bluuebunny/crossref_metadata_2025 huggingface dataset:
A triagem auditiva neonatal antecipa o diagnóstico e a intervenção em crianças com perda auditiva?
Authors: Rodrigues Gabriela Ribeiro Ivo , Loiola-Barreiro Camila Miranda , Pereira Tânia , Pomilio Mariza Cavenaghi Argentino
Published: October 2015

Objetivo Identificar a idade de diagnóstico, intervenção e amplificação pré e pós-implantação da Triagem Auditiva Neonatal (TAN) em um serviço de saúde auditiva e comparar aos indicadores propostos pelo Comitê Conjunto para Audição Infantil.Métodos Trezentos e treze prontuários de crianças atendidas no setor de reabilitação auditiva foram analisados, verificando se foi realizada a triagem auditiva e seu resultado, suspeita e idade de diagnóstico, intervenção e amplificação e se estas últimas atendiam aos indicadores preconizados: três meses para diagnóstico e seis meses para intervenção.Resultados Crianças identificadas pela TAN foram diagnosticadas e iniciaram a intervenção mais cedo do que as que não realizaram. Considerando-se a demanda institucional pré e pós a implantação da TAN, observou-se redução da idade de intervenção e amplificação após a implantação. Independentemente do resultado obtido na TAN (passa/falha), as crianças que passaram pela triagem apresentaram vantagem, quando comparadas às não triadas, uma vez que, dentre as triadas, antecipou-se o diagnóstico, a intervenção e a amplificação. Menos da metade das crianças que falharam na TAN concluíram o diagnóstico e iniciaram a intervenção no tempo preconizado.Conclusão A TAN antecipou o diagnóstico e a intervenção em crianças com perda auditiva. Contudo, fatores como a não adesão da família e as peculiaridades do diagnóstico retardaram os processos, impedindo que os indicadores preconizados fossem alcançados, na maior parte das crianças.
Adaptação da Bateria Montreal de Avaliação da Comunicação para o Português Europeu
Authors: Kerr Mônica de Souza , Pagliarin Karina Carlesso , Casarin Fabiola Schwengber , Mineiro Ana , Ferré Perrine , Joanette Yves , Fonseca Rochele Paz
Published: October 2015

Objetivo Realizar a adaptação neuropsicolinguística da Bateria Montreal de Avaliação da Comunicação - versão brasileira (Bateria MAC-BR) - à realidade sociocultural portuguesa – Bateria MAC versão Portugal (Bateria MAC-PT).Métodos O processo de adaptação envolveu seis etapas: 1) análise comparativa da Bateria MAC-BR com sua versão original canadense; 2) adaptação e desenvolvimento de novos estímulos por especialistas; 3) análise de juízes não especialistas; 4) análise de juízes especialistas; 5) estudo piloto 1 (n=10); 6) estudo piloto 2 (n=30) e concordância entre avaliadores.Resultados O cumprimento das etapas levou a mudanças importantes na Bateria MAC, que permitiram a adaptação adequada para realidade sociocultural e linguística portuguesa.Conclusão A bateria MAC-PT é uma ferramenta clínica útil para a avaliação da comunicação de pacientes com lesão neurológica.
Comparação da atividade elétrica dos músculos supra-hióideos durante a realização de diferentes exercícios linguais
Authors: Furlan Renata Maria Moreira Moraes , Rezende Bárbara Antunes , Motta Andréa Rodrigues
Published: October 2015

Objetivo Pesquisar a atividade elétrica dos músculos supra-hióideos em oito diferentes exercícios isométricos e sugerir o exercício mais apropriado para normalização dos dados.Métodos Participaram do estudo 22 indivíduos do gênero feminino, com idades entre 19 e 38 anos (M=24,1 anos e DP=3,8 anos). Primeiramente, os participantes foram submetidos à avaliação clínica da língua. Em seguida, por meio de eletromiografia, foi feito o registro da atividade elétrica da região submentual durante o repouso e realização dos exercícios isométricos: sucção de língua no palato; pressão de língua no palato; pressão de ápice de língua contra o palato; pressão de ápice de língua contra a papila palatina; retração exagerada de língua; lateralização de língua e protrusão de língua. A ordem de realização dos exercícios foi randomizada entre os participantes. Os dados coletados foram analisados, utilizando-se os testes Kruskal Wallis e Mann-Whitney. Adotou-se como nível de significância em todas as análises, valor de p≤0,05.Resultados A atividade elétrica encontrada para todos os exercícios diferiu apenas daquela medida durante o repouso lingual, não apresentando diferença com significância estatística quando os exercícios foram comparados entre si.Conclusão Não houve diferença na ativação elétrica da musculatura supra-hióidea nos diversos tipos de exercícios realizados. Portanto, nenhum destes exercícios foi mais apropriado, em relação aos demais, para normalização dos dados.
Correlação entre tempo de trânsito oral e faríngeo no acidente vascular cerebral
Authors: Santos Rarissa Rúbia Dallaqua dos , Cola Paula Cristina , Jorge Adriana Gomes , Peres Fernanda Matias , Lauris José Roberto Pereira , Silva Roberta Gonçalves da
Published: October 2015

