Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Postoperative recovery after mandibular third molar surgery. By Dr. Akhila Damodar { dr.akhila.n@gmail.com }
This study sought to evaluate postoperative recovery after mandibular third molar surgery, with and without the use of sutures.
Krishna BP, Reddy BP, Yashavanth Kumar DS, Ummar M, Shekhar V, Chandra Tiwari RV. Role of Serratiopeptidase and Dexamethasone in the Control of Postoperative Swelling. Ann Maxillofac Surg. 2020 Jan-Jun;10(1):108-113. doi: 10.4103/ams.ams_249_19. Epub 2020 Jun 8. PubMed PMID: 32855925; PubMed Central PMCID: PMC7433958.
44.Rohini Kanitkar Kamat et al. A Comparative Assessment of the Efficiency of ThreeDimensional plates over single Superior Border Plating in the management of Mandibular Angle Fractures. J Res Adv Dent 2020;10:3s:17-22.
42.Shilpa Sunil Khanna et al. Efficacy of Tranexamic Acid on Intraoperative Blood Loss in third molar Surgery: A Split Mouth Randomized Study. J Res Adv Dent 2020;10:3:192-196.
Effect of Surgery Difficulty According to Impaction Level on the Incidence of...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Mahendra Azad et al. GAINT ODONTOGENIC KERATOCYST OF MANDIBLE OPERATED UNDER LOCAL ANESTHESIA- A CASE REPORT. JOURNAL OF DENTAL HEALTH & RESEARCH (VOL. 1, ISSUE 2, JUL - DEC 2020): 24-2
Postoperative recovery after mandibular third molar surgery. By Dr. Akhila Damodar { dr.akhila.n@gmail.com }
This study sought to evaluate postoperative recovery after mandibular third molar surgery, with and without the use of sutures.
Krishna BP, Reddy BP, Yashavanth Kumar DS, Ummar M, Shekhar V, Chandra Tiwari RV. Role of Serratiopeptidase and Dexamethasone in the Control of Postoperative Swelling. Ann Maxillofac Surg. 2020 Jan-Jun;10(1):108-113. doi: 10.4103/ams.ams_249_19. Epub 2020 Jun 8. PubMed PMID: 32855925; PubMed Central PMCID: PMC7433958.
44.Rohini Kanitkar Kamat et al. A Comparative Assessment of the Efficiency of ThreeDimensional plates over single Superior Border Plating in the management of Mandibular Angle Fractures. J Res Adv Dent 2020;10:3s:17-22.
42.Shilpa Sunil Khanna et al. Efficacy of Tranexamic Acid on Intraoperative Blood Loss in third molar Surgery: A Split Mouth Randomized Study. J Res Adv Dent 2020;10:3:192-196.
Effect of Surgery Difficulty According to Impaction Level on the Incidence of...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Mahendra Azad et al. GAINT ODONTOGENIC KERATOCYST OF MANDIBLE OPERATED UNDER LOCAL ANESTHESIA- A CASE REPORT. JOURNAL OF DENTAL HEALTH & RESEARCH (VOL. 1, ISSUE 2, JUL - DEC 2020): 24-2
60.Srinivasan S, Velusamy G, Munshi MAI, Radhakrishnan K, Tiwari RVC. Comparative Study of Antifungal Efficacy of Various Endodontic Irrigants with and without Clotrimazole in Extracted Teeth Inoculated with Candida albicans. J Contemp Dent Pract. 2020 Dec 1;21(12):1325-1330. PubMed PMID: 33893253.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
65.Izna, Sasank Kuntamukkula VK, Khanna SS, Salokhe O, Chandra Tiwari RV, Tiwari H. Knowledge and Apprehension of Dental Health Professionals Pertaining to COVID in Southern India: A Questionnaire Study. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S448-S451. doi: 10.4103/jpbs.JPBS_551_20. Epub 2021 Jun 5. PubMed PMID: 34447131; PubMed Central PMCID: PMC8375944.
Vohra P, Belkhode V, Nimonkar S, Potdar S, Bhanot R, Izna, Tiwari RVC. Evaluation and diagnostic usefulness of saliva for detection of HIV antibodies: A cross-sectional study. J Family Med Prim Care. 2020 May;9(5):2437-2441. doi: 10.4103/jfmpc.jfmpc_138_20. eCollection 2020 May. PubMed PMID: 32754516; PubMed Central PMCID: PMC7380795
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. Sahu, et al.: Efficacy and latency of twin mix vs 2% lignocaine HCL in surgical removal of impacted M3
Journal of Family Medicine and Primary Care 905 Volume 9 : Issue 2 : February 2020
substances which act as mediators of the inflammatory response.
