A Study of Hemodynamic Effects of Rocuronium Bromide and other Muscle Relaxants in Cardiac Surgery

Introduction: Use of muscle relaxants in cardiac surgeryposes a challenge to anaesthesia due to narrow margin of safetyand limited cardiovascular function. Therefore aim of presentstudy is to find out the hemodynamic effects of Rocuroniumbromide and other muscle relaxant in cardiac surgery.Material and Methods: Present study was carried out on sixty(60) patients of different age groups from both sexes scheduledfor various cardiac surgical procedures at L.P.S. Institute ofCardiology, GSVM medical college Kanpur during the periodof August 1998 to August 1999. Patients were classified in 3equal groups. Muscle relaxants were given according to thegroup and hemodynamic parameters were recorded carefullyat the interval of two, five and ten minutes.Results: No statistically significant changes were observed insystolic blood pressure, diastolic blood pressure and centralvenous pressure at 2 minutes, 5 minutes and 10 minutes afterthe administration of all three drugs (P >0.05) comparedwith control values. Significant increase in heart rate wasobserved at 2 minutes and 5 minutes after the administrationof Pancuronium (P <0.05).Conclusion: On basis of present study’s result, it can besaid that Rocuronium bromide is safer in cardiac surgery ascompared to Vecuronium & Pancuronium.

Efficacy of TENS versus Conservative Pain Control Measures in Post Herpetic Neuralgia: A Retrospective Observational Study.

Abstracts: Background & Objective: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in treatment of post herpetic neuralgia (PHN) compared with conservative pain control measures. Methodology: A retrospective institution based observational study was conducted evaluating the records of patients visiting the dermatology OPD during last 6 consecutive months for herpes zoster and PHN. 152 out of 6240 new cases had herpes zoster and 50 of these patients had PHN which was defined as persistence of pain at the involved site one month after subsidence of rash. Pain was quantitatively noted in these patients on a visual analogue scale (VAS) from 0-10.Three treatment groups were compared: only TENS therapy, TENS with analgesics (most commonly NSAIDS) and tab gabapentin along with tab amitriptyline as tricyclic antidepressant. ANOVA test was applied to study the statistical difference in treatment response between the three groups. Results: Mean baseline VAS in the groups was 6.6, 7.06 and 6.78 respectively. At the end of treatment the mean VAS was 2.1, 2.39 and 2.86 respectively. We found that there was 68.1%, 66.1% and 57.8% improvement in VAS in the individual groups respectively. The improvement was found to be statistically significant (p<0.05) in all the three treatment groups. Intergroup analysis, however, did not reveal any statistically significant difference between the groups. Conclusion: TENS is a safe and effective measure for pain control in post herpetic neuralgia patients. However, its efficacy over conventional pain control measures like NSAIDs and tab gabapentin and tricyclic antidepressants could not ascertained. Our study also revealed that initiation of antiviral therapy within 72 hours did not affect the severity of PHN.

The effect of amlodipine on blood glucose level and its interaction with oral hypoglycemic drugs in albino rabbits.

Background: Amlodipine used as many cardiac conditions esp in hypertension. Diabetes affects cardiovascular system adversely. So this study was done to see effect of amlodipine on blood glucose level and its interaction with commonly used oral hypoglycemic agents in diabetic & non diabetic albino rabbits. Methods: Rabbits were divided into nine groups of 6 rabbits in each group. I and II group were non-diabetic given normal saline and amlodipine respectively. Group III to IX were made diabetic by using alloxan monohydrate (150mg/kg i.p.) & given normal saline, glimepiride, metformin, pioglitazone, amlodipine + glimepiride, amlodipine + metformin and amlodipine + pioglitazone respectively. All drugs were given orally once daily for 7 day except group VII, VIII and IX in which glimepiride, metformin and pioglitazone were added on 7th day. After GTT blood glucose level were measured at 0, 1, 2 and 6 hours on 7th day in all groups by using spectrophotometer. Results: After 7 days of treatment the amlodipine produced significant hyperglycemia in normal rabbits. Amlodipine on combination, causes significant decreased in hypoglycemic effect of glimepiride, significant increased the hypoglycemic effect of metformin, while no significant changes in hypoglycemic effects of pioglitazone in diabetic rabbits. Conclusion: The present study shows that amlodipine causes hyperglycemia in normal rabbits. Amlodipine significantly altered hypoglycemic effect of glimepiride and metformin as compared to control group. If these finding are true to human beings then amlodipine should be use cautiously in diabetic patient on oral hypoglycemic drugs.