Objetivo Correlacionar o tempo de trânsito oral total (TTOT) com o início da resposta faríngea (IRF) e o tempo de trânsito faríngeo (TTF) no indivíduo, após acidente vascular cerebral (AVC).Métodos O estudo incluiu 61 exames de videofluoroscopia de deglutição de indivíduos após AVC hemisférico isquêmico. Destes, 28 eram do gênero masculino e 33 do gênero feminino, com faixa etária variando de 40 a 101 anos (média de 65 anos). Para análise dos resultados, os indivíduos foram divididos em dois grupos. O Grupo 1 (G1) constou de 17 indivíduos com tempo de trânsito oral total até 2000 ms, conforme normalidade, e o Grupo 2 (G2), de 44 indivíduos com tempo de trânsito oral total maior que 2000 ms. Foi realizada análise quantitativa da deglutição orofaríngea. Cada indivíduo foi observado durante a deglutição de uma colher de 5 ml com alimento na consistência pastosa. Foi aplicado o teste de correlação de Spearman.Resultados Não houve correlação entre o G1 e a IRF e o TTF. Houve fraca correlação entre o G2 e os parâmetros estudados.Conclusão O aumento do tempo de trânsito oral total no indivíduo após AVC possui correlação fraca com o aumento do tempo na fase faríngea.
Complement Factor H-Related 5-Hybrid Proteins Anchor Properdin and Activate Complement at Self-Surfaces
Authors: Chen Qian , Manzke Melanie , Hartmann Andrea , Büttner Maike , Amann Kerstin , Pauly Diana , Wiesener Michael , Skerka Christine , Zipfel Peter F.
Published: October 2015

C3 glomerulopathy (C3G) is a severe kidney disease for which no specific therapy exists. The causes of C3G are heterogeneous, and defective complement regulation is often linked to C3G pathogenesis. Copy number variations in the complement factor H-related (CFHR) gene cluster on chromosome 1q32 and CFHR5 mutant proteins associate with this disease. Here, we identified CFHR5 as a pattern recognition protein that binds to damaged human endothelial cell surfaces and to properdin, the human complement activator. We found the two N-terminal short consensus repeat domains of CFHR5 contact properdin and mediate dimer formation. These properdin-binding segments are duplicated in two mutant CFHR5 proteins, CFHR2-CFHR5Hyb from German patients with C3G and CFHR5Dup from Cypriot patients with C3G. Each of these mutated proteins assembled into large multimeric complexes and, compared to CFHR5, bound damaged human cell surfaces and properdin with greater intensity and exacerbated local complement activation. This enhanced surface binding and properdin recruitment was further evidenced in the mesangia of a transplanted and explanted kidney from a German patient with a CFHR2-CFHR5Hyb protein. Enhanced properdin staining correlated with local complement activation with C3b and C5b-9 deposition on the mesangial cell surface in vitro. This gain of function in complement activation for two disease-associated CFHR5 mutants describes a new disease mechanism of C3G, which is relevant for defining appropriate treatment options for this disorder.
The Choice of Hemodialysis Membrane Affects Bisphenol A Levels in Blood
Authors: Bosch-Panadero Enrique , Mas Sebastian , Sanchez-Ospina Didier , Camarero Vanesa , Pérez-Gómez Maria V. , Saez-Calero Isabel , Abaigar Pedro , Ortiz Alberto , Egido Jesus , González-Parra Emilio
Published: October 2015

Bisphenol A (BPA), a component of some dialysis membranes, accumulates in CKD. Observational studies have linked BPA exposure to kidney and cardiovascular injury in humans, and animal studies have described a causative link. Normal kidneys rapidly excrete BPA, but insufficient excretion may sensitize patients with CKD to adverse the effects of BPA. Using a crossover design, we studied the effect of dialysis with BPA-containing polysulfone or BPA-free polynephron dialyzers on BPA levels in 69 prevalent patients on hemodialysis: 28 patients started on polysulfone dialyzers and were switched to polynephron dialyzers; 41 patients started on polynephron dialyzers and were switched to polysulfone dialyzers. Results were grouped for analysis. Mean BPA levels increased after one hemodialysis session with polysulfone dialyzers but not with polynephron dialyzers. Chronic (3-month) use of polysulfone dialyzers did not significantly increase predialysis serum BPA levels, although a trend toward increase was detected (from 48.8±6.8 to 69.1±10.1 ng/ml). Chronic use of polynephron dialyzers reduced predialysis serum BPA (from 70.6±8.4 to 47.1±7.5 ng/ml, P<0.05). Intracellular BPA in PBMCs increased after chronic hemodialysis with polysulfone dialyzers (from 0.039±0.002 to 0.043±0.001 ng/106 cells, P<0.01), but decreased with polynephron dialyzers (from 0.045±0.001 to 0.036±0.001 ng/106 cells, P<0.01). Furthermore, chronic hemodialysis with polysulfone dialyzers increased oxidative stress in PBMCs and inflammatory marker concentrations in circulation. In vitro, polysulfone membranes released significantly more BPA into the culture medium and induced more cytokine production in cultured PBMCs than did polynephron membranes. In conclusion, dialyzer BPA content may contribute to BPA burden in patients on hemodialysis.
Renal Deletion of 12 kDa FK506-Binding Protein Attenuates Tacrolimus-Induced Hypertension
Authors: Lazelle Rebecca A. , McCully Belinda H. , Terker Andrew S. , Himmerkus Nina , Blankenstein Katharina I. , Mutig Kerim , Bleich Markus , Bachmann Sebastian , Yang Chao-Ling , Ellison David H.
Published: October 2015

