Fall In Hematocrit Research Articles

Assessing safety and feasibility of monopolar transurethral resection of the prostate without post-operative catheter traction: A randomized controlled trial.

Traction on the per-urethral catheter is commonly employed after monopolar transurethral resection of the prostate (mTURP) to reduce bleeding. However, its efficacy and impact on postoperative pain remain uncertain. Further, there is limited evidence to suggest any benefit regarding post-operative blood loss. In a randomized controlled trial, 62 patients undergoing mTURP were assigned to either a traction (n = 30) or non-traction (n = 32) group. Blood loss, postoperative pain, and analgesic requirements were assessed between January 2022 and April 2023. {(IHEC-PGR/2021/DM/M.Ch/Jan/02), CTRI Registration: CTRI/2022/01/039199.}. No significant differences were observed between the traction and non-traction groups regarding postoperative blood loss (p-value- 0.632), fall in hemoglobin (p-value- 0.719) and hematocrit (p-value- 0.937) levels, and length of postoperative hospital stay (p-value- 0.797). However, the traction group reported significantly higher postoperative pain scores (p-value < 0.001) and increased analgesic requirements (p-value < 0.001). The study suggests that 12-hours catheter traction after mTURP does not reduce blood loss and is associated with increased postoperative pain.

Western diet exacerbates aristolochic acid-induced nephropathy in mice

Aristolochic acid (AA) ingestion causes Balkan nephropathy, characterized by tubular injury and progression to chronic kidney disease (CKD). AA is taken up by proximal tubule cells via organic anion transport (OAT3) and induces p53-mediated DNA damage, but little is known about modulating factors. The Western diet (WD) is rich in saturated fats, sugars, and salt and contributes to the development of metabolic disorders such as obesity and diabetes, but also to the progression of CKD. The aim of this study was to elucidate the impact of WD on AA-induced kidney injury. 5-week-old male C57BL6 mice were fed with WD or normal chow (NC) for 8 weeks, followed by administration of AA every 3 days at a dose of 3 mg/kg for 3 weeks. Samples were collected after a 3-week recovery period (n=4/group for vehicle; n=7-8/group for AA). The AA-induced increase in plasma creatinine and the reduction of hematocrit were significantly greater in WD vs NC. This was associated with increased kidney gene expression in WD vs NC of markers of DNA damage ( p53), injury ( Kim1 and Ngal), and inflammation ( Tnfa). The WD group had a greater body weight and, therefore, received a higher total dose of AA (0.73 and 0.6 mg), which may have worsened kidney injury. Therefore, in a second series, the same total dose of AA (0.9 mg) was administered to WD and NC groups. WD similarly increased the AA-induced fall in hematocrit and rise in plasma creatinine and renal p53, Kim1, Ngal, and Tnfa mRNA expression compared to the NC group. Moreover, WD increased renal mRNA expression of Oat3. These findings suggest that WD increases the susceptibility to AA nephrotoxicity, possibly through upregulation of OAT3. This model may be useful for studying the mechanistic impact of Western diet on the development and progression of CKD caused by nephrotoxic agents. Supported by National Institutes of Health (NIH) Grants RF1AG061296 (PM, VV), R01DK132690 (VV), and P30 DK079337 (VV), the Department of Veterans Affairs, and a fellowship of the Manpei Suzuki Diabetes Foundation (YO). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Outcomes of bipolar TURP compared to monopolar TURP: A comprehensive literature review.

Transurethral resection of the prostate (TURP) is the commonest surgical procedure for the treatment of benign prostatic obstruction (BPO). Bipolar-TURP (BTURP) is being increasingly used as compared to the long-established Monopolar TURP (MTURP). In this systematic review, we compared the outcomes of BTURP vs MTURP. A systematic review was conducted using PubMed, EMBASE, Scopus, Google Scholar, and the Cochrane library using relevant search terms from inception of databases till June 2020. Using PRISMA methodology, 18 randomized control trials were reviewed comparing MTURP vs BTURP with a total of 8,393 patients. A significant drop in serum sodium was seen in four studies in MTURP vs BTURP and while there was zero incidence of TUR syndrome in BTURP group, there were 1-16 episodes of TUR syndrome across studies in the MTURP group. A significant fall in hematocrit was seen in three of nine studies with MTURP and one with a significant difference in blood transfusion rates. There were no significant differences in the incidence of clot retention across the studies with 1-5 cases in BTURP group vs 2-12 cases in MTURP group. There were no significant differences related to the duration of catheterization, operative time, resection volume, length of stay, quality of life, postoperative urethral stricture, and sexual function. Although both BTURP and MTURP improve urinary symptoms, BTURP is associated with less risk of hyponatremia, TUR syndrome, and blood loss compared to MTURP. There seems to be no significant difference in length of stay, urethral stricture, quality of life, and operative duration.

