Hours In Group Research Articles

Endoscopic Adenoidectomy with Microdebrider Versus Conventional Adenoidectomy

Background: Adenoidectomy is one of the most common surgical procedures performed in children in Bangladesh. Though conventional curettage is highly popular as it has the advantage of being cost effective and continues to be a commonly used method especially in developing countries but Microdebrider has opened the new horizon in this arena. To compare conventional curettage adenoidectomy and endoscopic-assisted powered adenoidectomy using a microdebrider.
 Materials and methods: This is randomized single blinded comparative study, which was performed in the Medical Center Hospital, Chattogram from August 2019 to July 2020. A total of 60 patients were randomly divided into two groups. Group I underwent conventional curettage adenoidectomy while Group II underwent endoscopic- assisted powered adenoidectomy. Duration of surgery, amount of intra-operative bleeding, adequateness of removal and damage to the adjacent structures were assessed and compared between two groups. All patients were followed for 12 months. Statistical analysis was done using statistical software package SPSS v 22.0. Data were represented as mean ± SD. Continuous variables were compared using the were using the t test while nonparametric data were compared using Mann-Whitney U test. The c2 test was used to compare the nominal data. A p value <0.05 was considered statistically significant. Ethical directives from the Managing Body of Medical Centre Hospital, Chattogram for this study was obtained.
 Results: in our study, we observed approximately almost three times more mean blood loss and total operating time in the endoscopic-assisted powered procedure compared to the conventional technique (149 and 56 ml, respectively, 63 and 27 min, respectively). Nine (30%) cases in group I had more than 50% residual adenoid tissue while 20 – 50% of residual adenoid tissue was documented among 7 patients (23%). Postoperative pain was found to be significantly higher in group I compared to group II. In both groups, recovery time ranged from 24-48 hour with a mean of 33.6 hour in group I and 36 hour for group II. 23 patients (77%) in group I presented with residual disease in the 3 months follow up period, where number of patients with the exact instance in group II was 0.
 Conclusion: Endoscopic assisted adenoidectomy may appear more handy over conventional curettage. But precise peri-operative care and awareness are required to attain the successful outcomes.
 JCMCTA 2022 ; 33 (1) : 88-92

A Comparison of Pediatric Appendicitis During the COVID-19 Pandemic and the Same Period Previous Year

Background: Although appendicitis is the most common emergency abdominal surgical pathology in the pediatric age group, there are a limited number of publications in the literature on how appendicitis has affected patients during the COVID-19 pandemic. Objectives: This study examined the effects of fear of being infected with COVID-19 and isolation measures on complications and morbidity in pediatric appendicitis cases. Methods: This study was performed in the Department of Pediatric Surgery, Faculty of Medicine, Health Sciences University, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey. Patients aged 18 years and younger who were operated on for appendicitis between 11 March 2019 and 11 May 2019 were classified as group 1, and patients aged 18 years and younger who were operated on for appendicitis between 11 March 2020 and 11 May 2020 (during the pandemic) were classified as group 2. Both groups were compared in terms of age, gender, symptoms, duration of symptoms, surgical method, duration of operation, length of hospital stay, and postoperative complications. Results: There were 85 patients in group 1 and 49 in group 2. The mean age was 11.5 ± 3.5 years in group 1 and 12.2 ± 3.0 years in group 2. While the mean hospital admission time for group 1 was 52.2 ± 38.5 hours, it was 50.2 ± 40.0 hours for group 2. The complicated appendicitis rates were 37% and 25% in group 1 and group 2, respectively. In group 1, 94.1% of the operations were completed laparoscopically, whereas, in group 2, this rate was 88.6%. The mean operation time was 64.0 ± 24.4 minutes in group 1 and 69.0 ± 33.0 minutes in group 2. The mean length of hospital stay was 2.9 ± 2.0 days in group 1 and 3.1 ± 3.40 days in group 2. The complication rate was 8.2% in group 1 and 11.4% in group 2. Conclusions: Despite the isolation measures and the risk of virus transmission, the psychosocial effects of the pandemic did not prevent real emergency cases with appendicitis from visiting hospitals.

