Group MK Research Articles

Malnutrition stratified by marasmus and kwashiorkor in adult patients with heart failure

Malnutrition is classified into marasmus and kwashiorkor in children. However, the clinical significance of these aspects is unclear in adult patients with heart failure (HF). We divided 2308 adult patients with HF into four groups according to marasmus type (body mass index < 18.5 kg/m2) and kwashiorkor type (serum albumin < 3.4 g/dL) malnutrition: Group C (no malnutrition, n = 1511, 65.5%), Group M (marasmus type malnutrition, n = 133, 5.8%), Group K (kwashiorkor type malnutrition, n = 554, 24.0%) and Group MK (marasmic-kwashiorkor type malnutrition, n = 110, 4.8%). Group M showed the lowest blood pressure. Groups K and MK showed higher levels of B-type natriuretic peptide. Right atrial pressure was lowest in Groups M and MK. Kaplan-Meir analysis demonstrated that Group MK had the lowest event-free rate of all-cause death and cardiac death. In the multivariable Cox proportional hazard analysis, Groups M, K, and MK were associated with all-cause death (hazard ratio 1.790, 1.657 and 2.313, respectively) and cardiac death (hazard ratio 2.053, 1.855 and 3.001, respectively) compared to Group C as a reference. Marasmus type and kwashiorkor type malnutrition are associated with distinct profiles and high mortality, and marasmic-kwashiorkor type malnutrition has the poorest prognosis.

Abstract 11577: Malnutrition Stratified by Marasmus and Kwashiorkor in Patients With Heart Failure

Introduction: Malnutrition is characterized by marasmus and kwashiorkor in children. However, the clinical significance of these aspects has been unclear in adult patients with heart failure (HF). Methods and Results: We divided a total of 1,888 patients with HF (median age 70.0, interquartile range 59.0-78.0) into four groups according to the presence/absence of marasmus type malnutrition (body mass index &lt; 18.5 kg/m 2 ) and kwashiorkor type malnutrition (serum albumin &lt; 3.4 g/dL): Group C (patients without malnutrition, n = 1,302, 69.0%), Group M (those with only marasmus, n = 117, 6.2%), Group K (those with only kwashiorkor, n = 390, 20.7%) and Group MK (those with both marasmus and kwashiorkor, n = 79, 4.2%). Group M showed lowest systolic blood pressure (Groups C, M, K, and MK; 122.0, 111.0, 125.0 and 122.0 mmHg, respectively, P &lt; 0.001). Groups K and MK showed higher levels of B-type natriuretic peptide (171.2, 375.4, 532.6 and 598.9 pg/mL, P &lt; 0.001). Mean right atrial pressure was lowest in Group M and highest in Group K (6.0, 5.0, 8.0 and 6.0 mmHg, P &lt; 0.001). Kaplan-Meir analysis demonstrated that Group MK had the lowest event-free rate of all-cause death compared to Group C, while Groups M and K had intermediate prognosis ( Figure ). In the multivariable Cox proportional hazard analysis, Groups M, K, MK were associated with all-cause death compared to Group C as a reference (adjusted hazard ratio 1.820, 1.623 and 2.248, respectively). Conclusions: Marasmus type malnutrition indicated wasting, kwashiorkor type malnutrition was characterized by congestion, and both types of malnutrition were independently associated with all-cause death in patients with HF.

Effects of Mamsyadi Kwatha in primary insomnia - A randomized controlled trial

BackgroundInsomnia is the second most commonly presenting symptom, after pain, in clinics. Insomnia prevalence in India is 28.1 %. Objective: This study explores the effect of Mamsyadi Kwatha in the management of primary insomnia. Materials and methodsFifty patients attending KLE Ayurveda hospital meeting the diagnostic criteria of primary insomnia (DSM IV TR) were enrolled. Patients were randomly divided into two groups: group MK and TK. Intervention in group MK was 24 ml of Mamsyadi Kwatha twice a day and in group TK was 24 ml of Tagaradi Kwatha twice a day for 30 days. Assessment was done through primary outcome measures like Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), insomnia severity index (ISI). Secondary outcome measures were sleep diary recordings of past 15 days and depression anxiety and stress scale (DASS). Follow ups were at base line, 15th and 30th day of interventions. Laboratory assessments of liver function test, haemoglobin, and serum creatinine levels were carried at base line and 30th day of intervention. ResultsEffect on primary and secondary outcomes showed that both the drugs were comparable. = Within group comparison of both the drugs showed that they produced significant improvement in PSQI, ESS, ISI, sleep diary variables, and DASS. However, Mamsyadi kwath has additional benefit of early recovery in total sleep. Both the drugs showed good safety profile evaluated through serum creatinine and liver function tests. ConclusionThe effects of Mamsyadi Kwatha is comparable to Tagaradi Kwatha. Both drugs produced significant improvement in clinical assessments of insomnia, anxiety, depression, and stress.

