Efficacy of spinal ropivacaine versus ropivacaine with fentanyl in transurethral resection operations

Background:

The low-dose ropivacaine provides differential spinal block to reduce adverse hemodynamic effects in elderly patients. Addition of intrathecal fentanyl with ropivacaine may enhance analgesia and early postoperative mobility. The present study was performed to evaluate the efficacy of intrathecal ropivacaine alone and in combination with fentanyl in transurethral resection operation.

Methods:

Sixty male patients aged >50 years of ASA I-III scheduled for elective transurethral resection were included in a prospective, randomized, double-blinded study and they were divided in two groups of 30 each. Group A (n = 30) received intrathecal injection of ropivacaine 2 ml (0.75%) and Group B (n = 30) ropivacaine 1.8 ml (0.75%) with fentanyl 10 μg. The characteristics of onset and regression of sensory and motor blockade, hemodynamic stability, and side effects were observed. Student's t test (for parametric data) and Mann-Whitney U test (for non-parametric data) were used for statistical analyses.

Results:

There were no significant differences between the two groups for patient demographic data, intraoperative hemodynamic parameters, side effects, and satisfaction to patients and surgeon. The highest level of sensory block was at T10 in group A and T9 in group B (P = 0.001). Duration of motor block was longer in group B being 210.51 ± 61.25 min than in group A being 286.25 ± 55.65 min (P < 0.001).

Conclusion:

The addition of fentanyl to ropivacaine may offer the advantage of shorter duration of complete motor block, hemodynamic stability, and without any increase in the frequency of major side effects.

Batf3 and Id2 have a synergistic effect on Irf8-directed classical CD8α+ dendritic cell development

Dendritic cells (DCs) are heterogeneous cell populations represented by different subtypes, each varying in terms of gene expression patterns and specific functions. Recent studies identified transcription factors essential for the development of different DC subtypes, yet molecular mechanisms for the developmental program and functions remain poorly understood. In this study, we developed and characterized a mouse DC progenitor-like cell line, designated DC9, from Irf8(-/-) bone marrow cells as a model for DC development and function. Expression of Irf8 in DC9 cells led to plasmacytoid DCs and CD8α(+) DC-like cells, with a concomitant increase in plasmacytoid DC- and CD8α(+) DC-specific gene transcripts and induction of type I IFNs and IL12p40 following TLR ligand stimulation. Irf8 expression in DC9 cells led to an increase in Id2 and Batf3 transcript levels, transcription factors shown to be important for the development of CD8α(+) DCs. We show that, without Irf8, expression of Id2 and Batf3 was not sufficient for directing classical CD8α(+) DC development. When coexpressed with Irf8, Batf3 and Id2 had a synergistic effect on classical CD8α(+) DC development. We demonstrate that Irf8 is upstream of Batf3 and Id2 in the classical CD8α(+) DC developmental program and define the hierarchical relationship of transcription factors important for classical CD8α(+) DC development.

Over-expression of gene encoding heat shock protein 70 from Mycobacterium tuberculosis and its evaluation as vaccine adjuvant

BACKGROUND

Heat shock proteins (Hsps) are evolutionary ancient and highly conserved molecular chaperons found in prokaryotes as well as eukaryotes. Hsp70 is a predominant member of Hsp family. Microbial Hsp70s (mHsp70s) have acquired special significance in immunity since they have been shown to be potent activators of the innate immune system and generate specific immune responses against tumours and infectious agents.

OBJECTIVES

The present study was aimed to clone express and purify recombinant Hsp70 from the Mycobacterium tuberculosis and characterise it immunologically. The study also aimed at determining the potential of recombinant M. tuberculosis heat shock protein (rMTB-Hsp70) as adjuvant or antigen carrier.

MATERIALS AND METHODS

Cloning of M. tuberculosis heat shock protein (MTB-Hsp70) amplicon was carried out using the pGEMT-Easy vector although for expression, pProExHTb prokaryotic expression vector was used. Purification of recombinant Hsp70 was carried out by nickel-nitrilotriacetic acid (Ni-NTA) affinity chromatography. For immunological characterization and determining the adjuvant effect of MTB-Hsp70, BALB/c mice were used. The data obtained was statistically analysed.

