This study investigated whether patients undergoing surgery with regional anesthesia who listened to music required less sedation than those who did not listen to music. 60 patients were randomly assigned to either listen to music of their choice (group M) or not listen to music (group C) during surgery. The dose of midazolam needed to achieve a sedation score of 3 or less was significantly lower in group M. Group M also had better sedation scores at 90 and 120 minutes after surgery began. While pain, discomfort and satisfaction scores did not differ, group C recalled more intraoperative conversations and sounds. The study concludes that music reduces the need for sedation and improves intraoperative recall during regional anesthesia.
Background: Perforated tympanic membrane and middle ear infection are among common complications treated by tympanoplasty. This study was aimed to compare the effects of underlay and overlay tympanoplasty on the improvement of hearing and tympanic membrane landmarks and post-operative complications as well.
Background: Perforated tympanic membrane and middle ear infection are among common complications treated by tympanoplasty. This study was aimed to compare the effects of underlay and overlay tympanoplasty on the improvement of hearing and tympanic membrane landmarks and post-operative complications as well.
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A single blind RCT to evaluate the effect of intraoperative bupivacaine infilteration fro post operative pain relief was conducted. Observations based on the VAS and mean duration for requirement of 1st analgesic dose post operatively. Results compared with other similar studies and found that the there is significant reduction in the VAS of post operative pain and increase in the duration for requirement for the 1st dose of the analgesic postoperatively
Endoscopic ultrasonography (EUS) is an outpatient procedure
During an EUS procedure, an upper gastrointestinal (GI) scope is inserted into the esophagus through the mouth to obtain ultrasonographic as well as endoluminal images of various upper gastrointestinal pathologies.
Intensive Aphasia Treatment Program
The North Memorial Stroke Center is the first in the region to offer this innovative outpatient program that includes many hours of intense therapy over the course of three weeks. The program is designed to help participants relearn old ways or develop new alternative ways of communicating. Patients participate in a combination of individual and group treatments sessions for approximately three and a half hours per day, five days a week.
This presentation was delivered during a webinar held by the association of anaesthetists in association with RA-UK entitled "New Blocks - Friend or Foe?".
This took place on 19th October 2021.
In this short presentation - Dr Pawa covers: a brief overview of the history of Paravertebral blocks; how he got introduced to them; some updates on our understanding on the anatomy; and whether they still have a role in modern anaesthetic practice.
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A single blind RCT to evaluate the effect of intraoperative bupivacaine infilteration fro post operative pain relief was conducted. Observations based on the VAS and mean duration for requirement of 1st analgesic dose post operatively. Results compared with other similar studies and found that the there is significant reduction in the VAS of post operative pain and increase in the duration for requirement for the 1st dose of the analgesic postoperatively
Endoscopic ultrasonography (EUS) is an outpatient procedure
During an EUS procedure, an upper gastrointestinal (GI) scope is inserted into the esophagus through the mouth to obtain ultrasonographic as well as endoluminal images of various upper gastrointestinal pathologies.
Intensive Aphasia Treatment Program
The North Memorial Stroke Center is the first in the region to offer this innovative outpatient program that includes many hours of intense therapy over the course of three weeks. The program is designed to help participants relearn old ways or develop new alternative ways of communicating. Patients participate in a combination of individual and group treatments sessions for approximately three and a half hours per day, five days a week.
This presentation was delivered during a webinar held by the association of anaesthetists in association with RA-UK entitled "New Blocks - Friend or Foe?".
This took place on 19th October 2021.
In this short presentation - Dr Pawa covers: a brief overview of the history of Paravertebral blocks; how he got introduced to them; some updates on our understanding on the anatomy; and whether they still have a role in modern anaesthetic practice.
G20 Foundation Lecture on Green Growth, Sustainability and Climate Change at ...G20_Foundation
G20 is a group of 20 major economies which represent 90% of the world’s overall GDP, 80% of world trade and 2/3 of the world’s population. As a result of a G20 Summit, the heads of state produce a leaders declaration, where they agree to a number of macro economical reforms and regulations.
Since Green Growth, Sustainability and Energy Efficiency were significant agenda topics through past G20 presidencies, the first part of this lecture will evaluate the success of the governance process and identify key obstacles for implementation. The second part will deal with governance innovation and dialogue facilitation between governments, businesses, academia and civil society. Inclusions will be underlined as an important measure for improvement of quality and acceptance of the governmental decision making process.
http://www.g20foundation.org/
The G20 Foundation is an independent platform formed to help develop a framework for better global governance.
As an intermediary platform, the G20 Foundation positions itself as process enabler and a facilitator between governments, business, and academia within the G20 process.
We add value through encouraging broader public consensus and understanding of the G20 commitments which leads to higher accountability and raises effectiveness of a governance process.
As a non-partisan think tank, we stimulate constructive and effective discussions within “Outreach Dialogue” in order to support the implementation of the G20 commitments on a national level.
Thereby we foster the development of innovative solutions to global challenges, such as economic stability and sustainable growth.
20 Graphic Design Resources that will Make you Master of the GameLogo Design Guru
Designers can be self-tutors, all thanks to the various resources available online. It’s actually quite easy to get stuck in hoarding bookmarks and feeling overwhelmed by all this abundance of resources. But to actually start learning, you’ll need to take action. Here's your starting point
The role of hyperbaric oxygen therapy in Sudden Sensorineural Hearing Loss: A...Apollo Hospitals
Sudden Sensorineural Hearing Loss (SSNHL) is a hearing impairment of more than 30 dB occurring within a period of upto 3 days in three consecutive pure tone frequencies. Hyperbaric oxygen therapy (HBOT) in recent years has gained relevance for treating SSNHL in combination with other agents. The aim of this study is to review the outcomes in patients with SSNHL treated with HBOT at our centre.
Evaluation of Radiotherapy Effect on Auditory System in Patients with Head and Neck Tumors by Seyedeh Mahtab Ashja Arvan in Experiments in Rhinology & Otolaryngology
Radiotherapy in patients with head and neck tumors may result in damage of different organs such as eyes and ears. However, there is no consensus regarding the level of damage, especially its effect on hearing threshold. This study has been designed to determine the effect of radiotherapy on auditory system of patients with head and neck tumors.
https://crimsonpublishers.com/ero/fulltext/ERO.000509.php
Preemptive Analgesia for Attenuation of Postoperative Pain in Patients Underg...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
How to reduce patient anxiety before a urodynamics test?Clark Love
Urodynamic testing is a group of tests used to evaluate how well how well the bladder, sphincters, and urethra are storing and releasing urine. Due to the nature of urodynamic testing, some patients experience anxiety. However, there are a few simple steps that can be taken to significantly reduce patient anxiety.
