International Journal of Advances in Medicine https://www.ijmedicine.com/index.php/ijam <p>International Journal of Advances in Medicine (IJAM) is an open access, international, peer-reviewed journal that publishes medical news, original clinical research of interest to physicians in medicine, and reviews on all aspects of clinical medicine. The journal's full text is available online at https://www.ijmedicine.com. The journal allows free access to its contents. International Journal of Advances in Medicine is dedicated to bringing physicians the best research and key information. The journal has a broad coverage of relevant topics in the various disciplines of medicine. International Journal of Advances in Medicine (IJAM) is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, analytic reviews such as meta-analyses, insightful editorials, medical news, case reports, adverse drug reactions, short communications, correspondence, images in medical practice, clinical problem solving, perspectives and new drug updates. The journal publishes all research study types, from study protocols to phase I-IV trials to meta-analyses, including small or specialist studies. It is published every<strong> two months</strong> and available in print and online version. International Journal of Advances in Medicine (IJAM) complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.</p> <p><strong>Issues: 6 per year</strong></p> <p><strong>Email: </strong><a href="mailto:medipeditor@gmail.com" target="_blank" rel="noopener">medipeditor@gmail.com</a>, <a href="mailto:editor@ijmedicine.com" target="_blank" rel="noopener">editor@ijmedicine.com</a></p> <p><strong>Print ISSN:</strong> 2349-3925</p> <p><strong>Online ISSN:</strong> 2349-3933</p> <p><strong>Publisher:</strong> <a href="http://www.medipacademy.com/" target="_blank" rel="noopener"><strong>Medip Academy</strong></a></p> <p><strong>DOI prefix:</strong> 10.18203</p> <p>Medip Academy is a member of Publishers International Linking Association, Inc. 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Artificial pancreas is an emerging novel therapeutic solution for diabetes mellitus based on the automatic insulin delivery system (AID). Medtronic's MiniMed 670G System (hybrid closed loop) was the first artificial pancreas approved by food and drug administration (FAD) and currently in clinical use. Efficiency, success rate, cost, and very less usage were few major barriers for an artificial pancreas. We described the basic structure, functions, limitations, and future of the artificial pancreas.</p> Sumanth Marupuru Veeraj Dudem Zeal Soni Dhruvi Doshi Srikar Reddy Vummenthala Vaishnavi Gummalla Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 624 627 10.18203/2349-3933.ijam20243071 Heart failure related to hyperthyroidism in young woman https://www.ijmedicine.com/index.php/ijam/article/view/4119 <p>Acute decompensated heart failure is a clinical condition that is precipitated by underlying pathology, including thyroid disorders. The condition of hyperthyroidism can result in a hyperactive circulation, which can increase cardiac output and metabolic demands, ultimately leading to heart failure. A 35-year-old woman presented to the hospital with acute shortness of breath that increased during the night, as well as bilateral edema in the lower extremities, palpitations, and intermittent chest pain. According to the patient's medical history, hyperthyroidism was diagnosed two years ago; however, the patient has not adhered to the prescribed treatment. The physical examination shows low blood pressure (80/60 mmHg), tachycardia, and increased jugular venous pressure. Lung auscultation detects bilateral fine crackles. A decrease in ejection fraction is evident on echocardiography. The laboratory results indicated hyperthyroidism. Initial treatment includes a saline infusion, a dobutamine infusion, a high-dose furosemide drip, acetazolamide as an extra diuretic, clopidogrel, atorvastatin, isosorbide dinitrate under the tongue, sacubitril/valsartan, spironolactone, and enoxaparin. This case highlights the importance of recognizing the multifactorial nature of heart failure, especially in patients with hyperthyroidism.</p> Kadek Adi Sudarmika Ni Luh Eka Sriayu Wulandari Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 599 602 10.18203/2349-3933.ijam20243064 Thyroid isthmus agenesis coinciding with papillary thyroid carcinoma: a case report https://www.ijmedicine.com/index.php/ijam/article/view/4140 <p>Thyroid isthmus agenesis is a rare congenital anomaly characterized by the absence of the thyroid isthmus. Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy. The coexistence of thyroid isthmus agenesis and PTC is extremely rare, with limited cases reported in the literature. This case report aims to describe a rare presentation of thyroid isthmus agenesis coinciding with PTC, detailing the clinical presentation, diagnostic approach, and management. Here, we discuss a case of a 49-year-old female presented with neck pain attributed to a cervical disc issue. An MRI scan incidentally identified a left thyroid lesion measuring 5×2.5 cm. Neck ultrasound confirmed a 2.4×2.7×4.2 cm lesion in the left lobe with no suspicious lymph node enlargement. Fine-needle aspiration (FNA) biopsy indicated PTC, classified as Bethesda VI. The patient underwent total thyroidectomy. Intraoperatively, the absence of the thyroid isthmus was noted. Histopathology confirmed a unifocal, 3.9×1.8 cm PTC of the classic subtype, staged as PT2pNx, with no neurovascular invasion and a tumor-free left thyroid lobe. The patient had an uneventful recovery and was discharged two days postoperatively. The absence of the thyroid isthmus can complicate surgical procedures. Preoperative imaging and careful intraoperative management are crucial. This case report highlights the rarity of thyroid isthmus agenesis coinciding with PTC, and emphasizes the importance of recognizing anatomical variations and their implications for surgical management and prognosis. Although it is hypothesized that abnormal development may predispose to malignancy, further studies are warranted to explore the potential association between congenital thyroid anomalies and thyroid malignancy.</p> Murad M. Hamiedah Bilal Al-Bdour Wael I. Alshoubaki Hussien R. Al-Nawaiseh Hamza M. Aljaafreh Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 603 606 10.18203/2349-3933.ijam20243065 Satisfying result after endpoint management laser in acute central serous chorioretinopathy: a case report https://www.ijmedicine.com/index.php/ijam/article/view/4126 <p style="font-weight: 400;">Central serous chorioretinopathy (CSC) is a condition where there is a buildup of fluid under the retina, specifically at the macula, causing neurosensory retinal detachment. This condition affected by many factors, one of them was psychological stress and male gender. CSC is a self-limiting disease, but in acute, chronic, and recurrent CSC in functionally monocular patient also could be considered as giving treatment. We presented a case of a 44 years old functionally monocular patient treated successfully with Endpoint management (EpM) Laser. After EpM laser was done, the subretinal fluid absorbed resolved, no darker spot straight ahead, and central foveal thickness in right eye was decreasing on the 14th day post operative. Treatment of CSC with visual loss is successful and efficient with EpM laser. Without harming retinal pigment epithelium, it accelerates sub-retinal fluid absorption and enhances visual rehabilitation.</p> Anak Agung Diyananda Paramita Ari Andayani Ni Made Ari Suryathi Sudjana Ni Made Kartika Rahayu Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 607 610 10.18203/2349-3933.ijam20243066 Successful management of chronic inflammatory demyelinating polyradiculoneuropathy: a rare case report https://www.ijmedicine.com/index.php/ijam/article/view/4112 <p>Acute immune-mediated demyelinating polyradiculoneuropathy is a rare neuropathic disorder characterized by significant motor involvement. The remitting and relapsing form of this disease is known as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). This case report presents the clinical features, diagnostic process, and successful management of a 37-year-old female patient with CIDP. The patient visited the emergency department with complaints of fever, numbness, and progressive weakness in all limbs. There was a similar previous history of weakness in limbs. The patient was treated with administration of high-dose methylprednisolone which led to resolution of symptoms. This case shows the importance of thorough clinical evaluation and prior history taking.</p> Deeksha Jatoth Surendar Sumanth Marupuru Atharva Jagawat Amulya Kalluri Chatla Sai Sutheertha E. Rishitha Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 611 614 10.18203/2349-3933.ijam20243067 A novel case of rickettsial encephalitis presenting as isolated global aphasia https://www.ijmedicine.com/index.php/ijam/article/view/4092 <p>This case report details a novel presentation of rickettsial encephalitis in a 25-year-old male patient who arrived with a 4-day history of fever and altered sensorium, marked by no verbal output and a loss of social inhibitions. Clinical examination revealed a 2x2 cm eschar on the right leg, moderate splenomegaly, thrombocytopenia, and leucopenia. An MRI of the brain showed focal T2/FLAIR hyperintensity involving the splenium of the corpus callosum, suggestive of cytotoxic lesions of the corpus callosum (CLOCCs). Despite the lack of structural abnormalities in primary language areas, the patient exhibited global aphasia. A positive Weil-Felix test indicated rickettsial infection. The patient was treated with ceftriaxone and doxycycline, leading to gradual neurological improvement and complete recovery within 15 days. This case highlights the importance of high clinical suspicion for rickettsial encephalitis, timely diagnosis, and appropriate antimicrobial therapy to achieve favorable outcomes.