Effectiveness of Nerve Blocks for Management of Head and Neck Cancer Associated Neuropathic Pain Disorders; a Retrospective Study

Introduction: A portion of patients with head and neck cancer (HNC)-associated pain may not experience relief in symptoms with non-invasive modalities. A nerve block is a procedure in which a local anesthetic agent is injected along the nerve track to preferentially block sensory transmission. The literature on the effectiveness of nerve blocks in the management of HNC-related pain is limited. The purpose of this study was to determine the effectiveness of nerve blocks in management of breakthrough HNC-associated trigeminal or cervical neuropathic pain disorders. Materials and Methods: A retrospective chart review of patients who underwent a nerve block or infiltration procedure in the regions of head and neck for management of breakthrough HNC-associated trigeminal or cervical neuropathic pain disorders in the Orofacial Pain Medicine clinic, Shaukat Khanum Memorial Cancer Hospital and Research Centre, between November 2018 and November 2019 was completed. Information regarding demographics, diagnosis, and pain characteristics was extracted and reviewed. The Fisher-exact test and Mann-Whitney U test were used for analysis between independent and dependent variables. Results: A total of 27 participants were included in the investigation, of which 66.7 % were males. The average pre-procedure pain score was 6.85 ± 2.54. Following intervention, 81.5 % of the participants experienced greater than 75 % relief in pain for longer than 48 hours. The mean immediate post-procedure pain score was 0.26 ± 1.02 and the average duration of relief was 6.10 ± 6.50 weeks. The significant effect of nerve blocks was found to be statistically associated with the concurrent use of amitriptyline (p = 0.017). Conclusion: Nerve blocks, as an adjunctive therapy to pharmacologic treatment, can provide significant relief to patients with breakthrough HNC-associated trigeminal and cervical neuropathic pain disorders. However, the duration of relief experienced by the participants is inconsistent. The beneficial effect of nerve blocks appears to be more common in patients that were concurrently using amitriptyline

Clinical Outcomes of physiologically-guided revascularisation

Objective: To assess the clinical outcomes of revascularisation based on fractional flow reserve (FFR) and/or instantaneous wave-free ratio (iFR).Study design: Descriptive study.Place and duration of study: Department of Medicine, The Aga Khan University Hospital, Karachi from January 2012 to January 2020.Methodology: A cohort of patients having moderate to severe coronary stenosis, undergoing coronary revascularisation based on invasive physiological assessment (FFR or iFR) were assessed. The participants were divided into the revascularisation-deferred group and the revascularization-performed group, based on the physiological results. Cox-proportional hazard model building was done, using a stepwise approach by assessing all plausible interactions and considering p-value ≤0.05 as statistically significant.Results: The frequency of major adverse cardiac event (MACE) and target vessel revascularisation was 8.4% and 3.2% in the revascularisation-performed group as compared to 6.4% and 3.2% in the revascularisation-deferred group. In adjusted models, no statistically significant difference was noted in MACE when comparing the revascularisation-performed group with a deferred group.Conclusion: Revascularisation guided by invasive physiological assessment with FFR or iFR is clinically safe and led to better resource utilisation. Key Words: Fractional flow reserve, Instantaneous wave-free ratio, Invasive physiological assessment, Low-middle income country

Hyperbolic type harmonically convex function and integral inequalities

In this paper, we define a new class of harmonic convexity i.e. Hyperbolic type harmonic convexity and explore its algebraic properties. Employing this new definition, some integral inequalities of Hermite-Hadamard type are presented. Furthermore, we have presented Hermite-Hadamard inequality involving Riemann Liouville fractional integral operator. We believe the ideas and techniques of this paper may inspire further research in various branches of pure and applied sciences.Publisher's Versio

New Ostrowski-Type Fractional Integral Inequalities via Generalized Exponential-Type Convex Functions and Applications

Recently, fractional calculus has been the center of attraction for researchers in mathematical sciences because of its basic definitions, properties and applications in tackling real-life problems. The main purpose of this article is to present some fractional integral inequalities of Ostrowski type for a new class of convex mapping. Specifically, n–polynomial exponentially s–convex via fractional operator are established. Additionally, we present a new Hermite–Hadamard fractional integral inequality. Some special cases of the results are discussed as well. Due to the nature of convexity theory, there exists a strong relationship between convexity and symmetry. When working on either of the concepts, it can be applied to the other one as well. Integral inequalities concerned with convexity have a lot of applications in various fields of mathematics in which symmetry has a great part to play. Finally, in applications, some new limits for special means of positive real numbers and midpoint formula are given. These new outcomes yield a few generalizations of the earlier outcomes already published in the literature

