Orthodontic Pain and Patients’ Quality of Life: Patient Experiences and Provider Assessments

Objectives:To compare orthodontic pain and its Influence on quality of patient’s life as perceived by them with that assessed by their orthodontic care providers.Materials and Methods:It was crosses sectional study involving 75 patients attending the orthodontic clinic and14 orthodontic care providers from September to October 2010. Patients aged 16 and older, receiving fixed orthodontic treatments were included. Patients and orthodontists scored painduring different orthodontic procedures using a qualitative pain intensity scale which graded pain for different orthodontic procedures. Oral health related quality of life (OHRQoL) was assessed by means of a 4-point likert scale to measure the influence of orthodontic treatment related pain on different aspects of life.Results:For change of consistency of diet (p=0.02) statistically significant difference was observed between mean ranks of patients and orthodontists. For pain during record taking, higher mean ranks were reported for patients aged between 20-30 years (p = 0.01) whereas for pain after separator placement, patients aged above 30 had higher mean ranks (p = 0.05).Conclusions:Orthodontists can accurately estimate the degree of pain their patients’ experience. Significant proportions of patients experience substantial degrees pain during the visits, subsequent to orthodontic visits and pain due to fixed orthodontic appliance therapy transiently affects patients’ OHRQoL

Which is a better marker for overweight: waist height ratio or waist circumference?

Background: The global prevalence of obesity has been increasing. Body mass index, waist circumference and waist height ratio have been widely used for nutritional assessment. Waist height ratio has the advantage of taking into account abdominal obesity as well as height associated with body fat accumulation or distribution. The objective of this study was to suggest cut off points for waist circumference and waist height ratio to identify overweight in Omani adults.Methods: Weight, height, waist circumference and waist height ratio were measured for all participants. Pearson’s correlation was used to determine correlation of BMI with waist circumference and waist height ratio. ROC curve was used to identify AUC and specific cut off point for anthropometric indicators.Results: The largest proportion of overweight was picked up by waist height ratio across both the genders. Correlation of BMI with waist height ratio was stronger (r=0.699) than correlation with waist circumference (r=0.589) for both the genders. Maximum AUC was for waist height ratio in males (AUC=0.833, 95% CI=0.791-0.875). The specific cut off point for waist circumference in males and females was 89.5cm and 87.6cm respectively. The specific cut off point for waist height ratio in males and females was 0.53 and 0.57 respectively.Conclusions: Maximum participants were found overweight by waist height ratio followed by waist circumference and the least by BMI. The higher cut off points should be used in this population for identifying overweight people.

Predictors of hypertension in Oman

Background: According to the Oman World Health Survey in 2008, the prevalence of hypertension in Oman is about 40%. Hypertension is associated with old people, male gender, smoker and impaired glucose tolerance. The objective of the study was to find out the important predictors of hypertension in Oman.Methods: A cross sectional study in Omani adults more than 18 years of age was conducted. Blood pressure was measured and participants were classified as having hypertension. Height and weight was measured and body mass index was used to classify obesity by WHO guidelines. Multiple logistic regression was used to find the predictors of hypertension.Results: Increase in age and body mass index were found to be important covariates of hypertension. People in the age group of 30 to 50 years were at high risk of hypertension (OR 1.6, p<0.05); likelihood increased to three times in more than 50 years age group (p<0.01) in univariate analysis. Overweight had almost 2 times (p<0.05) and obese had five times (p<0.01) more likelihood of hypertension than normal weight people. People with less education had more likelihood of hypertension. Smokers (OR 2.9, p<0.01) and males (OR 1.5, p<0.05) were at a higher risk of hypertension than non-smokers and females in multivariate analysis. Percentage accuracy of classification was 67.4%.Conclusions: Age more than 50 years, male gender, BMI more than 30 and smoking were important predictors of hypertension in the study population

Diagnostic dilemmas in fulminating sub-acute sclerosing pan-encephalitis (SSPE) with atypical presentation

@#Subacute sclerosing panencephalitis (SSPE) is a progressive, fatal disease of the central nervous system caused by a persistent measles virus in the brain. It is clinically characterized by insidious onset of intellectual deterioration and behavioral changes followed by myoclonic jerks and eventually complete neurologic deterioration. In about 10% of patients, the clinical manifestations of SSPE are not typical and that may cause a delay in the diagnosis. We report here 3 cases of SSPE with atypical presentations. Bilateral vision loss, hemiparesis, ataxia and acute encephalopathy with focal seizures were respectively the presenting symptoms at the onset of disease. The typical periodic EEG complexes in two patients and positive CSF measles IgG antibody led to the diagnosis of SSPE.

