Significant Decrease In Heart Rate Research Articles

Effects of acute carotid baroreceptor stimulation on sympathetic nerve traffic in resistant and uncontrolled hypertension: a systematic review and meta-analysis.

In resistant hypertensive patients acute carotid baroreflex stimulation is associated with a blood pressure (BP) reduction, believed to be mediated by a central sympathoinhbition.The evidence for this sympathomodulatory effect is limited, however. This meta-analysis is the first to examine the sympathomodulatory effects of acute carotid baroreflex stimulation in drug-resistant and uncontrolled hypertension, based on the results of microneurographic studies. The analysis included 3 studies assessing muscle sympathetic nerve activity (MSNA) and examining 41 resistant uncontrolled hypertensives. The evaluation included assessment of the relationships between MSNA and clinic heart rate and BP changes associated with the procedure. Carotid baroreflex stimulation induced an acute reduction in clinic systolic and diastolic BP which achieved statistical significance for the former variable only [systolic BP: -19.98 mmHg (90% CI, -30.52, -9.43), P < 0.002], [diastolic BP: -5.49 mmHg (90% CI, -11.38, 0.39), P = NS]. These BP changes were accompanied by a significant MSNA reduction [-4.28 bursts/min (90% CI, -8.62, 0.06), P < 0.07], and by a significant heart rate decrease [-3.65 beats/min (90% CI, -5.49, -1.81), P < 0.001]. No significant relationship was detected beween the MSNA, systolic and diastolic BP changes induced by the procedure, this being the case also for heart rate. Our data show that the acute BP lowering responses to carotid baroreflex stimulation, although associated with a significant MSNA reduction, are not quantitatively related to the sympathomoderating effects of the procedure. This may suggest that these BP effects depend only in part on central sympathoinhibition, at least in the acute phase following the intervention.

Polystyrene microplastics enhance microcystin-LR-induced cardiovascular toxicity and oxidative stress in zebrafish embryos

The health risks associated with combined exposure to microplastics (MPs) and cyanobacteria toxins have gained increasing attention due to the large-scale prevalence of cyanobacterial blooms and accumulation of MPs in aquatic environments. Therefore, we explored the cardiovascular toxic effects of microcystin-LR (MC-LR, 1, 10, 100 μg/L) in the presence of 5 μm polystyrene microplastics (PS-MPs, 100 μg/L) and 80 nm polystyrene nanoplastics (PS-NPs, 100 μg/L) in zebrafish models. Embryos were exposed to certain PS-MPs and PS-NPs conditions in water between 3 h post-fertilization (hpf) and 168 hpf. Compared to MC-LR alone, a significant decrease in heart rate was observed as well as notable pericardial edema in the MC-LR + PS-MPs/NPs groups. At the same time, sinus venosus and bulbus arteriosus (SV-BA) distances were significantly increased. Furthermore, the addition of PS-MPs/NPs caused thrombosis in the caudal vein and more severe vascular damage in zebrafish larvae compared to MC-LR alone. Our findings revealed that combined exposure to PS-NPs and MC-LR could significantly decreased the expression of genes associated with cardiovascular development (myh6, nkx2.5, tnnt2a, and vegfaa), ATPase (atp1a3b, atp1b2b, atp2a1l, atp2b1a, and atp2b4), and the calcium channel (cacna1ab and ryr2a) compared to exposure to MC-LR alone. In addition, co-exposure with PS-MPs/NPs exacerbated the MC-LR-induced reactive oxygen species (ROS) production, as well as the ROS-stimulated apoptosis and heightened inflammation. We also discovered that astaxanthin (ASTA) treatment partially attenuated these cardiovascular toxic effects. Our findings confirm that exposure to MC-LR and PS-MPs/NPs affects cardiovascular development through calcium signaling interference and ROS-induced cardiovascular cell apoptosis. This study highlights the potential environmental risks of the co-existence of MC-LR and PS-MPs/NPs for fetal health, particularly cardiovascular development.

Virtual Reality Adaptive Training for Personalized Stress Inoculation.

