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Epidural Plasma Rich in Growth Factors for Degenerative Disc Disease: A Valuable Alternative to Conventional “Palliative Medicine”
Correa Jose,
Cortés Henry,
Abella Patricia,
García Edwin
Issue:
Volume 7, Issue 1, June 2019
Pages:
1-6
Received:
19 August 2018
Accepted:
23 October 2018
Published:
28 February 2019
Abstract: It is only through the understanding of lumbar spine pathophysiology and its clinical correlates that specific rational treatment for patients becomes possible. Intervertebral disc disease (IDD) is a progressive, chronic, degenerative disease. Over time, the degeneration worsens and ultimately becomes irreversible. The pathogenesis of IDD involves a complex interplay of inflammatory, immunological, and pressure-related processes. Current treatments for IDD, proposed in most ´consensus protocols´ do not correspond to the pathophysiological process involved in the IDD, as these treatments are mainly focused on relieving pain (palliative pain medicine). Surgical techniques (including fusion, laminectomy, and discectomy), aim to stabilize the spine and/or decompress the spinal or the foraminal canal thus alleviating symptoms, but these techniques are not addressed to regarding the cause of the degeneration, and sometimes even accelerate the degeneration of the adjacent segments. Recently, biological therapies have been attracting more attention in the field of intervertebral disc repair and regeneration. Plasma rich in growth factors (PRGF) has the ability to repair and regenerate bone and condral tissue and has a remarkable neuroprotective and anti-inflammatory actions by modulating the immune response, reversing IDD and relieving the neuropathic pain. Growth factors have been associated with the initiation of a healing cascade that leads to cellular chemotaxis, angiogenesis, synthesis of collagen matrix, and cell proliferation. This paper briefly describes the current understanding of growth factors and our experience with PRGF injected by the epidural route.
Abstract: It is only through the understanding of lumbar spine pathophysiology and its clinical correlates that specific rational treatment for patients becomes possible. Intervertebral disc disease (IDD) is a progressive, chronic, degenerative disease. Over time, the degeneration worsens and ultimately becomes irreversible. The pathogenesis of IDD involves ...
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Role of the Qst-Testing for the Determination of the Nervus Intermedius Neuralgia Phenotype – Case Report
Bruno Vítor Martins Santiago,
Carlos Darcy Alves Bersot,
Fernando Cardoso de Lemos Souza,
Odilea Rangel Gonçalves,
Nivaldo Ribeiro Villela
Issue:
Volume 7, Issue 1, June 2019
Pages:
7-12
Received:
24 November 2018
Accepted:
26 December 2018
Published:
28 February 2019
Abstract: Background and Objectives: Nervus Intermedius neuralgia is a rare and difficult to suspect entity. This study aims to present the case of intermedius neuralgia, discusses the implications of the phenotype in the patient approach, as well as the role of quantitative susceptibility testing (QST), as an important tool in the diagnosis and therapeutic management. Case report: 40-year-old female patient, smoker, accompanied by neurology (generalized tonic-clonic seizures), in use of carbamazepine. During one of the seizures, she said fall from height, resulting in fracture of the left temporal bone and ipsilateral facial paralysis. After to optimal the therapy, she had no more seizures, but evolved with paroxysmal pain, shock-like, located in the groove between the ear and scalp at high intensity, with shooting area in the wall of the external auditory channel. Reports that had more crisis with the arrival of winter. The examination revealed mechanical hyperalgesia and "wind-up" phenomenon on the affected side. CT mastoid with evidence of temporal fracture to the left crossing the mast cells. Electroneuromyography corroborating with peripheral facial paralysis. Other tests without changes. It was submitted to the QST-test, evidencing hyperalgesia to cold in the region corresponding to the pain complaint. Lamotrigine was associated with the treatment regimen with 90% improvement of symptoms. Conclusion: This is a rare etiology and difficult diagnosis. The QST-test was extremely important, as well as aid in the diagnosis also allows us to identify the great variability of phenotypic profile within each etiology, which may reflect distinct pathophysiological mechanisms, with different therapeutic responses. There is evidence that lamotrigine assist in the treatment of neuropathic pain associated hyperalgesia to cold.
Abstract: Background and Objectives: Nervus Intermedius neuralgia is a rare and difficult to suspect entity. This study aims to present the case of intermedius neuralgia, discusses the implications of the phenotype in the patient approach, as well as the role of quantitative susceptibility testing (QST), as an important tool in the diagnosis and therapeutic ...
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The Effect on Outcome of Adding Magnesium Sulphate to Bupivacaine in the Ultrasound-guided Supraclavicular Brachial Plexus Block Anesthesia
Ashraf Mohamed Ghali,
Khalid Mohamad Awid Molokhia,
Sameh Abdelkhalik Ahmed
Issue:
Volume 7, Issue 1, June 2019
Pages:
13-19
Received:
28 December 2018
Accepted:
19 February 2019
Published:
5 March 2019
Abstract: This study evaluated the motor and sensory block durations and the postoperative analgesic effects of adding Magnesium Sulphate to Bupivacaine HCL for Ultrasound-guided supraclavicular brachial plexus block. Sixty ASA I-II patients subjected to elective forearm or hand surgery were randomly divided equally into 1 of 2 groups depending upon the local anesthesia (LA) solution used to receive either 23 mL of bupivacaine HCL 0.5% plus 2 mL normal saline (group B) or 23 mL of bupivacaine HCL 0.5% plus Magnesium Sulphate 100 mg diluted with 2mL normal saline (group BM). Motor and sensory block durations were evaluated until the return of normal motor and sensory function. The degree of pain was assessed during the surgery period and 24 hours postoperatively. The results of this study showed that Magnesium Sulphate provided significantly longer motor block duration (329.33 ± 86.54 min vs 237.46 ± 62.91 min, P = 0.001) and significantly longer sensory block duration (356.00 ± 117.02 min vs 278.00 ± 87.23 min, P = 0.005) when compared with bupivacaine alone. Furthermore, the patients in the Magnesium Sulphate group achieved significantly (P < 0.001) lower values of Visual Analogue Scale (VAS) of pain between the periods from 4 to 12 hours postoperatively. There was significantly less diclofenac consumed (mg) in the Magnesium Sulphate group. The patients in the Magnesium Sulphate group reported significantly higher rates of good sleep quality on the first postoperative night (75%) compared with the patients in the bupivacaine group (25%). Also, the patient satisfaction was significantly higher in the Magnesium Sulphate group compared with the bupivacaine group (75% vs 25%). We concluded that Magnesium Sulphate 100 mg to bupivacaine HCL extended the motor and sensory block durations, provided more effective postoperative analgesia with improvement in the sleep quality of the first postoperative night, and provided better patient satisfaction compared to bupivacaine HCL alone.
