Day Care Surgery in Otolaryngology : a three year Prospective Study

Day care surgery is now an integral part of otolaryngology and is widely practised in the West. But in our military setup it still has to gain popularity. A Day Care Surgical Centre was established at Armed Forces Clinic in 1996. In the period May 1998 to Apr 2001, a total of 752 otolaryngology cases were operated at the centre, of which 474 cases were major and 278 cases were minor. All cases were performed under local anaesthesia supplemented by sedation. Strict patient selection criteria were adopted resulting in a low immediate post-operative complication rate (1.46%). None required admission to hospital for the management of complications. The feasibility of performing otolaryngological surgery on a day care basis is demonstrated, especially in nasal and aural cases. The experience gained shows that high medical standards can be achieved with low resource expenditure. Patient selection criteria and guidelines are suggested.Key Words: Day care, Otolaryngology, Surgery     

POST OPERATIVE PAIN RELIEF IN CAESAREAN SECTION

Eighty female patients in the age group of 20-40 years, weighing 40 ± 15 Kg, in ASA physical status I and II, awaiting either elective or emergency caesarean delivery were selected for this study. Patients with cardiovascular disorders and those with significant systemic ailments were excluded from the study. They were randomly divided into two equal groups of 40 patients each. Group I was subdivided randomly into two equal sub-groups (1A and 1B) of 20 patients each and was selected for administration of epidural narcotics. Patients in sub-group 1A were given epidural morphine in the dose of 3-5 mg and those in subgroup 1B were given buprenorphine in the dose of 0.1-0.15 mg. Group II consisting of 40 patients, were again subdivided randomly into two equal subgroups (2A and 2B) of 20 patients each and were selected for administration of parenteral (intravenous) narcotics. Patients in subgroup 2A were given morphine in the dose of 5-7.5 mg I.V., and those in subgroup 2B were given 0.15-0.3 mg of buprenorphine intravenously. The degree of pain relief was assessed by applying numerical rating scale (NRS) and resulting complications were observed and recorded. It was found that 60-80% of patients with epidural narcotics, with various dosage schedules, experienced good to excellent analgesia as compared to 30-40% of patients with parenteral use of narcotics.KEY WORDS: Analgesia, Caesarean section, Epidural narcotics     

Glimpsing undergraduate research from the view of the advisors of Nursing scholarships

This research aimed at understanding the meaning of undergraduate research for supervisors of Nursing scholarship students in a university in the South of Brazil. The methodological reference used was the Grounded Theory, by the means of interviews with seven undergraduate research scholarship advisors forming two sample groups. The phenomenon "glimpsing undergraduate research activities of research groups coordinated by nursing advisors, the basis of competency formation in research of the scholarships" emerged form the interrelation of six categories. To be a advisor and researcher of human resources in research form undergraduation requires pedagogical, instrumental, and managerial competencies associated to research policies of nursing and health.     

Neuroimaging Evidence of Altered Fronto-Cortical and Striatal Function after Prolonged Cocaine Self-Administration in the Rat

Cocaine addiction is often modeled in experimental paradigms where rodents learn to self-administer (SA) the drug. However, the extent to which these models replicate the functional alterations observed in clinical neuroimaging studies of cocaine addiction remains unknown. We used magnetic resonance imaging (MRI) to assess basal and evoked brain function in rats subjected to a prolonged, extended-access cocaine SA scheme. Specifically, we measured basal cerebral blood volume (bCBV), an established correlate of basal metabolism, and assessed the reactivity of the dopaminergic system by mapping the pharmacological MRI (phMRI) response evoked by the dopamine-releaser amphetamine. Cocaine-exposed subjects exhibited reduced bCBV in fronto-cortical areas, nucleus accumbens, ventral hippocampus, and thalamus. The cocaine group also showed an attenuated functional response to amphetamine in ventrostriatal areas, an effect that was significantly correlated with total cocaine intake. An inverse relationship between bCBV in the reticular thalamus and the frontal response elicited by amphetamine was found in control subjects but not in the cocaine group, suggesting that the inhibitory interplay within this attentional circuit may be compromised by the drug. Importantly, histopathological analysis did not reveal significant alterations of the microvascular bed in the brain of cocaine-exposed subjects, suggesting that the imaging findings cannot be merely ascribed to cocaine-induced vascular damage. These results document that chronic, extended-access cocaine SA in the rat produces focal fronto-cortical and striatal alterations that serve as plausible neurobiological substrate for the behavioral expression of compulsive drug intake in laboratory animals.     

