17 cases will be subjected to bilateral Ultrasound-guided Quadratus lumborum block through bilateral catheter insertion for perioperative analgesia.

17 cases will be subjected to epidural catheter insertion for perioperative analgesia (as a control group).

Pain, Postoperative

Ultrasound guided transmuscular approach for quadratus lumborum block using an 18 gauge Touhy's epidural needle to insert the catheter. Normal saline 5 mL will be used to identify that plane. A volume of 20 ml of 0.25% of Bupivacaine bolus will be injected in that plane just over QL. This will be followed by epidural catheter insertion to facilitate continuous infusion. A similar procedure will be performed on the other side. A continuous infusion of 0.2% Bupivacaine at 5 ml/h will be administered to the patient.
This transmuscular quadratus lumborum (TQL) block, has been suggested to be a simple and perhaps safer alternative to the anterior approach as was described for the original QL block

Quadratus Lumborum Block Using Bupivacaine 0.2%

With Patients placed in sitting position, puncture site will be identified at (T8-9, T9-10, or T10-11) intervertebral spaces. Using aseptic conditions, an 18G Tuohy epidural needle will be used to insert epidural catheter as appropriate.
Induction of epidural analgesia with 10-15 ml bupivacaine 0.25% preoperatively with top up doses of 5-7 ml bupivacaine 0.25% or equivalent administered judiciously till we achieve analgesic level of T4 to L1. The calculated top up doses will be administered each hour using bupivacaine 0.25% or by using a continuous infusion syringe pump for equivalent doses

Epidural Analgesia Using Bupivacaine 0.25%

National Cancer Institute - Cairo University

Perioperative Analgesic Efficiency of Quadratus Lumborum Block vs Epidural in Radical Cystectomy

Perioperative Analgesic Efficiency of Ultrasound Guided Quadratus Lumborum Block Versus Epidural Analgesia in Bladder Cancer Patients Undergoing Radical Cystectomy

The primary outcome measures visual analogue pain scores in the two groups at the end of surgery

The primary outcome measures visual analogue pain scores in the two groups 6 hours postoperatively

The primary outcome measures visual analogue pain scores in the two groups 24 hours postoperatively

The primary outcome measures visual analogue pain scores in the two groups 48 hours postoperatively

Postoperative Nausea and Vomiting using nausea score (0 for none, 1 for mild to moderate nausea, 2 for moderate nausea, 3 for severe nausea accompanied by vomiting) When patient's nausea score reaches ≥ 2; intravenous anti-emetics in the form of Ondasetron 8mg and will be administered and recorded in all groups

During pain assessment using visual analogue score, if VAS score is ≥ 4, intravenous morphine 3mg will be administered 18. The mean first time for morphine requirement will be recorded in all groups (mean+- SD). Total 48 h morphine consumption will be recorded in all groups

Patient satisfaction with the technique and analgesia to be assessed at the end of study (at 48 hours period) and will be put on a scale from 1 to 4 (poor = 1, fair = 2, good = 3, excellent = 4)

National Cancer Institute, Egypt

Group (A): 17 cases will be subjected to bilateral Ultrasound-guided Quadratus lumborum block through bilateral catheter insertion for perioperative analgesia.
Group (B): 17 cases will be subjected to epidural catheter insertion for perioperative analgesia (as a control group).
This number is to be increased to 34 patients (17 patients in each group) to account for the necessity to use non-parametric test. Sample size was calculated using G*Power program (University of Düsseldorf, Düsseldorf, Germany) 17, 20, 21.

Cohort of 50 patients with CKD of unknown aetiology Inclusion and exclusion criteria below Measure of arterial stiffness using pulse wave velocity technology Assessment of BMI, central and brachial blood pressure, arterial stiffness and 'arterial age' will be made and fed back to the patient. this information will be given in a 'results sheet' that the participant will be encouraged to give to their Gp for further treatments required.

