International Journal of Medical Research & Review (IJMRR)
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Labour Analgesia
Get PDFRegional anaesthesia is nowadays commonly practised universally. It provides superior pain relief in first & second stages of labour, anesthesia for episiotomy & instrumental delivery
Spinal versus general anaesthesia in percutaneous nephrolithotomy
Get PDFBackground: Hemodynamic stability and blood loss reduction are subjects to further consideration in patients undergoing percutaneous nephrolithotomy (PNCL).
Objectives: This study compared the preference of spinal anaesthesia (SA) or general anaesthesia (GA) in respect to mentioned concerns.
Methods: In this randomized clinical trial, 59 patients who underwent PCNL divided into SA and GA groups. 15-20 mg from intra-thecal bupivacaine 0.5%, and premedication of 0.01-0.02 mg from midazolam, were given to patients in SA group (n = 29). Patients in GA group (n = 30) received premedication of 1-2 μg/kg from fentanyl and 0.01-0.02 mg/kg from midazolam, and intravenously anaesthetized with 100 μg/kg/min of propofol and 0.5 mg/kg of atracurium, given by continuous infusion and N2O/O2 50%. Mean arterial pressure (MAP) and heart rate were recorded intra-operatively and during recovery.
Results: MAP and heart rate show no significant differences at designated time points between two groups (P > 0.05). Surgery time, anesthesia time, bleeding volume, and analgesic intake were significantly reduced in SA group (P < 0.05).
Conclusions: Regional epidural anaesthesia is an alternative technique for PCNL which achieves more patient satisfaction, less early postoperative pain and less adverse effects from medication with the same efficacy and safety compared to general anaesthesia. It seems that, in patients undergoing PNCL, SA is as effective and safe as GA and with many advantages over it
To study the correlation of symptoms of angina with the diagnosis of ST Segment Elevation Myocardial Infarction (STEMI)
Get PDFIntroduction: Chest pain is amongst the commonest causes of visits to the emergency department. A rapid assessment with a prompt evaluation with an electrocardiogram clinches the diagnosis in most cases. However, with ever increasing strain on our limited resources, patient reported symptoms are central to initial assessment and must decide the course of action. Although considered ominous signs requiring further, often emergent, assessment, data on correlation of symptoms of angina with ST segment elevation is limited in contemporary literature.
Methodology: 230 patients with biomarker proven ST segment elevation myocardial infarction (STEMI) were studied and assessed for frequency of the four, patient reported, cardinal symptoms of angina, namely retrosternal chest discomfort, diaphoresis, palpitations and radiation. We assessed the relative presence or absence of these supposedly cardinal symptoms of angina and set out to classify the most important symptoms of angina.
Results: Our study shows that presence of three or more above symptoms is associated with a much higher possibility of an actual STEMI as opposed to only one symptom. Furthermore, a measurable increase in the probability of MI exists, when the number of patient reported symptoms increases from none to all four, as mentioned above. Though the study also reaffirmed the association between hypertension and Type 2 Diabetes Mellitus with acute coronary syndromes, our study was neither powered, nor designed to study this association.
Conclusions: Patient reported symptoms have a direct and additive correlation with STEMI. A quick but detailed history in the emergency department is of paramount importance to identify high risk patients
A study of functional outcomes of distal humerus fractures operated by triceps reflecting approach
Get PDFIntroduction: Approaches to distal humerus has been a great controversy of which cheverons osteotomy is considered a gold standard. However it is associated with implant and procedure related complication, Hence we studied a triceps reflecting (Bryan –Morrey) approach with some modification so as to achieve good exposure to distal humerus with intact olecranon.
Methods: In our study we retrospectively studied 13 skeletally mature distal humerus fractures at our center treated by TRA with minimum follow up for a period of 3 months. They were functionally assessed with DASH Score, MAYO score, triceps power evaluation with MRC grading, measurements of ROM and Radiological union.
Results: Mean duration of follow up was Ten months in 13 patients, with an average age of 43.23 years. The mean Quick DASH score was 3.85, mean Mayo score was 89 indicating an good performance, mean Triceps muscle power MRC grading 5 with adequate mean functional ROM 23-114 degree(extension –flexion). Only 2 patients had complication of which one was screw breakage and other was wound dehiscence which was not related to approach.
