Pub Date : 2023-05-01DOI: 10.4103/mamcjms.mamcjms_21_23
M. Manohar, Hemanth Tirupathi, Prashant Kumar, K. Kaur, Sumedha Vashishth, N. Bangarwa
Background: Airway gadgetry is expanding at an exponential rate. It is imperative to understand the intubating characteristics of supraglottic devices so that the choice of device in patients is based on evidence rather than just the design. The present study was conducted to compare blind intubation with blockbuster LMA and Ambu Aura-i. Methodology: Sixty patients of either sex, 20 to 60 years of age, ASA I–III, scheduled to undergo elective surgery under general anesthesia, were included in this prospective, randomized, comparative study. Group A (n = 30) patients were intubated with AmbuAura-i, and Group B (n = 30) patients were intubated using BlockBuster LMA. Results: Endotracheal intubation was found easy in 76% of the patients and difficult in 10% of the patients intubated with Ambu Aura −i. A 13.3% failure rate was observed in group A. Intubation success rate of 100% was observed in Group B. 86.6% of patients were easily intubated, and seven patients were intubated with a bit of difficulty (P-value 0.010). The mean time of SGD insertion in Group A was 14.77 ± 5.563 seconds, and in Group B was 21.87 ± 7.186 seconds (P-value 0.000). SGD insertion attempts were significantly higher in Group B when compared to Group A (P-value 0.025). Conclusion: Although AA-i requires less time for the placement of SGD, blockbuster LMA remains the better choice with a 100% success rate of blind orotracheal intubation.
{"title":"Comparison of Ease and Success of Intubation through LMA Blockbuster and Ambu Aura-I in Patients Receiving General Anesthesia","authors":"M. Manohar, Hemanth Tirupathi, Prashant Kumar, K. Kaur, Sumedha Vashishth, N. Bangarwa","doi":"10.4103/mamcjms.mamcjms_21_23","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_21_23","url":null,"abstract":"Background: Airway gadgetry is expanding at an exponential rate. It is imperative to understand the intubating characteristics of supraglottic devices so that the choice of device in patients is based on evidence rather than just the design. The present study was conducted to compare blind intubation with blockbuster LMA and Ambu Aura-i. Methodology: Sixty patients of either sex, 20 to 60 years of age, ASA I–III, scheduled to undergo elective surgery under general anesthesia, were included in this prospective, randomized, comparative study. Group A (n = 30) patients were intubated with AmbuAura-i, and Group B (n = 30) patients were intubated using BlockBuster LMA. Results: Endotracheal intubation was found easy in 76% of the patients and difficult in 10% of the patients intubated with Ambu Aura −i. A 13.3% failure rate was observed in group A. Intubation success rate of 100% was observed in Group B. 86.6% of patients were easily intubated, and seven patients were intubated with a bit of difficulty (P-value 0.010). The mean time of SGD insertion in Group A was 14.77 ± 5.563 seconds, and in Group B was 21.87 ± 7.186 seconds (P-value 0.000). SGD insertion attempts were significantly higher in Group B when compared to Group A (P-value 0.025). Conclusion: Although AA-i requires less time for the placement of SGD, blockbuster LMA remains the better choice with a 100% success rate of blind orotracheal intubation.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48943720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.4103/mamcjms.mamcjms_17_23
Faheem Qanoongo, Mehreen Faheem, A. Raina, P. Shah
Background: It is becoming widely understood that evaluating a patient’s quality of life (QOL) is crucial to managing their epilepsy. The study aimed to explore the impact of sociodemographic, clinical, and pharmacotherapy factors on QOL in patients with epilepsy. Methods: This was a cross-sectional study conducted over 2 years at the outpatient and inpatient Department of Medicine (Neurology Division) of SMHS Hospital, affiliated with Government Medical College, Srinagar. The patients with epilepsy with a definite diagnosis of epilepsy as per the International League Against Epilepsy (ILAE) guidelines were included. Results: Patients on polytherapy had significantly lower scores for overall QOL, energy/fatigue, medication effects, social functioning, and overall score. Patients on monotherapy scored significantly lower for the said domains, including the seizure worry domain, compared to those patients with epilepsy who were antiepileptic drugs (AEDs) naive. Conclusion: Individuals who were receiving monotherapy had greater QOL scores than those who were receiving traditional AEDs and had focal epilepsy. Furthermore, in patient with epilepsy, all QOL domains were significantly predicted by increased seizure frequency and the presence of adverse drug reactions (ADRs).
