Significant Increase In Duration Research Articles

PC078. Rising Incidence of Femoral Pseudoaneurysm After Cardiac Catheterization Results in Significant Increases in Hospital Cost and Length of Stay

Femoral pseudoaneurysm (FPA) is the most common complication associated with percutaneous coronary interventions. The purpose of this study is to identify the risk factors associated with FPA after cardiac catheterization, and the impact of FPA on total hospital cost and duration of stay. The Nationwide/National Inpatient Sample was queried from 2006 to 2014 to identify patients having percutaneous coronary interventions who then developed FPA. The χ2 test, Wilcoxon rank-sum test, Cochran-Armitage trend test, and multivariable logistic regression analysis were used for data analysis and statistics. Total hospital cost adjusted to 2014 dollars, and duration of stay are reported as a median with an interquartile range (IQR). A total of 12,439,109 patients had coronary procedures from 2006 to 2014. Among them, 36,262 (290 per 100,000 cases) developed FPA. The rate has increased from 260 in 100,000 in 2006 to 310 in 100,000 in 2014 (P < .0001 for trend). Patient age is associated with FPA, with patients 75 and older having a significantly greater rate of FPA (0.44%) compared with other age groups: 18-54 (0.18%), 55-64 (0.23%), and 65-74 (0.32%; P < .0001). FPA is twice as prevalent in females vs males (0.40% vs 0.22%; P < .0001). Caucasians and Hispanics were more likely to develop FPA compared with African Americans (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.59-1.83 and OR, 1.64; 95% CI, 1.54-1.74, respectively). As expected, diagnostic procedures had the lowest rate of FPA (0.22%) compared with angioplasty (0.39%) or stent placement (0.33%; P < .0001). Surprisingly, patients with elective admission were 1.22 times as likely to have FPA (95% CI, 1.19-1.25) than those with nonelective hospitalization. Interestingly, patients in urban hospitals had the highest incidence of FPA (0.30% in urban teaching and 0.28% in urban nonteaching vs 0.20% in rural hospitals; P < .0001). Compared with the Northeast region, FPA incidence was greater in the West (OR, 1.12; 95% CI, 1.08-1.16) and highest in the Midwest and South regions (OR, 1.24; 95% CI, 1.20-1.28 for both). FPA resulted in a significant increase in duration of stay, from 3 days (IQR, 1-6 days) to 5 days (IQR, 3-9 days; P < .001), and resulted in a 30% increase in total cost of hospitalization, from $15,651 (IQR, $10,102-$24,967) to $22,347 (IQR, $15,159-$34,030). FPA after coronary procedures is a significant complication, resulting in unacceptable increases in both hospital duration of stay and total cost. With the incidence of FPA increasing, urgent attention and further root cause analysis is indicated to reduce this adverse trend in patient outcomes.

CNS Activity of Myristica fragrans Houtt. - An Experimental Study

Objective: To evaluatethe role of Myristica fragrans Houtt. for its analgesic, sedative and anxiogenic activity.Method: Charles Foster rats were administered orally the ethanolic extract (EEMF) and fractions of extract in ethyl acetate (EAMF), chloroform (CMF), and n-hexane (HMF). They were screened for sedative activity using Pentobarbitone sleep potentiation test, analgesic activity using Eddy’s hot plate and Tail flick test; and anxiogenic or anxiolytic activity using Open field test.Result: In pentobarbitone induced sleep potentiation test, the ethanolic extract (EEMF) and ethyl acetate fraction (EAMF) showed significant decrease in latency of sleep and highly significant increase in duration of sleep. In Open field test, EEMF, EAMF and HMF showed highly significant decrease in locomotion parameters as shown by decrease in rearing, preening and ambulation. In Eddy’s hot plate test and Tail flick test, highly significant increase in reaction time was seen in EEMF, EAMF, HMF groups.Conclusion: The observed results suggest that Myristica fragrans has analgesic, anxiogenic and sedative activity.Bangladesh Journal of Medical Science Vol.17(1) 2018 p.98-106

