International Journal of Health and Clinical Research
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Effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubationc
Get PDFBackground: The α2 adrenoreceptor agonist, Dexmedetomidine, provides excellent sedation with minimal cardiovascular instability or respiratory depression and may be a useful adjunct to facilitate smooth tracheal extubation. Materials and methods: We retrospectively analyzed the data of patients who underwent elective general surgical and ENT procedures, fifty patients were included in this study, patients who received an intravenous infusion of dexmedetomidine (group A) 0.4mcg/kg in 100ml NS over 15 min were compared to those who didn’t receive dexmedetomidine (group B). Heart rate, systolic, diastolic, and mean arterial pressures were recorded while starting injection, at 1, 3, 5, 10, 15 minutes after starting injection, during extubation, at 1, 3, 5 minutes after extubation, and thereafter every 5 minutes for 30 minutes were collected and Quality of extubation which was evaluated on a 5-point scale and postoperative sedation on a 6-point scale were collected and analyzed. Any event of laryngospasm, bronchospasm, desaturation, respiratory depression, vomiting, hypotension, and undue sedation was noted from the data. Results: Heart rate, systolic, diastolic, and mean arterial pressures were significantly higher in group B (P < 0.05). The extubation quality score of the majority of patients was 2 in group A and 3 in group B. Sedation score of most patients was 3 in group A and 2 in group B. Bradycardia and hypotension incidences were higher in group B. One patient in group A and two patients in group B had vomiting. No patient had any other side effects. Conclusion: Dexmedetomidine 0.4 mcg/kg administered 15 minutes before extubation had been found to stabilize hemodynamics and facilitate smooth extubation and increase postoperative sedation
A Study Of Maternal And Fetal Outcomes In Gestational Diabetes Mellitus
Get PDFAim:To study maternal and fetal outcomes in patients with gestational diabetes mellitusObjectives:To study the maternal outcome in terms of mode of delivery, antepartum, Intrapartum and post -partum complicationsTo study fetal outcome in terms of maturity, birth weight, presence of congenital anomalies, and neonatal complications in cases ofgestational diabetes.Materials and Methods: In this prospective observational study we included 30 patients with gestational diabetes mellitus and were studied forfeto-maternal outcome. Results: In this present study 30 cases of gestational diabetes mellitus were studied. It was observed that gestationaldiabetes mellitus maximum among patients belonged to age group 26-30 years (33%), maximum seen among multigravida patients (56%). 50%cases delivered by caesarean section, maternal complications like preeclampsia (8 cases), polyhydramnios (13 cases), uteroplacental insufficiency(3 cases), macrosomia (5 cases), intrauterine fetal death (1 case). 6 neonates developed respiratory distress syndrome, 10 developedhypoglycemia, and 11 neonates required NICU admission. Conclusion: Gestational diabetes mellitus poses short term as well as long termeffects on the health of both mother and the child. Therefore all antenatal women attending the OPD should be offered universal screening forGDM. Early diagnosis and treatment of gestational diabetes with adequate antenatal care, timely referral, management of the identified cases areessential to reduce the adverse maternal and neonatal outcomes
Yoga Intervention in Patients of Depression and its Comparison with Conventional Treatment: A Randomized Controlled Trial
Get PDFIntroduction: Depression contributes significantly to global health burden. Yoga leverages many physiological and psychological changes involved in mood enhancement and may have the potential for being effective in patients of depression. Yoga comprises a mind-body intervention consisting of various elements including asanas, pranayama, and dhyana. Aim: To determine and compare the severity of depression in the study participants (with and without yoga intervention) with 3 months of follow-up and to analyse how different domains of the depression changed in patients of depression with and without yoga intervention. Material and method: An interventional study was conducted on 60 patients of depression aged 18-45 years, were randomized into an interventional group (with yoga intervention) and control group (without intervention of yoga). Depression scores were measured using the Hamilton Depression Rating Scale (HDRS), at the beginning (baseline), after one month and three months. Result: A statistically significant difference was observed with time scale at baseline, after one month and three months in both, interventional group (F(1.543, 44.752) = 408.14, p < 0.001) and in control group (F (1.720,49.877) = 5.740, p < 0.05). A significant difference was also observed between interventional and control group (p < 0.001) after three months of yoga intervention, whereas no significant difference was observed at baseline and after one month of yoga intervention. Conclusion: Yoga intervention resulted in a significant reduction in depression scores within one month and improves its various domains significantly, whereas conventional treatment benefits take longer time and not improve all domains of depression
