Reflex Research Articles

HYGIENIC SUBSTANTIATION OF DIMENSIONS OF SANITARY PROTECTIVE ZONES FOR MEDIUM SIZE PIG FARMS WITH A GLANCE TO CHARACTERISTICS OF DISTRIBUTION OF ODORIGENIC CHEMICAL AGENTS IN ATMOSPHERIC AIR

The high frequency of complaints from the local population on the appearance of reflex and vegetative reactions associated with chemical pollution of the atmospheric air makes actual the effectiveness of establishing sanitary protection zones around the agro-industrial enterprises in accordance with existing regulatory documents. Thereby raises the need to search new approaches and methods for establishing the safety of such enterprises. Conducted field studies of pollutant concentrations in the atmospheric air at the border of the sanitary protection and residential areas from the industrial squares of pig farms with a 30,000 head capacity before and after the conversion of manure storage facilities, as well as further comparison of the obtained results indicate a change in the level of contamination of the ground atmosphere layer by emissions of certain chemical agents in dynamics. Whereas a repeated feature of the pollution increasing near the residential area, which adjoins the industrial squares, was noted. The exceeding of odor limen for certain polluting chemical agents is noted in the absence of excess of its state hygienic norm in the atmospheric air. The results obtained after the realization of engineering, constructive and environmental solutions and usage of limit values for odors made it possible to adjust the standard sizes of the sanitary protection zone for the production area of the pig farm at the southeastern direction.

Observation on the efficacy of sub-Tenon’s retrobulbar anesthesia in scleral buckling surgery

Objective To observe the efficacy of sub-Tenon’s retrobulbar anesthesia in scleral buckling surgery. Methods The data of 62 eyes of 62 patients who underwent scleral buckling surgery were randomly divided into two groups. Group A, 32 eyes of 32 cases, received sub-Tenon’s retrobulbar anesthesia ; group B, 30 eyes of 30 cases, underwent classical retrobulbal anesthesia. The degrees of pain were evaluated by visual analogue pain scale(VAPS) at different time points. The akinesia of eye was evaluated by akinesia score at different time points. Degree of satisfaction of surgeon and complications of anesthesia were observed and recorded. Results The difference of degree of pain between the two groups was statistically significant at 30 s, 1 min, 2 min after anesthesia and during operation(P 0.05). The difference of akinesia score between the two groups was statistically significant at 30 s, 1 min, 2 min, 3 min and during operation(P 0.05). The degree of satisfaction of group A was better than that of group B, the difference was statistically significant(P 0.05). No amaurosis or oculocardiac reflex happened. Conclusion Sub-Tenon’s retrobulbar anesthesia can provide faster analgesic effect and better satisfication, and it is a safe and effective anesthesia method. Key words: Anesthesia, retrobulbar, sub-Tenon’s; Buckling, scleral

Research progress of mechanisms for vasovagal syncope in children

Vasovagal syncope(VVS), with its relatively high morbidity, is one of the most common types of autonomic-mediated reflex syncope in children, which can seriously affect pediatric patients in their life and study.A series of research have shown that the mechanism for VVS is closely related to autonomic nervous imbalance, neurohormonal factor, and cerebral blood flow abnormality, and has a certain degree of genetic tendency.Now the progress in the mechanisms for VVS at home and abroad is reviewed, in order to provide certain help for further research. Key words: Vasovagal syncope; Mechanisms; Child

Clinical analysis of transurethral holmium laser therapy for non-muscle invasive bladder cancer

Objective To evaluate the advantages and disadvantages of holmium laser resection and transurethral resection for the treatment of non-muscle invasive bladder cancer(NMIBC). Methods The clinical records of totally 167 patients with NMIBC were divided into transurethral holmium laser resection of bladder cancer(HOLRBT) group(n=78) and TURBT group(n=89). The operation time, obturator nerve reflex, the rate of intraoperative bladder perforation, the incidence of postoperative bleeding and the rate of tumor recurrence were compared between the two groups. Results The mean operation time was similar in the two groups (P>0.05). Less obturator nerve reflex, the rate of intraoperative bladder perforation and the incidence of postoperative bleeding were observed in HOLRBT group(P 0.05). Conclusions The HOLRBT therapy has definite effects on the treatment of NMIBT as TURBT.Compared with the TURBT, HOLRBT has more advantages with wieldy operation method, high security and low complication. In short, we should choose the suitable operation means according to the different conditions. Key words: Urinary Bladder Neoplasms; Cystectomy; Lasers, Solid-State; Holmium

Neural pathways involved in infection-induced inflammation: recent insights and clinical implications.

