Incidence Of Dry Mouth Research Articles

Comparison of the efficacy and complications of tolterodine and α-adrenergic receptor blockers in improving ureteral stent-related symptoms: A systematic review and meta-analysis.

We conducted a systematic evaluation of the therapeutic efficacy and complications of tolterodine and α-adrenergic receptor blockers in alleviating ureteral stent-related symptoms. Until August 2023, we conducted a comprehensive literature search on PubMed, Embase, Web of Science, and Cochrane Library to identify randomized controlled trials evaluating the efficacy and complications of tolterodine and α-adrenergic receptor blockers in treating ureteral stent-related symptoms. Two reviewers independently screened studies and extracted data. The scores from various domains of the Ureteral Stent Symptom Questionnaire (USSQ) were summarized and compared, and statistical analysis was performed using RevMan 5.4.0 software. A total of 8 studies met the inclusion criteria for our analysis. These studies were conducted at different centers. All studies were randomized controlled trials, involving a total of 487 patients, with 244 patients receiving α-adrenergic receptor blockers and 243 patients receiving tolterodine. The results showed that tolterodine demonstrated significantly better improvement in body pain (MD, 1.56; 95% CI [0.46, 2.66]; p = 0.005) (MD, 0.46; 95% CI [0.12, 0.80]; p = 0.008) (MD, 3.21; 95% CI [1.89, 4.52]; p = 0.00001) among patients after ureteral stent placement compared to α-adrenergic receptor blockers at different time points. Additionally, at 4 weeks, tolterodine showed superior improvement in general health (MD, 0.15; 95% CI [0.03, 0.27]; p = 0.01) and urinary symptoms (MD, 1.62; 95% CI [0.59, 2.66]; p = 0.002) compared to α-adrenergic receptor blockers, while at 6 weeks, tolterodine showed better improvement in work performance (MD, -1.60; 95% CI [-2.73, -0.48]; p = 0.005) compared to α-adrenergic receptor blockers. Additionally, the incidence of dry mouth (RR, 4.21; 95% CI [1.38, 12.87]; p = 0.01) is higher with the use of tolterodine compared to α-adrenergic receptor blockers. However, there were no significant statistical differences between the two drugs in other outcomes. This meta-analysis suggests that tolterodine is superior to α-adrenergic receptor blockers in improving physical pain symptoms after ureteral stent placement, while α-adrenergic receptor blockers are more effective than tolterodine in enhancing work performance. Additionally, the incidence of dry mouth is higher with the use of tolterodine compared to α-adrenergic receptor blockers. However, higher-quality randomized controlled trials are needed to further investigate this issue.

Comparative assessment of efficacy and safety of approved oral therapies for overactive bladder: a systematic review and network meta-analysis.

Pubmed, Embase, Web of Science, and the Cochrane Register of Clinical Trials databases were systematically searched. The search time frame was from database creation to June 2, 2022. Randomized controlled double-blind trials of oral medication for overactive bladder were screened against the protocol's entry criteria. Trials were evaluated for quality using the Cochrane Risk of Bias Assessment Tool, and data were statistically analyzed using Stata 16.0 software. A total of 60 randomized controlled double-blind clinical trials were included involving 50,333 subjects. Solifenacin 10mg was the most effective in mean daily micturitions and incontinence episodes, solifenacin 5/10mg in mean daily urinary urgency episodes and nocturia episodes, fesoterodine 8mg in urgency incontinence episodes/d and oxybutynin 5mg in voided volume/micturition. In terms of safety, solifenacin 5mg, ER-tolterodine 4mg, mirabegron, vibegron and ER-oxybutynin 10mg all showed a better incidence of dry mouth, fesoterodine 4mg, ER-oxybutynin 10mg, tolterodine 2mg, and vibegron in the incidence of constipation. Compared to placebo, imidafenacin 0.1mg showed a significantly increased incidence in hypertension, solifenacin 10mg in urinary tract infection, fesoterodine 4/8mg and darifenacin 15mg in headache. Solifenacin showed better efficacy. For safety, most anticholinergic drugs were more likely to cause dry mouth and constipation, lower doses were better tolerated. The choice of drugs should be tailored to the patient's specific situation to find the best balance between efficacy and safety.

