Standardized Quantitative Evaluation of Clinical Effectiveness and Side Effect Profile of Subcutaneous and Sublingual Allergen-Specific Immunotherapy in Children: A 5-Year Single Center Experience

Objective: Allergen-specific immunotherapy (allergen-SIT) is a treatment method with variable efficacy in allergic diseases. This study aimed to investigate the effectiveness of allergen immunotherapy, frequency of LRs and SRs and variables affecting these parameters in patients who underwent allergen-SIT. Materials and Methods: In this study, the recorded data of 81 patients, who received subcutaneous (SCIT) or sublingual (SLIT) allergen immunotherapy for respiratory allergic diseases between 2014 and 2019, were analyzed. In asthma and/or allergic rhinoconjunctivitis (ARC) patients, the effectiveness of treatment was evaluated by analysing the change rates in disease symptom, medication and combined scores (symptom + medication) and visual analog score (VAS). Treatment success was defined by the degree of decrease in scores as; high response above 50%; low response between 20-50%; and failure <20%.Results: The mean age of allergen-SIT initiation was 11.4± 3.1 years. Diagnostic distributions of the patients were asthma (± ARC) in 64.2%, and ARC (without asthma) in 35.8%. The mode of allergen-SIT was SCIT in 77.8% (65% asthma and 35% ARC) and SLIT in 22.2% (61.1% asthma and 38.9% ARC). The main allergens used in allergen-SIT were mite (79%), grass-grain pollen (33.3%), alternaria (9.9%) and olea (8.6%). There was a significant decrease in symptoms, medication, combined and VAS scores in the asthma and ARC groups (p <0.0001), when end-SCIT values were compared to baseline. SLIT also resulted in significant decreases in these scores except asthma medication score. Among the asthma patients the rate of high-responders was 88.8% by SCIT and 50% by SLIT, according to combined asthma score. Among the ARC (without asthma) patients the rate of high-responders was 100% for both SCIT and SLIT. SCIT resulted in local (LR) and systemic side effects (SR) in 18% and 0.6% (all Grade I and Grade II) of the total injections performed. A high number of total injections was significantly associated with higher LR and SR rates. While LR was observed in 16.6% of the patients who underwent SLIT, no systemic reaction was found in any of the patients. Conclusion: SCIT was highly successful in the treatment of asthma and ARC in terms of the degree of therapeutic response. SLIT resulted in a high rate of good response in ARC patients, but a lower response degree in asthmatic patients. Systemic side effects were very low as a result of close risk monitoring and the dose adjustments performed. Keywords: Allergen-specific immunotherapy, SCIT, SLIT, efficacy, symptom score, medication score, visual analog score, side effects

Implementation of a Low-Cost 3D-Printed Feline Larynx Model for Veterinary Students

Endotracheal intubation (EI) in domestic cats is an important skill that veterinary students learn in order to perform anesthesia safely in this species. Implementing a 3D-printed larynx model (LaryngoCUBE) during the instruction process may improve student’s learning of EI in felines. Twenty-two third-year students performed EI in cats with standard training (ST), and 16 students trained with the model (MT) the day before the laboratory. It was evaluated whether training with the model decreases the time and number of EI attempts, students’ perceived difficulty performing EI using a visual analog score (VAS; 0 cm = very easy, 10 cm = extremely difficult; median [minimum–maximum]), and the incidence of failure to perform EI. The EI time on ST (58 [18–160] seconds) was longer, but not statistically different from MT (29 [13–120] seconds; p = .101). The number of EI attempts on ST (2 [1–3]) was higher than MT (1 [1–3]; p = .005). The VAS on the ST and MT were 4.5 (0.0–10.0) cm and 3.0 (0.2–10.0) cm, respectively ( p = .029). The failure rate was 27% on the ST and 25% on the MT ( p = 1.000). Students who practiced with a larynx model took fewer attempts to perform EI, tended to be faster, and found that EI was easier. However, the EI success rate in MT was not improved.

