Continuous Intra-Incisional Bupivacaine for Postoperative Analgesia after Hip Nailing Surgery: A Randomized Clinical Trial.

Background: The effectiveness of continuous wound infiltration (CWI) as a postoperative pain-control technique has been shown in many surgical procedures. This study investigates the effect of CWI of local anesthetic on postoperative pain control in intertrochanteric fracture patients undergoing hip nailing surgery. Methods: In this randomized clinical trial, 48 patients who were scheduled for hip nailing surgery were randomly assigned to receive (n = 24) or not receive (n = 24) bupivacaine infusion through a catheter inside the surgical wound, postoperatively. Pain intensity (NRS), required dose of morphine, and drug-related complications within 24 hours of the intervention were assessed and compared. Results: Pain intensity was significantly lower in the bupivacaine group both during the recovery room stay and in the ward in the first 24 hours after the procedure (P < 0.001). In the recovery room, the control group patients had a higher morphine consumption compared to the bupivacaine group (P < 0.001) and requested it earlier than the bupivacaine group (60 (45-60) vs. 360 (195-480) minutes) (P < 0.001). In the ward, all control group patients used the PCA morphine pump, while only 54% of the bupivacaine group self-administered morphine through the pump, with a significantly lower total morphine consumption (1 (0-2) vs. 10 (5-14) mg, P < 0.001). None of the patients in the bupivacaine group required additional morphine, while 37.5% of the control requested additional morphine (P=0.002). Altogether, the control group had a higher total morphine consumption compared to the bupivacaine group in the first 24 hours (10.5 (6-15.5) vs. 1 (0-2) mg, P < 0.001). Conclusion: CWI of bupivacaine helps better pain reduction during the early postoperative hours while it reduces opioid consumption, minimizes nausea and vomiting, and improves patient satisfaction.

Efficacy of Isoflurane-Remifentanil versus Propofol-Remifentanil on Controlled Hypotension and Surgeon Satisfaction in Rhinoplasty: A Single-Blind Clinical Trial Study.

Background: Rhinoplasty is a complex but popular surgery in Iran. The main complications of the surgery are post-operative bleeding and nasal septal hematoma due to poor intra-operative controlled hypertension. This study aimed to compare the efficacy of isoflurane-remifentanil (I-R) versus propofol-remifentanil (P-R) to induce controlled hypotension and to assess surgeon satisfaction with each of these combinations during rhinoplasty. Methods: In 2020-2021, a single-blind clinical study was conducted on 98 patients aged 18-50 years undergoing rhinoplasty at Mother and Child Hospital (Shiraz, Iran). Patients were randomly divided into P-R (n=48) and I-R (n=50) groups. Changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were assessed during surgery and in the recovery room. A questionnaire was used to evaluate the level of surgeon satisfaction. Data were analyzed using independent samples t test, Chi-square test, and repeated measures ANOVA with SPSS software. P<0.05 was considered statistically significant. Results: Five minutes after anesthesia induction, the P-R combination had a greater effect on reducing SBP (P=0.010), DBP (P=0.007), MAP (P=0.003), and HR (P=0.026) than I-R. However, from the 40th minute to the end of surgery and after 30 minutes of recovery, the I-R combination had a slightly better effect on blood pressure reduction than P-R. There was no difference in surgeon satisfaction with either of the two drug combinations. Conclusion: Both P-R and I-R combinations are recommended to induce hypotension during rhinoplasty. However, I-R is more effective than P-R in inducing the desired controlled hypotension.

Gene Expression of Toll-Like Receptors 2 and 4 in Renal Transplant Rejection.

