The purpose of our study was to determine the added effect of a balance training program to conventional pulmonary rehabilitation on exercise capacity, balance, fall risk and health related quality of life in patients with moderate COPD. A Randomized Control Trial with two groups- Experimental and Control groups. 133 participants were randomly allocated to either the conventional pulmonary rehabilitation group or the combined pulmonary rehabilitation group with balance training. In the present study we found statistically significant improvement in Berg Balance Scale by -22.55%, Timed Up and Go test by -46.46%, Single Leg Stance Test by -51.69%, Activities Balance Confidence Score by 13.89%, Elderly Falls Screening Test by -57.42%, Six-minutes walk test by 3.04%, and St. George respiratory questionnaire total score by -18.16%.It is recommended that implementation of 8 weeks balance training with conventional pulmonary rehabilitation program is beneficial on improving balance, six-minute walk distance and health related quality of life in subjects with moderate COPD.
Cannulation of the subclavian vein has its inherent risks. Post procedure chest radiograph is one of the investigations done to rule out immediate complications. Unless the clinician is aware as to what to look for in the radiograph, some of the dangerous complications can be overlooked. Accidental subclavian artery cannulation is identifi ed immediately by color and jet of the blood. Also the position of the catheter tip has to be confi rmed by obtaining the arterial pressure tracing using a pressure transducer. Non availability of Doppler ultrasound and pressure transducer are limiting factors for immediate confi rmation of proper catheter placement. Also, in patients with severe hypotension and reduced oxygen content of blood, accidental arterial puncture may not show the characteristic bright red pulsatile back fl ow of arterial blood. In these situations radiography can be used as a diagnostic tool to rule out subclavian artery cannulation.
Context:To Study the outcome following central vein catheterization in patients receiving chemotherapy.Aims:To Study the outcome of central venous catheterization in terms of difficulty during insertion, duration, incidence of infections and other complications and reasons for removal.Settings and Designs:Prospective observational study conducted in 100 patients attending to Gujarat Cancer and Research Institute.Materials and Methods:Both onco-medical and onco-surgical patients who required insertion of central venous catheters were enrolled after ethical approval from June 2008 to November 2010. The study comprised 100 patients.Statistical Analysis Used:Mean and percentage.Results:Mean duration of the indwelling catheter was 109 days for Hickman catheter, 39 days for cavafix and 59 days for certofix. Difficulty in insertion and arrhythmias were common complications. There were no incidences of major life threatening complications. Catheter related infection was 30%. The commonest reason for catheter removal was treatment completion 72%. The next frequent cause was catheter infection 14% and patient death 6%.Conclusions:Even though central venous catheterization is associated with acceptable complications, they serve a useful aid in management of patients on chemotherapy.
Unanticipated difficult intubation can be the worst nightmare of an anaesthetist. This becomes all the more challenging when the anaesthetized patient is a pregnant mother. We describe a difficult airway in a term mother with foetal distress for an emergency caesarian section.
Symmetrical peripheral gangrene (SPG) is a devastating complication seen in critical care settings due to several contributory factors like low perfusion, high dose of vasopressors, disseminated intravascular coagulation, etc. Arterial cannulation is commonly done in critical patients for monitoring. We report a case of patient who developed early features of SPG which recovered in one hand, although it progressed in the hand which had the arterial cannula.
Phenylephrine is the drug presently recommended for prevention of maternal hypotension during caesarean section. The optimal infusion dose is still undetermined. We tried to determine the optimal infusion dose of phenylephrine to prevent maternal hypotension. After Institutional Ethical committee approval, consenting one hundred ASA physical status I or II parturients for elective caesarean delivery were included randomized into 4 groups of 25 each by picking lots. Group P25, P50, P75 and P100 received phenylephrine infusion in concentrations of 25, 50, 75 and 100µ g/ min respectively. After administering spinal anaesthesia a infusion was started as per group allocation. 20% change in baseline mean blood pressure was taken for intervention. Hypotension was treated with 50µg phenylephrine bolus, bradycardia treated with atropine 0.6 mg. Hypertension treated by stopping the infusion. Neonatal Apgar at 1 and 5 minutes and base deficit in cord blood was assessed. Demographic, anaesthetic and surgical characteristics were comparable. 25% of patients in group P25 had hypotension requiring bolus phenylephrine dose. 40% in group P75 and 55% in group P100 had hypertension requiring infusion to be stopped. 6 patients in group P75 and 9 patients in group P100 required atropine to treat bradycardia. Neonatal outcome were comparable in 4 groups. Conclusions: Phenylephrine in an infusion dose of 50µg/min gives stable haemodynamics with good neonatal outcome.
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