Ventilator associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

Background and Objectives:Patients on mechanical ventilation in intensive care unit (ICU) are often uncomfortable because of anxiety, pain, and endotracheal intubation; therefore, require sedation. Alpha-2 agonists are known to produce sedation. We compared clonidine and dexmedetomidine as sole agents for sedation.Study Design:Prospective, randomized, controlled open-label study.Materials and Methods:A total of 70 patients requiring a minimum of 12 h of mechanical ventilation with concomitant sedation, were randomly allocated into two groups. Group C (n = 35) received intravenous (IV) clonidine (1 μg/kg/h titrated up to 2 μg/kg/h to attain target sedation), and Group D (n = 35) received IV dexmedetomidine for sedation (loading 0.7 μg/kg and maintenance 0.2 μg/kg/h titrated up to 0.7 μg/kg/h to achieve target sedation). A Ramsay Sedation Score of 3-4 was considered as target sedation. Additional sedation with diazepam was given when required to achieve target sedation. The quality of sedation, hemodynamic changes and adverse effects were noted and compared between the two groups.Results:Target sedation was achieved in 86% observations in Group D and 62% in Group C (P = 0.04). Additional sedation was needed by more patients in Group C compared with Group D (14 and 8 in Groups C and D, respectively, P = 0.034), mainly due to concomitant hypotension on increasing the dose of clonidine. Hypotension was the most common side-effect in Group C, occurring in 11/35 patients of Group C and 3/35 patients of Group D (P = 0.02). Rebound hypertension was seen in four patients receiving clonidine, but none in receiving dexmedetomidine.Conclusion:Both clonidine and dexmedetomidine produced effective sedation; however, the hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients.

Background:The transverse abdominis plane (TAP) block, a regional block provides effective analgesia after lower abdominal surgeries if used as part of multimodal analgesia. In this prospective, randomized double-blind study, we determined the efficacy of TAP block in patients undergoing cesarean section.Materials and Methods:Totally, 62 parturients undergoing cesarean section were randomized in a double-blind manner to receive either bilateral TAP block at the end of surgery with 20 ml of 0.25% bupivacaine or no TAP block, in addition to standard analgesic comprising 75 mg diclofenac 8 hourly and intravenous patient-controlled analgesia (PCA) tramadol. Each patient was assessed at 0, 4, 8, 12, 24, 36, and 48 h after surgery by an independent observer for pain at rest and on movement using numeric rating scale of 0-10, time of 1st demand for tramadol, total consumption of PCA tramadol, satisfaction with pain management and side effects. Results: Use of tramadol was reduced in patients given TAP block by 50% compared to patients given no block during 48 h after surgery (P < 0.001). Pain scores were lower both on rest and activity at each time point for 24 h in study group (P < 0.001), time of first analgesia was significantly longer, satisfaction was higher, and side effects were less in study group compared to control group.Conclusion:Transverse abdominis plane block was effective in providing analgesia with a substantial reduction in tramadol use during 48 h after cesarean section when used as adjunctive to standard analgesia.

This is a prospective study conducted in a dedicated post-dates clinic to investigate the importance of antenatal ultrasound, Doppler and cardiotocographic (CTG) indices in the prediction of adverse intra-partum events in prolonged pregnancy. Operative delivery for abnormal fetal ECG-ST segment analysis and/or an arterial cord pH < 7.15 were regarded as adverse events. There were 462 singleton pregnancies with 87 adverse intra-partum events included in the analysis. Intra-partum adverse events were associated with nulliparity, oligohydramnios and induction of labour. The birth weight of fetuses was significantly less in the group with adverse intra-partum events. Logistic regression analysis showed that only nulliparity, birth weight and oligohydramnios had a significant independent influence on the risk of an adverse intra-partum event. Nulliparity was associated with five-fold increase in risk of an adverse intra-partum event. Oligohydramnios was associated with a three-fold increase in the risk. The risk decreased with increasing birth weight.

Transverse abdominis plane (TAP) blocks, over the past decade, have emerged as a reliable tool in multimodal analgesia. Although they block only the somatic component of pain, studies have still revealed a consistent benefit in the first 24–48 hours after surgery in terms of pain scores and overall opioid consumption. The safety and dependability has increased with ultrasound usage. The aim of this review is to help the reader appreciate the applied anatomy required for a TAP block and its congeners, to standardize its nomenclature, and to help choose between variants of a TAP block and its complications and safety profile.

Sclerosing odontogenic carcinoma (SOC) was described in 2008 and is

Central venous catheterization is associated with its share of complications. Most of these complications can be avoided and treated by appropriate patient selection, careful insertion technique and vigilance following catheter insertion. We report a patient presenting with unilateral hydrothorax due malposition of central venous catheter in lung parenchyma. Prompt recognition of complication and its treatment remedied the situation.

Background Catheter-induced urethral erosion can involve meatus, glans and any extent of penile shaft. These injuries cause a lot of psychological, social and sexual trauma to the patient. Though the use of condom drainage system can render this spinal cord injury patient effectively dry, but can lead to penile or urethral complications. Many of these patients are kept on indwelling catheter. Long duration catheterization, poor catheter care in such paraplegic patients and other morbid patients may lead to urethral erosions. We conducted a prospective study of catheter-induced urethral injury from July 2014 to February 2016 in our tertiary care centre. The demographics, past history of illness, catheter material, and duration of catheterization, securing of catheter, local examination findings and associated comorbidities were recorded. Factors leading to urethral erosion were evaluated. And patients, who were fit and were willing for surgery, underwent tubularized urethral plate urethroplasty after 4–6-week supra-pubic diversion. The objective of the study was to evaluate factors of urethral erosion, and the results tubularized urethral plate urethroplasty in iatrogenic hypospadias. Results We had twelve patients of catheter associated urethral injury in the study period. Age of the patients varied from 34 to 95 years with a mean of 61.25 years. Duration of catheterization ranged from 6 to 24 months with a mean duration 10.9 months. Catheters used were silicon coated, not secured to abdomen and had comorbid condition of neurological or cardiac origin in all patients. Long duration of catheter, poor quality of catheter and poor catheter care such moribund with poor body resistance patients were the main causative factor for urethral erosion. Urethral injuries varied from erosion of distal 2 cm to entire ventral urethra till penoscrotal junction with or without penile torque. Six of these patients underwent tubularized urethral plate urethroplasty with good cosmetic and functional postoperative outcome. Conclusion Patients of spinal cord injury, patients with comorbid condition like diabetes mellitus and ischaemic heart disease, poor catheter care and long duration catheterization are likely to have severe urethral injury. Extent of injury may vary from meatal erosion to erosion of entire ventral urethra till penoscrotal junction leading to iatrogenic hypospadias. These patients either may be put on clean intermittent catheterization or supra-pubic catheterization. Results of tubularized urethral plate urethroplasty in such iatrogenic hypospadias are very good.