Dextrose In Water Research Articles

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses.

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment, and recently, ultrasound-guided perineural injection (UPIT) and percutaneous flexor retinaculum release (UPCTR) have been utilized to treat CTS. However, no systematic review or meta-analysis has included both intervention types of ultrasound-guided interventions for CTS. Therefore, we performed this review using four databases (i.e., PubMed, EMBASE, Scopus, and Cochrane) to evaluate the quality of evidence, effectiveness, and safety of the published studies on ultrasound-guided interventions in CTS. Among sixty studies selected for systemic review, 20 randomized treatment comparison or controlled studies were included in six meta-analyses. Steroid UPIT with ultrasound guidance outperformed that with landmark guidance. UPIT with higher-dose steroids outperformed that with lower-dose steroids. UPIT with 5% dextrose in water (D5W) outperformed control injection and hydrodissection with high-volume D5W was superior to that with low-volume D5W. UPIT with platelet-rich plasma outperformed various control treatments. UPCTR outperformed open surgery in terms of symptom improvement but not functional improvement. No serious adverse events were reported in the studies reviewed. The findings suggest that both UPIT and UPCTR may provide clinically important benefits and appear safe. Further treatment comparison studies are required to determine comparative therapeutic efficacy.

Evidence That Binding of Cyclic GMP to the Extracellular Domain of NKA (Sodium-Potassium ATPase) Mediates Natriuresis.

Extracellular renal interstitial guanosine cyclic 3',5'-monophosphate (cGMP) inhibits renal proximal tubule (RPT) sodium (Na+) reabsorption via Src (Src family kinase) activation. Through which target extracellular cGMP acts to induce natriuresis is unknown. We hypothesized that cGMP binds to the extracellular α1-subunit of NKA (sodium-potassium ATPase) on RPT basolateral membranes to inhibit Na+ transport similar to ouabain-a cardiotonic steroid. Urine Na+ excretion was measured in uninephrectomized 12-week-old female Sprague-Dawley rats that received renal interstitial infusions of vehicle (5% dextrose in water), cGMP (18, 36, and 72 μg/kg per minute; 30 minutes each), or cGMP+rostafuroxin (12 ng/kg per minute) or were subjected to pressure-natriuresis±rostafuroxin infusion. Rostafuroxin is a digitoxigenin derivative that displaces ouabain from NKA. Renal interstitial cGMP and raised renal perfusion pressure induced natriuresis and increased phosphorylated SrcTyr416 and Erk 1/2 (extracellular signal-regulated protein kinase 1/2)Thr202/Tyr204; these responses were abolished with rostafuroxin coinfusion. To assess cGMP binding to NKA, we performed competitive binding studies with isolated rat RPTs using bodipy-ouabain (2 μM)+cGMP (10 µM) or rostafuroxin (10 µM) and 8-biotin-11-cGMP (2 μM)+ouabain (10 μM) or rostafuroxin (10 µM). cGMP or rostafuroxin reduced bodipy-ouabain fluorescence intensity, and ouabain or rostafuroxin reduced 8-biotin-11-cGMP staining. We cross-linked isolated rat RPTs with 4-N3-PET-8-biotin-11-cGMP (2 μM); 8-N3-6-biotin-10-cAMP served as negative control. Precipitation with streptavidin beads followed by immunoblot analysis showed that RPTs after cross-linking with 4-N3-PET-8-biotin-11-cGMP exhibited a significantly stronger signal for NKA than non-cross-linked samples and cross-linked or non-cross-linked 8-N3-6-biotin-10-cAMP RPTs. Ouabain (10 μM) reduced NKA in cross-linked 4-N3-PET-8-biotin-11-cGMP RPTs confirming fluorescence staining. 4-N3-PET-8-biotin-11-cGMP cross-linked samples were separated by SDS gel electrophoresis and slices corresponding to NKA molecular weight excised and processed for mass spectrometry. NKA was the second most abundant protein with 50 unique NKA peptides covering 47% of amino acids in NKA. Molecular modeling demonstrated a potential cGMP docking site in the ouabain-binding pocket of NKA. cGMP can bind to NKA and thereby mediate natriuresis.

Sodium bicarbonate alters protein stability and blood coagulability in a simulated Impella purge gap model.

