Rare hybrid tumor of odontogenic fibromyxoma and central giant cell granuloma in maxilla: First reported case.

Fibromyxoma is a locally aggressive rare benign tumor of mesenchymal origin with or without odontogenic epithelium. The etiology of this tumor remains unknown and it is responsible for approximately 3-8% of all cysts and tumors. Another locally destructive benign lesion is central giant cell granuloma (CGCG) which contains osteoclast-like multinucleated giant cells. CGCG accounts for about 7% of all benign jaw tumors, which usually affects younger females. A hybrid lesion with histologic features of both central fibromyxoma and CGCG has not been reported in the literature so far. In the present article, we report the first case of a hybrid tumor comprising odontogenic fibromyxoma with CGCG in a female along with a brief review of its clinical presentation, radiographic features, histological features, and management.

Audit of Demographics, Treatment Patterns and Outcomes of Differentiated Thyroid Cancers Treated with Tyrosine Kinase Inhibitors.

The real-world patterns of TKI use in differentiated thyroid cancer (DTC) are largely governed by the accessibility and financial feasibility of the patient with more sorafenib use compared to lenvatinib. There are limited data available on the toxicity profile, safety and tolerance of sorafenib and lenvatinib in DTC. Hence, we audited our practice on DTC. This is a retrospective single-centre analysis of patients with DTC who were referred to the Department of Medical Oncology for systemic therapy. Baseline demographics (age, sex, ECOG PS, comorbidities, substance use), tumour details (site of metastasis), previous treatment details, clinical features at metastasis (symptoms), the pattern of treatment, adverse events and outcomes including progression and death were extracted. There were 67 patients with DTC referred for systemic therapy; the median age was 56 (33-81) with a male preponderance (55.6%). The most common reason to start TKI therapy was radioactive iodine (RAI) cumulative dose > 600 milliCurie, followed by low iodine uptake in the RAI low-dose scan done at progression. The most common TKI used in the first line was sorafenib in 56 (83.6%) patients followed by lenvatinib in 9 (13.4%) patients. Papillary thyroid carcinoma was the most common histology (51, 76.1%), and the rest were follicular carcinoma (16, 23.9%). With a median follow-up of 36 months, the median PFS was 13.2 months (95% CI 10.4-16.0). The median OS was 18.8 months (95% CI 10.0-27.6). Among variables tested, no factors had a significant impact on the PFS or OS. The most common adverse events were hand-foot syndrome (54, 80.5%), diarrhoea (23, 33.3%) and transaminitis (24, 34.4%). The pattern of care of patients with RAI-refractory DTC is TKI therapy, especially sorafenib and lenvatinib in the real-world settings with comparable efficacy and safety profile compared to international literature.

Effects of IV dexmedetomidine as a pre-medication on clinical profile of bupivacaine spinal anaesthesia in lower abdominal surgeries: a randomized clinical study.

Introduction: to evaluate the effects of intravenous (IV) dexmedetomidine as a pre-medication on clinical profile of bupivacaine spinal anaesthesia in lower abdominal surgeries. Methods: this prospective randomized double blind study was done on 60 patients with ASA grade I/II undergoing lower abdominal surgeries under bupivacaine spinal anaesthesia. They were allocated to group-1 and group-2. Group-1 (control group) received normal saline and group-2 (study group) received IV dexmedetomidine 1 µg/kg over 10 min as premedication. Five minutes after premedication, subarachnoid block (SAB) was given with 3 ml of 0.5% hyperbaric bupivacaine following which sensory and motor blockade, hemodynamic changes, sedation, and complications of the surgery were recorded and this data was analyzed statistically using χ2 test, corrected χ2 test, Fisher´s exact test, and test of proportion (Z-test). Results: the results of the present study showed that in group-2 there was significant decrease in the onset of sensory block, higher level of sensory blockade achieved, less time required to attain highest level of anaesthesia, prolonged time required for 2 dermatomal regression, prolonged duration of sensory blockade, prolonged duration of analgesia, decrease in onset of motor blockade, no significant increase in duration of motor blockade, there was overall hemodynamic stability except for few cases of bradycardia responding to atropine and hypotension responding to mephentramine, adequate and acceptable intraoperative sedation, and significantly less incidence of shivering in perioperative period. Conclusion: IV infusion of dexmedetomidine 1 µg/kg body weight prior to SAB can be recommended to achieve better sensory blockade and adequate hemodynamic stability and sedation.

Ultrasonographic Changes in Transorbital Measurement of Optic Nerve Sheath Diameter in Magnesium Sulfate-Treated Severely Preeclamptic Patients: A Prospective Observational Study.

Introduction: Severe preeclampsia can lead to various complications including increased intracranial pressure (ICP) which can be catastrophic but difficult to detect because of variable nonspecific symptoms. Ultrasonography has been used as noninvasive measure to monitor optic nerve sheath diameter (ONSD) as a marker of raised ICP. Effect of MgSO4 on ICP can modify the management approach, need for additional monitoring, targeting hemodynamic goals, timing of delivery, and choice of anesthesia. We evaluated the effect of MgSO4 on raised ICP in severely preeclamptic patients using ultrasound-guided ONSD as a surrogate marker of ICP. Methodology: This prospective observational study was conducted after ethical committee approval and written informed consent from patients. Ultrasound-guided ONSD was measured and compared in 47 severe preeclamptic patients before and at 1 h, 4 h, 12 h, and 24 h after starting MgSO4 therapy. The analysis of data was done by one-way analysis of variance using Statistical Package for the Social Science. Results: Mean ONSD was 5.56 ± 0.30 mm in our study group. ONSD above 5.8 mm was seen in 17 (36.17%) patients and was considered as marker of raised ICP. There was a significant decrease in ONSD after 4 h of administration of MgSO4. No significant correlation was observed between mean arterial pressure, serum magnesium level, and ONSD. Conclusion: Ultrasound-guided ONSD measurement can be used as a quick, noninvasive bedside tool in severe preeclamptic patient on MgSO4 treatment as marker of ICP which help us in determining clinical severity, therapeutic response, and to decide further course of management.

