Possible involvement of sialidase and sialyltransferase activities in a stage-dependent recycling of sialic acid in some organs of type 1 and type 2 diabetic rats.

Background: Type 1 (T1D) and type 2 (T2D) diabetes lead to an aberrant metabolism of sialoglycoconjugates and elevated free serum sialic acid (FSSA) level. The present study evaluated sialidase and sialyltranferase activities in serum and some organs relevant to diabetes at early and late stages of T1D and T2D. Methods: Sialic acid level with sialidase and sialyltransferase activities were monitored in the serum, liver, pancreas, skeletal muscle and kidney of diabetic animals at early and late stages of the diseases. Results: The FSSA and activity of sialidase in the serum were significantly increased at late stage of both T1D and T2D while sialic acid level in the liver was significantly decreased in the early and late stages of T1D and T2D, respectively. Furthermore, the activity of sialidase was significantly elevated in most of the diabetes-relevant organs while the activity of sialyltransferase remained largely unchanged. A multiple regression analysis revealed the contribution of the liver to the FSSA while pancreas and kidney contributed to the activity of sialidase in the serum. Conclusions: We concluded that the release of hepatic sialic acid in addition to pancreatic and renal sialidase might (in)directly contribute to the increased FSSA during both types of diabetes mellitus.

A comparison of fascia iliaca compartment block with intravenous analgesia to improve pain control in patients with femoral fracture.

Background: The most common approach to managing severe pain following femoral fracture is with intravenous systemic analgesics, such as opioid analgesics and non-steroidal anti-inflammatory drugs associated with side effects such as respiratory depression, nausea, and vomiting. These side effects might be intolerable in trauma patients and may result in under treatment of pain. Improving the quality of analgesia may reduce these intolerable side effects. Our study compared the efficacy of fascia iliaca compartment block (FICB) with intravenous analgesics for preoperative pain management of femoral fractures. Patients and Methods: The study was a quality improvement prospective randomised study, where 50 patients aged between 18 and 65 years, and American society of anesthesiologists I and II were recruited into two groups. Group A received FICB with a combination of 0.4 mL/kg of 0.5% plain bupivacaine and adrenaline 1:200,000 made up to 30 mL, while group B received placebo FICB using 30 mL normal saline. Also, group B received a combination of intravenous paracetamol 15 mg/kg not exceeding 900 mg and tramadol 1 mg/kg not exceeding 100 mg, while group A received an equal volume as normal saline intravenously. Results: The study revealed no significant difference in age, gender, associated injuries, X-ray description of fractures, and mechanism of injuries; however, there was a significant difference in the NRS-pain score at 30 min, summed pain intensity difference for 4 h and patient satisfaction in the FICB group compared to the standard group. Conclusion: The study revealed that FICB results in better pain control compared to a combination of intravenous tramadol and paracetamol in patients with femoral fractures.

The impact of scheduling ketamine as an internationally controlled substance on anaesthesia care in Sub-Saharan Africa: a case study and key informant interviews.

BACKGROUND: Access to anaesthesia and surgical care is a major problem for people living in Sub-Saharan Africa. In this region, ketamine is critical for the provision of anaesthesia care. However, efforts to control ketamine internationally as a controlled substance may significantly impact its accessibility. This research therefore aims to estimate the importance of ketamine for anaesthesia and surgical care in Sub-Saharan Africa and assess the potential impact on access to ketamine if it were to be scheduled. METHODS: This research is a mixed-methods study, comprising of a cross-sectional survey at the hospital level in Rwanda, and key informant interviews with experts on anaesthesia care in Sub-Saharan Africa. Data on availability of four anaesthetic agents were collected from hospitals (n = 54) in Rwanda. Semi-structured interviews with 10 key informants were conducted, collecting information on the importance of ketamine, the potential impact of scheduling ketamine internationally, and opinions on misuse of ketamine. Interviews were transcribed verbatim and analysed using a thematic analysis approach. RESULTS: The survey conducted in Rwanda found that availability of ketamine and propofol was comparable at around 80%, while thiopental and inhalational agents were available at only about half of the hospitals. Significant barriers impeding access to anaesthesia care were identified, including a general lack of attention given to the specialty by governments, a shortage of anaesthesiologists and migration of trained anaesthesiologists, and a scarcity of medicines and equipment. Ketamine was described as critical for the provision of anaesthesia care as a consequence of these barriers. Misuse of ketamine was not believed to be an issue by the informants. CONCLUSION: Ketamine is critical for the provision of anaesthesia care in Sub-Saharan Africa, and its scheduling would have a significantly negative impact on its availability for anaesthesia care.

