International Journal of Health and Clinical Research
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Study of effect of dexmedetomidine with levobupivacaine on the onset and duration of analgesia and anaesthesia in brachial plexus block
Get PDFObjective: To Compare the efficacy Of Dexmedetomidine as an Adjuvant to Levobupivacaine in Axillary Brachial Plexus Block in Upper Limb Surgeries. Materials and methods: Hundred patients aged 18 to 60 years, scheduled for elective orthopedic operations in the upper limb, under axillary approach of brachial plexus block were randomized to two equal groups of 50 each into Group LBD receiving 25 ml of 0.5% levobupivacaine and Dexmedetomidine(1 mcg/kg) , while group LB received 25 ml of 0.5% levobupivacaine .The primary objective was to compare duration of sensory ( post operative analgesia ) block with or without addition of Dexmedetomidine to levobupivacaine . The secondary objective was to compare the onset and duration of sensory and motor block and hemodynamic parameters following the block between the groups intraoperatively at regular intervals. Results: There is significant prolonged duration of sensory and motor blockade in group LBD compared to group LB (P<0.001). Mean duration of sensory blockade (Group LBD, 14.91±1.19 hrs and Group LB, 10.73±.888 hrs). There is significant early onset of sensory and motor block in group LBD compared to group LB (P<0.001) [Onset of sensory block (group LBD, 7.8±1.58min; group LB, 11.04±1.55 min). Onset of motor block (group LBD, 14.2 ± 2.12min; group LB, 16.14 ± 2.119 min)]. Conclusion: Dexmedetomidine 1μg/kg when added to 25mL of Levobupivacaine 0.5% for axillary brachial plexus block speeds the onset of sensory and motor blocks (P < 0.05). The combination produces improved analgesia, resulting in a prolonged effect and reduced requirements for rescue analgesic
A comparative study on morbidity profile among the geriatric population of urban and rural area of West Bengal
Get PDFBackground- According to the WHO Ageing & Health Factsheet, the proportion of the world's population over 60 years will nearly double from 12% to 22% between 2015 and 2020, the number of people aged 60 years and older will outnumber children younger than 5 years by 2020, 80% of older people will be living in low- and middle-income countries in 2050. With this background present study was conducted to compare on morbidity profile among the geriatric population of urban and rural area of West Bengal. Methods – Community based cross sectional study was conducted in rural field practice area and urban slum which is urban field practice area of Community Medicine department of a Medical College situated at Kolkata, West Bengal from January 2021 to March 2021. Total sample size is 412, are be divided equally in both urban and rural areas i.e. 206 complete samples from each area are interviewed by a pre-designed, pretested structured questionnaire. The collected data was compiled with the help of Microsoft excel & analyzed by SPSS version – 19, in terms of statistical methods like table, mean, standard deviation, chi square, z test, multiple logistic regression. Results - In urban area, 69.4% of geriatric population belonged to 60-69 years & 48% geriatric population belonged to 70-79 years of age groups whereas in rural area the findings were respectively 63.6 % & 30.6 %.43.7% of total geriatric populations are financially independent and out of 56.3% dependent populations, rural geriatric population showed marginally higher predominance (60.2%) over the urban (52.4%). It is revealed from this study that acid peptic disorder (53.6%) is the major G.I disorders, followed by constipation (44.2%) and dental caries (40.0%). We also found that 42.5% geriatric population are suffering depression. Urban geriatric populations were suffering (46.6%) a little more from depression than rural population (38.3%). Conclusions- The present study reveals high prevalence of morbidity among geriatric population. So, awareness among elderly people should be created for regular health check-ups for prevention and early detection of their health problems
A study on etiology, clinical manifeststions and management of deep neck space infections