COMPARATIVE EVALUATION OF DEXMEDETOMIDINE AND FENTANYL FOR EPIDURAL ANALGESIA IN LOWER LIMB ORTHOPEDIC SURGERIES

A study conducted between two groups to compare : Ropivacaine + Dexmedetomidine (RD) and Ropivacaine + Fentanyl (RF), comprising 50 patients each. Inj. Ropivacaine, 15 ml of 0.75%, was administered epidurally in both the groups with addition of 1 μg/kg of dexmedetomidine in RD group and 1 ฀g/kg of fentanyl in RF group. Besides cardio-respiratory parameters and sedation scores, various block characteristics were also observed. The study was compiled systematically and analyzed using ANOVA with post-hoc signicance, Chisquare test and Fisher's exact test. Value of P<0.05 is considered signicant and P<0.001 as highly signicant.As compared both groups.RD group was signicantly earlier in establishment of complete motor blockade, sensory analgesia at T10. Postoperatively sedation better in RD group. Incidence of nausea and vomiting was signicantly high in the RF group, while incidence of dry mouth was signicantly higher in the RD group. At the end of study Dexmedetomidine seems to be a better alternative to fentanyl as an epidural adjuvant.

Role of Prophylactic Intramuscular Glycopyrrolate in Preventing Hypotension and Bradycardia in Patients Undergoing Elective Lower Limb Surgeries under Spinal Anaesthesia: A Randomised Placebo-controlled Study

Introduction: Spinal anaesthesia is an extensively used anaesthetic technique for infraumbilical surgeries. Despite its many advantages, hypotension and bradycardia are two common complications. The incidence of bradycardia following spinal anaesthesia is higher in young adults. Although a few previous studies have observed that intramuscular glycopyrrolate is effective in preventing spinal-induced bradycardia and hypotension in elderly and parturient patients, there is a lack of reported studies in the young population. Aim: To evaluate the role of intramuscular glycopyrrolate in the prevention of bradycardia and hypotension in adult patients undergoing lower limb surgeries. Materials and Methods: A randomised, parallel-group, doubleblind, placebo-controlled study was conducted in the Department of Anaesthesiology at Calcutta National Medical College, Kolkata, West Bengal, India. The duration of the study was 15 months, from July 2021 to September 2022. A total of 60 patients aged 18-45 years, of either sex, with American Society of Anaesthesiologists (ASA) physical status I and II, undergoing elective lower limb surgeries under spinal anaesthesia. The patients were randomised into two groups: group G received intramuscular glycopyrrolate 1 mL (0.2 mg) and group N received intramuscular normal saline 1 mL 15 minutes prior to spinal anaesthesia. Hyperbaric bupivacaine (0.5%) 3 mL and fentanyl (25 mcg) 0.5 mL were injected intrathecally. Haemodynamic parameters were monitored. All data were analysed using appropriate statistical tests. A p-value of <0.05 was considered statistically significant. Changes in Heart Rate (HR) were considered the primary outcome variable. The secondary outcome variables were changes in Mean Arterial Pressure (MAP), incidence of bradycardia and hypotension, phenylephrine requirement, and incidence of dry mouth. Results: The mean age of the study participants of group G and group N was 34.17 years and 33.63 years. The two groups were comparable in terms of demographic profile. In comparison to group N, patients in group G showed a significantly higher HR throughout the intraoperative period (p<0.001) and at 60 minutes in the postoperative period. The incidence of hypotension was significantly higher in group N (53.33%) compared to group G (3.33%, p<0.001), and the MAP was lower in group N compared to group G in the intraoperative period. The number of patients requiring phenylephrine was also higher in group N (53.33%) compared to those in group G (3.33%). Conclusion: Prophylactic use of intramuscular glycopyrrolate can maintain stable haemodynamics in patients undergoing lower limb surgeries under spinal anaesthesia. It can maintain a higher HR and reduces the incidence of hypotension following spinal anaesthesia.

The Effect of Combination Use of Hemodialysis and Hemoperfusion on Microinflammation in Elderly Patients with Maintenance Hemodialysis

