Magnitude of domestic violence and its socio-demographic correlates among pregnant women in Delhi

Context:

Domestic violence is violation of basic human rights, and poses a threat to the physical, mental, and social health aspects of women and her children. The causation of domestic violence is precipitated by many risk factors.

Aims:

Aim was to estimate the magnitude of domestic violence overall, and its sub-types, among pregnant women. The study also aimed to find the associated socio-demographic determinants of domestic violence among the subjects.

Settings and Design:

The study was designed as a cross-sectional study to estimate the prevalence of domestic violence and to find socio-demographic correlates in its causation. A total of 1500 apparently healthy pregnant women, with gestation up to 20 weeks were interviewed.

Methods and Materials:

A pre-tested semi-structured interview schedule was used to collect data on socio-demographic variables and details of domestic violence, after explaining the purpose of study to the subjects and obtaining informed consent.

Statistical Analysis Used:

Data was entered in Ms-Excel and IBM SPSS Version 25 was used for statistical analysis.

Results:

The findings revealed overall prevalence of domestic violence to be 29.7%, with emotional and verbal type of violence being most common type. Caste, religion, literacy status of study subjects, and occupational status of spouses of study subjects were reported as significant correlates affecting the causation of domestic violence among the subjects.

Conclusions:

The findings highlight the burden and thus, stress for the need for effective involvement of all sectors in the elimination of domestic violence against women as a public health issue and develop zero-tolerance towards it.

Evaluation of Arterial to End-tidal Carbon Dioxide Pressure Differences during Laparoscopic Renal Surgery in the Lateral Decubitus Position

Background:

End-tidal carbon dioxide (PEtCO₂) is a noninvasive reliable technique to measure arterial partial pressure of carbon dioxide (PaCO2) in the body under general anesthesia. However, gradient between PaCO₂ and PEtCO₂ (P[a-Et] CO₂) is influenced by many factors.

Aims:

In the present study, we evaluated the changes in P (a-Et) CO₂ for laparoscopic donor nephrectomy in lateral decubitus position (LDP).

Settings and Design:

This was an observational, double-blinded, tertiary care center-based study.

Methods:

Thirty-one American Society of Anesthesiologists Class I and Class II patients of either sex undergoing laparoscopic donor nephrectomy in LDP under general anesthesia were included. An arterial cannula was inserted, PaCO₂ was measured at eight predesignated time intervals, and PEtCO₂ was also noted at the corresponding time period.

Statistical Analysis:

Data were analyzed using a two-way analysis of variance for repeated measurements using one dependent variable and one within-subject factor (time). Quantitative data were presented as mean ± standard deviation or median and interquartile range, as appropriate.

Results:

The mean P (a-Et) CO₂ gradient was 5.67 ± 1.36 mmHg 10 min after induction of anesthesia in the supine position (T1a). Ten minutes after LDP, P (a-Et) CO₂ gradient was 7.38 ± 1.45 mmHg (T1b) and was higher than T1a. The P (a-Et) CO₂ values 10 min after release of pneumoperitoneum and 10 min after making the patient supine were significantly higher than the T1a value. The highest value of P (a-Et) CO₂ gradient was at 30 min after creation of pneumoperitoneum (T30), i.e., 9.99 ± 1.70 mmHg. Pearson's correlation coefficient showed that the degree of correlation varied considerably during surgery due to interindividual variability (R² T1a vs. T60 was 0.61 vs. 0.17).

Conclusions:

PEtCO₂ does not reliably predict PaCO₂ in healthy patients scheduled for laparoscopic renal surgery in LDP.

Therapeutics of premature hair graying: A long journey ahead

Premature graying of hair has major psychosocial and socioeconomic repercussion, as it is considered as a sign of hastily progressing old age, ill health and often leads to loss of self-esteem. Hair is said to gray prematurely when it happens before the age of 20 years in Caucasians, 25 years in Asians, and 30 years in Africans. The hair color chiefly depends on melanin pigment, and fabrication of this pigment takes place in melanosomes through the process of melanogenesis. This complex biochemical pathway (melanogenesis) is further dependent on tyrosinase which acts as fuel.The normal human scalp is subjected to various factors categorized as intrinsic and extrinsic leading to graying of hair. Intrinsic factors comprise of variants responsible for changes at genetic level while extrinsic factors include air pollution, ultraviolet radiation, smoking, and nutrition. It has been proposed that direct or indirect effect of all these factors results in the generation of reactive oxygen species (ROS), thus leading to further damage. Though research has expanded in last few years in terms of microscopic, biochemical (hormonal, enzymatic), and molecular changes happening within hair follicle/shaft, still the exact mechanism leading to premature graying of hair is not well understood. Probable solutions toward this quandary are diet, herbal remedies, and temporary hair colorants. Ironically, the latter one being the most common has various side effects such as allergic reactions, inflammation, and hair loss. The aim of this paper was to review the manifestation and probable future interventions in preventing premature hair graying.

