Post Operation Research Articles

BENEFICIAL EFFECTS OF A NOVEL INTRAOPERATIVE SURGICAL IRRIGANT ON POST-OPERATIVE KNEE SWELLING AND LIMB FUNCTION IN PRIMARY TOTAL KNEE ARTHROPLASTY

Total knee arthroplasty (TKA) is one of the most common elective orthopedic procedures performed in inpatient and outpatient settings. Swelling, stiffness and pain are common complications that occur after TKA resulting in functional impairment of the joint. Reducing post-operative (PO) inflammation, which consequently helps mitigate edema, swelling and pain, is critical to functional recovery after surgery. This pilot study was designed to evaluate the effects of the intraoperative application of a novel surgical irrigant called XPERIENCE® Advanced Surgical Irrigation (XP), on post TKA lower extremity swelling, joint function, and pain, as part of an all-encompassing swelling reduction regimen. Intraoperative povidone-iodine (PI) application was used as the control. Swelling; an indicator of inflammation, was measured by single frequency-bioimpedance assessment (SF-BIA). Range of motion (ROM) and reliance on ambulatory assistive devices (AAD) were evaluated as indicators of functional recovery. Narcotic consumption for pain management and numerical pain scoring were evaluated as surrogate, limited indicators of quality of life. These parameters were assessed over a period of 6 weeks post index TKA and compared between the control cohort treated intraoperatively with PI and the intervention cohort treated intraoperatively with XP. Intraoperative irrigation with XP resulted in statistically significant improvements in PO swelling at days 7 (p<0.05) and 14 (p<0.01) post index surgery compared to the PI treated control cohort. Statistically significant improvements in ROM at day 7 (p=0.043) and AAD usage at day 21 (p=0.049) were noted in the XP cohort compared to the PI cohort. The XP cohort exhibited a quicker “weaning off opioids” timeline evidenced by the PI cohort reaching half of the maximum percentage of subjects using opioids 8 days later than the XP cohort. There was no statistically significant difference noted in numerical pain scores between the two cohorts. This pilot study signifies the utility of XP as a multifunctional, intraoperative surgical irrigation solution which has demonstrable benefits of reducing PO swelling with the potential to impact functional recovery after TKA.

Cryotherapy in Postoperative Shoulder Surgery: A Systematic Review.

Cryotherapy, a therapeutic technique involving localized cooling of the body, has gained popularity for postsurgical rehabilitation. It induces a reduction in cellular metabolism, vasoconstriction, and pain relief, making it an attractive option for managing postoperative (PO) shoulder pain. This systematic review aimed to assess the effectiveness of cryotherapy in PO shoulder patients, focusing on pain, range of motion, functionality, and temperature changes. The review included six randomized clinical trials, involving a total of 233 patients who underwent various shoulder surgeries. Cryotherapy was applied using different methods, including Cryo/Cuff, Cryoton®, Polar Care 300, and ice packs. Results indicated that cryotherapy was generally effective in reducing PO shoulder pain. However, one study found no significant difference in pain outcomes between the cryotherapy group and control group. Furthermore, three studies demonstrated a decrease in intra-articular and skin temperatures with cryotherapy application. A risk of bias analysis revealed some concerns in the overall risk of bias for five studies, with one study considered to have a high risk of bias. Although publication bias assessment was not conducted due to the limited number of included studies, it was noted that the studies exhibited heterogeneity in terms of population, intervention methods, and outcome measures. In conclusion, cryotherapy appears to be a promising adjunctive treatment for PO shoulder pain, although the existing evidence has some limitations, including small sample sizes and methodological concerns. More high-quality studies are needed to establish the full extent of cryotherapy's effectiveness in PO shoulder rehabilitation, especially regarding its impact on functionality and range of motion.

