scholarly journals Evaluation of Intubating Conditions during Direct Laryngoscopy using Sniffing Position and Simple Head Extension- A Randomised Clinical Trial

2021 ◽  
Author(s):  
Amanjot Singh ◽  
Rupinder Kaur ◽  
Gurpreet Singh ◽  
Kewal Krishan Gupta
Keyword(s):  
Clinical Trial ◽  
Tracheal Intubation ◽  
Direct Laryngoscopy ◽  
Randomised Clinical Trial ◽  
P Value ◽  
Group I ◽  
Head Extension ◽  
Number Of Patients ◽  
Lehane Grade ◽  
Group Ii

Introduction: Optimal laryngeal visualisation during direct laryngoscopy requires adequate positioning of the head and neck. Traditionally, Sniffing Position (SP) is the recommended position to provide superior glottic visualisation. However various studies in recent past have challenged the superiority of SP. Aim: To evaluate whether SP provides better glottic visualisation and ease of intubation {as assessed by total Intubation Difficulty Score (IDS) score as well as its individual components} compared to Simple Head Extension (SHE) during direct laryngoscopy and endotracheal intubation. Materials and Methods: The randomised clinical trial was conducted at GGS Medical College and Hospital, Faridkot, Punjab, India, from May 2019 to October 2020, on 220 patients. Patients undergoing elective surgeries under general anaesthesia were randomly divided into two groups. Laryngoscopy and tracheal intubation in Group I was done in SP, which was obtained by placing a non compressible pillow of height 8 cm under the patient’s head. Patients in Group II underwent laryngoscopy and tracheal intubation in SHE position. Glottic visualisation using modified Cormack and Lehane (CL) grades, IDS and sympathetic responses between the two groups were studied. The data was compared using student’s t-test and Chi-square test. Results: Cormack and Lehane Grade I was seen in 69 (62.7%) of patients in Group I as against 51(46.4%) of patients in Group II (p-value=0.015). Easy intubation (total IDS score=0) was seen in a greater number of patients in Group I (60.9%) as compared to Group II (40.95%) (p-value=0.003). Slight difficulty in intubation (total IDS score=1-5) was encountered in 50.0% of patients in group II (n=55) and 35.5% of patients in group I (n=39) (p-value=0.029). Conclusion: The present study concluded that use of SP resulted in better glottic visualisation and was associated with favourable intubation conditions as compared to SHE position.

scholarly journals Excision with primary midline closure compared with Limberg flap in the treatment of sacrococcygeal pilonidal disease: a randomised clinical trial

2019 ◽  
Vol 101 (1) ◽  
pp. 21-29 ◽  
Author(s):  
M Arnous ◽  
H Elgendy ◽  
W Thabet ◽  
SH Emile ◽  
SA Elbaz ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hospital Stay ◽  
Recurrence Rate ◽  
Primary Closure ◽  
Randomised Clinical Trial ◽  
Limberg Flap ◽  
Complication Rates ◽  
Cosmetic Results ◽  
Group I ◽  
Group Ii

BackgroundAlthough several surgical techniques for treatment of sacrococcygeal pilonidal sinus (SPND) have been described, there is no consensus on the optimal surgical procedure. In this study we compared excision with primary closure and Limberg flap in the treatment of SPND.MethodsThis was a prospective randomised clinical trial in patients with SPND who were randomly allocated to one of two groups: group I (excision and primary closure) and group II (Limberg flap technique). The primary outcome of the trial was recurrence of SPND whereas postoperative complications, return to work and cosmetic results were the secondary outcomes.ResultsSixty patients were included, with a mean age of 24.1 years and mean body mass index (BMI) of 26.8 kg/m2. Group 1 had significantly shorter operation time than group II. Both groups had similar hospital stay and comparable complication rates (43.3% vs 30%; P = 0.4). Group I had significantly higher recurrence rate (20% vs 0; P < 0.02) and significantly better cosmetic satisfaction score than group II. Being hairy (P = 0.04), positive family history (P = 0.03), diabetes mellitus (P = 0.005) and history of previous surgery for SPND (P = 0.01) were the significant predictors for recurrence.ConclusionsThe Limberg flap is an effective technique for the treatment of SPND with very low recurrence rate and comparable complication rate and hospital stay to excision and primary closure. Excision and primary closure offered the advantages of quicker healing time, earlier resumption of daily activities, better cosmetic results, which may render it more suitable for patients with low risk for recurrence.

