Loss Of Reflex Research Articles

Caffeine intoxication: Behavioral and electrocorticographic patterns in Wistar rats.

Caffeine is a psychoactive substance used worldwide. The present study analyzes the seizure-related behavior and electrocorticographic (ECoG) patterns observed in rats following of a toxic dose of caffeine (150mg/kg; intraperitoneal). Sixty-three rats were divided into three experiments: 1-Behavior's Description associated with caffeine-induced convulsion; 2- Comparison of the electrocorticographic patterns induced by caffeine and pentylenetetrazole, and 3- Assessment of the electrocorticographic response to antiepileptic drugs (diazepam, phenytoin, and phenobarbital). The behavioral analysis demonstrated tonic-clonic seizures with a loss of postural reflex and a latency of 365.8s after the caffeine's administration. Caffeine-induced changes in the ECoG were consistent with the development of seizures with rapid evolution and burst potential consistent with the behavioral patterns observed during the caffeine-induced seizure. The ECoG of the brainwaves varied significantly between the seizures caused by caffeine and pentylenetetrazole. The predominant brain forces observed during the seizures were beta-band oscillations. The caffeine-induced seizures were resistant to attempted control with phenytoin and phenobarbital, but responded well to diazepam, which is consistent with a study of Pilocarpine, which showed that diazepam has anticonvulsant effects. These findings are important for the development of effective treatments for caffeine intoxication, in particular for individuals with a low seizure threshold.

Tmprss6 Depletion-Mediated Iron Deficiency Attenuates the Clinical Course of Plasmodium Berghei Infection in Mice

Background Anaemia and malaria cause a great burden of disease and commonly co-exist. Field studies have linked iron deficiency with decreased malaria risk but may be confounded. We aimed to define the association between iron status and malaria risk in an in vivo experimental system. Using the P. berghei mouse malaria model, we assessed the impact of both severe iron overload and iron deficiency using inducible hepcidin (Hamp) knockout (iHamp-KO), Tmprss6 knockout (Tmprss6-KO) and Tmprss6 knockdown (Tmprss6-KD) mouse models. Homozygous mutations of HAMP (encoding hepcidin) cause severe iron overload, while homozygous inactivation of TMPRSS6 leads to hepcidin overexpression and iron deficiency. MethodsP. berghei infection of C57BL/6 mice is an experimental model of cerebral and severe malaria. The majority of mice develop neurological symptoms between day 6-10 post infection, surviving mice usually develop hyperparasitaemia and symptoms of severe anaemia by day 20. Mice were infected with PbmCherryLuci sporozoites by intravenous injection. Luciferase activity was used to assess liver infection and egress. Mice were analysed by IVIS at 24, 36, 52 and 55/56 hours post infection. From day 3 post infection peripheral parasitaemia was assessed daily. Mice were euthanised if they showed signs of cerebral malaria (such as loss of self-righting reflex and hind-limb paresis), severe anaemia, or if parasitaemia reached >20% (iHamp-KO and Tmprss6-KO) or >30% (Tmprss6-KD) in line with animal ethics requirements. iHamp-KO mice received tamoxifen intraperitoneally daily for 5 days 3 months prior to infection to induce Hamp deletion. Controls were iHamp-KO littermates that received vehicle alone. Tmprss6-KO mice were infected at about 24 weeks of age and compared to littermate heterozygote controls which are known to have a negligible phenotype. Tmprss6-KD was achieved through treatment of WT mice with siTMP, a GalNAc siRNA conjugate targeting Tmprss6. Mice received siTMP 5mg/kg s.c. 3 weekly starting 8 weeks prior to P. berghei infection, or a single treatment on day 3 (expected onset of blood stage infection) or day 6 (expected onset of high risk period for cerebral malaria), while controls received PBS. Results iHamp-KO mice had lower peak liver infection (p=0.0097), but egress was not affected, and there was no effect on overall survival or survival from cerebral malaria. Tmprss6-KO mice showed higher liver infection compared with heterozygous littermate controls at all timepoints, but egress was not different. Tmprss6-KO mice had improved overall survival compared with heterozygous controls (p=0.0004) and improved survival from cerebral malaria (p=0.0004). All 7 heterozygous controls succumbed to cerebral malaria by day 10, compared to 1 of 6 Tmprss6-KO animals (Figure 1). We further investigated effects of iron deficiency on malaria severity using Tmprss6 knockdown. Mice treated with siTMP for 8-10 weeks had markedly reduced Tmprss6 and elevated Hamp expression in the liver, and lower haemoglobin, MCV, and plasma iron. Tmprss6-KD mice, treated 8 weeks prior to P. berghei infection exhibited reduced parasitaemia, and took longer to reach 10%, 20% and 30% parasitaemia (Figure 2). There was no change in survival from cerebral malaria. Tmprss6-KD after infection did not change parasitaemia or survival. Conclusion Experimental iron deficiency via Tmprss6 downregulation attenuated malaria disease phenotype in mice. These data provide experimental evidence to support observational data that iron deficiency provides protection against malaria infection. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management

