Impact of Topical Epinephrine with Xylocaine on Drainage After Axillary Lymph Node Dissection: A Randomized Controlled Trial.

INTRODUCTION: We evaluated the impact of topical epinephrine with xylocaine on drainage after axillary lymph node dissection. METHODS: Fifty-two women were randomized into two groups, epinephrine with xylocaine drainage (ED) and conventional drainage group (CD). The amount of drainage, duration of drainage catheter, incidence of seroma formation and wound infection were noted. RESULTS: The mean total drainage volume was less in ED group as compared to CD group (195 ml vs. 353 ml; p = .002). Drainage catheter was removed earlier in ED group as compared to CD group (5.07 + / - 0.99 days vs. 6.65 + / - 1.07 days; p = 0.0001). The incidence of seroma and wound infection was similar in two groups. CONCLUSION: Topical epinephrine with xylocaine after axillary lymph node dissection results in significantly decreased drainage volume and duration of drainage.

Effectiveness of adhesive taping to reduce pain, swelling and trismus after fracture mandible surgery.

Swelling, pain and trismus constitute the major post-operative morbidity after surgery for mandibular fractures. We assessed the role of kinesio taping in mitigating these. Two groups of 15 patients were compared; those who had such applied to the side of the fracture and a control group of those who did not. Pain, swelling and trismus were assessed pre-operatively, and on the second, third and fifth post-operative days, and found to be significantly less in the study group. This simple technique is therefore effective. It is a simple frugal intervention without any side effects.

Barriers to CPAP Use in India: An Exploratory Study.

STUDY OBJECTIVES: To investigate adherence to continuous positive airway pressure (CPAP) therapy and identify barriers to CPAP use among patients with obstructive sleep apnea (OSA) in India. METHODS: A self-devised semistructured questionnaire (which collected patients' demographic information, socioeconomic position, and information about disease status, symptoms, and complications) was administered to consecutive patients with moderate to severe OSA from June 2015 to August 2016. Patients were grouped according to CPAP device buying behavior (buyers versus nonbuyers) and CPAP compliance behavior (compliant versus noncompliant). RESULTS: Out of 187 patients with moderate-severe OSA, 79 patients were enrolled for this study. The overall adherence rate (usage > 4 hours per night on > 70% nights) was 30.3%. Among the patients in the buyer group, adherence was 82.7%. Fifty patients did not buy a CPAP device; 30 of these 50 patients (60%) said financial constraints were the most important reason for not buying a CPAP device. Patients without financial constraints had higher chances-odds ratio (95% confidence interval) = 4.85 (1.6-16.1)-of buying a CPAP device than patients with financial constraints. Patients with more severe disease (ie, lower nadir oxygen saturation during sleep, higher apnea-hypopnea index, or presence of obesity hypoventilation syndrome) were more likely to buy and use a CPAP device. CONCLUSIONS: The main cause of nonuse of CPAP in India is the inability to buy a CPAP device. In patients who are able to buy a CPAP device, adherence was significantly higher (82.7%) compared to adherence in the study's overall population (30.3%). Furthermore, patients with more severe OSA were more likely to buy a device and adhere to CPAP. Patients' behaviors and attitudes are also important barriers in using CPAP. There needs to be increased awareness of the benefits of CPAP therapy among patients.

Mangiferin attenuates oxidative stress induced renal cell damage through activation of PI3K induced Akt and Nrf-2 mediated signaling pathways.

BACKGROUND: Mangiferin is a polyphenolic xanthonoid with remarkable antioxidant activity. Oxidative stress plays the key role in tert-butyl hydroperoxide (tBHP) induced renal cell damage. In this scenario, we consider mangiferin, as a safe agent in tBHP induced renal cell death and rationalize its action systematically, in normal human kidney epithelial cells (NKE). METHODS: NKE cells were exposed to 20 µM mangiferin for 2 h followed by 50 µM tBHP for 18 h. The effect on endogenous ROS production, antioxidant status (antioxidant enzymes and thiols), mitochondrial membrane potential, apoptotic signaling molecules, PI3K mediated signaling cascades and cell cycle progression were examined using various biochemical assays, FACS and immunoblot analyses. RESULTS: tBHP exposure damaged the NKE cells and decreased its viability. It also elevated the intracellular ROS and other oxidative stress-related biomarkers within the cells. However, mangiferin dose dependently, exhibited significant protection against this oxidative cellular damage. Mangiferin inhibited tBHP induced activation of different pro-apoptotic signals and thus protected the renal cells against mitochondrial permeabilization. Further, mangiferin enhanced the expression of cell proliferative signaling cascade molecules, Cyclin d1, NFκB and antioxidant molecules HO-1, SOD2, by PI3K/Akt dependent pathway. However, the inhibitor of PI3K abolished mangiferin's protective activity. CONCLUSIONS: Results show Mangiferin maintains the intracellular anti-oxidant status, induces the expression of PI3K and its downstream molecules and shields NKE cells against the tBHP induced cytotoxicity. GENERAL SIGNIFICANCE: Mangiferin can be indicated as a therapeutic agent in oxidative stress-mediated renal toxicity. This protective action of mangiferin primarily attributes to its potent antioxidant and antiapoptotic nature.

