Efficacy of orally disintegrating film of ondansetron versus intravenous ondansetron in prophylaxis of postoperative nausea and vomiting in patients undergoing elective gynaecological laparoscopic procedures: A prospective randomised, double-blind placebo-controlled study.

BACKGROUND AND AIMS: Ondansetron is one of the most widely used drugs for postoperative nausea and vomiting (PONV) prophylaxis. Orally disintegrating film (ODF) formulations are relatively recent innovations. We evaluated the efficacy of ODF of ondansetron for the prophylaxis of PONV. METHODS: One hundred and eighty American Society of Anaesthesiologists-I or II women, in the age group 18-65 years, scheduled for elective gynaecological laparoscopic procedures were studied in a prospective randomised, double-blind, placebo-controlled trial. The patients were randomised into four groups: Placebo, intravenous (IV) ondansetron 4 mg, ODF of ondansetron 4 mg (ODF4) and 8 mg (ODF8) groups. PONV was assessed in two epochs of 0-6 and 7-24 h. Primary outcome measure was the incidence of PONV and secondary outcome measures were severity of nausea, need for rescue anti-emetic, analgesic consumption, time to oral intake, overall patient satisfaction and side effects such as headache and dizziness. PONV was compared using analysis of variance or Mann-Whitney U-test as applicable. RESULTS: Data of 173 patients were analysed. The incidence of postoperative nausea was significantly lower (P = 0.04) only during the 0-6 h in the ODF8 group when compared with the placebo group. During the 0-6 h interval postoperatively, the ODF8 group had a significantly lower incidence of vomiting when compared with the placebo (P = 0.002) and the IV group (P = 0.044). During the 0-24 h interval postoperatively, ODF4 (P = 0.01) and ODF8 (P = 0.002) groups had a significantly lower incidence of vomiting compared to the placebo group. CONCLUSIONS: Orally disintegrating film of ondansetron is an efficacious, novel, convenient and may be a cost-effective option for the prophylaxis of PONV.

Musculoskeletal disorders in caregivers of children with cerebral palsy following a multilevel surgery.

The patients of cerebral palsy need assistance for their self activities which expose the caregivers to different risk factors of musculoskeletal disorders. But there is a scarcity of studies revealing the prevalence and the risk factors present among the caregivers of the cerebral palsy children. This lead to formulate a study to identify prevalence and risk factors among the caregivers of cerebral palsy children. Result revealed that most of the caregivers among both the groups were female (63.4% and 69.3%). The common age group of the children who underwent multilevel surgery was at the age group of 6 - 10 years. It has been observed that among the study group 56.5% were totally cooperative children. The Caregiver Strain Index value showed there is no significant difference among both the groups. Regional body pain of shoulder, elbow, upper back, lower back and ankle revealed a higher prevalence among the study group. Clinical diagnosis revealed prevalence of MPS, FMS and TOS among the study group were 27.6%, 24.5% and 23.0% respectively. Study further revealed that cooperativeness of the child was significantly associated with lower back pain, MPS, FMS and TOS among the study group.

Virtual reality based therapy for post operative rehabilitation of children with cerebral palsy.

Virtual reality is the use of interactive replication created with computer hardware and software to impart users with opportunities to engage in environments that appear to feel similar to real world objects and events. The commonest rehabilitation program of cerebral palsy children involves stretching, strengthening, mobilization and various other activities, whereas the use of virtual reality based training (VRBT) for rehabilitation of cerebral palsy is not common. To understand the effect of VRBT a study was formulated. Twenty nine subjects participated (study group--14 and control group--15). Outcome measures were MACS, PBS, level of participation, motivation, cooperation and satisfaction of the child. Results revealed that balance and manual ability were significantly improved in both the groups (Balance: study: t-2.28, p<0.05; control: t-3.5, p<0.01; Manual ability: study: t-5.58, p<0.001; control: t-7.06, p<0.001). PBS had significantly greater improvement in the study group (t-t-2.02, p<0.05). Level of participation, motivation, cooperation and satisfaction of the child were also reported to be significantly higher among the study group as compared with control group. To the author's best knowledge, this is the first study on using the VR-based therapy for the postoperative rehabilitation of children with CP which need further elaboration with larger sample size.

Risk factors, clinical features and outcome of treatment of work related musculoskeletal disorders in on-site clinics among IT companies in India.

Workrelated musculoskeletal disorders among the IT professional is a common area of concern worldwide. This study was taken up to analyze the prevalence of risk factors, clinical features and outcome of treatment in onsite clinics in vaious information technology companies in India. Result revealed poor office ergonomics (54%), lack of keyboard tray (25%), lack of mouse tray (35%), lack of foot rest (60%), improper monitor height (80%) were the major self reported risk factors. Major identified MSD were Myofascial Pain Syndrome (49.20%), Thoracic outlet syndrome (25.02%), Fibromyalgia syndrome (8.5%). Majorly affected body regions were neck (64.9%), shoulder (42.1%), lower back (56.5%) and thigh (34.2%). The results were comparable with the literature. Feedback of the participants also revealed most of the participants were well satisfied with SHARAN's protocol.

A rare case of antepartum posterior reversible encephalopathy syndrome.

Pre-eclampsia and eclampsia are well-known causative factors of posterior reversible encephalopathy syndrome (PRES). There are only a few reported cases of antepartum PRES. We report a 25-year-old primigravid woman who presented with eight months of amenorrhoea and an abrupt onset of eclampsia associated with a history of a fall. A computed tomography scan ruled out intracranial haemorrhage and PRES was diagnosed. She responded well to supportive care, labour was induced and maternal and neonatal outcomes were good. Antepartum PRES poses different challenges to those of PRES in non-obstetric or postpartum patients, because of the additional management aspects required to ensure foetal wellbeing. We were posed with a difficult decision about the disadvantages of caesarean section versus those of vaginal delivery in our patient.