Factors affecting the Duration of Surgical Extraction of Impacted Mandibular Third Molars

ABSTRACTAimThe aim of this study is to evaluate the effect of demographic, clinical, and radiographic factors on the duration of surgical extraction of impacted lower third molars.Materials and methodsThis retrospective study included patients who underwent surgical removal of impacted lower third molars, and the investigated factors were demographic data including age and gender, radiographic data including the impacted tooth angulation and depth of impaction and ramus relation, and clinical data including the state of eruption of the impacted teeth. These factors were evaluated for association with the duration of surgery. Descriptive statistical analysis included percentages and mean ± standard deviation (SD). Student's t-test was used to compare means between two groups, while for comparing the means among three or more groups for statistical significance, analysis of variance (ANOVA) test was used.ResultsForty patients were included: 20 (50%) males and 20 (50%) females. The age range was from 17 to 37 years with a mean ± SD of 23.4 ± 5.016 years. The duration of surgery (± SD) in all the patients ranged from 10 to 40 minutes with a mean of 25.8 ± 8.56 minutes. Clinically unerupted teeth and deep ramus relationship were associated with statistically significant increase in duration of surgical extraction.ConclusionThis study identifies state of eruption and ramus relation to be significant predictive factors, whereas other investigated factors, namely, age of patient, sex, angulation of teeth, and depth of impaction, were found to be not significant in determining the duration of surgery and hence, the difficulty of extraction.Clinical significanceDuration of surgical extraction of impacted mandibular third molars can be considered as an indicator for difficulty of surgical extraction. Difficult surgical extraction of impacted mandibular third molars can be anticipated in clinically unerupted teeth and those with deep ramus relationship.How to cite this articleBede SY. Factors affecting the Duration of Surgical Extraction of Impacted Mandibular Third Molars. World J Dent 2018;9(1):8-12.

Larvicidal and Growth-Regulatory Activities of Methanolic and N-hexane Extracts of Leaf of Ficus vallis-choudae Delile (Rosales: Moraceae) against Culex quinquefasciatus (Diptera: Culicidae)

The study aimed at determining the larvicidal and Insect-Growth-Regulating (IGR) potentials of n-hexane and methanolic extracts of Leaf of Ficus vallis-choudae against Culex quinquefasciatus mosquitoes in a bid to develop a cost effective and eco-friendly control lead. Collected leaves of the plants were air-dried, pulverized and sohxlet-extracted. Phytochemical screening of the crude extracts was done following standard protocols. Graded concentrations of 0.00625 to 0.05 mg/L (n-hexane extract) and 0.2 to 0.5 mg/L (methanolic extract) of the crude extract were assayed against fourth larval instar of the mosquito species. The mosquitoes were monitored from zero to 48 hours post-exposure to determine mortality. Sub lethal concentrations of 0.00625 (n-hexane) and 0.2 mg/L (methanol) were assayed for IGR activities. The phytochemical screening of crude extracts of the leaf revealed presence of seven secondary metabolites, whose presence was dependent on extraction solvent. They include flavonoids, tannins, saponins, cardiac glycosides, steroids, anthraquinones and terpenoids. After 48 hours post-exposure, analyses revealed a time and dose-dependent toxicity of the leaf extracts. The LC 50 and LC 90 , respectively, of the n-hexane and methanolic extracts were, 0.022 and 0.042 mg/L, and 0.355 and 0.463 mg/L, respectively. IGR studies revealed significant increase in duration of development by the sub lethal concentrations. This study revealed larvicidal and IGR potential of n-hexane and methanolic extracts of the leaf of Ficus vallis-choudae , and therefore, a promising lead agent for development of larvicides for mosquito vector control .

