Anesthetic management of a pediatric patient with situs solitus and dextrocardia

Dextrocardia with situs inversus is a rare heart condition with a genetic predisposition. Although most individuals lead a normal healthy life and usually, it is an incidental finding. Due to their unique anatomical variations and associated congenital variations, they may pose challenges to attending clinicians. We are hereby reporting a successful anesthetic management of the case of a 2.5-year-old child who presented for emergency laparotomy and on investigations, was found to have dextrocardia along with situs solitus.

To evaluate analgesic efficacy of dexamethasone as an adjuvant to ropivacaine in pectoral nerve block: A prospective randomized control study.

Background: Pectoral nerve (Pecs) block is an effective component of multimodal analgesic regimens for breast surgeries. In present study we compared analgesic effect of dexamethasone 8 mg as an adjuvant to 0.25% ropivacaine versus 0.25% ropivacaine alone in pectoral nerve block. Methods: The study was conducted in a randomized manner on 60 female patients of American Society of Anesthesiologists (ASA) Grade I and II, aged between 18 to 65 years, scheduled to undergo modified radical mastectomy under general anesthesia (GA). The patients were randomly allocated into 2 groups of 30 patients each. Group A received ultrasound (US)-guided Pecs block with 30 ml of 0.25% ropivacaine and 10 ml normal saline (total volume 40 ml) and Group B received with 30 ml of 0.25% ropivacaine and 8 mg dexamethasone in and 10 ml normal saline (total volume 40 ml). Post-operatively visual analogue score (VAS), duration of analgesia and total analgesic consumption was noted. Student t-test, Mann Whitney U test and Chi-square test were used for statistical analysis. Results: VAS were persistently low for first 4 hours in group B and for first 9 hours in group A (p value < 0.001 at some intervals). The mean duration of analgesia was prolonged in group B as compared to group A (612.33 ± 41.77 min in Group B and 307.70 ± 22.37min in group A) (p <0.001). Total analgesic consumption in first 24 hours post-operatively was also statistically lower in Group B (97.50± 34.96 mg) as compared to group A (177.50± 36.76) (p<0.001). No patient under study reported any adverse effects. Conclusion: Addition of 8 mg dexamethasone as adjuvant to 0.25% ropivacaine for pectoral nerve block increases the duration of analgesia and significantly reduces the amount of analgesic requirement in first 24 hours postoperatively without any significant adverse effects.

Histoarchitecture and Histochemical Studies on the Lacrimal Gland of Pig (Sus scrofa)

The fresh tissues were collected from five pigs of either sex and processed for histomorphological studies. The gland was located on dorso-lateral aspect of the eye in the orbital cavity. The gland was multilobar tubulo-acinar with predominance of acini. It was covered by a thick connective tissue capsule and connective tissue septa, which penetrate into the glandular parenchyma and divided the gland into lobes and lobules. The acini were of mixed type but predominantly sero-mucous in nature. The secretory units were followed by a duct system. The excretory duct system was made up of intercalated, intralobular, interlobular and large excretory ducts. The strong presence of glycogen in the acini was demonstrated with the help PAS (McManus’) stain. The ducts showed very weak reaction for the presence of glycogen but goblet cells in the stratified ducts showed strong positive reaction for PAS. The acini showed strong reaction for acidic mucosubstances with PAS-AB. The goblet cells in the stratified ducts also showed strong positive activity towards the PAS-AB. The intense activity towards the Alcian blue showed presence of sialomucins and hyaluronic acids in glandular parenchyma of the lacrimal gland

The Commonly Encountered Rheumatological Manifestations amongst Patients with Type 2 Diabetes.

