Increased oral inflammation, leukocytes, and leptin, and lower adiponectin in overweight or obesity

Objectives

The association between body mass index (BMI) and oral diseases was investigated, and levels of obesity-related inflammatory mediators were evaluated.

Subjects and Methods

Participants (n = 160) were clinically and radiographically examined for oral diseases. Blood profiles were recorded. Levels of adiponectin, leptin, and C-reactive protein (CRP) were measured.

Results

One hundred and thirteen (70.6%) participants had overweight or obese status (BMI ≥ 23.0 kg/m²). Sum of dental diseases and severe periodontitis were higher in overweight or obese individuals than in normal-weight participants (p = .037 and p = .002, respectively). A significant difference in oral mucosal disorders between normal weight and overweight or obesity was not found. Plasma leukocyte counts, liver enzymes, leptin, and CRP levels were increased while adiponectin levels were decreased in individuals with BMI≥23.0 kg/m² compared with normal-weight participants. After adjusting for age, sex, fasting plasma glucose level, smoking, and exercise, obesity was associated with sum of dental diseases (ß = 0.239, p = .013), severe periodontitis (OR=4.52; 95% CI 1.37, 14.95, p = .013), adiponectin (ß = –0.359, p < .001), leptin (ß = 0.630, p < .001), and CRP levels (OR=12.66; 95% CI 3.07, 52.21, p < .001).

Conclusion

Overweight or obese Thai people were related to an increase in inflammatory dental and periodontal diseases with an altered health profile and plasma inflammatory mediators.

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Assessment of the efficacy and safety of a new complex skin cream in Asian women: A controlled clinical trial

Summary

Background

Medical products such as hydroquinone and tretinoin have been widely used to treat various types of skin hyperpigmentation. However, these products are limited in daily use given their adverse effects. Other alternative agents with fewer adverse side effects have been developed. However, single agents often do not produce satisfactory results.

Aims

To evaluate the efficacy and safety of a new brightening complex cream containing niacinamide, tranexamic acid, oxyresveratrol, glutathione disulfide, and linoleic acid.

Patients and Methods

A total of 26 Korean women seeking to lighten their skin were enrolled. The product was applied on the face two times per day for 12 weeks. Standardized photographs were taken at baseline, 4 weeks, 8 weeks, and 12 weeks. Efficacy was assessed using melanin index (MI), erythema index (EI), and chromatic aberration values (L*, a*, and b*). Improvement perceived by investigators and patients was measured as well.

Results

The L*-value was increased at 8 weeks (0.7±2.5, P<.05) and at 12 weeks (0.8±2.5, P<.05). The MI was significantly decreased at 8 weeks (−4.2±4.5, P<.05) and at 12 weeks (−3.8±4.8, P<.001). The EI was significantly improved at 12 weeks (−3.2±2.2, P<.001). More than 80% of patients were considered improved at 12 weeks based on the view of the investigators and patients.

Conclusions

The new brightening complex cream was proved to be effective and safe in Asian women.

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Treatment of red tattoo reaction using CO 2 laser

http://ift.tt/2rdV14q

Variability of high-dose melphalan exposure on oral mucositis in patients undergoing prophylactic low-level laser therapy

Abstract

The present study outlines the clinical impact and risk factors of oral mucositis in 79 patients with multiple myeloma following high-dose melphalan for autologous transplant. All patients underwent daily prophylactic low-level indium gallium aluminum phosphate diode laser therapy (660 nm, 15 mW, 3.75 J/cm², 10 s per point) from the beginning of the conditioning regimen up to day +2. Oral mucositis assessments were made daily until hospital discharge. For analysis, oral mucositis was divided into two groups according to severity: group 1, patients with oral mucositis grade <III (n = 71) and group 2, patients with oral mucositis grade ≥III (n = 8). Univariate logistic models were used to determine the risk factors. Patients in group 1 were found to have statistically fewer days of oral pain than those in group 2 (3.94 and 6.25 days, respectively, p = 0.014). Morphine was required in 75% of patients in group 2, versus 42.25% in group 1 (p = 0.06). Risk of severe oral mucositis was associated with higher serum creatinine levels (OR = 6.10; 95% CI 1.25–31.60; p = 0.02) and older age (OR = 1.21; 95% CI 1.05–1.47; p = 0.027). Severe oral mucositis was associated with worse clinical outcomes. Older patients and those with renal dysfunction previous autologous transplant had the greatest risk for severe oral mucositis despite prophylactic laser treatment. Our results highlight the importance of further research to define the dose, application time, and number of prophylactic laser sessions in those patients with the greatest risk for severe oral mucositis.

http://ift.tt/2rdgfiT

Tumescent anaesthesia: its applications and well tolerated use in the out-of-operating room setting.

Purpose of review: Tumescent anaesthesia is a method of administering dilute local anaesthetic into the subcutaneous tissue. Many anaesthesiologists are unfamiliar with the technique, its applications and potential risks. Recent findings: The maximum safe dose of lidocaine with epinephrine in tumescent anaesthesia for liposuction is probably between 35 and 55 mg/kg. Without liposuction, the maximum dose of lidocaine with epinephrine should be no more than 28 mg/kg. After tumescent infiltration for liposuction, serum lidocaine concentrations peak between 12 and 16 h after injection. When tumescent lidocaine without epinephrine is used for endovenous laser therapy, peak serum lidocaine concentrations are observed much earlier, between 1 and 2 h after injection. Slow administration of more dilute concentrations of local anaesthetic decreases the risk of local anaesthetic systemic toxicity. Summary: Although appealing because of its ability to provide prolonged analgesia, high doses of local anaesthetic are frequently administered using the tumescent technique, and absorption of local anaesthetic from the subcutaneous tissue is variable. When caring for patients having procedures in which tumescent anaesthesia is used, the risk of local anaesthetic toxicity should be acknowledged and lipid emulsion should be available for prompt treatment if needed. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2roY873

Sedation for advanced procedures in the bronchoscopy suite: proceduralist or anesthesiologist?.

Purpose of review: This article focuses on the issue of sedation provided either by proceduralists or anesthesiologists for advanced bronchoscopy procedures. The relative merits of both approaches are presented. Current evidence from the literature and guideline recommendations relevant to this topic are reviewed. Recent findings: In general, patient and proceduralist satisfaction as well as patient safety are increased when intravenous sedation is provided for advanced bronchoscopic procedures. However, guidelines by various societies remain vague on defining the appropriate level of care required when providing sedation for these procedures. In addition, targeted depth of sedation varies considerably among practitioners. While in some settings, nonanesthesiologist-administered propofol sedation has been proven safe; nevertheless, its use is controversial, especially in the bronchoscopy suite. Summary: The role of the anesthesiologist in sedation for advanced bronchoscopy remains undefined. When deep sedation for prolonged interventional procedures is needed or when dealing with patients who have multiple comorbidities, an anesthesiologist should be involved. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2qPpwOf

Safety of deep sedation in the endoscopy suite.

Purpose of review: As the complexity of endoscopic procedures increases, the use of propofol and the desire for deep sedation are becoming more common in the endoscopy suite. This review explores sedation depth, agents used for sedation, recommended monitoring, and adverse event risks that occur during sedation for endoscopy. Recent findings: The sedation provider for endoscopy varies by practice location and with regulatory requirements. As increasingly deep levels of sedation are used in this setting, the need for all providers to have training in the ability to rescue patients from sedation-related side effects is paramount. Propofol has an important role for prolonged and uncomfortable endoscopic interventions and has a strong safety record in the endoscopy suite. Vital signs monitoring is recommended during all endoscopy sedation, and there is emerging interest in advanced monitoring (e.g., capnography, processed electroencephalogram, respiratory monitoring) in this setting. The reported rate of adverse events during endoscopy sedation varies widely; however, advanced age and increasing American Society of Anesthesiologists physical status score are consistently associated with increased risk. Whether anesthesiologist-administered sedation is safer than non-anesthesiologist-administered sedation remains controversial. Summary: This review provides some guidance to providers who administer sedation in the endoscopy suite and is intended to improve the safety of patients. The recommendations are based on best available evidence and expert opinion. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The role of the anaesthesiologist in air ambulance medicine.

Purpose of review: The care administered on air ambulances has become increasing complex. This has led to a discussion among experts as to whether air ambulance travel should be manned by physicians. This review provides evidence in support of anaesthesiologists being the physician-leaders in air ambulance medicine, because of their training in advanced airway management, critical care, and resuscitation. Recent findings: Successful prehospital care requires the ability to perform a complex set of advanced diagnostics and interventions. These include airway management, haemorrhage control, pain management, point-of-care diagnostics, complex interfacility transport, and advanced interventions. This skill set closely mirrors the training and expertise of anaesthesiologists. Summary: There are few studies investigating the specific benefit of anaesthesiologists in air ambulance medicine. However, current evidence indicates that their presence does improve patient care and safety. Future studies on this topic should use evidence-based quality indicators and standardized data sets to seek answers to optimal staffing of air ambulance teams. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Perioperative management of antithrombotic therapies.

Purpose of review: Perioperative coagulation management is becoming increasingly frequent in the daily routine of the anesthesiologist and with the plethora of new substances on the market also increasingly complex. The perioperative setting poses unique challenges requiring an individualized evaluation and management of antithrombotic therapy. This review shall summarize the newest developments in this domain. Recent findings: New data in patients with atrial fibrillation have led to a paradigm change in the perioperative management of antithrombotics. The role of bridging therapy has been downgraded in the guidelines, which only foresee bridging in patients with high thromboembolic risk. Furthermore, direct oral anticoagulants are now a cornerstone in antithrombotic therapy, calling for specific perioperative management. The new reversal agents idarucizumab, and potentially in the future andexanet alfa and ciraparantag, will play an increasingly important role in the treatment of major bleeding in this group of patients. Summary: With the new evidence and treatment options available, perioperative coagulation management is experiencing a Renaissance, opening many interesting new doors, but also presenting the clinician with new challenges. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Importance of Group Therapeutic Support for Family Members of Children with Alopecia Areata: A Cross-Sectional Survey Study

Abstract

Background/Objectives

The psychological effect of alopecia areata (AA) is well documented, but group interaction may help lessen this burden. We aimed to determine factors that draw patients with AA and their families to group events.

Methods

Surveys were administered at the annual alopecia areata bowling social in 2015 and 2016. This event is a unique opportunity for children with AA and their families to meet others with the disease and connect with local support group resources from the Minnesota branch of the National Alopecia Areata Foundation. Data from 2015 and 2016 were combined. Comparisons of subgroups were performed using Fisher exact tests for response frequencies and percentages and two-sample t tests for mean values.

Results

An equal number of men and women participated in the study (n = 13 each). The average age was 41.1 years. There were no significant differences (p > 0.05) in survey responses based on respondent age or sex. Twenty-three (88.5%) attendees sought to connect with others with AA and met three or more people during the event. Seventeen (65.4%) also attended other support group events. Twelve respondents (46.2%) came to support a friend or family member. One hundred percent of attendees identified socializing with others with AA as important.

