Tropical tourist destinations frequently encounter marine injuries. Sea urchin stings are commonly seen, but injuries with coral fragments can simulate their presentation, leading to diagnostic dilemmas. We report a case of a 36-year-old male Indian tourist who sustained a puncture wound over the plantar aspect of the foot while walking barefoot in shallow waters of Mauritius. The wound clinically resembled a sea urchin sting. However, wound exploration under aseptic precautions revealed a fragment of coral as the causative foreign agent. The wound was managed with removal of the fragment, irrigation, a compression bandage, tetanus prophylaxis, and oral antibiotics. Radiologic investigations following the procedure were negative for any retained foreign body. Follow-up showed satisfactory wound healing; nevertheless, the patient had local tenderness at the injury site and pain while walking, which was due to granuloma formation as revealed on an ultrasound without any signs of infection. The pain eventually subsided after 2 months. Coral injuries can mimic sea urchin stings clinically. Awareness of this possibility, careful wound exploration, and accurate diagnosis are critical to avoid misdiagnosis and complications. Tourists visiting the island countries should be aware of the dangers of aquatic wildlife and should be vigilant while taking part in water activities.

Abstract Background: Caudal epidural steroid injection (CESI) is a well-established minimally invasive technique used in the management of radicular pain secondary to prolapsed intervertebral disc (PIVD). Limited evidence exists comparing the efficacy of CESI at specific lumbar levels, particularly between L5 and S1 radicular pain. Objective: The objective of the study was to evaluate and compare the clinical efficacy of CESI in patients with L5 versus S1 radicular pain due to PIVD. Materials and Methods: A prospective interventional study was conducted over a period of 18 months in the department of physical medicine and rehabilitation at a tertiary care institute. Forty patients with MRI-confirmed PIVD at either L4–5 or L5–S1 level were assigned to two groups based on the involved nerve root (L5 or S1). Each participant received a single CESI containing methylprednisolone acetate, 2% lignocaine, 0.25% bupivacaine and normal saline under aseptic precautions. Outcomes were assessed using the Visual Analogue Scale (VAS) for pain and the Oswestry Disability Index (ODI) for functional status at baseline, 1 month and 3 months post-injection. Results: Both groups showed statistically significant improvement in VAS and ODI scores at 1-month and 3-month follow-ups compared to baseline ( P < 0.05). However, intergroup comparison revealed no statistically significant difference between the L5 and S1 groups at any follow-up interval ( P > 0.05). Conclusion: CESI is effective in reducing pain and improving function in patients with radicular pain due to PIVD. Its efficacy appears comparable in both L5 and S1 radicular pain, supporting its continued use regardless of the affected nerve root level.

BACKGROUND Correct placement of the spinal needle is crucial for spinal anesthesia. Due to physiological changes associated with pregnancy like weight gain and changes in the curvature of spine, performing spinal anesthesia may be difficult leading to multiple attempts, inadvertent nerve injuries and patient discomfort. So a pre-procedural estimation of the skin to subarachnoid space depth may be beneficial. This study aims to estimate the skin to subarachnoid space depth by using Ultrasound in pregnant females undergoing cesarean section under spinal anesthesia. METHODS This was a prospective, observational study conducted at a district hospital of Nepal in parturients undergoing cesarean section under spinal anesthesia. A pre-procedural ultrasound of lumbo-sacral spine was done by using 2-5 Hz curvilinear probe and skin to subarachnoid space depth (SSD) was measured at the level of L3-L4 using inbuilt calipers after which subarachnoid block was performed under all aseptic precautions. RESULTS Total patients included in the study were 50 pregnant females with mean age being 24.5 (± 8.56). The ultrasound estimated SSD was found to be 4.24 ± 0.48 cm. CONCLUSIONS Ultrasound estimated SSD in the study population was found to be 4.24 ± 0.48 cm which is almost same as the inserted length of spinal needle. So, use of ultrasound can be very helpful in performing subarachnoid block.

