ABSTRACT
Ivermectin is a US Food and Drug Administration (FDA)-approved antiparasitic agent with antiviral and anti-inflammatory properties. Although recent studies reported the possible anti-inflammatory activity of ivermectin in respiratory injuries, its potential therapeutic effect on pulmonary fibrosis (PF) has not been investigated. This study aimed to explore the ability of ivermectin (0.6 mg/kg) to alleviate bleomycin-induced biochemical derangements and histological changes in an experimental PF rat model. This can provide the means to validate the clinical utility of ivermectin as a treatment option for idiopathic PF. The results showed that ivermectin mitigated the bleomycin-evoked pulmonary injury, as manifested by the reduced infiltration of inflammatory cells, as well as decreased the inflammation and fibrosis scores. Intriguingly, ivermectin decreased collagen fiber deposition and suppressed transforming growth factor-β1 (TGF-β1) and fibronectin protein expression, highlighting its anti-fibrotic activity. This study revealed for the first time that ivermectin can suppress the nucleotide-binding oligomerization domain (NOD)-like receptor family pyrin domain-containing protein 3 (NLRP3) inflammasome, as manifested by the reduced gene expression of NLRP3 and the apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), with a subsequent decline in the interleukin-1β (IL-1β) level. In addition, ivermectin inhibited the expression of intracellular nuclear factor-κB (NF-κB) and hypoxia‑inducible factor‑1α (HIF-1α) proteins along with lowering the oxidative stress and apoptotic markers. Altogether, this study revealed that ivermectin could ameliorate pulmonary inflammation and fibrosis induced by bleomycin. These beneficial effects were mediated, at least partly, via the downregulation of TGF-β1 and fibronectin, as well as the suppression of NLRP3 inflammasome through modulating the expression of HIF‑1α and NF-κB.
Subject(s)
Animals , Rats , Anti-Inflammatory Agents , Bleomycin/toxicity , Fibronectins/metabolism , Fibrosis , Inflammasomes/metabolism , Ivermectin/adverse effects , NF-kappa B/metabolism , NLR Family, Pyrin Domain-Containing 3 Protein/metabolism , Pulmonary Fibrosis/drug therapyABSTRACT
Abstract Introduction Endotracheal intubation is a procedure associated with a high level of exposure to the COVID-19 virus. This has led to the search of alternatives to reduce the risk of contamination, including the so-called aerosol box. Objective To compare time and difficulty of orotracheal intubation when using the aerosol box in a simulated setting. Methodology Observational study conducted with the participation of 33 anesthetist physicians and anesthesia residents; groups were compared in terms of time and intubation difficulty using a conventional Macintosh laryngoscope and the McGRATH™ MAC (Medtronic) videolaryngoscope with or without aerosol box. In order to determine performance with the intubation maneuver, crude hazard ratios were estimated, and a Cox multivariate regression model was built, adjusted by anesthetist years of experience and difficulties during the procedure. Results On average, the aerosol box increased intubation time by 7.57 seconds (SD 8.33) when the videolaryngoscope was used, and by 6.62 (SD 5.74) with the Macintosh. Overall, 132 intubations were performed, with 121 successful and 6 failed first-time attempts (4 with the use of the aerosol box); 16 participants (48.48%) reported difficulty handling the box. With the use of the Macintosh, intubation was found to be faster than with the videolaryngoscope (cHR: 1.36 [95% CI 0.64-2.88]; adjusted HR: 2.20 [95% CI 0.73-6.62]). Conclusions The use of the aerosol box and personal protective equipment in a simulation setting hinders the intubation maneuver and may result in protracted execution time.