Comparative study between bupivacaine-dexmedetomidine combination and bupivacaine (plain) in brachial plexus block using nerve stimulator

Introduction: Brachial plexus block has evolved into a valuable and safe alternative to general anaesthesia for the upper limb surgeries. It is a great tool in the anaesthetic armamentarium for relief of pain preoperatively, perioperatively and post operatively. It is possible and desirable for patient to remain ambulatory. Adjuvants with local anaesthetics in brachial plexus block are being used to achieve quick, dense and prolonged block. Dexmedetomidine added to local anesthetics prolongs the duration of block and postoperative analgesia in brachial plexus block. Methods and Methodology: It is a prospective, randomised, comparative study of 60 patients admitted in a tertiary hospital for upper limb surgery who were posted under regional anaesthesia during the period of October 2012 to December 2014. The patients taken in this study were allocated into two groups randomly. Group B (n=30) 20millilitres (ml) of 0.5%% bupivacaine +1ml saline and group D (n=30) 20ml of 0.5% bupivacaine +1microgram (mcg)/kilogram (kg) dexmedetomidine was given. Results: There were no clinical or statistically significant differences in the demographic profile of patients in either group. Onset of sensory block in radial, median and ulnar nerve distributions were significantly shorter in group B. Motor onset was also significantly shorter in group B. However rescue time was higher in group D. There were no adverse effects noted in both the groups. There was a significant percentage of GA conversion seen in case of group. B. Discussion: Onset of sensory block was faster in Group B than in Group D, onset of motor block was faster in Group B than in Group D, and the difference was statistically significant. There was significant increase in duration of analgesia in Group D (456.12±97.99 min) as compared with Group B (289.67±62.50 min). The difference was statistically significant No side-effects (nausea, vomiting, dry mouth) were reported during the first 24 h in the post-operative period in both the groups. From this study, we would like to suggest that dexmedetomidine can be safely used with local anaesthetic in peripheral nerve blocks; however, further trials to determine the exact dose and effect of neurotoxicity on the human nerve are required.

Effect of Visual Feedback on the Static and Kinematic Characteristics of Handwriting

Research on visual feedback has not produced consistent results to show how visual feedback or the lack, thereof, influences individual handwriting characteristics. A two-pronged approach was designed to investigate the degree of this influence. For this purpose, samples of signatures as well as cursive and block text, written with and without visual feedback, were collected from 40 volunteers and imported into a PC via a pen tablet, using an electronic inking pen. The data was analyzed in a handwriting movement analysis software module specially designed for this research that was added to the software MovAlyzeR by Neuroscript LLC. Two forensic document examiners (FDEs) independently analyzed samples from the two groups (samples executed with normal visual feedback versus the group of samples executed without visual feedback). They found no fundamental differences between these two groups. Their analyses also demonstrated that a large number of similarities existed in the general design of the allographs (alternative forms of a letter or other grapheme) and in the pictorial aspects, regardless of the complexity of the samples. In the cursive and block handwriting, four main qualitative characteristics were linked to the absence of visual feedback: change of overall size, non-uniformity of left margins, change of baseline alignment, and inclusion of extra trajectories. The statistical analysis verified the above findings. The comparative analysis also suggests that gender, educational level (above high school) and handedness create an insignificant influence on the individual characteristics of writing produced with and without visual feedback. The only notable exception is the relationship between signature duration and educational level. The volunteers with a medium education level showed a significant increase in duration while signing their names without visual feedback in comparison to those with higher education levels. The combination of the above findings suggests that handwriting is not fundamentally influenced by visual feedback. &#x0D; Purchase Article - $10

A Comparative Study to Evaluate the Efficacy of Butorphanol as an Adjuvant to Epidural Analgesia for Rib Fractures

