Effects of Various Anaesthetic Techniques on Haemodynamic Stability and Inflammatory Cytokine (IL-6) Level in Patients Undergoing Breast Cancer Surgery

Introduction: Multimodal anaesthesia techniques includeregional anaesthesia in the form of paravertebral block andvarious anaesthetic drugs which acts on different sites of painpathway with different mechanism of action, results in goodquality of analgesia with minimal side effects. They improverecovery along with early mobilization and rehabilitationand early resumption. This technique lowers the level ofinflammatory cytokines. Due to this we aim to evaluate theeffects multimodal anaesthesia technique on level of IL-6inflammatory cytokines in breast carcinoma surgery.Material and Methods: Patients were randomized intofollowing three groups (n=30 in each group) using a computergenerated random number tables. Group I: paracetamol 10 mg/kg, Group II: paracetamol at 10 mg/kg and dexmedetomidine0.5μg/kg, Group III: paracetamol 10 mg/kg, dexmedetomidine0.5 μg/kg and paravertebral block with levobupivacaine.Fentany (2 μg/kg) with general anaesthesia were common inall three groups. Statistical Analysis: All the categorical datawas compared by using student “t” test, chi-square test andparametric data by analysis of variance (ANOVA).Results: Patients of group III was haemodynamically morestable as compared to group II and I. IL-6 level was 358.15, ingroup I, 354 in group II and 346.65 in group III preoperativelywhile 324.85 in group I, 320.95 in group II, 278.35 in group IIIafter 2 hour surgery. IL-6 level was significantly different ingroup III as compared to group II and group I postoperatively.Conclusion: Multimodal approach is a better anesthetictechnique in terms of hemodynamic stability with decreasedlevels of IL-6 inflammatory cytokines.

Lipoprotein [a] levels in relation to severity of coronary artery disease in north Indian patients

Lipoprotein [a] [Lp [a]] is an established risk marker of coronary artery disease which is independent from other risk factors. The aim was to address the association between Lp [a] and CAD risk in North Indians. To evaluate whether high levels of lipoprotein [a] [Lp [a]] is a predictor of risk and is related to the severity of CAD. This was a cross-sectional study done on 360 patients presenting with chest pain. Coronary angiography revealed CAD in 270 patients and 90 patients without CAD. Lipoprotein [a] level, lipid profile, fasting blood glucose, anthropometric and clinical parameters were analyzed. Lipoprotein [a] 21.0 mg/dL is associated with the presence of coronary lesions [P = 0.0001]. A highly significant difference in Lp [a] levels was observed between normal coronaries vs. single-vessel disease, double-and triple-vessel disease [P < 0.0001]. Body mass index [BMI] was significantly raised in CAD group compared to normal coronary. Multivariate analysis found that Lp [a] was considered an independent predictor for severity of CAD and Lp [a] levels 21.0 mg/dL are associated with severe patterns of coronary atherosclerosis

A biochemical and histopathological evaluation of generalized pulp calcification in young permanent teeth.

Pulp calcifications are a frequent finding on bitewing and periapical radiographs in older age-groups but their occurrence in the entire dentition in young subjects is unusual. We report such an unusual occurrence of generalized pulp calcification in a 13-year-old Indian female. Radiographic examination of the dentition revealed pulp calcifications in all permanent teeth, located mostly in the pulp chamber but with some in the root canals. The patient's dental, medical, and family history was noncontributory. Biochemical analysis of the removed pulp calcification from one of the teeth during endodontic treatment showed large amounts of calcium, phosphorus, and carbonate. However, metabolic evaluation of patient through liver and kidney function tests and other blood investigations did not reveal any metabolic disorder. The patient was also evaluated for any systemic, syndromic, or genetic involvement but this was also noncontributory. Therefore, we propose that this unusual case of generalized pulp calcification is of idiopathic origin. In this work, histopathological and biochemical evaluations of the pulp calcification was done to try and understand the initiation and progress of calcifications in pulpal tissue.

Chronic osteomyelitis; microbiology of long bones in a tertiary care hospital

To determine the causative organism of long bone chronic osteomylitis through culture of the sequestrum. Descriptive case series. Orthopaedic Surgery Unit, Mardan Medical Complex Teaching hospital, Bacha Khan Medical College, Mardan, KPK, Pakistan from September 2011 to April 2012. Twenty five patients with radiologically proven chronic osteomyelitis of long bones who had been free of antibiotic therapy for at least 48 hours, excluding those with diabetic foot, decubitus ulcers, and infected implant. At least one specimen of sequestrum was taken from each individual and subjected to complete microbiologic analysis. Staphylococcus aureus was the most frequently found organism [n=11, 44%], followed by Enterobacteriaceae [n=5, 20%], coagulase-negative staphylococci [n=3,12%] Escherichia coli [n=2, 8%] P aeruginosa [n=1, 4%], Streptococcus species [n=1, 4%] and no growth [n=2, 8%].More than one microorganism was isolated in two [8%] patients. Staphylococcus aureus was the most common organism isolated. Sequestrum culture provides accurate identification of causative bacteria

Transabdominal preperitoneal laparoscopic inguinal hernia repair

To determine the outcome of transabdominal preperitoneal [TAPP] inguinal hernia repair. Descriptive study. At Surgical C Unit, Khyber Teaching Hospital Peshawar, from April 2010 to June 2011. A total of 88 patients, aged between 16-60 year were included in the study and subjected to transabdominal preperitoneal inguinal hernia repair. The outcome measures such as operative time, length of hospital stay and postoperative complications were analyzed. The mean age of patients was 38.64 +/- 9.04 year. The mean operative time was 60.13 +/- 14.76 minutes. The mean hospital stay was 1.45 +/- 0.72 days. The postoperative complications were urinary retention [n=1 - 1.1%], wound hematoma [n=1 - 1.1%], surgical site infection [n=2 - 2.2%] and recurrence of hernia [n=1 - 1.1%]. Transabdominal preperitoneal inguinal hernia repair is associated with minimal complications but requires a long learning curve

Prevalence of dry eye in GMCHRC Ajman, UAE

The present study was to determine the prevalence of dry eye and its risk factors. In this cross-sectional study of a hospital-based population, there were 309 participants, 48% males and 52% females; 33% students and 68% employees. The data were collected using a structured questionnaire, which included sociodemographic variables, medical history, daily activities and questions for Ocular Surface Disease Index [OSDI]. Of the participants 89 were randomly selected, and Schirmer's test was done on the same day morning and evening, recording their day time activities. Data were analyzed using PASW 17.0, to compare between means paired t-test was done. Chi square test was done to test the association. Prevalence of dry eye was 17.8% by Ocular Surface Disease Index [OSDI] score, and 21.3% among Schirmer's test participants. Former was relatively higher in the 15-34 age group, while by the latter it was higher in the 35-44 age group [33.3%]. 18% females and 17.6% of males had dry eye. Prevalence of dry eye with refractive error is 25.5%. There was a significant association of dry eye with eye problems [p<0.001], usage of glasses [p<0.006] and medication for eye diseases [p<0.002]. Dry eye was significantly higher using OSDI among computer users [p<0.045]. Other activities, contact lens use, family history, work environment, associated medical conditions, and personal habits did not show any significant association with dry eye. There is a high prevalence of dry eye among the students and employees of the hospital under study, more so among those with eye problems, dryness of nose, mouth and throat and computer users. Other activities and factors showed no influence on tear reduction