The impact of caudally administrated tramadol on immune response and analgesic efficacy for pediatric patients: a comparative randomized clinical trial

BACKGROUND: Immune responses appear to be affected by anesthetics and analgesics. We investigated the effects of caudal tramadol on the postoperative immune response and pain management in pediatric patients. METHODS: Sixty ASA-I pediatric patients aged 3–10 years undergoing lower abdominal surgery. Patients were randomly assigned either to a caudal bupivacaine (0.25%) group (group B), or a group that received caudal tramadol (1 mg/kg) added to the bupivacaine (0.25%) (group T). Both were diluted in a 0.9% NaCl solution to a total volume of 1ml/kg. The systemic immune response was measured by collecting blood samples preoperatively, at the end of anesthesia, and at 24 and 72 hours postoperatively, and studied for interleukin IL-6, C-reactive proteins (CRP) cortisol levels, and leucocytes with its differential count. Postoperative pain was assessed along with sedation scales. RESULTS: Postoperative production of IL-6 was significantly higher in group B at the end of anesthesia, than at the 24th hour, and at the 72nd hour in group B and group T, respectively. The immune response showed leukocytosis with increased percentages of neutrophil and monocytes, and a decreased lymphocyte response rate within both groups with no significant differences between the groups. Cortisol and CRP were significantly higher in group B. CONCLUSIONS: Adding tramadol to a caudal bupivacaine block can attenuate the pro-inflammatory cytokine response, Cortisol, and CRP in children undergoing lower abdominal surgery.

Diabetes Health Profile-18 is Reliable, Valid and Sensitive in Singapore

<p><b>INTRODUCTION</b>The Diabetes Health Profile-18 (DHP-18) measures diabetes-related psychological well-being in patients with type 2 diabetes mellitus (T2DM). It includes 3 subscales: psychological distress (PD), barriers to activity and disinhibited eating. The psychometric properties of the DHP have not been evaluated in Asia. The aim of this study was to determine the psychometric properties of the DHP in multiethnic Singapore.</p><p><b>MATERIALS AND METHODS</b>Patients between the ages of 18 to 65 diagnosed with diabetes (either type 1 or type 2) for at least 1 year were recruited from a diabetes outpatient clinic in a tertiary hospital. They completed a set of self-administered questionnaires including sociodemographic information and the DHP. Validity of the DHP was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Reliability was assessed with internal consistency and sensitivity was determined by effect size, associated with detecting a statistically significant and clinically important difference between various patient subgroups.</p><p><b>RESULTS</b>A total of 204 patients with mean age 45.4 (11.9) years, comprising 64% males and 50% Chinese, 27% Indian and 12% Malay were studied. In CFA, model fit was poor. Forced 3-factor EFA supported the original 3-factor structure of the DHP. Convergent and discriminant validity was demonstrated (100% scaling success). DHP was sensitive across majority of social demographic, clinical and social-functioning determinants (i.e., effect size >0.3). Cronbach's alpha exceeded 0.70 for all subscales. Ceiling effects were negligible but large floor effects were seen for the PD subscale (23%).</p><p><b>CONCLUSION</b>The DHP is valid, reliable and sensitive for measuring well-being in Asian patients with T2DM.</p>

Nanoparticles improved drug radio protective activity.

Radioprotective agents are synthetic compounds or natural products that are immediately administrated before irradiation to reduce injuries caused by ionizing radiation. Toxicity, short duration, and the unfavorable routes of administration, have prevented the widespread use of most radioprotective agents in practice. This study aimed to evaluate the use of slowly release- long circulation biodegradable polymer Poly(lactide-co-glycolide) (PLGA) as carrier for certain water-soluble radioprotective agents. Penicillamine and Potassium Iodide (KI) were selected as examples of radioprotectors which can be used to protect against both internal radionuclide (chronic radiation exposure) and external-beam irradiation (acute radiation exposure). Emulsion-solvent evaporation method (ESE) was used to prepare hydrophilic-drug loaded PLGA Nanoparticles (PLGA- NPs) in an efficient and reproducible manner. The radioprotective efficacy was assessed by 30 days-survival percentage, relative body weights, and (liver & spleen) total cell counts. Results revealed that single oral administration of Penicillamine-NPs or KINPs was effective as free drug (for 5 successive days) which indicate that PLGA-NPs could be used to modulate radioprotective drug activity in biological system, and to improve drug efficacy in different body organs for longer duration than the equal dose of free drug.

Intravenous versus topical tranexamic acid for pediatric open cardiac surgery in cyanotic heart disease

Objective This study was designed to investigate and compare the possibility of reducing postoperative blood requirements by using Tranexamic acid TX either intravenously or topically in pediatric patients with cyanotic heart disease. Study Design Double-blind, r and omized fashion Setting Children's Hospital - Assiut University- Egypt Participants 120 children undergoing repair of cyanotic congenital heart disease. Measurements and Main Results: Patients were r and omized into three equal groups 40 patients in each one; Control C group did not receive either study drug, Intravenous Tranexamic acid ITX group received Intravenous TX 50 mg / kg at the induction of anesthesia followed by infusion of 1 mg/kg/hr. till 6 hours postoperatively while the topical Tranexamic acid group TTX received topical TX 50 mg / kg poured into the precordial cavity before sternal closure. Total blood loss and transfusion requirement within the first 24 hours postoperatively were recorded together with hematocrit percentage, platelet counts and coagulation studies. In addition; chest closure time, duration of mechanical ventilation, length of Intensive Care Unit ICU stay and length of hospital stay were recorded and the occurrence of re-exploration for excess bleeding, or any other thrombotic or adverse events were recorded. Postoperative blood loss during the first 24 h was significantly higher in the C group 29.13 +/- 8.69 ml/kg compared to the other two groups who were treated with Tranexamic acid either intravenously or topically. ITX group patientrecorded less blood loss 13.05 +/- 7.88 ml/kg in comparison to TTX group 17.40 +/- 8.117 ml/kg. The amount of packed red blood cells and Fresh Frozen Plasma FFP transfusion in the first 24 hours administrated were significantly less in the ITX group patients 10.75 +/- 6.53, 12.00 +/- 5.86 ml/kg followed by TTX group patients 12.60 +/- 6.90, 10.50 +/- 6.77 ml/kg compared to control group of patients 25.00 +/- 6.53, 25.95 +/- 8.05 ml/kg. The control group had the largest re-exploration rate. ITX group had the shortest ventilation time, ICU and hospital stay. No significant difference between the three groups as regard the coagulation parameters except for significant lowest level of fibrin degradation product in ITX group. No side effects were recorded among the three groups. Conclusion: Tranexamic acid effectively reduces postoperative blood loss and the need for transfusion of allogeneic blood products in patients with cyanotic congenital heart disease. However, the intravenous regimen seems to be more effective than the topical one. Key words: Pediatric cyanotic heart disease; Tranexamic acid; Postoperative; Blood transfusion