2nd Hour Research Articles

The Effect of Virtual Reality on Pain, Anxiety, Physiological Parameters, and Postspinal Headache in Patients Undergoing Spinal Anesthesia: A Randomized Controlled Trial

PurposeThe purpose of this research was to determine the effect of virtual reality (VR) on pain, anxiety, physiological parameters, and postspinal headache in patients undergoing spinal anesthesia. DesignThis was a randomized controlled experimental trial. MethodsThe research was conducted in the operating room unit of the state hospital in Hakkari-Şemdinli District Center between May 2021 and June 2022. Data were collected using the Descriptive Information Form, visual analog scale (VAS), verbal category scale (VCS), State-Trait Anxiety Inventory, and the Application Registration Form to record preoperative and postoperative oxygen saturation and heart rate. FindingsWhen the groups’ VAS and VCS mean scores were compared for head and incision site pain, the mean scores of headache and incision site pain in both groups were found to be significantly lower in the experimental group patients (P < .001). In addition, the difference between the groups in headache VAS and VCS mean scores at all hours was statistically significant; incision site pain VAS and VCS mean scores were significantly lower between the groups at all hours, except the 1st and 2nd hours (P < .001). While there was no significant difference in the State-Trait Anxiety Inventory (SAS) pretest mean scores between the groups (P > .05), the SAS post-test mean scores of the experimental group were significantly lower (P < .05). The mean heart rate in the intraoperative and postoperative periods and the mean saturation in the postoperative period differed significantly between the groups (P < .05). The difference between the blood pressure averages before, during, and after the operation was not statistically significant in both groups (P > .05). While nausea and vomiting was significant in the experimental group only at the 2nd hour (P < .05), it was not statistically significant at the other hours (P > .05). ConclusionsVR was found to effectively reduce pain, anxiety, postspinal headache, and increase the oxygen saturation level in the postoperative period in patients who underwent spinal anesthesia. Hence, VR is an effective treatment for patients who have undergone surgery under spinal anesthesia.

Stair climbing interventions reduce postprandial hyperglycemia but not cognitive functions: findings of a randomized cross-over trial

Prolonged sitting can negatively impact postprandial glucose levels and cognitive functions. Stair climbing interventions have potential to mitigate these risks however remains unexplored. The present study aimed to explore the effects of stair climbing bouts on postprandial glucose and cognitive functions during prolonged sitting. Twenty-eight sedentary young adults (aged 20 – 30 years) underwent two intervention visits after standardized lunch for two hours: (1) STAIR: the participants climbed two flight of stairs for two minutes every 30 minutes; (2) SIT: the participants continued to sit. Blood glucose was measured using capillary finger prick method while attention function was measured using computer-based cognitive tests at baseline, end of 1st hour and 2nd hour. Significant interaction (F2, 54 = 15.96, p <0.001) was observed for conditions and time. During STAIR visit, significant changes in postprandial glucose at 1st hour (β = - 2.6 mmol/dl, p <0.001) and 2nd hour (β = 3.0 mmol/dl, p <0.001). No significant difference in the attention functions with time and conditions was observed. Stair climbing interruptions may be a promising solution to prevent high glycemic excursion occurring during prolonged sitting following postprandial sessions. However, the clinical benefits of stair climbing on attention functions remain unconvinced.

Effects of Intraoperative Lignocaine Infusion on Heamodynamics and Postoperative Analgesic Requirement after Day Case Laparoscopic Surgery

Background:Intravenous lignocaine is an amide local anaesthetic known for its analgesic, anti-hyperalgesic, anti-inflammatory and anti-arrhythmic properties. During perioperative period of laparoscopic surgeries haemodynamic alteration occurs due to laryngoscopy, intubation, and surgical excision, gas insufflation during pneumoperitoneum, inadequate analgesia and inadequate depth of anaesthesia. Intravenous lignocaine is often administered to suppress the haemodynamic response and as an analgesic agent. We aimed to evaluate the effect of intravenous infusion of lignocaine on haemodynamic response and post-operative analgesic requirement. Objectives:The purpose of this study was to evaluate the effect of intravenous infusion of lignocaine on haemodynamic and postoperative analgesic requirements after laparoscopic day case surgeries. Material and method:Four hundred Sixty (460) patients were selected who’s were going to be operated for laparoscopic surgeries (Laparoscopic Cholecystectomy, laparoscopic Hernioplasty, laparoscopic appendicectomy, Diagnostic laparoscopy due to infertility) were grouped into exposed (Group L) who were received lignocaine infusion @1mg/kg/hr and controlled (Group C) who were received placebo. Systematic random sampling was employed. Results:Demographic characteristics were comparable between the groups p&gt;0.05. In lignocaine group intraoperative mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure and mean heart rate were significantly lower than control group (p&lt;0.05). Twenty four hour mean VAS score (0 – 10 cm) at immediate recovery, 1st, 2nd, 3rd, 6th, 12th and 24th hour were lower in lignocaine group (p&lt;0.05). The mean time of first analgesic requirement were longer (120 minutes) in lignocaine group compared to 40 minutes in control group (p&lt;0.001) and the mean total tramadol consumption is less in lignocaine group (p&lt;0.001). Conclusion:Intra operative lignocaine infusion causes more haemodynamic stability and decreases postoperative pain score, required longer time for first analgesic requirement and reduced total analgesic consumption in laparoscopic surgeries. J Bangladesh Coll Phys Surg 2024; 42: 312-320

