PURPOSE: Simultaneous bilateral total knee arthroplasty (TKA) is associated with excessive blood loss and morbidity arising from postoperative reduction in hemoglobin (Hb). The purpose of this prospective randomized study was to determine if drains have any effect on blood loss, postoperative reduction in Hb levels and transfusion rates compared to no drainage in simultaneous bilateral TKAs. MATERIALS AND METHODS: Two hundred and thirty patients who underwent simultaneous bilateral TKA by a single surgeon were randomly allotted to drain or no-drain group (n=115 in each group). Postoperative Hb level, blood loss volume and transfusion rate were compared between the two groups. RESULTS: The mean postoperative Hb level (p=0.38), blood loss volume (p=0.33) and transfusion rate (p=0.52) in the drain group were not significantly different compared to the no-drain group. No statistical difference was found in terms of complications, readmissions and mortality rates between the two groups. CONCLUSIONS: No significant difference was observed in the two groups with respect to blood loss and blood transfusion. Non-drainage does not offer an advantage over drainage with respect to conserving blood in simultaneous bilateral TKA.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Blood Transfusion ; Drainage ; Humans ; Knee ; Mortality ; Postoperative Hemorrhage ; Prospective Studies ; Suction

PURPOSE: Restoring the native patellar thickness after patellar resurfacing provides optimal function of the knee after arthroplasty and minimises complications related to the patellofemoral articulation. The aim of this study was to assess the usefulness of a thin patellar button (6.2 mm) in patients with a patella thickness of less than 20 mm during total knee arthroplasty. MATERIALS AND METHODS: This is a retrospective case control study. A total of 54 female patients with an intraoperative patellar thickness of < 20 mm, resurfaced with a patellar button of 6.2 mm in thickness were identified (group 1). They were matched with 54 patients with a patellar thickness of 20–23 mm, resurfaced with a patellar button of 8 mm (group 2), based on age, sex, body mass index, and deformity. A clinical and radiological evaluation was done at a minimum 2-year follow-up. RESULTS: The preoperative mean patellar thickness was 18.94±1.07 mm and was restored to 19.06±0.79 mm in group 1, as compared to 21.63±0.99 mm and 21.72±0.99 mm in group 2. The mean postoperative range of motion was 122.22°±9.25° in group 1 and 123.52°±8.72° in group 2 (p=0.13). No patellar bone or button related complications were observed in any patient in either group. CONCLUSIONS: The 6.2 mm thin patella is useful to restore the native thickness in patients with a patellar thickness of less than 20 mm without risk of button fracture, loosening or overstuffing.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Body Mass Index ; Case-Control Studies ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Knee ; Matched-Pair Analysis ; Patella ; Patellofemoral Joint ; Range of Motion, Articular ; Retrospective Studies

The use of aromatherapy for the reduction of anxiety levels during dental treatment procedures has been well established in the literature; however, there is limited evidence regarding its efficacy. The present meta-analysis is an attempt to assess the association between the use of aromatherapy and anxiety levels among dental patients.A comprehensive search was conducted across Medline, Scopus, Web of Science, EBSCO host, Cochrane databases, and Google Scholar for studies evaluating aromatherapy and anxiety level among dental patients. PRISMA guidelines were followed for the meta-analysis. Randomized and cluster-randomized trials comparing aromatherapy with controls were included. The random-effects model was used to assess the mean differences in anxiety levels of patients visiting dental OPD. The significance value was set at P < 0.05. Six studies were identified that met the requirements for inclusion. Aromatherapy was significantly associated with reduction in patient anxiety levels during dental treatment (pooled mean difference: -3.36 [95% CI, -3.77 – -2.95, P = 0.00001). Low heterogeneity was noted between studies (I2 = 1%, P = 0.41) analyzed in the meta-analysis. High certainty of the evidence was obtained from the association between the use of aromatherapy and dental anxiety. This meta-analysis suggests that aromatherapy is effective in reducing dental anxiety. When used judiciously, the results of this work should encourage the use of aromatherapy to reduce patient anxiety levels during dental procedures

Methods: The study included 60 patients graded American Society of Anesthesiologists I and II and scheduled for thoracolumbar spine surgery involving >3 vertebral levels. The patients were divided into two groups: group KD (ketodex) and group F (fentanyl). The primary objective was to compare the postoperative analgesic requirements among the groups. The secondary objectives included a comparison of the intraoperative anesthetic requirements, postoperative pain scores, hemodynamic parameters, side effects of the study drugs, and the duration of post-anesthesia care unit stay of both the groups. Results: Ketodex use prolonged the mean time to first rescue analgesia (22.00±2.30 hours vs. 11.69±3.02 hours, p <0.001) and reduced the requirement of rescue analgesics in the first 24 hours postoperatively compared to fentanyl use (70.00±8.16 μg vs. 113.31±36.65 μg, p =0.03). The intraoperative requirement of desflurane was comparable between the groups (p >0.05). The postoperative pain scores were significantly lower in the group KD than in group F at most timepoints (p <0.05). Patients in group KD had a shorter post-anesthesia care unit stay than group F did (p <0.001). Conclusions Low-dose ketodex could be a safe substitute for fentanyl infusion when employed as an anesthetic adjuvant for patients undergoing thoracolumbar spine surgeries involving >3 vertebral levels to achieve prolonged analgesia without any opioidrelated side effects.

