Hidrodisección guiada por ultrasonido para el tratamiento de pacientes con sindrome del tunel carpiano / Ultrasound-Guided hydrodissection for treatment of Patients with Carpal Tunnel Syndrome

El estudio tuvo como objetivo comparar el grupo de hidrodisección de solución salina normal guiada por ultrasonido más esteroides y el grupo de hidrodisección de solución salina normal guiada por ultrasonido sola en pacientes con síndrome del túnel carpiano (STC), y determinar su relevancia clínica en relación con los resultados del tratamiento. Realizamos 60 hidrodisecciones guiadas por ecografía con solución salina normal con y sin inyecciones de corticosteroides en 51 pacientes con STC y evaluamos los resultados de la ecografía antes y después 21. Evers S, Thoreson AR, Smith J, Zhao C, Geske JR, Amadio PC. Ultrasound-guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel. Muscle Nerve 2017 June 16. doi: 10.1002/mus.25723. 22. Smith J, Wisniewski S, J, Finnoff JT, Payne JM. Sonographically Guided Carpal Tunnel Injections. J Ultrasound Med 2008;27:1485-1490. 23. Trescott AME. Peripheral Nerve Entrapments: Clinical Diagnosis and Management. Switzerland: Springer International Publishing; 2016 24. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2002(4). 25. Atroshi I, Flondell M, Hofer M, Ranstam J. Methyprednisolone Injections for the Carpal Tunnel Syndrome: A randomized Placebo-Controlled Trial. Ann Int Med 2013;159:309-317. 26. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-de Jong B. Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice. BMC family practice 2010;11:54. 27. Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Tsai CK, et al. Six-month efficacy of perineural dextrose for carpal tunnel syndrome: A prospective, randomized, double-blind, controlledtrial. Mayo Clinic proceedings 2017;92:1179-1189. 28. Kirwan J. Is there a place for intra-articular hyaluronate in osteoarthritis of the knee? The Knee 2001;8:93-101. 29. Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR, Jr., et al. The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: Ameta-analysis of evidence level 1 studies. The American journal of sports medicine 2017;45:2647-2653. 30. Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P. Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology. 2001;56(11):1459­ 66 31. Ortiz-Corredor F, Enriquez F, Diaz-Ruiz J, Calambas N. Natural evolution of carpal tunnel syndrome in untreated patients. Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 2008;119:1373-1378 32. Gordon T, Brushart TM, Chan KM. Augmenting nerve regeneration with electrical stimulation. Neurol Res 2008; 30:1012- 1022. 33. Aulisa L, Tamburrelli F, Padua R, Romanini E, Lo Monaco M, Padua L. Carpal tunnel syndrome: Indication for surgical treatment based on electrophysiologic study. J Hand Surg Am 1998; 23:687-691. 34. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom- de Jong B. Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice. BMC Fam Pract. 2010;11:54. 35. Girlanda P, Dattola R, Venuto C, Mangiapane R, Nicolosi C, Messina C. Local steroid treatment in idiopathic carpal tunnel syndrome: short- and longterm efficacy. J Neurol. 1993; 240(3):187- 190. 36. Karadas¸ Ö, Tok F, Ulas¸ UH, Odabas¸i Z. The effectiveness of triamcinolone acetonide vs. procaine hydrochloride injection in the management of carpal tunnel syndrome: a double blind randomized clinical trial. Am J Phys Med Rehabil. 2011; 90(4):287-292. 128 LA PRENSA MÉDICA ARGENTINA Ultrasound-Guided hydrodissection for treatment of Patients with Carpal Tunnel Syndrome V.107/Nº 2 de la inyección. Clasificamos estas inyecciones en dos grupos según la solución salina normal más corticosteroide (grupo de esteroides). solución salina normal (grupo de control) y también registramos datos clínicos que incluyen el sexo, la edad, el lado de la inyección, el peso corporal y la duración de las molestias relacionadas con el STC antes de la inyección. Los resultados se midieron mediante la escala analógica visual que se asignó para evaluar el resultado primario. Los resultados secundarios se evaluaron mediante el cuestionario del síndrome del túnel carpiano de Boston, el área transversal del nervio mediano y estudios electrofisiológicos. La evaluación se realizó antes de la inyección y 1, 3 y 6 meses después de la inyección, y se comparó el alivio de los síntomas de los pacientes que recibieron la inyección de solución salina normal y de esteroides. Comparamos las hidrodisecciones con la solución salina normal y las inyecciones de corticosteroides; los datos clínicos, la preinyección de CSA-MN en la entrada del túnel carpiano y las puntuaciones de BCTQ antes de la inyección no mostraron diferencias significativas entre los grupos (p> 0,05). Todos los pacientes (datos de 30 muñecas en cada grupo) completaron el estudio. En comparación con el grupo de control, en todos los momentos posteriores a la inyección, ambos grupos tuvieron una reducción significativa del dolor y la discapacidad, una mejoría en las medidas de respuesta electrofisiológica y una disminución del área transversal del nervio mediano. Nuestro estudio revela que la solución salina normal guiada por ecografía con y sin hidrodisección de corticosteroides tiene un efecto terapéutico en los pacientes con STC. Se demostró que la hidrodisección nerviosa es potencialmente beneficiosa para los pacientes con STC antes de la cirugía. La hidrodisección es un procedimiento simple y mínimamente invasivo que se puede realizar utilizando únicamente NS. Además, en comparación con la inyección a ciegas, la hidrodisección bajo guía ecográfica puede reducir las posibilidades de lesión nerviosa.

