International Journal of Health and Clinical Research
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Efficacy of clomiphene citrate and letrozole in intrauterine insemination cycles
Get PDFBackground: There are two commonly used drugs for ovulation induction, Letrozole and Clomiphene Citrate (CC). Aim of the present study was to evaluate the efficacy of Letrozole and CC in women undergoing Intrauterine insemination (IUI) and also to compare the effects of Letrozole and CC on total number of follicles, endometrial thickness, hormone levels and pregnancy rates. Methodology: In our study we recruited 63 patients attending KSHEMA IVF (Fertility and Reproductive Medicine Center) and OBG OPD, Justice K.S Hegde Charitable Hospital,at Deralakatte, Mangalore between January 2018 to June 2019. There were 35 patients in Letrozole group and 28 patients in CC group. Serial TVS was performed in both the groups until a mature follicle of diameter 18 mm is seen. Gonadotropin injections were added as per the requirement of the patients in each cycle following which hCG trigger was given and after 34-36 hours IUI was performed. Results: The endometrial thickness in CC group was found to be more than in Letrozole Group (8.21±1.64 VS 7.36±1.25), which was statistically significant, which correlates with another finding of the study ,i.e, pregnancy rates were higher in CC group than Letrozole group(63.5% Vs 37.5%). It was found in our study that number of follicles were more in Letrozole group than CC group(61.1% Vs 38.9%). The required mean dose of Gonadotropin was found to be less in Letrozole than in CC group (104.23±56.86 Vs 168.75±77.63). Conclusion: CC has been considered as the first line agent for ovulation induction since years. In our study, it was found that endometrial thickness was statistically more in patients whoreceived CC than Letrozole and pregnancy rates were higher in CC group. Also, number of dominant follicles was found more in Letrozole group. Patients in Letrozole group required less units of additional Gonadotropins.Hence we can conclude that Letrozole can be a better agent for ovulation induction, but CC might have a higher pregnancy rate than Letrozole.However it requires further study with larger sample size and sufficient study period so that the pregnancy outcomes can be studie
Hemodynamics and Pain on injection, A comparison observational study between Propofol MCT_LCT and Propofol LCT preparations
Get PDFIntroduction- Propofol is an intravenous induction agent popular for induction, maintanence and smooth recovery from anaesthesia in both adults and children. It has gained popularity due to its intravenous sedative – hypnotic property producing rapid unconsciousness. The conventional preparation of Propofol contains a higher percentage of aqueous phase which contains free propofol responsible for pain on injection. Objectives – To compare the injection pain on induction with 1% Propofol LCT and 1% Propofol MCT / LCT preparations. To compare intraoperative hemodynamic changes between the two preparations. Methods- The current study is an observational study done in Fifty patients aged 20-60 years of American Society of Anaesthesiologists (ASA) Physical status I and II undergoing surgery under General Anaesthesia in Pushpagiri Institute of Medical Science and Research Centre. Patients were recruited by consecutive sampling technique, grouped into two with each group having 25 each. Group MCT – received Propofol MCT / LCT (2mg/kg), Group LCT – received Propofol LCT (2mg/kg). The pain was assessed by a second anaesthesiologist using the 4 point scale. Results - The incidence of pain was more with Group LCT. The incidence of pain score 0 with no pain were 0% in Group LCT whereas 16% in Group MCT. The incidence of pain score 1 was highest in Group MCT with 76% whereas 4% with Group LCT. The incidence of pain score 2 was highest in Group LCT with 60% vs 8% in Group MCT. Conclusion- Propofol Medium Chain triglyceride / Long Chain triglyceride used for intravenous injection did not eliminate pain completely but definitively had less pain on injection compared to Propofol Long Chain Triglyceride preparation. There were no significant hemodynamic changes for both the groups other than heart rate variability
Use of dexmedetomidine in monitored anaesthesia care for burr hole and evacuation of chronic sub-dural haematoma: A comparison with general anaesthesia
Get PDFBackgroundBurr hole craniotomy surgery is commonly used for evacuation of Chronic sub dural haematoma. Either Local anaesthesia withsedation or General anaesthesia is used for such cases. Monitored Anaesthesia Care has been advocated as safer tool. Dexmede tomidine hassedation without respira tory depression, analgesia and sympatholytic effect which make it an attractive agent for sedation during MAC. MethodsT o tal 60 patients were randomized in 2 equal groups: G roup D received a loading dose of 0. 7 mcg/kg of dexmedetomidine over 10 minutesintravenously followed by a maintenance infusion of 0. 5 mcg/kg/h, infiltration with 2 ml of injection 0.5% bupivacaine and 2 mL of injection 2%lignocaine at each burr hole site. In G roup G: intubation with balanced general anesthesia given. Results: Mean time to recovery from anesthesiawas less in group D 12.67±3.14 versus 18.40±5.04; p<0.001) but no significant changes in anesthesia onset time, total duration of surgery totalduration of hospital stay.. The hemodynamic changes were significantly more in group G as compared to group D at the time of induction, after5 minutes of induction and at the time of extubation. Overall postoperative complications were significantly more P = 0.041) in the group G ascompared with group D. Conclusion: U se of dexmedetomidine is effective and safe for surgical evacuation of chronic subdural hematoma viaburr hole craniotomy
