[show abstract][hide abstract] ABSTRACT: Unanticipated difficult tracheal intubation is a significant source of morbidity and mortality in anesthetized patients. A number of modules have been developed to predict difficult airways, but they are often complex in nature. We combined the modified Mallampati score (M), thyromental distance (T), anatomical abnormality (A), and cervical mobility (C) into a single scoring system with the acronym M-TAC, and evaluated it against Mallampati scoring.
We prospectively analyzed 500 adult patients of the American Society of Anesthesiologists (ASA) class I or II, scheduled for elective surgery under general anesthesia. Preoperative airway assessments using M-TAC were performed, all of which were given a score. Anesthesiologists, blinded to the pre-anesthetic airway assessment, performed laryngoscopy and graded the laryngoscopic view as per Cormack and Lehane's classification. For the study purpose, difficult laryngoscopy was defined as Cormack and Lehane Grade 3 or 4 of laryngoscopic view.
An M-TAC score ≥ 4 had a significantly higher sensitivity (96% vs. 72%) and specificity (86% vs. 78%) with a high positive predictive value (44% vs. 28%) and a very low false negative value (2% vs. 15%) in comparison with Mallampati scoring (p < 0.05). Analysis of the receiver operating characteristic (ROC) curve for predicting difficult laryngoscopy revealed an area under the curve of 0.83 (95% CI = 0.78-0.88) for Mallampati scoring and 0.94 (95% CI = 0.92-0.96) for M-TAC scoring system.
The M-TAC scoring system has provided a higher sensitivity and specificity in predicting difficult laryngoscopy in comparison with Mallampati classification.
Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists. 06/2013; 51(2):58-62.
[show abstract][hide abstract] ABSTRACT: Topical capsaicin and eutectic mixture of local anesthetics (EMLA) have been found to be equally effective in minimizing the pain of venipuncture. After the injection of capsaicin, both tertiary amine local anesthetics and their quaternary ammonium derivatives can elicit a prolonged and predominantly sensory/nociceptor selective block. We hypothesized that the combined application of capsaicin and ELMA will be more effective than their individual effect, and lower concentrations of individual drugs in this mixture may also be associated with reduced side effects.
One hundred twenty patients were randomized into 4 equal groups. The control group received plain lubricant cream; the EMLA group received EMLA cream; the capsaicin group received Myolaxin ointment (containing oleoresin capsaicin equivalent to capsaicin 0.075% w/w, methylsalicylate IP 20% w/w, menthol IP 10% w/w, camphor USP 5% w/w, and eucalyptus oil IP 5% w/w); and the EMLA + capsaicin group received EMLA cream and Myolaxin ointment mixed in equal amounts. An anesthesiologist applied the cream to a 10-cm(2) area (site of venous cannulation) on the dorsum of the nondominant hand of the patient 1 hour before venipuncture and covered the area with an occlusive transparent dressing. Venipuncture was performed with an 18-gauge cannula after removing the dressing. Venipuncture pain was graded by the patient on a 0 to 10 visual analog scale, where 0 means no pain and 10 means worst imaginable pain. P values (after correction for multiple comparisons) of <0.05 were considered significant.
The incidence of no pain on venous cannulation (primary end point) was 0% in the control group (0/30). The incidence of no pain were significantly higher in the EMLA group (32%, 9/28, 95% corrected confidence interval for the difference 12%-57%, P = 0.0025), capsaicin group (30%, 9/30, 10%-53%, P = 0.0031), and EMLA + capsaicin groups (47%, 14/30, 25%-69%, P < 0.0001). Severity of venipuncture pain as assessed by visual analog scale median (interquartile range) was lower in the EMLA + capsaicin group 1 (2) compared with other groups 3 (1), 1.5 (3), and 1.5 (3) for control, EMLA, and capsaicin, respectively (P < 0.001, P = 0.04, and P = 0.04, respectively).
We observed that the combination of capsaicin and EMLA in a low concentration is as effective in managing venous cannulation as when applied as an individual drug alone. Larger studies with varying concentration of capsaicin and EMLA are recommended to more fully evaluate the potential advantages.
