Effect of fluticasone-impregnated throat packs on postoperative sore throat (POST) and hoarseness of voice: A randomized clinical trial.

Background: Post-operative sore throat (POST) is one of the most common complaints post-endotracheal intubation and can be decreased through various interventions. This study aimed to determine the effect of fluticasone-impregnated versus saline throat packs on the occurrence and severity of POST and voice hoarseness. Methods: This prospective, randomized, double-blinded trial was conducted on patients undergoing nasosinus surgeries at Kasturba Medical College and Hospital. Patients were randomized to groups based on a computer-generated table of random numbers post-intubation after placing a definite length of oropharyngeal packs into group F (fluticasone) who received four puffs of fluticasone furoate-soaked throat packs and group C (control) wherein normal saline-soaked throat packs were used. Determining the incidence of POST and voice hoarseness was the primary outcome; severity of POST and voice hoarseness, patient satisfaction scores at 24 hours post-surgery and adverse events were secondary outcomes. Results: Overall, 86 patients were randomized and 43 patients were included in each group. Incidence of POST (%) and voice hoarseness (%) were 55.8, 55.6, 55.8, 53.4 and 30.2, 28, 28, 28 in group C. Incidence of POST (%) and voice hoarseness (%) were 37.2, 37.2, 37.2, 34.8 and 14, 14, 14,14 in group F at 1, 2, 6 and 24 hours, respectively, however, the p values were not found to be significant at any time interval. There was no significant difference in terms of severity of POST and voice hoarseness, patient satisfaction scores between the groups and there were no reported adverse events. Conclusions: In patients undergoing nasosinus surgery under general anesthesia with endotracheal intubation, fluticasone furoate-impregnated throat packs failed to show any significant reduction in the incidence and severity of POST as well as hoarseness of voice, and even though it was not statistically significant, the fluticasone impregnated group had higher patient satisfaction scores. Registration: CTRI ( CTRI/2020/09/027946; 22/09/2020).

Root Bark Extract of Oroxylum indicum Vent. Inhibits Solid and Ascites Tumors and Prevents the Development of DMBA-Induced Skin Papilloma Formation.

Oroxylum indicum is a traditionally used plant in Ayurvedic and folk medicines. The plant is useful for the management of gastrointestinal diseases as well as skin diseases. In the present study, we analyzed the antitumor potential of O. indicum in Dalton's lymphoma ascites tumor cells (DLA) and Ehrlich ascites carcinoma (EAC)-induced solid and ascites tumors. Further, the potential of O. indicum extract (OIM) on skin papilloma induction by dimethyl benz(a) anthracene (DMBA) and croton oil was evaluated. The chemical composition of the extract was analyzed using UPLC-Q-TOF-MS. The predominant compounds present in the extract were demethoxycentaureidin 7-O-rutinoside, isorhamnetin-3-O-rutinoside, baicalein-7-O-glucuronide, 5,6,7-trihydroxyflavone, 3-Hydroxy-3',4',5'-trimethoxyflavone, 5,7-dihydroxy-3-(4-methoxyphenyl) chromen-4-one, and 4'-Hydroxy-5,7-dimethoxyflavanone. Treatment with high-dose OIM enhanced the percentage of survival in ascites tumor-bearing mice by 34.97%. Likewise, high and low doses of OIM reduced the tumor volume in mice by 61.84% and 54.21%, respectively. Further, the skin papilloma formation was brought down by the administration of low- and high-dose groups of OIM (by 67.51% and 75.63%). Overall, the study concludes that the Oroxylum indicum root bark extract is a potentially active antitumor and anticancer agent.

Autologous Fat Grafting with or without Processing: A Study in an Indian Clinical Context.

