Preemptive use of adjunctive IV lidocaine for enhanced recovery after abdominal hysterectomy for overweight and obese women: a prospective, randomized, double-blind, placebo-controlled study

Background: This investigation planned to evaluate the clinical results of adjunctive IV lidocaine bolus dose plus infusion for one hour after surgery in patients who underwent an abdominal hysterectomy in obese and overweight women.Methods: We performed a double-blind, placebo-controlled study, (ClinicalTrials.gov identifier: NC03748108), with patients undergoing abdominal hysterectomy divided into 2 groups: one group received intravenous lidocaine single bolus dose preoperatively and IV infusions till one hour after the surgical procedure, and the opposite received normal saline infusion (placebo). We assessed postoperative results, including pain scores rankings on a visual analog scale (VAS) in rest and movement, administration frequency of pethidine. Postoperative nausea and vomiting, the period of hospital stay (LOS), time to ambulate, and patient satisfaction at forty-eight hours had been evaluated. Chi-square test and Monte Carlo test have been used for comparison among groups.Results: There were 120 patients in our study. The visual analog scale (VAS), pain scores, length of hospital stay (LOS), and administration frequency of pethidine were significantly lower in the lidocaine group. The total amount of consumed pethidine was significantly lower in the lidocaine than the placebo group. There was a significant reduction in post-operative pain which was assessed by visual analog scale (VAS) after 2,4,8,12, and 24 hours either during movement or during rest in the lidocaine group compared to the placebo group, p=(0. 0001,0.0001,0.0001,0.0001 and 0.0001).Conclusions: The administration of adjuvant intravenous lidocaine infusion reduces pain during the postoperative period after abdominal hysterectomy, is associated with early recovery, decreased postoperative opioid analgesic requirement, and better patient satisfaction in overweight and obese women undergoing abdominal hysterectomy.

Age-dependent pharmacokinetics and effect of roscovitine on Cdk5 and Erk1/2 in the rat brain.

Roscovitine is a cyclin-dependent kinase (Cdk) and signal-regulated kinase (Erk1/2) inhibitor that has been shown to be effective against several cancer types including brain tumors. We have shown previously that roscovitine crosses the blood brain barrier (BBB) and is rapidly eliminated from both plasma and brain in adult rats. However, age-dependent kinetics and its effects on the brain have not been reported. In the present study, we investigated the pharmacokinetics of roscovitine in adult and in 14 days old rats after the administration of a single dose of 25 mg/kg. Moreover, we studied the effect of the drug on Cdk5 and Erk1/2 activities in three brain regions, hippocampus, frontal cortex and cerebellum. The pharmacokinetics of roscovitine followed a two-compartment model in both plasma and brain in both adult and young rats. The terminal elimination half-life was 7 h in brain as well as in plasma in rat pups compared to < 0.5 h observed in adult rats. Brain exposure expressed as AUC brain/AUC plasma was 100% in rat pups compared to 20% found in adult rats. Roscovitine induced a significant Cdk5 inhibition and significant Erk1/2 activation in all studied pups brain regions at 2 h. This is the first study describing age-dependent pharmacokinetics of roscovitine and showing the high brain exposure of infant rats to the drug. Thus, roscovitine may be a promising candidate for the treatment of brain tumors in children

Monkeypox Outbreak: More queries posed as cases globally soar

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The relation between of insulin like growth factor II and endometrial carcinoma

Background: Endometrial cancer is the most common gynecologic malignancy in the United States and the fourth most common cancer in women. The need of a soft marker that can be used with CA-125 tumor marker for early detection of endometrial cancer and to predict late stages and advanced histopathological grades and to specify the cases who will be managed by complete surgical staging including para aortic and pelvic lymphadenectomy is of great importance. The aim of the study was to evaluate the role of insulin like growth factor 2 in endometrial carcinoma and to correlate it with different histopathological grades of the disease.Methods: This study was applied on sixty patients with abnormal uterine bleeding and were divided into two groups, Group A included 30 cases of endometrial carcinoma, while Group B included 30 cases complaining of abnormal vaginal bleeding due to other causes as a control group. Serum samples were taken from all patients and estimation of IGF-2 serum levels using ElISA technique was done. Comparison of IGF-2 serum level between both groups and correlation of its levels with different histopathological grades of endometrial cancer group were done.Results: As regard comparison between both groups and ILGF2 serum level, study results demonstrated that ILGF2 levels ranged between 600.0-1440.0 ng/ml and 40.0-560.0 ng/ml with the mean of 781.33 ng/ml±196.45 and 336.0 ng/ml±212.86 for cases Group A and control Group B respectively. There was a statistically significant difference between the two studied groups regarding ILGF2 serum level (p<0.001). As regards correlation between histopathological grades and ILGF-2 serum level in cases Group A, the study revealed a strong positive correlation.Conclusions: ILGF-2 can be used as a serum marker for endometroid adenocarcinoma of the body of the uterus and to predict its higher histopathological grades