Background Subarachnoid block is the most widely used technique for lower limb surgeries because of its cost-effectiveness, good muscle relaxation, reliability, prolonged analgesia and early ambulation. Clonidine as an adjuvant for subarachnoid block may improve analgesia. So, in this study, we propose to evaluate the analgesic efficacy of hyperbaric levobupivacaine with or without clonidine in patients undergoing surgery for femoral fractures. Secondarily, we also compared sensory and motor block characteristics and noted side effects. Methods Subarachnoid block was given in sitting position under all aseptic precautions at the level of L2-L3or L3-L4intervertebral space as per the standard protocol. Intrathecal drug was given according to the group allotted as follows: Group-LC: 15 mg of 0.5%hyperbaric levobupivacaine (3 ml) + 15 mcg of clonidine (0.1 ml); Group-LN: 15 mg of 0.5% hyperbaric levobupivacaine (3 ml) + normal saline (0.1 ml) The total volume of intrathecal drug was 3.1 ml in both groups. Block characteristics were assessed using loss of pinprick sensation for sensory block and Modified Bromage Scale (MBS) for motor block. Hemodynamic variables were also recorded. Results The demographic profiles of both groups were comparable to each other with respect to gender, American Society of Anesthesiologists (ASA) grade, weight and height of patients. The duration of effective analgesia was 166.67 ±31.72min in group LC and98.80 ±8.99 min in group LN (p <0.001). The difference was statistically significant. The mean time of onset of sensory block was 6.53 ±1.60 min and 4.00 ±1.69 min (p =0.001); the mean time to achieve a maximum height of the sensory block was 11.53 ±3.72 min and 6.67 ±1.45 min (p <0.001) in groups LC and LN, respectively and were statistically significant. The median maximum block height was comparable in both groups. The maximum motor block achieved and motor block at the time of rescue analgesia were comparable in both groups. Intraoperative and postoperative hemodynamic parameters (heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP)) were comparable among the groups LC and LN, except in DBP at 90 mins, where in group LC the mean was 77.00 ±6.32 min and in group LN it was 81.73 ±6.25 min, which was statistically significant. Sedation scores were comparable in both groups intraoperatively and postoperatively. None of the patients had any sedation in either ofthe groups, and all the patients were easily arousable in group LC and group LN, respectively. No major side effects were observed in either of the groups except one patient (6.7%) in group LC and one patient (6.7%) in group LN developed nausea, and five patients (33.3%) in group LC and three patients (20.0%) in group LN had shivering, which was managed promptly. Conclusion Addition of 15 mcg of clonidine to 3 mL (15 mg) of 0.5% hyperbaric levobupivacaine provides a longer duration of effective analgesia with minimal side effects.

Surgical site infections (SSIs) are a frequent cause of postoperative morbidity and mortality, leading to prolonged hospital stays, increased healthcare costs, and additional antibiotic use. The rising occurrence of infections caused by multidrug-resistant (MDR) organisms further complicates management. Continuous hospital-acquired infection (HAI) surveillance, adherence to infection prevention protocols, and timely surgical prophylaxis play a critical role in SSI prevention. This study aimed to determine the prevalence of SSIs in a tertiary care teaching hospital, identify the bacterial pathogens, evaluate their antimicrobial resistance patterns, and emphasize the need for targeted preventive strategies. A retrospective analysis was conducted in the Department of Microbiology, NRI General Hospital, Andhra Pradesh, India, over a two-year period (August 2023-July 2025). Postoperative patients with suspected SSIs were evaluated, and specimens were collected under aseptic precautions. Microbiological identification and antimicrobial susceptibility testing were performed using standard protocols and the VITEK 2 Compact system, following CLSI guidelines. Isolates were screened for methicillin resistance, extended-spectrum β-lactamase (ESBL) production, carbapenem resistance, and multidrug-resistance. Out of 21,952 surgeries, 50 culture-positive SSI cases were identified (0.23%). The majority occurred in the 21-40 year age group (56%) and in females (68%). Obstetrics and Gynecology accounted for most infections (58%), predominantly after emergency surgeries. The leading organism was Escherichia coli (40%), followed by Klebsiella spp. (26%) and Pseudomonas aeruginosa (12%). Resistance patterns revealed MRSA (4%), MDR (8%), ESBL producers (14%), and carbapenem resistance (14%). E. coli showed high susceptibility to tigecycline (90%) and amikacin (80%), while Klebsiella spp. and Pseudomonas spp. isolates responded best to tigecycline and carbapenems, respectively. Although SSI prevalence was low, infections were concentrated in emergency obstetric procedures and mainly caused by Gram-negative bacilli. The detection of ESBL and carbapenem-resistant strains emphasizes the need for robust infection control, antimicrobial stewardship and timely prophylactic measures to reduce SSI risk and improve outcomes.

