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Background:Optimizing cardiovascular function to ensure adequate tissue oxygen delivery is a key objective in the care of critically ill patients with burns. Hemodynamic monitoring may be necessary to optimize resuscitation in serious burn patients with reasonable safety. Invasive central venous pressure (CVP) monitoring has become the corner stone of hemodynamic monitoring in patients with burns but is associated with inherent risks and technical difficulties. Previous studies on perioperative patients have shown that measurement of peripheral venous pressure (PVP) is a less invasive and cost-effective procedure and can reliably predict CVP.Objective:The aim of the present prospective clinical study was to determine whether a reliable association exists between changes in CVP and PVP over a long period in patients admitted to the Burns Intensive Care Unit (BICU).Subjects and Methods:The CVP and PVP were measured simultaneously hourly in 30 burns patients in the BICU up to 10 consecutive hours. The predictability of CVP by monitoring PVP was tested by applying the linear regression formula and also using the Bland–Altman plots of repeated measures to evaluate the agreement between CVP and PVP.Results:The regression formula revealed a reliable and significant association between CVP and PVP. The overall mean difference between CVP and PVP was 1.628 ± 0.84 mmHg (P < 0.001). The Bland–Altman diagram also showed a perfect agreement between the two pressures throughout the 10 h period.Conclusion:Peripheral venous pressure measured from a peripheral intravenous catheter in burns patients is a reliable estimation of CVP, and its changes have good concordance with CVP over a long period of time.

BACKGROUNDAbdominal hysterectomy is associated with moderate-to-severe postoperative pain. Among non-opioid analgesics diclofenac, paracetamol and ketorolac are most commonly used.

Transfusion-related acute lung injury (TRALI) is a rare but serious complication of blood transfusion. We present a suspected case of TRALI in a 39-year-old female patient who underwent total abdominal hysterectomy under uneventful general anesthesia. The patient developed acute desaturation due to noncardiogenic pulmonary edema while receiving compatible blood transfusion on the second postoperative day. As her symptoms were refractory to supportive treatment, she was mechanically ventilated for 3 days and successfully extubated on the fourth day. By exclusion, a clinical diagnosis of TRALI was made. The treatment for TRALI requires discontinuing transfusion and giving respiratory and cardiovascular support. Most cases show clinical improvement in first few hours and resolve completely within 96 h.

Introduction: Chromosomal aberrations are the most frequent and significant disorders, the forms of which vary widely. It is a wellestablished fact that ultrasound-based screening for chromosomal anomalies in the first trimester should include NT measurement. Study objective was to see the effect of simulation based ultrasonography training compared with conventional training only, on performance of first year radiology residents in nuchal translucency (NT) measurement. Material and methods: This is a comparative study between two 1 st year radiology residents. The study is a single center, randomized observer-blind trial. One of the resident was trained in the conventional method. The other resident received simulation based ultrasonography training (for 2 week) in NT scan. Following the training modules, both the participants performed NT scan on 100 pregnant women using Philips Affinity 50 machine. Subsequently, those images was evaluated by a blinded experienced radiologist who scored them based on specific criteria. Results: The results showed a distinct difference in the performance of the two study participants. The participant trained in simulation fared better with higher total mean score (p value 0.009). Statistically significant difference was found between certain evaluation criteria. Conclusion: Accurate NT measurement is a demanding process. Traditional ultrasound teaching is a time consuming process using human models, direct faculty time, and a dedicated ultrasound machine. Our study is one of the first to examine skills transfer after simulationbased ultrasound training. It demonstrates that, compared with conventional training only, simulation-based ultrasound training during residency has a better immediate impact. The study showed that the use of an ultrasound simulator is an effective instrument of learning for residents. It can have reaching impact if integrated into the teaching curriculum to supplement the conventional training.