Comparison of Efficacy of Halstead and Vazirani Akinosi Block Technique in Achieving Mandibular Anesthesia

OBJECTIVE: To compare the efficacy of Halstead and Vasirani Akinosi block techniques in achieving mandibular anesthesia during exodontia among subjects reporting to Watim Teaching Hospital. STUDY DESIGN: Randomized controlled trial. PLACE AND DURATION OF STUDY: This study was conducted in the department of Maxillofacial Surgery, Watim Dental Hospital, Rawalpindi from July 2019 to January2020. MATERIALS AND METHODS: This is a randomized control trail of 60 patients. Duration of onset of anesthesia, pain during injection, incidence of aspiration, success and failure of Halstead and Vasirani Akinosi techniques and their mean doses were analyzed and compared by using SPSS version 17.Comparison of categorical variables was done by Chi-square test. Comparison of non-categorical variables was done by independent sample t-test. p value of less than 0.05 was considered significant. RESULTS: 28(93.3%) experienced moderate while 2(6.7%) experienced severe pain in Halstead group, while 30(100%) experienced mild pain in Vasirani Akinosi group. Halstead technique was successful in 22(73.3%) while unsuccessful in 8(26.7%) patients. Vasirani Akinosi technique was successful in 29(96.7%) and unsuccessful in 1(3.3%) patients. CONCLUSION: It may be concluded from analysis in the present study that Vasirani Akinosi technique was statistically superior in all parameters such as duration of onset, pain during injection, aspiration and success rate as compared to the conventional Halstead block technique. KEY WORDS: Extraction tooth, local anesthesia, Vasirani-Akinosi technique, nerve block

Comparison of Efficacy of Halstead and Vazirani Akinosi Block Technique in Achieving Mandibular Anesthesia

OBJECTIVE: To compare the efficacy of Halstead and Vasirani Akinosi block techniques in achieving mandibular anesthesia during exodontia among subjects reporting to Watim Teaching Hospital. STUDY DESIGN: Randomized controlled trial. PLACE AND DURATION OF STUDY: This study was conducted in the department of Maxillofacial Surgery, Watim Dental Hospital, Rawalpindi from July 2019 to January2020. MATERIALS AND METHODS: This is a randomized control trail of 60 patients. Duration of onset of anesthesia, pain during injection, incidence of aspiration, success and failure of Halstead and Vasirani Akinosi techniques and their mean doses were analyzed and compared by using SPSS version 17.Comparison of categorical variables was done by Chi-square test. Comparison of non-categorical variables was done by independent sample t-test. p value of less than 0.05 was considered significant. RESULTS: 28(93.3%) experienced moderate while 2(6.7%) experienced severe pain in Halstead group, while 30(100%) experienced mild pain in Vasirani Akinosi group. Halstead technique was successful in 22(73.3%) while unsuccessful in 8(26.7%) patients. Vasirani Akinosi technique was successful in 29(96.7%) and unsuccessful in 1(3.3%) patients. CONCLUSION: It may be concluded from analysis in the present study that Vasirani Akinosi technique was statistically superior in all parameters such as duration of onset, pain during injection, aspiration and success rate as compared to the conventional Halstead block technique. KEY WORDS: Extraction tooth, local anesthesia, Vasirani-Akinosi technique, nerve block

To Determine Mean Change In Weight Of Patients Undergoing Maxillomandibular Fixation

Abstract Objective: Optimum management of patient needs is the most important step for the restoration of form and function. Maxillomandibular fixation is one of the treatment modalities used very frequently in maxillofacial surgery. This study aims to determine the mean change in weight in patients undergoing Maxillomandibular Fixation. Methods: This observational cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery Foundation University Medical College from 27th April 2018 to 22nd January 2019. This study included patients male and female, who presented with maxillofacial trauma, orthognathic surgery and procedures in which MMF ( Maxillomandibular fixation ) was indicated were included in this study. Pre-operative weight was measured in kilograms with an analogue weight machine and designated as W1. Patients were advised to a liquid diet and kept on follow-up. After four weeks of MMF again weight of the patient was measured and designated as W2. Follow-up was done through the patient's contact number. Results: In this study, the mean weight of patients preoperatively was 59.46±12.23 Kg. The postoperative mean weight of patients was 57.81±11.58 Kg. A decrease of 1.65 Kg was seen in the patient’s weight postoperatively.  No significant difference was seen for weight change in patients postoperatively with age, gender, educational status, occupational status, socioeconomic status and an indication of MMF. Conclusion: Results of this study showed weight loss in patients who underwent maxillomandibular fixation. This factor should be considered during the perioperative period to prevent postoperative complications, postoperative weight loss, and malnutrition of patients undergoing maxillomandibular surgery and reflect the need for guidance on diet postoperatively, mainly directed to frequency of feeding and high protein liquid diet and nutritional supplements.

Kras Diagnosing the Little-Known Cancers Oncogene through Liquid Biopsy: Review

Tissue biopsy, till date, is a gold standard for tumor diagnosis, grading, treatment, and detecting genetic evidences for identifying appropriate personalized treatments. However, it is painful, invasive, expensive, and risky making sequential biopsies basically impractical. Detection of Kras genes through liquid biopsy is the growing theragnostic technique, which is more sensitive, specific, much cost-effective and quick method for detecting the mutational status of cancers. Liquid biopsy detects biomarkers present in various body fluids, such as plasma, urine, saliva and cerebrospinal fluid, harboring cancer degraded fragments and cells shed by carcinoma such as circulating tumor cells, microRNA and circulating tumor DNA. It can be utilized as a pre-screening test for initial stage cancers also where multiple sampling is required for monitoring cancer therapies. Kras is the most extensively mutated cancer oncogene involve in altering the downstream signaling pathways, increasing oncogenic signaling, which is typically associated with poor prognosis and resistance to therapy. This review was conducted to clarify its prognostic significance as well as its mutational role in different carcinomas. To identify studies related to Kras mutation Medline, PubMed, Google Scholar and Web of Science search engines were explored and forty two relevant researches were finalized from year 2005 to 2019

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Comparison of KRAS gene in circulating tumor DNA levels vs histological grading of colorectal cancer patients through liquid biopsy

Background: To determine KRAS gene in circulating tumor DNA in comparison with histological grading through liquid biopsy in colorectal cancer patients. Methods: This dual-centered cross-sectional study included 73 diagnosed patients of colorectal cancer at different grading levels [Grade I, well differentiated (n = 7, 9.5%); Grade II, moderately differentiated (n = 14,18.9%); and Grade III, poorly differentiated (n = 52, 70%)]. Blood was collected, and plasma was separated. ctDNA was extracted, using magnetic bead-based technique (MagMAX Cell-Free DNA kit). KRAS gene was quantified through qPCR. STRING database was used to find KRAS interactomes. Results: Mean threshold cycle (CT value) of KRAS gene in Grade III samples showed significantly higher (P = 0.001) levels of ctDNA (2.7 ± 1.14) compared with Grade II and Grade I (3.1 ± 0.68, 2.3 ± 0.60), respectively. Grading characterization showed that rectal cancer (n = 22, 42.3%) with Grade III (68.8%) was more prevalent than colon and sigmoid cancer (n = 19, 36.5%, n = 11, 21%, respectively). STRING database showed 10 functional genes interacting with KRAS expressed as gene/proteins. Conclusion: Liquid biopsy can be used to detect ctDNA in plasma of CRC patients and enabled to detect the KRAS gene by qPCR. The technique being less invasive and cost-effective is convenient for multiple biopsies in different cancers

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit