scholarly journals Comparison of recovery profile between sevoflurane and isoflurane as volatile agents in neurosurgery in Indian population

2021 ◽  
Vol 8 (10) ◽  
pp. 2988
Author(s):  
Satyen Kumar Singh ◽  
Munish Kumar ◽  
Ajit Bhardwaj ◽  
Vikas Chawla ◽  
Ritu Grewal ◽  
...  
Keyword(s):  
Neurological Examination ◽  
Tertiary Care ◽  
Volatile Anesthetic ◽  
Anesthetic Techniques ◽  
Care Hospital ◽  
Anesthetic Agents ◽  
Orientation Time ◽  
The Difference ◽  
Recovery From Anesthesia ◽  
Rapid Emergence

Background: In most instances rapid emergence from general anesthesia after intracranial neurosurgery is desirable. The most compelling reason for this is the need for the patient to cooperate with a postoperative neurological examination intended to screen for such potential intracranial disaster as hematoma formation, herniation, and cerebrovascular accidents. Anesthetic techniques were adopted to achieve rapid emergence. In this respect, inhaled anesthetic agents have an important role in influencing the recovery time after anesthesia and surgery. The aim of this study is to compare isoflurane and sevoflurane as regard to speed of recovery from anesthesia and recovery of post-operative cognitive function in Indian populationMethods:  The study was carried out as randomized control, blinded study of patients undergoing neurosurgery in   tertiary care hospital. Sample sizes of 60 patients were studied. They were divided into two groups. Results: Sevoflurane shows faster emergence, extubation, motor control (in form of hand squeeze) and orientation time as compared to isoflurane. Though clinically the time difference for the various variables studied was 0.8 to 2.7 min only, statistically the results were significant and supported the basis for this difference as the difference in blood gas solubility coefficient between sevoflurane and isofluraneConclusions: Sevoflurane is recommended for use for faster extubation, emergence and post-operative neurological examination. The observation shows good brain relaxation with the use of both volatile anesthetic agents 

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

A COMPARATIVE STUDY OF INTRALESIONAL TRIAMCINOLONE ACETONIDE ALONE VERSUS COMBINATION OF 5-FLUOROURACIL AND TRIAMCINOLONE ACETONIDE IN THE TREATMENT OF KELOID

2021 ◽  
pp. 71-74
Author(s):  
Neha Gupta ◽  
Vijay Paliwal ◽  
Kanchan Kumawat ◽  
Narendra Kumar ◽  
Imran Khan ◽  
...  
Keyword(s):  
Triamcinolone Acetonide ◽  
Tertiary Care ◽  
Inhibitory Effect ◽  
Combination Group ◽  
Intralesional Injection ◽  
Care Hospital ◽  
Intralesional Corticosteroid ◽  
Pyrimidine Analogue ◽  
The Difference ◽  
Group B

Background: Keloids are benign proliferative condition of dermal broblast. Intralesional corticosteroid improves keloid but associated with signicant adverse effects like dyspigmentation, tissue atrophy and telengectasia and contraindicated in certain conditions like hypertension and diabetes. 5-Fluorouracil (5-FU), a pyrimidine analogue with an inhibitory effect on TGF-β induced broblast proliferation is useful in treatment of keloids but is associated with ulceration and pain. A low dose of Triamcinolone if added to 5-FU injection overcomes these issues. Approach: This study was conducted in a tertiary care hospital. Sixty patients; thirty in each group were included. In group A, once weekly intralesional Triamcinolone and in group B, intralesional injection of Triamcinolone mixed with 5-Flurouracil in 1: 9 dilution were injected for 8 sessions. Parameters of Vancouver scale were noted at the baseline and at the end of treatment. Results: Out of 60 patients enrolled in this study. The combination group was better in improving height (62.11% vs 78%), pliability (44.14% vs 8.81%), and vascularity (55.78% vs 61.30%) and results were statistically signicant (P valve <0.05) however it was not better in improving pigmentation (43.47% vs 20%) and volume (69.79% vs 80.76%) (P valve > 0.05). Pain and pruritus improved completely (100%) in both the groups at the end of the treatment. Excellent improvement in patient and observer assessment score was seen in 96.67% vs 3.33% in combination group and TAC group respectively. The difference was statistically signicant (P valve<0.05). Combination was better irrespective of age of the patient, duration, site, and origin of keloid. All patients treated with 5 FU develop ulceration and pain. Conclusion: Both the therapies are effective but combination is superior to TAC alone. We advocate that 5-FU should be used alone, addition of TCA does not have any added advantage in therapeutic outcome rather it increases the cost of treatment.

