2nd Hour Research Articles

Hot herbal compresses as therapy for reducing labor pain levels in the first stage of active phase in primigravida

HIGHLIGHTS 1. Labor pain, a physiological during labor, is regared as the most severe pain experienced by women.2. Hot herbal compress was provided as a therapy for reducing labor pain level in the first stage of active phase in primigravida.3. Hot herbal compress was found to have an effect as a therapy for reducing labor pain level in the first stage of the active phase of primigravida. ABSTRACT Objective: To prove the effect of providing hot herbal compresses as a therapy for reducing the level of labor pain in the first stage of the active phase of primigravida Materials and Methods: This was a true experimental study using pretest and posttest designs with control group. There was an intervention group (n=19) which was provided with hot herbal compress therapy for 20 minutes with a temperature between 37-51.5oC and a control group (n=19) receiving breathing exercise therapy. Respondents were selected by inclusion and exclusion criteria and randomization was carried out to determine whether the respondents were included in the intervention or control group by drawing lots. Results: Hot herbal compress therapy reduced the level of labor pain in the first active phase at the 1st hour treatment by 49.3% (p=0.000), the 2nd hour by 50.3% (p=0.000), and the third hour by 22.4% (p=0.009). Conclusion: Hot herbal compresses have an effect as a therapy for reducing pain levels of labor in the first stage of the active phase of primigravida.

Effectivity of Quadratus Lumborum Block in Pediatric Patient Undergoing Abdominal Surgery at Sanglah General Hospital: A Case Series

The Quadratus Lumborum Block (QLB) technique is a peripheral nerve block technique that aims to block pain in the abdominal area. This technique can be useful in surgeries with abdominal-pelvic incisions. In clinical studies, QLB have also been shown to provide less opioid consumption and longer postoperative analgesia than most of conventional procedures such as TAP (Transversus Abdominis Plane) blocks. Our case series study included five patients undergoing abdominal procedure with QLB approach. Mean age of patients included in this study was 2,8 years old; mean weight of 15,2 kg; mean height of 98,8 cm and mean BMI of 71 kg/m2. All patients were classified as ASA physical status I-II. Mean duration of operation was 94 minutes, and mean total opioid used was 6,6 mg. The pain severity score in FLACC was 0 in all patients at 0, 1st and 2nd hours post-operatively. However, the FLACC score at 4th hours were variable with a maximum score of 3. All patients had the FLACC score of 0 after the 4th hours. This study concludes that QLB is an effective analgesic option for patients undergoing abdominal procedure reflected by lower pain intensity using FLACC scoring system and reduced post-operative analgesic consumption. Keywords: Quadratus Lumborum Block, Post-Operative Analgesia, Opioid.

An open-label clinical trial of oral transmucosal haloperidol and oral transmucosal olanzapine in the treatment of terminal delirium at home

BackgroundThe phenomenon of restlessness, agitation, or cognitive disturbances experienced by dying patients is well-known in palliative care; more than half of these patients will experience delirium symptoms at end-of-life. When not identified early and effectively managed, delirium symptoms could lead to caregiver and patient distress and harm.MethodsEighty patients with a prognosis of 7 days or less will be recruited for an open-label randomised control trial. The two arms compare oral-transmucosal haloperidol 2.5 mg vs olanzapine 5 mg over 72 h. The severity of agitation, delirium and toxicities of treatments will be compared at the 24th, 48th and 72nd hour after drug administration.DiscussionThis trial is the first to compare anti-psychotics in the management of delirium at the dying stage in the home hospice setting using the oral transmucosal route. Ethical considerations, as well as recruitment procedures, are discussed.Trial registrationThis study was registered in ClinicalTrials.gov – identifier NCT04750395

Alteration in central vascular and cognitive functions during simulated work conditions in males – a secondary analysis from a randomised controlled trial

