Intravenous Paracetamol Versus Patient-Controlled Analgesia With Morphine for the Pain Management Following Diagnostic Knee Arthroscopy in Trauma Patients: A Randomized Clinical Trial

Background: Most patients undergoing outpatient surgeries have the unpleasant experience of high level pain after surgery. Compared with open surgeries, arthroscopic procedures are less painful; however, inadequate pain management could be associated with significant concerns. Opioids alone or in combination with local anesthetics are frequently used for diminishing postoperative pain using intravenous or epidural infusion pumps. Despite morphine various disadvantages, it is commonly used for controlling pain after surgery. Objectives: The aim of this study was to compare intravenous paracetamol and patient-controlled analgesia (PCA) with morphine for the pain management following diagnostic knee arthroscopy in trauma patients. Patients and Methods: Sixty trauma patients who were scheduled to undergo knee arthroscopy were randomly divided into two groups. Patients immediately received intravenous infusion of 1 g paracetamol within 15 minutes after surgery and every 6 hours to 24 hours in the paracetamol group. The patient-controlled analgesia group received morphine through PCA infusion pump at 2 mL/h base rate and 1mL bolus every 15 minutes. Pain level, nausea and vomiting, and sedation were measured and recorded during entering the recovery, 15 and 30 minutes after entering the recovery, 2, 6, and 24 hours after starting morphine pump infusion in the morphine and paracetamol in the paracetamol groups. Results: There was no significant difference regarding the pain level at different times after entering the recovery between the two groups. No one from the paracetamol group developed drug complications. However, 22.3% in the PCA morphine suffered from postoperative nausea; there was a statistically significant difference regarding the sedation level, nausea, and vomiting at various times between the two groups. Conclusions: Intravenous administration of paracetamol immediately after knee arthroscopy improved postoperative pain, decreased analgesic administration, maintained stable hemodynamic parameters, had no complications related to opiates, no nausea and vomiting, and increased patient satisfaction and comfort in comparison to PCA with morphine

Standardization and in-house ELISA setup for helicobacter pylori serologic diagnosis

Helicobacter pylori (H.pylori) is the most prominent causative agent of gastroduodenal diseases all over the world. Other manifestations such as urticaria and coronary heart diseases, also are suspected to be induced by H.pylori. Non invasive methods are preferred for diagnosis; and ELISA, because of its reliability, speed, sensitivity and specificity is widely preferred as diagnostic tool. Previously we have used IFA, and here, we report an indirect ELISA technique for H.pylori diagnosis. First, 9 strains, of H.pylori isolated from biopsies, were cultured, and the soluble crude antigen was used to coat ELISA plates. Antigen concentration and conjugated antiserum dilution were optimised using checker board method. In this study the gold standard was: rapid urease test, culture and direct smear. Patient serum dillution and the cut-off value was determind, using 22 negative and 30 positive confirmed samples according to ROC curve and the results were compared with a commercial kit. The sensitivity and specificity of this method were 93.2 percent and 95.4 percent respectively. A commercial ELISA Kit, was used and compared simultaneously. The sensitivity and specificity were 87.8 percent and 73 percent respectively. Therefore, regarding the acceptable sensitivity and specificity, ease of work of ELISA, being economical and non-invasive, it can be employed in diagnosis of H.pylori infection and also in epidemiological studies

Evaluation of regulatory T lymphocytes and IL2Ra and FOXP3 gene expression in peripheral mononuclear cells from patients with amyotrophic lateral sclerosis

Background: Loss of neuroprotective role of CD4+ helper T cells, regulatory T cells, and M2 microglia constitutively results in the rapid neural death in the �rapidly progressive phase� of amyotrophic lateral sclerosis (ALS). Aim: We aimed to investigate relative count of CD4+ and regulatory T lymphocytes and expression level of IL2Ra and FOXP3 genes in peripheral blood mononuclear cells (PBMCs) from patients with ALS. Method: We performed a flow cytometric analysis on PBMC from 38 patients with ALS and 32 controls to determine the count of CD4+ and CD4+CD25+ cells. Quantitative real-time PCR analyses were implemented to determine the level of expression of FOXP3 and IL-2Rα (CD25) genes in the peripheral blood mononucleated cells. Results: We found a significant higher proportion of CD4+ T cells (p value < 0.001), along with a significantly reduced proportion of CD4+CD25+ Treg cells (p value = 0.001, p value = 0.02), in the peripheral blood of patient�s with ALS. Conclusion: The results of our study are in line with the hypothesis that in the early phase of ALS, neuroprotective helper T cells infiltrate in the affected areas in the lumbar spinal cord. This was reflected in higher peripheral percentage of CD4+ helper T cells and higher expression of FOXP3 and IL-2Rα. The observed demise in the number of active CD4+CD25+ regulatory T cells might indicate early signs of progression to later stages of ALS in our study group. Interestingly, disease duration was the sole independent significant determining factor that predicted CD4+CD25+ regulatory T cell counts in the peripheral blood of patients at various stages of ALS, according to a logistic regression model. © 2018 Royal Academy of Medicine in Irelan