Opiode-saving anesthesia and analgesia as a component of ERAS in endoscopic adrenalectomy in obese patients

BACKGROUND: Anesthetic management during interventions on the adrenal glands is quite complex. Difficulties in conducting anesthesia are often determined by concomitant obesity, which is associated with an increased sensitivity of the respiratory center to the action of opioids. This condition contributes to an increase in the frequency of respiratory and other disorders with the use of opioids.
 AIM: This work aimed to study the influence of different variants of perioperative anesthesia and analgesia administered during retroperitoneoscopic adrenalectomy in obese patients during the perioperative period.
 MATERIALS AND METHODS: A randomized study of 94 patients who underwent retroperitoneoscopic adrenalectomy for adrenal neoplasms was performed. Depending on the type of perioperative analgesia, the patients were divided into two groups. In group 1 (n=33), the operation was performed under combined anesthesia based on the low-flow desflurane inhalation; for perioperative analgesia, only systemic opioid administration was provided. In group 2 (n=30), the operation was performed under anesthesia based on low-flow desflurane inhalation in combination with the blockade of the fascial space of the erector muscle. In group 3 (n=31), the operation was performed under anesthesia based on desflurane in combination with drugs for non-opioid analgesia. critical incidents.
 RESULTS: Surgical intervention of the wound under inhalation anesthesia with ESP blockade (ropivacaine) and a combination of drugs for non-opioid analgesia promotes faster post-anesthetic rehabilitation, effective postoperative analgesia, and fewer complications in the early postoperative period compared with anesthesia using systemic opioid analgesics. This effect contributed to significantly shorter hospitalization of 97 hours for group 2 (95% CI 85-102) (p=0,042) and 94 hours for group 3 (95% CI 82-101) (p=0,039) compared with the 126 hours for group 1 (95% CI 114-135).
 CONCLUSIONS: Anesthesia based on desflurane in combination with ESP blockade and a multiple drugs for non-opioid anesthesia is an effective method that promotes fast post-anesthesia rehabilitation and shortens the hospitalization period for retroperitoneoscopic adrenalectomy for aldostectomy in the perioperative period.

Effect of Single Dose Fenofibrate as an Adjunct to Phototherapy on Unconjugated Neonatal Hyperbilirubinemia: A RCT

Background: Fenofibrate is used as an adjunct therapy to reduce bilirubin level and duration of phototherapy. This study was done to determine the efficacy of fenofibrate in the treatment of unconjugated neonatal hyperbilirubinemia.
 Materials & Method: Total 60 neonates were enrolled and devided into two groups. In group A, a single dose of oral fenofibrate (10mg/kg) was given along with phototherapy, and Group B only phototherapy. Blood samples were collected every 24 hours for total and indirect bilirubin. SGPT was done before and after 24 hours of giving fenofibrate.
 Result: Baseline serum bilirubin was 16.86± 0.89 in group A and 17.31± 1.19 in group B. After 24 hours of starting phototherapy, the bilirubin level came down to a lower value of 14.83 ± 0.95 mg/dl in group A and 15.73 ± 1.32 mg/dl in group B. After 48 hours it was 12.85 ± 1.06 mg/dl and 14.20 ± 1.24 mg/dl in group A and group B respectively. (P-value 0.004 and 0.001). The mean time needed for phototherapy was 51.20 ± 8.29 hours in group A and 70.40± 6.08 hours in group B (P-value 0.001). The duration was shorter in the fenofibrate group in comparison to the control group. No side effects of fenofibrate were observed after a single dose administration.
 Conclusion: Administration of a single dose of fenofibrate as an adjunct along with phototherapy to neonates showed a significant reduction of serum bilirubin and duration of phototherapy.
 BANGLADESH J CHILD HEALTH 2021; VOL 45 (2) : 89-93

Effect of early breast feeding on pain perception in women undergoing spinal anaesthesia for caesarean delivery: a comparative study