Low anterior resection syndrome (LARS) is a condition of anorectal dysfunction that occurs frequently following anal sphincter-preserving surgery for rectal cancer and can reduce the quality of life. In this review, we summarize the main symptoms and pathophysiology of this syndrome and discuss the treatment approaches. Early evaluation and initiation of appropriate treatment postoperatively are crucial. The most frequently used tool to evaluate the severity of LARS is the LARS score, and an anorectal manometer is used for objective evaluation. LARS is believed to be caused by multiple factors, and some of its causes include direct structural damage to the anal sphincter, damage to the innervation, loss of rectoanal inhibitory reflex, and decreased rectal volume and compliance. Diet modifications, medications, pelvic floor muscle training and biofeedback are the primary treatments, and rectal irrigation can be added as a secondary treatment. If LARS symptoms persist even after 1 to 2 years and significantly reduce the quality of life, antegrade irrigation, sacral nerve stimulation or definitive stoma may be considered. High-quality evidence-based studies on LARS treatment are lacking, and randomized controlled trials aimed at developing severity-based treatment algorithms are needed.

Quantal Response and Histopathological Effects of Sub-lethal Concentrations of a Selected Oilfield Chemical on African Catfish (Clarias gariepinus)

The behavioural and histological effects of sublethal concentrations (0.0 ml/L, 12.8 ml/L, 25.59 ml/L, 38.39 ml/L, 51.19 ml/L, and 63.99 ml/L) of Xylene were evaluated in African Catfish (Clarias gariepinus) after 28 days of exposure. Physico-chemical parameters such as temperature, conductivity, hydrogen ion concentration (pH), total hardness, total dissolved solids, dissolved oxygen, total alkalinity, ammonia, and nitrate levels in the experiment were monitored using the standard method. Significant variations were observed in the different units except for the controlled unit. Behavioural changes were observed closely during the sublethal toxicity test using standard procedures. The bioassay experiments were repeated three times and the renewable test method was used. concentrations showed histopathological alterations in the gills and liver. Severely deformations were observed at 12.80ml/l, 38.39ml/l), 51.19ml/l, and 63.99ml/l. No form of abnormalities was observed in the fish gill and liver in the controlled unit. Progressive hyperventilation, faster operculum and tail beat movement, erratic movement, gulping of air, and spiralling. jumping, display of vigorous jerky movement suffocation, and loss of reflex were observed in C. gariepinus exposed to higher sublethal concentrations of Xylene. There was a significant dose-dependent variation in parameters in the experiment. In conclusion, xylene caused an alteration in the histopathological parameters and the behaviour of C. garienpinus. Therefore, we recommend the need for realistic regulatory measures and proper monitoring and sensitization on use to stakeholders.