BACKGROUND: Although fat grafting has become an attractive method of correction of soft tissue deficiencies, variability in results exists. As the understanding of mechanism of survival of graft improves, the concepts regarding fat grafting change. There are many ways to process the aspirated fat with no clear method superior. AIM: The aim of this study was to evaluate the role of processing during autologous fat transfer. MATERIALS AND METHODS: The patients were serially divided into two groups, namely, A and B. Harvesting of lipoaspirate and injection of fat were same in both the groups. In group A, no processing was done. In group B, the fat was processed by sedimentation and injected. Patient satisfaction was assessed following the procedure and statistical analysis was done using the Mann-Whitney U-test. RESULTS: Young females between 21 and 30 years formed the majority of patients who opted for fat grafting procedure. Most of the procedures were performed for defects in the face (93.3%). The most common indication of fat grafting was contour deformities, with abdomen being the most preferred donor site. The mean patients' satisfaction following fat grafting without processing is 2.2 ± 0.68. The mean patients' satisfaction following fat grafting with processing is 2.53 ± 0.99. CONCLUSION: There was not a statistically significant difference in patient outcomes following fat grafting, with or without processing, in terms of patient satisfaction. Autologous fat grafting was found to be a safe procedure with no significant complications.

Comparison of Nasopharyngeal Temperature Measured at Fossa of Rosenmuller and Blindly Inserted Temperature Probe with Esophageal Temperature: A Cross-Sectional Study.

INTRODUCTION: Monitoring body temperature and maintaining normothermia are now essentially the standard-of-care during anesthesia. This study was designed to compare the temperature measured by nasopharyngeal temperature probes inserted by landmark method and fiberscope-guided method with esophageal temperature. We hypothesized that placing the temperature probe at the level of fossa of Rosenmuller will reflect core temperature as it is in close relationship to the brain. SUBJECTS AND METHODS: Sixty-five patients aged 18-60 years were enrolled in this cross-sectional study. Two methods were used in our study to place the temperature probes. In landmark-based method, we inserted temperature probe through nostril for a depth equal to philtrum-tragus distance. In fiberscope-guided method, the temperature probe was inserted into nostril and its tip was positioned at fossa of Rosenmuller under fiberscope guidance. RESULTS: The nasopharyngeal temperatures were recorded at seven time intervals along with esophageal temperature. Mean temperatures were calculated at three different sites. The degree of agreement between two methods at seven time intervals was also calculated. Both methods had good correlation with esophageal temperature. Depth of insertion of temperature probes was documented. There was difference in depth of insertion of temperature probe of around 4.26 cm between two methods, probe length from philtrum to tragus (D1) being longer than distance from fossa of Rosenmuller to nares (D2). CONCLUSIONS: Nasopharyngeal temperature measured at fossa of Rosenmuller with probe inserted by fiberscope-guided method and that measured by landmark-based method with probe inserted according to philtrum-tragus distance shows good correlation with esophageal temperature.

The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice.

BACKGROUND: The finger skin and soft-tissue defects are reconstructive challenges due to their nature and the intricate extensor apparatus and flexors it protects. The reverse dorsal metacarpal artery (RDMA) is a time-tested option for the reconstruction of the same. MATERIALS AND METHODS: A total of 14 cases of RDMA flap for finger defects involving proximal to distal phalanx were performed. Thirteen of these patients were male and one patient female and the most common mode of injury was occupational in nature followed by road traffic accident. The overall appearance was assessed for the flap and the donor site. The associated injuries and the range of motion were noted. RESULTS: All but one flap survived completely. One patient had partial distal flap loss, which was tackled with split-thickness skin grafting. The flap size varied from 3.5 cm × 1.5 cm to 9 cm × 2 cm with mean of 6.64 cm × 1.72 cm. The mean age of the patients was 33.4 years. All the patients had acceptable aesthesis. The donor site had no complications and healed with linear scar. CONCLUSIONS: RDMA flap is a reliable flap for finger defects reconstruction. The range of movement mainly depends on the associated injury rather than flap transfer alone and to prove this we require doing analysis of range of movement in patients with flap done alone or with associated injuries.

