Pub Date : 2024-05-01DOI: 10.3126/ajms.v15i5.62925
Priyanka C Chovatiya, Mamta Rani Varma, Kavita G Bodar
Background: In India, family members undertake the care of a considerable number of patients with chronic illnesses like cancer at home, yet despite the recognition of their pivotal role as caregivers, scant attention is given to the suffering they endure. Aims and Objectives: The aim of the study is to study the sociodemographic characteristics of caregivers and children/adolescents with cancer undergoing cancer treatment and assess the caregiver’s burden of children/adolescents suffering from cancer. Materials and Methods: A cross-sectional study involving caregivers of children having cancer who were availing services at Cancer Institute (Lions Cancer Detection Center), New Civil Hospital, Surat, to identify the burden among caregivers of children of 0–19 years of age group. A total of 237 participants were enrolled in the study from June 2019 to November 2019. Using a standardized, validated version of the Zarit Burden Interview was used for data collection. Data entry into Microsoft Excel and analysis was done by Epi Info. Univariate analysis was done to calculate mean and standard deviation while bivariate analysis by Chi-square test. Results: The study population consisted of 99 (41.8%) males and 138 (58.2%) female caregivers aged 18–58 years. One hundred and twenty-five (52.7%) caregivers reported no or minimal burden while 64 (27.0%) caregivers reported mild-to-moderate burden. Conclusion: In view of the substantial burden on family caregivers coupled with the lack of an adequate number of cancer hospitals, there is a public health imperative to recognize this important group. All levels of health staff in cancer hospitals in developing countries should be sensitized to the various burdens faced by family caregivers.
{"title":"Caring for the caregivers: A cross-sectional study of the burden experienced by family caregivers of children with cancer in South Gujarat","authors":"Priyanka C Chovatiya, Mamta Rani Varma, Kavita G Bodar","doi":"10.3126/ajms.v15i5.62925","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62925","url":null,"abstract":"Background: In India, family members undertake the care of a considerable number of patients with chronic illnesses like cancer at home, yet despite the recognition of their pivotal role as caregivers, scant attention is given to the suffering they endure.\u0000Aims and Objectives: The aim of the study is to study the sociodemographic characteristics of caregivers and children/adolescents with cancer undergoing cancer treatment and assess the caregiver’s burden of children/adolescents suffering from cancer.\u0000Materials and Methods: A cross-sectional study involving caregivers of children having cancer who were availing services at Cancer Institute (Lions Cancer Detection Center), New Civil Hospital, Surat, to identify the burden among caregivers of children of 0–19 years of age group. A total of 237 participants were enrolled in the study from June 2019 to November 2019. Using a standardized, validated version of the Zarit Burden Interview was used for data collection. Data entry into Microsoft Excel and analysis was done by Epi Info. Univariate analysis was done to calculate mean and standard deviation while bivariate analysis by Chi-square test.\u0000Results: The study population consisted of 99 (41.8%) males and 138 (58.2%) female caregivers aged 18–58 years. One hundred and twenty-five (52.7%) caregivers reported no or minimal burden while 64 (27.0%) caregivers reported mild-to-moderate burden.\u0000Conclusion: In view of the substantial burden on family caregivers coupled with the lack of an adequate number of cancer hospitals, there is a public health imperative to recognize this important group. All levels of health staff in cancer hospitals in developing countries should be sensitized to the various burdens faced by family caregivers.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141025547","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 : 2024-05-01DOI: 10.3126/ajms.v15i5.62847
Ambarish Ghosh, Maidul Islam SK, Raghav Oza
In recent years, screen time exposure and attention-deficit hyperactivity disorder (ADHD) symptom interrelations in children have garnered increasing attention. Understanding the screen time’s impact on ADHD has become crucial due to its potential influence on socialization, neurobehavioral development, and the prevalence of ADHD among pediatric populations. Conforming to the guidelines of the preferred reporting items for systematic reviews and meta-analyses, a systematic examination was undertaken, centering on research investigating the correlation between screen time and ADHD symptoms in children. The search encompassed databases including MEDLINE (through PubMed), ScienceDirect, Wiley online library, PsycINFO, ERIC, JSTOR, and PsycArticles, utilizing descriptors such as “screen time” and “attention-deficit hyperactivity disorder.” The initial search yielded 2480 articles, supplemented by an additional 10 articles from reference searches, resulting in a total of 2480 records. Excluding the duplicates, 1590 articles were screened based on abstracts, of which 130 underwent full-text examination. Ultimately, 15 studies included in this review met the inclusion criteria. These studies, conducted between 2013 and 2023, comprised cross-sectional, longitudinal, and interventional designs, presenting varying associations between screen time and ADHD symptoms across different age groups. The findings from the selected studies depict a complex relationship between screen time exposure and ADHD symptoms in children. While some studies highlight significant correlations between increased screen exposure and ADHD symptoms, others present conflicting results, indicating the need for further research. Understanding these nuances is crucial in formulating targeted interventions and delineating clearer guidelines to manage screen time concerning ADHD in children.
