Journal of the Indian Medical Association
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The submental route for endotracheal intubation is an alternative to nasal intubation or tracheo- stomy in the surgical management of patients with complex craniomaxillofacial injuries. The critical indication for submental intubation is the requirement for intra-operative maxillomandibular fixation in the presence of injuries that preclude nasal intubation and in a situation where a tracheostomy is not otherwise required. Maxillomandibular fixation is essential to re-establish dental occlusion for a normal functional result in dentate patients with fractures involving alveolar segments of the jaws. ⋯ Nasotracheal intubation is often used but is contra-indicated in the presence of skull base fractures and will interfere with the access to certain fracture types. A tracheostomy has a high potential complication rate and in many patients, an alternative to the oral airway is not required beyond the peri-operative period. Submental intuba- tion is a simple and useful technique with low morbidity in selected cases of craniomaxillofacial trauma.
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Since significant number of cases of bronchial asthma are first seen by general practitioners (GPs) and physicians, the present study was undertaken to assess the asthma management practices among GPs and physicians in and around Pune city of Maharashtra. It was a prospective study in which 40 GPs and 30 physicians were personally administered a questionnaire dealing with use of diagnostic methods and management plan in chronic asthma. Spirometry was used for diagnosis by 16 physicians (53.3%) and 7 GPs (17.5%) and peak flow meter by 1 GP (2.5%) and 5 physicians (16.6%). ⋯ Overall management skills of physicians were better than GPs. However, they need to be educated about more frequent use of spirometry or peak flow meter in confirmation of diagnosis, increasing use of inhalation therapy, emphasising the role of inhaled steroids to patients and providing optimal asthma education to all patients. There is an urgent need to educate GPs in almost all aspects of asthma management.
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Randomized Controlled Trial Comparative Study
Comparison of injection lignocaine (preservative free) 1.5 mg/kg i.v with oral pregabalin 150 mg for attenuation haemodynamic response to laryngoscopy and tracheal intubation.
Endotracheal intubation is sine quo non for safe conduct of general anaesthesia. Pregabalin, an anticonvulsant drug is being studied for control of haemodynamic response to laryngoscopy and intubation. Some authors have found that pregabalin 150 mg orally attenuates the haemodynamic response to laryngoscopy. ⋯ Pregabalin was more effective than lignocaine in controlling diastolic blood pressure at 1, 3 and 5 minutes following laryngoscopy, and mean arterial pressure at land 3 minutes following laryngoscopy. There was no difference between two groups when systolic BP and rate pressure product were compared. Lignocaine (preservative free) thus, exerts better control over heart rate and pregabalin exerts better control over diastolic and mean blood pressure following laryngoscopy.
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Quality of life is as important as quantity of life, if not more. In some life-threatening diseases, the possibility of cure is sometimes poor, and symptoms of the disease reduce the quality of life too. Improvement of symptoms helps the patients to live more comfortably while allowing them to retain their autonomy and dignity despite the life-threatening disease. ⋯ There are different models and methods of delivery of palliative care and the involvement of family in the care of the patient produces the best outcome. Palliative care can be delivered both at a dedicated centre as well as at the patient's home, depending on the preferences of the patient. This paper discusses the efforts towards providing care for patients in different stages of cancer therapy.
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Even in the light of newer and less nephrotoxic contrast media solutions, their increased use during standard and new radiological procedures has resulted in the growing incidence of contrast-induced nephropathy, an iatrogenic disorder caused by exposure to contrast media. This retrospective study was conducted among the patients admitted in North Bengal Medical College from January 2007 to December 2010 with significant rise in serum creatinine level within 48 to 72 hours of systemic administration of contrast media. The study sample constituted 14 patients with mean age being 45.2 years. ⋯ Once developed, contrast induced nephropathy is associated with high morbidity, long hospital-stay and patient becomes dependent on haemodialysis. Till now, no available current treatment can reverse or ameliorate the condition once it develops. Some precautionary measures taken in the high risk patients before administration of contrast medium is essential to reduce the incidence.