Background: Alteration in the central vascular hemodynamics is speculated to influence cognitive functions, including executive functions in young adults. Prolonged sitting is associated with compromised central vascular functions, which activity micro-breaks could mitigate. However, the association between the carotid vascular hemodynamic alteration and the executive functions is yet to be explored. Methods: We administered a randomised controlled trial investigating the effects of various intensities' micro-breaks on central vascular and cognitive functions during simulated work conditions for four hours. The carotid artery hemodynamics and cognitive functions were measured by Duplex ultrasound at 0th, 2nd and 4th hour and computer-based Flanker tests at 0th, 1st, 2nd, 3rd and 4th hour of visit days, respectively. From the randomised controlled trial, we extracted the secondary data of carotid artery hemodynamics and cognitive functions change at the 4th hour from the baseline and analysed for any relation. Results: Though we observed linear relation between the carotid artery hemodynamics and the executive functions, the relation was not statistically significant. we found a significant reduction in carotid artery diameter during prolonged sitting (0.03 cm [95%CI 0.01, 0.05]), velocity (10.35 cm/s [95%CI -2.85, 17.86]) and shear rate during interrupted sitting (174.39 [95%CI 65.67, 283.11]) We found increased accuracy during prolonged sitting (12.7% [95%CI 0.66, 24.81]) and sitting with light-intensity activity breaks (6.92% [95%CI 1.39, 12.44]). We did not find any significant relation between the change in central vascular functions (carotid artery diameter, velocity, shear rate and blood flow) and the cognitive functions during three different work conditions. Conclusion: Though a significant relation between carotid artery function and cognitive function could not be established, microbreaks can mitigate the vascular and cognitive risks associated with prolonged sitting.

Effect of low-dose intravenous ketamine on postoperative pain following cesarean section under spinal anesthesia: A prospective cohort study, Ethiopia

BackgroundFollowing cesarean delivery, mothers experience moderate to severe pain since postoperative analgesia of spinal anesthesia is limited by duration of local anesthetic agents used. Analgesic effect of local anesthetic agents could be extended and supported by adding either intravenous or intrathecal adjuvants. The primary outcome of this study is to assess effect of low-dose intravenous ketamine on postoperative pain following cesarean section under spinal anesthesia. Materials and methodsThis prospective observational cohort study recruits 60 parturients who underwent elective cesarean delivery under spinal anesthesia. Those parturients who received intravenous ketamine 0.25 mg/kg following spinal anesthesia were considered as exposed group/ketamine group. The Non-exposed group was those parturients who didn't receive intravenous ketamine following spinal anesthesia. Numerical rating scale pain score, time to request first analgesia and total analgesia consumptions were recorded starting from 1st hour to 24 h after the end of surgery. ResultsThe median and Inter quartile range (IQR) for postoperative numerical rating scale pain score was significantly higher in non-exposed group compered to ketamine group at 1st and 2nd hour after operation (P-value<0.05). Time to request first analgesia was significantly longer in ketamine group [192.5(140–210) minutes] compared to non-Exposed group [146(130–160) minutes] with P-value < 0.001. Tramadol consumption within 24 h postoperatively were significantly lower in ketamine group compared to non-exposed group (P-value < 0.001). ConclusionLow dose intravenous ketamine before skin incision was extended postoperative first analgesia request time by average of 45.5 min and decrease total analgesia consumption in 24 h.

What are the independent parameters associated with increased mortality risk in patients with severe sepsis or septic shock in the intensive care unit?

Objective: Determining the factors associated with prognosis in patients with sepsis admitted to the intensive care unit who were treated according to international guidelines. Patients were evaluated with respect to treatment results, morbidity and mortality rates, infection foci and pathogens.&#x0D; Materials and Methods: A total of 43 patients with severe sepsis who were treated in Trakya University Medical Faculty, Department of Medical Intensive Care, between July 2009 and December 2009, were enrolled in this prospective observational study. Patients were grouped as survivors and non-survivors. Clinical characteristics and APACHE II, SAPS II, SOFA scores were recorded. Factors associated with mortality were analyzed by Cox regression.&#x0D; Results: Overall mortality rate was 23.2%. Patients with failure in three or more organs had higher mortality (p = 0.001). Also, mortality rates were higher in patients with cardiovascular, renal, hematological and neurological failure in the first day (p = 0.002, p = 0.011, p = 0.020, p = 0.019, respectively). All scores at the 24th and 72nd hours were significantly higher in the non-survivor group compared to survivors (p

Efficacy of Intravenous Ibuprofen and Intravenous Paracetamol in Multimodal Pain Management of Postoperative Pain After Percutaneous Nephrolithotomy

