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Objectives: To assess the influence of digital strategies on individual behaviour, considerations, and decisions regarding health issues. To evaluate the impact of digital advertisements on the decision to receive vaccines, take the COVID-19 vaccination as a case report. Methodology: A structured 5-axes questionnaire was distributed through a Google form and completed by 351 participants. The investigated variables were information, “discomfort, anxiety, and fear,” motivation, reference groups, and the decision to take the vaccine. The reliability analysis was carried out to assess the internal consistency of the study elements. Multicollinearity and multiple regression analyses were utilized to evaluate the research hypothesis. Results: A positive correlation and robust internal consistency between the variables were confirmed. The overall Cronbach’s alpha (α) is 0.93, indicating a solid association between the variables and the consistency of the measuring scale. The information, emotion, motivation, and reference group have a moderate level of importance with average mean values of 3.61, 3.74, 3.55, and 3.88, respectively. The correlation of the decision to take the vaccine with the information and the emotion variables was the highest (Pearson’s correlation of 0.675 and 0.676, respectively). The motivation and reference groups showed lower associations (Pearson’s correlation of 0.558 and 0.496). The results of the multiple linear regression analysis (α ≤ 0.05) confirm the hypothesis by demonstrating that the independent variables significantly influenced the decision to take the vaccine. The F-value (98.26) and significance level (p < 0.00) provide further validation of the model. Conclusion: Information and emotional concerns significantly impact health decision-making, while motivation and reference groups have a considerable role. It is a warranty of expanding digital strategies to improve health literacy and equity.

Abstract Background The leaves of Erlangea tomentosa (ET) are used to treat several bacterial infections like respiratory tract infections, skin infections, diarrhea and gastrointestinal disorders. However, there is limited information about the compounds responsible for its bacterial activities. The study aimed at isolation and characterisation of phytochemicals from the leaf extracts of ET. Results Three compounds were isolated from leaf extracts of ET and characterised. Two compounds; eriodictyol-7-O-β-glucoside (1) and 5, 7, 3′, 4′-tetrahydroxy-7-O-[6"-O-(acetyl)-β-D-glucopyrancsyloxy]-flavanone (coccinoside A) (2) were identified from ethyl acetate extract while one compound; di-(2-ethylhexyl) phthalate (3) was identified from dichloromethane extract. Conclusion Compounds; 1, 2 and 3 were isolated and identified from ET and genus Erlangea for the first time. The reported antibacterial properties of compound 3 in literature could be responsible for the antibacterial activities of ET and the traditional use of ET.

Background: Pregnancy imposes unique physiological requirements on the mother’s thyroid gland to meet the thyroid hormone demands both for her and the fetus. A lack of consensus in current guidelines on diagnosing thyroid dysfunction during pregnancy and administering levothyroxine raises concerns regarding treatment efficacy. As hypothyroidism—subclinical or overt—is a recognized risk factor for an unfavorable pregnancy outcome, the administration of excessive or unneeded therapy can also lead to complications. Objective: This study aims to evaluate the prevalence of levothyroxine replacement therapy among euthyroid pregnant women. Materials and methods: A retrospective cohort study was conducted using the data from 6237 pregnant women who delivered at the OB/GYN Hospital “Dr. Shterev” in Sofia, Bulgaria, between January 2017 and December 2022. Thyroid function data were available for 1746 pregnant women meeting inclusion criteria: aged > 18 years, with singleton pregnancies, and thyroid hormone level tests conducted no later than mid-second trimester. Results: According to pregnancy-specific thyroid disorder diagnostic criteria, patients were categorized into euthyroid (n = 1066), subclinical hypothyroidism (n = 421), overt hypothyroidism (n = 48), isolated maternal hypothyroxinemia (n = 160), gestational thyrotoxicosis (n = 46), and Graves’ disease (n = 5). Analysis revealed that 37.7% (n = 401) of euthyroid pregnant women were prescribed levothyroxine. Only 22.9% (n = 92) of euthyroid women received hormone replacement therapy due to autoimmune thyroiditis. Conclusion: Our findings prompt consideration regarding the appropriateness of levothyroxine therapy for euthyroid pregnant women. Clear guidance is warranted on the initiation of hormone replacement therapy during pregnancy.

Diabetic peripheral neuropathy (DPN) is a common comorbid in diabetic patients. Oxidative stress and inflammation are key to DPN’s etiology, making them possible therapy targets. Red fruit oil (RFO) may treat DPN due to its antioxidant and anti-inflammatory properties. The RFO effect in the streptozotocin (STZ)-induced DPN model was examined in terms of spinal cord oxidative and inflammatory functions. STZ 55 mg/kg BW intraperitoneally caused DPN. Seven weeks after induction, rats received vehicle, pregabalin, or RFO at 0.3, 0.6, or 1.2 mL/kg BW for three weeks. Post-treatment thermal hyperalgesia and cold allodynia were examined. Measurements of spinal levels of malondialdehyde (MDA), catalase, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), inducible nitric oxide (iNOS), and nuclear factor-kappa beta (NFκB) were used to measure oxidative and inflammatory indices. In addition, spinal histology was examined. All metrics improved after three weeks of RFO treatment. RFO at 0.6 and 1.2 mL/kg BW significantly reduced MDA, TNF-α, IL-6, iNOS, and NFκB while raising catalase levels. These matched thermal and cold stimulus latency improvements. Additionally, STZ-induced spinal cellular damage was reduced. This study suggests that RFO may be an alternate DPN treatment.

High-flow non-invasive ventilation (NIV) devices reduce the morbidity and mortality of COVID-19. The objective was to evaluate the use of the non-invasive ventilation device with high-flow helmet CPAP designed in Peru in patients with severe acute respiratory syndrome (COVID-19) hospitalized in the emergency services of five hospitals. Prospective multicenter and cross-sectional observational study from five hospitals from July to August 2020. 19 patients were recruited and divided into two groups (G-1 n = 10; G-2 n = 9) applying clinical and gasometric parameters as indicators of disease evolution upon hospital admission and within 24 hours. A progressive increase in these parameters was observed in those patients who used the NIV CPAP helmet within the first 24 hours. In G-01, improvement was evident in 90% (n = 9/10): PaO2 (range 48–137; average: 82.49 ± 8.07; p-value = 0.008), CO2 (25.2–51.0; 36.62 ± 2.62; p-value p = 0.327), and the PaO2/FiO2 coefficient (87–318; 191.5 ± 18.68). 10% of patients did not progress optimally, being subjected to endotracheal intubation and invasive mechanical ventilation. In G-02 the values ​​were %SatO2 (range 92–98; 96 ± 0.76) and the SaO2/FiO2 coefficient (214–228; 223.2 ± 1.80), indicating significant improvement within 24 hours (p < 0.001). It is concluded that the use of the CPAP helmet non-invasive ventilation (NIV) device contributes to improving gasometric values ​​and clinical condition. Being an alternative to recover typical cases of COVID-19 in all hospitals in Peru.

Cancer remains one of the most lethal diseases globally, with CHK1 being a critical pathway frequently altered in cancer progression. This study evaluated the anticancer and cytotoxic properties of the ethanol extract of Matoa (Pometia pinnata) leaves in silico and in vitro. Maceration was conducted to obtain the ethanol extract with physicochemical, pharmacokinetic, and toxicity predictions conducted using Lipinski’s Rule of Five, pkCSM, and Pro-Tox II. Molecular docking was performed using Autodock Vina and DOCK6.2, followed by molecular dynamic simulations using GROMACS. Cytotoxicity assays on MCF-7 cells were carried out using the MTT methods. The results demonstrated that the extract tested positive for flavonoids, alkaloids, tannins, saponins, glycosides, and steroids. The extract also shows potential inhibitory activity against CHK1, supported by favorable binding affinities and critical amino acid interactions. Additionally, the extract exhibited a moderate cytotoxic effect on cell MCF-7 with an IC50 of 139 µg/mL.

