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Surgical Airway management in Critically ill Patients: A Review article
Full text linkAbstract: -
Tracheostomy is among the most frequently performed procedures in critically ill patients, being done in medical and surgical intensive care units (ICUs).1,2,3,4., there is little agreement on the indications, timing of tracheostomy in critically ill patients. The most common indication for tracheostomy in the ICU is need for prolonged mechanical ventilation.7, 8. Tracheostomy has several advantages over endotracheal intubation, Recent ACCP (American college of chest physicians) guidelines 22 suggest that tracheostomy should be considered after an initial period of stabilization on the ventilator, when it becomes apparent that the patient will require prolonged ventilator assistance. Despite having been a known about the complications of prolong ETT insitu, the specifics of how, when, and why to perform a surgical airway are still debated. New methods of surgical airway management have to be evaluated against the gold standard, which will always be the open tracheostomy. Today we have to evaluate these new procedures not only by their efficacy but also by their cost effectiveness.
 
Incidence and Predictors of Nasopharyngeal Airway to Facilitate Nasotracheal Intubation
Full text linkBackground: Nasotracheal intubation is the most frequent approach of airway management in oral and maxillofacial surgical procedure. However, many times, it is related to ensuing bleeding from trauma to nasopharyngeal mucosa. This study was done to determine how effectively nasopharyngeal airways (NPAs) performed at making nasopharyngeal insertion simple and minimize trauma during nasotracheal intubation. Objectives: The aim of this study is to determine the incidence and predictors of nasopharyngeal airway to facilitate nasotracheal intubation. Methods: This study was carried out in the Anaesthesiology Department of Dhaka Dental College and Hospital. The subjects of the study were the patients who underwent maxillofacial surgery and required nasotracheal intubation. Nasotracheal intubation was done on 900 patients during the study period from January 2022 to December 2022. Results: The majority of patients 891(99.0%) had successful nasotracheal intubation. The patients in this study ranged in age from 10 to 60 years old and the majority were male 685(76.1%). A small percentage of patients reported postoperative complications such as runny nose 12 (1.3%), epistaxis or nasal bleeding 10(1.2%), nasal trauma or pain 12(1.3%), inflammation or ulceration of the nose with full recovery 6(0.6%), and sinusitis 10(1.2%) among individuals. For atraumatic nasotracheal intubation, nasal cavity dilatation with nasopharyngeal airways was useful. Conclusions: Dilatation of nasal cavity with nasopharyngeal airways (NPAs) extensively eases the insertion of endotracheal tube (ETT) into the nasopharynx and significantly decreases the incidence and severity of trauma and bleeding during nasotracheal intubation.
 
Cancer Treatment Delay Due to COVID-19 Infection in Cancer Patients Attended in a Tertiary Hospital of Bangladesh
Full text linkIntroduction: The COVID-19 pandemic had a significant impact on health care systems worldwide. However, the brunt of this impact was on the cancer patients getting treatment in specialized oncology hospitals. Objective: to assess the cancer treatment delay due to covid-19 infection in cancer patients attended in a tertiary hospital of Bangladesh. Methods: It was a retrospective observational study and data of all patients dept. of Radiation Oncology, Combined Military Hospital (CMH), Dhaka, Bangladesh from July to December 2020 with cancer or history of cancer with COVID-19 was collected from interview of patient or attendant and medical records in a preformed data collection sheet and then analyzed. Results: Total 60 patients included were divided into two groups elderly population (>65 year) and younger population, the mean age of patient at diagnosis was 50 years, ranging from 28 to 72 years old, only 10 patients were aged 65 years or more. The most common co morbid condition associated was HTN followed by diabetes mellitus, IHD, bronchial asthma and cerebrovascular accident, patients with multiple co morbidities (26%) were also present in this study. Symptomatic analysis revealed most of the patient diagnosed asymptomatically (32%) and among symptoms fever (28%), shortness of breath (13%) and cough (15%) were the most frequent ones, patients also presented with anosmia, loose motion or altered consciousness. Haematologic and biochemical finding of COVID-19 infected patients shows most of the patients had anaemia (45%) and lymphopaenia (50%) in CBC, hyponatraemia (65%) as electrolyte imbalance and also increased D dimer (85%), raised Ferritin (55%) and high CRP (65%) in biochemical parameter. The most prevailing cancers was breast cancer, Head neck region (larynx, pharynx, oral cavity), Gastrointestinal tract (GIT inc. esophagus, stomach, colorectal) followed by lung, gynecologic, central nervous system (CNS), genitourinary tract, lymphoma and carcinoma unknown primary (CUP). Most of the patients received combined modality treatment including surgery, radiotherapy and chemotherapy. Patients delay in attending oncologist, delay or gap in initiation and continuation of cancer treatment like surgery, radiotherapy or chemotherapy occurred in most of the patients, the average gap of treatment due to COVID-19 infection was 3 months with a minimum gap of 10 days to extending upto 8 months. Conclusion: In conclusion, COVID-19 positivity during the scheduled radiotherapy treatment course chemotherapy and surgery has caused treatment delays. Multiple patient factors, such as race and ethnicity, underlying primary malignant neoplasms, multimorbidity, geographic location, receipt of COVID-19 vaccine, severity of COVID-19, and timing of COVID-19 diagnosis, were associated with delays in cancer treatment.
