Impact of propofol and sevoflurane anesthesia on cognition and emotion in gastric cancer patients undergoing radical resection

BACKGROUND Propofol and sevoflurane are commonly used anesthetic agents for maintenance anesthesia during radical resection of gastric cancer.However,there is a debate concerning their differential effects on cognitive function,anxiety,and depression in patients undergoing this procedure.AIM To compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function,anxiety,depression,and organ function in patients undergoing radical resection of gastric cancer.METHODS A total of 80 patients were involved in this research.The subjects were divided into two groups:Propofol group and sevoflurane group.The evaluation scale for cognitive function was the Loewenstein occupational therapy cognitive assessment(LOTCA),and anxiety and depression were assessed with the aid of the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Hemodynamic indicators,oxidative stress levels,and pulmonary function were also measured.RESULTS The LOTCA score at 1 d after surgery was significantly lower in the propofol group than in the sevoflurane group.Additionally,the SAS and SDS scores of the sevoflurane group were significantly lower than those of the propofol group.The sevoflurane group showed greater stability in heart rate as well as the mean arterial pressure compared to the propofol group.Moreover,the sevoflurane group displayed better pulmonary function and less lung injury than the propofol group.CONCLUSION Both propofol and sevoflurane could be utilized as maintenance anesthesia during radical resection of gastric cancer.Propofol anesthesia has a minimal effect on patients'pulmonary function,consequently enhancing their postoperative recovery.Sevoflurane anesthesia causes less impairment on patients'cognitive function and mitigates negative emotions,leading to an improved postoperative mental state.Therefore,the selection of anesthetic agents should be based on the individual patient's specific circumstances.

Microbiological and Antibiotic Susceptibility Patterns in Cardiothoracic and Vascular Intensive Care Unit of a Tertiary Level Hospital in Nepal

Background: Sepsis has been one of the most important conditions for morbidity and mortality of Intensive care unit (ICU) patients. Antibiotics remain one of the major combating factors for it. Indiscriminate antimicrobial usage and poor prescription practices have contributed to the development of multidrug resistant (MDR) organisms. Therefore, the current study was designed to evaluate the spectrum, and susceptibility patterns of pathogens isolated from patients admitted to our Cardiothoracic and Vascular Intensive care unit. Materials and Methods: The study was conducted in Cardiothoracic and Vascular ICU of a tertiary care teaching hospital from February 2019 to March 2021. Samples (blood, urine, wound swab, tracheal aspirate, and central venous catheter tip) for culture were taken from all the patients in Sepsis admitted in Cardiothoracic and Vascular ICU above 18 years of age during the study period. The culture reports (microbiological profile and their susceptibility pattern) were collected and data collection of all enrolled patients was done. Results: Out of the total 128 samples studied 75 (58.5%) were culture positive. The predominant organisms isolated were Gram negative organisms (Klebsiella, Pseudomonas, Acinetobacter, followed by E. coli). The highest prevalence of microbial growth was found in tracheal aspirate (46.8%), followed by blood (21.8%). Antibiotic susceptibility results showed the highest sensitivity of those common pathogens towards higher antibiotics only (especially Polymyxin B and Colistin). Conclusion: The emergence of multidrug resistant organisms and lesser availability of a higher group of antibiotics is a major concern. So there is a need for regular hospital based antibiograms, strict infection control programs, and implementation of antimicrobial stewardship programmes for guiding clinicians in choosing appropriate therapy and preventing the surge of multidrug resistant organisms.

IL13RA2 promotes progression of infantile haemangioma by activating glycolysis and the Wnt/β-catenin signaling pathway

Background:Interleukin 13 receptor subunit alpha 2(IL13RA2)plays an essential role in the progression of many cancers.However,the role of IL13RA2 in infantile haemangioma(IH)is still unknown.Materials and Methods:IL13RA2 expression in IH tissues was analyzed using western blot,qRT-PCR,and immunofluorescence.The role of IL13RA2 in haemangioma-derived endothelial cells(HemECs)was determined following knockdown or overexpression of IL13RA2 using CCK-8,colony formation,apoptosis,wound healing,tubule formation,Transwell,and western blot.Results:IL13RA2 expression was upregulated in IH tissues.IL13RA2 overexpression promoted proliferation,migration,and invasion of HemECs and induced glycolysis,which was confirmed with a glycolysis inhibitor.Specifically,IL13RA2 interacted withβ-catenin and activated the Wnt/β-catenin pathway in HemECs,which were involved in the above-mentioned effects of IL13RA2.Conclusions:These findings revealed that targeting IL13RA2 is a potential therapeutic approach for IH.

Hypoxia in the pulmonary vein increases pulmonary vascular resistance independently of oxygen in the pulmonary artery

Introduction:Hypoxic pulmonary vasoconstriction(HPV)can be a challenging clinical problem.It is not fully elucidated where in the circulation the regulation of resistance takes place.It is often referred to as if it is in the arteries,but we hypothesized that it is in the venous side of the pulmonary circulation.Methods:In an open thorax model,pigs were treated with a veno-venous extra corporeal membrane oxygenator to either oxygenate or deoxygenate blood passing through the pulmonary vessels.At the same time the lungs were ventilated with extreme variations of inspired air from 5%to 100%oxygen,making it possible to make combinations of high and low oxygen content through the pulmonary circulation.A flow probe was inserted around the main pulmonary artery and catheters in the pulmonary artery and in the left atrium were used for pressure monitoring and blood tests.Under different combinations of oxygenation,pulmonary vascular resistance(PVR)was calculated.Results:With unchanged level of oxygen in the pulmonary artery and reduced inspired oxygen fraction lowering oxygen tension from 29 to 6.7 kPa in the pulmonary vein,PVR was doubled.With more extreme hypoxia PVR suddenly decreased.Combinations with low oxygenation in the pulmonary artery did not systematic influence PVR if there was enough oxygen in the inspired air and in the pulmonary veins.Discussion:The impact of hypoxia occurs from the alveolar level and forward with the blood flow.The experiments indicated that the regulation of PVR is mediated from the venous side.

Multi-cohort comprehensive analysis unveiling the clinical value and therapeutic effect of GNAL in glioma

Clinical data indicates that glioma patients have poor treatment outcomes and clinical prognosis.The role of olfactory signaling pathway-related genes(OSPRGs)in glioma has not been fully elucidated.In this study,we aimed to investigate the role and relationship between OSPRGs and glioma.Univariate and multivariate Cox regression analyses were performed to assess the relationship between OSPRGs and the overall survival of glioma based on public cohorts,and the target gene(G Protein Subunit Alpha L,GNAL)was screened.The association of GNAL expression with clinicopathological characteristics,gene mutation landscape,tumor immune microenvironment(TIME),deoxyribonucleic acid(DNA)methylation,and naris-occlusion controlled genes(NOCGs)was performed.Immunohistochemistry was used to evaluate GNAL level in glioma.Further analysis was conducted to evaluate the drug sensitivity,immunotherapy response,and functional enrichment of GNAL.GNAL was an independent prognostic factor,and patients with low GNAL expression have a poor prognosis.Expression of GNAL was closely associated with clinicopathological characteristics,DNA methylation,and several immune-related pathways.Immune infiltration analysis indicated that GNAL levels were negatively correlated with immune scores.GNAL low-expression group showed efficacy with anti-PD-1 therapy.Ten compounds with significantly different half-maximal inhibitory concentration(IC50)values between the GNAL high and low-expression groups were identified.Furthermore,its expression was associated with several immune cells,immune-related genes,and NOCGs.The expression of GNAL is closely associated with clinicopathological characteristics,TIME,and the response to therapeutic interventions,highlighting its potential as a prognostic biomarker for glioma.