Radiofrequency Thermoablation of the Gasserian Ganglion Versus the Peripheral Branches of the Trigeminal Nerve for Treatment of Trigeminal Neuralgia: A Randomized, Control Trial

BACKGROUND

Trigeminal neuralgia is the most painful condition of facial pain leading to impairment of routine activities. Although radiofrequency thermoablation (RFT) of the Gasserian ganglion is widely used for the treatment of idiopathic trigeminal neuralgia in patients having ineffective pain relief with medical therapy, the incidence of complications like hypoesthesia, neuroparalytic keratitis, and masticatory muscles weakness is high. Recent case reports have shown the effectiveness of RFT of the peripheral branches of the trigeminal nerve for relief of refractory chronic facial pain conditions including trigeminal neuralgia.

OBJECTIVES

This study was conducted to compare the efficacy and safety of RFT of the peripheral branches of the trigeminal nerve with RFT of the Gasserian ganglion for the management of idiopathic trigeminal neuralgia.

STUDY DESIGN

Prospective, randomized, observer-blinded, clinical trial.

SETTING

Tertiary care hospital and medical education and research institute.

METHODS

A total of 40 adult patients of idiopathic trigeminal neuralgia were randomly allocated into 2 groups. The control group received RFT of the Gasserian ganglion while the study group received RFT of the peripheral branches of trigeminal nerve. The procedures were performed in the operation room under all aseptic precautions with fluoroscopic guidance. Post-procedure, the patients were assessed for loss of sensation along the nerve distribution and the adequacy of pain relief on the Numerical Rating Scale (NRS). The patients were followed up for 3 month to assess the quality of pain relief by the NRS and the Barrow Neurological Institute (BNI) pain intensity scale. Improvement in pain was considered excellent if patients had complete pain relief without any medication, good if there was significant reduction in pain (> 50%) with or without medication, and poor if there was less than 50% reduction in pain with medications. Patients were also assessed for numbness and any other side effects. Patients' satisfaction with the procedure was recorded.

RESULTS

Nineteen patients in the control group and 18 in study group had effective pain relief of up to 3 months. Their pain scores were comparable at all time intervals, though the number of patients receiving supplementary medications was more in study group at 2 months (P = 0.015). The patients showed overall satisfaction score of 8.5 (8-9) and 8 (7-9) in control and study groups respectively. The average procedure duration was 30 (30-38) minutes in the control group and 28 (25-40) minutes in the study group. Most of the patients in both groups had mild numbness after the procedure. One patient in the control group had lower eyelid swelling and another had mild weakness of the masseter muscle, which resolved few days later. No major complication was reported in the study group except for 1 patient who reported local ecchymosis.

LIMITATIONS

The main limitation of the study is that the patients and the investigator performing the procedure were not blinded, though the person who assessed the patient during follow-up was blinded to the group assignment. Another limitation is that we could not follow up with the patients after 3 months due to time constraints.

CONCLUSION

We found that radiofrequency thermoablation of the peripheral branches of the trigeminal nerve is an effective and safe procedure for the management of idiopathic trigeminal neuralgia.

KEY WORDS

Idiopathic trigeminal neuralgia, radiofrequency thermoablation, Gasserian ganglion, peripheral nerve branches, pain, trigeminal nerve.

Room-Temperature Columnar Liquid Crystals as Efficient Pure Deep-Blue Emitters in Organic Light-Emitting Diodes with an External Quantum Efficiency of 4.0

A novel design of aggregation-induced emission (AIE) active columnar (Col) luminomesogens is reported, and they are demonstrated to act as highly efficient deep-blue emitters in organic light-emitting diodes (OLEDs). All derivatives exhibit Col liquid crystalline (LC) behavior at room temperature over a wide temperature range and desirable alignment properties, which is very important in using them as materials for organic electronic devices. These new AIE active luminomesogens were found to act as highly efficient emitters in OLEDs and unveiled a maximum external quantum efficiency of 4.0% for the first time in Col LCs with Commission International de l'E'clairage coordinates of (0.17, 0.07), which closely matches the National Television System Committee (NTSC) standard, corresponding to pure deep blue color. The detailed supramolecular assembly of the compounds has been characterized by modeling in the mesophase derived from small- and wide-angle X-ray scattering results.