{"title":"The clinical, sociodemographic, and pharmacotherapeutic characteristics influencing quality of life in patients with epilepsy","authors":"Faheem Qanoongo, Mehreen Faheem, A. Raina, P. Shah","doi":"10.4103/mamcjms.mamcjms_17_23","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_17_23","url":null,"abstract":"Background: It is becoming widely understood that evaluating a patient’s quality of life (QOL) is crucial to managing their epilepsy. The study aimed to explore the impact of sociodemographic, clinical, and pharmacotherapy factors on QOL in patients with epilepsy. Methods: This was a cross-sectional study conducted over 2 years at the outpatient and inpatient Department of Medicine (Neurology Division) of SMHS Hospital, affiliated with Government Medical College, Srinagar. The patients with epilepsy with a definite diagnosis of epilepsy as per the International League Against Epilepsy (ILAE) guidelines were included. Results: Patients on polytherapy had significantly lower scores for overall QOL, energy/fatigue, medication effects, social functioning, and overall score. Patients on monotherapy scored significantly lower for the said domains, including the seizure worry domain, compared to those patients with epilepsy who were antiepileptic drugs (AEDs) naive. Conclusion: Individuals who were receiving monotherapy had greater QOL scores than those who were receiving traditional AEDs and had focal epilepsy. Furthermore, in patient with epilepsy, all QOL domains were significantly predicted by increased seizure frequency and the presence of adverse drug reactions (ADRs).","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41299226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.4103/mamcjms.mamcjms_14_23
Ashish Agarwal, Anant Agarwal, Ashutosh Kumar
Introduction: The neurovascular surgical structures are protected by quantitative understanding of cervical pedicle morphology and aiding in better surgical outcome. Aim of the study is to do morphometric analysis of subaxial cervical pedicle by noncomputerized computed tomography (CT) scans. Materials and Methods: From 50 volunteers, a total of 500 cervical pedicles were evaluated using axial and sagittal CT scan. Five parameters such as outer pedicle width (OPW), inner pedicle width (IPW), pedicle height (PH), pedicle transverse angle (PTA) and pedicle axis length (PAL) were analyzed. Result: OPW, IPW, PH, and PAL show increase in values from C3 to C7, while PTA shows a decrease in value from C3 to C7. Conclusion: The cervical pedicle dimension of our study population was smaller than other studies carried out on Asian and European population. Hence, the planning for pedicle screw fixation should be race specific.
{"title":"Should planning of cervical pedicle screws be race specific? Computed tomography–based morphometric analysis","authors":"Ashish Agarwal, Anant Agarwal, Ashutosh Kumar","doi":"10.4103/mamcjms.mamcjms_14_23","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_14_23","url":null,"abstract":"Introduction: The neurovascular surgical structures are protected by quantitative understanding of cervical pedicle morphology and aiding in better surgical outcome. Aim of the study is to do morphometric analysis of subaxial cervical pedicle by noncomputerized computed tomography (CT) scans. Materials and Methods: From 50 volunteers, a total of 500 cervical pedicles were evaluated using axial and sagittal CT scan. Five parameters such as outer pedicle width (OPW), inner pedicle width (IPW), pedicle height (PH), pedicle transverse angle (PTA) and pedicle axis length (PAL) were analyzed. Result: OPW, IPW, PH, and PAL show increase in values from C3 to C7, while PTA shows a decrease in value from C3 to C7. Conclusion: The cervical pedicle dimension of our study population was smaller than other studies carried out on Asian and European population. Hence, the planning for pedicle screw fixation should be race specific.