To evaluate a personalized adaptive training program designed for stress prevention using graduated stress exposure. Astronauts in the high-risk space mission environment are prone to performance-impairing stress responses, making preemptive stress inoculation essential for their training. This work developed an adaptive virtual reality-based system that adjusts environmental stressors based on real-time stress indicators to optimize training stress levels. Sixty-five healthy subjects underwent task training in one of three groups: skill-only (no stressors), fixed-graduated (prescheduled stressor changes), and adaptive. Psychological (subjective stress, task engagement, distress, worry, anxiety, and workload) and physiological (heart rate, heart rate variability, blood pressure, and electrodermal activity) responses were measured. The adaptive condition showed a significant decrease in heart rate and a decreasing trend in heart rate variability ratio, with no changes in the other training conditions. Distress showed a decreasing trend for the graduated and adaptive conditions. Task engagement showed a significant increase for adaptive and a significant decrease for the graduated condition. All training conditions showed a significant decrease in worry and anxiety and a significant increase in the other heart rate variability metrics. Although all training conditions mitigated some stress, the preponderance of trial effects for the adaptive condition supports that it is more successful at decreasing stress. The integration of real-time personalized stress exposure within a VR-based training program not only prepares individuals for high-stress situations by preemptively mitigating stress but also customizes stressor levels to the crew member's current state, potentially enhancing resilience to future stressors.

The effect of virtual rainforest and a white noise mobile application on satisfaction, tolerance, comfort, and vital signs during arthroscopy

Background and purposeThis study was conducted to investigate the effect of Virtual Rainforest (VRF) and a White Noise (WN) mobile applications on patient satisfaction, tolerance, comfort, and vital signs during arthroscopic knee surgery. MethodsThis is a randomized, controlled, interventional study. The study was completed with a total of 93 participants, 31 in the VRF group, 31 in the WN group, and 31 in the control group. Data were collected using a Patient Information Form and a Visual Analog Scale for satisfaction, tolerance, and comfort. ResultsThe results of study showed that there were significant increases in tolerance, satisfaction, comfort, respiratory rate, and oxygen saturation levels and significant decreases in heart rate, systolic and diastolic blood pressures in both VRF and WN groups (p < .05). In the control group, no significant difference was found between the means of the variables before and after the procedure (p > .05). ConclusionAccording to the results of the study, VRF and WN applied during the arthroscopy procedure increased satisfaction, tolerance, and comfort in patients and had a positive effect on vital signs. Trial and protocol registrationClinicalTrials.gov, NCT05992714.

Effects of home-based exergaming on cardio-metabolic and cognitive health in physically inactive individuals.

To examine the effects of a home-based exergame training over 6 weeks on cardio-metabolic and cognitive health, as well as training adherence, in physically inactive individuals. Twenty participants were equipped with an exergame system specifically designed for use at home. Each participant performed at least three weekly exercise sessions at ≥80% of their individual maximum heart rate, over 6 weeks. Exercise duration increased biweekly until 75 min of vigorous exercise were performed in Weeks 5 and 6. Maximum oxygen uptake (VO2max), cardio-metabolic profiling, and neuro-cognitive tests were performed at baseline and study end. Additionally, training adherence was assessed via training diaries. After 6 weeks of home-based exergaming, VO2max increased significantly, while there was a significant decrease in heart rate (resting and maximum), blood pressure (systolic, diastolic and mean), and low-density lipoprotein cholesterol. Dynamic balance and reaction time improved after 6 weeks of exergaming. Training adherence was 88.4%. Home-based exergaming induced a clinically relevant increase in VO2max, a determinant of cardiovascular health, accompanied by further improvements in cardiovascular, metabolic and neuro-cognitive parameters. Exergaming may, therefore, offer an innovative approach to increasing regular physical activity, improving metabolic risk profile, and preventing chronic diseases.

Acceptability and Perceived Utility of Virtual Reality Among People Who Are Incarcerated Who Use Drugs.

People who are incarcerated are at heightened risk of overdose upon community reentry. Virtual reality (VR) may provide an innovative tool for overdose prevention intervention in corrections facilities. This mixed methods study sought to understand incarcerated individuals' perspectives on VR for overdose prevention and explore physiological arousal associated with use of VR equipment. Study participants were 20 individuals, stratified by gender, with an opioid use disorder at a county jail. Qualitative interviews assessed acceptability and perceived utility of VR in the jail setting. Thematic analysis indicated high levels of acceptability and potential utility in the following areas: (a) mental health and substance use interventions, (b) community reentry skills training, and (c) communication and conflict resolution skills. Heart rate variability (HRV) data were collected continuously during the interview and during VR exposure to explore whether exposure to the VR environment provoked arousal. Physiological data analyses showed a significant decrease in heart rate (HR) [b = -3.14, t(18) = -3.85, p < .01] and no arousal as measured by root mean square of successive RR interval differences (RMSSD) [b = -0.06, t(18) = -1.06, p = .30] and high frequency-HRV (HF-HRV) [b = -0.21, t(18) = -1.71, p = .10]. This study demonstrated high acceptability and decreased HR response of VR among incarcerated people who use drugs.

