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Background: This randomized prospective double-blind study was designed to evaluate the efficacy and side effects of low doses clonidine for perioperative haemodynamic stability and postoperative recovery.Methods: Patient’s with ASA grade I–II undergoing laparoscopic cholecystectomy were randomized into three groups of 30 patients each. All patients received either normal saline 10 ml (Group I) or 0.8 µg/kg (Group II) or 1 µg/kg (Group III) over duration of 180 seconds, 10 min prior to laryngoscopy and intubation. Anaesthesia was induced with 1% propofol (2 mg/kg) and maintained with nitrous oxide 60% in oxygen and isoflurane. The parameters assessed at various time intervals were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and sedation score.Results: Both doses of clonidine proved to be effective in perioperative haemodynamic stability. Clonidine 0.8 mcg/kg was as effectve and safer to Clonidine 1 mcg/kg for attenuatíon of the hemodynamíc responses to laparoscopy. There were no significant differences in the parameters of recovery between groups.Conclusions: Significant hemodynamic derangements can occur during laproscopic cholecystectomy at intubation, pneumoperitoneum and extubation. These were effectively attenuated by premedication with 0.8 mcg/kg and 1 mcg/kg of intravenous clonidine. Dose of 1 mcg/kg though found to be effective but produced adverse effects in form of hypotension and bradycardia.
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Background: Diabetes mellitus (DM) is one of the major causes of mortality & morbidity, and patient’s with better control of glycaemic parameters have lesser chronic complications associated with it. Though monotherapy with metformin is first choice for T2DM but is effective in less than 50% of patient and they should be managed with two drug therapy. Both Glimepiride and Sitagliptin are effective with metformin but there has been no study done in this region hence, we planned to study comparison of effects of glimepiride and sitagliptin with metformin in patient of T2DM.Methods: This prospective, open-label, randomized study was done in all patient diagnosed with T2DM, not adequately managed by metformin alone. The patient was divided into two group G (Glimepiride with Metformin) and Group S (Sitagliptin with Metformin) and had a follow up at 3 and 6 months. The biochemical parameters were assessed at 12 weeks and 24 weeks.Results: The result of this study show that both glimepiride and sitagliptin with metformin significantly (p<0.05) lowered both the fasting blood sugar as well as postprandial blood glucose at 3 and 6 months. Glimepiride was more effective in lowering (p<0.05) the plasma glucose at 3 months but both the drugs had comparable result at 6 months. This study also showed that glycosylated haemoglobin was lowered in both groups at three and six months as compared to Day 0 (p<0.05), with glimepiride having better control of glycosylated haemoglobin at 3 months with both groups having comparable result at 6 months.Conclusions: To conclude, this study compared effects of sitagliptin and glimepiride on glycaemic parameters in patients of T2DM and found that both drugs had comparable results.
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Background: The prevalence of type 2 diabetes mellitus(T2DM) is growing worldwide, and these patients may beasymptomatic and present with complications at the time ofdiagnosis. Diabetic neuropathy is the most commoncomplication affecting the patients who may present with distalpolyneuropathy at the time of diagnosis and also poorglycaemic control. The Diabetic peripheral polyneuropathyaffects approximately 1 in every 10 newly diagnosed patients,whereas two third of patients with diabetes mellitus haveclinical or subclinical neuropathy.Objective: This study is designed to find prevalence of diabeticperipheral neuropathy in Newly Diagnosed Patients of T2DM ina tertiary care hospital.Materials and Methods: This observational study was carriedout in patients diagnosed with T2DM as per ADA criteria. Athorough clinical examination; Nerve conduction velocitytesting; evaluation of plasma glucose and glycosylatedhemoglobin and assessment of neuropathy by using theDiabetic neuropathy index and diabetic neuropathy score wasperformed on all patients.Results: 18% of patients had signs of peripheral neuropathyas shown by NCV testing at the time of diagnosis. Thesepatients had elevated levels of glycosylated hemoglobin,fasting plasma glucose and 2-hour plasma glucose and lowerscores of DNI and DNS which were statistically significant. Themost common type of neuropathy seen in these patients wassensorimotor involvement with demyelinating type ofneuropathy with more involvement of lower limbs. The NCVstudies showed reduced distal latency and prolongedamplitude as well as conduction velocity in patients withdiabetic neuropathy.Conclusion: Our study showed that approximately 1 in 5newly diagnosed patients with type 2 diabetes mellitus are atrisk of developing diabetic peripheral neuropathy.