Development and validation of a 6-gene signature derived from RNA modification-associated genes for the diagnosis of Acute Stanford Type A Aortic Dissection

Background Acute Stanford Type A Aortic Dissection(ATAAD)is a critical medical emergency characterized by significant morbidity and mortality.This study aims to identify specific gene expression patterns and RNA modification associated with ATAAD.Methods The GSE153434 dataset was obtained from the Gene Expression Omnibus(GEO)database.Differential expression analysis was conducted to identify differential expression genes(DEGs)associated with ATAAD.To validate the involvement of RNA modification in ATAAD,RNA modification-related genes(M6A,M1A,M5C,APA,A-to-I)were acquired from GeneCards,following by Least Absolute Shrinkage and Selection Operator(LASSO)regression analysis.A gene prediction signature consisting of key genes was established,and Real-time PCR was used to validate the gene expression in clinical samples.The patients were then divided into high and low-risk groups,and subsequent enrichment analysis,including Gene Ontology(GO),Kyoto Encyclopedia of Genes and Genomes(KEGG),Gene Set Enrichment Analysis(GSEA),Gene Set Variation Analysis(GSVA),and assessments of immune infiltration.A co-expression network analysis(WGCNA)was performed to explore gene-phenotype relationships and identify key genes.Results A total of 45 RNA modification genes were acquired.Six gene signatures(YTHDC1,WTAP,CFI,ADARB1,ADARB2,TET3)were developed for ATAAD diagnosis and risk stratification.Enrichment analysis suggested the potential involvement of inflammation and extracellular matrix pathways in the progression of ATAAD.The incorporation of pertinent genes from the GSE147026 dataset into the six-gene signature further validated the model's effectiveness.A significant upregulation in WTAP,ADARB2,and TET3 expression,whereas YTHDC1 exhibited a noteworthy downregulation in the ATAAD group.Conclusion Six-gene signature could serve as an efficient model for predicting the diagnosis of ATAAD.

Impact of baseline steroids on the efficacy of neoadjuvant immunochemotherapy in locally advanced esophageal squamous cell carcinoma

BACKGROUND Immunochemotherapy involving the combination of programmed cell death 1/programmed cell death ligand 1 inhibitors with chemotherapy has advanced the treatment of locally advanced esophageal squamous cell carcinoma(ESCC).The use of corticosteroids as pretreatment might reduce immunotherapy efficacy.AIM To investigate the impact of baseline corticosteroid use on neoadjuvant immunochemotherapy(nIC)outcomes in locally advanced ESCC patients.METHODS Patients with locally advanced ESCC who received nIC at Sun Yat-sen University Cancer Center and the Third Affiliated Hospital of Sun Yat-sen University were included.Patients were divided into dexamethasone and antihistamine groups on the basis of the administered pretreatment.Antiallergic efficacy and safety were evaluated,as well as its impact on short-term efficacy[complete pathological response(pCR),major pathological response(MPR)]and long-term efficacy[overall survival(OS),progression-free survival(PFS)]of nIC.RESULTS From September 2019 to September 2023,142 patients were analyzed.No severe treatment-related adverse events or deaths were observed.Allergy occurrence was greater in the antihistamine group(P=0.014).Short-term efficacy was not significantly different:The pCR rates were 29.9%and 40.0%,and the MPR rates were 57.9%and 65.7%in the dexamethasone and antihistamine groups,respectively.The long-term efficacy was not significantly different:The 2 years OS rates were 95.2%and 93.5%,and the 2 years PFS rates were 90.3%and 87.8%.Subgroup analysis revealed no difference in OS between the 20 mg dexamethasone group and the<20 mg dexamethasone group,but PFS was significantly greater in the 20 mg dexamethasone group(93.9%vs 56.4%,P=0.001).CONCLUSION Dexamethasone or antihistamines can be used before nIC in locally advanced ESCC without affecting short-or long-term efficacy.Administering 20 mg dexamethasone before nIC may improve PFS in ESCC.

Effect of programmed comprehensive nursing on delirium incidence in intensive care unit children following severe cardiac surgery