Oxidative Stress Biomarkers Activities and Histological Changes in African Catfish (Clarias gariepinus) Exposed to Carwash Wastewater

The study evaluated the acute toxicity of vehicle wastewater on African catfish (Clarias gariepinus). With a weight range of 250–275.5g and a mean length of 23.5-28.5cm, 150 post-juvenile catfish were purchased from Dalar Kifi Fish Farm BUK New site road, Kano State, and acclimated in a tank for 14 days. Fish were exposed to different vehicle wastewater concentrations of 0.0, 20, 40, 60, and 80% v/v with 5-level exposure concentrations during the acute test (96 hours) in a Completely Randomized Design (CRD) employing renewal bioassay. The acute bioassay showed that the LC50 for the wastewater was 56 percent by volume at 96 hours. Compared to the control, the exposed fish exhibited abnormal swimming, erratic opercular movement, reflex loss, mucus secretion, increased air gulping with an increase in wastewater concentration. Except for water temperature, Biochemical Oxygen Demand (BOD) and pH, the remaining physicochemical parameters were not within the WHO/FAO recommended Standard The order of concentrations of the heavy metal in the wastewater was Cu > Pb > Cd > Cr > Ni. Antioxidant biomarker activities showed that Glutathione reductase (GSH) reduced in the same manner while Catalase (CAT) and Superoxide dismutase (SOD) activities rose considerably (P<0.05) in the liver and gill tissues. Histopathological changes observed in gill tissues were as follows: Hyperplasia, necrosis, primary and secondary lamellae distortion, and epithelial thickening distortion. Hepatic cell breakdown, fatty degeneration, cellular infiltration, localized fibrosis, and cellular necrosis were all visible in the liver tissues. It can be inferred that changes in the histology and activity of the oxidative stress enzymes in fish tissues after exposure to wastewater harmed the experimental fish. As a result of their effects on fish and other non-target aquatic biotas, it is advised that the competent authorities create initiatives to reduce the indiscriminate discharge of untreated vehicle wash wastewater.

Atypical Myasthenia Gravis Presentation with Limb-Girdle Weakness

Myasthenia Gravis is a disorder characterized by autoantibodies targeting different proteins across the neuromuscular junction. The typical presentation of Myasthenia Gravis involves oculobulbar weakness, classically ptosis that may or may not be symmetric. Patients may also present with a more dramatic presentation of generalized weakness or even in myasthenic crisis requiring respiratory support for oxygenation. While these are the common presentations, our patient, a 63 year old male, presented with an atypical presentation of what is described as Limb-Girdle Myasthenia Gravis. This patient presented with proximal arm and leg weakness that rapidly progressed and lead to loss of reflexes, appearing to be a myelopathy prior to obtaining an electromyography/nerve conduction study which demonstrated decrement of 21% in ulnar, 22% in median, and 59% of radial nerves during 2Hz repetitive stimulation. Our patient improved with plasmapheresis and prednisone with full recovery of strength.

Tandem pore domain acid-sensitive K channel 3 (TASK-3) regulates visual sensitivity in healthy and aging retina.

Retinal ganglion cells (RGCs) not only collect but also integrate visual signals and send them from the retina to the brain. The mechanisms underlying the RGC integration of synaptic activity within retinal circuits have not been fully explored. Here, we identified a pronounced expression of tandem pore domain acid-sensitive potassium channel 3 (TASK-3), a two–pore domain potassium channel (K2P), in RGCs. By using a specific antagonist and TASK-3 knockout mice, we found that TASK-3 regulates the intrinsic excitability and the light sensitivity of RGCs by sensing neuronal activity–dependent extracellular acidification. In vivo, the blockade or loss of TASK-3 dampened pupillary light reflex, visual acuity, and contrast sensitivity. Furthermore, overexpressing TASK-3 specifically in RGCs using an adeno-associated virus approach restored the visual function of TASK-3 knockout mice and aged mice where the expression and function of TASK-3 were reduced. Thus, our results provide evidence that implicates a critical role of K2P in visual processing in the retina.

Extracranial Etiology of Acute Onset Ataxia and Weakness: Small but Deadly.