These symptoms are not observed immediately after surgery
but rather begin gradually, peaking 2 days after the procedure.
Apart from nonsteroidal antiinflammatory drugs, corticosteroids
have been widely used in a number of clinical trials as an aid to
improve the post‑surgical sequelae.[2]
Steroids prevent diapedesis,
the initial leakage of fluids from the capillaries, and stabilize the
membranes of the cellular lysosomes which hold large quantities
of hydrolytic enzymes. There is also a decrease in the formation
of bradykinin, a powerful vasodilating substance, thereby
reducing the postoperative swelling.[3]
However even with ample
clinical trials, clinicians remain uncertain about the preferred
route of administration of steroids.[4]
This study compares
the effectiveness of pterygomandibular nerve block using 2%
lignocaine HCL with 1:80,000 adrenaline to twin mix (4 mg of
dexamethasone mixed with 2% lignocaine Hcl with 1:80,000
adrenaline) on postoperative discomfort after mandibular third
molar surgery.
Materials and Methods
Patient selection and anesthesia
This study was conducted with kind approval from the
institutional ethical committee (20-12-2017) with proper
signed informed consent being taken from the patients before
the procedure.[5]
The study containing 40 subjects, referred
to the department of oral and maxillofacial surgery, were
divided into 20 subjects each in group A (control group) and
group B (twin‑mix group). Patients within the age range of
18–60 years planned for elective surgical removal of unilateral
impacted mandibular third molar and fulfilling the inclusion
criteria were selected for the study. All patients were of Indian
origin. The inclusion criterion was ASA Class I subjects
presenting with unilaterally impacted mandibular third molar
with similar difficulty indices. The exclusion criteria were
the presence of acute infection and/or swelling and pain at
the time of surgery, medically compromised patients, any
history of allergy to local anesthetic drugs, and refusal of
informed consent. Each patient was randomly selected to
receive anesthesia using 1.8 ml 2% lignocaine with 1:80,000
epinephrine in group A or 2.8 ml twin mix (1.8 ml 2% lignocaine
with 1:80,000 epinephrine + 1 ml 4 mg dexamethasone) in
group B. Preparation of twin mix was done by mixing 1.8 ml
of 2% lignocaine with 1:80,000 epinephrine with 1 ml of 4 mg
dexamethasone immediately before dispensing.[6]
The same
operator performed all inferior alveolar nerve block injections
in a standardized manner. Two plane aspiration was done and
the solution was deposited at the rate of 1 ml/min. After
injecting the anesthetic solution, the time to anesthetic effect
was recorded (defined as the time elapsed from full needle
withdrawal until the onset of subjective signs of anesthesia),
also the duration of anesthesia was recorded from initial patient
perception of the anesthetic effect to the time when the effect
subsides. The need to reanesthetize the surgical site was also
recorded. A 10‑point visual analog scale (VAS) was used to
subjectively assess the overall pain intensity while injecting the
study drug, during surgery, and in the postoperative period. All
the findings were carefully recorded and statistically analyzed.
Surgical procedure
All the patients received antibiotics (amoxicillin + clavulanic acid
625 mg) 1 h prior to surgery. Surgical access to the mandibular
third molars was achieved using wards or modified ward’s incision
depending upon the difficulty level of impaction, mucoperiosteal
flap was raised, and bone removal was done with a 702 surgical
carbide tapered fissure bur (SS White) using straight surgical
micro‑motor/hand piece under copious normal saline irrigation.
The impacted tooth was removed in toto or after odontectomy
as desired, based on the type of impaction and root pattern.
Surgical site was thoroughly irrigated and sutured with 3–0
silk sutures. The time required for each surgical procedure was
recorded from incision to the placement of the last suture.
Postoperative instructions were given to the patients. All the
patients were prescribed tablets amoxicillin + clavulanic acid
625 mg and diclofenac potassium 50 mg tablet twice for 5 days.