The Impella® microaxial blood pumps utilize purge fluid containing heparin to prevent biofouling of internal surfaces. Purge fluid interfaces with blood or blood components at two notable internal locations: (1) 5-8μm radial gap ("Radial Gap" or "Gap 1") between the motor shaft and bearing, a site accessible by blood proteins or small molecules; and (2) 100 μm axial gap ("Axial Gap" or "Gap 2") between the impeller rotor and bearing, the site of mixing with larger circulating blood components. Despite its efficacy, heparin in the purge fluid complicates overall patient anticoagulation management. Here, we investigate sodium bicarbonate as an alternative to heparin in the purge fluid in a simulated purge gap micro-environment. To assess protein stability simulated at Gap 1, human serum albumin (HSA; 40 mg/ml) species were quantified utilizing size exclusion liquid chromatography (SEC-HPLC) after stirring with purge fluid (5% dextrose in water (D5W) with heparin (25 U/ml) or sodium bicarbonate (25 or 50 mEq/L)) over a 24-h period. pH measurements were taken immediately prior to stirring. Mixing between blood and purge fluid at Gap 2 was mimicked in vitro utilizing a 60:40 blood: purge fluid ratio. Purge fluid consisted of D5W with or without sodium bicarbonate (25 or 50 mEq/L). Human citrated blood samples were freshly collected with or without the addition of heparin (5U/ml). Coagulability was determined via thromboelastography (TEG). pH measurements of blood mixtures were taken immediately before and after TEG analysis. Sodium bicarbonate alone or synergistically with heparin was effective in increasing protein stability, increasing pH, and reducing coagulability. In the Gap 1 model, sodium bicarbonate led to preservation of HSA monomer after 24h mixing, with monomer composing 88.3 ± 2.3% and 88.6 ± 0.9% of total HSA species for 25 or 50 mEq/L sodium bicarbonate, respectively. Only 60.4 ± 4.3% monomer was observed with D5W alone (p < 0.005). HSA aggregates and fragments were evident in heparin and D5W purge mixtures, but absent in sodium bicarbonate (25 and 50 mEq/L). pH of HSA mixtures significantly increased in the presence of sodium bicarbonate. In the Gap 2 model, combined heparin (5U/ml) and sodium bicarbonate prolonged clotting time (TEG-ACT), leading to an average increase of 795 ± 275 s (p=0.04) and 846 243 s (p=0.03). This trend of reduced coagulability was similarly observed in clot initiation time (R time), clot formation time (K time), and clotting rate (α angle). Blood mixture pH measurements increased with addition of sodium bicarbonate in both heparinized and non-heparinized blood samples. Sodium bicarbonate in the purge fluid has the potential to significantly increase protein stability and reduce protein denaturation at the Impella® radial gap (Gap 1), while reducing blood coagulation at the Impella® axial gap (Gap 2). The influence of sodium bicarbonate on the biochemical environment of the purge fluid may ensure stable purge flow resistance and play a synergistic or supportive role in the purge gap micro-environment when used with systemic anticoagulation.

A clinically utilized intravenous continuous rate infusion of diltiazem does not significantly decrease systolic function in healthy dogs.

To determine if left ventricular systolic function on echocardiography, systemic blood pressure, and electrocardiography change with a clinically accepted intravenous (IV) diltiazem constant rate infusion (CRI) compared to a control. 10 healthy client-owned adult dogs. Prospective, masked, crossover study from May 27, 2021, to August 22, 2021. Dogs were randomized to receive diltiazem (loading dose of 240 μg/kg, IV followed by a CRI of 6 μg/kg/min for 300 minutes) or the same volume of 5% dextrose in water (D5W) administered IV followed by the opposite intervention after a 7-day washout. Blood pressure was monitored during each CRI, and echocardiographic and electrocardiographic studies were performed immediately before the CRI and during the last hour of the CRI. Postdiltiazem systolic time interval (STI) (median, 0.30; range, 0.16 to 0.34) was significantly lower than post-D5W STI (median, 0.32; range, 0.22 to 0.40; P = .046). All other echocardiographic parameters did not differ significantly between each of the groups after receiving diltiazem or D5W. Systemic blood pressure did not change significantly with either diltiazem (P = .450) or D5W (P = .940), and none of the dogs became hypotensive at any point in the study. Expectedly, negative dromotropy was observed with diltiazem. A significant decrease in left ventricular systolic function was not appreciated in healthy dogs receiving diltiazem at a clinically accepted intravenous infusion rate at this dosing regimen. Further studies are needed in dogs with cardiac disease.

The Effectiveness of Facet Joint Injection with Steroid and Botulinum Toxin in Severe Lumbar Central Spinal Stenosis: A Randomized Controlled Trial.

