Effect of bilateral infraorbital nerve block on intraoperative anesthetic requirements, hemodynamics, glycemic levels, and extubation in infants undergoing cheiloplasty under general anesthesia

Rajan, Sunil,Mathew, Jacob,Kumar, Lakshmi The Korean Dental Society of Anesthsiology 2021 Journal of Dental Anesthesia and Pain Medicine Vol.21 No.2

Background: Inappropriate use of intravenous and inhaled anesthetics may be dangerous in infants undergoing facial cleft surgeries. This study primarily aimed to compare the effect of infraorbital nerve block on sevoflurane requirement in infants undergoing cheiloplasty. Intraoperative opioid consumption, hemodynamics, blood glucose levels, extubation time, and delirium were also compared. Methods: This prospective, randomized, double-blinded study was conducted in 34 infants undergoing cheiloplasty under general anesthesia. After induction, group A received bilateral infraorbital nerve block with 0.5 mL of 0.5% bupivacaine and group B 0.5 mL saline. An increase in heart rate or blood pressure > 20% was managed by increasing sevoflurane by 2-2.5%, followed by fentanyl 0.5 ㎍/kg bolus. The chi-square test and independent-sample t-test were used where applicable. Results: Demographics, duration of surgery, and intravenous fluids used were comparable between the groups. Compared to group A, patients in group B had significantly higher consumption of fentanyl (14.2 ± 4.4 ㎍ vs. 22.1 ± 6.2 ㎍) and sevoflurane (14.2 ± 4.8 mL vs. 26.8 ± 15.6 mL). Intraoperative hemodynamic parameters were significantly lower in group A, the number of times increases in hemodynamic parameters occurred, and fentanyl supplemental bolus was required remained significantly lower in group A than in group B. Intraoperative glycemic levels remained higher in group B, and the extubation time was significantly shorter in group A than in group B (4.40 ± 1.60 min vs. 9.2 ± 2.18 min). Group A had a lesser occurrence of postoperative delirium. Conclusion: Supplemental infraorbital block in infants undergoing cheiloplasty under general anesthesia resulted in significantly decreased anesthetic requirements and optimal hemodynamic and glycemic levels with faster extubation and lesser delirium.

Assessment of Quality of Life and Functional Outcomes of Operated Cases of Hirschsprung Disease in a Developing Country

Loganathan, Arun Kumar,Mathew, Aleena Sara,Kurian, Jujju Jacob The Korean Society of Pediatric Gastroenterology 2021 Pediatric gastroenterology, hepatology & nutrition Vol.24 No.2

Purpose: Children treated for Hirschsprung disease (HD) are adversely affected by fecal incontinence and soiling. This can be detrimental to their physical, psychosocial quality of life (QoL) and impacts the normal functioning of their family. QoL studies in HD are predominantly from developed countries. We measured general quality of life, impact on family and functional bowel status using validated questionnaires in HD children in a developing country. Methods: Patients with HD, treated in a tertiary paediatric institution in India between 2010 and 2017, were identified. Patients and/or their proxy completed the Pediatric Quality of Life and Family Impact Module questionnaires. Functional outcomes were assessed using Rintala's score. Results: A 86 children and their parents participated in the study. Majority had rectosigmoid disease (67.4%) and underwent Soave's endoanal pull through (74.4%). A 21% of patients had low Rintala score indicating poor functional bowel outcomes. Only 11% of children had poor QoL scores. Family functioning outcomes were also severely affected in the same subgroup of patients. There was statistically significant correlation between Rintala score and QoL scores (p-value<0.001). Disease severity, type of surgery, and duration of follow-up did not have a statistically significant impact on the QoL. Conclusion: QoL in children with HD was comparable to the general population. Bowel dysfunction affects a notable number of children and was the most significant determinant of poor QoL.

Non Hepatic Surgery in Cirrhotic Patients: 10 Year Experience - Vision Beyond Nihilism

( Saurabh Galodha ),( Waliullah Siddiqui ),( Jacob Mathew ),( John Mathew ),( Manipadam ),( Abhishek Yadav ),( Mahesh S,H Ramesh ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Non hepatic surgery in cirrhotic patients has been viewed with a feeling of nihilism with reported in hospital mortality rates of 8-25%. In this study we look for risk factors associated with increased morbidity and mortality and present a positive perspective for these patients. Methods: A retrospective analysis of patients with cirrhosis undergoing nonhepatic surgery during the period from January 2007 to December 2016 was done. Child Turcot Pugh (CTP) and MELD scores, intraoperative parameters, perioperative morbidity (Clavien Dindo classification) and mortality and hospital stay was recorded. Results: 193 patients with cirrhosis underwent non-hepatic surgery. 88 patients (45%) had biliary pathology. Other groups were gastroduodenal (n=20,10%), pancreatic (n=13,6.7%), colorectal (n=15,7.5%) and hernia (n=13,6.7%). 38 patients (19.6%) underwent surgery for malignancy. Emergency surgery was done in 6 patients. 133 patients had CTP grade A while 49 patients grade B and 11 patients had grade C. Mean MELD score was 8.5 ± 5.2. Overall mean operating time was 3.1 ± 1.1 hours with mean blood loss of 105 ± 40 ml while in those undergoing major surgery (Frey’s procedure, pancreaticoduodenectomy, colorectal resections, gastrectomy) operating time was 4.5 ± 2.6 hours and blood loss was 335 ± 130 ml. Median blood transfusion requirement was 2 (1-5) PRBC in these patients. Major morbidity (Clavien Dindo > 3) was seen in 11 patients (5.6%) with majority having CTP grade C (n=6,55%). Perioperative mortality occurred in 2 patients (1%). Patients undergoing surgery in emergency had more morbidity (n=2,33%) and mortality (n=1,16%). Conclusions: In cirrhotic patients undergoing non-hepatic surgery factors associated with poor outcomes are emergency surgery, higher CTP grade and MELD score. We need to shun nihilistic attitude in these patients as better preoperative optimization and meticulous surgery lead to very good outcomes.

