bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Perineural and Intravenous Dexamethasone as an Adjuvant to Levobupivacaine in Ultrasound-Guided Infraclavicular Brachial Plexus Block
Authors: Veena G. , Pangotra Anshu , Kumar Shailesh , Prakash Jay , Rao Natesh S. , Priye Shio
Published: August 2021

Background:

The effect of perineural versus intravenous (i.v.) dexamethasone (4 mg) when added to levobupivacaine as an adjuvant has not been well studied.

Aims:

This study was conducted to compare the analgesic efficacy of perineural and i.v. dexamethasone as an adjuvant to levobupivacaine in infraclavicular brachial plexus (ICBP) block.

Settings and Design:

This was a prospective, randomized, double-blind study.

Materials and Methods:

This study was conducted on 68 patients with the ultrasound-guided ICBP block, randomly allocated into two groups (34 each). Four patients had failed block (2 in each group) that was excluded from the study. Group A received 25 mL of levobupivacaine 0.5% and 1 mL of normal saline for the block and i.v. dexamethasone 4 mg. Group B received 25 mL of levobupivacaine 0.5% with 4 mg of perineural dexamethasone for the block. Postoperative vitals and different block characteristics were assessed.

Statistical Analysis Used:

Student's independent sample t-test and Chi-square test were used for statistical analysis.

Results:

The duration of motor block and analgesia in Group A was 1245.94 ± 153.22 min and 1310.16 ± 151.68 min, respectively. However, in Group B, the duration of motor block and analgesia was 1768.13 ± 309.86 min and 1743.59 ± 231.39 min, respectively, which was more when compared to Group A (P < 0.001). The Visual Analog Scale score of ≥3 in Group A was 37% and in Group B was 9% (P = 0.008). Four cases had delayed regression of motor block in the perineural group.

Conclusions:

Perineural dexamethasone significantly prolonged the duration of motor block promoted by levobupivacaine in infraclavicular brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period when compared with the intravenous dexamethasone.
US Residents’ Perspectives on the Introduction, Conduct, and Value of American Board of Anesthesiology's Objective Structured Clinical Examination-Results of the 1st Nationwide Questionnaire Survey
Authors: Goudra Basavana , Guthal Arjun
Published: August 2021

Introduction:

Passing the Objective Structured Clinical Examination (OSCE) is currently a requirement for the vast majority (not all) of candidates to gain American Board of Anesthesiology (ABA) initial certification. Many publications from the ABA have attempted to justify its introduction, conduct and value. However, the ABA has never attempted to understand the views of the residents.

Methods:

A total of 4237 residents at various training levels from 132 programs were surveyed by asking to fill a Google questionnaire prospectively between March 8th, 2021 and April 10th, 2021. Every potential participant was sent an original email followed by 2 reminders.

Results:

The overall response rate was 17.26% (710 responses to 4112 invitations). On a 5-point Likert scale with 1 as “very inaccurate” and 5 as “very accurate,” the mean accuracy of objective structured clinical examination (OSCE) in assessing communication skills and professionalism was 2.3 and 2.1 respectively. In terms of the usefulness of OSCE training for improving physicians' clinical practice, avoiding lawsuits, teaching effective communication with patients and teaching effective communication with other providers, the means on a 5-point Likert scale with 1 as “Not at all useful” and 5 as “Very useful” were 1.86, 1.69, 1.79, and 1.82 respectively. Residents unanimously thought that factors such as culture, race/ethnicity, religion and language adversely influence the assessment of communication skills. On a 5-point Likert scale with 1 as “not at all affected” and 5 as “very affected,” the corresponding scores were 3.45, 3.19, 3.89, and 3.18 respectively. Interestingly, nationality and political affiliation were also thought to influence this assessment, however, to a lesser extent. In addition, residents believed it is inappropriate to test non-cardiac anesthesiologists for TEE skills (2.39), but felt it was appropriate to test non-regional anesthesiologists in Ultrasound skills (3.29). Lastly, nearly 80% of the residents think that money was the primary motivating factor behind ABA's introduction of the OSCE. Over 96% residents think that OSCE should be stalled, either permanently scrapped (60.8%) or paused (35.8%).

Conclusions:

Anesthesiology residents in the United States overwhelmingly indicated that the OSCE does not serve any useful purpose and should be immediately halted.
Thoracic Epidural Analgesia for Lumbosacral Spine Surgery
Authors: Kour Loveleen , Sharma Nandita , Dogra Disha
Published: August 2021

Background:

Traditional analgesics such as diclofenac and celecoxib have long been used in lumbosacral spine surgeries. Recently, preemptive single-shot caudal analgesia has been investigated by some workers with favorable results. We hypothesized that the thoracic route would not only allow preemptive but also postoperative analgesia through catheter insertion.

Aim:

We aimed at studying the feasibility and efficacy of thoracic epidural analgesia (TEA) in lumbosacral spine surgeries.

Settings and Design:

This was a prospective, randomized, controlled study that comprised 60 American Society of Anesthesiologist (ASA) Physical Status I and II patients posted for lumbosacral spine surgeries.

Materials and Methods:

Sixty ASA I and II patients were randomly divided into two groups: Group T – TEA was given using 0.2% ropivacaine 10 mL preemptive and postoperatively. Group C patients were given analgesia with intramuscular diclofenac 75 mg. Hemodynamic parameters, postoperative Visual Analog Scale scores, and neurological complications were noted.

Statistical Analysis:

Student's independent t-test for comparing the continuous variables and Chi-square test for the categorical variables. Kruskal–Wallis test was used for postoperative pain data.