BackgroundPostoperative pain reduction is a key priority after caesarean delivery. Current recommendations are to breastfeed the baby as soon as possible after birth, including after caesarean section. However, analgesics can transfer into breast milk, and hence an ideal scenario is a postoperative period free from analgesics and pain. The aim of this study was to determine the effect of early breastfeeding on pain perception after caesarean delivery with spinal anaesthesia in the Gaza Strip. MethodsData for the comparative study were collected by research nurses at the Al Helal Al Emirati Hospital, Rafah, Gaza Strip, occupied Palestinian territory, from May to October, 2019. All women who had delivered at the hospital were encouraged to breastfeed as early as possible after caesarean delivery. Women who underwent caesarean delivery with spinal anaesthesia were assigned to one of two groups. Group 1 were women who breastfed in the first hour after caesarean delivery. Group 2 were women who were unable to breastfeed early (within 24 h) owing to maternal morbidity or neonatal causes such as admission to the neonatal intensive care units or a stillborn baby. A pain assessment scale (PAS; range 1–5, in which 1=no pain and 5=worst pain imaginable) was used to record the pain 1 h after the end of the caesarean delivery and then at 6 h, 12 h, 18 h, and 24 h. The time from the end of the caesarean delivery to the first demand for other analgesia and the total amounts and types of analgesics used in 24 h were recorded. The study was approved by the Palestinian Ministry of Health and the Helsinki Committee, Gaza Strip. Women provided verbal informed consent before participation. FindingsIn the period of the study there were approximately 590 women who delivered by caesarean section at Al Helal Al Emirati hospital, of whom 149 received spinal anaesthesia. Data from these 149 patients (mean age 30·85 years [SD 6·29]) were investigated: 111 (75%) in group 1 and 38 (26%) in group 2. The reported pain was lower in the first and 12th hour in group 1 than in group 2 (first hour, PAS 1·35 for group 1 vs 1·87 for group 2, p=0·004; 12th hour, PAS 1·35 for group 1 vs 1·73 for group 2, p=0·015). In group 1, 40 (36%) of 111 women needed analgesics after caesarean delivery, compared with 22 (58%) of 38 women in group 2 (p=0·018). Of the women who needed additional analgesia, 33 (83%) of 40 took only one analgesic and five (13%) of 40 took two analgesics in group 1, compared with 15 (68%) of 22 who took one analgesic and six (27%) of 22 who took two analgesics in group 2 (p=0·345 for group 1 vs group 2). The mean time to needing other analgesic drugs was longer in group 1 than in group 2 (10·54 h [SD 1·25] vs 6·40 h [SD 1·43]; p=0·035). InterpretationBreastfeeding within 1 h after caesarean delivery with spinal anaesthesia was associated with better pain reduction than no breastfeeding within 24 h. A multicentre study over a longer period post delivery, with a larger study population to include more types of delivery, would be of great benefit. FundingNone.

Intraocular Pressure and its Variation with Total Amount of Energy used Following Nd: YAG Capsulotomy in Pseudophakic

Purpose: The objective of the study was how Nd: YAG laser capsulotomy affected IOP and how it changed with the amount of energy utilised. Methods: A prospective, multi ccentered study was conducted between September 2021 to February 2022 in Ophthalmology Department departments. Total of sixty pseudophakic eyes of both genders, age ranging between 40 to 60 years with significant posterior capsular opacity following uncomplicated cataract surgery were included through non-probability purposive sampling technique. Inflammation, ocular malignancies, posterior segment disease, and systemic disease participants were all ruled excluded. After detailed history and ocular examination, Nd: YAG laser posterior capsulotomy was done. Patients were divided into two groups on the basis of total amount of laser energy used was noted as high energy (>50mJ) and low energy (<50mJ) and then post-laser IOP after one hour and 24 hours measured. Data was analyzed by using SPSS through repeated measure ANOVA for comparison of quantitative variables. Results: Best corrected visual acuity after Nd: YAG capsulotomy improved significantly (P=0.001). Pre-laser IOP was 14.01± 2.95 mmHg. Mean high energy was 76mJ and low energy 40mJ. Elevated IOP was seen in 55 patients, significantly increase in IOP after 1 hour in both groups (P=0.000). After 24hours IOP change was significantly higher in high energy group (p=0.033) than in low energy. Post-laser IOP after 1 hour in high energy group was 21.89±4.59 mmHg and in low energy group 16.79±2.89 mmHg. IOP after 24hour in high energy group was 19.89± 3.05 mmHg and in low energy group 14.98±1.79 mmHg. Conclusions: After Nd: YAG laser capsulotomy, there is a considerable increase in IOP, which varies depending on the overall amount of energy used. Greater the amount of Nd-YAG energy has significantly higher chances of raising IOP. Hence, it was suggested that each patient after Nd: YAG capsulotomy must monitored for IOP variation. Keywords: Intraocular pressure, Nd: YAG capsulotomy, Energy level, Posterior capsular opacity, Visual acuity

Effect of Intrathecal Dexmedetomedine as Adjuvant to Bupivacaine in Caesarian Section: A Double Blind Study