Integration of Chemical and Biofertilizers Improved the Availability of Nitrogen and Phosphorus in Soil but Did Not Influence the Growth of Young Natural Rubber Plants

Mercykutty Joseph,Kochuthresiamma Joseph,Jacob Mathew 한국토양비료학회 2014 한국토양비료학회 학술발표회 초록집 Vol.2014 No.6

Quantum Mechanical Simulation for the Analysis, Optimization and Accelerated Development of Precursors and Processes for Atomic Layer Deposition (ALD)

Mustard, Thomas Jeffrey Lomax,Kwak, Hyunwook Shaun,Goldberg, Alexander,Gavartin, Jacob,Morisato, Tsuguo,Yoshidome, Daisuke,Halls, Mathew David The Korean Ceramic Society 2016 한국세라믹학회지 Vol.53 No.3

Continued miniaturization and increasingly exact requirements for thin film deposition in the semiconductor industry is driving the search for new effective, efficient, selective precursors and processes. The requirements of defect-free, conformal films, and precise thickness control have focused attention on atomic layer deposition (ALD). ALD precursors so far have been developed through a trial-and-error experimental approach, leveraging the expertise and tribal knowledge of individual research groups. Precursors can show significant variation in performance, depending on specific choice of co-reactant, deposition stage, and processing conditions. The chemical design space for reactive thin film precursors is enormous and there is urgent need for the development of computational approaches to help identify new ligand-metal architectures and functional co-reactants that deliver the required surface activity for next-generation thin-film deposition processes. In this paper we discuss quantum mechanical simulation (e.g. density functional theory, DFT) applied to ALD precursor reactivity and state-of-the-art automated screening approaches to assist experimental efforts leading toward optimized precursors for next-generation ALD processes.

Salivary Her2/neu Levels in Differentiation of Oral Premalignant Disorders and Oral Squamous Cell Carcinomas

Varun, Chopra,Dineshkumar, Thayalan,Jayant, VS,Rameshkumar, Annasamy,Rajkumar, Krishnan,Rajashree, Padmanaban,Mathew, Jacob,Arunvignesh, Rajendran K Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.14

Background: Oral squamous cell carcinoma (OSCC) is thought to develop from precancerous dysplastic lesions through multistep processes of carcinogenesis involving activation of oncogenes and loss of tumor suppressor genes. The human epidermal growth factor receptor 2 (Her-2/neu [erbB-2]), a cell membrane glycoprotein, is a growth factor receptor that has receptor tyrosine kinase activity. Her2/neu activation plays a central role in cell proliferation and survival. It has been shown that overexpression of Her2/neu increases the rate of cell division and growth, leading to precancerous changes. The aim of the present study was to compare the serum and salivary Her2/neu levels between cases with premalignant and malignant oral lesions. Materials and Methods: Fasting blood samples and unstimulated saliva by passive drooling were collected from three groups of healthy control (n=20), premalignant disorder (PMD) (n=20) and OSCC (n=25) subjects. The HER2 extracellular domain (HER2 ECD) levels were measured using ELISA. Results: The levels of serum Her2/neu showed no significant differences between any of the groups but on the other hand salivary Her2/neu levels were found to be significantly (p<0.05) higher when compared between control (median 68.7 pg/ml, range: 21.5 - 75.8) and OSCC (median 145.6 pg/ml, range: 45.1-191.1). A similar trend was observed when comparing between PMD (median 43.3, range: 22.1 -94.7) and OSCC with a statistical significance of p<0.05. Conclusions: Our study provided evidence of increased salivary Her2/neu in OSCC when compared to PMD and control which was not the case for serum levels. This suggests that probably Her2/neu is not highly amplified as in breast cancer so as to be reflected in serum. Since saliva is in local vicinity of the OSCC, even a mild increase might be mirrored. On the whole, this study proposes Her2/neu as marker for distinguishing premalignant and malignant conditions.

Diaphragmatic herniation following donor hepatectomy for living donor liver transplantation

Rajiv Lochan,Rehan Saif,Naveen Ganjoo,Mallikarjun Sakpal,Charles Panackal,Kaiser Raja,Jayanth Reddy,Sonal Asthana,Mathew Jacob 한국간담췌외과학회 2017 Annals of hepato-biliary-pancreatic surgery Vol.21 No.4

A clear appreciation of benefits and risks associated with living donor hepatectomy is important to facilitate counselling for the donor, family, and recipient in preparation for living donor liver transplant (LDLT). We report a life-threatening complication occurring in one of our live liver donors at 12 weeks following hemi-liver donation. We experienced five donor complications among our first 50 LDLT: Clavien Grade 1, n=1; Clavien grade 2, n=3; and Clavien grade 3B, n=1. The one with Clavien grade 3B had a life-threatening diaphragmatic hernia occurring 12 weeks following hepatectomy. This was promptly recognized and emergency surgery was performed. The donor is well at 1-year follow-up. Here we provide a review of reported instances of diaphragmatic hernia following donor hepatectomy with an attempt to elucidate the pathophysiology behind such occurrence. Life-threatening donor risk needs to be balanced with recipient benefit and risk on a tripartite basis during the counselling process for LDLT. With increasing use of LDLT, we need to be aware of such life-threatening complication. Preventive measures in this regard and counselling for such complication should be incorporated into routine work-up for potential live liver donor.