Objective: The present study was undertaken to assess the perceived stress levels in medical students and doctors in India during coronavirus disease (COVID-19) pandemic. Various studies have been done to assess the perceived stress levels among medical professionals and other associated health care workers, but no significant study has been done among medical students. This study is done with a special emphasis on the latter. Methods: A semi-validated online questionnaire was used to collect stress scores among medical students and doctors using Perceived Stress Scale. The aggravating and relieving factors of stress were also recorded and analyzed. Results: A total of 346 responses were analyzed from across various medical schools of country. The mean cumulative stress score among participants was 18.2 ± 6.8 indicating moderate stress with 34 (9.8%) respondents reporting high stress scores. Female gender was identified as a risk factor (OR 2.76, 95% CI: 1.58, 4.78; P < 0.001). Stress scores were higher among those not directly involved in COVID-19 care (OR 1.08, 95% CI: 0.57, 2.05; P = 0.47). Education and health of the family were major concerns recorded in 39% and 38% participants, respectively. The main stress aggravating factors were found to be news/media (39%) and unsafe work environment (16%). Among the stress relieving factors, hobbies (31%), family support (25%), and meditation (23%) were common. Conclusions: A moderate to high stress was reported in medical students and doctors. Educational concerns should be equally addressed as health care delivery and personal safety.
{"title":"Perceived Stress Among Medical Students and Doctors in India During COVID-19 Pandemic","authors":"Nishtha Agrawal, Hitakshi Sharma, Aashima Dabas, Anurag Mishra","doi":"10.4103/mamcjms.mamcjms_17_21","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_17_21","url":null,"abstract":"Objective: The present study was undertaken to assess the perceived stress levels in medical students and doctors in India during coronavirus disease (COVID-19) pandemic. Various studies have been done to assess the perceived stress levels among medical professionals and other associated health care workers, but no significant study has been done among medical students. This study is done with a special emphasis on the latter. Methods: A semi-validated online questionnaire was used to collect stress scores among medical students and doctors using Perceived Stress Scale. The aggravating and relieving factors of stress were also recorded and analyzed. Results: A total of 346 responses were analyzed from across various medical schools of country. The mean cumulative stress score among participants was 18.2 ± 6.8 indicating moderate stress with 34 (9.8%) respondents reporting high stress scores. Female gender was identified as a risk factor (OR 2.76, 95% CI: 1.58, 4.78; P < 0.001). Stress scores were higher among those not directly involved in COVID-19 care (OR 1.08, 95% CI: 0.57, 2.05; P = 0.47). Education and health of the family were major concerns recorded in 39% and 38% participants, respectively. The main stress aggravating factors were found to be news/media (39%) and unsafe work environment (16%). Among the stress relieving factors, hobbies (31%), family support (25%), and meditation (23%) were common. Conclusions: A moderate to high stress was reported in medical students and doctors. Educational concerns should be equally addressed as health care delivery and personal safety.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46484202","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 : 2021-01-01DOI: 10.4103/mamcjms.mamcjms_36_21
D. Arora
{"title":"Looking Forward with Hope and Victory","authors":"D. Arora","doi":"10.4103/mamcjms.mamcjms_36_21","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_36_21","url":null,"abstract":"","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47753814","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 : 2021-01-01DOI: 10.4103/mamcjms.mamcjms_130_20
Rajeev K. Kotnala, D. Tempe, P. Mishra, S. Ramji, Amaresh P. Patil
Background: In the city of Delhi, with rapidly increasing number of COVID-19 positive patients, a need for creating a large COVID-19 care center (CCC) for mildly symptomatic patients was badly felt. This paper describes the challenges of setting up a 2000 bed facility and the experience with the first 400 patients treated in the center. Methods: The Indo-Tibetan Border Police was assigned this task, which was completed in a record time of 10 days in collaboration with several other government and nongovernment agencies. Results: All the involved agencies displayed teamwork of the highest order and completed the task. The first 400 mildly symptomatic patients were successfully treated at the center. Patient safety was the priority, and a protocol was devised for early detection of patients worsening further to moderate (oxygen saturation [SpO2] 90%–94% on room air) or severe category (SpO2 < 90% on room air), and arrange timely transfer to a COVID hospital. Twenty-six patients progressed to moderate disease and were managed with oxygen therapy in an area designated as COVID health center (200 beds) having facilities to oxygenate the patients, one patient required bilevel positive airway pressure. Thirteen patients were transferred to a COVID hospital as they worsened to severe category. All patients were discharged home; the mean hospital length of stay was 9 ± 2.3 days. Conclusions: With careful planning and team work, it is possible to commission a large CCC in a short span of time. The patients can be safely managed in such a facility.
