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Cureus Apr 2024Introduction The skin, along with its subcutaneous tissue, constitutes one of the major organ systems of the human body. Dermatosurgery is the branch dealing with skin...
Introduction The skin, along with its subcutaneous tissue, constitutes one of the major organ systems of the human body. Dermatosurgery is the branch dealing with skin conditions that operate at the level of skin, without disturbing the of the human organ system. Materials and methods A cross-sectional study was undertaken, which included 100 patients comprised of 50 patients in each group. For group A, the topical anesthetic agent used was a eutectic mixture of topical 2.5% lignocaine and 2.5% prilocaine cream (EMLA); for group B, infiltration anesthesia with 2% lignocaine injection. Patients satisfying the inclusion and exclusion criteria were recruited for the study. All the participants were requested to rate the pain at the time of drug administration, during the dermatosurgical procedure, and post-procedurally with a visual analogue scale (VAS) separately. Results In this study, 50% of the participants were of the age group of 21-40 years. Males constituted 57.8% whereas females constituted 42.2%. The common procedures performed in the study were electrocautery at 37%, intralesional platelet-rich plasma (PRP) at 16%, and intralesional steroid at 7%. In group A, the VAS score during drug administration was 0. In the group B, 70% had a VAS score of 4-6, and 30% had a VAS score of 1-3 pre-procedurally. The mean VAS score during procedure was 3.06 for group A and 1.03 for group B. Conclusion The study inferred that topical anesthesia is a better choice in superficial dermatosurgical procedures for providing adequate anesthesia and improved compliance when compared to infiltrative anesthesia.
PubMed: 38738090
DOI: 10.7759/cureus.57966 -
Anaesthesia, Critical Care & Pain... Dec 2023Spinal anesthesia with intrathecal morphine (ITM) is a common anesthesia technique for cesarean delivery. The hypothesis was that the addition of ITM will delay... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Spinal anesthesia with intrathecal morphine (ITM) is a common anesthesia technique for cesarean delivery. The hypothesis was that the addition of ITM will delay micturition in women undergoing cesarean delivery.
METHODS
Fifty-six ASA physical status I and II women scheduled to undergo elective cesarean delivery under spinal anesthesia were randomized to the PSM group (50 mg prilocaine + 2.5 mcg sufentanil + 100 mcg morphine; n = 30) or PS group (50 mg prilocaine + 2.5 mcg sufentanil; n = 24). The patients in the PS group received a bilateral transverse abdominal plane (TAP) block. The primary outcome was the effect of ITM on the time to micturition and the secondary outcome was the need for bladder re-catheterization.
RESULTS
The time to first urge to urinate (8 [6-10] hours in the PSM group versus 6 [4-6] hours in the PS group) and the time to first micturition (10 [8-12] hours in the PSM group versus 6 [6-8] hours in the PS group) were significantly (p < 0.001) prolonged in the PSM group. Two patients in the PSM group met the 800 mL criterium for urinary catheterization after 6 and 8 h respectively.
CONCLUSION
This study is the first randomized trial to demonstrate that the addition of ITM to the standardized mixture of prilocaine and sufentanil significantly delayed micturition.
Topics: Pregnancy; Humans; Female; Morphine; Sufentanil; Urinary Bladder; Analgesics, Opioid; Pain, Postoperative; Prilocaine; Double-Blind Method
PubMed: 37364852
DOI: 10.1016/j.accpm.2023.101269 -
Iranian Endodontic Journal 2024This study investigates the influence of root length in mandibular molars with irreversible pulpitis on the success of supplemental intraligamentary injection following...
INTRODUCTION
This study investigates the influence of root length in mandibular molars with irreversible pulpitis on the success of supplemental intraligamentary injection following an inferior alveolar nerve (IAN) block. Various factors, including anatomical location, tooth type, and anesthetic solution, may affect supplemental anesthesia success.
MATERIALS AND METHODS
A total of 251 patients diagnosed with irreversible pulpitis in mandibular first or second molars underwent buccal infiltration anesthesia (4% articaine with 1:100,000 epinephrine) after IAN block injection (3% prilocaine and 0.03 IU/mL of felypressin). Fifty patients experiencing pain during access cavity preparation received supplemental intraligamentary injection (0.3 mL of 2% lidocaine with 1:80,000 epinephrine) at each mesial and distal line angle. The root length of treated teeth was recorded using an apex locator. Data analysis involved independent t-tests, Chi-square tests, and logistic regression.
RESULTS
Successful supplemental intraligamentary injection was observed in 21 (42%) out of 50 patients. No significant correlation was found between the mean length of mesiobuccal (=0.61), mesiolingual (=0.34), or distal (=0.60) canals of mandibular molars and the injection's success. Logistic regression analysis, however, revealed a significant impact of mesiolingual canal length on the success rate [OR 0.09 (0.01-0.79), =0.030].
CONCLUSION
The root length of mandibular first and second molars does not significantly affect the success of supplemental intraligamentary injection.
