Introduction: Spinal anesthesia is a simple, reliable, and most common anesthetic technique practiced worldwide. However, spinal anesthesia is associated with side effects such as hypotension, bradycardia, and shivering. Hypotension is most common intraoperative complication during spinal anaesthesia for caesarean section which has detrimental effects on both mother and fetus. Objective: To compare the effect of intravenous ondansetron with placebo for attenuation of spinal induced hypotension, change in heart rate, requirement for vasopressor and incidence of shivering and postoperative nausea- vomiting. Methods: A prospective randomised double blind study was conducted at Department of Anesthesia, Monno Medical College & Hospital, Manikganj, Bangladesh from July to December 2022. Total 100 patients belonging to ASA Class-I and II, aged 25-35 years, weight 40-60 kilograms, undergoing cesarean delivery under spinal anesthesia were included in this study. Group O (n=50) received 6mg ondansetron in normal saline intravenously; total volume made 10ml. Group S (n=50) received 10ml normal saline intravenously. Patient with history of PIH, convulsion, compromised airway or morbid obesity and required general anaesthesia for supplementation were excluded from study. Blood pressure and heart rate were checked every 5minutes till the end of the surgery. Data was analyzed by chi square test. Results: Total 100 patients were investigated for the effect of prophylactic ondansetron 6mg intravenously on fall in SBP, DBP and MBP, number of vasopressor boluses and total dose of vasopressor required. Distribution of cases according to age was comparable (p-0.339) in both groups (ondansetron group-25.27±3.62 and normal saline group- 24.63±3.60). In both groups maximum patients were below 25yrs old. We also studied the effect of ondansetron on the level of sensory height, duration of subarachnoid block to start of surgery, duration of surgery, heart rate, incidence of nausea, shivering and bradycardia. Systolic, diastolic and mean blood pressure were found to be higher in group O as compare to group S at different time intervals (p value < 0.05). In group O 66% patients required vasopressors whereas in group S 90% patients required vasopressors. Incidence of nausea and vomiting is less in group O (p-value=0.001). Conclusion: we conclude that prophylactic use of intravenous ondansetron prevent incidence of hypotension and less vasopressor is required to treat hypotension. Prophylactic ondansetron use is associated with less incidence of nausea and vomiting in spinal anesthesia in healthy parturient.

Background: In the developing world, morbidity and mortality in under-five year old children is an important public health problem. Paediatric intensive care unit (PICU) is set aside for managing children with life-threatening illnesses. There is increased survival of critically ill children, with advances in intensive care facilities. Outcome depends on the underlying nature of the disease, associated co-morbidities, clinical condition of the patient at presentation, infrastructure and the quality of care provided in the unit. Objective: To examine pattern and clinical outcome of patients admitted in the pediatric intensive care unit. Methods: This is a prospective observational study conducted in Pediatric Intensive Care Unit (PICU) of-Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh from January to December 2021. All patients from age of 1 month to 18 years admitted to PICU meeting the inclusion criteria are included in the study. PICU records of all admissions, transfer out, discharges and deaths were used for this study. Data used from the records included age, sex, diagnosis, and outcome of all the patients admitted to PICU. The outcome is classified as transfers to pediatric wards, discharges, patients who left against medical advice (LAMA), and deaths. Results: Total of 431 patients were admitted into PICU. (201) 46.6% were infants, and (230) 53.4% patients aged 1-18 years. Their ages ranged from one month to 18 years, with the mean age being 40.01 ± 45.79 months. There were 264 (61.3%) male and 167 (38.7%) female patients giving an M: F ratio of 1.58:1. The most common cause of admission was respiratory 195 (45.2%), infectious 107 (24.8%), surgical 31 (7.2%), cardiovascular 21 (4.9%), neurological 45 (10.4%), haematological 12(2.8%), renal 04 (0.9%) and others 16 (2.7%). Disorders needing surgical intervention were the commonest condition in children of all age groups. The overall mortality rate was 22.5%. Ninety Seven (22.5%) patients died during the period, consisting of 53 (54.6%) males and 44 (45.4%) females, with their mean age being 53.71 months (range, one month to 18 years). 40 (41.2%) of Respiratory dysfunction, 23 (23.7%) of cardiovascular disorders, 12 (12.4%) of neurological problems, 5 (5.2%) of Haematological disfunction, and 17 (17.5%) patients died in the postoperative period. Conclusions: Diseases including infections were the predominant conditions leading to PICU admissions in our setting. In our PICU, mortality is low. Most of the deaths were serious illnesses with poor prognosis that require adequate medical knowledge, facilities, equipment and infrastructure. This forms a major challenge in Low and Middle Income Countries (LMIC). We advocate a focus on continuous development within the sphere of influence. This highlights the importance of addressing critically ill children and expanding intensive care facilities in the region

