Background and aim: Nebulized dexmedetomidine is a promising non-invasive technique of topical anesthesia as an adjunct to lignocaine for awake fiberoptic intubation (AFOI). The study aimed to compare two different doses of dexmedetomidine with lignocaine nebulization for AFOI in patients undergoing elective surgery.Material and methods: Ninety-six adult patients of either sex aged 18 to 50 years, belonging to the American Society of Anesthesiologists (ASA) Physical Status (PS) I or II, for AFOI, were enrolled and randomly allocated into three groups of 32 each. Patients received nebulization with either lignocaine alone (Group C) or lignocaine and dexmedetomidine (Groups D1 and D2) for 15 minutes. Cough severity was the primary outcome, while intubation comfort score, post-intubation behavior assessment, patient satisfaction score, Ramsay sedation scale (RSS) score, hemodynamics, and side effects were secondary outcomes.Results: The median cough scores were 2(1-2), 1(1-2) and 1(1-1); median intubation comfort scores were 1(1-2), 1(0-1) and 0(0-0); median post intubation behavior scores were 1(1-2), 1(0-1) and 0(0-0); median postoperative patient satisfaction scores were 2(1-2), 0(0-1) and 0(0-0); and median Ramsay sedation scores were 1(1-2), 2(2-3) and 3(2-3) in Group C, Group D1 and Group D2 respectively and the differences were statistically significant, (P<0.05). The difference in hemodynamic parameters was also statistically significant (P<0.05). Conclusions: Although both doses of nebulized dexmedetomidine (1 μg/kg and 2 μg/kg) are safe and effective for AFOI, the nebulized dexmedetomidine (2 μg/kg) appears to be more effective for AFOI.
Background and aim: Incisional hernia is a known complication following abdominal surgery, particularly following obstetric and open gynecological procedures. In settings where these procedures are prevalent, understanding risk factors and effective management strategies is crucial for improved patient care. This study aimed to provide a more precise characterization of risk factors and surgical outcomes in this population through a streamlined prospective analysis. Material and methods: This prospective observational study was conducted at a tertiary teaching hospital between January 2022 and December 2024, enrolling 61 consecutive patients presenting with incisional hernia resulting from obstetric or gynaecologic surgery. Data on demographics, index operation, hernia characteristics, operative details, and postoperative complications were collected and analyzed descriptively. Results: The most common index procedures were emergency procedures, with cesarean section accounting for 62% and abdominal hysterectomy accounting for 19.6%. The most common risk factor was wound infection, observed in 30 patients. Hernia defects ranged from 2 cm to >4 cm, with most measuring 3–4 cm. Sublay mesh repair was the most common surgical repair, performed in 36 patients. Postoperative complications included seroma in 24 patients, wound infection in 17 patients, and chronic Pain in 12 patients. No recurrence was observed during follow-up; however, interpretation is limited by the sample size and the duration of follow-up. Conclusions: Incisional hernia after obstetric and gynecologic procedures remains a clinical challenge. Sublay mesh repair demonstrated favorable, durable outcomes with no recurrence in this series. Preventive strategies focusing on infection control are critical for reducing the burden of this condition locally.
