International Journal of Medical Research & Review (IJMRR)
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Variation in patterns of superficial vein of cubital fossa
Get PDFAim: To determine anatomical variations of superficial veins of cubital fossa.
Background: The cubital fossa Veins lie superficially in the subcutaneous tissue and not paired with any artery, they are easy to view and access. The superficial veins include the cephalic, basilic, median cubital, and antebrachial veins and their tributaries. The knowledge of superficial venous distribution of the cubital fossa is important, not only from an anatomical-clinical and surgical point of view, but also anthropologically and biologically.
Materials and Methods: The study done on120 males and 30 females were randomly selected from among the rural area of central India which also include the students and staff members of J.N.M. College Sawangi Wardha (M.S.) 150 cases of right upper limbs and 150 cases of left upper limbs. After taking the subject\u27s consent, the superficial veins of the cubital fossa were made prominent by using tourniquet. The patterns of cubital veins were marked on skin and photograph are taken.
Results: the patterns of arrangement of superficial cubital vein observed are as follow. Type I –MCoV joining with the CV and BV in 51%., type II CV bifurcating intoMBV and MCV which join BV and ACV respectively, Type III-MVF bifurcating in MBV and MCV 9.66%., Type IV- 7.66%subjects of present study the CV terminates in to BV and ACV runs separately, In Type V- 3% of subjects the CV communicating directly with BV and ACV was absent and Type VI –A large single CV ascending upwards without any communication with other veins. 3 of 300 subjects i.e. 1%.
Conclusion: Numerous studies in different races and ethnic groups have shown similarities and differences in the deposition of the superficial veins of the cubital fossa. Various procedure should be perform with caution bearing in mind the anatomical variation present in these region
Hemodynamic Responses and intubating conditions in laryngeal mask airway insertion a comparative study of propofol versus sevoflurane
Get PDFBackground: LMA is an effective alternative to the endotracheal tube for securing the airway in short surgical procedures. Propofol is a widely used anaesthetic agent for the insertion of Laryngeal Mask Airway. Sevoflurane is a volatile anaesthetic agent, which combines rapid, smooth inhalational induction of anaesthesia with rapid recovery, making it ideal for day care anaesthesia.
Objective: To study if the use of sevoflurane can be used as an alternative to IV propofol for laryngeal mask airway insertion.
Primary objective: Hemodynamic responses during Laryngeal mask insertion.
Secondary objective: Intubating conditions during laryngeal mask airway insertion.
Study design: A Randomized control trial.
Methods: 100 adults were allocated by randomization into two groups of 50 each; group P (Propofol) and group S (Sevoflurane). Patients in group P were induced with 2.5mg/kg intravenous propofol with 50%O2 & 50%N2O and in group S with 8% sevoflurane in 50%O2 & 50% N2O vital capacity breath technique. Laryngeal mask airway was inserted after adequate jaw relaxation was attained and hemodynamic responses like pulse rate, blood pressure were monitored. The grading of conditions for laryngeal mask airway insertion and number of attempts were noted. All the data collected was analysed statistically.
Results: We observed that more number of attempts were required for LMA insertion in Group S (14.0%) compared to Group P (0.0%) which is statistically significant with P=0.012. Heart rate at one minute and 2 minutes after LMA insertion showed a fall with Propofol which was statistically significant as compared to Sevoflurane. There is a significant difference of fall in mean arterial blood pressure in group P during induction, one minute, 2 minutes and 5 minutes when compared between the two groups. Sevoflurane took longer time for induction and LMA insertion compared to Propofol which is statistically significant. Moderate patient movement were noticed in 5 patients of group S and no patient movement were noticed in group P and is statistically significant (P – 0.022). Quality of insertion with propofol was excellent in all patients. With sevoflurane quality of insertion ranged from excellent to satisfactory.
