A limitation of the study is that a SARS-CoV-2 infection was not ruled out as the cause of gastro-enteritis leading to the initial admission. Because the events apparently took place after the start of the SARS-CoV-2 pandemic, it cannot be ruled out that the patient deteriorated because of an undiagnosed COVID-19 infection. Arguments for a SARS-CoV-2 infection are that the patient was institutionalized and manifested with gastro-enteritis. Institutionalized patients are at an increased risk of contracting and dying from a SARS-CoV-2 infection [2]. It is also known that SARS-CoV-2 infections can manifest itself not only in the lungs but also in extra-pulmonary sites, including the gastro-intestinal tract [3]. In patients with manifestations of COVID-19 with extra-pulmonary onset, the causative agent can be difficult to confirm. We should be told whether the patient was SARS-CoV-2 vaccinated at the time of the first deterioration. 

Background: The present study was done to compare the Post Procedural medication requirement and side effects among the patients of chronic pelvic pain in pulsed radiofrequency ablation versus thermal radiofrequency ablation of Ganglion Impar. Material and Methods: The present study was prospective, randomized, single blinded study and was based on series of 30 patients presenting with chronic pelvic pain, having already failed conservative medical management, presenting in Pain clinic if IGMC Shimla. The patients were divided into 2 groups of 15 patients. Patients in Group A(n = 15) were given thermal radiofrequency ablation where as patients in Group B were given pulsed radiofrequency ablation. Results: Mean age (in years) in group A and B was found to be 47.60±6.833 and 42.67±7.807 years respectively. The p value was calculated to be 0.76 which was found to be statistically non significant. In Group A, 13(86.7%) patients didn’t need any Medication to be started Post Procedure and 2(13.3%) need medication post procedural while in Group B, 6(40.0%) patients didn’t need any Medication to be started Post Procedure and 9(60.0%) need medication post procedural. The P value was 0.021 which was statistically significant. In both Group A and B None of the patients had any side effects post procedural. Conclusion: Present study showed that Post Procedural medication requirement was significantly less in group A as compared to group B and none of the patients had any side effects post procedural in both Groups.

Background: The present study was done to compare the Visual Analog Scale (VAS) score between Thermal and Pulsed radiofrequency ablation in Ganglion Impar block for treatment of chronic pelvic pain in female patients. Material and Methods: The present study was prospective, randomized, single blinded study and was based on series of 30 patients presenting with chronic pelvic pain, having already failed conservative medical management, presenting in Pain clinic if IGMC Shimla. The patients were divided into 2 groups of 15 patients. Patients in Group A (n = 15) were given thermal radiofrequency ablation where as patients in Group B were given pulsed radiofrequency ablation. Results: Mean Pre-procedural VAS score of the patients in Group A was 7.93±0.704 where as mean Pre-procedure VAS score in patients of group B was 8.00±0.655 (p = 0.790). Mean 24 Hours Post Procedural VAS Score of the patients in Group A was 2.53±0.516 where as mean 24 Hours Post Procedural VAS Score in patients of group B was 3.53 ±0.640 (p = 0.000). Mean 1 week Post Procedural VAS Score of the patients in Group A was 2.60±0.507 where as mean 1 week Post Procedural VAS Score in patients of group B was 3.40 ±0.507 (p = 0.000) Mean 2 week Post Procedural VAS Score of the patients in Group A was 2.33±0.507 where as mean 2 week Post Procedural VAS Score in patients of group B was 3.31±0.564. (p = 0.000). Mean 3 week Post Procedural VAS Score of the patients in Group A was 2.31±0.415 where as mean 3 week Post Procedural VAS Score in patients of group B was 3.29±0.516 (p =0.000). Conclusion: Present study showed that mean Post Procedural VAS Score (24 Hours, 1,2 and 3 week) was significantly lower in group A as compared to group B. we can conclude that thermal radiofrequency ablation of ganglion impar for chronic pelvic pain produces prolonged pain free period in the patients as compared to patients who were treated with pulsed radio frequency ablation.