Comparison of efficacy of tranexamic acid irrigation versus intravenous injection for preventing blood loss in percutaneous nephrolithotomy

Purpose: Bleeding is the most dreadful and distressing complication of percutaneous nephrolithotomy, which can cause significant morbidity. Intravenous use of tranexamic acid to reduce bleeding complication is widely established. Our aim is to compare the result between the two groups using tranexamic acid intravenous and in irrigation solution. Materials and methods: A total of 160 patients were enrolled in this study. Patients were randomly allocated to two groups. Group 1 received 0.1% tranexamic acid solution (1000 mg in 1 L of irrigation solution (normal saline)). Group 2 received 1 g tranexamic acid intravenously in intraoperative period. Results: The mean estimated fall in haematocrit, mean estimated total blood loss and mean operative time in tranexamic acid irrigation group is significantly less compared to intravenous tranexamic acid group. No significant difference was found with regards to stone clearance. Conclusion: We found that tranexamic acid irrigation was safe and associated with reduced blood loss as compared to intravenous tranexamic acid.

HEMODYNAMIC STATUS- PREDICTOR OF OUTCOME IN NON OPERATIVE MANAGEMENT OF ISOLATED TRAUMATIC SPLENIC INJURY

Background: Blunt abdominal trauma is the most common cause of splenic injury and spleen is the most common organ injured in trauma patients both in children and adults. Abdomino-pelvic ultrasound is very efcient radiological investigation in the diagnosis of splenic injuries; it can detect intraperitoneal hemorrhage, splenic capsular tears, and the vascularity of the spleen. Moreover, computed tomography (CT) scan is investigation of choice in hemodynamically stable.CT also guides the surgeon towards management of injuries, and maintaining the low threshold for surgical intervention in correlation with hemodynamic unstable patient with traumatic splenic injury.CT also guides the surgeon towards management of injuries, and maintaining the low threshold for surgical intervention in correlation with hemodynamic unstable patient with traumatic splenic injury. However, even patients with CT scan nding of “blush on CT”, indicating higher grades of injury, if hemodynamically stable still can be managed successfully with NOM as per literature. Methods: This is a hospital based prospective observational study, done on 45 hemodynamically stable patients of splenic trauma, in Accident and Emergency Department of General Surgery, Government Medical College and hospital Srinagar, over a period of 24 months from September 2018 to September 2020. Results:Haemodynamics Status of patient: Our study showed that various parameters dening haemodynamic status of patient are predictors for outcome of study. Various parameters arePulse rate (P-value 0.001), Systolic blood pressure (P-value &lt;0.001), Diastolic blood pressure (P-value 0.001), Haemoglobin (Pvalue &lt;0.001), Haematocrit (P-value &lt;0.001), and Blood transfusions (P-value &lt;0.001). All parameters showed statistical signicance with P-values &lt;0.001. Conclusion: Success of NOM increases, if patient is hemodynamically stable which is predicted by various parameters like pulse rate, blood pressure, urine output, fall in hemoglobin and hematocrit, number of blood transfusions, saturation, temperature and others. NOM in splenic trauma should be management of choice in all hemodynamically stable patients, regardless of blood group and neurological status of patient on admission.Success of isolated splenic injury depends on multiple factors such as availability of ICUs, high dependency units for strict monitoring,blood banks and availability of multidisciplinary team efforts encompassing anesthetics, trauma surgeons, radiologists, for successful outcome. NOM of isolated splenic trauma, is associated with very low morbidity, no complications, and no mortality, when applied in hemodynamically stable patient. Every patient of splenic trauma who is considered for NOM, should be properly counselled about emergency signs and should be advised to report to emergency if any of emergency signs were present. This group of patients must be closely monitored for delayed bleeding in case of NOM of splenic trauma.

Does Miniaturization Actually Decrease Bleeding After Percutaneous Nephrolithotomy? A Single-Center Randomized Trial.

