Determinants of visit-to-visit systolic blood pressure variability among Ghanaians with hypertension and diabetes mellitus

Objective: To identify the determinants of systolic blood pressure variability (SBPV) among Ghanaians. Design: We undertook a secondary analysis of data collected in a prospective study Setting: The study involved patients with hypertension and or diabetes receiving care in five hospitals in Ghana Main outcome measures: We assessed determinants of SBPV among 2,785 Ghanaian patients. We calculated the standard deviation (SD) of systolic BP recordings of 3 to 10 visits per patient over 18 months as a measure of SBPV. A multivariate linear regression analysis was fitted to identify factors independently associated with risk visit-to-visit SBP standard deviation. Results: The mean SD of individual patient visit-to-visit SBP overall was 14.8±6.3 mm Hg. Those with hypertension and diabetes had the highest SD of 15.4 ±6.2 mm Hg followed by 15.2 ±6.5 mm Hg among those with hypertension only and then 12.0 ± 5.2 mm Hg among those with diabetes only, p<0.0001. Factors independently associated with SBPV with adjusted ß coefficients (95% CI) included age: 0.06 (0.03 ­ 0.08) for each year rise in age, eGFR -0.03 (-0.05 - -0.02) for each ml/min rise, low monthly income of <210 Ghana cedis 1.45 (0.43-2.46), and secondary level of education -1.10 (-1.69, -0.50). Antihypertensive classes were associated with SBPV, the strongest associations being hydralazine 2.35 (0.03 ­ 4.68) and Methyldopa 3.08 (2.39 ­ 3.77). Conclusion: Several socio-demographic and clinical factors are associated with SBPV. Future studies should assess the contribution of SBPV to CVD outcomes among indigenous Africans and identify actionable targets.

Psychosocial Perceptions as Significant Impact Modifiers - A Mixed Method Research Among Hospitalized Covid-19 Patients in A Tertiary Care Hospital in Coimbatore District, Tamil Nadu

Context: Covid 19 pandemic which evolved in successive waves had profound pyschosocial impact on affected in-dividuals. Perceptions had impact on both individual and environmental level with potential behavioural conse-quences. The aim of the research is to study the psychosocial perception and psychological impact of COVID- 19 among hospitalized COVID-19 patients. Methodology: The study was a mixed method research (Quan-Qual sequential design) conducted in the Covid wards of a tertiary care hospital in Coimbatore district. The psychological impact was assessed us-ing the General Health Questionnaire, Perceived Stress Scale. The results of quantitative analyses and qualitative analyses were expressed as proportions and done using thematic analysis using grounded theory respectively. Results: About 55% of the hospitalized Covid-19 patients had psychological impact. On multivariate analysis, the factors which emerged as independent risk factors for presence of psychological morbidi-ties due to COVID were presence of high stress level, sleep disturbances and their perception of COVID as high threat. Conclusions: Focussed Counselling with specific reference to attend to spiritual health component in addition, would go a long way in diminishing immediate and long-term psychological impact due to covid-19 illness.

Outcomes Following the Use of Angiotensin II in Patients with Postoperative Vasoplegic Syndrome: A Case Series

Catecholamine?resistant postoperative vasoplegic syndrome (PVS) lacks effective treatment modalities. Synthetic angiotensin II was recently approved for the treatment of vasodilatory shock; however, its use in PVS is not well described. We report outcomes in six patients receiving angiotensin II for the treatment of isolated PVS. All patients achieved their MAP goal and the majority showed improvement in lactate and background catecholamine dose; however, variables of perfusion changed discordantly. Three of six patients survived to hospital discharge.

