Comparison of the effect of nitroglycerin, magnesium sulphate and dexmedetomidine as hypotensive agents in lumbar spine surgery

Background: in orthopedic procedures more blood is lost from raw bone and muscle surface than from identifiable blood vessels. Moderate hypotensive anesthesia was found to significantly decrease the average blood loss by nearly 40%, reduce the need for transfusion by 45% and shorten the average operating time by nearly 10%. Objective: The aim of the current study was to compare magnesium sulphate and dexmedetomidine with nitroglycerin as regard hypotensive effect as primary outcome, volume of blood loss, blood substitution and pattern of recovery as secondary outcome during lumbar spine surgery. Patients and Methods: This prospective, controlled, comperative, randomized, double blind study included a total of ninty patients aged 21-50 years of both sex, ASA I-II scheduled for elective lumber spine surgery, attending at Department of Orthopedic, AL-Azher university Hospital in Assuit as single center study. Patients have received either dexmedetomidine, magnesium sulfate or nitroglycerine. Results: There were highly significant difference (P <0.000) with duration of surgery between different study groups with duration of surgery shortest in dexmedetomidine group followed by magnesium sulfate group and then nitroglycerine group. There were highly significant differences between different study groups with fluid maintenance with higher volume in nitroglycerine group then magnesium sulfate group and then dexmedetomidine group. There were highly significant differences (P <0.000) with systolic blood pressure between study groups at A1 and hypotensive agent discontinuation with lowest systolic blood pressure in dexmedetomidine group followed by magnesium sulfate group and then nitroglycerine group. Conclusion: nitroglycerine, magnesium sulfate and dexmedetomidine could induce hypotension, but dexmedetomidine showed more favorable hemodynamic profile as regard blood pressure and heart rate

Detection of specific secretory IGA in saliva and stool of patients for diagnosis of Schistosoma mansoni infection

A total of thirty enzyme-linked immunosorbent [ELISA] assays detecting serum and secretory immunoglobulins against Schistosoma mansoni cercarial antigen preparation [CAP], soluble egg antigen [SEA], and adult worm antigen [AWA] were evaluated for diagnosis of Schistosoma mansoni infections. For each antigen, serum IgM, IgG, IgA, IgE, IgG1, IgG2 and IgG4 and secretory IgA in unstimulated saliva, stimulated saliva arid stool were quantitatively determined in samples from 116 Schistosoma mansoni infected subjects and 50 normal controls. Cut off values and evaluation parameters were calculated from receiver operating characteristic [ROC] curve. With serum samples, CAP-IgG, CAP-IgG1, SEA-IgG, SEA-IgG1, AWA-IgG1 and AWA-IgG4 were the best assays showing sensitivities of 94.8, 91.4, 95.7, 94.8, 91.4, and 94.8%, respectively, and specificities of 100, 92, 96, 100, 92, and 100%, respectively. With secretory IgA, stimulated saliva SEA and AWA-IgA, and stool SEA-IgA showed the best results with sensitivities of 85.4, 93.1, and 89.7%, respectively, and specificities of 100, 92, and 96%, respectively. In conclusion, different antibody classes determined showed high sensitivities and specificities in diagnosis of active schistosomiasis. Secretory IgA against Schistosoma mansoni antigens showed promising sensitivities and specificities, which make it a helpful tool in diagnosis of active schistosomiasis in the future, as it is an easy non invasive technique, which may help in epidemiological studies

Transfer of serum suppressive activity, which inhibit lymphocyte proliferative response to Schistosoma mansoni antigens, from Schistosoma mansoni infected mothers to their offspring

The study objective was to find if serum specific suppressive activities on Lymphocyte transformation in response to Schistosoma mansoni [S. mansoni] antigens, usually present in serum of chronic S. mansoni infected patients, are permeable through the placenta from S. mansoni infected mothers to their newborns. Also, to find if such transferred activities are maintained during breast feeding and after weaning. Control group of 8 normal mothers and their offspring and 3 study groups of 13, 11, 11 S. mansoni infected mothers and their newborns, breast-fed infants and weaned children were included in the study. Proliferative response of Lymphocytes, from S. mansoni donors, to S. mansoni soluble egg antigen [SEA] and adult worm antigen [AWA], in presence of serum from each infected mothers groups, showed significantly higher suppressive activity than when the same lymphocytes were incubated with the same antigens in presence of serum from normal mothers group. This suppressive activity was transferred from S. mansoni infected mothers to their newborns' serum and maintained in their barest-fed infants' serum as donors' lymphocytes showed significantly higher suppressive activity in presence of serum from these two groups than in presence of serum from offspring of normal mothers. Serum from weaned children of S. mansoni infected mothers still showed suppressive activity significantly higher than serum from offspring of normal mothers but significantly lower than suppressive activity of serum from newborns and breast-fed infants of S. mansoni infected mothers. No significant difference in suppressive activity in presence of serum from different groups when donors' lymphocytes were stimulated by PHA indicating that this transferred suppressive activity is specific to S. mansoni antigens. Interleukin-10 [IL-10] production by donors' lymphocytes when stimulated by different stimulants showed results parallel to suppressive activity. Also, IL-10 production by donors' lymphocytes when stimulated by SEA and AWA in presence of serum from offspring of S. mansoni infected mothers showed highly significant positive correlation with suppressive activity of donors' lymphocytes when stimulated by the same antigens in presence of the same serum [P = 0.001 and < 0.001 respectively]. The parallelism and correlation between effect of serum on suppressive activity and IL-10 production suggest that IL-10 production is one of the main mechanisms by which serum affect lymphocytes transformation. These results suggest that the antischistosomal immunological status of S. mansoni infected mothers affects the future of their offspring when infected with S. mansoni and encourage studying the use of effective pathology modulating vaccines with mothers during pregnancy and lactation