An observational study to compare the effect of pregabalin with pregabalin and dexamethasone for post operative analgesia in orthopedic surgeries under spinal anesthesia.

Background: Post-operative pain is a troublesome problem after orthopedic surgeries. Pregabalin acts as a synthetic analog of the neurotransmitter gamma-aminobutyric acid (GABA) with analgesic, anticonvulsant, and anxiolytic effects. Pregabalin is effective in controlling postoperative pain and in decreasing analgesic consumption. Glucocorticoids have strong anti-inflammatory effects and exhibit antiemetic and analgesic efficacy. Dexamethasone increases the efficacy of analgesia when given alone or in combination with other drugs. Material and methods: The aim was to determine the efficiency of pregabalin alone and the combination with dexamethasone to the orthopedic operations regarding postoperative pain control and analgesic consumption. It was an observational study in which participants were allocated in two groups of 30 each. In group P – Tab Pregabalin: 300 mg and in group D –Tab Pregabalin: 300 mg + Inj. Dexamethasone: 16 mg IV was given. Pain was assessed by Visual analogue scale at 0, 2, 4, 6, 12, 24 hours post-operatively. Any patient with the visual analogue scale more than 3 were given Inj. diclofenac 1.5 mg/kg IM. Time since spinal anesthesia to the first dose of analgesic and total dose of analgesic in first 24 hours was recorded. P<0.05 was considered statistically significant. Agrawal R, Mehta M, Patel J. An observational study to compare the effect of pregabalin with pregabalin and dexamethasone for post operative analgesia in orthopedic surgeries under spinal anesthesia. IAIM, 2016; 3(4): 146-155. Page 147 Results: Rescue analgesia was not required only in 1 (3.3%) case in Group D. Those who required analgesia, maximum proportion of patients required two doses in Group P (n=17, 56.6 %) while in Group D the max proportion of patients required one dose (n=15; 50.0%). Statistically, the number of patients requiring more number of rescue analgesia was significantly higher in Group P as compared to Group D (p<0.001). Conclusion: Combined administration of pregabalin and dexamethasone conferred analgesic benefits superior to those of pregabalin alone, by reducing the requirement of rescue analgesia and side effects.

Study of occupational exposure to insecticides while spraying in cotton farms.

Organophosphorus compounds (OPC) are commonly used in farms and agricultural fields as insecticides. This study deals with manifestations of exposure among 40 workers engaged in the spraying of cotton crops with these insecticides over a period of two months. The compounds used were mostly monocrotophos, acephate, chlorpyriphos, methyl parathion and propanophos. All patients were illiterate males in the range of 15 years to 50 years of age. They showed typical manifestations of OPC poisoning. All of them responded to conventional treatment for OPC poisoning. There was one death. During the course of the survey it was found that none of the farmers were using protective gear as mandated by chapter VIII of Insecticides Rules, 1971 (Insecticides Act, 1968). A few of these workers were exposed to the insecticide for as much as nine hours per day for three days. In practice, in some deaths associated with OPC poisoning, history of inhalation is given. It is important to note that this could change the manner of death from suicidal to accidental. Due precaution must therefore be exercised in such cases before opining on the manner of death. It is imperative that extensive and persistent farmer education is done with regard to the implementation of various provisions under the Insecticides Rules, 1971, especially safety issues.

Obesity amongst affluent adolescent girls.

OBJECTIVE: To assess the prevalence and type of obesity in affluent schoolgirls aged 16 and 17 yr. METHODS: A cross-sectional study was conducted in 2002, in 4 randomly selected public schools of Delhi. All girls from randomly chosen classes were included. Weight, height and waist and hip circumferences were measured for all 414 schoolgirls and their socio-demographic profile was recorded. Body mass index [BMI] and waist hip ratio [WHR] were calculated for all the girls. BMI > 30 (i.e.--95th percentile) denotes obesity and BMI > 25 (i.e.--85th percentile) denotes overweight as according to International Obesity Task Force (IOTF) criteria. WC > 80 cm or WHR > 0.85 denote central obesity. RESULTS: Prevalence of obesity and overweight amongst the study subjects was 5.3% and 15.2% respectively (IOTF). Out of the 22 obese girls central obesity was present in 21 girls (95.4%) [WC > 80 cm] and 12 girls (54.5%) [WHR > 0.85]. CONCLUSION: There is significant prevalence of obesity in affluent schoolgirls in Delhi and more than half of them have central obesity.

