International Journal of Health and Clinical Research
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Dexmedetomidine as an Intrathecal Adjuvant with Hyperbaric Bupivacaine for Lengthy Lower Limb Orthopaedic Surgeries: A Randomized Double Blinded Case Control Study
Full text linkBackground: Spinal anesthesia is efficient but of limited duration. Intrathecal dexmedetomidine prolongs the sensory and motor blockade of bupivacaine. This study has been designed to evaluate the addition of 10 μg of dexmedetomidine to 0.5% hyperbaric bupivacaine 4 ml intrathecally for elective lower limb orthopaedic surgeries. Aims & Objectives: To evaluate the onset and duration of sensory and motor block, the effect on hemodynamics, postoperative analgesia, and adverse effects of intrathecal dexmedetomidine with 0.5% hyperbaric bupivacaine.Patients & Methods: This is a randomized double blinded study. Forty patients classified in ASA I & II scheduled for elective lower limb orthopaedic procedures expected to extend more than 3 hrs were studied. Patients were allocated into two groups of 20 each. Group B (n=20) received 0.5 % bupivacaine 20 mg only. Group D (n=20) received intrathecal 0.5% bupivacaine 20 mg + dexmedetomidine 10 μg. Onset and duration of the sensory block, motor block, hemodynamics, pain, and sedation were assessed intraoperatively and postoperatively for 24 hrs. The incidences of adverse effects were determined. Results: There was significant difference between the two groups as regards to spinal block characteristics. The mean duration of motor block in Group B and D were 195.5 and 385.5 min, respectively. The mean duration of sensory regression to L1 in Group B and D were 167.5 and 358.5 min, respectively. Time to 2-segment regression in Group B and D were 79.5 and 132.5 min, respectively. The mean duration of analgesia in Group B and D were 223.5 min and 326.5 min, respectively. The patients in Group D had significant prolongation of the motor and sensory block (P < 0.001). Conclusion: Intrathecal dexmedetomidine in the dose of 10 μg significantly prolongs the anaesthetic effects of hyperbaric bupivacaine and can be beneficial in surgeries of long duration, precluding the need for an epidural or general anesthesia
A cross sectional study to establish the prevalence of urinary tract infection in preterm labour
Full text linkIntroduction: The perinatal morbidity and mortality are 2-7 times more than that of term pregnancy. Preterm neonate suffers many complications during and after delivery. Hence early diagnosis and management of etiological factors is necessary. Preterm births are multifactorial in origin. Chorioamniotis, UTI, anatomical defect of uterus, placental abnormalities and defect in conceptus are the important known causes of preterm labour. Hydramnios, multiple pregnancy, malpresentation, serious maternal disease, psychological problems are other etiological factors. Materials and Methods: A cross sectional study was conducted at Department of Obstetrics and Gynecology, Hazaribagh Medical College, Hazaribagh from January 2020 to December 2020 (1 year). Detailed clinical history including age of patient, level of education, duration of antenatal care, parity, obstetrical history was taken. Gestational age was calculated from menstrual history from the first day of the last menstrual period in a 28 days cycle and/or early ultrasound examination. General examination, systemic examination and obstetric examination were done. Investigations such as Hb, Total leucocyte count, Blood sugar, Blood grouping, HIV, Hbsag, VDRL were carried out. Clean catch midstream urine samples were collected from all patients in a sterile container. Two samples were thus collected: 1st sample for microscopic examination, 2nd sample for culture and sensitivity. Results: Out of 264 cases of preterm labour studied the prevalence of UTI in preterm labour was 30.1%. Majority of respondents were between age 25-29 years which was 49.4%. Most of the patients were booked as in 77.2% of cases. Around 91.8% were from rural background. Around 75.9% belonged to the lower socio-economic class. It was found in my study that UTI was more prevalent in multipara. Prevalence of UTI among illiterates was as high as 92.4%. Majority of the respondents belonged to late preterm with period of gestation from 34 to 37 weeks. E-coli were the most common organism isolated in urine culture which accounted for 69% of the samples. Out of the cases studied only 1.3% were complicated by pyelonephritis. Conclusion: It can be concluded that all pregnant women should be screened for UTI and treated with appropriate antibiotics if the culture is positive and then retested for cure to prevent complications. In addition, health education to all pregnant females specifically those of low socio-economic class will help in preventing urinary tract infections