Introduction: Miniaturization of percutaneous nephrolithotomy (mPCNL) was proposed to decrease postoperative bleeding, as there is decreased parenchymal injury compared with standard percutaneous nephrolithotomy (SPCNL). Published randomized controlled trials (RCTs) evaluating bleeding after mPCNL have shown conflicting results. Hence, the evidence to say that mPCNL offers less postoperative bleeding is not robust. Materials and Methods: Prospective RCT was done by comparing mPCNL and SPCNL for treatment of renal stones of size 1 to 3 cm. Patients with active urinary tract infection, renal malformation, uncorrected coagulopathy, and raised serum creatinine (>1.5 mg/dL) were excluded. Blood loss was evaluated by measuring fall in hemoglobin and hematocrit on postoperative day 1. Postoperative pain was evaluated by visual analogue scale (VAS) score at 6, 24, and 48 hours. Results: A total of 60 patients (30 in each arm) were enrolled during the study period. All the baseline preoperative variables were comparable in both the groups. The SPCNL group had a significantly higher drop in hematocrit level as compared with mPCNL (4.6 ± 3.1% vs 3.1 ± 2.1%, p = 0.02). The mean fall in hemoglobin was higher in SPCNL as compared with mPCNL (1.61 ± 0.9 gm% vs 1.21 ± 0.7 gm%, p = 0.07), but it was not significant. Blood transfusion (BT) rate was comparable in both the groups (one patient in each group). The mPCNL group had significantly less VAS scores at 6 hours (3.27 ± 1.20 vs 4.40 ± 1.52, p = 0.002) and 24 hours (2.10 ± 0.54 vs 2.83 ± 1.05, p = 0.001) after surgery. Postoperative complications and hospital stay were comparable in both the arms. Conclusion: mPCNL is associated with less postoperative bleeding and pain than SPCNL. However, the small tract size does not prevent against the clinically significant bleeding requiring BT.

A Longitudinal Study on Comparison of Haematocrit, Glasgow Score and Computed Tomography Abdomen as Prognostic Markers in Assessment of Severity in Acute Pancreatitis

Introduction: Acute Pancreatitis (AP) can present from a mild self-limiting process that requires only supportive care to severe disease that can cause multiple Organ Failure (OF) and high mortality. It is therefore important to identify such patients at increased risk of OF and mortality at the earliest. Aim: To evaluate and compare the efficacy of three prognostic markers namely Haematocrit, Glasgow scoring and Computed Tomography (CT) abdomen in assessing the severity of AP. Materials and Methods: A prospective longitudinal study was done on 120 patients diagnosed with AP, over a period of 18 months. Haematocrit was done at admission and at 48 hours. A fall in haematocrit of more than 10% was considered sensitive. Modified Glasgow score was assessed at admission and after 48 hours. Other variables include blood glucose level, white blood count, blood urea nitrogen, serum calcium, partial oxygen pressure (PaO2), decrease in haematocrit, serum Lactate Dehydrogenase (LDH), serum aspartate aminotransferase (AST) and serum albumin. A score of ≥3 was considered sensitive. CT of abdomen was done at 72 hours and a Computed Tomography Severity Index (CTSI) score of ≥4 was considered sensitive. The results of each prognostic marker were graphed and compared to assess Length of Hospital Stay (LOHS), need for Intensive Care Unit Admission (ICUA), OF and mortality. Results: The mean LOHS was six days. Haematocrit was sensitive in 23 of 79 patients that stayed in hospital for &gt;6 days. Modified Glasgow scores were sensitive in 35 of 79 patients. CT of abdomen was sensitive in 59 out of 79 patients. Total 29 of 120 patients were admitted in the ICU, out of which difference in haematocrit was sensitive in 14 patients, Modified Glasgow coma score of ≥3 was seen in 14 patients and CTSI scores were sensitive in 22 patients. Twelve out of 120 patients developed OF. All 12 patients showed a sensitive Modified Glasgow scores of ≥3 and CTSI ≥4, whereas only five patients were sensitive for fall in haematocrit. Five patients died during the study. All five patients were sensitive for fall in haematocrit Glasgow coma scores and CT abdomen. Among the prognostic markers, haematocrit showed 100% sensitivity, specificity and Positive Predictive Value (PPV) than the other prognostic markers making haematocrit the better prognostic marker. Conclusion: CT of abdomen is a reliable prognostic marker in terms of assessment of LOHS, need for Intensive Care Unit (ICU) care and mortality. Modified Glasgow score is accurate in assessing OF. Haematocrit is specific in assessing the need for ICU care and mortality.