Isolation, characterization and anti-inflammatory activity of compounds from the Vernonia amygdalina.

The need to explore the abundance of natural products cannot be overemphasized particularly in the management of various disease conditions. In traditional medical practice, Vernonia amygdalina has been widely adopted in the management of various inflammatory disorders. The objective of this investigation was to isolate the bioactive principles from the stem-bark and root of V. amygdalina and assess the anti-inflammatory (in vitro) activity of both the crude extracts and the isolated compounds. Following extraction with the methanol, the extract was subjected to gravity column chromatography and the resultant fractions was further purified to obtained pure compounds. The structural elucidation of the compounds were based on data obtained from 1H to 13C nuclear magnetic resonance (NMR) spectroscopies as well as fourier transform infrared (FT-IR). Using diclofenac as a control drug, the albumin denaturation assay was used to determine the in vitro anti-inflammatory activity of the extracts and isolates. Three distinct compounds characterized are vernoamyoside D, luteolin-7-α-o-glucuronide, and vernotolaside, a new glycoside. When compared to diclofenac, which has an IC50 of 167.8 µg/mL, luteolin-7-α-o-glucuronide, vernoamyoside D, and vernotolaside all showed significant inhibitions with respective IC50 values 549.8, 379.5, and 201.7 µg/mL. Vernotolaside is reported for the first time from the root. The assertion that the plant is used in traditional medicine for the management of inflammatory disorder is somewhat validated by the confirmation of the existence of the compounds with the biochemical actions. Further validation of the isolated compounds would be required in animal studies.

Antiplasmodial Activity of ß-Ionone and the Effect of the Compound on Amelioration of Anaemia and Oxidative Organ Damage in Mice Infected with Plasmodium berghei.

INTRODUCTION: Owing to evolution of parasite strains that are resistant to existing antimalarial drugs, research for novel antimalarial medicines is progressing on numerous fronts. PURPOSE: Herein, we evaluated the in vivo anti-Plasmodium berghei activity of ß-ionone including its ameliorative potential towards P. berghei-associated anaemia and oxidative organ damage. METHODS: Mice were infected with chloroquine-sensitive strain of P. berghei and then treated with ß-ionone at doses of 10 and 20 mg/kg body weight (BW) for seven days. The parasitemia, packed cell volume and redox sensitive biomarkers in the liver, brain and spleen were estimated. RESULTS: Our result showed that ß-ionone, in a dose-dependent fashion, significantly (p < 0.05) repressed the multiplication of P. berghei. More so, the compound, at doses of 10 and 20 mg/kg BW, significantly (p < 0.05) mitigated anaemia and organ damage induced by P. berghei. CONCLUSION: Overall, the findings demonstrated that ß-ionone has antiplasmodial actions and plays a mitigative role against P. berghei-induced anaemia and oxidative organ damage.

Therapeutic activity of eugenol towards mitigation of anaemia and oxidative organ damage caused by Plasmodium berghei.

The parasite responsible for causing malaria infection, Plasmodium, is known to exhibit resistance to a number of already available treatments. This has prompted the continue search for new antimalarial drugs ranging from medicinal plant parts to synthetic compounds. In lieu of this, the mitigative action of the bioactive compound, eugenol towards P. berghei-induced anaemia and oxidative organ damage was investigated following a demonstration of in vitro and in vivo antiplasmodial effects. Mice were infected with chloroquine-sensitive strain of P. berghei and thereafter treated with eugenol at doses of 10 and 20 mg/kg body weight (BW) for seven days. The packed cell volume and redox sensitive biomarkers in the liver, brain and spleen were measured. Our result demonstrated that eugenol significantly (p < 0.05) ameliorated the P. berghei-associated anaemia at a dose of 10 mg/kg BW. In addition, the compound, at a dose of 10 mg/kg BW, significantly (p < 0.05) alleviated the P. berghei-induced organ damage. This evidently confirmed that eugenol plays an ameliorative role towards P. berghei-related pathological alterations. Hence, the study opens up a new therapeutic use of eugenol against plasmodium parasite.