 
Asthma management: A call to action in a changing environmental paradigm
Full text linkThis review article examines the impact of environmental changes on asthma prevalence and severity, emphasizing the need for proactive management strategies. It explores the various environmental triggers of asthma, including air pollution, allergens, and indoor air quality. Additionally, it discusses the influence of climate change on asthma, specifically addressing the increased pollen season, extreme weather events, and heat-related effects. The article concludes by advocating for environmental policies, public awareness campaigns, healthcare provider guidance, and community engagement as crucial components of a comprehensive approach to asthma management in the face of a changing environmental paradigm
Prevalence of LV diastolic dysfunction in people with type 2 diabetes mellitus with a normal systolic function
Full text linkBackground and Aims: To determine the incidence of LV diastolic dysfunction (LVDD) in type 2 diabetics having a normal LV systolic function. This observational study aimed to determine the prevalence of LVDD in a normotensive T2DM population with a preserved Left Ventricular Ejection Fraction (LVEF) and to impress the importance of initiating early therapy with agents like SGLT2 inhibitors.
Materials and Methods: Persons diagnosed with T2DM underwent standard TTE and assessment of their LVEF and grading of LV diastolic dysfunction. LVEF ≥ 50% was considered as normal. All the subjects underwent resting transthoracic 2-dimensional echocardiography and Doppler imaging, to assess left ventricular systolic and diastolic function. A total of 2,150 cases were assessed at the hospital, over 4 years.
Results: Of the 2,150 cases included 56% (1204) were males, and 44% (946) were females,
72% (1548), [59% males and 41% females] had Grade I LV diastolic dysfunction.
Conclusion: This observational study concludes that there is a huge prevalence of LV diastolic dysfunction, in people with T2DM, which is an important risk factor for cardiac morbidity and mortality, which may lead to the development of overt heart failure and progression to coronary artery disease if not corrected early.
