Cardiac surgery is unique in using cardiopulmonary bypass in various clinical scenarios. Injury of vital organs is unavoidable in the perioperative period. Acute kidney injury is a consequence of the systemic inflammatory response after bypass, emboli, ischemia, and low cardiac output states, reportedly occurring in 30%-40% of open heart surgeries. Acute kidney injury is associated with increased morbidity, mortality, and cost. Many preventive measures (off-pump procedures, decreased crossclamp time, pulsatile flow, adequate hydration) are taken in the perioperative period to avoid organ injury, but in vain. Traditionally, blood urea, serum creatinine, and creatinine clearance rate were applied for prediction of acute kidney injury. The recent emergence of biomarkers such as neutrophil gelatinase-associated lipocalin, cystatin C, liver-type fatty acid binding protein, interleukin-18, kidney injury molecule-1, and tetrahydrobiopterin have helped in detecting acute kidney injury long before the rise of serum creatinine. These biomarkers can also be used as tools for predicting therapeutic effects in acute kidney injury and for monitoring drug toxicity. This review consolidates the knowledge of biomarkers and their application in acute kidney injury management.

Objective: Pregnancy is characterized by profound changes in the function of

Background: Pregnancy leads to profound alterations in the respiratory system of the mother, leading to alteration in the normal course of common pulmonary diseases. However there is insufficient information regarding the changes in respiratory parameters of smaller airways in different trimesters of pregnancy. Objective: This study was designed to evaluate the pulmonary function tests in 1 st , 2 nd and 3 rd trimesters of pregnancy & compare them with non-pregnant control group. Methods: A cross-sectional study was carried in 200 healthy women in the age range of 19-35 years. The subjects were distributed in four groups, i.e control (non-pregnant) group and 1 st , 2 nd & 3 rd trimester pregnant groups. Number of subjects in each group was 50. We recorded respiratory parameters in control and study groups. Statistical analysis was done by 'Z' test. Results: There is significant decrease in FEV1, FEV1%, FEF25-75%, FEF25%, FEF50%, FEF75% in all trimesters of pregnancy with maximum decrease in 1 st trimester. Conclusion: The changes in pulmonary functions are attributed to the marked changes in the respiratory parameters during pregnancy. This knowledge of pulmonary function changes during pregnancy may be helpful in the prevention of gestational complications associated with an inadequate maternal respiratory adaptation.

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Objective Renal dysfunction after cardiopulmonary bypass (CBP) ranges from subclinical injury to established renal failure requiring dialysis. The pathophysiology is multifactorial, and recently, hemodilution during CBP has been thought to be an important determinant of postoperative renal injury. In this study, we attempted to assess the independent effect of hemodilution on renal function. We also aimed to identify the optimal hematocrit where hemodilution-induced renal injury is minimal. Methods A prospective observational study was conducted on 200 patients between February 2012 and July 2013. One hundred fifty patients were included in the study group, who were further subdivided on the basis of lowest hemodilution as mild hemodilution (>25%), moderate hemodilution (21%–25%), and severe hemodilution (<21%) categories. The primary outcome of the study was renal outcome measure, which was assessed by comparing the creatinine clearance across the groups. Results The creatinine clearance decreased over a period in all three groups. When compared with mild or moderate hemodilution, the reduction in creatinine clearance was significantly higher in the group with severe hemodilution (P ≤ 0.0001). However, there was no significant difference in creatinine clearance reduction between the mild and moderate hemodilution groups (P = 0.813; 95% confidence interval, −8.41 to 10.68). Conclusions Based on our observations, we would like to propose that a hematocrit of 21% should be considered the critical threshold. Hematocrit below this value of 21% during CBP is associated with the most significant deterioration in renal function.

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Background and Aims: National Medical commission of India (NMC) has introduced Competency based Medical Education (CBME) following the international trend. Competency based assessment differs from traditional assessment and we need to adopt to newer work place-based assessments (WPBA). Direct Observation of Procedural Skills (DOPS) is one such assessment tool, which assesses procedural skills of a student. Hence this study was conducted to evaluate the effectiveness of DOPS among Anesthesiology postgraduate students. Material and Methods: A prospective interventional study was conducted, where in 55 postgraduate students underwent DOPS assessment while performing three routine core skills of Anesthesiology. Observations were documented (Pre-DOPS-Score) and immediate verbal feedback was given. Students were educated through demonstration of all three procedures on actual patients by three faculty members using the DOPS checklist. The students were finally assessed again with proforma and DOPS scores were documented (Post-DOPS Score). Mean Pre-DOPS and Post-DOPS assessment Scores were compared. Student and faculty Perceptions were taken regarding the DOPS assessment. Results: There was significant improvement in the procedural skill performance after DOPS with a statistically significant difference. Average time taken for DOPS test was 11 min. Average time taken for giving feedback was 13 min. Students and faculty members gave positive feedback about DOPS. Conclusion: DOPS is very feasible and effective assessment tool, improves procedural skills of Anaesthesiology postgraduate students, helps to develop good clinical skills which finally brings good clinical care.

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