bluuebunny/crossref_metadata_2025 huggingface dataset:
Opioid-Sparing Post-Cesarean Analgesia Using Intravenous Diclofenac-Acetaminophen Combination: A Prospective, Randomized Clinical Trial
Authors: Bhatia Nidhi , Jain Kajal , Kumari Kamlesh , Ashok Vighnesh , Dhir Ankita , Kumar Mandeep
Published: April 2023

Background:

Current research promotes opioid-sparing analgesia as an approach to enhanced recovery after cesarean (ERAC). In developing countries, non-opioid-based analgesia is routinely practiced in obstetric settings, as opioids are not freely accessible. There are no randomized trials evaluating intravenous diclofenac and acetaminophen for postoperative analgesia following elective cesarean section.

Methods:

Women scheduled for elective cesarean delivery under subarachnoid block were enrolled if they fulfilled the inclusion criteria. They were randomized to receive either intravenous diclofenac or intravenous diclofenac-acetaminophen combination at the end of surgery and at predefined time intervals during the 24-hour postoperative period. The primary outcome measure of our study was 24-hour rescue analgesic (tramadol) consumption. Secondary outcome measures included time to first request for rescue analgesia, postoperative pain at rest and on movement, episodes of nausea, retching, and vomiting during the 24-hour postoperative period and overall patient satisfaction.

Results:

The 24-hour rescue analgesic consumption was significantly lesser in the diclofenac-acetaminophen group compared to the diclofenac group (56.25 ± 47.73 mg vs. 92.86 ± 50.83 mg; P = 0.00). Time to first request for rescue analgesia was earlier in the diclofenac group compared to the diclofenac-acetaminophen group (3.96 ± 2.40 h vs. 5.64 ± 3.58 h, P = 0.01). Parturients given a combination of intravenous diclofenac and acetaminophen used 40% less tramadol in the first 24 hours following cesarean section and were more satisfied with their pain management when compared to those given intravenous diclofenac alone.

Conclusion:

Following cesarean section, intravenous diclofenac-acetaminophen combination provides superior analgesia with significantly lesser opioid consumption and higher patient satisfaction when compared to intravenous diclofenac alone. This combination is effective, easy to administer, opioid-sparing and is compatible with ERAC regimens.
Retrospective Observational Case Series of Management of Placenta Accreta at Tertiary Care Institution
Authors: Patil Yogita , Motghare Abhilasha , Walavalkar Dhwani Sanjiv , Chincholi Indrani
Published: April 2023

Introduction:

Placenta accreta is a general term, when part of the placenta or the entire placenta invades and is inseparable from the uterine wall. The incidence is considerably higher in women with both a previous caesarean delivery and placenta praevia, occurring in around 1 in every 20 such women. Resorption of the retained, poorly perfused placenta can be augmented by concurrent treatment with methotrexate when fertility is desired. In cases where operative measures are required, placement of Internal Iliac artery (IIA) balloons preoperatively and their inflation intraoperatively, reduces maternal morbidity and mortality.

Materials and Methodology:

We present a case series of 14 patients with placenta accreta diagnosed preoperatively, 7 of whom had IIA balloons placed before undergoing Caesarean section and 7 did not have such an intervention. The maternal and foetal morbidity and mortality were studied, including the need for blood and blood product transfusions.

Results:

Internal Iliac Balloon placements did not change the requirement for blood and blood product transfudion in both groups. The group who had IIA balloon placed preoperatively had better maternal and fetal outcome as compared to the group who had no such intervention.
Height-Adjusted Dose of Intrathecal Bupivacaine on Surgical Anesthesia for the Cesarean Section
Authors: Saring Noyomi , Basar Tomar , Sanyal Ramapati , Nania Mihin
Published: April 2023

Background:

In the spinal anesthetic technique, local anesthetic dose (concentration and volume) is the main determinant of its adequacy and success of block to be achieved. The lack of pain during surgical intervention rather than on dermatome sensory block level is considered to be an appropriate indicator of surgical anesthesia. Spinal anesthesia is the most common anesthetic technique to provide anesthesia for the elective or emergent cesarean section (CS). However, spinal block-induced maternal hypotension is the most common adverse effect during single-shot spinal anesthesia. In our study, we aim to study the height-adjusted dose of 0.5% Bupivacaine Heavy (BH) in achieving surgical anesthesia and its effect on maternal hypotension.

Participants and Method:

One hundred parturients scheduled for elective CS were enrolled and were compared to the parallel arms of parturients receiving conventional BH. Fifty parturients in each group were included. In the conventional group (B), participants received spinal block with 12 mg of 0.5% BH, and in the height adjusted-dose group (H), participants received a dose of 0.5% BH in 0.06 mg per centimetre height. A sensory block level of T6 dermatome or higher was consider adequate to start surgery. The adequate surgical anesthesia is considered to be achieved if cesarean delivery can be performed without supplementary analgesia. The need of supplementary analgesia, conversion to general anesthesia, or no block till 15 min of intrathecal BH is considered spinal failure.

Results:

4% of the height-adjusted dose group have a low block level. Two cases complained of pain, and of them, one received supplementary analgesia and one was converted to general anesthesia. Systolic hypotension of a maternal blood pressure of less than 90 mm Hg was found in 19 (38%) and 10 (20%) in the conventional group and HAD group, respectively, which was highly significant statistically (p value 0.001%).