Lignin from Brewers' Spent Grain: Structural and Thermal Evaluations.

Lignocellulose is a renewable ubiquitous material that comprises cellulose, hemicellulose, and lignin. Lignin has been isolated from different lignocellulosic biomass via chemical treatments, but there has been little or no investigation carried out on the processing of lignin from brewers' spent grain (BSG) to the best of authors' knowledge. This material makes up 85% of the brewery industry's byproducts. Its high moisture content hastens its deterioration, which has posed a huge challenge to its preservation and transportation; this eventually causes environmental pollution. One of the methods of solving this environmental menace is the extraction of lignin as a precursor for carbon fiber production from this waste. This study considers the viability of sourcing lignin from BSG with the use of acid solutions at 100 °C. Structural and thermal analyses were carried out on extracted samples, and the results were compared with other biomass-soured lignin to assess the proficiency of this isolation technique. Wet BSG sourced from Nigeria Breweries (NB), Lagos, was washed and sun-dried for 7 days. Tetraoxosulphate (VI) (H2SO4), hydrochloric (HCl), and acetic acid, each of 10 M, were individually reacted with dried BSG at 100 °C for 3 h and designated as H2, HC, and AC lignin. The residue (lignin) was washed and dried for analysis. Wavenumber shift values from Fourier transform infrared spectroscopy (FTIR) show that intra- and intermolecular OH interactions in H2 lignin are the strongest and possess the highest magnitude of hydrogen-bond enthalpy (5.73 kCal/mol). The thermogravimetric analysis (TGA) results show that a higher lignin yield can be achieved when it is isolated from BSG, as 82.9, 79.3, and 70.2% were realized for H2, HC, and AC lignin. The highest size of ordered domains (0.0299 nm) displayed by H2 lignin from X-ray diffraction (XRD) informs that it has the greatest potential of forming nanofibers via electrospinning. The enthalpy of reaction values of 133.3, 126.6, and 114.1 J/g recorded for H2, HC, and AC lignin, respectively, from differential scanning calorimetry (DSC) results affirm that H2 lignin is the most thermally stable with the highest glass transition temperature (Tg = 107 °C).

Biological functions and structural biology of Plasmodium falciparum autophagy-related proteins: The under-explored options for novel antimalarial drug design.

Malaria remains a threat to global public health and the available antimalarial drugs are undermined by side effects and parasite resistance, suggesting an emphasis on new potential targets. Among the novel targets, Plasmodium falciparum autophagy-related proteins (PfAtg) remain a priority. In this paper, we reviewed the existing knowledge on the functions and structural biology of PfAtg including the compounds with inhibitory activity toward P. falciparum Atg8-Atg3 protein-protein interaction (PfAtg8-PfAtg3 PPI). A total of five PfAtg (PfAtg5, PfAtg8, PfAtg12, PfAtg18, and Rab7) were observed to have autophagic and/or non-autophagic roles. Available data showed that PfAtg8 has conserved hydrophobic pockets, which allows it to interact with PfAtg3 to form PfAtg8-PfAtg3 PPI. Additionally, 2-bromo-N-(4-pyridin-2-yl-1,3-thiazol-2-yl) benzamide was identified as the most powerful inhibitor of PfAtg8-PfAtg3 PPI. Due to the dearth of knowledge in this field, we hope that the article would open an avenue to further research on the remaining PfAtg as possible drug candidates.

Artificial Intelligence Based Approach for Classification of Human Activities Using MEMS Sensors Data.

The integration of Micro Electronic Mechanical Systems (MEMS) sensor technology in smartphones has greatly improved the capability for Human Activity Recognition (HAR). By utilizing Machine Learning (ML) techniques and data from these sensors, various human motion activities can be classified. This study performed experiments and compiled a large dataset of nine daily activities, including Laying Down, Stationary, Walking, Brisk Walking, Running, Stairs-Up, Stairs-Down, Squatting, and Cycling. Several ML models, such as Decision Tree Classifier, Random Forest Classifier, K Neighbors Classifier, Multinomial Logistic Regression, Gaussian Naive Bayes, and Support Vector Machine, were trained on sensor data collected from accelerometer, gyroscope, and magnetometer embedded in smartphones and wearable devices. The highest test accuracy of 95% was achieved using the random forest algorithm. Additionally, a custom-built Bidirectional Long-Short-Term Memory (Bi-LSTM) model, a type of Recurrent Neural Network (RNN), was proposed and yielded an improved test accuracy of 98.1%. This approach differs from traditional algorithmic-based human activity detection used in current wearable technologies, resulting in improved accuracy.