{"title":"Screen time and effects on attention deficient hyperactivity disorder in children - A systematic review","authors":"Ambarish Ghosh, Maidul Islam SK, Raghav Oza","doi":"10.3126/ajms.v15i5.62847","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62847","url":null,"abstract":"In recent years, screen time exposure and attention-deficit hyperactivity disorder (ADHD) symptom interrelations in children have garnered increasing attention. Understanding the screen time’s impact on ADHD has become crucial due to its potential influence on socialization, neurobehavioral development, and the prevalence of ADHD among pediatric populations. Conforming to the guidelines of the preferred reporting items for systematic reviews and meta-analyses, a systematic examination was undertaken, centering on research investigating the correlation between screen time and ADHD symptoms in children. The search encompassed databases including MEDLINE (through PubMed), ScienceDirect, Wiley online library, PsycINFO, ERIC, JSTOR, and PsycArticles, utilizing descriptors such as “screen time” and “attention-deficit hyperactivity disorder.” The initial search yielded 2480 articles, supplemented by an additional 10 articles from reference searches, resulting in a total of 2480 records. Excluding the duplicates, 1590 articles were screened based on abstracts, of which 130 underwent full-text examination. Ultimately, 15 studies included in this review met the inclusion criteria. These studies, conducted between 2013 and 2023, comprised cross-sectional, longitudinal, and interventional designs, presenting varying associations between screen time and ADHD symptoms across different age groups. The findings from the selected studies depict a complex relationship between screen time exposure and ADHD symptoms in children. While some studies highlight significant correlations between increased screen exposure and ADHD symptoms, others present conflicting results, indicating the need for further research. Understanding these nuances is crucial in formulating targeted interventions and delineating clearer guidelines to manage screen time concerning ADHD in children.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141044605","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: Fentanyl-induced cough (FIC) is an undesirable side effect associated with intravenous injection of the opioid fentanyl, which can lead to an increase in intraocular, intrathoracic, and intraabdominal pressures. The incidence of FIC is reported to be 18–65%, more common in young females, who are also at high risk population for post-operative nausea and vomiting (PONV). FIC and PONV are both common anesthesia-related events that seem to have common risk factors. Aims and Objectives: The objectives of the study were to find out the incidence of FIC in female patients undergoing elective surgery under general anesthesia and if FIC was a risk factor for developing PONV. Materials and Methods: A randomized, prospective study was done to compare the incidence of FIC and its correlation with PONV. 263 adult female patients belonging to American Society of Anesthesiologists status I and II, aged 18–59 years, posted for elective surgery under general anesthesia were studied over a period of 2 years. Pre-operatively, fentanyl (2 mg/kg body weight) was injected intravenously over 10 s as premedication, and the occurrence of any episode of cough within 60 s of fentanyl administration was taken as FIC. The incidence and severity of PONV were assessed in the same study population for a 24-h period. The incidence of FIC during general anesthesia in the study population was noted, and its correlation with PONV was analyzed. Results: The incidence of FIC in the study population was found to be 27%. The incidence of PONV in the FIC group was found to be 38%, as compared to 29.7% in the non-FIC group. FIC group had a higher incidence of PONV than the non-FIC group, but it was statistically insignificant (P=0.254). Conclusion: The incidence of PONV was slightly higher in the FIC group than in the non-FIC group, but it was not statistically significant.
