International Journal of Health and Clinical Research
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Evaluation of oral olanzapine versus oral ondansetron in prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgeries under general anesthesia: A comparative study
Get PDFIntroduction: Nausea and vomiting in the postoperative period occur in 20% to 30% of patients, and together nausea and vomiting are second most common and distressing to patients[1]. The general incidence of vomiting is about 30%, the incidence of nausea is about 50%, and in a subset of high-risk patients, the postoperative nausea and vomiting PONV rate can be high as 80% during the 24hr after emergence[2]. However, the incidence rate of PONV after laparoscopic cholecystectomy (LC) is higher than that after other types of surgery. Materials and methods: Data was randomly collected from 120 ASA I and II patients scheduled for surgery under general anesthesia between 18 to 50 yrs. It was a prospective randomized double blinded study. After obtaining informed written consent from parents, the study population was randomly assigned to two groups using a random sequence (Random Sequence Generator, available at www.random.on). Group A: Patients received Tablet Ondansetron 16mg (2 tablets of ondansetron 8mg) 1 hour before surgery with sips of water. Group B: Patient received Tablet Olanzapine 5mg (2 tablets of Olanzapine 2.5mg) 4 hours before surgery with sips of water. Group A received placebo 4hrs before surgery and Group B received placebo 1hour before surgery. Monitoring includes electrocardiography (ECG), oxygen saturation (SpO2), non-invasive blood pressure (NIBP), end tidal carbon dioxide (EtCO2), respiratory rate (RR), train of four (TOF). Results: Mean age of subjects in group A was 38.7 + 9.8 years and in group B was 35.8 + 9.4 years. There was no significant difference in age distribution between two groups. In Group A 55% were females and 45% were males and in group B 50% of them were female and male respectively. There was no significant difference in gender distribution between two groups with p=0.583. In Group A 56.7% had ASA I and 43.3% had ASA II and in group B 50% of them had ASA I and II respectively to significant difference between two groups with p=0.464. Conclusion: To conclude, our study demonstrates that premedication with oral olanzapine 5mg provides reduction in the overall incidence of post-operative nausea and vomiting (PONV) which is comparable to ondansetron in patients undergoing general anaesthesia. It also reduced analgesic requirement and causes arousable sedation postoperatively
Clinico pathological study of cutaneous lesions in HIV positive patients
Get PDFBackground: AIDS is a fatal illness caused by human immunodeficiency virus. About 90% ofthe HIV infected individuals sufferfrom one ormore skin lesions.The proportion of skincomplications and severity of several common cutaneous diseases are increased in HIV infected patients. Aim: 1. To study the histopathology of different cutaneous lesions present in HIV positive patients. 2. To correlate histopathological diagnosis with clinical diagnosis of skin lesions in HIV positive patients. Materials and Methods: Clinico pathological study of 65 skin biopsy specimens from HIVseropositive patients with cutaneous manifestations was carried out. Laboratory findings carriedout for the patients like routine haematological tests, serology test for HIV and CD4 and CD8 T cell count were noted and included in the study. Results: A total of 31 skin lesions were identified from 65patients. Specific microscopic findings were seen in all these cases. The infectious etiology was seen in 26 cases (40%), non infectious skin lesions in 23 cases (35.38%) and neoplastic lesions in 3 cases (4.61%). The spectrum of histopathological findings was correlated with clinical diagnosis. Clinico-histopathological discrepancies were observed in 5cases(7.66%). Conclusion: Cutaneous biopsy confirmed the diagnosisin many cases andin few cases it revealed clinically unsuspected diagnosis which reiterates the necessity of histopathologic investigations of cutaneous lesions in HIV/AIDS patients
A analysis of functional and clinical outcome of pilon fracture treated with an anterolateral plate fixation in a tertiary care center: Prospective study