Results:

Duration and quality of analgesia were superior in Group T. There were more hemodynamic alterations in Group C but no neurological complication in any patient.

Conclusion:

TEA proves to be an effective analgesic technique for lumbosacral spine surgeries.
Effectiveness and Safety of Extubation before Reversal of Neuromuscular Blockade versus Traditional Technique in Providing Smooth Extubation
Authors: Babu Karthik C. , Rajan Sunil , Sandhya Sai V. K , Raj Renjima , Paul Jerry , Kumar Lakshmi
Published: August 2021

Background:

Traditional extubation often leads to bucking, coughing, and undesirable hemodynamic changes. Extubation just before administering reversal could reduce force of coughing, bucking and may provide better extubation conditions.

Aim of Study:

The aim of the study was to assess the incidence of bucking with extubation just before administering reversal of neuromuscular blockade compared to traditional technique of awake extubation. Incidence of coughing during extubation, vomiting/regurgitation, aspiration, hemodynamic changes, postoperative bleeding, and extubation conditions were also assessed.

Settings and Design:

This was a prospective randomized study conducted in a tertiary care institute.

Subjects and Methods:

Forty patients were allocated into two equal groups. In Group E, at the end of surgery, extubation was performed and reversal was administered after extubation. In Group L, reversal was given and patients were extubated in the traditional way. Quality of extubation was assessed using extubation quality score.

Statistical Tests Used:

Pearson Chi-square test, Fisher's exact test, and independent sample t-test.

Results:

Group E showed significantly lower incidence of bucking (15% vs. 65%) and coughing (10% vs. 45%). Incidences of desaturation and regurgitation/aspiration were comparable. In Group E, 85% of patients did not cough during extubation compared to 50% in Group L. Extubation quality was significantly better in Group E. Although extubation time was significantly shorter in Group E, recovery time was comparable in both groups.

Conclusion:

Extubation just before reversal of neuromuscular blockade resulted in lesser incidence of bucking and coughing during extubation with lesser postoperative bleeding compared to traditional technique of awake extubation without added risks of regurgitation, aspiration, or delayed recovery.
Efficacy and Safety of Sugammadex versus Neostigmine in Reversing Neuromuscular Blockade in Morbidly Obese Adult Patients
Authors: Subramani Yamini , Querney Jill , He Susan , Nagappa Mahesh , Yang Homer , Fayad Ashraf
Published: August 2021

Context:

Sugammadex is known to reverse neuromuscular blockade (NMB) more rapidly and reliably than neostigmine. However, data remain limited in bariatric patients. In this review, we systematically evaluated the efficacy and safety of sugammadex versus neostigmine in reversing NMB in morbidly obese (MO) patients undergoing bariatric surgery.

Aims:

Our primary objective was to determine the recovery time from drug administration to a train-of-four (TOF) ratio >0.9 from a moderate or deep NMB.

Settings and Design:

This systematic review and meta-analysis (SR and MA) was conducted in accordance with the Preferred Items for SRs and MAs guidelines.

Subjects and Methods:

A systematic search was conducted within multiple databases for studies that compared sugammadex and neostigmine in MO patients.

Statistical Analysis Used:

We reported data as mean difference (MD) or odds ratios (OR) and corresponding 95% confidence interval (CI) using random-effects models. A two-sided P < 0.05 was considered statistically significant.

Results:

Seven studies with 386 participants met the inclusion criteria. Sugammadex significantly reduced the time of reversal of moderate NMB-to-TOF ratio >0.9 compared to neostigmine, with a mean time of 2.5 min (standard deviation [SD] 1.25) versus 18.2 min (SD 17.6), respectively (MD: −14.52; 95% CI: −20.08, −8.96; P < 0.00001; I
2 = 96%). The number of patients who had composite adverse events was significantly lower with sugammadex (21.2% of patients) compared to neostigmine (52.5% of patients) (OR: 0.15; 95% CI: 0.07–0.32; P < 0.00001; I
2 = 0%).

Conclusions:

Sugammadex reverses NMB more rapidly with fewer adverse events than neostigmine in MO patients undergoing bariatric surgery.
Comparison of Oral versus Intramuscular Clonidine for Prolongation of Bupivacaine Spinal Anesthesia in Patients Undergoing Total Abdominal Hysterectomy
Authors: Mishra Smarika , Gogia Pratiksha , Singh Prachi , Tripathi Manoj , Yadav Sandeep , Malviya Deepak
Published: August 2021

Background:

Clonidine is a commonly used agent for premedication through oral, intravenous, and intramuscular route. Very few studies mentioned intramuscular clonidine as premedication.

Aims and Objectives:

The aim of the present study is to compare oral and intramuscular clonidine as predication agent in bupivacaine spinal anesthesia patients.

Materials and Methods:

In our study, recruited patients were randomly allocated in three groups of 32 each. All patients received intrathecal bupivacaine heavy 3 mL with oral 150 μg clonidine in Group 1, intramuscular 150 μg clonidine in Group 2, and oral placebo tablet in Group 3 1 h before taking the patient in operation theater. We have assessed for duration of sensory block, duration of motor block, duration of analgesia, sedation score, and hemodynamic changes in groups.

Statistical Analysis:

The parametric data were expressed as mean ± standard deviation. Primary analysis of parametric data between the two groups was done by student's t-test, and among three groups, analysis of variance was used.

