bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of clinical indices with halitosis grading in chronic periodontitis: A randomized control trial
Authors: Veeray Junaid Mushtaq , Gupta K. K. , Soni Sweta , Kothari Divya
Published: August 2023

Background:

Oral malodor is a major periodontal complaint, but the best method for assessing the halitosis grade is still undefined. The primary objective of the study was to detect the halitosis grade in the exhaled breath using the three distinct techniques and to compare the readings with different clinical indices to find out the best method of halitosis grading.

Materials and Methods:

A total of 90 patients with chronic periodontitis having oral malodor were included in the study. The subjective assessment of the exhaled breath (halitosis grading) was done by three different methods; using a handheld portable Tanita FitScan sulfide monitor, by Halitox toxin assay, and by organoleptic (Sniff test) method. The findings were then compared with the clinical parameters of poor oral hygiene like plaque index (PI), gingival index (GI), gingival bleeding index (BI), and pocket depth (PD) to detect the best method of halitosis grading.

Results:

The mean age of the patients included was 38.23 ± 8.83 (mean ± standard deviation) years. The median value of halitosis grading as obtained by Tanita FitScan was 3.0 (95% confidence interval as 2 and 4) which was then compared with clinical indices (PI, GI, BI, and PD) and the results were statistically significant (P < 0.05), whereas the other two techniques of halitosis grading gave insignificant results.

Conclusion:

The results confirmed that the halitosis grading done using Tanita FitScan sulfide monitor is more appropriate with respect to clinical indices when compared with the other two techniques.
Paradental cyst with hyaline ring granuloma masquerading as pericoronitis
Authors: Vasanthi V. , Tha Tamizh Paavai , Kumar A. Ramesh , Balasubramanian Sasikala
Published: August 2023

Paradental cyst is an odontogenic cyst associated with pericoronitis in partly erupted mandibular third molars. It is an inflammatory cyst common among the mandibular molars. The cyst is most commonly seen on the distal or distobuccal aspect of the third molars. The angle of tooth and food impaction has been postulated to be responsible for the development of the cyst in third molars. The source of the epithelium has been reported as reduced enamel epithelium. The paradental cyst is frequently misdiagnosed as a radicular cyst or dentigerous cyst. We report a case of paradental cyst in a patient with partially erupted mandibular third molar with food impaction and resulting hyaline ring granuloma.
Adjunctive benefit of probiotic supplementation along with nonsurgical therapy for peri-implant diseases – A systematic review and meta-analysis
Authors: Ambili R. , Nazimudeen Nias Bin
Published: August 2023

Peri-implant diseases are prevalent conditions, but a predictable management strategy is still lacking. The objective of the present article was to evaluate the adjunctive benefits of probiotics with nonsurgical therapy in the management of peri-implant diseases. The review protocol was registered in PROSPERO and prepared according to PRISMA guidelines. Randomized controlled clinical trials in patients diagnosed with the peri-implant disease where probiotic was used as an adjunct to nonsurgical therapy were included in the study. The risk difference of percentage reduction in bleeding on probing, plaque accumulation, and mean difference in probing pocket depth reductions at implant level were estimated using a random effect model due to high heterogeneity among studies. Four studies fulfilled the criteria for selection. Two of them presented data on both peri-implantitis and peri-implant mucositis and they were considered separate studies during meta-analysis. Significant reduction in percentage of bleeding on probing was noticed at 1 and 3 months (−0.28 [−0.48, −0.09], P = 0.004 and − 0.19 [−0.35, −0.02], P = 0.03, respectively), but the reduction was not statistically significant at 6 months. Similar results were also observed for plaque accumulation. No statistically significant reduction in probing pocket depth was observed in the probiotic group during any of the re-evaluations.

Conclusion:

Adjunctive therapy of probiotics may improve the efficacy of nonsurgical therapy of peri-implant diseases for up to 3 months. However, moderate certainty was observed for a reduction in bleeding on probing after 1-month re-evaluation alone.
In vitro evaluation of remineralizing agents on dentinal tubule occlusion: A scanning electron microscopic study
Authors: Sathish Akanksha Kidiyur , Gopalkrishna Pratibha , Kumar Santhosh
Published: August 2023

Context:

Over the years, numerous treatment modalities have been researched for the management of dentinal hypersensitivity. A recent remineralizing agent containing a phase of amorphous calcium phosphate combined with fluoride has shown the ability to rapidly convert into biomimetic hydroxyapatite. This potential can be utilized in occluding the dentinal tubules for the treatment of hypersensitivity.

Aims:

The present study aims to compare the effectiveness of biomimetic hydroxyapatite-based tooth mousse and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) tooth mousse as desensitizing agents on dentinal tubule occlusion.

Materials and Methods:

The in vitro study design involved 30 prepared dentin specimens that were divided into three groups: Group A: negative control, Group B: CPP-ACP tooth mousse (GC tooth mousse™), and Group C: fluoride-doped amorphous calcium phosphate (F-ACP) tooth mousse (Curasept Biosmalto Denti Sensibili Tooth Mousse). The specimens were observed under a scanning electron microscope (SEM) and an attached energy-dispersive X-ray (EDX) spectroscopy apparatus after 1 week.

Statistical Analysis:

The data were analyzed using Kruskal–Wallis test and post hoc Mann–Whitney test for intragroup and intergroup analysis, respectively.