Introduction: Primary tumor resection can prevent future tumor-related complications in patients with stage IV colorectal cancer. This may influence the quality of life and prevent colostomies associated with the emergency surgery. Laparoscopic approach plays an important role in attempts to reduce perioperative complications in this specific group of patients. Purpose: The aim is to assess early perioperative results in a group of 17 patients with stage IV colorectal cancer—multiple incurable liver metastases and/or pulmonary/peritoneal metastases of the disease. On the other hand, postoperative complications may delay administration of chemotherapy and influence survival. Materials and methods: We analyze retrospectively the perioperative results in a group of 17 patients with laparoscopic palliative colorectal resections for stage IV colorectal cancer. Assessment includes perioperative complications, median hospital stay, perioperative blood loss, need for blood transfusion, operative time, and type of surgical procedure. Results: We performed totally laparoscopic 10 sigmoid resections, five left colectomies, and two right colectomies. Fourteen simultaneous liver biopsies were performed during laparoscopy. No perioperative deaths were registered. Perioperative mortality rate is 0%. Perioperative morbidity rate is 0%. No perioperative complications. The median perioperative stay is 5.3 days. Median blood loss is 47.9 mL. Overall, three units of blood were transfused. The median transfusion rate is 0.17 units per patient. The median operative time is 130.2 minutes. Conclusion: The laparoscopic approach is associated with very good perioperative results in patients with stage IV colorectal cancer and palliative resection of the primary tumor. Early hospital discharge and minimal operative trauma may not influence early administration of chemotherapy.

Drug-induced liver injury (DILI) is a serious complication of many drugs, including carbamazepine; this study investigates the protective effect of pentoxifylline (PTX) against DILI induced by carbamazepine in rat models by attenuating CYP3A4 and NF-κB gene expression. Forty rats were divided into five groups: the control group received no treatment, the induction group received 50 mg/kg carbamazepine orally for 28 days, and three groups received PTX (100, 200, and 300 mg/kg) once daily for one hour before carbamazepine induction for 28 days. Then, the rats were euthanized, and blood and liver tissue were collected for biochemical, gene expression, and histopathology. PTX attenuates the carbamazepine-induced increased CYP3A4 and NF-κB gene expression, with the highest dose showing the best result. PTX also reduced aspartate aminotransferase, alanine aminotransferase, and malondialdehyde, while glutathione levels increased. In conclusion, PTX is highly efficacious in preventing and restoring the liver cells’ normal morphology and cellular function caused by carbamazepine hepatotoxicity. A possible mechanism of the PTC effect is hindering oxidative stress by scavenging free radicals and enhancing the body’s natural defense antioxidant system. Additionally, it exerts an anti-inflammatory impact by modulating NF-κB gene expression.

Chronic heart failure (CHF) is a severe condition that affects millions of people worldwide. Despite standardized treatments, patients often face recurrent symptoms such as dyspnea, edema, and fatigue, which impair their quality of life and contribute to high mortality and hospital readmission rates. Traditional Chinese Medicine (TCM) offers alternative therapies, and Qishen Yiqi Dropping Pills (QYDP) has emerged as a potential treatment for CHF. QYDP is composed of Danshen, Huangqi, Jiangxiang, and Sanqi and is known for its ability to promote circulation, enhance Qi, and support cardiac health. Although clinical studies have suggested that QYDP can alleviate CHF symptoms, the underlying molecular mechanisms are not fully understood. In this study, network pharmacology and molecular docking were used to explore the pharmacological targets of QYDP for CHF treatment. Four core genes were identified: AKT1, HIF1A, STAT3, and MYC. Molecular docking confirmed the interactions between these genes and active compounds in QYDP, such as kaempferol, luteolin, quercetin, tanshinone IIa, and cryptotanshinone. These findings suggest that QYDP may treat CHF through a multitarget mechanism, offering new insights into its therapeutic potential and providing a basis for further clinical research.

Clinical registries play an increasingly important role in determining national health policy, financial effectiveness, and generating scientific hypotheses. However, there is no universally accepted structure for these registries in Europe or worldwide. Many countries face significant challenges in organizing their clinical registries, considering the local peculiarities of the healthcare system, political organization, financial constraints, and labor capabilities. When organizing a national registry, it is essential to find the right balance between available resources, structure, and the benefits obtained—whether scientific, financial, or related to local health policy. A possible, but incomplete, quantitative assessment of the scientific usefulness of a registry can be determined through bibliometric analysis, which examines the number of unique published articles containing scientific analyses based on the respective registry. Our study aims to analyze the correlation between various registry characteristics and the scientific value of 16 national coronary registries in Europe (plus the USA), examining the number of unique published articles in PubMed.

A study was conducted to synthesize a new set of compounds named comp.4–7 using the 1,3,4 tautomer of oxadiazole as the centroid unit. These compounds were subjected to various characterization processes, including thin-layer chromatography, infrared spectroscopy, and 1HNMR spectroscopy. The study was based on previous research that established several compounds’ diverse range of biological activities, such as hydrazide Schiff’s bases (hydrazones), oxadiazoles, thiophenes, and isoxazoles. These compounds had been found to possess properties against bacteria, fungi, TB, viruses, cancer cells, and inflammatory responses, as well as analgesic properties. The results of the docking study were conducted in MOE software, targeting the largest binding site of E. coli gyrase B (PDB: 6YD9) as identified by SITE FINDER, suggesting that these compounds had great potential to be effective antibacterial agents. To evaluate the synthesized compounds antibacterial activities, the well diffusion method was used, and the findings revealed that the synthesized compounds exhibit slight to moderate activities against E. coli, S. aureus, and K. pneumoniae.

Creams are semisolid dosage forms widely used for pharmaceutical and cosmetic purposes due to their pleasant appearance, easy spreadability, and the possibility to deliver hydrophobic and hydrophilic active agents. The aim of the current study was to evaluate the impact of type and concentration of different oil phases on the mechanical and rheological properties of cosmetic creams. For this purpose, a series of blank and anti-age creams were prepared applying the hot homogenization method (9000 rpm for 5 minutes). The blank creams contained an emulsifying base (Neofin Nat 8% w/w) and varying types of lipid phase: 1) babassu oil (8% w/w), 2) Cannabis sativa (2% w/w) and Camelina sativa (6% w/w) oils, 3) babassu (6% w/w) and Cannabis sativa (2% w/w) oils, and 4) babassu (6% w/w) and Camelina sativa (2% w/w) oils. The anti-age creams contained additionally Jasminum sambac flower extract (5% w/w) and Аrgireline® solution (5% w/w). The spreading, mechanical, and rheological properties of the developed formulations were investigated. The anti-age cream based on babassu (6% w/w) and Camelina sativa (2% w/w) oils exhibited suitable textural and rheological characteristics that would facilitate its application onto skin and provide sufficient contact time to exert its beneficial effects.

