To Study the Effectiveness of Inhalation Technique Training in Patients with COPD and Asthma

Introduction: Asthma and chronic obstructive pulmonary disease (COPD) are characterized by chronic airway inflammation. Lack of knowledge about the correct inhalation techniques leads to poor control of both diseases. This study aimed to study the effectiveness of inhalation technique training in patients with COPD and asthma. Materials and methods: A total of 132 patients fulfilling the inclusion criteria were trained with the correct technique of inhalation on day 0 and at the end of 1 and 6 months. Evaluation of technique training was done on these three occasions posttraining. The mean score of devices was obtained, and the mean inhalation technique score of various devices was compared. Results: Out of 132 patients, 65.1% (86/132) patients were using a dry powdered inhaler (DPIs), 26.5% (35/132) patients used metered dose inhalers (MDIs), and 8.4% (11/132) patients used MDI with spacer. The mean scores of patients using MDI at baseline were 5.68 ± 0.83, and after 1 month, 6.68 ± 0.58 (p < 0.000). The inhalation technique mean score of MDI improved after 6 months, 7.02 ± 0.56 as compared to baseline (p < 0.008) mean score of the patients using DPIs improved after 1 month, 5.53 ± 0.58 as compared to baseline 4.37 ± 5.53 (p < 0.000). There was no statistical improvement in the device mean score of DPIs after 6 months, 5.62 ± 0.55 when compared with 1 month, 5.53 ± 0.58 (p < 0.117). Patients who used pressurized metered-dose inhalers (pMDI) with spacers improved their inhalation score after 1 month by 6.90 ± 0.94 as compared to the baseline score of 6.90 ± 0.94 (p < 0.001). The mean score decreased marginally after 6 months, 7.818 ± 0.60, as compared to the score at the end of 1 month of 8.27 ± 0.64 (p < 0.053). Discussion: Patients showed improvement in the technique of inhalation after educational training, reinstructions, and a standard checklist.

Correlation Of Serum Albumin And Red Cell Distribution Width (RDW) With Deep Vein Thrombosis And Pulmonary Embolism A Retrospective Study

Background:Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a severe and potentially lethal disease, with serious short and long?term complications and a potentially fatal outcome. Objective:To determine the correlation of Serum Albumin and Red cell Distribution Width( RDW),with deep vein thrombosis and pulmonary embolism.Materials & Methods: A retrospective study was carried out from the archive of patients with an event of VTE admitted in theGeneral Medicine ward, Jhalawar Medical College, Jhalawar, Rajasthan. Patients’ demographics, presenting symptoms, laboratory tests particularly RDW and Serum Albumin, medications, interventions, and outcomes were collected.Result:A total of 131 cases wereevaluated. Majority of the patients (48.8%) were in age group 45-64 years. The mean duration of hospitalization stay of venous thromboembolism (VTE) patients was 6.6 ± 1.4 days. Mean RDW (%) of the total study participants was 15.3 ± 1.4. Mean serum albumin of the total study participants was 3.3 ± 0.8.Conclusion:Majority of the patients were found with higher RDW and Low Serum Albumin.

Analysis of association between lichen planus with hepatitis B and hepatitis C virus infection in patients attending outpatient department of dermatology at tertiary care hospital in Central Rajasthan

Background: Lichen planus (LP) is a non-infectious cutaneous disease, characterized by the presence of itchy, flat from top, polygonal, and papular lesions having a strikingly violaceous color. Objectives: The objectives are as follows: (1) To establish the association of hepatitis B and hepatitis C with LP in urban areas of Ajmer and (2) to analyze the derangements in liver function tests of LP patients who attended the outpatient Department of Dermatology in JLN Hospital Ajmer. Materials and Methods: To conduct the study, 102 patients of LP and 100 control subjects were selected between age groups of 18 and 60 years. A detailed history including age, sex, race, residence, clinical symptoms, and their duration was recorded. Control group was selected from blood donors at blood bank of Jawaharlal Nehru Medical College, Ajmer, and was corresponding in age and sex to those of study group. A thorough clinical examination, systemic and cutaneous examination was performed. Clinical findings classical of LP and lesions confirmed histopathologically were used to establish the diagnosis of LP. A rapid test kit was used for detecting seropositivity for hepatitis B virus (HBV) and hepatitis C virus (HCV). Chi-square test and multivariate regression analysis using SPSS version 16 were used to analyze the collected research data. Results: None of the patients of LP in the study group were HCV and HBV positive. None of the control group was positive for both viral infections. In 16 patients (15.68%), the levels of serum aspartate aminotransferase were beyond the normal limits, and higher levels of alanine aminotransferase were detected in 5 patients (4.90%). Bilirubin concentrations higher than the normal limits were detected in total 16 patients (15.68%). Conclusion: No association of hepatitis B and C with LP could be established from the present study. More detailed research is needed to establish the correlation between hepatitis B and C and LP.