A 4-year-old girl presented to the emergency department as a stroke alert with acute onset ataxia and leg weakness. She experienced repeated falls and inability to move her legs. Her neurologic examination revealed ataxia, bilateral distal predominant weakness, and loss of reflexes. She underwent brain MRI which identified a tick on the right occiput (Figure 1). The patient decompensated and was sent to the pediatric intensive care unit where the tick was carefully removed (Figure 2). She fully recovered 4 days later.

A spinal manipulative therapy altered brain activity in patients with lumbar disc herniation: A resting-state functional magnetic resonance imaging study.

PurposeLumbar disc herniation (LDH) is one of the leading causes of low-back pain and results in a series of clinical symptoms, including pain, reflex loss, and muscle weakness. Spinal manipulative therapy (SMT) can relieve pain and promote internal and external stabilization of the lumbar spine. In this study, we investigated whether the brain alterations of LDH patients with SMT were frequency-dependent based on the calculation of Amplitude of Low-Frequency Fluctuations (ALFF) and fractional ALFF (fALFF). Further, we established a cohort of LDH patients to evaluate the contribution of SMT treatments to brain functional reorganization.MethodsA total of 55 participants, including 27 LDH patients and 28 health controls (HCs), were collected. All LDH patients underwent two fMRI scans (before SMT and after the sixth SMT session). To represent LDH-related brain oscillatory activities, we calculated the ALFF and fALFF in the conventional band (0.01–0.08 Hz), the slow-4 band (0.027–0.073 Hz), and the slow-5 band (0.01–0.027 Hz). Moreover, we extracted ALFF and fALFF values in clusters with significant differences to evaluate the SMT effect.ResultsCompared with HCs, the LDH patients before SMT (LDH-pre) exhibited increased fALFF in right lingual gyri in the conventional band, and showed increased fALFF in left Cerebelum_Crus1 in the slow-4 band. We further examined the abnormal brain activities changes before and after the SMT intervention. The ALFF and fALFF values of LDH-pre group were higher than those of the HCs and LDH-pos groups. After SMT, the increased ALFF and fALFF values were suppressed for patients in conventional band and slow-4 band.ConclusionThe present study characterized the altered regional patterns in spontaneous neural activity in patients with LDH. Meanwhile, SMT is an effective treatment of LDH, and we supposed that it might have been involved in modulating dysfunctional brain regions which are important for the processing of pain. The findings of the current study may provide new insights to understand pathological mechanism of LDH.

Variasi Dosis Spray Ekstrak Etanol Solanum melongena L. dan Cananga adorata terhadap Perubahan Gejala Toksik, Fungsi Hepar, dan Hispatologi Mencit (Mus musculus)

The purpose of this study was to determine toxic symptoms (loss of reflex), enzyme activity of SGOT and SGPT, and liver histopathology of experimental mice (Mus musculus) exposed to a combination formulation of 96% ethanol extract spray of Solanum melongena L. and Cananga adorata flower oil. True experimental research design with Post Test Only Control Group Design, this study used 4 treatment groups and 1 control group, data collected in the form of toxic symptoms (loss of reflex), SGOT enzymatic activity, and liver histopathological picture of experimental mice (Mus musculus). Which was analyzed by One Way Anova and Descriptive test. The results showed that the changes in toxic physical symptoms (loss of reflexes) of experimental mice (Mus musculus) after 30 minutes of spraying were strange reactions to walking around without direction, sensitivity to touch, changes in social interaction colliding with each other, lethargy, eye opacity and excessive blinking, respiratory rate. increased, which returned to normal at 4 hours to 168 hours after spraying. The activity of the SGOT and SGPT enzymes after 168 hours of spraying showed that the higher the dosage of the formulation, the higher the activity of the SGOT and SGPT enzymes, but the increase was still within normal limits, the histopathological results of liver morphology grading at various research doses showed Normal and Mild. Conclusion: Solanum melongena L. and Cananga adorata flower oil combined did not cause pathological effects in experimental mice (Mus musculus).