Aim: To explore the impact of dexmedetomedine as adjuvant to hyperbaric bupivacaine 0.5% in spinal anaesthesia in caesarian section. Methods: This study was conducted in Services Hospital, Lahore from 23-2-21 to 31-05-21. Two groups of 30 each were made by dividing patients randomly. Group B was given hyperbaric bupivacaine 0.5% (10mg) diluted in normal saline and in Group BD dexmedetomedine 5µg (0.5 ml) was added to 10mg hyperbaric bupivacaine (0.5%). Spinal Anaesthesia was administered with 25G spinal needle. Haemodynamic changes, onset and duration of sensory and motor block were documented. Inadequate perioperative analgesia was relieved with ketamine. Comparison of hemodynamics was done by independent sample t-test. Characteristics of motor and sensory block, analgesic time period were all presented as median (IQR) and compared by Mann Whitney U test. Comparison of categorical variables was done by Chi square. p< 0.05 was considered significant. Results: The median time for sensory block onset was 2.0(2.0 - 3.0) in Group B vs 2.0(2.0 - 3.0) BD. The median time to reach maximum sensory block was not significantly different. (p-0.151). The two segment sensory regression time was significantly longer in group BD with median time 2.2(2.0 – 3.0) vs 1.5(1.3 – 2.0) hours in group B. Significant increase in analgesic duration was seen in group BD (p<0.001). Onset of motor block was higher in group BD significantly (p-0.04). Significant increase in motor block duration was seen (p<0.05) in BD vs B group with respective median times 6.0(5.5 – 7.0) and 3.5(3.0 – 4.0). Conclusion: Intrathecal Dexmedetomidine 5 µg with hyperbaric bupivacaine significantly prolongs both sensory and motor block and prolongs the duration of analgesia in lower segment caesarian section. Keywords: Dexmedetomedine, Spinal Anaesthesia, Sensory block, Motor block

Strong association between acute phase reactants (high-sensitivity C-reactive protein and erythrocyte sedimentation rate) and the familial Mediterranean fever (FMF) in patients but not with the MEFV genotype

Background and objectiveFMF (Familial Mediterranean fever) is an autoinflammatory hereditary disease with autosomal-recessive mode of inheritance.The main objective of our research was to establish if there is a link between acute phase reactants (APRs) (i.e. hs-CRP and ESR) and FMF in patients compared to controls at the time of diagnosis and before starting colchicine therapy. We also tried to find out if there is an association between the MEFV gene genotypes in FMF patients and APRs (ESR and hs-CRP). Moreover, we tried to find if there is a link between M694V genotypes and the hs-CRP and ESR levels. ResultsThis study was achieved on 101 FMF patients (group I), as well as 107 healthy individuals (group II). hs-CRP values ranged from 0.02 to 104 mg/L and from 0.1 to 5.29 mg/L in groups I and II, respectively. Mean hs-CRP was 7.97 ± 18.58 and 1.23 ± 1.58 mg/L in groups I and II, respectively. The p-value is 0.000243 which strongly indicates a significant difference between both groups. ESR values ranged between 1 and 75 mm in 1 h in group I and between 0.1 and 3.6 mm in one hour in group II. Mean ESR was 17.25 ± 19.40 and 1.31 ± 1.21 mm in one hour in group I and II, respectively. The p-value is <0.00001 which indicates a significant difference between both groups. However, our study did not indicate any link between genotypes of MEFV mutations and hs-CRP levels and ESR in our patients, in addition to the lack of a strong link between the M694V mutation and hs-CRP levels and ESR. ConclusionOur data show the significance of hs-CRP levels and ESR in patients with FMF when diagnosing the disease, before starting the colchicine treatment and in attack-free periods, which may give us an impression about the disease severity.

Foreign body removal with the assistance of ultrasound guidance and methylene blue staining in children-a cohort study.

Soft tissue foreign bodies (FBs) are very commonly observed in paediatric emergency departments. Not all FBs can be removed effectively, even via open surgery and image intensifier guidance. In the current study, we evaluated the efficiency of FB removal with the assistance of ultrasound (US) and methylene blue (MB) staining. We enrolled 80 patients at our clinical center between May 2016 and December 2020. Eleven patients were operated upon with the assistance of US guidance and MB and were defined as group A; the other 69 patients were defined as group B. For the patients in group A, US was first used to locate the FB; MB was then injected next to the FB. Open surgery was subsequently performed. For group B, the FBs were removed by conventional methods. The surgical outcomes were evaluated according to surgical duration, incision infection rates, radiograph exposure times, and FB residue rates. The average surgery time for group A was 0.35 ± 0.10hours; the corresponding time was 0.49 ± 0.50hours in group B and there was a significant difference between the groups (p = 0.032). The radiograph exposure times were 1.33 ± 0.34 in group A and 4.65 ± 1.81 times in group B (p = 0.021). This study demonstrates that assistance of US and MB staining is a more efficient approach compared with traditional methods for FB removal, and this surgical method can be used effectively for FB removal in children.