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42973980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Patients undergoing modified radical mastectomy (MRM) experience acute pain. Inadequate acute postoperative pain control may lead to anxiety, hemodynamic imbalance and development of chronic pain syndrome. Hence analgesia is extremely important for favourable outcome. This study was undertaken to compare the efficacy of ultrasound guided thoracic paravertebral block (TPVB) versus ultrasound guided thoracic erector spinae plane block (ESPB) with clonidine as an adjuvant to local anaesthetic for post-operative analgesia in modified radical mastectomy. Method: This prospective randomized interventional comparative trial, involving 60 patients were undergoing modified radical mastectomy for breast cancer surgery, was conducted in a tertiary care teaching hospital over 18 months. Sixty patients undergoing MRM for breast cancer under general anaesthesia were enrolled. The patients were randomly allocated into one of the two groups. Group E received ultrasound guided erector spinae block and Group P received Paravertebral block at the level of 4th thoracic vertebra (T4). Both the groups were given 21 mL of 0.5% ropivacaine and 1 μg/kg of clonidine diluted in 1 mL of saline (making total volume of up to 22 mL). Primary outcome measure was to compare duration of analgesia, that is from the time of block administration till the time to first rescue analgesia demanded by the patients. Secondary outcome measures were mean visual analogue scale (VAS) score at rest as well as during abduction of ipsilateral arm at various time points, total intraoperative fentanyl and tramadol requirement up to 24 hours postoperatively; postoperative nausea and vomiting; patients satisfaction at the end of 24 hours postoperatively. Statistical method used: Quantitative variables were compared using Independent t-test/Mann-Whitney Test (when the data sets were not normally distributed). Qualitative variables were compared using Chi-Square test /Fisher’s exact test.A p value of <0.05 was considered statistically significant. Results: Duration of analgesi, that is, time of first rescue analgesia from the administration of the block was comparable between the two study groups. The mean (SD) duration of analgesia in group E was 22.78 (3.31) hours and in group P was 22.88 (3.34) hours (P = 0.914). Both the groups were comparable in terms of fentanyl requirement and total 24 hours tramadol requirement Other parameters like postoperative nausea vomiting, effect on hemodynamic and overall patient satisfaction were also comparable between the two groups. Conclusions: Both ultrasound guided ESPB and TPVB are equally efficacious in providing postoperative analgesia in patients undergoing modified radical mastectomy.
{"title":"Comparison of Efficacy of Erector Spinae Plane Block with Paravertebral Block for Postoperative Analgesia in Patients Undergoing Breast Cancer Surgery","authors":"Arjun Singh, Nidhi Agrawal, Udismita Baruah, Surabhi Sandill","doi":"10.4103/mamcjms.mamcjms_16_23","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_16_23","url":null,"abstract":"Background: Patients undergoing modified radical mastectomy (MRM) experience acute pain. Inadequate acute postoperative pain control may lead to anxiety, hemodynamic imbalance and development of chronic pain syndrome. Hence analgesia is extremely important for favourable outcome. This study was undertaken to compare the efficacy of ultrasound guided thoracic paravertebral block (TPVB) versus ultrasound guided thoracic erector spinae plane block (ESPB) with clonidine as an adjuvant to local anaesthetic for post-operative analgesia in modified radical mastectomy. Method: This prospective randomized interventional comparative trial, involving 60 patients were undergoing modified radical mastectomy for breast cancer surgery, was conducted in a tertiary care teaching hospital over 18 months. Sixty patients undergoing MRM for breast cancer under general anaesthesia were enrolled. The patients were randomly allocated into one of the two groups. Group E received ultrasound guided erector spinae block and Group P received Paravertebral block at the level of 4th thoracic vertebra (T4). Both the groups were given 21 