Randomized clinical study comparing safety and efficacy of adjuvant intrathecal clonidine versus normal saline along with bupivacaine anaesthesia in lower limb surgery patients

Background: Various adjuvants have been used in intrathecal anesthesia to avoid intraoperative visceral and somatic pain and prolong postoperative analgesia. Clonidine, partially selective α2-agonist, is being evaluated as a neuraxial adjuvant with intrathecal bupivacaine. The objective of the study was to evaluate and compare safety and efficacy of intrathecal clonidine as adjuvant to bupivacaine with control normal saline.Methods: American Society of Anesthesiologist grade 1 and 2 patients (60 patients) were randomly divided into two groups of 30 patients each for lower limb surgeries. Study group injected with intrathecal 3ml of 0.5% Bupivacaine heavy (15mg) + 1µg/kg of clonidine and control group injected with 3ml of 0.5% Bupivacaine heavy (15mg) + equivalent dose of normal saline. The onset and duration of sensory and motor block, duration of analgesia, and the incidence of side effects in both groups were observed and compared.Results: Time for 2 segment regressions in study group was 186.17±25.92 minutes compared to control was 103.20±19.15 minutes (p value<0.001). Total duration of analgesia in control was 226.50±35.69 minutes and in the study group was 465.67±100.37 minutes (p value<0.001). The average duration of motor block in control group was 181.17±26.12 minutes compared to study group was 217.80±41.51 minutes (p value<0.001). The small dose of intrathecal clonidine is not significantly associated with systemic side effects such as bradycardia and hypotension.Conclusions: Clonidine added to bupivacaine for intrathecal anesthesia effectively increases the duration of sensory block, duration of motor block and duration of analgesia and does not produce any significant hemodynamic changes. No significant side effects are associated with it

Association of oral glucose tolerance test and pregnancy and fetal outcome

Background: Gestational diabetes mellitus (GDM) affects 2-25% of pregnancies depending on population characteristics and criteria used. It is associated with an increased risk of fetal malformation and perinatal mortality. The aim of the study was to know the prevalence of GDM, the risk factors associated with women with GDM and the feto-maternal outcome.Methods: A prospective study conducted among 200 antenatal women attending Obstetrics and Gynaecology (OBG) Outpatient Department in A. J. Institute of Medical Sciences and Research Center from March 2019 to August 2019. GDM was diagnosed with 2-hour 75 gm oral glucose tolerance test according to diabetes in pregnancy study group of India (DIPSI) criteria. Basic demographic details and maternal and fetal outcomes were analysed.Results: The prevalence of GDM was high (24.5%) compared to other studies. Normoglycemia was achieved with diet alone in 71.5%, diet and metformin in 16.3% and 12.2% with insulin. Risk factors included higher body mass index (BMI) and history of GDM. Emergency caesarean rate was higher among GDM women (p&lt;0.05). Fetal complications and neonatal intensive care unit (NICU) admissions were also higher in this group (p&lt;0.001 and p&lt;0.05).Conclusions: The higher prevalence shows the importance of early detection and timely intervention for pregnancy complicated with GDM. Due to this high-risk pregnancy, there’s increased incidence of maternal and fetal outcomes which can be reduced with glycaemic control and adequate fetal surveillance

Timescale for equilibration of N/Z gradients in dinuclear systems

Equilibration of N/Z in binary breakup of an excited and transiently deformed projectile-like fragment (PLF*), produced in peripheral collisions of 64Zn + 27Al, 64Zn, 209Bi at E/A = 45 MeV, is examined. The composition of emitted light fragments (3<=Z<=6) changes with the decay angle of the PLF*. The most neutron-rich fragments observed are associated with a small rotation angle. A clear target dependence is observed with the largest initial N/Z correlated with the heavy, neutron-rich target. Using the rotation angle as a clock, we deduce that N/Z equilibration persists for times as long as 3-4 zs (1zs = 1 x 10^-21 s = 300 fm/c). The rate of N/Z equilibration is found to depend on the initial neutron gradient within the PLF*.Comment: 6 pages, 4 figure

A randomized controlled comparative clinical trial on Jwarahara effect of Mukkaamukkatukaadi Syrup with Kiratatikta Syrup in Febrile Children