Abstract A number of species have developed detoxification strategies that allow them to accumulate high amounts of heavy metals in their tissues and grow despite a high heavy metal (HM) concentration in soils. Thus, they are considered hyperaccumulator or accumulator species, attractive for phytoremediation purposes. Families reported to contain a high number of hyperaccumulator species are Asteraceae, Euphorbiaceae, Rubiaceae, Fabaceae, Scrophulariaceae, Myrtaceae, Proteaceae, Caryophylaceae, and Tiliaceae. Indeed, the family Scrophulariaceae has a large extension, with Buddleja, Eremophila, Scrophularia, and Verbascum being some of the best-known genera containing species used for medicinal purposes. This review focuses on identifying the species used in folk medicine that belong to these four genera and can accumulate high concentrations of heavy metals (HMs). Additionally, the human health risks related to the consumption of HM hyperaccumulator species are discussed, as well as the feasibility of plant tissue culture to provide safe vegetal material for medicinal uses or to estimate the intrinsic potential of species for phytoremediation purposes. The following species have demonstrated the ability to accumulate HMs and grow in mine or HM-polluted soils, as well as use in traditional medicine: Buddleja asiatica, B. cordata, B. davidii, B. lindleyana, B. macrostachya, B. paniculata, B. scordioides, Eremophila latrobei, Scrophularia canina subsp. bicolor, S. ningpoensis, S. striata, Verbascum bombyciferum, V. olympicum, V. phrygium, and V. thapsus. In some of these species, antioxidant machinery has been proven to participate as a defense strategy against exposure to high HM concentrations. Consuming plants that accumulate high amounts of HMs has been described as a potential risk to human health. Plant tissue culture has also been established in a few of these species, whether to propagate or use them as a bioactive phytochemical source. Promoting safety and quality control related to the HM concentrations in the tissues of these plants used by populations for curative purposes is necessary. Further research must be carried out on several species for phytoremediation purposes. Graphical abstract

Abstract Background Antimicrobial resistance (AMR) is a major worldwide health concern, characterized by the ability of microorganisms to withstand the effects of medications that once effectively treated infections. Phage therapy has emerged as a promising alternative for management of multidrug-resistant (MDR) bacterial infections. Acinetobacter baumannii (A. baumannii) exemplifies the emergence of bacteria resistant to clinically relevant antimicrobials, leading to severe nosocomial infections and exhibiting extensive and pan drug-resistant (XDR and PDR) traits. In response, this study isolated A. baumannii virulent phage designated as vB_AbaP_PhE54 against carbapenem-resistant A. baumannii (CRAB) pathogen and examined its morphological characteristics using an electron micrograph. Phage stability at different temperatures, pH, chloroform, safety, therapeutic evaluation, and growth kinetics have been analyzed. Results The A. baumannii phage vB_AbaP_PhE54 belongs morphologically to the Podoviridae family with very short, noncontractile tails, the phage demonstrated high thermal tolerance and infectivity across a pH range of 4–11, although it displayed a narrow host range. One-step growth kinetics indicated a burst size of 85 PFU (Plaque Forming Unit) per infected cell and a latent period of 20 min. Additionally, therapeutic efficiency in a mouse model showed total elimination of CRAB pathogen from lungs homogenates of mice and recovery from lung inflammation in all infected mice. On the other hand, safety evaluation of isolated phage revealed no adverse effects on structural or morphological tissue integrity. Conclusions These findings suggest that A. baumannii phage vB_AbaP_PhE54 could be a viable safe therapeutic option against A. baumannii infections, warranting further research into its clinical applications.

Abstract Background This study is aimed to develop a simple, effective and economic method for the UV spectrophotometric analysis of amoxicillin trihydrate in the presence of acetaminophen. The Beer–Lambert law was obeyed in the concentration range of 2–10 µg/ml for amoxicillin trihydrate, acetaminophen and combinations, in all the different pH media: pH 1.2, 6.8, 7.4 and neutral (double-distilled water). For the simultaneous equation method, the absorbance maxima of amoxicillin trihydrate was found at 228 nm, and for acetaminophen, it was found at 243 nm, after scanning the solutions in respective buffers. Result The standard curve of amoxicillin trihydrate and acetaminophen was plotted, and the correlation coefficient (R2) value was found to be in the range of 0.991–0.994 and 0.993–0.999, respectively. These two drugs were combined in a ratio of 5:3 (amoxicillin trihydrate: acetaminophen), and its absorbance maxima was discovered at 232 nm (isoabsorptive point), where its correlation coefficient was calculated from the standard curve which is in range of 0.993–0.996. The above-mentioned method was found to comply all the validation parameters as per the ICH guidelines such as accuracy, precision, linearity, LOD, LOQ, reproducibility and recovery. This method is successfully applied to estimate the combination of these two drugs in their pharmaceutical dosage forms without and interaction of their excipients. This method is based on to check the stability of amoxicillin trihydrate in different pH media in the presence of acetaminophen. Conclusion Hydrolysis of beta-lactam ring of amoxicillin trihydrate occurs in acidic pH (below 2) which causes the formation of amoxicilloic acid which may cause reduction in its microbial activity but neither shifting of wavelength nor appearance of extra peak occurred in UV spectroscopy. Although some changes of % area of amoxicillin trihydrate is observed in acidic media in HPLC method, there are no significant changes observed among the amoxicillin trihydrate solutions with acetaminophen prepared in different pH media, when using UV spectrophotometric method.

Abstract Malaria remains one of the causes of extreme mortality in southern Africa and Southeast Asia. Despite extreme efforts to control and eliminate malaria, the appearance of drug-resistant parasites and their spread is a major concern. In this context various therapeutic, diagnostics, and technological advancements need to be studied and implemented in the near future. Nanoparticles have a crucial role in enhancing intracellular retention, subcellular target specificity, and even drug escape from intracellular enzymatic inactivation. Additionally, the selectivity and specificity of anti-malarial against the target were increased by the functionalization of nanoparticles, which led to improved safety and efficacy. Recent studies show the efficacy of metallic nanoparticles against the vector Anopheles mosquito and the malaria parasite Plasmodium species. So, here in the present review, we will discuss the various metal-based nanoparticles that have been studied for malaria treatment or used for the development of detection and diagnosis between the year 2013 and till date. This review also covers the future prospects of these nanoparticles in this field.

Abstract Cannabis flower scent is one of the key characteristics of the cannabis plant. The diverse scents impact user experiences and offer medicinal benefits. These scents originate from volatile compounds, particularly terpenes and terpenoids. This study characterized the volatile profile of 19 different dried cannabis flowers using gas chromatography-mass spectrometry coupled with headspace-solid phase microextraction (HS-SPME-GC-MS). A total of 75 compounds were identified, including alcohols, aldehydes, benzenes, esters, ketone, monoterpenes, monoterpenoids, sesquiterpenes, and sesquiterpenoids. Cluster analysis was able to group the 19 cannabis cultivars into five clusters based on volatile chemotypes using chemometric techniques of hierarchical cluster analysis (HCA) and principal component analysis (PCA). Potential discriminant markers of each cultivar were then analyzed using a supervised partial least squares discriminant analysis (PLS-DA) verified through Variable Importance in Projection values (VIP), identifying twenty discriminant markers. In addition, the correlations among 75 volatile compounds were also obtained. The findings of this study provide a valuable database of single cannabis cultivars, useful for identifying individual strains and verifying their quality. Clustering the cultivars by volatile chemotype can be used for the classification of cannabis in the market. The results of this study are expected to be a starting point for further cannabis breeding programs to expand knowledge of this plant. Furthermore, the proposed method is applicable to other aroma plants in the future.

Managing suicidality in persons with chronic pain is a challenging clinical scenario with no treatment guidelines to inform clinical decision-making related to suicide risk mitigation. Applying appropriate risk mitigation strategies, such as opioid education and naloxone distribution, lethal means safety education, increased frequency of appointments, individualized opioid tapers, consideration of nonopioid pharmacotherapy, nonpharmacological treatment options, and addressing modifiable risk factors, can decrease suicide risk. Recommending a treatment plan for patients with chronic pain experiencing suicidality is explored through 3 patient cases.

