Akshaya Narayan Shetti

Abernethy malformation is a rare congenital vascular malformation in which anomalous communication is seen between portal and systemic circulation. While treating the main goal is to prevent shunting of portal blood into the systemic circulation and preserving hepatic blood flow. This can be achieved surgically or non-surgical method. We report anaesthetic management of non-surgical closure of type II Abernethy malformation of 10 year old female child who had undergone ostium secundum ASD (atrial septal defect) patch closure. Keywords: Abernethy malformation, ASD, Cyanosis, Endovascular device placement

For better diagnosis and treatment planning, co-operation, coordination and interaction between different specialties in dentistry are utmost important. Interaction between the different disciplines is necessary and in some cases it is crucial in facilitating coordinated dental therapy. The interrelationship between Orthodontics and Periodontics is many times symbiotic. In many instances, periodontal health is improved by orthodontic tooth movement, whereas orthodontic tooth movement is often facilitated by periodontal therapy. Prior to 1970’s orthodontic treatment not so often recommended to prevent periodontal diseases. Crowded teeth result in plaque accumulation because of difficulty in cleaning. Gingivitis may lead to periodontal diseases. Orthodontic treatment can foster periodontal health and it may also prevent periodontal diseases. Keywords: Ortho-perio Interrelationship, Malocclusion, Orthodontic treatment, Periodontitis

Jejunostomy is a surgical procedure where in a tube is placed in the lumen of proximal part of jejunum. This technique is mainly used to administer nutrition in case of patients with obstructive or operative area related to upper gastrointestinal system. This is one of the type to feed the nutrition and or medications by enteral means. Keywords: Jejunostomy feeding, Nutrition, Complications

Majority of neurosurgical procedures are performed under general anaesthesia. It is still possible to perform some of the procedures under regional anaesthesia like scalp block. It involves blocking the nerves that innervate the scalp. The technique is easy to perform, but the practitioners should be aware of possible complications because of closer relation of blood vessels with nerves. Despite various advantages over general anaesthesia scalp block is not practiced routinely. This article reviews the relevant anatomy and technique of scalp block. Keywords: Scalp block, Burr hole, Neurosurgery, Anaesthesia, Pain

Acute pesticide poisoning is a very common in rural India. The pesticides used in the agriculture are major contributors in poisoning either intentiaonal or accidental. Poisoning itself is a major global concern. Hexaconazole is not as common poison in India and very few cases are reports. We report a rare case of hexaconazole poisoning and its successful management in rural tertiary care unit. Keywords: Triazole, Hexamethonium, Glucuronidation

Introduction: Endotracheal tube (ETT) is commonly used to provide positive pressure ventilation. ETT cuff pressure is maintained within a range of 20 to 30 cmH2O. High pressure affects micro-circulation and integrity of the tracheal mucosa, resulting in complications. The cuff pressure is measured by connecting a pressure gauge device to pilot balloon. Two variety devices are available; analog or digital manometers. Present study is used to study the efficacy of AG CUFFILLL (Digital) compared with standard PORTEX Cuff inflator/pressure gauge (Analog) for the measurement of ETT cuff pressure. Materials and Methods: This study was conducted after obtaining institutional ethical clearance and written informed consent.100 patients between the age of 18-70yrs who fulfilled inclusion criteria. We measured ETT cuff pressure using AG CUFFILL (Digital) and standard PORTEX Cuff inflator/pressure gauge and compared the pressure recording of the two equipment and we studied ease of use for both. Result: Out of 100 patients between the age of 18-70yrs, 61 patients (61%) were male and 39 patients (39%) were female. Mean cuff pressure of ETT using AG CUFFILL was 36.29±6.36 cmH2O and in PORTEX was 33.97±6.16cm H2O. Mean difference in the values between the cuff pressure measured by AG CUFFILL and PORTEX was ± 2.67. Comparing the two devices, it was noticed that in 05 (5%) patients measuring ETT cuff pressure using AG CUFFILL was difficult as the values were fluctuating. Conclusions: Based on results, authors recommend AG CUFFILL for ETT cuff pressure measurement owing to its accuracy, non-bulky, and ease to carry. Keywords: Endotracheal tube, Cuff pressure, AG CUFFILL, Pilot balloon, Digital, Analogue

