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Comparison of Dexmedetomidine and Propofol for Sedation in Patients Undergoing Upper Limb Orthopedic Surgery under Regional Anesthesia with Brachial Plexus Block 比较右美托咪定和丙泊酚对在臂丛神经阻滞区域麻醉下进行上肢矫形手术的患者的镇静作用
Pub Date : 2024-04-13 DOI: 10.4103/jssrp.jssrp_35_23
Neha Padhi, Samir Hota, Mahendra Ekka, Siddhanta Choudhury, Smrutirani Mund, Jajati Keshari Panigrahi, Jyoti Prakash Samal
The search for the ideal sedative during regional anesthesia continues. Propofol is widely as a sedative intraoperatively. It may cause troublesome hemodynamic changes. Dexmedetomidine is an α2 agonist with sedative, anxiolytic, and analgesic properties. In this study, we compared dexmedetomidine with propofol as sedatives during surgeries under brachial plexus block. In our study, 70 American Society of Anesthesiologists I Class and II patients about to undergo upper limb surgeries under brachial plexus block were blinded and randomly allocated to receive either propofol (Group P) or dexmedetomidine (Group D) infusion. Brachial plexus block was performed, and after confirmation of adequate sensory and motor block, an initial loading dose of the drug was administered over 10 min, followed by a maintenance dose till the end of the surgery. Titration of the rate of infusion was done so as to maintain Ramsay Sedation Score (RSS) of 3–4 and Bispectral Index (BIS) of 60–80. Hemodynamic and respiratory parameters were monitored intraoperatively. Adverse effects such as hypotension, bradycardia, respiratory depression, and incidence of oversedation and undersedation were also noted. The collected data were evaluated using appropriate statistical tests in SPSS version 22®. P <0.05 was considered statistically significant. The RSS remained at 4 in Group P from 20 min onward and for Group D, RSS remained at 3 after 30 min. Post-induction, there was a reduction in BIS in both the groups, but patients in Group P showed statistically significant lower values of BIS when compared with Group D. The fall in mean arterial pressure was more in Group P as compared to Group D. Nine (25.71%) incidences of hypotension were seen in Group P and none in Group D. The decrease in heart rate was more profound in Group D as compared with Group P and one incidence of bradycardia observed in Group D. The respiratory rate was relatively stable in Group D as compared to Group P. The oxygen saturation (SpO2) values in the majority of the patients in both groups were above 92%, but three patients in Group P had SpO2 <92%. In Group P, 6 (17.14%) incidences of oversedation and 8 (22.85%) incidences of undersedation were observed. In Group D, 7 (20%) incidences of undersedation with no incidence of oversedation were observed. Dexmedetomidine at recommended doses has a better sedative property with less effect on hemodynamics and respiration as compared to propofol.
在区域麻醉中寻找理想镇静剂的工作仍在继续。异丙酚被广泛用作术中镇静剂。它可能会引起麻烦的血流动力学变化。右美托咪定是α2激动剂,具有镇静、抗焦虑和镇痛作用。在这项研究中,我们比较了右美托咪定和异丙酚在臂丛神经阻滞手术中作为镇静剂的作用。 在我们的研究中,70 名即将在臂丛神经阻滞下接受上肢手术的美国麻醉医师协会 I 级和 II 级患者被随机分配到接受异丙酚(P 组)或右美托咪定(D 组)输注的盲区。进行臂丛神经阻滞,在确认充分的感觉和运动阻滞后,在 10 分钟内给予初始负荷剂量的药物,随后给予维持剂量直至手术结束。对输注速度进行调节,以保持拉姆塞镇静评分(RSS)在 3-4 分,双频谱指数(BIS)在 60-80 分。术中监测血液动力学和呼吸参数。还注意到低血压、心动过缓、呼吸抑制等不良反应以及过度镇静和镇静不足的发生率。收集的数据通过 SPSS 22® 版进行了适当的统计检验。P<0.05为差异有统计学意义。 从 20 分钟起,P 组的 RSS 保持在 4,而 D 组的 RSS 在 30 分钟后保持在 3。诱导后,两组患者的 BIS 值均有所下降,但 P 组患者的 BIS 值较 D 组低,差异有统计学意义。与 P 组相比,D 组的心率下降幅度更大,并观察到一次心动过缓。与 P 组相比,D 组的呼吸频率相对稳定。在 P 组,观察到 6 例(17.14%)过度镇静,8 例(22.85%)镇静不足。在 D 组中,观察到 7 例(20%)过度镇静,无过度镇静。 与异丙酚相比,推荐剂量的右美托咪定镇静效果更好,对血液动力学和呼吸的影响更小。
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引用次数: 0
Citation Cartels: A Hidden Menace in the Scientific Publication 引文卡特尔:科学出版物中隐藏的威胁
Pub Date : 2024-04-13 DOI: 10.4103/jssrp.jssrp_3_24
G. Dharmshaktu
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引用次数: 0
Rural Health – Why and How 农村卫生--为什么和如何
Pub Date : 2024-04-13 DOI: 10.4103/jssrp.jssrp_36_23
Sunil K Raina, Raman Kumar
With access a major issue on the supply side of the supply– demand chain of health care, reaching out to the rural population is not only needed but also imperative as part of delivering comprehensive primary health care.