Results:

The SEM analysis of the F-ACP group showed statistically greater percentage of tubule occlusion (40.21%) compared to the CPP-ACP group (38.15%). EDX analysis of both F-ACP and CPP-ACP groups revealed calcium, phosphorus, carbon, oxygen, and silica with an additional fluoride element in the F-ACP group.

Conclusions:

In the present study, both remineralizing agents were able to occlude the dentinal tubules. Among the two, the F-ACP tooth mousse showed greater tubule occlusion, and therefore, appears promising as an upcoming remineralizing agent in the management of dentinal hypersensitivity.
Incidence of Breast Cancer among Blood Groups of Women in the Holy Governorate of Karbala
Authors: Abdulridha Al-Ganimi Ahmed Khudhair , Abd Al-Salam Aqeel S.
Published: August 2023

Introduction:

Breast cancer is a significant problem that affects women all over the world and is a leading cause of death among these patients. ABO blood groups are stable and vary by socioeconomic, geographical, and ethnic groupings. Blood type affects susceptibility and results.

Objective:

Previous studies have discovered a correlation between ABO blood type and Rh system as risk factors for breast cancer.

Aim:

To identify the association of breast cancer prevalence between women’s blood groups and the Rh factor system in Karbala Governorate.

Materials and Methods:

A total of 1026 women were chosen, with 736 cases and 290 controls. The case group includes patients with breast cancer, and all of them had their cancer diagnosis confirmed by biopsy. The control group consisted of women who had never been diagnosed with cancer of breast.

Results:

Blood group type O (39.7%), blood group type A (26.1%), blood group type B (25.4%), and blood group type AB (8.8%) were the most common ABO blood types among cancer of breast patients. The percentages of groups of ABO blood for healthy donor control were as follows: blood group type O (40.0%), blood group type A (27.6%), blood group type B (21.7%), and AB (10.7%) with P = 0.05 or higher. There is a significant difference in the Rh factor between breast cancer patients and healthy control (P = 0.003). There were noticeable differences in age categories between patients diagnosed with breast cancer and the controls in this study (P = 0.000).

Conclusion:

There is no correlation between ABO blood types and breast cancer in this group of Iraqi women. There is a statistically significant difference, with a P value of 0.003, between patients diagnosed with breast cancer and healthy controls in terms of the Rh factor.
Detection of Class 1 Integron and Antibiotic Resistance of β-Lactamase-Producing Escherichia coli Isolated from Four Hospitals in Babylon, Iraq
Authors: Khulaif Mohammed Jasim , Al-Charrakh Alaa H.
Published: August 2023

Background:

The emergence of multidrug-resistant Escherichia coli is a major public health threat worldwide.

Objectives:

This study was conducted to determine the sensitivity pattern and class 1 integron of E. coli isolated from various clinical sources in Babylon, Iraq.

Materials and Methods:

A total of 1874 clinical samples were collected from patients between February and June 2022. Antimicrobial susceptibility of E. coli to different antibiotics was determined using the Vitek-2 compact system. Class 1 integron was detected genetically.

Results:

From 1874 clinical samples, 231 (12.3%) isolates belonged to E. coli. Isolates from urine were more frequent in females than in males. All isolates were resistant to ampicillin, amoxicillin, and amoxicillin/clavulanate. Escherichia coli isolates showed high sensitivity to meropenem, ertapenem, imipenem, amikacin, and isepamicin. Isolates from vaginal discharge were resistant to cephazolin, ciprofloxacin, levofloxacin, sparfloxacin, nalidixic acid, and aztreonam. Isolates from diabetic foot ulcer showed high resistance to ciprofloxacin, levofloxacin, sparfloxacin, nalidixic acid, norfloxacin, and ceftazidime. All E. coli isolates were multidrug-resistant (MDR) and 67% of them were extended-spectrum β-lactamase (ESBL) producers, most prevalent in urine and vaginal discharge. Approximately 99.1% of E. coli isolates carried class 1 integron.

Conclusions:

Escherichia coli isolated from various clinical specimens showed differences in antibiotic susceptibility patterns, with high resistance to commonly used antibiotics. The most effective antibiotics against E. coli isolates were ertapenem, imipenem, meropenem, amikacin, and isepamicin. However, MDR E. coli isolates showed high resistance rates to most of the antibiotics tested. ESBL-producing E. coli showed high prevalence. Class 1 integron is the leading cause of antibiotic resistance.
Most Common Risk Factors Associated with Peripartum Cardiomyopathy amongst Kurdish Population
Authors: Amen Shwan Othman , Rasool Banan Qasim , Shehata Dina Gamal , Al-Hadeethi Ban Tareq , Maqdasy Reveen Faud , Qader San Mohammed , Hashim Al Lami Bareq Sabeeh , Albuquerque Ana Luisa , Affas Ziad R. , Yousif Salah Hassan , Maaroof Payam Z.
Published: August 2023

Background:

Peripartum cardiomyopathy (PPCM) is idiopathic cardiomyopathy that presents during the last trimester or the first several months after delivery and it is a serious complication of pregnancy.

Objectives:

The aim was to assess the most common risk factors seen among pregnant women leading to PPCM and factors that are associated with better outcomes after therapy.

Materials and Methods:

A total of 20 patients who presented to the outpatient cardiology clinic and fulfilled the diagnostic criteria of the European Society of Cardiology were recruited to participate in the study. A detailed history was obtained and left ventricular measurements were evaluated using M-mode, 2-dimentional, and Simpson methods to estimate the ejection fraction. Data were analyzed using the Statistical Package for the Social Sciences.