Conclusions

Group interaction is an important source of therapeutic support for people with AA and their families.

http://ift.tt/2roRpdf

Acceptability, Feasibility, and Effectiveness of Interdisciplinary Group Education Sessions for Women Veterans with a History of Sexual Trauma

Violence and Gender , Vol. 0, No. 0.


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Intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks

Objectives/Hypothesis

Spontaneous cerebrospinal fluid (CSF) leaks are associated with increased intracranial pressure (ICP) and considered a manifestation of idiopathic intracranial hypertension. Although postoperative acetazolamide and placement of CSF shunt systems are considered valuable interventions for elevated ICP, the impact on recurrence rate remains unclear. The objective of this study was to systematically review evidence from reported literature to evaluate whether postoperative ICP management reduces recurrence rates after primary endoscopic repair.

Study Design

Prospective case series and systematic review.

Methods

Demographics, defect location, success rates, and ICP management in spontaneous CSF leak patients were prospectively collected over 8 years. A search was also conducted in PubMed to identify studies reporting cases of spontaneous CSF rhinorrhea.

Results

Fifty-six articles with nonduplicated data were identified and combined with a prospective series of 108 patients for a total of 679 patients treated for spontaneous CSF rhinorrhea. Average age was 50.4 years with 77% female. Average body mass index was 35.8 kg/m². Defects were most commonly located in the sphenoid sinus (n = 334) followed by the ethmoid (n = 318) and the frontal sinus (n = 46). Successful primary repair was 92.82% in patient cohorts where ICP evaluation and intervention with acetazolamide or CSF shunt systems was performed, but was significantly decreased to 81.87% in series with no active management of elevated ICP (P < .001).

Conclusions

Evaluation and intervention for elevated ICP in spontaneous CSF leaks is associated with significantly improved success rates following primary endoscopic repair.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2roFsU5

Early neurocognitive improvements following parathyroidectomy for primary hyperparathyroidism

Objectives

To establish a time frame for postoperative improvements in neurocognitive function in patients who undergo parathyroidectomy for primary hyperparathyroidism by utilizing repeat neuropsychological assessment at multiple time points before and after surgery.

Study Design

Prospective cohort study.

Methods

A prospective study was conducted at a tertiary academic medical center between August 2014 and December 2015, including 50 patients with primary hyperparathyroidism who underwent parathyroidectomy. A panel of neurocognitive tests was administered at two separate time points: preoperative and 1-week postoperative. Validated neuropsychological assessment tools were utilized, including Rey Auditory-Verbal Learning Test, Trail Making Test A and B, Benton Controlled Oral Word Association, WAIS-IV Digit Span, Hospital Anxiety and Depression Scale, Positive and Negative Affect Schedule, and Insomnia Severity Index. Barona Information Sheet was used to collect demographic data. Paired t tests were to compare pre- and postoperative scores.

Results

Thirty-five patients completed the preoperative and 1-week postoperative testing. In cognitive testing, significant improvement was noted in immediate recall (P < 0.001), working memory (P = 0.011), and attention (P = 0.008) at 1-week postoperative. In mood testing, depression (P < 0.001), anxiety (P < 0.001), and negative affect (P = 0.001) scores were significantly improved at 1-week postoperative. Insomnia scores also were significantly improved at 1 week (P < 0.001).

Conclusion

Objective improvements in neurocognitive function following parathyroidectomy for primary hyperparathyroidism were noted as early as 1 week after surgery, which is earlier than previously reported.

Level of Evidence

2b. Laryngoscope, 2017

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In response to “Otolaryngology workforce analysis”

http://ift.tt/2rowO7W

Evaluation of leg wrapping for the prevention of postspinal hypotension in cesarean section under spinal anesthesia

Aparna Abhijit Bagle, Adithya Vishnu, Anil Kumar, Amit Malik, Vinit Garg, Gayatri Khanvilkar

Anesthesia: Essays and Researches 2017 11(2):439-443

Background: Spinal blockade provides excellent anesthesia for patients undergoing cesarean section. However, hypotension after spinal anesthesia is a common adverse effect that is commonly experienced in patients undergoing cesarean section. The aim of our study was to analyze if a simple technique like leg wrapping with elastic crepe bandage would be effective in controlling postspinal hypotension. Materials and Methods: Sixty full-term pregnant patients who were posted for cesarean section belonging to American Society of Anesthesiologists I and II were divided into two groups. Patients in Group W had their legs wrapped with elastic crepe bandage and in the other Group N, leg wrapping was not done. All the patients were preloaded with Ringer lactate at 10 ml/kg before the spinal anesthesia. The hemodynamic parameters were monitored every 3 min until the delivery of the baby and every 5 min until the end of surgery. If hypotension occurred, then along with crystalloid loading a bolus dose of mephentermine 6 mg was given intravenously. Statistical Analysis: Statistical software "Numbers version 3.6.1 (2566)" was used for statistical calculations. Results: Frequency of hypotension in Group W (10%) was significantly less compared to Group N (60%). Vasopressor requirement was significantly less in Group W (P = 0.009), which was highly significant. Conclusion: Wrapping of lower extremities was a simple, easy, and an effective method of decreasing episodes of hypotension and vasopressor requirement after spinal anesthesia in cesarean patients and needs to be practiced routinely.

http://ift.tt/2qpPTsC

Effect of single compared to repeated doses of intravenous S(+) ketamine on the release of pro-inflammatory cytokines in patients undergoing radical prostatectomy

Hassan Mohamed Ali, Ali M Mokhtar

Anesthesia: Essays and Researches 2017 11(2):282-286

Background: Radical prostatectomy is a major surgical procedure that is associated with marked inflammatory response and impairment of the immune system which may affect the postoperative outcome. The aim of this study was to evaluate the effect of preincision single or multiple doses of S(+) ketamine on the pro-inflammatory cytokines, namely tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). Patients and Methods: This is a randomized controlled trial including 60 American Society of Anesthesiologists Physical Status I and II patients scheduled for radical prostatectomy under combined general-epidural anesthesia in Cairo university Teaching Hospital. Patients were randomly divided into three groups each of twenty patients: Group I received no S(+) ketamine (control group), Group II received S(+) ketamine as a single preincision dose, and Group III received preincision and repeated doses of S(+) ketamine. S(+) ketamine was injected as a single intravenous dose of 0.5 mg/kg in Group II and III, repeated as 0.2 mg/kg at 20 min interval until 30 min before the end of surgery. Results: The three groups were comparable in age, weight, and duration of the operation. The study also revealed that a single preincision dose of S(+) ketamine decreased TNF-α to reach 1027.04 ± 50.13 μ/ml and IL-6 to reach 506.89 ± 25.35 pg/ml whereas the repeated doses of S(+) ketamine decreased TNF-α to reach 905.64 ± 35065 μ/ml and IL-6 to reach 412.79 ± 16.5 pg/ml (P < 0.05). Conclusion: S(+) ketamine suppresses pro-inflammatory cytokine production, especially when given in repeated doses.

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Anesthetic management of a parturient with severe pulmonary restenosis posted for cesarean section

Rajkiran Babubhai Shah, Beena P Butala, Geeta P Parikh

Anesthesia: Essays and Researches 2017 11(2):517-519

Adults with congenital heart disease are increasing due to improvement in infant heart surgery and availability of better cardiac care. Pregnancy in these patients requires multidisciplinary team approach due to circulatory changes. We describe an anesthetic management of the parturient undergoing cesarean section having severe pulmonary restenosis.

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Comparison of usefulness of ketamine and magnesium sulfate nebulizations for attenuating postoperative sore throat, hoarseness of voice, and cough

Sunil Rajan, George Jacob Malayil, Rekha Varghese, Lakshmi Kumar

Anesthesia: Essays and Researches 2017 11(2):287-293

Context: Postoperative sore throat (POST) is a complication that is unresolved in patients undergoing endotracheal intubation. Aim: To compare the effects of ketamine and magnesium sulfate nebulizations in two strengths, on the incidence and severity of POST, hoarseness, and cough. Settings and Design: Sixty surgical patients undergoing elective abdominal and lower limb surgeries under combined epidural and general anesthesia were included in this prospective, randomized, double-blinded study. Subjects and Methods: Patients in each group were nebulized with the respective study drug 15 min prior to the surgery, i.e., ketamine in Group K, magnesium sulfate 250 mg, and 500 mg in Group M1 and Group M2, respectively, and normal saline as control in Group C. A standardized anesthesia protocol was followed for all patients. After extubation, the patients were asked to grade POST, hoarseness, and cough at 0, 2, 4, 12, and 24 h. Statistical Analysis Used: One-way analysis of variance, Chi-square test, Fisher's exact test, paired t-tests, and Wilcoxon's signed-rank test as applicable. Results: Ketamine and magnesium sulfate 500 mg demonstrated a statistically significant decrease in POST at 0, 2, and 4 h, and postoperative hoarseness at 0 h. There was decrease in the incidence and severity of sore throat, hoarseness, and cough at all periods in the study groups as compared with control. Conclusion: Nebulization with ketamine 50 mg and magnesium sulfate 500 mg, 15 min before induction of general anesthesia and intubation, reduce the incidence and severity of POST and hoarseness of voice.

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Prophylactic use of intravenous clonidine compared to tramadol in prevention of intraoperative shivering under regional anesthesia

Sarmila Guha (Banerjee), Pallab Kumar Nath, Rita Halder, Ujjwal Bandyopadhyay

Anesthesia: Essays and Researches 2017 11(2):477-482

Objectives: This study aimed to evaluate the relative efficacy of prophylactic intravenous (IV) clonidine and tramadol for control of intraoperative shivering following spinal anesthesia. Materials and Methods: After institutional ethical clearance, 142 patients were chosen from either gender, aged 20–60 years, physical status American Society of Anesthesiology Class I and II scheduled for elective infraumbilical surgery under spinal anesthesia. Patients were randomized into two groups: Group C (n = 71) received injection clonidine 50 μg) IV in 100 ml normal saline (NS) over 10 min and Group T (n = 71) received injection tramadol 50 mg IV. In 100 ml NS over 10 min after spinal anesthesia. Results: Incidence of shivering was not significant when compared between the two groups (P > 0.05). The axillary temperatures fell significantly in Group C from the baseline and remained at a significantly lower level up to 60 min after rescue drug was administered in patients who shivered. There was a similar fall in axillary temperature in Group T in patients having shivering, but the difference was not significant. When compared between the two groups among patients who shivered, the difference in fall of temperature was not significant. Side effects such as hypotension, bradycardia, and sedation were significantly more common in clonidine group, whereas nausea was significantly more common patients of tramadol group. Conclusion: Prophylactic administration of both tramadol and clonidine is effective for controlling shivering under spinal anesthesia. However, tramadol is better because of higher response rate, less sedation, and lesser hemodynamic alterations.