Effect of Scalp Block on Postoperative Pain Relief in Craniotomy Patients

The efficacy of scalp nerve block using 0.5% bupivacaine with adrenaline for postoperative pain relief in craniotomy patients was evaluated in 40 ASA I or II adult patients undergoing supratentorial craniotomy. A standard general anaesthesia technique was followed. Patients were randomly divided into two groups. Group B received 0.5% bupivacaine with 1:400,000 adrenaline and group S received normal saline with 1:400,000 adrenaline, both after skin closure. Postoperative pain was assessed at 30 seconds and 1, 2, 4, 6, 8 and 12 hours using a numerical rating scale. Diclofenac IM was administered as rescue analgesia if patients reported a numerical rating scale of 40 or more. Tramadol TV was administered as second rescue analgesia. Sixty per cent of patients in group S experienced moderate to severe pain (numerical rating scale of 40 or more) at some time during the first 12 postoperative hours in comparison to 25% patients in group B. Median pain scores were significantly lower in group B for up to 6 hours. Significantly more patients were pain free up to four hours in group B. Median duration for the requirement of first dose of diclofenac was longer in group B compared to group S (360 min vs 30 min, P<0.01). The number of doses of diclofenac (5 vs 19) was significantly lower in group B compared to group S (P<0.01). Tramadol was required by six patients in group S only. Scalp nerve block using 0.5% bupivacaine with 1:400,000 adrenaline decreases the incidence and severity of postoperative pain in patients undergoing supratentorial craniotomy.

Reversibly photoswitchable alkoxy azobenzenes connected benzenetricarboxamide discotic liquid crystals with perpetual long range columnar assembly

Reversibly photoswitchable discotic liquid crystals (DLCs) with no change in columnar assembly.

Hydrogen-bond mediated columnar liquid crystalline assemblies of C3-symmetric heptazine derivatives at ambient temperature

A new class of hydrogen (H) bonded fluorescent liquid crystals (FLCs) based on a newly discovered s-heptazine fluorophore discotic component have been synthesized. The tendency of the s-heptazine core to form H-bonded LCs has been explored for the first time. Interestingly, the pure heptazine derivatives (non-mesomorphic) on complexation with tri-alkoxy benzoic acids exhibit enantiotropic columnar mesomorphism over a wide range of temperatures including room temperature. This indicates the strength of the resulting H-bonded complexes. The H-bonded supramolecular complexes were studied through FT-IR, temperature dependent FT-IR and NMR studies and H-D exchange studies, and their thermal behaviour was deduced through polarized optical microscopy (POM), differential scanning calorimetry (DSC) and X-ray diffraction (XRD) studies. Because of the inherently fluorescent pure heptazine derivative, the resulting complexes exhibit fluorescent behaviour in the solution state as well as in the solid state.

Minimum Alveolar Concentration of Desflurane for Maintaining BIS Below 50 in Children and Effect of Caudal Analgesia on it

Context:

Neuraxial techniques have sedative properties secondary to decreased inputs from sensory and motor afferents. We hypothesized that caudal analgesia decreases the requirement of desflurane as measured by bispectral index (BIS).

Aims:

This study aims to determine the minimum alveolar concentration (MAC) of desflurane for maintaining BIS below 50 (MACBIS₅₀) in children undergoing infraumbilical surgeries with laryngeal mask airway (LMA) and study the effect of caudal analgesia on the same.

Settings and Design:

This is prospective and observational study.

Subjects and Methods:

Thirty-nine American Society of Anesthesiologists physical status Classes I and II children in between 1 and 8 years of age undergoing elective infraumbilical surgery under general anesthesia were allocated randomly into two groups (Group C and Group D) after induction with sevoflurane and LMA insertion. In Group C, caudal block was performed with 0.75 mL/kg of 0.25% bupivacaine and BIS values were recorded after 10 min for 1 min at 10 s intervals. In Group D, BIS was recorded for desflurane for 1 min at 10 s intervals followed by a caudal block with the same dose.

Statistical Analysis Used:

Dixon up-down method with a step size of 0.5%, and probit analysis were used for analysis.

Results:

A total of 39 patients were enrolled. MAC of desflurane for maintaining MACBIS₅₀ was 5.57 (95% confidence interval [CI] 5.22–5.95) in Group D and 4.31 (95% CI 3.12–5.08) in Group C. The use of caudal anesthesia lowered the MAC of desflurane for maintaining MACBIS₅₀ in children by 22.36% (P < 0.001).

Conclusions:

The use of caudal analgesia significantly reduced MAC of desflurane for maintaining MACBIS₅₀ in children undergoing infraumbilical surgeries using LMA.

