Efficacy of Unilateral Spinal Anaesthesia and Sequential Combined Spinal Epidural Anaesthesia for Surgery of Lower Limb - A Prospective and Comparative Study

Background: Orthopaedic anaesthesia plan requires customi-zation as per patient’s need for safe outcome. Sequential Combined Spinal Epidural Anaesthesia (Sequential CSEA) and Unilateral Single Shot Spinal anaesthesia (Unilateral SA), both have advantages over conventional spinal anaesthesia that they provide longer lasting block with less hypotension. Aim: To compare safety and efficacy of unilateral spinal anaesthesia with sequential combined spinal epidural anaesthesia for lower limb orthopaedic surgery. Methods: This prospective randomized study was conducted on sixty ASA I-III patients aged 18- 65 years undergoing lower limb orthopaedic surgeries of approximately two hours duration. Sequential CSE group received spinal with 5 mg of 0.5 hyperbaric bupivacaine followed by incremental epidural top up of 2 cc of 0.5% isobaric bupivacaine to achieve and maintain T10 level. In unilateral SA group, unilateral spinal anaesthesia was given with 10 mg of 0.5% hyperbaric bupivacaine. Haemodynamic parameter, anaesthesia readiness time and block characteristics were recorded and results were analysed using unpaired Student's t-test. Results: There was no failure of block, surgical anaesthesia with T10 sensory level and bromage score three motor block was achieved by all patients in both groups. Anaesthesia readiness time was less in unilateral SA (p<0.001) Incidences of hypotension (p-0.0059) and mean ephedrine dose were significantly less in sequential CSEA. Five patients of unilateral SA required supplementation with general anaesthesia. Conclusion: Thus, our study concludes that unilateral SA is a cost-effective and rapidly performed anaesthetic technique. Unilateral SA with 10 mg bupivacaine and sequential CSEA with 5 mg spinal and incremental epidural top up, both provide good quality sensory and motor block for lower limb orthopaedic surgery but sequential CSEA provides significantly more stable haemodynamics with feasibility to prolong block. Thus sequential CSEA should be preferred over unilateral SA in high risk patients especially for major lower limb orthopaedic surgeries.

Knowledge and Awareness Regarding Leprosy and its Treatment Among Leprosy Patients in a Tertiary Care Hospital

Background: Study was conducted to assess awareness of leprosy and its treatment among leprosy patients presenting at a tertiary care hospital in Lucknow (UP), India. Methods: The study was conducted by a qualified interviewer using a 12-point self-prepared questionnaire on 78 leprosy patients turning up at the Dermatology Out-Patient Department of  I.I.M.S & R and Hospital in Lucknow (UP) from January 2015 to June 2016. Results: Around 73% patients had heard about leprosy, while remaining 27% patients were either unaware or not sure. About 33% of the total 78 patients thought leprosy to be a type of infection, 21.7% said it was due to bad blood, 20.5% said it was exclusively a skin disease, 10% attributed it to supernatural phenomenon and rest of the 14%  patients were unsure about its cause. Nearly 43.5% patients believed that they got the disease by coming in direct contact with some infected individual and 25.6% patients believed it to be as a result of some alteration in the blood. About 56.4% patients believed that leprosy was a communicable disease. Only 30.7% patients were confident that leprosy was curable. Approximately 72% patients knew one or more sign/symptom of leprosy. Only 23% patients were well aware of multidrug therapy (MDT) for leprosy while even a further lower percentage had knowledge of its free availability at government hospitals or centres. More than 90% patients did not know about the duration of treatment. Only about 27% patients believed that allopathic medications would be best for curing leprosy while remaining 63% patients were either not sure or believed that alternate medicine (unani, homeopathy or auyurveda) could cure leprosy better. Literacy influenced the answer for many of the questions although in few areas it had less or no effect at all. Conclusion: Awareness of leprosy is still not adequate among the masses. Further steps are needed to ensure that basic knowledge of leprosy, its signs & symptoms, MDT and its availability is conveyed more to the general population by educating them at the grass root level through various literacy programme and other innovative ideas.

