ABSTRACT
In an attempt to improve the patient comfort after thyroidectomy, various methods of pain-relief have been tried to prolong the duration and to improve the quality of postoperative analgesia. Cervical plexus block using steroids like dexamethasone, administered as an adjuvant along with local anaesthetic agents, could be of particular interest. Methods: Fifty patients undergoing elective thyroidectomy were randomly assigned to one of the following groups containing twenty five patients each. Group D patients received 8 mg (2 ml) of dexamethasone added to 13 ml of 0.25% levobupivacaine as cervical plexus block (total volume 15 ml). Group L patients received 13 ml of 0.25% levobupivacaine and 2 ml of isotonic saline (15 ml in total) as cervical plexus block. Analgesic effect was evaluated by measuring pain intensity (VAS score) and duration of analgesia. Results: A longer delay was observed for first requirement of supplementary analgesic in group D (572.24±68.42 minutes ) compared to group L (402.46±52.34 minutes). Total consumption of diclofenac sodium in first 24 hours in postoperative period was significantly less in group D. No significant side effects were noted. Conclusion: Dexamethasone, used as adjuvant to levobupivacaine for cervical plexus block in patients undergoing thyroidectomy, improve the quality and prolong the duration of post operative analgesia.
ABSTRACT
Antimicrobials are very frequently used medications in Obstetrics and Gynaecology in there wide range of operative procedures and in treating various infections. Administering antimicrobial prophylaxis is a standard practice in caesarean section which is given in pre, intra and postoperative peroids. The present study was aimed to explore the antibiotic usage pattern in caesarean section in Bankura Sammilani Medical College , Bankura. Methods: A prospective observational study was conducted in the Department of Gynaecology and Obstetrics (G&O) in collaboration with the Department of Pharmacology of the Bankura Sammilani Medical College, Bankura. The study was carried out for a period of two months from February to March 2019. Results: Among 364 cases mostly were primigravida, commonest prescribed antibiotic being ceftriaxone parenteral followed by cefuroxime by oral route. Conclusion: Appropriate dose with proper duration of antimicrobial therapy in both elective and emergency Caesarean Section reduces the infective complication of mother and the new born.
ABSTRACT
Informed consent remains an important ethical and legal document ensuring autonomy of the research participants. Objective: The present study was undertaken with the idea to find out the gap in respect to knowledge, attitude and practice in acquiring Informed Consent so that we can improve the procedure of acquiring consent in accordance with the present regulations. Methods: Questionnaire based close ended cross sectional study within 1 week time frame in Bankura Sammilani Medical college involving the resident doctors pursuing their post graduate degrees. Results: Though 83.4% had the knowledge but 68% do not feel necessary to take consent. The major limitation being excessive work load and lack of time. Conclusion: The study revealed that there was lot of lacunae in their knowledge giving rise to improper attitude and practice regarding Informed consent procedure in a research project.
ABSTRACT
In the absence of effective vector control measures and vaccines against leishmaniasis, effective chemotherapy remains the mainstay of treatment. Identification of post-kala-azar dermal leishmaniasis (PKDL) is important due to the long and toxic treatment and the fact that PKDL patients may serve as a reservoir for visceral leishmaniasis (VL). This retrospective study was done to assess the outcome of pharmacotherapy in post-kala-azar dermal leishmaniasis (PKDL) patients in a specialty public hospital in Kolkata. Methods: The hospital records of all consecutive PKDL patients admitted at Calcutta School of Tropical Medicine (CSTM), Kolkata during the last five years - 2010-2014, were reviewed and the relevant information inputs as documented studied to realize the noted objectives. Clinical presentation on admission including presence of co-infections (particularly HIV), trends and patterns of treatment regimens and rationale thereof, if available; treatment (anti-leishmaniasis) outcomes in reference to efficacy, safety and tolerability, fatality like serious complications and mortality and adverse drug reactions (for anti-leishmaninal drugs primarily), if any was noted. Results: PKDL cases presented with insidious onset skin lesions of different types without much systemic illness. 2 out of 19 cases presented with fever and 2 other cases had mild anemia. PKDL cases presented with 4 types of skin lesions. Multiple macular or hyppigmented macular lesions were commonest, 8 out of 19 cases (42.10%). In PKDL cases treatment outcome was difficult to say unless parasitologically declared negative, though clinically regression of the lesions were visible in all cases. Tolerability was least with AmB followed by SSG and best with miltefosine. Conclusion: So, it can be concluded from this study that in this institute PKDL were treated with conventional and liposomal AmB as well as with SSG, miltefosine and combination therapy. Among the regimens short course L-AmB was found to be the most efficacious and tolerable in respect to ADRs and hospital stay.