{"title":"Challenges and Experience of Setting Up a 2000 Bed COVID-19 Care Center on an Urgent Basis at Delhi","authors":"Rajeev K. Kotnala, D. Tempe, P. Mishra, S. Ramji, Amaresh P. Patil","doi":"10.4103/mamcjms.mamcjms_130_20","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_130_20","url":null,"abstract":"Background: In the city of Delhi, with rapidly increasing number of COVID-19 positive patients, a need for creating a large COVID-19 care center (CCC) for mildly symptomatic patients was badly felt. This paper describes the challenges of setting up a 2000 bed facility and the experience with the first 400 patients treated in the center. Methods: The Indo-Tibetan Border Police was assigned this task, which was completed in a record time of 10 days in collaboration with several other government and nongovernment agencies. Results: All the involved agencies displayed teamwork of the highest order and completed the task. The first 400 mildly symptomatic patients were successfully treated at the center. Patient safety was the priority, and a protocol was devised for early detection of patients worsening further to moderate (oxygen saturation [SpO2] 90%–94% on room air) or severe category (SpO2 < 90% on room air), and arrange timely transfer to a COVID hospital. Twenty-six patients progressed to moderate disease and were managed with oxygen therapy in an area designated as COVID health center (200 beds) having facilities to oxygenate the patients, one patient required bilevel positive airway pressure. Thirteen patients were transferred to a COVID hospital as they worsened to severe category. All patients were discharged home; the mean hospital length of stay was 9 ± 2.3 days. Conclusions: With careful planning and team work, it is possible to commission a large CCC in a short span of time. The patients can be safely managed in such a facility.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46053545","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 : 2021-01-01DOI: 10.4103/mamcjms.mamcjms_105_20
Saket Prakash, Raj Kumar, Sonam Patel, M. Patralekh, L. Maini
Background and Purpose: COVID-19 was declared as a pandemic on March 11, 2020 by World Health Organization. Resident doctors, including interns, are the frontline of health care workers, have always been at risk of infectious diseases, and the spread of the novel severe acute respiratory syndrome (SARS)-CoV-2 virus. The purpose of this survey was to gather opinions about personal safety, general knowledge, preventive behaviors, attitude, risk perception on COVID-19, and institutional approach toward this pandemic. Methods: This cross-sectional, online survey-based study was conducted from April 18, 2020 to April 21, 2020 in India. Data was collected from health care professionals, mainly frontline doctors, that is, residents and interns. Questionnaire consisted of 41 questions, statistical analysis was done using SPSS software version 26 (IBM Corp). Chi-square test was used to investigate the level of association among variables at the significance level of P < 0.05. Results: About 332 doctors completed the survey. Most of the junior resident (academic), from category A, B, and C received training for donning and doffing, and we found they were aware of donning and doffing (P-value < 0.05). It was also found that N95 was the most common personal protective equipment (PPE) stock missing in the institution. Survey also revealed that most of the surgeons had stopped planned surgery (P-value < 0.05) and also there was a significant decrease in emergency surgery and consultations (P-value < 0.05). Conclusion: We have restricted access to essential PPE. Protecting health care workers had been a governmental health priority. Institutions and government should urgently implement policies to support health care workers in the time of the COVID-19 pandemic.
