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Background@#This study aimed to analyze the efficacy of single-dose corticosteroid injection (CSI) administered at 6 weeks postoperative to treat stiffness following arthroscopic rotator cuff repair (ARCR). @*Methods@#In this prospective, multicentric, case-control study, post-ARCR stiffness at 6 weeks was treated with either a single dose of intra-articular CSI (CSI group) or physical therapy with oral analgesics (non-CSI group). Pain intensity according to visual analog scale (VAS), functional outcome using the Constant Murley Shoulder Score, time to return to activities of daily living (ADLs), and retear rate were recorded at 6 weeks, 9 weeks, 12 weeks, 6 months, 12 months, and 18 months postoperatively in both groups. @*Results@#A total of 149 patients (54.5%) in the CSI group and 124 patients (45.5%) in the non-CSI group were included in this study. Pain and function were significantly better in the CSI group at 9-week, 12-week, and 6-month (P<0.001) follow-up, whereas they were not significantly different when the groups were compared at 12- and 18-month follow-up. The mean duration to return to ADLs was significantly shorter (P<0.001) in the CSI group. The incidence of retears was not significantly different (P=0.36) between groups at the end of 18 months of follow-up. @*Conclusions@#Single-dose intra-articular CSI administered at 6 weeks postoperative to treat post-ARCR stiffness significantly improved pain, function, and duration of return to ADLs without increasing the risk of retears compared to patients who did not receive intra-articular CSI.
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Background@#Nonhuman primates are used for research purposes such as studying diseases and drug discovery and development programs. Various clinical pathology parameters are used as biomarkers of disease conditions in biomedical research. Detailed reports of these parameters are not available for Indian-origin rhesus macaques. To meet the increasing need for information, we conducted this study on 121 adult Indian rhesus macaques (57 wild-sourced and 64 inhouse animals, aged 3–7 years). A total of 18 hematology and 18 biochemistry parameters were evaluated and reported in this study. Data from these parameters were statistically evaluated for significance amongst inhouse and wild-born animals and for differences amongst sexes. The reference range was calculated according to C28-A3 guidelines for reporting reference intervals of clinical laboratory parameters. @*Results@#Source of the animals and sex appeared to have statistically significant effects on reference values and range. Wild-born animals reported higher WBC, platelets, neutrophils, RBC, hemoglobin, HCT, MCV, and total protein values in comparison to inhouse monkeys. Sex-based differences were observed for parameters such as RBCs, hemoglobin, HCT, creatinine, calcium, phosphorus, albumin, and total protein amongst others. @*Conclusions@#Through this study, we have established a comprehensive data set of reference values and intervals for certain hematological and biochemical parameters which will help researchers in planning, conducting, and interpreting various aspects of biomedical research employing Indian-origin rhesus monkeys.
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BACKGROUND@#Autologous platelet concentrates such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) have gained overwhelming popularity in regenerative endodontics. Clinical evidence reveals the lack of a particular advantage of using PRP or PRF over an evoked blood clot in promoting canal wall thickening and/or continued root development in immature necrotic teeth. Moreover, despite stimulating tissue repair and repopulating the root canals of immature and mature permanent teeth, the new vital tissue may not possess the functional activity of the native pulp tissue. @*METHODS@#To better understand the origin, nature, and long-term fate of the tissue types found within the pulp space, we critically examine all available histo-/morphological evidence for pulp–dentine complex regeneration using PRP and/or PRF, alone or together with an evoked blood clot, specialised or unspecialised primary cells, and other biomaterials. @*RESULTS@#Histological data from clinical studies is scant. Reportedly, the inner dentinal surface supports cementum-like tissue formation, but this interface likely deviates in structure and function from the native cementodentinal junction.Presence of bone-like tissue within the pulp space is intriguing since de novo osteogenesis requires closely coordinated recruitment and differentiation of osteoprogenitor cells. Compared to untreated necrotic teeth, an evoked blood clot (with/ without PRF) improves fracture resistance. Tooth regeneration using PRF and dental bud cells is unreliable and the constituent neoformed tissues are poorly organised. @*CONCLUSION@#PRP/PRF fail to demonstrate a significant advantage over an induced blood clot, alone. The true nature of neoformed tissues remains poorly characterised while their response to subsequent insult/injury is unexplored.