Low Blood Pressure is Independent of Plasma Renin in the Bmal1 Knockout Rat

Blood pressure (BP) is a crucial physiological parameter that exhibits a circadian rhythm in healthy individuals. Loss of this rhythm is associated with morbidity and mortality. To determine the contribution of the molecular clock to BP regulation, we developed a rat strain with whole body loss of Bmal1 gene expression,a core component of the transcription/translation feedback loop known as the molecular clock. We previously reported that Bmal1‐/‐ rats of both sexes have rhythmic BP, but lower than Bmal1+/+ controls. Given the importance of the renin‐angiotensin system in BP control, we hypothesized that loss of Bmal1 may reduce plasma renin activity in the Bmal1‐/‐ rat. For this experiment, male rats were housed in a 12:12h light/dark cycle with constant humidity and temperature. Water and food (0.49% NaCl) were available ad libitum. BP was measured by a telemetry transmitter implanted in the abdominal aorta of 10‐week‐old rats. After a 10‐day surgical recovery period, BP was recorded for 2 minutes every 10 minutes at 1000 samples/second. Mean BP, assessed by cosinor analysis, was lower in male Bmal1‐/‐ (MBP MESOR: 109±2 mmHg, n=9) animals compared to littermate Bmal1+/+ controls (MBP MESOR: 117±3 mmHg, n=8, p&lt;0.05, ANOVA). In a separate cohort of animals, plasma was collected from male Bmal1‐/‐ rats and littermate Bmal1+/+ controls across the circadian day every four hours in groups of 2‐6 at each time point starting at zeitgeber time (ZT) 0 (07:00) and ending at ZT 20. Plasma renin activity (PRA) and total prorenin/renin were measured by ELISA (name the kits used). PRA was similar between male Bmal1‐/‐ and Bmal1+/+ rats during the light (Bmal1+/+: 1.4±0.5 vs Bmal1‐/‐: 2.5±0.6 ng/mL, p=0.21, Student’s t‐test) and dark (Bmal1+/+:2.4±0.7 vs Bmal1‐/‐: 2.4±0.5 ng/mL, p=0.97, Student’s t‐test) periods. Plasma total prorenin/renin was similar between Bmal1‐/‐ and Bmal1+/+ rats during the light (Bmal1+/+: 8.8±1.7 vs Bmal1‐/‐: 6.9±0.7 ng/mL, p=0.36, Student’s t‐test) and dark (Bmal1+/+: 2.7±1.3 vs Bmal1‐/‐: 5.2±1.7 ng/mL, p=0.27, Student’s t‐test) periods. These data suggest that loss of Bmal1 does not directly affect systemic plasma renin activity or total prorenin/renin concentrations in the rat. Furthermore, the lowered blood pressure observed in rats lacking Bmal1 does not appear to be a result of systemic changes in circulating renin activity or concentration.

Ureteroscopy under General Anesthesia Versus Spinal Anesthesia: Stone Clearance and Morbidity

Objectives: To compare stone clearance by ureteroscopy carried out under General anesthesia versus Spinal anesthesia for the treatment of ureteric Stone. Place and duration: For two years from Feb 2019 to Feb 2022, in the Urology department of Islam Medical College Sialkot. Methods: Total 42 patients were selected for study. Males were 26, and Females were 16. Age ranges from 20 years to 56 years. All subjects endured ureteroscopic method for ureteric Stone with semi rigid ureteroscope 8/8.4 fr. The two groups of 21 patients equally were formed. Group A were given General Anesthesia and Group B receiving Spinal Anesthesia. The hospital stays, operative Time, clearance of stones, post-operative and intra operative complications were noted. Results: There were 21 patients in both groups, 16 (76.2%) men in group A (general anesthesia), and 18 (85.7%) men in group B (spinal anesthesia). There were 5 (23.8%) women in A group and 3 (14.3%) women in B group. The patients mean age was 34.1 and 37.2 years in groups A and B, correspondingly. The mean size of stone was 0.80 cm in A group and in group B, it was 1.21 cm (p = 0.001). The surgery duration in group A was 40.9 ± 1.30 mints and for group B; 31.4 ± 2.09 minutes (p = 0.031). The mean stay in hospital was 20.8 and 17.4 hours in groups A (range 8 to 48 hours) and B group (range 6 to 24 hours, p = 0.074), correspondingly (p = 0.073). The mean visual-analog pain score was 3.2 in group A and for group B, VAS was 1.7. Conclusion: In this series, ureteroscopy under spinal anesthesia shortened the duration of surgery and hospital stay and did not carry the risk of additional serious complications. Keywords: Ureteroscopy (URS), Ureteric stone, General anesthesia and spinal anesthesia.