Background: The caudal epidural block is an effective technique that is very common and popular in pediatric regional anesthesia practice. The conventional method of the caudal epidural block is not free of complication. The “no turn” technique is a very easy approach that reduces the risks associated with the conventional method. Aim of the study: Aim of the study was to evaluate the success rate and safety of the 'no turn technique' for caudal epidural block in pediatric patients. Methods: This is a prospective observational study; 440 patients were enrolled and analyzed. The study was carried out in the period of July 2018 to December 2018 at the Department of pediatric anesthesiology, Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh. All patients were attempted Ivani's no turn technique of caudal epidural block. Result: The mean time required to perform needle insertion was 0.8minutes.The technique was successfulin435 (98.86%)cases. The successful technique was considered as the needle was placed in caudal space with the absence of a bloody tap Subcutaneous placement of the needle after the first attempt occurred in two cases in the conventional method group and three cases in the new method group. No occurrence of duralpuncture. Among435 cases caudal was successful at the first attempt.3(0.68%) cases.1(0.23%) Patient needed second attempt and another1(0.23%) patient needed third attempt. The technique failed in 1(0.23%)case. Conclusion: Ivani's 'no turn technique' is an easy method with a high success rate and less complications.

Background: Mumps is a contagious viral infection that primarily affects children and young adults. The disease is characterized by swelling of the salivary glands, which causes pain and fever. Although the incidence of mumps has decreased in recent years due to vaccination, outbreaks continue to occur. Mumps can lead to serious complications, such as meningitis, encephalitis, and pancreatitis, particularly in unvaccinated individuals. Aim of the study: The aim of the study was to understand the epidemiology, clinical features, and management of mumps in children is crucial for preventing and managing outbreaks. Methods: This hospital-based prospective observational study was conducted at the Department of Pediatric High Dependency and isolation, Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh. This study enrolled and analyzed sixty patients from January 2019 to December 2021. Result: The majority of patients, 56.67%, were between 6-10 years old, 23.33% were between 1-5 years old, 13.33% were between 11-15 years old, and 6.67% were between 16-18 years old. The mean duration of illness was 9.0±2 days. Furthermore, 60% of patients experienced constitutional symptoms such as headache, myalgia, or fatigue. Cough and dysphagia were observed in 83.33% and 47% of the patients, respectively. Conclusion: In conclusion, preventing mumps in children is crucial to reducing the disease burden in Bangladesh. Vaccination is the most effective way to prevent mumps, and the vaccine is available in the country's national immunization program. However, vaccine coverage must be improved to ensure that all children receive the vaccine.

Background: Blood safety begins with a healthy donor. Collecting blood which is safe for transfusion is one of the principal challenges in the health care system. Transfusion of a contaminated blood increases the morbidity and mortality of the recipient. Aims and objectives: The aim of the present study was to estimate the seroprevalence of Transfusion Transmissible Infections(TTI’s) among blood donors and to estimate the prevalence of co-infection rate. Materials and methods: A retrospective study was conducted at Adichunchanagiri hospital and research centre, B.G. Nagara for a period of two years and involved testing of 3831 blood donors, who were serologically screened for HIV, HCV, HBV and Syphilis at the blood bank. Results: For a period of 2 years, a total of 3831 donors were tested. Among them 2339(61.05%) were voluntary donors and 1492(38.94%) were replacement donors. Male donors constituted for about 2681(69.98%) and females 1150(30.01%). Overall seropositivity for all TTI’s was 1.33%. Seropositivity was more among voluntary donors(0.83%) compared to replacement donors(0.5%). Seroprevalence of HIV is 0.10%, HBV is 0.96%, HCV is 0.26%, Syphilis is 0%. There were no occurrence of concomitant infections in the present study. Conclusion: Seroprevalence of HBV was more among voluntary donors, HIV and HCV seroprevalence was higher among replacement donors. Hence thorough screening of blood donors is must to prevent TTI’s to recipients. Category: Infectious diseases, Serology

Background: Acne is generally regarded as a skin disorder of adolescents, but off late the prevalence has been increasing in adults too; especially in women. Hyperandrogenism is considered as an important contributing factor for the development of acne in adult women. If elevated androgens are found patients may benefit from various methods of hormonal therapy and reduce psychological morbidity. As there is paucity of data on role of circulating androgens in female acne, this study was undertaken to evaluate the same. Aims and objectives: To evaluate the correlation between serum free testosterone levels and adult acne in females. Materials and methods: A case control study from January 2020 to June 2021 was conducted at Department of DVL, Guntur Medical College. 50 adult acne female patients and 50 age and sex-matched healthy controls were enrolled in the study. Blood levels of free testosterone, total testosterone, sex hormone binding globulin were measured on day 1-3 of menstrual cycle and free androgen index was calculated. Results: Adult acne cases were commonly reported in 25-30years age group with moderate severity. Although free testosterone levels were within normal limits in cases statistically significant difference was seen compared to the controls. Total testosterone and free androgen index vales were significantly elevated in cases and correlated positively with severity of acne. Conclusion: Free androgen index can be used as a surrogate marker for hyperandrogenemia in cases where free and total testosterone cases fall within normal limits. We reiterate the role of androgens and as a corollary the need for hormonal evaluation and timely anti- androgen therapy for adult acne in females.

