Postoperative Day In Groups Research Articles

Can silver nanoparticles stabilized by Fenugreek (Trigonella foenm -graecum) improve tibial bone defects repair in rabbits? A preliminary study

Background: A fracture is considered a medical emergency leading to considerable complications. Aim: This study aimed to describe the accelerating action of Ag-NPs-FG on fracture healing in rabbits. Methods: AgNPs were reduced with FG, loaded into a starch gel base, and investigated for their morphology, size, and charge. Four equal groups were randomly formed of 40 adult male rabbits. A 3.5 mm diameter bone defect was created at the proximal metaphysis the right tibia in each rabbit. Groups 1 to 4 were injected with placebo saline, AgNPs-FG, plain gel, and FG-gel at the bone defect zone, respectively. The healing was assessed for 8 weeks postoperatively based on the radiographic, bone turnover markers, and histopathological examinations. Results: The AgNPs-FG was obtained as a faint reddish color, spherical in shape, with an absorbance of 423 nm, a size of 118.0±1.7 nm, and a surface charge of -7.8±0.518 mV. The prepared AgNPs-FG hydrogel was clear, translucent, and homogenous. The pH values were 6.55-6.5±0.2, the viscosity of 4000 and 1875 cPs, and spreadability of 1.6±0.14 and 2.0±0.15 for both FG and AgNPs-FG hydrogel, respectively. Radiographic union scale was significantly (p<0.05) improved in group 2 with significant (P < 0.05) increase of bone turnover markers was found in comparison to other treated groups. Histopathological examination revealed the formation of mature bone on the 28th postoperative day in groups 2 and 4. Conclusion: Colloidal nano-formulation of AgNPs-FG loaded hydrogel could be a promising formulation to accelerate rabbits' tibial bone healing process.

Efficacy of short-term splint immobilization in the treatment of pediatric discoid lateral meniscus after saucerization management.

There are no universal guidelines for rehabilitation after saucerization for children with discoid lateral meniscus. This study determined if short-term knee splint immobilization and delayed rehabilitation produces the same benefit as early rehabilitation after saucerization in children, in terms of knee function and pain intensity. A retrospective review was performed by categorizing patients into 2 groups depending on whether a splint immobilization was adopted postoperatively: for group A, rehabilitation began early without splint immobilization after surgery, and for group B, a knee splint was immobilized for 2 weeks. Numerical rating scale scores were collected in patients 1, 3, and 7 days, Lysholm scores were measured at 4 and 8 weeks postoperatively, and the gradual return to normal activities was documented. Forty-eight patients and 53 knees were included: group A had 30 patients with 31 knees, and group B had 18 patients with 22 knees. There was no improvement in numerical rating scale scores on the 1st (P=.519), 3rd (P=.421), and 7th (P=.295) postoperative days in group B. The Lysholm scores of group A (62.94 ± 8.68) was higher than that of group B (46.68 ± 9.82) measured 4 weeks following surgery, but there was no difference at 8 weeks (P=.237), and both groups had similar time to return to normal activities (P=.363). For discoid lateral meniscus patients who underwent isolated saucerization, short-term splint immobilization did not significantly help relieve postoperative pain. There was a comparable time-course for return to normal activities in both study groups.

Enhanced recovery after spinal surgery protocol versus conventional care in non- insulin diabetic patients: A prospective randomized trial

ABSTRACT Background Enhanced Recovery After Surgery (ERAS) approach was proven in many surgical specialties. This prospective, randomized, single-blinded trial was designed to assess the effectiveness of ERAS on quality of recovery (QOR) after surgery in non-insulin-dependent diabetic patients. Patients and methods 72 patients undergoing elective lumbar decompressive surgery were randomly allocated to one of two equal groups receiving either ERAS protocol in group E or conventional care in group C. QOR after surgery using QOR-40 score, pain score, perioperative opioid consumption, time to early ambulation, serum markers of stress response, length of stay and possible perioperative complications were recorded. Results QOR-40 scores were significantly greater in group E at PACU, first postoperative day and second postoperative day (P = 0.015, 0.041 and 0.048, respectively). VAS was significantly lower in group E in the first eight hours postoperative. Time to first postoperative analgesic requirement was significantly longer in group E (P = 0.0001). Intraoperative fentanyl and postoperative nalbuphine requirements were significantly less in group E (P = 0.001, and 0.0001, respectively). Time to early ambulation was significantly less in group E (P = 0.006). Both CRP and interleukin-6 were significantly less at the second postoperative day in group E (P = 0.001, and 0.017, respectively). There was insignificant difference among groups in length of hospital stay and intraoperative insulin requirements (P = 0.251, and 0.347, respectively). Conclusion In non-insulin diabetic patients, enhanced recovery after spinal surgery improved quality of recovery, lowered pain scores, reduced perioperative opioid consumption, allowed early ambulation and decreased stress response but not length of hospital stay.