The Corona virus disease 2019 is a contagious disease caused by severe acute respiratory syndrome coronavirus 2. The disease has since spread worldwide, leading to an ongoing pandemic. The attitude and knowledge of health care specialists towards vaccination is very important. Hence we conducted a study among critical care nurses.This cross sectional study is conducted among 76 adult critical care unit nurses who received Covishield vaccine. The survey included 13 questions. Post first dose of vaccination Out of 76 critical care nurse, 49 (64.5%) were males and 27 (35.5%) were females. 42(55.3%) nurses were posted for covid duty while 34( 44.7%) were never posted for covid duty, among these all 31( 40.8%) were suffered with covid infection before vaccination. Post first dose of COVID 19 vaccination, 65(85.5%) nurses developed symptoms while 11 (14.5%) were asymptomatic. Post second dose of vaccination; Out of Out of 76 critical care nurses participated in the study, 50 (66%) were males and 26 (34%) were females. 42(55%) nurses were posted for covid duty while 34 (45%)  were never posted for covid duty. Among all critical care nurses 31 (40.8%) were diagnosed with COVID 19 positive before vaccination while 45(59.2%) were found to be COVID negative. Post second dose of COVID 19 vaccination, 50(66%) nurses developed symptoms while 26(34%) were asymptomatic. Based on our study the side effects are present with covishield vaccine. Nurses are willing to take booster dose and to promote vaccination too. Keywords: Critical care, Covid 19, Vaccination, Shot term effects

Needle-stick injuries (NSIs) are a hazard for nursing staff and public health. Nursing workers are at high risk for occupational exposure to blood-borne pathogens via sharp injuries of the needle-stick. Needle-stick injuries (NSIs) are described as penetrating wounds caused by a device that is contaminated with another person’s body fluids. Needle-stick injuries are injuries acquired by needles like -scalp vein needles, hypodermic needles, blood sample collection needles, intracath stylets, lumbar puncture needles used to connect parts of IV delivery systems. Needle-stick injuries (NSIs) form a medium for the transmission of bloodborne infections. Strict use of personnel protective equipment while working in the hospital should be made compulsory. To study incidences of needle stick injury among nurses working in Rural tertiary care Unit, Loni. Ethical approval for this study was obtained from the Institutional Ethical Committee. Seventy-six nurses, who fulfilled inclusion criteria were included and data was obtained through survey. This study involves 76 nursing staff. Of them all, 27(35.5%) nursing staff experienced NSIsThe administration of medication was common action that caused most of needle-stick injuries mentioned by 14 (18.4%) nursing staff. IV cannula was the device that caused many needle-stick injuries reported by 17 (21.1%) nursing staff. Thenursing professionals are the main key players in both elective and emergency situations. There is a quite higher incidence of needle stick injury among critical care nurses. This might be due to handling of emergency cases and attempting to secure the intravenous line or to deliver the medications. Creating awareness and training appropriately is mandatory for critical care nurses. Keywords: Vaccination, Occupational, Injuries

Background: Operative trauma affects the physiology of ?uid and electrolytes within the body. Magnitude and duration of this response is directly proportional to the severity of the trauma. Inorganic electrolytes like sodium, potassium, chloride and calcium are very important constituents of the body. There are preoperative, intraoperative and postoperative changes in both fluid volume and electrolyte compositions. Material and Methods: The cases were selected among the patients operated in the Tertiary Care Hospital and then getting admitted to ICU from November 2020 to April 2021. Males and females, more than 18 years of age, got operated in same hospital were included in the study. The latest preoperative serum sodium and potassium levels had been noted. The postoperative serum sodium and potassium levels along with postoperative day had been noted till the patient was in ICU. There was gradual rise in the serum sodium level till post-operative day -6 and then it started decreasing and attained its normal preoperative value on post-operative day-11. The preoperative sodium level was restored in all cases by the 11th postoperative day. Results: There was a gradual fall in serum potassium level from post-operative day-1 to post-operative day-6 and then it started increasing and attained pre-operative value by post-operative day-11. So, the response of serum sodium and serum potassium is contrary to each other. Conclusion: Based on the study results, increased sodium and decreased potassium levels were observed in postoperative cases. Normalization of these two electrolyte are seen postoperative day seven onwards. Keywords: Critical care, Electrolytes, post­operative, Potassium, Sodium, Trauma

