Background and Aims Postoperative sore throat (POST) is common after endotracheal intubation making patients uncomfortable and anxious in postoperative period. The present study was undertaken to compare efficacy of equal dose of dexamethasone in preventing POST via three different routes, i.e., intravenous, topical, and nebulization before surgery. Methods and Results The present prospective double-blind randomized parallel group trial included 190 patients of either sex above 18 years, American Society of Anesthesiologists (ASA) physical status I–II posted for laparoscopic cholecystectomy. The patients were divided into three groups. Patients in group N were nebulized with 8 mg dexamethasone prior to surgery, patients in group I received intravenous dexamethasone (8 mg) before induction of anesthesia, while patients in group C were intubated with endotracheal tube which was pretreated (cuff soaked in dexamethasone 8 mg). The severity of POST and hoarseness of voice was determined by interviewing patients after 24-h of completion of surgery. Incidence of POST decreased in all patients with maximum decrease in group N (18%), while 30.8% in group I and 30.4% in group C. This decrease was not statistically significant when compared to group I (p 0.14) as well as group C (p 0.15). Incidence of hoarseness significantly decreased in group N (15.6%) as compared to group I (40.3%) as well as group C (39.1%). This decrease was statistically significant when compared to group I (p 0.005) as well as group C (p 0.009). Conclusions Topical dexamethasone (group C) is as effective as intravenous dexamethasone in decreasing incidence of POST, while both the techniques are not effective in decreasing hoarseness of voice. Nebulization is most effective method in decreasing POST as well as hoarseness. Trial Registration CTRI/2017/08/009524 dated 29 August 2017 prospectively.

Acute appendicitis is the most common surgical non-gynaecological pathology during pregnancy. In this study, pregnant patients admitted with diagnosis of acute appendicitis in the last two years were evaluated retrospectively.  Aim was to study the outcome of pregnancy with acute appendicitis. This was a retrospective study done on pregnant patients with acute appendicitis admitted between october 2017 and September 2019 in SLBS Government Medical College and Hospital, Mandi, HP. 7 pregnant patients were admitted for acute appendicitis. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, operative findings, mean hospital stay and outcome. In 4 out of 7 patients, acute appendicitis was confirmed and appendicectomy was performed. All of them were operated with open technique. There was no fetal or maternal morbidity or mortality in any patient. All patients delivered healthy babies during the postoperative course. Early surgical intervention is indicated if acute appendicitis is suspected. Pregnancy is not a reason to delay surgery.

Background: Spinal anaesthesia is the frequently used central block used in a surgical procedure. Different local anaesthetic drugs used in spinal anaesthesia differ in their analgesic property, lipid solubility, protein binding, pKa, and degree of spread, the baricity of solution being one of the primary determinants of spread of solutions. Aims: To compare and evaluate the anaesthetic profile of preservative free 0.5% isobaric ropivacaine and bupivacaine in patients undergoing lower abdominal surgeries. Materials and Methods: The clinical study enrolled 100 patients posted for lower abdominal surgeries under spinal anaesthesia. All the patients were then randomized and received either isobaric preservative free 3ml(15mg) of 0.5% bupivacaine (Group A, n=50) or 3ml(15mg) of 0.5% ropivacaine (Group B, n=50). Onset and duration of sensory and motor blocks, haemodynamic changes and any other side effects were noted.Results: Demographic variables between the two groups were not significant. Onset of sensory block was delayed in ropivacaine group B (4.80 ± 0.92 vs 4.35 ± 0.88 min, p <0.05) than group A, whereas duration was found to be significantly more in group A (170.29 ± 14.14 vs 155.77 ± 13.97min, p<0.05) than group B. Onset of motor block was also earlier in group A than group B with p value< 0.05, whereas duration was significantly shorter in group B (140.08 ± 16.58 vs 160.95 ± 15.74min). The two groups were comparable in maximum level of blockade reached and haemodynamic parameters. Incidence of hypotension and bradycardia was significantly less in ropivacaine group. Conclusion: This study establishes that ropivacaine produces good sensory block and is more stable hemodynamically with lesser side effects.

Background: Inguinal hernioplasty remain one of the most commonly performed operations worldwide.  Local anaesthesia can be a preferred method in day-case hernia surgeries. Present study was thus conducted to determine whether local anaesthetic technique is an acceptable alternative to spinal anaesthesia for hernia repair, especially with regards to operative conditions, postoperative pain relief and complications.Methods: This was a prospective randomized single blinded clinical study consisting of sixty patients conducted after the ethical committee clearance. The patients posted for tension free lichtenstein elective hernioplasty were allocated to either of two groups, group A (n=30) were given local anaesthesia and patients in group B (n=30) were given spinal anaesthesia. The operative and postoperative pain sore using visual analogue scale, duration of surgery and any other complications were recorded.Results: There was no demographic difference between the two groups. Time taken in local anesthesia was higher than spinal anesthesia. Intraoperative pain was higher in local anesthesia than spinal anesthesia. There was no difference in post-operative pain scores (p>0.05). Post-operative complications were more in spinal anesthesia group e.g. urinary retention, headache, etc.Conclusions: Local anesthesia can be another good choice for inguinal hernia repair owing to its advantages and less complications, but it can’t be confirmed that local anaesthesia is better than spinal anaesthesia. It can be reliably concluded that local anaesthesia can be a preferred method in day-case hernia surgeries owing to its advantages of ease of administration and less complications.

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Background: Sporotrichosis (most reported subcutaneous mycosis) is caused by sporothrix schenckii species complex, a common saprophyte of soil, decaying wood, hay, and sphagnum moss caused by agent's inoculation on the skin or mucous membrane by trauma with contaminated soil and plant material. Aim and Objective: To study the clinico-epidemiological profile and unusual presentations in an area of high endemicity. Material and Methods: Retrospective analysis of 96 consecutive, diagnosed patients of sporotrichosis attending the Dermatology outpatient clinic between July 2015 to May 2018 was done. Clinical details regarding age, gender, occupation, onset, duration and progression of lesion, sites involved, history of trauma and various clinical patterns were recorded. Results: Of the 96 patients, 36(37.5%) were males and 60(62.5%) females (ratio 1:1.6). Seventy two (75%) patients were between the age group of 20-79 years with majority that is 56 (58.3%) between 20-59 years, these being the most active years of life. History of trauma was reported by 44% patients however 56% denied any such history. Clinically, 63 patients were of FCS and 33 were of LCS. Histopathology was consistent with sporotricosis in 42% patients, was suggestive of granuloma in 8%, deep fungal infections in 3%, results were awaited in 2% and not consistent in 45% patients. Conclusion:This study ascertains the clinico-epidemiological profile in the area as it was conducted in the endemic area of sporotrichosis and various unusual presentations were noted. The non-healing ulcer although is a rare presentation but the diagnosis could not be overlooked and the clinical suspicion is the key to diagnosis. Timely initiation of an effective treatment is imperative to prevent chronicity and morbidity. Culture remains gold standard; however, histology provides support to the diagnosis.

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