A prospective study of maternal and foetal outcome in prolonged pregnancy in tertiary care centre
Full text linkBackground: Prolonged pregnancy always possess a high risk, as there is a possibility of foetal distress and foetal death due to progressive foetal hypoxia following placental insufficiency. Maternal risks due to prolonged pregnancy includes labour dystocia, increase in severe perineal injury due to macrosomia, doubling inthe rate of caesarean delivery and cause anxiety. Aimed for analyse the maternal and foetal outcome, in prolonged pregnancy at tertiary carecentre. Material & Method: All the pregnant mother hospitalized after 40 weeks of gestation at Government maternity hospital, Hanamkonda are included in present study. The study was conducted form July 2019 to September 2020 and included 150 pregnant mothers who fulfilled the inclusion criteria. Result: Total of 150 pregnant women with prolonge dpregnancy consented to be part of study. The mean age of the pregnant women was 23.36±2.77, 52% of women were primigravida and 48% were multigravida. Among the women, 88% were in 40wks to 40wks6D, 10% were in 41wks to 41wks6D and 2.0% were in >42wks of gestation. Majority of new-born with birth weight of 2.5 to 3.5kg in 80% and 14.7% new-born had higher birth weight of >3.5kg. There was no significant association between themode of delivery and gestational age in present study (p>0.05). There is a significant association between the caesarean section and gravida of the pregnant women (p<0.01). There is a significant association between the gestational week with the APGAR score. Gestational age >42wks had the lower APGAR score of <4(p<0.01). Conclusion: The prolonge dpregnancy is associated with significant increased risk of perinatal complications like foetal distress. There are significant higher risk of obstetric complications such as cephalopelvic disproportion, deep transverse arrest and caesarean section. There was higher incidence of the maternal and foetal complications among the primigravida compared tomultigravida
To compare the efficacy of intravaginal misoprostol with intracervical dinoprostone gel in induction of labour at term
Full text linkIntroduction: There are various mechanical and pharmacological methods currently in use for induction of labour, however no single method or agent has been found suitable for all clinical conditions. Aims: To compare efficacy of induction of labour with Dinoprostone gel and Misoprostol with respect to induction delivery interval, type of delivery.To study the maternal and fetal outcome of both groups. Materials and methods: This randomized prospective study was conducted in 100 low risk singleton pregnant women who consented for the study and in whom cervical ripening and labour induction was indicated were studied. 50 women received Misoprostol-25μg in the posterior vaginal fornix and other 50 patients received intracervical Dinoprostone-0.5mg gel. Results: In the Dinoprostone group the mean induction delivery interval was 17.0±3.10hrs. In the Misoprostol group the mean induction delivery interval was 12.0±2.23 hrs.80% cases had a vaginal delivery and 20% had caesarean section in Dinoprostone group. In the Misoprostol group 10% cases were failed inductions, the major cause being fetal distress. There was 38% incidence of side effects of Dinoprostone of which vomiting 4% and PPH 22% were seen commonly. In Misoprostol group tachysystole 4% and hyperstimulation 6% formed the major side effects out of an incidence of 30%.There was a 6% incidence of thick meconium stained liquor in Misoprostol group, compared 2% incidence in Dinoprostone group. There was 10% incidence of NICU admission in both groups. Meconium aspiration syndrome and birth asphyxia were the major indications with an incidence of 6% and 4% Misoprostol group. Hyperbiluribinemia was the major cause of NICU admission in Dinoprostone group with an incidence of 6%. Conclusion: Misoprostol is apparently safe, efficient and a cost-effective drug for induction of labour
Computed Tomographic Evaluation for Acute Pancreatitis Diagnosis