Introduction: Type 1 DM is the result of complete or neartotal insulin deficiency. Type 2 DM is a heterogeneous groupof disorders characterized by variable degrees of insulinresistance, impaired insulin secretion, and increased glucoseproduction. Several studies have reported an associationof early osteoarthritis and DM. The present study wasconducted with the aim to analyze the commonly encounteredrheumatological manifestations amongst patients with type 2diabetes.Material and methods: The study was conducted among100 patients of already diagnosed type 2 diabetes mellitus,attending outpatient/inpatient department of Department ofMedicine, Rajindra Hospital/ Government Medical College,Patiala. The selected patients were subjected to furtherevaluation using Baseline diabetic questionnaire: Name, age,sex, occupation especially manual labor, height, weight, BMI(We considered overweight subjects with a BMI between25 and 29.9 and obesity with BMI >30 kg/m2)3, durationand onset of type 2 diabetes, smoking habits, any historyof systemic diseases, medications: oral hypoglycemic orinsulin injection, blood sugar level: fasting, post prandialand glycosylated hemoglobin. Musculoskeletal system wassystematically examined. Student t test was used for statisticalanalysis. Probability value of less than 0.05 was consideredas significant.Results: The age ranges from 41 years to 80 years. Most ofthe patients were between 61-70 years of age and were 40%of the total patients. In our study out of 100 diabetic patients27 had rheumatological manifestations. The most commonmanifestation was Osteoarthritis (Osteoarthritis knee in ourstudy) which was found to be present in 14% cases. Out of 100patients 27 had rheumatological manifestations out of which11 were males and 16 were females. 35 males and 38 femaleswere without rheumatological manifestations.Conclusion: Rheumatological manifestations are commonamongst subjects with Type 2 diabetes mellitus. The overallprevalence of rheumatological manifestations was 27%. Thiscould be helpful in preventing chronic disability in patientsand improving their quality of life. Good glycemic control isa key to prevent rheumatological manifestations in patientswith T2DM.

A Study of LVEF in Patients of Subclinical Thyroid Dysfunction with Heart Failure

Heart failure is clinically defined as a syndrome caused by cardiac dysfunction generally resulting from myocardial muscle dysfunction or loss. Heart failure is a leading cause of hospitalization in people older than 65. Extensive evidence indicates that the cardiovascular system responds to the minimal but persistent changes in circulating thyroid hormone levels, which are typical of individuals with subclinical thyroid dysfunction. Subclinical hypothyroidism is associated with impaired LV diastolic function and subtle systolic dysfunction and an enhanced risk for atherosclerosis and myocardial infarction. Methods: A total of 200 patients between age group of 45 to 75 yrs, presenting in medical emergency and medical outdoor of Guru Nanak Dev Hospital, Government Medical College Amritsar with heart failure were studied.Comparison of Thyroid Profile and LVEF was done at Baseline, 3 months and 6 months. Results: The change in TSH, FT3, FT4, LVEF was significant at 3 months and 6 months as compared to baseline. Changes in FT4, LVEF, were significant at 3 months and 6 months, thus signifying progression of disease and worsening of cardiac functions. Conclusion: In treatment group in subclinical hyporthyroidism patients, after comparing the thyroid profile and 2D Echocardiography after 6 months; TSH, LVEF both have shown improvement (p <0.05).

Study of Plasma Glycemic Levels and Serum Magnesium Levels in Diabetes Mellitus (DM) and Non-Diabetic Healthy Controls: A Comparative Study

Introduction: Patients of DM are known to have low levelsof serum magnesium levels as compared to non-diabetics.There is a link between the low magnesium levels and poorglycemic controls and subsequently leading to complicationsin diabetic patients. The aim of this study was to assess theserum magnesium levels in relation to glycemic status indiabetic patients as compared to non-diabetics.Material and Methods: 172 cases of previously diagnosedDM were taken along with the age and sex matched controlswho were healthy and non-diabetic and their blood sampleswere analyzed for magnesium and blood sugar fasting andpost prandial.Results: In our study we have found that there is a significanthypomagnesemia in diabetic cases as compared to nondiabetic controls which is in accordance with other studies.There also exists a negative correlation between mean serummagnesium levels (2.08 ± 0.4 mg/dL) and mean fastingplasma sugar (FBS) (159.72 ± 71.60 mg/dL) and mean postprandial sugar (PPS) (222.76 ± 100.86 mg/dL) levels. Nosignificant variation as per age and sex in serum magnesiumlevels amongst diabetic subjects have been found in our study.Conclusion: Hypomagnesemia is common in diabetics ashas been found in our study also, and it helps in regulationof glycemic levels and in turn also affects magnesium levels.Considering estimation of magnesium as a routine laboratorywork up protocol in the management of diabetes may preventvarious complications due to hypomagnesemia with earlytherapeutic intervention.

