Intravenous versus perineural dexmedetomidine as adjuvant in adductor canal block for total knee arthroplasty / 대한마취과학회지

Background@#The shivering effect after spinal anesthesia in total knee arthroplasty (TKA) is challenging for anesthesiologists. This study aimed to compare two administration routes of dexmedetomidine as a post-neuraxial shivering prevention measure and an adjunctive analgesic and sedative agent. @*Methods@#Fifty-six patients were randomly allocated into two equal groups. The intravenous dexmedetomidine (IV dex) group received an IV infusion of 0.5 µg/kg dexmedetomidine diluted in 20 ml saline and an adductor canal block (ACB) consisting of 20 ml of 0.25% levobupivacaine and 1 ml saline. The adductor canal block dexmedetomidine (ACB dex) group received a 20 ml IV infusion of saline and an ACB consisting of 20 ml 0.25% levobupivacaine and 1 ml of 0.5 µg/kg dexmedetomidine. @*Results@#The incidence of shivering 1 h post spinal anesthesia was equal in both groups (50%); however, the shivering grade was significantly lower in the IV dex group 1 h postoperatively. The onset of sensory block was significantly later in the IV dex group (22.14 ± 2.52 min) than in the ACB dex group (12 ± 3.31 min). Postoperative analgesic duration (h) was significantly longer in the ACB dex group (12.28 ± 4.47) compared to the IV dex group (9.28 ± 1.90). The sedation scores were also significantly higher in the IV dex group in the preoperative, intraoperative, and immediate postoperative periods. @*Conclusions@#While perineural ACB dexmedetomidine had similar intraoperative anti-shivering with less sedative effects as IV dexmedetomidine, it was associated with both less shivering control and superior analgesia post-TKA under spinal anesthesia.

Reconstruction of the Long Process of the Incus by Use of Glass Ionomer Cement: Our Experience

Abstract Introduction Chronic suppurative otitis media is one of the most common causes of reversible conductive hearing loss which can lead to necrosis of the ossicles. The incus, especially its long process, is the most common ossicle affected. Objectives The present study aims to assess the use of glass ionomer cement for the reconstruction of the long process of the incus. Methods The present study was conducted on 27 patients with chronic suppurative otitis media with central perforation with dry and quiescent ears with an eroded long process of the incus submitted to tympanoplasty. The audiological evaluations were done on all patients, including preoperative and postoperative evaluation of the airbone gap; the average pure tone threshold was done 6 months postoperatively. Results The average air pure tone threshold was 42.8 dB preoperatively and 22.5 dB postoperatively. The postoperative air pure tone thresholds were significantly smaller than the preoperative values (p < 0.01). The air-bone gap was 30.5 dB at 500 Hz, 31.6 dB at 1 KHz, and 24.1 dB at 2 kHz preoperatively, and 7.7 dB at 500 Hz, 7.2 dB at 1 KHz, and 7.1 dB at 2 kHz postoperatively at the end of 6 months of follow-up. There were significant hearing gains in the air-bone gap (p < 0.001). Conclusion Glass ionomer cement is a useful and effective material for bridging the defect of the long process of the incus.

Correlation study of [CMV] in the presence of [HCV] and/or [HBV] in hepatocellular carcinoma [HCC] patients

The involvement of CMV in hepatocellular carcinoma [HCC] is not totally defined till now. The aim of this work is to study the prevalence of CMV in HCC patients and its correlation to hepatitis B virus [HBV] and hepatitis C virus [HCV] related HCC carcinogenesis. Forty hepatic disease patients were involved 10 [25%] of them were Not suffering from HCC and 30 with HCC [75%] and its complications. Different investigations have been measured in serum of all patients concerned to liver complications. These measurements were HCV RNA and HBV DNA both using Real- Time PCR technique. CMV, AFP and ANA using ELISA technique. Finally SGOT and SGPT using conventional clinical analysis techniques. Concerning HCC +ve patients 73.4% of them were CMV -ve and 26.6% were CMV +ve, while 16.7% of them were HCV -ve and 83.3% were HCV +ve and 50% of them were HBV -ve and HBV +ve. Concerning HCC -ve patients 80% of them were CMV -ve and 20% were CMV +ve, while all were HCV -ve and HBV -ve. High AFP concentration was observed in 93.4% of HCC +ve patients. In conclusion both HBV and HCV and AFP were found to be highly specific risk factors in HCC patients [P< 0.0001], while CMV viral activities were not a risk factor to HCC patient [P< 0.673]

new validated HPTLC method for quantitative determination of 1, 5-dicaffeoylquinic acid in Inula crithmoides roots

