Does dual-energy abdominal computed tomography increase the radiation dose to patients : a prospective observational study

Purpose: The aim of our study was to compare single-energy (SECT) and dual-energy (DECT) abdominal computed tomography (CT) examinations in matched patient cohorts regarding the differences in effective radiation dose (ERD) and image quality performed in a third-generation dual-source computed tomography (DSCT) scanner. Material and methods: Our study included 100 patients, who were divided randomly into 2 groups. The patients included in Group A were scanned by SECT, and Group B members were scanned by DECT. Volume CT dose index (CTDIvol), dose length product (DLP), and ERD for venous phase acquisition were recorded in each patient and were normalised for 40 cm. Analyses were performed by using statistical software (SPSS version 20.0 for windows), and Bonferroni correction for multiple comparisons was applied for p-values and confidence intervals. Results: Average ERD based on DLP values normalised for 40 cm acquisition were obtained for both Group A and Group B. The mean ERD for Group A was 11.89 mSv, and for group B it was 6.87 mSv. There was a significant difference in these values between Group A and Group B as shown by a p-value of < 0.001. On subjective and objective analysis, there was no statistically significant difference in image quality between the 2 groups. Conclusions: The protocols in third-generation DSCT using dual-energy mode resulted in significant reductions in the effective radiation dose (by approximately 58%) compared to SECT in routine abdominal examination in matched cohorts. Therefore, the quantitative imaging potential of DECT can be utilised in needed patients with decreased radiation dose in third-generation DSCT

β

A number of xenobiotic-inducible cytochrome P450s (CYPs) are now known to be localized in the mitochondrial compartment, though their pharmacological or toxicological roles remain unclear. Here, we show that BNF treatment markedly inhibits liver mitochondrial O2 consumption rate (OCR), ADP-dependent OCR, and also reserve OCR, in wild-type mice but not in Cyp1a1/1a2(−/−) double knockout mice. BNF treatment markedly affected mitochondrial complex I and complex IV activities and also attenuated mitochondrial gene expression. Furthermore, under in vitro conditions, BNF treatment induced cellular ROS production, which was inhibited by mitochondria-targeted antioxidant Mito-CP and CYP inhibitor proadefin, suggesting that most of the ROS production was intramitochondrial and probably involved the catalytic activity of mitochondrial CYP1 enzymes. Interestingly, our results also show that the AHR antagonist resveratrol, markedly attenuated BNF-induced liver mitochondrial defects in wild-type mice, confirming the role of AHR and AHR-regulated CYP1 genes in eliciting mitochondrial dysfunction. These results are consistent with reduced BNF-induced mitochondrial toxicity in Cyp1a1/1a2(−/−) mice and elevated ROS production in COS cells stably expressing CYP1A1. We propose that increased mitochondrial ROS production and respiratory dysfunction are part of xenobiotic toxicity. Resveratrol, a chemopreventive agent, renders protection against BNF-induced toxicity

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Midazolam as an adjuvant to intrathecal lignocaine: A prospective randomized control study

Context: Unfortunately in the past decade, phenomenon of transient neurologic symptoms (TNS) cast doubts on the use of lignocaine for spinal anesthesia. Intrathecal midazolam has been proved to have its role in relieving neuropathic pain. We attempted to study the role of midazolam as an adjuvant to intrathecal lignocaine. Aims: The primary objective of the study was to evaluate the effect of intrathecal midazolam as an adjuvant to spinal lignocaine in terms of quality and duration of spinal sensory blockade. The secondary objectives are to study the effect on hemodynamics and the incidence of TNS. Settings and Design: A prospective randomized control double-blinded study in American Society of Anesthesiology I and II surgical population. Materials and Methods: Hundred healthy adult patients scheduled for elective infraumbilical surgery were randomly assigned to group A patients received spinal anesthesia with 1.5 ml of 5% lignocaine heavy with 0.4 ml of 0.9% saline and group B (control group) received spinal anesthesia with 1.5 ml of 5% heavy lignocaine with 0.4 ml of preservative-free 0.5% midazolam. Statistical Analysis Used: Z test for study parameters and analysis of variance was used for hemodynamic parameters in the same group. P < 0.05 was considered statistically significant. Results: Midazolam resulted in improved quality of sensory blockade in terms of early onset, increased duration of effective analgesia, and delayed two segment regression time and also decreases the incidence of TNS with intrathecal lignocaine. Conclusions: Midazolam is an effective adjuvant to intrathecal lignocaine

Ultrasound evaluation of effect of different degree of wrist extension on radial artery dimension at the wrist joint

Context: Successful arterial cannulation requires wide and patent arterial lumen. A recent study has shown that success rate of radial arterial cannulation at first attempt is more at 45° angle of wrist extension in both young and elderly patients. No study has reasoned whether these high success rates at 45° is because of less compression of the radial artery at this particular angle of wrist extension. Hence, we attempted to study whether the radial artery dimensions changes with increasing angles of wrist extension in young, healthy female volunteers using ultrasound examination. Aim: To investigate the effect of increasing angle of wrist extension of 0, 15, 30, 45, 60, and 75° on radial artery dimensions at the level of the wrist joint using ultrasound examination. Settings and Design: A prospective single blinded study in volunteers. Subjects and Methods: Sonographic measurements of radial artery dimension at the wrist level were performed in 48 young, healthy female subjects. Height (anteroposterior in mm), width (mediolateral in mm) and depth (skin to artery) were measured at wrist extension of 0, 15, 30, 45, 60, and 75°. The dimensions at each angle are compared with 0° as the control and statistical analysis done. Statistical Analysis: One-way analysis of variance test. Results: No statistically significant change in dimension of the radial artery is observed with increasing angle of wrist extension. Conclusion: Ultrasound evaluation showed that increasing angle of wrist extension does not significantly change the dimensions of radial artery at the wrist joint level in young healthy female volunteers

