EOI block useful component of multimodal analgesia regimens for upper abdominal surgeries, suggests study

Upper abdominal surgical incisions result in significant pain during and after surgery. While neuraxial techniques are the standard for managing pain, they can be linked to complications. There’s a recognition of interfascial plane block techniques as a component of multimodal pain relief for upper abdominal surgeries with subcostal incisions, such as the TAP block, QL block, and ESP block. Recent study compared the effectiveness of the external oblique intercostal (EOI) block versus the subcostal transversus abdominis plane (TAP) block for postoperative pain management in patients undergoing upper abdominal surgeries.

The study involved 50 patients who were randomly assigned to receive either the EOI block or the subcostal TAP block. The primary outcome was the time to activation of patient-controlled analgesia (PCA) after the surgery. The researchers also assessed secondary outcomes such as 24-hour opioid consumption, pain scores, patient satisfaction, and block-related complications. The results showed that patients who received the EOI block had a significantly longer time to activation of the PCA compared to the subcostal TAP block group (610 minutes vs. 410 minutes, p=0.001). The 24-hour postoperative opioid (fentanyl) consumption was also lower in the EOI block group (102 μg vs. 123 μg, p=0.019). Patients in the EOI block group had better pain scores at 30 minutes and 6 hours, as well as higher patient satisfaction scores.

Conclusion

The researchers conclude that the EOI block provides more effective postoperative analgesia compared to the subcostal TAP block in patients undergoing upper abdominal surgeries. The EOI block was able to prolong the duration of PCA activation and reduce opioid consumption, leading to better pain control and higher patient satisfaction. No significant block-related complications were observed in either group.

Future Implications

The authors suggest that the EOI block may be a useful component of multimodal analgesia regimens for upper abdominal surgeries, as it can effectively target the lateral and anterior cutaneous branches of the intercostal nerves. Further studies comparing the EOI block to other regional anesthesia techniques, such as erector spinae or paravertebral blocks, may provide additional insights into the optimal pain management strategies for this patient population.

Key Points

1. The study compared the effectiveness of the external oblique intercostal (EOI) block versus the subcostal transversus abdominis plane (TAP) block for postoperative pain management in patients undergoing upper abdominal surgeries.

2. The primary outcome was the time to activation of patient-controlled analgesia (PCA) after the surgery, and the researchers also assessed secondary outcomes such as 24-hour opioid consumption, pain scores, patient satisfaction, and block-related complications.

3. Patients who received the EOI block had a significantly longer time to activation of the PCA compared to the subcostal TAP block group, and their 24-hour postoperative opioid consumption was also lower.

4. Patients in the EOI block group had better pain scores at 30 minutes and 6 hours, as well as higher patient satisfaction scores.

5. The researchers concluded that the EOI block provides more effective postoperative analgesia compared to the subcostal TAP block in patients undergoing upper abdominal surgeries.

6. The authors suggest that the EOI block may be a useful component of multimodal analgesia regimens for upper abdominal surgeries, and further studies comparing the EOI block to other regional anesthesia techniques may provide additional insights.

Reference –

Shrey S, Sinha C, Kumar A, Kumar A, Kumar A, Nambiar S. Comparison of analgesic efficacy of ultrasound‑guided external oblique intercostal plane block and subcostal transverses abdominis plane block in patients undergoing upper abdominal surgery: A randomised clinical study. Indian J Anaesth 2024;68:965‑70

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Clinical Outcome of Vernal Keratoconjunctivitis in Childhood: Long-Term Observation

Vernal keratoconjunctivitis (VKC) is an ocular disorder
characterized by severe inflammation affecting both the cornea and conjunctiva
that mainly affects boys in the first decade of life. Although the symptoms of
VKC usually persist despite treatment, with seasonal deterioration, the
condition generally resolves spontaneously with the onset of puberty. Some
cases of VKC result in refractory atopic keratoconjunctivitis (AKC) in
adulthood. Those cases complicated by atopic dermatitis (AD) may require
therapeutic measures beyond this age into adulthood to control the disease, and
permanent changes to the ocular surface and visual impairment may occur. Long-term
follow-up has been rarely reported for VKC because of the need for long-term
clinical evaluation. Authors investigated the long-term clinical outcome of VKC
treated and controlled in their hospital, which might reflect the recent
changes in clinical features of VKC especially derived by the introduction of
immunosuppressive eye drops. The most relevant clinical features that emerged
from this evaluation were analyzed for their prognostic value based on longterm
follow-up. The aim of the present study was also to evaluate the relationship
between the cure/non-cure groups and clinical findings derived from long-term
observation of VKC cases