Lumbar central spinal stenosis (LCSS) is a common disorder that causes disability and pain in the elderly. It causes pain in the radicular leg. Recently, transforaminal epidural steroid injection (TFESI) has been widely used to control radicular leg pain caused by LCSS. However, in cases of severe LCSS, drugs injected using TFESI cannot spread into the spinal canal and would have less therapeutic effects than in mild LCSS. To compensate for this limitation of TFESI, we injected steroids and botulinum toxin type A into the bilateral facet joints, evaluated their effects, and compared them with those of TFESI. One hundred patients with severe LCSS were included in the study and randomly allocated to either the facet injection (FI) or TFESI group. For 50 patients in the FI group, 30 mg (40 mg/mL) of triamcinolone with 50 IU of botulinum toxin type A mixed with a 1 mL solution of 100 mL of 50% dextrose water and 30 mL of 4% lidocaine were administered into the bilateral facet joints under fluoroscopy. For 50 patients in the TFESI group, 30 mg (40 mg/mL) of triamcinolone with 0.8 mL of 2% lidocaine and 2.5 mL of 50% dextrose water was injected bilaterally under fluoroscopy. Radicular leg pain (measured with a numeric rating scale) and pain-related disability (measured with the modified Oswestry Disability Index) due to severe LCSS were significantly reduced after facet joint injection. The therapeutic effects were greater after facet joint injection than after bilateral TFESI. The injection of a mixed solution of steroids and botulinum toxin type A into the bilateral facet joints would be a beneficial therapeutic option in patients with severe LCSS.

Hydro-dissection: An Effective Intra-Operative Technique for Difficult Laparoscopic Cholecystectomies

Hydrodissection, a technique used to treat nerve entrapments, involves injecting an anaesthetic, saline, or 5% dextrose in water to separate the nerve from the surrounding tissue. Objectives: To assess the efficacy of this technique in all patients undergoing difficult laparoscopic cholecystectomy in terms of operative time, haemorrhage, and intra-operative complications. Methods: A multicenter observational study was conducted at the department of surgery, PAF Faisal Hospital and Anis Bantva Trust Hospital Karachi. A total of 219 patients were included in this study who underwent laparoscopic cholecystectomy for symptomatic gall stones, with age ranging from 18-70 years, with intra-operative Cuschieri classification &gt;1, using a non-probability sampling method. Results: This study included 219 patients from hospital records categorized as per intra-operative difficulty grading of Cuschieri from grade II-IV. The mean age of patients was 40.46 ±12.50 years, with an average duration of symptoms of 16.95 ± 8.73 days. There were 160 (73.1%) males and 59 (26.9%) females. About two-thirds of patients were admitted through the emergency department. The pre-operative and intraoperative diagnosis of patients was symptomatic cholelithiasis 76 (34.7%), acute on chronic cholecystitis (27.9%), chronic cholecystitis 57 (26.0%), empyema and mucocele gallbladder 11 (5%) each, and Gangrenous gallbladder 3 (1.4%) were recorded. Conclusion: This study showed a clear association of intra-operative complicated anatomy during laparoscopic cholecystectomy to its conversion to open cholecystectomy. Techniques of dissection are of significant importance to minimize injuries to vital structures

Effects of an intravenous infusion of diltiazem on glomerular filtration rate, electrolyte excretion, and urine output in healthy dogs.

Acute kidney injury (AKI) in dogs has a high case fatality rate. Diltiazem might improve renal function, but effect of intravenous infusion has not been adequately studied in dogs. To determine if an intravenous infusion of diltiazem improves renal function through changes in glomerular filtration rate (GFR), fractional excretion of sodium (FENa), and urine output (UOP) in healthy dogs. Ten healthy adult dogs. Prospective, unmasked, crossover study. Dogs were randomized to receive diltiazem (loading dose of 240 μg/kg followed by 6μg/kg/min for 300 min) or the same volume of 5% dextrose in water (D5W). The opposite treatment was given after a 7-day washout period. GFR and FENa were obtained at baseline and after infusion. UOP was measured starting 1hour before diltiazem administration. GFR did not significantly increase from baseline with diltiazem (before diltiazem median=2.371 mL/min/kg, range=1.605-4.359; after diltiazem median=2.305 mL/min/kg, range=1.629-4.387; median difference=0.080 mL/min/kg, 95% confidence interval [CI]=-0.417 to 0.757; P=.85), and there was no difference in D5W GFR before and after diltiazem (median=2.389 mL/min/kg, range=1.600-3.557; median difference=0.036 mL/min/kg, 95% CI=-0.241 to 1.112; P=.69). FENa did not increase from baseline after administration of diltiazem (median difference=0%, 95% CI=-0.1 to 0.1; P=.81), and there was no difference in D5W FENa (median difference=0.1%, 95% CI=-0.1 to 0.2; P=.26). UOP did not increase with diltiazem (P=.06). Intravenous administration of diltiazem does not improve markers of renal function in healthy dogs. Further studies are needed in dogs with AKI.