A Comparative Study between Ultrasound Guided Trans-muscular Quadratus Lumborum Block Versus Ultrasound Guided Transversus Abdominis Plane Block as postoperative analgesia in Laparoscopic Bariatric Surgery

Background A variety of unwanted post-operative consequences, including patient suffering, respiratory distress complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain are due to poorly controlled acute pain after laparoscopic abdominal surgery. Aim of the Work is to compare the analgesic efficacy of ultrasound-guided TQL with TAP block during laparoscopic bariatric surgery and to improve the outcome of the patients undergoing laparoscopic bariatric surgery under general anesthesia who suffer from postoperative pain and also in the early postoperative period regarding pain relief, decreasing postoperative opioid requirements, provision of comfort, early mobilization and improved respiratory functions. Patients and Methods The study was conducted on 40 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 20 patients each: Group TQL (n = 20): received combined general anesthesia with TQL block. Group TAP (n = 20): received combined general anesthesia with TAP block. Results TQL block has more analgesic efficacy than TAP block. The first call for rescue analgesia (Meperidine), total meperidine consumption and pain scores (visual analog score at rest and movement) indicated the superiority of the analgesic technique TQL block. Conclusion TQL with general anesthesia was more effective technique in providing analgesia after laparoscopic bariatric surgery without associated hemodynamic instability in comparison to TAP block with general anesthesia and also the first call for rescue analgesia (Meperidine), total meperidine consumption and pain scores (visual analog score at rest and movement) indicated the superiority of the analgesic technique TQL block.

Impact of dexamethasone added to intra-articular morphine and bupivaciane for post-operative analgesia after knee arthroscopy

Background Pain relief after knee arthroscopy is very important for early recovery and rehabilitation. Many drugs were used intra-articularly to prolong postoperative analgesia and diminish post-operative pain. The present study studies the effects of adding dexamethasone to intra-articular morphine and bupivacaine combination on postoperative pain after knee arthroscopy. Aim of the Work The aim of the study is to evaluate the effect of adding dexamethasone (8mg) to intra-articular morphine (10mg) and bupivacaine (25mg) injection on postoperative pain after knee arthroscopy. Patients and Methods A randomized double-blinded clinical trial was carried out on 40 patients undergoing knee arthroscopy. Patients were divided randomly into two equal groups. All drugs used were injected intra-articularly at the end of arthroscopy. In the control group, patients were administered 10mg morphine added to bupivacaine 25mg. In the study group, patients were administered 10mg morphine and 8mg dexamethasone added to bupivacaine 25mg. Visual analog score for pain at rest and movement, time to first analgesic request, total analgesic consumption, duration of analgesia and adverse effects were recorded. Results The study group showed lower visual analog score at rest and movement, prolonged postoperative analgesia, and decreased total analgesic consumption compared with the control group. Conclusion Adding dexamethasone to intra-articular combination of morphine and bupivacaine after knee arthroscopy prolongs the duration of analgesia, lowers pain scores, and decreases total analgesic consumption with no detected adverse effects.

Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for lower calyx renal stones

Background: Due to the anatomic characteristics of the lower calyx, lower polar stones are difficult to be removed through the ureter, retrograde intrarenal surgery (RIRS) can be used to deal with lower polar stones, while mini-percutaneous nephrolithotomy(mini-PCNL) is mainly used to deal RIRS failed to eliminate the stone. Aims and Objectives: Prospective comparison of mini-PCNL and retrograde intrarenal surgery outcomes in lower calyx managementwith respect to surgery duration, pain score (visual analog score), analgesic requirement, hemoglobin drop, and hospital stay. Materials and Methods: This is a prospective study in 50 patients (25 cases of RIRS and 25 cases of MINIPERC) over 2 years who came to the urology departme with lower calyx stone of size up to 20mm. The selection of the management methods was primarily based on the patient’s preferences. Preoperatively, all patients underwent routine workup and CT KUB plain. The primary and secondary objective was stone clearance rates, retreatment rate, complications, surgical duration, pain score (visual analog score [VAS]), analgesic requirement, hemoglobin drop, and hospital stay. Results: Miniperc and RIRS had stone clearance rates of 100% and 96%, respectively. In the RIRS group, one patient required retreatment for 1month. Hospital stay, intraoperative and post-operative complications were non-significant between both groups. Operative duration (P=0.003) was lower in the Miniperc group. Hemoglobin drop (P<0.0013), patient pain, and visual analog scale score at 6, 24, and 48 h, as well as an analgesic requirement (P<0.020), were all lower in the RIRS group. Conclusion: The stone clearance rates in both modalities are high, and complications are low. RIRS requires a longer operative duration, and it is associated with favorable pain scores and a lower hemoglobin drop.