Clinical assessment of corneal complications of manual small incision cataract surgery at tertiary care centre

: To assess corneal complications and visual outcome of manual small incision cataract surgery.: This study comprises of 227 patients in a tertiary care centre in Kolar district, who underwent MSICS were examined for corneal complications and visual outcome postoperatively on Day 1, 1 week, and at the end of 6 week also visual acuity (VA) assessment, anterior segment evaluation with slit lamp biomicroscopy, posterior segment evaluation using indirect ophthalmoscopy, and keratometry was done.227 participants were included in the study, of whom 138 (61%) were female and 89 (39%) were male. The maximum number of patients being in the age group of 61-70 (42.7%). OCTET grading was done for corneal edema patients and on post op Day 1, total 62 patients who had corneal edema in the study were graded according to OCTET classification, and 6 patients (9.6%) had grade 1, 17 patients (27.4%) had grade 2 and 39 patients (63%) had grade 3. At the end of 6 week postoperatively, 45 patients had clear cornea, and 5 patients (8%) had grade 1, 6 patients (9.5%) had grade 2, and 7 patients (11.1%) had grade 3, and 82.3% of patients had VA of 6/6 to 6/9 followed by 11% had 6/12 to 6/18 and 6.6% had 6/24 to 6/36.: Small incision cataract surgery is most cost-effective surgery if corneal endothelium is protected during surgery and will have early visual rehabilitation.

Evaluation bone healing agents: radiological presentative on lidocaine and diclofenac in rabbits

This study aimed to assess the impact of intraosseous injections of 2% lidocaine hydrochloride and 3.75% Diclofenac on bone regeneration. Forty-five adult male rabbits of a local breed were used to create a 3.5mm hole in the proximal third of the medial aspect of the tibia using an electric drill, with continuous isotonic regular saline irrigation to prevent thermal necrosis. The rabbits were randomly divided into three groups of fifteen each (n=15): a control group without any treatment, Group 1 (Lidocaine HCl), which received a daily dose of 2% lidocaine HCl (2 mg/kg body weight) for five days post-operation (P.O.), and Group 2 (Diclofenac), which received 3.75% Diclofenac (20 mg/kg body weight). Radiographic evaluations were conducted at the end of the 7th, 14th, and 21st days P.O. The findings demonstrated accelerated bone regeneration and development in Group 1 compared to Group 2 and the control group. In conclusion, intraosseous injection of 2% Lidocaine HCl (2mg/kg B.W.) showed a stimulatory effect on bone healing, with osteogenic tissue and trabecular bone formation being visible in radiographic images at the end of the first week, indicating a more effective outcome compared to the Diclofenac and control groups.

Efficacy of autologous platelet rich fibrin (PRF) and hydroxyapatite bioactive glass (HABG) in the management of intra bony defects -A randomized controlled trial

The ultimate aim of periodontal therapy is regeneration. Traditionally, many techniques and agents were used. The therapeutic outcome in treatment of intra bony defects can be augmented with the use of growth factors alongside bone grafts. The present clinical trial was designed to assess the efficacy of an alloplastic composite graft and the combination of autologous platelet rich fibrin with the graft in the management of intra bony defects. A total of 45 systemically healthy patients with intra bony defects indicated for flap surgery were selected from the outpatient department of periodontics. The patients were divided into three groups with the help of a computer generated random number table. Age, sex, and periodontal parameters (probing pocket depth, clinical attachment level, gingival marginal level, plaque index, modified sulcus bleeding index) and presence of intra bony defects were recorded. The defects in group I patients were treated with autologous PRF along with the graft, group II with graft, and group III with open flap debridement alone. All the patients were recalled at 3, 6, 9 months after surgery, and the periodontal parameters were recorded in each recall. The baseline parameters were compared with 9 month post op periodontal parameters by non parametric test for ANOVA (Kruskal Wallis). Maximum pocket depth reduction (5.86±1.03) maximum gain in attachment (4.64± 1.08), reduction in modified sulcus bleeding index were seen in group I, which is statistically significant between the groups. Though change in gingival marginal level is minimum for group I (1.21± 0.42), it was not statistically significant. Group I showed the maximum percentage of sites with bone fill (92.9%) which was also statistically significant when analyzed by the chi-square test. The Combination of autologous PRF with the hydroxy apatite bioglass graft in the management of intra bony defects showed improved clinical and radiographic outcome.

