ABSTRACT
Background: To assess effect and safety of beta blockers in hypertensive patients.Material & Methods:One hundred twelve adult patients who were diagnosed cases of hypertension of either gender were divided into 2 groups. Each group contained 56 patients. Group I received 25 mg atenolol twice daily and group II received 25 mg metoprolol tartrate twice daily. History of diabetes, kidney disease, lipid disorder, incident cardiovascular (CV) events etc. was recorded. Blood pressure (systolic and diastolic) was recorded before starting and after starting the drug therapy.Results:Age group 20-40 years had 12 in group I and 11 in group II, 41-60 years had 14 in group I and 17 in group II and >60 years had 30 in group I and 28 in group II. There were 40 males and 16 females in group I and 38 males and 18 females in group II. A significant difference in males and females within the group (P< 0.05) and non- significant intergroup difference was observed (P> 0.05). The mean SBP found to be 149.4 mm Hg in group I and 146.7 mm Hg in group II and DBP was 85.4 mm Hg in group I and 83.6 mm Hg in group II at baseline and SBP was 135.4 mm Hg in group I and 134.6 mm Hg in group II and 78.2 mm Hg in group I and 78.0 mm Hg in group II at 6 months. Diabetes mellitus was seen in 12 in group I and 19 in group II, lipid disorders 17 in group I and 28 in group II, chronic kidney disease 11 in group I and 16 in group II and CV event 2 in group I and 4 in group II. Conclusions:Both beta blockers found to be equally effective in management of patients with hypertension.
ABSTRACT
Background: Vitamin A also plays a role in the morphology and physiology of the eyeball. The present study was conducted to assess prevalence and risk factors of vitamin A deficiency among children and women. Methods: The present study was conducted on 96 children of age ranged 5-12 years and their mothers of both genders. Parents of toddlers were asked for symptoms, suggesting that the child may have poor vision in dim light. The body mass index (BMI) was calculated. Serum retinol levels were measured for all participants high-performance liquid. Results: Out of 96 patients, boys were 54 and girls were 42. Out of 54 boys, 7 boys and out of 42 girls, 4 girls had vitamin A deficiency. 56 mothers had low SES, 28 had medium and 12 had high. Mother education was upto college level in 28 and upto high school in 78. Number of children in family was >2 seen in 52 and 2 in 44 parents. The difference was significant (P< 0.05). Conclusion: The prevalence of vitamin A deficiency was found to be 11.45%. Risk factors were low socio- economic status, >2 children in family and low education level of mothers.
ABSTRACT
Background: Diabetes mellitus is a devastating metabolic disorder that places an economic burden. The present study was conducted to assess prevalence of diabetic peripheral neuropathy in type II diabetics. Methods: The present study was conducted on 114 type II diabetes patients of both genders. Patients were subjected to fasting blood sugar, random blood sugar and glycosylated hemoglobin to know diabetic status. A thorough clinical examination was done. Physical signs such as numbness, ulcerations loss of reflexes were recorded. Results: Out of 114 patients, males were 64 and females were 50. Out of 114 patients, 46 (40.3%) had PNP. In patients with PDN, 32 had ulcerations and 38 had numbness of limbs. The difference was non- significant (P> 0.05). There were 2 cases of DPN with 5 years, 10 cases with 5-10 years and 34 cases with >10 years of DPN. The difference was significant (P<0.05). Conclusion: Authors found that among type II diabetic patients, 46 had diabetic peripheral neuropathy.
