International Journal of Health and Clinical Research
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Comparative study to evaluate the clinical efficacy and safety of Isobaric Levobupivacaine Versus Hyperbaric Bupivacaine in lower limb orthopaedic surgeries
Full text linkIntroduction: Spinal anesthesia is a popular technique for lower limb orthopaedic surgeries. Hyperbaric bupivacaine in 8% glucose is often used. Clinically, this manifests as an unpredictable median sensory block height with a large inter individual spread and is occasionally associated with block failure when the spinal block has not spread high enough for surgery. Materials and Method: This is prospective and cross-sectional study conducted at Department of Anesthesia, Tertiary care teaching Hospital over a period of 1 year. Total 60 patients scheduled for elective lower limb surgeries, ASA physical status class I or II, were enrolled into this prospective randomized, double blind study. Patients were randomly divided into two groups. For Group L (n = 30); 12.5 mg 0.5% (2.5 ml) levobupivacaine, for group B (n = 30); 12.5 mg 0.5% (2.5 ml) bupivacaine heavy administered intrathecally within some 10 seconds. Results: In both groups, there is a percentage decrease in SBP (mean preoperative SBP 127.93 ± 6.50 mmHg for Group B and 128.70 ± 5.40 mmHg for Group L) and DBP (mean preoperative DBP 78.83 ± 3.42 mmHg for Group B and 80.13 ± 3.05 mmHg for Group L) after 12 minutes of anesthesia (p=0.0157); and at 50, 55, 60, 65 min incidences of hypotension have more in Group B (p=0.0445, p=0.0365, p=0.0090, p=0.0202 respectively). Duration of surgery and duration of anaesthesia were also noted. Mean duration of surgery was 94.0667 ± 26.0714 minutes (range 20 130 min) in Group B versus 95.9667 ± 16.9349 minutes in Group L (range 45 120 min. Mean duration of anaesthesia was 104.6000 ± 24.4111 minutes in Group B (range 30 140 min) versus 101.4333 ± 26.4193minutes in Group L (range 25 130 min). No significant differences between the groups (p=0.6315). Conclusions: The results of this study indicate that levobupivacaine and racemic bupivacaine show equally effective potencies for spinal anesthesia. Bupivacaine group showed earlier onset of action but there is no significant difference between levobupivacaine and bupivacaine regarding the duration of sensory and motor blockades. Intrathecal administration resulted in higher incidences of bradycardia in bupivacaine group
Demographic and Clinical Profile of Presbyopia in a Tertiary Care Centre
Full text linkIntroduction: Presbyopia is an age related loss of accommodative amplitude leading to difficulty with near vision and near work. The onset of presbyopia occurs around 40-45 years of age in most individuals. It may lead to difficultly in performing various tasks of daily routine Keeping in view the high prevalence of uncorrected presbyopia, this study was conceptualized to study the demographic profile of presbyopia, in order to create awareness among the general population, which would help us in managing this condition, more effectively. Material and methods: This observational, cross-sectional study was carried out among 500 patients who presented to out-patient clinics. Detailed medical history and ocular examination was done. Distance visual acuity was recorded with Snellen chart and near vision with Jagger’s chart. All data was entered in Microsoft excel and subsequently analyzed with OpenEpi software version 3. Results: The prevalence of presbyopia was 22.8% with mean age of 52.17±9.52 years and age range of 32- 60 years. Females were more commonly affected (75.44%) as compared to males. Most of the patients presented with difficulty in near vision (69.29%) and were emmetropic for distance vision (63.15%). Maximum patients were literate (80.7%). Homemakers and office-worker seek medical advice earlier as compared to others. Conclusions: Females were more commonly affected and had younger onset of presbyopia as comapared to males. Hypermetropia was more commonly associated with presbyopia as compared to myopia
Prevalence of Anemia in Chronic Kidney Disease in Tertiary Care Hospital of North India