{"title":"Incidence of fentanyl induced cough and fentanyl induced cough as a risk factor for post operative nausea and vomiting","authors":"Sis Jose, Apoorwa Nawrathan Kothari, Rashmi Rani, Usha Ramakrishna Sastry, Deepa Baskaran, Arpana Kedlaya","doi":"10.3126/ajms.v15i5.62210","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62210","url":null,"abstract":"Background: Fentanyl-induced cough (FIC) is an undesirable side effect associated with intravenous injection of the opioid fentanyl, which can lead to an increase in intraocular, intrathoracic, and intraabdominal pressures. The incidence of FIC is reported to be 18–65%, more common in young females, who are also at high risk population for post-operative nausea and vomiting (PONV). FIC and PONV are both common anesthesia-related events that seem to have common risk factors.\u0000 Aims and Objectives: The objectives of the study were to find out the incidence of FIC in female patients undergoing elective surgery under general anesthesia and if FIC was a risk factor for developing PONV.\u0000Materials and Methods: A randomized, prospective study was done to compare the incidence of FIC and its correlation with PONV. 263 adult female patients belonging to American Society of Anesthesiologists status I and II, aged 18–59 years, posted for elective surgery under general anesthesia were studied over a period of 2 years. Pre-operatively, fentanyl (2 mg/kg body weight) was injected intravenously over 10 s as premedication, and the occurrence of any episode of cough within 60 s of fentanyl administration was taken as FIC. The incidence and severity of PONV were assessed in the same study population for a 24-h period. The incidence of FIC during general anesthesia in the study population was noted, and its correlation with PONV was analyzed.\u0000Results: The incidence of FIC in the study population was found to be 27%. The incidence of PONV in the FIC group was found to be 38%, as compared to 29.7% in the non-FIC group. FIC group had a higher incidence of PONV than the non-FIC group, but it was statistically insignificant (P=0.254).\u0000Conclusion: The incidence of PONV was slightly higher in the FIC group than in the non-FIC group, but it was not statistically significant.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141048176","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: Ventral abdominal wall hernia surgery is a common procedure in the armamentarium of surgeons. The most common forms of these surgical procedures in adults are the repair of incisional hernias and surgery for paraumbilical hernias. Aims and Objectives: Open onlay mesh repair versus laparoscopic intraperitoneal dual mesh repair (intraperitoneal onlay mesh[IPOM]) for ventral hernia compared to the duration of surgery, post-operative pain, postoperative complications, post-operative hospital stay, return to normal activity, recurrence, and cosmesis. Materials and Methods: The prospective non-randomized study was done in the Maharani Laxmi Bai Medical College, Jhansi, between January 2021 and June 2022 including 100 patients was applied for treatment of ventral hernia repair. Fifty patients were subjected to Group A (open onlay mesh repair) and 50 patients were subjected to Group B (laparoscopic intraperitoneal dual mesh repair). Results: The mean surgery durations were significantly lower in laparoscopic repair when compared to open repair (P<0.001). Themean post-operative stay in the hospital was shorter for the laparoscopic group than for the open hernia group (10.28±2.100 vs. 8.02±1.378 days; P≤0.001). Return to activity or normal daily work is significantly lower in the laparoscopic group as compared to open repair of hernia (5.12±0.659 vs. 2.94±0.550 days; P<0.001). There were fewer post-operative complications with laparoscopy. Conclusion: Laparoscopic intraperitoneal dual mesh repair (IPOM) for ventral hernia in our experience was safe and resulted in fewer complications, shorter hospital stays, and better cosmesis results. Hence, it should be considered the better choice for ventral hernia repair.
背景：腹壁疝手术是外科医生常用的手术方式。这些手术在成人中最常见的形式是切口疝修补术和脐旁疝手术：腹腔镜腹膜内双网片修补术（intraperitoneal onlay mesh[IPOM]）与开放式网片修补术治疗腹股沟疝在手术时间、术后疼痛、术后并发症、术后住院时间、恢复正常活动、复发和外观方面的比较：这项前瞻性非随机研究于 2021 年 1 月至 2022 年 6 月在詹西的 Maharani Laxmi Bai 医学院进行，共有 100 名患者接受了腹股沟疝修补术治疗。结果显示，A组（开放式腹膜网片修补术）和B组（腹腔镜腹膜内双网片修补术）各有50名患者：结果：腹腔镜修复术的平均手术时间明显短于开腹修复术（P<0.001）。腹腔镜组的术后平均住院时间（10.28±2.100 天 vs. 8.02±1.378 天；P≤0.001）短于开放式疝气组。腹腔镜组恢复活动或正常日常工作的时间明显少于开放式疝修补术组（5.12±0.659 天 vs. 2.94±0.550 天；P<0.001）。腹腔镜手术的术后并发症较少：结论：根据我们的经验，腹腔镜腹膜内双网片修补术（IPOM）治疗腹股沟疝安全、并发症少、住院时间短、外观效果好。因此，腹腔镜腹股沟疝修补术应被视为更好的选择。
{"title":"Comparative study of open onlay mesh repair versus laparoscopic intraperitoneal dual mesh repair for ventral hernia","authors":"Surya Prakash, Asha Gaud, Dinesh Kumar, Junior Resident","doi":"10.3126/ajms.v15i5.62755","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62755","url":null,"abstract":"Background: Ventral abdominal wall hernia surgery is a common procedure in the armamentarium of surgeons. The most common forms of these surgical procedures in adults are the repair of incisional hernias and surgery for paraumbilical hernias.\u0000Aims and Objectives: Open onlay mesh repair versus laparoscopic intraperitoneal dual mesh repair (intraperitoneal onlay mesh[IPOM]) for ventral hernia compared to the duration of surgery, post-operative pain, postoperative complications, post-operative hospital stay, return to normal activity, recurrence, and cosmesis.\u0000Materials and Methods: The prospective non-randomized study was done in the Maharani Laxmi Bai Medical College, Jhansi, between January 2021 and June 2022 including 100 patients was applied for treatment of ventral hernia repair. Fifty patients were subjected to Group A (open onlay mesh repair) and 50 patients were subjected to Group B (laparoscopic intraperitoneal dual mesh repair).\u0000Results: The mean surgery durations were significantly lower in laparoscopic repair when compared to open repair (P<0.001). Themean post-operative stay in the hospital was shorter for the laparoscopic group than for the open hernia group (10.28±2.100 vs. 8.02±1.378 days; P≤0.001). Return to activity or normal daily work is significantly lower in the laparoscopic group as compared to open repair of hernia (5.12±0.659 vs. 2.94±0.550 days; P<0.001). There were fewer post-operative complications with laparoscopy.\u0000Conclusion: Laparoscopic intraperitoneal dual mesh repair (IPOM) for ventral hernia in our experience was safe and resulted in fewer complications, shorter hospital stays, and better cosmesis results. Hence, it should be considered the better choice for ventral hernia repair.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141050762","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 : 2024-05-01DOI: 10.3126/ajms.v15i5.63114