ABSTRACT
The prevalence of hypertension in children and adolescents seems to be increasing. The present study aimed to investigate the best anthropometric determinants of high blood pressure in school children. Methods: The present study was conducted in the department of Community Medicine. It comprised of 1160 school children age ranged 12-16 years of both genders. In all children, height (cm), weight (kg), systolic and diastolic blood pressure, Body mass index (kg/m2), Waist circumference (cm) Triceps skinfold (mm) was recorded. Results: Maximum boys were in age 12 years and 16 years and girls in age 14 years, followed by 70 boys in 12 years, 80 in 15 years and 60 in 14 years. 48 girls in 15 years, 42 in 13 years, 38 in 12 years and 17 in 16 years. Boys had 22% and girls had 20% of prevalence of hypertension. The mean height in males was 155.2 cm and in girls was 146.2 cm, weight was 37.4 kg in boys and 32.1 kg in girls, SBP was 132.4 mm Hg in boys and 124.6 mm Hg in girls. DBP was 86.2 mm Hg in boys and 74.6 mm Hg in girls. Conclusion: There is a positive correlation of weight of subjects and systolic and diastolic blood pressure in subjects. Early screening for high blood pressure in school students and introducing effective lifestyle modifications at an early age to prevent the epidemic of non-communicable diseases in future is the need of hour.
ABSTRACT
Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a major and one of the most serious public health challenges in today’s world. The present study was conducted to assess knowledge and attitude regarding HIV in rural population. Methods: The present cross sectional study was conducted by involving 960 rural population of both genders. Study participant should be more than 15 years of age and resident of the same village was used as inclusion criteria. General information such as name, age, gender etc. was recorded. A questionnaire was prepared which were related to knowledge and attitude of rural population regarding HIV. Respondents were instructed to respond in yes or no. Results: Out of 960 subjects 620 were aware of HIV/AIDS, 680 were aware of VCCT, 650 were aware of VCCT centre, 830 had heard of condom and 760 were aware of ARV. The difference was significant (P< 0.05). Conclusion: Authors found that respondents had sufficient knowledge and attitude regarding HIV infection.
ABSTRACT
Nutritional iron deficiency is the main cause of anemia throughout the world. It is especially common in women of reproductive age and particularly during pregnancy. Anemia during pregnancy is associated with adverse perinatal outcomes in the form of preterm birth, stillbirth, small for gestational age babies and increased perinatal mortality. There is persistently high prevalence of anemia in Indian mothers despite a national program in place. Objective: To assess the prevalence of anaemia, its different types and their association with maternal and perinatal outcomes. Methods: This study was conducted on 100 pregnant patients with severe anemia. The study population was divided into 3 groups based on basis of peripheral smear picture i.e. microcytic, macrocytic and dimorphic anemia. These pregnant mothers were followed up until their time of delivery and associations between anaemia types and maternal as well neonatal adverse outcomes were explored. All the data collected was analyzed using statistical computer software (STATA Version 13.0). Result: Microcytic hypochromic anemia was most commonly present (45 patients, 45%). Intrauterine growth restriction was seen in 20% of total study population and out of these, majority were born to mother with macrocytic anemia (32.5%). The same trend was also seen for gestational hypertension with 8.9%. 32.5% and 6.7% patients having gestational hypertension in microcytic, macrocytic and dimorphic anemia groups respectively (p=0.009). A total of 23 patients had low birth weight babies; 65.2% patients with low birth weight babies had macrocytic anemia and this difference was statistically significant (p=0.024). Overall 15% of babies were small for gestational age, out of which 66.7% babies were in macrocytic anemia group. Low Apgar score at one minute after birth was seen in four babies born to mothers having macrocytic anemia and this was a statistically significant relationship (p=0.044). Conclusion: Anemia is increasingly becoming prevalent and is associated with poor maternal and perinatal outcomes. Public health interventions should be made by way of appropriate food fortifications to reduce prevalence of anemia Early diagnosis should be made by appropriate investigations and proper therapy should be started as soon as possible according to type of anemia, in order to prevent adverse maternal and foetal outcomes.
