bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparative Study of Dexmedetomidine as Adjuvant to 0.5% Bupivacaine in Erector Spinae Plane Block for Perioperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy
Authors:   Junior Resident,  Department of Anaesthesiology, Vydehi institute of medical sciences and research centre, Whitefield, Bengaluru 560066, Karnataka., S Reddy Sampreeta , Bisht Swati ,   Professor, Department of Anaesthesiology, Vydehi institute of medical sciences and research centre, Whitefield, Bengaluru 560066, Karnataka.
Published: January 2024

Context: Patients undergoing percutaneous nephrolithotomy (PCNL) experience considerable post-operative pain. Perioperative pain control for PCNL using regional anaesthesia techniques like erector spinae plane block (ESPB) helpsin better outcome in terms of pain, fentanyl requirement. It also indirectly helps in faster recovery and early discharge from hospital. Aims: To assess and compare perioperative pain control provided by ESPB with 0.5% bupivacaine and dexmedetomidine as adjuvant to it. Settings and Design: This randomized case control study was undertaken in a tertiary care centre. 60 patientsplanned for elective unilateral PCNL over a period of 15 months. Patients were randomized into two groups (Group B and group D) using envelope method. Patients were compared for fentanyl consumption, duration and effectiveness of analgesia obtained. Methods and Materials: ESPB was administered pre operatively under ultrasound guidance at the level of 10th thoracic vertebrae. Needle tip was visualised above transverse process of 10th thoracic vertebra. Position was confirmed by hydro dissection on injecting normal saline under ultrasound and drug was injected.Patients were assessed for painat specific time intervals. Total opioid consumption was noted. Data obtained was recorded and analysed. Statistical analysis used: Statistical analysis was performed by SPSS software v.23.0. Oneway analysis of variance, Bonferroni correction, Chi square test was used. P value of <0.05 was considered statistically significant. Results: Dexmedetomidine as adjuvant to local anaesthetic agent improves the quality and prolongs the duration of analgesia. It also decreases total fentanyl consumption. Conclusion: ESPB provides adequate analgesia for PCNL. Addition of dexmedetomidine decreases fentanyl and sevoflurane consumption meanwhile increasing duration of analgesia.
Anaesthetic Managemetnt of Surgical Resecton of A Giant Mediastinal Mass – A Case Report
Authors:   Consultant Pediatric, Cardiac Anaesthesia, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK,, Paddalwar Snigdha , Dhabe Vaibhav ,   Consultant Pediatric, SRCC Children's Hospital, K-Khadey Marg, opposite Haji Ali, Mumbai, Maharashtra 400034, India., Shah Hiren ,   Junior Consultant Pediatric, SRCC Children's Hospital, K-Khadey Marg, opposite Haji Ali, Mumbai, Maharashtra 400034, India.
Published: January 2024

Giant mediastinal mass tumors have been associated with perioperative respiratory and circulatory life- threatening complications during induction of general anaesthesia and initiation of positive pressure ventilation leading to sudden cardiac arrest known as MMS, ‘Mediastinal mass syndrome’ (4, 5,6). A detailed meticulous preanaesthetic evaluation and a well thought out anaesthetic plan can avoid life-threatening events during management of these patients. We report a successful anaesthetic management of a 12 yrs old pediatric patient with a left sided giant mediastinal germ cell tumor, posted for complete surgical resection. We followed the guiding principles for anaesthetic management of such cases, maintaining propped up position, avoiding muscle relaxants, maintaining spontaneous breathing, keeping cardiac team and perfusion team ready to cannulate and institute CPB in case of sudden cardiorespiratory collapse, adapting to low volume ventilation and titrated and step wise induction of anaesthesia.
Comparative Study of Lignocaine, Lignocaine with Dexmedetomidine and Lignocaine with Fentanyl for Biers Block in Upper Extremity Surgeries
Authors:   Assistant Professor, Department of Anesthesia, Raichur Institute of Medical Sciences, Raichur, Karnataka 584102, India., Raghavendra P G , M H Chandana ,   Assistant Professor, Department of Anesthesia, Vijaynagar Institute of Medical Sciences, Ballari, Karnataka 583104, India.
Published: January 2024

Background: Dexmedetomidine and Fentanyl have been used effectively along with local anaesthetics to shorten the onset, prolong the duration of the block, and to increase postoperative analgesia. We compared fentanyl and dexmedetomidine as adjuvants to lignocaine for Biers Block for upper extremity surgeries. Materials and Methods: After Institutional approval and informed consent, 90 ASA 1 and 2 volunteers were taken into the study. 30 patients were randomly allocated each in Group A to receive Biers block for upper extremity with 3 mg/kg of 0.5% lignocaine; in Group B, with 3 mg/kg of 0.5 % lignocaine with 0.5 mcg/kg dexmedetomidine and Group C received Biers block of upper extremity with 3 mg/kg of 0.5% lignocaine with 1mcg/kg Fentanyl. The onset of sensory, complete motor block and tourniquet pain were observed and any symptoms after cuff deflation were recorded. Usual haemodynamic monitoring used. Statistical Analysis: ANOVA (Analysis of Variance) and Chi-square tests were used for data analyses; p value of <0.05 considered significant. Results: Groups A, B and C were comparable in demographic and surgical parameters. The speed of onset of sensory and motor block was higher in Group C (Fentanyl) (p <0.0001). The tourniquet pain occurred significantly later in Group B (Dexmedetomidine) (p<0.0001). There were few incidences of bradycardia in Group B. Conclusion: In conclusion, present study suggested that dexmedetomidine and fentanyl will enhance the quality of anaesthesia, providing a shorter onset time of sensory and motor block, delayed first analgesia requirement. Keywords: Biers block; Local Anesthetic: Lignocaine Hydrochloride; a-2 Agonist: Dexmedetomidine; Fentanyl.
Comparison of Nerve Stimulator Guided and Ultrasound Guided Interscalene Brachial Plexus Block in Shoulder Surgery
Authors:   Professor and Head, Department of Anesthesiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra 442102, India., Tidke Sucheta , Choudhary Divya ,   Post graduate student, Department of Anesthesiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra 442102, India., Tidke Sunil ,   Professor and Head, Department of Anatomy, Government Medical College, Shahdol, Madhya Pradesh 484001, India., Bhandari Dhiraj ,   Professor, Department of Anesthesiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra 442102, India., P Benhur ,   Professor, Department of Anesthesiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra 442102, India., Jain Sudha ,   Professor, Department of Anesthesiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra 442102, India.
Published: January 2024