Cohort of 50 patients with CKD of known cause Inclusion and exclusion criteria below Measure of arterial stiffness using pulse wave velocity technology Assessment of BMI, central and brachial blood pressure, arterial stiffness and 'arterial age' will be made and fed back to the patient. this information will be given in a 'results sheet' that the participant will be encouraged to give to their Gp for further treatments required.

Cohort of 50 participants who are healthy Sri Lankan volunteers Inclusion and exclusion criteria below Measure of arterial stiffness using pulse wave velocity technology Assessment of BMI, central and brachial blood pressure, arterial stiffness and 'arterial age' will be made and fed back to the patient. this information will be given in a 'results sheet' that the participant will be encouraged to give to their Gp for further treatments required.

To recruit a cohort of up to 250 CKDu patients from specific CKDu clinics in Anuradhapura and Padavi-Sri Pura for detailed history, basic anthropometric tests, and further analysis of serum, and urine. Analysis for biomarkers of kidney damage, proteomics, exosomes, and DNA adducts will be used to seek information that may complement already collected data and help refine aetiological hypotheses.
Inclusion and Exclusion criteria as per CKDu cases in cohort 1

Urine samples: up to 30ml Blood samples: up to 40ml - 2 x EDTA blood bottles + 2 x serum gel Z bottles

CKDu

Arterial Stiffness

Proteinuria

Serum Creatinine

Urinary Biomarkers

DNA Adducts

The following will be measured: brachial systolic and diastolic bp, heart rate, mean arterial bp, pulse pressure, brachial augmentation index (difference between the amplitudes of the late (backward) systolic wave (P2) and the early (forward) systolic wave (P1) over the pulse pressure x 100), central augmentation, ejection duration of the left ventricle, return time (time of the pulse wave travelling from aortic root to the bifurcation and back), aortic pulse wave velocity ( velocity of the pulse wave in the aorta), central systolic bp, central pulse pressure and diastolic reflection area (provides information about the quality of diastolic filling in the coronary arteries).
We will perform an arterial age assessment. Patients are given a feedback form with their results to give to their general. Those with increased arterial stiffness will be tested for serum calcium and phosphate levels, and audited to ensure that a statin is commenced if not contraindicated.

Arterial Stiffness Assessment

WHO + Sri Lankan Ministry of Health collaborative study

Oliver JJ, Webb DJ. Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. Arterioscler Thromb Vasc Biol. Apr 1 2003;23(4):554-566

Sarnak MJ, Levey AS et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research,

Teaching Hospital Anuradhapura

An Investigation Into the Cardiovascular Risk and Aetiology of CKDu in Sri Lanka

Arterial stiffness will be measured using the TensioMed® Arteriograph™. Damage to large arteries contributes to increased cardiovascular risk in CKD. Atherosclerosis is the most frequent cause of arterial damage but medial calcification seen in CKD also leads to arterial stiffening. This stiffening causes elevated systolic blood pressure, increased left ventricular workload and the gradual development of LVH, and also a fall in diastolic blood pressure impairing coronary blood flow. Arterial calcification and stiffness are independent predictors of all-cause and cardiovascular mortality in CKD patients. It is unclear whether the CVD risk associated with CKDu is the same as it is for CKD of known cause. We plan to measure arterial stiffness in both CKD and CKDu patients. We will compare stiffness measurements in CKD of unknown cause with those of a well characterised cohort of CKD patients in Edinburgh. Healthy Sri Lankan volunteers will give an assessment of 'background stiffness'.

As the aetiology of CKDu remains unknown, we will collect blood and urine samples from a cohort of p to 259 CKDu patients to explore the aetiology further. These samples will be analysed for biomarkers of kidney damage, proteomics, exosomes, and DNA adducts.

arsenic/ضمور

Perioperative Analgesic Efficiency of Quadratus Lumborum Block vs Epidural in Radical Cystectomy

An Investigation Into the Cardiovascular Risk and Aetiology of CKDu in Sri Lanka

قاعدة بيانات الأعشاب الطبية الأكثر اكتمالا التي يدعمها العلم