ABSTRACT
Background & Objective: NMDA is a receptor for the excitatory neurotransmitter glutamate, which is released with noxious peripheral stimuli. The activation of NMDA receptors has been associated with hyperalgesia, neuropathic pain, and reduced functionality of opioid receptors. Hyperalgesia and neuropathic pain are a result of increased spinal neuron sensitization, leading to a heightened level of pain. The reduced function of opioid receptors is caused by a decrease in the opioid receptor's sensitivity. Therefore, NMDA antagonists have a role in these areas of pain management. Ketamine is a strong NMDA antagonist. To study the role of NMDA receptors in pain and modulation by blocking the receptors through antagonist ketamine given pre-emptively and postoperatively via epidural route in patients of lower limb amputation. Methodology: This study was conducted at Civil Hospital Ahmedabad during the year 2012-2015 with the permission of ethical committee of hospital and after written informed consent of 60 adult patients of age group 18- 60 years of either sex and ASA grade 1 or 2 posted for lower limb amputation. Patients were divided into three groups where one was administered epidural opioid and ketamine, the second group was administered epidural opioid only and in the third group epidural saline was administered. Pain scores of all the groups were compared. Results: Requirement of first dose of analgesia in group 1 is after 12.5±1.03hrs, in group 2 after7.6± 0.98 hrs and in group3 after 3.4± 0.8hrs and average duration between consecutive analgesic doses were 11.5hrs in group 1, 7.6hrs in group 2 and 4.5hrs in group 3 respectively. Conclusion: NMDA receptor antagonist is effective in management of acute post-operative pain compared to opioid analgesics alone as the time to first dose of analgesia is much larger in group 1 than 2 and 3. Ketamine has definitive role in opioid sparing effect as supplemental analgesic requirement is decreased.
ABSTRACT
Background and Objectives: The ABO blood group is arguably the best known, yet the most functionally mysterious, genetic polymorphism in human. A number of studies have shown the susceptibility to several infectious diseases is related to patient’s blood group. Malaria is one of the diseases and Malaria remains the most complex and overwhelming health problem facing humanity especially in the vast majority of tropical and subtropical regions of the world. The resurgence of malaria is a serious public health problem in many parts of the world including India. It is therefore important to identify the factors which contribute to susceptibility of hosts. AIM: In order to study the distribution and correlate the incidence of ABO blood group in healthy individuals and Plasmodium falciparum malaria patients admitted in Civil Hospital, Ahmedabad with Plasmodium falciparum infection. To evaluate the morbidity and mortality associated with Plasmodium falciparum malaria infection. To figure out the correlation between ABO blood group and complications caused by Plasmodium Falciparum infection. To find out the blood group which confer some resistance against the plasmodium falciparum malaria infection. Methods: The study conducted from January 2009 to August-2010 (1year, 8 months) on 62 diagnosed cases of Plasmodium falciparum malaria patients admitted in Civil Hospital, Ahmadabad. Patients who were tested positive for plasmodium falciparum and treated for the same in the indoor wards of Civil Hospital, Ahmedabad were taken for study. Observation and Results: out of 62 cases 21 (33.80) were in blood group A, 19 (30.64) were in blood group B, 7(11.29) were in blood group AB and 15 (24.20) were in blood group O. Out of 660 controls selected 161 (24.39%) were of blood group A, 224 (33.93%) were of blood group B, 68 (10.30%) of blood group AB and 207 (31.36%) belonged to blood group O. Conclusion: So we see through Statistical data that although blood group B is commonest in controls but in patients plasmodium falciparum malaria blood group A (33.80%) followed by blood group B (30.64%), blood group O was at 3rd place and AB was least common in cases. By Statistical data there is high relative risk in blood group A (1.38) followed by blood group AB (1.09). Distribution of blood group in healthy individual shows blood group B is more common in India followed by group O then group A and lastly group AB, whereas falciparum malaria incidence is highest in group A (high relative risk is present) followed by group B, then group O and least in group AB. Incidence of malaria is seen higher among young age group (below 30 years) and in male sex probably due to occupational exposure.Highest morbidity and complications are observed in group A followed by group B. Group O appears to be immune to severe complications of falciparum malaria. Mortality is seen equally in group A and B. Death is not noted in group O. As blood group O reduces plasmodium rosseting.