Assessing the Potential of Adenosine and L-Theanine as Metabolic Suppressants for Improving Shipping of the New Zealand Scampi (Metanephrops challengeri)

Live crustaceans, especially lobsters, crabs, and shrimp, fetch premium prices in many international seafood markets, especially in parts of Asia. To access these market opportunities, live crustaceans frequently need to be transported over long distances, which can involve prolonged air exposure resulting in elevated stress and increased morbidity and mortality. Interventions which deliver metabolic suppression to live crustaceans during their transport have the potential to improve outcomes from live shipping. In this study, the administration of adenosine (Ado) and L-theanine (L-th) were assessed for metabolic suppression in the New Zealand scampi, Metanephrops challengeri, a deep sea lobster which is highly prized as seafood, and with excellent prospects for supply into premium live seafood markets. The administration to scampi of Ado and L-th in isolation or as a mixture (Ado/L-th), caused a significant decrease in heart rate (HR) with a lasting effect for the 4 hr experimental period. However, this depression of HR did not translate into a systemic downregulation of metabolism, as measured by the key metabolites, i.e., glycogen utilization and the accumulation of lactate and ammonia. The lack of systematic metabolic downregulation would preclude the potential use of Ado and L-th for commercial application in live shipping of crustaceans.

Efficacy of recombinant human brain natriuretic peptide as an adjuvant therapy for severe heart failure, and its impact on oxidative stress and quality of life in patients

Purpose: To evaluate the efficacy of recombinant human brain natriuretic peptide as an adjuvant therapy for severe heart failure, and its effect on oxidative stress and quality of life in patients.&#x0D; Methods: The study was conducted on 100 patients with severe heart failure who met the screening criteria for this study. They were evenly but randomly divided into two groups. Patients in the control group were given routine treatment (diuretics and cardiac stimulants) for severe heart failure, while the study group received recombinant human brain natriuretic peptide adjuvant therapy in addition to the treatment administered to the control group. Cardiac function, heart rate, oxidative stress indicators, quality of life levels, and adverse drug reactions during treatment were compared before and after treatment.&#x0D; Results: After the intervention, the NT-proBNP level in the study group was significantly lower than in the control group while LVEF level was significantly higher than in the control group (p &lt; 0.05). Compared with the control group, the study group showed a significant decrease in heart rate (p &lt; 0.05). The MDA level of the study group was significantly lower than that of the control group while the SOD and GSH-PX levels were significantly higher than those of the control group (p &lt; 0.05). In addition, the GQOLI-74 score of the study group was significantly higher than that of the control group (p &lt; 0.05). Furthermore, there was no statistically significant difference in incidence of adverse reaction between control and study groups (14.0 and 16.0 %, respectively, p &lt; 0.05).&#x0D; Conclusion: Recombinant human brain natriuretic peptide has a significant therapeutic effect on severe heart failure, thus improving patients' cardiac function, alleviating their oxidative stress state and enhancing their quality of life, and is also safe.

To study the efficiency of high-flow nasal cannula in improving the arterial blood gas parameters in children admitted to pediatric intensive care unit with respiratory distress

Abstract Background: In recent times, heated humidified high-flow nasal cannula has become increasingly popular and is now recognized as a standard respiratory support method for pediatric patients experiencing acute respiratory distress. Aims and Objectives: To study the correlation of high-flow nasal cannula (HFNC) with arterial blood gas (ABG) and clinical parameters. Materials and Methods: This prospective observational study included children aged 1 month to 14 years experiencing acute respiratory distress receiving HFNC support. Demographic information, vital signs, and ABG parameters were collected at four-time points: the first ABG at “0” h, indicating admission; the second ABG at “1” h, approximately 1 h after HFNC initiation; the third ABG at “12” h, as a follow-up after the initiation of respiratory support; and the fourth ABG at “24” h, representing daily monitoring for assessing the child’s condition and outcomes. The collected data was subjected to analysis. Results: The study included 133 children, of which 64.66% were male and 35.34% were female, with a mean age of 0.9 years (ranging from 0.3 to 3 years) and a mean weight of 7.8 kg (ranging from 4.7 to 11.8 kg). Over time, there was a statistically significant decrease in heart rate, respiratory rate, and the need for FiO2. Significant reductions in these parameters were observed within the first hour of initiating HFNC therapy, and improvements continued at 12 and 24 h compared to the baseline values (P value &lt; 0.05). The study also revealed a decreasing trend in pCO2 and lactate levels over time. Statistically significant reductions in these parameters were noted at the first hour of HFNC initiation, and improvements persisted at 12 and 24 h compared to the baseline (P value &lt; 0.05). On the other hand, there was an increasing trend in SpO2, pO2, base excess, and HCO3 over time. Significant increases in these parameters were observed at the first hour of HFNC initiation, and the positive trend continued at 12 and 24 h compared to the baseline (P value &lt; 0.05). Conclusion: HFNC can serve as the primary noninvasive respiratory support for children facing respiratory distress. The majority of patients in our study demonstrated good tolerance to the HFNC. Notably, the utilization of HFNC resulted in a significant enhancement of the comfort scale among the participants. Positive changes were observed in vital parameters, comfort scale, and ABG parameters within just 1 h of initiating HFNC.

