bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of low dose hyperbaric bupivacaine with or without fentanyl in perianal surgeries: A prospective randomized double blind trial
Authors: Jangi Krishan Gopal , Kuldeep Arti , Raiger Lalit Kumar , Sharma Swati 
Published: March 2021

Spinal anaesthesia should be ideal for perianal surgeries due to its quick onset, reliable anaesthesia with minimal supplies making it cost-effective technique with rapid turnover time.90 patients of ASA grade I-II scheduled for perianal surgeries divided into three groups of 30 each according to intrathecal dose of local anaesthetic: Group LB (Low dose bupivacaine): 0.6 ml of 0.5% hyperbaric bupivacaine (3mg), Group ULBF (ultralow dose bupivacaine plus fentanyl): 0.4 ml of 0.5% hyperbaric bupivacaine (2 mg) + 0.2 ml of fentanyl (10 µg) and Group ULB (ultra low dose of bupivacaine): 0.4 ml of 0.5% hyperbaric bupivacaine (2 mg) + 0.2 ml of normal saline. Three groups were compared in terms of success of block, time to first rescue analgesic from time of block, total rescue analgesic (tramadol) needed in 8 hours since time of block, visual analogue score (VAS) and patient satisfaction score.Successful saddle block was achieved in all patients in Group ULBF, 27 patients in Group LB and none in Group ULB. Group ULBF showed significantly lower mean VAS score when compared to Group ULB and Group LB, and Group LB when compared to Group ULB. Thus the group using fentanyl intrathecally had significantly lesser pain, so the requirement for the first dose of rescue analgesic was significantly earlier in Group ULB and delayed in Group ULBF. Patient satisfaction score was significantly higher in Group ULBF as compared to Group LB and Group ULB and in Group LB as compared to Group ULB.Use of hyperbaric bupivacaine in dose of 3 mg and 2 mg with fentanyl (10 μg) in saddle block are an effective method of achieving successful surgical anaesthesia in patients undergoing perianal surgeries. Hyperbaric bupivacaine (2mg) with fentanyl (10µg) is better than other in providing postoperative analgesia.
Comparison of ketofol versus propofol for procedural sedation and analgesia in cervical cancer brachytherapy: A prospective, randomized double blind study
Authors: Gupta Monika , Damor Pankaj , Naithani Udita , Verma Ritu , Yadav Ansika 
Published: March 2021

Most common drug used for outpatient procedural sedation and analgesia is propofol, with limitations like systemic hypotension. Combining propofol with ketamine preserves sedation efficacy, minimizing their respective adverse effects. So, we aimed to compare ketofol (ketamine+propofol) versus propofol regarding their total drug consumption, recovery profile, effect on haemodynamic and respiratory parameters in brachytherapy patients. A prospective, randomized, controlled double blind study was carried out in 100 female patients between 20-60 years, 30-70kg, ASA I-III undergoing brachytherapy as outpatient procedure on elective basis, after ethical clearance from institutional committee. These were randomly divided into 2 groups (50 each). Group P-Injpropofol (10mg/ml) 2mg/kg for induction and 20mg as supplementation. Group K-Injketofol (10mg/ml) (ketamine 50mg+propofol 100mg, 1:2) 2mg/kg for induction and 20 mg as supplementation.The supplementation dose required was significantly higher in propofol group (800mg) as compared to ketofol group (20mg) (p=0.00). Also, the fall in SBP and DBP was significantly less in ketofol group than propofol group (p&#60;0.01). The mean awakening time (time from end of procedure to MRSS =3) andmean recovery time (time from end of procedure to achievement of Aldrete score 10) was more in ketofol group than propofol group (p&#60;0.003), the difference was less than 1-2 min, so it was clinically not significant. Ketamine-propofol combination in 1:2 ratio in a single syringe as ketofolis better alternative to propofol in providing sedation and analgesia with better haemodynamic stability, for outpatient brachytherapy procedure in cancer cervix patients.
A clinical study: Inguinal hernia repair under local block
Authors: Parikh Palakben , Kapadia Rupal , Musa Hanna , Mehta Namrata , Kapadiya Lalit 
Published: March 2021

