Anticoagulants are routinely used in stroke, embolism, infarct, etc. Blood clotting profile in such patients needs to be monitored frequently. Anticoagulants which can be administered orally such as warfarin and dicoumarol are preferred in such patients. Injectable anticoagulants such as heparin are prescribed when anticoagulation therapy is required for short duration. Absence of oral form of heparin makes it impractical for long-term use. Currently, warfarin and coumarone derivatives are the best available oral anticoagulants in market. They act by inhibiting decarboxylation of blood clotting factors II, VII, IX, and X. Pharmacological response of warfarin and dicoumarol needs to be monitored by frequent assessments of prothrombin time (PT) and international normalized ratio (INR). There is a need for a drug which can overcome these limitations. Apixaban is an oral anticoagulant which acts by inhibiting factor Xa. It does not require laboratory monitoring of PT and INR. Hence, it overcomes the limitations of heparin and warfarin. It acts by selectively inhibiting the activated factor Xa in a reversible manner. Apixaban has an oral bioavailability of ~50%. It is administered as twice daily dose. It is excreted in urine and feces. Apixaban is useful in atrial fibrillation, venous thromboembolism, and pulmonary embolism. Bleeding is the major side effect of apixaban. It has been found that apixaban has superiority over warfarin and aspirin in terms of efficacy and safety. Further studies are required to monitor and assess the pharmacokinetics, efficacy, adverse effects, and drug interaction data in many populations and sub-populations throughout the world.

Gynecomastia is a benign enlargement of the male breast tissue, either due to the proliferation of glandular tissue or deposition of fat in breast tissue, usually caused by imbalance of estrogen and androgen hormones in body. Gynecomastia has a trimodal age distribution and begins as a small lump beneath the nipple which may be tender. Gynecomastia is usually benign but may be a cause of embarrassment for some. Evaluation of gynecomastia is performed with an aim at diagnosing the cause for the same. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery depending on the etiology.

Introduction: The bleeding during surgery for tumors located at skull base can be torrential. The preoperative embolisation can minimize the blood loss and can create a comfortable environment for surgeon to operate these highly vascular tumors. Materials and Methods: The patients of various skull base tumors were divided into two groups. Group I included 45 patients not embolised prior to surgery and Group II included 37 patients who were embolised prior to surgery. Surgery was performed within 72 hours of the embolisaton. Patients in the two groups were compared for amount of blood loss, time during surgery, extent of tumor removal, complications, hospital stay and mortality. Comfort to surgeon during surgery was assessed by Pant Surgeons Satisfaction Score (PS3). Results: Amount of blood loss in Group I was more than 500 ml in majority as compared to Group II (P < 0.001).Operation room timings were more than 3 hours in Group I (P < 0.001). Similarly extent of surgery was better with lesser complications and mortality in Group II (P < 0.001).The hospital stay was less than 8 days in Group II (P < 0.001). Interestingly the operating surgeons were more comfortable and happy with their surgery if the patients were previously embolised i.e. PS3 of 3 or 4 (P< 0.001). Conclusion: Skull based tumors can be embolized in the preoperative period safely with the endovascular techniques to reduce the complications associated with surgical intervention.

Aims: The aim of this study was to assess for and compare the effect of prone and supine position on cardiorespiratory outcome among infants with respiratory distress (RD) and to screen any complications during positioning. Settings and Design: Quantitative experimental research approach was adopted for the study. It was a randomized clinical trial with parallel group design conducted in pediatric unit of St. Stephen's Hospital, Delhi. Methods: The population comprised infants with RD having a score of 3–7 Downes score system scale admitted in pediatric unit. Participants were randomized and treatment allocation by permuted block design. No blinding was done. Pre- and post-intervention cardiorespiratory outcomes (heart rate [HR], respiratory rate [RR], oxygen saturation level (SpO₂), and RD) were assessed. Statistical Analysis Used: SPSS version 20 was used for our analysis. Descriptive and inferential statistics was used for the analysis. Results: Total sample size included 60 infants with RD, 30 in each group (prone and supine position). The analysis showed that both intervention group had led to an improvement in HR, RR, SpO₂, and RD with both group, but the effectiveness was more among the infants receiving prone position as evidenced by the pre- and post-intervention mean changes for all the variables (HR, RR, SpO₂, and RD). Conclusions: The present study revealed that the introduction of prone position leads to an improvement in HR, RR, SpO₂, and RD among infants with RD, without any complications such as apnoea or vomiting as compared to supine position.