RESULTS

Hsp70 gene was cloned, sequenced and the sequence data were submitted to National Center for Biotechnology Information (NCBI). Recombinant MTB-Hsp70 was successfully over-expressed using the prokaryotic expression system and purified to homogeneity. The protein was found to be immunodominant. Significant adjuvant effect was produced by the rMTB-Hsp70 when inoculated with recombinant outer membrane protein 31; however, effect was less than the conventionally used the Freund's adjuvant.

CONCLUSION

Protocol standardised can be followed for bulk production of rHsp70 in a cost-effective manner. Significant adjuvant effect was produced by rMTB-Hsp70; however, the effect was than Freund's adjuvant. Further, studies need to be carried out to explore its applicability as carrier of antigen.

Acute mania after thyroxin supplementation in hypothyroid state

The current literature variedly ascribes depressive and manic symptoms to hypo- and hyperthyroid state, respectively, reporting mania in hypothyroidism as an unusual entity. More unusual is precipitation of manic state in hypothyroid subjects after thyroxine supplementation for which studies report otherwise treating manic symptoms in hypothyroid state with thyroxine. We report a case of a patient whose acute mania appears to have been precipitated by thyroxine supplementation in hypothyroidism state. This case underscores the importance of thyroid screening in patients with mood and psychotic disorders, as well as the potency of thyroxine in producing manic symptoms.

A descriptive analysis of patients presenting to psychosexual clinic at a tertiary care center

BACKGROUND

Psychosexual problems are very common presentation, be it with psychiatric or physical illness but there are very few studies available on psychosexual disorders especially in the Indian context. Indian society is deeply ingrained in customs and several misconceptions, myths, prejudices, and social taboos are attached to sex which makes it further very difficult to tackle.

OBJECTIVES

The aim of this current study was to descriptively analyze the nature of sexual disorders in a tertiary care center.

MATERIALS AND METHODS

The current retrospective chart review included 698 consecutive subjects seeking treatment for their psychosexual problems at the Sexual Clinic, Department of Psychiatry, Dr. Ram Manohar Hospital, New Delhi (between 2006 and 2010).

RESULTS

This study observed erectile dysfunction (ED) (29.5%), Premature ejaculation (PME) (24.6%), Dhat syndrome (DS) (18.1%), and ED with PME (17.5%) as the common sexual dysfunctions leading to treatment seeking. DS was the major complaint among younger and unmarried individuals. We observed more married individuals seeking treatment for sexual disorders.

CONCLUSIONS

These findings provide important information on a relatively under-researched area.

HIV presenting as young-onset dementia

With the advent of retroviral therapies, the incidence of severe dementia associated with HIV has been reduced, although minor neurocognitive impairment is being increasingly recognized in the course of illness. We report a case of a young woman presenting with HIV-associated dementia and raise awareness of its presentation in young age and as the first presenting symptom.

A study of profile of disability certificate seeking patients with schizophrenia over a 5 year period

BACKGROUND

Schizophrenia has been identified as one of the most disabling condition known to mankind. Until recently there was no published literature on disability certification seeking behavior of patients diagnosed with schizophrenia. The current study aimed at understanding the profile of patients diagnosed with schizophrenia seeking disability certification for a tertiary level multispecialty hospital in India.

MATERIALS AND METHODS

The study was carried out at the Psychiatry department for a tertiary care hospital in India. The evaluation of the subjects was carried out in the presence of a primary care giver. First, the diagnosis was established using International Statistical Classification of Diseases and Related Health Conditions (ICD)-10. Subsequently, the disability was assessed using Indian Disability Evaluation Assessment Scale (IDEAS). Data were analyzed using SPSS (Statistical Package for Social Sciences) software version 17.

RESULTS

A total of 169 subjects seeking disability certification over the study period of 5 years were diagnosed with schizophrenia. Out of 169 subjects 132 (78.1%) were male and 37 (21.9%) were female. There was a statistically significant difference in the marital status of the male and female study subjects. Family history of psychiatric illness was positive in 9.8% of male subjects and 10.8% of female subjects. There was no significant difference between male and female subjects for the duration of illness and duration of being on treatment. Male and female subjects did not differ significantly on the IDEAS global score, personal care, interpersonal interaction, and understanding and communication domains of IDEAS. The two groups differed significantly on the work domain.

