A comparative study of two different doses of magnesium sulfate on pneumoperitoneum-related hemodynamics and on the recovery in patients undergoing laparoscopic gynecological surgeries: A double-blind, randomized, clinical study

Background: Pneumoperitoneum (PP) with carbon dioxide (CO2) induces hemodynamic response due to the release of catecholamines and vasopressin. Magnesium Sulfate (MgSo4) inhibits the release of these mediators and attenuates the hemodynamic responses to carbon dioxide PP. Aims and Objectives: This study aimed to compare two different doses of intravenous Magnesium Sulfate on attenuating PP-related hemodynamic responses. We also evaluated recovery time, the time interval between administration of the reversal agent and extubation. Materials and Methods: Seventy female patients undergoing laparoscopic surgeries were randomized into two groups. Group I received 30 mg/kg of MgSo4 and Group II received 50 mg/kg of MgSo4 intravenous infusion prior to PP, respectively. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured at regular intervals. The secondary outcome, Train of four ratio (TOF%), at reversal and extubation was recorded. Recovery time was noted. Results: Demographic data, HR, SBP, DBP, and MAP were comparable between groups I and II, with no clinical and statistical significance in the ‘P’ value. The mean TOF ratio (%) at reversal was lower in group II (58.47±5.40) versus group I (66.93±3.43), with a P<0.001. The mean TOF ratio (%) at extubation was lower in group II (93.70±2.39) versus group I (97.47±1.59), with a P<0.001. Recovery time in minutes was higher in group II (17.80±1.19) versus group I (13.87±0.67), with a P<0.001. Conclusion: Magnesium Sulfate 30 mg/kg and 50 mg/kg intravenous infusions prior to CO2 PP showed comparable hemodynamics in laparoscopic gynecological surgery. However, Magnesium Sulfate 50 mg/kg resulted in prolonged recovery from non-depolarizing muscle relaxants, necessitating neuromuscular monitoring for safer use

Treatment With Naringenin Elevates the Activity of Transcription Factor Nrf2 to Protect Pancreatic β-Cells From Streptozotocin-Induced Diabetes in vitro and in vivo

Chronic hyperglycemia and unusually high oxidative stress are the key contributors for diabetes in humans. Since nuclear factor E2-related factor 2 (Nrf2) controls the expression of antioxidant- and detoxification genes, it is hypothesized that targeted activation of Nrf2 using phytochemicals is likely to protect pancreatic β-cells, from oxidative damage, thereby mitigates the complications of diabetes. Naringenin is one such activator of Nrf2. However, it is currently not known whether the protective effect of naringenin against streptozotocin (STZ) induced damage is mediated by Nrf2 activation. Hence, the potential of naringenin to activate Nrf2 and protect pancreatic β-cells from STZ-induced damage in MIN6 cells is studied. In MIN6 cells, naringenin could activate Nrf2 and its target genes GST and NQO1, thereby inhibit cellular apoptosis. In animals, administration of 50 mg/kg body weight naringenin, for 45 days, significantly decreased STZ-induced blood glucose levels, normalized the lipid profile, and augmented the levels of antioxidants in pancreatic tissues. Immunohistochemical analysis measuring the number of insulin-positive cells in pancreas showed restoration of insulin expression similar to control animals. Furthermore, naringenin promoted glycolysis while inhibiting gluconeogenesis. In conclusion, naringenin could be a good anti-diabetic agent, which works by promoting Nrf2 levels and by decreasing cellular oxidative stress