Development of a Modified Surveillance Definition of Central Line–Associated Bloodstream Infections for Patients with Hematologic Malignancies

2012 ◽  
Vol 33 (9) ◽  
pp. 865-868 ◽  
Author(s):  
Megan J. DiGiorgio ◽  
Cynthia Fatica ◽  
Mary Oden ◽  
Brian Bolwell ◽  
Mikkael Sekeres ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Hematologic Malignancies ◽  
Central Line ◽  
Marrow Transplant ◽  
Care Hospital ◽  
The Difference ◽  
Definition Of ◽  
Clabsi Rate

Objective.To develop a modified surveillance definition of central line-associated bloodstream infection (mCLABSI) specific for our population of patients with hematologic malignancies to better support ongoing improvement efforts at our hospital.Design.Retrospective cohort study.Patients.Hematologic malignancies population in a 1,200-bed tertiary care hospital on a 22-bed bone marrow transplant (BMT) unit and a 22-bed leukemia unit.Methods.An mCLABSI definition was developed, and pathogens and rates were compared against those determined using the National Healthcare Safety Network (NHSN) definition.Results.By the NHSN definition the CLABSI rate on the BMT unit was 6.0 per 1,000 central line-days, and by the mCLABSI definition the rate was 2.0 per 1,000 line-days (P < .001). On the leukemia unit, the NHSN CLABSI rate was 14.4 per 1,000 line-days, and the mCLABSI rate was 8.2 per 1,000 line-days (P = .009). The top 3 CLABSI pathogens by the NHSN definition were Enterococcus species, Klebsiella species, and Escherichia coli. The top 3 CLABSI pathogens by the mCLABSI definition were coagulase-negative Staphylococcus (CONS), Pseudomonas aeruginosa, and Staphylococcus aureus. The difference in the incidence of CONS as a cause of CLABSI under the 2 definitions was statistically significant (P < .001).Conclusions.A modified surveillance definition of CLABSI was associated with an increase in the identification of staphylococci as the cause of CLABSIs, as opposed to enteric pathogens, and a decrease in CLABSI rates.

scholarly journals Impact of Fluoroquinolone Exposure Prior to Tuberculosis Diagnosis on Clinical Outcomes in Immunocompromised Patients

2016 ◽  
Vol 60 (7) ◽  
pp. 4005-4012 ◽  
Author(s):  
Ju Young Lee ◽  
Hyun Jung Lee ◽  
Yong Kyun Kim ◽  
Shinae Yu ◽  
Jiwon Jung ◽  
...  
Keyword(s):  
Median Time ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Care Hospital ◽  
Immunocompromised Patients ◽  
Tb Treatment ◽  
Significant Difference ◽  
Tuberculosis Diagnosis ◽  
The Difference

ABSTRACTThere have been concerns about an association of fluoroquinolone (FQ) use prior to tuberculosis (TB) diagnosis with adverse outcomes. However, FQ use might prevent clinical deterioration in missed TB patients, especially in those who are immunocompromised, until they receive definitive anti-TB treatment. All adult immunocompromised patients with smear-negative and culture-positive TB at a tertiary care hospital in Korea over a 2-year period were included in this study. Long-term FQ (≥7 days) use was defined as exposure to FQ for at least 7 days prior to TB diagnosis. A total of 194 patients were identified: 33 (17%) in the long-term FQ group and 161 (83%) in the comparator, including a short-term FQ group (n= 23), non-FQ group (n= 78), and a group receiving no antibiotics (n= 60). Patients in the long-term FQ group presented with atypical chest radiologic pattern more frequently than those in the comparator (77% [24/31] versus 46% [63/138];P= 0.001). The median time from mycobacterial test to positive mycobacterial culture appeared to be longer in the long-term FQ group (8.1 weeks versus 7.7 weeks;P= 0.09), although the difference was not statistically significant. Patients in the long-term FQ group were less likely to receive empirical anti-TB treatment (55% versus 74%;P= 0.03). The median time from mycobacterial test to anti-TB therapy was longer in the long-term FQ group (4.6 weeks versus 2.2 weeks;P< 0.001), but there was no significant difference in FQ resistance (0% versus 3%;P> 0.99) or in the 30-day (6% versus 6%;P> 0.99) or 90-day (12% versus 12%;P> 0.99) mortality rate between the two groups. FQ exposure (≥7 days) prior to TB diagnosis in immunocompromised patients appears not to be associated with adverse outcomes.

