A study of clinical findings among newly diagnosed TB patients who are diagnosed diabetics under medications

Background: Tuberculosis remains a leading cause of death globally. In 2014 there were an estimated 12.8 million new cases of tuberculosis worldwide. The incidence of tuberculosis is greatest among those with conditions impairing immunity such as HIV infection and diabetes. Type 2 Diabetes mellitus amongst Indians occur a decade earlier when compared to the western population. Indians have more abdominal obesity and the waist-hip ratio. Aim of the study: Clinical findings Among Newly Diagnosed Tb Patients who are diagnosed Diabetics under Medications. Materials and methods: 100 cases of newly diagnosed sputum positive pulmonary tuberculosis with diabetes were fitting the inclusion criteria admitted over the period of 2 years from 2016-2017. Subjects were selected from medicine ward, pulmonology ward andTuberculosis ward under DTC. The diagnosis of Pulmonary tuberculosis was made with clinical presentation and verification by detection of acid-fast bacilli under a microscope. Results: Among the study population, 33(33.00%) were smokers, 38 (38.00%) were alcoholics and 9 (9.00%) were habituated to pan chewing. Among the study population, 53 (53.00%) had dyspnoea, 41 (41.00%) had chest pain, 66(66.00%) had a loss of appetite, 60 (60.00%) had an evening rise of temperature, 81(81.00%) had a loss of weight, 32 (32.00%) had hemoptysis, 78(78.00%) had a cough. Conclusion: DM was associated with more symptoms but not with increased severity of TB and had a negative effect on the outcome of anti-TB treatment. The findings of this study underline the need to improve the care of patients with concomitant DM and TB, especially in developing countries. Therefore, we advocate screening patients with TB for DM, especially those aged >35 years. Vijayaraju, J.A. Elanchezhian. A study of clinical findings among newly diagnosed TB patients who are diagnosed diabetics under medications. IAIM, 2019; 6(2): 96-101. Page 97 Prospective studies are needed to determine the effects of tighter glycemic control on TB treatment and outcome.

A comparative study of I-gel and LMA fastrach as a conduit for blind endotracheal intubation

Background: The most important duty of an anesthesiologist is to protect the patient‟s airway and to provide adequate ventilation. The anesthesiologist should be skilled enough to make decisions at the circumstances of difficult intubations. We compared the success rate of blind tracheal intubation through two different supraglottic airway devices, I-GEL and ILMA using PVC endotracheal tube. We studied the complications in both the techniques. The aim of the study: To compare the advanced I-GEL, to ILMA as a conduit for blind endotracheal intubation for patients posted for elective procedures under general anesthesia. Materials and methods: A Prospective randomized study was conducted in 80 adult patients who undergone elective surgery under general anesthesia. They were divided into 2 groups- each group included 40 patients. Group A - I-GEL, Group B- ILMA. We noted the Ease of insertion, Duration of successful attempts, No. of failed attempts, Total intubation time and First attempt success rate. We recorded Heart rate, Blood pressure, Pulse oximetry, EtCO2 and Complications of I-gel and ILMA insertion. Results: Supraglottic device insertion time (15.62s vs 17.17s) and Supraglottic device removal time (15.82s vs 16.55s) were the least I-GEL group. The first attempt success rate for tracheal intubation (87.5% vs 60%) and Success rate for insertion (95% vs 72.5%) were high in the ILMA group. There was no statistical difference in Total intubation time, Complications, Hemodynamic response to intubation, No. of attempts for supraglottic device insertion and Time for first attempt tracheal intubation. Ebenezer Joel Kumar E, Bridgit Merlin J, Anu Asheetha R. A comparative study of I-gel and LMA fastrach as a conduit for blind endotracheal intubation. IAIM, 2019; 6(2): 87-95. Page 88 Conclusion: We concluded I-GEL aids easy and rapid insertion as a supraglottic airway device, but when it is used as a conduit for blind endotracheal intubation, the failure rate is high as there is more incidence of oesophageal intubation. On the contrary, ILMA being a gold standard device meant for intubation guide has a high first attempt success rate for blind endotracheal intubation.

