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Local Versus Systemic Tranexamic Acid in Total Hip Arthroplasty in Young Adults
Kushwaha NS, Singh S, Kumar S, Singh A, Abbas MB, Deshwal S, Agarwal R
Cureus. 2023;15(3):e36230
Abstract
Background Total hip arthroplasty (THA) is the most successful orthopedic elective surgical procedure for end-stage hip arthritis. THA is linked with significant blood loss, ranging from 1,188 to 1,651 mL, and a transfusion rate of 16-37%, which frequently results in postoperative blood transfusions. Postoperative blood transfusions can be avoided by using autologous blood transfusion, intraoperative blood saving, local anesthetic, hypotensive anesthesia, and antifibrinolytic medications such as tranexamic acid (TXA) administration. Methodology A double-blinded, placebo-controlled, randomized, controlled study was conducted with three prospective groups to investigate the efficacy of topical and systemic routes of a single intraoperative dose (1.5 g) of TXA. Patients were recruited from our center between October 2021 to March 2022 who were undergoing primary total hip replacement. Estimated blood loss was calculated and compared in groups, and a p-value of <0.05 was taken as significant. Results A total of 60 patients were recruited in our study. Estimated blood loss was similar in both treatment groups, 816.8 ± 219.9 mL in the systemic TXA group and 775.5 ± 107.2 mL in the topical TXA group. The placebo group had 1,066.3 ± 150.4 mL estimated blood loss, which was significantly higher compared to the treatment groups. Conclusions Administration of TXA (1.5 g) significantly lowers blood loss without increasing problems, which can eliminate concerns about intravenous TXA use. TXA reduces blood loss by 270 mL on average.
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2.
Efficacy and Safety of Concentrated Growth Factors and Platelet- Rich Fibrin on Stability and Bone Regeneration in Patients with Immediate Dental Implants: A Randomized Controlled Trial
Gaur S, Chugh A, Chaudhry K, Bajpayee A, Jain G, Chugh VK, Kumar P, Singh S
The International journal of oral & maxillofacial implants. 2022;37(4):784-792
Abstract
PURPOSE Immediate dental implants revolutionized the field of implant dentistry with significant advantages over conventional implants. The lack of adequate bone in the extraction socket raises the question of the appropriate timing of implant loading. Platelet concentrates have been used widely to accelerate bone regeneration in the maxillofacial region. This study evaluates the effect of platelet concentrates on bone healing and implant stability in the maxillary and mandibular molar regions. Bone regeneration is regulated by several growth factors, particularly vascular endothelial growth factor (VEGF) and transforming growth factor-β1 (TGF-β1); therefore, quantification of these factors in platelet concentrates and its correlation with bone healing has been assessed in this study. MATERIALS AND METHODS The primary aim of this randomized clinical trial was to compare the stability of immediate dental implants in the maxillary and mandibular molar regions treated with platelet-rich fibrin (PRF) versus concentrated growth factors (CGF) using resonance frequency analysis (RFA). The secondary objectives were to evaluate the bone regenerate around implants with the use of PRF and CGF and to quantify growth factors VEGF and TGF-β1 in the prepared CGF and PRF and their correlation with bone healing, if any. A total of 36 patients were randomized into three groups (12 each): control, PRF, and CGF. In all patients, immediate implants were placed either with or without platelet concentrate (PRF or CGF). Implant stability was measured using RFA immediately postoperatively and at 4, 8, and 12 or 16 weeks (12 weeks for mandible and 16 weeks for maxilla) postoperatively. Radiodensity and the bone gap (horizontal/vertical) were measured on intraoral periapical radiographs immediately postoperatively and at 8 weeks and 12 or 16 weeks postoperatively. RESULTS On comparing the implant stability quotient (ISQ), radiodensity/grayscale (GS), and horizontal and vertical bone gap (HG and VG), there was no significant difference noted between the three groups at any point in time. On ISQ analysis at 8 weeks, the control group showed a significant improvement (P = .04), whereas at 12 or 16 weeks, significant improvement was seen in PRF (P = .03) and CGF groups (P = .02). In GS assessment, only the control group showed significant improvement at 12 or 16 weeks (P = .009). In horizontal and vertical bone gap analysis all three groups showed significant improvement at 8 weeks (control [P < .001], PRF [P = .001], CGF [P = .01]) as well as 12 or 16 weeks (control [P < .001], PRF [P < .001], CGF [P = .006]). The enzyme-linked immunosorbent assay (ELISA) quantification of VEGF and TGF-β1 showed significant concentration of VEGF in PRF as compared to the plasma, while concentration of TGF-β1 was found to be comparable in both groups. CONCLUSION The application of platelet concentrates seems to enhance stability of implants, but intergroup results were nonsignificant at all time points. There was no statistically significant difference between the three groups when comparing quality (radiodensity/grayscale) and quantity (horizontal and vertical gap reduction) of bone regenerate. Studies with larger sample sizes are required to make conclusive assertions regarding efficacy of platelet concentrates in dental implants.
