ABSTRACT
Background:Spinal anaesthesia has become the method of choice for caesarean section and hyperbaric bupivacaine isthe most commonly used drug. Intrathecal fentanyl is reported to augment analgesia produced by local anaesthetics through binding with spinal opioid receptors. Clonidine has antinociceptive effect by its action on the spinal α2 receptors and intrathecal clonidine has been successfully used for postcaesarean analgesia. Objectives: To compare efficacy and side effects of fentanyl and clonidine as adjuvant to hyperbaric bupivacaine used in spinal anaesthesia for caesarean section. Methods: Ninety healthy patients of ASA physical status l & ll, aged 18-30 years, undergoing elective caesarean section under spinal anaesthesia were randomized to two equal groups. One received 25 μg fentanyl and another 45 μg clonidine, with 0.5% hyperbaric bupivacaine (2.2 ml) intrathecally in total volume of 2.8 ml made up by addition of normal saline. Heart rate, blood pressure and SpO2 were documented at regular intervals. Pain scores were recorded by visual analogue scale. Results: The duration of analgesia was 236.9 ± 19.70 min with fentanyl and 217.2 ± 20.32 min with clonidine (p < 0.001). Hypotension occurred in 19 and 37 subjects receiving fentanyl and clonidine respectively (p < 0.001). Conclusion: Clonidine is not superior to fentanyl intrathecally as hypotension is more frequent without any significant prolongation of analgesia.
ABSTRACT
Background & objectives: There has been an extensive invasion of tuberculosis at the global level by multidrug resistant as well as extensively drug resistant organisms. Attempts to recover the pathogen in pure culture have frequently failed since the specimens are often highly contaminated and also due to use of insufficient or over-active decontamination procedures. Hence in the present study different methods of decontamination were tested to evaluate their independent efficacies for culture of Mycobacterium tuberculosis. Methods: A total of 359 samples (241 sputum, 59 urine, 50 endometrium biopsy, 9 pus samples) from clinically suspected cases of tuberculosis were subjected to four different methods of decontamination followed by inoculation in Lowenstein-Jensen medium (LJM), and bilayered medium (BLM) and Kirchner’s liquid medium (KLM) to determine the influence of differential decontamination processes. Sputum scanty and positive specimens were graded and each sample was subjected to decontamination by four different techniques. Results: Treatment of specimens with 4 per cent NaOH yielded minimum recovery of pure cultures, while use of 2 per cent NaOH produced higher number of contaminants compared to other methods of decontamination. Addition of N-acetyl L-cystein (NALC) coupled with 2 per cent NaOH to the samples for decontamination provided fairly reasonable recovery, but the highest number of M. tuberculosis cultures could be obtained when the specimens were treated with tri-sodium phosphate and benzalkonium (TSPB). Among the sputum positive cases recovery of growth of M. tuberculosis was higher with greater number of bacilli present in the specimens. Regarding the influence of culture media, BLM produced not only rapid growth, but reasonably higher rate of isolation of M. tuberculosis. Interpretation & conclusions: Although use of TSPB was found to be an efficient method of decontamination for successful isolation of M. tuberculosis from contaminated samples, both NALC+ 2 per cent NaOH and TSPB also showed significant recovery of M. tuberculosis cultures in BLM that can facilitate early diagnosis and initiation of treatment.
ABSTRACT
Background & objectives: There is resurgence of tuberculosis in recent years in spite of availability of comprehensive multidrug therapy. Conventional culture media require a long time for the appearance of growth of Mycobacterium tuberculosis, while the other methods are expensive. Hence, a rapid low cost and safe bilayered medium was developed for early growth and sensitivity testing of M. tuberculosis and the results were compared with those on Lowenstein Jensen medium, Middlebrook 7H10 and Kirchner’s liquid media. Methods: A specially designed bilayered medium, consisting of a lower layer of Lowenstein Jensen medium without malachite green and a top layer of Middlebrook 7H 10 medium with added antibiotics and antifungal agents was prepared. Sputum from clinically suspected cases of tuberculosis, pleural fluid and pus samples were inoculated on the bilayered medium along with the inoculation on other conventional media after proper decontamination and concentration of the samples. Antibiotic sensitivity pattern was determined against a few rapidly growing control and test strains by disc diffusion technique and the results could be recorded by 3 to 7 days. Results: Statistically significant (P< 0.001) isolation rate was obtained on this bilayered medium when compared with the other three media, being 81.7 per cent growth by 7 days. Antibiotic sensitivity test could be recorded by 3 days in case of the rapidly growing strains on this medium, and by 7 days in case of M. tuberculosis strains. Interpretation & conclusions: Bilayered medium produced rapid growth earliest by 48 h, higher isolation rates were achieved as compared to the other conventional media and drug sensitivity testing could also be carried out successfully. Thus, the bilayered medium can be used for obtaining early culture report.