ĀKĀRAKARA AS DERMAL ANAESTHETIC

Nowadays, the role of local anaesthesia in the surgical field is highly appraisable. Local anaesthetics are the drugs that produce a loss of sensation over the localised areas without producing a loss of consciousness. Humans have been using various methods to block pain for thousands of years. Controlling pain during the śhastrakarma in śalyatantra has been always challenging. There has been the introduction of various methods of local anaesthetics since the origin of medical science, topical anaesthetics being one of them. Studies have been conducted to discover novel anaesthetic agents by various scholars. Herbal extracts do not stand far in the pathway of this search. Owing to these discoveries, 30% ethanolic extract gel of Ākārakara (Spilanthes calva DC.) is selected here as a topical anaesthetic to evaluate the efficacy in facilitating the management of warts by a painful procedure agnikarma. Keywords: Dermal anaesthetic, Ākārakara, Spilanthol

Comparison of efficacy of eutectic mixture of local anaesthetic with amethocaine on pain during venipuncture among term neonates in a tertiary care hospital, India

Background: Neonates are frequently subjected to painful procedures which can adversely affect future pain perception. Pain control measures during invasive procedures include non-pharmacological and pharmacological methods. One pharmacological intervention that can be used prior to a needle insertion procedure is application of a topical local anaesthetic to numb the skin. Topical anaesthetics prevent nerve impulse transmission, promoting skin analgesia by acting on the free dermal terminations. This study compares the efficacy of eutectic mixture of local anaesthetic with amethocaine on pain during venipuncture among term neonates. Methods: A randomized clinical trial was conducted with 70 term neonates who underwent venepuncture in neonatal intensive care unit of a tertiary care centre. A simple random sampling technique was used to enrol the neonates who met the inclusion criteria. Neonatal infant pain scale was used to collect the data. Descriptive and inferential statistics were used to analyse the data. frequency and percentage were used to describe the clinical and demographic variables of the study participants. The efficacy of topical local anaesthetics was analysed using independent student t test. Chi-square test was used to identify the association of level of pain with clinical and demographic characteristics of the neonate. The analysis was done with SPSS 21st version.Results: Compared to amethocaine group, in eutectic mixture of local anaesthetic (EMLA) group only lesser number of neonates experienced severe level of pain and mild to moderate level of pain. Though mean pain score in EMLA group (3.457±1.633) was lesser than amethocaine group (4.000±1.514) it was not significant (p=0.347).Conclusions: The study revealed the efficacy of topical anaesthetics in relieving pain in term neonates during venipuncture.

Management of recurrent aphthous ulcer using corticosteroids, local anesthetics and nutritional supplements

Recurrent Aphthous ulcers are the most common oral lesions among dental patients. The ulcers, which usually occur on the nonkeratinized oral mucosa, can cause considerable pain and may interfere with eating, speaking, and swallowing. Therefore, it is of interest to report data on the management of recurrent aphthous ulcer using corticosteroids, local anesthetics and nutritional supplements. Case sheets of 76 patients who underwent treatment for recurrent aphthous ulcer between June 2019 and March 2020 at the Saveetha Dental College, India were used in this analysis. Data was analyzed using Chi square test at a P value < 0.05 that is statistically significant. Results show that topical anaesthetics in population (49%) were more effective that corticosteroids. Thus, topical anaesthetics are recommended for recurrent aphthous ulcer.

Fins are relevant non-lethal surrogates for muscle to measure stable isotopes in amphibians

Stable isotope analyses (SIA) are now widely used in ecology research to quantify the trophic implications of a large range of ecological processes. Non-destructive sampling methods have been successfully developed for most vertebrates, but the validation of such methods is missing in amphibians. Filling this methodological gap is critical to reduce the significant lack of knowledge on the trophic ecology of this imperilled group. The relevance of tail fin as a surrogate for muscle, a tissue routinely used for SIA, was assessed in four amphibian species, including tadpoles and adult newts, by (1) testing the link between the isotope ratios of carbon and nitrogen in fin and muscle, and addressing the additional practical issues of (2) the effects of a topical anaesthetic on isotope ratios, and (3) the minimum quantities of fin needed for SIA to limit the severity of sampling. The isotope ratios were highly correlated between the two tissues in all four species. Equations were provided to predict muscle estimates from fin values for each species separately and grouped by their taxonomic order (anurans or urodeles), which represent a valuable solution for any other species. Topical anaesthetics had little influence on isotope ratios, and the surface of tail fin needed for SIA was small. We conclude that the tail fin of amphibians can be used as a non-lethal surrogate for muscle in SIA, and this offers promising prospects for research on the trophic ecology of amphibians, and potentially on their conservation.

