[Case report: Treatment of burning pain and Post traumatic refractory allodynia in foot digits, with low dose of ketamine]

Frequent simulation and irritation of NMDA receptors by glutamate mediators can lead to burning pain, allodynia and hyperalgesia, even after stopping the irritant factor. Opioid-induced hyperalgesia and peripheral nerve injuries in lower extremities orthopedic surgeries can also make the same symptoms, which sometimes make it difficult to diagnose it from causalgia [type II complex regional pain syndrome]. Post-traumatic neuralgia is not so common, often does not respond well to usual medications and prolongs the patient's stay in hospital. Noting the anatomical and physiological aspects of pain transmission pathways and also role of pain transmission inhibitors via NMDA receptors in pain management, opens us a new window to the role of medicines such as ketamine in prevention and treatment of neuropathic or chronic postoperative pains. We report a case involving refractory neuropathic pain which is eventually controlled with low dose of ketamine

[ effects of adding ketamine to morphine in patient-controlled intravenous analgesia after orthopedic surgeries]

A routine method to control post-operative pain is patient-controlled intravenous analgesia [PCIA] using opioids. Regarding complications of opioids, it seems necessary to reduce their dosage and to improve the quality of analgesia using adjuvants. We aimed to assess the effect of adding ketamine to morphine in PCIA pumps for post-operative pain control in orthopedic patients. Sixty patients, being 20-60 years old [ASA class I-II] and undergoing orthopedic surgery in lower extremity, were enrolled They had no history of opioid addiction or epilepsy. Our patients were randomly allocated to three groups 20 mg morphine sulfate, 100 mg ketamine plus 20 mg morphine and 200 mg ketamine plus 10 mg morphine in their PCIA pump. The pain score was evaluated using VAS [0-10] and VRS [0-5]; besides the sedation score and the degree of nausea-vomiting were assessed with Ramsay scale [0-5] and N and V score [1-4], respectively. All these measurements were performed 2, 4, 12, 24, and 48 hours postoperatively. The incidence of adverse drug reactions was not different among the three groups [p>0.05], but pain control was significantly better in the second and third group [ketamine plus morphine] in comparison with the first one [p<0.05]. There was no difference in the quality of pain control between the second and the third groups. Also, the need for additional opioid was significantly reduced in the two latter groups compared with the first one [p<0.05]. Adding ketamine to morphine in PCIA pumps would result in better pain control and less need for additional break-through analgesic

Genetic heterogeneity among Leishmania major isolates in Iran determined by restriction fragment length polymorphism [RFLP] and multilocus microsatellite typing [MLMT]

In recent years, molecular methods for characterizing genetic heterogeneity have found a major place in modern approaches. In this study, two different molecular techniques including Restriction Fragment Length Polymorphism [RFLP] and Multi Locus microsatellite typing [MLMT] were carried out in order to evaluate genetic heterogeneity among isolates of Leishmania major in Iran. In this experimental study, 24 Lmajor isolates from different endemic foci of cutaneous leishmaniasis were evaluated. All samples were amplified by specific primers for Internal Transcribed Spacer ribosomal RNA [ITS_rRNA] and miniexon genes [ME]. Ten different microsatellite markers were applied to 24 collected isolates as well. Restriction fragment length polymorphism of Polymerase chain reaction of ITS-rRNA and ME regions was identified in polyacrylamide gel electrophoresis. Size polymorphisms in PCR products of microsatellites markers were measured in the CEQ 8000 automated genetic analysis system. Population structure of the isolates was investigated by Structure Version 2.3.2 software. According to ITS- RFLP and ME-RFLP techniques, three and two different strains of Lmajor were determined, respectively, while microsattellites markers revealed 21 different genotypes, which were clustered in three genetic groups using structure software. Although genetic heterogeneity among studied L. major isolates was identified by molecular tools as used in this study, it seems that microsatellites markers are more useful in population structure and epidemiological studies. Our findings also showed correlation between different identified strains and their geographical regions

Ondansetron and meperidine prevent postoperative shivering after general anesthesia

Postoperative shivering is one of the common problems following general anesthesia and may lead to multiple complications. The aim of this study was to examine the preventive effects of Ondansetron and Meperidine on postoperative shivering. This randomized placebo-controlled double blind clinical trial included 90 patients scheduled for elective gynecologic operations, randomly divided to three groups. Ondansetron [4 mg], Meperidine [0. 4 mg/kg] and 2 cc normal saline [as a control group] were administered immediately before the induction of anesthesia. Anesthesia induced equivalently for all. Patients were observed in terms of vital signs, side effects and shivering. Postoperative shivering was observed in 13. 3% of patients in Ondansetron group and 20% of Meperidine group, significantly lower than the controls [50%]. The reduction of core and dermal temperature during the anesthesia and recovery, changes in systolic and diastolic blood pressure and heart rate were similar in all three groups. The incidence of nausea was similar among the three groups of study while vomiting occurred in 6. 7% of the Meperidine group and 3. 3% of the controls but none in the patients receiving Ondansetron. Ondansetron can effectively reduce post operative shivering