Mean Pulse Rate Research Articles

The Comparison of Deep Sedation and Moderate Sedation in Pneumatic Balloon Dilation of Achalasia Patients

Background: Pneumatic Balloon Dilation (PBD) as an achalasia treatment is painful procedure because of tearing the lower esophageal sphincter (LES) muscle fibres. Recently, two sedation methods including the moderate sedation and deep sedation are used for increasing the convenience of the patients and gastroenterologist.
 Methods: To compare the efficacy of moderate and deep sedation in PBD in treatment of Idiopathic Achalasia (IA).
 Results: We prospectively assessed 200 IA patients. The first 100 patients (group A) underwent PBD by the moderate sedation using diazepam or midazolam and meperidine injections. The patients in the group B (100 patients) received midazolam, fentanyl and propofol as a deep sedation. The pulse rate (PR), systolic and diastolic blood pressure (SBP, DBP), respiratory rate (RR), and oxygen saturation were monitored before, during and after PBD and achalasia symptom scores (ASS) were collected before and 1.5 months after treatment. The mean PR during and after procedures in the group B were significantly lower compared to the group A (p 0.001, 0.028). The patients in group B revealed less SBP and DBP after PBD versus group A (p 0.004, 0.002). The mean psi for 30 mm and 35 mm balloon dilators were significantly increased in group B compared to group (p 0.0001, 0.002).
 Conclusion: We concluded that the deep sedation of achalasia patients in the PBD process can improved the efficacy of PBD and decreased the complications (transient chest pain) of the procedures. The patients with the deep sedation revealed less tachycardia and blood pressure rising and tolerated more pressure in balloon dilators.

Evaluation of Physiological Parameters During Recovery in Children Treated Under General Anesthesia - A Retrospective Cohort Study

Introduction: General anesthesia is used predolminantly in pediatric dentistry. However, certain concerns over evaluating physiological parameters in children after postoperative dental treatment after under-recovery of general anesthesia still remain a concern Aim: The current study aim is to evaluate the physiological parameters during postoperative treatment on children treated over general anesthesia. Materials and methods: Children under the age group of 1-12 years were included in the study. The data of physiological parameters which include, systolic and diastolic blood pressure, pulse rate were taken into the study from the DIAS record and were analyzed using SPSS software. Results: 
 The results show that the mean value of systolic heart pressure is 74.06, diastolic blood pressure is 37.52 and the average mean pulse rate is 131. Conclusion: The study concludes that all the physiological parameters were within the normal range during recovery in children who underwent dental treatment under general anesthesia.

Effect of Routine dental procedures on the pulse rate and peripheral oxygen saturation in pediatric patients

Dental treatment can cause anxiety in a child further leading to physiological changes that affects the success of dental care. This cross-sectional study was carried out to assess the changes in the pulse rate and peripheral oxygen saturation in children undergoing routine dental treatment. Total 80 patients of 6 to 12 years old were included in the study who were divided into four groups according the dental treatment they receive. Data was analyzed using SPSS-16. It was observed that the patients undergoing extraction (group IV) had higher mean pulse rate before, during and after the procedures; 100.25±9.33, 101.85±13.52, 98.85±7.63 respectively. Lowest SpO2 was recorded in the patients undergoing pulp therapy before the procedure (96.90±3.66). Pulse rate was higher in females compared to males but it was not statistically significant. The children in extraction group selecting facial image scale 4 had more mean pulse rate before during and after the procedure. The mean pulse rate was high in patients undergoing extraction in both first visit (103.00±9.21) and subsequent visits (101.36±15.28). It was concluded that physiological changes occur during routine dental treatment therefore monitoring should be done in order to prevent any dental emergencies.

Corrected QT interval in cirrhosis: A systematic review and meta-analysis.