In total, 45 consecutive patients clinically diagnosed with
VKC aged 4 to 12 years at onset at the Department of Ophthalmology of Fukuoka
University Hospital were included. Patients were treated with immunosuppressive
eye drops without simultaneous corticosteroid eye drops, except for the
occurrence of exacerbations. Collated variables were gender, age at onset,
clinical score of ocular lesions (conjunctival giant papillae, limbal edema and
corneal epithelial lesions) at the first visit, and clinical score of atopic
dermatitis (AD) at baseline.

The observation period ranged from 24 to 188 months, with
median of 70 months. Among the 45 cases enrolled, all noncured cases (14 cases)
observed clinically were complicated by AD. Cumulative cure rate was 74.5% and
84.9% at eight- and ten-year follow-up, respectively. Ten-year cumulative cure
rates of cases with and without AD were 50.5% and 100%, respectively, and a
significant difference was found between these cumulative cure curves. Binomial
regression analysis revealed that AD and gender were significantly related to
worse outcome, and this binomial regression model had high sensitivity and
specificity.

In conclusion, several novel findings have been gained from
this observational case series. In this chronological survey, the ten-year
cumulative cure rate of VKC was 84.9%, and 15.1% of cases remained uncured after
10 years of observation in the cure curve. There was a significant difference
in the long-term outcome between VKC cases with and without AD. Binomial
regression analysis showed that AD and male gender were significantly related
to a worse outcome. The binomial regression model had high sensitivity and
specificity. The clinical outcome in VKC might be predicted by several factors
that can be evaluated in the early clinical phase.

Source: Shimokawa et al; Clinical Ophthalmology 2024:18
2339–2347

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Ten point preoperative checklist for selecting patients for outpatient joint replacement surgery, enumerates study

With advancements in perioperative care, joint replacement (JR) surgery is undergoing a transition from opacified in-patient institutions to nimble out-patient Ambulatory Surgical Centers (ASC). The goal of JR in ASC setting is safe patient discharge with subsequent rehabilitation without readmission. Multi-modal preoperative rehabilitation (MMPR) is a novel field of perioperative care, encompassing comprehensive parameters to ensure smooth transition from fitness for surgery to JR in outpatient setting. At present, there are no open-access schemes for selecting patients qualified for JR in the ASC setting.

In the article, Madhav Chowdhry & Edward J. McPherson proposed an evidence-based, 10-point systematic evaluation of patients with target endpoints for MMPR to qualify patients for JR as an outpatient procedure. It has been published in ‘Arthroplasty’ journal

This checklist is a non-proprietary scheme serving as an initial framework for surgeons exploring surgery in the ASC setting.

The authors introduced factors for a prehabilitation scheme, called Checklist Outpatient-Joint Replacement (CO-JR) to qualify patients for outpatient JR surgery.

These factors have been developed based on an extensive literature review and the significant experience of authors to incorporate variables that drive a successful outpatient JR procedure.

The factors include patient education, psychiatric & cognitive ability, medical fitness, musculoskeletal capability, financial ability, transportation access, patient motivation, information technology (IT) capabilities, along with ability to recover independently at home postoperatively.

The CO-JR scheme is under the process of validation at multiple institutions.

The authors commented – “Our goal is to develop a non-proprietary, open access 10-point CO-JR scheme, developed by the collaborative effort of surgeons across the world, serving as a framework for successfully selecting patients for JR surgery in the ASC setting. We acknowledge that the needs of global populations vary, and the available medical resources are not alike. In the future, we envision a Modified CO-JR for various countries requiring different needs suiting their local ethnic and demographic variances, e.g., Modified CO-JR India, Modified CO-JR Nigeria, Modified CO-JR New Zealand, Modified CO-JR USA etc. The proposed scheme is aimed to serve as a benchmark and is currently under the process of validation. With this initial proposal, we encourage concomitant input and validation to create a common, global platform for JR in the ASC setting. In the future, we would encourage an in-person consensus meeting to further expand this grading system.”