Introduction: This study was conducted to compare the two techniques, Nerve stimulator guided and Ultrasound guidance for Interscalene brachial plexus block in shoulder and upper arm surgeries. Methods: Total 80 patients were included in our study which were randomly allotted by sealed envelope technique two groups namely US-guided (Group US) or NS-guided (group NS). The drug mixture of 0.375% bupivacaine and 0.5% lignocaine with 1:200000 adrenaline was used. Results: Comparison between the Nerve Stimulator (NS) and Ultrasound guided (US) technique of interscalene brachial plexus block revealed that the number of pricks(1-77.5%, 2-20%, 3-2.5% in US group and 1-52.5%, 2-35%, 3-12.5% in NS group), block execution time (5.32(0.50) min in US and 7.10 (0.62) min in NS group), time of onset of sensory and motor block was significantly less in US group ascompare to NS groups. The recovery from sensory (11.9 (1.19) hrs in US and 8.74(0.71) hrs in NS, p=0.0001) and motor block (6.76(0.63) hrs in US and 5.35 (0.48) hrs in NS group, p=0.001) also was significantly longer US group than in NS group. VAS scores were significantly lower in group US group than in NS group in post operative periods. The incidence blockade failure requiring general anesthesia was not significant. Block was successful in 95% of cases in US group and 85% of cases in NS group. Conclusion: Effective quality of the block, execution time, onset of sensory and motor block, recovery from sensory and motor block and VAS scores were more satisfactory with ultrasound technique than the nerve stimulator technique. Keywords: Interscalene block; Nerve stimulator; USG guidance.
Evaluation of Efficacy of Bolus Ringer's Acetate in Preventing Hypotension Following Lower Limb Tourniquet Release
Authors:   Junior Resident, Department of Anesthesiology, Bharatividyapeeth Medical College Pune, Maharashtra 411030, India., Teja Reddy Divya , Aphale Shubhada ,   Professor, Department of Anesthesiology, Bharatividyapeeth Medical College Pune, Maharashtra 411030, India.
Published: January 2024

Background: Haemodynamic instability is a common entity following tourniquet release exacerbated by old age and comorbidities. Aim: To evaluate efficacy of bolus Ringer’s acetate in preventing hypotension following tourniquet release. Methods: After ethical committee’s approval, a comparative study was conducted in tertiary care hospital. Study was conducted on 80 consenting patients, control (n=40) and study (n=40) group between 20-80 years of age belonging to American Society of Anaesthesiologist (ASA)Grade I-II undergoing lower limb surgeries. Patients were divided into two equal groups, Group C patients did not receive bolus of Ringer’s acetate and Group S were given additional bolus of 200 ml of Ringer’s acetate prior to tourniquet release. Haemodynamic variables (heart rate (HR), Systolic, Diastolic and Mean arterial pressures, Electrocardiogram (ECG)) were monitored before and after release of tourniquet at frequent intervals. Hypotensive episodes (Fall in systolic blood pressure (SBP) >20% from baseline) and vasopressor requirement (If SBP <80mmHg then Inj. Ephedrine IV 5 mg) were noted. Results: Statistical analysis was done using Chi-Square test and independent sample t test. Intergroup comparison of haemodynamic variables before and after release of tourniquet is comparable and is not statistically significant. Intragroup comparison of haemodynamic variables in Group C was lower when compared to Group S after release of tourniquet and this finding is statistically significant. The incidence of hypotension and vasopressor requirement was significantly higher in Group C compared to Group S (Pvalue<0.029). Conclusion: Preloading with Ringer’s acetate prior to tourniquet release in Group S may possibly be responsible for reduction in incidence of hypotension and vasopressor requirement. Keywords: Ringer’s acetate; Hypotension; Tourniquet.
Role of Acromioaxillosuprasternal Notch Index (AASI) as a New Predictor of Difficult Visualization of Larynx in Comparison with Modified Mallampati Test
Authors:   Assistant Professor, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka 560002, India., K P Madhu , Rajur Sneha ,   Senior Resident, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka 560002, India., . Yathish ,   Senior Resident, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka 560002, India.
Published: January 2024

