Diagnostic variability and therapeutic efficacy of ECT in Nepalese sample.

BACKGROUND: Though electroconvulsive therapy (ECT) has been used in Nepal for last twenty years, researches regarding its use, its efficacy and other data are non-existent. AIMS: The objective of this study was to know about diagnostic variability and therapeutic efficacy of the use of ECT in hospitalized patients. METHODS: This is a prospective comparative study between patients who received ECT and who did not using ICD-10 as diagnostic confirmation. Psychopathology was evaluated using Brief Psychiatric Research Scale (BPRS), Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS) between the groups at admission, at discharge, at 1st month, at 6th month and at 12th month. Functional assessment of patients was done using Global Assessment of Function (GAF). Modified ECT was performed using general anaesthetic agent. RESULTS: 47 patients received ECT as compared to 78 patients who were non-receivers. The patients with most common five diagnosis were paranoid schizophrenia (14.4%); psychotic depression (13.6%) ; undifferentiated schizophrenia (8.8%) ; bipolar mania (7.2% ) ;severe depression without psychosis (5.6%) . There was significant decrease in BPRS in ECT receiver as compared to non-receivers at discharge (p=0.0001), 1st month (p=0.0001), 6th month (p=0.0001) and 12th month (p=0.0001) ; in YMRS at discharge (p=.008), 1st month (p=.002) and at 12th month (p=.015) ; in HAMD-M at discharge (p=0.0001), at 1st month (p=0.0001), at 6th month (p=0.0001) and at 12th month (p=0.0001) ; in GAF at discharge (p=0.0001), at 6th month (p=0.0001) and at 12th month (p=0.0001). CONCLUSION: There was significant improvement in overall psychopathology of patients who received ECT as compared to non-receivers. The improvement was shown by decrement in scores in BPRS, YMRS, HDRS and GAF at the time of discharge, 1st month, 6th month and 12th month which were statistically significant. Day to day functional status of patients also improved as shown by GAF. The efficacy of ECT was very significantly shown in this study with all the psychiatric spectrum disorders.

A comparison of 25 gauge Quincke spinal needle with 26 gauge Eldor spinal needle for the elective Caesarian sections: insertion characteristics and complications.

OBJECTIVE: The study was designed to compare the insertion characteristics and incidence of PDPH between 25 gauge Quincke needle and 26 gauge Eldor needle for spinal anaesthesia in elective c/s. METHOD: 60 pregnant women (aged 19-35 yrs and weighing 58 -67 kg) undergoing elective caesarean section were randomized into group A (Quincke spinal needle group) or group B (Eldor spinal needle group). Spinal anaesthesia was performed with 2.9 ml 0.5% heavy bupivacaine using 25 gauge Quincke spinal needle in group A and 26 Gauge Eldor spinal needle in group B. Onset, time of first identification of backflow of CSF, number of attempts, level of sensory and motor blockade, failure of anaesthesia, inadequate anaesthesia and incidence of PDPH were recorded. RESULT: Quincke spinal needle was found easy at insertion, first attempt was successful in 90% of cases, whereas Eldor spinal needle was successful at first attempt in only 60% of cases. Early identification of CSF was seen in Eldor spinal needle group in 3.5 seconds vs. 5.2 seconds in Quincke spinal needle group. Blood mixed CSF was seen in 8 Quincke spinal needle group vs. none in Eldor spinal needle group. Onset was similar between both groups i.e. in 6 minutes. Failure of anaesthesia was none in Eldor spinal needle group vs. 2 in quincke spinal needle group. Height of sensory block achieved was T4 level in 26 parturients,T6 in 1 ,T8 in 1 and no anaesthesia at all in another 2 parturient as compared to T4 level in 29 and T3 in 1 parturient in Eldor spinal needle group. The degree of motor block with the use of Bromage criteria showed a motor score of 1 or 2 in 26 parturients in Quincke spinal needle group vs. same in all cases in Eldor spinal needle group. The total incidence of PDPH was 8.3 % (5 out of 60 parturient) which occurred all in Quincke spinal needle group. 2 parturient who developed severe PDPH required epidural blood patch. CONCLUSION: 26 gauge Eldor spinal needle was found to be better than 25 gauge Quincke spinal needle for caesarian sections to decrease the incidence of PDPH, though not all insertion characteristics were in favour of the Eldor needle.