BACKGROUND The Million Death Study Collaborators in the British Medical Journal have estimated that the people living with HIV/AIDS population to be between 1.4-1.6 million. Development of Antiretroviral Therapy (ART) has been one of the dramatic advances in the history of medicine. Among several factors that can affect the ART outcome, adherence to the ART has been cited as a major factor associated with poor outcomes. For ART to have maximum effect greater than 95%, adherence has been suggested. Additionally, non adherence to ART is a major cause of HIV drug resistance. Especially, in the Indian context, adherence to ART is very important due to the sheer number of HIV/AIDS cases, the socioeconomic status, diversity of the population and regions. That is, the socioeconomic challenges faced by patients contribute to nonadherence to ART in India. With this background, this study was done with the primary objective of assessing the level of adherence to the given regimen of ART as per the NACO guidelines and factors influencing adherence. MATERIALS AND METHODS This is a prospective patient record-based study conducted in the Antiretroviral Therapy Centre at MKCG Medical College, Berhampur, from January 2016 to June 2016. Simple random sampling technique was used to select 150 patients' records from the ART Centre of the medical college. The data was collected in a predesigned case record form from the patient card available at antiretroviral therapy centre. The patients were followed up through the patient card for six months from their recruitment. The adherence to treatment was evaluated using the adherence score adopted by NACO where a score of 1, 2 and 3 implied that 95%, 80-95% and <80% of the medication were taken respectively. The adherence score were further analysed with reference to the sociodemographic characteristics and the adverse drug reactions encountered during the therapy. Descriptive statistics was used to analyse and report the data Graph Pad Prism V 2.0 (trial version). RESULTS There was a predominance of male patients over females with the maximum number of cases were in the age group of 35 to 44 years and majority of the subjects are uneducated, married and unemployed. More than 90% patients had an adherence score of 1 (>95% medication taken). Persons with primary education, married individuals and persons without employment had better improvement in adherence score than other groups. Anaemia was the predominant adverse drug reaction encountered. CONCLUSION The findings of this study imply that, to increase the adherence to therapy and reduce dropout the nonadherent groups need to be targeted. This will prevent the development of drug resistance and treatment failure.
Background: Neuropathic pain (NeP) is caused by a disease like lesion; it is the disease of the somatosensory nervous system. NeP also caused some severe health disorders such as diabetic peripheral neuropathy (DPN), postherpetic neuralgia (PHN), and spinal cord injury (SCI). Along with the severe health issues, NeP adversely affects the quality of life (QOL) as well as an economic burden on the infected persons and their family plus society. Aim: The aim of the study is to define the efficiency of pregabalin for the treatment of moderate or severe baseline neuropathic pain at a tertiary care centre in Ganjam, Odisha. Materials and Methods: It was a randomized study conducted between August 2019 and January 2020 at the MKCG Medical College Berhampur, Ganjam, Odisha on 700 patients. Simple randomization technique was employed to give patients either pregabalin or placebo. All the patients aged >18 years were selected for the study. The pain was assessed for all the patients using the 11-point numeric rating scale, where 0 = no pain and 10 = worst possible pain. All the patients having pain score >4 were involved in the study. Patients who were below 18 years of age were omitted from the study. Further, the patients whose pain score was below four were also omitted from the study. Results: It was observed that there were 455 patients in the Pregabalin group, and in the placebo group, there were 245 patients. The patients were also bifurcated as per the severity of their discomfort, in which 513 patients were comprised in the moderate section, whereas 187 patients were encompassed in the severe section. 63-71 years was the median age. In the moderate and severe pain group, standard mean pain scores were equivalent among the pregabalin and placebo treatment groups. There was a statistically significant difference among both the groups with respect to the change in pain score. This implies that pregabalin reduced pain more significantly as compared to the placebo group. The above table also depicted the improvement in mean sleep scores as well. There was a statistically significant difference among both the groups with respect to the sleep scores. The sleep score in the pregabalin group improved from the baseline to endpoint more significantly as compared to the placebo group. In the moderate to severe pregabalin group, 90% of the patients experienced at least one treatment-emergent as compared to 70% in the placebo group. The most common side effects of the AE were weight gain, dizziness, and peripheral edema. The highest discontinuation from the study was observed in the pregabalin group. Conclusion: It was found that the pregabalin was effective in terms of reducing pain and had greater tolerability with the patients. It was also identified that the patients in the severe pain segment shifted to mild segment with the use of pregabalin dosage.