Full text linkIntroduction: Pancreatitis is one of the most complicated and difficult to treat of all the abdominal ailments. The most prevalent diagnostic imaging modalities for pancreatic examination are USG and abdominal CT. In both diagnosing and displaying the extent, computed tomography (CT) is more accurate and sensitive than ultrasound (USG). The importance of determining the aetiology and severity of acute pancreatitis early on is critical for rapid treatment and thorough monitoring of patients with severe pancreatitis. Materials and Methods: This Hospital-based prospective study comprised of a total of 40 patients. Of 40 Cases of suspected acute pancreatitis referred to the department of Radio-diagnosis for contrast-enhanced computed tomography on the clinical suspicion/diagnosis of acute pancreatitis, altered biochemical parameters in favour of acute pancreatitis were included in this study. Results: The present study consisted of 40 patients who were suspected to havepancreatitis. The peak age of incidence was noted in 31-40 years. Etiology of pancreatitis in 23 cases (57.5%) gallstones and alcoholic comprising of 8 (20%). The contour of the pancreatic gland was irregular in 25 (62.5%) patients while in 15 (37.5%) it was regular.7 patients are normal and 33 patients had enlargement of the pancreas with focal enlargement seen in 14 patients (35%)while the 18 patients (47.5%) showed diffuse enlargement. The density of the pancreatic gland was normal in 4 (10.0%) patients; focally hypodense in 23 (57.5%) of patients, generalized hypodensities in 8 (20 %) patients, and the entire gland was distorted in 3 patients (7.5%). Organ failure, death seen in only severe category in revised Atlanta classification, moderate and severe category in modified Mortele CTSI, mild, moderate, severe category in Balthazar CTSI. Conclusions: In every case, a CT scan revealed the disease's exact morphological appearance. Using several CT numerical grading systems, CECT was particularly beneficial in staging acute pancreatitis
Assessment of awareness of cervical cancer and pap smear screening among women of reproductive age group
Full text linkBackground: Most cervical cancers are caused by the human papillomavirus (HPV), which is transmitted through sexual contact. The present study was conducted to assess awareness of cervical cancer and pap smear screening among women of reproductive age group. Materials & Methods: 90 women age ranged 20-50 years visiting the department pf Obstetrics & Gynecology were selected and a questionnaire was prepared and response was obtained form all. The responses of the study participants were scored as 1 point for a correct response, 0 for no response (don’t know), and – 1 point for an incorrect response. Results: Age group 20-30 years had 35, 31- 40 years had 23 and 41-50 years had 32 patients. Age group 20-30 years had good awareness in 15%, 31-40 years had in 20%, 41-50 years had in 12%. Good awareness was seen in those having none education in 12%, primary in 20% and secondary in 50%. Good awareness in married was seen in 35%, single in 30%, widow in 35% and separated in 40%. Skilled in 45%, unskilled in 25% and semiskilled in 30%. Rural in 15% and urban in 40%. Good awareness was seen in those having socio- economic statusI in 55%, II in 35%, III in 20%, IV in 5% and V in 0. The risk factors identified were weak immunity in 23, use of oral contraceptive pills (OCPs) in 15, many children in 45, having many sexual partners in 20, smoking in 14 and HPV infection in 19. Conclusion: Women of reproductive age group had inadequate knowledge regarding cervical cancer and pap smear screening
Study of Non compliance to Directly Observed Treatment Short-course (DOTS) at a tertiary hospital in Dhule district (Maharashtra)
Full text linkBackground: India has been engaged in TB control activities for more than 50 years. Yet TB continues to be severest health crisis. TB kills an estimated 480000 Indians every year and more than 1400 per day. Tuberculosis is a preventable & curable communicable disease requiring prolonged treatment. The therapeutic regimens recommended by WHO and used in India, under National Tuberculosis Elimination Programme (NTEP) have been shown to be very effective for both preventing and treating tuberculosis. But poor compliance to treatment is a major barrier to its control and cause for drug resistance. Study objective: Study objective was to find out extent and causes of non-compliance to DOTS at a