scholarly journals The Role of Low Dose Misoprostol in Cervical Ripening and Induction of Labour Beyond the Age of Viability and its Effects on Maternal and Fetal Outcomes

JMS SKIMS ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 18-21
Author(s):  
Humaira Ali ◽  
Cimona Lyn Saldanha ◽  
Tabasum Parveiz ◽  
Rabia Khurshid
Keyword(s):  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
P Value ◽  
Delivery Time ◽  
Fetal Outcomes ◽  
Group I ◽  
Number Of Patients ◽  
Group Ii ◽  
Vaginal Misoprostol

This study was conducted to compare the efficacy and safety of oral (50 μg) and vaginal (25 μg) misoprostol for cervical ripening and induction of labour. Two hundred patients with indications for labour induction randomly received either 50 μg oral misoprostol every 4 h (Group-I) or 25 μg vaginal misoprostol every 4 h (Group-II), for maximum of six doses. Mean induction to delivery time, delivery within 24 hrs, mode of delivery, oxytocin use, number of doses used, failed induction rate and maternal complication and fetal outcomes were compared for the two groups. Mean induction delivery time was significantly longer in Group-I (20.55±5.59 hrs) than in Group-II (16.70±7.12 hrs) (with mean difference of 3.85 and P-value of <0.001). Mean number of doses of misoprostol used for oral and vaginal misoprostol study populations were 2.61±0.94 and2.37±1.20respectively. Oxytocin augmentation was required in significantly more number of patients in oral group (80%) than in vaginal group (68%) with P-value of 0.027. There were 3 failed inductions in the oral and 4 in the vaginal group after a total of six doses of misoprostol. Incidence of maternal and fetal complications was similar between two groups. Our findings indicated that, 25μg vaginal misoprostol has the potential to induce labor as safely as, and more effectively than, 50 μg oral analogue. JMS 2017; 20(1):18-21

scholarly journals Evaluation of Glottic Visualization and Ease of Intubation at Induction of General Anesthesia

2021 ◽  
Vol 15 (9) ◽  
pp. 2178-2181
Author(s):  
Abaid-Ur- Rehman ◽  
Muhammad Azam ◽  
Zeeshan Khan ◽  
Amjad Nadeem ◽  
Umer Farooq ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
General Anesthesia ◽  
Analytical Study ◽  
Demographic Data ◽  
P Value ◽  
Research Education ◽  
Macintosh Blade ◽  
Group I ◽  
Males And Females ◽  
Group Ii

Aim: To compare the frequency of better glottic visualization and ease of tracheal intubation in Macintosh versus McCoy blades. Study design: An observational analytical study. Settings: Department of Anesthesia, Lahore Medical and Dental College/Ghurki trust teaching hospital, Lahore. Study duration: Six months (2nd September 2017 to 1st March 2018) Methods: After approval from research, education and clinical audit department, we selected 60 patients for elective procedures under general anesthesia of age ranges from 20-40 years including both males and females. Patients were randomized by lottery method into two groups I & II. Laryngoscopy was performed with McCoy in group I and with Macintosh in group II and the best possible view of the glottis was obtained. After achieving best possible glottis view of each patient, vocal cord visualization was determined according to Grade-I to IV. Ease of tracheal intubation was also noted. Results: The demographic data was comparable in both groups. In this study, we have found better glottic visualization in 60.0% of patients with Macintosh blade (group II) and with McCoy blade (group I), it was 83.33% (p-value = 0.045). Ease of intubation was 73.33% with Macintosh blade (group II) and with McCoy blade (group I), it was 93.33% (p-value = 0.038). Conclusion: We concluded that frequency of better glottic visualization and ease of tracheal intubation with McCoy blade is higher as compared to Macintosh blade. Keywords: Endotracheal intubation, Glottic visualization, McCoy blades, Macintosh blades.