Conclusion:

Intrathecal hyperbaric bupivacaine in height adjusted 0.06 mg per cm height of patient can achieve surgical anesthesia with maintainance of systolic blood pressure. However, low dosing of intrathecal BH has higher cases of block failure in comparison to the conventional fixed dose regime of spinal anesthesia.
Comparison of Norepinephrine Bolus Versus Infusion for Prevention of Post-Spinal Hypotension in Parturients with Preeclampsia Undergoing Cesarean Section
Authors: Wakhloo Renu , Devi Ritu , Gandotra Megha , Kant Vishal
Published: April 2023

Background:

Currently, spinal anesthesia for cesarean section is the anesthetic technique of choice for women with preeclampsia in the absence of contraindications to neuraxial anesthesia. Recently, norepinephrine has been introduced for prevention and treatment of hypotension associated with spinal anesthesia; however, only a couple of studies have compared norepinephrine infusion and bolus.

Aims:

This study aims to compare primarily the efficacy and safety of norepinephrine bolus given therapeutically and norepinephrine infusion given prophylactically for management of hypotension and effects on other hemodynamic parameters in parturients with preeclampsia undergoing cesarean section under spinal anesthesia and secondarily to determine the effects of study drugs on neonatal Apgar score and arterial blood gas analysis of neonatal blood.

Methods:

In this prospective randomized study, 100 singleton full-term pregnant females of ASA grade II, aged 18–35 years, diagnosed with preeclampsia (controlled on single antihypertensive drug with BP ≤140/90), scheduled for elective cesarean section under spinal anesthesia were randomly divided into two groups. Group A: Received therapeutic norepinephrine bolus (4 mg) only when hypotension (fall in SBP to ≤20% of baseline) was detected after spinal anesthesia. Group B: Received prophylactic intravenous norepinephrine infusion (4 mg/min) immediately after induction of spinal anesthesia.

Results:

Heart rate, systolic, diastolic, and mean blood pressure had statistically significant difference at 3,4,5,6,7,8,9, and 10 mins of surgery. Number of episodes of hypotension and number of norepinephrine boluses used in Group A were higher and statistically significant (p-value < 0.001) than Group B. Apgar score at 1 and 5 minutes as well as umbilical artery parameters in two groups was comparable and statistically insignificant (p-value 0.301 for Apgar at 1 min and P value 0.562 for Apgar at 5 mins).

Conclusion:

Although both norepinephrine bolus and infusion doses are an effective way to treat spinal anesthesia-related hypotension in patients with preeclampsia undergoing cesarean section with comparable maternal and fetal side effects, infusion dose of norepinephrine is better in maintaining hemodynamics of parturients with insignificant changes in neonatal outcomes.
The Effect of Music on Serum Cortisol Levels and Anxiety in Patients Undergoing Lower Segment Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Interventional Study
Authors: Kaur Harpreet , Bansal Gopal L. , Sreehari S , Shukla Veena , Harsh Harsh K. , Pareek Ravi
Published: April 2023

Background and Aims:

Surgical procedures performed using spinal anesthesia techniques present a special challenge to anesthesiologists, because patients are awake and exposed to multiple anxiety-provoking visual and auditory stimuli. Therefore, this study was carried out to define the effect of music on the level of cortisol and anxiety in patients under spinal anesthesia undergoing elective lower-segment cesarean section (LSCS).

Methods:

The study was conducted on 60 patients undergoing LSCS under spinal anesthesia. The patients were divided into two groups containing 30 patients each. Group A received music through headphones and group B did not receive any music. Blood samples for serum cortisol and visual analog score for anxiety (VASA) were evaluated in both groups in pre-operative and post-operative periods.

Results:

Student’s t-test was used for comparison of serum cortisol levels. The mean cortisol levels in group A were 32.44 ± 14.42 mg/dl in the pre-operative and 33.59 ± 12.74 mg/dl in the post-operative period (P = 0.583). However, in group B, the mean cortisol levels were 25.24 ± 13.54 mg/dl in the pre-operative period and 30.22 ± 17.04 mg/dl in the post-operative period. The difference was highly significant (P = 0.023). The mean VASA 1 score in group A as 5.22 ± 0.73 and in group B was 6.00 ± 0.82. The difference was not significant (P = 0.608). However, VASA 2 in group A was 4.90 ± 0.66 and group B was 5.89 ± 0.99. This difference was highly significant (P = 0.0001).

Conclusion:

This study›s results showed that listening to music during surgery under spinal anesthesia significantly reduces cortisol levels (P = 0.023) as well as anxiety score (P = 0.0001).
Enhanced Recovery after Cesarean Delivery & Role of Anesthesiologists: A Narrative Review
Authors: Ismail Samina , Hameed Malika
Published: April 2023

Enhanced recovery after cesarean delivery (ERAC) is an evidence-based interdisciplinary protocol with an aim to improve quality of care and patient satisfaction while lowering health care cost by reducing length of hospital stay. It is an approach that combines several evidence-based perioperative care components to hasten patient recovery. ERAC uses multidisciplinary approach with inclusion of all stakeholders including anesthesiologists, obstetricians, pediatricians, nurses, pharmacists, patients, and hospital administration. Therefore, institutional support, local infrastructure, and compliance of all supporting systems are necessary for the successful implementation of ERAC. The role of anesthesiologists in implementation of standardized care cannot be disregarded as they are involved in the provision of perioperative services to improve maternal outcomes and healthcare quality. The purpose of this narrative review is to explore the components and guidelines from the enhanced recovery after surgery for caesarean delivery, highlight the responsibility of anesthesiologists in the existing and emerging ERAC programs and the difficulties associated with implementing the ERAC in resource-constrained environments.
Computed Tomographic Study on the Prevalence of the Onodi Cell
Authors: Ominde Beryl S. , Ikubor Joyce , Igbigbi Patrick S.
Published: April 2023

Context:

The prevalence of the Onodi cell varies in different populations. Its involvement in sinus pathology is characterized by varied clinical symptoms due to its proximity to the internal carotid artery and optic nerve. Endoscopic surgical management of sinus pathologies poses a great risk of injury to these neurovascular structures.