Tacrolimus is a widely used immunosuppressive drug that inhibits the phosphatase calcineurin when bound to the 12 kDa FK506-binding protein (FKBP12). When this binding occurs in T cells, it leads to immunosuppression. Tacrolimus also causes side effects, however, such as hypertension and hyperkalemia. Previously, we reported that tacrolimus stimulates the renal thiazide-sensitive sodium chloride cotransporter (NCC), which is necessary for the development of hypertension. However, it was unclear if tacrolimus-induced hypertension resulted from tacrolimus effects in renal epithelial cells directly or in extrarenal tissues, and whether inhibition of calcineurin was required. To address these questions, we developed a mouse model in which FKBP12 could be deleted along the nephron. FKBP12 disruption alone did not cause phenotypic effects. When treated with tacrolimus, however, BP and the renal abundance of phosphorylated NCC were lower in mice lacking FKBP12 along the nephron than in control mice. Mice lacking FKBP12 along the nephron also maintained a normal relationship between plasma potassium levels and the abundance of phosphorylated NCC with tacrolimus treatment. In cultured cells, tacrolimus inhibited dephosphorylation of NCC. Together, these results suggest that tacrolimus causes hypertension predominantly by inhibiting calcineurin directly in cells expressing NCC, indicating thiazide diuretics may be particularly effective for lowering BP in tacrolimus-treated patients with hypertension.
De la originalidad y sus desplazamientos artísticos. El artefacto de la copia y lo abominable de lo original.
Authors: Méndez Llopis Carles
Published: October 2015

La heterogeneidad y complejidad en la producción simbólica y la creación artística actual invita al escrutinio y reconsideración de parámetros heredados en el campo cultural. Las diversas crisis atravesadas en el ámbito, así como aquellas que siguen ubicándose como centros de la discusión, generan agotamientos conceptuales sobre axiomas que se distancian de la generación del conocimiento contemporánea. En este sentido, el presente texto analiza el ideal de originalidad -diseminado sobre todo desde la perspectiva romántica- para comprender y acotar sus tentáculos, insertándolos en la autorreflexión disciplinar del presente, en las nuevas estructuraciones artísticas que vienen desenvolviéndose desde los años sesenta, así como en los escenarios de digitalización y virtualización que vivimos en la actualidad. Todo ello, determina no sólo diferentes estrategias en las relaciones entre los ámbitos de producción, recepción y consumo, sino también conexiones entre conceptos como original y copia que no se habían dado hasta hace relativamente poco. Lo que sigue es por tanto, una aproximación teórica a la necesaria reformulación de estándares monolíticos en el ámbito artístico, una crítica a la originalidad.
Two-port vs. conventional (three-port) laparoscopic appendicectomy: a new technique in laparoscopic appendicectomy
Authors: Mhatre Hemant P. , Kanake Vijay B. , Nandu Vipul V.
Published: October 2015

Background: Three-port laparoscopic appendicectomy has proven its worth in the management of appendicitis. From a cosmesis, the umbilical and suprapubic portsites are hidden by natural camouflages, the Right Iliac Fossa (RIF) port is the only visible external sign of surgery. The two-port technique avoids even this marker of abdominal invasion.  

Methods: 58 patients were studied for this study. Data was collected prospectively. The two port appendicectomy was performed with 10 mm umbilical working port and 5 mm supra-pubic camera port. A stitch was taken transparietaly in RIF which was under camera guidance passed through the tip of appendix and held with suture to retract the appendix. The base was ligated with an intra-corporeal knot and appendix cut and delivered out. Three port appendicectomy was performed via the 10 mm umbilical, 5 mm supra-pubic and 5mm right iliac fossa ports. The appendicular stump was ligated with an endoloop or an intra-corporeal knot, appendix cut and delivered out

Results: 58 patients underwent surgery over the one year period for appendicitis. Out of 26 cases attempted, the two port appendicectomy was successful in 21 cases, with conversion to the three-port technique in 4 and conversion to open in 1 case. The complication rates, return to work were comparable between the two groups. Duration of operation was more whereas length of hospital stay was less in two port appendicectomy group as compared to conventional laparoscopic group.

Conclusions: Patients who underwent two port appendicectomy had a cosmetically better appearing scar than compared to three port appendicectomy cases.
Clinical profile in metabolic syndrome
Authors: Pulamte Rothangpui , Thiyam Geeta , Joute Zothansung
Published: October 2015

Background: The metabolic syndrome is a condition characterized by a constellation of metabolic disorders including: abdominal obesity, insulin resistance/glucose intolerance, atherogenic dyslipidemia [elevated Triglyceride (TG), and lower High Density Lipoprotein (HDL-c)], raised blood pressure, proinflammatory and prothrombotic state. It was referred to as the “X syndrome” by Kylin in the 1920’s and described as a phenomenon of the clustering of obesity, hypertension, and gout.1 Aims and objects: To correlate different clinical and biochemical parameters in metabolic syndrome among the staff of   Hospital in Imphal.  

Methods: A total of 239 staffs were selected randomly from the Hospital, Imphal, Manipur. Sample size was calculated based on the prevalence of metabolic syndrome of 33.2%4 with 95% precision, coming to a sample size of 237.

Results: Metabolic syndrome was found in 49 out of 239 staffs and its prevalence was 21% which increased with age. There was a strong association between metabolic syndrome and obesity. There is lower prevalence rate of metabolic syndrome among the staff compared to other studies. This may have resulted from a number of factors including younger age, physical activities and ethnic origin.

Conclusions: Measuring MetS components is necessary for the early detection of this abnormal condition and early intervention.

 
An investigation of gross α & gross β radioactivity level of Xiaoqing River from 2008 to 2015
Authors: Wang Yan , Tian Kun , Wang Hui , Sang Wenjuan
Published: October 2015

Background: Purpose of current study was to investigate the gross α & gross β radioactivity level of Xiaoqing River in Jinan from 2008 to 2015.

Methods: According to National Standards of P.R., China.