Although the immune and nervous systems have long been considered independent biological systems, they turn out to mingle and interact extensively. The present review summarizes recent insights into the neural pathways activated by and involved in infection-induced inflammation and discusses potential clinical applications. The simplest activation concerns a reflex action within C-fibers leading to neurogenic inflammation. Low concentrations of pro-inflammatory cytokines or bacterial fragments may also act on these afferent nerve fibers to signal the central nervous system and bring about early fever, hyperalgesia and sickness behavior. In the brain, the preoptic area and the paraventricular hypothalamus are part of a neuronal network mediating sympathetic activation underlying fever while brainstem circuits play a role in the reduction of food intake after systemic exposure to bacterial fragments. A vagally-mediated anti-inflammatory reflex mechanism has been proposed and, in turn, questioned because the major immune organs driving inflammation, such as the spleen, are not innervated by vagal efferent fibers. On the contrary, sympathetic nerves do innervate these organs and modulate immune cell responses, production of inflammatory mediators and bacterial dissemination. Noradrenaline, which is both released by these fibers and often administered during sepsis, along with adrenaline, may exert pro-inflammatory actions through the stimulation of β1 adrenergic receptors, as antagonists of this receptor have been shown to exert anti-inflammatory effects in experimental sepsis.

Pupillometry: Psychology, Physiology, and Function.

Pupils respond to three distinct kinds of stimuli: they constrict in response to brightness (the pupil light response), constrict in response to near fixation (the pupil near response), and dilate in response to increases in arousal and mental effort, either triggered by an external stimulus or spontaneously. In this review, I describe these three pupil responses, how they are related to high-level cognition, and the neural pathways that control them. I also discuss the functional relevance of pupil responses, that is, how pupil responses help us to better see the world. Although pupil responses likely serve many functions, not all of which are fully understood, one important function is to optimize vision either for acuity (small pupils see sharper) and depth of field (small pupils see sharply at a wider range of distances), or for sensitivity (large pupils are better able to detect faint stimuli); that is, pupils change their size to optimize vision for a particular situation. In many ways, pupil responses are similar to other eye movements, such as saccades and smooth pursuit: like these other eye movements, pupil responses have properties of both reflexive and voluntary action, and are part of active visual exploration.

Combination of dexmedetomidine with retrobulbar block in pediatric patients undergoing enucleation of eyeballs

Objective To evaluate effects of retrobulbar block combined with dexmedetomidine(Dex) on intraoperative management, postoperative pain, and recovery quality in pediatric patients undergoing enucleation of eyeballs. Methods Forty five pediatric patients(1-6 years) scheduled for enucleation of eyeballs were enrolled and randomly assigned into 3 groups(n=15), respectively received retrobulbar block combined with Dex(group ND), retrobulbar block(group N), and Dex(group D). In group ND, 0.5 μg/kg Dex was infused within 10 min after induction of anesthesia, and retrobulbar nerve block was achieved by surgeon before enucleation of eyeballs. In group N, retrobulbar nerve block was achieved before enucleation of eyeballs. In group D, 0.5 μg/kg Dex was administrated after induction of anesthesia. The MAP and HR were recorded before (T1), during (T2), and after (T3) the placement of orbital implant, and immediately after the removal of laryngeal mask airway(T4) and leave from PACU(T5). The pain scales, postoperative analgesics usage, nausea, and vomiting were assessed 2, 6 h and 24 h after operation. The perioperative adverse events were also recorded. Satisfaction regarding sleeping and pain condition was rated by parents 24 h after operation. Results The incidence of bradycardia during orbital implant placement was lower in group ND(8.3%) and group N(0) than in group D(41.7%, P<0.05). Pain scales in group ND[0(1), 0(1)] were lower than those in group N [2(2), 2(1)] and group D [3(1), 2(1)] 2 h and 6 h after operation(P<0.05), but not 24h after operation. In group ND, patients used less anal acetaminophen compared with other two groups. The severity of nausea and vomiting(no less than 2) in group ND and group N was significantly lower than that in group D. Satisfactory scores were the highest in group ND. Conclusions Retrobulbar block combined with Dex decreased oculocardiac reflex during enucleation of eyeballs in pediatric patients, and provided more satisfactory analgesic effects with fewer incidences of nausea and vomiting. Key words: Pediatric; Eye enucleation; Dexmedetomidine; Retrobulbar block

