Journal of Evidence Based Medicine and Healthcare最新文献

{"title":"Histopathological Study of Placenta in COVID-19 Positive Mothers in a Tertiary Care Hospital, South Kerala","authors":"K. Govindan, Jithesh Girijakumar, S. Radha, Priyasree Jayasimham, Reshma Pallikara Kunjunny","doi":"10.18410/jebmh/2021/588","DOIUrl":"https://doi.org/10.18410/jebmh/2021/588","url":null,"abstract":"BACKGROUND The coronavirus disease 2019 (Covid-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), is a global public health emergency. Data on the effect of coronavirus disease 2019 in pregnancy is limited to few case series. The purpose of this study was to describe the histopathological findings in the placentas of women with Covid-19 during pregnancy. METHODS Pregnant women with Covid-19 who delivered between August 1, 2020 and May 10, 2021, at Government Medical College, Trivandrum were considered for the study. Handling of specimens were carried out using Indian council of medical research (ICMR) guidelines for Covid-19 specimens. Placentas underwent routine clinical examination and processing. Clinical information was retrieved from the medical records. Histological examination was performed and features classified into maternal vascular malperfusion (MVM) and fetal vascular malperfusion (FVM). RESULTS 50 placentas from patients with severe acute respiratory syndrome coronavirus 2 were examined [33 patients delivered at term, 12 patients were preterm, 4 cases were intrauterine fetal demise and 1 case was medical termination of pregnancy (MTP)]. Patients with risk factors for maternal and fetal vascular malperfusion were excluded. 8 cases showed features of maternal vascular malperfusion and 11 cases showed features of fetal vascular malperfusion. Among intra uterine fetal death (IUFD) cases, 2 cases showed features of vascular malperfusion, 7 cases showed low grade acute inflammatory pathology which needs further studies with a greater number of cases to establish relationship with Covid-19 virus. CONCLUSIONS Covid-19 placentas showed increased rates of maternal and fetal vascular malperfusion. These changes may reflect a hypercoagulable state influencing placental pathology and hence an increased antenatal surveillance for women diagnosed with SARS–CoV-2 infection may be warranted. Further studies with control groups are necessary to determine the reproducibility and significance of these initial findings. KEYWORDS Covid-19, Pregnancy, Maternal Vascular Malperfusion, Fetal Vascular Malperfusion.","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82734919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Magnesium Levels in Ischemic Cerebral Stroke Patients and Its Correlation with Severity of Neurological Disability – A Longitudinal Observational Study from Sri Amritsar, Punjab","authors":"Jasleen Kaur, S. B. Nayyar, T. Sikri, J. Kaur, H. S. Deep","doi":"10.18410/jebmh/2021/586","DOIUrl":"https://doi.org/10.18410/jebmh/2021/586","url":null,"abstract":"BACKGROUND World Health Organization (WHO) clinically defines a stroke as ‘the rapid development of clinical signs and symptoms of a focal neurological disturbance lasting more than 24 hours or leading to death with no apparent cause other than vascular origin’. Hypo magnesia (ionized form) leads to neuromuscular hyperirritability, tremors, increased vascular resistance, coronary vasospasm and hypertension. Magnesium deficiency triggers vasoconstriction enhancing vascular endothelial injury and hence leads to atherosclerosis. In the present study, we wanted to evaluate serum magnesium levels in ischemic cerebral stroke patients and correlate its severity with the neurological disability using modified Rankin scale (mRS) and Canadian neurological scale. METHODS It was a longitudinal observational study, undertaken in the Department of Medicine in Sri Guru Ram Das Institute of Medical Sciences and Research, Sri Amritsar from December 2018 to June 2020. 60 patients with acute ischemic cerebral stroke fulfilling the inclusion criteria were selected. 