There is considerate amount of stress which lies in the application of antibiotics in critically ill patients. A study on pre-hospital antibiotic administration in such patients would provide crucial data and go a long way in determining and understanding trends in antibiotic prescribing, to identify where necessary steps to be taken to improve prescribing are most needed and to measure progress. Materials and Methods:  After ethical committee approval, we have conducted an observational crosssectional study for four months. We collected the data from patient or the relatives regarding prehospital antibiotic therapy on admission. Results: A total of 137 patients got admitted in the Medical intensive care unit (MICU) during the study period. Out of them, 91.24% of patients got admitted directly in MICU and 8.75% were referred from different hospitals. Those who received antibiotics prior to the admission were 2.18% and 93.43% of patients had not received antibiotics; the other patients who were not sure of antibiotic consumption were 4.37%. Among those 2.18% of patients who received, it was observed the most commonly utilized first antibiotic in our study was amoxicillin clavulanate potassium 66.66%. In all the patients that received more than one antibiotic, Metronidazole was the second antibiotic that was administered via intravenous route. Conclusion: Amoxicillin clavulanate potassium was the most commonly and metronidazole was the second most antibiotic prescribed in prehospital admission. Proper guidelines should be initiated for the starting of the antibiotic therapies in India for general practitioners. Keywords: Antibiotics, Incidence, Prehospital, Critically ill.

A 23-year male patient came to Rural Tertiary Care Hospital with complaints of fever, difficulty in talking, disorientation and neck stiffness and was diagnosed with Dengue. When Dengue antibody testing was done, IgM was positive while IgG and NS1 being negative. We report an evaluation of an IgM seropositive case for dengue who showed neurological manifestation whose MRI Brain suggested Meningitis. CSF examination suggested Tuberculous Meningitis in the course of the infection. The patient responded to medications during hospitalisation, was discharged in a haemodynamically stable condition and was advised to continue with antitubercular treatment and tapering dose of oral steroids. Hence one should not avoid considering a Cerebrospinal fluid examination especially of patients belonging to Dengue endemic areas. Keywords: CSF examination, Dengue, Meningitis, Tuberculosis.

Myocardial infarction is a crucial and commonly seen in the Indian population. The disease is prevalent in both rural and urban area. Timely detection, awareness of the myocardial infarction among the population especially rural Indians should be taken seriously. Here we discuss an unusual case of myocardial infarction. Keywords: Pain, Myocardial infarction, Angiography, Angioplasty.

Disinfection and sterilization are important and core steps in healthcare system. The infection control is not only for the benefit of the patient but presently it is a medico legally held responsible. One should have adequate knowledge about the sterilization of equipment. Although various disposable single use materials are present in healthcare system it will not be a cost effective method especially for the developing and underdeveloped countries. Inadequate knowledge will lead to hospital acquired infections and may also lead to life threatening cross infections. A proper infection control team and multidisciplinary approach will help to counter the infections in a scientific and cost effective way. This article describes various methods used for sterilization and also describes various commonly used equipment and their sterilization techniques. Keywords: Anesthesia, Critical care, Disinfection, Ethylene oxide, Sterilization

For all practical purposes the actual meaning of medico legal term is medical treatment and its legal association to it. One should be aware of all possible medico legal aspects when dealing with patients. Since the government of India labels the practice of medical profession as business one should be aware of consumer protection acts. Day by day the medicolegal cases are increasing and one should have adequate knowledge to take care of themselves. It is not uncommon that the doctors are sued for the sake of money and well-targeted as the profession is legally bound. This article highlights the concerns about medicolegal aspects in relation to anesthesiologists. Keywords: Consumer protection act, Critical care, Case, Medicolegal

Introduction: Various types of diseases are seen in pregnant patients, it may be prior to the pregnancy or during the pregnancy period. Certain diseases may lead to critical care admission and may be either elective or emergency admission. Aims and Objectives: This study was conducted to know the pattern and outcome of obstetric patients getting admitted to the medical critical care unit of our tertiary care hospital. Materials and Methods: This is a retrospective study, and we collected the data from the records for two years duration, starting from 1st January 2020 to 31st December 2021. Results: A total of 97 patients were admitted and a maximum number of patients were aged between 18-25 years. 56(57.7%) of patients were primigravida, and 58(59.8%) of the patients were registered cases. 82(84.5%) of cases were registered under the medico-legal case as per Indian law. 68(70.1%) patients had lower segment cesarean sections. Among 97 patients, 22(22.7%) of patients had comorbid illnesses. A total of 22(22.7%) patients got admitted for poisoning-related issues, which was the single most common cause among 97 admissions. 25(25.8%) of patients were on mechanical ventilation and the average number of critical care unit stay was 4 days. 65(67%) patients survived, 15(15.5%) patients died, and the remaining patient was either took discharged against the advice or referred. Conclusion: Obstetric patient admission in the rural critical care unit is not uncommon, and poisoning is the most common cause of admission in the medical critical care unit. Keywords: Critical care, Medical, Obstetric, Poisoning, Rural, Outcome

Medication errors in anesthesia can have serious consequences for patients, including morbidity and mortality. These errors can occur at any stage of the medication administration process, from prescribing and preparation to administration and monitoring. Learning from medication errors is essential to improving patient safety in anesthesia. To address medication errors in anesthesia, various strategies have been developed, including the use of checklists, protocols, and simulation training. The implementation of technology, such as barcode scanning and automated dispensing systems, has also been effective in reducing medication errors. Learning from medication errors involves identifying the root causes of the error, analyzing the factors that contributed to the error, and implementing strategies to prevent similar errors from occurring in the future. A culture of safety that encourages reporting and analysis of errors is crucial for learning from medication errors. Improving patient safety in anesthesia requires a collaborative effort among healthcare professionals, including anesthesiologists, nurses, and pharmacists, as well as a commitment to continuous improvement through learning from errors. Keywords: Anesthesia, Checklist, Medication errors, Nurses, Patient safety, Simulation training

Artificial Intelligence (AI) is a rapidly growing field that has the potential to revolutionize various industries, including healthcare. In the field of anesthesia, AI has shown great promise in improving patient outcomes and enhancing the overall efficiency and safety of anesthesia practices. One of the main ways AI is being used in anesthesia is through predictive modeling, where machine learning algorithms are trained on large datasets to identify patterns and make predictions about patient outcomes. For example, AI can be used to predict patient response to anesthesia, predict the likelihood of postoperative complications, or optimize drug dosing. This allows anesthesiologists to make more informed decisions and reduce the risk of adverse events. Another area where AI is being used in anesthesia is in computer-assisted drug dosing. With the help of AI, anesthesiologists can determine the optimal dose of anesthesia for each patient, taking into account factors such as age, weight, medical history, and the type of surgery being performed. This helps to improve patient safety and reduce the risk of adverse events. As AI technology continues to advance, it is likely that the use of AI in anesthesia will become more widespread, and it will play an increasingly important role in improving patient outcomes and enhancing the overall quality of care in the field of anesthesia. Overall, the integration of AI in anesthesia is a promising development that has the potential to transform the field and improve patient outcomes. Telemedicine is one of the area where AI is utilized which will drastically contribute the healthcare system especially for underdeveloped and developing countries. Keywords: Anesthesia, Artificial Intelligence, Future, Healthcare, Technology

