Accidental injection of lignocaine with adrenaline in subarachnoid space: a case report

Drug errors are very common in medical field especially in anaesthesia where it’s the game of drugs. Here, we are presenting a case in which accidentally we injected lignocaine with adrenaline in place of heavy bupivacaine. Patient was of geriatric age group and posted for lower limb surgery under combined spinal epidural anaesthesia after placement of epidural catheter lumber puncture was done and 3ml of lignocaine with adrenaline was injected. After this patient develop complete sensory, motor blockade with hypotension. Level of block was up to T12 level patient was monitored for signs and symptoms of ransient neurologic syndrome (TNS) and anterior spinal artery syndrome for 24 hours. After 24 hours patient develop no complications and posted for surgery under general anaesthesia.so we have to be very careful about the labelling of drugs

Successful Ablation of Antero-septal Accessory Pathway in the Non-Coronary Cusp in a Child

A 15-year-old boy with Wolff-Parkinson-White syndrome underwent an electrophysiology study for symptoms of palpitations and persistence of pre-excitation during peak exercise. He was detected to have right antero-septal accessory pathway with relatively long effective refractory period and no inducible tachycardia. He had only transient normalization with cryoablation. Eight months later, he presented again with two episodes of seizures with preceding palpitations. Neurology evaluation was unremarkable with a normal electroencephalogram. In view of his symptoms in association with evidence of pre-excitation, he underwent a second electrophysiology study with ablation. Cryoablation in the anterior septum again achieved only transient normalization. Mapping in the non-coronary cusp identified an earliest accessory pathway potential. RF ablation was performed in the non-coronary cusp with immediate normalization of his electrocardiogram. At 6 month follow-up, he continues to have no pre-excitation on his EKG. Ablation of the anteroseptal accessory pathway in the non-coronary cusp can be safely performed in patients' refractory to conventional ablation sites and techniques

Arrhythmias and Sudden Death among Older Children and Young Adults Following Tetralogy of F allot Repair in the Current Era: Are Previously Reported Risk Factors Still Applicable?

Background Young adult patients (pts) with repaired tetralogy of F allot ( TOF ) remain at risk for arrhythmias ( A r) and sudden cardiac death ( SCD ). Based on past studies with earlier pt subsets, A r/ SCD events were associated with right ventricular ( RV ) systolic pressures >60 mm Hg, outflow tract gradients >20 mm Hg, and QRS duration >180 ms. However, there are limited recent studies to evaluate these risk factors in the current patient generation. Methods Patients with TOF followed over the past 50 years were grouped by presence of any arrhythmias (group 1), absence of arrhythmias (group 2), and presence of SCD or significant ventricular arrhythmias (group 3) and correlated with current pt age, gender, age at repair, repair types, echocardiogram, cardiac magnetic resonance imaging, electrocardiogram/ H olter, hemodynamics, and electrophysiology findings. Results Of 109 pts, 52 were male aged 17–58 years. Of these, 59 (54%) had A r, two of whom had SCD . These 59 pts were chronologically older at the time of analysis, with repair at an older age and wider QRS duration (78–240, mean 158 ms) when compared with those without A r. However, there was no correlation with surgical era, surgical repair, gender, RV pressure >60 mm Hg, right ventricular outflow tract gradient >20 mm Hg, or RV end‐diastolic volume on CMRI . Conclusions A r/ SCD risk continues to correlate with repair age and advancing pt age. QRS duration is longer in these patients but at a shorter interval (mean 158 ms) and less RV pressure (mean 43 mm Hg) than previously reported. In the current TOF patient generation, neither surgical era, type of repair, RV outflow gradient nor RV volume correlate with A r/ SCD . Electrophysiologic testing to verify and identify arrhythmias remains clinically effective.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108615/1/chd12153.pd

Evaluation of Phyto Chemical Biochemical and In Vitro Antioxidant Potential of Angelica Glauca Grown at High Altitude Areas of Western Himalayas