5 ml venous sample for serum magnesium level was taken within 24 hours and on day 5 of admission. Presence or absence of hypomagnesemia in patients after acute cerebral ischemic stroke was recorded during the hospital stay of patients, receiving standard management protocol of ischemic stroke. The correlation co-efficient of serum magnesium level with modified Rankin scale and Canadian neurological scale was calculated. RESULTS The mean age of patients was 61.6 ± 1.6 years, 42 (70 %) patients were male and 18 (30 %) were females and there was male preponderance. The mean serum magnesium level was measured as 1.78 ± 0.2 mg/dL, it was observed that the mean value for mRS was 3.93 ± 0.75 and Canadian neurological scale was 7.11 ± 2.01 within 24 hours and on the 5th day the mean value for mRS was 3.5 ± 1.09 and Canadian neurological scale was 8.02 ± 2.97. The present study observed a statistically significant correlation between mRS score and serum magnesium level as well as Canadian neurological scale and serum magnesium levels. CONCLUSIONS It was concluded through the results of this study that low levels of magnesium in the body can cause more severe stroke. KEYWORDS Stroke, Serum Magnesium, Hypomagnesemia, Modified Rankin Scale, Canadian Neurological Scale","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82778959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Study on Functional Outcome of Distal Radius Fractures Treated with POP Cast Versus Percutaneous K-Wire Fixation (Both After Closed Reduction) In Kannur Medical College, Kerala, India","authors":"P. AdnanSiddique, Sasikumar Sasidharan, Prateek Chandak","doi":"10.18410/jebmh/2021/583","DOIUrl":"https://doi.org/10.18410/jebmh/2021/583","url":null,"abstract":"BACKGROUND Closed reduction with plaster of Paris (POP) cast for extra-articular distal radius fractures was an accepted method of treatment worldwide. But the maintenance of reduced fracture fragments was unpredictable. Closed reduction and ‘K’ wire fixation with casting was also recommended widely. There was no definite option prescribed for either of the methods. In this study, we wanted to compare the final outcome of management of the distal radius fractures in adults with closed reduction and POP casing versus closed reduction with percutaneous K-wiring. METHODS A prospective, randomized, and comparative study was conducted on the final outcome of two methods of treatment for the fractures of distal end of radius. One method (Group A of 23 patients) consisted of closed reduction and POP casing and the other (Group B of 23 patients) consisted of K-wiring under C arm (23 patients in each group). Radiological and functional parameters were compared at fixed intervals for 15 months and final outcome scores were correlated and compared using Gartland and Werley functional scoring system. RESULTS In group A, AO type 2R3A2.1 fractures were observed in 03/23 (13.04 %) patients and 04/23 (17.39 %) in Group B patients. Type 2R3A2. 2 fractures were observed in 05/23 (21.73%) of the group A patients and 07/23 of the group B patients. Type 2R3A2.3 fractures were observed in 15/23 of the group A and 12/23 (52.17%) of the group B patients. Both the methods of treatment were correlating well with the various variables. CONCLUSIONS Closed reduction with percutaneous K wiring and below elbow cast application was a simple, minimally invasive technique that provided added stability and functional outcome with respect to treatment of extra-articular distal radius fracture. The conventional method of closed reduction and POP cast was closely correlating with the K wire immobilization method. There was no significant statistical difference between the two methods in the functional outcome after treatment of distal end radius fractures. KEYWORDS Radius, ‘K’ Wire, Closed Reduction, Stable Fracture, Bone Healing and Immobilize","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73901813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Study of Oral Atenolol and Oral Clonidine as Premedication for Hypotensive Anaesthesia in Patients Undergoing Functional Endoscopic Sinus Surgery under General Anaesthesia - A Randomized, Double Blinded Study in a Tertiary Care Hospital, Tirupati","authors":"K. Mydhili, K. Sreehari, Y. Vijayakumari, Tanuja T.V.L.","doi":"10.18410/jebmh/2021/578","DOIUrl":"https://doi.org/10.18410/jebmh/2021/578","url":null,"abstract":"BACKGROUND Bleeding during functional endoscopy sinus surgery (FESS) remains a main consideration. Even a small amount of blood may disturb the endoscopic view, increasing the likelihood of complications. So, we decided to compare the effects of clonidine and atenolol as oral premedication for hypotensive anaesthesia in patients