Conclusion: TRA is a better option as it avoids creating a new fracture and preserving the joint anatomy as compared to olecranon osteotomy with adequate exposure of the joint to carry out the fixation. As from our series functional outcomes of strength of triceps is comparable with that of the other side
Effect of progressive muscle relaxation on post-operative analgesia
Get PDFBackground: Postoperative pain begins with surgical trauma, the intensity reduces gradually and ends with tissue recovery. Effective pain management is essential to minimize unnecessary distress and potential complications.
Aim: The study aimed to assess the effect of progressive muscle relaxation technique on post-operative analgesia in patients undergoing abdominal surgery.
Materials and Methods: Evaluative research approach, quasi experimental time series design and simple random sampling technique were used to select 20 samples in experimental and control group respectively.
Results: Progressive muscle relaxation was the only influencing factor on reducing pain on 1st and 2nd post-operative day and no significant association was found between the research variables and level of pain. Mean arterial pressure was positively correlated with level of pain (<0.05).
Conclusion: Progressive muscle relaxation technique was effective in reducing post-operative pain and the results of this study can be incorporated in surgical units for proper management of post-operative analgesia
Serum Vitamin D levels in Chronic Obstructive Pulmonary Disease
Get PDFIntroduction: Lower serum 25 (0H) Vitamin D is associated with decreased lung function in healthy population and various lung disease. Information on the relationship of levels of serum 25 (OH) Vitamin D with severity of Chronic Obstructive Pulmonary Disease (COPD) is important in standardizing the treatment, in planning appropriate follow up and improving quality of life. This study also warranted further trial to assess the effect of serum 25 (OH) vitamin D on morbidity and mortality in COPD patients.
Material and Methods: It was a prospective (observational), cross-sectional study which included all patients with Chronic Obstructive Pulmonary Disease (COPD) attended the Department of Pulmonary Medicine, People’s College of Medical Sciences & RC, Bhopal, over a period of 1 year 6 months.
Results: The mean serum 25 (OH) vitamin D level in COPD patients was 27.86±16.47 ng/ml. There was no significant difference in serum 25 (OH) vitamin D between patients in different age groups. The serum 25 (OH) vitamin D levels varied significantly between different GOLD stages and different mMRC dyspnea grades. The patient who had a history of admission for twice or more in the past 1 year had a lower mean serum 25 (OH) vitamin D level as compared to patient with just one or no hospitalization in the past.
Conclusion: Decrease serum 25(0H) vitamin D levels were associated with increase airway obstruction
Role of dexmedetomidine in myocardial protection during beating coronary artery bypass grafting.
Get PDFBackground: On-pump CABG is associated with a high risk of myocardial injuries and other complications that result into myocardial ischemia and arrhythmias. OPCAB surgery may reduce, although not entirely eliminate, these myocardial injuries. This prospective study was designed to determine whether the intraoperative use of Dexmedetomidine could reduce the incidence of myocardial injuries after off pump CABG.
Methods: A total of 100 patients who underwent off-pump coronary artery bypass surgery were included and randomly divided into Dexmedetomidine treated and Control groups (groups B and A, respectively) 50 patients in each groups. Following the first vascular anastomosis grafting, the patients in group B received a loading dose of 0.5 μg/kg/10min of Dexmedetomidine via central venous catheter followed by a continuous infusion of 0.5 μg/kg/hr of Dexmedetomidine. The infusion was discontinued at the end of surgery. In group A, 0.9% physiological saline was infused using identical methods to group B.
Results: The primary outcomes measured included serum levels of cardiac biomarkers like CPK-MB & Trop I. Secondary outcomes included hemodynamic stability, ischemia or arrhythmia events & post-operative ICU stay. Dexmedetomidine use significantly reduced postoperative CPK-MB (26.38 ± 7.11 v/s 30.48 ± 9.84, P=0.019) & Trop I (0.678 ± 0.742 v/s 1.011 ± 0.67, P=0.021) at 24 & 48 hours respectively. Intraoperative dexmedetomidine therapy also reduced the risk of overall complications.
Conclusion: Intra operative administration of low-dose dexmedetomidine reduces myocardial damage during off-pump coronary artery bypass grafting surgery as indicated by significantly decreased level of cardiac biochemical markers, CK-MB and cTnI post-operatively
A comparison of BMI and Lipid Profile in patients with metabolic syndrome and Type 2 Diabetes Mellitus
Get PDFIntroduction: Diabetes mellitus is a metabolic disease known by chronic hyperglycemia which results from defective insulin action and secretion. Metabolic syndrome consists of a constellation of metabolic abnormalities that confer increased risk of diabetes mellitus. The aim of the present study was to study BMI and lipid profile in patients with metabolic syndrome and type 2 diabetes mellitus.
