bluuebunny/crossref_metadata_2025 huggingface dataset:
Image-guided navigation and video-assisted thoracoscopic spine surgery: the second generation
Authors: Johnson J. Patrick , Drazin Doniel , King Wesley A. , Kim Terrence T.
Published: March 2014

Object

Video-assisted thoracoscopic surgery (VATS) has evolved for treatment of a variety of spinal disorders. Early incorporation with image-guided surgery (IGS) was challenged due to reproducibility and adaptability, limiting the procedure's acceptance. In the present study, the authors report their experience with second-generation IGS and VATS technologies for anterior thoracic minimally invasive spinal (MIS) procedures.

Methods

The surgical procedure is described in detail including operating room set-up, patient positioning (a lateral decubitus position), placement of the spinal reference frame and portal, radiographic localization, registration, surgical instruments, and the image-guided thoracoscopic discectomy.

Results

Combined IGS and VATS procedures were successfully performed and assisted in anatomical localization in 14 patients. The mean patient age was 59 years (range 32–73 years). Disc herniation pathology represented the most common indication for surgery (n = 8 patients); intrathoracic spinal tumors were present in 4 patients and the remaining patients had infection and ossification of the posterior longitudinal ligament. All patients required chest tube drainage postoperatively, and all but 1 patient had drainage discontinued the following day. The only complication was a seroma that was presumed to be due to steroid therapy for postoperative weakness. At the final follow-up, 11 of the patients were improved neurologically, 2 patients had baseline neurological status, and the 1 patient with postoperative weakness was able to ambulate, albeit with an assistive device.

The evolution of thoracoscopic surgical procedures occurring over 20 years is presented, including their limitations. The combination of VATS and IGS technologies is discussed including their safety and the importance of 3D imaging. In cases of large open thoracotomy procedures, surgeries require difficult, extensive, and invasive access through the chest cavity; using a MIS procedure can potentially eliminate many of the complications and morbidities associated with large open procedures. The authors report their experience with thoracic spinal surgeries that involved MIS procedures and the new technologies.

Conclusions

The most significant advance in IGS procedures has resulted from intraoperative CT scanning and automatic registration with the IGS workstation. Image guidance can be used in conjunction with VATS techniques for thoracic discectomy, spinal tumors, infection, and ossification of the posterior longitudinal ligament. The authors' initial experience has revealed this technique to be useful and potentially applicable to other MIS procedures.
Experience with intraoperative navigation and imaging during endoscopic transnasal spinal approaches to the foramen magnum and odontoid
Authors: Choudhri Omar , Mindea Stefan A. , Feroze Abdullah , Soudry Ethan , Chang Steven D. , Nayak Jayakar V.
Published: March 2014

Object

In this study the authors share their experience using intraoperative spinal navigation and imaging for endoscopic transnasal approaches to the odontoid in 5 patients undergoing C1–2 surgery for basilar invagination at Stanford Hospital and Clinics from 2010 to 2013.

Methods

Of these 5 patients undergoing C1–2 surgery for basilar invagination, 4 underwent a 2-tiered anterior C1–2 resection with posterior occipitocervical fusion during a first stage surgery, followed by endoscopic endonasal odontoidectomy in a separate setting. Intraoperative stereotactic navigation was performed using a surgical navigation system in all cases. Navigation accuracy, characterized as target registration error, ranged between 0.8 mm and 2 mm, with an average of 1.2 mm. Intraoperative imaging using a CT scanner was also performed in 2 patients.

Results

Endoscopic decompression of the brainstem was achieved in all patients, and no intraoperative complications were encountered. All patients were extubated within 24 hours after surgery and were able to swallow within 48 hours. After appropriate initial reconstruction of the defect at the craniocervical junction, no postoperative CSF leakage, arterial injury, or need for reoperation was encountered; 1 patient developed mild postoperative velopharyngeal insufficiency that resolved by the 6-month follow-up evaluation. There were no deaths and no patients required tracheostomy placement. The average inpatient stay after surgery varied between 72 and 96 hours, without extended intensive care unit stays for any patient.

Conclusions

Technologies such as intraoperative CT scanning and merged MRI/CT can provide the surgeon with detailed, virtual real-time information about the extent of complex endoscopic vertebral segment resection and brainstem decompression and lessens the prospect of revision or secondary procedures in this challenging surgical corridor. Moreover, patients experience limited morbidity and can tolerate early oral intake after transnasal endoscopic odontoidectomy. Essential to the successful undertaking of these endoscopic adventures is 1) an understanding of the endoscopic nasal, skull base, and neurovascular anatomy; 2) advanced and extended-length instrumentation including navigation; and 3) a team approach between experienced rhinologists and spine surgeons comfortable with endoscopic skull base techniques
Introduction: Intraoperative spinal imaging and navigation
Authors: Drazin Doniel , Kim Terrence T. , Polly David W. , Johnson J. Patrick
Published: March 2014

Image-guided surgery (IGS) has been evolving since the early 1990s and is now used on a daily basis in the operating theater for spine surgery at many institutions. In the last 5 years, spinal IGS has greatly benefitted from important enhancements including portable intraoperative CT (iCT) coupled with high-speed computerized stereotactic navigation systems and optical-based camera tracking technology.
Climate Change, Adaptation, and Climate-Ready Development Assistance
Authors: Light Andrew , Taraska Gwynne
Published: March 2014