Further reading:

A 10‑point preoperative checklist: selecting patients for outpatient joint replacement surgery.

Chowdhry and McPherson

Arthroplasty (2024) 6:52

https://doi.org/10.1186/s42836-024-00270-2

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Platelet-to-albumin ratio helps predict mortality risk in patients undergoing peritoneal dialysis: Study

A new study published in the journal of BMC Nephrology showed that in patients receiving peritoneal dialysis (PD), the platelet-to-albumin ratio (PAR) is a separate predictor of cardiovascular disease and all-cause mortality. The long-term survival rate of patients receiving PD is still poor, despite the fact that peritoneal dialysis is an effective treatment for renal replacement. A poor prognosis for a number of illnesses is linked to the platelet-to-albumin ratio, which was recently shown to be a measure of nutritional and inflammatory conditions. Nevertheless, nothing is known about the relationship between serum PAR and the prognosis of PD patients. The purpose of this study was to assess the predictive power of PAR for cardiovascular disease (CVD) and all-cause mortality in PD patients.

Patients enduring Parkinson’s disease (PD) were recruited for this multicenter cohort research between January 1, 2009, and September 30, 2018. The quartiles of the patients’ baseline PAR were used to create four groups. Mortality from all causes and CVD was the main outcome. The relationship between the PAR and death from all causes or from CVD was assessed using Cox proportional hazards models. The performance of PAR and other inflammatory markers was compared using the receiver operating characteristic (ROC) curve. The incremental predictive value of PAR in comparison to the baseline model for predicting all-cause and CVD mortality was examined using the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

The study included a total of 2825 patients, which included 747 death cases over the 47.5 ± 28.3-month follow-up period, 415 of which were due to CVD. Placement in Q4 was linked to a higher risk of both CVD and all-cause death as compared to Q1. According to the adjusted limited cubic spline analysis, there was a linear connection between the PAR and cardiovascular and all-cause mortality.

The interaction tests revealed no positive relationships. With corresponding AUC values of 0.611 for all-cause mortality and 0.609 for cardiovascular mortality, PAR demonstrated greater predictive value for death when compared to other inflammatory markers. The inclusion of PAR in the baseline model produced a moderate but substantial increase in outcome prediction, as indicated by the C-statistic, continuous NRI, and IDI. Overall, this study showed that in patients receiving PD, elevated blood PAR was strongly linked to an increased risk of death from all causes and from CVD.

Reference:

Ma, H., Chen, J., Zhan, X., Ao, S., Deng, J., Tang, R., Peng, F., Tian, N., Wen, Y., Wang, X., Feng, X., Su, N., Tang, X., Wu, X., Zhou, Q., & Xu, Q. (2024). Platelet-to-albumin ratio: a potential biomarker for predicting all-cause and cardiovascular mortality in patients undergoing peritoneal dialysis. In BMC Nephrology (Vol. 25, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12882-024-03792-8

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For Moderate to Severe acne, CAB gel turns out to be effective treatment. Study

For Moderate to Severe acne, CAB gel turns out to be effective treatment suggests a study published in the Journal of Drugs in Dermatology.

Clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% gel (CAB) is the only fixed-dose triple-combination treatment approved for acne. This post hoc analysis assessed the impact of sex on efficacy and safety/tolerability of CAB.

Methods: In two multicenter, double-blind, phase 3 studies (NCT04214639 and NCT04214652), participants aged ≥9 years with moderate-to-severe acne were randomized (2:1) to 12 weeks of once-daily treatment with CAB or vehicle gel. Pooled data were analyzed by sex. Assessments included treatment success (≥2-grade reduction from baseline in Evaluator’s Global Severity Score and a score of 0 [clear] or 1 [almost clear]), inflammatory/noninflammatory lesion counts, Acne-Specific Quality of Life (Acne-QoL) questionnaire, treatment-emergent adverse events (TEAEs), and cutaneous safety/tolerability. Results: At week 12, treatment success rates were significantly greater with CAB versus vehicle irrespective of sex (females: 53.7% vs 23.0%; males: 43.1% vs 24.6%; P<0.05, both). CAB-treated female and male participants both experienced greater reductions from baseline versus vehicle in inflammatory (females: 77.7% vs 57.9%; males: 77.5% vs 57.1%; P<0.001, both) and noninflammatory lesions (females: 72.5% vs 45.6%; males: 72.3% vs 49.6%; P<0.001, both). Acne-QoL improvements from baseline to week 12 were significantly greater with CAB than vehicle. No significant differences in any efficacy measures between CAB-treated males and females were observed. Most TEAEs were of mild-to-moderate severity; no sex-based trends for safety/tolerability were observed. CAB demonstrated comparable efficacy, quality-of-life improvements, and safety in female and male participants with moderate-to-severe acne. As the first fixed-dose, triple-combination topical formulation, CAB represents an important new treatment for acne.