The study aimed to compare Ultrasound-Guided Normal saline plus steroid hydrodissection group and Ultrasound-Guided normal saline alone hydrodissection group in patients with carpal tunnel syndrome (CTS), and to determine their clinical relevance in relation to treatment outcomes. We performed 60 US-guided hydrodissections Normal saline with and without corticosteroid injections in 51 patients with CTS and evaluated their pre- and post-injection US findings. We categorized these injections into two groups based on the normal saline plus corticosteroid (steroid group). normal saline (control group) and we also recorded clinical data including gender, age, side of injection, BW, and the duration of pre-injection CTS related discomfort. The outcomes were measured using the visual analog scale was assigned to assess the primary outcome. The secondary outcomes were assessed using the Boston Carpal Tunnel Syndrome Questionnaire, cross-sectional area of the median nerve, and electrophysiological studies. The assessment was performed prior to injection, and 1, 3, and 6 months' post-injection, and the symptom relief for the patients receiving normal saline and steroid injection were compared. We compared hydrodissections with normal saline and corticosteroid injections the clinical data, pre injection CSA-MN at the inlet of the carpal tunnel, and pre-injection BCTQ scores showed no significant intergroup differences (p > 0.05). All patients (data from 30 wrists in each group) completed the study. Compared both the control group, at all post-injection time points, both groups had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve. Our study reveals that ultrasound-guided Normal saline with and without corticosteroid hydrodissection has therapeutic effect in patients CTS. Nerve hydrodissection was shown to be potentially beneficial for CTS patients' pre-surgery. Hydrodissection is a simple, minimally invasive procedure that can be performed using only NS. In addition, compared to blind injection, hydrodissection under ultrasound guidance can lower the chances of nerve injury.

Plano de análise estatística para o estudo Balanced Solution versus Saline in Intensive Care Study (BaSICS) / Statistical analysis plan for the Balanced Solution versus Saline in Intensive Care Study (BaSICS)

RESUMO Objetivo: Relatar o plano de análise estatística (primeira versão) para o estudo Balanced Solutions versus Saline in Intensive Care Study (BaSICS). Métodos: O estudo BaSICS é um ensaio multicêntrico fatorial e randomizado que avaliará os efeitos da administração dos fluidos Plasma-Lyte 148 em comparação com solução salina 0,9% como fluido de escolha em pacientes críticos, assim como os efeitos de uma velocidade de infusão lenta (333mL/hora) em comparação com uma velocidade de infusão rápida (999mL/hora) durante desafios com volume, em importantes desfechos do paciente. O tipo de fluido será mantido cego para os investigadores, pacientes e nas análises. Não será possível, entretanto, ocultar dos investigadores a velocidade de infusão, mas os procedimentos de análise serão mantidos cegos quanto a esse aspecto. Resultados: O estudo BaSICS terá como parâmetro primário a mortalidade em 90 dias, que será testada com utilização de modelos de risco proporcional de Cox de efeitos mistos, considerando os centros de estudo como variável randômica (modelos de fragilidade) ajustada por idade, disfunção de órgãos e tipo de admissão. Os parâmetros secundários importantes incluem terapia de substituição renal até 90 dias, insuficiência renal aguda, disfunção de órgãos nos dias 3 e 7 e dias sem ventilação mecânica em 28 dias. Conclusão: Este artigo fornece detalhes referentes à primeira versão do plano de análise estatística para o estudo BaSICS e orientará a análise do estudo após a conclusão do seguimento.