Comparative evaluation of efficacy of skin staples and conventional sutures in closure of extraoral surgical wounds in neck region: A double-blind clinical study.

Background: The development of the skin stapling technique for surgical wound closure is less time-consuming than the conventional sutures. Aim: This study aims to evaluate the efficacy of skin staples and 4-0 prolene conventional suture in closure of extraoral surgical wounds in neck region in elective maxillofacial surgery. Materials and Methods: The study was conducted on a total of 60 patients, who were equally divided into three groups. In Group 1, wound closure was done using skin staples; in Group 2, wound closure was done using 4-0 prolene suture, and in Group 3, wound closure was done using both skin staples and 4-0 prolene suture. These groups were compared in terms of rate of wound closure; early postoperative pain; pain on the removal of staple and suture; rate of removal of staple and suture; scar evaluation by the clinician, patient, and two-blind observers on 15th day, 1 month, 3 months, and 6 months. Results: The rate of closure was significantly faster in staple group than in suture group. There was no significant difference in the postoperative pain, pain on removal and rate of removal between the two methods of closure. However, within the groups, more postoperative pain was observed in wound with incision length of >5 cm. Initially, on 10th postoperative day, the appearance of scar was significantly better in suture group but after 6 months, scar was better in staple group. Conclusion: The staple method of wound closure appears to be better than conventional suture in terms of rate of closure and scar appearance.

Comparative Evaluation of Different Doses of Intravenous Dexmedetomidine on Hemodynamic Response during Laryngoscopy and Endotracheal Intubation in Geriatric Patients Undergoing Spine Surgeries: A Prospective, Double-Blind Study.

BACKGROUND: Dexmedetomidine, a selective alpha 2 (α2)-adrenergic receptor agonist, has been used to blunt the hemodynamic response associated with laryngoscopy and tracheal intubation, which is a common concern for the anesthesiologist, especially in high-risk patients and geriatric age group. AIM AND OBJECTIVES: The current study is to evaluate and compare the effects of different doses of dexmedetomidine in controlling hemodynamic response during tracheal intubation in geriatric patients. MATERIALS AND METHODS: After getting approval from the Ethical Committee, 90 patients of the American Society of Anesthesiologist Physical Status Classes I and II, aged ≥60 years, were randomly assigned into three groups: Group I (normal saline, n = 30), Group II - dexmedetomidine (0.50 µg/kg, n = 30), and Group III - dexmedetomidine (1.00 µg/kg, n = 30). Dexmedetomidine was infused for 10 min before induction. Data were recorded as before infusion (T0), at the end of infusion (T1), before tracheal intubation (T2), at the moment of tracheal intubation (T3) 5 min after tracheal intubation (T4), and 10 min after tracheal intubation (T5). Modified observer's assessment of alertness/sedation scale score was observed at the time of T0 and T1. All statistical analyses were done using SPSS version 22. RESULTS: Mean systolic blood pressure was statistically significantly (P < 0.05) more among Group I compared to Group II and III at T2, T3, and T4. Mean heart rate (HR) value was significantly (P < 0.05) more among Group I compared to Group III from T1 to T5, whereas there was no significant change in HR between Group I and Group II and at T4 and T5 h was comparable in Group II and Group III. CONCLUSION: This study concluded that more acceptable hemodynamic changes were seen with 0.50 µg/kg dexmedetomidine when compared with 1.0 µg/kg dexmedetomidine during intubation. A lower dose besides being cost-effective is also free of side effects associated with the higher dose of 1 µg/kg dexmedetomidine.

Efficacy of Alvogyl (Combination of Iodoform + Butylparaminobenzoate) and Zinc Oxide Eugenol for Dry Socket.

CONTEXT: Alveolar osteitis (AO) (dry socket) is a postoperative healing complication after tooth extraction. Pain is considered the most important symptom of dry socket which can vary in frequency and intensity. AIM: The aim of the present study was to evaluate the management of AO with alvogyl and zinc oxide eugenol (ZOE). STUDY DESIGN: This study was designed as a single-blinded prospective study with a sample size of fifty patients included in the study after obtaining the informed consent. MATERIALS AND METHODS: All the fifty patients with dry socket were randomly selected and divided into two groups as follows: (1) Group I: Patients who received alvogyl paste as an intrasocket medication and (2) Group II: Patients who received ZOE as an obtundant dressing. STATISTICAL ANALYSIS USED: Data were analyzed using t-test and Chi-square test. RESULTS: The mean number of dressings required was less in Group I as compared to Group II, and thus Group I showed faster healing. In addition, the intensity of pain decreased more rapidly in Group I as compared to Group II. The mean time required for complete pain relief was less in Group I as compared to Group II, and thus Group I showed faster relief from pain. CONCLUSION: Alvogyl is better for the management of dry socket by virtue of shorter time required for complete pain relief, fewer visits for dressing change, and faster clinical healing of the socket.