ABSTRACT
Osteoarthritis (OA) is the most common type of arthritis. Its high prevalence, especially in the elderly, and the high rate of disability related to disease make it a leading cause of impaired mobility in the elderly. To evaluate the efficacy, safety and tolerability of tapentadol in OA of knee joint in Indian population this study was undertaken. Methods: A prospective observational study involving patients of 40 years and above suffering from moderate to severe pain due to OA of knee joints attending the orthopaedics OPD of the National Medical College were recruited according to inclusion and exclusion criteria. Pain intensity was measured by 10 point VAS score on baseline and 2 follow up visits at 1st and 2nd week. Patients were given 50 -100 mg twice daily oral tapentadol tablets. ADRs were noted and data analysis done. Results: Total of 84 with baseline mean VAS score was 4.7 (SD 0.62). Significant reductions from baseline were noted at 1 week and 2 weeks follow up visits. At first follow up visit i.e on week 1 the mean pain intensity score was 2.48 (SD 1.45) whereas in 2nd follow up visit on week 2 it was 1.7 (SD 1.39). The change in pain intensity score were statistically significant (p<0.0001) for both the situations. Adverse drug events were mostly non serious. Commonly presented ADRs were diarrhoea, nausea, dizziness, constipation and hyperhidrosis. The incidence were around 6%. Conclusion: This observational study of pain relief in patients suffering from moderate to severe pain due to OA had been treated with tapentadol showed significant clinical improvement with few adverse effects. There are limitations due to small sample size and non-comparative design.
ABSTRACT
Background: As hypofractionated radiotherapy for post-operative breast cancer patients safe, effective and more convenient, it might be beneficial for patients of developing countries like ours. Objective: This study was done to evaluate the safety and efficacy of hypofractionated whole breast radiation therapy in patients who underwent breast conserving surgery and hypofractionated radiation therapy in patients who underwent mastectomy and axillary clearance. Materials and method: This cross sectional study was conducted in Delta Hospital Ltd, Dhaka, Bangladesh, including 50 postoperative patients, (12 patients in Breast Conservation Therapy group and 38 in Post Mastectomy Radiation Therapy group), with invasive ductal carcinoma of breast treated with this hypofractionated radiotherapy protocol during the last 1.5 year. The patients were treated with 3DCRT, LINAC, 6 MV photon and appropriate electron energy. Results: Minimal post treatment acute morbidity was observed. Forty seven patients (94%) had grade-I acute skin toxicity and only 3 patients (6%) developed grade-II acute skin toxicity. Conclusion: Hypofractionated radiotherapy is as safe and effective as conventional fractionated radiotherapy and superior in terms of convenience.