Efficacy of Dexmedetomidine and Labetalol for Induced Hypotension in Endoscopic Sinus Surgeries: A Randomised Clinical Study

Introduction: Functional Endoscopic Sinus Surgery (FESS) is one of the most commonly performed surgical procedures that requires minimal bleeding during the procedure. Dexmedetomidine, an alpha-agonist and labetalol, a betablocker, have been used to decrease intraoperative bleeding and provide optimal surgical conditions. Aim: To evaluate the efficacy of labetalol and dexmedetomidine on intraoperative blood loss and surgical conditions during FESS. Materials and Methods: The present randomised singleblinded clinical study was conducted in the Department of Anaesthesiology, Gandhi Medical College and associated Hamidia Hospital, Bhopal, India, from January 2020 to May 2021. Study was performed on 60 patients aged 18-60 years undergoing FESS. The patients were divided into two groups: Labetalol (L) or Dexmedetomidine (D). Heart rate and arterial blood pressure were measured after induction, during and at the end of the surgery. An assessment of bleeding was done by a blinded surgeon. Surgical field quality, surgeon satisfaction, emergence time, Aldrete score and any side effects were observed. Data were analysed using the Statistical Package of Social Sciences (SPSS) software version 17.0 for Windows and the unpaired student t-test. Results: In the total study population, the mean age in group D was 42.96±11.52 years and in group L was 47.33±10.97 years. In both groups, female patients were more prevalent than males (Group L: 53.3%; Group D: 60%). There was a significant decrease in heart rate in group D compared to group L during and after the operation. Mean Arterial Pressure (MAP) after induction (106.63±6.094 mmHg vs 114.80±6.272 mmHg), at extubation and after extubation for six hours was significantly higher in group L than in group D. The emergence time of group D was higher than that of the labetalol group. The surgical field quality and surgeon satisfaction were significantly higher in group D. Time to reach Aldrete score ≥9 (15.67±1.788 vs 11.23±1.654), time for first analgesic requirement and Ramsay sedation score were found to be higher in group D and were statistically significant. Conclusion: Both dexmedetomidine and labetalol can be used for controlled hypotension during FESS. Dexmedetomidine provides more haemodynamic stability and is ideal for creating a better surgical field during endoscopic surgeries.

Reiki intervention for supporting healthcare professional care behaviors in pediatric palliative care: A pilot study.

Pediatric healthcare professionals (HCPs) working in a palliative setting may experience challenges during their clinical practice in addressing the complex end-of-life phase of children and their families. Nurses, especially, have a frontline role in providing assistance, thereby becoming at risk of physical and psychological burden. Pediatric psychologists have an ethical responsibility to help colleagues by proposing self-care interventions that will improve their well-being and, indirectly, the work climate. This study investigated the impact of a complementary therapy, delivered by a pediatric psychologist and a nurse, on physical and psychological variables among nurses at the Paediatric Hospice of the Regina Margherita Children's Hospital in Italy. Thirty-five nurses participated in 5 weeks of Reiki sessions for an overall total of 175 sessions. The effect of the sessions was analyzed through a paired t-test analysis comparing the values of heart rate, oxygen saturation, and systolic and diastolic pressure collected before and after each session. The same test was conducted comparing the values of the 3 burnout subscales for each of the 35 nurses collected before the beginning of the first session with those collected at the end of the last session 2 months later. Results underlined a positive short-term effect with a significant decrease in heart rate before and after each session (t = 11.5, p < .001) and in systolic pressure (t = 2, p < .05). In addition, a decrease in emotional exhaustion symptoms was found (t = 2.3, p < .05) at the end of the intervention. Reiki could be a valid strategy to complement traditional pediatric psychology clinical practice designed to protect HCPs from emotional and physical demands and to create a more supportive workplace for staff and patients alike.