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Efficacy of dexmedetomidine infusion for procedural comfort and intraoperative sedation in patients undergoing surgeries with subarachnoid block: A randomized double-blind clinical trial

Dewan Roshan Singh, Kusha Nag, Amrutha Bindu Nagella, VR Hemanth Kumar, Antony John Charles

Anesthesia: Essays and Researches 2017 11(2):294-299

Introduction: There is increasing evidence to include sedation as an integral part of regional anesthesia to ensure patient comfort. This may compromise patient cooperation, an important component of regional anesthesia. We decided to determine the efficacy of dexmedetomidine (0.3 μg/kg/h and 0.5 μg/kg/h) for allaying procedural discomfort and ensuring their cooperation in patients undergoing surgery with subarachnoid block. Setting: Tertiary care center. Materials and Methods: Sixty patients with the American Society of Anesthesiologists physical status Class I and II posted for surgeries under subarachnoid block were randomized into two groups of 30 each to receive dexmedetomidine in a loading dose of 1 μg/kg in both groups followed by continuous infusion of 0.3 μg/kg/h in Group D 0.3 and 0.5 μg/kg/h in Group D 0.5. Observer assessment sedation score, ease of positioning score, response to spinal needle insertion, hemodynamic parameters, patient satisfaction (PS) score, and surgeon satisfaction (SS) score were evaluated. Results: Median observer Assessment Sedation Score ranged between four and three at all times during dexmedetomidine infusion in Group D 0.3. In Group D 0.5, median Observer assessment of alertness/sedation scale ranged between three and two. Ease of positioning (P = 1.000) and response to spinal needle insertion (P = 0.521) were comparable in both groups. PS was higher in Group D 0.5 as compared to Group D 0.3. SS score was comparable in both the groups. Conclusion: Intravenous dexmedetomidine infusion 0.3 μg/kg/h produces effective sedation in patients undergoing surgery with spinal anesthesia while ensuring patient cooperation for positioning and without any recall of the procedure in postoperative period.

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A simple novel technique to make any supraglottic airway device magnetic resonance imaging compatible: A fusion of the past with the present

Ashish Kannaujia, Saipriya Tewari, Alka Verma

Anesthesia: Essays and Researches 2017 11(2):535-536



http://ift.tt/2qpUWcw

Lignocaine versus ropivacaine infiltration for postpartum perineal pain

Jyoti P Deshpande, Girish Y Saundattikar

Anesthesia: Essays and Researches 2017 11(2):300-303

Background: Millions of women worldwide undergo postpartum perineal repair under local infiltration. Inadequate postpartum pain management can negatively impact a mother's physical and psychological recovery. Aims: To study and compare the analgesic effect and maternal satisfaction with lignocaine versus ropivacaine infiltration for postpartum perineal pain relief. Materials and Methods: After clearance from the Institutional Ethics Committee, a double-blind prospective randomized study carried out on 100 parturients of aged 18–40 years who had spontaneous vaginal delivery, comparing 1% lignocaine and 0.75% ropivacaine infiltration for the repair of selective episiotomy or perineal injury. Time of the first analgesic (TFA) demand, maternal satisfaction at 24 h, and visual analog scale (VAS) pain score were studied. Statistical Analysis: Chi-square test and Student's t-test were used and P< 0.05 was considered as significant. Results: VAS pain score was significantly lower at 2 and 4 h in ropivacaine group versus lignocaine group (P < 0.0001). Significantly, longer TFA (10.2 ± 1.54 vs. 2.20 ± 0.44 h, P< 0.0001) and higher percentage of maternal satisfaction (86% vs. 44%) were observed in ropivacaine as compared to lignocaine group (P < 0.0001). Conclusions: Prolonged analgesia and higher rate of maternal satisfaction were found when ropivacaine infiltration was used for perineal repair as compared to lignocaine.

http://ift.tt/2pUuioY

The postdural puncture headache and back pain: The comparison of 26-gauge atraucan and 26-gauge quincke spinal needles in obstetric patients

Mehmet Salim Akdemir, Ayhan Kaydu, Yonca Yanlı, Mehtap Özdemir, Erhan Gökçek, Haktan Karaman

Anesthesia: Essays and Researches 2017 11(2):458-462

Background: The postdural puncture headache (PDPH) and postdural puncture backache (PDPB) are well-known complications of spinal anesthesia. There are some attempts to reduce the frequency of complication such as different design of the spinal needles. Aims: The primary outcome of this study is to compare the incidence of PDPH between 26-gauge Atraucan and 26-gauge Quincke spinal needles in elective cesarean operations. The severity of symptoms, the incidence of backache, technical issues, and comparison of cost of needles are secondary outcomes. Materials and Methods: After Investigational Review Board approval, a randomized, prospective, double-blinded study was designed in 682 American Society of Anesthesiologists I–II women having elective cesarean operations under spinal anesthesia. Patients were divided into two groups as 26-gauge Atraucan Group A (n = 323) and 26-gauge Quincke spinal needles Group Q (n = 342). All patients were questioned about backache 1 week later. Differences between categorical variables were evaluated with Chi-square test. Continuous variables were compared by Student's t-test for two independent groups. A two-sided P< 0.05 was considered statistically significant for all analyses. Results: There were no significant differences between groups in all demographic data. The one attempt success rate of the dural puncture in Group A (70,58%) and in Group Q (69.3%) was similar (P > 0.05). The incidence of PDPH was 6.5% in Group A and 4.9% in Group Q (P > 0.05). The epidural blood patch was performed to the three patients in Group A and five patients in Group Q who had severe headache (P > 0.05). The incidence of PDPB was 4.33% versus 2.04% in Group A and Group Q (P > 0.05). Conclusions: The incidence of complication rates and technical handling characteristics did not differ between two groups. Quincke needle is cheaper than Atracaun needle, so it can be a cost-effective choice in obstetric patients.

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Financial implications of intravenous anesthetic drug wastage in operation room

Suvarna Kaniyil, A Krishnadas, Arun Kumar Parathody, KT Ramadas

Anesthesia: Essays and Researches 2017 11(2):304-308

Background and Objectives: Anesthetic drugs and material wastage are common in operation rooms (ORs). In this era of escalating health-care expenditure, cost reduction strategies are highly relevant. The aim of this study was to assess the amount of daily intravenous anesthetic drug wastage from major ORs and to estimate its financial burden. Any preventive measures to minimize drug wastage are also looked for. Methods: It was a prospective study conducted at the major ORs of a tertiary care hospital after getting the Institutional Research Committee approval. The total amount of all drugs wasted at the end of a surgical day from each major OR was audited for five nonconsecutive weeks. Drug wasted includes the drugs leftover in the syringes unutilized and opened vials/ampoules. The total cost of the wasted drugs and average daily loss were estimated. Results: The drugs wasted in large quantities included propofol, thiopentone sodium, vecuronium, mephentermine, lignocaine, midazolam, atropine, succinylcholine, and atracurium in that order. The total cost of the wasted drugs during the study period was Rs. 59,631.49, and the average daily loss was Rs. 1987.67. The average daily cost of wasted drug was maximum for vecuronium (Rs. 699.93) followed by propofol (Rs. 662.26). Interpretation and Conclusions: Financial implications of anesthetic drug wastage can be significant. Propofol and vecuronium contributed maximum to the financial burden. Suggestions for preventive measures to minimize the wastage include education of staff and residents about the cost of drugs, emphasizing on the judicial use of costly drugs.

http://ift.tt/2pUKDtL

The analgesic efficacy of dexamethasone added to ropivacaine in transversus abdominis plane block for transabdominal hysterectomy under subarachnoid block

Jyoti P Deshpande, Poonam S Ghodki, Shalini P Sardesai

Anesthesia: Essays and Researches 2017 11(2):499-502

Background and Aims: Ultrasound-guided transversus abdominis plane (TAP) block has been proven as a safe and effective analgesic technique for several lower abdominal surgeries. Various adjuvants have been used to intensify the quality and prolong the local anesthetic effect. We evaluated the analgesic efficacy of dexamethasone addition to ropivacaine in TAP block following open abdominal hysterectomy. Materials and Methods: After clearance from the Institutional Ethics Committee, a double-blind, prospective, randomized study was carried out on sixty patients aged 40–60 years posted for elective open abdominal hysterectomy comparing bilateral TAP block using 20 ml of 0.5% ropivacaine + 1 ml of 0.9% saline (control Group R) or 20 ml of 0.5% ropivacaine + 4 mg dexamethasone (Group RD). The aim of our study was to observe postoperative pain score (visual analog scale [VAS]), time for first analgesic (TFA) demand, total analgesic consumption, and incidence of nausea or vomiting. Statistical Analysis: Chi-square test and Student's t-test were used, and P< 0.05 was considered as statistically significant. Results: Postoperative VAS pain scores were significantly lower at 4, 6, and 12 h in Group RD as compared to Group R (P < 0.05). Significantly longer TFA (13.2 ± 7.6 vs. 7.1 ± 4.6 h, P< 0.001) with lesser tramadol requirement in first 24 h (50.2 ± 34 vs. 94 ± 35 mg, P< 0.001) were observed in Group RD as compared to Group R. Incidence of nausea or vomiting was statistically insignificant between the groups (P > 0.05). Conclusions: Addition of dexamethasone to ropivacaine TAP block prolonged the postoperative analgesia and reduced analgesic requirement following abdominal hysterectomy.

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Dexmedetomidine as an anesthetic adjuvant in intracranial surgery

Ankita Batra, Reetu Verma, VK Bhatia, Girish Chandra, Shashi Bhushan

Anesthesia: Essays and Researches 2017 11(2):309-313

Background: The basic principle of neuroanesthesia is to provide hemodynamic stability, provision of optimal operative conditions, maintenance of cerebral perfusion pressure, and cerebral oxygenation. Aim: This study was undertaken to see the effect of dexmedetomidine infusion on hemodynamics and its ability to act as an anesthetic adjuvant in patients undergoing supratentorial tumor surgery. Setting and Design: Prospective randomized control double blind study. Subjects and Methods: In this study, we compared two groups with 25 patients in each group. Group C patients received saline infusion during surgery and 4 μg/kg of fentanyl intravenously (i.v.) at the induction and at pin head application. Group D patients received dexmedetomidine infusion during surgery at the rate of 0.4 μg/kg/h and 2 μg/kg of fentanyl i.v. at the induction and at pin head application Statistical Analyses Used: Parametric data were analyzed using Student's t-test. The categorical data were studied using Chi-squared test or Fisher's test as appropriate. Results: The vitals remained within 20% of baseline in both groups during the study period except at the time of extubation where the rise in heart rate was more than 20% in control group. The requirement of thiopentone for induction was significantly less in dexmedetomidine group. In dexmedetomidine group, less number of patients required intraoperative fentanyl (P < 0.05), and the time to rescue analgesic was also more in Group D (P < 0.05). Conclusion: Dexmedetomidine infusion started before surgery maintains hemodynamic stability intraoperatively and is effective in attenuating the cardiovascular responses to intubation, skull pin application, and extubation. It decreases the requirement of other anesthetic agents as well.

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Continuous positive airway pressure prevents hypoxia in dental patient with obstructive sleep apnea syndrome under intravenous sedation

Anton A Kasatkin, Aleksei P Reshetnikov, Aleksandr L Urakov, Dmitrii Y Baimurzin

Anesthesia: Essays and Researches 2017 11(2):528-530

Use of sedation in patients with obstructive sleep apnea (OSA) in dentistry is limited. Hypoxia may develop during medication sleep in dental patients with OSA because of repetitive partial or complete obstruction of the upper airway. In this regard, anesthesiologists prefer not to give any sedative to surgical patients with OSA or support the use of general anesthesia due to good airway control. We report a case where we could successfully sedate a dental patient with OSA using intraoperative continuous positive airway pressure (CPAP) without hypoxia. Use of sedation and intraoperative CPAP in patients with OSA may be considered only if the effectiveness at home CPAP therapy is proven.