Corrected QT (QTc) interval is prolonged in patients with liver cirrhosis and has been proposed to correlate with the severity of the disease. However, the effects of sex, age, severity, and etiology of cirrhosis on QTc have not been elucidated. At the same time, the role of treatment, acute illness, and liver transplantation (Tx) remains largely unknown. To determine the mean QTc in patients with cirrhosis, assess whether QTc is prolonged in patients with cirrhosis, and investigate whether QTc is affected by factors such as sex, age, severity, etiology, treatment, acute illness, and liver Tx. In the present systematic review and meta-analysis, the searching protocol "{[QTc] OR [QT interval] OR [QT-interval] OR [Q-T syndrome]} AND {[cirrhosis] OR [Child-Pugh] OR [MELD]}" was applied in PubMed, EMBASE, and Google Scholar databases to identify studies that reported QTc in patients with cirrhosis and published after 1998. Seventy-three studies were considered eligible. Data concerning first author, year of publication, type of study, method used, sample size, mean age, female ratio, alcoholic etiology of cirrhosis ratio, Child-Pugh A/B/C ratio, mean model for end-stage liver disease (MELD) score, treatment with β-blockers, episode of acute gastrointestinal bleeding, formula for QT correction, mean pulse rate, QTc in patients with cirrhosis and controls, and QTc according to etiology of cirrhosis, sex, Child-Pugh stage, MELD score, and liver Tx status (pre-Tx/post-Tx) were retrieved. The Newcastle-Ottawa quality assessment scale appraised the quality of the eligible studies. Effect estimates, expressed as proportions or standardized mean differences, were combined using the random-effects, generic inverse variance method of DerSimonian and Laird. Subgroup, sensitivity analysis, and meta-regressions were applied to assess heterogeneity. The study has been registered in the PROSPERO database (CRD42023416595). QTc combined mean in patients with cirrhosis was 444.8 ms [95% confidence interval (CI): 440.4-449.2; P < 0.001 when compared with the upper normal limit of 440 ms], presenting high heterogeneity (I2 = 97.5%; 95%CI: 97.2%-97.8%); both Egger's and Begg's tests showed non-significance. QTc was elongated in patients with cirrhosis compared with controls (P < 0.001). QTc was longer in patients with Child-Pugh C cirrhosis when compared with Child-Pugh B and A (P < 0.001); Child-Pugh B patients presented longer QTc when compared with Child-Pugh A patients (P = 0.003). The MELD score was higher in patients with cirrhosis with QTc > 440 ms when compared with QTc ≤ 440 ms (P < 0.001). No correlation of QTc with age (P = 0.693), sex (P = 0.753), or etiology (P = 0.418) was detected. β-blockers shortened QTc (P< 0.001). QTc was prolonged during acute gastrointestinal bleeding (P = 0.020). Tx tended to improve QTc (P < 0.001). No other sources of QTc heterogeneity were revealed. QTc is prolonged in cirrhosis independently of sex, age, and etiology but is correlated with severity and affected by β-blockers and acute gastrointestinal bleeding. QTc is improved after liver Tx.

The Effects of Remifentanil, Dexmedetomidine, and Metoral as Adjuncts to Thiopental on Hemodynamic Status After Electroconvulsive Therapy in Patients with Major Depressive Disorder: A Randomized Controlled Clinical Trial.

Depression is a prevalent mental disorder affecting more than 300 million people of all ages globally. Despite being the first-line treatment for depression, antidepressant medications are only effective for 60% - 70% of patients. Electroconvulsive therapy (ECT) is an effective treatment for severe cases, although it can result in short-term side effects. This study aimed to compare the effectiveness of remifentanil, dexmedetomidine, and metoral as premedications for ECT in patients with major depressive disorder (MDD). In this prospective double-blinded randomized controlled clinical trial, a total of 120 MDD patients aged 18 - 60 were included. They were randomly assigned to receive remifentanil, dexmedetomidine, or metoral in combination with thiopental before ECT. Hemodynamic responses (mean arterial blood pressure, pulse rate, arterial blood oxygen saturation), seizure duration, recovery time, agitation scores, and patient satisfaction scores (reverse coded) were measured and compared. Dexmedetomidine exhibited superior hemodynamic control with lower mean arterial blood pressure (P < 0.001) and pulse rate (P < 0.001) than remifentanil and metoral. Patients receiving dexmedetomidine or remifentanil showed reduced agitation (P < 0.001) and better satisfaction than the metoral group (P < 0.001). Remifentanil displayed intermediate outcomes, while metoral exhibited the least favorable results. Seizure duration was not significantly different between the dexmedetomidine and remifentanil groups (P = 0.843). Dexmedetomidine is considered the most satisfactory group due to the better control of blood pressure, heart rate, and agitation and better patient satisfaction despite the longer recovery time.

Blood pressure and electrocardiographic profile of children with sickle cell anaemia in steady-state and vaso-occlusive crisis.