Type-2 Diabetes Mellitus: Risks amongst urban India
Get PDFBackground and objectives: Diabetes has arisen as a significant wellbeing challenge in India because of a quick ascent in the number of diabetes cases. The early ID of high danger people through screening and early mediations as a way of life adjustments and treatment would help in the anticipation of diabetes and its entanglements. This review was done to survey the danger of type 2 diabetes mellitus (T2DM) in an urban slum population utilizing the Indian Diabetes Risk Score (IDRS) and to decide the variables related to high-risk scores. Methods: A people group-based cross-sectional review was led among the urban slum population in South Bihar, India. A sum of 136 review members was chosen haphazardly from the records. A pre-planned and pre-tried organized survey was utilized for information assortment. Appraisal of hazard of T2DM was finished utilizing the IDRS. Results: Of the 136 review members, 101 (74.3%) were at high danger (IDRS ≥60) trailed by 32 (23.5%) at moderate danger (IDRS 30-50) and three (2.2%) at generally safe (IDRS <30). 62 (92.5%) people in the age bunch ≥50 yr were at high danger contrasted with 34 (63%) in 35-49 yr age bunch. Most (n=35, 87.5%) of stationary specialists were at high danger contrasted with those utilized in moderate (n=52, 75.4%) and exhausting work (n=14, 51.9%).Conclusion: Nearly three-fourths (74.3%) of the review members were at a high danger of creating T2DM. Age, sort of occupation, stomach weight, general corpulence, and hypertension were the variables fundamentally connected with high danger IDRS score
Comparison of Intravenous Esmolol and Oral Clonidine for Attenuation of Stress Response to Laryngoscopy and Intubation in Patients Undergoing Surgery under General Anesthesia: A Randomized Clinical Study
Get PDFIntroduction: Direct laryngoscopy and endotracheal intubation are the most noxious stimuli during induction of anaesthesia. Airway instrumentation frequently induces a cardiovascular stress response characterized by hypertension and tachycardia due to reflex sympathoadrenal discharge caused by epipharyngeal and parapharyngeal stimulation. Various pharmacological approaches have been used to attenuate the pressure responses to laryngoscopy and tracheal intubation e.g. volatile inhalational agents, lignocaine, opioids, sodium nitroprusside, nitroglycerine, calcium channel blockers, and adrenergic blockers (alpha -2 agonists and beta blockers).Objectives: The purpose of this study is to compare the efficacy and safety of i.v esmolol and oral clonidine in attenuating the changes of blood pressure and heart rate by tracheal intubation.Materials and Methods: 40 patients posted for various surgeries under general anesthesia were randomly divided into two groups. Group C subjects received Clonidine 150 mcg PO, 90 minutes prior to induction of anaesthesia where as Group E subjects received I.V Esmolol 0.5mg/kg 90 seconds prior to intubation. To maintain blinding, Group C patients received I.V 0.9% Normal saline 90 seconds prior to intubation where as Group E patients received placebo tablet containing multi vitamins 90 minutes prior to induction .HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), Mean arterial pressure (MAP) , rate pressure product (RPP), Spo2, ECG will be recorded prior to induction (Base line), at the time of intubation and 1, 3, 5, and 10 min after intubation . Type of study: A randomized clinical study.Results: Pulse rate, SBP, DBP, MAP and RPP were comparable at baseline, at time of induction, during laryngoscopy and intubation and throughout whole study period it was not statistically significant in both groups (p>0.05). However in Intergroup comparison, SBP was comparable at base line and after 5 min of laryngoscopy and intubation in both groups, but SBP was significantly higher after 1 and 3 min of laryngoscopy and intubation in Group E than Group C. Also, there was statistically significant increase in MAP following laryngoscopy and intubation at one min in Group E than Group C (P<0.05). RPP was significantly higher after 1 and 3 min of laryngoscopy and intubation in Group E than Group C. Postoperative complications like dryness of mouth, excessive sedation, PONV, hypotension, Bradycardia, bronchospasm were not observed in any case in both groups. Conclusion: This study concluded that clonidine and esmolol provide hemodynamic stability but clonidine provides more stability with postoperative sedation