Pelvic floor electromyography and urine flow patterns in children with vesicoureteral reflux and lower urinary tract symptoms

ABSTRACT Objective: To determine the different urine flow patterns and active pelvic floor electromyography (EMG) during voiding in children with vesicoureteral reflux (VUR) as well as presenting the prevalence of lower urinary tract symptoms in these patients. Materials and Methods: We retrospectively reviewed the charts of children diagnosed with VUR after toilet training from Sep 2013 to Jan 2016. 225 anatomically and neurologically normal children were included. The reflux was diagnosed with voiding cystourethrography. The study was comprised an interview by means of a symptom questionnaire, a voiding diary, uroflowmetry with EMG and kidney and bladder ultrasounds. Urine flow patterns were classified as bell shape, staccato, interrupted, tower and plateau based on the current International Children's Continence Society guidelines. Results: Of 225 children with VUR (175 girls, 50 boys), underwent uroflowmetry + EMG, 151 (67.1%) had an abnormal urine flow pattern. An active pelvic floor EMG during voiding was confirmed in 113 (50.2%) children. The flow patterns were staccato in 76 (33.7 %), interrupted in 41 (18.2%), Plateau in 26 (11.5%), tower in 12 (5.3%) and a bell shape or normal pattern in 70 (31.5%). Urinary tract infection, enuresis and constipation respectively, were more frequent symptoms in these patients. Conclusions: Bladder/bowel dysfunction is common in patients with VUR that increases the risk of breakthrough urinary tract infections in children receiving antibiotic prophylaxis and reduces the success rate for endoscopic injection therapy. Therefore investigation of voiding dysfunction with primary assessment tools can be used prior to treating VUR.

Randomized controlled trial on the comparison of chest tube drainage and needle aspiration in the treatment of primary spontaneous pneumothorax

Objectives: To evaluate the efficacy of the chest tube drainage [CTD] and the needle aspiration [NA] in the treatment of primary Spontaneous pneumothorax [SP]

Methods: In a randomized controlled trial, seventy patients suffering SP were divided equally into two subgroups, as follows: [A] CTD and [B] NA. The immediate and one-week rate of the treatments was the primary endpoints. Postoperative complications, length of hospital stay and incidence of pneumothorax recurrence during one-year follow up were also recorded

Results: The immediate success of treatment was 68.5% and 54.2% of patients in CTD and NA groups, respectively that showed no significant difference between study groups [P: 0.16]. The complete lung expansion after one week observed in 32 [91.4%] of NA group and 33 [94.2%] patients in CTD group [P: 0.5]. Pneumothorax recurrence was detected in 13 patients [4 in NA and 9 in CTD group] [P: 0.11]. Mean pain intensity was significantly lower in the NA group at the first hour after the procedure, the first postoperative day and the first week after the intervention [P< 0.001]

Conclusion: Needle aspiration [NA] can be applied as a first step treatment in patients with primary SP, considering its advantages

Gonadotropin-releasing Hormone Agonist Plus Aromatase Inhibitor in the Treatment of Uterine Leiomyoma in Near Menopause Patient: A Case Series Study