Comparison of intramuscular alfaxalone with medetomidine-ketamine for inducing anaesthesia in Trachemys scripta spp. undergoing sterilization

ObjectiveTo compare the effect of two anaesthetic protocols on heart rate (HR), time to muscle relaxation and tracheal intubation and time to surgical plane of anaesthesia, in Trachemys scripta spp. undergoing oophorectomy. Study designProspective randomized clinical study. AnimalsA total of 43 healthy female turtles. MethodsMorphine (1.5 mg kg–1) was injected subcutaneously 2 hours before anaesthesia induction. The turtles were randomly administered either medetomidine (0.2 mg kg–1) and ketamine (10 mg kg–1) (group MK; n = 23) or alfaxalone (20 mg kg–1) (group A; n = 20) intramuscularly followed by bupivacaine (2 mg kg–1) administered subcutaneously along the incision site. Anaesthesia was maintained with isoflurane delivered in oxygen (100%). HR and the anaesthetic depth score (ADS) were recorded every 5 minutes from induction to recovery. A Friedman test followed by Wilcoxon tests with Bonferroni adjustment were used to compare these non-parametric data (HR and ADS) between groups and over time. Time to muscle relaxation of neck and limbs (TMR), tracheal tube insertion (TTTI) and stage of surgical anaesthesia (TADS≤3) were recorded and compared between groups using a Welch’s t test after logarithmic transformation. ResultsMedian values of TMR, TTTI and TADS≤3 were 4, 9.5 and 25 minutes in group A, respectively, and 14, 20 and 35 minutes in group MK (TMR, TTTIp ≤ 0.0001; TADS≤3p = 0.001). Plane of anaesthesia was significantly deeper in group A than in group MK for the first 20 minutes (p < 0.01). HR at 10 and 15 minutes post injection was significantly lower in group MK (28 beats minute–1) than in group A (36 and 34 beats minute–1) (p < 0.02). Conclusions and clinical relevanceAfter intramuscular injection in Trachemys scripta spp., tracheal intubation, muscle relaxation and a surgical plane of anaesthesia developed faster with alfaxalone than medetomidine–ketamine.

Procedural sedation in children for fractionated radiation treatment: Intranasal dexmedetomidine versus oral midazolam and ketamine.

Sedation in paediatric cancer for fractionated radiation treatment (RT) is unique as the child has to be still for accurate delivery of RT, monitoring of the child is from a remote location and sedation is repeated for multiple sessions of RT. The present study was undertaken to compare the efficacy of intranasal dexmedetomidine with oral midazolam and ketamine combination for repeated sedation during fractionated RT in paediatric oncology. Ninety children aged between 3-6 years, planned for 21 fractions of RT, were randomised to receive intranasal dexmedetomidine 2 μg/kg (group D) or oral midazolam 0.2 mg/kg and ketamine 5 mg/kg (group MK). The 21 sessions of fractionated radiotherapy were divided into three subgroups of seven consecutive exposures 1-7, 8-14 and 15-21 for comparison. The primary endpoint was to determine the incidence of successful sedation. The sedation score achieved, time to satisfactory sedation and discharge, rescue ketamine required, and side effects were secondary endpoints. The incidence of successful sedation in the three successive RT subgroups; sessions: 1-7, 8-14 and 15-21, was 82%, 75.6% and 66.7% in group D, as compared to 40%, 24.4% and 13.3% in group MK, respectively. (P < 0.001). A decrease in successful sedation was noted in the successive subgroups. Time to successful sedation and discharge was earlier in group D in comparison to MK (P = 0.000). More patients in group MK required rescue ketamine (P = 000). Intranasal dexmedetomidine produces more satisfactory sedation as compared to oral ketamine with midazolam for fractionated RT.