Some Integral Inequalities Involving Exponential Type Convex Functions and Applications

In this present case, we focus and explore the idea of a new family of convex function namely exponentialtype m–convex functions. To support this newly introduced idea, we elaborate some of its nice algebraicproperties. Employing this, we investigate the novel version of Hermite–Hadamard type integral inequality.Furthermore, to enhance the paper, we present several new refinements of Hermite–Hadamard (H−H) inequality.Further, in the manner of this newly introduced idea, we investigate some applications of specialmeans. These new results yield us some generalizations of the prior results in the literature. We believe, themethodology investigated in this paper will further inspire intrigued researchers

Thermal growth in solar water pump using Prandtl-Eyring hybrid nanofluid: a solar energy application

Nowadays, with the advantages of nanotechnology and solar radiation, the research of Solar Water Pump (SWP) production has become a trend. In this article, Prandtl-Eyring hybrid nanofluid (P-EHNF) is chosen as a working fluid in the SWP model for the production of SWP in a parabolic trough surface collector (PTSC) is investigated for the case of numerous viscous dissipation, heat radiations, heat source, and the entropy generation analysis. By using a well-established numerical scheme the group of equations in terms of energy and momentum have been handled that is called the Keller-box method. The velocity, temperature, and shear stress are briefly explained and displayed in tables and figures. Nusselt number and surface drag coefficient are also being taken into reflection for illustrating the numerical results. The first finding is the improvement in SWP production is generated by amplification in thermal radiation and thermal conductivity variables. A single nanofluid and hybrid nanofluid is very crucial to provide us the efficient heat energy sources. Further, the thermal efficiency of MoS2-Cu/EO than Cu-EO is between 3.3 and 4.4% The second finding is the addition of entropy is due to the increasing level of radiative flow, nanoparticles size, and Prandtl-Eyring variable

Several integral inequalities for (α, s, m) -convex functions

In this paper, we establish several new integral inequalities for (alpha, s, m)-convex functions. We recapture the Hermite-Hadamard inequality as a particular case. In order to obtain our results, we use classical inequalities such as Holder inequality, Holder-Iscan inequality and Power mean inequality. We formulate several bounds involving special functions like classical Euler-Gamma, Beta and Psi-Gamma functions. We also give some applications

Clinical outcomes of patients with deferred revascularisation based on fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) negative coronary artery lesions in Pakistani population

Objective: To assess long-term clinical outcomes and factors associated with target vessel revascularisation in patients with deferred revascularisation based on negative fractional flow reserve and negative instantaneous wave-free ratio.Methods: The longitudinal, retrospective study was conducted from July 1, 2020, to January 1, 2022, at the Aga Khan University Hospital, Karachi, and comprised medical records from January 2012 to January 2020 of patients with deferred revascularisation having intermediate to severe coronary lesions on coronary angiogram and had negative fractional flow reserve \u3e0.80 or instantaneous wave-free ratio \u3e0.89 and had not undergone immediate or planned revascularisation on the basis of negative physiological assessment. Data was collected from the institutional records, while final follow-up was taken by reviewing the medical records or telephonic interviews regarding any major adverse cardiac event after the index procedure. Data was analysed using Stata 14.2.Results: Of the 345 patients, 245(71%) were males. The overall mean age was 62±11 years. There were 194(56%) patients who presented with stable angina and 151(44%) presented with acute coronary syndrome. Mean fractional flow reserve was 0.87±0.04 and mean instantaneous wave-free ratio was 0.93±0.03. Multivessel disease was present in 223(65%) patients. Median follow-up period was 29 months (IQR: 24-36 months). Major adverse cardiovascular events occurred in 22(6%) patients, and target vessel revascularisation was required in 11(3%). Diabetes and percentage of stenosis were found to be independent predictors of major adverse cardiovascular events (p\u3c0.05).Conclusions: Deferral of revascularisation and opting for medical treatment for coronary artery stenosis with higher fractional flow reserve or instantaneous wave-free ratio could be considered a safe and reasonable strategy