Background: Pre-operative airway assessment should be able to predict potential difficult airway, allowing management plan to be developed ahead of time. Hence this study was aimed to compare Acromio-AxilloSuprasternal Notch Index (AASI), a new simple bedside test with Modified Mallampati Test (MMP) in predicting difficult visualization of larynx. Materials and Methods: After ethical committee clearance and informed written consent, 320 patients of ASA I and II posted for elective surgery under general anaesthesia were included in this study. AASI and MMP were noted during preanaesthetic airway assessment. After induction of anaesthesia, a blinded and experienced anaesthetist did laryngoscopy, intubated the patient and noted Cormack-Lehane(CL) grading of laryngeal view. The data observed was analysed using Receiver operating characteristic curve(ROC) analysis to compare AASI and MMP. A P value less than 0.05 was considered statistically significant. Results: Incidence of Difficult Visualization of Larynx(DVL) in our study was 8.4%. AASI had better Sensitivity(88.89% v/s 22.22%), Specificity(98.63% v/s 95.22%),Positive predictive value (85.71% v/s 26.32%), Negative predictive value (98.97% v/s 93%) and Diagnostic accuracy(97.81% v/s 89.03%) in comparison with MMP respectively (P <0.001) when cut off reference value of 0.56 AASI was taken. Conclusion: AASI is a better predictor of difficult laryngoscopy with a higher sensitivity and positive predictive value in comparison with MMP. Hence AASI can be used as a simple bedside test to predict difficult airway during pre-anaesthetic airway assessment. Keywords: Acromioaxillosuprasternal notch index (AASI); Modified Mallampati test (MMP); Cormack-Lehane (CL) grade; Difficult visualization of larynx (DVL); Airway assessment.
Dilated Cardiomyopathy: Effect of Trendelenberg Position on Intraoperative Hemodynamics: Case Reports
Authors:   Consultant Anesthetist, Department of Anesthesia, Meditrina Hospital, Kollam, Kerala 691021, India, Arvind Dineep
Published: January 2024

Preoperative cardiomyopathy is a significant anaesthetic challenge. We present the anaesthetic managementof two cases of dilated cardiomyopathy both with global LV hypokinesia and EF <35% Intervention. A low trendelenberg position (10º) was used in both cases which might have helped in maintaining preload and hence hemodynamic stability. Minimum fluid was administered in the intraoperative phase in both cases. Conclusion: Maintaining a low trendelenberg position during anaesthesia with careful monitoring may be beneficial for hemodynamic stability in dilated cardiomyopathy patients
Incidence of Neurological, Ophthalmic and Otological Symptoms in Laparoscopic Surgery in Post Operative Period: An Observational Study
Authors:   Resident Doctor, Department of Anesthesiology, Bharati Vidyapeeth Medical College, Pune 411043, Maharashtra, India., Shivnani Sneha , Bobde Sarojini ,   Professor, Department of Anesthesiology, Bharati Vidyapeeth Medical College, Pune 411043, Maharashtra, India., Swami Sarita ,   Professor, Department of Anesthesiology, Bharati Vidyapeeth Medical College, Pune 411043, Maharashtra, India., Vashishtha Vasu ,   Attending Consultant, Department of Minimal Invasive and Bariatric Surgery, Artemis Hospital, Gurugram, Haryana 122001, India.
Published: January 2024

Context: Laparoscopic surgery technique creates certain changes in various systems presenting as post-operative side effects and symptoms. Aims: To observe incidence of post-operative neurological, ophthalmic and otological symptoms in patients undergoing laparoscopic surgery. Setting and Design: Institutional setting, retrospective observational study Material and methods: After ethical committee clearance, 100 patients undergoing laparoscopic surgery, meeting inclusion criteria were included in the study. Patients were monitored intraoperatively for haemodynamic changes;EtCO2, Ppeak. After extubation in post-operative period, patientswere monitored for signs and symptoms in PACU, after 4 hours and 2nd post-operative day and system specific symptoms noted. Statistical analysis used: Data collection done using SPSS 21.0. Analysis of collected data done using independent t test, paired t test, chi-square test and Fischer’s test. Results: Out of 100 patients,36 patients showed symptoms. 8 patients had BMI >35kg/m2, 7 out of them had neurological (p value=0.14) and all 3 neurological, ophthalmic and otological symptoms. Trendelenburg combined with lithotomy position was used in 7 patients, 6 patients showed symptoms, 5 of them showed neurological symptoms (p value=0.006) and 3 showed ophthalmic symptoms (p value=0.002). Total colorectal surgeries done were 5, out of which 4 showed symptoms. Total gynaecological surgeries done were 10, out of which 7 showed symptoms, neurological=6 and ophthalmic=3. Mean duration of insufflation in neurological symptoms- 4.06hrs (p-value 0.007), for ophthalmicsymptoms-4hrs (p-value 0.334) and otological symptoms-8hrs (p-value 0.002). Certain parameters like EtCO2, Peak airway pressures, increased during insufflation and continued to remain high even after desufflation (P value=0.0001). Age of the patients, Intra-abdominal pressure (IAP) and comorbidities did not show significant impact on incidence of symptoms. Conclusion: Trendelenburg with lithotomy position, higher BMI, longer duration of insufflation can be major factors contributing to neurological and ophthalmic symptoms in laparoscopic surgeries.
A Comparative Study between IV Clonidine 1.5Mcg/Kg and IV Lignocaine 1.5 Mg/Kg as Premedication for Attenuation of Hemodynamic Responses to Pneumoperitoneum in Laparoscopic Surgeries
Authors:   Assistant Professor, DNB Anaesthesiology, SVS Medical College, Mahabubnagar, Telangana 509001., JS Soumya , Joshi Sapana ,   Assistant Professor, MD Anaesthesiology,  Gadag Institute of Medical sciences, Gadag, Karnataka 582103, India., Rajpurohit Shravan ,   MS General Surgery, Gadag Institute of Medical sciences, Gadag, Karnataka 582103, India.
Published: January 2024

