International Journal of Advances in Health Sciences (IJHS)
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Quality of life in elderly cancer patients: A hospital based study
No full textBackground - There are over 200 different known cancers that afflict humans. Increasing age is a major risk factor for developing cancer. India is witnessing a demographic transformation from a younger society to a mature one. There has been a growing call to understand the medical and psychological challenges that elderly patients confront. Moreover when these elderly people, already an under privileged class, suffer from a devastating illness like cancer, puts a lot of psychological and financial stress on the patient and the caregiver, thus affecting their quality of life.Aims – The present study was undertaken to assess the quality of life in this socially and economically under privileged class of population suffering from malignancies. The study also aimed at finding the pattern of malignancies in this group of population and factors affecting the Quality of Life (QoL) in them.Methods - Subjects were recruited from patients above 60 years of age presenting in medicine or oncology OPD and / or IPD, of Himalayan Institute of Medical Sciences, Doiwala, Dehradun with a primary diagnosis of cancer. SF -36 questionnaire was used to generate data.Statistical analysis - Data was analyzed by descriptive statistics.Results–Gastrointestinal malignancies were the most common malignancies in the elderly population, to be followed by lung and head and neck malignancies. Most of them present in advanced stages of disease. The Quality of Life (QoL) of these patients was negatively affected by the type of malignancy and its staging. Socio-demographic patterns like age, sex, education, financial status and life style also play a key role in QoL.Conclusion- The incidence of cancer is increasing in elderly and it has a negative impact on the QoL in this under privileged class of population. Therefore, it is important to identify the various malignancies at an early stage and other factors predicting quality of life in this age group so as to build up a comprehensive and multidimensional approach in their treatment
Comparison Of Two Total Intravenous Anaesthesia Techniques : Propofol-Ketamine vs Propofol-Fentanyl In Minor Surgeries On Quality Of Induction And Haemodynamic Changes During Induction
No full textIntroduction: T.I.V.A has many advantages over inhalational anaesthetics . The drugs used for T.I.VA. have a quicker onset, recovery and minimal side effects .This study was conducted to compare the two T.I.V.A techniques Propofol-Ketamine and Propofol-Fentanyl during induction and to study their haemodynamic characteristics during induction.Materials and Methods: 100 patients undergoing short surgical procedures less than 30 minutes, of ASA grade I and II, 20 to 50 years of age were randomized into two groups. Group A – Patients received Injection ketamine 0.5 mg/kg I/V followed by I/V propofol 1% at the rate of 40mg/10seconds till the end point of induction. Group B -Patients received Injection fentanyl 1.5 microgram/kg I/V followed by I/V propofol 1% . Top up doses (25 mg) of propofol were given when the patient became light. Induction characteristics were studied and monitoring for HR, SBP, DBP, RR at 1 and 3 minutes of induction were done. The results were tabulated and analyzed statistically with student unpaired ‘t’test and Chi square test. P value(<0.05) was considered significant.Results: Propofol- ketamine group is better as compared to propofol- fentanyl in T.I.V.A as lesser induction dose (85.00±7.04 mg) and less top up doses of propofol were required (3.06±0.82) With lesser pain on induction and lesser involuntary movements. Propofol- ketamine group is better in terms of haemodynamic stability and also causes lesser depression of respiration.Conclusions: Propofol-Ketamine group is better during induction and produces stable haemodynamics compared to Propofol- Fentanyl group
Morphology and Topographic anatomy of Meningo-orbital foramen in North-Indian Population
No full textIntroduction- Variations can be found in every system of the body and can rarely be labeled as abnormal. Human skull is the most complex and important bony structure as it houses the most vital organ, known as Brain. Minor variations in the ossicles, foramina and ridges of the cranium have aroused the curiosity of anatomist worldwide for many decades and for many reasons. Variations in foramina have been studied by various people as these variants have been found to be related to many disease states like osteopetrosis, osteoporosis, cruzons syndrome, neurofibromatosis, brachymicrocephaly and mental retardations. This study involves Meningo-orbital foramen and its variations in human subjects. It is found in the lateral wall of the orbit, lateral to the lateral end of superior orbital fissure. It can be single or multiple. This foramen represents an embryonic conduit between supra-orbital division of the stapedial artery and the permanent stem of ophthalmic artery. The anatomy of the cranio-orbitalforamen and the course of the orbital branch should be well known by surgeons reconstructing the anterior base ofthe skull, the orbit after orbital base surgery, and during excision of meningiomas.The knowledge of this foramen and structures related with it has a great significance for ophthalmologist and neurosurgeons. With this background in mind the present study was conducted to explore the incidence and location of this foramen in North-Indian population
