Comparative study between bupivacaine heavy vs pethidine intrathecally to study early haemodynamic changes and postoperative analgesia in patients undergoing caesarean section

Objective: To study early hemodynamic changes and duration of postoperative analgesia between two study groups of intrathecal pethidine and bupivacaine heavy in patients undergoing caesarean section. Methodology: Total number of 60 patients of ASA I and II, undergoing caesarean section were enrolled in the study. All the patients were divided into two groups: Pethidine and Bupivacaine heavy. The dose of pethidine for subarachnoid block was 1mg/kg and in Bupivacaine group 2.2ml of 0.5% bupivacaine heavy was given intrathecally. Heart rate and blood pressure of all the patients were recorded before subarachnoid block. After giving spinal anesthesia, the heart rate and blood pressure were monitored and recorded in different time intervals. The duration of postoperative analgesia in all patients was recorded in postoperative ward. The APGAR Scores of the babies were recorded in 1and 5 minutes after delivery. The data were statistically compared using independent sample t-test. Conclusion: The hemodynamic parameters (HR & BP) were compared in different time intervals. The difference in heart rate and blood pressure at different time intervals in the two study groups were statistically insignificant as (p > 0.05). The total duration of postoperative analgesia in patients receiving sole intrathecal pethidine was 8 hours and 30 minutes. Where as, in Bupivacaine group the duration was 2 hrs and 36 minutes. This has been found statistically significant (p<0.05).     

Oral myiasis: A case report

Myiasis is a disease commonly seen in animals, especially sheep and cattle. The condition is rare in man. A patient with a neglected fractured mandible with superimposed myiasis is reported.     

Decreased clearance of Pseudomonas aeruginosa from airways of mice deficient in lysozyme M

Lysozyme is a ubiquitous and abundant, cationic, antimicrobial polypeptide of leukocytes and epithelia, but its biological function in host defense is largely unexplored. To ascertain the role of lysozyme during bacterial infection of murine airways, we exposed the airways of lysozyme M-deficient (lys M-/-) mice to the pulmonary pathogen Pseudomonas aeruginosa and examined the host's response to infection. Despite partial compensation as a result of the appearance of lysozyme P in the infected airways of lys M-/- mice, these lys M-/- mice showed decreased clearance of P. aeruginosa compared with their lys M+/- or lys M+/+ littermates. Lysozyme contributes to optimal clearance of P. aeruginosa from the murine airways.     

Endoscopic transpapillary nasopancreatic drainage alone to treat pancreatic ascites and pleural effusion

BACKGROUND: Pancreatic ascites and pleural effusion are uncommon sequelae of pancreatitis and are associated with significant morbidity and mortality. Endoscopic decompression of the pancreatic duct through transpapillary stent or nasopancreatic drain (NPD) has shown encouraging results but the experience is limited. The aim of the present study was to evaluate the efficacy of endoscopic transpapillary nasopancreatic drainage in patients with pancreatic ascites and pleural effusion. METHODS: Over a period of 9 years, 10 patients (eight male) with pancreatic ascites and/or pleural effusion with pancreatic duct disruption documented on pancreatogram were studied. After informed consent, endoscopic transpapillary NPD was placed. The end-points were resolution of ascites and/or pleural effusion or need for surgery. RESULTS: Of 10 patients (age range: 13 months-46 years), four patients had only ascites, four had only pleural effusion and two had both ascites and pleural effusion. Ascites and/or pleural effusion resolved in all the patients within 4 weeks of placement of NPD. The healing of ductal disruption was demonstrated by nasopancreatogram as early as 2 weeks and NPD could be removed without necessitating another endoscopy. No major complications related to NPD placement were noted. There was no recurrence of pancreatic ascites and/or pleural effusion at a mean follow up of 39 months. CONCLUSIONS: Pancreatic ascites and pleural effusion can be effectively treated by endoscopic retrograde pancreatography and transpapillary NPD placement.     