OBJECTIVES: There are many drugs for of symptomatic fibroids. Gonadotropin-releasing hormone (GnRH) agonists are the well known drugs. Also, aromatase inhibitors are effective. All published studies surveyed the effect of one of these two drugs. In this study as the first study decided to evaluate the effectiveness of the combination of GnRH agonists + aromatise inhibitor on the uterine fibroids. METHODS: A cross-sectional prospective case series study was performed on 10 known cases of uterine fibroids late perimenopause, at least 3 myomas >5 cm, abnormal uterine bleeding and anemia due to fibroids, candidate for hysterectomy, no tendency to surgery. A single dose of Diphereline 11.25 mg, SR plus 2.5 mg of Letrozole daily for 4 weeks with add-back therapy + calcium carbonate were used. The second dose of Diphereline 11.25 mg, SR was used 3 months after the first injection. The patients were followed until 3 years. RESULTS: The mean age of the study group was 49.90 ± 1.66. The mean fibroid size reduced from 15.05 ± 57.20 cm to 13.56 ± 39.39 cm (P = 0.012) and fibroid volume reduced from 72.78 ± 110.6 to 50.96 ± 64.2 (P = 0.116). There was no signification changes in the serum level of hormones at the end of six months. Eight cases were menopause at the end of the study and hypoestrogenism symptoms did not happened in none of the cases until the end of 24 months. Except in one case, there was no need to do surgery on others. CONCLUSIONS: Combination of Diphereline + Letrozole probably could prevent surgery in cases that have multiple fibroids, perimenopause, anemic and candidate for surgery.

Molecular markers associated with the agronomic traits in the medicinal plant lemon balm / Marcadores moleculares associados aos traços agronômicos na planta medicinal erva cidreira

Finding association between molecular markers and agronomic traits provide an excellent tool for indirect selection of a trait of interest in the population. In this study, stepwise regression analysis was used to estimate associations between ISSR and RAPD markers with some agronomic traits in lemon balm ecotypes. The analysis of results revealed significant associations between the traits and some of the studied loci. For all the traits, more than one informative marker was detected. Totally,90informative markers, including 48 ISSR loci and 42 RAPD loci, were identified. The SA-R-10, UBC826-1, UBC812-9, UBC813-10, UBC825-4, OPA-01-15, OPC-04-7 and CS-56-8 markers or fragment showed a significant correlation with Essential oil percentage and controlled 99.8% of the phenotypic variation. These markers are relatively more reliable. Among the RAPD primers, special attention should be drawn to primer SA-R, which had the highest associated fragments with the traits including days for 50% flowering, number of branches per plant, fresh weight and dry weight. Some of ISSR and RAPD markers were associated with more than one trait in multiple regression analysis that may be due to pleiotropic effect of the linked quantitative trait locus on different traits or its linkage to different genes. These primers have been found useful for improved lemon balm.

Encontrar associação entre marcadores moleculares e traços agronômicos é uma excelente ferramenta para seleção indireta de um traço de interesse na população. Neste estudo, foi utilizada a análise de regressão stepwise para estimar associações entre marcadores ISSR e RAPD com algumas características agronômicas em ecótipos de erva cidreira. A análise dos resultados revelou associações significativas entre os traços e alguns dos loci estudados. Para todos os traços mais de um marcador informativo foi detectado. Foram identificados 90 marcadores informativos, incluindo 48 loci ISSR e 42 loci RAPD. Os marcadoresou fragmentos SA-R-10, UBC826-1, UBC812-9, UBC813-10, UBC825-4, OPA-01-15, OPC-04-7 e CS-56-8 mostraram uma correlação significativa com a percentagem de óleo essencial e controlaram 99,8% da variação fenotípica. Estes marcadores são considerados relativamente mais confiáveis. Entre os primers RAPD, destaca-se o primer SA-R, que apresentou os maiores fragmentos associados com as características, incluindo dias para 50% de floração, número de ramos por planta, peso fresco e peso seco. Alguns dos marcadores ISSR e RAPD foram associados a mais de um traço na análise de regressão múltipla que pode ser devido ao efeito pleiotrópico do locus de traço quantitativo ligado em diferentes traços ou sua ligação a diferentes genes. Estes iniciadores provaram ser úteis para o melhoramento da erva cidreira.