Disease spectrum and prognostic factors of 499 cases of acquired immune deficiency syndrome complicated with central nervous system infections in Chongqing

Objective To describe the disease spectrum, morbidity, mortality and prognostic factors of acquired immune deficiency syndrome (AIDS) patients complicated with central nervous system (CNS) infections. Methods The data of 4 426 AIDS patients from February 2013 to February 2017 in Chongqing public health medical center were collected, among which 499 cases had CNS infection. The morbidity and mortality of CNS infections were calculated. Association between different CNS infections and CD4+ T cell counts was analyzed. Prognostic factors for the outcome of hospitalization were also studied. Mann-Whitney U test was used for continuous variables. Univariate and multivariate analyses were performed by logistic regression analysis. Results The morbidity of CNS infections in AIDS patients was 11.27% (499/4 426). The most prevalent CNS infections were tuberculous meningitis (4.50%), cryptococcal meningitis (3.25%) and CNS infections with unknown etiology (1.11%). The mortality rate was 18.84% (94/499), among which tuberculous meningitis accounted for 35 cases (17.59%), cryptococcal meningitis 23 cases (15.79%) and CNS infections with unknown etiology 19 cases (38.76%). The average CD4+ T cell count level in those who died were significantly lower than that in those who survived (Z=-2.51, P=0.001). Visual impairment, nuchal rigidity, positive pathologic reflexes, consciousness disturbance, CD4+ T cell counts<50 cells/μL and HIV RNA≥5 lg copies/mL at baseline were independent prognostic factors for mortality. Conclusions The morbidity and mortality of CNS infections are high among AIDS patients in Chongqing, and those patients with severe immunosuppression are usually affected. Older age, consciousness disturtance and severe immunosuppression are three independent risk factors for mortality. Key words: Acquired immune deficiency syndrome; Central nervous system disease; Disease spectrum; Retrospective analysis

COMBINATION HERBAL EXPECTORANTS IN PEDIATRIC PRACTICE

Cough is one of the most common reasons for seeking medical treatment, and there are many reasons for its occurrence. Conventional expectorants are the most widely used medications in paediatric practice to this day, among which one may identify a large group of drugs with reflexive action that usually contain plant-derived substances. The article reviews present-day knowledge on the mechanisms of action and clinical efficacy of these drugs, provides practical recommendations on the rational use of expectorant therapy for bronchopulmonary diseases in children. It is known that the efficacy of treatment with medicinal plants is caused by their complex multicomponent composition. The use of combination drugs that have a simultaneous effect on various pathogenetic mechanisms of inflammation and coughing is becoming a promising area of mucoactive therapy. Due to relative safety, affordability and efficacy, the modern official herbal medicine is increasingly becoming the subject of informed choice in paediatric practice.

Mimicking Adie's pupils in the early phase of meningeal neurosyphilis

AbstractWe report on a patient who presented at our hospital with complaints of bilateral pupillary dilatation and abnormal ocular movement. These symptoms gradually worsened over a few months. After subsequent serological and CSF examinations, he was diagnosed with meningeal neurosyphilis. His pupillary abnormality was marked by deficits of the light reflex and accommodation reaction. Pilocarpine tests demonstrated less hypersensitivity in the bilateral pupils, which indicated preganglionic parasympathetic pupillary involvement. The symptoms improved with penicillin injection therapy. This case provides evidence of pupillary parasympathetic denervation associated with meningeal involvement in the early phase of neurosyphilis. It could be distinguished from a classical Adie's tonic pupil caused by postganglionic long‐standing denervation.

