International Journal of Health and Clinical Research
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A Comparative Study of Two Different Doses of Dexmedetomidine on Attenuation of Stress Response to Endotracheal Intubation in Patients Undergoing Elective Surgeries Under General Anaesthesia
Get PDFIntroduction: Under general anaesthesia, laryngoscopy and endotracheal intubation elicit a strong sympathoadrenal response with potentially fatal implications in individuals with cardiovascular and cerebrovascular illnesses. To counteract this reaction, a variety of pharmacological treatments have been used.Aim: The present study was planned to compare the effects of two different doses of dexmedetomidine (bolus doses) on attenuation of stress response to Laryngoscopy and Endotracheal Intubation. Materials & Methods: A Randomized double-blinded prospective comparative study. Sixty patients of both sex (ASA grade I or II) undergoing GA were randomly divided into two groups equally as Group A (dexmedetomidine 1μg·kg− 1) and Group B (dexmedetomidine 0.5μg.kg− 1). Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at baseline, after completion of infusion (T1), 1 min (T2), 3min (T3), 5min (T4), & 10min (T5) following intubation.Results: The Student’s independent t-test was employed for comparing continuous variables. Chi-square test or Fisher’s exact test, whichever is appropriate, was applied for comparing categorical variables. Immediately after intubation, there was a lesser rise of SBP, DBP, and MAP in both the groups but there was a significant reduction in pressure values in group A at 1 minute after intubation compared to group B. Conclusion: Dexmedetomidine at a dose of 1μg·kg-1administered over 10 minutes before induction of general anaesthesia more effectively attenuates the haemodynamic response to laryngoscopy and intubation than dexmedetomidine 0.5μg·kg-1infusion over the same period, without any significant adverse effects
Clinical profile and outcome of patients on Maintenance Hemodialysis hospitalized with Covid 19 infection – A retrospective study from a tertiary care centre of Eastern India
Get PDFBackground: Patients on maintenance hemodialysis (MHD) are more vulnerable to SARS-CoV-2infection because of uraemia related immune dysfunction leading to impaired immune defences and pro-inflammatory state, increased comorbidity burden, frequent hospital admissions and the risk of cross-contamination in the dialysis centres. Presence of comorbidities is associated with poor outcome.This study primarily designed to assess the clinical profile, treatment and outcome in MHD patients hospitalized with COVID-19 infection. Methods: This was a retrospective hospital record based study, including all the patients on MHD admitted with COVID-19 infection between1st may2020 to 1st March 2021. Categorical and Continuous variable were presented as proportions and mean SD.The statistical significance level was set at 0.05 (two-tailed). Results: 56 patients(Male 47 and Female 9) on MHD were admitted during the study period.We observed that half of the patients admitted survived and were discharged from the hospital and median hospital stay being 13.5 (6-17) days.The mean age of non survivors was significantly higher as compared to survivors. 56.9 years (14.9) vs 47.8 (16.8)years (P0.05)No statistical significant difference was found in outcome based on gender or comorbidities. Significantly higher mortality was noted among patients on invasive ventilation (87.1%) Among lab variables Lymphopenia and hypoalbuminemia were significantly associated with poor outcome. Conclusions: We observed a high mortality rate among maintenance hemodialysis patients hospitalized for COVID-19.Lower serum albumin and lymphocyte count at admission were associated with poor prognosis
A cross sectional study of magnitude of diabetic retinopathy in outpatients presenting with cataract in a secondary care hospital
Get PDFIntroduction: Patients with cataract most often have retinal pathology which may affect the visual prognosis and outcome following cataract surgery. Diabetic retinopathy and age-related macular degeneration are both age dependent diseases of retina which manifest around the same age as cataract. Also, the occlusive diseases affect the patients in the senile cataract age group. Materials and Methods: This study was a Cross Sectional Study conducted in the Department of Ophthalmology, Govt Medical College Baramulla for a period of one and half years from January 2020 to June 2021. Around 900 patients with complaints of defective vision who attended the outpatient department and diagnosed to have cataract are screened. Among them 100 patients were found to have posterior segment pathologies. Patients with normal posterior segment, patients with glaucoma and patients with vitreoretinal diseases other than diabetic retinopathy were excluded from the study. Results: In our study 40% were found to have diabetic retinopathy of various stages. There is a significant association of NPDR with respect to CSME and there is highly significant association (p<0.01) of disease progression to advanced diabetic eye disease after the disease enters the PDR stage. Conclusion: There is a significant impact on vision secondary to vitreoretinal diseases which show increase in incidence with age. The more severe the diabetic retinopathy, the worse is the visual prognosis. In cataract patients, early detection and prompt treatment of retinal diseases like diabetic retinopathies and vaso-occlusive diseases can prevent their progression and there by improve the visual outcome following cataract surgery
An observational study on serum electrolytes among patients with acute exacerbations of chronic bronchial asthma at a tertiary care hospital of Bihar