Laparoscopy, has emerged as the main stay for most of the commonly performed surgeries. Pneumoperitoneum and different positions of the patient during laparoscopy contribute to adverse cardiovascular effects like elevated arterial pressure, increased systemic and pulmonary vascular resistance and reduced cardiac output. This randomised controlled double blind prospective study was conducted to compare the efficacy of intravenous(I.V) Lidocaine and I.V. Clonidine in providing hemodynamic stability in patients undergoing laparoscopic surgeries. Methods: Seventy five adult patients of ASA grade 1 and 2, scheduled for elective laparoscopic surgery with a mean duration of 30- 90 minutes, were randomly allocated to one of the three groups. Group A: Clonidine group (n=25) - received injection Clonidine 1.5 mcg/kg 15 minutes prior to induction of anaesthesia. Group B: Lidocaine group (n=25) - injection Lidocaine 1.5 mg/kg 90 seconds prior to induction of anaesthesia. Group C: Control group (n=25) - received 10 ml normal saline intravenously. Results: There is no statistically significant difference between lidocaine and control group regarding mean HR, SBP, DBP, MAP during the entire period of pneumoperitoneum. Whereas, there is significant increase of blood pressures (SBP, DBP, MAP) in the lidocaine and control groups compared to the clonidine group from intubation, throughout the period of pneumoperitoneum. Clonidine also decreases the requirement of propofol for induction. Conclusion: I.V Clonidine 1.5mcg/kg premedication is more effective than Lidocaine 1.5mg/kg at preventing changes in hemodynamic parameters induced by carbondioxide pneumoperitoneum. Keywords: Pneumoperitoneum, I.V Clonidine, I.V Lignocaine, Hemodynamic parameters.
Continuous Spinal Anaesthesia in a Leprosy Patient with Femur Fracture
Authors:   Post graduate student, Department of Anaesthesiology, K Chandramohan ,   Sri Devaraj Urs Medical College, RL Jalappa Hospital, SDUAHER, Tamaka, Kolar, Karnataka 563101, India., Madhusudhana Ravi ,   Professor& HOD, Department of Anaesthesiology; Sri Devaraj Urs Medical College, RL Jalappa Hospital, SDUAHER, Tamaka, Kolar, Karnataka 563101, India.
Published: January 2024

Introduction: Leprosy is a chronic infectious disease caused by Mycobacterium leprae and affects the skin and nerves. Leprosy patients in which peripheral neuropathy and the involvement of other organs may have dysautonomia in the heart and respiratory system and autonomic involvement. Case Report: A 65 year-old patient was posted for fixing of right intertrochanteric with left subtrochanteric fracture femur. The possibility of a difficult airway was considered because of the mouth and nose deformities. Difficult airway equipment, such as a fibre-optic bronchoscopy and laryngeal mask (LMA) were made available. The patient’s vitals were normal. The haemogram and biochemistry measurements were normal. Under aseptic conditions in the sitting position at the L3–4 level, the subarachnoid space was identified with a 18-G Tuohy needle, the catheter was threaded into subarachnoid space and fixed at 10cm.1.2 mL(6mg) of 0.5% hyperbaric bupivacaine (6mg) administered. After 1hour from the starting of procedure, again 1.2 ml(6mg) of 0.5% hyperbaric bupivacaine administered through the catheter. Level achieved till T10. BP was 72/42mmHg, treated with 12mg Mephentermine. Inj.Fentanyl 50mcg given through the catheter and the catheter was removed. Conclusion: Appropriate assessment before anaesthesia and preparation are important in the management of anaesthesia of patients with leprosy. Regional anaesthesia can be used as an alternative for patients without autonomic neuropathy and with a suspicion of systemic involvement and with difficult intubation Keywords: Continuous spinal anaesthesia; Leprosy; Regional anaesthesia.
Post-Operative Analgesia with Preventive and Post-Operative Rectal Diclofenac in Patients undergoing Caesarean Section Under Spinal Anesthesia: A Comparative Study
Authors:   Junior Resident, Department of Anesthesiology, MOSC Medical College, Kolenchery, Kerala 682311, India., Benny Augustine , Thomas Shwetha Susan ,   Junior Resident, Department of Anesthesiology, MOSC Medical College, Kolenchery, Kerala 682311, India., George Manjit ,   Consultant Anesthetist, North Cumbria Integrated Care NHS Trust, UK.
Published: January 2024