PurposeMany different techniques, including multimodal analgesia, have been used for the management of postoperative pain after Percutaneous nephrolithotomy (PCNL). Ketorolac, intravenous (IV) paracetamol, rofecoxib, and IV ibuprofen have been used as a part of a multimodal analgesic approach in different surgical procedures. However, the efficacy of IV ibuprofen has not been well elucidated in adult patients undergoing elective PCNL. The aim of the study was to examine the efficacy of IV ibuprofen compared to IV paracetamol after elective PCNL. DesignThis was a prospective randomized clinic study. MethodsThe study was conducted with 50 patients scheduled for PNCL between the ages of 18 and 65. IV ibuprofen 800 mg infusion was used for Group I, and 1 g IV paracetamol infusion Group P. IV tramadol infusion was administered with a Patient Controlled Analgesia device for postoperative analgesia. The primary outcome was 24-hour tramadol consumption. Secondary outcomes were pain intensity and side effects of the drugs. All outcomes were recorded in the 30th minute in the PACU and in 2, 4, 6, 12, 24 hours postoperatively. FindingsTotal postoperative tramadol consumption was significantly lower in Group I compared with Group P (P = .031). There was also a significant decrease in the cumulative tramadol consumption between the two groups in the 2nd and 24th hours (P < .012). In all measurement periods, pain intensity, sedation score, nausea and vomiting, itching, additional analgesia, and satisfaction with pain management were similar between the two groups. ConclusionIV ibuprofen, used as a part of multimodal tramadol-based analgesia reduced tramadol consumption compared with IV paracetamol in the first 24 hours postoperatively after elective PCNL. The IV ibuprofen-tramadol combination seems appeared superior to a paracetamol-tramadol combination.

Evaluation of an ex vivo model of the blood-perfused equine uterus

Uterine pathologies are the most common causes of infertility in mares. This study aimed to establish an ex vivo blood-perfused model for equine uteri and investigate the possible effects of different cycle stages (estrus, diestrus and anestrus) on the applicability of the model. Uteri (n = 13) were collected at an abattoir, flushed with preservation solution, transported to the laboratory on ice, and isolated perfused with autologous blood for 6 h (n = 12). For negative control, one uterus was handled as described but left without perfusion for 6 h. The cycle stage was determined by examination of the ovaries for the presence of Graafian follicles or corpora lutea and analysis of plasma progesterone concentration (estrus: n = 4; diestrus: n = 4; anestrus: n = 4). Sonomicrometry crystals were implanted into the myometrium to record spontaneous contractions and the response to 0.5 IU oxytocin after 6 h of perfusion. Analyses of the arterial and venous perfusate were performed every hour to determine glucose consumption, lactate production, pH, lactate dehydrogenase activity (LDH), and potassium concentration (K+). Biopsy samples were obtained directly after slaughter, after transportation, after equilibration, after 4, 5, and 6 h of perfusion, and immediately after removal from the perfusion system. The uteri's glucose consumption and lactate production increased over time (p < 0.05), but no differences among cycle stages were detected. pH (arterial and venous) increased over time (p < 0.05). No changes for LDH were observed. K+ increased after 4 h of perfusion (p < 0.05), but was unaffected by the cycle stage. Spontaneous contractions were present in all perfused uteri, but myometrial activity in the negative control was limited to the 2nd hour of perfusion. No effects of cycle stage on contraction amplitude and duration after oxytocin administration were detected. The cycle stage did not affect frequency (except after 5 h of perfusion), amplitude, duration of contractions, or edema formation. Histology revealed congestion of endometrial capillaries after 4, 5, and 6 h perfusion time. In conclusion, the ex vivo model was capable of supporting the functionality of equine uteri for 6 h. However, viability and histomorphology of the endometrium appeared to be impaired after 4 h of perfusion. Effects of the cycle stage on the applicability of the model were absent.

Chemical, Biological &amp; Pharmacological Investigations of Different Fractional Extracts of Passiflora edulis Sims. (Family: Passifloraceae)

