Senior Professor’s scientific contributions

Introduction: The major responsibility of the anesthesiologist is to provide adequate ventilation to the patient because airway related problems are still the most common cause of anaesthesia related morbidity and mortality. The use of I-gel has been reported in laparoscopic surgeries and was found equally effective ventilatory device as PLMA. Therefore, we planned this study to compare I-gel and PLMA with ET tube in patients undergoing laparoscopic cholecystectomy. Materials and Methods: This prospective study was conducted on 90 patients of both sex, 18-60 years age, ASA grade I-II, scheduled for elective laproscopic surgery under general anaesthesia. All patients were randomised into three groups of 30 patients each; Group I (I-gel), Group P (PLMA), Group E (ET Tube). Attempts of insertion of devices, effective airway time and easiness of gastric tube; hemodynamic parameters (HR, MAP, SpO2 and EtCO2) were recorded. Results: There was significantly less 2 nd attempt required in I-gel group(10%) as compared with ET tube (36.7%) and PLMA (13.3%),(p=0.019). Laryngopharyngeal morbidity were significantly more in Group E as compared to Group P and I (p<0.05). Hemodynamic changes were significantly higher in Group E immediately after intubation which persisted for 3 minutes and immediately after extubation (p= 0.00). Conclusion: Supraglottic Airway Devices (PLMA and I-gel) were as effective as ET tube in establishing airway and the haemodynamic stability is better then ET tube in laparoscopic cholecystectomy.

Neurotoxicity has been rarely described with metronidazole. The serious neurological adverse effects may appear with prolonged/high dose of metronidazole. Presenting a patient with liver abscess who developed cerebellar ataxia following extended use of metronidazole. The cerebellar ataxia induced rarely by metronidazole is reversible following discontinuation of drug.

Introduction: Central nervous system (CNS) tuberculosis (TB), particularly tuberculous meningitis, is the severest form of Mycobacterium tuberculosis (MTB) infection causing severe neurological defects or even death. The recent introduction of cartridge-based nucleic acid amplification test (CBNAAT) has significantly transformed the diagnostics of TB in adults, but its application for the diagnosis of pediatric TB is under evaluation. Objective: This study was conducted by for cerebrospinal fluid (CSF) examination in the detection of MTB by the culture and sensitivity and CBNAAT in the diagnosis of childhood CNS TB. Methods: A prospective hospital-based study was conducted from July 2017 to June 2018 in the pediatric department of a tertiary care unit. A total of 65 randomly selected patients, suspected of CNS TB, were included in this study. CSF was tested for CBNAAT and culture and sensitivity other routine investigations such as specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both CBNAAT and culture and sensitivity. Mantoux test was also performed, and the statistical analysis was performed using Chi-square test. p=0.05 was considered to be statistically significant. Results: Culture positive TB was found in 26 out of the 65 children. The sensitivity, specificity, PPV, and NPV for CBNAAT and culture and sensitivity were 65.71%, 90.00%, 88.46%, and 69.23%, respectively. CBNAAT was detected to be more in 12 TB cases and was more sensitive than culture and sensitivity. Positive history of contact (p=0.04), reactive Mantoux test (p<0.005), presence of Bacillus Calmette Guerin (BCG) scar (p=0.02), and low socioeconomic status were independently associated with a positive CBNAAT result. Conclusion: Analysis of CSF sample with CBNAAT is a sensitive and specific method for rapid diagnosis of CNS TB in children. Compared to culture and sensitivity, CBNAAT offers better sensitivity and its scale-up will improve access to CNS TB diagnostics in children. Although a negative CBNAAT does not rule out TB.