Biochemical Changes Using Sterile Water and 1.5% Glycine in TURP: A Randomized Study

Introduction: Endoscopic procedures in urology require irrigating fluid to provide a clear field of vision and to wash away debris. Glycine (1.5%) has been widely used, however sterile water is easily available and inexpensive. Excessive absorption of irrigation fluid can lead to dyselectrolytemia, hemolysis and systemic complications. In this study we compare 1.5% glycine with sterile water as irrigation fluid for Trans Urethral Resection Of Prostate (TURP). Materials and Method: In this prospective randomized study, we analysed 60 patients with symptomatic Benign Prostatic Hyperplasia (BPH) undergoing TURP with either 1.5% glycine or sterile water as irrigation fluid. The duration of surgery, weight of prostate resected, volume of fluid absorbed were compared. Post-operative levels of hemoglobin, hematocrit, electrolytes and renal function tests at 15 mins, 3 hrs and 6 hrs were analysed. Results: The mean decrease in hemoglobin at 6 hrs was more with 1.5% glycine (1.05±0.28 vs 0.89±0.14g/dL) and was statistically significant (P = 0.031). The mean fall in haematocrit at 6 hrs was significantly more with 1.5% glycine (4.87±1.41 vs 3.94±1.32%) (P = 0.046). The post-operative levels of blood urea were significantly less with 1.5% glycine at 15 mins, 3 hrs and 6 hrs (P 0.05). Nine patients (30%) who received 1.5% glycine and 8 patients (26.6%) receiving sterile water had dilutional hyponatremia at 6 hrs, but there were no significant difference between the two groups (P = 0.38). None of the patients developed TURP syndrome. Conclusion: Biochemical changes with sterile water was significantly less when compared with 1.5% glycine in TURP. Most of the changes observed were at 6 hrs after surgery. Hence sterile water can be considered as a safer and inexpensive alternative to glycine in resource-limited settings of low-income countries.

Comparison of blood loss between intra-articular and intra-venous administration of tranexamic acid in primary total knee arthroplasty.

Objective: To compare the blood loss between intra-articular and intra-venous administration of tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty. Design of study: It was a randomized controlled trial. Study duration and settings: This study was carried out at the Orthopedic Departments of Combined Military Hospital Lahore and Rawalpindi from Jan 2016 to March 2018. Methodology: Patients of both the genders were involved this study who had age in the rage of 40–80 years undergoing primary unilateral total knee arthroplasty for degenerative conditions like osteoarthritis and rheumatoid arthritis. These patients were randomly divided into two treatment groups. Patients in IA group received intra-articular tranexamic acid while those in IV group received intravenous tranexamic acid. From all the patients, a written signed consent was taken. Findings: Females were predominant with male-to-female ratio of 1:3.7. The mean age of the patients was 67.3 ± 8.2 years while the mean BMI was 30.9 ± 2.9 Kg/m2. Majority (n = 191, 95.5%) of the patients had osteoarthritis while remaining 9 (4.5%) patients had rheumatoid arthritis. There was no statistically significant difference between intra-articular and intra-venous administration of tranexamic acid in terms of mean post-operative hemoglobin (9.93 ± 1.14 vs. 9.87 ± 1.26 g/dL; p-value = 0.724), mean post-operative hematocrit (34.8 ± 1.66 vs. 34.73 ± 1.27%; p-value = 0.594), and mean fall in hemoglobin (2.27 ± 0.34 vs. 2.25 ± 0.30 g/dL; p-value = 0.587) and hematocrit (2.34 ± 0.94 vs. 2.46 ± 0.28%; p-value = 0.216). Conclusion: Intra-articular administration of tranexamic acid was found to be as effective and safe as intra-venous administration in reducing blood loss in primary total knee arthroplasty. Due to convenience, the use of intra-articular administration of tranexamic acid after primary TKA may be considered in future practice.

Efficacy and Safety of Supracostal Access for Mini Percutaneous Nephrolithotomy in Pediatric Patients

To evaluate the efficacy and safety of supracostal percutaneous nephrolithotomy (PCNL) through the 11th intercostal space and compare it with subcostal PCNL in children with renal calculi. Children with renal calculi who underwent PCNL between January 2010 and December 2017 were divided into 2 groups: supracostal PCNL (group 1) and subcostal PCNL (group 2). Stone location, stone burden, location of the access points, operative time, postoperative visual pain score, success rate, hospital stay, and complications according to the modified Clavien classification were compared. Comparison of medians was done using Mann Whitney U test and the means were compared using t test. Group 1 had 50 patients while group 2 had 60 patients. The stone-free rate was 84.0% and 85.0% in groups 1 and 2, respectively after 1 session of PCNL (P=.885). After auxiliary procedures, it increased to 96.0% and 96.6%, respectively (P=.852). The mean fall in hematocrit was 0.9% in group 1 and 1.5% in group 2 (P=.11) whereas the median pain score was 4 in group 1 and 3 in group 2 (P=.37). In all, 54 complications were recorded the commonest among which were grade I (81.5%). Twenty-nine complications were observed in group 1 while 25 complications were observed in group 2 (P=.088). One patient developed nephropleural fistula while another patient developed hydropneumothorax. Both belonged to group 1. Supracostal access for PCNL is an effective and safe alternative to subcostal access for children with renal calculi in terms of stone-free rate and complications.

