International Journal of Health and Clinical Research
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Comparative study between Buprenorphine and Fentanyl transdermal patch to evaluate post-operative pain relief after cardiac surgery: A randomized control trial study
Get PDFIntroduction: Pain due to thoracotomy creates greatest demand for postoperative analgesia. Multimodal analgesia with various routes can be of great help to fulfill demands of analgesia in these patients. Opioids given by transdermal route offers newer modality of management with potential benefits of being noninvasive, sustained blood levels and bypasses first pass metabolism. We aimed to evaluate efficacy of Buprenorphine and Fentanyl Transdermal patch for post-operative pain relief after cardiac surgery. Methods: It was prospective, randomized, double-blind study in which 60 adult patients undergoing cardiac surgery were randomly segregated into two groups. Group A: 30 patients received Buprenorphine transdermal patch (10mcg/hr) and Group B: 30 patients received Fentanyl transdermal patch (50mcg/hr) 12- 24 hours prior to extubation. Analgesia was assessed using VAS score along with hemodynamic parameters and adverse effects. Results: Demographic parameters, baseline hemodynamics and perioperative hemodynamics were comparable. Baseline VAS score was comparable in two groups however statistically significant difference in two groups in VAS was observed thereafter till 72 hours. VAS score was higher in group A as compared to group B at the time of removal of ICD. 3 (10%) and 2 (6.7%) patients in Group A and Group B respectively required rescue analgesic which was not significant. Time for requirement of first rescue analgesic was significantly longer in Group B compared to Group A ie767.13 ± 73.59 minutes vs. 1224.37 ± 39.37 minutes. Adverse effects were comparable in two groups. Conclusion: Fentanyl and Buprenorphine TDDS are effective in postoperative analgesia in cardiac surgical patients. However Fentanyl TDDS has better analgesia
Correlation between MRI and arthroscopy findings inrotator cuff tears
Get PDFIntroduction: Rotator cuff tears are one of the most common causes of shoulder pain causing significant disability[1]. 86% of patients with shoulder pain are due to the abnormality of rotator cuff disorders[2]. MRI has revolutionized the diagnosis of shoulder pathologies. MRI is a proved sensitive, accurate, cost-effective and a non-invasive tool in investigating shoulder pathology[3]. Currently, Arthroscopy is considered as the “reference standard” for the diagnosis of shoulder pathologies. Aim/purpose: The purpose of this study attempted to assess the sensitivity and specificity of MRI with gold standard of direct visualization under arthroscope for individual rotator cuff tendons injury. Materials and methods: This is a hospital based prospective and comparative study conducted in the department of Radio diagnosis, Apollo Hospitals, Jubilee hills, Hyderabad between march 2019 to September 2020. 75 patients of both sexes and age groups > 18years (minimum and maximum age of the patient seen in my study are 20 years and 86 years respectively) with history of shoulder pain, restricted movements, instability and injuries who underwent MRI investigation and subsequently underwent ARTHROSCOPY.Data was collected on a pre-designed proforma by detailed history, thorough radiological investigations followed by arthroscopy findings. The data was collected analysed and reported as Sensitivity, Specificity, Positive predictive value (PPV), Negative predictive value (NPV) and Accuracy of MRI for each type of rotator cuff tendon tears. Correlation between MRI and Arthroscopy was done using Kappa statistics and p value. The whole data obtained was analyzed using Statistical Package for Social Sciences, version 23.0. Results: MRI examination showed all 75 patients had supraspinatus tears of which 43 are full thickness tears and 32 are partial thickness tears, 19 out of 75 patients had infraspinatus tears of which 14 are full thickness tears and 5 are partial thickness tears and 15 out of 75 patients had subscapularis tendon tears. There is no teres minor tendon tears reported in the present study. Supraspinatus tendon tears: In the present study arthroscopically proven supraspinatus tendon tears are 39(F) full thickness tears and 22 partial thickness tears (P 1 16 + P2 6). The sensitivity, specificity, PPV, NPV and accuracy of MRI in full thickness supraspinatus tears is 79.6%, 84.6%, 90.7, 68.8 and 81.3 respectively. Kappa value is 0.609(substantial) and p value was <0.001, highly significant. The sensitivity, specificity, PPV, NPV