Get PDFBackground: Deep neck space infections (DNSI) are serious diseases that involve several spaces in the neck. These are commonly seen in low socioeconomic group with poor oral hygiene, and nutritional disorders. These are bacterial infections originating from the upper aerodigestive tract. The incidence of this disease was relatively high before the advent of antibiotics. Treatment of DNSI includes antibiotic therapy, airway management and surgical intervention. Aims: To determine the various etiological, associated risk factors and clinical manifestations in Deep Neck Space Infections. Materials and methods: It is a Retrospective study done in 80 Patients diagnosed as Deep Neck Space Infection clinically and radiologically and Undergoing treatment for the same Patients diagnosed with Deep Neck Space Infection clinically and radiologically. Results: In this study 50 cases were male and 30 cases were female with a male to female ratio being 1.66 : 1. .The commonest age group was 21— 30 years (32.5%). The commonest site was Ludwigs angina with 19 cases followed by submandibular space infections with 17 cases with swelling has main presenting complaint. In this study 50 cases had dental caries as etiology ; around 18 cases was associated with anaemia. Ultrasound and CECT neck was used as vital imaging techniques. With maximum 25 days and minimum 8 days hospital stay. 61 cases underwent surgical (Incision and Drainage) , 19 cases with medical management. pus culture showed 23 cases with Streptococcus pyogenes followed by 8 cases with Pseudomonas. All cases responded to ceftriaxone and metronidazole combinations with 14 cases with Piperacillin and metronidazole. There were 2 deaths due to impending renal failure. Conclusions: Incision and Drainage is the mainstay of surgical treatment with wide exposure and use of betadine solution impregnated wick at the wound site daily. Patient education regarding oral and dental hygiene has to be stressed and Control of diabetes , proper nutrition to prevent deep neck space infections
Prevalence and clinical burden of Gestational diabetes mellitus at a tertiary care centre in Kozhikode Kerala, India
Get PDFBackground: Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. It has serious health implications like preeclampsia, caesarean delivery and Type 2 diabetes in mother later. This research was done to assess the prevalence , risk factors and foetal birth weights of mothers with GDM in a tertiary care in North Kerala. Methods: Descriptive cross sectional study conducted in Department of OBG, KMCT Medical College Kozhikode ,Kerala from Jan 2018 -Jan 2021 where 189 women who are diagnosed to have GDM were studied to assess the maternal and foetal outcome. Maternal and foetal outcome was studied. Results: The incidence of GDM in the population studied was 5.78%. 44.4% were in 25-29 years group. 63% of these diabetic mothers were overweight and obese. Pre-eclampsia complicating pregnancy was noted in 26% patients. 65.6% needed insulin therapy with MNT and exercise. Weight gain of 9- 12 kg was noted in 69.8% of GDM mothers. Mean baby weight was 3185.85gms. 55.55% patients delivered vaginally. 18 /189 deliveries were vacuum assisted. 46 % patients underwent LSCS. Conclusions: Gestational diabetes complicating pregnancy has both adverse maternal and foetal outcome. Timely identification and counselling regarding glycaemic control of mothers and surveillance of foetus will avert maternal and neonatal morbidity
A study of C-reactive protein in diabetic and non-diabetic patients with acute myocardial infarctions
Get PDFBackground: In this study we wanted to determine the CRP level at the time of admission as a strong predictor of hospital mortality and morbidity in patients with Diabetes mellitus as well as in patients without Diabetes mellitus who had acute myocardial infarction. Methods: This is a longitudinal study, conducted among patients of acute myocardial infarction admitted in ICU in Gandhi Medical College, from January 2021 to December 2021. Foe each study patient, a detailed history was taken, he/she was examined in detail, relevant investigations like ECG changes, lipid profile, CPKMB enzyme levels, blood glucose levels (FBS/PPBS) and C-reactive protein were done, the patient was followed till discharge and all complications like arrhythmias, failure and outcome were noted. Results: 96% of diabetic patients were found to be having CRP level >7mg/l as compared to 80% of non-diabetic patients with acute myocardial infarction. The mean CRP in diabetic group was 51.80 mg/l as compared to 15.78mg/l in non-diabetic group which was statistically significant (p<0.001).10% of diabetic patients had mortality as compared with 4% in non-diabetic group. Diabetic patients who died in hospital presented with higher plasma levels of CRP on admission as compared to non-diabetic patients. Conclusions: CRP on admission is a strong predictor for hospital morbidity and mortality in both diabetic and non-diabetic patients with acute myocardial infarction. Diabetic patients presented with higher CRP levels compared with those in non-diabetic patients with acute myocardial infarction. CRP may serve as marker in predicting the hospital mortality in patients with acute myocardial infarction. It can be concluded that significant high values of CRP in diabetics may indicate a considerable damage to the vascular endothelium, which could play role in causation of cardiovascular events
