Comparative Study between Bupivacaine-Dexmedetomidine versus Bupivacaine-Dexamethasone in Skin Infiltration as Post-Operative Analgesia for Patients undergoing Abdominoplasty Surgeries

Abstract Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Aim of the Work To compare skin infiltration with bupivacaine-dexmedetomidine mixture versus bupivacaine-dexamethasone mixture for analgesia in abdominoplasty under general anesthesia. Patients and Methods A prospective randomized clinical trial study was conducted in Ain Shams university hospital on 40 adult patients undergoing Abdominoplasty surgeries. The patients were randomly divided into two groups using their computer-generated random numbers will be enrolled in group I for bupivacaine-dexmedetomidine and group II for bupivacaine-dexamethasone. Results This study demonstrated that the addition of dexmedetomidine to wound infiltration with local anesthetics improves postoperative pain and reduces the need for analgesics. Conclusion Wound infiltration with bupivacaine -dexmedetomidine mixture provides prolonged local anesthetic effect, decreases the need for rescue analgesics, and provides better sedation than bupivacaine–dexamethasone mixture in patients undergoing Abdominoplasty surgeries.

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A comparative study between bupivacaine-dexmedetomidine mixture versus bupivacaine-magnesium mixture in Pre-incision skin infiltration for para-umbilical hernia repair regarding their intraoperative and postoperative analgesic effect

QJM ◽

10.1093/qjmed/hcab086.089 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Nahla Y Kandeel ◽

Mohsen A Bassiony ◽

Ahmed K Soliman ◽

Heba F Toulan

Keyword(s):

Hernia Repair ◽

Umbilical Hernia ◽

Pain Treatment ◽

Incisional Hernia Repair ◽

University Hospital ◽

Wound Infiltration ◽

Treatment Protocols ◽

C Fibers ◽

Umbilical Hernia Repair ◽

Skin Infiltration

Abstract Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Aim of the Work to compare skin infiltration with bupivacaine-dexmedetomidine mixture versus bupivacainemagnesium mixture for analgesia in patients undergoing para-umbilical hernia repair under general anesthesia. magnesium. Results This study demonstrated that the addition of dexmedetomidine to wound infiltration with local anesthetics improves postoperative pain and reduces the need for analgesics which can be explained by different mechanisms: inhibition of painconduction in C -fibers, decreased in the production of inflammatory cytokines, the vasoconstrictive effect of 2 on vascular smooth muscle prolongs the time of analgesia, inhibition of tetrodotoxin-sensitive Na+ channels, and the absorption of dexmedetomidine to systemic circulation resulting in supraspinal analgesia. Patients and Methods A prospective randomized clinical trial study was conducted in Ain Shams university hospital on 44 adult patients undergoing para umbilical hernia or infra umbilical incisional hernia repair. The patients were randomly divided into two groups using their computer-generated random numbers will be enrolled in group D for bupivacaine-dexmedetomidine and group M for bupivacaine- Conclusion Pre-skin incision wound infiltration with dexmedetomidine–bupivacaine mixture provides prolonged local anesthetic effect, decreases the need for rescue analgesics, and provides better sedation than bupivacaine–magnesium sulfate mixture or bupivacaine alone in patients undergoing surgeries for hernia repair.

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Comparative Study between Ultrasound Guided Oblique Subcostal Transversus Abdominis Plane Block and Local Wound Infiltration as Postoperative Analgesia in Hepatectomy

QJM ◽

10.1093/qjmed/hcab086.079 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mostafa Noshy Mohamed El-Hanafy ◽

Amr Mohamed El-said Kamal ◽

Alfred Maurice Said ◽

Amr Ahmed Kasem

Keyword(s):

Pain Treatment ◽

Analgesic Efficacy ◽

Bowel Function ◽

Transversus Abdominis ◽

Tap Block ◽

Transversus Abdominis Plane ◽

University Hospitals ◽

Wound Infiltration ◽

Treatment Protocols ◽

Pain Scores

Abstract Background Poorly controlled acute pain after hepatectomy is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Objective to assess the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared local wound infiltration after hepatectomy regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). The study was conducted on 60 randomly chosen patients aged 18 to 60 years, American Society of Anesthesiologists (ASA) class I ,II and III scheduled for hepatectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 30 patients each: Results The results of the study revealed that there is Patients receiving TAP block had significantly lower pain scores for 12 h after operation and decrease total need of analgesic in first 24 h post operative compared with patients who received wound infiltration. Conclusion oblique subcostal TAP block was effective in reducing postoperative pain scores at rest and movement for 12-24 hours and lower total 24-h postoperative opioid and analgesic consumption after hepatectomy under general anesthesia, compared to local wound infiltration.