Predicting Major Complications Following Laparotomy for Gastrointestinal Conditions Using Surgical Apgar Score: A Prospective Analysis in a Nigerian Population.

Background: Surgical Apgar score (SAS) is one of the risk assessment tools used in predicting postoperative complications. It is a simple and inexpensive tool composed of three intra-operative variables; lowest heart rate, lowest mean arterial blood pressure, and estimated blood loss, which are scored with a total of 10 points, based on which patients are risk stratified for developing post-operative complications. SAS was found to have good predictive accuracy for post-operative morbidity and mortality. The main objective of this study was to determine the efficacy of SAS in predicting major complications following laparotomy for gastrointestinal conditions. Materials and Methods: The study was a prospective observational study, conducted in Aminu Kano Teaching Hospital, Kano, Nigeria. Eighty-three adult patients, who required laparotomy for gastrointestinal conditions were recruited. Data was collected using proforma, and patients were followed up for 30 days. The intra-operative parameters for SAS were scored, and according to the scores, patients were risk stratified for developing post-operative complications. The data were analyzed; sensitivity, specificity, and accuracy of the SAS were determined. Results: A total of 83 patients were recruited in the study. About half (44.6%) of the patients developed major post-operative complications and a mortality rate of 7.2%. Most of the patients that died had low SAS. The sensitivity, specificity, accuracy, and AUC of SAS found were: 83.8%. 47.8%, 63.9% and 0.74 (95% CI; 0.63-0.84, P < 0.001) respectively. Conclusion: This study revealed that SAS is efficacious in predicting major complications following laparotomy for gastrointestinal conditions.

Adenoid and Tonsil Hypertrophy in Zaria, North Western Nigeria: Review of Clinical Presentation and Surgical Outcome.

Background: Adenotonsillar hypertrophy is one of the most common childhood disorder that necessitates presentation to the ear nose and throat specialist. The disorder may be managed conservatively or by surgery. Aim: To highlight the clinical presentation and surgical treatment outcome of patients managed for adenoid and tonsillar hypertrophy at Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Materials and Methods: The case records of patients managed for adenoid and tonsil hypertrophy were reviewed from January 2013 to December 2017 at the Division of Otorhinolaryngology, Department of Surgery Ahmadu Bello University Teaching hospital Zaria, - Northwestern Nigeria. Case notes with incomplete information and /or missing pages were excluded. The data were analyzed using IBM SPSS (for windows, version 23). Results: There were 56 (55.4%) males and 45 (44.6%) females with male to female ratio of 1.2:1. Their ages ranged from 2-16 years with a mean and standard deviation of 4.0 and 3.2 respectively. The most common symptom at presentation was snoring 85 (84.2%) followed by rhinorrhea 81(80.2%). Findings from the radiologic investigations revealed that majority of the patients had severely narrowed nasopharyngeal air column 83(82,2%) Adenotonsillectomy was the most common surgery performed on most of the patients 63(62.4%) who presented with adenotonsillar hypertrophy. Majority of the patients 95(94.1%) had resolution of symptoms within the period of follow up. Four (4.0%) of them had recurrent adenoidal growth. Conclusion: Snoring, rhinorrhea and mouth breathing were the most common symptoms of adenotonsillar hypertrophy. The outcome of adenotonsillar surgeries in our patients is good, with the majority having resolution of symptoms.

Practices and perception of healthcare workers towards infection control measures during the COVID-19 pandemic: a cross-sectional online survey from Nigeria.

