International Journal of Health and Clinical Research
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Self-medication- A challenge in the present scenario: Experience from an urban slum of Darjeeling district, West Bengal
Get PDFBackground: Self- medication is an important concern for health authorities at global level. There is much public and professional concern regarding self-medication practices, which has increased in the last few decades, especially in the developing countries. Objectives: To determine prevalence of self-medication practice and factors associated with self-medication, attitude & perception of people towards self-medication. Methods: A cross sectional study was conducted in urban field practice area of a tertiary care teaching institute of North Eastern India. 190 subjects were selected through complete enumeration technique during a period of six months. Participants were interviewed using predesigned, pretested and validated self-administered questionnaire. Information regarding self-medication use in the past three months & associated socio-demographic factors, purpose, source of drug procurement, perception regarding self-medication use were collected. Relationship between variables were determined by multiple logistic regression analysis. Results: Self-medication was found in 94.2% of the study participants. Fever with cough & cold followed by gastritis &bodyache were the common illness where self-medication was being used. NSAIDs (62.6%), PPI (57.8%), Amoxycillin-Clavulanic Acid (66.7%), cough syrups (46.9%) and anti-histaminic (31.2%) were found among the commonly self-medicated medicines. Commonest method adopted to obtain drugs was compelling symptoms (47.9%). Saving time (82.4%) was noted as most common reason for self-medication. Males, people above poverty level& distance of their households to nearest health facility<3 km were significantly associated with self- medication. Conclusion: Enforcement of rules determining drug prescription and dispensing, health education of people & regulation may help in limiting self-medication practices
Comparison of chloroprocaine and chloroprocaine with clonidine in spinal anaesthesia: A prospective study, double-blind randomised trial
Get PDFBackground and Aims: Clonidine improves quality of spinal anaesthesia as an adjuvant with bupivacaine and ropivacaine, but has not been studied much in combination with preservative-free 2-chloroprocaine, hence this study. Methods: This prospective randomised control trial was conducted in 60 adult male patients of age 18-60 years undergoing urological surgeries of short duration (<40 minutes). Patients were randomly assigned into two groups: Group A (n=30), patients who received intrathecal injection of 2-chloroprocaine and Group B (n=30), patients who received intrathecal injection of 2-chloroprocaine with 30μg of clonidine. The primary aim of our study was to compare isobaric 1% 2-chloroprocaine and 1% 2-chloroprocaine with 30μg of clonidine in terms of onset and duration of motor block, onset and duration of sensory block, time for 2 segment regression of sensory block and peak block height. Statistical analysis was done using SPSS version 20.0. Quantitative data was analysed by student’s ‘t’ test and qualitative data by Chi-square test. Results: Onset of sensory blockade was faster and peak block height was higher for Group B. There was no statistically significant difference in the onset of motor blockade and time of 2 segment regression between the two groups. The total duration of sensory and motor block was longer in Group B compared to Group A and mean time for first request of analgesic was longer in Group B compared to Group A. There was no statistically significant difference in the heart rate and mean arterial pressure between the groups at various time intervals. There was no incidence of hypotension, bradycardia or post spinal head ache in the two groups. Conclusion: Addition of 30μg of Clonidine to 4ml of 1% Chloroprocaine intrathecally enhances onset and duration of sensory and motor blockade in urological surgeries of short duration without significant difference in the hemodynamic parameters and side effects compared to Chloroprocaine alone
Use of Titanium elastic nailing in children 6-16 years of age with femoral diaphyseal fractures
Get PDFBackground: Significant controversy continues regarding the best methods of treating paediatric femoral shaft fractures. Over last 3 decades, operative management of paediatric femoral shaft fractures in age group 6-16 years has been gaining popularity. Titanium Elastic Nailing has now become the choice of fixation in femoral shaft fractures in this age groups. Objective: To evaluate the results of titanium elastic nailing system (TENS) in paediatric femoral diaphyseal fractures of children aged 6-16 years. Material and Methods: 32 patients (19 boys, 13 girls) in the age range of 6-16 years (average 10.2 years) with recent (< 5 days) femoral shaft fractures (23 closed, 7 Grade- I and 2 Grade- II Gustilo Anderson compound) were fixed with TENS. Evaluation was done on the basis of clinical and radiological evidences. The results were judged using Flynn’s scoring criteria. Results: Primary union was achieved in all patients without any rotational deformity. Mean operation time was 68 minutes. The results were excellent in 24 patients (75%) and successful in 8 patients (25%). There were 4 cases showing entry site irritation and 2 cases showing superficial infection. Functional outcome was good for those who achieved union. Conclusion: It was seen that excellent level of bone union was achieved by performing tens nail fixation in paediatric femoral fractures.Elasticity of nail provided enough counterforce to the muscular forces. TEN is an effective treatment option in selected cases of femoral diaphyseal fractures in the 6-16 years age group
Observational study on the incidence and risk factors for seroma formation following modified radical mastectomy