Conclusion: Sevoflurane is associated with good hemodynamic stability but intubating conditions provided with propofol is superior. Prolonged time for jaw relaxation with sevoflurane when compared to propofol may delay laryngeal mask airway insertion. Quality of insertion with propofol was excellent in all patients. With sevoflurane quality of insertion ranged from excellent to satisfactory
Comparison of dexmedetomidine and clonidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block
Get PDFIntroduction: There are always efforts to find better and safer local anaesthetics along with adjuvants for supraclavicular brachial plexus block. Levobupivacaine has strongly emerged as a safer alternative for regional anaesthesia than its racemic sibling bupivacaine. Alpha 2 agonists are combined with local anaesthetics to improve the quality of regional anaesthesia.
Method: A prospective randomized study was carried out which included 60 adult patients between the ages of 18-65 years of ASA grade I and II who underwent upper limb orthopaedic surgeries. Group A received 30 ml of 0.5% levobupivacaine with 150µg of clonidine and Group B received admixture of 30 ml of 0.5% levobupivacaine with 100 µg of Dexmedetomidine. Onset, duration of sensory and motor blockade and duration of analgesia were observed.
Results: Duration of postoperative analgesia in group A was 14.36±0.36 minutes and in group B was 16.90±2.29 minutes. Hence from the above observation, the duration of analgesia in group B is longer than group A which is statistically highly significant (p<0.001).
Conclusion: Dexmedetomidine as an adjuvant 0.5% levobupivacaine is more effective in prolonging the duration of sensory and motor block and post operative analgesia compare to clonidine as an adjuvant to 0.5% levobupivacaine
Histopathological study of breast lesions
Get PDFObjectives: To study the histopathological features of neoplastic and non neoplastic lesions of breast. To correlate the pathological findings with clinical parameters.
Design and methods: We have studied total 161 cases of breast lesions over a period of two years in our institute. The specimens were received in histopathology section of our department. Detailed gross examination of specimens was done followed by fixation, thorough sampling, and tissue processing. The different lesions were studied by histopathological examination and analysed. Neoplastic lesions were classified according to the WHO classification (2012).
Results: Out of the 161 cases, 128 cases had neoplastic lesions and 32 cases had non-neoplastic lesions, and one case had coexistent neoplastic and nonneoplastic lesions. Two cases had dual neoplastic lesions. Out of the total 129 cases with neoplastic lesions, 76 cases had benign breast tumors, 53 cases had malignant breast tumors, and 2 cases had precursor lesions. Fibroadenoma was the most common benign tumour with 60 cases. Invasive carcinoma no special type was the most common malignant tumour with 43 cases. Special subtypes of invasive carcinoma found in our study were metaplastic carcinoma (3 cases) and mucinous carcinoma (1 case). The most common nonneoplastic lesion was mastitis with 12 cases, followed by duct ectasia and fibrocystic change. There were 4 cases of gynaecomastia. All the tumors involved upper outer quadrant most frequently. The benign tumors were most frequent in second, third and fourth decades, malignant tumours were seen beyond 4th decade. The nonneoplastic lesions were common in 4th decade.
Conclusion: Histopathological study is important in the management of breast lump
Estimation of male stature by ulnar length in Madhya Pradesh region by using linear regression analysis
Get PDFIntroduction: Establishment of reliable formula for stature estimation from fragments of bones especially in forensic examination is important for individual identification. Sexual differences in height and of long bones exist so there is need for studies emphasizing quantitative standards of sexual dimorphism in different populations. Limited availability of gender specific studies of stature estimation by using individual bones provide data for forensic identification that led me to study ulna bone to establish a linear regression equation for stature estimation in living adult males of age group 18-26 yrs in Madhya Pradesh region.
Material & Methods: Cross sectional study was conducted in Department of Anatomy, Gandhi Medical College, Bhopal (M.P.) on 238 males by using anthropometer and spreading caliper and statistically analyzed. Ulna length were measured independently on right and left sides of each subject with the help of spreading caliper from the tip of olecranon process to the tip of styloid process and vertex to heel height was measured in the standing erect posture with subject looking forward straight to the horizon.