undergoing FESS under general anaesthesia. The purpose of this study was to analyse and compare the efficacy of oral atenolol versus oral clonidine as premedication under general anaesthesia for induced hypotension in patients undergoing a functional endoscopic sinus surgery. METHODS The study included total 100 patients of age (18 – 60 years) [American Society of Anaesthesiologists (ASA grade I and II)] who were randomly divided into two groups of 50 each. Group - A (n = 50), a non-labelled clonidine tablet PO was given to the patients in the clonidine group in the dose of 2 mcg/kg at 7 pm the day before surgery and 4 mcg/kg two hours before surgery. Group - B (n = 50), a non-labelled atenolol 25 mg tablet was given PO to the patients in the atenolol group at 7 pm the day before surgery and also 2 hours before surgery. Induction and maintenance of general anaesthesia was performed by the same standard protocol for both groups. Hemodynamic effects [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), quality of surgical field, intraoperative complications, and post anaesthetic discharge score system (PADSS)] were recorded and statistically analysed. RESULTS The hemodynamic stability and good quality surgical field was obtained in both the groups. The lesser incidence of intraoperative complications recorded with atenolol gives it a more favourable profile when compared to clonidine. CONCLUSIONS We conclude that both oral clonidine and atenolol premedication provides superior and predictable perioperative hemodynamic control, reduces the requirement of hypotensive agents, and produces acceptable recovery characteristics. The lesser incidence of intraoperative complications recorded with atenolol gives it a more favourable profile when compared to clonidine. KEYWORDS Atenolol, Clonidine, Functional Endoscopic Sinus Surgery (FESS)","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82049305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Hyponatremia in Neurosurgical Patients in South India – An Institution-Based Observational Study","authors":"Surumi Makkat Mukkil Sheikh, Neetha Thattaparambil Chandran, A. Karthik, I. Hameed, Sunanda Chulliparambil","doi":"10.18410/jebmh/2021/585","DOIUrl":"https://doi.org/10.18410/jebmh/2021/585","url":null,"abstract":"BACKGROUND Hyponatremia is the most frequently encountered electrolyte abnormality in hospitalized patients, especially those with neurological injury. Acute onset hyponatremia is common in patients with any type of cerebral insult including traumatic brain injury (TBI), subarachnoid haemorrhage (SAH) and brain tumours. Also seen as a complication of intracranial procedures, contributing to increased morbidity and mortality. Early diagnosis and effective management can reduce mortality associated with this condition. This study was done to estimate the prevalence of hyponatremia in neurosurgical patients in our institution. METHODS This is an observational study that analysed the adult patients admitted to the neuro intensive care unit (ICU) after having undergone the neurosurgical procedure from January 2019 to July 2019. A structured questionnaire was used for data collection. The prevalence of hyponatremia was calculated with preoperative serum sodium levels in the study population. RESULTS In this study with 61 patients undergoing neurosurgical procedures, the prevalence of hyponatremia was 34.4 %. The majority of patients for surgery comes between 41 to 50 years. 57.4 % cases were with traumatic brain injury, 11.5 % cases were with sub arachnoid haemorrhage and 31.1 % were with intracranial tumour. 26 % of hyponatremia patients belonged to mild grade while 8 % to moderate grade. 62.5 % of patients above 70 years, 44.4 % of patients between 51 to 60 years and 40 % of patients between 61 and 70 years presented with mild hyponatremia. 