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Hemodynamic responses at intubation, change of position, and skin incision: A comparison of multimodal analgesia with conventional analgesic regime

Keelara Shivalingaiah Savitha, Radhika Dhanpal, MS Vikram

Anesthesia: Essays and Researches 2017 11(2):314-320

Background: Lumbar spine surgery is associated with hemodynamic variations at intubation, change of position, and skin incision. A balanced anesthesia with multimodal analgesia (MMA) is necessary to attenuate these changes. Aim: To assess the relative effectiveness of preemptive MMA compared with the conventional analgesic regime in suppressing the hemodynamic response to endotracheal intubation, prone positioning, and skin incision. Settings and Design: A randomized, prospective study involving 42 patients belonging to the American Society of Anesthesiologists Physical Status 1 and II scheduled to undergo elective lumbar spine surgery were allocated into two groups of 21 each. Materials and Methods: Forty-two patients were randomly allocated into Groups A and B. Group A (study group) received diclofenac, paracetamol, clonidine, and bupivacaine with adrenaline skin infiltration and Group B (control group) injection paracetamol and saline with adrenaline skin infiltration. Statistical Analysis Used: Hemodynamic parameters (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], and mean arterial pressure [MAP]) between the groups following intubation, prone position, and skin incision were noted and compared using repeated measure analysis of variance. One sample t-test was used to compare the standard mean concentration with the means of the study and control groups. P< 5% being considered statistically significant. Results: In the study group, HR, SBP, DBP, and MAP were lower at intubation and change of position as compared to the control group and were statistically significant. Conclusion: Preemptive MMA with balanced anesthesia is effective in attenuating the hemodynamic responses to multiple noxious stimuli during lumbar spine surgery.

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An audit of comparison of perioperative outcomes with the introduction of standardized preoperative evaluation form at a tertiary care hospital in rural India

Shraddha Vidyadhar Naik, Bilal Mohammad, Vitthal K Dhulkhed

Anesthesia: Essays and Researches 2017 11(2):426-430

Introduction: Preoperative evaluation of a patient is the fundamental component of anaesthetic practice. Inadequate documentation and record keeping on the preoperative evaluation form (PEF) can be a major obstacle to attaining good practice and improving patient outcomes following operative procedures. Aim: The aim of the study was to conduct an audit to assess the quality of the preoperative anaesthetic information gathered and to observe the quality profile after the introduction of a standardized pre-operative evaluation form. Study Design: This was a retrospective study, using a sample of 3000 files of patients who underwent elective surgery in a tertiary care hospital of rural India. We devised 11 quality indicators, looking at factors in the pre-operative, peri-operative and post-operative period, and used them to audit 3000 patient records in our Hospital. Results: We found several areas where quality could be significantly improved;last minute postponement/change of plan of planned surgeries has reduced from 134 (8.9%) to 23 (1.53%) cases after implementation of standardised PEF. 784 (52.26%) patients were not formally handed over to the theatre recovery staff before implementation of standardised PEF compared to 147(9.8%) after implementation of standardised PEF. Conclusion: This audit found several areas of practice that fall below expected standards before the introduction of standardised PEF, but after the introduction of standardised PEF there is a significant improvement in quality of pre anaesthetic evaluation and overall outcome of the patient. We therefore advocate the use of such standardised PEFs for performing preoperative and perioperative assessment of surgical patients.

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To study the efficacy of intravenous dexamethasone in prolonging the duration of spinal anesthesia in elective cesarean section

Priyanka Sunil Shalu, Poonam Sachin Ghodki

Anesthesia: Essays and Researches 2017 11(2):321-325

Background and Aims: Various additives have been evaluated for the purpose of enhancing quality of analgesia and prolonging duration of spinal anesthesia. This randomized, double-blind study was conducted to evaluate the efficacy of intravenous dexamethasone in spinal anesthesia. Methods: A total of sixty patients scheduled for lower segment cesarean section under spinal anesthesia were randomly allocated into two groups, group SD and group SN, including thirty patients each. All the patients received injection bupivacaine 0.5% heavy 10 mg through spinal anesthesia. Group SD received injection dexamethasone 8 mg intravenously, and group SN received injection normal saline (NS) 2 cc immediately after spinal anesthesia. Duration of sensory block, motor block, postoperative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia, total analgesic requirement in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded. Whenever demanded rescue analgesia was given in the form of injection tramadol 100 mg. Results: The mean duration of sensory block (min) in group SD and group SN was 162.50 and 106.17, respectively which was highly significant. Similarly, time to the requirement of first rescue analgesia was prolonged in group SD (8.67 h) as compared to group SN (4.40 h). Significant changes were also seen in VAS score in postoperative period after 1 h of surgery in group SD and group SN. Duration of motor block, intra- and post-operative hemodynamic parameters were comparable in both the groups. No side effects were recorded in both the groups. Conclusion: We concluded that administration of dexamethasone 8 mg intravenously prolongs the duration of postoperative analgesia and sensory block in patients undergoing lower segment cesarean section under spinal anesthesia.

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Anesthesiologist's role in relieving patient's anxiety

Brij Mohan, Rajan Kumar, Joginder Pal Attri, Veena Chatrath, Neeru Bala

Anesthesia: Essays and Researches 2017 11(2):449-452

Introduction: Anesthesia and surgery have proved to be highly anxiety provoking and with the rise of elective surgery, its aspect of patient's experience has become prominent in time. However, our fault as anesthesiologists is that we have not made people get versed with what we people as anesthesiologist do in the operating room. Hence, keeping in view all this, a study was carried out, in which video information/images regarding anesthesia and surgical procedure was shown to patients on PowerPoint Presentation. Different images showing previous patient's hospital journey were shown to educate patients. Methods: Two hundred patients scheduled to undergo elective surgery were taken and were divided into two groups of 100 each. Patients (study group or Group I) were shown video clippings/images of other previously operated patients and their hospital journey including surgery and anesthesia for which patient came in hospital. The study was carried out on the patient in each group while Group II was treated in normal way and not shown any type of images/videos. Hamilton Anxiety Rating Scale was used as a criterion to measure the level of anxiety in Group I and II at four different intervals that are before pre anesthetic check up (PAC), after showing videos and images in Group I, 1 h before surgery and 8 h after surgery. Statistical Analysis: The results of observation of both the groups at different intervals time were statistically compared and analyzed. These characteristics were analyzed using the "Chi-square tests" and "unpaired t-test." Results: Video and images information if done preoperatively have been shown to reduce patient's anxiety, although little is known regarding the effects of the method. Conclusion: Showing videos/images of hospital journey for educating the patients before the operation is beneficial to patients undergoing elective surgery.

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Randomized controlled trial for evaluating the analgesic effect of nalbuphine as an adjuvant to bupivacaine in supraclavicular block under ultrasound guidance

Nazia Nazir, Shruti Jain

Anesthesia: Essays and Researches 2017 11(2):326-329

Introduction: Benefits of regional anesthesia can be prolonged by adding adjuvants to local anesthetics. This study was designed to test the efficacy of adding nalbuphine to bupivacaine in supraclavicular brachial plexus blockade using ultrasound (US) guidance. Methodology: This was a prospective, randomized, double-blind study involving sixty patients of either sex undergoing elective orthopedic procedures of upper limb. In control Group C (n = 30), 30 mL of 0.375% bupivacaine + 1 mL normal saline and in study Group N (n = 30), 30 mL of 0.375% bupivacaine + 1 mL (10 mg) nalbuphine were used for giving supraclavicular block under US guidance. Parameters assessed were onset and duration of sensory and motor block, duration of analgesia (DOA), and any adverse events. Data between the groups were analyzed using independent t-test with SPSS 16.0 software. Results: In Group N, there was a statistically significant shorter time to onset of sensory blockade (4.89 ± 1.5 vs. 14.62 ± 1.73 min, P = 0.000), longer duration of sensory block (373.17 ± 15.56 min vs. 157.82 ± 11.02 min, P = 0.000), shorter onset time to achieve motor block (8.83 ± 1.9 min vs. 18.76 ± 1.75 min, P = 0.000), longer duration of motor block (313.92 ± 16.22 min vs. 121.87 ± 16.62 min, P = 0.000), and prolonged analgesia (389.33 ± 14.52 min vs. 171.65 ± 19.79 min, P = 0.000). Conclusion: Nalbuphine when added to bupivacaine as an adjuvant in supraclavicular block significantly shortened the onset of sensory and motor block and enhanced the duration of sensory and motor block and DOA.

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Comparison between conventional and ultrasound-guided supraclavicular brachial plexus block in upper limb surgeries

Kiran Abhayakumar Honnannavar, Mahantesh Shivangouda Mudakanagoudar

Anesthesia: Essays and Researches 2017 11(2):467-471

Introduction: Brachial plexus blockade is a time-tested technique for upper limb surgeries. The classical approach using paresthesia technique is a blind technique and may be associated with a higher failure rate and injury to the nerves and surrounding structures. To avoid some of these problems, use of peripheral nerve stimulator and ultrasound techniques were started which allowed better localization of the nerve/plexus. Ultrasound for supraclavicular brachial plexus block has improved the success rate of the block with excellent localization as well as improved safety margin. Hence, this study was planned for comparing the efficacy of conventional supraclavicular brachial plexus block with ultrasound-guided technique. Subjects and Methods: After obtaining the Institutional ethical committee approval and patient consent total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: US (Group US) and C (Group C). Both groups received 0.5% bupivacaine. The amount of local anesthetic injected calculated according to the body weight and was not crossing the toxic dosage (injection bupivacaine 2 mg/kg). The parameters compared between the two groups were lock execution time, time of onset of sensory and motor block, quality of sensory and motor block success rates were noted. The failed blocks were supplemented with general anesthesia. Results: Demographic data were comparable in both groups. The mean time taken for the procedure to administer a block by eliciting paresthesia is less compared to ultrasound, and it was statistically significant. The mean time of onset of motor block, sensory blockade, the duration of sensory and motor blockade was not statistically significant. The success rate of the block is more in ultrasound group than conventional group which was not clinically significant. The incidence of complications was seen more in conventional method. Conclusion: Ultrasound guidance is the safe and effective method for the supraclavicular brachial plexus block. Incidence of complications are less as ultrasound provides real-time visulaization of underlying structures and the spread of local anaesthetic.