Congenital Agenesis Of The Corpus Callosum With Intracerebral Lipoma And Fron...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
“Hemodynamic and recovery profile with Dexmedetomidine and Fentanyl in intrac...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Correlation of Estrogen and Progesterone Receptor expression in Breast Canceriosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Analytical Study of Urine Samples for Epidemiology of Urinary Tract Infection...iosrphr_editor
The current study was carried out in District Abbottabad aimed to determine the common urinary
tract infections in local community to determine the epidemiology of significant diseases in asymptomatic patients
of renal disorder. In this study a total of 1000 urine samples were examined during 3rd February to 1st April 2015
from patients attending Ayub Teaching Hospital Abbottabad by using dipstick and microscopic analysis of urine.
There were 638 females and 362 males patients examined during this period. The range of age groups is between
1.5 years to 80 years. Results of this study was reported as Pyuria 11%, Proteinuria 21.1%, Hematuria 10.4%,
Epithelial Cells 8.2%, pH 7.8 %, Granular casts 7.3%, Triple phosphate 6.6%, Calcium oxalate 6.4%, Glycosuria
6.3%, Bacteria 6.2% and mucous 4.1%. This study concludes that routing urinalysis should be performed for all
individuals to diagnose the asymptomatic diseases that will help in simple therapeutic measurements as urinalysis
is a simple step to determine the root of Urinary tract disorders.
Chest sonography images in neonatal r.d.s. And proposed gradingiosrphr_editor
BACKGROUND : Lung sonography has been used to monitor the patients of R.D.S. in
N.I.C.U. in recent times.
AIMS : To Describe and Grade the changes of R.D.S. by lung sonography.
SETTING & DESIGN : Tertiary care institutional set up in a rural medical college.
STUDY DURATION : September 2014 to May 2015. Follow-up variable, upto 2 weeks.
PROSPECTIVE, ANALYTICAL STUDY.
MATERIALS AND METHODS -This was a single institute study approved by the institutional ethics
committee. Prior informed consent was obtained from the parents. 100 consecutive patients admitted in
N.I.C.U. WITH gestational age < 36 weeks with respiratory complaints were enrolled. Chest x-ray was
obtained within few hours of admission and lung sonography was performed within 24 hours. Follow – up
sonography was performed as and when necessary. Sonography image was graded and correlated with chest
xray and clinical picture
The Comprehensive Review on Fat Soluble Vitaminsiosrphr_editor
This review article deals with brief description of fat soluble vitamins with figures and tables
showing statistical analytical data duly quoting the references wherever necessary. The word “soluble” actually
means “able to be dissolved.” Whether a vitamin is classified as 'fat-soluble' or 'water-soluble' has to do with
how the vitamin is absorbed, stored and removed from the body. Vitamins are tiny organic compounds with a
huge impact on the health and well-being of the body. The body needs a small amount of fat soluble vitamins in
order to stay in optimal health. Fat soluble vitamins play an important role in keeping the body healthy and
functioning from immune system and muscle and heart function, easy flow and clotting of blood as well as eye
health. They are critical to health and wellness–particularly reproductive health and wellness. Low-fat, no-fat
and vegan diets are woefully lacking in fat soluble vitamins. However a diet based on traditional foods can
naturally provide these vitamins. Science is still learning about many of the functions of vitamins. "Too much
vitamin A, D, or K can lead to increased levels that are unhealthy and can cause serious health consequences.
Diseased conditions leading to decreased fat absorption leads to decreased absorption of vitamins. The fatsoluble
vitamins work most safely and effectively when obtained them from natural foods within the context of a
diet rich in all their synergistic partners. If fat soluble vitamins are stored for lengthy time they generate threat
for toxicity than water soluble vitamins and such situation even aggravated, provided they are consumed in
excess. Vitamin products, above the legal limits are not considered food supplements and must be registered as
prescription or non-prescription (over-the-counter drugs) due to their potential side effects. Vitamin A and E
supplements do not provide health benefits for healthy individuals, instead they may enhance mortality, and it is
held proved that beta-carotene supplements can be harmful to smokers
Sulphasalazine Induced Toxic Epidermal Necrolysis A Case Reportiosrphr_editor
Toxic Epidermal Necrolysis (TEN) is a rare and life threatening mucocutaneous reaction
characterized by extensive necrosis and detachment of epidermis. The Worldwide incidence of TEN is 0.9 to 1.4
per million populations per year [1]. Here we have discussed a case of Toxic Epidermal Necrolysis secondary
to Sulfasalazine managed with fluid replacement, analgesics, anti-infective therapy aggressive nutritional
support and intravenous high dose steroid therapy.
Keywords- Toxic Epidermal Necrolysis, Sulfasalazine
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
FIBROLIPOMATOUS HAMARTOMA OF ULNAR NERVE: A RARE CASE REPORT.iosrphr_editor
Nervous fibrolipomatous hamartoma is said to be a rare tumor-like condition involving the peripheral
nerves,in which the epineurium and perineurium are enlarged and distorted by excess of fatty and fibrous tissue
s that infiltrate between and around nerve boundaries. The median nerve is more likely to develop a hamartoma
than other nerves with a predilection for the carpal tunnel.
A fibrolipomatous hamartoma – is a rare, benign, congenital lesion most commonly found in the median nerve,
usually at the level of the wrist or hand.
We report a case of this rare condition in ulnar nerve.
SELF MEDICATION PRACTICES FOR ORAL HEALTH PROBLEMS AMONG DENTAL PATIENTS IN B...iosrphr_editor
Introduction: Self‑ medication is commonly practiced all over the world. Self-medication is defined as the use
of medication by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of
consulting a medical practitioner. The present study was aimed to estimate the prevalence of self-medication for
oral health problems among dental patients in Bengaluru city; to identify triggering factors that could influence
self-medication practices; to identify sources of medications used; to identify sources of information about
medications used; and to identify reasons for self-medication.Study Design: A Cross sectional Study.Methods:A
survey was conducted among 175 subjects among dental patients in Bengaluru city. Data were collected
through a specially designed proforma using a closed‑ ended, self‑ administered questionnaire containing 15
questions, in five sections.
Results: The prevalence of
Clinico-haematological Profile of Falciparum Malaria in a Rural Hospital of T...iosrphr_editor
Aim: To study the clinico-haematological profile malaria in a rural hospital of Tripura.
Material and methods: A cross-sectional hospital-based study was done from at Kulai District
Hospital,Tripura. This hospital based cross sectional study was done on 60 confirmed cases of falciparum
malaria (either by peripheral smear or rapid diagnostic test) admitted in Kulai District Hospital. A case sheet
proforma was prepared and data (demographic profile,clinical feature, investigation, treatment, and
complication) from all indoor patients was collected and analyzed.