Aim:

This study elucidates the prevalence of the Onodi cell in a Nigerian Teaching Hospital.

Setting and Design:

This was a retrospective cross-sectional study conducted in the Radiology unit of a Teaching Hospital in Nigeria.

Materials and Methods:

Brain computed tomography (CT) images of 336 patients aged ≥20 years were evaluated for the presence of the Onodi cell. The study was approved by the institution before accessing the digital images. The age and gender of patients and the presence and location of the Onodi cell were recorded.

Statistical Analysis Used:

Data were entered in Statistical Package for Social Sciences version 23 for analysis of prevalence and subsequent comparisons using the Chi-square test. The significance level was considered at P < 0.05.

Results:

The prevalence of Onodi cell was 16.4% and was only observed unilaterally with a slightly lower frequency on the right (27, 8.0%) than the left (28, 8.3%). The prevalence did not show any significant side or gender differences (P > 0.05).

Conclusion:

The Onodi cell was present in the studied population, thus highlighting the need for their preoperative recognition on CT to abate iatrogenic complications during endoscopic surgeries.
Relationship of Serum Adiponectin Levels with Lipid Profile in Diabetic and Non-Diabetic Pregnant Women
Authors: Akhtar Yasmin , Khan Mudassir A. , Khan Muhammad S. , Malik Muhammad K. , Rehman Gulalai , Kashif Seemin
Published: April 2023

Context:

Adiponectin levels correlate positively with high-density lipoprotein (HDL), and negatively with serum triglyceride (TAG), low-density lipoprotein (LDL), and serum total cholesterol (TC).

Aims:

To find the relationship of serum adiponectin levels with lipid profiles in diabetic and non-diabetic pregnant women.

Settings and Design:

The study was performed in four public hospitals and one private tertiary care hospital in Peshawar, Pakistan. This study was a cross-sectional study.

Methods and Material:

Group A included 100 non-diabetic pregnant women, and Group B included 100 women with gestational diabetes mellitus. Inclusion criteria were a single fetus, 24 to 40 weeks pregnancy, with or without gestational diabetes. Exclusion criteria were multiple pregnancies, pre-existing diabetes, and other comorbidities. The serum adiponectin level and lipid profile of both groups were measured.

Statistical Analysis Used:

Descriptive analysis of all the variables was done. Independent-sample T-tests, Pearson's correlations, and binary logistic regression analyses were performed on SPSS version 20.

Results:

Adiponectin level was significantly lower in Group B (2.17 ± 1.84 μg/mL) as compared to Group A (9.94 ± 4.81 μg/mL). HDL level was significantly lower than normal in Group B. TC and LDL levels were higher than normal in both groups. A statistically significant relationship was found between adiponectin and HDL only. Binary logistic regression analysis showed that low adiponectin levels could predict diabetes in pregnancy.

Conclusions:

Regression analysis could not establish any relationship between adiponectin and lipid profile. However, adiponectin levels could show a relationship with the diabetic group. Hence adiponectin levels could possibly prove to be a biomarker of GDM.
Challenges in the Diagnosis and Management of a Patient with von Willebrand's Disease in a Resource-Limited Setting; A Case Report of a 7-Year-Old Boy with Massive Cephal-Hematoma
Authors: Haliru Dalha G. , Makuku Usman A. , Ojei Desmond
Published: April 2023

von Willebrand disease (vWD) is the commonest inherited bleeding disorder. In Nigeria like many other developing countries, there are only a few documented patients with this condition. This low number of patients with vWD in our setting is multifactorial; including lack of a high index of suspicion among clinicians, lack of diagnostic facilities, and unavailability of blood products and/or desmopressin used in treating bleeding episodes in these patients among others. We present a 7-year-old boy who presented to our facility with massive cephal-hematoma following trauma.
Investigation of Long-Term COVID-19 Patients’ Quality of Life and Affecting Factors: Data from Single COVID-19 Follow-Up Center
Authors: Uçan A , Güven ŞE , Mutlu FŞ , Bakılan F , Bildirici Y
Published: April 2023

ABSTRACT

Background:

Patients with COVID-19 experienced changes in their quality of life. However, far less is known about how quality of life changes in long-term COVID-19 follow-ups.

Aim:

This article aims to explore the relationship between quality of life change and long-term COVID-19 patient status in the COVID-19 follow-up center.

Patients and Methods:

This study was designed retrospectively with patients admitted to the COVID-19 follow-up center between January and May 2021. The single group consisted of 125 patients. Their status and 36-Item Short-Form Health Survey (SF-36) variables were compared at two different time intervals. The first admission indicates the first 3 months, and the second admission covers 3–6 months after being diagnosed with COVID-19.

