A Comparative Study between Thoracic Epidural and Conventional Methods of Pain Management in Post Thoracotomy Patients

Background: Postoperative discomfort has a negative impact on the outcome of thoracic surgical procedures, which are among the most painful operations. Controlling pain after a thoracotomy enhances patient satisfaction while lowering postoperative morbidity. Aim of the study: The aim of the study was to evaluate the effects of thoracic epidural and conventional pain management methods in post-thoracotomy patients.Material & Methods:A randomized cross-sectional comparative study was conducted among 260 patients of post thoracotomy between January 2018 and December 2020 in a single tertiary-care hospital of Dhaka, Bangladesh. Outcomes of surgery were evaluated using the visual analogue score (VAS) at resting and coughing time.Results:We divided all 260 patients into two groups (group A: thoracic epidural 130; group B: conventional/control 130). The mean age of the patients was 49.74�.46 years in group A and 50.48�.23 in group B. There were 61% male patients and 39% female patients, and the male: female ratio was 81:48 in group A, and 78:53 in group B. Mean duration of surgeries was 2.95� 67.92 hours and 2.84� 57.31 hours in group A and B respectively and mean follow up was 1.9 years and 1.4 years in group A and B respectively. The maximum number (36.9%%) of patients were in the age group of 50 to 54 years, and the minimum number (4.61%) of patients were in the age group of 35 to 39 years. In group A, the maximum number (31) of patients had gone through open window formation, and a minimum number of patients (4) had gone through segmentectomy. And in group B, the maximum number (33) of patients had gone through open window formation, and a minimum number (4) had gone through hydatid cyst removal surgery. The change between comparative values of postoperative mean VAS scores at resting time and coughing time of both groups of patients was significant in this study.Conclusions:In thoracotomy surgery, the efficacy of thoracic epidural anesthesia is more evident than in other types of surgery. Although managing thoracotomy pain might be challenging, the advantages of proper pain management are substantial.

High expression of the wild type of ALK gene is associated with favorable prognosis in human neuroblastomas

Anaplastic lymphoma kinase [ALK] gene is a transmembrane receptor tyrosine kinase initially discovered as part of the NPM-ALK fusion protein, resulting from a chromosomal rearrangement frequently associated with anaplastic large cell lymphomas. ALK is a novel dependence receptor and normally expressed in the developing and adult nervous system. The mutated ALK gene has been identified as a potential oncogene in human neuroblastomas [NBLs]. However, the frequency of mutation is only 5-8%. The present study was performed to examine the level of ALK mRNA gene expression in primary neuroblastoma patient tumor tissue samples and to assess the relation between ALK gene expression and other previously reported prognostic factors of neuroblastoma. Methods: Quantitative real-time RT-PCR was applied to examine the expression level of ALK mRNA. and its prognostic value in primary neuroblastoma patients was analyzed by the statistical methods. Immunohistochemical staining was used to check the expression level of ALK proteins. In analysis of 79 patients with sporadic primary neuroblastoma, we found that high expression level of ALK mRNA was significantly associated with Shimada's pathological classification [p=0.0000], patient's age [p-0.0000], MYCN amplification status [p=0.0000], tumor stage [p=0.0000][and] TrkA expression level [p=0.0390], all these factors are known to be associated with good prognosis in neuroblastoma. Of interest, immunohistochemical study revealed positive ALK in ALK-ampllfizd tissues and cell lines. Furthermore, mutation results showed that ALK mutation represented about 4.6% of cases and ALK amplification represented about 1.5% of cases. So that mutations not only occur among unfavorable cases with low ALK but also in favorable cases with high ALK expression. Our findings suggested that, high expression of wild type ALK is associated with good prognosis of NBL and that, as the mutation and amplification of ALK are reported to play an important role in NBL, also the expression level of wild type ALK gene might also have some function in cell growth as well as differentiation in neuroblastoma

Antishigellosis and Cytotoxic Potency of Crude Extracts and Isolated Constituents from Duranta repens

The crude ethanol extracts (stem and fruits), their fractions and two triterpenes, beta-Amyrin and 12-Oleanene 3beta, 21beta-diol, isolated as a mixture from the chloroform soluble fraction of an ethanolic extract of Duranta repens stem, were evaluated for antibacterial, antifungal activities by the disc diffusion method and cytotoxicity by brine shrimp lethality bioassay. The structures of the two compounds were confirmed by IR, 1H-NMR, 13C-NMR and LC-MS spectral data. The chloroform soluble fraction of stem and ethanol extract of fruits possess potent antishigellosis activity and also exhibited moderate activity against some pathogenic bacteria and fungi but the isolated compound 1 (mixture of beta-Amyrin and 12-Oleanene 3beta, 21beta-diol) showed mild to moderate inhibitory activity to microbial growth. The minimum inhibitory concentrations (MICs) of the extracts (stem and fruits), their fractions and compound 1 were found to be in the range of 32~128 microg/ml. The chloroform soluble fractions of stem and ethanol extract of fruit showed significant cytotoxicity with LC50 value of 0.94 microg/ml and 0.49 microg/ml, respectively against brine shrimp larvae.