Introduction Single-dose injectable aripiprazole lauroxil (SDIAL) is used with long-acting injectable (LAI) aripiprazole lauroxil in the treatment of schizophrenia. SDIAL can be used to either initiate treatment or supplement during maintenance when follow-up doses are not given within labeling recommendations. The primary objective was to determine the usage and appropriateness of SDIAL between the initiation and the maintenance supplementation use in a Medicaid database. The secondary objective was to determine the overall associated costs with the potentially inappropriate use of LAI aripiprazole lauroxil. Methods International Classification of Diseases, 10th edition codes were used to identify adult patients with schizophrenia and related disorders (18-64 years) who received SDIAL and/or LAI aripiprazole lauroxil between 2018 and 2020 using MarketScan Medicaid databases. The appropriateness of SDIAL was determined by package insert labeling timelines for treatment initiation and maintenance supplementation. Two authors independently reviewed each SDIAL claim for appropriateness. Descriptive statistics were used to analyze the data. Results After excluding possible billing errors, a total of 582 claims were identified for SDIAL. Of these, 21% were potentially inappropriate, with a higher proportion occurring during the maintenance phase. Overall, potential inappropriate use resulted in costs over $307 000. Discussion It appears that prescribers should be better educated on the appropriate use of SDIAL during maintenance supplementation.

Vesicular monoamine transporter 2 inhibitors (VMAT2i) are currently Food and Drug Administration–approved for the treatment of Huntington disease chorea and tardive dyskinesia. Additionally, they are often used for other hyperkinetic movement disorders in clinical practice. Due to a lack of head-to-head clinical trials, management of VMAT2i in the clinical setting may be unclear and rely on the clinical experience of the practitioner. Due to the limited distribution model, which typically requires VMAT2i to be dispensed by specialty pharmacies, access and initiation of treatment may present as barriers. Patient cases allow for the exploration of switching between VMAT2i, alternative routes of administration, utilization in pediatric and off-label conditions, and how to successfully initiate and monitor a patient on VMAT2i therapy.

Two Supreme Court cases in the United States describe the use of involuntary medication in individuals with mental illnesses. In addition to these legal requirements, clinicians must also incorporate ethics into treating these individuals, including the principles of autonomy and beneficence. Current guidelines do not provide specific recommendations for choosing an antipsychotic for a patient with schizophrenia who is being treated involuntarily. However, it is recommended that clinicians use general guidelines for the treatment of schizophrenia as a basis for narrowing down appropriate therapy, which may involve the use of long-acting injectable antipsychotics. Clinical considerations that should be accounted for include past medication trials, potential adverse effects, whether tolerability has been demonstrated, route of administration, dosing interval, requirement for oral overlap, comorbid conditions, patient preference, and access to the medication.

The effective use of duloxetine can be complicated by acute kidney injury, acute and/or chronic hepatic dysfunction, dysphagia, enteral nutrition, and common pharmacokinetic interactions. This article aimed to review the pharmacological properties of duloxetine pertinent to its use and to discuss the management of duloxetine in patients with common acute and chronic medical comorbidities. Management strategies based on clinical data and expert opinion are reviewed in 3 patient cases.

Oseltamivir (Tamiflu) package labeling has a warning for neuropsychiatric adverse events (NPAE), most commonly in children and adolescents, especially males. There are several case reports of NPAE in adults treated with oseltamivir, but few document patients with preexisting neuropsychiatric conditions without additional contributing factors. This case report describes a 22-year-old male with a history of bipolar disorder, depression, and attention-deficit/hyperactivity disorder who had been stable on his medication regimen before experiencing sudden worsening of symptoms after the initiation of oseltamivir. The case adds to previous literature by strengthening the correlation between oseltamivir and a sudden increase in neuropsychiatric symptoms. Providers should be aware that oseltamivir may exacerbate symptoms of previously stable patients. Depending on the severity of neuropsychiatric effects, discontinuation of oseltamivir and symptom treatment with pharmacotherapy may be warranted.

Burn is a suddenly occurring injury. The healing process of burn is complex. Aloe vera (L.) Burm.f. (Av) is widely used as Chinese folk medicine for the treatment of burn. While effective pharmacological components, role and mechanism of Av in the treatment of burn remain to be fully elucidated. Arachidonic Acid (AA) and Quercetin (QUE) are identified as active components of Av for the treatment of burn by network pharmacology analysis and experimental verification. Animal experiments’ results showed that AA and QUE could shorten the burn wound healing time. The expression of inflammatory factor TNF-α, MyD88 and P-NF-κB p65 were down-regulated and the ER (ESR1), SRC were up-regulated in AA treated NIH 3T3 cells. The expression of MyD88 was downregulated in QUE treated NIH 3T3 cells. The Av promotes burn healing may be via the anti-inflammatory effect and regulation on NF-κB signal pathway or estrogen signal pathway by its active components AA and QUE. This research may construct a bridge between Av and burn wounds, and skin therapy agent exploration.

Background: Insulin resistance is the underlying etiology for a variety of metabolic diseases including metabolic syndrome, type 2 diabetes, and obesity, alongside with their complication. The insulin resistance mechanism is complex and yet obscure. Vitamin D is a fundamental parameter involved in various ailments. We aimed to identify the link between vitamin D levels and glycemic/lipid parameters using patients with different metabolic diseases as a model. Methods: Serum samples were collected from patients with diabetes (n=20), metabolic syndrome (n=20), and obesity (n=15) versus the control group (n=18) with matched age, sex, and health status. Vitamin D and insulin were quantified by colorimetric technique and the total cholesterol (TC), triglyceride (TG), high density-lipoprotein (HDL) were measured in the studied groups using standard kits. Low density-lipoprotein (LDL), very low-density lipoprotein, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were calculated using standard formula. Results: The study found that insulin and vitamin D levels were significantly lower in diabetic [18.7±2.2, 16.5±4.4], metabolic syndrome [23.6±1.6, 18.6±3.4], and obese patients [15±1.9, 14.1±4.8] compared to the control group [9.8±4, 25±5.1]. Serum TC levels were higher in metabolic syndrome and obese subjects compared to control and diabetic subjects, TG levels were significantly higher in metabolic syndrome compared to the other groups, HDL levels were reduced in diabetic, metabolic syndrome, and obese groups compared to the control group, LDL levels were elevated in metabolic syndrome and obese groups compared to diabetic and control groups, VLDL levels were significantly higher in metabolic syndrome than in other groups. Conclusion: Vitamin D reduced in metabolic diseases reciprocally aligned with insulin level and associated with variation in lipid parameters.

Background: Medicinal plants are a rich source of antioxidants, and attention has been drawn to them in subsequent years, as the Moringa plant is one of these sources. The aim of this work is to identify the protective role of Moringa oil versus the oxidative stress induced by H2O2 in the salivary glands of rats. Materials methods: 27 rats were divided into 3 groups. A daily dose of 1000 mg/kg of moringa oil was used for the first group. The second group received a daily dosage of 2 ml/rat of 0.5% H2O2. For 21 days, the third group received a daily dosage of 1000 mg/kg of moringa oil and 2 ml/rat of 0.5% H2O2. After 7, 14, and 21 days blood samples are drawn to measure TAC, GSH and MDA, and salivary gland samples are taken for histological examination. Results: There are significant differences in TAC, GSH and MDA levels between the treatment groups within each period and significant variations across different periods within the same treatment group. The histological examination suggests that the Moringa oil group generally maintained normal glandular architecture, while the H₂O₂ group exhibited signs of degeneration and necrosis. The Moringa + H2O2 group showed a protective effect in some instances, preserving tissue structure. Conclusion: the findings imply that Moringa oil could offer protection against oxidative stress by influencing TAC levels and reducing MDA levels. The combination of H2O2 and Moringa oil seems to counterbalance the impact of hydrogen peroxide. Moreover the group using Moringa oil generally maintained a structure while the H2O2 group showed signs of deterioration and cell death. The group using both Moringa oil and H2O2 exhibited some effects at times preserving the tissue structure of the gland.