Incidence, risk factors and outcomes of cataract surgery after plaque brachytherapy for posterior uveal melanoma

PurposeTo examine incidence, risk factors, and outcomes of cataract surgery after plaque brachytherapy for posterior uveal melanoma. DesignRetrospective interventional cohort study contrasted with general population data. MethodsAll patients treated with plaque brachytherapy for a posterior uveal melanoma at Sweden's national referral center between 2010 and 2022 were included (n = 933). These patients were cross-referenced with data from the Swedish National Cataract Register. Competing risk incidences and outcomes of cataract surgery were compared with a random sample of 1000 individuals from the general population. ResultsThe 12-year incidence of cataract surgery after plaque brachytherapy was 27 % (95 % CI 23–31 %), which markedly exceeded the incidence of 16 % in the general population (95 % CI 13–18 %, Gray's P < 0.001). Patients treated with Iodine-125 had significantly higher incidence than patients treated with Ruthenium-106, and the latter had greater incidence than the general population (P < 0.001). In univariate competing risk regressions, older patients, female sex, thick tumors, and Iodine-125 were associated with cataract surgery. In multivariate analysis, older patients and Iodine-125 retained their significance. Outcomes of cataract surgery were overall similar in the plaque brachytherapy and general population, but the general population more often received post op. topical NSAID. ConclusionsIn this study, plaque brachytherapy for posterior uveal melanoma was associated with a significantly increased incidence of cataract surgery. Treatment with the gamma emitting isotope iodine-125 and older patient age at the time of brachytherapy emerged as the major risk factors. Outcomes of cataract surgery were comparable to the general population.

Clinical predictors and surgical outcomes following surgical treatment in patients with cervical spondylotic myelopathy, Addis Ababa, Ethiopia: A prospective study

BackgroundCSM is the most common cause of spinal dysfunction in adults older than 55 years of age and surgery is the mainstay of treatment for patients with CSM.The objective of our study was to assess the outcome of patients operated for CSM by using m-JOA and Recovery rate using Hirabayashi formula and evaluate clinical factors predicting surgical outcomes in patients undergoing decompressive surgeries. MethodologyAdult CSM patients fulfilling inclusion and exclusion criteria were enrolled at two hospitals. Patients were followed prospectively for a minimum of 06 month, with mJOA score, recovery rate (using Hirabayashi formula) and Postoperative complications assessments. Possible clinical predictive factors were also assessed. ResultsThere were 38 men and 19 women (mean age, 50.63 yr) enrolled in our study. 48 patients had anterior cervical procedure, 9 patients had posterior procedures.The mean mJOA scores at 6 months (13.33) and 1 year(14.74) after surgery were significantly higher than the mean preoperative mJOA (10.44) (P value = 0.01). 42(73.4 %)patients had recovery, 7 patients (11.9 %) remained the same while 8 (13.6 %) patients worsened. Average recovery rate was 36.59 ± 37.12 % in younger patients(<65yrs) and 2.4 ± 47.10 % in the group older than 65 years (P value = 0.043). Rate of recovery in patients with symptom duration of < 1 year was found to be better than those presented with symptom duration of > 1 year(39.11 % vs 15.54 %) with p-value = 0.035. Six patients had new neurologic deficit in the immediate postoperative period. ConclusionsSurgical treatment of CSM was associated with significant improvement in mJOA and recovery rate at 6 and 12 months. Age and duration of symptom were highly predictive of surgical. Our study showed a high rate of immediate post op neurologic deterioration but other complications in our study were comparable with those in previously reported CSM series.

Efficacy of Kinesio taping in post operative sequalae after surgical removal of mandibular third molars: a split mouth randomized control study

BackgroundThe surgical removal of impacted lower third molars produces a significant degree of trauma to the soft tissue and bony structures of the oral cavity, which can initiate considerable inflammatory reaction. Consequently, patient experiences pain, swelling, hemorrhage, nerve paraesthesia, limited mouth opening etc. The kinesiologic tape (KT) can help with blood and lymphatic circulation and has shown acceptable outcomes in reducing pain and in managing post-operative muscle spasm.MethodologyThe study was aimed to compare the effects of kinesiologic tape on post operative pain, swelling and trismus following surgical removal of mandibular third molar when compared to control group. 15 patients with bilaterally impacted mandibular third molar were included in the split mouth study. One side was randomly assigned as Group A where patient’s face was subjected to Kinesio tape application post extraction. The other was Group B where Kinesio tape was not applied. After extraction each patient was evaluated in terms of post op pain, swelling and trismus in post-op day 1,2 and 7th.ResultsThe pain was found to be significantly less (p = 0.042) in group A when compared to group B on the first day. The mean pain was 5.07 in KT group and 6.20 in No KT group on day 2nd. Post OP Swelling was statistically significantly less (p < 0.01) in Group A on 2nd & 3rd day. The postoperative mouth opening was more from the 2nd day in group A with mean of 26.07 mm and 20.33 mm in group B (p < 0.01).ConclusionThe kinesiologic taping originates from sports medicine, but can also used therapeutically for reducing post operative sequelae as demonstrated in our study. Kinesiologic tape (KT) enables patients to have a comfortable time post-operatively and helps to regain better quality of life.Trial registrationRegistered in Clinical Trial Registry—India.Registration number—CTRI/2021/05/033359, registration date – 04/05/2021.