The correlation between uremic pruritus and blood lead levels in prevalent hemodialysis patients and its relation to the severity of pruritus using visual analog score

Background Pruritus is a common and often distressing symptom in patients with chronic kidney disease. Though the pathogenesis of uremic pruritus remains poorly understood, systemic inflammation has presented itself as one of the possible explanations. High blood lead levels (BLLs) have been noted to be associated with inflammation and poor nutritional status in hemodialysis patients. Our aim is to study the relation between blood lead levels and uremic pruritus. This is a cross-sectional study that enrolled 50 patients; all were on regular hemodialysis 3 times per week for at least 6 months. Patients were divided into 2 groups, group 1 (n =10) with no pruritus and group 2 (n=40) with varying degrees of pruritus. Group 2 was further divided according to intensity of pruritus by visual analog score (VAS) into mild (n=10), moderate (n=20), and severe pruritus (n=10). Results There was a significant difference in serum lead levels and ferritin levels between groups 1 and 2 (p value < 0.01 and < 0.05, respectively). There was a statistically significant difference in serum lead levels in the groups with varying intensity of pruritus, having higher serum lead levels in patients who exhibited severe pruritus (p value < 0.005) Moreover, a statistically significant relation between elevated blood lead levels and the duration of dialysis was observed in this study. Conclusion Uremic pruritus is a multi-factorial phenomenon, and our study showed that blood lead levels in hemodialysis patients might be associated with increased intensity of pruritus.

Decompressive laminectomy with instrumented posterolateral fusion for degenerative lumbar disease in elderly, is it safe and beneficial?

Background With improvement of health care in last decades, the age of general population increased. As the elderly with degenerative lumbar disease needs to remain physically active for more years, lumbar decompression surgery with instrumented fusion is further considered and is gaining wide acceptance as it provides good results with relative minimal risk. This study aim to evaluate the safety and efficacy of lumbar decompression with instrumented fusion in elderly Results This is a prospective non-randomized clinical study conducted from July 2014 to July 2019. The included patients had chronic low back pain, radiculopathy, and/or neurogenic claudication due to degenerative lumbar disease with failed conservative management. They underwent lumbar decompression with instrumented posterolateral fusion. All patients were at least 55 years old at time of surgery and were clinically assessed as regard perioperative risk and morbidity, besides assessment of pre- and postoperative visual analog score (VAS) and Oswestry Disability Index (ODI). Data was collected and analyzed. Thirty-five patients were included in this study with mean age of 63 years. All patients presented with back pain, 77.1% with radiculopathy, and 60% with neurogenic claudication. Preoperative comorbidity was present in 60% of cases, where hypertension, diabetes, and cardiac troubles were 31.4%, 31.4%, and 14.3% respectively. The average operated level was 3.1. The complication rate was 11.4% with 2 cases with dural tear (5.7%), 2 cases with CSF leakage (5.7%), 1 case with wound seroma (2.8%), and 1 case with wound infection. Postoperative new comorbidity occurred in 5 cases (14.3%). Visual analog score (VAS) and Oswestry disability index (ODI) were recorded preoperatively and 18 months postoperatively; as regards pain, VAS improved significantly from 7.8 ± 0.87 to 1.8 ± 1.04 (P value< 0.00001), and ODI improved significantly from 58.1 ± 11 to 17.5 ± 8.3 (P value< 0.00001). Conclusion Lumbar decompression surgery with posterolateral instrumented fusion is a safe and effective surgery in elderly, as it provides significant results and gives them a chance for better quality of life. Preoperative comorbidity could be dealt with, and it should not be considered as a contraindication for surgery in this age group.

Evaluation of the Efficacy of Platelet Rich Plasma Injection in Chronic Lateral Epicondylitis

Background: Platelet-rich plasma helps in repair because of its growth factor. Platelet-rich plasma has been used in humans for its healing properties. Increased concentration of growth factors and secretory proteins may increase the process of healing on a cellular level. Aim: This study was done to check the effectiveness of PRP injections in patients with chronic lateral epicondylitis. Methodology: This was accomplished in patients visiting the orthopaedic OPD at the Sree Balaji Medical College and Hospital, Chennai, Tamilnadu. There were 40 physicians in this study, among whom 37 were homosexual and 87 were female. The mean age of the patients was 48.1 years (17-82 years). The study period was 3 months. The analytical method used is a visual analog score. Results: Effective therapy was performed with a decline of more than 20% (24 out of 40 patients) in visual analog score after a dual-month period. After 3 months in boys, the mean VAS score dropped from 6.88 to 9.41. Conclusion: Medication of PRP patients with chronic epicondylitis or PRP tennis elbow reduces pain and increases the flexibility of the affected knee joint.