Ensino de ética em cursos do campo de públicas: Uma análise a partir de Projetos Pedagógicos de Curso e das Diretrizes Curriculares Nacionais

As Diretrizes Curriculares Nacionais (DCN) do curso de graduação em Administração Pública trazem a discussão e o ensino da ética como conteúdo disciplinar básico e indispensável à formação do aluno. A partir dessa constatação, surgiu o interesse em saber como seu ensino é trabalhado e auxilia na formação profissional dos alunos dos cursos de graduação em Administração Pública no Brasil. Para tanto, realizou-se uma pesquisa documental em Projetos Pedagógicos de Cursos (PPC) do Campo de Públicas. Com base nos critérios de seleção definidos, foram relacionados quinze PPC para estudo. Os cursos do Campo de Públicas, norteados pelo ethos republicano e democrático, deveriam reproduzir esse princípio fundamental em todos os processos de ensino-aprendizagem e foi isso que se observou ao analisar os PPC, por meio das categorias de análise matriz curricular, ementas das disciplinas e perfil do egresso. Verificou-se que há, na maioria dos projetos, uma busca pela inserção da discussão da ação ética, crítica e reflexiva tanto durante o curso como na prática profissional. Em relação ao ensino de ética, acredita-se que, na medida em que o tema ganha força nas análises das organizações, ele pode induzir os administradores a desenvolverem um posicionamento mais reflexivo, crítico e socialmente responsável.

Международный продовольственный режим

The review article reveals the content of the concept of Food Regime, which is little-known in the Russian academic reference. The author monitored and codified the semantic dynamic of the terminological unit from its original interpretations to modern formulations based on the retrospective analysis. The rehabilitation of the academic merits of D. Puchala and R. Hopkins — authors who used the concept Food Regime for a few years before its universally recognized origin and official scientific debut, was accomplished with help of historical and comparative methods. The author implemented the method of ascension from the abstract to the concrete to demonstrating the classification of Food Regimes compiled on the basis of geopolitical interests in the sphere of international production, consumption, and distribution of foodstuffs. The characteristic features of historically formed Food Regime were described in the chronological order, as well as modern tendencies possessing reformist potential were identified. In particular, it has been established that the idea of Food Sovereignty (which is an alternative to the modern Corporate Food Regime) is the subject for acute academic disputes. The discussion between P. McMichael P. and H. Bernstein devoted to the “peasant question” — mobilization frame of the Food Sovereignty strategy was analyzed using the secondary data processing method. Due to the critical analysis, the author comes to the conclusion that it is necessary to follow the principles of the Food Sovereignty strategy to prevent the catastrophic prospects associated with ecosystem degradation, accelerated erosion of soils, the complete disappearance of biodiversity and corporate autoc racy successfully. The author is convinced that the idea of Food Sovereignty can ward off energetic liberalization of nature, intensive privatization of life and rapid monetization of unconditioned human reflexes.