Full text linkBackground: Chronic kidney disease (CKD) has emerged as a public health challenge in countries around the world. Anemia is a well-known complication in chronic kidney disease (CKD) and associated with progression of CKD, poor quality of life, and increase in morbidity and mortality.Early identification and treatment of anemia may improve CVS morbidity and mortality however, its identification and management have been reported to be suboptimal. Aim of study: This study aimed to determine the prevalence of anemia in chronic kidney disease patients in a tertiary care hospital. Methods: A cross sectional and observational study was conducted in a tertiary care hospital during the study period of August 2017 to February 2018. Results: A total of 121 participants were included to estimate the prevalence of anemia among chronic kidney disease patients. Most of the patients ( 47.10% ) belonged to the middle age group 40 to 60 years. Female patients (58.67%) were suffering from more CKD than the male patients (41.32%). Most of the patients (61.15%) were anemic. 46.28% CKD patients also suffering from diabetes mellitus. Most of the patients (54.54%) treated with oral iron agents for anemia in CKD patients. Conclusion: In this study most of the chronic kidney disease patients were anemic. Each center should determine the treatment strategy according to the patient’s characteristics. Periodic screening and intervention programs for anemia of CKD should be practiced to change the existing situation in the setting
A prospective study on role of PET-CT in the evaluation of lung masses in a tertiary care center
Full text linkBackground: Lung cancer is a leading cause of death in both men and women worldwide. For the past decades, Computed Tomography (CT) has been the gold standard imaging method in oncology. It has been used for initial staging, tumor evaluation after treatment, and follow-up of patients with cancer. The PET-CT scanners are essentially full ring coincidence detectors, the P.E.T. portion, physically mounted together with CT systems of various types. AIM: To study diagnostic role and accuracy of PET-CT in evaluating lung masses in our study population. Material & Methods: Study Design: Prospective cross-sectional study , Study area: The study was done in the Department of Radiodiagnosis & Dept.of.Nuclear medicine, Yashoda Hospital, Hyderabad. , Study Period: 1st Feb. 2011 to 30th June 2011. , Study population: patients who were recommended and referred for the evaluation of lung masses detected on chest x-ray or by CT., Sample size: All the patients who were referred for lung masses evaluation, within the study period. Samplingmethod: Purpose or convenient sampling method. Study tools: The machine used for this study is Siemens biograph sensation 16. Ethical consideration: Institutional Ethical committee permission was taken prior to the commencement of the study. Data collection procedure: After obtaining institutional Ethical clearance, the purpose of the study was explained to the patients and their consent was taken in this regard. Observations & Results: The mean and SD of age of the study population was 61.233 ± 10.101. Out of 30 patients, 10 (33%) patients were females and 20 (67%) patients were males. Conclusion: PET CT is sensitive for detecting sub clinical adenopathy and osseous involvement
Pattern of female deaths: An autopsy-based cross-sectional study
Full text linkObjective:To find out the pattern of firearm deaths including its manner and demographical aspects in Islamabad and to see institutions, administrations and planning authorities are taking remedial steps to reduce firearm deaths comprising of the most of the unnatural deaths in a society. Materials and Methods: This is a Cross-sectional study conducted at Tertiary care teaching hospital over a period of 1 year. The major sources of information reviewed in this study were the autopsy registers and autopsy reports of the police clinic, Benin City, Edo State, over 10 years. Results: A total of 200 female medicolegal autopsies were performed, accounting for 17.4% of all cases. The mean age of cases was 38.20 ± 17.39. Age group of 30–39 years accounted for 14.3% (n = 90) of cases, closely followed by the age group of 20–29 years, which accounted for 16.2% (n = 80) of cases. Accidental deaths accounted for 37% (n = 74) of cases. RTA was the most common cause of accidental deaths (n = 55; 84.4%). The most common pattern of RTA was a vehicle knocking down a pedestrian as seen in 36 cases (40.4%). The most common age group involved in RTA was 20–29 years (n = 17; 18.8%). For homicides, shotguns were mainly used (n = 25; 31.3%), distantly followed by those caused by the use of sharp objects (n = 14; 17.4%) and most cases belonged to the age groups of 40–49 years and 30–39 years (21.2% and 16.2%, respectively). In 4 (66.8%) cases, hanging was the method of choice for suicide. A majority of suicide victims (n = 2; 45%) were aged between 30 and 39 years, with an average age of 36.3. Diseases of the cardiovascular system accounted for 13.1% (n = 10) of cases, whereas pregnancy-associated deaths (excluding criminal abortions) accounted for 10% (n = 8) of cases in the natural causes group. Conclusion: There is a need to provide basic infrastructure, formulate policies, and implement them, to reduce female MLD, which a significant number of them are preventable