A study on prevalence of obstructive sleep apnea (OSA) in patients with metabolic syndrome (MS)
Get PDFThis was a cross-sectional hospital based study conducted in metabolic syndrome patients to determine the prevalence of OSA in. Patients fulfilling IDF criteria for metabolic syndrome were the study subjects. These patients were screened for OSA by clinical history, relevant physical examinations and Epworth Sleepiness Scale. Overnight Limited Polysomnography was performed in patients with high clinical probability of OSA. Statistical analysis of the collected data was carried out. It was found that prevalence of OSA in patients with MS was as high as 37.2%. Sub-group analysis showed that presence of symptoms like snoring, EDS and witnessed apnea were found to be higher in OSA group in comparison with the non OSA group. Association of different parameters like BMI, Neck circumference and waist circumference with OSA were found to be statistically significant among metabolic syndrome patients. This study reinforced the point that all the patients with MS and associated co-morbidities should be screened for undiagnosed OSA in them to stop further progression of the disease and to prevent target organ damage
A study on serum lipid profile in obese prediabetics
Get PDFBackground: Prediabetes is well-known to be a significant risk factor for type 2diabetes as well as heart disease and other chronic conditions. The pattern of multi-system involvement in prediabetes is similar to that of diabetic neuropathy. The purpose of this study was to determine the trend in fasting lipids in obese prediabetics who were obese at baseline. Objective: Obese patients with prediabetes were studied for their serum lipid profile. Materials and Methods: According to the inclusion criteria, this is a prospective case-control research with 40 patients and 40 controls who were admitted to Govt Medical College, Suryapet over 18 months. All of the pertinent information was gathered, and the variables were then examined using the t-test and the chi-square test. Results: Compared to the control group, the mean total cholesterol in the case group was 168.26, which was greater than the control group's 189.24. Triglycerides averaged 176.84mg/dl in the control group of obese patients, whereas they averaged 190.44mg/dl in the obese prediabetic group. However, LDL cholesterol was on the rise. Individuals with prediabetes had a haemoglobin A1C of 115.66, compared to 145.66 in the control group. A higher HDL cholesterol level of 40.34 was found in the control group, compared to a lower HDL cholesterol level of 35.68 in the case group, according to this study. Interestingly, there was no statistically significant difference in VLDL levels across the groups in this investigation. It was discovered that the control group had a mean VLDL of 31.3432. Individuals with obesity and pre- diabetes had a VLDL. Furthermore, when compared to FBS, it was discovered that HbA1c alone was not a sufficient technique for detecting dyslipidemia Conclusion: According to the findings of this study, all serum lipid markers, except for HDL-c, are considerably raised in prediabetic obese patients. Because of their dyslipidemic status, these prediabetic obese adults are at an increased risk of developing cardiovascular disease in the future
A Hospital Based Prospective Study to Evaluate the Effect of Collagen Dressing in Diabetic Foot Ulcer Patients
Get PDFBackground: Diabetic foot is one of the most significant and devastating complications of diabetes and is defined as a foot affected by ulceration that is associated with neuropathy and/or peripheral arterial disease of the lower limb in a patient with diabetes. The aim of this study to estimate the efficacy of Collagen dressing in patients with diabetic foot ulcer.Materials & Methods: A hospital based prospective study done on 30 patients with diabetic foot ulcer, who reported at department of general surgery in district hospital Dholpur during two year periods. All diabetic foot ulcer patients, with ulcer size less than 150 sqcm attending the Surgery Department were invited to participate in the study. All patients underwent a standard clinical and laboratory evaluation. Briefly, information about age, known DM duration, smoking habits, arterial blood pressure, and anthropometric measurements were collected. Critically ill patients and patients with underlying bone osteomyelitis or malignancy were excluded. In all patients, wound size was measured before treatment initiation.Results: In our study, overall, the chronic leg ulcer was found most commonly in elder age group above 50yrs. A significant reduction in healing was seen in patient presented with infection, with a mean percentage reduction in ulcer size of (45.42 ± 16.67), when compared to (68.56 ± 14.23) in patient who had no infection. P-value was <0.05* which is statistically significant. Pearson correlation test was used to test the correlation between percentage reduction in ulcer size with duration of diabetes, ulcer, antibiotics, hospital stay and duration of healing, all showing negative correlation. Conclusion: The use of newer dressings with collagen dressing may increase the wound-healing potentials of these new treatments, and further studies will be required to evaluate the effects of the combined treatments
