Fluid and salt retention have been described as a side effect of tacrolimus therapy. We report a case of unexplained massive fluid retention with pleural effusion and ascites in the immediate post-transplant period. The patient recovered immediately on conversion from tacrolimus to sirolimus.

Isolated renal mucormycosis (IRM) in an immunocompetent child is extremely rare condition and carries a grave prognosis. We report an 18-month-old child with IRM who was managed successfully with amphotericin B and nephrectomy.

Background The purpose of this study was to compare the efficacy and safety of dexmedetomidine versus dexmedetomidine and ketamine for sedation during awake fibreoptic intubation (FOI) in patients posted for elective surgeries. Ninety-eight American Society of Anesthesiologists Physical Status (ASA-PS) I–II patients with difficult airway and scheduled for elective surgeries were enrolled in this study after institutional ethics committee approval. Patients were randomly allocated into 2 groups, i.e. 49 patients in each group. Group D patients received 1 μg/kg dexmedetomidine IV over 10 min in 100-mL normal saline followed by a continuous infusion at 0.5 μg/kg/h till FOI and 5-mL normal saline followed by saline infusion. Group DK patients received 1 μg/kg dexmedetomidine IV over 10 min in 100-mL normal saline. Further, they received IV ketamine 15 mg as a bolus of 5 mL, followed by continuous infusion of ketamine at 20 mg/h until the end of intubation. The primary objective was to compare the efficacy of the combination of IV dexmedetomidine and ketamine with IV dexmedetomidine alone as sedation for FOI. Vocal cord movement, sedation, coughing, facial grimace score, recall of procedure, and haemodynamics were also compared in both groups. Results Demographic data, vocal cord movement, cough score, facial grimace score, total drugs used, hoarseness, sore throat and level of recall were comparable in both groups. Haemodynamics were significantly better in group DK at 2, 3, 4 and 5 min compared to group D. Conclusions Addition of ketamine to dexmedetomidine did not improve intubating conditions, reduce cough or improve recall of FOI. However, patients remain sedated when ketamine was used with dexmedetomidine. The study was not registered prospectively in any clinical trial registry.

Introduction: Several cases of long bone giant cell tumor have been reported in the literature. We report the case of a patient with a giant cell tumor in the distal ulna. This is very unusual, with a reported incidence of 0.45 to 6%. Case presentation: A 25-year-old female presented with a painful swelling of the right wrist. After performing a detailed clinical examination and investigations, a diagnosis of distal ulna giant cell tumor was made. The tumor was treated with an En bloc Resection, biopsy and stabilization of wrist using tri cortical bone graft. Conclusions: This tumor may have a good prognosis if it is diagnosed early and radically treated. It is important to be aware of atypical cancer localizations in order to perform a proper diagnosis.

Background Total knee arthroplasty (TKA) causes significant postoperative pain, imposing a limitation on postoperative mobilization crucial in regaining joint function. Ultrasound (US)-guided femoral nerve block (FNB) in complex knee surgeries is associated with better pain scores and fewer hospital admissions. Alpha-2 (α2) adrenoreceptor agonists have been the recent focus of interest as additives to local anesthetic. We aimed to compare the equivalent dose of dexmedetomidine and clonidine as an adjuvant to ropivacaine in US-guided FNB in TKA. A prospective, randomized, controlled, double-blinded study was conducted involving 80 American Society of Anesthesiologists’ physical status (ASA-PS) I, II, and III patients scheduled to undergo TKA under subarachnoid block. Group 1 (n = 40) patients received 1 μg/kg dexmedetomidine and group 2 (n = 40) patients with 1 μg/kg clonidine as adjuvants added to 20 ml of 0.75% ropivacaine. Duration of postoperative analgesia, pain scores, sedation scores, hemodynamics, rescue analgesia requirement, complications, and patient satisfaction were compared. Results The total duration of analgesia in group 1 was better compared to group 2 (p < 0.001). The patients were better sedated and the mean NRS scores were significantly lower (p < 0.05) in group 1 up to 24 h postoperatively. Total analgesic consumption was reduced in group 1, with a p value < 0.001. Patient satisfaction was significantly better (p < 0.001) in group 1 compared to group 2. Conclusion We conclude that dexmedetomidine added as an adjuvant in FNB increased the duration of analgesia when compared to clonidine with decreased NRS scores, reduced postoperative tramadol requirement, and better sedation and patient satisfaction. Trial registration Researchregistry6709, “Retrospectively registered” on 31 March 2021.