Results:

Mean age at diagnosis was 34.7 ± 5.2 years. Multiparous women constituted 60% of the study sample. Gestational age at presentation ranged between 28 and 38 weeks, with a mean of 32.9 ± 2.6. Being overweight was a common feature as 60% of patients had above-normal body mass index. Family history was reported in 50% of patients, followed by passive smoking (35%), hypertension (25%), thyroid disorders (30%), and type II diabetes mellitus (20%). The mean left ventricular ejection fraction at the time of diagnosis was 32.3% ± 6.7% with an increase to 44.2% ± 8.9% at follow-up. Younger patients were more likely to regain normal left ventricular function following diagnosis (P = 0.005).

Conclusion:

These preliminary results strongly demonstrate that advanced maternal age, anemia, multiparity, and family history were the most common risk factors seen among our population.
Microbiome and Metabolomics
Authors: Al-Khafaji Noor S.K. , Al-Dahmoshi Hussein O.M. , Chabuck Zainab Adil Ghani , Mahdi Zena Abdul-Ameer , Akram Muhammad , Sohail Adrish , Laila Umme , Zainab Rida , Khalil Muhammad Talha , Iftikhar Momina , Ozdemir Fethi Ahmet
Published: August 2023

The relationship between microbiome and metabolomics by studying the microbiota living in the human body and studying their effects on the concentration of metabolites, also to study effects of microbiota colonization on other bacteria or living organism entering the body. These microbiomes and metabolites not only act as an energy source for whole body organs but can also play a role in causing diseases as they affect beyond the gut. It is compulsory to understand the relationship of the microbiome with the food nutrients we take in. So, we will be able to improve the health by making some changes in dietary intake according to gut microorganisms. In this study, we observed the relationship of microbiome and the metabolomics they are involved in, with diseases related to them. As the number of metabolites in human body is an indicator of colonized number of microbiota and development of a disease related to it.
Molecular Detection of Genes Encoding for Adhesion Factors in Biofilm Formation among Uropathogenic Escherichia coli Isolates
Authors: Abbood Dina Hassan Abed , Obaid Alwan Zeena Hadi
Published: August 2023

Background:

The ability of Escherichia coli to build biofilms leads to the development of numerous diseases and makes their removal challenging. In addition to being the most common cause of urinary tract infections (UTIs), E. coli has been linked to disease in almost every area of the human body.

Objective:

The objective of the study was to evaluate the uropathogenic E. coli biofilm development using molecular and biochemical methods.

Materials and Methods:

Out of the total 117 urine samples obtained from UTI patients and diagnosed by selective media EMB (eosin methylene blue agar) and Vitek2 system, antibiotic sensitivity test, biofilm formation assay, and molecular detection of genes encoding for adhesion factors using polymerase chain reaction (PCR) technique were done.

Results:

Fifty E. coli isolates from both sexes of different ages were isolated; the UTI rate in females was 82% and in males was 18%. The result of the antibiotic sensitivity test, in terms of the percentage of resistance, was as follows: ampicillin, 50%; amoxicillin-clavulanate, 98%; ceftazidime, 72%; cefotaxime, 68%; aztreonam, 26%; gentamicin, 48%; levofloxacin, 36%; and trimethoprim, 52%, so that a high percentage of multidurg resistance resulted in the current study was 88%. The results of the quantification of biofilm formation revealed that all isolates produced biofilm with the following percentages: five (10%) as strong adherents, 36 (72%) as moderate biofilm producers, and nine (18%) were weak producers. The prevalence of genes fimH, csgA, and ag43 was 92%, 98%, and 92%, respectively, the result of detection of genes encoding for adhesion factors using PCR technique.

Conclusions:

The biofilm phenotype was indicated in all E. coli isolates and can confer virulence behavior and considered as a great challenging health problem and there is a significant association between adherent factor’s genes (fimH, csgA, ag43) and the ability to produce biofilm within E. coli isolates.
Heat Shock Protein 70 Biomarkers in Sperm and Its Association on Oligoasthenozoospermia, and Asthenozoospermia in Male Infertility
Authors: Abdel Jail Ahmed Saidi , AlSafi Wasan Ghazi , Raad Zahraa
Published: August 2023

Background:

The heat shock protein (Hsp70) is a protein that helps cells survive in harsh conditions and is involved in a variety of cellular biological processes.

Objectives:

To study the relationship between the levels of (Hsp70) in semen plasma of infertile (oligoasthenozoospermia (OA), asthenozoospermia (AZ) and fertile men and the effect of an increase and decrease on fertility.

Materials and Methods:

The study was conducted on 119 semen samples, 31 men with (AZ), 28 men with (OA), whereas another 60 healthy controls were diagnosed, semen samples were collected from Iraqi patients who attended infertility clinics for infertility diagnosis and assisted reproductive technologies in Karbala for the period between November 2021 and May 2022.

Results:

The mean (Hsp70) in the patient group were significantly higher than in the control group (P < 0.001). In comparison to (AZ) groups with (OA) found a significant difference in the mean level of (Hsp70) between (AZ) groups and (OA) groups (Hsp70) levels showed a negative significant correlation with the concentration, progressive cell and non-progressive cell, and a positive significant correlation with the sample volume, viscosity of semen, P < 0.05.