在医疗保健供需链的供应方,获取医疗保健服务是一个主要问题,因此,作为提供全面初级医疗保健服务的一部分,深入农村人口不仅是必要的,也是势在必行的。
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引用次数: 0
Charnley’s Traction Unit in the Distal Leg: An Alternative Option for Closed Correction of the Lower Limb Deformities in Rural Settings 查恩利腿远端牵引器:农村地区下肢畸形闭合矫正的另一种选择
Pub Date : 2024-04-13 DOI: 10.4103/jssrp.jssrp_38_23
G. Dharmshaktu
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引用次数: 0
The Role of Fine-needle Aspiration Cytology in Guiding Clinicians for Lymphadenopathy 细针抽吸细胞学在指导临床医生治疗淋巴腺病方面的作用
Pub Date : 2024-04-05 DOI: 10.4103/jssrp.jssrp_39_23
Saurabh Kumar, Sampa Choudhury, Vineeta Chadha, Suparna Dubey, Mhasisielie Zumu
Lymphadenopathy is a very common, routinely observed clinical finding which may be caused by a variety of pathological conditions, either a primary lymph node pathology or an underlying systemic disease. Fine-needle aspiration is a simple cost-effective diagnostic tool to screen these lesions, to enhance our knowledge, to understand lymph node pathology, as well as to assist clinicians for an effective management. The aim of our study was to evaluate the patterns of pathological lesions on lymph node cytology and also to assess any particular trend of diseases in comparison with demographic variables, lymph node size, and consistency in this geographic area. In this retrospective study, we studied the reports of 131 lymph node cytology samples collected over a duration of 1 year. All parameters were entered in the Excel sheet and were analyzed for descriptive statistics. The mean age of the patients was 32 years. Reactive lymphadenitis was the most common (42%) pathology, followed by tubercular lymphadenitis, metastatic lymph nodes, and lymphomas. Infectious or inflammatory lesions were noted in younger age groups, whereas malignancies were prominent in elderly patients. This study threw light on diseases, whether infectious, inflammatory, or lymphoproliferative in etiology, which presented with lymphadenopathy in this coastal area and also unveiled the patterns of metastatic lymph nodes, their primary site, and predilection for a particular nodal site.