Para Meatal Urethral Cyst
No full textA 18 year old male presented to us with parameatal urethral cyst in the dorsal aspect of glans penis in the midline . Excision was done . Patient was followed up for a period of six months. We are presenting this case for rarity
Transient blindness due to ketamine anaesthesia in a child
No full textWe report a 10 years old male child apparently normal till he suddenly developed generalised edema and decreased urine output of 10 days duration. A renal biopsy was done under aseptic conditions with Inj Midazolam and Inj Ketamine given for anaesthesia. The child complained of blindness after waking up. The blindness was transient and lasted for about 30min. Child’s vision completely recovered. Renal biopsy was suggestive of rapidly progressive glomerulonephritis (RPGN). Treatment was started with intravenous highdose methylprednisolone, intravenous cyclophosphamide and mycophenolate as mainstay medication. Thetreatment was rapidly effective with immediate decrease in anti-GBM titres and plasma creatinine. On follow up, the child has normal kidney function, blood pressure and no residual disease. This case report is to stress on an extremely rare side effect of ketamine, a commonly used anaesthetic drug for short procedures
Comparison of Propofol Versus Propofol + Ketamine for LMA Insertion in Children undergoing Elective Eye Surgery
No full textBackground: The major responsibility of an anaesthesiologist is to secure an unobstructed airway and provide adequate ventilation when general anaesthesia is administered. Supraglottic airway devices like Laryngeal Mask Airway (LMA) and cobra peri laryngeal airway are now considered as alternatives to endotracheal intubation for securing the airway and providing adequate ventilation even in difficult intubation and emergency situations.Aim of the study:To compare the efficacy and safety of Propofol induction Versus Propofol and analgesic dose of Ketamine for LMA insertion in children undergoing elective eye surgery. Materials and Methods: 50 patients of pediatric age group between 5 to 12 years belonging to ASA grade I scheduled for minor ophthalmic surgeries were randomised into two groups of 25 each. Group P was given Propofol IV and group PK was given Propofol and Ketamine IV. The insertion conditions of LMA, propofol requirement for induction, hemodynamic parameters and respiratory rate between the two groups were compared. Results: The study showed that the conditions for LMA insertion were better, hemodyanamics were more stable and requirement of propofol was lesser in PK group (Stastically significant p<0.05). Conclusion: Ketamine in analgesic dose combined with propofol for LMA insertion in children undergoing elective eye surgery is better than propofol alone in aspects of decreased requirement of propofol for induction, ease of LMA insertion, better hemodynamic stability and better maintenance of respiratory rate
Role of Magnetic Resonance Imaging in the detection of Mesial Temporal Sclerosis - A leading cause of seizure disorder.
No full textObjective: Mesial temporal sclerosis (MTS) is widely recognized as a significant underlying cause of temporal lobe epilepsy. Patients with intractable epilepsy may benefit from epilepsy surgery especially if they have a radiologically demonstrable cerebral lesion. Using a dedicated MRI protocol, it is possible to detect the aetiology of seizures & also detect an epileptogenic lesion in 80% of these patients. The purpose of this study was to evaluate the prevalence, reliability and prognostic value of MRI identification of MTS.
Methods: A prospective study of 120 patients with clinical impression of seizures from December 2012 to June 2014 were subjected to MRI scanning to evaluate the etiology of seizures. The proportion of Mesial temporal lobe epilepsy was estimated & also significance of Magnetic Resonance Spectroscopy in the detection of Mesial temporal lobe epilepsy was evaluated. Five MRI features of MTS were specifically evaluated: 1) Hyperintensity on both T2 W and FLAIR images,2)Loss of hippocampal architecture,3) Small atrophic unilateral hippocampus,4)Loss gray-white matter demarcation in the temporal lobe & 5) Prominance of ipsilateral temporal horn. In Magnetic Resonance Spectroscopy 3 of the following criteria were evaluated: Decrease in NAA peaks, decrease in NAA/Choline ratio & decrease in NAA/Creatinine ratio.