Get PDFIntroduction: Abnormal electrolyte levels in patients with bronchial asthma can be attributed to either low dietary intake or to adverse effects of asthma medications. Hypokalemia has been reported as an electrolyte disturbance in acute asthma. This study was aimed at assessing the levels of serum electrolytes in patients with acute exacerbation of bronchial asthma and comparing them against non-asthmatic controls. Materials and Methods: This observational study was conducted on Department of Biochemistry of, Darbhanga Medical College & Hospital, Laheriasri, Bihar, India from June 2021 to May 2022. The study population comprised of samples obtained in the department from patients who presented with complaints of acute exacerbation of bronchial asthma in the Emergency Department of the hospital. During the study period, samples from a total of 100 asthmatic patients were included. For comparison, I obtained samples from the Emergency department from 100 age and gender matched controls that were not asthmatics. The study was approved by the institutional ethics committee. The data collected were analyzed by SPSS version 20. Results: A total of 200 patients were included in the study, 100 in each group, cases and controls. Both the groups were age and gender matched. The mean (SD) age of cases was 38.9 (14.7) years for cases and 40.4 (12.9) years. There was male preponderance noted in both the groups. T test for age and gender showed a p value of >0.05, that means the groups were comparable. Except for mean serum chloride, all the electrolytes had mean value lower among cases as compared to controls. Among cases, the mean serum sodium, calcium and magnesium were significantly lower than that of control population. Conclusion: The present study showed that there was a significant decrease of sodium, magnesium and calcium levels during exacerbations in asthmatics
Study of Serum total protein, albumin and globulin Level in Children with Malarial Infection in Civil Hospital, Ahmedabad
Get PDFIntroduction: Malaria is a major protozoal disease in many developing countries that is main cause of for 20-30 lakhs deaths per year. This study will give us a proper view for monitoring and management of these patients. Material and Method: Fifty children with Malaria are included in the study as cases and equal number of age and sex matched healthy children formed the control group. Study is conducted during the period of August 2014 to October 2016. Result: there is significant difference in serum Total protein levels in cases and controls (p value is 0.0393). And in serum albumin levels in cases and controls (p value is less than 0.0001) and in serum globulin levels in cases and controls (p value is 0.0114). Conclusion: Children having malaria has low serum total protein, albumin and globulin as compare to healthy individuals. Impairment of hepatic function associated with severe malaria may be responsible for the hypoproteinemia and hypoalbuminemia reported in this study. Moreover, plasma albumin is a negative acute phase protein, the level of which falls as a result of malaria infection probably due to an increase in its trans-capillary escape rat
A comparative study of hemodynamic response with Laryngoscopic endotracheal intubation and laryngeal Mask airway insertion in hypertensive patients
Get PDFBackground:The hemodynamic response which has been associated with laryngoscopy and tracheal intubation may be harmful to certain patients. The laryngeal mask airway decreases the need for laryngoscopy and provides positive pressure ventilation in appropriate patients.Aim:This is a comparative study of hemodynamic response with laryngoscopy and endotracheal intubation and LMA insertion in hypertensive patients.Materials and Methods:60 Hypertensive patients aged between 40 to 60 years of either sex of ASA grade II were randomly allotted into two groups of 30 each, group ET and group LMA. LMA insertion or tracheal intubation was performed after inducing with propofol and muscle relaxation with succinyl choline. Anesthesia was maintained with isoflurane, oxygen and nitrous oxide, the heart rate, SBP, DBP, mean arterial pressure were measured after induction and immediately after insertion / intubation and then after 1, 3, 5 minutes.Results:There was a significant difference (p < 0.000) in mean increase in heart rate (38.23% in group ET versus 28.26% in group LMA). The increase in arterial pressure was also significant. The SBP increased 40.16% in group ET compared with 37.60% in group LMA (p< 0.000). The DBP was also increased by 22.73% and 14.23% in group ET and group LMA respectively. The MAP values were maximum after airway instrumentation. However, we found that the values after LMA insertion were significantly low compared to tracheal intubation for the first 3 minutes.Conclusion:The data suggest a similar, but attenuated response associated with mask insertion in comparison to laryngoscopy and intubation. Hence use of LMA may offer some advantage over tracheal intubation in anesthetic management of patients where avoidance of pressure response is of particular concern
Autologous serum eye drops V/S Lubricating Eye Drops in Treatment of Dry Eye Disease
Get PDFPurpose – To compare efficacy of Autologous serum eye drops vs that of Lubricating eye drops in patients of Dry eye disease.Methods –A single blind randomised control trial was conducted over a period of 6 months (from June 2022 to December 2022 after due approval fromdepartmental ethics committee.378 patients who visited our OPD with typical complaints of Dry eye disease (due to any cause) were given theoption of centrifuging a small quantity (10 ml) autologous blood and use eye drops prepared from its serum or go with conventional eye drops.90patients chose autologous serum eye drops (Group A) where as rest were alternatively given CMC(0.5%w/v) and sodium hyaluronate (0.1 to0.3%w/v) and patients were asked to follow-up after 15days,30 days and 90 days. Schirmer I test score, and tear film break up time (TF-BUT)were used as efficacy parameters. Safety was monitored on all visits.Subjective Improvement in symptoms were duly noted. The scores ofSchirmer I test improved in both Gorup A as well as Group B, but a greater improvement was seen in Group A (at day 90: 22.75 ± 3.04 mm vs.21.78 ± 3.36 mm, P: 0.04). The values of TF-BUT improved in both groups, the difference being statistically insignificant.Conclusion- Autologous plasma was almost equally effacious with slightly more improvement seen in TBUT while CMC and Sodiumhyaluronate tear substitutes were equally efficacious and all three were safe in reducing symptoms of dry eye