Background and aims: To study the analgesic efficacy of preventive rectal Diclofenac in comparison to post-operative rectal Diclofenac in elective caesarean section surgeries. Methodology: After obtaining approval from institution ethics committee, patients undergoing elective caesarean section under spinal anesthesia were included in the study and divided into two groups ED(Early Diclofenac) & LD(Late Diclofenac), differing in the time of administration of first dose of 100mg rectal Diclofenac. Pain scores were noted at 12 & 24 hours post administration of first dose of rectal Diclofenac, using the numerical rating score. Rescue analgesia was given in form of Tramadol infusion. Time to first rescue analgesia, postoperative pain scores at 12& 24 hours, cumulative opioid requirements and side effects if any were noted. Results: We observed a statistically significant difference in the time to first rescue analgesia between the two groups. There was no statistically significant difference in the average pain scores, cumulative opioid requirements and side effects between the two groups. Conclusion: Rectal Diclofenac is an effective modality for treatment of postoperative pain after caesarean section. Preventive rectal Diclofenac, in comparison to postoperative Diclofenac significantly prolongs the duration to first rescue analgesia. The two groups did not differ significantly in the cumulative opioid consumption at 24 hours. There was no statistically significant difference in pain scores at 12 and 24 hours between the two groups. The average pain scores in both groups were around 3/10.
Comparative Study of Recovery and Cognitive Dysfunction Following Desflurane versus Sevoflurane in General Anesthesia in Elderly Patient Undergoing Major Surgery
Authors:   Senior resident, BJ Medical College and Civil Hospital, Ahmedabad, Gujrat 380016, India., Swaminarayan Mansi N , Gupta Sahil D ,   Second year Resident, BJ Medical College and Civil Hospital, Ahmedabad, Gujrat 380016, India., Patel Nirali M ,   Senior resident, BJ Medical College and Civil Hospital, Ahmedabad, Gujrat 380016, India.
Published: January 2024

Geriatric patients (age 65 years and above) are more prone to POCD who undergo general anesthesia. Also the geriatric patients with co morbidities and substance abuse have higher chances for POCD. Objective: To compare Post-operative cognitive status and recovery (time specific) in geriatric patients undergoing general anesthesia with sevoflurane or desflurane, by MMSE score. Also to compare other side effects and recovery. Materials and Methods: This is prospective, randomized, interventional, single blind study. A study of 70 patients of either sex, ASA-I/II/III in the age group of above 65 years who were operated under general anesthesia and randomly allocated in two equal groups. Group S consisted of 35 patients who were given sevoflurane. Group D consisted of 35 patients who were given desflurane. MMSE score was taken pre-operatively and patients with score more than 27 were selected for this study. Results: Statistically significant immediate recovery from general anesthesia was noted in group D compared to group S. But difference in post-operative MMSE score at 1 hour, 3 hours and 6 hours between group S and group D was statistically insignificant. Conclusion: Patients given General Anesthesia with Desflurane showed early recovery signs, i.e. eye opening, following of verbal commands and extubation compared to patients given sevoflurane which is statistically proven. But MMSE score was lesser in desflurane than sevoflurane, which was insignificant.
Effect of Intravenous Dexamethasone on Prolongation of Analgesia Following Supraclavicular Brachial Plexus Block
Authors:   Senior resident, Department of Orthopedics, Lady Hardinge Medical college, Delhi 110001, India., ... Manisha , Sinha Abhinav ,   Associate Professor, Department of Orthopedics, Lady Hardinge Medical college, Delhi 110001, India.
Published: January 2024

Objective: Intravenous dexamethasone prolongs the duration of analgesia and motor block provided by brachial plexus block with plain 0.5% bupivacaine. Material and Methods: After obtaining Ethical Committee’s approval, informed consent was taken from the patients involved in the study. The 60 patients included in the study were divided randomly into two groups with 30 patients in each. In group P, ultrasound guided supraclavicular brachial plexus block was given with 30 ml of plain 0.5% bupivacaine without any additive followed by 2 ml of normal saline intravenously. In group D, ultrasound guided supraclavicular brachial plexus block was given with 30 ml plain 0.5% bupivacaine followed by 8 milligrams (2 ml) dexamethasone intravenously, injected after giving the block. Following this, duration of analgesia and duration of motor block was calculated for both the groups. Results: The mean duration of analgesia in group P (plain bupivacaine 0.5% in block with 2 ml normal saline iv) was 365±20 minutes (approx 6 hours) while the mean duration of analgesia in group D (plain bupivacaine 0.5% in block with 8 mg dexamethasone iv) was 902±30 minutes (approx 15 hours). The duration of motor block noted in group P was 253±32 minutes (approximately 4 hours) and that in group D was 572±36 minutes (approximately 9.5 hours). Both these results were highly significant. (p<0.001). Conclusion: Intravenous (IV) administration of dexamethasone along with supraclavicular brachial plexus block with 0.5% bupivacaine significantly prolongs analgesia as well as motor block provided by the block. As dexamethsone is still not approved for perineural use by the various drug regulatory authorities around the world including FDA and long term effects of perineural dexamethasone are still under study, IV administration of dexamethasone should be preferred over perineural use in contemporary practice of anaesthesia.><0.001) Conclusion: Intravenous (IV) administration of dexamethasone along with supraclavicular brachial plexus block with 0.5% bupivacaine significantly prolongs analgesia as well as motor block provided by the block. As dexamethsone is still not approved for perineural use by the various drug regulatory authorities around the world including FDA and long term effects of perineural dexamethasone are still under study, IV administration of dexamethasone should be preferred over perineural use in contemporary practice of anaesthesia.
Role of Low Level Laser Therapy (LLLT) in Pressure Sore Management
Authors:   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India-605006., H.K. Sudhanva , R.K. Chittoria ,   Professor and Head, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India-605006., B. Preethitha ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India-605006., K. Senthil ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India-605006., S. Elan ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India-605006., K. Sireesha ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India-605006., C. Vinayak ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India-605006.
Published: January 2024