Abstract Objective: To report the statistical analysis plan (first version) for the Balanced Solutions versus Saline in Intensive Care Study (BaSICS). Methods: BaSICS is a multicenter factorial randomized controlled trial that will assess the effects of Plasma-Lyte 148 versus 0.9% saline as the fluid of choice in critically ill patients, as well as the effects of a slow (333mL/h) versus rapid (999mL/h) infusion speed during fluid challenges, on important patient outcomes. The fluid type will be blinded for investigators, patients and the analyses. No blinding will be possible for the infusion speed for the investigators, but all analyses will be kept blinded during the analysis procedure. Results: BaSICS will have 90-day mortality as its primary endpoint, which will be tested using mixed-effects Cox proportional hazard models, considering sites as a random variable (frailty models) adjusted for age, organ dysfunction and admission type. Important secondary endpoints include renal replacement therapy up to 90 days, acute renal failure, organ dysfunction at days 3 and 7, and mechanical ventilation-free days within 28 days. Conclusion: This manuscript provides details on the first version of the statistical analysis plan for the BaSICS trial and will guide the study's analysis when follow-up is finished.

Role of intraperitoneal instillation of bupivacaine after laparoscopic cholecystectomy for post-operative pain management: a randomized controlled trial

Background: Intra peritoneal (IP) local anaesthesia (LA) is a simple, cheap and safest method of providing post-operative (post-op) analgesia after laparoscopic cholecystectomy (LC). In this research, the role of intraperitoneal (IP) instillation of bupivacaine on post-op pain was studied. Post-op pain at 6, 12 and 24 hours was assessed using numeric rating scale. The degree of ambulation postoperatively at 6 and 24 hours and the requirement of analgesics was taken into account. The length of hospital stay was also a factor.Methods: A total of 76 patients during January 2018 to December 2018, undergoing LC, fitting the inclusion criteria were included randomly and divided in to two groups, bupivacaine group (B) and control group (A) based on a pre-generated random number sequence by the principal investigator. The surgical outcome was compared based on multiple parameters and the primary outcome measures were the post-op pain and analgesic requirement.Results: Degree of ambulation at 6 hours was significantly better in group B, compared to group A (p=0.008). The requirement of first dose of rescue analgesia was found to be within 6 hours (post-op) in 34 patients of group A (89.47%) as compared to 13 patients of group B (34.21%), was found to be statistically significant (p<0.001). There was statistically significant (p=0.002) difference with respect to length of hospital stay between the two groups.Conclusions: In our study we found that IP bupivacaine (0.5%) is an effective, economical, safe method of post-op pain management with better post-op recovery.

Comparative Study of IV Esmolol, IV Diltiazem, and IV Lignocaine Hydrochloride in Attenuating Pressure Response to Laryngoscopy and Intubation.

Not many studies have compared more than two drugs in attenuating pressor responses to laryngoscopy and intubation. This study compares four groups of considerable size. The present study compared intravenous esmolol, diltiazem, and lignocaine, for their efficacy to abate pressure response to laryngoscopy and intubation. METHODSThis is a prospective, randomized, double-blinded, controlled clinical study conducted among 220 patients of ASA grade I/II (age 18–60 years), undergoing elective surgical procedure requiring general anaesthesia with endotracheal intubation over a period of 15 months at a tertiary hospital setup. Study subjects were categorised as Groups D, E, L, and N that received diltiazem (0.2 mg/Kg IV), esmolol (2 mg/Kg IV), lignocaine (1.5 mg/Kg IV), and normal saline, respectively; each group had 55 patients. Haemodynamic parameters were recorded at baseline, after drug administration, immediately after intubation, and at 1-, 3-, and 5-minutes after intubation. Data entry and analysis were performed using MS Excel and SPSS-PC-17 version, respectively. One-way ANOVA and the chi-square test were used to evaluate the difference. P < 0.05 was considered significant. RESULTSA maximum increase in haemodynamic parameters occurred immediately after intubation. The increase in heart rate and rate pressure product were significantly lower in Group E (+2.93% & +15.31%), whereas the increase in blood pressure was lower in Group D (8.51%). CONCLUSIONSHaemodynamic stability during laryngoscopy and endotracheal intubation is an integral and essential goal of any anaesthetic management plan and was more effectively maintained with esmolol and diltiazem than with lignocaine.

A comparative study of collagen granules vs conventional dressing in the management of chronic ulcer

Background: A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are often considered chronic. Aim of this study the efficacy of topical use of collagen granules in wound healing.Methods: In this prospective study, a total of 60 patients were divided into two groups, according to type of dressing i.e. for group A patients collagen granules were used and for group B patients normal saline dressing was used. Collagen granules used for this study was Medfil II.Results: The Mean ulcer size at day 1 in group A was 16.29 cm2 with a SD of 6.07cm2. In Group B, the mean ulcer size at day 1 was 14.73 cm2 with a SD of 6.37 cm2. The Z value is 0.93 and p value is >0.5. This is comparable but statistically not relevant.Conclusions: The use of Collagen Granules dressing accelerated the rate of wound healing in chronic ulcers In this study authors found that the rate of wound healing was significantly better in using Collagen Granules but after 2 weeks.

