Background: Airway management is critical in trauma patients, where the risk of aspiration and respiratory compromise is high. Supraglottic airway devices (SGAs) are often utilized when endotracheal intubation is difficult or has failed. This study aims to compare the esophageal seal pressure (ESP), oropharyngeal leak pressure (OLP), and other performance parameters of the I-gel and I-gel Plus in a simulated setting. Materials and methods: This study was conducted in a simulation laboratory using a high-fidelity manikin modified to measure ESP. ESP was determined by adding methylene blue-stained water to a vertically positioned tube connected to the esophagus and observing the height of liquid leakage into the oral cavity. Each SGA was tested three times, with insertion performed by an experienced anesthesiologist. Additional parameters evaluated included OLP, insertion time, and the success and timing of blind and fiberoptic-guided endotracheal intubation. Results: The ESP of the I-gel Plus was higher than that of the I-gel in all attempts, indicating improved esophageal sealing. The OLP and insertion time for the I-gel Plus were also superior. Blind intubation success rates and time for both blind and fiberoptic-guided intubations were better with the I-gel Plus. Conclusion: The I-gel Plus demonstrated superior performance compared to the I-gel, with higher ESP and OLP, faster insertion, and improved intubation success rates. These findings suggest that the I-gel Plus may provide enhanced airway protection and ease of use in trauma and emergency settings. Further clinical studies are needed to validate these findings.

Background: Predictive modeling demonstrated high sensitivity for outcomes but faced challenges in accurately predicting mortality. Settings and design: This study was conducted in patients admitted to the Neuro intensive care unit (ICU) in a tertiary care hospital. Materials and methods: This retrospective observational study was conducted on 2,144 patients admitted to the neurosurgical ICU at King George's Medical University, Lucknow covering data from October 1, 2023 to September 30, 2024. Data collection focused on variables essential for outcome analysis, including demographics, primary diagnoses, computed tomography (CT) and magnetic resonance imaging (MRI) imaging findings, treatment modalities, and final discharge statuses. Observations: It revealed a prevalence of conservative management for diffuse axonal injuries (DAIs) and a strong correlation between CT imaging findings and treatment decisions. This report lays the foundation for applying artificial intelligence (AI) in neurosurgical ICU, with suggestions for further dataset balancing to enhance predictive utility. Conclusion: This analysis highlights the application of AI for significant patterns in neurosurgical ICU outcomes, with a notable reliance on conservative management for severe neurotrauma cases.

Background: The COVID-19 pandemic has been accompanied by a surge in secondary complications, including mucormycosis, a rare but potentially fatal fungal infection. This study investigates the risk factors associated with mucormycosis in COVID-19 patients, aiming to inform clinical practice and improve prevention and management strategies. Materials and methods: A retrospective case series was conducted at King George's Medical University, Lucknow. Data were collected from 30 patients diagnosed with mucormycosis and a history of COVID-19 between May 2021 and October 2021. Demographic, clinical, and therapeutic information was analyzed. Descriptive statistics were used to summarize findings, focusing on comorbidities, treatments, and disease outcomes. Results: Among the 30 cases, 96.67% had rhino-orbito-cerebral mucormycosis. Diabetes mellitus was the most common comorbidity (83.33%), with 20% newly diagnosed. Corticosteroid use was noted in 33.33%, while 66.67% reported zinc supplementation during COVID-19 treatment. Oxygen therapy, including high-flow oxygen and noninvasive ventilation, was recorded in 33.33% of cases. Imaging techniques such as computed tomography and magnetic resonance imaging were crucial for diagnosis in cases with negative potassium hydroxide (KOH) mount results. Conclusion: This study underscores the multifactorial nature of COVID-19-associated mucormycosis, with diabetes mellitus, steroid use, and zinc supplementation emerging as significant risk factors. Strict glycemic control, judicious steroid use, and cautious zinc supplementation are critical in preventing this life-threatening complication. Further studies are essential to refine these findings.