Results: The MR examination revealed pathological findings in 39 (32.50%) out of 120 patients which includes, 17(43.6%) mesial temporal sclerosis. The % of MRI features evaluated were Hyperintensity on T2W & FLAIR images were noted in 47.1%, loss of Hippocampal architecture in17.6%, small atrophic unilateral hippocampus in 35.3% & loss of grey-white differentiation in 29.4%.
Conclusions: Mesial temporal sclerosis was identified as the leading epileptogenic lesion.MR spectroscopy showed a significant role in the detection of MTS
Abu Al-Qasim Zahrawi’s contribution in ophthalmology
No full textAbu al-Qasim Zahrawi (A.D. 936-1013) was considered the greatest medieval surgeon. He has been described by many as the father of surgery. His greatest contribution to medicine is the Kitab al-Tasrif, a thirty-volume encyclopedia of medical & surgical practices. His pioneering contributions to the field of surgical procedures and instruments had an enormous impact in the East and West,as well into the modern period, where some of his discoveries are still applied in medicine& surgery.
Al-Zahrawi had a special interest in eyelid surgery. He gave sensible suggestions on the use of fine instruments, of which he had a wide variety. The third volume described detailed procedures of performing ophthalmic operations including “cataract”.He described surgical management of different pathological conditions i.e.Entropion, Entropion, trichiasis,ptosis and symblepharon. Abu-al-Qasim was specialized in curing disease by cauterization. He describes about more than 20 cauterizes for specific indications, these include the punctuate cautery and the crescentic cautery for Ptosis of eyelids, lacrimal and perianal fistula are some examples of the beneficial and effective cauterization. He invented several devices used during surgery, for purposes such as inspection of the interior of the urethra, applying and removing foreign bodies from the throat, inspection of the ear, etc.The finely pointed scalpel to cut up a swollen foreign body in the ear, eye speculum, fine conjectivital hooks, ophthalmic scissors, fine couching needles, scrappers for teeth, forceps for the removal of broken roots of teeth and for the wiring of teeth, and the use of ox bone for artificial teeth. The operative removal of a ranula and the use of a tonsil guillotine and mouth gag in a tonsillectomy are among the original discoveries of Al-Zahrawi. The details ofophthalmic Surgeries among above will be presented in full length paper
Rhinoscleroma Revisited
No full textRhinoscleroma is a chronic disease characterized by the formation of granuloma in the airways, caused by the bacterium Klebsiella pneumoniae subspecies rhinoscleromatis. It was earlier thought to involve only nasal passages but later found to be a disease of the upper respiratory tract. It is characterized by the appearance of foamy macrophages called Mikulicz cells and Russell bodies. Here, we present a case with both nasal and laryngeal involvement diagnosed in back ground of unilateral vocal cord palsy which is a very rare cause of vocal cord palsy
Metabolic Syndrome: A Comparative Study of Definitions In North Indian Subjects
No full textINTRODUCTION: The term “Metabolic Syndrome” is applied to a group of modifiable risk factors in an individual and if not identified at earliest may ultimately increase the risk of developing CVD and T2DM.
AIM: Our aim was to compare the prevalence of Metabolic Syndrome in 200 North Indian subjects using three international definitions i.e. NCEP-ATPIII, IDF and modified NCEP ATP III.
MATERIALS & METHODS:The study was conducted in the Department of Biochemistry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala in 200 subjects of the age group 20-60 years, attending the OPD. The subjects were selected by simple random sampling method for the duration of 6 months from the month of January 2011 to June 2011.
RESULTS: Out of 200 subjects, who participated in the study, 102 were females and 98 were males. MS was diagnosed in 34.5%, 36% & 43%, according to NCEP ATP III, IDF and modified NCEP ATP III definition; respectively. Gender wise distribution came out to be 40.8%, 37.7% and 48.9% in males, according to NCEP ATP III, IDF and modified NCEP ATP III definition; respectively. In females it was 28.4%, 34.3%, and 38.2% according to NCEP ATP III, IDF and modified NCEP ATP III definition; respectively.
CONCLUSION: Our study clearly provided the evidence that modified NCEP ATP III definition provides better markers other than two definitions in the identification of MS. So, early diagnosis and appropriate intervention may help in the reduction of morbidity and mortality arising due to the complications of metabolic syndrome.