Abstract Introduction: Pain management via epidural catheters have emerged as an optimal method of pain control in patients with rib fractures (RF). This study was done to evaluate the efficacy of butorphanol in this subset of patients. Materials and methods: Sixty patients were randomly allocated in two groups R (ropivacaine only) and B (ropivacaine with butorphanol). Group R patients received 0.2% ropivacaine epidurally (10 mL) while group B patients received 0.2% ropivacaine and 1 mg butorphanol epidurally (10 mL). Baseline respiratory rate, oxygen saturation, partial pressure of oxygen (PaO2), visual analog score (VAS), peak inspiratory flow rate (PIFR) were noted in both the groups. Results: There was significant increase in duration of analgesia and nonsignificant reduction in VAS score in group B, and nonsignificant decrease in invasive ventilation cases and significant reduction in length of intensive care unit (ICU) stay in group B. There were no significant adverse effects in both the groups except for nausea in group B. Conclusion: Butorphanol as an adjuvant to epidural analgesia leads to better oxygenation, decrease in length of ICU stay and duration of mechanical ventilation without increase in significant side effects.

Postpartum estrogen withdrawal impairs GABAergic inhibition and LTD induction in basolateral amygdala complex via down-regulation of GPR30

Postpartum estrogen (E2) withdrawal is known to be a particularly vulnerable time for depressive symptoms. In this study, ovariectomized (OVX) mice were treated with co-administration of estradiol benzoate and progesterone (E2/P4) followed by administration of E2 alone (E2) and a subsequent E2 withdrawal (EW) to mimic the hormonal changes during pregnancy and postpartum. The objective of this study was to investigate the influence of E2 withdrawal after hormone-simulated pregnancy on synaptic function and plasticity in basolateral amygdala complex (BLA). In comparison to control mice, EW mice spent less time in the central portion of open-field test and open arms of elevated plus-maze. Excitatory postsynaptic potentials (EPSPs) slopes at external capsule BLA synapse were reduced in E2/P4-mice, recovered in E2-mice, and increased in EW-mice. EW-mice showed a significant increase in duration of EPSPs and paired-pulse inhibition (PPI) with multi-spike responses of EPSPs and impairment of long-term depression (LTD) induction, which were corrected by GABAAR agonist muscimol. Levels of estrogen receptor (ER) GPR30, ERα and ERβ expression in BLA of EW-mice were lower than those in control mice. The bath-application of GPR30 agonist G-1 in BLA of EW-mice recovered the GABAAR-mediated inhibition and LTD indication, but ERβ agonist DPN or ERα agonist PPT could not. A single BLA-injection of G-1 rather than DPN or PPT in EW-mice could partially relieve the anxiety-like behaviors. The results indicate that postpartum E2 withdrawal causes dysfunction of GABAAR-mediated inhibition in the BLA through reducing GPR30 expression, which impairs LTD induction and causes anxiety-like behaviors.

Revisiting summertime hot extremes in China during 1961–2015: Overlooked compound extremes and significant changes

AbstractSummertime hot extremes in China are categorized into three distinct types, i.e., independent hot days, independent hot nights, and compound events, based on differing configurations between daily maximum and minimum temperature. Linear trends for multiple indictors of these subtypes and traditionally defined hot days/nights exhibited remarkable differences in significance, magnitude, and even sign, especially for events involving daytime extremes. Thus, some significant changes masked in conventional analyses are successfully uncovered. Particularly, the dominance of independent hot days has decayed significantly, accompanied by a rapid boom of compound events and/or independent hot nights in different regions. These nighttime‐accentuated hot extremes have exhibited significant increases in duration, intensity, and spatial extent, with much stronger trends detected in severest events.

Cardiac injury after convulsive status epilepticus in children.

