ABSTRACT
Background: The prevalence of obesity is increasing at an alarming rate even in the developing country like India. Increased adiposity is the risk factor for the development of hypertension, diabetes and cardiovascular disease. The excess fat mass associated with obesity is known to cause haemodynamic changes like increase in preload and after load and also peripheral resistance. The study aims to evaluate the association between the obesity and Diastolic function using echocardiography in uncomplicated young obese individuals. Materials and Methods: The study was conducted in age matched 24 young male obese individuals and 26 male controls. Anthropometric parameters like height (cms), weight (kgs) were measured. BMI was calculated. Controls with BMI of 18.50 – 24.99 kg/m2 , Obese individuals with BMI ? 30 kg/m2 . Echocardiograms were performed using GE Vivid T 8 by standard techniques. The early diastolic (E) and atrial (A) velocities were measured and the E/A ratio was calculated. The deceleration time (in ms) was also assessed. Statistical analysis was done using ‘t’ test Results: The mean values of the early diastolic (E) velocity and E/A ratio were lesser in the group of obese individuals when compared with the controls and was statistically significant. Deceleration time and left ventricular end diastolic volume were greater in obese individuals. Conclusion: The present study suggests a significant decrease in the diastolic function in obese individuals when other risk factors are excluded. So obesity is found to have detriment on diastolic function and may lead to cardiac failure. Echocardiographic study should be included in the evaluation of obesity for early detection diastolic dysfunction. Preventive measures should be taken to decrease the morbidity and mortality associated with obesity.
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Background: Intrauterine contraceptive devices are one of the most efficient, cost effective long acting reversible contraceptives. But the worrying clinical symptoms, misconceptions and higher rates of genital tract infection have become a hurdle in its acceptance as the first choice of contraception. The objective of this study was to study the common reasons for removal of IUCD.Methods: An observational study was done involving 430 women who reported to the OBG Outpatient of the hospitals attached to Bangalore Medical College, over a period of 2 years, for IUCD removal. Socio-demographic details, clinical symptoms compelling IUCD removal were elicited. The removed IUCD was subjected to culture and sensitivity. Initial descriptive analysis was used and statistical tests of significance like chi-square were used to know the relation between genital infections and IUCD. P value <0.05 was considered significant.Results: Of the 430 women, 46.9% were between 21-25 years of age, 49.3% were primipara, and 71% used IUCD for 1-3 years. Most common reason for removal in the first 2 years was heavy menstrual bleed followed by pain abdomen. 15.3% culture reports showed growth of bacteria, with maximum cultures positive in <5 years of usage, the association was statistically significant.Conclusions: Present study shows a lower risk of bacterial infections among IUCD users. Hence, effective counseling regarding the safety of IUCD over other spacing methods is essential to increase its acceptance.
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Back ground: Holt-Oram is rare autosomal disorder, clinically characterised by congenital cardiac defects and morphological abnormalities of the upper limbs. Case characteristics:10 days old neonate born to first degree consangunious parents presented with upper limb anomaly and cardiac defects. Obseravations : Hypoplastic left thumb with ASD, VSD and PDAwas present. Message- Neonate with upper limb anomaly should be evaluated for congenital hear disease
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Background: Renal hilum is the middle concavity of the medial border of kidney which communicates with renalsinus. The disposition of renal hilar structures has been described in anatomical textbook from anterior toposterior as the renal vein, renal artery and renal pelvis. Variations in arrangement of renal hilar structureswere detected incidentally while performing investigative imaging and angiographic procedures. Anatomicalknowledge of structures at the renal hilum is of great importance for various urological surgical procedures andalso during interpretation of various radiological techniques related to the kidney.Objective: To evaluate the arrangement of renal hilar structures in human cadaversMaterials and Methods: Present work was carried out in the Department of Anatomy, Sri Devaraj Urs medicalcollege, Kolar on fifty pairs of morphological normal kidneys of embalmed cadavers. Renal hilum of each kidneywas dissected carefully to see the arrangement of renal artery, vein and pelvis and their anteroposterior relationsat the hilum were recorded.Results: The arrangement of renal hilar structures exhibited great variations. The patterns of arrangement of thehilar structures were classified into 12 major patterns. In 32 % kidney we observed the classical arrangement ofhilar structures described in standard textbooks as renal vein, renal artery and pelvis. In 36% cases anteriortrunk of renal artery is the most anteriorly placed structure at the renal hilum. In 21% cases we observed anteriorand posterior tributaries of renal vein. The renal pelvis in between the divisions of renal artery and tributariesof renal vein was noted in 43% cases. We noticed the formation of the renal pelvis outside the hilum in 7% cases.Conclusion: Present study will help to provide better knowledge of disposition of renal hilar structures which willbe useful for the urological surgeons, radiologists and anatomists.