Background and aim: Breast carcinoma is a biologically heterogeneous malignancy with distinct molecular subtypes that differ in prognosis and therapeutic response. Immunohistochemistry (IHC)-based surrogate molecular classification using estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67 provides a practical alternative to gene expression profiling. This study evaluated the distribution of molecular subtypes and their association with clinicopathological parameters. Material and methods: A retrospective hospital-based cross-sectional study was conducted on 108 histopathologically confirmed cases of primary breast carcinoma diagnosed between August 2022 and July 2024 at a tertiary care center in Vadodara, Gujarat. Tumors were graded using the modified Scarff-Bloom-Richardson (Nottingham) grading system. Immunohistochemistry for ER, PR, HER2, Ki-67, and CK5/6 was performed according to established guidelines. Molecular subtype analysis was performed in 97 cases after excluding 11 HER2-equivocal cases without confirmatory fluorescence in situ hybridization. Results: Invasive carcinoma of no special type was the predominant histological subtype, and Grade II tumors were the most common. Luminal B was the predominant molecular subtype, followed by triple-negative breast cancer, Luminal A, and HER2-enriched tumors. Molecular subtype showed significant associations with histological subtype, ER, PR, HER2, and Ki-67 expression, but not with age, tumor size, histological grade, lymphovascular invasion, perineural invasion, or lymph node status. Conclusions: Luminal B was the predominant molecular subtype in this cohort. IHC-based surrogate molecular classification is a practical approach for routine breast cancer subtyping and provides clinically relevant prognostic stratification in resource-limited settings. Larger multicenter studies with long-term follow-up are needed to validate these findings.
Kidney transplantation remains the treatment of choice for patients with end-stage kidney disease (ESKD); however, grafts with multiple renal arteries (MRA) continue to pose technical challenges because of their complex vascular anatomy. This study aimed to describe our institutional experience with individualized vascular reconstruction strategies for living-donor kidneys with complex arterial anatomy and to evaluate their early clinical outcomes. We retrospectively reviewed six consecutive living-donor kidney transplantations performed between October 2021 and February 2023 involving grafts with dual, triple, or early arterial branching. The vascular reconstruction technique was selected based on the anatomical configuration. It included pantaloon reconstruction for closely spaced arteries, separate end-to-side anastomoses for widely spaced vessels, and an inferior epigastric artery anastomosis for distant polar arteries before implantation into the external iliac vessels. All six recipients (five males and one female; mean age, 35.5 years) demonstrated immediate graft perfusion and prompt urine output following transplantation, with progressive improvement in renal function and a mean discharge serum creatinine of 1.16 mg/dL (range, 0.72–1.60 mg/dL). No major postoperative complications, including vascular thrombosis, urinary leakage, delayed graft function, or acute rejection, were observed, and all patients were discharged between postoperative days 5 and 8 with stable graft function. These findings demonstrate that meticulous preoperative planning and individualized vascular reconstruction based on arterial anatomy enable the safe transplantation of kidneys with multiple renal arteries and provide excellent short-term outcomes, supporting the broader utilization of these anatomically complex grafts to expand the living-donor pool.
Background and aim: Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder associated with substantial cardiovascular, metabolic, and neurocognitive complications. Although Continuous Positive Airway Pressure (CPAP) is considered the gold standard treatment, limited patient adherence has increased interest in Oral Appliance Therapy (OAT) as a more acceptable alternative. This study evaluated treatment outcomes and adherence to OAT and explored factors influencing therapeutic success. Material and methods: A cross-sectional quantitative study was conducted among adult OSA patients treated with adjustable mandibular advancement devices. Data were collected using structured questionnaires and clinical records, including demographic characteristics, diagnostic methods, appliance type, titration procedures, follow-up frequency, side effects, adherence patterns, and interdisciplinary collaboration between dentists and sleep physicians. Descriptive statistics were used to summarize the findings. Results: Most participants were middle-aged men diagnosed using polysomnography or home sleep apnea testing. Higher adherence rates (6–7 nights per week) and better clinical outcomes were associated with regular clinician-guided titration, frequent follow-up visits, and effective collaboration between dentists and sleep physicians. These outcomes included reductions in daytime sleepiness, snoring, and the Apnea–Hypopnea Index (AHI). In contrast, unmanaged side effects and irregular follow-up were linked to lower adherence and reduced treatment effectiveness. In addition, administrative and insurance support facilitated timely initiation of therapy and improved long-term use. Conclusions: OAT is an effective and well-tolerated treatment for patients with mild to moderate OSA. Standardized titration, objective adherence monitoring, regular follow-up, and multidisciplinary care are essential for optimizing treatment outcomes and sustaining long-term adherence.