</p> Tanvi Vinay Wagh Gauri Nilajkar Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 615 617 10.18203/2349-3933.ijam20243068 Prader Willi syndrome in a neonate with aspiration pneumonitis: a case report https://www.ijmedicine.com/index.php/ijam/article/view/4115 <p>Prader Willi syndrome (PWS) is a rare genetic disease, even rarely diagnosed in neonates. PWS in a neonate presents with central hypotonia and feeding difficulty. Hereby, we report first neonatal case from India, who presented with aspiration pneumonitis. This case is presented to understand the subtle clinical features of PWS in neonates to facilitate early diagnosis and early intervention which improves quality of life. A term neonate presented at 9 days of life with complain of choking while feeding followed by rapid breathing. Apart from severe respiratory distress general examination revealed facial dysmorphology and bilateral cryptorchidism with scrotal hypoplasia. There was marked central hypotonia and weak cry. A provisional diagnosis of PWS with aspiration pneumonia was made and karyotyping along with DNA methylation was sent. Positive DNA methylation confirmed our diagnosis. Baby was managed with i.v antibiotics and parents were given basic information about PWS. They were educated about feeding techniques to prevent choking spells and informed about multidisciplinary care that baby will require. Prader Willi Syndrome should be considered in differential diagnosis in neonate presenting with central hypotonia, feeding difficulties and prompt diagnostic DNA testing should be done for confirmation.</p> Shweta Singh Reema Agarwal B. D. Bhatia Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 618 620 10.18203/2349-3933.ijam20243069 Negative pressure pulmonary edema and angioedema: a fatal correlation https://www.ijmedicine.com/index.php/ijam/article/view/4143 <p>Negative pressure pulmonary edema (NPPE), a non-cardiogenic pulmonary edema resulting from acute or chronic upper airway obstruction, remains a significant challenge in critical care settings due to the morbidity and mortality associated with undiagnosed cases. The most accepted pathophysiology involves the high inspiratory pressure required to counteract the upper airway obstruction, which leads to progressive negative intrapleural pressure. This results in increased pulmonary microvascular pressure, causing alveolar flooding. Among reported cases, laryngospasm in the postoperative period is the most common cause of NPPE. Management involves securing the airway and providing positive pressure ventilation. However, prevention and treatment remain subjects of further research.</p> Ananya Das Sahil Kumar Jaideep Pilania Jithesh G. Mukesh Bairwa Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 621 623 10.18203/2349-3933.ijam20243070 Cumbo sign - an alluring sign in lung hydatid cyst https://www.ijmedicine.com/index.php/ijam/article/view/4121 <p>Hydatid cyst of the lung is a prevalent condition that can be identified through serological tests or radiological imaging. In this case, an X-ray of the patient revealed characteristic signs of a hydatid cyst, which were pivotal in establishing the diagnosis. This diagnosis was subsequently confirmed through serological testing. The patient was successfully treated with symptomatic management and anthelminthic medication. A 27-year-old male patient presented with a 1-month history of fever, a week-long cough with blood-streaked sputum, and left-sided chest pain. Additional symptoms included weight loss, but he denied wheezing, shortness of breath, or close contact with dogs.</p> Ambadas Rathod Daljinderjit Kaur Rajdeep Singh Aman Kumar Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 628 629 10.18203/2349-3933.ijam20243072 Evaluation of traumatic spinal injury using low tesla MRI scan in a semi-urban environment of Nigeria https://www.ijmedicine.com/index.php/ijam/article/view/4131 <p><strong>Background: </strong>Spine injuries following trauma could present with profound life-altering consequences. Most spine injuries follow motor vehicle accidents, falls, and violence. Neurological injuries are common sequelae of spine trauma with huge medical, financial, and social consequences. Magnetic resonance imaging (MRI) allows better visualization of the supporting structures and the spinal cord in such trauma. To evaluate the patterns of traumatic spine injuries on low Tesla MRI scans in a semi-urban environment in the North Central Region of Nigeria.