The value of epidural magnesium sulfate as an adjuvant to bupivacaine and fentanyl for labor analgesia

AbstractObjectiveWe conducted this clinical study to assess the adjuvant effects of single dose magnesium sulfate (Mg) when administered epidurally during labor with fentanyl and bupivacaine.MethodsEighty healthy nulliparous women in labor requesting epidural analgesia were divided into two groups. Group 1 received bupivacaine 0.125% with magnesium sulfate 50mg and fentanyl 50μg as a loading dose; group 2, received bupivacaine 0.125% and fentanyl 50μg only. Hemodynamic parameters, motor and sensory evaluation, cervical dilation at time of consenting, the progress of labor, the visual analog pain score (VAS), Apgar score, cord blood acid base status, side effects as nausea, vomiting, itching and respiratory depression were recorded. Fetal heart rate tracings were also documented.ResultsEpidural single dose magnesium sulfate added to bupivacaine and fentanyl in labor resulted in significantly faster onset and longer duration of epidural analgesia (169±50min) in comparison to those patients who received bupivacaine and fentanyl only (105±41min), also there was a significant reduction in the number of women requiring additional boluses of bupivacaine when Mg was added (P=0.016). The two groups had no significant differences as regards maternal satisfaction score, maternal and neonatal adverse effects.ConclusionMagnesium sulfate added to bupivacaine and fentanyl for labor epidural analgesia resulted in faster onset, longer duration of action and reduced the break through pain

A randomized controlled study of the effects of adding ultra-low dose naloxone to lidocaine for intravenous regional anesthesia

Objective: This study was designed to evaluate the effect of adding ultra-low dose of naloxone as an adjuvant to lidocaine for intravenous regional anesthesia (IVRA). Method: Forty patients undergoing elective short procedures in the upper limb were randomly and blindly divided into two groups of twenty patients each. Group L (n = 20) received 3 mg/kg of 2% lidocaine diluted with normal saline to 30 ml. Group LN (n = 20) received 3 mg/kg of 2% lidocaine and naloxone 100 ng (1 ml) diluted with normal saline to 30 ml. Onset and recovery time of sensory and motor block, intraoperative and post-operative pain were measured by visual analog score (VAS), and also intraoperative analgesic requirement, time of first requirement of diclofenac postoperatively, total amount of diclofenac needed in 24 h, patient’s satisfaction and surgeon’s satisfaction scores were measured. Results: Recovery of sensory block was significantly longer in group LN (26.7 ± 2.8 min) compared to group L (16.3 ± 0.6 min); p value (0.000). Also the recovery of motor block was significantly longer in group LN (19.1 ± 1.0 min) compared to group L (17.9 ± 1.2 min), p value (0.002). Intraoperative fentanyl requirement was significantly less in group LN (15.8 ± 5.0 mcg) compared to group L (40.0 ± 10.5 mcg), p value (0.000). 1st fentanyl requirement time was significantly longer in group LN (22.4 ± 3.1 min) than in group L (14.5 ± 6.1 min), p value (0.000). Time of first analgesic requirement post-operative was longer in group LN (78.5 ± 6.8 min) compared to group L (40.5 ± 2.0 min), p value (0.000). Total amount of diclofenac needed in 24 h was significantly less in group LN (57 ± 50 mg) compared to group L (120 ± 45 mg), p value (0.000). Conclusion: The addition of ultra-low-dose naloxone 100 ng to lidocaine for IVRA in upper limb surgery, prolonged the duration of sensory and motor block, and reduced tourniquet pain, as well as intraoperative and postoperative analgesic consumption

The effect of ondansetron in preventing the hypotensive bradycardic events during shoulder arthroscopy done under interscalene block in the sitting position

Purpose: This study was conducted to test whether blocking the serotonin receptors by intravenous [IV] ondansetron; can help in reducing the hypotensive bradycardic events [HB events] associated with shoulder arthroscopy done in the sitting position under interscalene plexus block [ISB]. Methods: One hundred and fifty patients, scheduled for shoulder arthroscopy in the sitting position under ISB, were randomly assigned to one of three groups receiving either: 4 mg ondansetron, or 8 mg ondansetron or saline. Results: IV injection of ondansetron 4 mg or 8 mg significantly reduced the incidence of HB events from 20.4% in the saline group to 6.1% after injection of 4 mg ondansetron and 6% after injection of 8 mg ondansetron; p value [0.030]. Conclusion: IV ondansetron either 4 mg or 8 mg reduces the HB events during shoulder arthroscopy in the sitting position under ISB