Dental Practitioners’ Opinions and Methods in the Management of Oral Mucosal Lesions and TMJ Disorders in Dakshina Kannada District: A Questionnaire Based Survey

INTRODUCTION: Oral mucosal lesions and temperomandibular joint (TMJ) disorders are important areas of concern in the present dental practice due to their increasing prevalence. Timely management is important as it aids in maximal prognosis.AIMS AND OBJECTIVES: The aim of the study was to determine the awareness of dental practitioners in Dakshina Kannada district of Karnataka, regarding various aspects of oral mucosal lesions and TMJ disorders. And also to know their interest in managing such disorders.MATERIALS AND METHODS: A self- administered questionnaire was constructed and given to dental practitioners, selected through multistage cluster random sampling method; from Dakshina Kannada district. Chi-square test was performed and the level of significance was set at p < 0.05.RESULTS: The majority of dental practitioners had a dental practice of duration five to ten years. Many of the respondents (72%) indicated that oral ulcers are the most common mucosal lesions and prescribed topical anaesthetics for these. The investigations suggested were blood investigations (24%) for various oral mucosal lesions and radiographs (20%) for TMJ disorders. Different pharmacological treatments provided by the majority of the respondents were topical anaesthetics and multi vitamin supplements. About 34% dental practitioners routinely refer the patients to specialty practitioners.CONCLUSION: The present study shows that there should be emphasis on workshops and various other awareness programs for general dental practitioners for better understanding of the subject and about the latest protocols regarding referral of the patients to specialists.

Ejaculatory disorders

Ejaculatory/orgasmic disorders are common male sexual dysfunctions, and include premature ejaculation (PE), inhibited ejaculation, anejaculation, retrograde ejaculation, and anorgasmia.Premature ejaculation management is largely dependent upon aetiology. Life-long PE is best managed with PE pharmacotherapy (selective serotonin re-uptake inhibitor [SSRI] and/or topical anaesthetics). The management of acquired PE is aetiology-specific and may include erectile dysfunction (ED) pharmacotherapy in men with co-morbid ED. Behavioural therapy is indicated when psychogenic or relationship factors are present and is often best combined with PE pharmacotherapy in an integrated treatment programme. Delayed ejaculation, anejaculation, and/or anorgasmia may have a biogenic and/or psychogenic aetiology. Men with age-related penile hypoanesthesia should be educated, reassured, and instructed in revised sexual techniques which maximize arousal. No drugs have yet been approved by regulatory agencies for this purpose, and most drugs identified for potential use have limited efficacy, impart significant side effects, or are considered experimental in nature.

Toilet bronchoscopy in the ICU

Critically-ill patients retain respiratory secretions. Toilet bronchoscopy is applied to aspirate retained secretions and revert lung atelectasis. Toilet bronchoscopy is particularly indicated when retained secretions are visible during the procedureand air-bronchograms are not present at the chest radiograph. Yet, toilet bronchoscopy should only be applied when other less invasive methods of secretion removal have failed. Ventilatory settings during the intervention, the inspiratory fraction of oxygen should be increased to 100%. In volume control ventilation, the pressure limit alarm needs to be increased; during pressure-controlled ventilation, the set inspiratory pressure should be increased. The external PEEP should be decreased to at least 50% of the baseline values, to prevent barotrauma. The use of sedatives, analgesics, and topical anaesthetics is mandatory to achieve favourable procedural condition. Toilet bronchoscopy is also feasible and safe in critically-ill patients undergoing non-invasive ventilation.

Topical anaesthetics for premature ejaculation: a systematic review and meta-analysis

Eutectic Mixture of Local Anaesthetics (EMLA) is recommended for use off-label as a treatment for premature ejaculation (PE). Other topical anaesthetics are available, some of which have been evaluated against oral treatments. The purpose of this systematic review was to evaluate the evidence from randomised controlled trials (RCTs) for topical anaesthetics in the management of PE. Bibliographic databases including MEDLINE were searched to August 2014. The primary outcome was intra-vaginal ejaculatory latency time (IELT). Methodological quality of RCTs was assessed. IELT and other outcomes were pooled across RCTs in a meta-analysis. Between-trial heterogeneity was assessed. Nine RCTs were included. Seven were of unclear methodological quality. Pooled evidence (two RCTs, 43 participants) suggests that EMLA is significantly more effective than placebo at increasing IELT (P < 0.00001). Individual RCT evidence also suggests that Topical Eutectic-like Mixture for Premature Ejaculation (TEMPE) spray and lidocaine gel are both significantly more effective than placebo (P = 0.003; P < 0.00001); and lidocaine gel is significantly more effective than sildenafil or paroxetine (P = 0.01; P = 0.0001). TEMPE spray is associated with significantly more adverse events than placebo (P = 0.003). More systemic adverse events are reported with tramadol, sildenafil and paroxetine than with lidocaine gel. Diverse methods of assessing sexual satisfaction and ejaculatory control with topical anaesthetics are reported and evidence is conflicting. Topical anaesthetics appear more effective than placebo, paroxetine and sildenafil at increasing IELT in men with PE. However, the methodological quality of the existing RCT evidence base is uncertain.