Anita Malik

Increased myeloperoxidase enzyme activity in plasma is an indicator of inflammation and onset of sepsis

INTRODUCTION Circulating lipopolysaccharides released from bacteria may activate both neutrophils and monocytes. The activated neutrophils release myeloperoxidase (MPO), a specific enzyme with strong oxidative activity. The aim of this study was to evaluate MPO enzyme activity in plasma of critically ill patients and to check the hypothesis that these concentrations in plasma would be higher in sepsis and systemic inflammatory conditions, as neutrophils release their contents before proliferating in response to stress. MATERIAL AND METHODS Blood samples were collected from 105 critically ill patients admitted to the intensive care unit, consisting of those with systemic inflammatory response syndrome (n = 42), sepsis (n = 37), and septic shock (n = 26). Plasma MPO enzyme activity was determined by o-dianisidine-H(2)O(2) method, modified for 96-well plates. RESULTS The plasma MPO enzyme activity in sepsis patients was significantly higher than that in the control group (mean, 2.4 ± 1.8 in sepsis and 1.86 ± 1.2 nmol per milligram protein per 10 minutes in systemic inflammatory response syndrome vs 0.32 ± 0.11 nmol per milligram protein per 10 minutes in healthy controls). Mean plasma lactate levels in sepsis (7.8 ± 1.2 mmol/L) and shock patients (9.5 ± 1.2 mmol/L) and cytokines like tumor necrosis factor-α, interleukin-8, and interleukin-1β were simultaneously evaluated to establish onset of inflammation and sepsis. These results show that neutrophil activation occurring during inflammation and sepsis could be detected by plasma MPO concentration. CONCLUSION The plasma MPO concentrations may be a marker of the neutrophil proliferation and severity of inflammation.

A Prospective Randomized Study Comparing Percutaneous Nephrolithotomy under Combined Spinal-Epidural Anesthesia with Percutaneous Nephrolithotomy under General Anesthesia

Objective: A prospective randomized study was executed to compare the surgical parameters and stone clearance in patients who underwent percutaneous nephrolithotomy (PNL) under combined spinal-epidural anesthesia (CSEA) versus those who underwent PNL under general anesthesia (GA). Methods: Between January 2008 to December 2009, 64 patients with renal calculi were randomized into 2 groups and evaluated for the purpose of this study. Group 1 consisted of patients who underwent PNL under CSEA and Group 2 consisted of patients who underwent PNL under GA. The operative time, stone clearance rate, visual pain analog score, mean analgesic dose and mean hospital stay were compared amongst other parameters. Results: The difference between visual pain analog score after the operation and the dose of analgesic requirement was significant on statistical analysis between both groups. Conclusion: PNL under CSEA is as effective and safe as PNL under GA. Patients who undergo PNL under CESA require lesser analgesic dose and have a shorter hospital stay.

Tumor necrosis factor gene polymorphism results in high TNF level in sepsis and septic shock.

INTRODUCTION Systemic sepsis releases several cytokines among which tumor necrosis factor alfa (TNFα) has emerged as key cytokine causing septic shock. Single Nucleotide Polymorphisms (SNPs) at positions -238, -308, -376 and +489 in the promoter region of TNF gene exhibit differential association to inflammation and increased TNF production in sepsis. MATERIALS AND METHODS This research work was carried out in 278 critically ill patients and 115 controls. The patients were divided into four groups: Healthy controls, SIRS, Sepsis and Septic shock. Plasma cytokine level was evaluated by ELISA. Specific sequences of TNF gene (-238, -308, -376, +489) were amplified using polychromase chain reaction (PCR). SNP detected by BamHiI, NcoI, FokI, TaiI restriction enzymes. RESULTS Mean plasma TNFα level in healthy Control group was 8.37 ± 2.23 pg/ml, in SIRS group, the mean plasma TNFα level was 77.99 ± 5.51 pg/ml, in Sepsis patients 187.1 ± 14.33 pg/ml and in septic shock 202.2 ± 14.85 pg/ml; range 56.17-417.1 pg/ml. SNP was studied among different patient groups, which showed a higher frequency of mutants among sepsis and shock patients as compared to control. CONCLUSION Plasma TNF alpha level was significantly high in patients with sepsis and septic shock. SNP of TNF gene showed significant association between polymorphism and development of severe sepsis and septic shock, this would help us in evaluating patients at high risk for septic shock and such patients needed to obtain a rational basis for therapy.