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Comparitive Study Between Ultrasound Guided Rectus Sheath Block versus Local Wound Infiltration for Post-Operative Analgesia in Patients Undergoing Midline Exploratory Surgeries

QJM ◽

10.1093/qjmed/hcaa039.077 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

H O Mahmoud ◽

A M Elhennawy ◽

M M M M Ali ◽

A A A Abdelhalim

Keyword(s):

General Anaesthesia ◽

Pain Treatment ◽

Rectus Sheath ◽

Analgesic Efficacy ◽

Bowel Function ◽

University Hospitals ◽

Wound Infiltration ◽

Duration Of Action ◽

Treatment Protocols ◽

Rectus Sheath Block

Abstract Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress. respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Objective To assess the postoperative analgesic efficacy of Rectus Sheath Block (RSB) compared local wound infiltration after midline incision regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods All patients were informed with the procedure US guided RSB block and were trained to use the visual analogue scale (VAS). The study was conducted on 50 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective midline exploratory surgery. In Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 25 patients each: RSB block Group: received general anaesthesia and 20 ml of 0.25% bupivacaine on each side under ultrasound guidance. Local wound infiltration: received general anaesthesia and with 0.25% bupivacaine 20 ml at surgical site. Results The results of the study revealed that there is Patients receiving RSB block had significantly lower pain scores at rest for 12 h and on mobilization for 6 h after operation and decrease total need of analgesic in first 24 h post-operative compared with patients who received wound infiltration of local aneasthetic. Conclusion U/S-guided rectus sheath block is as effective analgesic technique as local infiltration of the surgical wound, with longer duration of action and pethidine -sparing effect during the postoperative period after midline exploratory surgeries.

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Comparative study between Bilateral U/S guided Transversus Abdominis Plane Block versus local wound infiltration for post-operative pain management in lower abdominal surgeries

QJM ◽

10.1093/qjmed/hcaa039.027 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M M H Nafie ◽

D S Mahmoud ◽

M M Kamal ◽

A G M Mohie

Keyword(s):

Abdominal Surgery ◽

Pain Treatment ◽

Analgesic Efficacy ◽

Transversus Abdominis ◽

Tap Block ◽

Transversus Abdominis Plane ◽

University Hospitals ◽

Wound Infiltration ◽

Treatment Protocols ◽

Pain Scores

Abstract Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Objective to assess the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared local wound infiltration after lower abdominal surgery regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). The study was conducted on 100 randomly chosen patients aged 25 to 55 years, American Society of Anesthesiologists (ASA) class I or II scheduled for lower abdominal surgery in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 50 patients each: Results The results of the study revealed that there is Patients receiving TAP block had significantly lower pain scores for 12 h after operation and decrease total need of analgesic in first 24 h post operative compared with patients who received wound infiltration. Conclusion Bilateral TAP block was effective in reducing postoperative pain scores at rest and movement for 8-12hours and lower total 24-h postoperative opioid and analgesic consumption after lower abdominal surgeries under general anesthesia, compared to local wound infiltration..

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Comparison of Human Thymus Gland between Young and Old Age

10.53350/pjmhs211561907 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1907-1909

Author(s):

Faiza Mehboob ◽

Ponum Mirani ◽

M. Kamran Ameer ◽

Khurram Shabeer ◽

Muhammad Ali Qamar ◽

...