</p> <p><strong>Methods: </strong>A retrospective study involving 92 patients who had spine MRI scans using a 0.2T machine following trauma to the spine from 2017 to 2021 at the Jos University Teaching Hospital.</p> <p><strong>Results: </strong>The male gender was the most affected accounting for 83.7% with age group 21-40 years being the most affected (54.3%), followed by age group 41-60 (26%). Over half (52.2%) of the patients had cervical spine injuries, 39.1% had thoracic spine injuries, and lumbar spine injuries were seen in 19.6% of the patients. On Spinal cord involvement, the study revealed that 19 (20.7%) were normal,13 (14.1%) had contusion (Haemorrhage) while 45 (48.9%), 7 (7.6%), 10 (10.9%), and 10 (10.9%) had compression, edema, partial transection and complete transection respectively.</p> <p><strong>Conclusions: </strong>0.2T MRI was able to identify spinal injuries and these injuries mostly affect young adult males with the cervical spine being the most affected. Road Traffic-related incidents were the leading mechanism with Assault from ethno-religious crises and Injury arising from collapse mining ponds adding to it.</p> Anthony E. Gabkwet Emmanuel O. Igoh Folake Y. Taiwo Dangyang D. Mwarak Abdul J. Salaam Samuel J. Danjem Oyetayo O. Oladele Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 554 558 10.18203/2349-3933.ijam20243057 Assessing cilnidipine and its combination usage in Indian settings: a knowledge, attitude, and practice survey https://www.ijmedicine.com/index.php/ijam/article/view/4108 <p><strong>Background: </strong>Hypertension, affecting 31% of the Indian population, is a major risk factor for cardiovascular diseases. Cilnidipine is used in its management, alone or in combination with ARB. The objective of the current KAP survey was to assess the knowledge of healthcare professionals (HCPs) regarding hypertension management, their attitudes toward its treatment, and the application of this knowledge in clinical practice.</p> <p><strong>Method: </strong>A pan-India cross-sectional KAP survey was conducted from April 2022 to March 2023. The survey utilized a specially designed questionnaire focusing on various aspects of using cilnidipine and its combination with Telmisartan in hypertension management. A total of 1,254 HCPs with recognized qualifications participated. Descriptive statistics were employed for data analysis.</p> <p><strong>Results: </strong>Around 56% of HCPs initiated monotherapy of an antihypertensive drug at an SBP level of 140 mmHg, while 57% initiated combination therapy at an SBP&gt;160 mmHg. Nearly 43% reported initiating combination therapy in 20-30% of patients as initial treatment. Cilnidipine was preferred over amlodipine mainly due to decreased pedal edema. Cilnidipine monotherapy benefits young hypertensive patients (46%) and those with chronic kidney disease (CKD, 44%). Cilnidipine and telmisartan combination benefits patients with uncontrolled hypertension (46%), diabetes (43%), and CKD (41%). Advantages of this combination include less fluid retention, better compliance and tolerability, and less pedal edema.</p> <p><strong>Conclusion: </strong>This KAP survey highlights current practices in hypertension management, emphasizing the use of cilnidipine and its combination, attributed to their favorable tolerability and suitability for diverse patient profiles.</p> Mukesh Shete Ashish Saxena Akshay Nakrani Chirag Shah Heena Bhojwani Dinesh Jiwane Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 559 565 10.18203/2349-3933.ijam20243058 Effect of ayurveda-based panchakarma and lifestyle modification on global longitudinal strain in cardiac disorder patients https://www.ijmedicine.com/index.php/ijam/article/view/4110 <p><strong>Background:</strong> The present sought to study the change in global longitudinal strain (GLS) after 90 days in known cases of cardiac disorders with Ayurveda based Panchakarma and lifestyle modification.</p> <p><strong>Methods:</strong> A retrospective, observational, single-centre study was conducted from July 2021 to April 2022 in Maharashtra, India. Patients aged 18 years and above, diagnosed with inducible ischemia on stress test who underwent the ischemia reversal program (IRP) included in this study. Follow-up was conducted at 90 days. Day 1 and day 90 data were compared.</p> <p><strong>Results:</strong> A total of 32 patients were assessed. Anthropometric variables such as weight (day1: 68.31±12.40 kg and day 90: 63.82±10.93 kg, p=0.00) and abdominal girth (day 1: 93.56±9.60 cm and day 90: 88.22±6.19 cm, p=0.00) improved at the 90-day follow-up. The lipid profile also improved for variables such as high-density lipoprotein (day 1: 27.66±2.69 mmol/l and day 90: 31.94±2.69 mmol/l, p=0.00), low-density lipoprotein (day 1: 146.88 ± 44.68 mmol/l and day 90: 102.00±9.10 mmol/l, p=0.00), and triglycerides (day 1: 206.03±43.41 mmol/l and day 90: 157.53±35.70 mmol/l, p=0.00). Vo2 max changed from 16.93 ± 7.87 ml/kg/min to 30.83±3.76 ml/kg/min, p=0.00). GLS improved from -14.08±3.79 to -16.35±3.26.