Background: Patients with maintenance hemodialysis (MHD) generally have a microinflammatory state. The aim of this study was to investigate the effects of hemodialysis (HD) combined with hemoperfusion (HP) on microinflammatory state in elderly patients with MHD. Methods: One hundred and fifty elderly patients with MHD were randomly divided into the control group and the observation group. The control group received simple HD treatment, and the observation group received combined HD + HP treatment on the basis of the control group. After 6 months of continuous treatment, the patients were evaluated to compare the quality of life, inflammation, adverse reactions, and nutritional indicators in the 2 groups before and after treatment. Results: There was no significant difference in the quality of life between the 2 groups before treatment. After treatment, the scores of psychological aspects, physiological aspects, social aspects, environmental aspects, and independent ability in the observation group were higher than those in the control group, with statistical significance (p < 0.05). There was no statistical significance in the level of inflammation between 2 groups before treatment. After treatment, the levels of hs-CRP, Hcy, IL-6, and TNF-α in the observation group were significantly lower than those in the control group, with statistical significance (p < 0.05). The incidence of dry mouth, skin reaction, neuritis, and subcutaneous tissue fibrosis in the observation group was lower than that in the control group, with statistical significance (p < 0.05). There was no statistical significance in nutritional level indexes between 2 groups before treatment (p₁ > 0.05). After treatment, the levels of hemoglobin, total protein, albumin, and transferrin in the observation group were significantly higher than those in the control group, with statistical significance (p < 0.05). Conclusion: The clinical effect of HD combined with HP in elderly MHD patients is significant, which can effectively reduce the incidence of adverse reactions and inflammation in the patients and improve the quality of life and nutritional indicators of the patients.

Maternal hemodynamic effect of prophylactic glycopyrrolate after spinal anaesthesia for elective caesarean section

Introduction: Hypotension and bradycardia are the most common complications during spinal anesthesia. Bradycardia decreases cardiac output, resulting in hypotension and even cardiac arrest. Glycopyrronium, an anticholinergic drug increases heart rate and prevents bradycardia during spinal anesthesia by blocking the effects of acetylcholine on the sinoatrial node. The study aims to measure the maternal hemodynamic effect of glycopyrrolate after spinal anesthesia for elective caesarean section.&#x0D; Method: An intervention, comparative study was conducted in Patan Hospital after approval from Ethical Committee. Eighty-two pregnant women scheduled for elective caesarean section were randomly assigned in two groups by sealed envelope method; Group I received glycopyrrolate 0.2mg intravenous, Group II did not receive glycopyrrolate. The patient’s heart rate, blood pressure, mean arterial pressure, a total dose of ephedrine, the occurrence of nausea, vomiting, and dry mouth were recorded. Independent-T test, chi-square test were used for statistical analysis.&#x0D; Result: Among 82 elective caesarean sections, 41 in each group, Group II (non-glycopyrrolate) reported increased heart rate compared to Group I (glycopyrrolate), but was statistically not significant. The highest recorded diastolic blood pressure was more in Group I compared to Group II and was statistically significant. The highest recorded Mean Arterial Pressure was high in the glycopyrrolate group and was statistically significant. The total dose of ephedrine was lower in the statistically significant glycopyrrolate group. The incidence of dry mouth was more in the glycopyrrolate group and the difference was statistically significant.&#x0D; Conclusion: Glycopyrrolate reduces the incidence of hypotension but not bradycardia and decreases the need for vasopressor.

The Incidence of Dry Mouth in Diabetes Mellitus

The Incidence of Dry Mouth in Diabetes Mellitus

The role of dry mouth in screening sleep apnea

Purpose of the studyEffective screening questionnaires are essential for early detection of obstructive sleep apnea (OSA). The STOP-Bang questionnaire has high sensitivity but low specificity. Dry mouth is a typical...

Adjuvant Chemotherapy with Chinese Herbal Medicine Formulas Versus Placebo in Patients with Lung Adenocarcinoma after Radical Surgery: a Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

BackgroundThe toxicity and side effects caused by adjuvant chemotherapy (ACT) after radical surgery for lung adenocarcinoma (LAC) lead to early termination frequently. This study was conducted to provide an objective basis for the effect of Chinese herbal medicine formulas (CHMFs) combined with chemotherapy in reducing toxicity and enhancing efficacy of ACT.MethodFrom February 17th, 2012 to March 20th, 2015, 233 patients from 7 hospitals diagnosed with LAC in IB~IIIA stage were randomly assigned into ACT + CHMF group (116 patients) and ACT + placebo group (117 patients). CHMF was taken orally until the end of chemotherapy. Chemotherapy-related toxic, side effects were investigated as the primary outcome. Disease-free survival (DFS) and overall survival (OS) were used as the secondary outcome.ResultsAt one week following chemotherapy, the incidence of dry mouth, diarrhea and thrombocytopenia significantly decreased in CHMF group (P = 0.017, P = 0.033, P = 0.019, respectively). At two weeks following chemotherapy, fatigue and diarrhea were more obvious in the placebo group (P = 0.028, P = 0.025, respectively). In addition, patients in the CHMF group showed an increase in median DFS from 37.1 to 51.5 months compared with placebo group although there was no statistical significance (P = 0.16). In the stage IB subgroup, the CHMF group had a significantly better DFS (HR (95% CI) = 0.53 (0.28–0.99), P = 0.046). There was no significant difference in OS between the groups (P = 0.72).ConclusionFor patients with LAC, ACT combined with CHMF after radical surgery can prolong the DFS time especially in the early stage, and reduces the chemotherapy-related toxic and side effects.Trial RegistrationNCT 01441752. Registered 14 July, 2011.

