Patients In Group-A Research Articles

MULTIPLE VACUUM SYRINGE BLOOD ASPIRATION PROCEDURE (MVSBAP): A NEW HORIZON OF RAKTAMOKSHANA PROCEDURE IN PANCHAKARMA THERAPY OF AYURVEDA

Panchakarma is a specialized branch of Ayurveda that primarily deals with the body's purification (Shodhana) of doshas. As we know, the word Panchakarma refers to five special therapeutic procedures like Vamana, Virechana, Vasti, Nasya and Raktamokshana. Raktamokshana is an effective bloodletting therapy. Classically it is described as of six types, i.e. (1) Shringa, (2) Jalauka, (3) Alabu, (4) Shiravedha, (5) Prachchhana and (6) Ghatiyantra. In the present study, a clinical trial has been done, especially in the disease of Gridhrasi, with particular reference to Sciatica by combining Parchchhana and Ghatiyantra, a modified form of Raktamokshana therapy, called Multiple Vacuum Syringe Blood Aspiration Procedure (MVSBAP). Sciatica is painful neuralgia of the Sciatic Nerve in which pain starts from the gluteal region and buttock and comes down through the back of thigh, knee, calf and outer border of the foot. Sixty patients were selected for the clinical trial using a simple random sampling method from the OPD and IPD of Government Ayurveda College and Hospital, Varanasi, Uttar Pradesh, India. Two groups are made like Group-A and Group-B, each consisting of 30 patients. Patients of Group-A are treated with only traditional Ayurvedic medicines, and patients of Group-B are treated with MVSBAP and traditional Ayurvedic medication. After one month of final treatment, assessment is done on statistical parameters, which show pretty better results in Group-B patients. The application of MVSBAP in the disease of Gridhrasi draws a new horizon to the ailing humanities.

Comparison of Vonoprazan and Amoxicillin Dual Therapy with Standard Triple Therapy with Proton Pump Inhibitor for Helicobacter Pylori eradication: A Randomized Control Trial.

Objectives:To compare the efficacy of Vonoprazan based dual treatment versus PPI based treatment for the eradication of Helicobacter pylori infection.Methods:A randomized controlled trial was conducted in Department of Medicine/Gastroenterology Ruth KM Pfau Civil Hospital, DMC during the period of 22 June to 21 September 2021. Sample size was calculated as 96 in each Group. All patients of age 18-75 years with Helicobacter Pylori Infection were inducted and randomly allocated to two groups. Group-A: were given Capsule Amoxicillin 1 gm; Tablet Clarithromycin 500 mg; Capsule Omeprazole 20 mg all medications were given twice daily for two weeks. Group-B were given Capsule Amoxicillin 1 gm; Tablet Vonoprazan 20 mg (Vonozon©, m/s Getz Pharma, Pakistan) twice daily for two weeks. Confirmation of Hp eradication was done by stool Hp antigen test four weeks after completion of treatment. Nine and four patients were lost to follow-up in Group-A & B respectively. Analysis was conducted on 87 patients in Group-A and 92 patients in Group-B.Results:Out of eighty-seven patients in Group-A and ninety-two patients in Group-B, 73 (83.9%) patients in Group-A and 86 (93.5%) patients in Group-B had negative H pylori result respectively after treatment (p = .042). Significantly higher frequencies of adverse events were observed in Group-A as compared to Group-B in nausea/vomiting (p = .035) and bloating (p = .045).Conclusion:VA-dual provides an acceptable eradication rate with fewer adverse events.

A Clinico-Pathological Study on Pleehodaraw.s.r. to Splenomegaly and its Comparative Management with Sarapunkha Ksharaand Sarapunkha Ghana Vati