Exfoliative Dermatitis: A Clinico-etiological Study

Background: Exfoliative dermatitis or erythroderma is a symptom complex characterized by universal desquamation and erythema of the skin in response to various internal or external, known or unknown factors. Largely it is a secondary process and therefore it is mandatory to establish its etiopathology to facilitate the precise management. We attempted to establish the different causes of exfoliative dermatitis. Methods: We reviewed the clinical, laboratory and histopathological findings of 50 patients diagnosed with exfoliative dermatitis. Results: The frequency of exfoliative dermatitis was found to be 0.1 percent. The male-female ratio was 2.5:1 and majority of patients were in their 5th & 6th decade of life (mean age at diagnosis being 45.2 years). The total duration of disease ranged from 2 months to 1 year. The common causative factors were preexisting dermatomes (64%), followed by idiopathic (18%), drug induced (16%) and malignancy (2%). The most common dermatoses were psoriasis (24%) and eczema (24%). Carbamazepine (6%) and antitubercular drugs (6%) were the most frequent drugs which induced exfoliative dermatitis. Apart from scaling with erythema, pruritus and thickening of skin were found in all patients. Anemia was the most common finding (90%), followed by fever (42%), lymphadenopathy (38%) and edema (32%). The best Clinicopathological correlation was found in psoriasis and pemphigus foliaceous. Conclusions: This study outlined that the underlying etiologic factors of exfoliative dermatitis may show geographic variations. In this study preexisting dermatoses was most common cause of exfoliative dermatitis followed by idiopathic causes. Clinical features were identical irrespective of the etiology.

Desmoglein Compensation Theory: An explanations for Early Appearance of Oral lesions as Compared to Skin Lesions in Pemphigus Vulgaris

Pemphigus is a life-threatening autoimmune blistering disease targeting skin and mucous membranes. It is clinically characterized by flaccid blisters and erosions, while histologically shows intraepithelial acantholysis.  The disruption of desmoglein-dependent cell adhesion by autoantibodies is the basic pathophysiology in blister formation of pemphigus. The clinical and histological spectrum of pemphigus is complex and differs in various variants of pemphigus. This review offers an answer to why the splits associated with pemphigus foliaceus occur in the superficial layer of the epidermis, while those of pemphigus vulgaris occur deep in the epidermis. With the help of desmoglein compensation theory, it logically explains why oral erosions develop in patients with pemphigus vulgaris, but not in patients with pemphigus foliaceus and why some patients with pemphigus vulgaris have only oral involvement, but others have extensive lesions on both skin and mucous membranes. Learning objective: After completing this article, readers shall be familiar with the clinical presentations, histologic findings, immunopathology  of classical pemphigus and its  variants. It discusses the  desmoglein compensation theory of pathogenesis. along with the management of pemphigus.

Phototherapy as an effective treatment for Majocchi's disease - Case report

Pigmented purpuric dermatoses are chronic and relapsing disorders characterized by a symmetrical rash of petechial and pigmentary macules, mainly confined to the lower limbs. Purpura annularis telangiectodes of Majocchi is a less common variant of Pigmented purpuric dermatoses characterized by punctate telangiectatic macules progressing to annular, hyperpigmented patches with central clearing and infrequent atrophy. A 12 year-old girl presented with asymptomatic round to oval reddish brown macules, present symmetrically over her lower and upper limbs for 3 years. Few lesions were annular in shape. Biopsy from the lesion was compatible with Pigmented purpuric dermatoses. On the basis of clinical and histopathological findings, a diagnosis of Purpura annularis telangiectodes of Majocchi was made. The patient began phototherapy thrice a week and showed excellent response.