Results:

Cough and chest pain increased in the second admission (P < 0.001). No significant differences were found in SF-36 change according to age. The general health subgroup scores were lower in females than males (P = 0.004). The SF-36 Form’s subgroups for physical function, physical role, emotional role, bodily pain, energy, mental health, general health, and social function showed improvement (P = 0.001, P = 0.001, P = 0.026 P < 0.001, P = 0.007, P = 0.031, P <0.001, P <0.001, respectively). In addition, comparing with the SF-36 subgroups in terms of treatment places, a significant result was found between the inpatient and intensive care unit (ICU) in the general health subgroup (P = 0.044).

Conclusions:

The results show that quality of life may worsen during follow-up for COVID-19. In summary, these findings have significant implications for understanding long-term COVID-19 patients with a multidisciplinary approach and the necessity of follow-up centers to detect the unpredictable results of long-term COVID-19.
Can Malocclusion among Children Impact their Oral Health-Related Quality of Life? Parents’ Perspective
Authors: AlJameel AH , Almoammar K , Alfawaz NF , Alqahtani SA , Alotaibi GA , Albarakati SF
Published: April 2023

ABSTRACT

Background and Aim:

Malocclusion can negatively impact the quality of life of children. Therefore, this study assesses the impact of proxy-reported malocclusion and oral health-related quality of life among children in Riyadh, Saudi Arabia, from the parents or guardians’ perspectives.

Materials and Methods:

A self-administered electronic questionnaire was used to assess the correlation between proxy-reported malocclusion conditions during the early mixed dentition stage (children age 6-12 years) and oral health-related quality of life using the OHIP-14 measure. All collected data were analyzed using SPSS.

Results:

Among the 353 participants in the study, anterior open-bite was the most common proxy-reported malocclusion with a prevalence of 19%, followed by unilateral posterior cross bite (13.3%). Furthermore, 31% reported that their children sometimes experienced negative impacts on quality of life from malocclusions. The results also show that OHIP-14 scores were significantly associated with all proxy-reported malocclusion (p < 0.05). The highest OHIP-14 score was found to be significantly associated with the presence of deep-bite from parents’ or guardians’ perspective.

Conclusion:

The presence of some proxy-assessed malocclusion was associated with negative impacts on children’s oral health-related quality of life. This is very important to consider when assessing the need for orthodontic intervention, especially at this stage as this age is critical in building a child’s confidence and self-esteem.
Significance of Immunohistochemical Markers in Women with Breast Cancer
Authors: Çaparlar MA , Dokcu Ş , Eroğlu A
Published: April 2023

ABSTRACT

Background and Aims:

This study aimed to investigate the importance of immunohistochemical (IHC) markers and other prognostic variables in the definition of breast cancer.

Patients and Methods:

Two hundred female patients who underwent breast cancer surgery were classified into two groups according to age: young women (≤45 years; n = 104) and older women (≥65 years; n = 96). Molecular subtypes and local stages were determined. The Kaplan–Meier method was used to estimate the survival curves. The relationships among categorical variables were analyzed using the Chi-square test.

Results:

The difference between the tumor diameter and distribution of Ki-67 levels was significant (P = 0.001, P < 0.05). T stage, local stage, histological grade, estrogen receptor status, lymphovascular invasion status, axillary nodal state, human epidermal growth factor receptor 2 status, and distribution of molecular subtypes were correlated (P < 0.05). The mean disease-free survival rates (DFS) at 1, 2, and 5 years were found 92.9%, 86.5%, and 70.1%, respectively, in the young female group. The DFS rates of older patients were 96.7%, 95.4%, and 84.6%, respectively.

Conclusion:

This study showed that young age was associated with poor prognostic features at the IHC marker level.
Comparative Histopathological Analyses of Non-Scarring Alopecia in Systemic Lupus Erythematosus Patients in Lagos Nigeria
Authors: Anaba EL , Dawodu OO , Cole-Adeife O , Olaosebikan H
Published: April 2023

ABSTRACT

Background:

Systemic lupus erythematosus (SLE) is known to cause non-scarring alopecia. However, histopathological evaluation is uncommon.

Aim:

The objective of this study was to document the histopathology of non-scarring alopecia and to compare histopathology of alopecic and normal appearing scalp areas in SLE hair loss patients.

Patients and Methods:

A cross-sectional comparative evaluation of scalp biopsies from 23 SLE patients; 12 with hair loss and 11 without was conducted over a 7-month period in 2020. A total of 58 scalp biopsies stained with H and E (23 vertical and 35 cross-sectional) were evaluated. Mucin deposit evaluation was done using Alcian blue (pH 2.5).

Results:

There were no significant differences in the sociodemographic data between the patients. The SLE hair loss patients demonstrated mucin deposition (91.7%), reduced size/number of sebaceous glands (58.3%), epidermal atrophy (50.0%), naked arrector pili muscles (50.0%), lymphocytic infiltration (33.3%), pigment incontinence (16.7%), fibrous stellae (16.7%), increased telogen percentage, and increased terminal versus vellus hair ratios. On comparing the histopathology of those who had hair loss to those without hair loss, the only significant difference was in the number and size of sebaceous gland. There were no significant differences between scalp areas with and without hair loss in the SLE hair loss patients.