Traditional justifications for state-to-state development assistance include charity, basic rights and self-interest. Except in unusual cases such as war-reparations agreements, development assistance has typically been justified for reasons such as the above, without reference to any history of injury that holds between the states. We argue that climate change creates relationships of harm that can be cited to supplement and strengthen the traditional claims for development assistance. Finally, to demonstrate the utility of this analysis, we offer a brief application of our reasoning to the emerging conflict in the United Nations over the future post-2015 development agenda.
Adaptation as Precaution
Authors: Hartzell-Nichols Lauren
Published: March 2014

Precaution is usually associated with the intuition that it is better to be safe than sorry, and/or that it is sometimes necessary to act in advance of scientific certainty to prevent harmful outcomes. At this point, we cannot entirely prevent climate change, but we can affect how harmful such change is. Adaptation may therefore be understood as a precautionary measure against the damage due to climate change. ‘The’ precautionary principle alone is too vague to shape adaptation policy, but a limited catastrophic precautionary principle may productively guide adaptation policy makers. I argue in this paper that an explicit commitment to a precautionary approach based on the catastrophic precautionary principle could and should be made to strengthen the adaptation policies introduced at the United Nations Framework Convention on Climate Change (UNFCCC).
Towards a More Grounded and Dynamic Sociology of Climate-Change Adaptation
Authors: Mulligan Martin John
Published: March 2014

Lever-Tracy (2010) concluded from a review of major international sociological journals that sociology is ‘lagging behind’ in terms of research on the challenges of global climate change. More recently, John Urry (2011) contributed a rather speculative book on ‘post-carbon sociology’, yet sociologists continue to lag behind geographers and psychologists in contemplating the social and cultural dimensions of climate-change adaptation. The findings of the present paper suggest that the sociology of climate-change adaptation could take its lead from the work of cultural and human geographers on people-place relationships, and engage with art theory and practice to offer imaginative insights into the scope and scale of the climate-change challenge. Sociologists could also make a major contribution to current debate on the roles of community action and community engagement in climate-change adaptation, noting that the word ‘community’ is open to abuse and misunderstanding. Drawing on his own research on the challenges facing local communities in Australia and Sri Lanka, the author combines previously disconnected bodies of literature to identify some important points of departure for the journey towards Urry's ‘post-carbon sociology’.
Sourcing Stability in a Time of Climate Change
Authors: Shockley Kenneth
Published: March 2014

Anthropogenic climate change poses a direct and imminent threat to the stability of modern society. Recent reports of the probable consequences of climate change paint a grim picture; they describe a world environmentally much less stable than the world to which we have become accustomed. As we begin to adapt to our changing climate, we will need to identify new sources for the stability necessary for a flourishing society. I suggest that this stability should come from the ideals of the good life we seek to promote when we focus on capabilities, on the substantial freedoms humans need to flourish. These ideals serve as a stable foundation for well-being in a time of great environmental and social instability; they should serve as guides for our policies, practices and institutions. I conclude by appealing to capabilities as a means of integrating well-being into our adaptation strategies, and show how doing so may well provide a way of formulating a powerful moral justification for adaptation strategies appropriate for both the developed and the developing world.
Editorial Vol.2(1)
Authors: Talukder Md Humayun Kabir , Lasker Shamima Parvin
Published: March 2014

DOI: http://dx.doi.org/10.3329/bjme.v2i1.18128 Bangladesh Journal of Medical Education Vol.2(1) 2011
Stress and Depression among undergraduate Medical Students of Bangladesh
Authors: Sultana Nazma
Published: March 2014

This cross-sectional descriptive type of study was conducted to explore the level of stress and depression and to find out the various socio-demographic, academic factors which act as barriers to study among undergraduate medical students of Bangladesh. The study was conducted at Dhaka Medical College during the period of April 2009 to June 2009. The students of 1st year to 5th year were the study population. A total of 425 students participated in the study. After taking proper approval from the concerned authority adopting convenient sampling technique data were collected through a self administered questionnaire with validated Kessler 10 psychological distress scale. The study revealed that only (1%) respondents were free from any sorts of psychological stress. Over one third (34.6%) had mild stress, (39.8%) moderate stress and about one fourth (24.9%) was suffering from severe stress according to Kessler 10 Psychological distress scale. A significant proportion of male respondents (73%) had moderate to severe psychological distress compared to the female respondents (56%) p<0.001. A significant higher proportion (56%) of those experiencing study pressure had moderate to severe stress as well (p<0.001). Having political affiliation, higher proportion of students (66%) reported no or mild stress. It is researchers opinion that politically affiliated students usually maintain good relationship with their teachers which help them to pass or they influence their teachers to bring result in their favor or teachers favor them to keep their position undisturbed. Lower proportion (34%) reported to have moderate to severe stress. The differences between politically affiliated and not politically affiliated groups are statistically significant p<0.001.This study demonstrates that factors which are responsible for students stress and depression are not similar in all countries. Sources of stress of our students should be checked out for the betterment of our students. The study recommended that need for intervention like social and psychological support to improve the quality of life of medical students. Students advisors should be provided who will train students about stress management. DOI: http://dx.doi.org/10.3329/bjme.v2i1.18130 Bangladesh Journal of Medical Education Vol.2(1) 2011: 6-9
Views of teachers' and Interns' regarding teaching- learning of communication skills in undergraduate medical education in Bangladesh
Authors: Alam Abu Saleh Mohammed Monirul , Talukder Md Humayun Kabir , Haque Farhana , Rahman Shah Mohammed Hafizur , Amin Md Shoheilul , Ansary Jamil Ahsan
Published: March 2014

