Cardiac arrhythmia is a common medical condition. It significantly affects the patient's wellbeing and daily living. Cardiac arrhythmia is characterized by autonomic dysfunction. the mental health factors such as anxiety, depression, and stress are also the risk factors of cardiac arrhythmia. Yoga is one of the mind-body practices that have a positive impact on cardiac health. Yoga helps to alleviate stress, anxiety, and depression. It also helps to correct autonomic dysfunction. The scientific evidence suggests the beneficial effects of yoga in cardiac arrhythmia.
Background: Head and neck cancer (HNC) surgery is associated with high intraoperative blood loss which may require urgent blood transfusion. Many strategies have been recommended to decrease the need for allogenic transfusion. Use of perioperative tranexamic acid (TA) has a promising role. Aims: This study was to evaluate the effectiveness of single preoperative bolus dose of TA on blood loss prevention and red blood cell transfusion in patients undergoing HNC surgery. Study Design: A prospective, double-blind, and randomized controlled study. Materials and Methods: From 2007 July to 2010 January; 80 patients, aged (35–55), of American Society of Anesthesiologists II-III scheduled for unilateral HNC surgeries were randomly received either TA (Group T) in a dose of 20 mg/kg diluted to 25 cc with normal saline or an equivalent volume of normal saline (Group C) in a tertiary care hospital. Hemoglobin (Hb) concentration, platelet count, packed cell volume, fibrinogen level, D-dimer level were measured pre- and post-operatively. Results: Saline (C) Group required more blood, colloid, crystalloid for blood loss. In Group T, 32 patients did not require transfusion of any blood products compared to five patients in Group C (P < 0.0001) and only eight units of blood was transfused in Group T, whereas a total of 42 units of blood was transfused in Group C. Even after numerous transfusions, Hb% after 6 h and 24 h in Group C were significantly low in comparison with Group T (P < 0.05). Conclusion: Thus, TA significantly reduces blood loss and chances of colloid, blood, and crystalloid transfusion caused by HNC surgery.
This study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalized coronavirus disease 2019 (COVID-19) adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC).NCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined.Analysis of 29 509 hospitalized, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18 752 (63.6%)] showed that 15 678 (53.1%) had at least one comorbidity. Among 25 715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n = 3957). Adjusted odds of dying were significantly higher in age group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy and tuberculosis, presenting with dyspnoea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6-7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4-0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3-0.7)] were protected from in-hospital mortality.WHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality.
Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation in the setting of persistent AF (PeAF) with heart failure (HF) is challenging and often has poor outcome. However, guideline and studies indicate ablation strategy in this group to reduce mortality and HF-related hospitalization. Purpose We have conducted a network meta-analysis (NMA) of all-cause mortality and improvement of HF-related QOL in patients of PeAF with systolic heart failure comparing rate controlling drugs (RCDs), anti-arrhythmic drugs (AAD), catheter ablation (CA) of PeAF and AV nodal ablation with univentricular or biventricular pacing (AVNA). Method Bayesian network meta-analysis of randomized controlled studies comparing mortality and QOL among individual treatment arms (e.g. RCDs, AADs, CA and AVNA) and pair-wise network meta-analysis comparing CA and other treatment arms (RCD, AAD and AVNA) were performed using MetInsight V3. Markov chain Monte Carlo (MCMC) modeling was used to estimate the relative ranking probability of each treatment group. Results Published data of 14 studies including 3698 patients were included in the NMA with a median follow-up of two years (1A, 2A). The Bayesian modelling with MCMC analysis for pair-wise comparison clearly demonstrated that, AAD [OR (95% CrI): 2.10 (0.43-9.0)], AVNA [OR (95% CrI): 1.32 (0.14-11.7)] and RCDs [OR (95% CrI): 2.76 (0.5-14.1)] have higher all-cause mortality than CA but not within the radar of statistical significance (1B). The Bayesian modelling with MCMC analysis for pair-wise comparison clearly demonstrated that, AADs [MD (95% CrI): 8.02 (-8.32-27.8)], AVNA [MD (95% CrI): 17.0 (-1.9-33.1)] and RCDs [MD (95% CrI): 13.0 (0.1-24.5)] have lesser improvement in QOL than CA but not within the radar of statistical significance (2B). Based on the Bayesian model, CA results in lower all-cause mortality and highest improvement of QOL in the patients of AF with HF (3A, 3B). Conclusion This shapes way for future treatment guidelines in patients with PeAF with HF group and points towards CA to be undertaken before medical therapy fails. This also paves way for further research to confirm the longevity of the beneficial effects and to find the specific subsets of AF with HF patients that would be benefited most from CA. Abstract Figure