Conclusion:

There are differences in size and number of sebaceous glands on histopathology between SLE patients who have hair loss and those who do not. Also, there are no histopathological differences between alopecic and non-alopecic scalp areas of SLE patient.
Are Patients with Covid-19 at Risk of Long-Term Chronic Kidney Disease?
Authors: Kemeç Z , Akgül F
Published: April 2023

ABSTRACT

Background:

The relationship between Coronavirus Disease 2019 (COVID-19) and acute kidney injury (AKI) is well-established. However, a comprehensive evaluation of kidney outcomes in the long-term course of COVID-19 is not yet been performed. The aim of this study is to investigate whether chronic kidney disease (CKD) develops within six months after hospital discharge in COVID-19 patients who did not have kidney damage at the time of admission to the hospital.

Patients and Methods:

This single-center retrospective study investigated a total of 1008 participants selected from 7500 COVID-19 patients with real-time reverse transcription-polymerase chain reaction (RT-PCR) positivity. All patients had mild/moderate or severe COVID-19. Patients were randomly selected from inpatient and outpatient settings. Critical COVID-19 patients were not included.

Results:

The mean age of the patients was 56.57 ± 16.30 years, and 69.9% of them were male. The comorbidity percentages of the participants were as follows; 19.5% coronary artery disease (CAD), 28.6% diabetes mellitus (DM), 36.2% hypertension (HT), 3.1% cerebrovascular obstruction (CVO), 1.7% malignancy, 2.6% chronic obstructive pulmonary disease (COPD), 9.4% asthma, % 1.7 dementia, 9.9% hyperlipidaemia, and 1.7% hepatitis B virus (HBV). Kidney function tests of these patients at first admission and 6 months later were compared to reveal the relationship between COVID-19 and CKD. Serum glucose, sodium estimated glomerular filtration rate (eGFR), and uric acid levels were found to be high in the post-COVID-19 period (P = 0.001). However, there were a decrease in serum albumin, potassium, alanine aminotransferase (ALT), C-reactive protein (CRP), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and gamma-glutamyl transferase (GGT) levels (P = 0.001). The difference between the first measurement of serum urea and creatinine (Cr) levels and the measurement 6 months later was not statistically significant (P = 0.102 and P = 0.300, respectively).

Conclusions:

Those who survived the mild/moderate and severe clinical manifestations of COVID-19 did not exhibit any risk of kidney outcomes after the acute phase of the disease, suggesting that the kidney can protect itself over a long period of time.
Acute Mastoiditis in Children: A Tertiary Care Center Experience in 2015–2021
Authors: Karaaslan A , Çetin C , Köle MT , Avcı H , Akın Y
Published: April 2023

ABSTRACT

Background:

Acute mastoiditis is a suppurative infection of mastoid air cells and is the most common intratemporal complication of otitis media.

Aim:

This study aimed to evaluate the demographic and clinical characteristics and treatment outcomes of children with acute mastoiditis (AM).

Patients and Methods:

We retrospectively reviewed the medical records of hospitalized pediatric patients aged between 1 month and 18 years with a diagnosis of AM between May 2015 and December 2021.

Results:

A total of 28 hospitalized children with AM were enrolled in this study, of whom 22 (78.6%) were males and 6 (21.4%) were females with a mean ± standard deviation age of 93.5 ± 53.2 months (range = 6 months–16.1 years). The most common clinical symptoms were postauricular erythema (n = 17, 60.7%), tenderness (n = 16, 57.1%), swelling (n = 14, 50%), fever (n = 14, 50%), and auricular protrusion (n = 7, 25%). Mastoiditis complications occurred in 10 (35.7%) children. The most common extracranial complication was subperiosteal abscess (n = 8, 28.6%). The erythrocyte sedimentation rate (ESR) and the rate of antibiotic use before hospitalization were higher in patients with complicated mastoiditis (P = 0.006 and P = 0.039, respectively). Surgery was performed in 12 (42.9%) patients. Statistically, more surgical interventions were performed in patients who developed complications (P = 0.003).

Conclusion:

AM continues as an important disease of childhood. Successful results are obtained with systemic antibiotic therapy and additional surgical intervention as necessary. A careful evaluation of patients with a high ESR and those who received antibiotic therapy before hospitalization is appropriate due to the correlation between these factors and the risk of complication development.
A New Anatomical Brachial Plexus Variation during Interscalene Block
Authors: Gungor I , Ozdemir MG , Emmez G , Ucar M , Kaptan AI , Gunaydın DB
Published: April 2023

ABSTRACT

We aimed to present our anesthetic management for an ultrasound-guided (USG) interscalene block in the presence of a new brachial plexus variation in a 59-year-old male patient underwent shoulder arthroscopy. An accessory muscle between the anterior scalene (ASM) and middle scalene muscle (MSM) was viewed via ultrasound. When four roots that the accessory muscle separated into two groups, which should be normally present between the ASM and MSM were displayed, we decided to use nerve stimulator to perform block. The contraction response from the deltoid muscle group from both root groups was regarded as a possible new brachial plexus variation in the C5 nerve root. For interscalene block, 30 ml of 0.375% bupivacaine was used via multi-injection. We confirmed this new brachial plexus variation with magnetic resonance neurography for the first time in a patient. Interscalene block should be definitely performed under USG and when a new anatomical variation is suspected, roots should be separated with a nerve stimulator to increase the success of the block.
Management of Congenital Pseudoarthrosis using Ilizarov Device–Delsuth, Oghara Experience
Authors: Enemudo Roy E , Edomwonyi Edwin O , Obumse Arthur T , Uyilawa Okhuaihesuyi
Published: April 2023

ABSTRACT

Background:

Congenital pseudoarthrosis of the tibia (CPT) is a rare and very difficult pediatric orthopedic condition to manage. It occurs spontaneously or from a trivial trauma. It results from a dysplastic periosteum that is more osteoclastic and less osteoblastic in nature. Successful treatment targets excision of the dysplastic periosteum and replacement with viable one and bone graft ± bone morphogenic proteins to aid union. Stabilization of the union site with intramedullary implants is advised to prevent refracture.