Results: The gross α radioactivity concentration ranges from 0.02 to 0.17) Bq/L with an average concentration value of 0.05Bq/L; the gross β radioactivity concentration ranges from 0.09 to 0.23) Bq/L with an average concentration value of 0.15Bq/L.

Conclusions: The gross α & gross β radioactivity level of Xiaoqing River were in the normal background range during the years from 2008 to 2015.
Evaluation of the microbiological quality of cattle carcasses in some slaughterhouses at Benin, West Africa
Authors: Ahouandjnou H. , Baba-Moussa F. , Bonou J. , Dougnon V. , Adéoti Z. , Yedji R. , Toukourou F. , Baba-Moussa L.
Published: October 2015

Background: Slaughterhouse is one of the major critical points in meat hygiene with slaughtering being the stage of occurrence of most contamination risks.

Methods: This study aimed to assess the microbiological quality of cattle carcasses in the slaughterhouses of Cotonou/Porto-Novo. Samples were collected by excision from four parts on each carcass (neck, shoulder, flank and thigh). A total of eighty (80) samples from twenty (20) carcasses were analysed. Bacteriological analysis was achieved according to APC. ISO 4833: 2003; ISO 21528-2 and ISO 6579: 2002 norms, respectively for evaluate the aerobic plate count, enteric bacteria count, and qualitative detection of Salmonella.  

Results: Results varied according to carcass parts, with no significant difference between the bacterial loads of these parts regarding the APC. However, a significant difference was observed between the load in enteric bacteria between the neck and the thigh. With respect to EC regulations (N° 2073/2005), the thigh is the most contaminated part with 100% unsatisfactory results for APC, as well as, enteric bacteria count together with high contamination by Salmonella (detected in 75% of thigh samples). Then following the shoulder, showing 100% unsatisfactory results for APC and enteric bacterial load with presence of Salmonella in 55% of samples.

Conclusions: Although being the most contaminated site, the inner part of the thigh had the lowest contamination level with respect to APC.
Causes of cancellation for elective orthopedic procedures on the day of surgery
Authors: Karnalkar Asmita , Karnalkar Pratap
Published: October 2015

Background: A retrospective observational study was conducted to find out the reasons for cancellation of elective orthopedic surgical inpatients on the day of surgery and to plan for future suggestive actions to decrease unnecessary cancellations.

Methods: This was a retrospective observational study conducted at medical teaching hospital for 3 years from January 1, 2012 to December 31, 2014. The data was collected from postponement register. The files of cases that were cancelled were reviewed for the reasons of cancellations. The reasons were classified as anaesthetist related, administrative issues, surgeon related and patient related issues.

Results: During the study period, 7673patients were posted for elective orthopedic procedures. 6.49 % patients were cancelled on the day of surgery. The frequency of cancellations was more in anesthetist related issues (38.9%). Cancellations due to administrative issues, patient related issues and surgeon related were 30%, 27.7% & 3.4% respectively.

Conclusions: Although cancellations were only 6.49% of total elective operations, this can be reduced by implementing and following the recommendations that have been proposed. More thorough and detailed documentation is needed to achieve this.
Spigelian hernia - an unusual abdominal hernia: a case report and review of literature
Authors: Rout Suman Saurav , Sahoo Prakash Kumar
Published: October 2015

Spigelian hernias are rare abdominal wall defects that occur at the semilunar line lateral to the rectus abdominis muscle. They are situated between the muscular layers of the abdominal wall and can be easily overlooked because of abdominal obesity. Generally difficult to diagnose because of their location and vague non-specific symptoms radiographic studies have been beneficial in confirming the diagnosis. The diagnosis has been considerably aided by the introduction of ultrasonography and Computed Tomography (CT). Once the diagnosis is made operative management is indicated due to chances of incarceration. We report a 48 years old patient from the IMS and SUM hospital, Bhubaneswar, Odisha, India who presented with colicky lower abdominal pain associated with a non-tender swelling above and lateral to the left inguinal canal. A diagnosis of Spigelian hernia was made and confirmed on exploration. The hernia was reduced and the defect repaired. His recovery was uneventful.
Supplementary pulse polio immunization program: an experience from Ground zero
Authors: Johnson Abel K. Samuel , Prasad R Vishnu , R Parthasarathy , Singh Zile
Published: October 2015

Independent polio immunization campaign monitoring is carried out to assess the quality and impact of supplementary immunization activities. It is critical in guiding any necessary mid-course corrections if gaps or problems are found. The need of the hour is to maintain this status by continuing the immunization activities without any discrimination based on caste, creed, sect, state or religion. It was a great sight to witness the Polio workers in the interiors of the country doing a great job to make INDIA proud and continue as a POLIO ELIMINATED COUNTRY. All the credit goes to these workers who tirelessly cycles and walks withstanding the rain and sun that made India a POLIO FREE country. Objective of this article is to highlight some of the observations by a WHO external monitor posted in a District of Tamilnadu.
Granular myringitis: current status of management
Authors: Bansal Mohan
Published: October 2015

The Granular Myringitis (GM) is not uncommon though in medical literature it has been reported among the rarer conditions. The aim of this article is to review the clinical features and management of Granular Myringitis (GM). GM is characterized by granulation tissue on the outer surface of the Tympanic Membrane (TM) with or without the involvement of deep bony External Auditory Canal (EAC). The granulations are either localized or diffuse. The granulations over tympanic membrane continue to grow slowly for years. The ensuing fibrosis in patients with granulations of deep bony meatal wall can result into an atresia of the deep bony EAC. The presenting symptom of GM is an ear discharge which may be foul-smelling. However many patients have a sensation of fullness, irritation, mild pain or itching in the ear. If perforation occurs the underlay perichondrium or temporalis fascia grafting is done. In some of the refractory cases granulations are removed and the raw area is covered with skin. Many patients respond well to meticulous microscopic aural toilet and topical antibiotic and steroid ear drops. If patients do not respond then application of topical caustic agents are employed.
Otoacoustic emissions in detection of pre-clinical noise induced cochlear damage in military personnel
Authors: Bhatia Abhijeet
Published: October 2015

Background: Objective of current study to analyse the utility of TEOAEs and DPOAEs to detect cochlear damage due to chronic exposure to firearm noise in Indian military personnel at a preclinical stage. Military personnel are exposed to firearm noise and need to be assessed for cochlear damage periodically.