Comparison of the trometamol-balanced solution with two other crystalloid solutions for fluid resuscitation of a rat hemorrhagic model

Research progress on the causes and preventive measures of central venous catheter blockage / 中国实用护理杂志

Central venous catheters (CVCs) are now widely used in critical care for critical care, fluid resuscitation, drug infusion, parenteral nutrition, hemodynamic monitoring, chemotherapy, and continuous blood purification treatment. Although the application of CVCs can facilitate clinical medical care work, the proportion of patients with various catheter complications will exceed 15%, and the incidence of catheter blockage is about 25%. At present, adequate flushing and effective sealing are considered to be important means to reduce and prevent catheter blockage. This article reviews the prevention of central venous catheter occlusion with different sealing fluids, in order to provide reference for clinical nurses to prevent central venous catheter occlusion.

Effect of Prior Administration of Butorphanol and Lidocaine on Pain during Propofol Injection

The aim of this study was to investigate the effect of prior administration of butorphanol, lidocaine and normal saline in minimizing Propofol injection pain. Methods: The study comprised of 99 patients divided into three groups of 33 each, in the department operation rooms of Anaesthesiology/Surgery, State Referral Hospital of Zoram Medical College, Falkawn, Mizoram during the period of March 2017 to April 2019. Ninety nine patients of ASA grade I and II, aged between 18 and 60 years of both sexes scheduled to undergo major elective surgery under general anaesthesia were included. Results: Pain on intravenous injection of propofol was experienced by 9 (27.27%) patients from butorphanol group as compared to 18 (54.55%) and 22 (66.67%) patients in the lidocaine and placebo groups respectively. Data analysis showed a chi-square test value of 15.3 and p-value 0f <0.05. Conclusion: The present study shows that prior administration of butorphenol significantly reduced pain on intravenous injection of propofol whereas lidocaine pretreatment too reduces propofol injection pain as compared to a placebo, but failed to show statistically significant results.

Efficacy of intracuff dexamethasone in reducing the incidence of post-operative sore throat: an original article

Background: Postoperative sore throat is the most common and most distressing complaint of patients after general anaesthesia with cuffed endotracheal tube. By this study our aim was to assess the efficacy of intracuff dexamethasone in reducing the incidence of this distressing postoperative symptom.Methods: Patients were divided into two groups D and N depending on cuff filling with dexamethasone and normal saline respectively. The cuff was prefilled with dexamethasone or normal saline  one hour prior to intubation to allow time for cuff to be saturated following which the cuff was deflated. General anaesthesia was administered and patients were intubated, and cuff inflated with drug according to group allocated. Patients were assessed and graded for sore throat using VAS scale both at rest and with swallowing. Assessment was done one hour, six, 12 and 24hours post operatively. Presence of hoarseness of voice and cough was assessed on a 2-point scale 0=absent and 1=present, 24hrs after surgery.Results: The incidence of sore throat at 24hours postoperative was reduced in group D than in group N. 4 patients (8%) in group D had sore throat while 27 patients (57%) in group N had sore throat at 24hours. This was statistically significant (p<0.05). The cough incidence was reduced in group D while there was no difference in incidence of hoarseness of voice between the two groups.Conclusions: Intracuff dexamethasone decreases the incidence of postoperative sore throat when compared to intracuff normal saline. Dexamethasone also reduces postoperative cough incidence but does not reduce the incidence of hoarseness of voice.

Comparative evaluation of nebulised 3% saline versus nebulised 0.9% saline in the treatment of acute bronchiolitis

Background: Acute bronchiolitis is the most common respiratory tract infection in young children. Despite the high prevalence of acute bronchiolitis, no consensus exists on the management. Studies have shown that except oxygen therapy, no other treatment found to be effective. Hence, the present study was conducted to find out the efficacy of nebulised 3% saline versus is 0.9% saline for the treatment of acute bronchiolitis.Methods: A prospective randomized controlled study of 150 children between the age group of 2 months to 24 months with signs and symptoms of Acute Bronchiolitis admitted to Indira Gandhi Institute of Child Health, Bangalore from January 2016 to December 2016 formed the study group, they were randomized into 2 groups, one received 3% saline nebulization and the other received 0.9% saline.Results: A total of 150 children were enrolled in the study, 75 children (group A) received 0.9% saline and 75 children (group B) received 3% saline. At 24 hours, the mean clinical severity score for group A was 2.49'1.03 and group B was 2.16'0.49 (P=0.013). The duration of hospital stay was shorter (1-3 days) in 3% saline with a mean of 2.35 days and was longer (3-5 days) in 0.9% saline with mean value of 4.04 days which was statistically significant (p <0.001).Conclusions: 3% saline nebulization can be used as an effective treatment for acute bronchiolitis. It significantly reduced the clinical severity score and length of hospital stay compared to 0.9% normal saline.