Results:

Duration of motor block was found significantly high in Group 2 than Group 1 (208.06 ± 9.48 vs. 200.25 ± 9.42; P < 0.05). Duration of sensory block was also found significantly high in Group 2 than Group 1 (219.69 ± 9.44 vs. 210.25 ± 9.68; P < 0.05). Time to give first dose of analgesia was also found greater in Group 2 than Group 1 (234.66 ± 11.76 vs. 217.75 ± 10.09; P < 0.05). Sedation score and other side effects were found statistically nonsignificant between Group 1 and 2.

Conclusion:

We can conclude that preoperative intramuscular clonidine is a better alternate of oral clonidine for bupivacaine spinal anesthesia in terms of long duration of motor and sensory block and less requirement of analgesic with clinically insignificant side effects.
Ultrasound Guided Adductor Canal Block vs Intra Articular Analgesia for Post-operative Pain Relief after Arthroscopic Knee Surgeries
Authors: Mittal Saurabh , Mehrotra Shreesh , Asthana Veena , Agarwal Atul
Published: August 2021

Context and Aims:

Our aim was to assess the postoperative analgesia after ultrasound-guided “Adductor canal block” (ACB) and “Intraarticular Analgesia” (IAA) in arthroscopic knee surgeries postoperatively.

Settings and Design:

This experimental, randomized prospective study was conducted in the Department of Anesthesia, Himalayan Institute of Medical Sciences, Dehradun.

Subjects and Methods:

Sixty patients, who underwent arthroscopic knee surgeries were divided into two groups, with 30 patients each. Each group was given spinal anesthesia using 3 ml of 0.5% hyperbaric Bupivacaine. After completion of surgery, Group I patients were given ultrasound-guided ACB, Group II patients were given IAA. Postoperatively, pain was assessed using the Numeric Rating Scale (NRS). Time of first analgesic requirement and total postoperative tramadol consumption in the 1st 24 h were recorded.

Results:

No significant difference was seen between both groups pertaining to patient's demographic data, type, and duration of surgery. The difference in the median NRS score between both the groups at different time intervals was statistically insignificant (P > 0.05). Total tramadol consumption in Group I (172.85 ± 82.59) mg was more than Group II (157.85 ± 33.83) mg. The duration of first analgesic requirement was 351.43 min, 342.86 min for Group I and II, respectively.

Conclusion:

To conclude, both ACB and IAA provide good postoperative pain control in arthroscopic knee surgeries with no significant difference in pain scores and postoperative analgesic requirement.
Early Catheter-Directed Thrombolysis Without Bowel Resection in Acute Mesenteric Ischaemia for a Symptomatic COVID-19 Patient
Authors: Bhuiyan Aniruddha Sanjoy , Balani Prashant , Dalal Vijay N , Maheshwari Govardhan S
Published: August 2021

Newer evidence states that COVID-19 pneumonia induces a hypercoagulable state leading to vascular and microvascular thrombotic events. Acute mesenteric ischaemia (AMI) is a potentially fatal vascular emergency with overall mortality of 60%–80%. However, till date, only a few cases of superior mesenteric artery thrombosis in COVID-19 positive patients are reported and most have succumbed to COVID-19 or mesenteric ischemia. Physicians treating COVID-19 usually treat respiratory symptoms and may completely overlook any other uncommon pathology. This case report emphasizes that a patient with early detection and management of acute mesenteric ischaemia being symptomatic for COVID-19 can avoid major bowel surgery and negates any morbidity or mortality associated with the same.
A Higher Body Mass Index Means Worse Satisfaction Outcome in Obese Patients Undergoing Varicose Vein Surgery
Authors: Premnath Sivaram , Nour Elafra , Abdelhaliem Amr , Rowlands Timothy E , Kuhan Ganesh
Published: August 2021

Introduction:

Obesity (body mass index [BMI] >30) and lower limb venous disease (LLVD) is a common problem, yet there is a sparsity of evidence in its management. The aim was to carry out a satisfaction survey on such patients following their venous surgery from a single center.

Methods:

Three hundred and thirty procedures carried out from January 2017 to April 2018. Eighty-seven patients with BMI > 30 were selected and case notes reviewed retrospectively. Data on demography, risk factors, Clinical, Etiology, Anatomy, Pathology (CEAP) status, operative data, and complications were collected. Fifty-three patients had a telephone follow-up to assess satisfaction in terms of symptoms and appearance. Logistic regression analysis was carried out to identify factors contributing to a worse outcome.

Results:

The mean age was 53.1 (50.6% were male). The mean BMI was 36.11 (30–56). CEAP grade of more than 3 was present in 69.8% (44/87). Most patients were treated by radiofrequency ablation (81.6% [71/87]). Significant complications occurred in 3.4% (3/87) after surgery. The median follow-up was 22 months (14–30). Symptoms improvement was reported in 74% (39/53), while 5.6% (3/53) reported worse symptoms. In terms of appearance, 71.6% (38/53) reported improvement, while 7.5% (4/53) reported worse appearance. Logistic regression analysis identified BMI to be a significant risk factor (odds ratio 1.257 (95% confidence interval 1.004–1.575).