mL of 0.5% ropivacaine and 1 μg/kg of clonidine diluted in 1 mL of saline (making total volume of up to 22 mL). Primary outcome measure was to compare duration of analgesia, that is from the time of block administration till the time to first rescue analgesia demanded by the patients. Secondary outcome measures were mean visual analogue scale (VAS) score at rest as well as during abduction of ipsilateral arm at various time points, total intraoperative fentanyl and tramadol requirement up to 24 hours postoperatively; postoperative nausea and vomiting; patients satisfaction at the end of 24 hours postoperatively. Statistical method used: Quantitative variables were compared using Independent t-test/Mann-Whitney Test (when the data sets were not normally distributed). Qualitative variables were compared using Chi-Square test /Fisher’s exact test.A p value of <0.05 was considered statistically significant. Results: Duration of analgesi, that is, time of first rescue analgesia from the administration of the block was comparable between the two study groups. The mean (SD) duration of analgesia in group E was 22.78 (3.31) hours and in group P was 22.88 (3.34) hours (P = 0.914). Both the groups were comparable in terms of fentanyl requirement and total 24 hours tramadol requirement Other parameters like postoperative nausea vomiting, effect on hemodynamic and overall patient satisfaction were also comparable between the two groups. Conclusions: Both ultrasound guided ESPB and TPVB are equally efficacious in providing postoperative analgesia in patients undergoing modified radical mastectomy.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45702065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.4103/mamcjms.mamcjms_45_22
Saurabh Singh, Preeti Jain
Background and Objectives: The potential role of exercise as an aid to conventional smoking-cessation measures is being increasingly suggested. The present study was conducted with the aim of assessing and comparing the influence of short-duration, moderate-intensity exercise on the urge to smoke, and mood and physical withdrawal symptoms among male smokers following an overnight temporary abstinence from smoking with those who smoked ad-libitum. Methods: Thirty male smokers between 18 and 45 years, who smoked >10 cigarettes/day for >1 year were recruited and randomized into two different groups (n = 15 in each group). The abstinent group included smokers who had at least 10 hours of overnight temporary abstinence from smoking on test day. The non-abstinent group included smokers who smoked ad libitum without having any temporary abstinence from smoking on test day. Nicotine dependence, smoking-urge, and withdrawal symptoms were assessed using the Fagerström test for nicotine dependence (FTND), brief questionnaire on smoking-urge (QSU-Brief), and the mood and physical symptom scale (MPSS), respectively. All subjects in both groups performed moderate-intensity exercise on a friction-type bicycle-ergometer at a fixed frictional force of 2 kg for 5 minutes at 40‑60% of heart-rate reserve. QSU-Brief and MPSS were assessed pre-exercise and post-exercise (immediately, 5 and 10 minutes after stoppage of exercise). Results: QSU-brief and MPSS scores were comparable in both groups at all time points (P > 0.05). There was a significant decline (P < 0.001) in QSU-brief and MPSS scores immediately following exercise in both groups, which persisted after 5 (P < 0.001) and 10 minutes post-exercise (P < 0.01). Interpretation and Conclusions: Our results indicate that a single session of short-duration, moderate-intensity exercise effectively alleviated the smoking urge and negative effects of nicotine withdrawal symptoms in both study groups and led to an overall improvement in their mood. The results further indicated that these beneficial roles of exercise persisted even after a 10 minutes of stoppage of physical activity. We recommend the incorporation of a brief session of moderate exercise as a smoking cessation aid to provide additive relief from cigarette cravings and nicotine withdrawal symptoms in smokers attempting to quit.