Conclusion:

The total level of Hsp70 in the semen of men is higher in infertile men (AZ) and (OA), whereas we find lower levels in the semen of fertile men. A negative relationship was also found between the level of Hsp70 with semen concentrations and sperm motility and a positive relationship with the volume of the semen sample and its viscosity.
An Overview of Chikungunya Disease, Origins, Symptoms, Transmission, Route of Infection, Diagnosis, and Treatment
Authors: Hussien Faleeha Habeeb
Published: August 2023

Chikungunya is a disease caused by the Chikungunya virus (CHIKV), an alphavirus transmitted by a mosquito. This disease has spread to different countries around the world with many outbreaks occurring. Even though CHIKV had already been a mystery since its isolation in 1952, the article provides an overview of the disease’s prevalence, historical background, clinical signs, methods of transmission, laboratory diagnosis, and remedies utilized.
Genetic and Biochemical Detection of Salmonella enterica Isolated from Patients Suffering Watery Diarrhea and Typhoid Fever in Babylon Province
Authors: Aziz Abdul Aziz T. Abdul , Abdul-Lateef Lamees A.
Published: August 2023

Background:

Salmonellosis is a severe infectious zoonotic disease, which increases the importance of identifying and controlling the causative strains.

Objectives:

This study aimed to develop a rapid molecular diagnostic test to determine and purify bacterial isolates based on the specific primer. SE1472298-2 for Salmonella serovar enteritidis; gene STM4497 demonstrated specificity for Salmonella serovar typhimurium and gene O antigen synthesis tyv for Salmonella serovar typhi isolated from patients in Babylon province, Iraq.

Materials and Methods:

Two hundred clinical stool specimens were collected from patients suffering from watery diarrhea. Blood specimens obtained from patients with typhoid fever who were admitted to three hospitals of Babylon Governorate.

Results:

There were a total of 200 samples; 34 (17%) were discovered by biochemical tests. The diagnosis of these samples was confirmed by polymerase chain reaction, depending on the target gene, so the number of isolates was 25 (73.53%), Salmonella enteritidis 13 (52%) Salmonella typhimurium 6 (24%), and Salmonella typhi 6 (24%).

Conclusion:

Molecular techniques, particularly polymerase chain reaction, can rapidly and precisely identify Salmonella isolates.
Association between Single Nucleotide Polymorphisms of F3 Gene (rs12029080 T>G and rs11165176 C>T) with Thrombosis in SARS-CoV-2 Patients in Babylon Province
Authors: Jaafar Salim Shamkhi , Shareef Hasanain Khaleel
Published: August 2023

Background:

Severe acute respiratory syndrome coronavirus 2 is a respiratory virus that has a strong association with pulmonary morbidity and thrombosis and has caused death in much of the sick population. The coagulation factor III gene (F3) produces tissue factor (TF) a cell-surface glycoprotein. It is the primary initiator of the extrinsic blood coagulation cascade.

Objectives:

The study aimed to identify the single nucleotide polymorphism (SNP) of F3 gene (rs12029080 T>G and rs11165176 C>T) and D-dimer linked to thrombosis in coronavirus disease (COVID-19) patients.

Materials and Methods:

Blood samples were collected from 30 patients infected by COVID-19 in Babylon Province. Detection of the polymorphism was done by using sequencing technique.

Results:

The results of the polymerase chain reaction of the amplification targeted region had shown two valid SNPs: rs11165176C>T and rs11165176. We discovered that heterozygous C/T had a higher genotypic frequency than homozygous C/C (odd ratio (OR) = 1.14, 95% confidence interval (CI) = 0.41–3.15, P = 0.796) and the homozygous variation T/T genotypic frequency is comparable to that of homozygous C/C (OR = 1.4, 95% CI = 0.43–4.86, P = 0.543). The C and T alleles frequencies showed statistical difference as reported in F3 (rs11165176) between COVID-19 patients and control (P = 0.053), 29 (48.3%) and 31 (51.6%), respectively, than in control groups, C allele 34 (56.7%) and T allele 26 (43.3%). Therefore, the T allele was most frequent in COVID-19 patients and control groups.

Conclusion:

According to the results of our statistical research, there was a significant link between F3 gene rs11165176 and the development of thrombosis in patients with COVID-19 to be a potential D-dimer associated with COVID-19 patients.
Possible Protective Effect of Spanish Black Radish on Hematological Parameters Aganist Benzene - Induced Leukemia in Rats
Authors: Al-Rubaye Baneen Hayder , Al-Ali Ibtisam Abbas , Hussein Khalid Ali
Published: August 2023

Background:

The Spanish black radish, which is grown all over the world and is full of useful nutrients, helps in the therapy of many illnesses.

Objective:

The aim of this study was to evaluate the possible protective effect of Spanish black radish extracts against benzene-induced leukemia in rats.

Materials and Methods:

A total of 35 rats were purchased from the animal house at the College of Pharmacy, University of Karbala, Iraq. Benzene was used for the induction of leukemia in experimental animals. An extract of black radish was set after mixing up 50 g of the finely powdered plant material with two solvents (500 mL of 100% ethanol or water). After leukemia induction, rats were randomly divided into seven groups: first group, negative control group; second group, positive control group; third group, (lack radish aqueous extract 100 mg/kg; fourth group, black radish aqueous extract 200 mg/kg; fifth group, black radish ethanol extract 100 mg/kg; sixth group, black radish ethanol extract 200 mg/kg; and seventh group, cyclophosphamide 5 mg/kg.

Results:

Leukemia induction resulted in a severe increase in the total leukocyte count and a severe decrease in red blood cells, hemoglobin, and platelet levels of the experimental animals. However, there were no significant differences between the negatively treated group and the benzene-treated group regarding platelet count. Posttreatment with Spanish black radish extracts, especially the aqueous plant extract, shows an improvement in blood profiles compared to the benzene-treated group.