Conclusions:

The higher the BMI, the lesser the patient satisfaction after varicose vein surgery. Obese patients with LLVD can be treated successfully with a high satisfaction rate for BMI class 1 and 2.
Single-Stage Ruptured Internal Carotid Artery Aneurysm Clipping with Contralateral Carotid Endarterectomy
Authors: Gopal Swaroop , Dutta Abinash , Satish Rudrappa
Published: August 2021

Concomitant ruptured intracranial aneurysm and severe contralateral internal carotid artery (ICA) stenosis pose a surgical dilemma. There are no guidelines. Most reports suggest an ipsilateral association. The outcome depends on planning and strategy. This 49-year-old male with ruptured C6 segment ICA aneurysm had 90% calcific carotid stenosis contralaterally. He underwent simultaneous surgery for both. The surgical steps involved and the reason behind the sequence of steps are unique to this situation and led to a good outcome. The strategy and the technicalities involved are discussed in this report.
Operative Management and Outcomes of Peripheral Vascular Trauma in Pediatric and Adolescent Population
Authors: Kumar Madhur , Pramanik Subrata , Gupta Anubhav
Published: August 2021

Introduction:

Unique characteristics of vascular injuries in children such as pronounced vascular spasm and lack of tissue support over small, thin-walled vessel make vascular repair challenging. This retrospective study was done to evaluate the management and outcome of pediatric and adolescent peripheral vascular trauma.

Methodology:

Fifteen patients with peripheral vascular trauma who met the inclusion criteria during the study period (August 2019-July 2020) were included. Data were analyzed retrospectively.

Results:

Majority, 12(80%) of patients suffered blunt trauma. Primary repair in 13(86.66%) patients was the most common surgical technique employed. All the patients had associated long bone fracture dealt with internal fixation. Four (26.66%) cases had median nerve injury which was amenable to direct repair. Associated venous injury in 5 (33.33%) was also repaired. No mortality, re-operations, or amputation was noted.

Conclusion:

Excellent limb salvage rate was achieved. Initial revascularization without delay should be the norm. Associated neurological involvement determines postoperative functional outcome. Clinical evaluation with Doppler assessment saves time and crucial in vascular injuries prone to spasm.
Assessment of Quality of Life Between Patients Undergoing Pharmacomechanical Catheter-Directed Thrombolysis Versus Conservative Management with Iliofemoro-Popliteal Deep-Vein Thrombosis
Authors: Yeramsetti SVR Krishna , Ghanwat Shrikant Pandurang , Sahu Tapish , Sheorain Virender , Grover Tarun , Parakh Rajiv
Published: August 2021

Background:

Pharmacomechanical catheter-directed thrombolysis (PCDT) has revolutionized the treatment of acute deep-vein thrombosis (DVT). Assessment and comparison of quality of life (QOL) in patients treated with anticoagulation alone and PCDT need to be elaborated more in the context of better management of patients. The objective of this study was to compare and assess QOL using health-related QOL (HRQOL) which includes short form-36 (SF-36) and VIENES QOL/sym scoring systems in anticoagulation alone group and patients treated with PCDT.

Methods:

There were 130 consecutive patients presenting to our department with acute iliofemoro-popliteal DVT (IFPDVT) with <2 weeks duration treated between April 2018 and April 2019 were included in the study. Sixty-five patients received anticoagulation alone and the other 65 patients received PCDT along with anticoagulation. Patients were assessed at baseline, the 1st month, and the 6th month in terms of QOL, deep venous patency (DVP), and deep venous reflux (DVR).

Results:

There was a statistically significant difference between the two groups in terms of QOL at 1st and 6 months. Mean physical component score and mental component score were statistically significantly better in PCDT than the conservative group at 1 and 6 months, respectively (P = 0.001). Mean venous insufficiency epidemiological and economic study (VEINES) QOL and VEINES SYM scores were significantly better in PCDT group than conservative group at 1 and 6 months, respectively (P = 0.001).

Conclusion:

QOL, DVP, and DVR are significantly better when PCDT is offered as an initial option when compared to anticoagulation alone. HRQOL (SF 36 and VEINESQOL/SYM score) should be considered as an outcome measure in clinical studies on patients with IFPDVT along with other comparison parameters with respect to QOL. However, long-term follow-up is required to establish the superiority of PCDT in IFPDVT patients.
Outcomes with Aspirin and Clopidogrel Versus Aspirin and Rivaroxaban in Infrainguinal Endovascular Revascularization for Critical Limb Ischemia
Authors: Nishan B , Hudgi Vishal , Siva Krishna K , Ahsan V P , Rodney Roshan , Raj K B
Published: August 2021

Background:

The purpose of the study was to assess the benefits of dual antithrombotic therapy in the management of peripheral arterial disease in Indian population.

Methods:

We conducted a prospective review of patients on dual antithrombotic therapy who underwent infra-inguinal endovascular revascularisation at JIVAS for 18 months.

Objectives:

To study the outcomes with aspirin + clopidogrel (CA) versus aspirin + rivaroxaban (RA) after infrainguinal endovascular revascularization for critical limb ischemia. The main objective was to assess primary patency of vessel after endovascular revascularization. The secondary objectives were to study limb salvage, major adverse limb events (MALEs), major adverse cardiac events (MACEs), bleeding events (major and minor), and wound healing.

Results:

In the present study, a total of 104 patients underwent infrainguinal revascularization and fulfilled the inclusion criteria, of which 48 received RA and 56 received CA. The mean age was 49.8 years with no significant differences in the baseline demographics and comorbidities between the two groups. The primary objective of vessel patency was assessed measuring the ankle brachial index which was 0.91 in the RA group and 0.96 in the CA group and remained the same on follow-up till 6 months and mean trans cutaneous oxygen pressure of around 34 in both the groups. There was no significant difference in the incidence of MALE (2.1% in RA vs. 7.1% in CA;P= 0.2), MACE (6.3% in RA vs. 10.7% in CA;P= 0.4), wound healing (81% RA vs. 75% CA;P= 0.4), safety parameter of bleeding (6.3% RA vs. 3.6% CA), creatinine, and liver function tests (LFT) during the study period.

