Journal of the Indian Medical Association
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Multicenter Study Comparative Study
Persons with major psychiatric illness in prisons--a three years study.
A research project entitled 'operation oasis' was implemented in West Bengal prisons by SEVAC, supported by the National Human Rights Commission of India for identification of the persons suffering from major psychiatric illnesses (ie, schizophrenia, psychosis not otherwise specified, mood disorder not otherwise specified) in prisons, making arrangements for their psychiatric treatment and rehabilitation and assessing the changes in them after intervention. Dum Dum Central Jail, Presidency Jail (female section), and Berhampore Central Jail were selected as the project fields. The prison inmates were screened through clinical examination and mental state examination. ⋯ During the project implementation period, 3871 prison inmates (male 3527 + female 344) were screened and 10% (n = 401) were identified as suffering from major psychiatric illnesses, of which 64% (n = 258) were housed in the prisons for minor offences/stray cases and 90% (n = 363) were undertrials. The findings concluded with a global assessment of functioning score improvement with a statistical significance of p < 0.01 level (Z = 5.06) for the patients. This study shows that a qualitative change took place in the life situations of the mentally ill people who were brought under the purview of psychiatric treatment and rehabilitation.
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Randomized Controlled Trial Comparative Study
Comparative study of postoperative analgesia and sedation after upper abdominal surgery with thoracic epidural administration of bupivacaine with/without midazolam.
Currently continuous epidural administration of local anaesthetics with opioids is widely used for postoperative analgesia. To avoid the side-effects of opioids a drug that can replace opioids is most welcome. Midazolam not only has no side-effects but also has the advantages of sedation and amnesia. ⋯ Statistically significant differences in pulse, BP, RR and SpO2 were not seen. Better sedation, analgesia scores and amnesia were noted in patients belonging to group B as compared to patients of group A. This combination may thus replace routinely used combinations of opioids and local anaesthetics.
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Randomized Controlled Trial Comparative Study
Pressor responses following insertion of laryngeal mask airway in patients with controlled hypertension: comparison with tracheal intubation.
The present study was undertaken in patients with controlled hypertension to determine the pressor responses following insertion of laryngeal mask airway (LMA) as compared to endotracheal intubation. Two hundred patients with controlled hypertension of either sex, belonging to ASA II undergoing elective surgical procedures of 11/2 to 2 hours duration, were studied in a randomised manner into two equal groups: A(n =100) and B(n = 100) depending on whether LMA or endotracheal tube was used. General anaesthesia and controlled ventilation was undertaken according to standard procedure. ⋯ Heart rate also increased from baseline value in endotracheal intubation group than in LMA (P<0.05). To conclude insertion of LMA was associated with lesser pressure response as compared to endotracheal intubation in patients with controlled hypertension. It is an effective method to avoid laryngoscopic pressor response during endotracheal intubation in hypertensive patients.
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Parenteral non-steroidal anti-inflammatory drugs (NSAIDs) are useful agents in the treatment of postoperative pain and other acute traumatic painful conditions such as fractures. Clinical trials with lornoxicam, an oxicam derivative, document its efficacy as a potent analgesic with excellent anti-inflammatory properties in painful and or/inflammatory conditions including postoperative pain and arthritic conditions. However, there is no documentation of the efficacy and tolerability of intravenous lornoxicam in Indian patients with acute painful conditions such painful traumatic conditions requiring hospitalisation and parenteral analgesics. ⋯ Therapy with intravenous lornoxicam was well tolerated with only 5 patients reporting adverse events such as headache (n=3) and gastritis (n=1) of mild to moderate intensity but transient. Overall, global tolerability was rated as good to excellent in 98.4% of the total cases and fair in only 1.6% of the cases. In conclusion, the results of the present study indicate that intravenous lornoxicam is a potent NSAID with an optimal efficacy/toxicity ratio and thus could be a suitable therapeutic option in the management of patients with painful traumatic conditions requiring parenteral NSAIDs and hospitalisation.