A case of Miller Fisher syndrome with delayed onset peripheral facial nerve palsy after COVID-19 vaccination: a case report

BackgroundTo prevent the spread of the novel coronavirus disease 2019 (COVID-19) infection, various vaccines have been developed and used in a large number of people worldwide. One of the most commonly used vaccines is the mRNA vaccine developed by Moderna. Although several studies have shown this vaccine to be safe, the full extent of its side effects has not yet been known. Miller-Fisher syndrome (MFS) is a rare condition that manifests ophthalmoplegia, ataxia, and loss of tendon reflexes. It is a subtype of Guillain–Barré syndrome and an immune-mediated disease related to serum IgG anti-GQ1b antibodies. Several vaccines including those for COVID-19 have been reported to induce MFS. However, there have been no reports of MFS following Moderna COVID-19 vaccine administration.Case presentationA 70-year-old man was referred to our hospital due to diplopia that manifested 1 week after receiving the second Moderna vaccine dose. The patient presented with restricted abduction of both eyes, mild ataxia, and loss of tendon reflexes. He was diagnosed with MFS based on his neurological findings and detection of serum anti-GQ1b antibodies. The patient was administered intravenous immunoglobulin, and his symptoms gradually improved. Five days after admission, the patient showed peripheral facial paralysis on the right side. This symptom was suggested to be a delayed onset of peripheral facial nerve palsy following MFS that gradually improved by administration of steroids and antiviral drugs.ConclusionThere have been no previous reports of MFS after Moderna COVID-19 vaccination. This case may provide new information about the possible neurological side effects of COVID-19 vaccines.

LARYNGEAL MASK AIRWAY INSERTION: COMPARISON OF SEVOFLURANE WITH PROPOFOL IN ADULTS

Methods: A cross-sectional observational study was conducted on patients scheduled for vascular, reconstructive, gynaecological, and day care surgeries for whom propofol (P) and sevoflurane (S) were used as induction agent for LMA insertion. All patients who fulfilled the inclusion and exclusion criteria and had given propofol or sevoflurane at various departments during the specified duration were included in the study and data were collected using pre-defined protocol. A total of 100 consecutive patients (50 patients in each group) were included in the study. Objectives: The objectives of the study were to evaluate and compare sevoflurane in one vital capacity breath with propofol in dose of 2 mg/kg for ease of laryngeal mask airway (LMA) insertion in adults. Results: The mean age for sevoflurane (S) group and propofol (P) group was 35.30, standard deviation (SD) 8.74 and 34.88, SD 9.37, respectively. Heart rate (HR) at 2 min, 3 min, and 4 min after induction showed a fall with propofol which was statistically significant. There was statistically significant difference in systolic blood pressure at on 1 min, 2 min, 3 min, and 4 min when compared between the two groups. A statistically significant fall in the systolic blood pressure in Group P was noted when compared to Group S. There was statistically significant difference in diastolic blood pressure at 4 min when compared between the two groups. A fall in the diastolic blood pressure in Group P was noted when compared to Group S at 4 min. There was fall in blood pressure in Group P when compared with Group S and this was significant. Fall in oxygen saturation in 3 and 4 min was significant. However, this fall was not clinically significant, as the values remained above 94%. There was increase in end-tidal carbon dioxide in 1, 2, 3, and 4 min and was statistically significant between the two groups. Sevoflurane took longer time for induction and LMA insertion. Loss of eye lash reflex, jaw relaxation, and LMA insertion were lost earlier with propofol and were statistically significant. The overall LMA insertion was excellent with propofol in 50 patients and with sevoflurane 48 patients had excellent condition and two were satisfactory. Conclusion: In our study, sevoflurane was associated with good hemodynamic stability, but quality of anesthesia provided with propofol was superior. Delayed jaw relaxation with sevoflurane when compared to propofol delayed LMA insertion. The overall insertion was excellent with propofol with all 50 patients as compared to sevoflurane.

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups.