Get PDFIntroduction: Breast cancer is the most common malignancy in women and second leading cause of cancer death among women. The surgical treatment of choice for these patients is either modified radical mastectomy or breast preservation depending upon stage of the disease. Seroma formation is the most frequent postoperative complication after breast cancer surgery, of which the pathogenesis has not been fully understood. In view of this, we collected data to determine the incidence and risk factors related to seroma formation in our patients and increase its scope and hence attempt to prevent it. Materials and methods: An observational study was conducted in 126 female patients who have undergone MRM from the Department of General Surgery, Government Medical College, Kozhikode from November 2020 to November 2021. Those who are having seroma clinically within 4 weeks of surgery are sent for radiological evaluation (USG), size measured accordingly. Statistical analysis of the data performed and Pearson Chi-square test and Fisher’s Exact test were used for comparing categorical variables between groups. Results: The threshold age of development of seroma formation after MRM was ≥56.The threshold BMI of development of seroma formation after MRM was ≥27.50kg/m2.The threshold tumour size of development of seroma formation after MRM was ≥4cms. Out of 26 patients who underwent level 3 axillary dissection, 13 patients (81.2%) developed seroma. Level 2 axillary dissection was performed in 110 patients and only 26 ( 23.6%) patients developed seroma. >12 lymph nodes were removed in 33 patients and 25(75.8 %) developed seroma. In 93 patients with < 12 lymph nodes removed only 14 (15.1%) patients developed seroma. Conclusion: 1. 31% of patients in the study population who had undergone MRM developed seroma within four weeks after surgery. 2. Seroma formation after MRM showed positive correlation with age, BMI, tumour size, level 3 axillary dissection and >12 lymph nodes removed during surgery. 3. There was no correlation between seroma formation and day of drain removal, neoadjuvant chemotherapy, usage of breast bandage and shoulder exercises
Efficacy of evening primrose oil and danazol in mastalgia–An observational study with respect to breast pain chart
Get PDFBackground: Mastalgia is the most common symptom encountered in women who have gone under breast imaging, and 70% of women suffer from breast pain at least once in their lifetimes[1,2]. Mastalgia is defined as tension, discomfort and pain in one or both breasts[3]. Materials and methods: An Observational study was conducted upon 100 patients of Mastalgia receiving treatment in the Surgery Outpatient Department. Breast pain chart was initiated to classify mastalgia into cyclical or non-cyclical type and the response of respective drug monitored with Cardiff Breast Pain Score. These patients were either treated with Danazol (50mg BD) or Evening Primrose Oil (1000 mg BD). Duration of the study was from October 2018 to August 2020 in the Department of General Surgery, M. G. M. Medical College & L. S. K. hospital. Results: In this study overall mastalgia showed better useful response with Danazol (59. 2%) than with EPO (41. 2%) and this difference was statistically significant (Fisher’s exact test2-tailedpvalue0. 05). Cyclical mastalgia showed better observed response with Danazol (69. 4%) than EPO (47. 2%), this difference coming out to be statistically significant, Fisher’s exact test 2-tailed p value0. 02. Non-cyclical mastalgia showed slightly better observed response with Danazol (30. 8%) than EPO (26. 7%), this difference coming out to be statistically in significant, and Fisher’s exact test2-tailed p value0. 40. Conclusion: No significant adverse effects were observed with the doses of Danazol and Evening Primrose Oil (EPO) during the observed period
Correlation between abscess volume and liver function test in liver abscess
Get PDFBackground: Liver abscess is highly prevalent in India due to poor sanitation, overcrowding, inadequate nutrition, chronic alcoholism and diabetes. The modern diagnostics like ultrasound and computed tomography to locate and drain the abscess have reduced the mortality to 2-12%. However, due to the complications of liver abscess especially the amebic ones the morbidity is still high. This study aims to study the correlation of various LFT parameters with abscess volume which can render the opportunity for early detection of high risk patients, start early treatment thus reducing the overall morbidity. Methods: The study was conducted over a period of 6 months on 50 patients of liver abscess. History and physical examination was done. All patients were subjected to complete hemogram, liver function test, coagulation profile (PT/INR) and USG abdomen. The data was recorded and compiled in excel sheets and analyzed using Pearsons correlation coefficient (R) method.Results: The mean age of the patients was 45 years with male preponderance. Amoebic liver abscess was predominant. Alcoholism, smoking and diabetes mellitus were the main predisposing factors. Fever, right upper quadrant pain, elevated ALP, low albumin, increased PT INR points towards the diagnosis of liver abscess. Complications seen were pleural effusion (26%), ascites (36%) and intraperitoneal rupture (6%). On analysis, liver abscess size is significantly positively correlated with INR, ALP, liver enzymes and negatively correlated with serum albumin level.Conclusions: An early diagnosis and a prompt management of liver abscess is necessary to hault its progression and avoid serious complications like intraperitoneal rupture which causes significant morbidity. Thus, LFT can be used to estimate the liver abscess size and predict the severity and prognosis of patient
Comparison between blind nasal and fiber optic intubation in maxillofacial trauma posted for elective surgery