The use of aromatherapy for the reduction of anxiety levels during dental treatment procedures has been well established in the literature; however, there is limited evidence regarding its efficacy. The present meta-analysis is an attempt to assess the association between the use of aromatherapy and anxiety levels among dental patients.A comprehensive search was conducted across Medline, Scopus, Web of Science, EBSCO host, Cochrane databases, and Google Scholar for studies evaluating aromatherapy and anxiety level among dental patients. PRISMA guidelines were followed for the meta-analysis. Randomized and cluster-randomized trials comparing aromatherapy with controls were included. The random-effects model was used to assess the mean differences in anxiety levels of patients visiting dental OPD. The significance value was set at P < 0.05. Six studies were identified that met the requirements for inclusion. Aromatherapy was significantly associated with reduction in patient anxiety levels during dental treatment (pooled mean difference: -3.36 [95% CI, -3.77 – -2.95, P = 0.00001). Low heterogeneity was noted between studies (I2 = 1%, P = 0.41) analyzed in the meta-analysis. High certainty of the evidence was obtained from the association between the use of aromatherapy and dental anxiety. This meta-analysis suggests that aromatherapy is effective in reducing dental anxiety. When used judiciously, the results of this work should encourage the use of aromatherapy to reduce patient anxiety levels during dental procedures

A 5-month-old male child was admitted with cough and fever, during which excessive bleeding occurred from a venipuncture site. Born from a third-degree consanguineous marriage, the child was developmentally normal. Routine blood tests showed a slightly elevated white blood cell count due to infection, while coagulation studies revealed prolonged PT and APTT. A mixing study indicated no inhibitors.Advanced testing showed normal levels of fibrinogen and factor VIII, but a significantly low factor V level (2.2%), indicating moderate factor V deficiency. The child received fresh frozen plasma (FFP) transfusions as needed and has been thriving with regular follow-ups. Genetic counseling was provided to the parents, who also had abnormal coagulation profiles but no bleeding tendencies. Genetic testing was offered but not pursued due to financial constraints. This case highlights the importance of awareness of inherited bleeding disorders in consanguineous families and the need for supportive management and counseling.

A 5-month-old male child was admitted with cough and fever, during which excessive bleeding occurred from a venipuncture site. Born from a third-degree consanguineous marriage, the child was developmentally normal. Routine blood tests showed a slightly elevated white blood cell count due to infection, while coagulation studies revealed prolonged PT and APTT. A mixing study indicated no inhibitors.Advanced testing showed normal levels of fibrinogen and factor VIII, but a significantly low factor V level (2.2%), indicating moderate factor V deficiency. The child received fresh frozen plasma (FFP) transfusions as needed and has been thriving with regular follow-ups. Genetic counseling was provided to the parents, who also had abnormal coagulation profiles but no bleeding tendencies. Genetic testing was offered but not pursued due to financial constraints. This case highlights the importance of awareness of inherited bleeding disorders in consanguineous families and the need for supportive management and counseling.

A 5-month-old male child was admitted with cough and fever, during which excessive bleeding occurred from a venipuncture site. Born from a third-degree consanguineous marriage, the child was developmentally normal. Routine blood tests showed a slightly elevated white blood cell count due to infection, while coagulation studies revealed prolonged PT and APTT. A mixing study indicated no inhibitors.Advanced testing showed normal levels of fibrinogen and factor VIII, but a significantly low factor V level (2.2%), indicating moderate factor V deficiency. The child received fresh frozen plasma (FFP) transfusions as needed and has been thriving with regular follow-ups. Genetic counseling was provided to the parents, who also had abnormal coagulation profiles but no bleeding tendencies. Genetic testing was offered but not pursued due to financial constraints. This case highlights the importance of awareness of inherited bleeding disorders in consanguineous families and the need for supportive management and counseling.

A 5-month-old male child was admitted with cough and fever, during which excessive bleeding occurred from a venipuncture site. Born from a third-degree consanguineous marriage, the child was developmentally normal. Routine blood tests showed a slightly elevated white blood cell count due to infection, while coagulation studies revealed prolonged PT and APTT. A mixing study indicated no inhibitors.Advanced testing showed normal levels of fibrinogen and factor VIII, but a significantly low factor V level (2.2%), indicating moderate factor V deficiency. The child received fresh frozen plasma (FFP) transfusions as needed and has been thriving with regular follow-ups. Genetic counseling was provided to the parents, who also had abnormal coagulation profiles but no bleeding tendencies. Genetic testing was offered but not pursued due to financial constraints. This case highlights the importance of awareness of inherited bleeding disorders in consanguineous families and the need for supportive management and counseling.