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Effect of pregabalin premedication on the requirement of anesthetic and analgesic drugs in laparoscopic cholecystectomy: Randomized comparison of two doses

Prasoon Gupta, Anudeep Saxena, Lalita Chaudhary

Anesthesia: Essays and Researches 2017 11(2):330-333

Background: Preoperative medication has a vital role in anesthesia. Pregabalin (PG) is a newer drug of gabapentinoid class and is six times more potent than gabapentin. Our study was designed to evaluate the effect of PG as premedication on the perioperative anesthetic requirement and analgesia. Materials and Methods: The study was conducted on ninety patients of American Society of Anesthesiologists Grade I and II of age group 20–60 years, allocated to one of the three groups of thirty patients each. Group I received tablet diazepam 10 mg HS and 5 mg 1 h before surgery, Group II received capsule PG 75 mg HS and 150 mg 1 h before surgery, and Group III received capsule PG 75 mg HS and 300 mg 1 h before surgery. Patients were induced with injection fentanyl citrate, thiopentone sodium, and rocuronium bromide and maintained by 66% N2O + 33% O2gas mixture with sevoflurane and intermittent boluses of fentanyl. Results: Perioperative consumption of thiopentone sodium was 5.59 ± 0.49 mg/kg in Group I, 4.29 ± 0.53 mg/kg in Group II, and 4.06 ± 0.59 mg/kg in Group III; fentanyl was 1.55 ± 0.42 μg/kg in Group I, 1.00 ± 0.00 μg/kg in Group II, and 1.05 ± 0.20 μg/kg in Group III; sevoflurane (%) was 1.20 ± 0.31 in Group I, 0.933 ± 0.25 in Group II, and 1.00 ± 0.00 in Group III. Perioperative requirement of thiopentone sodium, opioid, and inhalational agent was significantly less in Group II and III when compared with Group I. Maximum number of patients required postoperative rescue analgesia within 0–2 h of surgery in Group I, 2–4 h of surgery in Group II, and 6–8 h after surgery in Group III. Patients were more comfortable and asleep with a longer pain-free postoperative period in PG groups. Conclusion: PG premedication effectively reduced the consumption of all anesthetic agents during induction and maintenance of anesthesia as compared to diazepam. Patient's postoperative comfort and pain-free duration were also greater with PG premedication; more so with PG 300 mg as compared to PG 150 mg.

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Exploring the Concern about Food Allergies among Secondary School and University Students in Ontario, Canada: A Descriptive Analysis

Our objective was to explore the perceived risk of food allergies among students in Ontario, Canada. We analyzed blinding questions ("I am concerned about food allergies"; "food allergies are currently a big threat to my health") from three existing food safety surveys, given to high school and university undergraduate students () circa February 2015, using descriptive analysis, and explored how concern related to demographics and self-reported cooking ability using linear regression. Overall, high school students were neutral in their concern, although Food and Nutrition students specifically were significantly less concerned () than high school students overall. University undergraduates were moderately unconcerned about food allergies. Concern was highest in younger students, decreasing between 13 and 18 years of age and plateauing between 19 and 23 years. Among students aged 13–18 years, concern was higher among those who worked or volunteered in a daycare and who had previously taken a food preparation course. Among students aged 19–23 years, concern was higher among females and those with less advanced cooking abilities. Concern was significantly correlated with perceiving food allergies as a personal threat. This study offers a first exploration of perceived risk of food allergies among this demographic and can guide future, more rigorous assessments.

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Editorial Board

Publication date: May–June 2017
Source:American Journal of Otolaryngology, Volume 38, Issue 3





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Table of Contents

Publication date: May–June 2017
Source:American Journal of Otolaryngology, Volume 38, Issue 3





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Guidelines for Contributing Authors

Publication date: May–June 2017
Source:American Journal of Otolaryngology, Volume 38, Issue 3





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Natriuretic peptide receptor A is related to the expression of vascular endothelial growth factors A and C, and is associated with the invasion potential of tongue squamous cell carcinoma

Publication date: Available online 15 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Y. Nakao, S. Yamada, S. Yanamoto, T. Tomioka, T. Naruse, T. Ikeda, H. Kurita, M. Umeda
Natriuretic peptide receptor A (NPRA) is one of the natriuretic peptide receptors. NPRA has been reported to play a role in the carcinogenesis of various tumours, as well as functional roles in renal, cardiovascular, endocrine, and skeletal homeostasis. The clinicopathological significance of NPRA in tongue squamous cell carcinoma (TSCC) was examined in this study. The overexpression of NPRA was more frequent in TSCC (21/58, 36.2%) than in the normal oral epithelium (0/10, 0%) (P<0.05). It was also more frequently observed in cancers with higher grades according to the pattern of invasion (grades 1–2 vs. grades 3–4, P<0.01). Additionally, there was a tendency towards an association between the N classification and NPRA expression (N0 vs. N1–2, P=0.06). Significant correlations were also observed between the expression of NPRA and that of VEGF-A (P<0.001) and VEGF-C (P<0.001). The high-NPRA expression group had a significantly poorer prognosis, with a 5-year disease-specific survival rate of 39.7%, compared to 97.0% in the low-expression group (P<0.001). Multivariate analysis suggested that the overexpression of NPRA may also be an independent prognostic factor (P<0.05). In conclusion, NPRA is associated with VEGF expression levels, invasion, and metastasis, and may be a prognostic factor in TSCC patients.



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Assessment of vertical ridge augmentation in anterior aesthetic zone using onlay xenografts with titanium mesh versus the inlay bone grafting technique: A randomized clinical trial

Publication date: Available online 16 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Mounir, S. Mounir, A.A. Elfetouh, M.A. Shaker
The aim of this study was to evaluate the final vertical gain at the deficient anterior maxillary alveolar ridges using onlay bone grafts with titanium mesh versus inlay bone grafting. This was a single institutional randomized comparative clinical trial. The study population included 16 patients, with edentulous anterior maxillary alveolar ridges (40 implant sites) who were presented and treated at the Faculty of Oral and Dental Medicine in Cairo University from September 2013 to August 2015. Selected patients were randomly divided into two equal groups. The control group received onlay particulate xenograft together with titanium mesh as a space-maintaining device while the study group received inlay block xenograft (sandwich osteotomy) fixed with mini-plates. Assessment using cone beam computed tomography (CBCT) included the mean percentage of vertical gain at the proposed implant sites after 6 months taken from cross-sectional cuts. A total of 40 delayed implant placements were done. Results showed that there was no statistical significance between the two groups (P=0.2); the mean percentage of 6 months postoperative vertical bone gain in the control group was 20.7% and that in the study group was 31.6%.



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Aesthetic and functional outcomes in patients with a nasal prosthesis

Publication date: Available online 15 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): C. Becker, A.M. Becker, K.K.K. Dahlem, C. Offergeld, J. Pfeiffer
The aim was to evaluate the aesthetic and functional outcomes in patients with a nasal prosthesis after radical tumour resection. A questionnaire with 15 domains was created to evaluate the satisfaction of patients with their nasal prosthesis. Correlations with the results of the University of Washington Quality of Life (UWQOL) questionnaire, which was also completed by the patients, were analyzed. Forty-three patients with a partial or total nasal prosthesis completed the questionnaire. Twenty-seven patients were male and 16 were female; their median age was 62 years. The median follow-up time after tumour resection was 33 months. The best result was obtained for overall function (85.5) and the worst result for nasal crusts (58.5). The average daily duration of prosthesis use was 17.4h. There were sex-dependent and age-dependent differences in the domain 'self-confidence', age-dependent differences in the domain 'stability during sporting activities', and differences in the domain 'nose bleed' depending on the time since tumour resection. All patients would recommend this rehabilitation after rhinectomy. 'Satisfaction with function' had the most influence on UWQOL domains. The nasal prosthesis is a well-accepted rehabilitation after rhinectomy. The results for appearance are comparable to those obtained for nasal reconstruction, and high scores were found for the functional domains.



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Localized myofascial pain responds better than referring myofascial pain to botulinum toxin injections

Publication date: Available online 15 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): W.A. Abboud, S. Hassin-Baer, M. Joachim, N. Givol, R. Yahalom
Myofascial pain of the muscles of mastication is a common temporomandibular disorder. Patients unresponsive to conservative treatment modalities pose a therapeutic challenge to the treating clinician. The efficacy of intramuscular botulinum toxin injections for recalcitrant cases is still not well established due to mixed results from clinical trials. The Diagnostic Criteria of Temporomandibular Disorders (DC/TMD) classified chronic muscle pain broadly into a localized pattern (when pain is localized to the site of palpation or the muscle palpated) and a referring pattern (when the pain spreads beyond the boundary of the muscle being palpated). The medical records of 25 consecutive patients treated with botulinum were analysed retrospectively. Significant pain reduction was achieved in 69.2% of the patients with localized myofascial pain and 16.7% of the patients with referring myofascial pain (P=0.015). Seventy-seven per cent of the patients with localized myofascial pain reported using less analgesic throughout the follow-up period, whereas only 25% of the patients with referring myofascial pain (P=0.017). The effects of botulinum toxin in responsive patients subsided after a mean of 3.21 months. Patients with localized myofascial pain benefited from botulinum toxin injections, but patients with referring myofascial pain responded poorly to this treatment.



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There is variability in our perception of the standard head orientation

Publication date: Available online 15 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): G.N. Hughes, J. Gateño, J.D. English, J.F. Teichgraeber, J.J. Xia
The purposes of this study were to determine: (1) whether an observer's perception of the correct anatomical alignment of the head changes with time, and (2) whether different observers agree on the correct anatomical alignment. To determine whether the perception of the correct anatomical alignment changes with time (intra-observer comparison), a group of 30 observers were asked to orient, into anatomical alignment, the three-dimensional (3D) head photograph of a normal man, on two separate occasions. To determine whether different observers agree on the correct anatomical alignment (inter-observer comparison), the observed orientations were compared. The results of intra-observer comparisons showed substantial variability between the first and second anatomical alignments. Bland–Altman coefficients of repeatability for pitch, yaw, and roll, were 6.9°, 4.4°, and 2.4°, respectively. The results of inter-observer comparisons showed that the agreement for roll was good (sample variance 0.4, standard deviation (SD) 0.7°), the agreement for yaw was moderate (sample variance 2.0, SD 1.4°), and the agreement for pitch was poor (sample variance 15.5, SD 3.9°). In conclusion, the perception of correct anatomical alignment changes considerably with time. Different observers disagree on the correct anatomical alignment. Agreement among multiple observers was bad for pitch, moderate for yaw, and good for roll.



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Does pterygomaxillary disjunction in surgically assisted rapid maxillary expansion influence upper airway volume? A prospective study using Dolphin Imaging 3D

Publication date: Available online 15 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J. Rômulo de Medeiros, M. Ferraro Bezerra, F.W. Gurgel Costa, T. Pinheiro Bezerra, C.R. de Araújo Alencar, E.C. Studart Soares
Surgically assisted rapid maxillary expansion has been used for the treatment of transverse maxillary deficiency. This prospective study aimed to evaluate the effect of this surgery (with or without pterygomaxillary disjunction) on the upper airway volume. The patients were randomly divided into two groups: without pterygomaxillary disjunction (−PD) and with pterygomaxillary disjunction (+PD). Eleven patients per group were estimated to obtain a representative sample (90% of power and 95% of confidence level). Volumetric images of cone beam computed tomography scans were obtained preoperatively, immediately after Hyrax screw stabilization and 6 months after Hyrax screw stabilization. Volumetric measurements of the nasal cavity, maxillary sinuses, nasopharynx, and oropharynx, and of the minimum oropharynx cross-sectional area were obtained using Dolphin 3D Imaging Software. The final sample consisted of 25 adult individuals (+PD group, n=12; −PD group, n=13). In the +PD group, we observed a statistically significant increase immediately after Hyrax screw stabilization for the nasopharynx volume (P=0.003), oropharynx volume (P=0.007) and oropharynx cross-sectional area (P=0.001). Pterygomaxillary disjunction resulted in a significant (P <0.05) increase in volumetric measurements of the nasopharynx and minimum oropharynx cross-sectional area 6 months after the expander device stabilization.



