Respiratory effects of propofol-ketamine and propofl-fentanyl combinations for total intravenous anaesthesia

propofol combined with other intravenous analgesic agents has been used as the sole anaesthetic agent to provide hypnosis and analgesia for various minor and major surgeries. However, because it lacks analgesic property, propofol in large doses causes respiratory depression. Combination of propofol with other analgesic agents reduces the dose of propofol necessary for procedural sedation. Objectives: This study evaluated the respiratory effects of two drug combinations: propofol-ketamine and propofol-fentanyl used as the sole anaesthetic agents. Method: one hundred and eight adults aged 18 to 50 years of either gender with ASA physical status I & II, randomly grouped into K and F, comprising of 54 patients each. Group K received propofol-ketamine while group F received propofol-fentanyl for induction and maintenance of anaesthesia. Respiratory Rate (RR) and Oxygen saturation (SpO were recorded before and one 2) minutes after induction of anaesthesia and thereafter every five minutes till the end of procedure and at recovery till the patient is fully recovered. Results: Demographic and clinical characteristics such as age, sex, weight, duration of surgery, types of surgical procedures and volumes of drugs used were comparable between the two groups. Fall in respiratory rate was greater in propofol-fentanyl group compared to propofol-ketamine group during maintenance and early postoperative period (p<0.05). Conclusion: Both propofol-ketamine and propofolfentanyl combinations produced safe and effective anaesthesia. Propofol-ketamine results in a more stable respiratory profile

Volkmann's Ischemic Contracture Treatment: Our Experience.

Background: Volkmann's Ischemic Contracture (VIC) follows treatment of limb fractures by traditional bone setters in our environment and usually present for treatment of the deformity.Objectives: This study highlights the result of treatment by tendon elongation and subsequent physiotherapy.Methods: All patients presenting at the Orthopaedic Outpatient Department seeking for treatment of the deformity were operated upon.Results: Those with type I VIC do better in terms of cosmetics and function. It is also worthwhile to operate on all forms of VIC.Conclusion: It is beneficial to operate on patients with VIC

Background: Madelung's deformity is a congenital abnormality of the wrist caused by a disturbance of growth that retards the development of the ulnar and volar aspect of the distal radial physis, usually idiopathic, but can be associated with bone dysplas

Background: Madelung's deformity is a congenital abnormality of the wrist caused by a disturbance of growth that retards the development of the ulnar and volar aspect of the distal radial physis, usually idiopathic, but can be associated with bone dysplasias and Turner's syndrome, or acquired following trauma that disrupts growth of the radial ulnar volar physis. The exact nature of the pathologic process that causes the disturbance in growth is unknown.Method: This patient presented to us at the age of 20 years and we did closing wedge osteotmy with stabilisation with intrmedullary rush nail. Follow up was for two years. She no longer has pain and the deformity remains corrected.Results: Corrective osteotomy and stabilisation corrects the deformity and gives good results, both functionally and cosmetically.Summary: Even when they present late, patients with Madelung's deformity can benefit from surgery.Key words: Madelung's deformity, closing wedge osteotomy, Intramedulary Rush nail

Extended-Release Niacin Alters the Metabolism of Plasma Apolipoprotein (Apo) A-I and ApoB-Containing Lipoproteins

Objectives— Extended-release niacin effectively lowers plasma TG levels and raises plasma high-density lipoprotein (HDL) cholesterol levels, but the mechanisms responsible for these effects are unclear. Methods and Results— We examined the effects of extended-release niacin (2 g/d) and extended-release niacin (2 g/d) plus lovastatin (40 mg/d), relative to placebo, on the kinetics of apolipoprotein (apo) A-I and apoA-II in HDL, apoB-100 in TG-rich lipoproteins (TRL), intermediate-density lipoproteins (IDL) and low-density lipoproteins (LDL), and apoB-48 in TRL in 5 men with combined hyperlipidemia. Niacin significantly increased HDL cholesterol and apoA-I concentrations, associated with a significant increase in apoA-I production rate (PR) and no change in fractional catabolic rate (FCR). Plasma TRL apoB-100 levels were significantly lowered by niacin, accompanied by a trend toward an increase in FCR and no change in PR. Niacin treatment significantly increased TRL apoB-48 FCR but had no effect on apoB-48 PR. No effects of niacin on concentrations or kinetic parameters of IDL and LDL apoB-100 and HDL apoA-II were noted. The addition of lovastatin to niacin promoted a lowering in LDL apoB-100 attributable to increased LDL apoB-100 FCR. Conclusion— Niacin treatment was associated with significant increases in HDL apoA-I concentrations and production, as well as enhanced clearance of TRL apoB-100 and apoB-48

The Impact of COVID-19 on the Treatment of Opioid Use Disorder in Carceral Facilities: a Cross-sectional Study

While the COVID-19 pandemic disrupted healthcare delivery everywhere, persons with carceral system involvement and opioid use disorder (OUD) were disproportionately impacted and vulnerable to severe COVID-associated illness. Carceral settings and community treatment programs (CTPs) rapidly developed protocols to sustain healthcare delivery while reducing risk of COVID-19 transmission. This survey study assessed changes to OUD treatment, telemedicine use, and re-entry support services among carceral and CTPs participating in the National Institute on Drug Abuse (NIDA)-funded study, Long-Acting Buprenorphine vs. Naltrexone Opioid Treatments in Criminal Justice System-Involved Adults (EXIT-CJS) study. In December 2020, carceral sites (n = 6; median pre-COVID 2020 monthly census = 3468 people) and CTPs (n = 7; median pre-COVID 2020 monthly census = 550 patients) participating in EXIT-CJS completed a cross-sectional web-based survey. The survey assessed changes pre- (January–March 2020) and post- (April–September 2020) COVID-19 in OUD treatment, telemedicine use, re-entry supports and referral practices. Compared to January–March 2020, half of carceral sites (n = 3) increased the total number of persons initiating medication for opioid use disorder (MOUD) from April–September 2020, while a third (n = 2) decreased the number of persons initiated. Most CTPs (n = 4) reported a decrease in the number of new admissions from April–September 2020, with two programs stopping or pausing MOUD programs due to COVID-19. All carceral sites with pre-COVID telemedicine use (n = 5) increased or maintained telemedicine use, and all CTPs providing MOUD (n = 6) increased telemedicine use. While expansion of telemedicine services supported MOUD service delivery, the majority of sites experienced challenges providing community support post-release, including referrals to housing, employment, and transportation services. During the COVID-19 pandemic, this small sample of carceral and CTP sites innovated to continue delivery of treatment for OUD. Expansion of telemedicine services was critical to support MOUD service delivery. Despite these innovations, sites experienced challenges providing reintegration supports for persons in the community. Pre-COVID strategies for identifying and engaging individuals while incarcerated may be less effective since the pandemic. In addition to expanding research on the most effective telemedicine practices for carceral settings, research exploring strategies to expand housing and employment support during reintegration are critical