This cross-sectional descriptive study was carried out among the teachers and interns doctors of four medical colleges of Dhaka city in last one year (2010-2011).Data was collected by conveniance sampling. In-depth interview of the teachers were taken to explore their views regarding current situation, what should be, and recommendations for future curriculum about teaching communication skills. Information was collected from interns by semi-structured questionnarie. Alocation of score for response of each item was based on 5 point Likert scale.Total respondents were 249 out of which intern doctors were 218 and 31 were teachers. Teachers were chosen from eight clinical subjects as the conveniance of the researcher. Selected 14 variables of communication skills were used in this study. By reviewing the study it was seen that most of the interns gave opinion that they were not taught communication skills in their cinical classes. It was seen in the study that majority of the teachers confessed that they don't teach communication skills in stuctured way. All of them agreed that it must be taught in stuctured way and assessed. DOI: http://dx.doi.org/10.3329/bjme.v2i1.18132 Bangladesh Journal of Medical Education Vol.2(1) 2011: 14-17
Medical teacher: how much they are satisfied with their job?
Authors: Khanam Rawshan Ara , Talukder Humayun Kabir , Nargis Tahmina , Khan Abdul Wohab , Ali SM Idris , Mia Abdal , Rubaiyat Afrin , Rahman Tawhidur , Rabbi Golam , Ahmed Wakil
Published: March 2014

Job satisfaction includes the fulfillment of both extrinsic and intrinsic satisfaction dimensions.. To find out the views of medical teachers regarding their job satisfaction this study was carried out in 10 medical colleges for one year among 218 teachers working in preclinical, paraclinical and clinical departments of those medical colleges. Structured questionnaire using 47 characters related to job satisfaction were compiled under 8 themes. Among these for 39 questions 5 point Likert scale was used as rating scale .For satisfaction or dissatisfaction 3 was taken as the cut off value. Mean age of the respondents were 42 years and they passed 3 years after last promotion, 41% teachers were female , 87% were married and 81 % had post graduate degrees. Among the 8 themes teachers were highly satisfied with all of the 4 items under theme 1( relation with others). Teachers were also satisfied with theme 2 (teaching related responsibilities )& theme 3 ( teaching environment) though level of satisfaction was not very high. Teachers were not satisfied with activities related to current work ie, theme 4 but highly dissatisfied with the facilities available other than the salary ( theme5). Regarding local administration medical teachers were highly dissatisfied (theme 6) but there was low level satisfaction with central administration (theme7). Regarding clinical teachers satisfaction all teachers were highly satisfied with all the items (theme 8). Satisfaction with one or other aspect of their job was 58.6% which was not very high. Low salary , adverse environment, political interference in posting promotion was the most important cause for dissatisfaction. DOI: http://dx.doi.org/10.3329/bjme.v2i1.18133 Bangladesh Journal of Medical Education Vol.2(1) 2011: 18-22
Views of Medical Teachers Regarding the Need of Training or Course on Medical Education
Authors: Ali SM Idris , Talukder Md Humayun Kabit , Khatun Momena , Khanom Rowsan Ara , Miah Md Abdal , Ahmed Md Wakil , Rabbi Golam , Rahman Md Touhidur , Khan Md Abdul Wahab
Published: March 2014

Background Medical education in Bangladesh is poorly assessed and there is a general lack of documented knowledge about the challenges facing this field and the needs for its development. This study aimed to assess the need of medical education training or course for the teachers of medical colleges. Methods A quantitative study based on a self-administered questionnaire of a purposive sample of 204 teachers of different medical colleges was conducted from 1st July, 2011 to 30th June 2012 to explore their views regarding the training or course in medical education. Results The study revealed that majority (98.5%) of respondents showed their interest for training or course on medical education. Among them 61% preferred a regular course, 29% desired for training program and 10% for refresher training on medical education. Most of the respondents (68%) agreed that there are some barriers to participate in a training or course on medical education. Conclusions The existing medical education system face significant problems and it needs important and comprehensive improvements in or course on medical education. There is a need for further research in this field to explore the identified problems in a more in-depth manner in order to better understand of the problems and needs of training or course on medical education. DOI: http://dx.doi.org/10.3329/bjme.v2i2.18135 Bangladesh Journal of Medical Education Vol.2(2) 2011: 7-11
Smokers Anaesthesia
Authors: Islam Munirul
Published: March 2014

