Introduction Cervical myelopathy (CM) is caused by degenerative or congenital changes in the discs and soft tissues of the cervical spine, leading to chronic compression of the spinal cord. The current treatment for moderate-tosevere CM is surgical decompression, which is effective in most cases; however, it can cause inflammation of the nervous system and spinal cord reperfusion injury, resulting in perioperative neurological complications and suboptimal neurological recovery. The aim of this study was to investigate the therapeutic effects of the combination of erythropoietin and methylprednisolone in the treatment of ischemia-reperfusion injury to the spinal cord and to analyze its effects on the levels of interleukin-1 beta (IL-1β), interleukin-1 receptor antagonist (IL-1RA), and interleukin-8 (IL-8). Materials and methods This study included 110 patients admitted to the hospital due to cervical spondylotic myelopathy. They were randomized into two groups of 55 patients each: a control and an observation group. In both groups of patients, fusion internal fixation and anterior cervical discectomy were performed. The difference, however, was that the control group received a rapid intravenous injection of 30 mg/kg methylprednisolone 30 minutes prior to spinal cord decompression, while the observation group received an intravenous injection of 30 mg/kg methylprednisolone and 3,000 U/kg erythropoietin 30 minutes before spinal cord decompression. The study was approved by the Hospital Ethical Committee of the Dow University of Health Sciences, Karachi. The neurological function of both groups of patients was assessed before the procedure and three months after the treatment using the Japanese Orthopedic Association (JOA) method of assessing spinal cord function (40-point rating method). Enzyme-linked immunosorbent assay (ELISA) was performed to measure the levels of neuron-specific enolase (NSE), S-100β, IL-1RA, IL-1β, and IL-8 in both groups. The quality of life of patients in both groups was assessed three months after the treatment with the World Health Organization Quality of Life assessment instrument (WHOQOL-100). Results Before the treatment, there was no significant variance between the two groups in the JOA score and the 40point rating method. Similarly, there was no significant difference in the levels of IL-1β, IL-1RA, and IL-8 between the two groups (p-value = 0.262, 0.387, and 0.154 respectively) prior to the treatment. Three months after the treatment, the levels of IL-1β and IL-8 in the observation group were 21.83 ±3.65 ng/l and 357.07 ±32.36 ng/l respectively, both lower than the control group value (p-value = 0.026, 0.028 respectively). The level of IL-1RA in follow-up was 21.59 ±1.15 ng/l, which was higher than that in the control group. Three months after the treatment, all the WHOQOL-100 parameters of the observation group for psychology, physiology, social relations, independence, spirituality, environment, and general quality of life were higher than those of the control group; the variance ...
Out of 210 patients, 146 were found to have degenerative scoliosis at the level of the lumbar and thoracolumbar spine. Fifty-two patients had a right convex curve, and 94 had a left convex curve. Sixty-nine patients had GERD. According to the analysis of the multivariate logistic regression, the Cobb angle was highly related to GERD (p-value <0.05 and odds ratio of 1.031). The participants were grouped according to the Cobb angle of curve at the lumbar spine (less than 30 degrees with a large right-sided convex curve, 30 and more with a small curve, and more than 30+ degrees with a large left-sided convex curve). The study revealed that a large left-sided convex curve was highly related to GERD, with a p-value <0.05 and odds ratio of 10.935. ConclusionsThe left-sided large convex curve at the thoracolumbar or lumbar spine, especially when the Cobb angle was more than 30 degrees, was highly associated with GERD. Therefore, the symptoms of GERD should be monitored in the elderly population with degenerative scoliosis.
IntroductionThis brief study shows the consumption of two medications that are related to those patients who have gone through the complicated procedure of craniotomy. The basic aim of these drugs is to subside the aftereffects of the procedure like postoperative nausea and vomiting in patients. Hereby, the study outlines the functional efficiency of dexamethasone along with the metoclopramide and dexamethasone alone. Materials and methodsRandomly two groups were listed of 120 patients that have undergone elective craniotomy with ASA I-II. These groups were called out as group A and group B. Group A was under the medication of combination of dexamethasone and metoclopramide 8 mg and 10 mg, respectively, induced separately while group B was induced with 8 mg of dexamethasone along with 2 ml of normal saline. These drugs were induced right before anesthesia. The procedure from here on gets the same for both groups. After the surgical approach, a verbal evaluation was taken from the members of each group to collect specific data accordingly within the first 24 hours. As the method is double-blinded thus the patients were unaware of the ongoing research study. In any case of a mishap, rescue antiemetic drugs were also considered for the patients who would have experienced uncontrolled nausea and vomiting in the timeframe. ResultsThe results show that only 16.7% of the patients from group A showed signs of nausea and only 5% showed vomiting while 31.7% of the patients from group B showed signs of nausea and 11.7% showed vomiting. It clearly showed that the patients tend to have either no sign of nausea and vomiting or showed little controllable nausea and vomiting when induced with dexamethasone and metoclopramide compared to those who were induced with the dexamethasone alone. ConclusionsPostoperative nausea and vomiting are studied in terms of those who had undergone craniotomy. This study shows the prophylaxis of adverse effects of postoperative nausea and vomiting between the two groups under the influence of altered drugs. Thus, the results were noticeably in the favor of the combination treatment of dexamethasone and metoclopramide.
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