A Hospital Based Retrospective Study to Estimate the Prevalence of Hysterectomy During One Year Period in Dholpur District in Rajasthan
Get PDFBackground: Hysterectomy is one of the most frequently performed surgical procedures during reproductive ages in many countries worldwide after caesarean section. Accordingly, the aim of this study to estimate incidence of hysterectomy in a low-income setting in district hospital, Dholpur, Rajasthan, India.Materials & Methods: This was an analytic cross-sectional study involving a retrospective review of clinical records at the district hospital, Dholpur over a 2 year period. Medical records of all women who had hysterectomies at the district hospital during this study period were captured with the help of a data capture sheet. Dependent Variables include indications of Hysterectomy, Complications of Hysterectomy and Outcomes of Hysterectomy. Independent Variables include age, Parity, Co-morbid factors, Level of Surgical Expertise, Uterine Size, Duration of Surgery, Past History of Surgery, and Type of Hysterectomy. Results: The mean age of women who had hysterectomies at the unit was 47.3 years. Nulliparous women constituted 8% of hysterectomy cases with the rest being parous. Majority of the women were employed in the farmers (38%). More than half of the patients had at least primary level of education (85.0%) with only a little over 15% having no education at all. Patients who had hysterectomy were predominantly muslims 48% with hindus occupying the second position (45%). The prevalence of the various indications, in descending order is as follows: uterine fibroids 70 (70%), utero-vaginal prolapse 5(5%), ovarian tumour 6 (6%), ruptured uterus 5 (5%), cancer of the endometrium 3 (3%), postpartum haemorrhage (PPH) 4 (4%), haemorrhage 4 (4%), and placenta anomalies 3 (3%).Conclusion: The burden of untreated morbidity, combined with attitudes towards the uterus, and a health system ill equipped to manage women’s gynaecological health needs, has rendered hysterectomy both medically rational, and socially acceptable, for low-income women in this setting
Bacterial Pattern and Antibiogram of Isolates from the Patients Admitted in a Pediatric Intensive Care Unit of Central Gujarat: A Prospective Observational Study
Get PDFBackground: The incidence of hospital acquired infection (HAI) is 5-7 folds more in ICU set up. In last two decades, along with antibiotic related adverse effects, HAI has become a special health problem resulting in increased morbidities, mortalities and burden of cost. There is a wide diversity in the incidence of microbial agents and their antimicrobial susceptibility from the various set ups such as indoor wards, Neonatal intensive care units (NICUs), PICUs etc. There is also variation in the proportion and types of infections among different subsets of patients within the same PICU at different season and due to geographical variation of the diseases. Objective: To assess the antimicrobial sensitivity pattern of bacterial isolates from the patients admitted in the PICU of a tertiary care center of central Gujarat. Methodology: This was a prospective observational hospital-based study, carried out at tertiary care center at Kashiben Gordhandas Patel children hospital, Vadodara, Gujarat, India from September 2019 to May 2020. Patients admitted to PICU were assessed for eligibility and enrolled after obtaining parental consent and checking for inclusion criteria. Patients were inquired about the presenting symptoms and were examined thoroughly. Clinical profile and demographical details were taken as per proforma. Basic hematological investigations such as complete blood count and C reactive protein were done in all cases. Various tissue samples were taken from the patients admitted in a PICU with positive septic screen to identify the bacterial isolates and their sensitivity pattern. Results: A total of 691 cases were admitted in PICU. Among the total 90 positive cultures, 61(67.7%) bacterial isolates were Gram negative (GN) bacteria, while 23(25.5%) were Gram-positive (GP) bacteria and 6(6.6%) were mycobacterium tuberculosis. S.typhi was the commonest bacteria found in 27% of the clinical specimens, followed by E.coli found in 22%, P. aeruginosa and Klebsiella pneumoniae in 7% each. Among GP isolates, Staphylococcus aureus was found in 14% of which MRSA was seen in 2%. S.pneumoniae and Enterococcus spp. were detected in 7% and 4% respectively. Conclusion: Common microorganisms found were Salmonella typhi in blood, E coli in urine, S. aureus in pus, pseudomonas and streptococcus pneumonia in CSF culture. Gram-negative bacteria were the predominant pathogens. Most gram-negative bacterial isolates showed resistance to multiple antibiotics but S Typhi still have good sensitivity for ceftriaxone/cefotaxim. Gram positive isolates especially S aureus showed resistance to commonly used antibiotics like penicillin, pipercillin+tazobactum but high sensitivity for newer drugs like linezolid, vancomycin, teicoplanin & tigecycline