Назогастральна декомпресія шлункової трубки у пацієнтів після лапароскопічної рукавної резекції шлунка

The aim of our study was to evaluate gastric decompression in patients after laparoscopy sleeve gastrectomy (LSG). We performed a retrospective analysis of the treatment of 64 patients with morbid obesity who underwent laparoscopy sleeve gastrectomy. 25 patients who have undergo LSG with a nasogastric tube placement composed group 1; in the other 39 patients, no nasogastric tube was placed (group 2). No statistical differences were observed between groups 1 and 2 regarding gender distribution, age, weight, body mass index, and excessive weight. Intraoperative blood loss (184 ± 85.1 vs. 164.1 ± 58.4 ml, respectively) and operative time (132.1 ± 24.5 vs. 120.8 ± 23.6 min, respectively) were comparable between the groups. A staple line leak once occurred on the 5th postoperative day in group 1 and no leak was observed in group 2 patients. The complication rate, mainly, tube-related otolaryngological complications, was higher in group 1. Postoperative hospital stay was significantly longer in group 1 vs. group 2 patients (8.9 ± 2.1 vs. 6.3 ± 1.7 days, respectively; t = 5.89). We conclude that routine placement of a nasogastric tube in LSG patients is not useful in reducing leak incidence.

A Comparative Evaluation of Post-operative Pain Management Using Erector Spinae Plane Block and Oblique Transverse Abdominis Plane Block in Patients Undergoing Laparoscopic Cholecystectomy.

Introduction Acute pain following laparoscopic surgeries interferes with the rehabilitation of the patient. Knowledge about the pain pathway from a particular area helps in blocking pain transmission at different sites. Ultrasonography (USG)-guided peripheral nerve blocks help in controlling pain better than non-steroidal anti-inflammatory drugs (NSAIDS) and opioids since they directly act by interrupting the pain pathway and interfere less with the physiology of the body. This study was planned with the objectives to evaluate the analgesic efficacy of USG-guided erector spinae plane block (ESPB)and oblique subcostal transversus abdominis plane (OSTAP) block in patients undergoing elective laparoscopic cholecystectomy, to compare the analgesic requirements in both groups, and to compare the VAS scores in both groups. Materials and methods A total of 138 patients were randomized into two groups, with 69 patients in each group, and received either bilateral ESP (group 'E') or bilateral OSTAP (group 'O'). Those in group E received the block at the T7 level, and those in group O received the block in the subcostal region, with 20 ml of 0.2% ropivacaine and 4 mg of dexamethasone. The procedures were done after securing the airway. The total analgesic requirement and visual analogue scale (VAS) scoring in the first 24 hours post-operatively were observed, along with intra-operative opioid consumption. The opioid requirement, block-related complications, and patient feedback regarding post-operative pain control were also assessed. The results were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 23.0 (IBM Corp., Armonk, NY). Continuous and categorical data were analyzed using appropriate statistical analysis. A p-value <0.05 was considered statistically significant. Results The VAS scores were significantly lower during the first post-operative day in group E than in group O. In group E, VAS scoring was less than 4 for the first 24 hours post-surgery. In group O, VAS scores remained greater than or equal to 4 after four hours post-surgery, thereby indicating that the patients required opioids. Only seven patients in group E received tramadol, compared to 62 patients in group O. The mean tramadol requirement of seven patients in group 'E' was 65.71 ± 26.3 mg, and the mean tramadol requirement of 62 patients was 114.56 ± 36.8 mg (p = 0.0012). The patients in group 'O' demanded tramadol significantly more times than those in group 'E'. Conclusion It was concluded that USG-guided ESP block provides better pain control and decreases consumption of opioids post-operatively than OSTAP block in patients undergoing laparoscopic cholecystectomy surgeries. The block was found to be safe with no adverse effects, therefore it can be a part of multimodal analgesia.

Temperature management of intraoperative cardiopulmonary bypass in valve replacement surgery: a retrospective analysis of the impact on postoperative organ function.