This study was conducted to evaluate advantages of local anaesthesia in high risk patients and to assess patient’s satisfaction, speed of recovery and postoperative analgesia. In our study we gave combined Ilioinguinal and Iliohypogastric nerve block with field block in 30 patients. The patients were monitored for hemodynamic changes and total duration of analgesia and quality of analgesia. In this study 23% patients were of ASA I, 30% ASA II and 46.7% had ASA III grade. All patients were hemodynamically stable throughout procedure and surgery. Average duration of the analgesia was 188 min (about 3 hours). Quality of analgesia was excellent in 66.6% patients, good in 16.6% patients, poor in 6.6% patients and 10%patients had severe intolerable pain and converted to GA. We found that inguinal hernia repair under local anaesthesia was safe, simple, cost-effective and also provides good postoperative analgesia. It is more useful in high risk patients where we need to avoid effects of general, spinal or epidural anaesthesia for hernia surgeries.
Comparison of adjuvant effects of intrathecal magnesium sulfate and dexmedetomidine with hyperbaric bupivacaine
Authors: Poovathai Raja , Sundararaju Sathis C , Kamal Batcha Mohamed Haaris B 
Published: March 2021

Surgeries involving infraumblical regions are commonly done under spinal anaesthesia. No single adjuvant to bupivacaine found to prolong the duration of analgesia and to reduce its limitations. To compare the block characteristics of intrathecal administration of dexmedetomidine and magnesium sulfate as an adjuvant with bupivacaine in infraumblical surgeries. This is a prospective randomized double-blinded study. Around 90 American Society of Anaesthesiologist physical status I and II patients, scheduled for infraumblical surgeries were enrolled in this study. Patients were randomly assigned into Group B (bupivacaine), Group D (bupivacaine plus dexmedetomidine) and Group M (bupivacaine plus magnesium sulfate). In the operating theatre, baseline values were recorded. Onset and duration of sensory and motor block, time of rescue analgesia were noted. The onset of sensory block was rapid in Group D (2.63 ± 0.66 min) and slow in Group M (6.35 ± 0.87 min) when compared to Group B (2.93 ± 0.785 min) with a statistically significant difference. Motor duration (min) was prolonged in Group D (423.00 ± 12.360) and early in the Group M (165 ± 31.55) when compared to Group B (219.23 ± 14.875). For the surgery, which requires prompt onset and long duration of analgesia,dexmedetomidine can be used as an adjuvant. However, surgical procedures that permit delayed onset block and shorter duration of analgesia,magnesium sulfate can be preferred.
Evaluation of performance of Ambu® AuraGainTM and Laryngeal Mask Airway® SupremeTM in adult patients for elective surgeries under general anaesthesia: A randomized prospective comparative study
Authors: Kumar M R Anil , B S Smruthy , S Hemalatha , C L Gurudatt 
Published: March 2021

Second generation supraglottic airway devices (SAD) are gaining importance due to their better seal pressure. Recently introduced Ambu® AuraGain™ (AAG) and LMA® Supreme™ (LMAS) needs evaluation regarding their safety and efficacy. Evaluation of AAG and LMAS in terms of Oropharyngeal Leak Pressure (OLP) and performance characteristics. : A randomised prospective comparative study done in JSS Medical College and Hospital, Mysuru, Karnataka, India. 140 adult patients posted for elective surgeries requiring general anaesthesia were randomised into two groups. SAD was inserted using standardized techniques and evaluated for OLP as primary objective.The data analysed using SPSS software version 22 and descriptive statistics were expressed as mean ± standard deviation (SD), percentage. Kruskal-Wallis rank sum tests were used for quantative data analysis, p &#60;0.05 was considered significant. 138 patients (AAG = 68; LMAS =70) completed the study. There was significant difference noted between the OLP of AAG 33.59±3.65 cmH2O and LMAS 29.67±3.28 cmH2O (p value 0.001). LMAS had first attempt insertion success rate of 87% (61/70) as against 80% (56/70) in AAG, but was statistically insignificant (p value 0.549). Mean time for insertion of LMAS was 18.94± 5.2 seconds and AAG 20.11±4.9 seconds, (p value = 0.18). The ease of insertion of SAD, gastric tube insertion through the SAD and post-operative complications were comparable between the groups. Ambu® AuraGain™ was found to have a higher OLP in sustaining positive pressure ventilation, airway protection against aspiration in patients undergoing general anaesthesia.Oropharyngeal leak pressure is better with Ambu® AuraGain™ compared to LMA® Supreme™ while other performance characteristics of both the devices are comparable.
The effect of pre-emptive paracetamol on postoperative analgesic requirement in patients undergoing laparoscopic cholecystectomy: A randomized control study
Authors: Sarna Rashi , Arora Geetika , Chauhan Rajeev , Bloria Summit 
Published: March 2021