ABSTRACT
Tympanoplasty is a common surgery for chronic otitis media. Few studies have looked at the outcomes of microscope assisted (MT) and endoscope assisted (ET) tympanoplasty. Aim: The study aims to analyze the results of endoscope and microscope assisted approaches for tympanoplasty in patients with chronic otitis media. Outcomes were intra-operative and post operative complications as well as functional outcomes (i.e. improvement in hearing as assessed by pure tone audiometry)/. Methods: This study was conducted at a tertiary care hospital. It included 100 subjects – 50 each in Microscope assisted tympanoplasty (MT) and endoscope assisted tympanoplasty (ET) assisted group. Study participants included those with chronic otitis media with central perforation and dry ear for 4 weeks. All the subjects underwent Type 1 tympanoplasty using either endoscopic or microscopic technique. The subjects were assigned to the above two groups alternatively. The key outcomes assessed were time taken for surgery (incision to closure), comfort level of the patient (by measuring pain score), proportion with graft rejection in both the groups and improvement in hearing. Results: We found that endoscope assisted surgery (ET) led to improvement in bone and air conduction and decreased air bone gap, compared to microscope assisted tympanoplasty (MT). There was a 15.5 dB improvement in MT group while the corresponding improvement in ET group was 16.8 dB (P=0.04). The mean improvements in post-operative air conduction were 29.8 dB and 26.1 dB respectively in ET and MT groups (P=0.02). The post-operative air bone conduction gap was 9.9 dB and 7.8 dB respectively in MT and ET groups (P=0.03). We also observed significantly reduced intra-operative pain scores and post-operative pain scores in those who were operated using endoscopy. Conclusion: The endoscope assisted tympanoplasty offers better outcome than microscope assisted approach and is a better choice for surgery
ABSTRACT
Stress is an important reference point in health studies and it is related to both an individual's general health status and different illnesses, including mental disorders, cancer, cardiovascular disease, drug abuse, chronic diseases, etc. Hence; under the light of above mentioned data, the present study was planned to assess various determinants of stress factors among general population. Methods: A total of 200 subjects were included in the present study. A selfframed questionnaire was given to all the subjects for obtaining complete demographic and clinical details of all the subjects. Second part of the questionnaire included assessment of information in relation stress related personal life parameters. The Nordic Questionnaire for Psychological and Social Factors at Work (QPS Nordic) in order to assess perceived stress was given to all subjects and asked to respond. All the answers were graded into three categories as follows: Category A: None or minimal stress, Category B: Stress to some extent, and Category C: Very much stress. All the results were recorded in Microsoft excel sheet and were analyzed by SPSS software. Results: Among subjects less than 30 years of age, 25 subjects had category B stress, while 20 subjects had category C stress. Significant results were obtained while assessing the distribution of stress among males and females. Also significant results were obtained while assessing the distribution of stress among employed people. Conclusion: Stress is particularly common in employed subjects, especially males.
ABSTRACT
The present study was conducted to assess risk factors of chronic diseases in geriatrics. Methods: The present study was conducted on 86 patients aged >60 years of age of both genders. Patients were of diabetes, hypertension, arthritis, angina, chronic lung disease and stroke. In all subjects risk factors for chronic diseases were assessed. Results: Out of 86 patients, males were 52 and females were 34. Diabetes was present in 26, hypertension in 22, arthritis in 15, angina in 8, chronic lung disease in 11 and stroke in 4. The difference was significant (P< 0.05). The most common risk factor in diabetes patients was low socioeconomic status and primary education, in hypertension was primary education and low socioeconomic status, in arthritis was low SES, in angina was tobacco, in chronic lung disease was tobacco and in stroke was tobacco and alcohol. Conclusion: Common risk factors were low socioeconomic status, alcohol, tobacco and primary education.
