Abstract Background This study aimed to determine the incidence and outcome of post‐traumatic ( PT ) intra‐abdominal hypertension ( IAH ) and abdominal compartment syndrome ( ACS ) after the advances in haemostatic resuscitation. Methods This is a prospective cohort study from J anuary 2009– D ecember 2011 involving patients with PT haemorrhagic shock. Patients' demographics, fluid resuscitation (<24 h) and damage control laparotomy ( DCL ), morbidity and mortality were assessed. Patients were divided into group 1 (no DCL ) and group 2 ( DCL needed). Further, group 1 was subdivided into three subgroups ( IA pressure ( IAP ) <12, 12–20 and >20 mmHg ). Results One hundred seventeen patients enrolled in the study (102 in group 1 and 15 in group 2) with a mean age of 35 ± 14, injury severity score ( ISS ) of 23 ± 10, base deficit of −8.7 ± 2.7 mmol/ L , serum lactate of 4.6 ± 2.5 mg/d L and haemoglobin level of 8.8 ± 2. Patients received 7 ± 5 red blood cell units, 6 ± 4.7 fresh frozen plasma units and 8.3 ± 3 L of crystalloid per 24 h. There were significant difference between the two groups regarding crystalloid volume, blood transfusion, base deficit and intensive care unit length of stay. However, mortality was higher in group 2 (20% versus 6%). IAP ≥ 20 mmHg was reported in 16.7% patients, while 25.5% had IAP < 12 and 57.8% had IAP of 12–20 mmHg . Patients with IAP > 20 had worse metabolic acidosis and received more blood compared with other groups. One patient died because of ACS (0.9%). Overall multiorgan failure and mortality were 5 and 7.7%, respectively. Conclusion With current practice of minimal fluid resuscitation and liberal use of damage control strategies among trauma patients, the IAH was common transient phenomena but the incidence of ACS is remarkably low.
Diabetes mellitus is a condition of increased blood glucose level in the body. Antihyperlipidemic drugs like statins and fibrates are widely used for prophylactic treatment in dyslipideamia and atherosclerosis. Diabetic dislipidemia exists with increased triglycerides, low HDL and high LDL levels. Hence, with oral hypoglycemic drugs, the addition of a lipid-lowering drug is necessary for controlling dislipidemia. In such a situation, there may be chances of drug–drug interactions between antidiabetic and antihyperlipidemic drugs. The present study is planned to evaluate the safety of gliclazide (antidiabetic) in the presence of pravastatin and gemfibrozil (antihyperlpidemic) in rats. Studies in normal and alloxan-induced diabetic rats were conducted with oral doses of gliclazide and their combination with pravastatin and gemfibrozil, with an adequate washout period in between the treatments. Blood samples were collected in rats by retroorbital puncture at 0, 1, 2, 3, 4, 6, 8, 10 and 12 h. All the blood samples were analyzed for glucose by GOD –POD. Gliclazide (½ TD) produced hypoglycemic activity in normal and diabetic rats, with peak activity at 2 and 8 h. Pravastatin (TD) + gemfibrozil (TD) combination treatment increased the hypoglycemic effect of gliclazide in normal rats or diabetic rats when administered together. The interaction observed due to inhibition of both the enzymes (CYP 450 2C9 and CYP 450 3A4) responsible for the metabolism of gliclazide showed increased half-life, which was seen in the present study. Because concomitant administration of gliclazide with provastatin and gemfibrozil in diabetes is associated with atherosclerosis, it should be contraindicated or used with caution.
Background: Among the various complications of pregnancy, pregnancy-induced hypertension is found to be the most common which may affect maternal and fetal outcome. Pregnancy induced hypertension can cause growth retardation of fetus.
Aim and Objective: This study aims to assess hemodynamic variations in uteroplacental circulation in pregnancy-induced hypertension and its effect on fetal outcome.
Materials and Methods: The study was carried out at tertiary care hospital of nawab shah for the period of 06 months at Department of Radiology in association with Department of Gyne and Obs. Total 106 participants were selected for the study and all females were pregnant with 1st or 2nd trimester gestational record and medical history was taken from all participants and co-morbidities was also evaluated. Blood pressure was checked from all participants from their right arm in lying position and Ultrasound test was repeated as per requirement through color Doppler ultrasound machine and Data was analyzed by using statistical software SPSS. 24.00 version.
Results: After collection of research data from all participants, the entire data was assembled for the analysis. Participants were divided into various age groups as 26 were in 18-21yeras, 34 in 22-25years, 21 in 26-29years and only 07 were from 34-37years. 26 participants were belongs to 1st trimester, 34 among 2nd trimester and 21 in third trimester. PI was also noted with three different readings 32 in Umbilical artery, 21 in middle cerebral artery and 37 in uterine artery. RI was also noted among different arteries 41 in umbilical, 36 in middle cerebral and 39 in uterine arteries. S/D was also noted, 33 in umbilical artery, 49 in middle cerebral artery and 30 in uterine arteries.
Conclusion: Pregnancy-induced hypertension causes hemodynamic variations in uteroplacental vasculature which may be responsible for causing impaired fetal growth in some cases.
