Pectoral nerve blocks for transvenous subpectoral pacemaker insertion in children: a randomized controlled study / 대한마취과학회지

Background@#Postoperative pain management after pacemaker insertion routinely requires opioid agents, nonsteroidal anti-inflammatory drugs, or paracetamol. However, interest in opioid-sparing multimodal pain management to minimize postoperative narcotic use has increased recently. This study aimed to assess the pectoral nerve (PECS) block versus standard treatment on postoperative pain control and opioid consumption in pediatric patients after transvenous subpectoral pacemaker insertion.Method: In this randomized controlled study, 40 pediatric patients underwent transvenous subpectoral pacemaker insertion with either congenital or postoperative complete heart block. Patients were randomly assigned to two groups: Group C (control) received conventional analgesic care without any block and Group P (pectoral) received a PECS block. Demographics, procedural variables, postoperative pain, and postoperative opioid consumption were compared between the two groups. @*Results@#In children undergoing transvenous subpectoral pacemaker insertion, the PECS block was associated with a longer procedure time; however, the cumulative dose of fentanyl and atracurium was reduced and the hemodynamic profile was superior in Group P compared with Group C intraoperatively. Postoperatively, the PECS block was associated with lower postprocedural pain scores, which was reflected by the longer interval before the first call for rescue analgesia and lower postoperative morphine consumption, without an increase in the rate of complications. @*Conclusion@#Ultrasound-guided PECS blocks are associated with a good intraoperative hemodynamic profile, reduced postoperative pain scores, and lower total opioid consumption in children undergoing transvenous subpectoral pacemaker placement.

Monoclonal Antibody-Based Dipstick Assay: A Reliable Field Applicable Technique for Diagnosis of Schistosoma mansoni Infection Using Human Serum and Urine Samples

A field applicable diagnostic technique, the dipstick assay, was evaluated for its sensitivity and specificity in diagnosing human Schistosoma mansoni infection. A monoclonal antibody (mAb) against S. mansoni adult worm tegumental antigen (AWTA) was employed in dipstick and sandwich ELISA for detection of circulating schistosome antigen (CSA) in both serum and urine samples. Based on clinical and parasitological examinations, 60 S. mansoni-infected patients, 30 patients infected with parasites other than schistosomiasis, and 30 uninfected healthy individuals were selected. The sensitivity and specificity of dipstick assay in urine samples were 86.7% and 90.0%, respectively, compared to 90.0% sensitivity and 91.7% specificity of sandwich ELISA. In serum samples, the sensitivity and specificity were 88.3% and 91.7% for dipstick assay vs. 91.7% and 95.0% for sandwich ELISA, respectively. The diagnostic efficacy of dipstick assay in urine and serum samples was 88.3% and 90.0%, while it was 90.8% and 93.3% for sandwich ELISA, respectively. The diagnostic indices of dipstick assay and ELISA either in serum or in urine were statistically comparable (P>0.05). In conclusion, the dipstick assay offers an alternative simple, rapid, non-invasive technique in detecting CSA or complement to stool examinations especially in field studies.

Preparation of an acellular dermal matrix using the freeze-thawing technique with and without gamma irradiation

An acellular dermal matrix [ADM] is a dermal substitute in which the skin is treated to remove epithelial and dermal cellular components. To compare the histological and immunohistochemical structures of ADMs prepared using the freeze-thawing technique with or without gamma irradiation. Twenty-one human skin specimens were used and divided into three equal groups: group I [control group], group II, in which skin specimens were subjected to three repeated freeze-thawing cycles, and group III, in which skin specimens were subjected to three repeated freeze-thawing cycles and subsequent exposure to 5000 rad gamma irradiation. Skin specimens from the previous groups were examined histologically and immunohistochemically for laminin. A morphometric study was carried out for the determination of the number of cells per high-power field [hpf] in both the papillary and the reticular dermis. Both methods of ADM preparation resulted in extensive extraction of cellular components with preservation of the basic dermal architecture as there was a highly significant decrease in the number of cells/hpf in both layers of the dermis in groups II and III as compared with the control group [P<0.001]. However, there was further decellularization in group III as there was a highly significant decrease in the number of cells/ hpf in both the papillary and the reticular dermis in group III as compared with group II [P<0.001]. Immunohistochemical stain of laminin revealed preservation of the epidermal basement membrane in groups II and III. A combination of irradiation and a freeze-thawing technique is recommended in the preparation of ADM for efficient decellularization