Remimazolam is a new ultra short-acting benzodiazepine originally developed as an improved version of midazolam. Recent studies have demonstrated non-inferiority of remimazolam to propofol in general anesthesia. However, to date, few studies have investigated the induction bolus dose of remimazolam required to achieve general anesthesia. We aimed to determine the 95% effective dose (ED95) of remimazolam bolus required to achieve loss of consciousness (LOC) and the appropriate doses for different age groups. Patients aged 20-79 years with the American Society of Anesthesiologists physical status of I or II were enrolled in this study. A total of 120 patients were included representing young, middle-aged, and elderly groups. Loss of eyelash reflex and verbal response after the administration of remimazolam was considered successful LOC. The ED95 of remimazolam was determined using a biased coin up-and-down design with sequential allocation and the isotonic regression method. The ED95 of remimazolam for induction of general anesthesia was 0.367 mg/kg (95% CI [0.277, 0.392]) in the young group, 0.369 mg/kg (95% CI [0.266, 0.394]) in the middle-aged group, and 0.249 mg/kg (95% CI [0.199, 0.288]) in the elderly group. During the study period, none of the patients required rescue medications for hypotension or bradycardia. This study investigated the ED95 of remimazolam bolus for anesthesia induction. The precise dosing of the ED95 can help maintain hemodynamic stability during the induction of anesthesia.

No Reduction in the 226-Hz Probe Tone Acoustic Reflex Amplitude Following Severe Inner Hair Cell Loss in Chinchillas.

The relationship between the middle ear acoustic reflex (AR) and inner hair cell (IHC) loss is currently unknown. Given that IHC are believed to convey nearly all acoustic information to the central auditory nervous system, it has been assumed that loss of IHC would significantly impact the AR. To evaluate this relationship, we assessed the presence and amplitude of the AR in chinchillas before and after treatment with carboplatin, an anticancer drug that reliably and selectively destroys IHC in this species. Baseline measures of hearing sensitivity, including auditory brainstem response (ABR) thresholds and distortion product otoacoustic emissions (DPOAE), were assessed and then re-evaluated following carboplatin treatment. Post-carboplatin ABR thresholds and DPOAE were found to be unchanged or slightly elevated; results were consistent with published reports. Our main hypothesis was that loss of IHC would abolish the reflex or significantly reduce its amplitude. Contrary to our hypothesis, the ipsilateral 226-Hz AR continued to be reliably elicited following carboplatin treatment. Post-mortem histological analysis confirmed significant IHC loss (65-85 %), but no measurable loss of outer hair cells (OHCs). Given that loss of IHC alone does not significantly reduce the 226-Hz AR, our results suggest that few IHC are needed to maintain the 226-Hz AR response. These results suggest additional studies are needed to better understand the role of IHC in the reflex arc, present opportunities to further study the reflex pathway, and could change how we use the clinical AR as a potential diagnostic tool for IHC dysfunction, including those related to IHC synaptopathy.

Phenotype Characterization of a Mice Genetic Model of Absolute Blindness.

Recent technological development requires new approaches to address the problem of blindness. Such approaches need to be able to ensure that no cells with photosensitive capability remain in the retina. The presented model, Opn4−/− × Pde6brd10/rd10 (O×Rd) double mutant murine, is a combination of a mutation in the Pde6b gene (photoreceptor degeneration) together with a deletion of the Opn4 gene (responsible for the expression of melanopsin in the intrinsically photosensitive retinal ganglion cells). This model has been characterized and compared with those of WT mice and murine animal models displaying both mutations separately. A total loss of pupillary reflex was observed. Likewise, behavioral tests demonstrated loss of rejection to illuminated spaces and a complete decrease in visual acuity (optomotor test). Functional recordings showed an absolute disappearance of various wave components of the full-field and pattern electroretinogram (fERG, pERG). Likewise, visual evoked potential (VEP) could not be recorded. Immunohistochemical staining showed marked degeneration of the outer retinal layers and the absence of melanopsin staining. The combination of both mutations has generated an animal model that does not show any photosensitive element in its retina. This model is a potential tool for the study of new ophthalmological approaches such as optosensitive agents.