This study aimed to systematically analyze the effects of cardiopulmonary bypass (CPB) at different temperatures on the function of different organs in patients after heart valve replacement and to investigate its safety and feasibility. The data of 275 heart valve replacement surgery patients who underwent static suction compound anesthesia under CPB between February 2018 and October 2019 were retrospectively analyzed and divided into normothermic CPB anesthesia group (group 0), shallow hypothermic CPB anesthesia group (group 1), medium hypothermic CPB anesthesia group (group 2), and deep hypothermic CPB anesthesia group (group 3) according to the different intraoperative CPB temperatures. The basic preoperative conditions, cardiac resuscitation, number of defibrillations, postoperative ICU stay, postoperative hospital stay, and postoperative evaluation of different organ functions, such as heart, lung, and kidney functions, were analyzed and studied in each group. The comparison of preoperative and postoperative pulmonary artery pressure and left ventricular internal diameter (LVD) was statistically significant in each group (p < 0.05), and the postoperative pulmonary function pressure was statistically significant in group 0 compared with groups 1 and 2 (p < 0.05). The preoperative glomerular filtration rate (eGFR) and the eGFR on the first postoperative day were statistically significant in all the groups (p < 0.05), and the eGFR on the first postoperative day in groups 1 and 2 were statistically significant (p < 0.05). The control of appropriate temperature during CPB was associated with the recovery of organ function in patients after valve replacement. Intravenous compound general anesthesia with superficial hypothermic CPB might be more beneficial in recovering cardiac, pulmonary, and renal functions.

Insulin sensitivity and C-reactive protein levels after laparoscopic and open cholecystectomy - seven days follow-up

Introduction/Objective. The development of acute insulin resistance after surgery intervention is associated with the type and magnitude of operation and tissue injury. The aim of our study was to compare insulin sensitivity assessed by homeostatic model assessment of insulin resistance (HOMA-IR) and C-reactive protein (CRP) before and after laparoscopic and open cholecystectomy during seven days follow-up. Methods. In total, 92 patients were divided into two groups: laparoscopic cholecystectomy (Group 1) (n = 61) and open cholecystectomy (Group 2) (n = 31). Glucose, insulin and CRP levels were measured at day 0 and at postoperative days one, three and seven. Glucose, insulin and CRP were determined using commercial assay on Roche Cobas 6000 automated analyzer (Roche Diagnostics, Manheim, Germany). Results. There was no statistical difference between studied groups concerning age (p = 0.626), body mass index (p = 0.548), glucose (p = 0.947), insulin (p = 0.212), HOMA-IR (p = 0.390) and CRP (p = 0.546) at day 0. At day one, higher values of CRP were found in group 2 compared with group 1 (p = 0.046). At day three, significantly higher values of glucose and HOMA-IR were found in group 2 compared with group 1 (p = 0.025, p = 0.036, respectively). Conclusion. Increase in CRP precedes deterioration of insulin sensitivity measured by HOMA-IR after cholecystectomy. Impairment of insulin sensitivity was more pronounced at postoperative day three in group with open cholecystectomy. On the basis of our results, laparoscopic cholecystectomy induced less impairment in insulin sensitivity and lower inflammatory response.

A Clinical Study on the Surgical Management of Third Eyelid Gland Prolapse in Dogs

Background: The current study was undertaken to evaluate the clinical efficacy of two different surgical methods for management of third eyelid gland prolapse in dogs. Methods: The study was conducted on 14 eyes of 11 dogs presented with third eyelid gland prolapse for surgical treatment. Two groups dogs were subjected to clinical and ophthalmic examination based on the surgical technique used i.e., Group I (n=8) in which modified Morgan’s pocket technique, Group II (n=6) in which modified orbital rim anchorage technique was used. Among the breeds brachycephalic dogs (54.54%, n=6) followed by mesocephalic dogs (45.45%, n=5). The modified Morgan’s pocket technique was adopted in 8 eyes of 7 dogs (1 bilateral, 6 unilateral) and the modified orbital rim anchorage technique was performed in 6 eyes of 4 dogs (2 bilateral, 2 unilateral). In Group I, the mean pre-operative Schirmer tear test value was 16.87±0.72 mm/min and in Group II, it was 17.33±0.67 mm/min, both values increased on 30th Post-operative day. Statistical analysis revealed that there was no significant difference between the two groups (p greater than 0.05), but there were significant differences within each group (p less than 0.05). The fluorescein dye test was repeated on 1st,7th,14th, 30th days post-operatively and found positive in the left eye of one dog with the reduced bilateral cherry eye on 7th post-operative day in group I. Third eyelid mobility was normal post-operatively in all the cases of group I. Whereas in group II, it is restricted in all the cases. Three cases regained normal contour by the 10th post-operative day whereas 5 cases by the 14th postoperative day in group I. In group II, 3 cases regained normal contour by 12th post-operative day and 3 cases regained by 14th post-operative day. One case in the group I tested positive for superficial corneal ulcer on the 7th post-operative day. One dog in group I had a recurrence after 45 days of repositioning. One dog in group II with reduced bilateral cherry eye had a recurrence in the left eye 30 days after surgery. Result: Present study, Modified Morgan’s pocket technique was considered superior over the modified orbital rim anchorage technique in view of technical feasibility and unrestricted third eyelid mobility.