Aims:

To highlight the outcome of treatment of CPT with the Ilizarov procedure, bone graft, and use of bisphosphonate (sodium alendronate).

Patients and Methods:

This is a retrospective study of five patients treated for CPT using the Ilizarov procedure, bone graft, and use of bisphosphonate in the Delta State University Teaching Hospital, Oghara in Delta State, Nigeria. Inclusion criteria were patients that had a fracture of the tibia ± fibula spontaneously or from minor trauma. Exclusion criteria were patients that had pathological fractures or fractures from significant trauma. The outcome was graded into good, fair and poor.

Results:

Five patients were seen in this study. The male/female ratio was 2:3. The age was 6–18 years (mean = 11.5 years). The limb length discrepancy was 6–12 cm (mean = 7.2 cm) pre-operation and zero after completion of distraction. There was the loss of some regeneration in two patients at the end of consolidation. Two patients had hypertrophic CPT, while three patients had atrophic. Union was good in four and fair in one. Complications seen were ankle stiffness bending of the regenerate and loss of length of regenerate.

Conclusion:

CPT is a rare condition worldwide that is associated with nonunion and complicated by post-operation refracture or non-union has been successfully treated with a procedure that entails use of Ilizarov technique, bone graft bisphosphonate and support with intramedullary nails.
Ameloblastic fibrosarcoma transformation from ameloblastic fibroma
Authors: Ramakrishnan Divya Sanjeevi , Gouthaman Sudarssan Subramaniam , Muthusekhar M. R.
Published: April 2023

Ameloblastic fibrosarcoma (AFS) is an extremely rare malignant odontogenic tumor. It is composed of benign odontogenic epithelium, resembling that of ameloblastoma, and a mesenchymal part exhibiting features of fibrosarcoma. The development of this lesion in the jaws is either de novo or from preexisting ameloblastic fibroma which has been well documented. The most commonly affected site within the jaw is the posterior mandible. These tumors show local aggressiveness and a high tendency to recur. We present a case of a 33-year-old female patient with swelling of the right posterior mandible for 2 months and progressive paresthesia of the same region for the past 6 months. Patient's history revealed undergoing surgical enucleation for ameloblastic fibroma before a year in the same region as current swelling. Examination of the swelling revealed an ulceroprolifeartive Growth of 6 × 4.5 cm extending from premolar to molar region. Primary investigation involved biopsy of the swelling, which was reported as sarcoma for which resection of the right hemimandible and selective neck dissection was performed. Following surgery, the final histopathology report of the resected specimen was reported to be AFS. One year after the surgical procedure, the patient is clinically and radiologically disease-free. Considering the aggressive nature of these tumors, it is vital to give an accurate diagnosis through biopsy, which is considered as gold standard diagnostic evidence, so that the surgeon plans the appropriate therapeutic decision. Knowledge of this rare entity and its histologic features as opposed to the more common benign counterparts such as ameloblastoma or ameloblastic fibroma is crucial as the latter involves a conservative treatment approach while the former can only be treated through aggressive resections.
Opportunistic use of naturally expanded neck skin for a buccal mucosa defect
Authors: Jaiswal Dushyant , Borle Firoz , Belgaumwala Tasneem
Published: April 2023

A 77-year-old female presented with an ulceroproliferative lesion of the left buccal mucosa extending to the commissure, diagnosed with squamous cell carcinoma on biopsy. She also had a large thyroid swelling, with expanded skin, diagnosed with a multinodular goiter. The patient underwent buccal mucosa wide local excision with left-sided selective neck dissection and total thyroidectomy. The naturally expanded skin over the anterior neck overlying the goiter was used for the reconstruction of the buccal mucosa defect based on the perforator unexpectedly arising directly from the external carotid artery instead of superior thyroid artery. The venous drainage was to an internal jugular vein tributary, multiple dilated veins on the flap were draining into this vein. We describe the innovative use of locally expanded skin for buccal mucosa reconstruction and thereby avoiding the morbidity of a free flap transfer and associated donor site morbidity.
Facial soft-tissue changes after anterior maxillary osteotomy
Authors: Harsha Gorrela , Thota Rasagna , Alwala Aditya Mohan
Published: April 2023

Aims:

The aim of this study was to analyze and assess the soft-tissue response in patients treated by anterior maxillary osteotomy (AMO) in the postoperative period at 3, 6, and 9 months and to qualitatively assess the outcome of the surgery by the patients.

Patients and Methods:

The study included twenty adult healthy patients between 18 and 25 years with skeletal Class II malocclusion and requiring AMO setback for the correction of facial deformity. Preoperative and postoperative lateral cephalograms were taken and soft-tissue changes that occurred following AMO were compared at 3, 6, and 9 months postoperatively. The stability and acceptance of the soft-tissue changes were analyzed, and the patient's acceptance for the soft-tissue changes was measured on the surgical rating scale (SRS).