Tetracycline, tetracycline + gelatin sponge and placebo on postoperative pain after mandibular molar extraction

Background: Surgical removal of lower third molars is a common oral surgical procedure which causes more severe pain in comparison to the other types of oral surgery. The present study was conducted to compare tetracycline, tetracycline + gelatin sponge and placebo on postoperative pain after mandibular molar extraction. Materials &amp; Methods: 90 patients undergoing mandibular third molar extraction of both genders were randomly divided into three groups of 30 each. Group I patients were treated with intrasocket tetracycline alone, group II patients were treated with intrasocket tetracycline + gelatin sponge and group III patients were treated without any intrasocket medicaments. The postoperative pain scores were evaluated at 24 hours, 48 hours, and 7 days postoperatively. Results: There were 16 males and 14 females in group I, 12 males and 18 females in group II and 10 males and 20 females in group III. The mean VAS at 24 hours in group I was 32.4, at 48 hours was 33.1 and at 7 days was 25.2, in group II was 28.5, 28.2 and 25.0 and in group III was 38.5, 39.1 and 35.7 at 24 hours, 48 hours and 7 days respectively. The difference was significant (P&lt; 0.05).

Efficacy and speed of conversion of recent onset atrial fibrillation using oral propafenone versus parenteral amiodarone: A randomized controlled comparative study

BackgroundAtrial fibrillation is the most commonly encountered arrhythmia. Several antiarrhythmic agents are effective in restoring and maintaining sinus rhythm. Aim of the workTo compare the efficacy and rapidity of conversion of recent onset atrial fibrillation using oral propafenone versus intravenous infusion of amiodarone. MethodsThe study included 200 patients with recent onset atrial fibrillation. Patients were equally divided into 2 groups; group A where intravenous infusion amiodarone was given and group B where oral propafenone was administrated. The effectiveness and the time needed for conversion of atrial fibrillation to sinus rhythm were compared in both groups. ResultsThe success of conversion of atrial fibrillation to sinus rhythm was 83% in group A and 85% in group B, p-value = 0.699. The time elapsed from drug administration till conversion of atrial fibrillation was 9.07 ± 5.04 hours in group A versus 3.9 ± 1.54 hours in group B, p-value = 0.001. In both groups, patients who showed failed conversion had a significantly larger left atrial diameter and a significantly higher high sensitivity C-reactive protein (hsCRP) level. ConclusionOral propafenone was faster than parenteral amiodarone in the conversion of recent onset atrial fibrillation to sinus rhythm. Patients with failed conversion had a bigger left atrial diameter and a higher hsCRP when compared to patients with successful conversion.

Length of hospital stay in laparoscopic transabdominal preperitoneal repair compared to open Mesh repair in patients with inguinal hernia: a randomized controlled trial

Introduction: One of the challenges faced by surgeons during repair of inguinal hernias is to adopt an approach with minimum complications of infection, chronic pain, and recurrence of hernia. Along with traditional techniques, modern methods of Laparoscopic Repair and Open Mesh Repair have been introduced and need further evaluation.&#x0D; Objective: To compare the mean length of hospital stay in laparoscopic trans abdominal preperitoneal repair versus open Mesh repair in patients undergoing inguinal hernia repair with Mesh.&#x0D; Methods: A total of 334 patients of male gender with Inguinal hernias of any side and ASA score I and II were included in the study. History of Immunosuppression, concomitant other types of abdominal hernias, and recurrent hernias, were excluded. 167 patients were in Group A or laparoscopic trans abdominal preperitoneal repair group while 167 patients were in Group B or open Mesh repair. Data regarding length of hospital stay from both groups was recorded on especially designed proforma. Data were analyzed by SPSS 22 for descriptive and comparative statistics, keeping p≤0.05 as significant.&#x0D; Results: Age range in this study was from 18 to 50 years. In group A, the mean age was 40.173 ± 6.19 years and mean duration of procedure was 37.658 ± 6.36 minutes; in group B, the mean age was 38.443 ± 5.10 years and mean duration of procedure was 61.748 ± 11.65 minutes. Majority of patients belonged to ASA-I in both groups. Moreover, majority of patients had right sided hernia in both groups. Mean length of hospital stay was 31.760 ± 11.25 hours in group A and 58.922 ± 11.98 hours in group B (p&lt;0.001).&#x0D; Conclusion: Laparoscopic approach for hernia repair had better outcome than open Mesh repair in terms of shorter duration of hospital stay.&#x0D; Keywords: Inguinal hernia, Laparoscopic trans abdominal preperitoneal repair, Open Mesh repair, Length of hospital stay.

Comparison of desflurane and propofol in the speed and the quality of emergence from anesthesia in patients undergoing lung cancer surgery-a prospective, randomized study.