Keyword(s):

Connective Tissue ◽

Old Age ◽

Age Groups ◽

Young Age ◽

University Hospital ◽

P Value ◽

Old Patients ◽

Human Thymus ◽

Group I ◽

Significant Difference

Aim: Study was conducted to examine the different parameters of human thymus glands of young and old patients and compare the findings between both age groups. Study Design: Comparative/observational study Place and Study: Study was conducted at Anatomy department of Nishtar Medical University Hospital, Multan for duration of six months from 15th January 2020 to 15th July 2020. Methods: Total 54 specimens of human thymus of 54 patients were enrolled in this study. All specimens were divided in to two groups I and II, Group I contains 27 patients with ages <30 years and group II with 27 patients having ages 45 to 60 years. All specimens were fixed in 10% formalin solution and then processed for paraffin embedding. Compare the different parameters such as thickness of interlobular connective tissue and thymic capsule, length and number of Hassal’s corpuscles between both groups. Data was analyzed by SPSS 24.0. Results: In group I 12 (44.44%) patients were ages <15 years and 15 (55.56%) patients were ages >15 years. In group 13 (48.15%) and 14 (51.85%) patients were ages <50 years and >50 years. There was a significant difference observed between both groups regarding thickness of interlobular connective tissue and thymic capsule, quantity and length of Hassal’s corpuscles with p-value <0.05. Conclusion: It is to be concluded that patients with young age had significantly less thickness of thymic capsule and interlobular connective tissue with more in number and decreasing size of Hassal’s corpuscles as compared to old age patients. Keywords: Human Thymus Glands, Young Age, Old Age

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Early versus delayed operative management of appendicular mass

QJM ◽

10.1093/qjmed/hcab097.043 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hassan sayed Tantawy ◽

Amr Mohamed El Hefny ◽

Ahmed Yasser Abd El Halim ◽

Mohammed Ali Abdel Ghaffar Nasr

Keyword(s):

Retrospective Study ◽

Acute Abdomen ◽

Defense Mechanisms ◽

Operative Management ◽

University Hospital ◽

Greater Omentum ◽

Abdominal Ultrasonography ◽

Military Hospitals ◽

Group I ◽

Appendicular Mass

Abstract Background Acute appendicitis is one of the most common causes of acute abdomen. It may be either complicated or uncomplicated. Sometimes the acute inflammation of the appendix may be enclosed by the patient’s own defense mechanisms to form inflammatory phlegmon. Complicated appendicitis is a palpable appendiceal mass, phlegmon, or a localized abscess. A phlegmon is an inflammatory tumor consisting of the inflamed appendix, with the greater omentum and adjacent viscera. Aim of the Work To determine the preferred approach taken to the management of the appendicular mass, to compare between acute appendectomy and delayed surgical intervention for appendicular mass, and to determine patient outcome following appendectomy for appendicular mass. Material and Methods: Study A retrospective study. Study Setting The study has been conducted in Ain Shams University Hospital (El-Demerdash) and military hospitals in Cairo and Alexandria under supervision of thesis supervisors. Study Period The study retrospectively analyze data of patients diagnosed as appendicular mass between January 2017 and December 2017. Study Population: Inclusion Criteria Patients with acute abdomen, diagnosed as appendicular mass by clinical examination and imaging (US and CT). Exclusion Criteria Females with right ovarian problems. Cases with right ureteric stones. Cases of recurrence. Abdominal ultrasonography and CT did not confirm the mass. Results The present study was a descriptive, retrospective, study that included 20 patients diagnosed with appendicular mass attended to surgery clinics at El-Demerdash and Military hospitals between January 2017 and December 2017. The patients were divided into two groups: Group I including 10 patients started conservative treatment then received delayed appendectomy. Group II including 10 patients received early appendectomy. Conclusion In conclusion, early appendicectomy is a safe and superior option in patients with appendicular mass compared to delayed appendicectomy. The results indicate that early appendicectomy leads to shorter hospital stay and return to normal activities than delayed appendicectomy. Moreover, postoperative difficulties and complications were less following early appendicectomy. The early appendectomy appears to achieve more favorable outcomes in patients with more severe symptoms, high fever, and high inflammatory markers. Nonetheless, more studies are necessary to confirm our findings.

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Urinary N-telopeptide- A diagnostic Test or A Screening Test?

