Background/Objective The clinical profile and course of COVID-19 evolved perilously in a second wave, leading to the use of various treatment modalities that included homeopathy. This prognostic factor research (PFR) study aimed to identify clinically useful homeopathic medicines in this second wave. Methods This was a retrospective, multi-centred observational study performed from March 2021 to May 2021 on confirmed COVID-19 cases who were either in home isolation or at COVID Care Centres in Delhi, India. The data were collected from integrated COVID Care Centres where homeopathic medicines were prescribed along with conventional treatment. Only those cases that met a set of selection criteria were considered for analysis. The likelihood ratio (LR) was calculated for the frequently occurring symptoms of the prescribed medicines. An LR of 1.3 or greater was considered meaningful. Results Out of 769 confirmed COVID-19 cases reported, 514 cases were selected for analysis, including 467 in home isolation. The most common complaints were cough, fever, myalgia, sore throat, loss of taste and/or smell, and anxiety. Most cases improved and there was no adverse reaction. Certain new symptoms, e.g., headache, dryness of mouth and conjunctivitis, were also seen. Thirty-nine medicines were prescribed, the most frequent being Bryonia alba followed by Arsenicum album, Pulsatilla nigricans, Belladonna, Gelsemium sempervirens, Hepar sulphuris, Phosphorus, Rhus toxicodendron and Mercurius solubilis. By calculating LR, the prescribing indications of these nine medicines were ascertained. Conclusion Add-on use of homeopathic medicines has shown encouraging results in the second wave of COVID-19 in integrated care facilities. Further COVID-related research is required to be undertaken on the most commonly prescribed medicines.
Background: Post-operative tonsillectomy pain is widely observed especially among children which leads to longer hospitalization, slower recovery, eating disorder and continuation of IV fluids ingestion. Objective: To compare mean pain scores between intravenous versus rectal acetaminophen in children undergoing tonsillectomy. Study Design: Randomized controlled trial Place and Duration of Study: Department of Anesthesiology, Surgical Intensive Care & Pain Management, Civil Hospital Karachi, Dow University of Health Sciences, Karachi from 15th July 2015 to 14th January 2016. Methodology: Seventy eight patients with American Society of Anesthesiologist Physical Status (ASA) I and II having age 4-10 years of either gender presented with chronic tonsillitis and duration of disease of more than or equal to one year and underwent elective surgeries (tonsillectomy) were enrolled. Patients were randomly allocated by computer generated random number in two groups; group A received intravenous acetaminophen and group B received rectal acetaminophen. In group A, intravenous acetaminophen 10mg/kg was given and in group B, rectal acetaminophen 15mg/kg was given. Postoperative pain was assessed after 4 hour in ward based on CHIPPS criteria. Results: Mean age was 6.69 2.12 years in intravenous group whereas 5.94±1.97 years in rectal group (P=0.114). Mean duration of disease in intravenous group was 1.82±0.72 years whereas in rectal group, it was 2.07±0.62 (P=0.097). Mean pain score in intravenous group was 2.65±0.05 and 1.97±0.01in rectal group (P=0.001). Conclusion: Significant difference was observed in mean pain scores between intravenous versus rectal acetaminophen in children undergoing tonsillectomy Keywords: Tonsillectomy, Intravenous versus rectal acetaminophen, Pain scores
Aim: To compare outcome of transverses abdominis plane block versus placebo for postoperative analgesia in inguinal hernia repair under general anaesthesia Study design: Randomized controlled trial Place and duration: Department of Anesthesia Jinnah Postgraduate Medical Centre, Karachi from 6th September 2017 to 6th February 2018 Methodology: One hundred patients with inguinal hernia repair under spinal anaesthesia were enrolled. They were divided into two groups; group A (receiving Bupivacaine) and group B (receiving normal saline). Outcome was checked by comparing both the groups for pain score and analgesic consumption. Results: There were 64(64%) males where as 36(36%) females with mean age of 40.32±6.710 years. In group A, the mean pain score was 4.64±1.54and mean analgesic consumption was 139.38±46.98 while in group B it was 5.62±1.29and 238.30±44.49. Conclusion: The ultrasound directed transversus-abdominis plane block delivers an efficient and virtuous post-operative analgesia method. It also decreases the requirement of analgesic with provision of reliable visual analogue scale scores having reduced complications after the surgery of inguinal hernia. Keywords: Pain score, Analgesic consumption, Spinal anesthesia, Inguinal hernia
Background: The raise in mean blood pressure and heart rate associated with intubation and laryngoscopy is harmful for patients of ischemic heart disease, hypertension, raised intracranial and intraocular pressure. To counter this problem nalbuphine began to be used. Nalbuphine is an opioidagonist antagonist which acts on ê receptor as agonist and on μ receptors as antagonist. We chose to study its haemodynamic response to orotracheal intubation. Aim: To compare the mean systolic and diastolic blood pressure with nalbuphine with morphine after laryngoscopic tracheal intubation in elective coronary artery bypass grafting. Methods: The study was a randomized controlled trial. 100 patients fulfilling selection criteria were included in the study from Operation theatre of Department of Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi. Patients were randomly divided in two equal groups by using lottery method. In group A, morphine was administered and in group B, Nalbuphine were administered during induction of general anaesthesia. History was taken from patients. Demographic information like age, gender and co-morbid. Patients were followed for results of the study. All information of was noted and entered in the Proforma. Results: One hundred patients fulfilling selection criteria were included in the study. In group A, morphine was administered and in group B, Nalbuphine were administered during induction of general anaesthesia. Comparison of SBP and DBP has been done between both of the study groups mean and SD of SBP in morphine group was 113.16 and 9.15(p-value=0.007), in nalbuphine group 120.90 and 11.46(p-value=0.03), respectively. Conclusion: It had been considered that morphine offers better analgesic conditions, but it also cause hemodynamic instability. nalbuphine can help in preventing anaesthesia complications, and cause less hemodynamic instability which results in less requirement of maintenance drugs for attenuation. This study to confirmed that nalbuphine can help in less fluctuation in hemodynamic conditions of the patients as compared to morphine. Keywords: Coronary artery bypass grafting, systolic blood pressure, diastolic blood pressure, nalbuphine, morphine
Background/Introduction The majority of people who recover from coronavirus disease 2019 (COVID-19) experience tachycardia and/or palpitations after slight activity or at rest. In some cases, the resting heart rate may remain above 100 beats per minute or get exacerbated out of proportion by slight activity. This persistent tachycardia appearing in post-COVID-19 may clinically present as inappropriate sinus tachycardia (IST). The common mode of diagnosis is electrocardiography after excluding other causes of tachycardia. So far, there is no reported study evaluating individualised homoeopathic intervention in post-COVID-19 IST in peer-reviewed homoeopathic journals. Method This report describes a case of tachycardia and palpitations developed after COVID-19. After complete evaluation of laboratory reports and clinical examination, the diagnosis of IST was made. After detailed case taking and repertorisation, Naja tripudians was prescribed as an individualised homoeopathic remedy to treat the case. Outcomes were assessed objectively on the basis of electrocardiography and subjectively using outcome related to impact on daily living (ORIDL) scale. Result There was a marked subjective improvement along with objective improvement as evidenced by electrocardiography images. The case showed a 4+ outcome on ORIDL scale. The Modified Naranjo Criteria total score was +9 out of a possible +13, providing definite evidence to attribute the clinical outcome with the homoeopathic intervention. Conclusion This single case demonstrates that Naja tripudians, a rarely used drug, may be helpful in treating post-COVID-19 IST. Clinical trials in this direction are required to conclude firm causal attribution.
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