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BACKGROUND@#Autologous platelet concentrates such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) have gained overwhelming popularity in regenerative endodontics. Clinical evidence reveals the lack of a particular advantage of using PRP or PRF over an evoked blood clot in promoting canal wall thickening and/or continued root development in immature necrotic teeth. Moreover, despite stimulating tissue repair and repopulating the root canals of immature and mature permanent teeth, the new vital tissue may not possess the functional activity of the native pulp tissue. @*METHODS@#To better understand the origin, nature, and long-term fate of the tissue types found within the pulp space, we critically examine all available histo-/morphological evidence for pulp–dentine complex regeneration using PRP and/or PRF, alone or together with an evoked blood clot, specialised or unspecialised primary cells, and other biomaterials. @*RESULTS@#Histological data from clinical studies is scant. Reportedly, the inner dentinal surface supports cementum-like tissue formation, but this interface likely deviates in structure and function from the native cementodentinal junction.Presence of bone-like tissue within the pulp space is intriguing since de novo osteogenesis requires closely coordinated recruitment and differentiation of osteoprogenitor cells. Compared to untreated necrotic teeth, an evoked blood clot (with/ without PRF) improves fracture resistance. Tooth regeneration using PRF and dental bud cells is unreliable and the constituent neoformed tissues are poorly organised. @*CONCLUSION@#PRP/PRF fail to demonstrate a significant advantage over an induced blood clot, alone. The true nature of neoformed tissues remains poorly characterised while their response to subsequent insult/injury is unexplored.
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Enantioseparation of three β-blockers,i.e.,atenolol,metoprolol and propranolol,was studied on amylose tris(3-chloro-5-methylphenylcarbamate) immobilized chiral stationary phase using supercritical fluid chromatography (SFC).The effect of organic modifiers (methanol,isopropanol and their mixture),col-umn temperature and back pressure on chiral separation of β-blockers was evaluated.Optimum chro-matographic separation with respect to resolution,retention,and analysis time was achieved using a mixture of CO2 and 0.1％ isopropyl amine in isopropanol:methanol (50:50,V/V),in 75:25 (V/V) ratio.Under the optimized conditions,the resolution factors (Rs) and separation factors (α) were greater than 3.0 and 1.5,respectively.Further,with increase in temperature (25-45 ℃) and pressure (100-150 bars)there was corresponding decrease in retention factors (k),α and Rs.However,a reverse trend (α and Rs)was observed for atenolol with increase in temperature.The thermodynamic data from van't Hoff plots revealed that the enantioseparation was enthalpy driven for metoprolol and propranolol while entropy driven for atenolol.To understand the mechanism of chiral recognition and the elution behavior of the enantiomers,molecular docking studies were performed.The binding energies obtained from simulation studies were in good agreement with the elution order found experimentally and also with the free energy values.The method was validated in the concentration range of 0.5-10 μg/mL for all the enan-tiomers.The limit of detection and limit of quantitation ranged from 0.126 to 0.137 μg/mL and 0.376-0.414 μg/mL,respectively.The method was used successfully to analyze these drugs in pharmaceutical preparations.
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OBJECTIVES: This study aimed to evaluate the effect of clinical factors on the outcome of arthrocentesis in the treatment of temporomandibular joint (TMJ) internal derangement. MATERIALS AND METHODS: Fifty patients with TMJ internal derangement underwent arthrocentesis using ringer's lactate. The present study evaluated the contribution of the clinical variables of age, time since onset, visual analogue scale (VAS) pain level, and range of motion (ROM) on the outcomes of TMJ arthrocentesis: age (≤25 years, >25 and ≤40 years, >40 and ≤60 years), VAS pain level (≤5, >5 and ≤7, >7 and ≤10), and ROM ( 7 (OR, 11.25; P=0.039), and a maximum vertical opening of < 25 mm (OR, 7.70; P=0.038). CONCLUSION: Lavage of the superior joint space with ringer's lactate resulted in significant reduction in pain and improvement in mouth opening. Patients with a greater inflammatory component and younger patients benefitted more from arthrocentesis. Evaluation of these clinical variables helped in predictive modelling, which may provide clinicians with the opportunity to identify “at-benefit” patients early and initiate specific treatment.