A Novel Agnostic Respiratory Stimulant as a Treatment for Apnea of Prematurity: A Proof-of-Concept Study.

Aim/Objective: ENA-001 is a novel selective antagonist of large-conductance BK (big potassium) channels located in the carotid bodies, where they act as chemoreceptors that sense low arterial oxygen levels and establish a feedback loop to brainstem nuclei responsible for initiating spontaneous breathing and maintaining adequate oxygen to tissues. ENA-001 attenuates respiratory depression induced by a variety of chemical agents, essentially "agnostic" to the precipitating drug (e.g., opioid(s), benzodiazepine, alcohol, or propofol). But it had not been tested against respiratory depression resulting from a physiological cause, such as apnea of prematurity (AOP). This proof-of-principle study used a well-described animal model (premature lamb) to test the effectiveness of ENA-001 in the setting of an under-developed respiratory control system, similar to that in human AOP.Materials and Methods: A set of twin lambs was delivered prematurely via caesarian section at 135 ± 2 d gestational age (GA). An arterial catheter was connected to a transducer for pressure monitoring and a venous catheter was connected to a pump for continuous infusion of 5% dextrose in water (D5W). Lambs were to receive four mechanical breaths for lung recruitment and then started on continuous positive airway pressure (CPAP). After a stabilization period of 15 minutes, the protocol called for the first lamb to be started on continuous infusion of ENA-001, with ascending dose hourly (0.4, 1.1, 2.0, 12.0 mg/kg/hr), while the second lamb was to serve as a sham (D5W) control. At least 10 representative breaths free of artifact from motion or atypical breaths were recorded using a pulmonary function system designed for neonatal research. To maintain a stable plane of anesthesia, repeat doses of fentanyl (1 µg IM) were given as needed based on blood pressure response to stimulation.Results: Two male lambs were delivered. Unexpectedly, neither lamb exhibited a drive for spontaneous breathing. Each required manual ventilation, with a complete absence of spontaneous effort. Despite the poor prognosis owing to the absence of ventilatory effort, continuous infusion of the first dose of ENA-001 was started 20 minutes after birth. The test animal continued to require manual ventilation, which was continued for an additional 10 minutes. An intravenous (IV) bolus of ENA-001 was given. Nearly instantaneously following the delivery of the IV bolus, the lamb began breathing spontaneously and did not require manual intervention for the remainder of the study. The sham animal was delivered approximately an hour following the test animal. As with the test animal, the sham animal lacked spontaneous breathing efforts. A decision was made to manually ventilate for 30 minutes to match the course for the test animal. At the 30-minute time point, an IV bolus infusion of ENA-001 was delivered. Nearly instantaneously following the delivery of the IV bolus, the lamb began breathing spontaneously. After several minutes, the spontaneous breathing efforts abated, and manual ventilation was resumed. The animal was then sacrificed for tissue harvest.Conclusion: These results suggest that ENA-001 might be an effective therapy, alone or as a co-medication, for the treatment of AOP. They further suggest that ENA-001 might have broader applications in situations of neurological ventilatory insufficiency.

Ultrasound-guided 5% dextrose prolotherapy versus corticosteroid injection in carpal tunnel syndrome: arandomized, controlled clinical trial.

Aim: The main assessment of this study is to analyze the efficiency of ultrasound-guided dextrose prolotherapy against corticosteroid injections for the treatment of carpal tunnel syndrome. Materials &methods:A total of54 patients with carpal tunnel syndrome were included. Patients who were assigned into the prolotherapy group were injected with 5cc 5% dextrose water under ultrasound guidance. Patients in the corticosteroid group received ultrasound-guided 1ml triamcinolone 40mg/mlinjection. Results: The inter-group analysis revealed that dextrose prolotherapy has a similar efficacy as corticosteroid for improving pain intensity, functional limitation in daily life, electrophysiologic parametersand ultrasonographic outcomes. No remarkable difference was found between the two treatments until 3months of follow-up. Conclusion: Dextrose 5% has similar efficacy as triamcinolonefor improving pain intensity, functional limitation in daily life, electrophysiologic parametersand ultrasonographic outcomes.

PO-696-04 COMPLEX IMPEDANCE ASSESSMENT OF PULMONARY VENOUS OCCLUSION DURING CRYOBALLOON ABLATION

Traditional assessment of pulmonary vein occlusion (PVO) during cryoballoon ablation (CBA) has included contrast injection, pressure waveform (PW) assessment and color doppler flow (CDF) on intracardiac echocardiography. A novel mapping system [Kodex (K), EPD Solutions, Philips] offers a unique tool to assess PVO based on differences in complex impedance with either a comparison with a free-floating CB baseline (BL), or with assessment of temporal impedance change after injection of non-contrast fluid [normal saline or 5% dextrose in water (D5W)].