scholarly journals Remifentanil-Induced Abdominal Pain: A Randomised Clinical Trial

2009 ◽  
Vol 37 (3) ◽  
pp. 447-449 ◽  
Author(s):  
S. Jahanbakhsh ◽  
A. Bameshki ◽  
P. Khashayar
Keyword(s):  
Clinical Trial ◽  
Abdominal Pain ◽  
Cataract Surgery ◽  
Muscle Relaxation ◽  
Postoperative Nausea And Vomiting ◽  
Randomised Clinical Trial ◽  
Control Group ◽  
P Value ◽  
Number Of Patients ◽  
Remifentanil Group

Remifentanil is an ultra-short-acting opioid, widely used for induction and maintenance of anaesthesia in various types of operations. We recently noted that a great number of patients receiving remifentanil in their anaesthetic regimen experienced postoperative abdominal pain. As a result, we performed this study to investigate its incidence. This randomised single-blinded clinical trial was conducted on 300 patients who were undergoing elective cataract surgery under general anaesthesia. The patients were randomly divided into two groups. In the control group (n=150), anaesthesia was induced with fentanyl and propofol and maintained with propofol by infusion and 60% N2O. In the remifentanil group, anaesthesia was induced with remifentanil and propofol and maintained with remifentanil infusion and inhalation of 60% N2O. Atracurium was used for muscle relaxation in both groups. Abdominal pain was observed in 79 patients (52.6%) in the remifentanil group, 10 of whom required a therapeutic intervention, but in only three patients in the control group, none of whom required an intervention (P value = 0.001). Postoperative nausea and vomiting were reported in seven and 10 patients (4.7%) in the remifentanil and control group, respectively. These findings indicate that abdominal pain is very common in patients receiving remifentanil by infusion for cataract surgery.

'Aorta code' implementation and preliminary results of a multidisciplinary protocol for patients with acute aortic syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Ferrera Duran ◽  
I Vilacosta ◽  
J Perez-Villacastin ◽  
P Busca ◽  
A Carrero ◽  
...  
Keyword(s):  
Emergency Room ◽  
Aortic Surgery ◽  
Referral Hospital ◽  
Acute Aortic Syndrome ◽  
Preliminary Results ◽  
Group I ◽  
Aortic Pathology ◽  
Number Of Patients ◽  
Group Ii ◽  
Patient’S Outcome

Abstract Background Expediting life-saving care for patients with acute aortic syndrome (AAS) through multi-disciplinary code protocols is a potential method to improve outcomes. Other code protocols for cardiovascular emergencies, such as ST-elevation myocardial infarction and stroke have shown excellent results. Aim To examine the implementation and preliminary results of a code protocol “Aorta Code” for patients with AAS in a healthcare framework of a 4-hospital network in our city by reviewing the number of patients detected, patient's transference time, aortic surgery and patient's outcome during a trial period of 10 months (April 2019-January 2020). A comparison with a previous 2-year period with standard of care management of AAS was performed. Methods “Aorta Code” uses a specific diagnostic algorithm to improve detection of patients with AAS at the emergency room, facilitates their quick transfer to the referral hospital by activating a paging system, and places acute cardiovascular care unit, operating room and surgeons specialized in aortic pathology on standby. Results Compared to a previous 2-year period (2017–2018) (group I), the current implementation of “Aorta Code” in a period of 10 months (group II) in our 4-hospital network involving the healthcare of 1.100000 inhabitants resulted in the detection of more patients with AAS (group-I: n=18 patients (0.8 patients/month), group-II: n=19 patients (1.9 patients/month); p=0.013). AAS detection in secondary hospitals importantly increased (33.3% vs 63.8%, p=0.07). The “Aorta Code” achieved a significant decrease in patient's transference time to referral hospital (group-I: median 259 min (IQR 150–1911), group-II: median 129 min (IQR 95.5–167.25); p=0.035). There was a marked reduction in the number of surgeons involved in the “Aorta Code” (group-I= 7 cardiac, 6 vascular, group-II= 2 cardiac, 2 vascular). Thirty-day mortality was lower in group-II in the whole AAS cohort (group-I= 22.2%, group-II= 12.5%; p=0.660) and in type A AAS (28.6% vs 18.2%, p=0.661). Misdiagnosis rate (false-calls): 11 patients (7 of them with non-acute aortic disease). Conclusion “Aorta Code” facilitates detecting patients with AAS at the emergency room, speeds them to the referral hospital center, allows patients to be treated by surgeons specialized in aortic surgery and improves patient's outcome. Further prospective studies examining the utility of “Aorta Code” are warranted. Funding Acknowledgement Type of funding source: None