{"title":"Public Sector Resident Doctors’ Knowledge and Practices Amidst COVID-19: A Cross-Sectional Analysis","authors":"Saket Prakash, Raj Kumar, Sonam Patel, M. Patralekh, L. Maini","doi":"10.4103/mamcjms.mamcjms_105_20","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_105_20","url":null,"abstract":"Background and Purpose: COVID-19 was declared as a pandemic on March 11, 2020 by World Health Organization. Resident doctors, including interns, are the frontline of health care workers, have always been at risk of infectious diseases, and the spread of the novel severe acute respiratory syndrome (SARS)-CoV-2 virus. The purpose of this survey was to gather opinions about personal safety, general knowledge, preventive behaviors, attitude, risk perception on COVID-19, and institutional approach toward this pandemic. Methods: This cross-sectional, online survey-based study was conducted from April 18, 2020 to April 21, 2020 in India. Data was collected from health care professionals, mainly frontline doctors, that is, residents and interns. Questionnaire consisted of 41 questions, statistical analysis was done using SPSS software version 26 (IBM Corp). Chi-square test was used to investigate the level of association among variables at the significance level of P < 0.05. Results: About 332 doctors completed the survey. Most of the junior resident (academic), from category A, B, and C received training for donning and doffing, and we found they were aware of donning and doffing (P-value < 0.05). It was also found that N95 was the most common personal protective equipment (PPE) stock missing in the institution. Survey also revealed that most of the surgeons had stopped planned surgery (P-value < 0.05) and also there was a significant decrease in emergency surgery and consultations (P-value < 0.05). Conclusion: We have restricted access to essential PPE. Protecting health care workers had been a governmental health priority. Institutions and government should urgently implement policies to support health care workers in the time of the COVID-19 pandemic.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46725281","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 : 2021-01-01DOI: 10.4103/mamcjms.mamcjms_1_21
S. Garg, B. Banerjee, G. Meena, N. Sharma, M. Singh
Introduction: Air pollution is a major determinant of several lung diseases. With air pollution being a cause of concern in Delhi, present study aimed to assess proportion of individuals with impairment of lung function and factors associated with it. Methodology: A community-based cross-sectional study was conducted among adult population of Delhi. Data were collected by interview of subjects, with spirometry done on all subjects using portable spirometer. Statistical Analysis: Categorical variables were presented as percentages and compared using chi‐square test. Logistic regression analysis was done for independent predictors of lung function impairment. Significance was considered at P ≤ 0.05. Results: Total 3019 individuals were screened and 34.35% had lung function impairment, majority having restrictive disorder. Univariate analysis showed impairment was slightly higher in women, though not significant. Significantly more proportion of subjects with impairment were in higher age group, with lower levels of education, in working population and in those living in Delhi for longer duration. Students had lower risk of impairment when compared to those doing office job. Most of the findings were substantiated by multivariate analysis. Conclusion: Though spirometry is not an ideal screening test, this study does reflect that more than one-third of study subjects had impaired lung function, with those in higher age group having higher odds for lung function impairment, probably indicating the cumulative effect of air pollution. Measures for curbing air pollution are hence need of the hour and other broader determinants of health should be addressed through evidence-informed public policies and actions across all sectors.