Methods: This cross sectional study was conducted from May 2004 to Apr 2005. Indian army soldiers and general civilian population were included in the study. The TEOAE and DPOAE parameters of two control groups (civilians, no noise exposure, no HL: control group 1; soldiers, noise exposed, hearing loss: Control group 2) were compared with the study group (soldiers, noise exposure, no hearing loss: Study group).

Results: TEOAE amplitudes of the study group varied significantly from those of both the control groups at almost all frequencies. Overall amplitude too followed a similar trend. However, although the DPOAE amplitude of the study group was less than that of control group 1, the difference was not significant. The DPOAE amplitude of study group varied significantly from control group 2.

Conclusions: TEOAEs proved to be useful to distinguish between green ears and ears chronically exposed to impulse noise with and without hearing loss. But DPOAEs proved to be useful in distinguishing only between normal hearing from hearing loss ears.
Do we really need a new journal?
Authors: Sharma Apurb , Pradhan Bishwas
Published: October 2015

No Abstract AvailableJournal of Society of Anesthesiologists 2014 1(1): 1-2
Study of factors associated with waiting time for patients undergoing emergency surgery in a tertiary care centre in Nepal
Authors: Acharya Subhash Prasad , Dharel Dinesh , Upadhyaya Smrity , Khanal Nabin , Dahal Sandesh , Dahal Sumit , Aryal Karmapath
Published: October 2015

Background: Emergency surgeries throughout the world are demanding earlier surgical times. In a developing country like Nepal this cannot be possible because of lot of factors. So we planned to study such factors that could interplay and increase the waiting time for emergency surgeries.  Methods: A prospective observational study was conducted over 45 days and all patients diagnosed with general surgical and orthopedic emergencies were followed till they were operated.  Results: Out of 1211 patients presenting to emergency department, 92 required emergency surgery. The mean age was 29.72 year and 76.1% of the patients were male. The mean time from presentation to the emergency department to the first surgical consultation was 170 minutes, from surgical consultation to decision of surgery was 28 minutes, from decision of surgery to transfer to operating room was 426 minutes, from arrival in operating room to anesthesia consultation was 18 minutes, and from anesthesia consultation to start of surgical incision was 75 minutes. The total average waiting time from arrival at emergency department to the start of surgery was 717 minutes. The factors were, viz., pre-occupancy of theatre (59.8%), special procedures/intervention required prior to surgery (23.9%), arrangement of logistics/finances by patient family (13%), arrangement of blood products (10.9%), consultations (9.8%), delay in giving consent by patients/family (5.4%), delay in arrangement of supplies (9.8%), and shift change of nursing staff (3.3%).  Conclusion: This study shows that various preventable factors increases waiting times for emergency surgeries that should be minimized so that waiting times can be reduced.Journal of Society of Anesthesiologists 2014 1(1): 7-12
Efficacy and safety of intrathecal morphine for post cesarean section analgesia
Authors: Gami Rupesh Kumar , Jahan Kumar , Jha Chandra Bhushan
Published: October 2015

Background: Government of Nepal has been conducting Cesarean section under “Safe Motherhood” program all over country. The purpose of this study was to evaluate the efficacy and safety of intrathecal morphine for post cesarean analgesia under spinal anesthesia.  Methods: A total of 300 parturients posted for Cesarean section under spinal anesthesia were divided into two groups of 150 each in this prospective randomized case-control study. Morphine group received 0.15 mg of intrathecal morphine mixed in 12 mg of 0.5% bupivacaine heavy while control group received 12 mg of 0.5% bupivacaine heavy alone, after proper preparation of spinal anesthesia. The parturients were assessed for first request of analgesic as per Visual Analog Scale, frequency of analgesics required within 24 hr, nausea, vomiting, pruritus, sedation and respiratory depression.Results: Postoperative analgesia was significantly greater in morphine group as compare to control group (12.1 ± 7.6 vs 3.7 ± 2.9 hr). Frequency of analgesics requirements was also significantly lower in morphine group (1.7 ± 2.0 vs 3.4 ± 8.1). Visual Analog Scale was below 4 at most of time in morphine group. The incidence of nausea, vomiting and pruritus were more in morphine group as compare to control group but without any respiratory depression. There was no significant difference in APGAR score among fetus.  Conclusion: Mixing low dose of intrathecal morphine in standard dose of spinal anesthesia effectively prolongs the duration of post cesarean analgesia and decreases the frequency of analgesics requirement without any major complication in parturients or fetus.Journal of Society of Anesthesiologists 2014 1(1): 13-17
Pre-incisional epidural magnesium provides pre-emptive and postoperative analgesia in lower abdominal surgeries: a comparative study
Authors: Shrestha Ninadini , Gurung Renu , Marhatta Moda Nath
Published: October 2015