Results: Value of correlation coefficient(r) of right ulna with stature was found to be 0.995 and left ulna with stature was 0.997. Regression equations and graphs interpret the height from the ulnar length in males.
Conclusion: The regression formula derived will be useful for anatomists, clinician, anthropologists and forensic experts for estimation of the individual stature in Madhya Pradesh region for establishing identity
An analysis of adult non-neoplastic nephrectomies at a tertiary care centre in Mumbai
Get PDFIntroduction: Nephrectomies are an integral part of urological practice and a wide range of renal diseases are seen on histopathological examination of non-neoplastic nephrectomy specimens.
Objective: The objective of this study was to assess the incidence, clinical presentation and the histological spectrum of various non-neoplastic renal diseases detected in nephrectomy specimens at our institute and to compare our observations with the conventional patterns seen.
Material and Methods: This is a retrospective 6 year study of adult non-neoplastic nephrectomies (ANNN) conducted in a tertiary care centre in Mumbai and includes 359 cases from January 2009 to December 2015. The paraffin blocks and slides were retrieved from our archives and analysed along with clinical features, radiological findings.
Results: 359 ANNN specimens received over a 6 year period were studied. Most of the patients were in the sixth decade with a slight female preponderance. Flank pain was the commonest presenting symptom seen in 79.94% of cases. The most frequent surgical indication for ANNN was obstructive uropathy (47.08%) which includes calculus disease and PUJ obstruction followed by non-functioning kidney (42.06%). On histopathological examination, the most common gross pathology was acalculus hydronephrosis (40.67%) and the most frequent histopathological diagnosis was chronic pyelonephritis seen in 79.38% cases. Calculus obstructive uropathy amounted to 39.27% cases and acalculus obstructive uropathy amounted to 25.07% cases of chronic pyelonephritis.
Conclusion: The most frequent surgical indication was obstructive uropathy and the most common histopathological diagnosis was chronic pyelonephritis. Calculus and acalculus obstructive uropathy amounted to almost 65% of the cases of chronic pyelonephritis
Microbiological flora of cell phones: a reservoir of potential pathogens?
Get PDFBackground: Hospital associated infections are a major problem in all hospital settings. The heavy use of cell phones which come in close contact with the body surfaces could act as a fomite for microorganisms and it can transmit pathogenic as well as non pathogenic microorganisms.
Objective: To determine the rate of bacterial contamination of cell phones of hospital staff and to study their antibiogram.
Methods: A cross-sectional study was conducted in a tertiary care hospital. Sterile swabs were collected from cell phone surfaces of healthcare workers (HCW). The samples were processed as per standard microbiological techniques and antimicrobial susceptibility testing was done.
Results: Out of the 100 cell phones studied, 60(60%) showed bacterial growth. 28(56%) were from doctors and 32(64%) from the paramedical staff. Staphylococcus aureus with 37(55.23%) isolates was predominant followed by CONS 12(17.93%), Pseudomonas sp. 7(10.44%), E. coli 4(5.97%) and Klebsiella pneumoniae 3(4.47%), 2(2.98%) Acinetobacter sp and Bacillus sp. 36 of HCW had cleaned their cell phones out of which 16 (44.44%) showed bacterial growth whereas 64 cell phones had never been cleaned, out of which 44 (68.75%) showed bacterial growth. Among the Gram positive isolates, Linezolid and Vancomycin were the most effective antibiotics and Imipenem and Piperacillin-Tazobactam were most effective against Gram negative isolates.
Conclusion: HCW are exposed to pathogenic microorganisms which can be easily transferred to their cell phones thus acting as a source of infection to others. Cleaning of cellphones with alcohol based disinfectants and frequent hand washing should be encouraged
Clinical study of benign lesions of larynx
Get PDFAim of Study: To analyze over a period of 2 years, the demographics such as age, sex, distribution, occupation, the site of involvement, symptomatology and prognosis of the most frequent benign lesions of larynx.
