Effects of chest physiotherapy and cognitive behavioral therapy in preventing post-operative complications in a patient who has undergone double barrel ileostomy: a case study

Bowel obstruction is a common complication in advanced ovarian cancer with a reported obstruction rate between 5–42%, which is treated with resection and anastomosis. Post-operative complications (PPCs) generally occur due to immobility, decreased chest expansion, reduced thoracic mobility, weakness of respiratory muscles, severe pain at the suture site, and bandaging, making it difficult for the patient to cough. Thick and sticky mucus and depressed mucociliary clearance as an effect of anesthesia, cause accumulation of secretions in the lungs and can lead to PPCs. All this leads to prolonged hospital stays for the patient and delays recovery. Hence, our study aims to study the effects of chest physiotherapy and cognitive behavioral therapy in preventing post-operative complications in a patient who has undergone double barrel ileostomy. A 47-year-old female presented with the chief complaint of pain in the abdomen, for 2 months, which was dull aching and did not relieve with medication. She underwent double barrel ileostomy surgery. Following surgery, a 1- week exercise program was designed for the patient, which included the combination of chest PT and cognitive behavioral therapy with pre- and post-assessment of 3 scales, HAM-A, MGS-2, and POP DST, which showed remarkable differences in the pre and post values of the patient. Our present study concluded that post-operative physiotherapy intervention of chest PT and cognitive behavioral therapy was effective in preventing post-operative complications in the patient and promoted her early discharge from the hospital.

Study of maternal mortality at a tertiary care centre

Background: Pregnancy is not a disease and so pregnancy related death is almost always preventable. High rates of maternal deaths still exist in places, particularly in underdeveloped communities. The objective was to identify the maternal mortality ratio in our tertiary care centre and to discuss about the causes for maternal deaths.Methods: The present study is a prospective observational study on maternal mortality conducted in the department of Obstetrics and Gynecology, VDGMC, Latur, Maharashtra, India during the period of  18 months from January 2019 to June 2020.Results are expressed in frequencies and percentages.Results: Maternal mortality ratio (MMR) in our present study is 335.85 per 1,00,000 live birth. Among direct obstetric causes of maternal deaths, there were 58% hypertensive disorder cases,25% APH cases,25% puerperal sepsis cases, 8% embolism cases. Among indirect causes of maternal deaths, there were 61% anemic cases,39% liver disease cases,33% DIC cases, 11% heart disease.Conclusions: Maternal mortality is widely accepted as a key indicator of health and socioeconomic development. Each stage should be a positive experience, ensuring women and their babies reach their full potential for health and well-being

The Dictators’ Digital Dilemma: When Do States Disconnect Their Digital Networks?

When do governments decide to interfere with the Internet, and why? While many observers celebrate the creative use of digital media by activists and civil society leaders, there are a significant number of incidents involving government-led Internet shutdowns. Governments have offered a range of reasons for interfering with digital networks, employed many tactics, and experienced both costs and benefits in doing so.http://deepblue.lib.umich.edu/bitstream/2027.42/117569/1/2011_Howard-Agarwal-Hussain_Brookings.pd

A donor hemovigilance study: evaluation of adverse reactions to blood donors at tertiary care teaching hospital

Background: Donor hemovigilance is an important aspect of the hemovigilance system and contributes to decrease the blood donor’s complications and improving blood donor safety and functioning of blood bank. Reporting of adverse reactions associated with blood donations has been covered under National blood donor vigilance programme. This study was carried out to estimate the adverse events in blood donors and to promote their safety.Methods: The study was conducted over a period of 6 months, from 1st January 2017 to 30th June 2017 after getting approval from institutional ethics committee at tertiary care teaching hospital. Prior informed consent was obtained and donor confidentiality was ensured. The donors were observed for adverse event during or after donation. For delayed reactions, donors were requested to contact the researcher or designated departmental staff. Data was collected in case record form. Data entry was done in excel 2013 and appropriate Statistical test (chi square) was applied.Results: During study period total 7970 donors were registered, out of which 53.27% donors have donated their blood in blood camps and 46.72% have in blood bank. Incidence of donor reactions was 1.54%. Incidence of adverse reaction was higher at blood camps (58.53%). Authors found highest number of cases of mild vaso vagal type reactions (53%). Other types of reactions observed were painful arm, hematoma, delayed bleeding, tingling and moderate type of vaso vagal reaction.Conclusions: Authors did not find any major serious events like convulsion, thrombophlebitis or arterial puncture during study period. It considers that safety of donors was maintained