Low-flow ECCO2R conjoined with renal replacement therapy platform to manage pulmonary vascular dysfunction with refractory hypercapnia in ARDS

BackgroundHypercapnia worsens lung vascular dysfunction during acute respiratory distress syndrome (ARDS). We tested whether an extracorporeal carbon dioxide removal (ECCO2R) device based on a renal replacement therapy platform (Prismalung®) may reduce PaCO2 and alleviate lung vascular dysfunction in ARDS patients with refractory hypercapnia. MethodsWe planned to prospectively include 20 patients with moderate-to-severe ARDS, pulmonary vascular dysfunction on echocardiography, and PaCO2 ≥ 48 mmHg despite instrumental dead space reduction and the increase in respiratory rate. Hemodynamics, echocardiography, respiratory mechanics, and arterial blood gases were recorded at 2 (H2), 6 (H6) and 24 (H24) hours as ECCO2R treatment was continued for at least 24 h. ResultsOnly eight patients were included, and the study was stopped due to worldwide shortage of ECCO2R membranes and the pandemic. Only one patient fulfilled the primary endpoint criterion (decrease in PaCO2 of more than 20 %) at H2, but this objective was achieved in half of patients (n = 4) at H6. The percentage of patients with a PaCO2 value < 48 mmHg increased with time, from 0/8 (0 %) at H0, to 3/8 (37.5 %) at H2 and 4/8 (50 %) at H6 (p = 0.04). There was no major change in hemodynamic and echocardiographic variables with ECCO2R, except for a significant decrease in heart rate. ECCO2R was prematurely discontinued before H24 in five (62.5 %) patients, due to membrane clotting in all cases. ConclusionsThis pilot study testing showed a narrow efficacy and high rate of membrane thrombosis with the first version of the system. Improved versions should be tested in future trials. Trial registrationRegistered at clinicaltrials.gov, identifier: NCT03303807, Registered: October 6, 2017, https://clinicaltrials.gov/ct2/show/NCT03303807.

Conditional knock out of cytosolic thioredoxin (Trx) in cardiomyocytes impairs cardiac function and exacerbates ischemia-reperfusion injury

Abstract Introduction Coronary heart disease with myocardial infarction (MI) is a leading cause of mortality in the world despite timely reperfusion of occluded coronary artery. Myocardial damage due to restoration of blood flow, known as reperfusion injury account for about 50% of final MI size. The role of Trx in protection against myocardial ischemia reperfusion has been reported; however, these studies were mostly performed using ex vivo isolated mouse/rat heart with retrograde perfusion or with injected rhTrx. However, the role of loss of Trx specifically in the myocytes using a conditional deletion has never been reported. Here, we determined whether loss of Trx in myocytes would promote ischemia-reperfusion injury, even if the endocardial endothelial cells express normal levels of Trx. Purpose We investigated the effect of specific deletion of Trx in cardiomyocytes on base-line cardiac function and cardiac function in ischemia-reperfusion of heart using conditional knockout of Trx (aMHC-Trx-KO) in the cardiomyocytes with normal levels of Trx in the endothelial cells to determine specifc contribution of Trx in cardiac function in I/R. Methods A Trx floxed mouse line was created with introduction of loxP sites flanking the mouse Trx gene. Further, the conditional deletion of Trx in cardiomyocytes was produced by breeding homozygous Trx-floxed (Trxfl/fl) mice with aMHC-Cre mice strain. The resulting aMHC-Trx-KO mice was identified by genotyping and conditional deletion of Trx in myocytes was achieved by injecting Tomoxifen (75mg/Kg in oil). The aMHC-Trx-KO mice were subjected to 30 minutes of ischemia by ligation of left descending coronary artery(LAD) and reperfusion was performed by release of slipknot and allowing blood flow of 60 minutes before sacrificing animals. The animal protocol was approved by the IACUC of the Texas Tech University Health Sciences Center, Lubbock. Echocardiography on animals was performed using Vevo 3100 (Visual Sonic). Statistical analysis was performed by Prism 8.0 (GraphPad). Results Deletion of Trx caused significant cardiac dysfunction in aMHC-Trx-KO mice compared to Trxfl/fl mice without treatment with tomoxifen. The ejection fraction (EF%, 52.82 vs. 73.83) and fractional shortening (FS%, 41.42 vs.25.89) were significantly reduced. Further, these mice subjected to I/R showed exacerbated cardiac dysfunction with significant decrease in heart rate and did not survive the reperfusion. We also found significant mitochondrial structural abnormalities and mitochondrial dysfunction in aMHC-Trx-KO mice compared to non-transgenic or Trxfl/fl mice without tomoxifen treatment. Conclusion Deletion of Trx in cardiomyocyte causes significant myocardial dysfunction. Further, Trx is required to protect against myocardial dysfunction in ischemia-reperfusion injury. Our data also suggest that cardiac mitochondria is specifically impacted by loss of Trx deletion.Figure-1