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Evaluation of the papilla level adjacent to implants placed in fresh, healing or healed sites: A systematic review

Publication date: Available online 15 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M.C. Goiato, R.A. de Medeiros, E.V.F. da Silva, D.M. dos Santos
A better understanding of factors that can lead to papilla formation or recession, such as the type of site where the implant was placed, is of fundamental importance to the aesthetic success of the rehabilitation. The aim of this study was to perform a systematic review of the literature regarding the formation or recession of papilla adjacent to implants placed in fresh, healing or healed sites. The protocol for this study was registered in the PROSPERO database (registration number CRD 42016033784). An electronic search was performed by two independent reviewers who applied the inclusion and exclusion criteria on the PubMed/MEDLINE, Scopus, and Embase databases from January 2005 up to February 2016. The initial screening yielded 1,065 articles, from which 15 were selected for a systematic review after applying the inclusion and exclusion criteria. Nine studies compared fresh and healed sites, four studies compared healing and healed sites, one study compared fresh and healing sites, and one study analysed all three sites. The majority of studies identified by this systematic review showed no difference between groups after the longer follow-up period. The sites where the implants were placed did not have a long-term influence on papilla formation or recession.



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Does local delivery of bisphosphonates influence the osseointegration of titanium implants? A systematic review

Publication date: Available online 15 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M.B. Guimarães, T.H. Antes, M.B. Dolacio, D.D. Pereira, M. Marquezan
The aim of this study was to systematically review the influence of the local delivery of bisphosphonates on the osseointegration of titanium implants in humans. A search of health sciences databases was performed (The Cochrane Library, Embase, PubMed MEDLINE, ISI Web of Knowledge, Scopus, and SIGLE OpenGrey), including articles published until October 2016. A total of 679 articles were identified. Following the removal of duplicates, 278 were screened by title and abstract. The complete texts of seven studies were read, and of these, three met the inclusion criteria. Each article included in the analysis was submitted to a quality and level of evidence evaluation, and relevant data were extracted and tabulated. Despite methodological differences, all articles presented positive results for osseointegration when a local bisphosphonate was used: the authors reported greater implant stability, better implant survival rates, and reduced peri-implant bone loss when compared with the control groups. On the basis of the results of this systematic review, it is concluded that the local use of a bisphosphonate appears to favour the osseointegration of titanium implants in humans. Nonetheless, a higher level of standardization and the control of methodological bias is required in future research so that stronger evidence might be produced.



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Assessment of vertical ridge augmentation in anterior aesthetic zone using onlay xenografts with titanium mesh versus the inlay bone grafting technique: A randomized clinical trial

The aim of this study was to evaluate the final vertical gain at the deficient anterior maxillary alveolar ridges using onlay bone grafts with titanium mesh versus inlay bone grafting. This was a single institutional randomized comparative clinical trial. The study population included 16 patients, with edentulous anterior maxillary alveolar ridges (40 implant sites) who were presented and treated at the Faculty of Oral and Dental Medicine in Cairo University from September 2013 to August 2015. Selected patients were randomly divided into two equal groups.

http://ift.tt/2qpGvpd

Screening for psychological distress: a new approach to identify the patient´s psychological needs in a pilot study on oral cancer patients

A new screening tool has been developed to predict the psychological needs of patients with oral cancer.

http://ift.tt/2rojnVv

Automated Cleft Speech Evaluation Using Speech Recognition

Perceptual evaluation remains the gold-standard evaluation of cleft speech, but with any human interpretation, there can be bias. Eliminating bias, allowing comparison of speech data between units, is labor and time intensive. Globally, there is a shortage of listeners. We have developed a computer learning system to evaluate cleft speech.Our automated cleft speech evaluator interprets resonance and articulatory cleft speech errors. Speech recognition engines typically ignore voice characteristics and speech errors of the speaker, but in cleft speech evaluation, these features are paramount.

http://ift.tt/2qpLC9b

Half of US Men Have Penile HPV, But What Does This Mean?

Population-level testing for penile HPV infection showed a high and 'surprising' prevalence of HPV. But what does it mean clinically?
Medscape Medical News

http://ift.tt/2qjQrQS

EpiPens Should Work At Least a While Past Expiration Dates

It's worth a shot to use an expired EpiPen, if that's all that's available, a new study suggests.
Reuters Health Information

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Preparing pathology for precision medicine: challenges and opportunities

http://ift.tt/2qpWiV9

Metástasis de adenocarcinoma de vesícula biliar a piel de conducto auditivo externo, a propósito de un caso

Publication date: Available online 15 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): Valery Nuñez Carrasco, Jose Luis Serdio Arias, Juan Jose Artazkoz del Toro, Leticia Melgar Vilaplana




http://ift.tt/2ronH8j

Comments on “Alveolar sarcoma of the parapharyngeal space: A case report”

Publication date: Available online 15 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): Ana María Cano-Valdez, Diana Brisa Sevilla-Lizcano, Abelardo Meneses-García




http://ift.tt/2qP0y1F

Vértigo posicional paroxístico benigno, ese gran desconocido

Publication date: Available online 15 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): Virginia Franco-Gutiérrez, Paz Pérez




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Does calcemia influence the onset of myringosclerosis after myringotomy with the insertion of ventilation tubes?

Publication date: Available online 15 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): Carla Branco, João Paço
IntroductionMyringosclerosis is one of the most frequent late complications of the insertion of ventilation tubes, and its aetiopathogenesis remains unknown. The calcification that occurs in the formation of myringosclerosis plaque raises the hypothesis of the presence of a calcium metabolism disorder. The objective is to determine whether calcemia contributes to the development of myringoscelerosis after insertion of ventilation tubes.Material and methodsA longitudinal, prospective, analytical cohort study was conducted in patients undergoing myringotomy with the insertion of ventilation tubes due to otitis media with effusion. Calcemia was evaluated pre-operatively and in the follow-up the appearance of myringosclerosis and the percentage of the tympanum involved were evaluated.ResultsThe study included 156 patients (297 ears), with calcemia values ranging from 7.6 to 10.2mg/dl. Myringosclerosis was identified in 35.4% of the operated ears. No relationship was found between the appearance of myringosclerosis and calcemia (p=.596). It was found, however, that the greater the percentage of the tympanum affected by myringosclerosis, the lower the calcemia values (p=.014).ConclusionThe population studied had calcemia values within the normal range, which allows us to infer that no changes in calcium metabolism are required for the development of myringosclerosis. Moreover, unlike in previous studies, higher calcium levels are not associated with more myringosclerosis. Calcemia did not influence the appearance of myringosclerosis after myringotomy with the insertion of ventilation tubes.



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Facial asymmetry revisited: Part I- diagnosis and treatment planning

Publication date: Available online 15 May 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Dhirendra Srivastava, Harpreet Singh, Sonal Mishra, Poonam Sharma, Pranav Kapoor, Lokesh Chandra
Facial asymmetry is an individualized characteristic and is commonly observed sub clinically in overall population. However, clinically significant facial asymmetry with associated morphologic, esthetic and stomatognathic problems warrant investigation of the underlying etiology and comprehensive clinical examination in conjunction with imaging studies for diagnosis, localization of asymmetry and treatment planning. The principal aim of this article is to present an invaluable insight into etiopathogenesis, myriad classifications and various systematic diagnostic approaches indispensable for formulation of treatment plan and appropriate management of facial asymmetry.



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SOP – Palliative Sedierung

http://ift.tt/2rnf5hQ

SOP – Schmerztherapie bei Palliativpatienten

http://ift.tt/2qNMzZT

Epistaxis in anticoagulated patients: Fewer hospital admissions and shorter hospital stays on rivaroxaban compared to phenprocoumon

Abstract

Objectives

Treatment of epistaxis in patients on anticoagulants is challenging and associated with higher admission rates and longer hospital stays compared to patients without anticoagulation. However, there is little information about epistaxis in patients taking new direct oral anticoagulants such as rivaroxaban compared to patients on traditional vitamin-K antagonists such as phenprocoumon.

Design

Retrospective cohort study.

Setting

The study was conducted at the emergency department of the University Hospital Inselspital, Bern, Switzerland.

Participants

All admissions to the emergency department of the University Hospital Inselspital, Bern, Switzerland from July 1st 2012 to June 30th 2016 with non-traumatic epistaxis on anticoagulant therapy with phenprocoumon or rivaroxaban were included.

Main outcome measures

We compared clinical outcome parameters (admission rates, length of hospital stay and mortality) for both anticoagulant groups.

Results

We included 440 patients with epistaxis, 123 (28%) on rivaroxaban and 317 (72%) on phenprocoumon. Fewer hospital admissions and shorter hospital stays were found in patients under rivaroxaban (12 (10.4%) vs. 57 (18.0%) patients, p=0.033; 0.7±2.2 vs. 1.5±3.7 days, p=0.011) compared to phenprocoumon. Anterior epistaxis was more common in the rivaroxaban group in contrast to posterior epistaxis in patients on phenprocoumon (74 (60.2%) vs. 139 (43.8%) patients, p=0.002; 7 (5.7%) vs. 39 (12.3%) patients, p=0.042).

Conclusions

Our data suggests that epistaxis on direct oral anticoagulation with rivaroxaban is associated with shorter hospital stays and fewer hospital admissions than epistaxis on vitamin-K antagonist phenprocoumon.

This article is protected by copyright. All rights reserved.

