CARE Hospitals

Introduction:Unilateral biportal endoscopy (UBE) is a novel technique for spine surgeries gaining popularity in recent times. Being minimally invasive, certain complications, such as dural tears can be difficult to manage due to restricted access. Incidental dural tears are common during endoscopic spine surgery and various techniques, such as application of fibrin sealant, non-penetrating dural clips, pressure with gelfoam and conversion to minimally invasive or open surgery have been described for the management. This study aims to describe the “Hanky in the Pocket” Technique with collagen matrix inlay to manage incidental dural tears during UBE spine surgery.Case Series:We present a prospective case series of five patients with dural tears <4 mm during UBE spine surgery for the lumbar spine managed intra operatively with the aforementioned technique. All five patients achieved the Minimal Clinically Important Difference cutoff for visual analog scale (VAS) leg pain, VAS low back ache and Oswestry Disability Index Score at the end of 3 months of surgery. No complications of cerebrospinal fluid leak or neurodeficits were encountered with this technique based on a follow-up of 1 year.Conclusion:“Hanky in the Pocket” Technique with collagen matrix inlay is a safe and effective technique for the management of incidental small dural tears. Importantly, it is less time consuming, avoids conversion to open surgery and demonstrates a good functional outcome.

Ayurvedic methods of treatment for diabetes included medicinal formulations along with suggestion of healthy diet and activities. By ayurvedic perspective treatment of diabetes depends on prognosis and pathogenesis of Prameha Vyadhi (diabetes). Vataja Prameha which can be correlated with type 2 diabetic condition is mentioned as Asadhya that is no cure but it can be manageable with Ayurveda. For this a detailed study of pathogenic process in Prameha is essential. It included etiological factors, Dosh-Dushya involved in pathogenesis, pre-symptomatic phase, symptomatic phase, complications etc. As like modern science, Ayurveda has not mentioned the specific age for prevalence of Prameha. This case is about a K/C/O type 2 DM for last 3 years to a female patient of very young age (26 years) and had just begun to show an early stage of diabetic complications like neuropathy and retinopathy. When she consulted to Jeena Sikho Lifecare Limited Hospital, Derabassi, Punjab for Ayurvedic therapy this case was diagnosed as Vataja Prameha and treatment had been started accordingly. After 7 days of Panchkarma therapies, she showed some relief in symptoms. Then she was prescribed some herbal and herbo-mineral formulations along with lifestyle recommendation. Following to 10 months of this treatment her HbA1c showed positive finding of reduction in HbA1c by 2 % as compared to before treatment finding. Her diabetic condition shifted significantly from diabetic range to non-diabetic range within 10 months. She also mentioned relief in her chief complaints present at the time of consultation. Her treatment included formulations made up of contextual anti-diabetic herbs and minerals, diet and exercise recommendation and Panchkarma therapy.

Introduction: Inhaled alkyl nitrite analogues, commonly known as “poppers,” are short-acting vasodilators that can cause euphoria, dizziness, and related effects. Nitrites rarely result in acute life-threatening complications such as ventricular dysrhythmias. We report a case of electrical storm following accidental inhalation of isobutyl nitrite. Case Presentation: A 40-year-old male had accidental occupational exposure to isobutyl nitrite, after which he became unconscious and was brought to our hospital. On arrival, he was found to be in ventricular fibrillation, and cardiopulmonary resuscitation was initiated as per Advanced Cardiac Life Support protocol. He required three defibrillations, with return of spontaneous circulation achieved after 30 minutes. Post-resuscitation, an SaO2–SpO2 gap of 15% was noted, suggesting a high probability of methemoglobinemia. The patient was immediately treated with methylene blue (2 mg/kg) and transferred to the intensive care unit. Due to hypotension, vasopressors and inotropes were initiated. Two-dimensional echocardiography revealed severe left ventricular systolic dysfunction with an ejection fraction of approximately 30%. Management and Outcome: In the ICU, the patient developed multiple episodes of ventricular tachycardia requiring cardioversion, without sustained return of spontaneous circulation. Extracorporeal cardiopulmonary resuscitation was initiated using a 25 Fr multistage venous cannula in the left femoral vein and a 19 Fr return cannula in the right common femoral artery. Spontaneous circulation was achieved within eight minutes. Over the next 24 hours, the patient experienced eight additional episodes of ventricular tachycardia, all managed with cardioversion, and was started on a lignocaine infusion for 48 hours. The patient gradually regained sensorium, and co-oximetry showed no evidence of methemoglobinemia. Left ventricular function improved to 40%. ECMO was weaned and discontinued on day three. The patient was extubated on day four and discharged on day nine with no recurrence of arrhythmias on telemetry. Conclusion: This case highlights a rare but life-threatening complication of isobutyl nitrite exposure presenting as refractory ventricular arrhythmias. Prompt recognition and timely initiation of extracorporeal support were crucial for survival.

