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Research article:-Anaesthesia
R.Uma1, Meera Rani Nayak2 & Hansa Jayakumar3
1,2Assisstant professor, 3Professor, Department of anaesthesia, Sree Balaji Medical College and Hospital, Chennai, India.
Abstract:-
Clonidine is an alpha2 adrenorecptor agonist which has become a popular adjuvant in anaesthesia. Its effectiveness in providing better intraoperative hemodynamics has been well proven. In our study we show the effectiveness of bolus doses of iv clonidine without a follow up infusion in providing better hemodynamic stability in laparoscopic cholecystectomy. METHODS: We did a randomised placebo controlled study to assess the effect of intravenous clonidine on intraoperative hemodynamics in 40patients who underwent elective laparoscopic cholecystectomy. Patients were randomised into 2 groups. Group C received iv clonidine at a dose of 3micrograms/kg over 15mts prior to induction and Group P recieved same volume of NS(normal saline).Anaesthesia was induced and maintained with propofol, fentanyl and vecuronium bromide, isoflurane and nitrous and oxygen 2:1. Pulse rate(PR) and mean arterial pressure(MAP) were recorded prior to induction, 2mts after intubation, before pneumoperitoneum, 10 and 20mts after pneumoperitoneum and 10mts after extubation. Post operative recovery was assessed using the ramsay sedation score at 30mins, 60mins and 120mins. The occurrence of adverse effects such as nausea, vomiting, hypotension, bradycardia and respiratory depression where also noted. RESULTS AND DISCUSSION: Patients in group C maintained greater intraoperative hemodynamic stability. There was significant decrease in PR and MAP in the Group-C during pneumoperitoneum and after extubation.
Key words:- Clonidine, laparoscopic cholecystectomy, hemodynamic stability.
References:
1. Ghignone M, Calvillo O, Quintin L. Anesthesia and hypertension : the effect of clonidine on perioperative hemodynamics and isoflurane requirements. Anesthesiology 1987; 67:3-10.
2. Ghignone M, Quintin L, Duke PC, Kehler CH, Calvillo O. Effects of clonidine on narcotic requirements and hemodynamics response during induction of fentanyl anesthesia and endotracheal intubation. Anesthesiology 1986;64:36-42.
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4. Parlow JL, Bégou G, Sagnard P, Cottet-Emard JM, Levron JC, Annat G, Bonnet F, Ghignone M, Hughson R, Viale JP, Quintin L. Cardiac baroreflex during the postoperative period in patients with hypertension. Effect of clonidine. Anesthesiology 1999;90:681-92.
5. Flacke JW, Bloor BC, Flacke WE, Wong D, Dazza S, Stead SW, Laks H. Reduced narcotic requirements by clonidine with improved hemodynamic and adrenergic stability in patients undergoing coronary bypass surgery. Anesthesiology, 1987; 67:11-9.
6. Quintin L, Bonnet F, Macquin I, Szekely B, Becquemin JP, Ghignone M. Aortic surgery : effect of clonidine on intraoperative catecholaminergic and circulatory stability. Acta Anaesthesiol Scand, 1990; 34:132-13.
7.Guglieminotti J,Descraques C, Petitmaire S, Almenza L, Grenapin O, Mantz J, Effects of premdication on dose requirements for propofol; comparison of clonidine and hydroxyzine. Br J Anaesth 1998; 80:733-6.
8.Kulka PJ, Tryba M, Sczepanski U, Zenz M. Does clonidine modify the hypnotic effect of propofol? Anaesthetist 1993; 42:630-7.
9.Fehr SB, Zalunardo MP, Seifert B, Rentsch KM, Rohling RG, Pasch T, et al.Clonidine decreases propofol requirements during anaesthesia: effect of bispectral index. Br J Anaesth 2001:86:627-32.
10.Taittonen M, Kirvela O, Aantaa R. Kanto J. Cardiovascular and metabolic responses to clonidine and midazolam premedication. Eur J Anaesthesiol 1997:14:190-6.
11.De Deyne C, Struys M, Heylen R, De Jough R, Vander Laenen M, Buyse L, Dedhislage J, Rolly G. Influence of intravenous clonidine pretreatment on anaesthetic requirements during BIS EEG guided sevoflurane anaesthesia. J Clin Anesth 2000 Feb;12(1):52-7.