Postoperative Prevalence and Risk Factors for Serum Hypokalemia in Patients with Primary Total Joint Arthroplasty.

Regular monitoring of serum potassium after a total joint arthroplasty (TJA) is a form of routine examination that can help detect abnormal serum potassium levels and reduce the incidences of adverse events that may occur on account of postoperative hypokalemia. Previous studies rarely discussed hypokalemia after joint replacement. In the present study, our primary goal was to investigate the incidence and possible risk factors of hypokalemia after a total hip and knee replacement procedure was performed. This study included patients who underwent a unilateral total knee or hip arthroplasty in our department between April 2017 and March 2018. Serum potassium levels pre and post operation were collected and retrospectively analyzed. The differences in age, gender, body mass index (BMI), history of diseases, red blood cell (RBC), hemoglobin, hematocrit, glomerular filtration rate, ejection fraction, blood glucose, urine creatinine, urea nitrogen, intraoperative blood loss, operation time, drainage, preoperative potassium, surgery type, were compared between those patients diagnosed with hypokalemia and their non-hypokalemia at different times post surgery. Thereafter, the risk factors of postoperative hypokalemia patients were analyzed using statistical procedure multiple logistic regression model. The risk of hypokalemia after TJA was 53.1%, while, that on the first, third, and fifth day after operation was 12.5%, 40.7%, and 9.6% respectively. The serum potassium level on the first, third, and fifth postoperative days was 3.84 ± 0.32, 3.59 ± 0.34, and 3.80 ± 0.32 mmol/l, respectively. However, the level on the third day appeared to be the lowest (p = 0.015) of them all. The independent risk factors for hypokalemia after a total hip and knee replacement were the level of preoperative serum potassium concentration (p = 0.011), preoperative red blood cells counts (p = 0.027), and history of diabetes (p = 0.007). Regular monitoring of serum potassium concentration should be performed post TJA. We need to pay more attention to the patient's preoperative potassium levels along with their red blood cell counts especially in patients diagnosed with type 2 diabetes mellitus.

Comparative study of surgical management of chronic pancreatitis

Background: Chronic pancreatitis is a chronic inflammatory disease, characterised by irreversible, progressive destruction of pancreatic tissue, with progressive fibrosis of pancreas, leading to progressive loss of both exocrine and endocrine function. Chronic pancreatitis is characterised by the patient complaining of relentless pain abdomen with its radiation to the back, the history of persistent vomiting, which forces the patient to take. The surgical procedure can be carried out either via open approach or laparoscopically. The purpose of this thesis is to study the various methods of how surgical management can be provided to the patients and to compare the outcomes of these methods in terms of the length of the patient’s hospital stays and various intra op and post op complications. Methods: A total of 50 patients suffering from chronic pancreatitis undergoing elective pancreaticojejunostomy in Grant government medical college, Mumbai during the time period of October 2020 to September 2022 were included in this prospective cohort study. Results: The mean age of the study population was 36.6 years, and significant improvement was seen in laparoscopic method with mean blood loss of 104 ml, initiation of enteral nutrition of 4 days and average length of hospital stay being 8 days. Conclusions: This work significantly advances our understanding of various operative techniques of pancreatojejunostomy laparoscopic and open. This study aims to study the various advantages and disadvantages of one technique over the other.