Convulsive status epilepticus (CSE) is a medical emergency with high mortality that usually occurs within 30 days following the seizure activity. One of the potential mechanisms contributing to mortality in this period following CSE is cardiac injury. The aim of the present study was to evaluate cardiac injury after CSE in children. Sixty children presented with CSE were enrolled in this study. Thirty healthy children with matched age and sex were taken as a control. Electrocardiogram (ECG), echocardiographic examinations, plasma concentration of cardiac troponin I (cTnI) and brain-type natriuretic peptide (BNP) were done 6h after control of seizure for patients and control groups. Thirty three patients were presented with CSE for the first time. ECG changes were present in 55% of patients with CSE in the form of conduction abnormalities, ischemic changes, and arrhythmias. Echocardiographic examinations revealed a significant increase in left ventricular end-diastolic dimension (LVEDD) and left ventricular end systolic dimension (LVESD) in patients with CSE than control group. Moreover, a significant decrease in LV systolic function and RV diastolic function were detected by tissue Doppler. The mean plasma concentrations of BNP and cTnI were significantly higher in patients with CSE than the control group (p value<0.001). The overall mortality in our study was 8.3% (5/60); four of them had ECG changes. There was significant increase in duration of CSE, length of intensive care and hospital admission in CSE patients with ECG changes than those without ECG changes with p values 0.001, 0.031 and <0.001 respectively. Cardiac injury in convulsive SE is common and may be under recognized. So, cardiac assessment should be a routine step in CSE patients' management.

A comparative study to evaluate the efficacy of butorphanol as an adjuvant to epidural analgesia for rib fractures

Background: Pain management through epidural catheters has emerged as optimal method of pain control in patients with rib fractures. This study was done to evaluate the efficacy of butorphanol in this subset of patients. Materials and Methods: Sixty patients were randomly allocated in two Groups R and B. Group R patients received 0.2% ropivacaine epidurally (10 mL) while Group B patients who received 0.2% ropivacaine and 1 mg butorphanol epidurally (10 mL). Baseline respiratory rate, oxygen saturation, partial pressure of oxygen, visual analog score (VAS), and peak inspiratory flow rate were noted in both the groups. Results: There was a significant increase in duration of analgesia and nonsignificant reduction in VAS score in Group B and nonsignificant decrease in invasive ventilation cases and significant reduction in length of Intensive Care Unit (ICU) stay in Group B. There were no significant adverse effects in both the groups except for nausea in Group B. Conclusion: Butorphanol as an adjuvant to epidural analgesia leads to better oxygenation, decreased length of ICU stay, and duration of mechanical ventilation without increase in significant side effects.

Comparing the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam or Magnesium Sulphate Combination in Patients Undergoing Elective Infraumbilical Surgery

Background.Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia.Aim of the Work.The aim of this study was to decrease bupivacaine dose used in spinal anesthesia in patients undergoing orthopedic lower limb surgery and reduce its possible side effects.Patient and Methods.Sixty adult patients of both sexes, divided into three.Group Creceived 2.5 mL bupivacaine and 0.5 mL saline 0.9%.Group Areceived 2.5 mL bupivacaine and 0.5 mL midazolam.Group Breceived 2.5 mL bupivacaine and 0.5 mL magnesium sulphate.Results.As regards onset of both motor and sensory blockade, there are a significant decrease in group A and a significant increase in group B as compared to group C, with a significant decrease in duration of motor blockade and significant increase in duration of sensory blockade in both group A and group B, respectively, as compared to group C, with a significant decrease in the duration of sensory blockade in group B as compared to group C.Conclusions.These results suggested that intrathecal midazolam as an adjuvant for bupivacaine increases the duration of both sensory and motor blockade more than that of magnesium sulphate.

Effect of Nalbuphine as Adjuvant to Bupivacaine for Ultrasound-Guided Supraclavicular Brachial Plexus Block

Background: Nalbuphine is a derivative of 14-hydroxymorphine which is a strong analgesic with mixed k agonist and μ antagonist. Nalbuphine was studied several times as adjuvant to local anesthetics in spinal, epidural and local intravenous block. The aim of this study was to evaluate the effect of nalbuphine as an adjuvant to local anesthetics in supraclavicular brachial plexus block. Patients and Methods: Fifty-six patients undergoing elective forearm and hand surgery under supraclavicular brachial plexus block were allocated randomly into one of two groups of 28 patients each to receive either 25 ml (0.5%) bupivacaine with 1 ml of NS or 25 ml (0.5%) bupivacaine with 1 ml (20 mg) nalbuphine. Onset time and duration of both sensory and motor block, and post-operative analgesia were observed. Result: Nalbuphine group showed significant increase in the duration of motor block (412.59 ± 18.63), when compared to control group (353.70 ± 29.019) p-value < 0.001, also, there was significant increase in sensory duration in nalbuphine group (718.14 ± 21.04) when compared to control group (610.18 ± 26.33) p-value < 0.001, without affecting the onset time of the blockade. And also, there was a significant increase in the duration of analgesic effect in nalbuphine group (835.18 ± 42.45) when compared to control group (708.14 ± 54.57) p-value < 0.001. Conclusion: The present study demonstrates that addition of 20 mg nalbuphine to bupivacaine in supraclavicular brachial plexus block is associated with significant increase in the duration of both sensory and motor block and also prolong the duration of analgesia.