</p> <p><strong>Conclusion:</strong> Panchakarma therapy and lifestyle modifications help in improving global longitudinal strain, reducing symptoms of chest pain, breathlessness, dyspnea on exertion, improved V02 peak and improved weight loss and ejection fraction.</p> Priti S. Muramkar Nilesh Kulthe Pravin Ghadigaonkar Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 566 570 10.18203/2349-3933.ijam20243059 Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as a marker of disease activity in patients with systemic lupus erythematosus https://www.ijmedicine.com/index.php/ijam/article/view/4122 <p><strong>Background:</strong> Systemic lupus erythematosus (SLE) is a female predominant multiple system involving autoimmune inflammatory disorder. Considering the affordability and wide availability of the recently studied marker of inflammation neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), this study was done to investigate the relationship between NLR and PLR with the disease activity in patients with SLE.</p> <p><strong>Methods</strong>: In this hospital based cross sectional study done in Assam medical college and hospital, Dibrugarh done over one year period, newly diagnosed SLE patients above the age of 13 years were included. Patients with underlying disorders or on medications that may affect cell counts, drug induced lupus and recent history of blood transfusion were excluded. The disease activity was calculated using SLE disease activity index 2000 (SLEDAI-2K) and the patients were divided in two groups, group-A (SLEDAI-2K score <u>&lt;</u>9) and group-B (SLEDAI-2K score &gt;9) and correlation was sought with NLR and PLR.</p> <p><strong>Results:</strong> In this study 49 patients were included, with a mean age of 26.33 years and a female predominance (98%). NLR was found to be higher in group-B (11.37 vs 8.05, p&lt;0.001) and NLR positively correlated with SLEDAI-2K score (p&lt;0.001), ESR (p&lt;0.001) and CRP (p=0.212). PLR had a positive correlation with SLEDAI-2K score, CRP, and ESR, although it was the correlation with ESR that was statistically significant (p=0.029).</p> <p><strong>Conclusions:</strong> NLR and PLR was found to have a positive correlation with SLEDAI-2K scores, CRP and ESR and therefore can serve as an inexpensive marker of disease activity in patients with SLE.</p> Aritra Saha Ajit Kumar Pegu Rebecca R. Marak Zarika Ahmed Mayuree Thakuria Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 571 577 10.18203/2349-3933.ijam20243060 Chronic medical conditions and health care utilization in Indian marathon athletes: a cross-sectional observational study https://www.ijmedicine.com/index.php/ijam/article/view/4124 <p><strong>Background: </strong>The purpose of this study was to investigate the prevalence of chronic medical conditions and healthcare utilization among Indian marathon athletes through a digital survey.</p> <p><strong>Methods: </strong>This was a cross-sectional, observational study that employed a questionnaire-based digital survey of Indian marathon athletes. The survey collected data on participants' demographics, training history, chronic medical conditions, and healthcare utilization. Descriptive statistics were used to analyze the data.</p> <p><strong>Results: </strong>A total of 224 marathon athletes participated in the survey from April 2023 to June 2023. The largest segment of respondents (40.6%) fell within the age bracket of over 50 years, and 82.3% were male. Among the participants, 84.9% were married, and 77% were employed in the private sector. About 56% were involved in some sports activity prior and 90% opined they follow a healthy lifestyle. On comorbidities, hypertension was most prevalent (23.2%) followed by diabetes (13%), hyperlipidemia (9.3%), and asthma (2.2%). About 95% do not take any pain medications during a marathon and 29 % were not aware of the precautions to be taken for running a marathon with chronic medical conditions. Around 69.6% do not consult a physician to get advice and approval before a marathon and 73.1% mentioned that they do not take regular medication for chronic medical conditions like diabetes and hypertension</p> <p><strong>Conclusion: </strong>Indian marathon athletes have a significant prevalence of chronic medical conditions, with hypertension, asthma, and diabetes being the most common. A substantial proportion of athletes sustain injuries during training and competition, leading to healthcare utilization, particularly for physical therapy. These findings highlight the importance of comprehensive pre-participation medical evaluations and targeted injury prevention strategies for this population.