Each patient was evaluated for postoperative pain, facial swelling,
and maximal mouth opening on the first, third, and seventh
postoperative day. Pain was recorded using 10‑point VAS scale;
facial swelling using measurements between tragus to angle
of mouth, menton, and angle of mandible, and postoperative
maximal mouth opening interincisally using vernier caliper.[7]
Results
All the 20 nerve blocks in group B (twin‑mix group)
were successful, not requiring reanesthesia, whereas, in
group A (control group), 05 out of 20 subjects required
the need for reanesthesia. The mean time recorded for the
surgical procedure was 26.9 ± 4.12 min for study group A
and 29.8 ± 4.18 min for study group B, showing no statistical
difference (t = 0–2.206, P = 0–0.73). Mean VAS value for the
pain/sting on local anesthetic injection/block was 1.05 ± 0.68 for
study group B which was comparatively less than study group A,
i.e. 1.70 ± 1.08 [Table 1]. Time of onset of local anesthesia was
51.35 ± 7.15 s for study group B which was significantly less as
compared to 80.85 ± 10.00 s for study group A, showing the much
faster onset of anesthesia in case of twin‑mix group. The mean
duration of soft tissue anesthesia was clinically and statistically
much longer for study group B (250.85 ± 37.86 min) than study
group A (142.10 ± 36.84 min) Table 2. Intraoperative VAS
scores did not show any statistical difference between the study
group B (0.75 ± 0.85) and the control group A (1.75 ± 0.91).
Postoperative mean visual analog scale scores for group B were
Table 1: Mean VAS value for the pain/sting on local
anesthetic injection/block
Solution Mean (±SD) VAS value for the pain/
sting on local anesthetic injection/block
2% Lignocaine with
1:200,000 Epinephrine
1.7000±1.08
Twin mix 1.0500±0.68
[Downloaded free from http://www.jfmpc.com on Tuesday, March 3, 2020, IP: 183.83.106.191]
3. Sahu, et al.: Efficacy and latency of twin mix vs 2% lignocaine HCL in surgical removal of impacted M3
Journal of Family Medicine and Primary Care 906 Volume 9 : Issue 2 : February 2020
lower in the first, third, and seventh postoperative day [Table 3].
On the first postoperative day, in the control group A, there was
a gradual increase in the facial swelling from the first to third
postoperative day followed by the reduction in the swelling till
seventh postoperative day. In the study group B, facial swelling
was maximum on the first postoperative day followed by a
reduction in the swelling till seventh postoperative day. Mean
reduction in mouth opening in group B was significantly lower
on the first, third, and seventh postoperative day. On comparative
evaluation between study group A and study group B, patients
in the control group had more severe swelling and reduction in
mouth opening in the postoperative period. Recovery from the
local anesthetic was complete, without any residual deficit in all
the patients in both the study groups.
Discussion
Every oral surgeon encounters problems of pain, swelling,
and trismus associated with third molar surgery.[3]
Steroids
are added to local anesthetic agents in order to prolong the
duration of anesthesia and improve the quality of pain relief.
This combination provides both neuroaxial route and peripheral
nerve blocks.[8‑10]
Dexamethasone exerts potent antiinflammatory
action by inducing the synthesis of endogenous proteins, which
acts by blocking the enzymatic activation of phospholipase
A2.[11]
Dionne et al. stated that glucocorticoids act as potential
suppressor agents of multiple signaling pathways involved in the
inflammatory response causing decreased levels of inflammatory
mediators at the site of injury, and therefore, corticosteroids
are used as the drug of choice used after surgical procedures to
suppress acute inflammatory manifestations.[12]
Bhargava et al. in their prospective study used dexamethasone as
an intraspace injection in surgical removal of mandibular third
molars and found that addition of dexamethasone to lignocaine
and its administration as an intraspace injection significantly
shortens the latency and prolongs the duration of the soft
tissue anesthesia, thereby improving the quality of life in the
postoperative period.[11]
In our study, 1 ml (4 mg) dexamethasone with 2% lignocaine
is used as an intraspace injection prior to third molar surgery.
All the patients in group T showed a mean latency of
51.3500 ± 7.15 s and longer duration of soft tissue anesthesia
(mean 250.8500 ± 37.86 s).
Grossi et al.[13]
concluded that corticosteroids are primarily
used after surgical procedures for suppressing tissue mediators
of inflammation, thereby reducing transudation of fluids and
lessening edema. Although some reduction of postoperative pain
generally accompanies a reduction of edema, steroids alone do
not have a clinically significant analgesic effect.
In our study, patients in study group T showed a significant
reduction in VAS score on the first, third, and seventh
postoperative day.