First Report of Fusarium oxysporum f. sp. ciceris on Chickpea (Cicer arietinum) in Serbia

Chickpea (Cicer arietinum L.) is one of the most commonly consumed legume crops worldwide, cultivated in more than 55 countries (FAOSTAT, 2017). However, in Serbia, it is a novel crop grown on approximately 120 acres, but the areas under this crop slightly increase each year. Fusarium wilt caused by F. oxysporum f. sp. ciceris is one of the most economically important disease in the most chickpea-growing areas (Jimenez-Diaz et al., 2015), but yet there has been no formal report of the Fusarium wilt of chickpea in Serbia. In June 2018, the first symptoms of Fusarium wilt were registered at Rimski Šančevi (Vojvodina Province), Serbia (N 45019.311' E 019049.933') as wilted chickpea plants grouped in patches on approximately 5% plants in the area of 3 acres. Symptoms as yellowing and necrosis of foliage appeared as late wilt in the podding stage. Roots of affected plants showed no external discoloration, but cross-sections showed dark-brown discoloration of xylem tissue. To isolate the causal agent, symptomatic plants were collected, and ten cuttings of symptomatic root tissue were surface disinfected with 2% sodium hypochlorite solution for 5 min, rinsed three times in sterile distilled water, air-dried on sterilized filter paper and plated on potato dextrose agar (PDA) and water agar (WA) amended with streptomycin sulfate. After seven days of incubation at 25°C in the dark, isolates were preliminarily identified according to their morphological characters and Fusarium Laboratory Manual (Leslie and Summerell, 2006). For each isolate 100, micro/macroconidia and chlamydospores were measured. Conidia were hyaline; macroconidia sickle-shaped, with blunt ends, 2-4 septa (10.1-17.7 x 3.1-5.8 µm); microconidia ellipsoidal, 0-1 septa (4.9-8.6-2.7-3.5 µm). Chlamydospores were globose (4.3-8.8 µm). Representative isolates (K343, K375 and K378) were purified by a single-spore technique for further analyses (Leslie and Summerell, 2006). Molecular identification of three representative isolates (K343, K375 and K378) was made by sequencing the rRNA internal transcribed spacer (ITS) region and translation elongation factor 1α (TEF1) gen. For all isolates, the ITS and TEF1 genes were amplified and sequenced with primers ITS1/4 (White et al. 1990), EF1-728 and EF1-986 (Rehner and Buckley 2005). Based on a BLAST search of the NCBI nucleotide database, the ITS sequences (GenBank MK920204.1, MK928423.1 and MK928424.1) had 99.8% identity with F. oxysporum f. sp. ciceris isolate (MK074845.1). The TEF1 (GenBank MN788462.1, MN788463.1 and MN788464.1) had 96.3 -100% identities with F. oxysporum f. sp. ciceris isolate (FJ538245.1). The pathogenicity test was conducted on 7-day old plants according to the drench method described by Maitlo et al. (2016). The concentration of inoculation suspensions was adjusted on 1x106, and ten plants per isolate were tested and inoculated with 10 ml of suspension. Control plants were drenched with 10 ml of sterilized distilled water. Nine days after inoculation, first symptoms as leaves wilting and white mycelia presence around stem base occurred on plants inoculated with isolate K378. On day 11, the first symptoms occurred on plants inoculated with isolates K343 and K375 as well. Up to the 13th day after inoculation, all plants were wilted, and the pathogen was successfully reisolated and confirmed as F. oxysporum f.sp. ciceris. To the best of our knowledge, this is the first report of F. oxysporum f.sp. ciceris causing Fusarium wilt on chickpea in Serbia. <br> Acknowledgements <br>This research was supported by the Ministry of Education, Science and Technological Development of the Republic of Serbia, grant number: 451-03-9/2021-14/200032 <br>

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Using N-Butyl Cyanoacrylate With D5W Push Technique.