tertiary hospital. Material and Methods: Present study was cross sectional study. Using purposive sampling method all 112 sputum positive pulmonary tuberculosis patients, registered from January 2020 to December 2020 in the DOTS centres under department of Respiratory Medicine, A. C. P. M. Medical College and Hospital, Dhule (Maharashtra) India, were included in study. Age less than 18 years and drug resistant cases were excluded. The information was obtained from treatment cards of patients. Information of non-compliant was further elicited from the patients/DOTS providers. A criterion for non-compliance (Lost to follow up) was patient missed treatment for one month or more at any time during the treatment period. Results: During study period, total 112 cases were enrolled. In present study non-compliance was observed in 9 cases (08.03 %). In non-compliant cases, majority were from 31-40 year age group (33.34 %), male (66.67%), educated up to 12th standard (44.45 %), housewives (22.22 %), labourer (33.34 %) by occupation, belonging to Kuppuswamy’s socioeconomic class V (44.45 %), living alone/with friends (11.11 %), married (77.78 %). Among non-compliant cases other factors such as alcohol consumption (22.22 %), smoking (33.33 %) & family history of TB (11.11 %) were noted. Among non-compliant cases, majority were newly diagnosed (77.78 %) followed by previously treated (22.22 %). Factors observed for non-compliance were patients feeling better so no need to continue treatment (44.45 %), side effects of drugs (22.22 %), migrated to other places (22.22 %). & fear of social stigma (11.11 %) Conclusion: In spite of one to one counseling at treatment initiation and retrieval action during follow up, non-compliance was observed in 9 cases (8.03%). Associated factors like male sex, young age, previous treatment and causes of non compliance like stopping treatment after feeling better, intolerance to anti TB drugs, migrating to other places and fear of stigma suggests improvement in health education to patient and family members, stringent follow up by healthcare providers, and use of newer treatment tracking methods
Diagnosis of breast lesions on frozen section and its cyto-histopathological correlation
Full text linkAim: To compare the finding of frozen section with findings of FNAC and histopathology & study the sensitivity, specificity and predictive value of frozen section biopsy. Methods: A hospital based cross sectional study was done to compare the finding of frozen section with findings of FNAC and histopathology. This research included total 70 female patients of age group 11-80 years clinically presenting with palpable breast lesions referred to the Department of Pathology, for FNAC, frozen section and histopathological evaluation and a prospective study was conducted. FNAC procedure was performed according to the standard protocol. Only diagnosed cases were included in the study. Cases did not undergo surgery were excluded from the study. Results: Following FNAC, out of the total 70 cases, 35 (50%) patients had benign breast lesions while 35 (50%) patients had malignant breast lesions. Following Frozen Section, out of the total 70 cases, 33 cases (47.1%) were benign lesions and 37 cases (52.9%) were malignant. According to The histopathological diagnosis of breast lesions noted that 32 (45.7%) patients had benign breast lesions while 38 (54.3%) patients had malignant breast lesions. Frozen section findings correlated with the histopathological findings in 69 of 70 cases (98.6%), which included 32 of 32 (100%) of the benign lesions and 37 of 38 (97.4%) of the malignant lesions. 1 case of malignant lesion was wrongly diagnosed as benign on frozen section findings. The correlation of frozen section and histopathological findings was found to be statistically significant as per Chi-Square test (p<0.05). FNAC findings correlated with the histopathological findings in 65 of 70 cases (92.9%), which included 31 of 32 (96.9%) of the benign lesions and 34 of 38 (89.5%) of the malignant lesions. 