Anesthesia and analgesia 03/2013; 116(3):568-71. · 3.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Severe cardiovascular responses in the form of tachycardia and hypertension following nasal speculum insertion occur during sublabial rhinoseptal trans-sphenoid approach for resection of small pituitary tumours. We compare the effects of preoperative administration of clonidine (α-2 agonist) and atenolol (α-blocker) over haemodynamic response, caused by speculum insertion during trans-sphenoid pituitary resection. We enrolled 66 patients in age range 18-65 years, of ASA I-II, and of either sex undergoing elective sublabial rhinoseptal trans-sphenoidal hypophysectomy. Group I (control) received placebo, group II (clonidine) received tablet clonidine 5 µg/kg, and group III (atenolol) received tablet atenolol 0.5 mg/kg. The heart rate increased on speculum insertion and 5 and 10 minutes following speculum insertion as compared to the pre-speculum values in the control group, while no change in the heart rate was observed in other groups (P<0.05). There was a rise in the mean arterial pressure during and 5, 10, and 15 minutes after nasal speculum insertion in the control group, whereas it was not seen in other groups (P<0.05). We therefore suggest that oral clonidine and oral atenolol (given 2 hours prior to surgery) is an equally effective and safe method of attenuating haemodynamic response caused by nasal speculum insertion during trans-sphenoid pituitary resection.
Indian journal of anaesthesia 03/2011; 55(2):135-40.
[show abstract][hide abstract] ABSTRACT: To evaluate the efficacy of tadalafil as add-on therapy in secondary RP resistant to vasodilators.
Patients with scleroderma and MCTD having four or more RP attacks per week despite being on vasodilators were randomized to receive either placebo or tadalafil (20 mg) on alternate days as add-on therapy to their current vasodilators for 6 weeks. After a 7-day washout, patients were crossed over to the other arm. Primary endpoints were improvement in the daily frequency and duration of RP episodes and RP condition score (RCS). Secondary outcome measures were healing of existing and appearance of new digital ulcers (DUs) and improvement in scleroderma-specific HAQ (SHAQ), quality of life (QoL), flow-mediated dilatation (FMD), patient and physician global assessment.
Twenty-four of 25 recruited patients completed the study. All the patients were receiving calcium channel blockers and in addition 18 were receiving other vasodilators. During tadalafil therapy significant improvement in mean daily frequency, mean daily duration of RP and mean daily RCS were observed as compared with baseline and placebo. All the 24 digital lesions healed during tadalafil therapy as compared with 3/13 during the placebo treatment (P<0.0001). One new DU was reported during tadalafil therapy vs 13 during placebo therapy (P=0.0005). QoL, SHAQ, FMD, patient and physician global assessment significantly improved while on tadalafil. No serious adverse event was observed.
Tadalafil as add-on therapy improves symptoms of RP, heals and prevents new DUs and improves QoL in patients with resistant secondary RP.
Clinicaltrials.gov, http://clinicaltrials.gov/, identifier: NCT00626665.
[show abstract][hide abstract] ABSTRACT: Size can predict malignancy in adrenocortical tumors, but the same extrapolation for pheochromocytomas (PCC) is controversial. The goal of this study was to find a correlation between the tumor size and malignant potential of PCC and determine whether the "Pheochromocytoma of the adrenal gland scaled score" (PASS) proposed by Thompson can be applied to predict malignancy.
A retrospective analysis of patients with PCC operated on from 1991 to 2007 revealed 98 PCC removed from 93 patients. Tumor size was available for 90 tumors. Six (6.4%) patients had proven malignancy. Five familial cases were excluded from the PASS analysis.
Of the benign cases, none developed recurrence or metastasis. There were 54 (60%) tumors > 6 cm and 36 (40%) tumors ≤ 6 cm. All 12 PASS parameters were individually present in higher frequency in the >6-cm group; but the difference was not statistically significant except cellular monotony (p = 0.02). Overall, a PASS ≤ 4 was found in 57 patients. Mean PASS was statistically significantly higher in the >6-cm group (4.4 vs. 3.3, p = 0.04). Of the sporadic benign cases, 21 (41%) patients with tumor size > 6 cm had a PASS of >4, and none of them developed metastasis. PASS ≤ 4 was found in 25 (81%) PCC in the ≤6-cm group, and none developed metastases. PASS ≥ 4 was found in six (19%) patients in the ≤6-cm group, and none developed metastases. 68 patients completed 5-year follow-up, and the remaining had a mean follow-up of 28.7 months. No correlation was found between tumor size and PASS > 4 and PASS ≤ 4 (7.8 cm vs. 7.1 cm; p = 0.23).
Presently there is not enough evidence to indict a large (>6 cm) PCC as malignant. Furthermore, PASS cannot be reliably applied to PCC for predicting malignancy.
