Effects of low dose propofol on inflammatory responses to lipopolysaccharide-induced shock in conscious rats

Acute kidney injury [AKI] is a major culprit of mortality in endotoxemia. Propofol has been commonly used in critically ill patients for sedation. This experiment attempted to elucidate the effects and possible mechanisms of propofol on AKI induced by endotoxin shock. Expermentations were carried out wing anesthetized, ventilated rats and isolated perfused kidneys. Endotoxemia was induced by intraperetoneal [i.p] injection of lipopolysaccharide [LPS, 15 mg kg-1]. Subhypnotic dosage of propofol [40 mg/kg] was injected by i.p. route to study its action on LPS induced-endotoxemia in rats. The rats were randomly assigned into five groups of 8 rats each [FIG: 1]. Kidney pathology was evaluated to quantify the kidney injury score. Plasma tumor necrosis factor alpha, [TNF alpha] and interleukin-10[IL-10] were examined. Post treatment of propofol at low or high dose attenuated or prevented the extent of Am. It also reduced the plasma level of TNF alpha, and IL-10. Our results suggest that propofol exerts protective effect on the endotoxin-induced AKI. In addition, propofol abrogates the microvascular leakage of water and protein in the kidneys. The results imply that the use of propofol in critically ill is not only for sedation, but also useful for the prevention of inflammatory progression and organ damage

Relation between visfatin, insulin resistance and androgen levels in women with polycystic ovary syndrome with and without clinical hyperandrogenism running title: visfatin and polycystic ovary syndrome

Background: Polycyhc ovary syndrome PCOS is the most common cause of infertility due to anovulation. PCOS patients are at a higher risk of developing type 2 diabetes mellitus and cardiovascular disease. Controversial results were reported regarding levels of visfatin among PCOS patients

Objectives: the aim of the present study was to investigate serum visfatin, testosterone and insulin resistance and the association between these parameters in PCOS patients with and without clinical hyperandrogenism

Subjects and Methods: A total of forty PCOS patients and twenty age BMI-matched overweight healthy control subjects were enrolled in this study. PCOS patients were further divided according to the presence or the absence of clinical hyperandrogenism. Serum visfatin, testosterone, insulin and glucose were measured and the homeostasis model assessment of insulin resistance [HOMA-IR] was calculated

Results: PCOS patients had higher levels of visfatin, testosterone and HOMA-IR compared with the controls. Positive correlation was seen between insulin and testosterone in PCOS patients. PCOS patients with clinical hyperandrogenism had relatively higher levels of visfatin, testosterone and HOMA-IR compared with those without clinical hyperandrogenism. Furthermore, serum visfatin positively correlated with serum insulin and testosterone in PCOS patients with clinical hyperandrogenism, but not in those without clinical hvperandrogenism

Conclusion: There are strong relationships between visfatin and hyperinsulinemia, and hyperandrogenism. Further investigation is needed to elucidate the molecular mechanism behind these relationships

Insulin resistance and cognitive impairment in type II diabetes mellitus

Background: Type II Diabetes mellitus [DM] is a metabolic disorder that is characterized by high blood glucose because of the insulin resistance. Significant 1 more interest has been dedicated to the effect of type II diabetes on the brain. Along with cerebrovascular disease, type II diabetes is implicated in the development of other neurological co-morbidities

Aim of the work: To study cognitive functions in type II DM and the effect of insulin resistance on it

Subjects and methods: In the present study, cognitive function tests were done for 37 subjects; control [n= 17], type II DM [n= 20]. These tests include mini mental state examination [MMSE], Wechsler adult intelligence scale [WAIS], Wechsler memory scale [WMS] and Cognitive Event related potential [P300]. Circulating levels of glycosylated haemoglobin [HbA[1c]] and insulin were determined in venous blood samples of both groups

Results: MMSE was significantly lower in type II DM than control group [p-value = 0.034]. However no significant difference between type II DM and control group in WAIS and WMS except in visual reproduction [p-value = 0.048]. P300 latency was significantly longer in type II DM than controls [p- value 0.0001]. P300 amplitude was decreased significantly in type II DM than controls [p-value= 0.0001]. HbA[1c] and insulin was significantly higher in type II DM than controls [p-value= 0.0001]

Conclusion: type II DM is associated with cognitive impairment which may be due to insulin resistance

preemptive value of oral clonidine and gabapentin on morphine consumption by patient controlled analgesia after conservative breast surgery