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Observational study of free public sunscreen dispenser use at a major US outdoor event

To the Editor: The American Academy of Dermatology and Centers for Disease Control and Prevention currently recommend sun protection measures in outdoor public spaces as part of a strategy to combat the rising incidence of skin cancer.1,2 However, few venues have opted to offer free sunscreen, and to our knowledge the use in such venues has not been described in detail.

http://ift.tt/2qodzO5

Physiological Striae Atrophicae of Adolescence with Involvement of the Axillae and Proximal Arms

We report a 16-year-old adolescent male with multiple violaceous, atrophic, vertical linear striae isolated to the axillae and proximal arms of approximately one-year duration. In the past two years, he indulged in heavy weight-lifting. He experienced a growth spurt over the past few years. The patient was otherwise in good health and was not on any medications. Physiological striae atrophicae of adolescence where the striae were restricted to the axillae and proximal arms have very rarely been reported.

http://ift.tt/2qnPt6D

Use of propranolol in a remote region of rural Guatemala to treat a large facial infantile haemangioma

We present a female infant with a right-sided facial and neck haemangioma, from a remote, resource-poor community in rural Guatemala. She received first-line treatment, propranolol, with marked reduction in tumour size and erythema. Treatment was stopped after 35 weeks due to recurrent diarrhoea and sustained weight loss. Propranolol can be used to safely treat infants with haemangiomas in remote, rural communities if there is adequate follow-up, education and communication. Periocular haemangiomas should be treated promptly to avoid visual impairment. Infants with large facial haemangiomas should be screened for Posterior fossa anomalies, Hemangioma, Arterial anomalies, Cardiac anomalies, and Eye anomalies (PHACE) syndrome, and specialists should be involved. The case also highlights the difficulty of providing treatment for a complex illness when basic health needs, such as food security and water sanitation, are limited.

http://ift.tt/2qnyEZ0

Full-thickness gaping wound in the inguinal region of prenatal origin in an extremely premature baby

Description

This baby boy weighing 810 g at birth was born at 24 6/7 weeks to a healthy primigravida with uncomplicated pregnancy until 24 weeks. She was hospitalised from 24 weeks' gestation onwards for threatened preterm labour. Serial bedside ultrasound showed the baby to be in a breech position with bulging membranes and a visible loop of umbilical cord within the cervical os. About 48 hours prior to delivery, there was some leaking of amniotic fluid indicating possible rupture of membranes. She was not in active labour apart from intermittent contractions. Elective caesarean section was done for concerns with cord prolapse. Delivery was unremarkable with no surgical trauma or traction to the leg as confirmed by the obstetrician. The infant was resuscitated per protocol and transferred to the neonatal intensive care unit. At birth, the baby was found to have a full-thickness deep gaping wound in the right inguinal...

http://ift.tt/2pSnsjQ

Treatment of severe hypocalcaemia due to osteoblastic metastases in a patient with post-thyroidectomy hypoparathyroidism with 153Sm-EDTMP

Symptomatic hypocalcaemia is an uncommon finding in patients with malignant tumours. We describe a patient with advanced metastatic breast cancer who developed severe hypocalcaemia caused by the combination of osteoblastic metastases and a permanent postoperative hypoparathyroidism. The patient failed to be treated with the conventional replacement therapy and was submitted effectively to radionucleotide therapy with ¹⁵³Sm.

http://ift.tt/2qnLdUp

SynRinse Irrigation Pilot (SIP) Trial

Conditions:   Sinusitis, Chronic;   Cystic Fibrosis With Other Manifestations
Intervention:   Drug: Synrinse
Sponsor:   University of Washington
Not yet recruiting - verified May 2017

http://ift.tt/2rc3FAv

Health Care Coach Support in Reducing Acute Care Use and Cost in Patients With Cancer

Conditions:   Acute Myeloid Leukemia;   Brain Glioblastoma;   Estrogen Receptor Negative;   Extensive Stage Small Cell Lung Carcinoma;   Head and Neck Carcinoma;   HER2/Neu Negative;   Hormone-Resistant Prostate Cancer;   Limited Stage Small Cell Lung Carcinoma;   Myelodysplastic Syndrome;   Progesterone Receptor Negative;   Progressive Disease;   Recurrent Carcinoma;   Stage II Pancreatic Cancer;   Stage II Rectal Cancer;   Stage IIA Pancreatic Cancer;   Stage IIA Rectal Cancer;   Stage IIB Pancreatic Cancer;   Stage IIB Rectal Cancer;   Stage IIC Rectal Cancer;   Stage III Colon Cancer;   Stage III Esophageal Cancer;   Stage III Gastric Cancer;   Stage III Non-Small Cell Lung Cancer;   Stage III Ovarian Cancer;   Stage III Pancreatic Cancer;   Stage III Rectal Cancer;   Stage III Skin Melanoma;   Stage IIIA Colon Cancer;   Stage IIIA Esophageal Cancer;   Stage IIIA Gastric Cancer;   Stage IIIA Non-Small Cell Lung Cancer;   Stage IIIA Ovarian Cancer;   Stage IIIA Rectal Cancer;   Stage IIIA Skin Melanoma;   Stage IIIB Colon Cancer;   Stage IIIB Esophageal Cancer;   Stage IIIB Gastric Cancer;   Stage IIIB Non-Small Cell Lung Cancer;   Stage IIIB Ovarian Cancer;   Stage IIIB Rectal Cancer;   Stage IIIB Skin Melanoma;   Stage IIIC Colon Cancer;   Stage IIIC Esophageal Cancer;   Stage IIIC Gastric Cancer;   Stage IIIC Ovarian Cancer;   Stage IIIC Rectal Cancer;   Stage IIIC Skin Melanoma;   Stage IV Bladder Cancer;   Stage IV Bone Sarcoma;   Stage IV Breast Cancer;   Stage IV Colon Cancer;   Stage IV Esophageal Cancer;   Stage IV Gastric Cancer;   Stage IV Non-Small Cell Lung Cancer;   Stage IV Ovarian Cancer;   Stage IV Pancreatic Cancer;   Stage IV Rectal Cancer;   Stage IV Renal Cell Cancer;   Stage IV Skin Melanoma;   Stage IV Soft Tissue Sarcoma;   Stage IVA Bone Sarcoma;   Stage IVA Colon Cancer;   Stage IVA Rectal Cancer;   Stage IVB Bone Sarcoma;   Stage IVB Colon Cancer;   Stage IVB Rectal Cancer;   Triple-Negative Breast Carcinoma
Interventions:   Other: Best Practice;   Other: Laboratory Biomarker Analysis;   Procedure: Supportive Care;   Other: Survey Administration
Sponsor:   Stanford University
Recruiting - verified May 2017

http://ift.tt/2pQN1SV

A Study of Taselisib + Fulvestrant Versus Placebo + Fulvestrant in Participants With Advanced or Metastatic Breast Cancer Who Have Disease Recurrence or Progression During or After Aromatase Inhibitor Therapy

Condition:   Breast Cancer
Interventions:   Drug: Taselisib;   Drug: Placebo;   Drug: Fulvestrant
Sponsor:   Hoffmann-La Roche
Recruiting - verified May 2017

http://ift.tt/2rc1yMX

A case of refractory chronic rhinosinusitis with anti-desmoglein 3 IgG4 autoantibody

Publication date: Available online 15 May 2017
Source:Allergology International
Author(s): Yasushi Ota, Fumio Ishikawa, Toshiya Sato, Nobuyuki Hiruta, Makoto Kitamura, Hiromitsu Yokota, Yoshihiro Ikemiyagi, Hideaki Bujo, Mutsunori Fujiwara, Mitsuya Suzuki




http://ift.tt/2rbCJAX

Social isolation and cancer management – advanced rectal cancer with patient delay following the 2011 triple disaster in Fukushima, Japan: a case report

Little is known about the effects of social isolation in the elderly on their process of gaining health information and seeking health care.

http://ift.tt/2qndydV

Why a registry of Chronic Urticaria (CUR) is needed

Chronic urticaria (CU) has a major effect on patients' quality of life. While there have been progressive advances regarding its pathogenesis and treatment, much remains to be done.

http://ift.tt/2pS0KrP

Evaluation of the skin phototoxicity and photosensitivity of honeybee venom

Summary

Objective

Bee (Apis mellifera L.) venom (BV) has been used as a cosmetic ingredient owing to its anti-aging, anti-inflammatory, and antibacterial effects. The aim of this study was to assess the skin safety of BV.

Methods

For this purpose, skin phototoxicity and sensitization tests were conducted in healthy male Hartley guinea pigs. The animals were divided into three groups (n=5) for the phototoxicity test: G1 (negative control), G2 (BV gel treatment), and G3 (positive control). After specified treatments, the animals were irradiated with ultraviolet A (15 J/cm²). The photosensitivity test was also performed in three groups: G4 (negative control, n=5), G5 (BV gel treatment, n=10), and G6 (positive control, n=5).

Results

Erythema and edema were observed after 24, 48, and 72 hours in the positive control group, but not in the negative control and BV gel groups. Application of BV to the guinea pig skin had no toxic effects on any clinical signs, body weight, or mortality. In addition, it did not evoke a skin reaction in both either the skin phototoxicity and skin photosensitization tests.

Conclusion

Therefore, it can be concluded that BV has the potential to be developed as a drug ingredient for topical uses.

http://ift.tt/2pRTI6E

Risankizumab versus ustekinumab for moderate-to-severe plaque psoriasis

http://ift.tt/2pQq4PO

The gut–brain connection and the use of probiotics for the treatment of depression, anxiety and obsessive-compulsive disorders in dermatology

http://ift.tt/2rb4FVG

Increased proportions of functionally impaired regulatory T cell subsets in systemic sclerosis

Publication date: Available online 15 May 2017
Source:Clinical Immunology
Author(s): Emese Ugor, Diána Simon, Giovanni Almanzar, Ramóna Pap, József Najbauer, Péter Németh, Péter Balogh, Martina Prelog, László Czirják, Tímea Berki
Treg abnormalities have been implicated in the pathogenesis of systemic sclerosis (SSc). Treg subpopulations and their cytokines, IL-10 and TGF-β in the peripheral blood of early stage SSc patients were investigated. We hypothesized that epigenetically regulated methylation of the FOXP3 promoter and enhancer regions are altered in Tregs of SSc patients, which might be involved in the T cell imbalance. CD4+CD25+Foxp3+CD127− Treg cells were significantly elevated in patients with diffuse cutaneous SSc and in patients with anti-Scl-70/RNA-Pol-III autoantibody positivity and with lung fibrosis. Increased CD62L+ Treg cells were present in all SSc subgroups. The production of immunosuppressive cytokines by both CD127− and CD62L+ Tregs was diminished. We observed reduced methylation of Treg specific FOXP3 enhancer regions, and elevated FOXP3 gene expression in active SSc cases with negative correlation in the frequency of CD62L+IL-10+ Tregs. Our data indicate an inappropriate distribution and cytokine production of Treg cells in early form SSc.



http://ift.tt/2qmXsR7

Complete remission of primary cutaneous intravascular large B-cell lymphoma with R-CHOP followed by rituximab monotherapy

http://ift.tt/2rldzMH

Necrolytic migratory erythema associated with glucagonoma treated successfully with cyclosporine

http://ift.tt/2qmH2Z5

An Atypical variant of Supero-lateral dislocation of mandibular condyle: A case report

Publication date: Available online 15 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Kapil Malik, Subhas C. Debnath, Apurba K. Adhyapok, Kriti Hazarika
Dislocation of the mandibular condyle from the glenoid fossa can occur in anterior, posterior, lateral, and superior direction. All the groups apart from anterior dislocation are rare. Superolateral dislocation is seldom encountered in clinical practice. It is generally associated with fracture of the anterior or contralateral side of the mandible. The occurrence of superolateral dislocation of the condyle hooked above the zygomatic arch with associated fracture of the medial pole of the condyle is rare and reported only once in the literature.We present here another case report in which the patient had such superolateral dislocation of the mandibular condyle with fractured medial pole, and without any associated fracture of the anterior or contralateral side of the mandible. The condyle was hooked laterally above the zygomatic arch. Open reduction of dislocated condyle was performed and a good outcome was obtained.