1, 5-Dicaffeoylquinic acid [1, 5-DCQA], a potent HIV-1 integrase inhibitor, is currently undergoing an evaluation as a promising novel HIV therapeutic agent. This work aims at developing an accurate, rapid, repeatable and robust HPTLC method for the determination of 1, 5-DCQA in its natural sources. 1, 5-DCQA is the major component of the n-butanol fraction, the most biologically active hepatoprotective fraction, of Inula crithmoides roots extract. Thus, it will be of interest to evaluate the plant roots as a potential source of 1, 5-DCQA using a fully validated HPTLC method. The percentage of 1, 5-DCQA in the studied plant [0.035% w/w] was found to be approximately similar to those previously determined in other antioxidant herbal drugs, in which 1, 5-DCQA is the main phenolic constituent. The results obtained showed that the described HPTLC method is suitable for routine use in quality control of herbal raw material, extracts and pharmaceutical preparations containing 1, 5-DCQA. No HPTLC method has been reported in literature for the determination of 1, 5-DCQA in medicinal plants

Hypertension and dyslipidemia in type 2 Diabetes Mellitus: a record based study

In United Arab Emirates [UAE], the prevalence of Diabetes Mellitus was 19.6% in 1998-2000. Co-morbidity with Hypertension [HT] and Dyslipidemia [DL] increases the probability of cardiovascular complications, and hence the importance of control of all these conditions. The purpose of the present study was to study the distribution of HT and DL in patients with type 2 Diabetes Mellitus [DM] and their control. Source of data was the records of one private and one government hospital in Northern Emirates, UAE. 294 patients with type- 2 DM, who attended the hospitals from September to November, 2009 were included. A checklist was used for collection of data. Relevant data were collected from the records, entered on Microsoft Excel spreadsheet and analyzed using PASW 17.0 statistics. Proportions and Chi-square tests were used for assessing the co-morbidity of DL and HT, and control of DM with respect to socio-demographic variables. Of the total DM patients, 50.7% were males, 95% married, 76.5% of Middle East origin and only 12.6% were paying patients. The most common [49%] age group was 40- 59 years. 8.6% of the DM patients did not have DL or HT, 69.6% had DL, 88% had HT, and 66.1% had both. There was a statistically significant [p<0.05] association between age and DL and nationality and DL, but not with HT. Duration of DL and HT were similar to that of DM. only 32% had DM under control. As for control of DL, 60.2% had triglyceride under control, 59.5% LDL and 7.4% HDL, 39.3% had systolic and 52.7% diastolic blood pressure under control. Co-morbidity with HT and DL is found to be high in the patients with type -2 DM. The poor control of all three conditions highlights the importance of all levels of prevention to reduce the risk of cardiovascular complications

Comparison of some heavy metal levels of round sardinella [Sardinella Aurita], dusky spinefoot [Siganus luridus] and Atlantic lizardfish [Synodus saurus] from Mex bay in Alexandria

Heavy metal [Cd, Cr, Cu, Cr, Pb, and Hg] concentrations in the muscle and liver of three fish species Round sardinella [Sardinella aurita], Dusky spinefoot [Siganus luridus] and Atlantic lizardfish [Synodus saurus] from Mex bay in Alexandria were measured and the relationships between fish size [length and weight] and metal concentrations in the tissues were investigated by linear regression analysis. Metal concentrations [as microg g-1 w. wt.] were highest in the liver and lowest in the muscle of all the fish species. Highest concentrations of Cd [0.36] and Cr [8.04] were measured in liver tissues of S. saurus and S. luridus, respectively. The liver of S. saurus showed strikingly high Cu concentrations [11.6]. Results of correlation coefficient showed that, except in a few cases, significant relationships between metal concentrations and fish size were negative. Highly significant [P<0.001] negative relationships were found between fish length and Cd concentrations in the liver of S. luridus and S. saurus, Cr concentrations in the muscles and liver of S. luridus and liver of S. saurus and Cu concentrations in the liver of S. saurus is and muscles of S. luridus. Cu and Hg concentrations in the liver of S. aurita also showed very significant [P<0.001] negative relationships. While, very significant [P<0.001] positive relationships found between Cd and Cr in the liver S. luridus and S. saurus, Hg and Pb in the liver of S saurus. The amount of metals consumed weekly calculated for each metal was compared with the provisional tolerable weekly intakes [PTWI]