Introduction: Interscalene Brachial Plexus Block (ISBPB) block provides optimal analgesia for shoulder and upper arm surgery. However, higher incidence of phrenic nerve palsy limits the application of ISBPB for patients with limited pulmonary reserve. The Supplemented Suprascapular Nerve Block (SSNB) is a landmark based technique that is believed to block the sensory fibres supplying major part of shoulder joint, as well as, supraspinatus and infraspinatus muscles. Aim: To compare the analgesic effect and duration of sensory block in interscalene versus interscalene with SSNB block for shoulder and upper arm surgery. Materials and Methods: This double-blinded randomised controlled study was conducted in a Tertiary Care Institute, from April 2021 to march 2022. Eighty patients posted for shoulder and upper arm surgery were divided into two equal groups (group A and B). In group A (n=40), 30 mL 0.5% levobupivacaine in ISBPB and in group B (n=40), 15 mL 0.5% levobupivacaine in ISBPB+15 mL 0.5% levobupivacaine in SSNB were administered. Demographic data, sensory and motor block, onset times and durations, time to administer first rescue analgesic, total analgesic requirement, indications of upper arm surgeries, surgical bleeding and surgeon’s satisfaction score, postoperative Visual Analogue Scale (VAS) score were recorded for each patient. Results: The onset and duration of sensory and motor block was significantly faster and longer in group B. Consequently, time to administer first rescue analgesic in group A vs group B (325.88±33.23 vs. 348.34±37.12) minutes were significantly delayed and in lesser in amount in group B respectively. On the other hand, suprascapular block reduced the odds of block-related respiratory (group A vs group B are 14 and 10, respectively) complications. In group B postoperative VAS score at 24 hour was significantly lower (p-value <0.05) than group A was (3.5 vs 4.5). Intraoperative haemodynamic parameters were comparable among two groups throughout the study period. Conclusion: SSNB when supplemented with Interscalene Block (ISB) could be an effective adjunct for shoulder and upper arm surgery. This combination prolongs the sensory blockade duration, reduces requirement of analgesics and side-effects in postoperative period.
Abstract Background Studies indicate that uninterrupted anticoagulation (UA) is superior to interrupted anticoagulation (IA) in the periprocedural period during catheter ablation of atrial fibrillation. Still IA is followed in many centers considering the bleeding risk. This meta‐analysis compares interrupted and uninterrupted direct oral anticoagulation during catheter ablation of atrial fibrillation. Methods A systematic search into PubMed, EMBASE, and the Cochrane databases was performed and five studies were selected that directly compared IA vs UA before ablation and reported procedural outcomes, embolic, and bleeding events. The primary outcome of the study was major adverse cerebro‐cardiovascular events. Results The meta‐analysis included 840 patients with UA and 938 patients with IA. Median follow‐up was 30 days. Activated clotting time (ACT) before first heparin bolus was significantly longer with UA ( P = .006), whereas mean ACT was similar between the two groups ( P = .19). Total heparin dose needed was significantly higher with IA (mean, ‒1.61; 95% CI, ‒2.67 to ‒0.55; P = .003). Mean procedure time did not vary between groups ( P = .81). Overall complication rates were low, with similar major adverse cerebro‐cardiovascular event ( P = .40) and total bleeding ( P = .55) rates between groups. Silent cerebral events (SCEs) were significantly more frequent with IA (log odds ratio, ‒0.90; 95% CI, ‒1.59 to ‒0.22; P < .01; I 2 , 33%). Rates of major bleeding, minor bleeding, pericardial effusion, cardiac tamponade, and puncture complications were similar between groups. Conclusions UA during atrial fibrillation ablation has similar bleeding event rates, procedural times, and mean ACTs as IA, with fewer SCEs.