A rare presentation of mammary Paget's disease involving the entire breast in the absence of any underlying ductal malignancy.

Paget's disease of the breast is an uncommon form of breast cancer presenting as an eczematous eruption over the nipple and/or areola. The diagnosis remains elusive with varied presentations, mimicking many benign skin diseases, the awareness of which is indispensable for diagnosis and minimizing morbidity. Most of the cases have an associated malignancy of the underlying breast tissue. There have been very few reports wherein the disease has occurred independent of any underlying malignancy. Since, the initial presentation is limited to skin; it is the dermatologist who plays a key role in making a diagnosis, thus, facilitating proper management. We report a rare presentation of mammary Paget's disease with a wide cutaneous spread probably attributed to a significantly delayed diagnosis without any associated underlying malignancy.

Rosai-Dorfman disease with sinonasal mucosal involvement.

Rosai-Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy (SHML) is a rare benign disorder that typically manifests as massive lymphadenopathy and systemic symptoms. The authors report a 27-year-old man who presented with nasal mass and generalised cervical lymphadenopathy. Cytological and histopathological examination of lymph nodes demonstrated lymphophagocytosis (emperipolesis) consistent with a diagnosis of RDD. There was remarkable regression in the size of nasal polyps and lymph nodes after systemic corticosteroids. The clinical and histological aspects of the disease are discussed as a rare cause of generalised lymphadenopathy.

Evaluation of the antimicrobial activity of various concentrations of Tulsi (Ocimum sanctum) extract against Streptococcus mutans: An in vitro study.

Aim: To determine if Tulsi (Ocimum sanctum) extract has an antimicrobial activity against Streptococcus mutans and to determine which concentration of Tulsi (Ocimum sanctum) extract among the 15 concentrations investigated has the maximum antimicrobial activity. Setting and Design: Experimental design, in vitro study, Lab setting. Materials and Methods: Ethanolic extract of Tulsi was prepared by the cold extraction method. The extract was then diluted with an inert solvent, dimethyl formamide, to obtain 15 different concentrations (0.5%, 1%, 1.5%, 2%, 2.5%, 3%, 3.5%, 4%, 4.5%, 5%, 6%, 7% 8%, 9%, 10%) of the extract. 0.2% chlorhexidine was used as a positive control and dimethyl formamide was used as a negative control. The extract, along with the controls, was then subjected to microbiological investigation to determine which concentration among the 15 different concentrations of the extract gave a wider inhibition zone against Streptococcus mutans. The zones of inhibition were measured in millimeters using a vernier caliper. Results: At the 4% concentration of Tulsi extract, a zone of inhibition of 22 mm was obtained. This was the widest zone of inhibition observed among all the 15 different concentrations of Tulsi that were investigated. Conclusion: Tulsi extract demonstrated an antimicrobial property against Streptococcus mutans.

Serum cortisol and thyroid hormone levels in neonates with sepsis.

OBJECTIVE: To evaluate the thyroid hormone and cortisol levels in neonates with sepsis in relation to the final outcome. It was hypothesized that the hormonal level could act as some prognostic guideline. METHODS: Forty nine neonates, aged 8- 28 days, diagnosed as neonatal sepsis were selected for the study. Neonates below 8 days of age, 35 weeks of gestation and 2000 g of birth weight were excluded from the study. Twenty FT-AGA neonates beyond day 7 of life served as control for the study. The hormones were estimated by radioimmunoassay. RESULTS: The neonates with sepsis had significantly higher mean serum cortisol and lower mean serum total T4 at admission as compared to healthy neonates. The mean serum total T3 level was also lower, but the difference was not statistically significant. The mean serum TSH levels were comparable in both groups. The levels normalised following recovery. Sixteen neonates succumbed to the disease process. The non-survivors had significantly lower mean total T3 and total T4 levels as compared to the survivors. CONCLUSION: The endocrinal abnormalities are of transient nature as a response to sepsis. Low total T3 and total T4 are the predictors of adverse outcome in neonates with sepsis.