Sedation with dexmedetomidine decreases skin perfusion in cats.

To evaluate skin perfusion in cats receiving dexmedetomidine compared to a placebo. 9 healthy adult research cats. A randomized, blinded, placebo-controlled study design was used. Two sites, the dorsal metatarsus (site: limb) and lateral flank (site: flank), were evaluated with laser speckle contrast imaging (LSCI) at baseline and following administration of dexmedetomidine (1, 3, or 5 mcg/kg, IV) or a placebo (0.9% saline, IV). Mean speckle contrast (MSC), a surrogate for perfusion, was obtained from LSCI and compared between treatments. Heart rate, sedation score, and body temperature were recorded. Skin perfusion to the flank and limb, reported as MSC, was assessed via LSCI at baseline and at 5, 10, and 15 minutes posttreatment. There was a significant decrease in heart rate (P < .001) in cats receiving 1, 3, and 5 mcg/kg dexmedetomidine compared to placebo. There was a significant increase in median sedation score at all time points postsedation compared to baseline (P < .018). Changes in MSC for the metatarsus were not significantly different between treatments at any time point (P = .12). For the flank, MSC was significantly higher for cats treated with dexmedetomidine compared to baseline (P ≤ .01). Skin perfusion to the flank decreased as early as 5 minutes posttreatment with dexmedetomidine and persisted for at least 15 minutes, regardless of dexmedetomidine dose. Dexmedetomidine decreased skin perfusion in cats, even at low doses. Veterinarians may elect for an alternative sedative medication when decreased skin perfusion is a concern.

Effect on Satisfactory Seizure Control and Heart Rate Variability of Thread-Embedding Acupuncture for Drug-Resistant Epilepsy: A Patient-Assessor Blinded, Randomized Controlled Trial.

This randomized controlled trial investigates the efficacy of thread-embedding acupuncture (TEA) compared to sham TEA in treating drug-resistant epilepsy (DRE). Fifty-four DRE outpatients were randomly divided into two groups: TEA (27 patients) and sham TEA (27 patients). Both groups received four sessions of TEA or sham TEA, spaced four weeks apart, targeting GV20, GV14, BL15, BL18, ST40, and GB34 acupoints. Antiseizure medications were maintained at consistent doses throughout the study. Outcome measures included satisfactory seizure control, seizure freedom, and heart rate (HR) and heart rate variability (HRV) measurements. TEA demonstrated a significantly higher rate of satisfactory seizure control at follow-up compared to the sham TEA group (37% vs. 3.7%, p = 0.003). While no significant intergroup differences were observed in HR, HRV, and HRV components at each stage, the TEA group experienced a significant decrease in HR and a significant increase in HRV posttreatment. This study demonstrates TEA's effectiveness in managing DRE and suggests its impact may relate to heightened parasympathetic nerve activity. Further research with extended follow-up periods is necessary to validate these findings.

Role of berberine on angiogenesis and blood flow hemodynamics using zebrafish model.