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3.
Effect of preoperative finasteride on perioperative blood loss during transurethral resection of the prostate and on microvessel density in patients with benign prostatic hyperplasia: An open label randomized controlled trial
Dutt UK, Kumar S, Dorairajan LN, Badhe BA, Manikandan R, Singh S
Urology annals. 2021;13(3):199-204
Abstract
OBJECTIVE Transurethral resection of the prostate (TURP) is a common procedure for the treatment of benign prostatic hyperplasia (BPH). Previous studies on the effect of 5-alpha reductase inhibitors on perioperative blood loss in TURP and microvessel density (MVD) in the prostate are equivocal. We evaluated whether pretreatment with finasteride for 2 weeks before surgery can reduce perioperative blood loss in TURP and MVD in the prostate. MATERIALS AND METHODS Sixty-eight patients of BPH planned for TURP were randomized into two groups. The study group comprising 34 patients was treated with finasteride (5 mg/day) for 2 weeks and the placebo group comprising 34 patients received placebo for 2 weeks, before TURP. Blood loss was measured in terms of a reduction in the blood hemoglobin (Hb) and hematocrit (HCT) levels between preoperative values and 24 h after surgery. MVD was measured in the resected prostate tissue stained with anti-CD31 monoclonal antibody. RESULTS The reduction of Hb and HCT in the finasteride group was significantly lower than the reduction in the placebo group (P < 0.05). The artery (P = 0.005), vein (P = 0.05), and gland (P = 0.008) densities were significantly less in the finasteride group than in the placebo group. There was no significant correlation between blood loss and MVD. CONCLUSIONS Our study suggests a clear advantage of the preoperative use of finasteride for 2 weeks by reducing the perioperative blood loss in TURP in patients with BPH. While there is a significant reduction in MVD in the prostate on treatment with finasteride, it is not clear that this is the mechanism of reduction in blood loss in TURP.
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4.
