Adenoid hypertrophy is common in children. Size of the adenoid increases up to the age of 6 years, then slowly atrophies and completely disappears at the age of 16 years. Adenoid hypertrophy in adults is rare. Present study shows that adenoid hypertrophy is now increasing in adults because of various causes. Study has been conducted in the Department of ENT and Head & Neck Surgery, Alluri Sitarama Raju Academy of Medical science, Eluru, Andhra Pradesh, India. Study shows that incidence of adenoid hypertrophy is increasing as the cause of nasal obstruction in adults. This study identified the different causes of adenoid hypertrophy in adult patients. The common causes of adenoid hypertrophy in adults are chronic infection and allergy. Pollution and smoking are also important predisposing factors. Sometimes it is also associated with sinonasal malignancy, lymphoma and HIV infection. Study shows that 21 % of adult nasal obstruction is due to adenoid hypertrophy. But in case of the patient with chronic tonsillitis only 9 % were associated with adenoid hypertrophy. Males are more commonly involved (70 %) then female, may be because of out door activities and more commonly exposed to pollutants. And most commonly involved age group is 16-25 years (60 %). Majority of the cases with adenoid hypertrophy are associated with infection and allergy i.e. descending infection in 33.3 % cases, ascending infection in 20 % cases and allergic rhinitis in 30 % cases. Association of malignant sinonasal tumors, non Hodgkin's lymphoma and HIV infections are rare i.e. 3.3 % each. So any cases of adult adenoid hypertrophy should be treated seriously to exclude the dangerous causes.
A bstract Objectives The objective of this review was to compare the effectiveness of Colistin monotherapy and combination therapy for the treatment of multidrug-resistant gram-negative bacterial infections. Data sources PubMed, Cochrane Library. Study eligibility, interventions, and exclusions In this systematic review, we included all retrospective and prospective studies and randomized controlled trials (RCTs) that compared intravenous polymyxin monotherapy and combination therapy with any other antibiotic for treating multidrug-resistant infections. Studies using inhaled polymyxins with 5 or less than 5 patients were excluded. The primary outcome was 30-day all-cause mortality and if not reported at day 30 we extracted and documented the closest time point. Both crude outcome rates and adjusted effect estimates were extracted for mortality. Study appraisal, data extraction and synthesis Search string used was “(Colistin OR polymyxin) AND ( Enterobacteriaceae OR Klebsiella OR Acinetobacter OR Escherichia coli OR Pseudomonas ) AND (random OR prospective OR retrospective OR cohort OR observational OR blind).” Thirty-nine studies were included in our analysis; out of which 6 RCTs were included and 9 studies used carbapenem as the adjunctive antibiotic. Each study was screened and reviewed for eligibility independently by two authors and data extrapolated on an Excel sheet. Results The meta-analysis of polymyxin monotherapy vs. combination therapy in multidrug-resistant infections yielded an odds ratio (OR) of 0.81 (95% confidence interval [CI]: 0.65–1.01) with minimal heterogeneity ( I 2 = 40%), whereas pooled analysis of this comparison in studies that included carbapenem as combination therapy yielded an OR of 0.64 (CI: 0.40–1.03; I 2 = 62%). Likewise, the pooled analysis of the RCTs yielded an OR of 0.82 (95% CI: 0.58–1.16, I 2 = 22%). All these showed no statistical significance. However, it was seen that polymyxin combination therapy was more effective in multidrug-resistant infections compared to polymyxin monotherapy. The effectiveness was more glaring when carbapenems were used as the combination drug instead of any other antibiotic and more so in many in vitro studies that used polymyxin combination therapy. Conclusion Although statistically insignificant, it would be prudent to use polymyxin combination therapy to treat multidrug-resistant gram-negative bacilli (GNB) infection over monotherapy with preference to use carbapenem as the adjunct alongside polymyxins. How to cite this article Samal S, Mishra SB, Pat...
BACKGROUND The study was done to evaluate the effect of oral ketamine when it is used as an adjuvant in 35 cancer patients (19 men and 16 women) experiencing neuropathic pain. The patients were already on maximally tolerable doses of morphine and pregabalin for neuropathic pain and had a pain score > 6 on a 0-10 scale. Oral ketamine 0.5 mg/kg thrice daily was added to their regular medication. Patients were instructed to maintain a pain diary to record their pain score and record any other adverse effects. A decrease of ≥ 3 from initial score or a score of ≤ 3 was considered to be adequate response. Nine patients experienced nausea, out of which two had vomiting and five developed loss of appetite. Twenty-three patients complained of drowsiness initially, but it gradually decreased over 2-3 weeks among twenty of them. 2 of them withdrew (one on the 8 th and the other on the 12 th day) citing excessive sedation. 30 out of 35 patients experienced adequate pain relief. There were no complaints of visual or auditory hallucinations from any of the patients. The above study suggests that low-dose oral ketamine is potent and helpful in management of intractable neuropathic pain in cancer patients; however, we have to be observant regarding its side effects. MATERIALS AND METHODS This is a prospective observational study conducted by the Department of Anaesthesiology, Critical Care and Pain Management along with Department of Oncology of Hi-Tech Medical College and Hospital in the period from May 2016-June 2017. After obtaining Institutional Ethical Committee clearance, we proceeded with the study. Cancer patients diagnosed with neuropathic pain based on clinical criteria were enrolled for the study. RESULTS In this study, 35 patients (19 men, 16 women) with neuropathic pain were included (Table 1 and 2). The mean average pain score prior to treatment was 8.03 ± 0.68 (Table 4). Twenty out of thirty-five patients had remarkable pain relief by the 10 th day. The mean NRS reduced to 5.06 ± 1.43 (p < 0.001) by the 10 th day of intervention. Thirty out of thirty-five patients had a decrease of more than 3 in NRS over the study period. The pain scores of these 30 patients varied between 3.0 ± 0.78 and 4.83 ± 1.23 over the next three weeks, i.e. till the end of the study. CONCLUSION In the above study, it can be seen that oral ketamine in low doses has been effective in treatment of neuropathic pain in cancer patients. The adverse effects of parenteral ketamine are much lesser when administered orally. Hence, the positive outcome lays the foundation for larger studies, which can help in setting up guidelines regarding indications for ketamine as an adjuvant to analgesic regimens.
The present study was undertaken to observe the endotracheal tube cuff pressure by manual and automated methods during percutaneous dilatational tracheostomy. Materials and Methods:The study recruited 60 patients of the age group of 30-60 years 20 and 50 yrs of ASA grade I/II and MPG I/II. Informed consent was obtained from all the participants and confidentiality of data was maintained. Patients with severe complications were excluded from the study. After recruiting, patients were divided into two groups with 30 participants in each group. Group 1 cuff pressure was monitored manually and group 2 cuff pressure was monitored automatically. Results: Demographic data was not significantly different between the groups. There was no air leak from side of ETTc. Airway pressure was significantly high in group 1. No significant difference was observed in tidal volume in both groups. P value for baseline pressure is 0.7504. P value for pressure set up after monitoring cuff is 0.4271. P value for pressure set up after monitoring cuff after one hour is 0.2885. P value for pressure set up after monitoring cuff after two hours is 0.2095. By conventional criteria, this difference is considered to be not statistically significant. Conclusion:The study results confirm that both manual and automated methods are equally effective in the maintenance of respiratory functions. Further detailed studies are necessary in this area.
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