STATISTICAL ANALYSIS OF THE CASUISTRY OF A SAMPLE OF METASTATIC DISEASE IN THE SPINE

ABSTRACT Objective: The objective of this study is to present demographic data on the occurrence of spinal metastases in the service where the work was performed and to investigate the reliability of the modified Tokuhashi score in the decision making in patients with metastatic spinal cancer. Methods: We conducted a review of medical records of all cases of vertebral bone metastasis, confirmed by anatomopathological examination, from January 2009 to June 2012. Data review included demographic details, origin of the primary cancer, duration of symptoms, localization of metastases, Karnofsky performance scale and survival based on modified Tokuhashi score. We divided patients into three groups. Group A included patients with life expectancy of less than six months, group B included patients with life expectancy of between six and 12 months, and group C included patients with a life expectancy of more than 12 months. We compared the calculated survival with the current survival in the three groups with all patients followed-up to a minimum of 1 year or until death. Results: The predict survival in group A was 63.6% according to the modified Tokuhashi score, albeit group B had only 30% agreement. Conclusions: For patients in group A, the agreement rate of patient survival was better (63.4%) than that observed in patients in group B (30%). Our sample had no patient classified as group C.

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Multiple craniotomies in the management of multifocal and multicentric glioblastoma

Journal of Neurosurgery ◽

10.3171/2010.6.jns091326 ◽

2011 ◽

Vol 114 (3) ◽

pp. 576-584 ◽

Cited By ~ 43

Author(s):

Wael Hassaneen ◽

Nicholas B. Levine ◽

Dima Suki ◽

Abhijit L. Salaskar ◽

Alessandra de Moura Lima ◽

...

Keyword(s):

Postoperative Morbidity ◽

Extent Of Resection ◽

Survival Duration ◽

Karnofsky Performance Scale ◽

Complication Rates ◽

Group A ◽

Group B ◽

Performance Scale ◽

Single Lesion

Object Multiple craniotomies have been performed for resection of multiple brain metastases in the same surgical session with satisfactory outcomes, but the role of this procedure in the management of multifocal and multicentric glioblastomas is undetermined, although it is not the standard approach at most centers. Methods The authors performed a retrospective analysis of data prospectively collected between 1993 and 2008 in 20 patients with multifocal or multicentric glioblastomas (Group A) who underwent resection of all lesions via multiple craniotomies during a single surgical session. Twenty patients who underwent resection of solitary glioblastoma (Group B) were selected to match Group A with respect to the preoperative Karnofsky Performance Scale (KPS) score, tumor functional grade, extent of resection, age at time of surgery, and year of surgery. Clinical and neurosurgical outcomes were evaluated. Results In Group A, the median age was 52 years (range 32–78 years); 70% of patients were male; the median preoperative KPS score was 80 (range 50–100); and 9 patients had multicentric glioblastomas and 11 had multifocal glioblastomas. Aggressive resection of all lesions in Group A was achieved via multiple craniotomies in the same session, with a median extent of resection of 100%. Groups A and B were comparable with respect to all the matching variables as well as the amount of tumor necrosis, number of cysts, and the use of intraoperative navigation. The overall median survival duration was 9.7 months in Group A and 10.5 months in Group B (p = 0.34). Group A and Group B (single craniotomy) had complication rates of 30% and 35% and 30-day mortality rates of 5% (1 patient) and 0%, respectively. Conclusions Aggressive resection of all lesions in selected patients with multifocal or multicentric glioblastomas resulted in a survival duration comparable with that of patients undergoing surgery for a single lesion, without an associated increase in postoperative morbidity. This finding may indicate that conventional wisdom of a minimal role for surgical treatment in glioblastoma should at least be questioned.