Arunkumar Muthalu, Arthi Asokan, Vimala Ananthy
Background: Dexmedetomidine is a selective alpha-2-adrenoceptor agonist. It exerts both sedative and analgesic effects through mechanisms different from those of other sedatives. The safety and efficacy of dexmedetomidine are altered by various factors. Aims and Objectives: This study aims at identifying the various factors that will affect the sedative and hemodynamic responses of dexmedetomidine in seriously ill patients. Materials and Methods: A continuous infusion of dexmedetomidine (0.2–0.7 μg/kg/h) was administered to intensive care unit patients who needed sedation. We investigated the safety and effectiveness of administering dexmedetomidine between responders and non-responders over a short (≤24 h) and lengthy (>24 h) period. Results: A total of 84 patients were analyzed who received dexmedetomidine. The longest possible duration of dexmedetomidine administration was 24.7 days and 7.8 days, respectively. Compared to the first 24 h, the number of patients who needed more sedatives or analgesics was not increasing beyond that time. In the first 24 h and after the first 24 h, 35 out of 84 patients (41.2%) and 22 out of 84 patients (26.3%), respectively, needed more sedatives; in the first 24 h and after the first 24 h, 22 out of 84 patients (26.0%) and 18 out of 84 patients (21.4%) needed more analgesics. Conclusion: The safety and effectiveness of dexmedetomidine were similar across the demographic factors in this study. The interindividual variability due to pharmacokinetic parameters can be further studied along with pharmacogenomic factors that may cause the difference in the responses to dexmedetomidine use.
{"title":"Sedative and hemodynamic response of dexmedetomidine in critically ill South Indian population","authors":"Arunkumar Muthalu, Arthi Asokan, Vimala Ananthy","doi":"10.3126/ajms.v15i5.63114","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.63114","url":null,"abstract":"Background: Dexmedetomidine is a selective alpha-2-adrenoceptor agonist. It exerts both sedative and analgesic effects through mechanisms different from those of other sedatives. The safety and efficacy of dexmedetomidine are altered by various factors.\u0000Aims and Objectives: This study aims at identifying the various factors that will affect the sedative and hemodynamic responses of dexmedetomidine in seriously ill patients.\u0000Materials and Methods: A continuous infusion of dexmedetomidine (0.2–0.7 μg/kg/h) was administered to intensive care unit patients who needed sedation. We investigated the safety and effectiveness of administering dexmedetomidine between responders and non-responders over a short (≤24 h) and lengthy (>24 h) period.\u0000Results: A total of 84 patients were analyzed who received dexmedetomidine. The longest possible duration of dexmedetomidine administration was 24.7 days and 7.8 days, respectively. Compared to the first 24 h, the number of patients who needed more sedatives or analgesics was not increasing beyond that time. In the first 24 h and after the first 24 h, 35 out of 84 patients (41.2%) and 22 out of 84 patients (26.3%), respectively, needed more sedatives; in the first 24 h and after the first 24 h, 22 out of 84 patients (26.0%) and 18 out of 84 patients (21.4%) needed more analgesics.\u0000Conclusion: The safety and effectiveness of dexmedetomidine were similar across the demographic factors in this study. The interindividual variability due to pharmacokinetic parameters can be further studied along with pharmacogenomic factors that may cause the difference in the responses to dexmedetomidine use.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141051749","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: Insulin resistance plays a crucial role in the onset of type 2 diabetes, with body mass index (BMI) being a significant determinant. Aims and Objectives: This study examines the link between BMI and insulin resistance in pre-diabetic individuals to inform strategies for early diabetes intervention. Materials and Methods: This cross-sectional study involved 100 pre-diabetic participants. Data on demographic characteristics, BMI, insulin resistance (measured by the Homeostatic Model Assessment for Insulin Resistance, HOMA-IR), lipid profiles, and blood pressure (BP) were collected. Participants were categorized into normal weight, overweight, and obese groups to explore the relationship between BMI and insulin resistance and its impact on metabolic and cardiovascular health. Results: The average participant age was 45.8 years (SD=12.3), with a slight majority being female (52%) and an average BMI of 28.4 kg/m² (SD=4.5). A significant positive correlation (r=0.64, P<0.001) between BMI and the HOMA-IR index highlighted the association between increased BMI and insulin resistance. Obese individuals had a notably higher HOMA-IR index (3.5±1.3) compared to those overweight (2.5±1.0) and of normal weight (1.9±0.8). In addition, the study found worsening lipid profiles and increased BP with higher BMI categories. Gender did not significantly affect insulin resistance, whereas a slight increase in HOMA-IR with age was noted (r=0.23, P=0.02). Conclusion: The findings highlight the strong correlation between higher BMI and increased insulin resistance in pre-diabetics. They emphasize the importance of managing body weight to mitigate the risk of diabetes and cardiovascular diseases.
