Macrolipasemia variant of macroenzymes: An endocrine laboma.

Macroenzymes, formed by polymerization of physiological enzymes with immunoglobulins, have slower renal clearance rates due to their higher molecular mass. They are usually incidentally detected, have no pathophysiological importance, and can potentially lead to over-treatment and iatrogenic morbidity. We present, possibly for the first time, a macro-lipasemia variant of macroenzyme, detected in a 14-year-old girl with type-1 diabetes admitted with severe hyperglycaemia and pain abdomen.

Correlation coefficient between plethysmographic variability index and Systolic Pressure Variation as an indicator for fluid responsiveness in hypotensive patients in the ICU/OT.

Background: Prediction of fluid responsiveness in hypotensive patients is a challenge. The correlation between a novel noninvasive dynamic indicator, Pleth Variability Index (PVI ®), and a gold-standard Systolic Pressure Variation (SPV) as a measure of fluid responsiveness was assessed in the Intensive Care Unit (ICU) or Operation Theatre (OT) in a tertiary care hospital.

Methods: A prospective experimental study was conducted over a span of one year on 100 mechanically ventilated patients with hypotension.

[Not Available].

Oral diseases are a burden for developing countries such as India where owing to socioeconomic conditions cost is a factor in selecting the type of treatment. Dental care in India is provided at various levels of care including standalone clinics run by individual dental surgeons, multi-speciality dental centres providing specialist care under one roof including paediatric, prosthodontics, and so on and dental centres affiliated with hospitals having facilities for provision of operation theatre and anaesthesia services. Most dental procedures are performed as day-care procedures requiring local anaesthetics, oral, or moderate intravenous sedation and anxiolytics while maxillofacial procedures are carried out in a controlled operation theatre setting.

Concept of BIDI years: Relevance to the perioperative period.

Background: The cumulative effect of cigarette smoking is usually measured by "pack years," but the same is not present for Bidis. This study was conducted to calculate the concept of "bidi years" in comparison to the concept of "pack-years" for a cigarette.

Methods: Thirty random samples, each of bidis and cigarettes, were selected through a survey of common brands used by smokers in India.

The changing face of postgraduate anaesthesia teaching curriculum: Need of the hour!

The speciality of anaesthesiology is evolving rapidly. The recent pandemic witnessed anaesthesiologists as the front-liners catering not only as critical care physicians but also as trainers and even administrators. Today, anaesthesiologists are required to have not just sound clinical knowledge but also proficiency in skills and techniques and aptitude for leadership.

Association of ischemic electrocardiographic changes in high-altitude areas with coronary angiography.

Background: Soldiers native to lowlands, while sojourning at high altitude (HA), are referred to tertiary care centers with electrocardiographic (ECG) abnormalities. Exposure to HA may precipitate myocardial ischemia in subjects with underlying coronary artery disease (CAD). Conversely, it may produce physiological ECG changes mimicking those of CAD, causing a diagnostic dilemma.

Artificial intelligence in critical care: Its about time!

Currently, most critical care information is not expressed automatically at a granular level, rather is continually assessed by overindulged Intensive Care Unit (ICU) staff. Furthermore, due to different confounding morbidities and the uniqueness of the ICU setting, it is difficult to protocolize treatment regimens in the ICU. In highly complex ICU setting where man and resource management becomes extremely challenging, definite advancements are required to implement Artificial Intelligence (AI) for prognosticating the course of the disease to aid in informed decision-making.

Sigma Metric Evaluation of Drugs in a Clinical Laboratory: Importance of Choosing Appropriate Total Allowable Error and a Troubleshooting Roadmap.

 Stringent quality control is an essential requisite of diagnostic laboratories to deliver consistent results. Measures used to assess the performance of a clinical chemistry laboratory are internal quality control and external quality assurance scheme (EQAS). However, the number of errors cannot be measured by the above but can be quantified by sigma metrics.

Optimal management of brain-dead organ donor.

Maintaining a brain stem-dead (BSD) donor is specialized science. It is a daunting task as they are fragile patients who need to be handled with utmost care owing to extreme haemodynamically instability and need the best of monitoring for maintenance of organs. To ensure a successful transplant, a BSD donor first needs to be identified on time.