Determinants of COVID-19 vaccine acceptance and hesitancy among healthcare professionals in the Kintampo North Municipality, Bono East Region, Ghana

tives: To assess the determinants of COVID-19 vaccine acceptance and hesitation among Health Care Professionals (HCPs) in the Kintampo North Municipality of Ghana. Design: An analytical cross-sectional study. Setting: The study was carried out in the Kintampo North Municipality. Participants: All health care professionals within the Kintampo North Municipality of Ghana. Main outcome measure: Acceptance of COVID-19 vaccine. Results: In all, 215 HCPs were included in this study. The overall vaccine acceptance was 78.6% among HCPs, while 21.4% were hesitant to receive the COVID-19 vaccine. Majority (57.7%) of HCPs believed that COVID-19 vaccines were safe. The following factors were found to influence vaccine acceptance significantly; those who knew someone who has taken the vaccine (adjusted Odds Ratio [aOR]; 14.9, 95% Confidence Interval [95% CI];5.0-45.0, p<0.001), those who think COVID -19 vaccine in Ghana was safe (AOR;9.2, 95%CI;3.3-25.8, P<0.001), those who said vaccines are effective in controlling COVID-19 transmission (aOR=5.0, 95%CI;2.1-12.4, p<0.001), and those who have never refused vaccines in the past (aOR=7.8, 95CI;1.6-37.8, p=0.01). Conclusion: The study indicated high COVID-19 vaccination acceptability among HCPs. However, some HCPs are hesitant to take COVID-19 vaccinations immediately. Increased adoption of COVID-19 vaccinations among HCPs and the broader Ghanaian population requires concerted efforts, including strengthening public health education on the perceived risks and safety of COVID-19 vaccines

Contemporary prevalence and predictors of anxiety among patients living with HIVAIDS in Ghana

Objectives: To identify the prevalence and associated factors of anxiety in people living with HIV/AIDS in a tertiary centre in Ghana. Design: The study employed a cross-sectional design. Setting: The study was conducted in the outpatient HIV clinic of a tertiary hospital. Participants: Participants were adult PLWHA receiving OPD care, including those established on combined antiretroviral therapy (cART) and newer patients who were not on cART. Four hundred ninety-five participants aged ≥30 years were consecutively enrolled on the study. Interventions: Demographic and clinical data were collected using standard questionnaires and patient files. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression analysis was done to identify associated factors. Main outcome measure: Proportion of PLWHA who had HADS score of ≥8 Results: Overall prevalence of anxiety was 61.0% (95%CI: 56.6 ­ 65.3), with no significant difference between recently diagnosed (≤ 6 months, 64.3%) and those with established diagnoses (>6 months, 59.1%). Urban residence (aOR: 1.67, 95%CI: 1.12 ­ 2.51), alcohol use (aOR: 1.64, 95%CI: 1.13 ­ 2.38) and depression (aOR: 13.62, 95%CI: 7.91 ­ 23.45) were independently associated with anxiety. Conclusion: In this sample, 6 in 10 Ghanaian PLWHA had evidence of anxiety. Liaison with the national mental health service for more comprehensive and integrated care and further research into the mental health of PLWHA is recommended to reduce this high burden of anxiety

Stereoelectroencephalography in Pediatric Epilepsy Surgery

Stereoelectroencephalography (SEEG) is an invasive technique used during the surgical management of medically refractory epilepsy. The utility of SEEG rests in its ability to survey the three-dimensional organization of the epileptogenic zone as well as nearby eloquent cortices. Once concentrated to specialized centers in Europe and Canada, the SEEG methodology has gained worldwide popularity due to its favorable morbidity profile, superior coverage of deep structures, and ability to perform multilobar explorations without the need for craniotomy. This rapid shift in practice represents both a challenge and an opportunity for pediatric neurosurgeons familiar with the subdural grid approach. The purpose of this review is to discuss the indications, technique, and safety of long-term SEEG monitoring in children. In addition to reviewing the conceptual and technical points of the diagnostic evaluation, attention will also be given to SEEG-based interventions (e.g., radiofrequency thermo-coagulation).

Stereoelectroencephalography in Pediatric Epilepsy Surgery

Stereoelectroencephalography (SEEG) is an invasive technique used during the surgical management of medically refractory epilepsy. The utility of SEEG rests in its ability to survey the three-dimensional organization of the epileptogenic zone as well as nearby eloquent cortices. Once concentrated to specialized centers in Europe and Canada, the SEEG methodology has gained worldwide popularity due to its favorable morbidity profile, superior coverage of deep structures, and ability to perform multilobar explorations without the need for craniotomy. This rapid shift in practice represents both a challenge and an opportunity for pediatric neurosurgeons familiar with the subdural grid approach. The purpose of this review is to discuss the indications, technique, and safety of long-term SEEG monitoring in children. In addition to reviewing the conceptual and technical points of the diagnostic evaluation, attention will also be given to SEEG-based interventions (e.g., radiofrequency thermo-coagulation).