Result: Out of 60 patients, 40(66.6%) were males and 20 (33.4%) were females. Most of the patients were
between the age group 21-40 years with the highest prevalence between the age group of 21-30. Fever was the
most common symptom. Anemia was present in 42(70%) patients, out of which 6(10%) patients had severe
anemia. Thrombocytopenia was present in 36(60%) patients.Abnormal liver function tests were observed in
26(43.3%) subjects while abnormal kidney function tests were observed in16(26.6%) patients. All the 60
patients received Artemisinin based antimalarial drugs.
Conclusion: Early detection, prompt management, and adequate supportive therapy may reduce mortality due
to falciparum cerebral malaria.
Indonesian Wild Ginger (Zingiber sp) Extract: Antibacterial Activity against ...iosrphr_editor
Lempuyang gajah (Zingiber zerumbet (L.) Smith), lempuyang pahit (Zingiber amaricans BL.), and
lempuyang wangi (Zingiber aromaticum Vahl.) are used as traditional medicine (jamu) in Indonesia. It is also
used for treatment of microbial infections, helps to increase appetite and stimulate digestion in chickens.
Information on their uses are available, but only limited in the scientific data on their bioactivity. The study was
conducted on the antibacterial effect of organic extracts of these plants with Mycoplasma gallisepticum as the
agent of chronic respiratory disease in chickens. Juice and extracts of fresh and dried rhizome are evaluated
through the disc diffusion assay and minimum inhibitory concentration. Oxytetracyclin (30 µg) are used as
standards. All extracts are individually exhibited as antibacterial activity against Mycoplasma gallisepticum (7
± 0.11 mm to 21 ± 0.86 mm). The minimum inhibitory concentration (MIC) determination of plants extracts are
ranged from 7.8 mg/ml to 31.2 mg/ml. The preliminary results suggested promising antibacterial properties of
wild ginger from Indonesia, and probably could be used in management of chronic respiratory disease in
chickens.
A case of allergy and food sensitivity: the nasunin, natural color of eggplantiosrphr_editor
Abstract: Allergies and food sensitivities can both be considered as "adverse reactions individualistic" to food.
Are pathological and individual forms because they affect a few individuals in way rather serious; immediate
or delayed reactions occur instead with simple effects histamine, or, in severe cases with respiratory and
anaphylactic shock
The eggplant (Solanum melongena L.) is known to cause food allergies in some Asian countries, but detailed
studies on allergies caused by eggplant are lacking, however, it was highlighted the presence of allergens in
edible parts of eggplant with preponderance in the peel .
The purpose of this study was to propose an extraction method rapid, efficient and cost of natural dye from
waste products from the food industry, such as the peels of eggplant, from which it was extracted, isolated and
purified the nasunin,a colored molecule in red-fuchsia.
Nasusin was tested on 58 patients to evaluate the potential sensitizing effect on the skin. The results demonstrate
that allergenic effects are negligible and therefore the nasunin can be used as a colorant in various industrial
sectors with a certain safety margin
Complete NMR Assignment of MogrosidesII A2, II E andIII A1Isolated from Luo H...iosrphr_editor
NMR analysis allowed complete assignments of three known mogrol glycosides, Mogroside IIA2 (1),
II E (2)and IIIA1 (3), isolated from the extracts of Luo Han Guo. Herein, complete 1H and 13C NMR
assignmentsof all threemogrosidesare described based on NMR experiments (1H NMR, 13C NMR, COSY,
HSQC-DEPT, HMBC, NOESY and 1DTOCSY) and mass spectral data.
Nanoemulsion and Nanoemulgel as a Topical Formulationiosrphr_editor
: Nanoemulsion is referred type of emulsion with uniform and extremely small droplet size in the range
of 20-200 nm. Nanoemulsion provides numerous advantages over other carrier such as polymeric nanoparticle
and liposomes, including low cost preparation procedure, high hydrophilic and lipophilic drug loading system
to enhance the longer shelf live upon preserving the therapeutic agents. Incorporating the preparation of
nanoemulsion with hydrogel matrix to produce nanoemulgel exhibited by the two separate systems that forming
it. Nanoemulgel possesses the properties of thixotropic, non-greasy, effortlessly spreadable, easily be removed,
emollient, not staining, soluble in water, longer shelf life, bio-friendly, translucent and agreeable appearance.
Pharmacokinetics of High-Dose Methotrexate in Egyptian Children with Acute Ly...iosrphr_editor
Aim:Since several factors have been shown to influence the clearance of methotrexate, the purpose of this study
was to identify potential relationships between patient covariates and the methotrexate clearance estimates and
deduce a pharmacokinetic model for the estimation of methotrexate clearance in Egyptian pediatric ALL
patients that may help dosage adjustment and achieve target steady-state plasma concentrations in a similar
sittings.
Patients and methods: A total of 94 pediatric patients with B-cell ALL, of whom 70 were the studied population
and 24 were the test population, were treated with four courses of HDMTX doses 2.5 gm/m2
(low-risk arm) or 5
gm/m2
(standard-/high-risk arm) given every other week by intermittent intravenous infusions over 24 hours as
a part of their treatment protocol. Patients were monitored for the 24 hour MTX concentration and the systemic
methotrexate clearance was calculated for each methotrexate dose
Epidemiology of Tuberculosis (TB) in Albania 1998-2009iosrphr_editor
Abstract : In Albania, many people erroneously think that tuberculosis (TB) is a disease of the past-an illness
that no longer constitutes a public health threat. Surveillance is an integral part of tuberculosis (TB) control.
Albania has a highTB notification rate and there are doubts about underreporting. The evolution of the
incidence of tuberculosis is presented, together with more detailed figures over the period 1998-2009. These
figures were obtained by the monthly forms (called 14/Sh) compared with the individual notification data.
Objective: To examine the distribution and sources of increased tuberculosis (TB) morbidity and reporting
system deficiencies in the Albania from 1998 through 2009. Metodology: The study is descriptive one conductet
during the period 1998-2009. The statistical analysis is based on data reported from regional level (regional
epidemiological departments) to the central level (Public Health Institute). Results: The main findings were:
discordance between the collected data (individual form) and reported data (monthly form); tuberculosis
incidence rate shows little oscillations which ranges from 6.67 to 9.2 cases/100.000 population; 50% of the
regions show a lack of information on the confirmation of diagnosis and laboratory examination type used for
confirmation. Conclusion: TB disease in high-risk populations where it is difficult to detect, diagnose, and treat;
limitations of current control measures and the need for new tests and treatments, including an effective
vaccine; improving information system, regulation of individual form and personnel training.