COMPARISON OF ORAL MIDAZOLAM,ORAL DEXMEDETOMIDINE AND ORAL MIDAZOLAM KETAMINE COMBINATION FOR PREMEDICATION IN PAEDIATRIC SURGERY

Background: Children especially age group &lt;10years undergoing operation may experience preoperative anxiety &amp; may be uncooperative.This uncooperative behavior of children may be observed at the time of separation from parents, venipuncture or mask application. Untreated anxiety may lead to difficult induction, greater rescue analgesic needs, emergence delirium (ED), behavioural &amp; postoperative psychological effects. An atraumatic premedication, calm separation from parents can minimize these problems and a smooth induction of anaesthesia can be achieved.Method : Prospective randomized double blind active controlled study was conducted in Government medical college &amp; hospital, Aurangabad from 2018 to 2020 after Institution Ethics Committee approval. 75 ASA I &amp; II subjects aged between 2 to 5 year weighing less than 15 Kg posted for elective paediatric surgery under general anaesthesia at tertiary care centre were selected. They were randomly allocated into 3 groups Group M ,Group M K &amp; Group D with 25 subjects in each group using computer generated randomization list. Oral premedication was given in each group 30 minutes before surgery.Baseline heart rate,SBP and RR measured before administering premedication and at 10 minutes intervals up to 30 to 45 minutes after premedication. Results: Sedation &amp; anxiolysis score at induction[S1] was significant higher in Group M K&amp; Group D [p Value &lt;0.05] compared to Group M. Sedation at the time of separation from parents [S2] was better in Group M K &amp; Group D compared to Group M[p Value &lt;0.05].Sedation during Mask Acceptance[S3] was better in Group M K &amp; Group D compared to Group M[p Value &lt;0.05].Wake up Behaviour [when the patient recovers from anaesthesia at end of surgery [S4] ] was assessed &amp; Subjects were more Sedated[post anaesthesia] in Group D when compared to Group m &amp; Group M K[p Value &lt;0.05]. Time taken for maximum change in vital parameters was more in Group D followed by Group M K and Group M respectively p Value 0.001].There was significant changes in Vital parameters in Group D compared to Group M &amp; Group M K .Bradycardia p Value 0.00044] &amp; Hypotension [p Value 0.01]was more significant in Group D when compared to Group MK &amp;Group M Conclusion: Oral Midazolam (0.2mg/kg) &amp; Ketamine (2mg/kg) combination &amp; oral Dexmedetomidine (0.5 g/kg) both provide satisfactory sedation levels &amp; offers significant ease of separation from parents with satisfactory mask acceptance in children&lt;10 years compared to oral Midazolam alone.

A comparison of sedation with midazolam–ketamine versus propofol–fentanyl during Endoscopic retrograde cholangiopancreatography in adults

Background: Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) require adequate sedation or general anesthesia. This prospective clinical study investigated the safety and efficacy of midazolam -Ketamine versus propofol-fentanyl during ERCP procedures. patients and Methods: The study included 80 patients who underwent ERCP following anesthesiologist-administered sedation with fentanyl-propofol and other group midazolam-Ketamine. Procedural data, oxygen saturation, blood pressure, heart rate, recovery time, discharge times the effectiveness of sedation during the procedure was assess according to Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scores. Results: Sedation related complications occurred in 13 of 40 patients in group Ketamine – midazolam and 5 of 40 patients in group fentanyl-propofol included nausea / vomiting, agitation and headache. Most events were minor and did not necessitate discontinuation of the procedure. Successful cannulation was performed in all patients. the time of recovery was significantly lower in group MK with 5.15 ± 1.3 min compared to 6.15 ± 2 in group FP, and discharge was significantly. lower in group FP with 20.35 ± 0.7 min, compared to 24.15 ± 3.4 min in group MK. this occurred due to the number of patients who had side effects in midazolam-Ketamine group was more than the other group. Conclusion: We concluded that FP, more suitable for sedation and less complications rather than MK. Although no significant complications were seen.

Comparison of oral Midazolam versus Combination of Low Dose Oral Midzolam–Ketamine for Premedication in Paediatric Surgical Patients

Background and need for study: One of the challenge faced by paediatric anaesthesiologist is the allaying of fear of a child in the preoperative period. Among the commonly used premedicant in children, midazolam is the front runner. A combination low dose of ketamine and midazolam have been tried to overcome the deficiencies of ketamine and midazolam alone. Aims: This research was planned to compare the effectiveness of combination of low dose midzolam–ketamine with oral midazolam alone as a premedicant in paediatric patients in terms of degree of sedation, separation from parents, mask acceptance, and postoperative recovery Design: Prospective, randomised, double blind controlled study. Methods: Sixty children of ASA physical status I or II, aged between 1 and 12 years, who were scheduled to undergo elective minor surgery were randomised into two groups M and MK of thirty children each. Children in group M were administered with oral midazolam 0.5 mg.kg-1 mixed with 2 ml of honey and group MK were administered with combination of low dose oral midzolam (0.25 mg.kg-1) &amp; oral ketamine (3 mg.kg-1) for premedication mixed with 2 ml of honey. Patient was assessed for parental separation anxiety, mask acceptance, level of sedation and emergence delirium. Statistical Analysis: Difference with respect to anxiety at separation from parents and tolerance to mask between the two groups was analysed using chi-square test . Difference with respect to incidence and severity of emergence delirium between the two groups was analysed using an independent sample t test . The P &lt;0.05 was considered significant. Results: Parental separation was acceptable in 23 patients (76.7%) in group M and 28 patients in (93.3%) in group MK (Table 2, 3). Mask acceptance was satisfactory in 13 (43.3%) in group M and 19(63.3%) in group MK. Post-operative delirium was noted in one patient in each group. Conclusion: The low dose mixture of ketamine and midazolam provides better parental separation and mask acceptance with better cooperation during induction of anaesthesia.

Oral premedication in children: Comparison of combination of midazolam-ketamine and oral midazolam- A Randomised trial

Introduction: Premedication with sedative drugs is often used in paediatric practice as one of the modalities to reduce preoperative anxiety in children undergoing surgery. It reduces both patient and parental anxiety and improves overall satisfaction. Also, provides anterograde amnesia and reduces postoperative behavioral changes and adverse outcomes in children. The ideal premedication in children should be readily acceptable and should have speedy and reliable onset with negligible side effects. Materials and Methods: After obtaining institutional medical ethics committee approval, sixty ASA physical status I or II children, aged 1-8 years scheduled for elective surgery were randomly allocated into one of the two groups. Group M (n=30): received preservative free oral midazolam 0.5mg/kg (1ml=5mg) + acetaminophen based syrup (5ml=120mg) upto maximum value of 0.4ml/kg. Group MK (n=30): received preservative free oral midazolam 0.25 mg/kg (1ml=5mg)with 3mg/kg oral ketamine(1ml=50mg) + acetaminophen based syrup (5ml=120mg) upto maximum value of 0.4ml/kg. Results: Combination of midazolam0.25mg/kg and ketamine3mg/kg provided faster onset and higher degree of sedation, comparable incidence of satisfactory parental separation and mask acceptance without any added side effects in comparison to midazolam 0.5mg/kg. Conclusion: Addition of low dose ketamine to midazolam as a premedication provides adequate sedation. Keywords: Premedication, Midazolam, Ketamine, Pediatric patients, Sedation

The effect of vitamin K on the wound healing process in rat skin achieved by common wound dressing agents

Background and objective: Vitamin K is a fat-soluble vitamin that plays an important role in the coagulation pathways of living organisms. A popular application of vitamin K has been used to help in the extravascular removal of blood from the skin. The aim of the present study was to test the wound healing effect of vitamin K and some common wound dressing agents available in Erbil city clinical settings such; the moist exposed burn ointment (MEBO) and the Cica silver spray to test their combination with vitamin K injections. Methods: Six groups of albino rats were used (6 rats in each group). Group M received Mebo ointment, Group Creceived Cica silver spray, Group K received Vitamin K injection, Group MK received Mebo ointment+vitamin K injection.Group CK received Cica silver spray +vitamin K Group, and Group N received no- treatment. The duration of the experiments was as 7, 14, and 21 days post wound surgery.The percentage of wound contraction was measured, and the blood serum was collected to test the level of transforming growth factor β (TGFβ) and platelet-derived growth factor (PDGF). Results: Data presented in our study showed that the best wound contraction percentage(99%) was obtained by the MK treated rats compared to the control group. Similar results were obtained fromTGFβ and PDGF data in which MK group showed a significant increase in the levels of these growth factors. Conclusion: The wound healing process is supposed to be due to an increase of TGFβ, PDGF, and enhanced fibroblast proliferation and neovascularization of tissues.

Ameliorating effects of berberine on MK-801-induced cognitive and motor impairments in a neonatal rat model of schizophrenia

Neonatal administration of MK-801 (NMDA receptor antagonist) results in schizophrenia-like behaviors in rodents. Berberine (BBR) is a herbal alkaloid, which shows many neuroprotective properties in neurodegenerative diseases. The present study was designed to clarify whether systemic administration of BBR improves motor and cognitive disturbances induced by MK-801 treatment. Male Wistar rat pups were treated with intraperitoneal administration of saline (1 ml/kg) as a control group, MK-801 (1 mg/kg), BBR (20 mg/kg) and BBR (20 mg/kg) plus MK- 801 (1 mg/kg). Treatments were administered on postnatal day (P) 6–10 for once daily. To assess motor learning, coordination as well as spatial learning and memory, behavioral evaluation was performed at P55–60, using the rotarod, open field, and Morris water maze paradigm. MK-801 injection led to motor perturbations in both the open field and accelerating rotarod tests, which were restored by BBR. Also, BBR improved learning impairments, although it had no significant effect on the Probe test. Taken together, it can be concluded that BBR produces a neuroprotective effect in rats with MK-801-associated behavioral deficits. Given that the MK-801 exposure demonstrates an animal model of schizophrenia, we suggest that timely BBR administration may act as a potential treatment in schizophrenic patients.