Nephrogenic ascites: prevalence and effect of daily nocturnal high flux hemodialysis
Get PDFBackground: Nephrogenic ascites (NA) is the end stage renal disease. A study was conducted to find the prevalence of NA in chronic kidney disease (CKD) maintenance hemodialysis (MHD) patients and also to find the effect of daily nocturnal high flux hemodialysis (NHFH) as treatment modality in these study members. Methods: It was a prospective observational study, conducted in the department of nephrology, GSL Medical College. Individuals aged >18years, on CKD V on MHD, diagnosed with NA and treated with daily NHFH for one month were included. Various factors such as variation in body weight, heart rate, blood pressure (BP), abdominal girth, serum parameters such as albumin, calcium, phosphorous, PTH, Hb%, Kt/v, portal vein diameter, ejection fraction, left ventricular mass index (LVMI), AV access failure before and after initiation of nocturnal hemodialysis (NH) were analysed. Student’s t-test was used to find the mean difference. Results: Total 12 (100%) participants were included male female ratio was 3. Statistically there was significant difference in mean systolic and diastolic BP, serum calcium, Phosphrous and PTH before and after NHD. But there was no significant difference in serum albumin levels. Conclusion: Decrease in NA with daily NH using high flux dialyzer. In addition, improvement in clinical parameters such as reduction of BP, HR, body weight, improvement in various serum parameters and decrease in LV mass index, improvement in LVEF. However, studies with large sample size is strongly recommended
Comparison of Effectiveness of dexamethasone and dexmedetomidine as an adjuvant in Plexus Block by Supraclavicular Approach
Get PDFBackground- Supraclavicular brachial plexus block is a commonly employed regional nerve block technique for upper extremity surgery. Various adjuvants were added to local anaesthetics in brachial plexus block to achieve rapid onset and prolonged block. Objectives- To compare dexamethasone and dexmedetomidine as an adjuvant to local anaesthetic agent in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block and duration of blockade. Methods-Forty ASA I and II patients scheduled for elective upper limb surgeries under supraclavicular brachial plexus block were divided into two equal groups in a double- blinded fashion. Group one was given 0.25% Bupivacaine 2 milligram/kg as local anaesthetic and Dexmedetomidine 1microgram/kg as adjuvant. Group two was given 0.25% Bupivacaine 2 milligram/kg and Dexamethasone 100microgram/kg as adjuvant. Onset and duration of sensory and motor blockade and hemodynamic stability were recorded. All patients were observed for any side effects and complications. All data were recorded and statistical analysis was done. Results- Sensory block and motor block onset was earlier in dexmedetomidine group.The duration of blockade was also prolonged in dexmedetomidine group when compared with dexamethasone group and is not associated with any major side-effect. Conclusion-Dexmedetomidine is a better adjuvant than dexamethasone in supraclavicular brachial plexus block
An observational study to evaluate dexmedetomidine and preservative free ketamine for epidural analgesia for lower limb orthopaedics surgery
