A comparative study of tracheal intubation through i-gel® and Intubating Laryngeal Mask Airway ( ILMA®).

In this prospective randomized study, success rate of blind tracheal intubation through two different supraglottic airway devices viz. i-gel ® and the intubating laryngeal mask airway (ILMA)® was compared a using conventional polyvinylchloride endotracheal tubes. Eighty patients undergoing elective surgery under general anaesthesia were randomized in two groups comprising of 40 patients each to tracheal intubation using either i-gel or ILMA. After induction of anesthesia, supraglottic airway device(SAD) was inserted and on achieving adequate ventilation with the device, the fibrescopic view of the larynx was obtained through the SAD for laryngeal grading. Then fiberscope was removed and blind tracheal intubation was attempted through the SAD. Success at first attempt and overall tracheal intubation success rates were evaluated and tracheal intubation time was measured.There was no difference in the incidence of adequate ventilation with either of the SAD. The glottic view ( Laryngeal grading ) was better in i-gel group. The grade 1 laryngeal grading was obtained in 82.5% cases in i-gel group as compared to 75% cases in ILMA group. The success rate in first attempt was 65% in i-gel group and 52.55% in ILMA group, while overall success rate was 77.5% in i-gel group as compared to 62.5% in ILMA group. Time taken for successful tracheal intubation through i-gel was lesser (20.4 sec.) as compared to ILMA (30.68 sec.) and the difference was statistically significant (p <0.001). Both the SADs were proved to be useful alternative to conventional laryngoscope for tracheal intubation. In the present study, i-gel had better success rate in tracheal intubation as compared to ILMA.

Formulation and evaluation of sustained release ondansetron poloxamer based solid suppositories.

The present investigation studies the effect of water swellable polymer hydroxylpropylmethyl cellulose (HPMC K4M, Methocel) on in vitro release of ondansetron from suppositories. Suppositories were prepared by using mixture of Poloxamer 407 and Poloxamer 188 hydrophilic bases. Suppositories containing 16 mg of ondansetron were prepared by fusion method. Weight variation, content uniformity, breaking (hardness), disintegration time, melting point and liquefaction time of the formulations were determined. In vitro release test was carried out according to USP XXII basket method. In vitro release data demonstrates ondansetron release from suppositories up to 12hrs and follows the zero order kinetics from poloxamer mixture based suppositories.

Prescription writing skills of pre-clinical medical and dental undergraduate students.

Objective of this prospective study was to assess the acquisition of prescribing skill of preclinical medical and dental undergraduate students. Prescription writing skills of 258 students of both first and second year of MBBS and BDS students were analyzed through an objective structured practical examination. MBBS student of second year scored 85.01% and 92.82% respectively in physician and drug related component whereas first year MBBS students scored 89.9% and 83.4%. BDS student of first year scored 91.96% and 86.33% in physician and drug related components which is better than second year that scored 83.33% and 77.94% respectively. This study revealed that the students of both courses acquire prescribing skills to a limited extent during preclinical phase. Prescribing errors were found both in physician and drug related components. To minimize the different form of prescribing errors vigorous training in the internship period will help to minimize prescribing errors and improve rational prescribing too.

Incidence of congenital heart disease in tertiary care hospital.