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v10i2.424 ◽

2019 ◽

Vol 10 (2) ◽

pp. 1298-1301

Author(s):

Ganesan G Ram ◽

Jambu N

Keyword(s):

Diagnostic Test ◽

Roc Curve ◽

Gold Standard ◽

Screening Test ◽

Dual Energy ◽

University Hospital ◽

Control Group ◽

X Ray ◽

Dexa Scan ◽

Group I

Dual-energy X-ray absorptiometry (DEXA) scan is the gold standard investigation for diagnosing osteoporosis. The limitations of "gold standard" Dual-energy X-ray absorptiometry scan were many. The aim of this study is to find whether urinary n telopeptide can be used to diagnose osteoporosis — prospective cohort study done at Sri Ramachandra Medical University between August 2014 to December 2018. The study was done amongst the postmenopausal females and older males who came to the University hospital as an inpatient or an outpatient with suspected osteoporosis. We had 110 persons participated in the study. The patients were divided into two groups. Group, I was cases whose Dexa scan was osteoporosis/ osteopenia, and Group II was a control that had standard Dexa. The results from Dexa Scan are taken as the gold standard against urinary n telopeptide and a 2x2 table formed. Sensitivity, specificity, positive predictive value, likelihood ratio, area under ROC curve will be calculated. The mean value of urinary N Telopeptide in the case group was 182.5 and in control group was 49.8. The ROC curve was formed and cut off was calculated to be 71. Urinary N telopeptide can very well be considered as a diagnostic test and can’t be considered as a gold standard diagnostic test as there is some limitation as it is a bone resorption biomarker having some pre-analytical and biochemical variability which can alter the results. It can be used as an adjuvant and as a screening test along with gold standard Dexa in diagnosing osteoporosis.

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Challenges in Steroid and Anticoagulant Therapy in Severe COVID-19 Pneumonia: A Prospective Study

Antibiotics ◽

10.3390/antibiotics10101214 ◽

2021 ◽

Vol 10 (10) ◽

pp. 1214

Author(s):

Alaa Thabet Hassan ◽

Alaa E. Abd Elmoniem ◽

Marwa Mahmoud Abdelrady ◽

Mona Embarek Mohamed ◽

Mohamed A. Mokhtar ◽

...

Keyword(s):

Treatment Protocol ◽

Severe Pneumonia ◽

High Risk Group ◽

University Hospital ◽

Treatment Protocols ◽

Neutrophil Lymphocyte Ratio ◽

Treatment Type ◽

Acute Kidney Disease ◽

Significant Difference ◽

Group B

Background: As COVID-19 has neither a standard treatment protocol nor guidelines, there are many treatment protocols for anti-inflammatory corticosteroids and anti-coagulations for severe COVID-19 pneumonia patients. This study aimed to assess the most suitable modality in this high-risk group. Methods: A prospective, experimental study design was adopted that included 123 severe COVID-19 pneumonia patients admitted at Assiut University Hospital. Patients were divided into three groups according to a combined corticosteroid and anticoagulants therapy protocol. Group A included 32 patients, group B included 45 patients, and group C included 46 patients. Assessment of cases was conducted according to the treatment type and duration, weaning duration from oxygen therapy, length of hospital and ICU stay, and complications during treatment. Three months follow-up after discharge was performed. Results: the three patient groups showed significant differences regarding the 3-month outcome, whereas Group C showed the highest cure rate, lowest lung fibrosis, and lowest mortality rate over the other two groups. The in-hospital outcome, the development of pulmonary embolism, bleeding, hematoma, acute kidney disease, and myocardial infarction showed a significant difference between groups (p values < 0.05). Mortality predictors among severe COVID-19 patients by multivariable Cox hazard regression included treatment modality, history of comorbid diseases, increased C reactive protein, high neutrophil-lymphocyte ratio, and shorter ICU and hospital stay. Conclusion: the use of combined methylprednisolone and therapeutic Enoxaparin, according to a flexible protocol for COVID-19 patients with severe pneumonia, had two benefits; the prevention of disease complications and improved clinical outcome.

