Comparative-study-of-etomidate-and-propofol-for-induction-of-general-anesthesia-in-elderly-patients

Introduction: An ideal induction agent for general anesthesia should have hemodynamic stability, minimal respiratory side effect and rapid recovery. Presently etomidate and propofol are popular rapid acting inducing agents. Material and methods: After obtaining informed written consent from patients this prospective, randomized, double blind study was conducted in 100 patients of ASA grade 3 and 4 posted for elective surgeries under general anaesthesia. They were divided into two groups of 50 in each group based on random number as group A and group B. The patients in Group A given Inj. Propofol and the patients in Group B received Inj. Etomidate. Parameters such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and spo2 were monitored continuously and recorded. Incidence and degree of pain of myoclonic movements were recorded. Demographic variables such as age,Result: gender, weight and ASA grade were comparable no significant difference existed between both the groups.Baseline mean heart rate, mean systolic blood pressure and mean diastolic blood pressure were comparable in both the Groups. (P>0.05)Significant (P<0.05) fall in mean systolic blood pressure, mean diastolic pressure and mean arterial pressure was observed immediately after induction, at 2, 5, 10 minutes up to 30 minutes in group A (propofol) compare to group B (etomidate). After then no significant difference seen in mean systolic pressure, mean diastolic pressure and mean arterial pressure. Etomidate was found ideal for its hemodynamic stability when compared to PropofolConclusion: along with less incidence of pain on injection, the only drawback being high incidence of myoclonus elderly patient.

Colonic fibromatosis - a case report and review of the literature / Fibromatose colônica - relato de caso e revisão da literatura

ABSTRACT Intra-abdominal desmoids tumours are very rare and usually occur in patients with familiar adenomatous polyposis and previous surgery. They represent fibroepithelial growths with varied biologic behavior and therefore different prognosis. We report a case of a 60-year-old patient with a large right colonic mass who underwent right hemicolectomy. Histology proved morphological and immuno-histochemical features indicating fibromatosis. This desmoid tumour appeared growing from the colonic wall rather than the mesocolon, confirming a true colonic wall fibromatosis, a deep isolated form of intra-abdominal fibromatosis. Surgical resection is the treatment of choice in isolated well confirmed lesions. Multidisciplinary team approach is crucial for treatment and prognosis.

RESUMO Os tumores desmoides intra-abdominais são muito raros e geralmente ocorrem em pacientes com polipose adenomatosa familiar e cirurgia prévia. Eles representam crescimentos fibroepiteliais com comportamento biológico variado e, portanto, prognóstico diferente. Relatamos o caso de um paciente de 60 anos com grande massa colônica à direita, submetido a hemicolectomia direita. A histologia demonstrou características morfológicas e imuno-histoquímicas que indicavam fibromatose. Este tumor desmoide surgiu crescendo a partir da parede do cólon, e não do mesocólon, confirmando uma verdadeira fibromatose da parede do cólon, uma forma isolada profunda de fibromatose intra-abdominal. A ressecção cirúrgica é o tratamento de escolha em lesões isoladas bem confirmadas. A abordagem multidisciplinar é crucial para o tratamento e prognóstico.

Vascular endothelial growth factor insertion/deletion gene polymorphism in West Indian patients of type 2 diabetes and diabetic nephropathy.

Diabetic nephropathy (DN) is a major cause of morbidity and mortality in diabetes. Vascular endothelial growth factor (VEGF) is a potent multi-functional cytokine which plays a key role in the pathogenesis of DN. In this study, we evaluated the possible association of the VEGF gene (I/D) polymorphisms with DN in type 2 diabetes patients in West Indian population. Genotyping (I/D) of the VEGF gene polymorphism was done by the polymerase chain reaction. A total of 103 patients with type 2 diabetes, 102 patients with DN, 108 patients with non-diabetic nephropathy and 143 healthy controls were genotyped. The frequency of VEGF genotype distribution and biochemical parameters like creatinine and HbA1c were compared in diabetic, diabetic nephropathy, non diabetic nephropathy and control groups. We found significant difference in creatinine level in DN and NDN groups on comparison with control group. Our study suggests that I/D polymorphism in the promoter region of the VEGF gene is not associated with DN in type 2 diabetes patients, but might have a role in development of non-diabetic nephropathy.

Trends of various anthropometric measurements of children born in a tertiary care center.