Etiologia da hiperglicemia em crianças críticas e o impacto da disfunção de órgãos

RESUMO Objetivo: Verificar a incidência da hiperglicemia de estresse em crianças em condição grave e investigar a etiologia da hiperglicemia com base em um modelo de avaliação da homeostasia. Métodos: Estudo prospectivo de coorte, conduzido em uma unidade de terapia intensiva pediátrica da Cairo University, que incluiu 60 crianças com doença grave e 21 controles saudáveis. Utilizaram-se os níveis séricos de glicose, insulina e peptídeo C, avaliados em até 24 horas após a admissão. O modelo de avaliação da homeostasia foi utilizado para analisar a função das células beta e a sensibilidade à insulina. Resultados: A hiperglicemia foi estimada em 70% dos pacientes. Valores de glicemia ≥ 180mg/dL se associaram com desfechos piores. Os níveis de glicemia se correlacionaram de forma positiva com o Pediatric Risk for Mortality (PRISM III) e o número de órgãos com disfunção (p = 0,019 e p = 0,022, respectivamente), enquanto os níveis de insulina se correlacionaram de forma negativa com o número de órgãos com disfunção (r = -0,33; p = 0,01). O modelo de avaliação da homeostasia revelou que 26 (43,3%) das crianças em condições graves tinham baixa função de células beta e 18 (30%) baixa sensibilidade à insulina. Detectou-se patologia combinada em apenas dois (3,3%) pacientes. Baixa função de células beta se associou de forma significante com a presença de disfunção de múltiplos órgãos, disfunção respiratória, cardiovascular e hematológica, e presença de sepse. Conclusões: A disfunção de células beta pareceu ser prevalente em nossa coorte e se associou com disfunção de múltiplos órgãos

Body, wrist, and hand anthropometric measurements as risk factors for carpal tunnel syndrome

Aim The aim of this study was to identify cut-off values for body, hand, and wrist measurements in order to correctly identify individuals with increased risk of carpal tunnel syndrome (CTS). Patients and methods This study included 30 patients with clinically diagnosed and electrophysiologically confirmed idiopathic CTS and 30 age-matched and sex-matched healthy volunteers as the control group. Both groups performed sensory and motor conduction studies of the median nerve. Body, hand, and wrist anthropometric measurements were taken including weight, height, waist circumference, hip circumferences, wrist depth/width, third digit length, palm length/width, and hand length. Obesity indicators and hand/wrist ratios were calculated. Area under the ROC curve (AUC), confidence intervals, cut-off values, sensitivity, and specificity were calculated separately for each measured parameter. Results There were statistically significant differences among the studied participants regarding all measured anthropometric parameters (P<0.001). As a result, all studied patients had squarer wrists and shorter hands than healthy participants. The AUC values for all studied measurements showed high accuracy (AUC<95) except for hip circumference, waist-to-hip ratio, palm length, third digit length, and digit index which showed moderate accuracy. In the studied patients there were positive significant correlations between BMI, wrist depth, wrist ratio, and shape index with an electrophysiological severity grading of CTS of the studied patients; on the other hand, there were negative significant correlations between palm length, hand length, and hand ratio with electrophysiological severity grading of CTS. Conclusion The cut-off values for body, wrist, and hand anthropometric measurements are useful tools to assess the risk factors for CTS

The use of overnight pulse oximetry and phoniatrics parameters in the screening protocol of obstructive sleep apnea

