ANALGESIC EFFECT OF PRE-EMPTIVE ORAL NSAIDS ON POST-ENDODONTIC PAIN LEVELS IN SINGLE VISIT ENDODONTICS -A SYSTEMATIC REVIEW

Background: Pre-emptive analgesia is an anti-nociceptive treatment which reduces the postoperative pain by preventing the processing of altered afferent input. As most of the patients present with pain preoperatively have higher levels of released local inflammatory mediators. Thus, pretreatment analgesia decreases the establishment of central sensitization, a mechanism by which spinal neurons increase their response to peripheral nociceptive impulse. Objective: This systematic review aims to compare and evaluate the postoperative pain levels and analgesic intake on preoperative oral administration of NSAIDs in single visit root canal treatment. Data Sources: The present review was done according to PRISMA guidelines and was registered in the PROSPERO (Centre for Reviews and Dissemination University of York; http://www.crd.york.ac.uk/PROSPERO). Registration number - CRD42020195775. The research question was formulated based on the PICO strategy. A comprehensive electronic literature search was conducted across PubMed/Medline, Scopus and Cochrane Database independently by two reviewers. Study Eligibility Criteria: Articles published from January 1990 to May 2019 that focused on preemptive strategies in single visit root canal treatment were included in the present review. Based on specified inclusion and exclusion criteria’s, the selected articles were subjected to quality assessment, and the risk of bias was evaluated. Methods: A total of 6 articles were included, out of which three were hand searched. The overall risk of bias of included studies was moderate, and the study limitations were high. Results: Among the studies included, Ibuprofen was considered as the best drug of choice in single visit endodontics. Limitations: The present review was assessing only the effectiveness of NSAIDs in single visit root canal treatment. But ideally comprehensive literature should search on effectiveness in both single and multiple visit root canal treatments. Conclusion: The present systematic review concluded that ibuprofen was considered to be an effective drug in single visit root canal treatment

A Conceptual Frame Work of Supply Chain Integration for Competitive Advantage

Growth as one of the key preconditions to survive in the market is forcing companies to compete on international markets and at the same time defend domestic market share from international competitors. The result of that is increased complexity of supply chains, pressure to decrease cost and improve service level. To cope with the complexity and increased customer requirements, active management of the supply chain is a prerequisite. As supply chain is a network of three or more entities directly involved in the upstream and downstream flows of products, services, finance and information from a source to a customer, management of it is a complex task. There is significant evidence from literature that the effective implementation of integrated supply chain management (SCM) has the potential to generate significant improvements in the performance of firms. The higher levels of SCM practice can lead to enhanced competitive advantage and improved organizational performance. In order to achieve efficient supply chain integration for the processes or activities; the organizations should recognize and understand all the integration challenges of supply chain. The aim of this paper is to investigate previous research studying the relationship between supply chain integration and performance and understand the importance of supply chain integration for competitive position of organization. Address the challenges encountered in integration of supply chain. Propose a conceptual frame work to reap the potential benefits of effective supply chain integration

Early postoperative outcomes of dunking pancreatojejunostomy

Background: There is no gold standard method for pancreatico-enteric reconstruction.  In our department, dunking pancreatojejunostomy (DPJ) and Duct to mucosa PJ technique are done as per surgeon’s choice.  In this study, authors evaluate the early postoperative outcomes following DPJ based on ISGPS (2007).Methods: A Retrospective analysis of prospectively collected data from January 2008 to December 2015. Detailed information on these patients was maintained on a prospectively held computerized database. Routine drain amylase estimations are being done on POD 3and 5 for all patients undergoing pancreatic resections and on all subsequent days if output is suggestive of pancreatic fistula. Details of patients who have undergone pancreatic resection with duct to mucosa type of pancreato-intestinal anastomosis during the same period (64 patients) were also collected prospectively and analysed. DPJ and Duct to mucosa groups were not comparable with respect to age, duct size, pancreatic gland texture and co-morbidities. Hence direct comparison between the two groups has not been carried out.Results: A total of 75 of 139 pancreatic resections with pancreatointestinal anastomosis who had dunking PJ and fulfilled the study criteria were analysed; none were excluded for analysing early outcomes. 19 out of 75 (25.5%) developed grade ‘A’ POPF, five out of 75 (6.6%) developed Grade ‘B’ POPF and three out of 75 (3.3%) developed Grade ‘C’ POPF. 20 out of 75 (26.6%) had grade ‘A’ DGE, five out of 75 (6.6%) had grade ‘B’ DGE. PPH occurred in four out of 75 (5.3%), two out of four were early PPH, one was managed by coiling and other by re-laparotomy, two were late PPH both managed by coiling of the pseudo aneurysms. There was no 30-day mortality.Conclusions: Dunking (Invagiantion) pancreatojejunostomy has accepatable early outcomes with clinically significant/relevant postoperative pancreatic fistula rates of Grade B (6.6%) and Grade C (4%), delayed gastric emptying (33.2%) and post pancreatic hemorrhage (5.3%) rates. The outcomes are comparable with Duct-to-mucosa PJ mentioned in literature