To compare the cardiovascular features of patients with sickle cell anaemia (SCA) in steady-state with those in vaso-occlusive crisis (VOC) at the Wesley Guild Hospital (WGH). A descriptive cross-sectional, matched, case-control study among children with SCA at the WGH, a tertiary health facility in southwest Nigeria. The participants were recruited from the children's emergency unit and paediatric haematology clinic of the WGH. Consisted of 93 children with VOC (cases) and 93 age and sex-matched in steady state (controls), aged 5 - 15 years. Cardiovascular parameters, including pulse rate, blood pressure, and electrocardiographic profile, were assessed and compared using the appropriate statistical tests. The mean (SD) age of the cases and controls were 8.8 (3.2) years and 9.0 (3.1) years, respectively (p= 0.106). There was no significant difference in the mean height of the groups. The mean pulse rate, diastolic, systolic, and mean arterial pressures were significantly higher in the cases than in the controls. A significantly higher proportion of the cases than the controls also had a higher frequency of heart blocks, prolonged QTc interval, ST elevation or depression, and T wave abnormality (p = 0.018, 0.039, 0.041, 0.009, respectively). The prevalence of chamber enlargements was not significantly different between the two groups. Cardiovascular dysfunction is worse during VOC when compared with steady state. Physicians should look for these dysfunctions in SCA children with VOC to reduce mortality from the disease. None declared.

Evaluation of the Erbium-doped Yttrium Aluminum Garnet Laser and the Conventional Method on Pain Perception and Anxiety Level in Children during Caries Removal: A Randomized Split-mouth Study.

To assess and compare children's anxiety level and pain perception during cavity preparation using an erbium-doped yttrium aluminum garnet (Er:YAG) laser vs traditional rotational treatment. A randomized, controlled, split-mouth clinical trial was carried out in 35 healthy children with 70 carious primary molars. Teeth were divided equally into two groups according to the method of treatment. A bur was used to prepare the cavity in one quadrant, while an Er:YAG laser was used to prepare the cavity in the other quadrant. Anxiety was assessed using Venham's dental anxiety scale and a fingertip pulse oximeter. The pain was assessed using the Wong-Baker Face Pain Rating Scale, and the number of local anesthesia (LA) needed during both procedures was also considered. The mean age was 9.4 ± 1.29. Males accounted for 51.4% of the participants. There were no statistically significant variations in pulse rate at the baseline between Er:YAG laser and the conventional treatments. The mean pulse rate was higher during the conventional intervention than during the laser intervention; this difference was statistically significant vs the baseline pulse rate. The mean pulse rate with the conventional method was significantly higher during and after cavity formation than with the laser method. The Er:YAG laser and the conventional groups showed statistically significant differences in the Venham's and Wong-Baker scores. The scores of both scales were much higher in the conventional group. The number of participants who requested LA during the conventional technique was significantly higher than during the laser procedure. Using Er:YAG lasers to remove caries produces minimal pain and anxiety and reduces the requirement for LA. During cavity preparation, the Er:YAG laser helps children stay calm. Abdrabuh RE, El Meligy OAES, Felemban OM, et al. Evaluation of the Erbium-doped Yttrium Aluminum Garnet Laser and the Conventional Method on Pain Perception and Anxiety Level in Children during Caries Removal: A Randomized Split-mouth Study. Int J Clin Pediatr Dent 2023;16(S-1):S39-S44.

Effect of Breathing Exercises on Spo2 Levels and Pulse Rate in Covid-19 Patients

The impact of COVID-19 grew worse by its quick onset, the overwhelming number of patients in need of urgent care, and the lack of awareness of its signs beforehand. It mostly affected the respiratory system, making respiratory rehabilitation extremely important. This study was carried out to see the effectiveness of breathing exercises along with the postural changes in COVID-19 patients under acute hospital care. A total of 40 subjects with age group between 18 years to 60 years, diagnosed with COVID-19 were included according to the selection criteria and were divided into 2 equal groups of 20 subjects each. The subjects in Group A received positioning protocol while those in Group B received breathing exercises along with positioning protocol. After 7 days of intervention, the mean SpO2(88.6% vs 89.9%, P&lt;0.001) and pulse rate (82 vs 91 beats/minute, P&lt;0.001) for Group A and Group B respectively. This study concluded that breathing exercises along with postural changes in patients hospitalized with COVID-19 is an effective rehabilitation program for improving SPO2 levels and pulse rate. KEYWORDS: Breathing exercises, COVID-19, Postural changes, Respiratory rehabilitation.

