Effectiveness of 0.125% Bupivacaine versus 0.125% Ropivacaine in Epidural Labour Analgesia- A Randomised Clinical Study

Introduction: Epidurally administered local anaesthetics provide most effective analgesia during labour process. Among the available local anaesthetics, bupivacaine and ropivacaine are the most commonly used drugs in concentrations ranging from 0.0625% to 0.125% and 0.08% to 0.125%, respectively. Both these drugs are weak bases, highly protein-bound, highly lipid soluble, and have a pKa of 8.1, low unionised fraction, thus, having a slightly longer time for onset of action but with a longer duration of action and have less transfer across the placenta. Hence, they are ideal drugs for use in labour analgesia. Aim: To compare the effectiveness of programmed intermittent bolus of 0.125% bupivacaine vs 0.125% ropivacaine in low volumes in full term primigravidas for epidural labour analgesia. Materials and Methods: This randomised clinical study was conducetd at PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, between June 2020 and December 2021 among 80 full-term primi parturients requiring normal vaginal delivery. They were randomly divided into two groups of 40 each. Group B received 10 mL of 0.125% bupivacaine and group R received 10 mL of 0.125% ropivacaine as initial bolus dose. Repeat doses of 5 mL was given every 60 minutes or when the patient had Visual Analogue Score (VAS) score >4 with a maximum dose of 10 mL/hr with a 20 minute interval between two doses. Parameters assessed were onset, duration, level and quality of analgesia, motor blockade, number of epidural top ups, total volume of drug consumed, mode of delivery, duration of labour, APGAR score, haemodynamics, patient satisfaction and complications. Data was entered in Microsoft Excel 2010 version and analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: Both drugs were equally effective in terms of analgesia, maternal and foetal outcomes. Bupivacaine had a faster onset of action (7.075±0.916 min) compared to ropivacaine (8.225±0.891 min) (p-value=0.001). Ropivacaine had a shorter duration of action (43.1±2.30 min vs 47.9±4.16 min in group B) (p-value=0.0001), requiring more top-up doses (5.2±0.46 vs 4.77±0.61 in group B) (p-value=0.0007), and more total volume of drug (38.5±3.08 mL vs 35.5±4 mL in group B) (p-value=0.002). It also caused lesser motor blockade (Bromage score of 1 in 1 parturient vs 8 parturients in group B) (p-value=0.0129) and better overall maternal satisfaction score (excellent) in 30 parturients vs 25 parturients in group B. APGAR scores at 1 minute and 5 minutes were comparable between the two groups. Mean heart rates, mean blood pressures were also comparable between the two groups. There were no significant adverse effects in either groups. Conclusion: By providing minimal motor blockade and adequate analgesia 0.125% ropivacaine allows parturients to go through the labour process with excellent maternal satisfaction and minimal adverse effects compared to 0.125% bupivacaine

Assessment of Chemical Inhibitor Addition to Improve the Gas Production from Biowaste

The coexistence of sulphate-reducing bacteria and methanogenic archaea in the reactors during the anaerobic digestion from sulphate-containing waste could favor the accumulation of sulfide on the biogas, and therefore reduce its quality. In this study, the effect of sulphate-reducing bacteria inhibitor (MoO−2 4 ) addition in a two phase system from sulphate-containing municipal solid waste to improve the quality of the biogas has been investigated. The results showed that although SRB and sulphide production decreased, the use of inhibitor was not effective to improve the anaerobic digestion in a two phase system from sulphate-containing waste, since a significant decrease on biogas and organic matter removal were observed. Before MoO−2 4 addition the average values of volatile solid were around 12 g/kg, after 5 days of inhibitor use, those values did exceed to 28 g/kg. Molybdate caused acidification in the reactor and it was according to decrease in the pH values. In relation to microbial consortia, the effect of inhibitor was a decrease in Bacteria (44%; 60% in sulphate-reducing bacteria) and Archaea (38%) population