and accuracy of MRI in supraspinatus partial articular surface tears is 80.0%, 83.6%, 64.0, 92 and 82.6. Kappa value is 0.589(moderate) and p value is <0.01, highly significant. The sensitivity, specificity, PPV, NPV and accuracy of MRI in supraspinatus partial bursal surface tears are 100%, 98.6%, 85.7, 100.0. and 98.6 respectively. Kappa value is 0.916(almost perfect) and p value is <0.01, highly significant. Infraspinatus tendon tears: Out of 19 (F 14 + P 5) cases arthroscopically proven infraspinatus tendon tears are 10 full thickness tears and 5 partial thickness tears (P). The sensitivity, specificity, NPV and accuracy value of MRI in full thickness infraspinatus tears are 100 % ,93.8%, 71.4,100 and 94.7. Kappa value is 0.803(almost perfect) and p value is <0.001, highly significant. The sensitivity, specificity, PPV, NPV and accuracy value of MRI in partial thickness infraspinatus tears are 55.6%, 100%, 100, 94.3. and 94.7. Kappa value is 0.687(substantial) and p value is <0.001, highly significant. Subscapularis tendon tears: Out of 15 cases in the present study arthroscopically proven subscapularis tendon tears are 11 partial thickness tears (P). The sensitivity specificity, NPV and accuracy of MRI in the detection of subscapularis tears is 100%, 93.8%, 73.3, 100 and 94.7. Kappa value is 0.815(almost perfect) and p value is <0.001, highly significant. Conclusion: In the present study accuracy in detecting full thickness and partial thickness tears in infraspinatus and subscapularis and partial tears of supraspinatus is high as compared to supraspinatus full thickness tears. On comparing results of individual tendon tears in our study suggests, that Magnetic resonance imaging has high sensitivity, specificity and accuracy in diagnosing full thickness and partial thickness tears of supraspinatus tendon tears, subscapularis tears and full thickness tears of infraspinatus tendons. Sensitivity in detecting infraspinatus tendon partial thickness tears was lower, however it has high specificity and accurac
To determine the association of serum VIT D level and uterine fibroid in premenopausal women
Get PDFBackground: Uterine Fibroid are monoclonal, benign tumors originating from the smooth muscle cell of uterus and predominantly located in the pelvis. Main hormones for uterine fibroid are estrogen and progesterone. Fibroids mainly consist of extracellular matrix that contain collagen, fibronectin and proteoglycans. vitamin D deficiency has been proven to be a major risk factor in the development of fibroid. Mean 25(OH)D serum levels are significantly low in uterine fibroid women as compared to healthy women. Aims & objectives: To estimate serum vitamin D level in the premenopausal women under age group of 30 to 45 years diagnosed with uterine fibroid and healthy women of same age, weight, locality and ethnicity and to compare serum vitamin D level among both groups. Materials and methods: An observational case control study done in the dept of Obstetrics & Gynaecology of MGM Medical College & M.Y Hospital, Indore Madhya Pradesh from 1st April 2020 to 31st march 2021 in the women attending outpatient dept, in the age group of 30-45 year. After obtaining informed consent, 3 ml of blood sample was collected from all the participants and vit D level measured in the serum by ELISA. Result: total 200 women (100 cases, 100 control) underwent the study. Most study participants among case and control are of age 30-35 years. None of them had BMI below normal and most of control and cases were overweight. Most common parity among them was 2. 91% of cases had vit D deficiency while 32% of control had vit D deficiency and 68% of control were having normal vit D levels. Conclusion: The present study shows there is positive correlation between vit D level and uterine fibroid (OR=21.48), which is suggestive of some contribution of hypovitaminosis of vit D in etiology of uterine fibroid
Ferrous sulphate - Ascorbate induced DNA damage and protection by natural compounds
Get PDFObjectives: The in vitro antioxidant and inhibition of Ferrous sulphate: Ascorbate induced fragmentation of DNA by crude proteins of Agathi seeds (Sesbania grandiflora Linn) evaluated using various relevant assays. Materials and methods: Assays like DPPH, Hydroxyl radicals, Ferric ion reducing, Ferrous ion chelation, Cytochrome C and Ferrous sulphate-Ascorbate complex induced DNA damage prevention studies were done to evaluate the antioxidant capacity of Agathi seed protein. Results: Agathi seeds (Sesbania grandiflora Linn) protein showed more antioxidant and free radical scavenging activity. It scavenged approximately 71% of hydroxyl and 1,1-diphenyl-2-picrylhydrazayl radicals 61%. In addition, it reduced cytochrome c and ferric ion levels, chelated ferrous ions and inhibited Ferrous sulfate:Ascorbate-induced fragmentation and sugar oxidation of DNA. Conclusion: These results establish the antioxidant potential of crude proteins of (Sesbania grandiflora Linn)