Small intestinal adenocarcinoma in Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome (PJS) is characterized by intestinal hamartomatous polyposis (usually affecting the jejunum) and mucocutaneous melanin spots. Though malignant changes are not common, PJS can predispose to carcinoma in the GI tract and elsewhere. We report a 25-year-old man with PJS who developed small intestinal adenocarcinoma and presented with small bowel obstruction due to jejuno-ileal intussusception.

Epidemiological investigation of cholera outbreak in a periurban slum colony in Chandigarh.

An investigation was carried out in a periurban slum colony in Chandigarh in September 1999 following a report of two microscopically confirmed cases of cholera admitted in Govt. Medical College Hospital, Chandigarh. Rapid survey in the colony covering a population of 1404 found that there were 14 cases of diarrhoea in the colony with attack rate of 9.97/1000 population. Majority (70%) of cases were females and 62% cases were under five years of age. Health education, ORS packets and medications were distributed to cases. Water sampling was also done and it was found that water from one of the hand pump was positive for V. cholerae 01 biotype El Tor serotype Ogawa. Closing of that hand pump and chlorination of drinking water in other parts of slum was recommended to higher health authorities, which was done immediately. Surveillance for diarrhoeal diseases was found to be poor. Provision of safe drinking water, improving sanitation and strengthening of disease surveillance is necessary for control of cholera and other diarrhoeal diseases in slum areas.

Vitamin a status of pregnant women and effect of post partum vitamin a supplementation.

OBJECTIVE: To assess the Vitamin A status of pregnant women in their third trimester using maternal serum retinol levels as the indicator; and (ii) To assess the impact of postpartum Vitamin A supplementation on the Vitamin A status of exclusively breastfed infants. DESIGN: Prospective randomized single blind controlled study. SETTING: Teaching Hospital. SUBJECTS: 109 apparently healthy primi and second gravida women registered at the antenatal clinic were included in the study and followed up for three months postpartum. Serum retinol levels of pregnant mothers in their third trimester (35-37 weeks) and cord blood levels after delivery were estimated. Mothers were then assigned to two groups. The experimental group included 53 mothers who received a single dose of 2 lakh units of Vitamin A orally. The control group had 56 mothers who did not receive Vitamin A. Mothers and infants were followed up for three months. The serum retinol of infants and the breast milk retinol levels were estimated at the end of three months and the results were compared. The growth of the infants was also monitored. RESULTS: Subclinical Vitamin A deficiency was seen in 29.67% of pregnant women. At the end of three months, 69.6% of mothers in the control group had breast milk retinol levels below 30 mg/dl, as opposed to 36.1% in the experimental group. Forty five per cent of infants in the control group had subclinical vitamin A deficiency compared to none in the experimental group. There was no difference in the growth of infants in the two groups. However, the infant serum and the breast milk retinol levels were significantly higher in the supplemented group. CONCLUSION: There is a high prevalence of inapparent Vitamin A deficiency (29.7%) in pregnant women in their third trimester from lower socio-economic strata. Postpartum Vitamin A supplementation had a beneficial impact on the infant serum retional and the breast milk retinol level but no effect on infant growth.

Evaluation of CSF-adenosine deaminase activity in tubercular meningitis.

