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Emergence agitation, also known as emergence excitement, emergence delirium or post anaesthetic excitement is a well-recognized clinical phenomenon occurring in the immediate postoperative period following general anaesthesia.1 Though it is most often seen in children and elderly,2,3 with literature focused on this population, it can affect all age groups. Emergence is the transition from unconsciousness to full wakefulness4 and most often this transition from general anaesthesia is smooth and uneventful.5 Emergence agitation is usually seen during the first 15-30 minutes following awakening from general anaesthesia3,6 and has varied clinical presentation. It can be characterized by agitation, restlessness, hyperactivity, irritability, thrashing, crying, moaning, incoherence and uncooperative behaviour.3,4,6Though emergence agitation is well recognized clinically, it is not well understood. The reasons being, lack of clear definition, lack of reliable and valid assessment tools, difficulty in differentiating between agitation and pain and uncertainty about its clinical significance.2 The incidence reported in paediatric population is 12-13%3 and about 10-15% in geriatric age group.7,8 There are various risk factors recognized to be associated with EA. They are presence of an endotracheal tube or urinary catheter, pain, premedication with benzodiazepine, use of inhalational anaesthetics,3,5 breast, abdominal9 and otolaryngologic surgeries.10,11 Presence of hypoxia, hypothermia, hypoglycaemia, electrolyte disturbances and sepsis can in addition add on to the incidence of EA.3,5
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Control of post-operative pain is imperative for patient comfort, early mobilization and faster recovery.(1) Specifically, good post-operative pain management has been shown to be effective in reducing peri-operative morbidity associated with acute coronary events and thrombotic events in high risk patients. (2) At the same time, it has been an endeavour to reduce peri-operative opioid consumption and its associated complications. In this respect, an effective multimodal strategy which affords best control of post-operative pain is very important.Increasingly, Regional Techniques are gaining popularity as a part of multimodal post-operative analgesic regimen. Regional Anaesthesia has been shown to reduce the incidence of post-operative nausea and vomiting while also providing benefits that go even beyond patient comfort.Epidural Analgesia is a time tested technique for post-operative analgesia. It has proven efficacy and use of epidural catheters for post-operative analgesia is a norm at many centres. However, the epidural technique comes with its own risk of complications. Also, there are many situations where it would be contraindicated to use the epidural technique. Thus, an equally effective alternative regional anaesthetic technique would be useful in such situations.The Transversus Abdominis Plane (TAP) Block and TAP catheter based continuous blocks are relatively new techniques whose efficacy has been well documented in the scientific literature (3), (4), (5), (6) They are regional anaesthesia techniques which provide analgesia to the skin and muscles of the anterior abdominal wall. (7) It was first described just about a decade ago and has undergone several modifications which in turn have expanded its scope of application for an increasing range of surgical procedures. (8) Their advantage over epidural technique lies in the fact that it does not cause hemodynamic instability. Another advantage is that they can be used in patients with mild platelet or coagulation abnormalities where neuraxial techniques would be contra-indicated. Despite a low risk of complications and a high success rate, it is an underutilized technique. (9)METHODSAfter obtaining ethical clearance certificate from the institution’s ethics committee, a prospective randomized comparative study was conducted among 72 patients, who were to undergo elective lower abdominal surgeries, admitted to Sri Devaraj Urs Medical College Hospital from September 2012 to Aug 2013.Sample SizeIn a previous study by Vandriessche et al A VAS score of 4.8 cm (SD: 1.8 cm) for TAP block group and VAS score of 3.2 cm (SD: 2.1 cm) for epidural group was observed. Assuming similar results, it was calculated that to obtain a power of 80% within a confidence interval of 95%, a minimum of 30 patients were required in each of the two groups. Thus, a total of 60 patients were required at the least. An additional 5% (6 in each group) were taken to account for drop-outs from the study.
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Introduction: Hyperlipidemia, one of the important risk factor of atherosclerosis, is an abnormality commonly encountered in patients with chronic kidney disease. There are several other important risk factors, such as smoking, proteinuria, oxidative stress, inflammation and dyslipidemia that independently or in combination with elevated blood pressure, can cause deterioration in renal function. Aim of the study: To analyze lipid alterations that can occur in chronic kidney disease patients. Materials and methods: This study was conducted among 50 patients with chronic kidney disease. All the patients with established chronic kidney disease ensured with radiological evidence and on conservative treatment were included in the study. Lipid profile parameters are estimated under standard techniques. Results: Total cholesterol (TC), Triglycerides (TGL), High-Density Lipoprotein (HDL), and LowDensity Lipoprotein (LDL) of all the patients were investigated for the lipid profile study. It was found that the majority (80%) of the study participants were found to have low HDL, 62% of the participants were found to have a high triglyceride level. Overall, seven patients (14%) showed abnormal lipid profile with respect to all the four parameters. Conclusion: HDL-C levels were lower and triglycerides, total cholesterol, and TGL levels were higher in the study group. There is a statistically significant increase in serum triglycerides level in patients with CKD stage 3, 4 and 5. Predominant lipid abnormalities were reduced HDL-C levels and elevated TGL.