OGBN P32 Outcomes of patient with Biliary Dyskinesia undergoing laparoscopic cholecystectomy - A multicentre cohort study

Abstract Background Biliary dyskinesia (BD) is a benign disorder characterized by recurrent episodes of biliary pain in the absence of gallstones on ultrasound, normal liver function tests and an ejection fraction (EF) of &amp;lt;35% on hepatobiliary iminodiacetic acid (HIDA) scan. Laparoscopic cholecystectomy (LC) remains the only known effective treatment for BD. However, many surgeons are reluctant to offer LC in such patients due to the fear of non-resolution of symptoms. Our aim was to analyse the outcome of patients who underwent LC for BD in terms of resolution of the biliary symptoms. Methods Multicentre retrospective cohort study of patients who have BD proven on HIDA scan from January 2015 to December 2022. BD was defined as EF ≤35% on HIDA scan. Those with EF ≤35% but had evidence of gallstones, microlithiasis or post op leak were excluded from the study. Electronic case notes were reviewed for demographic details, duration of symptoms, body mass index (BMI), liver function test (LFT), radiological investigations, endoscopy report and histopathology results of cholecystectomy. Rome IV criteria of functional gastrointestinal (GI) disorders was used to confirm symptoms were biliary in origin. Results Of the 222 patients who had HIDA scan, 35 (15.7%) patients had BD. 26 (74.2%) were female and median age was 42 years (IQR 33-55). Median time from the onset of symptoms and HIDA scan was 18 months. 19 (54.2%) patients had LC preformed, 9 (25.7%) were discharged with decision of LC not required, 4 (11.4 %) had no further review and 2 (5.7%) still having LC under consideration. Histopathology of LC was, chronic inflammation in 10 (52.6%), cholesterosis in 3 (15.8%) and 4 (20.1%) had normal gallbladder. 13 (68.4%) patients who underwent LC were symptom free 12 months post-surgery. Conclusions BD although painful and potentially lifestyle limiting, does not progress to more serious consequences if untreated. Diagnosis is usually difficult, and patients go through extensive investigations before they have HIDA scan. LC improves the symptoms in two thirds of patients and should be offered to all patients with BD with appropriate counselling.

Thromboelastography (TEG) parameters as potential predictors of malignancy and tumor progression in colorectal cancer

PurposeThe purpose of this study was to investigate the use of thromboelastography (TEG) in patients with colorectal cancer and to examine whether the TEG parameters can be used as potential markers for disease screening and prediction of disease severity.MethodsOne-hundred fifteen healthy controls (HC), 43 patients with benign adenoma (BA), and 387 patients with colorectal cancers (CRC) were included in the study. TEG parameters (reaction time, R; clot kinetics, K; alpha angle, α-angle; maximum amplitude, MA), conventional laboratory parameters, and clinical information were collected and analyzed among the HC, BA, and CRC groups. Receiver operating characteristics (ROC) were used for differential analysis. The correlation between TEG parameters and pathological information of CRC (differentiation degree, vaso-nerve infiltration, TNM stage) was analyzed. The differences in TEG parameters at different stages of disease and pre-/post operation were compared.ResultsShorter K and higher α-angle/MA were found in patients with CRC compared with HC and BA (P < 0.001). TEG parameters demonstrated moderate diagnostic value (distinguish CRC from HC + BA: K-AUC = 0.693, α-angle-AUC = 0.687, MA-AUC = 0.700) in CRC but did not outperform traditional laboratory parameters. TEG hypercoagulability was closely associated with tumor markers (carcinoma embryonic antigen and carbohydrate antigen 19–9) and pathological information (differentiation degree, vaso-nerve infiltration, and TNM stage) (P < 0.05). Trend analysis showed that K decreased, but α-angle/MA increased gradually as the tumor progressed (P < 0.001). K- and α-angle showed slightly better sensitivity in predicting advanced tumors compared to traditional laboratory parameters. In CRC patients, 3–6 months after tumor resection, K [from 1.8 (1.5, 2.3) to 1.9 (1.6, 2.6)], α-angle [from 65.3 (59.0, 68.6) to 63.7 (56.6, 68.5)], and MA [from 61.0 (58.2, 66.0) to 58.9 (55.8, 61.3)] exhibited modest improvements compared to their preoperative values (P < 0.05).ConclusionTEG parameters possess moderate diagnostic value in CRC diagnosis and predicting advanced tumors, and they are closely linked to surgical interventions. Although TEG parameters do not significantly outperform traditional laboratory parameters, they still hold promise as potential alternative indicators in CRC patients.

