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Volume 6, Number 3, July-September 2020

EDITORIAL

Anbazhagan Kolandaswamy

Congo Red (CRD) Test in Prediction of Preeclampsia: An Innovative Mobile Health Solution

[Year:2020] [Month:July-September] [Volume:6] [Number:3] [Pages:1] [Pages No:00 - 00]

PDF  |  DOI: 10.5005/jmeds-6-3-iv  |  Open Access |  How to cite  | 

Original Article

S Charuvi, Hiremathada Sahajananda, S Dwajani

Suppression of Cortisol Levels by a Bolus Dose of Etomidate in Patients Undergoing Laparoscopic Cholecystectomy

[Year:2020] [Month:July-September] [Volume:6] [Number:3] [Pages:6] [Pages No:41 - 46]

Keywords: Cortisol levels, Etomidate, Laparoscopic cholecystectomy

PDF  |  DOI: 10.5005/jp-journals-10045-00157  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The main purpose of the study was to determine the effect of a bolus dose of etomidate on serum cortisol levels in patients undergoing laparoscopic cholecystectomy. As there are a lot of controversies regarding this, detailed research was carried out to find answers regarding the question as to whether etomidate suppresses the cortisol levels or not. Materials and methods: In this prospective interventional study, 31 ASA physical status I and II patients undergoing laparoscopic cholecystectomy were enrolled. Pre-anesthetic medication consisted of the tab. diazepam 5 mg the previous night and tab. ranitidine 150 mg the previous night and the next day morning at 5 am with sips of water. The patient was then induced with 0.4 mg/kg of etomidate intravenously. Skeletal muscle relaxant vancuronium of 0.1 mg/kg was administered. Intubation was performed with an appropriate endotracheal tube. Anesthesia was maintained with N2O, O2, and isoflurane. After surgery, the patient was reversed using neostigmine and glycopyrrolate. The patient was extubated when awake and then shifted to the recovery room and after one hour to the postoperative ward. Three venous samples, 2 mL each were drawn from each patient. The first blood sample T1 was drawn at 9 am on the day of the surgery before the induction of etomidate, the second blood sample T2 was 1 hour after the induction of etomidate which coincided with pneumoperitoneum, and the third blood sample T3 was drawn at 9 am the following morning. After the blood samples were collected in the red top vacutainers, they were allowed to clot naturally for about 30 minutes at room temperature after which tubes were centrifuged for 15 minutes at 1,000, 2,000, and 3,000 rpm, respectively, for the first, second, and third samples. After the separation of the serum, they were stored at −80°C until analysis. Sample analysis for cortisol estimation was done using Cobas E-411 machine using the electrochemiluminescence method. The statistical analysis was applied to analyze the demographic data, Chi-square test for categorical variables. Analysis was done using RM-ANOVA and significance was set at p < 0.05. Results: The statistical analysis showed the above table shows that males showed mean cortisol values of 11.48 ± 2.05 at time T1 which was at baseline, 9.78 ± 1.72 at time T2 which was at pneumoperitoneum, and 5.038 ± 4.22 at time T3 which was at 24 hours. The female patients showed mean cortisol values of 13.407 ± 2.33 at T1, 11.47 ± 2.65 at T2, and 7.065 ± 5.41 at T3. The combined mean cortisol levels of the patients were: 12.291 ± 1.57, 10.49 ± 1.52, and 6.085 ± 3.36 at intervals of T1, T2, and T3, respectively. According to the Student\'s t-test, the cortisol levels show that the p value (0.11) between T1 vs T2 does not show any significance. The p value (0.001) of T1 vs T3 is extremely significant and shows cortisol suppression and helps in proving the objective of the study. The p value (0.02) of T2 vs T3 was significant and shows that the cortisol levels are suppressed. Conclusion: Hence, this study showed that the cortisol levels are suppressed by a bolus dose of etomidate in patients undergoing laparoscopic cholecystectomy. It was not related to any adverse outcome. The major advantage of etomidate over other available intravenous induction agents is attributed to the remarkable cardiovascular stability it offers in patients with cardiac disease. It provides a “stress-free” state, in children which is of importance in high-stress surgeries like the Intracardiac repair of Tetralogy of Fallot using Cardiopulmonary Bypass. Its use probably could be restricted to those situations where it offers a clinical advantage over other available drugs until the clinical relevance of the adrenal suppression effects of etomidate is fully known.

CASE REPORT

Vishnuvardhan Gopalakrishnan, Sumanth T Parameshwaraiah, Vidhyavathi Malyam, Asha C Sannappa, Suha Riyaz

Peripheral and Facial Edema Associated with Olanzapine: A Case Report

[Year:2020] [Month:July-September] [Volume:6] [Number:3] [Pages:2] [Pages No:47 - 48]

Keywords: Atypical antipsychotics, Edema, Olanzapine, Side effects

PDF  |  DOI: 10.5005/jp-journals-10045-00153  |  Open Access |  How to cite  | 

Abstract

Olanzapine is a potent second-generation antipsychotic commonly used in the treatment of many psychiatric illnesses. It is considered more potent and has less incidence of extrapyramidal symptoms compared with first-generation antipsychotics. With sedation and weight gain being considered as the most common adverse effects, it has also been reported that peripheral edema is associated with olanzapine therapy, but only a few cases of facial edema have been reported so far. However, a definitive cause and consequence of edema are not established, as it is not commonly encountered in medical practice. As olanzapine is a commonly used atypical antipsychotic, we report a case of bilateral pitting pedal edema and facial edema in a woman with no medical comorbidities after initiating olanzapine therapy. All systemic causes of edema were ruled out, and it was completely resolved after discontinuation of olanzapine.

