Oral Rivaroxaban in the Prophylaxis of COVID-19 Induced Coagulopathy

Background: Preliminary data highlights the importance of anticoagulation therapy in the prevention and treatment of thromboembolism in SARS CoV-2 infection. There is insufficient data comparing the safety and efficacy of direct oral anticoagulants (DOACs) and subcutaneous enoxaparin in the prophylactic management of COVID-19 associated thromboembolic disease, particularly in mild to moderate cases of COVID-19 infection. Objectives: The study was designed to investigate the efficacy of oral rivaroxaban as a prophylactic anticoagulant in mild to moderate SARS CoV-2 infection. Methods: In this randomized, open-label, prospective superiority trial involving hospitalized patients with confirmed mild or moderate COVID-19 disease without known thromboembolism, we assigned 230 patients to receive either once-daily oral rivaroxaban (10mg or 15mg) or once-daily subcutaneous enoxaparin (40mg or 60mg) for a median duration of 8 days. The primary outcome was a composite of all major, clinically relevant haemorrhagic and thrombotic events. Results: The primary efficacy outcome occurred in 4 of 115 patients in the rivaroxaban group (3.5%) versus 16 of 113 patients in the enoxaparin group (14.2%) (hazard ratio 0.207, 95% confidence interval [CI], 0.069 to 0.621, P=0.005). Adverse events developed in 4.3% of patients in the study group and 12.4% in the enoxaparin group (hazard ratio 0.328; 95% CI, 0.118 to 0.910; P=0.032). Major bleeding was seen in 1 patient (0.9%) in the rivaroxaban group and 3 patients (2.7%) in the enoxaparin group. Conclusions: Rivaroxaban alone was superior to enoxaparin for the prophylactic management of coagulopathy associated with mild to moderate SARS CoV-2 infection.

Awareness of cervical cancer and practice of Papanicolou smears among adult women availing health services or visiting a rural maternity hospital, Ramnagara District, Karnataka, India

Background: Cervical cancer is a leading cause of cancer-related deaths among women worldwide. Almost 87% of cervical cancer deaths occur in low and middle-income countries. The study was conducted to assess the awareness of cervical cancer and practice of Papanicolou (Pap) smears among women availing health services or visiting a rural maternity hospital, Karnataka.Methods: A hospital-based cross-sectional study was conducted using a 50-item interview schedule. The interview was administered to women >18 years of age who availed services at the hospital and their caretakers.Results: Mean age of the 158 women interviewed was 32.68±13.7 years. Only 21% of women had heard about cervical cancer. Only 11.4% knew at least one symptom and 1.9% knew one risk factor of cervical cancer. Most of the women (99%) were not aware about prevention of cervical cancer. Only 4% of the women had heard about Pap smears and 3% of the women had undergone a Pap smear test.Conclusions: Women in our study had very poor awareness of cervical cancer and practice of Pap smears. Gainfully employed women (OR=32; 8.8-111.2) and women who reported cervical cancer among family members or friends (OR=116; 20.2-665.4).  were more likely to have heard about cervical cancer. This study indicates a need to increase the awareness on cervical cancer and its prevention especially regarding Pap smears among rural women in Karnataka.

Whole brain radiotherapy for patients with brain metastasis from lung cancer – Prognostic significance of RTOG-RPA score

Background: Whole brain radiotherapy for patients with brain metastasis from lung cancer – prognostic significance of RTOG-RPA score. Aim: To evaluate the prognostic significance of Recursive partition Analysis (RPA) score in predicting the survival in patients with brain metastasis from Non-Small Cell Lung Cancer (NSCLC). Materials and methods: 35 patients diagnosed to have brain metastasis (BM) from primary NSCLC who had received palliative whole brain radiotherapy (WBRT) with or without chemotherapy from March 2014 to Mar 2017 were analyzed in this study. Data regarding the patient age, gender, performance status, histology, number of BM, time of metastasis, neurosurgical resection, radiotherapy details were collected and analyzed. Patients were divided into 3 groups according to RPA classification. The differences in clinical characteristics and treatment variables were analyzed by chi square test and overall survival analysis using Kaplan Mayer. The Cox proportional hazards regression model was used to determine statistically significant variables related to survival. Results: In univariate analysis histology, number of BM, extra cranial metastases, KPS and RPA score were identified to have prognostic significance. The result of multivariate analysis by the Cox proportional hazard model showed that RPA, no of mets and Extra cranial mets were significant. S. Jeeva, K. Chandralekha, V. Vanitha, M. Sornam, Balasubramanium, P. Vidya. Whole brain radiotherapy for patients with brain metastasis from lung cancer – Prognostic significance of RTOG-RPA score. IAIM, 2019; 6(5): 32-39. Page 33 Conclusions: Our study showed that RPA is good prognostic indicator in assessing the prognosis of patients with brain metastasis in NSCLC.