RADIOLOGICAL AND CLINICAL OUTCOMES IN ADOLESCENT IDIOPATHIC SCOLIOSIS CORRECTIVE FUSION SURGERY

Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spine characterized by a Cobb angle of at least 10 degrees. The goal of surgery is to not only prevent progression but restore sagittal and coronal balance, protecting cardiopulmonary function and improving cosmesis.We reviewed the impact of deformity correction surgery in terms of radiology and patient reported outcome(PROMs).The senior authors prospectively maintained database from 2003 –2022 was retrospectively analysed in terms of pre- and post-operative patient reported outcome measures (SRS 22) as well as radiological parameters.44 patients with AIS were identified with pre and post op PROMS. The average age at surgery was 15yrs with 84% female. 38% had a Lenke 1 curve and 3 patients had Lenke 6 curves. 73% had posterior surgery.There was a total improvement in SRS 22 scores by 7.8%. Patients reported significant satisfaction with treatment 4.8/5 and improvement in self-image with a change of 0.4 (p&lt;0.001). However, no difference in function, pain and mental health were recorded.Overall, proximal thoracic (PT) curves improved from 24 degrees to 11 degrees (p&lt;0.001), Main thoracic (MT) curve 55 degrees to 19 degrees and Thoracolumbar/Lumbar curves (TL/L) 45 degreesto 11 degrees. Pre-operative flexibility and post-operative correction were 0.40 and 0.41 respectively for PT curve. MT was 0.32 and 0.67. That for TL/L was 0.57 and 0.71 respectively.Surgery yields significant main curve correction correlating with high patient reported satisfaction rate. Although total SRS 22 score yielded 7.8% improvement, sub-analysis of self-image showed the most significant improvement.

Abstract 12344: Effect of Valved versus Non-Valved Conduits in Norwood Procedure on Ventricular Size and Function in Stage I Palliation for Hypoplastic Left Heart Syndrome

Background: Mortality in the interstage period remains high in hypoplastic left heart syndrome (HLHS) after introduction of the right ventricle (RV) to pulmonary artery conduit to the Norwood procedure. Prior studies have not shown long term survival benefit with conduits, possibly due to regurgitation and volume load, which may cause decreased RV function. Valved conduits (VC) were introduced more recently to address these limitations. Hypothesis: The goal of the study was to assess differences in RV size and function during the interstage period between patients undergoing Norwood procedure with valved versus non-valved conduits (NVC). We hypothesized that patients with VC would have smaller increases in RV size and improved function compared to those with NVC. Methods: Twenty-five consecutive neonates with HLHS who underwent Norwood procedure with VC were compared to 25 consecutive neonates who underwent Norwood with NVC from 2013 and 2022. Primary outcomes were RV size measured by end diastolic area (EDA) on 4-chamber images and function measured by RV fractional area change and global longitudinal strain. Results: Most patients with VC (96%) did not develop more than mild conduit regurgitation. There was no difference in EDA increase one month post op between groups, but there was a significantly smaller increase in EDA pre-Glenn compared to baseline in the VC group (Table 1). Functional measures were not significantly different during follow up. There was no difference in interstage cardiac events or mortality. Conclusions: Patients with VC at time of Norwood had smaller increases in ventricular size compared to those with NVC, but there were no differences in functional parameters during follow up. It is possible decreased volume load will have a beneficial long term effect on the immature myocardium of infants with HLHS. Larger studies are needed to further examine the hemodynamic benefits of VC in the interstage period and throughout the stages of palliation.

Assessment of open rhinoplasty in correction of secondary nasal deformities associated with congenital anomalies in maxillofacial region

Purpose: Nasal deformities associated with cleft lip are one of the most difficult nose correction procedures. This study aims at correction of the nasal deformity that occurred after the initial repair of the lip, which was done at an early age, and achieving the best possible results aesthetically and functionally. Methods: The sample included patients presenting at the department of oral and maxillofacial surgery in Hospital between 2017-2018. We applied open rhinoplasty technique to correct nasal deformity according to a specific protocol. One year post operation, we analyzed clinical images before and after surgery and compared the results with the ideal normative values within society. Functional results were evaluated and the level of satisfaction of patients aesthetically was determined. Results: 10 patients aged between 16-35 years old were included in our study. The results showed improvement in the aesthetic aspect of the nose through the correction of the emergence and rotation of the tip of the nose. This technique did not significantly affect the functional results. Therefore the functional results were satisfactory. This technique has achieved good and satisfying results aesthetically and functionally. Conclusion: The data collected from this study demonstrates that open rhinoplasty technique in nasal deformities is effective in aesthetic improvement and it presents satisfactory results at the functional level.