Total Phenol and Antioxidant from Seed and Peel of Ripe and Unripe of Indones...iosrphr_editor
Study on total phenol and antioxidantactivity ofsugar apple fruits of various solvent, part of fruits, and level of ripening. Solvent extraction used were 80% (v/v) methanol, 50% (v/v) acetone, boiling water, and 50% (v/v) ethanol. Part of fruits thatbeen used for samples were seed and peel which are normally by products of sugar apple processing, level of ripening were unripe, and ripe sugar apple fruits. Total phenol was determined by Folin-ciocalteau method. Total antioxidant was quantified by 1,1-diphenyl-2-picrylhydrazyl(DPPH) method.Therewas a difference in type of solvent, part of fruits, and level of ripeningon total phenol and antioxidant concentration of sugar apple fruits. Seeds have higher total phenol concentration than peels of this fruits. Unripe sugar apple fruits have higher total phenol and antioxidant than ripe fruit. The best solvent for phenol extraction was ethanol 50%butthe best solvent for antioxidant extraction was acetone 50%.
A Review on Step-by-Step Analytical Method Validationiosrphr_editor
When analytical method is utilized to generate results about the characteristics of drug related samples it is essential that the results are trustworthy. They may be utilized as the basis for decisions relating to administering the drug to patients. Analytical method validation required during drug development and manufacturing and these analytical methods are fit for their intended purpose. To comply with the requirements of GMP pharmaceutical industries should have an overall validation policy which documents how validation will be performed. The purpose of this validation is to show that processes involved in the development and manufacture of drug, production and analytical testing can be performed in an effective and reproducible manner. This review article provides guidance on how to perform validation characteristics for the analytical method which are utilized in pharmaceutical analysis.
A Cross Sectional Study of Ethnic Differences in Occurrence and Severity of A...iosrphr_editor
Non-steroidal anti-inflammatory drugs are the most widely used "over the counter" medication all over the world despite their complications in different major organs. Present studies envisaged for knowing the occurrence and severity of adverse drug reactions from NSAIDs in different ethnic communities of Sikkim. A cross sectional study was undertaken in the medicine outpatients department of a secondary and tertiary care hospital. The patients belonging to Nepalese, Bhutias, Lepchas ethnic communities and others community (settlers from other parts of India) were included to analyzed the data based on the age and gender, ethnicity and ADRs, drugs and ADRs. Severity assessment was done using Hartwing and Siegel scale and causality assessment by Naranjo scale. Total 109 cases of ADRs, predominating in female were detected. Nepalese were the most affected and Gastrointestinal tract (GIT) being the most affected organ in them. Diclofenac showed maximum number of ADRs in all the communities. Maximum number of cases occurred on single day use (40.36%) of drugs. All the cases were belonging to the "possible category" and the maximum being the mild (72.48%) in nature. It is advisable to consider the ethnic/racial differences equally with other factors, to improve the safety and efficacy of a drug.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
IOSRPHR(www.iosrphr.org) IOSR Journal of Pharmacy
1. IOSR Journal of Pharmacy
Vol. 2, Issue 3, May-June, 2012, PP.569-578
THE EFFICASY OF MUSIC IN LOWERING INTRA-OPERATIVE
SEDATION REQUIREMENT AND RECALL OF INTRA OPERATIVE
PROCESSES
Vijay Sharma
(MBBS, DA, MD, DNB), Benhur Premendran (MBBS, MD), Himaunshu Dongre (MBBS, MD),
Usha Domkondwar (MBBS, DA, MD)
Department of Anaesthesiology, Mahatma Gandhi Institute Of Medical Sciences, Sevagram,
ABSTRACT
Background: It has been known for a long time that music has characteristic psychological and physiological effects in
humans. It is a non-pharmacological technique that is inexpensive, non invasive and has no major side effects. Surgery with
music is being increasingly reported at many of the today‟s modern hospitals, documenting music‟s powerful soothing,
calming, sedating effects on subjects including a significant reduction in the amount of anesthesia needed.
Aims and Objectives: To find out whether patients undergoing elective surgery under regional anesthesia, who hear a pre-
selected music during surgery through a headphone, need a lower dose of intra-operative sedatives and have a reduced recall
of intra-operative processes
Methods: 60 Patients undergoing elective orthopedic,gynaecological or urological Surgeries under regional anaesthesia
between June to August 2009 were randomized into either listening to Music(group M,n=30),or not listening to music(group
C,n=30). Midazolum was given for sedation in either of the groups to achieve a Observer‟s Assessment of
Sedation/Alertness Score(OAS) of 3 or less.We compared the total dose of Midazolum required and OAS scores in both the
groups. Post operative recall of Intraoperative processes by patient was assessed on answers to a 6 point Questionnaire and
VAS score for pain,discomfort and dissatisfaction with the sedative method employed was sought.
Results:The Mean dose Of Midazolum to achieve Sedation was significantly lower (p<0.01) in the patients that listened to
Music during their surgery.Desirable OAS score (<3) were significantly better in the Music group at 90 ant 120 min from
start of the surgery .There was no significant differences in the VAS scores for pain ,discomfort or dissatisfcation with the
sedation method employed in either groups(P>0.01). Intra operative instances of conversations between the doctors/nurses
and other OR staff and Sounds of monitors, instruments,etc were more significantly recalled by those who did not listened to
music during their surgery (P<0.01).
Conclusion: Our study concludes that patients undergoing elective surgery under regional anesthesia , who hear a pre-
selected music during surgery through a head-phone, need lower dosage of intra-operative sedatives and have a reduced
recall of intra-operative processes thus creating an effective,safe and cheap non pharmacological method of sedating
conscious patients operated under regional anaesthesia.We recommend that Favourite Music via headphones should be
provided to all the patients who are fond of music listening during the surgical procedures expected to last one and half hours
or more .
Keywords: Music, Intraoperative sedation, Recall of intraoperative processes.
INTRODUCTION:
The search for improved and cost effective means of enhancing patient‟s outcome in the immediate post-operative
period has lead to evaluation of the effectiveness of non-pharmacological interventions in improving patient recovery (1). It
has been known for a long time that music has characteristic psychological and physiological effects in humans. It is a non-
pharmacological technique that is inexpensive, non invasive and has no side effects.. Ample of studies exist that document
music's powerful benefits including a significant reduction in the amount of anesthesia needed(1).
We all know Patients coming to Operation room (OR) are worried , need privacy, silence & reassurance. Noises
and comments in operation room range from sounds from scissors, drills ,saws.etc to comments & remarks on patient‟s
disease, body shape , weight, behavior …etc. These are key areas of ethics in operation theatre, which expects noise should
be kept to minimum. Discussions & stories should be in staff rooms only, away from patients! Jokes and laughing should not
be done before induction of general anaesthesia or loudly in front of patients under local or regional anaesthesia,especially in
languages that they understand. Deficiencies exist in the application of some ethical standards inspite of all measures.