Early exposure of laparoscopic anatomy to first year medical undergraduate students: is it necessary?

The teaching of undergraduate anatomy is particularly based on cadaveric dissection. Currently, medical curriculum is continually evolving and focusing on clinical application, especially for first year medical undergraduate students. Recently, surgical educators defined a role for laparoscopy in teaching anatomy. This study was conducted to know the opinion by first year medical undergraduate students, of current teaching practices and which teaching modalities should be emphasized. In this study a total of 200 first-year medical undergraduate students were exposed to a Diagnostic Laparoscopy with appendectomy video, with explanation/commentary by a laparoscopic surgeon. A pre-test and a post-test questionnaire were given before and after exposure to the video. The objective of the study was to collect students’ opinion by answering the questions in the questionnaire. All pre-test and post-test questionnaire results were analysed. The results were quantified in terms of percentage. The knowledge of anatomy of abdominal wall and peritoneal cavity improved from 62% to 91% of students after exposure to surgical video. Similarly, knowledge regarding laparoscopy improved from 37% to 85% and awareness about surgical video as an additional method of learning improved from 46% to 89%. Almost 93% of students were able to appreciate the organs and structures within intraperitoneal cavity. Hence, the clinicians/surgeons need to try their best and put in their maximum efforts to make the training of future medical graduates more efficient and knowledgeable in anatomy subject, by creating interest in learning of the subject by using such additional method (surgical videos) learning tool

IS DOSE TITRATION REQUIRED FOR ANTIHYPERTENSIVE AGENTS IN GERIATRIC DIABETIC PATIENTS?

Objective: The objective of this study is to evaluate the antihypertensive drug usage and dosage differences between geriatric and non-geriatric diabetics with reference to the duration of hypertension and creatinine clearance (Crcl).Methods: In this observational study, patients with type 2 diabetes mellitus were grouped into geriatric (age ≥60 years) and non-geriatric (age <60 years). Patients' demographic data, duration of hypertension, drugs prescribed, and serum creatinine were recorded after the patients had a stabilized antihypertensive dose for 6 months. Crcl was calculated using Cockcroft–Gault formula. The dosages of antihypertensives were converted into equivalent doses for easy comparison within a group. For angiotensin-converting enzyme inhibitors (ACEIs), enalapril was considered as prototype, and for angiotensin receptor blockers (ARBs) losartan, beta-blocker atenolol, and calcium channel blockers (CCBs), amlodipine was considered as prototype. Univariate analysis was done for comparison of drug doses between groups.Results: A total of 336 diabetics with hypertension were included, of which 252 were geriatric and 84 non-geriatric. Duration of hypertension was expectedly longer in the geriatric group (8.40±7.26 vs. 5.46±5.67; p=0.001). Systolic blood pressure was higher in geriatrics (137.14±13.51 vs. 133.38±12.49; p=0.01). When adjusted for the duration of hypertension and Crcl, there were no significant differences in the mean converted equivalent doses of beta-blockers, CCBs, ARBs, and hydrochlorothiazide between geriatrics and non-geriatrics. However, statistically significant lower converted equivalent doses of all ACEIs were needed in geriatrics compared to non-geriatrics, when adjusted for duration of hypertension and Crcl. Enalapril required 20.57% and ramipril required 18.36% dose reduction in geriatrics compared to non-geriatrics.Conclusion: A 20% dosage reduction is needed for ACEIs in the elderly