A novel therapeutic approach for reducing postoperative inflammatory complications after impacted mandibular third molar removal.

Background:This study was designed to compare effect of combined use of dexamethasone and honey versus each agent alone in controlling complications associated with removal of impacted mandibular third molar.Methods:This randomized clinical study included patients suffering from impacted mandibular wisdom teeth. Patients were divided randomly into 4 groups. Group I, control, group II, received dexamethasone injection preoperatively, group III, received honey locally in the wound after extraction, and group IV, received dexamethasone injection preoperatively and topical honey application. All patients were evaluated preoperatively and postoperatively to assess facial edema, interincisal distance, pain, and total analgesic dose used.Results:Significant edema developed in group I than other groups and improved significantly in group II and III on seventh postoperative day, and tenth postoperative day in group I. Insignificant edema developed in group IV. Significant decrease in interincisal distance occurred in all groups on third postoperative day that improved significantly on seventh postoperative days in all groups except group I, it improved on tenth postoperative day. Pain was significantly minimum in group IV than other groups and its maximum degree was in group I.Conclusion:Both dexamethasone and honey are an effective way of minimizing swelling, pain, and trismus after removal of impacted lower third molars. Both agents either alone or in combination provide simple, safe, painless, and cost-effective method to eliminate postoperative discomfort. However, dexamethasone or honey can decrease complications related to surgical extraction of mandibular third molar, the simultaneous application of both agents is more effective method in this regard.

Anastomotic Urethroplasty with Double Layer Continuous Running Suture Re-Anastomosis Versus Interrupted Suture Re-Anastomosis for Infective Bulbar Urethral Strictures: A Prospective Randomised Trial.

Introduction: The objective of this study was to compare a double-layer running suture re-anastomosis urethral stricture repair with early catheter removal to the conventional interrupted suture re-anastomosis after excision of a bulbar urethral stricture. Methods: A consecutive series of patients with bulbar urethral stricture were enrolled in the study. The patients were randomized into two groups according to an odd/even serial number distribution. Patients’ medical records were analyzed for demographics, stricture characteristics, and lower urinary tract obstructive symptoms. The outcomes were based on the presence/absence of obstructive voiding symptoms, and retrograde urethrography (RGU) performed on the first post-operative day in Group 1 and in both groups (Groups 1 and 2) at six weeks after surgery. Flexible urethroscopy was only performed on specific cases where RGU was unclear both pre- and post-operatively or when clinical recurrence was suspected. The minimum follow-up (FU) was 18 months. Success was defined as no need for subsequent dilatation, direct vision internal urethrotomy (DVIU), or urethroplasty. Results: A total of thirty-six patients with a mean age of 45 years (range 20 to 69 years) with bulbar urethral stricture were included in this study. Group 1 and Group 2 included 19 and 17 patients, respectively. Two patients were lost during randomization and subsequently to FU. The average stricture lengths were comparable between the two groups according to the retrograde urethrogram: 1.20 cm (range 0.6 to 2) in Group 1 and 1.27 cm (range 0.5 to 2.4) in Group 2, respectively (p = 0.631). The success rate for Group 1 was 90% after a mean follow-up of thirty-six months (range 20 to 40), which was clinically significant compared to the 71% in Group 2 after a mean FU of thirty-three months (range 19 to 40; p = 0.0218; 95% CI: 0.462–41.5766). Conclusions: Anastomotic urethroplasty (AR) performed with a double layer re-anastomosis had a cure rate comparable to the conventional anastomosis with interrupted sutures after a follow-up of eighteen months and longer. The urethral catheter can be safely removed within twenty-four hours after the excision of stricture and double-layer re-anastomosis.

