Benefits of the enhanced recovery after surgery pathway for orthognathic surgery.

The enhanced recovery after surgery (ERAS) protocol was designed to improve patient outcomes and decrease complications, opioid use, and postoperative nausea and vomiting (PONV). The aim of this retrospective cohort study was to examine the effectiveness of ERAS protocols implemented in orthognathic surgeries from 2017 to 2018 at the University of Alabama at Birmingham Hospital by measuring opioid use and PONV. Two groups were identified through chart review, a non-ERAS group (traditional) of patients who had surgery without a protocol and an ERAS group of patients who had surgery with the ERAS protocol. The anesthesia and surgical teams followed a standardized protocol for perioperative management. All procedures were performed by a single surgeon and included single- and double-jaw surgeries and adjunctive procedures. The patient charts were analyzed for postoperative opioid consumption (measured in morphine milligram equivalents, MME) and PONV. IBM SPSS Statistics version 26 was used to conduct the statistical analyses. The ERAS group received less opioids during the postoperative period than the control group (31.2 MME vs 54.6 MME, P= 0.002). The ERAS group also had a lower incidence of PONV, with 1.2 episodes of PONV compared to 2.4 episodes in the non-ERAS group (P= 0.008). This study demonstrates that the ERAS protocol is effective in decreasing postoperative opioid consumption and PONV.

Anti-dermatophyte activity of Leguminosae plants from Southern Brazil with emphasis on Mimosa pigra (Leguminosae).

BACKGROUND: Intensive prophylactic use of antifungals leads to the increase of drug resistance and the need for new and more effective treatments are real. Plants from Leguminosae family are rich in flavonoids, for which numerous biological activities have been described, including antifungal effects. PURPOSE: To screen methanolic extracts from Leguminosae species looking for alternative sources for antifungal agents (anti-dermatophyte and anti-Candida) and their innocuity. METHODS: Antifungal activity was evaluated using the strains Candida albicans, C. krusei, C. glabrata, C. tropicalis, C. parapsilosis, Epidermophyton floccosum, Trichophyton mentagrophytes, T. rubrum and, Microsporum gypseum in the broth microdilution method. Later, the minimum inhibitory concentration (MIC) for Mimosa pigra, Eriosema heterophyllum, and Chamaecrista nictitans was determined. The most promising extract was fractionated and cytotoxicity and genotoxicity of the most active fraction were also assayed. RESULTS: Fungicide and/or fungistatic activity against dermatophyte strains were presented by 60% of the methanolic extracts assayed. M. pigra, E. heterophyllum, and C. nictitans methanolic extracts could inhibit dermatophyte strains at concentrations ranging from 1.9 to 1000µg/mL. M. pigra showed the lowest MIC values for a dichloromethane fraction (1.9µg/mL) without DNA damage at 10 and 50µg/mL and 100% of cell viability of human leukocytes. CONCLUSION: Our results indicate that methanolic extracts from Leguminosae plants are potential sources of antifungal compounds, mainly the extract and fractions from M. pigra. The dichloromethane fraction from M. pigra did not showed in vitro toxicity according to the applied assays.