Middle meningeal artery (MMA) embolization has been recognized as a promising treatment for patients with subdural hematoma (SDH). To present the technical feasibility and efficacy of n-butyl cyanoacrylate (n-BCA) embolization in the largest consecutive cohort to date. We retrospectively reviewed our consecutive cases of recurrent SDH treated with MMA embolization using diluted n-BCA with the "sugar rush" technique. In brief, a 2.1-Fr microcatheter was used to selectively catheterize the frontal and posterior branches of the MMA. 5% dextrose in water (D5W) was injected through an intermediate catheter while injecting n-BCA through the microcatheter. Complete obliteration of MMA and lack of SDH recurrence in a 3-6 months follow-up computed tomography scan were defined as efficacy outcomes. Cranial nerve palsy, vision loss, transient neurological deficit, and stroke were defined as safety outcomes. A total of 61 patients were identified with a mean (±standard deviation) age of 62.5 ± 9 years. In 6 patients (10%), coil embolization of the origin of the frontal or posterior branch was performed because super-selective catheterization of the branch was unsuccessful because of tortuous anatomy. Complete obliteration of frontal and posterior branches was achieved in 100% of the cases. Recurrent SDH was seen in 3 patients (5%). No incidence of cranial nerve palsy, vision loss, or stroke occurred. One patient suffered a transient neurological deficit. MMA embolization using diluted n-BCA with concomitant D5W injection is associated with a high degree of distal penetration and complete branch occlusion and minimal risk of cranial nerve palsy or other thromboembolic complications.

A stability indicating method development and validation of apixaban in pharmaceutical dosage form by using RP-HPLC and In-Vitro evaluation of apixaban suspension delivery through enteral feeding tubes

A simple, consistent and sensitive stability indicating reversed phase high performance liquid chromatography (RP-HPLC) method was developed for the determination of Apixaban in pharmaceutical dosage form by using Zorbax C18 (150 mm x 4.6 mm, 5μm particle size) with a mobile phase consisting of Ammonium Formate Buffer: Acetonitrile in a ratio of 65:35% v/v and successfully validated as per the international council for harmonization (ICH) guideline. The method was found to be simple, robust, precise, sensitive, accurate; specific and stress degradation studies were performed with acidic, alkaline, oxidative, thermal, humidity and photolytic stress conditions as per ICH guidelines. In separate in-vitro experiments, Apixaban suspension passed through feeding tubes to develop a clog-free suspension delivery method. Nasogastric tube (8-French [Fr]) and diluents (water, 5% dextrose in water) were tested. Recovery of Apixaban Suspension in water and 5% dextrose in water at “0 and 15” minutes incubation time were nearly 100% in 8-Fr nasogastric (NG) tubes. Keywords: Apixaban, Stress Degradation, Stability Indicating Assay Method, Nasogastric Tube.

A randomized trial to determine the minimum effective lidocaine volume for median nerve block using hydrodissection

Ultrasound-guided hydrodissection with 5% dextrose in water (DW5) creates a peri-nervous compartment, separating the nerve from the neighboring anatomical structures. The aim of this randomized study was to determine the minimum volume of lidocaine 2% with epinephrine 1:200,000 required when using this technique to achieve an effective median nerve block at the elbow in 95% of patients (MEAV95). Fifty-two patients scheduled for elective hand surgery received an ultrasound-guided circumferential perineural injection of 4 ml DW5 and an injection of local anesthetic (LA) following a biased coin up-and-down sequential allocation method. A successful block was defined as a light touch completely suppressed on the two distal phalanges of the index finger within a 30-min evaluation period. The MEAV95 of lidocaine 2% with epinephrine was 4 ml [IQR 3.5–4.0]. Successful median nerve block was obtained in 38 cases (82.6%) with median onset time of 20.0 [10.0–21.2] minutes (95% CI 15–20). The analgesia duration was 248 [208–286] minutes (95% CI 222–276). Using an ultrasound-guided hydrodissection technique with DW5, the MEAV95 to block the median nerve at the elbow with 2% lidocaine with epinephrine was 4 ml [IQR 3.5–4.0]. This volume is close to that usually recommended in clinical practice.Trial registration clinicaltrials.gov. NCT02438657, Date of registration: May 8, 2015.

Amino acid infusions in umbilical artery catheters enhance protein administration in infants born at extremely low gestational age.

It is challenging to provide extremely low gestational age neonates (ELGANs) with adequate protein supply. This study aimed to investigate whether amino acid (AA) infusion in the umbilical artery catheter (UAC) in ELGANs is safe and enhances protein supply and growth. A before and after study including infants born <27weeks, treated in Uppsala, Sweden, during 2004-2007, compared those receiving normal saline/10% dextrose in water with those receiving AA infusion in the UAC. Data were retrieved from the Extremely Preterm Infants in Sweden Study, hospital records and the Swedish Neonatal Quality Register. Group comparisons, univariate and multivariate analyses were conducted. AA group (n = 41, females 39%) received on average approximately 0.3g/kg/day more protein during the first postnatal week, compared to control group (n = 30, females 40%) (unstandardised coefficient (B) 0.26, p .001) but no difference was noted during 8-28 postnatal days. The type of infusion was not associated with growth variables. The incidence of neonatal morbidities and UAC-related thrombosis did not differ between the groups. AA infusions in the UACs in ELGANs is safe and enhances protein supply during the first postnatal week. However, this practice is not associated with growth during the first 28 postnatal days.

