Journal of Chemical Health Risks (Islamic Azad University, Iran)
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Critical Care Management of Polytrauma Patient: A Comparison of Opiod based Analgesic Versus Multimodal Approaches
Get PDFBackground: Polytrauma patients require effective and safe analgesia for optimal recovery in critical care. Opioid-based analgesia, while effective, is associated with several side effects. Multimodal analgesia, which uses a combination of drugs acting via different mechanisms, has been proposed as a safer and equally effective alternative.
Aim: To compare the effectiveness of opioid-based analgesic therapy versus multimodal analgesia in polytrauma patients admitted to the ICU, focusing on pain control, opioid use, complications, and recovery outcomes.
Methods: This retrospective observational study included 200 polytrauma patients admitted to the ICU of a tertiary care center from January to December 2023. Patients were divided into two groups: opioid-based analgesia (n=100) and multimodal analgesia (n=100). Outcomes assessed included pain scores (VAS), total opioid consumption (MMEs), incidence of complications, ICU stay duration, extubation time, and opioid dependence at discharge. Statistical analysis was performed using t-tests and chi-square tests, with p<0.05 considered significant.
Results: Patients receiving multimodal analgesia had significantly lower pain scores at 12, 24, and 48 hours (p<0.01) and reduced opioid consumption (45.3 MMEs vs. 85.7 MMEs, p<0.0001). Complications such as respiratory depression (8% vs. 22%, p=0.011) and nausea (13% vs. 28%, p=0.022) were lower in the multimodal group. ICU stay (5.1 vs. 6.4 days, p=0.008) and extubation time (13.9 vs. 18.2 hours, p=0.003) were also significantly reduced. At 3-month follow-up, persistent pain and opioid use at discharge were lower in the multimodal group.
Conclusion: Multimodal analgesia provides superior pain relief with fewer complications and better recovery outcomes than opioid-based monotherapy in the ICU management of polytrauma patients. These findings support broader implementation of multimodal strategies in trauma care protocols
A Comparative Study of Evaluating Effects of Dexmedetomidine and Buprenorphine as an Adjuvant to Bupivacaine in Scalp Block for Supratentorial Craniotomy Surgeries in a Tertiary Care Hospital
Get PDFBackground: Regional anaesthesia techniques have been shown to be effective in reducing intraoperative aesthetic requirement, provide intraoperative hemodynamic stability and postoperative analgesia requirement too. Scalp block when used in patients with craniotomy provides effective analgesia for short duration; however, addition of dexmedetomidine may prolong duration of analgesia and provide intraoperative hemodynamic stability. Similar effects may be observed with buprenorphine. Hence, we aimed to evaluate effect of scalp block with addition of dexmedetomidine and buprenorphine to bupivacaine on intraoperative hemodynamic parameters and postoperative analgesia in patients undergoing supratentorial craniotomy.
Methods: We enrolled 60 patients undergoing elective supratentorial craniotomy and divided into two groups; group B received 19ml of bupivacaine 0.25% with 2mcg/kg of buprenorphine making volume of 20 ml and group D received 19ml of bupivacaine 0.25% with 1 mcg/kg of dexmedetomidine with total volume of 20 ml. Patients hemodynamic parameters were recorded intraoperatively and VAS score, rescue analgesia requirement was noted postoperatively.
Results: We found that patients were more stable hemodynamically in intraoperative period in dexmedetomidine group compared to buprenorphine group. Duration of analgesia was significantly prolonged in dexmedetomidine group. Sedation score and postoperative analgesia requirement was more in buprenorphine group.
Conclusion: Our study found that addition of dexmedetomidine and buprenorphine prolonged duration of analgesia postoperatively and provided intraoperative hemodynamic stability. However, these effects were better with dexmedetomidine group and were without much sedation and other postoperative complications compared to buprenorphine group
Beyond the Benefits: High-Dose Metformin and Emerging Metabolic Risks in type 2 diabetic patients
Get PDFIntroduction: Metformin is well-known for its several beneficial effects on diabetic complications. However, the results regarding the dose-effect relationship remain unclear.
Objectives: This study aimed to evaluate the effects of different doses of metformin on the metabolic profile and oxidative markers in Type 2 diabetes (T2D) patients.