Reducing the incidence of exposure to blood and body fluids

Methods: we used a Pareto chart to identify priority areas for our project based on magnitude of incidence of BBF exposures. A driver diagram was developed with four main primary drivers including risk awareness, attitudes and practice, staff experience, and leadership engagement. Interventions ramps and changes were implemented using multiple PDSA cycles addressing staff knowledge and awareness about BBF exposure prevention and management using surveys and learning brochures and assessment of staff compliance with safe practice. The project included the following measures (i) outcome measure: number of days between BBF exposure incidents; (ii) Process measures: BBF exposure risk awareness score, attitude and practice score, and proportion of staff compliant with BBF exposure safe practice; (iii) BBF reporting exposure score and proportion of staff satisfied with BBF exposure prevention and management policy. Ethical approval of the project was not required. Results: about 80% of BBF exposure incidents were due to needlestick injuries. Emergency unit, operating theatre, hemodialysis unit, laboratory unit, and utility services accounted for 80% of all BBF exposure incidents. Around 47% of the incidents occurred among nurses. Our project was associated with increase in attitude and safe practice score form 75% to 100%. The compliance with safe practice increased from 77% to 86%, and reporting of exposure increased from 75% to 100%. Staff satisfaction increased from 65% at baseline to 96%. Knowledge about prevention and management of BBF exposure (safe practice) increased from 60% to 92% in the hemodialysis unit. However, the median number of days between BBF exposures increased from 13 days at baseline to 18 days in May 2019. Conclusion: our quality improvement project has identified the priorities clinical areas accounting for the majority of BBF exposure incident. The initial phase of the project in hemodialysis unit was associated with significant increase in knowledge scores about prevention and management of BBF exposure, compliance with safe practice, and staff satisfaction. In addition, the project was associated with significant increase in reporting of BBF exposure, which explains why we were not able to increase the median number of days between BBF exposures to 50 days. We have started spreading our interventions and change ideas to other units in Al-Khor general Hospital. Quality improvement projects can reduce the incidence of BBF exposure having the priority areas identified and the relevant drivers are addressed appropriatel

Interferon gamma: is it a co-player in the pathogenesis of idiopathic nephrotic syndrome

Introduction: Idiopathic nephrotic syndrome (INS), the most common form of NS in childhood, was considered 4 decades ago as a systemic disorder of T cells, mediated through its released cytokines. To date, the exact incriminated cytokine or immunological mediator is not properly defined. Interferon gamma (IFN-γ), a pro-inflammatory cytokine, is thought to have a role in the provocation of the T cell mediated INS relapse, through promotion of T helper1 (Th1) differentiation and suppression of regulatory T cells (Treg). Aim of the study: to evaluate the immunopathogenic role of IFN-γ in children with steroid sensitive idiopathic nephrotic syndrome (SSNS) through monitoring the changes in its levels with disease course. Methods: This study included twenty-five newly diagnosed children with SSINS. They were all given full dose prednisolone, evaluated at initial diagnosis and at full remission as regards the serum level of IFN-γ. Results: Serum levels of IFN-γ were lowermost at time of diagnosis and increased with remission on corticosteroids. Conclusions: this study points to a role for the lower serum IFN-γ at diagnosis, in the immunopathogenesis of INS than at remission and the rise in its serum level might be a marker of remission induction, however this awaits confirmation in larger scale studies. Studies on renal biopsy specimens are needed to determine the exact renal in situ levels and effects of IFN-

Effect of pesticides applied in cowpea production on rumen microbial fermentation of cowpea haulms as reflected in in vitro gas production

The present study assessed the effect of lambda cyhalothrin, cypermethrin and dimethoate residues in cowpea haulm on microbial fermentation using gas syringes as incubators. The lambda cyhalothrin, cypermethrin and dimethoate were applied at the vegetative, flowering and podding stages of the cowpea at the rate of 2.66 mg/L, 5.14 mg/L and 6.68 mg/L of water, respectively. Dimethoate was detected in the cowpea haulm at the highest concentration of 1.38 mg/kg. The haulm with no pesticide treatment was incubated with media containing rumen fluid, and pesticides were added at concentrations of 40 mg/kg, 80 mg/kg and 120 mg/kg. In vitro gas production was measured at 3 h, 6 h, 12 h, 24 h, 48 h, 72 h and 96 h to estimate the rate of gas evolution. Gas production in general was influenced by pesticide application. In general, gas evolution was reduced by increasing levels of lambda cyhalothrin up to 80 mg/kg. However, an increase in gas accumulation was observed with increasing levels of dimethoate, while the application of cypermethrin yielded no noticeable change in gas production. The study indicates that pesticide residues may function as toxins at concentrations greater than those encountered in the field or lethal dose (LD50) and may inhibit the growth of rumen microbes

Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernia with severe gastroesophageal reflux disease. A retrospective cohort study

Background: Laparoscopic Nissen Fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications affecting patient satisfaction. The aim of this study is to assess the value of the intraoperative endomanometric evaluation of esophagogastric competence and pressure combined with LNF in patients with large sliding hiatus hernia (&gt; 5&nbsp;cm) with severe GERD (DeMeester score &gt;100). Materials and methods: This is a retrospective, multicenter cohort study. Baseline characteristics, postoperative dysphagia and gas bloat syndrome, recurrent symptoms, and satisfaction were collected from a prospectively maintained database. Outcomes analyzed included recurrent reflux symptoms, postoperative side effects, and satisfaction with surgery. Results: 360 patients were stratified into endomanometric LNF (180 patients, LNF+) and LNF alone (180 patients, LNF). Recurrent heartburn (3.9% vs. 8.3%) and recurrent regurgitation (2.2% vs. 5%) showed a lower incidence in the LNF+ group (P=0.012). Postoperative score III recurrent heartburn and score III regurgitations occurred in 0% vs. 3.3% and 0% vs. 2.8% cases in the LNF+ and LNF groups, respectively (P=0.005). Postoperative persistent dysphagia and gas bloat syndrome occurred in 1.75% vs. 5.6% and 0% vs. 3.9% of patients (P=0.001). Score III postoperative persistent dysphagia was 0% vs. 2.8% in the two groups (P=0.007). There was no redo surgery for dysphagia after LNF+. Patient satisfaction at the end of the study was 93.3% vs. 86.7% in both cohorts, respectively (P=0.05). Conclusions: Intraoperative high-resolution manometry (HRM) and endoscopic were feasible in all patients, and the outcomes were favorable from an effectiveness and safety standpoint

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London