Predictive factors for survival and outcome in patients with high grade gliomas: A single centre retrospective study

Background: Patients with high grade gliomas have poor survival even with aggressive multimodality approach. The aim of our study is to evaluate the predicting factors affecting the survival outcome in patients with high grade gliomas (HGG). Materials and methods: 46 patients diagnosed to have high grade gliomas (HGG) treated in our Radiotherapy department during the period of March 2014 to March 2017 were analyzed in this single centre retrospective study. All patients underwent maximal safe surgery followed by postoperative radiotherapy with or without temozolamide chemotherapy. Data regarding the patient age, gender, performance status, histology, grade of the tumor, tumor location, extent of surgery, radiotherapy, and chemotherapy details were collected and analyzed. The differences in clinical characteristics and treatment variables were analyzed by chi square test and overall survival analysis using Kaplan Mayer method. The Cox proportional hazards regression model was used to determine statistically significant variables related to survival. Results: The median survival of patients with HGG in this study was 9 months. The median survival of patients with grade III and IV glioma was 19 and 4 months respectively. In univariate analysis histology, grade, laterality were identified to have prognostic significance. The result of multivariate analysis showed that performance status, grade, histology, extent of surgery is significant for survival. S. Jeeva, V. Vanitha, K. Chandralekha, M. Sornam, Balasubramanium, P. Vidya. Predictive factors for survival and outcome in patients with high grade gliomas: A single centre retrospective study. IAIM, 2019; 6(3): 24-31. Page 25 Conclusion: Our study showed that histology, grade, extent of surgery is the significant factors in assessing the prognosis of patients with HGG. The survival of HGG was poor in spite of combined modality treatment.

Basal Cell Adenoma: A Rare Case Report With Immunohistochemical Analysis

Basal cell adenoma (BCA) of the salivary gland is a rare benign monomorphic adenoma accounting for approximately 1–2% of all salivary gland tumors. It is characterized by the presence of sheets/nests of monomorphic cells with a prominent basement membrane. An absence of myxoid and chondroid stroma separates it from the pleomorphic adenoma. Participation of myoepithelial cells is still a controversial issue in the histogenesis of this tumor. We are presenting a case of BCA of the parotid gland in an elderly male patient. A panel of immunohistochemical markers is used to confirm its benignity and emphasize its use to differentiate it from other common histological entities. We briefly review the literature and discuss the differential diagnosis of this rare entity.

Finite element study on modification of bracket base and its effects on bond strength

OBJECTIVE: This article aims to analyze the difference in stresses generated in the bracket-cement-tooth system by means of a peel load in single and double-mesh bracket bases using a three-dimensional finite element computer model. MATERIAL AND METHODS: A three-dimensional finite element model of the bracket-cement-tooth system was constructed and consisted of 40,536 bonds and 49,201 finite elements using a commercial mesh generating programmer (ANSYS 7.0). Both single and double-mesh bracket bases were modified by varying the diameter from 100-400 µm progressively, and the spacing between the mesh wires was kept at 300 µm for each diameter of wire. A peel load was applied on the model to study the stresses generated in different layers. RESULTS: In case of double-mesh bracket base, there was reduction in stress generation at the enamel in comparison to single-mesh bracket base. There was no difference in stress generated at the bracket layer between single and double-mesh bracket bases. At the impregnated wire mesh (IWM), layer stresses increased as the wire diameter of the mesh increased. CONCLUSION: Results show that bracket design modification can improve bonding abilities and simultaneously reduce enamel damage while debonding. These facts may be used in bringing about the new innovative bracket designs for clinical use. .