Methods: A total of 285 T2D patients were stratified into three groups based on their metformin dosage: 500–1000 mg/day (Dose 1, n = 58), 1000–1500 mg/day (Dose 2, n = 66), and 1500–3000 mg/day (Dose 3, n = 161). A control group of 90 non-diabetic subjects was included. Metabolic (glucose, lipid profile, renal, and hepatic function), hematological and coagulation parameters, and oxidative stress markers (malondialdehyde (MDA), carbonylated proteins (CP), nitric oxide (NO), superoxide radical (O₂), catalase (CAT), and reduced glutathione (GSH)) were analyzed.
Results: Despite metformin therapy, patients displayed persistent hyperglycemia and elevated HbA1c levels, indicating suboptimal glycemic control. A dose-dependent worsening of lipid parameters was observed, characterized by increased LDL and triglycerides and reduced HDL levels, suggesting an elevated cardiovascular risk. Hematological alterations—including reduced red blood cells and hemoglobin, along with increased bilirubin and ferritin—were more pronounced at higher doses, possibly reflecting hepatic stress. Furthermore, high-dose metformin was associated with elevated inflammatory and oxidative stress markers, potentially compromising its antioxidant and anti-inflammatory properties.
Conclusions: These findings highlight a potential risk associated with higher doses of metformin in T2D patients, emphasizing the need for personalized dosing strategies and regular monitoring of metabolic and oxidative indicators to minimize adverse effects
A Cross-Sectional Observational Study on the Prevalence and Profile of Anemia in Type 2 Diabetes Mellitus Patients at a Tertiary Care Teaching Hospital in Jaipur
Get PDFAIM
This study aims to study the anemia profile in type 2 diabetes mellitus patients in Jaipur\u27s tertiary care teaching hospital.
MATERIAL AND METHODS
The study involved 210 type 2 diabetes patients. The study was a prospective, cross-sectional observational study on type 2 DM. All the necessary data were collected through a data collection form and analyzed in SPSS v.27 (IBM). P value <0.05 was considered statistically significant.
RESULTS
The study was carried out over six months among JNUIMSRC patients and patients. The patients were evaluated for demographic information, laboratory factors, and diabetes mellitus complications, as shown in the table. A total of 210 individuals were investigated, with (49%) male and (51%) female. Diabetes mellitus has become more common as people get older. Diabetes affects 4(6.55%) of people between the ages of 15 and 30 and 26(42.62%) of people over the age of >62 years. The most common type of anemia observed was normocytic. The total number of anemic patients observed was 79.52%. It was observed in this study that the prevalence of anemia was more common in the socioeconomic upper lower (IV) class and was statistically significant (0.014).
CONCLUSION
The study found a higher prevalence of anemia, especially in females, with normocytic anemia being most common. Anemia increased with age, particularly in Type 2 Diabetes Mellitus patients. Socioeconomic factors also played a role, with the upper-lower class showing the highest prevalence. These findings highlight the need for targeted interventions based on gender, age, and socioeconomic status
Comparison of Periodontal Stresses in Maxillary Anterior Teeth by Two Methods of En-Masse Retraction: A 3-D Finite Element Analysis
Get PDFIntroduction: Periodontal ligament, tooth, and alveolar bone react as deformable entities under loads. Stresses in the PDL believed to be the starting factor in tooth movement, and various types of stresses are transmitted to bone through the PDL. Therefore, it is essential to consider these tissues as continuous unit to help in quantitative assessment of stress and strain in periodontium. FEM provides an approximate solution for response of the 3-dimensional (3D) structures to applied external loads under certain boundary conditions.
Materials and Methods: Total of four models were created i.e. two models with retraction by elastomeric chain and two models with retraction by NiTi coil spring with help of implant placed at 3 mm and 5 mm height from alveolar crest. Results were represented in the form of stress diagrams.
Results: En-masse retraction with elastomeric chain showed more periodontal stresses. Increasing the height of mini-screw implant was also associated with increase in periodontal stresses.