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Comparison of the effects of Dexamethasone and Ondansetron on the Reduction of Postoperative Nausea and Vomiting following Cesarean Section under Spinal Anesthesia

Current Clinical Pharmacology ◽

10.2174/1574884715666200302122800 ◽

2020 ◽

Vol 15 ◽

Author(s):

Arash karimi ◽

Jahanbakhsh Nejadi ◽

Mahnaz Shamseh ◽

Nooshin Ronasi ◽

Mehdi Birjandi

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Postoperative Nausea ◽

Demographic Data ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Elective Cesarean Section ◽

Double Blind ◽

Group A ◽

Group B

Background: Postoperative nausea and vomiting (PONV) is a common complication associated with the use of anesthesia. Several antiemetics are used to reduce the incidence and severity of PONV. The aim of this study is to investigate the role of dexamethasone and ondansetron to treat PONV in patients undergoing cesarean section (c-section) under spinal anesthesia. Methods: This double-blind clinical trial study was performed on patients who were referred to the operating room of Haji Karim Asali Hospital of Khorramabad for elective cesarean section in 2016-17. Upon meeting the inclusion criteria, patients were allotted into two groups (n=60). Group A received 8mg of dexamethasone and group B received 4mg of ondansetron after spinal anesthesia. The Visual Analog Scale (VAS) questionnaire and Depression-Anxiety-Stress Scale (DASS) questionnaire was used for the analysis. Patients with mild to moderate stress, anxiety, and depression were included in the study. Data were analyzed using SPSS 16 software. Results: There was no difference in the demographic data of the two groups. The mean severity of nausea in group A was significantly higher than in group B. The frequency of vomiting in group A was 20 times higher than group B, which was found to be statistically significant, p = 0.018. Concerning the type of delivery with the frequency of nausea, the results showed that the frequency of nausea in group A was 3.24 times higher than group B, however, this difference was not statistically significant, p = 0.106. Conclusion: Based on the results of this study, ondansetron had a significant effect on the alleviation of postoperative nausea and vomiting, as compared to dexamethasone in c-section surgical candidates.

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Changes in the palliative performance scale may be as important as the initial palliative performance scale for predicting survival in terminal cancer patients

Palliative & Supportive Care ◽

10.1017/s1478951520001248 ◽

2021 ◽

pp. 1-5

Author(s):

Guk Jin Lee ◽

Ji Hyun Gwak ◽

Myoung Sim Kim ◽

Mi Yeong Lee ◽

Seo Ree Kim ◽

...

Keyword(s):

Cancer Patients ◽

Gastrointestinal Cancer ◽

Poor Prognosis ◽

Accurate Estimation ◽

Terminal Cancer ◽

Hospice Patients ◽

Terminal Cancer Patients ◽

Group A ◽

Group B ◽

Performance Scale

Abstract Objective The accurate estimation of expected survival in terminal cancer patients is important. The palliative performance scale (PPS) is an important factor in predicting survival of hospice patients. The purpose of this study was to examine how initial status of PPS and changes in PPS affect the survival of hospice patients in Korea. Method We retrospectively examined 315 patients who were admitted to our hospice unit between January 2017 and December 2018. The patients were divided based on the PPS of ≥50% (group A) and ≤40% (group B). We performed survival analysis for factors associated with the length of survival (LOS) in group A. Based on the hospice team's weekly evaluation of PPS, we examined the effect of initial levels and changes in group A on the prognosis of patients who survived for 2 weeks or more. Results At the time of admission to hospice, 265 (84.1%) patients were PPS ≥50%, and 50 (15.9%) were PPS ≤40%. The median LOS of PPS ≥50% and PPS ≤40% were 15 (2–158 days) and 9 (2–43 days), respectively. Male, gastrointestinal cancer, and lower initial PPS all predicted poor prognosis in group A. Male, gastrointestinal cancer, and a PPS change of 10% or greater, compared with initial status 1 week and 2 weeks of hospitalization, were all predictors of poor prognosis in group A patients who survived for 2 weeks or longer. Significance of results Our research demonstrates the significance of PPS change at 1 week and 2 weeks, suggesting the importance of evaluating not only initial PPS but also change in PPS.

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Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1740925 ◽

2021 ◽

Author(s):

Beniamino Brunetti ◽

Rosa Salzillo ◽

Stefania Tenna ◽

Bruno Brunetti ◽

Mario Alessandri Bonetti ◽

...