{"title":"Assessing the impact of body mass index on insulin resistance and metabolic risk factors in pre-diabetic individuals: A comprehensive cross-sectional study","authors":"Satyanarayana Raju, Pyda Vijaya, Ch. BS Srinivas, Ritu Vaish, Usha Rani","doi":"10.3126/ajms.v15i5.62793","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62793","url":null,"abstract":"Background: Insulin resistance plays a crucial role in the onset of type 2 diabetes, with body mass index (BMI) being a significant determinant.\u0000Aims and Objectives: This study examines the link between BMI and insulin resistance in pre-diabetic individuals to inform strategies for early diabetes intervention.\u0000Materials and Methods: This cross-sectional study involved 100 pre-diabetic participants. Data on demographic characteristics, BMI, insulin resistance (measured by the Homeostatic Model Assessment for Insulin Resistance, HOMA-IR), lipid profiles, and blood pressure (BP) were collected. Participants were categorized into normal weight, overweight, and obese groups to explore the relationship between BMI and insulin resistance and its impact on metabolic and cardiovascular health.\u0000Results: The average participant age was 45.8 years (SD=12.3), with a slight majority being female (52%) and an average BMI of 28.4 kg/m² (SD=4.5). A significant positive correlation (r=0.64, P<0.001) between BMI and the HOMA-IR index highlighted the association between increased BMI and insulin resistance. Obese individuals had a notably higher HOMA-IR index (3.5±1.3) compared to those overweight (2.5±1.0) and of normal weight (1.9±0.8). In addition, the study found worsening lipid profiles and increased BP with higher BMI categories. Gender did not significantly affect insulin resistance, whereas a slight increase in HOMA-IR with age was noted (r=0.23, P=0.02).\u0000Conclusion: The findings highlight the strong correlation between higher BMI and increased insulin resistance in pre-diabetics. They emphasize the importance of managing body weight to mitigate the risk of diabetes and cardiovascular diseases.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141049419","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: Ventilator-associated pneumonia (VAP) is defined as infection of lung parenchyma in patients exposed to invasive mechanical ventilation for at least 48 h. VAP is the second most common hospital-acquired infection with a mortality rate up to 40%. Aims and Objectives: To determine the microbiological profile of VAP-related samples, the demographic profile of patients, and associated risk factors. Materials and Methods: VAP-related samples including endotracheal tube tip, tracheal secretions, and bronchoalveolar lavage (BAL) fluid were collected from 73 patients during the study period from January 2023 to November 2023. Their blood samples were also collected for automated blood culture. Samples were processed as per standard protocol. Results: Out of the total patients, 60.31% were male and 39.68% were female. 61–80 years was the most commonly affected age group. The most commonly isolated micro-organism was Acinetobacter baumannii with the highest sensitivity to polymixin B and tigecycline. Associated blood culture positivity was maximum in patients whose samples of ET tube tip, tracheal secretions, and BAL fluid had isolated A. baumannii and Klebsiella pneumoniae. Two Candida albicans were isolated with sensitivities to voriconazole and amphotericin B. Many patients had associated septicemia. Endotracheal intubation and tracheal suction were the most common risk factors associated. Conclusion: As associated septicemia may increase the mortality rate manifold blood samples should also be collected in suspected VAP patients along with VAP-related samples for early detection of sepsis leading to better patient management.
