Efficacy of spinal ropivacaine versus ropivacaine with fentanyl in transurethral resection operations

Background:

The low-dose ropivacaine provides differential spinal block to reduce adverse hemodynamic effects in elderly patients. Addition of intrathecal fentanyl with ropivacaine may enhance analgesia and early postoperative mobility. The present study was performed to evaluate the efficacy of intrathecal ropivacaine alone and in combination with fentanyl in transurethral resection operation.

Methods:

Sixty male patients aged >50 years of ASA I-III scheduled for elective transurethral resection were included in a prospective, randomized, double-blinded study and they were divided in two groups of 30 each. Group A (n = 30) received intrathecal injection of ropivacaine 2 ml (0.75%) and Group B (n = 30) ropivacaine 1.8 ml (0.75%) with fentanyl 10 μg. The characteristics of onset and regression of sensory and motor blockade, hemodynamic stability, and side effects were observed. Student's t test (for parametric data) and Mann-Whitney U test (for non-parametric data) were used for statistical analyses.

Results:

There were no significant differences between the two groups for patient demographic data, intraoperative hemodynamic parameters, side effects, and satisfaction to patients and surgeon. The highest level of sensory block was at T10 in group A and T9 in group B (P = 0.001). Duration of motor block was longer in group B being 210.51 ± 61.25 min than in group A being 286.25 ± 55.65 min (P < 0.001).

Conclusion:

The addition of fentanyl to ropivacaine may offer the advantage of shorter duration of complete motor block, hemodynamic stability, and without any increase in the frequency of major side effects.

Treating stones in transplanted kidneys

The formation of calculi in renal allografts is an uncommon complication in renal transplant recipients, with a reported incidence of 0.2-1.7% according to retrospective studies. Although the majority of these stones appear to form de novo following renal transplantation (RTX), there is a growing body of evidence suggesting that more often than previously thought they may be transplanted with the donor graft itself. The etiology and pathophysiology of renal graft stones is multifactorial. A combination of metabolic and urodynamic factors predispose to stone formation and these are generally found more frequently in allograft rather than native kidneys. In addition tertiary hyperparathyroidism (following RTX) plays an important role. Renal allograft stones can pose significant challenges for the clinician. The diagnosis requires a high index of suspicion and must be prompt, as these patients' reliance on a solitary kidney for their renal function leaves them susceptible to significant morbidity. However, reports in the literature come largely from anecdotal experience and case reports, meaning that there is a limited consensus regarding how best to manage the condition. We suggest that interventional treatment should be guided primarily by stone size and individual patient presentation. Good outcomes have been reported with shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy, but optimal management of the risk factors leading to calculi formation (i.e., prevention) will remain the most cost-effective management.

Oratest: a new concept to test caries activity

Caries activity tests are based on the concept of a specific odontogenic infection, the principle causative organism being streptococci mutans. Their predominance is attributed to its acidogenic and aciduric nature after a selective growth advantages over the other non- acid tolerant organisms. Many studies on caries activity are aimed at finding relevant microorganisms. Till date, the ideal method to evaluate in terms of sensitivity, specialization and reliability has not been found. Many of these caries activity tests require extensive work up time and additional equipment. Rosenberg et al. in 1989 developed Oratest, a simple, economical, non- invasive and less time-consuming test for estimating the oral microbial level. The test is simple and consists of rinsing the mouth with 10 ml of sterile milk, 3 ml of which is mixed with 0.12 ml of 0.1% methylene blue dye and observed for colour change. The present study sample consists of twenty five children with dental caries and twenty five controls, free of caries, gingivitis and other oral ailments. This study is being conducted in the department of Oral Pathology & Microbiology and is in the preliminary phase so further results are awaited.

No health without mental health: challenges and opportunities in global mental health

Mental health is an essential component of health, yet it is often not given the attention that ir deserves as a global health and development issue. In this paper, we examine the global health context, including the substantial burden of disease, resources available for mental health, treatment gap, human rights issues, links between mental health and development, and economic impact of mental disorders. Then we consider recent actions taken at the global level to advance mental health as a global health issue. Finally, we look at South Africa as an example of a country that is ripe for change in its approach to mental health. This is a country with a high prevalence of mental disorders and a large treatment gap, yet it has a number of strengths on which to build a response to improving population mental health. We make suggestions as to how South Africa can move ahead on its mental health agenda, whilst also being a model for other countries in the region and across the globe.

Sevelamer carbonate experience in Indian end stage renal disease patients

This open label, multicentric, comparative clinical trial was done to compare the efficacy and tolerability of two sevelamer formulations, sevelamer carbonate, and sevelamer hydrochloride, in the treatment of hyperphosphatemia in Indian end stage renal disease (ESRD) patients. A total of 97 ESRD patients on hemodialysis, were enrolled. Patients were randomized to receive either sevelamer carbonate or sevelamer hydrochloride. All patients were evaluated every week for 6 weeks for efficacy and safety variables. Total 88 patients completed the study. After 6 weeks of therapy, there were similar reductions (P<0.0001) in mean serum phosphorus and the CaxP product both the groups. The responder rates for test and reference groups were 75%, 68.18% respectively (P=0.3474). The adverse events reported were nausea, abdominal pain/discomfort, heartburn, constipation, diarrhea, increased prothrombin time, and severe arthritis. No serious adverse events were reported. There was no significant difference between the groups for adverse events and the laboratory parameters. From the results of this multicentric, comparative, randomized clinical study on sevelamer carbonate we can recommend that sevelamer carbonate may be used as a phosphate binder in Indian chronic kidney disease patients.

