Magnesium sulphate within multimodal analgesia, pre-emptive, or preventive analgesia

Background Magnesium (Mg) is a non-competitive N-methyl d-aspartate receptor antagonist with antinociceptive effects. Multimodal therapy is the optimal strategy for perioperative pain control to minimize the need for opioids. Inflammation caused by tissue trauma or direct nerve injury is responsible for the perioperative pain. The concept of “pre-emptive” analgesia, analgesic strategies administered prior to the stimulus, can modify the peripheral and central nervous system processing of noxious stimuli, thereby reducing central sensitization, hyperalgesia, and allodynia remains controversial. A more encompassing approach to the reduction of postoperative pain is the concept of “preventive” analgesia. The purpose of the study is to detect the proper use of MgSO4 as an analgesic being a non-competitive N-methyl d-aspartate (NMDA). Results There is no statistically significant difference in the haemodynamic parameters, intraoperative (33% vs 20%) and postoperative requirement for analgesics 6.6% vs 10% among groups I and II, respectively. There is no significant difference in the numerical analogue scale, where 16 vs 17 patients with no pain, 12 vs 10 with mild pain, and 2 vs 3 with moderate pain in groups I and II, respectively. Conclusion The use of MgSO4 in a bolus with or without infusion is comparable in the control of intraoperative and postoperative pain.

Review on the performance characteristics and quality standards of motorcycle protective clothing

Motorcycle protective clothing is designed to protect motorcyclists from injuries during accidents. It helps to protect the motorcyclist and pillion passengers during the collision and acts as a barrier between the rider’s skin and tarmac surface. Soft tissue trauma is common in motorcycle accidents and protective clothing can protect the soft tissue of the riders up to a certain extent during accidents. Though there are many reasons for road accidents and injuries, the reasons such as uncomfortable clothing, thermally inefficient protective clothing during hot climatic conditions, and ineffective performance of the personal protective equipment (PPE) are also to be considered seriously. Motorcycle clothing is specially designed in such a way that it could give better protection against impact and abrasion during the collision. An increase in the usage of the motorcycle has also in turn increased the crash statistics. This paper deals with the significance of motorcycle clothing, materials, test standards, and their performance characteristics. As per the review results, most of the motorcycle protective clothing has failed to meet out the quality standard protocols. Impact resistance, abrasion resistance, thermal comfort, and ergonomics are the major areas where more focus is required. Design of appropriate fabrics assuring requisites of motorcycle clothing is very challenging and extensive research is still intended in these areas.

Multiple ligament knee injuries: Clinical practice guidelines

Multiple ligament knee injuries involve tears of two or more of the four major knee ligament structures, and are commonly noted following knee dislocations. These devastating injuries are often associated with soft-tissue trauma, neurovascular deficit, and concomitant articular cartilage or meniscus tears. The complexity of presentation, and spectrum of treatment options, makes these injuries unique and extremely challenging to even the most experienced knee surgeons. A high level of suspicion, and a comprehensive clinical and radiological examination, is required to identify all injured structures. The current literature supports surgical management of these injuries, with cruciate reconstructions, and repair/augmented repair/ reconstruction of collateral ligaments. This review article analyses management principle of multiple ligament knee injuries, and formulates clinical practice guidelines with treatment algorithms essential to plan individualized management of these complex heterogeneous injuries.

Outcomes and Complications Associated with Acute Gunshot Fractures in Cats and Dogs

Objective The aim of this study was to summarize outcomes and complications of gunshot fracture management in small animals. Study Design Review of cats and dogs with radiographically confirmed acute gunshot fractures, presenting data on signalment, fracture location, fracture management (surgical vs. non-surgical, type of surgical repair), fracture comminution, extent of soft tissue trauma, postoperative complication and overall outcome. A poor outcome was defined as patient death, major postoperative complication or limb amputation (both as primary treatment or secondary to postoperative complications). Results Ninety-seven animals with 137 acute gunshot-induced fractures were identified. There were 21 (15.3%) maxillofacial, 16 (11.7%) vertebral column, 8 (5.8%) rib, 56 (40.9%) distal long bone (below stifle/cubital joint) and 36 (26.3%) proximal long bone (at or above stifle/cubital joint) fractures. Overall, 20/37 cases with sufficient follow-up details incurred a poor fracture outcome. Extensive soft tissue trauma at the fracture site was associated with an increased likelihood of poor outcome. The most common poor outcomes were primary limb amputations (7 cases) and postoperative complications (3 osteomyelitis/surgical site infections, 4 delayed/non-unions). Conclusions Gunshot fractures overall have high likelihood of poor outcome. Severe soft tissue injury is associated with complications. Mitigating poor outcome likely requires early aggressive wound management.