There are situations when patients are unfit for anesthesia or unwilling for surgery when plastic surgeon has to make the wound heal by secondary intention.In such situations adjunct therapies like Low Level Laser (LLL) helps in promoting wound healing. LLL are lasers with a wave-length between 600 and 1000 nanometers and power from 5 to 500 Mw. The bio-stimulatory properties of LLL has been found to accelerate wound healing, tissue repair and regeneration. This study highlights the application of LLL in a 40-year-old male with multiple pressure sores unfit foranesthesia.
Application of Radio Frequency in the Management of Neurofibroma
Authors:   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India., K.R. Sireesha , R.K. Chittoria ,   Professor & Registrar (Academic), Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India., B. Preethitha ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India., S. Elankumar ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India., C. Vinayak ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India., M.S. Kumaran ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India., H.K. Sudhanva ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India., A. Aggarwal ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India., G. Saurabh ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India.
Published: January 2024

The usual practice of making skin incisions by a scalpel leads to more bleeding and time spent on achieving hemostasis. An alternative to this is to use electromagnetic radiation of high frequency in the form of radiofrequency to make skin inciosns that are more precise, accurate, associated with less bleeding and in turn less time consuming giving more defined result. Neurofibromatosis type 1 is associated with multiple swellings all over the body with surgical management required for aesthetic reasons or for symptomatic swellings.
Study of Obsessive Compulsive Disorder in Adult Females of Maharashtra population
Authors:   Associate Professor, Department of Psychiatry, Shri Bhausaheb Hire Government Medical College and Hospital, Dhule, Maharashtra 424001, India., Pawar Jeevan Atmaram
Published: January 2024

Out of 450 adults females having the symptoms of OCD 38 (8.4%) were diagnosed as OCD. Among these 9 (23%) had obsession 11 (28%) had compulsion and 18 (47%) patient had mixed OCD clinical presentation. The family history of OCD Patients was 14 (36%) were disturbed family, 8 (21%) were divorcee, 13 (34%) were unmarried, 3 (7.8%) were widow. In the obsession study, aggressive patients were 2 (16.6%), sexual obsession were 3 (25%), religious obsession were 2 (16.6%), hoarding obsession were 2 (16.6%), contamination obsession were 2 (16.6%), somatic obsession were 1 (8.3%). Patients presenting with compulsive symptoms are as 3 (21.4%) had repeated washing, 2 (14.2) had repeated checking, 2 (14.2%) had repeated counting, 4 (28.5%) had repeated cleaning, 2 (14.2%) had arranging compulsion, 1 (7.1%) had hoarding or collecting compulsion. Comorbid disorders with OCD were 9 (23.6%) major depressive disorder, 3 (7.8%) had eating disorder, 4 (10.5%) had phobia, 5(13.1%) had impulsive control disorder, 4 (10.5%) had panic disorder, 4 (10.5%) had generalized anxiety disorder, 2 (5.2%) had substance use disorder, 3 (7.8%) had schizophrenia, 4 (10.5%) had undiagnosed disorder with OCD. This study will be quite useful to psychiatrist to differentiate the various clinical symptoms of obsessive compulsive and mixed symptoms. Moreover comorbid disorders of OCD with non-genetic disorders of OCD have satisfactory improvement with newer drugs, of anti depressant.
Pattern of Thyroid Dysfunction in HIV Patients
Authors:   Registrar, Dept. of Medicine, Government Medical College, Bakshi Nagar, Jammu, Jammu and Kashmir 180001, India., Kotwal Shalini , Singh J.B. ,   Assistant Professor, Dept. of Medicine, Government Medical College, Bakshi Nagar, Jammu, Jammu and Kashmir 180001, India., Singh Bhanu Pratap ,   Registrar, Dept. of Medicine, Government Medical College, Bakshi Nagar, Jammu, Jammu and Kashmir 180001, India., Kotwal Suman Kumar ,   Assistant Professor, Dept. of Medicine, Government Medical College, Bakshi Nagar, Jammu, Jammu and Kashmir 180001, India.
Published: January 2024

Introduction: Abnormalities of the endocrine glands functions are not uncommon in patients infected with HIV. Many studies have shown high prevalence of thyroid dysfunction in HIV patients. We have undertaken this study to know pattern of thyroid dysfunction in patients registered to our ART centre. Materials and methods: 100 HIV patients registered in ARTcentre of government medical college Jammu were enrolled for study. Besides baseline investigation FT3, FT4, TSH levels and CD4 counts were assessed in all patients. Results: 64% were women and 36% were men and mean age of our study group patients was 37.19±8.79. Out of 100 seropositive HIV patients, 69% were on antiretroviral therapy. Sick euthyroid syndrome was observed in 13% patients, subclinical hypothyroidism in 9% and 78% were euthyroid. Point prevalence of thyroid dysfunction in HIV infected patients was observed to be 22%. Conclusion: Thyroid dysfunction is very common in patients infected with HIV and should be assessed in all patients, as thyroid hormones play important role not only in metabolism but also in uence immune system.
Thyrotoxicosis Precipitating Diabetic Ketoacidosis: A case report
Authors:   Assistant professor, Dept. of Medicine, Government Medical College, Bakshi Nagar, Jammu, Jammu and Kashmir 180001, India., Kotwal Suman Kumar , Verma Som Nath ,   Seniore resident, Dept. of Medicine, Government Medical College, Bakshi Nagar, Jammu, Jammu and Kashmir 180001, India., Mahajan Annil ,   Professor, Dept. of Medicine, Government Medical College, Bakshi Nagar, Jammu, Jammu and Kashmir 180001, India.
Published: January 2024