Conclusion:

Both the antithrombotic regimens can be considered safe and efficacious in the postoperative management of patients undergoing infrainguinal revascularization; with maintenance of primary patency, comparable wound healing, incidence of MALE and MACE, and safe with no bleeding; and no impairment in the serum creatinine and LFTs during follow-up.
Factors Affecting the Long Term Patency of Arteriovenous Access for Hemodialysis
Authors: Gangadharan Ashwini Naveen , Prasad Rajendra Basavanthappa , Anandasu Ranjith Kumar , Vardhan J P , Ramswamy Chandrashekar Anagavalli , Desai Sanjay C , Maruthu Pandian Adharsh Kumar , Mitta Nivedita , Kumar Hemanth
Published: August 2021

Objective:

The objective of the study was to analyze and evaluate the possible factors in the long-term patency of arteriovenous (AV) access for hemodialysis (HD).

Materials and Methods:

This was a cross-sectional study recruiting patients from January 2019 to December 2019. All patients who have a working HD vascular access, either AV fistula (AVF) or AV graft which has been working for at least 2 years were included and collected demographic data along with other parameters such as timing of creation, interventions, dialysis sessions, and antiplatelet therapy among others.

Results:

We included 81 patients with AV access patent more than 2 years; 22.5% were aged >65 years, 39.6% were diabetic, 68.5% were hypertensive, and 26.1% had vascular disease. Analysis revealed that the patient factors such as current tobacco usage and side of creation and technical factors such as maturation time, number of dialysis sessions, and single-center dialysis have a significant effect on the patency of the AV access, while the factors such as past tobacco usage, diabetes, hypertension, use of jugular catheter before access creation, and cannulation technique could not establish any statistical effect on the patency of AV access.

Conclusion:

There is a complex interaction of factors that may affect the patency of an individual AV access. These need to be carefully considered when selecting surgical site or technique, adjuvant treatments, and follow-up protocols for AVFs.
Hybrid and Percutaneous Salvage of a Thrombosed Native Arteriovenous Fistula
Authors: Agarwal Rahul , Atreyapurapu Viswanath , Sharma Pritee , Yerramsetty Vamsi Krishna , Burli Pradeep , Atturu Gnaneswar , Gupta Prem C
Published: August 2021

Context:

Outcomes of salvage procedures for thrombosed native arteriovenous fistulas (AVFs) are studied.

Aims:

The aim of this study is to assess the short- to mid-term results of percutaneous and hybrid approaches used for salvage of thrombosed native AVF.

Settings and Design:

This study design was a single-center, descriptive, prospective study.

Materials and Methods:

All patients undergoing hybrid or percutaneous salvage procedure between July 2018 and September 2019 were included in the study. Patient demographics, clinical, and operative details and follow-up data at 1 year were collected from a prospectively maintained database and subjected to statistical analysis. Salvage procedure selection and techniques were studied.

Statistical Analysis:

Chi-square test and Fisher's exact test.P< 0.05 was considered statistically significant.

Results:

Out of 135 patients undergoing salvage procedure during the study period, 85 patients were included in the study based on inclusion and exclusion criteria. The age of the study population ranged from 18 to 75 years with a mean of 53.33. 75.3% (n = 64) were males. Seventy-seven (90.58%) patients were hypertensive, 45 (52.94%) were diabetic, and 22 (25.88%) had coronary artery disease. The mean time to procedure from the failure of AVF was 8.22 days. The most common type of AVF was brachiocephalic (45.88% [n = 39]), followed by radiocephalic (36.47% [n = 31]) and basilic vein transposition (BVT) (17.64% [n = 15]). Stenotic sites were juxta anastomotic in 42 (49.41%), cephalic arch or axillary swing segment (for BVT) in 28 (32.94%), and intervening segment in 54 (63.52%). Sixty patients underwent hybrid salvage and 25 underwent percutaneous salvage procedure. Technical success was 88.23% on table and 83.53% at 24 h. Primary, primary assisted, and secondary patency was 67.86%, 82.14%, and 89.29% at 6 months and 50%, 68.75%, and 83.33% at 12 months. Anastomotic thrombosis was associated with significantly high technical failure (35.7% vs. 12.67%,P= 0.049).

Conclusions:

A combination of open and endovascular procedures to salvage thrombosed native AVF's is feasible and is associated with good short- and mid-term patency. A thrombosed anastomosis in a failed AVF decreases the success rate of salvage procedures.
Miraculous Escape in a Case of Penetrating Neck Injury by Arrow
Authors: Lahiri Raja , Mahapatra Subhendu Sekhar
Published: August 2021

Penetrating neck injuries due to arrowheads have become extremely rare in most of the nations. Although the basic principles of management remain the same as that of other penetrating injuries, certain extra precautions need to be taken while managing such cases. A 56-year-old man who suffered from an arrow injury to the neck had a lucky escape from any significant injury to vital structures. The patient underwent successful surgical removal of the arrowhead. Knowledge of the various principles of management of such injuries is key to a successful outcome.
Role of Digital Subtraction Angiography in Diagnosis of Fibromusculardysplasia
Authors: Wang Christine , Singla Animesh , Kotecha Krishna , Nguyen Daniel
Published: August 2021