Background: Magnesium sulphate has been used successfully as a non opioid analgesic adjuvant for postoperative pain management. This prospective controlled study was designed to evaluate the pre-emptive analgesic efficacy of adding magnesium to epidural analgesia in patients undergoing lower abdominal surgeries.Methodology: In a randomized, double- blind study sixty patients undergoing lower abdominal surgery under general anesthesia were assigned to three groups. Pre-magnesium (Group PI), post-magnesium (Group PO) and control (Group C) group. Anesthetic technique was standardized. Patients in pre-magnesium group received bolus of magnesium 50 mg via epidural before induction of anaesthesia followed by boluses of 10 mg h-1 until end of surgery. Post-magnesium group patients received epidural saline during the same time periods plus bolus epidural magnesium 50 mg at the end of surgery. Patients in control group received epidural saline during all three periods. Patients in the magnesium groups received bolus epidural analgesia with Fentanyl 8mcg, Bupivacaine 0.1%, and Magnesium 8mg in a volume of 8 ml after operation, when patient complained of pain and VAS score was more than 4. Patients in the control group received epidural analgesia with Fentanyl 8 mcg and Bupivacaine 0.1% in a volume of 8ml. Blood Pressure, pulse rate, respiratory rate, time to the first request for analgesic, visual analogue scale at rest, 24 hour, opioids consumption and side effect profiles were studied for 24 hours postoperatively.Results: The demographic parameters were comparable. Group PI had significantly lower VAS scores at all times 0,2,4,6,10,14,18 and 24 hours than those in the Group PO or Group C(P<0.05). The groups were similar with respect to haemodynamic, respiratory variables and side effects.Conclusion: Epidural Magnesium sulphate provided preemptive analgesia, and an a analgesic-sparing effect that improved postoperative analgesia without increasing the incidence of side-effects.Journal of Society of Anesthesiologists 2014 1(1): 22-28
Comparison of Lignocaine and Esmolol in attenuating cardiovascular response to laryngoscopy and endotracheal intubation
Authors: Shrestha Anil , Acharya Subhash Prasad , Amatya Roshna
Published: October 2015

Background: Laryngoscopy and tracheal intubation induces cardiovascular stress response characterized by tachycardia and hypertension, which are well tolerated in normotensive individuals but are of greater significance in patients with cardiovascular and cerebrovascular disorders. The quest for an effective suppression of these responses continues.Materials and Methods: A randomized, prospective, double blind, placebo controlled study was conducted in which the efficacy of Lignocaine 1.5 mg/kg and Esmolol 1.5 mg/kg were compared in attenuating the cardiovascular response to laryngoscopy and tracheal intubation in sixty patients undergoing elective surgery under general endotracheal anaesthesia. Patients were divided into three groups receiving Lignocaine, Esmolol or Normal saline (control). Anaesthesia was induced with intravenous Thiopental Sodium 5 mg/kg and intubation was facilitated with Vecuronium 0.12 mg/kg after administering the study drug. Blood pressure and heart rate were compared among the three groups.Results: The increase in Systolic blood pressure was not significant, but Diastolic and Mean Arterial Pressures increased significantly in control group whereas it was attenuated more effectively in Esmolol group (p<0.05) compared to lignocaine group. The increase in HR was significantly lower (p<0.05) in Esmolol group compared with lignocaine and control group.Conclusion: Esmolol is more effective than lignocaine in attenuating cardiovascular response to laryngoscopy and tracheal intubationJournal of Society of Anesthesiologists 2014 1(1): 29-35
Use of Granisetron for prevention of hypotension and bradycardia due to spinal anesthesia: A double blind randomised control trial
Authors: Shrestha Battu Kumar , Acharya Subhash Prasad , Marhatta Moda Nath
Published: October 2015

Background: The common adverse effects of spinal anaesthesia include hypotension and bradycardia are due to sympathetic nerve blockade and activation of the Bezold-Jarisch reflex. The Bezold-Jarisch reflex in spinal anaesthesia may be mediated by peripheral 5-HT3 type serotonin receptors. We hypothesized that blockade of type 3 serotonin receptors by using intravenous Granisetron might reduce hypotension and bradycardia induced by spinal anaesthesia.Methodology: Sixty American Society of Anesthesiologists Physical Status I and II patients undergoing lower abdominal surgeries were randomized to receive either Normal Saline (control) or Granisetron 40 mcg/kg intravenously five minutes before subarachnoid block. Heart rates, systolic blood pressure, diastolic blood pressure, mean arterial pressure was recorded every two minutes for ten minutes and then every five minutes for another twenty minutes. Hemodynamic parameters were compared with baseline in each group.Results: There was decrease in all measured variables when compared with baseline values in both groups. There was less reduction in diastolic blood pressure in Granisetron group statistically significant at 10, 15, 20, 25 and 30 minutes. However, the less decrease in mean arterial pressure was statistically significant at 30 minutes only. There were no significant differences in systolic blood pressure and heart rate values between the groups.Conclusions: Granisetron given intravenously does not decrease the incidence of hypotension and bradycardia following subarachnoid block in patients undergoing lower abdominal surgery. However, it attenuates the fall of diastolic and mean arterial pressure spinal anaesthesia.Journal of Society of Anesthesiologists 2014 1(1): 36-39
Perioperative ischaemia and management of patients with coronary stents: current practice
Authors: Pokharel Jeju Nath
Published: October 2015