ABSTRACT
Prostaglandin E2(cerviprime gel), an inducing agent is instilled intracervically or placed high in the posterior fornix of the vagina and may need to be re-in- stilled after 6 h if required. Another alternative is misoprostol (15-deoxy-16- hydroxy-16-methyl prostoglandin E1) which is used in various dosages. Methods: This was a prospective observational study of nulliparous women undergoing labor induction for one year, 100 womens, in a tertiary care center. Participants were then randomly assigned to pre-induction cervical ripening with a dinoprostone vaginal insert (0.5mg) (group I), and with misoprostol (50 microg) intravaginally(group II). Result: From our study observation, maximum patients delivered normal vaginal delivery. Of the vaginal deliveries six (18%) of PGE2 group and five patients(10%) of PGE1 having meconium stained liquor after ARM or spontaneous rupture of membrane, fetal heart was reassuring i.e, no fetal distress was there. The caesarean section rate in both groups nine (18%) and (10%) was statistically insignificant. Mean change in bishop score was also not significant in both groups. Need for oxytocine after 8hrs of induction between both group was significant, 84% in dinoprostone group and 56% in misoprostol group. Gastrointestinal side effects, uterine tacchysystole, uterine hyperstimulation was more common in misoprostol group than dinoprostone group, that is statistically significant. Induction to delivery time was shorter in misoprostol group that is statistically significant. No adverse neonatal outcomes that can directly be related with both drugs. Both agents are equally efficacious in causing cervical repining and almost equal changes in mean bishops. Conclusion: Misoprostol is an excellent labour-inducing agent and can be used liberally for labour induction, unlike PGE2 gel, is comparatively cheaper and is stable at room temperature; thus, it could be an ideal inducing agent in poor resource settings. Local application of misoprostol tablet in posterior vagina is easier method than dinoprostone insertion. Intravaginal insertion of misoprostol tablet is superior to dinoprostone gel in inducing labour and shorter interval between induction and delivery.
ABSTRACT
As estimated by WHO, globally a total of 36.9 million [34.3 – 41.4 million] people were living with HIV in 2014. Quality of life (QOL) of HIV/AIDS patients is becoming an important element for understanding and assessing the overall health care and management in health care settings. The objective of this study was to determine the QOL of patients living with HIV/AIDS in Delhi. Systemic Random sampling method was used to identify the subjects from the antiretroviral therapy clinic (ART) situated in tertiary care hospital in Delhi. Methods: 200 patients were interviewed with the WHOQOL-HIV instrument. Questionnaire included items on socio-demographic data, multi-item scales and had six domains namely physical, psychological, level of independence, social relationships, environment and spirituality religion. Results: Study subjects were aged between 18-60 years with mean age of 34.46±8.76 years, and comprised of 41%females. 29 % of studied subjects were illiterate. More than 1/3rd of the patients (84% females) were unemployed and did not have any source of income. All QOL domains were observed to be higher for males in comparison to females. Single/widow patients had better QOL in comparison to married patients. QOL was observed to be better among those who were young, had better educational qualifications, were employed, asymptomatic, had shorter duration of treatment and those who stayed closer to the ART center. Conclusion: Correlation of scores of six domains with overall QOL score and among individual domains was found to be statistically significant.
ABSTRACT
The objective of the study was to document the bladder behaviour in response to rehabilitation intervention in patients with traumatic spinal cord injury (SCI) using urodynamic study (UDS). Additionally, it also aimed to compare the nature of the bladder in a rehabilitated and non- rehabilitated neurogenic bladder of traumatic SCI. Study design: The study adopted a prospective follow-up design. Setting: Department of Physical and Rehabilitation Medicine, Jawahar Lal Nehru Medical College and Hospital (JLNMCH), Bhagalpur, Bihar, India. Methods: One hundred and thirty traumatic SCI patients mean age 31.3±7.8 years, 113 males and 17 females, admitted for rehabilitation were done UDS to see the bladder behaviour in response to rehabilitation intervention and compare the nature of bladder of the rehabilitated and that of the non-rehabilitated neurogenic bladder. Result: There were significant changes in the max. cystometric capacity (p=0.019) after rehab intervention in upper motor neuron (UMN) neurogenic bladders. The compliance, Pdet. at first desire to void and Pdet. at max. cystometric capacity were also found to have significant correlations (p=0.010, 0.010 and 0.013 respectively) in those with UMN neurogenic bladders. However, the volume at the first desire to void did not show significant changes after rehabilitation intervention (p=0.54). Significant decrease in amplitude and frequency was found in involuntary contractions (detrusor hyper-reflexia). In lower motor neuron (LMN) neurogenic bladder significant changes after rehabilitation intervention was found only in the max. cystometric capacity (p=0.015). Conclusion: Based on these findings we conclude that the change in the nature of the rehabilitated neurogenic bladder is different with the type of bladder.