背景：呼吸机相关性肺炎（VAP）是指暴露于有创机械通气至少 48 小时的患者的肺实质感染。VAP 是第二大常见的医院获得性感染，死亡率高达 40%：确定 VAP 相关样本的微生物学特征、患者的人口统计学特征以及相关风险因素：在2023年1月至2023年11月的研究期间，收集了73名患者的VAP相关样本，包括气管导管尖端、气管分泌物和支气管肺泡灌洗液（BAL）。此外，还采集了他们的血液样本进行自动血液培养。样本按照标准方案进行处理：在所有患者中，男性占 60.31%，女性占 39.68%。61-80 岁是最常见的患病年龄组。最常分离出的微生物是鲍曼不动杆菌，其对多粘菌素 B 和替加环素的敏感性最高。在 ET 管尖端、气管分泌物和 BAL 液样本中分离出鲍曼不动杆菌和肺炎克雷伯菌的患者中，相关血液培养阳性率最高。许多患者伴有脓毒血症。气管插管和气管抽吸是最常见的相关风险因素：结论：由于伴发脓毒血症可能会成倍增加死亡率，因此还应为疑似 VAP 患者采集血液样本以及与 VAP 相关的样本，以便及早发现脓毒血症，从而更好地管理患者。
{"title":"Ventilator-associated pneumonia – An unwanted terror and a loathsome burden on the health-care cost in the recent era","authors":"Sharmila Gupta, Debarati Banerjee, Rituparna Haldar","doi":"10.3126/ajms.v15i5.63404","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.63404","url":null,"abstract":"Background: Ventilator-associated pneumonia (VAP) is defined as infection of lung parenchyma in patients exposed to invasive mechanical ventilation for at least 48 h. VAP is the second most common hospital-acquired infection with a mortality rate up to 40%.\u0000Aims and Objectives: To determine the microbiological profile of VAP-related samples, the demographic profile of patients, and associated risk factors.\u0000Materials and Methods: VAP-related samples including endotracheal tube tip, tracheal secretions, and bronchoalveolar lavage (BAL) fluid were collected from 73 patients during the study period from January 2023 to November 2023. Their blood samples were also collected for automated blood culture. Samples were processed as per standard protocol.\u0000Results: Out of the total patients, 60.31% were male and 39.68% were female. 61–80 years was the most commonly affected age group. The most commonly isolated micro-organism was Acinetobacter baumannii with the highest sensitivity to polymixin B and tigecycline. Associated blood culture positivity was maximum in patients whose samples of ET tube tip, tracheal secretions, and BAL fluid had isolated A. baumannii and Klebsiella pneumoniae. Two Candida albicans were isolated with sensitivities to voriconazole and amphotericin B. Many patients had associated septicemia. Endotracheal intubation and tracheal suction were the most common risk factors associated.\u0000Conclusion: As associated septicemia may increase the mortality rate manifold blood samples should also be collected in suspected VAP patients along with VAP-related samples for early detection of sepsis leading to better patient management.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141058510","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 : 2024-05-01DOI: 10.3126/ajms.v15i5.62539
Anup Kumar Harichandan, Manaswini Khuntia, B. P. Sahu, Sourav Dash, Debadas Biswal, Harikrishna Dalai, S. Jena
Background: Opioid analgesics with local anesthetics in an epidural route are extremely safe, effective, and reliable methods of post-operative pain relief. Aims and Objectives: The primary objective is to compare the duration of analgesia and pain scoring by visual analog scale. The secondary objective is to monitor sedation, hemodynamic changes, and side effects such as nausea, vomiting, shivering, and pruritus. Materials and Methods: A prospective randomized comparative study of 0.2% ropivacaine with nalbuphine and 0.2% ropivacaine with fentanyl in epidural route for post-operative analgesia in elective lower limb surgeries under spinal anesthesia was carried out in a population of 80 patients. After 1½ h of surgery under spinal anesthesia, patients in group RF received 10 mL of 0.2% ropivacaine with 25 mcg of fentanyl and those in group RN received 10 mL of 0.2% ropivacaine with 2.5 mg of nalbuphine and were observed for the study parameters over time. Results: The mean duration of analgesia was longer in group RN than in group RF (398.45 vs. 222.88 min). The hemodynamic parameters such as heart rate, mean arterial pressure, and respiratory ratewere statistically significant from 240 to 480 min which is 4–6 h in group RF and 6–8 h in group RN. 27.5% of patients in group RN attained sedation whereas 7.5% of subjects in group RF had a sedation score of 2 and above at 30 min. The subjects in group RN had a lower visual analog score than group RF. 12% and 4% of patients had vomiting in group RN and group RF, respectively. Conclusion: Epidural nalbuphine in a dose of 2.5 mg with 0.2% ropivacaine provided a longer duration of analgesia with better pain score and more sedation which was advantageous for post-operative patient compliance and satisfaction as compared to 25 mcg of fentanyl with 0.2% ropivacaine.