Binocular Visual Function With Staged Implantation of Diffractive Multifocal Intraocular Lenses With Three Add Powers

To evaluate the binocular visual function and depth of focus after staged implantation of diffractive multifocal intraocular lenses (MIOLs) with 3 different add powers following cataract removal. Prospective comparative case series. Setting: Institutional. Both eyes of 56 patients that underwent staged implantation of bifocal IOLs. In the first eye, MIOLs with a+4.0-diopter (D) add power were implanted. Based on outcomes at 1week postoperatively and patient preference for near vision, 1 of 3 near add powers-+4.0 D (group MM),+3.25 D (group ML), or+2.75 D (group MK)-was implanted in the fellow eye. Three months postoperatively, the binocular uncorrected and distance-corrected visual acuities (BUCVA and BDCVA, respectively) at 5.0, 1.0, 0.5, 0.4, and 0.3 meters; binocular defocus curves; contrast sensitivity; and near stereopsis were measured. The MM, ML, and MK groups included 21, 18, and 17 patients, respectively. The mean BUCVA in the MM group was significantly (P= .003) worse than that in the MK group at 0.5 meter. The BDCVAs at 0.5 meter in the ML and MK groups were significantly (P < .02) better than that in the MM group. The defocus curves with the -2.0 D refraction differed significantly (P < .001) between the MM and MK groups. The binocular contrast sensitivity and stereopsis values did not differ significantly. Staged implantation of different add powers obtained better binocular intermediate visual acuity without degradation of visual function.

Ketamine with Midazolam and Ketamine alone as oral premedication in children: a randomized trial

Background: Fear of operation, injections, physicians and peculiar operation theatre environment where children are separated from their parents prior to anesthesia invariably produce traumatic experiences in tender mind of young children. Midazolam and Ketamine are useful for oral premedication in children to allay anxiety, allow separation from parents and to ensure smooth induction.Methodology: It was a prospective, randomized, double-blinded and comparative study conducted in 80 children of ASA I and II aged 1-6years undergoing elective ophthalmological procedures under general anesthesia. Children were randomized and divided into two groups, K received 4mg/kg of Ketamine and MK received 0.2mg/kg of Midazolam+2mg/kg of Ketamine peroral. Sedation level, ease of parental separation and ease of mask acceptance were evaluated within 20-30 minutes on a 4-point scale. The time to achieve modified Aldrete score of ≥9 was also noted.Results: Two groups were identical regarding age, sex, weight and ASA status. In sedation score, 31(77.5%) children in group K and 35(87.5%) children in group MK were awake, calm and quite (score3)(p=0.50). In parental separation score, 34(85%) children in group MK and 25(62.5%) children in group K have good separation, awake and calm (score2) (p=0.04). In mask acceptance score, 34(85%) children in group MK and 17(42.5%) children in group K were calm, awake, cooperative, accepting Mask (score1)(p=0.001). Time of recovery in group K was 17.92}6.50min whereas in group MK was 17.80}4.059min(p=0.91).Conclusion: Ketamine 4mg/kg and combination of Midazolam 0.2mg/kg with Ketamine 2mg/kg are equally effective but low dose combination is safe and superior. Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, Page: 66-73

Dexmedetomidine-ketamine versus magnesium sulfate-ketamine for sedating children undergoing bronchoscopic fiberoptic intubation