Conclusion:

Our study indicates that Spanish black radish might be a promising natural, antileukemic source.
Quality of Life among Amputees
Authors: AL-Jubori Rusull Hamza Kh , Yasir Amean A. , Hindi Nada Khazal K.
Published: August 2023

Background:

Social support for amputee patients can get them out of the atmosphere of illness or disability and inspire them with a great deal of optimism and hope and make them forget the missing part, even if temporarily.

Objectives:

The study aimed to investigate the relationship between social support and quality of life (QoL) among amputees.

Materials and Methods:

The research was carried included 250 clients who undergo lower and upper amputation, using a standardized questionnaire for measuring the social support and QoL (WHOQOL-BREF) of amputees who attended Babylon Rehabilitation Centers, Iraq. Data were collected using interviews on individual bases with the participants and analyzed by descriptive and inferential approaches.

Results:

The results indicate the average age of the women was 50 years (ranged 50–59 years), male (68.8%), married (61.2%), secondary school (38%), employment (34%), insufficient monthly income (41.2%), amputation due to conditions (48.4%), in lower extremities (56.4%) for more than 10 years on amputation (48.8%). The results show that social support is positively significant with physical QoL (r = 0.153; P = 0.000), psychological QoL (r = 0.235; P = 0.000), and social QoL (r = 0.170; P = 0.000). QoL among amputees was significant (positive) and related to social support (r = 0.250; P = 0.000).

Conclusions:

Amputees who receive social support from others develop self-confidence, can support others socially, are less likely to suffer from mental illnesses, and are better able to deal with frustration. We discover that social support boosts the individual’s capacity to withstand frustration and lessens a great deal of psychological anguish since the person can handle his problems in a sensible and good way. Strong social support from family, friends, and community members enables amputees to deal with challenges and live their life more successfully.
Impact of Indium Oxide Nanoparticles Mouth Wash in Prevention of Human Dental Enamel Caries (In Vitro Study)
Authors: Hasan Dhuha Malek , Abbas Maha Jamal , Al-Ghurabi Batool Hassan
Published: August 2023

Background:

Despite the fact that fluoride-based remineralization technologies have dominated preventive dentistry for the past century, new and innovative nanomaterials approaches are transforming the industry. A variety of unique metal nanoparticles (NPs) materials are now be easily available to assist remineralization of the dental enamel surface.

Objectives:

This study was reported to prevent and treat of dental caries using indium oxide NPs suspension solution application in comparison to de-ionized water and sodium fluoride on human tooth enamel by surface microhardness analysis for the surface dental enamel.

Materials and Methods:

Field emission scanning electron microscopy, X-ray diffraction, and ultraviolet (UV)-visible absorption spectrophotometer were used to evaluate the physical characteristics of an indium oxide NPs suspension solution that was created by the laser ablation in liquid. Microhardness Vickers test was used to evaluate the microhardness of teeth. Teeth samples were 60 teeth that were divided randomly into two phases; each phase consisted of prevented and treated groups with indium oxide NPs, control-positive group was treated with sodium fluoride, and control-negative group was treated with deionized water. Each group was consisted of 10 teeth.

Results:

The results showed that there was an increase in microhardness be recorded for both preventive and treatment groups after the application of an indium oxide NPs suspension solution.

Conclusion:

Laser-prepared indium oxide NPs colloidal suspensions were found to be effective as a remineralizing agent to human dental enamel and thus can be considered as an alternative to sodium fluoride mouth wash.
Comparative evaluation of clonidine and dexamethasone as adjuvants to ropivacaine for ultrasound-guided transversus abdominis plane block
Authors: Hemlata  , Singh Rajesh Kumar , Verma Reetu , Singh Dinesh , Chaudhary Ajay Kumar , Kushwaha Brij Bihari
Published: August 2023

Aim:

This study aims to study the effect of addition of clonidine and dexamethasone to ropivacaine for ultrasound-guided TAP block in patients undergoing abdominal surgeries. We primarily compared the quality and duration of postoperative analgesia.

Materials and Methods:

This randomized double-blind study was done after taking approval from Institutional Ethical Committee and written informed consent from all the patients. Sixty patients undergoing abdominal surgery under general anesthesia were enrolled in the study and randomly divided into two groups: Group-RC (n = 30) and Group-RD (n = 30). Patients in both the groups were given bilateral ultrasound-guided TAP block at the end of surgery. Patients in Group-RC received 20 ml ropivacaine 0.2% with 75 μg clonidine on each side and patients in Group-RD received 20 ml ropivacaine 0.2% with 4 mg dexamethasone on each side.

Results:

Visual analogue scale score for pain was significantly less in Group-RC as compared to Group-RD at all-time intervals (P <.05). Duration of pain relief in Group-RC was significantly greater than in Group-RD (16.50 ± 6.68 vs. 9.67 ± 6.46 h; P = 0.001). Requirement of rescue analgesia was also significantly less in Group-RC as compared to Group-RD (80% vs. 90%; P = 0.014). Except for a higher incidence of nausea in Group-RC, there was no other significant difference in the incidence of complications between the two groups.