Introduction-Udara rogasare classified into 8 types according to different Acharyas.Pleehodarais one among them.The main cause behind the development of Udara rogais ‘Mandagni’. In Ayurveda Pleehodaramay be correlated with Splenomegaly. Sarapunkhaa herbal drug mentioned in Ayurvedaclassics is effective in Pleehodara.So, a comparative single blind study of Sarapunkha Ksharaand Sarapunkha Ghana Vatiare taken into consideration for clinical trial for present study. Aims:To study about the comparative clinical efficacy of Sarapunkha Ksharaand Sarapunkha Ghana Vatiin the management of Pleehodara.Material and Methods-This is a single-blind comparative clinical study with a pre-test and post-test design. The patients were Randomly categorised into two groups.30 patients of Group-A(15) and Group-B(15) patients were registered from OPD and IPD of Govt. Ayurvedic College and Hospital, Balangir presented with Subjective parameters and Objective Parameters. After diagnosis they were under trial withAyurvedicformulations of Sarapunkha Ksharagiven 500mg twice daily after food in Group A and Sarapunkha Ghana Vatigiven 2tab(1 tab-500mg) twice daily after food with luke warm water for a period of 30 days respectively. The subjective and objective parameters were assessed in 10 days interval to interpret the result by statistical evaluation.Observation and Results: It had been observed that the result of trial drug Group-A patients was significant (<0.05) to reduce both subjective and objective Parameters after 30 days of treatment as compare to Group-B patients.Conclusion:On comparison between two groups, Sarapunkha Kshara had shown more effect thanSarapunkha Ghan Vati.No adverse effects were noticed during clinical trial in both groups

Clinical value of propranolol combined with oxaliplatin and tigio in concurrent chemoradiotherapy for locally advanced gastric cancer

Objectives:To investigate the clinical value of propranolol combined with oxaliplatin and tigio in concurrent chemoradiotherapy for locally advanced gastric cancer.Methods:A total of 74 patients with locally advanced gastric cancer admitted to the First Affiliated Hospital of Hainan Medical University from August 2018 to June 2020 were selected as the subject and divided into two groups by random number table method: Group-A and Group-B, with 37 cases in each group. Patients in Group-A were treated with oxaliplatin injection and oral administration of tigio combined with concurrent radiotherapy, while patients in Group-B were given propranolol on the basis of treatment in Group-A. The clinical efficacy and incidence of adverse reactions in the two groups were observed.Results:The response rate (RR) of Group-B was higher than that of Group-A, but with no statistically significant difference (P>0.05). No statistical difference was observed in the incidence of gastrointestinal reaction, bone marrow suppression, oral mucositis, and the incidence of grade III-IV adverse reactions in the two groups (P>0.05). There were no serious adverse reactions related to propranolol in Group-B, and the levels of tumor markers CEA, CA50, CA125, and CA242 in Group-B were lower than those in Group-A.Conclusion:Propranolol combined with oxaliplatin and tigio boasts satisfactory sensitization safety in radiotherapy for gastric cancer, but its sensitization effect needs to be further investigated in a multi-center study involving large sample size.

The Effect of Rasanjanadi Taila Nasya and Gudardraka internally in Vataja Pratishyaya ( Allergic Rhinitis ): A Randomized Comparative Clinical Study

In Pratishyaya (Rhinitis), Vata is the main Dosha (humors) associated with Kapha, Pitta and Rakta (Blood) in its manifestation. Its improper management leads to Dushta Pratishyaya and further may cause complications like Badhirya (Hearing loss), Andhatwa (Blindness), Aghranatwam (Anosmia). Vataja Pratishyaya may be correlated with Allergic Rhinitis which is the commonest disease affecting more than 30% to 40% of all allergies in India. This study is aimed to understand the efficacy of Rasanjanadi Taila Nasya (Instillation of medicated oil in nostrils) and Gudardraka internally in Vataja Partishaya (Allergic Rhinitis). A randomized comparative clinical study of three groups (15 patients in each) was carried where patients in Group-A were given with Gudardraka orally, Group-B were given with Rasanjanadi Taila Nasya and in Group-C were given Rasanjanadi Taila Nasya along with Gudardraka orally. Assessment was done on the basis of subjective and objective parameters and analysed by Pearson’s Chi-square test. Objective parameters, within the group was analysed with paired t-test and between groups Repeated Measure ANOVA test. Intra-group comparison showed statistically significant results in all three Groups with a steady decrease in symptoms. The comparative analysis showed Group-C was the most effective with 53.3 % cure rate and remaining 46.6 % patients with marked relief.