Perceived parental rejection predicting attention deficit hyper activity disorder, oppositional deficient disorder and conduct disorder among Pakistani adolescents

Background: Parental optimistic relations and parental hostile patterns are forecaster of emotional disorders among the school children

Objectives: The study aimed at examining effect of perceived parental rejection with disruptive behaviors e.g., attention deficit hyper activity disorder, oppositional deficient disorder and conduct disorder in Adolescents of single parents

Study design, settings and duration: Cross-sectional study was conducted in universities of Rawalpindi and Islamabad for duration of 8 months

Subjects and Methods: After taking inform written consent 200 adolescents [male= 90, 45%; female=110, 55%] of age 18-23 years studying in universities of Rawalpindi and Islamabad were enrolled. Perceived Parental Rejection was measured with the help of Urdu version of Parental Acceptance-Rejection Questionnaire and Disruptive Behavior Disorders were assessed by Disruptive Behavior Disorder [DBD] rating scale

Results: Finding of the present study showed that perceived parental rejection is a significant predictor of disruptive behavior disorders e.g., ADHD, oppositional deficient disorder, and conduct disorder in adolescents of single parents with low income. It has been found that there is no significant mean difference between male and females on disruptive behavior disorders

Conclusion: The perceived parental rejection increase emotional disorders e.g., ADHD, oppositional deficient disorder and conduct disorder in children

Pyoderma gangrenosum associated with ulcerative colitis: a case report

Pyoderma gangrenosum [PG] is an uncommon ulcerative cutaneous condition of heterogeneous etiology. It is characterized by rapid progression of painful necrolytic ulcer

It is associated with systemic diseases in at least 50% of patients. Diagnosis is made by exclusion of other causes of similar appearing cutaneous ulcerations including infections, malignancy, etc. In our case pyoderma gangrenosum was associated with ulcerative colitis

role of M2000 as an anti-inflammatory agent in toll-like receptor 2/microRNA-155 pathway

Background: M2000 is a newly designed and safe Non-Steroidal Anti-Inflammatory Drug [NSAID]. The aim of this study was to assess the effects of M2000 on expression levels of Suppressor of Cytokine Signaling-1 [SOCS-1] and Src Homology-2 domain containing inositol-5'-phosphatase 1 [SHIP1] proteins via Toll-Like Receptor [TLR] 2/microRNA-155 pathway

Methods: HEK293 TLR2 cell line and Peripheral Blood Mononuclear Cells [PBMCs] were treated by different concentrations of M2000 in MTT assay. RNA was extracted by miRN easy Mini kit. Then, cDNA was synthesized and the expression levels of SOCS1, SHIP1 and miRNA155 were evaluated by Quantitative Real time PCR

Results: Our results showed that M2000 significantly increased the expression levels of SOCS1 and SHIP-1 in Lipopolysachride [LPS]-treated and non-treated cells. Moreover, M2000 decreased expression level of miR-155 in LPS treated PBMCs

Conclusion: M2000 can be used as NSAID in LPS induced inflammation and decrease inflammatory cytokines production by targeting SOCS1, SHIP1 and miR-155 in autoimmune and inflammatory diseases

Pancreatic tuberculosis in an immunocompetent patient: a case report and review of the literature

Pancreatic tuberculosis is extremely rare and its clinical and radiological findings are similar to those of pancreatic malignancy. The diagnosis of pancreatic tuberculosis is not usually made prior to surgery. Here, we report a case of pancreatic tuberculosis, presented with abdominal pain and weight loss. Abdominal computed tomography [CT] showed a 62 mm x 32 mm septate solid-cystic mass in the pancreatic head area with extension into the hilum of the liver. There was no evidence of inflammation or pancreatitis. Endoscopic ultrasound-fine needle aspiration [EUS-FNA] could not yield the diagnosis. Exploratory laparotomy and further pathological evaluation suggested pancreatic tuberculosis. Response to antituberculosis treatment confirmed the diagnosis. Finally, previous case reports and case studies of pancreatic tuberculosis in the literature are fully investigated

