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Tuesday, March 19, 2019

Critical Care Medicine

Center Effects in Hospital Mortality of Critically Ill Patients With Hematologic Malignancies
Objectives: We aimed to investigate center effects on hospital mortality of ICU patients with hematologic malignancies and to explore interactions between center and patients characteristics. Design: Multicenter prospective cohort. Setting: Seventeen ICUs across France and Belgium. Patients: One-thousand eleven patients with hematologic malignancies hospitalized in ICUs. Interventions: Reanalysis of the original data using state-of-the-art statistical methods with permutation...
Critical Care Medicine - Published Ahead-of-Print
Tue Mar 19, 2019 02:00
Original Intracerebral Hemorrhage Score for the Prediction of Short-Term Mortality in Cerebral Hemorrhage: Systematic Review and Meta-Analysis
Objectives: To systematically assess the discrimination and calibration of the Intracerebral Hemorrhage score for prediction of short-term mortality in intracerebral hemorrhage patients and to study its determinants using heterogeneity analysis. Data Sources: PubMed, ISI Web of Knowledge, Scopus, and CENTRAL from inception to September 15, 2018. Study Selection: Adult studies validating the Intracerebral Hemorrhage score for mortality prediction in nontraumatic intracerebral hemorrhage...
Critical Care Medicine - Published Ahead-of-Print
Tue Mar 19, 2019 02:00
Health Insurance and Out-of-Pocket Costs in the Last Year of Life Among Decedents Utilizing the ICU
Objectives: Use of intensive care is increasing in the United States and may be associated with high financial burden on patients and their families near the end of life. Our objective was to estimate out-of-pocket costs in the last year of life for individuals who required intensive care in the months prior to death and examine how these costs vary by insurance coverage. Design: Observational cohort study using seven waves of post-death interview data (2002–2014). Participants: Decedents...
Critical Care Medicine - Published Ahead-of-Print
Tue Mar 19, 2019 02:00
Trigeminal Nerve Stimulation: A Novel Method of Resuscitation for Hemorrhagic Shock
Objectives: To determine if trigeminal nerve stimulation can ameliorate the consequences of acute blood loss and improve survival after severe hemorrhagic shock. Design: Animal study. Setting: University research laboratory. Subjects: Male Sprague-Dawley rats. Interventions: Severe hemorrhagic shock was induced in rats by withdrawing blood until the mean arterial blood pressure reached 27 ± 1 mm Hg for the first 5 minutes and then maintained at 27 ± 2 mm Hg for 30 minutes....
Critical Care Medicine - Published Ahead-of-Print
Tue Mar 19, 2019 02:00
Outcomes of Cancer Patients Discharged From ICU After a Decision to Forgo Life-Sustaining Therapies
Objectives: Many cancer patients are admitted to an ICU and decisions to forgo life-sustaining therapies are frequent during ICU stay. A significant proportion of these patients are subsequently discharged from ICU, but their outcomes are unknown. Design: Retrospective. Setting: ICU of oncological hospital. Patients: Adult cancer patients admitted to ICU, then with a decision to forgo life-sustaining therapies and that were discharged from ICU. Interventions: None. Measurements...
Critical Care Medicine - Published Ahead-of-Print
Tue Mar 19, 2019 02:00
Prognostic Value of Glial Fibrillary Acidic Protein in Patients With Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis
Objectives: Biomarkers have been suggested as potential prognostic predictors following a moderate or severe traumatic brain injury but their prognostic accuracy is still uncertain. The objective of this systematic review is to assess the ability of the glial fibrillary acidic protein to predict prognosis in patients with moderate or severe traumatic brain injury. Data Sources: MEDLINE, Embase, CENTRAL, and BIOSIS electronic databases and conference abstracts, bibliographies of selected studies,...
Critical Care Medicine - Published Ahead-of-Print
Tue Mar 19, 2019 02:00
Cardiac Arrest and Subsequent Hospitalization–Induced Posttraumatic Stress Is Associated With 1-Year Risk of Major Adverse Cardiovascular Events and All-Cause Mortality
Objectives: To compare 1-year all-cause mortality and major adverse cardiovascular events in cardiac arrest survivors with and without posttraumatic stress disorder symptomatology at hospital discharge. Design: Prospective, observational cohort. Setting: ICUs at a tertiary-care center. Patients: Adults with return of spontaneous circulation after in-hospital or out-of-hospital cardiac arrest between September 2015 and September 2017. A consecutive sample of survivors with sufficient...
Critical Care Medicine - Published Ahead-of-Print
Tue Mar 19, 2019 02:00
Nebulized Amikacin and Fosfomycin for Severe Pseudomonas aeruginosa Pneumonia: An Experimental Study
Objectives: Latest trials failed to confirm merits of nebulized amikacin for critically ill patients with nosocomial pneumonia. We studied various nebulized and IV antibiotic regimens in a porcine model of severe Pseudomonas aeruginosa pneumonia, resistant to amikacin, fosfomycin, and susceptible to meropenem. Design: Prospective randomized animal study. Setting: Animal Research, University of Barcelona, Spain. Subjects: Thirty female pigs. Interventions: The animals were randomized...
Critical Care Medicine - Published Ahead-of-Print
Fri Mar 15, 2019 02:00
Effect of Documenting Prognosis on the Information Provided to ICU Proxies: A Randomized Trial
Objectives: The Critical Care Choosing Wisely Task Force recommends that intensivists offer patients at high risk for death or severe functional impairment the option of pursuing care focused on comfort. We tested the a priori hypothesis that intensivists who are prompted to document patient prognosis are more likely to disclose prognosis and offer comfort-focused care. Design: Randomized controlled trial (clinicaltrials.gov: NCT02721810). Setting: High-fidelity Simulation Center in...
Critical Care Medicine - Published Ahead-of-Print
Fri Mar 15, 2019 02:00
Transfusion-Associated Circulatory Overload in ICUs: A Scoping Review of Incidence, Risk Factors, and Outcomes
Transfusion-associated circulatory overload is the most frequent serious adverse transfusion reaction, with an incidence close to 1% of transfused patients in the general adult population. Patients in ICUs are probably more at risk of transfusion-associated circulatory overload as they are more frequently transfused and associated with more comorbidities. However, the epidemiology of transfusion-associated circulatory overload in ICU is not well characterized, leading to a risk of underdiagnosis. ...
Critical Care Medicine - Published Ahead-of-Print
Fri Mar 15, 2019 02:00
Effect of Neurally Adjusted Ventilatory Assist on Patient-Ventilator Interaction in Mechanically Ventilated Adults: A Systematic Review and Meta-Analysis
Objectives: Patient-ventilator asynchrony is common among critically ill patients undergoing mechanical ventilation and has been associated with adverse outcomes. Neurally adjusted ventilatory assist is a ventilatory mode that may lead to improved patient-ventilator synchrony. We conducted a systematic review to determine the impact of neurally adjusted ventilatory assist on patient-ventilator asynchrony, other physiologic variables, and clinical outcomes in adult patients undergoing invasive...
Critical Care Medicine - Published Ahead-of-Print
Fri Mar 15, 2019 02:00
Comparison of Two Techniques to Measure Optic Nerve Sheath Diameter in Patients at Risk for Increased Intracranial Pressure
Objectives: Intracranial pressure over 20 mm Hg is associated with poor neurologic prognosis, but measuring intracranial pressure directly requires an invasive procedure. Dilation of the optic nerve sheath on axial ultrasound of the eye has been correlated with elevated intracranial pressure, but optimal cutoffs have been inconsistent possibly related to the measurement technique. A coronal technique has been studied on healthy volunteers but not on patients with high intracranial pressure. We...
Critical Care Medicine - Published Ahead-of-Print
Fri Mar 15, 2019 02:00
Acute Kidney Stress and Prevention of Acute Kidney Injury
Critical care physicians continue to be challenged to recognize an environment that has the potential to result in acute kidney injury, with its associated short- and long-term consequences. The recent development of cell cycle arrest biomarkers that signal the potential development of acute kidney injury is part of an evolution in the molecular diagnosis and understanding of acute kidney injury. A preinjury phase that may lead to acute kidney injury has been described as "acute kidney stress." This...
Critical Care Medicine - Published Ahead-of-Print
Fri Mar 15, 2019 02:00
High-Flow Oxygen Therapy After Noninvasive Ventilation Interruption in Patients Recovering From Hypercapnic Acute Respiratory Failure: A Physiological Crossover Trial
Objectives: Assessing gas exchange, diaphragm function, respiratory rate, and patient comfort during high-flow oxygen therapy and standard oxygen at the time of noninvasive ventilation discontinuation. Design: Randomized crossover physiologic study. Setting: Two ICUs. Patients: Thirty chronic obstructive pulmonary disease patients with hypercapnic acute respiratory failure receiving noninvasive ventilation greater than 24 hours. Interventions: All patients underwent five 30-minute...
Critical Care Medicine - Published Ahead-of-Print
Fri Mar 15, 2019 02:00
Enhanced Renal Clearance in Patients With Hemorrhagic Stroke
Objectives: To evaluate enhanced renal clearance over time in patients with aneurysmal subarachnoid hemorrhage or intracerebral hemorrhage via measured creatinine clearance and to compare measured creatinine clearance to creatinine clearance calculated by the Cockcroft-Gault equation and estimated glomerular filtration rate calculated by the Modification of Diet in Renal Diseases equation. Design: Prospective, observational study. Setting: Neurosciences ICU in a tertiary care academic...
Critical Care Medicine - Published Ahead-of-Print
Wed Mar 13, 2019 02:00
Pro: Critical Care Ultrasound Should Be a Priority First-Line Assessment Tool in Neurocritical Care
No abstract available
Critical Care Medicine - Published Ahead-of-Print
Wed Mar 13, 2019 02:00
Moderate-Intensity Insulin Therapy Is Associated With Reduced Length of Stay in Critically Ill Patients With Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State
Objectives: Insulin infusion therapy is commonly used in the hospital setting to manage diabetic ketoacidosis and hyperosmolar hyperglycemic state. Clinical evidence suggests both hypoglycemia and glycemic variability negatively impact patient outcomes. The hypothesis of this study was that moderate-intensity insulin therapy decreases hospital length of stay and prevalence of hypoglycemia in patients with diabetic ketoacidosis and hyperosmolar hyperglycemic state. Design: Pre-post study. ...
Critical Care Medicine - Published Ahead-of-Print
Thu Mar 07, 2019 02:00