Ventricular Effective Refraction Period and Ventricular Repolarization Analysis in Experimental Tachycardiomyopathy in Swine

Swine are recognized animal models of human cardiovascular diseases. However, little is known on the CHF-associated changes in the electrophysiological ventricular parameters of humans and animals. The aim of this study was to analyze changes in the durations of ventricular effective refraction period (VERP), QT and QTc intervals of pigs with chronic tachycardia-induced tachycardiomyopathy (TIC). The study was comprised of 28 adult pigs (8 females and 20 males) of the Polish Large White breed. A one-chamber pacemaker was implanted in each of the 28 pigs. Electrocardiographic, echocardiographic and electrophysiological studies were carried out prior to the pacemaker implantation and at subsequent 4-week intervals. All electrocardiographic, echocardiographic and short electrophysiological study measurements in all swine were done under general anesthesia (propofol) after premedication with midazolam, medetomidine, and ketamine. No significant changes in the duration of QT interval and corrected QT interval (QTc) were observed during consecutive weeks of the experiment. The duration of the QTc interval of female pigs was shown to be significantly longer than that of the males throughout the whole study period. Beginning from the 12th week of rapid ventricular pacing, a significant increase in duration of VERP was observed in both male and female pigs. Males and females did not differ significantly in terms of VERP duration determined throughout the whole study period. Ventricular pacing, stimulation with 2 and 3 premature impulses at progressively shorter coupling intervals and an imposed rhythm of 130 bpm or 150 bpm induced transient ventricular tachycardia in one female pig and four male pigs. One episode of permanent ventricular tachycardia was observed. The number of induced arrhythmias increased proportionally to the severity of heart failure and duration of the experiment. However, relatively aggressive protocols of stimulation were required in order to induce arrhythmia in the studied pigs.

Impact of specific training and competition on myocardial structure and function in different age ranges of male handball players.

Handball activity involves cardiac changes and demands a mixture of both eccentric and concentric remodeling within the heart. This study seeks to explore heart performance and cardiac remodeling likely to define cardiac parameters which influence specific performance in male handball players across different age ranges. Forty three players, with a regular training and competitive background in handball separated into three groups aged on average 11.78±0.41 for youth players aka “schools”, “elite juniors” 15.99±0.81 and “elite adults” 24.46±2.63 years, underwent echocardiography and ECG examinations. Incremental ergocycle and specific field (SFT) tests have also been conducted. With age and regular training and competition, myocardial remodeling in different age ranges exhibit significant differences in dilatation’s parameters between “schools” and “juniors” players, such as the end-diastolic diameter (LVEDD) and the end-systolic diameter of the left ventricle (LVESD), the root of aorta (Ao) and left atrial (LA), while significant increase is observed between “juniors” and “adults” players in the interventricular septum (IVS), the posterior wall thicknesses (PWT) and LV mass index. ECG changes are also noted but NS differences were observed in studied parameters. For incremental maximal test, players demonstrate a significant increase in duration and total work between “schools” and “juniors” and, in total work only, between “juniors” and “seniors”. The SFT shows improvement in performance which ranged between 26.17±1.83 sec to 31.23±2.34 sec respectively from “seniors” to “schools”. The cross-sectional approach used to compare groups with prior hypothesis that there would be differences in exercise performance and cardiac parameters depending on duration of prior handball practice, leads to point out the early cardiac remodeling within the heart as adaptive change. Prevalence of cardiac chamber dilation with less hypertrophy remodeling was found from “schools” to “juniors” while a prevalence of cardiac hypertrophy with less pronounced chamber dilation remodeling was noted later.