12.Altan A, Turgut N, Yildiz F, Turkmen A, Ustun H. Effect of magnesium sulphate and clonidine on propofol consumption, haemodynamics and post operative recovery. Br J Anaesth2006;94:438-41.
13. Manjushree Ray, Dhurjoti Prosad Bhattacharjee, Bimal Hajra, Rita Pal, and Nilay Chatterjee. Effect of clonidine and magnesium sulphate on anaesthetic consumption, haemodynamics and postoperative recerovy: A comparative study: Indian J Anaesth. 2010 Mar-Apr; 54(2): 137–41.
14.Shivinder Singh, Kapil Arora. Effect of clonidine premedication on perioperative hemodynamic response and post operative analgesic requirements for patients undergoing laparoscopic cholecystectomy. Indian J Anaesth. 2011,Vol 55,Issue 1;26-30.
15.Mrinmoy Das, Manjushree Ray, Gauri Mukherjee. Hemodynamic changes during laparoscopic cholecystectomy: Effect of clonidine premedication. Indian J Anesth. 2007,Vol 51, Issue 3;205.
16.Naude GP,Ryan MK, Pianim NA,Klein SR, Lippmann M, Bongard FS. Comparative stress hormone changes during helium versus carbon di oxide laparoscopic cholecystectomy. J Laparoendosc Surg 1996;6:93-8.
17. Harron DW,Ridell JG, Shanks RG. Effects of azepexole and clonidine on baroreceptor mediated reflex bradycardia and physiological tremor in man. Br J Clin Pharmacol 1985;20:431-6.
Copyright © 2013 R.Uma, Meera Rani Nayak & Hansa Jayakumar. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Case Report:-Otorhinolaryngology
Dutta Sumanta K1* , Nandy Sumit2 , Chakraborty Debdulal3 & Basu Keya4.
1Associate Professor, 3Assistant Professor, Department of Otorhinolaryngology, ,2Demonstrator, 4Professor & Head, Department of Pathology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India.
Abstract:- Rhinosporidiosis is a chronic granulomatous disease of the muco-cutaneous tissue, which clinically presents as polypoidal growths. Cutaneous lesions are infrequent and are generally associated with mucosal lesions. We present a case of scalp rhinosporidiosis in association with recurrent nasopharyngeal rhinosporidiosis in a 52 year old male patient. He presented with nasal mass, nasal obstruction, episodes of epistaxsis and dysphagia to solid foods. This was accompanied with two small flesh coloured warty polypoidal lesions over the scalp. Past history revealed similar type of nasal complaints for last 35 years for which he was operated 13 times before in different hospitals! Histopathology of the cutaneous and nasopharyngeal masses revealed numerous sporangia containing spores of various sizes in a vascular connective tissue, confirming the diagnosis of cutaneous and nasopharyngeal rhinosporidiosis. Because of rarity of skin involvement (particularly scalp) and noting the high frequency of recurrence of this disease, this case has been reported.
Key words:- Cutaneous rhinosporidiosis, Nasopharyngeal, Recurrence, Scalp.
References:-
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3.Keefe MA, Loh KS, Chong SM, Pang YT, Soh K. Rhinosporidiosis: differential diagnosis of a large nasal mass. Otolaryngol Head Neck Surg 2001;124:121-2.
4.Fredricks DN, Jolly JA, Lepp PW, Kosek JC, Relman DA. Rhinosporidium seeberi: a human pathogen from a novel group of aquatic protistan parasites. Emerg Infect Diseases 2000;6(3):273-82.
5.Shenoy MM, Girisha BS, Bhandari SK, Peter R. Cutaneous rhinosporidiosis. Indian J Dermatol Venereol Leprol 2007;73:179-81.
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Copyright © 2013 Dutta Sumanta K et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Research article:-Orthopaedics
Salgia Anil1*, Agarwal Tushar2,Biswas S. K3,Sanghi Sahil4 & Sachdev Abhishek4.
1Professor,2Assistant Professor,3Professor & HOD,4Resident,Department of Orthopaedics, Padmashree Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri, Pune 411018.India.
