To Study the Association of Cerebrovascular Disease with Metabolic Syndrome in Western Uttar Pradesh

Objective: To Study the association of cerebrovascular disease with metabolic syndrome. Methods: A Total 104 patients were included in this study & investigated for cerebrovascular disease associated with metabolic syndrome or not. A study of presence or absence of metabolic syndrome in cerebrovascular disease was done. P value was calculated by using analysis of variance test (ANOVA) & P value <0.05 was considered as statistically significant. Results: Total 104 patients were included in this study in 72 patients (69.23%) were suffering from metabolic syndrome and 32 patient (30.77%) were not suffering from metabolic syndrome. Most of the patients suffering from cerebrovascular disease associated with metabolic syndrome were of older age groups (61.11%)>61 years. Second most common group was (22.22%) 51-60 years. Other patients of cerebrovascular disease not suffering from metabolic syndrome (56.25%) in 51-60 years followed by (31.25%) in 41-50 years. Amongst the patients suffering from cerebrovascular accident and metabolic syndrome males outnumbered females, although this data is not statistically significant p=0.4. Among the Cerebrovascular accident patient group prevalence was highest therefore raised fasting blood sugar (n=58) (80.55%) and low HDL values (75.2%), whereas it was highest for Hypertension (88.89%). In the cerebrovascular accident group out of total 104 patients 72%(n=72) were suffering from metabolic syndrome and 30.77%(n=32) were not suffering from metabolic syndrome there is positive correlation between metabolic syndrome and cerebrovascular accident .Using Test for equality for proportion (zscore) this data is found to be statistically significant. Conclusion: In cerebrovascular accident group (total patients =104) 67.5%(n=108) were having 3 risk factors, 50%(n=80) were having 4 risk factors and 11.25%(n=18) were having 5 risk factors of metabolic syndrome among the cases .Among the patients suffering from cerebrovascular accident (total patients =104) the prevalence of hypertension was 88.89%(n=64),of low HDL was 75.2%(n=54),of high TGs was 80.55%(n=58),of raised waist circumference was 58.32%(n=42) and of increased fasting blood sugar was 80.55%(n=58) in the case group.

Nasal septal angle deviation: effect on lateral wall in nasal obstruction

Background: Deviation of the nasal septum (DNS) refers to the convexity of the septum to one side disturbing the nasal physiology with obstructed nasal breathing leading to lateral nasal wall abnormalities and paranasal sinuses (PNS) mucosal disease. Knowledge of nasal morphological parameters plays an important role in planning successful nasal surgery. Our aim was to evaluate the angle of septal deviation (ASD) on CT scan and study its influence on the lateral nasal wall abnormalities and PNS mucosal disease.Methods: A prospective cross-sectional observational study was conducted on 130 patients with clinical evidence of DNS and chronic sinusitis. The direction and severity of DNS was recorded on CT scan along with evaluation of lateral nasal wall and sinus mucosal abnormalities.Results: Increasing ASD had statistically significant correlation with the lateral nasal wall abnormalities, most commonly, contralateral middle and inferior turbinate hypertrophy (p-value <0.0001). No significant association was found with the incidence of ipsilateral or contralateral osteomeatal complex (OMC) obstruction and sinus mucosal disease.Conclusions: The direction and severity of septal deviation has significant impact on contralateral middle and inferior turbinate hypertrophy. The analysis of these ancillary pathologies can be of great help to the surgeon in better management of patients with nasal obstruction.

Anesthesia for cesarean delivery in a patient with large anterior mediastinal tumor presenting as intrathoracic airway compression

Anterior mediastinal mass is a rare pathology that presents considerable anesthetic challenges due to cardiopulmonary compromise. We present a case that was referred to us in the third trimester of pregnancy with severe breathlessness and orthopnea. An elective cesarean delivery was performed under combined spinal epidural anesthesia with a favorable outcome. We discuss the perioperative considerations in these patients with a review of the literature

Effects of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia: a randomized study

The present study was designed to evaluate the effect of intravenous dexmedetomidine on spinal anesthesia with 0.5% of hyperbaric bupivacaine. One hundred American Society of Anesthesiologists [ASA] physical status I/II patients undergoing elective surgeries under spinal anesthesia were randomized into two groups of 50 each. Immediately after subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine, patients in group D received a loading dose of 1 microg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 microg/kg/h till the end of surgery, whereas patients in group C received an equivalent quantity of normal saline. The time taken for regression of motor blockade to modified Bromage scale 0 was significantly prolonged in group D [220.7 +/- 16.5 min] compared to group C [131 +/- 10.5 min] [P < 0.001]. The level of sensory block was higher in group D [T 6.88 +/- 1.1] than group C [T 7.66 +/- 0.8] [P < 0.001]. The duration for two-dermatomal regression of sensory blockade [137.4 +/- 10.9 min vs. 102.8 +/- 14.8 min] and the duration of sensory block [269.8 +/- 20.7 min vs. 169.2 +/- 12.1 min] were significantly prolonged in group D compared to group C [P < 0.001]. Intraoperative Ramsay sedation scores were higher in group D [4.4 +/- 0.7] compared to group C [2 +/- 0.1] [P < 0.001]. Higher proportion of patients in group D had bradycardia [33% vs. 4%] [P < 0.001], as compared to group C. The 24-h mean analgesic requirement was less and the time to first request for postoperative analgesic was prolonged in group D than in group C [P < 0.001]. Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anesthesia. The incidence of bradycardia is significantly higher when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anesthesia. Dexmedetomidine provides excellent intraoperative sedation and postoperative analgesia.

Wire-Aided Reintubation Following Rigid Bronchoscopy: A Safe Technique.

The management of a neonate with a known difficult airway is a challenge to any clinician. We report a four-day-old neonate with a known difficult airway, who presented to us for rigid bronchoscopy. We used an innovative, economical and easily available adult central venous line guidewire to secure the airway and reintubate the child.