Conclusion:

Addition of Clonidine (75 μg) to ropivacaine for ultrasound-guided TAP block provides better and prolonged postoperative analgesia as compared to addition of dexamethasone (4 mg) without any significant side-effects.
Comparison of modified Mallampati test and thyromental height test for preoperative airway assessment
Authors: Chhatrapati Swati , Bloria Summit , Singh Nidhi , Paul Shamik , Luthra Ankur , Kataria Ketan K. , Vithani Samira , Omar Syed , Narayanan Nayanar V. Krishna
Published: August 2023

Background:

Prevision of a potentially difficult airway in the preoperative period is imperative. The available tools are evaluation of mouth opening, Mallampati test; atlanto-occipital extension; hyomental, thyromental, and sternomental distances; and upper lip bite test; thyromental height test (TMHT) is a new indicator.

Aims:

To compare the effectiveness of preoperative anaesthetic airway evaluation methods of TMHT and Modified mallampati test (MMT) to predict the difficulty in intubation.

Materials and Methods:

A prospective observational study was aimed to compare the effectiveness of preoperative anesthetic airway evaluation methods of TMHT and modified Mallampati test (MMT) to predict the difficulty in intubation. A total of 150 subjects were included in this study. MMT and TMHT were compared, and sensitivity, specificity, predictive values, and accuracy were calculated.

Results:

On comparison, we found TMHT to be more sensitive (93.33%) than MMT (77.78%); both tests have high specificity (TMHT 91.43%; MMT 81.90%). Positive predictive value was 82.35% for TMHT and 64.81% for MMT. Similarly, negative predictive value was 96.97% for TMHT and 89.58% for MMT. Accuracy was 92.00% for TMHT and 80.66% for MMT.

Conclusions:

TMHT can predict difficult intubation better than MMT (high positive predictive value). However, both TMHT and MMT predict easy intubations effectively, their negative predictive values being high.
Neuromyelitis optica
Authors: Rapeti Kalyani Manasa , Paliwal Bharat , Sharma Ankur , Kamal Manoj , Bhatia Pradeep
Published: August 2023

Neuromyelitis optica (NMO), a rare devastating demyelinating syndrome involving optic neuritis and myelitis, poses a challenge to anesthesiologists. Here, we present the anesthetic management of a diagnosed case of NMO posted for total hip replacement. Although literature documenting adverse outcomes with both general anesthesia (GA) and spinal anesthesia (SA), more so with SA, it should always be considered if benefits outweigh the risk of GA. An uneventful perioperative period in the previous two surgeries favored SA as an anesthetic technique for consecutively third time in this case with smooth recovery.
Stellate Ganglion Block and Neurolysis for Refractory Ventricular Arrhythmia
Authors: Aggarwal Anurag , Balyan Rohit , Suresh Varun , Gupta Bhavna
Published: August 2023

Enhanced electrical activity, ventricular arrhythmia (VA), and cardiac instability due to increased sympathetic tone may be refractory to standard medical treatment and ablation procedures. Stellate ganglion block (SGB) has been used to treat refractory VA; however, there is insufficient information in the literature on its long-term outcome. Herein, we described three patients that were successfully treated with ultrasound-guided left SGB (LSGB) and chemical neurolysis. Ultrasound-guided LSGB may be considered as rescue or bridge therapy for stabilizing ventricular rhythm before a definitive procedure is planned.
Current practice and attitudes regarding the perioperative use of cuffed tracheal tubes for pediatric and neonatal tracheal intubation
Authors: Motiani Poonam , Ahmad Zainab , Sharma Pramod Kumar , Gupta Anju , Jain Mukul Kumar , Sahu Dinesh Kumar
Published: August 2023

Introduction:

the use of cuffed endotracheal tubes (ETTs) in children is debatable. Despite recent literature on the use of cuffed ETT in children, its use is relatively low even in developed world. We conducted this survey to explore the perceptions and patterns of cuffed/uncuffed ETT usage in children, <5 years of age.

Materials and Methods:

This descriptive cross-sectional survey was done using a specially designed Google Form that was circulated among anesthesiologists of any grade practicing in India. The questionnaire was validated by seven experts on a 4-point scale as per the standardized model of content validity index and those with an index <0.78 were modified. Thereafter, the questionnaire was circulated over a month through WhatsApp and a reminder was sent every week for a month.

Results:

The total response rate was 55% (99/180) and after excluding the responses of postgraduates, 96 responses were evaluated. The use of pediatric cuffed ETT was similar among institutions. Only 35.5% of the respondents routinely used cuffed tubes regularly. The common reasons for nonusage of cuffed tubes included fear of higher resistance to flow and risk of subglottic injury. Those anesthesiologists who were performing higher pediatric cases were more inclined to use a cuffed ETT. Endotracheal cuff pressure was monitored routinely by 40% of the respondents who used cuffed tube.

Conclusion:

Anesthesiologists practicing pediatric anesthesia are more likely to choose cuffed ETT in children aged <5 years. Safety norms such as cuff pressure monitoring are not being followed routinely when these tubes are used.
A questionnaire-based cross-sectional pilot survey on adherence to the recognized guidelines by the airway managers during intubation at the time of COVID-19 pandemic
Authors: Guha Debarshi , Dwivedi Deepak , Paul Debashish , Chakrabarti Soumya , Talukdar Jupi , Singh Shalendra
Published: August 2023

Background and Aims:

COVID-19 infection has the potential to spread exponentially during aerosol-generating procedures like intubation. The aim was to find the compliance toward the actual practice as well as the existing knowledge gap and adherence to the guidelines among the medical professionals while attempting intubation in a known or suspected COVID-19 patients.