Behavioural Toxicity of a Combined Oilfield Chemicals on African Catfish (Clarias gariepinus) (Burchell 1822)

The toxicity of the combination of xylene and diesel at a 50:50 ratio on the African catfish (Clarias gariepinus) was investigated using a static bioassay for 96hrs. No significant difference (P>0.05) was observed in the Physicochemical parameters of the experimental water after exposure for 24 hours among the different concentration gradients and the controlled unit. Although there was an increased variation along the concentration gradient observed after 96hours. The behavioral responses of the test fish from 24-96 hours of exposure show normal behavioral responses in the control. C. gariepinus exposed to 25 ml/l to 50 mg/l concentration of the toxicant showed normal behavior from 24 to 48 hours. Afterward, the fish that were active stopped swimming and remained static for a while in response to the sudden changes in the surrounding environment. Generally, fish exposed to higher concentrations such as 100 ml/l to 250 ml/l of the test chemicals showed progressive hyperventilation and abnormal behavior like gulping air, erratic swimming movement, very fast swimming, jumping, and displaying vigorous jerky movement suffocation, and loss of reflex. A faster operculum and tail beat movement was also observed with Spiraling. The behavioral responses increased significantly (P<0.05) with an increase in concentration per time as compared to the control group of fish. The noticeable behavioural difference was recorded for the different concentrations of the test chemical. An eco-friendly chemical that is within the acceptable limits recommended by WHO and DPR should be used in well stimulation and cleaning for sustainable biodiversity and a healthy aquatic environment.

Investigation of anaesthetic potentials of various extracts of Annona muricata (sour sop) in Wister albino rat and dog

ObjectivesLocal and general anaesthetics currently used in clinical practice are not absolutely safe and efficacious. Hence two or more drugs are used for induction and maintenance of general anaesthesia. MethodsIn view of this, local and general anaesthetic potentials of Annona muricata extracts were investigated prospectively in laboratory using rat and dog. A total of 15 animals comprising 6 rats (3 males; 3 females) and 9 dogs (5 males; 4 females) were used. Secondary metabolites in root bark, leaf, stem bark and seed of Annona muricata were qualitatively and quantitatively determined. Methanol and water extracts were tested for induction and maintenance of surgical anaesthesia in rat and dog. The dose of the extracts (1250 mg/kg body weight of rat) that produced deep anaesthesia in rats was translated to 150, 170 and 150 mg/kg of root bark methanol extract (RBME), stem bark water extract (SBWE) and seed water extract (SWE), respectively. Each extract was administered to female and male dog for induction and maintenance of anaesthesia. Laparatomy was carried out via linea alba, and the length of small intestine (220 cm) and large intestine (32 cm) were measured using measuring ruler. ResultsPhenols and tannins were significantly lower (p < 0.05) as compared to saponins, flavonoids, alkaloids and glycosides. The median lethal dose (LD50) of methanol extract was < 5000 mg/kg in female and > 5000 mg/kg in male rats, respectively. Sedation, anaesthesia, male mounting and death were observed within 4 days of extract administration in the female rats, However, 12.5 mg/kg showed significant (p < 0.05) local anaesthesia on the test surgical sites. The male administered 170 mg/kg of SBWE showed salivation, significantly decreased respiratory rate, and loss of palpebral reflex, excretion, urination that characterized plane III; stage III of anaesthesia (deep anaesthesia) which lasted for 67 min. ConclusionsAqueous extract of Annona muricata have very potent local and general anaesthetic effects for a period of over 1 h. The observed effects may be due to presence of secondary metabolites.

Extended aseptic handling and anaesthetic efficacy of propofol preserved under different conditions