Keyword(s):

Functional Outcomes ◽

Locoregional Recurrence ◽

Demographic Data ◽

Exact Test ◽

Significant Difference ◽

Chi Squared ◽

Group A ◽

The Aesthetic ◽

One Year ◽

Group B

Abstract Background Evidence in literature about the best reconstructive approach after melanoma resection is controversial, with some authors advocating that tissue rearrangement flap techniques might hinder the early detection of local relapses. The aim of the present study is to evaluate oncological, aesthetic, and functional outcomes following melanoma reconstruction using pedicled perforator-based flaps. Methods The authors reviewed all patients affected by melanoma treated during a 6-year period. Demographic data, tumor characteristics, and operative variables were evaluated. Locoregional recurrence was assessed with clinical and radiological follow-up. One-year postoperatively patients rated on a 5-point Likert scale the aesthetic and functional outcomes of the procedure. Three blind observers examined preoperative and 1-year postoperative photographs and rated the aesthetic outcome of the reconstructive procedure. Results One-hundred sixty-five patients were treated with wide excision and delayed reconstruction, including pedicled perforator-based flaps in 70 patients (group A) and primary closure in 95 patients (group B). Mean Breslow thickness was 2.972 and 2.189 mm in group A and B, respectively. There was no statistically significant difference in locoregional recurrence (chi-squared test, p = 0.8333; Fisher's exact test, p > 0.9999) between the two groups. Group A reported a higher satisfaction with both the aesthetic (mean rating 4.390 in group A and 4.094 in group B) and functional (mean rating 4.732 in group A and 4.170 in group B) outcomes of the procedure, the latter being statistically significant (p = 0.0006). Conclusion This series suggests that pedicled perforator-based flaps provide optimal aesthetic and functional outcomes in melanoma reconstruction without impairing the locoregional control of the disease.

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Time out: should vitamin D dosing be based on patient's body mass index (BMI): a prospective controlled study

Journal of Nutritional Science ◽

10.1017/jns.2021.100 ◽

2021 ◽

Vol 10 ◽

Author(s):

Mir Sadat-Ali ◽

Khalid W. AlTabash ◽

Haifa A. Al-Turki ◽

Sulaiman A. AlMousa ◽

Hasan N. AlSayed

Keyword(s):

Vitamin D ◽

Vitamin D3 ◽

Standard Dose ◽

Demographic Data ◽

Controlled Study ◽

Daily Dose ◽

Calcium Phosphorus ◽

Group A ◽

Pre Treatment ◽

Group B

Abstract The recommended daily dose of vitamin D is 2000 IU was found to be insufficient in many patients. The objective of the present study is to find whether the daily dose of vitamin D should be based on BMI. Two hundred and thirty patients with an established vitamin D deficiency (serum level of 25 Hydroxy vitamin D3 (25OHD3) of ≤20 ng/ml) and patients with BMI ≥30 kg/m2 were included in the study. Demographic data, comorbidities and BMI were recorded. Pre-treatment and post-treatment serum 25OHD3, calcium, phosphorus and parathyroid hormone (PTH) were tested at 0-, 3- and 6-month periods. Patients were treated with a standard dose of 50 000 IU of vitamin D weekly and 600/1200 mg of calcium a day. Once their level of 25OHD3 reached ≥30 ng/ml, patients were randomised into two groups. Group A received a standard recommended maintenance dose of 2000 IU daily and Group B patients received 125 IU/kg/m2 of vitamin D3. The data were entered in the database and analysed. The mean age of Group A was 50⋅74 ± 7⋅64 years compared to 52⋅32 ± 7⋅21 years in Group B. In both groups, pre-treatment vitamin D level was ≤15 ng/ml and increased to 34⋅6 ± 2⋅6 and 33⋅7 ± 2⋅4 ng/ml at the end of 3 months treatment with a dose 50 000 IU of vitamin D3 and calcium 600/1200 mg once a day for group A and group B, respectively. At 6 months, patients in Group A 25OHD3 level was 22⋅8 ± 3⋅80 and in Group B was 34⋅0 ± 1⋅85 ng/ml (P < 0⋅001). This preliminary study suggests that obese patients need higher dosage of vitamin D than the recommended dose. It is prudent that the dosage should be based on the BMI to maintain normal levels for a healthy musculoskeletal system.

