The Effects of Premedication With Three Different Doses of Intravenous Dexmedetomidine on Spinal Anesthesia: A Randomized Comparative Study.

BACKGROUND: Intravenous dexmedetomidine is one of the commonly preferred techniques for sedation during any regional procedure. However, only a very few studies compared the impact of different bolus doses during spinal anesthesia, and none for our geographical area. MATERIALS AND METHODS: A total of 60 patients were allocated into either of the three groups (group I, II, III) to receive intravenous dexmedetomidine 0.5, 0.75, and 1 mcg/kg, respectively. The primary outcome was to compare the duration of sensory and motor blockade and the secondary outcomes were the level of sedation, hemodynamic stability, duration of analgesia, and the side effects, if any. RESULTS: Two-dermatome regression time and the duration of motor block were significantly higher in groups II and III when compared to group I. However, the difference in duration of analgesia, Ramsay sedation scores, bradycardia, and hypotension was statistically insignificant between the groups. CONCLUSION: Intravenous dexmedetomidine in doses of 0.75 and 1 mcg/kg significantly prolongs the two-dermatome regression time and duration of the motor block when compared to 0.5 mcg/kg dose. Hence, it is better to titrate the dose between 0.75 and 1 mcg/kg, as the administration of bolus intravenous Dex in doses ranging between 0.75 and 1 mcg/kg appears to provide adequate intraoperative block characteristics while maintaining hemodynamic stability without any significant respiratory depression or other adverse effects.

Assessment of Continuous Epidural Analgesia Versus Continuous Surgical Transverse Abdominis Plane Block for Postoperative Analgesia in Gynecological Surgeries.

Background Surgical transverse abdominis plane (TAP) block has been studied in various surgeries. However, its role particularly in the form of continuous infusion in comparison to epidural infusion in open gynecological surgeries remains unknown. Hence, this study was taken up. Methodology Sixty patients were assigned to either of the two groups: continuous epidural (Group E) or continuous infusion in the surgical TAP (Group S). The primary outcomes were visual analog scale (VAS) pain scores and rescue analgesic requirements. Postoperative complications such as nausea/vomiting, hypotension, and bradycardia were also assessed. Results Mean pain scores were significantly lesser in Group E. However, 80% (24) of Group E and 50% (15) of Group S did not require rescue analgesia, which was not statistically significant. Adverse effects did not differ significantly between the two groups. Conclusions The efficacy of the continuous surgical TAP block is similar to a continuous epidural. Therefore, it can be considered in settings with limited resources and expertise or in cases of contraindications for an epidural.

An unusual occurrence of synovial sarcoma in forearm: a case report.

Soft tissue sarcomas are group of malignant tumours arising from extra skeletal mesenchymal tissue. Presenting a patient with swelling over the posterior aspect of left arm for 6 months, gradually increasing in size for four months and rapidly increasing in size for last 2 months and not associated with pain. Peripheral pulses felt. Ultrasound showed large solid cystic intramuscular lesion arising from triceps muscle and Trucut biopsy showed poorly differentiated malignancy. Magnetic resonance imaging (MRI) left arm impression was large lobulated solid cystic space occupying lesion in triceps muscle, possibility of neoplastic lesion. Here the patient underwent wide local excision and reconstruction procedure followed by Radiotherapy, chemotherapy and regular follow up.

Comparative Evaluation of Antimicrobial Efficacy of Toothpastes Containing Probiotic and Neem as Primary Ingredient on Salivary Streptococcus mutans in Melmaruvathur Population: An In Vivo Study.