Get PDFIntroduction: This clinical study presents the short-term results of the Pilon fracture treated with open reduction and internal fixation through an anterolateral approach and further re-analyse the different complication rates and outcome percentages during surgical treatment through an anterolateral approach. Materials and methods: The present study is a prospective descriptive study involving 22 patients with Pilon fracture treated by ORIF through an anterolateral approach at the Department of Orthopaedics, Narayana Medical College and hospital, Nellore, Andhra Pradesh from June 2021 to May 2022. Results: In our study, among 22 cases, the majority of patients were male (77%). The mean age group of our patients has been 40 -60 years. Right-sided injury and left-sided injury are almost equal. Functional outcome was measured using Mazur criteria. According to these, we found that 12 patients (54.54%) had excellent functional outcome, 8 patients (36.36%) had good functional outcome and 2 patients had fair functional outcome following ORIF with anterolateral plate for tibial pilon fractures and are comparable with other studies in the literature review. Discussion: In our study functional outcome was measured using Mazur ankle score. According to these we found 12 patients (54.54%) had excellent functional outcome and 8 patients (36.36%) had good functional outcome and 2 patients (9.1%) had fair functional outcome following open reduction and internal fixation with anterolateral for tibial pilon fracture
Functional outcome of unilateral plating with lag screws in bicondylar tibial fractures
Get PDFObjective: Management of Bicondylar (tibial plateau) fractures is a challenge. In literature dual plating is considered to be the treatment of choice for these fractures. In this study we studied the functional outcome of open reduction internal fixation with plating on one side, enhanced by cannulated cancellous screws on the other side. Method: From October 2019 to October 2021, we studied 27 patients with bicondylar tibial plateau fractures (schatzker type V and Type VI) treated using plate on one side and cannulated cancellous screws (inserted percutaneously) on the other side. Result: The mean age was 40.03 ± 11.54 years. Most common mode of injury was road traffic accidents. We used schatzker classification to classify the fractures. Majority of the fractures (59.26 %) were schatzker type VI fractures. Post operative radiographs were taken at at 6 weeks, 3 months, 6 months and 12 months. The average time for union of fractures was 4.5 ± 2.28 months. 2 patients (8.70 %) developed deep wound infections, 1 (4.34%) of these had delayed union. 1 (4.34%) patient had lateral subluxation of knee post operatively with previous primary osteoarthritis. The rate of infection was lower than traditional dual plating. There were no cases of non-union or post operative loss of reduction. Conclusion: Per our limited experience we believe that open reduction internal fixation with plating on one side with cannulated cancellous screws on the other, is a better alternative in the management of schatzker Type V and VI tibial plateau fractures
Study to Determine the Incidence and Pregnancy Outcomes in Women With Obstetric Cholestasis in a Tertiary Care Centre
Get PDFBackground: Obstetric cholestasis is the most common liver disorder during pregnancy which normally presents in the second half of pregnancy. The present study has made an effort to determine the incidence and pregnancy outcomes in women with obstetric Cholestasis. Aims and Objectives: To determine the incidence and analyse pregnancy outcome in women with obstetric cholestasis. Methodology: Cross Sectional Prospective Study. Results: The incidence of obstetric cholestasis hence was found to be 2%.Most of the patients belonged to age group 20-24 years. (52.86%), of gestational age 32-36 weeks at diagnosis (67.14%), of >36 weeks gestational age at delivery (64.29% ), mostly primigravida ( 64.29%) and non smoker (92.86%).47.14% Patients had vaginal delivery of which 12.5% was spontaneous, 16.25% was induced, and 12.5% was instrumental.52.86% patients delivered by lower segment caesarean section of which 12.5% was elective, 6.25% was due to failed induction, and 15% was due to meconium stained liquor and foetal distress. 54.29% patients got relief from pruritus in 1 week of administration of UDCA. Regarding complications, about 15.71% landed in postpartum hemorrhage, 11.42% had altered coagulation profile, 35.71% had preterm labour, 24.29% had altered lipid profile and 17.14% had insomnia. 21.4% of babies had low birth weight, 35.71% were preterm, 30% small for gestational age, 15.71% had abnormal CTG, 48.57% had meconium stained liquor,11.42% had respiratory distress, 21.4% needed NICU admission and 1.43% had intrauterine death. Conclusion: Considering the adverse effects on foetus, pregnant women should be judiciously followed through the antenatal period till delivery. Decision regarding early induction should be taken considering risk of prematurity, low birth weight and NICU admission