A Comparative Study of the Safety and Efficacy of Amlodipine and Enalapril when Prescribed as Monotherapy in Patients with Isolated Systolic Hypertension

Background: Most elderly patients with high blood pressure have isolated systolic hypertension. Enalapril and amlodipine are respectively the most commonly prescribed ACE inhibitors and calcium channel blockers in Nepal. The goal of the current study was to compare the adverse drug reaction associated with amlodipine and enalapril in the study population as well as to compare the mean blood pressure and pulse rate reductions caused by amlodipine and enalapril in isolated systolic hypertensive patients.&#x0D; Materials and Methods: A comparative cross-sectional study was performed on 72 patients of both genders within the age group of 30 to 90 years; with isolated systolic hypertension; attending the out-patients department of Medicine of Nobel Medical College and Teaching Hospital; from December 2022 to February 2023. Mean reductions in systolic and diastolic blood pressure in the two treatment groups over the eight-weeks study period was calculated and then compared. Frequencies of patients developing different side effects was also calculated and compared between the two groups.&#x0D; Results: Systolic blood pressure was reduced by 16.1% in amlodipine group and by 18.8 % in enalapril group. Enalapril was slightly more efficacious in reducing the systolic blood pressure but such changes were found to be of no significant difference when compared between the two groups. (p &gt; 0.05). The incidence of adverse effect was more in the amlodipine group in comparison to the enalapril group. Dry cough, dizziness, headache and fatigue with enalapril; and headache, peripheral edema, shortness of breath, fatigue, and flushing and dizziness with amlodipine were the common adverse effects.&#x0D; Conclusion: Both amlodipine and enalapril were equally effective in lowering systolic blood pressure without significantly lowering diastolic blood pressure. They were also generally well tolerated, though amlodipine was slightly more likely to cause side effects.

Relationship between respiratory event-related arousal and increased pulse rate in patients with obstructive sleep apnea

Objective: To investigate the relationship between respiratory event-related arousal and increased pulse rate in patients with obstructive sleep apnea (OSA), and to evaluate whether elevated pulse rate can be used as a surrogate marker of arousal. Methods: A total of 80 patients [40 males and 40 females, age range (18-63 years), mean age (37±13) years] who attended the Sleep Center of the Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital for polysomnography (PSG) from January 2021 to August 2022 were enrolled. Stable PSG recordings of non-rapid eye movement (NREM) sleep to compare the mean pulse rate (PR), the lowest PR 10 seconds before the onset of arousal, and the highest PR within 10 seconds after the end of arousal associated with each respiratory event. At the same time, the correlation between the arousal index and the pulse rate increase index (PRRI), as well as ΔPR1 (highest PR-lowest PR) and ΔPR2 (highest PR-mean PR), respectively, with the duration of respiratory events, the duration of arousal, the magnitude of pulse oximetry (SpO2) decline, and the lowest SpO2 was analyzed. Among the 53 patients, 10 events without arousal and 10 events with arousal (matched for the magnitude of SpO2 decline) were selected for NREM in each of the 53 patients, and ΔPR before and after termination of respiratory events in the two groups was compared. In addition, 50 patients were simultaneously subjected to portable sleep monitoring (PM) and divided into non-severe OSA group (n=22) and severe OSA group (n=28), and ΔPR≥3 times,≥6 times,≥9 times, and≥12 times after respiratory events were used as surrogate markers of arousal, and ΔPR was scored manually and integrated into the respiratory event index (REI) of PM. Then, we compared the agreement between REI calculated from the four PR cut-off points and the apnea-hypopnea index (AHIPSG) calculated by the gold standard PSG. Results: ΔPR1 [(13±7)times/min] and ΔPR2 [(11±6)times/min] were significantly higher in patients with severe OSA than in patients with non-OSA,mild and moderate OSA. The arousal index was positively correlated with the four PRRIs (r 0.968, 0.886, 0.773, 0.687, P<0.001, respectively), and the highest PR [(77±12) times/min] within 10 s after the end of arousal was significantly higher than the lowest PR [(65±10) times/min, t=113.24, P<0.001] and the mean PR [(67±11) times/min, t=103.02, P<0.001]. ΔPR1 and ΔPR2 were moderately correlated with the decrease in SpO2 (r=0.490, 0.469, P<0.001). After matching the magnitude of SpO2 decline, the ΔPR[(9±6)/min] before and after the termination of respiratory events with arousal was significantly higher than that of respiratory events without arousal [(6±5)/min, t=7.72, P<0.001]. The differences between REI+PRRI3 and REI+PRRI6 and AHIPSG in the non-severe OSA group were not statistically significant (P values 0.055 and 0.442, respectively), and REI+PRRI6 and AHIPSG showed good agreement (the mean difference was 0.7 times/h, 95%CI 8.3-7.0 times/h). The four indicators of PM in the severe OSA group were statistically different from AHIPSG (all P<0.05), and the agreement was poor. Conclusions: Respiratory event-related arousal in OSA patients is independently associated with increased PR, and frequent arousal may lead to increased frequency of PR fluctuations, and elevated PR may be used as a surrogate marker of arousal, especially in patients with non-severe OSA, where elevated PR≥6 times significantly improves the diagnostic agreement between PM and PSG.