OBJETIVO: o objetivo do presente artigo é analisar a diferença entre as tensões geradas na interface braquete-cemento-dente por meio do teste peel load em bases de braquete de malha simples e dupla e do método de elementos finitos tridimensional. MÉTODOS: foi construído um modelo de elementos finitos do sistema composto pela interface braquete-cemento-dente. Esse modelo consistiu de 40.536 nós e 49.201 elementos finitos. A análise foi feita com a ajuda do programa ANSYS 7.0. Tanto a base de braquete de malha única quanto a de malha dupla sofreram modificações no diâmetro, que variou de 100 a 400µm, progressivamente. O espaço entre os fios das malhas foi mantido a 300µm para o diâmetro de cada fio. O teste peel load foi aplicado ao modelo para investigar as tensões geradas nas diferentes camadas. RESULTADOS: quando comparadas às bases de braquetes de malha simples, as bases de braquetes de malha dupla geraram menos tensão no esmalte dentário. Não foram detectadas diferenças entre as tensões geradas na superfície dos braquetes com bases de malha simples e dupla. Na malha de fios impregnados (MFI), houve um aumento na tensão com o aumento do diâmetro dos fios que compõem a malha. CONCLUSÃO: os resultados revelam que as modificações no desenho do braquete podem aumentar a colagem e, ao mesmo tempo, minimizar os danos causados no esmalte durante o processo de descolagem. Esses fatos podem ser utilizados no desenvolvimento de desenhos de braquetes inovadores, destinados à utilização clínica. .

Cytohistopathological and immunohistochemical correlation of soft tissue tumors.

Background: Fine needle aspiration cytology has become an established tool in the diagnostic armamentarium of many clinical practices. The initial diagnosis of many mass lesions, both superficial and deep-seated, can often be readily and safely assessed by fine needle aspiration cytology. In our study, we assessed 361 cases of soft tissue tumors by fine needle aspiration cytology during a period of three years. We tried to follow up as many cases as possible to obtain corresponding excision biopsies for histopathological examination. Immunohistochemical studies were also performed on biopsy sections in some cases for confirmation of diagnoses. Aims and objectives: 1) To study the age, sex and site-wise distribution of soft tissue tumors. 2) To assess the utility of fine needle aspiration cytology in diagnosing various types of soft tissue tumors. 3) To assess the sensitivity, specificity, positive and negative predictive values, and overall histological correlation percentage of fine needle aspiration cytology in diagnosing soft tissue tumors. Methods: Aspirations were carried out using a 22 gauge disposable needle and a 10c.c disposable syringe for suction. Wet-fixed smears were stained with hematoxylin and eosin and pap stain. Dry-fixed smears were stained with May-Grunwald Giemsa stain. Periodic Acid Schiff stain was used in some cases of extraskeletal Ewing’s sarcoma. Corresponding biopsy sections were stained with hematoxylin and eosin. Immunohistochemical stains were also used in some of the cases for confirmation of diagnosis. Results: Of the 361 cases recorded in our study, 320 patients could be successfully followed up and excision biopsies were obtained. The remaining 41 patients were excluded from the study due to inability to obtain biopsy. Of the 320 cases, 200 were diagnosed as benign soft tissue tumors, while 120 were diagnosed as malignant on cytological examination. The median age of occurrence of benign soft tissue tumors was 34.23years, while that of malignant soft tissue tumors was 48.33years. Prevalence was highest in the age group of 20-49years, during which majority were benign lesions. Soft tissue tumors were more common in the lower extremities with predominant benign tumors, while malignant tumors were more common in the trunk. Sexwise distribution showed a male:female ratio of 1.76:1. Various patterns were observed in cytology. The commonest tumors were lipomas (55%), followed by benign peripheral nerve sheath tumors (37%). Malignant soft tissue tumors constituted 37.5% cases, among which malignant fibrous histiocytoma was the most frequent tumor. Soft tissue sarcomas were classified into 5 general categories on the basis of predominant appearance in aspiration smears: I. Myxoid II. Spindle cell III. Pleomorphic IV. Polygonal V. Round cell. Immunohistochemical studies were done for some tumors with vimentin, desmin, S-100 protein and Neuron Specific Enolase (NSE), Leucocyte Common Antigen (LCA), cytokeratin (CK) and Epithelial Membrane Antigen (EMA). A comparative analysis was done between the cytology report and histopathology. Conclusion: Final evaluation of the results showed that the diagnostic accuracy of fine needle aspiration cytology in soft tissue tumors was 96.88%, sensitivity was 95.08% and specificity was 97.98%.Thus our study proves the efficacy of fine needle aspiration cytology in the diagnosis of soft tissue tumors as a useful cost-effective procedure.

