Comparative study of perioperative morbidities of the conventional and ultrasound-guided suprapubic catheterization in the patients of urinary retention during emergency

Background: Urinary retention is one of the common urological emergencies and conventional ‘blind’ SPC frequently used comfortable as well superior procedure for patients. During conventional SPC, the distended bladder is identified by palpation or percussion without proper attention to intervening bowel segment and other structures. However, the recently published data suggests that if, ultrasound is used during SPC, and it identifies not only bladder but also intervening bowel segment which complications. Therefore, the objective of this study was to assess and compare the perioperative complications of both methods.Methods: This prospective study was conducted between years November’2017 to June’2019. Sixty patients (n=60) of urinary retention were randomized to undergo ultrasound guided or conventional SPC procedures. Patients were divided into two equal groups of 30 patients in US-SPC (Group-A) and C-SPC (Group-B). After either SPC, the patients were closely observed for development of complications.Results: Overall, the patients had mean age of 53.87+21.418 and 53.87+21.418 years in C-SPC and US-SPC group, respectively. Mean operative time and subsequent initial urine drainage were almost equal in both groups. However, in C-SPC group, 5(16.7%) patients developed complications in the form of 03 misplaced catheters outside bladder, 01 into retro pubic space and another 01 into rectum. All patients in Group-A required ultrasound guided revision of SPC compared to none in Group-B.Conclusion: Overall, the ultrasound-guided SPC (US-SPC) is safer procedure compared to conventional ‘blind’ C-SPC in relieving urinary retention in emergency, thus it should be recommended procedure whenever need arise for SPC procedure

Association of glycosylated hemoglobin with mortality of patients in intensive care unit: a prospective observation study

INTRODUCTION: Glycated hemoglobin (HbA1c) is the most commonly used clinical test to estimate mean blood glucose during the past 2 to 3 months. In addition to diagnostic purposes, the HbA1c level also predicts diabetes complications. The aim of this study was to determine the association of glycosylated hemoglobin with mortality in intensive care unit (ICU). MATERIALS AND METHODS: A prospective observational study was conducted in the ICU with a total of 281 patients. These patients were classified into two groups based on their HbA1c levels: one group with HbA1c level < 6.5 % and another group with HbA1c level ≥ 6.5%. The following data were collected during the study period. Clinical details and scores such as the APACHE II score (Acute Physiology and Chronic Health Assessment) and daily SOFA (Sequential Organ Failure Assessment) scores for the period of stay in the ICU. ICU morbidities as the need for mechanical ventilation, the use of inotropes / vasopressors, the length of stay in the ICU, and the requirement of renal replacement therapy (RRT). The outcome measures were ICU mortality and 28-day mortality. RESULTS: Of 281 patients admitted to the ICU for more than 48 hours, 157 patients (55.9%) had HbA1c levels < 6.5%, with the remaining 124 (44.1%) had levels ≥ 6.5%. ICU mortality was present in 107 (38.07%) cases. ICU mortality was higher in patients in the HbA1c ≥ 6.5% group compared to the HbA1c < 6.5% group. This was statistically significant (p-value <0.001). Mortality at 28 days was observed in 125 (44.48%) cases. Patients with an HbA1c value ≥ 6.5%, there was a higher mortality at 28 days compared to patients with an HbA1c value < 6.5%. This was found to be statistically significant (p-value <0.001). CONCLUSIONS: The study showed that glycated hemoglobin levels (HbA1c) levels ≥ 6.5% had a significantly higher mortality rate compared to the patient in the HbA1c level < 6.5%

Correlation of vitamin D deficiency with mortality in critically ill patients admitted to the intensive care unit

INTRODUCTION: Vitamin D, which is a fat-soluble vitamin, plays a key role in enhancing the intestinal absorption of calcium, magnesium and phosphate. In severely ill patients, vitamin D can adversely affect immune and metabolic functions, contributing to poorer outcomes. The aim of this study was to correlate vitamin D with mortality in critically ill patients. MATERIALS AND METHODS: prospective observational study was conducted, involving 162 patients in an intensive care unit (ICU). 162 patients were divided into two groups according to vitamin D Deficiency Group levels ≤ 20 ng/ml and Non vitamin D deficiency group levels <20 ng / ml and non-vitamin D deficiency group B levels > 20ng/ml. Data collected during the study included the APACHE II (acute physiology and chronic health evaluation) score at ICU admission, SOFA (sequential organ failure assessment) scores throughout the ICU stay, the need for mechanical ventilation, inotropic support, length of stay in ICU, and ICU outcomes, which were classified as either discharge or mortality. RESULTS: Of the 162 patient admitted to ICU, the prevalence of vitamin D deficiency in this study was 140 (86.4%) and nondeficient 22 (13.6%). The mortality rate in the vitamin D deficient group was 40% compared to 18.18% in the nondeficient group. The difference in mortality in both groups for mortality was statistically significant (p-value < 0.05). Vitamin D deficiency was not associated as an independent risk factor for ICU mortality [Odds ratio (OR) 1.220, 95% CI (0.825- 1.805) (p-value -0.320)]. CONCLUSIONS: The vitamin D-deficient group had a significantly higher mortality rate compared to the patient in the nondeficient group. But vitamin D deficiency was not found to be an independent risk factor for mortality

Anaesthetic concerns for large intracranial cyst excision: expect the unexpected!

Neurosurgical procedures in infants poses various challenges such as difficulty in venous cannulation, securing invasive vascular lines, difficult airway, controlling intra-cranial tension, managing large fluid shifts to positioning- related issues and temperature maintenance. We hereby present an case of a large intracranial space occupying lesion, suspected to be a hydatid cyst, which later turned out to be an infected ventricular cyst and intraoperative problems. A thorough preparation prior to operation of infected cystic lesion of the brain is required including anticipation of massive blood loss and its management. A slow decompression of the large cystic lesion should be done