DNA mutations in the D-Loop control region of the mitochondrial [MT] genome in breast tissues from women with or without cancer

To investigate the potential role of somatic mitochondrial DNA [mtDNA] mutations in tumorigenesis, the occurrence of mutations in mtDNA of breast carcinoma was studied. We chose to focus on the D-Loop [displacement loop] control region, which contains the L-strand [light strand] promoter, an mtTF1 binding site and the mt3 H-strand [heavy strand] control element. Previous studies had suggested that, this region contains an age-dependent mutation hotspot, i.e. T414G transversion. We postulated that if a similar phenomenon occurred in breast tissues, then tissue genotyping at the mtDNA locus might serve as a means of determining the cumulative mutation burden within the tissue independent of a person’s chronological age. To test the hypothesis that mutation frequency in mtDNA in human breast tissues 1] correlate with case versus control status and 2] correlate with age and presumably exposure, we sequenced breast tumors and normal adjacent tissues along with matched blood from 40 cancer cases and normal tissues and matched blood from 23 women without cancer. Unlike predicted, we found no evidence of T414G mutation, even in older women. We observed 7 other homoplasmic mutations in this region with a higher frequency in tissue samples from cancer cases than those in controls. Most of these mutations were T to C or C to T transitions, but one represented a differential length of CA repeats. No age dependency was observed in the occurrence of these mutations. While many mutations detected in tumors were also present in normal adjacent tissues, the mutation profiles were different in breast tissues and peripheral lymphocytes. These observations suggest that mutations in the D-loop region of the mtDNA in human breast tissues are not an age-dependent phenomenon, but rather reflect genomic instability in tumorigenesis

Evaluation of the immune response in patients with chronic HCV infection

The imbalance in the cytokine production by the hepatitis C viral [HCV] infection might contribute to the chronicity of liver inflammation with subsequent progression to hepatocellular carcinoma [HCC]. The current study was performed to evaluate the immunomodulatory effects of HCV infection of normal donor peripheral blood mononuclear cells [PBMC] as well as in patients with chronic HCV infection and patients. The study included 363 subjects [group 1] with chronic liver disease and 40 healthy control subjects [group 2]. Of group 1, three hundred and thirty seven patients were HCV Ab positive as was measured by HCV enzyme immunoassay [EIA] version 3.0. Only 250 patients had HCV RNA in their sera as evidenced by polymerase chain reaction [PCR]. Of the PCR positive patients, sixty-eight patients were further as a representative subgroup, 68 HCV RNA positive patients were subjected to HCV subjected to quantitative branched DNA assay, 12 patients had high viremia, 33 had moderate viremia and 23 had low viremia. All patients were subjected to lL-4, IL-1Beta, and TNF-alpha estimation by ELISA viremia. All subjects were subjected to IL-4, lL-1Beta, and TNF-alpha estimation by EIA. Group 1 showed a significant increase in serum levels of TNF-alpha, lL-4 and ALT, and lowered levels of IL-1Beta and albumin compared to Group 2. Within group 1, HCV RNA positive patients demonstrated increased levels of lL-4 and ALT, and decreased levels of IL-1Beta and albumin compared to Nov RNA negative patients. TNF-alpha levels showed insignificant change among between both subgroups. Treatment of phytohaemaggiutinin [PHA]-stimulated normal donor-PBMC with pelleted virus led to decrease in their rate of proliferation [as determined by H3. Thymidine uptake] in a dose response manner. This response was partaliy reversed after addition of HCV RNA positive patients’ sera. To conclude, HCV infection leads to imbalance of cytokine release with predominance of Th2 cytokines over Th1, which was evident from the increased levels of IL-4, and the decreased levels of lL-1beta in patients' sera infected with HCV