European Journal of Cardiovascular Medicine

Background: Paediatric cardiac surgery patients are at high risk for bleeding and the antifibrinolytic drug tranexamic acid (TXA) is often used to reduce blood loss. However dosing schemes remain empirical as a consequence of the absence of pharmacokinetic study in this population. The authors’ objectives were thus to investigate the population pharmacokinetics of  tranexamic acid (TXA) in paediatric cardiac surgery patients during cardiopulmonary bypass (CPB). Aims and objectives: To assist customize the TXA dosage; population pharmacokinetic modeling can be used to find differences in drug behaviour among various paediatric groups (e.g., based on age, weight, or other clinical parameters). To determine the difference between low dosage and high dosage tranexamic acid (TXA) in relation to activated clotting time (ACT). Materials and Methods: This is an prospective Randomized interventional comparative study in Department of Paediatric cardiac anesthesia and critical care,Shri Sathya sai sanjeevani Hospital Raipur and study duration was 1 year. The sample size of this study is 120. Result: In High dose TXA(100 mg/kg) with protamine, 5 (8.5%) patients had AP window with PMVSD, 5 (8.5%) patient had complete Atrio- ventricular canal defect, 1 (1.7%) patients had Doubly committed VSD, 2 (3.3%) patients had Inlet VSD, 2 (3.3%) patients had OS-ASD, 1 (1.7%) patient had Partial atrio ventricular canal defect, 18(30 %) patients had Perimembranous VSD, 11 (18.3%) patients had Tetralogy of fallot, 3 (5.1%) patients had TOF with Absent Pulmonary Valve, 12 (20.0%) patients had muscular VSD. In low dose TXA (30mg/kg) with protamine, 5 (8.3%) patients had OS- ASD, 45 (71.4%) patients had Perimembranous VSD, 8 (13.3%) patients had Tetralogy of fallot, 1 (1.7%) patient had muscular VSD,1 (1.7%) patient had VSD with DCRV.  Conclusion: Based on population pharmacokinetics, this study offers a useful dosage schedule for tranexamic acid (TXA) in children having heart surgery. The pharmacokinetic diversity across various paediatric age groups and weight is properly taken into account in the established dosage regimen. It guarantees the best possible therapeutic doses while lowering the possibility of side effects from both under and overdose. With its ability to be tailored to clinical practise,the program gives medical professionals a dependable ,evidence based method of administering TXA to its high risk patient group.To improve the dosage plan and validate its clinical effectiveness and safety,more validation through clinical studies will be necessary.

To conclude high dose TXA is highly effective in indian paediatric cardiac surgery patients in comparison to low dose TXA without showing any adverse effects.To further confirm this more well designed and adequately powered randomised trials are needed.

Objective: To describe coronary artery anomalies (CAAs), with emphasis on clinically significant variants, and to highlight their association with sudden cardiac death (SCD), particularly in young individuals. Materials and Methods: A descriptive overview based on existing clinical observations and literature regarding the anatomical variations of coronary artery origin and course, with particular focus on anomalies involving origin from the opposite sinus of Valsalva and their clinical implications. Results: Most CAAs were found to be benign and incidentally detected during cardiac catheterization. However, anomalies involving the origin of a coronary artery from the opposite sinus demonstrated significant clinical relevance. The interarterial course, where the artery passes between the aorta and pulmonary artery, was identified as the most critical (“malignant”) variant, showing a strong association with an increased risk of SCD, especially in younger patients. Conclusion: While the majority of CAAs are benign, certain variants—particularly those with an interarterial course—carry a high risk of sudden cardiac death. Early recognition and appropriate evaluation of these anomalies are essential for risk stratification and prevention of adverse outcomes.

Background: Thyroid nodules are common endocrine disorders, with most being benign, although a small proportion may be malignant. Accurate evaluation is essential for appropriate diagnosis and management. Fine needle aspiration cytology (FNAC), ultrasonography (USG) with TIRADS classification, and thyroid function tests (TFTs) play a key role in assessment. Aim: To analyze the cytomorphological spectrum of palpable thyroid lesions and correlate findings with sonographic and biochemical parameters. Methods: This prospective observational study included 96 patients with palpable thyroid lesions conducted over two years at K.M. Medical College and Hospital. FNAC was performed and reported using the Bethesda System for Reporting Thyroid Cytopathology. Ultrasonographic evaluation was done using TIRADS classification, and TFTs (T3, T4, TSH) were assessed using chemiluminescence immunoassay. Data were analyzed using SPSS software. Results: Most patients were in the 20–50 years age group (68.8%) and euthyroid (54.2%). Colloid goitre was the most common clinical (67.7%) and radiological (41.7%) diagnosis. Cytologically, benign lesions predominated (45.8%), with colloid goitre being the most frequent finding. Most nodules were classified as TIRADS 1 (69.8%), indicating low malignancy risk. FNAC showed adenomatous nodules as the most common diagnosis (50%), while malignant cases were rare (2.1%). Higher Bethesda categories correlated with suspicious ultrasound features such as hypoechogenicity and microcalcifications. Conclusion: FNAC combined with ultrasonography and biochemical assessment provides a reliable and effective diagnostic approach. An integrated evaluation improves diagnostic accuracy, facilitates early detection of malignancy, and supports appropriate management of thyroid lesions.

Background: Levobupivacaine and ropivacaine are long-acting amide local anaesthetics with favourable cardiotoxicity profiles compared to racemic bupivacaine. While both have been studied individually against bupivacaine for spinal anaesthesia, direct comparison of hyperbaric levobupivacaine 0.5% and hyperbaric ropivacaine 0.75% for perianal surgeries remains unexplored. This study aimed to compare the onset of sensory and motor block, duration of analgesia, and haemodynamic profile of the two agents. Methods: This prospective, randomised, double-blind study enrolled 72 adult ASA I–II patients aged 18–60 years scheduled for elective perianal surgeries under spinal anaesthesia. Patients were randomised into two groups: Group L received 2.0 ml (10 mg) of 0.5% hyperbaric levobupivacaine, and Group R received 2.0 ml (15 mg) of 0.75% hyperbaric ropivacaine intrathecally at the L3–L4 interspace using a 25G Quincke needle in the sitting position. Onset of sensory block (to T12), onset of motor block (Bromage scale 2), and duration of analgesia (time to first rescue analgesic) were the primary outcomes. Haemodynamic parameters and adverse effects were recorded. Results: The onset of sensory block was significantly faster in Group L (3.8 ± 0.9 min) compared to Group R (5.1 ± 1.2 min) (p<0.001). Onset of motor block was also earlier in Group L (5.2 ± 1.1 min vs. 6.8 ± 1.4 min, p<0.001). Duration of analgesia was significantly longer in Group R (148.6 ± 18.3 min vs. 128.4 ± 15.7 min, p<0.001). Haemodynamic parameters were comparable between groups. No significant adverse effects were noted in either group. Conclusion: Hyperbaric levobupivacaine 0.5% provides faster onset of sensory and motor block, while hyperbaric ropivacaine 0.75% offers a longer duration of analgesia. Both agents are safe and effective for spinal anaesthesia in perianal surgeries.