Efficacy of ultrasound-guided bilateral rectus sheath block vs. local anesthetic infiltration in gynecologic oncology patients undergoing midline laparotomy: a triple-blinded randomized controlled trial.

Postoperative pain is a serious problem in gynecological oncology patients. Rectus sheath block (RSB) is increasingly utilized as a part of multimodal analgesia. The purpose of this three blinded, randomized-controlled trial is to compare the analgesic efficacy of ultrasound-guided (US-guided) bilateral rectus sheath block (BRSB) and local anesthetic wound infiltration (LAWI) application in patients undergoing midline laparotomy for gynecologic cancer. This prospective, single-center, three-blinded, randomized clinical trial enrolled a total of 60 patients who underwent surgery through a midline laparotomy. Patients were randomly allocated into two groups and were administered either LAWI or BRSB with 20 mL of 0.25% bupivacaine just after the end of surgery. Both groups were compared for Numeric Rating Scale (NRS) pain scores, time to first analgesic requirement, total tramadol consumption. Fifty-five patients (BRSB=28, LAWI=27) completed the study. The BRSB group had significantly lower NRS scores at 2, 6, 12, and 24th hours (P<0.001). The median (interquartile range, IQR) NRS scores for BRSB group were 3 (3-3) at 2nd hours, 3 (2-4) at 6th hours, 3 (2-4) at 12th hours and 3 (2-3) at 24th hours. For the LAWI group, the median (IQR) NRS scores were 4 (3-4) at 2nd hours, 4 (3-5) at 6th hours, 4 (3-4) at 12th hours and 4 (3-4) at 24th hours. The BRSB group had significantly less additional tramadol consumption than the LAWI group (P<0.001). The US-guided BRSB is a safe and feasible technique. This technique resulted in reduced postoperative pain scores, decreased tramadol usage, and prolonged pain relief compared to LAWI.

Impact of yoga on the cognitive function among desk‐based workers

IntroductionProlonged sitting negatively impacts cognitive functions, such as working memory and inhibitory control. As sedentary behaviour rises in workplaces, interventions like yoga breaks, which combine physical activity and mindfulness, may mitigate these effects. While specific research on yoga breaks is limited, related studies suggest potential cognitive benefits. MethodsThis prospective, single-centre crossover trial took place from September 2022 to January 2023 at the Radiology Lab, KMC Manipal. Participants experienced three sessions: uninterrupted sitting, pranayama breaks, and yoga breaks, each lasting four hours. Executive functions were assessed hourly using computer-based tests (Eriksen’s Flanker Test and N-Back Test). Statistical analyses included repeated measures ANOVA and Friedman’s test. ResultsParticipants, with a mean age of 30.24 years, showed fastest reaction times during the yoga intervention in the Flanker Test, followed by pranayama and sitting. However, accuracy did not significantly differ between groups in both tests.Reaction times decreased significantly from the 0th to the 2nd and 4th hours in the Flanker Test, but not between the 2nd and 4th hours. In the N-Back test, accuracy declined over time for all interventions, without significant group differences. ConclusionYoga and pranayama breaks potentially improve reaction times during prolonged sitting but do not significantly impact accuracy in cognitive tasks. These findings suggest that while activity breaks can enhance certain cognitive functions, further research is needed to optimize interventions for cognitive health in sedentary work environments.

Umbilical Catheter Extravasation Mimicking Necrotizing Enterocolitis in a Preterm Neonate: A Diagnostic Challenge.