</p> Medha Oak Ajit S. Oak Bageshree Oak Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 578 583 10.18203/2349-3933.ijam20243061 Natural history of subclinical hypothyroidism in diabetes mellitus: a prospective observational study https://www.ijmedicine.com/index.php/ijam/article/view/4134 <p><strong>Background: </strong>The natural course of subclinical hypothyroidism (SCH) is variable. Several studies have shown that not all SCH progresses to overt hypothyroidism (OH). Little data are available regarding the natural course of SCH in diabetes mellitus (DM). We aimed to investigate the natural course of SCH in DM patients.</p> <p><strong>Methods: </strong>A total of 118 patients with SCH (52 with DM and 66 without DM) were enrolled in this prospective observational study. Anthropometric, thyroid hormone and Anti-thyroid peroxidase (TPO) antibody (Ab) level were measured at baseline. Thyroid hormone levels were also estimated at 6 month and 12 months.</p> <p><strong>Result: </strong>The majority of the patients, 76(61.86%), remained with SCH, 21(17.8%) progressed to OH and 24 (20.83%) reverted to normal. The rate of progression to OH (DM: 7.69% vs non-DM: 25.76%) was significantly lower in patients with diabetes than in those without. Multivariate logistic regression analysis showed that the risk factors for progression to OH were the glycemic status and thyroid autoantibody.</p> <p><strong>Conclusion: </strong>The present study suggests that patient with SCH have variable disease courses. Glycemic status and autoimmunity are the two most powerful predictors of OH. DM protects the progression to OH whereas thyroid autoantibody increases the risk of progression to OH. We recommend a more aggressive follow up for thyroid autoantibody positive and non-diabetic patients.</p> Shailendra Kumar Singh Rina Singh Sonam Bedi Arun Kumar Pandey Alankar Tiwari Pradeep Kumar Rai Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 584 590 10.18203/2349-3933.ijam20243062 A prospective randomised comparative study of intrathecal buprenorphine versus intrathecal magnesium sulphate as an adjuvant to 0.5% hyperbaric bupivacaine for lower limb surgeries under subarachnoid block https://www.ijmedicine.com/index.php/ijam/article/view/4139 <p><strong>Background:</strong> Spinal anaesthesia can be strengthened and improved postoperative analgesia can be achieved by adding an adjuvant to a local anaesthetic. The objective of this study is to assess the onset and duration of sensory and motor block, duration of analgesia and to compare the efficacy of 0.5 percentage of hyperbaric bupivacaine with magnesium sulfate to that of 0.5 percentage of hyperbaric bupivacaine in conjunction with buprenorphine during surgeries of the lower limb.</p> <p><strong>Methods:</strong> A total of 60 ASA 1 and 2 patients undergoing lower limb surgeries under spinal anaesthesia, were randomly divided into two groups (30 each). Group B was administered a 15mg dose of a 0.5% heavy bupivacaine solution, in conjunction with 1 mcg/kg buprenorphine, as an adjuvant. Conversely, Group M received the same dosage but was additionally infused with 0.5 ml (50 mg) of magnesium sulfate (Total 3.5 ml) The subarachnoid block was performed in the interspace between the L3-L4 vertebrae following a confirmed cerebrospinal fluid (CSF) flow in the seated position. The onset of analgesic effect, degree of blockade, sedation score, duration of analgesia, occurrence of adverse effects and hemodynamic parameters were all meticulously monitored.</p> <p><strong>Results:</strong> The findings of this study revealed no significant disparities in age, sex, weight or the mean duration of surgery across the two groups. Furthermore, there was no significant difference in the time required for the onset of motor block between the study groups (p&gt;0.05). Mean duration of sensory block (141.83 vs 90.0 mins; p&lt;0.01) and motor block (267.8 vs 218.1; p&lt;0.01) was significantly more in cases of magnesium sulphate group as compared to buprenorphine group. Mean duration of analgesia (294.83 vs 245.5; p&lt;0.01) was significantly more in cases of magnesium sulphate group as compared to buprenorphine group.</p> <p><strong>Conclusions:</strong> A good analgesia is achieved by magnesium sulphate as compared to buprenorphine when added to 0.5% hyperbaric bupivacaine for lower limb surgeries. Depth of sensory block was greater with magnesium sulphate.</p> Gajanan Fultambkar Rohith Salla Vijayanand Budi Copyright (c) 2024 International Journal of Advances in Medicine 2024-10-24 2024-10-24 11 6 591 598 10.18203/2349-3933.ijam20243063