Angiogenesis and hemodynamic instability created by the irregular blood vessels causes hypoperfusion and angiogenesis-mediated diseases. Therefore, therapies focusing on controlling angiogenesis will be a valuable approach to treat a broad spectrum of diseases. In this study, we explored the anti-angiogenic potential of berberine (BBR) and also analyzed blood flow hemodynamics using zebrafish embryos. Zebrafish embryos treated with BBR (0.01-0.75 mM) at various doses at 1hour post-fertilization (hpf) developed a variety of phenotypic variations including aberrant blood vessels, tail bending, edema, and hemorrhage. Survival rates were much lower at higher dosages, and hatching rates were almost 99%, whereas control group appeared normal. Heart rate is an essential measure that has a strong association with hemodynamics. We used ImageJ software to study the heart rate of embryos treated with BBR, preceded by video processing. The resultant graph shows a significant decrease in heart rate of embryos treated with BBR in dose-dependent manner. Also, RBC staining using o-Dianisidine confirms the anti-angiogenic potential of BBR by indicating the decrease in the intersegmental vessels at 0.5 and 0.75 mM treated embryos. Further, the gene expression study determined that the transcripts (vegf, vegfr2, nrp1a, hif-1α, nos2a, nos2b, cox-2a, and cox-2b) measured were found to be downregulated by BBR at 0.5mM concentration, from which we conclude that enos/vegf signaling could play an important role in modulating angiogenesis. Our data imply that BBR may be an effective compound for suppressing angiogenesis in vivo, which might be helpful in the treatment of vascular disorders like cancer and diabetic retinopathy in future.

Safety and Efficacy of Ivabradine as a Rate Control for the Heart in Sepsis

Abstract Background Sepsis and septic shock represent a major health problem among the critically ill patients all over the world, with associated substantial morbidity and mortality rates ranging from 18 % to 50 %. The incidence of sepsis has increased steadily over the last three decades, at least in part because of aging western population. Despite our increased understanding, improved support and more powerful antibiotic therapy, sepsis is still reported as the second leading cause of death in non-coronary intensive care units, and the tenth-mostcommon cause of death overall (the first being heart disease). Children under 12 months and elderly have the highest incidence of severe sepsis). Objective Evaluation of the role of heart rate control using enteral Ivabradine in the management of patients with sepsis. Assessment of the effect of enteral Ivabradine on outcome of septic patients regarding need for vasopressor therapy, mechanical ventilation, renal replacement therapy, length of ICU stay, in- hospital mortality and 30 days mortality. Patients and Methods The study was comparative prospective case / control study conducted on 60 critically ill patients admitted with sepsis and or septic shock to the Critical Care Department at Kobry Elkoba Military complex at 12 month from 8/2019 up to 8/ 2020. Results Significant decrease in follow up lactate at end of Ivabradine treatment, compared to control group without Ivabradine treatment (p = 0.025). Significant decrease in follow up of crp level in group A than group B at day 2 and day 4 with (p = 0.013), (p = 0.018) respectively. Significant decrease in heart rate in group A in comparison with group B during first 48 hour with (p = 0.008). Significant difference between group A and group B regarding weaning from mechanical ventilation with (p = 0.001). There was no statistically significant difference found between group A and group B regarding rate of mortality with p-value = 0.606. Conclusion Use of enteral Ivabradine can reduce pathologically elevated heart rate in patients with sepsis but didn‘t affect survival, length of ICU stay, between septic patient.

Nalbuphin as an Adjuvant to Levobupivacaine in Caudal Analgesia in Children

Abstract Background Caudal anethesia is the single most important pediatric regional anethetic technique and is increasingly performed in pediatric regional anesthesia practices. It is preferred in order to relieve intraoperative and postoperative pain in children of all age groups undergoing pelvi-abdominal or lower limbs surgeries using levobupivacaine 0.25%.Various adjuvant have been added to levobupivacaine to prolong postoperative caudal analgesia. Nalbuphine as many opioids can be added in caudal analgesia. This prospective randomised double blind study was done to compare the effects of plain levobupivacaine 0.25% versus Levobupivacaine 0.25% plus nalbuphine 0.1 mg/kg single-shot for postoperative pain relief in children undergoing hypospadius repair surgery. Materis and Methods At total of 64 pediatric patient 1 to 3 years old with American society of Anethesiologist (ASA) status | to |‖, undergoing hypospadius repair surgery were prospectively randomized into two groups, Group 1 received levobupivacaine 0.25% only 1 ml/kg plus 1 ml normal saline and group 2 received levobupivacaine 0.25% 1 ml/kg plus 0.1 mg/kg in 1 ml normal saline. The primary outcome of the study were time to first analgesia request, total consumption of rescue analgesia and the FLACC scale (face, legs, activity, cry and consonlability). The secondary outcome were heart rate (HR), mean arterial blood pressure (MAP), Oxygen saturation, occurrence of complications (respiratory depression, pruritis, xerostomia and postoperative nausea and vomiting). Results During surgery adequate intraoperative analgesia was defined by hemodynamic stability. An increase in the HR or MAP within 15 minutes greater than 15% compared to the baseline values obtained before skin incision recieved a rescue opioid in the form of fentanyl 5 mcg /kg and was excluded from the study. The difference between the two groups regarding time to first analgesia request was highly significant, group 1 (7.28±1.07), group 2 (11.59±2.54) (p &amp;lt; 0.01).The comparison between the two groups regarding the total consumption of rescue analgesia was also significant, group 1 (23.47±8.17), group 2 (19.23±7.31) (p &amp;lt; 0.05). There was statistically significant increase in FLACC in group 1 than group 2 at 30 min and up to 8 hours. There was no significant decrease in HR or MAP in group 2 more than group 1 except between 20 min and 8 hours. There was no statistically significant difference found between two studied groups regarding oxygen saturation regarding intraoperative and postoperative follow up. No patients in both groups had respiratory depression, xerostomia or pruritis.Few patients (3 _4) had postoperative nausea and vomiting with no statistically significant difference between the two groups. Conclusion The combination between nalbuphine and Levobupivacaine was valuable as regarding efficacy and safety profiles in pediatric analgesia. The intensity and duration of analgesia were remarkable compared to levobupivacaine alone. Fortunately, there were no side effects of systemic hazards recorded from systemic absorption of nalbuphine. To recommend considering nalbuphine as one of the valuable adjuvants to levobupivacaine in epidural analgesia according to its efficacy and safety profile.