Oto-rhino-laryngologie,Pathologie Cervico-faciale

Remerciements aux lecteurs

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s):



Thrombose post-traumatique du sinus sigmoïde par corps étranger transmastoïdien

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): G. Badidi, S. Chabrier, J.M. Prades, A. Karkas



Infection nasosinusienne Ă  burkholderia gladioli

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): C. Zanotti, S. Munari, G. Brescia, U. Barion

Résumé
Introduction

Burkholderia gladioli est une bactĂ©rie aĂ©robie gram-nĂ©gative en bâtonnets, et non fermentaire, qui a Ă©tĂ© identifiĂ©e la première fois comme pathogène pour les plantes. La plupart des infections Ă  B. gladioli rapportĂ©es dans la littĂ©rature concernent des adultes et des nouveau-nĂ©s immunodĂ©primĂ©s. Chez l'homme, B. gladioli est souvent associĂ©e Ă  un pronostic dĂ©favorable.

Cas clinique

Nous dĂ©crivons le premier cas d'infection nasosinusienne due Ă  B. gladioli et Staphylococcus aureus chez une patiente immunocompĂ©tente ayant fait un voyage rĂ©cent au Congo.

Discussion

Comme dans les quelques autres cas rapportĂ©s impliquant des patients immunocompĂ©tents, la prise en charge adaptĂ©e pour cette infection Ă  B. gladioli multirĂ©sistante Ă©tait une combinaison de chirurgie et d'antibiotiques adaptĂ©s Ă  l'antibiogramme.



Coloration noire récidivante de la langue et des dents

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): R. Hervochon, Q. Lisan, F. Rubin



Une masse nasale atypique

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): E. Drapier, M. Makeieff, X. Dubernard



Une localisation épiglottique asymptomatique inattendue dans le cadre d'une maladie de Kimura

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): F. Dezoteux, R. Dubois, G. Lefèvre, J.P. Lecoutre, D. Staumont-Sallé, O. Carpentier

Résumé
Introduction

La maladie de Kimura est un syndrome lymphoprolifératif chronique d'étiologie inconnue qui affecte la peau et les ganglions lymphatiques. Il survient principalement chez les jeunes hommes d'origine asiatique. L'histoire naturelle de l'atteinte épiglottique asymptomatique n'est pas connue. Cette atteinte rare n'est souvent diagnostiquée que lorsque la croissance de la tumeur commence à obstruer les voies respiratoires supérieures.

Observation

Il s'agit d'un homme d'origine nord-africaine âgĂ© de 34 ans prĂ©sentant un tableau associant fatigue et multiples nodules cutanĂ©s fluctuants lentement progressifs dans les rĂ©gions mandibulaires et rĂ©troauriculaires droites. Un scanner cervical a confirmĂ© une tumeur des tissus mous du corps mandibulaire droit et a Ă©galement rĂ©vĂ©lĂ© un Ă©paississement inattendu de l'Ă©piglotte. La nasofibroscopie a confirmĂ© les rĂ©sultats de la tomodensitomĂ©trie et a montrĂ© un Ă©paississement de l'Ă©piglotte. Notre diagnostic de maladie de Kimura Ă©tait basĂ© sur l'examen histologique d'Ă©chantillons de biopsie prĂ©levĂ©es sur la tumeur mandibulaire droite, un ganglion lymphatique cervical et l'Ă©piglotte.

Discussion

La plupart des cas de maladie de Kimura avec atteinte épiglottique sont révélés par dysphonie et dysphagie. Il n'y a pas de consensus sur les examens complémentaires à effectuer. Cette observation soulève la question dépistage systématique des lésions dans des sites anatomiques inhabituels et potentiellement dangereux au cours de cette affection.



Sinusalgies maxillaires radiotransparentes par agenesie de l'ostium membraneux

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): R. Jankowski, C. Rumeau, D.T. Nguyen, P. Gallet

Résumé
Introduction

L'absence d'opacité scanographique lors du bilan de douleurs faciales conduit classiquement à éliminer une étiologie sinusienne. Nous rapportons une observation qui contredit cet adage et révèle une nouvelle cause de sinusalgie.

Observation

Un homme de 16 ans prĂ©sentait un tableau de « sinusites aiguĂ«s hyperalgiques » rĂ©cidivantes dĂ©clenchĂ©es par les changements de pression (altitude, plongĂ©e, surf), sans opacitĂ© sinusienne au scanner. Pourtant l'exploration chirurgicale a permis de constater l'absence de tout ostium maxillaire (principal ou accessoire). Une antrostomie chirurgicale a mis fin aux douleurs.

Discussion

La physiopathologie de ce faux tableau de « sinusites aiguĂ«s rĂ©cidivantes » et l'efficacitĂ© de l'antrostomie s'expliquent par la thĂ©orie Ă©vo-dĂ©vo de la formation et du rĂ´le des sinus paranasaux. Ce cas illustre une absence d'abouchement dans l'ethmoĂŻde du sac membranaire tapissant la cavitĂ© sinusienne, formĂ©e après dĂ©gĂ©nĂ©rescence de la moelle Ă©rythropoĂŻĂ©tique dans l'os maxillaire. La production permanente de monoxyde d'azote par l'Ă©pithĂ©lium sinusien est Ă©liminĂ©e par simple diffusion transmembranaire en condition environnementale stable, mais insuffisamment lors des changements pressionnels rapides, provoquant des sinusalgies parfois hyperalgiques. Cette observation ouvre la voie Ă  de plus amples Ă©tudes sur le rĂ´le des sinus dans la pathologie faciale et la physiologie respiratoire.



Dacryocystocèle congénitale bilatérale

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): P.C. de Sousa, M. Neves, D. Duarte, P. Azevedo

Résumé
Introduction

Les nouveau-nés respirent exclusivement par le nez. Une obstruction nasale peut donc entraîner une cyanose et une désaturation. Malgré le fait qu'elle soit très rare, la dacryocystocèle congénitale bilatérale est une étiologie possible du syndrome de détresse respiratoire chez le nouveau-né.

Résumé du cas clinique Il s'agit d'un nouveau-né de sexe masculin présentant une détresse respiratoire due à une lésion nasale polypoïde et bleuâtre bilatérale occupant la quasi-totalité des méats inférieurs. L'imagerie a confirmé une dacryocystocèle bilatérale. Le traitement a été symptomatique et une évacuation spontanée est survenue, améliorant la détresse respiratoire.

Discussion

Le diagnostic de dacryocystocèle congénitale est clinique bien que des examens d'imagerie puissent être demandés pour le confirmer. Le traitement est controversé en raison de l'évolution spontanément variable de la maladie. Une prise en charge symptomatique initiale peut être recommandée mais, en l'absence d'amélioration spontanée de l'obstruction des voies aériennes, une prise en charge chirurgicale est obligatoire.



Fraisage et contrôle du méat auditif interne par endoscope fixé

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): X. Dubernard, J.-C. Kleiber, M. Makeieff, A. Bazin, A. Chays

Résumé

En cas de résection chirurgicale d'un schwannome vestibulaire par voie rétro sigmoïde, le contrôle des structures vestibulaires en particulier du canal semi-circulaire postérieur est impératif si l'objectif de conservation de l'audition s'ajoute à celui d'une exérèse tumorale totale. Le fraisage du méat acoustique interne (MAI) est une étape délicate au cours de laquelle les structures vestibulaires peuvent être involontairement ouvertes. L'orientation du MAI explique la formation de zone d'ombre propice à leur ouverture si le fraisage est réalisé au microscope. L'endoscopie portée expose en totalité la zone opératoire mais bloque l'une des mains du chirurgien rendant la chirurgie délicate. L'endoscopie fixée est une solution permettant de rendre au chirurgien sa liberté opératoire tout en garantissant un contrôle précis de son geste. Elle permet le repérage et le contournement des structures vestibulaires tout en étant au plus près de la tumeur. Le schwannome peut se laisser cliver en totalité, le fond du MAI étant correctement contrôlé tout en respectant le nerf facial et le nerf cochléaire.



