Comparison between intrathecal and intravenous betamethasone for post-operative pain following cesarean section: a randomized clinical trial

Objective: Inadequate postoperative pain relief after cesarean section can increase complications. In this study, we evaluated the effect of intrathecal betamethasone as an adjunct to bupivacaine on postoperative pain in patients undergoing cesarean section

Methodology: Ninety-nine patients undergoing cesarean section were assigned to one of three groups. Group 1 [Control] patients received intrathecal bupivacaine, Group 2 patients received intrathecal bupivacaine plus preservative free betamethasone and Group 3 patients received betamethasone intravenously with intrathecal bupivacaine. After surgery, diclofenac in suppository form was administered as needed for analgesia. Postoperative diclofenac requirements, time to first analgesic administration and visual analogue scale pain scores were recorded by a blinded observer

Results: Supplemental analgesic dose requirement with diclofenac for the first 24 hours were significantly less in both groups that received betamethasone compared to the control group [P < 0.0001]. The mean duration of postoperative analgesia was 336.8+/-86 min in Intrathecal group and 312.4+/-106 min in Intravenous group compared with 245.4+/-93 min in control group [P =0.001]. Visual analogue scale scores were significantly less at 4 hours [P < 0.0001] and 6 hours [P < 0.0001] after surgery in groups that received betamethasone in comparison to control group. The pain scores at 6 hours after surgery were higher in the Intravenous group compared with the Intrathecal group [P = 0.001]; However visual analogue scale was not different at 12 and 24 hours after surgery between groups [p > 0.05]

Conclusion: Intrathecal betamethasone reduced pain and decreased the required dose of diclofenac in 24 hours after cesarean section

Immunotherapy with imiquimod increases the efficacy of glucantime therapy of leishmania major infection

Leishmaniasis is a complex disease which presents as visceral, cutaneous and mucocutaneous forms. The current treatment options for this infection are very limited and the immunological state of the host appears to play an important role in the efficacy of the treatment. Immunostimulation through immune response activating agents such as Imiquimod is another rational approach for this purpose. We assessed the efficacy of immunotherapy with Imiquimod alone or combined with Glucantime for treatment of Leishmania major infection in BALB/c mice. Treatment efficacy was monitored by determination of thickness and parasite load of infected foot-pad of mice. The footpad thickness revealed that treatment with Imiquimod plus Glucantime has the highest efficacy. The results were confirmed by parasite load of infected footpad. Our data shows that treatment of Leishmania major infection in BALB/c mice by the combined Imiquimod and Glucantime is more efficient than each drug alone. The combination of Imiquimod with chemotherapy may offer a way for more efficient treatment of leishmaniasis

Immune response following oral immunization with BCG encapsulated in alginate microspheres

Different methods have been used for BCG vaccination. Alginate microspheres are useful in delivery of vaccines to the gastrointestinal tract by oral route. To compare the immune response following oral microencapsulated and subcutaneous [SC] route administration of BCG vaccine in BALB/c mice. Alginate microspheres were produced by an internal emulsification method within olive oil. Four groups of mice were studied, including two groups receiving oral gavages of microencapsulated and free BCG, one receiving SC injection of BCG, and a control group. T cell proliferation, specific anti-BCG total IgG, and IgG subclasses [IgG1 and IgG2a] were compared between groups 5 and 12 weeks after vaccination. The best result was achieved using oral microencapsulated form in comparison with oral BCG alone. Delivery of oral BCG with alginate microspheres is an effective way to induce immune response in BALB/c mice