Background: Obstructive sleep apnea–hypopnea syndrome (OSAHS) is a major public health problem due to its high prevalence rate. Polysomnography is the current golden standard test for diagnosis of OSAHS. The studies with pulse oximetry reveal a high sensitivity and suggest that as a screening tool, these may exclude some patients with negative studies from further work-up for OSAHS. Acoustic analysis of snoring sounds would offer the advantage of a non-invasive technique that would be used to monitor normal sleep. The posterior vocal tract resonances (i.e. F1 and F2) of OSA patients would yield lower frequency values compared to non-OSA individuals. Objective: To determine the sensitivity and specificity of overnight oximetry and phoniatrics parameters in evaluation of OSAHS and to compare the results with those obtained from polysomnography (PSG) as the gold standard test. Patients and methods: Twenty patients, were presented with presumptive clinical diagnosis of OSAHS, each patient was subjected to: Full history taking: including age, sex, complain and Epworth Sleepiness Scale (ESS). Systemic examination: Including general examination and body mass index (BMI). Standard ENT examination and fibroptic pharyngoscopy with Müller maneuver. Polysomnography was done using RESMED Apnea Link screening device. Other tests: Acoustic analysis of voice and acoustic analysis of snoring sounds using computerized speech lab (CSL). Pulse oximetry: The overnight oximetry was analyzed using the Wrist Pulse Oximeter MD300W. Results: Eighteen patients (90%) were found to have OSAHS and two patients (10%) were simple snorers. The sensitivity of overnight pulse oximetry for an apnea hypopnea index of >5, >15, and >30/h was 66.7%, 80%, and 100% respectively and the specificity was 50%. The formant frequencies of different vowels (i, u and a) in OSA patients and non-OSA snorers revealed that the mean F1 value for the vowel /i/ was significantly lowered in OSA patients. In addition, the mean F2 value of the vowel /i/ and /u/ was markedly lowered in OSA patients. There was significant increase in values of bandwidths (BW1 and BW2) for /i/ and /u/ vowels in OSA patients in comparison to non-OSA snorers. Acoustic analysis of snoring sounds revealed that; in the palatal snorers group, the average pitch was 105 ± 8 Hz and in the tongue base snorers group the average pitch was 263 ± 17 Hz; meanwhile the average pitch in the combined group was 160 ± 14 Hz. The difference was highly significant between the 3 groups. However harmonic to noise ratio was increased in patients with tongue base obstruction. Conclusions: Polysomnography is the current golden standard test for diagnosis and evaluation of degree of OSA. Overnight pulse oximetry offers an inexpensive method of screening for and diagnosing OSAHS. Oximetry alone allowed confident recognition of moderate and severe cases of OSAHS. Acoustic analysis of snoring sounds and voice in patients with snoring and/or OSAHS is useful as a screening or supportive method with other investigations to diagnose the site of upper airway obstruction during sleep

Exploring the antimicrobial activity of <i>Origanum majorana L.</i> against the highly virulent multidrug-resistant <i>Acinetobacter baumannii AB5075</i>:UPLC-HRMS profiling with in vitro and in silico studies

BackgroundThe infamous multidrug-resistant (MDR) bacterium Acinetobacter baumannii is becoming a nightmare in intensive care units across the globe. Since there are now very few effective antimicrobial agents, it is necessary to explore unconventional resources for novel antimicrobials. This study investigated the potential antimicrobial activity of Origanum majorana L. against A. baumannii employing multiple approaches including antimicrobial susceptibility, fractionation, ultra-performance liquid chromatography–high-resolution mass spectrometry (UPLC-HRMS) dereplication, and in silico analysis for target/ligand identification.ResultsOn the extremely pathogenic MDR strain A. baumannii AB5075, O. majorana L. has shown a significant growth inhibitory effect (MIC = 0.675 mg/mL). The polar 50% methanol fraction was the most active (MIC = 0.5 mg/mL). The UPLC-HRMS dereplication of the bioactive fraction detected 29 metabolites belonging to different chemical classes. Justicidin B, one of the identified metabolites, was projected by preliminary in silico analysis to be the most highly scoring metabolite for binding with molecular targets in A. baumannii with a Fit score = 8.56 for enoyl-ACP reductase (FabI) (PDB ID: 6AHE), suggesting it to be its potential target. Additionally, docking, molecular dynamics simulation, and bioinformatics analysis suggested that this interaction is similar to a well-known FabI inhibitor. The amino acids involved in the interaction are conserved among different MDR A. baumannii strains and the effectiveness could extend to Gram-negative pathogens within the ESKAPE group.ConclusionsOriganum majorana L. extract exhibits antimicrobial activity against A. baumannii using one or more metabolites in its 50% methanol fraction. The characterized active metabolite is hypothesized to be justicidin B which inhibits the growth of A. baumannii AB5075 via targeting its fatty acid synthesis