Results:

All the soft-tissue parameters showed noticeable changes following AMO. Statistically significant difference was observed with nasolabial angle, upper lip, and lower lip inclination. All the patients were moderately satisfied with the outcome of the surgery.

Conclusion:

This study aims in quantifying the soft-tissue changes following the AMO and the quality of the changes were recorded based on the SRS by the patients. Although there are changes associated with all the parameters assessed, significant differences was observed in nasolabial angle, upper lip, and lower lip inclination. The surgeon must be aware of the soft-tissue adaptation following the surgery for better outcomes.
Radio frequency analysis of partially grafted immediate dental implant with and without use of static magnetic field
Authors: Yadav Akanksha , Kumar Lakshya , Pal Uma Shankar , Singh Mayank , Bhatt Madan Lal Brham , Patil Ranjitkumar , Verma Aditi
Published: April 2023

Background:

Replacement of missing teeth with dental implants represents one of the most successful treatment modalities in modern dentistry. Patients desire for a shorter treatment time has made clinicians to attempt loading implants early or immediately after placement. The primary stability is determined by density and mechanical properties of the bone, the implant design, edentulous site complications, and the surgical technique. Various researchers have tried to achieve faster osseointegration static magnetic field is one of them. So the aim of this study was to investigate whether Static magnetic field created by using safer magnets was useful to promote osseointegration.

Materials and Methods:

Subjects were selected according to the predetermined inclusion and exclusion criteria in two groups (20 in each group). Conventional implant placement protocol was used and implant placement was performed and grafting was done. Magnetic healing cap was used in group I and conventional healing cap in group II. Implant stability assessment using radio frequency analyser was assessed at 2, 3 and 4 months on interval.

Result:

Mann-Whitney U test revealed that there was significant difference was observed between the groups I and II at 2, 3 and 4 months of interval (P < 0.001). Static magnetic field improve osseointegration in group I as compared to group II.

Conclusion:

The present double-blinded RCT showed significantly improved implant stability and osseointegration in implants which were stimulated by static magnetic field by using magnetic healing cap as compared to implants with conventional healing cap.
Periodontal status of patients with nontubercular respiratory diseases hospitalized in a tertiary care hospital
Authors: Verma Ajay Kumar , Pandey Anuj Kumar , Gupta Abhaya , Verma Umesh Pratap , Kant Surya , Kushwaha Ram Awadh Singh , Singh Arpita , Kumar Hemant , Chaudhary Shyam Chand
Published: April 2023

Background:

There is strong evidence that periodontal disease (PD) is related to various systemic diseases including respiratory diseases. Dental plaque is the primal cause of PD, and it can also be used as a reservoir of lung pathogens. After inhalation, it can cause a variety of respiratory infections. In addition, low nutritional status and immuneosuppression due to treatment or disease progression may affect the oral health of the hospitalized patients with nontubercular respiratory diseases. Here, we aimed to assess the periodontal status in hospitalized patients with nontubercular respiratory problems.

Materials and Methods:

We have enrolled 100 hospitalized nontubercular respiratory ill patients and 100 periodontal patients in this study. Periodontal clinical parameters, namely plaque index (PI), gingival index (GI), pocket probing depth (PPD), and clinical attachment level (CAL) were evaluated in both the groups. Modified Kuppuswamy's socioeconomic scale was utilized to assess the education, occupation, and monthly family income.

Results:

Sociodemographic profile was comparable in both the studied groups. Hospitalized patients with nontubercular respiratory diseases had more severe PD (PPD and CAL) and poorer oral hygiene (higher PI), although the GI was lower compared to patients in the periodontal group. In addition, compared with patients in the high-income group, low-income patients are at greater risk of periodontal infections.

Conclusions:

Our data show that the prevalence of periodontal infections in hospitalized patients with non-tubercular respiratory diseases is higher, indicating that there is an association between PD and respiratory diseases.
Comparative study of different distraction rates in separate retractions of canine
Authors: Parihar Ajit Vikram , Verma Shivam , Subash P. , Singh Akhilesh Kumar
Published: April 2023

Introduction:

Orthodontic treatment typically lasts 18–24 months, but depending on the conditions, it can take a longer duration. In recent years, accelerated orthodontics has been the subject of extensive research to shorten the duration of treatment. In distraction osteogenesis (DO), the surgically created joints are slowly and controllably displaced over time by gradual traction. This results in simultaneous growth of soft tissues and bone volumes at the osteotomy site. The DO field is currently experiencing a modern surge of research and development that has been able to implement numerous innovative and revolutionary distraction systems. In this study, we are comparing two different rates of dentoalveolar distraction.

Materials and Methods:

With the use of custom-made distractors, we will compare the different ranges of activation of distractors and their dental effects. Participants are separated into two groups based on 0.4 mm/day activation and 0.5 mm/day activation.

Results:

During the study period, the average tooth movement rate for Group 1 was 0.52 mm and for Group 2 was 0.58 mm. Group 1 completed canine distraction in 11.42 ± 1.81 days and Group 2 in 10.05 ± 1.68 days.