EFFICACY OF DRY NEEDLING TECHNIQUE VERSUS CERVICAL MANIPULATION TECHNIQUE ON PATIENTS WITH MIGRAINE

Background of the study: Migraine is serious health problem in 15% of general population. The patients with migraine exhibited active Trigger Points in their neck extensor muscles. Dry needling is a treatment using a thin filament sterile needle to puncture skin and create tiny lesions in a muscle, tendon, to help restore normal physiology function, and reduce pain. Needling has applications for myofascial pain, chronic pain, headache, migraine. Cervical Manipulation Technique has been used to reduce pain and improve range of motion and used in the treatment of patients with head and neck disorders, including neck pain and stiffness, muscle-tension headache, and migraine. The aim of this study is to compare the effectiveness of dry needling technique versus cervical manipulation technique on patients with migraine. Methodology: 30 patients were randomly divided into two groups; fifteen patients in the experimental group-A received cervical manipulation technique (3 times/week) and fifteen patients in the experimental group-B received Dry needling technique. The VAS and NDI were used as outcome measures. Result: Comparing between Group A and Group B showed significant difference in effectiveness on pain and Neck disability with P value >0.0001 among patients with migraine. Group B with Dry needling technique found more effective than Group A with cervical manipulation technique with mean difference of (2.867) and (11.40) over (2.267) and (10.47) respectively. Conclusion: Dry needling technique group is more effective over cervical manipulation technique on enhancing on pain and neck disability. Therefore, this study concludes that Dry needling technique is an effective intervention for migraine patients.

Impact of Diabetes Mellitus on in Hospital Adverse Outcomes after First Episode of Acute Coronary Syndrome

Objective: To determine the impact of diabetes on adverse outcomes amongst patients presenting for the first time with acute coronary syndrome. Study design: Cohort Study Methodology: A total of 340 patients were enrolled in this study. At presentation patients were divided in two equal age and gender matched groups with 170 patients in Group-A having diabetes and another 170 being non-diabetics in Group-B. Patients were followed up for period of index hospitalization and all adverse outcomes were noted in both groups as per operational definition. Results: Mean age in Group-A with diabetes was 54±12.7 years whereas in non diabetics it was56±13.12 years. In both groups there was male predominance with approximately 60% males and 40% females. In diabetic group, 38% patients had typical chest pain, 62% patients had dyspnea, 20% patients had cardiogenic shock while in non diabetic group, 20% patients had typical chest pain, 40% patients had dyspnea, 10% patients had cardiogenic shock. In diabetic group, 38% patients had heart failure, 10% patients died while in non diabetics 20% had heart failure and 5% patients died. Conclusion: This study concluded that in hospital adverse outcomes after first episode of acute coronary syndrome were more frequent in diabetic patients as compare to non diabetic patients. Keywords: Acute coronary syndrome, Adverse outcomes, First attack

Comparison of Conservative and Surgical Treatment of Grade III Acromio-Clavicular Dislocation

Objectives: To compare the mean of constant score between conservative and surgical treatment in patients with Grade-III acromio-clavicular dislocation. Design: This was an RCT (randomized controlled trial). Study Settings: It was conducted at the Orthopedic Department of Sir Ganga Ram Hospital Lahore over 1 year from July 2020 to June 2021. Study Procedure: This study involved 94 both male and female patients aged between 18-60 years presenting in orthopedic emergency with Grade-III AC dislocation. These patients were assigned into two treatment groups randomly. Patients in Group-A were managed conservatively while those in Group-B were managed surgically with hook plate. Outcome variable was functional shoulder outcome which was assessed after 6 weeks of treatment using constant score. An informed written consent was gained from every patient. Results: The mean age of the patients was 29.9±9.5 years. Majority (n=44, 46.8%) of the patients were young and were aged between 18-30 years followed by 31-40 years (36.2%) and 41-50 years (17.0%). There were 89 (94.7%) male and 5 (5.3%) female patients in the study group with a male to female ratio of 17.8:1. The mean BMI of these patients was 25.2±2.2 Kg/m2. Right side was more frequently involved (54.3%) as compared to the left side (45.7%). Upon follow-up, the mean constant score was significantly higher in patients treated surgically as compared to conservative treatment (86.72±6.75 vs. 67.43±8.93; p-value<0.001). Similar substantial difference was observed through different subgroups based on patient’s age, gender, BMI and side involved. Conclusion: Surgical treatment of patients with Grade-III acromioclavicular dislocation was associated with better functional shoulder outcome as compared to conservative treatment and should be preferred in future practice if there is no contraindication to surgery. Keywords: Grade-III AC Dislocation, Conservative Treatment, Surgical Treatment, Shoulder Function

Vesical stone management by percutaneous cystolitholapexy versus open vesicolithotomy among children.