Clinical Evaluation Osteogenic Properties of Demineralised Bone Matrix (DBM) Xenograft in Femur Fracture in Dogs

Background: Fracture is one of the common problems encountered in dogs. Fracture healing most of the times results into complications like delayed union, mal-union and non-union. To deal with these complications bone grafting is an important technique lying with clinicians. Methods: The present study was conducted on 14 clinical cases of dogs with femur fracture. After preliminary examination the dogs were randomly divided into two groups. In group A (n=8) fractures were managed by intramedullary pinning and in group B (n=6), fractures were managed by IM pinning and demineralised bone matrix (DBM) xenograft implantation at the fracture site. The efficacy of the treatment was assessed on the basis of clinical, hemato-biochemical and radiographic observation on day 0 and on 7th, 15th, 30th, 45th and 60th post-operative days. Result: The pain, lameness and weight bearing scores on the affected limb showed non-significant (P greater than 0.05) variations between the two groups on different post-operative intervals. The hematological parameters also varied non-significantly (P greater than 0.05) between the two groups. A significant (P less than 0.05) increase in the serum alkaline phosphatase values was observed upto 30th post-operative day in group B animals as compared to group A animals and thereafter it gradually decreases and return to normal level on 60th post-operative day in both the groups. Radiographic scores were better in group B dogs. Early radiographic signs of fracture healing were observed in group B dogs than group A dogs. No any graft related complications were observed during the study.

Methylprednisolone and Hyaluronic Acid versus Each Agent Alone to Control Complication of Impacted Wisdom Removal.

Introduction Extraction of impacted molars is commonest operation in oral cavity and associated with complications disturbing patient's quality of life. Hyaluronic acid is a nontoxic agent recommended for wound management due to its anti-inflammatory effects. Also, methylprednisolone sodium is used to reduce pain and edema. The aim this study was to compare the effect of combined use of corticosteroid and hyaluronic acid versus each agent alone in controlling postextraction complications of impacted mandibular third molars. Materials and Methods This prospective randomized trial included patients suffering from impacted mandibular third molar. Patients were divided into four groups. Group I, control, and group II received methylprednisolone sodium succinate injection preoperatively, group III received hyaluronic acid applied in extraction socket, and group IV received preoperative methylprednisolone sodium succinate injection and topical hyaluronic acid in the socket. All patients were evaluated preoperatively and postoperative day to assess swelling, pain, mouth opening, and total analgesic dose. Results Group IV showed insignificant edema along the study period, and other groups showed significant edema on third postoperative day that improved on seventh postoperative in group II and III and tenth postoperative day in group I. Significant decreased mouth opening occurred on second postoperative day in group I, while in other groups, it occurred in third postoperative day. Significant improvement occurred on seventh postoperative day in all groups except in group I which occurred on tenth postoperative day. There was less pain and analgesic dose reported in group IV than other groups. Conclusion Combined use of methylprednisolone sodium succinate and hyaluronic acid significantly decrease postoperative complications than using each agent alone.

Comparative Evaluation of Preoperative Local and Systemic Intramuscular Administration of Dexamethasone Injection in Mandibular Third Molar Impaction Surgery

Statement of the problemThe study aimed to evaluate the effect of systemic and local intramuscular administration of dexamethasone on pain and mouth opening and postoperative swelling following mandibular third molar impaction surgery and to verify its effect on functional outcome. Materials and methodsThe study comprised of 36 cases graded as moderately difficult according to the Pederson difficulty index, further subdivided equally into 2 groups. In Group I, 2ml of 8mg dexamethasone was injected intramuscularly in the masseter muscle 2 hours prior to surgery. In Group 2, a 2ml injection of 8mg dexamethasone was injected in the deltoid muscle 2 hours prior to surgery (Figure 1). All the patients were evaluated for pain, mouth opening, and postoperative swelling at first, third, and seventh postoperative day, and intergroup comparisons were made for both groups. Methods of data analysisStatistical analysis was performed using SPSS software (IBM Corp, Armonk, NY). Data were presented as mean and appropriate. Statistical tests were applied. ResultsBoth groups showed improvement in mouth opening with the resolution of pain and postoperative swelling in the last follow-up. However, Group I showed a considerable reduction in swelling and pain with less trismus when compared with Group II at all intervals (Table 1). Outcomes dataFor Group I, the mean changes in mouth opening were noted to be 26.94±1.06 mm, 31.05±1.03mm, 36.87±0.72, respectively at first, third, and seventh postoperative day from the initial mean mouth opening of 37.67±1.89mm (Figure 2). Mean changes in mouth opening for patients in Group II were noted to be 23.06±0.99mm, 27.88±0.99, and 35.05±0.63, respectively at first, third, and seventh postoperative day (Figure 4). The highest pain score was seen at first postoperative day after surgery (7.15±1.08 in Group I; 8.5±1.44 in Group II). The mean score for pain obtained was 5.11±1.01; 1.01±0.82, and 5.38±1.37; 2.069±1.12 for Group I and Group II at the end of postoperative third and seventh day, respectively. The average postoperative swelling for Group I was 5.83±1.18mm, 4.73±0.83mm, and 4.47±0.58mm, respectively, at first, third, and seventh postoperative day. Similarly, the average postoperative swelling was 6.93±1.72mm, 6.05±0.94mm, and 4.64±0.81mm at first, third, and seventh postoperative day in Group II. ConclusionLocal intramuscular injection of dexamethasone through intra-buccal approach can be a simple, useful adjunct in the surgical treatment of impacted third molars for minimizing swelling, trismus, and pain following surgical extraction.

