Background: Spinal anaesthesia with bupivacaine for lower limb and lower abdominal surgeries is limited by the fixed duration of action and cannot be prolonged except with usage of spinal catheters which increase the chance of infection and occurrence of haemodynamic instability when used in high doses. To minimize the instability in haemodynamics, several neuraxial adjuvants have been used. Methods: We carried out a prospective randomized double-blind study in 60 patients posted for lower abdominal and lower limb surgeries. Patients were divided into two groups of 30 each. Both groups received 3 mL of intrathecal hyperbaric 0.5% bupivacaine. In addition, ketamine group (Gr K) received ketamine 0.1mg/kg body weight intathecal (made to total volume of 0.5 mL); saline group (Gr S) received equal volumes of 0.9% normal saline intrathecally. The onset and duration of sensory and motor blockade and intraoperative haemodynamics were studied. Results: Addition of ketamine in comparison to saline administration produced significantly earlier onset (5.2±1 Vs. 3.4±1; p=0.000), prolonged duration of sensory block (129.7±14.9 Vs. 111.3±11; p=0.000) and long duration of postoperative analgesia (150.8±11.7 Vs. 127.8±12.8; p=0.000). Conclusion: Addition of ketamine to intrathecal hyperbaric bupivacaine provides better intraoperative spinal block characteristics, stable haemodynamics and longer duration of postoperative analgesia.

Background: In Staphylococcus aureus purine metabolism plays a crucial role in the formation of biofilm which is a key pathogenic factor. The present study is aimed in the characterization of inosine monophosphate dehydrogenase (IMPDH) from Staphylococcus aureus ATCC 12600. Methods: IMPDH gene was amplified using primers designed from IMPDH gene sequence of S. aureus reported in the database. Then polymerase chain reaction (PCR) product was cloned in the Sma I site of M13mp18 and expressed in Escherichia coli JM109. The recombinant IMPDH (rIMPDH) was overexpressed with 1 mM isopropyl beta-D-1- thiogalactopyranoside (IPTG); Michaelis constant (K_m), maximum enzyme velocity (V_max) and catalytic constant (K_cat) of expressed IMPDH were determined. Results: The enzyme kinetics of IMPDH grown under aerobic conditions showed a K_m of 43.71±1.56 μM, V_max of 0.247±0.84/μM/mg/min and K_cat of 2.74±0.015/min while in anaerobic conditions the kinetics showed K_m of 42.81±3.154/μM, V_max of 0.378±0.036 μM/mg/min and K_cat of 4.78±0.021/min, indicating elevated levels of IMPDH activity under anaerobic conditions. Three-folds increased activity in the presence of 1 mM adenosine triphosphate (ATP) correlated with biofilm formation. The kinetics of pure rIMPDH were close to the native IMPDH of S. aureus ATCC12600 and the enzyme showed single band in sodium dodecyl sulphate polyacrylamide gel electrophoresis with a molecular weight of 53 KDa. Conclusions: Elevated activity of IMPDH was observed in S. aureus grown under anaerobic conditions and this was correlated with the biofilm formation indicating the linkage between purine metabolism and pathogenesis.

Background: Platelet transfusions are essential to prevent morbidity and mortality in patients who are severely thrombocytopenic and are at risk of spontaneous bleeding. Platelets are currently obtained either by fractionation of whole blood or by platelet apheresis. The quality of single donor platelets (SDP) in terms of yield influences platelet recovery in the recipient and allows prolonging intervals between transfusions. Material and Methods: Donor demographic and laboratory data were analyzed prior to performing plateletpheresis to identify donor factors that influence platelet yield. The study was conducted on 130 healthy, first-time plateletpheresis donors over a period of 4 years. The plateletpheresis procedures were performed using Fresenius Kabi COM.TEC and Hemonetics MCS plus separator. A relationship between pre-donation donor variables and yield of platelets was studied using the Pearson correlation. Results: The mean platelet yield was 3.16±0.62x10¹¹ per unit. A positive correlation was observed between platelet yield and pre-donation platelet count, body mass index (BMI; Kg/m²) of the donor, while a negative correlation was observed between age and the platelet yield. Conclusion: Donor pre-donation platelet count, BMI and donor age influence platelet yield. Young healthy donors with a high platelet count and better BMI can give a better platelet yield in the SDP.