{"title":"Acute Influence of Moderate Exercise on Smoking Urge, Mood, and Physical Withdrawal Symptoms: A Comparative Study in Smokers with and without Temporary Smoking Abstinence","authors":"Saurabh Singh, Preeti Jain","doi":"10.4103/mamcjms.mamcjms_45_22","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_45_22","url":null,"abstract":"Background and Objectives: The potential role of exercise as an aid to conventional smoking-cessation measures is being increasingly suggested. The present study was conducted with the aim of assessing and comparing the influence of short-duration, moderate-intensity exercise on the urge to smoke, and mood and physical withdrawal symptoms among male smokers following an overnight temporary abstinence from smoking with those who smoked ad-libitum. Methods: Thirty male smokers between 18 and 45 years, who smoked >10 cigarettes/day for >1 year were recruited and randomized into two different groups (n = 15 in each group). The abstinent group included smokers who had at least 10 hours of overnight temporary abstinence from smoking on test day. The non-abstinent group included smokers who smoked ad libitum without having any temporary abstinence from smoking on test day. Nicotine dependence, smoking-urge, and withdrawal symptoms were assessed using the Fagerström test for nicotine dependence (FTND), brief questionnaire on smoking-urge (QSU-Brief), and the mood and physical symptom scale (MPSS), respectively. All subjects in both groups performed moderate-intensity exercise on a friction-type bicycle-ergometer at a fixed frictional force of 2 kg for 5 minutes at 40‑60% of heart-rate reserve. QSU-Brief and MPSS were assessed pre-exercise and post-exercise (immediately, 5 and 10 minutes after stoppage of exercise). Results: QSU-brief and MPSS scores were comparable in both groups at all time points (P > 0.05). There was a significant decline (P < 0.001) in QSU-brief and MPSS scores immediately following exercise in both groups, which persisted after 5 (P < 0.001) and 10 minutes post-exercise (P < 0.01). Interpretation and Conclusions: Our results indicate that a single session of short-duration, moderate-intensity exercise effectively alleviated the smoking urge and negative effects of nicotine withdrawal symptoms in both study groups and led to an overall improvement in their mood. The results further indicated that these beneficial roles of exercise persisted even after a 10 minutes of stoppage of physical activity. We recommend the incorporation of a brief session of moderate exercise as a smoking cessation aid to provide additive relief from cigarette cravings and nicotine withdrawal symptoms in smokers attempting to quit.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48197425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.4103/mamcjms.mamcjms_64_22
M. Banday, W. Shah, A. Sudhanshu, G. Mufti, N. Bhat, A. Baba, R. Hamid
Background: Adhesive small bowel obstruction is a significant cause of postoperative morbidity in children. There are limited studies on the epidemiology and scope of conservative management for adhesive small bowel obstruction in children. The purpose of this study was to determine the presentation, risk factors, and management, including the role of Gastrografin, for adhesive small bowel obstruction in children. Methods: Between June 2015 and June 2020, 90 patients with an adhesive small bowel obstruction presented to our pediatric surgery department. Out of these, 10 patients underwent upfront surgery and were excluded, while the rest were put on conservative treatment. Patients who failed to improve after 24 hours of conservative management in the absence of signs of strangulation were administered Gastrografin. Patients were evaluated clinically and radiologically to determine the resolution of the obstruction. Results: The mean age was 9.04 ± 3.89 with sex a ratio of 2.6:1. Vomiting was the most symptom (90% cases), followed by pain abdomen (87.5%). Appendectomy (50%) and enterotomy for worm obstruction (17.5%) were the most common previous surgical procedures leading to acute small bowel obstruction. Recurrent obstruction was seen in 7.5% of the cases. Thirty eight (47.5%) patients were successfully managed conservatively by standard decompression therapy. Oral administration of Gastrografin successfully resolved the obstruction in 43% patients who failed standard decompression therapy, whereas 24 (30%) patients with persistent obstruction required laparotomy. Conclusion: Adhesive small bowel obstruction is a common surgical emergency in children. It can occur at any age and after laparotomy for any surgical condition; however, history of appendectomy is associated with high incidence of adhesion obstruction. Vomiting and abdominal pain are constant symptoms. Conservative management with standard decompressive therapy followed by using water-soluble contrast agents (Gastrografin) is a safe and effective approach in managing adhesion obstruction in selected children without signs of bowel ischemia.
