Sciatic lateral popliteal block with clonidine alone or clonidine plus 0.2% ropivacaine: effect on the intra-and postoperative analgesia for lower extremity surgery in children: a randomized prospective controlled study

<p>Abstract</p> <p>Background</p> <p>The effect of adding clonidine to local anesthetics for nerve or plexus blocks remains unclear. Most of the studies in adults have demonstrated the positive effects of clonidine on intra- and postoperative analgesia when used as an adjunctive agent or in some cases as a single to regional techniques. In the pediatric population, there are only few trials involving clonidine as an adjunct to regional anesthesia, and the analgesic benefits are not definite in this group of patients. The evidence concerning perineural administration of clonidine is so far inconclusive in children, as different types and volume of local anesthetic agents have been used in these studies. Moreover, the efficacy of regional anesthesia is largely affected by the operator's technique, accuracy and severity of operation.</p> <p>Methods</p> <p>The use of clonidine alone or combined with 0.2% ropivacaine for effective analgesia after mild to moderate painful foot surgery was assessed in 66 children, after combined sciatic lateral popliteal block (SLPB) plus femoral block. The patients were randomly assigned into three groups to receive placebo, clonidine, and clonidine plus ropivacaine. Time to first analgesic request in the groups was analyzed by using Kaplan-Meier and the log-rank test (mean time, median time, 95% CI).</p> <p>Results</p> <p>In our study, clonidine administered alone in the SLPB seems promising, maintaining intraoperatively the hemodynamic parameters SAP, DAP, HR to the lower normal values so that no patient needed nalbuphine under 0.6 MAC sevoflurane anesthesia, and postoperatively without analgesic request for a median time of 6 hours. In addition, clonidine administered as adjuvant enhances ropivacaine's analgesic effect for the first postoperative day in the majority of children (p = 0.001). Clonidine and clonidine plus ropivacaine groups also didn’t demonstrate PONV, motor blockade, and moreover, the parents of children expressed their satisfaction with the excellent perioperative management of their children, with satisfaction score 9.74 ± 0.45 and 9.73 ± 0.70 respectively. On the contrary all the patients in the control group required rescue nalbuphine in the recovery room, and postoperatively, along with high incidence of PONV, and the parents of children reported a low satisfaction score (7.50 ± 0.70).</p> <p>Conclusions</p> <p>Clonidine appears promising more as an adjuvant in 0.2% ropivacaine and less than alone in the SLPB plus femoral block in children undergoing mild to moderate painful foot surgery, with no side effects.</p> <p>Trial registration</p> <p>ClinicalTrials.gov, <a href="http://www.controlled-trials.com/ISRCTN90832436">ISRCTN90832436</a>, (ref: CCT-NAPN-20886).</p

A construction of constant scalar curvature manifolds with delaunay-type ends

It has been showed by Byde that it is possible to attach a Delaunay-type end to a compact nondegenerate manifold of positive constant scalar curvature, provided it is locally conformally flat in a neighborhood of the attaching point. The resulting manifold is noncompact with the same constant scalar curvature. The main goal of this paper is to generalize this result. We will construct a one-parameter family of solutions to the positive singular Yamabe problem for any compact non-degenerate manifold with Weyl tensor vanishing to sufficiently high order at the singular point. If the dimension is at most 5, no condition on the Weyl tensor is needed. We will use perturbation techniques and gluing methods

Status of vitamins A and E in schoolchildren in the centre west of Tunisia : a population-based study

Objective: The present study was undertaken to assess the status of vitamins A and E (VA and VE, respectively) and their main determinants in Tunisian children. Design: Cross-sectional population-based study. Setting: Kasserine Governorate in the centre west of Tunisia. Subjects: A total of 7407 children attending the first grade of elementary school were included. VA and VE were assessed by HPLC. Results: The prevalence of moderate VA deficiency (VAD; < 0.70 mu mol/l) was 2.3% and VE deficiency (VED; < 6.97 mu mol/l) was 5.4%. Low status in VA (0.70-1.05 mu mol/l) and VE (6.97-11.61 mu mol/l) was observed in 17% and 20.2% of children, respectively. No child exhibited severe VA or VE deficiency (< 0.35 and < 2.32 mu mol/l, respectively). The main predictors of VAD were advanced age (OR = 1.65; 95% CI 1.13, 2.41; P=0.05) and sickness within the past 2 weeks (OR = 1.51; 95% CI 1.09, 2.09; P=0.01). Predictors of VED were living in the pen-urban region (OR = 1.60; 95% CI 1.28, 2.01; P < 0001) and sickness within the past 2 weeks (OR = 0.75; 95% CI 0.60, 0.94; P=0.01). Conclusions: Moderate VAD and VED were uncommon in Tunisian children. However, low status in VA and/or VE remains frequent. A reinforcement of the national strategies for children's nutrition and health is needed, particularly in disadvantaged regions. Supplementation of VA and VE is not necessary in Tunisia, but food fortification may be beneficial

URINARY CREATINE AT REST AND AFTER REPEATED SPRINTS IN ATHLETES: A PILOT STUDY

Creatine plays a key role in muscle function and its evaluation is important in athletes. In this study, urinary creatine concentration was measured in order to highlight its possible significance in monitoring sprinters. The study included 51 sprinters and 25 age- and sex-matched untrained subjects as a control group. Body composition was measured and dietary intake estimated. Urine samples were collected before and after standardized physical exercise. Creatine was assessed by gas chromatography mass spectrometry. Basal urinary creatine (UC) was significantly lower in sprinters than controls (34±30 vs. 74±3 μmol/mmol creatinine, p<0.05). UC was inversely correlated with body mass (r=-0.34, p<0.01) and lean mass (r=- 0.30, p<0.05), and positively correlated with fat mass (r=0.32, p<0.05). After acute exercise, urinary creatine significantly decreased in both athletes and controls. UC is low in sprinters at rest and further decreases after exercise, most likely due to a high uptake and use of creatine by muscles, as muscle mass and physical activity are supposed to be greater in athletes than untrained subjects. Further studies are needed to test the value of urinary creatine as a non-invasive marker of physical condition and as a parameter for managing Cr supplementation in athletes

Dihydropteridine reductase deficiency in a large consanguineous tunisian family: Clinical, biochemical, and neuropathologic findings

We report the case of a large consanguineous Tunisian family of seven siblings suffering from dihydropteridine reductase deficiency with either typical clinical, biochemical, or autopsy findings. Two cousins also were reported to have the same symptoms. This metabolic disorder is characterized by severe microcephaly, psychomotor regression, and progressive basal ganglia calcifications. Dihydropteridine reductase assay on samples collected from the two brothers still alive did not show measurable activity. The sister and four brothers died between the ages of 3 years and 7 years. A neuropathology study done on the sister showed diffuse demyelination throughout the white matter and spongy vacuolation in the subthalamic nuclei, the superior cerebellar peduncles and the tegmentum tracts of the brain stem. The anterointernal part of the putamen was completely necrotic with nearly total nerve cell loss. Abnormal vascular proliferation and calcification of the walls of small, medium, and large arteries and veins, as well as diffusely scattered pericapillary and isolated calcospherites, were seen in this necrotic region. We think that folate deficiency may be involved in the pathogenesis of the basal ganglia calcification