Κυριακή, 28 Φεβρουαρίου 2016

EMERGENCY PERIPARTUM HYSTERECTOMY: INCIDENCE, INDICATIONS AND FETOMATERNAL OUTCOME IN A TERTIARY CARE HOSPITAL

2016-02-28T23-03-01Z
Source: International Journal of Current Research and Review
Saima Wani, Perveena Fareed, Yasmeena Gull, Neha Mahajan.
Objectives: The objectives of this study were to determine the incidence, maternal characteristics, indications and the maternal and perinatal outcome of emergency peripartum hysterectomies done in the Department of Obstetrics and Gynecology Government Medical College Srinagar. Study Design: This was a retrospective descriptive study done from January 2011-December 2013 over a three year period. Results: The incidence of peripartum hysterectomy during the study period was 1.46/1000 deliveries. The frequent age group was 31-35 years. The main indication of peripartum hysterectomy was life threatening hemorrhage due to uterine rupture (23), uterine atony (22), placenta accrete (18), placental abruption (16), placenta previa (13), broad ligament hematoma (7), retained placenta, Secondary postpartum hemorrhage and uterine fibroid (1 each) 81.37% hysterectomies were total and 16.63% were subtotal. The average pre- and intraoperative blood loss was 2.5 Lt +0.6. All patients needed blood transfusion. All patients received Perioperative antibiotics. Intraoperative complications developed in 15 patients which were bladder injury (5), Adnexial bleeding (5) and broad ligament hematoma (4). 69.6% patients needed intensive care. The common post operative complications were febrile morbidity (15.68%), wound sepsis (10.78%), pneumonia (8.82%), coagulopathy (5.88%), Cuff cellulitis and vesicovaginal fistula (1.96% each). The stillbirth rate was 303/1000. Most stillbirths occurred in uterine rupture (61.29%) followed by placental abruption (25.80%). Maternal mortality rate was 117/1000 live births. The average hospital stay was 13+4days. Conclusion: Emergency peripartum hysterectomy has significant effect on fetomaternal morbidity and mortality. Hence antenatal identification of high risk patients and proper management of second and third stage of labor and emergency preparedness are important in decreasing the rate of peripartum hysterectomy and improving the outcome.


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EVALUATION OF COLOR AND LIGHTING PREFERENCES IN ARCHITECTS’ OFFICES FOR ENHANCING PRODUCTIVITY

2016-02-28T23-03-01Z
Source: International Journal of Current Research and Review
Zahra Poursafar, Nandineni Rama Devi, Lewlyn L. R. Rodrigues.
Background: Knowledge of design basics is key to the successful planning and implementation of any interior design project. The elements and principles of design represent general, universal ideas that refer to every aspect of design. Aim: This paper is focusing on occupants Preferences regarding to Color and Lighting in the Architects offices in Iran and India to increase the level of personalization in work environment and improving the Productivity. The outcome of this research would establish the link between architectural elements and Productivity. Moreover, the study would give clear indicators for the future architects to have a base for understanding the requirements and produce architectural components to suit to their specific requirements. Methodology: The data was primarily sourced through a self-administered survey questionnaire using random sampling method on representative sampling basis. Result: The finding of the study indicated that for employees in offices there are wide variety of Preferences in case of Color and Lighting. Also the outcome reveals employees Productivity in architects offices is affected by architectural elements. Conclusion: There are different Preferences regarding Colour and Lighting for employees in architects offices under the study. This difference would depend on distinction among behavioural, attitudinal and emotional pattern of the individuals. The result is based on the users subjective impression and personal Preferences in case of Colour and Lighting.


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Copyright

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1





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Contributors

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1





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Contents

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1





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Forthcoming Issues

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1





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Preoperative Evaluation—Can We Really Make a Difference in Outcomes?

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Lee A. Fleisher




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Preoperative Evaluation

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Debra Domino Pulley, Deborah C. Richman




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Preoperative Evaluation

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Debra Domino Pulley, Deborah C. Richman




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Preoperative Clinics

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Angela F. Edwards, Barbara Slawski

Teaser

Preoperative evaluation clinics have been shown to enhance operating room efficiency, decrease day-of-surgery cancellations, reduce hospital costs, and improve the quality of patient care. Although programs differ in staffing, structure, financial support, and daily operations, they share the common goal of preoperative risk reduction in order for patients to proceed safely through the perioperative period. Effective preoperative evaluation occurs if processes are standardized to ensure clinical, regulatory, and accreditation guidelines are met while keeping medical optimization and patient satisfaction at the forefront. Although no universally accepted standard model exists, there are key components to a successful preoperative process.


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Preoperative Consultations

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Stephan R. Thilen, Duminda N. Wijeysundera, Miriam M. Treggiari

Teaser

Preoperative consultation is an important intervention that likely has most benefits for intermediate-risk to high-risk patients undergoing major surgery. Consultation rates are likely increasing and there is significant practice variation in the use of consultation. Consultations should be available within a well-organized and coordinated process of preoperative assessment. Preoperative consults should be accessible to anesthesia and surgical teams involved in the procedure and to the providers involved in postoperative care. The role of preoperative consultation should evolve as a rational approach and emerge as a value-based service. New payment methodologies are likely to facilitate appropriate use of this important resource.


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Perioperative Ethical Issues

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Arvind Chandrakantan, Tracie Saunders

Teaser

Shared decision-making is a paradigm of patient engagement that is assuming greater importance in the era of value-based health care. The basic tenets include patient engagement on clinical decisions, taking into account multiple factors that influence physician and patient decision-making. Understanding and reconciling diametrically opposed views of care are important tenets of shared decision-making. Because many decisions are made preoperatively, the applicability of these principles may be useful especially in the situation of a higher risk surgical candidate. Many patients with Do-Not-Resuscitate (DNR) orders are undergoing procedures to improve quality of life. This article explores shared decision-making and DNR.


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Preoperative Laboratory Testing

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Matthias Bock, Gerhard Fritsch, David L. Hepner

Teaser

Routine preoperative testing is not cost-effective, because it is unlikely to identify significant abnormalities. Abnormal findings from routine testing are more likely to be false positive, are costly to pursue, introduce a new risk, increase the patient's anxiety, and are inconvenient to the patient. Abnormal findings rarely alter the surgical or anesthetic plan, and there is usually no association between perioperative complications and abnormal laboratory results. Incidental findings and false positive results may lead to increased hospital visits and admissions. Preoperative testing needs to be done based on a targeted history and physical examination and the type of surgery.


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Preoperative Assessment of the Patient with Cardiac Disease Undergoing Noncardiac Surgery

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Lee A. Fleisher

Teaser

The American College of Cardiology/American Heart Association has published Guidelines on Perioperative Evaluation. Preoperative evaluation should focus on identifying patients with symptomatic and asymptomatic coronary artery disease. The guidelines advocate using the American College of Surgeons National Surgical Quality Improvement Project Risk Index to determine perioperative risk. Diagnostic testing should be reserved for those at increased risk with poor exercise capacity. Indications for coronary interventions are the same in the perioperative period as in the nonoperative setting. In patients with a prior coronary stent, optimal antiplatelet therapy and timing of elective noncardiac surgery is evolving.


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Preoperative Evaluation

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Anand Lakshminarasimhachar, Gerald W. Smetana

Teaser

Postoperative pulmonary complications (PPCs) are common after major non-thoracic surgery and associated with significant morbidity and high cost of care. A number of risk factors are strong predictors of PPCs. The overall goal of the preoperative pulmonary evaluation is to identify these potential, patient and procedure-related risks and optimize the health of the patients before surgery. A thorough clinical examination supported by appropriate laboratory tests will help guide the clinician to provide optimal perioperative care.