Diet containing seeds of Buchholzia coriacea accelerates healing of acetic acid induced colitis in rats

Objective: To investigate the anti-colitic effects of diet containing seeds of Buchholzia coriacea (B. coriacea) on acetic acid induced ulcerative colitis. Methods: Male Wistar rats (70-100 g) were fed with standard diets (control group) or with same diet containing B. coriacea seeds at 12.5% or 25% for six weeks. At the sixth week, colitis was induced by intra-rectal administration of 1 mL/200 g 6% acetic acid. Animals were sacrificed at days 0 (before induction), 1, 3 and 7 post induction to assess disease severity via evaluation of stool consistency, haematological variables and histomorphometry of colon tissues. Results: A significant increase in body weight was observed in the 12.5% B. coriacea fed group compared to the control. B. coriacea significantly reduced stool consistency and microscopic scores. Histological evaluation revealed significantly decreased inflammatory aggregates in B. coriacea fed groups compared to control after colitis induction. There was a significant decrease in packed cell volume, red blood cell and haemoglobin concentration in the control group at day 1 post colitis induction compared to 12.5% B. coriacea fed groups. Neutrophils and white blood cell were also significantly increased after colitis induction in the control group while these were significantly decreased in the B. coriacea fed groups. Conclusions: The addition of B. coriacea seeds to diets promotes healing of acetic acid induced colitis by suppressing infiltration of inflammatory aggregates and ameliorating anemia.

Open intramedullary nailing for segmental long bone fractures: an effective alternative in a resource-restricted environment

Background: Closed, locked intramedullary nailing has been accepted as the gold standard in the care of femoral fractures, with reported union rates as high as 98-100%. Closed, locked intramedullary nailing often requires expensive equipment which is a challenge in developing countries.Segmental long bone fractures are often a result of high-energy trauma and hence often associated with a lot of injuries to the surrounding soft tissues. This consequently results in higher rates of delayed or nonunion. This study was proposed to review the outcome of management of segmental fractures with locked intramedullary nails, using an open method of reduction. Methods: A retrospective analysis was made of data obtained from all segmental long bone fractures treated with intramedullary nailing over a 1-year period. Records were retrieved from the folders of patients operated on from January 2011 to December 2011. Patients were followed up for a minimum of 1 year after the surgery. Results: We managed a total of 12 segmental long bone fractures in 11 patients. Eight of the 12 fractures were femoral fractures and 10 of the fractures were closed fractures. All but one fracture (91.7%) achieved union within 4 months with no major complications. Conclusions: Open method of locked intramedullary nailing achieves satisfactory results when used for the management of long bone fractures. The method can be used for segmental fractures of the humerus, femur, and tibia, with high union rates. This is particularly useful in low-income societies where the use of intraoperative imaging may be unavailable or unaffordable. It gives patients in such societies, a chance for comparable outcomes in terms of union rates as well as avoidance of major complications. Larger prospective studies will be necessary to conclusively validate the efficacy of this fixation method in this environment

High malaria transmission in a forested malaria focus in French Guiana: How can exophagic Anopheles darlingi thwart vector control and prevention measures?

In French Guiana, malaria vector control and prevention relies on indoor residual spraying and distribution of long lasting insecticidal nets. These measures are based on solid epidemiological evidence but reveal a poor understanding of the vector. The current study investigated the behaviour of both vectors and humans in relation to the ongoing prevention strategies. In 2012 and 2013, Anopheles mosquitoes were sampled outdoors at different seasons and in various time slots. The collected mosquitoes were identified and screened for Plasmodium infection. Data on human behaviour and malaria episodes were obtained from an interview. A total of 3,135 Anopheles mosquitoes were collected, of which Anopheles darlingi was the predominant species (96.2%). For the December 2012-February 2013 period, the Plasmodium vivax infection rate for An. darlingi was 7.8%, and the entomological inoculation rate was 35.7 infective bites per person per three-month span. In spite of high bednet usage (95.7%) in 2012 and 2013, 52.2% and 37.0% of the participants, respectively, had at least one malaria episode. An. darlingi displayed heterogeneous biting behaviour that peaked between 20:30 and 22:30; however, 27.6% of the inhabitants were not yet protected by bednets by 21:30. The use of additional individual and collective protective measures is required to limit exposure to infective mosquito bites and reduce vector densities.