scholarly journals A comparative study of tapentadol versus tramadol in the treatment of low back pain

2020 ◽  
Vol 9 (7) ◽  
pp. 1064
Author(s):  
Laxman Verma ◽  
Pankaj Kumar Chaudhary ◽  
Chandresh Gupta ◽  
Umesh Saroj
Keyword(s):  
Pain Intensity ◽  
Tertiary Care ◽  
Care Hospital ◽  
Medical Assessment ◽  
Group I ◽  
Parallel Group ◽  
Reduction Of Pain ◽  
The Mean ◽  
Group Ii ◽  
The Difference

Background: Nontraumatic musculoskeletal disorders are the main reason for presentation to the emergency department with Rachialgia being the most common reason to request medical assessment among them. Methods: This was a prospective, randomized, parallel group open labelled study conducted in a district level tertiary care hospital attached to a medical teaching institute. Patients were randomized into two groups. Group I (63 patients) received tablet tramadol 50 mg twice daily orally and group II (63 patients) received tablet tapentadol 50 mg twice daily orally.Results: The mean age of the patients of group I was 40.6±9.6 years and in the group II was 42.7±10.6 years. A total of 61 males participated in the study of which 31 males were enrolled in group I and 30 in group II while 65 females participated in the study of which 32 females were enrolled in group I and 33 in group II. The mean reduction of pain intensity VAS score at the end of 4 weeks from baseline in group I and group II were 34.57 and 37.55 respectively. The difference in the mean reduction of pain intensity VAS between the two groups was not statistically significant.Conclusions: We conclude that both the drugs show significant reduction in the pain intensity in moderate to severe CLBP patients. Tapentadol is as efficacious as tramadol in moderate to severe CLBP. However, tapentadol is better tolerated than tramadol.

scholarly journals Tamsulosin versus tadalafil as medical expulsive therapy of distal ureteric stones: a comparative study

2019 ◽  
Vol 6 (3) ◽  
pp. 982
Author(s):  
Chirag Parikh ◽  
Vipul Gurjar ◽  
Sneh Shah
Keyword(s):  
Comparative Study ◽  
Tertiary Care ◽  
Care Hospital ◽  
Analgesic Requirement ◽  
Medical Expulsive Therapy ◽  
Significance Levels ◽  
Colicky Pain ◽  
The Difference ◽  
Primary Focus ◽  
Distal Ureteric Stones

Background: The management of patients with ureteral calculi has changed dramatically in the current era, with the conservative approach being the primary focus, its main benefit being minimum patient morbidity. The use of the expectant approach for distal ureteric stones can be extended with the use of adjuvant medical expulsive therapy (MET), which is able to reduce symptoms and facilitate stone expulsion. The present study was thus conducted to determine single best monotherapy for medical expulsive therapy of distal ureteric stones by comparing Tadalafil and Tamsulosin.Methods: A hospital based comparative study was conducted at Department of Surgery of a tertiary care hospital. A total of 60 eligible cases of lower uretric calculus were included in the study. These 60 patients were then divided into 2 groups of 30 each to receive one of the two medical therapy i.e. Tadalafil and Tamsulosin.Results: Mean expulsion of calculi was significantly earlier in patients managed by tadalafil as compared to tamsulosin (13.1 vs 16.92 days; p<0.05). Complete expulsion was seen in 86.7% cases on tadalafil as compared to only 63.3% cases on tamsulosin (p<0.05). Mean analgesic use (2.69 vs 1.81; p<0.05) and episodes of colicy pain (1.41 vs 0.43; p<0.05) were significantly higher in patients managed by tamsulosin. The number of hospital visits required during treatment was also more with tamsulosin, but the difference did not reach significance levels (2.56 vs 2.02 days; p=0.06). No difference was seen in the adverse effect profile of both drugs.Conclusions: Tadalafil also provides early stone expulsion, a greater decrease in colicky pain episodes, and a greater decrease in analgesic requirement. Both drugs are safe, effective, and well tolerated with minor side effects. Thus tadalafil is safe, efficacious, and well tolerated as medical expulsive therapy for distal ureteric stones.