Materials and methods: 50 controls, 50 individuals with metabolic syndrome and 50 individuals with type 2 diabetes mellitus were selected by purposive sampling technique. BMI was calculated and serum levels of cholesterol, triglycerides, LDL, VLDL and HDL were estimated in controls and cases.
Results: BMI, serum triglycerides, VLDL, cholesterol/HDL ratio were significantly increased (p<0.05) and serum HDL levels were significantly decreased (p<0.05) in metabolic syndrome and type 2 diabetes compared to controls.
Conclusion: Our study concluded that there is significant dyslipidemia in patients with metabolic syndrome and type 2 diabetes mellitus
Clinicobacterial and histopathological study of chronic dacryocystitis
Get PDFIntroduction: Diseases of lacrimal drainage system account for nearly 3% of visits to eye clinic. Chronic dacryocystitis is a frequently encountered disorder among these patients. The aim of this study was to identify the organisms responsible and to determine the antibiotic susceptibility pattern of the bacterial isolates from conjunctiva and nasal mucosa in cases of chronic dacryocystitis and comparing with lacrimal sac specimen.
Material and Methods: Prospective longitudinal study carried out in 40 cases suffering from chronic dacryocystitis. After complete history and local examination of the cases, the sac was excised and examined histopathologically in pathology department. Swabs of the smear were taken in all cases were cultured and antibiotic sensitivity was done. The results were analyzed by using mean, median and the Chi-square (χ2) test.
Results: The maximum incidence of the disease has been in the 4th and 5th decade of life, females were more predominantly affected than the males. The epithelial hypertrophy was the most common histological finding i.e 77.5%, the second common was squamous metaplasia followed by goblet cell formation. Culture and antibiotic sensitivity was done in all cases; out of these the maximum cases were found to be sterile i.e.55%. The bacteria which have been isolated in the 45% cases in order of frequency were staphylococcus 20%, streptococcus12.5% and pneumococcus 12.5% respectively.
Conclusion: Majority of the chronic dacryocystitis cases are caused by Staphylococcus, streptococcus and pneumococcus. Amoxyclav and 3rd generation cephalosporins can be used to treat chronic dacryocystitis. The epithelial hypertrophy and Non-specific chronic inflammation with fibrosis is indeed the most commonly reported histopathological finding in lacrimal sac wall biopsy specimens. Microbiological analysis and antimicrobial susceptibility pattern is mandatory for the selection of a specific antimicrobial therapy and to the control of further resistance development of bacterial strains
Asymptomatic urinary tract infection with multidrug resistant pathogens in retro positive patients on ART
Get PDFIntroduction: Asymptomatic urinary tract infection refers to occurrence of bacteria in urine without causing symptoms. UTI is more prevalent among retro positive patients compared to people without HIV. Objectives – The study was done to determine prevalence of UTI, common etiologies and antibiotic susceptibility pattern of urinary isolates among HIV seropositive patients attending ART centre for CD4 counts.
Materials & Methods: –A total of 109 patients without any symptoms of UTI were included in the study. AST was done using Kirby Bauer disk diffusion method.CD4 count was done using FACS counter.
Results: Out of the 109 cases tested, 55 were males, and 54 cases were females. No growth was seen in 60 (55.04%) samples, insignificant bacteriuria in 9(8.26%) samples. Significant growth was seen in 40 samples (36.7%). Among the 54 females, 44% had significant growth. Among 55 males, significant growth was seen in 29.1%. The isolated organisms included Escherichia coli - 9(22.5%), Staphylococcus aureus - 7(17.5%), Candida albicans - 7(17.5%). Bacterial isolates showing resistance to three or more categories of antibiotics were considered Multidrug resistant (MDR). Multidrug resistance was seen among 16 bacterial isolates (48.5%). HIV positive patients with CD4 counts of <200 had higher rates of asymptomatic bacteriuria.
Conclusion: Screening of HIV seropositive patients with lower CD4 counts for asymptomatic UTI helps in early diagnosis and appropriate, early management of MDR will reduce morbidity