Objective: To compare outcomes, safety and complications of vesical stone management among children by open vesicolithotomy versus percutaneous cystolitholapaxy. Study Design: Cross Sectional study. Setting: Department of Urology and Kidney Transplantation Pir Abdul Qadir Institute of Medical Sciences Gambat. Period: July 2020 to December 2020. Material & Methods: Children with vesical stone, having age 1-12 years and fulfilling inclusion criteria were selected for this study. Total 50 cases were selected using non-probability consecutive sampling technique. Patients were divided into two groups Group-A and Group-B on the basis of given treatment each group containing 25 cases. Patients in Group-A were underwent open vesicolithotomy and those in group-B were underwent percutaneous cystolitholapexy. Procedure was done under general anesthesia. Alken metallic dilators were used for the dilatation of tract. Adult nephroscope with 24Fr sheath was used. Postoperative outcomes of both methods were compared with each other. Pneumatic fragmentation was used to break stones > 1.5cm in size. Results: Total 50 cases were studied, 25 cases in each group-A and group-B. Stone size was 1-3 cm in both groups. Age range of the patients was 1-12 years with mean age of 4.25 ± 1.4 years. Mean hospital stay was 2.6 days in group-A and 1.3 days in group-B. Mean requirement of analgesia (ketorolac) was 30.2mg in group-A and 14.8mg in group-B. Most common postoperative complication was fever observed in 28% cases in group-A and hematuria observed in 24% cases in group-B. Conclusion: Percutaneous cystolitholapexy is a minimal invasive procedure suitable among children with high success rate and minimum complications like postoperative fever, hematuria, urinary leakage and pain.

ADHESIVE CAPSULITIS; MANAGEMENT BY PHYSIOTHERAPY VERSUS INTRA-ARTICULAR CORTICOSTEROID INJECTION

Objective: To determine outcomes of intra-articular corticosteroids injection versus physiotherapy for the treatment of adhesive capsulitis using mean pain score on the visual analogue scale.
 Study Design: Comparative prospective study.
 Place and Duration of Study: Orthopedic outpatient department, Bahawal Victoria Hospital Bahawalpur from Jan to Jun 2021.
 Methodology: A total of 120 cases having adhesive capsulitis (frozen shoulder) were included in the study according to inclusion criteria. Non-probability consecutive sampling technique was used for the selection of cases. Patients were divided into two groups, group-A and group B, each containing 60 cases. Patients in group-A were given intra-articular steroid injection (2ml triamcinolone 40mg ± 2ml of bupivacaine). Patients in group B received ten sessions of physiotherapy by a welltrained physiotherapist under the supervision of an orthopaedic surgeon on alternate days. After six weeks, outcomes were measured in terms of pain score using a visual analogue pain scale.
 Results: Significant improvement was seen among patients in group-A with mean pain score from 7.32 ± 0.89 measured initially to 5.44 ± 1.37 measured after six weeks (p<0.001). No significant improvement was found among patients in group B with a mean pain score of 7.58 ± 0.94 measured initially to 7.12 ± 0.88 measured after six weeks (p>0.05).
 Conclusion: Significant improvement in pain relief can be achieved using intra-articular steroid injection administered in the shoulder as compared to supervised sessions of physiotherapy among patients with adhesive capsulitis.

Role of misoprostol 4 hourly versus 6 hourly in medical termination of pregnancy in 2nd trimester.

Objective: To determine efficacy of misoprostol given in 4 hourly versus 6 hourly intervals in second trimester for termination of pregnancy. Study Design: Cross sectional study. Setting: Study was conducted at the department of Obstetrics and Gynecology of Jinnah Medical and Dental College Karachi Allied Hospital. Period: March to August 2020. Material & Methods: Pregnant ladies in second trimester, requiring abortion due to medical reasons, were planned for termination of pregnancy. Two groups were made. Patients in Group-A were given misoprostol 4 hourly and those in Group-B were given misoprostol 6 hourly. Similar dose of drug (200ug) was given in both groups and monitoring was done. If abortion done in 48 hours, it was considered effective abortion and if not happened in 48 hours, it was considered a failed abortion. Consent was taken from all ladies in study group. Ethical approval was taken from ethical review committee. Results: Total 140 cases were studied, 70 cases in each group, A & B. Age range of cases was 16-40 years with mean age of 26.4±3.5 years. Most of the cases were having age between 20-30 years (63.5%). Group-A (N=70) was given misoprostol 4 hourly, where abortion was done in 94.3% cases while abortion failed in 5.7% cases. In Group-B (N=70) misoprostol was given 6 hourly, induced abortion in 82.8% and failed in 17.1% cases. Conclusion: Misoprostol dose of 20ug given via vaginal route is much effective drug for medical termination of pregnancy when given 4 hourly instead 6 hourly, with low failure rate.