Conclusions: For the same height of mini-screw implant, en masse retraction with elastomeric chain demonstrated a higher amount of periodontal stresses as compared to NiTi coil springs. The highest stress throughout the PDL was always present around cervical area in both types of en-masse retraction, indicating that cervical area, apart from apex, bears the most loads and might be considered as susceptible area for potential tissue damage. Increasing height of mini-screw implant more gingivally associated with more amount of periodontal stresses in both types of en-masse retraction
A Clinical Study on the Prevalence and Risk Factors of Obstructive Sleep Apnea among Chronic Kidney Disease Patients
Get PDFBackground: A common issue is that individuals suffering from Chronic Kidney Disease often remain undiagnosed for Obstructive Sleep Apnea (OSA). The incidence of OSA tends to increase as kidney function deteriorates, which poses heightened risks to cardiovascular health and metabolic processes. Early identification of symptoms and the condition itself can assist patients in improving their quality of life and enhance their prospects for recovery.
Aim and Objectives:
To identify how much OSA occurs in CKD patients at Stages 2–4 and assess risk factors for the disease.
To examine how OSA affects people in the beginning (Stages 2 and 3) and advanced (Stage 4) stages of chronic kidney disease.
To find out which factors may lead to OSA among patients with CKD.
Materials and Methods: The study included people with stable chronic kidney disease who were cared for at nephrology and internal medicine outpatient practices. We applied the CKD-EPI equation to find the stage of CKD in all patients. Stage 2 and Stage 3 were included in Group 1 for analysis, and Stage 4 was Group 2 in the same analysis. All participants had their responses evaluated with the Berlin Questionnaire. An RMS Mobile split-night polysomnography was performed to ensure and grade the level of OSA risk in patients. The information used was EEG, EOG, EMG, airflow, respiratory effort, ECG, oxygen saturation, body position, and snoring. Things looked at were the age of the patient, their sex, the duration of chronic kidney disease, diabetes, hypertension, whether fluid was overloaded, their neck size, Mallampati score, and the results of their chemical blood tests.
Results and Discussion: A significantly elevated prevalence of OSA was observed in Group 2 (Stage 4 CKD) compared to Group 1 (Stages 2 and 3). Individuals exhibiting more severe OSA were more prone to experience advanced CKD. The researchers identified several critical risk factors, including older age, male gender, diabetes, hypertension, increased neck circumference, and a higher score on the Mallampati scale. Additionally, excessive fluid retention and a prolonged duration of CKD were both associated with an increased likelihood of OSA.
Conclusion: The occurrence of OSA significantly increases in patients with CKD as their condition deteriorates. Consistently monitoring and responding to early indicators in high-risk CKD patients could potentially reduce complications and lead to improved outcomes
Comparative Analysis of Serum IL-6 Levels in Stable COPD and Acute Exacerbation of COPD Patients
Get PDFBackground: Chronic Obstructive Pulmonary Disease (COPD) is defined by chronic inflammation and progressive limitation of airflow. Exacerbations of COPD (AECOPD) are usually accompanied by higher levels of systemic inflammation and are frequently associated with increased inflammatory cytokines like Interleukin-6 (IL-6).
Objective: To evaluate and compare serum IL-6 levels in patients with stable COPD and those with AECOPD.
Methods: A cross-sectional observational study was conducted on 60 COPD patients in Uttar Pradesh University of Medical Sciences, Saifai. Patients were divided into two groups: 30 with stable COPD and 30 with AECOPD. Serum IL-6 levels were quantified with ELISA. Statistical evaluation was done using the Student’s t-test where p < 0.05 was considered significant.
Results: The mean IL-6 level of the stable COPD group was 6.4 ± 2.1 pg/mL whereas for the AECOPD group it was 18.7 ± 5.6 pg/mL. Difference was statistically significant (p < 0.001), corroborating the view that IL-6 levels increase significantly during exacerbations.