ABSTRACT
Background: Bronchodilators and glucocorticoids have been proven to be very effective and safe in asthma treatment, which recommend the use of steroids and β2-agonist (long or short acting) as the first line of treatment in of asthma. This study was aimed to compare the efficacy of three different inhaled corticosteroids ciclesonide, budesonide, and fluticasone in bronchial asthma. Methods: A total of 30 patients with mild to moderately persistent bronchial asthma was selected as per the NAEPP classification in the expert panel report (EPR) update 2002, NHLBL USA 2003. They were randomly divided into 3 groups of 10 patients each, and they were given 3 different steroid inhalers (ciclesonide or budesonide or fluticasone). Baseline and post-therapy spirometry were performed on day 1 and after 2 months and 6 months of treatment. Data were analyzed using SPSS software. Results: It was observed that most of the cases (43.3%) were between 26 and 35 years of age with female preponderance (56.6%). Significant symptomatic improvement was observed in all 3 groups. The percentage of improvement in mean peak expiratory flow rate was 17%, 18%, and 18% in ciclesonide, budesonide, and fluticasone group, respectively. The percentage improvement of forced expiratory volume in 1 second (FEV1)/forced vital capacity after bronchodilatation was 18%, 18%, and 19% in ciclesonide, budesonide, and fluticasone group, respectively. The improvement in mean FEV1% predicted was 20%, 19%, and 21% in three groups, respectively. Conclusion: Steroid therapy along with β2-agonists showed a significant improvement in symptoms. There was no difference among the three different types of steroids.
ABSTRACT
Importance of imaging in all clinical or medical research, and especially, of Computerized Axial Tomography (CAT scan), has demonstrated a unique place in diagnostic or radiation therapy. Two-dimensional images of internal structures of the body are examined and reported. This process of imaging, any anatomical location, viz. head and neck, thorax, pelvis, etc. takes about 30 seconds to perform with a minimal dose of less than 1.6- 2.0 mGy. The images are constructed by the hardware with software algorithm, using the attenuation and absorption of X rays of tissues, of varying electron densities of the anatomical structures. Sometimes a contrast dye is injected to a patient intravenously, rectally or orally, to make hollow or fluid-filled structures such as blood vessels more visible. Radiologists and radiation oncologists are confronted with a task to delineate the information of the CT images to a meaningful diagnosis. The images are, therefore, valuable for diagnostic reports, some of these may relate to cancerous tumors and tissues. Cancer treatment, radiation therapy or else, from such observations may start. But an artifact and distortion on such images will contribute to erroneous and/or unusable interpretations in offering a clinical report to provide wrong clinical decisions. The implications of the presence of distortion in CT images is, for a patient, described here so as to instruct the experts, in medical and clinical fields, to rectify the situation in acquiring a sharp and flawless image or in reaching the correct clinical goal.
ABSTRACT
Background: Cervical cancer remains the most common cancer among women in this part of the world. Bangladesh has the highest level of incidence and mortality rates due to cervical cancer among women. Cervical cancer is a preventable disease by screening and treatment of pre-invasive condition. Unfortunately, there is no effective screening program in Bangladesh. Objective: The objective was to analyze the clinico-pathologic characteristics and, subsequently the therapy delivered to the patients. Materials and method: This cross sectional study was done from January to December 2011 in oncology division of Delta Medical College and Hospital, Dhaka, Bangladesh. During this period a total of 2264 female carcinoma patients were registered. Out of them 523 patients were with the diagnosis of carcinoma of cervix. Evaluation and characterization of patients with carcinoma cervix were done according to the age group, clinical stages and surgical status. External beam radiotherapy (EBRT) and doses, brachytherapy doses and fractions, time interval between EBRT and brachytherapy, neo-adjuvant and concurrent chemotherapy status were the factors taken into consideration for the analysis of treatment of these patients. Results: The study revealed that the incidence of carcinoma cervix was 23% and highest incidence was between 40-50 years of age group, most of the patients were in Stage IIB (34%) and IIIB (28%) and 31% with unknown stage. About 44% patients were referred postoperatively and most of them with unknown stage. Almost 90% patients received EBRT, 24% patients received concurrent chemo-radiation, 46% of them completed 5 cycles of concurrent chemotherapy and 8.6% patients received neo-adjuvant chemotherapy. About 69% patients received brachytherapy with HDR Co-60 sources and 23% of patients received their brachytherapy treatment after 12 weeks of completion of EBRT. Conclusion: Lack of proper clinical evaluation and documentation, delay in referral and lack of implementation of a standard protocol for the treatment of carcinoma cervix are the major obstacles in our country.