Comparison of sleeve dissection vs plastibell circumcision in terms of operation time and post op complications - A prospective randomized controlled trial.

Objective: To compare sleeve dissection vs plastibell circumcision. Study Design: Randomized Control Trial. Setting: Department of Surgical Outpatient, Gulab Devi Hospital, Lahore. Period: Between July 2021 and July 2022. Material &amp; Methods: This study was conducted on 110 children of different ages who presented with uncircumcised phallus for circumcision. They were divided randomly for any of two methods: Sleeve dissection and Plastibell circumcision. The complications which were observed were: bleeding, incomplete circumcision, meatal stenosis and plastibell slippage. Results: A total of 110 boys (55 in each group) were operated for circumcision during the study period and were subjected to analysis. The mean age group of babies with plastibell was 2.25 ± 1.32 months as compared to sleeve dissection 2.87 ± 1.67 months and P-Value was found to be (0.034). The mean procedural time of babies with plastibell was 9.94 ± 3.22 minutes as compared to sleeve dissection 13.1 ± 3.07 minutes and P-Value was obtained as (0.000). Overall complication rate was 10.9% in plastibell technique while 14.5% complication rate was present in sleeve dissection technique with a P-value (0.388). Conclusion: As Plastibell circumcision has less rate of complication so Plastibell circumcision is considered safer and less time consuming as compared to Sleeve dissection circumcision.

Evaluation of the Efficacy of Intraperitoneal Instillation of Ropivacaine with Dexmedetomidine Versus Ropivacaine with Ketamine for Post Operative Pain Relief following Laparoscopic Cholecystectomy: A Randomized Controlled Study

Background: Adjuvants are added to intraperitoneal local anesthetics to prolong analgesia however no study compares Dexmedetomiditine with Ketamine as adjuvant to Ropivacaine for laparoscopic cholecystectomy.&#x0D; To compare efficacy of intraperitoneal instillation of Ropivacine with Dexmedetomidine versus Ropivacaine with Ketamine for postoperative pain relief following laparoscopic cholecystectomy.&#x0D; Methods: Sixty patients ASA I and ASA II undergoing laparoscopic cholecystectomy were randomly allocated in three groups and received Ropivacaine 0.2 % (group R), Ropivacaine 0.2 % alongwith Dexmedetomidine 0.7 micogrms/ kg (group RD) and Ropivacaine with Ketamine 0.5 mg/kg (group RK) to a total volume of 40ml.The primary outcome measured was time to request of rescue analgesia while secondary outcomes were post op numeric rating scale, total dose of rescue analgesia required in 24 hours and haemodynamic parameters in postoperative period.&#x0D; Results: The median time to request of rescue analgesia was shortest in R group 55 [42.5-70] minutes followed by RK group 60 [50.50-72.50] and maximum in the group RD the time being 900 [86.25 -1440] minutes while haemodynamics remained stable in all the groups. Similar findings were seen for total demand of analgesia in 24 hours as well as NRS scale both static and dynamic which was measured periodically in the first 24 hours.&#x0D; Conclusion: Dexmedetomiditine 0.7 micrograms per kg when used as adjuvant with Ropivacine is effective combination that prolongs duration than Ropivacaine alone or when used with Ketamine 0.5 mg per kg body weight however total dose of rescue analgesia was significantly less in Ketamine group compared to Ropivacine alone and least when Dexmedetomiditine is used as adjuvant.

Untargeted Metabolomic Study of Lung Cancer Patients after Surgery with Curative Intent.

Lung cancer (LC) is a leading cause of mortality, claiming more than 1.8 million deaths per year worldwide. Surgery is one of the most effective treatments when the disease is in its early stages. The study of metabolic alterations after surgical intervention with curative intent could be used to assess the response to treatment or the detection of cancer recurrence. In this study, we have evaluated the metabolomic profile of serum samples (n = 110) from preoperative (PRE) and postoperative (POST) LC patients collected at two different time points (1 month, A; 3-6 months, B) with respect to healthy people. An untargeted metabolomic platform based on reversed phase (RP) and hydrophilic interaction chromatography (HILIC), using ultra-high performance liquid chromatography (UHPLC) and mass spectrometry (MS), was applied (MassIVE ID MSV000092213). Twenty-two altered metabolites were annotated by comparing all the different studied groups. DG(14,0/22:1), stearamide, proline, and E,e-carotene-3,3'-dione were found altered in PRE, and their levels returned to those of a baseline control group 3-6 months after surgery. Furthermore, 3-galactosyllactose levels remained altered after intervention in some patients. This study provides unique insights into the metabolic profiles of LC patients after surgery at two different time points by combining complementary analytical methods.

