Serum magnesium levels in newly diagnosed type 2 diabetes mellitus and its relation with microvascular complications of diabetes

Background: Prevalence of hypomagnesaemia is significantly higher in diabetic patients with microvascular complications compared to diabetics with no microvascular complications. The aim of this study is to measure levels of serum magnesium in patients with newly diagnosed type 2 diabetes mellitus and study its association with the presenting microvascular complications.Methods: This was hospital based, one year cross-sectional study carried out in Department of Medicine, IGMC Shimla in patients with newly diagnosed type 2 diabetes mellitus. Total 53 patients were enrolled in this study who presented in medicine OPD or admitted in medicine ward.Results: Serum Magnesium value of the patients ranged from 1.20-3.0 mg/dl with mean value of 1.9±0.3 mg/dl. Fourteen patients (26.4%) had hypomagnesaemia. A total of 34 (64.2%) patients presented with complications of diabetes in which proteinuria was present in 34 (64.2%), retinopathy in 4 (7.5%) and neuropathy in 1 (1.9%). Fourteen (41.2%) patients with hypomagnesaemia presented with complications of diabetes (p value=0.003). 34 (64.2%) patients presented with proteinuria out of which 14 (41.2%) patients had hypomagnesaemia while 20 (58.8%) had normomagnesaemia (p=0.03). One (1.9%) patient had neuropathy and hypomagnesaemia was also present in this patient (p=0.6). Four patients (7.5%) presented with retinopathy out of which 3 (5.7%) had hypomagnesaemia while 1 (1.9%) had normomagnesaemia.Conclusions: Hypomagnesaemia is associated with microvascular complications of diabetes. Also there is statistically significant relationship between proteinuria and hypomagnesaemia in patients with newly diagnosed type 2 diabetes mellitus.

Comparative evaluation of post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients undergoing laparoscopic cholecystectomy

International Journal of Clinical Trials| January-March2020| Vol 7| Issue 1Page 28International Journal of Clinical TrialsKatoch ML et al. Int J Clin Trials. 2020Feb;7(1):28-31http://www.ijclinicaltrials.compISSN2349-3240| eISSN 2349-3259Original ResearchArticleComparative evaluation of post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients undergoing laparoscopic cholecystectomyMadan Lal Katoch, Loveleen Kour*INTRODUCTIONPain has been defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Unrelieved postoperative pain may result in clinical and psychological changes that increase morbidity and decrease the quality of life.1Besides the distress caused, severe postoperative pain increases the work of breathing as it limits full chest expansion and impairs patient’s ability to cough effectively.2Many interventions have been tried to reduce such severe pain; including epidural analgesia, patient controlled analgesia, transversus abdominis plane block and local wound infiltration.Laparoscopic cholecystectomy is commonly performed procedure for treating symptomatic gallstones. The benefits of laparoscopic surgery include reduced haemmorhage, smaller and more cosmetic incision and shorter hospital stay. Pain after laparoscopy results from ABSTRACT

Effect of different definitions of prescription point “A” in high dose rate brachytherapy for cervical cancer

Aim: This study intended to compare the dosimetric parameters using different definitions of prescription point A in high dose rate (HDR) brachytherapy of cervical cancer patients. Background: Manchester point A has been widely used for prescribing dose in brachytherapy. However, due to certain limitations of this point, a new definition of point A has been recommended by the American Brachytherapy Society (ABS). Materials and Methods: We retrospectively investigated 55 computed tomography-based plans of 20 cervical cancer patients treated with Ir-192-based intracavitary HDR brachytherapy. The dose of 7 Gy in 3 fractions each was prescribed to point A using revised Manchester definition of point A (AMAN) and ABS guideline definition (AABS). The effect of both definitions on various parameters including dose to point A and 90% of tumor volume (D90), dose received by 2cc volume of bladder, rectum and small bowel and treatment volume receiving 100% of prescription dose (V100) was analyzed. Results: Mean percentage difference of point AMAN dose and AABS dose with respect to prescription dose was 1.25% ± 1.43% and 1.21% ± 1.01%, respectively. Mean V100 was 80.4 ± 20.45cc and 88.47 ± 16.78cc for AMAN and AABS plans, respectively, while mean percentage difference between prescribed dose and D90 was found to be –37.90% ± 25.06% and –30.47% ± 25.50% respectively for both the definitions. Conclusion: Doses to both Manchester point A and ABS point A may be recorded during the transition period. However, ABS point A can be preferred over the Manchester point A as it conforms better with the desired dosimetric outcome and is found to be more static.