Pulsed Radiofrequency Ablation for the Treatment of Glossopharyngeal Neuralgia Secondary to Oropharyngeal Carcinoma

BACKGROUND

The management of glossopharyngeal neuralgia due to oropharyngeal carcinoma is particularly difficult because of rich innervations of the area, erosive nature of neoplasm and dynamic pain evoked by the functional movements like swallowing and chewing. Few case reports have shown the efficacy of pulsed radiofrequency (PRF) treatment in primary and secondary glossopharyngeal neuralgia in non-cancer patients. However, the efficacy of PRF ablation of the glossopharyngeal nerve in oral cancer patients is not known.

OBJECTIVES

This study was conducted to evaluate the efficacy and safety of PRF ablation of the glossopharyngeal nerve for the management of oropharyngeal cancer pain involving the base of the tongue, tonsillar fossa, and oropharynx.

STUDY DESIGN

Prospective interventional clinical trial.

SETTING

Tertiary care hospital and medical education and research institute.

METHODS

A total of 25 adult patients suffering from oropharyngeal carcinoma, complaining of severe pain in the area mainly supplied by glossopharyngeal nerve, were included. The patients underwent fluoroscopy-guided PRF ablation of the glossopharyngeal nerve of the affected site 3 times at 42°C temperature for 120 seconds with 22-gauge, 10 cm long, 5 mm active tip radiofrequency needle. They were followed up for one year for pain relief, nausea-vomiting and sleep disturbances. The treatment was considered effective if there was 50% reduction in pain score at 2 weeks.

RESULTS

There was significant reduction in the overall pain score including site specific pain, odynophagia and ear pain after radiofrequency ablation (P < 0.0001) in all the patients. This was associated with decreased opioid consumption (P < 0.001), lesser nausea/vomiting, and improved sleep. The treatment was effective in 23 out of 25 patients (92%) for more than 3 months. No major complication was observed in any patient. The average duration of effective pain relief was 5 to 9 months.

LIMITATIONS

Patients having bilateral glossopharyngeal neuralgia or an advanced stage of oral cancer with large lymph nodes at the angle of mandible were not included. This study was a single-center observational clinical trial and further multi-center, randomized, controlled trails are needed to obtain higher level of evidence.

CONCLUSION

Our results showed that PRF ablation can be used effectively and safely for the treatment of glossopharyngeal neuralgia secondary to oropharyngeal carcinoma.

KEY WORDS

Glossopharyngeal neuralgia, ear pain, odynophagia, oral cancer pain, pulsed radiofrequency ablation, side effects.

Comparison of the ProSeal laryngeal mask airway with the I-Gel™ in the different head-and-neck positions in anaesthetised paralysed children: A randomised controlled trial

Background and Aims:

Head and neck movements alter the shape of the pharynx, resulting in changes in the oropharyngeal leaking pressures and ventilation with supragottic airway devices. We compared the effect of the different head-and-neck positions on the oropharyngeal leak pressures and ventilation with the I-Gel™ and ProSeal™ laryngeal mask airway (PLMA) in anaesthetised paralysed children.

Methods:

A total of 70 children were randomly assigned to receive PLMA (n = 35) or I-Gel™ (n = 35) for airway management. Oropharyngeal leak pressure in maximum flexion, maximum extension and the neutral position was taken as the primary outcome. Peak inspiratory pressures (PIPs), expired tidal volume, ventilation score and fibreoptic grading were also assessed.

Results:

No significant difference was noted in oropharyngeal leak pressures of PLMA and I-Gel™ during neutral (P = 0.34), flexion (P = 0.46) or extension (P = 0.18). PIPs mean (standard deviation [SD]) were significantly higher (17.7 [4.03] vs. 14.6 [2.4] cm H₂O, P = 0.002) and expired tidal volume mean [SD] was significantly lower (5.5 [1.6] vs. 6.9 [2] ml/kg, P = 0.0017) with I-Gel™ compared to PLMA. Fibreoptic grading and ventilation score were comparable in both the groups in all the three head-and-neck positions.

Conclusion:

PLMA and I-Gel™, both recorded similar oropharyngeal leaking pressures in all the three head-and-neck positions. However, higher peak pressures and lower expired tidal volume in maximum flexion of the neck while ventilating with I-Gel may warrant caution and future evaluation.