淋巴结病是一种非常常见的常规临床症状,可能由多种病理情况引起,包括原发性淋巴结病变或潜在的全身性疾病。细针穿刺是一种简单、经济有效的诊断工具,可用于筛查这些病变,增加我们的知识,了解淋巴结病理,并协助临床医生进行有效的治疗。 我们的研究旨在评估淋巴结细胞学病理病变的模式,并根据该地区的人口统计学变量、淋巴结大小和一致性来评估疾病的特殊趋势。 在这项回顾性研究中,我们对历时一年收集的 131 份淋巴结细胞学样本报告进行了研究。所有参数都输入了 Excel 表格,并进行了描述性统计分析。 患者的平均年龄为 32 岁。反应性淋巴结炎是最常见的病变(42%),其次是结核性淋巴结炎、转移性淋巴结和淋巴瘤。感染性或炎症性病变多见于年轻群体,而恶性肿瘤则多见于老年患者。 这项研究揭示了沿海地区淋巴结病的病因,包括感染性、炎症性或淋巴增生性疾病,还揭示了转移性淋巴结的形态、原发部位以及对特定结节部位的偏好。
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引用次数: 0
Challenges of rural health care in India and digitalization of health care 印度农村卫生保健的挑战和卫生保健的数字化
Pub Date : 2023-05-01 DOI: 10.4103/jssrp.jssrp_30_23
Raman K Kumar, Alka S. Grover
India is currently the most populous country in the world, with pressing unmet needs of the population living in rural and remote areas. Digitization of health care has opened a new window to solve public health challenges of the communities as it has the potential to remove the physical barrier between urban and rural areas. Several mHealth applications have been introduced in the recent 2–3 years in India. mHealth apps are being used to deliver health-care information, reminders, and support to rural communities. For health-care managers, digitalization makes their work of supply chain management easier in rural areas, ensuring that essential health-care resources are available to the communities in a more efficient manner.
印度目前是世界上人口最多的国家,生活在农村和偏远地区的人口的需求迫切需要满足。医疗保健数字化为解决社区公共卫生挑战打开了一扇新窗口,因为它有可能消除城乡之间的物理障碍。最近2-3年,印度推出了几款移动医疗应用。移动医疗应用程序被用于向农村社区提供医疗保健信息、提醒和支持。对于卫生保健管理人员来说,数字化使他们在农村地区的供应链管理工作更容易,确保社区以更有效的方式获得基本的卫生保健资源。
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引用次数: 0
Role of POP boot traction in lower limb deformities POP靴牵引治疗下肢畸形的作用
Pub Date : 2023-05-01 DOI: 10.4103/jssrp.jssrp_33_22
Sudhir Mishra, Dileep Kumar, Ganesh Yadav, A. Gupta, M. Srivastava
Background: In India, postpolio residual paralysis (PPRP) patients, present with multiple deformities, which requires surgical intervention, and in rural setting, it poses a big challenge for doctors. Traction is one of the oldest treatments in fracture reduction and deformity correction. The objective of this study was to evaluate the clinical outcome of plaster of Paris (POP) boot traction for the correction of lower limb deformities in PPRP patients. Materials and Methods: This retrospective case series represents 14 cases of PPRP with hip and/or knee deformity treated with POP boot traction for deformity correction, followed by caliper application. Deformities were classified as mild, moderate, and severe and assessed weekly during treatment. Results: There were 8 females and 6 males. The mean age of participants was 22.21 ± 8.107 years, and the mean duration of traction was 5.21 ± 1.76 weeks. There were seven patients with unilateral knee deformity, two patients with bilateral knee deformity, two patients with unilateral hip and knee deformity, and three patients with bilateral hip and knee deformity. The mean baseline deformity angle was 37.41, and the mean postprocedure deformity angle was 15.89. Conclusions: POP boot traction is a low-cost intervention in PPRP patients and can give promising results in the correction of lower limb deformities.
