Ketamine as an adjunct to bupivacaine in infra-orbital nerve block analgesia after cleft lip repair / Cetamina como adjuvante de bupivacaína em bloqueio do nervo infraorbitário para analgesia após correção de lábio leporino

Abstract Objectives: We conducted this study to investigate the safety and analgesic efficacy of the addition of Ketamine to Bupivacaine in bilateral extra-oral infra-orbital nerve block in children undergoing cleft lip surgeries. Methods: Sixty patients were randomly allocated into two groups (n = 30), Group B received infra-orbital nerve block with 2 mL of 0.25% Bupivacaine and Group BK received 0.5 mg.kg-1 Ketamine for each side added to 1 mL of 0.5% Bupivacaine solution diluted up to 2 mL solution to 0.25% Bupivacaine concentration. Assessment parameters included; hemodynamics, recovery time, time to first oral intake, postoperative Faces Legs Activity Cry Consolability (FLACC) scores, Four-point Agitation scores, analgesic consumption and adverse effects. Results: Patients in Group BK showed lower postoperative FLACC scores during all recorded time points (p < 0.0001). Two patients in Group BK versus 12 in Group B requested for postoperative rescue analgesia (p < 0.001). There were no differences between groups in time, minutes (min), to first request for rescue analgesia. Patients in Group BK reported lower analgesic consumption (366.67 ± 45.67 vs. 240.0 ± 0.0 mg, p < 0.04). The time to first oral intake was significantly reduced in Group BK (87.67 ± 15.41 vs. 27.33 ± 8.68 min, p < 0.001). Lower postoperative Agitation scores were recorded in Group BK patients that reached a statistical significance at 45 min (0.86 ± 0.11 vs. 0.46 ± 0.16, p < 0.04) and in the first hour (h) postoperatively (1.40 ± 0.17 vs. 0.67 ± 0.14, p < 0.003). Higher parent satisfaction scores were recorded in Group BK (p < 0.04) without significant adverse effects. Conclusions: The addition of Ketamine to Bupivacaine has accentuated the analgesic efficacy of infra-orbital nerve block in children undergoing cleft lip repair surgeries.

Resumo Objetivos: Realizamos este estudo para avaliar a segurança e eficácia da analgesia com a adição de cetamina à bupivacaína em bloqueio do nervo infraorbitário, bilateral e extraoral, em crianças submetidas à cirurgia de lábio leporino. Métodos: Foram randomicamente alocados 60 pacientes em dois grupos (n = 30): o Grupo B recebeu bloqueio do nervo infraorbitário com bupivacaína a 0,25% (2 mL) e o Grupo BC recebeu bloqueio com cetamina (0,5 mg.kg-1) em cada lado, mais a adição de 1 mL de solução de bupivacaína a 0,5% diluída até 2 mL da concentração a 0,25%. Os parâmetros de avaliação incluíram: hemodinâmica, tempo de recuperação, tempo até a primeira ingestão oral, escores da escala FLACC (que avalia a expressão facial [Face], os movimentos das pernas [Legs], a atividade [Activity], o choro [Cry] e a consolabilidade [Consolability]), escores de agitação em escala de quatro pontos, consumo de analgésicos e efeitos adversos no pós-operatório. Resultados: Os pacientes do Grupo BC apresentaram escores FLACC mais baixos em todos os momentos mensurados no pós-operatório (p < 0,0001). Dois pacientes do Grupo BC versus 12 do Grupo B solicitaram analgesia de resgate no pós-operatório (p < 0,001). Não houve diferenças entre os grupos em relação ao tempo até a primeira solicitação de analgesia de resgate. Os pacientes do Grupo BC relataram consumo menor de analgésicos (366,67 ± 45,67 vs. 240,0 ± 0,0 mg, p < 0,04). O tempo em minutos (min) até a primeira ingestão oral foi significativamente reduzido no Grupo BC (87,67 ± 15,41 vs. 27,33 ± 8,68 min, p < 0,001). Escores mais baixos de agitação no pós-operatório foram registrados para os pacientes do Grupo BC, com significância estatística no tempo de 45 min (0,86 ± 0,11 vs. 0,46 ± 0,16; p < 0,04) e na primeira hora de pós-operatório (1,40 ± 0,17 vs. 0,67 ± 0,14; p < 0,003). Índices mais altos de satisfação dos pais foram registrados no Grupo BC (p < 0,04), sem efeitos adversos significativos. Conclusões: A adição de cetamina à bupivacaína acentuou a eficácia analgésica do bloqueio do nervo infraorbitário em crianças submetidas à cirurgia de correção de lábio leporino.