Multimodality imaging features of different properties in multifocal choroiditis

Objective To observe multimodality imaging features of different properties in multifocal choroiditis (MFC). Methods Twenty-eight patients (51 eyes) with MFC were enrolled in this study. There were 10 males and 18 females. The patients aged from 31 to 49 years, with the mean age of (41.5±0.8) years. There were 23 bilateral patients and 5 unilateral patients. All patients underwent best corrected visual acuity (BCVA), slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus colorized photography, infrared fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) examinations. The lesions were classified as active inflammatory lesion, inactive inflammatory lesion, active choroidal neovascularization (CNV) and inactive CNV. The multimodality imaging features of different properties in MFC was observed. Results In fundus colour photography, the boundaries of active inflammatory lesions were blurry, while inactive inflammatory lesions had relatively clear boundaries. Secondary active CNV showed mild uplift and surrounding retinal edema; Secondary active CNV lesions showed mild uplift, retinal edema around the lesion; Secondary non-active CNV had no retinal exudate edema lesions, but had lesions fibrosis and varying degrees of pigmentation. Infrared fundus examination revealed that both active and inactive inflammatory lesions showed a uniform punctate or sheet-like fluorescence. The fluorescence of CNV lesions was not uniform; there was a bright ring around the strong fluorescence. FAF found that active inflammatory lesions showed weak autofluorescence (AF), surrounded by a strong fluorescence ring; inactive inflammatory lesions showed AF loss. Secondary active CNV lesions showed strong AF with a bright ring along the edge, and obscured fluorescence for co-occurred hemorrhagic edema; secondary non-active CNV lesions were strong AF, surrounded by a weak AF ring. FFA revealed that active inflammatory lesions showed weak fluorescence in the early stage, and fluorescence gradually increased in the late stage with slight leakage. Inactive inflammatory lesions showed typical transmitted fluorescence. Fluorescein leakage secondary to active CNV was significant; lesions secondary to inactive CNV showed scar staining. In OCT, the active inflammatory lesions showed moderately weak reflex signals in the protruding lesions under the retinal pigment epithelium (RPE). The inactive inflammatory lesions showed penetrable RPE defects or choroidal scar, it also showed clear RPE uplift lesions with a strong reflection signal. Secondary active CNV showed subretinal fluid retention; secondary non-active CNV showed RPE defects and choroidal scarring. Conclusions Active inflammatory lesions in MFC have blurred boundary, retinal edema and fluorescein leakage in FFA; inactive inflammatory lesions have clear boundary and typical transmitted fluorescence in FFA, and no retinal edema. Secondary active CNV showed subretinal fluid in OCT; and secondary non-active CNV showed RPE defects and choroidal scarring. Key words: Choroiditis/diagnosis; Fluorescein angiography; Tomography, optical coherence

The clinical study of thulium laser combined with intravesical instillation of pirarubicin in the treatment of non-muscle invasive bladder cancer

Objective To investigate the clinical efficacy of transurethral thulium laser enucleation combined with intravesical instillation of pirarubicin in the treatment of non-muscle invasive bladder cancer. Methods The clinical data of 67 cases of non-muscle invasive bladder cancer who were treated in our hospital from January 2014 to January 2015 were analyzed retrospectively. Including 56 cases single tumor and 11 cases multiple tumors, the tumor diameter ranged from 0.5 to 2.7 cm [mean (2.1±0.4)cm]. All patients were treated by transurethral thulium laser enucleation combined with immediate postoperative instillation of pirarubicin and maintenance instillation of pirarubicin. Regular cystoscopy after operation and long-term follow-up was performed. Results All the operations were successfully enucleationed tumor with once time. The average time of tumor enucleation was (17.3 ± 6.8)min, the intraoperative blood loss was no more than 10 mL. There was no dilutional hyponatremia, bladder perforation, obturator nerve reflex were found in all patients. Postoperative complications included 7 cases of mild hematuria, 2 cases of urinary tract infection, 1 case of urethral stricture, and all patients were cured by symptomatic treatment. Followed up for 6 to 24 months with a mean of (13.6±3.4)months. Five cases were lost to follow up, 8 cases (12.9%) had recu-rrence, 1 case (1.6%) had progression, 13 patients had grade I adverse reactions during intravesical instillation of pirarubicin. Conclusions The transurethral thulium laser enucleation combined with intravesical instillation of pirarubicin for treatment of non-muscle invasive bladder cancer is safe and effective, it is worthy of clinical application. Key words: Urinary Bladder Neoplasms; Thulium; Epirubicin

Analysis of the analgesic effect and safety of dexmedetomidine combined with dorsal penile nerve block in children with circumcision