A fluoroscopic assessment of brachial plexus block by the supraclavicular approach: Have we been overmedicating?

Background: Ultrasonography-guided supraclavicular brachial plexus block has demonstrated safety as compared with landmark or nerve stimulation techniques. However, the minimum effective analgesic volume (MEAV) necessary for adequate blockade has not been determined. This study was undertaken to assess under fluoroscopy the postinjection spread of different drug volumes with clinical correlation.

COVID-2019: Experience of setting up quarantine center.

Indians stranded in countries reporting widespread transmission of COVID-19 in Jan to Mar 2020 were evacuated at short notice. Unclear and evolving evidence on COVID-19, risk of transmission of the disease from pre-symptomatic, asymptomatic and known cases of COVID-19 has put the spotlight back on the practice of quarantine. The article describes the processes, inter-sectoral coordination and methodology adopted for putting in place all measures for a successful evacuation and subsequent quarantine of the evacuees at the first Quarantine camp set up in India at Manesar, Gurugram near New Delhi by the Armed Forces.

A Rare Case of Epileptic Seizure After-effect Resulting in Nontraumatic Spontaneous Subdural Hemorrhage.

Unlabelled: Generalized tonic-clonic seizures (GTCS) result in diverse physiological alterations that are mostly short-lived and rarely lead to immediate serious consequences. Some early serious complications reported are head trauma and aspiration. While most cases of seizures are diagnosed readily from clinical history, some cases remain indolent and present later.

Recurrent Metabolic Acidosis during High-dose Midazolam Therapy for Refractory Status Epilepticus.

High-dose continuous midazolam therapy has been used successfully for control of refractory status epilepticus. However, normal anion gap (AG) metabolic acidosis, a deleterious complication of this therapy is underrecognized. Even though previously reported in an isolated case report in a pediatric patient, we observed similar complication in an adult patient.

A study of the efficacy of stellate ganglion blocks in complex regional pain syndromes of the upper body.

Background And Aims: The effect of stellate ganglion blocks (SGBs) was examined in complex regional pain syndromes (CRPS) of the upper body.

Material And Methods: A total of 287 SGB were given to patients with documented CRPS on medications. Spontaneous and provoked pain assessment was done with numeric pain rating scale (NPRS).

Interplay between PAPP-A, inflammation and adiposity in patients with angiographically proven acute coronary syndrome (ACS).

Introduction Studies conducted in the recent past have demonstrated the role of inflammation, obesity and dysfunctional insulin signaling as contributing factors in the pathogenesis of acute coronary syndrome (ACS). However, pharmacological interventions targeting a single pathway have not proven useful in the long run. This indicates that a synergism occurs between the various risk factors and hence calls for a combinatorial approach.

Hydroxyeyhyl starch: Controversies revisited.

Hydroxyethyl starch (HES) family has been one of the cornerstones in fluid management for over four decades. Recent evidence from clinical studies and meta-analyses has raised few concerns about the safety of these fluids, especially in certain subpopulations of patients. High-quality clinical trials and meta-analyses have emphasized nephrotoxic effects, increased risk of bleeding, and a trend toward higher mortality in these patients after the use of HES solutions.

A prospective review of the labor analgesia programme in a teaching hospital.

Background: The structured labor analgesia programme in our tertiary care hospital has been in place for the past few years. We undertook this study to analyze the programme and to draw conclusions to further improve the outcomes.

Methods: A prospective analysis of the data pertaining to 200 patients participating in an ongoing labor analgesia programme in a tertiary care hospital from Nov 2008 to Aug 2009 was performed.

Incidence of healthcare associated infection in the surgical ICU of a tertiary care hospital.

Background: Healthcare associated infections (HAI) have taken on a new dimension with outbreaks of increasingly resistant organisms becoming common. Protocol-based infection control practices in the intensive care unit (ICU) are extremely important. Moreover, baseline information of the incidence of HAI helps in planning-specific interventions at infection control.