Background: The use of real time ultrasound (US) for insertion of central venous catheters is limited by various factors such as availability, space constraints, and perceived lack of need according to surveys including cardiovascular anesthesiologists. Methods: After the ethical committee approval and patient consent, 201 adult patients scheduled for elective cardiac surgery were randomized to undergo internal jugular vein (IJV) cannulation by either of the two methods: Landmark technique (control group), static US technique using the transthoracic echocardiography (TTE) probe (US group). The success rate, number of attempts, total cannulation time, and complication rate in the two groups were compared. Results: The overall success rate and the first attempt success rate were significantly higher in the control group than the US group (99% vs. 89.6%, P = 0.003 and 87.6% vs. 70.8%, P = 0.003, respectively). The total number of attempts to locate the IJV with the finder needle as well as the puncture needle was significantly lower in the control group than the US group (2.2 vs. 1.3, P = 0.001and 1.7 vs. 1.2, P = 0.021, respectively). The incidence of arterial puncture was higher in the US group than the control group (9.4% vs. 1.9%, P= 0.020). The total cannulation time was also higher in the US group (430 ± 320 s) than the control group (197 ± 116 s, P= 0.001). Conclusion: The landmark technique has a higher success rate, lower complication rate, and total cannulation time as compared with the static US technique using the TTE probe for IJV cannulation in adult cardiac surgical patients.

The results of mitral valve surgery have improved steadily. The current operative mortality rates for mitral valve surgery are reported to be in the region of 1.5% for mitral valve repair and 5.5% for mitral valve replacement. To ensure good perioperative patient outcome, it is imperative to follow management techniques based on sound scientific principles. In this review article, the authors describe anesthetic management, complexities of cardiopulmonary bypass and weaning from cardiopulmonary bypass in patients of varying severity of mitral stenosis.

This report describes a 55-year-old healthy male, who presented with defective vision, 2 days after a fall from height. Ophthalmoscopy showed multiple superficial retinal hemorrhages with cotton wool spots near the optic disc of the right eye. The left eye was normal. There was no evidence of focal neurological deficits, long bone fractures, or chest compression. With the history of trauma and characteristic retinal findings, a diagnosis of Purtscher's retinopathy was made. The patient was treated with tapering dose of systemic steroid. Visual acuity failed to regain with development of consecutive optic atrophy.

Since its initial description in 1964, various ophthalmic indications of neodymium: Yttrium-aluminum-garnet (Nd: YAG) laser have evolved. The common indications include capsulotomy of posterior capsule for opacification following cataract surgery and peripheral iridotomy in angle closure glaucoma. We present the case of successful use of Nd: YAG laser in treatment of occlusio pupillae and iridolenticular ring synechiae in a 37-year-old male presenting with bilateral 360° posterior synechiae secondary to chronic anterior uveitis.

Multiple sclerosis (MS), an inflammatory, demyelinating disease of central nervous system, is the most common cause of neurological disability in young females. MS occurs in India but is comparatively very less as compared to the West. Due to its rarity, obstetricians do not encounter pregnancies with MS in India often. We report a case of a 21-year-old, primigravida who presented to us at 9 weeks of pregnancy. She was a diagnosed case of MS for 4 years. Later in pregnancy, she had walking and gait difficulty. No change in drug dosage was required, and patient had a static course of disease during pregnancy. The patient had an emergency cesarean section. Pregnancy in women with MS is not considered high risk anymore; however, there are some challenges such as managing disability and modifying ongoing therapy. Multi-disciplinary approach is the mainstay of management. Due to severe disability of routine activities such as walking, nursing herself and the baby, pregnancy with MS poses big management challenge. Social issues should be taken care of prior to conception in Indian perspective.