BACKGROUND Programmed comprehensive nursing was adopted for intensive care unit(ICU)children following severe cardiac surgery to improve respiratory function and delirium incidence.AIM To explore how programmed comprehensive nursing impacts respiratory func-tion and delirium incidence in ICU children post cardiac surgery.METHODS Between January 2022 and January 2024,180 pediatric patients from the Chil-dren’s Hospital of Nanjing were admitted to the ICU after cardiac surgery and randomly grouped.The control group comprised 90 patients and received routine nursing care.The observation group comprised 90 patients and received program-med comprehensive nursing.Both groups received continuous nursing care until discharge.Their respiratory function,incidence of delirium,and clinical outcomes were compared.The memory state and sleep quality of both groups were com-pared.RESULTS The incidence of delirium was 5.56%in the observation group when admitted to ICU,which was lower than that in the control group(20.00%;P<0.05).The observation group demonstrated higher peak expiratory flow rate,respiratory frequency,deep breathing volume,and tidal volume in the ICU compared with the control group.Additionally,the observation group showed higher sleep depth,sleep latency,night awakening,return to sleep,and sleep quality com-pared with the control group(P<0.05).CONCLUSION Programmed comprehensive nursing in ICU patients following severe cardiac surgery can reduce the impact on respiratory function,improve sleep quality,and alleviate postoperative delirium,showing significant promise for clinical application.

Application of ^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography imaging in recurrent anastomotic tumors after surgery in digestive tract tumors

BACKGROUND This study was to investigate the application value of whole-body dynamic ^(18)F-fluorodeoxyglucose(FDG)positron emission tomography/computed tomogra-phy(PET/CT)imaging in recurrent anastomotic tumors of digestive tract after gastric and esophageal cancer surgery.Postoperative patients with gastric and esophageal cancer have a high risk of tumor recurrence,and traditional imaging methods have certain limitations in early detection of recurrent tumors.Whole-body dynamic ^(18)F-FDG PET/CT imaging,due to its high sensitivity and specifi-city,can provide comprehensive information on tumor metabolic activity,which is expected to improve the early diagnosis rate of postoperative recurrent tumors,and provide an important reference for clinical treatment decision-making.METHODS A retrospective analysis was performed on 53 patients with upper digestive tract tumors after operation and systemic dynamic ^(18)F-FDG PET/CT imaging indi-cating abnormal FDG uptake by anastomosis,including 29 cases of gastric cancer and 24 cases of esophageal cancer.According to the follow-up results of gas-troscopy and other imaging examinations before and after PET/CT examination,the patients were divided into an anastomotic recurrence group and anastomotic inflammation group.Patlak multi-parameter analysis software was used to obtain the metabolic rate(MRFDG),volume of distribution maximum(DVmax)of anastomotic lesions,and MRmean and DVmean of normal liver tissue.The lesion/background ratio(LBR)was calculated by dividing the MRFDG and DVmax of the anastomotic lesion by the MRmean and DVmean of the normal liver tissue,respectively,to obtain LBR-MRFDG and LBR-DVmax.An independent sample t test was used for statistical analysis,and a receiver operating characteristic curve was used to analyze the differential diagnostic efficacy of each parameter for anastomotic recurrence and inflammation.RESULTS The dynamic ^(18)F-FDG PET/CT imaging parameters MRFDG,DVmax,LBR-MRFDG,and LBR-DVmax of postoperative anastomotic lesions in gastric cancer and esophageal cancer showed statistically significant differences between the recurrence group and the inflammatory group(P<0.05).The parameter LBR-MRFDG showed good diagnostic efficacy in differentiating anastomotic inflammation from recurrent lesions.In the gastric cancer group,the area under the curve(AUC)value was 0.935(0.778,0.993)when the threshold was 1.83,and in the esophageal cancer group,the AUC value was 1.When 86 is the threshold,the AUC value is 0.927(0.743,0.993).CONCLUSION Whole-body dynamic ^(18)F-FDG PET/CT imaging can accurately differentiate the diagnosis of postoperative anastomotic recurrence and inflammation of gastric cancer and esophageal cancer and has the potential to be an effective monitoring method for patients with upper digestive tract tumors after surgical treatment.

Case Report: Surgical Correction of Transposition of the Great Arteries with Aortopulmonary Window

Introduction:Transposition of the great arteries(TGA)with aortopulmonary window is a rare type of congenital heart disease with limited experience.We reported a neonate aged 25 days receiving the arterial switch operation and assisted with extracorporeal membrane oxygenation.Conclusion:TGA with aortopulmonary window can be safely correctly with the arterial switch operation.

