Throughout their lifetime, an individual may sustain many injuries and recover spontaneously over a period of time, without even realizing the injury in the first place. Wound healing occurs due to a proliferation of stem cells capable of restoring the injured tissue. The ability of adult stem cells to repair tissue is dependent upon the intrinsic ability of tissues to proliferate. The amazing capacity of embryonic stem cells to give rise to virtually any type of tissue has intensified the search for similar cell lineage in adults to treat various diseases including cardiovascular diseases. The ability to convert adult stem cells into pluripotent cells that resemble embryonic cells, and to transplant those in the desired organ for regenerative therapy is very attractive, and may offer the possibility of treating harmful disease-causing mutations. The race is on to find the best cells for treatment of cardiovascular disease. There is a need for the ideal stem cell, delivery strategies, myocardial retention, and time of administration in the ideal patient population. There are multiple modes of stem cell delivery to the heart with different cell retention rates that vary depending upon method and site of injection, such as intra coronary, intramyocardial or via coronary sinus. While there are crucial issues such as retention of stem cells, microvascular plugging, biodistribution, homing to myocardium, and various proapoptotic factors in the ischemic myocardium, the regenerative potential of stem cells offers an enormous impact on clinical applications in the management of cardiovascular diseases.
Background: To compare propofol and etomidate as anaesthetic agents for elective non-cardiac surgery with respect to stability of haemodynamic parameters, systemic side effects and quality of induction.Methods: Randomised, blinded study of 100 patients posted for elective non-cardia surgery under general anaesthesia, divided in to two group. In group P(n=50) induction was achieved with injection Propofol 1mg/kg, whereas in group E(n=50), it was achieved with injection etomidate 0.3mg/kg after premedication with injection midazolam 0.04mg/kg and fentanyl 2µg/kg in both the group. Hemodynamic parameters like, heart rate, systolic BP, diastolic BP, Mean BP and induction time in seconds, pain on injection, myoclonus, post-operative nausea, vomiting were recorded at different time intervals (base line, at induction, immediately after intubation and 1,3,5 and 15 min after intubation).Results: There was no statistically difference was found in demographic profile and baseline hemodynamic parameters but significant different was found in intraoperative mean HR, SBP, DBP, MBP at various time intervals, and our result was more in favour of E group as compare to P, in which above recorded vital parameters were decreased more than E and induction time was also faster in E as compare to P. Pain on injection and post-operative nausea, vomiting was more in group P as compare to E, however the myoclonus movements was more in E group as compare to P but statistically not significant.Conclusions: Etomidate is a better intravenous induction agent of anaesthesia than Propofol in hemodynamically unstable patient also as it has faster onset of action with less pain and post-operative nausea, vomiting with good hemodynamic stability.
Objective In the midst of the COVID-19 pandemic, many children presenting with persistent fever, rashes, conjunctivitis, abdominal pain, respiratory distress, and shock were reported and diagnosed with multisystem inflammatory syndrome in children (MIS-C). The aim of the study was to observe the clinical presentation and outcome of MIS-C treated at a tertiary care hospital. Methods Eighteen children, aged 24 days to 18 years, with suspected MIS-C were admitted. Their clinical presentation, laboratory parameters, radiological investigations, management, and outcomes were recorded. Results Median age was 8 years (interquartile range [IQR]: 0.5, 14), and the male-to-female ratio was 1:1. Fever, tachycardia, respiratory distress, hypotension, and seizures with altered sensorium were present in 94.4, 88.8, 83.3, 44.4, and 44.4% of the cases, respectively. Median erythrocyte sedimentation rate, C-reactive protein, serum ferritin, and d-Dimer levels were 21 mm/h, 151 mg/L (1,14.2, 319), 1,091 µg/L (737.4, 1,456), and 3,094 ng/mL (990, 4,300), respectively. Methylprednisolone was given to all patients. Low molecular weight heparin and intravenous immunoglobulin (IVIG) were instituted in 83.3 and 38.8% cases, respectively. Seventeen patients (94.4%) required oxygen therapy and 44.4% needed mechanical ventilation. Fourteen patients (77.7%) recovered completely and four cases (22.2%) expired during the hospital stay. The need for ventilation and the presence of shock adversely affected the outcome. Conclusion Chief clinical presentations in the patients of MIS-C were fever, respiratory distress, hypotension, and altered sensorium. Among admitted patients, 87.8% cases were managed successfully by systemic corticosteroids with or without IVIG. Need for mechanical ventilation, shock, and central nervous system symptoms at admission appear to be important factors that can lead to mortality.
Introduction: Supraclavicular brachial plexus block is used for providing pain relief in upper limb surgeries and has many advantages over general anaesthesia. Alpha-2-adrenergic agonists are chosen with local anaesthetics for their sedative, analgesic and antihypertensive properties. Aim: To compare the efficacy of clonidine and dexmedetomidine when added to 0.5% ropivacaine in nerve stimulator guided supraclavicular block when performed for upper limb surgeries. Materials and Methods: This randomised clinical study was conducted in the Department of Anaesthesia Mata Chanan Devi Hospital, New Delhi, India (tertiary care center), from September 2015 to September 2016. Total 90 patients were randomly allocated into three groups. Group A {Inj. ropivacaine 0.5% (29 mL)+ normal saline 1 mL to make 30 mL}, group B {Inj. ropivacaine 0.5% (29 mL)+ clonidine 1 μg kg-1 to make 30 mL) and group C {Inj. ropivacaine 0.5% (29 mL)+ dexmedetomidine 1 μg kg-1 to make 30 mL}. Parameters observed included onset of sensory and motor block, total motor duration, postoperative analgesia as primary outcome; and intraoperative haemodynamic parameters and side effects as secondary outcome. Results: All the three groups were found to be similar with demographic profile. Patients in dexmedetomidine group showed faster onset and longer duration of sensory and motor blocks (p-value<0.01). The mean onset of sensory block in minutes was 12.03±2.20, 8.20±1.40, 6.80±1.35 in groups A, B and C, respectively (p-value<0.001). The mean onset of motor block in minutes was 18.47±2.78, 13.37±2.86 and 11.30±2.04 in group A, group B and C, respectively (p-value<0.001). The mean duration of analgesia in group A, B and C was 555.17±65.36, 710.00±73.58 and 902.67±116.65 minutes, respectively (p-value<0.001). The mean duration of motor block in group A, group B and group C were 330.00±51.78, 418.17±38.29 and 516.83±50.33 minutes, respectively (p<0.0001). The duration of postoperative analgesia and total motor duration were significantly prolonged in dexmedetomidine group than group A and B. Conclusion: It can be concluded that both clonidine and dexmedetomidine increases the total motor duration and postoperative analgesia when added to ropivacaine, but dexmedetomidine is a better choice when used in supraclavicular block, without any significant side-effects.
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