Background: Radiations plays an important role in various diagnostic and therapeutic procedures within health facilities, but its use poses inherent risks to both healthcare professionals and patients. Understanding the knowledge, attitude, and safety practices of physicians in relation to radiation safety is paramount for ensuring the well-being of all stakeholders involved. Physicians, as key decision-makers in medical procedures involving radiation, need to be well-informed about the associated risks and safety measures. Objective: To determine the physician knowledge, attitude and safety practice towards radiation safety. Study Design: Cross-sectional study. Settings: Pakistan Institute of Medical Sciences, Islamabad Pakistan. Duration: March 2020 to February 2021. Methods: All the physician relevant to exposure to ionizing radiation, such as radiology, nuclear medicine, interventional cardiology, and oncology, having minimum one year or more experience in radiological field of either age and gender were included. Data collection was carried out through a structured questionnaire, specifically designed to evaluate participants' understanding of radiation safety principles, their attitudes towards adherence to safety protocols, and their day-to-day practices in radiological procedures. The collected data was analyzed using appropriate statistical methods SPSS version 26. Results: Majority of participants experience medical radiation exposure less than once per week (42.1%), with a significant portion having exposure more than three times per week (40.8%). 90.8% of participants have never undergone a radiation protection course, despite 73.7% expressing willingness to participate in such a course if provided by their institution. 52.7% strongly disagreed that radiation significantly affects childbearing, while 39.5% believe they are safe within 1 meter of radiation exposure. On a positive note, 86.8% of participants correctly identified the ALARA principle for radiation protection. Regarding the implementation of safety protocols, only 28.9% were more likely to wear a lead apron, and 22.4% never wore it. Conclusion: Health care professionals lacks adequate knowledge, training and attitude regarding radiation safety protocols. Lack of adequate knowledge and training leads to poor utilization of radiation safety equipment and it is a source of health hazard for both medical professionals and the patients.
BACKGROUND: Laryngeal Mask Airway (LMA) placement is now considered a common airway management practice. Although there are many studies which focus on various airway techniques, research regarding difficult LMA placement is limited, particularly for anesthesiologist trainees OBJECTIVE: To assess the effectiveness of Laryngeal Mask Airway (LMA) placement after induction with propofol or thiopentone in one hundred day case urological patients. METHODS: An analytical, non interventional, cross sectional comparative study. Patients were divided into Group A (Propofol Group n=50) received propofol (2.5mg/kg) and Group B (Thiopentone group n=50) received thiopentone sodium (4-6 mg/kg) IV. Management of anaesthesia was identical in both groups. Standard monitoring was including NIBP, pulse oxymetery and ECG was done. Co-induction with done with midazolam 0.1 mg/kg body weight. LMA was inserted after adequate level of anaesthesia and then assessed. The presence of gaging, coughing, laryngospasm and movement were noted , recorded by a colleague anaesthetist who entered the induction room during the two minutes assisted ventilation phase and was not aware of the type of induction agent. Statistical analysis was done by using SPSS version 10. The mean and standard deviation was calculated for age. Frequency of subjects was calculated for gender Lund and stovner assessment scheme. The p value of less than 0.05 was considered significant. RESULTS: Thiopentone was associated with an adverse response in 76% of patients, compared with propofol in 26% (p<0.01). Head movement, Laryngospasm, inadequate jaw relaxation were more common using thiopentone (p<0.05). The quality of anaesthesia according to patients was significantly higher in the propofol group (Group A, 80%) than in thiopentone group (Group B, 30%). CONCLUSION: Adverse responses in Group A were less than Group B. Propofol, therefore is superior to thiopentone as an induction agent for laryngeal mask airway.
The Diameter protocol as an AAA protocol is designed as an improved Version as well as substitute of RADIUS Protocol. Diameter Protocol adds up more capability for the advancement of Security architecture for Distributed Network System in order to track which services and resources used. Authorization and Accounting in cloud based environment as well as its applications have significant role because of support of huge seamless enterprise coverage with globalized communities of subscribers. In this paper, the authors have taken an overview on how recent and advanced features are evolving with the application of Diameter based protocol in New and Upcoming Technologies.
Recently, phacovitrectomy, which is the combination Mixed connective tissue disease (MCTD) was first described by SHARP and COLLEGUES in 1972. The clinical and laboratorial manifestations overlap with those of SLE, Scleroderma and Polymyositis, along with presence of higher titers of antibodies against antigen, U1-RNP. We report a rare case of MCTD, who presented with all the known features along with prominent complaint of impotence. This impotence responded dramatically to the usual management of MCTD which included a combination of steroids, HCQ and Methotrexate.
Background and objective: Idiopathic Congenital Talipes Equinovarus (CTEV) is a complex deformity that is difficult to correct. The treatment of clubfoot is controversial and continues to be one of the biggest challenges in paediatric orthopaedics. Most orthopaedicians agree that the initial treatment should be non-surgical and should be started soon after birth. We aimed to study a short term follow up of 30 patients treated by the Ponseti method at the department of Orthopaedics, Mahatma Gandhi Medical College & Research Institute, Pondicherry to assess the efficacy of Ponseti’s technique for the treatment of CTEV. Methods: 30 patients were selected from the Out-Patient section of the Department of Orthopaedics and Traumatology, M.G.M.C & R.I, Pondicherry for correction of idiopathic CTEV using the Ponseti technique from June 2011 to March 2013. Children included in the study were assessed for the severity of the deformity using the Pirani severity scoring system and clinical photographs were obtained. Casting of the foot was started by the technique described by Ponseti. Before cast placement every week, the foot deformity severity was assessed using the Pirani scoring system. These patients were followed up in a prospective manner for a period of minimum of six months. Results: At 6 months’ follow-up, Ponseti’s technique gave us 64.86% excellent results, 29.72% good results and a 5.4% poor results. 43.24 % required pecutaneous tenotomy, while 56.76% did not require tenotomy. There was an incidence of 8.1% for postero-medial soft tissue release. Interpretation and conclusion: The Ponseti method is a safe and cost effective treatment modality for congenital idiopathic clubfoot which gives excellent results, and radically decreases the need for extensive corrective surgery.
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