We present a case series of four patients with severe traumatic brain injury (TBI) and neurogenic fever (NF), admitted to the intensive care unit. Each patient exhibited refractory fever unresponsive to standard antipyretic and cooling measures. Baclofen therapy was initiated at doses ranging from 10 to 20 mg, administered via enteral route, and titrated as needed. In all cases, baclofen led to a significant reduction in fever episodes within 24 hours of initiation. Complete resolution of hyperthermia was achieved within 48 hours in three patients and 72 hours in one patient. Baclofen was well-tolerated, with no adverse effects observed. Fever did not recur during tapering or cessation of therapy. This case series highlights the efficacy and safety of baclofen as an adjunctive treatment for NF in TBI patients. Baclofen offers a targeted therapeutic approach by addressing the hypothalamic dysregulation underlying NF. Larger, controlled studies are warranted to validate these findings and establish standardized treatment protocols.

Unanticipated difficult airway management is a critical challenge in anesthetic practice, with potential catastrophic outcomes, especially in cardiac surgical patients. This vulnerable population is prone to hemodynamic instability during airway manipulation, heightening the risk of adverse events. Supraglottic airway devices (SADs) have emerged as valuable tools for rescue ventilation in such emergencies, offering rapid airway establishment and hemodynamic stability. We present three cases of unanticipated difficult airways in cardiac surgical patients, where SADs—specifically the I-gel and Ambu AuraGain—were successfully utilized for ventilation and as conduits for fiberoptic-guided endotracheal intubation. In all three cases, SADs were successfully placed following failed intubation attempts, ensuring immediate restoration of oxygenation and ventilation. These devices allowed fiberoptic-guided intubation without further airway trauma or hemodynamic compromise. No airway-related complications were observed in the perioperative period. Incorporating SADs into airway management protocols may help in managing challenging clinical scenarios.

Background: Loculated pleural effusion, characterized by fibrinous septations within the pleural space, poses a significant challenge to effective drainage, leading to persistent symptoms and increased morbidity. Intrapleural fibrinolytic therapy, using agents such as streptokinase, has emerged as a minimally invasive alternative to surgical interventions for managing loculated effusions. This case series highlights the use of intrapleural streptokinase in three patients with loculated pleural effusion due to distinct etiologies, demonstrating its efficacy in facilitating fluid drainage and improving clinical outcomes. The first case involved a 54-year-old male with bilateral loculated pleural effusions following mitral valve replacement surgery. The second case described a 38-year-old male with traumatic hemothorax, where streptokinase facilitated the drainage of 1,500 mL of fluid, allowing lung re-expansion. The third case detailed a 56-year-old male with empyema, where streptokinase led to complete drainage of 1,200 mL of purulent fluid. Intrapleural streptokinase proved to be an effective and safe adjunct in managing loculated pleural effusions, reducing the need for invasive procedures and enhancing recovery. This series underscores its role as a valuable therapeutic option in diverse clinical scenarios.

Peripartum cardiomyopathy (PPCM) is a rare, yet potentially life-threatening condition characterized by left ventricular systolic dysfunction that occurs during late pregnancy or the early postpartum period. Bromocriptine, a dopamine receptor agonist, inhibits prolactin secretion and has shown promise as an adjunctive therapy for PPCM. We present a case series describing four patients with severe PPCM successfully managed with bromocriptine in conjunction with standard heart failure therapy and thromboembolic prophylaxis. All four patients had severe symptoms of heart failure, including dyspnea, fatigue, and reduced left ventricular ejection fraction (LVEF) ranging from 20 to 35%. Bromocriptine therapy was initiated along with the standard heart failure treatment. Clinical improvement was observed within days of initiating bromocriptine, with progressive recovery of cardiac function. Follow-up echocardiography demonstrated significant improvement in LVEF, reaching 45–55% after discharge. Bromocriptine, as an adjunct to standard therapy, shows promise in improving outcomes in PPCM patients.

Aim and background: Meckel's diverticulum (MD) is a common congenital anomaly, typically asymptomatic and often overlooked. Spontaneous perforation of MD is an extremely uncommon but life-threatening complication that can lead to significant morbidity and mortality. Case description: We describe a case of spontaneous perforation of MD in a middle-aged female with common variable immunodeficiency, decompensated liver disease, and coeliac disease. The patient presented with acute onset fever with chills and diarrhea with pain and progressive distension of the abdomen. Clinical examination and investigations suggested bowel perforation, for which emergency laparotomy was done. Conclusion: Our case report emphasizes that perforated MD should be considered as a differential diagnosis in immunocompromised patients with acute abdomen. A multidisciplinary approach is needed for accurate diagnosis and appropriate management of these patients. Clinical significance: In immunocompromised patients with acute abdomen and evidence of perforation of hollow organs, the differential diagnosis should include MD perforation.