Effect of Clarithromycin administration on pregnant albino rats during the cleavage period of gestation and on their embryos

Background: Clarithromycin is a macrolide antibiotic used to treat common infections including respiratory tract, skin and Helicobacter pylori. This work investigates whether the administration of clarithromycin to pregnant females during the cleavage phase of gestation was associated with a risk of miscarriages and offspring morphological malformation and skeletal anomalies, histological changes and DNA fragmentation of embryos and liver of pregnant rats. Two major groups of pregnant albino rats were used. The animals of the control group received distilled water from the 1[st] to 7[th] days of gestation.One subgroup [C1] was sacrificed on the 8[th] day; and the other [C2] was sacrificed on the 20[th] day of gestation. The treated group was drenched 45 mg/kg clarithromycin [therapeutic dose] suspension from 1[st] to 7[th] day of gestation. The first subgroup [T1] was sacrificed on the 8th day and the other [T2] was sacrificed on the 20th day of gestation

Results: The obtained results showed a decrease in maternal body weight gain, increase in the rate of abortion, resorption and growth retardation of fetuses and some malformation in the skeletal system of the treated group. Histopathological studies of pregnant and fetal rats revealed congestion and dilatation of the central vein, fatty degeneration of the hepatocytes and severe DNA fragmentation

Effect of Clarithromycin administration during late gestational period on the pregnant albino rats and their fetuses

Background: Clarithromycin, a new macrolide antibiotic, is effective in the management of a wide range of clinical problems including outpatient treatment of community-acquired pneumonia, shortening the course of peptic ulcer disease associated with Helicobacter pylori infection and curing previously resistant respiratory infections in immune-compromised patients. The present study is planned to study the effect of clarithromycin on the pregnant female rats and their fetuses during the last gestational period stage. This study includes the effect of clarithromycin on therate of abortion, malformation of fetuses, skeletal, histological changes and DNA fragmentation of liver cells of pregnant rats and their fetuses. In the present study two groups of pregnant animals were used. The first group received distilled water from 15[th] to 19[th] days of gestation and used as control and sacrificed at 20[th] day of gestation. The other group is orally administered with 45mg/kgclarithromycin from 15[th] to 19[th] days and sacrifices at 20[th] day of gestation [the therapeutic dose]. The obtained results showed a significant decrease in maternal body weight gain and increase in the rate of abortion, resorption and growth retardation of fetuses.Fetuses of the treated group showed severe lack of ossification on the skull bones, phalanges and sternum bone as well as shortness in the ulna and radius bones. Histological studies of pregnant rats revealed congestion and dilatation of the central vein of the liver lobules and fatty degeneration of the hepatocytes with severe DNA fragmentation.In 20 day-fetuses, there were a marked increase of necrotic hepatocytes associated with increased average of megakaryocytes and periportal leukocytic infiltration

Coxsackie B virus infection in patients with type 1 diabetes mellitus

Aim: Infection with Coxsackie B viruses has been linked to type 1 diabetes mellitus. Three of 18 serum samples [16.7%] taken from children at the onset of diabetes and two of 17 serum samples [11.8%] taken from adults in the course of type 1 DM [i.e. postonset] were positive for Coxsackie B virus. Subjects and We performed reverse transcriptase polymerase chain reaction [RT-PCR] to detect RNA of enteroviruses in serum samples. Subsequent virus isolation and neutralization test were done using polyvalent and then monovalent anti Coxsackie B [CB] sera to detect CB serotype. Three patients had Coxsakie virus B4 [2 children and one adult] and 2 patients had Coxsackie virus B3 [one child and one adult]. By contrast none of the 20 age and sex matched healthy control [10 children and 10 adults] had Coxsackie viruses in their serum samples. All five patients positive for Coxsackie virus gave positive history of metabolic decompensation i.e. ketosis either at the onset or in the course of the disease [P = 0.002, Fisher's exact test]. By contrast none of the Coxsackie negative diabetic children [0%] and 7 of 15 Coxsackie negative diabetic adults [46.7%] gave past history of ketosis [P = 0.001 and P = 0.47, respectively]. Conclusions: The present study demonstrates that Coxsackie B virus RNA can be detected in serum from children at the onset and adults in the course of type 1 DM and that it may play a role in triggering metabolic decompensation especially in children. Coxsackie B4 and B3 strains may specially have diabetogenic properties. The present study provides further evidence for a role of enteroviruses in children and adult type 1 diabetes