Prevention of hypertension during trans-sphenoidal surgery--the effect of bilateral maxillary nerve block with local anaesthetics

BACKGROUND

Severe cardiovascular responses are known to occur during trans-sphenoidal excision of the pituitary gland despite adequate depth of anaesthesia. This study was undertaken to evaluate the effects of bilateral maxillary nerve block with local anaesthetics on the cardiovascular responses to various stimuli during this procedure.

METHODS

In a group of 32 patients, 5-10 ml of a mixture of bupivacaine 0.5% and lignocaine 2% (1:1) was injected in the pterygopalatine fossa after induction of general anaesthesia. Seven control group patients did not receive any nerve block. In all the patients, general anaesthesia was induced with thiopentone and maintained with nitrous oxide-oxygen, pentazocine, boluses of thiopentone and halothane. Pancuronium was used for neuromuscular blockade.

RESULTS

In both the groups, maximum hypertension occurred on opening the blades of the bivalve nasal speculum. In the study group, hypertensive response was significantly less following nasal infiltration with adrenaline containing solution (10.26% increase vs. 23.08% in the control group, P < 0.05), nasal dissection (2.82% vs. 9.45%, P < 0.01) and on application of the nasal speculum (14.93% vs. 35.16%, P < 0.01). The effect on heart rate response was not significant.

CONCLUSION

The described technique is a useful adjunct to general anaesthesia for suppressing the haemodynamic responses during trans-sphenoidal surgery.

Familiarity and pronounceability of nouns and names

Ratings of familiarity and pronounceability were obtained from a random sample of 199 surnames (selected from over 80,000 entries in the Purdue University phone book) and 199 nouns (from the Kucera-Francis, 1967, word database). The distributions of ratings for nouns versus names are substantially different: Nouns were rated as more familiar and easier to pronounce than surnames. Frequency and familiarity were more closely related in the proper name pool than the word pool, although both correlations were modest. Ratings of familiarity and pronounceability were highly related for both groups. A production experiment showed that rated pronounceability was highly related to the time taken to produce a name. These data confirm the common belief that there are differences in the statistical and distributional properties of words as compared to proper names. The value of using frequency and the ratings of familiarity and pronounceability for predicting variations in actual pronunciations of words and names are discussed.

Molecular cloning, expression and mapping of the translational initiation factor eIF1 gene in Oryza sativa

Protein translation is very sensitive to salt stress and the proteins involved in this process may be an important determinant of salt tolerance. We isolated a rice cDNA clone (OseIF1) from a salt-tolerant indica cultivar (Pokkali) subjected to 150 mm NaCl, the deduced amino acid sequence of which had homology with the Sui1 suppressor locus in Saccharomyces cerevisiaei Hansen. The sequence contains 753 bp with an open-reading frame of 345 bp and shares similarity with the sequences of Sui1 and eIF1 in plants and mammals. Southern analysis indicates that the gene is present in more than a single copy per haploid genome and mapped to chromosome 1 of rice. Expression of the gene was increased by salt stress and also upregulated after exogenous ABA and mannitol treatments, suggesting that its induction is related to the water-deficit effect of high salt.

Outcomes of Clostridioides difficile infection in acute heart failure hospitalizations: insights from the National Inpatient Database

BACKGROUND

Heart failure (HF) patients are at a greater risk for nosocomial infections due to their higher prevalence of comorbidities, readmission rates, and prolonged hospital stays. Clostridioides difficile infection (CDI) remains a common nosocomial infection in hospitalized patients.

AIM

To identify patients with a diagnosis of acute HF and stratified based on the presence of CDI, using the National Inpatient Sample (NIS) database from 2016 to 2020.

METHODS

Adjusted odds ratios (aOR) of in-hospital outcomes were calculated, and a propensity-matched analysis was performed.

FINDINGS

Of 536,595 acute HF hospitalizations in this timeframe, 3030 were also diagnosed with CDI (0.56%). Patients with acute HF and CDI had significantly higher in-hospital mortality (adjusted odds ratio: (aOR): 1.91), cardiac arrest (aOR: 1.66), and use of mechanical circulatory support (MCS) (aOR 2.42). In propensity-matched analysis, in-hospital mortality (13.71 vs 8.44%; P=0.005), septic shock (7.54 vs 3.33%; P=0.002), and use of MCS (7.19 vs 3.68%; P=0.009) were significantly higher in HF patients with CDI than without. Coexisting neurological disease (aOR: 3.74) and liver disease (aOR: 2.97) showed the strongest association as independent predictors of mortality. HF patients with CDI had longer hospital stays (14.45 ± 19.40 vs 5.44 ± 7.10 days; P<0.0001) and higher inflation-adjusted total hospital costs ($186,225 ± 376,485 vs $60,740 ± 153,992; P<0.001) compared to those without CDI.

CONCLUSION

The occurrence of concomitant CDI in patients admitted with acute HF exacerbation is associated with worse in-hospital outcomes and deaths as well as longer hospitalizations and greater financial cost.