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The use of intrathecal (IT) dexamethasone during subarachnoid block (SAB) has not been evaluated. There are no pooled data available to decide on the optimal regimen of IT dexamethasone during SAB, irrespective of the type of surgery. There is uncertainty about its dosage, effectiveness, and safety, and a need to establish clear guidelines on its use. Our objective was to evaluate the effectiveness and safety of use of IT dexamethasone during SAB. We performed a meta-analysis (PROSPERO, CRD42022304944) of trials that included patients who underwent a variety of surgical procedures under SAB. Patients received concomitant IT dexamethasone as an adjuvant to spinal local anesthetics. The analyzed outcomes included sensory and motor effects as well as adverse and/or beneficial side effects. Subgroup analysis was planned based on different doses used. Trial sequential analysis (TSA) was used to estimate the required sample size information (RIS) for each outcome. Eighteen studies (2531 participants) were included in this analysis. Addition of IT dexamethasone (4-8 mg) to heavy bupivacaine effectively prolonged the duration of sensory blockade (mean difference, MD = 63.8 minutes; [95% confidence interval, CI, 33.1-94.5], P < 0.0001), two-segment regression time (MD = 20.1[95% CI, 0.96-39.2], P = 0.04) and first rescue analgesic time (MD = 143.3 [95% CI, 90.3-196.0], P = 0.001). Subgroup analyses revealed superior effects of 8 mg dose over 4 mg for sensory and analgesic effects. The effect of dexamethasone on duration of motor blockade was inconclusive. Additionally, lower risk ratios (RRs) were recorded for spinal anesthesia-related hypotension (RR = 0.74 [95% CI, 0.6-0.9], P = 0.0003) and nausea/vomiting (RR = 0.62 [95% CI, 0.41-0.93], P = 0.02) in the dexamethasone group. For outcomes such as sensory blockade, analgesia, and hypotension, the required information size was reached during TSA. In conclusion, IT dexamethasone, used as an adjuvant to spinal local anesthetic, especially at the dose of 8 mg, increases sensory blockade duration and the time for request of the first rescue analgesic. SAB-induced side effects such as hypotension, nausea, and vomiting are lesser with the use of IT dexamethasone. However, further studies are necessary to draw meaningful conclusions on its safety profile.

Automatic identification of salient features in large medical datasets, particularly in chest x-ray (CXR) images, is a crucial research area. Accurately detecting critical findings such as emphysema, pneumothorax, and chronic bronchitis can aid radiologists in prioritizing time-sensitive cases and screening for abnormalities. However, traditional deep neural network approaches often require bounding box annotations, which can be time-consuming and challenging to obtain. This study proposes an explainable ensemble learning approach, CX-Net, for lung segmentation and diagnosing lung disorders using CXR images. We compare four state-of-the-art convolutional neural network models, including feature pyramid network, U-Net, LinkNet, and a customized U-Net model with ImageNet feature extraction, data augmentation, and dropout regularizations. All models are trained on the Montgomery and VinDR-CXR datasets with and without segmented ground-truth masks. To achieve model explainability, we integrate SHapley Additive exPlanations (SHAP) and gradient-weighted class activation mapping (Grad-CAM) techniques, which enable a better understanding of the decision-making process and provide visual explanations of critical regions within the CXR images. By employing ensembling, our outlier-resistant CX-Net achieves superior performance in lung segmentation, with Jaccard overlap similarity of 0.992, Dice coefficients of 0.994, precision of 0.993, recall of 0.980, and accuracy of 0.976. The proposed approach demonstrates strong generalization capabilities on the VinDr-CXR dataset and is the first study to use these datasets for semantic lung segmentation with semi-supervised localization. In conclusion, this paper presents an explainable ensemble learning approach for lung segmentation and diagnosing lung disorders using CXR images. Extensive experimental results show that our method efficiently and accurately extracts regions of interest in CXR images from publicly available datasets, indicating its potential for integration into clinical decision support systems. Furthermore, incorporating SHAP and Grad-CAM techniques further enhances the interpretability and trustworthiness of the AI-driven diagnostic system.

Primary or metastatic cancers involving the intra-abdominal organ systems frequently result in abdominal pain, of both abdominal visceral and somatic types. This pain can be extremely severe and distressing to patients, and very often requires the use of opioid-based medications for modification of pain to tolerable levels. Adjunctive therapies have also been described, including interventional procedures such as celiac plexus blockade. Both treatment modalities have obvious benefit, but also substantial risk. We present a case of significant and intractable abdominal cancer pain, and describe successful management of this pain with the relatively safe and simply performed ultrasound guided transverse abdominal plane (TAP) block.

Rabbit anti-thymocyte globulin (Thymoglobulin®, Sanofi-Aventis, Quebec, Canada) a purified gamma immune globulin obtained from the serum of rabbits immunised against human thymocytes, is widely used as an immunosuppressant agent to prevent acute rejection during solid organ transplantation. Anaphylaxis after first-time exposure to the drug is rare, but may be associated with devastating consequences. We present the case of a patient undergoing renal transplantation who developed intraoperative cardiac arrest due to severe allergic reaction immediately after initiation of Thymoglobulin® intravenous infusion. The patient was successfully resuscitated, but developed chronic chest pain from left-sided rib fractures sustained during chest compressions, and was evaluated by the same senior staff anaesthesiologist as an outpatient in the pain clinic. A high level of suspicion from anaesthesia providers is paramount in the diagnosis and management of intraoperative drug-induced severe allergic reactions, furthermore there is an opportunity for continued care of these patients by anaesthesia providers beyond the return of spontaneous circulation.

Introduction: Intraoral chair side porcelain repair system is a quick, painless and highly patient acceptable procedure, without removal of restoration or fabrication of new restoration. There are very limited studies conducted to evaluate the shear bond strength of repair systems after different surface treatment. Objectives of Research: The objective of research was to evaluate the shear bond strength of two intraoral porcelain repair systems Clearfil repair system (Kuraray) and Ceramic repair system (Ivoclar) to repair metal-ceramic restoration after three different surface treatment. Materials and Methods: Totally, 120 discs of base metal alloy were fabricated. The opaque, dentine and enamel of ceramic were applied to achieve the uniform thickness. Defect was created, and repair was done using two repair systems after different surface treatment. Shear bond strength was measured. Results: Analysis of variance was utilized. Ceramic repair system after 40% phosphoric acid surface treatment showed the highest mean value and Clearfil repair system after surface treatment with 37% phosphoric acid showed the lowest. The statistical difference was found to be significant between the groups. Conclusion: The shear bond strength of Ceramic repair system with 40% phosphoric acid etching showed highest shear bond strength as compared to other system and surface treatment used in the study.

Edentulous patients with maxillectomy defects present a significant challenge for prosthetic rehabilitation and the adaptive capabilities of the patient as retention is highly compromised. Hence, the option of using endosseous implants to increase obturator retention has been used. A patient of mucormycosis of the left maxilla was treated with surgical excision. After satisfactory healing, definitive implant supported magnet retained prosthesis was fabricated for the patient. Implants with magnetic units offer a practical method of improving the retention of obturators provided acceptable prosthetic protocols are followed for the rehabilitation.