Background: Guillain-Barré Syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy and an important cause of acute flaccid paralysis (AFP) worldwide. Respiratory insufficiency requiring ventilator occurs in 30% of patients that prolong the hospital stay, leading to morbidity and mortality. There had been relatively few studies of Guillain-Barre syndrome in adults from South India. Aim: To evaluate clinical profile, epidemiological, laboratory, and electro diagnostic features of patients with GBS in adults. Settings and design: A prospective study was conducted over a period of 4 years at ESIC Superspeciality Hospital, Hyderabad. Materials and methods: Total 36 patients were identified and data was collected. We studied the epidemiological, clinical, electrophysiological features and their outcome. We subdivided Hughes grade 5 into 5A and 5B based on the requirement of ventilator. Statistical Analysis: Data obtained in the study were subjected to statistical analysis with Statistical Package for Social Sciences (SPSS) version 18. Bivariate analysis was done using chi-square test. Results: Of 36 GBS patients, 21(58.3%) were males; the mean age was 35 years. Antecedent infection was found in 23(63.8%). Majority 12 (33%) were in Hughes grade 4, 10 (27.7%) were in Hughes grade 5A. 97.2% had limb weakness. A significant association was found between low Medical research sum score (MRC) and respiratory failure. Most predominant neurophysiological variant was acute inflammatory demyelinating polyradiculoneuropathy (AIDP) 12 (33.3%). Duration of illness was less than 1week in 19 (52.7%) of cases. Asymmetry was observed in 5 (13.8%) and recurrence of Guillain-Barre Syndrome seen in 2 (5.5%) cases. Complete recovery was noted at 6 months in 34 (94.4%) cases. Conclusion: Early diagnosis of respiratory failure and prompt intervention improves patient outcome. Further large sample studies are required to assess respiratory failure and subdivision of Hughes grade 5.
Background: Stroke is the leading cause of acquired disability worldwide. Better understanding of risk factors helps to reduce the community burden of stroke. Aim of the study was to determine pattern of ischemic stroke subtype and associated risk factors. Methods: Of 220 patients with first ever stroke, 168 patients of ischemic stroke were enrolled prospectively from January 2016 to May 2016 at ESIC Superspeciality hospital, Hyderabad. Patients were categorized in accordance with the Trial of Org 10172 in Acute Stroke treatment (TOAST) criteria. Results: Of 168 patients, 110 (65.4%) were males; male to female ratio was 1.8:1. The mean age was years. Small vessel occlusion (SVO) occurred in younger age group as compared to other stroke subtypes. Frequency of large-artery atherosclerosis (LAA) (46.4%) was highest (Extracranial: 41.1%, intracranial: 36.9%), followed by SVO (32.4%), cardio embolism (15.4%), undetermined (4.7%) and other determined causes (1.1%). Risk factors included dyslipidemia (79%), hypertension (67.8%), smoking (58.3%), alcohol use (54.7%), diabetes (40.4%) and physical inactivity (27.3%). Common association observed was smoking (P -0.004) and alcohol (P -0.003) with LAA and SVO, and dilated cardiomyopathy with cardio embolism. Conclusions: LAA was observed frequently than SVO. Frequency of SVO was lower than Asian but higher than western, while cardio embolism was lower than Western and similar to Asian stroke studies. Dyslipidemia was the predominant risk factor than hypertension reported from Asian and Western stroke registry. This unique pattern can be attributed to differences in demographic and risk factor profiles. The study confirms the need for vigorous primary and secondary prevention measures targeting modifiable risk factors of stroke.
Our aim was to study the effects of dexmedetomidine on anesthetic consumption, duration of surgery, time to extubation and post-operative emergence when used as an adjunct to general anesthesia in endoscopic nasal surgeries. Fifty two patients scheduled for elective nasal surgery (Functional Endoscopic Sinus Surgery and Functional Endoscopic Nasal surgery) were randomized into two groups. Dexmedetomidine-group (D) and placebo or control-group (C). Dexmedetomidine was administered to the D group at a bolus dose of 0.5 ug/kg via an intravenous infusion pump over 10 min. Intraoperative maintenance was supplied by a continuous infusion of 0.2 ug/kg/hr. Infusion of Dexmedetomidine was stopped when the major surgical intervention was over. Group C was given equal amounts of normal saline, instead of Dexmedetomidine. The intraoperative hemodynamics during the surgery were recorded on a proforma. The duration of surgery, time to extubation and amount of anesthetic agents consumed in both the groups were noted. We found that there was a statistically significant difference in anesthetic consumption between both groups. The time to extubation was more in group C(p value < 0.05) .Awakening scores were better in group D(p value < 0.05).No significant difference in the duration of surgery was found.Our conclusion was that Dexmedetomidine reduces anesthetic agent consumption significantly when used as an adjunct in endoscopic nasal surgeries, thereby leading to shorter extubation times and better awakening scores.
Anesthetic management of patients with coronary artery disease undergoing noncardiac surgery is quite challenging. Such patients are at increased risk of perioperative cardiac complications and death. We report an illustrative case of a 62-year-old male with ischemic heart disease and anomalous coronary arteries for obstructed paraumbilical hernia repair.
Introduction: Chronic kidney disease is a global threat to health particularly for developing countries because of its increasing incidence, poor outcome and high cost of treatment. The treatment includes dialysis and renal transplantation. Appropriate drug selection for patients with chronic kidney disease (CKD) is important in order to avoid unwanted drug effects and to ensure optimal patient outcomes. Rational drug prescription is a difficult task in CKD patients. So, present study was planned to know the prescribing pattern of drugs in chronic kidney disease on maintenance hemodialysis at Jaipur, Rajasthan.
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