One inch incision-mesh plug repair versus laparoscopic trans-abdominal preperitoneal repair of the primary indirect inguinal hernia: a prospective comparative study

Background: Management of inguinal hernia by minimally invasive incision and minimal dissection with optimal outcomes remains an unmet need for general surgeons. The most common hernia repair procedures are Lichtenstein hernioplasty and laparoscopic hernia repair; TAPP and TEP. The modification of mesh plug repair (MPR); one inch incision-MPR (OI-MPR); could achieve optimal outcomes comparable to that of laparoscopic hernia repair. The objective of the study was to assess OI-MPR approach for management of primary indirect inguinal hernia and its outcomes in comparison to laparoscopic TAPP repair.Methods: During the period from September 2017 to March 2019, 63 patients with indirect inguinal hernia were selected randomly to one of two groups; group-A included 35 patients underwent one inch incision-mesh plug repair (OI-MPR), group-B included 28 patients underwent laparoscopic TAPP.Results: The mean operative time of group-A was 31.74±4.74 min which was significantly shorter than that of group-B (81.22±7.44 min). The mean hospital stay duration in group-A was 0.57±0.18 day and in group-B, it was 1.18±0.39 day. The patients of group-A returned to normal physical activities earlier than the patients of group-B. The duration of postoperative pain was shorter and less severe in group-A than that of group-B. Regarding complications, there was no statistically significant difference found between both groups.Conclusions: One inch incision-MPR is a simple, feasible and cost-effective approach with low morbidities and low burden on the patients and the healthcare facilities.

Effects of tamsulosin and tamsulosin+solifenacin combination therapy for the treatment of ureteral stent related lower urinary tract symptoms

Objective: To evaluate the effect of tamsulosin and tamsulosin+ solifenacin combination therapy in improving the lower urinary tract symptoms of patients with indwelling double-J ureteral stents. Study design: Prospective observational comparative study Place and duration of study: Department of urology & Renal transplantation (dr. psims and rf) from March 2019 to October 2020. Methods: Total 100 patients having lower urinary tract symptoms after DJ stent insertion were selected for the study. DJ stenting was done in these patients following ureterorenoscopy (URS) and intracorporeal lithotripsy, percutaneous nephrolithotomy (PCNL), ureterolithotomy, pyelolithotomy, pyeloplasty and in patients with obstructive uropathy. All the patients were allocated two different groups. Group A received Tamsulosin 0.4 mg & Group B received Tamsulosin 0.4 mg and Solifenacin 5 mg daily once a day every day. The IPSS questionnaire was filled on day of per urethral catheter removal and on the day of DJ stent removal. Results were made on the day of DJ stent removal by comparing the mean change in IPSS in both groups. Independent sample t-test and paired t-test were applied. P-value < 0.05 was taken as significant. Result: Mean age was 41.6±13.75 years in Group-A and 38.24±12.24 years in Group-B. Total number of male patients was 25 (50%) in Group-A and 31 (62%) in Group-B. Female patients in Group-A were 25 (50%) and 19 (38%) in Group-B. Mean IPSS was 9.32 ±2.39 in Group-A and 9.52 ±3.39 in Group-B at baseline (p=0.62). After 2 weeks IPSS was 3.98 ±1.74 in Group-A and 2.36 ±1.51 in Group-B (p=0.0001). There was a statistically significant difference between group A and group B in the IPSS score. Trial registration: The study protocol was registered on Clinical Trials Registry- India (ICMR-NIMS) on April 30th, 2020 (registration number: CTRI/2020/04/024945). Conclusions: The mean change in IPSS by combined treatment of Tamsulosin and Solifenacin was significant when compared to Tamsulosin alone in treatment of DJ stents related LUTS.