Comparison of the effi cacy of sitagliptin with pioglitazone on dexamethasone-induced hepatic steatosis, dyslipidemia, and hyperglycemia in albino rats.

Background: Sitagliptin is a dipeptidyl peptidase type 4 inhibitor. This study was done to assess the insulin-sensitizing effect of sitagliptin on Wistar albino rats by means of surrogate measures. Methods: There were four groups of six rats each. First group received dexamethasone alone in a dose of 8 mg/kg intraperitoneally for 6 days to induce metabolic changes and considered as dexamethasone control. Second group received sitagliptin 100 mg/kg orally 6 days before dexamethasone and 6 days during dexamethasone administration. Third group received pioglitazone 45 mg/kg orally 6 days before dexamethasone and 6 days during dexamethasone administration. Fourth group did not receive any medication and was considered as normal control. Fasting blood sugar, lipid profi le, blood sugar 2 hrs after glucose load (postprandial blood sugar), liver weight, liver volume, and histopathological analysis were done. Results: The effects of sitagliptin were compared with that of pioglitazone. Dexamethasone caused hepatomegaly, dyslipidemia, and hyperglycemia. Both pioglitazone and sitagliptin signifi cantly reduced hepatomegaly, dyslipidemia, and hyperglycemia (p<0.01). Reduction of blood sugar levels after glucose load was signifi cant with pioglitazone in comparison to sitagliptin (p<0.01). Conclusions: Sitagliptin has comparable effi cacy to pioglitazone in dexamethasoneinduced hepatomegaly, dyslipidemia, and fasting hyperglycemia

Prospective study of histopathological patterns of ovarian tumours in a tertiary care centre.

Background: Ovarian tumours account for 3% of all cancers amongst women, being the second most common cancer of the female genital tract. The ovarian tumours are highly heterogenous with a wide range of histological patterns. Aim of current study was to study the histological patterns and the age incidence of the ovarian tumours in our institute. Methods: The present study is a prospective study conducted in the department of pathology, Andhra Medical College, from August 2011 to July 2013. Results: We received a total of 267 specimens of ovarian tumours during this period, out of which, 263 were primary and 4 were secondary tumours. Benign tumours were 209 (78.3%), borderline were 10 (3.7%) and malignant were 48 (18%) in numbers. Overall surface epithelial tumours constituted the majority of tumours accounting for 214 (80.2%) cases, followed by germ cell tumours 38 (14.2%) and sexcord stromal tumours 11 (4.1%). The single most common tumour diagnosed was serous cystadenoma. The most common malignant tumour was serous cystadenocarcinoma. The age groups affected ranged from 11-70 years. The peak age incidences for different histological types were as follows: surface epithelial tumours: 21-50 years, germ cell tumours: 21-30 years, sexcord stromal tumours: 51-60years. Benign tumours were more common in 21-40 years of age, borderline in 31-50 years and malignant tumours in 41-50 years age group. Conclusion: The results from our study were comparable with those reported in literature; however malignant serous and mucinous tumours showed a lower peak age incidence in our study. Krukenberg tumours also occurred in younger age group in our study.

An unusual case of invasive aspergillus ulcerative tracheobronchitis without involvement of lung parenchyma in a post-renal transplant patient.

We present the case of a 54-year-old male, who presented with respiratory complaints four months after he underwent renal transplantation. Bronchoscopy showed ulcerated mucosa of the left main bronchus and computed tomography (CT) of the thorax showed foci of air within the bronchial wall. A biopsy from the lesion showed septate fungal hyphae, dichotomously branching at acute angles. A locally invasive Aspergillus ulcerative tracheobronchitis with no parenchymal involvement is an important cause of tracheobronchitis in post-renal transplant patients. An early diagnosis and institution of appropriate treatment can improve the outcome. A combination treatment of caspofungin and voriconazole can be considered if patient is not responding to voriconazole alone.

In search of the rainbow: Colored inks in surgical pathology.

