International Journal of Health and Clinical Research
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Comparison of induction characteristics of etomidate versus thiopentone sodium
Get PDFIntroduction: Induction with suitable drug by intravenous route for induction of anaesthesia is an important element of anaesthesia management. Patients are susceptible to hemodynamic liability at the time of induction. Thus, an agent with least effect on hemodynamics would be the agent of choice. Aim: To compare the induction characteristics of Etomidate and Thiopentone Sodium during induction of general anaesthesia. Objective: To observe the Hemodynamic changes during induction with Etomidate and Thiopentone sodium (Heart rate, Systolic Blood pressure, Diastolic Blood pressure, Mean arterial pressure). Settings and design: The study was conducted in the department of anaesthesia of BVP MCH, over a period of two year from June 2014-2016, on patients undergoing elective surgery under general anaesthesia. Methods: 60 adult patients aged 18 – 50 years, belonging to ASA grade 1 and 2, undergoing elective surgery under general anaesthesia, were divided randomly into two groups of 30 patients each. Group T patients were induced with injection thiopentone sodium 5 mg/kg, Group E with injection etomidate 0.3 mg/kg intravenously. Statistical analysis: Data are presented as mean and standard deviation. The statistical analysis was performed using SPSS version 20. A “p” value of less than 0.05 was taken as significant. Results: There was no significant change in mean heart rate at one, two and three minute after induction as compared with the mean heart rate at the time of induction in both groups(p>0.05). In Groups T and E there was a significant fall in systolic blood pressure, diastolic blood pressure and mean arterial pressure at one, two and three minute after induction, as compared to the induction value (p<0.05). Conclusion: Etomidate offers superior hemodynamic stability during induction compared to Thiopentone. Thus Etomidate is a better induction agent for general anaesthesia
A Study On Prevalence Of Catheter Associated Urinary Tract Infections In A Tertiary Care Facility Of Bihar
Get PDFIntroduction: Urinary tract infection (UTI) is one of the most common infections in humans, accounting for more than 150 million cases worldwide. Beyond the initial urinary infection, catheter-associated UTIs (CAUTIs) can lead to complications including bacteremia, endocarditis, osteomyelitis, septic arthritis, and meningitis. With this background, the current study was designed to provide baseline information of such infections in the hospital and to identify the microbial pathogens associated with these infections. Methodology: A cross-sectional study was carried by the Department of Microbiology, Jan Nayak Karpuri Thakur Medical College and Hospital, Bihar, from January 2021 to July 2021. Both adult males and females were included in the study group. Before starting the study, the purpose of the study was explained to the subjects, and informed consent was obtained. Approval was acquired from the Ethical Committee. Results: The present study comprised of 150 catheterized urine samples collected with proper aseptic precautions. Mean age of the participating patients was 47.5 years with a standard deviation of 7.2 years. The age range was 17 years to 81 years. The male to female ratio was calculated and approximated to 1.5:1. The incidence rate of CAUTI calculated for this study for ICU and wards were 3.7 and 17.2 per 1000 catheter-days, respectively and catheter utilization ratio was 0.59 and 0.07 in ICU and ward, respectively. Conclusion: The study underscores the pressing need for the development of antimicrobial urinary catheters and their deployment when longer duration of catheter access is required
Biochemical Parameters in Symptomatic and Asymptomatic COVID 19 patients- A comparative study
Get PDFBackground: Covid-19 was first reported in Wuhan, China in the month of December 2019. Studies shows that different laboratory parameters are altered in Covid-19 patients with varied severity, and are useful as biomarkers to assess the progression of the disease. Certain biochemical parameters may predict the severity or the progression towards severity of the Covid-19 disease. Studies have stated that significant high value of LDH was noted in case of seriously ill patients. AST/ALT ratio a strong indicator of liver damage is used in analysing the severity of the disease. Elevation of ferritin is noted in case of inflammation. D-dimer has been identified as a potential indicator for its prognosis in COVID-19 patients. Methods: Total of 102 patients with RT-PCR test positive for COVID-19 were enrolled in the study. Study population is classified as Asymptomatic and symptomatic. Biochemical parameters like AST, ALT, Ferritin, D-dimer, LDH were analysed in serum samples obtained from the above patients. Fisher exact test and Chi-square test were used to find the significance of study parameters. Results: AST/ALT ratio was found to be moderately significant (p=0.044) with an increased value in symptomatic patients. LDH, D-Dimer and ferritin values were found to be high in symptomatic patients compared to asymptomatic patients and found to be statistically significant. Conclusion: Routinely used biochemical parameters show promise as potential markers of severity and prognosis. However further studies are required to evaluate the statistical utility of these markers