General versus spinal anesthesia in percutaneous nephrolithotomy: A comparative study

Background: Percutaneous nephrolithotomy (PCNL) is usually done under general anesthesia (GA). However, it can be done under spinal anesthesia (SA) which can have advantages like less bleeding, less postoperative pain, low dose analgesic requirement and less drug intake. Aim: In our study, we had compared the efficacy and safety of general versus Spinal Anaesthesia in PCNL. Materials and methods: In prospective randomized study, 100 patients undergoing PCNL were randomly assigned into two groups; group A (n = 50) underwent PCNL under GA, by injecting thiopentone, succinylcholine and vecuronium and group B (n = 50) received SA, by injecting bupivacaine and fentanyl in spinal space L4 in sitting position. Thereafter, a urethral catheter was placed in lithotomy position, head of the table was tilted down for 5 to 10 minutes, and the level of anesthesia was checked. Then, PCNL was done by standard technique. Results: Hemodynamic stability was more in SA group. Heart rate and mean arterial pressure intraoperatively at 5, 10, 15 mins and at 60 mins and postoperatively at 0, 2 and 6 hours was significantly less in SA group (P < 0.05) as compared to GA group. The VAS score was 5.29±0.62 in GA group and 0.98±0.89 in SA group at 0 hour, 5.58±0.49 in GA group and 1.88±0.84 in SA group at 2 hours and 4.26±1.30 in GA group and 2.10±1.02 in SA group at 6 hours which was significantly Meena M, Mantan K, Saxena M, Dhawan S, Sethia S, Meena A. General versus spinal anesthesia in percutaneous nephrolithotomy: A comparative study. IAIM, 2017; 4(9): 59-66. Page 60 lower in SA group in comparison with GA group (P < 0.05). Mean analgesic requirement within 24 hours was lower in SA group (76±36.05) than GA group (140±28.57) and it was statistically highly significant (p<0.001). Postoperative nausea and vomiting was more in GA group than SA group. Conclusion: Spinal anaesthesia is a safe alternative to GA for PCNL with better pain relief, less analgesic requirement, less side effects.

Study on branching pattern of aortic arch in Indian / 대한해부학회지

Knowledge of the branching pattern of aortic arch is important during supra-aortic angiography, aortic instrumentation, thoracic and neck surgery. The purpose of this study is to describe different branching pattern of arch of aorta in Indian subjects, in order to offer useful data to anatomists, radiologists, vascular surgeons while relating it to the embryological basis. Seventy five arches of adult Indian cadavers were exposed and their branches examined during cadaveric dissection in the Department of Anatomy, Government Medical College, Nagpur. The usual three-branched aortic arch was found in 58 cadavers (77.3%); the 11 (14.66%) remaining aortic arch showed only two branches, out of which one was a common trunk, which incorporated the brachiocephalic trunk and left common carotid and other left subclavian artery and 6 (8%) aortic arches showed direct arch origin of the left vertebral artery. Although the variations are usually asymptomatic, they may cause dyspnoea, dysphasia, intermittent claudication, misinterpretation of radiological examinations and complications during neck and thorax surgery. Knowledge of different patterns of arch of aorta is critical when invading the arch of aorta and its branches by instruments, as all these areas are delicate.

values of CA-125, progesterone, beta-HCG and estradiol in the early prediction of ectopic pregnancy

To explore the diagnostic value and measurement of serum CA-125, the single measurement of progesterone [P], beta-HCG, and estradiol [E2] in the early diagnosis of ectopic pregnancy. Serum levels of CA-125, progesterone, beta-HCG and estradiol were measured by Enzyme Linked Immuno Sorbent Assay [ELISA] techniques in 40 symptomatic women with ectopic pregnancy and 24 women with normal intrauterine pregnancy during gestational age of 4-10 weeks at Al-Kadhmiya Teaching Hospital, Baghdad, Iraq, between November 2010 and June 2011. The mean +/- SEM serum levels of CA-125, progesterone, beta-HCG, and estradiol in patients with ectopic pregnancies [16.51 +/- 2.39U/ml; 2.54 +/- 0.47ng/ml; 72.75 +/- 12.27mIU/ml; 13.4 +/- 2.14pg/ml; respectively] were significantly lower than the levels in normal intrauterine pregnancies [74.25 +/- 18.5U/ ml; 28.36 +/- 3.7ng/ml; 249.54 +/- 18.0mIU/ml; 112.7 +/- 23.6pg/ml; respectively]. When using a CA-125 concentration of 20.5 U/ml as a cut-off value for the diagnosis of ectopic pregnancy, sensitivity was 75.7%, specificity 100%, the positive predictive value was 100% and the negative predictive value 71.4%. The measurement of CA-125 and progesterone levels is useful in discriminating ectopic from normal gestations