This randomized, double-blinded placebo-controlled study was designed to assess the effect of oral clonidine and oral gabapentin on the postoperative patient controlled analgesia by intravenous morphine concerning dose, duration of analgesia, hemodynamic changes and side effects. Sixty female patients were undergoing elective conservative breast surgery under general anaethesia. The patients were randomized to three groups: Clonidine group received oral 5ug/kg, Gabapentin group received oral 300 mg and control group received placebo tab. The medications were given 90 min before surgery. The following parameter were measured:, heart rate, mean arterial pressure, oxygen saturation, pain intensity, the total dose of morphine consumption, nausea and vomiting was recorded. In the clonidine group, there was significant reduction of morphine consumption versus gabapentin and control groups [15.9 +/- 4.6], [25.3 +/- 2.2] and [32.2 +/- 3.5] respectively [P<0.005]. The VAS pain score was significantly lower in clonidine group in comparison to gabapentin and control group throughout the all periods of the study [P<0.005]. There was decrease in HR and MABP in the three studied groups all over the period of the study and this reduction is not significant but in between the three studied groups and between clonidine and gabapentin and between clonidine and control groups there was significant difference in mean arterial blood pressure at 6 hours only [P<0.005]. As regard to the incidence of nausea and vomiting there was insignificant difference in between the three studied groups but there was significant difference between the control group and other two groups. Preemptive oral clonidine was better than oral gabapentin as regard to postoperative morphine consumption, the quality of analgesia and hemodynamic effects. On the other hand, oral gabapentin drug was less of value in management of acute pain

Effect of haemodilution by intravenous crystalloids on coagulation system in surgical breast cancer patients

Aside from the efficacy of a specific solution, possible side-effects have become an increasing concern. One of the most important issues for assessing the optimal intravascular volume replacement strategy is the influence on the haemostatic process and subsequent influence on bleeding or the development of thrombosis. The aim of our study is an assessment of the effects of intravenous fluid administration especially crystalloids during operation in a progressive manners [progressive haemodilution] on coagulation system in cancer patients [breast cancer]. 36 female patients scheduled for breast cancer surgery above 18 years, weight ranged from 50-70 kg, ASA physical state I or II were included in the study and exclude all anaemic patients, patients with abnormal preoperative coagulation data. Patients were divided into 3 groups according to degree of haemodilution depending upon their haemodynamic stability: Group A [12 patients]: volume infused to them up to 500 ml saline 0.9%, Group B[12 patients]: received 1000 ml and Group C[12 patients]: received 1500 ml. All patients received general anaesthesia and continuously monitored with ECG, central venous pressure [CVP], non invasive blood pressure and pulse oximetry in each group during the period of surgery and the first 24hours postoperatively. Blood samples taken before surgery, after induction of anaesthesia, after the end of fluid infusion, after surgery, 5 hours, 12 hours and 24 hours postoperatively and the following parameter was measured complete blood picture, prothrombin time, prothrombin concentration, International normalized ratio [INK], activated partial thrompolastin time [a PTT], fibrinogen, fibrin degradation product [FDP], factor VIII, antithrombin III [AT III] and thrombin antithrombin complex [TAT]. The present study demonstrate no significant difference in white blood cell count, haematocrite value or platelet count apart from slight reduction in platelet count in between group A and B, while there is a steady decrease in red blood cell count [RBCs] and haemoglobin concentration [Hb] in the same group and in between the three groups. There was significant increase in prothrombin time, activated partial thromboplastin time and international normalized ratio [INR] in group A, while in groups E and C shows increase in prothrombin time and INK Prothrombin concentration was significantly decreased in the three groups. Fibrinogen concentration was significantly deceased in the same group and in between groups. Factor VIII concentration shows no significant difference in the same group and in between groups. Also, in AT III concentration shows slight reduction in it but no significant difference in the same group and in between groups. Fibrin degradation product [FDP] show no significant difference in the same group and in between groups, while the concentration of thrombin antithrombin complex [TAT] in our study shows significant increase in group A and C but in between groups there were no significant changes. The relationship between haemodilution thrombosis and haemostasis is probably more complicated than we used to believe. We found limited crystalloids administration with slow rate of infusion during surgery is beneficial for patient postoperative coagulation. Intravenous fluid administration, while being routine therapy for patients in operating rooms, may be harmful used in rapid fluid loading

effect of intraoperative use of esmolol and nicardipine on splanchnic perfusion in functional endoscopic sinus surgery