INTRODUCTION: This study investigated the practices and perceptions of Health care workers (HCWs) in Nigeria towards infection control practices during the COVID-19 pandemic. METHODOLOGY: This cross-sectional study was conducted among HCWs in Nigeria healthcare facilities using a 25-item validated online questionnaire. The hyperlink of the questionnaire was shared with the various professional associations/societies and hospitals in June 2020. RESULTS: A total of 426 HCWs completed the questionnaire with pharmacists (28.8%), nurses/midwives (22.7%) and medical doctors (20.1%) being the highest respondents. Less than 50% of the HCWs had previous training on COVID-19 and how to use personal protective equipment (PPE). Only one in five HCWs had access to adequate PPE during the COVID-19 pandemic. Overall, the HCWs had good infection control practices with better practices observed among those who attended training on COVID-19 infection and those trained on how to use PPE. Lack of funds to purchase PPEs (55.3%), lack of access to PPE (52.5%) and lack of training on how to use PPE (44.0%) were the most common barriers to adherence to infection control guidelines. CONCLUSIONS: HCWs in Nigeria have limited access to adequate PPE and lack adequate support from health authorities. Attendance of training on the use of PPE and COVID-19 infection were associated with access to adequate PPE and better infection control practices. Training of HCWs, provision of adequate PPE, and support are recommended to improve compliance with infection control guidelines.

Contemporary trends in the incidence of spontaneous coronary artery dissection (SCAD) - ethnic and household income disparities.

OBJECTIVES: Spontaneous coronary artery dissection (SCAD) may contribute to 35% of acute coronary syndrome among women ≤50 years of age. We aimed to investigate the overall incidence, as well as the trends of SCAD incidence based on race, household income, and the U.S. census regions utilizing the National Inpatient Sample. METHODS: In this retrospective cohort study the discharge data were extracted from the NIS using 9th and 10th revisions of the International Classification Disease for SCAD. RESULTS: We found that the incidence of SCAD is rising in all U.S. census regions, and patients were predominantly females. Overall crude incidence of SCAD per 1,000,000 discharges per year was found to be 4.95 (2010), 5.73 (2011), 5.34 (2012), 6.18 (2013), 7.64 (2014), 8.11 (2015), 14.58 (2016), and 14.81 (2017). There was a higher incidence of SCAD in white population and higher-income groups. Among U.S. census regions, West has had the highest incidence followed by the Northeast, Midwest, and South. Statistically significant differences were observed in year-to-year SCAD incidence among racial groups, household income quintiles, and U.S. census regions (P < 0.0001). CONCLUSION: Recent trends indicate that the incidence is highest among White race, highest household income quintile, and in U.S. CENS-R4 (Census Region 4: West). These findings defy classic racial trends in cardiovascular disease burden which need further discovery.

Speech as a Biomarker for COVID-19 Detection Using Machine Learning.

The use of speech as a biomedical signal for diagnosing COVID-19 is investigated using statistical analysis of speech spectral features and classification algorithms based on machine learning. It is established that spectral features of speech, obtained by computing the short-time Fourier Transform (STFT), get altered in a statistical sense as a result of physiological changes. These spectral features are then used as input features to machine learning-based classification algorithms to classify them as coming from a COVID-19 positive individual or not. Speech samples from healthy as well as "asymptomatic" COVID-19 positive individuals have been used in this study. It is shown that the RMS error of statistical distribution fitting is higher in the case of speech samples of COVID-19 positive speech samples as compared to the speech samples of healthy individuals. Five state-of-the-art machine learning classification algorithms have also been analyzed, and the performance evaluation metrics of these algorithms are also presented. The tuning of machine learning model parameters is done so as to minimize the misclassification of COVID-19 positive individuals as being COVID-19 negative since the cost associated with this misclassification is higher than the opposite misclassification. The best performance in terms of the "recall" metric is observed for the Decision Forest algorithm which gives a recall value of 0.7892.

High-carbohydrate diet lacked the potential to ameliorate parasitemia and oxidative stress in mice infected with Plasmodium berghei.

The search for a novel prophylactic agent against malaria is on the rise due to the negative socio-economic impact of the disease in tropical and subtropical regions of the world. Sequel to this, we evaluated the in vivo anti-Plasmodium berghei activity of a high-carbohydrate diet as well as the effects of the diet on parasite-associated anemia and organ damage. Mice were fed with either standard or a high-carbohydrate diet for 4 weeks and subsequently infected with chloroquine-sensitive strain of P. berghei. The levels of parasitemia, blood glucose, packed cell volume, and redox sensitive biomarkers of brain and liver tissues were measured. Data from this study showed that high-carbohydrate significantly (p < 0.05) aggravated the multiplication of P. berghei in the animals. Furthermore, our result demonstrated that blood glucose level in P. berghei-infected mice fed with a high-carbohydrate diet was insignificantly (p > 0.05) depleted. Additionally, our findings revealed that high-carbohydrate did not demonstrate a significant (p < 0.05) ameliorative potentials against P. berghei-induced anemia and oxidative stress in the brain and liver tissues. We concluded that high-carbohydrate diet was unable to suppress P. berghei upsurge and accordingly could not mitigate certain pathological alterations induced by P. berghei infection.