In the evaluation of antimicrobial activity, antibacterial activity of ethanol, chloroform &amp; n-hexane extracts of P. edulis was tested against 10 bacteria at concentrations of 500µg/disc. Standard antibiotic disc of Azithromycin (30 µg/disc) was used for the comparison. The extracts showed no activity against gm (+ve) &amp; gm (-ve) bacteria at a concentration of 500 µg/disc. Antifungal activity of ethanol, chloroform &amp; n-hexane extracts of P. edulis was tested against 7 fungi at concentrations of 500µg/disc. Standard antifungal disc of Fluconazole (30 µg/disc) was used for the comparison. In antifungal screening the chloroform extract showed activity against A. fumigatus (15nm). In DPPH scavenging assay the ethanol extract of leaves showed maximum % inhibition of 73.41% at 100μg/ml while the standard ascorbic acid showed % inhibition of 82.14% at the same concentration. The DPPH radical scavenging activity was increased by increasing the concentration of the sample extract. The extract exhibited considerable DPPH free radical scavenging activity as indicated by their IC50 values which indicate the potency of scavenging activity. Standard ascorbic acid was found to have an IC50 of 1.66μg/ml. In comparison to standard ascorbic acid, ethanol extract of P. edulis showed of an IC50 of 2.57μg/ml. In the evaluation of anti-inflammatory activity by albumin denaturation assay method, the percent inhibition of protein denaturation in the experiment of ethanol extract of leaves of P. edulis was found to be 55.454% at 500μg/ml, 49.818% at 250μg/ml and 41.818% at 125μg/ml. The extract possesses significant activity comparable with that of the standard acetyl salicylic acid which showed percent inhibition of protein denaturation of 91.945%, 88.181% and 45.454% in the same concentration range. In this analgesic activity study using Eddy’s hot plate method in mice, the ethanol extract of P. edulis showed mild analgesic activity. After 30 minutes of administration of standard drug (Diclofenac 9 mg/kg), mean latency was found to be 17.34sec. While the extract at concentration of 400 mg/kg exposed mean latency of 6.67sec. Respectively. During antipyretic activity by Brewer’s yeast induced pyrexia method in mice, the ethanol extract of leaves of P. edulis produced moderate antipyretic activity. In this test, the extract reduced temperature from 102.4°F to 99.84°F (p=0.151188), 98.74°F (p=0.070485), 98.6℉ (p=0.056108), 98.37℉ (p=0.039072) and 98.27°F (p=0.110528) in 1st, 2nd, 3rd, 4th and 5th hour respectively and caused maximum reduction of temperature in 1st hour. During antidiarrhoeal activity by castor oil induced test in mice, the ethanol extract of P. edulis produced moderate antidiarrheal episode. The latent period and the total diarrheic faces were found to be 0.978 hr &amp; 8.34 at 500 mg/kg for P. edulis as compared to standard (Loperamide 3mg/kg) 2.845 hr &amp; 5.34. In the sedative and hypnotic activity by using open field box, hole cross box and swing Test method on swiss albino mice ethanol extract of P. edulis showed moderate sedative and hypnotic activity. During the open field test, squares crossed by the group receiving standard Diazepam and ethanol extract of leaves of P. edulis were 63 and 84.34 respectively. During the swing test, number of swings observed after administration of standard Diazepam and ethanol extract of leaves of P. edulis were 3.67 and 8.67 respectively. During diuretic activity by using the Lipschitz test in mice, ethanol, n-hexane and chloroform extracts of P. edulis (500mg/kg body wt.) showed no activity compared to standard drug Furosemide (20mg/kg body wt.)

Comparison of Three Different Surgical Techniques in Patients Undergoing VATS and Open Thoracotomy

This study aimed to determine the impact of surgical approach on postoperative recovery, quality of life, and satisfaction level in patients undergoing uniportal or multiportal video-assisted thoracoscopic surgery (VATS) or open thoracotomy. This prospective study included patients who underwent open thoracotomy, uniportal VATS, or multiportal VATS in a tertiary Hospital between January 1, 2019 and May 1, 2021. Recovery was evaluated at postoperative 24th, 48th, and 72nd hours, and 1 month using the Postoperative Recovery Index (PoRI); quality of life was evaluated using the Short Form 36 (SF-36) at postoperative 1 month; and patient satisfaction\was assessed with visual analog scale (VAS) at postoperative 72nd hours and at 1 month. Of 215 patients screened, 163 patients met the inclusion criteria. Women had higher PoRI values than men at postoperative 24th, 48th, and 72nd hours. Open thoracotomy was associated with higher PoRI values, lower SF-36 scores (except social functioning), and lower satisfaction at postoperative 72nd hours compared to VATS. Patients in the uniportal and multiportal VATS groups had similar postoperative recovery, satisfaction, and quality of life outcomes. Satisfaction was similar in all groups at 1 month. Both uniportal and multiportal VATS were superior to open thoracotomy in terms of postoperative recovery, quality of life, and patient satisfaction. Long-term studies with larger patient populations comparing uniport and multiport VATS are needed.