Comparison of Outcome of Lateral Pinning Versus Medial and Lateral Cross Pinning in Childhood Supracondylar Fractures of Humerus

2021 ◽  
Vol 15 (9) ◽  
pp. 2873-2875
Author(s):  
Mudassar Nazzar ◽  
Muhammad Adeel-Ur- Rehman ◽  
Rizwan Anwar ◽  
Omer Farooq Tanveer ◽  
Muhammad Abdul Hanan ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Ulnar Nerve ◽  
Functional Outcomes ◽  
P Value ◽  
Supracondylar Fractures ◽  
Group I ◽  
Pin Fixation ◽  
Group Ii ◽  
Carrying Angle ◽  
Ulnar Nerve Injury

Objectives: To compare the complications and outcomes of lateral entry pin fixation with medial and lateral pin fixation for Gartland type III supracondylar fractures of humerus. Methodology: This prospective comparative study involving 190 patients of Gartland type III close supracondylar fractures were included. from March-2019 to Dec-2020. In all patients, initially the elbow was mobilized using the splint placed above the elbow joint at 30 to 45 degrees’ flexion. After closed reduction, lateral pinning was applied in group I and in group II lateral and medial cross pinning was applied using the standard protocol. Patients were followed for iatrogenic ulnar nerve injury, radiologic and function outcomes in-terms of loss of reduction, elbow range of motion, loss in carrying angle and functional outcomes. Results: The two groups were comparable for loss of elbow range of motion, loss of carrying angle and loss of Bauman's angle. On clinical examination, immediate post-operative ulnar nerve injury was diagnosed in 4 (4.2%) cases in group II and in no patient in group I (p-value 0.12). Satisfactory functional outcomes were achieved in 85 (89.5%) patients in group I and in 88 (92.6%) patients in group II (p-value 0.44). Conclusion: Lateral pinning provided stable fixation clinically and radiologically as compared to lateral and medial cross pinning. Keywords: Supracondylar fracture of Humerus, Iatrogenic ulnar nerve injury, Lateral pin entry, lateral and medial cross pin entry.

Comparison of Adverse Outcomes in Cirrhotic and Non-Cirrhotic Patients with Covid-19 Disease

2021 ◽  
Vol 15 (7) ◽  
pp. 2289-2291
Author(s):  
Jahangir Anjum ◽  
Talal Safdar ◽  
Muhammad Imran ◽  
Muazzam Fuaad ◽  
Waheed Iqbal ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Teaching Hospital ◽  
Adverse Outcomes ◽  
Chronic Liver ◽  
P Value ◽  
Group I ◽  
Cirrhotic Patients ◽  
Group Ii ◽  
Disease Study