Prospective comparison of the Pediatric Appendicitis Score and Alvarado score for clinical diagnosis of acute appendicitis in children
Get PDFBackground: In the Alvarado score and the pediatric appendicitis scoring systems, there is a reference score above which surgery is recommended while only observation is warranted below the specific score. The present study was conducted among children presented in surgical emergency with right lower abdominal pain having sign and symptoms of acute appendicitis at Gouri Devi institute of medical sciences and hospital, Rajbandh Durgapur-12 From November 2020 to October 2021. Material and methods: The present study was conducted among children presented in surgical emergency with right lower abdominal pain having sign and symptoms of acute appendicitis at Gouri Devi institute of medical sciences and hospital Rajbandh Durgapur-12 From November 2020 to November 2021. Each enrolled patient was awarded clinical scores according to both the Alvarado scoring system and the pediatric appendicitis scoring system. The statistical values were calculated for both scoring systems at cutoff score 7. Results: 100 patients were included in the study. Of the enrolled patients, 70 were males and 30 were females. 47 patients were included in the operated group (seven or more than seven group) and 53 patients were included in the observational group (less than seven group). Out of those 53 patients classified as the observational group, 39(73.58%) patients got settled during observation without any complication while 14 (26.41%) had to be proceeded with surgery because of an increase in their score (PAS/Alvarado) values during their observational period. Out of total 100 patients, 61 got operated i.e. 47 patients were included in the operated group (seven or more than seven group) and 14 patients (less than seven group) were operated. Out of 61 got operated and according to histopathology report 50 were confirmed as acute appendicitis while 11 were declared as negative appendectomies. According to the Alvarado scoring system, 43 patients were in the “seven or more than seven” group while 18 patients were in the “less than seven” group. According to histopathology at cutoff value 7, the Alvarado score resulted in 39 correct diagnoses of appendicitis and 4 innocent appendectomies. According to the pediatric appendicitis scoring system, 47 patients were in the “seven or more than seven” group while 14 patients were in the “less than seven” group. According to histopathology cutoff value 7, the pediatric appendicitis score resulted in 43 correct diagnoses of appendicitis and 4 innocent appendectomies. Conclusion: The pediatric appendicitis score (PAS) was superior in diagnosing acute appendicitis in the pediatric population than the Alvarado score as indicated by the values of diagnostic accuracy
A prospective observational study of colorectal cancer in a tertiary care hospital in north India
Get PDFIntroduction: Globally, colorectal cancers are the third most common cancers contributing 8.9% of all cancers in both males and females.Although Incidence of rectal malignanciesvaries widely, developing countries have reported lower rates, particularly in Africa and Asia. Materials and Methods: The study was conducted in a tertiary care hospital in North India from March 2020- February 2021.40patients provisionally diagnosed as having rectal malignancies either clinically or radiologically were includedin the study to examineepidemiological and clinical characteristics of colorectal patientssuch as age, gender, personal history, histopathological type/ stage and mode of treatment. Results: Maximum number of cases was reported in the age group 41-50 years i.e., 14 (35%).Rectal malignancy was found in relatively young age group with a mean age of 49.5 years and males were prone than females in the ratio of 3:1.Bleeding per rectum was the most common complaint followed by altered bowel habits.Majority of cases reported history of smoking and alcohol intake. Vegetarians had lower incidence in comparison to those on mixed diet. 48% were moderately differentiated adenocarcinomas followed by24% cases which were well differentiated adenocarcinomas. Palpable rectal growth was found in 80% of patients.Maximum number ofpatients presented in early stage 30 (75%) followed by locally advanced stage 6 (15%) and metastasis stage 4 (10%) and abdominoperineal resection was the most commonly performed surgery. Conclusion: CRC in our institution is more often observed in younger individuals than what is reported infrom other parts of the country. Also, further studies with larger sample size are required to understand the role of other local factors like diet and personal habits in this region. A high index of suspicion and measures promoting early detection among young adults should be encouraged
Analgesic Efficacy of Right Subcostal Transversus Abdominis (STA) Block Supplemented by Bilateral Rectus Sheath Block (RSB) under USG Guidance and Its Comparison with Port Site Infiltration of Local Anaesthetic in Laparoscopic Cholecystectomy
Get PDFBackground and Aims: Pain after Laparoscopic Cholecystectomy is multifactorial, pain is most intense on the day of surgery with the incisional pain predominating over the visceral pain. Subcostal transversus abdominis (STA) block and Rectus sheath block (RSB) has been proven to reduce the pain from midline abdominal incision in laparoscopic surgery. This study aimed to compare the analgesic efficacy of USG guided subcostal transversus abdominis (STA) Block and rectus sheath block vs port site infiltration of local anesthetic in terms of quality of intraoperative and post-operative pain relief (NRS), need of rescue analgesics, hemodynamic stability and 24 hr postoperative patient satisfaction score.Methods: Sixty patients scheduled for laparoscopic cholecystectomy were randomly allocated to two groups either to receive USG guided right STA and bilateral RSB (n = 30, Group A) or port site infiltration of local anesthetic (n = 30, Group B group). Intraoperative and postoperative hemodynamics, pain score and need of rescue analgesics were monitored.Results: The study group (Group A) had significantly reduced NRS score and tramadol consumption over 24 hr. Total tramadol consumption in patients receiving port site local anaesthetic infiltrations (Group B group) was approximately twice (200 ± 100 mg) as compared to patients in block group (Group A) (100 ± 50 mg) (P < 0.0001). Conclusion: It is concluded that ultrasound-guided STA and RSB produce effective post-operative analgesia for the incisional pain in laparoscopic cholecystectomy surgeries and act as a supplementary method in multimodal analgesia
A prospective study on computed tomography guided fine needle aspiration cytology of peripheral lung lesions
Get PDFIntroduction: Percutaneous fine needle aspiration cytology (FnAC) of the lung is generally indicated for the diagnosis of pulmonary lesions. There are many hazards associated with performing thoracotomy for lung lesions. FnAC has become a diagnostic tool to assess the nature of radiographically demonstrable lung lesions. The general acceptance of FnA has been low but the appreciation of this method for lung lesions has been rapid due to the difficulty in otherwise diagnosing small peripheral lung lesions. Fear of neoplastic implantation in the needle track may have initially inhibited its use but have proven groundless. Materials and Methods: A total of 80 cases were included in the study. The study period was from January 2020 to December 2020. All patients presented with respiratory symptoms with a localized lung lesion clinically, which was confirmed radiologically. Patients were placed in the supine, prone, right lateral or left lateral position depending on the location of the lesion so that the lesion was nearest to the aspirator. Results: The diagnostic accuracy was 95% considering cytological criteria as the standard. The most common age group affected was 41–70 years (67.5%). However age groups in both extremes of life were affected less. The youngest patient was 20 years old whereas the oldest was 78 years old. Of the forty patients, twenty-seven were males and thirteen were females. A male preponderance was therefore noted in this study with a M:F ratio of 2.081. Table I shows the distribution of the cases. The predominant lesion found in this study was malignancy in twenty-four cases (60%), followed by an inflammatory lesion in twelve cases (30%). One case each was reported as suspicious of malignancy (2.5%) and as a granulomatous lesion (2.5%). Conclusion: Percutaneous, transthoracic FnAC is a relatively simple procedure with good patient acceptance and low morbidity. It is an accurate, safe and repeatable procedure in the diagnosis of difficult lung lesions. Ct scan has enabled the visualization of previously inaccessible tumors, which can now be guided by this procedure, leading to a greater yield of cytological material and a significantly greater predictability of true positive cases in malignant lesions. FnAC should be used earlier and more frequently to shorten the diagnostic interval and allow more prompt therapy for persistent lung lesions