Sporting Activity After Arthroscopic Bankart Repair for Chronic Glenohumeral Instability

The purpose of this study was to collect detailed data on postoperative sporting activity after arthroscopic Bankart repair for chronic shoulder instability. Of 113 patients who underwent arthroscopic Bankart repair between February 2008 and August 2010, 81 met the inclusion criteria and were surveyed by a specially designed postal sport-specific questionnaire. Of these 81 patients, 66 (82%) were available for evaluation. All previously active patients performed some activity at follow-up. Of 9 patients (56%) who had been inactive, 5 took up new activities postoperatively. Forty-four patients (66%) stated that surgery had (strongly) improved their sporting proficiency. Seventeen patients (26%) reported no impact, and 5 patients (8%) reported a further deterioration compared with preoperatively. The improvement in sporting proficiency was negatively correlated with the preoperative risk level (ρ=0.42, P < .001), preoperative performance level (ρ= 0.31, P= .012), and preoperative Tegner scale (ρ= 0.36, P=.003), as well as hours of sporting activity per week (ρ= 0.25, P= .042), whereas age showed a positive correlation (ρ= 0.28, P= .023). There was no change in duration, frequency, number of disciplines, Tegner activity scale, risk category, or performance level. Arthroscopic Bankart repair provides a high rate of return to activity among patients treated for chronic shoulder instability. A number of previously inactive patients returned to activity postoperatively. However, one-third of patients reported no benefit from surgery in terms of sporting activity. The improvement in sporting proficiency was highly dependent on the demands on the shoulder in sports, as well as the age of the patient. Overall, there was no significant increase in duration, frequency, number of disciplines, Tegner activity scale, or performance level between preoperative and follow-up evaluation and no increased return to high-risk activities. Level IV, therapeutic case series.

Comparison of different doses of magnesium sulphate and fentanyl as adjuvants to bupivacaine for infraumbilical surgeries under subarachnoid block.

Background and Aims:Spinal anaesthesia is used for many years for surgeries below the level of umbilicus. It has certain disadvantages such as limited duration of blockade and post-operative analgesia. This study was undertaken to evaluate the effects of additives fentanyl and magnesium sulphate along with bupivacaine during spinal anaesthesia for prolongation of analgesia and motor blockade.Methods:This randomised study was conducted in 120 patients of either sex of American Society of Anesthesiologists physical status I and II, posted for infraumbilical surgeries. Patients were randomly allocated to four groups and were given the following drugs intrathecally as per group distribution; group A - bupivacaine 15 mg (0.5% heavy) with fentanyl 25 μg, group B - bupivacaine 15 mg (0.5% heavy) with magnesium 100 mg, group C - bupivacaine 15 mg (0.5% heavy) with magnesium 50 mg and group D - bupivacaine 15 mg (0.5% heavy) with 0.5 ml normal saline. Parameters monitored were duration of analgesia along with haemodynamic parameters and side effects. Data were analysed using the Student's t-test for the continuous variables and two-tailed Fisher exact test or Chi-square test for categorical variables.Results:There was significant increase in duration of analgesia in group A (374.37 min) and B (328.13 min) as compared to group C (274.87 min) and D (246.03 min). In group A, all haemodynamic parameters decreased by more than 20%, compared to baseline parameters, which was clinically and statistically significant as compared to other groups. There was also increase in duration of motor blockade in groups A and B.Conclusion:Addition of magnesium sulphate at 100 mg dose or fentanyl 25 μg as adjuvants to intrathecal bupivacaine significantly prolongs the duration of analgesia, though in the given doses, magnesium provides better haemodynamic stability than fentanyl, with fewer side effects.