Role of active nitrogen molecules in progression of septic shock.

Active nitrogen molecules are formed as a result of cell metabolism. They are essential for cell metabolism, but when produced in excess, they contribute to the pathogenesis of several disease processes. These nitrogen molecules play an important role in vascular instability of septic shock. This study was planned to detect the role of active nitrogen molecules in the progression of septic shock.

Comparative study of ropivacaine with ropivacaine-fentanyl and ropivacaine-fentanyl- magnesium sulfate in epidural anesthesia for lower limb surgeries

Epidural anesthesia presently is one of the most useful techniques in modern Anesthesiology. Its versatility, gives anesthesiologist the opportunity to provide surgical anesthesia along with post-operative analgesia. As a sole regional anesthesia technique it is routinely used for abdominal and lower limb surgeries. For achieving desired per-operative anesthetic effect and to reduce the deleterious hemodynamic response of large volumes of local anesthetic agents, opioids and adjuvant drugs are routinely used in epidural space, but the exact volume and concentration required has not been validated yet. ABSTRACT

Comparative evaluation of different volumes of 70% alcohol in celiac plexus block for upper abdominal malignsancies

Context: Celiac plexus block (CPB) (is an effective way to reduce cancer-associated pain in upper abdominal malignancies. Aims: To evaluate the efficacy and safety of different volumes of 70% alcohol in CPB. Settings and Design: Prospective, randomized, controlled clinical study. Subjects and Methods: Thirty patients of carcinoma gall bladder were randomly divided into three groups (n = 10) to receive 20, 30, and 40 ml of 70% alcohol in CPB. Statistical Analysis Used: All the continuous data were assessed analysis of variance followed by post-hoc tests (Tukey′s Honestly Significant Difference test). Ordinal data were compared using Kruskal-Wallis H-test followed by Mann-Whitney U-test. Categorical comparisons were performed using Chi-square test. Results: A significant difference in visual analog scale (VAS) score of Group I, Group I and Group III was observed from week 6 onward until the end of the study. At all these time intervals, VAS scores in Group I was higher than both Groups II and III during this time interval. VAS scores in Group III were significantly lower as compared to Group II from week 10 onward until the end of the study. As compared to baseline, at all the follow-up intervals, mean morphine requirement was significantly lower in Group II and Group III. A quality of life (QOL) score of Group III were higher as compared to Group I. Between Group II and Group III, significant difference was observed at week 16 only when Group III had a higher score as compared to Group II. Conclusions: VAS score, QOL, and reduction in morphine consumption were increased on increasing the volume of alcohol in CPB, 40 ml being most effective.

Evaluation of WHO guided pain management protocol in cases of cancer cervix

Introduction and Aims: Pain is a common debilitating symptom of cancer cervix. It occurs in 25-50% patients with newly diagnosed malignancies and in more than 75% of those with advanced disease. Yet, it is one of the most unattended problem. Henceforth, this study was planned to assess pain and to evaluate the response to pain management according to WHO step ladder protocol in cases of cancer cervix. Materials and Methods: This was a prospective cohort study that included patients of cancer cervix with pain. Patients of cancer cervix with severe systemic debilitating illness and those who had undergone major surgery in past 2 weeks were excluded from the study. The severity of pain was assessed by using visual analogue scale. Pain was managed according to WHO step ladder protocol for pain. Result: Total 61.5% patients of cancer cervix presented with pain. Success rate of WHO pain management protocol was 95.3%. Conclusion: Pain management was done effectively using WHO guided step ladder pain management protocol in 95.3% of cases. Oral Morphine is an effective drug for pain management. It is easily titratable and has a favorable benefit to risk ratio.