Reconstruction de la paroi antérieure du sinus frontal par prothèse en titane sur-mesure après exérèse d'un ostéome géant du sinus frontal

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): J. Fanchette, B. Faucon, F. Cartry, M. Ratajczak

Résumé

L'ostéome est une tumeur osseuse bénigne, fréquemment rencontrée au niveau naso-sinusien, le plus souvent asymptomatique. Le traitement est chirurgical et s'impose lorsque le patient devient symptomatique ou présente des complications opthalmologiques ou neurologiques. Bien que l'approche endoscopique soit de plus en plus utilisée si la localisation et/ou la taille de l'ostéome le permettent, la chirurgie par voie ouverte peut être préférable et reste encore la référence. Nous présentons dans cette note technique un cas d'ostéome géant du sinus frontal ayant nécessité une exérèse par voie bicoronale, avec reconstruction par une prothèse en titane réalisée sur-mesure.



Anaesthesia

Prediction of endotracheal tube size in children by predicting subglottic diameter using ultrasonographic measurement versus traditional formulas
Shubhi Singh, Parul Jindal, Priya Ramakrishnan, Shailendra Raghuvanshi

Saudi Journal of Anaesthesia 2019 13(2):93-99

Background: Paediatric airway assessment remains the most challenging task before the anaesthesiologists. Recent advancement in ultrasonography techniques should now allow for accurate and descriptive evaluation of paediatric airway. To compare calculated external diameters of the endotracheal tube from physical indices of traditional formulas and predetermined by ultrasound. Materials and Methods: 100 subjects of either sex between 12-60 months of age, undergoing various elective surgeries under general anaesthesia requiring endotracheal intubation were enrolled in the study. The transverse diameter was measured at the level of cricoids cartilage by ultrasonography. The tracheal tube was considered best fit if air leak was satisfactory at 15-20 cm H2O of airway pressure. The obtained values were compared with the values of endotracheal tube size calculated by various age, height, weight based formulas and diameter of right and left little finger. The correlation of size of Endotracheal tube by different modalities was done and Pearson's correlation coefficient was obtained. Results: According to Pearson's correlation there was a moderate correlation of best fit Endotracheal tube with endotracheal tube size by age based formula (r = 0.743), body length based formula (r = 0.683), right little finger based formula (r = 0.587), left little finger based formula (r = 0.587) and multivariate formula (r = 0.741). There was a strong correlation with ultrasonography (r = 0.943). Conclusion: Ultrasonography is a reliable method of estimation of subglottic diameter and for prediction of endotracheal tube size in children. 


Postoperative analgesia with ropivacaine and dexmedetomidine for ultrasound-guided fascia iliaca compartment block after arthroscopic knee surgery
Ying Li, Jun Geng, Laiyou Wen, Jianqing Chen, Zhen Wu

Saudi Journal of Anaesthesia 2019 13(2):100-105

Objective: The objective of this study is to evaluate the postoperative analgesic effect of a combination of ropivacaine and dexmedetomidine for ultrasound-guided fascia iliaca compartment block (FICB) after knee arthroscopy. Materials and Methods: Forty patients scheduled for knee arthroscopy were randomized to receive either 30 ml of 0.25% ropivacaine alone (Group A, n = 20) or combined with dexmedetomidine 1 μg/kg (Group B, n = 20). Pain intensity was evaluated using the visual analogue scale (VAS), at rest and during activity at 4, 6, 8, 12, and 24 h after surgery. Level of consciousness was evaluated using the Ramsay sedation score. Time to first analgesic request after surgery, the dose of analgesic used in the first 24 h after surgery, variation of heart rate, and adverse reactions were also recorded. Results: VAS scores at 6 and 12 h after surgery were significantly lower in Group B compared to Group A (P < 0.05). No significant difference was observed in the Ramsay sedation score or time to first analgesic request after surgery (P > 0.05). The total dose of analgesic used in the first 24 h after surgery was higher in Group A than in Group B. The incidence of bradycardia was higher in Group B compared to Group A. No adverse reactions were observed in either group. Conclusion: FICB with a combination of ropivacaine and dexmedetomidine resulted in significant reduction of VAS scores with lower postoperative analgesic requirement after arthroscopic knee surgery. No adverse reactions or complications were noted except for lower heart rate in Group B patients. 


Knowledge of patients on safe medication use in relation to nonsteroidal anti-inflammatory drugs
Salmeen D Babelghaith, Mohamed N Alarifi, Syed Wajid, Tariq M Alhawassi, Sara K Alqahtani, Sultan M Alghadeer

Saudi Journal of Anaesthesia 2019 13(2):106-111

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed and used medications that are used as analgesic, antipyretic, or anti-inflammatory agents, but have a high risk of adverse effects. Objective: The main purpose of this study is to evaluate the knowledge of patients toward the risks and safe usage of NSAIDs. Methods: A descriptive cross-sectional study was conducted among patients who attended orthopedic clinics at King Khalid University Hospital in Riyadh, Saudi Arabia, during December 2017 to February 2018. A self-administered questionnaire comprising three sections [sociodemographic information, patients' knowledge of NSAIDs, and the attitude toward receiving information about NSAIDs' adverse drug reactions (ADRs)] was used. The attitude was measured with a 5-point Likert scale. Results: The mean duration of NSAIDs usage was 7.3 ± 6.9 years. Only 45% of the respondents used NSAIDs daily, while 38% said they only used NSAIDs as needed. Nearly one-quarter of patients (25.5%) were counseled by a healthcare provider on the risks of NSAIDs. Almost 94% and 90.5% of the study subjects agreed that physicians and pharmacists, respectively, should play an essential role in providing information regarding ADRs to their patients. More than half of the respondents claimed that information about ADRs might lead them to discontinue their medicines. More than one-third of respondents stated that their healthcare setting provided them with insufficient knowledge of ADRs. Conclusion: Counseling of patients may diminish potentially inappropriate use and increase risk awareness. Healthcare providers can improve their role in identifying and counseling patients on NSAIDs. 


Role of academic anesthesiology department in introducing patient safety module into medical school curriculum: 5 years-experience at King Abdulaziz University, Saudi Arabia
Abeer A Arab

Saudi Journal of Anaesthesia 2019 13(2):112-118

Background: Medical schools' curricula face increasing number of must to add-on components. Although the World Health Organization has emphasized integrating teaching patient safety and quality improvement in medical curricula, only few medical schools have responded and included these topics in their curricula. Objective: This article aimed to describe the process of foundation and integration of patient safety module led by academic anaesthesiology department at King Abdulaziz's Faculty of Medicine. It also describes the main achievements and the most important challenges faced during implementation of this module during the last 5 academic years to guide other aspiring academic anaesthesiology departments in other medical schools for them to replicate the success. Methods and Subjects: Patient safety module was designed to be interprofessional and multidisciplinary module that depends on evidence-based approach to patient safety. It was offered during the 6th year medical study started in 2011–2012 as part of an integrated, hybrid, system-based curriculum at King Abdulaziz's Faculty of Medicine. The mode was delivered through interactive lecture (15% of the module contact hours), e-learning (15%), and practical sessions (70%). Student's assessment during the module included written exams and presentation of a patient safety advocacy project on group base. Results: The module committee continuously assessed the outcome measures of the module that included results of student's assessment, student's satisfaction, as well as student's self-reported learning of the module outcome. The module committee continuously revised the module in the light of these outcomes. Conclusion: Today medical school curricula aspire to graduate market-place ready safe and efficient future physicians. This requires implementation of effective programs that help students to recognize and show appropriate clinical and patient safety skills early and continuously in their professional education. 


Dexmedetomidine versus fentanyl added to bupivacaine for epidural analgesia in combination with general anesthesia for elective lumbar disc operations: A prospective, randomized double-blinded study
Amin Mohammed Alansary, Marwa Ahmed Khairy Elbeialy

Saudi Journal of Anaesthesia 2019 13(2):119-125

Background: The literature on drugs used for combined general anesthesia and epidural analgesia (CGE) in lumbar operations is scarce. The purpose of the study was to compare the addition of either dexmedetomidine or fentanyl to bupivacaine for epidural analgesia in combination with general anesthesia with regard to efficacy and adverse events in such operations. Materials and Methods: This prospective, randomized, double-blinded study was conducted on 80 patients who were scheduled for an elective lumbar disc operation, age 20–65 years, of either sex and American Society of Anesthesiologists physical status I or II. They were randomly allocated into one of the two groups – group bupivacaine-dexmedetomidine (BD) (n = 40): patients who received CGE with 15 mL of bupivacaine 0.20% plus 50 μg of dexmedetomidine and group bupivacaine-fentanyl (BF) (n = 40): patients who received CGE with 15 mL of bupivacaine 0.20% plus 50 μg fentanyl. The primary outcome was time to first analgesic requirement, whereas the secondary outcomes were the total opioid consumption and pain scores during the first 24 h. The incidence of adverse postoperative (PO) effects related to the study drugs, such as sedation, nausea and vomiting, pruritus, shivering, and respiratory depression, was also documented. Results: Patients in the BD group experienced a significantly prolonged pain-free period, lower total opioid consumption, and lower pain scores than patients in the BF group (P < 0.001). Patients in the BD group showed a significantly lower intraoperative heart rate and mean blood pressure (P < 0.001). Regarding adverse events, there were greater PO sedation scores (P < 0.001) and less frequent episodes of PO nausea and vomiting in the BD group. In addition, patients in the BD group showed less pruritis and shivering. There were no reported cases of respiratory depression in either group. Conclusion: CGE with bupivacaine plus dexmedetomidine provided better PO pain control than bupivacaine plus fentanyl, with fewer adverse events overall. 