Fibromuscular dysplasia (FMD) is a vascular disease characterized by abnormal arterial wall architecture, usually visualized angiographically as the classic “string of beads” sign. We present the diagnostic dilemma of a 51-year-old woman admitted for a spontaneous renal infarct, with initial examination and investigations equivocal. She was consequently assessed for thromboembolic and vasculitic disease, before proceeding to digital subtraction angiography (DSA). This invasive method elucidated an area of focal FMD, previously not seen on computed tomography angiography (CTA). This is unusual due to CTA's high sensitivity and specificity but could be attributed to the less common subtype of FMD which requires combined imaging modalities to arrive at a diagnosis. Hence, there may be a role for the dual use of CTA and DSA in young patients presenting with a spontaneous renal infarct in the absence of other diagnoses.
Intraoperative Transesophageal Echocardiographic Detection of Large Mobile Aortic Thrombus in a Patient with Iron Deficiency Anemia Presenting as Acute Limb Ischemia
Authors: Chennakeshavallu GN , Sankar Sruthi
Published: August 2021

Quantitative and qualitative abnormalities in red blood cells are associated with arterial thrombosis. We report a case of a middle-aged female with iron deficiency anemia (IDA) presenting as bilateral acute limb ischemia (ALI) and on evaluation with transesophageal echocardiography (TEE) a large mobile thrombus was detected in the descending thoracic aorta. Her limbs were salvaged with successful bilateral surgical embolectomy and fasciotomies. The aortic thrombus was resolved with anticoagulation and correction of iron deficiency. We conclude that TEE evaluation of aorta is warranted in middle age females with IDA presenting as ALI.
Contralateral Deep-Vein Thrombosis in Lliac Vein Stenting – Incidence, Etiology, and Prevention
Authors: Shanmugham Venkataprasanna K , Bollineny Venkatesh , Sutradhar Prasenjit , George Robbie K
Published: August 2021

Iliocaval venous obstruction is a significant contributor to venous hypertension. Recanalization and stenting of chronic deep venous obstructions are minimally invasive and have been proven to be safe and effective with low complication rates over the past few decades. Common iliac vein (CIV) stents are usually extended into the inferior vena cava (IVC) to some extent to ensure adequately that key areas of stenosis are adequately treated. This may lead to contralateral CIV jailing and increase the risk of contralateral deep-vein thrombosis (DVT). The reported incidence of contralateral DVT after CIV stent placement from different studies varies from 1% to 15.6%. The predicted risk factors are noncompliance with anticoagulation, underestimation of the postthrombotic venous disease, preexisting IVC filter, incorrect stent placement, preexisting contralateral internal iliac vein thrombosis, malignancy, and thrombophilia. Literature suggests that the use of intravascular ultrasound, newer dedicated stents, and Z-stent modification reduces the incidence of contralateral DVT. Precise stent deployment technique and proper attention to other hematological risk factors are the key to preventing this complication. This article will review the incidence, mechanism, risk factors, and technical aspects of how to avoid this unfortunate complication. We will also review the newer dedicated venous stents.
Vaginoscopic Incision of Oblique Vaginal Septum in an Adolescent Girl with OHVIRA Syndrome
Authors: Nigam Aruna , Aggarwal Pragati , Baghel Anamika , Gupta Neha , Sharma Sumedha , Jain Abhinav
Published: August 2021

OHVIRA syndrome comprises uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. It usually presents with pain abdomen and pelvic or vaginal mass with normal menses. Early diagnosis is important to prevent complications in later life. The case of a 12-year-old girl who presented with pain abdomen and progressive dysmenorrhea for the last 6 months (since menarche) is discussed. She was managed successfully with vaginoscopic septal incision with simultaneous preservation of hymenal integrity.
An angulated parotid duct sialolith
Authors: Shah Jigna S. , Rathod Mayur , Dubey Jaya
Published: August 2021

Sialolithiasis is one of the most common diseases of salivary glands and major cause for their dysfunction. It is more common in submandibular glands than in the parotid glands. In this report, the diagnosis and treatment of an unusual angulated parotid duct sialolith in a 25-year-old female in left Stensen's duct are presented with recurrent pericoronitis. Role of soft tissue intraoral periapical radiograph and cone beam computerized tomography in diagnosis and determining location and dimensions of sialolith is discussed.
The effect of alendronate on lipid profile of postmenopausal women with osteopenia and prediabetes
Authors: Karimifard Maryam , Aminorroaya Ashraf , Amini Massoud , Kachuie Ali , Feizi Awat , Yamini Sima Aminorroaya , Alijanvand Moluk Hadi
Published: August 2021

Background:

Prediabetes is a high-risk state for developing diabetes at an annual rate of 5%–10%. Early intervention can prevent further complications, including metabolic syndrome. Bisphosphonates are commonly used for osteoporotic postmenopausal women. The purpose of this study was to assess the effects of bisphosphonates on lipid profile including triglyceride (TG), total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) of prediabetic postmenopausal women with osteopenia.

Materials and Methods:

In this triple-blind randomized controlled trial, sixty prediabetic, postmenopausal women with sufficient Vitamin D and osteopenia, aged 45–60 years, were randomly enrolled in two groups of intervention (receiving 70-mg alendronate for 12 weeks [duration for maximum metabolic effect of bisphosphonates], n = 30) and control (receiving placebo, n = 30) according to a randomized block procedure of size 2 and 1:1 allocation ratio. The primary outcome of the study, the lipid profile, was evaluated before and after the interventions. The effect of the intervention was assessed using analysis of covariance.