In a well‑conducted trial with patients serving as their own
control, Graziani et al.[14]
investigated the effect of submucosal
injection of dexamethasone 4 mg in 43 subjects undergoing
bilateral surgical extraction of lower third molars. With regard to
the edema analysis, each treatment subgroup showed a reduced
postoperative degree of edema compared with the control
group, as highly significant on the second postoperative day as
after 1 week.
In agreement with Graziani et al.,[14]
our data shows that the
intraspace administration of dexamethasone 4 mg resulted in a
highly significant decrease in edema on the third postoperative
day.
Bhargava et al.[15]
in their study concluded that twin‑mix
administration did reduce the severity of trismus in the study
patients when seen in comparison to the control group. The
reduction of trismus may be attributed to the suppression of fluid
transudation and relatively lesser edema in the twin‑mix group.
In our study, patients in study group T showed a significant
reduction in postoperative trismus in the first, third, and seventh
day.
Berrada et al. reported in their study that alkalinization of local
anesthetic agents may shorten the onset time and lengthen the
duration of action and, hence, increases its clinical effectiveness,
and makes its injection more comfortable.[16]
Local anesthetics
exist in equilibrium between the basic uncharged (nonionized)
form, which is lipid‑soluble, and the charged (ionized) cationic
form, which is water‑soluble. Lipid soluble, nonionized form
of the local anesthetic penetrates the neural sheath and nerve
membrane. The ionized form of the local anesthetic binds with
the sodium channel and prevents the propagating of nerve
Table 2: Mean latency and duration of the soft tissue
anesthesia in the study groups
Study group Mean latency in sec (±SD) Mean duration in min (±SD)
Group C 80.8500±10.00 142.1000±36.84
Group T 51.3500±7.15 250.8500±37.86
‘t’ ‑10.728 9.206
Table 3: Mean operative and postoperative visual analog scale scores
Study
group
Mean visual analog scale scores (± SD)
Surgical Procedure First postoperative day Third postoperative day Seventh postoperative day
Group C 1.7500±0.91047 2.7500±1.16416 2.1000±1.02084 0.9000±0.91191
Group T 0.7500±0.85070 1.2000±0.76777 0.6000±0.68056 0.2000±0.41039
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4. Sahu, et al.: Efficacy and latency of twin mix vs 2% lignocaine HCL in surgical removal of impacted M3
Journal of Family Medicine and Primary Care 907 Volume 9 : Issue 2 : February 2020
impulses. Altering the pH to a more basic solution tends to
increase the amount of nonionized form compared to ionized
form which will speed the onset of action. Increasing the pH
of lidocaine decreases the pain associated with its infiltration.[17]
This study utilized 2.8 ml study solutions for pterygomandibular
nerve blocks to maintain volume parameter consistent in
twin‑mix groups, 1 ml more than the standard inferior alveolar
block. Steroid induces shorter onset and prolonged duration,
apart from change in pH, which may also be due to the property
of vasoconstriction of dexamethasone, or by an increase in the
activity of the inhibitory potassium channels on nociceptive
C‑fibers (via glucocorticoid receptors), thus decreasing their
activity.[18,19]
Addition of dexamethasone increases the pH,
thereby increases the amount of free base of the local anesthetic,
decreases the time required for onset of the anesthetic, decreases
pain during injection, and improves overall patients postoperative
comfort and quality of life as demonstrated by the postoperative
VAS scores and measurements for the facial swelling and
reduction in mouth opening.
In this study, patients in group T showed a significantly faster
onset of anesthesia (mean: 51.35 ± 7.15 s). Pain during injection
for both groups C and T does not show much statistical
difference, whereas VAS score for group T shows a significant
decrease in pain on postoperative first, third, and seventh day.
Facial swelling for patients of group T shows a significant
decrease in the postoperative first, third, and seventh day with
the peak level on the third postoperative day. Patients of group T
does not show much decrease in mouth opening as compared
to group C.
Conclusion
Clinical anesthetic efficacy of twin mix offers the advantage
of single prick co‑administration of dexamethasone with
local anesthetic, lesser sting of local anesthetic injection,
shorter aesthetic latency, and prolonged duration of the
soft tissue anesthesia and a decrease in postoperative
discomfort after the oral surgical procedure. A long‑term
stability study is mandated to assess the compatibility of
the mixture components for its production, storage, and
shelf‑life assessment.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient
consent forms. In the form, the patients have given their consent
for their images and other clinical information to be reported in
the journal. The patients understand that their names and initials
will not be published and due efforts will be made to conceal
their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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