The distal radius fracture: concomitant fractures and their relevancy.

The distal radius keeps heading the list of commonly fractured bones. Although little is known about the frequency and localization of accompanying fractures as well as their influence on the total course of in-patient treatment. This study is supposed to show the influence of concomitant fractures. These fractures should be identified as risk factors for a prolonged stay to improve the in hospital treatment. We retrospectively reviewed 721 patients with distal radius fracture. Frequency and localization of concomitant fractures, AO-type, patient age as well as duration of in-hospital treatment were analyzed. Out of 721 patients 124 (17.2%) had one or more concomitant fractures (CF). The most common CF were proximal femur fractures, pelvic ring fractures and humerus fractures. Compared to patients without CF, these patients showed a significant increase in duration of post operative hospital stay (5.2 vs. 12.5 days, p=0.0001). Patients presenting a concomitant fracture should be thoroughly cared for by their physicians and therapists. Especially an early and focused mobilization and a well-timed relocation for further medical treatment are important to reduce avoidable treatment days in the acute care hospital.

Dexmedetomidine; an adjuvant drug for fast track technique in pediatric cardiac surgery

BackgroundSimple surgical procedures in pediatric open cardiac surgery can be planned for early extubation by using dexmedetomidine alpha2 agonist. Early extubation is associated with shortening of postoperative ventilation and intensive care unit length of stay. The aim of this study was to examine the effects of dexmedetomidine on recovery profile, ICU length of stay, analgesic needs, and hospital stay in pediatric patients undergoing elective correction of congenital heart diseases using CPB.MethodsForty patients with age ranging from 2–10 years of either sex submitted for elective correction of simple congenital heart diseases undergoing CPB. All patients were premedicated in preoperative area with intramuscular 0.1 mg/kg midazolam and 0.015 mg/kg atropine sulfate. Patients were randomly classified into one of two equal groups (n = 20). In the Dex group, patients received an initial bolus dose of dexmedetomidine (0.4 μg/kg) over 10 min, followed by continuous infusion of 0.5 μg/kg/hr. In the control group, patients received an initial bolus dose of saline over 10 min, followed by continuous infusion of 0.5 μg/kg/hr.ResultsMAP, HR, the total dose of intra-operative fentanyl, vasodilator needs, time of extubation, pain score, ICU length of stay and hospital stay were significantly higher in the control group when compared with DEX group. Also in control group these were significant decrease in HR and MAP relative to baseline. There was significant increase in duration of inotropic support in control group than DEX group.ConclusionDexmedetomidine is a short-acting alpha2-adrenoceptor agonist with many desirable clinical benefits that encourage its use in the perioperative period. Dexmedetomidine has anesthesia-sparing effects, it decreases MAP, HR and with reasonable analgesic effect.

Effects of Citicoline Sodium on corneal reflex, anesthesia and analgesia duration after thiopental sodium injection in dogs- A preliminary report

Citicoline is a natural substance with neuroprotective and repairing effects. It can also increase the phosphor metabolites in cerebral cortex. Regarding the various effects of citicoline on central nervous system, this research aims at studying the effects of citicoline on the Thiopental sodium anesthesia. Six dogs were anesthetized by intravenous injection of 20 mg ∕ kg of 2.5% Thiopental sodium. After the appearance of recovery signs, both experimental and control groups received either 250 mg citicoline or two milliliter normal saline intravenously, immediately before the second injection of Thiopental sodium. Length of anesthesia, duration of analgesia and response to corneal reflex were measured, and statistically analyzed. Results showed a significant increase in duration of analgesia and a significant decrease in the length of negative corneal reflex in experimental group. Comparison of duration of anesthesia between the two groups showed no significant difference. These findings showed that using citicoline prior to Thiopental sodium anesthesia can improve brain function by decreasing the duration of lack of response to corneal reflex and also regarding the increasing effect of Citicoline on analgesia duration, the use of citicoline as a pre-anesthetic for Thiopental Sodium can probably be considered in the future studies.