 
Role of Iron Deficiency Anaemia as A Risk Factor for Wheeze Associated Respiratory Tract Infection in Children
Full text linkIntroduction: Acute lower respiratory tract infections form a major portion of early childhood illnesses and infections. Iron deficiency anemia is an independent risk factor for lower respiratory tract infections (LRTI), however may also play an important role in wheeze associated respiratory tract infections. Wheezing is common in children with cumulative prevalence of almost 50% by the age of 6 yrs. Objective: To assess the role of iron deficiency anemia as a risk factor for wheeze associated respiratory tract infection in children. Methods: This case control study was conducted at Department of Pediatrics, Rajshahi Medical College Hospital, Rajshahi, Bangladesh from January to June 2022. Total 60 patients from both groups were included in our study. Among children six months to five years and having ≥2 episodes of wheeze associated respiratory tract infections. The clinical presentation and laboratory profile were recorded on a predesignated proforma. Iron deficiency anemia was diagnosed by hemoglobin <11.0 gm%, serum ferritin<12 ng/ml and RDW>15%. The statistical analysis was done using SPSS, Version 21. Results: A total of 60 children were enrolled in the study, of which 30 were cases and 30 were matched controls. Majority of subjects in both groups were male (n=19;63.3%), with male to female ratio of 1.6:1. On clinical evaluation of the cases, pallor was observed in 17 (56.7%) cases, mild to moderate respiratory distress was observed in 8 (26.7%), chest in drawing in 7 (23.3%), audible wheeze on inspiration in 3 (10%), presence of rhonchi in 2 (6.7%), hyper resonant note on percussion in 6.7% and bilateral wheeze in 27 (90%) cases. Proportion of cases with iron deficiency anemia were higher among cases (33.3%) as compared to controls (23.3%) but the difference between two groups was not significant statistically (p=0.373) despite having higher risk (OR=1.49;95% CI=0.62-3.59). Mean monocyte, eosinophil and absolute eosinophil count was found to be significantly higher in cases as compared to controls (p<0.05). Conclusion: The present study does not suggest a possible linkage between iron deficiency anemia and wheeze associated respiratory infection, however its role as causative factor needs to be explored through long-term prospective and intervention studies on a large population
To Identify the Clinical Parameters Suggestive of Stroke in Patients Presenting to Emergency Department with Vertigo
Full text linkBackground and Purpose: Investigating every vertigo patient for central or peripheral MRI and other treatments is expensive and taxing for the system. Thus, emergency physicians must identify stroke patients and give immediate treatment to minimize disastrous results.
Methods: 500-bed BGS Global hospital prospective cohort research. Consecutive vertigo patients endure history, head impulse, nystagmus, skew deviation, and neurological symptoms such leg or truncal ataxia. Scheduled brain MRIs. MRI found strokes. Clinical assessment and normal MRI found peripheral lesions.
Results: Of the 102 acute vertigo patients, 70 were peripheral and 32 central (29 posterior circulation stroke, 2 anterior circulation, and 1 central venous thrombosis). Vertigo patients averaged 49.64706 ± 14.3931 (SD). 36 women, 66 males (64.3%). ED presentation averages 12.54902 ± 10.76355 (SD) hours. Central and peripheral causes were explored. Vomiting, hearing problems, headaches, and tinnitus did not discriminate central from peripheral causes (p <0.01). Diplopia, Dysphagia, Dysarthria, Head impulse test, Nystagmus examination, Skew deviation test, and neurological indicators such limb or truncal ataxia separate central from peripheral causes (p <0.01). Diplopia, Dysarthria, Dysphagia, Nystagmus, Skew deviation, and ataxia have poor sensitivity and high specificity. High-sensitivity, low-specificity head impulse test. This study shows that individual characteristics cannot distinguish central from peripheral vertigo. The study showed good sensitivity 92.31% (0.63 to 0.99) and specificity 100% (0.87 to 1). This test distinguishes central from peripheral vertigo.
Conclusions: Absence of Diplopia, Dysphagia, Dysarthria, abnormal head impulse test, No direction-changing Nystagmus, and absence of Skew deviation in the first clinical visit with vertigo can reliably exclude central cause and discharged home from ED safely without further investigations and imaging.
 
Role of prophylactic antibiotic of single dose versus multiple doses in uncomplicated groin Hernia Surgery
Full text linkBackground: Surgical site infection is the most common complication encountered in inguinal hernia (IH) surgery. Antibiotic prophylaxis for groin hernia surgery may limit wound infection. However, there is a debate to use in general. Objectives: The aim of this study is to compare the effect of prophylactic single dose versus multiple doses antibiotic in uncomplicated groin hernia patients were admitted in a tertiary care hospital. Methods: This randomized clinical trial was conducted for twenty-four months in the department of Surgery of Rangpur Medical College and Hospital. A total of 132 patients with uncomplicated groin hernia were included after considering the inclusion and exclusion criteria. Informed written consent was obtained from the participants. Ethical clearance was obtained before beginning of the study from the ERC. Detailed history was taken and clinical examination was done. Patients were randomly divided into two groups. Group A received antibiotic prophylaxis of single dose and Group B received multiple doses antibiotic. Patients were followed up at 3rd and 5th postoperative day and surgical site infection was evaluated by ASEPSIS scoring system. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: The mean age of the patients was 48.94±10.04 and 50.26±10.37 years in group A and B accordingly. Male predominance was observed in both groups A and B. Age and gender was statistically similar in both groups. Surgical site infection was significantly high among patients who received multiple doses antibiotic (9.09% Vs 6.06%). Group A patients were discharged comparatively early than group B patients with statistical significance. Mean hospital stay was also longer in group B patients than group A patients (3.93±1.41 days Vs 3.34±1.41 days). Conclusion: Present study findings indicate that surgical site infections could be reduced by using a prophylactic single dose antibiotic prior to surgical treatment for uncomplicated inguinal hernia. But before finalizing the comment, further larger study is recommended
Study of renal profile in children with congenital heart disease in western rural Maharashtra.
