bluuebunny/crossref_metadata_2025_split huggingface dataset:
To study the efficacy and post-operative sedation in intravenous and intrathecal clonidine in patients undergoing laproscopic assisted vaginal hysterectomy under general anesthesia
Authors: G Asha , Masamaddi Geethanjali S , S Amith 
Published: March 2021

Advent of Laparoscopy have benefitted patients in terms of lesser tissue damage, early ambulation, decreased duration of hospital stay and reduced analgesic needs. However caproperitoneum and position of patient during laparoscopic procedure induces pathophysiological changes that may potentially complicate anesthetic management. Various pharmacological methods have been tried to overcome complications associated with pneumoperitoneum. One among those drugs is Clonidine, a centrally acting α-adrenergic receptors agonist has sedative, anxiolytic, analgesic properties and stabilizes circulatory system. It diminishes stress response hence increases perioperative circulatory stability in patients undergoing laparoscopic surgeries. In addition, it increases cardiac bar reflex sensitivity in hypertensive individuals, and thus, stabilizes blood pressure by enhancing the role of changes in heart rate.To study the efficacy and post-operative sedation in intravenous and intrathecal clonidine in patients undergoing laparoscopic assisted vaginal hysterectomy under general anesthesia.Patients were divided randomly into 2 groups (A group & B group) of 30 each. Patients assigned to group a, received 50 mcg of clonidine in 50ml of normal saline over 10 minutes 10 minutes before induction. Patients assigned to group B, received intrathecal clonidine 50 mcg in 1 ml in sitting position at L3-L4 interspace using 27G quincke’s spinal needle just before induction. Intraoperative monitoring included heart rate (HR), continuous electrocardiography, noninvasive systolic (SBP), diastolic (DBP), mean blood pressure (MBP), pulse oximetry (SpO) and EtCO. Systolic, diastolic, mean arterial blood pressures and heart rate were recorded at regular interval and plotted on graph.During capnoperitoneum, mean HR values, mean SBP values, mean DBP values, mean MAP values in (IT) group B were below the baseline and that in group A (IV) were near the baseline. Efficacy of Intrathecal route of clonidine administration during laparoscopic hysterectomy surgeries have better control of heart rate, mean systolic and diastolic blood pressure and mean arterial pressure is better during capnoperitoneum compared to intra venous clonidine. But post-operative sedation and adverse effects in both routes are statistically insignificant.
A prospective randomized controlled trial to compare the efficacy of wound instillation with 0.25% bupivacaine, 0.2% ropivacaine and normal saline for postoperative analgesia in breast surgery
Authors: Lalit Kumar Raiger  , Mathur Shuchi , Gehlot Ravindra , Bedi Vikram 
Published: March 2021

Modified Radical Mastectomy (MRM) is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection.We hypothesized that instillation of 0.25% bupivacaine and 0.2% ropivacaine through chest and axillary drains into the wound may provide postoperative analgesia, even better than infiltration along the line of incision. In this prospective randomized controlled study 68 patients aged more than 18 years were divided into four groups. All patients were administered general anesthesia. At the end of the procedure, axillary and chest drains were placed before closure. Group C was the control group with no instillation, group B received 40 ml 0.25% bupivacaine, group R received 40 ml 0.2% ropivacaine and group S received 40 ml normal saline (20ml through each drain) and the drains were clamped for 10 mins. After extubation, pain score was evaluated using Visual Analogue Scale (VAS) at rest, cough and overhead abduction of the arm at 0,1,2,3,4,8,12 and 24 hours. Rescue analgesia was injection tramadol, given if the pain score ≥ 3. Statistical analysis was performed using SPSS version 21. There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (p&#60;0.001). The mean duration of analgesia in the ropivacaine, bupivacaine, saline group and the control group were 10.64 hours, 10.07 hours, 7.49 hours and 2.3 hours respectively. Wound instillation with local anesthetics is a simple and effective means of providing good analgesia without any major side effects.
A comparison of hemodynamic profile of intraperitoneal instillation of ropivacaine versus bupivacaine in laparoscopic surgeries
Authors: N Ramya , Piriya K Sanmuga , S Balasubramanian , J Vigneswaran , Kumar K Suresh , B S Suresh Anand 
Published: March 2021