Angelica glauca Edgew is an important medicinal and aromatic herb (family Apiaceae). The roots of A. glauca commonly used as spices by local peoples. In the present study, the phytochemical constituents, biochemical parameters and, in-vitro antioxidant activity of A. glauca roots collected from the Himalayan region have been studied. For preliminary phytochemical analysis, the hydroalcoholic and aqueous root extract of Angelica glauca were screened for the presence of carbohydrates, protein, alkaloids, glycosides, sterols, triterpenes, saponin, tannins, phenols, flavonoids, and coumarin. The biochemical parameter and in-vitro antioxidant potential of Angelica glauca were analysed by using standard methods. Phytochemical analysis of extract showed major classes of phytochemicals constituents such as carbohydrates, protein, alkaloids, glycosides, sterols, triterpenes, saponin, tannins, phenols, flavonoids, and coumarin. The results from the current study demonstrated that A.glauca roots contained carbohydrate (21±0.72 %), crude protein (12.7±0.31 %), total ash (3.86±0.034 %), dietary fiber (18.9±0.14 %), total fat (4.5±0.38 %) and ascorbic acid (68.5±0.19mg/100g). The hydroalcoholic extract showed the highest quantity of total phenol, total flavonoids, and total tannin content compared to aqueous extract. The hydroalcoholic extract exhibited high DPPH radical scavenging activity (IC50=68.1±0.34 µg/ml). The result showed that A.glauca roots have high nutritional and antioxidant potential. Hence the plant can be used as a nutraceutical and natural antioxidant

Central Venous Catheter-Associated Pericardial Tamponade in a 6-Day Old: A Case Report

Introduction. Pericardial effusion (PCE) and tamponade can cause significant morbidity and mortality in neonates. Such cases have been reported in the literature in various contexts. Case Presentation. A 6-day old neonate with meconium aspiration syndrome and persistent pulmonary hypertension of newborn on high frequency oscillator ventilation and inhaled nitric oxide was referred to our hospital with a large pericardial effusion causing hemodynamic compromise. Prompt pericardiocentesis led to significant improvement in the cardio-respiratory status and removal of the central line prevented the fluid from reaccumulating. Cellular and biochemical analysis aided in the diagnosis of catheter related etiology with possibility of infusate diffusion into the pericardial space. Conclusion. We present this paper to emphasize the importance of recognizing this uncommon but serious complication of central venous catheters in intensive care units. We also discuss the proposed hypothesis for the mechanism of production of PCE

Post spinal anaesthesia shivering- incidence and associated risk factors in patients undergoing lower limb and abdominal surgeries

Background: This study was conducted to evaluate the incidence of shivering and likely associated risk factors following spinal anaesthesia in patients undergoing lower abdominal and lower limb surgeries.Methods: The present study was conducted in MMIMSR, Department of anaesthesia from December 2016 to September 2018. It was an observational study which was conducted over a period of 2 years. Patients who were scheduled to undergo elective lower abdominal and lower limb surgeries under spinal anaesthesia were included in study.Results: The present study depicts a high incidence of post spinal shivering, which was 42.8%. Majority of the patients belonged to the young age group between 20-30 years. The mean time of onset of shivering, was around 25 mins. Duration of shivering was observed between 15-75 minutess with a mean of 43.75 and SD±19.39.Conclusions: Shivering is one of the distressing complications of spinal block, which may be deleterious to the patients with poor cardio-respiratory reserve

Truncated hemoglobin, HbN, is post-translationally modified in Mycobacterium tuberculosis and modulates host-pathogen interactions during intracellular infection

Mycobacterium tuberculosis (Mtb) is a phenomenally successful human pathogen having evolved mechanisms that allow it to survive within the hazardous environment of macrophages and establish long term, persistent infection in the host against the control of cell-mediated immunity. One such mechanism is mediated by the truncated hemoglobin, HbN, of Mtb that displays a potent O2-dependent nitric oxide dioxygenase activity and protects its host from the toxicity of macrophage-generated nitric oxide (NO). Here we demonstrate for the first time that HbN is post-translationally modified by glycosylation in Mtb and remains localized on the cell membrane and the cell wall. The glycan linkage in the HbN was identified as mannose. The elevated expression of HbN in Mtb and M. smegmatis facilitated their entry within the macrophages as compared with isogenic control cells, and mutation in the glycan linkage of HbN disrupted this effect. Additionally, HbN-expressing cells exhibited higher survival within the THP-1 and mouse peritoneal macrophages, simultaneously increasing the intracellular level of proinflammatory cytokines IL-6 and TNF-α and suppressing the expression of co-stimulatory surface markers CD80 and CD86. These results, thus, suggest the involvement of HbN in modulating the host-pathogen interactions and immune system of the host apart from protecting the bacilli from nitrosative stress inside the activated macrophages, consequently driving cells toward increased infectivity and intracellular survival