Retrospective analysis of clinical outcome of placental abruption in GGH Kadapa
Full text linkObjective: To determine the frequency obstetric risk factors, and the subsequent feto-maternal outcome in women suffering from placental abruption. Methods: Retrospective case series study in Dept. OF OBG, GGH, Kadapa from October 2020 to September 2021 whose gestational age crossed 24 weeks, data was collected from patient records, Variables included are age, gravida, antenatal care grade of abruption, associated complications like preeclampsia, anemia. The outcome assessed by mode of delivery, DIC, PPH, shock, ARF, preterm birth, intrauterine demise, stillbirth, NICU care. Results: Out of total Deliveries for 1 year in GGH Kadapa for the year October 2020 to September 2021 is 8747, Abruption cases are 46, gives a frequency of 0.5% of total deliveries. Out of all abruption cases, referred from the periphery were 6 in number, all others were unbooked cases. The majority of women (69.5%) were in between 20 to 30 years. The mean age was 27+/-5 years, the youngest was 19 years, and the oldest was 38 years ofage.70% were multigravida. 65% were delivered preterm before 37 completed weeks. The main mode of delivery was vaginal delivery (56.5%). The associated major risk factor was preeclampsia (63%).4.3% had PPH,4.3% went into ARF,8.6% had coagulation abnormalities,2.1 % went into shock,2.1% had liver enzyme alteration.43.5% had no fetal heart sounds at the time of admission.6.5% died after birth due to birth asphyxia. Conclusion: Abruption is an obstetric emergency. Frequency of abruption placenta is alarming high with adverse maternal and fetal outcome
Case series of Pleural effusion in Antenatal womens
Full text linkPleural diseases in pregnancy is less common in our settings compared to general population. However these group of diseases may lead to significant diagnostic dilemmas with high morbidity and mortality. Most of the symptoms may be confused with normal physiological changes. Clinicians should differentiate these diseases from normal physiological changes by meticulous history taking and clinical examination. Careful multi-disciplinary team management involving the obstetricians, paediatricians, anaesthetists, pneumologists and thoracic surgeons in intensive care settings can save lives.In this case series , We are reporting four different clinical scenarios which presented as pleural effusion in antenatal mothers with varied etiology. It is incumbent upon clinicians caring for pregnant women to be alert to distinguish between pathology and normal physiology so that they can get appropriate timely interventions
A Prospective observational study on ischemic stroke and impact of thyroid profile at a tertiary care center
Full text linkBackground: Stroke is reckoned as a major manifestation of Cardio-Vascular Diseases (CVD) and an alarming reason for long-term disability, mortality, and morbidity in India. Among the widespread endocrine disorders, Thyroid dysfunction tends to influence prognosis and stroke risks in multifarious ways. Aim: The objective of this study is to determine the possible association of serum T3 level with the severity of a stroke and post-stroke recovery. Methodology: This study included 588 patients admitted with the diagnosis of ischemic stroke who had visited the emergency department of the Indira Gandhi Institute of Medical Sciences, Patna. Patients who were above age of 18 were included in the study.Results: The findings revealed that about 273 (46.42%) patients were diagnosed with the ischemic stroke while 314 (53.40%) patients were diagnosed with haemorrhagic stroke. The average age +SD of the study was 58.2 + 12.4, and the male to female ratio was 1.45:2. Among the common risk factors determined, hypertension (76.65%) was the highest and dyslipidemia was second highest (52.98%), hemiplegia (84.12%) has been found as the most common clinical presentation. Conclusion: Increased levels of TSH might correlate with better functional outcomes, however, a low level of T3/fT3 would correlate with worse outcomes among the patients of acute ischemic stroke (AIS)