Hence the purpose of our study was to find out whether patients undergoing elective surgery under regional
anesthesia, who hear a pre-selected music during surgery through a head-phone, need a lower dose of intra-operative
sedatives and have a reduced recall of intra-operative processes ?
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METHODS AND MATERIALS:
Setting: The present study was carried out in the Department of Anaesthesiology at MGIMS-Sevagram which is a
rural 648 bedded tertiary care hospital and Medical college located at Sevagram, District Wardha, State of Maharashtra,
India.
Study design: This randomized, single blinded controlled trial was carried out after seeking approval from
institutional ethical committee in adult patients fulfilling inclusion criteria‟s as mentioned below and who were scheduled for
surgeries under regional anesthesia between May to July 2009 and who had given informed written consent for willingness
to participate in this study .
The patient since aware of the type of intervention couldnot be blinded in our study.
Inclusion criteria were:
Patients for elective surgeries planned under Spinal anaesthesia,
ASA status I or II
Age group 18-60 years
Either liking music or ambivalent
Exclusion criteria were:
Age<18 ,>60 years
ASA status III and above
Pts with hearing impairment
Known psychiatric or memory disorder
Unwillingness to participate in the study(no Consent)
Disliking for Music
Special materials used were:
Portable music player
Head phone sized enough to cover whole ear
Choice of music selection
Screening: Starting from 1st May 2009 till July 2009 , all patients who were posted in the OT list of gynaecology
,orthopedics or urology for surgery under regional anaesthesia were screened and included in this study. These specefic
branches were preferred since the procedures in these branches often range between avg. to long duration and due to specific
positions required to carry out surgeries in these patients, such patients often need supplemental sedation. Routinely in our
setup we use Midazolum 1 to 2 mg IV as initial bolus followed by further supplemental doses of approx. 1 mg as and when
the supervising anesthesiologist may feel necessary , so as to reduce their discomfort, pain or to make up for the weaning
effect of anaesthesia. On an average 4-8 cases are scheduled for surgery under regional anaesthesia in the operative list of
gynaecology ,orthopedics or urology combined at our centre .All these patients were evaluated atleast 1 day prior to their
surgery in the pre-anaesthesia check-up O.P.D (PAC O.P.D) where we selected our study group based on inclusion and
exclusion criteria above and desired their voluntary participation.
Study procedure:
Pre-op room: In this study we randomly divided all such patients fulfilling our inclusion criterias into 2 groups..Group M
was the one in which Music of patient‟s choice from 3 categories “spiritual”, “filmy”, “instrumental” all of which were in
patient‟s preferred language was provided . Group C received no music through music player but were still given
headphones to wear . Selection to Music or No Music group was made from pre-sealed envelopes containing paper -chits
with letter M (music) or letter C (Control i.e no music) which was picked up by patients themselves in presence and
supervision by Person „A‟ in pre op waiting area, who did not participate in further study procedure inside the operation
room. Any spontaneous reporting of anxiety, voluntary demand for sedation, observer assessment of sedation/alertness
score(OAS) ,Heart rate, NIBP(Non invasive blood pressure) were noted as baseline values. Group C received Midazolum
1mg IM atleast for 1 hour before finally transferring to Operation room(OR) whereas Music was applied in the Group M
similarly for the same minimum duration of 1 hour.
Operation room: After an hour of application of the head phones with volume adjusted by patient themselves , pts were
shifted to the OR (operation room) and Person „B‟ who was blinded from details of the study and group differentiation
supervised notification of all data intra-operatively. Inside the operation room, team of anaesthesiologists were totally blinded
from the nature and purpose of the ongoing study with strict instruction not to touch the headphones or examine it for
presence or absence of sounds. Routine monitors were attached to the patient, with recording of Pulse rate,
NIBP,ECG,Pulse Oximetry,ETCO2 level (end tidal carbondioxide) at arrival and as were felt necessary for conductance of
a particular case . All patients were placed an Inrtacath and site secured for IV access. Any self reported anxiety and/ or
voluntary demand for sedation by patient at the beginning of the procedure was noted. All patients as usual received anti-
emetic and antacid prophylaxis by inj. Ondansetron 0.08mg/kg, and inj. Ranitidine 1mg/kg respectively. Following this
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patients were given anaesthesia and initial 3 parameters Pulse rate , NIBP, plus level of sedation assessed on a simple 5 point
sedation scale(OAS score) was noted , initially at 5 min interval for 30 min and subsequently at 10 min interval till
completion of the surgery. Decision to give Inj. Midazolum was on assessment of sedation scale done by Person „B‟
(blinded from the study protocol). Other parameters noted during course of the surgery were total duration of surgery, total
dose of midazolum given intra -operatively, any complaints of pain, discomfort ,signs of over sedation ,fall In Spo2 <95%
and voluntary request for sedation.
Post-Op Wards: As a part of our secondary aim to assess patients recall of Operation room noises and their overall
experience of the sedation method employed , Person C blinded from the group allocation and details of study protocol got
answers filled to a questionnaire consisting of 5 questions (ment to judge patients recall of OR events ) during the post
operative visit on the same day evening as well got the VAS scale for intra- op pain, discomfort and dissatisfaction with the
sedation method from the patient.
All patients as already mentioned received prior information regarding the study and any person who didnot consent to
participate in the trial received usual care and attention as per departmental protocol. The sedative premedication on the
operative day given before start of study in the pre op room was not calculated in dose requirements during the surgery. All
above data were later assembled and then analyzed by investigators of this study.
Study variables : We collected the following variables in the study:
a) Demographic variables (Age,Sex,Education ,ASA–PS score {American Society of Anaesthesiologist physical
Status score},Music listening habit), b)Surgical data ( duration, and type of surgery) b) any self reported anxiety before or
during the surgery d) Number of voluntary requests for sedation before and during the surgery ,e) OAS score every 5 min
(30 min) and every 10 min thereafter f) total doses of Midazolum in mgs intra operatively f )VAS Scores for Intra- Op pain,
discomfort and dissatisfaction g) Assesment of responses to 5 point Questionnaire.