Comparison of Intubating Conditions at 60 Seconds with Cisatracurium 4*ED95 Dose and Cisatracurium 2*ED95 Dose Plus Priming Dose and Low Dose Ketamine.

To compare the intubating conditions at 60 seconds between 4*ED95 dose of cisatracurium and 2*ED95 dose of cisatracurium in combination with priming and low dose ketamine. jaw relaxation for laryngoscopy, vocal cord position on laryngoscopy, and coughing or bucking response to intubation. To compare the hemodynamic changes up 10 minutes after intubation in the two groups. In this prospective study, a total of 68 patients were undergoing general anesthesia for surgery with placement of endotracheal tube placement. Patients will be divided into two groups comprising 34 patients each. The patients were allocated one of the two groups by computerized randomization. *Group A received bolus dose of cisatracurium which is 0.2 mg/kg (4*ED95). **Group B received cisatracurium in dose of 0.1 mg/kg (2*ED95) with priming (which is 10% of the bolus dose) and low dose ketamine of about 0.5 mg/kg. It was possible to achieve acceptable laryngoscopy and intubating condition in both the groups within 90 seconds. When grades of laryngoscopy and ease of intubation were compared, 2*ED95 dose along with priming plus low dose ketamine produced superior results than 4*ED95 group. When the mean arterial pressure and pulse rate were compared between the two groups, it was observed that mean arterial pressure and pulse rate were only slightly higher in the 2*ED95 along with priming and ketamine.

Predictors of 30-day mortality in patients with an international normalized ratio of 4.5 - 10 due to warfarin-related overanticoagulation: a retrospective cohort study

Purpose: Although it has been shown that vitamin K administration does not benefit patients with INR levels between 4.5 to 10, there are studies in the literature showing that some complications including the risk of bleeding in these patients increase significantly. For this reason, it is crucial to select high-risk patients who present with elevated INR to apply closer follow-up and monitoring. The primary objective of our study is to define the predictors for 30-day mortality of the patients with an INR between 4.5 to 10 due to warfarin-related overanticoagulation. The secondary objective of our study is to derive a regression model which can predict mortality in 30 days and to compare the performance of this model with the National Early Warning Score-2(NEWS-2).&#x0D; Materials and Methods: We included patients older than 18 years old, admitted between the dates 01.01.2016 - 01.01.2022 who are using warfarin as medication and with an INR between 4.5 – 10 in our study. We excluded patients with trauma, major bleeding on admission or patients with missing data. For the regression model, backward-wald stepwise method was utilized. We used the Hosmer-Lemeshow test for the goodness of fit. For the overall performance of the model, we evaluated the Nagelkerke R Square, and the Reciever Operating Characteristics test. DeLong test was used to compare the area under the curves (AUC).&#x0D; Results: A total of 263 patients were examined in the statistical analysis. Mean arterial pressure, SpO2, pulse rate, and age were the independent predictors of 30-day mortality. The model have classified 81.4% of the patients correctly. The AUC of the regression model was 0.848 (0.799 to 0.898). The sensitivity of the model as a tool for mortality prediction was 94.1%, specificity 66.5%, and accuracy 71.9%. The AUC of the NEWS-2 score for 30-day mortality was calculated as 0.782 (95%CI = 0.715 to 0.849). The difference between the AUCs of our model and the NEWS-2 score was statistically significant.&#x0D; Conclusion: Mean arterial pressure, SpO2, heart rate, and age were the independent predictors for the 30-day mortality of patients with an INR between 4.5 to 10 due to overanticoagulation because of warfarin medication. The regression model we derived showed good overall discrimination and performed significantly better than NEWS-2 score.

Playing it down - effectiveness of clay therapy, origami and building blocks in the management of dental anxiety among children aged 6-10 years

