COVID-19 is characterized by marked variability in clinical severity. Vitamin D had recently been reviewed as one of the factors that may affect the severity in COVID-19. The objective of current study is to analyze the vitamin D level in COVID-19 patients and its impact on the disease severity. After approval from Ethics Committee, M.L.B Medical College the current study was undertaken as continuous prospective observational study of 6 weeks. Participants were COVID-19 patients of age group 30–60 years admitted during the study period of 6 weeks. Study included either asymptomatic COVID-19 patients (Group A) or severely ill patients requiring ICU admission (Group B). Serum concentration of 25 (OH)D, were measured along with serum IL-6; TNFα and serum ferritin. Standard statistical analysis was performed to analyze the differences. Current Study enrolled 154 patients, 91 in Group A and 63 patients in Group B. The mean level of vitamin D (in ng/mL) was 27.89 ± 6.21 in Group A and 14.35 ± 5.79 in Group B, the difference was highly significant. The prevalence of vitamin D deficiency was 32.96% and 96.82% respectively in Group A and Group B. Out of total 154 patients, 90 patients were found to be deficient in vitamin D (Group A: 29; Group B: 61). Serum level of inflammatory markers was found to be higher in vitamin D deficient COVID-19 patients viz. IL-6 level (in pg/mL) 19.34 ± 6.17 vs 12.18 ± 4.29; Serum ferritin 319.17 ± 38.21 ng/mL vs 186.83 ± 20.18 ng/mL; TNFα level (in pg/mL) 13.26 ± 5.64 vs 11.87 ± 3.15. The fatality rate was high in vitamin D deficient (21% vs 3.1%). Vitamin D level is markedly low in severe COVID-19 patients. Inflammatory response is high in vitamin D deficient COVID-19 patients. This all translates into increased mortality in vitamin D deficient COVID-19 patients. As per the flexible approach in the current COVID-19 pandemic authors recommend mass administration of vitamin D supplements to population at risk for COVID-19.
Bain H circuit is an innovatively modified breathing circuit designed for the transportation and resuscitation of patients with coronavirus disease . For this circuit, the Heidbrink valve was replaced with a 15F inlet and 15M/22F outlet adjustable pressure-limiting (APL) valve, and a high-efficiency particulate air filter was placed over the APL outlet valve. The circuit is designed to filter the novel coronavirus without any increase in dead space or resistance. All benefits of the conventional Bain circuit were retained. Besides its use in dedicated COVID-19 areas, this circuit can be used in other emergency units of the hospital. (A&A Practice. 2021;15:e01530.) GLOSSARY APL = adjustable pressure-limiting; COVID-19 = coronavirus disease 2019; HEPA = high-efficiency particulate air; HME = heat and moisture exchanger; ICU = XXX; RT-PCR = reverse transcription polymerase chain reaction; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; WHO = World Health Organization
Retrograde intubation is a well established technique for intubating a patient with difficult airway. Since the first description of retrograde intubation in 1960 several modifications have been reported. However, all techniques require a cricothyroid membrane puncture by a thick needle usually <16G, and specialized catheters. We have devised a novel technique of retrograde intubation using a 20G intravenous catheter, prolene suture (size 0) and an enteric feeding catheter (EFC) size 14F for retrograde intubation. All of the required items are economical and easily available in operation theatre. Till now, we have successfully used this technique in seven patients with difficult airway.
BACKGROUND: Laparoscopic cholecystectomy is a relatively new surgical procedure which is enjoying ever increasing popularity and presenting new anesthetic challenges. Volatile anesthetics play an important role in the management of haemodynamic changes due to CO2 pneumoperitoneum during laparoscopic surgeries. The aim of the study is to evaluate Isoflurane Vs Halothane as an adjunct to obtund haemodynamic response due to CO2 pneumoperitoneum. MATERIALS & METHODS: 50 patients aged 20-60 yrs of either sex belonging to ASA grade I & II scheduled for elective laparoscopic cholecystectomy admitted in MLB Medical College, Jhansi were randomly divided into two group. Group I-O2: N2O + Inhalational agent (Isoflurane 1.5-2%) Group II-O2: N2O + Inhalational agent (Halothane 1.5-2%) RESULTS : Hypertensive response due to CO2 pneumoperitoneum was well suppressed by Isoflurane (1.5-2%) {Group-I} which maintained pulse rate at a relatively higher side than halothane, (1.5-2%){Group II} decreased mean arterial pressure more significantly than halothane without any difference in arterial oxygen saturation (SPO2) and end tidal CO2 concentration (ETCO2). CONCLUSION: This can be concluded from the study that Isoflurane (Group-I) more effectively attenuated the haemodynamic response due to CO2 pneumoperitoneum during laparoscopic cholecystectomy as compared to Halothane (Group-II) under balanced anesthetic technique.
Background: The objective of this study was to study, assess, and diagnose causes of acute abdomen accurately, to determine the accuracy of multidetector computed tomography (CT) for confirmation of negative, diagnosed, or equivocal ultrasonography (USG) cases, and to establish role of CT as the primary imaging modality. Aims and Objective: To study, assess and diagnose causes of acute abdomen accurately, To determine the accuracy of MDCT for confirmation of Negative, diagnosed or equivocal USG cases & To establish role of CT as the primary imaging modality. Materials and Methods: One hundred and twenty random patients were included in this prospective study. USG and CT were done in all patients. Axial, coronal, and sagittal reformatted images were studied. Intravenous and oral contrast were also used depending on the clinical condition. All these patients were followed up diagnosis obtained before and after CT were compared with intraoperative findings or final clinical diagnosis at discharge. Results: Among 120 patients, confirmative CT diagnosis was made in 111 cases and was discordant in seven cases, while two cases could not be followed up. Forty-five cases underwent surgical management and rest of them were managed medically. Conclusion: CT abdomen done in patients presenting with non-traumatic acute abdominal pain which helps to make accurate diagnosis and planning the appropriate treatment.
Background and Aims: Ultrasound is a safe and non-invasive method for detecting numerous pathologies. Pediatric patients are often uncooperative which leads to decreased quality and increased time of scan. We compared the conventional means alone and combination of oral midazolam for the above cited purpose. Material and Methods: This double blind prospective study (CTRI/2016/06/007030) was conducted after obtaining due approval from institutional ethical committee. One hundred Children aged 2-6 years belonging to ASA class 1 or 2, posted for high resolution ultrasonography of abdomen were included in the study. They were randomised to receive midazolam 0.3 mg/kg mixed in 20 mL of apple juice (Group I) or 20 mL of apple juice alone (Group II) 20 minutes prior to the procedure. The parameters assessed were level of cooperation, sonologist's satisfaction, total scan time, heart rate and SpO 2 . Results: Out of 100 patients, 44 patients of group I and 42 of group II were analysed. The cooperation score was significantly higher in Group I (35%) than Group II (19%). Likert scale revealed very satisfied and satisfied rating in 61.3% (Group I) and 21.4% (Group II). The time taken by sonologist and number of attempts were significantly less in Group I than Group II. There was no difference in discharge time between the groups. There was no reportable adverse event in either group. Conclusion: Oral midazolam is a safe and effective agent to aid routine abdominal ultrasonography in pediatric patients.
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