Materials and Methods:

A cross-sectional web-based survey format was planned using English questionnaire in an online form (Google® Forms). One hundred and forty valid responses for 27 questions were received. Maximum participation was received from Indian anesthesiologists working in government, semi-government, and private health facilities, performing the intubation routinely. All the valid responses were statistically analyzed by calculating the significant difference in means and proportions, with P < 0.05 being considered statistically significant.

Results:

Eighty percent of the respondents received training for donning and doffing and regularly wore personal protective equipment for the airway procedure. Scarce simulation training (22.1%), minimum screening before entering into a intubation scene (37.9%), frequent use of bag-mask ventilation (18.2%) or high flow nasal cannula (19.7%) use for preoxygenation, confirmation of the depth of endotracheal tube by auscultation (34.5%), and having no plan B in case of unanticipated difficult airway (27.9%) make the knowledge gap evident. The survey pointed out toward the infrastructural requirement of negative pressure intubation rooms, availability of waveform capnography, and widespread use of videolaryngoscope.

Conclusion:

This survey gives us an insight into the compliance with existing lacunae and nonuniform practices of the recommended guidelines for the airway management during COVID-19 pandemic with its pragmatic solution.
Comparison of ketamine–propofol (ketofol) versus midazolam–fentanyl for procedural sedation and analgesia in emergency care department
Authors: Begum K Charishma , Gnanadurai Kingsly Robert , Sreekanth Chandrappa , Pushpa Latha D. S.
Published: August 2023

Background:

Various anesthetic drugs are used for procedures conducted outside the operation theater. Very few studies are done in the emergency department to compare the combination of ketamine and propofol (ketofol) versus midazolam–fentanyl for procedural sedation and analgesia, thus we conducted this study to compare these drug combinations in terms of analgesic and sedation efficacy in the emergency department.

Materials and Methods:

A prospective, open-label, randomized, comparative study was conducted on 60 patients, who were randomly assigned to the ketofol and midazolam–fentanyl groups (30 each) to compare these drugs in terms of sedation efficacy using modified Ramsay sedation score, pain scores using Visual Analog Scale, and alteration of hemodynamic, adverse effects such as respiratory distress and nausea. The mean pain score before and after the study was compared using paired t-test, and the difference between the two groups was assessed using Student's t-test. Chi-square test and Fisher's exact test were employed to compare the distribution of qualitative data.

Results:

Our study showed that ketofol provides better analgesia as compared to the midazolam–fentanyl group because reduction in Visual Analog Scale scores was 1.27 ± 1.52 (mean ± standard deviation [SD]) in the ketofol group as compared to 3.07 ± 1.25 (mean ± SD) in the midazolam–fentanyl group. Ketofol 4.47±0.73 (mean ± SD) had a better modified Ramsay sedation score when compared to midazolam–fentanyl 3.47±0.90 (mean ± SD). There was reduction in systolic (from 119 ± 18.4 to 113.3 ± 18.81 mmHg) and diastolic blood pressure (from 72 ± 9.61 to 69.67 ± 10.33 mmHg) in the midazolam–fentanyl group during and after the procedure in comparison to the ketofol group where none had hypotension.

Conclusion:

Results concluded that ketamine–propofol (ketofol) combination is safe and better in providing adequate analgesia and sedation than midazolam and fentanyl combination in the emergency room.
A prospective randomized study to compare intrathecal isobaric levobupivacaine with or without fentanyl in various infraumbilical surgeries
Authors: Mathur Veena , Verma Anand Kumar , Khare Arvind , Garg Deepak Kumar , Thada Beena , Singh Maina
Published: August 2023

Background and Aims:

Subarachnoid block is the most preferred anesthetic technique for infraumbilical surgeries as it provides better postoperative analgesia, effective muscle relaxation, and cost-effectiveness. Levobupivacaine is preferable over bupivacaine due to its lower cardiotoxicity, prolonged sensory block, and shorter duration of motor block. Opioids as an adjuvant to intrathecal local anesthetics enhance the quality of both analgesia and anesthesia during intraoperative as well as postoperative period. The present study aimed to compare levobupivacaine with and without fentanyl in spinal anesthesia.

Methods:

In this prospective, randomized, double-blinded study, a total of 80 patients belonging to the American Society of Anesthesiologists Physical Status I and II were enrolled for infraumbilical surgeries. Patients were randomly allocated into two groups. Group Levobupivacaine (L) (n = 40) received isobaric levobupivacaine 0.5% 2.5 ml with 0.5 ml normal saline and Group Levobupivacaine + fentanyl (LF) (n = 40) received isobaric levobupivacaine 0.5% 2.5 ml with fentanyl 25 μg (0.5 ml). Time of onset and duration of both sensory and motor block, Visual Analog Scale score, duration of analgesia, hemodynamic changes, and any adverse events were noted in both the groups.

Results:

The onset of both sensory and motor block was significantly faster in Group LF (P < 0.05). The duration of sensory block was significantly longer in Group LF (P < 0.05). The duration of motor block was found to be comparable between two groups with stable hemodynamics and no perioperative sedation (P > 0.05). The duration of analgesia was significantly longer in Group LF (336.5 ± 31.3 min) compared to Group L (223.65 ± 32.17 min) P < 0.001.