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Background: Coronary artery disease (CAD) has become the most common cause of mortality in the entire world. Homocysteine is implicated as an early atherosclerotic promoter. Homocysteine (Hcy) is an essential amino acid in humans. It has been known as a novel and independent risk factor for coronary heart disease (CHD). The prevalence of hyperhomocysteinemia varies between 5% and 30% in the general population. Aim of the study: To assess whether hyperhomocysteinemia is one of the independent risk factors for coronary artery disease. Materials and methods: The study was conducted in the Department of General Medicine, Government K.A.P. Viswanatham Medical College, Trichy from 2017-2018. Totally 100 Patients who were presented to our hospital with coronary artery disease of age group 30 to 70 years were included in the study. Diagnosis of coronary artery disease was made based on a history of angina pain, electrocardiography (ECG) changes and cardiac enzyme levels. Diagnosis of acute MI was made according to WHO criteria. Results: Among the 100 patients, 66 had acute Myocardial Infarction and 34 had angina. Among the 52 patients who had hyperhomocysteinemia, 34 patients (65%) were young with age ≤ 45 years and 18 patients (35%) were with age> 45 years. In our study, 66 patients with MI were included. Among the 28 patients (42.4%) were young with age <45 years. In this group of young patients with MI, 21 patients (65.4%) had hyperhomocysteinemia and 7 patients (34.6%) had normal homocysteine level. Conclusion: Finally, during the last decade, the utility of homocysteine in predicting risk for N. Ramesh, K. Ganesan. A study on serum homocysteine as an independent risk factor for coronary artery disease. IAIM, 2019; 6(6): 75-80. Page 76 atherothrombotic vascular disease has been evaluated in several observational studies in a large number of patients. These studies show that the overall risk for vascular disease is small, with prospective, longitudinal studies reporting a weaker association between homocysteine and atherothrombotic vascular disease compared to retrospective case-control and cross-sectional studies. Furthermore, randomized controlled trials of homocysteine-lowering therapy have failed to prove a causal relationship.
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Intracranial germinomas belong to the class of germ cell tumors which are relatively rare intracranial tumors. Early recognition of this neoplasm is vital as germinomas are highly radiosensitive and effective/ early radiation therapy can result in relatively favourable overall prognosis. In this article we describe a 19 years old man who presented with pituitary tumor in the suprasellar region for which transsphenoidal decompression and biopsy was done. The histopathological examination confirmed it to be germinoma and he underwent craniospinal radiotherapy.
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The study was done to assess the prevalence of malocclusion and orthodontic treatment needs using Dental Aesthetic Index [DAI] among 12-15 years old school children in Davangere, Karnataka - India. A total of 2010 high school students [991 males and 1019 females] randomly selected from public and private schools were examined for malocclusion using Dental Aesthetic Index by single examiner.The results showed that the mean Dental Aesthetic Index score of 18.2, with males having a significantly higher DAI score [18.9] than females [17.5]. It was observed that 83.4% of the study population had DAI score <25 which required no or slight treatment. 15.5% required elective treatment and only 1.1% of the children with DAI score of 31-35 required emergency treatment. A highly statistical significant difference in DAI scores was found between males and females [P <0.001]
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Humans , Male , Female , Orthodontics , Schools , Child , Esthetics, Dental , PrevalenceABSTRACT
Amebic colitis is common in developing countries, with its variable and non-specific symptoms. Amebomas occur rarely, resulting from the formation of annular granulation tissue, usually in the cecum and in the ascending colon. This report describes the case of a 59-year-old male who presented with abdominal pain. Radiological examination depicted concentric thickening of the cecal wall with mass formation and a cystic lesion in the liver. The endoscopy performed showed a growth in the ascending colon. Biopsy revealed extensive necrosis and inflammatory cells. The patient was referred to this hospital for surgical treatment with a provisional diagnosis of carcinoma of the colon. Peroperatively, a cecal mass was identified. However, suspected secondaries were not seen on the surface of the liver. Histological examination of the right hemicolectomy specimen revealed cecal and ascending colon amebomas. Trophozoites of Entamoeba histolytica were better recognized after periodic acid-Schiff staining. Treatment with Metronidazole for 2 weeks followed by diloxanide furoate for an additional 2 weeks was administered. The liver lesion resolved completely after 8 weeks. Colonic ameboma accompanied by amebic liver abscess may be misdiagnosed as metastatic colon cancer. A high index of suspicion is essential for diagnosis when dealing with colonic masses and liver lesions, especially in the tropics.
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Pure fatty tumors of the uterus are exceedingly rare. The more common lipomatous tumor is lipoleiomyoma with varying amounts of two components. Most are post-operative chance findings following hysterectomy for leiomyoma. Computed Tomography and Magnetic Resonance Imaging can assist in pre-operative diagnosis. A 60 year old post-menopausal woman presented with a mass per abdomen. Ultrasound revealed fibroid uterus with lipomatous areas. The hysterectomy specimen showed a pure intramural lipoma of the uterus. As clinical symptoms and signs of uterine lipoma are indistinguishable from uterine leiomyoma, various imaging techniques can aid in pre-operative diagnosis. The diagnosis of pure lipoma of the uterus should only be made when any smooth muscle if present is confined to the periphery of the tumor.