Inadequate pain relief in the postoperative phase is a well-known problem world-wide. Aside from the suffering caused by insufficient pain relief, this is an issue with potential adverse physiological and psychological consequences for patients in addition to financial draw backs for caregivers. Poorly managed pain may interfere with postoperative complications, cause patient suffering and prolong recovery. Patients may anticipate future medical interventions with greater anxiety if pain has not been managed effectively in the past. To assess postoperative hemodynamics of intra peritoneal instillation of Ropivacaine and bupivacaine in Laparoscopic surgeries. The present study was conducted at Sri Manakula Vinayagar Medical College and Hospital, Pondicherry in the Department of Anaesthesia. The double blinded randomized experimental study was conducted from October 2017 to May 2019.The sample size of 50 study subjects was selected using the mean pain score at 3.6 with 80% power and 95% confidence interval. In each of the group 25 study subjects were allotted based on randomization. All patients were instilled with 30 ml of solution in a standardized manner by the operating surgeon under vision before removal of trocar at the end of the surgical procedure. Group R received 30 ml (0.2%) ropivacaine and group B received 30 ml (0.25%) bupivacaine. The drugs were prepared and given to the investigator who was blind to the identity of drugs. The heart rate was found to be comparable between two groups at 10 min, 30 Min, 60 Min, 120 Min, 4 Hrs, 8 Hrs, 12 Hrs and at 24 hrs and the p value was found to be non-significant. The Systolic Blood pressure was found to be statistically significant between the two groups at 10 Min, 30 Min, 60 Min, 120 Min, 4 hrs, 8 Hrs and 12 hrs. Whereas at 24 hrs the difference of Systolic Blood Pressure was found to be non-significant. Heart rate was similar in both the study groups at various time intervals. Systolic blood pressure and diastolic blood pressure was significantly high among patients in Bupivacaine group measures in most of the time intervals, while mean blood pressure differences were inconsistent over the follow up period.
Comparison of ultrasound guided costoclavicular brachial plexus block versus supraclavicular brachial plexus block for forearm and hand surgeries for surgical anaesthesia: A prospective randomised clinical study
Authors: Janardhaniyengar Sowmya M , Ramesh Shubha M , Kantharaju Shankar 
Published: March 2021

Successful brachial plexus blocks (BPB) rely on proper techniques of nerve localization, needle placement and local anesthetic injection. This study aimed at comparing the efficacy of costoclavicular brachial plexus block versus supraclavicular brachial plexus block for forearm and hand surgeries for providing surgical anesthesia by evaluating the time of onset of sensory and motor blockade, nerve sparing effect and duration of analgesia in both the groups.Fifty patients with ASA physical status 1, 2 and 3 undergoing forearm and hand surgeries were recruited. Fifty patients in Group C (n=25) and Group S (n=25) received 20 ml 0.5% ropivacaine by ultrasound guided costoclavicular and supraclavicular BPB respectively. The primary outcome measure was the time of onset of sensory and motor blockade. Secondary outcome measures included nerve sparing effect and duration of analgesia. Statistical analysis was done with student-t test, unpaired t-test and Fisher exact test. In our study, onset of sensory blockade (8.20 ± 0.58 mins vs 9.72 ± 0.84 mins) and onset of motor blockade (11.72 ± 0.79 mins vs 12.56 ± 0.92 mins) were significantly shorter in group C when compared to group S. We did not find any nerve sparing effect in both the groups unlike other studies. Duration of analgesia (13.14±0.91 hours vs 12.84±0.93 hours) and requirement of rescue analgesics were comparable in both the groups. : We conclude that ultrasound guided costoclavicular BPB has shorter procedural time and rapid onset of sensory-motor blockade compared to supraclavicular BPB.
Anaesthesia management of coronary artery perforation during Percutaneous Coronary Intervention (PCI)
Authors: Chodankar Ninad D , Jain Sulekha , Panthakey Harvesp D , Mehta Hemant H 
Published: March 2021