{"title":"A randomized comparative study of epidural ropivacaine 0.2% with adjuvant fentanyl or nalbuphine for post-operative analgesia in lower limb surgeries","authors":"Anup Kumar Harichandan, Manaswini Khuntia, B. P. Sahu, Sourav Dash, Debadas Biswal, Harikrishna Dalai, S. Jena","doi":"10.3126/ajms.v15i5.62539","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62539","url":null,"abstract":"Background: Opioid analgesics with local anesthetics in an epidural route are extremely safe, effective, and reliable methods of post-operative pain relief.\u0000 Aims and Objectives: The primary objective is to compare the duration of analgesia and pain scoring by visual analog scale. The secondary objective is to monitor sedation, hemodynamic changes, and side effects such as nausea, vomiting, shivering, and pruritus.\u0000Materials and Methods: A prospective randomized comparative study of 0.2% ropivacaine with nalbuphine and 0.2% ropivacaine with fentanyl in epidural route for post-operative analgesia in elective lower limb surgeries under spinal anesthesia was carried out in a population of 80 patients. After 1½ h of surgery under spinal anesthesia, patients in group RF received 10 mL of 0.2% ropivacaine with 25 mcg of fentanyl and those in group RN received 10 mL of 0.2% ropivacaine with 2.5 mg of nalbuphine and were observed for the study parameters over time.\u0000Results: The mean duration of analgesia was longer in group RN than in group RF (398.45 vs. 222.88 min). The hemodynamic parameters such as heart rate, mean arterial pressure, and respiratory ratewere statistically significant from 240 to 480 min which is 4–6 h in group RF and 6–8 h in group RN. 27.5% of patients in group RN attained sedation whereas 7.5% of subjects in group RF had a sedation score of 2 and above at 30 min. The subjects in group RN had a lower visual analog score than group RF. 12% and 4% of patients had vomiting in group RN and group RF, respectively.\u0000Conclusion: Epidural nalbuphine in a dose of 2.5 mg with 0.2% ropivacaine provided a longer duration of analgesia with better pain score and more sedation which was advantageous for post-operative patient compliance and satisfaction as compared to 25 mcg of fentanyl with 0.2% ropivacaine.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141046722","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 : 2024-05-01DOI: 10.3126/ajms.v15i5.62482
Asna Zehra Naqvi, Vignesh Balasubaramaniam, Wasif Raza, Lajpat Rai, Graham S Whiteley
Recently, laparoscopic surgeries (LPSs) are becoming increasingly prevalent. Incorporating these methods into clinical practice necessitates an in-depth understanding of the surgical techniques and multifaceted instrumentation that are specific to a slightly invasive operation. Within this systematic review, attention is directed to the technique for pneumoperitoneum creation, like the open and closed technique, to select optimal procedures along with appropriate utilization, with prominence on complication avoidance. This systematic literature review (SLR) examined significant findings from 2018 to 2023. This SLR complies with the quality standards suggested by the PRISMA document. Web of Science, SCOPUS, ProQuest, ScienceDirect, and SpringerLink are the resources. The exclusion criteria included case reports, abstracts, and letters, as well as inclusion criteria included randomized, quasi-randomized, non-randomized, and cohort investigations on human patients, provided that they liked access safety methods and presented values. According to the findings, it can be concluded that the LP inspection of the abdominal cavity (AC), which necessitates cannula implantation, is safe and effective. Closed (Veress needle technique) and open (Hasson technique) pneumoperitoneum induction techniques are frequently utilized. Most laparoscopy (LP) surgeons prefer closed LP utilizing a Veress needle and the first trocar’s masked insertion. Critics of the Veress needle, however, assert that this technique increases the risk of vascular injury. According to proponents of the open Hasson technique, vascular injury could be entirely avoided. The use of an open approach utilizing a blunt-tipped trocar for the formation of pneumoperitoneum may provide a potentially safer alternative during LPSs, depending on safety considerations.
近来，腹腔镜手术（LPS）越来越盛行。要将这些方法应用于临床实践，就必须深入了解微创手术特有的外科技术和多方面的器械。在这篇系统性综述中，我们关注腹腔积气形成的技术，如开放式和闭合式技术，以选择最佳的手术方法和适当的使用方法，并重点关注并发症的避免。本系统性文献综述（SLR）研究了2018年至2023年的重要发现。本SLR符合PRISMA文件建议的质量标准。资源包括 Web of Science、SCOPUS、ProQuest、ScienceDirect 和 SpringerLink。排除标准包括病例报告、摘要和信件，纳入标准包括对人类患者进行的随机、准随机、非随机和队列研究，前提是这些研究喜欢访问安全方法并提出了数值。根据研究结果，可以得出结论：必须植入插管的腹腔（AC）LP检查是安全有效的。闭合式（Veress针技术）和开放式（Hasson技术）腹腔积气诱导技术经常被使用。大多数腹腔镜手术（LP）外科医生更倾向于使用Veress针进行闭式腹腔镜手术，并在第一根套管插入时进行遮盖。然而，Veress针的批评者认为这种技术会增加血管损伤的风险。开放式哈森技术的支持者认为，血管损伤完全可以避免。利用钝头套管形成腹腔积气的开放式方法可能是 LPS 期间更安全的替代方法，这取决于安全方面的考虑。