Comparison of levobupivacaine vs bupivacaine in thoracic spinal anaesthesia for laparoscopic cholecystectomies

Background: Levobupivacaine is the pure S enantiomer of racemic bupivacaine. It is a long acting variant that is less toxic to the heart and central nervous system. It has gained relevance and popularity in the modern anaesthetic practice. Thoracic spinal anaesthesia has been shown to an effective   and safe anaesthetic approach for a varied spectrum of surgeries including laparoscopic cholecystectomies.  Incorporation   of epidural catheter adds flexibility and the provision of postoperative analgesia. To adopt thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies was chosen in the study. This study aimed at comparing the efficacy of levobupivacaine and bupivacaine in thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies.Methods: Total 60 ASA 1 and 2 patients scheduled for laparoscopic cholecystectomies were chosen for the purpose of this study extending from January 2019 to May 2019.  They were randomly divided into two groups - group L and group B. Both the groups received thoracic combined spinal anaesthesia using 2ml of 0.5% isobaric levobupivacaine and 25 µg (0.5ml) fentanyl in group L and 2ml of 0.5% isobaric bupivacaine and 25 µg (0.5ml) fentanyl in group B.  The duration of sensory and motor block, peak block height, maximum motor block achieved, haemodynamic variables and any postoperative neurological complications were evaluated.Results: Both the groups showed similar onset of sensory and motor block. The duration of motor block was similar in both the drug groups; however, levobupivacaine showed a significantly loner duration of sensory block.  There were no significant haemodynamic differences between the two groups and no postoperative neurological complications were seen in any patient.Conclusions: Levobupivacaine was found to be slightly better than bupivacaine in thoracic combined spinal epidural anaesthesia.

Do phosphatase of regenerating liver‑3, matrix metalloproteinases‑2, matrix metalloproteinases‑9, and epidermal growth factor receptor‑1 predict response to therapy and survival in glioblastoma multiforme.

Context: Poor survival of the glioblastoma multiforme (GBM) has been attributed in part to the invasive nature of the lesion making complete surgical removal near impossible. Phosphatase of regenerating liver‑3 (PRL‑3), matrix metalloproteinases‑2 and ‑9 (MMP‑2 and MMP‑9), and epidermal growth factor receptor (EGFR‑1) play a role in invasive nature of tumor cells. Aims: This study was conducted to evaluate PRL‑3, MMP‑2, MMP‑9, and EGFR‑1 (markers) expression in cases to GBM and to correlate their expression with therapy response and survival. Settings and Design: GBM cases (n = 62) underwent surgery followed by radiation (n = 34) and chemoradiation (n = 28). Using WHO Response Evaluation Criteria in Solid Tumors criteria response to therapy was assessed at 3 months and cases followed up for survival. Subjects and Methods: Expression of markers was assessed by immunohistochemistry as a percentage of positive tumor cells in hot spots. Statistical Analysis Used: Kaplan–Meier, ANOVA, Chi‑square test, univariate, and multivariate Cox‑regression analysis was done. Results: Response to therapy was evident in 54.8% cases of responders with the mean survival of 494.03 ± 201.13 days and 45.2% cases of non responders (278.32 ± 121.66 days) with P = 0.001. Mean survival for the patient’s opted chemoradiation was 457.43 ± 222.48 days which was approximately 3 months greater than those who opted radiation alone (P = 0.029). We found PRL‑3 overexpression was an independent, significant, poor prognostic factor for survival by multivariate analysis (P = 0.044). Cases negative for MMP’s and EGFR showed increased survival, but the difference was insignificant. Conclusion: PRL‑3 expression appears to be related to an adverse disease outcome.