Odontogenic-onset mucormycosis: A case series from a tertiary care institute in North India.

Acute Suppurative Otitis Media(ASOM) is a very common disease of childhood caused by various bacteria and viruses. Amoxicillin is used as first line antibiotics in the community setting as well as hospital setting. This is a hospital based prospective observational cross-sectional study. All cases of ASOM of patients under 14 years presenting to the Patan Hospital with duration of less than 6weeks were included in the study. Ear discharge was collected using sterile cotton swab using aseptic precautions and sent to the Department of Microbiology for further processing. The children were treated with amoxicillin (80mg/kg/day) with maximum dose not exceeding 3g/day and follow up was done after 1 week of antibiotic therapy for clinical responsiveness. Out of 32 cases, 13 cases showed no growth of organism in the culture sensitivity reports. Among remaining 19 cases, 9 were sensitive and 10 were resistant to amoxicillin. Coagulase negative Staphylococcus (7) was the most common organism grown in the laboratory followed by Staphylococcus aureus (4) and Klebsiella pneumoniae (4). Chloramphenicol, linezolid, clindamycin and trimethoprim-sulphamethoxazole were the most common antibiotics sensitive to the organisms grown besides amoxicillin. Out of total 32 patients, 31 were responsive to high dose amoxicillin at the end of 1 week. Oral amoxicillin in high doses is effective in the treatment of ASOM in children.

Background and objective: Chronic kidney disease (CKD) is frequently complicated by hematological abnormalities, including anemia, thrombocytopenia, and leukocyte disorders, which significantly impact morbidity and survival. This study aimed to evaluate hematological indices and abnormalities in patients with CKD and determine their associations with disease severity across stages 3-5.Methods: This cross-sectional observational study was carried out in the Department of Nephrology, Lahore General Hospital, Pakistan, between August 2023 and February 2024, following Institutional Review Board approval. A total of 412 patients aged 18-70 years with CKD stages 3-5, defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria, were recruited using non-probability consecutive sampling after obtaining written informed consent. Patients with known hematological disorders, acute infections, malignancy, chronic hepatitis B or C, HIV, recent blood transfusion, use of erythropoiesis-stimulating agents, or pregnancy were excluded. Venous blood samples (10 mL) were collected under aseptic precautions and analyzed for hematological indices using the Sysmex KX-2 analyzer (Kobe, Japan). Biochemical parameters were measured on Cobas Integra 400 Plus (Roche Diagnostics, Germany).Results: A total of 412 patients were evaluated, with a mean age of 44.26 ± 14.05 years; 181 (43.9%) were aged 18-45 years, and 231 (56.1%) were 46-70 years. Men comprised 266 (64.6%) and women 146 (35.4%). The mean disease duration was 4.93 ± 2.61 years, with 247 (60%) reporting <5 years. Diabetes mellitus (40%) and hypertension (31.3%) were the leading etiologies. CKD stages included 100 (24.3%) in stage 3, 169 (41%) in stage 4, and 143 (34.7%) in stage 5. Hemoglobin (Hb) declined from 12.65 ± 1.05 g/dL (stage 3) to 9.98 ± 1.97 g/dL (stage 5, p < 0.001). Hematocrit (Hct) decreased from 35.61 ± 4.33% to 29.20 ± 5.45%, red blood cell (RBC) count from 4.04 ± 0.74 × 10¹²/L to 3.38 ± 0.50 × 10¹²/L, and platelet (PLT) count from 272.15 ± 116.68 × 10⁹/L to 197.82 ± 130.32 × 10⁹/L. Red cell distribution width (RDW) increased from 13.58 ± 1.37% to 15.79 ± 1.50% (p < 0.001). Anemia was present in 38%, 68%, and 92.3% of stages 3, 4, and 5, respectively; thrombocytopenia (14%-34.3%), leukopenia (11%-25.2%), and leukocytosis (7%-22.4%) also increased significantly with disease severity.Conclusion: Hematological indices deteriorate with advancing CKD, with anemia, thrombocytopenia, and leukocyte abnormalities showing strong associations with disease severity. Routine hematological monitoring is essential for early detection and management of these complications to mitigate disease-related morbidity and improve patient outcomes.