Clinical and morphological study of the acute leukemia with special cytochemical stains myeloperoxidase (MPO) and periodic acid schiff (PAS) – A prospective study in tertiary care hospital
Get PDFIntroduction: Acute leukemia is a hematological disorder defined by presence of 20% or more blasts in peripheral blood, bone marrow or other tissue[4-6]. It is divided into Acute Myeloid Leukemia (AML), Acute Lymphoblastic Leukemia (ALL) and Acute Leukemia of Ambiguous Lineage on the basis of morphological, cytochemical & antigenic characteristics. Further sub classification of AML & ALL has been done on the basis of morphology, cytochemistry, cytogenetics, immunophenotyping and molecular studies[4,5]. Aims and Objectives:1. To find out incidence of leukemia in J.A. Group of Hospitals Gwalior (M.P)2. To classify leukemias into different subtypes based on French–American-British (FAB) morphology.3. To perform cytochemical staining of all cases and establishing role of cytochemistry in diagnosis of leukemia.4. To study various clinical & hematological parameters in leukemias.5. Flow cytometric evaluation of various types of leukemia will be done.Material and method: This present study was conducted in department of pathology Gajra Raja Medical College and J.A. group of Hospitals Gwalior from January 2020 to June 2021 and total 71 cases of leukemia were studied, cytochemistry were done in 49 cases and FCM were done in 15 cases. Results: In our study on the basis of morphology alone 28 (39.43%) cases were diagnosed and sub classified as ALL- 10 cases (14.08%), AML-18 cases (25.35%) and 43 cases (60.56 %) were not sub classified. With combined use of cytochemistry along with morphology 44 cases (96%) were diagnosed and sub classified, 5 cases (4%) were not sub classified. Conclusion: In a setting of lack of facilities for immunophenotyping as in majority of centers in the underdeveloped and developing countries, morphology combined with cytochemical staining still serves the best purpose in diagnosis of acute leukemias
Outcome of open cholecystectomy and laparoscopic cholecystectomy- A comparative study
Get PDFBackground: Cholelithiasis, which continues to be one of the most common digestive disorders encountered, was traditionally being dealt by conventional or open cholecystectomy. With the introduction of laparoscopic cholecystectomy, the surgical community witnessed a revolution in basic ideology and the importance of minimal access surgery has suddenly impacted. Materials and Methods: 50 patients admitted at Adichunchanagiri institute of medical science with a diagnosis of calculous cholecystitis underwent open / laparoscopic cholecystectomy. 25patients constituted each group. Results: The duration of Laparoscopic cholecystectomy was significantly more than for open cholecystectomy (median 95 min in LC and 80 min in OC). One patients of laparoscopic group required conversion to open procedure. The drains were required in less number of patients of Laparoscopic cholecystectomy group and for less number of days. No Wound infection was seen in Laparoscopic cholecystectomy patient when compared to 5 in OC patients. The Visual Analogue Scale for pain in the post op period was significantly less for LC patients compared to OC patients (median 7 in OC group as compared to 4 in LC group) . The duration of hospital stay was significantly longer for OC group than for LC group (Mean of 7.84 days versus 3.68 days respectively). The cosmetic result was significantly better in LC group than OC group ( Mean cosmetic score of 4.72 in LC group and 3.44 in OC group. Median score was 5 for LC group and 3 for OC group). Conclusion: Laparoscopic cholecystectomy is Superior to Open cholecystectomy. Therefore, laparoscopic cholecystectomy is considered the “Gold Standard” procedure for cholecystectomy
A cross sectional study of clinicopathological association in chronic liver disease