Perioperative ischaemia is a common cause of cardiac morbidity and cardiac death during perioperative period in patient with coronary artery disease or with other risk factors. The incidence of perioperative ischaemia is about 20 to 70% in patient with coronary artery disease or coronary artery disease risk factors. Post operative cardiac events (the combined incidence of nonfatal myocardial infarction, unstable angina, heart failure and sudden cardiac death) vary between 5.5 to 53% and postoperative myocardial infarction varies between 1.4 to 43%. Prolonged ST- segment depression along with hypercoagulability caused by surgical stress, platelet activation, increased fibrinogen activity and decreased fibrinolytic activities may lead to coronary thrombosis, ischaemia, nonfatal infarction or sudden cardiac death. Patients with coronary stents especially before complete endothelialization of the stents are of high risk category for these complications. Anesthesiologist being a perioperative physician should understand safety issues of these patients to prevent from ischaemia, coronary thrombosis and subsequent infarction or sudden cardiac death. Risk identification, optimization, monitoring, diagnosis of the problem, prevention and management are very crucial during perioperative period to enhance the quality service and patient safety.Journal of Society of Anesthesiologists 2014 1(1): 40-48
Anaesthesia for the patient undergoing Hepatectomy
Authors: Shakya Bigen Man
Published: October 2015

A 41 year old lady was planned for left hepatectomy for Intrahepatic Cholangiocarcinoma. This article describes the case and perioperative concerns during hepatectomy. Hepatectomy is a challenging procedure both for surgeons and anaesthesiologist. Better understandings of physiology and advancements in both the fields have markedly reduced the mortality related to hepatectomy. The major concern is the blood loss during the resection of tumor. Blood loss is minimized by multi - modal perioperative techniques. Pringle maneuver is used by surgeons to minimize blood loss during resection but have significant hemodynamic changes. The central venous pressure should be kept below 5 cm of H2O particularly during resection to minimize blood loss. The use of epidural for postoperative analgesia is controversial. Postoperative hepatic failure occurs in 3 % of cases. A good postoperative care with monitoring on relevant parameters is needed for better outcome.Journal of Society of Anesthesiologists 2014 1(1): 49-50
Impacted tooth brush in retromolar area: a practical management of difficult airway
Authors: Deo Gopendra Prasad , Majhi Prakash Chandra
Published: October 2015

Proper airway management is an important skill for an Anaesthesiologist. This case report deals with airway management performed in a forty five years lady, with impacted tooth brush in the retromolar region on the right side. She was intubated and the foreign body was removed surgically without any peri-operative complications. This case report discusses the complications and management of oropharyngeal injuries by stick-like foreign bodies such as a toothbrush or a chopstick. The article also focuses on basic airway management and some tracheal intubation techniques that may be performed to solve a difficult airway.Journal of Society of Anesthesiologists 2014 1(1): 51-54
Critical Care Medicine: An emerging super specialty in Nepal
Authors: Acharya Subhash Prasad
Published: October 2015

No Abstract AvailableJournal of Society of Anesthesiologists 2014 1(1): 55-58
Comparison of postoperative analgesic effectiveness of combined intraperitoneal instillation and periportal infiltration of bupivacaine with intraperitoneal instillation or periportal infiltration alone for laparoscopic cholecystectomy
Authors: Bhattarai Prajjwal Raj , Bhattarai Balkrishna , Sah Birendra Prasad , Rahman Tanvir R , Ghimire Ashish , Adhikary Shailesh
Published: October 2015

Background: Visceral pain is the major component of pain after laparoscopic cholecystectomy. Periportal infiltration and peritoneal instillation of local anesthetics have been reported to be effective in various laparoscopic procedures. Aim of this study was to find out the analgesic effectiveness and duration of analgesia following combined intraperitoneal instillation and periportal infiltration of bupivacaine and to compare it with peritoneal instillation or periportal infiltration alone.Methods: A prospective, randomized, double blinded study was conducted in 90 adult patients undergoing elective laparoscopic cholecystectomy. The patients were randomized into three groups. Group 1 received intraperitoneal instillation of 20 ml of 0.5% bupivacaine. Group 2 received periportal infiltration of 10 ml of 0.25% bupivacaine. Group 3 received combination of both. After standard balanced anesthesia technique, patients were observed in postoperative period for pain and hemodynamic variables, that were recorded ½ hourly for 1 hour, then at 4, 8, 12 and 24 hours postoperatively. The time and doses for rescue analgesia, if given, were also recorded.Results: Combined peritoneal instillation and periportal infiltration provided a mean duration of analgesia of 6 hours. Peritoneal instillation alone provided analgesia for three hours while periportal infiltration alone provided analgesia for one hour. The combination group required one third (116.67 mg vs. 173.33 mg) less analgesic than periportal group and one fifth (116.67 mg vs. 148.33 mg) less than that of peritoneal group. No adverse effects were noted.Conclusion: Combined intraperitoneal instillation and periportal infiltration of bupivacaine reduced postoperative pain after laparoscopic cholecystectomy better than intraperitoneal instillation or periportal infiltration of bupivacaine alone.Journal of Society of Anesthesiologists 2014 1(2): 59-64
Anaesthesia education in Nepal - What residents think
Authors: Shrestha Anil
Published: October 2015