Visual Outcomes of Cataract Surgery at the Eye Foundation Community Hospital in Nigeria

Aims: To determine the visual outcome of cataract surgeries postoperatively at first day, one and three months. &#x0D; Study Design: Retrospective, case series study.&#x0D; Place and Duration of Study: Eye Foundation Community Hospital, Ilese-Ijebu-Imushin, Ogun state of Nigeria. 3-month duration from June 1st 2019 to August 31st 2019.&#x0D; Methodology: All patients 18 years and above operated for cataract surgery without comorbidity were included in the study. Type of surgery done were manual small incision cataract surgery (MSICS) and phacoemulsification. Patient data were entered into excel spread sheet created for the study. From where it was cleaned up and exported in to statistical package for social sciences 20. Visual outcome was assessed on the first day, first month and at third month post operatively. Snellen visual acuity was converted to log MAR. P value = 0.05 is determined as statistically significant. &#x0D; Results: Two hundred and fifty (250) patients or eyes were analysed in this study. Two hundred and twenty patients (88%) had MSICS, 30 (12%) had phacoemulsification. Preoperatively, majority (150, 60%) presented with visual acuity less than 3/60 followed by patients with visual acuity between 6/18 to 6/60 (76, 30.4%). Nineteen patients (7.6%) had visual acuity of 6/18 or better. Mean preoperative log MAR was 1.6 ± 0.8 (equivalent to count finger). 3-month post op, two hundred and fourteen (85.6%) had uncorrected visual acuity of 6/18 or better while 231 patients (92.4%) had best corrected (with pinhole) visual acuity of 6/18 or better. (P=0.004 and 0.038 respectively). &#x0D; Conclusion: There is an appreciable improvement in the visual outcome following cataract surgery.

Pulmonary Hypertension in Pregnancy: A Case Report

Background: Pulmonary Hypertension (PH) is a disease characterized by distressing symptoms and decreased life expectancy due to the narrowing of the blood vessels of the lungs, which often leads to right heart failure. The prevalence of PH in women is 97 cases per million, with 64% of the main causes of PH in pregnancy congenital heart defects, resulting in a very high maternal and fetal mortality rate. Case Report: A 38-year-old G4P1A2 31-week gestational age complained of shortness of breath for 5 days. Physical examination revealed blood pressure was 107/62 mmHg, Heart Rate was 98 beats per minute, respiration 40x per minute, and SpO2 88% with NRM 10 Lpm. The heart examination obtained heart sound I -II regular and a systolic murmur was heard between the left 2nd ribs. Abdominal examination was single fetus, intrauterine, breech presentation, His (+), fetal heart rate 160 beats per minute. vaginal toucher 2 cm in labour. ultrasound examination singles fetal, transverse lies, with an estimated fetal weight of 1600 grams. Echocardiography finding: ASD II L to R shunt with LV EF 60%(T), 62% (S), dilated RA-RV, TR severe, MR mild, High Probability of Pulmonary Hypertension. The patient was diagnosed with Dyspnea, Pulmonary edema caused by cardiogenic, ASD II, High probability of PH, NYHA IV, and Breech presentation in labor. Decided to perform a caesarian section and sterilization. The Male baby was born with 1570 grams Apgar Score 3-5-7. post operation patient was admitted to ICU. Twelve hours after the operation the patient had decreased control and became a PH crisis then the patient was declared dead. Results: The death of the patient, in this case, was caused by cardiogenic shock due to Pulmonary Hypertension Crisis. Conclusion: Early diagnosis along with collaborative and comprehensive management of pulmonary hypertension is needed for good maternal and fetal outcomes. Keywords: pulmonary hypertension, pregnancy, heart disease. Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sebelas Maret University / Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126, Central Java, Indonesia. Email: trisulo.wasyanto@staff.uns.ac.id. Mobile: +62811294225.