Twenty-seven vials of propofol and 20 Albino rats were used in this study to determine the effect of refrigeration and aseptic handling on contamination and anaesthesia of propofol. The vials were assigned to three groups of nine (9) vials per group in 3 replicates. They were opened aseptically and the contents transferred to sterile bottles. VR group were stored in a refrigerator at 40C, VS in an infrared hood chamber, and VT stored on a bench. Propofol was aseptically aspirated from each vial immediately after opening and at 8, 10, 12, 24, 48 and 168 hours for culture on nutrient and McConkey agar. Qualitative and quantitative analysis of the isolates were carried out. Twenty adult Albino Wistar rats were assigned to 4 groups of 5 rats per group. One group (VF) of rats was anaesthetized with fresh propofol, while the remaining 3 groups were anaesthetized with the preserved propofol from each drug group, stored at the longest duration at which contamination was not evident at culture. Durations of anaesthesia, corneal reflex loss, and abdominal twitch and tail sensation loss, were measured. Data was analyzed using ANOVA and Duncan Multiple Range Test using SPSS version 22. Values of p &lt; 0.05 were considered significant. Contamination occurred in the VS, VR and VT groups at 168, 48 and 12 hours respectively. This contravenes the opinion that opened propofol vials become contaminated after 8 hours. Bacillus subtilis, Streptococcus pneumonia, Lactobacillus spp, Klebsiella pneumonia and Staphylococcus epidermidis were isolated from the various groups. The indices of anaesthesia did not differ significantly among the groups. Therefore, following strict adherence to aseptic techniques, propofol may be safely used for up to 24 hours if stored either in a refrigerator or in a sterile environment, without any significant alterations in its anaesthetic characteristics.

Immunotherapy in Pediatric Guillain-Barré Syndrome: Intravenous Immunoglobulin, Plasmapheresis, Both or Something Else?

Guillain-Barré syndrome (GBS) is an autoimmune disease of the peripheral nervous system that is clinically characterized by rapidly progressing and symmetric muscle weakness, loss (or decrease) of deep tendon reflexes and respiratory distress, leading in some cases to the need for artificial ventilation. This is a clinical diagnosis that can be supported by the integration of several results, coming from cerebrospinal fluid examination, neuroimaging, nerve conduction studies and serum analysis. Plasma exchange and intravenous immunoglobulin (IgIV) are both treatments that have proven to be effective in improving motor recovery and reducing the need for mechanic ventilation. While their efficacy is comparable, IgIV is the first line treatment and plasma exchange is not used as the primary approach due to the need for specialized personnel and specific equipment. However, some long-term results with intravenous monotherapy are not always the most favorable and, therefore, studies combining the two interventions have begun to be developed. One of them, defining the zipper method, proved that intercalating both techniques may improve the outcome when compared to each therapy on its own. Nevertheless, approaches with monoclonal antibodies, such as eculizumab, seem interesting, but only in adults, so far. In this article, we aim to review existing evidence on the immune therapeutic approach to GBS in children.

Factors Influencing the Diagnosis of Chronic Inflammatory Demyelinating

BACKGROUND: Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a neurological disorder that leads to demyelination of peripheral nerves presenting with an array of symptoms. Symptoms of CIDP include but are not limited to loss of sensation, loss of reflexes, tingling and pain, and weakness. European Federation Neurological Society (EFNS) has developed guidelines for the diagnosis of this disorder. The objective of this study is to look at the relationship between the EFNS diagnostic criteria and whether patients that have the diagnosis of CIDP met this criteria. Data collection was completed on the patients diagnosed with CIDP and then the patients that were diagnosed but did not meet the criteria were analyzed to see what common outliers exist that led to the diagnosis.&#x0D; &#x0D; RESULTS: A total of 20 patients (13 males and 7 females) were included in the study. Eighty-three percent of patients that were correctly diagnosed using the EFNS/PNS guidelines displayed hyporeflexia at the time of their diagnosis. A large majority of the patients (83%) correctly diagnosed using the EFNS/PNS guidelines displayed distal weakness at the time of their diagnosis. At the time of their diagnosis, EMG showed that majority of those who did not meet the EFNS/PNS criteria had no nerves that displayed increased latency. Fifty-eight percent of those who did meet the criteria outlined by the EFNS/PNS guidelines had two or more nerves that presented with increased latency. Testing the velocity of patients displayed that all of the patients that did not meet the EFNS/PNS criteria did not present with nerves that had diminished velocity.&#x0D; &#x0D; CONCLUSION: CIDP misdiagnosis continues to be an issue leading to mismanagement of these patients. This study showed a preference of the clinical component for diagnosis of CIDP even if electrophysiological criteria was not met.