BackgroundAnesthesia with desflurane or propofol enables rapid emergence. In patients undergoing lung cancer surgery, however, the speed of emergence from desflurane, but not from propofol, may be affected by the deteriorated postoperative respiratory function. We prospectively compared the speed and quality of emergence between desflurane and propofol.MethodsWe conducted a parallel study. Eighty patients scheduled for lung cancer surgery were randomly allocated to Desflurane group (Group D) and Propofol group (Group P). Combined general and epidural anesthesia was performed in the identical way except for the anesthetic.ResultsThere was no significant difference between the groups in the time to awakening, extubation, or orientation. However, emergence agitation (EA) occurred more frequently in Group D than in Group P (20/40 vs. 4/40, P<0.001). Numbers of patients not achieving full scores in respiration and circulation components of the modified Aldrete score 5 min after extubation were more in Group D (4/40 vs. 0/40, P=0.040; and 8/40 vs. 2/40, P=0.043, respectively). More patients required antiemetics during postoperative 24 hours in Group D (15/40 vs. 7/40, P=0.045).ConclusionsDesflurane was not inferior to propofol in the speed of emergence from anesthesia after lung cancer surgery, but it was slightly inferior to propofol in the quality of emergence.Trial RegistrationUMIN-CTR identifier: UMIN000009221.

Role of tranexamic acid in the prevention of primary postpartum haemorrhage.

Objectives: To determine the role of TRANEXAMIC ACID in prevention of primary postpartum haemorrhage in women. Study Design: Observational Retrospective Cohort Design. Settings: DHQ Hospital, Gujranwala. Period: April 2016 to July 2018. Material &amp; Methods: The data of 110 women who suffered postpartum haemorrhage was retrieved from the hospital records. Exclusion criteria included all the females who were below and equal to 18 years of age. Patients suffering from acute respiratory distress syndrome (ARDS), on long-term anti-inflammatory and steroid therapy were also excluded. Whereas all the women who had experienced postpartum haemorrhage after birth were included. Results: We retrieved data of 110 women who had experienced postpartum haemorrhage after birth. The age of participants was averaged 28.95 + 7.6 years. The group I was named as early treatment group and contained 35 women whereas the group II (late treatment or without TRANEXAMIC ACID) had 75 women. The mean age of women is higher in the group I i.e. 30.2 +6.8 than 27.7+8.4. The TRANEXAMIC ACID was given intravenously with an average dose of 1 gram (0.1-3.0 grams) 1.5 hours after the birth. This was an average time for all cases in group I. The average time was 4.6 hours in group II. Conclusion: We concluded that use of intravenous TRANEXAMIC ACID in postpartum haemorrhage is associated with reduced haemorrhage but a low dose at early treatment may not yield good results.

Serum bile acid response to oral glucose is attenuated in patients with early type 2 diabetes and correlates with 2-hour plasma glucose in individuals without diabetes.

AimTo determine the serum bile acid (BA) response to 75‐g oral glucose in individuals without diabetes, and whether this is attenuated in patients with ‘early’ type 2 diabetes (T2D) and related to the glycaemic response at 2 hours in either group.MethodsForty newly diagnosed, treatment‐naïve Han Chinese T2D subjects and 40 age‐, gender‐, and body mass index‐matched controls without T2D ingested a 75‐g glucose drink after an overnight fast. Plasma glucose and serum concentrations of total and individual BAs, fibroblast growth factor‐19 (FGF‐19), total glucagon‐like peptide‐1 (GLP‐1), and insulin, were measured before and 2 hours after oral glucose.ResultsFasting total BA levels were higher in T2D than control subjects (P < .05). At 2 hours, the BA profile exhibited a shift from baseline in both groups, with increases in conjugated BAs and/or decreases in unconjugated BAs. There were increases in total BA and FGF‐19 levels in control (both P < .05), but not T2D, subjects. Plasma glucose concentrations at 2 hours related inversely to serum total BA levels in control subjects (r = −0.42, P = .006). Total GLP‐1 and the insulin/glucose ratio were increased at 2 hours in both groups, and the magnitude of the increase was greater in control subjects.ConclusionsThe serum BA response to a 75‐g oral glucose load is attenuated in patients with ‘early’ T2D, as is the secretion of FGF‐19 and GLP‐1, while in individuals without T2D it correlates with 2‐hour plasma glucose levels. These observations support a role for BAs in the regulation of postprandial glucose metabolism.