Artificial Intelligence (AI) is rapidly advancing in the field of dentistry, offering new and innovative solutions to improve the accuracy and efficiency of oral healthcare. In recent years, AI has been used in a variety of dental specialties, including oral pathology, prosthodontics, endodontic, periodontics, and implant dentistry. AI algorithms can analyze dental images, assist with diagnosis, improve treatment planning, automate routine tasks, and predict outcomes. These advancements have the potential to significantly improve the quality of dental care, leading to better outcomes for patients. However, it is important to consider both the benefits and potential limitations of AI in dentistry, and to ensure that these systems are used in a responsible and ethical manner. This abstract highlights the impact of AI in dentistry, and the potential for continued advancements in this field to revolutionize oral healthcare. Keywords: Artificial intelligence, Dentistry, Periodontics, Endodontics

The field of surgery has come a long way since the days of sharpened stones and crude instruments. Today, medical professionals rely on a range of high-tech tools and technologies to perform a wide variety of procedures, from routine operations to life-saving treatments. As surgical technology continues to advance, many experts believe that algorithms will play an increasingly important role in the operating room of the future. Algorithms, which are sets of mathematical instructions that help computers solve complex problems, can be used in a number of ways to enhance the surgical process. For example, they can be used to create virtual simulations of surgical procedures, allowing medical professionals to practice and perfect their techniques in a safe and controlled environment. Algorithms can also be used to analyze patient data, providing doctors with valuable insights into the best ways to approach a particular case. Another area where algorithms are expected to make a big impact is in the field of robotics. Robotic systems can be programmed to perform complex surgical procedures with greater precision and accuracy than is possible with human hands alone. In addition, robots can be equipped with algorithms that help them make real-time decisions during a procedure, ensuring that the patient receives the best possible care. Overall, the integration of algorithms into the surgical process represents a major step forward in the field of medicine. Keywords: Advancements, Algorithms, Artefecial intelligence, Efficiency, Integration, Surgery

Pharmacotherapy is an essential component of dental practice to manage pain, prevent infections, and maintain oral health. Analgesics such as non steroidal anti-inflammatory drugs (NSAIDs) and opioids are commonly used to manage pain during and after dental procedures. Antibiotics are prescribed to treat and prevent infections, but their use should be limited to reduce the risk of antibiotic resistance. Local anesthetics provide safe and effective pain relief during dental procedures. Fluorides are used to prevent tooth decay and strengthen tooth enamel. Dental healthcare providers should evaluate each patient's individual needs and medical history to determine the most appropriate pharmacotherapy. Patient education on the proper use of medications and potential side effects is also important. By incorporating pharmacotherapy as part of a comprehensive dental care plan, patients can experience a more comfortable and successful dental experience. Keywords: Pharmacotherapy, Pharmacotherapeutics, Dentistry, Antibiotics

Ergonomics plays a crucial role in the field of dentistry, as it directly impacts the well-being of dental professionals and the quality of patient care. This review article aims to provide a comprehensive overview of the current insights into the application of ergonomics in dentistry, while also exploring the future directions and potential advancements in this field. Various aspects of dental ergonomics are explored, including equipment design, operatory setup, and practitioner posture. The article highlights recent advancements in ergonomic equipment, such as adjustable chairs, dental loupes, and ergonomic instruments, which aim to minimize physical strain and discomfort during dental procedures. Moreover, the review article sheds light on the significance of proper posture and body mechanics in dentistry. It emphasizes the importance of maintaining neutral body positions and provides evidence-based guidelines for ergonomic posture during dental treatments. In addition to addressing the current insights into dental ergonomics, this article explores future directions and potential advancements in the field. It discusses emerging technologies, such as robotic assistance and virtual reality simulations, which hold promise for improving ergonomics and transforming the dental practice.   Keywords: Ergonomics, Dentistry, Musculoskeletal disorders, Posture