Objective: Supraglottic airway devices are pivotal tools for airway management in anesthesia. The I-gel, a widely used second-generation airway device, is recognized for ease of insertion and low complication rate. This study aims to compare the ease of insertion of I-gel and associated insertion conditions when used with Fentanyl and Dexmedetomidine in combination with Propofol. Methods: After obtaining approval of ethical committee, a total of 60 patients were enrolled a tertiary care hospital and divided into two groups. Group F received 2 mcg/kg of intravenous fentanyl and propofol; Group D received 1 mcg/kg of intravenous dexmedetomidine infusion in 10 minutes and propofol. The ease of I-gel insertion and jaw relaxation was assessed using the modified Lund and Stovener criteria and Young’s criteria, respectively. The physiologic variables, adverse events like apnea, desaturation, cough, jaw movement; and additional requirement of propofol bolus doses were recorded at baseline, first, third, fifth and tenth minutes after insertion. Results: No significant differences were observed in jaw relaxation, ease of I-gel insertion, and adverse events. The apnea duration was shorter in Group D (12.1±2.3 min vs 15.1±2.8, p&lt;0.001). Respiratory rate was significantly lower in Group F. It was easier to insert I-gel in Group D (p=0.213). Ramsay Score was higher and Aldrete score was lower in Group D (p&lt;0.001). Conclusion: Dexmedetomidine as an adjuvant to propofol is a safe alternative to combination of propofol and fentanyl in pediatric surgeries. Although both drugs maintain a stable hemodynamic profile, dexmedetomidine demonstrates superior efficacy in preserving respiratory stimulus.

Hypertension has been traditionally known to be highlighted by mean blood pressure; however, emerging evidence exhibits that blood pressure variability (BPV), including short-term, day-to-day, and visit-to-visit fluctuations can have an implication across multiple body systems. Elevated BPV reflects repetitive hemodynamic stress, affecting the physiologic hemostasis contributing to vascular injury and end organ damage. This narrative review is a compilation of recent evidence on the prognostic value of BPV, explained by pathophysiology, various devices with its measurement approaches, and, essentially, the clinical implication of BPV and the use of such devices utilizing artificial intelligence. A comprehensive literature search across PubMed, Cochrane Library, Scopus, and Web of Science were conducted, focusing on observational studies, cohorts, randomized trials, and meta-analyses. Higher BPV has been associated with an increased risk of cardiovascular mortality, stroke, coronary events, and heart failure, the progression of chronic kidney disease, cognitive decline, and preeclampsia, among other end organ damage, despite mean blood pressure. The various pathophysiologic mechanisms include autonomic dysregulation, arterial stiffness, endothelial dysfunction, circadian rhythm alteration, and systemic inflammation, which result in vascular remodeling and multisystem damage. Antihypertensive medications such as calcium channel blockers and renin-angiotensin-aldosterone system inhibitors seem to reduce BPV; randomized trials have not specifically investigated their BPV-reducing effects. The aim of this review is to highlight that BPV is a dynamic marker of multisystem risk, and question how various AI-based devices can aid continuous BPV monitoring and patient specific risk stratification.

Controlled and sustained antibiotic delivery is critical for combating antimicrobial resistance while minimizing side effects. Herein, a novel biodegradable hydrogel system, synthesized via gamma irradiation, incorporating fluorescent carbon dots (CDs) as multifunctional nano-crosslinkers, has been reported. The CDs, prepared from sustainable bio-precursors, reinforced the polymer network and enhanced the mechanical stability and swelling behavior, while simultaneously serving as intrinsic fluorescent probes for potential real-time monitoring of degradation and drug release. Thorough characterization revealed consistent morphology, adjustable biodegradability, and enhanced rheological characteristics. Drug release investigations demonstrated a diffusion-controlled mechanism, wherein the integration of CD diminished the cumulative antibiotic release from approximately 70% to approximately 40%, thereby facilitating precise regulation of release kinetics. The single-step gamma irradiation method facilitates concurrent crosslinking and sterilization, providing an efficient and scalable production strategy. This study presents a multifunctional hydrogel platform that integrates sustainable nanomaterials, regulated drug administration, and real-time monitoring, thereby facilitating the development of advanced theragnostic systems.