There are many techniques for reduction of mean arterial blood pressure [MAP] and heart rate [HR] during anesthesia. We designed this prospective, randomized, double-blinded study to test the effect of this technique for maintaining hemodynamic stability during general anesthesia and their influences on splanchnic perfusion. Sixty healthy consenting patients undergoing functional endoscopic sinus surgery [FESS] were randomly assigned to 1 of 3 treatment groups: Group I [control n = 20] received normal saline 5 mL and 1 mL, followed by a saline infusion at a rate of 0.005 mL kg[-1] min[1]; Group 2 [n = 20] received esmolol 50 mg and saline 1.mL, followed by an esmolol infusion 5 micro g kg[-1] min[-1]; and Group 3 [n = 20] received esmolol 50 mg and nicardipine 1 mg, followed by an esmolol infusion 5 micro g kg[-1] min[-1]. The study drugs were administered after the induction of anesthesia with fentanyl 1.5 micro g/kg, and propofol 2 mg/kg IV. Tracheal intubation was facilitated with vecuronium 0.12 mg/kg IV. Anesthesia was initially maintained with sevoflurane 2% end-tidal and N[2]O 50% In oxygen in all 3 groups. After induction of anesthesia a gastric tonometer [TRIP] NGS Catheter and a radial catheter were inserted. Baseline values of gastric intramucosal pH [pHi] were determined before induction of hypotension. The [pHi] values were calculated every 30 min until hypotension was discontinued .The CO2 -gap [i.e., the difference between arterial and gastric Pco2] was registered. Arterial blood lactate levels also were measured. During surgery, the mean arterial blood pressure [MAP] was maintained within +/- 15% of the baseline value by varying the study drug infusion rate and the inspired concentration of sevoflurane. In addition to MAP and heart-rate values, were recorded throughout the perioperative period. Recovery times and postoperative side effects were assessed. None of the [pHi] values calculated was less than 7.35 in the three studied groups. Arterial blood lactate levels did not increase in any of the patients. Compared with the control group, adjunctive use of esmolol and nicardipine attenuated the increase in heart rate [in Group 2] and MAP [in Group 3]. after tracheal intubation. Furthermore, the use of an esmolol infusion as an adjunct to sevoflurane to control the acute autonomic responses during the maintenance period significantly decreased emergence times [4 +/- 2 versus 7 +/- 4 min], decreased the need for postoperative opioid analgesics [35% versus 60%], and reduced the time before discharge [209 +/- 89 versus 269 +/- 100 min]. We conclude that the adjunctive use of esmolol alone or in combination with nicardipine during the induction of anesthesia reduced the hemodynamic response to tracheal intubation. It did not compromise splanchnic tissue oxygen balance in healthy patients nor increased blood lactate. Furthermore, use of an esmolol infusion as an adjuvant to sevoflurane- N[2] O anesthesia for controlling the acute hemodynamic responses during the maintenance period improved the recovery profile after functional endoscopic sinus surgery

Elevation of liver enzymes after laparoscopic cholecystectomy versus open cholecystectomy

Laparoscopic cholecystectomy [LC] has been accepted as an alternative to laparotomy, and has become the standard treatment of benign gall bladder diseases. However, it has been noticed that following LC, the serum level of certain liver enzymes rises markedly, in patients who had preoperatively normal liver enzyme value. We measured serum values of hepatic alcohol dehydrogenase [AD] and glutathione S-transferase [GST] alanine aminotransferase [ALT] and aspertase aminotransferase [AST], in 80 patients who underwent open cholecystectomy or laparoscopic cholecystectomy, they were divided randomly into two groups. Group 1[40 patients] underwent laparoscopic cholecystectomy [LC]. Group 11[40 patients] underwent open cholecystectomy [OC]. To assess the liver function, serum liver enzymes of AD, GST, ALT, and AST were measured before operations and at 1, 3, 7, and 10 days postoperative. Pre operative AD, GST, ALT, and AST were insignificantly different between the two groups. Twenty four hours after the procedure. AD, GST, ALT and AST increased significantly in the LC group [AD 8.1 +/- 2.2 U/L, GST 82.2 +/- 19.1 U/L, ALT 87.1 +/- 24.2 U/L, and AST 95.1 +/- 7.7 U/L but in [OC] group these enzymes were [AD 4.8 +/- 1.9 U/L, GST 35.3 +/- 3.9 U/L, ALT 27.8 +/- 11.9 U/L, and AST 5.3 +/- 0.9 U/L]. A further increase in serum AD, GST, ALT and AST value in LC group at the 3 [rd] day after the operation [AD 9.3 +/- 1.5 U/L, GST 103.5 +/- 21.6 U/L, ALT 99.3 +/- 19.4 U/L, and AST 120.9 +/- 10.4 U/L] but in [OC] group these enzymes were [AD 5.6 +/- 3.4 U/L, GST 47.9 +/- 1.4 U/L, ALT 38.6 +/- 3.4 U/L, and AST 17.9 +/- 1.4 U/L]. Slow return to normality occurred 7-10 days after the procedure in the LC group. Alterations in hepatic function occur after LC and appear to be clinically insignificant. These alterations in hepatic function return to normal levels within ten days. CO2 pneumoperitoneum seems to be the main reason for these changes but other factors may also contribute