Paclitaxel causes electrophysiological changes in the anterior cingulate cortex via modulation of the gamma-aminobutyric acid-ergic system

Objective: The aim of this study was to elucidate any electrophysiological changes that may contribute to the development of neuropathic pain during treatment with the anticancer drug paclitaxel, particularly in the micro-aminobutyric acid [GABA] system

Materials and Methods: One hundred and eight Sprague-Dawley rats were used [untreated control: 43; vehicle-treated: 21, and paclitaxel-treated: 44]. Paclitaxel [8 mg/kg] was administered intraperitoneally on 2 alternate days to induce mechanical allodynia. The rats were sacrificed 7 days after treatment to obtain slices of the anterior cingulate cortex [ACC], a brain region involved in the central processing of pain. Field excitatory postsynaptic potentials [fEPSPs] were recorded in layer II/III of ACC slices, and stimulus-response curves were constructed. The observed effects were pharmacologically characterized by bath application of GABA and appropriate drugs to the slices

Results: The paclitaxel-treated rats developed mechanical allodynia [i.e. reduced withdrawal threshold to mechanical stimuli]. Slices from paclitaxel-treated rats produced a significantly higher maximal response [Emax] than those from untreated rats [p < 0.001]. Bath application of GABA [0.4 microM] reversed this effect and returned the excitability to a level similar to control. Pretreatment of the slices with the GABAB receptor blocker CGP 55845 [50 microM] increased Emax in slices from untreated rats [p < 0.01] but not from paclitaxel-treated rats

Conclusion: In this study, there was a GABA deficit in paclitaxel-treated rats compared to untreated ones. Such a deficit could contribute to the pathophysiology of paclitaxel-induced neuropathic pain [PINP]. Thus, the GABAergic system might be a potential therapeutic target for managing PINP

Changes in Hospital Admissions and Mortality for Complications of Cirrhosis: Implications for Clinicians and Health Systems

No abstract available.

Novel actions of oxazolidinones: in vitro screening of a triazolyloxazolidinone for anticonvulsant activity

To test the hypothesis that a triazolyloxazolidinone [PH084] has anticonvulsant activity by examining its effects on in vitro seizure models in the rat hippocampus. Whole-cell synaptic currents, action potentials and extracellular population spikes [PS] were recorded in the cell body area of rat hippocampal CA1 region in acutely prepared slices. Chemical [picrotoxin [100 micro m] and zero magnesium] and electrical seizures were induced and the effect of PH084 [10 micro M] was tested on cellular responses, multiple spikes and spontaneous bursting frequencies. PH084 depressed evoked excitatory postsynaptic currents, action potential firing frequency and PS amplitude. All of these responses did not recover to baseline after 15-20 min washout of PH084. Perfusion with zero magnesium ion [Mg[2+]]-containing buffer converted a single PS to multiple PS [mPS] accompanied by spontaneous burst. PH084 suppressed the mPS and the spontaneous burst frequency and it also suppressed the picrotoxin-induced mPS number. However, it did not affect the frequency of stimulus train-induced after discharge or bursts. Furthermore, 8-10 min pretreatment with PH084 did not affect the ability of zero Mg[2+] buffer, picrotoxin or stimulus train to induce epileptiform activity. Thus, while PH084 may have potential for anticonvulsant activity against chemically induced seizures, it has little or no potential against electrically induced seizures or in preventing epileptiform discharge

Peru's national folic acid fortification program and its effect on neural tube defects in Lima / Programa nacional del Perú de fortificación con ácido fólico y su efecto sobre los defectos del tubo neural en Lima