Background: One of the most important marker of general health of children is attained growth. Growth of a child is depend on various factors like socioeconomics and geography. Aims & Objective: To study trends of various anthropometric measurements of children born in a tertiary care center. Material and Methods: 120 full term infants were followed up monthly for 12 months. Physical growth was measured in the form of weight, crown heel length, chest circumference and cranial circumference by standard methods. Developmental screening test was done in various subdivision like Gross motor, Fine motor and vision, Hearing and speech and Social behaviour by standard methods. Passive tone was evaluated by measuring popliteal angle with the help of goniometer. Results: It was observed that total weight gain in male baby was 5.52 kg while that in female baby was 5.26kg during 12 months duration after birth. Maximum weight gain was observed in first three months after birth. Mean length observed at birth in present study was 48.29 cm which increased to 72.47 cm at the end of 12 month. Maximum increment in length was recorded in first 6 months of life. Total increment in length was 24.42cm for male baby while increment for female baby was 23.91 cm. Maximum increment in length occurred in first three months after birth. Mean chest circumference in male baby observed in present study was 33.57 cm at birth, 44.49 cm at 12 month while in female baby the same was 32.34 cm and 43.47 cm at birth and at 12 month respectively. Total increment in popliteal angle during first year of life was 90.35 degree. Maximum increment in angle was observed during 6 months to 9 months period. Few growth parameters were better in higher socio-economical classes. Conclusion: Periodic assessment of growth parameters should be done in different geographical areas to understand the pattern which may help in policy decisions.

Role of hepatic and pancreatic oxidative stress in arsenic induced diabetic condition in Wistar rats.

Arsenic, a potent environmental toxicant has been reported to induce diabetes mellitus, but its potential biological mechanism(s) has not been much investigated. The present study was designed to correlate pancreatic and hepatic oxidative stress with arsenic induced diabetes mellitus in experimental animals. Male albino Wistar rats were administered with low (1.5 mg kg-1 b.wt.) and high (5.0 mg kg-1 b.wt.) sodium arsenite orally for 4 week. Hyperglycemic condition was observed in arsenic exposed groups as indicated by increased (P<0.001) fasting plasma glucose, glycosylated hemoglobin (HbA1c) and impaired glucose tolerance (IGT), which were accompanied by an increase in the level of lipid peroxidation (P<0.001), protein oxidation (P<0.05 at low dose and P<0.001 at high dose) and nitric oxide (NO) (P<0.001) in hepatic and pancreatic tissue compared to control. Furthermore, superoxide dismutase (SOD) (P<0.001), catalase (CAT) (P<0.001) and glutathione-S-transferase (GST) (P<0.05 at low dose and P<0.001 at high dose) activities were elevated, while glutathione peroxidase (GPx) (P<0.05 at low dose and P<0.001 at high dose) and GSH level showed significant (P<0.001) depletion in both studied tissue of arsenic exposed rats compared to control. Arsenic induced hepatotoxicity was manifested by an increase (P<0.001) in serum ALT, AST and ALP. Arsenic exposure leads to accumulation of arsenic (P<0.05) and significant (P<0.05) depletion of copper and zinc level in hepatic and pancreatic tissue as compared to control. Our data suggests that sub-chronic arsenic exposure induces diabetic condition which may be mediated due to increased oxidative stress in hepatic and pancreatic tissue.

Formulation design, in vitro evaluation and stability studies on mucoadhesive buccal films of anti-anginal calcium channel blocker.

Diltiazem hydrochloride has poor oral bioavailability, easily undergo first passage effect in the liver. Hence, an attempt was made to prepare and evaluate mucoadhesive buccal films containing diltiazem hydrochloride by employing HPMC, eudragit, ethyl cellulose alone and in combination with PVP. The I.R and DSC studies showed that there was no interaction between drug and the utilized polymer. The prepared mucoadhesive buccal films showed uniform thickness, weight, folding endurance, surface pH, drug content and swelling index. The drug content of all the formulation was found to be uniform. In vitro drug release studies indicated that the films prepared with HPMC (3%) and ethyl cellulose (4%) has shown fast and slow release respectively. The formulations incorporated with SLS and sodium glycocholate indicated significant drug release from F11 and F15. Later the in-situ diffusion studies using goat cheek pouch showed faster drug release from film with 1% (SLS). About 93.04% and 91.83% of drug release profile were observed during in situ diffusion studies at the end of 9hrs and 18 hrs respectively. The formulated films were stable during stability studies at 45ºC and 75%RH with respect to drug content.

Sub-chronic arsenic exposure aggravates nephrotoxicity in experimental diabetic rats.

The present experiment was planned to study nephrotoxicity in experimental diabetic rats under sub-chronic exposure to arsenic. Alloxan induced diabetic and control rats were exposed to sodium arsenite (0 and 5.5 mg/kg, orally) for 30 days. More pronounced nephrotoxic effects were noted in arsenic exposed diabetic group as evidenced by increased blood urea nitrogen, serum creatinine and relative kidney weight and decreased level of reduced glutathione and glutathione peroxidase activity compared to non arsenic exposed diabetic group. Increased level of lipid peroxidation, protein oxidation, superoxide dismutase and catalase activities under diabetic condition remained unchanged in arsenic exposed diabetic group compared to unexposed diabetic group.