Comparative study on effects of dexmedetomidine and dexamethasone on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic surgery

Objective:To compare the safety and efficacy of dexmedetomidine and dexamethasone for the prevention of postoperative nausea and vomiting(PONV)in patients scheduled for laparoscopic surgery.Methods:A total of 86 female patients were prospectively administered dexmedetomidine 1μg/kg i.v.(the group A,n=43),and dexamethasone 8 mg i.v.(the group B,n=43).The two groups were compared in treatment response,hemodynamic changes,and Numerical Analog Scale(NAS).Besides,the relation of PONV with patient baseline characteristics in the perioperative period was determined as well.Results:Patients in group A had lower PONV scores(t=3.1,P<0.002),less needs for rescue anti-emetics(χ2=0.47,P<0.001),and decreased intraoperative heart rate(t=9.72,P<0.001)and mean arterial pressure(t=7.58,P<0.001)compared to that of group B.Group A reported lower NAS than group B(t=2.66,P<0.001).In addition,we found no relationship between PONV score and rescue anti-emetic requirement,age,or body mass index(P=0.96,P=0.60,P=0.28,respectively).Conclusion:Dexmedetomidine could be used as an effective antiemetic in laparoscopic surgeries,with better efficacy than dexamethasone.Dexmedetomidine not only can reduce PONV but also is effective in postoperative analgesia.

A rare fatal case of rabies coexisting with COVID-19

Rabies is a zoonotic disease that affects the central nervous system(CNS)of humans with an extremely high mortality rate.This disease is transmitted to humans through the bite of rabid animals,usually dogs.Post-exposure prophylaxis(PEP)is recommended for all rabid animal bites.If delayed or missed there is a very high chance of developing the disease which is almost always fatal.About 55000 human rabies-related deaths are reported due to delayed or deferred rabies PEP in the world annually[1].The public usually ignores earlier indicators of rabies and is unwilling to consult a doctor,to avoid contracting COVID-19 during hospital visit[2].We present a case of human rabies infection due to non-compliant PEP amid the COVID-19 pandemic following a rabid dog bite.

Tendo-Achilles injury:An observational study in a tertiary care hospital

Objective:To report demographic and injury characteristics of tendo-Achilles(TA)injury,and determine its association with the use of Indian style commode seat(ISCS),the clinical and functional outcomes.Methods:This observational study was conducted between 1 January 2016 and 31 December 2019,and a total of 44 patients with TA injury were included in the study.Their demographic profile,etiology,operative details,and functional outcomes were studied.All patients underwent primary repair followed by standard postoperative management and follow-up for 6 months.Results:Out of 44 patients,7(15.9%)sustained closed injuries while 37(84.1%)sustained open injuries.In open injury cases,30(81%)patients suffered an injury due to slipping in ISCS,4(11%)from road traffic accidents,and 3(8%)due to falling of a heavy object.Besides,20.45%of cases of ISCS injury had associated neurovascular injury.Twenty(45%)patients took more than 90 days to start independent ambulation.At 6 months follow-up,no one could reach pre-injury fitness status.Conclusions:Open TA injury by ISCS is an important,under-reported,and preventable cause of loss of physically active manpower in institutional setups.

New-onset atrial fibrillation among COVID-19 patients: A narrative review

Over the last three years,research has focused on examining cardiac issues arising from coronavirus disease 2019(COVID-19)infection,including the emergence of new-onset atrial fibrillation(NOAF).Still,no clinical study was conducted on the persistence of this arrhythmia after COVID-19 recovery.Our objective was to co-mpose a narrative review that investigates COVID-19-associated NOAF,emphasi-zing the evolving pathophysiological mechanisms akin to those suggested for sustaining AF.Given the distinct strategies involved in the persistence of atrial AF and the crucial burden of persistent AF,we aim to underscore the importance of extended follow-up for COVID-19-associated NOAF.A comprehensive search was conducted for articles published between December 2019 and February 11,2023,focusing on similarities in the pathophysiology of NOAF after COVID-19 and those persisting AF.Also,the latest data on incidence,morbidity-mortality,and management of NOAF in COVID-19 were investigated.Considerable overlaps between the mechanisms of emerging NOAF after COVID-19 infection and persistent AF were observed,mostly involving reactive oxygen pathways.With potential atrial remodeling associated with NOAF in COVID-19 patients,this group of patients might benefit from long-term follow-up and different management.Future cohort studies could help determine long-term outcomes of NOAF after COVID-19.

Dengue fever leading to acute dengue hemorrhagic leukoencephalitis:A case report

Rationale:Dengue fever is a prevalent tropical infectious disease that has a broad panorama of presentations from mild febrile illness to life-threatening manifestations in the form of dengue hemorrhagic fever and dengue shock syndrome.Patient’s concerns:A 20-year-old male presented with a 2-day history of fever,multiple episodes of vomiting,and altered sensorium.Diagnosis:Dengue fever leading to acute hemorrhagic leukoencephalitis.Interventions:Multiple transfusions of single donor platelets,intravenous methylprednisolone,intravenous immunoglobulin,anti-seizure prophylaxis,and broad-spectrum antibiotics.Outcomes:Repeat brain magnetic resonance imaging showed resolution of lesions.The patient was subsequently discharged from the hospital in a healthy state.Lessons:This report helps us to gain a better understanding of the patient’s presentation,which will help to improve the timely recognition and prevention of this rare devastating presentation.

Cope's sign and complete heart block secondary to acute cholecystitis: A case report

Rationale: Cope's sign is reflex bradycardia seen in the patient presenting with symptoms of acute cholecystitis. This bradycardia may be due to vagally mediated cardio-biliary reflex. Many of these reflexes due to acute cholecystitis have similar clinical features (some electrocardiographic changes like bradycardia, complete heart block, and asystole) mimicking that of acute coronary syndrome. Patient's concern: A 60-year old male presented with symptoms of acute cholecystitis and referred to the emergency department with complete heart block and abdominal pain with hypotension requiring an emergency temporary pacemaker. Diagnosis: Cope's sign and complete heart block. Intervention: Emergency temporary cardiac pacemaker insertion. Outcomes: The patient was discharged after three days with regular follow-up and advice for laparoscopic cholecystectomy. Lessons: Complete heart block or any symptomatic bradycardia associated with abdominal pain should be under consideration of cholecystitis that may be associated with either presence or absence of gall stones due to cardio biliary reflex.