Subject(s)
Humans , Arthrocentesis , Joints , Lactic Acid , Logistic Models , Mouth , Odds Ratio , Range of Motion, Articular , Temporomandibular Joint , Therapeutic IrrigationABSTRACT
OBJECTIVES@#This study aimed to evaluate the effect of clinical factors on the outcome of arthrocentesis in the treatment of temporomandibular joint (TMJ) internal derangement.@*MATERIALS AND METHODS@#Fifty patients with TMJ internal derangement underwent arthrocentesis using ringer's lactate. The present study evaluated the contribution of the clinical variables of age, time since onset, visual analogue scale (VAS) pain level, and range of motion (ROM) on the outcomes of TMJ arthrocentesis: age (≤25 years, >25 and ≤40 years, >40 and ≤60 years), VAS pain level (≤5, >5 and ≤7, >7 and ≤10), and ROM ( 7 (OR, 11.25; P=0.039), and a maximum vertical opening of < 25 mm (OR, 7.70; P=0.038).@*CONCLUSION@#Lavage of the superior joint space with ringer's lactate resulted in significant reduction in pain and improvement in mouth opening. Patients with a greater inflammatory component and younger patients benefitted more from arthrocentesis. Evaluation of these clinical variables helped in predictive modelling, which may provide clinicians with the opportunity to identify “at-benefit†patients early and initiate specific treatment.
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Objective: To assess the mid-term functional outcome of arthroscopic assisted anterior cruciate ligament [ACL] reconstruction using bone-patellar tendon-bone [BPTB] graft based upon subjective scores. Study Design: Cross sectional study. Place and Duration of study: Department of Orthopaedics and Spine, Doctors Hospital and Medical Centre, Lahore, Pakistan from Jan to Dec 2016
Patients and Methods: After fulfilling the inclusion criteria 52 patients who underwent arthroscopic assisted ACL reconstruction were enrolled into the study. Patients were subjectively evaluated with Lysholm knee scoring scale and Tegner activity scale. Preoperative scores were obtained and compared with those obtained 6 months after surgery and were analyzed using wilcoxon signed-rank test on IBM SPSS statistics version 20
Results: Mean difference between preoperative and 6 months postoperative Lysholm scores was 30.04 +/- 13.42 [p<0.001] and mean difference in Tegner activity scale was 2.88 +/- 1.11 [p<0.001]. Excellent scores were obtained in 40 [77%] patients, good in 1 [2%], fair in 7 [13%] and poor in 4 [8%] of patients. Postoperative complications included anterior knee pain in 3 [5.76%], superficial surgical site infection in 1 [1.9%], deep surgical site infection in 1[1.9%] and joint stiffness in 1 [1.9%] patient
Conclusion: Arthroscopic assisted ACL reconstruction using BPTB autograft showed an excellent functional outcome explained in terms of subjective evaluation as depicted by Lysholm knee scoring scale and Tegner activity scale
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OBJECTIVE: The use of robotic radical hysterectomy has greatly increased in the treatment of early stage cervical cancer. We sought to compare surgical and oncologic outcomes of women undergoing robotic radical hysterectomy compared to open radical hysterectomy. METHODS: The clinic-pathologic, treatment, and recurrence data were abstracted through an Institutional Review Board-approved protocol at 2 separate large tertiary care centers in Seattle, Swedish Medical Center and the University of Washington. Data were collected from 2001–2012. Comparisons between the robotic and open cohorts were made for complications, recurrence, progression-free survival (PFS), and overall survival (OS). RESULTS: In the study period, 109 robotic radical hysterectomies were performed. These were compared to 202 open radical hysterectomies. The groups were comparable in terms of age and body mass index (BMI). Length of stay (LOS) was considerably shorter in the robotic group (42.7 vs. 112.6 hours, p<0.001) as was estimated blood loss (EBL; 105.9 vs. 482.6 mL, p<0.001). There were more complications in the open radical hysterectomy group, 23.4% vs. 9.2% in the robotic group (p=0.002). The recurrence rate was comparable between the groups (10.1% vs. 10.4%, p=0.730). In multivariate adjusted analysis, robotic surgery was not a statistically significant predictor of PFS (p=0.230) or OS (0.85). CONCLUSION: Our study, one of the largest multi-institution cohorts of patients undergoing robotic radical hysterectomy, suggest robotic radical hysterectomy leads to comparable oncologic outcomes in the treatment of early stage cervical cancer with improved short-term surgical outcomes such as decreased LOS and EBL.
