Amla increased the protein expression of liver FXR, LXRα, PPARα and their downstream proteins Insig-2, ABCA1 and LDLR. This property of amla to modulate some of the key proteins involved in lipid metabolism promises its usefulness as a preventive agent for dyslipidemia and hepatic steatosis.
Background and Aims: The ultrasound-guided infraclavicular brachial plexus block (USG ICBPB) is a popular technique for forearm surgeries distal to the elbow. Our study details the ultrasound (US) characteristics of this block and the structures encountered by the needle in four approaches to the infraclavicular area – lateral infraclavicular (LICF), costoclavicular medial to lateral (CML) and lateral to medial (CLM) and retroclavicular (R) by anatomical dissection. Methods: USG ICBPB was performed in 10 cadavers—5 on the right side and 5 on the left side by each of four approaches and with an 18 gauge Tuohy needle kept in situ , and US characteristics were noted. Anatomical dissection was done and important structures were described in detail. Results: Needle tip and shaft visibility were least with LICF approach and best in R approach. Needle angle correlated with chest and neck circumference in LICF and CML groups. During dissection, in all approaches, neurovascular structures have been observed in the near vicinity of the needle, especially the thoracoacromial artery (TAA) or its branches. In the R approach, the 'blind spot' behind the clavicle is an area where neurovascular structures were present. Conclusion: The R approach gives better visibility of needle shaft beyond the clavicle, but the clavicle acts as a 'blind-spot' for the US beam obliterating important neurovascular structures. The various neurovascular structures the needle traverses or in its immediate vicinity, do not necessarily make the CML, CLM or R approach any better than the LICF approach.
INTRODUCTIONDuring perioperative period there are important events which cause escalation in blood pressure like tracheal intubation, surgical incision, emergence from anaesthesia and post-operative pain.1 This rise in blood pressure is exaggerated in patients who have preoperative untreated hypertension.2 In a study on the contribution of hypertension to death due to cardiovascular complications within 30 days of anaesthesia and surgery, preoperative hypertension was found to be four times likely than matched controls.3 So detecting and treating these patients is of paramount importance due to the high degree of morbidity and mortality these patients carry. ABSTRACTBackground: Untreated perioperative hypertension can have deleterious effect on patient outcome following surgery. Therefore, many anaesthesiologists prefer to have elective surgeries deferred till the blood pressure is under control. This results in delay and inconvenience to the patient. We designed this study to determine the magnitude of this problem. Methods:The pre-anaesthesia records of 400 consecutive patients who underwent surgery under general or regional anaesthesia were reviewed. They were grouped into known hypertensive, newly detected hypertensive in the present visit or normal. Results: 6.4% of patients in the above 40 year age group, who are the population at risk for developing hypertension, had newly detected hypertension. Higher percentage of women than men in this age group were hypertensive though not statistically significant. The prevalence of hypertension (the sum of known hypertensive and newly detected hypertensive patients) was 9.25% in our study. In the above 40 age group this figure was 18.8%. Significantly higher numbers of women were hypertensive as compared to men (23.4% vs 11.6%) in this age group. Conclusions: Our findings show that the number of newly detected hypertensive patients in the surgical population is low and hence this does not pose a significant problem. The percentage of newly detected hypertension and the prevalence of hypertension in the present study are lower than that reported in the general population from other parts of India. This warrants further studies in our geographical area to determine if similar trend exists in the general population too.
We present an unusual case of life-threatening hemothorax in a 15-year-old boy following subclavian vein tear during internal jugular vein (IJV) cannulation prior to initiation of surgery (mitral valve replacement). Successful IJV cannulation was done in the third attempt. However, we missed the subclavian tear which occurred during the first two initial attempts as there was no clinical evidence suggestive of it at that point of time. This undiagnosed hemothorax led to hemodynamic decompensation requiring high volume and inotropic support to wean the patient off cardiopulmonary bypass. This unusually high requirement of fluid and inotropes required the surgeon to look for noncardiac causes for the hemodynamic disturbance and he noticed a bulge in the right pleura, which on exploration had approximately 1.5 L of collected blood. It was then retrospectively analyzed that the cause of this hemothorax could have been the undue lateral orientation of the needle during IJV cannulation and the advancement of the dilator to its entire length could have injured the subclavian vein. Here, we also would like to discuss the safety precautions to be taken during the cannulation, like the needle orientation and the length to which the dilator must be advanced for safe central venous cannulation.
Background: The "Severe Acute Respiratory Syndrome Coronavirus 2 disease has caused globally a challenging and threatening pandemic (COVID-19), with massive health and economic losses [1]. In India national vaccination campaigns kick started officially on January 16, 2021, and the vaccines were prioritized for frontline workers and susceptible groups. Individual vaccination can prevent or minimise a number of outcomes, including lab confirmed infection, symptomatic illness, infectivity rate, or a combination of these [2-3]. India had initially approved two vaccines under the trade name Covishield and Covaxin against COVID. Aim: Demonstrate the efficacy of a single / two -dose schedule of COVID vaccine in the prevention of ICU mortality. Methods: In this retrospective study, we included all COVID 19 confirmed patients who were admitted in covid designated ICU from March 15 to July 31 2021. Demographic, clinical, laboratory and radiological data were collected from all patients received in ICU. Primary outcome was to assess the mortality outcome in vaccinated COVID patients. Secondary outcome measured were to find an association between severity of the pneumonia and comorbidities, PaO2/Fio2 ratio, Neutrophil lymphocyte ratio, D dimer and CT severity score. Results: 319 patients were enrolled in the study. 252 patients were not vaccinated.59 had received the first dose and 8 patients had received both the doses. The mortality among vaccinated patients were less compared to nonvaccinated and significant (p value 0.030). Mortality among single and double dose vaccinated patients couldn’t be made out because only 8 patients had received both the doses. Among the demographic profile, difference in age between vaccinated and unvaccinated was statistically significant. (64.39 ±11.916/ 54.18±14.124 p<.001. Among comorbidities hypertension, diabetes, obesity was associated with significant mortality. Admission saturation and mean PaO2/FiO2 ratio were high among vaccinated and significant. Neutrophil lymphocyte ratio, D dimer CT severity score were high among non vaccinated compared to vaccinated. There is no difference in mode of oxygen delivery in both vaccinated and non vaccinated patient. Days of ICU stayal was less among vaccinated. Conclusion: Effectiveness of vaccine against SARS-CoV-2 infection after the first dose of immunisation is convincingly evident. However second dose of immunization should be continued to attain total protection.
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