Background: Hypertension and Type 2 diabetes are the two factors having a great impact on the mortality and morbidity of a substantial amount of population over the globe. It has also been identified that Hypertension and Type 2 diabetes co-exist in the majority of the patients. There is a wide range of antihypertensive drugs available for the management of hypertension namely, enzyme inhibitors (ACEIs), diuretics (D), beta-blockers (β Bs), calcium-channel blockers (CCBs), and angiotensin receptor blockers (ARBs). Aim: To study the Efficacy and tolerability of antihypertensive drugs in Diabetic and Non-Diabetic patients at a tertiary care centre in Ganjam, Odisha Materials and Methods: A prospective study with 400 patients was conducted in which 200 were included in the non-diabetic group, and 200 were included in the diabetic group. The study period was six months, from June 2019 to November 2019, and it was conducted at the MKCG Medical College Berhampur, Ganjam Odisha. Patients with Type 1 diabetes were excluded from the study. All the patients suffering from mild and moderate hypertension were included in the study. Also, the patients with and without type 2 diabetes were included in the study. Results: Fifty of the non-diabetics with hypertension belonged to 51-70 years of age group. Similarly, 52.5% of the patient in the Diabetics with Hypertension group belonged to 51-70 years. There was no statistically significant difference among the different mean values among the diabetic and non-diabetic patients except the mean values of diabetic and non-diabetic patients under AST when given ßB + CCB + D + ACEI. There was no statistically significant difference among the renal function of various drugs among the diabetic and non-diabetic group. More people were given two drugs combination as compared to monotherapy, three drugs combination and four drugs combination. There was no statistically significant difference among the various drug combinations on the systolic blood pressure. It was identified various mean urea, mean creatinine and mean uric acid values for different drug combinations. There was no statistically significant difference among the renal function of various drugs among the diabetic and nondiabetic group. Conclusion:The study concluded that antihypertensive drugs were significantly helpful in treating systolic blood pressure. The BP was controlled substantially in the diabetics and non-diabetics using the ACEI drug.
Background: Tibia plateau fractures constitute 1%of all fractures. Bicondylar fractures account for 10-30%, whereas isolated medial and lateral condyle fractures constitute the remaining injuries. Although only 3% of these fractures are open injuries, many of them have closed degloving, deep abrasions or severe soft tissue injuries which require careful consideration in deciding the timing and the nature of surgery. Proximal tibia fractures may be difficult to treat even in experienced hands due to intraarticular extension, comminution, cartilage damage and soft tissue injuries of the cruciate ligaments and menisci. Aim: To compare the functional and surgical outcomes of operative treatment of unicondylar and bicondylar fractures. Materials and Methods: It was a prospective and comparative study of Surgical and functional outcome of proximal tibial fractures in the department of orthopaedics from July 2019 to December 2019. Clearance was obtained from the hospital ethical committee. Fifty patients were taken into consideration for the study. All patients are selected on the basis of history, clinical examination and radiography. The Schatzker's classification was used to classify these fractures. The patients were followed up for an average period of 6 to 12 months. The patients were divided into two groups. Twenty-five patients in the unicondylar fracture group 1and 25 patients in the bicondylar fracture group 2. Results: The mean age of group 1 patients was 45.72±10.85 years, and that of group 2 patients was 46.40±8.602 years (p>0.05). In group 1 there were 18 (72%) males and 7 (28%) females, in group 2 there were 21 (84%) males and 4 (16%) females. In group 1, the mean union time was 3.04 ± 0.351 and in group 2 was 3.1± 0.433(p>0.05). In group 1, the mean follow-up time was 12.81 ± 2.09 and in group 2 was 13.04 ± 2.28 (p>0.05). The mean functional score of group 1 was 91.2±12.27, and in group 2, it was 87±18.2 (p>0.050). In group1 mean WOMAC score was 12.2 ± 21.179, and in group 2 was 16.72 ± 16.923 (p>0.05). 2 patients had hypertension, and none of the patients had diabetes. While in group two, three patients had diabetes, and two patients had hypertension. Conclusion:In the light of the aforementioned results, it was found in the surgical and functional outcomes of both unicondylar and bicondylar fractures of the proximal tibia are satisfactory and comparable to each other. Furthermore, it was identified that Factors such as age, gender and the fracture type did not influence the outcome in both the study groups. Additionally, most fractures occurred in the middle age group with male preponderance in both unicondylar and bicondylar fractures.
Introduction: The anesthetic choices for lengthy lower limbs orthopedic procedures may comprise general anesthesia and limited types of regional techniques such as epidural, continuous spinal, or combined nerve blocks. Ropivacaine is a long-acting amide local anesthetic with a potentially improved safety profile when compared to bupivacaine. Dexmedetomidine and fentanyl are two such adjuvant drugs that have been used in combination with bupivacaine or ropivacaine to enhance the analgesic efficacy of the drugs and that facilitate early achievement and prolongation of block. Material and Methods: This is a Comparative, prospective and single study of postoperative epidural analgesia was done in 140 patients, posted for elective surgeries selected randomly, after approval from Ethical committee, conducted over a period of 6 months. Patients of either sex with age between 18 to 60 years. ASA grades I and II. Elective lower limb Orthopaedic and lower Abdominal surgery were included. Patients` refusal, Spinal deformities. Bleeding disorders, Neurological deficit. Local skin infection around the site of needle insertion and Allergic to local anaesthetic drugs were excluded. Results: A total of 140 patients of either sex selected in this study.
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