Trends in Clinical and Medical Sciences (TCMS)

Our main goal is to compare effect of ondansetron and ramosetron in attenuation of propofol-induced pain during induction of anaesthesia. A total of sixty subjects with American Society of Anesthesiologists (ASA) physical status (PS) 1 and 2, age ranging 18-60 years scheduled for various elective surgical procedures under general anaesthesia were included and were randomly divided into 2 groups. Group 1 received 4 mg of ondansetron and Group II received 0.3 mg of ramosetron. Mean age of patients in group 1 was 36.2 years and in group 2 was 36.0 years. There were 16 males and 14 females in group 1 and 17 males and 13 females in group 2. ASA grade I was seen in 20 in group 1 and 24 in group 2 and ASA grade II was seen in 10 in group 1 and 6 in group 2. A non- significant difference between both groups was seen (P> 0.05). Pain score 0 was observed in 14 in group 1 and 20 in group 2, score 1 in 9 in group 1 and 6 in group 2, score 2 in 4 in group 1 and 3 in group 2 and score 3 seen in 3 in group 1 and 1 in group 2. A significant difference between both groups was seen (P< 0.05). Ramosetron alone can be used to reduce the propofol-induced pain. Pre-treatment with IV ramosetron found to be effective as compared to ondansetron in preventing propofol-induced pain.

The aim of this paper is to compare single versus multiple gall stone disease in patients undergoing laparoscopic cholecystectomy. A total of one hundred and thirty patients (males- 52, females- 78) within age group 20-65 years presented with cholelithiasis were divided into 2 groups. Group 1 comprised of single stone patients and group II had multiple stones. Each group had 65 patients. Parameters compared were symptoms and operative findings between both groups, Analysis of results was carried with chi0 square test. Most common clinical symptoms found to be fever in both groups (87%- group 1, 90%- group 2). Other symptoms were dyspepsia seen in 25% and 30%, nausea/ vomiting in 45% and 38% in group 1 and 2 patients respectively. Females were commonly affected and maximum case were observed in age group 40-50 years. Multiple gall stones patients had more symptoms and prevalence of conversion to open surgery was more in these patients. Group 1 patients showed gall bladder distention in 56 and group 2 in 62 patients, gall bladder contraction was seen in 6 patients in group 1 and 3 in group 2, adhesions were exhibited by 11 patients in group 1 and 20 in group 2. 4 patients in group 2 converted to open surgery. Gangrenous gall bladder was seen in 1 in group 1 and 5 in group 2.

The aim of this paper is to compare different treatment modalities in management of plantar fasciitis. Forty- five patients with plantar fasciitis (males- 2- females- 20) were randomized into 3 groups. Group 1 patients received conventional treatment, group 2 patients received heat treatment with silicone heel pad and group 3 patients received active plantar fascia stretching with sham calf stretching. Patient was evaluated using foot function index (FFI) and the foot and ankle disability index (FADI). In group 1, foot function pre-intervention index score and post-intervention score was 68.2 and 43.5, in group 2 was 64.8 and 6.9 and in group 3 was 70.5 and 1.6 respectively. A significant difference was observed (P< 0.05). In group 1, pre-intervention foot and ankle disability score and post-intervention score was 61.5 and 76.4, in group 2 was 66.5 and 95.2 and in group 3 was 61.3 and 97.6 respectively. A significant difference was observed (P< 0.05). Active plantar fascia stretching with sham calf stretching exercise resulted in most significant improvement in FFI and FADI score followed by treatment with heat and silicone heel pad and conventional treatment.

Aim: To assess risk factors for development of type II diabetes. Materials & Methods: 80 patients of type 2 diabetes mellitus >40 years of age were put in group 1 group 2 were healthy subjects irrespective of gender. Factors such as family history, physical activity, blood pressure, alcohol consumption and BMI was recorded. Results: Alcohol consumption was present in 45 in group 1 and 20 un group 2, family history was positive in 65 group 1 and 12 in group 2, sedentary life was seen in 52 group 1 and 25 in group 2, BMI was underweight seen in 14 in group 1 and 5 in group 2, normal 12 in group 1 and 46 in group 2, overweight 30 BMI was underweight seen in 14 in group 1 and 5 in group 2, normal12 in group 1 and 14 in group 2 and obese 22 and 15 46 in group 2. Blood pressure was normal seen 16 in group 1 and 42 in group 2, pre- hypertension 24 in group 1 and 26 in group 2, hypertension stage 1 in 30 in group 1 and 10 in group 2 and hypertension stage 2 seen in 10 in group 1 and 2 in group 2. A significant difference was observed (P< 0.05). Conclusion: Common risk factors in diabetes was overweight, hypertension, lack of physical activity and alcohol consumption.

Aim: To evaluate anesthetic management in renal transplant patients. Methodology: Ninety- two renal transplant patients were part of the study. Parameters such as type of transplant, reason for chronic kidney disease, preoperative data, history of dialysis, preoperative anesthesia management, monitoring details and the outcome were recorded. Results: Chronic glomerulonephritis (CGN) in 28 (30.4%), chronic interstitial nephritis (CIN) in 20 (21.7%), polycystic kidney disease (PCKD) in 11 (11.9%), obstructive nephropathy (Ob. N) in 4 (4.3%), diabetic nephropathy (DN) in 8 (8.7%), hereditary nephropathy in 3 (3.2%), reflux nephropathy in 12 (13%) and membranoproliferative glomerulonephritis (MPGN) in 6 (6.5%). In 32 (35.6%) patients, isoflurane was inhalational agent and recovery time was 25.1 minute, in 40 (43.4%), desflurane was inhalational agent and recovery time was 22.7 minutes and in 20 (21.7%), sevoflurane was inhalational agent and recovery time was 32.1 minutes. A significant difference was observed (P< 0.05). Conclusion: Anesthesia management has made renal transplantation safe and predictable. Postoperative maintenance of renal transplant patients have contributed to the success of renal transplant programme.