Effects of three-dimensional quality assessment nursing intervention on efficacy and disease management of patients undergoing esophageal cancer surgery

BACKGROUND Esophageal cancer is one of the most common malignant tumors.The three-dimensional quality structure model is a quality assessment theory that includes three dimensions:Structure,process,and results.AIM To investigate the effects of nursing interventions with three-dimensional quality assessment on the efficacy and disease management ability of patients undergoing esophageal cancer surgery.METHODS In this prospective study,the control group received routine nursing,and the intervention group additionally received a three-dimensional quality assessment intervention based on the above routine care.Self-efficacy and patient disease management abilities were evaluated using the General Self-Efficacy Scale(GSES)and Exercise of Self-Care Agency scale,respectively.IBM SPSS Statistics for Windows,version 17.0,was used for the data processing.RESULTS This study recruited 112 patients who were assigned to the control and experi-mental groups(n=56 per group).Before the intervention,there was no significant difference in GSES scores between the two groups(P>0.05).After the inter-vention,the GSES scores of both groups increased,with the experimental group showing higher values(P<0.05).At the time of discharge and three months after discharge,the scores for positive attitudes,self-stress reduction,and total score of health promotion in the experimental group were higher than those in the control group(P<0.05).CONCLUSION The implementation of a three-dimensional quality structure model for postoperative patients with esophageal cancer can effectively improve their self-management ability and self-efficacy of postoperative patients.

Pathological diagnosis and immunohistochemical analysis of giant retrosternal goiter in the elderly: A case report

BACKGROUND Elderly giant retrosternal thyroid goiter is a rare yet significant medical condition,often presenting clinical symptoms that can be confused with other diseases,posing diagnostic and therapeutic challenges.This study aims to delve into the characteristics and potential mechanisms of this ailment through pathological diagnosis and immunohistochemical analysis,providing clinicians with more precise diagnostic and treatment strategies.A 77-year-old male,was admitted to hospital with the chief complaint of finding a goiter in the semilunar month during physical examination,accompanied by dyspnea.Locally protruding into the superior mediastinum,the adjacent structure was compressed,the trachea was compressed to the right,and the local lumen was slightly narrowed.The patient was diagnosed with giant retrosternal goiter.Considering dyspnea caused by trachea compression,our department planned to perform giant retrosternal thyroidectomy.Immunohistochemical results:Tg(+),TTF-1(+),Calcitonin(CT)(I),Ki-67(+,about 20%),CD34(-).Retrosternal goiter means that more than 50%of the volume of the thyroid gland is below the upper margin of the sternum.As retrosternal goiter disease is a relatively rare disease,once the disease is diagnosed,it should be timely surgical treatment,and the treatment is more difficult,the need for professional medical team for comprehensive treatment.CONCLUSION The imaging manifestations of giant retrosternal goiter are atypical,histomorphology and immunohistochemistry can assist in its diagnosis.This article reviews the relevant literature of giant retrosternal goiter immunohisto-chemistry and shows that giant retrosternal goiter is positive for Tg,TTF-1,and Ki-67.

Recent advances in the diagnostic methods and therapeutic strategies of transthyretin cardiac amyloidosis

Cardiac amyloidosis is a progressive disease characterized by the buildup of amyloid fibrils in the extracellular space of the heart.It is divided in 2 main types,immunoglobulin light chain amyloidosis and transthyretin amyloidosis(ATTR),and ATTR amyloidosis is further divided in 2 subtypes,non-hereditary wild type ATTR and hereditary mutant variant amyloidosis.Incidence and prevalence of ATTR cardiac amyloidosis is increasing over the last years due to the improvements in diagnostic methods.Survival rates are improving due to the development of novel therapeutic strategies.Tafamidis is the only disease-modifying approved therapy in ATTR amyloidosis so far.However,the most recent advances in medical therapies have added more options with the potential to become part of the therapeutic armamentarium of the disease.Agents including acoramidis,eplontersen,vutrisiran,patisiran and anti-monoclonal antibody NI006 are being investigated on cardiac function in large,multicenter controlled trials which are expected to be completed within the next 2-3 years,providing promising results in patients with ATTR cardiac amyloidosis.However,further and ongoing research is required in order to improve diagnostic methods that could provide an early diagnosis,as well as survival and quality of life of these patients.