Phase Behavior of a New Class of Anthraquinone-Based Discotic Liquid Crystals

Five novel columnar liquid crystalline compounds (4.1-4.5) consisting of a central anthraquinone core carrying four alkoxy chains (R = n-C₆H₁₃, n-C₈H₁₇, n-C₁₀H₂₁, n-C₁₂H₂₅, and 3,7-dimethyl octyl) with two diagonally opposite 1-ethynyl-4-pentylbenzene units were synthesized, and their phase transitions were investigated between changes in the molecular structure and their self-assembly into the columnar mesophases. Small and wide-angle X-ray scattering (SAXS/WAXS) studies were performed to deduce the exact nature of the mesophases, and their corresponding electron density maps were derived from the intensities of the peaks observed in the diffraction patterns. A comparison of compounds with different alkoxy chains indicated that the soft crystal columnar rectangular (Cr_colrec) phase was stable at lower temperature for the shortest peripheral alkoxy chain (4.1; R = n-C₆H₁₃) and was found to exhibit the columnar hexagonal (Col_h) phase and then the discotic nematic (N_D) phase with increasing temperature. In contrast, increasing the peripheral chain length to n-C₈H₁₇ or the branched one (4.2 and 4.5) stabilized the Col_h phase at lower temperature and showed the N_D phase at higher temperature. Further increase in chain length (4.3 and 4.4; n-C₁₀H₂₁, n-C₁₂H₂₅) demonstrated the formation of the N_D phase. Conductivity measurement in the Col_h mesophase was found to be almost 10 times higher in magnitude than the corresponding Cr_colrec phase. The HOMO-LUMO band gap of all the compounds was found to be in the range from 2.79 to 2.82 eV, which is quite less and comparable with the optical energy band gap.

Heptazine: an Electron-Deficient Fluorescent Core for Discotic Liquid Crystals

Herein, room-temperature discotic liquid crystals based on heptazine, an electron deficient central core, are reported for the first time. Mesomorphic behaviors of the materials are also investigated. Supramolecular assembly of the mesophase derivatives were confirmed by X-ray scattering experiments. Heptazine-based solid thin films are strong blue light emitters, whereas in the solution state, they are weakly emissive or non-emissive. The band gap energy is found to be low in this class of compounds. Formation of room-temperature mesophases, low band-gap behavior, and strong blue-light emission in the solid state are promising attributes for optoelectronic applications of the materials.

Effects of intraoperative liberal fluid therapy on postoperative nausea and vomiting in children-A randomized controlled trial

BACKGROUND

Postoperative nausea and vomiting (PONV) is one of the most distressing complications following surgery. Supplemental perioperative fluid therapy might be an effective strategy to reduce PONV in children.

OBJECTIVES

The study was conducted to evaluate the effects of intraoperative liberal fluid therapy with crystalloids on PONV in children.

METHODS

In this randomized trial, a total of 150 children of 3-7 years undergoing lower abdominal and penile surgery under general anesthesia were randomly assigned into two groups. "Restricted group" received 10 mL kg^-1 h^-1 and "Liberal group" received 30 mL kg^-1 h^-1 infusion of Ringer's lactate solution intraoperatively. All patients received a caudal block and intravenous paracetamol for analgesia. No opioids and muscle relaxants were used. All episodes of nausea-vomiting and the requirement of rescue antiemetic were assessed during 24 hours postoperatively.

RESULTS

The incidence of PONV was significantly less in the liberal group patients as compared to the restricted group; 33 (45.8%) patients in the restricted group had vomiting as compared to 20 (27.4%) patients in the liberal group (RR 0.59, 95% CI: 0.38-0.93, P=.021). The adjusted odds ratio of PONV for the liberal group vs restricted group was 2.24 (95% CI: 1.12-4.48, P=.022). The incidence of fluid intake during the first 6 postoperative hours was significantly higher in the restricted group patients; 60 (83%) children in the restricted group complained of thirst as compared to 12 (17%) children in the liberal group (RR 0.19, 95% CI: 0.18-0.33, P=.0001). The parents of the liberal group were more satisfied as compared to the restricted group (mean difference -0.9, 95% CI: -1.8, -0.1, P=.04). None of the children had any complication attributed to the liberal fluid therapy.

CONCLUSION

Liberal intraoperative fluid therapy was found to be effective in reducing PONV in children undergoing lower abdominal surgery.

Hyperchloremic Metabolic Acidosis Following Total Gut Irrigation with Normal Saline in Pediatric Patients: A Rare Occurrence

Use of 0.9% sodium chloride for total gut irrigation (TGI) through nasogastric route is an effective method of bowel preparation in children undergoing colorectal surgeries. TGI with normal saline (NS) can result in nausea, vomiting, abdominal distension, and mild electrolyte imbalance; however, hyperchloremic metabolic acidosis has not been documented. We report two cases of hyperchloremic metabolic acidosis in children posted for colorectal surgery following TGI with NS who were successfully managed.