DOI: http://dx.doi.org/10.3329/jbsa.v22i2.18139 Journal of BSA, 2009; 22(2): 38-39
Effect of small dose intermittent IV pethidine in combination with diclofenac for post operative pain relief
Authors: Banik Debabrata , Hye Md Abdul , Akhtaruzzaman AKM , Aziz Lutful , Yeasmeen Sabina , Iqbal KM
Published: March 2014

Background: Post operative pain is an acute type of pain. There is convincing evidence that unrelieved post operative pain may result in harmful physiological and psychological effects with significant morbidity and even mortality. Complete and effective pain management is an essential for the patient who recovers from surgery. For this reason we used easy available drugs opioid, NSAID and its combination for better post operative analgesia with the aim of avoiding expensive patient controlled analgesia technique, infusion or intramuscular painful roout of administration. Methods: 120 patients ASA grade-I and II were selected for post operative pain releive in upper and lower abdominal surgery. All patients divided into three groups and each group are equal in number and same type of surgery. Among the three groups, two groups received small intermittent intravenous pethidine and diclofenac pre and post operatively and other groups received intra muscular pethidine with diclofenac pre and post operatively (controlled group). All vital parameter and pain score both VAS and VRS were recorded in perioperative period up to 24 hours postoperatively. Result: Good level of anaesthesia was achieved in all groups (VAS>30mm) of upper and lower abdominal surgery except early post operative period. In early post operative period significant difference of VAS in group II and III (P<.01) was found with group I. But after half an hour and one hour significant difference of VAS in group II and III (P<0.02, P<0.001) was found with group I. Over all excellent analgesia was possible in group II VAS, VRS always more than 30mm and all vital sign were stable. Conclusion: Small intravenous intermittent dose of pethidine in combination with diclofenac sodium effectively controlled post-operative pain. DOI: http://dx.doi.org/10.3329/jbsa.v22i2.18140 Journal of BSA, 2009; 22(2): 40-47
Use of labetalol and glyceryl trinitrate for induced hypotension in spine surgery- A comparative study
Authors: Yeasmeen Sabina , Siddique Md Rafayet Ullah , Islam Amirul , Aktaruzzaman AKM , Banik Debabrata , Hye Abdul
Published: March 2014

Background: Induced hypotension is used to reduce blood loss especially in those operations where even a small amount of blood can obscure the operative field such as spine surgery. Objectives: To compare the effect of labetalol with that of glyceryl trinitrate to reduce intraoperative blood loss by inducing elective hypotension without any tachycardia and to improve quality of surgical field during spine surgery. Method: A total number of thirty patients (ASA grade I & II) were selected randomly into two groups, fifteen in each group. Group-I received glyceryl tinitrate (1000?g) and Group-II received labetalol (5mg) intravenously 3 minutes before induction of anaesthesia. Heart rate, mean arterial pressure was observed in two study groups 15 minutes interval in intra-operative period and quality of surgical field was detected by 4 points VRS (Verbal rating scale) after completion of surgery by asking the surgeon. Results: Heart rate varied significantly in two study groups after induction of anaesthesia except baseline and pre induction (p< 0.05). Labetalol associated with improved quality of surgical field visualization than glyceryltrinitrate (p = 0.034). Conclusion: Our study concluded that labetalol is effective than glyceryltrinitrate to reduce blood loss in spine surgery. DOI: http://dx.doi.org/10.3329/jbsa.v22i2.18141 Journal of BSA, 2009; 22(2): 48-53
Comparative study of quality of subarachnoid blocks for caeasarean section by using bupivacaine alone & bupivacaine - fentanyl combination
Authors: Paul Manisha , Dhar Satyajit , Banik Debasish , Huda AK Quamrul , Hossain Moinul , Choudhury Gulshan Ara , Alam AKM Shamsul , Chowdhury AYF Elahi
Published: March 2014

Background: The popularity of subarachnoid block (SAB) in cesarean section in recent times is due to better understanding of the physiological changes associated with it and proper appreciation of its advantages & complications. Hyperbaric bupivacaine in adequate dose (12mg or more) for SAB often causes complications like hypotension, shivering, nausea, vomiting, chest pain & epigastric pain. Objectives: The aim of study is to reduce these complications by using bupivacaine-fentanyl combination. Method: 150 patients of ASA grade I & II waiting for cesarean section under SAB were randomly allocated into three equal groups. Group A : Received 0.5% hyperbaric bupivacaine-10 mg (2ml) Group B : Received 0.5% hyperbaric bupivacaine-10 mg (2ml) & fentanyl- 15 ?g [0.3ml] Group C : Received 0.5% hyperbaric bupivacaine - 8 mg (1.6ml) & fentanyl- 15 ?g. [0.3ml] Parametric data like pulse, blood pressure, among the groups were analyzed by ANOVA test & nonparametric data like chest discomfort, epigastric pain, nausea, vomiting were analyzed by chi-square test. Results: In this study we found better analgesia & quality of block in bupivacaine-fentanyl group than bupivacaine alone group (p<.001). Conclusion: By adding fentanyl we can reduce the dose of bupivacaine & also improve the quality of block. DOI: http://dx.doi.org/10.3329/jbsa.v22i2.18144 Journal of BSA, 2009; 22(2): 61-65
Organisms associated with ventilator associated pneumonia (VAP) in intensive care units (ICU)
Authors: Selina Farhana , Talha Khandaker Abu , Islam Amirul , Hasan Zahidul , Hyder Masum , Selvapandian S
Published: March 2014