World Journal of Surgery 12/2010; 34(12):3022-8. · 2.23 Impact Factor
[show abstract][hide abstract] ABSTRACT: Preinduction i.v. fentanyl bolus is associated with coughing in 28-65% of patients. Fentanyl-induced coughing (FIC) is not always benign and can be remarkably troublesome at the most critical moment of induction of anaesthesia when airway reflex is lost. We postulated that the huffing manoeuvre, a forced expiration against open glottis, just before i.v. fentanyl, may suppress this undesirable spasmodic cough.
Three hundred patients of ASA I and II, aged 18-60 yr, undergoing elective surgical procedures were randomly allocated into two groups consisting of 150 patients. Both groups received i.v. fentanyl (2.5 microg kg(-1)). Group 1 patients breathed normally whereas Group 2 patients were asked to perform huffing manoeuvre just before the fentanyl injection. The incidence of cough was recorded for 1 min before the induction of anaesthesia, and graded as mild (1-2 cough), moderate (3-5 cough), and severe (>5 cough). The incidence of FIC was analysed with Fisher's exact test and severity was analysed with the Mann-Whitney U-test. A P-value of <0.05 was considered significant.
The incidence of cough was 32% in the control group and 4% in the huffing manoeuvre group (P<0.00). In the control group, 12% of FIC cases were moderate to severe in nature whereas no patient suffered severe coughing in the huffing manoeuvre group (P=0.049).
A huffing manoeuvre performed just before i.v. fentanyl (2.5 microg kg(-1)) significantly reduces the incidence and severity of FIC in the majority of the patients.
BJA British Journal of Anaesthesia 11/2009; 104(1):40-3. · 4.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: Postoperative sore throat (POST) contributes to postoperative morbidity. Licorice has been used as an expectorant in cough and cold preparations. In this study, we evaluated the efficacy of licorice gargle for attenuating POST.
Forty adults (18-60 yr), ASA physical status I and II of either sex, undergoing elective lumber laminectomy were randomized into two groups of 20 each. Group C: received water; Group L: received 0.5 g licorice in water. Both groups received a 30 mL mixture for 30 s, 5 min before anesthesia which was standardized. The incidence and severity of POST at rest and on swallowing and side effects were assessed at 0, 2, 4, and 24 h, postoperatively. Severity of POST was assessed by visual analog scale (between 0 and 100 mm; where 0 means no sore throat and 100 means worst imaginable sore throat). Postextubation cough was assessed immediately after tracheal extubation. Data were analyzed by Z test and Fisher's exact test. P < 0.05 was considered as significant.
POST (incidence and severity) was reduced in the Group L compared with Group C at rest and on swallowing for all time points (P < 0.05), except that the severity of POST at rest, at 24 h, was similar in both groups (P > 0.05). Postextubation cough was reduced in Group L compared with Group C (P < 0.05). There was no difference in side effects between groups (P > 0.05).
Licorice gargle performed 5 min before anesthesia is effective in attenuating the incidence and severity of POST.
Anesthesia and analgesia 07/2009; 109(1):77-81. · 3.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of the present study was to determine the impact of universal salt iodization (USI) on the prevalence of iodine deficiency in the population of an area previously known to have severe iodine deficiency in India.
In a cross-sectional survey, a total of 2860 subjects residing in fifty-three villages of four sub-districts of Gonda District were examined for goitre and urinary iodine concentration. Free thyroxine and thyroid-stimulating hormone levels were also measured. Salt samples from households were collected for estimation of iodine content.
A reduction in goitre prevalence was observed from 69 % reported in 1982 to 27.7 % assessed in 2007. However, 34 % of villages still had very high endemicity of goitre (goitre prevalence >30 %). Twenty-three per cent of households consumed a negligible amount (<5 ppm) and 56 % of households consumed an insufficient amount (5-15 ppm) of iodine from salt.
Although there was an overall improvement in iodine nutrition as revealed by decreased goitre prevalence and increased median urinary iodine levels, there were several pockets of severe deficiency that require a more targeted approach. Poor coverage, the use of unpackaged crystal salt with inadequate iodine and the washing of salt before use by 90 % of rural households are the major causes of persisting iodine-deficiency disorders. This demonstrates lapses in USI implementation, lack of monitoring and the need to identify hot spots. We advocate strengthening the USI programme with a mass education component, the supply of adequately iodized salt and the implementation of complementary strategies for vulnerable groups, particularly neonates and lactating mothers.