An observational analytical clinical research study and asystematic review on the clinical pharmacology ofrectal organoids in cystic fibrosis
Get PDFIntroduction: Rectal organoid cultures, derived from the rectal epithelia, are three-dimensional (3D) primary stem cell cultures that self-organize into tissue-recapitulating “mini-guts” in vitro that enable the long-term expansion and biobanking of primary patient tissue using defined growth conditions. This clinical research and systematic review was conducted for systematically investigatingthe clinical pharmacological aspectsof the rectalorganoids in cystic fibrosis, with thorough explanations and analyses of the medical study literature and evidences compiled from the various studies conducted, whichexplained the clinical pharmacology of rectal organoids. Objectives: The objective of this study was an observational analytical clinical research and a systematic review on the clinical pharmacology of rectal organoids in cystic fibrosis. Methods: The study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) Statement and Guidelines, 2009, described by the Cochrane Collaboration in June, 2016. At first, the steps of identification included the records which were identified through database searching and the additional records which were identified through other sources. This led to the steps of screening, which included the screened records after the duplicates were removed. From these screened records, few records were excluded, as per the exclusion criteria. Then, in the eligibility step, the full text articles were assessed for eligibility, from which few full text articles were excluded, according to the exclusion criteria, with adequate reasons. This led to the final inclusion step, where the studies were included in the qualitative synthesis of a systematic review, according to the inclusion criteria, and ultimately the studies were included in the quantitative synthesis.An observational analytical clinical pharmacological research study was also conducted. Results: This clinical research and systematic review, contributed 5898 refined and relevant medical records, among total 8371 records obtained from the study databases search. It also described theclinical pharmacology of rectal organoids in cystic fibrosis,which elaboratedthis systematic review and observational analytical clinical research study. Conclusions: To conclude, this clinical research and systematic review provided the refined qualitatively synthesised medical records, study literature and databases, as well as a descriptive analysis on the clinical pharmacology of rectal organoids in cystic fibrosis
Histomorphology of surgically removed fallopian tubes
Get PDFBackground: Fallopian tubes are common surgical specimen in pathology laboratory and there have been only few studies documenting the variable presentations of fallopian tube pathology, which prompted the present study. Material and Methods: A two year prospective study of specimens of fallopian tubes was done Formalin-fixed, paraffin-embedded tissue sections were stained with hematoxylin and Eosin. Results: Inflammatory lesions of tubes comprised maximum number of cases followed by ectopic pregnancies. No primary neoplastic lesion was found in the study. Serial sections of fallopian tubes and section from representative areas are essential for a pathologist so that the diagnosis of these pathological entities is not missed. Conclusion: Most of the fallopian tube lesions were identified incidentally. Knowledge of the general frequency of these variations in general surgical pathology practice can be valuable to pathologists
A study on catheter associated blood stream infections at a tertiary care hospital of Bihar
Get PDFIntroduction: Intravascular catheters are indispensable in modern-day medical practice, particularly in intensive care units (ICUs). The incidence of CRBSI varies considerably by type of catheter, frequency of catheter manipulation, and patient related factors (e.g., underlying disease and acuity of illness). Materials and Methods: It was case-control study conducted in the Department of Microbiology, Darbhanga Medical College, Laheriasri, Bihar, India from January 2020 to December 2020. The number of participants in this study was 100 cases and 100 controls. Patients aged >18 yrs, admitted in intensive care units with intravascular catheters, were included. Skin was cleaned with 70% alcohol prior to catheter removal. Drying was avoided by sealing the tube and transporting the same to the laboratory as soon as possible. In blood processing, blood was collected within 48 hours of catheter collection under all aseptic precautions in a BacT bottle and analyzed using the BacT ALERT system. Antibiotic sensitivity pattern was done by Kirby-Bauer disk diffusion method as recommended by Clinical Laboratory Standard Institute (CLSI). Statistical analyses were done using SPSS 16.0 and strength of association is expressed as odds ratio which was derived using logistic regression analysis. Results: Out of 100 samples, 81% of the isolates were bacteria, while 17% of the pathogens were Candida species and only 2% were polymicrobial. While majority (70.4%, 19/27) of the organism of CRBSI was Gram positive, majority (61.6%, 45/73) of the organism of CRLI were Gram negative.The commonest pathogen of CRBSI was Staphylococcus aureus (12/27) and the least common was Acinetobacter baumannii (1/27). Candida spp. Conclusions: The increasing rate of CRBSI is a matter of concern to our hospital set up. This work will help both the clinicians as well as microbiologists in better management of patients as well as in prevention of nosocomial bloodstream infection, especially due to multidrug resistant organisms
A prospective study showing functional outcome & complications following PHILOS plating in proximal humerus fractures
Get PDFBackground: Significant controversy continues regarding the best methods of treating displaced proximal humerus fractures. Over last 3 decades, various modalities of fixations have evolved for proximal humerus fractures (like k-wires, screw fixation, T-buttress plate, conventional plate, locking plate & prosthetic replacement). Because they provide rigid anatomical fixation & higher angular stability, the proximal humerus locking plate is now the implant of choice for treating displaced proximal humerus fractures. Objective: To evaluate functional outcome & complications of PHILOS (Proximal humerus internal locking system) plating in proximal humerus fracture. Material &Methods: This prospective study include, a total 40 patients with displaced proximal humerus fracture, who were managed surgically with open reduction & internal fixation with PHILOS plating either by deltopectoral or deltoid splitting approach, between September 2019 to September 2020. Graded physiotherapy done in postoperative period. Average follow up period was 6 months. During follow up functional outcome was assessed by Neer’s score, fracture union was assessed radiologically, complications arrived if any, were managed accordingly. Results: Out of 40 patients, thirty patients having excellent, seven patients had satisfactory, two patients had unsatisfactory, one patient was failure according to Neer’s score. Mean Neer’s score was 89.05. Out of 40 patients, six developed various complications like shoulder stiffness, varus malunion, postoperative infection, implant loosening, avascular necrosis of humeral head. Average time taken for the fracture union was 12 weeks, assessed radiologically. Conclusion: PHILOS plating for displaced& comminuted proximal humerus fractures have results in excellent functional& radiological outcome with minimal complications
Bile duct injury during laparoscopic cholecystectomy: Experience from a tertiary care hospital of Bihar, India
Get PDFIntroduction: Bile duct stone is a common disease. In the case of United States, around 30 million people are affected by bile duct stone disease annually, and around 750,000 cholecystectomies are performed per year. The aim of the study is to know the risks, incidence, types, causes of BDIs, their timing and clinical presentations, various imaging modalities, and management by various methods. Materials and Methods: An observational study was carried out on 100 patients at Department of General Surgery, Darbhanga Medical College and Hospital, Laheriasri, Bihar, India. All patients who underwent laparoscopic cholecystectomy with BDIs were observed and followed up. The study was conducted over a period of one year From July 2020 to June 2021 included all cases of BDI during this duration. Prior approval was obtained from the Institutional Ethics Committee. Informed written consent was obtained from each patient before participation in the study. Results: A total of 100 patients were observed in the study period. The mean age of these patients was 43.8 ± 18.2 years with a female preponderance. The conversion of laparoscopy to open surgery was done among 12 cases. In 9 cases, this was done because of BDI, and, in 3cases, it was done because of short cystic duct with adhesions, inflammation, and difficulty in laparoscopy. BDI was observed in 5 patients and BL occurred in another 4 cases. Of 5 cases of BDI, 4 cases were detected intraoperative and 1 case was detected postoperatively. The cases detected at the time of surgery were managed surgically by end-to-end anastomosis over a T-tube and Roux-en-Y hepaticojejunostomy. Conclusion: The surgeon doing laparoscopic cholecystectomy should be aware about management of such injuries, and long-term follow-up should be done for such patients