Obstetrical Soft Tissue Trauma during Spontaneous Vaginal Birth in the Romanian Adolescent Population—Multicentric Comparative Study with Adult Population

Romania is a country with high rates of adolescent births, associating scarce comprehensive obstetrical management with this specific population. This research aims to assess soft tissue trauma after vaginal birth in teenage mothers compared to their adult counterparts. A retrospective case-control study was conducted for one year in two hospitals. All vaginal deliveries were considered; the age cut-off value was considered at 20 years old for case and control groups. Lacerations were divided into three subgroups, considering the involved anatomical region; group I: labial and periurethral lacerations, group II: vaginal and perineal lacerations, and group III: cervical lacerations. There were 1498 women included in the study: 298 young mothers and 1200 adults. Teenagers were more likely to have an episiotomy during vaginal delivery compared to adult women: 56% versus 26.7% (p = 0.00, Pearson Chi-square) and a 1.89 times increased risk for developing additional group II lacerations: p = 0.01, Pearson Chi-square test with Bonferroni correction: OR = 1.89, 95% CI: 1.18–3.02. Group II lacerations were the most frequent type of birth trauma in both study groups. Fetal weight ≥4000 g was associated with a two times higher risk for vaginal and perineal lacerations when age criterion was not considered (OR = 1.98, 95% CI: 1.13–3.47, p = 0.01). The incidence of group I and II lacerations increased with age: from 0% and 9.1% between 10 and 14 years old to 6% and 26.2% between 18 and 19 years old. All groups of lacerations were more often identified in the case group, compared to the adult group. Fetal macrosomia and spontaneously ruptured membranes at admission could not be documented as risk factors for obstetrical injury in young mothers. Episiotomy performed in teenagers was not a protective procedure for group II lacerations.

Minimal Invasive Technique for The Esthetic Management of Midline Diastema: A Case Report

It is a case report of a minimally invasive technique for diastema restoration with sectional veneer fabrication. It involves a technically demanding procedure and less time with minimal disruption and stress to soft tissue. The method presented in this case report depicts the closure of anterior spacing by an aesthetic sectional veneer. Successful restoration in present-day dentistry includes minimal biological cost, promising longevity and esthetic integration in addition to traditional criteria. However, several other factors influence patient acceptance, such as the uncomplicated technique, possible intraoral repair, reduced soft tissue trauma, and affordable financial cost. The clinical procedure of sectional veneers, presented in this case, introduces an additional treatment option to produce a minimal invasive diastema restoration in a single appointment, with a reduced number of clinical steps. Keywords: Midline Diastema, Maxillary Anterior Diastema, Minimal Invasion Techniques, Esthetical Management, Partial Veneers

Types and causes of chronic pain after laparoscopic operations

Laparoscopy has been introduced as a minimally invasive approach that has been developed to achieve the intended outcomes by open surgeries but with less frequent body injuries and complications. However, evidence indicates that the reported favourable outcomes are mainly based on retrospective data and using historical controls and only a few prospective investigations and clinical trials were published. Furthermore, studies have also demonstrated that following laparoscopy, severe pain can develop similar to or equal to the pain reported during open surgeries that develop within the earliest hours due to the significant tissue trauma introduced by laparoscopy. The present literature review discussed the different causes and types of chronic pain following laparoscopy. We also shed more light on the potential mechanisms and pathophysiology that attributes to the development of pain following laparoscopy. Many studies have indicated the development of chronic pain after 3, 6 and 12 months after hysterectomy, cholecystectomy, nephrectomy, colorectal surgeries and other abdominal surgeries. The development of postoperative main might be attributed to the tissue or nerve injury and associated inflammatory status that can also aid to the development of pain in such settings. Evidence also shows that the incidental pain following laparoscopy is similar or superior to that following open surgeries. Therefore, further interventional approaches are needed to enhance the outcomes.