{"title":"A Cross-Sectional Study on Lung Function Status of Adults in Delhi","authors":"S. Garg, B. Banerjee, G. Meena, N. Sharma, M. Singh","doi":"10.4103/mamcjms.mamcjms_1_21","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_1_21","url":null,"abstract":"Introduction: Air pollution is a major determinant of several lung diseases. With air pollution being a cause of concern in Delhi, present study aimed to assess proportion of individuals with impairment of lung function and factors associated with it. Methodology: A community-based cross-sectional study was conducted among adult population of Delhi. Data were collected by interview of subjects, with spirometry done on all subjects using portable spirometer. Statistical Analysis: Categorical variables were presented as percentages and compared using chi‐square test. Logistic regression analysis was done for independent predictors of lung function impairment. Significance was considered at P ≤ 0.05. Results: Total 3019 individuals were screened and 34.35% had lung function impairment, majority having restrictive disorder. Univariate analysis showed impairment was slightly higher in women, though not significant. Significantly more proportion of subjects with impairment were in higher age group, with lower levels of education, in working population and in those living in Delhi for longer duration. Students had lower risk of impairment when compared to those doing office job. Most of the findings were substantiated by multivariate analysis. Conclusion: Though spirometry is not an ideal screening test, this study does reflect that more than one-third of study subjects had impaired lung function, with those in higher age group having higher odds for lung function impairment, probably indicating the cumulative effect of air pollution. Measures for curbing air pollution are hence need of the hour and other broader determinants of health should be addressed through evidence-informed public policies and actions across all sectors.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47902219","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 : 2021-01-01DOI: 10.4103/mamcjms.mamcjms_15_21
S. Shrivastava, P. Shrivastava
In order to accomplish the vision to produce a competent medical graduate, a number of strategies have been proposed. In that regard, effective clinical supervision of the teachers is an exclusive requirement, which plays an important role in the learning and the professional growth of the students. In broad terms, the act of clinical supervision helps to ensure patient safety, educate the student, sustain the set standards of quality of care, identify the problems encountered by the student, support them to accomplish learning outcomes, and by doing all this monitor the learning progression. In conclusion, clinical supervision of students and residents during medical training is an effective approach to ensure attainment of the learning outcomes. However, clinical supervision has been more often than not ignored, and thus there is an indispensable need to establish a supervision framework in each of the medical colleges for the benefit of the students and the society at large.
{"title":"Ensuring Effective Clinical Supervision of Medical Students and Residents During Their Training Period","authors":"S. Shrivastava, P. Shrivastava","doi":"10.4103/mamcjms.mamcjms_15_21","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_15_21","url":null,"abstract":"In order to accomplish the vision to produce a competent medical graduate, a number of strategies have been proposed. In that regard, effective clinical supervision of the teachers is an exclusive requirement, which plays an important role in the learning and the professional growth of the students. In broad terms, the act of clinical supervision helps to ensure patient safety, educate the student, sustain the set standards of quality of care, identify the problems encountered by the student, support them to accomplish learning outcomes, and by doing all this monitor the learning progression. In conclusion, clinical supervision of students and residents during medical training is an effective approach to ensure attainment of the learning outcomes. However, clinical supervision has been more often than not ignored, and thus there is an indispensable need to establish a supervision framework in each of the medical colleges for the benefit of the students and the society at large.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47493009","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 : 2021-01-01DOI: 10.4103/mamcjms.mamcjms_121_20
Vijay Kumar, Preeti Singh, S. Misra, S. Marwah, G. Baweja
Introduction: Establishing the diagnosis of splenomegaly is a clinical and pathological conundrum. The present study aimed to evaluate the clinicohematological findings and the significance of bone marrow examination in establishing the etiology of splenomegaly. Materials and Methods: This study was a retrospective analysis of patients with splenomegaly who had indications for bone marrow examination. The study was conducted over a period of 2 years. Detailed hematological and serological investigations were analyzed in those patients. Results: There were 96 males and 60 females. Most of the patients presented with fever. A mild degree of splenomegaly was found in 56.4% of the patients, followed by moderate (39.7%), and massive (3.9%) degree of splenomegaly. Pancytopenia was noted in 15.4% of the patients. Anemia was observed in 96.2% of the cases. Erythroid hyperplasia was the most common bone marrow finding (37.2%). Etiologies of splenomegaly were documented by the clinico-laboratory evaluation in 45.5% of the patients. Bone marrow examination along with peripheral blood examination alone established etiologies in 15.4% of the patients. Conclusion: Anemia and hematological malignancies formed a major part of the etiologies of splenomegaly. Bone marrow examination was an inevitable investigation in these situations. Serological investigations were useful in the diagnosis of nutrition deficiency anemia and infectious etiology. The grade of splenomegaly assessed clinically at the time of presentation provided an important clue for the etiology. Bone marrow examination proved to be an important diagnostic tool in the workup of patients with splenomegaly.