Public Health Nutrition 06/2009; 13(3):424-9. · 2.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: Catheter-related bladder discomfort (CRBD) is defined as an urge to void or discomfort in the supra-pubic region; reported postoperatively in patients who have had urinary catheterization intra-operatively. We have evaluated tramadol, a centrally acting opioid analgesic with muscarinic receptor antagonist properties for prevention of CRBD.
Fifty-four adults (18-60 yr), ASA physical status I and II of either sex, undergoing elective percutaneous nephro-lithomy were randomly divided into two groups of 27 each. Control (C) group received normal saline (NS; 2 ml), whereas Tramadol (T) group received tramadol 1.5 mg kg(-1). All medications were diluted in 2 ml NS and administered 30 min before extubation. Intra-operatively, urinary catherization was performed with a 16 Fr Foley's catheter, and the balloon was inflated with 10 ml distilled water. The CRBD was assessed at 0, 1, 2, and 6 h after patient's arrival in the post-anaesthesia care unit along with total postoperative fentanyl requirement. Severity of CRBD was graded as none, mild, moderate and severe. Data were analysed by one-way ANOVA, Z-test, and Fisher's exact test. P<0.05 was considered significant.
Incidence and severity of CRBD was reduced in T group compared with C group at all time points (P<0.05). Postoperative pain as assessed by visual analogue scale and total postoperative fentanyl requirement (microg kg(-1)) was also reduced in the T group [176 (SD 26.5)] compared with C group [210 (34.6)] (P<0.05).
Tramadol 1.5 mg kg(-1) administered i.v. 30 min before extubation decreases the incidence and severity of CRBD and postoperative fentanyl requirement.
BJA British Journal of Anaesthesia 10/2008; 101(4):506-10. · 4.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: Postoperative pain is the dominating complaint and the primary reason for prolonged convalescence after laparoscopic cholecystectomy. We have evaluated the efficacy of a single preoperative dose of pregabalin for attenuating postoperative pain and fentanyl consumption after laparoscopic cholecystectomy.
Sixty adults (16-60 yr), ASA physical status I and II, of either sex undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized placebo controlled, double-blind study. Subjects were divided into two groups of 30 each to receive either a matching placebo or pregabalin 150 mg, administered orally 1 h before surgery. Postoperative pain (static and dynamic) was assessed by a 100 mm visual analogue scale, where 0, no pain; 100, worst imaginable pain. Subjects received patient-controlled i.v. fentanyl analgesia during the postoperative period. Results were analysed by Student's t-test, chi(2) test, Mann-Whitney U-test, and Fisher's exact test.
Postoperative pain (static and dynamic) and postoperative patient-controlled fentanyl consumption were reduced in the pregabalin group compared with the placebo group (P<0.05). Side-effects were similar in both groups.
A single preoperative oral dose of pregabalin 150 mg is an effective method for reducing postoperative pain and fentanyl consumption in patients undergoing laparoscopic cholecystectomy.
BJA British Journal of Anaesthesia 09/2008; 101(5):700-4. · 4.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: Cardiopulmonary bypass (CPB) provides a unique circumstance to study the effects of drugs on the systemic vasculature. Thus, this study was designed to evaluate the effects of sodium bicarbonate on the systemic circulation during CPB in humans.
Randomized, double-blind study. Setting: Tertiary care university hospital.
Patients presenting for coronary artery bypass graft surgery with CPB.
In this double-blind study, 22 consecutive adult patients of both sexes undergoing cardiac surgery were randomized into 2 groups. After establishing CPB and cardioplegia, patients in group 1 (n = 11) received saline (0.9%) (1.2 mL/kg), and group 2 received sodium bicarbonate (SB) (7%) (1.2 mL/kg). The blood level in the cardiotomy reservoir, pump flow, and mean arterial pressure were measured for 25 minutes.
The SB-treated patients (group 2) showed significantly greater (p < 0.05) decreases in cardiotomy reservoir blood volume (336 +/- 186 mL) than the saline-treated (140 +/- 97 mL) patients. The mean arterial pressure in group 2 patients significantly (p < 0.05) increased (from 49 +/- 11.9 to 65 +/- 5.3 mmHg) more than in the saline group (from 50 +/- 6.8 to 57 +/- 9.2 mmHg) after 20 minutes. The decrease in reservoir volume significantly (p < 0.05) and inversely correlated (r = -0.61) with the acidotic state of the patients before SB.
This study found a biphasic response to SB on the systemic circulation during CPB. Early dilation of venous capacitance vessels occurred followed by arteriolar constriction over the 20-minute study interval.