Developing and Implementing Nursing Care Protocol Regarding Management of Postpartum Hemorrhage

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality in developingcountries. PPH is defined as any blood loss >500 ml following vaginal delivery and >1000 ml after cesarean section.It can also be defined as fall in hematocrit >10% or blood loss >15% of total blood volume, or 10% measured perpartum decline in hemoglobin levels. Aim of the study: the aim of this quasi-experimental study was to evaluate theeffect of Developing and implementing Nursing Care protocol regarding management of postpartum hemorrhage onPatients outcomes and complications. Setting: This study was conducted at Assiut Women's Health Hospital,postpartum unit .Sample: Purposive sample with a total of 140 Postpartum Hemorrhage patients was recruited,divided into two groups (control and study) 70 patients for each group Result: this study found that a significantdifference between the routine and designed protocol in nursing management of postpartum hemorrhage . thesefindings show that the patient outcomes improved in study cases when compared with control cases which appearedin stop of bleeding 95.7% in study group, 82.8% in control group and conscious level 87.1%in study group,78.6 incontrol group with normal conscious level Conclusion: This research concluded that nursing care protocol waseffective in reducing postpartum hemorrhage outcome and complications. Recommendations: clearly writtenPostpartum Hemorrhage management protocol, adapted for a particular hospital, should be developed and used inclinical practice.

Immersion in Water During Active Labor Decreases Postpartum Hematocrit Fall Following Vaginal Delivery

OBJECTIVE: The objective of the study was to investigate the effect of immersion in water strategy during labor on postpartum bleeding by calculating the postpartum reduction rates of the hematocrit values of the patients.STUDY DESIGN: The study groups consisted of 84 women undergoing vaginal delivery with immersion in water during labor (group 1) and the control group (group 2) of 84 women undergoing normal vaginal delivery. Patients who have received additional medical and surgical interventions for alleviation of postpartum hemorrhage, patients who have undergone an episiotomy and/or perineal trauma were not included in the study. All data were taken from patients who have delivered with spontaneous vaginal delivery. Postpartum hematocrit fall rates of the groups have been compared and the effect of immersion in water on postpartum hemorrhage has been evaluated.RESULTS: The study groups consisted of 84 women undergoing vaginal delivery with immersion in water during labor (Group 1) and the control group (Group 2) of 84 women undergoing vaginal delivery at the hospital. The women in the two groups were matched with respect to age, parity, birth weight and gestational age. The mean age of the women was 29.8±4.8 and 30.5±4.9 respectively. The mean hematocrit difference in the first group was 2.08 ± 1.88 and in the second group was 3.81 ± 1.55. The mean percentage of hematocrit reduction in the first group was 5.71% and in the second group 10.23%.CONCLUSION: Our data showed that mean hematocrit level decreases among women following vaginal delivery more than women who give birth vaginally within immersion in water during labor. The percentage of hematocrit reduction in the water birth group was lower than in the control group. Water birth seems to facilitate uterine contractions more efficiently following vaginal delivery.

Complications and Risks of Percutaneous Renal Biopsy.

BACKGROUND:Renal biopsy performed in native and transplant kidneys is generally considered a safe procedure.AIM:In this study, we evaluated renal biopsy complications and risk factors in one nephrology facility.MATERIAL AND METHODS:We conducted a three-year retrospective study on patients who underwent renal biopsy between January 2014 and December 2016. Strict written biopsy protocol was followed. Clinical and laboratory data were obtained from medical charts. Complications were categorised as minor and major, according to the need for intervention. Minor complications included macrohematuria and/or hematoma that did not require intervention. Major complications included hematuria or hematoma with fall of hematocrit that required a blood transfusion, surgery or caused death. A binary logistic regression model was used to analyse the possible factors associated with complications after the biopsy.RESULTS:We analysed 345 biopsies; samples were taken from patients aged from 15-81 years, of whom 61% were men. A total of 21 (6%) patients developed a complication, 4.4% minor and 1.7% major complications. There were no nephrectomy or death due to biopsy intervention. Overweight patients, as well as those with higher creatinine, lower hemoglobin, higher blood pressure and biopsy due to AKI had higher chances to develop complications (p = 0.037, p = 0.023, p = 0.032, p = 0.002, p = 0.002, respectively). The patients’ age, gender, kidney dimension, number of passes and uninterrupted aspirin therapy were not found as significant predictors of complications. In the multivariate logistic model, body weight (OR = 1.031, 95%CI = 1.002-1.062), lower hemoglobin (OR = 0.973, 95%CI = 0.951–0.996) and hypertension (OR = 1.025, 95%CI = 1.007-1.044) increased the risk of complications in biopsied patients.CONCLUSION:Renal biopsy is a safe procedure with a low risk of complications when strict biopsy protocol is observed. Correction of anaemia and blood pressure is to be considered before the biopsy.

Efficacy of intercostal nerve block with 0.25% bupivacaine in percutaneous nephrolithotomy: A prospective randomized clinical trial.

Introduction and Aim:Several techniques have been used to lower the morbidity of percutaneous nephrostomy (PCN) tube after percutaneous nephrolithotomy (PCNL). The outcomes of intercostal nerve block (ICB) versus peritubal block (PTB) with 0.25% bupivacaine to alleviate post-PCNL pain were compared.Materials and Methods:After obtaining an informed written consent and local institutional ethics clearance, 64 patients undergoing PCNL were computer randomized to receive either an intercostal block/ICB (Group I) or a peritubal block/PTB (Group II) using 0.25% bupivacaine infiltration, after termination of the procedure. They were evaluated for visual analog scale (VAS) score, first analgesic requirement, and the total analgesic demand along with fall in hematocrit, PCN indwelling time, blood transfusion rate, complications, and mean hospital stay in the postoperative period. The protocol was registered with CTRI/2018/03/012717.Results:Patients in both the groups were comparable on the basis of demographic data, preoperative renal function, stone burden, and hematocrit value. The mean VAS score at 6, 12, 24, and 48 h was significantly lower in the Group II versus Group I (P < 0.001). The total mean analgesic requirement was 160.16 and 103.13 mg of diclofenac sodium in Group I and Group II, respectively, which was significantly higher in Group I versus Group II (P < 0.001). The time to first analgesic demand was significantly higher in PT group (8.06 ± 1.99 h vs. 12.97 ± 1.96 h) in Group I/ICNB and Group II/PT, respectively (P < 0.001). Both the groups were comparable in terms of postoperative hematuria, hematocrit fall, nephrostomy site leak, hospital stay, need of blood transfusions, stone-free rate/retreatment rate, postoperative urinary tract infections, and overall complication rate (Modified Clavien–Dindo classification) which were not statistically significant.Conclusion:Post PCNL, PTB was associated with significantly lower post operative pain and discomfort versus ICB as demonstrated by the significantly lower DVAS pain scores, higher mean time to first analgesic demand and lower mean total analgesic demandt with ICB. Bupivacaine was a safe and effective local anesthetic agent for PTB in select patients for facilitating quick relief from the morbid postoperative pain and discomfort following PCNL.

Clinical illness and outcomes in Nigerian children with persistent early-appearing anaemia following initiation of artemisinin-based combination treatments of uncomplicated falciparum malaria.

In non-anaemic children with malaria, early-appearing anaemia (EAA) is common following artemisinin-based combination treatments (ACTs) and it may become persistent (PEAA). The factors contributing to and kinetics of resolution of the deficit in haematocrit from baseline (DIHFB) characteristic of ACTs-related PEAA were evaluated in 540 consecutive children with malaria treated with artemether-lumefantrine, artesunate-amodiaquine or dihydroartemisinin-piperaquine. Asymptomatic PEAA occurred in 62 children. In a multiple logistic regression model, a duration of illness ≤3 days before presentation, haematocrit <35% before and <25% one day after treatment initiation, drug attributable fall in haematocrit ≥6%, and treatment with dihydroartemisinin-piperaquine independently predicted PEAA. Overall, mean DIHFB was 5.7% (95% CI 4.8–6.6) 7 days after treatment initiation and was similar for all treatments. Time to 90% reduction in DIHFB was significantly longer in artemether-lumefantrine-treated children compared with other treatments. In a one compartment model, declines in DIHFB were monoexponential with overall mean estimated half-time of 3.9 days (95% CI 2.6–5.1), Cmax of 7.6% (95% CI 6.7–8.4), and Vd of 0.17 L/kg (95% CI 0.04–0.95). In Bland-Altman analyses, overall mean anaemia recovery time (AnRT) of 17.4 days (95% CI 15.5–19.4) showed insignificant bias with 4, 5 or 6 multiples of half-time of DIHFB. Ten children after recovery from PEAA progressed to late-appearing anaemia (LAA). Progression was associated with female gender and artesunate-amodiaquine treatment. Asymptomatic PEAA is common following ACTs. PEAA or its progression to LAA may have implications for case and community management of anaemia and for anaemia control efforts in sub-Saharan Africa where ACTs have become first-line antimalarials.Trial registration: Pan Africa Clinical Trial Registration PACTR201709002064150, 1 March 2017 http://www.pactr.org

Tubeless percutaneous nephrolithotomy, are there any real benefits?

Aims & objectives: To assess the benefits of Tubeless PCNL [T PCNL] with regard to cost, tolerability over conventional PCNL [C PCNL]. Materials and Methods: This prospective study included patients undergoing Percutaneus nephrolithotomy during a period between 2007 to 2017. The selection criteria for placing the patient in tubeless arm were - Maximum stone burden of 3 cm; Single access tract; Minimal or negligible hemorrhage during the procedure; Operative time of less than two hours; lack of collecting system perforations; clinically insignificant residual fragments. In those who met the criteria antegrade stenting was done without a nephrostomy. In those patients, who did not full fill the inclusion criteria, a 24 F Nephrostomy tube was placed at the end of procedure. Results: The study cohort included 373 patients consisting of 211 males and 162 females in 3rd to 5th decades of their lives. Those under T PCNL and C PCNL arms were 301 and 72 respectively. The stone size varied from 17-27 mm with a mean of 22 mm. The procedure time varied between 35 to 97 minutes with a mean of 66 minutes. The T PCNL arm was analyzed with regard to Analgesic requirement; Duration of hospital stay and the total cost of the treatment and compared with those under C PCNL. Patients under had their catheter removed on 2nd postoperative day and discharged on the same day afternoon if the operative site did not develop any leak. For those under C PCNL, Nephrostomy was clamped at 48hrs if the drainage was clear and X KUB did not show any significant residual fragments. Re look procedure was planned if there bigger residual fragments. The pain was assessed using visual analogue scale (VAS) at 6, 12 & 24 hrs. Post procedure and analgesia was administered as per requirement. Majority of patients (90.7%), under T PCNL rated their pain perception highest (4-6) at 6 hrs., which came down to 2-4 at 12 hrs. They did not need any analgesia at 24 hrs., rating their pain at 1-2. mean of 3.9. The same under C PCNL was higher at 8-9 on VAS at 6 hrs, 6-8 at 12 hrs and 4-6 at 24 hrs. Parenteral Diclofenac the drug of choice for pain relief and the mean analgesic requirement was 75 mg of Diclofenac. The Analgesic requirement was higher under C PCNL arm. None required blood transfusion as the fall in hematocrit was negligible under T PCNL. The mean hospital stay in those who underwent T PCNL was 3 days as compared to 5 days under C PCNL. Conclusion: Tubeless PCNL offers a significant benefit in terms of lesser analgesic requirement, shorter hospital stay but necessitates an additional procedure with cost in stent removal. By using stents with setons might obviate stent removal and hence the cost.

A comparison of the efficacy of carbetocin and oxytocin on hemorrhage-related changes in women with cesarean deliveries for different indications

ObjectiveTo compare the efficacy of carbetocin and oxytocin on hemorrhage-related changes in women with cesarean deliveries (CS) for different indications. Materials and methodsA retrospective cohort study was conducted on 1568 women with CS before labor onset (elective CS, n = 1153) or during labor (intrapartum CS, n = 415) after 24 weeks’ gestation. We compared the fall in hemoglobin (Hb) and hematocrit (Hct) levels after CS, estimated blood loss, the need for additional uterotonic agents, blood transfusion, and the rate of postpartum hemorrhage between women with carbetocin and women with oxytocin treatment, stratified by indications for CS. ResultsFor women with elective CS, decreased Hb and Hct falls were noted with carbetocin treatment compared to oxytocin treatment in women with indications for prior CS, fetal malpresentation, and multiple gestation. The need for additional uterotonics was less in CS for prior CS, fetal malpresentation, and cephalopelvic disproportion and fewer transfusions in CS for multiple gestation in women with carbetocin compared to women with oxytocin treatment. For women with intrapartum CS, carbetocin was associated with decreased use of additional uterotonic agents and transfusion in CS for dysfunctional labor. ConclusionCarbetocin and oxytocin had differential effects on hemorrhage-related changes in women with CS for different indications.

Pacing of an Untrained 17-Year-Old Teenager in a Marathon Attempt.