Background and aims Meticulous airway management, with the support of satisfactory sedation while keeping up a patent airway and guaranteeing ventilation, is an integral part for conscious sedation for bronchoscopic fiberoptic intubation in pediatric patients. This randomized double-blinded, prospective, comparative, clinical study aimed to compare the effects of dexmedetomidine-ketamine versus magnesium sulfate-ketamine for sedating children experiencing bronchoscopic fiberoptic intubation. The primary outcome was intubation scores as assessed by (a) vocal cord movement, (b) coughing, and (c) limb movement. Secondary outcomes were intubation time and patient tolerance using fiberoptic intubation comfort score. Patients and methods A total of 60 patients having American Society of Anesthesiologist grade I aged between 7 and 14 years undergoing elective minor infraumbilical surgeries were included in the study. Patients were randomly allocated to one of two groups: group DK patients (n=30) received intravenous loading dose of dexmedetomidine (2 µg/kg) in 20 min, and then were maintained by 0.5 µg/kg/h infusion until successful placement of the tube in the trachea, and intravenous ketamine (0.5 mg/kg/h) after finishing the loading dose, and just before fiberoptic intubation, and group MK patients (n=30) received intravenous loading dose of magnesium sulfate (40 mg/kg) in 20 min, and then were maintained by 10 mg/kg/h until successful placement of the tube in the trachea, and ketamine (0.5 mg/kg) after finishing the loading dose, and just before fiberoptic intubation. Continuous data were summarized as mean±SD, whereas discrete (categorical) in percentage. The groups were compared by independent Student’s ‘t’ test. The discrete (categorical) variables were compared by χ2-test. Results Intubation scores were better in group DK than group MK for vocal cord movement (P=0.009) and limb movement (P=0.0016), but there was no statistically significant difference in coughing (P=0.89). Time required for intubation was significantly less in group DK, as compared with the group MK (76.4±13.25 and 89.83±20.069 s, P=0.043). There was better fiberoptic intubation comfort score in group DK (P=0.0032). All patients were successfully intubated through fiberoptic bronchoscope in both groups. There were no significant hemodynamic changes between the two groups. Conclusion Intravenous dexmedetomidine/ketamine improved awaken bronchoscopic fiberoptic intubation in children with better intubation scores, intubation tolerance, and less intubation time when compared with magnesium sulfate-ketamine.

The Comparison of the Efficacy and Safety of Midazolam, Ketamine, and Midazolam Combined with Ketamine Administered Nasally for Premedication in Children.

Background:In this prospective, randomized study, we evaluated the intranasal administration of Midazolam ketamine combination, midazolam, and ketamine in premedication for children.Material and Methods:We studied 60 American Society of Anesthesiology physical status Classes I and II children aged between 1 and 10 years undergoing ear nose throat operations. All cases were premedicated 15 min before operation with intranasal administration of 0.2 mg/kg midazolam in Group M, 5 mg/kg Ketamine in Group K, and 0.1 mg/kg Midazolam + 3 mg/kg ketamine in Group MK. Patients were evaluated for sedation, anxiety scores, respiratory, and hemodynamic effects before premedication, 5 min interval between induction and postoperative period.Results:There was no difference with respect to age, sex, weight, the duration of the operation, and for mask tolerance. Sedation scores were significantly higher in Group MK. There was no statistically difference between the groups for heart rate, oxygen saturation, and respiratory rate.Conclusion:We concluded that intranasal MK combination provides sufficient sedation, comfortable anesthesia induction with postoperative recovery for pediatric premedication.

Effects of combined human parathyroid hormone (1-34) and menaquinone-4 treatment on the interface of hydroxyapatite-coated titanium implants in the femur of osteoporotic rats.

The objective of this study was to investigate the effects of human parathyroid hormone (1-34) (PTH1-34; PTH) plus menaquinone-4 (vitamin K2; MK) on the osseous integration of hydroxyapatite (HA)-coated implants in osteoporotic rats. Ovariectomized female Sprague-Dawley rats were used for the study. Twelve weeks after bilateral ovariectomy, HA-coated titanium implants were inserted bilaterally in the femoral medullary canal of the remaining 40 ovariectomized rats. All animals were then randomly assigned to four groups: Control, MK, PTH and PTH+MK. The rats from groups MK, PTH and PTH+MK received vitamin K2 (30mg/kg/day), PTH1-34 (60μg/kg, three times a week), or both for 12weeks. Thereafter, serum levels of γ-carboxylated osteocalcin (Gla-OC) were quantitated by ELISA and the bilateral femurs of rats were harvested for evaluation. The combination of PTH and MK clearly increased the serum levels of Gla-OC (a specific marker for bone formation) compared to PTH or MK alone. The results of our study indicated that all treated groups had increased new bone formation around the surface of implants and increased push-out force compared to Control. In addition, PTH+MK treatment showed the strongest effects in histological, micro-computed tomography and biomechanical tests. In summary, our results confirm that treatment with PTH1-34 and MK together may have a therapeutic advantage over PTH or MK monotherapy on bone healing around HA-coated implants in osteoporotic rats.