We reviewed with interest the study by Diaz et al [1]. on three cases of Guillain-Barré Syndrome (GBS) associated with SARS-CoV-2 infection, all of whom were treated with intravenous immunoglobulins (IVIG) and showed favorable outcomes despite prolonged ICU stays. While the study contributes valuable insights, it presents several limitations. The diagnostic algorithm for GBS in sedated or ventilated patients should be expanded to include autonomic disturbances, cytokine profiles, and response to ex juvantibus IVIG. Important clinical details are missing, including the duration of intubation, timing of symptom recognition, and rationale for delayed GBS diagnosis in two patients. In one case, critical illness neuropathy and drug-induced neuropathy were not adequately ruled out. CSF analyses lacked SARS-CoV-2 PCR testing, and post-vaccination outcomes were not discussed. Autonomic dysfunction and cranial nerve involvement, especially facial diplegia, require further elaboration given their relevance in neuro-COVID. The use of the term “differential diagnoses” for infectious triggers of GBS is inappropriate and should be revised. Overall, while the study offers meaningful observations, these limitations should be addressed to strengthen its conclusions and clinical utility.

We read with interest the case report by Della Corte et al. detailing a 12-year-old male with neuro-COVID presenting with drowsiness, memory impairment, prosopagnosia, myoclonus, and other neurological symptoms, all of which resolved following treatment with intravenous immunoglobulins (IVIG). While the case is noteworthy, we raise several concerns. The claim that this is the first pediatric case of SARS-CoV-2–associated myoclonus is questionable, as earlier reports have described similar presentations. Furthermore, the patient exhibited signs of Quadri spasticity, clonus, and a positive Babinski sign, suggesting involvement of the pyramidal tract—findings that were not fully explored in the original report. Discrepancies exist between the described clinical findings and the supplementary video data, particularly regarding limb involvement. Essential diagnostic details, such as video-EEG, spinal MRI, inflammatory markers (e.g., interleukin-6, D-dimer), and the exclusion of venous sinus thrombosis, are missing. The delayed initiation of a neurological work-up also raises concerns. While the report is significant for being the first to link prosopagnosia with pediatric neuro-COVID, other key neurological features were insufficiently addressed, limiting the strength and interpretation of the study’s conclusions.

Background: Preoperative anxiety is common in children that can have impact on induction, emergence from anesthesia and/ or on the psychological state of the child. Intranasal route offers an advantage of rapid and virtually complete absorption due to high mucosal vascularity.Objective: The present study aimed to compare efficacy of midazolam with clonidine for intranasal premedication in pediatric patients scheduled to undergo elective orodental surgeries. Methods: One hundred and five children of either sex, aged between 3-7 years belonging to American Society of Anesthesiologists (ASA) physical status 1 and 2 undergoing elective orodental surgeries were randomly assigned to three study groups. Group 1 (n = 35) received 0.5 ml of 0.2 mg/kg midazolam, Group 2 (n = 35) received 0.5 ml 1µ/kg clonidine and Group 3 (n = 35) received 0.5 ml of normal saline in each nostril 40 minutes before inducing anesthesia. Heart rate, mean arterial blood pressure, SpO2, degree of sedation was measured every 10 minutes till 30 minutes according to the 5- point sedation scale. The reaction to intravenous (i.v.) cannulation was noted according to 4-point scale and child’s face mask acceptance was noted according to 5-point scale. After induction of anesthesia, vitals were noted every 10 minutes, intraoperatively. Postoperatively, level of sedation was assessed every 10 minutes for one hour using 3- point scale. Results: The difference in sedation score between group 1 and 2 was insignificant at 10 minutes but highly significant at 20 min, 30 min and 40 minutes with more sedation in clonidine group. Heart rate and blood pressure were lower in clonidine group. Children in group 2 had better reaction to i.v. cannulation and mask acceptance scores compared with group 1. Postoperative sedation was highest in clonidine group and these children had better wake up scores than midazolam. Conclusion: Compared to midazolam, intranasal clonidine provides higher sedation level, better mask acceptance and better response to intravenous cannulation.