A prospective study to evaluate the efficacy of ultrasound-guided ganglion impar block in patients with chronic perineal pain
Anju Ghai, Priti Jangra, Sarthak Wadhera, Nandita Kad, RK Karwasra, Ankur Sahu, Rajmala Jaiswal

Saudi Journal of Anaesthesia 2019 13(2):126-130

Background: The blockade of the ganglion impar has been described to relieve the intractable perineal pain of sympathetic origin in patients with coccydynia. Chronic perineal pain (CPP) has been effectively managed by ganglion impar block. The feasibility, safety, and efficacy of ultrasound (US)-guided ganglion impar block by transsacrococcygeal approach was analyzed in the present study. Methods: A total of 15 patients with CPP were administered US-guided ganglion impar block using out of plane approach. Patients were followed for VAS and quality of life using Karnofsky performance status (KS), Linear Analog Scale Assessment (LASA), and constipation score up to 2 months at different time intervals. Time required to perform the procedure, number of attempts, and any complications were also noted. Results: The mean time required to perform the procedure was 7.67 ± 1.23 min. There were no adverse events. All the patients had significant pain relief during 2 month follow-up (P < 0.05 compared to baseline VAS). The KS and LASA score improved post block which was statistically significant. The dose of nonsteroidal anti-inflammatory drugs (NSAIDS) decreased from preblock state with statistically significant difference, while the difference in dose of tramadol and morphine was statistically insignificant. Conclusion: US-guided ganglion impar block is technically feasible and safe technique. USG can be used to locate sacrococcygeal junction (SCJ) and facilitate the performance of ganglion impar block. The efficacy and safety of the US-guided ganglion impar blockades needs a proper evaluation in the randomized controlled trials. 


Cytoreductive onco-surgery with combined hyperthermic intraperitoneal chemotherapy and hyperthermic intrathoracic chemotherapy: Perioperative challenges
Rohini Dattatri, Rakesh Garg, Mukur Dipi Ray

Saudi Journal of Anaesthesia 2019 13(2):131-135

Cytoreductive surgeries (CRSs) are the common management modality for advanced cancers. The perioperative period is impacted by major surgical resection and its associated effects. The surgical morbidity is further enhanced when the resection of abdominal and thoracic cavity is required simultaneously. It is added on by the effects of hyperthermic intraperitoneal chemotherapy (HIPEC) and hyperthermic intrathoracic chemotherapy (HITHOC). These procedures are technically challenging with potential for high perioperative morbidity and mortality. We report a case of 56-year-old female diagnosed with carcinoma ovary with pleural metastases and malignant right pleural effusion and scheduled for CRS with HIPEC together with HITHOC. 


Giant meningoencephalocele with Arnold-Chiari type III malformation and anaesthetic challenges: A rare case report
Veena Ganeriwal, Paulomi Dey, Rupali Bawage, Baburao Gore

Saudi Journal of Anaesthesia 2019 13(2):136-139

Meningoencephalocele means protrusion or herniation of brain (neural) tissue along with meninges through a defect in the cranium into a swelling filled with cerebrospinal fluid (CSF). It is very rarely associated with Arnold-Chiari type III (ACM type III). Size, location and type of content of the swelling determine the surgical as well as anaesthetic problems. The most common challenges faced by anaesthesiologist in managing these patients are related to positioning of head and prevention of rupture of swelling, airway management, fluid and blood loss and maintenance of body temperature. In order to manage huge meningoencephalocele, you need a well-planned approach amongst anaesthesiologist and surgeon. 


Anesthetic management of separation of conjoint twins: Challenges and limitations
Choudhary Deepak, Sharma Vandana, Bhatia Pradeep, Kothari Nikhil

Saudi Journal of Anaesthesia 2019 13(2):140-143

A conjoint twin is a rare congenital anomaly. The separation of conjoint twins presents a unique challenge to anesthesiologists. We report the anesthetic management of successful separation of thoraco-omphalopagus conjoint twins, along with challenges and limitations that we faced in perioperative period. We highlight the importance of a multidisciplinary approach, proper preoperative planning, and perioperative vigilance regarding monitoring and complication. 


Unexpected difficult airway caused by prior wide neck surgery
Daeseok Oh

Saudi Journal of Anaesthesia 2019 13(2):144-145



Medicine and Surgery

Prevalence of anemia and iron status among nomadic Fulani children in a grazing reserve in Northwestern Nigeria
Halima Bello-Manga, Sani Awwalu, Ifeoma P Ijei, Abdulaziz Hassan, Aisha I Mamman

Archives of Medicine and Surgery 2018 3(2):43-48

Introduction: Iron is one of the most important micronutrients that play a vital role in hemoglobin (Hb) synthesis, cellular metabolism, and psychomotor function in humans. Iron deficiency is a major cause of anemia worldwide, particularly in children. The nomadic Fulanis have a migratory lifestyle determined by the availability of water and pasture for their livestock, making them difficult to reach, thus the paucity of knowledge on their health status. Objectives: To assess the Hb concentration, red cell indices, serum ferritin, and transferrin receptor levels among nomadic Fulani children in Ladduga grazing reserve of Kaduna state, Nigeria. Materials, Subjects, and Methods: This was a cross-sectional, descriptive study using questionnaires and physical examination of 340 children (5–15 years). Their complete blood count was determined by automation; serum ferritin and soluble transferrin receptor (sTFR) levels were assayed using enzyme-linked immunosorbent assay technique. Data obtained was analyzed using SPSS version 20.0. Level of significance was set at P ≤ 0.05. Results: The prevalence of anemia was 40.3%, which was significantly higher among the children aged 5–9 years (54.7%) compared to 30.5% in the 10–15 years age group (Z-statistic = 4.5, P= <0.001). Iron deficiency anemia was observed in only 19 (5.6%) of the study population. Median (interquartile ranges) serum ferritin and mean ± standard deviation sTFR levels were 56.0 (55.8) μg/L and 34.73 ± 14.29 nmol/L, respectively. Majority (77.4%) of the participants had normal iron stores and only 18.8% had low stores. Among the 137 participants with anemia, 19 (13.9%), 76 (55.5%), 102 (74.5%), and 76 (55.5%) had serum ferritin <30 μg/L, sTfR > 28.1 nmol/L, mean corpuscular volume <80 fl, and mean corpuscular hemoglobin <27 pg, respectively. Conclusion: There is a high prevalence of anemia among nomadic Fulani children at Ladduga grazing reserve. However, iron deficiency is not the only cause of anemia.


Quality of life assessment among individuals with sickle cell disease attending hematology clinic of a Tertiary Hospital in Northwest Nigeria
Ma'awiyyah Babale Sufiyan, Sadiq Tijani, Lawal Aminu

Archives of Medicine and Surgery 2018 3(2):49-55

Background: Globally, sickle cell disease (SCD) is the most common inherited disorder, with Nigeria having the greatest burden of the disease. SCD was thought to be a disease of childhood because many died early in life from related complications. However, advances in SCD treatment have altered its course such that the majority of children are living into adulthood. Individuals with SCD suffer increased school absenteeism, poor school performance, increased hospital visits, and increased hospitalization, thus affecting their quality of life (QOL) compared to normal individuals. Subjects and Methods: We conducted a hospital-based, descriptive, cross-sectional study among 120 individuals with SCD attending hematology clinic in a tertiary hospital, selected using systematic sampling technique. Pretested, structured, interviewer-administered questionnaire adapted from RAND's Short Form-36 was used for the data collection. Completed questionnaires were coded, and data were entered into SPSS software version 23.0 for analysis. Univariate and bivariate analyses were conducted among variables. Associations between categorical variables were tested for significance using Chi-square test and Student's t-test. Statistical significance was said to be achieved where P < 0.05. Results: A total of 120 participants were studied with an age range of 10–45 years and a median age of 20 years. Majority (54.2%) of the participants were in the age group of 10–20 years. In addition, 13 (10.8%) perceived their general health status as poor, whereas 71 (59.2%) had the perception of falling sick easily, than the normal individuals. The Health-Related Quality of Life (HRQOL) scores for the eight domains are as follows: bodily pain (62.3 ± 24.3), physical functioning (56.7 ± 25.5), physical role limitation (32.1 ± 37.7), social activities (59.5 ± 27.4), general mental health (42.0 ± 39.7), emotional status (59.1 ± 14.1), vitality (52.9 ± 13.1), and general health perceptions (50.8 ± 21.1). Conclusion: We found that the QOL of individuals with SCD is generally poor in all the domains of HRQOL, especially in the areas of role limitations due to physical and emotional health. Therefore, in addition to measures taken to reduce SCD complications, other interventions should target improving their physical and emotional health. We also recommend improving HRQOL among all the other domains as a clinical end point.


Airway management of patients with temporomandibular joint disorder: A 12-year retrospective review in ABUTH Zaria
AbdulGafar Adeniyi Yunus, Benjamin Fomete, Ifeanyi Kene Aghadi, Hamisu Yakubu

Archives of Medicine and Surgery 2018 3(2):56-58

Background: Temporomandibular joint (TMJ) ankylosis is a condition associated with restricted mouth opening. Following induction of general anesthesia, airway obstruction may occur leading to “can't ventilate and can't intubate scenario.” The anticipation of difficult airway and choice of appropriate intubation techniques usually prevent anesthetic morbidity and mortality. Patients and Methods: Both the surgeons' and the anesthetic review, as well as the anesthetic chart of the 36 patients managed at Ahmadu Bello University Teaching Hospital between January 2006 and December 2017, were studied. Data collected were bio-data of the patients, extent of mouth opening, and the techniques of intubation used. Results: The mean age of the patients was 26.9 ± 1.64, with a male to female ratio of 1:1.1. There were more male 19 (52.8%) than female 17 (47.2%). Tracheal intubation was achieved with the aid of nasal fiberoptic technique in 22 (61.1%) patients, 8 patients (22.2%) were intubated by tracheostomy, 4 patients (11.1%) were intubated by blind nasal intubation, while 2 patients (5.6%) required endotracheal intubation through conventional oral laryngoscopy. The interincisor gap was between 0 and <1 cm in all the patients which indicated significantly restricted mouth opening, with an average of zero interincisor gap. Conclusion: Fiberoptic intubation was the most used approach of achieving tracheal intubation in patients with TMJ disorder.


