Comparison of Magnesium Sulphate and Dexmedetomidine for Attenuation of Stress Response in Patients undergoing Laparoscopic Cholecystectomy under General Anaesthesia by Measuring Biochemical Markers of Stress Response: A Prospective Randomized Study

Background: Laryngoscopy, endotracheal intubation, pneumoperitoneum creation and extubation is stressful event marked by hemodynamic changes during laparoscopic procedures. This increases secretion of many biochemical stress markers for example, cortisol levels, TNF-alpha levels, CRP levels, blood Sugar levels. Aim of the study was to compare magnesium sulphate and dexmedetomidine for attenuation of stress response in patients undergoing laparoscopic cholecystectomy under general anaesthesia by measuring biochemical markers of stress response. Methods: 60 patients, age between 18 to 60 years of either sex, who were undergoing Laparoscopic cholecystectomy randomized into two groups of 30 patients each by computer generated random number. Group M- received magnesium sulphate 50 mg/kg and group D -  received dexmedetomidine 1 µg/kg. Results: The demographic data were comparable in both groups. Cortisol levels rise in both the groups but significantly more in group M than group D at 30 minute (p-value < 0.001) and 4 hours (p-value < 0.001). CRP levels rise in both the groups but significantly more in group M than group D at 30 min (p-value 0.013) and 4 hours (p-value 0.020). Blood sugar levels rise in both the groups but significantly more in group M than group D at 30 min, 4 hours and 24 hours (p-value <0.001). TNF-alpha levels rise in both the groups but significantly more in group M than group D at 30 min (p-value 0.005) and 4 hours (p-value 0.007). Conclusion: We conclude that biochemical stress marker levels (Cortisol levels, TNF-alpha, levels, CRP levels, Blood Sugar levels) were more increased in the magnesium sulphate group compared with the dexmedetomidine group. Heart rate and Mean arterial pressure   were higher in the Magnesium sulphate group than the Dexmedetomidine group. Dexmedetomidine is better than magnesium sulphate in attenuating the stress of surgery in patients undergoing laparoscopic cholecystectomy

Identification of risk factors for malaria control by focused interventions in Ranchi district, Jharkhand, India

Background & objectives: Ranchi, the capital of Jharkhand state is endemic for malaria, particularly the Bundu Primary Health Centre (PHC) is the worst affected. Therefore, a study was initiated during 2009 using remote sensing (RS) and geographical information system (GIS) to identify risk factors responsible for high endemicity in this PHC. Methods: Bundu and Angara in Ranchi district were identified as high and low malaria endemic PHCs based on epidemiological data of three years (2007–09). The habitation, streams, other water body, landform, PHC and village boundary thematic maps were prepared using IRS-P6/LISS III-IV imageries and macro level breeding sites were identified. Digital elevation model (DEM) of the PHCs was generated using Cartosat Stereo Pair images and from DEM, slope map was derived to calculate flat area. From slope, aspect map was derived to indicate direction of water flow. Length of perennial streams, area under rocky terrain and buffer zones of 250, 500 and 750 m were constructed around streams. High resolution remote sensing imageries were used to identify micro level breeding sites. Based on macro-micro breeding sites, six villages from each PHC were selected randomly having combination of different parameters representing all ecotypes. Entomological data were collected during 2010–11 in pre- and post-monsoon seasons following standard techniques and analyzed statistically. Differential analysis was attempted to comprehend socioeconomic and other determinants associated with malaria transmission. Results: The study identified eight risk factors responsible for higher malaria endemicity in Bundu in comparison to Angara PHC based on ecological, entomological, socioeconomic and other local parameters. Conclusion: Focused interventions in integrated vector management (IVM) mode are required to be carried out in the district for better management and control of disease

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Design of control policies for spatially inhomogeneous robot swarms with application to commercial pollination

Abstract — We present an approach to designing scalable, decentralized control policies that produce a desired collective behavior in a spatially inhomogeneous robotic swarm that emulates a system of chemically reacting molecules. Our approach is based on abstracting the swarm to an advectiondiffusion-reaction partial differential equation model, which we solve numerically using smoothed particle hydrodynamics (SPH), a meshfree technique that is suitable for advectiondominated systems. The parameters of the macroscopic model are mapped onto the deterministic and random components of individual robot motion and the probabilities that determine stochastic robot task transitions. For very large swarms that are prohibitively expensive to simulate, the macroscopic model, which is independent of the population size, is a useful tool for synthesizing robot control policies with guarantees on performance in a top-down fashion. We illustrate our methodology by formulating a model of rabbiteye blueberry pollination by a swarm of robotic bees and using the macroscopic model to select control policies for efficient pollination. I