Introduction: Globally more than 1•9 billion individuals have inadequate iodine nutrition of whom 285 million are school-aged children. [1] Nutritional Iodine deficiency could result in abortion, stillbirth, mental retardation, deaf mutism, squint, dwarfism, goitre, neuromotor defects etc. [2] Prevalence surveys of iodine status, including measurement of urinary iodine levels and an analysis of the salt situation is needed for sustained elimination. [3] It was found in India, 337 districts were endemic for Iodine deficiency disorder i.e., prevalence is >10% [4]. Community based research may be more practical and less costly and possible on a more regular basis. [4,5] Considering this the present study was undertaken to find the recent status of Iodine deficiency disorders in the subpopulation of Maharashtra. Objectives: To study the prevalence of goitre, median urine iodine levels in 6 to 12 years children. And to study pattern and practices of salt consumption and salt iodine estimation at household level. Methodology: A cross sectional observational study of 551 children from six randomly selected schools from different localities was done during the period, 1/4/2019 to 1/3/2020.History taking, clinical examination was done and on spot urine sample and household salt sample were collected for iodine estimation. Results: Prevalence of goitre was 1.45%. Median urinary iodine level was 90mcg/L. 55% of households were having Salts with Iodine content of >15 pp Study shows the Iodine deficiency of mild endemicity in the area. Goitre was not found to be a public health problem.

Epidermoid cysts are developmental benign cysts which are frequently encountered on location like extremities, scalp, face, rarely on locations like external ear. Very few cases of EIC are described in this location and have been reported in literature. The lesion is usually benign but may undergo malignant transformation if left untreated. Therefore timely diagnosis by FNAC is useful and considered necessary for evaluation of such cases. We hereby describe a case of 4 years old child who was referred to cytopathology department for FNAC for the swelling involving upper part of left side of pinna extending to posterior aspect measuring 3.0 x 2.1 cm in size and was non tender. It was diagnosed as EIC on FNAC and subsequently confirmed on HPE. FNAC is found useful tool to diagnose such uncommon lesions found at unusual locations.

The facial nerve weakness post parotid surgery can result from a combination of trauma while dissecting right on the nerve, traction injury to the nerve, heat injury secondary to use of electrocautery and prolonged operating time. We tried to study the one factor i.e. the operating time. Total of 30 patients admitted in the ENT department between year 2014 and 2018, undergoing parotid surgery for benign pathology by the same primary surgeon were selected. Facial nerve was identified in each by antegrade method. In first ten (10) patients, tragal pointer was used to identify facial nerve and for further twenty (20) cases, posterior belly digastric was used for the identification. Average time taken using tragal pointer as the landmark was 39.7 minutes and average time taken using posterior belly of digastric was 20.65 minutes. P value was found to be significant ( < 0.01) by using both independent sample t test and one way ANOVA test. We found that time taken using posterior belly of digastric as landmark was significantly shorter than tragal pointer. Hence we can control the operating time by using posterior belly of digastric as the primary landmark for facial nerve identification.

Background and Aims: The present survey aims to assess the training and practices of Indian anaesthesia residents in central venous cannulation, and the barriers for not using US (ultrasound) and practicing internationally accepted guidelines for improved patient safety. Methods: The cross-sectional survey was conducted among Doctor of Medicine (MD) and Diplomate of National board of examinations (DNB)anaesthesia residents from different medical institutes across the country.The questionnaire included 20 questions and was validated for content by 6 experts. It was formatted on Google Forms and the link was sent on different zonal PG groups using WhatsApp. Results: Supervised training method was reported by 84.9% and 74.9% of the residents for landmark and US-guided CVC insertion respectively. Only around 8-9% had attended simulation sessions. Almost one-third of the residents did not have a printed checklist for the same, and one-fifth did not obtain informed consent at alltimes. About 12.2% residents either never followed all aseptic guidelines, or followed them occasionally. The most common barriers for not using US by residents for CVC cannulation were its non-availability in the institute (16.9%), limited availability for residents (63.8%), longer procedure time and learning curve (16.4 % and 12.7% respectively), and faculty preference for teaching by landmark technique (13.4%). Conclusion: Although anaesthesiology residents are being trained in US-guided CVC insertion, there are various barriers to its use in clinical practice like limited availability of USG for residents after routine hours, longer procedure time and learning curve, and faculty preference for teaching by landmark technique. The survey advocates and encourages simulation based training for the residents, and workshops for training and teaching of US and simulation for the faculty.