Background: Organisms associated with ventilator associated pneumonia (VAP) in intensive care units (ICU). Aims and objectives: To identify the organisms associated with ventilator associated pneumonia and to compare our study with other international studies. Methods: This observational study on VAP was conducted in different ICU of Square Hospital Limited during the two years. Any ventilated patient who developed fever or respiratory distress was clinically assessed by attending physician. This includes time of developing fever after intubation, physical examination findings (auscultation finding, pattern of temperature) and X-ray findings. On the day of onset of fever or respiratory distress, tracheal aspiration was done and the aspirated fluid was sent to microbiology lab. for culture and sensitivity test. If patient was designated to be suffering from VAP all relevant information was documented in a structured questionnaire. Results: In our study we found 15 organisms responsible for VAP. Among these common organisms were pseudomonus(35%), acinetobacter(29%), klebsiella(16%), MSSA (10%), MRSA(9).Total number of cases was 79. Among these 21 patients expired which was 26.5% of the whole series. Total 534 patients died in this hospital during this 2 years. Death for VAP was 4% of the total death of the hospital. Conclusion: Pseudomonas was the most commonest among identified organisms with ventilator associated pneumonia and medicine department having maximum number of VAP patients. To compare our results with those of international studies we found similarity in organisms, primary diagnosis and mortality. DOI: http://dx.doi.org/10.3329/jbsa.v22i2.18146 Journal of BSA, 2009; 22(2): 72-77
Perioperative anaesthetic management of a child with cushings syndrome for bilateral adrenalectomy
Authors: Yeasmeen Sabina , Banik Debasish , Huda Quamrul , Reza Sayeed Mahmud Ali , Hye Abdul , Ahmed Anwar
Published: March 2014

Nearly twenty five percent of the cases of cushings syndrome are due to adrenal hyperplasia without an ACTH secreting tumour. Twenty percent of patients with endogenous cushing have adrenocortical tumour about half of which are benign adenoma. Surgical intervention done due to failed medi cal therapy and in case of adrenal adenoma. A child aged 4½ years, weighting 29kg with features suggestive of cushings syndrome was admitted under paediatric surgery unit in Bangabandhu Sheikh Mujib Medical University. On investigation serum cortisol levels were raised. blood pressure was controlled by ACE inhibitor, calcium channel blocker and beta-blocker. He was scheduled for resection of adrenal cortical tumour. Electrolyte imbalance was corrected, steroid replacement was done. Patient was haemodynamically stable preoperatively.Surgery was completed unevenetfuly. Postoperatively patient was kept in ICU, ventilation maintained by control mode (CMV). After 24 hours the patient was extubated. When the patient found haemodynamically stable he was sent to the recovery room. DOI: http://dx.doi.org/10.3329/jbsa.v22i2.18148 Journal of BSA, 2009; 22(2): 84-87
Beware of randomly used opioid!
Authors: Banik Debabrata
Published: March 2014

DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18149 Journal of BSA, 2010; 23(1): 1-2
Evaluation of intubation condition following administration of rocuronium in comparison to atracurium in paediatric patients
Authors: Khan Abdul Kuddus , Wadud MM Abdul , Gafur Azizul , Siddique Rafayetullah , Banik Debabrata
Published: March 2014

Background. Optimum intubation condition is paramount important for early and easy passage of endotracheal tube through the glottis and that results from adequate muscle relaxation. Rocuronium and atracurium are muscle relaxants used for short and intermediate duration of surgical processes. Objective: This study, compares the intubation condition and haemodynamic changes in paediatric patients following administration of rocuronium and atracurium to get rid of the side effects of succinylcholine. Method. The study was carried out in 60 patients aged 11/2 to 10 years, ASA I-II, under general anaesthesia. The patients were divided into two groups: rocuronium Gr R and atracurium Gr A. Induction was done with halothane 3.5-4% and for intubation rocuronium 0.6 mg/kg and atracurium 0.46 mg/kg were given to patients of Gr R and Gr A respectively. The intubation condition was assessed and gradded at 60 seconds after neuromuscular blocking agents. At the same time TOF ratios were recorded. Results. Rocuronium produced good to excellent intubation condition (score 3.80 ± 0.07) in all patients at 60 seconds whereas that of atracurium poor intubation condition (score 2 ± 0.00). TOF ratios showed more relaxation of adductor pollicis muscle in Gr R than Gr A (Gr R = 60.43 ± 0.87, Gr A = 78.90 ± 0.72). (p < 0.001). Cardiovascular stability was not significantly difference in both the groups before induction and intubation. Conclusion. Rocuronium produced better intubation condition in comparison to atracurium. DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18150 Journal of BSA, 2010; 23(1): 3-7
Caudal bupivacaine - midazolam for post operative analgesia in children
Authors: Ali Idris , Islam Amirul , Morshed Golam , Islam Nurul , Ali Ashia , Khatun UH Shahera
Published: March 2014