{"title":"A Prospective Clinical Evaluation of Adhesive Small Bowel Obstruction in Infants and Children","authors":"M. Banday, W. Shah, A. Sudhanshu, G. Mufti, N. Bhat, A. Baba, R. Hamid","doi":"10.4103/mamcjms.mamcjms_64_22","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_64_22","url":null,"abstract":"Background: Adhesive small bowel obstruction is a significant cause of postoperative morbidity in children. There are limited studies on the epidemiology and scope of conservative management for adhesive small bowel obstruction in children. The purpose of this study was to determine the presentation, risk factors, and management, including the role of Gastrografin, for adhesive small bowel obstruction in children. Methods: Between June 2015 and June 2020, 90 patients with an adhesive small bowel obstruction presented to our pediatric surgery department. Out of these, 10 patients underwent upfront surgery and were excluded, while the rest were put on conservative treatment. Patients who failed to improve after 24 hours of conservative management in the absence of signs of strangulation were administered Gastrografin. Patients were evaluated clinically and radiologically to determine the resolution of the obstruction. Results: The mean age was 9.04 ± 3.89 with sex a ratio of 2.6:1. Vomiting was the most symptom (90% cases), followed by pain abdomen (87.5%). Appendectomy (50%) and enterotomy for worm obstruction (17.5%) were the most common previous surgical procedures leading to acute small bowel obstruction. Recurrent obstruction was seen in 7.5% of the cases. Thirty eight (47.5%) patients were successfully managed conservatively by standard decompression therapy. Oral administration of Gastrografin successfully resolved the obstruction in 43% patients who failed standard decompression therapy, whereas 24 (30%) patients with persistent obstruction required laparotomy. Conclusion: Adhesive small bowel obstruction is a common surgical emergency in children. It can occur at any age and after laparotomy for any surgical condition; however, history of appendectomy is associated with high incidence of adhesion obstruction. Vomiting and abdominal pain are constant symptoms. Conservative management with standard decompressive therapy followed by using water-soluble contrast agents (Gastrografin) is a safe and effective approach in managing adhesion obstruction in selected children without signs of bowel ischemia.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43648102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.4103/mamcjms.mamcjms_85_21
R. Ranjan, Namrata, Anil Singh, Varun Kumar
Posterior reversible encephalopathy (PRES) is a clinico-radiological syndrome that is characterized by headache, altered mental status, seizure, and visual disturbances and is associated with vasogenic edema of white matter predominantly affecting the posterior circulation, that is, occipital lobe and parietal lobe of brain. Atypical sites of involvement include temporal lobes, deep white matter, ganglio-thalamic complexes, brain stem, and cerebellum. Posterior reversible encephalopathy with spinal cord involvement (PRES-SCI) is a new rare entity first described in 2014 by Havenon with about 21 cases reported till 2017. As is with PRES, PRES-SCI is also mostly seen in setting of acute accelerated hypertension with clinical presentation of headache, vomiting, and acute hypertensive retinopathy. This variant of PRES has been reported to be more common in young male patients. In this case report, we present two rare cases of PRES-SCI in a 14-year-old female and 6-year-old male.
{"title":"Atypical Posterior Reversible Encephalopathy with Spinal Cord Involvement (PRES-SCI) − A Rare Entity","authors":"R. Ranjan, Namrata, Anil Singh, Varun Kumar","doi":"10.4103/mamcjms.mamcjms_85_21","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_85_21","url":null,"abstract":"Posterior reversible encephalopathy (PRES) is a clinico-radiological syndrome that is characterized by headache, altered mental status, seizure, and visual disturbances and is associated with vasogenic edema of white matter predominantly affecting the posterior circulation, that is, occipital lobe and parietal lobe of brain. Atypical sites of involvement include temporal lobes, deep white matter, ganglio-thalamic complexes, brain stem, and cerebellum. Posterior reversible encephalopathy with spinal cord involvement (PRES-SCI) is a new rare entity first described in 2014 by Havenon with about 21 cases reported till 2017. As is with PRES, PRES-SCI is also mostly seen in setting of acute accelerated hypertension with clinical presentation of headache, vomiting, and acute hypertensive retinopathy. This variant of PRES has been reported to be more common in young male patients. In this case report, we present two rare cases of PRES-SCI in a 14-year-old female and 6-year-old male.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47388801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.4103/mamcjms.mamcjms_5_23
Mayur Nairita, Biswas Madhuri, Shatanik Mondal
Background & Aims: Most common side effect of subarachnoid block during caesarean delivery is postspinal hypotension which can lead to increased maternal and neonatal morbidity and mortality. Phenylephrine has been shown to be effective in preventing commonly encountered hypotension associated with spinal anesthesia (60% to 70%) in obstetric patients and has become the vasopressor of choice. The following study was conducted to compare the dose requirement of intravenous oxytocin between patients receiving an infusion of prophylactic intravenous phenylephrine to those receiving a saline control infusion under spinal anesthesia in patients undergoing caesarean delivery. Material & Methods: It was a double-blinded, randomized controlled study having 48 subjects in test and control arm each. Results: The mean oxytocin dose administered was higher in the phenylephrine group than in the control group (6.1 ± 2.7 (IU) vs. 5.2 ± 2.3 IU, respectively). The proportion of patients who required a secondary uterotonic agent was higher in the phenylephrine intervention group (22% vs. 8%, respectively). Conclusion: Obstetricians and anesthesiologists must pay close attention to uterine tone for patients receiving a phenylephrine infusion for the prevention of postspinal hypotension and the increased dose requirement of oxytocin. Future multicentric studies are required to further establish the effects of continuous infusion as found in our study.