Platelet-Rich Fibrin for Hard- and Soft-Tissue Healing in Mandibular Third Molar Extraction Socket
Sybil D, Sawai M, Faisal M, Singh S, Jain V
Annals of maxillofacial surgery. 2020;10(1):102-107
Abstract
BACKGROUND Successful management of patients reporting with extreme sensitivity in second molar after surgical extraction of deeply impacted mandibular third molar poses a big challenge to oral surgeons and periodontists worldwide. A variety of grafts, barrier membranes, and guided tissue regeneration techniques have been used postsurgically for soft- and hard-tissue formation. In the current study, platelet-rich fibrin (PRF), a second-generation platelet aggregate, was assessed for its effectiveness in promoting hard- and soft-tissue healing. OBJECTIVE The aim of the study was to evaluate the efficacy of PRF in hard- and soft-tissue healing after extraction of mandibular third molar. MATERIALS AND METHODS Bilateral surgical disimpaction of mandibular third molar was done on 25 patients. In every patient, randomly allocated test side received PRF and the other side acted as control. Pain, edema, tenderness, sensitivity, Sulcus Bleeding Index (SBI), Plaque Index, clinical attachment level (CAL), probing depth, and bone height were measured at different intervals for a maximum period of 6 months. RESULTS There was a statistically significant improvement in patients' signs and symptoms of pain, tenderness, edema, and sensitivity with the use of PRF. A statistically significant improvement was seen in SBI, Plaque Index, and probing depths, while CALs and bone height were not influenced by PRF use. CONCLUSION PRF is a very viable and useful biomaterial for soft-tissue healing and relieving patient symptoms, however, it does not help in hard-tissue healing with respect to cortical bone.
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5.
A comparison of two pulp revascularization techniques using platelet-rich plasma and whole blood clot
Ramachandran N, Singh S, Podar R, Kulkarni G, Shetty R, Chandrasekhar P
Journal of conservative dentistry : JCD. 2020;23(6):637-643
Abstract
AIM: The aim of this preliminary study was to compare outcomes of two regenerative endodontic protocols in necrotic teeth with open apices. METHODOLOGY Forty teeth with open apices in patients with an age range of 15-54 were randomly distributed in two groups: group 1, with whole blood clot in the canal (n=20) and group 2, whole blood with Platelet rich plasma (PRP) in the canal (n=20). Clinical and radiological follow up assessments were undertaken over a period ranging from 6 months to one year. Radiographic Root Area (RRA) was measured using the freeware ImageJ. Statistical analysis was performed using the independent samples t test and the Chi-squared test, the significance level was set at p=0.05. RESULTS There was no difference in the percentage change in RRA between the PRP group and whole blood-clot + PRP group. CONCLUSION Whole blood clot and PRP are comparable on the grounds of percentage change in RRA and there is no statistically significant difference between the two in a follow-up period of up to one year.
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6.
Evaluation of the relative efficacy of autologous platelet-rich fibrin membrane in combination with beta-tricalcium phosphate (Septodont- resorbable tissue replacement) alloplast versus beta-TCP alloplast alone in the treatment of grade II furcation defects
Rani N, Kaushal S, Singh S, Nandlal, Khan MA, Pathak AK
National journal of maxillofacial surgery. 2018;9((2):):196-204.
Abstract
Introduction: Platelet-rich fibrin (PRF) is considered as the second-generation platelet concentrate, contains combined properties of fibrin, platelets, leukocytes, growth factors, and cytokines that make it as healing biomaterial with incredible potential for hard tissue and soft tissue regeneration. The present study was aimed to evaluate the effectiveness of PRF with beta-tricalcium phosphate (beta-TCP) graft (R. T. R) and compare it with beta-TCP allograft alone in the treatment of mandibular Grade II furcation defects. Material and Methods: A total of 20 mandibular Grade II furcation defects sites were assigned in the study and treated with either beta-TCP alone (Group I) or beta-TCP with PRF membrane (Group II). The clinical parameters analyzed were probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), horizontal defect depth (HDD), and vertical defect depth (VDD), recorded baseline and at 6 months reentry. Results: At 6 months, both groups showed statistically significant results for all parameters from their baseline value, although intergroup changes were statistically insignificant. In Group I, gain in CAL was 2.80 +/- 1.40 and in Group II it was 3.00 +/- 1.44. Bone fill in Group I was VDD (3.50 +/- 2.12) and HDD (3.70 +/- 0.67), whereas Group II showed VDD (3.70 +/- 1.57) and HDD (4.0 +/- 0.88), respectively. PPD reduction was higher in Group I (3.50 +/- 2.27) than Group II (2.80 +/- 1.93). At reentry GR was established, Group I showed higher GR (0.70 +/- 0.67) and Group II (0.40 +/- 0.52). Conclusions: Significant improvement was found in both groups, but the combination of PRF with beta-TCP allograft led to more favorable improvement in the management of Grade II furcation defect except PPD.
