Rashmi Datta

Hydroxyeyhyl starch: Controversies revisited.

Hydroxyethyl starch (HES) family has been one of the cornerstones in fluid management for over four decades. Recent evidence from clinical studies and meta-analyses has raised few concerns about the safety of these fluids, especially in certain subpopulations of patients. High-quality clinical trials and meta-analyses have emphasized nephrotoxic effects, increased risk of bleeding, and a trend toward higher mortality in these patients after the use of HES solutions. Scientific evidence was derived from international guidelines, aggregated research literature, and opinion-based evidence was obtained from surveys and other activities (e.g., internet postings). On critical analysis of the current data available, it can be summarized that further large scale trials are still indicated before HES can be discarded.

Impact of Nasal Symptoms on the Quality of Life of Fresh Inductees in High Altitude

BACKGROUND Troops deployed in high altitude areas of Ladakh face nasal problems in the form of obstructive nasal symptoms and recurrent epistaxis. This study analyses the changes in the nasal mucociliary transit times (NMTT) and deterioration in quality of life of troops on first high altitude induction. METHODS A prospective study on 100 healthy volunteers was done. Mucociliary transit time was measured and a standardized quality of life questionnaire (RQLQ) administered at onset and after a period of three months in high altitude. Thereafter the subjects were divided into two groups and the study group was administered normal saline nasal drops. The observations were taken and results were statistically analysed after a period of three months. RESULT The mucociliary transit time was prolonged after a three month stay in high altitude (p< 0.005). Normal saline nasal drops were successful in improving the nasal mucociliary transit times (p < 0.05). There was a statistically significant derangement in the quality of life which was improved by administering normal saline nasal drops (p<0.05). CONCLUSION An increased muco-cilliary transport time after exposure to high altitude denotes a deranged physiology of the nasal mucosa. This leads to a statistically significant adverse impact on the quality of life of the troops deployed. The use of normal saline nasal drops is a simple and effective method of reversing some of these changes.

Frostbite of the Pinna and Nose

Frostbite is a feared manifestation of cold injury to the troops deployed in extreme cold areas. We report two cases of severe frost bite affecting the face. The rarity of such cases and their unique management prompted us to report these cases.

Analysis of bulked segregants to identify molecular markers linked with cocoon weight and cocoon shell weight in the silkworm Bombyx mori L

Two silkworm strains viz, B20 Λ (high cocoon shell ratio) and C. Nichi (low cocoon shell ratio) were sib mated for 10 generations to determine the homozygosis. Both bulked segregant analysis (BSA) and near isogenic lines (NIL) studies were done to identify the RFLP markers closely linked to cocoon shell parameters. Three hundred and fifty-two random clones were identified as the low copy number sequence and used for identification of Restriction Fragment Length Polymorphic (RFLP) marker linked to cocoon weight and cocoon shell character. In the bulk segregant analysis>DNA from the parents (B20 Λ C. Nichi), F1 and F2 progeny of high shell ratio (HSR) and low shell ratio (LSR) were screened for hybridization with the random clones. Polymorphic banding pattern achieved through southern hybridization with different probes indicated the probable correlation of polymorphism with high and low cocoon shell character which are possible landmarks in identifying the putative marker(s) for the cocoon shell character. Out of the 100 probes tried with parents, F1, F2 and their bulks, 10 probes were found to be closely linked to cocoon shell characters.

A study of the efficacy of stellate ganglion blocks in complex regional pain syndromes of the upper body

Background and Aims: The effect of stellate ganglion blocks (SGBs) was examined in complex regional pain syndromes (CRPS) of the upper body. Material and Methods: A total of 287 SGB were given to patients with documented CRPS on medications. Spontaneous and provoked pain assessment was done with numeric pain rating scale (NPRS). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and range of motion (ROM) was recorded before and after each blockade. Difference between a 15-point “global rating of change” scale determined the minimal clinically important difference of the DASH score. Results: The overall mean pain reduction was 73.2% (r = 0.83, P < 0.001) considering spontaneous and 55.8% (r = 0.77, P < 0.001) on provoked pain. Mean DASH score decreased from 53 (range 36–63; P = 0.14) to 10.4 (range 10–49.2; P = 0.005). The sensitivity to change was 6.9 for spontaneous and 4.9 for provoked pain. Increase in ipsilateral limb temperature has a good correlation with Horners syndrome (HS) and sympathetic blockade. Minor, self-limiting complications, such as hoarseness, dysphagia, local hematoma, and ipsilateral brachial plexus block occurred in 11.5%. A rare complication of contralateral HS was documented. One patient developed a small pneumothorax, but it did not require intervention. Conclusions: SGB are relatively safe and effective management in patients with neuropathic conditions already on pharmacotherapy. Serial blocks attained an average reduction in pain by >3 NPRS points from the baseline for both spontaneous and provoked pain with a decrease in mean DASH score and improvement in ROM.

Angelman syndrome and anaesthetic considerations

1. Mikhael H, Vadivelu N, Braveman F. Safety of spinal anesthesia in a patient with achondroplasia for cesarean section. Curr Drug Saf. 2011;6:130‐1. 2. İnan G, Yayla E, Taş Ü, Arık E, Günaydın Bs. Single Shot Spinal Anaesthesia for Caesarean Delivery of Two Achondroplasic Parturients. Turkish Journal of Anaesthesiology and Reanimation 2015:43.(4): 285‐7. 3. Samra T, Sharma S. Estimation of the dose of hyperbaric bupivacaine for spinal anaesthesia for emergency caesarean section in an achondroplastic dwarf. Indian J Anaesth 2010;54:481‐2. Access this article online

Use of Surgical Facemasks in the Operation Theatre: Effective or Habit?

In the era of cost constraints, shrinking hospital budgets and evidence-based medicine, many health-care professionals have begun re-examining traditional infection control practices. There has been much debate about whether the wearing of surgical facemasks (SFMs) in the operation theatre (OT), distinct from respiratory protective devices (RPDs), is an effective practice to prevent surgical site infections (SSI) or is just a habit that has no basis in fact.