Background and objectives: Beta-blockers are the most used antihypertensive agents due to their blood pressure-lowering effect alongside decreasing heart rate. Nebivolol (NB) seems to provide typical antihypertensive alongside vasorelaxant effects. The present study aimed to elucidate the differential impacts of NB on bovine coronary tone with a specific focus on the involvement of nitric oxide and K+ channels. Using an in vitro isolated bovine coronary segments, vascular reactivity was assessed through tension measurement in response to NB. Methods: Using isolated tissue baths, the impact of NB on bovine coronary artery segments' contractility was assessed. The contractions were induced by KCl, NB was added to check the vasorelaxant effects, and methylene blue was used to examine the role of NO. In addition, the effect on tone was compared with another β-blocker, propranolol, to determine the role of adrenoceptor. Results: NB significantly induced relaxation in the coronary bovine artery segments, 49.7 ± 7.84 VS 4.44 ± 6.87. Incubation with methylene blue (30 μM) inhibited NB relaxation, 46.08 ± 4.37 vs MB 12.16 ± 4.28, KCl depolarization did not affect on the relaxation induced by NB in comparison to U46619 precontraction KCl 39.52 ± 6.19 vs U46619 58.41 ± 28.92. Propranolol had no effect on the coronary tone when compared to NB, 87.05 ± 7.05 VS Propranolol 34.28 ± 5.71. Conclusions: Our results show that NO but not K+ channel activation is involved in the mechanism of NB induced coronary artery relaxation. These results highlight the necessity of taking these pathways into account when extrapolating the effects of NB in clinical settings.

Background: Herbal medicines are the cornerstone of folk medicine. Pharmacists are often the primary first line of care in community settings. They can play a vital role by providing information and supplying genuine herbal medicines (HMs) and dietary supplements (DSs). Evidence-based data on pharmacist's awareness of and views on adulterated medicines in developing nations is limited. Aims: This study aims to explore the knowledge, attitudes, and practices of Iraqi community pharmacists towards adulterated HMs sold in community pharmacies. Methods: a cross-sectional web survey with a convenient sample of Iraqi community pharmacists between the 3rd of January and the 13th of February 2024, using a validated questionnaire. Results: A total of 408 pharmacists participated in this study. 63.5%, 54.2%, and 64.46% have adequate knowledge, an intense attitude in a positive direction, and appropriate practices toward the adulteration of HMs and DSs, respectively. A significant correlation was found between knowledge, attitude, and practice. Male participants were found to have higher knowledge scores than females, but female participants were found to have more appropriate practice than males. Conclusion: The study findings revealed that a large proportion of the Iraqi community pharmacists had adequate knowledge, an intense attitude in the positive direction, and appropriate practice towards adulteration of HMs and DSs.

Background: Diabetic foot ulcers (DFU) occur in up to 15% of all diabetic patients and are a leading cause of nontraumatic amputation worldwide. DFUs require identifying the etiology and assessing the co-morbidities to provide the correct therapeutic approach, essential to reducing lower-extremity amputation risk.The high rates of therapy failure have resulted in the development of new therapies. Aim: Highlight the current trends in DFU management that could replace or complement the classical strategy for the management of DFU, as well as selective and targeted strategies that are needed to improve the healing process. Method: The authors, with precision, conducted an exhaustive literature search by thoroughly exploring the Science Direct, Scopus, PubMed, and Web of Science databases. They specifically sought out published studies and original articles that were featured in esteemed peer-reviewed journals and reported on original research. Conclusion: These new techniques are promising but still mostly unproven. New and generally more expensive therapies should be seen as adding to traditional approaches and not a replacement for conventional approaches.

Objective This study aimed to assess the overall economic impact of clinical pharmacist interventions in the neonatal ICU (NICU) in Qatar. Methods A retrospective review of neonates’ records was performed over a 3-month duration in the NICU of Qatar to determine the total economic benefit of clinical pharmacist interventions. The total benefit of interventions was calculated by considering the cost avoidance due to preventable adverse drug events (ADEs) and the cost savings associated with the revised resource use due to interventions. Sensitivity analyses were conducted to ensure the robustness and generalizability of the results. Results A total of 513 interventions were analyzed, involving 150 neonates. Most of the drug-related problems were related to therapy dosing, followed by drug choice appropriateness, the addition of prophylactic treatment, and administration frequency. The overall annual benefit was estimated at QAR 4,178,352 (1,147,584), which consisted of cost avoidance of QAR 1,050,680 (USD 288,648) and an overall cost saving of QAR −6091 (USD −1673). Conclusions While the clinical pharmacist interventions led to increased resource utilisation and associated costs, when considering the avoided costs of ADEs, the overall clinical pharmacist practices in the NICU setting were economically beneficial.

Background Vaccines offer arguably the most cost-effective public health intervention. Vaccine supply chain management which is a critical building block faces many Human resources challenges mainly due to the special attributes of vaccines. Objective This study attempted to measure the effect of training on vaccine cold chain handler knowledge and practices. Methods A cross-sectional research design, using predominantly quantitative data collection techniques, was used. Facilities that have offered vaccination services for more than a year and report through the HMIS system were eligible for selection. Observation checklists and structured questionnaires were used. SPSS was used to analyse data. Results Vaccine cold chain management among the study group had an average score of 65.33% range (31–85%). The average knowledge score among the study respondents was 62.42% with a range (45–95%). The knowledge of respondents generally increases with an additional increase in the number of training modalities. Conclusions The status of VCCM is at about 65.33% below the target of 80% set by the EVM. The trainings have an effect on both knowledge of handlers and their practice especially when deployed in a multi-pronged design and thus these trainings need to be aligned to achieve synergy. ABBREVIATIONS CCE, Cold Chain Equipment; DHIS2, District Health Information Systems 2; DHO, District Health Officer; DPT, Diphtheria, Pertussis, Tetanus; DVS, District Vaccine Stores; EPI, Expanded Program for Immunisation; EVM, Effective Vaccine Management; FEFO, First Expiry First Out; GAVI, Global Alliance for Vaccines and Immunisation; HMIS, Health Information Management Systems; IRC, International Rescue Committee; KII, Key Informant Interview; LIAT, logistics indicator assessment tool; PATH, Program for Appropriate Technology in Health; PHC, Primary Health Care; QPPU, Quantification and Planning and Procurement Unit; SOPs, Standard Operating Procedures; SPSS, Statistical Package for Social Sciences; UNEPI, Uganda National Expanded Program for Immunisation; UNICEF, United Nations Children's Fund; VPD, Vaccine Preventable Diseases; VVM, Vaccine Vial Monitors; WHO, World Health Organisation

Cancer has been a severe public health and social problem, a leading disease that has diminished the quality of life, and a barrier to improving life expectancy. Neocryptolepine is an indole-quinoline alkaloid isolated from Cryptolepis sanguinolenta which grows in some African countries. This review summarizes the structures of 228 neocryptolepine derivatives, including 84 neocryptolepine derivatives synthesized by our laboratory, and analyzed the cytotoxic effects and mechanism of action at the cellular level. Neocryptolepine derivatives 43 , 65 , 93 , and 96 have good cytotoxicity against gastric cancer AGS cells and the IC 50 value reached 43 nM, 148 nM, 2.9 μM, and 4.5 μM, respectively. The IC 50 values of compounds 64 and 69 on colorectal cancer HCT116 cells reached 0.33 and 0.35 μM, respectively. In addition, the structure-activity relationship of these compounds is discussed in this review. Topoisomerase II is discussed as a possible inhibition target of neocryptolepine derivatives in several cancer cell lines by binding DNA. The structures of the reported neocryptolepine derivatives and the possible cytotoxic mechanisms are analyzed. This review provides a fundamental reference for anticancer drug development of neocryptolepine and its derivatives as anti-tumor agents.