Get PDFBackground: The technique of epidural anesthesia and analgesia have become widespread following their introduction and acceptance by the patients in surgical and obstetric practice. Adjuvants to bupivacaine have been used to enhance good quality perioperative and postoperative anesthesia and analgesia. Aim: The aim of the study is to evaluate the effect of post operative analgesia after epidural dexemedetomidine and preservative free ketamine for lower limb orthopaedics surgery. Method: This prospective, single centre, observational study includes 60 patients of ASA grade 1 and 2 for lower limb orthopaedics surgeries. Each group was given 14 mg 0.5% hyperbaric bupivacaine via spinal anaesthesia. Group A received bolus dose 1 μg/kg dexmedetomidine diluted to 5 mL in normal saline (NS) and Group B received bolus dose 0.5 mg/kg ketamine diluted to 5 mL in NS through epidural catheter. The epidural infusion was started 1 h after starting surgery. Group A received bupivacaine 0.125% with dexmedetomidine (1 μg/mL) and Group B received bupivacaine 0.125% with PF ketamine (0.5 mg/mL). Result: Time of receding of sensory and motor blockade was more with dexmedetomidine than with preservative free ketamine (p<0.05). Also the requirement of rescue analgesia needed is less with dexmedetomidine (2.2±0.52) than with ketamine (3.4 ±0.47) and the difference was statistically significant (P = 0.0001). Conclusion: Dexmeditomedine was to be more effective and superior as compared to preservative free ketamine as an adjuvant to enhance effect of bupivacaine for epidurals
Clinico-epidemiological profile of sexually transmitted infections in patients attending a tertiary health care hospital in southern Himachal Pradesh: A retrospective study
Get PDFIntroduction: Sexually transmitted infections (STIs) are a public health problem and are a burden to the individual, his family and community. The prevalence of STIs is very high in developing nations including India and varies widely across different regions. There is enormous need to study the pattern of STIs in various regions of country for implementation of control strategies. Aims: To estimate the prevalence and to study the clinico-epidemiological profile and trends of sexually transmitted infections in patients attending the STI clinic of a tertiary care hospital in southern Himachal Pradesh. Material and methods: Records of patients attending the STI clinic during last two years i e from January 2019 to December 2020 was retrieved and analysed retrospectively. Results: Vulvovaginal candidiasis was the most common (non viral) STI seen in 624(39.3%) patients. While genital warts (8.7%), molluscum contagiosum (8.2%) and herpes genitalis (7.2%) were the common viral STIs. Bacterial STIs like gonococcal urithritis(7.9%), chancroid (6.6%), bacterial vaginosis (6.3%), non gonococcal urithritis (3.9%), lymphogranuloma venereum (LGV) (3.6%) and non gonococcal cervicitis (3%) were not uncommon. Rapid plasma regain test (RPR) was found to be reactive in 24(1.5%) patients, out of which, 14(0.9%) were males and 10(0.6%) were females. HIV seropositivity was seen in 2(0.2%) patients and both of them were males. Conclusion: Fungal STI was more common as compared to viral STIs. Trend for viral STIs is increasing and that for bacterial STIs is declining among STI clinic attendees, which is consistent with other studies from different regions
An Observational Study to Compare Interval Cholecystectomy And Early Cholecystectomy Among Patients Of Acute Cholecystitis At A Tertiary Care Centre In Bihar
Get PDFIntroduction: Cholecystectomy is the treatment of choice for patients with acute cholecystitis. If the surgery is performed within 2-3 days of presentation of patient with symptoms of acute inflammation, it is called as early cholecystectomy. With this background, this study was planned and conducted to generate evidences by comparing outcomes of patients undergoing interval and early cholecystectomy at a tertiary medical college of Bihar. Methodology: An observational prospective study was conducted by Department of General surgery, Madhubani Medical College & Hospital, Bihar, India. Prior clearance was obtained from the Institutional Ethics Committee. All patients presenting with features suggestive of acute cholecystitis in surgical OPD or emergency during the study duration of 12 months from January 2021 to December 2021 were considered for inclusion in the study. Result: Out of 100 patients were recruited for the study, 50 cases in each group. Group 2 patients were investigated afresh for the subsequent operative intervention. The mean age of the patients was 46.1 ± 9.3 years and 49.3 ± 12.4 years in groups 1 and 2, respectively. There was a female predominance observed in both the groups. Wound infection was noted in 10% patients of group 1 and 12% patients of group 2. Biliary leak was found in 19% patients of group 1 and 23% patients of group 2. Mean hospital stay was 8.2 ± 2.2days and 10.2 ± 5.4days in group 1 and 2, respectively. Conclusion: So early surgery is found to be more economical than delayed surgery in acute cholecystitis if the diagnosis could be confirmed in proper time