Background/Aim: Having reliable indicators and markers that would help in prognosticating the survival are invaluable and would consequently assist in the course of effective treatment. Our objectives in this study were to compare the ability of SI and mSI to predict the primary outcomes of overall 28-day mortality rate in SARS-CoV-2 infected hemodynamic unstable critically ill patients. Methods: This study was retrospectively conducted and both of confirmed and suspected affected critically ill COVID-19 patients were included in our study. Hemodynamics variables of SI and mSI were mathematically calculated after dividing HR over SBP and MAP. All tested variables and others were comparatively compared across the two studied affected COVID-19 patients; Survivors Cohort (Cohort I) and Non-Survivors Cohort (Cohort II) using One Sample and Independent-T Tests in addition to Chi Square Test for categorical retrievable data. ROC curves were constructed for SI and mSI and the area under the ROC curves (AUROCs) were statistically compared using proposed Delong Method. The optimal operating cutoffs on each ROC curve for the two tested prognosticators were also investigated by picking the highest youden’s index. Results: The mean age of the whole study cohort was 51.88±16.22 years and the Non-Survivors Cohort were significantly older than the Survivors Cohort. Significantly, males were distributed in the study in approximately 2.57: 1 ratio compared to female. There were statistically significant differences regarding serum albumin levels profile during the 1st admission week, among the 3 serial albumin day levels. The overall incidences of NOPST were assessed at 65.9% during an average of 14.08±4.06 days. The Non-Survivors Cohort had also significantly higher SI and mSI compared to Survivors Cohort [1.16±0.14 bpm/mmHg and 1.67±0.23 bpm/mmHg versus 0.92±0.04 bpm/mmHg and 1.30±0.07 bpm/mmHg; +0.24±0.01 bpm/mmHg and -0.37±0.01 bpm/mmHg, respectively, p-value = 0.001]. SI had a higher AUROC than mSI with Area±SEM (95% CI; Range) of 0.983±0.002 (95% CI; 0.978-0.987) versus 0.959±0.004 (95% CI; 0.950-0.967) and the best cut-off values for SI and mSI were 0.99 bpm/mmHg and 1.43 bpm/mmHg, respectively. Conclusion: In summary, our stated hemodynamic based mortality prognosticators may be an early effective, no-cost bedside, realistic, reliable triaging modalities with high sensitivity, specificity, performance. Also, SI may be used as an additional or readily available red flag bedside assessment tool for severe disease.

Background: Present study was done to evaluate eyelid position and Discharge from eyes among patients admitted in Adult Intensive Care Unit. Material and Methods: It was a prospective observational study carried in AICU over period of one year by Department of Ophthalmology, Dr. RPGMC Kangra at Tanda. All the patients who were admitted in AICU greater than 48 hours between ages of 18-65 years were included and evaluated for socio-demographic information like age, gender etc. Thorough ophthalmic examination was also done for eyelid position and eye discharge and analyzed using epi info v7 software. Results: A total of 126 patients were included in the study. Mean age of the study participants was 41.8 years. 64.3% of the patients were males while 35.7% were females. 26.2% of the right eyes had grade 3 eyelid positions at 48 hours, 67% at the end of first week, 64% at the end of second week and at the end of fourth and fifth week, none of the right eyes had grade 3 eyelid position. 24.6% of the left eyes had grade 3 eyelid positions at 48 hours 67% At the end of first week, 64% at the end of second week and At the end of fourth and fifth week, none of the left eyes had grade 3 eyelid position. Rate of mucopurulent discharge was 14.2% and 11.9% in right and left eyes respectively at 48 hours. At the end of first week, the rate of mucopurulent discharge was 59.2% in the right eyes and 63% in left eyes. At the end of second week, the rate of mucopurulent discharge was 18.2% and 36.4% in right and left eyes respectively. Three right eyes out of 5 eyes and one left eye out of 5 eyes showed mucopurulent discharge at the end of third week. At the end of fourth and fifth week, none of the eyes showed mucopurulent discharge. Conclusion: Eye care which may include lubrication with eye drops, administration of broad-spectrum antibiotics, taping of eye lids and regular examination by ophthalmologists can markedly reduce eye related complications among AICU admitted patients.