Abstract: Background: Chronic shoulder pain is pain that lingers more than three months continuously or intermittently associated with restricted range of movement. Shoulder pain with restriction of movements is commonly seen in inflammatory and degenerative disease of shoulder joint. Suprascapular nerve block has shown promising results in limited trials in reducing shoulder pain and improvement in range of movements. No large randomized placebo controlled trials examining the efficacy of suprascapular nerve block for shoulder pain using bupivacaine/bupivicane+methyl prednisolone comparing pain and improvement in range of movement is available. Aims & objectives: To assess and compare the efficacy of Suprascapular nerve block for chronic shoulder pain using placebo (normal Saline), only Bupvicain and Bupvicain +methyl prednisolone, in terms of pain relief, duration of relief and improvement in range of movements. Methods and materials: 90 cases with chronic shoulder pain were evaluated clinically and radiologically. At random these cases were allotted three study groups. On randomized basis group of 30 cases were given 10ml of 0.5% bupivacaine, another 30 cases were given 10 ml of 0.5%bupivacaine and 40mg of methylprednisolone acetate and remaining 30 were given .9% normal saline as placebo to block the suprascapular nerve as an outpatient procedure. Cases were followed up on 2nd, 7th, 21st and 90 days for range of movements and for pain according to VAS score. Results: Evaluation of the efficacy of the block was compared by verbal pain scores and improvement of range of movement in % at 2 days, 7 days, 21days and 3 months after the injection. Maximum improvement is noted with bupivacaine+methyl for suprascapular nerve block in cases of chronic shoulder pain. Conclusion: Suprascapular nerve block is safe, effective and well tolerated treatment for patient with chronic shoulder pain. Study group with mixed drug of bupivacaine and methyl prednisolone is most effective. .
Key words: Chronic shoulder pain, Suprascapular nerve block, Bupivacaine, Methylprednisolone acetate, Placebo (normal saline). References: 1.Pope D Croft P et al. Prevalence of shoulder pain in the community: the influence of case definition. Ann Rheum Dis 1997;56:308-12.
.Chakravarty KK, Webley M. Disorders of the shoulder: an often unrecognized cause of disability in elderly people. BMJ 1990;300:848–9.
3.Ritchie ED, Tong D, Chung F, Norris AM, Miniaci A, Vairavanathan SD. Suprascapular nerve block for postoperative pain relief in arthroscopic surgery: a new modality? Anesth Analg 1997;84:1306–12.
4.Gray H. Anatomy: descriptive and applied. 30th ed. London: Longmans, Green and Co, 1949:1123–4.
5.Emery P, Wedderburn L, Grahame R. Suprascapular nerve block for shoulder pain in rheumatoid arthritis. BMJ 1989;299:1079–80.
6.Brown DE, James DC, Roy S. Pain relief by suprascapular nerve block in glenohumeral arthritis. Scand J Rheumatol 1988;17:411–5.
7.Green S, Buchbinder R, Glazier R, Forbes A. Systematic review of randomized controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy. BMJ 1998;316:354–60.
8.Van der Heijden GJ, van der Windt DA, Kleijnen J, Koes BW, Bouter LM. Steroid injections for shoulder disorders: a systematic review of randomized clinical trials. Br J Gen Pract 1996;46:309–16.
9.Van der Winddt DA, van der Heijden GJ, Scholten RJ, Koes BW, Bouter LM. The efficacy of non-steroidal anti-inflammatory drugs (NSAIDS) for shoulder complaints. A systematic review. J Clin Epidemiol 1995;48:691–704.
10.Dangoisse MJ, Wilson DJ, Glynn CJ. MRI and clinical study of an easy safe technique of suprascapular nerve blockade. Acta Anaesth Belg 1994;45:49–54.
11.Gado K, Emery P. Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in cases with rheumatoid arthritis. Ann Rheum Dis 1993;52:215–8.
12.Woolf CJ. Somatic pain pathogenesis and prevention. Br. J Anaesth 1995;75;169-76.
13.Lewis RN. The use of combined suprascapular and circumflex nerve blocks in management of chronic arthritis of the shoulder joint. Eur Acad Anaesth 1999;16;37-41.