CONCLUSIONS

Majority of patients with schizophrenia seeking disability certificate continue to be male. However, male and female subjects tend to differ very little on various socio-demographic and illness related variables. The levels of disability are also comparable among males and females. However, the work related disability is relatively higher among males and females continue to be financially dependent on the family members.

Immediate post-anaesthesia recovery 2013: Association of Anaesthetists of Great Britain and Ireland

1. After general, epidural or spinal anaesthesia, all patients should be recovered in a specially designated area (henceforth 'post-anaesthesia care unit', PACU) that complies with the standards and recommendations described in this document. 2. The anaesthetist must formally hand over the care of a patient to an appropriately trained and registered PACU practitioner. 3. Agreed, written criteria for discharge of patients from the PACU to the ward should be in place in all units. 4. An effective emergency call system must be in place in every PACU and tested regularly. 5. No fewer than two staff (of whom at least one must be a registered practitioner) should be present when there is a patient in a PACU who does not fulfil the criteria for discharge to the ward. 6. All registered practitioners should be appropriately trained in accordance with the standards and competencies detailed in the UK National Core Competencies for Post Anaesthesia Care. 7. All patients must be observed on a one-to-one basis by an anaesthetist or registered PACU practitioner until they have regained control of their airway, have stable cardiovascular and respiratory systems and are awake and able to communicate. 8. All patients with tracheal tubes in place in a PACU should be monitored with continuous capnography. The removal of tracheal tubes is the responsibility of the anaesthetist. 9. There should be a specially designated area for the recovery of children that is appropriately equipped and staffed. 10. All standards and recommendations described in this document should be applied to all areas in which patients recover after anaesthesia, to include those anaesthetics given for obstetric, cardiology, imaging and dental procedures, and in psychiatric units and community hospitals. Only registered PACU practitioners who are familiar with these areas should be allocated to recover patients in them as and when required. 11. Patients' dignity and privacy should be respected at all times but patients' safety must always be the primary concern. When critically ill patients are managed in a PACU because of bed shortages, the primary responsibility for the patient lies with the hospital's critical care team. The standard of nursing and medical care should be equal to that in the hospital's critical care units. Audit and critical incident reporting systems should be in place in all PACUs.

An analysis of paramilitary referrals to psychiatric services at a tertiary care center

BACKGROUND

There is a dearth of specialized mental health services for Indian paramilitary service personnel. Those requiring psychiatric evaluation are referred to government psychiatric services often with minimal information. Hence, major diagnostic and decision making relies on the psychiatrist's clinical evaluation and judgment. The aim of the present study was to quantitatively evaluate the paramilitary referrals to psychiatric services at a tertiary care referral center.

MATERIALS AND METHODS

A retrospective chart analysis of all consecutive referrals by various Indian paramilitary services to a tertiary care hospital (2008-2010) was carried out.

RESULTS

Among the sample of 18 referrals, all were males (mean age: 37 years ± standard deviation (SD) =7.79). Various reasons for referral included: Evaluation of fitness for duty (83.3%), fitness to handle firearms (16.7%), and for disability certification (5.6%). There were no informants at all in 22.2%, and family members were available in only 11.1%. Hence, most referrals were admitted to the psychiatry ward for observation for various lengths of time. The mean duration of assessment (outpatient and inpatient) was 17.89 days (SD = 20.74) and final reported diagnoses were schizophrenia, depression, and bipolar disorder in 16.7, 11.1, and 11.1%, respectively. There was concurrent history of alcohol and nicotine dependence (40%). A large group (40%) was diagnosed not to suffer from a major mental illness, while a firm and final diagnosis could not be arrived at in 16.7% subjects. Only one subject was given the fitness to handle firearms, fitness for duty was refused in three (16.7%) subjects, and one subject was referred to neurology after being diagnosed as a case of seizure disorder.

CONCLUSION

There is an urgent need for intensive training both to paramilitary physicians as well as to general hospital psychiatrists regarding proper assessment of paramilitary personnel, as there are frequent chances of the cases being undiagnosed or improperly diagnosed.