Zeqi ( Euphorbia helioscopia L. ), is a widely distributed plant of the Euphorbiaceae family. Zeqi is a famous Chinese herbal medicine with the effects of inducing diuresis for removing edema, killing pathogens and relieve itching, etc. It can be used to treat edema, dysentery, osteomyelitis, cancer and many other diseases. With the development of processing and extraction technologies, a series of active substances have been extracted from Zeqi, including terpenes, steroids, tannins and flavonoids. Among these components, terpenes are the most abundant. Recent pharmacological studies indicated that Zeqi has multifunction including antitumor activity, antiviral activity, anti-inflammatory activity, anthelmintic activity, antibacterial activity, and antioxidant activity. To provide a more comprehensive analysis of the application of traditional Chinese medicine Zeqi in clinical treatment and modern medicine, we summarize in this review the pharmacological studies on Zeqi in recent years.

Postoperative pain management in patients undergoing thoracoabdominal surgery always remains challenging for the anesthesiologist. As a method of pain management, multimodal analgesia is commonly used. In recent years, interfascial plane blocks like erector spine plane block (ESPB), retrolaminar block (RLB), transverse thoracic plane block, and pectointercostal plane block have been increasingly utilized as important components of acute postoperative pain management in truncal surgeries. Here, we reviewed the analgesic efficacy of ultrasound (US)-guided retrolaminar block in patients undergoing truncal surgeries. The primary objective of this review was total opioid consumption within 24 hours of the postoperative period. The secondary objectives were postoperative pain score, time to first analgesic requirement, and adverse effects. All articles relevant to the retrolaminar block were searched in six major databases (PubMed, Embase, Medline, Ovid, PMC, and Google Scholar). A total of 706 records were identified, out of which only 11 kinds of literature were included in this review article, based on our inclusion criteria. The published literature suggests that retrolaminar (RLB) provides more effective analgesia in comparison to the erector spinae block (ESP), is associated with reduced opioid consumption and numeric rating scale (NRS) score, and is not inferior to paravertebral (PVB). There is an evidence that a retrolaminar block can effectively relieve pain during truncal surgery. RLB had a lower rate of complications, was simpler to perform, and required shorter hospital stays.

Sublingual (SL) buprenorphine has been used as a modality of managing acute postoperative pain in many studies. This systematic review aimed to investigate the safety and efficacy of SL buprenorphine as an analgesic for various surgeries. After registering the protocol with PROSPERO, we searched PubMed, Cochrane Library, and Ovid databases with relevant keywords. The primary outcomes were 24-hour pain scores, and the secondary outcomes were postoperative nausea and vomiting, sedation scores, pruritus, rescue analgesia, and urinary retention. The risk of bias scale was used to identify the quality of evidence. From the 103 articles identified, four randomized-controlled trials fulfilled the inclusion criteria for qualitative analysis. The overall risk of bias was low. Most of the studies showed that the use of SL buprenorphine led to either better or comparable pain scores when compared to a control group with lesser or tolerable adverse events. There was a lot of heterogeneity across the studies in this systematic review in terms of the type of surgery performed, the comparison groups, doses of buprenorphine, and the outcomes that were assessed. Therefore, a quantitative meta-analysis was not performed. The results of this systematic review should be interpreted with caution due to heterogeneity in the methodology. Adequately powered studies with robust methodology should investigate the safety and efficacy of SL buprenorphine when used for postoperative analgesia.

Interventional endoscopy procedures are challenging for anaesthesiologists due to the various patient, procedural, logistic, and position-related issues. Complex endoscopic procedures like biliary interventions and endoscopic myotomy necessitate longer procedural duration. The mode of anaesthesia is usually deep sedation without any definitive airway device and is frequently associated with hypoxemia events which can be catastrophic. An endotracheal tube, though the gold standard for securing the airway, would prolong the anaesthesia time and delay the recovery. The laryngeal mask airway Gastro™ is a novel supraglottic airway device specifically meant for these procedures as it provides access to the gastrointestinal tract simultaneously with a patent airway. Though its purported advantages are undoubted, its clinical usage has various pitfalls that can hinder its wider acceptance and practical utility, especially when newly introduced. The literature is limited on the feasibility of this device in both the ease of endoscopy and the prevention of hypoxemia. In this review, we have discussed the device’s properties, its varied use cases, the supporting evidence for the same, the caveats, and the future perspectives.

Hanging is suspension of a person by noose or ligature around the neck. Hanging has been used as a judicial execution method since medieval times and is still a common method of suicide in developing countries. The term “near hanging” is used for those who survive long enough to reach the hospital, and these patients still hold mortality as high as 45%. These patients can present with a wide array of complaints involving cardiovascular, neurologic, and pulmonary systems and local injuries to the airway and vascular structures. High serum lactate and cardiac arrest at arrival are some of the prognostic factors which portend a poor prognosis. Early admission and aggressive treatment are essential to provide best neurologic outcome. Due to paucity of definitive guidelines, therapy has to be based on clinical reports and expertise of the treating physician. Hence, near-hanging patients pose a great challenge in primary emergency care and intensive care management. This review aims to outline the pathophysiology, prognostic indicators, and recent evidence in the management of near-hanging patients.

Background and Aims: For the aggressive treatment of postoperative pain, nonpharmacological methods (NPMs) are gaining importance complementary to routine multimodal pain management. The primary aim of the study was to assess the incidence of use of NPMs in our hospital. Secondary objectives were to correlate the pain scores, patient satisfaction, and percentage of time the patient was in severe pain within 72 h postsurgery with the use of NPMs when in pain/not in pain. The effect of NPMs on the physical and emotional outcome of patients as per the American Pain Society Patient Outcome Questionnaire (APS-POQ) was also assessed. Material and Methods: After obtaining approval from the institutional ethics committee (IEC), the trial was registered with the Clinical Trials Registry of India (CTRI). Informed consent was obtained from adult patients on the third postoperative day of elective surgeries. Their responses to the APS-POQ and to a few additional questions about their beliefs on the use of NPM were recorded. Results: Only one-fourth of the total study population were using NPMs for pain management in the hospital. After propensity matching for surgery and postoperative analgesia, two groups were made: one using NPM for pain relief (n = 49) and the other not using NPM (n = 98). There was no significant difference among the satisfaction score (P = 0.31), least pain score (P = 0.68), and worst pain score (P = 0.43) within 72 h postoperatively in either of the groups. Emotional and physical outcomes as per the APS-POQ were similar in both the groups. Conclusion: NPMs are rarely practiced and used during postoperative pain in our hospital. No difference in pain scores, patient satisfaction, and emotional and physical outcomes of the APS-POQ was seen in the group that indulged in NPMs.

Background and Aims: Bispectral index (BIS) and minimum alveolar concentration (MAC) are commonly used to monitor the depth of anesthesia. The objective was to study the correlation between BIS and age-adjusted minimum alveolar concentration (aaMAC) during the maintenance phase of anesthesia. The influence of variables affecting BIS and or aaMAC was studied to determine an equation between BIS and aaMAC. Material and Methods: This prospective observational study was carried out after institutional ethical approval in adult patients 18–60 years of either sex, ASA I and II posted for elective surgery under general anesthesia. Five minutes after airway management, BIS values and aaMAC equivalents were noted during the maintenance phase of anesthesia. aaMAC and corresponding BIS values were recorded every minute for periods, where the anesthetic agent concentration had remained the same during preceding 5 minutes till the switching off of the anesthetic agent. Age, sex, ASA status, use of nitrous oxide, inhalational agent, dose of midazolam, and opioid used were also recorded. Results: BIS/aaMAC showed an inverse correlation. Increasing age, ASA II status, morphine equivalent >5, and use of nitrous oxide, sevoflurane, or isoflurane were associated with a higher BIS at equivalent aaMAC. Using the exchangeable correlation structure, a generalized estimation equation was obtained as the best predictor. Conclusion: Factors affecting both aaMAC and BIS affect the relationship between the two, and although there are wide variations, BIS and aaMAC can be equated and values of either can be calculated if one is known using a generalized estimates equation.