Study of role of tablet misoprostol and extra amniotic normal saline in second trimester abortion

Background: Second-trimester pregnancy termination comprises 10 to 15 percent of the approximately 42 million abortions performed annually worldwide.  Second-trimester procedures can be performed either with medication or by mechanical methods (Foleys catheter) or surgically by dilation and evacuation (D and E) or hysterotomy. The objective of the present study was to evaluate and compare the efficacy and safety of Tablet Misoprostol and extra amniotic infusion of normal saline with balloon catheter in second trimester abortion, to find out the maternal outcome, to compare the induction- to delivery interval between tablet misoprostol and extra amniotic infusion of normal saline with balloon catheter and to compare the cost of induction between tablet misoprostol and extra amniotic infusion of normal saline   with balloon catheter.Methods: This randomized controlled study was carried out in the Obstetrics and Gynecology. Department of C.U. Shah Medical College, Surendranagar, from 23th August 2017 to 20th August 2018.Results: Amongst the 100 participants, 50 induction is done with tab. Misoprostol and 50 induction done with EASIBC. Success rate is higher in tab. Misoprost which is 90.20% and in EASIBC is 75.51%. There were longer induction abortion interval in EASIBC: Need for curettage among Misoprostol is 5 and EASIBC is 9. Major complication like PPH occurred in two cases in induction with tab. Misoprostol, which is managed by further intervention and no death occurred. No major complication occurred in induction with EASIBC.Conclusions: Excluding the side effects and complications, which are manageable induction with tab. Misoprostol is better than EASIBC in terms of induction abortion interval, effectiveness, acceptability.

A Comparative Study Of Effects Of Clonidine And Magnesium Sulphate On Propofol Requirement In Craniotomy Patients Under General Anaesthesia

Introduction :Awareness can be defined as the subjective experience of external or internal stimuli. Recent review of reported cases of awareness suggested the absence of volatile agents or intravenous agents during maintenance of anaesthesia 2. Material & Methods:The study was conducted in SMS Medical College and attached hospital, Jaipur after approval from the institutional ethics committee. The present study was conducted in 105 patients 35 in each group of ASA physical status 1 & 2 posted for elective spinal surgery under general anaesthesia, age between 20-50 years, Hospital – based, randomized, double blind, comparative interventional study. The sample size was calculated 35 subjects in each group. Results: In recovery period, the time to reach BIS to 80 was found to be significantly more in Group B compared to Group C and Group A [P<0.001]. When the groups were compared, all the three parameters of recovery (extubation time, response to verbal commands and time for orientation) were found to be significantly longer in Group B. There were no significant difference between the other two groups, i.e. Group Aand Group C (P< 0.001).Propofol Induction and Maintenance dose found to be significantly more in Group C as compared to group B than Group A. (P < 0.001). Total Propofol requirement was significantly more in group C as compared to group B than Group A. (P< 0.001). Conclusion: Perioperative use of both clonidine and magnesium sulphate significantly reduced the requirement of propofol. They were able to attenuate the haemodynamic response to tracheal intubation. Clonidine was associated with bradycardia and hypotension. Magnesium sulphate caused a delay in recovery.

Cloro, el ion olvidado y su relación con el suero fisiológico / The forgotten ion Cl

Chloride is the anion of highest concentration in the extracellular fluid, it contributes between 100 to 300 mosm/L to the tonicity of plasma[1], and its plasma concentration is frequently reported in the different services as part of the general evaluation of plasma electrolytes. However, chloremia is often not taken into account beyond its role in the acid-base calculation. In the last times, chloride has begun to take importance by diverse reports where it would be associated to dyschloremias and in particular the hyperchloremic acidosis with harmful effects in the organism[2]. On the other hand, we have normal saline, which is massively used worldwide[3]. With a composition characterized by supra-physiological levels of chloride[4], being the main cause of hyperchloremic acidosis[5]. The objective of this review is to show the importance of chloride in different systems of the body, its relationship with normal saline and in turn the relationship of this one with the potential deleterious effects of hyperchloremic acidosis.