Managing acute abdomen in very low birth weight (VLBW) and premature infants presents a diagnostic challenge, often necessitating a thorough assessment to discern underlying causes. Umbilical venous catheters (UVCs), commonly used in neonatal intensive care, are essential but not without risks. A 29-week premature male infant, born to a 23-year-old mother, was referred to our clinic on the 16th day of life with a suspected diagnosis of necrotizing enterocolitis (NEC). The infant had spent the first day intubated and received non-invasive respiratory support for 15 days. A 5 French UVC was inserted at the 2nd hour of life, and by the 3rd day of life, the infant transitioned to minimal enteral feeding. Between the 12th and 16th days of life, the infant initially diagnosed with NEC due to symptoms such as decreased stool passage and abdominal distension. The patient had been on a continuous course of antibiotic treatment throughout the entirety of his life, commencing on the very first day due to suspected early neonatal sepsis, followed by nosocomial sepsis during the hospitalization, and persisting with antibiotic therapy for suspected NEC. The case took a unique turn upon further evaluation after being referred to our unit. Despite a preliminary NEC diagnosis, further evaluation revealed umbilical catheter complications, leading to total parenteral nutrition extravasation. Removal of the catheter, drainage, and antibiotic adjustment resulted in improved clinical outcomes. In neonatal care, cautious management is vital when dealing with infants exhibiting abdominal symptoms. A nuanced approach, including differential diagnosis and careful antibiotic use, is essential.

Treatment of Domestic Wastewater Using Membrane Bioreactor (MBR) Pilot Plant: A Case Study of Wastewater from Kklung Hok’s Treatment Pond and The Environmental Research and Training Centre (ERTC), Pathumthani, Thailand

This research performant of Membrane Bioreactor (MBR) pilot plant for treatment of Wastewater from Khlung Hok’s treatment pond volume of 250 liter and The Environmental Research and Training Centre (ERTC) volume of 100 liter, both wastewater was mix on MBR. Aeration was fed at air flow rate 150 l/min over two hours to provide the oxygen for microorganisms. Further, Aeration was fed continuously for 6 hours. sample were collected every one hour. Result found that: the wastewater variation of pH, DO, BOD, COD, NH4+, NO2– concentration of the feed tank from Khlung Hok’s treatment pond were 7.16, 0.60 mg/l, 95mg/l, 157 mg/l, 34.96 ppm and NO2 not found and from ERTC’s wastewater were 6.87, 0.41 mg/l, 93 mg/l, 160 mg/l, 21.23 ppm and 0.043 ppm, respectively. After air flow in MBR over 2 hour the concentration of influent was found 6.64, 0.60 mg/l, 48 mg/l, 105.67 mg/l, 22.30 ppm and 0.031 ppm, respectively. And during the whole process effluent pH concentration were between 6.64-7.46, DO were between 1.11-5.8 mg/l. The removal BOD efficiency were over 89.58% (on 5th hour), COD were over 75.39% (on 4th hour), NH4 were over 53.61% of (on first hour) and were over NO2 48.71% of (on 2nd hour), respectively. Result indicated that effective removal BOD, COD, NH4+ and NO2– by MBR could be achieved and increased in scale for use in the fieldwork or the treatment of wastewater in the environment.

Is a two-hour monitoring period sufficient and safe for patients undergoing ultrasound-guided percutaneous liver mass biopsy?: A prospective and multicenter experience.

To investigate whether patients undergoing percutaneous liver mass biopsy (PLMB) can be safely discharged following a two-hour monitoring period. A multi-center prospective analysis was conducted for 375 patients (196 males and 179 females), mean age 63 ± 12.45 years (range 37-89) who underwent PLMB between August 2023 and March 2024. Patients were monitored for 24 h, and complications were classified as minor or major. The timing of complications was categorized into three groups: within the first two hours, between the 2nd and 24th hours, and within 1 week after 24 hours. Minor complications occurred in 18.93% (71/375) and major complications in 2.13% (8/375). Most minor complications (80.2%, 57/71) appeared within the first two hours, 12.7% (9/71) between 2 and 24 h, and 7.1% (5/71) after 24 h. All major complications (62.5%, 5/8) except late-onset cases, occurred within the first two hours. No major complications occurred between 2 and 24 h. Late-onset major complications occurred in 37.5% (3/8) after 24 h. The two-hour monitoring period did not adversely impact patient management regarding minor complications and is safe for identifying all major complications except for late-onset ones. Extending the post-biopsy recovery period does not significantly improve patient care.

Regulation of STAT3 and NF-κB signaling pathways by trans-Anethole in testicular ischemia-reperfusion injury and its gonadoprotective effect.