Subject(s)
Female , Humans , Body Mass Index , Cohort Studies , Disease-Free Survival , Drug Therapy , Hysterectomy , Length of Stay , Recurrence , Tertiary Care Centers , Uterine Cervical Neoplasms , WashingtonABSTRACT
BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a chronic psycho-physiological disorder. It is considered to be the most common functional gastrointestinal disorder, and about 50–90% of IBS patients have associated psychiatric co-morbidity. We aimed to study psychiatric co-morbidities in patients with IBS visiting a tertiary care center. METHODS: This was a cross-sectional case-control study conducted over a duration of one and a half years from January 2014 to July 2015. Patients were selected from the out-patient department of gastroenterology. About 160 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. The healthy attendants of cases were selected as controls. A total of 200 controls were selected. Rome-III criteria were used to diagnose IBS. For diagnosing psychiatric disorders, we used the Mini International Neuropsychiatric Interview Schedule Plus. RESULTS: Mean age of our cases and controls was 39.7 ± 11.4 and 37.7 ± 9.6 years, respectively. Females outnumbered males in our cases as well as their controls by a ratio of 2:1 approximately. Psychiatric disorders were seen in 84.4% of IBS patients as compared to 41.5% in controls. Major psychiatric disorders seen in our patients were generalized anxiety disorders (30.0%) and depression (28.0%). CONCLUSIONS: The majority of patients with IBS who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.
Subject(s)
Female , Humans , Male , Anxiety Disorders , Appointments and Schedules , Case-Control Studies , Depression , Gastroenterology , Gastrointestinal Diseases , India , Informed Consent , Irritable Bowel Syndrome , Outpatients , Tertiary Care Centers , Tertiary HealthcareABSTRACT
PURPOSE: The p15(Ink4b) gene exerts its influence as an inhibitor of cyclin-dependent kinases and is frequently associated with hematological malignancies. Inactivation of this gene through DNA methylation has been found to be the most prevalent epigenetic alteration reported, with a high frequency in all French-American-British subtypes of acute myeloid leukemias, including acute promyelocytic leukemia (APL). In this study,we investigated the prognostic significance of p15 gene promoter hypermethylation and its expression in APL patients of Kashmir (North India). MATERIALS AND METHODS: p15 gene promoter hypermethylation was conducted by methylation-specific polymerase chain reaction, while its subsequent expression analysis was carried out by semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: Of the 37 patients, 16 (43.2%) were found to have methylated p15 genes. Of these 16 cases, seven (43.8%) were methylated partially and nine (56.2%) were found to have complete methylation. Moreover, nine of the 37 patients (24.3%) who presented with leukocytosis at their baseline had complete p15 gene methylation as well (p < 0.05). Semiquantitative RT-PCR showed a complete loss of p15 expression in nine patients with complete methylation coupled with leukocytosis (p=0.031), while seven patients with partial methylation showed decreased p15 expression. Six patients relapsed during the maintenance phase of treatment and were found to have a completely methylated p15 gene and no p15 mRNA. CONCLUSION: Complete methylation and loss of p15 gene expression causes susceptibility to relapse and decreased survival in APL patients. Thus, p15 promoter hypermethylation is a prospective prognostic indicator and a reliable clinical aid in assessment of patients with APL.