Study of Fundus Changes In Pregnancy Induced Hypertension
Get PDFBackground: Hypertensive disorders in pregnancy are the most common medical complications affecting 7-15% of all pregnancies. Pre eclampsia remains one of the top five causes of maternal and perinatal mortality worldwide. The preeclampsia/eclampsia syndrome is a multisystem disorder that can involve cardiovascular , hematologic , hepatic, renal and neurologic systems along with the eye and visual pathways. Aim: To study prevalence and assess various retinal changes in pregnancy induced hypertension and to determine the association of various factors of toxaemia of pregnancy with retinal changes which includes age, parity, blood pressure, proteinuria, and severity of the disease.Methodology: This is prospective observational hospital-based study. Total of 150 patients with a diagnosis of Pregnancy induced hypertension admitted in department of Obstetrics and Gynecology of our hospital were included in this study. Age, gestation period, gravida, level of blood pressure and proteinuria were noted. All Fundus findings were noted on Amsler grid . Indirect Ophthalmoscopy with 20D was used for fundoscopy. Results: A total of 150 Pregnancy induced hypertension patient’s fundus were examined. Mean age of patients was 25.1 years. The gestation period ranged from 20 weeks to 40 weeks; 34 (22.66% ) patients had Grade 1 hypertensive Retinopathy , 04 (2.6%) patients had Grade 2 Hypertensive retinopathy ; No signs of Hemorrhages or exudates or retinal detachment. Conclusion: Early ocular examination to assess severity of Pregnancy induced hypertension at regular intervals & timely intervention of time to prevent complications and improved outcome of pregnancy
Healthcare seeking behaviour during the COVID 19 lockdown in an urbanized village in Delhi: A cross-sectional study
Get PDFIntroduction: In response to the COVID pandemic, the government of India announced a country-wide lockdown on 25th March,2020, extended till 31st May,2020. Fear in the community about accessing non-COVID services would have affected healthcare-seeking behaviour.Methodology: UHTC(Urban Health Training Center),Aliganj caters to 6000 population, in an urbanized village of South Delhi. We used a pre-designed, semi-structured questionnaire on sociodemographic details and health-seeking behaviour on adults who regularly sought health care from UHTC. We used systematic random sampling to select patients attending UHTC during November-December 2020 and analysed the data in SPSS.Results: Of 218 patients,198 required consultations during the lockdown. 116(58.5%) accessed an alternate government health facility,58(29.2%) accessed a private clinic, while 2(1%) opted for teleconsultation. 113 patients reported to have not taken the medication previously prescribed from UHTC. Reasons cited were unavailability of medicines in pharmacies[49(43.3%)], drugs were expensive[47(41.2%)] and migration to the village where the medicine was unavailable[17(15%)].Conclusions: More than one-fourth of the study population visited private clinics during the lockdown for consultations. 44.3% of the patients bought medicines from private pharmacies resulting in out-of-pocket expenditure. There was low uptake of telemedicine services. Unavailability and cost were barriers to taking prescribed medication during the COVID 19 lockdown
A Study on Phototherapy Induced Electrolyte Imbalance in Hyperbilirubinemia of New Borns Admitted in NICU Of Tertiary Care Centre
Get PDFIntroduction: Nearly all newborns acquire abnormally high levels of bilirubin (i.e., total serum bilirubin (TSB) greater than 1 mg/dL [17 micro mol/L], which is the maximum limit of what is considered normal for adults). If TSB levels continue to rise, the newborn may show obvious signs of jaundice.Phototherapy is the first line of treatment for unconjugated hyperbilirubinemia in newborn infants who have been born full term or who were born late preterm.Phototherapy should be recommended only when threshold or near-threshold TSB levels are reached, and only with acceptable light sources that have been appropriately recognized. This study was conducted to estimate the serum electrolytes in term neonates before