背景:在印度,脊髓灰质炎后残余瘫痪(PPRP)患者存在多种畸形,需要手术干预,在农村环境中,这对医生提出了很大的挑战。牵引是最古老的骨折复位和畸形矫正方法之一。本研究的目的是评估巴黎石膏(POP)靴牵引矫正PPRP患者下肢畸形的临床效果。材料和方法:本回顾性病例系列包括14例伴有髋关节和/或膝关节畸形的PPRP,采用POP靴牵引进行畸形矫正,然后应用卡钳。畸形分为轻度、中度和重度,并在治疗期间每周评估一次。结果:女性8例,男性6例。参与者平均年龄为22.21±8.107岁,平均牵引时间为5.21±1.76周。单侧膝关节畸形7例,双侧膝关节畸形2例,单侧髋关节和膝关节畸形2例,双侧髋关节和膝关节畸形3例。平均基线畸形角为37.41,平均术后畸形角为15.89。结论:POP靴牵引是一种低成本的干预措施,对PPRP患者的下肢畸形矫正有良好的效果。
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引用次数: 0
Study on the effectiveness of percutaneous needle tendo Achilles tenotomy in congenital talipes equinovarus children 经皮针跟腱切断术治疗先天性马蹄内翻患儿疗效的研究
Pub Date : 2023-05-01 DOI: 10.4103/jssrp.jssrp_15_23
P. Madhuchandra, G. Sunilsanthosh, KP Raju
Introduction: Congenital talipes equinovarus (CTEV) is one of the most common deformities that affects the human foot and ankle, and Ponseti method of correction is universally accepted procedure. Most of the patients need a percutaneous tenotomy of tendo Achilles for residual equinus deformity. Various methods of tenotomy such as cataract knife, No. 11 blade, and 21-G needle are available. We studied the effectiveness of percutaneous needle tenotomy of the Achilles tendon in CTEV children for residual equinus deformity. Materials and Methods: Forty-three patients of serially manipulated and casted CTEV patients were subjected to a percutaneous needle tenotomy at our institute, followed by cast and orthosis. Tenotomy and regeneration were confirmed ultrasonologically and complete tenotomy was demonstrated by animal cadaver study. Results: All the patients were followed up regularly and an average of 25° of passive dorsiflexion was achieved at an average of 2-year follow-up. No cases of skin scarring, neurovascular compromise, stiffness, or cast complications were noted in our series. Conclusion: We conclude that percutaneous needle tenotomy for residual equinus deformity in a serially casted CTEV patient is a simple, effective, and safe method in giving a functionally and cosmetically good plantigrade foot.
简介:先天性马蹄足内翻(CTEV)是影响人类足部和踝关节最常见的畸形之一,Ponseti矫正法是普遍接受的手术方法。大多数患者需要经皮跟腱切断术治疗残留的马蹄骨畸形。使用白内障刀、11号刀片、21-G针等多种方法进行肌腱切断术。我们研究了经皮针跟腱切开术治疗CTEV儿童残留马蹄骨畸形的有效性。材料与方法:43例CTEV患者在我院行经皮针刺肌腱切断术,然后行石膏和矫形。超声检查证实了肌腱切开术和再生,动物尸体研究证实了完全的肌腱切开术。结果:所有患者均得到定期随访,平均随访2年,平均被动背屈25°。在我们的研究中没有发现皮肤瘢痕、神经血管损伤、僵硬或石膏并发症。结论:经皮针肌腱切开术治疗连续铸造CTEV患者残留马蹄骨畸形是一种简单、有效、安全的方法,可以获得功能和美容良好的跖足。
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引用次数: 0
Profile of screen time and its determinants in under-five children in a rural Indian population 印度农村5岁以下儿童屏幕时间及其决定因素概况
Pub Date : 2023-05-01 DOI: 10.4103/jssrp.jssrp_24_23
AJenit Osborn, S. Gayathri, T. Satheesh, Karthikeyan Shanmugam
Background: Excess screen viewing can deteriorate the well-being of under-five children. Identifying the modifiable screen determinants can pave the way to develop strategies for optimization. Objectives: The objective of the study was to study the profile of screen time among children between 12 and 59 months of age and to determine the risk factors associated with increased screen time. Materials and Methods: A community-based cross-sectional study was done in rural villages of Tamil Nadu among 418 children aged 12–59 months by universal sampling method during August 2021 to January 2022. Parents of the children were interviewed using a predesigned semi-structured questionnaire. Results: The prevalence of screen viewing among the study population was 96.9% and their average screen time was 106.85 ± 77.95 min/day. The prevalence of excess screen time (nonadherence to the WHO recommendations) was estimated to be 70%. The most common reason for offering screen time to children was feeding/mealtime (45.7%). The risk determinants identified for higher screen time were access to multiple gadgets (P < 0.001), first screen exposure before 1 year of age (P < 0.001), having erratic screen-viewing hours (P = 0.002), snacking during screen time (P < 0.001), screen time before bed (P < 0.001), and those who were overweight (P = 0.027). Maternal screen time and children's screen time had a positive association (r = 0.367, P < 0.001), whereas children's screen time and sleep duration were negatively associated (r = −0.139, P = 0.004). Conclusions: This study reiterates the high prevalence of excess screen time among the study population. Multiple risk determinants identified can be utilized to plan interventions and awareness programs to regulate screen time in under-five children.