Background: Traditionally, the sniffing position has been considered a standard head and neck position during direct laryngoscopy. The perfect head and neck position for video laryngoscopy has yet not been described. Hence, we planned the present study to compare the neutral and sniffing position for ease of intubation using Airtraq. Methods: A total of 60 patients were randomized into two groups. Patients were intubated with their heads in neutral and sniffing positions in Group NP and SP, respectively. Ease of intubation was taken as a primary outcome. Laryngoscopy time, intubation time, percentage of glottic opening (POGO), the number of attempts for Airtraq and endotracheal tube, insertion of Airtraq, the success rate of intubation, optimization maneuvers, and complications were taken as secondary objectives. Data were analyzed using SPSS software, V.22.(1). Results: For ease of intubation, we used a visual analog scale (VAS) and Fremantle scores. VAS score (mm) in the median (interquartile range [IQR]) was 32 (24, 34) and 28 (24, 32) in NP and SP groups, respectively (P = 0.37). Twenty-four (80%) patients in NP and 23 (76.67%) patients in the SP group had a Fremantle score of F1 (full view; easy intubation). One (3.33%) patient in both groups had a score of F2 (full view; modified intubation). Five (16.67%) and six (20%) patients in NP and SP groups had P1 scores. Overall, there was no difference in Fremantle’s score between the groups (P = 0.945). The number of attempts, optimization maneuvers, and complications were statistically comparable between the groups. Conclusion: There is no difference in the ease of intubation between the neutral and sniffing position using the Airtraq optical laryngoscope.

Background and Aims: Enhanced recovery after surgery (ERAS) has been applied in various laparoscopic procedures. Intravenous lidocaine (IVL) infusion is used for laparoscopic procedures as a part of ERAS protocols. The study aimed to evaluate the role of IVL infusion in enhanced bowel recovery after laparoscopic renal surgeries. Material and Methods: A randomized, double-blind, placebo-control trial was conducted on 80 patients (with American Society of Anesthesiologists physical status I–II) who presented for laparoscopic renal surgeries under general anesthesia. The study period was from Oct 2018 to Sept 2019. By computer-generated codes, patients were randomly divided into two groups: L (lidocaine) and C (control). Group L received an intravenous (IV) bolus (1.5 mg/kg) of 2% lidocaine over 2 min, followed by an IV lidocaine infusion at the rate of 1.5 mg/kg/h until skin closure. Group C received the same volume of bolus followed by normal saline infusion. Patients were monitored for bowel functions, total hospital stay, and total analgesic consumption. Student’s t-test and Chi-square test were used for quantitative data and occurrence of events, respectively. P

Background and Aims: Intravenous sedation during spinal anesthesia has the advantages of increased duration of spinal anesthesia and better postoperative pain control. The aim of this study was to compare the effect of intravenous bolus and infusion of dexmedetomidine versus ketamine given intraoperative on the postoperative analgesia in fracture femur patients operated under subarachnoid block. Material and Methods: In this prospective randomized double-blind controlled study, 75 patients aged 18–65 years posted for elective surgery were selected and randomly divided into three groups to receive ketamine (group K), dexmedetomidine (group D), and saline (control group C). Postoperative pain was evaluated using the numerical rating scale (NRS). The duration of analgesia and the amount of analgesic consumption were also recorded. Student’s t-test and Chi-square test were used to compare the two groups, and one-way ANOVA with posthoc analysis was performed for comparison of the three groups. Results: Patients in the ketamine group had better postoperative analgesia as assessed by decreased pain (on the NRS scale) and decreased need for postoperative rescue analgesics (P < 0.001). The duration of sensory block and motor block was prolonged in group K as compared to the other two groups (P < 0.001). Conclusion: Intraoperative use of intravenous ketamine was superior to dexmedetomidine for postoperative analgesia in fracture femur patients operated under subarachnoid block.

Background and Aims: Even though patient tolerance is critical to the success of noninvasive ventilation (NIV), research on using sedation to improve tolerance to NIV after traumatic chest injuries is limited. We hypothesized that dexmedetomidine would be superior to ketamine in terms of patient tolerance and lengthening the NIV sessions after blunt chest trauma. Material and Methods: This randomized, double-blinded, placebo-controlled trial included 45 patients of both genders aged 18–60 who needed NIV after blunt chest trauma. The patients were randomly assigned to one of three groups (n = 15) for receiving dexmedetomidine, ketamine, or placebo (0.9% sodium chloride solution) infusion to maintain a Richmond Agitation Sedation Scale (RASS) score between 0 and − 3 during two successive NIV sessions. Patients were evaluated for the duration of the NIV sessions, RASS, Visual Analog Scale (VAS), and the total amount of rescue analgesia consumed. Results: The mean duration of the NIV sessions was significantly longer in patients who received dexmedetomidine (P < 0.001) or ketamine (P < 0.001) compared to placebo. However, the NIV durations did not differ significantly between the dexmedetomidine and ketamine groups (P > 0.05). The dexmedetomidine group had a significantly lower RASS score compared to the ketamine (P < 0.001) and placebo (P < 0.001) groups, whereas the ketamine group had a significantly lower VAS compared to the dexmedetomidine (P = 0.005) and placebo (P = 0.022) groups and required significantly less total morphine (P = 0.001) compared to the other groups. Conclusion: The duration of the NIV sessions for patients with blunt chest trauma did not differ significantly between the dexmedetomidine and ketamine groups.

Background and Aims: An exaggerated hemodynamic response to endotracheal intubation is observed in hypertensive patients, and its attenuation proves challenging. The role of oral ivabradine, a unique heart rate-lowering drug with a favorable hemodynamic profile, is not yet studied. The aim of this study was to evaluate the effect of oral ivabradine on the attenuation of hemodynamic response to endotracheal intubation in hypertensive surgical patients assessed by rate pressure product (RPP), which is a very reliable indicator of myocardial oxygen demand. Material and Methods: Sixty medically controlled hypertensive surgical patients, aged 30–65 years, receiving general anesthesia were divided into two equal groups: Group I received a tablet of ivabradine 5 mg and group C received a placebo tablet 1 hour before induction. Heart rate (HR) and systolic, diastolic, and mean arterial blood pressure (SBP, DBP, and MAP) were recorded at baseline, preoperative, immediately after intubation, 1 min, 3 min, 5 min, and 10 min following intubation. RPP was calculated at the above time intervals. Data were analyzed using the unpaired t-test and the Chi-square test as required, with P < 0.05 considered significant. Results: The maximum value of RPP after intubation was significantly less in group I (11065.64 ± 606.56) as compared to group C (16774.64 ± 1242.87), P = 0.000. All hemodynamic variables, RPP, HR, SBP, DBP, and MAP, remained significantly less in group I than group C at all time intervals (P = 0.000). These parameters never increased above baseline after intubation in the ivabradine group, indicating effective attenuation of the intubation response. Conclusion: Premedication with oral ivabradine 5 mg is very effective in attenuating the hemodynamic response to intubation in hypertensive patients.

Background and Aims: Both operating table height and patient level in relation to the anesthesiologist influence supraglottic airway device (SAD) insertion and task performance in terms of physical and mental workload. The aim of the study was to find out the appropriate table height during SAD insertion in terms of time taken for insertion, success rate, ease of insertion, and anesthesiologist comfort. Material and Methods: In this randomized controlled trial, 90 American Society of Anesthesiologists physical status I and II patients, aged between 18 and 60 years, scheduled for elective surgery were recruited. Patients were divided into three groups of 30 each. During SAD insertion, the table height was adjusted so that the patient’s forehead was at the level of 5 cm above the xiphoid process in group I, at the level of the xiphoid process in group II, and at the level of 5 cm below the xiphoid process in group III of the anesthesiologist. We measured SAD insertion time, first attempt success rate, ease of insertion, and anesthesiologist comfort during the procedure. Results: The SAD insertion time (in seconds) was lower in group III than in groups I and II, and a significant difference was found between the groups (P < 0.05). The mean ease of insertion score, anesthesiologist comfort, and the first-attempt success rate of SAD insertion were higher in group III than in groups I and II, and the difference among the groups was statistically significant (P < 0.05). Conclusions: We conclude that the lower table height with the patient’s forehead at the level of 5 cm below the xiphoid process of the anesthesiologist is ergonomically more efficient during SAD (I-gel) insertion. This table height is also more comfortable for the anesthesiologist during SAD placement.

