BackgroundDiabetic nephropathy is a chronic micro vascular complication of poorly controlled diabetes mellitus (DM), leading to end stage renal disease (ESRD). Control of DM is monitored by HbA1c. There are two early markers -to assess early renal impairment: Microalbuminuria (MA) & Glomerular Filtration Rate (GFR). Estimation of MA -needs 24 hours collection of urine. GFR is clinically assessed by creatinine clearance rate (CCR) at the same time for accurate estimation of GFR which also needs 24 hours urine collection. Faulty timing and non compliance for 24 hours urine collection -may give erroneous results. MA is better reflected by spot urine urinary albumin-creatinine ratio (ACR). Some formula based calculation of GFR, called estimated GFR (eGFR) are well correlated with CCR which needs only single blood sample for S.Creatinine (S.Cr). For example one such formula is Cockroft-Gault (C-G) formula.
Background: Stroke rehabilitation is a program designed to help the stroke patients to overcome the disability. Few studies have evaluated the profile of stroke patients. To provide information about demographic data & disease pattern among the patients receiving stroke rehabilitation.
Methods: A retrospective study was carried out in the Department of Physical Medicine and Rehabilitation (PMR), National Institute of Neuroscience and Hospital (NINSH) Dhaka, Bangladesh for the period of two year from 1st July 2013 to 30th June, 2015.
Results: Total five thousand nine hundred thirty nine (n=5939) patients were studied, of which 62.33% were male and 37.67% were female. Maximum patients (27.93%) belong to 51-60 years of age. Major patients (52.67%) came from Dhaka city and most of the studied patients were housewife (25.43%). Largest disease group was ischaemic stroke (81.7%). Regarding service pattern, 69.59% patients received outdoor and 30.41% indoor services. Among clinical profile of stroke, 90.5% were first time onset, almost 99% suffered limb weakness, 24.03% speech problem and 32.6% face involvement. Maximum patients (58.8%) had history of multiple risk factors.
Conclusion: Rehabilitation procedures in stroke patients can enable greater return of neurological functions and prevents complication, thereby improves long term outcome and quality of life.
Chatt Maa Shi Hosp Med Coll J; Vol.17 (1); Jan 2018; Page 9-12
Objectives: To find out if combined general anaesthesia (GA) with high thoracic epidural anaesthesia (HTEA) was better in controlling haemodynamic condition and reducing incidences of arrhythmia during induction of GA and during positioning and handling of the heart itself by the surgeons. Materials and Method: Forty (40) patients of 40-65 yrs age were randomly selected and divided in two groups (group A, n= 20: combined HTEA and GA- study group, group B, n= 20: GA alone- control group). Group A received HTEA introduced through an indwelling epidural catheter at C7-T1 or T1-T2 interspace. Lignocaine (1%) 5 ml and Bupivacain (0.25%) 5ml with Fentanyl 10 mg was given through the catheter as bolus followed by Bupivacain (0.25%) 5ml with Fentanyl 10 mg was given at 2 hours interval. General anaesthesia was induced and maintained in a standardized manner for all patients of both the groups. The parameters monitored were Heart Rate (HR), Arterial Blood Pressure (ABP), and Electrocardiogram (ECG - arrhythmia and ST changes), Oxygen saturation (SpO2) and Central Venous Pressure (CVP) during the procedure Results: Induction of GA was smoother and with fewer blood pressure peaks in all patients of group A. They demonstrated a stable haemodynamic status throughout operation in general and during positioning of the heart and bypass grafting in particular. Incidences and severity of cardiac arrhythmias were also less during these periods. Conclusion: Combined HTEA-GA technique for OPCAB procedure is safe and affords to achieve stable haemodynamic status during induction of GA. It also allows reducing incidence of arrhythmias during cardiac position and grafting. Regarding the above qualities, group A appeared superior to group B. DOI: 10.3329/jbcps.v26i3.4193 J Bangladesh Coll Phys Surg 2008; 26: 116-120
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