Histopathological changes in gallbladder mucosa associated with cholelithiasis: A prospective study

Background and Aims: Cholelithiasis is known to produce diverse histopathological changes in the gallbladder mucosa. In the present study, we aimed to find the correlation between various gallstone characteristics (i.e., number, size, and morphological type) with the type of mucosal response in gallbladder mucosa (i.e., inflammation, hyperplasia, metaplasia, and carcinoma). Methods: The present study was conducted prospectively on 100 patients undergoing cholecystectomy for symptomatic cholecystitis. Gallstones were assessed for various parameters, i.e., number, size, and morphological type. Gallbladder mucosa was subjected to histopathological examination. Sections were taken from body, fundus, and neck of gallbladder. Results: Of 100 cases, maximum type was of mixed stones (54%) and was multiple in number (46%). However, gallstone type and number are nonsignificant variables to produce precancerous lesions (i.e., hyperplasia and metaplasia). Statistically significant results were obtained while comparing the mucosal response with gallstone size (P = 0.012). Conclusion: As the gallstone size increases, the response in gallbladder mucosa changes from cholecystitis, hyperplasia, and metaplasia to carcinoma. Gallstone type and number are nonsignificant variables to produce precancerous lesions

Comparative evaluation of various analgesic drugs in Wistar rats used as a teaching tool to teach animal experiments to post graduate MD Pharmacology students

Background: Postgraduates when join Pharmacology department, they don’t have much idea about guidelines and methods to do animal experiments. This study was designed to sensitize postgraduate students to animal experiments by evaluating the anti-inflammatory effects and the efficacy of diclofenac, tramadol and etoricoxib in reducing paw edema in wistar rats.Methods: The wistar rats of 225-250gram were divided into four groups (n=10 each). In all the groups the paw edema on right paw was created using 0.1ml of 1% formalin subcutaneously. Group 1 rats (control), group 2 were given diclofenac, group 3 were given tramadol and group 4 were given etoricoxib orally. The parameters assessed were water displacement in plethysmography after 2, 4, 24, 48 hours of giving the drug. The circumference of edematous paws after 4 hours, licking of paw was observed over 30minutes of giving the drug and was compared. Pre and post study feedback were obtained from the students by using a preformed questionnaire to assess the knowledge gained by the students.Results: The test showed that all the drugs were effective in reducing inflammation, circumference of edema and the licking duration significantly (p<0.05). The post study answering of questions by postgraduate was 100% in comparison to pre-study answering which was 33%.Conclusions: A short animal study conducted as a teaching tool to postgraduate students was able to teach the guidelines of animal experiments and handling of animals effectively.

Relation of bone mineral density with severity of liver cirrhosis

Background: Osteoporosis is commonly associated with chronic liver disease. Pathologic fracture in osteoporotic patients affects quality of life as well as decrease life expectancy. Around 40% of patients with chronic liver disease may experience osteoporotic fracture. The present study was undertaken to observe the relation of bone mineral density (BMD) with severity of liver cirrhosis along with effects of smoking and alcohol.Methods: A total of 187 liver cirrhosis patients who were admitted in SMS Hospital were taken for study and were classified into class A, B, C as per Child Turcot Pugh’s classification, after applying inclusion and exclusion criteria. All patients underwent standard laboratory testing and bone densitometric studies of the lumbar spine using dual X-ray absorptiometry (DEXA) scan. Statistical analysis done.Results: The bone mineral density was significantly low in Class C. Class C have 41 patients of osteoporosis out of 62 whereas only 16 patients have osteoporosis in Class B and only 1 case of osteoporosis in class A. Hypocalcemia and hypophosphatemia were more in class C as in comparison to class A and B. Also, chronic smoking and alcohol intake were strongly associated with the severity of cirrhosis.Conclusions: The prevalence of osteopenia and osteoporosis is higher in cirrhotic patients and significantly increases with severity. Hypocalcemia and hypophosphatemia are also associated with the cirrhosis. Thus, patients should undergo routine bone densitometry assessment and, if necessary, to be treated for osteoporosis

Comparative study of CA-125 and 2D echo for detection of right ventricular failure in COPD patients