Postpartum Hemorrhage: Kegawatdaruratan dalam Persalinan Ibu Hamil

Postpartum hemorrhage merupakan penyebab kematian tertinggi pada ibu hamil utamanya pada negara berkembang. Hal ini disebabkan oleh berbagai kondisi yang di kelompokkan dalam 4T yaitu tone, tissue, trauma, dan trombosis namun atoni uteri yang termasuk dalam kelompok tone menempati posisi teratas. Tingginya angka kematian di negara berkembang memiliki korelasi dengan penatalaksanaan manajemen aktif kala tika. Ketersediaan oksitosin dan uterotonikyang terbatas di berbagai wilayah menyebabkan manajemen aktif kala tiga tidak bisa dilakukan, hal ini berpotensi tinggi berujung pada postpartum hemorrhage. Di lain sisi, aspek kultur budaya, sosial, ekonomi, dan tingkat pendidikan dari masyarakat juga mempengaruhi tingkat mortalitas dari postpartum hemorrhage. Postpartum hemorrhage terjadi dengan cepat dan tak terprediksi sehingga klinisi harus segera menyadari saat hal ini terjadi. Hingga saat ini belum ada algoritma tatalaksana yang pasti terkait pencegahan postpartum hemorrhage namun kunci dari keberhasilan penanganan adalah identifikasi penyebab perdarahan yang akurat dan cepat. Identifikasi dari postpartum hemorrhage dapat dilakukan dengan Obstetric Shock Index (OSI), sistem pengukuran menggunakan Quantitative Blood Loss (QBL), dan The Rule of 30. Penatalaksanaan terkait postpartum hemorrhage disesuaikan dengan kondisi dari ibu saat persalinan dan juga tahapan persalinan. Pasien dengan resiko postpartum hemorrhage akan mendapatkan tatalaksana yang berbeda baik pada kala satu, kala dua, dan kala tiga. Kunci dari pencegahan postpartum hemorrhage adalah dengan pemberian oksitosin dan uterotonik. Pencegahan dapat dilakukan dengan melakukan program pengenalan dan pemanfaatan fasilitas kesehatan serta melakukan manajemen aktif kala tiga Kata kunci: Postpartum hemorrhage, kematian, ibu hamil

The Effect of Injection of Saline Adrenaline (1/100000) 15ml versus 5ml on the Skin Edema and Thickness in Rhinoplasty Intraoperative

Background Nasal skin edema is a common result of soft and bony tissue trauma during rhinoplastic procedures. In a cosmetic surgery like rhinoplasty, skin edema can fade the cosmetic results and can lead to dissatisfaction for both the surgeon and the patient. Local saline /adrenaline injection is claimed to reduce the nasal skin edema intraoperative. Aim of the work To assess effect of injection of saline adrenaline (1/100000) 15ml versus 5ml on the skin oedema and thickness during rhinoplasty through thesis study. Subjects and Methods In this study 30 cases of rhinoplasty will be operated, 15 cases will be injected by saline adrenaline (1/100000) of 5ml and the others 15 cases will be injected by saline adrenaline (1/100000) of 15 ml, then measuring the skin oedema after 10 minutes of saline adrenaline (1/100000) injection, after 30 minutes and after 60 minutes of the injection at three sites; the dorsum, supratip and the tip of the nose by Seal Gouge Caliper (surgical caliber). Results the intraoperative skin edema was significantly decreased with local injection of large amount (15ml) of saline /adrenaline 1/100000 than the usual injected amount (5ml) saline /adrenaline 1/100000 specially at the tip and the supratip of the nose and specially at 30 min and 60 min after injection, but statistically significance difference only at 60min at the dorsum. Conclusion that the skin oedema much less with injection of 15ml of saline adrenaline (1/100000) in comparison to injection of 5ml of saline adrenaline (1/100000).

Immediate Implant Placement and Provisionalization in the Esthetic Zone: A 6.5-Year Follow-Up and Literature Review

The success of dental implant therapy in the esthetic zone requires not only functional osseointegration but also a satisfactory esthetic outcome. To establish harmony, balance, and continuity of gingival architecture between an implant restoration and the adjacent natural dentition is challenging. Immediate implant placement and provisionalization following tooth extraction have been documented as a predictable treatment modality, with fewer surgical interventions needed, to replace a missing tooth in the esthetic zone. This case report illustrates immediate implant placement and provisionalization to replace a failing maxillary right central incisor while maintaining optimal gingival esthetics. The maxillary right central incisor was extracted without flap elevation to minimize soft and hard tissue trauma. Immediately afterwards, the implant was installed using a surgical stent and restored with a provisional crown that had no occlusal contacts. During healing, no significant adverse effects were observed clinically or radiographically. This proposed treatment modality provided the patient with immediate esthetics, function, and comfort without any complications during a follow-up period of 6.5 years.