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Stratification and Risk Reduction of Perioperative Acute Kidney Injury

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Selma Ishag, Charuhas V. Thakar

Teaser

Perioperative acute kidney injury (AKI) is associated with an increased morbidity and mortality. The incidence of AKI varies depending on preoperative risk factors and the surgical setting. Preoperative risk stratification is critical for informed consent and perioperative planning. Perioperative renal protection strategies are potentially invaluable in the prevention of AKI. Current advances in the development of biomarkers may offer the opportunity for early diagnosis and the implementation of therapeutic strategies. Increased awareness and concerted efforts by all perioperative physicians are needed to provide an improved outcome for surgical patients.


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Perioperative Approach to Anticoagulants and Hematologic Disorders

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Jisu Kim, Richard Huh, Amir K. Jaffer

Teaser

Hematologic disorders and patients on anticoagulants or at risk for venous thromboembolism encompass a broad array of diagnoses, which can potentially complicate perioperative planning and management. This article addresses both bleeding and clotting concerns as well as special hematologic issues.


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Preoperative Anemia

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Ankit J. Kansagra, Mihaela S. Stefan

Teaser

Previously undiagnosed anemia is often identified during routine assessment of surgical patients. Although studies suggest that perioperative anemia is associated with worse outcomes and a strong predictor for postoperative red cell transfusions, anemia is frequently ignored. Preoperative optimization of patients undergoing elective surgical procedures associated with significant blood loss, along with strategies to minimize intraoperative blood loss, shows promise for reducing postoperative transfusions and improving outcomes. In most situations, anemia can be corrected prior to elective surgeries and interventions. Future research should assess the timing and methods of optimization of preoperative anemia in surgery and which patients are best candidates for therapy.


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Preoperative Nutrition and Prehabilitation

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Ruchir Gupta, Tong J. Gan

Teaser

Enhanced recovery after surgery is the natural evolution of what were previously referred to as fast track programs and seeks to implement a series of interventions to improve and enhance recovery after major surgical procedures. Two important preoperative aspects are nutrition and prehabilitation. Identifying nutritionally deficient patients allows preoperative intervention to optimize their nutritional status. The contribution of cardiopulmonary exercise testing to the evaluation of perioperative risk, subsequent development of a training program, and the use of indices to risk stratify and measure improvement after a training program allow a personalized preoperative program to be developed for each patient.


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Preoperative Evaluation of Patients with Diabetes Mellitus

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Joshua D. Miller, Deborah C. Richman

Teaser

There are more than 29 million people in the United States with diabetes; it is estimated that by 2050, one in 3 individuals will have the disease. At least 50% of patients with diabetes are expected to undergo surgery in their lifetime. Complications from uncontrolled diabetes can impact multiple organ systems and affect perioperative risk. In this review, the authors discuss principles in diabetes management that will assist the perioperative clinician in caring for patients with diabetes.


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Preoperative Assessment of Geriatric Patients

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Justin G. Knittel, Troy S. Wildes

Teaser

Geriatric patients are over-represented in hospitalizations, surgeries, and perioperative complications. Special consideration is required for this patient group in the perioperative period because of the prevalence of comorbid diseases, functional impairments, and other deficits. A comprehensive preoperative evaluation strategy is recommended to identify and address these issues. Systematic, multidomain assessments should be performed and paired with risk reduction efforts. A shared understanding of patient function and long-term health goals is also important for providing patient-centered care of the geriatric surgical patient.


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Implantable Devices

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Ana Costa, Deborah C. Richman

Teaser

Technology is the prominent feature of the twenty-first century, including in medicine. There are very few organs that cannot be stimulated, shocked, or infused. With more and more implantable devices being approved for clinical use, anesthesiologists have to regularly take care of patients who have these devices. An understanding of the devices, the associated comorbidities, and the perioperative risks is crucial for safe management of these patients. Cardiac devices are discussed in some detail; neurostimulators and other implantable devices are briefly described. The principles of assessment and management are similar for all patients with implanted devices.