rare presentation of primary heptic lymphoma: a case report

Primary hepatic lymphoma [PHL] was a rare malignancy usually presenting with abdominal pain, malaise, Hepatomegaly, B-symptoms, fatigue, nausea, vomiting and jaundice. It mostly involves liver without any palpable lymphadenopathy and leukemia in peripheral blood smear. On July 22, 2014, a 64 year old man presented with abdominal pain localizing in Right upper quadrant and fullness from 2 years ago without any weight loss or constitutional symptoms. His physical examination revealed no mass or lymphadenopathy and lab data showed rise in Alkaline phosphatase [ALP] and Gamma-glutamyl transferase [gamma-GT]. Abdominal computed tomography [CT] scan with contrast showed a calcified lesion in the left lobe of liver and ill-defined hypodense area in medial segment of the left lobe of liver adjacent to gallbladder associated with mild central intra hepatic bile ducts dilation showing more enhancement in delay phase suggested peripheral cholangiocarcinoma. Finally surgical core needle biopsy of the liver confirmed malignant lymphoma of B cell type and patient was referred to oncologist for chemotherapy. His chemotherapy regimen consisted of rituximab 600 milligram [mg], endoxan 1250 mg, adriamycin 80 mg, vincristine 2 mg, prednisolone 100 mg [durgin five days] for 6 courses. After 5 months chemotherapy, on December 22, 2014 a follow up CT scan with IV and oral contrast was done. There was no evidence of previous mass lesion in the liver. In the follow up on May 9, 2015, he had no specific symptoms and all of his lab data were in normal range

atypical presentation of acute appendicitis: a 77 years old man with left lower quadrant pain

With an occurrence of 7%, appendicitis is one of the most common abdominal emergencies requiring surgery. Since the variation in positions and length of the appendix may produce varying symptoms and signs which mimic other diseases, having knowledge of the variations in the position of the appendix is of significant importance

Here, we present a 77-year-old man with acute appendicitis presenting with lower abdominal pain, fever, chills, and dys-uria. Physical examination revealed tenderness and rebound tenderness in the left lower quadrant more pronounced in the right lower quadrant with Icukocyiosis on blood tests. Both ultrasonography and abdominopelvic computed tomography scan demonstrated a severe inflammation at paracecal mesenteric fat with extension to para sigmoid portion which was in favor of diverticulitis rather than appendicitis

A 2-week treatment with intravenous antibiotic regimen was initiated for the patient and from the second day of antibiotic therapy, the patient's fever and abdominal pain improved. A second CT-scan performed three weeks after completion of a 14-day course of antibiotics, revealed a dilated long appendix [diameter: 12mm, length: 10 cm] with extension of its tip to the medial wall of sigmoid. Physicians should consider appendicitis when evaluating an acute abdomen to prevent any delay in diagnosis of atypical presentations and decrease the mortality and morbidity related to the complications

Chronic myeloid leukemia blood inflicted injury in cord derived Wharton's jelly mesenchymal stem cells

Objective: To determine the effects of blood from CML patients on human umbilical cord derived Wharton's jelly mesenchymal stem cells [WJMSCs] for evaluation of their therapeutic potential

Study Design: An experimental study

Place and Duration of Study: Centre for Research in Molecular Medicine, University of Lahore, from September 2013 to December 2014

Methodology: Possible behavior of WJMSCs in CML patients was assessed by culturing these cells in their plasma. WJMSCs at passage 3 were cultured in plasma isolated from 9 CML patients as well as 9 normal subjects. Effects on cell viability, proliferation, LDH release, paracrine factors [p38 and p53] and oxidative stress were evaluated

Results: WJMSCs cultured in plasma of CML patients showed decreased viability, slow proliferation, high LDH release, high expression of p38 and p53 and a high oxidative stress compared to normal subjects

Conclusion: Stressed environment of CML patients' blood/plasma induced injury to WJMSCs as well as reduced their viability. Effectiveness of these cells for therapeutics of CML is, therefore, likely to be reduced

diagnostic role of magnetic resonance enterography as a complementary test to colonoscopy in active Crohn's disease