Comparative study of bupivacaine-fentanyl versus bupivacaine-clonidine in patients undergoing spinal anaesthesia for lower abdominal surgery
Get PDFBackground: There are many adjuvants used along with bupivacaine for subarachnoid block, but Fentanyl and Clonidine are commonly used as adjuvants to intrathecal bupivacaine for prolonging both sensory and motor blockade as well as postoperative analgesia in patients undergoing lowerabdominal surgery.AIM: The present study aimedto compare the effect of intrathecal Clonidine and Fentanyl as adjuvants to Bupivacaine in the subarachnoid block for lower abdominal surgery. Materials and methods: 200 patients belonging to the American Society of Anaesthesiologists I or II,scheduled for lower abdominal surgeryunder spinal anaesthesia were randomly allocated to one of the two following groups to receive Bupivacaine 15mg combined with 50g clonidine (group A; N =100), Bupivacaine 15mg combined with 25g., fentanyl (groupB; N=100). Parameters like time for an adequate level of analgesia, peak sensory and motor level reached, duration of sensory, motor block, and incidence of complications was noted in this prospective, randomized double-blinded study. Result: Both the groups were comparable in demographic data, onset and duration of sensory and motor blockade, and hemodynamic parameters, but the duration of analgesia was significantly longer in the Clonidine group when compared with the Fentanyl group,with a mild increase in sedation score. Conclusion: The addition of intrathecal Clonidine in a dose of 50g provided prolonged postoperative analgesia with minimum side effects compared to Fentanyl and other different doses of Clonidine
An Innovative Stump Stenting Technique for Dissection of Cholecystocystic Stump after Subtotal Cholecystectomy in Difficult Gallbladders to avoid complications associated with the Residual Gallbladder Stump. A Prospective Study
Get PDFBackground: The management of difficult gallbladders often need some innovative techniques and cannot always be done by standard antegrade dissection as there can be dense assimilated adhesions due to recurrent chronic inflammatory process causing distortion in the anatomy of calot’s triangle, thereby increasing the risk of biliovascular injuries. So the only bail out option in such situation becomes subtotal cholecystectomy by some other techniques to avoid biliary and vascular injuries. But the residual cholecystocystic stump following subtotal cholecystectomy is associated with certain complications like stump cholecystitis, stump calculi and post cholecystectomy syndromes.Objectives: To avoid the complications of residual cholecystocystic stump, we go one step beyond subtotal cholecystectomy by stenting the residual GB stump with feeding tube or guide wire which delineates the orientation of cystic as well as common bile duct and facilitates further dissection of cholecystocystic stump to an optimum extent which completely abolishes the residual cholecystocystic stump and also makes it complete cholecystectomy and no further residual stump and its associated complications.Methods: The study conducted in postgraduate department of surgery Government Medical College Jammu and in a corporate hospital of Jammu over a period of three years from January 2018 to January 2021. A total of 83 patients of difficult gallbladders associated with frozen and distorted calot’s triangle were included in the study.Results: During postoperative period and follow up period in our study of 83 patients of difficult gallbladders with frozen calot’s triangle, we have a bile leak in five patients, in two due to missed CBD stone and consequently slipping of cystic duct clips. ERCP with clearance of CBD stones were done followed by stenting of CBD and patient settled within 3-5 days. Rest of three were from accessory duct which also settled spontaneously within 3-7 days. No major bile duct injury occurred. Port site infection occurred in 8 patients, 3 confirmed as atypical mycobacterial infections. 11 patients had systemic complications which settled with expectant management. Two elderly patients of perforated gallbladders died due to systemic complications. Rest of the patients had uneventful and smooth recovery.Conclusion: Stenting of residual cholecystocystic stump followed by dissection is a viable, effective and safe option to convert subtotal cholecystectomy into complete cholecystectomy and to avoid the long term complications associated with residual gallbladder stump