Ultrasound assessment of subglottic region for estimation of appropriate endotracheal tube size in pediatric anesthesia

Background and Aims: Endotracheal tube (ETT) selection in pediatric patients is mainly done with the age, height, or weight-based formula. We compared ultrasound assessment of the subglottic area to predict the outer diameter of the ETT, with that of modified Cole's formula. The aim of the study is to compare the appropriateness of uncuffed ETT selection based on modified Cole's formula with that of ultrasound assessment method of subglottic diameter in children undergoing surgical procedures under general anesthesia. Material and Methods: This is a prospective, randomized, parallel group study. One hundred and fifty American Society of Anesthesiologists I and II patients of age 2–6 years were randomly allotted into two groups: Group A - ETT selection based on ultrasound assessment of subglottic diameter. Group B - ETT selection based on modified Cole's formula. The study parameters are the internal diameter and external diameter (OD) of the predicted ETT by the two methods and that of the appropriate size ETT used. Results: The incidence of appropriate tube selection was 74.7% in the ultrasound based group while it was 45.3% in the modified Cole's formula group. There was a strong correlation between OD of the optimal ETT used and the ultrasound assessed subglottic diameter. Bland–Altman analysis of OD of appropriately sized ETT and subglottic diameter by ultrasound assessment has a bias of 0.02 mm with limits of agreement of +1.78 to −1.74. Conclusion: Ultrasonographic assessment of the subglottic diameter at the cricoid region is a better tool in predicting the appropriate size uncuffed ETT than modified Cole's formula

Anesthetic experience of two consecutive caesarean sections in a parturient with congenitally corrected transposition of great arteries and complete heart block: A case report

We describe the clinical course of two subsequent caesarean sections in the same parturient with congenitally corrected transposition of great arteries (CCTGA) complicated with complete heart block. CCTGA represents <1% of all forms of congenital heart diseases. In such patients, the hemodynamic effects of pregnancy and surgery may trigger systemic ventricular failure. In these parturients, ventricular dysfunction will also progress rapidly with subsequent pregnancies. The literature review showed no evidence describing the anesthetic management of these high-risk parturients. We used combined spinal epidural anesthesia uneventfully for both the caesarean sections in this patient. This case report will discuss the details of this rare congenital heart disease and the anesthetic management

The effect of subcutaneous infiltration of nitroglycerin on the arterial cannulation under ultrasound guidance: a prospective randomized study

Background: Ultrasound (US) guidance has not improved the success rate of radial artery cannulation to nearly 100%. This explains the other factors that can be improved to increase the success rate. This study analyses the effect of subcutaneously infiltrated nitroglycerin on the first-attempt success rate of the US-guided short-axis method of radial artery cannulation. Patients and Methods: Two hundred and fourteen patients were randomized into two groups. In group N, 250 mcg nitroglycerin and 10 mg lignocaine were infiltrated subcutaneously at the cannulation site of the radial artery. Whereas in the control group (group S), the subjects received saline and 10 mg of lignocaine. The measured outcomes were the first-attempt success rate, cannulation time, and radial artery diameter changes. All cannulations were carried out with US guidance and employed the short-axis method. Results: One hundred and ninety-eight patients were analyzed. We found significant differences in both first-attempt success rates (P < 0.001) and decreased cannulation time (6.09 ± 2.08 vs. 3.33 ± 2.18 min, P < 0.001) in group N. The mean differences in the radial artery diameter were also significantly larger in group N at the puncture site (25.0 ± 19.5 vs. 1.9 ± 13.1 mm, P < 0.001) and at the radial fossa (23.1 ± 12.67 vs. 8.4 ± 6.5 mm, P < 0.001). Conclusion: Subcutaneous infiltration of nitroglycerin at the puncture site increases the first-attempt success rate of the US-guided short-axis method of radial arterial cannulation. Furthermore, it also decreases the cannulation time and increases the radial artery diameter

Ultrasonically promoted synthesis of N-benzylmorpholine under polymer-supported phase-transfer catalysis – a kinetic study

45-52Kinetics of synthesis of N-benzylmorpholine has been studied by carrying out the reaction of morpholine with benzyl bromide using aqueous potassium hydroxide and catalyzed by a newly synthesized polymer supported mono-site phase transfer catalyst viz., polymer supported N-benzyl-N-ethyl-N-isopropylpropan-2-aminium bromide (PSPTC) under ultrasonic (40 kHz, 300 W) assisted organic solvent conditions. The pseudo first-order kinetic equation has been applied to describe the overall reaction. Under ultrasonication (40 kHz, 300 W) in a batch reactor, the overall reaction rate has been observed to be greatly enhanced than that without ultrasound. The phenomenon for the dependence of the reaction rate on the amount of PSPTC and ultrasonication have been explained