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Background: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition associated with high morbidity and mortality. A correct diagnosis of COPD can decrease symptoms, reduce frequency and severity of exacerbations, improve health status, improve exercise capacity, and prolong survival. Inhaler devices are mainstay in management of chronic obstructive pulmonary disease and their proper usage requires continuous training. A thorough literature search has shown limited data on the outcome of various techniques and devices used in COPD; hence this study is being done to study the outcome of use of inhalers in patients with COPD following training. Methods: This prospective, observational study was conducted on patients suffering from COPD as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The patients were given instructions and training correctly all patients were called after one month and spirometry parameters were assessed after one month. Spirometry and St. George Respiratory Questionnaire was administered to all participants. Results: A total of 60 patients were enrolled in study with the mean age of 49.37±17.65 years. 19 patient suffering from COPD also had concurrent diseases associated. Revolizer was used by 60% of patients. There was a significant (p<0.05) improvement in FEV1 and PEF after 1 month of proper use of inhalation technique. All patients showed a statistically significant (p<0.05) improvement in symptoms score in SGRQ. Conclusion: A significant improvement in FEV1, Ratio of FEV1/FVC and PEF was observed after 1 month, there was also improvement in Quality of life of patients.
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Background: Chronic obstructive pulmonary disease (COPD) is characterized by symptoms of dyspnoea, paroxysmal coughing, fatigue, and insomnia associated with considerable impact on quality of life of patients. Inhaled corticosteroid/long-acting β2-agonist combinations (ICS/LABA) are endorsed for maintenance therapy for COPD. So, we designed this study to compare the treatment of combination of salmeterol or formoterol with fluticasone on Quality of life (QOL) of patients suffering from chronic obstructive pulmonary disease (COPD). Methods: This prospective, randomized, parallel group study was conducted 45 patients suffering from COPD were enrolled in the study after they signed a written informed consent. The patients were divided in two groups based on the treatment in two groups. Group 1 was on treatment with salmeterol with fluticasone whereas group 2 was on treatment with formoterol with fluticasone; they were assessed at baseline and 4weeks. Patients were subjected to St George Respiratory Questionnaire (SGRQ) and WHO – Quality of life (WHO-QOL Bref) Questionnaire. Results: A total of 24 patients in group 1 and 21 patients in group 2 completed the study. The demographic profile of patients was comparable at baseline. Patients in both groups had showed a statistically significant improvement in symptoms score as compared to baseline as is evident by lower scores in SGRQ and high scores in WHO-QOL Bref score Patients on formoterol and fluticasone had slightly better scores as compared to the other group though it was not statistically significant. Conclusions: Both the treatment showed significant improvement in symptoms as well as quality of life as compared to baseline and a combination of formoterol and fluticasone was slightly better as compared to combination of salmeterol and fluticasone.
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Background: Suturing of caesarean incision leads to reduction in maternal mortality, suturing can be done in either single layer or double layer. Many studies have shown both of them to be effective, with no conclusive evidence of preference of any one of them. The objective of this study was to compare method of uterine closure by single-layer and double-layer closure keeping in mind the intraoperative and postoperative morbidity in index pregnancy and risk of uterine rupture in future pregnancy. Methods: This prospective randomized controlled study was done from March 2007 to January 2009, a total of 357 women were enrolled for lower segment caesarean section either to single layer (n=188) or double layer (n=169) closure of uterine incision. Primary outcome measures studied were operating time, intraoperative blood loss, and febrile morbidity in index pregnancy and chances of uterine rupture in subsequent pregnancy. Secondary outcome measures were cystitis, wound infection and hospital stay. Results were compared by Chi-square test. Results: Patients with single layer closure had significantly (p<0.05) less operative time and estimated blood loss as compared to double layer closure. There was also a statistically significant (p<0.05) difference in febrile morbidity and hospital stay in single layer closure of uterus. There was however no significant difference in other variables also, in subsequent pregnancy with previous caesarean section there was no difference in pregnancy outcome in both groups was not statistically significant (p-value>0.05). Operative findings in subsequent pregnancy don’t differ much. Conclusions: Single layer closure was associated with lesser operating time, intra-operative blood loss, febrile morbidity and hospital stay in index pregnancy as compared to double-layer closure.