Reference:

Lain ET, Bhatia N, Kircik L, Gold LS, Harper JC, Bunick CG, Guenin E, Baldwin H, Feldman SR, Rosso JQD. Clindamycin Phosphate 1.2%/Adapalene 0.15%/Benzoyl Peroxide 3.1% Gel for Male and Female Acne: Phase 3 Analysis. J Drugs Dermatol. 2024 Oct 1;23(10):873-881. doi: 10.36849/JDD.2024.8484. PMID: 39361705.

Keywords:

For, Moderate, Severe, acne, CAB, gel, turns, effective, treatment, study, Lain ET, Bhatia N, Kircik L, Gold LS, Harper JC, Bunick CG, Guenin E, Baldwin H, Feldman SR, Rosso JQD, Journal of Drugs in Dermatology

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Medical Student in Chennai Allegedly commits suicide, investigation underway

Chennai- In an unfortunate incident, a medical student in Chennai allegedly committed suicide in his hostel room near Porur in Chennai.

The medico has been identified as Rishikesh, a resident of Kumarapalayam in Namakkal district. He was a medical student studying in a private medical college in Chennai. It is believed that he took the drastic step after feeling dejected over his relationship issues.

Also Read: Chennai Shocker: Oncologist Stabbed multiple times by Patient’s Son, Critical

After the incident took place, the police were informed and a preliminary investigation was conducted. The preliminary police investigation revealed that the student was depressed due to ‘love failure’. His body has been recovered and sent to Kilpauk Medical College Hospital for post-mortem, reports DTNext.

Currently, the police filed a case under the relevant section of IPC. Further investigation in this regard is underway.

A few days back 23-year-old student, also a trainee doctor of Meenakshi Medical College in Kanchipuram allegedly committed suicide by jumping from the fifth floor of her hostel building.

Medical Dialogues team had previously also reported about a 2nd-year MBBS student of Pondicherry Institute of Medical Sciences (PIMS) who allegedly committed suicide by hanging himself in a lodge near Thideer Nagar in Madurai. The 20-year-old student was struggling with stress regarding his studies and left the house on July 8. His family after being unable to find him filed a missing complaint at the police station.

His death came to light when a room boy knocked on the door of the student’s room but he did not answer. After receiving no response from him, the boy called the police who broke open the door and found the student hanging from the ceiling. 

Also Read: Final year MBBS Medico jumps to death from hostel building in Chennai

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Depression rates in LGBTQIA+ students are three times higher than their peers, research suggests

Findings published in the Journal of American College Health uncover an alarming rise in depression rates among all higher education students in the United States, but especially among sexual and gender minorities. This population includes those who identified as lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual (LGBTQIA+), non-binary or gender non-conforming, and other identities.

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Survey reveals most parents don’t ask about firearms in the homes their kids visit

Over 60% of Illinois parents had never asked another parent about an unlocked firearm in their home before allowing their child to visit for a playdate, according to a survey from Ann & Robert H. Lurie Children’s Hospital of Chicago published in Pediatrics.

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Experiment shows time alone heightens ‘threat alert’ in teenagers—even when using social media

People in their late teens experience an increased sensitivity to threats after just a few hours left in a room on their own—an effect that endures even if they are interacting online with friends and family.

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Could a genetic flaw be the key to stopping people craving sugary treats?

A study published in Gastroenterology provides novel genetic insights into dietary preferences and opens the possibility of targeting SI to selectively reduce sucrose intake at the population level.

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