Testicular ischemia reperfusion (I/R) injury is a significant urological problem where clinical interventions may be inadequate, and the antioxidants might be potential co-treatment modalities. This study examined the gonadoprotective effect of trans-Anethole in testicular I/R injury. Twenty-eight male rats were divided into four groups. Rats in the I/R, I/R + t100, I/R + t200 groups underwent bilateral testicular I/R injury. The I/R + t100 and I/R + t200 groups received 100 or 200 mg/kg trans-Anethole at the 2nd hour of ischemia. Microscopic evaluations demonstrated that testicular I/R injury leads to severe testicular degeneration. Tissue oxidative stress, pro-apoptotic Bcl-2 associated X (Bax) and Caspase 3, pro-inflammatory Tumor necrosis factor-alpha (TNF-α), Interleukin-1 beta (IL-1β) and Interleukin 6 (IL-6) cytokines levels were significantly (p < 0.05) upregulated when compared to the Control group. Additionally, transcription factors Signal transducer and activator of transcription 3 (STAT3) and Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) levels increased significantly (p < 0.05) compared to the Control group. Tissue disrupted parameters in the I/R + t200 group were significantly different (p < 0.05) from the I/R group, contrasting with the slight improvement in the I/R + t100 group. The STAT3 and NF-κB expression levels in the I/R + t200 group were significantly suppressed (p < 0.05) compared to the I/R group. In conclusion, our study indicates that trans-Anethole could enhance gonadoprotective activity in testicular I/R injury, potentially involving transcription factors STAT3 and NF-κB. However, before the consumption of trans-Anethole-containing natural or manufactured goods, the potential benefits and side effects should be carefully evaluated.

Effect of different patient positions on endotracheal tube cuff pressure in patients undergoing urological procedures: a prospective study.

The endotracheal tube (ETT) contains a cuff that is placed in the trachea to prevent gas leakage and aspiration of secretions and gastric contents. However, patient positioning after intubation may cause ETT displacement and changes in cuff pressure. Evaluate the effect of different patient positions on ETT cuff pressure in patients undergoing urological procedures in supine, prone, lateral flank, and lithotomy positions. Prospective and observational study. A university hospital in Turkey. Patients who underwent surgeries under general anesthesia in different patient positions were involved. After intubation (T0), the cuff pressure was checked with a manometer and adjusted to 25 cmH2O and continuously monitored. The cuff pressure was checked before (T1) and after achieving the final position (T2) and then at 5, (T3), 10, (T4), 15 minutes (T5) of the position, at the end of the procedure (T6) and before extubation (T7). At postoperative 2nd and 12th hours, the patients were interviewed for sore throat, hoarseness, and cough. The effect of different patient positions on the ETT cuff pressure. 200 patients. The cuff pressure increased significantly at T2 in the lithotomy, lateral flank, and prone groups (P<.001 each). The highest increase in cuff pressure occurred in the prone group (34.3 [7.5] cmH2O). Over time, the cuff pressure decreased in all groups during surgery. Postoperative complications at the 2nd postoperative hour were similar in all groups; however, the mean cuff pressure was significantly higher in the patients with postoperative sore throat or cough (sore throat: P=.003; cough: P=.047). ETT cuff pressures are affected by different patient positioning; therefore, regular recording and adjustment of cuff pressure are necessary for patient safety. We used ETT of a single manufacturer. Therefore, our findings may not be applicable to other types of ETT.

A case of MERS presenting with acute motor aphasia and tetraparesis and literature review

BackgroundMild encephalopathy wıth reversible splenial lesions (MERS) are a clinical–radiological diagnosis that can be diagnosed with radiological imaging and can be accompanied by impaired consciousness, aphasia, headache, and paralysis. MERS can be divided into two different types based on radiological findings; Involvement of the splenium is seen in type 1, and involvement of the splenium and deep white matter is seen in type 2. MERS Type 2 is very rare in adults. Here, we describe a patient diagnosed with MERS Type 2 and our therapeutic intervention.Case presentationA 22-year-old woman presented with slurred speech, weakness in the extremities and headache that started 14 h ago. The patient had sore throat and fever of 37.6 °C for 2 days, and medical history or family history were unremarkable. Neurological examination revealed that she was conscious, cooperative, with no signs of meningeal irritation. Speech comprehension, naming, and repetition were preserved, motor examination revealed 5/5 left upper extremity strength, 4/5 right upper extremity strength, and 2/5 bilateral lower extremity strength. Diffusion-weighted magnetic resonance imaging (MRI-DWI) revealed bilateral deep white matter and splenium symmetrical diffusion restriction. Blood tests showed high C-reactive protein (CRP) and no leukocytosis. No cells were detected in the cerebrospinal fluid (CSF), protein was 151 mg/dl, glucose was within normal limits. The patient, who developed quadriparesis during follow-up, was started on pulse dose steroids. Neurological examination improved to patient’s baseline at the 12th hour of treatment. In the 72nd hour control MRI-DWI, it was seen that the lesions had regressed. Culture/Polymerase chain reaction (PCR) for bacterial/viral infection agents came back negative. After steroids were given for 5 days, patient was discharged at her baseline.ConclusionsMERS is a rare diagnosis in adults and can be radiologically confused with acute toxic leukoencephalopathy. It can be distinguished clinically by the absence of prior infection, fever, and toxic agent exposure. Although there is no consensus in the literature regarding the treatment, the clinical picture improved rapidly after steroid in our case. Despite being rare, it should be considered in the differential diagnosis of patients with deep white matter lesions in adults.