ABSTRACT
Introduction: Anal fissure (AF) is a common disease. It causes considerable discomfort, loss of working days, and reduction in quality of life. Symptoms of AF include anal pain during defecation and bleeding per anus. Acute AF is treated conservatively, but chronic AF (CAF) does not usually respond to conservative treatment. Anal stretch (Lord’s procedure), reintroduced into AF therapy in 1964 with significant success rates, is, however, associated with recurrence rates varying from 2% to 80%, a high risk of incontinence (up to 51%), and is widely criticized despite a reported cure rate of approximately 90%. Materials and Methods: The present prospective study was conducted after due approval of “Scientific and Ethical Committee” in the Department of General Surgery of Mata Chanan Devi Hospital, New Delhi, during the period from October 2013 to May 2015 on patients attending the outpatient department or emergency department of this hospital. Results: In the present study, all 50 patients were selected and randomized into two treatment groups. Results were compared among two groups: Group B: Patients receiving Botulinum toxin-A (BOTOX) injection (n1 = 25) and Study Groups Group1=Group-B ,Group-2=Group-D. Randomisation Will Be As Follows. Group-B (Botox) Vs Group-D(Lords Procedure): Patients who underwent Lord’s procedure (n2 = 25). All results are well tabulated and described in figure format for well understanding in main article. Conclusion: BOTOX is as good as an option, compared to ancient yet routinely practiced LORD’S anal dilatation technique for CAF. BOTOX significantly reduces pain in patients with CAF as compared to Lord’s procedure. BOTOX has definite action in reducing the spasm of internal anal sphincter which is the chief cause of development of CAF. Spasm significantly improves with BOTOX compared to Lord’s procedure.
ABSTRACT
Background: Planter fasciitis is an injury of unknown origin in more than 80% cases. It affects quality of life as well as daily activity of the patients. Various surgical procedures, autologous blood and steroid injection also have been applied without constant success. Platelets rich plasma have been found effective in various orthopedically disorders like osteoarthritis, tennis elbow etc. That is why the present study was designed to compare the efficacy of platelets rich plasma injections and steroidal injections for the treatment of planter fasciitis. Methods: The present interventional study was conducted fromJuly 2016 to June 2018. Study population was divided into groups. Group I included patients (n=40) of a single ultra sound guided platelets rich plasma injection whereas, group II contained patients (n=40) with a single ultra sound guided depomedrol 40 mg injection. Scores of VAS and AOFAS were recorded at the initial level and follow ups after the injections. Follow up examinations were done at 6 weeks, 6 months and 12 months. Results: There was a significant improvement in mean VAS scores of platelet rich plasma group patients (1.8) compare to corticosteroid injection group patients (3.4) after one year of the treatment. However, results showed that steroids failed to show long term decrease in VAS score (p<0.05). Mean AOFAS was significantly increased (64.4) in the steroid group at 6wks as in comparison of platelet rich plasma group (52.2). Conclusion: Findings of the present study showed that improvement in steroid group was faster but benefits were lost in longer run. In contrast, platelets rich plasma was more effective in sustaining the long term beneficial effects.