Demographic distribution and pattern of orofacial clefts in a Nigerian Urban Hospital
Benjamin Fomete, Ezekiel Taiwo Adebayo, Otasowie Daniel Osunde, Lilian Ejije Ahaji, Idowu Omobolaji

Archives of Medicine and Surgery 2018 3(2):59-62

Introduction: Clefts lip and palate are the most common deformities in the head-and-neck region. They vary in the severity of presentation from small notches in the lip to clefts that extend through the alveolar ridge in the mouth and involve the floor of the nostrils/palate. They may either occur in isolation (asyndromic) or in association with other congenital anomalies as part of a syndrome as observed. Patients and Methods: This is a retrospective clinic-based study of records of patients seen with orofacial clefts from 2009 to 2014, at the Army Dental Clinic, Bonny Cantonment, Lagos, Nigeria. Results: A total of 43 cases of cleft lip and palate of varying degrees were seen over the study period. There were slightly more males (n = 23, 53.5%) than that of females (n = 20, 46.5%). The age at presentation ranged from 4 days old to 46 years and the median age was 3 years. In terms of age distribution, patients aged 3 years and below (n = 23; 53%) were the most predominant group. This was followed by the 4–7 years (n = 6; 13.9%) age bracket. Patients aged 8–11 years, 12–15 years, and 28–31 years were equally distributed with 3 (6.9%) each. Conclusion: A significant minority of orofacial clefts patients still present in adulthood possibly due to ignorance about treatment options and poverty to access surgical treatment.


A retrospective review of airway management in maxillofacial trauma
Abdulghaffar Adeniyi Yunus, Benjamin Fomete, Sule Umar

Archives of Medicine and Surgery 2018 3(2):63-66

Background: Maxillofacial injury has been described in the medical literature as early as 2500 BC. Although, these injuries appear very fearsome. They cause menace to life only, if they obstruct the airway. This is of utmost concern to the anesthetist, because of their closeness to the airway. Patients and Methods: A retrospective study of patients who underwent surgery for facial fractures within the period of 10 years in a Nigerian tertiary health care facility. Results: There were 264 cases of facial fracture with panfacial fracture, i.e., 123 cases (46.6%) constituting the bulk. The majority, i.e., 187 (70.8%) were male and the mean age was 33 years. Nasotracheal intubation (213 [81.5%]) was the technique widely used followed by orotracheal intubation (41 [15.5%]). The majority of the patients, i.e. 145 (54.9%) was Mallampati III and had advanced airway management. Most of our patients had the American Society of Anesthesiologists II, complications occurred in only 6% of patients. Conclusion: Nasal intubation was the preferred mode of intubation by the maxillofacial surgeons and the anesthetists.


Comparative evaluation of two diagnostic methods for the detection of chlamydia trachomatis in endocervical specimens
Oluwafemi Temidayo Ige

Archives of Medicine and Surgery 2018 3(2):67-70

Context: Genital infections caused by Chlamydia trachomatis have been a significant healthcare problem recognized throughout the world in recent years. The World Health Organization estimates that approximately two million new cases of genital chlamydial infection occur annually in females. Objectives: The objective was to compare the performance of the glycogen assay test to the polymerase chain reaction (PCR) in the diagnosis of genital chlamydial infection. Materials and Methods: Consenting female patients were consecutively recruited for the study until the sample size of 365 was achieved. Two endocervical specimens were collected from each of the patients using sterile plastic-shaft Dacron swabs. C. trachomatis test kit (Autobio Company China) was used according to the manufacturer's instructions. The test is a biochemical assay for the detection of C. trachomatis in clinical samples taken from the genital tract. PCR was also done for each sample. Data management was done using the Statistical Package for the Social Sciences version 20.0. Results: Of the women studied, 95 (26%) were positive and 270 (74%) negative for genital chlamydial infection using the PCR, while 244 (66.8%) tested positive and 121 (31.2%) tested negative using the glycogen assay. Conclusions: With the results generated above and using the PCR as the standard, sensitivity for the glycogen assay was 86.3%, specificity was 40%, and the predictive value for a positive result was 33.6%, while that for a negative result was 89.3%. The glycogen assay kit is locally available, not expensive (compared to the very high cost of PCR) and often used in the diagnosis of genital chlamydial infection. However, with a sensitivity of 86.3% and specificity of 40% for the glycogen assay, found in this study, the test kit is far from ideal as a tool for the rapid diagnosis of genital C. trachomatis infection, as it will yield high numbers of false-positive results.


Knowledge, attitude, and practice of cold chain management among primary health care workers in Giwa, Northwestern Nigeria
Bilkisu Nwankwo, Shuaibu Joga Joga, Abdulhakeem A Olorukooba, Lawal Amadu, Mary O Onoja-Alexander, Khadeejah L Hamza

Archives of Medicine and Surgery 2018 3(2):71-76

Background: Cold chain management is a system of transport and storage of vaccines in a potent state from the time of manufacture to the time of administration. Preserving vaccines from its manufacture through administration requires adequate cold chain infrastructure, compliance with standards, and effective management. At the end of the chain, are healthcare providers who should have adequate knowledge to manage the cold chain. Aim: The aim of this study is to assess knowledge, attitude, and practice of cold chain management among primary health care (PHC) workers. Materials and Methods: A cross-sectional study was carried out using a pretested, structured, interviewer-administered questionnaire. A multistage sampling method was used in selecting the 78 respondents. Data were collated and analyzed using Statistical Package for Social Sciences version 23. Data were presented using frequencies and proportions. Results: Majority (71.8%) of the respondents knew the correct temperature range for which vaccines should be stored. Only 3.8% of the respondents had good knowledge of cold chain management. About two-thirds (75.6%) of the respondents agreed that cold chain management is important. Most respondents (78.5%) showed a positive attitude toward cold chain management. Only over half (51.3%) of the respondents had appropriate practice. Conclusion: This study has shown that the PHC workers in the study area had poor knowledge, about two-thirds had a positive attitude and only about half of them had appropriate practice on cold chain management. The local government department should improve on training and retraining of PHC workers on cold chain management.


Personal and food hygiene practices among street-food vendors in Sabon-Gari local government area of Kaduna State, Nigeria
Ahmad Ayuba Umar, Mohammed Nasir Sambo, Kabiru Sabitu, Zubairu Iliyasu, Muawiya Babale Sufiyan, Khadija Liman Hamza

Archives of Medicine and Surgery 2018 3(2):77-83

Background: Street-food vendors play an important role in the etiology of foodborne disease outbreaks. Foodborne disease pathogens may be transferred by street-food vendors to food either directly or by cross contamination. Deeply concerned by this, the 53rd World Health Assembly in May, 2000 adopted a resolution calling on the World Health Organization (WHO) and its member states to recognize food safety as an essential public health function. The resolution also called on WHO to develop a global strategy for reducing the burden of foodborne diseases. This study, therefore, was aimed at assessing the personal and food hygiene among street-food vendors in Sabon Gari Local Government Area of Kaduna State. Materials and Methods: A cross-sectional descriptive study was conducted among 109 adults food vendors that sell cooked food or food items by the roadside or open spaces in the streets of Sabon Gari local government area (LGA) using multistage sampling technique. Observation checklist and a pretested interviewer-administered questionnaire with closed-ended questions were used for data collection. The obtained data were entered into a computer, cleaned and analyzed using IBM SPSS statistics version 20. Univariate and Bivariate analyses were conducted among the variables. Associations between categorical variables were tested for significance using Chi-square or Fischer's exact test. Statistical significance was said to be achieved where P ≤ 0.05. Results: Most of the street-food vendors were within the age group 35–44 years (40.4%), while 49.5% of the people who patronized them were passers-by. Half (50.5%) of the street-food vendors normally operate under a shade to sell food to customers. All of them did not receive any formal training on personal and food hygiene. Half (50.4%) of the respondents and 48.6% of them had poor practices of personal and food hygiene, respectively. However, 67.0% of the street-food vendors had a fair environmental sanitation status around their vending sites. Conclusion: The study found that none of the street-food vendors had ever received any form of formal training on personal and food hygiene. Many of them have poor personal and food hygiene practices; however, a significant proportion of them have a fairly good environmental sanitation status around their vending sites. Formal training on personal and food hygiene should be conducted among all street-food vendors in the LGA to improve on their personal and food hygienic practices for the vending of safe food to their consumers.