OBJECTIVE: To evaluate the impact of Peru's national folic acid fortification program on folic acid content in wheat flour, and the effect on birth prevalence of neural tube defects (NTDs) in Lima, and to compare the program's legislative requirements with international standards. METHODS: Bread was sampled from six sites across Peru and tested for folic acid. Data were obtained from the largest obstetric hospital in Lima on the prevalence of births (live and still) with NTDs during both the pre-fortification period (2004-2005) and post-fortification years (2007-2008). RESULTS: Folic acid content in the sampled bread met national legislative requirements but was less than one-half of the level recommended for Peru by the World Health Organization (WHO) (2.6 mg/kg wheat flour). Birth prevalence of NTDs was 18.4/10 000 in the pre-fortification period and 20.0/10 000 during post-fortification years. Relative risk for NTDs after fortification was 1.02 (95% confidence interval 0.77-1.35, P = 0.90). CONCLUSIONS: Peruvian legislative requirements for folic acid fortification are below international (WHO) recommendations; birth prevalence of NTDs in Lima is higher than international benchmarks; and no decrease in NTDs following fortification of flour with folic acid (according to Peruvian national standards) was observed. As increasing the level of folic acid in flour remains the most sustainable way of preventing NTDs, it is recommended that Peru increase its folic acid fortification requirements to meet those recommended by WHO (2.6 mg/kg).

OBJETIVO: Evaluar la repercusión que el programa nacional del Perú de fortificación con ácido fólico tiene en el contenido de ácido fólico de la harina de trigo y en la prevalencia de nacimientos de niños con defectos del tubo neural en Lima, así como comparar los requisitos legislativos del programa con las normas internacionales. MÉTODOS: Se hizo un muestreo del pan en seis zonas de Perú y se analizó su contenido de ácido fólico. Se obtuvieron datos del mayor hospital obstétrico de Lima referentes a la prevalencia de nacimientos de niños vivos o mortinatos con defectos del tubo neural durante el período anterior a la fortificación (2004-2005) y el posterior a la misma (2007-2008). RESULTADOS: El contenido de ácido fólico en las muestras de pan obtenidas satisfizo los requisitos legislativos nacionales, si bien fue inferior a la mitad de la concentración que la Organización Mundial de la Salud (OMS) recomienda para el Perú (2,6 mg/kg de harina de trigo). La prevalencia de nacimientos de niños con defectos del tubo neural fue de 18,4/10 000 en el período anterior a la fortificación y de 20,0/10 000 en los años posteriores a la fortificación. El riesgo relativo de los defectos del tubo neural después de la fortificación fue de 1,02 (intervalo de confianza de 95%: 0,77-1,35; P = 0,90). CONCLUSIONES: Los valores que la legislación peruana exige en lo que respecta a la fortificación con ácido fólico son inferiores a los que se recomiendan internacionalmente (OMS). La prevalencia de nacimientos de niños con defectos del tubo neural en Lima es superior a las cifras de referencia internacionales. Por otra parte, no se observó ninguna disminución de los defectos del tubo neural después de fortificar la harina con ácido fólico (según los valores normalizados nacionales peruanos). Dado que el aumento de la concentración de ácido fólico en la harina sigue siendo la manera más sostenible de prevenir los defectos del tubo neural, se recomienda que el Perú haga más estrictos los requisitos relativos a la fortificación con ácido fólico para ajustarse a los valores recomendados por la OMS (2,6 mg/kg).

Anti-ulcerogenic and proton pump (H+, K+ ATPase) inhibitory activity of Kolaviron from Garcinia kola Heckel in rodents.

Anti-ulcer potential and proton pump inhibitory activity of kolaviron (KV) isolated from Garcinia kola Heckel has been evaluated using different ulcer models. Cold-restraint (CRU), aspirin (ASP), alcohol (AL), pyloric ligation (PL) induced gastric ulcer models were used to assess  anti-ulcerogenic activity of KV in rats. Effects of KV on gastric juice for free and total acidity, peptic activity and mucin secretion were also evaluated. The H+, K+-ATPase activity was assayed in gastric microsomes, spectrophotometrically. Results of this study showed that KV (200 mg/kg) reduced the incidence of ulcers in CRU (69.0%), PL (67.6%), ASP (68.6%) and AL (51.5%). Reductions were also observed in free acidity (32.6%), total acidity (56.2%) and peptic activity (35.4%) with increase in mucin secretion by 40.1%. KV inhibited the H+,K+-ATPase activity with IC50 of 43.8 g/ml compared with omeprazole with IC50 of 32.3 g/ml. KV showed both cyto-protective and anti-secretory potentials against peptic ulcer models, and a proton pump inhibitory activity. KV may emerge as a potent anti-ulcer compound.