Background: Present study was done to evaluate the Indications for admission and its association with ocular surface disorders among patients admitted in Adult Intensive Care Unit of a Tertiary Care Hospital. Material and Methods: It was a prospective observational studycarried in AICU over period of one year by Department of Ophthalmology, Dr. RPGMC Kangra at Tanda. All the patients who were admitted in AICU greater than 48 hours between ages of 18-65 years were included and evaluated for socio-demographic information like age, gender, indications for admission etc. Thorough ophthalmic examination was also done for ocular surface disorders and analysed using epi info v7 software. Results: A total of 126 patients were included in the study. Mean age of the study participants was 41.8 years.  Maximum patients, 23.8% of the patients were in age group of 51 and 60 years followed by 23% between 21 and 30 years and 41 and 50 years each. 64.3% of the patients were males while 35.7% were females. The most common indication for AICU admission was post-operative monitoring (30.9%) followed by head injury (19.8%) and orthopaedic injury (11.1%). In the present study, 74 (58.7%) of the patients had ocular surface disorders. Ocular surface disorders were observed most commonly among patients who had head injury Followed by Post-operative monitoring and Respiratory Insufficiency as indication for AICU admission. Conclusion: The present study concluded that post-operative monitoring was the most common indication for AICU admission and Ocular surface disorders were observed most commonly among patients who had head injury.

Introduction: Pain from propofol injection can be severe and distressing in some patients. Various methods and agents has been used to alleviate this pain. One of the agents is ketamine which has been used in different sub-anaesthetic doses to reduce propofol injection pain in comparison with different agents. None of the studies till date have used ketamine in dose less than 0.1 mg/kg. The aim of the present study was to compare ketamine in doses of 0.05 and 0.1 mg/kg to attenuate propofol injection pain. Material and Method: 48 ASA I and II adult patients undergoing different elective surgical procedures under general anaesthesia were randomised into 3 groups of 16 patients each. Group A patients received ketamine 0.05 mg/kg in 2 mL while group B patients received ketamine 0.1mg/kg in 2mL. Group C patients served as placebo control and were administered 2mL 0.9% normal saline intravenously. The venous drainage was occluded manually by rubber tourniquet at mid-arm. Subsequently the study drug or the placebo was administered as per group allocation. One minute later, 25% of calculated propofol induction dose was injected over 5 seconds. VAS score for pain of propofol injection was assessed at 0, 1 and 2 minutes after the propofol injection. Thereafter, general anaesthesia technique was continued as per standard technique giving the remaining 75% of propofol. Patient’s heart rate and blood pressure were recorded at 0, 1 and 2 minutes after the administration of 25% of the calculated dose of propofol. Any evidence of hallucination was observed in the recovery room. Results: Demographic profile and the ASA grade of the patients in the 3 groups was uniformly distributed. The mean VAS score for pain perception in group B patients at 1 and 2 minutes was 0.56 and 1.06 respectively. In contrast, the mean VAS for pain was 3.88 and 5.06 at 1 and 2 minutes respectively in group C. The VAS score of patients belonging to group A was closer to that seen in group B patients. This difference in VAS score was statistically highly significant between the groups at 1 and 2 minutes. A significant fall in systolic blood pressure was noted at 2 minutes after administering 25% of the propofol induction dose in all the 3 groups. In contrast, no significant changes were noted at one minute when compared to baseline. There was insignificant fall in the heart rate at 1 and 2 minutes following the administration of 25% propofol in group A & B. In contrast, an insignificant rise in heart rate was noted at 1 and 2 minutes in group C. Conclusion: The results of this study demonstrate that 0.01 mg/kg of ketamine administered one minute prior to propofol injection is effective and superior to 0.05 mg/kg of ketamine in relieving propofol injection pain without any side effects.