背景:过度看屏幕会损害五岁以下儿童的健康。确定可修改的筛选决定因素可以为制定优化策略铺平道路。目的:本研究的目的是研究12至59个月大的儿童的屏幕时间概况,并确定与屏幕时间增加相关的危险因素。材料与方法:采用普遍抽样方法,于2021年8月至2022年1月在泰米尔纳德邦农村对418名12-59个月的儿童进行了以社区为基础的横断面研究。使用预先设计的半结构化问卷对孩子的父母进行了采访。结果:研究人群的屏幕观看率为96.9%,平均屏幕时间为106.85±77.95 min/d。屏幕时间过长(不遵守世卫组织建议)的患病率估计为70%。给孩子提供屏幕时间的最常见原因是喂食/用餐时间(45.7%)。确定的高屏幕时间的风险决定因素是使用多种电子设备(P < 0.001)、1岁前首次接触屏幕(P < 0.001)、不稳定的屏幕观看时间(P = 0.002)、屏幕时间内吃零食(P < 0.001)、睡前看屏幕时间(P < 0.001)和超重(P = 0.027)。母亲屏幕时间与儿童屏幕时间呈正相关(r = 0.367, P < 0.001),而儿童屏幕时间与睡眠时间呈负相关(r = - 0.139, P = 0.004)。结论:本研究重申了研究人群中屏幕时间过长的高患病率。已确定的多种风险决定因素可用于规划干预措施和提高认识方案,以调节五岁以下儿童的屏幕时间。
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引用次数: 0
Exercise and sleep affect blood pressure and blood sugar of hypertensive patients 运动和睡眠对高血压患者的血压和血糖有影响
Pub Date : 2023-05-01 DOI: 10.4103/jssrp.jssrp_4_23
Kusum K. Rohilla, Sonia Gulia, C. Kalyani
Aim: Hypertension is a major worldwide health issue because of its great prevalence. This study's aim was to check the effects of exercise and sleep on blood pressure (BP) and blood sugar among hypertensive patients. Materials and Methods: The study was a descriptive study that was conducted on 545 hypertensive patients at the All India Institute of Medical Sciences, Rishikesh, using validated self-structured questionnaire tools. Results: Hypertensive patients bio-demographic characteristics, sleep, exercise, and physical activity were examined and presented as frequency and percentage. Majority of hypertensive patients were male (55%), illiterate (25%), and their sleeping were OK during the night (38%). Their mean systolic BP (SBP) was 156.17 ± 15.83 mmHg, the diastolic BP was 91.81 ± 12.93 mmHg, and random blood sugar was 127.27 ± 6.06 g/dl, respectively. Among hypertensive patients doing regular exercise (0.009*) and a good sleep pattern (0.000*) help in the reduction of SBP at 0.05 level of significance. Conclusion: The prevalence of hypertension is significant and regular exercise and good sleep habits can help hypertensive patients to lower their SBP.
目的:高血压发病率高,是世界性的重大健康问题。这项研究的目的是检查运动和睡眠对高血压患者血压和血糖的影响。材料和方法:本研究是一项描述性研究,使用经过验证的自结构化问卷调查工具,对Rishikesh全印度医学科学研究所的545名高血压患者进行了研究。结果:检查了高血压患者的生物统计学特征、睡眠、运动和身体活动,并以频率和百分比表示。高血压患者以男性居多(55%),文盲居多(25%),夜间睡眠正常(38%)。平均收缩压(SBP)为156.17±15.83 mmHg,舒张压(SBP)为91.81±12.93 mmHg,随机血糖为127.27±6.06 g/dl。在高血压患者中,经常运动(0.009*)和良好的睡眠模式(0.000*)有助于降低收缩压,其显著性水平为0.05。结论:高血压患病率显著,有规律的运动和良好的睡眠习惯有助于降低高血压患者的收缩压。
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引用次数: 0
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Journal of Surgical Specialties and Rural Practice
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