Molecular identification and eco-friendly management of rice brown planthoppers in Bangladesh

Infestation by various insect pests is the main constraint for growing rice where rice brown planthopper (Nilaparvata lugens Stål) can severely damage rice plants directly through feeding. Therefore, the study aims to detect rice brown planthoppers (BPH) and provide environment-friendly management tactics to mitigate the problem which caused by brown planthoppers. The BPH samples were collected from rice fields of different locations in the Patuakhali of Bangladesh for molecular identification. A molecularly single species of rice brown planthopper, Nilaparavata lugens was identified using mitochondrial cytochrome oxidase subunit I (mtCOI) universal marker. The nucleotide sequences of collected samples were compared with other nucleotide sequences from the GenBank database of NCBI, which make single clades in the phylogenetic tree at an insignificant distance. Moreover, brown planthopper management observations were recorded in laboratory conditions after providing an artificial diet with different treatments of plant-based insecticides Neem oil (1 %, 5 %, and 10 %), Castor oil (1 %, 5 %, and 10 %) where only 20 % sucrose solution was used as negative control and Abamectin (1 %, 5 % and 10 %) were also used as a positive control for comparing the efficacy of plant-based insecticides on rice brown planthoppers. The results showed the highest mortality (100 %) of rice brown planthoppers was recorded by Abamectin 10 %, followed by Abamectin 5 %. Neem 10 % performed better than Abamectin 1 % during 1st hour. Initial after exposure of 2nd hour for Abamectin 1 % revealed greater mortality (59 %) than Neem 10 %. Neem 5 % showed less effect on mortality in brown planthopper than Neem 10 % but was higher than Neem 1 % during 6 h of observation. The Castor oil of 10 % caused higher mortality than the Castor of 5 % but not up to the marks of Abamectin and different concentrations of Neem oil. Castor oil of 1 % and control have shown no mortality of brown planthopper for 6 h of observation.

Effect of post-mating GnRH or TAK-683 (Kisspeptin analog) treatment on the reproductive performance and serum progesterone concentration in ewes during the non-breeding season

This study was designed to evaluate the effect of post-mating GnRH or TAK-683 (kisspeptin analog) treatment on serum progesterone (P4) concentrations and fertility parameters of ewes during the non-breeding season. One hundred and twenty multiparous, lactating Awassi ewes were used. For estrus synchronization, vaginal sponges containing 60 mg of medroxyprogesterone acetate (MAP) were inserted into the vagina and kept there for nine days. On the day of sponge removal (day 0), 500 IU of eCG and 75 µg of d-cloprostenol were given intramuscularly. Rams were introduced in the flock 24 h after sponge removal and kept with the ewes for 26 days, allowing a second mating period after synchronized estrus. On the fourth day after mating (day 6) the ewes mated by the rams between the 24th and 72nd hours (n = 105) were randomly divided into three groups. Control group (n = 36) received 1 ml of saline solution subcutaneously; GnRH group (n = 34) received 4 μg of buserelin acetate intramuscularly; TAK-683 group (n = 35) received 5 μg of TAK-683 acetate subcutaneously. Blood samples were taken to measure serum P4 concentrations (ng/ml) at sponge insertion and on the 6th, 9th, 12th, 15th, 19th, 35th, and 50th days after sponge removal. Pregnancy diagnosis was conducted via serum P4 concentration measurement on the 19th day and transrectal ultrasonography on days 35 and 50. The results showed that GnRH treatment (4.823 ± 0.238; 2.151 ± 0.272) increased (P<0.05) the mean P4 concentration (ng/ml) in pregnant and non-pregnant ewes during the first mating period compared to Control (3.708 ± 0.207; 1.515 ± 0.164), while TAK-683 treatment (4.457 ± 0.181; 1.967 ± 0.213) was not different between groups. GnRH (58.82 %) and TAK-683 (42.10 %) treatments increased the pregnancy rate in the second mating period in comparison to the Control group (17.39 %) (P<0.05). Cumulative pregnancy and fecundity rates were higher in GnRH (79.41 %; 120.58 %) and TAK-683 (68.57 %; 100.0 %) groups than in the Control group (17.39 %; 58.33 %) (P<0.05). There was no difference in late embryonic loss rate among the groups (P>0.05), whereas early fetal loss rate tended to be lower in the TAK-683 (0 %) and GnRH (0 %) groups than in the Control group (15.38 %) (P=0.07). The total pregnancy loss rate (from day 19 to day 50 post-mating) was lower in GnRH (0 %) and TAK-683 (0 %) groups relative to the Control group (21.42 %) (P<0.05). There were no statistical differences among the groups in terms of the first mating period pregnancy rate, twinning rate, and litter size (P>0.05). As a result, treatment with GnRH and TAK-683 on the fourth day after mating increased fecundity in lactating ewes outside the breeding season by preventing total pregnancy losses (from day 19 to day 50) and increasing second mating pregnancy rates.