El cloro es el anión de mayor concentración en el líquido extracelular, aporta entre 100 a 300 mosm/L a la tonicidad del plasma[1], su concentración plasmática es frecuentemente informada en los distintos servicios como parte de la evaluación general de los electrolitos plasmáticos. Sin embargo, la cloremia muchas veces no es tomada en cuenta más allá de su rol en el cálculo ácido-base. En el último tiempo, el cloro ha comenzado a tomar importancia por diversos reportes donde se asociaría a las discloremias y en particular la acidosis hiperclorémica con efectos dañinos en el organismo[2]. Por otra parte, tenemos el suero fisiológico, el cual es masivamente usado a nivel mundial[3]. Con una composición caracterizada por niveles supra fisiológicos de cloro[4], siendo el principal causante de la acidosis hiperclorémica[5]. El objetivo de esta revisión es mostrar la importancia que cumple el cloro en distintos sistemas del organismo, su relación con el suero fisiológico y a su vez la relación de este, con los potenciales efectos deletéreos de la acidosis hiperclorémica.

A comparative study of acetated isotonic electrolyte solution, normal saline solution, and lactated ringer’s solution in the initial fluid resuscitation of children 1 month to 18 years old with severe dengue at the Philippine Children’s Medical Center

BACKGROUND@#At PCMC, acetated isotonic electrolyte solution is used in the initial resuscitation in severe dengue patients. However, no local study has comparedacetated isotonic electrolyte solution against normal saline and lactated Ringer’s solutions.@*OBJECTIVE@#This study aims to determine the comparative recovery time to achieve initial and sustained cardiovascular stability in severe dengue patients using acetated isotonic electrolyte solution, normal saline solution, and lactated Ringer’s solution.@*METHODOLOGY@#This is a retrospective cohort study involving 166 severe dengue patients 1 month to 18 years old admitted at the PICU from 2014 to 2016. They were divided into 3 groups based on the initial fluid used: 58 in the AIES group, 58 in the NSS group, and 50 in the LRS group.@*RESULTS@#AIES group had the shortest time to achieve initial and sustained stability among patients without re-shock. Also, AIES group needed less fluid to establish stability and had less re-shock, less use of colloid and inotropes, less blood transfusion,and less need for mechanical ventilation and dialysis. NSS had the most fluid shift to AIES and/or colloid while LRS had the most colloid used. Hyperchloremic metabolic acidosis was mostly seen in the NSS group. The length of ICU stay was almost the same in all groups. There was zero mortality in AIES group as compared to 3 on NSS group and 2 in LRS group.@*CONCLUSION AND RECOMMENDATION@#Acetated isotonic electrolyte solution is more effectivethan normal saline and lactated Ringer’s solutions in initial fluid resuscitation among severe dengue patients. It should be the fluid of choice in the initial resuscitation among severe dengue patients. It is recommended that a randomized control study with more patients be conducted.

Dose and timing of normal saline resuscitation on endothelial glycocalyx in early septic shock / 中华危重病急救医学