Subject(s)
Humans , Cyclin-Dependent Kinases , DNA Methylation , Epigenomics , Gene Expression , Hematologic Neoplasms , Leukemia, Myeloid, Acute , Leukemia, Promyelocytic, Acute , Leukocytosis , Methylation , Polymerase Chain Reaction , Prognosis , Prospective Studies , Recurrence , Reverse Transcriptase Polymerase Chain Reaction , RNA, MessengerABSTRACT
PURPOSE: The p15(Ink4b) gene exerts its influence as an inhibitor of cyclin-dependent kinases and is frequently associated with hematological malignancies. Inactivation of this gene through DNA methylation has been found to be the most prevalent epigenetic alteration reported, with a high frequency in all French-American-British subtypes of acute myeloid leukemias, including acute promyelocytic leukemia (APL). In this study,we investigated the prognostic significance of p15 gene promoter hypermethylation and its expression in APL patients of Kashmir (North India). MATERIALS AND METHODS: p15 gene promoter hypermethylation was conducted by methylation-specific polymerase chain reaction, while its subsequent expression analysis was carried out by semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: Of the 37 patients, 16 (43.2%) were found to have methylated p15 genes. Of these 16 cases, seven (43.8%) were methylated partially and nine (56.2%) were found to have complete methylation. Moreover, nine of the 37 patients (24.3%) who presented with leukocytosis at their baseline had complete p15 gene methylation as well (p < 0.05). Semiquantitative RT-PCR showed a complete loss of p15 expression in nine patients with complete methylation coupled with leukocytosis (p=0.031), while seven patients with partial methylation showed decreased p15 expression. Six patients relapsed during the maintenance phase of treatment and were found to have a completely methylated p15 gene and no p15 mRNA. CONCLUSION: Complete methylation and loss of p15 gene expression causes susceptibility to relapse and decreased survival in APL patients. Thus, p15 promoter hypermethylation is a prospective prognostic indicator and a reliable clinical aid in assessment of patients with APL.
Subject(s)
Humans , Cyclin-Dependent Kinases , DNA Methylation , Epigenomics , Gene Expression , Hematologic Neoplasms , Leukemia, Myeloid, Acute , Leukemia, Promyelocytic, Acute , Leukocytosis , Methylation , Polymerase Chain Reaction , Prognosis , Prospective Studies , Recurrence , Reverse Transcriptase Polymerase Chain Reaction , RNA, MessengerABSTRACT
Background: Abdominal field blocks with local anesthetic solutions have been suggested in postoperative analgesia in patients undergoing abdominal wall incisions. In the present study we assessed the analgesic efficacy of ultrasound guided rectus sheath and transversus abdominis plane blocks over first 24 postoperative hours after cesarean deliveries performed through pfannensteil or midline incisions
Methodology: Sixty women undergoing elective or emergency cesarean delivery were enrolled in this randomized, controlled, double-blind trial, and then randomized either to undergo ultrasound guided rectus sheath and transversus abdominis plane blocks with bupivacaine [n=30] or no block [n=30]. Inj diclofenac and inj. paracetamol 1 G, were given to all patients, and inj tramadol was given on request as a rescue analgesic. All patients received a spinal anesthesia with 0.5% heavy bupivacaine, and at the end of surgery [after the skin sutures] bilateral rectus sheath and transversus abdominis plane blocks were performed using 15 to 20 ml of 0.25% bupivacaine in each block on either side [to maximal dose of 3 mg/kg] and no block in the control patients. Each patient was evaluated postoperatively by a blinded investigator at 2, 4, 6, 12 and 24 h postoperatively
Results: Ultrasound guided abdominal field blocks with 0.25% bupivacaine reduced the total tramadol requirement in the first 24 postoperative hours [157 +/- 50.709 vs 386.67 +/- 29.16 mg] and also the visual analogue pain scores at 2 [2 vs 8], 4 [2 vs 8],6 [2 vs 8],12 [4 vs 7] and 24 [4 vs 7] hours postoperatively. No significant difference was found between groups in the incidence of nausea. Sedation was reduced in the patients who received the blocks. There were no complications attributed to the blocks
Conclusion: Ultrasound guided abdominal field blocks, as a part of a multimodal analgesic regimen, provided greater analgesia up to 24 h postoperatively after elective or emergency cesarean delivery
Subject(s)
Humans , Female , Cesarean Section , Abdomen , Ultrasonography , Pain, Postoperative , Pregnancy , Prospective Studies , Analgesia , Abdominal Muscles , Double-Blind MethodABSTRACT
Background: Headache disorders represent a major public health problem globally. It is more so in developing countries with rising trend in young adults affecting negatively their quality of life. There has been very little information on the epidemiology of headache disorder in Kashmir India which has witnessed prolonged and large scale militancy related disturbance. A prospective population based study was undertaken in Srinagar district of Kashmir to determine the prevalence of headache disorder. Methods: The study was a cross sectional survey using cluster sampling with a culturally adapted version of pretested questionnaire translated into local language, in Hazratbal Community Block of Srinagar. In the first phase households were screened. Individuals with headache were then examined by a senior neurologist for migraine and non migraine disorder. Results: The overall prevalence of headache was 66.2 % with female preponderance. Occurrence of headache was as high as 79.90 % in adults of 19-45 years. The prevalence rate declined after the age of 45 years in both the genders. Women had higher prevalence rate than men in all age groups and for all headache categories. Age distribution showed prevalence rate of migraine of 45.69% in young adults of 19-45 years; females 55.44% and males 32.79 %. Non migraine headache was more common than migraine type, and was more prevalent in young age group in both the genders, highest in adolescents (74.20 %). Conclusion: The high prevalence rate of headache both migrainous and non migrainous in Kashmir may be related to the stress the community has been subjected to from militancy related conflict since 1990.
