Comparison of postoperative analgesia and sedation responses of intravenous dexmedetomidine and esmolol during laparoscopic cholecystectomy

Background: Although, the concept of laparoscopic surgeries has revolutionised the surgical practice and has markedly reduced the incidence of complications especially postoperative pain. However, the menace of postoperative pain still remains challenge, especially in first 24 hours. The present study was conducted to comparatively analyse the postoperative pain and sedation using intravenous dexmedetomidine and intravenous esmolol during laparoscopic cholecystectomy.Methods: Study was conducted on 90 adult patients aged 18-60 years of ASA grade I or II of both genders, scheduled for laparoscopic cholecystectomy under general anaesthesia. Patients were randomized into three groups of 30 patients each. Patients of group A received esmolol infusion (loading: 1 mg/kg and maintenance: 5-15 µg/kg/min), patients of group B received dexmedetomidine infusion (loading: 0.7 µg/kg and maintenance: 0.4 µg/kg/hour) and group C (control group) received normal saline infusion. During the post-operative period of 24 hours, patient were monitored for sedation using Ramsay sedation score like pain, using visual analogue score (VAS), incidence of post-operative nausea and vomiting and use of any drug for pain, vomiting and any other side effect.Results: Frequency of pain was highest in group C at all post periods, followed by group A and was least in group B. The mean sedation score of group B was comparatively higher as compared to both group C and group A.Conclusions: The inference authors drew was that dexmedetomidine is better analgesic with aurousable sedation

Mapping the Racial Inequality in Place: Using Youth Perceptions to Identify Unequal Exposure to Neighborhood Environmental Hazards

Black youth are more likely than white youth to grow up in poor, segregated neighborhoods. This racial inequality in the neighborhood environments of black youth increases their contact with hazardous neighborhood environmental features including violence and toxic exposures that contribute to racial inequality in youth health and well-being. While the concept of neighborhood effects has been studied at length by social scientists, this work has not been as frequently situated within an environmental justice (EJ) paradigm. The present study used youth perceptions gained from in-depth interviews with youth from one Pittsburgh, Pennsylvania neighborhood to identify neighborhood environmental health hazards. We then mapped these youth-identified features to examine how they are spatially and racially distributed across the city. Our results suggest that the intersection of race and poverty, neighborhood disorder, housing abandonment, and crime were salient issues for youth. The maps show support for the youths’ assertions that the environments of black and white individuals across the city of Pittsburgh differ in noteworthy ways. This multi-lens, mixed-method analysis was designed to challenge some of the assumptions we make about addressing environmental inequality using youths’ own opinions on the issue to drive our inquiry

Effectiveness of Haemophilus influenzae type b conjugate vaccine on radiologically-confirmed pneumonia in young children in Pakistan.

OBJECTIVE: The effectiveness of Haemophilus influenzae type b (Hib) vaccine in preventing severe pneumonia in Asian children has been questioned, and many large Asian countries yet to introduce Hib conjugate vaccine in immunization programs. The primary objective of this study was to assess Hib conjugate vaccine effectiveness (VE) on radiologically-confirmed pneumonia in children born after introduction of Hib conjugate vaccine in Pakistan. STUDY DESIGN: A matched case-control study enrolled cases of radiologically-confirmed pneumonia in several hospitals serving low-income populations during 2009-2011. Cases were matched by age and season with 3 hospital and 5 neighborhood controls. Pneumonia was diagnosed using standardized World Health Organization criteria for chest radiograph interpretation. Matched OR were estimated for VE. RESULTS: A total of 1027 children with radiologically-confirmed pneumonia were enrolled; 975 cases, 2925 hospital controls, and 4875 neighborhood controls were analyzed. The coverage for 3 doses of diphtheria-tetanus-pertussis-hepatitis B-Hib conjugate vaccine was 13.7%, 18%, and 22.7% in cases, hospital controls and neighborhood controls, respectively. Estimated Hib VE for radiologically-confirmed pneumonia was 62% with 3 doses of vaccine using hospital controls and 70% using neighborhood controls. CONCLUSIONS: Hib conjugate vaccine prevented a significant fraction of radiologically-confirmed pneumonia in children in Pakistan. Maximizing impact on child survival needs improved immunization coverage

Effectiveness of 10-valent pneumococcal conjugate vaccine against vaccine-type invasive pneumococcal disease in Pakistan

Objective: To assess the effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) against invasive pneumococcal disease (IPD) due to vaccine serotypes of Streptococcus pneumoniae post introduction of the vaccine into the routine immunization program in Pakistan. Methods: A matched case–control study was conducted at 16 hospitals in Sindh Province, Pakistan. Children aged <5 years (eligible to receive PCV10) who presented with radiographically confirmed pneumonia and/or meningitis were enrolled as cases. PCR for the lytA gene was conducted on blood (for radiographic pneumonia) and cerebrospinal fluid (for meningitis) samples to detect S. pneumoniae. The proportion of IPD due to vaccine serotypes (including vaccine-related serogroups) was determined through serial multiplex PCR. For each case, at least five controls were enrolled from children hospitalized at the same institution, matched for age, district, and season. Results: Of 92 IPD patients enrolled during July 2013 to March 2017, 24 (26.0%) had disease caused by vaccine serotypes. Most case (87.5% of 24) and control (66.4% of 134) children had not received any PCV10 doses. The estimated effectiveness of PCV10 against vaccine-type IPD was 72.7% (95% confidence interval (CI) −7.2% to 92.6%) with at least one dose, 78.8% (95% CI −11.9% to 96.0%) for at least two doses, and 81.9% (95% CI −55.7% to 97.9%) for all three doses of vaccine. Conclusions: The vaccine effectiveness point estimates for PCV10 were high and increased with increasing number of doses. However, vaccine effectiveness estimates did not reach statistical significance, possibly due to low power. The findings indicate the likely impact of vaccine in reducing the burden of vaccine-type IPD if vaccine uptake can be improved. Keywords: Pneumococcal conjugate vaccine, Effectiveness, Invasive pneumococcal diseas

Stathmin-2 loss leads to neurofilament-dependent axonal collapse driving motor and sensory denervation.

The mRNA transcript of the human STMN2 gene, encoding for stathmin-2 protein (also called SCG10), is profoundly impacted by TAR DNA-binding protein 43 (TDP-43) loss of function. The latter is a hallmark of several neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS). Using a combination of approaches, including transient antisense oligonucleotide-mediated suppression, sustained shRNA-induced depletion in aging mice, and germline deletion, we show that stathmin-2 has an important role in the establishment and maintenance of neurofilament-dependent axoplasmic organization that is critical for preserving the caliber and conduction velocity of myelinated large-diameter axons. Persistent stathmin-2 loss in adult mice results in pathologies found in ALS, including reduced interneurofilament spacing, axonal caliber collapse that drives tearing within outer myelin layers, diminished conduction velocity, progressive motor and sensory deficits, and muscle denervation. These findings reinforce restoration of stathmin-2 as an attractive therapeutic approach for ALS and other TDP-43-dependent neurodegenerative diseases