Comparisons of Therapeutic Efficacy and Safety of Solifenacin versus Tolterodine in Patients with Overactive Bladder: A Meta-Analysis

Objectives: This meta-analysis was to assess solifenacin and tolterodine in patients with overactive bladder. Methods: We searched PubMed, the Cochrane Library, EMBASE, CNKI, Wanfang, and ClinicalTrials.gov databases for randomized controlled trials (RCTs). The efficacy endpoint was daily micturition frequency, daily urgency episodes, daily incontinence episodes, and micturition volume per voiding. The safety endpoint was the incidence of the rate of major bleeding, intracranial bleeding, and gastrointestinal bleeding. Results:Seven RCTs met the inclusion criteria and 1,318 patients were included. The meta-analysis showed that, compared with tolterodine, solifenacin was associated with similar daily micturition frequency, daily urgency episodes, daily incontinence episode, and micturition volume per voiding at 8 and 12 weeks of follow-up. Moreover, no significant difference was obtained in the incidence of dry mouth between solifenacin and tolterodine at 8 and 12 weeks of follow-up. However, tolterodine decreased the constipation rate at 12 weeks compared with solifenacin. Conclusion: Solifenacin and tolterodine yielded similar results on daily micturition frequency, daily urgency episodes, daily incontinence episodes, micturition volume per voiding, and the incidence of dry mouth. However, tolterodine can decrease the constipation rate at 12 weeks compared with solifenacin.

Vibegron (RVT-901/MK-4618/KRP-114V) Administered Once Daily as Monotherapy or Concomitantly with Tolterodine in Patients with an Overactive Bladder: A Multicenter, Phase IIb, Randomized, Double-blind, Controlled Trial

BackgroundAntimuscarinics have shown modest efficacy with unwanted side effects in patients with overactive bladder (OAB). Efficacy of vibegron, a new β3-adrenergic receptor agonist, for OAB is unknown. ObjectiveTo evaluate the efficacy of once-daily oral vibegron in OAB patients (primary), and its safety, tolerability, and efficacy when administered alone or concomitantly with tolterodine (secondary). Design, setting, and participantsInternational, phase IIb, randomized, double-blind, placebo- and active comparator–controlled, two-part superiority trial (2011–2013) in OAB-wet or OAB-dry patients aged 18–75 yr (NCT01314872). InterventionsPart 1: once-daily oral vibegron monotherapy (3 [V3], 15 [V15], 50 [V50], or 100 [V100] mg), tolterodine extended release 4mg (TER4), or placebo for 8 wk, or combination V50/TER4 for 4 wk and then V50 for 4 wk; part 2: V100/TER4, V100, TER4, or placebo for 4 wk. Outcome measurements and statistical analysisAverage daily micturitions at week 8 of part 1 (primary); urge incontinence episodes, total incontinence episodes, and urgency episodes (secondary). Results and limitationsOverall, 1395 patients were randomized. From baseline to week 8, V50 and V100 significantly decreased average daily micturitions (least square mean difference [95% confidence interval], −0.64 [−1.11, −0.18]; p=0.007 and −0.91 [−1.37, −0.44]; p<0.001, respectively) and the number of urge incontinence episodes (−0.72 [−1.11, −0.33] and −0.71 [−1.10, −0.32], respectively; both p<0.001) versus placebo. All vibegron doses were well tolerated. The incidence of dry mouth was higher with TER4 than with vibegron monotherapy. Results are limited by the relatively short treatment duration. ConclusionsOnce-daily V50 and V100 improved OAB symptoms; vibegron was well tolerated as monotherapy and concomitantly with tolterodine. Further development is warranted. Patient summaryAntimuscarinics, commonly used to treat overactive bladder, produce modest efficacy and unwanted side effects. In this study, a different type of drug (vibegron) was efficacious and safe, alone or with an antimuscarinic (tolterodine).