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7.
Day care PNL using 'Santosh-PGI hemostatic seal' versus standard PNL: a randomized controlled study
Kumar S, Singh S, Singh P, Singh SK
Central European Journal of Urology. 2016;69((2)):190-7.
Abstract
INTRODUCTION To compare the outcomes of tubeless day care PNL using hemostatic seal in the access tract versus standard PNL. MATERIAL AND METHODS It was a prospective randomized controlled study. Cases were randomized to either the day care group with hemostatic seal (DCS) or the control group where patients were admitted and a nephrostomy tube was placed at the conclusion of surgery. RESULTS A total of 180 cases were screened and out of these, 113 were included in the final analysis. The stone clearance rates were comparable in both the groups. The mean drop in hemoglobin was significantly lower in DCS group than the control group (1.05 +/-0.68 vs. 1.30 +/-0.58 gm/dl, p = 0.038).Mean postoperative pain score, analgesic requirement (paracetamol) and duration of hospital stay were also significantly lower in the DCS group (3.79 +/-1.23 vs. 6.12 +/-0.96, 1.48 +/-0.50 vs. 4.09 +/-1.11 grams and 0.48 +/-0.26 vs. 4.74 +/-1.53 days respectively; p <0.05). The incidence of urine leakage through the access tract site was significantly lower in the DCS subgroup when compared to the controls (3.6% vs. 21.1%, p <0.05). Cases in the DCS group resumed their normal activities in a significantly shorter time (8.05 +/-3.05 vs.18.42 +/-4.42 days; p <0.05). Higher proportion of cases in the DCS group got re-admitted, although it was not a statistically significant number (7.1% vs. 1.8%; p = 0.21). CONCLUSIONS Tubeless day care PNL with composite hemostatic tract seal is considered safe. It resulted in a significant reduction of blood loss and analgesic requirement with significantly reduced hospital stay, nephrostomy tube site morbidity and time required to resume normal activity when compared to the standard PNL. However, patients must be compliant with the given instructions and should have access to a health care facility, as few of them may need re-admission.
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8.
Conjunctival autografting without fibrin glue or sutures for pterygium surgery
Singh PK, Singh S, Vyas C, Singh M
Cornea. 2013;32((1):):104-7.
Abstract
PURPOSE A prospective randomized case-control study conducted at a tertiary level eye care center to compare the outcomes of conjunctival autograft (CAG) with fibrin glue and CAG with patients' own blood acting as a bioadhesive in treating pterygium after surgical excision. METHODS Twenty eyes of 20 patients with pterygium were randomly divided into 2 groups: group I (10 eyes) underwent CAG with fibrin glue and group II (10 eyes) underwent CAG with the patients' own blood coagulum acting as a bioadhesive or fixative. RESULTS The time required for the surgery was compared. The patients were then closely followed up for a period of 12 months for anatomy, outcomes of graft, recurrence rate, graft displacement, retraction, inflammatory reaction, if any, graft failure, or any other complications. The duration of surgery was less in group I (mean duration, 14.74 +/- 2.35 minutes) than group II (mean duration, 17.45 +/- 2.89 minutes). We found that although the rate of recurrences was equal in grafts with the glue (10%) and the grafting with autologous blood (10%), the complications regarding graft displacement and graft retraction were more common in patients with grafting with autologous blood (10%) than in those with grafting with the glue. However, the difference was not found to be statistically significant (P = 0.3185). These complications were associated with larger grafts. CONCLUSIONS This study suggests that autologous fibrin in blood is a useful alternative method for graft fixation in pterygium surgery. We found the newer procedure of autografing free of any untoward complication in small- to average-sized grafts.