Sixty patients of inflammatory brain disease were diagnosed and classified according to clinico-investigational criteria by Ahuja et al into tuberculous meningitis group (36 patients) and non-tuberculous meningitis group (24 patients). Tuberculous meningitis (TBM) patients were classified as probable (9 patients) and possible (27 patients) TBM. Non-TBM group comprised of pyogenic meningitis (8.3%), viral encephalitis (23.3%), cerebral malaria (5%) and enteric encephalopathy (3.3%). Cerebrospinal fluid-adenosine deaminase (CSF-ADA) activities were measured in both TBM and non-TBM groups. Mean CSF-ADA levels in TBM patients was 9.61 +/- 4.10 IU/L and was significantly elevated as compared to viral encephalitis and enteric encephalopathy cases; but difference was insignificant in comparison to pyogenic meningitis (7.92 +/- 0.95 IU/L) and cerebral malaria. Using 8 IU/L as cut off value for diagnosis of TBM a sensitivity of 44% and specificity of 75% was observed.

Acute iron poisoning.

Accidental iron ingestion is not uncommon in children and has become a leading cause of unintentional pharmaceutical ingestion fatality. Difficulty in obtaining urgent serum iron levels in majority of hospitals in India, lack of objective indices for starting and stopping the chelation therapy and the cost of chelation therapy, all pose a significant challenge for a clinician in managing an acutely intoxicated patient. This review emphasizes the need for early recognition and correct intervention of a child with acute iron overdose to avoid undue morbidity and mortality.

Melioidosis--rare or overlooked?

The word melioidosis conjures images of a rare, exotic disease meant only for large textbooks of pediatrics, to be read only to be forgotten or even to be ignored completely. The following two cases of melioidosis from India will surely serve as an eye opener.

Behavior problems in nephrotic syndrome.

OBJECTIVES: To evaluate the adaptive competences and behavioral problems in children with nephrotic syndrome, and whether their mothers also showed features of psychosocial stress. DESIGN: Prospective case-control study. SETTING: Pediatric Out-Patient Department. SUBJECTS: Seventy consecutive patients of nephrotic syndrome, between the ages of 4 to 14 years, and their mothers constituted cases. The control group, matched for age, sex and socioeconomic status comprised of 46 children and their mothers. The mother's description of the child's behavior, on the Child Behavior Checklist (CBCL), was obtained to assess behavioral problems and social competences. The level of anxiety in the mother was assessed using the PGI Health Questionnaire N2. RESULTS: Children with nephrotic syndrome showed features of depressed, hyperactive or aggressive behavior. Somatic complaints, social withdrawal and poor school performance were also observed. These problems did not interfere with compliance to treatment and only 7 patients required psychological interventions. Boys with nephrotic syndrome had more hyperactive and aggressive behavior as compared to girls. The scores on the CBCL were well correlated with the anxiety scores of the mother. CONCLUSIONS: These observations suggest the presence of minor behavior problems in a significant proportion of children with nephrotic syndrome. The severity of these problems may be related to the attitude of the mother towards the child's illness.

Coping and adaptation in parents of children suffering from acute lymphoblastic leukemia.

The coping and adaptation of 30 parents of children suffering from A.L.L. (during first remission), was studied with the Thematic Apperception Test (TAT--Indian modification). Emotional distress was evident in the stories of 83%, only 37% maintained an expectation of a positive outcome. Parents' psychiatric morbidity was found to be associated with the gender of the parent, employment status, and on the TAT--with the expectation of an unfavourable outcome, feelings of lack of self efficacy and emotional distress. Particularly depression. A significant association between the presence of psychiatric disturbance in the children and the parents was also found.

Coping and adaptation in acute lymphoblastic leukemia.

The coping and adaptation of 39 children (6-12 years) to Acute Lymphoblastic Leukemia was studied during the first remission with a projective technique--Children's Apperception Test (CAT-S). Seventy seven percent of the children gave adequate responses. Among these, disease awareness was present in 96%, expectation of a favourable outcome was held by 70%, though 61% evidenced emotional distress. Children's psychiatric morbidity was found to be associated with non-response to CAT-S, to anxiety related themes, and negatively with ability to maintain an expectation of a positive outcome.