Background: Diabetic ketoacidosis (DKA) is acute complication of diabetes mellitus. It is commonly seen in type 1 diabetes mellitus and rarely also seen in type 2 diabetes mellitus. In more than fifty percent of cases precipitating factor is usually unrecognized. Case report: A 35 years women with type 1 diabetes mellitus presented with (DKA), with no apparent precipitating factor. Following initial correction of the DKA, persisting tachycardia, thyromegaly and thyroid functions confirmed diagnosis of thyrotoxicosis. Treatment with propranolol and carbimazole helped in the normalization of metabolic states. We hereby report a case of DKA precipitated by thyrotoxicosis. Conclusion: Thyrotoxicosis is known to destabilize diabetes control, it should be considered as one of the precipitating factor for diabetic ketoacidosis.
Estimation of Stature among Tribal Males from the Measurements of Digit Length in Udaipur District of Rajasthan
Authors:   Associate Professor, Department of Anatomy, Geetanjali Medical College, Udaipur, Rajasthan Rajasthan 313001, India., Taneja Charu
Published: January 2024

Background: Estimation of stature has a very significant role to play in forensic anthropometry for personal identification. Present study is undertaken to derive regression equations for estimation of stature from digit length. Material and methods: Present study was carried out on 481 males subjects among the tribal population of Udaipur district. The stature and digit length were calculated and the data was analyzed statistically and the regression equations were derived. Result: The correlation between height and digit length in Tribals of Udaipur was found correlation coefficient (r) as 0.0519 for right digit and for left digit it was 0.0473 and for combined digit length 'r' was 0.0496 in males. Conclusion: The present study revealed that the Digit length in males was highly significant of right and left sides (p < 0.05). There was a high correlation between right & left side digit length of males (0.999). There was a very low correlation between digit length of males of right (0.051) and left (0.047) sides with the stature.
A Study of Seroprevalence of Rubella Among School Girls and AnteNatal Women
Authors:   Senior Advisor, Dept. of Preventive and Social Medicine, Command Hospital, Udhampur, Jammu and Kashmir 182101, India., Adhya Saibal , Tyagi Arun ,   Professor & Head, Dept. of Medicine, PDVVPF’s Medical College, Ahmednagar, Maharashtra 414111, India., V Pavithra ,   Classi ed Specialist, Dept. of Pediatrics, Military Hospital, Agra, Uttar Pradesh 282001, India., Ranjan Praveer ,   Senior Advisor, Dept. of Pathology, Command Hospital, Pune, Maharashtra 411040, India.
Published: January 2024

Background: Rubella is the leading vaccinepreventable cause of birth defects. Rubella infection in pregnant women may cause fatal death or congenital defects known as congenital rubella syndrome. Still, Rubella vaccination is not part of the universal immunization program in the country. Aim: To study the seroprevalence of rubella in adolescent school girls and ante-natal women. Methods: A multi-centric study to determine the seroprevalence of rubella among children and families was carried out in Delhi and Pune so as to arrive at a decision to find out the magnitude of the problem. Six hundred antenatal mothers attending service hospital OPD and six hundred school students of classes VI to XII were evaluated for presence of rubella IgG and IgM. In addition, certain socioeconomic parameters were also studied. Result: It was found that 29% girls in Pune and 24% in Delhi were susceptible to Rubella. The agestratified seroprevalence shows susceptibility to rubella decreased as the age increased among the girls of Pune. Approximately 10% of the screened ante-women were susceptible to Rubella in both cities. Conclusion: Ten percent of the mothers were susceptible to rubella infection during pregnancy and are thus at a risk of giving birth to babies with Congenital Rubella Syndrome. The adolescent girls though had a higher prevalence of seronegativity. World Health Organisation (WHO) has long ago recommended universal immunisation against Rubella. It is logical that rubella vaccine should be introduced in the immunization schedule for school going girls.
A Study On Microalbuminuria in Non-Diabetics and Normotensive Patients of Ischemic Heart Disease (IHD)
Authors:   Assistant professor, Department of Medicine, SMBT Institute of Medical Sciences and Research Centre, Dhamangoan, Nashik, Maharashtra 422403, India., Gondake Sachin Mahadu , Chitale Manoj Sharadrao ,   Professor, Department of Medicine, SMBT Institute of Medical Sciences and Research Centre, Dhamangoan, Nashik, Maharashtra 422403, India.
Published: January 2024

Background: Ischemic heart disease (IHD) account for large proportion of deaths and disabilities worldwide. Microalbuminuria is a known indicator of atherosclerosis and its association with ischemic heart disease (IHD) has been extensively studied. But the significance of urine microalbumin in non-diabetics, non-hypertensive ischemic heart disease, however, is yet to be elucidated. Materials and Methods: In present study 100 patients of ischemic heart disease (IHD) with no history of diabetes mellitus and hypertension were studied to ascertain the role of microalbuminuria as a marker of ischemic heart disease. Results: Out of all patients 85% were males and 15% females. In present study microalbuminuria (20–200 mg/L) was found in 69% of patients. Conclusion: In present study high microalbuminuria was observed in non-diabetic non-hypertensive ischemic heart disease patients.
Comprehensive Study of Clubfoot in Children of North Chotanagpur Division of Jharkhand
Authors:   Assistant Professor, Department of Anatomy, Hazaribagh Medical College, Hazaribagh, Jharkhand 825301, India., Rani Sudha , Gupta Govind Kumar ,   Associate Professor, Department of Orthopaedics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand 834009, India., Prasad Makardhwaj ,   Professor, Department of Anatomy,Patliputra Medical College and Hospital, Dhanbad, Jharkhand 826005, India., Dwivedi Pannag Bhushan ,   Professor, Department Orthopaedics, Patliputra Medical College and Hospital, Dhanbad, Jharkhand 826005, India.
Published: January 2024