Two Sides of the Same Story: Alcohol Use and HIV Risk Taking in South India

This qualitative study examines the role of alcohol in sexual risk among male migrant workers and female sex workers in two South Indian states. Most men reported using alcohol for increased energy and courage prior to their sexual experiences and to reduce feelings of loneliness and isolation. Sex workers, on the other hand, often stated that they avoided alcohol prior to sex in order to stay alert and reduce the risk of violence. Both groups reported that drinking often increased male aggression and reduced condom use. Research is needed to examine the prevalence of these patterns as well as factors associated with sexual risk and violence, in order to develop targeted interventions for these groups. Future risk reduction programs may benefit from addressing safer ways of meeting the needs expressed by the participants. This may include strategies to defuse volatile situations, safe ways of improving the sexual experience, and interventions aimed at alleviating loneliness and isolation for migrants

Optimal functional outcome measures for assessing treatment for Dupuytren's disease: A systematic review and recommendations for future practice

This article is available through the Brunel Open Access Publishing Fund. Copyright © 2013 Ball et al.; licensee BioMed Central Ltd.Background: Dupuytren's disease of the hand is a common condition affecting the palmar fascia, resulting in progressive flexion deformities of the digits and hence limitation of hand function. The optimal treatment remains unclear as outcomes studies have used a variety of measures for assessment. Methods: A literature search was performed for all publications describing surgical treatment, percutaneous needle aponeurotomy or collagenase injection for primary or recurrent Dupuytren’s disease where outcomes had been monitored using functional measures. Results: Ninety-one studies met the inclusion criteria. Twenty-two studies reported outcomes using patient reported outcome measures (PROMs) ranging from validated questionnaires to self-reported measures for return to work and self-rated disability. The Disability of Arm, Shoulder and Hand (DASH) score was the most utilised patient-reported function measure (n=11). Patient satisfaction was reported by eighteen studies but no single method was used consistently. Range of movement was the most frequent physical measure and was reported in all 91 studies. However, the methods of measurement and reporting varied, with seventeen different techniques being used. Other physical measures included grip and pinch strength and sensibility, again with variations in measurement protocols. The mean follow-up time ranged from 2 weeks to 17 years. Conclusions: There is little consistency in the reporting of outcomes for interventions in patients with Dupuytren’s disease, making it impossible to compare the efficacy of different treatment modalities. Although there are limitations to the existing generic patient reported outcomes measures, a combination of these together with a disease-specific questionnaire, and physical measures of active and passive individual joint Range of movement (ROM), grip and sensibility using standardised protocols should be used for future outcomes studies. As Dupuytren’s disease tends to recur following treatment as well as extend to involve other areas of the hand, follow-up times should be standardised and designed to capture both short and long term outcomes

NetPath: a public resource of curated signal transduction pathways

NetPath, a novel community resource of curated human signaling pathways is presented and its utility demonstrated using immune signaling data

Validity of the disabilities of the Arm, Shoulder and Hand patient-reported outcome measure (DASH) and the Quickdash when used in Dupuytren’s disease

This study investigated aspects of the validity and reliability of the 30-item Disabilities of the Arm, Shoulder and Hand patient-reported outcome measure (DASH) and its relationship with the shorter 11-item QuickDASH in patients with Dupuytren’s disease. Seven hundred and fifty-nine DASH questionnaires were studied, covering pre- and postoperative patients undergoing different treatments for Dupuytren’s disease. Items related to pain rose early after treatment before returning to baseline, suggesting that studying pain is relevant during postoperative recovery. Across all 759 sets of responses, the QuickDASH agreed closely with the DASH. In exploratory factor analysis, the DASH was not unidimensional, questioning the validity of the DASH summary score in Dupuytren’s disease. Further validation of existing PROMs for use in Dupuytren’s disease is needed. These data suggest that pain is a relevant symptom to study during postoperative recovery following treatment for Dupuytren’s disease