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   Table of Contents - Current issue
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July-December 2018
Volume 5 | Issue 2
Page Nos. 53-96

Online since Friday, December 28, 2018

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EDITORIAL  

Simulation in anaesthesia Highly accessed article p. 53
Sanjeev Kumar Jain, Rohit Kumar Varshney
DOI:10.4103/ami.ami_88_18  
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ORIGINAL ARTICLES Top

Features of acid–base balance of bone marrow p. 55
Lyudmila P Nikolaeva
DOI:10.4103/ami.ami_80_17  
Context: Bone marrow (BM) pH has rarely been measured, and the long BM has barely been studied at all because intravital obtaining of the long BM is impossible due to the extreme strength of the long bone tissue. Aims: The study aimed to investigate the acid–base balance of the BM and to compare the acid–base properties of long BM and flat BM. Subjects and Methods: Forty flat BM samples were extracted by sternal puncture. Forty long BM samples were extracted from the femora in patients who had to have a limb amputated. A blood gas and acid–base status analyzer were used to determine pH. Results: Flat BM pH is similar to blood p; the long BM pH is acidic and ranges from 6.7 to 6.9. Hematopoietic stem cells occur in both acidic and slightly alkaline environments. The blood gas and acid–base status analyzer used in this study are suitable for determining the acid–base properties of BM. Conclusions: The acid–base status appears to be an important factor of stem cell differentiation. This paper can be of interest to biotechnologists and researchers who investigate possibilities to influence the differentiation and properties of the stem cells.
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Incidence of atrial fibrillation after cardiac surgery and its pharmacological management p. 58
Persis Ann George, Anila Varkey, Adithya Nandan, Uday Venkat Mateti, Mundayat Gopalakrishnan, Rovin Mathew Theempalangad
DOI:10.4103/ami.ami_88_17  
Aim: Postoperative atrial fibrillation (POAF) is one of the most commonly occurring complications after cardiac surgery. The study aims to determine the incidence of POAF and to analyze its pharmacological management in patients scheduled for cardiac surgery. Methodology: A prospective observational study was carried out for 6 months (October 2016 to March 2017) in cardiothoracic surgery. Drug therapy details by medication chart review and clinical review in patients who underwent coronary artery bypass graft, mitral valve replacement (MVR), and aortic valve replacement was carried out and analyzed for the incidence of POAF. The statistical analysis was performed using SPSS. Results: A total of 83 patients were recruited for this study. The POAF incidence was 18.07% with the highest incidence on the 2nd postoperative day. The mean age of patients with POAF was 49.40 ± 12.77 years. Rheumatic heart disease and alcohol were identified as the predisposing factors of POAF. The incidence of POAF was the highest following MVR (80%) than other cardiac surgeries. Patients who developed POAF had a longer length of hospitalization (median 9 vs. 7 days). Amiodarone, metoprolol, verapamil, atorvastatin, clopidogrel, and aspirin were the most frequently prescribed drugs for the management of POAF. Administration of metoprolol, nebivolol, atorvastatin, bisoprolol, metoprolol + atorvastatin + aspirin, and other combinations before cardiac surgery reduced the risk of developing POAF. Conclusion: The overall incidence of POAF was 18.07%. Amiodarone (13.3%), metoprolol (40%), verapamil (66.7%), aspirin (26.7%), clopidogrel (13.3%), and atorvastatin (20%) were found to be safe and effective in the treatment of POAF patients.
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Caregivers' awareness and perception of cardiopulmonary resuscitation: Our experience p. 63
Ibrahim Aliyu, Abdulsalam Mohammed, Zainab F Ibrahim
DOI:10.4103/ami.ami_19_18  
Introduction: Adverse health-related events such as cardiac arrest can occur at any location: it is broadly classified as out-of-hospital or in-hospital cardiac arrest. The location of cardiac arrest however affects outcome; the actions of caregivers and bystanders may influence the outcome of witnessed out-of-hospital cardiac arrest; therefore, their knowledge of cardiopulmonary resuscitation (CPR) is relevant. Materials and Methods: This was a questionnaire-based cross-sectional study conducted at the Paediatric Outpatient Clinic and Paediatric Specialty Clinic of Aminu Kano Teaching Hospital. Results: There were 120 (33.3%) males and 240 (66.7%) females, with a male-to-female ratio of 1:2. Only 57 (15.8%) respondents were aware of CPR. However, 69 (19.2%) respondents were aware of chest compression. One hundred and twenty-nine (35.8%) respondents reported that they could perform mouth-to-mouth resuscitation on their own children; however, 66 (18.3%) respondents reported willingness to perform mouth-to-mouth resuscitation on another person's child if the need arose. Only 15 (4.2%) respondents had training on CPR. Six (40%) respondents were trained at school. However, caregivers in the chronic illness subgroup were more willing to perform mouth-to-mouth resuscitation. Caregivers of children with acute illnesses would use palm kernel oil to treat convulsion; however, those of the chronic illness group would mostly use herbs to treat convulsion; this observation was statistically significant (Fisher's exact test = 32.457, P = 0.00). Conclusion: There was poor awareness of CPR among respondents; furthermore, there was lack of willingness to perform CPR by most respondents on children.
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A comparative analysis of the baska mask versus I-gel for general anesthesia in surgical patients undergoing laparoscopic cholecystectomy p. 69
Usha Kumari Chaudhary, Som Raj Mahajan, Monika Mahajan, Charu Sharma, Mukesh Sharma
DOI:10.4103/ami.ami_41_18  