Abstract: This study evaluated the motor and sensory block durations and the postoperative analgesic effects of adding Magnesium Sulphate to Bupivacaine HCL for Ultrasound-guided supraclavicular brachial plexus block. Sixty ASA I-II patients subjected to elective forearm or hand surgery were randomly divided equally into 1 of 2 groups depending upon the loca...
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Perceived Threats Towards Cervical Cancer Among Women ≥ 15 Years in Arsi Zone, Southeastern Ethiopia: A Community Based Cross-sectional Study
Gemechu Chemeda Feyisa,
Feyisa Tolessa
Issue:
Volume 7, Issue 1, June 2019
Pages:
20-26
Received:
15 January 2019
Accepted:
12 March 2019
Published:
26 April 2019
Abstract: All cancer mortality accounted 18.4 per 100,000 in Ethiopia. Cancer of the cervix is the second common cause of cancer with incidence of 16.4 per 100,000 in the country. The aim of this study was to assess women’s perception of susceptibility and severity of cervical cancer and their associate factors in Arsi zone, southeastern Ethiopia. A community based cross-sectional study design was carried out in Arsi zone, southeastern Ethiopia among 906 women aged ≥ 15 years using multi-stage sampling technique. Binary logistic regression model was used to determine the association of socio-demographic characteristics and reproductive variables on perceived threats to cervical cancer at p-value of <0.05 using SPSS. When perceived susceptibility and severity combined (perceived threat), 739 (81.9%) of women had low perceived threats to cervical cancer. Ever exposed to STI [AOR=5.8, 95% CI: (2.3-14.9)], ever heard of cervical cancer [AOR=1.87, 95% CI: (1.3-2.8)], ever heard cervical cancer screening [AOR=3.4, 95% CI: (1.7-6.9)], preferences of screening in the future [AOR=2.34, 95% CI: (1.18-4.62)], ever smoked [AOR=2.5, 95% CI: (1.1-5.9)] and ever had abortion [AOR=1.32, 95% CI: (1.05-2.25)] were independently associated with perceived threats to cervical cancer. Women who ever smoked had 2.5 times more likely to perceive threats towards cervical cancer than those non-smokers. The study found that more than one-third of women believed that they were not at risk of developing cervical cancer and the majority of them had lower perceived threats of cervical cancer, which could be a major obstacle in the uptake of cervical cancer screening in the community. Therefore, changing the women’s perception of susceptibility and severity of the disease which enhances screening in the community was recommended.
Abstract: All cancer mortality accounted 18.4 per 100,000 in Ethiopia. Cancer of the cervix is the second common cause of cancer with incidence of 16.4 per 100,000 in the country. The aim of this study was to assess women’s perception of susceptibility and severity of cervical cancer and their associate factors in Arsi zone, southeastern Ethiopia. A communit...
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Anesthetic Management and Role of Dexmedetomidine During Intraoperative Wake Up Test in Juvenile Idiopathic Scoliosis Correction Surgery: A Case Report
Pipat Saeyup,
Chanon Thanaboriboon
Issue:
Volume 7, Issue 1, June 2019
Pages:
27-30
Received:
18 April 2019
Accepted:
11 June 2019
Published:
29 June 2019
Abstract: Although neurophysiologic monitoring has been continuously developing, a wake-up test is still regarded as gold standard to detect intraoperative motor dysfunction for scoliosis correction surgery. When the wake-up test is being performed, a calm and co-operative patient is truly required. Anesthesia for the wake-up test is one of the greatest challenges for anesthesiologists. One of the anesthesia for the test includes dexmedetomidine. Dexmedetomidine has sedative, analgesic and sympatholytic properties, suitable for the wake-up test procedures. This report aims to demonstrate results of dexmedetomidine to detect the intraoperative motor dysfunction for the scoliosis correction surgery during the performed wake up test. This patient was 11 years old. She was diagnosed juvenile idiopathic scoliosis with the Cobb’s angle 55 degrees. She was scheduled for posterior fusion scoliosis correction with the intraoperative wake-up test. After the surgeon team requested the wake-up test, desflurane was discontinued, but dexmedetomidine was continued with the infusion. The test took only eight minutes before the patient’s awakening with satisfying condition. The girl was perfectly co-operative without any postoperative recalls. During the wake-up test, dexmedetomidine was suggested as a kind of pertinent anesthetic considerations. Its properties were of analgesic, sedative, sympatholytic, and neuro-protective properties.
Abstract: Although neurophysiologic monitoring has been continuously developing, a wake-up test is still regarded as gold standard to detect intraoperative motor dysfunction for scoliosis correction surgery. When the wake-up test is being performed, a calm and co-operative patient is truly required. Anesthesia for the wake-up test is one of the greatest chal...
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