Background Certain dermatological disorders can result in major morbidity and mortality. There are few studies worldwide regarding mortality in dermatology, with a paucity of data on the epidemiological and aetiological profile of sepsis in dermatology patients, necessitating further research and awareness. We aimed to bridge this gap by studying the mortality associated with dermatological diseases at a tertiary care hospital in southern India. Methods Inpatient records of all patients admitted over a period of 5 years (2018-2022) with a dermatological disease and systemic complications resulting in mortality were reviewed. Details regarding the nature of the disorder, disease characteristics, investigations, treatment, and course of hospitalization were collected and analyzed. Results Thirteen patients with dermatological disease-related mortality were included in the study. Mortality was highest in the 4th-6th decade age group. Cutaneous adverse drug reactions accounted for the highest mortality. Septic shock was the most common cause of death in these patients. Conclusion Cutaneous adverse drug reactions are a common cause of mortality among dermatology inpatients. Sepsis and multiorgan dysfunction are important complications in these patients, highlighting the role of strict aseptic precautions, barrier nursing and multidisciplinary care in patients with extensive skin involvement.

Background: Otitis media is a prevalent ENT infection in developing regions, increasingly complicated by antimicrobial resistance. Empirical treatment without microbiological guidance has led to selective pressure, promoting resistant strains. The need for local surveillance of pathogen profiles and resistance trends to guide successful therapy and stewardship activities is highlighted by rising failure rates and the prevalence of biofilm-forming organisms such as Pseudomonas aeruginosa and Staphylococcus aureus.Methods: For ten months, a prospective observational study was carried out at a tertiary care center, involving 390 patients with clinically diagnosed otitis media. All patients presented with profuse otorrhea unresponsive to empirical antibiotics. Aural swabs were collected under aseptic precautions, cultured on standard media, and put through the Kirby-Bauer disc diffusion method of antimicrobial susceptibility testing in compliance with CLSI recommendations.Results: Pseudomonas aeruginosa and Proteus mirabilis were the predominant Gram-negative isolates, while S. aureus was the most common Gram-positive organism. High resistance rates (&gt;70%) were observed against ampicillin, amoxicillin-clavulanate, and cotrimoxazole. Sensitivity was better retained with ciprofloxacin, gentamicin, and amikacin, although early signs of resistance were noted. Multidrug-resistant (MDR) phenotypes were common, particularly among Pseudomonas isolates.Conclusion: The microbial landscape of ENT infections is shifting, with a growing prevalence of MDR pathogens and declining efficacy of conventional antibiotics. Empirical treatment protocols must be reevaluated in light of local resistance data. Routine culture and sensitivity testing should be integrated into clinical practice to support evidence-based antibiotic stewardship and improve patient outcomes.

The text is an introduction to six articles on ultrasound-guided musculoskeletal interventions for the major extremity joints. Each article provides a detailed overview of injections for the shoulder, elbow, wrist and hand, hip, knee, ankle, and foot. The text of this manuscript emphasizes general advantages, techniques, and practical considerations of ultrasound guided injections. It highlights the benefits of ultrasound guidance over traditional palpation-based methods, emphasizing improved accuracy, safety, and therapeutic efficacy. Various ultrasound-guided techniques, including in-plane and out-of-plane needle approaches and indirect marking methods, are discussed. Key factors influencing procedural success, such as needle visibility optimization, proper ultrasound settings, and aseptic precautions, are explored in detail. Additionally, the article briefly describes training methods for mastering ultrasound-guided injections.

Neurological complications following obstetric neuraxial anaesthesia: a four-year United Kingdom population-based study of epidural haematoma and epidural abscess (2014-2017).

