Background:There are many adjuvant used along with bupivacaine for subarachnoid block, but fentanyl and clonidine are commonly used as adjuvant to intrathecal bupivacaine for prolonging both sensory and motor blockade as well as postoperative analgesia in patients undergoing lower abdominal surgeries.Objective:There is a paucity of studies comparing the efficacy of fentanyl and clonidine as adjuvant to intrathecal bupivacaine for improving intraoperative effect and postoperative analgesia in lower abdominal surgeries instigated us compare the effect of these drugs.Methods:This prospective, randomized study is conducted on 100 American Society of Anesthesiologists I or II patients between 18 and 65 years of age divided into two groups of 50 each. The patients were given 2.5 ml of 0.5% hyperbaric bupivacaine with either 50 μg of clonidine (BC Group) or 25 μg of fentanyl (BF Group) intrathecally. The onset and duration of sensory and motor block, sedation score, hemodynamic parameters, total analgesia time, and potential side effects were recorded and compared.Results:Both the groups were comparable in demographic data, onset and duration of sensory and motor blockade, hemodynamic parameters, but the duration of analgesia is significantly longer in clonidine group when compared with fentanyl group. Sedation score is more in clonidine group.Conclusion:Addition of clonidine to intrathecal bupivacaine offers longer duration of postoperative analgesia than fentanyl but with higher sedation.

The promotion of epidural and spinal blocks as preferred and safe techniques for Caesarean section and the use of lumbar puncture for diagnostic and therapeutic purposes place patients at risk of developing Post-Dural Puncture Headache (PDPH). A dull and throbbing bilateral headache associated with changes in posture (Worsened by sitting and standing and better lying down), that develops within seven days of a lumbar puncture or an inadvertent dural puncture must raise the suspicion of PDPH. The exact causative mechanism is unclear, but symptoms of PDPH are generally attributed to excessive loss of Cerebrospinal Fluid (CSF). The risk of PDPH is increased with the use of cutting and large-bore needles and with horizontal orientation of the needle bevel.

BACKGROUND: Local and locoregional flaps are very useful in reconstruction of head and neck defects. Each case should be judged on its merits and selection of flap (local or locoregional) should be done by considering various factors. AIM: To study the etiological factors, type, distribution, management of head and neck defects (post traumatic, post malignancy & congenital) by using local and locoregional flaps and the overall cosmetic effect and function of both donor as well as recipient sites. MATERIAL AND METHODS: 40 patients were studied in a multispecialty hospital admitted in the trauma unit or as OPD patients. After stabilization, especially in trauma patients, patients were fully investigated and treatment protocol was made and reconstruction was done as per protocol. RESULTS: In this study, the mean age of patients was 29.8 years. The main cause of head and neck defects was post traumatic (58%) followed by malignancy (23%), infections (10%) and others (9 %). The mean age for post traumatic defects was 26.42 years. In post malignant defects, Basal cell carcinoma was the major cause of defect (50%) followed by oral malignancy (54%). All the patients with oral carcinoma were tobacco chewers and 50 % were alcoholic. Middle third of face (67%) was most common site for defect followed by scalp (14%), upper third (7%) and lower third face (6%). In the middle third of face, nose (38%) was commonest site of defects followed by cheek (34%) and ears (28%). Local flaps were used in 38% of defects as compared to locoregional flaps (62%). Advancement flaps were mainly done for cheek defects (70%). Rotation and transposition flaps were done mainly for scalp defects. Most common locoregional flap done was median forehead flap (27%) followed by deltopectoral flap. CONCLUSION: Local and locoregional flaps are still very useful in reconstruction of head and neck defects. This is in accordance with Gille's rules of reconstruction i.e." like replaces like". Treatment of the head and neck defects should be individualized. Each case should be judged on its merits and selection of flaps (local or locoregional) should be done by considering various factors like type of defect, site of defect, amount of associated injuries, and the condition of adjacent skin.

SMBG and Telemonitoring participants used the Glucometer for blood glucose analysis that enabled patients to record profile on 3 consecutive days prior to each scheduled study visit. ACG used to visit clinic/ hospital for regular blood glucose monitoring and follow-up as per schedule. All Participants received training in the use of the glucometer and instructions how to identify glycemic patterns and how to resolve them by changes in physical activity, portion sizes, and/or meal composition. Telemonitoring means measurement of BG at home and reports are sent by the text message or by email. Patients put on telemonitoring group were instructed to measure their BG, weight at home and report it by email or by telephone. Their data was entered in the Excel sheet and was interpreted. Any minor modification in treatment or in diet was communicated through email or telephone. Data was continuously monitored by the treating physician and instructions were inserted on the excel sheet. 480 patients screened, 374 (SMBG =123, TMG= 125, ACG =126) were eligible and were enrolled in the study. Of these 10 (SMBG =4, TMG= 3, ACG =3) patients doesn't gave consent and 15(SMBG =4, TMG= 6, ACG =5 ) patients were lost to follow up . So data of total 349 patients was collected, interpreted and analysed.

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