Detection of Fasciola Antigen in Serum and Stool Samples

Fascioliasis as a zoonotic disease that affects humans is more important than previously thought especially in endemic areas .This work estimates immunodiagnosis of Fasciola by detecting both circulating and copro-antigens. Rabbit anti-cysteine protease was prepared and used for antigen capture and detection by sandwich EUSA. Fasciola antigen detection in sera of naturally infected animals revealed high sensitivity [87.75%] and specificity [94.38%]. Copro antigen detection in stool of naturally infected animals yielded 93.19% sensitivity and 96.62% specificity respectively. A pilot application of both assays was performed for a sample of subjects. The sandwich ELISA detected antigen in sera of Fasciola patients with 92.4% sensitivity and 94.7% specificity. The sandwich ELISA achieved high sensitivity [100%] and specificity [90.63%] for coproantigen detection. Detection of Fasciola antigen in stool could be introduced as cost effective, non invasive standard assay for the screen diagnosis of Fasciola in humans living in endemic areas. These assays may be promising for inimunodiagnosis of fascioliasis that could be complementary tool to parasitological examination

cross sectional study of hepatitis B, C, some trace elements, heavy metals, aflatoxin B1 and schistosomiasis in a rural population, Egypt

Chronic liver diseases are disastrous to health. Many factors are associated with their prevalence, hence endemicity. These are mainly infectious, parasitic and toxic. A survey was conducted in a village south to Cairo. Large industries concerned with iron and steel industry, metals smelting, cement manufacturing and electric station were located north to the village. A systematic random sample of houses was selected. All individuals inside the houses were invited to share in the study. Sample size was 84 individuals. Hepatitis markers were done [HBsAg and anti-HCV antibodies]. The levels of some heavy metals were assessed; which were lead, mercury, arsenic, aluminum, manganese, nickel, chromium and cadmium. Levels of some trace elements were assessed. These were copper, iron, selenium and zinc. Aflatoxin B1 was assessed in serum. Assessment of schistosomal circulating antigen and antibodies was carried out. Abdominal ultrasonograghy was done to assess liver condition. Univariate logistic regression analysis was done to assess the association between studied variables and HBsAg or anti-HCV sero-positive subjects. The association between studied variables and bilharzial or fatty liver, diagnosed by ultrasonography, were also assessed. The univariate logistic regression analysis revealed odds ratios at the following results. For HBsAg sero positive subjects, aflatoxin B1, lead, chromium and schistosomal antigen and antibodies were higher than negative ones where odds ratios were; 6.2, 1.6, 1.6, 1.6 and 1.7, respectively. None of the variables showed statistically significant difference. For anti-HCV antibodies sero-positive subjects, aflatoxin Bi and chromium had the highest odds ratios among the studied variables, [odds ratios were 2.5 and 2.4, respectively]. Bilharzial liver showed higher significant positivity of anti-HCV antibodies and insignificant decreased level of zinc than negative ones [odds ratios were 7.2 and 4.5, respectively]. Fatty liver cases showed higher statistically significant positivity of anti-HCV antibodies and chromium than negative ones. Odds ratios were 8.0 and 7.1, respectively. Statistically significant lower level of aflatoxin B1 was shown in fatty liver than normal liver subjects. Multivariate logistic regression analysis for fatty liver showed that only anti-HCV antibodies sero-positivity had statistically significant odds ratio in comparison to chromium level and aflatoxin B1. It is concluded that some heavy metals, and Aflatoxin B1 had a definite association with liver diseases in the area under study. Having anti-HCV antibodies had a relation with fatty liver and with bilharzial liver more than having HBsAg. It is recommended that environmental management to factories nearby the village is urgently needed to decrease exposure to heavy metals. Prevention of hepatitis infection and aflatoxin exposure through different means is also recommended, other wise health care authorities would be confronted with unusual cases of HCC in the nearby future