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Background@#Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management. @*Methods@#An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis.The primary outcome measure was the proportion of patients with significant painrelief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months). @*Results@#This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence. @*Conclusions@#Based on the present systematic review, with one RCT and 5 nonrandomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.
ABSTRACT
Background@#Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management. @*Methods@#An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis.The primary outcome measure was the proportion of patients with significant painrelief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months). @*Results@#This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence. @*Conclusions@#Based on the present systematic review, with one RCT and 5 nonrandomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.
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Background: Endotracheal intubation is of paramount importance in general anaesthesia requires relaxation of laryngeal musculature leading to total inactivity of vocal cords. Suxamethonium chloride, a depolarizing muscle relaxant due to its quick onset of action and excellent intubating conditions has remained a muscle relaxant of choice. Rocuronium was proved to be safe alternative to suxamethonium for endotracheal intubation. Aims & Objective: To find out the utility of Inj. Rocuronium Bromide a non-depolarizing muscle relaxant (NDMR) as an alternative to Suxamethonium chloride, a depolarizing muscle relaxant (DMR) for the purpose of intubation of trachea with emphasis on onset of time for muscle relaxation, duration of action, hemodynamic changes and complications if any. Materials and Methods: This is a randomized clinical study carried out at tertiary care center. 90 patients were randomly divided into three groups. Group S60 (n=30) - Inj. Suxamethonium 1.5 mg/kg IV given I.V, Group R60 (n=30) - Inj. Rocuronium 0.6 mg/kg IV given I.V and Group R90 (n=30) - Inj. Rocuronium 0.6 mg/kg IV given I.V. The intubating conditions were judged clinically at fixed time interval i.e. either at 60 seconds or 90 seconds as per the group of patient, after the injection of study drug with the help of four point scale. The observed results were compiled and analyzed statistically by using chi-square test for qualitative data and students “t” test for quantitative data, the analysing system being that of EPI INFO. Results: The mean age was 29.2 ± 12.60, 28.83 ± 8.50 & 30.1 ± 10.47 years, respectively in S60, R60 and R90 group. Intubating conditions were excellent (score 8-9) in all the 30 patients (100%) in Group S60, in 23 patients (76.66%) of Group R60 and in 28 patients (93.33%) of Group R90. The mean onset time in our study were 46.66±5.46 seconds in Group S60, 76.33 ± 10.33 seconds in Group R60 and 78.33 ± 9.4 in R90. The duration of action in our study was 5.93 ± 1.25 minutes in Group S60 compared to 29.83±5.49minutes in Group R60 and 27.83 ± 3.13 minutes in R90. Conclusion: Rocuronium can serve as a good alternative to Suxamethonium for tracheal intubation in conditions where Suxamethonium is contraindicated or where its use is hazardous.
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Introduction: It has been always an area of diffuse clarity when you study malignancy and its pathogenesis. Recently, it has invited lot of interest among the researchers about the possibility of role of viruses in the initiation of carcinogenesis. Recent advances in the field of molecular biology and biotechnology have solved some problems with regard to pathogenesis. Human papilloma virus (HPV) and its role in the initiation of malignancy in the cervix is proven almost beyond doubt. Objectives: The present study is aimed at the role of two types of HPV 16 and 18 in the initiation of oral premalignant and squamous cell carcinoma. The study also aims at using polymerase chain reaction (PCR) in finding out the prevalence of these types diagnosed histologically as oral leukoplakia and oral squamous cell carcinoma and prevalence of its association with the habit of tobacco use. Materials and Methods:In the present study, 45 patients having histopathologically confirmed oral squamous cell carcinoma in the age range of 32-85 years were selected along with 20 histopathologically confirmed oral leukoplakia in the age range 22-66 years. All the samples were subjected to polymerase chain reaction. The PCR reaction was carried out in PTC 200 thermo-cycler [MJ Research Inc, Watertown, MA, USA]. Results: The site prevalence and co-infection rate of these two types of viruses are being analyzed using very simple non-invasive scrapings obtained from fresh scrapings and found to be really high. It was also observed that 73.3% (33/45) of the oral squamous cell carcinoma patients were positive for oral HPV type 16 while 71.1% (32/45) were positive for HPV type 18 infection and 57.7% (26/45) were found to have both HPV type 16 and HPV type 18 infections. Conclusions:HPV type 16, 18, and co-infection of both types showed high prevalence in oral squamous cell carcinoma.The prevalence of HPV type 18 was found to be higher than HPV type 16 and co-infection in oral leukoplakia. It was observed that the tongue and palate lesions in the oral squamous cell carcinoma patients showed high prevalence of HPV type 16, type 18, and co-infection compared with other sites.
Subject(s)
Adult , Aged , Carcinoma, Squamous Cell/analysis , Humans , Human papillomavirus 16/isolation & purification , Human papillomavirus 18/isolation & purification , Middle Aged , Mouth Neoplasms/analysis , Polymerase Chain Reaction/methods , PrevalenceABSTRACT
Primary ectopic meningiomas are rare. A case of a 16-year-old male who presented with a large mass in temporofrontal region is reported. X-ray skull showed soft tissue shadow with hyperostosis of frontal and temporal bone. CT scan of brain demonstrated a markedly enhancing lesion and bony hyperostosis with no intracranial component. Total excision of tumour with hyperostotic bone was done. Patient is well without any evidence of recurrence two years after surgery. Relevant literature is reviewed.