Objective To investigate the effect and safety of dexmedetomidine combined with dorsal penile nerve block for circumcision in children. Methods 130 children with circumcision were divided into the observation group and the control group according to the digital table, 65 cases in each group. The control group received total inhalation of seven halothane anesthesia, and the observation group received dexmedetomidine combined with dorsal penile nerve block anesthesia. The efficacy and safety of the two groups were compared. Results In the observation group after induction, the mean arterial pressure[(69.89±5.24)mmHg], awake and mean arterial pressure[(70.14±5.30)mmHg], rhythm of the heart after induction[(100.36±10.67)times/min], the rhythm of the heart when they woke up[(102.64±10.58)times/min], blood oxygen saturation after induction[(98.25±0.63)%], awake and blood oxygen saturation[(98.64±0.66)%]and other signs of vital signs had no statistically significant differences compared with the control group(F=0.130, 0.215, 0.548, 0.613, 0.106, 0.257, all P>0.05). In the observation group, the eyelash reflex disappearing time, operation time, awakening time were(23.16±2.13)s, (9.70±1.24)min, (10.03±1.27)min, respectively, which in the control group were(27.98±3.87)s, (11.88±2.87)min, (11.89±3.87)min, respectively, there were statistically significant differences between the two groups(t=8.797, 5.621, 6.633, all P<0.05). In the observation group, the postoperative agitation score, sedation score, pain score were(2.75±1.25)points, (1.11±0.13)points, (5.26±1.44)points, respectively, which in the control group were(6.78±2.89)points, (1.11±0.13)points, (8.97±3.64)points, respectively, there were statistically significant differences between the two groups(t=10.318, 17.236, 10.318, all P<0.05). Conclusion Application of dexmedetomidine combined with penile dorsal nerve block anesthesia in pediatric circumcision takes effect quickly, children with stable vital signs, less postoperative agitation, it is worthy of popularization and application in clinic. Key words: Circumcision, male; Penis; Nerve block; Dexmedetomidine; Child

Palmomental reflex is an important clinical marker of REM sleep behavior disorder in patients with Parkinson’s disease

OBJECTIVES: To find important clinical features in differentiating patients with Parkinson’s disease (PD) with and without rapid eye movement sleep behavior disorder (RBD). METHODS: This study was a prospective, questionnaire-based study performed at the National Institute of Mental health and Neurosciences, Bangalore, after prior institutional ethical approval. Patients with PD were clinically examined and the presence of RBD was diagnosed using the minimal criteria for the diagnosis of RBD (International Classification of Sleep Disorders-1). RBD screening questionnaire based on the minimal criteria was used. The bed-partners were interviewed with Mayo sleep questionnaire. Other scales included Unified Parkinson’s Disease Rating Scale-part III (UPDRS-III), Hoehn and Yahr Stage, Mini-Mental Status Examination (MMSE), Pittsburgh sleep quality index, Parkinson’s Disease Sleep Scale, Epworth Sleep Scale (ESS), Hamilton anxiety rating scale (HAM-A), and Hamilton depression rating scale (HAM-D). RESULTS: A total of 126 patients with PD without RBD (mean age: 61.1±9.8 years) and 30 with RBD (mean age 54.1±11.1 years) were enrolled. The patients with RBD had higher gait score (P < 0.05), higher HAM-A (P = 0.02), and higher ESS score (P < 0.001) as compared to patients without RBD. Patients with RBD had a mean MMSE score of 26.87±2.31 (range: 23–30), and in patients, without RBD it was 27.98±2.33 (range: 23–30;. P = 0.005). There was no difference in features as olfactory dysfunction, rigidity score, blink rate, tremors, stooped stance, and postural instability in the two groups. However, palmomental reflex was present in 63.3% of patients with RBD and only 34.9% with non-RBD (P = 0.007). CONCLUSIONS: Patients with PD with RBD have a significant presence of palmomental reflex that can be a useful clinical marker.

Trigemino-Cardiac Reflex and High-Degree Atrioventricular Block in Recurrent Epistaxis

We present a case of a 55-year-old male who presented to emergency department with recurrent epistaxis. After placement of a 16-French Foley catheter in his right nare to tamponade the bleeding, the patient subsequently developed two episodes of syncope. Review of the telemetry rhythm strips showed that he had developed PR interval prolongation followed by complete atrioventricular block. Our case was likely secondary to stimulation of the trigemino-cardiac reflex, a neuro-cardiogenic reflex, that can occur after stimulation of the trigeminal nerve, whether centrally or peripherally. Patients can develop severe bradycardia, hypotension, asystole, and even death. The relatively common occurrence of epistaxis and its treatment with direct nasal tamponade require an increased awareness and possibly a requirement for telemetry monitoring to prevent complications from stimulation of this reflex. J Med Cases. 2018;9(1):16-18 doi: https://doi.org/10.14740/jmc2957w

Cough, a vital reflex. mechanisms, determinants and measurements.