Subject(s)
HeadacheABSTRACT
Background and study aims: gastric cancer is highly prevalent in Kashmir, as are lower gastrointestinal [LGI] malignancies. Colonic cancer, gastric cancer, and coeliac disease are the most important gastrointestinal [GI] causes of iron deficiency anaemia [IDA] worldwide. Approximately 9% of patients with IDA present with a suspicious lesion in the GI tract upon examination. However, the absence of GI symptoms and a possible lesion accounting for blood loss in IDA have not been studied in this zone with a high prevalence of GI malignancy. We aimed to examine IDA patients without GI symptoms to determine the most plausible cause of their blood loss
Patients and methods: a total of 100 patients with IDA and 250 control subjects without IDA and referred for gastrointestinal endoscopy were enrolled in a cross-sectional, comparative study. Patients presenting with a significant lesion proportionate to their anaemia in the upper GI tract were not examined further, if no further strong indications were present
Results: twenty-nine patients [29%] were found to have malignancy: 13 with gastric cancer and 16 with colonic malignancies. Other apparent causes of GI blood loss included peptic ulcer disease in 10 [10%] patients, haemorrhoids in 22 [25%], polyps in eight [three in the upper GI tract and five in the LGI tract], gastric erosions in eight [8%], and angiodysplasia, diverticulitis, and trichuriasis in two [2%] each
Conclusion: In light of the high incidence of GI malignancies in this patient group, a low threshold for GI screening as well as mass screening for IDA is needed
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Background: Triple-negative breast cancer [TNBC] is a poor prognostic subset of breast cancer that lacks the benefit of specific targeted therapy
Materials and Methods: A prospective study of the clinical profile of triple negative breast cancer cases at a tertiary referral centre. The duration of the study period was 26 months and the median follow up period was ten months. A total of 111 invasive breast cancer patients were evaluated from 1st August 2009 to 31st October 2011. We examined TNBC patients with respect to clinicopathological parameters, adjuvant chemotherapy regimens and relapse free survival
Results: In our study, patients were young [median age at presentation, 47 yrs], premenopausal [54%], tumour size was discordant with lymph node positivity, the histology was predominantly intraductal carcinoma [90%], histological grade higher than two [90%]. Relapses were early and preferential visceral [32%] and CNS metastasises [11.7%]. 91% of patients were eligible for adjuvant therapy but only 80% of the patients could complete full course of adjuvant chemotherapy. Anthracycline-based regimens [43%], sequential anthracycline and taxane-based regimen [24%] and other regimes like CMF [13%] were used as adjuvant chemotherapy in eligible TNBC patients. Median relapse free survival in patients following adjuvant chemotherapy was around 10 months at last follow-up
Conclusions: Patients with TNBC have aggressive clinicopathological characteristics with early and higher rate of disease relapse and therefore derive inadequate benefit from current adjuvant chemotherapy. So, new treatment strategies in adjuvant chemotherapy for TNBC are needed
Subject(s)
Humans , Female , Adult , Middle Aged , Prognosis , Prospective Studies , Anthracyclines , Drug Therapy , Lymph Nodes , Carcinoma, Intraductal, NoninfiltratingABSTRACT
Introduction: Breast cancer is the second most common cancer in the Indian female population. LABC and metastatic breast cancer are the most common stages at presentation in most low-resource countries. Although the incidence of LABC has decreased significantly in countries with enhanced resources thanks to widespread education and screening programs, it remains a daily encounter for surgeons and oncologists in low-resource countries. Neoadjuvant therapy has been studied widely for the treatment of LABC and is followed by locoregional therapy
Objectives: As per our hospital data, breast cancer is also found to be the second leading malignancy in women and locally advanced breast cancer is the most common type of breast cancer. Hence, we undertook this study to evaluate the clinical profile, histopathologic types and grade of the disease in our patients
