Browsing by Author "Atul Kumar Singh"

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A 2x1 oral care strategy (2% chlorhexidine + 1% sodium bicarbonate) significantly lowers VAP rates in mechanically ventilated CKD patients
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2025) Subash Sankaralingam; Arvind Bhalekar; Atul Kumar Singh; Sandeep Loha; Sanjeev Kumar; Aditya Prakash Nayak
Background & objective: Chronic kidney disease (CKD) patients in the ICU have elevated ventilator-associated pneumonia (VAP) risk. Chlorhexidine (CHX) oral care is standard, but efficacy may be enhanced by adding sodium bicarbonate (NaHCO₃) to alkalinize the oral environment and inhibit pathogenic colonization. We conducted this study to determine whether combining 2% CHX with 1% NaHCO₃ reduces VAP incidence versus CHX alone in mechanically ventilated CKD patients. Methodology: In this prospective, randomized, double-blind, placebo-controlled trial, 100 CKD patients (18–65 yrs) ventilated > 48 h were randomized to 2% CHX + 1% NaHCO₃ (n = 50) or 2% CHX + saline placebo (n = 50) twice daily for 5 days. Primary outcome: VAP incidence (CPIS ≥ 6 + clinical/radiological criteria). Secondary: oral pH, oropharyngeal colonization, microbiology, ventilation/ICU/hospital stay, mortality. Data analyzed with appropriate parametric/non-parametric tests; P < 0.05 significant. Results: Baseline characteristics were comparable. VAP incidence was halved with combination care (16.0% vs 32.0%; P = 0.048), with delayed onset (median 4.5 vs 3.0 days, P = 0.032) and higher Day-5 VAP-free survival (84% vs 68%). Oral pH rose significantly from Day 3 in the intervention arm (Day 5: 7.54 vs 7.29; P = 0.001). Heavy oral colonization was lower, but non-significant. MDRO rates (37.5% vs 56.3%) and carbapenem resistance were reduced. Ventilation duration (6.2 ± 2.1 vs 7.8 ± 2.5 days, P = 0.004) and ICU stay (8.9 ± 3.0 vs 10.5 ± 3.4 days, P = 0.011) were shorter. However, the mortality differences were non-significant. Conclusions: In high-risk CKD ICU patients, adding 1% NaHCO₃ to standard 2% CHX oral care halved VAP incidence, delayed onset, improved oral pH, reduced resistance rates, and shortened ventilation/ICU stays. This simple, low-cost measure warrants incorporation into VAP prevention bundles. © 2025, Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
A Comparative Reading of Pāṇinian Grammatical Tradition and Modern Science of Speech; Сравнительный анализ грамматической традиции Панини и современной науки о речи
(Belgorod State National Research University, 2025) Prabha Shankar Dwivedi; Atul Kumar Singh
The modern history of Western linguistics began with comparative philology and coincided with the colonisation of the East for a long time. The colonisation as a process not only involved an interplay of power, dominance and state, it was also a conquest of knowledge. Colonies such as India had a vast rubric of ancient knowledge and especially excelled in linguistics and philology. This paper is an attempt to showcase how the roots of various phonetic and phonological theories that defined and dominated modern linguistics were linked to the ancient Indian grammatical tradition. Scholars from Pāṇinian School of Grammar, such as Pāṇini, Kātyāyana, Patañjali, and Bhartṛhari, have explained a range of speech phenomena to which modern phonetics and phonology correspond significantly. This paper analyses the common grounds between prominent schools of Western phonology and their Indian counterparts and thus highlights a significant theoretical overlap between the knowledge offered by the Western linguistic schools and what was explained several centuries back by prominent Indian grammarians. From the linking of sounds to the psychological reality of a phoneme, the vast canvas of the Indian linguistic tradition could be verifiably seen as a precursor to the most of the structural turn in the twentieth century. Finally, the paper attempts to show the precedence of various recent concepts and theories, such as ‘distinctive feature theory’ or ‘generative grammar’ in the texts like Aṣṭādhyāyī and Vākyapdīya. © (2025), (Belgorod State National Research University). All rights reserved.