Results:

The lipid profiles showed no significant differences to the mean values at the baseline in both the groups (all P > 0.05). At the end of the study, the differences between the groups were not significant for 25(OH) D3 (mean difference: −11.09, 95% confidence interval: −32.43–10.25), T (4.19, −30.58–38.97), cholesterol (8.13, −13.07–29.33), LDL-cholesterol (5.07, −10.18–20.31), and HDL-cholesterol (−0.86, −6.04–4.31) when the baseline values and confounders were adjusted (all P > 0.05).

Conclusion:

No statistically significant difference was detected in the serum lipid profile of prediabetic postmenopausal women with osteopenia as a result of alendronate intervention. More studies with larger sample sizes and longer intervention periods are recommended.
Postoperative outcomes of intrasphincteric botox injection during hemorrhoidectomy
Authors: Alvandipour Mina , Tavallaei Mehdi , Rezaei Fatemeh , Khodabakhsh Hamed
Published: August 2021

Background:

Pain is the most common postoperative complication of hemorrhoidectomy. We evaluated the effectiveness of intrasphincteric Botox injection on posthemorrhoidectomy complications including pain reduction and wound healing.

Materials and Methods:

In this randomized, double-blind clinical trial, patients with Grades 3 or 4 symptomatic hemorrhoids who underwent open (Milligan-Morgan) hemorrhoidectomy were enrolled. The experimental group received intrasphincteric Botox injection during hemorrhoidectomy, while the controls received normal saline injection. Hemorrhoid grades, constipation status, history of hemorrhoidectomy, duration of operation, pain at rest and after defecation in six follow-up periods (6, 12, 24, and 48 h and 7 and 14 days after operation), wound healing (during follow-up after discharge with a 2-week period), analgesic use, and Botox side effects were evaluated and compared in the two experimental and control groups.

Results:

In this trial, 34 and 33 patients were randomly allocated in the experimental and control groups, respectively. Operation time was significantly higher in Botox group (P = 0.009). Mean dose of analgesics use in Botox was significantly lower (P < 0.001). Rate of wound healing during follow-ups was significantly higher in Botox group in the fifth follow-up (P = 0.009). Frequency of urinary retention (P = 0.02) and moderate itching (P = 0.01) was significantly higher in placebo than Botox group. Mean of postoperative pain at rest in Botox group was significantly lower at 12th, 24th, and 48th h and 7th and 14th days after operation (P < 0.01). Mean of postoperative pain in Botox group was significantly lower at 3rd to 5th defecation (P < 0.01).

Conclusion:

Our findings indicated that a single-dose injection of Botox during Milligan-Morgan hemorrhoidectomy is associated with less postsurgical pain at rest and during defecation and improved wound healing. It is suggested that it is a safe and effective procedure during hemorrhoidectomy regarding the procedure-related complications.
Comparison of the effects of dexmedetomidine and propofol in reducing recovery agitation in pediatric patients after ketamine procedural sedation in emergency department
Authors: Azizkhani Reza , Kouhestani Soheila , Heydari Farhad , Esmailian Mehrdad , Feizi Awat , Khalilian Gourtani Bahar , Safavi Mohammadreza
Published: August 2021

Background:

Ketamine has been a safe and effective sedative agent commonly used for painful pediatric procedures in the emergency department (ED). This study aimed to compare the effect of dexmedetomidine (Dex) and propofol when used as co-administration with ketamine on recovery agitation in children who underwent procedural sedation.

Materials and Methods:

In this prospective, randomized, and double-blind clinical trial, 93 children aged between 3 and 17 years with American Society of Anesthesiologists Class I and II undergoing short procedures in the ED were enrolled and assigned into three equal groups to receive either ketadex (Dex 0.7 μg/kg and ketamine 1 mg/kg), ketofol (propofol 0.5 mg/kg and ketamine 0.5 mg/kg), or ketamine alone (ketamine1 mg/kg) intravenously. Incidence and severity of recovery agitation were evaluated using the Richmond Agitation-Sedation Scale and compared between the groups.

Results:

There was no statistically significant difference between the three groups with respect to age, gender, and weight (P > 0.05). The incidence of recovery agitation was 3.2% in the ketadex group, 22.6% in the ketofol group, and 22.6% in the ketamine group (P = 0.002, children undergoing short procedures were recruited). There was a less unpleasant recovery reaction (hallucination, crying, and nightmares) in the ketadex group compared with the ketofol and ketamine groups (P < 0.05). There was no difference in the incidence of oxygen desaturation between the groups (P = 0.30).

Conclusion:

The co-administering of Dex to ketamine could significantly reduce the incidence and severity of recovery agitation in children sedated in the ED.
Genetic and biochemical studies of hepatic carcinoma in the Egyptian population
Authors: Elkhoudary Amany F , Elmougy Rehab , Elsaid Afaf , Wahba Yahya , Abdel-Aziz Abdel-Aziz F
Published: August 2021

Background:

Hepatocellular carcinoma (HCC), a deadly malignancy of the liver, is considered the third leading reason behind cancer deaths. It is more frequent in men than in women of ages above 50. Liver disease, leading to liver cirrhosis (LC), is mostly caused by alcoholism abuse, reaction diseases of the liver, or viral hepatitis B or C infection. Interleukin-6 (IL-6) is considered an effective pro-inflammatory cytokine, which plays a crucial role in the host defense mechanism. Its level is higher in HCC patients than in LC cases, indicating that tumor cells increase the production of cytokines. The X-ray repair cross-complementing group 1 (XRCC1) gene is a major DNA repair gene. It acts as a scaffold of various activities that are concerned in the repairing method by interacting with components of base excision repair. This study aims to measure the serum concentrations of IL6 and C-reactive protein (CRP) and investigate whether XRCC1 Arg194Trp and Arg399Gln polymorphisms are related to HCC disease.