14.Shanahan EM, Ahern M, Smith M, Wetherall M, Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis. 2003 May;62(5):400-6.
15.Lewis RN. The use of combined suprascapular and circumflex nerve blocks in management of chronic arthritis of shoulder joint. Eur Acad Anaesth 1999;16;37-41.
Copyright © 2013 Salgia Anil et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Original article:-
Madhao Gajanan Raje.
MD (Forensic Medicine & Toxicology), DFM (Family Medicine), DPM (Psychiatry), DPC (Counseling), BA (Psychology), MA (Philosophy), F-TA (Transactional Analysis). Practicing Psychiatrist & Psychotherapist, Nagpur, India.
Abstract:-
Crime committed by minor is called Juvenile Delinquency (JD). Incidence of JD world over is rising steeply. It has become growing menace & concern for healthcare, Judiciary, human rights, law and order dept. Growth of JD emphasizes failure of measures employed by Judiciary & Police. Reason of this failure lies in not understanding cause of Juvenile Delinquency. Criminal behavior of youths i.e. JD around the world doesn’t occur because of psychosocial issues only. Juvenile Delinquency is definitely more of a medical disease and not only a social or law-order problem. Once medical fraternity accepts this view then treatment/medical management related issues will be implemented freely all across the globe. Usually JD is a group behavior , though individual criminal-acts do herald the scenario. Criminal behavior of youth encompasses crimes like carrying firearms, vandalism/deliberately causing damage, arson, burglary, theft, gambling, alcohol related crimes, substance abuse, rape, & physical assault/Violence/murder. A family doctor is such an expert who gets easy opportunity to witness or know behavioral problems of adolescents in the family while treating routine ailment. If family doctor remains well educated about Juvenile Delinquency/ childhood aggression/offending behavior of youth of the family, then medical management would easily be ensued. Keeping this objective this commentary is designed.
Key words:- Juvenile Delinquency, Family therapy, Prevention, Truancy, Conduct disorder, Violence education & prevention, family & criminal behavior.
References:-
1.Ralph D. Rabinovitch, Juvenile Delinquency, Considerations of Etiology & Treatment, Pediatrics June 1956;17(6): 939-6.
2.Ilanna Sharon Mandel, What causes Juvenile Delinquency? , 2008, Dec.18.
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Copyright © 2013 Madhao G Raje.. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Research article:-Paediatrics
Caroline .A. Okoli1* & Gregory .E. Anekwe2
1Department of Paediatrics, University of Jos, Nigeria. 2Department of Biochemistry University of Jos, Nigeria.
Abstract: Background: In Nigeria, there is a very limited documentation on nutrient composition of fish species and the Africa catfish in particular. There is no documented data on identification of coenzyme Q10 in Africa catfish (Clarias gariepinus) liver oil. Africa catfish (Clarias gariepinus) is more common and cheaper than some other fishes rich in coenzyme Q10. Thus, identifying this nutrient in this fish could help in proper dietary planning, thereby ensuring better health. Method and Result The lipid fractions of the purified supernatant from centrifugation of 250g of 400 Africa catfish livers in 0.02M phosphate buffer pH7.0 were extracted using chloroform-methanol solution and purified by Folch wash giving a concentration of 100μg of lipids per μl. The lipid fraction was fractionated into neutral lipid and polar lipids by silicic acid chromatography and saponified using petroleum ether layer. Alumina column chromatography was used to fractionate and isolate the non-saponifiable parts including coenzyme fraction and their provisional identification was achieved by silica gel TLC and comparing of Rf values with that of reference standards after staining with iodine. The Rf of coenzyme fraction was 0.19.Confirmatory identification of coenzyme was by spectrophotometer. Coenzyme fraction and ubiquinone standard had peak absorption at 328nm and the concentration of ubiquinone in the coenzyme fraction was 0.6mg/ml Conclusion: Coenzyme Q10 is present in the liver oil of Africa catfish (Clarias gariepinus).
Key words: Co-enzyme Q10, ubiquinone Q10, Africa catfish (Clarias gariepinus), liver oil, Nigeria.
References:
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Copyright © 2013 Caroline. A Okoli & Gregory. E Anekwe. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.