The study was conducted on the ground covers in Sulaymaniyah district, northeastern Iraq located between longitudes (45°0'0"E) (45°20'0"E) and latitudes (35°50'0"N) (36°50'0"N), Remote sensing and GIS techniques were used, using Sentinel-2 satellite image data, with a spatial resolution of 10 meters. The results of the study showed that there are six ground covers: (Shrub and Grassland and natural pastures and agricultural areas ranked first, followed by rocky lands and barren lands, sparse vegetation covers, urban areas, dense vegetation cover, which form part of coniferous forests, and water). And in percentages (24, 22, 17, 14, 10.9 and 10.2%) respectively. Overall accuracy of 86% and Kappa Coefficient 0.82. These results are consistent with the reality of the study area.

The purpose of this placebo-controlled, double-blind study was to see how magnesium sulphate and clonidine affected perioperative hemodynamics, propofol consumption and postoperative recovery. Ninety ASA I–II patients undergoing elective laparoscopic surgery were randomized into three groups. Group M Patients received Inj. magnesium sulphate (40 mg/kg) in 20 mL saline infused over a period of 15 minutes before induction. Group C received Patients received Inj. Clonidine (3 mcg/kg) before induction. The Group S (Control group) received 20 mL normal saline over 15mind before induction. Propofol was used for induction of anaesthesia and for maintenance propofol infusion was used which was adjusted as per bispectral index along with intermittent fentanyl bolus and vecuronium as muscle relaxant According to type of data, different tests of statistical significance like Chi-square test, Kruskal Wallis test and one-way ANOVA were used. In the presence of magnesium sulphate and clonidine, propofol induction was rapid. The time it took for BIS to reach 60 was significantly shorter in groups M and C (p 0.0001) and compared to clonidine and control group post-operative recovery was more delayed in magnesium sulphate group (p 0.0001). There was no statistically significant difference between the groups in heart rate or arterial blood pressure. Preoperative use of magnesium sulphate and clonidine resulted in significant reduction in propofol requirements for induction as well as for maintenance (p 0.0001). To conclude Use of magnesium sulphate caused delayed recovery and hypotension and bradycardia was observed with clonidine, but both can be used as adjuvants with caution.

Background/Aim: β-Lactam/β-lactamase inhibitors (BL/BLIs) and carbapenems are often considered for the treatment of sepsis when the main suspected pathogens are Gram-negative bacteria, because of their broad spectrum of coverage. Our aim was to compare the clinical outcomes of the two most widely used empirical broad-spectrum antibiotics in Jordanian SARS-CoV-2 infected patients. Methods: A single-center, retrospectively study was conducted in a specialized COVID-19 isolation center at Queen Alia Military Hospital of the Royal Medical Services (RMS) in Jordan. Over 19 months. All Jordanian mild/moderate-severe/critical SARS-CoV-2 infected patients aged 18 years and above, whose hospital admission days exceeded at least 3 days and whose COVID-19 diagnosis were suspected or confirmed were included in our study. β-ABs were allocated to Non-PIP/TAZ group (Group I) and PIP/TAZ group (Group II). An Independent T and One-Sample T Tests and Chi Square Test will be used to analyze the parametric and non-parametric outcomes’ data, respectively. Results: 718 eligible studied patients were finally included in this study (718/4183, 18.67%) in which 247 patients (31.6%) had suspected COVID-19 infection and 534 (68.4%) had confirmed COVID-19 infection. The mean age of the whole study cohort was 59.40±10.60. Insignificantly, males were distributed in the study in approximately 2.309:1 ratio compared to females. The main finding of our study was that an investigated overall 28-day SARS-CoV-2 infected patients’ mortality were insignificantly recorded between the two ABs based categorized cohorts [75 (19.8%) vs 80 (19.9%), p-Value=0.997] over also insignificantly overall hospital Length of Stay (LOS) [11.17±2.79 days vs 11.28±2.91 days, -0.11±0.20 days, p-Value=0.595] for Cohort I and Cohort II, respectively. Conclusion: In summary, our results demonstrate that there were insignificant differences between Piperacillin/Tazobactam and Carbapenems regarding overall clinical impacts, when they were empirically administered in SARS-CoV-2 infected patients. Also, we explored that significant higher %cNa12 in PIP/TAZ Cohort (Cohort II) may have positive clinical advantages over Carbapenems in Non-PIP/TAZ (Cohort I).

Background/Aim: Several biochemical parameters in mechanically ventilated intensive care unit severe acute respiratory syndrome conronavirus-2 (MVICU-SARS-CoV-2) are strongly correlated with affected COVID-19 patients’ clinical outcomes. Of particular, C-Reactive Protein (CRP) and Ferritin (FER) levels are commonly used in clinical practices for theirs diagnostic and prognostic performances. So, in this study we aimed to explore the two tested positive acute-phase reactants prognosticating capabilities in MVICU-affected COVID-19 patients. Methods: A single-center study was retrospectively processed for eligible admitted MVICU-SARS-CoV-2 infected patients between March 2020 and September 2021. One-Sample and Independent T-Tests were conducted to analyze parametric data while in contrary, Mann Whitney-U and Chi Square Tests were conducted to analyze non-parametric data. A Receiver Operating Characteristic Test followed by Sensitivity Analysis were also conducted to plot the area of each tested prognosticator and to pick the operating optimal dichotomous levels with their corresponding sensitivity indices. Results: Overall 28-day ICU mortality was detected in 94 (48.70%) during an average of 12.40±4.79 days of ICU length of stay. The whole study cohort mean age was 58.37±9.96 years and the Non-Survivors Cohort were insignificantly younger than the Survivors Cohort (58.09±10.05 years vs 58.55±9.95 years, respectively, p>0.05). Significantly, males were distributed in the study in approximately a 2: 1 ratio compared to females. Biochemically, the c-reactive protein and ferritin were significantly higher in the Non-Survivors Cohort than in the Survivors Cohort (143.09±59.28 mg/dL and 891.51±377.82 ng/mL vs 88.38±34.38 mg/dL and 465.76±154.07 ng/mL, respectively, p<0.05). Conclusion: In global ever-shrinking in medical teams and facilities, elevated levels of CRP and FER can be potentially used for their reasonable performances and prognostic utilities in early risk stratification and clinical trending tracking in MVICU-SRAS-CoV-2 infected patients. Both tested biochemical prognosticators may facilitate in optimum resource provision and swift management protocols implementation.

Objectives: It appears that corticosteroidal agents, including Dexamethasone and Methylprednisolone, are the cost-effective therapeutic regarding positive clinical outcomes. The present study aims to explore the comparative positive clinical impacts of 6 mg and 12 mg IV Dexamethasone (DEX Cohorts) versus 20 mg and 40 mg Methylprednisolone (MET Cohorts) in Mechanically Ventilated Intensive Care Unit (MVICU) SARS-CoV-2 infected patients. Methods: An observational retrospective study was processed on admitted MVICU affected COVID-19 patients between Mar 2020 and Sep 2021. A One-Way ANOVA and Chi Square Tests were conducted to analyze the retrievable patients’ comparative data and to investigate the primary tested clinical outcomes of ICU length of stay and overall, 28-day ICU mortality rate. Results: The overall mean age in SARSO-CoV-2 infected patients was 59.80±10.74 years with significantly Male to Female distributed ratio of 2.42: 1. The shock index was significantly lower in the MET Cohorts compared with DEX Cohorts with Mean ± SD of (1.12±0.03 bpm/mmHg and 1.22±0.04 bpm/mmHg) vs (1.29±0.17 bpm/mmHg and 1.31±0.23 bpm/mmHg). During an average of 13.40±4.79 days and 19.67±6.81 days of the ICU and hospital stay days, the overall-28-day ICU mortality rate was stated on 136 (55.97%). Conclusion: Higher daily doses of either Dexamethasone (6 mg Q 12 hrs) or Methylprednisolone (40 mg Q 12 hrs) have significantly favorable positive outcomes [Dexamethasone > Methylprednisolone] when compared to lower daily doses of Dexamethasone (6 mg Q 24 hrs) or Methylprednisolone (20 mg Q 12 hours) [Methylprednisolone > Dexamethasone].

This study focused its objective on knowing the extent of complications that exist and generated by the type of anaesthesia on the patient. A study was conducted of 800 patients collected from different Hospitals Baghdad, Iraq. Complications were found in 120 patients. All statistical analyzes were performed for patients of age, gender and type of anesthesia used during in addition to that, the type of complications found in patients was identified and by relying on the statistical analysis program SPSS Soft 20 and MSEXCEL, the data and demographic characteristics of the patients were analyzed.

Background/Aim: A wealth of immunological evidence points out that hyperglycemic status (regardless of diabetes) makes individuals more susceptible to infection as well as higher in-hospital complications. In this study, we primarily aimed to identify the clinical and biochemical negative impacts of hyperglycemia risk factor across the two comparative cohorts. Secondly, we also explored the prognosticating utilities of three proposed BG related prognosticators in moderate-severe admitted SARS-CoV-2 infected patients. Methods: This study was retrospectively between Mar 2020 and Sep 2021. All retrievable and calculated variables were thereafter divided into two studied cohorts, Survivors Cohort (Cohort I) and Non-Survivors Cohort (Cohort II). Independent and One-Sample T-Tests and Chi-Square Test were used for comparative analysis and relative risk estimation. The Receiver operating characteristic analysis was used to explore the area under the curve and the sensitivity analysis was also performed to investigate the optimal cutoff values for the BG related prognosticators. Results: The mean age of the whole study cohort was 59.40±10.60 years and the Non-Survivors Cohort were insignificantly younger than the Survivors Cohort. Survivors Cohort had insignificantly higher average blood glucose level than Non-Survivors Cohort. Oppositely, Survivors Cohort had significantly lower average total daily insulin dosing compared to Non-Survivors Cohort. The overall hospital Length of Stay (LOS) which it was significantly lower in Non-Survivors Cohort compared to Survivors Cohort. Conclusion: As there were many cconcerns for the effect of hyperglycemia on immune cells and subsequently the overall clinical impacts, there is an urgent necessity to track the daily blood glucose levels, the changes in blood glucose from baseline, or alternatively the insulin infusion rate to keep their averages around 149.9 mg/dL, -38% and 1.35 IU/hr.

Background: Spinal anesthesia is widely considered a technique of choice for cesarean delivery. But due to fear of sudden and extensive sympathetic blockade, spinal anesthesia may not be considered safe in severe preeclampsia. Objectives: The aim of the present study was to compare the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), incidence of hypotension, phenyl ephrine requirement and neonatal outcome between normotensive and severe pre-eclamptic women undergoing cesarean section under spinal anesthesia. Material and Methods: A total of 35 severe pre-eclamptic (BP>160/110 mmHg) 3(Group A) and 35 healthy parturients (group B), meeting the inclusion criteria were included in the study. After preloading with 10 ml/kg of ringer lactate (RL) solution spinal anesthesia was administered with 12.5 mg of hyper baric bupivacaine.  Heart rate and blood pressure were recorded before spinal anesthesia and thereafter at 3 minute intervals upto 60 minutes. Hypotension was defined as MAP<30% of the baseline or a decrease in SBP to<100 mm Hg over the same time interval and was treated with 50 mcg phenylephrine intravenously (i.v). Apgar score was noted 1 and 5 min after birth. Results: The incidence rate of hypotension among the preeclamptic patients was lower than that of the healthy parturients (55.6% vs. 34.1%). The minimum SBP, DBP, and MAP recorded were lower in normotensive, and the difference between two groups was statistically significant. The mean phenylephrine requirement in the normotensive group (151.1±70) was significantly greater (p<0.0001) than that of pre-eclamptic group (48.3±35). The total doses of IV Phenylephrine for treating hypotension were significantly lower among the preeclamptic patients (72 mcg in preeclamptic patients versus 188 mcg in normotensive patients) (p<0.05). There was no statistical difference in the neonatal outcome and Apgar score in the study groups. Conclusion: Pre-eclamptics experienced less hypotension following subarachnoid block (SAB) than normotensives and required less phenylephrine with comparable fetal Apgar scores.