{"title":"Systematic review on techniques for the creation of pneumoperitoneum in laparoscopic surgeries","authors":"Asna Zehra Naqvi, Vignesh Balasubaramaniam, Wasif Raza, Lajpat Rai, Graham S Whiteley","doi":"10.3126/ajms.v15i5.62482","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62482","url":null,"abstract":"Recently, laparoscopic surgeries (LPSs) are becoming increasingly prevalent. Incorporating these methods into clinical practice necessitates an in-depth understanding of the surgical techniques and multifaceted instrumentation that are specific to a slightly invasive operation. Within this systematic review, attention is directed to the technique for pneumoperitoneum creation, like the open and closed technique, to select optimal procedures along with appropriate utilization, with prominence on complication avoidance. This systematic literature review (SLR) examined significant findings from 2018 to 2023. This SLR complies with the quality standards suggested by the PRISMA document. Web of Science, SCOPUS, ProQuest, ScienceDirect, and SpringerLink are the resources. The exclusion criteria included case reports, abstracts, and letters, as well as inclusion criteria included randomized, quasi-randomized, non-randomized, and cohort investigations on human patients, provided that they liked access safety methods and presented values. According to the findings, it can be concluded that the LP inspection of the abdominal cavity (AC), which necessitates cannula implantation, is safe and effective. Closed (Veress needle technique) and open (Hasson technique) pneumoperitoneum induction techniques are frequently utilized. Most laparoscopy (LP) surgeons prefer closed LP utilizing a Veress needle and the first trocar’s masked insertion. Critics of the Veress needle, however, assert that this technique increases the risk of vascular injury. According to proponents of the open Hasson technique, vascular injury could be entirely avoided. The use of an open approach utilizing a blunt-tipped trocar for the formation of pneumoperitoneum may provide a potentially safer alternative during LPSs, depending on safety considerations.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141055160","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 : 2024-05-01DOI: 10.3126/ajms.v15i5.62511
Abhishek Roy, S. Biswas, K. Patra, Kishore P Madhwani
Background: Metabolic liver diseases (MLDs) in children can present with a wide range of clinical features. Aims and Objectives: This study aims to increase the high index of suspicion among physicians and awareness among caregivers regarding early diagnosis of MLD. Materials and Methods: This hospital-based prospective observational study has been conducted in the Paediatric Outpatient Department and Inpatient Department of RG Kar Medical College, Kolkata, over 2 years from 2021 to 2023. A total of 47 children aged up to 12 years were diagnosed as various MLDs who fulfilled inclusion and exclusion criteria were included in the study. Template was generated and analysis was done on SPSS software. Results: The study sample was 47 children with MLDs. Mean age was 4.21±3.81 years. Males: female ratio was approximately 2.35:1. History of consanguinity among parents was present in 23.40% cases which affirmed the autosomal recessive mode of inheritance in most of the MLD. History of sibling deaths was there in 10 cases. The most common symptom was yellowish discoloration 21 (44.68%) followed by abdominal distension 12 (25.53%). There were diverse modes of presentations. The most common presentations were hepatomegaly 47 (100%) and splenomegaly 30 (63.83%). Of 47 MLDs, Wilson disease cases were maximum (27.66%) followed by glycogen storage disease (23.40%). Conclusion: High index of suspicion should be prevalent among physicians for early diagnosis of cases to reduce disease mortality and morbidity.
{"title":"Clinical profile of children with metabolic liver diseases presenting in a tertiary care hospital of Eastern India","authors":"Abhishek Roy, S. Biswas, K. Patra, Kishore P Madhwani","doi":"10.3126/ajms.v15i5.62511","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62511","url":null,"abstract":"Background: Metabolic liver diseases (MLDs) in children can present with a wide range of clinical features.\u0000Aims and Objectives: This study aims to increase the high index of suspicion among physicians and awareness among caregivers regarding early diagnosis of MLD.\u0000Materials and Methods: This hospital-based prospective observational study has been conducted in the Paediatric Outpatient Department and Inpatient Department of RG Kar Medical College, Kolkata, over 2 years from 2021 to 2023. A total of 47 children aged up to 12 years were diagnosed as various MLDs who fulfilled inclusion and exclusion criteria were included in the study. Template was generated and analysis was done on SPSS software.\u0000Results: The study sample was 47 children with MLDs. Mean age was 4.21±3.81 years. Males: female ratio was approximately 2.35:1. History of consanguinity among parents was present in 23.40% cases which affirmed the autosomal recessive mode of inheritance in most of the MLD. History of sibling deaths was there in 10 cases. The most common symptom was yellowish discoloration 21 (44.68%) followed by abdominal distension 12 (25.53%). There were diverse modes of presentations. The most common presentations were hepatomegaly 47 (100%) and splenomegaly 30 (63.83%). Of 47 MLDs, Wilson disease cases were maximum (27.66%) followed by glycogen storage disease (23.40%).\u0000Conclusion: High index of suspicion should be prevalent among physicians for early diagnosis of cases to reduce disease mortality and morbidity.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141045690","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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