Comparison of polyvinyl chloride, curved reinforced, and straight reinforced endotracheal tubes for tracheal intubation through Airtraq™ laryngoscope in anesthetized patients.

BACKGROUND AND AIMS: The Airtraq™ video laryngoscope facilitates tracheal intubations in patients with difficult airway or cervical spine immobilization. However, curved reinforced tracheal tube and straight reinforced tracheal tubes are useful where neck of the patient is likely to be moved or flexed or if patient is in prone position, wherein nonreinforced endotracheal tube (ETT) might get kinked and/or compressed. We compared intubation success rate of curved and straight reinforced tracheal tubes with polyvinyl chloride (PVC) tracheal tube using Airtaq™ laryngoscope in paralyzed and anesthetized patients. MATERIAL AND METHODS: Totally, 120 patients underwent random allocation to one of the three groups using computer-generated randomization table. Patients were intubated with appropriate size and type of ETT using Airtraq™ after obtaining optimal glottis view. Experienced anesthesiologist performed endotracheal intubation and unblinded observer noted down success and ease of intubation. RESULTS: Patients intubated with PVC tube (100%) had higher rates of successful intubation and shorter intubation time (4 s), in comparison to intubation with curved reinforced (92.5%) and straight reinforced tubes (SRTs) (85%) using Airtraq™ laryngoscope (AL). However, there was no statistical difference in the incidence of airway trauma among all the three groups. CONCLUSIONS: PVC tracheal tube is significantly superior to both curved and SRTs for intubation using AL.

Epithelial Mesenchymal Transition in Cancer Progression: Prev entive Phytochemicals.

BACKGROUND: Epithelial-Mesenchymal Transition (EMT) is the conversion of epithelial cells into mesenchymal phenotype generally observed during embryogenesis and wound healing as well as in malignant transformation. Several signaling pathways and transcription factors associated with EMT have been explored. Dietary phytochemicals that are multi-targeted agents which interfere with these pathways, assume preventive potential against pathologic EMT. OBJECTIVE: The present review aims to provide a detailed description of the nature and characteristics of EMT in physiological and pathophysiological conditions and the scope of phytochemicals in its prevention. METHOD: Details regarding the initiation, progression as well as prevention of pathologic EMT and metastasis and recent patents on preventive phytochemicals were obtained from PubMed literatures and patent databases. RESULTS: The phenotypic changes during EMT are regulated by transcription factors like Snail, Slug, Twist and Zeb, which are activated through diverse signaling pathways of TGF-ß, NF-kB, Wnt and Notch. s phytocompounds that are potent enough to interfere with these signaling pathways, which in turn prevent pathological implications of EMT. Present review also discusses 28 recent patents on those phytocompounds. CONCLUSION: EMT is a significant pharmacological target for developing preventive agents to combat pathological conditions like malignancy. Many of the phytochemicals cited in this review are being enrolled for different phases of clinical trials for their efficacy. In spite of the major limitations regarding bioavailability, sensitivity and tolerance of these compounds, their synthetic analogs, formulations and efficient drug delivery systems are also being attempted which will hopefully generate productive and promising results in near future.

Evaluation of effect of entropy monitoring on isoflurane consumption and recovery from anesthesia.