Spinal anesthesia during foot surgery

Purpose of the study. To improve the results of treatment of patients with diabetic foot syndrome by substantiating the optimal type of spinal anesthesia during foot surgery.&#x0D; Materials and methods. 70 patients undergoing treatment in the department of purulent surgery were examined. Patient groups: Group 1 – patients operated on under conditions of unilateral spinal anesthesia; Group 2 – patients operated on under traditional spinal anesthesia.&#x0D; Research methods. Assessment of the level and intensity of pain, concentration of catecholamines in urine in the first postoperative day, monitoring of blood pressure (BP), heart rate (HR), peripheral blood oxygen saturation (SpO2), Doppler scanning of peripheral blood flow in the foot, skin temperature integument of the foot during anesthesia and statistical.&#x0D; Results. In group 1, pain sensitivity during movement of the lower limb after anesthesia was 21% less pronounced than in group 2. In group 2, the heart rate decreased by 4,8% during anesthesia. The SpO2 level 20 minutes after the onset of anesthesia decreased in group 2 by 5,1% compared to group 1. The mean arterial pressure in group 2 decreased during anesthesia by 9,9%, in contrast to patients in group 1. After performing anesthesia, systolic blood pressure in the toe increased by 18,3%, and the temperature of the skin on the lateral surface of the leg increased by 3,7%. The concentration of adrenaline in the daily portion of urine in the next postoperative day in group 2 is 35,1% higher than in group 1.&#x0D; Conclusions. During anesthesia, the blood pressure, heart rate and SpO2 in group 1 did not change in comparison with the initial values (on the operating table before anesthesia). After anesthesia, an improvement in peripheral blood flow in the operated limb was noted. Unilateral spinal anesthesia, in comparison with traditional spinal anesthesia, has a positive effect on the stress response of the patient's body to surgery.

Retrospective Comparative Study of the Incidence of Hypocalcaemia in Total Thyroidectomy between Ain-Shams University as a Referral Center and Damanhour Medical National Institute

Abstract Background: Post-operative hypocalcaemia is one of the most serious complications of total thyroidectomy with variable degrees of morbidity. Aim of Study: The aim of this study was to to compare the incidenceandto examine several preoperative and imme-diate post-operative factorsfor development of hypocalcaemia after total thyroidectomy in patients who underwent total thyroidectomy in Ain-Shams University and Damanhour Medical National Institute. Patients and Methods: This retrospective study was conducted in Ain-Shams University Hospital and Damanhour Medical National Institute in the period between December 2015 and December 2019. It included 62 patients who under-went total thyroidectomy. The data was collected from patients' files in the Record Department. Results: There were 52 female and 10 male patients. The mean age was 38 years. Multi-nodular goiter was the most common indication of total thyroidectomy. The mean pre-operative serum Ca was 8.1mg/dl in group A and 8.3mg/dl in group B. 3 (9.7%) patients in group A and 7 (22.5%) in group B developed post-operative hypocalcemia. The highest fre-quency of transient hypocalcaemia was on 2nd post-operative day in group A and on 0 day in group B. There was only one patient 3.2% who required calcium and vitamin D supplement for more than six months. Conclusion: Hypocalcaemia is one of the major concerns following total thyroidectomy that can be prevented by me-ticulous surgical technique, identification and preservation of parathyroid glands and its vascularity. Post-operative monitoring of serum calcium & early treatment can prevent significant morbidity.

