Efficacy of clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block: A prospective study

Background and Aims: Bupivacaine has been the most frequently used local anaesthetic in brachial plexus block, but ropivacaine has also been successfully tried in the recent past. It is less cardiotoxic, less arrhythmogenic, less toxic to the central nervous system than bupivacaine, and it has intrinsic vasoconstrictor property. The effects of clonidine have been studied in peripheral nerve blockade. The purpose of this study was to evaluate the effects of clonidine on nerve blockade during brachial plexus block with ropivacaine using peripheral nerve stimulator. Methods: Sixty patients were randomly divided into two groups, Group A and B. Group A received 30 ml of 0.5% of ropivacaine with 0.5 ml normal saline while Group B received same amount of ropivacaine with 0.5 ml (equivalent to 75 μg) of clonidine for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post-operative analgesia and intra and post-operative complications. Results: There was a significant increase in duration of motor and sensory block and analgesia in Group B as compared to Group A patients (P < 0.0001). There was no significant difference in onset time in either group (P = 0.304). No significant side effects were noted. Conclusion: The addition of 75 μg of clonidine to ropivacaine for brachial plexus block prolongs motor and sensory block and analgesia without significant side effects

Pregnancy Outcome after Multifoetal Sac Reduction to Twin in Higher Order Multiple Pregnancies.

Objective: The aim of the study was to evaluate maternal and foetal outcome after fetoreduction in higher order multiple pregnancy. Materials and methods: This descriptive study was conducted at the Infertility Care and Research Centre (ICRC), Dhaka between 2006 and 2009. In eleven (11) cases, multifoetal pregnancy reduction (MFPR) were performed and maternal and foetal conditions were analyzed. All patients got pregnant after fertility treatment. The procedure was done between 8-10 weeks of gestation except in one case which was done at 17 weeks. Transvaginal approach under spinal anaesthesia was adopted for intracardiac injection of potassium chloride till cessation of cardiac pulsation. Antibiotic, aspirin, antispasmodic and progesterone were used for all patients. Main outcome measures were uterine contraction, leaking membrane, bleeding, infection, abortion, gestational age and birth weight. Results: Out of these eleven patients eight patients delivered twins at 37 weeks and one patient delivered a set of twin at 34 weeks and their antenatal period was uneventful. Two patients had abortions, one of which was not related with the procedure. No perinatal death was reported among 18 babies. Each of the babies born had an average weight of 2.42 kg. There was no serious maternal complication except rise of temp in one patient. Conclusion: Fetoreduction can improve the chances of survival and can reduce perinatal morbidity of remaining fetuses and can reduce maternal distress without any adverse affect to mother and foetuses. Key words: Sac reduction, multiple pregnanc

ΔPSap4#5 surface-functionalized abiraterone-loaded nanoparticle successfully inhibits carcinogen-induced prostate cancer in mice: a mechanistic investigation

Abstract Prostate cancer (PCa) is one of the fatal illnesses among males globally. PCa-treatment does not include radiotherapy. Chemotherapy eventually causes drug resistance, disease recurrence, metastatic advancement, multi-organ failure, and death. Preclinical data on PCa-induced by carcinogens are truly scarce. Although some data on xenograft-PCa in animals are available, they mostly belonged to immuno-compromised animals. Here, we developed ΔPSap4#5 aptamer surface-functionalized abiraterone-loaded biodegradable nanoparticle (Apt-ABR-NP) to investigate its targeting ability to prostate-specific membrane antigen (PSMA) in carcinogen-induced PCa mice and the therapeutic efficacy of the formulation. Aptamers are called synthetic monoclonal antibodies for their target specificity. However, they are devoid of the toxicity problem generally associated with the antibody. Abiraterone is a testosterone and androgen inhibitor, a new drug molecule that shows good therapeutic efficacy in PCa. The developed nanoparticles were physicochemically characterized and used for various in vitro and in vivo investigations. Nanoparticles had an average size of 149 nm with sustained drug release that followed Korsmeyer–Peppas kinetics. In vitro investigation showed that Apt-ABR-NP produced 87.4% apoptotic cells and 95.3% loss of mitochondrial membrane potential in LNCaP cells after 48 h of incubation. In vivo gamma scintigraphy, live imaging, and biodistribution studies in prostate cancer animal models showed the predominant targeting potential of Apt-ABR-NP. Histopathological investigation showed the remarkable therapeutic efficacy of the formulation. The pharmacokinetic study showed an increased biological half-life and enhanced blood residence time of Apt-ABR-NP. Apt-ABR-NP therapy can thus minimize off-target cytotoxicity, reduce drug loss due to site-specific delivery, and deliver abiraterone in a sustained manner to the organ of interest. Thus, the present study brings new hope for better therapeutic management of PCa in the near future. Graphical Abstrac