Analysis of caesarean sections according to Robson’s ten group classification system at a tertiary care teaching hospital in South India

Background: The caesarean section (CS) delivery rate is steadily increasing worldwide, including India. Identifying the proportion of women in various categories as per Robson's ten group classification system and CS rate among them is important to bring down the increasing CS rate.Methods: This retrospective study was conducted at Pondicherry Institute of Medical Sciences (PIMS), a tertiary careteaching hospital in Puducherry, South India. The data was collected for the women delivered by CS during January 2011 to December 2011 and proportions in various groups as per Robson’s ten-group classification system were calculated.Results: Among a total of 1123 women delivered during study period, 367 (32.6%) delivered by CS. The CS rates among various groups varied from 100% among women with breach presentation (group 6 and group 7) and abnormal lies (group 9) to 5.9% among multiparous women with spontaneous labour having single cephalic pregnancy (group 3). Among women with precious section, CS rate was very high (89.6%). Women with previous CS (group 5) contributed maximum (40.1%) to the total number of CS.Conclusions: In the present study, all women with breech presentation and abnormal lies delivered by CS and repeat CS was the highest contributor to all CS deliveries.  

An interesting case of anhidrosis

Ross syndrome is a rare syndrome of autonomic dysfunction which is characterized by segmental hypohidrosis/ anhidrosis, Adie tonic pupil and hyporeflexia/areflexia. Exact etiology is not known. It was first described in 1958 and approximately 50 cases have been described so far globally. We hereby report a case of segmental anhidrosis of left face, left upper limb and left side of chest with 3-year duration in a 26-year-old man who also had Adie’s tonic pupil in right eye and global areflexia on examination

Effect of post harvest treatments and harvesting stage on vase life and flower quality of cut Oriental lily

An investigation was carried out to study the effect of post harvest treatments and harvesting stage on vase life and flower quality of cut Oriental lily cv. Avocado. The results showed that highest vase life (15.83 days) and vase solution uptake (49.17 ml) was recorded with sucrose (2%) + 5-SSA (200ppm), whereas maximum flower diameter (15.17 cm) was recorded in vase solution containing sucrose (2%) + 5-SSA (100ppm). Earliest opening of florets (4.42 days) reported under sucrose (2%) + 5-SSA (200ppm). Effect of treatments was found non-significant in respect to opening of florets. Harvesting at green bud stage exhibited extended vase life (14.33 days) and higher vase solution uptake (40.43 ml), whereas maximum flower diameter (14.25 cm) recorded at 75% colour development stage. Based on the results it is concluded that 5-SSA could be an inexpensive and potential chemical for delaying senescence and for extending the keeping quality of cut liliums commercially

Prevalence of frailty and association with patient centered outcomes:A prospective registry-embedded cohort study from India

Purpose:We aimed to study the prevalence of frailty, evaluate risk factors, and understand impact on outcomes in India. Methods:This was a prospective registry-embedded cohort study across 7 intensive care units (ICUs) and included adult patients anticipated to stay for at least 48hrs. Primary exposure was frailty, as defined by a score ≥5 on the Clinical Frailty Scale and primary outcome was ICU mortality. Secondary outcomes included in-hospital mortality and resource utilization. We used generalized linear models to evaluate risk factors and model association between frailty and outcomes. Results:838 patients were included, with median (IQR) age 57 (42,68) yrs.; 64.8% were male. Prevalence of frailty was 19.8%. Charlson comorbidity index (OR:1.73 (95%CI:1.39,2.15)), Subjective Global Assessment categories mild/moderate malnourishment (OR:1.90 (95%CI:1.29, 2.80)) and severe malnourishment [OR:4.76 (95% CI:2.10,10.77)] were associated with frailty. Frailty was associated with higher odds of ICU mortality (adjusted OR:2.04 (95% CI:1.25,3.33)), hospital mortality (adjusted OR:2.36 (95%CI:1.45,3.84)), development of stage2/3 AKI (unadjusted OR:2.35 (95%CI:1.60, 3.43)), receipt of non-invasive ventilation (unadjusted OR:2.68 (95%CI:1.77, 4.03)), receipt of vasopressors (unadjusted OR:1.47 (95%CI:1.04, 2.07)), and receipt of kidney replacement therapy (unadjusted OR:3.15 (95%CI:1.90, 5.17)). Conclusions:Frailty is common among critically ill patients in India and is associated with worse outcomes. <br/

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention