Effect of Adding Physiotherapy Program to the Conservative Medical Therapy on Quality of Life and Pain in Chronic Rhinosinusitis Patients

Objective@#To assess the effectiveness of combining physiotherapy techniques with conservative medical treatment in chronic rhinosinusitis (CRS) patients. @*Methods@#Sixty-eight volunteers with CRS were randomly assigned. Group A received only traditional medical treatment, whereas group B received a physiotherapy program that included pulsed ultrasound therapy, sinus manual drainage techniques, and self-sinus massage technique in addition to traditional medical treatment. Interventions were applied 3 sessions a week for 4 weeks. The rhinosinusitis disability index (RSDI) served as the main outcome indicator for assessing the quality of life, and the secondary outcome measure was the pressure pain threshold (PPT) using a pressure algometer. @*Results@#Wilcoxon signed rank test revealed a significant reduction (p<0.001) in total RSDI values from 71.08±1.13 pretest to 47.14±1.15 posttest for group A, while it decreased from 70.64±1.20 pretreatment to 31.76±1.04 posttreatment for group B; furthermore, Mann–Whitney U-test revealed a significant difference (p<0.001) in total RSDI values between both groups when comparing the change of the pre-post data values, it was 23.94±0.95 for group A and 38.88±0.67 for group B. The independent t-test revealed a highly statistically significant increase (p<0.001) in the PPT values in the experimental group compared to the control group. @*Conclusion@#The physiotherapy program which included pulsed ultrasound therapy, sinus manual drainage technique, and self-sinus massage technique in conjunction with conventional medical treatment was more beneficial for enhancing the quality of life and PPT than traditional medical treatment alone in CRS patients.

Embryotoxicity following repetitive maternal exposure to scorpion venom

Although it is a frequent accident in a few countries, scorpion envenomation during pregnancy remains scarcely studied. In the present study, the effects of repetitive maternal exposure to Buthus occitanus tunetanus venom are investigated and its possible embryotoxic consequences on rats. Primigravid rats received a daily intraperitoneal dose of 1 mL/kg of saline solution or 300 µg/kg of crude scorpion venom, from the 7th to the 13th day of gestation. On the 21st day, the animals were deeply anesthetized using diethyl-ether. Then, blood was collected for chemical parameter analysis. Following euthanasia, morphometric measurements were carried out. The results showed a significant increase in maternal heart and lung absolute weights following venom treatment. However, the mean placental weight per rat was significantly diminished. Furthermore, blood urea concentration was higher in exposed rats (6.97 ± 0.62 mmol/L) than in those receiving saline solution (4.94 ± 0.90 mmol/L). Many organs of venom-treated rat fetuses (brain, liver, kidney and spleen) were smaller than those of controls. On the contrary, fetal lungs were significantly heavier in fetuses exposed to venom (3.2 ± 0.4 g) than in the others (3.0 ± 0.2 g). Subcutaneous blood clots, microphthalmia and total body and tail shortening were also observed in venom-treated fetuses. It is concluded that scorpion envenomation during pregnancy potentially causes intrauterine fetal alterations and growth impairment.(AU)

Role of cetuximab and sorafenib in treatment of metastatic colorectal cancer.

Background: The relationship of epidermal growth factor receptors (EGFR) pathway, such as PI3K, K-ras, and B-raf, with response to EGFR-targeted antibodies is less well studied. Aim: To assess sorafenib with cetuximab in treating metastatic colorectal cancer. Settings and Design: Thirty-five patients with metastatic colorectal cancer were randomized to receive cetuximab with or without oral sorafenib. Patients and Methods: Patients received cetuximab IV weekly for four weeks and oral sorafenib twice daily on days 1 - 28, with recycling every four weeks. The primary end point was the response rate (partial and complete), while the secondary end points were the adverse effects, time to progression and overall survival. Statistical Analysis was made using the Statistical Product and Service Solutions, using SPSS 10.0, with estimation of both time to progression and overall survival time by the Kaplan-Meier method and comparing the two groups with the use of a log-rank test. Results: Partial response was higher in cetuximab-sorafenib (EN), which constituted 33.3% compared to 17.6% in the cetuximab group (P = 0.44). Progression-free survival had a statistically higher significant difference in wild K-ras compared to mutant K-ras cases (P = .0001). Median overall survival was seven and five months in the (EN) and (E) groups respectively (P = 0.49). Conclusion: K-ras and B-raf was a predictor of response, so genotyping of tumors was needed for defining the patient population that was likely to benefit from the targeted therapy. A combination of therapy that simultaneously targets K-ras and B-raf could be a useful approach to increase the number of patients who may benefit from anti-EGFR therapy.

Propacetamol vs meperidine for analgesia during extracorporeal shock wave lithotripsy: a randomized double-blind study

As extracorporeal shock wave lithotripsy [ESWL] is carried out on an outpatient basis, it is crucial to choose an adequate analgesic with less adverse effects aiming to rapid post-ESWL discharge of patients. Propacetamol is a non opioid analgesic that seems to be suited to these goals because of its pharmacokinetics and pharmaco-dynamic characteristics. The safety and effectiveness of propacetamol use during ESWL in comparison to meperidine were evaluated in this study. Eighty patients with renal stones scheduled for ESWL procedure were randomly assigned to receive i.v. injection of either 2 gm propacetamol or 100 mg meperidine during ESWL without preoperative medications, according to a double-blinded protocol. Cardiorespiratory variables [respiratory rate, heart rate, mean arterial BP, peripheral O[2] saturation] were recorded before and every 5 min during ESWL and 15 min after the end of ESWL. During and after ESWL, patient arousal was assessed and nausea or vomiting were recorded. During ESWL an evaluation of effectiveness of pain management was done using 4 points scale: [0] No pain, [1] mild pain, [2] moderate pain, [3] severe pain. After ESWL the effectiveness of pain management was evaluated using 10-points visual analogue pain scale [VAS]. Gradual reduction of the mean blood pressure [MBP] was observed with meperidine use which became significant at 25 and 30 min after start of ESWL [p=0.003], while with propacetamol MBP was more stable. Also significant reduction of SpO[2] was observed with meperidine 10 min after the start of ESWL and even 15 min after the end of ESWL [p < 0.05], while it was insignificant with propacetamol. Respiratory upsets [short period of apnea with SpO[2] less than 90%], drowsiness, nausea and vomiting were observed with meperidine but not with propacetamol. Pain control during ESWL was not significantly different in both groups. The median value of pain scale was 0 [range 0 to 3] for group M and I [range 0 to 3] for group P [p = 0.25]. The mean value of VAS was [2.3 +/- 3.5] [range 0 to 10] for group M and [3.6 +/- 3.1] [range 0 to 8] for group P [p = 0.23]. Propacetamol is as effective as opioid-based analgesics yet it is safer and resulted in rapid discharge of patients following ESWL

One stage resection of acute sigmoid volvulus

In a descriptive prospective study, 20 patients with sigmoid volvulus and two with ileosigmoid knotting had primary resection of the redundant sigmoid colon with an immediate anastomosis after intraoperative antegrade colonic irrigation. Tube caecostomy was established in the two patients who required resection of both small bowel and sigmoid colon and in a further five patients in whom the integrity of the colorectal anastomosis was suspected. There was no clinical anastomosis leak and no mortality in any of the patients. Superficial wound infection occurred in three patients. The duration of hospital stay ranged from 10 to 14 days. The result showed that the procedure was associated with an acceptable morbidity and a short hospital stay. Also, it suggested that the resection of acute sigmoid volvulus and primary anastomosis after antegrade intraoperative colonic lavage safely provided that the patient is reasonably fit

Role of laparoscopy in the evaluation of abdominal stab wounds

Laparoscopy was performed on 30 patients with stab wounds to the abdomen to identify those with peritoneal penetration. Diagnostic or therapeutic manoeuvres were not attempted, evidence of peritoneal penetration mandated exploratory laparotomy. All patients were haemodynamically stable, with no evidence of intraperitoneal injury by clinical assessment. Eighteen patients [60%] underwent negative laparoscopy and no intraperitoneal injury was subsequently detected. Most of the patients [89%] with negative laparoscopy had anterior stab wounds to the abdomen. Laparoscopy demonstrated peritoneal penetration in twelve patients [40%] and subsequent laparotomy detected intraperitoneal injuries in ten patients [83%]. A nontherapeutic laparotomy rate of 8% was recorded. A complication rate of 6% due to laparoscopy was detected, all cases were managed conservatively with no deaths. In haemodynamically stable patients with anterior stab wounds to the abdomen and no clinical evidence of intraperitoneal injury, laparoscopy effectively and safely detects those with peritoneal penetration

Evaluation of incidental laparoscopic appendectomy for acute right lower quadrant abdominal pain

The procedure of incidental laparoscopic appendectomy during diagnostic laparoscopy for acute right lower quadrant abdominal pain was evaluated in fifty patients over a three-year period. Twenty-five patients underwent diagnostic laparoscopy alone [group I], while the other twenty-five patients underwent diagnostic laparoscopy with incidental laparoscopic appendectomy [group II]. There was no difference in length of hospitalization or morbidity between the two groups. No mortality or intraoperative sepsis were recorded. Two patients required appendectomy eleven days and twenty days, respectively, after diagnostic laparoscopy for recurrent acute right lower quadrant abdominal pain. 8% of the resected appendices demonstrated acute inflammation upon pathologic review