Comparative study of Bupivacaine and Ropivacaine in combination with fentanyl for Epidural anaesthesia in labour- A Randomized Controlled Trial
Get PDFIntroduction: Effective pain relief during labor is essential to reduce maternal and perinatal morbidity arising due to pain-induced maternal sympathetic activation, and to avoid unnecessary caesarean sections performed due to maternal anxiety. Despite the extensive use and relative safety of bupivacaine, newer drugs such as ropivacaine have been developed as alternative agents to decrease the risk for cardiac and central nervous system toxicity. Objective: To compare the effects on obstetric and neonatal outcomes between ropivacaine and bupivacaine in combination with fentanyl used in walking epidural analgesia.Materials and Methods: One hundred women who demanded epidural analgesia in active labor were randomly allocated into two groups; one group received 20 mL of ropivacaine 0.125% with fentanyl 50 μg and the other received 20 mL of bupivacaine 0.125% with fentanyl 50 μg. The efficacy of analgesia, adverse effects, and obstetric and neonatal outcomes of both groups were compared. SPSS was used for analysis. Results: There were no differences between the two study groups in the measured obstetric and neonatal outcomes. The onset time, duration of analgesia, and sensory levels were similar between the groups. Visual analog pain scale scores did not differ between the groups before analgesia or at any of the subsequent evaluation periods. Conclusion: Both ropivacaine and bupivacaine provide equivalent labor analgesia with high maternal satisfaction and tolerable adverse effects in the clinically used dose range
Effect of Excess Consumption of Caffeine on Cardiovascular Status
Get PDFObjective:This study was done to find whether excess consumption of caffeine containing beverage and other product on daily bases really have bad effect on our cardiovascular system or not . Method: All volunteer were divided into two groups depending on number of cups of coffee or other caffeine containing beverages and chocolates consumed by them. Group 1 was habitual drinkers and Group 2 was non-habitual drinkers. Then their basal HR, SBP and DBP were recorded and compared. Then same parameters were recorded at various time intervals after Queens College Step Test to find the recovery time of cardiovascular system.Result: There were no significant difference in mean basal HR, SBD and DBP between the groups. HR, SBP and DBP were almost same at various time interval after Queens College Step Test, except at time interval 5 sec. – 20 sec. where DBP was significantly higher in habitual caffeine drinkers compared to non habitual caffeine drinkers.Conclusion: From this study it has been concluded that caffeine doesn’t causes any harmful effect on cardiovascular system
Study of Anxiety, Depression and quality of Life in Patients with Chronic Obstructive Pulmonary Disease
Get PDFIntroduction: Neuropsychiatric symptoms associated with chronic lung disease include increased psychological distress as well as impairments in neuropsychological functioning. The most common psychiatric disorders in such patients are anxiety and depression. In addi tion, psychological distress in individuals with COPD is associated with restricted activities of daily living and impaired quality of life. Objectives: To assess the prevalence of anxiety, depressions, Health related QOL and also correlate them with sociodemographic variables in COPD patients. Material and Methods: An observational, analytical, cross-sectional, clinical study was adopted to assess the anxiety, depression and quality of life among patients with COPD. The sample size was 150 patients diagnosed with COPD from a tertiary care teaching hospital. Results: Results were categorised in to observational as well as analytical data. Depression (51%) or Anxiety (55%) are commonly prevalent in COPD patients. There is significant association between severity of COPD, and total score of HRQoL in those suffering from anxiety. Conclusion: The current study concludes that there is an increased prevalence of anxiety and depression in patients with Chronic Obstructive Pulmonary Disease. It is observed that there is a deterioration of health- related quality of life as the chronicity of the disease increases