Objective@#To observe the effect of different doses and timing of normal saline (NS) resuscitation combined with norepinephrine (NE) on endothelial glycocalyx in rabbits with early septic shock.@*Methods@#Thirty New Zealand male rabbits were randomly divided into sham group, model group, 30 mL and 60 mL timely resuscitation groups (30 mL and 60 mL timely group), and 30 mL delayed resuscitation group (30 mL delayed group) with 6 rabbits in each group. The rabbit model of septic shock was reproduced by cecal ligation and puncture (CLP). The rabbits in sham group were only received abdominal cavity open without cecal and ligation. The rabbits in 30 mL and 60 mL timely groups and 30 mL delayed group were intravenous infused with 30 mL/kg or 60 mL/kg NS immediately or 1 hour after model reproduction for 1 hour, and the mean arterial pressure (MAP) was maintained over 75 mmHg (1 mmHg = 0.133 kPa) compared with intravenous pumping of 0.02-0.05 μg·kg-1·min-1 NE followed by 5 mL/h NS infusion till the end of the experiment. The rabbits in sham and model groups were only given 5 mL/h NS. The changes in arterial blood gas before and immediately after resuscitation were observed in three fluid resuscitation groups. The internal jugular vein blood was collected at 0, 3, 6 hours after model reproduction. The levels of syndecan-1 (polysaccharide envelope marker) in plasma were determined by enzyme linked immunosorbent assay (ELISA). The rabbits were sacrificed at 6 hours after model reproduction, and the lung tissue was harvested. Western Blot was used to determine the protein expressions of intercellular adhesion molecule-1 (ICAM-1), matrix metalloproteinase 2 (MMP-2) and syndecan-1. The positive expression of syndecan-1 in lung tissue was observed by immunohistochemical method.@*Results@#① Blood gas analysis: compared with the results before resuscitation, the levels of lactic acid (Lac) after resuscitation in three fluid resuscitation groups were significantly decreased, especially in 30 mL timely group; the central venous blood oxygen saturation (ScvO2) was significantly increased, especially in 30 mL delayed group. Oxygenation index (PaO2/FiO2) was improved in 30 mL timely and 30 mL delayed resuscitation groups, which was decreased in 60 mL delayed group. ② Plasma marker: compared with sham group, plasma syndecan-1 level in model group was significantly increased with a time-dependent manner. Plasma syndecan-1 levels at 3 hours in 30 mL timely and 30 mL delayed groups were significantly decreased as compared with those of model group (ng/L: 138.0±2.4, 139.7±15.7 vs. 161.5±4.1, both P < 0.05), but it was significantly increased at 6 hours in 30 mL delayed group (ng/L: 213.1±19.4 vs. 206.4±15.5, P < 0.05). The plasma syndecan-1 levels at 3 hours and 6 hours in 60 mL timely group were significantly higher than those in model group (ng/L: 233.0±28.9 vs. 161.5±4.1, 252.3±27.2 vs. 206.4±15.5, both P < 0.05). ③ Protein expression in lung tissue: compared with sham group, the protein expressions of ICAM-1 and MMP-2 in lung tissue of model group were significantly increased, and syndecan-1 protein expression was significantly decreased. After 30 mL timely or 30 mL delayed resuscitation, the protein expressions of ICAM-1 and MMP-2 in lung tissue were significantly decreased, and syndecan-1 protein expression was significantly increased, especially in 30 mL timely group, which showed statistical differences as compared with those of model group (ICAM-1 protein: 0.56±0.09 vs. 1.04±0.05, MMP-2 protein: 0.83±0.15 vs. 1.06±0.06, syndecan-1 protein: 2.09±0.08 vs. 0.99±0.03, all P < 0.05). The change tendency of protein expressions in 60 mL timely group was opposite to the other two resuscitation groups. ④ Immunohistochemistry: the positive expression of syndecan-1 in lung tissues was significant in the sham group, and it was lowered in model group. The positive expression of syndecan-1 was increased after 30 mL timely or 30 mL delayed resuscitation, but further weakened in 60 mL timely group.@*Conclusions@#The dose and timing of resuscitation with NS in septic shock can affect pulmonary vascular endothelial glycocalyx function. The timely resuscitation with 30 mL NS in combination with NE plays a protective effect on endothelial cell and glycocalyx. However, NS resuscitation which was not timely or excessive infusion can make the glycocalyx degradation more obvious, resulting in increased endothelial permeability, microcirculation damaged, thus aggravate lung injury.

Comparison of Conventional Normal Saline Dressing and Honey Dressing in the Management of Chronic Non Healing Ulcers

Background: This study was to show the advantage of Honey dressing over conventional saline dressing in the management of chronic non healing ulcer. Materials and methods: This was an open study comparing conventional normal saline dressing and honey dressing in the management of chronic non healing ulcers done during July 2014 to June 2015 in general surgical wards of government TD medical college, Alappuzha. Results: Factors assessed include average hospital stay, culture sterility pre and post dressing, their outcome plan (discharged, amputated or grafted), whether diabetes and vascular compromise has altered the results in two groups etc. As in evidence with ancient literature and studies in modern literature it was proved that irrespective of age, sex, distribution of diabetes and vascular compromise in Doppler; honey dressing was significantly advantageous over conventional normal saline dressing in terms of culture sterility, better outcome plan as well as less stay in hospital. Conclusion: The honey dressing is a better alternative to conventional normal saline dressing which can also pave way for decrease in antibiotic resistance.

Normal saline for intravenous fluid therapy in critically ill patients / 中华创伤杂志(英文版)

The efficacy and safety of normal saline (NS) for fluid therapy in critically ill patients remain controversy. In this review, we summarized the evidence of randomized controlled trials (RCTs) which compared NS with other solutions in critically ill patients. The results showed that when compared with 6% hydroxyethyl starch (HES), NS may reduce the onset of acute kidney injury (AKI). However, there is no significant different in mortality and incidence of AKI when compared with 10% HES, albumin and buffered crystalloid solution. Therefore, it is important to prescribe intravenous fluid for patients according to their individual condition.