Abstract No. : ABS3199: Comparison of self-selected music and prefixed music on reduction of perioperative Anxiety in adult Patients undergoing laparoscopic surgeries under general Anaesthesia

Background &Aims:Preoperativeanxiety in patientsis associated with psychological effects.The current study aimed to compare the effects of self selected(SS) musicand prefixed (PF) musicin reducing preoperative anxiety.Methods:In this study, 90 patients posted for laparoscopic cholecystectomy were randomly divided into three groups equally. Patients in group SS and group PF listened toSSand PFfor 20 minutes in preoperative roomrespectively. Music continued until reversal of anaesthesia. Vitals of patients, VASscore for pain and post operative nausea and vomiting (PONV)score were noted at 1st and 2nd hour after surgery.Results:There was a statistically significant difference in anxiety score between SS and PF (p<0.05), between SS and Control(C)(p<0.05) and between PF and C (p<0.05). After music intervention of 20 minutes , heart rate, SBP at T2 was significantly reduced in SS and PF. At T5, thePONVscore was lower in SS and PF than C. There was significant difference in PONV score between SS and C (p<0.0001) and between PF and C (p<0.0003) There was significant difference inVASscore between SS and PF (p<0.05) , between SS and C (p<0.0001) and between PF and C (p<0.0001)Conclusion:SSmusic was more effectiveandenabled to maintain stable haemodynamic parameters throughout the surgery in reducing anxiety than PFmusic. PONV scores were comparable between SS and PFmusicgroups. SS music was more efficient in providing pain relief than PF music.

Anti-inflammatory Activity of Water Extract of Luvunga sarmentosa (BI.) Kurz Stem in the Animal Models

The study was aimed to determine the anti-inflammatory activity of water extract of the Luvunga sarmentosa stem in an animal model. Twenty-five Wistar rats were divided into five groups (n=5). Group 1 was administered 0.9% normal saline (negative control), group 2 was administered 150 mg/kg diclofenac sodium (positive control), and groups 3 to 5 were administered 50, 300, and 550 mg/kg BW of L. sarmentosa extract, respectively. Carrageenan was injected subcutaneously into each rat's subplantar region of the left hind paw. The paw volume was measured using a plethysmometer. The results showed that the water extract of L. sarmentosa stem (doses of 50, 300, and 550 mg/kg BW) significantly reduced the paw edema volume from the 4th to 5th hour compared to the negative control. The percent inhibition of edema at the 5th hour is 47.45; 46.95; 50.39%. The first phase of the edema (1st and 2nd hour) was not affected by the extract. Meanwhile, diclofenac sodium decreased paw edema volume from the 1st to 5th hour with a percent inhibition of 95.90% at the 5th hour. The histopathology result is relevant to the percentage inhibition of edema. Treatment with L. sarmentosa extract showed slight improvement, destruction of epidermal tissue, hyperkeratotic skin, and subepidermal edema. Meanwhile, positive control showed no inflammatory signs with normal keratin, subepidermal, and subcutaneous layers. The water extract of L. sarmentosa stem has anti-inflammatory activity. This extract effectively reduces the paw edema volume in the late phase with decreased neutrophil infiltration.

Comparison of Recovery Profiles of Patients Undergoing Endoscopic Lumbar Discectomy under Desflurane, Propofol, or Sevoflurane Anesthesia: A Randomized, Prospective, Clinical, Comparative Study

Background Agents like propofol, sevoflurane, and desflurane having rapid revival of psychomotor and cognitive functions translating into reliable anesthetic recovery are chosen for day care procedures. This prospective randomized comparative study was undertaken to compare the psychomotor and cognitive functions of patients undergoing discectomy under different anesthetic strategies. Methods Seventy-five adult American Society of Anesthesiologists grade I and II patients being operated for endoscopic lumbar discectomy under different anesthetic regimens were enrolled and were subjected to Trieger Dot Test (TDT), Digit Symbol Substitution Test (DSST), and Mini-Mental State Examination (MMSE) preoperatively at specified intervals postoperatively. There emergence and early recovery times, complications, and satisfaction levels were also noted. Results No difference was found in the postoperative TDT and DSST and MMSE scores among the groups at all the time points (15 minutes, 3 minutes, 1 hour, 2 hours, 3 hours, and 4 hours). TDT and DSST demonstrated a tendency to return to baseline by 2nd and 3rd hour postoperatively. Emergence and early recovery times were earlier in the inhalation groups ( p 0.005 and 0.007, respectively). Time required to attain a Modified Aldrete Score of 9, complications, and observed side effects were similar among the groups. Conclusion Patients in the three groups had similar impairments in their psychomotor and cognitive functions which recovered at comparable time periods postoperatively. Emergence and early recovery were, however, faster in the desflurane group.

