Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Abstract Introduction Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo (p < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.

Venous thromboembolism-incidence of deep venous thrombosis and pulmonary embolism in patients with head and neck cancer: a tertiary care experience in Pakistan

Introduction Although venous thromboembolism (VTE) is seen with morbidity and mortality in various surgical specialties, scarce data are available in the head and neck surgery domain. Objective We aim to determine the incidence of VTE in patients receiving surgery for head and neck cancer. Methods Four hundred thirteen patients who underwent head and neck surgery procedures between 2005 and 2013 were reviewed retrospectively. All patients with head and neck surgery had received thromboprophylaxis (i.e., compression stockings and subcutaneous heparin). Patient demographics, operating time, and length of hospital stay were analyzed. The incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) during the initial postoperative hospitalization was assessed. Results Twelve patients were identified who developed VTE. Three patients developed DVT, and nine developed PE. The incidence of DVT and PE was 0.72 and 2.17%, respectively. Interestingly, all of these patients had undergone excision of extensive head and neck cancers accompanied by a reconstructive procedure. Patients who developed PE had a longer hospital stay compared with those who only had DVT. There were overall three mortalities in the nine patients who developed PE. Conclusion Although VTE has a low incidence, it is a known complication of extensive head and neck surgeries with life-threatening outcomes. We recommend early mobilization and physiotherapy with the possible aid from appropriate mechanical and pharmacologic thromboprophylaxis.

Sequential Application of Plastic Media- Trickling Filter and Sand Filter for Domestic Wastewater Treatment at Low Temperature Condition.

Present research was aimed towards designing and construction of efficient plastic media-trickling filter (TF) for the treatment of domestic wastewater. The hydraulic flow rate through the TF was maintained at 80±2 ml/min at a temperature range of 5-15ºC by selecting treatment time of 12, 24, 36 and 48 hrs. Parameters like COD, BOD5, TSS, turbidity, NO3, NO2, SO4, PO4 and pathogenic indicator microbes were monitored after treatment of 12, 24, 36 and 48 hrs. The efficiency of the TF was improved with increase of time from 12 to 48 hrs. Maximum efficiency of TF was observed after 48 hrs treatment viz. 93.45, 93, 86.25, 57.8, 63.15, 25, 32.43, 99.95 and 86.3% reduction from the zero time value for BOD5, COD, TSS, PO4, SO4, NO3, NO2, turbidity and fecal coliforms respectively. Finally 48 hrs treated sample was passed through sand filter (SF) for further final polishing and approximately, 95.72, 95, 100, 73.5, 65.8, 58.3, 37.83, 100 and 91.5% reduction in BOD5, COD, TSS, PO4, SO4, NO3, NO2, turbidity and fecal coliforms was observed. This study showed that plastic media-trickling filter along with sand filter is a promising technology for wastewater treatment and can be scaled up for small communities in the developing countries.

Role of brown-rot fungi in the bioremoval of azo dyes under different conditions

The present study is vital to the understanding of bioremediation of structurally different azo dyes by some unusual Brown-rot fungi. Bioremoval of each dye (20 mg l-1) was tested in two different culture media under static and shaking conditions by taking inocula from different fungi. Fungal strains showed varying dyes removal abilities, though considerable high in case of Acid Red (AR) 151(di-azo) as compared to Orange (Or) II (mono-azo). With an exception of Aspergillus tereus SA3, all the fungal isolates showed higher removal of dyes in SDB. Under static condition, the maximum decolorizing fungal strains were; Aspergillus flavus SA2 (67 percent) and Alternaria spp. SA4 (57 percent) in AR 151, while Penicillium spp. (34 and 33 percent) in Orange II, in SDB and STE, respectively. Bioremoval of dyes was considerably increased when experiments were shifted from static to shaking mode. It was specifically increased ( percent) in; AR 151 (255) with Penicillium spp., Or II with A. flavus SA2 (112) and Alternaria spp. (111). The primary mechanism of dyes removal proved to be fungal biosorption. However, reduction of dyes (onto fungal) with formation of their products (α. naphthol, sulphalinic acid and aniline) furthermore revealed that dyes (specifically azo) were actually biodegraded.