Background: Adjuvant used with local anaesthetic agent in caudal is more effective for post operative analgesia in children . Aim and objective: To find out the duration and quality of caudal analgesia in children undergoing genitourinary surgery by combination of bupivacaine and midazolam. Methods: A total number of sixty patients ASA grade I&II were selected randomly as per inclusion & exclusion criteria in two groups. Thirty in each group. In group A, caudal block was given by bupivacainemidazolam mixture and in group B, caudal block was given by bupivacaine in lateral decubitus position, just after completion of surgery before reversed from GA. In post operative period arterial blood pressure, heart rate, and duration of analgesia were recorded. Results: There was no significant difference between the groups of blood pressure, heart rate, and pain score up to 30 min but after one hour of post operative period pain scores were significant(p<0.05). Conclusion: Midazolam improves the duration and quality of analgesic effect of bupivacaine. DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18152 Journal of BSA, 2010; 23(1): 8-13
Epidural triamcinolone for management of low back pain with radiation- a comparative study of two dose regime
Authors: Kamal Md Mustafa , Al Maruf Abdullah , Hossain Md Shahadat , Samad Md Abdus , Hasanuzzaman Md , Akhtaruzzaman AKM
Published: March 2014

Background: Low back pain is a very common specially in elderly people. Relief of pain is associated with decrease in morbidity, shorten hospital stay and increase patients satisfaction. Nerve block by epidural steroid and local anaesthetic is an acceptable method to reduce low back pain. Aim and objective: The present study was performed to compare low dose (40 mg) and high dose (80 mg) Triamcinolone to see their effectiveness and side effects in controlling low back pain. Method: This study was a randomized controlled trial. 60 patients with low back pain with radiation, and with positive CT/MRI support has been randomly selected by blind envelop method and divided into two groups, 30 patients in each. Group-A, patients received inj. Triamcinolone (40 mg) and Group-B patients received inj. Triamcinolone (80 mg) epidurally. Results: Both dosage produced effective analgesia in low back pain as assessed by visual analogue scale (VAS) and verbal rating scale (VRS) for the period up to 30 days after administration. Haemodynamic changes showed no significant difference between the two drugs after 30 days. Both drugs produced significant rise of fasting plasma glucose and leucocytosis for the period up to 30 days after administration. Conclusion: Low back pain can be effectively reduced by epidural low dose Triamcinolone (40 mg). DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18153 Journal of BSA, 2010; 23(1): 14-18
Monitored anaesthesia care in elderly patient - a prospective descriptional study
Authors: Al Maruf Abdullah , Latif Kazi Ashkar , Chowdhury Iqbal Hossain , Kamal Md Mustafa
Published: March 2014

Background: In elderly patients for some diagnostic, therapeutic and surgical procedure, Monitored anaesthesia care (MAC) may be an anaesthetic option for them. Aim and objective: This prospective study was designed to assess the efficacy, safety, and tolerability of MAC in elderly patients. Method: This study was performed on elderly patients of both sex, age from 50 years and above, scheduled to undergo different therapeutic, diagnostic and surgical procedures. The patients characteristics, pre-anaesthetic problems, anaesthetic techniques, anaesthetic agents, anesthetic time, MAC procedure and complications were assessed. Result: They involved mainly hypertension (26.49%) and diabetes mellitus (21.78%). Almost all procedure was done under sedation (70.38%), local anaesthesia (22.71%) and under only monitoring without sedation or local anaesthesia (6.90%). There were no serious adverse events reported in any patients during MAC. The common complications were arrhythmia (9.60%), vomiting (7.36%) and desaturation (4.56%), hypertension (5.64%). Complications were minor, transient and promptly managed and corrected. MAC duration was ranged from 15 to180 minutes. The mean procedure time was 35.1 + 12.5 minutes. Majority of cases were completed within 30 minutes (51.21%). Conclusion: In properly selected elderly patients, MAC is a safe and effective method of providing intraoperative care for some common diagnostic, therapeutic, and operative procedures. DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18154 Journal of BSA, 2010; 23(1): 19-24
Effect of preemptive intravenous ketorolac and bupivacaine infiltration on post operative pethidine consumption - a comparative study
Authors: Ahmed Jalal Uddin , Islam Md Shahidul , Islam Md Shafiqul , Mandal Mantosh Kumar , Islam Mohammad Sirajul , Shamsuzzoha Md , Akhtaruzzaman AKM
Published: March 2014

Background: Preemptive analgesia significantly reduces postoperative analgesic requirement. Multi modal approach for preemption has greater range of benefit and its use in treating postoperative pain has gaining popularity. Objectives: To observe the effect of preemptive bupivacaine infiltration and intravenous ketorolac on postoperative pethidine consumption in single and multiple preemptive techniques. Methods: One hundred and twenty patients of ASA physical status I&II requiring lower abdominal surgery under general anaesthesia were randomly allocated in four groups. Gr- A received bupivacaine infiltration and ketorolac injection, Gr-B received intravenous Ketorolac injection, Gr-C bupivacaine infiltration and Gr- D received nothing regarded as Control group. Data were analyzed by students t test, ANOVA and chi-square test as appropriate. Results: Patients characteristics, duration of surgery, haemodynamic status were comparable in four groups. Pain intensity in VAS was significantly reduced in Gr-A (p<0.00) than other three groups. Total pethidine consumption was also reduced significantly in Gr-A (p<0.05). Conclusion: Preemptive analgesics using in multiple modes gives better postoperative analgesia and patient comfort and less postoperative complications. DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18155 Journal of BSA, 2010; 23(1): 25-29
Nutritional Support to Critically Ill Patient
Authors: Chowdhury Iqbal Hossain
Published: March 2014

DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18156 Journal of BSA, 2010; 23(1): 30-33
Rarest of rare bombay blood group in bangladesh: a case report
Authors: Banu Tahmina , Ali SM
Published: March 2014

A 35 years old lady was admitted to Square Hospital for termination of pregnancy on a medico-legal background. She was a diagnosed case of carcinoma of pancreas with Whipples operation performed six months back and was on chemotherapy. During pre-operative check-up we surprisingly noticed that she has Bombay Blood Group. It is a very rare type of blood group and on routine blood grouping behaves as O unless reverse grouping or serum grouping has been done and can receive transfusion from only peoples having Bombay group. As the patients general condition was poor and had recently received chemotherapy and also had a extremely rare blood group ((I in 250000) we decided to keep ready one unit of blood. We decided to provide autologus blood transfusion, as there was no known person in family or in our blood banks record with Bombay Blood Group. The procedure was uneventful and needed no transfusion. As the patient was anaemic and weak, we decided to transfuse the blood in the post-operative period and the patient was discharged from the hospital next day morning. DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18157 Journal of BSA, 2010; 23(1): 34-36
Unintentional epidural catheter migration to subarachnoid space followed by continuous spinal anaesthesia: a case report
Authors: Sardar K , Chowdhury AKMN , Rahman MK
Published: March 2014

Among the complications of epidural anaesthesia catheter migration is a very rare one. A 45 years old lady was scheduled for repairing of post caesarean incisional hernia. We prefer the hanging drop technique for epidural space identification, and 3 ml air injection to reconfirm the epidural space. After a test dose of 2% lignocaine 2 ml with 10 microgram adrenaline, the catheter was secured with at 3 cm of its length within the epidural space. Immediately after test dose, she complained of lower limb motor lost. On monitor, bradycardia and severe hypotension was shown. Hemodynamic instability was corrected promptly. After proper resuscitation, we aspirate through epidural catheter. CSF was coming freely. We decided to continue with continuous spinal anaesthesia. We assembled a syringe pump. Continuous spinal anaesthesia was maintained with 0.125% bupivacaine @ 3ml/hour DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18158 Journal of BSA, 2010; 23(1): 34-36
The voice of American botanists: The founding and establishment of the American Journal of Botany, “American Botany,” and the Great War (1906–1935)
Authors: Smocovitis Vassiliki Betty
Published: March 2014

This paper examines the crucial early history of the American Journal of Botany from the years following the founding of the Botanical Society of America in 1906 to the termination of the agreement for publication with the Brooklyn Botanic Garden in 1935. It examines the efforts of individuals like F. C. Newcombe, who did the most to raise support for the journal and became the first Editor‐in‐Chief, in the context of the growing numbers of professional botanists and plant scientists who were actively engaged in research requiring appropriate publication venues and in the process of forming an independent identity as “American botanists.” It also examines the launching of the journal in the context of the Great War in Europe and the transition from German botany to American botany in the second decade of the 20th century.
Frailty Index to Measure Health Status in People with Systemic Sclerosis
Authors: Rockwood Michael R. , MacDonald Ellen , Sutton Evelyn , Rockwood Kenneth ,   Canadian Scleroderma Research Group, Baron Murray
Published: March 2014

Objective.

To develop and validate, as a measure of overall health status, a Frailty Index (FI) for patients (n = 1372) in the Canadian Scleroderma Research Group (CSRG) Registry.

Methods.

Forty-four items were selected from the CSRG database as health deficits and recoded using FI criteria. To test construct validity, we compared measurement properties of the CSRG-FI to other FI, and related it to measures of damage, age, and time since diagnosis. To test criterion validity, we compared the baseline FI to that at last recorded visit and to mortality.

Results.

The mean CSRG-FI was 0.33 with a sub-maximal limit of 0.67. In patients with diffuse disease, the mean was 0.38(SD 0.14); in patients with limited disease, the mean was 0.31(SD 0.13). The CSRG-FI was weakly (but significantly) correlated with the Rodnan Skin Score (r = 0.28 in people with diffuse disease; 0.18 with limited) and moderately with the Physician Assessment of Damage (r = 0.51 for both limited and diffuse). The risk of death increased with higher FI scores and with higher physician ratings of damage. The area under the receiver operating characteristic curve for the baseline FI in relation to death was 0.75, higher than for other measures (range: 0.57–0.67).

Conclusion.