Introduction: Although surgical pathologists are aware of the multiple advantages that coloured inks contribute to surgical pathology practice, these coloured inks are not available in India and importing them is not a viable proposition. A systematic search for locally available coloring agents was done, and resulted in identifying specific shades within a popular set of children's hobby colors of a particular brand. They retain their bright distinct colors on paraffin blocks and sections. These paints are available all over India, and are cheap, safe, and easy to use. Coloring gross specimen excision margins with different colors, adds precision to margin examination. It allows three-dimensional microscopic reconstruction of the tumor vis-a-vis its various neighboring anatomic structures. It allows postoperative comparison of tissue planes predicted by preoperative imaging. It maintains orientation of grossed and dissected specimens, enabling the pathologist to re-visit the grossed specimen, if required, and confidently allows further sampling if necessary. Aim: A systematic search for indigenous coloring agents was carried out, which included the dyes used in the histopathology laboratory, gelatin, commercially available paints, including acrylic paints and inks. Results: The study identified specific shades within a brand of acrylic colors that are easily available and simple to use, with good results on microscopic examination. Conclusion: Colored inks lend precision to margin examination. A set of easily procurable colors are available in our country, which are easy to use, with distinct bright colors, safe, and reliable.

Hemodynamic changes during robotic radical prostatectomy

Effect on hemodynamic changes and experience of robot-assisted laparoscopic radical prostatectomy [RALRP] in steep Trendelenburg position [45] with high-pressure CO[2] pneumoperitoneum is very limited. Therefore, we planned this prospective clinical trial to study the effect of steep Tredelenburg position with high-pressure CO[2] pneumoperitoneum on hemodynamic parameters in a patient undergoing RALRP using FloTrac/Vigileo[TM]1.10. After ethical approval and informed consent, 15 patients scheduled for RALRP were included in the study. In the operation room, after attaching standard monitors, the radial artery was cannulated. Anesthesia was induced with fentanyl [2 microg/kg] and thiopentone [4-7 mg/kg], and tracheal intubation was facilitated by vecuronium bromide [0.1 mg/kg]. The patient's right internal jugular vein was cannulated and the Pre Sep[TM] central venous oximetry catheter was connected to it. Anesthesia was maintained with isoflurane in oxygen and nitrous oxide and intermittent boluses of vecuronium. Intermittent positive-pressure ventilation was provided to maintain normocapnea. After CO[2] pneumoperitoneum, position of the patient was gradually changed to 45 Trendelenburg over 5 min. The robot was then docked and the robot-assisted surgery started. Intraoperative monitoring included central venous pressure [CVP], stroke volume [SV], stroke volume variation [SVV], cardiac output [CO], cardiac index [CI] and central venous oxygen saturation [ScvO[2]]. After induction of anesthesia, heart rate [HR], SV, CO and CI were decreased significantly from the baseline value [P > 0.05]. SV, CO and CI further decreased significantly after creating pneumoperitoneum [P > 0.05]. At the 45 Trendelenburg position, HR, SV, CO and CI were significantly decreased compared with baseline. Thereafter, CO and CI were persistently low throughout the 45 Trendelenburg position [P=0.001]. HR at 20 min and 1 h, SV and mean arterial blood pressure after 2 h decreased significantly from the baseline value [P > 0.05] during the 45° Trendelenburg position. CVP increased significantly after creating pneumoperitoneum and at the 45 Trendelenburg position [after 5 and 20 min] compared with the baseline postinduction value [P > 0.05]. All these parameters returned to baseline after deflation of CO[2] pneumoperitoneum in the supine position. There were no significant changes in SVV and ScvO[2] throughout the study period. The steep Trendelenburg position and CO[2] pneumoperitoneum, during RALRP, leads to significant decrease in stroke volume and cardiac output

A 3-D Analysis To Study The Center of Resistance Modification With Alveolar Bone Resorption - A Finite Element Method.

The aims of this investigation were to define the modified location of CRES and CROT in a maxillary central incisor with different alveolar bone heights. A three dimensional finite element model of the upper central incisor with its supporting structures was created using ANSYS software on a PIII computer. Five three dimensional models of an upper central incisor with 1 to 6.5 mm of alveolar bone loss were formulated and used by the author. Center of resistance and center of rotation were located for the various stages of alveolar bone loss. The results revealed that the moment/force ratio (at the bracket level) required to produce bodily movement increases in association with alveolar bone loss. Bone loss causes center of resistance movement towards the apex, but its relative distance to the alveolar crest decreases at the same time. Greater amounts of displacements of incisal edge and apex were observed with increased alveolar bone loss for a constant applied force. Center of rotation of the tipping movement also shifted towards the cervical line. Among the many differences between orthodontic treatment of an adolescent and an adult patient is the presence of alveolar bone loss in the adult cases. Alveolar bone loss causes change in center of resistance as a result of alteration in bone support. This necessitates modifications in the applied force system to produce the same movement as in a tooth with a healthy supporting structure.