Application of Peppermint Water Spray Combined With Cucumber Slice External Application or Lip Balm and Conventional Dipping in ICU Dry Mouth Patients

to analyze the effect of peppermint water spray combined with external application of cucumber slice or lip balm and conventional dipping in patients with dry mouth in intensive care unit (ICU). Methods: 120 patients with secondary xerostomia in our hospital from January 2018 to December 2019 were selected as the subjects. According to the different treatment methods, the patients were divided into A group (Peppermint water spray combined with cucumber slices for external application), group B (Peppermint water spray combined with lip gloss smear), group C (cotton swab dipped in normal saline), 40 cases in each group, and the saliva secretion and dry mouth before and after intervention in three groups were compared between the three groups. The degree of self-evaluation score and the evaluation of throat comfort and satisfaction after intervention. Results: after the intervention, the self-evaluation scores of salivary secretion and dry mouth degree of patients in group A and B were significantly higher than those before the intervention (P &lt; 0.01), the self-evaluation scores of salivary secretion and dry mouth degree of patients in group A were significantly higher than those in group B and C (P &lt; 0.01), and the self-evaluation scores of salivary secretion and dry mouth degree of patients in group B were significantly higher than those in group C (P &lt; 0.01). After intervention, the total effective rate of improvement of throat comfort in group A was 87.50%, which was significantly higher than 40.00% in group B and 0.00% in group C (P &lt; 0.01). The total effective rate of improvement of throat comfort in group B was significantly higher than that in group C (P &lt; 0.01). 97.50% of the patients in group A were significantly higher than 72.50% in group B and 2.50% in group C (P &lt; 0.01), and the patients in group B were significantly higher than those in group C (P &lt; 0.01). Conclusion: homemade peppermint water spray combined with external application of cucumber spray can effectively improve the symptoms of dry mouth and throat discomfort in patients with ICU, improve their satisfaction with treatment, and is conducive to the recovery of patients’ diseases, which is worthy of clinical promotion and application.

Comparison of Efficacy of Azithromycin and Levamisole in Combination with Azithromycin in Patients of Moderate to Severe Acne

Objective: To compare the efficacy of azithromycin plus levamisole versus azithromycin in the treatment of moderate to severe acne. Design: It was a randomized controlled trial. Study Settings: This study was conducted at Department of Pharmacology over 1 year from March 2020 to March 2021 at Khalifa Gulnawaz Teaching Hospital, Bannu, Khyber Pakhtunkhwa &amp; DHQ Teaching Hospital, Bannu, Khyber Pakhtunkhwa. Material and Methods: Sixty (120) patients of acne having either gender age between ≤18 to ≥28 years who meet the inclusion criteria were include in this study. Randomly patients were divided into two groups, in group A patients (n=60) were administered azithromycin (500 mg daily for 3 days in a week) plus levamisole (150 mg daily for two days in a week) for 8 weeks. In group B patients (n=60) patients were administered azithromycin 500 mg daily for 3 days for 8 weeks. “Acne Global Severity Score” was used for grading in patients who respond to treatment after 08 weeks therapy. Results: A total of 120 patients were enrolled in this study In Group-A Azithromycin + Levamisole, 19 males (31.66%) and 41 females (68.33%) and in Group-B (only Azithromycin) 23 males (38.33%) and 37 females (61.66%) were enrolled. Efficacy was noted in 52(86.66%) in patients of group-A receiving azithromycin plus levamisole combination where it was noted in 29(48.33%) in patients of group B receiving azithromycin (p=0.0031). Conclusion: It is concluded that for treatment of moderate acne vulgaris to severe acne vulgaris combination of azithromycin plus levamisole therapy proved more effective than azithromycin. However, there is need to conduct further comparative studies to measure efficacy in moderate acne vulgaris to severe acne vulgaris. Keywords: Azithromycin, Levanisole, Acne Vulgaris, Efficacy, Moderate Acne, Efficacy

Comparing the effect of insulin infusion alone and in combination of insulin infusion with salbutamol nebulization in treatment of hyperkalemia in diabetic and non-diabetic patients