scholarly journals Transabdominal Ultrasonography in Symptomatic Choledocholithiasis – Usefulness in Settings with Limited Resources

2019 ◽  
Vol 9 ◽  
pp. 31
Author(s):  
Supun Lakmal De Silva ◽  
Ajith Aloka Pathirana ◽  
Thejana Kamil Wijerathne ◽  
Bawantha Dilshan Gamage ◽  
Buddhika Kemiya Dassanayake ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Tertiary Care ◽  
Biliary Tree ◽  
Endoscopic Management ◽  
Resource Poor Setting ◽  
Care Hospital ◽  
Biliary Disease ◽  
Ultrasound Scan ◽  
Transabdominal Ultrasonography ◽  
The Difference

Objective: Ultrasonography remains the initial imaging modality in the management of biliary disease. This study is designed to evaluate the accuracy of transabdominal ultrasonography in diagnosing biliary pathology in patients with choledocholithiasis. Methods: This was a retrospective study of a continuous sample of patients over a period of 3 years ending in January 2016; these patients were referred for endoscopic management of choledocholithiasis to a tertiary care hospital in Colombo, Sri Lanka. Ultrasound reporting was carried out by different consultant radiologists at both the index and the referring hospitals. The findings of endoscopic retrograde cholangiograms were compared with the ultrasound scan (USS) results. Results: A total of 247 patients were included in the study. USS was 97.4% accurate in detecting intrahepatic duct dilatation (IHDD). Stone counts and the location of stone(s) in the USSs correlated strongly with the number of stones delivered during endoscopic removal and their location in cholangiograms (P < 0.001). The difference in mean diameter of the common bile duct (CBD) of patients with choledochal cysts (CCs) (18.57 mm) and of patients without them (12.39 mm) is statistically significant (P < 0.001). At 14.5 mm, the negative predictive value for a CC is 99.02%. Conclusion: Ultrasonography is a reliable tool in predicting IHDD, stone count, and the location of stones in the biliary tree, particularly in a resource-poor setting. A CBD diameter of 14.5 mm in transabdominal ultrasound scan can be used as a cutoff for predicting extrahepatic CC.

scholarly journals Semen and Spermatozoa Characteristics in Alcohol Users and Non-Users

2021 ◽  
pp. 102-106
Author(s):  
Tanuja Lella ◽  
A. Ruckmani ◽  
N. Pandiyan Pandiyan ◽  
R. Arunkumar
Keyword(s):  
Reproductive Medicine ◽  
Sperm Quality ◽  
Semen Analysis ◽  
Tertiary Care ◽  
Sperm Concentration ◽  
Care Hospital ◽  
Semen Volume ◽  
The Difference ◽  
One Year ◽  
Alcohol Users

Introduction: Increasing infertility rate worldwide raises research to investigate plausible reason health community. To find out the characteristics of semen and spermatozoa in alcohol users and compare these characteristics with that of non-users of alcohol. Methodology: The data on alcohol use and semen analysis were obtained from case records of patients reported to the Department of Andrology & Reproductive Medicine of a tertiary care hospital for a period of one year from January 2018 to December 2018. The semen volume, sperm concentration, motility and morphology in alcohol users were compared with non-users. Results: A total of 231 patients had reported to the Department of Andrology & Reproductive Medicine during the study period. Among them 81 (35.06%) were alcohol users and 150 (64.94%) alcohol non-users. Analysis of their semen reports revealed that the difference in semen volume and sperm morphology was not found to be statistically significant, but the sperm concentration and progressive motility of spermatozoa showed significant reduction in alcohol users compared to non – users (p<0.05). Conclusion: The semen volume and sperm quality were found to be low in alcohol users. Among the spermatozoa characteristics, sperm concentration and motility were significantly reduced in alcohol users.