Comparison of the clinical performance of airway management with the i-gel® and laryngeal mask airway Supreme™ in geriatric patients: a prospective and randomized study / 대한마취과학회지

BACKGROUND: Geriatric patients are susceptible to respiratory and hemodynamic adverse events during endotracheal intubation and extubation due to anatomic and physiological changes with aging. Supraglottic airway devices (SADs) provide reduced airway morbidity and increased hemodynamic stability in adults. However, studies that have compared the clinical performance of SADs in geriatric patients are limited. Therefore, we evaluated the clinical performance of airway management with i-gel® and laryngeal mask airway Supreme (LMA Supreme™) in geriatric patients. METHODS: The subjects were American Society of Anesthesiologists physical status classification I–III geriatric (65–85 years) patients who underwent elective surgery with general anesthesia and were randomly allocated into the i-gel® group and the LMA Supreme™ group. We compared the time for successful insertion on a first attempt as a primary outcome, and the secondary outcomes were success rate, ease of insertion, maneuver for successful ventilation, oropharyngeal leak pressure, gastric insufflation, fiberoptic view grades, ventilator problems, and adverse events. RESULTS: Insertion time was significantly shorter for the i-gel® than the LMA Supreme™ (21.4 ± 6.8 vs. 29.3 ± 9.9 s; P = 0.011). The i-gel® was also easier to insert than the LMA Supreme™ (P = 0.014). Gastric insufflation was less frequent with the i-gel® than the LMA Supreme™ (0% vs. 31.3%; P = 0.013). Other measurements were comparable between groups. CONCLUSIONS: Both devices can be safely applied to geriatric patients with similar success rates and oropharyngeal leak pressures. However, inserting the i-gel® was faster and easier compared to the LMA Supreme™ in geriatric patients.

Dispositivos supraglóticos: comportamiento de algunos parámetros de monitorización cardiorrespiratoria / Supraglottic devices: Behavior of some parameters of cardio-respiratory monitoring

Introducción: Los dispositivos supraglóticos son frecuentemente empleados para el abordaje de la vía aérea difícil y en situaciones en las cuales no sea necesaria la inserción de un tubo endotraqueal. Objetivo: Identificar el comportamiento de algunos parámetros de monitorización intraoperatoria con el empleo de tres dispositivos supraglóticos. Material y Método: Se realizó un estudio observacional descriptivo en 45 pacientes ASA I y II, a los cuales se le administró anestesia general para procederes quirúrgicos de corta duración. Se dividieron aleatoriamente en tres grupos, con 15 pacientes cada uno. En el primero se empleó la máscara laringea clásica, en el segundo el Combitubo y en el tercero la cánula COPA. Las variables utilizadas fueron: tiempo de inserción, presión arterial sistólica y diastólica, frecuencia cardiaca y saturación parcial de oxígeno antes y después de la colocación y presión inspiratoria pico en la vía aérea, luego de insertado. Resultados: Los tres dispositivos resultaron de fácil colocación en un tiempo inferior a un minuto. Las presiones arteriales y la frecuencia cardiaca, no sufrieron variaciones apreciables. La saturación parcial de oxígeno, se mantuvo entre 95 y 100 %. En la mayoría de los pacientes, la presión inspiratoria pico estuvo por encima de 25 cm de H2O en la totalidad de los pacientes en los que se utilizó el Combitubo. Conclusiones: Los tres dispositivos empleados son una buena opción para garantizar una adecuada oxigenación y ventilación.

Supraglottic devices are frequently used for approach of difficult airway, and situations where it isn't necessary insertion of endotracheal tube. Objective: To identify behavior of some parameters of intraoperative monitoring using three supraglottic devices. Methods: We made a descriptive and observational study in 45 ASA I and II patients, who received general anesthesia for short term surgical procedures. Three groups were divided in a randomized way, with 15 patients in each. In the first one, we used the classic laryngeal mask, in the second one, the Combitube, and in the third one, the COPA cannula. Variables used included: insertion time, systolic and diastolic arterial pressure, heart rate, and oxygen partial saturation before and after placement and peak inspiratory pressure in airway, after insertion. Results: Three devices were easily placed in less than a minute. In arterial pressures and heart rate there weren't significant changes. Oxygen partial saturation was between 95 and 100%. In most of patients, peak inspiratory pressure was above of 25 cm of H2O in all patients in which we used Combitube. Conclusions: Three devices used are a good choice to guarantee a proper oxygenation and ventilation.