Background: According to recent studies comparing magnetic resonance enterography [MRE] with ileocolonoscopy for assessing inflammation of small bowel and colonic segments in adults with active Crohn's disease [CD], we aimed to compare the accuracy of these two diagnostic methods in Iranian population

Method: During 2013-2014 a follow-up study was done on 30 patients with active CD ina gastroenterology clinic affiliated to Tehran University of Medical Sciences. MRE and ileocolonoscopy were performed for all the patients. All statistical analyses were performed using SPSS [version 18] and P value<0.05 was considered as statistically significant

Results: Of the 30 patients with active CD, 11[36.7%] were men and 19 [63.3%] were women with mean age of 37.30 +/- 13.66 years [range: 19-67 years]. MRE had sensitivity and specificity of 50% and 90% with positive predictive value [PPV] and negative predictive value [NPV] of 71.43 and 78.26, respectively for localizing sigmoid lesions and ileum had sensitivity and specificity of 84.21 and 45.45 with PPV and NPV of 72.73 and 62.50, respectively

Conclusion: While moderate sensitivity and high specificity of MRE in localizing colonic lesions makes it an appropriate confirmatory test after colonoscopy, the reported high sensitivity and moderate specificity of MRE versus colonoscopy in detecting ileal lesions makes it a suitable screening test for ileal lesions. Finally we can conclude that MRE can be an important complementary test to colonoscopy in detecting active disease

Accuracy of 99mTc [V]-dimercaptosuccinic acid scintigraphy and fecal calprotectin compared with colonoscopy in localizing active lesions in inflammatory bowel disease

Introduction: Due to limitation of colonoscopy in assessing the entire bowel and patients' intolerance in inflammatory bowel disease [IBD], in the current study, we aimed to prospectively compare the accuracy of [99m]Tc[V]-dimercaptosuccinic acid [DMSA] and fecal calprotectin with ileocolonoscopy as new methods for localizing inflammations

Methods: Current prospective study conducted between 2012 and 2014 on 30 patients with IBD attending Gastroenterology Clinic of Tehran University of Medical Sciences. Fecal calprotectin and disease activity were measured for all participants and all of them underwent [99m]Tc [V]-DMSA scintigraphy and colonoscopy. The accuracy of [99m]Tc [V]-DMSA scintigraphy and calprotectin in localizing bowel lesions were calculated

Results: A total of 22 patients with ulcerative colitis [UC] and 8 patients with Crohn's disease [CD] were evaluated in our study. Sensitivity, positive likelihood ratio [PLR], and positive predictive value [PPV] of scintigraphy and calprotectin over colonoscopy in localization of UC lesions were 86.36%, 0.86%, 100.00% and 90.91%, 0.91, and 100.00%, respectively. Meanwhile, it showed 66.67% sensitivity and 81.25% specificity with PLR=3.56, negative likelihood ratio [NLR]=0.41, PPV=84.21%, and negative predictive value [NPV]= 61.90% in localizing lesions in patients with CD. The calprotectin level had sensitivity, PLR, and PPV of 90.00%, 0.90, and 100.00% in detecting active disease over colonoscopy, respectively

Conclusion: The [99m]Tc [V]-DMSA scintigraphy would be an accurate method for detecting active inflammation in follow-up of patients with IBD and assessing response to treatment as a non-invasive and complementary method beside colonoscopy for more accurate diagnosis of CD or UC

effect of Migri-Heal on nitric oxide production in an in vitro inflammatory model of primary microglial cells

Background: Recently, much attention has been directed towards considering activated microgelial cells as putative targets for treatment of neurological disorders. MigriHeal as a novel herbal remedy was introduced for the treatment of migraine headaches. The previous researches has shown that MigriHea extracts can decrease NO in an in vitro inflammatory model. The aim of this study was to investigate the effect of MigriHeal on NO generation from LPS- stimulated microglia cells

Materials and Methods: Neonatal rat primary microglial cells were isolated from the mixed glial cultures and the purity of the cultures was determined by immunocytochemistry. Microglial cells were pretreated with Migri-Heal and activated by 1microg/ml LPS. Subsequently, NO levels in the culture supernatants were measured by a griess reaction. Our results showed that Migri-Heal 50microg/ml significantly reduced NO level in inflamed microglia in a dose-dependent manner