Objective: To evaluate the clinical efficacy and comparison of potassium lowering effect of insulin infusion alone and insulin infusion with salbutamol nebulization. Methods: This interventional study was conducted in a tertiary care hospital, for a period of one year. A total of 190 patients with hyperkalemia were divided into two groups. Group-A (diabetic [D] and non-diabetic [ND] patients) received salbutamol 20 mg three times daily (TDS) (nebulizer 5mg/2.5mL) administered over a period of 15 minutes with 10 units of regular insulin (diluted with 25% dextrose in non-diabetic only) over 30 minute TDS via infusion. Group-B (diabetic and non-diabetic patients) received 10 units of regular insulin (diluted with 25% dextrose in non-diabetic patients only) administered over 30 minute TDS via infusion. Potassium and glucose level was measured in patient blood sample after 0, 6, 12 and 24 hrs of treatment. Results: The potassium level was decreased by 30.09% (D) and 31.98% (ND) in Group-A, whereas by 31.98% (D) and 20.49% (ND) in Group-B, after 24 hrs. Whereas blood glucose level in diabetic patients of Group-A and Group-B was found to decrease up to 28.85 % and 40.78 % respectively after 6 hours. Both the treatments were found to be effective without any complication i.e. hypoglycaemia and hypokalaemia. Moreover, renal, liver, cardiac and respiratory function test also did not show significant changes after treatments when recorded bihourly Conclusion: From the results, salbutamol nebulizer with insulin is more effective in the treatment of hyperkalemia in diabetic and non-diabetic patients.

To Compare the Effect on IOP Following Primary Trabeculectomy with MMC 0.2% versus Trabeculectomy without MMC in Primary Open Angle Glaucoma

Objective: To determine the effect on intraocular pressure following primary Trabeculectomy with MMC 0.2% versus Trabeculectomy without MMC in Primary Open Angle Glaucoma.&#x0D; Study Design: This is a prospective and experimental Study.&#x0D; Setting: Study carried out at Ophthalmology Department, Shaheed Mohtarma Benazir Bhutto Medical University Larkana, from 01-03-2020 to 31-08-2020 (06 Months).&#x0D; Materials and Methods: The patients with primary open angle glaucoma were selected from glaucoma clinic after taking careful history and clinical examination. Patients selected for trabeculectomy into two groups. Group A includes 43 patients while Group B also includes 43 patients. Among Group A patients adjunctive MMC 0.2mg/ml for a period of 3 minutes was used during trabeculectomy as a primary procedure (Test Group) while Group B patients were operated without MMC 0.2% (Control Group). Follow-up period of 06 months was observed in both groups. The span of study was from 01-03-2020 to 31-08-2020.&#x0D; Results: The total of 86 Eyes of 86 patients of POAG were included in this study. Group A patients were operated for trabeculectomy with MMC while group B patients were operated for trabeculectomy without MMC. The mean IOP before surgery of Group-A was 25.39±2.42 mmHg while in Group-B it was 26.23±4.23mmHg. At day 1 of surgery in Group-A patients IOP was 13.20±3.05 mmHg while in Group-B patients IOP, was 14.09±4.04 mmHg. After 3 months in Group-A, IOP was 13.04±3.81 mmHg in Group-B IOP was 14.01±4.18 mmHg. Out of 43 patients in Group-A, 41(95.3%) were succeeded while in Group-B, 39(90.7%)were succeeded. Significant result was found for IOP reduction after 6 months of surgeryin group-A IOP was 13.48 + 2.86 mmHg while in group-B, IOP was 15.09 ±2.64 (P=0.754).&#x0D; Conclusion: Trabeculectomy with MMC as a primary procedure seems to be more effective than trabeculectomy without MMC.

COMPARISON OF INDUCTION WITH PROPOFOLAND SEVOFLURANE FOR LARYNGEAL MASK AIRWAY INSERTION DURING ELECTIVE SURGERIES

Background And Aims: Laryngeal mask airways are gaining popularity these days in airway management and can be used for various types of surgeries and also during resuscitation. The aim of the study is to compare the induction characteristics and hemodynamic changes associated with intravenous injection of Propofol or inhalational Sevourane induction for LMAinsertion during elective surgeries. Materials And Methods: It is a prospective, single blind, randomized controlled study that is conducted at Maharajah's Institute of Medical Sciences, Nellimarla,Vizianagaram from January 2019 to July 2019. The study consists of sixty patients belonging to ASA grade I &amp; II, aged between 20-60 years of both sexes, undergoing elective surgical procedures, which were randomly divided into 2 groups of 30 each. Patients in Group-A were induced with intravenous injection of Propofol 2mg/kg and inhalation of 100% Oxygen whereas in Group-B were induced with inhalation of 8% Sevourane in 100% Oxygen. The data regarding time for induction, LMAinsertion and hemodynamic parameters were recorded and compared in both the study groups. Results: The mean time taken for induction and insertion of LMAwas less in Group A(100±13.6sec) compared to Group B(120±14.2sec) and this difference is statistically signicant. The fall in MAPand HR in group - Ais also signicant. Conclusion: The quality of anaesthesia provided by propofol is better when compared to Sevourane for LMAinsertion, even though Sevourane is associated with better haemodynamic stability.