Objective: The aim of this study is to determine the comparison of adverse outcomes in cirrhotic and non-cirrhotic patients presented with coronavirus disease. Study Design: Place and Duration: The department of Medicine of Divisional Headquarters Teaching Hospital Mirpur Azad Kashmir and Mohiuddin Teaching Hospital, Mirpur AJK for six months during the period from October 2020 to March 2021. Methodology: Total 80covid-19 patients of both genders with or without chronic liver disease were enrolled in this study. Patients were aged between 20-55 years. Patients were divided in to two groups. Group I (with cirrhosis 40 patients) and group II (without cirrhosis 40 patients). Outcomes in term of mortality between both groups were examined. All the data was analyzed by SPSS 26.0 version. Results: There were 24 (60%) males and 16 (40%) were females with mean age 44.19±7.65 years in group I while in group II 27 (67.5%) and 13 (32.5%) patients were males and females with mean age 43.62±5.34 years. We found that mortality rate among patients of group I (cirrhotic) had high mortality rate13 (32.5%) as compared to patients without cirrhosis 5 (12.5%) in group II with p-value 0.0003. Conclusion: We concluded in this that frequency of adverse outcomes was significantly high among cirrhotic patients with coronavirus disease as compared to non-cirrhotic patients. Keywords: Corvid-19, Mortality, Chronic Liver Disease

scholarly journals Transport Factors Affecting the Outcome of Referred Neonates Admitted in A Tertiary Care Hospital

2018 ◽  
Vol 41 (3) ◽  
pp. 159-164 ◽  
Author(s):  
Madhabi Baidya ◽  
Mahfuza Shirin ◽  
Liton Chandra Saha
Keyword(s):  
Perinatal Asphyxia ◽  
Care Center ◽  
Tertiary Care ◽  
Preterm Neonates ◽  
P Value ◽  
Care Hospital ◽  
Cross Sectional ◽  
Neonatal Transport ◽  
Group I ◽  
Group Ii

Background: Adequate neonatal transport is a key component of care of the sick newborns who require referral to tertiary care center. Poor transportation is one of the iatrogenic factors associated with greater neonatal mortality. Neonatal transport is the greatest challenge faced today in our country. The purpose of this study was to find out characteristics of transport of referred neonates and to idention the factors that contribute to mortality.Methodology: This cross sectional study was conducted in Dhaka Shishu (Children) Hospital from June 2013 to November 2013. Both term and preterm neonates who were referred within first seven days of life were included and those with gross congenital abnormalities and left against medical advice were excluded from the study. After enrollment, data were collected using a structured questionnaire including birth details, interventions before transportation, reasons for referral, and details of transportation. Outcome & duration of hospital stay were also recorded. Neonates who were expired considered as group I and who were survived considered as group II. The study variables were analyzed for their association with immediate outcome by applying chi square test and t test. P value <0.05 was considered significant.Results: This study found that out of 332 neonates 181 were expired with 54.5% mortality rate. One eighty one neonates who were expired, considered as group I and one fifty one neonate were survived, considered as group II. The mortality was significantly high in male neonates [RR 0.80 (0.66-0.97)] and neonates those delivered at home [RR 1.34(1.10-1.64)] (p<0.05). Perinatal asphyxia, pre-term low birth weight, neonatal sepsis were the main causes of referral. It was found that transportation without any referral note [RR 1.40 (1.14- 1.71)], no advice regarding maintenance of airway[RR 1.50(1.17- 1.92)]and keeping warm [RR 1.51(1.17-1.950], resuscitation on admission [RR 1.63(1.23-2.17)] and transportation required > 3hours [RR 1.36(1.09-1.69)] were associated with significantly higher mortality among referred transported neonates(p<0.05).Conclusions: This study found that male neonates, home delivery, transportation without any referral note, no advice regarding maintenance of airway and keeping warm, resuscitation needed on admission and prolonged transportation time were significantly associated with mortality of referred transported neonates.Bangladesh J Child Health 2017; VOL 41 (3) :159-164

scholarly journals The prognostic role of inflammatory markers in COVID 19 patients – A retrospective analysis.