Quantitative proteomic changes in LPS-activated monocyte-derived dendritic cells : a SWATH-MS study

We would like to thank Fiona Cooke for her help with collection of blood samples. We wish to thank the Wellcome Trust for funding the purchase of the TripleTOF 5600+ mass spectrometer (grant number 094476/Z/10/Z) and their Institutional Strategic Support Fund (grant number 097831/Z/11/Z) for funding a PhD studentship (to D.W.-M.). This work was also supported by Arthritis Research UK (grant number 21261).Dendritic cells are key immune cells that respond to pathogens and co-ordinate many innate and adaptive immune responses. Quantitative mass spectrometry using Sequential Window Acquisition of all THeoretical fragment-ion spectra-Mass Spectrometry (SWATH-MS) was performed here to determine the global alterations in monocyte-derived dendritic cells (moDCs) in response to stimulation with lipopolysaccharide (LPS). A moDC library of 4,666 proteins was generated and proteins were quantified at 0, 6 and 24 h post-LPS stimulation using SWATH-MS. At 6 h and 24 h post-LPS exposure, the relative abundance of 227 and 282 proteins was statistically significantly altered (p-value≤0.05), respectively. Functional annotation of proteins exhibiting significant changes in expression between the various time points led to the identification of clusters of proteins implicated in distinct cellular processes including interferon and interleukin signalling, endocytosis, the ER-phagosome pathway and antigen-presentation. Major histocompatibility complex (MHC) class I proteins were highly upregulated at 24 h, in SWATH-MS, whilst MHC class II proteins exhibited comparatively less change over this period. This study provides new detailed insight into the global proteomic changes that occur in moDCs during antigen processing and presentation and further demonstrates the potential of SWATH-MS for the quantitative study of proteins involved in cellular processes.Publisher PDFPeer reviewe

Ischemia-modified albumin : crosstalk between fatty acid and cobalt binding

This work was supported by the Leverhulme Trust (grant ref. RPG-2017-214), BBSRC (grant ref. BB/J006467/1) and the British Heart Foundation (grant refs. PG/15/9/31270 and FS/15/42/31556).Myocardial ischemia is difficult to diagnose effectively with still few well-defined biochemical markers for identification in advance, or in the absence of myocardial necrosis. “Ischemia-modified albumin” (IMA), a form of albumin displaying reduced cobalt-binding affinity, is significantly elevated in ischemic patients, and the albumin cobalt-binding (ACB) assay can measure its level indirectly. Elucidating the molecular mechanism underlying the identity of IMA and the ACB assay hinges on understanding metal-binding properties of albumin. Albumin binds most metal ions and harbours four primary metal binding sites: site A, site B, the N-terminal site (NTS), and the free thiol at Cys34. Previous efforts to clarify the identity of IMA and the causes for its reduced cobalt-binding capacity were focused on the NTS site, but the degree of N-terminal modification could not be correlated to the presence of ischemia. More recent work suggested that Co2+ ions as used in the ACB assay bind preferentially to site B, then to site A, and finally to the NTS. This insight paved the way for a new consistent molecular basis of the ACB assay: albumin is also the main plasma carrier for free fatty acids (FFAs), and binding of a fatty acid to the high-affinity site FA2 results in conformational changes in albumin which prevent metal binding at site A and partially at site B. Thus, this review advances the hypothesis that high IMA levels in myocardial ischemia and many other conditions originate from high plasma FFA levels hampering the binding of Co2+ to sites A and/or B. This is supported by biophysical studies and the co-association of a range of pathological conditions with positive ACB assays and high plasma FFA levels.Publisher PDFPeer reviewe