Synthesis a group of 5(6)‐substituted benzimidazole Zn(II) and Co(II) complexes and investigation their cytotoxic and antimicrobial activities

AbstractA series of 5(6)‐substituted benzimidazole ligand‐zinc(II) and cobalt(II) complexes were synthesized and characterized by1H,13C NMR, IR, CHN analysis techniques. In vitro, anticancer and antimicrobial activities of ligand and complexes were evaluated. The cytotoxic activities of compounds were investigated against the human lung adenocarcinoma (A549) cell lines and healthy human lung bronchial epithelium (BEAS2B) cells. Compounds1,6, and8were observed to exhibit higher cytotoxic activity than the others at the 72nd hour. Also, the compounds showed varying degrees of antimicrobial activity against the microorganisms used. Compounds1,5, and8were most effective against standard strainsPseudomonas aeruginosaATCC 27853 andStaphylococcus aureusATCC 29213. As for the antifungal activity, compounds1,5,6, and8showed high antifungal activity against the yeast type fungiCandida albicansATCC 90028 andCandida tropicalis.

Efficiency of femoral nerve block for recovery after primary total knee arthroplasty

BackgroundFemoral nerve block (FNB) is a suitable option for pain management and recovery after total knee arthroplasty (TKA). It is usually used along with a multimodal analgesia protocol. The major disadvantage of FNB is the risk of quadriceps muscle strength loss. This study aims to compare the efficiency of the FNB with two different concentrations of bupivacaine for recovery after TKA. We primarily aim to provide adequate analgesia with a lower concentration of bupivacaine (0.125%) rather than the usual concentration (0.25%). Secondarily, we aim to compare the degree of motor block, opioid consumption, and ambulation time between the groups. The study was conducted as randomized, controlled, and double-blind. Sixty three patients were randomized into three groups: G125 (n:21) received FNB with 20ml of 0,125% bupivacaine, G25 (n:21) received 10ml of 0,25% bupivacaine and GCont (n:21) received no block.ResultsFor GCont, pain scores were significantly higher at 2nd, 6th, 12th, and 24th hours postoperatively, total opioid consumption was higher (G125: 75 mg, G25: 0 mg, GCont: 280 mg, p < 0.001) and first opioid demand time was earlier (G125: 12th hour, G25:21st hour GCont:2nd hour, p: 0.002). First knee flexion time and ambulation time were also delayed for GCont. G25 had lower scores for quadriceps muscle strength (manual test at 6th hour, G25: 3/5, G125: 4/5, GCont:5/5, p < 0.001) compared to other groups.ConclusionsG125 had lower quadriceps muscle strength loss compared to the G25; earlier ambulation and flexion times, low opioid consumption, and low pain scores compared to the control group. In this respect, we believe the femoral nerve block with 0.125% bupivacaine proves to be a suitable option for analgesia with the potential of maintaining enough muscle strength for recovery after TKA.Trial registrationClinicalTrials.gov Protocol Registration and Results System, NCT03623230. Registered 09 August 2018, at https://clinicaltrials.gov/ct2/show/NCT03623230

Nesfatin-1 ameliorates oxidative brain damage and memory impairment in rats induced with a single acute epileptic seizure

AimsWe aimed to investigate putative neuroprotective effects of nesfatin-1 on oxidative brain injury and memory dysfunction induced by a single epileptic seizure and to compare these effects with those of antiepileptic phenytoin. Main methodsWistar albino rats were randomly divided into a control group and pentylenetetrazole (PTZ)-seizure groups pretreated intraperitoneally (ip) with saline or nesfatin-1 (NES-1; 0.3, 1 or 3 μg/kg/day) or phenytoin (PHE; 40 mg/kg/day) or PHE + NES-1 (0.3 μg/kg/day) at 30 min before the single-dose PTZ injection (45 mg/kg; ip). All treatments were repeated at the 24th and 48th h of the provoked epileptic seizure. Passive-avoidance test was performed to assess memory function. The rats were decapitated at the 72nd hour of seizures and brain tissues were analyzed for histopathological changes and for measuring levels of malondialdehyde, glutathione, myeloperoxidase activity and reactive oxygen/nitrogen species. Key findingsIn parallel to the effects of phenytoin, NES-1 reduced seizure score, elevated antioxidant glutathione content, depressed generation of nitric oxide and protected against seizure-induced neuronal damage. Additionally, increased malondialdehyde levels and elevated glial fibrillary acidic protein immunoreactivity in the cortex and hippocampus were decreased and memory dysfunction was improved by NES-1. However, NES-1 had no impact on myeloperoxidase activity or production of reactive oxygen species in the brain. SignificanceThe findings of the present study demonstrate that nesfatin-1 treatment provides neuroprotection against seizure-induced oxidative damage and memory dysfunction by inhibiting reactive nitrogen species and upregulating antioxidant capacity, indicating its potential in alleviating memory deficits and increasing the effectiveness of conventional anti-convulsant therapies.