Stastics: As our routine departmental practice is to give sedation in adult patients proposed for surgery under spinal/epidural
anaesthesia with a starting dose of 1.5 mg Midazolum and increments of 1mg as felt necessary by observer. The sedative
dose requirement in each group more than 2mgs was measured and compared using a student‟s t-test. The Observer
assessment of sedation/alertness scale(OAS score) >3 was taken as an positive event as OAS score of <=3 wastargeted to
be achieved by either of the techniques as per our study protocol and VAS score for pain ,discomfort or dissatisfaction more
than 5cms(on a 1-10 cms Scale) was accepted as a positive event. We defined a p value of <0.01 for each of these outcomes
as indicative of a statistically significant difference in the intervention and standard care groups. The frequency of outcomes
were indicated as control event rate (CER) for the no-music group and experimental event rate (EER) for the music
group.The difference measure (absolute risk reduction or ARR) is also presented.
Sample size: This is first study of its kind in our hospital hence we have no clear idea regarding the exact sample size. One
similar study in past judging effect of music on sedative requirements during spinal anaesthesia had total sample size of 50
i.e both intervention and control group. Here we included 60 patients as our sample size.
OBSERVATION AND RESULTS:
A total of 60 patients ,[Controll Group(C)=30 ,Music Group (M)=30] meeting our inclusion criteria were enrolled in this
study. Mean age for both study groups combined was 39.9(12.8) years with minimum of 18 years and Maximum of 60 years.
Male :female ratio was 31:29 (51.6% vs 48.3%). 38 (63.3%) patients belonged to ASA I and 22 (36.6%) to ASA II. All
surgeries were Elective in nature with 33 out of 60 (55%) were Orthopedic surgeries whereas 24(40%) Gynaecological and
3(5%) Urological. Mean Duration of overall surgeries was between 121-180 min . Effectof Spinal blockade was complete as
per desired level in all the 60 patients.There was no significant differences between the demographic and the surgical data
amongst both the groups (See Table 1 ) viz.,age, sex, education ,nature of surgery,surgical department ,ASA physical status
,Music listening habit and the Mean duration of Surgery.Baseline record of variables like Self reported anxiety,Voluntary
demand for Sedation, Heart rate Systolic and Diastolic BP were comparable in both the study groups and showed no
significant difference (p value of each variable > 0.01) (See Table1)When given the choice out of total 60 pts, maximum 16
(53.3%) opted for instrumental music,whereas 11 (36.6%) chosed Filmy songs and 3 (10%) desired spiritual songs for
listening during surgery.
Mean dose of Midazolum needed in the Controll group was 2.91+/-0.54 mgs and was higher as compared to
1.13+/-0.36 mgs required in the the Music listening group and this difference is found to be statistically significant (P
value<0.01) (See Table 2 and Graph 1 ).Further “Absolute risk reduction”(ARR) for Midazolum dosage exceeding 2 mgs
significantly comes around -90% falling within 95% confidence interval and stating that there is 90% chance of midazolum
being needed more than 2 mgs in the control group with no music. Observer‟s Assessment of sedation/Alertness score (OAS
Score) tabulated every 30 min is as shown in (Table 2) and there was no statistical difference between the baseline OAS
score of the two groups . Significant difference was observed between the two groups from baseline values to values at
arrival. Control group patients were more awake than the Music group. OAS score at 30 min for control group showed
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lesser Mean OAS score (3.8+/-0.6) as compared to Music group(4.9+/-0.3). OAS score at 90 and 120 min in the Music group
were (3.0+/-0.5 , 2.7+/-0.5) respectively and were significantly lower (P value<0.01) in comparison to the Study group
(3.5+/-0.6 , 3.5+/-0.8) respectively.OAS scores at 60,150,180,210 min intervals were comparable in both the groups with no
statistical significance(P value >0.01).Absolute risk reduction measuring events such as occurrence of OAS scores >3 ,i.e
patients who could remain lightly sedated or fully alert despite receiving sedative medications were 23.3% in group of
patients who received only Midazolum till arrival in OR .Chance of being awake or alert at 30 min from arrival in OR was
30 % more in the music group ,at 90 min and 120 min 48.6% and 42.2% respectively higher in those receiving only
Midazolum.VAS Score for pain during surgery in both the groups were 0 ,VAS Score for discomfort during surgery in the
control group was 0.66+/-1.59 while that in the Music group was 0.16+-0.63, (Pvalue >0.01).VAS Score for Disatisfaction
with the sedation method in the control group was 0.75(1.6) while that in the Music group was 0(0.0) and remained
insignificant (P value>0.01) (See Table 2). There was no significant Absolute risk reduction percentage for VAS scores of
pain discomfort and dissatisfaction for either of the 2 sedation method.
The 5 questionnaire based assessment of the ability to recall intra operative events by patients in both the groups
(See Table:2 and Graphs 3A and 3B) showed that initial 4 questions regarding instances of their transfer from pre operative
waiting area to inside operation theatre, Insertion of spinal needle, IV access via Intracath, and Remembering start of their
operation by surgical skin incision were remembered by both the groups equally without significant difference (p >0.01) and
Absolute risk reduction was not significant.On asking to recall any conversation held by Doctors,Nurses,and /or other OR
staff during his/her surgery it was observed that 15 patients of the control group remembered few statements/words(surely
yes) amongst doctors as against only 2 patients of the Music group,however 15 patients of the control group heard
something vague but couldn‟t recall exact words or sentences (indefinite) as against 10 from the Music group.While almost
18 patients from the Music group were almost completely unable to recall any of the talks amongst OR staff none of the
midazolum group patient in our study showed such response.There was significant difference between the two study groups
for reply to above question and absolute risk reduction was found to 60% meaning that Music group had 60 % more chance
of not recalling intra op conversations amongst staff compared to control group,(See Table 2,Graphs 3A and 3B ).On ability
to recall any sounds of Machines ,drills ,saws, monitors, instruments etc during their surgery it was observed that 22 patients
of the control group remembered few statements/words (surely yes) amongst doctors as against only 4 patients of the Music
group, however 6 patients of the control group heard something vague but couldn‟t recall nature of sounds relating to
drills,saws,monitors,instruments etc (indefinite) as against 4 from the Music group.While almost 22 patients from the Music
group were totally unable to recall any of the instrument/equipment sounds inside the OR only 2 of the Controll group
patient in our study showed total loss of recall.There was significant difference between the two study groups for reply to
above question(P value <0.01).and music group had 66,6 % more chance of not recalling instruments or monitors noise
compared to the controll group(See: Table 2 and Graph 3A and 3B).