Although there has been increased scientific interest for physiological responses to endurance running and pacing, limited information exists for adolescents participating in endurance events. We are reporting the case of an untrained 17-year-old female teenager (body mass 50.6 kg, height 167 cm and body mass index 18.1 kg/m2) who intended to run a marathon within 6 hours without preparation. The young woman missed her goal by just 2 km. When the average running speed per hour was analysed, there was a major effect of race hour on running speed (p = 0.013, η2 = 0.320), where the running speed in the fifth hour (6.3 ± 0.2 km/h) was lower than in the second hour (6.9 ± 0.1 km/h). Despite a progressive decrease in running speed, she was still able to put on a final spurt, indicated by a 4th degree non-linear regression (R2=0.55). Creatine-kinase reached the initial value again after 5 days and the fall of hemoglobin and hematocrit indicated expansion of plasma volume. Running a marathon as a teenager did not impair physical health, especially when a self-selected pace was adopted. Laboratory parameters during running showed similar changes as have been reported for teenagers and adults after running a marathon. Increased values returned to base line within a few days. In summary, a female teenager at the age of 17 years without specific running preparation is able to achieve nearly a marathon distance during 6 hours of continuous running without harmful effects on health.

Intraventricular haemorrhage in a newborn

We report a 36-h-old very low birth weight female baby (Birth weight 1.1 kg) who was delivered at 29-week gestation. She developed respiratory distress at 4 h of life, in addition to reduced activity, recurrent apnoea, tensed anterior fontanel, progressively increasing occipitofrontal circumference and dramatic fall in haematocrit. Baseline Transfontanelle ultrasound scan (TFUSS) showed blood in the lateral ventricle extending to the parietal cortex with ventricular enlargement of >50%. Repeat TFUSS at 8 weeks showed Grade 3 periventricular leucomalacia.

Factors contributing to anaemia after uncomplicated falciparum malaria in under five year-old Nigerian children ten years following adoption of artemisinin-based combination therapies as first-line antimalarials

BackgroundArtemisinin-based combination therapies (ACTs) have remained efficacious treatments of acute falciparum malaria in many endemic areas but there is little evaluation of factors contributing to the anaemia of acute falciparum malaria following long term adoption of ACTs as first-line antimalarials in African children.MethodsMalarious <5 year-olds randomized to artemether-lumefantrine, artesunate-amodiaquine or dihydroartemisinin-piperaquine treatments were followed up clinically for 6 weeks. Anaemia was defined as haematocrit <30%; Malaria-attributable fall in haematocrit (MAFH) as the difference between haematocrit 28–42 days post- and pre-treatment; Total MAFH (TMAFH) as the difference between days 28–42 haematocrit and the lowest haematocrit recorded in the first week post-treatment initiation; Drug-attributable fall in haematocrit (DAFH) as the difference between MAFH and TMAFH; Early appearing anaemia (EAA) as haematocrit <30% occurring within 1 week in children with normal haematocrit pre-treatment. Predictors of anaemia pre-treatment, EAA, MAFH or DAFH >4% were evaluated by stepwise multiple logistic regression models. Survival analysis and kinetics of DAFH were evaluated by Kaplan-Meier estimator and non-compartment model, respectively.ResultsPre-treatment, 355 of 959 children were anaemic. Duration of illness >2 days and parasitaemia ≤10,000 μL−1 were independent predictors of anaemia pre-treatment. EAA occurred in 301 of 604 children. Predictors of EAA were age ≤ 15 months, history of fever pre-treatment and enrolment haematocrit ≤35%. The probabilities of progression from normal haematocrit to EAA were similar for all treatments. MAFH >4% occurred in 446 of 694 children; its predictors were anaemia pre-treatment, enrolment parasitaemia ≤50,000 μL−1, parasitaemia one day post-treatment initiation and gametocytaemia. DAFH >4% occurred in 334 of 719 children; its predictors were history of fever pre-and fever 1 day post-treatment initiation, haematocrit ≥37%, and parasitaemia >100,000 μL−1. In 432 children, declines in DAFH deficits were monoexponential with overall estimated half-time of 2.2d (95% CI 1.9–2.6). Area under curve of deficits in DAFH versus time and estimated half-time were significantly higher in non-anaemic children indicating greater loss of haematocrit in these children.ConclusionAfter ten years of adoption of ACTs, anaemia is common pre-and early post-treatment, falls in haematocrit attributable to a single infection is high, and DAFH >4% is common and significantly lower in anaemic compared to non-anaemic Nigerian children.Trial registrationPan African Clinical Trial Registry (PACTR) [PACTR201709002064150, 1 March 2017].