ABSTRACT
Background: Depression, the most common type of mental illness is the second leading cause of disability worldwide next to CAD. Vitamin B6, folate and vitamin B12 are involved in a series of methylation reaction that produce monoamine neurotransmitters, phospholipids and nucleotide. Therefore the present study was planned to assay the blood levels of vitamin B12 and folate in patients with depression. The objective of this was to study if metabolites are affected by diet and may be helpful in the prevention of depression. Methods: Current study was an experimental case control study, was conducted at Santosh Medical College. A total of 88 cases (44 patients and 44 controls) both males and females in the age between 18 - 65 years were included in the study. Hamilton depression rating scale (HDRS) -17 items scale was used to rate the level of depression. Results: In the present study a total of 88 subjects including 45 females and 43 males participated, out of which 44 were control, 24 males and rest 20 were females. Majority 55 patients were of no depression category, 11 were of mild depression category, 10 were of severe depression and rest 9, were of moderate depression category. Mean value of B12 were found lowest in ‘moderate’ depressed patients (115), than in ‘most severe depressed’ (137), followed by ‘severe’ and ‘mild’ depressed patients category. Value of HDRS increases with severity of depression, it was found lowest in the ‘mild’ (10.64), then it steadily increases with severity, moderate (15.11), severe (21.20) and most severe (27.55). Conclusion: This study showed that majority of the patients with clinical depression had vitamin B12 deficiency.
ABSTRACT
Background:To study the incidence of primary postpartum haemorrhage, morbidity and mortality. Methods: Study was carried out in department of obstetrics and gynaecology, Swaroop Rani Nehru and associated Hospital, M..L.N. Medical College Allahabad. All pregnant women who underwent vaginal delivery and those who were admitted within 24 hours of delivery were included in the study .Group allocation was done randomly in three groups. Analysis of study data was done by chi square test. Result:The incidence of primary postpartum haemorrhage was 4%.Maximum incidence was noted in group A (5.8%) and minimum in group C (4.2%) .The morbidity which were related to primary postpartum haemorrhage were anaemia (68%),infection (42%),blood transfusion related complications (26%),DIC(4%), and hysterectomy (3%). 0.3% of patients died of severe postpartum haemorrhage .Management options included intensive therapy ,B-Lynch sutures and hysterectomy. Conclusion: ?
ABSTRACT
Background: Breast cancer is the most common female cancer worldwide representing nearly a quarter (25%) of all cancers with an estimated 1.67 million new cancer cases diagnosed in 2012.This study was designed with the primary aim to compare the difference between MRI and Mammography in patients presenting with breast related complaints. Methods: This prospective study was conducted between Oct 2006 and Feb 2008 in the department of Radio diagnosis & Imaging at Army Hospital (Research & Referral), Delhi Cantt. Fifty patients screened with suspicious malignant breast lesions were taken up for the study. Results: Mammography Imaging revealed that most of the malignant masses were found to have architectural distortion & calcification with fewer cases of skin involvement, PI& Nipple retraction respectively. Benign masses were diagnosed with comparatively fewer cases of calcification and presence of other morphological features was rare. Various Imaging techniques have been compared with the Histopathology gold standard technique, When compared with USG Our study showed the sensitivity, specificity, PPV,NPV& Accuracy 67%,75%,80%,72%. Conclusion: Mammography compared to DCMRI has shown to produce false negative results, especially showing less sensitivity for diagnosis of breast cancer in younger women having dense breast
ABSTRACT
Background: Intertrochanteric fractures are one of the commonest fractures especially in the elderly with porotic bones. Our study was aimed to evaluate effectiveness of implant TSP in preventing above complication of DHS for unstable fracture I/T femur (i.e. Evan’s type III & V) measured in terms of fracture collapse, screw impaction, limb shortening &overall functional outcome. Methods: This prospective study was conducted in the Department of Orthopaedics, Traumatology, M G M Medical College & associated M. Y. Hospital, Indore from June 2008 to September 2010. 