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Table 1: Baseline Demographic and Surgical data
VARIABLE GROUP GROUP P value Pvalue
CONTROLL (C) MUSIC(M) <0.01
n=30 n=30
Age (yrs) 43.2(12.0) 36.7(13.0) 0.05 NS
Gender :
Males 12 (40%) 19 (63.3%) 0.07 NS
Females 18 (60%) 11 (36.6%)
Education :
<10 th std 13(43.3%) 15(50%)
10-12 th std 11(36.6%) 12(40%) 0.3 NS
>12 th std 6 (20%) 3 (10%)
Nature of surgery Elective Elective - NS
Department :
Orthopedics 12 (40%) 21 (70%)
Gynaecology 16 (53.3%) 8 (26.6%) 0.02 NS
Urology 2 (6.6%) 1 (3.3%)
Total Mean Dur ation of
surgery 1.9 (0.08) 1.5 (0.07) 0.02 NS
Code(hrs)
ASA Status:
ASA status1 16 (53.3%) 22 (73.3%) 0.10 NS
ASA status2 14 (46.6%) 8 (26.6%)
Pt likingMusic listening 13 (43.3%) 14 (46.6%)
Pt ambivalent for music 0.79 NS
listening 17 (56.6%) 16 (53.3%)
Pt who had Self reported 24 (80%) 21 (70%) 0.37 NS
anxiety
Pt who voluntary 28 (93.3%) 27 (90%) 0.64 NS
demanded for sedation
Mean Heart Rate 79.9 (11.0) 81.2 (9.0) 0.63 NS
Mean Systolic BP 126 (11.0) 124.2 (13.4) 0.57 NS
Mean Diastolic BP 78.5 (7.6) 78.8 (6.3) 0.87 NS
Where NS=Not significant
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Table 2: Post Intervention Data
VARIABLE GROUP GROUP MUSIC P value P<0.01
CONTROLL (M) n=30
(C ) n=30
Intraoperative Midazolum 2.91(0.54) 1.13(0.36) 0.00 P value
doses(mgs) <0.01
OAS base line 5.0(0.0) 5.0(0.0) - NS
OAS at atrrival in OR 5.0(0) 4.4(0.1) 0.002 P<0.01
OAS at 30 min 3.8(0.6) 4.9(0.3) 0.00 P <0.01
OAS at 60 min 3.1(1.0) 3.3(0.7) 0.47 NS
OAS at 90 min 3.5(0.6) 3.0(0.5) 0.002 P value
<0.01
OAS at 120 min 3.5(0.8) 2.7(0.5) 0.001 P value
<0.01
OAS at 150 min 3.2(1.3) 3.0(0.6) 0.74 NS
OAS at 180 min 3.5(0.7) 3.5(0.7) 1.0 NS
OAS at210 min -- 4.0(0.0) - NS
PtS who had Self reported 2 (6.6)%) 0(0%) 0.1 NS
anxiety
PtS who voluntary demanded for 5(16.6%) 0(0)% 0.02 NS
sedation
Mean VAS SCORE FOR PAIN 0 0 - NS
DURING SURGERY
Mean VAS SCORE FOR 0.66(1.59) 0.16(0.63) 0.1 NS
DISCOMFORT DURING
SURGERY
Mean VAS SCORE FOR 0.75(1.6) 0(0.0) 0.014 NS
DISATISFACTION WITH
SEDATION METHOD
1-no. of Patients unable to recall 0(0%) 2(6.6%) 1.0 NS
arrival in operation room from
pre op waiting area?
2- no.of Patients unable recall the 0(0%) 0(0%) 1.0 NS
instance when IV ACCESS was
taken at their arm(INTRACATH)?
3-no.of Patients unable to recall 0(0%) 0(0%) 1.0 NS
the instance when needle was
pricked at their back(SPINAL
NEEDLE)?
4-no. of Patients unable to recall 21(70.0%) 23(76.6%) 1.0 NS
start of their
operation(SURGICAL SKIN
INCISION)?
5-no. of patients unable to recall 0(0%) 18(60%) 0.0002 P value
any conversation held by Doctors <0.01
,nurses,and /or other op room staff
during their surgery?
6-no of -patients unable to recall 2(6.6%) 22(73.3%) 0.00 P value
sounds of Machines ,drills <0.01
,saws,monitors, instruments etc
during their surgery ?
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GRAPH: 1
5
TOTAL DOSE OF MIDAZOLUM
DOSE OF MIDAZOLUM
4
3
group Controll
2 group Music
1
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
PATIENTS
GRAPH 2:
COMPARISON OF SEDATION LEVELS BETWEEN THE 2
5
STUDY GROUPS
4
OAS SCORE
3
group Controll
2
group Music
1
0
0 30 60 90 120 150 180
TIME INTERVAL IN MIN
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GRAPH: 3A AND 3B
POST OPERATIVE POST OPERATIVE
QUESTIONNARE QUESTIONNAIRE
(CONTROLL GROUP) (MUSIC GROUP)
0 1 2 0 1 2
30 30 30 30
26
NO.OF PATIENTS
23
NO.OF PATIENTS
21 22 22 22
18
1515
10
8
6 6
4 43 44
1 2 2
0 0 0
Q1 Q2 Q3 Q4 Q5 Q6 Q1 Q2 Q3 Q4 Q5 Q6
QUESTIONS QUESTIONS
Please note: In graphs 3A and 3B 0= couldn‟t recall ,1= sure recall , 2= indefinite/unsure recall
DISCUSSION:
Use of music in operation theatre has been increasingly reported as well as recommended for beneficial effects on both
patients as well as operation room staff. Since long promoters of Music therapy have been claiming effects of music on sleep
and logical mechanisms behind it(10).
Our study had two basic parts one concerning the sedative aspect and the other on post operative recall of various
intra operative events.The main findings of our study are that patients who listened to music during surgery required less
doses of the sedative drug (midazolum) and that the desired level of Sedation was better achieved in the Music group as
compared to the Non music group. Regarding Post operative Recall Of Intra operative events our study found out that
patients who listened to Music via headphones could not recall conversations held by doctors, nurses, and /or other OR staff
during their surgery and also the sounds of machines ,drills ,saws, monitors, instruments etc during their surgery were less
heard and couldn‟t be subsequently recalled. Midazolum is one of the commonest drug used by anaesthesiologists for short
term sedation ,anxiolysis and amnesia in variety of surgical patients. The drug‟s safety profile and short duration of action
along with excellent amnesia reported with this drug makes it a popular choice among anaesthesiologists for regional
anaesthesia and Day care surgical settings. Our routine departmental practice for regional anaesthesia cases also involves
giving sedation to all adult patients with 1.5 mg stat after spinal anaesthesia and 1 mg top ups thereafter. Thus we counted
all such patients who required top up of 1mg or more over the initial 1.5mg for maintaining sedation and hence a group of
patients with a cutoff of mean dose requirement of more than 2 mg was taken and analysed. Our study found significantly
less requirement of midazolum needed for achieving desired level of sedation in the experimental group which is similar to
findings of Caroline lepage et al (2) where they also reported decrease in midazolum doses in the music listening group to
achieve a similar degree of relaxation.This could be due to the proposed theory of sedative action of music on mind and body
so called mechanism known as “Brain entraintment”(15) . An article by B.M.Wiley states “ Brain entraintment is essentially
our brain's electrical response to an outside stimulus, usually light or sound. From whatever is captured by our eyes, the
electrical responses that resonate within your brain are what you see. In other words, these result to an interpretation. This
brain entrainment is called a Cortical Evoked Response. In terms of sound, brain entrainment takes place with a rhythmic
beat. This rhythm is slowly reproduced by our brain until it resembles our brain waves. The interesting thing about our brains
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is that it has a tendency to fall into step with stimuli at the right frequencies. This is called Frequency Following Response.