Results: The results showed that different concentrations of Migri-Heal had no prominent effect on cell viability in presence of LPS as compared with the control group. In addition, the pretreatment of microglia cells with Migri-Heal can prevent from a morphological changes of the cells into the round and phagocytic shape

Conclusion: Our study demonstrated that MigriHeal might have NO scavenging properties. Integrative studies are warranted to uncover the novel pharmacological insights of this herbal remedy as an putative therapeutic approach against diseases -associated with inflammation

White Blood Cell Count to Mean Platelet Volume Ratio Is a Prognostic Factor in Patients with Non-ST Elevation Acute Coronary Syndrome with or without Metabolic Syndrome

BACKGROUND AND OBJECTIVES: Leukocyte and platelet have been found to be associated with metabolic syndrome (MetS). We aimed to determine the usefulness of a novel marker named white blood cell count to mean platelet volume ratio (WMR) for predicting outcomes of non-ST elevation acute coronary syndrome (NSTE-ACS) with or without MetS. SUBJECTS AND METHODS: A total of 331 NSTE-ACS individuals (60±12.5 years, 57.4% male) were enrolled and followed for a median of 24 months. MetS was identified using the National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: Patients were divided into two groups: high WMR (WMR≥720) and low WMR (WMR<720). Major adverse cardiovascular events (MACE) and MetS rates were significantly greater in the higher WMR group compared to those in the low WMR group (MACE: 14.3% vs. 25%, p=0.014; MetS: 50.9% vs. 75%, p<0.001). MetS was diagnosed in 62.2% of patients. MACE incidence in patients with or without MetS was comparable (p=0.737). Among MetS individuals, patients in the high WMR group had more MACE than the low WMR group (11.2% vs. 26.5%, p=0.007). However, MACE was comparable among non-MetS individuals (p=0.681). In multivariable Cox regression analysis, hazard ratios (HR) of MACE incidence for high-WMR in MetS individuals was 2.616 (95% confidence interval: 1.282–5.339, p=0.008). However, HR of MACE incidence for high WMR in non-MetS individuals was not significant. CONCLUSION: Among NSTE-ACS patients without revascularization therapy, elevated admission WMR was associated with an increased risk of developing composite MACE in MetS individuals but not in non-MetS patients.

Comparative Study of Evaluation of Pain on Injection of Propofol Pretreatment with two Different Doses of Butorphanol.

In a prospective, double-blind, placebo-controlled, randomized trial one-hundred-sixty eight ASA I-II adults, undergoing laparoscopic cholecystectomy were randomly assigned into 3 groups of 56 each. Group L received lidocaine 2% (40 mg), Group B-1 received butorphanol 1 mg. and Group B-2 received butorphanol 2 mg. One min after pretreatment patients received one-fourth of the total calculated dose of propofol (2.5 mg/kg) over 5 s. In the lignocaine group 28 (50.00%) patients had pain during propofol injection as compared with 11 (19.64%) and 9 (16.07%) in the butorphanol 1mg and butorphanol 2mg groups, respectively (P < 0.05). Intergroup comparison revealed that although the incidence of pain at propofol injection was more in lignocaine group, the severity was primarily mild and comparable among the three groups (P > 0.05). Butorphanol decreased the frequency (P < 0.05) of propofol pain when compared with lidocaine. However severity of pain on injection of propofol was comparable among both the groups given pretreatment with butorphanol. (P > 0.05). No difference in complications, such as pain, edema, wheal, or flare response, were observed at the injection site within the first 24 h after the operation. Duration of analgesia was higher in Group-B-2 compared to other two groups. (142.5±33.96 minutes in Group-B-2, 76.07±23.56 minutes in Group-B-1 and 80.35±21.48 minutes in Group -L). However this was also associated with higher number of patients in deep sedation at 30 minutes. Pretreatment with butorphanol 1 mg or 2mg are equally effective in relieving pain on injection of propofol & more effective than lignocaine.