Conclusions:

Retraction days decreased in Group 2, due to increased activation of the distractor. The anchorage loss in Group 2 was higher than that in Group 1, which was 1.39 mm lower. Unlike decreased activation, the mean tooth movement of Group 1 is higher than Group 2.
Frontal sinus stenting
Authors: Kajal Smile , Verma Hitesh
Published: April 2023

Giant mucocele of frontal sinus following facial trauma is not uncommon. It can lead to the gradual erosion of anterior and posterior bony walls and may extend to the orbital and intracranial structures leading to visual compromise or intracranial complications. A 52-year-old man presented with a history of swelling above the right eye, right eye proptosis, and decreased vision. He had a history of a road traffic accident 30 years ago following which he had lost vision in his left eye and had undergone surgery twice earlier for right frontal mucocele. Computed tomography showed cranialization of the right frontal sinus and a well-defined mass lesion in the region of frontal sinus compressing on the right eye globe. Naso-orbital meningoencephalocele was considered as a differential but magnetic imaging resonance confirmed the lesion as a mucocele. As this was the second recurrence and there was an endangered vision in the only functional eye, he underwent emergency excision of mucocele and recreation of the frontal sinus outflow tract (FSOT) with silastic stenting to maintain its patency. Post-operatively, the patient's vision returned to normal at a 1-week interval. There was a reduction in swelling and proptosis in a 6-month period and the stent was removed after 1 year. Treatment of recurrent frontal sinus mucocele can be challenging. Frontal sinus stenting can be considered in such cases to maintain the patency of FSOT for a prolonged period. Regular follow-up, inspection, and cleaning of the nasal cavity and the stented area are important to prevent any stent-related complications.
Evaluation of pre- and post-treatment masticatory and bite force efficiency in patients undergoing fixed orthodontic treatment and orthognathic surgery using T-Scan Novus occlusal analysis
Authors: Maurya Raj Kumar , Bhardwaj Preeti , Singh Harpreet , Mitra Rajat , Nakra Oonit , Mishra Harsh A.
Published: April 2023

Introduction and Background:

Orthodontic and orthognathic surgical treatment require quantified occlusion finish to rule out any temporomandibular disorders. Hence, the present study was proposed to analyze the occlusal efficiency in patients undergoing fixed orthodontic and combined orthodontic–orthognathic surgery using digital occlusal analysis.

Methodology:

A randomized multi-arm controlled trial was conducted on 55 patients divided into four groups, that is, group I: class I crowding/proclination required extraction for fixed orthodontic treatment, group II: class II div 1 required orthodontic treatment and/or myofunctional therapy, group III: skeletal class II required combined orthodontic and orthognathic surgical treatment, and group IV: skeletal class III required combined orthodontic and orthognathic surgical treatment. The pre-treatment, before debonding, and 1 year after debonding assessment of occlusion were carried out using T-Scan. The repeated analysis of variance (rANOVA) test along with post-hoc analysis was carried out for intra-group and inter-group assessments using SPSS (version 21, USA). The significance level was set at a ‘P’ value less than 0.05.

Results:

rANOVA measurement in groups I, II, and III showed a significant difference with respect to maximum bite force difference between right and left sides, anterior and posterior region, and left lateral disclusion time. However, group IV showed a significant difference with respect to maximum bite force in the anterior and posterior region as well as right and left lateral disclusion time only. Further application of the post-hoc Tukey test found a significant difference between the To value to T1 and T2 among all four groups.

Conclusion:

Improved bite force was found in all malocclusion groups which was gradual in improvement from pre-treatment to post-treatment and a subsequent retention phase. The study also reported the utility of digital occlusal assessment devices as reliable, repeatable, reproducible, and user-friendly in the determination of dynamic occlusion.
From External to Local: Opportunities and Lessons Learned from Transitioning COMSA-Mozambique
Authors: Rodríguez Daniela C. , Macicame Ivalda , Adriano Antonio , Chicumbe Sergio , Duce Pedro , Kante Almamy , Mavie Victor A. , Mbalane Etelvina , Nhachungue Sheila , Titus Nordino , Van Dyk Fred , Amouzou Agbessi
Published: April 2023

Donor transitions, where externally funded programs transfer to country ownership and management, are increasingly common. The Countrywide Mortality Surveillance for Action – Mozambique (COMSA) project established a nationwide surveillance system capturing vital events at the community level with funding from the Bill and Melinda Gates Foundation. COMSA was implemented in partnership between Johns Hopkins University (a U.S.-based academic institution) and the Instituto Nacional de Saúde (National Institute for Health) and Instituto Nacional de Estatística (National Institute for Statistics), two Mozambican public institutions. Midway through the project, the Gates Foundation directed COMSA’s partners to develop and implement a transition plan that ensured COMSA’s activities could be institutionalized after Gates Foundation funding ended. Here we describe the process and activities that COMSA underwent for transition planning, including stakeholder engagement and advocacy, securing financial commitments, documenting operational activities, capacity building, and supporting strategic planning. Facilitators included a project model that already embedded significant implementation and management responsibility with local agencies, high-level commitment to COMSA’s activities from local stakeholders, establishing dedicated personnel and budget to manage transition, and fortuitous timing for financing. Challenges included needing to engage multiple government agencies to ensure buy-in, navigating tensions around future roles and responsibilities, reviewing and adjusting existing implementation structures, and the reality that this transition involved shifting financing from one development partner to another. Transition implementation was also constrained by the COVID-19 pandemic because key stakeholders were engaged in response efforts. COMSA’s experience highlights lessons and threats for future programs facing donor transition in uncertain environments.