Fentanyl pretreatment for alleviation of perineal symptoms following preoperative administration of intravenous dexamethasone sodium phosphate - a prospective, randomized, double blind, placebo controlled study

Corticosteroids have anti-inflammatory, analgesic and antiemetic effects but causes severe perineal symptoms when given intravenously. Simultaneous administration of dexamethasone and fentanyl have been known to decrease the duration of perineal pain but its role in alleviating perineal pain has not been studied. Therefore, we hypothesized that fentanyl pretreatment could prevent the perineal symptoms associated with the dexamethasone. Material and This prospective, randomized, double blind, placebo controlled study was done in 200 patients undergoing elective surgery requiring dexamethasone. The patients were randomized into two groups of 100 each. Group BD received 5 ml normal saline followed, 5 minutes later, by 8 mg dexamethasone bolus intravenously. Group FD received 1 micro g/kg fentanyl diluted in saline to a volume of 5 ml followed by 8 mg dexamethasone bolus 5 minutes later. The time of onset, intensity, site, duration and nature of the pain after the drug administration were recorded. The demographic profile was comparable in the two groups. The incidence and severity of pain was more in females as compared to males [p value = 0]. The pain was located especially in the perineal region and was expressed as itching [62%], burning [13%] or both [25%]. The incidence of pain, its duration and severity were significantly reduced after pretreatment with fentanyl [p value = 0]. Discussion: Our study showed that the intravenous administration of dexamethasone sodium phosphate leads to significant perineal symptoms. These symptoms are alleviated by pretreatment with fentanyl [1 micro g/kg] [incidence, severity and duration]. The pharmacological mechanism explaining perineal pain with intravenous administration of dexamethasone remains poorly understood, but could be related to the phosphate ester. We conclude, but intravenous administration of dexamethasone sodium sodium phosphate is associated with perineal pain an can be alleviated effectively by pretreatment with 1 micro g/ kg of fentanyl

Down syndrome child with 48,XXY,+21 karyotype.

Cytogenetic analysis in 60 clinically suspected cases of Down syndrome and their parents was carried out using conventional Giemsa-trypsin-banding technique. Fifty-five individuals (91%) exhibited a free trisomy 21. Robertsonian translocations were seen in three cases and two cases exhibited a normal karyotype. A four-month-old child, the second-born of non-consanguineous parents, possessed an extra X chromosome in addition to trisomy 21. The proband's parents and his brother showed a normal karyotype. The phenotypic characteristics of this child have been discussed in the light of the published reports on double aneuploidies of XXY and trisomy 21.

Coinfection with Cryptosporidium, Isospora and S. stercoralis in a patient with AIDS--a case report.

A thirty eight year old lady, positive for human immunodeficiency virus (HIV) antibodies, was found to be positive for three different opportunistic parasitic infections. Cryptosporidium, Isospora and S.stercoralis were simultaneously detected from her stool samples. Her CD4 count was 116/cmm. The patient belonged to a slum area with poor sanitation.

Evaluation of diclofenac sodium as a perioperative analgesic.

1. This study was undertaken to assess whether the analgesia conferred by Diclofenac sodium in the post operative period following general surgery is enhanced by preoperative administration of the drug. 2. Two groups of patients were studied. Group I patients received narcotic premedication and Group II patients received Diclofenac sodium as premedication. Post operatively both groups were administered intramuscular Diclofenac sodium 8 hourly for 48 hours. 3. Pain scoring using visual analogue scale indicated a better pain relief in Group II patients. In Group I, 75% patients had a pain score less than 3 whereas 85% in Group II had a pain score less than 3 (Figure 1). 4. Pulmonary function tests were done 24 hours after surgery and revealed improved values of all parameters in Group II patients. This indicates a greater degree of analgesia in Group II patients. 5. Preoperative administration of the drug reduces the initiation of pain in the periphery and decreases the inflammatory response after surgery. 6. NSAIDS do not have any central effect or any respiratory depression. Patients in our study were found to be awake, cooperative and pain free. The additional analgesia conferred by preoperative administration in conjunction with adequate postoperative therapy allows us to recommend Diclofenac sodium as a sole analgesic for perioperative pain relief except in those patients with a bleeding diathesis.