Aim: To compare tension band wire and circumferential wiring for patellar fractures. Materials & Methods: One hundred twenty adult patients in age ranged 18- 50 years of either gender was randomly divided into groups viz. group 1 treated with tension band wire and group 2 with circumferential wiring for patellar fractures. Reich and Rosenberg scale, rage of motion and complications were recorded in both groups and compared. Results: At 4 weeks in group 1 and group 2, restriction of last \(10^{0}- 20^{0}\) was seen in 24 and 27, restriction of \(20^0-50^0\) was seen in 14 and 13, restriction \(>50^0\) was observed in 22 and 20. At 8 weeks, no restriction was seen in 8 and 9, restriction of last \(10^0- 20^0\) was seen in 38 and 39, restriction of \(20^0-50^0\) was seen in 10 and 9, restriction >500 was seen in 4 and 3. At 12 weeks, no restriction was seen in 15 and 20, restriction of last \(10^0- 20^0\) was seen in 35 and 32, restriction of \(20^0-50^0\) was seen in 8 and 7 and restriction \(>50^0\) was seen in 2 and 1 in group 1 and 2 patients respectively. A significant difference was observed (P< 0.05). Conclusion: Both techniques for the management of patellar fractures were equally effective in achieving functional outcome.

This paper aims to compare 0.1% topical triamcinolone acetonide, oral methotrexate, and a combination of 0.1% topical triamcinolone acetonide and oral methotrexate in the management of oral lichen planus. 60 histologically confirmed cases of oral lichen planus were divided into 3 groups. Group T was given 0.1% topical triamcinolone acetonide, group M was given topical methotrexate and group C was given combination of both 0.1% topical triamcinolone acetonide and oral methotrexate. Clinical severity score and VAS was compared. The mean CSS at baseline was 5.4 in group T, 4.2 in group M and 4.1 in group C and at 4 months was 2.6 in group T, 2.1 in group M and 0.82 in group C. Baseline VAS was 6.5 in group T, 6.2 in group M and 7.1 in group C and at 4 months was 2.5 in group T, 1.3 in group M and 0.25 in group C. Group T had 3.2 years, group M had 3.1 years and group C had 3.3 years of duration of symptoms. It is concluded that the combination of triamcinolone and methotrexate exhibited maximum relieve of symptoms in patients with oral lichen planus.

The aim of this paper is to assess Serum Adenosine Deaminase (ADA), Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels in patients with Psoriasis. Sixty- four patients with psoriasis were divided into three groups (mild, moderate, and severe) based on PASI scores. PASI score <10 defined psoriasis as mild, between 10 and 20 as moderate, and >20 as severe. The hsCRP was assayed by an enzyme-linked immunosorbent assay BIOS kit. ADA was measured through kinetic method. ESR was calculated using Westergren method. Group I patients had 8 males (mild), 9 males (moderate) and 10 males (severe) and group II had 20 males. There were 12 females (mild), 14 females (moderate) and 11 females (severe) and group II had 30 females. A non- significant difference was observed (P> 0.05). The mean hSCRP level in group I patients was 54.2 ng/ml and in group II was 19.6 ng/ml. The mean ADA level in group I patients was 22.5 U/L and in group II was 8.1 U/L. The mean ESR was 28.4 mm/h in group I and 13.2 mm/h in group II. A significant difference was observed (P< 0.05). This study demonstrated higher hSCRP, ESR and ADA level among patients suffering from psoriasis compared to healthy control.

The aim of this paper is to diagnose pre-eclampsia with spot urine albumin-creatinine ratio (ACR). Our study comprised of one hundred ten pregnancies within 20-28 weeks of gestation. Spot mid- stream urine sample was collected from all pregnant females and urine ACR estimation was done using immunoturbidimetric microalbumin method and modified Jaffe’s method for creatinine estimation. We found sensitivity of 90.4%, specificity of 98%, PPV of 91.6% and NPV of 97.2%. Systolic blood pressure in unaffected subjects was 110.2 mm Hg and in pre- eclamplsia was 152.6 mm Hg. Diastolic blood pressure in unaffected subjects was 78.4 mm Hg and in pre- eclamplsia was 96.8 mm Hg. In unaffected subjects, 4.5% showed positive test and 95.5% showed negative test. In pre- eclampsia subjects, 87.2% showed positive test and 12.8% showed negative test. Mann Whitney U test showed significant difference between two (Significant, P< 0.05). It has been observed that the role of urine albumin creatinine ratio in detection of Pre-eclampsia is evident. A higher sensitivity and specificity revealed its usefulness in early detection.

Aim: To assess various risk factors for development of CHD among patients. \Methodology: Seventy- eight patients of either sex were included. Various parameters such as age, gender, cardiac markers, family history, history of alcohol intake and smoking was recorded. Results: There were 32 patients >45 years of age and 46 below 45 years of age. Out of 78 patients, females were 27 and males were 51. It was found that 26 had primary education, 37 had secondary and 15 had higher education. 38 were employed and 40 were non- employed. 42 were married and 36 were unmarried. Family history was positive in 51 and negative in 26. 20 had hypertension, 36 had CHD and 22 had both HTN & CHD. 45 had habit of smoking, 47 had alcoholism and 40 had no physical activity. A significant difference was observed (P< 0.05). Conclusion: Common risk factors for CHD was obesity, hyperglycaemia, family history, high LDL- C, ALT level, smoking, alcoholism and lack of physical activity.