Journal of cardiothoracic and vascular anesthesia 05/2008; 22(2):199-203. · 1.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: Venous cannulation is often performed without any analgesia, even though pain experienced during this procedure is at times very distressing. Various pharmacological and nonpharmacological measures have been tried with variable results to minimize venous cannulation pain. We designed the present study to evaluate the efficacy of a flash of light on attenuating venous cannulation pain.
Ninety adults (15-60 yr), ASA physical status I and II, of either sex, undergoing elective laparoscopic cholecystectomy, were included in this prospective and randomized study. Patients were divided into three groups of 30 each. Group I (control); Group II (distraction): photographed without a flash of light; and Group III (flash): photographed with a flash of light just before venous cannulation of a vein on the dorsum of the nondominant hand. Immediately after the photograph, venous cannulation was performed using an 18-gauge cannula.
Two patients from each group could not be cannulated on their first attempt and were therefore dropped from subsequent analysis. The incidence of venous cannulation pain in the flash group was lower, i.e., 50% (14 of 28) when compared to 100% (28 of 28) observed in the other two study groups (P < 0.01). Severity of venous cannulation pain as assessed by the Visual Analog Scale scores (between 0 and 100; where 0 = no pain and 100 = worst imaginable pain) presented as median (interquartile range) were reduced in the flash [10(20)] and distraction [20(10)] groups compared with the control group [40(20)] (P < 0.01). The severity of venous cannulation pain was also reduced in the flash group compared with the distraction group (P < 0.01).
We conclude that a flash of light before venous cannulation is a safe, effective, and easy-to-use method for minimizing venous cannulation pain.
Anesthesia and analgesia 03/2008; 106(3):814-6, table of contents. · 3.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: There is a lack of information on the disease burden due to Taenia solium taeniasis and its associated risk factors in pig farming communities throughout the world. The present study was conducted in a rural pig farming community of north India to estimate the prevalence of T. solium taeniasis and associated factors. Demographic, clinical and epidemiological data were collected from 1181 subjects in 210 households in 30 villages. Stool specimens from 924 subjects were examined for eggs of Taenia and other parasites. Identification of T. solium was confirmed by morphological features of segments and species-specific DNA detection from segments and stool. The prevalence of T. solium taeniasis was 18.6% (172/924); factors associated with taeniasis on multivariate analysis were age above 15 years, history of passage of Taenia segments in stool, undercooked pork consumption and poor hand hygiene (hand-washing with clay/water after defecation). Seventy-eight subjects (6.6%) with epilepsy were identified. The study showed alarmingly high rates of epilepsy and T. solium taeniasis in the study community; it highlights the need for large-scale imaging-based surveys to identify the factors associated with epilepsy including neurocysticercosis. Health education, mass anthelminthic therapy and other preventive measures are required to control the menace of the disease.
Transactions of the Royal Society of Tropical Medicine and Hygiene 01/2008; 101(12):1241-7. · 1.82 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVES: Acute coronary syndrome (ACS) patients are prone to develop pulmonary
oedema with varied degree of hypoxaemia. The aim was to compare the risk for
pulmonary oedema and related complications during ACS amongst non-smokers vs.
METHODS: Prospective, observational study was performed in consecutive 68
patients presenting with ACS. They were divided into two groups; group 1 (n = 33)
non-smokers and group 2 (n = 35) chronic smokers. Standard conservative treatment
was given to maintain mean arterial pressure >or= 60 mmHg, oxygen saturation >
95%. The bedside chest x-ray was graded for Battler grading (0-4) for pulmonary
oedema. All patients were evaluated for troponin, serial creatinine kinase,
echocardiography, arterial blood gas, renal function and correlated with
inotropes requirement, active respiratory support, coronary care unit (CCU) stay
and hospital outcome.
RESULTS: Patients in both the groups had similar cardiac involvement for
cardiothoracic ratio, troponin, ejection fraction and creatinine kinase muscle
and brain (CK-MB). The bedside chest x-ray revealed significant (p < 0.05) lung
oedema grades (3 and 4) in 60% non-smokers (group 1) vs. smokers (11%). These
patients (group 1) also presented with significant (p < 0.001) hypoxaemia (lower
PaO(2)/FiO(2)-201 +/- 44), metabolic acidosis (higher lactate; 2.1 +/- 0.72
mmol/l, base deficit; -5.1 +/- 4.8) and hypocarbia (28 +/- 2.9 mmHg) than smokers
(group 2). The risk estimates for active respiratory support (OR =1.716) and
inotrope use (OR = 1.836) was three times higher in non-smokers than smokers.
