Clonidine does not improve quality of ropivacaine axillary brachial plexus block in children

Background: The addition of clonidine to peripheral nerve blocks is controversial in children. Objective: The aim of our study was to evaluate the effect of clonidine added to ropivacaine in pediatric axillary brachial plexus block (ABPB). Methods: Children aged 1–6 years, scheduled to undergo forearm or hand surgery, were recruited into this prospective, double‐blind controlled trial. Patients were randomly allocated to receive an ABPB either with ropivacaine 0.2% 0.4 ml·kg^?1 plus saline in 1 ml (RS) or ropivacaine 0.2% 0.4 ml·kg^?1 plus clonidine 1 μg·kg^?1 in 1 ml (RC). Primary endpoints were quality of postoperative analgesia as assessed by pain scores and total 24‐h postoperative analgesia requirements. Secondary outcomes were time to first analgesia request and duration of motor blockade. Results: Sixty patients were recruited (n = 30 per group) into the study. Pain scores were comparable throughout the first 24 h between the two groups. Ten children in the (RS) and six in (RC) groups required supplementary analgesia during the first 24 h (P = 0.24). Children who required further analgesia did so after 288 ± 94 min in the (RS) and 437 ± 204 min in the (RC) group (P = 0.06). There was no difference in the duration of motor block [186 ± 71 and 154 ± 56 min, P = 0.12 for (RS) and (RC), respectively]. Conclusion: Ropivacaine (0.2% 0.4 ml·kg^?1) for ABPB provides sufficient postoperative analgesia in children scheduled for forearm or hand surgery. The addition of clonidine to ABPB does not improve overall postoperative analgesia but may increase the time to first analgesia request.     

A Challenge in Diagnosis and Management: Uterine Torsion in Childhood

BackgroundUterine torsion is a rare event, which mostly reported in females with a gravid uterus and is exceptionally rare in children.CaseA 9-year-old girl presented with 3 days of intermittent lower abdominal pain. Ultrasound revealed an ovarian mass, but laparotomy revealed an ischemic enlarged ovary and uterus rotated 180°. No reperfusion occurred after 60 minutes. A subtotal hysterectomy and right salpingoophorectomy were thus performed.ConclusionUterine and adnexal torsion presents with symptoms similar to those of adnexal torsion. Delays in diagnosis and referral continue to be an issue, resulting in suboptimal outcomes. Uterine torsion, although exceedingly rare in childhood, appears to occur only in the setting of ovarian masses, which provide the impetus for the rotational force to the elongated cervix of the prepubertal uterus.     

Tuberculous mastitis–A great mimicker

ObjectiveTo focus on the increasing incidence of breast tuberculosis, its mistaken identity with carcinoma or pyogenic abscess and its effective diagnosis on cytology.MethodsThis retrospective study was carried over short period of two months. Six patients were included. air dried and wet fixed smears prepared and stained with May-Grunwwald-Giemsa and Papanicolaou respectively. Zeihl Neelson staining was also applied.ResultsAge groups varied from 16 to 70 years. Six cases presented within 2 months. Most common presentation was painless lump breast. One patient presented with discharging sinus. Lumps mostly favored right breast with predominance of upper outer quadrant. All except one were found to be positive for AFB.ConclusionsIncidences of tuberculous mastitis are increasing, can mimic carcinoma or abscess and should always be kept in differential diagnosis of lump breast. FNAC is helpful and ZN staining is gold standard in diagnosing acid fast bacilli.     

Novel approaches for reducing free light chains in patients with myeloma kidney

Myeloma kidney is a tubulointerstitial pathology that accounts for approximately 80-90% of severe acute kidney injury in patients with multiple myeloma. Unless there is rapid intervention, progressive irreversible damage from interstitial fibrosis and tubular atrophy occurs. Work over the past decade has demonstrated that an early sustained reduction in serum concentrations of pathogenic monoclonal free light chains (FLCs) leads to improved renal recovery rates. In turn, an early improvement in renal function is associated with improved patient survival. An early reduction in FLC levels should therefore become standard of care, although the optimum mechanisms to achieve this depletion of FLCs remain to be determined. To provide a coordinated, cross-disciplinary approach to research in this disease, the International Kidney and Monoclonal Gammopathy Research Group was formed. In this Review, we address the current state of knowledge in the management of myeloma kidney.     

Suicide in the elderly from a gender perspective

This study examines the relationship between suicide and aging from a gender perspective, examining the socially imposed boundaries of masculinity and femininity in the lives of elderly people who committed suicide. It is a qualitative study in which 50 psychosocial autopsies conducted with elderly relatives were selected from 10 cities in the North, South, Northeast and Midwest of Brazil. In this article we have identified situations of gender vulnerabilities in the lives of 13 people who committed suicide: 10 men and 3 women selected for their exemplary character. Two main categories were listed: the first refers to femininity including the "gender destiny" experienced by elderly women who commit suicide when they can no longer care for themselves or work. The second concerns the hegemonic masculinity in crisis, in which old men die after changing from the role of providers due to retirement or illness. It should be stressed that gender norms, codes of honor, power inequalities and stereotypes affect both women and men in terms of susceptibility to suicidal behavior.     

Applying multilevel model to the relationship of dietary patterns and colorectal cancer: an ongoing case–control study in Córdoba, Argentina

Purposes

Scientific literature has consistently shown the effects of certain diets on health but regional variations of dietary habits, and their relationship colorectal cancer (CRC) has been poorly studied in Argentina. Our aims were to identify dietary patterns and estimate their effect on CRC occurrence and to quantify the association between family history of CRC and CRC occurrence by applying multilevel models to estimate and interpret measures of variation.

Methods

Principal components factor analysis was performed to identify dietary patterns that were then used in a multilevel logistic regression applied to an ongoing case–control data about dietary exposure and CRC occurrence taking into account familiar clustering.

Results

Three dietary patterns were identified: “Southern Cone pattern” (red meat, wine, and starchy vegetables), “High-sugar drinks pattern”, and “Prudent pattern”. The study considered 41 cases and 95 controls. There was a significant promoting effects on CRC of “Southern Cone” (OR 1.5, 95%CI 1.0–2.2) and “High-sugar drinks” (OR 3.8, 95%CI 2.0–7.1) patterns, whereas “Prudent pattern” (OR 0.3, 95%CI 0.2–0.4) showed a significant protective effect at third tertile level. BMI, use of NSAIDs, and to have medical insurance showed significant effects. Variance of the random effect of family history of CRC was highly significant.

Conclusions

This novel approach for Argentina showed that Southern Cone and High-sugar drinks patterns were associated with a higher risk of CRC, whereas the Prudent pattern showed a protective effect. There was a significant clustering effect of family history of CRC.