PubMed: 38223836
DOI: 10.22037/iej.v19i1.42660 -
Journal of Clinical Medicine Mar 2024: The injection of local anesthetics is the procedure that still causes the most fear and anxiety in a dental session; to minimize this problem, we can use topical...
: The injection of local anesthetics is the procedure that still causes the most fear and anxiety in a dental session; to minimize this problem, we can use topical anesthesia. The aim of this study is to analyze the tolerability and the clinical efficacy in the control of pain, during the subsequent injection of the local anesthetic, of an experimental anesthetic patch with a new formulation, which was previously tested in gel formula. : A total of 150 children, aged 4 to 9 years, were included in the study. Each patient was treated using three different pre-anesthesia methods (placebo gel, experimental gel, and experimental patch), according to a split-mouth procedure, within a week of each other. The injection pain was analyzed using the WBFPRS and FLACC scales. Patients' caregivers' satisfaction was recorded at the end of the procedures. The data were analyzed using one-way ANOVA-RM, Wilcoxon-Mann-Whitney, Mann-Whitney U, and χ tests. : In this study, significantly higher pain ratings were observed with the topical placebo gel and lower pain ratings were observed with the experimental patch. : The use of the patch proved to be very effective in reducing pain both subjectively and objectively, in the absence of both local and systemic side effects, validating its use in the oral mucosa.
PubMed: 38541784
DOI: 10.3390/jcm13061558 -
Dermatology and Therapy Apr 2024Systemic toxicity of eutectic mixture of local anesthetics (EMLA) cream is rare and is most commonly observed in children, for example, upon extensive application, and...
INTRODUCTION
Systemic toxicity of eutectic mixture of local anesthetics (EMLA) cream is rare and is most commonly observed in children, for example, upon extensive application, and rarely occurs in adults with certain dispositions.
CASE REPORT
We report the case of a 71-year-old man who developed methemoglobinemia and systemic intoxication upon topical application of EMLA cream for leg ulcer and stasis dermatitis prior to surgical debridement. Approximately 45 min after application, the patient was found to be in a somnolent state, was unable to articulate, and showed peripheral cyanosis. The blood concentration of methemoglobin (MetHb) was 15.1%, and therefore, a diagnosis of systemic toxicity of EMLA due to methemoglobinemia was established. After removal of the cream, oxygen was applied, and further observation revealed that the patient's condition rapidly improved without any residue. In the following, we also discuss literature related to systemic EMLA intoxication.
CONCLUSION
EMLA cream may cause severe systemic toxicity even in adults under certain conditions, for example, when applied on damaged skin or in extensive amounts.
PubMed: 38568445
DOI: 10.1007/s13555-024-01139-7 -
Genes Mar 2024Autoimmunity is defined as the inability to regulate immunological activities in the body, especially in response to external triggers, leading to the attack of the...
Autoimmunity is defined as the inability to regulate immunological activities in the body, especially in response to external triggers, leading to the attack of the tissues and organs of the host. Outcomes include the onset of autoimmune diseases whose effects are primarily due to dysregulated immune responses. In past years, there have been cases that show an increased susceptibility to other autoimmune disorders in patients who are already experiencing the same type of disease. Research in this field has started analyzing the potential molecular and cellular causes of this interconnectedness, bearing in mind the possibility of advancing drugs and therapies for the treatment of autoimmunity. With that, this study aimed to determine the correlation of four autoimmune diseases, which are type 1 diabetes (T1D), psoriasis (PSR), systemic sclerosis (SSc), and systemic lupus erythematosus (SLE), by identifying highly preserved co-expressed genes among datasets using WGCNA. Functional annotation was then employed to characterize these sets of genes based on their systemic relationship as a whole to elucidate the biological processes, cellular components, and molecular functions of the pathways they are involved in. Lastly, drug repurposing analysis was performed to screen candidate drugs for repositioning that could regulate the abnormal expression of genes among the diseases. A total of thirteen modules were obtained from the analysis, the majority of which were associated with transcriptional, post-transcriptional, and post-translational modification processes. Also, the evaluation based on KEGG suggested the possible role of T differentiation in the simultaneous onset of the four diseases. Furthermore, clomiphene was the top drug candidate for regulating overexpressed hub genes; meanwhile, prilocaine was the top drug for regulating under-expressed hub genes. This study was geared towards utilizing transcriptomics approaches for the assessment of microarray data, which is different from the use of traditional genomic analyses. Such a research design for investigating correlations among autoimmune diseases may be the first of its kind.
Topics: Humans; Signal Transduction; Autoimmune Diseases; Diabetes Mellitus, Type 1; Oligonucleotide Array Sequence Analysis; Gene Regulatory Networks; Immune System; Scleroderma, Systemic; Lupus Erythematosus, Systemic; Psoriasis; Gene Expression Profiling
PubMed: 38674328
DOI: 10.3390/genes15040393