Clinical profile and treatment outcome of laryngeal cancer in a Nigerian Tertiary hospital.

BACKGROUND: Laryngeal cancer is one of the most common malignancies of the upper aerodigestive tract worldwide, and its management may sometimes be challenging, especially in developing countries due to late presentation, poverty and limited resources. AIM: This study aims to highlight the clinical profile and treatment outcome of laryngeal cancer in our centre. PATIENTS AND METHODS: This was a retrospective review of patients who were managed for laryngeal cancer between January 2011 and December 2020. RESULTS: There were 90 (89.1%) males and 11 (10.9%) females, with a male-to-female ratio of 8.2:1. The age ranged from 22 to 82 years, with a mean age of 57.2 ± 12.7 years. Fifty patients (49.5%) presented more than 1 year after the onset of the symptoms. Squamous cell carcinoma (SCCA) was the only histological diagnosis observed in our patients. The laryngeal cancer was transglottic in location in 45 (44.6%) patients, while 50 (49.5%) patients presented with Stage III disease. Twenty-one (20.8%) patients had total laryngectomy. Amongst the patients managed, 17 (17.0%) were still on follow-up. Up to 37 (37.0%) were referred for radiotherapy elsewhere after chemotherapy. Forty-one of the patients (40.0%) died during the course of their management. There was a statistically significant association between having definitive surgical management and survival beyond 5 years (Chi-square test = 8.635, P = 0.003). CONCLUSION: Majority of the patients presented late with transglottic SCCA. Surgical extirpation of the lesion was associated with better prognosis in our patients.

A High-Order EMSIW MIMO Antenna for Space-Constrained 5G Smartphone.

This paper proposes a high-order MIMO antenna operating at 3.5 GHz for a 5G new radio. Using an eighth-mode substrate integrated waveguide (EMSIW) cavity and considering a typical smartphone scenario, a two-element MIMO antenna is developed and extended to a twelve-element MIMO. These MIMO elements are closely spaced, and by employing multiple diversity techniques, high isolation is achieved without using a decoupling network. The asymmetric EMSIW structures resulted in radiation pattern diversity, and their orthogonal placement provides polarization diversity. The radiation characteristics and diversity performance are parametrically optimized for a two-element MIMO antenna. The experimental results exhibited 6.0 dB and 10.0 dB bandwidths of 250 and 100 MHz, respectively. The measured and simulated radiation patterns are closely matched with a peak gain of 3.4 dBi and isolation ≥36 dB. Encouraged with these results, higher-order MIMO, namely, four- and twelve-element MIMO are investigated, and isolation ≥35 and ≥22 dB are achieved, respectively. The channel capacity is found equal to 56.37 bps/Hz for twelve-element MIMO, which is nearly 6.25 times higher than the two-element counterpart. The hand and head proximity analysis reveal that the proposed antenna performances are within the acceptable limit. A detailed comparison with the previous works demonstrates that the proposed antenna offers a simple, low-cost, and compact MIMO antenna design solution with a high diversity performance.

Should Ketamine Not Be Banned? A Scoping Review.

OBJECTIVES: Although the importance of ketamine in clinical practice and in resource-poor settings and disaster zones, several attempts were made to reschedule it because of the issues around its misuse. Resisting future moves to reschedule ketamine is important for its continuous availability where needed. This scoping review addresses the question of whether ketamine should or should not be banned and the state of preparedness of low resource settings if ketamine petitions become successful in the future. METHODS: A search was performed using PubMed and Google Scholar to identify articles published in the English language from March 2015 to August 2020. The articles were searched with a wide range of priori search terms related to the research questions. The selection of articles was based on relevance and eligibility. RESULTS: Seventy-five articles were selected and grouped into 4 ethical themes. The search revealed that several articles addressed the importance of ketamine, pharmacology, misuse, supply, and consequences of a ketamine ban; however, none addressed how resource-poor countries should prepare for a future without the overreliance of ketamine. CONCLUSION: Four ketamine petitions in about 10 years are an indication that another may resurface soon; therefore, it is important to continue to study the clinical importance of ketamine while discouraging its overreliance for clinical practice.