Materials and Methods: 50 patients presenting with hoarseness of voice and diagnosed with benign lesion of larynx in ENT OPD of Dr. B.R.Ambedkar Medical College and Hospital were included in the study after taking their consent and the study was carried out for a period of 2 years between October 2013 to September 2015.
Results: In this study, it was noted that males were predominantly involved, maximum incidence between 31-40 years. Business men among males and housewives among females were commonly involved. Bilateral vocal cord nodule was the most common benign lesion of larynx, others included vocal cord polyp (both unilateral and bilateral) and Reinke’s edema. Most important predisposing factor was being vocal abuse in all the cases. Treatment given included speech therapy, medical management and MLS according to the diagnosis and patients were followed up for six months. 41.18% of patients with bilateral vocal cord nodule, 50% of patients with bilateral vocal cord polyp, 50% of patients with right vocal cord nodule, 75% of patients with left vocal cord polyp, 42.86% of patients with right vocal cord polyp and 100% of patient’s with Reinke’s edema were normal at follow up.
Conclusion: It was observed that vocal abuse was the most common predisposing factor for benign lesions of larynx and a multi modality treatment is necessary including medical, surgical and speech therapy to prevent recurrence
Role of CB-NAAT in diagnosing Mycobacterial tuberculosis and rifampicin resistance in tubercular peripheral lymphadenopathy
Get PDFIntroduction: Diagnosis of Extra Pulmonary TB (EPTB) remains a challenge. This study assessed the applicability of CB-NAAT in early diagnosis of EPTB, especially peripheral lymphadenopathy and early identification of MDR-TB in TB lymphadenopathy.
Material & Method: This was a prospective, cross sectional study, carried out on all patients of age group 10 to 80 years, who were suspected cases of tubercular peripheral lymphadenopathy, visiting the OPD of the Department of Pulmonary Medicine, People’s Hospital, Bhopal, over a period of 1 year 6 months. FNA of peripheral lymph nodes of 57 patients was sent for cytology and CB-NAAT.
Result: This study showed that statistical difference in diagnostic yield of FNAC (47/57 i.e. 82.4%) and CB-NAAT (44/57 i.e. 77.19%) in tubercular peripheral lymphnode sample was not significant. This implies that there was not much difference in these two test results. There was no rifampicin resistance in the population studied.
Conclusion: CB-NAAT did not diagnose more cases of TB-LN than FNAC
A comparative study of Fentanyl and Clonidine as additives to plain Bupivacaine in caudal anaesthesia in children
Get PDFIntroduction: The efficacy of clonidine or fentanyl as additives to alter the neuroendocrine stress response and emergence agitation in caudal anaesthesia in children is still not clear.
Objectives: To compare the efficacy and safety of Fentanyl and Clonidine as additives to plain bupivacaine in caudal anaesthesia in children.
Materials & Methods: A prospective, open labeled randomized controlled trial was conducted in Meenakshi Mission Hospital and Research Centre, Madurai, between August 2008 to June 2010. Children undergoing various elective infra-umbilical surgical procedures were included. Children were randomly assigned to either 0.5% Bupivacaine(B), Fentanyl plus 0.5% Bupivacaine (BF) or Clonidine Plus 0.5% Bupivacaine(BC) groups.
Results: A total of 90 children, with 30 subjects in each of the three intervention groups were included. Time taken for spontaneous movement was significantly higher (151.8±11.7) in BC group, as compared the other two groups. The duration of postoperative analgesia was lowest in Bupivacaine (146±91.2) alone group, followed by BF (293.5±154.5) and BC group (510±359.9). Sedation time also has shown a similar trend. The mean pain scores from 2 hours to 24 hours were highest in bupivacaine group, followed by BF and BC group. The differences in the sedation scores across the three study groups from 45minutes to 24-hour post-operative period were statistically significant.
Conclusions: Addition of clonidine 1µg/kg to 0.5% bupivacaine prolonged the duration of postoperative analgesia after a single shot caudal injection without any significant side effects when compared to bupivacaine 0.5% alone or its combination with fentanyl 1µg/kg