An observational study to evaluate the effect of different epidural analgesia regimens on dynamic pain scores in patients receiving epidural analgesia for postoperative pain relief after elective gynecological surgery.

Background and Aims:The primary measure of efficacy of any analgesic regimen is pain relief, but it is important to measure dynamic pain relief rather than pain relief at rest. Epidural analgesia is an effective technique for postoperative analgesia. The drug combinations given therein (local anesthetics with adjuvants such as opioids/alpha-2 agonists), however, remain a personal choice. The aim of this study was to evaluate dynamic pain scores in patients receiving different epidural analgesia regimens for postoperative pain relief after elective gynecological surgery used in our institution.Material and Methods:One hundred eighty-seven patients enrolled in this study received postoperatively either bupivacaine 0.125% + morphine 0.1 mg/mL (group BM) or bupivacaine 0.125% + fentanyl 2 μg/mL (group BF) or bupivacaine 0.125% + clonidine 1 μg/mL (group C1) or bupivacaine 0.125% + clonidine 2 μg/mL (group C2) by continuous epidural infusion @ 5 mL/h. Differences in dynamic pain scores (on coughing and mobilization), pain scores at rest, sensory and motor blockade, sedation scores, dry mouth, pruritus, nausea, and vomiting were recorded. Also duration of postoperative analgesia, epidural top-ups, requirement of rescue analgesic, and patient satisfaction were determined. All observations were carried out at 1, 2, 4, 8, and 12 h after surgery and then at 8 am, 12 noon, 4 pm, 8 pm on subsequent postoperative day till removal of epidural catheter (after 96 h).Results:There was no difference in demographic or hemodynamic profile among the four groups (P > 0.05). There was no statistically significant difference in pain scores at rest among the four groups but dynamic pain scores were found to be better in group C2 as compared to group BM, BF, and C1 at most of the time intervals although not statistically significant (P > 0.05). Requirement of rescue analgesics was lower in group BM and group C2 as compared to group BF and C1 (P < 0.01). Incidence of pruritus was 43.5% in group BM and 19% in group BF, while no patients in group C1 or C2 had pruritus. Mean postoperative nausea and vomiting (PONV) scores were higher in group BM and group BF as compared to group C1 and C2 (P < 0.001). Mean sedation scores were comparable in all four groups. Incidence of dry mouth was 22% in group C2 as compared to 11% in group C1, while no patients in group BM or BF had dry mouth. Patients in group C2 were more satisfied as compared to other three groups.Conclusions:Combination of clonidine 2 μg/mL to 0.125% bupivacaine @ 5 mL/h in combined spinal epidural provides better postoperative analgesia as compared to combination of bupivacaine with opioids with greater patient satisfaction and significantly reduced side effects.

Comparison of mirabegron and imidafenacin for efficacy and safety in Japanese female patients with overactive bladder: A randomized controlled trial (COMFORT study).

To evaluate the efficacy and safety of mirabegron compared with imidafenacin for the treatment of female patients with overactive bladder. Patients (n = 89) were randomized to receive 0.1 mg imidafenacin twice daily (n = 47) or 50 mg mirabegron once daily (n = 42) for 12 weeks. The primary efficacy end-point was change in total Overactive Bladder Symptom Score. Secondary efficacy end-points included change in Overactive Bladder Symptom Score, 3-day micturition diary, International Prostate Symptom Score and Overactive Bladder Questionnaire. Safety assessments included adverse events, vital signs, post-void residual volume and patient-reported incidence, and severity of distinctive symptoms related to adverse events. The mirabegron group showed a significantly reduced mean total Overactive Bladder Symptom Score from baseline, but no significant differences were noted in change of total Overactive Bladder Symptom Score compared with the imidafenacin group. Significant improvements in secondary efficacy end-points were observed regarding the mean number of micturitions/24 h, mean number of urgency episodes/24 h, mean number of incontinence episodes/24 h, mean volume voided/micturition, total International Prostate Symptom Score and quality of life in both groups, with no significant differences between the groups. The overall incidence of adverse events and the incidence of dry mouth were significantly higher in the imidafenacin group than in the mirabegron group. Patient-reported incidence and the severity of dry mouth were significantly exacerbated in the imidafenacin group. Treatment with 50 mg mirabegron once daily effectively relieves overactive bladder symptoms in women with fewer adverse events than treatment with antimuscarinics.