Effect of Hydroxypropylmethylcellulose versus Sodium Hyaluronate on corneal endothelial cell count in patients undergoing cataract surgery by phacoemulsification

Objective: To compare the effect of Hydroxypropyl methylcellulose versus Sodium Hyaluronate on corneal endothelial cell count in patients undergoing cataract surgery by phacoemulsification. Design: It was a randomized clinical trial. Study Settings: This study was conducted at the Eye Unit III, Mayo Hospital / KEMU, Lahore over 12 months period from June 2014 to May 2015. Hypothesis: There is a significant difference in protective effect on corneal endothelial cell loss with dispersive (Hydroxypropyl methylcellulose) viscoelastic agent as compared to cohesive (sodium hyaluronate) viscoelastic agent used during phacoemulsification with intraocular lens for the treatment of cataract. Material and Methods: Total 80 patients from both the genders aged between 40-70 years with cataract undergoing phacoemulsification surgery were involved in this study. Two equal treatment groups were made by random allocation. Patients in Group-A (n=40) received Hydroxypropyl methylcellulose as viscoelastic agent while patients in Group-B (n=40) received treatment with Sodium Hyaluronate. Surgery was carried out by phacoemulsification technique and follow-up was done at first week, 1st month and 3rd month post-operatively. Data was collected in terms of endothelial cell count by noncontact specular microscope. Results: Patients age was in the range of 40 to 70 years with a mean of 57.26 ± 8.00 years. There were 31 (38.75%) females and 49 (61.25%) male patients with a female to male ratio of 1.6:1. Both the groups had no statistically significant difference in the mean corneal cell count before surgery (2839.67±368.71 cells/mm2 vs. 2801.36 ± 332.52 cells/mm2; p-value= 06.27). Post-operative mean corneal cell count at 1 week, 1 month and 3 months was significantly higher in patients in Group-A compared to Group-B. Similarly, significant difference was noted across various subgroups of both the groups on the basis of patient’s age and gender. Conclusion: This study concluded that there is less corneal endothelial cell loss with dispersive Hydroxypropyl methylcellulose viscoelastic agent as compared to cohesive sodium hyaluronate viscoelastic agent used during phacoemulsification surgery with intraocular lens implant for the treatment of cataract. Keywords: Cataract, phacoemulsification, viscoelastic agents, corneal, endothelial cell.

Radiological and Functional Outcome of Distal Radius Fracture treated conservatively vs Percutaneous K-wire fixation

Aim: To compare the radiological and functional result of conservatively treated distant radius fractures (manipulation under anesthesia and plaster of paris) versus percutaneous K- wire fixation Study design: Retrospective Duration and place of study: Department of Orthopedic Surgery, The Indus Hospital, Raiwind campus Lahore from July 2018 to August 2020. Methods: The sample size of 100 patients aged between 18-60 years, closed, isolated distal radius fracture were included, and patients with diabetes mellitus, ischemic heart disease, pathological fractures, chronic renal disease, head injury, chronic liver disease, whose Glasgow coma scale was &lt;14, malignancy were excluded. Patients were randomized as A &amp; B by lottery method. They managed with conservative treatment ( manipulation under anesthesia (MUA) and plaster of paris (POP) cast) and K- wire fixation in groups A &amp; B, respectively. Side of the fractured bone, infection, radiological union, and function outcome were recorded. Results: Amongst the total 100 patients in group-A, 32(63.8%) were males, and 18(36.2%) were females, and 35 (70.2%) were males, and 15 (29.8%) were females in Group-B. in group A patients mean age was 38.86.19 years, while patients mean age of the group B was 39.57.36 years. With the conservative method, 45(95.7%), the union rate was while with the K- wire fixation method, the union rate was 48(96%). In group-A, 35(70%) had excellent, 10 (20%) good, 03 (6%) had an average, and 2(4%) poor and in group-B, 40(80%) had excellent, 04 (08%) good, 04(08%) had an average, and 02 (4%) poor functional outcome. Conclusion: In terms of clinical and radiological evaluation, fixation of a distal radius fracture with K-wires has a better outcome than conservative treatment (MUA and POP cast) with a low infection rate and better union and result. Keywords: closed fracture, distal radius, back slab, K-wires