Comparative efficacy of minimal concentration of racemic bupivacaine (0.0625%) with fentanyl and ropivacaine (0.1%) with fentanyl for epidural labor analgesia

TN Chethanananda, MR Shashank, N Madhu, J Achyutha, Karna Venkata Siva Kumar

Anesthesia: Essays and Researches 2017 11(3):583-588

Background and Aims: This study aims to compare the minimum effective concentration of local anesthetic (LA) bupivacaine and ropivacaine with highly lipid soluble opioids fentanyl for providing optimal labor epidural analgesia. Settings and Design: The objective of this study was to evaluate the efficacy of racemic bupivacaine 0.0625% and 0.1% of ropivacaine both mixed with 2 μg/ml of fentanyl for epidural labor analgesia in parturients with spontaneous labor and normal fetal heart rate tracing. Methodology: Sixty parturients requesting for labor analgesia were divided into two groups. Group B (n = 30) received racemic bupivacaine (0.0625%) and fentanyl 2 μg/ml of 10 ml and Group R (n = 30) received ropivacaine (0.1%) and fentanyl 2 μg/ml. In both groups, the drug was given in 5 ml fractionated doses at 5 min interval. Parturients not experiencing analgesia within 15 min of initial bolus were supplemented with additional 5 ml of the same concentration of the solution. Epidural analgesia was maintained by timed top ups at the end of 90 min with the dosage equal to the initial dose of the drug. Duration of labor analgesia, motor block, visual analog scale, maternal hemodynamic parameters, mode of delivery, and maternal satisfaction was assessed. Statistical Analysis: Data were analyzed with odds variance, unpaired t-test, and Chi-square tests. P < 0.05 was considered statistically significant. Results: In our study, results indicate that both drugs were equally effective clinically. Maternal demographic characteristics were comparable. There were no statistically significant differences in visual analog pain score, highest sensory block, maternal satisfaction, mode of delivery, total dose of LAs during labor and motor block at delivery between the groups. Conclusions: In our study, both the drugs produced equivalent analgesia for labor at low concentration when used with highly lipid soluble opioid such as fentanyl.

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Single minute of positive end-expiratory pressure at the time of induction: Effect on arterial blood gases and hemodynamics in morbidly obese patients undergoing laparoscopic bariatric surgery

Dipti Saxena, Priyank Singh, Atul Dixit, Bipin Arya, Mohit Bhandari, Sadhana Sanwatsarkar

Anesthesia: Essays and Researches 2017 11(3):758-761

Background: The effect of positive end-expiratory pressure (PEEP) has been studied in detail after induction of general anesthesia especially in obese individuals. However, sparse information can be gathered from the literature regarding its effect when applied at the time of induction and the time of onset of its effect. Thus, this study was planned to assess the effect of PEEP when applied for a single minute in morbidly obese patients. Materials and Methods: This was a randomized prospective study comprising seven morbidly obese patients (body mass index ≥40 kg/m2). Control group included 30 patients who received no PEEP at the time of induction. The study group consisted of thirty patients who were given a PEEP of 10 cmH2O. Serial arterial blood gas samples were taken preoperatively, at the time of intubation, 5 min after intubation and 10 min after intubation. Results: PaO2was significantly higher in test group (242.0 ± 116.0 mmHg) than in control group (183.0 ± 107.0 mmHg) just after intubation. PaCO2was comparable in control group (43.73 ± 6.32 mmHg) and test group (44.52 ± 6.33 mmHg) just after intubation but was significantly less in test group than in control group at 5 and 10 min thereafter. Hemodynamic parameters were comparable in both groups at all time intervals. Conclusion: Application of even a single minute of PEEP at the time of induction improves oxygenation without any adverse effects on hemodynamics, in morbidly obese patients undergoing laparoscopic Bariatric surgery.

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Morphoproteomics, E6/E7 in-situ hybridization, and biomedical analytics define the etiopathogenesis of HPV-associated oropharyngeal carcinoma and provide targeted therapeutic options

Abstract

Background

Human papillomavirus (HPV) has been identified as an etiopathogenetic factor in oropharyngeal squamous cell carcinoma. The HPV E6 and E7 oncogenes are instrumental in promoting proliferation and blocking differentiation leading to tumorigenesis. Although surgical intervention can remove such tumors, the potential for an etiologic field effect with recurrent disease is real. A downstream effector of E7 oncoprotein, enhancer of zeste homolog 2 (EZH2), is known to promote proliferation and to pose a block in differentiation and in turn, could lead to HPV-induced malignant transformation. However, the EZH2 pathway is amenable to low toxicity therapies designed to promote differentiation to a more benign state and prevent recurrent disease by inhibiting the incorporation of HPV into the genome. This is the first study using clinical specimens to demonstrate EZH2 protein expression in oropharyngeal carcinoma (OPC).

Methods

The study included eight patients with oropharyngeal carcinoma, confirmed p16INK4a- positive by immunohistochemistry (IHC). The tissue expression of E6/E7 messenger RNA (mRNA) was measured by RNAscope® in-situ hybridization technology. Expression of EZH2, Ki-67, and mitotic indices were assessed by morphoproteomic analysis. Biomedical analytics expanded the results with data from Ingenuity Pathway Analysis (IPA) and KEGG databases to construct a molecular network pathway for further insights.