Ageing is one of the well-known risk factors for many physiological disorders. This cross-sectional, observational study was carried out in the Department of Biochemistry, Community Based Medical College, Bangladesh (CBMC,B), Mymensingh, Bangladesh, from January to December 2024, from January to December, to see the association between age and the changes in fasting blood glucose, serum creatinine and total cholesterol levels among normal individuals. 100 subjects were included in this study following inclusion and exclusion criteria and categorized in group A (50 adults aged between 24 and 49 years) and group B (50 adults aged between 50 and 78 years). The clinical and historical information was collected through prescribed questionnaires to evaluate the exclusion criteria of the study. Fasting venous blood samples were taken from the subjects with all aseptic precautions. Fasting blood glucose, serum creatinine and total cholesterol were determined by enzymatic method using semi-automatic clinical chemistry analyzer. A significant increase in fasting blood glucose, serum creatinine and total cholesterol were observed in subjects aged above 50 compared to the subjects aged below 50 years (p&lt;0.001). Ageing leads to an increased risk of diabetes, renal failure and cardiovascular disease through derangements of blood glucose, creatinine and total cholesterol levels in elderly people of Bangladesh. CBMJ 2025 July: vol. 14 no. 02 P:87-92

Background Chronic suppurative otitis media is one of the most common cause of hearing impairment especially in developing countries due to illiteracy, poor hygiene, respiratory infections and poverty. If left unchecked, it can cause serious local and systemic complications. The aim of the study was to determine the causative organisms and their antibiotic susceptiility pattern.MethodsThis study included total 90 patients who were clinically diagnosed as chronic suppurative otitis media having active ear discharge presenting to outpatient Department of ENT, Bharatpur hospital from May 2024 to Feb 2025.Pus swab was obtained under aseptic precautions and samples were processed in microbiological lab using standard operating protocol. For isolated bacterial strains, antibiotic susceptibility test was performed by using Kirby Bauer disc diffusion method and the results were analyzed using simple statistical techniques.ResultsThe most commonly affected age group was &gt;40 years and majority of them had unilateral disease. Females were more affected than males. The most common isolated organisms were Pseudomonas aeruginosa (47.8%) and Staphylococcus aureus (8.9%) followed by Klebsiella Pneumoniae (7.8%), E. coli (5.6%), Proteusmirabilis (5.6%), Acinetobacter (3.3%), Coagulase negative Staph aureus (2.2%) and proteus vulgaris (1.1%). Majority of the common isolated strains were sensitive to Amikacin and Levofloxacin. Ciprofloxain was found to be one of the least sensitive drugs and majority of strains were found to be resistant to Amoxyclav and third generation cephalosporins.Conclusions Pseudomonas aeruginosa was the most common predominant isolated organism followed by Staphylococcus aureus. It is essential to know the etiological agents of CSOM and their antimicrobial susceptibility for effective treatment and preventing both the complications and development of antibiotic resistance.

ABSTRACTDespite modern aseptic precautions, surgical site infection remains a significant problem. Although the benefits of negative pressure wound therapy in the treatment of chronic wounds are well established, high‐level evidence is still lacking on the potential role of negative pressure in the prevention of surgical site infections. We conducted a multicenter, randomised, prospective trial of closed incision vacuum therapy. A total of 90 general surgery patients undergoing emergency laparotomy were enrolled and randomised, 45 cases in the treatment group and 45 cases in the control group. Our aim was to show a significant difference in the rate of surgical site infection between the two groups. In the study group, laparotomy wounds were treated with a single 5‐day course of prophylactic vacuum therapy, whereas the control group underwent conventional postoperative wound management with sterile gauze dressings. Ten of the 45 patients in the study group developed a surgical site infection compared to 20 of 45 in the control group (22.2% vs. 44.4% p = 0.025). Upon further analysis, the proportion of superficial SSIs was found to be significantly lower in the ciNPWT group (40% vs. 20% p = 0.038), whereas the difference in deep SSI rates was not statistically significant (4.4% vs. 4.4% p = 1.0). In conclusion, negative pressure wound therapy is not only an effective way to heal chronic wounds, but it's prophylactic use may reduce the overall rate of surgical site infections.Trial Registration:Clinicaltrials.gov: NCT03716687