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Background: Diabetes Mellitus is a leading disease of developing countries and its incidence is increasing day by day. Among Oral Hypoglycemic agents, Metformin is still the best treatment choice for type 2 diabetes mellitus. Metformin is associated with improvements in lipoprotein metabolism, including decreases in LDL-C, fasting and postprandial TGs, and free fatty acids. Methods: This prospective study was carried out on Type 2 Diabetic patients attending the Diabetic clinic at Teerthanker Mahaveer Medical College & Research Center, Moradabad. Only those patients were included who were not adequately controlled with a stable dose of metformin monotherapy. A total of 125 patients were enrolled in the study taking Glimepiride plus Metformin. The patients received therapy of metformin 500mg three times daily & glimepiride 5mg twice daily. Results: Out of the 125 patients enrolled in the study, only 82 patients completed the study. Out of 82 patients, 49 were males and 33 females. There was a significant reduction (p<0.05) of FPG as compared to baseline. The (PPBS) was reduced from 275.95 ±63.599 (mg/dl) to 167.04±27.084 (mg/dl) at 12 weeks and141.36±31.064(mg/dl) at 24 weeks (mg/dl). There was a significant reduction (p<0.05) of Hb1Ac, TC, TAG, LDL, VLDL, UA, SGOT as compared to baseline but no significant rise in HDL was seen as compared to baseline. Conclusion: Significant improvement in fasting blood sugar (FBS), Postprandial blood sugar (PPBS), Lipid profile and Glycosylated hemoglobin as compared to baseline.
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Background: More than a quarter of the total world population is anemic and half of them have iron deficiency anemia. Many studies done have shown that iron fortified legume staples are important source of proteins and non- heme iron in children; all infants treated with oral iron and visited weekly to record iron intake, feeding, and health showed improvement in cognitive, motor, and social-emotional development hand washing with soap and hand finger nail clipping reduced prevalence of anemia. So we designed this study to find out the cause of low hemoglobin in healthy females and its correlation with diet, weight and body mass index. Material and Methods: This open-label, prospective, observational study was conducted in 90 healthy volunteers belonging to nearby areas. The following parameters were observed and recorded: height, weight, body mass index (BMI) and hemoglobin estimation and questionnaire was given to the participants to record dietary intake. Results: All the volunteers completed the study were of an average age of 20.28±0.10 years and had average hemoglobin of 11.91 ± 0.11gm/dl and the average body mass index (BMI) was 21.73 ± 0.33 (kg/m2) respectively. It has been observed that haemoglobin has non-significant (p>0.05) correlation with age, weight, height and BMI. Majority of volunteers took more than three meals per day; eating food outside on one-two occasions per week and reported that their food was fried. Most of the participants reported consuming small proportions of food with fruits and milk being essential component. Conclusion: To conclude our study found that the participants although were not anaemic they had haemoglobin on the lower side of normal values and there was no correlation between with age and BMI.
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The objective of the study was to compare the efficacy and safety of duloxetine and venlafaxine in major depressive disorder. The study was conducted in 26 patients suffering from major depressive disorder as per DSM-IV criteria. Patients were randomized to two groups and were given duloxetine (20,40,60mg BD) and venlafaxine (75,150,225mg OD) for 6 weeks. The primary efficacy parameter was the Hamilton Depression Rating Scale (HDRS-17). Secondary efficacy parameters included the Montgomery and Asberg depression rating scale (MADRS) and clinical global impression (CGI) scale. Safety evaluation was based on treatment emergent adverse effects and laboratory investigations. There was significant decrease in HDRS, MADRS, CGI scores from baseline to endpoint (p<0.05) in both the groups. However the difference in scores between two groups was not statistically significant. Total mean HDRS score decreased from 27(SD=2.5) to 4 (SD=1.2) in duloxetine group and from 29(SD=2.3) to 4 (SD=1.0) in venlafaxine group at the end of therapy. Response and remission rate was 96% and 69% in duloxetine group as compared to 92% and 62% in venlafaxine group respectively. There was no significant difference in adverse effects and laboratory investigation in two groups. The findings of this study indicate that duloxetine may be an effective and safe antidepressant in Indian patients of major depressive disorder. It is equally effective to venlafaxine in patients of depression.