Pre-emptive paracetamol has been shown to decrease postoperative analgesia requirement in many patient populations; however evidence supporting its role in laparoscopic cholecystectomy is lacking. Our aim was to determine the effect of Pre-emptive paracetamol on post-operative analgesia requirement in patients undergoing laparoscopic cholecystectomy. Ninety patients belonging to American Society of Anesthesiologists physical status I or II were randomly assigned to 3 groups. Group I received 1 gram of paracetamol intravenously 30 min prior to surgery; Group II received 1 gram of paracetamol intravenously intraoperatively at time of skin closure and Group III was the control group and did not receive any paracetamol. The postoperative pain scores by VAS and analgesia requirement was compared in the 3 groups’ upto 6 hours postoperatively. The postoperative pain scores remained comparable in the 3 groups for most of the duration of study. The post-operative fentanyl consumption was significantly lesser in Groups I and II as compared to group III. There was no difference in the sedation scores and in the incidence of PONV in the two groups. Pre-emptive intravenous paracetamol is effective in the treatment of postoperative pain after laparoscopic cholecystectomy.
Total intravenous anaesthesia to facilitate bulbocavernous reflex in a 2-year-old child with tethered cord syndrome: A case report
Authors: Rajappa Deepak , Mittimanj Kavya , Masapu Dheeraj , Chandrashekar Shishir , Rudrappa Satish 
Published: March 2021

Tethered cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal canal. Intraoperative neurophysiological monitoring like somatosensory evoked potentials and transcranial motor evoked potentials can preclude surgically induced lesions to the nervous system and has become standard of care for many neurosurgical procedures. Despite the potential advantages of total intravenous anaesthesia, it is not a widely used anaesthetic technique in children. Recently, a few case reports have been published regarding the presence of metabolic acidosis even with a short term infusion of propofol. We present a case report in which total intravenous anaesthesia was used to facilitate BCR in a 2-year-old child, to monitor the functional integrity of the sacral reflex, which enables bladder and bowel function.
A retrospective study - epidemiological analysis of traumatic spinal injuries in Rajasthan, India
Authors: Chand Gautam , Avtar Malav Ram 
Published: March 2021

Traumatic spinal injuries (TSI) are major source of morbidity and motility throughout the world. Epidemiological study of TSI has an important role in future planning for prevention and management of them. Aim of this study was determine epidemiology of TSI in Jhalawar Rajasthan state of India. Retrospective analysis of patients hospital data records, admitted in Jhalawar medical college Rajasthan from January 2018 to Dec. 20019 (Period of Two Years).One hundred and fifty eight cases of traumatic spinal injuries reported in period of two years from January 2018 to December 2019. Male to female ratio was 2.16:1, the most prevent age group was 30-39 years (27.8%) followed by 20-29 years (19%). Fall from height (unprotected roof, well, tree, construction site/electric pole) was most common mode of injuries (44.9%) followed by road traffic accidents (43%). Most common level of injury was lumbar spine (55%) followed by thoracic spine (22.78%). Other associated injuries with TSI were head injuries (9.5%) and extremities injuries (9.5%). Maximum number of TSI cases was reported during summer season (may-14.5% and June 15.8%). TSI is major source of morbidity and mortality in Rajasthan India. Younger age group and Male are more commonly affected as compare to older age group and female. Accidental fall and RTA are major cause of TSI.
Oral 600mg misoprostol vs manual vacuum aspiration (MVA) for the management of incomplete abortion- a randomized controlled trail
Authors: Dutta Indranil , Mondal Woothvasita , Mondal Debraj 
Published: March 2021