{"title":"Utility of Bone Marrow Examination in the Diagnosis of Splenomegaly: Experience from a Tertiary Care Center","authors":"Vijay Kumar, Preeti Singh, S. Misra, S. Marwah, G. Baweja","doi":"10.4103/mamcjms.mamcjms_121_20","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_121_20","url":null,"abstract":"Introduction: Establishing the diagnosis of splenomegaly is a clinical and pathological conundrum. The present study aimed to evaluate the clinicohematological findings and the significance of bone marrow examination in establishing the etiology of splenomegaly. Materials and Methods: This study was a retrospective analysis of patients with splenomegaly who had indications for bone marrow examination. The study was conducted over a period of 2 years. Detailed hematological and serological investigations were analyzed in those patients. Results: There were 96 males and 60 females. Most of the patients presented with fever. A mild degree of splenomegaly was found in 56.4% of the patients, followed by moderate (39.7%), and massive (3.9%) degree of splenomegaly. Pancytopenia was noted in 15.4% of the patients. Anemia was observed in 96.2% of the cases. Erythroid hyperplasia was the most common bone marrow finding (37.2%). Etiologies of splenomegaly were documented by the clinico-laboratory evaluation in 45.5% of the patients. Bone marrow examination along with peripheral blood examination alone established etiologies in 15.4% of the patients. Conclusion: Anemia and hematological malignancies formed a major part of the etiologies of splenomegaly. Bone marrow examination was an inevitable investigation in these situations. Serological investigations were useful in the diagnosis of nutrition deficiency anemia and infectious etiology. The grade of splenomegaly assessed clinically at the time of presentation provided an important clue for the etiology. Bone marrow examination proved to be an important diagnostic tool in the workup of patients with splenomegaly.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42879191","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 : 2021-01-01DOI: 10.4103/mamcjms.mamcjms_11_21
Preeti Dhahiya, Neha Garg, M. Arora, D. Tempe
Introduction: Propofol is the most common drug used for providing sedation due to its short duration of action and early recovery. However, it may be associated with hypotension, desaturations, and bradycardia and does not provide analgesia, due to which various adjuncts are used along with it. Lignocaine decreases the doses of propofol and inhalational agent when used for visceral surgeries. Thus, we conducted a study to compare the dose of propofol along with lignocaine, ketamine, and fentanyl for sedation in endoscopic retrograde cholangiopancreatography (ERCP) procedure. Methods: A total of 105 patients were randomized into three groups. Sedation was provided by intravenous bolus injection of propofol 1 mg/kg in all patients followed by infusion of 0.5 mg/kg/hour. In group K bolus dose of intravenous ketamine was 0.5 mg/kg followed by infusion of 0.3 mg/kg/hour, in group L patients were given intravenous bolus of lignocaine 1.5 mg/kg followed by a infusion of 2 mg/kg/hour, in group F the matched volume of saline and 1 μ/kg fentanyl were administered. Intermittent boluses of propofol were given in all three groups in response to patients’ discomfort evidenced by grimaces, movement, or increase in heart rate or mean arterial pressure by >20% of baseline. The total dose of propofol consumed in the three groups was noted. Results: The total dose of propofol consumed and post-procedure abdominal pain was significantly higher in the fentanyl group but was comparable in lignocaine and ketamine groups. Conclusion: Lignocaine and ketamine were equally effective in deceasing propofol requirement and in preventing post-ERCP abdominal pain.