Evaluation of Anti-Diabetic and Anti-Hyperlipidemic Activities of Hydro-Alcoholic Crude Extract of the Shoot Tips of Crinum abyssinicum Hochst. ex A. Rich (Amaryllidaceae) in Mice.

BackgroundDespite the availability of synthetic antihyperglycaemic medications on the market, diabetes is on the rise. Though not scientifically proven, the Crinum abyssinicum Hochst. ex A. Rich. (Amaryllidaceae) has been used traditionally to treat diabetes. Crinum abyssinicum was tested in mice to see if it had anti-diabetic and anti-hyperlipidemic properties.MethodsThe hydro-alcoholic extract of Crinum abyssinicum shoot tips doses (100 mg/kg, 200 mg/kg, and 400 mg/kg) were administered to normoglycemic, oral glucose-loaded mice, and single and repeated dose-treated streptozotocin-induced diabetic model. Then, the blood glucose levels were measured for normoglycemic, oral glucose loaded and single dose treated streptozotocin model. Whereas in repeated dose-treated streptozotocin induced diabetic model, blood glucose level, body weight, and lipid profiles were measured.ResultsAfter oral administration, all extract doses (100 mg/kg (p < 0.01), 200 mg/kg (p < 0.001), and 400 mg/kg (p < 0.001)) significantly reduced blood glucose level of normal mice as compared to the control group. Significant reduction of post-prandial glucose was achieved with crude extract at a tested dose of 100 mg/kg (p < 0.05) both at 1st and 2nd hours; 200 mg/kg (p < 0.01) at the 1st hour and (p < 0.001) 2nd hours, and 400 mg/kg (p < 0.001) at the 1st and 2nd hours as compared to the negative control. In diabetic mice, the crude extract 200 mg/kg and 400 mg/kg; and glibenclamide 5 mg/kg significantly reduced (p < 0.001) blood glucose level on the 14th day as compared to the negative control. All doses of crude extract significantly improved the lipid profiles and the bodyweight of diabetic mice.ConclusionThese findings revealed that the hydro-alcoholic extract of Crinum abyssinicum shoot tips possess significant antihyperglycemic, antihyperlipidemic, and body weight improvements in streptozotocin-induced diabetic mice. Besides, it showed hypoglycaemic and anti-hyperglycaemic activities on normoglycemic and oral glucose loaded mice, respectively. These justify the claimed use of the plant in ameliorating diabetes mellitus in Ethiopian folk medicine.

Efficacy of preoperative transversus abdominis plane block in acute appendicitis pain and its success in postoperative pain: a retrospective study.

The aim of this study is to determine the analgesic efficacy of Transversus Abdominis Plane (TAP) block applied before anesthesia on preoperative abdominal pain and postoperative surgical pain in acute appendicitis. Among the patients aged 18 years and older who underwent open appendectomy with the diagnosis of acute appendicitis, patients who underwent TAP block were identified retrospectively. To the aim of this study, demographic data of the patients, preoperative change in pain scores at rest and with coughing, postoperative pain scores, need for postoperative analgesics were evaluated. Twenty-two patients who underwent preanesthetic lateral TAP block were accepted as the sample of the study. Preoperative 0th minute resting and rebound pain scores due to appendicitis before TAP block were 4.63 and 7.63, respectively. Resting and rebound pain scores at the 1st, 3rd, 5th, 10th, 15th, and 20th minutes after TAP block were respectively 2.95, 2.04, 1.27, 0.68, 0.50, 0.45 and 5.59, 4.68, 3.72, 2.77, 2.22, 1.86. Both resting and rebound pain scores decreased from the 1st minute to the 15th minute, with a statistically significant difference (p<0.05). The mean pain scores at the 1st, 2nd, 6th, 12th and 24th hours postoperatively were 3.72, 2.81, 2.13, 1.86, and 1.5, respectively. Six patients did not need analgesics in the first 24 hours. Opioid was administered to only one patient postoperatively. TAP block provides effective analgesia in the preoperative abdominal pain treatment of acute appendicitis cases. It also shows that effective postoperative analgesia can be achieved even when applied preoperatively.