Background: Children experience dental anxiety during their first dental visit, which affects the quality of dental treatment and gives rise to behaviour management problems. Clay, origami and building blocks have been effective in alleviating hospitalization anxiety in pediatric patients. These successful techniques in hospitalized pediatric patients have seldom been used in the dental set up. Therefore, the aim of this study is to assess and compare the efficacy of clay therapy, origami and building blocks in the management of dental anxiety in children aged 6-10 years. Methods: Sixty children aged 6-10 years, with no previous dentist exposure, with Frankl’s behaviour rating 2 or 3 having dental caries with international caries detection and assessment system (ICDAS) score 3 requiring restorations without local anesthesia were selected and divided into four groups. Group 1 – clay therapy; group 2 - building blocks; group 3 – origami; and group 4 – tell show do. Pulse rate, facial image scale (FIS) and face, leg, activity, cry, consolability (FLACC) behaviour scales were used to quantify anxious behaviour. Operator compliance and parent acceptance was rated on the Likert scale. Results: The results showed lower mean pulse rates, lower FIS and FLACC scores, and better operator compliance and parental acceptance in clay therapy, origami and building blocks groups than in the conventional tell-show-do group. The most significant reduction in all the parameters was seen in the clay therapy group. Conclusions: Clay therapy, origami and building blocks can be used as an effective means to reduce dental anxiety in children.

A Prospective Observational Study to Evaluate Cardiovascular Changes in Patients of Hypothyroidism.

Introduction Hypothyroidism is a common endocrine disorder in India and is easy to diagnose based on clinical manifestations and signs. Thyroid hormone affects the cardiovascular system. Fatiguability, dyspnea, weight gain, lower limb swelling, and bradycardia are some clinical manifestations. ECG changes in hypothyroidism include sinus bradycardia, prolonged QTc interval, changes in the morphology of the T-wave, QRS duration, and low voltage. Echocardiography changes include diastolic dysfunction, asymmetrical septal hypertrophy, and pericardial effusion. This study aimed to examine the cardiovascular changes in patients with hypothyroidism. Methodology Patients with hypothyroidism and cardiovascular changes were assessed using an electrocardiogram and echocardiography. Results A total of 68 hypothyroid patients were enrolled in the study. The mean age of patients was 41.93 ± 15.36 years, and the mean BMI was 24.64 ± 4.30 kg/m2. Of 68 hypothyroid patients, 57 (83.8%) were females, and 11 (16.2%) were males. The mean thyroid-stimulating hormone (TSH) level in the study population was 11.48 ± 22.02 (mIU/mL). The most common symptoms reported among the study participants were tiredness or weakness (67.6%), followed by dyspnea (42.6%). The mean pulse rate, systolic blood pressure, and diastolic blood pressure were 81.50 ± 16.16, 112.76 ± 7.05, and 70.68 ± 7.46, respectively. Pallor was the most common sign (22.1%) among all the people who participated in the study. The most common findings on the ECG were low voltage complexes (25%) followed by inversion of the T wave (23.5%). Other ECG findings were bradycardia (10.3%), right bundle branch block (7.4%), and QRS prolongation (2.9%). Echocardiography revealed 21 (30.8%) patients with grade 1 left ventricular diastolic dysfunction and pericardial effusion in two patients (2.94%). There was a significantly greater increase in the level of TSH in study participants. Conclusion Patients with abnormal ECG and echocardiography without other cardiovascular changes should be evaluated for hypothyroidism to improve the quality of care.

STUDY OF URIC ACID LEVELS IN PATIENTS WITH HYPOTHYROIDISM AND ITS CORRELATION WITH SERUM THYROID STIMULATION HORMONE LEVELS

Aim: we aimed to investigate whether there is a correlation between uric acid levels and TSH levels in the patients with hypothyroidism. This observational cross-sectional study was Material and method: conducted on patients attending OPD/ IPD of Hospitals afliated to Bangalore Medical College and Research Institute, Bangalore from November 2019 to May 2021. Data of all the patients satisfying the inclusion and exclusion criteria was collected. Data was analyzed by descriptive statistics. Pearson correlational analysis/Spearman's rank correlation was used to assess the correlation between Uric acid and TSH levels. A total of 90 cases were taken up Results: for the study. The mean age of the subjects was found to be 32±8 years, 82(91%) were females and only 8(9%) were males. The average height of the subjects was 158.67±9.31 cm. The average weight was 63.94±9.72 kg. The mean pulse rate of the subjects was 75.62±5.66, mean RR was 18.63±1.83, mean BP was 111±7/75±5. The average T3 was observed to be 1.59±0.96, average T4 was 3.83±3.73 and average TSH was 30.89±20.93. The mean serum uric acid of the subjects was 6.3±1.28 mg/dl, mean serum creatinine was 0.87±0.15 mg/dl and mean eGFR was 85.44±16.45, mean HB was 11.58±1.69, MCV was 79.81±6.76. Platate count was 2.92±1.35. The average Ferritin was found to be 185.21±359.03. The average LDH was 296.46±106.35, microcytic hypochromic anemia was present in 21(23%) subjects and normocytic normochromic anemia was present in 69(77%) subjects. Pearson correlation analysis showed that there was positive association between TSH and serum uric acid, among the subjects. However, the association was not found to be statistically signicant as p&gt;0.05. Although not statistically Conclusion: signicant, a positive correlation was observed between the uric acid and thyroid stimulating hormone.

The effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students: A pragmatic randomized controlled trial

AimThis study aimed to examine the effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students. BackgroundClinical simulation-based teaching implied a revolution in nursing education. Along with the many opportunities that simulation offers, some disadvantages, such as anxiety and stress experienced during simulation scenarios, could affect students’ satisfaction and self-confidence in learning. Therefore, laughter yoga could be an alternative method that reduces students' anxiety and stress levels and increases their self-confidence and satisfaction with simulation training. DesignThe study was designed as a pragmatic randomized controlled trial. SettingThis study was conducted at a university in Turkey. ParticipantsA total of 88 undergraduate nursing students were randomized to the intervention group (n = 44) or control group (n = 44). MethodsThe intervention group participated in the laughter yoga sessions just before the clinical simulation scenario, while the control group only performed the simulation training. The researchers examined the effect of laughter yoga on state anxiety, perceived stress levels, self-confidence and satisfaction in learning before and after the intervention. Data were collected between January - February 2022. ResultsThis study showed that the mean scores of state anxiety, perceived stress, mean pulse rate and arterial pressure of the intervention group were significantly lower than those of the control group (p < 0.05). In addition, there was also a significant group*time interaction between the groups on state anxiety, perceived stress, pulse, respiratory and mean arterial pressure scores (p < 0.05). Moreover, the mean scores of student satisfaction and self-confidence in the learning of the intervention group were significantly higher than those of the control group (p < 0.05). ConclusionThe findings showed that laughter yoga helped nursing students reduce their state anxiety and perceived stress levels related to simulation training and improved their self-confidence and satisfaction with learning. Additionally, it enhanced the students' vital signs (including mean pulse rate and mean arterial pressure). These positive results are promising for using LY as an easy, safe and effective method to reduce undergraduate nursing students’ stress and anxiety levels and to improve their learning satisfaction and self-confidence levels in clinical skills training such as simulation training.

Penetrating cardiac injury presentation and management in resource-limited settings: A case series from Ethiopia

Introduction and importancePenetrating cardiac injury is rare (0.1 % of trauma admissions) but fatal. Presentation is with features of cardiac tamponade or hemorrhagic shock. Urgent clinical evaluation, ultrasound, temporizing pericardiocentesis or surgical repair with cardiopulmonary bypass as back up consist of standard management. In this paper, experience of management of penetrating cardiac injury from a resource limited country is presented. Case presentationsThere were seven patients, five had a stab injury and two had gunshot wound. All were men with mean age of 31.1 years. Patients arrived within 30 min (3), 2 h (2), 4 h (1) and 18 h (1) after injury. Mean initial blood pressure and pulse rates were 83/51 mm Hg and 121, respectively. One patient had pericardiocentesis before referral. Exploration was via left anterolateral thoracotomy. Four (57.1 %) had right ventricle perforation, one had both right and left ventricle, and two (28.5 %) had left ventricle perforation. Suture repair (6) and pericardial patch (1) were done without bypass machine as back up. Mean duration of stay in the intensive care unit and in the surgical wards were 4.4 days (range: 2–15) and 10.8 days (range: 1–48), respectively. All were discharged improved. Clinical discussionPenetrating cardiac injury presents with low blood pressure and tachycardia after stab or gunshot wounds. Right ventricle is mostly affected. Pericardiocentesis can be done as temporary measure. While having bypass machine as back up is recommended, the absence of it should not preclude intervention. Suture repair can be done with left anterolateral thoracotomy. ConclusionPenetrating cardiac injury can be managed in resource limited settings without back up of cardiopulmonary bypass. Early identification and surgical intervention results in favorable outcome.

Management of Attention-Deficit Hyperactivity Disorder Children for Dental Procedures.