The Effect of High Glucose Intake on Weight Gain in Very Low Birth Weight Neonates: A Randomized Controlled Trial.

This study aims at evaluating the effect of high glucose intake as a component of total parenteral nutrition on birth weight (BW) regain in very low birth weight neonates. Ninety newborns with BW <1500 g were randomized to control or experimental groups. Both groups received the same total parenteral nutrition regimens except glucose intake provided by dextrose water (DW) serum: 7 to 15 g/kg/d (10% DW) in the former versus 8.75 to 18.75 g/kg/d (12.5% DW) in the latter. Body weight as the primary outcome was monitored until the BW was regained. Results revealed that neonates who received 12.5% DW regained BW significantly faster (10.98 ± 2.46 vs 13.24 ± 4.03 days, P = .024) and needed lesser duration of respiratory support (5.34 ± 2.11 vs 7.17 ± 3.19 days, P = .003). As the proposed intervention can reduce neonatal intensive care unit admission duration, it mitigates risks of health care-associated infections, while favorably affecting the health economy.

Efficacy of 5% Dextrose Water Injection for Peripheral Entrapment Neuropathy: A Narrative Review.

Current non-surgical treatment for peripheral entrapment neuropathy is considered insignificant and unsustainable; thus, it is essential to find an alternative novel treatment. The technique of perineural injection therapy using 5% dextrose water has been progressively used to treat many peripheral entrapment neuropathies and has been proven to have outstanding effects in a few high-quality studies. Currently, the twentieth edition of Harrison’s Principles of Internal Medicine textbook recommends this novel injection therapy as an alternative local treatment for carpal tunnel syndrome (CTS). Hence, this novel approach has become the mainstream method for treating CTS, and other studies have revealed its clinical benefit for other peripheral entrapment neuropathies. In this narrative review, we aimed to provide an insight into this treatment method and summarize the current studies on cases of peripheral entrapment neuropathy treated by this method.

Catheter Ablation Using Half-Normal Saline and Dextrose Irrigation in an OvineVentricularModel.

This study hypothesized that catheter ablation in healthy ovine ventricular myocardium using low ionic 0.45% saline (half-normal saline [HNS]) and nonionic 5% dextrose in water (D5W) would result in larger lesions compared with use of 0.9% saline (normal saline [NS]). Limited data exist regarding the safety and efficacy of catheter ablation using low and nonionic irrigants. Open irrigated ablation was performed on 14 beating ovine hearts (NS, n=5; HNS, n=4; D5W, n=5). Ablation was delivered by using identical parameters (ie, 30W in power control mode, 60-second duration, contact force of 10-20g in the endocardial ventricles and 5-10g in the epicardium). Catheter orientation and tissue contact were optimized by using intracardiac echocardiography. Lesion width, depth, and volume and number of steam pops were compared. Overall, 196 lesions were analyzed (mean duration: 56.7 ± 8.3 seconds; mean contact force: 15.3 ± 6.1 g; and mean impedance drop: 31 ± 19.1Ω). Compared with NS, HNS and D5W resulted in larger lesion volumes (NS 349.2 ± 245.1mm3 vs HNS 645.7 ± 386.4mm3 vs D5W 633.2 ± 387.1mm3; HNS vs NS; P< 0.001; D5W vs NS; P< 0.001; D5W vs HNS; P=0.87). However, D5W was associated with higher steam pop occurrence (NS 5% vs HNS 11% vs D5W 35%; HNS vs NS; P=0.22; D5W vs NS; P< 0.001; D5W vs HNS; P=0.002). Catheter ablation with HNS and D5W resulted in larger ablation lesions compared with NS but similar lesion dimensions between HNS and D5W. The increase in lesion size with HNS and D5W was associated with a higher incidence of steam pops, especially with D5W, compared with NS.