A randomized, double blind study comparing fentanyl with ketamine for transient chest discomfort/pain during LSCS under spinal anesthesia
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2017) Yashpal Singh; Shashi Prakash; Neeraj Kumar; Atul Kumar Singh; Bikram Kumar Gupta; Ram Badan Singh
Objective: Intraoperative transient chest discomfort/pain is a common problem during lower segment cesarean section (LSCS), incidence ranging from 30-60 %. Only a few drugs are available to treat it due to concerns regarding maternal and fetal safety. Fentanyl is commonly used but has limited or no availability in most of India especially in rural areas. So we planned this study to compare ketamine as alternative to fentanyl to treat this chest discomfort/pain. Methodology: This prospective, randomized, double blind study was carried out on sixty patients aged above 18 years, of American Society of Anesthesiologist (ASA) grade I or II scheduled for elective LSCS under spinal anesthesia, who complained of chest discomfort/pain within 15 min of delivery of baby. The parturients were randomly divided into two groups. Group F to receive inj fentanyl 1 μg/kg and Group K to receive inj ketamine 0.25 mg/kg intravenously immediately after complaining of chest discomfort/pain. Duration of surgery, time of onset of pain, time required to relieve pain, hemodynamic parameters, adverse event and duration of postoperative analgesia were observed. The drugs were compared by using equivalence test; Two-One-Sided-Test (TOST). Results: There was no difference in demographic profile and baseline parameter in both groups. After drug administration chest discomfort/pain was relieved in both groups effectively in 1.15±0.83 min vs. 1.23±0.48 min in Group F and Group K respectively, without any significant adverse event. Conclusion: Low dose ketamine can be used as alternative to fentanyl for transient retrosternal chest discomfort/pain during LSCS.
Hemodynamic Profiles of Etomidate versus Propofol-phenylephrine Combination for Induction of Anesthesia in Adult Cardiac Surgical Patients
(Wolters Kluwer Medknow Publications, 2025) Molli Kiran; Sri Rama Ananta Nagabhushanam Padala; Seema Seema; Atul Kumar Singh; Anagha P. Vinay; Swati Panwar
Background: Etomidate (ET), a cardiostable drug, is preferred to propofol while inducing anesthesia in patients with cardiac disease or sepsis despite concerns of increased mortality due to adrenocortical suppression. Phenylephrine (PE) was coadministered to counteract the hypotension associated with the propofol induction with success in low-risk patients undergoing noncardiac surgery. The primary objective of this prospective observational cohort study was to compare the incidence of hypotension at induction with ET versus propofol-PE (PP) combination in patients undergoing elective cardiac surgery. Materials and Methods: Group ET patients (n = 45) received ET, and group PP patients (n = 45) received a PP mixture (20 µg PE in every 10 mg of propofol) in titrated doses for anesthesia induction. The heart rate and mean arterial pressure (MAP) were recorded at 21 time points (baseline and every 30 s for 10 min after induction). Hypotension (fall in MAP more than 20% from the baseline) was managed by administering rescue bolus PE 1 μg/kg. Results: In groups ET and PP, respectively, there were 28 and 37 patients (P – 0.264) who had hypotension requiring 41 and 52 rescue PE doses (P – 0.254), during the first 10 min after induction of anesthesia. ET group patients had a significantly higher number of time points with hypertension (67 in group ET vs 14 in group PP; P < 0.0001) and tachycardia (124 in group ET vs 52 in group PP; P < 0.0001) after direct laryngoscopy and intubation. Conclusion: The incidence of hypotension is comparable in both the groups with PP combination attenuating the hemodynamic response to the intubation better. © 2025 Annals of Cardiac Anaesthesia.
The effects of 2,4-dichlorophenoxy acetic acid and isoproturon herbicides on the mitotic activity of wheat (Triticum aestivum L.) root tips; [Bugday kök uçlarina (Triticum aestivum L.) 2,4-diklorofenoksi asetik asit ve izoproturon herbisitinin etkisi]
(2010) Sanjay Kumar; Shashi Kiran Arya; Bijoy Krishna Roy; Atul Kumar Singh
The effects of the herbicides 2,4-dichlorophenoxy acetic acid and isoproturon on 3 wheat (Triticum aestivum L.) varieties (HUW 234, HUW 468, and HUW 533) were studied with regards to mitotic abnormalities and chromosomal behavior. Pre-soaked seeds were treated with both herbicides at concentrations of 50-1200 ppm. Both 2,4-D and isoproturon were highly mito-inhibitory and induced chromosomal abnormalities, such as precocious movement, stickiness, and chromosome bridges, with and without laggards and fragments at the anaphase and telophase. The frequency of chromosomal anomalies in almost all the targets used was high at the maximum dose of both herbicides, individually as well as in combination. Isoproturon was more toxic, as it resulted in high-level chromosomal damage in all the varieties. Both herbicides had a dose-dependent impact on the mitotic index (MI) and relative abnormality rate (RAR). These parameters collectively indicate that variety HUW 468 was more susceptible to the mito-depressive and chromotoxic action of the 2 herbicides. © TÜBITAK.