{"title":"Comparison of Ketamine, Lignocaine, and Fentanyl on Dose Requirement of Propofol in Patients Undergoing ERCP: A Randomized Controlled Trial","authors":"Preeti Dhahiya, Neha Garg, M. Arora, D. Tempe","doi":"10.4103/mamcjms.mamcjms_11_21","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_11_21","url":null,"abstract":"Introduction: Propofol is the most common drug used for providing sedation due to its short duration of action and early recovery. However, it may be associated with hypotension, desaturations, and bradycardia and does not provide analgesia, due to which various adjuncts are used along with it. Lignocaine decreases the doses of propofol and inhalational agent when used for visceral surgeries. Thus, we conducted a study to compare the dose of propofol along with lignocaine, ketamine, and fentanyl for sedation in endoscopic retrograde cholangiopancreatography (ERCP) procedure. Methods: A total of 105 patients were randomized into three groups. Sedation was provided by intravenous bolus injection of propofol 1 mg/kg in all patients followed by infusion of 0.5 mg/kg/hour. In group K bolus dose of intravenous ketamine was 0.5 mg/kg followed by infusion of 0.3 mg/kg/hour, in group L patients were given intravenous bolus of lignocaine 1.5 mg/kg followed by a infusion of 2 mg/kg/hour, in group F the matched volume of saline and 1 μ/kg fentanyl were administered. Intermittent boluses of propofol were given in all three groups in response to patients’ discomfort evidenced by grimaces, movement, or increase in heart rate or mean arterial pressure by >20% of baseline. The total dose of propofol consumed in the three groups was noted. Results: The total dose of propofol consumed and post-procedure abdominal pain was significantly higher in the fentanyl group but was comparable in lignocaine and ketamine groups. Conclusion: Lignocaine and ketamine were equally effective in deceasing propofol requirement and in preventing post-ERCP abdominal pain.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41618438","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 : 2021-01-01DOI: 10.4103/mamcjms.mamcjms_24_21
Elvis Kachari, Sapna Singh, Surabhi Gupta, J. Kumar
Ankle joint is affected by a large gamut of pathologies ranging from traumatic to nontraumatic in origin. Although ankle radiographs continue to serve as the initial investigation of choice, magnetic resonance imaging (MRI), owing to its superior soft tissue resolution and noninvasive nature is the most important investigative tool to evaluate ankle and hindfoot pain. MRI allows excellent assessment of soft tissue structures like ligaments, tendons, fascia, neurovascular bundle, and cartilage. MRI can also be used in detection of osseous injuries like bone contusions, stress and insufficiency fractures, osteonecrosis, osteochondral defects, and transient bone marrow edema. In this pictorial essay, we aim to study the normal anatomy of ankle joint as well as demonstrate a spectrum of common pathologies affecting the ankle joint with their salient imaging features on MRI.