Conclusion: IL-6 levels were significantly higher in AECOPD patients compared to those in a stable phase. This suggests that IL-6 may serve as a useful biomarker for identifying and monitoring acute exacerbations in COPD patients
Development and Characterization Of Β-Cyclodextrin-Based Nanosponge Gel Containing Herbal Extract using a Quality by Design (Qbd) Approach and its Antimicrobial Activity
Get PDFThis research explores the development of a β-cyclodextrin-based nanosponge gel incorporating an extract of Bryophyllum pinnatum to enhance its antibacterial properties. The extract is rich in bioactive compounds, including tannins, phenols, steroids, glycosides, alkaloids, and flavonoids. Nanosponges were synthesized using β-cyclodextrin and diphenyl carbonate as a crosslinking agent, resulting in spherical, porous structures. The nanosponges exhibited stable particle characteristics, with an average particle size of 192.01 nm and a zeta potential of -1.2 mV. The formulated gel showed high permeability and controlled release properties. The nanosponge formulation demonstrated improved antimicrobial activity against E.coli, compared to the Bryophyllum pinnatum extract. The zone of inhibition increased with concentration, reaching up to 13 mm at 1.5 mg/mL (Table 19), compared to only 7 mm for the extract. The findings support the potential of nanosponge-based delivery systems to enhance the therapeutic efficacy of plant extracts, highlighting their promise for future biomedical applications
Drug Utilization Review of Antiepileptic Medications in Pediatric Patients: Insights from a Rural Secondary Care Hospital
Get PDFIntroduction: Seizure is one of the most common neurological disorders in pediatric populations, often requiring management with antiepileptic drugs (AEDs). Drug utilization studies play a crucial role in evaluating prescribing patterns, optimizing therapy, and improving clinical outcomes. This study aims to assess AED utilization in pediatric patients at a rural secondary care hospital, providing insights into current treatment effectiveness and safety.
Aim: The study aims to evaluate the prescribing patterns of AEDs in pediatric patients and analyze the safety and efficacy of various AED regimens in a rural healthcare setting.
Study Design: A prospective, observational study involving pediatric inpatients at a rural secondary care hospital was conducted over a six-month period, from December 2023 to May 2024.
Methodology: The study includes 120 pediatric patients aged 1–14 who are prescribed AEDs. Data are collected on demographics, seizure types, AED regimens (monotherapy, dual therapy, polytherapy), and adverse drug reactions (ADRs). The causality of ADRs is assessed using the Naranjo Causality Assessment Scale. Statistical analysis is performed using SPSS V.17 to identify patterns and associations between seizure types, drug utilization, and clinical outcomes.
Results: The results show that 51% of the patients are aged 1–5 years, with tonic-clonic seizures being the most common type (23.3%). Clobazam is the most frequently prescribed AED (49%), followed by sodium valproate (34%) and midazolam (36%). Monotherapy is administered to 32% of the patients, dual therapy to 54%, and polytherapy to 8%. A seizure-free rate of 87% is observed, while 10% of patients report 1–2 episodes, and 3% experience more than two episodes. ADRs, primarily associated with phenytoin, include ataxia, rashes, and lymphadenopathy, leading to drug discontinuation in some cases.
Conclusion: This study highlights the prevalent use of Clobazam and the efficacy of dual therapy in managing pediatric seizures. The findings underscore the importance of continuous monitoring for ADRs, particularly in patients receiving phenytoin, and the role of clinical pharmacists in optimizing therapy. The high seizure-free rate suggests that AED regimens, when tailored to seizure type, can significantly improve outcomes in pediatric populations, particularly in rural healthcare settings
Unlocking Implant Planning: A Retrospective Cone Beam Computed Tomography Study of Inter-Radicular Septum in Immediate Maxillary Molar Implant Placement
Get PDFThis study highlights the assessment of inter radicular septum (IRS) on cone beam computed tomography (CBCT) as an important pre-treatment tool for immediate maxillary molar implant (IMI) placement. Aim: To evaluate the suitability of inter radicular septum (IRS) of the maxillary first and second molars using cone beam computed tomography to receive immediate implant placement. Objectives: To measure and compare IRS dimensions of the first and second molars and to assess the suitability to house an immediate implant. Method: A total OF 120 CBCT scans that displays IRS completely were selected for the study. The IRS was analyzed in all three dimensions and apex to floor of maxillary sinus dimension is also analyzed. Result: This study concludes more significant IRS in maxillary first molars when compared to the second molars, hence first molars were eligible sites for IMI placement