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The production of wheat crop is below average in many regions of the world which is ascribed to adverse environmental conditions including drought stress. The present study was conducted to appraise the beneficial role of exogenouslyapplied 5-aminolevulinic acid (ALA) on growth, yield and some key physio-biochemical characteristics of two commercially important wheat cultivars (Shafaq-06 and Uqab-2000) under well watered [100% field capacity (FC)] and water-deficit (60 and 80% FC) conditions. Imposition of varying water regimes significantly decreased fresh and dry weights of shoots, photosynthetic pigments (a and b), non-photochemical quenching of chlorophyll fluorescence (NPQ), quenching coefficient for non-photochemical (N) of chlorophyll fluorescence (qN), K + (potassium ion), Ca 2+ (calcium ion) and P (phosphorus) accumulation in shoot and root and yield-related attributes. In contrast, water deficit regimes caused improvement in F v /F m (chlorophyll fluorescence measurement), coefficient of photochemical quenching (qP), proline, glycinebetaine (GB) and hydrogen peroxide (H 2 O 2) contents. Foliar spray of ALA at the rate of 50, 100 and 150 mg/L along with control (no spray (NS) and/or water spray (WS)) significantly enhanced chlorophyll a and b pigments, qN, NPQ, qP, K + , Ca 2+ and P accumulation in both roots and shoots, proline, GB, total phenolics and malondialdehyde (MDA) contents and yield. The wheat Shafaq-06 was better in shoot dry weight, qN, NPQ and F v /F m , shoot and root K + , root Ca 2+ , proline, GB accumulation and yield attributes, while Uqab-2000 was better in chlorophyll a contents, root P and MDA contents. Overall, better growth and yield of Shafaq-06 than Uqab-2000 under water deficit regimes was found to be associated with ALA improved leaf fluorescence (qN, NPQ and F v /F m), shoot and root K + , root Ca 2+ , proline and GB accumulation.

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Currently, COVID-19 is one of the most pressing healthcare problems across the world. With no definitive pharmacological guidelines, multiple drugs were used to treat critical patients with little success. of Tocilizumab, a monoclonal antibody has shown some role in the treatment of Covid-19 infection. The study was a cross-sectional prospective observational study. It was conducted in the COVID-19 Intensive Care Unit (ICU) of Liaquat National Hospital and Medical College, and National Medical Centre Karachi. The study was conducted from 15 th June 2020 to 31 st July 2020. Objective of the study was to compare the outcomes of severe to critical COVID-19 patients with established Cytokine release Syndrome (CRS), who received Tocilizumab with the group received Tocilizumab followed by intravenous immunoglobulins (IVIG). Two groups were made with one receiving Tocilizumab alone while the other received IVIG after Tocilizumab. Comparison was then made based on frequency of mortality as well the need of mechanical ventilation and its range of days. In results 4 (15.4%) patients in Tocilizumab only group died while Tocilizumab followed by IVIG treated group had 10 (38.46%) deaths. 20 (76.9%) patients needed mechanical ventilation in Tocilizumab only group while Tocilizumab followed by IVIG treated group consisted of 23 (88.46%) patients. This concludes that the group with only Tocilizumab therapy has better outcome as compare to the group who received both Tocilizumab and intravenous immunoglobulins.

Aim/Background: Delirium is common in critically ill patients. For its treatment along with other sedatives, dexmedetomidine has also been prescribed by the clinicians.  However, the outcomes with its use are less well-defined by any study in local population. We aimed to study its effectiveness for delirium and the impact on hemodynamics in critically sick patients of our population. Methodology: It was a cross-sectional, prospective observational study conducted on 212 participants after ethical review committee approval at our hospital. Heart rate, systolic and diastolic blood pressures and Richmond Agitation Sedation Scale (RASS) scores were recorded before starting dexmedetomidine and within one hour of starting the drug. More than 10% decrease in heart rate (HR) or systolic or diastolic blood pressure was considered as an impact on hemodynamic parameters. An achievement of RASS of -2 was considered as effectiveness of drug.  Results: There was a mean drop of HR by 13.78 ± 18.58 beats/min (14.49%) after starting dexmedetomidine. Mean systolic blood pressure drop was 10.99 ± 20.67 mmHg (9.16%), and mean drop in diastolic blood pressure was 4.958 ± 12.53 mmHg after dexmedetomidine use. The mean value of RASS score achieved on dexmedetomidine was -2.  Conclusion: Our study concluded the effectiveness of dexmedetomidine as light sedation for delirium. It significantly impacted on hemodynamic parameters. Its impact on heart rate was more pronounced as compared to systolic and diastolic blood pressures. Key words: Dexmedetomidine; Critical care; Delirium; Hemodynamics Citation: Kausar S, Yasin I, Ahsan I, Rais Z. Effectiveness of dexmedetomidine for delirium and its impact on hemodynamics in critically ill patients. Anaesth. pain intensive care 2020;24(6):--- Received: 14 June 2020, Reviewed: 24 August, 19 October 2020, Accepted: 26 October 2020

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