Quality of life assessment: The world health organization perspective

Assessment of quality of life (QoL) and use of this information towards improvement of health care services is an important area of activity of the World Health Organization (WHO). This paper briefly discusses the conceptual basis and the methodology used in WHO's Quality of Life Project (WHOQOL). It describes the simultaneous development of instruments in widely different cultures to assess subjective QoL. Use of these instruments in the field of clinical trials with psychotropics is highlighted.

Apoptosis and Bcl-2 protein expression in human placenta over the course of normal pregnancy

Apoptosis plays a central role in organ development, homeostasis and immune defence in multicellular organisms and is strictly controlled in part by members of Bcl-2 family. The Bcl-2 is a pro-survival molecule identified through its involvement in B-cell lymphomas. The aim of the study was to evaluate the incidence of apoptosis in the human placenta at different stages of pregnancy and to correlate it further with Bcl-2 expression. A total of 96 placental samples from first trimester, mid-trimester and uncomplicated term pregnancies were collected (n = 32 + 32 + 32). M30 cyto death monoclonal antibody was used to identify apoptotic cells. The apoptosis index of first trimester placentae was 2.33 ± 1.70, mid- trimester was 1.77 ± 1.36 and term placenta was 1.15 ± 0.21. Bcl-2 protein was found immunolocalized in the cytoplasm of syncytiotrophoblast. Apoptosis index was significantly reduced in term cases as compared with first trimester (P < 0.002) and mid-trimester placentae (P = 0.01). On the contrary, Bcl-2 expression was significantly higher at term cases than in first trimester (P < 0.0001) and mid-trimester cases (P < 0.001). The present study divulges the importance of apoptosis in permitting normal physiological turnover of villous trophoblast and also exhibits the contribution of bcl-2 in maintaining syncytial integrity throughout normal pregnancy.

Effect of administration of rumen fungi on production performance of lactating buffaloes

Anaerobic fungi were orally dosed to lactating buffaloes to study their effect on the digestibility of a diet (composed of 50% wheat straw and 50% concentrate along with six kg maize green/animal/day), rumen fermentation patterns and milk production. Group I (control) was administered with fungus-free anaerobic broth, while group II and III were administered with Orpinomyces sp. C-14 or Piromyces sp. WNG-12 (250 ml; 3-5 days of growth/animal/ week), respectively. Milk production was higher in group II and III (8.42 and 8.48 kg/d) than in the control (8.03 kg/d) with virtually the same feed intake (i.e. 11.50 and 10.62 and 11.79 kg, respectively). There was an increase of 6% fat-corrected milk yield/animal/day in group II and III, respectively compared to the control. The milk fat was higher in the fungal culture administered groups than in the control group. The digestibility of dry matter, crude protein, neutral detergent fibre, acid detergent fibre, cellulose and digestible energy also increased significantly in group II and III. The pH and ammonia nitrogen were lower, whereas total volatile fatty acids, total nitrogen, trichloroacid precipitable nitrogen and number of zoospores/ml of rumen liquor were higher in group II and III when compared to the control. Hence, it can be stated that rumen fungi can be used as a direct-fed microbial in lactating buffaloes, to enhance the digestibility of wheat straw based diets leading to higher production.

Stromal differences in odontogenic cysts of a common histopathogenesis but with different biological behavior: a study with picrosirius red and polarizing microscopy

OBJECTIVES

The present study was undertaken to detect and compare the pattern of collagen fibers in odontogenic cysts and also to find out if this methodology could be used to predict the aggressive nature of odontogenic cysts by comparing with the odontogenic tumors.

MATERIALS AND METHODS

The collagen in the wall of 11 odontogenic keratocysts, 14 dentigerous cysts and 14 radicular cysts was studied histochemically by staining sections with picrosirius red and examining under polarizing microscope. This was compared to 10 cases of odontogenic tumors using Z test of proportion at 1% and 5%.

RESULTS

In dentigerous cysts, odontogenic keratocysts and odontogenic tumors, the predominant color of collagen fibers birefringence was found to be orangish red, whereas in radicular cysts the collagen fiber was of green color.

CONCLUSIONS

Similar birefringence pattern of collagen fibers between dentigerous cysts, odontogenic keratocysts and odontogenic tumors may indicate that these lesions have a common histogenesis with a broad spectrum of biological behavior and belong to the same group, i.e., are developmental in origin. Different patterns of radicular cysts suggest different biological behavior and a positive role of inflammation on polarization color of collagen fibers.

Bcl-2 and p53 expressions in Indian women with complete hydatidiform mole

INTRODUCTION

Hydatidiform moles have a high incidence rate in Asian countries like India. The molecular pathway leading to the pathogenesis and progression of hydatidiform moles is not yet understood. This study aimed to investigate the biological significance of Bcl-2 and p53 in complete hydatidiform moles (CHMs) as well as their influence on disease progression in the Indian population.

METHODS

Archival tissues from 35 patients with CHMs and 35 age-matched controls were examined for Bcl-2 and p53 expressions by immunohistochemistry.

RESULTS

Bcl-2 was found to be immunolocalised in the cytoplasm of the syncytiotrophoblast, whereas p53 was observed in both the nucleus and cytoplasm of the syncytiotrophoblast and cytotrophoblasts. In CHMs, Bcl-2 was detected in 23 percent of patients and p53 nuclear expression, in 66 percent. A significant decrease in Bcl-2 expression was observed in CHMs (p-value is 0.015), and the down-regulation of Bcl-2 significantly correlated with higher nuclear expression of p53 (p-value is 0.002), indicating an inverse association between the two proteins (p-value is 0.0001). However, no correlation was found between the clinical progress of patients with CHMs and p53 and those with Bcl-2 protein expression.

CONCLUSION

The current study demonstrated the significance of Bcl-2 and p53 in the pathogenesis of CHMs but did not reveal any association with disease progression.