Nephrotic syndrome and Obstetric anesthesia

Renal disorders in pregnancy can be both difficult to diagnose and manage. They are associated with poor maternal and/or fetal outcomes. In pregnancy, proteinuria is common and can range from mild urinary protein elevations to nephrotic levels. The diagnosis of nephrotic syndrome (NS) can be challenging, especially in pregnancy as it can be confused with preeclampsia. NS has an incidence of 0.012%–0.025% in pregnant women. It is diagnosed by the presence of more than 3 g/day of proteins in urine, serum albumin <30 g/dL, generalized edema, hypercholesterolemia, and lipiduria. Proteinuria with hypertension is characterized by the presence of hematuria, red cell casts, raised serum creatinine, and features suggestive of systemic disease. Other causes of proteinuria include preeclampsia, diabetes mellitus (Type 1 and Type 2), Immunoglobulin A nephropathy (Ig A glomerulonephritis), focal and segmental glomerulosclerosis, and lupus nephritis. The maternal risks of NS include acute kidney insult, chronic renal failure, gestational hypertension, preeclampsia, and complications due to hypoalbuminemia. Fetal considerations in NS include fetal growth retardation, prematurity, stillbirth, fetal anasarca, and polyhydramnios. Preconception counseling and immunosuppressive drug therapy can improve overall fetomaternal outcome. We hereby present a unique case of successful anesthetic management of NS in a parturient along with concurrent hypothyroidism and hypertension, for elective cesarean section

Postoperative Analgesia in Ultrasound-Guided 3-in-1 Block versus Fascia Illiaca Compartment Block in Adult Patients Undergoing Lower Limb Orthopaedic Surgeries under General Anaesthesia: A Randomised Clinical Study

Introduction: Three-in-one block and Fascia Illiaca Compartment Block (FICB) are two peripheral nerve block techniques that target the femoral nerve, obturator nerve and lateral femoral cutaneous nerve in a single injection. Both nerve blocks are used to provide anaesthesia and analgesia to the lower limb for various surgical procedures. The use of ultrasonography in peripheral nerve blocks helps to visualise the nerve, needle, and the distribution of the drug in real-time. It, thus, shortens the time of onset of sensory block, decreases performance time, and lowers the required drug doses, and finally increases chances of a favourable outcome from the nerve block. Aim: To compare the postoperative analgesic efficiency of ultrasound-guided 3-in-1 block with FICB in patients undergoing lower limb orthopaedic surgeries under General Anaesthesia (GA). Materials and Methods: A randomised clinical study was conducted at a tertiary care hospital. One hundred and fifty patients were randomly allocated to two groups, 3-in-1 block group or FICB. Both groups received the respective blocks after surgery before extubation. Postoperatively, Visual Analog Scale (VAS) scores were evaluated hourly for first 6 hours and 2 hourly thereafter until rescue analgesia was instituted. Time period from giving the block to giving rescue analgesia was noted as duration of analgesia. Injection diclofenac 1.5 mg/kg Intravenous (IV) was given when VAS value reached ≥4. Results: On analysis of 150 patients, divided into 3-in-1 block group (N=75) and FICB Group(N=75); mean age: 53.29±8.69 years; the VAS scores at 2 to 18 hours, 20 hours, and 22 hours after performing the blocks were significantly less in the 3-in-1 block group compared to FICB group. Also, the mean time (hours) for first rescue analgesia in FICB group (3.49±0.53) was earlier compared with 3-in-1 block group (7.35±0.51). Conclusion: A 3-in-1 block provides effective and prolonged postoperative analgesia in comparison to FICB

Infraclavicular brachial plexus block: Comparison of posterior cord stimulation with lateral or medial cord stimulation, a prospective double blinded study

Background: Infraclavicular approach to the brachial plexus sheath provides anesthesia for surgery on the distal arm, elbow, forearm, wrist, and hand. It has been found that evoked distal motor response or radial nerve-type motor response has influenced the success rate of single-injection infraclavicular brachial plexus block. Aim: We conducted this study to compare the extent and effectiveness of infraclavicular brachial plexus block achieved by injecting a local anesthetic drug after finding specific muscle action due to neural stimulator guided posterior cord stimulation and lateral cord/medial cord stimulation. Methods: After ethical committee approval, patients were randomly assigned to one of the two study groups of 30 patients each. In group 1, posterior cord stimulation was used and in group 2 lateral/medial cord stimulation was used for infraclavicular brachial plexus block. The extent of motor block and effectiveness of sensory block were assessed. Results: All four motor nerves that were selected for the extent of block were blocked in 23 cases (76.7%) in group 1 and in 15 cases (50.0%) in group 2 (P:0.032). The two groups did not differ significantly in the number of cases in which 0, 1, 2, and 3 nerves were blocked (P>0.05). In group 1, significantly lesser number of patients had pain on surgical manipulation compared with patients of group 2 (P:0.037). Conclusion: Stimulating the posterior cord guided by a nerve stimulator before local anesthetic injection is associated with greater extent of block (in the number of motor nerves blocked) and effectiveness of block (in reporting no pain during the surgery) than stimulation of either the lateral or medial cord