Steatosis in chronic hepatitis C: relationship to the virus and host risk factors

Background: Steatosis occurs frequently in hepatitis C. However, the mechanisms leading to this lesion are still unknown, and the role of steatosis in the progression of the disease remains controversial. The aim of the present paper was to determine the prevalence of steatosis in hepatitis C and its association with hepatitis C virus (HCV) genotype, viral load and the presence of risk factors for steatosis, and to analyze the association between steatosis and the intensity of liver disease. Methods: Patients infected with HCV who underwent liver biopsy were included. Patients coinfected with hepatitis B virus and/or human immunodeficiency virus and those previously treated for hepatitis C were excluded. The following risk factors for steatosis were investigated: obesity (body mass index [BMI] > 25 kg/m²), diabetes mellitus, hyperlipidemia, alcoholism, and use of potential steatosis‐inducing drugs. Histological analysis evaluated the presence of steatosis, the degree of periportal activity and staging. Patients with and without steatosis were compared regarding demographic, epidemiological, laboratory and histological characteristics. Logistic regression analysis was applied to identify variables that were independently associated with the presence of steatosis. Results: Ninety patients (55 men, 35 women) with a mean age of 45 ± 13 years were included. The prevalence of steatosis was 67%. Variables that remained independently associated with steatosis were age, female gender, obesity and genotype 3. Conclusions: The prevalence of steatosis in hepatitis C was high. Risk factors usually related to steatosis such as age, female gender and obesity, as well as genotype 3, were independently associated with the presence of steatosis. Steatosis was not independently associated with the intensity of histological liver disease.     

Temporal and spatial changes in the composition and structure of helminth component communities in European eels Anguilla anguilla in an Adriatic coastal lagoon and some freshwaters in Italy

The composition and diversity of the helminth component communities in eels Anguilla anguilla were determined in three separate localities in Italy: an Adriatic coastal lagoon, Comacchio and two freshwater localities, the River Po and the Lake Piediluco. Data from Comacchio lagoon were analysed over 15 years to determine whether community composition and diversity changed significantly overtime. The community was species rich (nine species, all marine except Proteocephalus macrocephalus) and was dominated by a suite of digeneans: Deropristis inflata, Helicometra fasciata, Lecithochirium musculus and Bucephalus anguillae. The community showed little change in composition over the period, but the relative abundance and dominance of the species did alter. By contrast, the component communities in the freshwater localities were species poor and the dominant species were freshwater acanthocephalans, Pomphorhyncus laevis in River Po and Acanthocephalus rhinensis in Lake Piediluco. The helminth community of Lake Piediluco with five species was richer than that of the River Po with only three species, but was poorer than that of Comacchio lagoons. Similarity indices between samples from Comacchio were high; between the lagoon and the freshwater localities and between the two freshwater localities, similarity indices were very low. Helminth component community structure in coastal lagoons was comparable across Europe. The helminth community in the River Po was similar to those in the River Tiber and other European rivers whilst that in Lake Piediluco was similar to that in other European lakes. Levels of the pathogenic Anguillicoloides crassus in swim bladders were consistently lower in prevalence and abundance in the coastal lagoons than in freshwater localities. This suggests that this parasite may have little impact on migrating eels if they are indeed primarily of marine origin and so it may be of little importance in the recent decline of eel populations throughout Europe.