RESUMO
Pain management plays a fundamental role in enhanced recovery after surgery pathways. The concept of multimodal analgesia in providing a balanced and effective approach to perioperative pain management is widely accepted and practiced, with regional anesthesia playing a pivotal role. Nerve block techniques can be utilized to achieve the goals of enhanced recovery, whether it be the resolution of ileus or time to mobilization. However, the recent expansion in the number and types of nerve block approaches can be daunting for general anesthesiologists. Which is the most appropriate regional technique to choose, and what skills and infrastructure are required for its implementation? A multidisciplinary team-based approach for defining the goals is essential, based on each patient's needs, and incorporating patient, surgical, and social factors. This review provides a framework for a personalized approach to postoperative pain management with an emphasis on regional anesthesia techniques.
RESUMO
The Government of India came out with a slew of notifications to streamline clinical research in the beginning of 2013 in response to the Supreme Court’s orders and a Parliamentary Standing Committee’s report. The notifications greatly influenced the structure, review process, outcomes and administration of ethics committees across India. In this study, we attempted to objectively evaluate the impact of these notifications on our institutional ethics committee’s (IEC) structure, review process, outcomes and administration. The results revealed that though the number of regulatory studies reviewed by our IEC remained the same, the number of studies actually approved decreased with an increase in the turnover time. The number of serious adverse events (SAEs) reported also fell, although the number of meetings held to discuss these SAEs increased significantly. The administrative workload rose with increased documentation. Though the annual income of the IEC fell marginally, the expenses shot up. We believe that the notifications definitely had an impact on the structure, review process, outcomes and administration of our IEC, although it remains to be seen whether they had a real impact on the research participants’ safety and well-being.
RESUMO
Background: Psoriasiform dermatoses is a common presentation of a wide spectrum of underlying diseases from a relatively harmless disease like chronic dermatitis to a detrimental disease like mycosis fungoides. Psoriasiform reaction pattern is a commonly encountered denominator in a wide variety of unrelated disorders. They include several unrelated disorders of the integument, which either in the beginning or in the course of progression/resolution, exhibit lesions resembling psoriasis. Aims: This study was designed and conducted to enlist clinical parameters, histopathology and clinicohistopathological co-relation of psoriasiform disorders. Methodology: 100 cases of psoriasiform dermatoses over a period of two years were studied. Their history, age, sex as well as morphology, distribution and histopathology of skin lesions were analysed. Results: Psoriasis is the commonest of all psoriasiform dermatoses (31%) followed by lichen planus (23%),lichen nitidus(9%), pitryasis rosea (7%) , seborrheic dermatitis (6%). The remaining dermatoses like lichenoid drug eruptions ,parapsoriasis , Reiter’s disease , mycosis fungoides , pitryriasis rubra pilaris and lichen striatus, lichen simplex chronic etc were uncommon. There was a slight male preponderance. (M: F: 1.3:1). Lesions were more common in limbs. There was a wide age variation for example lichen striatus was seen in 5 year male and mycosis fungoides in a 69 year old male. A good clinicopathological co-relation filled up the lacunae of both, the clinical approach as well as that of histopathology and helped in pinpointing the diagnosis (62 cases). In 10 cases, there was no co-relation between clinical and histopathological diagnosis. Conclusion: As the morbidity of these disorders ranges from a trifling affliction to a life threat, thorough clinico-pathological co-relation and prompt institution of specific treatment results in a better prognosis.
RESUMO
Interfollicular Hodgkin's lymphoma represents an unusual pattern of focal involvement of interfollicular zones by Hodgkin's lymphoma along with florid reactive follicular hyperplasia. It is often mistakenly diagnosed as a reactive change. We report a case of a 36 years old male with persistent lymphadenitis for three years, who was finally diagnosed as Interfollicular Hodgkin's lymphoma after being incorrectly diagnosed as reactive lymphadenitis. This case is reported in view of the unusual pattern of Hodgkin's lymphoma as well as its misdiagnosis as a benign lesion.