Abstract BACKGROUND: Studies indicate that uninterrupted anticoagulation is superior to interrupted anticoagulation in the periprocedural period during catheter ablation of atrial fibrillation and has better thromboembolic and hemorrhagic outcomes. Conversely, the few studies addressing the safety and efficacy of interrupted direct oral anticoagulant regimens during catheter ablation of atrial fibrillation are limited by small samples, short follow-up periods, rare events, and variable outcomes. The purpose of this meta-analysis was to compare interrupted and uninterrupted direct oral anticoagulation during catheter ablation of atrial fibrillation. METHODS: A systematic search into PubMed, EMBASE, and the Cochrane databases were performed and five studies were selected that directly that directly compared interrupted versus uninterrupted anticoagulation before ablation and reported procedural outcomes and embolic and bleeding events. The primary outcome of the study was major adverse cerebrocardiovascular events which was a composite of stroke/ transient ischemic attacks and major bleedings, total bleeding which was a composite of major and minor bleedings and silent cerebral events. RESULTS The meta-analysis included 840 patients with uninterrupted anticoagulation and 938 patients with interrupted anticoagulation. Median follow-up was 30 days. Baseline parameters were similar between groups. Activated clotting time before first heparin bolus was significantly longer with uninterrupted anticoagulation ( P =.006), whereas mean activated clotting time was similar between the 2 groups ( P =.19). Total heparin dose needed was significantly higher with interrupted anticoagulation (mean, ‒1.61; 95% CI, ‒2.67 to ‒0.55; P =.003). Mean procedure time did not vary between groups ( P =.81). Overall complication rates were low, with similar major adverse cerebrocardiovascular event ( P =.40) and total bleeding ( P =.55) rates between groups. Silent cerebral events were significantly more frequent with interrupted anticoagulation (log odds ratio, ‒0.90; 95% CI, ‒1.59 to ‒0.22; P <.01; I 2 , 33%). Rates of major bleeding, minor bleeding, pericardial effusion, cardiac tamponade, and puncture complications were similar between groups. CONCLUSIONS Uninterrupted anticoagulation during atrial fibrillation ablation has similar bleeding event rates, procedural times, and mean activated clotting times as interrupted anticoagulation, with fewer silent cerebral events.
International Journal of Medicine and Public Health,2013,3,3,200-206.DOI:10.4103/2230-8598.118952Published:July 2013Type:Original ArticleComparative evaluation of oral clonidine and midazolam as premedication on preoperative sedation and laryngoscopic stress response attenuation for the patients undergoing general anaesthesiaAnjan Das, Tushar Kanti Saha, Saikat Majumdar, Rahul Deb Mandal, Anindya Mukherjee, and Subrata Kumar Mandal Anjan Das, Tushar Kanti Saha1, Saikat Majumdar2, Rahul Deb Mandal3, Anindya Mukherjee2, Subrata Kumar Mandal Department of Anaesthesiology, S. D. Medical College, 1Community Medicine and 2Anaesthesiology, Nil Ratan Sircar Medical College, Kolkata, 3Gynaecology and Obstetrics, Burdwan Medical College, Burdwan, West Bengal, India Abstract:Context: Laryngoscopy and endotracheal intubation is associated detrimental hemodynamic changes like rise in blood pressure (BP), heart rate (HR) leading to adverse cardiological outcome specially in susceptible individuals. Aims: To compare the blood pressure (BP) and heart rate (HR) changes during laryngoscopy and endotracheal intubation as well as to evaluate the preoperative sedation status between oral clonidine and oral midazolam as premedication for the patients undergoing general anesthesia (GA). Settings and Design: Fifty patients between 18 and 60 years of age of either sex of American Society of Anesthesiologists (ASA) Grade I and II undergoing GA were randomly divided into two equal groups of 25 patients each. Group-C patients received clonidine 4 mcg/kg orally and Group-M patients received 0.5 mg/kg midazolam orally as premedication. Materials and Methods: After measuring baseline hemodynamic parameters patients of both groups received premedication. Preoperative sedation was assessed 2 hr after premedication administration. Standard anesthetic technique was followed. Hemodynamic (HR, BP) parameters were noted baseline, immediately after laryngoscopy and intubation and 5 min after intubation to observe the stress response. Results and Statistical Analysis: A significant difference in pre-operative sedation between two groups (P < 0.05) and midazolam (group M) produced significantly better sedation than clonidine (group C). Laryngoscopic stress response in group C was still at a lower level than baseline values and significantly (P < 0.005) less than group M. Conclusions: Oral midazolam is more effective in producing preoperative sedation than oral clonidine while on the contrary oral clonidine is more efficacious in reducing laryngoscopic stress response than oral midazolam. Laryngoscopy and intubation was better controlled by oral clonidine than midazolam. Keywords:Clonidine, endotracheal intubation, general anesthesia, laryngoscopy, midazolamView:PDF (485.38 KB)
