Background: Contrast-induced acute kidney injury (CIAKI) following coronary angiography is frequently observed in the general population. End-stage liver disease (ESLD) patients are at a particularly increased risk for development of CIAKI following coronary angiography due to preexisting renal hypoperfusion.Methods: We performed a retrospective study of 544 consecutive cardiac catheterizations in ESLD patients from December 2003 to May 2013 to calculate the incidence of CIAKI post-coronary angiography and to identify risk factors for CIAKI. CIAKI was defined as a serum creatinine increase of either ≥ 25% or ≥ 0.5 mg/dL from baseline within 72 hours. Multivariable and Cox regression analysis was performed for development of CIAKI and all-cause mortality, respectively.Results: Overall, 179 cases of coronary angiography were included in the final analysis. CIAKI occurred in 23% of patients. All-cause mortality was 52% in the CIAKI group and 37% in the non-CIAKI group, with a mean follow-up of 2.2 ± 3.8 years. Multivariable analysis identified intensive care unit admission (OR 2.72, CI 1.05–7.01, p < 0.05) and baseline estimated glomerular filtration rate (OR 1.02, CI 1.002–1.035, p < 0.05) as independent predictors of CIAKI. Cox regression analysis identified pre-angiography beta-blocker use (HR 2.13, CI 1.04–4.38, p < 0.05), international normalized ratio (HR 1.37, CI 1.05–1.78, p < 0.05) and Mehran risk score (HR 1.13, CI 1.02–1.25, p < 0.05) as independent predictors of all-cause mortality.Conclusions: CIAKI in ESLD patients undergoing coronary angiography occurs at a moderately elevated rate when compared to the general population.

To compare if single dose antibiotic is as effective as multiple doses in prevention of post-operative infection in caesarean section. To compare the cost effectiveness of drugs in both the groups. MATERIAL AND METHOD: This prospective randomized controlled study was carried out to evaluate the effectiveness of single dose antibiotic versus multiple doses in caesarean section. The study population consisted of 600 patients that were randomly allocated to single or multiple dose groups. All potentially infected cases were excluded from this study. All patients received inj Cefotaxime IV half hour before surgery. In addition the multiple dose group received antibiotics for five days post-operatively. Each patient in the study was observed till discharge for presence of any morbidity like endometritis, urinary tract infections, and wound infections. STATISTICAL ANALYSISIS: Fischer exact test, unpaired t test used for analysis. RESULTS: There was no statistically significance in the rate of infections in both the groups. The rate of febrile morbidity, endometritis, urinary tract infection and wound infections were statistically not significant. However the difference in cost of antibiotic in both the groups was significant. CONCLUSIONS: Single dose antibiotics are effective as multiple doses in prevention of post-operative infections in caesarean sections Careful periodic surveillance of antibiotic prophylaxis is necessary to detect the emergence of drug resistant strains of bacteria in our institution because it caters to the needs of local population.

SUMMARY Hypotension to a mean blood pressure of 33 mmHg for periods of 70 to 187 minutes was induced by increasing the inspired halothane concentration in 11 baboons which were already anaesthetized with 0.500 halothane, nitrous oxide, and oxygen. During hypotension, cerebral blood flow, measured by Xenon clearance and by a carotid electromagnetic flowmeter, decreased by more than half, and sagittal sinus oxygen saturation was 46%. Cerebral oxygen uptake fell from 5*15 to 3-56 ml./100 g/min at this deeper level of halothane anaesthesia. Cerebral hyperaemia developed after hypotension in those animals which regained a mean blood pressure greater than 70 mmHg. Acidbase measurements on CSF from the cisterna magna revealed no metabolic acidosis during or after hypotension. In all four animals with intact autoregulation before hypotension, this was absent or impaired afterwards.Controlled hypotension is used to diminish bleeding and to facilitate surgery. There is, however, a considerable disagreement about the safety of the technique; for example, Mayrhofer (1971) has written that: 'Induced hypotension, using ganglion-blocking drugs, should have been abandoned long ago as it is an unsafe and potentially dangerous technique', while Enderby (1972) has replied: 'We are today using this technique routinely and, moreover, have been doing so for more than 20 years'. When such divergent opinions are expressed, further investigation is indicated, and the present study was designed to elucidate the effect of controlled hypotension on cerebral blood flow, cerebral metabolism, and acid-base balance. Since it has been suggested (Nilsson and Siesjo, 1971) that hypotension with deep halothane anaesthesia may be safer than with other methods, because of the associated reduction in cerebral oxygen demand, it was decided to produce hypotension by this means in experimental animals. METHODSEleven baboons were premedicated with phencyclidine (0-8-1-0 mg/kg) and anaesthesia was induced and maintained with halothane, nitrous oxide, and 898 oxygen. After intramuscular injection of suxamethonium (50 mg) an endotracheal tube was inserted and the animals were artificially ventilated by a Palmer pump. Muscle relaxation was maintained by injecting pancuronium (I mg) intramuscularly at half-hourly intervals. End-tidal CO2 was monitored by an infrared gas analyser and ventilation was adjusted to maintain normocapnia. Endtidal halothane was measured intermittently by an ultraviolet halothane meter. The inspired oxygen was adjusted so that PaO2 remained above 100 mmHg. The temperature of the animal was kept at 370 C by automatically controlled heating lamps.Not all measurements were made on all animals and the animals were divided into three experimental groups as indicated in Table 1