{"title":"A randomized controlled study to compare the dose requirement of oxytocin for management of uterine atony in patients receiving prophylactic phenylephrine during caesarean delivery","authors":"Mayur Nairita, Biswas Madhuri, Shatanik Mondal","doi":"10.4103/mamcjms.mamcjms_5_23","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_5_23","url":null,"abstract":"Background & Aims: Most common side effect of subarachnoid block during caesarean delivery is postspinal hypotension which can lead to increased maternal and neonatal morbidity and mortality. Phenylephrine has been shown to be effective in preventing commonly encountered hypotension associated with spinal anesthesia (60% to 70%) in obstetric patients and has become the vasopressor of choice. The following study was conducted to compare the dose requirement of intravenous oxytocin between patients receiving an infusion of prophylactic intravenous phenylephrine to those receiving a saline control infusion under spinal anesthesia in patients undergoing caesarean delivery. Material & Methods: It was a double-blinded, randomized controlled study having 48 subjects in test and control arm each. Results: The mean oxytocin dose administered was higher in the phenylephrine group than in the control group (6.1 ± 2.7 (IU) vs. 5.2 ± 2.3 IU, respectively). The proportion of patients who required a secondary uterotonic agent was higher in the phenylephrine intervention group (22% vs. 8%, respectively). Conclusion: Obstetricians and anesthesiologists must pay close attention to uterine tone for patients receiving a phenylephrine infusion for the prevention of postspinal hypotension and the increased dose requirement of oxytocin. Future multicentric studies are required to further establish the effects of continuous infusion as found in our study.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44457162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.4103/mamcjms.mamcjms_27_23
Akshit Mittal, A. Afsar, Anish Tayal, M. Shetty
Artificial intelligence (AI) is gradually changing the landscape of medicine. With the advent of powerful computation and the availability of “big data,” the applications of AI in healthcare are expanding to realms, which were previously thought to be the domain of human intelligence. The applications of AI could be broadly classified into diagnostic and therapeutic categories. The diagnostic applications of AI include the procurement of specimens and interpretation of the findings. Similarly, novel AI algorithms are being applied to analyze retinal images and radiographs. Further, the algorithms could classify patients into clinically relevant categories and aid in decision making. The therapeutic applications of AI extend from prescribing medicines to performing robotic- and endoscope-assisted surgeries, with precision nearly as high as that of trained surgeons. Other applications of AI are predicting epidemics, developing drugs, and managing intensive care units (ICUs), to name a few. AI holds unprecedented potential to revolutionize patient care. The knowledge of AI applications can help clinicians and researchers appraise the current state of the utilization of AI in healthcare and may guide future research. In this article, the existing and upcoming applications of AI in healthcare are reviewed, with respect to various disciplines.