Rickets among children of a coastal area of Bangladesh.

Many children with rachitic deformities have been reported in southern coastal area of Bangladesh but the actual rate of prevalence was not known. A survey was conducted to determine the magnitude of rachitic problem among the children of Chakaria thana of Cox's Bazar district of Bangladesh. Nine hundred children between 1-15 years selected randomly from 30 villages of total 340 villages. Face to face interview of the parents was taken and the children were examined for evidences of rickets. Serum calcium, phosphorus, alkaline phosphatase (ALP) were estimated and radiology of limbs were done in all clinically suspected cases and in a control of every eighth child. Seventy eight children (8.7%) had physical features suggestive of rickets. Fifty eight (6.4%) children had 'clinical rickekts' (positive physical feature(s) but normal ALP and negative radiology), 12 (1.3%) children had 'biochemical rickets' (positive physical features and raised ALP but negative radiology) and 8 (0.9%) children had 'confirmed rickets' (positive physical features, raised ALP and positive radiology). Out of 78 children with rachitic feature(s), Pectus carinatum was found as the most common clinical feature in 26 (33.3%) children followed by genu valgum in 23 (29.4%) cases. Twenty two normal children (2.2%) had raised level of ALP (>300U/L). The prevalence of rickets is high in children of Chakaria and further study is needed to find out the exact aetiology of rickets in children there.

Effects of melatonin on blood cells

Daily subcutaneous injection of melatonin in a dose of 200 ug [0.5 ml] for seven days in one group of rats and for twenty-one days in another group produced an increase in the total number of WBCs, neutrophils, lymphocytes, eosinophils and basophils. These changes were marked in the twenty-one days treated group of rats. In seven days treated group, melatonin produced an increase in RBCs count and PCV% associated with a decrease in MCH and MCHC. In twenty-one days treated group, melatonin decreased PCV, Hb, MCV, MCH and MCHC. These findings suggested an immunostimulatory role for melatonin

Effect of melatonin on the initiation and growth of mammary tumors in female rats

The effect of the pineal hormone, melatonin, on the development of mammary tumors in rats treated, with 7, 12 dimethlbenz [a] anthracene [DMBA] was investigated. Daily subcutaneous treatment of melatonin [250 micro g] into female rats, previously injected with single dose [10 mg] of DMBA, prevented the appearance of any preneoplastic lesions in 30% of rats treated for three months. Melatonin treatment for six months prevented the appearance of pathological lesions in 20% of rats. It also prevented the appearance of adenocarcinoma, in 83, 33% of treated rats. Also, the preneoplastic changes in the remaining rats were prevented and improved by different values after melatonin treatment for three and six months. In addition to preventing and modifying tumor growth, melatonin decreased significantly serum prolactin, estradiol, and progesterone in these animals. Moreover it has been shown that the effect of melatonin after six months was more marked than after three months in both tumor growth and hormonal levels especially prolactin and estradiol which were claimed to be an important factor in the development of cancer breast

Effect of non Hodgkin's lymphoma [NHL] in children on serum ferritin and iron status