Comparison of Outcome of Bipolar Electrocautery versus Harmonic Scalpel in the Management of Third and Fourth Degree Hemorrhoids

Objective: To compare the outcome of bipolar electrocautery versus harmonic scalpel in the management of third degree hemorrhoids.&#x0D; Methodology: This is a comparative study performed at Different Private Clinics of Karachi from the duration of January 2020 to June 2020. Patients with symptomatic grade III hemorrhoids and grade IV hemorrhoids were randomly divided into two groups. . Either group had 64 patients. One group underwent hemorrhoidectomy using bipolar electrocautery (Group A), other group underwent hemorrhoidectomy using harmonic scalpel hemorrhoidectomy (Group B).&#x0D; Results: The total number of patients was 128 with 64 in either group. The mean operating time in group A was 22 ± 4.7 minutes, while that in group B was 35 ± 2.2 minutes. The mean duration of hospital stay among group A was 1.7 ± 0.5 days while among group B patients was 2.1 ± 1.2 days. Mean VAS score for pain at first post-operative day in group A patients was 7 ± 0.6 days while mean VAS score for pain among group B patients was 8.5 ± .2 days.&#x0D; Conclusion: Our study concludes that harmonic scalpel hemorrhoidectomy offers better post-operative patient satisfaction score as compared to bipolar diathermy. No significant difference in hospital stay was found. The number of patients with post-operative urinary retention were more in harmonic scalpel group while in diathermy group, more patients had post-operative hemorrhage.

Efficacy of Incentive Spirometry in Expiratory Muscle Training Following Abdominal Surgery

BACKGROUND: Incentive spirometry is a device which helps in the improvement of lung function after abdominal surgery. It motivates the patients by giving visual feedback about their lung volumes. It is one of the less expensive and user-friendlydevices. Incentive spirometry facilitates the patients to take slow deep breath and there by producing a sustained maximal inspiration (SMI) that mainly helps in the prevention of atelectasis. But it is a common practice for physiotherapists to teach the patients to do expiratory exercise by reversing the incentive spirometer. The simplest way to measure the maximal inspiratory and expiratory pressures is by respiratory pressure meter in cmH2o. OBJECTIVE: To find out the efficacy of incentive spirometer in improving the expiratory muscle strength following abdominal surgery. METHODOLOGY: Quasi-Experimental study. PROCEDURE: 30 subjects were conveniently selected based on inclusion and exclusion criteria and allotted to group A (n=15) and group B (n= 15). Both groups were trained for inspiratory muscle and group A was also trained for expiratory muscle using incentive spirometry. OUTCOME MEASURES: Maximal inspiratory pressure (MIP), Maximal expiratory pressure (MEP). RESULT: This study shows that the mean MIP value have improved from 2nd to 7th postoperative day, but it is not statistically significant (P&gt;0.05). The mean MEP values shows statistically significant (P&lt;0.05) improvement from second to 7th postoperative day in group A when compared to group B. CONCLUSION:This study concludes that there is significant improvement in the expiratory muscle strength along with inspiratory muscle strength by training with the Incentive spirometry in the upside down and upright positions respectively.

Preservation of the left ventricle contractility while performing of the combined mitral-aortal failure correction

Objective. The studying of possibilities of procedures, directed on preservation of left ventricle while doing a mitral valve prosthesis in operative correction of combined mitral-aortal failure.&#x0D; Materials and methods. In the analysis the results of surgical treatment of 340 patients, suffering combined mitral-aortal failure and a left-sided ventriculomegaly, who were operated in N. M. Amosov National Institute of Cardio-Vascular Surgery NAMS of Ukraine, were included. In all the patients a mitral valve prosthesis in combination with the aortal failure correction (prosthesis) was performed. In 83 patients the mitral valve prosthesis with complete preservation of posterior flap (Group A) was conducted, in 97 - with translocation of chords with papillar muscles of anterior flap in combination with posterior flap (Group B), in 160 - without preservation of the undervalvular apparatus (Group C). Definitely-systolic index of left ventricle in Groups A, B and C have constituted (87.4 ± 10.5), (88.4 ± 11.1) and (89.4 ± 11.5) ml/m2 accordingly; left ventricular ejection fraction have constituted 0.51 ± 0.03, 0.5 ± 0.03 and 0.51 ± 0.03 accordingly.&#x0D; Results. In Group A on a hospital stage 2 (2.5%) patients died, in Group B - 2 (2.1%) patients, and in Group C - 5 (3.1%). Definitely-systolic index of left ventricle on the tenth-eleventh postoperative day in Groups A, B and C have constituted (74.3 ± 9.8), (69.4 ± 8.2) and (76.4 ± 9.2) ml/m2 accordingly, while in late follow-up period - (55.4 ± 8.4), (49.4 ± 7.2) and (62.4 ± 7.2) ml/m2 accordingly. The left ventricle ejection fraction on the tenth-eleventh postoperative day in Groups A, B and C have constituted 0.54 ± 0.03, 0.55 ± 0.03 and 0.53 ± 0.03 accordingly, and in late follow-up period - 0.55 ± 0.03, 0.57 ± 0.03 and 0.54 ± 0.03 accordingly.&#x0D; Conclusion. In the left-sided ventriculomegaly and combined mitral-aortal failure the a maximal preservation of undervalvular structures of mitral valve, while its prosthesis performance, constitutes a serious component, which leads to improvement of morphometric indices of left ventricle on hospital stage and in follow-up period as well.