Pharmacology

Drugs in sport: The curse of doping and role of pharmacologist
Dhruv Mahendru, Subodh Kumar, Ajay Prakash, Bikash Medhi

Indian Journal of Pharmacology 2019 51(1):1-3



Microneedle – Future prospect for efficient drug delivery in diabetes management
Baishali A Jana, Ashish D Wadhwani

Indian Journal of Pharmacology 2019 51(1):4-10

This review aims at focusing on the use of microneedles (MNs) as an emerging novel drug delivery carrier for an effective treatment in diabetic patients. There are many limitations in various modes of delivery such as oral, subcutaneous, nasal, and other modes which cause pain and have many other side effects. Hence, this drug delivery research has found to have tremendous potential in combining both the diagnostic and therapeutic elements, thus treating diabetes in a better way. Most glucose-sensing techniques and conventional insulin therapies are engaged in the transfer of physical entities through the skin. MN- based drug delivery system can accomplish in an noninvasive or minimally invasive manner which can be an add on advantage towards pain-free administration, easy handling, discrete, continuous as well as providing a controlled release system. Hence, the review addresses on the current advancement of this bioengineered system like MNs, constituting a “smart” system specifically for autonomous diabetes therapy. 


A study to assess the methodological quality of in vivo animal experiments published in Indian journal of pharmacology: A retrospective, cross-sectional, observational study
Sandeep Kumar Gupta

Indian Journal of Pharmacology 2019 51(1):11-16

BACKGROUND: Good reporting of experimental research is a vital part of research process. Although the reporting guidelines such as Animal research: Reporting in vivo experiments (ARRIVE) require the authors to stick to a standard format, they do not guarantee study reports' validity. For assessing the study reports validity, critical appraisal tools are required. OBJECTIVE: The evaluation of the methodological quality of in vivo animal studies of Indian Journal of Pharmacology (IJP) published between 2011 and 2017 through critical appraisal was the primary objective. The secondary objective was to evaluate the adherence of selected studies to the ARRIVE guidelines. MATERIALS AND METHODS: All in vivo animal studies published as full-text articles in IJP from January 2011 to December 2017 and satisfying the inclusion norms were included. A checklist based on the underlying principles of ARRIVE statement was applied to in vivo animal research (AR) published in IJP. For critical appraisal of reports, risk-of-bias domains were also applied on studies from in vivo AR. RESULTS: One hundred and sixty-one studies satisfied the inclusion criteria. Seventy-three articles (45.34%, 95% confidence interval [CI]: 0.37–0.53) discussed about randomization procedure. Eighteen articles (11.18%, 95% CI: 0.07–0.16) gave details about blinding when assessing results. None of the studies provided details of sample size calculation. Eight articles (4.97%, 95% CI: 0.02–0.09) commented on the study limitations. CONCLUSION: It was found that adherence to only some criteria of ARRIVE guidelines was subpar. There is a need for optimal reporting of random distribution of animals to experimental groups, concealment of allocation, blinded outcome evaluation, computation of sample size, and attrition of animals for improving the validity of AR. 


Population pharmacokinetics of primaquine and the effect of hepatic and renal dysfunction: An exploratory approach
Kannan Sridharan, Chenna Keshava Reddy Sannala, Surulivelrajan Mallayasamy, Ayyappa Chaturvedula, Prashant Kadam, Nivrutti Hase, Akash Shukla, Nithya Gogtay, Urmila Thatte

Indian Journal of Pharmacology 2019 51(1):17-24

OBJECTIVES: We attempted to develop a population pharmacokinetic model for primaquine (PQ) and evaluate the effect of renal and hepatic dysfunction on PQ pharmacokinetics. MATERIALS AND METHODS: The data were collected from a prospective, nonrandomized clinical study in healthy volunteers and patients with mild-moderate hepatic dysfunction and renal dysfunction. Model development was conducted using NONMEM® software, and parameter estimation was conducted using first-order conditional estimation with interaction method. RESULTS: Final data included a total of 53 study participants (13 healthy individuals, 12 with mild hepatic dysfunction, 6 with moderate hepatic dysfunction, and 22 with renal dysfunction) with 458 concentrations records. Absorption rate constant (Ka) was constrained to be higher than elimination rate constant to avoid flip-flop situation. Mild hepatic dysfunction was a significant covariate on volume of distribution, and it is approximately three folds higher compared to other subjects. Fixed effects parameter estimates of the final model – absorption rate constant (Ka), volume of distribution (V), and clearance (CL) – were 0.95/h, 498 L, and 39 L/h, respectively. Between-subject variability estimates (% CV) on Ka, V, and CL were 77, 66, and 65, respectively. Residual error was modeled as combination error model with the parameter estimates for proportion error 12% CV and additive error (standard deviation) 1.5 ng/ml. CONCLUSION: Population pharmacokinetic modeling showed that the volume of distribution of PQ in subjects with moderate hepatic dysfunction increases approximately three folds resulting in a significantly lower plasma concentration. 


In vivo anti-arthritic activity of Bauhinia purpurea Linn. Bark Extract
Sunil Kumar, Rohit Kumar, YK Gupta, Surender Singh

Indian Journal of Pharmacology 2019 51(1):25-30

OBJECTIVE: Bauhinia purpurea (BP) Linn. (Caesalpiniaceae) is a plant of great medicinal importance and has been used since ancient times for treating many inflammatory conditions including arthritis. This study investigates the anti-arthritic potential of the hydroalcoholic extract from the stem bark of BP. MATERIALS AND METHODS: The anti-inflammatory and anti-arthritic activity of BP at various doses was used to evaluate its anti-inflammatory activity and anti-arthritic activity. Serum of arthritic rats was collected at day 21 for detecting serum cytokines level and to evaluate the effect of BP on its serum level. Furthermore, the safety of BP was evaluated in acute (5 days) and subacute (28 days) toxicity study in rats. RESULTS: There was a significant inhibition (P < 0.01) in paw edema at a different time scale with different doses of BP (50, 100, and 200 mg/kg). BP also demonstrated dose-dependent anti-arthritic activity on all observation days (3, 7, 14, and 21). In addition, there was also a significant decrease (P < 0.01) in oxidative stress markers, circulating pro-inflammatory cytokine (tumor necrosis factor alpha from 45.91 to 37.44, interleukin-1 (IL-1) β from 18.24 to 16.06, and IL-6 from 69.77 to 58.44) and an increase in anti-inflammatory cytokine (IL-10 from 8.07 to 12.07) levels. BP was found to be safe with an oral LD50 value of >2 g/kg in acute toxicity study and also no toxicological effect was observed in the oral subacute toxicity study. CONCLUSION: This study demonstrates that BP bark possesses anti-arthritic activity potential and confirm its folklore use in the treatment of inflammatory conditions. 


Homology modeling identified for purported drug targets to the neuroprotective effects of levodopa and asiaticoside-D in degenerated cerebral ganglions of Lumbricus terrestris
Mamangam Subaraja, A Kulandaisamy, N. R Siva Shanmugam, Arambakkam Janardhanam Vanisree

Indian Journal of Pharmacology 2019 51(1):31-39

CONTEXT: Homology modeling plays role in determining the therapeutic targets dreadful for condition such as neurodegenerative diseases (NDD), which pose challenge in achieving the effective managements. The structures of the serotonin transporter (SERT), aquaporin (AQP), and tropomyosin receptor kinase (TrkA) which are implicated in NDD pathology are still unknown for Lumbricus terrestris, but the three-dimensional (3D) structure of the human counterpart for modeling. AIM: This study aims to generate and evaluate the 3D structure of TrkA, SERT, and AQP proteins and their interaction with the ligands, namely Asiaticoside-D (AD) and levodopa (L-DOPA) the anti-NDD agents. SUBJECTS AND METHODS: Homology modeling for SERT, AQP, and TrkA proteins of Lumbricus terrestris using SWISS-MODEL Server and the modeled structure was validated using Rampage Server. Wet-lab analysis of their correspondent m-RNA levels was also done to validate the in silico data. RESULTS: It was found that TrkA had moderately high homology (67%) to human while SERT and AQP could exhibit 58% and 42%, respectively. The reliability of the model was assessed by Ramachandran plot analysis. Interactions of AD with the SERT, AQP-4, and TrkA showed the binding energies as −9.93, 8.88, and −7.58 of Kcal/mol, respectively, while for L-DOPA did show −3.93, −5.13, and −6.0 Kcal/mol, respectively. The levels of SERT, TrkA, and AQP-4 were significantly reduced (P < 0.001) on ROT induced when compared to those of control worms. On ROT + AD supplementation group (III), m-RNA levels were significantly increased (P < 0.05) when compared to those of ROT induced worms (group II). CONCLUSION: Our pioneering docking data propose the possible of target which is proved useful for therapeutic investigations against the unconquered better of NDD. 


Development and clinical evaluation of a dried urine spot method for detection of morphine among opioid users
Raka Jain, Rizwana Quraishi, Arpita Verma, Atul Ambekar

Indian Journal of Pharmacology 2019 51(1):40-44

BACKGROUND: In recent years, drug testing in body fluids has gained popularity for validating self-reported drug use. The storage and transportation of urine specimens is a major concern for remote areas where the facilities for performing drug abuse testing are lacking. AIMS AND OBJECTIVES: The aim of the present study was to develop an efficient method for testing opiate in dried urine spots (DUS) and to evaluate its clinical applicability. MATERIALS AND METHODS: The methodology involved optimization of conditions for extraction, recovery, short-, and long-term stability (room temperature, 4°C,−20°C) for detection of opiate from dried urine spots. Further, the extraction efficiency from dried urine spots was compared with the conventional drug testing methodology. The screening was done by using enzyme-linked immunosorbent assay technique, and confirmation was achieved by gas chromatography equipped with nitrogen phosphorus detector. RESULTS: Deionized water was found to be a suitable extracting solvent compare to bi-carbonate buffer (pH 9.2) and saline. Primary screening was achieved by 2 punches taken from a 20-μl (diameter 1.3 cm) spotted urine samples, whereas confirmation was achieved by 2 complete circles each of 20 μl sample volume. The recovery was found to be 99.41% in water. No sign of significant degradation was seen among all storage conditions. CONCLUSIONS: In the current study, DUS has achieved the same level of precision and reproducibility as that of standard methods used for drug testing in urine. Hence, the DUS sampling appears to have potential to detect opiate among drug users in a clinical setting. 


