Background and Aims:Dexamethasone as an adjuvant to bupivacaine for supraclavicular brachial plexus (SCBP) block prolongs motor and sensory blockade. However, the effect of dexamethasone (8 mg) when added to levobupivacaine has not been well studied. This study was conducted to find out analgesic efficacy of dexamethasone as adjuvant to levobupivacaine in SCBP block.Methods:Ultrasound- guided SCBP block was given to sixty patients, randomly assigned into two groups. Group S (thirty patients) received 2 mL normal saline with 25 mL levobupivacaine (0.5%) and Group D (thirty patients) received 2 mL of dexamethasone (8 mg) with 25 mL of levobupivacaine (0.5%), respectively. Time for the first rescue analgesia, number of rescue analgesics required in 24 h and different block characteristics was assessed. Chi-square test and Student's t-test were used for statistical analysis.Results:Time for request of the first rescue analgesia was 396.13 ± 109.42 min in Group S and 705.80 ± 121.46 min in Group D (P < 0.001). The requirement for rescue analgesics was more in Group S when compared to Group D. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S.Conclusion:The addition of dexamethasone to levobupivacaine in SCBP blockade prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block.
The debates on the devolution of powers to the panchayats since the last two decades received enormous attention because of the increasing role played by these institutions in planning and implementation of the development programmes in rural India. But it is observed that devolution agenda including the agenda of fiscal devolution and tax decentralization has not been taken up sincerely in many states including the states of Andhra Pradesh and Odisha. Based on the review of secondary data, the present article critically examines the status of the fiscal devolution to the panchayats in the states of Andhra Pradesh and Odisha. This article argues that both the states need to strengthen the own revenue of panchayats based on the recommendations of the Finance Commissions of the respective states. In this context, the process of tax decentralization and principles of sharing the state taxes should receive paramount importance.
Background: Ventilator associated pneumonia in critically ill patients are associated with high morbidity and mortality. Patients who are mechanically ventilated are at high risk of acquiring respiratory infections due to complex interplay between the endotracheal tube, host immunity and virulence of invading bacteria. To start empiric antimicrobial therapy knowledge of local antimicrobial resistance patterns are essential. Objectives of our study was to study antimicrobial sensitivity among organisms isolated from endotracheal aspirates of patients with VAP.Methods: This is a prospective observational study, done in 100 patients who were mechanically ventilated for various reasons in ICU of our hospital over a period of one year. Clinical parameters, investigation, microbiological profile and sensitive characteristics of endotracheal aspirate was recorded and analyzed.Results: Endotracheal aspirate culture and sensitivity was done in 100 patients.70 samples showed significant growth. Acinetobacter were isolated in 30 samples, Pseudomonas in 24, Klebsiella in 8, Enterobacter in 1, Citrobacter in 1 and Staphylococcus in 6 samples. Acinetobacter, Pseudomonas and Klebsiella were highly sensitive to colistin and polymyxin B, intermittently sensitive to meropenem and showed resistance to most of commonly used antibiotics.Conclusions: The commonest organism isolated endo-tracheal aspirate cultures were Acinetobacter and Pseudomonas which was highly sensitive to colistin and polymyxin B. A local antibiogram for each hospital, based on bacteriological patterns and susceptibilities is essential not only to initiate empiric therapy but also to prevent poor outcomes and help in framing the appropriate institutional antibiotic policy.
The Local Self Governing Institutions (LSGIs) in India have been playing a catalytic role in implementing development programs. The success of local governments in India, depends to a large extent on different socio-political conditions including a sound fiscal transfer. The devolution of powers to PRIs in India during the last two decades received widespread importance because of the increasing role played by the PRIs in the planning and implementation of development programmes. The local self-governing institutions can be instrumental in promoting development programmes in India, if required inter and intra-institutional issues can also be taken into consideration. These institutions can perform effectively only if the required fiscal, political and administrative powers are devolved to them within an appropriate institutional framework. The paper critically examines the importance of fiscal decentralisation of the local self-governing institutions in India while examining the prevailing institutional and policy constraints that have emerged as a key disturbing factor. The analysis of this paper is based on secondary data, field experiences and in-depth interaction with the key stakeholders who are familiar with such issues. Decentralised governance in India needs greater devolution of powers, particularly fiscal powers in the context of mammoth implementation of rural development programmes. Autonomy of the local governments should be kept intact by providing them upper hand in designing development programmes and raising revenue from the local resources available at their level.
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