COMPARATIVE EVALUATION OF THE EFFECTS OF DEXMEDETOMIDINE-PROPOFOL AND FENTANYL-PROPOFOL ON VARIOUS PARAMETERS DURING I-GEL INSERTION

Objectives: Supraglottic airway devices (SGAD) have become inevitable for routine and difficult airway management and various induction agents are used for SGAD insertion. The present study compares the insertion conditions for I-gel, using Dexmedetomidine and Fentanyl with Propofol. Methods: Sixty patients were included in the study and randomly divided into two groups. Group D received 1 mcg/kg Dexmedetomidine and Group F received 1 mcg/kg Fentanyl. The mean arterial blood pressure (MAP) and heart rate (HR) were recorded at baseline and after 1’, 3’ 5’, and 10’ after insertion. Results: A significant decrease in HR was seen in Group D at 3’, 5’, and 10’ after insertion when compared to its respective time intervals in Group F. However, when MAP was observed, the 5’ after insertion showed a decrease in blood pressure within the groups but when MAP between groups were compared, there was no significant variation between Group F and Group D at their respective time intervals after insertion. HR was significantly reduced with Dexmedetomidine compared to that with Fentanyl. Conclusion: Co-induction of Propofol with Fentanyl or Dexmedetomidine 1 mcg/kg provides satisfactory hemodynamic stability and comparable insertion condition for I-Gel.

Effect of Hydroalcoholic Extract of Ginger on Cardiac Parameters in Male Rats with Renovascular Hypertension

Introduction: High blood pressure is one of the most important concerns of the healthcare system, especially in low- and middle-income countries. In the present study, we aimed to investigate the protective effect of the hydromethanolic extract of ginger on cardiac parameters in male rats with renovascular hypertension. Method: A total of 54 rats were randomly divided into 6 groups as follows: control, hypertensive group, hypertensive group (hydromethanolic extract of ginger with a dose of 100 mg/kg), hypertensive group (hydromethanolic extract of ginger with a dose of 200 mg/kg), hypertensive group (hydromethanolic extract of ginger with a dose of 300 mg/kg), and surgical group receiving hydromethanolic extract of ginger with a dose of 200 mg/kg. Rats were gavaged for 42 days, once every day, using hydromethanol extract of ginger. Afterward, the heart rate was measured every 7 days. Ejection fraction (EF) and cardiac index were evaluated by SPSS-16 at a significance level of 0.05. Results: The results of the study showed that the hydroethanolic extract of ginger caused a significant decrease in heart rate in the group without induced blood pressure receiving ginger extract (dose of 200 mg/kg) and in the induced blood pressure group gavaged ginger at a dose of 200 mg/kg. It was also found that there was a significant difference between the average EF in the studied groups; however, the cardiac index had no significant difference in the studied groups. Conclusion: Hydroethanolic extract of ginger can reduce heart rate in hypertensive models and have a significant effect on cardiac output. Since ginger has no effect on cardiac index, studies with a longer duration of treatment are needed in this case, nevertheless, it can have a significant effect on ejection fraction