Background: COPD is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. It leads to cor pulmonale causing right ventricular failure. Present study compares the serum level of CA-125 and 2 D Echo for detection of right ventricular failure in COPD patients.Methods: In this study 178 patients suffering from COPD has been taken after following inclusion and exclusion criteria and informed consent. Serum CA 125 levels are evaluated in all patients and compared with the right ventricular functions.Results: The mean CA125 was higher in subjects with RV failure (96.32) as compared to those subjects with RV normal (37.17). The result was statistically significant. (p<0.001). The mean duration of illness was higher in subjects with raised CA125 (8.71 years) as compared to those with normal CA 125 (6.67 years) and the difference was also statistically significant (P<0.001).Conclusions: CA-125 levels have a good sensitivity and specificity for predicting right ventricular failure in COPD patients. Diagnostic accuracy, high positive and negative predictive value makes CA-125 a good predictor of right ventricular failure in COPD patients.

A Study on Association between Thyroid Stimulating Hormone Levels and Metabolic Syndrome Components.

Background: Since metabolic syndrome (MetS) and thyroid dysfunction (TD) are both characterized by a cluster of common abnormalities, it is possible that patients suffering from both disease entities might have compounded risk. This study was aimed to evaluate the pattern of TD in subjects with MetS and its relationship with components of the MetS. Methods: One hundred cases defined according to the International Diabetic Federation (IDF) criteria were evaluated for vital parameters, lipid and thyroid profile, along with other routine laboratory parameters. Results: There was a significant association of various metabolic syndrome parameters viz. body mass index(BMI), systolic blood pressure (SBP),diastolic blood pressure (DBP), total cholesterol(TC), triglycerides (TG) and fasting blood sugar(FBS) with TD (P<0.05). It was found that BMI, waist circumference (WC), SBP, total cholesterol (TC), triglyceride (TG) and FBS had significant (P<0.05) positive linear correlation whereas age and high density lipoprotein (HDL) had non-significant (P>0.05) negative correlation with thyroid stimulating hormone (TSH) levels. Conclusion: The prevalence of TD in patients with MetS was high; while subjects with SCH and elderly females were at increased risk.

Guillain-Barre Syndrome Presenting with Hyperreflexia – A Rare Case Report.

Guillian-Barre syndrome (GBS) is an acquired autoimmune polyradiculopathy. Areflexia and progressive flaccid weakness are essential for its diagnosis. Here we report a case of 25 year old female presenting with acute onset flaccid quadriparesis. The diagnosis of GBS was made on history and clinical findings supported by cerebro-spinal fluid (CSF) analysis and nerve conduction studies (NCS). The hallmark of this case was the presence of hyperreflexia in all four limbs without involvement of higher functions, sensory, autonomic and bulbar dysfunction. To diagnose this rare entity, a high index of suspicion is needed.

Lignocaine Jelly Cap as an Unusual Foreign Body in Urethra: A Case Report with Review of Literature.

There are different types of foreign objects, which may be difficult to imagine that have been documented in the literature as foreign body urethra. These bodies may be inserted into the urethra by self, migration from adjacent sites or iatrogenic rarely. Regardless of the motive for insertion, the extraction can be challenging and requires the creative organization of the full armamentarium of the specialists. The extraction techniques include open, laparoscopic, and endoscopic surgeries or combination of these. We present a case of 45 years old psychologically stable patient who came to the Outpatient Department with a lignocaine jelly cap as a foreign body in urethra, which was taken out with the open method under local anesthesia.

Embolization of a deep orbital varix through endovascular route.

We report a case of the primary deep orbital venous varix treated by endovascular coil embolization procedure by transfemoral catheterization. This method of treatment has the advantage of image‑guided localization of the pathology, real‑time management and confirmation of the success of the procedure in the sitting.

Challenges To Oral Health Care For The Individuals With Special Health Care Needs.

Individuals with special health care needs are often neglected in providing dental services. This article reviews the oral health status and various challenges in utilization of dental health care services by faced the individuals with special health care needs.

Patterns of cause of death in unknown dead bodies a three year study in a tertiary care hospital.