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A COMPARITIVE STUDY BETWEEN EPIDURAL BUTORPHANOL, NALBUPHINE AND FENTANYL FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINAL SURGERIES

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i5.16802 ◽

2017 ◽

Vol 10 (5) ◽

pp. 383

Author(s):

Swarna Banerjee ◽

Shaswat Kumar Pattnaik

Keyword(s):

Side Effects ◽

Demographic Data ◽

Age Groups ◽

Study Drug ◽

Sensory Block ◽

Lower Abdomen ◽

Post Operative Pain ◽

Catheter Group ◽

Group A ◽

Group B

Background: Achieving satisfactory post-operative analgesia with neuraxial administration of narcotics has been the subject of much research. The use of epidural opioids had become an increasingly popular technique for management of acute post-operative pain in recent times. This study evaluates post-operative analgesic benefits in patients administered epidural butorphanol, nalbuphine, and fentanyl as adjuvants with local anesthetics postoperatively for surgery under epidural anesthesia.Methods: A total of 75 patients belonging to age groups 18-60 years who were scheduled for surgeries of lower abdomen were randomly divided into groups of 25 each. Epidural technique was adopted for surgery of the lower abdomen for all patients with 0.5% bupivacaine. In the post-operative period, the study drug was given through epidural catheter. Group A received butorphanol 2 mg, Group B received fentanyl 100 μg, and Group C received nalbuphine 10 mg with 0.125% bupivacaine diluted to 10 ml in normal saline each. Onset, duration, quality of analgesia, hemodynamic changes, and side effects – such as sedation, pruritus, nausea, vomiting, respiratory depression, and urinary retention - were recorded and compared.Results: The demographic data were comparable in all three groups. The onset of sensory block was significantly earlier in Group B (fentanyl) than other two groups. Duration was significantly longer in Group A (butorphanol). No serious cardiorespiratory side effects were noted in any of groups.Conclusion: Fentanyl produces the faster onset of analgesia with adverse effects like pruritus. Butorphanol administered epidurally has the advantage of longer duration of analgesia than fentanyl or epidural nalbuphine with side effects such as nausea, vomiting, and sedation.Keywords: Epidural analgesia, Butorphanol, Fentanyl, Nalbuphine.

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Posterior Tibial Tendon Dysfunction: Its Association with Seronegative Inflammatory Disease

Foot & Ankle ◽

10.1177/107110078900900503 ◽

1989 ◽

Vol 9 (5) ◽

pp. 219-225 ◽

Cited By ~ 104

Author(s):

Mark Myerson ◽

Gary Solomon ◽

Michael Shereff

Keyword(s):

Inflammatory Disease ◽

Demographic Data ◽

Mechanical Trauma ◽

Posterior Tibial Tendon ◽

Inflammatory Disorder ◽

Posterior Tibial Tendon Dysfunction ◽

Posterior Tibial ◽

Systemic Inflammatory Disease ◽

Group A ◽

Group B

Idiopathic inflammation and rupture of the posterior tibial tendon (PTT) has received much attention in the recent literature. In this report of the presentation of PTT dysfunction as a manifestation of seronegative inflammatory disease, we describe the clinical and laboratory features of 76 patients with inflammation and/or rupture of the PTT. Analysis of all patients identified two discrete groups. Group A patients were younger (mean age 39 years) and had multiple manifestations of inflammation at other sites of ligament and tendon attachments (enthesopathy). Other features of a systemic inflammatory disorder such as oral ulcers, conjunctivitis, colitis, and especially psoriasis were common in the latter patients and their families. Group B consisted predominantly of elderly patients (mean age 64 years) with isolated dysfunction of the PTT. These two groups differed widely in the manner of clinical presentation, demographic data, family history, HLA data, and surgical pathology. These distinctions suggest different pathogeneses for posterior tibial tendinitis. Group A demonstrated local manifestations of a systemic inflammatory disease, whereas group B exhibited the effects of mechanical trauma and degeneration.