To detect the effect of Non Hodgkin 's lymphoma [NHL] on serum Ferritin and iron status in children, serum level of ferritin, iron total iron binding capacity and percentage of transferrin saturation were studied in 17 [10 male and 7 female] children with NHL as well as 10 [6 male and 4 female] healthy children who served as controls. NHL children showed significantly increased ferritin, iron and% of transferrin saturation together with significant decrease of total iron binding capacity compared with control children. After chemotherapy, serum ferritin exhibited a further significant increase. The high concentration of circulating ferritin seemed to be related to increased synthesis by tumor cells. The further increase after therapy could be attributed to cell injury by chemotherapeutic agents. Significant positive correlation was observed between serum ferritin and the number of circulating lymphocytes, serum iron and% of transferrin saturation in NHL children. However, no significant correlations were found between serum ferritin levels and blood haemoglobin concentration, mean corpuscular volume [MCV] and mean corpuscular haemoglobin concentration [MCHC] or the number of units of blood transfusions used during therapy. The levels of serum iron and% transferrin saturation did not correlate with number of units of blood transfusions used during therapy. The changes in iron concentration could reflect iron overload developing on top of increased requirements for iron by the growing tumor cells. Thus, ferritin could not function as a tumor marker in these children

Effect of caffeine on movements of the small intestine isolated from male rabbits

Caffeine [Caffeine-Sodium benzoate in doses of 0.6, 0.9 and 1.2 mg in 0.1 ml distilled water stimulated the amplitude of intestinal movements isolated from mature male rabbits. His stimulation increased with gradual increase in caffeine dosage. On the other hand, a small dose of caffeine [0.3 mg in 0.1 ml distilled water] was without effect on intestinal - movements while larger doses of caffeine [1.8 and 2.4 mg in 0.1 ml distilled water] decreased these movements. Avil [Pheniramine hydrogen maleate] which is a histaminic antagonist in a dose of 4.55 mg in.1 ml distilled water antagonized the effect of caffeine on the amplitude of intestinal movements, while other antagonists [atropine as anticholinergic drug and indomethacin as a prostaglandin inhibitor] failed to antagonize the effect of caffeine on isolated intestinal movements. These results led to the conclusion that caffeine acts through the release and potentiation of action of histamine on intestinal movements

Studies on testosterone level in female mature rabbits

This work was done to investigate the presence and origin of testosterone [T]T in the plasma of female mature rabbits. T was found to be present in a concentration of 0.129 ng/100 ml plasma. Intravenous [IV] injection of human chorionic gonadotropin [HCG] in a dose of 1000 IU resulted in a significant increase [P < 0.001 and P < 0.05] in plasma T level I and 6 hours after HCG injection. The level returned to the control value 10 hours after the injection. To study the origin of T in female rabbits bilateral ovariectomy was done in one group of rabbits and bilateral adrenalectomy was done in another group. In both groups, plasma T level significantly decreased [P < 0.05 and P < 0.001] 2 and 4 hours respectively after the operation. This indicates that both the ovaries and adrenals are important source for T production in mature female rabbits

Changes in ionic composition and O2 consumption of skeletal muscle in chronically alcoholic rabbits

Ingestion of ethanol [1.36 gm/kg BW] twice daily by mature male rabbits for period of 28 days produced significant increase in skeletal muscle Na+ and Ca++ and significant decrease in its K+ contents compared with the control group. Serum levels of these ions did not show any significant changes. O2 consumption of skeletal muscle and liver was significantly decreased compared with that of the control. Serum lactic dehydrogenase enzyme showed significant increase than the control. Rabbits receiving isocaloric amount of glucose did not show any significant change in their muscle ion content, serum ion level and serum lactic acid dehydrogenase enzyme. The results indicated that ethyl alcohol might induce muscle damage. This could be proved by decreased K+ and increased Ca++ contents in the muscle, decreased O2 consumption of the muscle and increased serum lactic acid dehydrogenase enzyme

Hemodilution and autotransfusion in pediatric cardiac surgery

Better understanding and advances in the management of neonates undergoing cardiac surgery have increased their survival. Twenty neonates were studied to evaluate the technique of acute hemodilution in open cardiac surgery. They were premedicated by rectal barbiturate, anesthetized and monitored for all vital signs and blood chemistry. Patients operated upon with hemodilution suffered less respiratory acidosis during bypass. They showed marked drop in pH which was rapidly corrected in the postoperative period. No significant change in blood pressure from the expected was observed. These neonates [with hemodilution] had more tendency to fluid retention, which is not of appreciable clinical significance. The technique of acute hemodilution in neonates undergoing open cardiac surgery with extracorporeal circulation proved to be successful