BACKGROUND AND AIMS: Entropy monitoring entails measurement of the effect of anesthetic on its target organ rather than merely the concentration of anesthetic in the brain (indicated by alveolar concentration based on which minimum alveolar concentration [MAC] is displayed). We proposed this prospective randomised study to evaluate the effect of entropy monitoring on isoflurane consumption and anesthesia recovery period. MATERIAL AND METHODS: Sixty patients undergoing total abdominal hysterectomy under general anesthesia using an endotracheal tube were enrolled in either clinical practice (CP) or entropy (E) group. In group CP, isoflurane was titrated as per clinical parameters and MAC values, while in Group E, it was titrated to entropy values between 40 and 60. Data including demographics, vital parameters, alveolar isoflurane concentration, MAC values, entropy values, and recovery profile were recorded in both groups. RESULTS: Demographic data and duration of surgery were comparable. Time to eye opening on command and time to extubation (mean ± standard deviation) were significantly shorter, in Group E (6.6 ± 3.66 and 7.27 ± 4.059 min) as compared to Group CP (9.77 ± 5.88 and 11.63 ± 6.90 min), respectively. Mean isoflurane consumption (ml/h) was 10.81 ± 2.08 in Group E and 11.45 ± 2.24 in Group CP and was not significantly different between the groups. Time to readiness to recovery room discharge and postanesthesia recovery scores were also same in both groups. CONCLUSION: Use of entropy monitoring does not change the amount of isoflurane consumed during maintenance of anesthesia or result in clinically significant faster recovery.

Vitamin E supplementation modulates the biological effects of omega-3 fatty acids in naturally aged rats.

Omega-3 fatty acids are well-known class of nutraceuticals with established health benefits. Recently, the oxidation products of these fatty acids are gaining attention, as they are likely to disturb body redox balance. Therefore, the efficacy of omega-3 fats under conditions of diminished antioxidant status, such as aging, is always a concern. Present study assessed the effects of omega-3 fats (DHA and EPA) together with or without vitamin-E in naturally aged rats. It was found that in omega-3 fats alone consumed rats the lipid profile was improved, while in omega-3 fat with vitamin-E-consumed group (OMVE), the hepato protective and antioxidant properties were pronounced, especially the redox status of brain tissue. It is possible that vitamin-E might have reduced the peroxidation of omega-3 fats, thereby allowing their synergistic effects. Hence, the use of vitamin-E along with omega-3 fat may be beneficial under aged conditions.

Multi-region to single region shear thinning transitions in drying PEDOT:PSS dispersions: contributions from charge density fluctuations.

The multiple shear thinning behaviour observed in dispersions of the conducting polymer, poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) ( PEDOT: PSS), in water during the drying process is explored. PEDOT: PSS dispersions in water can be non-stoichiometric polyelectrolyte complexes (PECs) with free polyanion (PSS) chains resulting in scrambled egg conformations. They also behave as charged colloidal particles. The behaviour of PEDOT: PSS dispersions as PECs and charged colloidal systems during drying is analyzed using rheology and TEM, zeta potential, conductivity, pH, dynamic light scattering (DLS) and rheo-small angle light scattering (rheo-SALS) information. The rheological behaviour is found to have significant contributions from conformational changes in the PEDOT: PSS PEC due to charge density fluctuations affecting the electrostatic persistence length, le. A low concentration regime with multiple shear thinning behaviour and a high concentration regime with single shear thinning behaviour were observed. The PEC behavior of PEDOT: PSS is further explored by charge neutralizing the dispersions with salts.

Radiographic mislead: apparent arterial placement of subclavian central venous catheter due to mediastinal shift.

Optimal placement of central venous catheters (CVC) is essential for accurate monitoring of central venous pressure (CVP) in major surgeries and ensuring long-term use of the catheter for managing the critically ill patient. Accidental subclavian artery catheterization is one of the most serious complications of the procedure. Radiography is commonly used to ensure optimal placement of CVC tip and rule out subclavian artery catheterization in the absence of Doppler ultrasound and a pressure transducer. We present a case of a haemodynamically unstable and hypoxaemic patient with mediastinal shift, in which the anaesthesiologist was in a dilemma about the arterial placement of the right subclavian CVC. The CVC crossing the midline due to mediastinal shift gave the false impression of it being placed in subclavian artery rather than the vein. Subsequently, it was proved to be correctly placed in the subclavian vein.

Anesthetic management of a child with corrected transposition of great vessels undergoing non-cardiac surgery.

We describe the successful anesthetic management of a 14-year-old child, a corrected case of transposition of great vessels in childhood and presently with residual atrial septal defect, peripheral cyanosis, and neurological deficit of lower limb presented for tendoachillis lengthening.