Background and Aims: Baska mask is a newly introduced membranous cuffed supraglottic device whereas I-gel is made up of thermoplastic elastomer, both suitably designed from the anatomical perspective of the airway. Settings and Design: We conducted randomized controlled comparative trial of the Baska mask versus I-gel in a patient undergoing laparoscopic cholecystectomy. Subjects and Methods: A total of 100 adult patients in the age group of 20–70 years undergoing elective laparoscopic cholecystectomy were randomly divided into two groups as follows: (1) Baska mask group and (2) I-gel group. The primary outcome was to compare oropharyngeal leak pressure (OLP) of Baska mask and I-gel groups. The secondary outcome was the ease of insertion and removal, number of attempts, insertion time, leak fraction, and laryngopharyngeal morbidity. Statistical Analysis Used: Demographic details were compared using the Chi-square and t-tests. Student's t-test for independent variables was used to compare means of data obtained. Results: Mean OLP was significantly higher in Baska mask group than I-gel group at insertion (29.54 ± 1.41 cm H2O vs. 23.16 ± 3.07 cm H2O, P = 0.02) and 30 min after insertion (33.54 ± 1.16 cm H2O vs. 25.97 ± 2.25 cm H2O, P = 0.001). Insertion time was 12.33 ± 2.61 s with Baska mask and 11.31 ± 1.84 s with I-gel (P = 0.02). Insertion was very easy in 58% of patients in Baska mask and 76% of patients in I-gel (P = 0.03). The leak fraction of Baska mask was significantly less than I-gel (3.56 ± 3.6 vs. 7.16 ± 2.45, P = 0.01). Laryngopharyngeal morbidity was comparable in the two groups. Conclusion: Baska mask is more effective in providing greater OLP compared to I-gel without any increase in laryngopharyngeal morbidity.
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Chromosomal aberrations in multiple myeloma: A study on Indian population p. 74
Angel Beula P. Royal, Syeda Sabiha S. Lubna, P Beaulah Angel, Vijaya V Mysorekar, TS Sundareshan
DOI:10.4103/ami.ami_42_18  
Aims: The aim of this study was to evaluate the complexity of the chromosomal abnormalities in multiple myeloma (MM) cases and to correlate the findings with the previous reported cases. Materials and Methods: Bone marrow samples were obtained from patients with MM and sent for cytogenetic study. The patient's details were logged and the cytogenetic test was performed. The karyotypes were analyzed and interpreted as per the standard guidelines. Results: Of the compiled data of cases from 2013 to 2016, 34 patients were diagnosed with MM. About 15% were below the age of 50, maximum patients were between ages of 61 and 70 years (50%). There were 25 male and 9 female. Twenty-one cases had normal karyotypes and few cases showed structural rearrangements and numerical abnormalities. Conclusions: From the data compiled, only a total of 34 cases were positive for MM, indicating that the disease is quite rare in our population. It has been previously reported that the disease usually occurs in people over the age of 50 years, however, in this study, 5 (15%) were below the age of 50 indicating that MM can affect the age group below 50 years as well. The numerical, structural abnormalities and few clonal abnormalities observed in our study added a few more to the previously reported abnormalities. However, the interesting finding of our study was a case with a combination of clones of hypodiploidy, hyperdiploidy, hypotetraploidy, and hypertetraploidy which was in contrary to the reported literatures, which were only one type of ploidy were observed. Thus, the heterogeneity and complexity of the chromosomal abnormalities in MM and the challenge in staging the disease have been proven in our study.
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Prevalence of exclusive breastfeeding and knowledge related to breastfeeding among mothers attending immunization center and well-baby clinic p. 79
Shuvendu Roy, Ashish K Simalti, Bindu T Nair
DOI:10.4103/ami.ami_56_18  
Background: The World Health Organization defines exclusive breastfeeding (EBF) as giving baby only breast milk for the first 6 months without adding any additional drink including water or food. We undertook this study with an objective to assess the prevalence of breastfeeding among mothers in North Indian setting. Aims: The aims of this study were to assess the prevalence of EBF among mothers attending a well-baby clinic and to look for variable significantly impacting probability of breastfeeding and assessing the challenges faced and existing knowledge regarding breastfeeding. Materials and Methods: This was a questionnaire-based one-point survey to assess the prevalence of EBF. The questionnaire was based on the review of literature and included parameters considered significant by various studies. Mother's knowledge regarding breastfeeding was assessed by another questionnaire. Results: A total of 970 mothers were approached who visited immunization center and well-baby clinic during the study. After taking out those who were unwilling and did not meet the criteria, we had 634 mothers who participated in our study. They were divided into two groups based on whether they exclusive breastfed their babies for 6 months or not. Comparison of both these groups revealed breastfeeding counseling to be the most important variable. Statistical Analysis Used: It is a cross-sectional type of study with a questionnaire-based one-point survey. The minimum sample size required was calculated using Daniel's formula: n = z2pq/d. Consequent sampling was done. Chi-square test for independence was done to assess the association between both the groups for all the parameters recorded. Conclusions: All mothers were aware that breast milk is beneficial for their baby; however, the biggest problem was anxiety regarding the adequacy of their breast milk. There is also need for a widespread campaign related to harm done by prelacteals and substitutes of breast milk including cow milk.
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REVIEW ARTICLE Top