Safety and tolerability of once-daily tiotropium Respimat® as add-on to at least inhaled corticosteroids in adult patients with symptomatic asthma: A pooled safety analysis

BackgroundTiotropium, a long-acting anticholinergic bronchodilator, has demonstrated efficacy and safety as add-on therapy to inhaled corticosteroids (ICS), with or without other maintenance therapies, in patients with symptomatic asthma. ObjectiveTo evaluate safety and tolerability of tiotropium delivered via the Respimat® device, compared with placebo, each as add-on to at least ICS therapy, in a pooled sample of adults with symptomatic asthma at different treatment steps. MethodsData were pooled from seven Phase II and III, randomised, double-blind, parallel-group trials of 12–52 weeks’ treatment duration, which investigated once-daily tiotropium Respimat® (5 μg, 2.5 μg) versus placebo as add-on to different background maintenance therapy including at least ICS. Adverse events (AEs) including serious AEs were assessed throughout treatment + 30 days after the last dose of trial medication. ResultsOf 3474 patients analysed, 2157 received tiotropium. The percentage of patients with AEs was comparable between treatment groups: tiotropium 5 μg, 60.8%; placebo 5 μg pool, 62.5%; tiotropium 2.5 μg, 57.1%; placebo 2.5 μg pool, 55.1%. Consistent with the disease profile, the most frequent AEs overall were asthma, decreased peak expiratory flow rate (both less frequent with tiotropium) and nasopharyngitis. Overall incidence of dry mouth, commonly associated with use of anticholinergics, was low: tiotropium 5 μg, 1.0%; placebo 5 μg pool, 0.5%; tiotropium 2.5 μg, 0.4%; placebo 2.5 μg pool, 0.5%. The percentage of cardiac disorder AEs was comparable between tiotropium and placebo: tiotropium 5 μg, 1.4%; placebo 5 μg pool, 1.4%; tiotropium 2.5 μg, 1.4%; placebo 2.5 μg pool, 1.1%. The proportions of patients with serious AEs were balanced across groups: tiotropium 5 μg, 4.0%; placebo 5 μg pool, 4.9%; tiotropium 2.5 μg, 2.0%; placebo 2.5 μg pool, 3.3%. ConclusionTiotropium Respimat® demonstrated safety and tolerability comparable with those of placebo, as add-on to at least ICS therapy, at different treatment steps in adults with symptomatic asthma.

Analysis of the efficacy of intensity-modulated radiotherapy and two-dimensional conventional radiotherapy in nasopharyngeal carcinoma with involvement of the cervical spine.

The aim of the present study was to retrospectively analyze the clinical efficacy and side-effects of two-dimensional conventional radiotherapy (2D-CRT) and intensity-modulated radiotherapy (IMRT) in 53 NPC patients with cervical spine involvement, without distant metastases. In total, 53 patients were enrolled in the present study, with 24 being treated with IMRT and 29 being treated with 2D-CRT. All 53 patients received platinum-based concurrent chemotherapy and 4-6 cycles of adjuvant chemotherapy subsequent to radiation. The patients were clinically staged according to the seventh edition of the UICC and AJCC staging systems. Overall survival (OS), local progression-free survival (LPFS) and distant metastasis-free survival (DMFS) rates were calculated. The 3- and 5-year OS rates were 87.7% and 45.5% in the IMRT-treated group and 65.5% and 9.1% in the 2D-CRT-treated group (P=0.01). The 3- and 5-year LPES rates were 87.4% and 69.9% in the IMRT-treated group compared with 49.4% and 9.4% in the 2D-CRT-treated group, respectively (P=0.00). The 3- and 5-year DMFS rates were 94.4 and 40.8% in the IMRT-treated group and 79.8 and 30.4% in the 2D-CRT-treated group (P=0.13). N stage (P=0.00) and radiotherapy methods (P=0.01) were relevant to the OS and LPFS rates, it also revealed a significant difference when the DMFS rates were analyzed in N stage. The incidence of dry mouth in the IMRT group was significantly lower (P=0.01), but there was no statistically significant difference in acute oropharyngeal mucositis or myelosuppression. IMRT had significant advantages in local control and OS compared with conventional 2D-CRT, but IMRT failed to reduce the incidence of distant metastasis.