An analysis on the adjuvant efficacy of intravenous or perineural administered dexamethasone in erector spina plane block applied to patients who had thoracotomy: a prospective randomized double-blind study

Aim: Thoracic surgery is one of the surgical procedures that necessitates effective pain management both before and after the procedure. Because of the adverse effects of opioids in thoracic surgeries, regional anesthesia has been widely used for postoperative analgesia. One of the most recent techniques used with this indication is erector spina plane block (ESPB). Many studies in regional anesthesia have shown that adding dexamethasone to local anesthetics as an adjuvant agent prolongs the analgesic effect. The purpose of the present study was to assess the effect of dexamethasone, which is used as a perineural and intravenous adjuvant, on the duration and level of analgesia of ESPB used in thoracic surgeries.&#x0D; Material and Method: This prospective, randomized controlled study included 60 patients who would have a thoracotomy under general anesthesia and ESP for peri-operative analgesia. Patients were divided into three groups: those who received perineural dexamethasone (Group PN), those who received IV dexamethasone (Group IV), and those who did not receive any dexamethasone at all (Group C-Control). Numerical rating scale (NRS) scores, rescue analgesic drug use and block times were recorded at the postoperative 2nd, 6th, 12th, 24th and 36th hours.&#x0D; Results: There was no statistically significant (p&gt;0.05) difference in blocking times or additional analgesic use between the three groups. There was no statistically significant (p&gt;0.05) difference in the NRS scores when the patients’ pain levels were measured in all three groups. 36th hour NRS scores and additional analgesic use were higher in the group that did not receive IV or perineural dexamethasone.&#x0D; Conclusion: NRS scores and rescue analgesic use were similar between ESPB groups with intravenous or perineural addition of 4 mg dexamethasone and ESPB group administered without dexamethasone. However, the NRS score average in the group C was greater than 3, particularly in the 36th hour NRS data, whereas the NRS scores in the group PN and group IV were less than 2.

The ICEBERG: A score and visual representation to track the severity of traumatic brain injury: Design principles and preliminary results.

Establishing neurological prognoses in traumatic brain injury (TBI) patients remains challenging. To help physicians in the early management of severe TBI, we have designed a visual score (ICEBERG score) including multimodal monitoring and treatment-related criteria. We evaluated the ICEBERG scores among patients with severe TBI to predict the 28-day mortality and long-term disability (Extended Glasgow Outcome Scale score at 3 years). In addition, we made a preliminary assessment of the nurses and doctors on the uptake and reception to the use of the ICEBERG visual tool. This study was part of a larger prospective cohort study of 207 patients with severe TBI in the Parisian region (PariS-TBI study). The ICEBERG score included six variables from multimodal monitoring and treatment-related criteria: cerebral perfusion pressure, intracranial pressure, body temperature, sedation depth, arterial partial pressure of CO 2 , and blood osmolarity. The primary outcome measures included the ICEBERG score and its relationship with hospital mortality and Extended Glasgow Outcome Score. The hospital mortality was 21% (45/207). The ICEBERG score baseline value and changes during the 72nd first hours were more strongly associated with TBI prognosis than the ICEBERG parameters measured individually. Interestingly, when the clinical and computed tomography parameters at admission were combined with the ICEBERG score at 48 hours using a multimodal approach, the predictive value was significantly increased (area under the curve = 0.92). Furthermore, comparing the ICEBERG visual representation with the traditional numerical readout revealed that changes in patient vitals were more promptly detected using ICEBERG representation ( p < 0.05). The ICEBERG score could represent a simple and effective method to describe severity in TBI patients, where a high score is associated with increased mortality and disability. In addition, ICEBERG representation could enhance the recognition of unmet therapeutic goals and dynamic evolution of the patient's condition. These preliminary results must be confirmed in a prospective manner. Diagnostic Tests or Criteria; Level III.