CENTRAL DIABETES INSIPIDUS IN THE SETTING OF ANOXIC BRAIN INJURY

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Central diabetes insipidus (CDI) presents with polyuria, increased thirst, hypernatremia, and the inability to concentrate urine due to low antidiuretic hormone (ADH). The most common causes of CDI are craniopharyngioma, Langerhans cell histiocytosis, trauma, sarcoidosis, metastases, and brain malformations. There are many case reports of CDI induced by traumatic brain injury, however few reports of CDI in the setting of anoxic brain injury. CASE PRESENTATION: A 35-year-old female with past medical history of polysubstance abuse and prior cardiac arrest presented after resuscitation from an out of hospital cardiac arrest. The patient was unresponsive for an unknown length of time. She was intubated in the emergency room and given naloxone without response. On exam she had absent brain stem reflexes with Glasgow coma scale of 3 and was hypotensive.Urine drug screen was positive for cannabinoids, cocaine, opiates, and phencyclidine. Bloodwork was significant for WBC 13,100 uL, creatinine 1.8 mg/dl, BUN 12 mg/dl, Glucose 463, sodium 136 mM, bicarbonate 15 mM, and lactate 16.8 mM. COVID-19 antigen and Influenza B were positive. Head CT showed diffuse loss of grey-white mater differentiation and diffuse sulcal effacement, consistent with global anoxia.She received 0.9% NaCl, broad-spectrum antibiotics, oseltamivir, insulin drip, sodium bicarbonate, and norepinephrine. 24 hours after admission, urine output increased from 1.3 to 7.8 liters/day and Serum sodium increased from 144 to 161 mM. She was started on 5% dextrose in water, however sodium continued to rise to 171 mM. Urine output was 290 ml/hour. Urine sodium was 21 mM and urine osmolality was 99 mOsm/kg, which suggests predominantly free water diuresis. The patient was given 2 L of 0.9% NaCl, the rate of D5W was increased, and 1 mcg of desmopressin was given parenterally. Following desmopressin administration, urine output reduced to 80 ml/hour, urine osmolality increased to 588 mOsm/kg, and sodium trended down to 144 mM.The diagnosis of CDI is supported by the favorable response to therapy. All sedation was held during hospitalization, however the patient remained unresponsive for 5 days and was terminally extubated. DISCUSSION: The exact mechanism behind development of CDI post-cardiac arrest is unknown, however theorized to be due to edema or injury to the hypothalamus. The hypothalamus is generally resistant to hypoxia, however extremely prolonged hypoxia and hypercapnia will cause extensive destruction via neuronal damage. There are few reported cases of CDI post-cardiac arrest. Our patient had significant response to desmopressin administration but had very poor neurologic response. As per our observation and prior reports, the development of CDI post-cardiac arrest is a poor prognostic indicator. CONCLUSIONS: Here we highlight the importance of diagnosing CDI in cardiac arrest patients to prevent further damage to the brain. REFERENCE #1: Koubar, S, Younes, E. Transient Central Diabetes Insipidus and Marked Hypernatremia following Cardiorespiratory Arrest. Hindawi, Case Reports in Nephrology (2017). https://doi.org/10.1155/2017/1574625 REFERENCE #2: Arisaka, O, Arisaka, M, Ikebe, A et al. Central diabetes insipidus in hypoxic brain damage. Child's Nerv Syst 8, 81–82 (1992). https://doi.org/10.1007/BF00298445 DISCLOSURES: No relevant relationships by ahmad alkhatatneh, source=Web Response No relevant relationships by Sharath Bellary, source=Web Response No relevant relationships by Nilam Bhavsar, source=Web Response No relevant relationships by Gowthami Sai Jagirdhar, source=Web Response

Effect of Testosterone Enanthate Modeling of Polycystic Ovary on Liver Irs-2 mRNA Expression in Rats: A Brief Report

There are many animal models for polycystic ovary (PCO); using exogenous testosterone enanthate is one of the methods of induction of these models. However, induction of insulin resistance should also be studied in the modeling technics. Therefore, the present study aims to investigate the expression of insulin receptor substrate (Irs)-2 mRNA in the liver tissue of rat PCO model. Nineteen Wistar rats were divided into three groups; (1) PCO modeling group (N =7) received daily 1.0 mg/100g testosterone enanthate solved in olive oil along with free access dextrose water 5%, (2) vehicle group (N =6), which handled like the PCO group, but did not receive testosterone enanthate, (3) control group (N =6) with standard care. All the animals were administered via intra-peritoneal injection for 14 days. Expression of Irs-2 mRNA was studied with real-time PCR and fold changes (FC) were reported. The average of expression in the control group was considered as the calibrator. About 13.4% expression reduction was found in the PCO group (FC =0.874, P-value =0.043). No significant reduction was found in the vehicle group (FC =0.951, P-value =0.076). However, analysis of variance did not show a significant difference between all the groups of study (P-value =0.085). The present model of PCO might induce insulin resistance at liver level with a low effect size via reduction in the mRNA expression of Irs-2. Study of the involved genes and molecules in other tissues of PCO animal models is suggested.