145 cases were registered in the study out of which 81 cases with unstable fracture intertrochanteric femur (type III & V of Evan`s) admitted and treated by internal fixation using TSP & DHS included. Preoperative assessment of fracture geometry was done using Evan’s classification. Intra operatively pattern of reduction achieved was seen on Antero-posterior and Lateral projections by image intensifier. Using TAD index assessment of Screw placement was done in postoperative period. Neck shaft angle measured on immediate post op x-ray with the help of Goniometer. During 1st follow up (2 weeks post op), 2nd follow up (4 weeks post op), 3rd follow up (3 months post op) and 4th follow up plain radiographs (true AP and true lateral hip with thigh) were obtained to look for signs of union and impaction. Functional results were evaluated after a period of 6 months postoperatively using new criteria devised from Harris hip score taking into consideration the needs of Indian patients (Modified Harris Hip Score). Results: Average screw impaction (Fracture collapse) was 15.8mm in DHS group & 6.5mm in TSP group. 20 patients (49%) out of 41 had screw impaction more than 15mm at 6 month of follow up, whereas only 1 patient (2.5%) out of 40 in TSP group. Average shortening in DHS group was 2.33cm & 1.42cm in TSP group. 25 (61%) out of 41 patients of DHS group had shortening more than 2cm whereas only 13 (32.5%) out of 40 patients in TSP group. In significant no. of patients excellent to good functional outcome (Harris Hip Score >60) was seen in TSP treated group. Average functional score was 76 in TSP group & 61.68 in DHS group. 28 patients (70%) out of 40 in TSP group had HHS >60 after 6 months of surgery, whereas only 17 patients (41.5%) out of 41 in DHS group. In type III fracture with TSP was having much better outcome than any other group. Conclusion:In unstable intertrochanteric fracture with lateral trochanteric wall fracture, reconstruction of lateral trochanteric wall & abductor mechanism using trochanter stabilizing plate helps in achieving anatomical reduction, imparts stability and prevents excessive sliding of screw & collapse, limb shortening. Thus it helps in achieving overall good functional outcome.
ABSTRACT
Background: Laparoscopic cholecystectomy is the gold standard for the surgical treatment of symptomatic gall-stones The aim of this prospective randomized study was to compare the surgical outcome of LC performed with the patient under spinal anaesthesia with that of LC performed with the patient under general anaesthesia in the management of symptomatic uncomplicated gallstone disease. Methods: An Observational Descriptive Study was done on total 100 cases. Outcome Measures noted were a) Conversion rate of laparoscopic cholecystectomy under spinal anaesthesia to general anaesthesia, b) Hypotension and c) Bradycardia. Results: Spinal anaesthesia is a feasible, safe and effective alternative to general anaesthesia for laparoscopic cholecystectomy. Intraoperative hypotension, and bradycardia need to be addressed during laparoscopic cholecystectomy under spinal anaesthesia. Provided with good patient selection laparoscopic cholecystectomy under spinal anaesthesia can substitute that under general anaesthesia. Conclusion: Laparoscopic cholecystectomy under spinal anaesthesia is a better option for selected group of patients while anticipating fast track surgery or day care surgery
ABSTRACT
Background:Spinal dysraphism occurs due to failure of fusion of parts along dorsal aspect of midline structures lying along spinal axis from skin to vertebrae and spinal cord. Congenital spinal anomalies may be minimal and asymptomatic like spinal bifida occulta, or severe with marked neurological deficits like Arnold-Chiari malformation or caudal regression syndrome. Aim: To compare the results obtained from Ultrasonography and Magnetic Resonance Imaging in patients with spinal dysraphism. Methods: A total of 50 patients of age group new born to 06 months, who had signs of spinal dysraphism, were included. The patients were subjected to spinal USS and MR imaging after obtaining informed written consent from parents. All the images were reviewed by experienced radiologists who were blinded to the results of other investigative modalities. The findings of the MRI were compared with USS examination. Results: Out of 50 patients, 98 percent patient were detected to hydromyelia, 94 percent of tethering of cord, 92 percent of lumboacaral MMC and 88 percent cases were of Associated Arnold Chiari type II malformation (AC). Only 10% of patients had cervicothoracic meningomyelocele, diastematomyelia and intraspinal lipoma as their primary pathologies. Sensitivity and specificity of USS were 100 in diagnosing most of the spinal deformities. The mean time required for the MRI examination was 26.96 min; however in comparison ultrasonography took less mean time (10.62 min). Conclusion: Paediatric spinal dysraphism and associated malformations are accurately diagnosed on MRI scan. On the other hand, limited access to MR imaging together with high costs and the need for extensive preparation of the patients diminishes its suitability as a screening method for spinal dysraphism