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Background: Combined spinal-epidural anesthesia technique for providing pain relief for orthopedic procedures has gained popularity. It combines the advantages of rapid onset and the reliability of blockade obtained spinally along with the flexibility given by epidural catheter avoiding the disadvantages of either technique used alone. Spinal anesthesia provides dense neural blockade of finite duration while epidural is more titratable producing less hemodynamic swings and postoperative analgesia. The epidural volume extension adds color to combined spinal-epidural anesthesia technique where the onset and the level of blockade obtained spinally are enhanced by administering saline or local anesthetic via the epidural catheter. The ideology behind this is the volume effect accomplished by injecting saline epidurally which would result in intrathecal compression and cephalad migration of spinal local anesthetic. S. Sudhakaran, S. Ashwini. A prospective study evaluating the effectiveness of epidural volume extension with normal saline in combined spinal epidural anesthesia for lower limb orthopedic surgeries using low dose intrathecal hyperbaric bupivacaine. IAIM, 2017; 4(11): 52-60. Page 53 Aim of the study: To identify the effectiveness of block profile provided by extending the epidural volume with normal saline for lower limb orthopedic surgeries using a low dose intrathecal hyperbaric bupivacaine without causing hemodynamic changes. Materials and methods: A prospective randomised controlled study involving 80 patients posted for elective lower limb orthopedic surgeries were divided into two groups of 40 each. Group A received combined spinal-epidural anesthesia with 10 mg of 0.5% bupivacaine with epidural volume extension of 10 ml normal saline. Group B received combined spinal-epidural anesthesia alone. The blood pressure and heart rate changes were observed at the 5th, 10th, 15th, 20th min and then every fifteen minutes. Results: Low dose of intrathecal hyperbaric bupivacaine (10 mg) with 25 micrograms of fentanyl with epidural volume extension (10ml normal saline) is associated with early onset of sensory and motor blockade, high level of sensory block, shorter time of two segment regression. Conclusion: In this study we can safely conclude that combination of spinal epidural with epidural volume extension with normal saline achieves an effective and shorter block time as evident by significantly lower maximum motor block time providing prolonged analgesia by requiring less topup dose of bupivacaine with higher level of sensory block at the tenth minute with shorter mean maximum sensory block time
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A clear knowledge of the location of the maxillo-facial foramina is essential for clinicians while performing endoscopic surgeries and regional nerve blocks. In the present study, a detailed analysis of the supraorbital foramen [SOF] and supraorbital notch [SON] of South Indian skulls is reported and the data are compared with those from other races and regions. Anatomical variation of SOF/SON was studied in 83 adult human skulls bilaterally, using "travelling Vernier's microscope". The skulls belonged to the cadavers of South Indian origin. The parameters used were distanced between the SON/ SOF and the nasal midline; distance between the SON/SOF and the frontozygomatic suture [FZS]; shape and height of the SOF; transverse diameter of the SON; the presence of accessory foramina [ACF] and their number; as well as the location and distance from the main SON/SOF. SON was more frequently found than the SOF. The mean distance of SON/SOF to the nasal midline was 22.24 mm on the right side and 22.2 mm on the left side. The mean distance of SON/SOF to the frontozygomatic suture was 29.34 mm on the right side and 28.7 mm on the left side. While the mean height of SOF was 3.5 mm on the right side and 3.04 mm on the left side. Also, the mean transverse diameter of SON was 5.17 mm on the right side and 5.58 mm on the left side. The accessory supraorbital foramina were observed in 66.25% of cases. There is a difference in the position and dimensions of SOF /SON between different races and people of different regions. Anatomical knowledge of SON /SOF is important in facilitating local anesthetic, forehead lifting, blepharoplasty and other craniofacial surgical procedures