Fentanyl versus Dexmedetomidine Infusion in Head and Neck Free Flap Surgery for Comparison of Hemodynamic Parameters and Anaesthetic Requirements: A Randomised Controlled Trial.

This prospective, double-blinded, randomized study aimed to compare the efficacy of dexmedetomidine and fentanyl infusions in maintaining hemodynamics during head and neck free flap surgery, as well as their impact on the relative amount of blood loss. Twenty patients with American Society of Anesthesiologists physical status I and II scheduled for elective head and neck free flap surgery were enrolled. The patients were randomly assigned to receive either dexmedetomidine (1µg/kg over 10min at anesthesia induction, followed by 0.2 to 0.75µg/kg per hour infusion during maintenance) or fentanyl (1 to 2µg/kg per hour infusion during maintenance). Intraoperative hemodynamic parameters, blood loss, blood transfusion requirements, surgeon satisfaction, adverse drug effects, and free flap survival up to 7 days were recorded. The dexmedetomidine group achieved a mean arterial pressure (MAP) value between 60 and 70 mmHg at multiple time points (15min, 3rd, 4th, 5th, and 6th hours), while the fentanyl group did not reach this range at any time point. The intergroup statistical analysis revealed a significant difference only at the 5th hour with (95% CI: -16.17 to -0.62) and P = 0.036. Additionally, the dexmedetomidine group exhibited lower heart rates (< 70/min) at several time points (15min, 2nd, 3rd, 4th, 5th, and 6th hours) compared to the fentanyl group. The intergroup comparison indicated a statistically significant difference only at the 3rd hour with (95% CI: -20.94 to -0.45) and P = 0.042. Dexmedetomidine can be a useful adjuvant of GA for inducing controlled hypotension and decreasing bleeding in free flap surgery of the head and neck region without any detrimental effect on the free flap survival.

Activation of the Alpha 7 Nicotinic Acetylcholine Receptor by GTS-21 Mitigates Contrast Nephropathy in a Rat Model.

Contrast nephropathy (CN) is characterized by oxidative stress, vasoconstriction, tubular toxicity, and hypoxia of the renal medulla. We aimed to test the therapeutic effects of an α7 nicotinic acetylcholine receptor (nAChR) agonist, GTS-21, in an experimental CN model. Male Sprague-Dawley rats (n = 40) were divided into 4 groups: saline-treated control, GTS-21-treated control, contrast, and GTS-21-treated contrast groups. Starting on the 1st day, GTS-21 (4 mg/kg, intraperitoneally) or saline was administered twice a day for 3 days. CN was induced on the second day by intravenous injection of indomethacin (10 mg/kg), <sc>l</sc>-NAME (10 mg/kg), and a contrast agent with high osmolarity (6 mL/kg; Urografin 76%). At the 72nd hour, blood and kidney samples were obtained for the determination of biochemical, histological, and gene expression parameters. Compared to those in control rats, the elevated serum BUN level in the contrast group decreased with GTS-21 treatment, while H&amp;E staining and TUNEL assays showed that contrast-induced renal injury was improved by GTS-21. Moreover, GTS-21 treatment in the CN also increased the antioxidant glutathione level. In the contrast group, a significant increase in IL-6 expression and a decrease in TGF-β expression were observed; however, GTS-21 treatment decreased IL-6 expression and increased TGF-β expression. GTS-21 significantly alleviated renal injury parameters through antioxidant, anti-inflammatory, and antiapoptotic mechanisms in the CN model.

Anterior quadratus lumborum block provided superior pain control and reduced opioid consumption in kidney transplantation: A randomized controlled trial.