Percutaneous Coronary Intervention (PCI) is an accepted modality of treatment in patient with coronary artery disease. Coronary artery perforation is very rare but serious complication that can occur while performing PCI. We describe two cases of coronary perforation while performing PCI. In first case, coronary perforation could not be sealed with coronary stent and required emergency surgery. And in second case, we were able to seal the coronary perforation with stent and avoid surgery.Coronary artery perforation requires team approach by cardiologist, anaesthesiologist and surgeon for early recovery and good outcome.
Effectiveness and side-effect profile of Vilazodone and Escitalopram in major Depressive Disorder – An observational study
Authors: Kodali Madhavi , Lella Srikanth , Bodepudi Sarath , Benerji Therissa , Mohan Parvathaneni Krishna 
Published: March 2021

Major depressive disorder (MDD) is characterized by a cluster of emotional, behavioral, and cognitive features causing functional impairment.Escitalopram and Vilazodone are approved drugs in management of MDD. Escitalopram is found to be efficacious in patients with MDD. However, sexual dysfunction and weight gain are of a primary concern leading to discontinuation of treatment. Vilazodone is efficacious for patients who do not respond to SSRI/SNRI monotherapy. Evidence suggests it to be associated with a better side effect profile.To study the effectiveness and side effect profile of vilazodone and escitalopram in patients diagnosed with MDD.All patients diagnosed with MDD and commenced for the first time on vilazodone or escitalopram were included in the study via purposive sampling. Effectiveness and side effect profiles of the patients were studied by applying HAM-D and ASEC, respectively, at baseline, at weeks 1, 2, 4, 6, and 8.There was a statistically significant difference in weeks 2, 4, and 6 for both the drugs. On intergroup comparison, no significant difference was found in terms of response rates. The number of side-effects was more in the escitalopram group. Taken together with our results, vilazodone appears to be equally effective as escitalopram in treating patients of MDD. However, vilazodone has the advantage of better tolerability as compared to escitalopram.Vilazodone was found to be equally effective as escitalopram in patients with MDD and has the advantage of better tolerability as compared to escitalopram.
Assesmentof Fibro Q test, AAR & APRI indices as markers of fibrosis in chronic liver disease
Authors: Ayyali Ambresh , A Shilpa 
Published: March 2021

Chronic liver disease can vary from mild hepatic inflammation without fibrosis to advanced hepatic fibrosis and cirrhosis. The use of ultrasound for the confirmation of complications during biopsy procedures increases the cost of treatment and may also increase the duration of hospitalization. Fibro Q test (FQT), Aspartate amino transferase – Alanine amino transferase ratio (AAR) & Aspartate amino transferase- platelet ratio index (APRI) are the three non-invasive and simple indices proposed for assessing fibrosis in CLD. To know the efficacy of the indices- Fibro Q test, AAR, APRI as markers of Fibrosis in CLD. To know which among these indices would be the high sensitive marker of liver fibrosis.This study includes 60 subjects, out of which 30 were clinically diagnosed as CLD and were confirmed by abdominal ultrasound and 30 were age matched healthy controls. Fibro Q, AAR & APRI were significantly increased in cases compared to controls. The increase in Fibro Q test in cases was highly significant (p-0.0001) when compared to controls.Fibro Q test, AAR & APRIindicesare efficient markers to evaluate liver fibrosis in CLD patients. Fibro Q, a novel non-invasive test, is highly sensitive marker than AAR & APRI.
Assessment of plasma fibrinogen as a marker of diabetic nephropathy
Authors: A Shilpa , Ambresh Ayyali 
Published: March 2021

Diabetes is one of the most common chronic hyperglycemic syndrome. Diabetic Nephropathy is one of the major complications of DM characterized by persistent albuminuria, increased arterial blood pressure, a relentless decline in glomerular filtration rate (GFR) & a high risk of cardiovascular morbidity & mortality. The biological marker of DN is fibrinogen. Fibrinogen, is increased in diabetic patients. An increase in plasma fibrinogen levels is also considered an independent risk factor for diabetic nephropathy. Fibrinogen is the major coagulation protein in blood.To find out whether the levels of Plasma Fibrinogen levels can be used as markers for the early diagnosis of DN.A case control study. The study includes total of 150 patients, of which 50 were diabetic without any complications, 50 were diabetic nephropathy patients and remaining 50 were age matched healthy controls. The mean plasma fibrinogen level in control group was 190.34 ± 72.83 mg/dl. The mean plasma fibrinogen levels in DM & DN groups were 522.76 ± 115.79 mg/dl & 657.64 ± 124.61 mg/dl respectively. In our study, fibrinogen levels were increased significantly in DM group compared to controls which was further increased in DN group. Hence above studies interpret that fibrinogen increases in diabetes with complications.Fibrinogen correlated positively with FBS, HbA, TC, triglyceride, LDL, Blood Urea, serum creatinine, TC/HDL, LDL/HDL & urine A/C ratio in both DM & DN group, whereas there was negative correlation of fibrinogen with HDL & eGFR. Thus fibrinogen could be used as early biomarkers for the diagnosis of DN.
Iranian Clinical Nurses’ and Midwives’ Attitudes and Awareness Towards Telenursing and Telehealth
Authors: Ranjbar Hossein , Bakhshi Mahmoud , Mahdizadeh Faezeh , Glinkowski Wojciech 
Published: March 2021