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A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation

Asian Journal of Medical Sciences ◽

10.3126/ajms.v9i1.18472 ◽

2018 ◽

Vol 9 (1) ◽

pp. 65-72

Author(s):

Erum Ozair ◽

Qazi Ehsan Ali ◽

Md Masood Husain Siddiqi ◽

Syed Hussain Amir ◽

Shagufta Naaz

Keyword(s):

Elective Surgery ◽

Pressor Response ◽

Demographic Data ◽

Hemodynamic Response ◽

T Test ◽

Chi Square ◽

Demographic Profiles ◽

Hemodynamic Variables ◽

Group A ◽

Group B

Background: Laryngoscopy and intubation are associated with a sympathetically mediated circulatory response due to irritation of respiratory tract which is associated with increase in pulse rate and blood pressure that may be dangerous.Aims and Objectives: The aim of the present study was to determine and compare the efficacy of dexmedetomidine and fentanyl in attenuating the hemodynamic response to laryngoscopy and intubation and to detect any complication or side effect as a result of these drugs.Materials and Methods: Following approval by ethical committee, 60 ASA grade I and II patients of either sex undergoing general anaesthesia for elective surgery were included in this study. Patients were randomly divided into two groups of 30 patients each. Dexmedetomidine in a dose of 1μg/kg was given to Group A patients and Fentanyl 2 μg/kg was given to Group B patients. Both the drugs were diluted with normal saline solution to make 10ml and were administered slow intravenous 10 min before induction.The hemodynamic parameters were recorded, demographic data was analyzed using unpaired t-test and hemodynamic variables were analyzed by using unpaired and paired t-test. Side effects were analyzed using chi square test.Result: The two groups were comparable in their demographic profiles. Dexmedetomidine proved itself to be an excellent drug when given intravenously as a premedicant in dose of 1μg/kg to attenuate hemodynamic response to laryngoscopy and intubation. It blunted the hemodynamic response to laryngoscopy and intubation to a greater magnitude than fentanylin a dose of 2μg/kg intravenously as a premedicant.Conclusion: We conclude that fentanyl 2μg/kg i.v. given ten minutes prior to airway instrumentation shows an inconsistent response to laryngoscopy and intubation. Between the two drugs under study, the use of dexmedetomidine 1μg/kg i.v. is satisfactory and produces a more favorable hemodynamic profile while fentanyl 2μg/kg is found to be non- dependable and less effective for the attenuation of the pressor response to laryngoscopy and endotracheal intubation. However, further larger studies are required to strengthen these conclusions.Asian Journal of Medical Sciences Vol.9(1) 2018 65-72

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The Prognostic Value of Serum APRIL Levels in Patients with Chronic Lymphocytic Leukemia

Blood ◽

10.1182/blood.v124.21.5648.5648 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5648-5648

Author(s):

Sinem Nihal Esatoglu ◽

Dilek Keskin ◽

Muge Kutnu ◽

Tugrul Elverdi ◽

Ayse Salihoglu ◽

...

Keyword(s):