Approximately one in five recognized pregnancies are spontaneously miscarried in the first trimester and an additional 22% end in induced abortion. Incomplete abortion occurs when there are retained products of conception (POC) after induced abortion (whether by unsafe or safe methods) or after spontaneous abortion, also known as miscarriage. Some women may resort to self-induction. These conditions increase the likelihood that women will experience abortion complications and will seek treatment for incomplete terminations. Incomplete abortion can be treated with expectant management, which allows for spontaneous evacuation of the uterus, or active management, using surgical or medical methods. Expectant management is not preferred by many providers due to its relatively low efficacy and the fact that the time interval to spontaneous expulsion is unpredictable.The study was performed in a Durgapur Steel plant hospital, a tertiary care Hospital in West Bengal, India. The institute caters a huge area, both rural and urban. The study was done between 1st January2019 to 31st October 2020.Study population was drawn from patients attended OPD and patients admitted with incomplete abortions, either of spontaneous or, induced etiology in the Dept. Of Obst, & Gynae, Durgapur Steel plant hospital. A total of 80 women were randomised to either a single dose of 600 micrograms of oral misoprostol or MVA.160 women were recruited to the trial, of which 80 women were grouped into misoprostol group & another 80 to MVA group. Immediately after abortion, all the patients were available & data collected from all the patients. But during next follow-up after 1-2 wk, 33 in the MVA group & 27 in the misoprostol group did not come (Lost to follow up n=33) for follow-up. So, approximately 41% (33) of participants in MVA group & 34% (27) in the misoprostol group were lost to follow-up.In our study both MVA & Misoprostol groups had similar age distribution. Mean age in MVA group 23.5 years (± 4.5) and in MISO group 23.4 Years (± 4.8). For treatment of first-trimester uncomplicated incomplete abortion, both manual vacuum aspiration and 600 µg oral misoprostol are safe, effective, and acceptable treatments. However, misoprostol appears to be somewhat better option than MVA, in regards to availability, low cost of therapy, less pain, less need of expert manpower or specialised instruments.
Comparison of dietary pattern and BMI in South Indian women with PCOS and controls
Authors: Gopalan Ushadevi , Ghose Seetesh , Karnaboopathy Ranganathan 
Published: March 2021

Polycystic ovarian syndrome is the most common endocrine and metabolic heterogeneous disorder among reproductive-aged women. Obesity worsens the metabolic, clinical and endocrine features of PCOS, mainly by increasing insulin resistance and hyperinsulinemiaObesity rates are increasing due to changing lifestyles, including unhealthy food habits. The objective of this study was to characterize the dietary pattern and BMI of PCOS women and to compare it with healthy controls.This study was a case-control study. Study Population was women in the age group 15-45 years with complaints s/o PCOS and age matched control group .PCOS cases were diagnosed using Rotterdam criteria and the controls were age matched women without PCOS. All the women were subjected to a detailed history taking and physical examination. The data was entered in Excel sheet and Statistical analysis was done using SPSS version 23.The average age of PCOS cases was 24.64 years. There was a statistically significant increase in history of snacking with ingestion of high caloric and oily food in PCOS cases compared to control women. PCOS women were more overweight and Obese compared to Control women and this difference was also statistically significant.The results of this study suggests with PCOS is associated with an increased intake of food high in calorie and saturated fat and that women who are obese or overweight are more likely to develop PCOS. Lifestyle modifications like healthy diet and regular exercise should be the front line therapy in PCOS women.
Estimation of incidence of Aerobic vaginitis in women presenting with symptoms of vaginitis
Authors: Vidyasagar Veena 
Published: March 2021

Vaginitis is found to be quite common among women who present in Gynecology OPD. Aerobic vaginitis is one of the causes of vaginitis which is typically marked by either an increased inflammatory response or by prominent signs of epithelial atrophy or both. The main aim of the study was to analyze the signs, symptoms and laboratory investigations among women presenting with symptoms of vaginitis. The study consisted of 155 cases of women presenting with symptoms of vaginitis. Brief general, systemic and detailed gynecological examinations were done and analysed. The incidence of Aerobic vaginitis in the study group was observed to be 7.74%. All cases of Aerobic vaginitis had unusual vaginal discharge as the presenting symptom. It was observed that 50% of cases had additional complaints of pruritus vulvae and vaginal irritation while 25% cases had complaints of dysuria and dyspareunia. pH of vaginal smears of these cases varied from 6 to 10, average being 7.75. On Gram staining, there were moderate to plenty number of pus cells and few to moderate number of epithelial cells. Organisms grown included Coagulase negative Staphylococci; Streptococci and Klebsiella species. Other causes of vaginitis included Candida - 14.19%, Trichomoniasis - 6.45% and Bacterial vaginosis 7.09%. The study concluded that the incidence of Aerobic vaginitis in the present study was less as compared to other studies. It is advisable to do culture with an antimicrobial sensitivity to find out the cause of vaginitis especially in cases presenting with recurrent symptoms of vaginitis. The type of antibiotics used to treat vaginitis must be very selective in order not to kill the beneficial bacteria that help in preservation of vaginal health and ecosystem.
Exploring Patient Safety Culture in a Kuwaiti Secondary Care Setting
Authors: Alqattan Hamad , Cleland Jennifer , Morrison Zoe , Cameron Isobel M. 
Published: March 2021