The research aimed to assess the effectiveness of inside-out anterior quadratus lumborum (QL3) block and local wound infiltration in managing postoperative pain and total morphine dosage following kidney transplantation. In this prospective, randomized, double-blind study; 46 end-stage renal disease patients undergoing kidney transplantation were randomly allocated into 2 groups: a QL group (n = 23) receiving 20 mL of 0.25% bupivacaine using the ultrasound-assisted inside-out technique before wound closure, while the local wound infiltration (LA) group (n = 23) receiving the same dose around the surgical wound and drain at the time of skin closure. The primary outcome measure was the numerical pain rating scale, with secondary outcomes including amount of morphine consumption at various postoperative time points (2nd, 4th, 6th, 12th, 18th and 24th hours). Patients in the QL group had significantly lower numerical rating scale scores at the 2nd and 4th hours, both at rest and during movement (P < .05). Although pain scores at rest and during movement at later time points were lower in the QL group compared to the LA group, these differences were not statistically significant. Cumulative morphine consumption at postoperative 4th, 6th, 12th, 18th and 24th hours was significantly lower in the QL group (P < .05). No patients experienced complications from the QL3 block. Ultrasound-assisted inside-out QL3 block significantly reduced postoperative pain levels at the 2nd and 4th hours, both at rest and during movement, and led to a reduction in cumulative morphine consumption from the 4th hour postoperatively, and persisting throughout the 24-hour period.

Prognostic significance of mean platelet volume to platelet count ratio in pediatric patients with acute kidney injury.

Mean platelet volume (MPV), which is regarded as a marker of thrombocyte function and activation, is related to increased morbidity and mortality. In critically ill patients, the ratio of MPV to platelets can independently predict adverse outcomes. This study aimed to investigate the prognostic value of the mean platelet volume/platelet count ratio (MPR) for mortality in children with acute kidney injury (AKI). In this retrospective study, patients hospitalized in the pediatric intensive care unit (PICU) between March 2020 and June 2022 were evaluated. Patients between 1 month and 18 years of age with AKI were enrolled. Clinical and laboratory data were compared between survivors and non-survivors. The MPR ratio was calculated on the first and third days of admission to the intensive care unit. A multiple logistic regression analysis was used to determine the association between MPR and mortality. ROC curves were used for the prediction performance of the logistic regression models and cut-off values of the thrombocyte indices. Sixty-three children with AKI were included in the study. The total mortality rate was 34.9% (n=22). MPR ratios were significantly higher in the non-survivors at admission (p=0.042) and at the 72nd hour (p=0.003). In the multiple logistic regression analysis, thrombocyte counts and MPR72h ratio were found to be independent risk parameters for adverse outcomes in children with AKI. MPR is an inexpensive and practical marker that may predict the outcome of children with AKI.

Intestinal Ultrasound in Diagnosis and Follow up of Patients with Crohn’s Disease

Abstract Background Crohn's disease (CD) causes transmural ulceration of any section of the gastrointestinal tract (GI), with the terminal ileum and colon being the most commonly affected. Aim of the Work The aim of this study is to assess the sensitivity &amp; specificity of Intestinal ultrasound In diagnosis and follow up of patients with Crohn’s Disease, and related possible complications. Patients and Methods A Cross sectional study in Gastroenterology Department of Ain Shams University Hospitals for 30 Patients with Crohn’s disease and The Patients were selected from inpatient and outpatient clinic of gastroenterology department of Ain Shams University Hospitals, in the period from July to December 2021. Results The present study revealed that the mean age of our patients was 54.3± 7.69 years with range from 38-68 years. Male cases were more than females ones, as (70%) were males while (30%) were females, with male to female ratio was 2.33: 1. The present study revealed that the mean hemoglobin level was 11.66 ± 1.46 mg/dl, and the mean RBC, 4.18±0.48. The mean platelets was 267.73±61.94 (K/UL), mean WBCs was 9.94 ± 1.83 (K/UL), neutrophils was 7648.57 ± 1460.02 (/UL), and lymphocytic count was 1356.50 ±469.30 (UL) and neutrophil/ lymphocyte ratio (NLR) was 5.93 ±1.35. Regarding the renal function tests and electrolyte profile, the mean serum urea, creatinine and uric acid were 46.43-±10.18, 1.10-±0.25 and 5.30-±0.68 mg/dl respectively. The mean levels of Na and K were 140.43 ±3.50 and 3.82±0.26 mEq/L respectively, the mean AST was 37.63 ±8.27 U/L, the mean ALT was 26.30 ±8.36 U/L, the mean total bilirubin was 1.01±0.17 mg/dl and the mean direct bilirubin was 0.60 ±0.27 mg/dl. We found that the mean PT was 14.17±2.65 sec. and the mean Serum Albumin was 4.16 ± 0.29 g/dl. In this study the mean CRP was 4.91 ±4.55, the mean ESR at first was 21.67 ±4.22 and 2nd hour was 47.43±10.94. Conclusion Crohn's disease (CD) is a progressive, inflammatory disease that occurs in genetically predisposed individuals and necessitates continuous monitoring and development of various methods for diagnostic and therapeutic treatment options, as well as the discovery of new medications. While colonoscopy is the gold standard in CD, US, CT and MRI, can provide information not only about the luminal side of the bowel but also about the serous side and the peripheral structure; additionally, US is repeatable, safe, and well-accepted, but unlike CT is radiation-free, and unlike MRI is inexpensive, virtually hazard-free, and available to all patients without contraindications.