Resumen Introducción La intubación endotraqueal es un procedimiento que se relaciona con alto nivel de exposición al virus de COVID-19, llevando a la búsqueda de alternativas para disminuir el riesgo de contaminación, entre ellas la llamada Caja de aerosoles. Objetivo Comparar el tiempo y dificultad en la intubación orotraqueal usando la caja de aerosoles en escenarios simulados. Metodología Estudio observacional, con participación de 33 médicos anestesiólogos y residentes de anestesia; se compararon los grupos en tiempo y dificultad de intubación con uso de laringoscopio convencional Macintosh y videolaringoscopio McGRATH™ MAC (Medtronic) utilizando la caja de aerosoles y sin ella. Para determinar el rendimiento en la maniobra de intubación se calcularon Hazard ratios crudos, se construyó modelo multivariado de Regresion de Cox ajustado por años de experiencia como anestesiólogo y dificultades durante el procedimiento. Resultados La caja de aerosoles aumentó en promedio el tiempo en segundos para la intubación con video-laringoscopio en 7,57 (DE: 8,33) y con Macintosh 6,62 (DE: 5,74). Se llevaron a cabo 132 intubaciones, 121 exitosas en el primer intento y 6 fallidas (4 con el uso de la caja de aerosoles). 16 participantes reconocieron alguna dificultad al manipular la caja (48,48 %). Con el uso de Macintosh se identificó tendencia a la intubación más rápido que con el videolaringoscopio (HRc: 1,36 [IC 95 %: 0,64-2,88]; HR ajustado: 2,20 [IC 95 %: 0,73-6,62]). Conclusiones Utilizar la caja de aerosoles y equipo de protección personal en un escenario simulado dificulta la maniobra de intubación y puede prolongar el tiempo de ejecución.
Subject(s)
Pancreas DivisumABSTRACT
@#<p style="text-align: justify;"><strong>OBJECTIVE: </strong>To compare actual tracheostomy tube sizes with estimated endotracheal tube sizes using age-related formula and tracheal diameter from preoperative radiographs among pediatric Filipino patients aged 0-18 years old undergoing tracheostomy.</p><p style="text-align: justify;"><strong>METHODS:</strong></p><p style="text-align: justify;"><strong> DESIGN:</strong> Review of records</p><p style="text-align: justify;"><strong> SETTING:</strong> Tertiary Private University Hospital in Dasmarinas, Cavite, Philippines</p><p style="text-align: justify;"><strong> PATIENTS:</strong> Pediatric patients regardless of gender, aged 0 to 18 years old, with a preoperative radiograph of the trachea, and who subsequently underwent tracheostomy anytime from January 1, 2007 to December 31, 2016 were considered for inclusion. Radiographs were measured, endotracheal tube sizes were computed using age-related formula, and recorded tracheotomy tube sizes were retrieved.</p><p style="text-align: justify;"><strong>RESULTS: </strong>Twenty-two patients (12 males, 10 females) aged 10 months to 18-years-old (median age: 11 years) were included in the study. Mean tube sizes were 6.46mm (+/- 1.492 SD) for age-related formula, 5.67mm (+/- 1.1849 SD) for radiograph-based estimation, and 5.0 for actual tracheostomy tube inserted in each patient. The Bland-Altman plot showed the bias estimate at 0.7913 and the lower and upper limits of agreement at -1.3598 and 2.9423 (confidence level 95% or 2 standard deviations away from the mean).</p><p style="text-align: justify;"><strong>CONCLUSION: </strong>The average value derived from radiograph-based estimation is less than the corresponding average value from age-related formula. There is a significant difference between age-related formula-based estimation and actual tracheostomy tube inserted. Since the range of differences between the two estimation methods is high, these results imply that the bias or the difference between measures from the two methods is not consistent, with the two methods exhibiting very poor agreement.</p><p style="text-align: justify;"><strong> </strong></p><p style="text-align: justify;"> </p>
Subject(s)
Humans , Male , Female , Tracheostomy , IntubationABSTRACT
Objective To compare the alaryngeal speakers'voice acoustic parameters and intra-tracheal pressure when they spoke different vowels.Methods 24 patients after tracheo-esophageal shunt phonation by the anastomosis of the membranous portion of the tracheal section with the anterior wall of esophagus after total laryngectomy and 16 esophageal speakers enrolled in this study. The voice acoustic parameters were measured when they spoke soft /a/ and soft /i/. The intra-tracheal pressure of 20 TE speakers was measured when spoke /a/ and /i/.Results There were no significant differences between vowel /a/ and /i/ in the two alaryngeal speaker group. The pressure of TE speakers after Shang's procedrue for comfortable /i/ was higher than that for /a/, and there was significant difference.Conclusion There were the same clinical meanings in evaluating alaryngeal voice acoustic aspect. when using vowel /a/ and /i/. However when using different vowel, the intrtracheal pressure was different in TE speakers.