Objectives: Qualitative studies can improve understanding of patient safety culture (PSC), which has been relatively neglected by researchers in the Gulf Cooperation Council context. This study employed a qualitative approach to explore healthcare staff and patients’ perceptions of PSC and how it can be improved. Methods: This qualitative study was conducted in a public hospital in Kuwait. Individual face-to-face interviews were used to understand the experience of healthcare staff and patients concerning PSC. After obtaining the required ethical approvals, maximum variation sampling was used. Interviews were recorded and transcribed. The analysis was inductive and thematic. Results: A total of 51 participants were included in this study (35 healthcare professionals and 16 patients). Data analysis revealed four overarching themes relevant to the research question: (1) workload; (2) communication; (3) environmental constraints; and (4) incident reporting. These issues were interrelated in practice. Kuwaiti and non-Kuwaiti participants held different views, particularly about the response to errors and expatriate staff members’ clinical skills. Conclusion: This study revealed multiple factors related to workload, communication, healthcare environment and incident reporting, which hindered the promotion of positive PSC in the included department. The presence of numerous constraints suggests that multiple interventions which target both individual and organisational levels should be implemented.

KEYWORDS
Health Services Research; Patient Safety; Safety Culture; Kuwait.
The Lived Experience of Victims of Catastrophic Coastal Erosion
Authors: Yesodharan Renjulal , Jose Tessy T. , Roach Erna J. 
Published: March 2021

Objectives: Environmental hazards are part of the Earth’s natural cycle and are ongoing within human history. When vulnerable situations meet environmental hazards, disasters occur where human and natural costs could be enormous. This study aimed to explore the experiences of the victims of coastal erosion during the monsoon season. Methods: Seven victims of catastrophic coastal erosion in the Kollam District of Kerala, India, were interviewed from December 2013 to February 2014. The study followed Edmond Husserl’s descriptive phenomenological method. Result: These interviews constituted the primary data source. Three main themes with eleven subthemes emerged from these data. The main themes were impact, consequences and recovery. The subthemes were living in constant fear, escaping from the catastrophe; cataclysmic sea waves and their tumultuous behaviour, instant damage and destruction, the epoch of losses; agony and suffering; homelessness-helplessness-sleeplessness mixed with fear; government aid only in dreams; haunting memories; never-ending daily needs; first home and native land; and the desire to go back to the site of the disaster. Conclusion: From the derived themes, a phenomenon associated with coastal erosion evolved. The phenomenon is termed “Catastrophic coastal erosion: A cycle of impact, consequences, and recovery”.

KEYWORDS
Disaster Victims; Ecological and Environmental Phenomena; Natural Disasters; Oceans and Seas; Quality of Life; Qualitative Research; Tsunamis; India.
Bilateral Systematised Epidermolytic Epidermal Nevus
Authors: Kerawala Sabeika R. , Rizvi Najam-us-Saher , Tabassum Saadia 
Published: March 2021

Verrucous epidermal nevi (VEN) are benign congenital hamartomas consisting of keratinocytes. Histological examination mostly exhibits hyperkeratosis, acanthosis, papillomatosis and, rarely, the features of epidermolytic hyperkeratosis (EHK). We report a case of a 6-year-old boy who presented at Aga Khan University Hospital, Karachi, Pakistan with bilaterally symmetrical linear epidermal nevi following Blaschko’s lines and showing epidermolytic hyperkeratosis on histology. The patient was treated with topical keratolytics and emolients which led to considerable improvement. To the best of the authors’ knowledge, this is the first report of VEN from Pakistan.

KEYWORDS
Verrucous Epidermal Nevus; Mosaicism; Epidermolytic Hyperkeratoses; Hamartoma; Case Report; Pakistan.