Role of JAK2-STAT3 signaling pathway in sevoflurane postconditioning-induced inhibition of mPTP opening during myocardial ischemia-reperfusion in rats

Objective To evaluate the role of Janus kinase 2-signal transducer and activator of transcription 3(JAK2-STAT3)signaling pathway in sevoflurane postconditioning-induced inhibition of mitochondrial permeability transition pore(mPTP)opening during myocardial ischemia-reperfusion(I/R)in rats. Methods Sixty pathogen-free healthy male Sprague-Dawley rats, weighing 250-300 g, were divided into 4 groups(n=15 each)using a random number table: I/R group, sevoflurane postconditioning group(group SP), AG-490 group(group AG)and sevoflurane postconditioning plus AG-490 group(group SP+ AG). Myocardial I/R was induced by 30 min ligation of the left anterior descending branch of coronary artery followed by 120 min reperfusion.In group SP, 2.8% sevoflurane was inhaled for 15 min starting from 2 min before reperfusion.JAK2 inhibitor AG-490 3 mg/kg was intravenously injected at 10 min before reperfusion in group AG.In group SP+ AG, AG-490 3 mg/kg was intravenously injected at 10 min before reperfusion, and 2.8% sevoflurane was inhaled for 15 min starting from 2 min before reperfusion.At 15 min of reperfusion, 5 rats were sacrificed and myocardial specimens were obtained for determination of the expression of JAK2, phosphorylated JAK2(p-JAK2), STAT3 and phosphorylated STAT3(p-STAT3)in myocardial tissues by Western blot.The ratios of p-JAK2 to JAK2 expression(p-JAK2/JAK2)and p-STAT3 to STAT3 expression(p-STAT3/STAT3)were calculated.Five rats were sacrificed at the end of reperfusion for measurement of myocardial infarct size.The left 5 rats were selected and sacrificed, myocardial specimens were obtained, and the opening of mPTP was detected by a calcein-cobalt quenching method. Results Compared with group I/R, the myocardial infarct size and mPTP opening were significantly decreased, and JAK2/p-JAK2 and STAT3/p-STAT3 were increased in group SP(P 0.05). Compared with group SP, the myocardial infarct size was significantly enlarged, the extent of mPTP opening was aggravated, and JAK2/p-JAK2 and STAT3/p-STAT3 were decreased in SP+ AG and AG groups(P<0.05). Conclusion The mechanism by which sevoflurane postconditioning inhibits the opening of mPTP during myocardial I/R is related to activation of JAK2-STAT3 signaling pathway in rats. Key words: Aesthetics, inhalation; Janus kinase 2; STAT3 transcription factor; Mitochondrial membrane transport proteins; Myocardial reperfusion injury; Ischemic postconditioning

Does sevoflurane add to outpatient procedural sedation in children? A randomised clinical trial

BackgroundThere is little evidence concerning the effect of sevoflurane in outpatient procedural sedation, especially in children. We hypothesised that the addition of sevoflurane to a sedation regimen improves children’s behaviour with minimal adverse events.MethodsThis is a randomised, triple-blind clinical trial conducted on an outpatient basis. Participants were 27 healthy children aged 4 to 6 years, who previously refused dental treatment with non-pharmacologic methods. All participants received oral midazolam (0.5 mg/kg, maximum 20 mg) and oral ketamine (3 mg/kg, maximum 50 mg) and, in addition: Group MK – 100% oxygen; Group MKS – inhalational sevoflurane at a sedative dose (final expired concentration between 0.3 and 0.4%). Dental appointments were video recorded for assessment of the children’s sleep patterns, crying, movements, and overall behaviour during the procedure with the Houpt scale. Intra- and post-operative adverse events were systematically reported. Data were analysed by bivariate analyses in the IBM SPSS v. 19, at a significance level of 5%.ResultsMK (n = 13) and MKS (n = 14) did not differ regarding the Houpt scores (P > 0.05), but 53.8% of children in the MK group showed hysterical and continuous crying at the time of the local anaesthesia injection, compared to 7.1% of children in the MKS group (P = 0.01; phi = 0.5). There was a trend toward less crying and movement over time during the dental appointment in the MKS group (P = 0.48). Minor adverse events were observed in 10 MK children and 4 MKS children (P = 0.01).ConclusionsThe addition of sevoflurane to oral midazolam-ketamine improved the children’s crying behaviour during local anaesthetic administration, and did not increase the occurrence of adverse events.Trial registrationClinical Trials NCT02284204. Registered 5 October 2014.

