Research Article
Open Access
Comparing the Efficacy of Regional Anesthesia Techniques in Pediatric Patients Undergoing Orthopedic Surgery
Pages 62 - 64
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Abstract
Background: Regional anesthesia techniques, such as epidural and peripheral nerve blocks, are increasingly used in pediatricorthopedic surgery to provide effective pain relief and reduce opioid consumption. However, the comparative efficacy of these techniques remains understudied in children. Objective: To compare the efficacy of epidural anesthesia and peripheral nerve blocks in pediatric patients undergoing orthopedic surgery, focusing on pain control, opioid consumption, and postoperative complications. Methods: A prospective, randomized controlled trial was conducted with 120 pediatric patients aged 2–12 years. Patients were randomized to receive either epidural anesthesia or peripheral nerve blocks. Primary outcomes included postoperative pain scores (using the FLACC scale) and opioid consumption. Secondary outcomes included time to ambulation and incidence of complications. Results: Both techniques provided effective pain relief, with no significant difference in FLACC scores at 6 hours (epidural: 2.1 ± 1.3 vs. nerve block: 2.3 ± 1.2, p=0.45). Opioid consumption was lower in the nerve block group (0.2 ± 0.1 mg/kg) compared to the epidural group (0.4 ± 0.2 mg/kg, p<0.01). Time to ambulation was shorter in the nerve block group (8.2 ± 2.1 hours) compared to the epidural group (12.5 ± 3.4 hours, p<0.001). Complications were rare in both groups. Conclusion: Peripheral nerve blocks offer comparable pain relief to epidural anesthesia but are associated with lower opioid consumption and faster recovery. Both techniques are safe and effective for pediatricorthopedic surgery.
Research Article
Open Access
Serum Cholinesterase as a Biomarker for Liver Cirrhosis
Renuka Ramesh Agrawal,
Ravindra Kishor Agrawal
Pages 57 - 61
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Abstract
Background – Cirrhosis of the liver is a frequently encountered disease. The commonly available tests used in assessing the severity of cirrhosis have certain drawbacks. The estimation of serum cholinesterase is useful to assess the severity and prognosis of the disease. Aim – The aim of the study is to compare the level of serum cholinesterase in patients with cirrhosis with other tests of liver function like serum albumin, serum bilirubin, PT INR, MELD and Child Pugh score. Materials and Methods – This was a hospital based observational study conducted for six months between March to August 2016 at Apeksha Critical care and multispecialty hospital private limited Nanded. Patients who were diagnosed with cirrhosis both clinically and by ultrasound were included in the study. The assay for serum cholinesterase was done in all patients. The correlation between the values of serum cholinesterase and serum albumin, bilirubin, INR, Child Pugh and MELD score were analysed. Results – A total of 100 patients were studied. The majority were males ( 80%) in the age group of 41to 50 years.(40%). The most common aetiological factor in this study was alcohol (68%). Of the clinical signs studied 83% had ascites, 72% had icterus, 63% had splenomegaly and 31% had hepatic encephalopathy. On analysis of the laboratory parameters, 71% had a bilirubin level more than 3 and 73% had an INR less than 1.7. The majority of the patients were in Child Pugh class B ( 41%) and 64% had MELD score greater than 15. On analyzing the correlation between serum cholinesterase and other tests of liver function, it was found that there was significant correlation with albumin, bilirubin, INR levels, Child Pugh and MELD score. Conclusion – A significant correlation was found between serum cholinesterase levels and the severity of Cirrhosis.
Research Article
Open Access
Risk factors of severe hypoglycemia among patients with type 2 diabetes mellitus in outpatient clinic of Tertiary Hospital
Sravan Reddy V,
Sarada Vempaty
Pages 51 - 56
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Abstract
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Background: Studies around the world have investigated which factors are associated with episodes of alteration of blood glucose level. It is through the characterization of these factors that nurses can plan and intervene accurately in the control of serum glucose levels in people with diabetes. Materials and methods: This study was a prospective cohort study conducted at Department of Medicine and Psychiatry, Malla Reddy Institute of Medical sciences. The clinic treats patients with various complications. Based on medical records, there were 4129 subjects with diabetes. A consecutive recruitment method was performed from October 2016 to January 2017. The inclusion criteria were T2DM patients, aged more than 18 years, who had regularly visited the clinic for at least one year. Result: Prevalence of hypoglycemia was 57.44% (95% CI 52.48-62.25). Severe hypoglycemia was found in 10.7% of the patients. The first reported symptom of hypoglycemia was dizziness (72%). The most common etiological factor leading to hypoglycemia was missing a meal (89.3%). Females were at a significant higher risk of developing hypoglycemia (OR 1.3, 95% CI 1.05-1.5, P < .05). Conclusion: This study has established the high prevalence of self-reported hypoglycaemia in the rural settings where resources are limited to monitor the glucose levels. The high prevalence urges the need for the primary care physicians to enquire about the hypoglycemic symptoms to all diabetic patients at each visit. It is also important to educate these patients about the symptoms of hypoglycemia and the importance of reporting of such symptoms, which will help in adjusting dose and preventing future attacks.