Safe intubation in Morquio-Brailsford syndrome: A challenge for the anesthesiologist.

Morquio-Brailsford syndrome is a type of mucopolysaccharidoses. It is a rare disease with features of short stature, atlantoaxial instability with risk of cord damage, odontoid hypoplasia, pectus carinatum, spine deformities, hepatomegaly, and restrictive lung disease. Neck movements during intubation are associated with the risk of quadriparesis due to cervical instability. This, along with the distortion of the airway anatomy due to deposition of mucopolysaccharides makes airway management arduous. We present our experience in management of difficult airway in a 3-year-old girl with Morquio-Brailsford syndrome posted for magnetic resonance imaging and computerized tomography scan of a suspected unstable cervical spine. As utmost sagacity during intubation is required, the child was intubated inside operation theatre in the presence of experienced anesthesiologists and then shifted to the peripheral location. Intubation was done with an endotracheal tube railroaded over a pediatric fibreoptic bronchoscope passed through the lumen of a classic laryngeal mask airway, keeping head in neutral position.

A prospective observational study of the outcome of central venous catheterization in 100 patients.

CONTEXT: To Study the outcome following central vein catheterization in patients receiving chemotherapy. AIMS: To Study the outcome of central venous catheterization in terms of difficulty during insertion, duration, incidence of infections and other complications and reasons for removal. SETTINGS AND DESIGNS: Prospective observational study conducted in 100 patients attending to Gujarat Cancer and Research Institute. MATERIALS AND METHODS: Both onco-medical and onco-surgical patients who required insertion of central venous catheters were enrolled after ethical approval from June 2008 to November 2010. The study comprised 100 patients. STATISTICAL ANALYSIS USED: Mean and percentage. RESULTS: Mean duration of the indwelling catheter was 109 days for Hickman catheter, 39 days for cavafix and 59 days for certofix. Difficulty in insertion and arrhythmias were common complications. There were no incidences of major life threatening complications. Catheter related infection was 30%. The commonest reason for catheter removal was treatment completion 72%. The next frequent cause was catheter infection 14% and patient death 6%. CONCLUSIONS: Even though central venous catheterization is associated with acceptable complications, they serve a useful aid in management of patients on chemotherapy.

Intraoperative management of atrial fibrillation in a patient with restrictive cardiomyopathy.

A 65-year-old patient with renal amyloidosis presented for Trans Urethral Resection of Prostate (TURP). There were no symptoms pertaining to the cardiorespiratory system. Preoperative investigations showed only secondary cardiomyopathy. Intraoperatively the patient developed atrial fibrillation with hypotension which was successfully managed by cardioversion.

Airway management in Escobar syndrome: A formidable challenge.

Escobar syndrome is a rare autosomal recessive disorder characterized by flexion joint and digit contractures, skin webbing, cleft palate, deformity of spine and cervical spine fusion. Associated difficult airway is mainly due to micrognathia, retrognathia, webbing of neck and limitation of the mouth opening and neck extension. We report a case of a 1 year old child with Escobar syndrome posted for bilateral hamstrings to quadriceps transfer. The child had adequate mouth opening with no evidence of cervical spine fusion, yet we faced difficulty in intubation which was ultimately overcome by securing a proseal laryngeal mask airway (PLMA) and then by intubating with an endotracheal tube railroaded over a paediatric fibreoptic bronchoscope passed through the lumen of a PLMA.

The role of trans-oral digital pressure in the removal of large dumbbell shaped tumor from deep lobe of parotid gland.

A 44-year-old male patient, a cardiothoracic surgeon by profession, presented with a tumor arising from the deep lobe of the right parotid gland. Investigations confirmed its para-pharyngeal location and its dumbbell shape. A total conservative parotidectomy was performed preserving full function of the facial nerve. The case is presented because of the unique technique used for this procedure.