frequency of premature ejaculation in patients with irritable bowel syndrome

Irritable bowel syndrome [IBS] is identified by chronic abdominal pain and altered bowel habits in the absence of organic etiology. Premature ejaculation is the most common male sexual disorder. We aimed to evaluate the frequency of premature ejaculation disorders in patients with IBS referred to a gastrointestinal clinic in Rafsanjan, Iran, in 2012. Of all the menreferred to the gastrointestinal clinic, those with a diagnosis of IBS [based on Rome-II criteria] were interviewed. Premature ejaculation disorder based on DSM-FV-TR criteria was documented by psychiatry interview. History of psychiatric diseases of the patients and their family were assessed by interview done by a psychiatrist. The data were analyzed by using SPSS software [version 16]. Descriptive statistics, inferential tests, and Chi-square test were used for analyses. One hundred and fifty two men with IBS were evaluated. Based on the Rome-II criteria, 89 [58.6%] patients were suffering from premature ejaculation disorder. Fifty nine [38.8%] patients expressed drug addiction. Sixty eight [44.7%] had a history of psychiatric disease in the past and 84 [55.3%] patients stated they were not suffering from any psychiatric diseases. Forty six [30.3%] patients had a history of psychiatric disease in their family, and 106 [69.7%] did not have any history of psychiatric disorder. High frequency of premature ejaculation in patients with IBS with a family history of psychiatric disorder and severe stress during the past year suggested that there was a relationship between factors contributing to psychiatric disorders [neurotransmitters, environmental factors, and genetics] and premature ejaculation. Premature ejaculation is more common in patients with IBS. Drug abuse, family history of psychiatric disorder, and severe emotional stress during the past year, significantly increase the frequency of premature ejaculation

Effect of eight weeks endurance exercise on liver enzymes in stopping drug women with methadone

Previous studies indicated that endurance exercise decreases levels of liver enzymes. The aim of this study was to determine the effect of endurance exercise on liver enzymes in eight weeks in Iranian women who are stopping the drug with methadone. sixty Iranian women prisoners including 30 cases as experimental group and 30 volunteers served as control. The mean age, height, weight, percent of BF, BMI and vo2max of experimental group was 33/8 years, 162/2 cm, 62/2 kg, 33/10, 24/22 and 16/18 ml/kg respectively. Experimental group was should run with 65%vo2max for 2 weeks [3 sessions in a week and for 25 minutes], with 65-75% vo2max for 3 weeks [3 sessions in a week for 35 minutes] and with 75-85% vo2max for 3 weeks [3 sessions in a week for 40 minutes]. The blood samples were collected in amount of 5 ml 48 hours before the first session and after the last session of the protocol. Other causes of abnormal liver enzymes such as hepatitis and autoimmune disorders etc. were excluded. The level of ALT [alanine aminotransferase] between experimental group and control group in post-test was not significant. But it was significantly differenced for level of AST [aspartate aminotransferase] when we compared the groups. On the other hands, the level of ALT and AST in post-test in contrast with pre-test in experimental group was not significant. The result of this study showed that endurance exercise for eight weeks did not normalize the level of ALT and AST of the study group. Therefore more investigation such as diet habits, demographic and other risk factors is recommended for these types of patients

Use of spirometry in detecting airway obstruction in asymptomatic smokers

To detect spirometric abnormalities in asymptomatic smokers in relation to duration of smoking. Cross sectional study. Place and Duration of Study: The study was carried out at PNS Shifa from Oct 2006 to June 2007. Subjects and Hundred individuals were included in this study who fulfilled the required criteria. Spirometry was done after briefing the patient about the procedure. Smokers were divided into two groups. Group I [5 to 9 pack years] and group II [? 10 pack years]. All relevant information were recorded on Performa [Annex-A]. The data was analyzed through SPSS-10, in terms of Mean +/- SD [Standard Deviation] for numeric response variables and independent sample T test was applied to compare significance of proportion for numeric response variables at p < 0.05. Categorical variables were compared by applying Chi-square test at p < 0.05 level of significance. Significant statistical difference was found between the mean age in the two groups with p-value of 0.011. This may be due to the longer duration of smoking history in Group II. Strong association was found between number of cigarette smoked and the pattern of airway obstruction as significant statistical difference of airway obstruction and early airflow limitation was found between the two groups of smokers at p value of 0.004. There is strong association between duration of smoking and development of airway obstruction even before the smoker become symptomatic