Effects of fatigue after sleep deprivation on cognitive functions in anaesthesia residents

Maintaining vigilance during an anaesthetic is hampered by a variety of factors relating to the patient, working environment and anaesthetist himself. Since fatigue is a common issue in the medical environment, there have been many studies of the effects of sleep deprivation and fatigue on human performance and well being. A review of the literature does not permit us to come to any specific conclusion due to the many flaws/shortcomings in most of the studies, including poor definition of the degree of acute sleep deprivation, lack of assessment of accumulated chronic fatigue, the effects of diurnal variation in performance, motivation and incentives etc. A need was felt to study the effects of fatigue associate with sleep deprivation in anaesthetists. We undertook this study in the anaesthesia residents to assess the effects of sleep deprivation on the mental performing abilities. Department of Anaesthesiology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab [India]. Residents of anaesthesia department. We excluded the variables known to affect the outcome. The residents who had used sedatives, alcohol or other similar CNS depressants; those with systemic illness/organic disorder or left handedness were excluded. In this study, fifty residents of anaesthesia were tested under two situations using a battery of cognitive function tests. Group I comprised of residents after their routine day duty [10 hrs, non sleep deprived]. Group II was formed by the same residents after their night duty with less than 4 hours of sleep in the previous 24 hours [sleep deprived]. The results lead us to the following. Fatigue following sleep deprivation adversely affects the psychomotor and cognitive functions of the anesthetist but not the short term

Right ventricular myocardial infarction: echocardiographic evidence among patients with inferior wall myocardial infarction.

Right ventricular myocardial infarction (RVMI) predominantly a complication of inferior wall myocardial infarction is a distinct clinical entity in which major hemodynamic disturbance may occur. Bedside hemodynamic measurement, electrocardiography, gated blood pool radionuclide angiography and echocardiography are used to identify right ventricular involvement in setting of inferior wall infarction. RVMI as assessed by various diagnostic methods accompanies 30 to 50% of inferior wall infarction. We studied 37 consecutive patients of acute inferior wall infarction (by non invasive method) to determine echocardiographic evidence of RVMI and compared its sensitivity to electrocardiography and clinical criteria. On echocardiography 12 out of 37 patients (32%) had right ventricular involvement. Kussmaul’s signs was present in 27% of the patients and it had sensitivity of 50%, specificity of 88% and predictive accuracy of 70%. Right sided precordial leads (V3R – V4R) on electrocardiography showed evidence of RVMI in 30% of patients with sensitivity, specificity and predictive accuracy of 67%, 88% and 73% respectively. Echocardiographic features included enlargement of right ventricle and hypokinesia or akinesia of right ventricular wall. Right ventricular dilatation and dysfunction is gained from relative right and left ventricular dimension on echocardiography. It is more sensitive and specific than clinical signs and ECG.

Solubilization studies on a three-component system of lin seed oil-water-nonionic surfactants

The technology of Solubilization deals mostly with that of hydrophobic matter in water [1]. Solubilization into aqueous media is of major practical importance in such areas as the formulation of products containing water insoluble ingredients. In a three component system of oil-water-surfactant, a solubilization or an emulsion appears depending upon the ratio of the throe components In the present study, line seed oil is mainly used and special attention is paid to the Solubilization system. The trangular diagrams are constructed by the method of water titration [2.7] with a trangular diagram and oil, water, and surfactant represented at each corner of the triangle, the effects of factors such as the surfactant type,-number of ethylene oxide molecules in the surfactant, aging and aging temperature on the appearance of the Solubilization region are studied. The term [Solubilization system] here means the system in which oil is homogenously and transparently dispersed in water or vice versa