Opinion about the cause of death in unknown dead bodies is a test of ability of the Forensic expert and on many occasions yields little or no results. The reasons may be inadequate/no history, disinterested Investigating officers unwilling to properly work out the case, partial/complete decomposition/destruction/mutilation of the body, etc. In such cases, identification of the body as such poses problems; rest aside the opinion regarding the cause/manner of death. The present 3 year study was undertaken to find the cause of death and the pattern of causes of death in unknown dead bodies, as well as the efforts made to establish the identity in these cases. Unidentified bodies comprised 4% of the total 1577 cases brought for postmortem examination to the department. Maximum number of cases belonged to the age group 41 -50 years, 35%. Majority of the opinions regarding the cause of death were given as cranio-cerebral damage, 30%, followed by “no definite opinion”, 28%. Viscera for chemical analysis were sent in 24%, histopathology in 8% and for both chemical analysis and histopathology, in 27% cases.

A comparative solubility enhancement study of rosuvastatin using solubilization techniques.

Solid dispersion of Rosuvastatin was prepared by solvent evaporation method; PEG (Polyethylene glycol) 4000, mannitol and urea were used as carriers. Hydrotropic studies were carried out using different hydrotropic agents (sodium acetate, sodium benzoate and salicylate) and Micellar solubilization was carried out using different surfactant solutions (sodium lauryl sulphate, tween 80 and cetrimide).The solubility enhancement of Rosuvastatin by different solubilization technique was observed in decreasing order as hydrotropic solubilization > solid dispersion > micellar solubilization. It was observed that the solubility increased with the increase in the concentration of hydrotropic agents and amongst the various hydrotropic agents used the solubility was Rosuvastatin was enhanced greatest to 55 folds with sodium salicylate. This increase may be attributed due to aggregation of the hydrotropic molecules and inclusion of one of these aggregates at high concentration probably by reacting to form an associated product as a result of hydrogen bonding.

Recent advances in the management of poisoning cases.

Deaths due to poisoning are on the rise over the years, despite advanced knowledge regarding their pharmacokinetics and pathology, and newer and better techniques being developed for the management of poisoning cases. The management of a poisoned patient has changed over the years. Though the general principles of treatment of a poisoned patient remain the same, traditional methods like gastric lavage, for example, have taken a back seat. There has been gaining popularity of newer methods like use of activated charcoal and a variety of newer antidotes. Attention has also shifted to toxidromes, the collection of symptoms and signs that consistently occur after ingestion of a particular toxin or drug. Grouping the various signs and symptoms exhibited by a poisoned patient into different toxidromes helps the physician in rapid identification of the toxidrome and saves time in evaluating and managing a poisoned patient. However, the mainstay of the treatment, according to the experts is stabilization of the patient.

Death due to ruptured ectopic pregnancy natural death or negligence.

A young adult female of low socio-economic status, and a labourer by profession, was brought dead to the Government Medical College & hospital, Chandigarh. History provided by her husband revealed that she had pain abdomen for the last five days for which she was getting treatment from a private practitioner. She had been prescribed NSAIDs and antispasmodics for the same. However, she was not investigated upon and no attempt was made by the practitioner to arrive at any diagnosis. The autopsy was conducted on the next day and at autopsy, about two-and-a-half liters of blood was present in the abdomen and pelvic cavity. Careful internal examination revealed a ruptured ectopic pregnancy as the source of bleeding. The case is discussed with regard to establishing whether the death could have been natural, due to the negligence of the treating doctor or due to contributory negligence. However, even in cases of contributory negligence, the “last chance doctrine” may not save the physician.

Torture and the law: An indian perspective.

Torture of a fellow human being by another human being is essentially an instrument to impose the will of the ‘strong’ over the ‘weak’. Over the years, the incidence of torture has only increased, with the methods becoming highly complex, involving psychical and/or physical exhaustion. These include deprivation of sleep, food and drink; sometimes combined with forced physical activities or forced standing for hours or even days. Freedom of movement and perception is restricted by confining the person to a very small dark room and his self-esteem is eroded by deprivation of toilet facilities and clothing or by constant verbal abuse. Inspite of checks posed by various laws including the International Humanitarian Law, such inhuman practices continue unabated. This article describes the Indian scenario of this world-wide phenomenon, with a view to sensitize the readers about this scourge on the society.