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COMPARATIVE STUDY BETWEEN THE EFFECT OF HISTAMINE RECEPTOR ANTAGONISTS OF TYPE II (FAMOTIDINE) AND PROTON PUMP INHIBITORS (OMEPRAZOLE) ON THE EFFICACY OF CALCIUM CARBONATE AS PHOSPHATE BINDER IN HAEMODIALYSIS PATIENT

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2017v9i8.12072 ◽

2017 ◽

Vol 9 (8) ◽

pp. 10

Author(s):

Hossam Aboelyazeed ◽

Sahar El-haggar ◽

Kamal Okasha

Keyword(s):

Calcium Carbonate ◽

Serum Calcium ◽

Phosphate Binder ◽

Renal Dialysis ◽

University Hospital ◽

Control Group ◽

Group Iii ◽

Group I ◽

Group Ii ◽

Pre Treatment

Objective: The purpose of this study was to compare the effect of famotidine versus omeprazole on the efficacy of calcium carbonate as a phosphate binder in the hemodialysis patient.Methods: From February 2014 to June 2014 a total number of 64 patients of both sexes were recruited from the department of renal dialysis, Tanta University Hospital, Egypt. Patients categorized into 3 groups. Group I (control group) consisted of 20 Patients (10) females and (10) males take calcium carbonate (caco3) (2.5–4 g/d) only, Group II consisted of 21 Patients (13) females and (8) males take the same dose of caco3 with famotidine 10 mg/d and Group III consisted of 23 Patients (8) females and (15) male take the same dose caco3 with omeprazole 20 mg/d.Results: All data are expressed as the mean±SD. Group II showed a significant increase (p<0.05) in serum phosphorus at 3rd mo with significant decreased (p<0.05) in serum calcium comparing with pre-treatment. Group III showed no significant change (p>0.05) in serum calcium, phosphorus and parathyroid hormone (PTH) comparing with pre-treatment. Both groups (II and III) showed a significant decrease in alkaline phosphatase (ALP) (p<0.05).Conclusion: Co-administration of famotidine with calcium carbonate aggravates hyperphosphatemia and this may increase the incidence of complications. The efficacy of calcium carbonate as a phosphate binder was not affected by co-administration of omeprazole.

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The Prevalence of Nondiabetic Renal Diseases in Patients with Diabetes Mellitus in the University Hospital of Ribeirão Preto, São Paulo

Journal of Diabetes Research ◽

10.1155/2020/2129459 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Diego Agra Souza ◽

Gyl Eanes Barros Silva ◽

Igor Lima Fernandes ◽

Dyego José Araújo de Brito ◽

Monique Pereira Rêgo Muniz ◽

...

Keyword(s):

Diabetes Mellitus ◽

Membranous Glomerulonephritis ◽

Sao Paulo ◽

Group Iv ◽

University Hospital ◽

Renal Diseases ◽

Group I ◽

Patients With Diabetes ◽

The University ◽

Time Since Diagnosis

Objective. To evaluate the prevalence of nondiabetic renal diseases (NDRDs) in renal biopsies of patients with diabetes mellitus (DM) in the University Hospital of Ribeirão Preto, São Paulo. Research Design and Methods. We conducted a retrospective study including kidney biopsies performed in diabetic patients between 1987 and 2013. We evaluated 79 biopsies during this period. The primary variable was the prevalence of NDRD in patients with DM. The secondary variables were the presence of systemic arterial hypertension (SAH), hematuria, time since diagnosis of DM, serum creatinine, and proteinuria levels. The cases were divided into the following groups: isolated diabetic nephropathy (DN—group I), isolated nondiabetic renal diseases (NDRD—group II), associated NDRD/DN (group III), and associated NDRD+NDRD/DN (group IV). Results. Most of the patients (58.22%) presented only alterations arising from DN. NDRDs were present in 41.77% of the patients. Membranous glomerulonephritis (30.3%) and IgA nephropathy (24.24%) were the most prevalent NDRDs. We found no differences between female and male patients with NDRD when assessing the secondary variables. A time since diagnosis of five years or less revealed a statistical difference (p=0.0005) in the comparison between the isolated DN (group I) and the NDRD+NDRD/DN (group IV). The other secondary variables were not significant in the comparison of the groups. Conclusions. We concluded that the prevalence of NDRD is 41.77%. Membranous glomerulonephritis was the most prevalent NDRD in our study. We also conclude that the probability of the presence of NDRD with or without concomitant DN is greater for patients who had biopsies with a time since diagnosis of five years or less. A time since diagnosis of ten years or more does not allow the exclusion of the presence of NDRD.

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