/47) of women in the sRTE group had Hb 648.5 g/dL compared to 37.8% (17/45) in the lcRTE group (p&lt;0.001). After adjustment for age and baseline Hb concentration, the difference in Hb concentrations due to LC fortification was 0.94 g/dL (95% CI 6.8-12.0; p&lt;0.001). Mean live birthweight in the lcRTE group was 2,695 g (SD 325 g) compared to 2,545 g (297 g) in the sRTE group (p=0.02). The lcRTE snacks increased infants\u2019 birthweight by 133.7 g (95% CI 7.3-260.2; p=0.04) compared to sRTE snacks. Leaf concentrate fortification of antenatal protein-calorie snacks in a low-income setting in India protected against declining maternal haemoglobin concentrations and increased infants\u2019 birthweight when compared with unfortified snacks. These findings require replication in a larger trial

Challenges and Policy Implications for Low-Carbon Pathway for Kerala: An Integrated Assessment Modelling Approach

As India has embarked on the journey of fulfilling its net-zero emissions target by 2070, the states of India are steering up too to meet the target. The per capita emissions for Kerala are lower than the national average. The energy sector is the main contributor to GHG emissions in Kerala. A major share of 76 percent of electricity power is purchased from other states. When other states undergo an energy transition, the availability of imported electricity may be a challenge for Kerala. Hence, the State needs to harness its own potential for renewable energy sources and incorporate improved technologies leading to energy efficiencies in all sectors. Accordingly, this paper has undertaken integrated modelling (an approach with the primary objective of quantifying the gains and losses of low-carbon transitions and their financial implications). The integrated modelling approach involves soft linking of the macroeconomic top-down CGE model and bottom-up (Messageix) energy model. The integrated model is a recursive dynamic model with multiple periods of time. In this paper, we have undertaken a policy scenario in which (i) the imports of fossil-based electricity from other states of India are restricted to Kerala, (ii) 50 percent of the existing potential of renewable electricity by various modes is achieved in Kerala and the rest of India, and (iii) energy efficiency in all energy sectors is increased to the tune of 2.5 percent per annum along with 1 percent total productivity growth per annum in all sectors of the Kerala and India economies. Our results show that the reduced import of fossil fuel electricity without any policy intervention to strengthen the renewable energy sector would hamper growth. On the other hand, investment in renewable energy to facilitate a complete energy transition with self-reliance on energy for the state would expand the economy, increase the returns to the factors of production, and increase employment. The key message that comes out from our simulation is that the energy transition towards renewable energy will not take place without complementarity support polices towards this sector. Our observation is that energy transition may be a win‒win situation in the sense that growth and employment creation may be positive with suitable policy intervention. It must be mentioned that the paper focused only on the energy sector. The developed model may be used in the future to focus on the economic implications of other policies, such as carbon sequestration

A randomised clinical study to compare the haemodynamic effects of etomidate with propofol during induction of general anaesthesia

Background: Induction agents are frequently associated with changes in heart rate and blood pressure and various adverse effects. Since the introduction of general anaesthesia, no ideal induction agent has yet been discovered in term of providing a stable hemodynamic with fewer adverse effects. This prospective randomized clinical study was conducted to compare propofol and etomidate for their effect on hemodynamic and various adverse effects on patients scheduled for elective surgeries during the induction of general anesthesia.Methods: 50 patients of ASA I and II of age group 18-60 years scheduled for elective surgeries under general anaesthesia were randomly assigned in two groups (n=25) receiving etomidate (0.3 mg/kg) in group E and propofol (2.5 mg/kg) in group P as an induction agent. Hemodynamic parameters were recorded at various time intervals. Any adverse effect pain on injection and myoclonus was carefully watched. VAS score was recorded for pain on injection. Statistical analysis was done using software (SPSS IBM version 20). P value was considered significant if (p&lt;0.05).Results: Demographic variables were comparable in both the groups. Hemodynamic parameters at baseline were comparable. There were no statistically significant differences among groups E and P in terms of heart rate (HR) (P&gt;0.05). Patients in propofol group showed significant fall of  systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and compared to etomidate (P&lt;0.05).) Pain on injection was more in propofol group (P=0.021), While incidence of myoclonus activity was higher in etomidate group (P=0.0027).Conclusions: Etomidate is a better induction agent over propofol as it provides more hemodynamic stability and less pain on injection as compared to propofol

Leaf concentrate as an alternative to iron and folic acid supplements for anaemic adolescent girls: a randomised controlled trial in India

Abstract Objective: Despite public health campaigns based on Fe and folic acid supplements, Fe-deficiency anaemia remains highly prevalent among women in India. We investigated leaf concentrate as an alternative to Fe and folic acid supplements for treating anaemia in adolescent girls. Design: Randomised controlled two-arm trial over 3 months: one group received daily Fe and folic acid (IFA; 60 mg Fe, 500 mg folic acid); the other daily leaf concentrate (LC; 5 mg Fe, 13 mg folic acid). Hb concentration, mean cell volume, serum Fe, serum ferritin and total Fe-binding capacity were measured pre-and post-intervention. Setting: Jaipur, India. Subjects: One hundred and two adolescent girls aged 14-18 years. Results: Of the 102 girls randomized to the two arms of the trial, four (3?9 %) were severely anaemic (Hb , 7 g/dl), twenty-eight (27?5 %) were moderately anaemic (Hb $7 g/dl, ,10 g/dl) and seventy (68?6$ 10 g/dl, ,12 g/dl). In the IFA group, eleven girls (20?4 %) withdrew due to side-effects, compared with one girl (2?1 %) in the LC group (P 5 0?005). Total losses to followup were 14/54 in the IFA group and 2/48 in the LC group. At the end of the trial, none of the eighty-six remaining girls were severely anaemic, nine (10?5 %) were moderately anaemic and twenty-six (30?2 %) were mildly anaemic; fifty-one (59?3 %) had normal Hb levels ($12 g/dl). After adjustment for baseline values, LC was as effective as IFA in improving serum Fe parameters and treating anaemia. Conclusions: Leaf concentrate is an effective, and more palatable, alternative to Fe and folic acid supplements for treating anaemia in adolescent girls