Background: Education in Anesthesiology is one of the growing fields of medical education in Nepal. The feedback and constructive suggestions from the Anesthesiology residents regarding their training program is essential for the improvement of the training program.Methods: This prospective questionnaire based study was done at five different medical institutions of Nepal where postgraduate training in Anesthesiology is available. Questionnaire consisting of several questions related to anesthesia training were distributed to 45 anesthesiology residents of different institutions and were asked to fill and return to the investigator.Results: Out of 45 questionnaires 38 responded. Only 50% of the respondents said that classes were regular in their institution. Only 23.68% of the residents were satisfied with the exam system. More than two third (76.32%) felt that their undergraduate education in anesthesiology was inadequate. Majority of the residents think that the education in anesthesiology in Nepal is at par or better than education in other subjects and 81.58% think that it is becoming better than before. Half of the residents feel that the facilities provided to them is better considering the national condition. Sixty-six percent of the residents think that the future of anesthesia in Nepal is bright.Conclusion: Majority of the residents think that the anesthesia education in undergraduate level is inadequate and developing anesthesia as a separate subject may attract more students to join anesthesiology. Most of the residents are satisfied with the improvement in education in anesthesia and its future but feel that there are lot more to do.Journal of Society of Anesthesiologists 2014 1(2): 65-69
Oral Clonidine in reduction of postoperative nausea and vomiting after laparoscopic cholecystectomy: A double blinded placebo controlled trial
Authors: Bhandari Sandip , Basnet Madindra , Shrestha Gentle Sunder , Marhatta Modh Nath
Published: October 2015

Background: The common adverse effects of laparoscopic cholecystectomy include nausea and vomiting. Surgical pneumoperitoneum can stimulate vagal response and induce the release of various emetogenic substances such as 5-hydroxytryptamine and acetylcholine. We hypothesized that oral Clonidine administered preoperatively reduces the post operative nausea and vomiting following laparoscopic cholecystectomy.Methodology: In a randomized, double-blinded placebo controlled study, seventy patients undergoing laparoscopic cholecystectomy were assigned to receive either oral Pyridoxine (placebo) or oral Clonidine 200?g 20-30 minutes before conduction of general anaesthesia. We assessed post operative nausea and vomiting and compared its incidence following laparoscopic cholecystectomy with prophylactic use of oral Clonidine or placebo. We also found out the requirements of rescue antiemetic medication (Ondansetron and Promethazine) for post operative nausea and vomiting after prophylactic use of oral Clonidine or Placebo.Results: Three patients in Clonidine group and 12 patients in Placebo group vomited in first two hours. Likewise, 11 and 22 patients vomited in Clonidine and Placebo group over 24 hours respectively. In group Clonidine, 18 patients had nausea in first two hours and 20 patients had nausea over 24 hours. In group Placebo, 33 patients developed nausea in first two hours and over 24 hours. Ten patients in Clonidine group and 19 patients in Placebo group required Ondansetron as rescue antiemetics over 24 hours.Conclusion: Oral Clonidine given pre-operative to patients undergoing laparoscopic cholecystectomy decrease the incidence of post operative nausea and vomiting.Journal of Society of Anesthesiologists 2014 1(2): 76-79
Entrapment of central venous catheter by a suture to the left atrial wall following double valve replacement
Authors: Gyawali Bidhan , Amatya Ashsish Govinda , Shrestha Battu Kumar , Pokharel Jeju Nath , Gautam Nabin Chandra
Published: October 2015

A 19-year-old female with severe mitral stenosis, moderate mitral regurgitation and severe aortic regurgitation was scheduled for double valve replacement. The central venous catheter inserted after induction of anesthesia could not be pulled out on an attempt to remove it on third postoperative day, and appeared to be stuck. Fluoroscopy confirmed the fixation of catheter at left atrial wall of the heart. This necessitated reopening the chest, cutting the suture and removing the catheter. We believe that our case is one of the few reports of central venous catheter sutured surgically to the atrial wall requiring re-exploration for removal. This kind of entrapment of central venous catheter by a suture is a possible complication in open heart surgeries. Cardiovascular anesthesiologists and surgeons should take measures to prevent such complication. Any attempt to pull it out could be fatal. Cautious handling is advocated whenever an entrapped central venous catheter is found. Checking the catheter for possible entrapment by gently pulling it a few centimeters at the time of atrial wall closure and using a shorter length catheter may be the strategies to prevent such complication.Journal of Society of Anesthesiologists 2014 1(2): 80-82
The first year: Journal of Society of Anesthesiologists of Nepal (JSAN)
Authors: Sharma Apurb , Pradhan Bishwas
Published: October 2015

Abstract not availableJournal of Society of Anesthesiologists of Nepal 2015; 2(1): 1
Hemodynamic response to Sevoflurane and Propofol induction: a comparative study
Authors: Rawal Prabhat , Bajracharya Uday
Published: October 2015

Background: Induction of anesthesia is a critical event and hemodynamic stability is an important factor during this period. Propofol is a commonly used intravenous anesthetic and Sevoflurane is a newly introduced inhalational anesthetic in the context of a developing country. This study compared the hemodynamics on induction of anesthesia with Propofol and Sevoflurane.Methods: A total of 108 American Society of Anesthesiologists physical status I patients undergoing elective surgical procedures under general anesthesia were randomized into two groups. Group ‘P’ patients were induced with intravenous 1% Propofol and Group ‘S’ patients were induced with inhalation of 8% Sevoflurane. Mean arterial pressures and heart rates were recorded at baseline, before induction, during induction and at 1, 3 and 5 minutes after induction of anesthesia before endotracheal intubation.Results: The two groups were comparable with respect to demographics and baseline hemodynamic parameters. There was a significant decrease in mean arterial pressure and heart rate from pre-induction values within both groups during and after induction. The reduction in mean arterial pressure was significantly more in Propofol group transiently during induction. The reduction in heart rate was significantly more in Sevoflurane group at 1, 3 and 5 minutes after induction (P < 0.05).Conclusion: Induction of anesthesia with Propofol demonstrated a greater decrease in mean arterial pressure whereas induction with Sevoflurane was associated with greater reduction in heart rate.Journal of Society of Anesthesiologists of Nepal 2015; 2(1): 2-7