37.5 % of patients above 70 years and 10 % of patients between 61 and 70 years presented with moderate hyponatremia. CONCLUSIONS Our study showed an increased prevalence of hyponatremia in neurosurgical patients which demand effective approaches for an accurate and timely diagnosis of this electrolyte disorder. Hyponatremia frequently occurs in patients with TBI, SAH and intracranial tumours. It is also essential to differentiate between syndrome of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting syndrome (CSW) as the treatment modalities are entirely different for these two entities. Early detection, close monitoring, etiological evaluation and prompt treatment based on aetiology can reduce the complications and improve patient’s outcomes. KEYWORDS Electrolyte Abnormality; Brain Injury, Morbidity","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87557429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Study of Topical Sucralfate and Povidone Iodine Dressing in Diabetic Foot Ulcers in a Tertiary Care Hospital in Tirupati","authors":"Bathena Sobha Rani, G. Prakash, B. Sarada, B. Desu, Y. Krishnan","doi":"10.18410/jebmh/2021/582","DOIUrl":"https://doi.org/10.18410/jebmh/2021/582","url":null,"abstract":"BACKGROUND Diabetic patients have reduced ability to metabolize glucose resulting in elevated blood sugar levels which further burdens the wound healing process. This leads to non-healing chronic ulcers. The sufferers of chronic diabetic foot ulcers are increasing globally due to lack of preventive and control measures. Sucralfate has been demonstrated in molecular studies to enhance the granulation tissue proliferation and thus promoting ulcer healing in the skin. Various clinical studies have also showed the efficacy of sucralfate in complete healing of the wound and in reducing the size of the wound. The purpose of this study was to compare the efficacy of topical sucralfate with that of povidone iodine dressing, in the healing of diabetic ulcers. METHODS This is a randomized comparative study. Among 100 patients, 50 patients received treatment in the form of povidone iodine dressings and 50 took treatment with sucralfate dressing. The patient underwent a detailed clinical examination. Relevant investigations were also done. The initial wound area was recorded after thorough debridement by measuring length x width. Both the groups underwent dressings once daily. The patients were followed up daily for a period of 3 weeks in both the groups. RESULTS In this study, the mean ± SD area of reduction of the ulcer was observed to be higher in sucralfate group 54.17 ± 10.08 than the povidone iodine group 16.07 ± 4.19. There was a statistically significant difference between the groups for the mean of area reduction (P < 0.0001, significant). CONCLUSIONS The ulcers in subjects treated with sucralfate dressing (S group) contracted more than the ulcers in the patients treated with povidone iodine (P group) (54.17 % Vs 16.07 %; P = < 0.0001, significant) which points out that sucralfate dressing is an effective modality in helping the reduction of wound area in patients with diabetic foot ulcers. KEYWORDS Diabetic, Sucralfate, Area of Reduction","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84987393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Remedial Teaching for Improving the Academic Performance of Poorly Performing Phase 1 Medical Students in Biochemistry Discipline at Government Medical College, Kozhikode, Kerala","authors":"Shaji Sreedhar, S. Appunni","doi":"10.18410/jebmh/2021/581","DOIUrl":"https://doi.org/10.18410/jebmh/2021/581","url":null,"abstract":"BACKGROUND Remedial teaching is an educational programme for increasing the academic performance of poorly performing students in a curriculum. Remedial teaching is finding specific learning difficulties in low achieving learners who are lagging behind in academics and providing them with necessary support and guidance to bring their academic performance closer to the required standard and to prevent them from occurring in future. METHODS This quasi-experimental study was conducted among first year medical students at Government Medical College, Kozhikode, Kerala from December 2019 to February 2020. All the sixty-four students who scored less than 50 % of marks in Biochemistry first internal examination were identified as poor performers. They were divided in to two groups, A and B, each consisting of thirty-two students by simple random method. The study skills of group A and group B students were assessed using study skills assessment questionnaire. They were also assessed on non-academic problems that affect their studies through open-ended interviews. Both the group students received academic support that included conceptual learning, logical thinking, reasoning skills and answering methods. In addition, group A students were given remedial teaching comprising study skills training, counselling sessions and motivation classes. At the end of eight weeks, a summative assessment was conducted for both the groups. A four-point Likert scale feedback questionnaire on remedial teaching was collected from group A students. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 16. RESULTS The mean mark of group A that received remedial teaching was significantly higher (P < 0.0001) than group B. The difference in mean marks between pre-test and post-test in group A was statistically significant (P < 0.0001). CONCLUSIONS Remedial teaching sessions are effective for improving the academic performance of poorly performing students in the subject of Biochemistry. KEYWORDS Remedial Teaching, Academic Support; Study Skills; Counselling; Motivation","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74649672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathological Evaluation of Lesions of Appendix - A Cross Sectional Study","authors":"A. Punnoose, Elizabeth Joseph, D. Joseph, B. Thomas","doi":"10.18410/jebmh/2021/580","DOIUrl":"https://doi.org/10.18410/jebmh/2021/580","url":null,"abstract":"BACKGROUND Appendix is considered as a vestigial organ in medical history. But recent studies reveal its importance in immunological function. Appendicectomy is one of the most common surgeries performed and acute appendicitis being the most frequent pathology noted. Various less common pathologies like parasitic infestation, granuloma, diverticulum, neoplasms are also described. In our institute, we have seen an increased rate of acute appendicitis and a relative increase in neoplastic conditions. The purpose of this study was histopathological evaluation of lesions of appendix over a period of five years and its association with demographic data. METHODS This cross-sectional study included all specimens received in the department of pathology with primary pathology in appendix. Appendix removed as a part of other surgical procedures were excluded. Relevant clinical data, gross findings and histopathological diagnoses were retrieved from pathology records and computer databases and statistical analysis was done using Statistical Package for Social Sciences (SPSS 16.0). RESULTS Out of the 576 cases, 485 (84 %) patients showed findings consistent with acute appendicitis on histopathological examination. Perforation rate was 4.86 % and was higher in male patients. Other pathologies include chronic appendicitis in 58 cases (10.06 %), eosinophilic appendicitis in one case (0.17 %), appendix with lymphoid hyperplasia in 14 cases (2.43 %), periappendicitis in 4 cases (0.69 %), fibrous obliteration of appendix in 2 cases (0.34 %), granulomatous appendicitis in 4 cases (0.69 %), appendix with lymphoid hyperplasia in 14 cases (2.43 %), diverticulitis in one case (0.17 %), tubular adenoma with low grade dysplasia in one case (0.17 %), neuroendocrine tumour in one case (0.17 %) and mucinous neoplasms in 5 cases (0.86 %). CONCLUSIONS The study supports routine histological examination of all the appendicectomy specimens to avoid missing of any clinically important condition which has significant impact on treatment and prognosis. Also noted an increased number of mucinous neoplasms suggesting the importance of future studies in this field. KEYWORDS Appendix, Acute Appendicitis, Chronic Appendicitis, Mucinous Neoplasms of Appendix, Diverticulitis","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"170 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80671994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Low Dose Olanzapine for the Control of Nausea and Vomiting in Patients Receiving Highly Emetogenic Chemotherapy in a Rural Medical College in Etawah District, Uttar Pradesh, India","authors":"Kailash Mittal, Parveen Mendiratta, N. Bala","doi":"10.18410/jebmh/2021/584","DOIUrl":"https://doi.org/10.18410/jebmh/2021/584","url":null,"abstract":"BACKGROUND Chemotherapy-induced nausea and vomiting (CINV) is a frequent and feared adverse effect of cancer chemotherapy. International guidelines recommend combinations of 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, dexamethasone, and/or neurokinin-1 (NK1) receptor antagonists for the control of CINV in patients receiving highly emetogenic chemotherapy (HEC) as a part of their treatment. Even though, nausea in delayed period is less controlled and poses a major concern for these patients. METHODS