Antiangiogenic activity of sophorolipids extracted from refined bleached deodorized palm olein
Shazmin Kithur Mohamed, Muhammad Asif, Mansoureh Vishkaei Nazari, Hussein M Baharetha, Syed Mahmood, Abdul Rashid M. Yatim, Aman Shah Abdul Majid, Amin Malik Shah Abdul Majid

Indian Journal of Pharmacology 2019 51(1):45-54

OBJECTIVES: Sophorolipids (SLs) are a group of surface-active glycolipids produced by a type of nonpathogenic yeast Candida bombicola in the presence of vegetable oil through fermentation technology. SLs have shown antitumor activity; however, the mechanism of action underlying the anticancer activity of SLs is poorly understood. This work evaluated the anticancer activity of SLs fermented from palm oil by exploring its antiangiogenic activity. MATERIALS AND METHODS: The SLs that were fermented and further characterized for their biochemical activities. Cytotoxicity study was performed to assess cytostatic properties. A series of in vitro and ex vivo angiogenesis assay was also carried out. The relative fold change in the expression of p53 mRNA by SLs was also studied. RESULTS: Altogether, the data show that SLs derived from palm oil fermentation process inhibited neovascularization in the ex vivo tissue segments and also the endothelial cell proliferation between 50% and 65% inhibition as a whole. The palm oil derived SLs also caused downregulation of the suppression level of vascular endothelial growth factor and also upregulate the p53 mRNA level. The analytical studies revealed the presence of high amount of phenolic compounds but with relatively weak antioxidant activity. The gas chromatography-mass spectrometry studies revealed abundant amount of palmitic and oleic acid, the latter an established antiangiogenic agent, and the former being proangiogenic. CONCLUSION: Therefore, it can be concluded from this study that SLs derived from fermented palm oil have potent antiangiogenic activity which may be attributed by its oleic acid component. 


Prescription pattern, short-term outcomes, and its determinants in patients with chronic kidney disease attending a tertiary care hospital
Rashmi Karabasappa Mamadi, Renuka Sathish, Dhiraj Ravindran Selvaraj, Rajni Rathore, Josephine Valsa Jose, Denis Xavier

Indian Journal of Pharmacology 2019 51(1):55-60

BACKGROUND: Chronic kidney disease (CKD) is a worldwide public health problem associated with an eight- to ten-fold increase in cardiovascular mortality. Among patients with CKD, on drug treatment, we aimed to determine the characteristics, etiology, patterns and rates of drug use, and outcomes and factors determining the outcomes at 6 months. METHODS: We conducted an observational follow-up study on inpatients with CKD at a tertiary care teaching hospital in South India. We collected data on patient characteristics, comorbidities, treatments at baseline, and treatments and outcomes at 6 months. We used Chi-squared tests and Cochran's Q-test to compare categorical variables, t-tests to compare continuous variables, and a multivariable logistic regression analysis to estimate the determinants of the outcome. RESULTS: We recruited 305 patients with the mean age 52.98 (±14.89) years, 73.1% were male and 55.4% patients were from a lower-middle socioeconomic background. About 72.1% were in CKD Stage 5 and 37.0% had diabetic nephropathy. Antihypertensives (84.6%) were the most common drug class prescribed, followed by multivitamins (65.2%), proton-pump inhibitors (64.9%), and antidiabetic drugs (32.5%). There was no significant difference in rates of drug use over 6 months. Increased serum creatinine (odds ratio [OR]: 1.29 [1.04, 1.60]; P = 0.017) and lower estimated glomerular filtration rate (eGFR) (OR: 38.23 [3.92, 372.06]; P = 0.002) predicted progression of CKD, and antiplatelets reduced progression (OR: 0.278 [0.09, 0.85]; P = 0.026). CONCLUSION: Diabetic nephropathy was the most common cause of CKD. There was no change in treatments over 6 months. Low eGFR predicted progression and use of antiplatelets reduced progression of CKD. Large multicenter studies are needed to study the variability in patient characteristics, treatment and outcomes to obtain a national picture, and to enable policy changes. 


Controlled infusion of intravenous cardiac drugs using global optimization
GC Sowparnika, M Thirumarimurugan, VM Sivakumar, N Vinoth

Indian Journal of Pharmacology 2019 51(1):61-71

OBJECTIVES: The objective of the study is to develop an automatic drug infusion control system during cardiovascular surgery. MATERIALS AND METHODS: Based on the clinical drug dosage analysis, the modeling of cardiovascular system with baroreceptor model is mathematically modeled using compartmental approach, considering the relationship between the volume and flow rate of blood during each heartbeat. This model is then combined with drug modeling of noradrenaline and nitroglycerine by deriving the volume and drug mass concentration equations, based on pharmacokinetics and pharmacodynamics of the drugs. The closed-loop patient models are derived from the open-loop data obtained from the physiology-drug model with covariate as age. The proportional-integral controller is designed based on optimal values obtained from bacterial foraging-oriented particle swarm optimization algorithm. The controllers are implemented individually for each control variable such as aortic pressure and cardiac output (CO), irrespective of varying weights based on the relative gain array analysis which depicts the maximum influence of cardiac drugs on control variables. RESULTS: The physiology-drug model output responses are simulated using MATLAB. The controlled responses of aortic pressure and CO with infusion rate of cardiac drugs are obtained. The robustness of the controller is checked by introducing variations in cardiovascular model parameters. The efficiency of the controller during normal and abnormal conditions is compared using time domain analysis. CONCLUSIONS: The controller design was efficient and can be further improved by designing switching-based controllers. 


Physical Therapy

Effect of intradialytic aerobic exercise on patients with diabetic nephropathy
Abdel Raoof A Neveen, El Nahas G Nesreen, Marae K Nadia, Galal M Al Shaimaa

Bulletin of Faculty of Physical Therapy 2019 24(1):1-7

Background Diabetes is a major health problem in nowadays’ society, as the number of patients with diabetes is growing continuously with their diabetic complications, especially kidney diseases, which is the most feared complication because of its substantial comorbidity, cost, and mortality. Purpose The aim of this study was to determine the effect of intradialytic aerobic exercise on kidney functions tests [serum calcium, serum creatinine, urine creatinine, urine albumin, and estimated glomerular filtration rate (GFR)] in patients with diabetic nephropathy. Materials and methods Thirty patients of both sexes (19 male and 11 female) under hemodialysis with a mean age of 54.13±4.32 years were selected from the renal rehabilitation unit of Edfou General Hospital. They were assigned randomly to two groups of equal number. Group A received a moderate-intensity intradialytic aerobic exercise program (12–13 on rate of perceived exertion scale), and group B received their regular dialysis program only. The treatment program continued for 8 weeks (three exercise sessions per week). Laboratory investigations for serum calcium, serum creatinine, urine creatinine, urine albumin, and estimated GFR were carried out at the beginning and after the end of the treatment program in both groups. Results The results of this study revealed a significant increase in serum calcium in group A compared with group B, and a significant decrease in serum creatinine and urine creatinine in group A compared with group B (P=0.03 and 0.04, respectively). There was no significant change in urine albumin and estimated GFR between the two groups. Conclusion Moderate-intensity intradialytic aerobic exercise (12–13 rate of perceived exertion scale) is beneficial in modulating serum calcium, serum creatinine, and urine creatinine in diabetic nephropathy patients.


Balance training: its influence on pulmonary rehabilitation
Khaled M Mounir, Noha S Elserty, Hany E Obaya

Bulletin of Faculty of Physical Therapy 2019 24(1):8-13

Background Balance disorders are one of the most important complications for patients with chronic obstructive pulmonary disease (COPD). Objective To investigate the effect of adding balance training to pulmonary rehabilitation program in improving balance in patients with COPD. Patients and methods A total of 48 male patients diagnosed as having COPD were selected from the outpatient clinic of Wadi El-Neel Hospital, Cairo, and their ages ranged from 60 to 65 years. Patients were assigned randomly into two equal groups. The study group received balance training with pulmonary rehabilitation program, and the control group received pulmonary rehabilitation program only. Exercise training was performed for both groups three times a week for 8 weeks. Balance assessment was performed by Berg Balance Scale, Balance Evaluation Systems Test, and 6-min walking test before and after training. Results The 2×2 mixed-model analysis of variance analysis demonstrated significant increase in the Berg Balance Scale and Balance Evaluation Systems Test after treatment in both groups, with a percentage of improvement in control group was 5.01 and 9.15%, respectively, whereas in the study group was 16.04 and 25.46%, respectively. However, the study group showed significant improvement than the control group after treatment in both tests. Regarding 6-min walking test, both groups showed significant increase after treatment, with a similar percentage of improvement in the control group (23.95%) and the study group (24.93%). There was no significant difference between the control and the study group after treatment. Conclusion Addition of balance training to pulmonary rehabilitation program was more effective in improving balance in elderly patients with COPD.