Background : Blood culture is the gold standard for the diagnosis of bacteremia. Contaminated blood cultures have been recognized as a troublesome issue. Emergency departments and intensive care units (ICU) are particularly susceptible to contaminated blood cultures. Methods : It was a retrospective study carried out on blood cultures submitted to department of microbiology from in patients in intensive care units (ICU’s) at SVIMS, tirupathi during three year period from January 2017 to December 2019. Results : A total number of blood cultures during this period were 46325, in which conventional were 27211, and automated bactalert were 19114. Among these, 4298 and 5456 were positive blood culture samples in conventional and automated blood cultures respectively. Contaminated blood cultures were 598 by conventional and 728 by automated bacTAlert 3D system methods. The mean blood contamination rate was 2.8, 3.2, 2.4 for 2017,2018,2019 respectively. Coagulase negative staphylococcus was the most predominant isolate, followed by Aerobic spore bearers (ASB) and diptheroids. Staphylococcus hominis was the most common isolated species of CONS. The greater number of samples were from Emergency medicine department followed by Nephrology department. Conclusion: Strict implementation of disinfectants, educational interventions, sampling from separate venipuncture sites under aseptic precautions, hand hygiene , proper infection control practices before and after collecting the sample are important in decreasing blood culture contamination rate

Background: This study was conducted to evaluate the course and outcome of aggressive retinopathy of prematurity (AROP) and to study the risk factors associated with AROP.Methodology: This was a prospective observational study, conducted in the Department of Ophthalmology, Gandhi Medical College, Bhopal, India, from August 2022 to June 2024 on preterm infants. Infants were examined in the retinopathy of prematurity (ROP) screening cubicle using aseptic precautions. All ocular findings were recorded on the proforma, and any abnormal findings were confirmed by the study guide. In cases where ROP is detected, fundus photo documentation is done. Counselling of the parents was conducted, emphasizing the importance of timely follow-up and the need for periodic reviews.Results: The incidence of ROP was 24.9%, while the incidence of AROP was 10.5%. Overall, AROP was detected in 107 eyes of 56 patients. Zone I was most commonly involved in 58 eyes (54.2%), followed by posterior zone II in 49 eyes (45.8%). We documented a significant association of AROP with prolonged duration of stay in the neonatal intensive care unit (NICU) (18.20±10.21 vs. 13.17±6.35 days), oxygen supplementation of more than one week (87.5% vs. 68.4%), prolonged duration of oxygen supplementation (16.50±8.34 vs. 10.50±5.2), and ventilatory support of more than one week (16.1% vs. 3.9%; p<0.05). We found regression following treatment with anti-vascular endothelial growth factor (anti-VEGF) in significantly higher proportions of cases with zone I AROP and progression following anti-VEGF in cases with zone II posterior AROP (p<0.05).Conclusions: The relatively high incidence of AROP, predominantly bilateral and affecting zone I, underscores the need for vigilant screening and early intervention in high-risk infants. Our findings reinforce the importance of minimizing exposure to supplemental oxygen and optimizing neonatal care practices to reduce the risk of AROP development and progression.

Peripheral nerve blocks have certain advantages over central neuraxial anaesthesia and general anaesthesia, hence they have become increasingly popular for the management of pain during surgery. The development of ultrasonography in regional anaesthesia made it possible to confirm precise needle placement and appropriate local anaesthetic administration. Furthermore, it is possible to prevent problems such as intravascular and intraneuronal injections. Real-time ultrasound not only lowers the amount of local anaesthetic needed for a successful nerve block but also enhances the quality of the block. Ultrasonographic guidance is beneficial in reducing intra neural injection and targets the neural sheath where drug can be deposited and block can be achieved with minimum possible volume. This study attempts to determine minimum possible volume of bupivacaine 0.5% to achieve adequate motor and sensory blockade by using ultrasound guided brachial plexus block. Methodology: The study was conducted in Department of Anaesthesiology, Gandhi Medical College and associated Hamidia Hospital, Bhopal during August 2022 to December 2023 after approval from institutional ethics committee. It was an Observational hospital-based study. The study was an observational study comprising of 75 patients between age group 18-60 years of either sex belonging to ASA grade I or II, scheduled for elective upper limb surgery. Patients with neurologic deficit in upper limb, Diaphragm palsy, Respiratory distress and Allergy to the local anaesthetics were excluded. Under all aseptic precautions ultrasonography was done at the level of supraclavicular region and structures traced from cephalic to caudal direction. the probe was placed in the coronal plane to visualize the subclavian artery and the brachial plexus in a transverse sectional view. Once the needle penetrated the brachial plexus, the bupivacaine 0.5% was injected after negative aspiration for blood or air just next to the artery, then the needle was repositioned to inject on the upper pole of the artery. Twenty five patients received 10 ml Drug (group A), next 25 patients received 15 ml Drug (group B) and next 25 patients received 20 ml Drug (group C) each. Result: Based on our findings, we determined that a volume of 15 ml of bupivacaine 0.5% reliably achieves effective sensory and motor blockade in the patients undergoing upper limb surgeries. This volume provides adequate anaesthesia while potentially reducing the risk of systemic toxicity associated with higher volume