AIM: This in vivo study was designed to compare the antimicrobial effect of toothpastes containing probiotics and neem on Streptococcus mutans in 18-30-year-old patients in Melmaruvathur population. MATERIALS AND METHODS: The study consisted of 60 patients who were randomly divided into two groups of 30 each. Group I received probiotic-based toothpaste (PerioBiotic), whereas Group II received neem-based toothpaste (Babool) as a preventive measure protocols to control the incidence and prevalence of dental caries. STUDY DESIGN PROTOCOLS: Participants were instructed to use the dentifrice selected for the study, two times a day for 60 days. Tests were performed on the saliva samples at the beginning of the study, 0 day, 15th day, 30th day, and 60th day following the use of toothpaste. The Statistical Package for the Social Sciences (SPSS-25) software, version, and Chi-square and one-way analysis of variance were used for data analysis. RESULTS: The toothpastes containing neem and probiotics as primary ingredients were efficient in reducing the number of bacterial count when comparing the baseline data with the 60 days data in both the groups as a therapeutic regimen. Intragroup values showed reduction in the number of bacterial count in both the groups in a gradual manner, whereas the intergroup values between the toothpaste showed no statistically significant difference in the bacterial count, and both toothpastes were efficient in reducing the bacterial count. CONCLUSION: This study reveals the influence of probiotics and neem on salivary S. mutans levels. The results revealed that neem-based and probiotic-based toothpaste, which were tested in this study, showed comparable antibacterial activity against the S. mutans. The neem-based toothpaste showed promising and good antimicrobial activity and reduced the level of bacterial count, which can be attributed to the presence of secondary metabolites, such as flavonoids, alkaloids, lectins, and polyphenols, as its active components. The effect of each component against the S. mutans needs to be quantified in further studies, and within the limitation of this short study, it can be considered as a better choice than commercially available toothpaste, which predominantly has chemicals as active ingredients, which in turn can compromise the safety aspects in the patients when used for controlling the dental caries for a longer duration.

Comparative Evaluation of Antifungal Activity of Octenidine: An In Vitro Confocal Laser Study.

AIM: The aim of this study was to evaluate the antifungal efficacy of a novel endodontic irrigant octenidine against conventional irrigants sodium hypochlorite and EDTA on Candida albicans growth in the young and old population by calculating the number of colonies formed and by qualitative identification of dead/viable fungi by Confocal laser scanning microscopy (CLSM) method. MATERIALS AND METHODS: The total number of samples used in the study was eighty samples after decoronation of the crown portion the middle third of root canal. Each group was subdivided into four subgroups with various irrigation protocols: (A) 17% EDTA + 5.25% NaOCl, (B) 100% Octenisept, (C) 17% EDTA + 5.25% NaOCl + 1% clotrimazole, and (D) phosphate buffer saline. After completion of irrigation ATCC samples (90028) of C. albicans were inoculated with 5 mL of peptone water each and incubated at 37°C for 72 hours to attain the turbidity corresponding to 0.5 McFarland standards CFU. Eight samples were analyzed for the formation of candidal colonies, and two samples for the assessment of viability of Candida by confocal laser scanning microscope in each subgroup. RESULTS: Comparison of antifungal efficacy of endodontic irrigants employed in the young and old populations revealed a significant reduction in the mean values of CFU and the mean values of percentage of non-viable microorganism by CLSM method. A positive relationship was revealed in the younger population which had a better antifungal efficacy than the older population in all the irrigant subgroups evaluated in the study. CONCLUSION: All the endodontic irrigants employed in our study had a good antifungal efficacy against Candida albicans. Octenisept had a maximum antifungal efficacy, while phosphate saline showed the least efficacy in both age groups, which was quantitatively evaluated by CFU method, and the same was confirmed through qualitative evaluation by CLSM method. CLINICAL SIGNIFICANCE: Candida albicans plays a major role in the establishment and pathogenesis of failed root canal treatment. Age-related changes alter the adhesion potential of dentin, in turn influence the outcome of endodontic therapy. Octenidine, a novel antifungal agent, can be substituted over the conventionally used EDTA and NaOCl with less adverse effects.

Curcumin-Loaded Nanostructured Lipid Carrier Modified with Partially Hydrolyzed Ginsenoside.