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The effect of permissive hypotension in combined traumatic brain injury and blunt abdominal trauma: an experimental study in swines

OBJECTIVE: Optimal hemodynamic resuscitation strategy of the trauma patient with uncontrolled hemorrhage and severe head injury in the pre-hospital setting remains a special challenge. Permissive hypotension prior to definite surgical haemostasis promotes coagulation, decreases blood loss and favors survival. However, hypotension is associated with poor outcome in severe head injury. The purpose of this experimental animal study was to assess the impact of permissive hypotension on survival, hemodynamic profile and brain oxygenation parameters before and/or after definite surgical haemostasis.

PATIENTS AND METHODS: Six-week-old pigs (n=12) underwent general anesthesia and brain injury was produced by the fluid percussion model. Animals were instrumented to measure hemodynamic parameters and cerebral blood flow. All animals (n=12) were subjected to laparotomy and a surgical knot was placed through the abdominal aorta wall. Uncontrolled hemorrhage was simulated by pulling out the intentionally left protruding free ends of the suture (goal MAP=30 mmHg). Animals were randomly divided into two groups; group A (n=6) was subjected to aggressive fluid resuscitation (goal SAP >80 mmHg) and group B (n=6) was left hypotensive (permissive hypotension). Animals who survived one hour of hypotensive shock underwent definite surgical haemostasis and were resuscitated for one hour. We measured survival, hemodynamic and brain oxygenation parameters at different time points before and after surgical haemostasis.

RESULTS: All animals from Group A and 50% from Group B died before surgical haemostasis. In surviving animals (Group B, 50%, p=0.033), MAP, CO, rCBF, SjO2 and AVDO2 were restored to pre-procedural levels.

CONCLUSIONS: Permissive hypotension by delaying fluid resuscitation up to definite surgical haemostasis improves survival, hemodynamics and allows restoration of cerebral oxygenation in severe head injury.

L'articolo The effect of permissive hypotension in combined traumatic brain injury and blunt abdominal trauma: an experimental study in swines sembra essere il primo su European Review.



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Management of Avian pox in Turkeys

2016-02-27T23-59-58Z
Source: International Journal of Livestock Research
Chaitanya yalavarthi, deepthi balam, Ramesh putchakayala.
Turkey poults were presented to clinic with cutaneous pustules all over body. Based on findings of clinical examination and lesions it was diagnosed as Avian pox. Successful management of Avian pox with procain pencillin and clinical outcome were discussed.


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Reproductive and Early Growth Traits of Intensively Reared West African Dwarf (WAD) Kids in a Humid Tropical Environment

2016-02-27T23-59-58Z
Source: International Journal of Livestock Research
Paul Chidiebere Okafor, Cosmas Chikezie Ogbu, Hariet Ndofor-Foleng.
The objectives of the study were to evaluate the reproductive, early growth and linear body traits of WAD goats reared intensively. Twenty-five WAD goats (20 does and 5 bucks) aged 7-8 months (9.0 to 12.0kg bwt) were mated naturally (1 buck: 4 does) to generate the kids studied. Animals were managed intensively. Kids suckled their dams until weaning before being separated. Litter size at birth, sex of kid, body weight (BW) and linear body traits from birth to 6 months of age (moa), weaning weight (Wwt), and mortality from birth to 6moa were evaluated. Data collected were presented using descriptive statistics. Pearson correlation analysis was used to study the relationship between traits. Birth weight was 1.75 ± 0.06kg; litter size was 2.08 ± 0.11 while Wwt was 7.11 ± 0.11kg. Body weight at 2, 4, and 6moa ranged between 4.00 and 5.20kg, 6.10 and 8.20kg, and 9.00 and 12.00kg, respectively. Body weight gain (BWG) at 2, 4, and 6 moa was 48.26 ± 1.16g/day, 52.21 ± 1.24g/day, and 49.39 ± 1.27g/day, respectively. Growth rate from birth to weaning, weaning to 6moa, and birth to 6moa was 45.04 ± 0.80g/d, 51.82 ± 1.30g/d, and 47.15 ± 0.55g/d, respectively. Number of males/litter, number of kids weaned/litter and mortality/litter from birth to 6moa was 0.54 ± 0.08, 1.86 ± 0.13, and 0.39 ± 0.17, respectively. Body weight values at different ages were positively interrelated (P


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