Cough is a natural defense mechanism that protects the respiratory tract from inhaling foreign bodies and by clearing excessive bronchial secretions. As a spontaneous reflex arc, it involves receptors, an afferent pathway, a center processing information, an efferent pathway and effectors. The determinant factor of cough efficacy is the operational volume of the lung, which in turn relies on the strength and coordination of respiratory and laryngeal muscles as well as on lung mechanics. Respiratory muscle weakness and dysfunction as well as expiratory flow limitation and lung hyperinflation may occur in some neuromuscular disorders and in obstructive airway diseases, respectively. Accordingly, all these diseases may show an ineffective cough. In this brief overview, we deal with the determinants of the cough efficacy and the clinical conditions affecting cough efficacy as well as the cough’s efficacy measurements in clinical setting. (www.actabiomedica.it)

Periodontal health status in hospitalized cerebral palsy patients of rural Punjab

Introduction: Cerebral palsy (CP) is an important neurological condition that originates in early childhood but affects individuals throughout the life. It leads to specific motor skill problems, delay in developmental milestones, and physical limitations such as abnormal muscle tonus, reflexes, and persistent infantile reflexes. Periodontal disease is the most prevalent oral condition in hospitalized CP patients. These patients are at a higher risk of periodontal disease due to physical and cognitive impairment. The lack of awareness and availability of oro dental care facilities in rural areas is also a hindrance in this regard. Objective: The objective of the present study was to evaluate the periodontal health status and treatment needs of hospitalized CP patients of rural Punjab. Methodology: Periodontal health status and treatment needs of hospitalized CP patients were determined by epidemiological indices. Questionnaires were filled by the patient's parents/attendants about the home-care oral hygiene measures and dietary habits of the patient. All patients were given nonsurgical periodontal therapy with reenforcement of oral hygiene measures as a part of our treatment plan. Results and Conclusion: From this study, it was concluded that periodontal disease is prevalent in hospitalized cerebral-palsied patients. Treatment needs for such patients include assisted oral health care, pain management, and constant psychosocial support. The inclusion of a dental healthcare professional in the management team would help improve the quality of life in these hospitalized cerebral-palsied patients.

Effect of ondansetron on hypotension and bradycardia associated with spinal anesthesia during cesarean section

Objective The aim of the study was to evaluate the efficacy of ondansetron during spinal anesthesia for cesarean section in overcoming the associated nausea, vomiting, bradycardia, and hypotension. Background Ondansetron, a widely used antiemetic and serotonin antagonist, has been safely used to blunt the Bezold–Jarisch reflex, resulting in less bradycardia and hypotension in humans undergoing spinal anesthesia. Patients and methods One hundred parturients scheduled for elective cesarean section were randomly allocated into two groups. Before induction of spinal anesthesia group I (n = 50) received intravenous ondansetron 4 mg and group II (n = 50) received normal saline. Blood pressure, heart rate (HR), nausea and vomiting, shivering, vasopressor requirements, and Apgar score at 1 and 5 min were assessed. Results Decreases in systolic arterial pressure were significantly lower in group I than in group II. Patients in group I had significantly less requirement for vasopressor (P = 0.005), needed lower dose of vasopressor (P = 0.01), and had significantly lower incidences of nausea and vomiting (P = 0.03). Decreases in HR were significantly lower in group I than in group II just after spinal anesthesia (P = 0.02), at 20 min (P = 0.01), and 50 min (P = 0.02). Decreases in mean blood pressure were significantly lower in group I than in group II just after spinal anesthesia (P = 0.007). Conclusion In parturient women undergoing elective cesarean section, intravenous 4 mg ondansetron significantly decreased the hypotension, HR fluctuation, and vasopressor doses used.