Anti-ulcer & antioxidant activities of Hedranthera barteri {(Hook F.) Pichon} with possible involvement of H+, K+ ATPase inhibitory activity.

Background & objective: Hedranthera barteri (HB) is used in folk medicine as a vermifuge, laxative and an anti-inflammatory agent. The aim of this study was to evaluate the anti-ulcer and antioxidant properties of the dichloromethane fraction of HB root (DMHBR). Methods: Anti-ulcerogenic activity was assessed in cold-restraint (CRU), aspirin (ASP), alcohol (AL), pyloric ligation (PL) induced gastric ulcer models in rats and histamine-induced duodenal ulcer (HST) in guinea pigs. The effect of DMHBR (100 mg/kg) on gastric juice for free and total acidity, peptic activity and mucin secretion, using the pylorus ligated model, were evaluated. The H+, K+-ATPase activity was assayed in gastric microsomes, spectrophotometrically. The in vitro anti-oxidant assays were explored through DPPH, nitric oxide, hydroxyl radical, superoxide anion scavenging assays. Results: DMHBR reduced the incidence of ulcers in CRU (63.3%), PL (58.5%), ASP (52.7%), HST (75.0%) and AL (53.87%). Also, reductions were observed in the free acidity (49.4%), total acidity (45.8%) and peptic activity (32.9%) with increase in the mucin secretion by 81.6 per cent. DMHBR (60-100 μg/ml) inhibited the H+,K+-ATPase activity with IC50 of 89.64 μg/ml compared with omeprazole (10-50 μg/ml ) with IC50 of 32.26 μg/ml. DMHBR showed antioxidant activity with IC50 values of DPPH (397.69 μg/ml), nitric oxide (475.88 μg/ml), hydroxyl radical (244.22 μg/ml) and superoxide anion radical (285.20 μg/ml). Interpretation & conclusion: DMHBR showed anti-ulcer activity against experimentally-induced peptic ulcer models and exhibited both cytoprotective and anti-secretory property. It exhibited a proton pump inhibition activity and its anti-ulcer properties may be partly ascribed to its antioxidant activities.

Therapeutic approaches to age-related dementias: rational search for effective drugs

Dementia of the Alzheimer's type is a disease associated with age. As the life expectancy of the world population increases, the incidence of dementia is predicted to increase. Currently, very few medications are available that can be used to mitigate the symptoms of the disease. This symptomatic therapy is not optimal and is associated with variable outcomes and side effects. Furthermore, none of these drugs have been clearly proven to stop or prevent the development of the disease. To begin to seriously address the current poor situation of pharmacotherapeutic management of these devastating diseases, more research is required to understand the pathological changes associated with dementia and to rationally design, synthesize and test compounds with potential for more efficacy and fewer side effects and possibly, disease modifying actions. The ideal compounds would be those which, in addition to providing symptomatic relief, also slow down disease progression with minimal side effects

Preemptive analgesic effect of lidocaine in a chronic neuropathic pain model / Efeito analgésico preemptivo da lidocaína em modelo de dor crônica neuropática

Preemptive analgesia inhibits the progression of pain caused by surgical lesions. To analyze the effect of lidocaine on postoperative pain relief, we performed compression of the right sciatic nerve in Wistar rats and observed the differences on behavior between the group that received lidocaine and the group that was not treated with the local anesthetics pre-operatively. Group 1 was not operated (control); group 2 underwent the sciatic nerve ligature without lidocaine; group 3, underwent surgery with previous local infiltration of lidocaine. Group 2 showed significantly longer scratching times with a peak on day 14 post-operative (p=0.0005) and reduction in the latency to both noxious (p=0.003) and non-noxious (p=0.004) thermal stimulus. Group 3 presented significantly shorter scratching times (p=0.004) and longer latency times when compared to Group 2. Preemptive use of lidocaine 2 percent can potentially reduce the postoperative neuropathic pain associated with sciatic nerve compression.