1 case was wrongly diagnosed as malignant on FNAC findings while 4 cases were wrongly diagnosed as benign. The correlation of FNAC and histopathological findings was found to be statistically significant as per Chi-Square test (p<0.05). The Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of Frozen section were 97.37%, 100%, 100% and 96.97% respectively. Accuracy of Frozen section was 98.57%. It was observed that frozen section was more accurate than FNAC with higher sensitivity (97.37% vs. 89.47%), specificity (100% vs. 96.88%), PPV (100% vs. 97.14%), NPV (96.97% vs. 88.57%) and accuracy (98.57% vs. 92.86%). Conclusion: Despite increasing popularity and undisputed utility of FNAC, there are cases where frozen section still stands out as the method of choice for rapid diagnosis mainly for determining the resection margins of the lesion and the extent of metastasis in case of malignant lesion to ensure no residual tumour mass thus helping in further treatment and follow-up of patients. Final histopathological study is required to accurately arrive at a definitive diagnosis along with IHC marker study which is considered as a gold standard for patient care
A Hospital-Based Study on Febrile Seizure and Iron Deficiency Anemia at A Tertiary Care Centre in Bihar
Full text linkIntroduction: Febrile seizure is the most common convulsive disorder in children which strikes 2% to 5% of children between 3 to 60 months of age. Some of the recent studies have reported that iron deficiency could be a risk factor for febrile seizure because the latter is more common in children under two years and iron deficiency anemia is also common in children of the same age. Here, we compared the iron status of children with febrile seizures and controls to investigate the association between iron status and febrile seizures in children admitted in Nalanda Medical College & Hospital, Patna, Bihar. Methodology: This prospective case control study was performed between October 2020 to September 2021. The study population consisted of 100 patients aged 6 to 60 months admitted in the Department of Pediatrics of Nalanda Medical College & Hospital, Patna, Bihar. 30 children with febrile seizures and 30 controls with febrile illness only were included in the study. The parents of all patients provided written informed consent for inclusion in the study, which was approved by the Institutional Ethics Committee. Results: The majority of FS were noted in the 6 to 24 months age group, which included more than 50% of the study subjects. Upper Respiratory Infection (URI) was the most common cause of febrile illness in our study. The mean temperature (measured from axilla) in the case group during the FS attack was 100.9 ± 2.1 °F which was significantly higher compared to the control group which was 98.2 ± 1.1 °F (p-value <0.05). Conclusion: Based on our study, there is strong evidence that parameters such as gender, peak body temperature, underlying cause of fever, & microcytic hypochromic anemia are the risk factors in occurrence of the first febrile seizure episode
A morphometric study of Mandibular Foramen in dry skulls and its clinical implications
Full text linkIntroduction The mandibular foramen (MF) is an opening which is found in the medial surface of the ramus of the mandible. It leads to mandibular canal which contains neurovascular structures such as Inferior alveolar nerve and vessels. Aims & Objective: To determine the location of mandibular foramen in relation to surrounding important reference points in dry adult human mandibles of South Indian population. Material & Methods: The study was conducted in 100 adult dry human mandibles of unknown sex obtained from the Department of Anatomy of a private medical college in Bangalore. Inclusion criteria: Intact mandibles with sockets for third molar teeth were included in the study. Damaged mandibles, mandibles with pathological abnormalities were excluded from the study. The position of Mandibular Foramen was determined using the distances of the mandibular foramen to the (a) base of mandible (MF-MB), (b) mandibular notch (MF-MN), (c) anterior border of the ramus (MF-AB) (d) posterior border of the ramus (MF-PB). The measurements were done on both sides with the help of a sliding vernier caliper. Observation & Results: The mean distance between the mandibular foramen and the base of the mandible was noted as 23.42 mm on the right side and 24.16 mm on the left side. The mean distance between the mandibular foramen and the mandibular notch was noted as 22.42 mm on the right side and 22.38 mm on the left side. There were no significant difference observed in the location of mandibular foramen in relation to the surrounding reference points between both the sides. Conclusion: The present study provides the location of the mandibular foramen in relation to surrounding important reference points in dry adult human mandibles of South Indian population