It's the „Frequency Following Response’ of our brains that brought about the development and science of binaural beats.
Because the brain is such a receptive subject to outside stimulus, the changes in our brain wave frequencies that result go as
far as changing our mental state of the moment. This is analogous to a person feeling very upbeat during exercise when he or
she is listening to dance music. This is also the reason why meditation classes play soothing music in the background to help
you relax and relieve stress. Sublimina "sleep tapes" and other types of CD tracks or machines that use binaural beats help
people to fall asleep. Binaural beats work like this: Say that you have two different sounds. One sound is at 100 Hz while the
other is at 104 Hz. Because of the brain's natural tendency to synchronize what it's hearing with its own frequencies, it
reproduces a 4 Hz beat - the difference between the two sounds. When our brain wave's frequency is anything below 5 Hz,
our state of consciousness is typically deep sleep. This beat therefore induces drowsiness and we get knocked out before we
know it.With brain waves at 8 to 14 Hz, we're in a relaxed state; at 14 to 30 Hz, we're alert. Two sounds that are far too
different then make no sense to the brain and therefore have no such altering effect to brain waves.”(15)
Effects of blocking of noise rather than direct action of Music as a suggested mechanism of better sedation ,have been
suggested in few studies for eg :by Jin gu kang (16) where Patients were divided into three groups: noise, silence, and music
. In the silence group, patients' ears were packed tightly to block ambient noise, whereas patient-selected music was applied
to patients in the music group.BIS scores were similar in the noise and music groups. In our study we had blocked ambient
noises in OR in the control group by applying well padded head phones in the control group as well which could dampen
surrounding noise to eliminate this bias.Also the Music Offered to patients was of their choice of language and belonged to
either of the three types viz instrumental,filmy or spiritual. Also quality of sound was ensured to be good to Avoid any
possibility of Auditory fatigue as suggested by Caroline lepage in his study (2).
Observer‟s Assessment of sedation/alertness score(OAS score) is believed to be best choice for precise assessment of
sedation level (3) and hence was applied for judging sedation by us. To allow comparison between doses it was necessary
that sedation level be same in both the groups and since our study was expecting to test post operative recall it was decided
that at least OAS scores less than 3 be the target to be achieved in both the groups. Although constant plane below OAS <=3
was not achieved in few cases in our study so the data was interpreted with some limitations. The person giving sedative
drug and noting the OAS score was blinded from the type intervention done in the patient by hiding music player inside
non transparent linen to eliminate any Hawthrone Effect (Special Interest Taken by the investigator in the treatment arm)(13).
We were slightly surprised to find out that OAS scores were significantly greater above 3 (100%)in the Control group
Compared to the Music group (76.6%)on arrival in OR from the pre op waiting area .Almost 100% awake state in the
Controll group could have occurred due to our fixed 1 mg dose selected for all patients irrespective of their weights and also
partially because of the unexpected delay in shifting to OR on expected time .When OAS scores were compared at 30 min
duration from the values noted at arrival in OR it was found out that the Music group had higher OAS>3 scores (100%) this
time as opposed to Controll group(70%).This could be explained by the fact that midazolum which was given just after
spinal anaesthesia, since rapidly acting would have caused quick fall in OAS scores leading to significant difference with
Music group in which midaz was given only after 30 min period and when OAS scores were found to be more than 3.
Further OAS scores at 60 min showed lower OAS values in both the groups but with no significant difference between the 2
groups. OAS scores at 90 and 120 min were higher in the control group(58.6 and 55.5% resp) compared to music group(10%
and 6.6% resp ) and clearly suggested that Music group was better sedated in this duration range . The trend graph of OAS
score shows that sedation within the music group although took longer to start around 60 min but was better maintained in
plane compared to the other group at time between 90-120min.Since many surgeries ended in this time frame causing
difference in number of observations in the two groups we did not compare OAS score beyond 120 min.VAS score on (0-
10cms scale) for Pain,Discomfort and Amount of dissatisfaction with the sedative method used with positive event
considered as scales marked above 5 were comparable in both groups.
Analysis of the 5 point questionnaire on various events of recall showed that there was no significant difference between the
2 study groups for the first four questions. We feel that in the OR ,intra cath and spinal needle prick and surgical skin incision
all happened at a duration quite early after patients arrival in the OR and poor amnesia for such events could have occurred
because of the lack of appropriate sedation levels at these time periods which was influenced by a multiple factors such as
patient handling, shifting to operating table, asking details of illness directly to patient by surgeons, pain of intracath and
spinal needle and positioning for surgery etc. Significant difference was present in inability to recall the conversations cheld
by Doctors ,nurses, and /or other OR staff during their surgery and the Music group faired better in this aspect .Similarly
music group had less recall of intra operative sounds of monitors ,instruments etc,compared to the other group.
Amnesia by midazolum is affected by the operating time (9).When a number of distinct Auditory signals are presented
simultaneously ,it is often difficult for the human ear to distinguish or discriminate between each of them .This phenomenon
known as „Masking‟ ,accounts for the difficulty experienced in hearing others talk in the presence of loud background
noise(5) .Hence even if the patients would have been in lighter planes of sedation in the music group, it is quite possible that
due to „Masking‟ patients of the music group did not recall verbal conversation and noises emerging from monitors or
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10. IOSR Journal of Pharmacy
Vol. 2, Issue 3, May-June, 2012, PP.569-578
instrument‟s resectively by 60 and 66.6 % more in comparison to the control group .But whether this inability to recall the
operative events by Music listening is direct amnestic action of music or was merely due to „Masking‟ effect described
above could not be commented by our study design .
CONCLUSION:
Our study concludes that patients undergoing elective surgery under regional anesthesia , who hear a pre-selected music
during surgery through a head-phone, need a lower dose of intra-operative sedatives and have a reduced recall of intra-
operative processes thus creating an effective, safe and cheap non pharmacological method of sedating conscious patients
operated under regional anaesthesia.We recommend that Favourite Music via headphones should be provided to all the
patients who are fond of music listening during the Surgical procedures expected to last one and half hours or more .
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