Efficacy of port-site infiltration with ropivacaine alone versus ropivacaine with fentanyl for postoperative analgesia in patients undergoing laparoscopic procedures

Background and aims: Wound infiltration as a pre-emptive measure to relieve post-operative pain is a common practice following laparoscopic procedures. The addition of adjuvants like opioids to local anesthetics can facilitate the prolongation of postoperative analgesia. Our primary aim was to compare the analgesic efficacy of peri-portal infiltration of Ropivacaine alone versus Ropivacaine with Fentanyl in patients undergoing laparoscopic operations. Methods: The study was conducted on 80 ASA physical status I and II patients, aged 18 to 65 years, undergoing surgical procedures under general anesthesia. Group R was infiltrated with Ropivacaine (0.5%) (18ml+2ml saline) while in Group RF, Ropivacaine(18ml) with Fentanyl 2ml (100礸)] was infiltrated around ports, before wound closure. At the end of the surgery, one of our study drug solutions was infiltrated, to which the patient as well as the assessor were blinded. Postoperative pain was assessed by the VAS (visual analog scale) score. Injection Tramadol 100mg was given as a rescue analgesic if the VAS score was ? 3. Student抯 t-test and Fischer抯 exact test were applied for continuous and categorical variables; Kruskal Wallis and Mann Whitney U test for nonparametric data. The entire statistical analysis was done using STATA 13[ STATA CORP. TEXAS, USA] software. Results: The mean duration of analgesia was significantly longer in group RF, with a requirement of fewer doses of rescue analgesics, compared to group R. Conclusion: The addition of Fentanyl to Ropivacaine for periportal infiltration was found to be superior to Ropivacaine alone in providing effective postoperative analgesia as well as reducing the requirement of rescue analgesics.

Evaluation of Depression and Anxiety and Its Association with CD4 Count among HIV Patients Taking Antiretroviral Therapy.

Depression and anxiety are the most common mental disorder affecting individuals with human immunodeficiency virus (HIV) infection. Anxiety is highly prevalent in HIV infected individuals in clinical studies. Early identification and treatment of depression and anxiety in patients may improve better outcome of ART Therapy. We wanted to evaluate the prevalence of depression and anxiety among HIV patients taking antiretroviral therapy and examine the predicting effect of depression and anxiety with demographics on CD4 count. MethodsThis study was conducted in the ART Plus center in Department of Medicine, PT JNM Medical college, Raipur, Chhattisgarh and Dr. Bhim Rao Ambedkar Memorial Hospital between July 2018 and June 2019. A total of 300 patients who were enrolled in the ART plus center, gave consent to participate in study. Participants were selected in systematic random sampling method irrespective of their age, gender, ethnicity, socio-economic status, occupation, education, and present CD4 count. Starting CD4 count was assessed on enrolment to ART center and present CD4 count repeated at the time of recruitment to our study. Depression was evaluated using Hamilton Depression Rating Scale and anxiety was measured by Hamilton Anxiety Rating Scale by a Psychiatrist. ResultsThe first model showed 8.8% of total variance (R= .297, R2=.088; F (5, 298) = 5.683; p<0.01) for starting CD4 count and second model showed 6.7% of total variance (R=.259, R2=.067; F (5, 298) = 4.221; p<0.01) for present CD4 count with five predictor variables (depression, treatment year, gender, age, anxiety). Depression of the patients was negatively associated with starting CD4 count (-.085, p<0.01) before starting ART Regimen. Treatment year of the patients was positively associated with present CD4 count (-.085, p<0.01). ConclusionsThe study demonstrates high prevalence of anxiety and depression among HIV positive patients taking antiretroviral therapy (ART) and strong correlation of depression and anxiety and its associated factors among HIV positive patients taking ART. High depression reported lower level of CD4 count before starting ART regimen.

Successful management of life threatening post partum haemorrage by uterine artery embolisation [UAE]

We report on a case of a 23 year old primigravida with intractable atonic life threatening post partum hemorrhage [PPH] following a normal vaginal delivery. The PPH was resistant to conventional medical procedures to arrest the bleeding. She was successfully treated non-surgically with Uterine Artery Embolization [UAE]. UAE is not only a life saving procedure, but may theoretically allow conservation of future fertility

Transcoronary ablation for septal hypertrophy of hypertrophic obstructive cardiomyopathy

Surgical myectomy has been successfully used to treat patients with symptomatic hypertrophic obstructive cardiomyopathy [HOCM] for the last four decades, but is a major open heart surgery and is available only in selected centers. Transcoronary ablation of septal hypertrophy [TASH] is becoming the preferred approach, because of the novelty of the procedure, being. less traumatic, non surgical technique which is now supported by the evidence of, thousands of successfully treated patients all over the world We present our initial experience which to our knowledge is the first report from this region

Successful thrombolytic therapy for complicating large right atrial thrombus

Thrombus embolization in the right side of the heart is an unusual disease process with high morbidity and mortality and its successful management poses a challenge. A 41-year-old male, 2 weeks after bilateral ankle fracture and immobilization, developed bilateral deep venous thrombosis. A large right atrial thrombus causing right ventricular dysfunction and pulmonary embolism was responsible for his acute dyspnoea. He was haemodynamically stable. He was treated with thrombolytics and anticoagulants. The literature search for the use of thrombolytic agents in patients with right heart thrombus complicating pulmonary thromboembolism, revealed limited reports. Our patient responded well to early tissue Plasminogen activator [t-PA] therapy and follow up with anticoagulation without any bleeding or systemic complication

Percutaneous coronary intervention [PCI] an emerging alternative to bypass surgery for unprotected left main artery disease

Both technological advances [including stenting and atherosclerotic techniques] and increased operator experience have led to the resurgence in percutaneous revascularization of unprotected left main disease over the past few years. We present our experience in two patients who undergone PCI for left main stem stenosis in different clinical settings

Successful thrombolytic therapy for complicating large right atrial thrombus

Thrombus embolization in the right side of the heart is an unusual disease process with high morbidity and mortality and its successful management poses a challenge. A 41-year-old male, 2 weeks after bilateral ankle fracture and immobilization, developed bilateral deep venous thrombosis. A large right atrial thrombus causing right ventricular dysfunction and pulmonary embolism was responsible for his acute dysponea. He was haemodynamically stable. He was treated with thrombolytics and anticoagulants. The literature search for the use of thrombolytic agents in patients with right heart thrombus complicating pulmonary thromboembolism, revealed limited reports. Our patient responded well to early tissue Plasminogen activator [t-PA] therapy and follow up with anticoagulation without any bleeding or systemic complication

Primary angioplasty and stenting for cardiogenic shock supported by an intra-aortic balloon pump

The leading cause of death in patients hospitalised for acute myocardial infarction is cardiogenic shock. We report a young patient who presented with cardiorespiratory arrest and cardiogenic shock following acute anterior wall myocardial infarction. He was resuscitated by direct current cardioversion ventricular fibrillation and underwent intra-aortic balloon supported primary angioplasty and direct stenting