Background A common psychiatric problem called attention-deficit hyperactivity disorder (ADHD) is characterized by impulsivity with resultant behavior issues and a very short attention span. The purpose of this study was to evaluate and compare the management of dental procedures in children with and without ADHD employing various behavior modification techniques. Materials and methods The study consisted of 121 children divided into two groups with 60 children diagnosed with ADHD and 60 children without ADHD between 7 and 15 years of age. Each of the three sessions, which were spaced a week apart, included a dental examination, oral prophylaxis, and a minor restorative procedure. The pulse rate (PR) and oxygen saturation (SpO2) were measured during each of these sessions. The study was conducted to evaluate the Tell-Show-Do (TSD) method, audiovisual distraction, and pharmacological management of children with and without ADHD during the dental procedure. IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States) was used to statistically analyze the findings. The mean values of the parameters from the three sessions were analyzed and compared using the Z-test. Result The children with ADHD included 39 (65%) boys and 21 (35%) girls, and the children without ADHD consisted of 27 (44.26%) boys and 33 (54.09%) girls. The mean values of the PR during sessions two and three were found to be statistically highly significant between the children with and without ADHD for TSD and audiovisual aids. In both groups, the mean SpO2 values for all the sessions were found to be statistically highly significant for the techniques evaluated (p<0.01). The change in the mean PR score for the ADHD children revealed a declining trend from sessions one through three for all the techniques evaluated (p<0.05), demonstrating a statistically significant effectiveness of the various techniques between the two groups and thereby revealing a decreased level of anxiety. Between sessions one and three, all of the three techniques showed a decreasing trend of SpO2 scores, with the exception of the pharmacological management of ADHD children (p<0.01) indicating that the uncontrollable ADHD children feel less anxious than in the other two approaches. Conclusion The findings of the study demonstrated that behavior management techniques were found to be effective at reducing anxiety in ADHD children than in children without ADHD. Our study further suggests that scheduling dental appointments into a series of short visits could enhance the effectiveness of the therapy and better cooperation of the children.

Comparative study of magnesium sulphate nebulization and lignocaine nebulization in prevention of postoperative sore throat (POST)

Background: General anaesthesia (GA) includes intubation a necessary step to provide adequate ventilation in patients under anaesthesia along with protection of airway from regurgitation and aspiration. Postoperative sore throat (POST), hoarseness of voice, cough are common sequelae. The present study compares the efficiency of preoperative nebulization of lignocaine hydrochloride and magnesium sulphate for reducing the incidence of POST in patients under GA. Methods: The study conducted in GMC Kota and attached hospitals on 100 patients of surgery duration one hour to three hours. Patients were randomly allocated in two groups Lignocaine group and Magnesium group. Results: The majority of patients belonged to the age between 40 and 70 years. There was no significant difference in the mean pulse rate, SBP, mean SpO2. Comparison of sore throat in both the groups at rest, just after extubation, 2 hours, 8 hours, 24 hours and 48 hours showed incidence more common in lignocaine group than magnesium group but no significant difference (P&gt;0.05). Hoarsness after extubation reduced within 24 hours in Magnesium group in comparison to Lignocaine group where it persists till 48 hrs. Conclusion: Incidence of sore throat, hoarseness of voice and cough was more common in lignocaine group and more in female patients. Both drugs can be used for prevention of postoperative sore throat, but magnesium sulphate has better results.

Effects of Tourniquet Inflation on Blood Pressure, Mean Arterial Pressure, and Pulse Rate during the Maintenance of Anesthesia Using a Combination of Dexmedetomidine and Isoflurane for Patients Undergoing Lower Extremity Surgery

Introduction: The utilization of pneumatic tourniquets in surgery can help surgeons optimize the surgical field and reduce the amount of bleeding. It can also cause hyperdynamic cardiovascular responses, such as increased blood pressure, mean arterial pressure, and pulse rate, which the administration of analgesia, anti-hypertension, and increased depth of anesthesia cannot correct. Excessive hemodynamic responses can lead to complications due to the utilization of tourniquets, namely increased intracranial pressure and acute heart failure. This study aims to analyze differences in the effects of tourniquet inflation on blood pressure, mean arterial pressure, and pulse rate during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane compared to that using only isoflurane for patients undergoing lower extremity surgery. Methods: This observational cohort study. The statistical test in this study was conducted using the Shapiro-Wilk test for normality and the Spearman test for correlation. The Chi-Square test was carried out to ensure the characteristics of patients in the two groups. Results: The results showed no significant effects of tourniquet inflation on blood pressure, mean arterial pressure, and pulse rate during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane. Meanwhile, tourniquet inflation during the maintenance of anesthesia using only isoflurane resulted in significant effects on blood pressure, mean arterial pressure, and pulse rate. The results also indicated significant differences between the effects of tourniquet inflation during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane and that using only isoflurane on the blood pressure, mean arterial pressure and pulse rate of patients undergoing lower extremity surgery. Conclusion: There are no significant effects of tourniquet inflation during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane on the blood pressure, mean arterial pressure, and pulse rate of patients undergoing lower extremity surgery.