AIMS AND OBJECTIVES: The present study was under taken to determine the spectrum, clinical profile and outcome of patients with congenital heart disease (CHD) admitted to a tertiary care hospital. MATERIALS AND METHODS: This is a retrospective, observational hospital based study conducted during January 2006 to December 2006. Out of 14461 admissions, 84 were cases of CHD. Only patients with echocardiographic proof of CHD were included in the study. Detailed clinical and laboratory findings and outcome of all cases were noted in pre-structured formats. Data were entered in MS-excel. Data was analyzed by software SPSS version 10. RESULTS: The incidence of CHD was 5.8 per 1000 hospitalized patients. Out of 84 CHD cases, 51 were males and 33 females; with a male to female ratio of 1.5:1. CHD presented more frequently during infancy (46 %). Acyanotic heart disease was detected in 58 (69 %) cases while cyanotic heart disease was detected in 26 (31%) cases. Among acyanotic heart disease, ventricular septal defect (VSD) was found in 49 (58.3%), atrial septal defect (ASD) in 4 patients (4.8%), endocardial cushion defect (ECD) in 2 patients (2.4%) and dextrocardia was found in 3 patients (3.6%). Among cyanotic heart disease, Tetralogy of Fallot (TOF) accounted for 13.1%, total anomalous pulmonary venous connection (TAPVC) 3.6%, transposition of great arteries (TGA) with VSD 1.2% and unspecified cases of heart disease was found in 13.1%. VSD and TOF were the most common lesions while other CHD like ASD, dextrocardia, TAPVC, ECD, TGA with VSD were encountered less frequently. The most common clinical presentations were failure to thrive (FTT) and developmental delay (86.9%), breathlessness (69%), lower respiratory tract infection (LRTI) (52%), congestive cardiac failure (CCF) (46%), cyanosis (20.2%), cyanotic spell (9.5%) and infective endocarditis (9.5%). The mortality rate was 20 %. CONCLUSION: The incidence of CHD was 5.8 per thousand hospitalized children. VSD, TOF were the most common congenital cardiac lesion. VSD was observed either isolated or associated with other lesions like TGA. The mortality rate was 20 %. The mortality usually occurred in those patients complicated with congestive cardiac failure, lower respiratory tract infection and infective endocarditis.

Acid base and electrolyte disturbance in diarrhoea.

OBJECTIVE: The present study was undertaken to study the frequency of electrolyte imbalance in children with diarrhoea and the relationship between electrolyte abnormalities and mortality. MATERIALS AND METHODS: This is a retrospective, observational hospital based study. Fifty seven children admitted to paediatric ward with diarrhoea and dehydration was evaluated for electrolyte and acid base status at presentation. The variables were analyzed using chi-square and student t- test. RESULTS: Majority (70%) of patients were below 2 years of age. There were 37 (65%) males and 20(35%) females. Electrolyte disturbance was observed in 46 (80%) patients while acid base disturbance was observed in all (100%) where the estimations were done. The major electrolyte disturbances noted were hyponatremia (56%), which was either isolated (26%) or associated with hypokalemia (26%). The second common abnormality was hypokalemia (46%) which was again either isolated (14%) or associated with hyponatremia (26%). About 10% patient had hypernatremia and about 3% had hyperkalemia. Twenty one (37 %) patients had mixed electrolyte imbalance. ABG analysis was performed only in 16 patients. Arterial blood gas analysis could be performed only in 16 patients. Metabolic acidosis was present in 15 (94%) while one (6%) had metabolic alkalosis. Out of 57, five patients (8.7%) expired. All of them had electrolyte abnormalities. Out of five patients who died one had isolated hyponatremia, 2 had hyponatremia + hypokalemia, while one each had hypernatremia + hypokalemia and hypernatremia+ hyperkalemia. Statistically significant mortality was observed in patients presenting with either hyponatremia or hypokalemia as compared to the group with normal electrolytes. CONCLUSION: Hyponatremia, hypokalemia and metabolic acidosis are common electrolyte and acid-base abnormalities in children with diarrhoea and dehydration and often responsible for mortality.

Prevalence and determinants of unmet need for family planning in a district of eastern region of Nepal.

OBJECTIVES: The unmet need for family planning is defined as the discrepancy between individual's contraceptive behaviors and their stated fertility preferences--The extent of which is very high in developing countries like Nepal. This study explores the unmet need and its determinants. METHODS: Among the teaching district of B.P. Koirala institute of Health Sciences, in the Eastern Region of Nepal, a district was selected randomly to conduct a cross-sectional study. A total of 1079 women were selected using systematic random sampling. We compared different demographic variables and sex-ration to unmet need by using means, percentage and applied chi-squared test where applicable. RESULT: The extent of unmet need is 25 percent with 9.5 percent for spacing and 15.5 percent for limiting. The mean age at marriage is 16(+/-3.2) years. A strong association of gender preferences towards male child and unmet need exist, which is highly significant. CONCLUSION: Unmet need is high despite extensive family planning program in Nepal. Mean age at marriage below legal age, low female education and gender discrimination are the factors responsible for unmet need.