This open label, prospective study was conducted in a rural medical college in Etawah District in Uttar Pradesh, India from November 2017 to November 2018 over a period of 1 year to observe the efficacy of low dose (5 mg OD) olanzapine in combination with standard anti-emetic regimen for the prevention of CINV. Olanzapine is a food and drug administration (FDA) approved antipsychotic drug that has anti-emetic activity and has shown to improve CINV. Low dose olanzapine along with a standard combination of ondansetron, dexamethasone and aprepitant was given to patients receiving highly emetogenic chemotherapy (Cisplatin >70 mg/m2 or doxorubicin-cyclophosphamide combination). CINV was assessed using common toxicity criteria of adverse events (CTCAE) version 5.0. RESULTS Complete response to nausea was observed in 90.90 %, 60.60 % and 54.54 % in acute, delayed and overall period respectively. Complete response to vomiting was observed in 96.96 %, 69.69 % and 66.66 % in acute, delayed and overall period respectively. Complete response to Grade-2 (or above) nausea was observed in 96.96 %, 93.93 % and 90.90 % in acute, delayed and overall period, respectively. Daytime Grade -3 somnolence which was seen in 2/33 patients (6.06 %) was attributable to olanzapine. Patients receiving olanzapine were more likely to have complete response of nausea and emesis in the early, late, and overall assessment periods especially of higher grade (G2 and G3). CONCLUSIONS The authors concluded that low dose olanzapine 5 mg OD combined with an NK1- receptor antagonist, a 5-HT3–receptor antagonist, and dexamethasone is safe and efficacious in the prevention of CINV in patients receiving HEC. KEYWORDS Olanzapine, Low Dose, CINV, HEC","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83185604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Two Muscle Relaxants for Tracheal Intubation in Patients Undergoing Surgery at Goa Medical College and Hospital","authors":"Anisha Deulker, R. Pai, S. Kamat, Eufemia Dias","doi":"10.18410/jebmh/2021/567","DOIUrl":"https://doi.org/10.18410/jebmh/2021/567","url":null,"abstract":"BACKGROUND Cisatracurium and atracurium are intermediate acting muscle relaxants which do not depend on renal or hepatic metabolism for elimination since they undergo Hofmann elimination. Despite the advantages of cisatracurium such as minimal effects on the cardiovascular system, no accumulative effects, no metabolite toxicity, and metabolic product has no neuromuscular blocking effects, due to slow onset and unsatisfactory intubating conditions, the use of cisatracurium is limited compared with those seen with equipotent doses of other neuromuscular blocking agents. This study was undertaken to find onset time and intubating conditions with 3 × ED95 doses of atracurium versus cisatracurium. METHODS ASA grade 1 or 2 patients, (N = 220) were randomly allocated into 2 groups to receive equipotent doses of either atracurium or cisatracurium. Intubating conditions were assessed using Cooper et al scale and neuromuscular monitoring done using TOF Watch SX. Haemodynamic responses and any adverse effects were noted. RESULTS The onset time was 167.36 ± 75.41 seconds (2.78 ± 1.25 minutes) in atracurium group whereas in cisatracurium group, onset time was 249.26 ± 75.90 seconds (4.15 ± 1.26) and the difference was statistically significant with p value of < 0.001. The difference in intubating conditions between the groups was statistically insignificant. However, atracurium produced a higher incidence of clinically acceptable conditions (excellent in 94.4 %) than cisatracurium (excellent in 87.3 %). The incidence of adverse effects such as erythema, flushing and bronchospasm was greater in Atracurium group though hypotension was observed in both groups. CONCLUSIONS Onset time and intubating conditions are significantly better with equipotent doses of atracurium compared to cisatracurium. But atracurium is associated with higher incidence of adverse effects such as erythema, flushing and bronchospasm, though the potential of cisatracurium to cause anaphylactoid reactions cannot be ignored. KEYWORDS Cisatracurium, Atracurium, Muscle Relaxants, Neuromuscular Blocking Agents, Erythema, Flushing, Bronchospasm, Hypotension, Anaphylactoid Reactions","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86304213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}