Get PDFIntroduction: Chronic liver disease is a liver disorder of varying causes and severity with variable clinical, biochemical and histological findings with severity lasting for 6 months or more. Many patients are asymptomatic and in others, symptoms may be mild or intermittent. In some patients, symptoms donot develop and the diagnosis is not made until the disease progresses to cirrhosis. Materials and Methods: The present study was a cross-sectional study that included analysis of clinicopathological data of 80 patients’ with clinically suspected chronic liver disease who were admitted to the Department of General Medicine, Viswabharathi Medical College and General Hospital, Kurnool between March 2020 and February 2021. A convenient sample of 80 was taken according to the total number of patients admitted to the medical wards. Results: Total number of patients (N = 80) of suspected chronic liver disease were included in the study in which 50 were males (62.5 %) and 30 were females (37.5 %), mean age was 48.48 years with a standard deviation of 11.03 years ranging from 26-70 years. Most of them (72 cases) were found in the age group of 30 - 69 years, majority of them (24) were in the age group of 50-59 years. Conclusion: Clinical diagnosis of chronic liver disease should be confirmed with histopathological examination. In appropriate clinical settings, the clinical diagnosis of chronic liver disease made by experts is fairly associated with histopathological diagnosis. Liver biopsy is a safe procedure that aids in establishing the diagnosis and helps in the appropriate management of a chronic liver disease
Curious case of a median nerve cystic schwannoma in antecubital fossa: Case report
Get PDFSchwannomas are benign tumourarising from nerve sheath of peripheral nerves. Over prolonged time period these schwannomas may undergo cystic and degenerative changes showing nuclear pleomorphism. Due to their cystic appearance, they may be confused with other benign cystic lesions of peripheral nerves or malignant neoplasms and result in extensive excision of the nerve causing unnecessary functional impairment to the patient. Median nerve is not very commonly affected. Here we present anunusual case of a median nerve cystic schwannoma in the antecubital fossa which presented as a swelling along with paraesthesia along median nerve distribution. On exploration it was found to be eccentric tumour and was resected with preservation of the nerve. Hence, careful clinicalanalysis and radiological examination is important to avoid extensive nerve excision and functional impairment.Also to prevent post op complications since it’s a tumour involving the nerve sheath and when it is present in the antecubital fossa it’s in close proximation to the brachial artery and thus unnecessary surgical intervention can cause vascular injury
Acute Temporomandibular Joint Dislocations: Surgical Management
Get PDFBackground: Jawbone and your skull are connected by a sliding hinge called the temporomandibular joint. On either side of your jaw, there is a joint. Temporomandibular disorder (TMD), which includes TMJ condition, can hurt your jaw joint and the muscles that move your jaw. Materials and Methods: This retrospective study involved a single hospital, a single surgeon, 19 patients, and 23 joint operations carried out over a ten-year period. The study group consisted of patients who met the inclusion and exclusion criteria and had previously undergone surgical correction using hook-shaped miniplates and miniscrews set with or without bone grafts. Results: With ages ranging from 32 to 58, there were a total of 12 females (mean age: 41.9 ±12.07 years) and 9 males (mean age: 39.8 ±13.6 years). Prior to surgery, each patient experienced the dislocation for an average of 19.26± 12.6 months. Prior to surgery, the mean maximal mouth opening (without pain) was 17.78 ±2.13 mm (12–25 mm), but it was 32.28± 3.17 mm (27–37 mm) after surgery. Throughout the 8 to 37 month follow-up period, there were no early or late surgical problems. Conclusion: The outcomes in this community of Indians are very comparable to those reported from other regions of the world
Study of Obstetric Emergency Admissions at Labour Room in a tertiary care centre during COVID 19 pandemic
Get PDFBackground: The above study was done to analyse obstetric emergency admissions during Covid 19 pandemic and to assess its impact over pregnant women coming to seek treatment at our tertiary care centre. Aims and Objectives: 1. To analyse and compare obstetric emergency admission at labour room during covid 19 pandemic with pre covid era.2.To analyse behaviour changes of pregnant women in seeking treatment during covid 19 pandemic. Methodology: Retrospective study. Results: Significant changes noted like increase in mortality, ICU admissions, morbidity load during Covid times as compared to non covid times. Conclusion: The government should develop healthcare system to deal with future pandemic. This should ensure availability of ample amount of funds for the continuity of maternity care