Objectives: This study aimed to examine the attitudes and awareness of Iranian clinical nurses and midwives towards telenursing and telehealth also referred to as e-health. Methods: The cross-sectional study was conducted from February to August 2019 in Iran. Nurses and midwives were randomly recruited from hospitals affiliated with Mashhad University of Medical Sciences in Mashhad, Iran using a stratified cluster random sampling method. Data were collected using a reliable and valid Persian-language questionnaire consisting of 32 close-ended survey items to examine Internet/computer access, daily Internet use and awareness of and general attitude towards telehealth and telenursing; statistical analyses were performed. Results: A total of 523 nurses and midwives were included in this study (response rate: 94.4%). The mean age and duration of clinical practice were 33.36 ± 7.46 and 8.88 ± 6.73 years, respectively. The majority of participants recognised the definition of telenursing (66.7%) and telehealth (80.1%). A positive attitude towards telenursing and telehealth was reported by 73.0% of the participants. Clinical nurses and midwives with a master's degree were more aware of the definition of telehealth compared to those with undergraduate bachelor degrees (P = 0.03). Additionally, midwives significantly more frequently presented a positive attitude towards telehealth and telenursing compared to nurses (86.2% versus 71.2%; P = 0.01). Conclusion: The positive attitude of the current participants was an important factor in the promotion of telenursing and telehealth. The implementation of educational and infrastructure developmental programs can help speed up executional processes in these fields.

KEYWORDS
Telenursing; Telemedicine; Nurses; Midwives; Attitude; Awareness; Iran.
Patterns of Prescribing Co-Amoxiclav to Children in Ibri Polyclinic, Oman
Authors: Al-Yaqoubi Weaam S. , Al-Maqbali Nadia S. 
Published: March 2021

Objectives: This study aimed to describe patterns of prescribing co-amoxiclav to children aged ≤5 years at a polyclinic in Oman and to assess level of adherence to the antibiotic prescription guidelines outlined by the Omani Ministry of Health (MOH). Methods: This cross-sectional retrospective study was conducted between June and December 2017 at Ibri Polyclinic (IPC) in Ibri, Oman. A random sample of 399 children aged ≤5 years who were prescribed a suspension of co-amoxiclav over the four winter months of 2016 were included in the study. The children’s electronic medical records were reviewed to determine whether the prescription complied with MOH guidelines. Results: The majority of the children were 2–3 years old (52.4%). Overall, 73.9% of prescriptions were written by general practitioners, while 26.1% were written by specialists. Co-amoxiclav therapy was the first line of management in 90.5% of cases, regardless of category of prescriber. Culture tests were ordered in only 43 cases (10.8%), of which five (11.6%) were found to be sensitive to the prescribed co-amoxiclav. Conclusion: Unnecessary antibiotics were prescribed to many paediatric patients attending IPC. Strict enforcement of the MOH antibiotic guidelines is needed to reduce irrational or discretionary prescription of this type of antibiotic. Healthcare providers should receive additional training in evidence-based methods of prescribing antibiotics.