Comparative study of intrathecal low dose hyperbaric bupivacaine 7.5mg and 12.5mg hyperbaric bupivacaine using fentanyl as an adjuvant in elderly patients undergoing lower limb and abdominal surgeries
Full text linkBackground: Spinal anaesthesia for lower limb surgeries is routinely used. It provides both analgesia and muscle relaxation, has rapid onset of action. However, many geriatric patients have coexisting cardiac or pulmonary diseases, it’s very important to limit the distribution of the block to prevent the possible hemodynamic and pulmonary adverse effects by using very small doses of local anesthetics. Many adjuvants have been used to prolong the duration of spinal anaesthesia. Aim: The aim of this study is to compare intrathecal low dose bupivacaine (7.5mg) + fentanyl (25μg) and 12.5mg bupivacaine + fentanyl in elderly patients undergoing lower limb and abdominal surgeries. Material and methods: Prospective, randomized, comparative study. After obtaining the Institutional ethics committee clearance and informed consent, a total of 80 elderly patients with ASA grade II-III scheduled for elective lower limb and abdominal surgeries were recruited in this study. Study was carried out at Dept, of Anaesthesiology, Krishna institute of medical sciences, Secunderabad. Results: Onset of sensory blockade, onset of motor blockade, time for two segment regression of sensory blockade, duration of motor blockade, duration of analgesia were studied. These parameters were tested every 2minutes until complete motor and sensory levels were achieved. Hemodynamic parameters like HR,SBP,DBP,MAP were studied in both the groups, and were recorded every 5 min for first 30 min, then every 15 min till the end of surgery . Demographic variables age, sex, ASA grade, weight, height were all comparable between the two groups. Basline HR, MAP, SPO2 were also comparable between the two groups. Time for onset of sensory blockade( group A- 4.17 ± 0.446 & group B – 3.5 ± 0.599 (p value 0. 001) Onset of motor blockade ( group A- 5.28±0.504 & group B - 4.36±0.476 ( p value 0.001 ).Duration of motor blockade (group A- 116.4±7.669 & group B-232.82±13.311 p value 0.001 ), In group B, there was significant delay in two segment regression of sensory blockade ( group A- 81.05± 5.905 & group B – 129.75± 15.890 p value 0.001) and also longer duration of analgesia was seen ( group A- 177.83± 13.7 & group B - 228.80± 14.576 p value 0.001 ). Conclusion: Based on the above observations, we conclude that low dose bupivacaine(7.5mg) with fentanyl is as good as 12.5mg bupivacaine with fentanyl in elderly patients undergoing lower limb and abdominal procedures as it provides profound analgesia, good muscle relaxation, good patient and surgeon satisfaction and better hemodynamic profile
A Randomized controlled trial to compare effectiveness and side-effects of Brinzolamide and Dorzolamide among patients with high intra-ocular pressure
Full text linkPrimary open angle glaucoma [POAG] is a chronic, progressive optic neuropathy in adults in which intraocular pressure (IOP) and other currently unknown factors contribute to damage of optic nerve. Reduction of elevated intraocular pressure is the only as yet proven approach to protect against visual field loss in patients with primary open angle glaucoma or ocular hypertension. First line therapy for elevated IOP is typically is a single topical agent like dorzolamid and brinzol amide. Aim: to compare effectiveness of dorzolamide and brinzolamide in lowering IOP. Methodology: This was a randomized controlled trial conducted at the Department of Ophthalmology, Jawahar Lal Nehru hospital, Ajmer, Rajasthan during the period from April 2017 to April 2018. A total of 52 patients (104 eyes) were initially enrolled in the study. Results: Topical brinzolamide 1% is found to be better than dorzolamide 2% as monotherapy for POAG and ocular hypertension as initial drug due to lower side effect and equal efficacy. Conclusion : The results of this study also indicate that both brinzolamide bid and dorzolamide t.i.d produced a clinically significant and equivalent lowering IOP in a large percentage of patients