Conclusion:

Intrathecal fentanyl (25 μg) can be effectively used as an adjuvant to isobaric 0.5% levobupivacaine as it provides better block characteristics with minimal adverse effects in patients undergoing infraumbilical surgeries.
Comparison of 0.125% and 0.2% ropivacaine in continuous lumbar plexus block for postoperative analgesia after total hip arthroplasty
Authors: Murugesan Anand , Gurunathan Deepak , Raghuraman M. S. , Indumathi Daivam , Sundary M. Thiriloga
Published: August 2023

Background:

Lower concentrations of ropivacaine in continuous lumbar plexus block (LPB) have not been studied adequately. Thus, we designed this prospective, randomized, comparative study to evaluate the two different concentrations of ropivacaine (0.125% and 0.2%) in continuous LPB for postoperative pain relief following total hip arthroplasty (THA).

Materials and Methods:

Fifty patients undergoing THA under standardized subarachnoid block have been randomly allocated to receive a continuous infusion of either 0.125% (Group 1) or 0.2% (Group 2) of ropivacaine in LPB done under the guidance of peripheral nerve stimulator. The primary outcome was consumption of tramadol during the first 24 h and the secondary outcomes were quality of sensory and motor blockade and consumption of ropivacaine.

Results:

The total amount of tramadol did not differ significantly (P = 0.442) between the two groups. Furthermore, the duration of sensory and motor blockade did not differ significantly between the two groups. However, the average consumption of ropivacaine was significantly lower in Group 1 when compared to Group 2 (238.80 mg vs. 380.64 mg, P = 0.0001).

Conclusion:

Administration of 0.125% of ropivacaine can be a better alternative as it would decrease the total amount of the local anesthetic in continuous LPB.
Liver fibrosis-4 score predicts mortality in critically ill patients with coronavirus disease 2019
Authors: Abosamak Mohammed Fawzi , Szergyuk Ivan , Santos De Oliveira Maria Helena , Lippi Giuseppe , Al-Jabbary Ahmed Suliman , Al-Najjar Amal H , Albadi Marzooq A , Henry Brandon M
Published: August 2023

Background:

Emerging evidence suggests that liver dysfunction in the course of coronavirus disease 2019 (COVID-19) illness is a critical prognostic factor for mortality in COVID-19 patients, and the Fibrosis-4 (FIB-4) score, developed to reflect level of hepatic fibrosis, has been associated with adverse outcomes in hospitalized COVID-19 patients. This study aimed to investigate intensive care unit (ICU) admitted patients, a high-risk subpopulation, research on which is lacking.

Materials and Methods:

This retrospective cohort study examined FIB-4 scores and clinical endpoints including death, acute cardiac injury (ACI), acute kidney injury, and need for mechanical ventilation in critically ill COVID-19 patients, without prior hepatic disease, throughout ICU stay.

Results:

Of 60 patients enrolled, 35% had ICU admission FIB-4 >2.67. Among nonsurvivors, FIB-4 was significantly higher at admission (median 3.19 vs. 1.44; P < 0.001) and only a minority normalized <1.45 (36.0%). Each one-unit increment in admission FIB-4 was associated with 67.4% increased odds of death (95% confidence interval [CI], 9.8%–162.6%; P = 0.017). FIB-4 >2.67 was associated with a median survival time of 18 days from ICU admission versus 40 days with FIB-4 <2.67 (P = 0.016). Admission FIB-4 was also higher in patients developing ACI (median 4.99 vs. 1.76; P < 0.001). FIB-4 correlated with age (r = 0.449; P < 0.001), and aspartate transaminase with alanine transaminase (r = 0.674; P < 0.001) and lactate dehydrogenase (r = 0.618; P < 0.001).

Conclusion:

High ICU admission FIB-4 is associated with mortality in critically ill COVID-19 patients, with failure to normalize at time of death, however, the high score is likely a result of generalized cytotoxicity rather than advanced hepatic fibrosis.
Comparison of two doses of intravenous esmolol in attenuation of hemodynamic response to extubation in laparoscopic surgeries
Authors: Kshama S. A. , Shenoy Laxmi , Sinha Shweta
Published: August 2023

Aims and Objectives:

The purpose of this study was the comparison of hemodynamic variables such as heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure during the extubation period following administration of two doses of intravenous (IV) esmolol.

Materials and Methods:

This prospective double-blind randomized controlled trial was conducted on patients (American Society of Anesthesiologists Physical Status), aged between 18 and 65 years, scheduled for elective laparoscopic procedure done under general anesthesia with endotracheal intubation. Sixty participants were randomized into three groups of 20 each, the first two groups received IV esmolol injection of 0.5 mg/kg and 1 mg/kg doses, respectively, and the third group received placebo injection of 10 ml of saline intravenously after the completion of surgery before extubation.

Statistical Analysis:

Statistical analysis of data was done using SPSS 20 software. Repeated measures analysis of variance (ANOVA) test was used for the analysis of trends of different parameters within the group. For comparison between the groups and to find if any significant difference exists, one-way ANOVA was used. Post hoc Tukey's test was used to find where the difference originated from, once significant difference was found.

Results:

Demographic data were statistically similar between groups. IV administration of esmolol at both 0.5 mg/kg and 1 mg/kg is effective in attenuating heart rate response but IV esmolol bolus of 1 mg/kg is more effective than bolus of 0.5 mg/kg in attenuating blood pressure response to extubation as it provided a more consistent hemodynamic control during the extubation as well as in the postextubation period.

Conclusion:

Extubation and emergence from general anesthesia cause significant increases in heart rate and blood pressure and emphasis must be given on attenuation of this sympathetic response, especially in vulnerable patients. IV administration of esmolol is effective in attenuation of heart rate response and blood pressure response with consistently good hemodynamic control during extubation postoperatively.