{"title":"Artificial intelligence and healthcare","authors":"Akshit Mittal, A. Afsar, Anish Tayal, M. Shetty","doi":"10.4103/mamcjms.mamcjms_27_23","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_27_23","url":null,"abstract":"Artificial intelligence (AI) is gradually changing the landscape of medicine. With the advent of powerful computation and the availability of “big data,” the applications of AI in healthcare are expanding to realms, which were previously thought to be the domain of human intelligence. The applications of AI could be broadly classified into diagnostic and therapeutic categories. The diagnostic applications of AI include the procurement of specimens and interpretation of the findings. Similarly, novel AI algorithms are being applied to analyze retinal images and radiographs. Further, the algorithms could classify patients into clinically relevant categories and aid in decision making. The therapeutic applications of AI extend from prescribing medicines to performing robotic- and endoscope-assisted surgeries, with precision nearly as high as that of trained surgeons. Other applications of AI are predicting epidemics, developing drugs, and managing intensive care units (ICUs), to name a few. AI holds unprecedented potential to revolutionize patient care. The knowledge of AI applications can help clinicians and researchers appraise the current state of the utilization of AI in healthcare and may guide future research. In this article, the existing and upcoming applications of AI in healthcare are reviewed, with respect to various disciplines.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45123107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/mamcjms.mamcjms_8_23
Meera Varadarajan, SM Ramaiah
Background: Iliopsoas bleed is a serious complication in people with hemophilia (PWH), with significant morbidity. Studies examining the profile, incidence, and outcomes in psoas bleeds are scarce and will shed more light and increase awareness about its management. Material and Methods: Data of 453 PWH with confirmed iliopsoas bleed treated at Bangalore Medical College were retrospectively analyzed. Results: Eighty-five (18.8%) PWH presented with total of 154 psoas bleeds. Their mean age was 21.96 years. Common symptoms were thigh/hip/groin pain (100.0%), hip flexion spasm (41.2%), numbness/tingling in quadriceps muscle (5.9%), abdominal tenderness (3.5%), hematuria, and anemia requiring blood transfusion in 2.4% each. Long-term complications were quadriceps atrophy (9.4%), permanent abnormal posture (10.6%), transient paresthesia in the distribution of femoral nerve (3.5%), and pseudo tumor in pelvis (1.2%). The overall average duration of therapy with clotting factor concentrate was 1.7 days with a mean duration of therapy of 1.4 days in patients without inhibitors and 2.8 days in patients with inhibitors (p = 0.010). The overall mean duration of hospitalization was 7.2 days with 5.3 days in PWH without inhibitors and 8.3 days in PWH with inhibitors (p = 0.342). Conclusion: Pain in hip joint/groin/hip flexion spasm suggests the possibility of an iliopsoas hematoma and early factor replacement therapy should be started to prevent complications. Early treatment at first sign of discomfort reduces the duration of treatment, and prevents severe complication and invasive interventions. Patients with inhibitors were overrepresented in the cohort who needed longer duration of factor replacement therapy.
{"title":"Iliopsoas bleeds in patients with hemophilia: A single-center experience from South India","authors":"Meera Varadarajan, SM Ramaiah","doi":"10.4103/mamcjms.mamcjms_8_23","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_8_23","url":null,"abstract":"Background: Iliopsoas bleed is a serious complication in people with hemophilia (PWH), with significant morbidity. Studies examining the profile, incidence, and outcomes in psoas bleeds are scarce and will shed more light and increase awareness about its management. Material and Methods: Data of 453 PWH with confirmed iliopsoas bleed treated at Bangalore Medical College were retrospectively analyzed. Results: Eighty-five (18.8%) PWH presented with total of 154 psoas bleeds. Their mean age was 21.96 years. Common symptoms were thigh/hip/groin pain (100.0%), hip flexion spasm (41.2%), numbness/tingling in quadriceps muscle (5.9%), abdominal tenderness (3.5%), hematuria, and anemia requiring blood transfusion in 2.4% each. Long-term complications were quadriceps atrophy (9.4%), permanent abnormal posture (10.6%), transient paresthesia in the distribution of femoral nerve (3.5%), and pseudo tumor in pelvis (1.2%). The overall average duration of therapy with clotting factor concentrate was 1.7 days with a mean duration of therapy of 1.4 days in patients without inhibitors and 2.8 days in patients with inhibitors (p = 0.010). The overall mean duration of hospitalization was 7.2 days with 5.3 days in PWH without inhibitors and 8.3 days in PWH with inhibitors (p = 0.342). Conclusion: Pain in hip joint/groin/hip flexion spasm suggests the possibility of an iliopsoas hematoma and early factor replacement therapy should be started to prevent complications. Early treatment at first sign of discomfort reduces the duration of treatment, and prevents severe complication and invasive interventions. Patients with inhibitors were overrepresented in the cohort who needed longer duration of factor replacement therapy.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47545481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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