Ayurvedic classics have described many diseases amongst which Jwara stands first because of its uniqueness to make everyone suffer, since birth to death. Jwara being one of the commonest symptoms which accompanies almost all constitutional diseases has been coined with the term Rogadhipathi. Fever is defined as temperature in rectum more than 100.4°F (38°C), in oral cavity above 99.5°F (37.5°C) or in axilla above 99°F (37. 2°C). If we don’t treat fever in its earlier stage, there will be more chances of hyperpyrexia which may cause febrile convulsions which leads to brain damage. Therefore, it is necessary to control fever at its earlier stage. One such Jwarahara formulation is Mukkaamukkatukaadi Gulika and Kiratatikta which is converted into syrup form to overcome the palatability issues. A sample size of 30 patients was selected by simple random sampling method and 15 patients were allotted in two groups. It was planned to compare the result between Mukkaamukkatukaadi syrup in Group A study group for STG and LTG and Kiratatikta syrup in Group B control group for STG and LTG. On STG comparison, the difference in mean in Group A and Group B were 0.49,0.44 before treatment changed to 0.96 and 0.98 after treatment respectively.&nbsp; On LTG comparison, the difference in mean in Group A and Group B were 0.49, 0.44 before treatment changed to 2.02 and 1.96 after follow up respectively. This depicts both the formulations effective when consumed for longer duration. From the results and observations it can be concluded that Group A and Group B are equally effective and equally significant on reducing the temperature in both STG and LTG. No adverse drug reaction was found during the study

A comparative study of hysteroscopy and transvaginal ultrasonography in diagnosis of endometrial pathology in abnormal uterine bleeding

Background: Abnormal uterine bleeding is the most common complaint in gynaecology and an important source of morbidity. The ideal diagnostic tool to determine the cause for the same continues to be debated. Objective of this study was to compare accuracy of hysteroscopy and transvaginal sonography in diagnosis of endometrial pathology in abnormal uterine bleeding.Methods: A total 100 women attending gynaecological outpatient in hospital attached to J. J. M. Medical College, Davangere with abnormal uterine bleeding fitting into the inclusion criteria during November 2014 to August 2016, were admitted and evaluated with Transvaginal sonography (TVS) and hysteroscopy. Data was collected and analysed.Results: Among 100 patients of AUB in this study, majority of the patients were in perimenopausal age group. Menorrhagia is the most common presentation (45%) followed by postmenopausal bleeding (20%). Anaemia was detected in 79% of patients. Hysteroscopy was taken as gold standard and TVS findings were compared. The sensitivity of TVS in detecting polyps, submucous fibroid were 22.2%, 11% respectively and for the normal variants like proliferative and secretory it was 50% and 79.2% respectively. TVS showed good correlation with hysteroscope findings for normal variants of endometrium, but poor correlation for intracavitary pathologies.Conclusions: Hysteroscopy is a rapid, safe, well tolerated and highly accurate means of diagnosing the cause of abnormal uterine bleeding in perimenopausal age group. Thus, it is advised as a first line investigation in evaluation of AUB

Fatal pulmonary embolism following shoulder arthroplasty: a case report

<p>Abstract</p> <p>Introduction</p> <p>Fatal pulmonary embolism following a shoulder joint replacement is a rare event. The exact prevalence of shoulder arthroplasties is not clear. Unlike hip and knee joint replacements where some form of thromboprophylaxis is routinely prescribed, no such guidelines and practice exist for shoulder replacements. Other case reports have confirmed fatal and non-fatal pulmonary embolisms following shoulder replacements, but particular risk factors were identifiable in those patients.</p> <p>Case presentation</p> <p>We report the case of a 73-year-old Caucasian woman with fatal pulmonary embolism secondary to a calf deep vein thrombosis following a shoulder joint replacement procedure. The patient was otherwise healthy; there were no other risk factors directly contributing to deep vein thrombosis and pulmonary embolism except for a body mass index of 34. Post-mortem examination confirmed that the patient had a thrombus in the calf and a pulmonary embolus.</p> <p>Conclusions</p> <p>Fatal deep vein thrombosis and pulmonary embolism can occur following shoulder joint replacements in otherwise normal patients. A high degree of suspicion should therefore be maintained in susceptible individuals. Thromboprophylaxis needs careful consideration in shoulder replacements in susceptible individuals.</p