The FI quantifies overall health status in people with scleroderma and predicts mortality. Whether the FI might help with decisions about who might best be served by more aggressive treatment, such as bone marrow transplantation, needs to be evaluated.
Systemic Autoimmune Rheumatic Disease Prevalence in Canada: Updated Analyses Across 7 Provinces
Authors: Broten Laurel , Aviña-Zubieta J. Antonio , Lacaille Diane , Joseph Lawrence , Hanly John G. , Lix Lisa , O’Donnell Siobhan , Barnabe Cheryl , Fortin Paul R. , Hudson Marie , Jean Sonia , Peschken Christine , Edworthy Steven M. , Svenson Larry , Pineau Christian A. , Clarke Ann E. , Smith Mark , Bélisle Patrick , Badley Elizabeth M. , Bergeron Louise , Bernatsky Sasha
Published: March 2014

Objective.

To estimate systemic autoimmune rheumatic disease (SARD) prevalence across 7 Canadian provinces using population-based administrative data evaluating both regional variations and the effects of age and sex.

Methods.

Using provincial physician billing and hospitalization data, cases of SARD (systemic lupus erythematosus, scleroderma, primary Sjögren syndrome, polymyositis/dermatomyositis) were ascertained. Three case definitions (rheumatology billing, 2-code physician billing, and hospital diagnosis) were combined to derive a SARD prevalence estimate for each province, categorized by age, sex, and rural/urban status. A hierarchical Bayesian latent class regression model was fit to account for the imperfect sensitivity and specificity of each case definition. The model also provided sensitivity estimates of different case definition approaches.

Results.

Prevalence estimates for overall SARD ranged between 2 and 5 cases per 1000 residents across provinces. Similar demographic trends were evident across provinces, with greater prevalence in women and in persons over 45 years old. SARD prevalence in women over 45 was close to 1%. Overall sensitivity was poor, but estimates for each of the 3 case definitions improved within older populations and were slightly higher for men compared to women.

Conclusion.

Our results are consistent with previous estimates and other North American findings, and provide results from coast to coast, as well as useful information about the degree of regional and demographic variations that can be seen within a single country. Our work demonstrates the usefulness of using multiple data sources, adjusting for the error in each, and providing estimates of the sensitivity of different case definition approaches.
Joint Involvement in Patients with Early Polymyalgia Rheumatica Using High-resolution Ultrasound and Its Contribution to the EULAR/ACR 2012 Classification Criteria for Polymyalgia Rheumatica
Authors: Weigand Sandra , Ehrenstein Boris , Fleck Martin , Hartung Wolfgang
Published: March 2014

Objective.

To assess joint involvement and the contribution of musculoskeletal ultrasound (MSUS) to the novel European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) 2012 classification criteria in patients with polymyalgia rheumatic (PMR).

Methods.

MSUS was performed in 54 consecutive patients with recent-onset PMR.

Results.

Biceps tenosynovitis of at least 1 shoulder has been observed in 70.4% of patients, and 64.8% had a bilateral biceps tenosynovitis. Subdeltoid bursitis (27.8% unilateral, 5.6% bilateral), glenohumeral synovitis (22.2% unilateral, 9.3% bilateral), and hip involvement (22.2% unilateral, 16.7% bilateral) were observed less frequently. The sensitivities of the classification criteria were 85.2% for EULAR/ACR without MSUS and 81.5% for EULAR/ACR with MSUS.

Conclusion.

The most common MSUS pathology was a biceps tenosynovitis. However, US findings had no effect on the sensitivity of the novel EULAR/ACR criteria for PMR.
Toward a Generalized Framework of Core Measurement Areas in Clinical Trials: A Position Paper for OMERACT 11
Authors: Boers Maarten , Idzerda Leanne , Kirwan John R. , Beaton Dorcas , Escorpizo Reuben , Boonen Annelies , Magasi Susan , Sinha Ian , Stucki Gerold , Tugwell Peter
Published: March 2014

Objective.

The Outcome Measures in Rheumatology (OMERACT) international consensus initiative has successfully developed core sets of outcome measures for trials of many rheumatologic conditions, but its expanding scope called for clarification and updating of its underlying conceptual framework and working process. To develop a core set of what we propose to call outcome measurement instruments, consensus must be reached both on what to measure and how to measure. This article deals with the first part: a framework necessary to ensure comprehensiveness of the domains chosen for measurement. We formulated a conceptual framework of core measurement areas in clinical trials, for discussion at the OMERACT 11 conference.

Methods.

We formulated a framework and definitions of key concepts adapted from the literature, and followed an iterative consensus process (small group processes and an Internet-based survey) of those involved including patients, health professionals, and methodologists within and outside rheumatology.

Results.

The draft framework comprises 4 core “areas”: death, life impact (all aspects of how a patient feels or functions), resource use (monetary and other costs of the health condition and interventions), and pathophysiologic manifestations (disease-specific clinical and psychological signs, biomarkers, and potential surrogate outcome measures necessary to assess specific effects). The survey responses (262 of 2293, response rate 11%) indicated broad agreement with the draft framework and the proposed definitions of key concepts, including understandability and feasibility. A total of 283 comments were processed.

Conclusion.

In an iterative process, we have developed a generic framework for outcome measurement and working definitions of key concepts ready for discussion at the OMERACT 11 conference.