and after phototherapy. Methodology: 50 neonates who were either delivered intramurally or extramurally and who were referred to this location with hyperbilirubinemia that was not associated with any comorbidities and who underwent phototherapy for at least 24 hours were included in the study. Conclusion: The findings of this study revealed a decline in the levels of serum sodium, potassium and calcium levels in infants exposed to PT. Even though the exact mechanism for this decline could not be understood clearly, further large sample studies are needed to elucidate the same. We must not forget that these imbalances might have an adverse effect on the neonates and must remain keen eyed.Hence we strongly suggest assessment of serum calcium, sodium, potassium, chloride, bicarbonate along with routine measurement of serum bilirubin in neonates before and after phototherapy. Thus by regular monitoring and maintaining normal serum electrolyte levels we can avoid the development of complications in icteric neonates receiving phototherapy
Study Of C – Reactive Protein With Carotid Intimal Thickness In Ischemic Stroke And Relation With Patient Outcome
Get PDFBackground: Stroke is the third most common cause of death in industrialized countries( 9% of all deaths) and one of the biggest causes of disability worldwide. The carotid intima-medial thickness ( IMT) has surfaced as a dependable independent marker of cardiovascular complaint. C- reactive protein( CRP) has been demonstrated to be an important contributory factor for Cardiovascular disease. The association of CRP with stroke is more credible in the presence of a higher carotid IMT.Objectives: To correlate between the levels of c reactive protein and bilateral carotid intima-medial thickness in patients with Acute ischemic stroke.Material & Methods: This is a prospective cross sectional study performed over a period of 1 year in 100 patients who presented to the department of general medicine at Alluri Sitarama Raju Academy of Medical Sciences, Eluru.Results: A total of 100 study participants were enrolled. The mean carotid intimal thickness levels and C-reactive protein levels were 0.833 ± 0.24 mm and 7.877 ± 3.76 mg/dl respectively. 50 out of 100 patients reported carotid intima medial thickness to be more than 0.8 mm. Highly significant association between carotid intima thickness with the patient outcome (p<0.003), whereas 65% reported CRP >6 mg/dl (p <0.001).Carotid medial thickness was significantly correlated with C- reactive protein (p<0.001).Conclusions: Addition of CRP and carotid intima-medial thickness to conventional risk factors resulted in a modest increase in the ability to predict cerebrovascular accident. Episodes leading to morbidity and mortality can be lowered by routine monitoring of identified risk factors among high-risk individuals and wider acceptance of expected line of treatment in tertiary centre with provision of emergency intensive care unit
Comparision of efficacy of buprenorphine and dexmedetomidine as adjuvants to ropivacaine in ultrasound guided supraclavicular block in upper limb surgeries
Get PDFBackground: Upper limb surgeries are commonly done under brachial plexus block. There are various approaches for brachial plexus block. Among them, supraclavicular approach is the most effective and commonly used method. It is performed at the division level with little or no sparing of dermatomes. A number of adjuvants have been used to enhance the effect of local anaesthetics in peripheral nerve block.This study was done to evaluate the efficacy of dexmedetomidine of 50μg over Buprenorphine of 300μg as an adjuvant to 0.5 % Ropivacaine in supraclavicular brachial plexus block. Objectives: To compare the efficacies of buprenorphine and dexmedetomidine asadjuvants to 0.5% ropivacaine used in USG guided supraclavicular brachial plexus block for elective upper limb surgeries. Material and methods: A prospective randomized comparative study. Institutional Ethical Committee approval was obtained to perform the study.Study was conducted on 50 Patients of ASA I, II of ages between 18-60 yrs who are undergoing elective upper limb surgeries performed under supraclavicular brachial plexus block. These patients are assigned into 2 groups of 25 each. Results: The results show that Dexmedetomidineas an adjuvant to Ropivacaine in supraclavicular brachial plexus block helps in prolonging the duration of motor blockade and duration of analgesia when compared to Buprenorphine without causing any post-operative side effects