Materials and Methods:

Whole-blood DNA was extracted from 123 HCC patients and 123 healthy volunteers. Tetra-primer amplification refractory mutation system was performed in the detection of XRCC1 Arg399Gln and Arg194Trp polymorphisms.

Results:

Serum concentration levels of IL-6 and CRP are significantly higher in patients with HCC than in control subjects. The allelic and genotype frequency distributions of XRCC1 (Arg399Gln and Arg194Trp) are significantly increased in HCC cases compared to healthy volunteers.

Conclusion:

Arg/Gln, Arg/Trp, Gln/Gln, and Trp/Trp genotypes are associated with higher risk HCC than the Arg/Arg genotype.
Dorsal Spinal Metastases Secondary to Squamous Cell Carcinoma Tongue
Authors: Maheshwari Vikas , Kumar Arun , Pandey Rohit , Debnath Abhinav
Published: August 2021

Oral squamous cell carcinoma metastasizes commonly to the lung, brain, skin, and occasionally to the bones such as vertebra and ribs. However, spread to the dorsal vertebra with cord compression is an extremely rare presentation. This case highlights this rare entity which was managed surgically. It enabled in ameliorating patient's distressing pain and restoring quality of life.
Serum pancreatic enzymes and imaging in paediatric acute pancreatitis
Authors: AlEdreesi Mohammed H. , AlAwamy Mohammed B.
Published: August 2021

Background:

In acute pancreatitis (AP), serum amylase, lipase and imaging help establish a diagnosis with recognised lipase superiority. Recent literature has debated serum amylase testing and proposed its elimination, but little is known about the diagnostic role of simultaneously measured serum amylase levels in patients with non-diagnostic lipase. This study examined the contribution of pancreatic enzymes and imaging and the role of simultaneously measured serum amylase in children with non-diagnostic serum lipase.

Methods:

Retrospective medical records review of children aged <18 years with a verified discharge diagnosis of first-attack AP between January 01, 1994, and December 31, 2016.

Results:

First-attack AP was confirmed in 127 children (median age, 12.5 years). The sensitivity was 90.4%, 54.3%, 42.2% and 36.4% for lipase, amylase, contrast-enhanced computed tomography and ultrasonography (US), respectively. Combination US and lipase identified 96.6% of AP cases. Simultaneous amylase and lipase measurements in 125 children showed that either was ≥3× the upper limit of normal (ULN) in 95.2%, while both were <3× the ULN in 4.8% of cases. Nondiagnostic lipase was seen in 12 (9.6%) children, and diagnosis was based on amylase level ≥3× the ULN in six children and imaging in the other six.

Conclusions:

Serum amylase, serum lipase and imaging should continue for the conclusive diagnosis of AP in children. Simultaneous serum amylase measurement helped diagnose AP with non-diagnostic lipase.
Revisiting World War 2 through the Lens of Psychology
Authors: Bhattacharjee Debanjan , Agrawal Adesh Kumar , Gowda Guru S.
Published: August 2021

World War 2 (WW2) has witnessed the rise of influential personalities such as Hitler, Mussolini, Stalin, Churchill, and Roosevelt. Many causes have been recorded in a history as causes of WW2; however, we argue that there has been complex psychological interaction between the leaders involved in the background of a crisis charged with paranoia and anxiety. Personality factors of the leaders probably helped as a catalyst in setting a cascade of events that resulted in mass causality. We discuss the psychological aspect of WW2 taking examples of few involved personalities.
“There is No Such Thing as Society
Authors: Di Nicola Vincenzo
Published: August 2021

The author follows up and replies to the three invited commentaries on his social psychiatry manifesto published in the first issue of World Social Psychiatry, emphasizing points of agreement with three practical examples of how research, practice, and policymaking can benefit from social psychiatry – or falter without implementing its powerful and relevant insights.
Psychological Trauma Through Mass Media
Authors: Rozanov Vsevolod Anatolievitch , Rutz Wolfgang
Published: August 2021

There is evidence from earlier studies that the probability to be traumatized by pictures of disasters is associated with a high level of exposure, the traumatic significance of the pictured event, prior exposure to similar real-life events, and personality variables. Preexisting symptoms of posttraumatic stress disorder, depression, and anxiety are predictors of the higher impact of mass media (MM) and social media (SM) contributing to a vicious cycle. We aimed to discuss mechanisms through which MM and SM may cause massive indirect traumatization of populations and that may be relevant for the psychosocial conditions that emerged during COVID-19 pandemic news bombardment. The current pandemic is an example of a serious and deadly disease with extremely enhanced representation in the MM and SM and high rates of unverified, false, and sometimes apocalyptic information. Both mass as well as social medial tendencies to select their news according to their controversial and often negatively affective load contribute to this. This phenomenon is characterized as “infodemic” – a situation that may have profound consequences for mental health due to undermining feelings of personal safety, corroding social cohesion, and inducing conflicts and bitterness. Pandemic-infodemic situation has shown that complicated but inevitable turn to higher transparency including ethically motivated restrictions of anonymity and the contents of the web– measures that, however, have to be sensitively balanced with the demands guaranteeing the freedom of opinion, the freedom of speech and the avoidance of censorship. In general, there is a need for complex solutions, difficult decisions, and intricate balances.