The Effect of Transdermal Nitroglycerine on Intrathecal Fentanyl with Bupivacaine for Postoperative Analgesia following Gynaecological Surgery

Fentanyl is a short-acting synthetic opioid with spinal analgesic properties and dose-dependent side-effects. The analgesic effect of opioids is mediated in part through activation of inhibitory descending pain pathways involving nitric oxide (as a central neurotransmitter) through the NO-cGMP system. This NO-cGMP pathway plays an important role in spinal nociception. The aim of the study was to evaluate the effect of transdermal nitroglycerine on the analgesic action of intrathecal fentanyl in patients undergoing abdominal hysterectomy. Patients (n=120) were randomised into one of four groups. All received 3 ml bupivacaine 0.5% plus 0.5 ml of an intrathecal test drug. Twenty minutes after lumbar puncture, a transdermal patch of either nitroglycerine or placebo was applied. Group B received spinal bupivacaine plus saline 0.5 ml and a placebo patch. Group B-N received bupivacaine plus saline 0.5 ml and a nitroglycerine patch. Group F received bupivacaine plus fentanyl 25 μg and a placebo patch. Group F-N received bupivacaine plus fentanyl 25 μg and a nitroglycerine patch. The duration of effective analgesia was longer in group FN (363.53±34.09 min) compared from the other groups (P <0.001). The times to two-segment regression in group F-N and group F were 132.87±31.2 min and 126.40±26.81 min respectively. The visual analog scale pain score at the time of the first rescue analgesic was similar in all groups. We conclude that nitroglycerine does not result in postoperative analgesia but enhances the analgesic effect of intrathecal fentanyl.

Clinical profile of group A meningococcal outbreak in Delhi

We present a retrospective analysis of clinical profile of 100 children admitted to a Government hospital at Delhi between April 2005 and December 2006 with group A meningococcal infection. Maximum children presented in late winter and spring. Younger children were less affected (5% children < 1 year). Fever (86%), vomiting (64%) and rash (63%) were the most common presenting symptoms. All children presented within 5 days of onset of symptoms and 52% within 24 hours. 67 % children had meningococcal meningitis; 20% had meningococcemia; and 13% had both. Overall mortality was 17%. Altered sensorium and shock at presentation significantly increased the mortality. All culture positive cases had group A Neisseria meningitides. All meningococcal isolates were sensitive to penicillin/ampicillin, ciprofloxacin, ceftriaxone, chloramphenicol and erythromycin except, one each resistant to ampicillin and erythromycin.

Epidemic of leptospirosis: an ICU experience

AIMS

To study the clinical profile and outcome of critically ill patients suffering from leptospirosis with organ dysfunction and correlate mortality with individual risk factors.

METHODS

A study of critically ill patients suffering from leptospirosis was carried out in the Medical Intensive Care Unit of a tertiary centre of a metropolitan city between 1st June 2002 and 31st May 2003. All the patients in whom diagnosis was confirmed by ELISA IgM antibody testing underwent thorough clinical examination and necessary biochemical investigations. They received standard antimicrobial therapy and extensive supportive therapy as required. Mortality was correlated with individual risk factors.

RESULTS

Out of 834 total admissions in this period, 60 (7.2%) patients suffered from leptospirosis. There were 48 males and 12 females with age ranging from 12 to 60 years, mean age being 40 years. The clinical manifestations varied from fever (58 patients), jaundice (38), subconjunctival haemorrhages (24), to altered sensorium (22). All the patients had evidence of severe sepsis. Forty six patients had multiple organ dysfunction syndrome (MODS) and 26 required ventilatory support. The total mortality in leptospirosis patients was 52% which was much higher compared to the total MICU mortality (31.4%) in the same period.

CONCLUSION

Leptospirosis is an important infection associated with high mortality when associated with organ dysfunction. The poor prognostic factors are preponderance of male sex, alcohol dependence, age group > 50 years, MODS, acute respiratory distress syndrome (ARDS), presence of acidosis and need for mechanical ventilation. However, timelyintervention and intensive therapy can save many young lives.

Genetic analysis of Karnal bunt (Neovossia indica) resistance in wheat

Embryos excised from seeds of six generations (P1, P2, F1, BC1, BC2 and F2) of a cross WH 283 WH 533 were cultured on modified MS medium already inoculated with secondary sporidia of Neovossia indica. Significant variations for callusing response (CR) (54 55-75 55%) were observed among generations but the presence or absence of N. indicia did not affect callusing response. A clear inhibition zone (IZ) was formed around each embryo showing callusing. The diameter of IZ varied significantly among generations and was maximum in the resistant genotype, WH 283 (3 60 cm). Fresh weight and dry weight of calli, initiated from embryo cultured and inoculated with N. indica, varied significantly among generations. Coefficient of infection as well as percentage of infection reflected the overdominance of susceptibility. Generation mean analysis showed that the three parameter model was adequate for diameter of IZ only. Six-parameter model showed that additive (in presence of N. indica), additive and additive dominance (in absence of N. indica) effects were also significant. Complementary type of epistasis for fresh weight of calli and dominance, and dominance dominance effects for dry weight of calli were observed in the presence of N. indica. Magnitude of additive effects was higher for diameter of IZ in three parameter model. Therefore, selection might assist in improving this trait and thus indirectly help in attaining the resistance towards N. indica.

Characterization of polyvinylalcohol microspheres of diclofenac sodium: application of statistical design

Microspheres of polyvinylalcohol (PVA) containing diclofenac sodium were prepared by an emulsion-chemical cross-linking method. A statistical design was used to study the variables that affect the preparation of microspheres and to study the release profile of diclofenac from the microspheres. To account for the drug content, a mass balance study of the process was performed. A high concentration of polyvinylalcohol, a high stirring speed, and a low level of glutaraldehyde were found to be important to obtain spherical and discrete microspheres. The concentration of polyvinylalcohol and the amount of heavy liquid paraffin were found to be critical factors in influencing the t50 value. Almost 98% of the total diclofenac sodium added was accounted for in mass balance studies.

Infants of diabetic mothers: a prospective study of neonatal complications in Harare, Zimbabwe

Complications in 42 newborn infants of diabetic mothers (IDM), both insulin- and non-insulin-dependent, were studied prospectively over a period of 16 months at Harare Maternity Hospital. Hypoglycaemia, the most common complication observed, was present in 23 (55%): only seven of these were symptomatic. In 21 of these 23 cases, blood glucose was stabilized during the first 24 hours of life. Jaundice and transient tachypnoea were each seen in 12 cases (29%). There were no cases of respiratory distress syndrome. One infant had polycythaemia requiring partial exchange transfusion. No life-threatening congenital malformations were seen. All infants were given special care initially and in the majority of cases this could be discontinued after 24 hours. With simple interventions, the morbidity of IDM born was found to be comparable to levels reported from developed countries.

Congenital syphilis in the newborn

We studied 53 newborn babies with congenital syphilis. The common clinical features seen were low birth weight, hepatosplenomegaly, anaemia, jaundice, and symmetrical superficial desquamation of the skin affecting palms and soles. The presence of these clinical signs is highly suggestive of early congenital syphilis. Hydrops fetalis without rhesus or ABO isoimmunisation should always arouse the suspicion of congenital syphilis.

Tuberculous manifestations in children

An analysis of 110 cases of primary tuberculosis in Zambian children revealed that 47% of them had protein energy malnutrition. Of all pulmonary manifestations, simple primary tuberculosis was predominant followed by segmental lesions. A high incidence of extra pulmonary involvement mainly tuberculous lymphadenitis was observed. Previous BCG inoculation was not protective in 37 (33.6%) children.