OBJECTIVES: Toll-like receptors are a crucial part of the innate immune system and have a pivotal role in the acquired immunity system. Studies have shown that Toll-like receptors 2 and 4 are important during the transplant process. Therefore, we analyzed the gene expression of Toll-like receptors 2 and 4 in cases of renal transplant rejection. We measured the messenger RNA expression levels of Toll-like receptors 2 and 4 in renal transplant rejection recipients compared with nonrejection recipients. MATERIALS AND METHODS: We enrolled 151 deceased-donor kidney transplant recipients, whom we divided into 2 groups: 101 nonrejection recipients and 50 recipients with acute allograft rejection. We collected 3 mL of blood (treated with ethylenediaminetetraacetic acid) from each patient. Ribonucleic acid extraction and complementary DNA synthesis were conducted for all samples, and the constructed complementary DNAs were used for real-time polymerase chain reaction analysis. RESULTS: We measured gene expression levels of Toll-like receptors 2 and 4 in renal transplant recipients with acute allograft rejection and in recipients who did not experience acute renal allograft rejection, and the results showed that messenger RNA expression levels for both Toll-like receptors 2 and 4 were significantly increased in the acute rejection group compared with the nonrejection group. CONCLUSIONS: Toll-like receptors 4 and 2 could increase the risk of acute rejection after renal transplant and could be defined as a risk factor for rejection. Further studies are recommended.

Evaluation of Smile Characteristics in Three Different Sagittal Malocclusions Before and After Nonextraction Orthodontic Treatment.

INTRODUCTION: To investigate the smile esthetics variables in three malocclusion classifications of angle to find out if the final smile esthetics was correlated with the initial types of malocclusion. MATERIALS AND METHODS: This cross-sectional study was performed on 90 adult patients (18-28 years old) with three classes of malocclusion (n = 30 for each class), who were just treated by an orthodontist based on standard edgewise (0.018 inch). A standardized smile mesh analysis was used to evaluate seven smile characteristics. RESULTS: Orthodontic treatment improved all the smile characteristics in the three groups. All groups showed an increase in smile width, smile index, and vertical indices; while, the transverse indices decreased. Significant increase was observed in four smile measurements in patients with Class II malocclusion. Comparing the smile characteristic changes among the three groups revealed that the changes induced by orthodontic treatment were significantly higher in patients with Class II malocclusion. CONCLUSION: The smile esthetics in all the three types of malocclusion benefited from the orthodontic treatment; however, the changes were more significant in Class II malocclusions. None of the three malocclusion types showed significant difference between the pre- and post-treatment smile characteristics.

Effect of composite/amalgam thickness on fracture resistance of maxillary premolar teeth, restored with combined amalgam-composite restorations.

BACKGROUND: Combined amalgam-composite restorations have been used through many years to benefit from the advantages of both dental amalgam and composite resin. Two variations have been mentioned for this technique, this study investigated the fracture resistance of maxillary premolar teeth with extended mesio-occluso-distal (MOD) cavities, restored with the two variations of combined amalgam-composite restorations. MATERIAL AND METHODS: Sixty intact extracted premolar teeth were randomly divided into 6 groups (G1-G6) of 10 teeth. G1; consisted of intact teeth and G2; consisted of teeth with MOD preparations were assigned as the positive and negative control groups respectively. Other experimental groups after MOD preparations were as follows: G3, amalgam restoration; G4, composite restoration; G5 combined amalgam-composite restoration with amalgam placement only on 1mm of the gingival floor of the proximal boxes; G6, combined amalgam-composite restoration with amalgam placement to the height of contact area of the proximal surface of the tooth. Fracture strength of the specimens was measured and the data were analyzed using one-way analysis of variance (ANOVA). The level of significance was P<0.05. Fracture mode of the specimens was also recorded. RESULTS: G1 had the highest value of fracture resistance (1736.90 N). G2 and G3 had the lowest fracture resistance (775.70 N and 874.70 N, respectively). The difference between G 4, 5 and 6 was not statistically significant. However, G4, G5 and G6 showed significantly higher resistance to fracture compared to G2 and G3. Fracture modes were favorable in all of the study groups except in G6. CONCLUSIONS: Fracture resistance of the premolars restored with the two variations of combined amalgam-composite restoration was similar to that achieved with composite restoration alone and more than that of amalgam restoration alone. It can be concluded that the thickness of amalgam in combined amalgam-composite restorations did not affect fracture resistance of the teeth. KEY WORDS: Amalgam, composite, fracture resistance, restoration.