Background and Aims: Post-Covid-19 cancer patients are likely to have poor postoperative outcomes following cancer surgeries. This is mainly because of the coexisting risk factors unique to cancer patients like immunosuppression, chemotherapy, and radiotherapy-induced risk of infection and malnutrition. The purpose of this study was to compare the postoperative morbidity in cancer patients with and without a history of Covid infection. Material and Methods: This was a prospective observational study. Subjects were divided into post-Covid 19 (PC) and non-Covid 19 (NC) groups based on the history of SARS CoV2. Preoperative data including details of past Covid infection, chemotherapy, radiotherapy, comorbidity index, Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) score, and nutritional indices were recorded for patients undergoing elective cancer surgery. Thirty-day postoperative morbidity, mortality was recorded. Results: Of the total patients (n = 414), 109 had postoperative complications (26.33%), reported to be higher in the PC group (33.87%) than the NC (25%) (P value: 0.19). Pulmonary complications were commonest with higher incidence in PC (25.8%) group (P value: 0.001). It was 40% in 2–4 weeks after Covid 19 diagnosis reducing to 18% and 25% in 4–8 weeks and 8–12 weeks, respectively. The overall mortality rate was 0.72%. P-POSSUM morbidity score was similar between the two groups. (PC: 38.30 ± 19.4; Covid negative 37.8 ± 16.7 P value 0.84). Old age, hypothyroidism, and low Prognostic nutritional index were associated with a higher incidence of complications. Conclusions: Cancer patients with a history of Covid infection undergoing elective surgery are at a higher risk of postoperative pulmonary complications.

Background and Aims: Pilonidal sinus surgery (PSS) can be done with local anaesthetic infiltration, spinal anaesthesia, or general anaesthesia (GA). Erector spinae plane block (ESPB) is used for peri-operative analgesia. Erector spinae muscles extend to the sacral region, so it can provide post-operative analgesia in PSS. We evaluate the post-operative analgesic efficacy of ultrasound-guided sacral ESPB, a novel technique, in patients undergoing PSS under GA. Material and Methods: Seventy patients aged 20–60 years, ASA class I and II, and scheduled for PSS under GA were included. Patients were randomly assigned to group I (control group), who received GA only, and in group II (SESPB group), sacral ESPB was performed after induction of GA. The primary outcome was post-operative pain evaluated by visual analogue score (VAS) at arrival to the post-anaesthesia care unit (PACU), 1, 2, 4, 8, 12, and 24 hours post-operative. The secondary outcomes were time to first analgesic request post-operative, intra-operative fentanyl consumption, and complications. Results: There were significantly higher VAS scores in group I compared to group II at arrival to PACU, 1, 2, 8, and 24 hours post-operative (P = 0.017,

Background and Aims: Nasotracheal intubation evokes greater hemodynamic responses than oral intubation. We compared the heart rate (HR) and mean arterial pressure (MAP) responses following nasal intubation during opioid-free anesthesia (OFA) using intravenous lignocaine versus standard regimen using morphine in cancer patients undergoing tumor resection. Material and Methods: This randomized, double-blinded study was conducted in 84 adults. Group A received lidocaine bolus 1.5 mg/kg over 10 min followed by infusion of 1 mg/kg/h. Group B received morphine 0.2mg/kg bolus over 10 min followed by infusion of 2mg/h. Protocols for induction and intubation were similar. Results: Mean HR and MAP at preinduction, immediately after induction, and at 1, 3, and 5 min after intubation were comparable in groups A and B. Intragroup comparison of preinduction HR with subsequent values in group A showed that the HR values at 1,3, and 5 min after intubation were significantly higher than the preinduction value. HR after induction was comparable. Intragroup analysis in group B showed that preinduction HR was comparable with HR after induction and at 3 and 5 min after intubation. HR at 1 min was significantly higher. Intragroup analysis in group A showed that the MAP values were significantly lower than the preinduction value after induction and at 1,3, and 5 min after intubation. In group B, MAP was significantly lower than the preinduction value after induction and at 3 and 5 min after intubation, with the value being comparable at 1 min. Conclusion: OFA with lignocaine bolus followed by infusion, as well as morphine did not attenuate the HR responses to nasal intubation in cancer patients. However, both techniques effectively blunted the MAP response.

Background and Aims: Inhalation anesthetics is basic knowledge that must be mastered by an anesthesiologist. Lack of competencies can result in higher morbidity and mortality in anesthesiology practice. Various learning methods were developed to improve understanding and retention. With the advancement of technology, the utilization of screen-based simulation (SBS) using applications is common, such as the Gas Man® application, to help students understand physiology, pathophysiology, and kinetic inhalation anesthetic agents. The primary objective of this study was to compare the knowledge improvement of anesthesia residents between the simulation-based and discussion-based learning methods on the uptake and distribution of anesthetic inhalation. The secondary objective was to compare the satisfaction levels of participants in both learning methods. Material and Methods: This study is a randomized controlled trial involving anesthesiology and intensive care residents from the Faculty of Medicine, Universitas Indonesia (FKUI) 2022–2023. The participants were randomized into two groups (simulation and discussion groups). A senior attending anesthesiologist led the discussion. The participants answered a pretest, followed by a 1-hour lecture about inhalation gas. Lastly, participants answered a posttest and filled in the satisfaction survey. Statistical analyses used the Mann–Whitney test to compare the two groups. The Wilcoxon test was used to compare the knowledge improvement between the two groups. Results: Thirty-eight residents underwent simulation-based (n = 19) and discussion-based (n = 19) learning methods. The simulation group demonstrated a median (interquartile range) posttest score of 80 (76.67–83.33) compared with the discussion group with a score of 50 (40–66.67) (P value

Background and Aims: Emergence delirium (ED) during the postanesthesia recovery phase presents significant challenges, especially among pediatric patients, with incidence rates spanning from 2% to 80%. This study sought to assess and compare the effectiveness of propofol and dexmedetomidine in addressing ED in pediatric patients undergoing sevoflurane anesthesia. The primary aim was to ascertain the prevalence of ED in both treatment cohorts, while secondary outcomes encompassed postoperative pain, hemodynamic responses, and the occurrence of complications. Material and Methods: Eighty children aged 2–6 years scheduled for short infraumbilical surgeries under general anesthesia were recruited in this trial. Propofol (1 mg/kg) or dexmedetomidine (0.3 μg/kg) was administered 10 min before completion of surgery. The Paediatric Anaesthesia Emergence Delirium scale was employed to evaluate ED every 5 min following extubation, wherein a score exceeding 12 was indicative of ED. Postoperative sedation was assessed using the Ramsay Sedation Scale, while pain levels were determined through the Face, Legs, Activity, Cry, and Consolability (FLACC) score. Any potential complications were closely monitored. Results: The incidence of ED at extubation was 2.50% and 70% in group D and P, respectively, and the trend of lower ED incidence was consistently observed at 5, 10, 15, and 30 min postextubation. The relative risk ratio at extubation was 4.103 (95% confidence interval: 2.49–6.76), highlighting a significant reduction of 4.1 times in the risk of ED when dexmedetomidine was administered. The dexmedetomidine group exhibited a lower incidence of postoperative pain. Conclusion: In comparison to propofol, dexmedetomidine demonstrated superior efficacy in reducing ED and postoperative pain in pediatric patients during general anesthesia, when administered before completion of surgery.