http://ift.tt/2rbeuTp

Association between severe dental caries and child abuse and neglect

Publication date: Available online 15 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Henk Sillevis Smitt, Jenny de Leeuw, Tjalling de Vries
PurposeIn our maxillofacial practice we encountered some children with severe dental caries and whose teeth had to be removed; many later appeared to be abused children. The authors hypothesized that in the group of children who underwent multiple tooth extractions for caries under general anaesthesia, a higher percentage of children were found to be abused compared to the normal population.MethodsWe identified children who underwent multiple tooth extractions under general anaesthesia in a well-defined region in the Netherlands in the years 2005 and 2006. Subsequently, we sought these children in the database of the Dutch national organisation against domestic violence and child abuse (Veilig Thuis) in 2015.ResultsOf the total group of 376 children, 205 (55%) underwent the procedure because of caries in this period. In 47 (23%, 95%CI 20 – 26) of this group of children, child abuse and neglect was established by Veilig Thuis, while in 27 of them, the procedure occurred before child abuse was established.ConclusionThere appears to be a strong association between severe dental caries and child abuse and neglect. Hence, severe dental caries could be regarded as an early symptom of child abuse and neglect.



http://ift.tt/2pPTvl8

Intraoperative Imaging Changes Management in Orbital Fracture Repair

Publication date: Available online 15 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Vedant Borad, Martin S. Lacey, David D. Hamlar, Harley S. Dresner, Girijesh K. Yadava, Warren Schubert
PurposeIntraoperative imaging is gaining widespread use in the management of facial fracture repair. The aim of this study is to determine if intraoperative imaging changes the management of orbital fracture repair.MethodsA retrospective case series was performed for all cases of orbital fracture repair from 2008 to 2015 in which the intraoperative O-arm was used at Regions Hospital, a level I trauma center. The primary outcome variable was if a change in management occurred, ranging from orbital plate repositioning to proceeding with orbital floor exploration.ResultsThe study sample was composed of 101 patients with a mean age of 40 +/- 15 years. Approximately 75% (76/101) of patients were male, and 25% (25/101) female. All cases were secondary to assault, motor vehicle accident, fall, or gunshot wounds. The use of the O-arm resulted in a change in management in 44% (44/101) of cases. In 48% (21/44) of these cases in which intraoperative imaging resulted in a change in management, the orbital plate was repositioned to optimize repair. In 16% (7/44) of these cases, the orbital plate was exchanged for a different size and/or type of plate. In 7% (3/44) of these cases, the orbital plate was reshaped by bending to improve contour for the repair. In another 7% (3/44) of these cases, the orbital plate was reshaped by trimming the plate to optimize the length and/or width of the plate for repair. In 7% of these cases, the orbital floor required exploration based on intraoperative imaging. In 5% of these cases, the orbital floor was found to be adequately reduced after zygoma reduction based on intraoperative imaging, and did not require exploration.ConclusionsThe use of intraoperative imaging allows the surgeon to make real-time changes in operative management ranging from orbital plate repositioning to deciding whether to proceed with orbital floor exploration. This not only allows for immediate optimization of repair, but may also decrease the need for revision procedures, reducing patient morbidity and improving patient outcomes.



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Piezosurgery for Sagittal Split Osteotomy: Procedure Duration and Post-Operative Sensory Perturbation

Publication date: Available online 15 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): R. Köhnke, A. Kolk, L. Kluwe, O. Ploder
AimTo evaluate piezosurgery for sagittal split osteotomy with regard to its duration and inferior alveolar nerve (IAN) perturbation.Patients and MethodIn this prospective randomised study, we evaluated a total of 100 sagittal split osteotomy procedures (BSSO) in 50 patients. Piezoelectric (group I) and conventional osteotomies (group II) were carried out on each side of the mandible of a patient by two specialists. All surgeons had at least one-year experience with piezosurgery. The period from incision to complete splitting of the mandibular bone was recorded (termed procedure duration). The intraoperative status (visibility and relocation) of the IAN was also recorded. The neurosensory function (NF) of the IAN was measured by the two-point-discrimination threshold and static light touch methods before surgery and post-operatively (1, 3, 6 weeks, 6, 12 months). Parameters were compared between the test-groups by the paired t-, non-parametric Wilcoxon - or chi-square test.ResultsIn intergroup comparison the mean duration of osteotomy was highly significantly shorter for group I (17±6 vs. 25±9 minutes, P<0.001). The rate of intraoperative exposed IAN was slightly lower for the piezo-group (68%) compared to group II (81%). However, the difference was not significant. Neurosensory disturbance (ND) and recovery of the IAN did not differ between both groups.ConclusionPiezoelectric osteotomy requires significantly less time than conventional mechanical approaches but shows no advantage in preventing neurosensory perturbation.



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In Reply

Publication date: Available online 15 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Faez S. Al-Hamed, Mohammed A.Q. Al-Saleh, Mohamed A. Tawfik, Ehab Abdelfadil




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The efficacy of codeine when added to paracetamol (acetaminophen) and ibuprofen for relief of postoperative pain after surgical removal of impacted third molars: a double-blind randomised control trial

Publication date: Available online 15 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Adrian D. Best, R.K. De Silva, W.M. Thomson, Darryl C. Tong, Claire M. Cameron, Harsha L. De Silva
BackgroundThe use of opioids in combination with nonopioids is common practice for acute pain management after third molar surgery. One such combination is paracetamol/ibuprofen/codeine. We assessed the efficacy of codeine when added to a paracetamol/ibuprofen regimen for pain relief following third molar surgery.MethodsThis study was a randomised, double-blind, placebo-controlled trial conducted in patients undergoing the surgical removal of at least one impacted mandibular third molar requiring bone removal. Participants were randomly allocated to either a control group (paracetamol 1000mg/ibuprofen 400mg) or an intervention group (paracetamol 1000mg/ibuprofen 400mg/codeine 60mg). All participants were treated under intravenous sedation and using identical surgical conditions and technique. Postoperative pain was assessed using visual analogue scales every 3 hours (while awake) for the first 48 hours following surgery. Pain was globally assessed using a questionnaire on day 3 after surgery.ResultsThere were 131 participants (36% male), with 67 in the control group and 64 in the intervention group. Baseline characteristics were similar for both groups. Data were analysed using a modified intention-to-treat analysis and, for this, a linear mixed model was used. The model showed that the baseline VAS score was associated with the subsequent VAS scores and that, with each 3hr period, the VAS score increased by an average of 0.08. The treatment effect was not statistically significant, indicating there was no difference in recorded pain levels between the two groups over the first 48 hours following mandibular third molar surgery. Similarly, the two groups did not differ in their global ratings of postoperative pain.ConclusionCodeine 60mg added to a paracetamol 1000mg/ibuprofen 400mg regimen does not improve analgesia following third molar surgery.



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Efficacy of Platelet-Rich Fibrin After Mandibular Third Molar Extraction: A Systematic Review and Meta-Analysis

Publication date: Available online 15 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): João Vitor dos Santos Canellas, Fabio Gamboa Ritto, Paulo Jose D'Albuquerque Medeiros




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Three Dimensional Reconstruction of Post Traumatic Deficient Anterior Maxilla

Publication date: Available online 15 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Adi Rachmiel, Dekel Shilo, Dror Aizenbud, Mark Pen, Dana Rachmiel, Omri Emodi
PurposeMaxillary retrognathism appears in 14.3% of the patients exhibiting malocclusion following trauma treatment. In this manuscript we describe the application of alveolar distraction osteogenesis(ADO) for treating the severely deficient anterior maxilla following trauma injuries, both in the vertical and anteroposterior planes.Material and MethodsThis is a retrospective study of patients exhibiting severe vertical and anteroposterior maxillary bone deficiency following trauma injuries and treated by ADO as a first stage with additional Le Fort I advancement when required. Predictor variables included ADO for alveolar augmentation and Le Fort I advancement for anteroposterior discrepancy following ADO. Outcome variables included dental implant failure and anteroposterior maxillary relations.ResultsTwelve patients with severe atrophic anterior maxilla secondary to trauma injuries were included and treated using ADO. In accordance to the size of the horizontal deficiency, one or two distractors were used. Vertical alveolar distraction was performed and the transported segments were elongated at a rate of 0.5 mm/day to a mean total of 13.9 mm (between 12-15 mm). In four cases out of twelve there was a severe anterior-posterior discrepancy of over 8 mm which could not be fully corrected using an anterior inclination during the vertical elongation. Therefore, a second stage of conventional Le-Fort I advancement was performed. 38 dental implants were inserted showing a survival rate of 97.37% with a median of 6.2 years follow-up.ConclusionsIn this manuscript we described the treatment of the deficient anterior maxilla following trauma injuries, both in the vertical and anteroposterior planes, including implant-based dental rehabilitation. The main advantages include simultaneous bone and mucosa augmentation, no donor site morbidity, significantly higher vertical augmentation compared to other methods and minimal relapse. Using an additional Le-Fort I advancement in severe cases permits a useful method for proper repositioning of the maxilla, thus resulting in superior inter-maxillary relations.



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Application of Combined Osteotomy and Reconstruction Pre-Bent Plate Position (CORPPP) Technology to Assist in the Precise Reconstruction of Segmental Mandibular Defects

Publication date: Available online 15 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ye Liang, Canhua Jiang, Limeng Wu, Wenjin Wang, Yonggang Liu, Xinchun Jian
PurposeTo introduce and evaluate the clinical effects of digital surgical guide plate technology in the combined osteotomy and reconstruction pre-bent plate position (CORPPP) technique during mandibular segmental resections.MethodSeven cases of segmental resections in mandibles with simultaneous vascularized free fibula flap reconstructions via oral and maxillofacial surgery were selected (Xiangya Hospital: June 2015-December 2015). Cone beam computed tomography (CBCT) and spiral CT scans of mandibles and fibular donor sites, respectively, were collected. Surgical simulations were conducted after data collection. Pre-bent titanium plates were emplaced within the predicted mandibular models. The samples were scanned via CBCT to obtain the positional relationships. Finally, CORPPP surgical guide plates with location holes were designed and fabricated on pre-bent titanium plates. The CORPPP surgical guide plates were applied in osteotomy and the emplacement of pre-bent titanium plates during surgery. CBCT scans were again conducted 2 weeks after surgery to examine the reconstructed composite models composed of mandibles and titanium plates. The scans were then compared with the preoperatively designed models. Additionally, the deviation of the integral and characteristic structure loci was analysed.ResultThe seven cases with emplaced pre-bent titanium plates exhibited good recovery in terms of occlusal relationships and the contour of the reconstructed mandibles. The absolute deviations in the integral analysis were 0.89±0.96 mm (mandibles) and 0.33±0.36 mm (titanium plates). The absolute deviations on the diseased side were as follows: 1.78±0.35 mm (condylar head), 2.43±0.29 mm (gonion), 2.22±0.22 mm (gnathion) and 2.66±0.36 mm (mesial inferior margin of the fibula).ConclusionThe results of this study suggest that mandibular segmental resections and the precise orientation of pre-bent titanium plates could be simultaneously assisted by CORPPP digital surgical guide plates. The use of these guide plates should be expanded.

Graphical abstract

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