{"title":"High-Resolution 3-Tesla MRI in the Evaluation of Ankle and Hindfoot Pain: A Pictorial Review","authors":"Elvis Kachari, Sapna Singh, Surabhi Gupta, J. Kumar","doi":"10.4103/mamcjms.mamcjms_24_21","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_24_21","url":null,"abstract":"Ankle joint is affected by a large gamut of pathologies ranging from traumatic to nontraumatic in origin. Although ankle radiographs continue to serve as the initial investigation of choice, magnetic resonance imaging (MRI), owing to its superior soft tissue resolution and noninvasive nature is the most important investigative tool to evaluate ankle and hindfoot pain. MRI allows excellent assessment of soft tissue structures like ligaments, tendons, fascia, neurovascular bundle, and cartilage. MRI can also be used in detection of osseous injuries like bone contusions, stress and insufficiency fractures, osteonecrosis, osteochondral defects, and transient bone marrow edema. In this pictorial essay, we aim to study the normal anatomy of ankle joint as well as demonstrate a spectrum of common pathologies affecting the ankle joint with their salient imaging features on MRI.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49412423","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 : 2021-01-01DOI: 10.4103/mamcjms.mamcjms_108_20
A. Tempe, Sonia Sindher, Niharika Dhiman, Devender Kumar, P. Mishra
Context: There is limited experience of use of dinoprostone controlled release vaginal pessary in Indian scenario. Hence, we aim to find its efficacy for induction of labor (IOL). Aims: To compare two formulations of dinoprostone: intracervical gel and controlled release vaginal pessary for IOL. Settings and Design: Randomized controlled study in a tertiary care center. Methods: A double-blinded randomized controlled study was done on 106 women with singleton pregnancy, 37 to 41 weeks with vertex presentation, no obvious fetal compromise, and planned for IOL. They were randomly divided into equal groups to receive either dinoprostone intracervical gel (Group A) or dinoprostone controlled release vaginal pessary (Group B). The main outcome measures: change in Bishop score (using simplified Bishop score) at 0 to 6 hours and 6 to 12 hours after application and success to initiate active labor. The secondary outcome measures: maternal adverse effect, induction to delivery time, requirement of oxytocin infusion, cesarean section rate, APGAR score, and neonatal intensive care unit admission. Statistical Analysis: Statistical Package for Social Sciences (SPSS) version 17.0. Results: Increase in Bishop score and women achieving active labor were more in Group B (90.6% vs. 41.5%; P < 0.01). Mean time from induction to delivery was higher in Group A (19.72 hours vs. 12.53 hours; P < 0.01). Requirement of oxytocin was lesser in Group B (35.8% vs. 75.5%; P < 0.001). No adverse maternal or fetal outcome was noted in either of the groups. Conclusions: Dinoprostone controlled release vaginal pessary has significantly better outcomes than intracervical gel for IOL.
{"title":"Comparison of Dinoprostone Controlled Release Vaginal Pessary with Dinoprostone Intracervical Gel for Preinduction Cervical Ripening and Induction of Labor at Term","authors":"A. Tempe, Sonia Sindher, Niharika Dhiman, Devender Kumar, P. Mishra","doi":"10.4103/mamcjms.mamcjms_108_20","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_108_20","url":null,"abstract":"Context: There is limited experience of use of dinoprostone controlled release vaginal pessary in Indian scenario. Hence, we aim to find its efficacy for induction of labor (IOL). Aims: To compare two formulations of dinoprostone: intracervical gel and controlled release vaginal pessary for IOL. Settings and Design: Randomized controlled study in a tertiary care center. Methods: A double-blinded randomized controlled study was done on 106 women with singleton pregnancy, 37 to 41 weeks with vertex presentation, no obvious fetal compromise, and planned for IOL. They were randomly divided into equal groups to receive either dinoprostone intracervical gel (Group A) or dinoprostone controlled release vaginal pessary (Group B). The main outcome measures: change in Bishop score (using simplified Bishop score) at 0 to 6 hours and 6 to 12 hours after application and success to initiate active labor. The secondary outcome measures: maternal adverse effect, induction to delivery time, requirement of oxytocin infusion, cesarean section rate, APGAR score, and neonatal intensive care unit admission. Statistical Analysis: Statistical Package for Social Sciences (SPSS) version 17.0. Results: Increase in Bishop score and women achieving active labor were more in Group B (90.6% vs. 41.5%; P < 0.01). Mean time from induction to delivery was higher in Group A (19.72 hours vs. 12.53 hours; P < 0.01). Requirement of oxytocin was lesser in Group B (35.8% vs. 75.5%; P < 0.001). No adverse maternal or fetal outcome was noted in either of the groups. Conclusions: Dinoprostone controlled release vaginal pessary has significantly better outcomes than intracervical gel for IOL.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48941318","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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