A analgesia preemptiva inibe a progressão da dor causada por lesão cirúrgica. Para analisar o efeito da lidocaína na diminuição da dor pós-operatória, submetemos ratos Wistar a compressão cirúrgica do nervo ciático e observamos diferenças em alguns padrões de comportamento entre o grupo tratado com lidocaína pré-operatória e o grupo não-tratado com o anestésico local. O grupo 1 não foi operado (controle); o grupo 2, submetido a ligadura do nervo ciático sem lidocaína, apresentou significativo aumento do tempo de coçar-se com um pico no 14º pós-operatório (p=0.0005) e redução na latência para os estímulos térmicos nocivo (p=0.003) e não-nocivo (p=0.004); o grupo 3, operado com a droga preemptiva, demonstrou significativo decréscimo no tempo de coçar-se (p=0.004) e maiores tempos de latência quando comparados aos do grupo 2. O uso preemptivo da lidocaína 2 por cento pode, potencialmente, reduzir a dor neuropática pós-operatória associada à compressão do nervo ciático.

Optimizing the Dose and Duration of Therapy for ChronicHepatitis C

Recent studies indicate that antiviral treatment with pegylated interferon alfa and ribavirin for hepatitis C can be individualized based on viral and host characteristics and the pattern of virologic response during the initial months of antiviral treatment. Patients with a low initial viral load who demonstrate a rapid virologic response to antiviral therapy may be treated with a shorter duration of therapy and are less sensitive to reduced dosing of ribavirin. Patients with delayed virologic response will require a longer duration of therapy - up to 72 weeks for patients with genotype 1 - in order to optimize chances of a sustained virologic response. Patients who were nonresponders or relapsed after an acceptable course of antiviral therapy may be retreated using a more intensive regimen and/or a longer duration of therapy. Previous nonresponders to pegylated interferon alfa and ribavirin are less likely to respond to retreatment unless they demonstrate a virologic response within the first three months of retreatment, lack advanced fibrosis, and can tolerate a more intensive and/or lengthier treatment. Individualized treatment based on viral genotype, viral load, the presence of advanced fibrosis, and initial virologic response can improve therapy for some patients and save resources in others.

Norepinephrine and E139 interactions on epileptiform activity in the rat hippocampus in vitro

We tested if E139, an anticonvulsant enaminone, interacts with norepinephrine [NE] to suppress population responses and chemically induced in vitro seizures in the rat hippocampus. Evoked field population spikes [PS] were recorded in the hippocampal CA1 area, and in vitro seizures were generated chemically using the zero Mg[2+]model. Low concentrations of E139 [/= 100 microM] enhanced them. For example, E139 [10 microM] depressed the PS amplitude by -23.9 +/- 2.3%, while 1 mM caused an enhancement. NE also depressed the PS by -34.5 +/- 6.0% and prevented E139 from subsequently depressing the PS amplitude. UK 14304, a selective alpha2-adrenoceptor agonist, also depressed the PS amplitude by -32.6 +/- 9.4% and occluded E139 suppression. NE suppression of PS was blocked by phentolamine and yohimbine which also blocked the effect of E139. Prazosin, a selective alpha1-adrenoceptor antagonist, did not block NE [-24.8 +/- 6.9%] or E139 [-29.7 +/- 6.1%] effects. Zero Mg[2+] buffer transformed a single PS to multiple spikes [MS; 3-8 spikes] and also induced spontaneous bursts [SB; 5-20/min]. NE suppressed the number of MS from 5.6 +/- 0.3 to 3.8 +/- 0.2. At its peak effect, E139 was able to further suppress the number of MS to 3.0 +/- 0.3. Yohimbine did not change the number of MS but blocked the NE- and E139-induced suppression of MS. SB frequency was suppressed by NE [-60.8 +/- 11.7%] which occluded E139 effects. Finally, SB were reversibly abolished by yohimbine [-94.5 +/- 11.7%]. E139 suppressed population responses and in vitro epileptiform activity by both adrenergic and non-adrenergic mechanisms