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Utility of Percutaneous Endoscopic Gastrostomy for Nutritional Supportin Patients with Oropharyngeal Dysphagia Madhavan Iyengar; Niket Attarde; Arpan Shah; Pooja Shah; Poornima. V.
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 4 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i4.16944

Background & Objectives: Maintenance of nutrition status of a patient is of paramount importance toclinicians treating medical or surgical diseases. Enteral nutrition is preferred over parental nutrition inpatients who are unable to swallow. Percutaneous endoscopic gastrostomy (PEG) is the preferred routeof nutritional support in patients with a functional gastrointestinal system who require long-term enteralnutrition and are unable to maintain oral intake. PEG offers superior access to the gastrointestinal systemover surgical methods.We aim to see utility of percutaneous endoscopic gastrostomy (PEG) for nutritional support in patientswith oropharyngeal dysphagia secondary to neurological deficits and its effect on the quality of life of thesepatients.Methodology: we studied retrospectively 25 patients with neurological oropharyngeal dysphagia in last 2years needing PEG insertion. We reviewed data of the patients for 3 months post insertion of PEG. Studywas based on body weight, haemoglobin and serum albumin level prior to and after PEG. All complicationsincluding sepsis, perforation, hemorrhage and death were recorded.Results: Our study showed significant improvement in levels of hemoglobin, albumin and weight gain afterPercutaneous endoscopic gastrostomy. There were no major complication.Conclusion: Percutaneous EndoscopicGastrostomy is an easy procedure that can be done bedside withoutcomplications in patients with neurological deficit. It improves nutritional status of the patient and alsoprevents aspiration pneumonia in patients with good gastric motility.

Observational Study to Compare Transdermal Nitroglycerin and Placebo Patch in Enhancing the Post-Operative analgesic Effect of Intrathecal Clonidine with Bupivacaine in Abdominal Hysterectomies Pooja Shah; Kandarp Vyas; Dinesh K. Chauhan; Jigisha Mehta
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 2 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i2.14360

Background: Hyperbaric Bupivacaine 0.5% is the most commonly used for spinal anaesthesia.To improve thequality & duration of analgesia many adjuvants have been used.Intrathecal clonidine binds with postsynapticalpha-2 receptors at the dorsal horn of the spinal cord,resulting in anti-nociceptive action.Transdermalnitroglycerin (tNTG) has been found to be converting nitroglycerin to Nitric Oxide(NO),which results inpain modulation in the central and peripheral nervous system by cyclic Guanosine Monophosphate(cGMP)through which the post-operative analgesia effect enhances.Method: Sixty patients Of ASA I/II aged between 20to60 years posted for hysterectomy under spinalanaesthesia were selected.Patients were randomly allotted into 2 equal groups.Group A received:Hyperbaric bupivacaine 0.5% (17.5 mg)+clonidine(50 mcg) + placebo patchGroup B received:hyperbaric bupivacaine0.5% (17.5 mg) + clonidine (50 mcg) + nitroglycerin (tntg)patch(nitroglycerin 25 mg/patch)We have observed onset and duration of sensory.and motor block,two segment regression time, duration ofanalgesia, hemodynamic changes and complication if any.Results: There was no statistically significant difference in demographic data and onset and duration ofmotor and sensory block. Duration of analgesia was significantly prolonged in clonidine with tNTG groupas compared to clonidine group with placebo group.Conclusion: Transdermal Nitroglycerin patch with intrathecal clonidine prolonged duration of analgesiawithout any changes in onset and duration of sensory and motor block.

Development of Simulated Educational Joint Mobilization Module Using Leap Motion Controller Pooja Shah; Waqar M. Naqvi; Sakshi P. Arora
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 2 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i2.14361

Background: Joint mobilization is a complicated task in terms of learning as well as teaching and ischaracterized by great inter subject variability. With reference to the acquisition of skills such as jointmobilisation, only a few studies have investigated the effectiveness of the provision of real-time visualfeedback on a computer screen in terms of students’ ability to establish optimal force and demonstrateadequate performance. There is lack of training in theory and practical skills in mobilization given to thePhysiotherapy students. Thus, an effort has been made in to practice it virtually using Leap Motion Controller.Method: Total 138 participants will be recruited as per the inclusion and exclusion criteria. A briefexplanation about the study will be given. Participants will be given exposure to the software and modalitybeing used along with demonstration. Followed by, a questionnaire to evaluate the effective learning usingthe System Usability Scale.Conclusion: The results from the study will significantly provide efficacy of the simulative device andevidence on the use of LMC for learning joint mobilization using the System Usability Scale.