Full text linkIntroduction: The incidence of congenital heart disease (CHD) is 8-10 per 1000 in India and worldwide and due to recent advancements in diagnostic modalities, early diagnosis and management are possible leading to an increase in long-term survival. Renal involvement is one of the known complications of CHD, especially in cyanotic CHD.
Materials & method: It was a prospective longitudinal study conducted at a tertiary care hospital, including 112 cases ranging from 1 month to 12 years of age with ECHO-proven CHD were studied for the renal profile. Investigations included urea, serum creatinine, serum electrolytes (Na, K, Ca), along with the Urine analysis for protein creatinine ratio. USG abdomen study for kidney size, bladder wall thickness, post-void residue, and pelvi-calceal dilatation was done.
Results: 83.9% of CHD were acyanotic and 16.1% were cyanotic CHD. The most common CHD was VSD (39.3%). Male predominance was noted with Male to Female ratio of 1.24:1.
The most common presenting symptom of CHD in our study was poor weight gain (71.4%). Anemia was found in 42 out of the total CHD cases (37.5%). Serum creatinine was raised in 5 patients (4.5%) of CHD. Incidence of elevated creatinine was more common in cyanotic CHD (16.7%) than cyanotic CHD (2.1%) Blood Urea was found to be abnormal in 9.8% of CHD.
Conclusion: Children with CHD are prone to develop renal problems and therefore need monitoring of renal parameters. Serum creatinine levels are most deranged and hence should be checked serially as it is one of the easily available laboratory parameters.
 
Efficacy and Safety of Intrathecal Morphine For Post Cesarean Analgesia Under Spinal Anesthesia
Full text linkBackground: Cesarean section is the most common operation in obstetrics. It is also a well-known fact that mother has to bear severe post-operative pain because of unavailability of better analgesic and modern techniques of pain control at all the centre and that too free of cost, in the current era of cost containment. Objective: To evaluate the efficacy and safety of intrathecal morphine for post cesarean analgesia under spinal anesthesia. Methods: This prospective, randomized, case-control study was conducted in Department of Anaesthesiology, Gonoshasthaya Samaj Vittik Medical College, Savar, Dhaka, Bangladesh from January to June 2022. A total of 150 parturients posted for Cesarean section under spinal anesthesia were divided into two groups of 75 each in this prospective randomized case-control study. Morphine group received 0.15 mg of intrathecal morphine mixed in 12 mg of 0.5% bupivacaine heavy while control group received 12 mg of 0.5% bupivacaine heavy alone, after proper preparation of spinal anesthesia. The parturients were assessed for first request of analgesic as per Visual Analog Scale, frequency of analgesics required within 24hr, nausea, vomiting, pruritus, sedation and respiratory depression. Results: Postoperative analgesia was significantly greater in morphine group as compare to control group (12.1±7.6 vs 3.7±2.9hr). Frequency of analgesics requirements was also significantly lower in morphine group (1.7±2.0 vs 3.4±8.1). Visual Analog Scale was below 4 at most of time in morphine group. The incidence of nausea, vomiting and pruritus were more in morphine group as compare to control group but without any respiratory depression. There was no significant difference in APGAR score among fetus. Conclusion: Mixing low dose of intrathecal morphine in standard dose of spinal anesthesia effectively prolongs the duration of post cesarean analgesia and decreases the frequency of analgesics requirement without any major complication in parturients or fetus.