Dexmedetomidine premedication in cataract surgery under topical anaesthesia: to assess patient and surgeon satisfaction

Background: Dexmedetomidine is a potent non-opioid analgesic that may enhance analgesia for cataract surgery under topical anaesthesia. This study was undertaken to assess sedation and analgesia provided by dexmedetomidine and evaluating patients’ satisfaction. Secondary aims were: (1) To study the effect of dexmedetomidine in decreasing the intraocular pressure. (2) The impact on surgeons’ satisfaction. (3) Hemodynamic effects.Methods: We conducted a prospective randomized study on ASA I/II patients presenting for cataract surgery under topical anesthesia. Patients were randomly assigned to two groups: group D received dexmedetomidine premedication 1 mcg/kg over 10 minutes and group C received saline at the same rate. Sedation and pain score, intraocular pressure, patient and surgeon satisfaction score and hemodynamics were monitored and compared.Results: There was a significant increase in sedation assessed by the Ramsay sedation score at all times in group D after receiving dexmedetomidine (p < 0.0001). However, pain scores (numeric rating scale) were similar in both groups (p > 0.05).Dexmedetomidine decreased the intraocular pressure and the difference was statistically highly significant (p < 0.0001). Group D had better patient and surgeon satisfaction score as against group C (p = 0.0001). Noticeably, the incidence of dry mouth was higher in group D. Hemodynamic parameters were well maintained in both groups with no adverse events in either group.Conclusions: Dexmedetomidine can be used safely for cataract surgery under topical anesthesia. Administration of dexmedetomidine was associated with better patient and surgeon satisfaction.

Comparative study of hemodynamic profile in intraoperative period and side effects of epidural ropivacaine with clonidine and dexmedetomidine for lower limb surgeries

Background: Epidural anesthesia gained great popularity by virtue of its distinct advantages over spinal anesthesia, such as provision of extended anesthesia in prolonged surgeries; early ambulation of patients, which reduces the hospital stay; and reduced incidence of postsurgical complications such as deep vein thrombosis. Objective: To study ropivacaine with clonidine and dexmedetomidine in epidural anesthesia for lower limb surgeries with respect to hemodynamic profile in intraoperative period and their side effects. Materials and Methods: Sixty patients of either sex of ASA grades I and II aged between 20 and 60 years were included in the study and randomly divided in two groups: group RC, patient received ropivacaine (0.75% 20 mL) with clonidine (2 mcg/kg; n = 30); group RD, patient received ropivacaine (0.75% 20 mL) with dexmedetomidine (1.5 mcg/kg; n = 30). The hemodynamic parameters recorded were mean heart rate, mean systolic blood pressure, mean diastolic blood pressure (DBP), and mean arterial pressure (MAP), respiratory rate, and oxygen saturation. These parameters were recorded preoperatively and then at 5-min intervals during intraoperative period till the end of the surgery. The study was carried out in the Department of Anesthesia, Grant Medical College Hospital, Indore, Madhya Pradesh, and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India. Results: Heart rate was lower in group RD compared with group RC from 10 to 40 min intraoperatively, although it remained stable throughout the intraoperative period in both the groups. DBP was lower in group RD compared with group RC from 15 to 20 min intraoperatively. MAP was lower in group RD compared with group RC from 10 to 20 min intraoperatively, although it remained stable throughout the intraoperative period in both the groups. Oxygen saturation and respiratory rate showed no statistically significant differences and remained stable throughout the intraoperative period in both the groups. The incidence of side effects such as nausea, vomiting, dizziness, headache, and respiratory depression was nil in both the groups, while the incidence of dry mouth in both the groups was equal 36.33%, and the difference was not significant. Conclusion: Hemodynamic parameters such as heart rate, blood pressure, oxygen saturation, and respiratory rate remained stable throughout the intraoperative period with both dexmedetomidine and clonidine.

Comparative analysis of epidural bupivacaine versus bupivacaine with dexmedetomidine for vaginal hysterectomy.