Detection of neutrophil CD64 may help in the early diagnosis of neonatal sepsis and may prevent unnecessary delay in diagnosis, enable prompt start of treatment and will help in reducing mortality and sepsis related complication. Another advantage is that neutrophil CD64 expression is not influenced by antibiotic therapy. Absence of any research in this field in our country has tempted me to undertook this study. This cross-sectional study was carried out in the Department of Clinical Pathology, Neonatology and Microbiology &amp; Immunology, BSMMU, Dhaka. Total 60 neonates who fulfilled inclusion criteria were included in the study. After taking inform written consent from patient’s attendant, blood sample were obtained from peripheral venipuncture in all neonates within 24 hours of admission with all aseptic precaution. A total 3.5 ml venous blood was taken of which 1.5 ml was collected in EDTA tube for complete blood count, PBF and for neutrophil CD64 estimation and another 2.0 ml for blood culture. Neutrophil CD64 expression were measured by Flow cytometry. In all observation, early onset of sepsis was observed more (62.5%) than that of late onset of sepsis. Among the infected newborns, male was predominant (57.5%). Preterm (82.5%) and low birth weight babies (77.5%) are more susceptible to infection. Premature rupture of membrane (PROM) &gt;24 hours was found to be an important risk factor in neonatal septicemia. Blood culture was found positive only in 9 (22.5%) cases. Platelet count and IT ratio were found significantly associated with sepsis (p&lt;0.05). In the present work neutrophil CD64 showed high sensitivity, specificity, PPV and high NPV (100%, 54.9%, 28.13% and 100% respectively). The results of our study also showed significantly elevated levels of CD64 in septic neonates (36.03±25.70) when compared with controls (4.85±2.95) and also their percentage of expression was higher in culture positive sepsis (77.07±15.07%) than culture negative sepsis (26.56±13.46). Combination of the studied markers such as neutrophil CD64 + IT ratio was associated with higher sensitivity (100%), specificity (62.5%), positive predictive values (32.14%), and high negative predictive value (100%). So neutrophil CD64 is more reliable marker for early diagnosis of neonatal sepsis. It is better than other established marker of neonatal sepsis. It prevents unnecessary delay of treatment and shortened the hospital stay, thereby reduce mortality and sepsis related complications.

With the regional anaesthetic technique used for brachial plexus block, the phrenic nerve (C3-C5) can be blocked due to its anatomical proximity to the brachial plexus and the effect of a significant volume of local anaesthetic deposited near the nerve roots. The goal of this study was to compare the incidence of hemi-diaphragmatic paralysis (HDP) following infraclavicular and supraclavicular approaches for brachial plexus block, using a low-volume local anaesthetic. A total of 60 patients were enrolled in this study: 30 patients were assigned to the supraclavicular brachial plexus block group, and 30 patients were assigned to the infraclavicular brachial plexus block group. Under aseptic precautions and ultrasound guidance, both groups received 20 mL of 0.5% bupivacaine. The diaphragmatic excursion was measured using ultrasound before the block and 2 hours afterward in the postoperative care unit. A reduction in excursion of more than 75% compared with pre-block values was considered complete paralysis, whereas a reduction of 25-75% was considered partial paralysis. Infraclavicular brachial plexus block (3.33%) had a lower incidence of HDP compared with supraclavicular brachial plexus block (36.66%). The complications in both groups were not significant, and there was no need to use general anaesthesia. The incidence of phrenic nerve palsy in the supraclavicular and infraclavicular brachial plexus groups was low, with a lower incidence of HDP in the infraclavicular group.