Pain Relief and Post-Operative Outcome in Patients Receiving Tramadol via Thoracic Epidural versus Intravenous Method in Coronary Artery Bypass Graft Surgery Jigisha Mehta; Dr. Mrugank Bhavsar; Sara Mary Thomas; Pooja Shah; Dinesh Chauhan
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 2 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i2.14767

Background & Objectives:Acute pain is common after cardiac surgery and can keep patients fromparticipating in activities that prevent postoperative complications especially respiratory complications.Accurate assessment and understanding of pain are vital for providing satisfactory pain control andoptimizing recovery.Our aim of the study was to compare pain relief and post-operative outcome in patients receiving Tramadolvia Thoracic epidural versus intravenous method in coronary artery bypass graft surgery.Methodology: Sixty patients aging 40-65 years posted for off pump coronary artery bypass graft surgerywere selected. They were randomly assigned into two groups.Group IVA (n = 30) received Inj. Tramadol(1 mg/kgiv)and Group TEA (n = 30) received Tramadol 0.5 mg/kgepidurallyhalf an hour before shiftingin cardiac recovery room. Hemodynamic parameters like Heart rate, systolic and diastolic blood pressure,pulmonary artery pressure were recorder for 72 hours postoperatively. We have compared extubation timein both the groups. Pain was assessed by visual analogue scale (VAS). Any patients with the VAS more than4 were treated with rescue analgesic. Duration of analgesia and total no. of rescue analgesia were recorded.Duration of stay in cardiac recovery room and in hospital was also recorded.Observation & Results: We have observed statistically significant difference in hemodynamic parametersbetween two groups with better stability in TEA group from shifting till next 72 hours. Extubation time wasalso earlier in TEA group. Mean duration of analgesia and VAS score was also better TEA group. All theseled to shorter length of cardiac recovery stay and earlier discharge from the hospital with less complication.Conclusion: Thoracic epidural analgesia is better than intravenous technique in terms of earlyextubation,maintaining hemodynamic stability and better postoperative analgesia with reduced length ofcardiac recovery and hospital stay.

An Observational Study of the Effect of Dexmedetomidine on Haemodynamic and Airway Responses During Extubation of Trachea Following Major Surgery Under General Anaesthesia Anuja Agrawal; Riddhi Shah; Kirti Patel; Pooja Shah; Dinesh Chauhan
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 3 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i3.15285

An Observational Study between Intrathecal Fentanyl and Butorphanol with Low Dose Bupivacaine to Facilitate Early Ambulation in Perineal Surgeries Malini Mehta; Soumya Jha; Pooja Shah
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 3 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i3.15330

Background: Neuraxial opioids are widely used with local anaesthetics as they allow lower dose of local anaesthetics while providing adequate anaesthesia and faster recovery from spinal anaesthesia because of their sympathetic and motor nerve sparing activities. In the last few years the number of surgeries performed on an ambulatory basis has increased worldwide because of many advantages like short hospital stay, less chance of wound infection and less chances of deep vein thrombosis.Methods: 64 patients of ASA- I or II of either gender who underwent perineal surgeries were divided into two groups of 32 each:- Group BF patients received 1ml of 0.5% hyperbaric bupivacaine with 20µg fentanyl(0.4ml) and Group BB patients received 1ml of 0.5% hyperbaric bupivacaine with 200µg butorphanol(0.2ml) and normal saline(0.2ml).Patients were observed for onset of sensory and motor blockade, duration of sensory and motor blockade, duration of analgesia and time to unassisted ambulation. There was no difference in onset of sensory and motor blockade between the two groups(P> 0.005).Patients receiving butorphanol had statistically significantly longer duration of sensory and motor blockade and duration of analgesia than fentanyl(p-0.001).Patients receiving fentanyl were observed to ambulate unassisted significantly early compared to butorphanol (p-0.001).Conclusion: Patients receiving intrathecal fentanyl 20µg can ambulate earlier compared to patients receiving butorphanol 200µg when used as an adjuvant with low dose hyperbaric bupivacaine 0.5% without any complication.

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