Fate of Right Coronary Artery Occlusion after a Surgically Repaired Aorto- Ventricular Tunnel in a Neonate

The aorto-ventricular tunnel is a rare congenital cardiac anomaly.We present a case of aorto-ventricular tunnel diagnosed via fetal echocardiography.Emergency surgery was performed on the 2nd day of life to close the tun-nel,located just in front of the right coronary ostium,due to the patient’s unstable health condition.The post-operative period revealed complete occlusion of the right coronary artery.Due to the patient’s stability,we opted not to reintervene on the right coronary artery.The patient fully recovered without the need for further coronary intervention.In cases of patients with an aorto-ventricular tunnel(AVT)and associated coronary lesions,it is crucial to exercise caution when intervening in the coronary arteries.

Animal Model of Aortic Valve Calcification: Their Methodology Helps Us Understand Aortic Valve Calcification

Aortic valve calcification disease (CAVD) is the most prevalent degenerative valve disease in humans, leading to significant morbidity and mortality. Despite its common occurrence, our understanding of the underlying mechanisms remains incomplete, and available treatment options are limited and risky. A more comprehensive understanding of the biology of CAVD is essential to identify new therapeutic strategies. Animal models have played a crucial role in advancing our knowledge of CAVD and exploring potential treatments. However, these models have inherent limitations as they cannot fully replicate the complex physiological mechanisms of human CAVD. In this review, we examine various CAVD models ranging from pigs to mice, highlighting the unique characteristics of each model to enhance our understanding of CAVD. While these models offer valuable insights, they also have limitations and shortcomings. We propose that the guide wire model shows promise for future CAVD research, and streamlining the methodology could enhance our understanding and expand the research scope in this field.

Exploring the Role of Serum Cystatin C in Early Detection of Acute Kidney Injury among On-Pump Cardiac Surgery Patients: A Single-Center Investigation in Bangladesh

Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of BSMMU in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cystatin C, with an Area under the ROC Curve of 0.864 and a cut-off value of 0.55 (p Conclusion: This study supports the superior utility of serum Cystatin C as an early detector of AKI in on-pump cardiac surgery patients compared to serum creatinine. Its ability to identify AKI several hours earlier may contribute to reduced morbidity, mortality, and healthcare costs. The findings underscore the significance of exploring novel biomarkers for improved post-cardiac surgery renal function assessment.

Implications of Elevated Serum Cortisol in the Onset of Postoperative Delirium Following Off-Pump Coronary Artery Bypass Grafting: Insights from a Bangladesh-Based Single Center Experience

Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.

Prognostic Role of Preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) in Mitral Valve Replacement (MVR) for Rheumatic Mitral Stenosis Patients

Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.

Comparison of Propofol and Fentanyl for Preventing Emergence Agitation Following Sevoflurane Anesthesia in Pediatric Patients: A Single-Center Study in Bangladesh

Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fewer incidences of nausea, vomiting, and rescue drug requirements compared to fentanyl.

Comparing Short-Term Outcomes of Right Mini-Thoracotomy and Median Sternotomy for Isolated Left Atrial Myxoma Excision

Background: Left atrial myxoma (LAM) is the most common heart tumor in adults, requiring prompt surgical removal to prevent complications like valvular obstruction or embolization. Objectives: This study aimed to compare early postoperative outcomes between two surgical approaches—right mini-thoracotomy and median sternotomy—for the removal of isolated left atrial myxoma. Methods: We conducted a prospective observational study at the Department of Cardiac Surgery, National Heart Foundation Hospital & Research Institute (NHFH&RI), Mirpur, Dhaka, from March 2017 to August 2019. Twenty-eight patients undergoing surgery for isolated left atrial myxoma were included. The surgical approach was determined by the operating surgeon. We analyzed outcomes like intubation time, Intensive Care Unit (ICU) stay, pain levels (Visual Analogue Scale score), and overall hospital stay using SPSS. Statistical significance was set at p Results: Patients in the right mini-thoracotomy group had longer mean intubation times (11.43 vs. 5.93 hours, p Conclusion: Despite longer intubation and ICU times, the right mini-thoracotomy approach offers a minimally invasive alternative for isolated left atrial myxoma excision, with favorable outcomes overall.