Sudeep Kumar

Reviewing the blood ordering schedule for elective orthopedic surgeries at a level one trauma care center.

Background: Patients undergoing elective orthopedic surgeries often incur excess blood loss necessitating transfusion. The preoperative placement of blood requests frequently overshoots the actual need resulting in unnecessary crossmatching. Aims: Our primary goal was to audit the blood utilization in elective orthopedic surgeries in our hospital over a 1-year period and recommend a blood ordering schedule. Materials and Methods: A retrospective analysis of patients who underwent elective orthopedic surgeries over a period of 1 year was done. The data collected include patients’ age, sex, type of surgical procedure, pre- and postoperative hemoglobin (Hb) levels, number of units crossmatched, returned, transfused, crossmatch to transfusion ratio (C:T), transfusion indices, estimated blood loss for each surgical procedure, and the actual and predicted fall in Hb. We propose a blood ordering schedule based on surgical blood ordering equation. Results and Conclusions: A total of 487 patients with a median age of 37±17 years (mean ± standard deviation) were evaluated. One thousand three hundred and seventy-seven units of blood were crossmatched and only 564 units were transfused to 260 patients. Fifty-nine percent of the units crossmatched were not transfused. Six of the 12 elective procedures had a C:T ratio higher than 2.5. Ten of the 12 procedures (83.3%) had a low transfusion index (TI < 0.5). The calculated red blood cell units were less than 0.5 in 5 of the 12 elective procedures, and hence we recommend a group and save policy for these procedures. Blood ordering schedule based on patient and surgical variables would provide an efficient way of blood utilization and management of resources.

Diagnostic accuracy of bedside emergency ultrasound screening for fractures in pediatric trauma patients

Background: Bedside ultrasound (BUS) can effectively identify fractures in the emergency department (ED). Aim: To assess the diagnostic accuracy of BUS for fractures in pediatric trauma patients. Setting and Design: Prospective observational study conducted in the ED. Material and Methods: Pediatric patients with upper and lower limb injuries requiring radiological examination were included. BUS examinations were done by emergency physicians who had undergone a brief training. X-rays were reviewed for the presence of fracture and the results of BUS and radiography were compared. Statistical analysis: STATA version 11 was used for statistical analysis of the data. Results: Forty-one patients were enrolled in the study. The sensitivity of the BUS in detecting fracture was 89% [95% confidence interval (CI): 51% to 99%] and the specificity was 100% (95% CI: 87% to 100%). The positive predictive value of BUS was 100% and negative predictive value was 97%. Conclusion: BUS can be utilized by emergency physicians after brief training to accurately identify long bone fractures in the pediatric age-group.

Study of Trace Elements in Patients of Hypothyroidismwith Special Reference to Zinc and Copper

Background: Hypothyroidism is a clinical entity resulting from a deficiency of thyroid hormones or, more rarely, from their impaired activity at the tissue level. Several mineral and trace elements are essential for normal thyroid hormone metabolism and co-existing deficiencies of these elements can impair thyroid function. The present study was conducted with the aim to find out the concentrations of zinc and copper in hypothyroidism and to determine the possible correlations between trace elements and thyroid hormones. Material and Methods: Our study included 40 patients with hypothyroidism and 40 normal control subjects. In all the subjects, T3, T4, and TSH were measured by ELISA whereas trace elements zinc and copper were measured colorimetrically. Results: Both zinc and copper were significantly reduced in patients of hypothyroidism as compared to controls (57.05±7.54 μg/dl vs. 98.02±7.77 μg/dl, p<0.001 and 73.86±6.22 μg/dl vs. 114.97±18.18 μg/dl, p<0.001, respectively). Zinc was significantly and positively correlated with T3 (r=0.326; p<0.05) in hypothyroidism patients but there was no significant correlation of zinc with rest of the hormones i.e, T4 (r=0.078; p>0.05) and TSH (r=-0.026; p>0.05) levels. With regard to copper, we did not find any significant correlation of copper with T3 (r=0.076; p>0.05), T4 (r=0.171; p>0.05) and TSH (r=0.167; p>0.05). Conclusion: In conclusion, hypothyroid patients had significantly decreased concentration of zinc and copper. Hence, diet rich in trace elements, viz. zinc and copper should be supplied to patients of hypothyroidism in order to maintain normal thyroid hormone function.

Accurate Positioning of Femoral and Tibial Tunnels in Single Bundle Anterior Cruciate Ligament Reconstruction Using the Indigenously Made Bernard and Hurtle Grid on a Transparency Sheet and C-arm

Many factors determine the outcome of the anterior cruciate ligament reconstruction surgery. The single most important factor, also well within the control of a surgeon, is tunnel placement. It is difficult to accurately determine the center of the anterior cruciate ligament foot print, and many a times it is also difficult to accurately define the intercondylar and bifurcate ridge. This makes determination of the accurate entry point of the guidewire difficult. We have printed our indigenously formed grid (equidistant boxes) on an old-fashioned transparency sheet. We use a fluoroscopy (C-arm) shot intraoperatively in the lateral position and superimpose this sheet to determine the position of the guidewire by calculating the percentage of boxes. We aim at 27.7% in proximal to distal and 37.5% in anterior to posterior on the femur side and 45% in front to back and medial to lateral on the tibial side. C-arm is freely available, but the inbuilt grid facility may be available in only the higher version of C-arms. Our indigenously designed grid can be easily used across the globe with ease to achieve accuracy in tunnel placement without violating anatomy and without any extra cost.

Tricuspid annular plane systolic excursion is reflective of biventricular function in critically ill patients

Patients and methods Hundred and one patients admitted to the ICU for sepsis, septic shock, acute cardio respiratory failure or other organ supportivecare. A trained cardiologist conducted transthoracic echocardiography within 48 hours of admission to ICU. Echocardiographic parameters of both right and left heart along with demographic, prognosis, hemodynamic, ventilator, and laboratory parameters wererecorded.