Materials and Methods: This study was undertaken over a period of three years comprising of 255 patients who underwent modified radical mastectomy following neoadjuvant chemotherapy after preliminary diagnosis of carcinoma on histopathological examination of the trucut biopsy specimens. Clinicopathological evaluation was done in all of these cases following standard protocols
Results: The study comprised of 252 female patients and 3 male patients in the age range of 26 to 70 years. Majority [255, 66.6%] of the cases were within the age range of 31-60 years. Three females had bilateral breast cancer. Invasive ductal carcinoma no special type was the most common histopathologic pattern, and was seen in 254 [98.4%] cases. Most tumors were Scarff Bloom Richardson grade II and American Joint Committee on Cancer pathologic stage 3
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Background and Aims: Intravenous dexmedetomidine is being increasingly used in perioperative setting including as an adjunct to local anesthetic in various regional techniques with an intent to either improve the block quality, increase the duration of block or to provide sedation and patient comfort during the periblock period. Intravenous dexmedetomidine when used just before or after spinal anesthesia has many desirable effects such as adequate sedation and patient comfort, longer sensory-motor blockade, prolonged postoperative analgesia and reduced post-anesthesia shivering. We aimed to study the effect of intravenous dexmedetomidine on spinal anesthesia with hyperbaric 0.5% bupivacaine
Methodology: One hundred American Society of Anesthesiologists [ASA] physical status I and II patients undergoing orthopaedic surgeries under spinal anesthesia were randomized into two groups of 50 each. After giving spinal anesthesia with 3.5 ml of 0.5% hyperbaric bupivacaine, patients in Group D received a loading dose of 1 microg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 microg/kg/h till the end of surgery, whereas patients in Group C received an equivalent quantity of normal saline. The two-dermatome pinprick sensory regression time, duration of the motor block, Ramsay sedation score [RSS], duration of analgesia and side effects of dexmedetomidine were assessed
Results: The time taken for regression of sensory block to S1 dermatome and Bromage 0 motor block was increased significantly by addition of dexmedetomidine. Time to first requirement of analgesic in postoperative period was more in Group D compared to Group C. Sedation was more in patients of Group D compared to Group C [P < 0.001]
Conclusion: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anesthesia. The incidence of bradycardia is significantly higher when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anesthesia. Dexmedetomidine provides excellent intraoperative sedation and postoperative analgesia
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Background and objectives: Laparoscopic tubal ligation [LTL] is a day care surgery and requires a small supraumbilical incision for the umbilical port. Pain after LTL is more than diagnostic laparoscopy. We aimed to examine the efficacy and benefits of a preemptive ultrasound guided single injection rectus sheath block [RSB] in providing improved early on postoperative pain scores in comparison to general anesthesia alone
Methodology: Sixty patients underwent elective LTL, were randomly allocated by a computer generated list into two groups: the ultrasound guided rectus sheath block group - the Group R, received a bilateral RSB using 20 ml of 0.25% bupivacaine on either side after initiation of anesthesia and earlier than the surgical incision; and general anesthesia group - the Group G, received general anesthesia alone. Intravenous tramadol was also given and its time was recorded. Pain was measured by verbal analogue score [VAS]. Sedation score [from 0 awake to 5 unarousable] was used to record sedation level. Any adverse events were recorded. Statistical Analysis was done with the help of SPSS software version 15. Mann-Whitney U-test, t-test, Pearson ?[2] test and Fisher's exact test was used for analysis of different variables. Statistical significance was set at 5%
Results: The rectus sheath block with bupivacaine compared with control group reduced verbal analogue scores. Tramadol requirements in the first 12 postoperative hours were also lower. The frequency of nausea and sedation was reduced in the Group R. There were no complications accredited to the rectus sheath block
Conclusion: Ultrasound guided rectus sheath block, as a part of multimodal analgesic regimen, provides superior analgesia up to 12 postoperative hours after voluntary laparoscopic tubal ligation