Maternal and Perinatal Outcomes in Hypertensive Disorders in Pregnancy
Get PDFIntroduction: Preeclampsia refers to the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. Pregnant women with preeclampsia are at an increased risk of adverse maternal, fetal and neonatal complications. The objective of the study is, therefore, to determine the maternal and perinatal outcome of preeclampsia without severity feature among women managed at a tertiary referral hospital in ASRAM, eluru. Materials and Methods: All patients beyond 20 weeks with pre-eclampsia admitted to ASRAM Hospital during two-year study period were enrolled in the study.Sample size is 100.The objective of this study was to analyze the type and rate of maternal and perinatal complications in preeclampsia. Women with preexisting renal disease, chronic hypertension, anemia, heart disease, epilepsy, thrombophilias, hemolytic disease, preexisting liver disease were excluded from the study. Obstetrics management was done as per existing protocol in the department. Magnesium sulphate was the drug of choice to control convulsions. Blood pressure was controlled by either tablet alpha methyl dopa or nifedipine or both. Results: Preeclampsia cases accounted for 100 (4.9%) of total deliveries. Majority (86.52%) were unbooked cases between 20 -25 years of age (63.48%) and were primigravida (60.44%) belonging to low socioeconomic status (73.91%). Commonest maternal complication in present study was eclampsia (34.56%) Total maternal deaths accounted for 14. Most common cause for maternal mortality was eclampsia with HELLP (9,64.28%). Total perinatal deaths accounted for164 and most common cause for perinatal death was prematurity (47,28.65%). Conclusion: Preeclampsia is major leading cause for poor maternal and fetal outcome. Regular antenatal checkup , early diagnosis , early interventions , early referral to tertiary centers, optimum timing and mode of delivery and awareness among patients will reduce both maternal and perinatal morbidity and mortality
A comparative study on nutritional assessment of adolescent population from urban and rural areas
Get PDFAims: The health and nutritional status of the children affects not only physical growth but also cognitive development and country's economic growth. Adolescents are the future of the nation and more vulnerable group. The study was, therefore, carried out to determine and compare the nutritional status of adolescents among rural and urban government school students in district Patiala, Punjab. Settings and Design: Cross sec-tional study was conducted on 600 adolescents, 300 rural and 300 urban students. Methods and Material: The nutritional status has been as-sessed with the help of anthropometric measurements. The weight and height were recorded of each student and BMI was calculated. weight for age, height for age and BMI for age Z scores compared with WHO 2007 growth standards. Statistical analysis used: The independent sample t-test was done to assess differences in the anthropometric variables. A two-tailed p value less than 0.05 considered significant. Results: Among rural students 27% were undernutrition as compared to 8.3% urban students with p value is <0.001 which was significant. 11% of rural students were significantly underweight as compared to urban students of only 1% (p <0.001). 69.4% of age group 10-13 years students were significant-ly underweight as compare to other age groups (p value <0.001). Similarly 49.5% of age group 10-13 years students were significantly stunted with p value < 0.001. Conclusions: Our results reveal that undernutrition is more prevalent among rural adolescent students. So, Government should implement some more special programs for improving adolescents health
Assess clinical outcomes following radiofrequency ablation for varicosevein and to identify subgroups who would benefit most from the treatment modality
Get PDFBackground: Varicose veins is a widespread condition causing widespread symtoms among people. The use of modalities like RFA and edovenous laser surgeries are gaining more attention and have become more popular nowadays compared to the open surgery, Studies comparing the effects and complications of EVRFA with other treatment modalities are still undergoing. Aim: To assess the clinical outcomes following Radiofrequency ablation for symptomatic varicose veins using Venous clinical severity scoring and to identify the clinical subgroups who would benefit the most from this treatment modality. Materials and methods: 57 cases of varicose veins done by EVRFA were assessed at the time of admission for procedure in Government medical college Kozhikode and their VCSS score and clinical subgroup to which they belong is documented. Data was collected by using questionnaire and these subjects were followed up at 3 months and 6 months post procedure and the same scores calculated again and compared. Results and Conclusion: EVRFA showed significant reduction in VCSS score of study subjects with also improvement in their clinical class. All clinical subgroups benefitted from the procedure in terms of VCSS score calculated at 3 months and 6 months post procedure with only C3 females having slightly delayed and lesser benefit compared with others and was found to be statistically significant