Attenuative role of mangiferin in oxidative stress-mediated liver dysfunction in arsenic-intoxicated murines.

Mangiferin (MAG), a natural xanthone mainly derived from mangoes, possesses great antioxidative potentials. The present study has been carried out to investigate the hepato-protective role of MAG, against arsenic (As)-induced oxidative damages in the murine liver. As, a well-known toxic metalloid, is ubiquitously found in nature and has been reported to affect nearly all the organs of the human body via oxidative impairment. Administration of As in the form of sodium arsenite (NaAsO2 ) at a dose of 10 mg/kg body weight for 3 months abruptly increased reactive oxygen species (ROS) level, led to oxidative stress and significantly depleted the first line of antioxidant defense system in the body. Moreover, As caused apoptosis in hepatocytes. Treatment with MAG at a dose of 40 mg/kg for body weight for 30 days simultaneously and separately after NaAsO2 administration decreased the ROS production and attenuated the alterations in the activities of all antioxidant indices. MAG also protected liver against the NaAsO2 -induced apoptosis and disintegrated hepatocytes, thus counteracting with As-induced toxicity. It could significantly inhibit the expression of different proapoptotic caspases and upregulate the expression of survival molecules such as Akt and Nrf2. On inhibiting Akt (by PI3K inhibitor, LY294002) and ERK1/2 (by ERK1/2 inhibitor, PD98059) specifically, caspase 3 got activated abolishing mangiferin's protective role on As-induced hepatotoxicity. So here, we have briefly elucidated the signaling cascades involved in As-induced apoptotic cell death in the liver and also the detailed cellular mechanism by which MAG provides protection to this organ. © 2016 BioFactors, 42(5):515-532, 2016.

Symmetrical peripheral gangrene-a case report and brief review.

A 30 year-old gentleman presented to casualty with history of pain abdomen for six days, fever and decreased urine output since two days. He was in a state of septic shock and was diagnosed to have intestinal perforation. His peripheral pulses were not palpable except for the femoral and brachial vessels. Despite fluid resuscitation, he needed infusion of high doses of dopamine and noradrenaline to maintain his blood pressure. He was operated for repair of perforation. On the first postoperative day, in the intensive care unit, vasopressin infusion was added in view of persistent hypotension. Appropriate fluid resuscitation and antibiotic therapy helped to wean him off inotropes and vasopressors by the second postoperative day. On the 3rd postoperative day, however, the patient developed discolouration and blebs on the fingers of left hand, followed by the right hand and then both the lower limbs. Subsequently, over a period of 10 days, this progressed to gangrene formation in the hands despite the patient being haemodynamically stable without any inotropes or vasopressors in this period. We conclude that the septic shock is a systemic derangement affecting all organ systems including coagulation and microcirculation. Early recognition and prompt management of sepsis, optimisation of fluid status to wean off the inotropes and vasopressors at the earliest is necessary to avoid catastrophes such as symmetrical peripheral gangrene.

Lifetime risk and trends in lung cancer incidence in greater Mumbai.

OBJECTIVE: To estimate the probability of developing lung cancer in the entire life span of the people of Greater Mumbai and variation according to age and sex. Information on cancer incidence trends in a community forms the scientific basis for planning and organising prevention, diagnosis and treatment. During the last 24 year period, a total of 11,458 lung cancer cases were registered (9,052 male and 2,406 female) by the Bombay Cancer Registry. Lung cancer accounts for 9.4% of all male cancers and 2.7% of those in females (6.2% of all cancers) in Greater Mumbai. The probability of developing cancer in the entire life span of the people of Greater Mumbai was estimated. METHODS: A method based on the cumulative risk of cancer was used to estimate the probabilities using lung cancer data collected by the population-based Bombay Cancer Registry from the years 1982 to 2005. For evaluation of trends, a linear regression model based on the logarithm of the observed incidence rates was applied. The annual percentage change was also computed for the evaluation. The cumulative incidence rate percentage was calculated by adding up the age-specific incidence rates at single ages and then expressed as a percentage. RESULTS: The results show that age-adjusted incidence rates of lung cancer during the period 1982 to 2005 showed a statistically significant decreasing trend in males and a statistically significant increasing trend among females. When these trends were examined across different age-groups (0-39, 40-64 and 65 or older), the rates showed a statistically significant decreasing trend from 0-64 years in males and a statistically significant increasing trend in females aged 65 years and older. The rates proved stable across the other age-groups. The probability estimates indicate that one out of every 74 men and one out of every 242 women will contract lung cancer at some time in their whole life in the absence of other causes of death, assuming that the current trends prevail over the time period. Most of them will acquire the disease after the age of 40 years, after which risk increases with time. CONCLUSIONS: The variation in age-adjusted incidence rate across different age-groups in both sexes clearly indicate that there has been a change in the etiology of lung cancer in Greater Mumbai over time. The most important reason for this would be decrease in smoking prevalence among males. The other reasons for this have to be explored through risk assessment studies, but these findings may be of general interest because changes in diagnostic practices are confounders in time trends of lung cancer in many developed countries, preventing inferences on changes in risk factors.