The objective of the present study was to investigate the effect of partially hydrolyzed ginsenoside on the physicochemical properties and in vitro release of curcumin from phospholipid-based nanostructured lipid carrier (NLC). NLC formulas modified with partially hydrolyzed ginsenoside (NLC-PG) were prepared with different amounts of ginsenoside using the conventional hot-melt method. The average particle size of curcumin-loaded NLC-PG ranged from 150 to 200 nm, and polydispersity index was in the range of 0.101-0.177, indicating monodispersed particle size distribution. Optical microscopy showed no sedimentation or recrystallization of curcumin even at 10,000 µg/ml concentration as NLC-PG in distilled water, indicating significantly enhanced solubility. TEM image showed that the nanoparticles were monodispersed with a multilayered core/shell structure. X-ray diffraction and FTIR spectroscopy showed that curcumin was amorphous in the NLC-PG, and there was no interaction between curcumin and the excipients. In vitro release study using simulated gastric/intestinal fluid media revealed that the release rate (Jss) of curcumin from the NLC-PG increased as a function of the ginsenoside content in the lipid carrier. Moreover, the Jss of curcumin kept gradually increasing in the presence of lipase, whereas in the presence of viscozyme, it sharply increased until the ginsenoside content reached 9.09% and subsequently plateaued. Partially hydrolyzed ginsenoside increased the Jss of curcumin from curcumin-loaded NLC-PG and therefore may be useful for improving the bioavailability of curcumin.

Trismus in head and neck cancer patients treated by telecobalt and effect of early rehabilitation measures.

CONTEXT: Trismus is one of the common late side effects of radiotherapy (RT) of head and neck cancers. It occurs in about 30% of patients treated by telecobalt. It, in turn, leads to significant morbidity, including malnutrition, difficulty in speaking, and compromised oral hygiene with severe psychosocial, and economic impacts. AIMS: To determine the prevalence of trismus and its progression in patients who have received radical concurrent chemoradiation for head and neck cancer by telecobalt at our institution. To note the effect of early rehabilitative measures on the severity of trismus and to assess its impact on the quality of life (QOL). SUBJECTS AND METHODS: A total of 47 evaluable patients of head and neck cancer patients treated by telecobalt with radical intent between January 2012 and December 2013 were analyzed and baseline maximal inter-incisal opening (MIO) and MIO at the completion of RT, after 3 months, 6 months, and 1 year, after completion of RT were noted. Grading of trismus was done using Modified Common Toxicity Criteria (CTCAE Version 3.0). QOL assessment was done using European Organization for Research and Treatment of Cancer QLQ-HN35. The time when the rehabilitative measures were started were also noted. STATISTICAL ANALYSIS USED: Chi-square test with Fisher exact probability test and Students t-test. RESULTS: Radiation-induced trismus (RIT) was seen in 31.9%, 34.04%, and 38.39% of cases at 3, 6, and 12 months after completion of RT. Grade II and III trismus accounted for 17.02% and 6.38% at the end of 1 year. Patients who started regular rehabilitative exercises soon, after completion of RT had a better mean MIO as compared to those who were not compliant (32 mm vs. 24 mm at 1 year), and there was a trend toward delayed progression in them. Trismus was also seen to adversely affect QOL of the patients. CONCLUSIONS: RIT is a major cause for late morbidity in patients treated with conventional RT leading to poor QOL. Early rehabilitative measures are useful in preventing progression of trismus.

The role of phosphoenolpyruvate carboxykinase in neuronal steroidogenesis under acute inflammation.

Phosphoenolpyruvate carboxykinase (PEPCK) is a key gluconeogenic enzyme found in many tissues throughout the body including brain. In the present study, we have investigated the effect of bacterial lipopolysaccharide (LPS) on PEPCK and its role in neuronal steroidogenesis. Adult female albino rats were administered LPS (5mg/kg body weight) to induce acute inflammation. LPS administration resulted in a significant increase of PEPCK mRNA expression with concomitant increase in mRNA levels of steroidogenic acute regulatory (StAR) protein and other steroidogenic enzymes including 3ß-hydroxysteroid dehydrogenase (3ß-HSD), 17ß-hydroxysteroid dehydrogenase (17ß-HSD) and aromatase in brain tissue. Further, the inhibition of PEPCK expression by glipizide significantly decreased the mRNA expression of steroidogenic proteins and concurrently increased the mRNA levels of proinflammatory cytokines under LPS administration. The results of this study suggest a novel finding that PEPCK may have an important role in neuronal steroidogenesis; which serves as an adaptive response under inflammation.