Background: Congenital musculoskeletal deformities of the foot are relatively common in newborns. About 80% or more of clubfoot comeout as result of isolated birth defects and are considered idiopathic. The aim of this study is to find out the status of such problem in North Chotanagpur Division of Jharkhand. Materials and Methods: The present study was conducted in the Patliputra Medical College & Hospital, Dhanbad, Jharkhand. Total 250 newborns and old baby were examined during this short period. Results: The total number of cases with clubfoot were 50 with an incidence of 1.9/1000 births. Occurrence of clubfoot was more common in male neonates than in female neonates (Male: Female ratio, 1:0.85), unilateral CTEV (58%) was more common than bilateral CTEV (42%). Idiopathic cases were more common than secondary cases. Conclusion: Significant numbers of cases were found in males, unilateral CTEV was more common.
Histomorphological Spectrum of Ovarian Lesions at a Rural Care Hospital in Gurugram
Authors:   P.G. resident, Department of Pathology, Faculty of Medicine and Health Science, SGT University, Gurugram, Haryana 122505, India., Kaul Neelaksh , ... Sweta ,   Associate professor, Department of Pathology, Faculty of Medicine and Health Science, SGT University, Gurugram, Haryana 122505, India., Sharma Uma ,   Professor and HOD, Department of Pathology, Faculty of Medicine and Health Science, SGT University, Gurugram, Haryana 122505, India.
Published: January 2024

Background: The ovaries are paired intrapelvic organs of female reproductive system. It is unique in the variety of lesions that can arise from ovary as it is complex in its embryology, histology and steroidogenesis. The ovary consists of totipotent sex cord cells and multipotent mesenchymal cells. They are common site of non-neoplastic and neoplastic lesions. Some non-neoplastic lesions of the ovary usually present as a pelvic mass and mimic an ovarian neoplasm and thus posses a great challenge to gynecological oncologist and pathologist. Therefore their proper recognition and classification is important for appropriate therapy. Material and Methods: A prospective clinicopathological study of 58 cases of non-neoplastic and neoplastic lesions of ovary was conducted in Department of Pathology, FMHS, SGT University, Gurugram over the period of one years from June 2018 to June 2019. The materials for this study were oopherectomy specimen, ovarian cystectomies as well as hysterectomy with unilateral/bilateral salphingoopherectomy received from department of Obstetrics and Gynecology. The non-neoplastic and neoplastic lesions from representative sections were studied and classified according to World Health Organisation (WHO) and correlation of histopathological patterns with age, bilaterality, morphology and grading of the tumour was done. Results: A total of 58 cases were studied out of which 31 (53.45%) cases were non-neoplastic and 27 (46.55%) cases were neoplastic. Among the 31 nonneoplastic cases, the most common lesion found was simple cyst with 13 (41.94%) cases followed by corpus luteal cyst with 6 (19.35%) cases. Among the 27 neoplastic ovarian lesions, 17 (62.96%) cases were benign tumour, 2 (7.4%) cases were borderline tumour and 8 (29.64%) cases were malignant tumour. These tumours were classified according to WHO classification and categorised in three main groups. Surface epithelial tumours constituted the majority with 17 (62.98%) cases, followed by germ cell tumours which constituted 8 (29.62%) cases and sex cord stromal tumours constituted 2 (7.4%) cases. Conclusion: Ovarian cancers are called as “silent killer” as in most of the primary ovarian tumour they remain asymptomatic until the advanced stage. However, histomorphological study of tumour is still the gold standard method, these observations and results proved to be valuable base line information regarding frequency and pattern of ovarian tumours.
Retrospective Analysis of Pattern of Poisoning in Tertiary Care Hospital, Hapur; NCR Region
Authors:   Assistant Professor, Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences New Delhi., Kumar Mahesh , Kumar Mansi ,   Assistant Professor, Department of Obstetrics & Gynaecology, Rama Medical College Hapur (Ghaziabad) UP., Kumar Adarsh ,   Professor & Head, Department of Forensic Medicine and Toxicology, University College of Medical Sciences, Delhi., Kumar Adarsh ,   Professor, Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences New Delhi., Kumar Gupta Sudhir ,   Professor & Head, Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences New Delhi.
Published: January 2024

A retrospective study of 140 cases of poisoning received in the casualty of Rama Medical College Hospital and Research Center Hapur (Ghaziabad) Uttar Pradesh during a span of last 3 years (2014-2016) was done to know the socio-economic profile and pattern of acute poisoning in the region. All admitted and brought dead cases of acute, known and unknown poisoning, from all age were included in the study. Males and females were 62% and 38% respectively. Most common age group was 21-30 years and majority of victims were married. Most of the victims belonged to lower (33.6%) or lower-middle (60.7%) class. Organophosphate (37.1%) was the most common poisoning, followed by Celphos (21.4%) and other unknown poisoning (18.6%) responsible for more than two-third of the cases. Majority of poisoning cases (85.7%) were suggestive of suicide, of which family quarrel (31.7%) and unemployment (22.5%) or loss in business were more common in male and ill treatment by husband/in-laws (27.5%) in female.