Treatment of patients suffering from exercise-induced asthma: Prevention of exercise-induced bronchial spasm – Literature review p. 84
Leonid Oleksijovych Bezrukov, Olena Kostiantynivna Koloskova, Lorina Alimivna Ivanova, Tetiana Mykhailivna Bilous, Olena Grygorivna Grygola, Yuliia Igorivna Voitkevich
DOI:10.4103/ami.ami_68_17  
Exercise-induced bronchial asthma (EIBA) or exercise-induced bronchial spasm is all terms that describe the phenomenon of transient obstruction of the bronchi after intensive physical stress. This article presents the recommendations about the rational administration of pharmacological and nonpharmacological methods of treatment of EIBA that in the majority of cases enables to provide considerable control over the disease without limitation of the physical activity of patients.
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CASE REPORTS Top

Penile entrapment: A case where innovation is the need of the hour p. 90
Gajanan Shripad Bhat
DOI:10.4103/ami.ami_87_17  
Penile entrapment is a rare and unique condition requiring urgent decompression to preserve the organ function and prevent complications. There is no universal method that is applicable to all cases as there are hardly any guidelines. Management of a 35-year-old male who presented to our emergency room with a metal ring around his penis has been described here. The case report highlights the need to devise one's own method to decompress the entrapped penis based on the available technology and manpower on hand in a given situation.
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The effectiveness of continuous venovenous hemodiafiltration in phenobarbital intoxication p. 92
Yasemin Coban, Dinçer Yildizdas, Özden Özgür Horoz, Nagehan Aslan, Didar Arslan
DOI:10.4103/ami.ami_20_18  
Phenobarbital continues to be widely used in childhood epilepsy. Incorrect drug prescription can sometimes lead to intoxication, particularly in young children. A 40-month-old female infant presented to our emergency department due to failure to awaken. The patient was assessed in terms of etiology of coma, and her history revealed that she had been given a 100 mg phenobarbital pill instead of 15 mg. Her blood phenobarbital level was high (>80 mg/dl). At physical examination, her Glasgow coma score was 6, the pupils were isochoric, pupillary light reflex was bilateral positive, deep tendon reflexes were absent, respiration was superficial, and pulmonary bilateral diffuse secretory rales were present, and the patient was intubated. Continuous venovenous hemodiafiltration (CVVHDF) was performed due to prolonged coma, intubation, and potentially fatal phenobarbital level. Blood phenobarbital levels at 4 and 12 h improved to >80 and 33.4 mg/dl, and the patient was extubated at 14 h. CVVHDF was effective in intoxication despite long-acting barbiturate phenobarbital not binding to protein. We think that this is a useful method capable of use in phenobarbital intoxications.
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LETTER TO EDITOR Top

Eliminating discrimination in the health sector to attain universal health coverage p. 95
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/ami.ami_57_18  
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