The differentiation of sepsis and systemic bacterial infections from other causes of systemic inflammatory response is crucial from the therapeutic point of view. The clinical signs and symptoms are non-specific and traditional biomarkers like white cell count, erythrocyte sedimentation rate and C-reactive protein are not sufficiently sensitive or specific to guide therapeutic decisions. Procalcitonin (PCT) is considered a reliable marker for the diagnosis and prognosis of moderate to severe bacterial infections, and it has also been evaluated to guide the clinicians in the rational usage of antibiotics. This review describes the diagnostic and prognostic role of PCT as a biomarker in various clinical settings along with the laboratory aspects and its usefulness in risk stratification and antibiotic stewardship.

We report a 35-year-old gentleman who presented to us with respiratory distress. He was diagnosed to have a large anterior mediastinal mass and was and posted for debulking of mediastinal mass. Immediately after intubation, airway collapsed and there was difficulty in ventilating the lungs, followed by drop in oxygen saturation. After sternotomy, oxygen saturation and airway pressures improved. In this report we discussed in detail about the successful anaesthetic considerations for patients with large anterior mediastinal tumour including the management of airway obstruction.

We report a case of a Primi gravida with preeclampsia and intrauterine foetal death. As she failed to respond to induction of labour she was taken up for caesarian section. On opening the abdomen, uterus was bicornuate with fundal rupture of left horn. Dead foetus presenting as breech was found in the left horn. After delivering the foetus and placenta the rent was sutured in two layers. In this case, induction of labour in patient with undiagnosed uterine anomaly has led to rupture. This case stresses the importance of early ultrasound in diagnosing uterine anomalies.

We report of the rare occurrence of pigment dispersion syndrome (PDS) with posterior subcapsular cataract in both eyes in a young male patient. The patient presented with complaints of progressive decrease in vision of one year duration. The patient also had high myopia with mild iridodonesis, phacodonesis and anterior insertion of zonules. Classical signs of PDS like Krukenberg's spindle on the posterior corneal surface were evident on slit lamp examination; transillumination defects in the iris could not be elicited by retroillumination as the iris was heavily pigmented. Gonioscopy revealed heavy and uniform pigmentation of trabecular meshwork. Evidence of a characteristic iris configuration on optical coherence tomography (OCT), namely, posterior bowing of iris in the mid periphery suggested the diagnosis of PDS. This case highlights the importance of OCT in identifying the iris configuration characteristically seen in PDS even in the absence of transillumination defects in the iris and reiterates the need to look for subtle signs like phacodonesis which are important when surgical intervention is planned.

“Ball valve thrombus” which is a spherical free floating clot in left atrium is an often quoted, but uncommonly encountered complication in patients with severe mitral stenosis of rheumatic origin, who are in atrial fibrillation. We describe the case of a 31-year-old lady with rheumatic heart disease, severe mitral stenosis and moderately severe aortic stenosis who had undergone closed mitral valvotomy 13 years ago. The patient presented with an episode of non-exertional syncope and breathlessness on exertion of 6 months duration and was in normal sinus rhythm. Echocardiography facilitated ante-mortem diagnosis and prompt institution of surgery was life saving.

Samarium-153-ethylene diamine tetramethylene phosphonate (samarium-153 EDTMP) is a novel systemic radiopharmaceutical, used for treatment of bone pain due to metastatic disease. We report a patient with carcinoma prostate, diffuse metastatic bone disease with severe back pain that was refractory to analgesics and morphine. He was also found to be anaemic (haemoglobin 8.1 g/dL). Inspite of anaemia and diffuse metastatic bone disease being relative contraindications for the use samarium-153-EDTMP, because of its potential for causing radiation induced myelotoxicity, the patient was treated with this modality and showed a remarkable response in pain control within a few days. He developed mild radiation induced myelotoxicity, which was subsequently managed with blood transfusion and supportive care. The present case highlights the utility of samarium-153 EDTMP therapy in patients with intractable pain due to diffuse metastatic bone disease.