scholarly journals Prevalence of Dengue, Chikungunya, and Zika Viruses in Febrile Pregnant Women: An Observational Study at a Tertiary Care Hospital in North India

2021 ◽  
Author(s):  
Akanksha Gupta ◽  
Parul Jain ◽  
Vimala Venkatesh ◽  
Anjoo Agarwal ◽  
D. Himanshu Reddy ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Rural Areas ◽  
Vaginal Bleeding ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Fetal Outcome ◽  
North India ◽  
Care Hospital ◽  
Delivery Outcome ◽  
The Difference

Dengue virus (DENV), chikungunya virus (CHIKV), and Zika virus (ZIKV) are arboviruses that can affect maternal and fetal outcome if acquired during pregnancy. This study was done to estimate the positivity of DENV, CHIKV, and ZIKV in febrile pregnant women attending a tertiary care hospital in north India. Symptomatic pregnant women were tested for these viruses by IgM ELISA and/or by Trioplex real-time polymerase chain reaction. Their symptoms and laboratory parameters were recorded and were followed up till delivery to know their immediate delivery outcome. Of 104 women tested, 50 (48.1%) were positive for viral markers. Of these, evidence of infection by DENV, CHIKV, and both was found in 34 (32.7%), 10 (9.6%), and 6 (5.8%), respectively. ZIKV was not detected in any woman. Maximum DENV positivity occurred in the third trimester of pregnancy and in women residing in urban than rural areas. Chills and rigors, arthralgia, retro-orbital pain, anemia, and vaginal bleeding were more commonly associated with DENV positivity. Backache, arthralgia, jaundice, and vaginal bleeding were more common in CHIKV positives but the difference between positives and nonpositives regarding these symptoms was not statistically significant. Dengue infections were associated with more frequent hospitalizations (OR = 8.38, 95% confidence intervals [CI] = 3.29–21.30) and mortality (OR = 19.0, 95% CI = 1.01–357.10). Hence, to conclude, in India wherever possible, all symptomatic pregnant women should be screened for DENV, CHIKV, and ZIKV as part of sentinel surveillance for ZIKV.

scholarly journals COVID-19 Pandemic: A Speed Breaker for Routine Immunisation

2021 ◽  
Author(s):  
Sumit Singh Bhadoria ◽  
Durgesh Shukla ◽  
Ashutosh Joshi
Keyword(s):  
Vaccination Coverage ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Secondary Data ◽  
Study Data ◽  
P Value ◽  
Care Hospital ◽  
Routine Immunisation ◽  
Vaccine Preventable Diseases ◽  
The Difference

Introduction: Immunisation services are affected by Coronavirus Disease 2019 (COVID-19) pandemic due to lockdown and fear of COVID among public along with problems of workforce management and vaccine supply. All these factors have led to decrease in vaccination coverage. It may further lead to increase in risk of vaccine preventable diseases. Aim: To assess the overall trend and evaluate the vaccination coverage during COVID-19 pandemic in a tertiary care hospital in Gwalior district. Materials and Methods: Record based secondary data from the immunisation OPD of the tertiary care hospital Gwalior, Madhya Pradesh, India, for the period of 01 February 2020 to 31 August 2020 was utilised in current study. Data were entered into Microsoft Excel version-2007 and analysed. Frequency, percentage, mean, and standard deviation were calculated as a descriptive measures and graphical presentation to show time trends. The p-value was calculated at 5% level of significance. Results: In the study, 817 children were included, with mean age of 7.46 ±13.59 months. Total 61.1% (499) children were male and 38.9% (318) were female. During the study period, all the children were vaccinated for Bacille Calmette-Guerin (BCG) (10.6%) Pentavalent-1 series (36.4%), Pentavalent-2 series (17.4%), Pentavalent-3 series (12.2%), Measles-Rubella (MR-1) (6.5%), Booster-I (11.8%) and Booster-II (5.1%). Delayed vaccination was seen in 51(6.20%) children. The delay was observed for Pentavalent-2 series (43.1%), pentavalent-3 series (51.0%) and MR-1 (5.9%) and the difference is significant at p-value <0.05. Conclusion: Immunisation services were severely interrupted and completely suspended in April 2020. Certain amount of delay in various doses was also observed. Maintaining routine immunisation is essential in preventing an outbreak of vaccine preventable diseases.

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