A Comparative Study between Ultrasound Guided Pectoral Nerve Block Type II versus Intravenous Patient Controlled Analgesia for Intra-Operative and Post-Operative Analgesia in Patients Undergoing Modified Radical Mastectomy

Abstract Background Breast surgery is becoming more and more common. Patients are often middle-aged women and with high public awareness around issues of breast cancer. The numbers are increasing. Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Regional anaesthesia techniques may improve post-operative analgesia for patients undergoing breast surgery. Aim of the Work The primary aim of this study is to compare the efficacy of PECS block versus PCA with iv morphine to provide prolonged post-operative analgesia. The secondary objective is to identify the side effects of both techniques as post-operative analgesic techniques. Patients and Methods This study is a randomized clinical trial study conducted in Ain-shams University Hospitals, Cairo, Egypt for 6 months after medical ethical committee approval. The participants were allocated randomly into two groups of 25 patients each: group A: Patients received general anaesthesia followed by PECS block at the end of the operation before extubation, group B: Patients received general anaesthesia followed by the PCA at the end of surgery after extubation. Results The VAS score in the PECS group was statistically significantly lower at the 1st, 2nd and 4th hours. In this case, the use of PECS for postoperative analgesia is as effective as intravenous Morphine PCA in pain treatment, but with less systemic side effect as the nausea and vomiting is significantly higher in the PCA group than the PECS group at the 6th hour, however, the need of intra operative opioids in PCA group is significant. Conclusion In modified radical mastectomy, PECS block is as effective as intravenous Morphine PCA in pain treatment. Compared with intravenous PCA, PECS block can be considered as a more preferable method because it can avoid the systemic actions of morphine used for PCA, and can decrease the need of analgesia intra-operative, however PCA analgesic effect last longer, less invasive technique and easier to be used while PECS block require hand skills and limited to 24 hours analgesia only.

Estimation of Formaldehyde Levels in Indoor Air of Gross Anatomy Laboratory

Introduction: Medical students spend majority of their times in Anatomy lab during their first year MBBS. Formalin has attracted attention as a health hazard for students and instructors as formalin concentrations in air of gross anatomy laboratories are often higher than permissible limits. Despite the known toxicity of formaldehyde and its potential health effects, laboratory workers and others have little enthusiasm for reducing or replacing the formaldehyde working solution Materials and Methods: The FA concentration (in ppm) of indoor air in Anatomy laboratory was measured using a SMILEDRIVE Portable air quality pollution meter. The mean FA concentration was measured after 1 hour after the cadavers were shifted to dissection table at three different levels a. At the level of floor b. At the level of roof c. 2 feets above the table (Breathing Zone of medical students) Three air samples from the breathing zones were tested and mean concentration of FA was taken with exhaust fan on at the level of roof and recorded as a. S1R- First immediately before the dissection (Zero hour), b. S2R- Second sample was collected after one hour after first sample was taken (First hour) and c. S3R- Third sample after two hours after first sample was taken (Second hour). Three air samples from the breathing zones were tested and mean concentration of FA was taken with exhaust fan on at the level of floor and recorded as a. S1F- First immediately before the dissection (Zero hour), b. S2F- Second sample was collected after one hour after first sample was taken (First hour) and c. S3F- Third sample after two hours after first sample was taken (Second hour). Results: The vertical distribution of FA was measured by taking the mean air samples at the level of floor, at roof level and about 2 feet above dissection table immediately after the cadavers were shifted to tables. It was found to be about 0.54ppm at the level of floor, 0.52 at the breathing zone and 0.51 ppm at roof level. The FA concentration was highest at the level of floor and least at the level of roof. On comparing S2F and S2R the p value was 1.335. Thus, it was not statistically significant. On comparing S3F and S3R the p value was 0.411. Thus, it was not statistically significant. Conclusion: The mean FA at the level of floor was 0.54 ppm. At the breathing zone the mean FA concentration was 0.51 ppm before the dissection was started. Exhaust fans at the level of roof were switched on and the second sample was taken after 1 hour. The FA concentration was 0.23 ppm. Third sample was taken at 2nd hour and FA concentration was 0.11 ppm. The exhaust fans at the level of floor were switched on. The air samples were measured at 0, 1st and 2nd hour at breathing zones. It was 0.51, 0.31 and 0,15 ppm respectively.