Prognostic Factors ◽

Demographic Data ◽

Lymphocytic Leukemia ◽

Rank Test ◽

Healthy Controls ◽

Log Rank Test ◽

Treatment Naïve ◽

Group A ◽

Group B ◽

Time To First Treatment

Abstract Introduction: Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with variable clinical course. Several studies have been conducted to predict outcome in patients with CLL and also have been going on. A proliferation inducing ligand (APRIL) has been shown to involve in survival and resistance to apoptosis in CLL, and APRIL molecule has been investigated as a prognostic marker in CLL patients. However, there are limited and controversial data regarding APRIL and its impact on prognosis in CLL. We aimed to compare serum APRIL levels in CLL patients with those of age and gender matched healthy subjects, and to investigate the relationship between APRIL and the other common prognostic factors, and to determine whether serum APRIL levels predict time to first treatment in CLL. Methods: After ethical approval and informed consent were obtained, between May and December 2012, venous blood samples were driven from 96 CLL patients’ and 25 healthy controls’, and serum APRIL levels were measured by ELISA. Demographic data and the prognostic markers were obtained from the patients’ files, and patients have been followed for a minimum of 12 months. We tested the correlation between APRIL with the, clinical and biological parameters, and used the log rank test to compare their Kaplan Meier curves. Results: Patients were divided into three groups: Treatment naive (group A, n=49), chemotherapy receiving (group B, n=25) and who had previously received chemotherapy (group C, n=22). Median APRIL level was higher in group A (2.78 vs 1.29; p=0.034) and group C (3.54 vs 1.29; p=0.001) when compared to healthy controls, but was not different in group B (1.56 vs 1.29; p=0.3) (Figure 1). Serum APRIL level in group A was negatively correlated with hemoglobin levels (r=-0.298; p=0.037) and platelet counts (r=-0.321; p=0.025) whereas no correlation with age, Rai and Binet stages, lymphocyte counts, β2-microglobulin and CD38 levels were detected. Group A patients were also divided into 2 subgroups (APRIL levels low, n=20 and APRIL levels high, n=29) using median natural logarithm of serum APRIL level as cut off. April low and high subgroups were similar with respect to demographic data and prognostic factors. Median time to first treatment was not reached in the APRIL low group, but was 104 months in the APRIL high group (p=0.13, log-rank test). Conclusions: Among the treatment naive patients, serum APRIL levels only negatively correlate with hemoglobin levels and platelet counts. These correlations seem to be associated with tumor burden rather than the prognosis, because APRIL levels were not different in chemotherapy receiving patients compared to healthy controls. Since a median survival time could not be reached in the APRIL low group, short follow up time might be an explanation why the APRIL levels did not predict the time to first treatment. In conclusion, our findings let us to think APRIL levels are not a useful marker to predict prognosis in patients with CLL. Figure 1. Median APRIL levels of CLL patients and healthy controls (ng/mL) Figure 1. Median APRIL levels of CLL patients and healthy controls (ng/mL) Disclosures No relevant conflicts of interest to declare.

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Comparative Evaluation of the Embrasure Wire versus Arch Bar Maxillomandibular Fixation in the Management of Mandibular Fractures: Are Arch Bars Replaceable?

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0037-1603453 ◽

2018 ◽

Vol 11 (2) ◽

pp. 118-123

Author(s):

Sanjay Rastogi ◽

Tousif Ahmed ◽

Kolli Giri ◽

Ramakant Dandriyal ◽

Indra B. Niranjana Prasad ◽

...

Keyword(s):

Statistical Significance ◽

Demographic Data ◽

Study Data ◽

Mandibular Fractures ◽

Intermaxillary Fixation ◽

Maxillomandibular Fixation ◽

Arch Bar ◽

Significant Difference ◽

Group A ◽

Group B

The aim of this prospective study was to appraise the role of embrasure wiring in the treatment of mandibular fractures over the arch bar as adjunctive techniques of maxillomandibular fixation (MMF). This study was conducted on 40 patients who were surgically treated for mandibular fractures with accessory use of MMF (embrasure: group A vs. arch bars: group B). All patients were evaluated for demographic data, etiology, and location of fracture. Characteristically, the complications, including wire injury, infection, and malocclusion, were recorded. The data were analyzed using Student's t-test and chi-square test as appropriate. Statistical significance was set at p < 0.05). In this study, data from 40 patients were included. In group A (embrasure wiring), time required for placement of MMF was significantly less than (7.85 ± 0.81 minutes) that in group B, and also there was less incidence of wire prick to the operator in group A than in group B ( p < 0.05). However, in terms of wire prick and malocclusion, no statistically significant difference was noted in groups A and B ( p > 0.05). Patient treated with embrasure wiring intermaxillary fixation had better outcomes especially in terms of time of placement and less incidence of wire prick injury when compared with arch bar.

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