Pharmacokinetics, Safety, and Synovial Fluid Concentrations of Single- and Multiple-Dose Oral Administration of 1 and 3 mg/kg Cannabidiol in Horses

Cannabidiol (CBD) products are widely marketed to horse owners, trainers, and veterinarians and are readily available to the consumer despite minimal pharmacokinetic or safety data being available. The objectives of this study were to determine the plasma pharmacokinetics, short-term safety, and synovial fluid levels of CBD following oral administration in horses. A prospective, randomized, controlled study design was used. Twelve horses were administered sunflower lecithin oil-based CBD at either 1 mg/kg (Group 1) or 3 mg/kg (Group 2) for a 24-hour pharmacokinetic study. Horses then received 0.5 mg/kg (Group 1) or 1.5 mg/kg (Group 2) CBD q12 PO for 6 weeks, with steady state and elimination sampling performed up to 96 hours post-final dose. Synovial fluid CBD concentrations were evaluated at 12 and 24 hours, and 5 weeks. Horses were monitored daily and clinicopathologic parameters were evaluated. Mean ± SD Cmax and tmax were 4.3 ± 2.1 ng/ml and 4.1 ± 4.1 hours, and 19.9 ± 15.6 ng/ml and 5.0 ± 3.7 hours for Groups 1 and 2, respectively. CBD was detectable in synovial fluid in 8/12 horses during steady state. Mild hypocalcemia was seen in all horses and elevated liver enzymes were observed in 8/12 horses, but these changes improved or normalized within 10 days after the final CBD dose. CBD had dose-dependent, but variable, oral bioavailability at 1 mg/kg and 3 mg/kg daily dosing and was consistently detectable at steady state in synovial fluid at the higher dose. Further investigation is needed to establish clinically effective doses.

A Comparative Study between Thoracic Epidural and Conventional Methods of Pain Management in Post Thoracotomy Patients

Background: Postoperative discomfort has a negative impact on the outcome of thoracic surgical procedures, which are among the most painful operations. Controlling pain after a thoracotomy enhances patient satisfaction while lowering postoperative morbidity. Aim of the study: The aim of the study was to evaluate the effects of thoracic epidural and conventional pain management methods in post-thoracotomy patients.Material &amp; Methods:A randomized cross-sectional comparative study was conducted among 260 patients of post thoracotomy between January 2018 and December 2020 in a single tertiary-care hospital of Dhaka, Bangladesh. Outcomes of surgery were evaluated using the visual analogue score (VAS) at resting and coughing time.Results:We divided all 260 patients into two groups (group A: thoracic epidural 130; group B: conventional/control 130). The mean age of the patients was 49.74±23.46 years in group A and 50.48±56.23 in group B. There were 61% male patients and 39% female patients, and the male: female ratio was 81:48 in group A, and 78:53 in group B. Mean duration of surgeries was 2.95± 67.92 hours and 2.84± 57.31 hours in group A and B respectively and mean follow up was 1.9 years and 1.4 years in group A and B respectively. The maximum number (36.9%%) of patients were in the age group of 50 to 54 years, and the minimum number (4.61%) of patients were in the age group of 35 to 39 years. In group A, the maximum number (31) of patients had gone through open window formation, and a minimum number of patients (4) had gone through segmentectomy. And in group B, the maximum number (33) of patients had gone through open window formation, and a minimum number (4) had gone through hydatid cyst removal surgery. The change between comparative values of postoperative mean VAS scores at resting time and coughing time of both groups of patients was significant in this study.Conclusions:In thoracotomy surgery, the efficacy of thoracic epidural anesthesia is more evident than in other types of surgery. Although managing thoracotomy pain might be challenging, the advantages of proper pain management are substantial.

113 Cannabidiol Supplementation and Physiological Response in Transported Horses

Abstract With traveling between competition use, breeding purposes, relocation to new owners; horses are the most transported animals of domesticated species. Transportation can lead to higher stress levels therefore impairing the immunological response. With an increase in stress, horses can experience illness, dehydration, abnormal feeding behavior, injuries, or negative stereotypic behaviors. Cannabidiol (CBD) supplementation has suggested the possibility in the reduction of anxiety and lessening impairment to immunity. The objective of this study was to determine if oral supplementation of CBD oil mediated physiological response to transportation. Six geldings were used in a switchback experimental design. Horses were housed in 11’x14’ stalls containing cameras to monitor feed and water intake and behavior. A control dose of olive oil (n = 4) or CBD oil (0.6 mg/kg BW; n = 3) was administered for five days. On day 7, horses were transported for three hours in groups of three. Variables measured included plasma cortisol, blood lactate, rectal temperature, and thermography imaging. Measurements were taken prior to transport, immediately following transport, and 24h post transportation. Horses underwent a 3-week washout period before returning to stalls. Control and treatment doses were switched between horses before repeating the experiment. Data were analyzed in R Studio© for analysis of variance (ANOVA). Findings were considered significant at P ≤ 0.05. There were no differences shown upon analysis in cortisol levels (P = 0.646), blood lactate levels (P = 0.560) or rectal body temperatures (P = 0.347). While oral supplementation of CBD oil may reduce stressors, further studies are needed to determine if CBD affects physiological response to transportation.