CONCLUSIONS: The higher degree of pulmonary oedema and hypoxemia probably
contributed to poor short-term outcome in non-smokers than smokers. It would be
important to recognise and treat hypoxaemia in non-smokers during ACS.
International Journal of Clinical Practice 01/2008; 62(12):1880-5. · 2.43 Impact Factor
[show abstract][hide abstract] ABSTRACT: We compared the incidence and severity of cough following a bolus of sufentanil with that following fentanyl in 510 patients, randomly allocated to receive sufentanil 0.3 microg.kg(-1), fentanyl 3 microg.kg(-1) or 5 ml sterile water intravenously over 5 s. Coughing was graded depending on the number of coughs as mild (1-2), moderate (3-5) and severe (> 5). The incidence of coughing was higher after sufentanil (26/165; 15%) and fentanyl (54/169; 32%) than in the control group (0/168; p < 0.001). Sufentanil was also associated with a lesser severity (p = 0.039) of coughing compared with fentanyl. We conclude that equipotent boluses of sufentanil and fentanyl increase the incidence of cough, although the incidence and severity of coughing with sufentanil are less than those with fentanyl.
[show abstract][hide abstract] ABSTRACT: To compare the efficacy and side effects of transdermal diclofenac patch with eutectic mixture of local anesthetic (EMLA) cream in attenuating venous cannulation pain.
Adult ASA I or II patients undergoing elective surgery were randomly divided into three groups of 150 each. Group 1 (Control) patients received a placebo patch; Group 2 (EMLA) patients received EMLA cream; Group 3 (Diclofenac) patients received a transdermal diclofenac patch. The patches were applied at the proposed venous cannulation site 60 min prior to cannulation and pain resulting from an 18G cannula was assessed on an ten-point visual analogue scale (VAS). The cannulation site was observed for blanching, erythema, induration and edema for up to 24 hr.
The incidence of venous cannulation pain was 100% in the control group, as compared to 37% and 48% of patients who experienced pain in the EMLA (P = 0.001) and diclofenac (P = 0.001) groups, respectively. The severity of venous cannulation pain [median (VAS) with interquartile ranges] was also higher in the control group: 6 (3) as compared to VAS sores of 0 (1) and 0 (2) in the EMLA (P = 0.001) and diclofenac (P = 0.001) groups. Blanching occurred with greater frequency in the EMLA group compared with the diclofenac (P = 0.001 at six hours) and placebo groups (P = 0.001 at six hours). Erythema, induration and edema were reduced in the diclofenac group compared with the EMLA (P = 0.001 for all comparisons) and placebo groups (P = 0.04 for edema at six hours and P = 0.001 for other comparisons).
Transdermal diclofenac patch and EMLA are equally effective in reducing venous cannulation pain, but signs of erythema, induration and edema are less frequently observed with the transdermal diclofenac patch.
Canadian Journal of Anaesthesia 04/2007; 54(3):196-200. · 2.13 Impact Factor
[show abstract][hide abstract] ABSTRACT: Neural tube defects (NTDs) are common birth defects (1 in 1,000) leading to significant morbidity and mortality. Periconceptional folic acid supplementation helps in prevention of 70% of NTDs. Recently, polymorphisms in genes encoding enzymes of the folate pathway have been implicated in causation of NTDs. Since the closure of neural tube occurs at multiple sites, the etiology of defect at different sites may be different - which explains the failure of folic acid supplementation to prevent all NTDs.
Molecular analysis of methylenetetrahydrofolate reductase polymorphisms was carried out using polymerase chain reaction and restriction enzyme digestion. We studied the association of these polymorphisms in mothers with a previous child with NTD and further refined the risk by stratification based on level of defect.
The frequency of 677C-->T homozygotes was higher in mothers with a previous child with NTD than the controls (OR = 1.6 (0.38-6.7), 95% CI, p = 0.72) but the difference was statistically insignificant. There was a significant difference in frequency of T alleles among mothers with a previous child with a 'lower' type of defect compared to controls (OR = 2.15 (1.13-4.1), 95% CI, p = 0.02). We did not find any significant association of 1298A-->C polymorphism with the level of NTDs.
We conclude that in the North Indian population, the 677C-->T allele of the MTHFR gene may be associated with the occurrence of a lower type of NTD. This points towards the differential role of thermolabile MTHFR at different sites of neural tube closure.
Gynecologic and Obstetric Investigation 02/2007; 63(3):146-50. · 1.10 Impact Factor