2021 ◽  
Author(s):  
Shivkumar Gopalakrishnan ◽  
sangeetha kandasamy ◽  
S.Malini ◽  
S.Peer Mohamed ◽  
k.velmurugan
Keyword(s):  
Inflammatory Markers ◽  
Severe Disease ◽  
Radiation Hazard ◽  
P Value ◽  
Binary Logistic Regression Analysis ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
D Dimer

Abstract Background. Approximately 5% of COVID-19 patients suffer near fatal disease. Clinical and radiologic features may predict severe disease albeit with limited specificity and radiation hazard. Laboratory biomarkers are eyed as simple, specific and point of care triage tools to optimize management decisions.This study aimed to study the role of inflammatory markers in prognosticating COVID-19 patients.Methodology. A hospital based retrospective study was conducted on COVID-19 adult inpatients classified into three groups as mild disease-recovered [Group I], severe disease-recovered [Group II] and dead [Group III]. Categorical outcomes were compared using Chi square test. Univariate binary logistic regression analysis was performed to test the association between the explanatory and outcome variables. Unadjusted OR along with 95% CI was calculated. The utility of lab parameters (Ferritin, LDH, D dimer, N/L ratio and PLT/L ratio) in predicting severity of COVID-19 was assessed by Receiver Operative Curve (ROC) analysis. P value < 0.05 was considered statistically significant.Results. The mean age was 49.32 +/- 17.1 years. Among study population, 378 were Group I, 66 Group II, and 56 Group III. Median levels of Ferritin among the 3 groups were 62ng/mL, 388.50 ng/mL and 1199.50 ng/mL. Median value of LDH were 95U/L, 720 and 982.50(p <0.001). D-dimer values of 3 groups were 23.20ng/mL, 104.30 ng/mL and 197.10 ng/mL (p <0.001). CRP done qualitatively was positive in 2 (0.53%), 30 (45.45%) and 53 (94.64%) of patients. The odds of patients suffering severe COVID-19 rose with rising values of ferritin, LDH and D-dimer [unadjusted OR 1.007, 1.004 &1.020]Conclusion. One time measurement of serum ferritin, LDH, D-dimer and CRP is promising to predict outcomes for COVID 19 inpatients. Single qualitative CRP was equally good but more cost effective than quantitative CRP. The most specific combination was NLR, Lymphocyte percentage and D-dimer levels done between 7th – 10th day of symptoms.

scholarly journals Results of modern tuboperitoneal infertility treatment

2009 ◽  
Vol 66 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Drenka Turjacanin-Pantelic ◽  
Dragana Bojovic-Jovic ◽  
Biljana Arsic ◽  
Eliana Garalejic
Keyword(s):  
Statistical Analysis ◽  
Surgical Treatment ◽  
Infertility Treatment ◽  
P Value ◽  
Modern Approach ◽  
Vitro Fertilization ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Background/Aim. A modern approach to surgical treatment of tuboperitoneal infertility is based on laporascopic techniques. The aim of this study was to compare results of tuboperitoneal infertility treatment by the use of laparoscopy and classical laparotomy. Methods. A retrospectiveprospective study on 66 women treated operatively form tuboperitoneal infertility was performed. Data from patient's anamnesis and those related to the surgical treatment results, obtained by the use of an inquiry, were used in retrospective and prospective analysis, respectively. Chi-square test was used in statistical analysis. P value < 0.05 was considered significant. Results. Classical laparotomy was used on 34 women in a period from 1996 to 1997, while 32 women were operated laparoscopically in a period from 1999 to 2000. The results were as follows: a total number of conceived women was 16 (24%), seven in the group I (20.6%) and nine in the group II (28.1%); 13 women were with one pregnancy, six in the group I (17.6%) and seven in the group II (22%). Twice pregnant were three women, one in the group I (2.9%) and two in the group II (6.2%). The resulting pregnancies were: five women with abortion spontaneous, two in the group I (5.9%) and three in the group II (9.4%); two women with extrauterine pregnancy in the group I (5.9%); three with pretemporal birth, one in the group I (2.9%) and two in the group II (6.2%), while six women were with the temporal birth, two in the group I (5.9%) and four in the group II (12.5%). Statistical analysis showed that there was no significant difference in the results between these two groups. Conclusion. Surgical treatment of tubeperitoneal infertility, regardless of the used methods (classical laparotomy or laparoscopy) was successful in a great number of women. These methods have a great advantage over in vitro fertilization, and they should not be ignored.

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