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Research Article
Open Access
Relation of Echocardiographic Parameters to Outcome of Patients with Severe Sepsis and Septic Shock
Pages 41 - 50
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Abstract
Myocardial dysfunction is one of the most important features of sepsis. The presence of cardiac dysfunc- tion in sepsis has been associated with high mortality rate in septic patients. Material & Methods: This was prospective, observational cohort (patient with severe sepsis and septic shock) study conducted over period of one year in medical intensive care unit. Patients with an initial diagnosis of severe sepsis or septic shock were enrolled. Aims & Objectives: To study demographic pro le, APACHE-II score and echocardiographic parameters in patients with severe sepsis and septic shock and to nd out relation of echocardiographic parameters to variables of sepsis and outcome. Study Popu- lation: All patients underwent laboratory investigations, APACHE-II score and Transthoracic 2- Dimensional echocardio- gram. Statistical analysis: Data was analysed by trial version SPSS-16 for mean, SD, chi-square test with‘p’ <0.05 was considered as statistically signi cant.
Research Article
Open Access
Pre-operative Speckle-tracking Imaging to Predict the Need for Right Ventricular Support in Patients Undergoing Left Ventricular Assist Device Implantation
Pages 31 - 40
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Abstract
Background: Right ventricular (RV) dysfunction after left ventricular assist device (LVAD) implantation significantly complicates post-device management and has been shown to be associated with increased mortality. Pre-operative identification of patients who may develop post-LVAD RV dysfunction is challenging. This study was designed to evaluate pre-operative echocardiographic speckle tracking imaging as a predictor of post operative RV dysfunction. Methods: Thirty-nine patients who underwent Heartmate II LVAD placement in a single center were studied. Pre- and post-operative clinical, hemodynamic, laboratory, and echocardiographic data were prospectively collected as part of an ongoing institutional LVAD database. RV strain parameters were measured retrospectively using off-line speckle- tracking analysis software. Results: Twenty five of 39 LVAD recipients developed acute RV failure during the early post-operative period. RV function in 14 of these recipients improved with inotropes and judicious adjustment of LVAD parameters. Eleven patients, however, expired despite aggressive medical therapy including 7 patients who underwent placement of an RVAD.
Research Article
Open Access
Patterns and determinants of cardiovascular drug utilization in coronary care unit patients of a tertiary care hospital
Pages 21 - 30
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Abstract
A wide variation exists in the patterns of pharmacotherapy among patients admitted with cardiovascular diseases. Very few studies have evaluated the potential determinants of drug utilization. Our objective was to evaluate the clinical characteristics and patterns of cardiovascular drug utilization among patients in coronary care unit (CCU) and assess the determinants of cardiovascular drug use among patients with coronary artery disease (CAD). Methods: In this retrospective cohort study, the medical records of CCU patients were reviewed inde-pendently by two trained physicians over one year. Patients were analyzed as two groups e those with CAD and without CAD. Multivariate logistic regression was done to identify the determinants of car- diovascular drug utilization in the CAD group.
Research Article
Open Access
Diastolic blood pressure is predictive of an elevated ventilatory efficiency slope in at-risk middle-aged obese adults that are asymptomatic for cardiovascular disease
Pages 11 - 20
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Abstract
Cardiopulmonary exercise tests (CPET)assess oxygen uptake (VO ) and ventilatory efficiency (V /VCO slope) as both are predictive measures of cardiovascular disease (CVD) severity in symptomatic adults. Specifically, the slope is a powerful prognostic tool for assessing CVD severity and prognosis as it is effectively independent of a patient’s capacity to reach volitional fatigue. In asymptomatic adults, several clinical risk factors for CVD have been established for use in health assessments, and as a method for early CVD detection and prevention.
Research Article
Open Access
Spontaneous Hemopericardium with Dabigatran Etexilate
Pages 1 - 10
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Abstract
A 66-year-old male who presented to ED with chest pain associated with shortness of breath. At presentation, he was found to be in atrial brilla- tion (A- b) with rapid ventricular rate (RVR). A- b converted spontaneously to normal sinus rhythm (NSR). However, he remained tachycardic, hypo- tensive and dyspneic. A stat chest computed tomography scan (CT) was performed and showed large pericardial effusion with Houns eld units of 12 in the anterior pocket and 21 in the posterior pocket. A beside echocar- diography was performed, and was consistent with cardiac tamponade. Pt was taken emergently to cardiac catheterization lab for pericardiocentesis. 500 cc of hemorrhagic pericardial uid was aspirated, and hemodynamics improved immediately. Approximately 2 weeks prior to the admission, the patient had been started on dabigatran etexilate (Pradaxa) for newly diag- nosed non-valvular paroxysmal atrial brillation.