Background:Dexmedetomidine a new drug, which is alpha-two agonist, is recommended by manufacturers as an adjuvant in epidural analgesia and anesthesia.Aims:To study the effects of dexmedetomidine on quality and efficacy of the epidural bupivacaine 0.5% for vaginal hysterectomies, by studying the onset of action, duration of action, highest dermatomal level achieved, degree of motor blockade, intraoperative and postoperative anesthesia and analgesia achieved.Setting and Design:Prospective randomized study.Materials and Methods:In this study, 60 American Society of Anesthesiologists I and II patients requiring vaginal hysterectomy were enrolled. Patients were randomly divided into two groups - Group I: Control group receiving epidural bupivacaine 0.5% 15–20 ml only.Group II:Group receiving of epidural bupivacaine 0.5% 15–20 ml with dexmedetomidine 05 mcg/kg. Following parameters were noted: Time to onset of T10 dermatomal level, maximum sensory level achieved, time for complete motor block, time for two segmental dermatomes regression, regression to S1 dermatome, time for first rescue analgesic and total top ups required during study.Statistical Analysis:Mean and standard deviation was calculated. We used two independent sample t-test to find the P value. Software used STATA 13.0.Results:The demographic profile was comparable between the groups. There was significant difference between two groups (P < 0.001) regarding onset of analgesia to T10 (17.12 ± 2.44 vs. 10.14 ± 2.94), time to achieve complete motor block (27.16 ± 4.52 vs. 22.98 ± 4.78), which was earlier in dexmedetomidine with bupivacaine group. Prolonged postoperative analgesia, less rescue top ups and adequate sedation score was found with dexmedetomidine group. The intraoperative hemodynamic changes were comparable in both the groups. The incidence of dry mouth, shivering and nausea was more with the dexmedetomidine group.Conclusion:We conclude that epidural dexmedetomidine 0.5 µg/kg is a good adjuvant providing early onset of sensory and motor block, adequate sedation and prolonged postoperative analgesia with minimal side-effects.

Meta-Analysis of Prevalence of Xerostomia in Diabetes Mellitus

Background: As with other complications of diabetes mellitus, the occurrence of dry mouth can lead to a poor quality of life. Therefore, this study aimed to identify the prevalence of xerostomia in patients with diabetes mellitus through a systematic review and meta-analysis. Method: Systematic review and meta-analysis. Results: After the screening process, 23 studies were included in the meta-analysis. Overall, the incidence of dry mouth was investigated in 1979 people with diabetes (cases) and 1225 controls. The global prevalence of diabetes in xerostomia was 42.22% (95% CI: 33.97%-50.92%). In the analysis by specific subtype, the overall prevalence was 37.42% (95% CI: 22.33%-55.44%) among individuals with Type 1 diabetes and 46.09% (95% CI: 23.99%-69.85%) among those with type 2 diabetes. The prevalence of xerostomia found in Asia (49.01%; 95% CI: 32.08%-66.16%) was higher than that found in Europe (40.04%; 95% CI: 29.58%-51.50%) and America (38.39%; 95% CI: 23.63%-55.65%). Analysis of the case-control studies showed a statistically significant association between xerostomia and diabetes mellitus (OR=3.15; 95% CI: 2.11-4.70; p<0.001). Conclusion: Through the data collected, we can infer that the prevalence of xerostomia in individuals affected by diabetes mellitus types 1 and 2 was high and independent of geographic location.

Comparison between the Effectiveness of Oral Phloroglucin and Cimetropium Bromide as Premedication for Diagnostic Esophagogastroduodenoscopy: An Open-Label, Randomized, Comparative Study

Background/AimsSuppression of gastrointestinal (GI) peristalsis during GI endoscopy commonly requires antispasmodic agents such as hyoscine butylbromide, atropine, glucagon, and cimetropium bromide. This study examined the efficacy of oral phloroglucin for the suppression of peristalsis, its impact on patient compliance, and any associated complications, and compared it with intravenous or intramuscular cimetropium bromide administration.MethodsThis was a randomized, investigator-blind, prospective comparative study. A total of 172 patients were randomized into two groups according to the following medications administered prior to upper endoscopy: oral phloroglucin (group A, n=86), and cimetropium bromide (group B, n=86). The numbers and the degrees of peristalsis events at the antrum and second duodenal portion were assessed for 30 seconds.ResultsA significantly higher number of gastric peristalsis events was observed in group A (0.49 vs. 0.08, p<0.001), but the difference was not clinically significant. No significant difference between both groups was found in the occurrence of duodenal peristalsis events (1.79 vs. 1.63, p=0.569). The incidence of dry mouth was significantly higher with cimetropium bromide than with phloroglucin (50% vs. 15.1%, p<0.001).ConclusionsOral phloroglucin can be used as an antispasmodic agent during upper endoscopy, and shows antispasmodic efficacy and adverse effects similar to those of cimetropium bromide.