Hypotension to a mean blood pressure of 33 mmHg for periods of 70 to 187 minutes was induced by increasing the inspired halothane concentration in 11 baboons which were already anaesthetized with 0.500 halothane, nitrous oxide, and oxygen. During hypotension, cerebral blood flow, measured by Xenon clearance and by a carotid electromagnetic flowmeter, decreased by more than half, and sagittal sinus oxygen saturation was 46%. Cerebral oxygen uptake fell from 5*15 to 3-56 ml./100 g/min at this deeper level of halothane anaesthesia. Cerebral hyperaemia developed after hypotension in those animals which regained a mean blood pressure greater than 70 mmHg. Acidbase measurements on CSF from the cisterna magna revealed no metabolic acidosis during or after hypotension. In all four animals with intact autoregulation before hypotension, this was absent or impaired afterwards.

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Not all patients with diabetes mellitus (DM) should be routinely prescribed daily aspirin (acetylsalicylic acid) for prevention regardless of their cardiovascular disease (CVD) risk. Aspirin is routinely prescribed for prevention of cardiovascular events that include nonfatal myocardial infarction (MI), unstable angina, ischemic stroke, transient ischemic attack (TIA) or cardiovascular death [1]. In general, the benefit of aspirin as primary prevention in patients who have a low-risk profile for cardiovascular events is questionable, particularly due to high risk of intracranial and gastrointestinal bleeding associated with aspirin use [2]. Given the increased risk for a cardiovascular event, the diabetic patient could benefit from aspirin therapy for primary prevention. However, the routine practice of aspirin for all diabetic patients has been controversial [2]. Nevertheless, administration of daily low-dose aspirin (81 mg) is well recognized in diabetics for secondary prevention [2,3].In 2015 thirty million Americans; 9.4% of the US population; with more than 1.5 million Americans are diagnosed with diabetes every year [4]. The incidence of diabetes is highest among American Indians/Alaskan Natives (15.1%) followed by African Americans (12.7%). Diabetes is associated with high cardiovascular morbidity and mortality that drives the cost of healthcare for diabetic patients to be 2.3 times higher than what cost would be for non-diabetic patients [4]. This lead to the emphasis on preventing cardiovascular events in diabetic patients by slowing atherosclerosis process using statin therapy, a healthy lifestyle and good glucose control.

Successful cardiac catheterization procedure begins with safe vascular access and ends with effective hemostasis after equipment removal. These new and advanced technologies in the cath lab require large‐bore arterial accesses. Large‐bore sheaths are associated with blood flow obstruction resulting in limb ischemia. In this case we present a 48‐year‐old woman was admitted NSTEMI and cardiogenic shock requiring mechanical circulatory support. Selective left common iliac angiography demonstrated obstructive flow at the level of the left CFA (access site). Therefore, ipsilateral bypass circuit was done. The current case illustrates the utility of a temporary ex‐vivo bypass circuit to preserve limb perfusion in the presence of an occlusive large bore sheath. The technique permits sufficient hemodynamic support while maintaining limb perfusion and can be used for any occlusive large bore sheath.

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