KEYWORDS
Antibiotics; Children; Co-Amoxiclav; Inappropriate Prescribing; Antibiotic Resistance; Oman.
Chronic Blunt Traumatic Thoracic Aortic Injuries
Authors: Al-Adawi Sara S.H. , Naiem Ahmed , Abdelhady Ibrahim , Al-Sukaiti Rashid , Al-Hajeri Mahmood , Stephen Edwin , Al-Shamsi Sulaiman , Al-Wahaibi Khalifa 
Published: March 2021

Blunt thoracic aortic injuries are potentially lethal. Those who survive may form an organised haematoma in the periadventitial space resulting in a pseudoaneurysm, which may be identified incidentally decades later. While the role of thoracic endovascular aortic repair (TEVAR) in acute settings has been established, its role in chronic cases is yet to be defined. We report three cases that were diagnosed incidentally six, nine and 18 years after the injury. Two were managed by TEVAR while the third declined intervention and is on annual followup. Patients with asymptomatic and stable pseudoaneurysms of the descending thoracic aorta should be offered surveillance versus TEVAR because the risk of rupture is not negligible, whilst taking into account the patient’s level of physical activity. These three cases highlight the importance of early diagnosis of aortic injuries in blunt trauma and its grading.

KEYWORDS
Thoracic Aortic Aneurysm; Endovascular Procedures; False Aneurysm; Nonpenetrating Wounds; Traffic Accidents; Oman.
Airway and Anaesthetic Challenges in a Child With Bronchus Suis and Superimposed Double Aortic Arch
Authors: Kuriakose Nigel , Al-Ismaili Mohamed , Raniga Sameer , Date Rohit , Al-Abady Ali , Al-Balushi Zainab 
Published: March 2021

Bronchus suis or tracheal bronchus is an accessory bronchus arising from the trachea above the carina. Double aortic arch is a congenital vascular anomaly with persistence of both left and right aortic arches beyond fetal life which can form a vascular ring compressing the major airways and may be symptomatic. We report the case of a 16-month-old girl who had recurrent episodes of respiratory distress requiring multiple hospitalisations and was diagnosed at the Sultan Qaboos University Hospital, Muscat, Oman in 2019 with a double aortic arch compressing upon a tracheal bronchus causing symptomatic emphysema of the right upper lobe. This report presents anaesthetic and airway challenges during the patient’s lobectomy. A single lumen cuffed endotracheal tube was successfully used as a bronchial blocker to occlude the origin of the aberrant bronchus. The position of the tube was confirmed intraoperatively using fibreoptic bronchoscopy. Following her discharge, she continued to have recurrent episodes of respiratory distress and three months after her last appointment she succumbed to her illness. To the best of the authors’ knowledge, this is the first such reported case in Oman.

KEYWORDS
Bronchus; Trachea; Aortic Arch; Endotracheal Intubation; Bronchoscopy; Anesthesia; Lobar Pneumonia; Oman.
Prevalence of Complications of Diabetes and Risk Factors Among Patients with Diabetes in the Diabetes Clinic in Southeast of Iran
Authors: Taheri Hamed , Rafaiee Roya , Rafaiee Raheleh 
Published: March 2021

Objective: Academic health services play an important role in the prevention and control of diabetes mellitus (DM) in Iran. This study aimed at determining the prevalence of DM-related complications and the associated risk factors among patients with DM in a university-affiliated outpatient diabetes clinic of a referral hospital in Southeast of Iran, Zahedan.
Materials and Methods: This cross-sectional study was conducted from January to April 2019 in an academic diabetes clinic. A total of 334 patients with DM, whose characteristics (age, sex, family history of DM, and substance abuse), as well as laboratory and clinical information, were recorded in the baseline forms, were included. The relationship between variables were assessed by Pearson’s correlation coefficient at P-value< 0.05 and using SPSS version 20.0.
Results: The mean age of the participants was 54.27 (±11.57) years. In these patients, DM type 2 was estimated at 99.1%, and the mean duration of the disease was 8.98 (±6.93) years. The findings showed that 77.2% of the patients had poor glycemic control. Also, 85.4% of the patients had fasting blood sugar (FBS) level >126 mg/dL. There was a significant relationship between insulin-dependent therapy and drug abuse (P-value <0.001). The prevalence of hyperlipidemia (68.9%), hypertension (50.6%), retinopathy (29.6%), nephropathy (11.7%), and neuropathy (12.3%) was also determined.
Conclusion: The majority of the patients (77.2%) in this study had poor glycemic control, and 69.9% of them suffered from microvascular complications, macrovascular complications, or both. Therefore, frequent visits accompanied by patient education could help to better diabetes control