Dharan

Pain, swelling, and limited mouth opening are common after surgical removal of impacted lower wisdom teeth due to local inflammation. This research compares the effects of two treatments, submucosal dexamethasone and oral trypsin-chymotrypsin, to see how well they reduce these postoperative issues. The study focuses on how these medications control inflammation and improve recovery after surgery. One treatment involves injecting dexamethasone locally under the mucosa near the surgical site. The other treatment is taking trypsin-chymotrypsin orally, which are enzymes thought to reduce inflammation by breaking down inflammatory peptides in the blood. These therapies are being assessed to compare their clinical effectiveness in reducing pain, swelling, and trismus after surgery. Participants will be monitored for three months to evaluate the outcomes of these treatments. Researchers will assess the reduction in postoperative symptoms such as pain, edema, and trismus. The study includes careful monitoring of inflammatory responses and will measure how each treatment influences healing and recovery after lower third molar surgery.

Researchers are studying how different altitudes affect the chance and severity of postdural puncture headache (PDPH) after spinal anesthesia for cesarean delivery. They believe that women living at high altitudes might have a higher risk of PDPH compared to those at lower altitudes. This is a prospective cohort study conducted in two locations in Nepal: a high-altitude site in Jumla at 2514 meters above sea level, and a low-altitude city in Dharan at 350 meters. Eligible participants are women scheduled for elective or non-elective cesarean delivery with spinal anesthesia. The anesthesia is given while sitting, using a 25-gauge pencil point spinal needle at the L3-L4 or L4-L5 vertebral space. Researchers will record baseline characteristics, including anxiety, depression, chronic pain, and existing headaches. The diagnosis of PDPH will follow the international headache society's criteria. During the study, participants will be monitored for the development of PDPH up to seven days after spinal anesthesia. Researchers will assess the number of patients who experience PDPH and track symptoms based on established guidelines. Patients who move between altitudes shortly after delivery or experience major complications will be excluded. The study aims to better understand how altitude influences PDPH occurrence and severity in women undergoing cesarean delivery under spinal anesthesia.

Researchers are evaluating the use of a lower INR target range (1.5 to 2.5) in patients who have a mechanical bileaflet heart valve in the aortic position. The study aims to determine whether this lower INR target can reduce the risk of bleeding without increasing the risk of blood clot formation or stroke. This is important because patients with mechanical heart valves need lifelong warfarin treatment, and finding the right INR balance could lessen bleeding complications. Participants will continue warfarin therapy after their mechanical valve replacement, but with different INR target ranges depending on their study group. The study compares the standard higher INR targets to the lower 1.5 to 2.5 range to assess safety and effectiveness. This is a Phase 3 clinical trial focusing on patients who had their bileaflet mechanical heart valve implanted at least three months prior. During the study, participants will be monitored for thrombosis or thromboembolism and major bleeding events over a period expected to last 2 to 3 years. Researchers will regularly measure INR levels to guide warfarin dosing and track outcomes related to bleeding and clotting. The results are intended to help doctors better manage warfarin dosing to reduce bleeding risks while preventing clots in this patient group.

Researchers are conducting a Phase III international study to evaluate whether an intravenous lidocaine infusion during breast cancer surgery can reduce the development of persistent pain three months after surgery. This trial includes patients undergoing lumpectomy or mastectomy, including prophylactic surgeries, to better understand ways to prevent long-term pain following breast cancer treatment. Participants are randomly assigned to receive either an intravenous lidocaine infusion or a placebo saline infusion during surgery. The lidocaine group receives a 1.5 mg/kg bolus at anesthesia induction followed by a continuous 2.0 mg/kg/hour infusion until the end of surgery and up to 30 minutes in the recovery room. The control group receives a saline solution following the same schedule. Both patients and researchers are blinded to the treatment allocation to ensure unbiased results. During the study, participants are monitored closely for the first three days after surgery and then followed up at three and twelve months. They report on pain levels, use of pain medications, and assessments of function, mood, and quality of life. The main outcome measured is the presence of persistent pain three months after surgery to determine if lidocaine can prevent chronic postoperative pain in breast cancer patients.