Results

Expression of E6 and E7 oncogenes in p16INK4a- positive oropharyngeal carcinoma was confirmed. EZH2 and its correlates, including elevated proliferation index (Ki-67) and mitotic progression were also present. Biomedical analytics validated the relationship between HPV- E6 and E7 and the expression of the EZH2 pathway.

Conclusion

There is morphoproteomic and mRNA evidence of the association of p16INK4a-HPV infection with the E6 and E7 oncogenes and the expression of EZH2, Ki-67 and mitotic progression in oropharyngeal carcinoma. The molecular network biology was confirmed by biomedical analytics as consistent with published literature. This is significant because the biology lends itself to targeted therapeutic options using metformin, curcumin, celecoxib and sulforaphane as therapeutic strategies to prevent progression or recurrence of disease.

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Adolescent Weapon Carrying and Use: Are the Correlates Gendered?

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


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Herbal combat against E. faecalis – An in vitro study

Publication date: Available online 12 August 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Shipra Jaidka, Rani Somani, Deepti Jawa Singh, Tasneem Sheikh
BackgroundHerbs have renewed importance in this modern era for their antimicrobial properties and fewer side effects. So a novel idea to use these herbs for pulpectomy; was implemented. There are chances of failure of pulpectomy due to inefficient removal of microbial load. Thus, for a successful endodontic treatment, obturating material with optimum antimicrobial properties is advocated in the present study.AimTo compare and evaluate the antibacterial efficacy of zinc oxide eugenol, zinc oxide with tulsi extract and zinc oxide with aloe vera as obturating materials against E. faecalis bacteria.Materials and MethodsAntimicrobial efficacy of zinc oxide eugenol as control, zinc oxide with tulsi extract and zinc oxide with aloe vera as experimental groups were assessed by using agar diffusion method. The statistical analysis was done.ResultsIntergroup comparison revealed significant difference amongst all the groups except between zinc oxide eugenol and zinc oxide with tulsi extract. Zinc oxide eugenol had significantly higher zone of inhibition among all the groups.ConclusionAccording to results obtained from the present study can be summarized as follows: Zinc oxide eugenol>Zinc oxide with tulsi extract>Zinc oxide with aloe vera.



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Lesión del conducto torácico a nivel cervical de forma espontánea: a propósito de un caso

Publication date: Available online 12 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Natalia Rodriguez, Maria Luisa Navarrete, Cesar Ortiz, Shelagh Dyer




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Miringoplastia con cartílago en alas de mariposa. Nuestra experiencia

Publication date: Available online 12 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Paula Cruz Toro, Ángela Callejo Castillo, Rafael Moya Martínez, Iván Domenech Juan
IntroducciónSe han propuesto múltiples técnicas quirúrgicas para cerrar perforaciones timpánicas. Eavey, hace dos décadas, describió una técnica destinada a cerrar perforaciones centrales en niños. Para ello diseñó un injerto de cartílago con forma de alas de mariposa que se colocaba entre la membrana timpánica. Dicha técnica demostró gran efectividad para el cierre de perforaciones así como baja morbilidad, rapidez y gran diferencia económica.MétodosSe realiza un estudio descriptivo de serie de casos analizando 32 intervenciones en niños y adultos con la técnica de Eavey modificada, durante el periodo de enero de 2012 a noviembre de 2016. Se evaluaron los resultados quirúrgicos y los resultados funcionales audiométricos.ResultadosEl éxito quirúrgico se logró en el 93% de los casos, incluyendo los cierres completos en 27 pacientes (84%) y 3 casos en los que se presentaron dehiscencias mínimas asintomáticas. Se presentó un rechazo del injerto y persistencia de la perforación y en un caso una perforación residual. No se describen complicaciones quirúrgicas o posquirúrgicas mayores asociadas al procedimiento. La mejoría de la media del gap audiométrico fue de 17dB preoperatorio a 7dB posterior a la intervención.ConclusionesLa técnica de Eavey modificada es un procedimiento con baja morbilidad, costo-efectiva, con facilidad técnica que demuestra ser eficaz para el cierre de perforaciones timpánicas en adultos y niños.IntroductionMultiple surgical techniques have been proposed to close tympanic perforations. Eavey, two decades ago, described a technique aimed at closing central perforations in children. For this, he designed a butterfly-shaped cartilage graft that was placed between the tympanic membrane in an inlay manner. This technique showed great effectiveness for the closure of perforations as well as low morbidity, rapidity and great economic difference.MethodsWe performed a descriptive study of a series of cases analysing 32 interventions in children and adults with the modified Eavey technique, during the period from January 2012 to November 2016. We evaluated the surgical and audiometric functional results.ResultsSurgical success was achieved in 93% of cases, including complete closures in 27 patients (84%) and 3 cases in which minimal asymptomatic dehiscences occurred. There was rejection of the graft and persistence of the perforation in only one case. No major surgical or postoperative complications associated with the procedure were described. The mean improvement in the audiometric gap was from 17dB preoperatively to 7dB after the intervention.ConclusionsThe modified Eavey technique is a low morbidity, cost-effective procedure with a technical facility that proves effective for the closure of tympanic perforations in adults and children.



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