Efficacy of transcatheter arterial chemoembolization combined with sorafenib in inhibiting tumor angiogenesis in a rabbit VX2 liver cancer model

BackgroundThe aim of this study was to investigate the effects of transcatheter arterial chemoembolization (TACE) combined with sorafenib on tumor angiogenesis. Materials and methodsThirty New Zealand rabbit VX2 liver cancer model animals were divided into five groups, which received either normal saline (A), TACE (B), sorafenib (C), sorafenib followed by TACE (D), or TACE followed by sorafenib (E). Serum vascular endothelial growth factor (VEGF) levels were measured before and after TACE via ELISA. Immunohistochemistry for CD34 was performed to evaluate microvessel density (MVD), and ultrasonography was used to access tumor volume. ResultsVEGF levels declined in group C but increased significantly on the 3rd post-operative day in groups B, D, and E. Levels decreased after the 7th post-operative day. Peak levels were significantly lower in group D than in groups B and E. On the 14th post-operative day, VEGF levels were the lowest in group C, followed by those in groups D and B. MVD was the lowest in group C followed by that in group D and E, and was the highest in group B. Group D had the smallest tumor volume. HE staining of tumor tissues from group C showed apoptosis in a scattered patchy pattern, whereas in groups B, D, and E, large areas of tumor cell necrosis were visible. ConclusionTACE can up-regulate serum VEGF levels, which in turn accelerates the formation of new blood vessels. Thus, TACE combined with sorafenib inhibits VEGF and angiogenesis, and pre-operative administration of sorafenib has a more superior anti-angiogenic effect than post-operative administration.

Comparison between intracameral ceftazidime &amp; cefuroxime for the prevention of post-operative endophthalmitis

Purpose: To compare the efficacy and safety of intracameral injection of ceftazidime and cefuroxime during cataract surgery for the prevention of post-operative endophthalmitis.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Ophthalmology Department Unit-1, Lahore General Hospital, Lahore.&#x0D; From November 2016 to March 2018.&#x0D; Material and Methods: Patients undergoing cataract surgery in the eye department were selected by convenient sampling to receive prophylactic intracameral antibiotics at the end of routine cataract surgery. Patients were divided into two groups; group A received Cefuroxime and group B received Ceftazidime both as 1 mg /0.1ml intracameral injections at the end of the surgery after wound hydration and before chamber formation. The patients were examined pre and post operatively on slit lamp and the number of cells in the anterior chamber (A/C) were counted on day 1, week 1 and week 6 after surgery.&#x0D; Results: Out of total 260 patients 130 were allocated to each group. On first post-operative day in Group A, A/C cell counts were grade 1 in 22 patients, grade 2 in 93 patients, grade 3 in 14 patients and Grade 4 in 1 patient. In group B, A/C cell counts were grade 1 in 11 patients, grade 2 in 96 patients, grade 3 in 20 patients and grade 4 in 3 patients. After one week, in group A, cell counts were grade 0 in 27 patients, grade 1 in 100 patients, grade 2 in 2 patients and grade 4 in 1 patient. While in group B, A/C cell counts were Grade 0 in 23 patients, grade 1 in 102 patients, grade 2 in 3 patients and grade 3 in 2 patients. After 6 weeks no patient in any group showed any activity in the anterior chamber.&#x0D; Conclusion: There is little difference in efficacy of intracameral ceftazidime antibiotic prophylaxis as compared to the intracameral cefuroxime.