Niramaya Hospital

Background: Spine surgery is challenging to anesthesiologist due to various factors. It is important to provide intraoperative hemodynamic stability, clear surgical field and a conscious, and pain free comfortable patient post-operative. Sevoflurane and desflurane provide rapid recovery. Dexmedetomidine provides sedation, stable, hemodynamics and analgesia. Dexmedetomidine has become an integral part of balanced anesthesia along with inhalational anesthetics in spine surgery. Aims and Objectives: Our study was done to compare recovery profile of sevoflurane and desflurane with dexmedetomidine and compare total dose of dexmedetomidine required in both the groups. Materials and Methods: Sixty ASA I-II patients undergoing spine surgery were randomly divided into two groups: Group A – Sevoflurane + Dexmedetomidine and Group B – Desflurane + Dexmedetomidine. Postoperatively, time to eye opening and extubation time was measured. The patient was shifted to post-anesthesia care unit (PACU) 10 min after extubation. Fast-track criteria (FTC) score was assessed for 1 h post-extubation in PACU. Results: Mean time to eye opening in Group A: 13.07±2.08 min which was significantly longer than in Group B: 9.17±2.23 min (P<0.05). Similarly, mean extubation time was shorter in Group B than in Group A, 12.77±2.50 min versus 17.83±2.68 min, respectively (P<0.05). FTC score was significantly higher in Group B as compared to Group A at all times (P<0.05), except at 60 min, when it was similar (P=1.000). Discharge criteria from PACU in all patients were achieved at 15 min in Group B, while in Group A, it was achieved at 30 min. Conclusion: We found that desflurane and dexmedetomidine combination is superior to sevoflurane and dexmedetomidine in time to eye opening and extubation time. Higher post-anesthesia recovery score (FTC score) is seen in desflurane/dexmedetomidine group than sevoflurane/dexmedetomidine group.

The main route of the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are through respiratory pathways and close contact of human-to-human. While information about other modes of transmission is comparatively less, some published literature supporting the likelihood of a fecal-oral mode of transmission has been accumulating. The diagnosis of SARS-COV-2 infected cases is based on the real-time reverse transcription-PCR (RT-PCR). The fecal excretion of SARS-COV-2 has been reported frequently, however, the role of fecal viral load with the severity of disease is not yet clear. Our study focused on the investigation of SARS-CoV-2 shedding in the fecal samples of patients with coronavirus disease 2019 (COVID-19). A total of 280 RT-PCR-positive patients were enrolled, among them 15.4% had gastrointestinal (GI) symptoms. It was shown that 62% of the patients were positive for SARS-CoV-2 RNA in fecal specimens. This positivity was not related to the presence of GI symptoms and the severity of disease. The next generation sequencing [NGS] of SARS-CoV-2 from fecal samples of patients was performed to analyze mutational variations. Findings from this study not only emphasized the potential presence of SARS-CoV-2 in feces, but also its continuing mutational changes and its possible role in fecal-oral transmission.

Abstract Background/Objective: Patients with type 2 diabetes face challenges when it comes to following recommendations (nutrition, exercise and medications). Using technology to understand glycemic responses can increase patient awareness about dietary and lifestyle changes. Coupled with coaching by an expert nutritionist, such a program may help improve patient adherence, resulting in a reduction in HbA1c and body mass index (BMI). Method: Fifty-seven patients with type 2 DM not at goal (HbA1c ≥ 6.5%) either on lifestyle modification, OHA with or without insulin, consenting to participate in the study were enrolled in the DIABEFLY program which included Ambulatory glucose monitoring (AGM) and correlating it with dietary intake for 14 days using a technology platform (FITTERFLY wellness app). Patients were explained their AGM graphs, in relation to their daily food and activity log, to make them aware of their personalised glycemic responses to various foods and accordingly diet plan was suggested. Nutritionists (coaches) interacted with patients over calls on Day 1, 7, 14, 30, 60 and Day 90 to explain recommendations, address any diabetes related queries and evaluate adherence to diet & exercise plans. Patients also had access to daily chat support for 90 days and received daily messages on glycemic responses, healthy food choices, exercise options, stress management, sleep, medication adherence, self-monitoring of blood glucose and complications of diabetes. Strictly, no advice on type or dosage of medication was given by the coaches. Statistical analysis for outcomes was done by t-test using SPSS software. Result: Out of 57 patients, mean age was 46 years, of which 70% were male and 30% were females. The baseline HbA1c was found to be 8.3% ± 1.68 which significantly decreased (p<0.05) to 7.4% ± 1.36 in 3 months. The Baseline BMI of 27.1± 4.9 kg/ sq m was significantly reduced (p<0.05) to 26.6±4.6 kg/sq m in 3 months. Discussion: With the availability of AGM devices, powerful food databases and technology to correlate these two had led to a new era of diabetes coaching. The personalised glycemic responses so calculated for every patient lead to more concrete understanding of changes necessary for better glycemic control. Regular interactions or reminders from an expert may act as a unique and necessary way of reinforcement to follow recommendations. In our study, though increased engagement with the programme resulted in a significant reduction in HbA1c and BMI. Conclusion: Personalized Glycemic response led coaching benefits patients with Type 2 diabetes mellitus helping them achieve two critical outcomes - lowering of HbA1c and reduction of BMI as early as three months. Keywords: AGM; Personalised glycemic response; Diabetes lifestyle coaching

Protein calorie malnutrition among infant are prevalent in many parts of India and is mainly due to inappropriate and inadequate feeding practice and ignorance of mother.Low-income population in our country cannot afford to use commercial infant food products due to financial constraints, or lack of knowledge.The most commonly used complementary food used is cow/buffalo milk followed by homemade semi-solids.Hence formulation and development of nutritious weaning foods from local and readily available raw materials has received considerable attention in many developing countries.Various texts in Ayurveda give formulas and foods for the development of the child.Ayurvedic herbs can be therefore be incorporated in weaning food formulas.The present study aimed to develop weaning food based on Ayurvedic Herbs (AH).The composition of the product formulated included Popped rice, Priyal seeds (Buchanania lanzan Spreng), Yashtimadhu (Glycyrrhiza glabra), Elaichi (Elettaria cardamomum), Shunthi (Zingiber officinale Roscoe), sugar in specific proportions.The formulated mixture was standardized to ascertain the correct proportion of ingredients and the resultant product was subjected to sensory analysis.Proximate composition, pH, density and viscosity of the product was assessed by standard methods Results of the study reflect that Ayurvedic based infant food not only satisfies the palatability aspect but also seems to be nutrient dense which makes it a good choice for weaning food.