Effectiveness of Hydrogen Peroxide as a sub gingival irrigant – A clinical study

Introduction: Periodontitis a chronic inflammatory disease results in the destruction of tooth supporting tissues, eventually progresses to tooth loss. Non-surgical periodontal therapy in form of scaling and root planning although considered as a gold standard, does not completely eradicate periodontal pathogens. Limitation of access and bacterial invasion of periodontal tissues being the main reason and hence the demand for an adjunctive measure is necessitated. Sub gingival irrigation interferes with various plaque components predominantly anaerobic bacterial flora which is known to initiate and perpetuate periodontal destruction. The aim of this study is to investigate the effect of sub gingival irrigation with 3% H2O2 compared to normal saline. Material and methods: 20 patients were taken for the study. After scaling and root planing, quadrants in each patient’s mouth were randomly treated two with 20 ml 3% H2O2 sub gingival irrigation and the other two with normal saline. Sub gingival irrigation was performed at baseline and after 1 and 2 weeks. The clinical parameters were recorded at baseline at the end of week 3 and at the end of week 5. Results: Results showed that sub gingival irrigation with 3% H2O2 produced a significant reduction in gingival bleeding, pocket depths and a significant gain in clinical attachment level compared to the control. Tahira Ashraf, Suhail Majid Jan, Roobal Behal, Rafiya Nazir, Abhima Kumar. Effectiveness of Hydrogen Peroxide as a sub gingival irrigant - A clinical study. IAIM, 2017; 4(11): 177-181. Page 178 Conclusion: The results of the present study conclude that that sub gingival irrigation with 3% H2O2 results in inflammation control manifested as decreased gingival bleeding, reduction in pocket depth and gain in relative attachment levels.

Nasal irrigation treatment for gestational rhinitis: a pilot study / 中国耳鼻咽喉头颈外科

OBJECTIVE Gestational rhinitis(GR) is a relatively common condition in women during pregnancy.Patients with GR often complain of nasal obstruction and rhinorrhea.The exact mechanism of GR are not clear.Safe and effective treatments for this disease have not been found to date.The aim of this study is to find an appropriate treatment method for GR.METHODS Thirty patients with GR were randomly divided into two groups.There were 15 patients in hypertonic saline group with a mean age of 28.73 years (range 24-31 years),and 15 patients in normal saline group with a mean age of 25.93 years (range 24-31 years).Hypertonic saline group was treated using 3.0％ saline with a temperature of 40℃ nasal irrigation,and normal saline group was treated with 0.9％ saline with a temperature of 40℃ nasal irrigation.The duration of the intervention period was 4 weeks.Visual Analog Scale(VAS) was used to evaluate the nasal symptoms including nasal obstruction and rhinorrhea,and the health-related quality of life was assessed with the 12-item Short Form Health Survey version 2.0(SF-12v2).Contents of histamine(HIS) and acetylcholinesterase(ACHE) in nasal lavage fluid(NLF) was assessed before and after 4-week treatment in the two groups in the study.RESULTS There were 28 patients completed the study.The total VAS scores of nasal symptoms including nasal obstruction and rhinorrhea decreased,and SF-12v2 score increased in the hypertonic saline group after 2-week,3-week and 4-week interventions.Furthermore,ACHE in NLF was also increased after 4-week treatment,but HIS showed no statistical changes.The VAS scores of nasal obstruction and rhinorrhea and SF-12v2 score after 2-week,3-week and 4-week interventions,and the contents of HIS and ACHE in NLF after 4-week treatment showed no statistical differences in the normal saline nasal irrigation group.There were statistical differences in the VAS scores of nasal obstruction and rhinorrhea,SF-12v2 score and ACHE in NLF after 4-week treatment,and no significant differences in the content of HIS in NLF between the 2 groups.CONCLUSION Hypertonic saline nasal irrigation is a safe and effective treatment for GR.

The efficacy of 3 irrigating solution in surgical removal of lower wisdom tooth: a pilot study

Surgical removal of impacted lower wisdom tooth has become increasingly costly to patient while still remains as the most common dental surgical procedure that is performed on outpatient basis. In the present study, a total of 23 patients with impacted lower wisdom tooth were surgically removed under local anaesthesia by using different irrigating solution namely, normal saline, distilled water and chlorhexidine. The samples underwent standard operating procedures and medication. Post operative complications in terms of pain, swelling, infection and delayed wound healing were assessed and compared on Day 1 and Day 7 after surgery. The result of this study showed that there is no significant difference between the three irrigating solution used in surgical removal of impacted lower wisdom tooth in terms of postoperative complication. A bigger scale of research with more samples is recommended to evaluate the most efficacy irrigating solution during surgical removal of impacted lower wisdom tooth.