Seven hundred rural families from different religious, economic, educational and occupational groups residing at different distances from the service health centre (PHC) were interviewed to study its service coverage and service bottlenecks. Acceptability, contact and effectiveness coverage, were respectively 64.8, 19.2 and 13.8 percent in case of medical care; 71.8, 28.3 and 27.2 percent in Maternal and Child Health Care Services; 45.7, 18.2 and 17.3 percent in case of Family Welfare Planning Services; and 64.4, 55.7 and 55.7 percent in immunization services. The higher income group utilized the services least 4.1 percent, compared to lower income group (17.7 percent). Utilization of the PHC services significantly declined with distance from the health centre. Less than 1/5th of the families (19.2 percent) utilized the medicare. Bottlenecks in service utilization were distance from PHC, and caste, education and income.An evaluation of health care services in a primary health center (PHC) in West Bengal is presented. The Chanditala Primary Health Center, established in 1961 in District Huoghly of West Bengal was the primary location examined. Villages were divided into 3 groups based on geographic distance from the health center 1-5 kms, 6-10 kms, and above 10 kms. Random sampling technique was used. 10 villages including 1 PHC village were selected; from these a 15% household sample was taken based on religion and caste. 700 families were studied overall. Medical care, maternal, and child health services, family planning services and immunization services were the principal services used as indicators measuring the level of health care coverage. Results in coverage area were tallied for acceptability, contact, and effectiveness coverage. Medical care figures were 84.4%, 19.2%, and 13.8% respectively. Maternal and child health care services figures were 71.8%, 28.3%, and 27.2%; family welfare planning services were 47.5%, 18.2%, and 17.3%. Figures for immunization services were 64.4%, 55.7%, and 55.7%. Lower income groups utilized the services more (17.7%), than higher income groups (4.1%). PHC services declined significantly with distance from the primary health center. 19.2% of the families surveyed used Medicare.
Background There are limited studies comparing the risk of osteoporosis and fractures between different direct oral anticoagulants (DOACs) and vitamin K antagonists (VKA) in non-valvular atrial fibrillation (AF). Using a network meta-analysis (NMA), we compared osteoporotic fractures among 5 different treatment arms, viz. dabigatran, rivaroxaban, apixaban, edoxaban, and VKA. Methods Ten studies, including 5 randomized control trials and 5 population-based studies, with a total of 321,844 patients (148,751 and 173,093 in the VKA and DOAC group, respectively) with a median follow-up of 2 years, were included. A Bayesian random-effects NMA model comparing fractures among the treatment arms was performed using MetInsight V3. Sensitivity analysis excluded studies with the highest residual deviances from the NMA model. Results The mean age of the patients was 70 years. The meta-analysis favored DOACs over VKA with significantly lower osteoporotic fracture (odds ratio [OR], 0.77; 95% credible interval [CrI], 0.70-0.86). The NMA demonstrated that fractures were significantly lower with apixaban compared with dabigatran (OR, 0.64; 95% CrI, 0.44-0.95); however, fractures were statistically similar between apixaban and rivaroxaban (OR, 0.84; 95% CrI, 0.58-1.24) and dabigatran and rivaroxaban (OR, 1.32; 95% CrI, 0.90-1.87). Based on the Bayesian model of NMA, the probability of osteoporotic fracture was highest with VKA and lowest with apixaban, followed by rivaroxaban, edoxaban, and dabigatran. Conclusions The decision to prescribe anticoagulants in elderly patients with AF should be made not only based on thrombotic and bleeding risks but also on the risk of osteoporotic fracture; these factors should be considered and incorporated in contemporary cardiology practice. Key words: Atrial fibrillation · Factor Xa inhibitors · Network meta-analysis · Osteoporotic fractures · Vitamin K
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