Role of Akt/GSK-3β signaling pathway in isoflurane preconditioning-induced inhibition of mPTP opening during myocardial ischemia-reperfusion in rats

Objective To evaluate the role of serine-threonine kinase(Akt)/glycogen synthase kinase-3 beta(GSK-3β)signaling pathway in isoflurane preconditioning-induced inhibition of mitochondrial permeability transition pore protein(mPTP)opening during myocardial ischemia-reperfusion(I/R)in rats. Methods Ninety-six male Sprague-Dawley rats, aged 3-4 months, weighing 200-250 g, were randomly divided into 4 groups(n=24 each)using a random number table: control group(group C); I/R group; isoflurane preconditioning group(group IPC); Akt inhibitor MK-2206 group(group MK). Myocardial I/R was induced by occlusion of the anterior descending branch of the left coronary artery for 30 min followed by 2 h of reperfusion.In group IPC, 1.5% isoflurane was inhaled for 30 min followed by 45 min washout, and then the model of myocardial I/R injury was established.In group MK, MK-2206 300 μg/kg(in dimethyl sulfoxide)was injected intraperitoneally at 30 min before isoflurane inhalation.At 2 h of reperfusion, 8 rats were selected and sacrificed, and the hearts were removed for determination of myocardial infarct size.At 2 h of reperfusion, 8 rats were selected, and blood samples were collected from the right internal jugular vein for determination of serum cardiac troponin I(cTnI) concentrations.The rats were then sacrificed, and myocardial specimens were obtained for determination of the expression of phosphorylated GSK-3β(p-GSK-3β)in cytoplasm and mitochondria(by Western blot)and co-expression of p-GSK-3β with adenine nucleotide translocator(ANT), voltage-dependent anion channel or cyclophilin D in myocardial tissues(using co-immunoprecipitation). At 2 h of reperfusion, 8 rats were selected and sacrificed, myocardial cells were obtained, and the opening time of mPTP was determined with a laser scanning confocal microscope. Results Compared with group C, the myocardial infarct size and serum cTnI concentrations were significantly increased, and the expression of p-GSK-3β in cytoplasm and mitochondria was up-regulated in I/R and IPC groups, the co-expression of p-GSK-3β with ANT was significantly down-regulated, and the opening time of mPTP was shortened in group I/R, and the co-expression of p-GSK-3β with ANT was significantly up-regulated, and the opening time of mPTP was prolonged in group IPC(P 0.05). Compared with group IPC, the myocardial infarct size and serum cTnI concentrations were significantly increased, the expression of p-GSK-3β in cytoplasm and mitochondria was up-regulated, the co-expression of p-GSK-3β with ANT was significantly down-regulated, and the opening time of mPTP was shortened in group MK(P<0.05). No co-expression of p-GSK-3β with voltage-dependent anion channel or cyclophilin D was found in myocardial tissues. Conclusion The mechanism by which isoflurane preconditioning inhibits mPTP opening during myocardial ischemia-reperfusion is partially related to activation of Akt/GSK-3β signaling pathway in rats. Key words: Isoflurane; Ischemic preconditioning; Myocardial reperfusion injury; Mitochondrial membrane transport proteins; Protein-serine-threonine kinases; Glycogen synthase kinase 3

Comparative evaluation of dexmedetomidine and midazolam-ketamine combination as sedative agents in pediatric dentistry: A double-blinded randomized controlled trial.

Background:Pharmacological methods have been used as an adjunct to enhance child cooperativeness and facilitate dental treatment.Objective:Purpose of this study was to evaluate and compare the effect of sedation by intranasal dexmedetomidine and oral combination drug midazolam–ketamine in a group of children with uncooperative behavior requiring dental treatment.Materials and Methods:This was a prospective, randomized, double-blind study that included patients 3–9 years old with American Society of Anesthesiologists-I status. About 36 children presenting early childhood caries were randomly assigned to one of three groups studied: Group MK received intranasal saline and oral midazolam (0.5 mg/kg) with ketamine (5 mg/kg) mixed in mango juice; Group DX received intranasal dexmedetomidine (1 μg/kg) and oral mango juice; and Group C received intranasal saline and oral mango juice. Patients' heart rate, blood pressure, and oxygen saturation were recorded before, during, and at the end of the procedure. Patients' behavior, sedation status, and wake up behavior were evaluated with modified observer assessment of alertness and sedation scale. Ease of treatment completion was evaluated according to Houpt scale.Results:Hemodynamic changes were statistically insignificant in Group MK and Group DX. About 75% patients in Group MK were successfully sedated as compared to 53.9% Group DX and none of the patients in Group C. Ease of treatment completion was better with Group MK as compared to Group DX and least with Group C. Around 50% patients in Group MK had postoperative complications.Conclusion:Oral midazolam–ketamine combination and intranasal dexmedetomidine evaluated in the present study can be used safely and effectively in uncooperative pediatric dental patients for producing conscious sedation.