CASE REPORT

Vishnuvardhan Gopalakrishnan, Sumanth T Parameshwaraiah, Vidhyavathi Mallyam, Subhashini Shanmugamurthi, Asha Chandahalli Sannappa

Outcome of Lorazepam-assisted Interview and Psychotherapy in a Middle-aged Female Patient with the Chronic Mixed Dissociative Disorder: A Case Report

[Year:2020] [Month:July-September] [Volume:6] [Number:3] [Pages:2] [Pages No:49 - 50]

Keywords: Catharsis and positive suggestions, Chronic psychogenic aphonia, Dissociative amnesia, Lorazepam-assisted interview, Trans and possession

PDF  |  DOI: 10.5005/jp-journals-10045-00154  |  Open Access |  How to cite  | 

Abstract

Dissociation is a neurotic defense mechanism developed against severe emotional distress and excessive anxiety. Dissociative disorder (DD) is not a single entity, but a wide spectrum of disorders with various subtypes. Typically, patients present with any of one subtype, and cases like dissociative motor disorder comes to medical attention sooner. Contrarily here we are discussing a patient who has symptoms of three subtypes, persisting for a prolonged period. As literature regarding chronic psychogenic aphonia is scarce, we are highlighting the case of a 35-year-old woman with 8 months longstanding history of mixed DD (psychogenic aphonia, dissociative amnesia along with trans and possessional state) because of underlying childhood trauma and multiple conflicts with family members. The focus will be on how lorazepam-assisted interview along with psychotherapy (supportive, catharsis, positive suggestion, and resolution of conflicts) works effectively in a chronic mixed DD.

CASE REPORT

Arpit Mago

Mucoepidermoid Carcinoma: Presentation at an Uncommon Site

[Year:2020] [Month:July-September] [Volume:6] [Number:3] [Pages:3] [Pages No:51 - 53]

Keywords: Case report, Mucoepidermoid carcinoma, Salivary gland

PDF  |  DOI: 10.5005/jp-journals-10045-00156  |  Open Access |  How to cite  | 

Abstract

Introduction: Mucoepidermoid carcinoma represents about 15% of salivary gland tumors. They occur mainly in the parotids (60–70%) but they account for a large fraction of salivary gland tumors in the minor salivary glands. Overall they are the most common form of primary malignant tumor of the salivary glands. Our report exemplifies the need to evaluate swellings of the neck region meticulously as it might not be just an inflammatory swelling but an indication of malignancy. Case report: A 36-year-old male patient was referred to our hospital for evaluation of a swelling in the upper neck which gradually progressed over a span of 3 months. It was painless, firm in consistency, and ovoid in shape. The blood and urine investigations were normal. Fine needle aspiration cytology (FNAC) was performed and the findings were correlated with IHC and the mass was confirmed to be a mucoepidermoid carcinoma. Discussion: Mucoepidermoid carcinomas show variability in their behavior. The prognosis is dependent on the clinical stage, site, grading. Duration before diagnosis ranges from months to years. The cure is possible in low and intermediate grades of tumors. Characteristically, it shows t[11;19][q21;p13] with MET1–MAML2 fusion in other cases it occurred in the parotid gland and palate. This is probably the first case reported to occur in a submandibular gland in a patient in the third decade of his life, with its incidence normally common in the 5th to 6th decade.

LETTER TO THE EDITOR

Poonam Kumari, Amarjeet Kumar, Chandni Sinha, Ajeet Kumar, Rajesh Kumar

Twisting of Tail End of the Reservoir Bag Malingering as Stuck Valve during Positive-pressure Ventilation

[Year:2020] [Month:July-September] [Volume:6] [Number:3] [Pages:2] [Pages No:54 - 55]

Keywords: Airway obstruction, Pediatric, Reservoir bag

PDF  |  DOI: 10.5005/jp-journals-10045-00155  |  Open Access |  How to cite  | 

Abstract

The most commonly used open circuit is The Jackson Rees modification of the Ayre\'s T-piece (Mapleson-F system) in pediatric patients because it has low resistance and nominal dead space. Here, we report a case in which we used the Jackson Rees circuit with bag tail valve for ventilation in pediatric patient weight 12 kg. During positive-pressure ventilation, we felt resistance and the patient was not ventilating. High pressure in the bag was being formed despite the valve was fully open. On inspection, we found out the cause was a twisted bag tail end as shown in Figure 1. We straighten the tail end of the bag, which aided in releasing air pressure and the patient started getting ventilation. The obstruction of the expiratory limb of the reservoir bag may be due to a stuck valve or due to twisting of its tail end. Due to high flexibility, twisting of the tail end of reservoir bag commonly found when it was held with tail end up position. Due to the twisting of the tail end of the reservoir bag, the expiratory limb becomes closed and high flow oxygen started going to the inspiratory limb. This may result in CO2 retention and barotraumas of the lungs if the obstruction was not released. We can prevent twisting of the tail end of the bag by keeping the Jackson Rees circuit in a vertical position with the tail end facing down.

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