Nasopharyngeal carriage of S. pneumoniae among young children in rural Nepal

Objectives  To provide epidemiologic data on Streptococcus pneumoniae ( Spn ) carriage in Nepal.
Methods  Prospective, population-based study among children in Sarlahi, Nepal to estimate carriage prevalence, identify risk factors, and determine antibiotic susceptibility patterns and serotype distribution. Between December 2003 and July 2004, NP specimens were collected from 604 children aged 1–36 months with acute lower respiratory infection (ALRI) and 604 healthy, age- and season-matched controls.
Results  Of the 1100 specimens analysed, carriage prevalence was approximately 80% in both groups. In the multivariate analyses, significant risk factors for Spn carriage in controls were Muslim religion [adjusted odds ratio (AOR): 2.93] and no latrine in the household (AOR: 2.41). Those treated for a recent illness had lower carriage rates (AOR: 0.37). Results were similar for ALRI cases with the addition of age ≥12 months (AOR: 1.68), and symptomatic infection (AOR: 3.78) as risk factors. The antibiotics and proportions of isolates resistant to them were as follows: penicillin 4.5%, cotrimoxazole 89.2%, chloramphenicol 1.4%, erythromycin 1.5% and tetracycline 22.7%. The most prevalent serogroups/types were 6, 19, 23, 15, 9 and 10.
Conclusions  Young children in rural Nepal experience high rates of Spn carriage. Most isolates were resistant to cotrimoxazole. Current conjugate Spn vaccines may substantially reduce the risk of a severe pneumonia and other Spn infections.     

Targeting newly enrolled low-age school children for the control of the intestinal helminth infection in rural Nepal

This study aims to identify an effective intervention group for the control of the intestinal helminth infection among school-age children in rural Nepal. We examined 1677 stool samples of school-age children from 25 schools and 1014 samples from 25 communities in rural Nepal. We used formalin-ether sedimentation technique for the microscopic examination of the stool samples and identified three major intestinal helminths: Ascariasis lumbricoides, hookworm and Trichuris trichiura. Our results revealed that the newly enrolled under-6-year-old children at the schools were more widely infected with at least one of the three major helminths than those in the communities (odds ratio [OR] 2.29). We detected a significant difference in the prevalence of A. lumbricoides (OR 1.70), hookworm (OR 2.57) and T.trichiura (OR 3.23) between under-6-year-old children at the schools and those at the communities. The study results suggest that an appropriate deworming programme is needed for the newly enrolled under-6-year-old children in the primary schools in Nepal.     

Novel self-nanoemulsifying drug delivery system for enhanced solubility and dissolution of lutein

Self-nanoemulsifying drug delivery system (SNEDDS) containing oil (Phosal 53 MCT), surfactant (Labrasol), and cosurfactant (Transcutol-HP or Lutrol-E400) was prepared to enhance solubility and dissolution of lutein. Ternary phase diagram of the SNEDDS was constructed to identify the self-emulsifying regions following which the percentage of oil, surfactant, and cosurfactant in the SNEDDS were optimized in terms of emulsification time and mean emulsion droplet size. The optimized SNEDDS consists of 25% oil, 60% surfactant, and 15% cosurfactant. When measured using USP XXIII dissolution apparatus II, the emulsification time of the SNEDDS prepared with Transcutol-HP as cosurfactant was less than 20 sec, and it was 20–30 sec in the SNEDDS prepared with Lutrol-E400. Mean emulsion droplet size was slightly smaller when Transcutol-HP was used as cosurfactant (80 ± 6 nm), compared to when Lutrol- E400 was used (93 ± 6 nm). Dissolution of lutein from the solid SNEDDS (physical mixture of the optimized SNEDDS and Aerosil 200) took place immediately (less than 5 min) in distilled water, and, once dissolved, no precipitation or aggregation of the drug were observed. In contrast, no drug was released from lutein powder or from the commercial product (Eyelac®) until 3 h of the study duration.