Get PDFBackground: Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient's survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient's airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult. Aim: To compare the safety and complications of blind nasal and fiber optic intubation in maxillofacial trauma. Materials and methods: This is an observational study, approved by the institutional ethical committee. An individual informed consent was taken from all the patients selected for the study. All the patients belonging to ASA grade 1 and 2, between the age group of 18 to 50 years of either sex. Posted for maxillofacial surgery under general anesthesia patients with comorbidities like copd, cardiovascular problems, patient refusal are excluded from the study. Total 40 patients with different types of facial fractures are included in the study they were divided into blind nasal group (20 patients) and fiberoptic group (20 patients). Discussion: The patient with maxillofacial trauma presents serious challenges for the physician because airway management in these patients can be complicated by their injury. The first challenge is to secure the airway for sufficient and effective breathing and/or ventilation. Fiberopticbronchoscopic intubation is best option for elective patients but has been considered difficult in maxillofacial trauma, patients with intraoral bleed. In both group of patients, securing the airway before induction of general anesthesia adds to the safety of anesthesia and helps minimize possibility of major complications. Conclusion: Awake fiberoptic intubation, is the best method for securing airway in patients with facial trauma when compared with blind nasal intubation
A Comparative study of Macintosh, McCoy and Video laryngoscope for hemodynamic alterations
Get PDFBackground and Aims: The different designs of laryngoscope have been developed to reduce the incidence of hemodynamic instability during endotracheal intubation. Primary aim of the study is to compare macintosh laryngoscope with mccoy and Truview EVO2 video laryngoscope in term of hemodynamic changes. Metarials and methods: Study was conducted in ninty patients ,thirty in each group, who require endotrachel intubation for elective surgery undergoing in general anesthesia. Results: Laryngoscopy with Truview EVO2 video laryngoscope and McCoy laryngoscope showed lesser hemodynamic alteration during intubation in comparisons with Macintosh laryngoscope. Conclusion: For orotracheal intubation, Truview EVO2 video laryngoscope provides better hemodynamic stability as compared to MacCoy and Macintosh laryngoscope
A Study on Prevalence and Risk Factors for Varicose Veins in a population
Get PDFBackground: Varicose veins are a common chronic venous disorder affecting 20 to 60% of adults worldwide. The present study was conducted to assess prevalence and risk factors for Varicose Veins in a population. Material and methods: This cross sectional study was conducted to assess prevalence and risk factors for Varicose Veins in a population. For the purpose of this study, varicose veins were defined as enlarged, tortuous, sub- cutaneous veins, either visible or palpable clinically with the patient standing. Data was analyzed using SPSS version 21. Results: The prevalence of varicose veins was found to be high in the population (72.22%). In maximum patients aging was the main risk factor for varicose veins(30.76%) followed by prolonged standing (24.35%). Conclusion: The present study concluded that aging, prolonged standing were significant risk factors for the development of varicose veins
A retrospective study of clinical spectrum and treatment outcomes of HIV associated cancers in a tertiary care centre
Get PDFIntroduction: With the introduction and widespread availability of highly active anti-retroviral therapy (HAART), the landscape of HIV/AIDS has changed considerably. This is true for HIV-associated malignancies as well. Post-HAART, the incidence of Kaposi's sarcoma and central nervous system (CNS) lymphoma (among AIDS-defining cancers) decreased in parallel with AIDS-defining infections. On the other hand, the incidence of systemic non-Hodgkin's lymphoma (NHL) and cervical cancer decreased less than others and remains higher in HIV-infected patients than in the general population. Currently, malignancies are the most frequent underlying cause of death (around one-third) of HIV-infected patients. Materials and Methods:The study was a retrospective observational study which included all the patients with HIV and cancer attending the Oncology Department OPD, GovtMedical College, Jammu between January 2020 and December 2020.Data obtained from the case records was used to fill up the proforma which included the patient factors (Age, sex, performance status, BMI, substance abuse), HIV related parameters (Time since diagnosis of HIV, baseline CD4 counts, comorbid conditions, treatment with HAART), tumour related factors (Site, type of cancer, subtype, stage, prognostic factors depending on the histology) and treatment aspects (Type of treatment, any requirement of dose modifications, toxicity, response, compliance). Results:The study included 100 patients with HIV and cancer (43 female patients and 57 male patients) with an average age of 42 years. A majority of the patients (71%) were in the 31-40 years age group, as shown in Table 1.The mean BMI of the study group was 19.45 (Range: 10 -26.5). Thirteen of the forty-four patients (29.5 %) had poor general condition with a performance status of 3 or 4 by the ECOG (Eastern Cooperative Oncology Group) scale. All patients were already enrolled for anti-retroviral therapy. The mean time to presentation of cancer after the diagnosis of HIV infection was 5.4 years (Range: 2 months to 15 years). Thirty-two patients had Non-AIDS Defining Cancers (NADC) and twelve had AIDS defining cancers (ADC). Conclusion: In the HAART era, NADCs are more common than ADCs. Standard chemotherapy achieves a response rate of 50% in HIV-NHL cases and 46% in HIV patients with solid cancers. The study illustrates the need for prolonged surveillance for the development of cancer in HIV patients. Early initiation of HAART, optimal chemotherapeutic regimens, appropriate palliative care and nutritional support should form an integral part of the care of HIV patients with cancer