The interaction of sex and body mass index on ventilatory functions in school children
Eman Wagdy, Samy A Nasef

Bulletin of Faculty of Physical Therapy 2019 24(1):14-19

Purpose This study was designed to study the interaction of sex and BMI on ventilatory functions in Egyptian school children. Design A cross-sectional study among the school children aged 8–12 years. Patients and methods Two hundred and nineteen normal children of both sexes (118 boys and 101 girls), their ages ranged between 8 and 12 years, were selected from one of the Egyptian governmental primary schools, Educational Administration, East Cairo, participated in this study. They were divided into two groups based on their BMI (low BMI 115 and normal BMI 104 consequently). Then each group was subdivided according to the sex (67 boys and 48 girls for low BMI subgroup while in normal BMI subgroup 51 boys and 53 girls were included). Anthropometric measurements were used to calculate the BMI. Ventilatory functions were measured using a spirometer. Results The results revealed statistically significant interaction between the effect of sex and BMI on forced vital capacity (P≤0.0001), forced expiratory volume in the first second (P≤0.0001) and no statistically significant interaction on forced expiratory volume in the first second/forced vital capacity % (P=0.44). Furthermore, there was no difference between boys and girls among the measured ventilatory functions. Conclusion There was an interaction between the effect of sex and BMI on ventilatory functions among Egyptian school children. Therefore, healthy nutrition and exercises are highly recommended in children with low BMI.


Acute response of serum cortisol to different intensities of resisted exercise in the elderly
Mona M Taha, Khaled M Mounir

Bulletin of Faculty of Physical Therapy 2019 24(1):20-25

Background Cortisol has a main role in stress response and high stress can affect the psychological and physical performance in the elderly. Aim To determine the acute response of serum cortisol to different intensities of resisted exercise in the elderly. Patients and methods A total of 60 elderly patients from both sexes (60–70 years) were equally and randomly assigned to three resistive training bouts: low-intensity (group A, 30% of 1RM), moderate-intensity (group B, 50% of 1RM), and high-intensity (group C, 80% of 1RM) with a 90–120 s rest period between sets. Blood samples that were analyzed included serum cortisol hormone before and 15 min postintervention. Results There was a statistically significant decrease in serum cortisol level in groups A and B at postintervention when compared with the preintervention value, while group C showed an insignificant difference. Conclusion In a sample of elderly patients undergoing three bouts of different intensities of resisted exercise, a low to moderate resisted exercise was superior to high intensity in decreasing the serum cortisol and consequently less stress post-exercise.


Impact of chronic kidney disease on anthropometric profile, health-related quality of life and cognitive function in children
Amira M. Abd El-Monem

Bulletin of Faculty of Physical Therapy 2019 24(1):26-31

Background Chronic kidney disease (CKD) is commonly labelled as a silent killer associated with multiple comorbid conditions. Purpose To explore the impact of CKD on anthropometric profile, health-related quality of life (QoL) and cognitive function in children. Patients and methods A total of 150 children with CKD, age ranged from 8 to 12 years were assigned according to glomerular filtration rate into three groups of equal numbers; group I (stage 2 and 3), group II (stage 4) and group III (stage 5). Anthropometric measurements, QoL and cognitive function were measured and compared to 100 healthy age-matched groups. Results Compared with normal children, children with CKD showed a statistically significant short stature, low body weight, anaemia and poor QoL and cognitive impairments. Moreover, those at stage 5 yielded the worse scores. Conclusion CKD is associated with comorbid conditions as growth failure, anaemia, poor QoL performance and cognitive impairments.


Lidocaine iontophoresis for postmastectomy intercostobrachial neuralgia: single-blinded randomized controlled trial
Nancy H Aboelnour, Walid A Abouelnaga

Bulletin of Faculty of Physical Therapy 2019 24(1):32-39

Aim The aim was to investigate the efficacy of lidocaine iontophoresis for neuropathic pain management in intercostobrachial neuralgia after mastectomy. Design A single-blinded randomized controlled trial was conducted. Patients and methods A total of 40 patients with partial or radical mastectomy were randomly divided into two equal groups: group A (lidocaine iontophoresis) and group B (lidocaine patch). The methods of assessment included visual analog scale (VAS) and pain DETECT questionnaire. Group A received lidocaine iontophoresis day after day for 4 weeks. Group B received lidocaine 5% patch (LIDODERM) onto the painful area for 12 h daily. Treatment program extended for 1 month, whereas evaluation was done before and after treatment. Results There was no significant difference between both groups in VAS (0.14) and pain DETECT questionnaire (0.32), before treatment. Comparison between groups after treatment revealed a significant reduction in VAS and pain DETECT questionnaire of group A compared with that of group B (P=0.0001). The percent of reduction in VAS of groups A and B was 86.47 and 61.11%, respectively, whereas the percent of reduction in pain DETECT questionnaire was 76 and 49.57%, respectively. Conclusion It was concluded that lidocaine iontophoresis was safe and effective method for intercostobrachial neuralgia management after mastectomy in expression of decreasing pain intensity and quality.


The effect of 12 weeks of resistive exercises versus aerobic exercises in overweight hypertensive postmenopausal women
Ghada E El-Refaye, Hanaa A Younis

Bulletin of Faculty of Physical Therapy 2019 24(1):40-48

Background Hypertension is the most important risk factor that affects women in the early years of postmenopausal period. Approximately 30–50% of the women develop hypertension before starting the age of 60 years, and beginning of hypertension can cause a variety of manifestations that are frequently associated with menopause. Objective The aim of this study was to determine and compare the effect of 12 weeks of resistive exercises versus aerobic exercises for the treatment of postmenopausal hypertension. Participants and methods A total of 60 postmenopausal women with hypertension were included. Their ages ranged from 50 to 60 years old; their BMI ranged from 30 to 34.9 kg/m2; and their blood pressure ranged between 140/90 and 170/105 mmHg. They were randomly assigned to group A, which received resistive exercises; group B, which received aerobic exercises; or group C (control group), which received antihypertensive medication (bisoprolol fumarate 5 mg). The three groups followed the treatment program for 12 weeks. Assessment of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) for all participants in the three groups (A, B, and C) was carried out before, after 6 weeks, and after the end of the treatment program through the use of mercury column sphygmomanometer. Results All groups (A, B, and C) recorded a significant decrease in both SBP and DBP values (P=0.001, 0.001, and 0.003, respectively, and P=0.001, 0.001, and 0.009, respectively) after the end of the 12 weeks of the treatment program when compared with their corresponding values measured before treatment. However, the participants in group A exhibited a greater reduction in DBP more than groups B and C. Conclusion These results suggest that the resistance exercises may be more effective than aerobic exercises in reducing SBP and DBP in postmenopausal women.


Alterations of static and dynamic balance in patients with lumbar radiculopathy
Mary K.N Takla

Bulletin of Faculty of Physical Therapy 2019 24(1):49-55

Background Lumbosacral radiculopathy (LR) is strongly associated with delayed recovery and persistent disability. Chronic LR may lead to somatosensory system impairment, resulting in decline of postural balance. Purpose The aim of the study was to investigate static and dynamic postural balance alterations in individuals with LR owing to lumbar disc herniation. Participants and methods In this case–control study design, 12 patients presenting with unilateral LR were included, whereas 12 normal individuals were randomly selected for control. Static balance was assessed functionally using Functional Reach Test. Dynamic balance was assessed via Biodex Balance System, where postural stability indices and the dynamic limits of stability were evaluated. Dynamic limits of stability parameters were expressed as direction control and time required to complete the test. Results There was significant reduction of mean values of Functional Reach Test in LR group (P<0.0001) when compared with the control. In addition, there was a significant increase of the mean values of overall stability index (P<0.0001) and postural stability indices (P<0.0002) and a significant decrease of the mean values of direction control (P<0.0001) in the LR group. Conclusion Patients with chronic LR have shown to have limited functional abilities and decreased postural balance both statically and dynamically when compared with normal individuals.


Transdermal lidocaine as treatment for chronic subjective tinnitus

: A pilot study

Publication date: Available online 18 March 2019

Source: American Journal of Otolaryngology

Author(s): Daniel C. O'Brien, Aaron D. Robinson, Nancy Wang, Rodney Diaz

Abstract
Objective

To assess the efficacy of transdermal lidocaine as a treatment for chronic subjective tinnitus as measured by the Tinnitus Functional Index (TFI).

Study design

Pilot, prospective efficacy trial.

Setting

Tertiary care hospital.

Patients

Men and women, over the age of 18 with chronic subjective tinnitus for >6 months.

Intervention

Daily application of commercially available transdermal lidocaine patch.

Outcome measure

Change in the TFI.

Results

The average pre-treatment TFI score was 56.2. After 1 month the average TFI decreased to 41 (p < 0.05). The scores dropped to 34 and 35 after 2 and 3 months of treatment respectively. Despite improvement in symptoms of tinnitus, most patients did not continue the study after the first month, dropping out due to the size, discomfort, and appearance of the lidocaine patch, failure to follow-up and lack of perceived benefit from treatment.

Conclusions

In this preliminary study, 5% transdermal lidocaine appears to be a potential treatment for chronic subjective tinnitus. The majority of subjects who completed 1 month of treatment had clinically significantly improved tinnitus. These findings are confounded however by the small sample size and significant drop out rate.

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