A randomized study of the effects of perioperative i.v. lidocaine on hemodynamic and hormonal responses for cesarean section

Purpose  Intravenous infusion of lidocaine attenuates the stress response to surgery. We aimed to evaluate the effects of perioperative lidocaine on the hemodynamic and hormonal responses for cesarean delivery. Methods  After the gaining of ethical approval, 90 patients scheduled for elective cesarean delivery were randomly allocated to receive either lidocaine 1.5 mg·kg⁻¹ i.v. bolus 30 min before induction, followed by an infusion of 1.5 mg·kg⁻¹·h⁻¹ until 1 h after surgery (n = 45), or saline placebo (n = 45). Anesthesia was maintained with 50% nitrous oxide in oxygen with 0.7% isoflurane. Hemodynamic variables, plasma cortisol, maternal and neonatal lidocaine concentrations, Apgar scores at 1 and 5 min, neonatal acid-base status, and the neurologic and adaptive capacity score (NACS) were recorded. Results  After induction, patients receiving lidocaine had a smaller increase in heart rate and mean arterial blood pressure (P < 0.02) and lower plasma cortisol concentrations (31.1 ± 9.91 vs 45.6 ± 8.43 μg·dL⁻¹; P < 0.001). There were no differences between the two groups in Apgar scores, NACS, or neonatal acid-base status. After delivery, maternal and umbilical venous concentrations and umbilical vein-to-maternal vein ratios of lidocaine were 2.05 ± 0.42 μg·mL⁻ and 1.06 ± 0.31 μg·mL⁻¹, and 0.52 ± 0.07, respectively. Conclusion  Perioperative lidocaine is safe and effective in attenuating the maternal stress response to surgery for cesarean delivery.     

Neuroprotective and Ameliorating Impacts of Omega‐3 Against Aspartame‐induced Neuronal and Astrocytic Degeneration

Aspartame (ASP) is one of the commonest artificial sweetener used all over the world and considered as an extremely risky compound and raises a lot of controversy. Therefore, this study was designed to investigate cellular damage of the anterior horn cells in the spinal cord of albino male rats and the possibility of hindering these changes by using omega‐3 (OM3).Thirty seven adult male albino rats were divided into three groups: Control, ASP‐treated and ASP + OM3‐treated groups. Spinal cord sections were prepared and stained with Hx&E, caspase‐3 and GFAP immunostaining. All data were morphometrically and statistically analyzed. In ASP‐treated group, the cell body of some degenerated neurons was swollen and its cytoplasm was vacuolated. Their nuclei were eccentric and pyknotic. Moreover, other neurons were of a heterogeneous pattern in the form of cell body shrinkage, loss of Nissl substance, intensely stained eosinophilic cytoplasm and a small darkly stained nucleus that may eventually fragment. However, the cells were apparently normal in ASP+ OM3‐treated group. Strong +ve caspase‐3 stained neurons were detected in ASP‐treated group. Furthermore, the immunoreaction was faint on treating the rats with both ASP and OM3. Few number of +ve GFAP‐ stained astrocytes were observed in ASP‐treated rats. On the other hand, the immunoreactivity for GFAP was found to be intense in the ASP + OM3‐treated group. Additionally, there was a significant decrease in the surface area percentage of the +ve GFAP‐stained astrocytes of the ASP‐treated group compared to the control and the ASP + OM3‐treated groups. Anat Rec, 300:1290–1298, 2017. © 2017 Wiley Periodicals, Inc.     

Implementation of a multidisciplinary team approach and fish oil emulsion administration in the management of infants with short bowel syndrome and parenteral nutrition-associated liver disease

OBJECTIVE:

To describe the authors’ experience with the implementation of a multidisciplinary approach and use of fish oil emulsion (FOE) in the management of infants with short bowel syndrome (SBS) and parenteral nutrition-associated liver disease (PNALD).

METHODS:

Between August 2006 and June 2009, four cases of SBS and severe PNALD were managed by the team using specifically developed protocols. The FOE was initiated if serum direct bilirubin levels were ≥100 μmol/L. To quantify the degree of exposure to high serum direct bilirubin levels over time, the area under the curve (AUC) for each patient was calculated before and after initiation of FOE. Linear regression analyses were performed to evaluate correlations between the AUC, duration of cholestasis and initiation of FOE.

RESULTS:

All patients survived and no complications were observed during the study period. After the first patient, FOE was initiated progressively earlier, but poor correlation between the AUC before and after its introduction was observed (r²=0.41924). However, there was strong correlation between the duration of PNALD before FOE initiation and time to resolution (r²=0.72133): the earlier the FOE was initiated, the shorter the time to resolution.

CONCLUSION:

The authors report a positive experience with the implementation of a multidisciplinary approach and the use of FOE in infants with SBS and severe PNALD. The earlier the FOE was initiated during the cholestatic process, the shorter the time to resolution. The present study is a hypothesis generator, raising the question of whether an earlier introduction of this particular therapy can effectively shorten the cholestasis process in these patients.     

Systematic evaluation of complications related to endoscopy in a training setting: A prospective 30-day outcomes study

BACKGROUND: The 30-day frequency of negative outcomes after outpatient endoscopy performed by gastroenterology fellows is unknown. METHODS: Questionnaires were mailed to 1000 consecutive patients 30 days after endoscopy to evaluate procedure-related negative outcomes (serious and minor adverse events) and patient satisfaction. Serious adverse events were defined as follows: oversedation requiring administration of a reversal agent, and those that resulted in a physician visit, emergency department visit, admission to the hospital, or death. Minor adverse events were defined as all problems other than serious adverse events that patients related to their endoscopic procedure. RESULTS: The 30-day frequency of negative outcomes in the 869 patients who responded was 14.3%, of which 0.6% were serious and 13.7% were minor adverse events. The frequency of negative outcomes was 17.1% for EGD, 15.0% for colonoscopy, 24.4% for combined EGD and colonoscopy, and 7.8% for flexible sigmoidoscopy. One hundred percent of the serious adverse events were known to us, but only 16.0% of minor adverse events (p < 0.001). Multiple logistic regression identified midazolam dose (OR for each 1 mg increase in dose 4.5; 95% CI [2.7, 7.3]; p < 0.001), treatment with warfarin (OR 3.0; 95% CI [1.4, 6.2]; p = 0.003), comorbid disease (OR 2.1; 95% CI [1.3, 3.4]; p = 0.001), endoscopy performed in July or August (OR 2.0; 95% CI [1.1,3.7]; p = 0.02), and age (OR for each 1 year increase in age 1.03; 95% CI [1.01, 1.05]; p = 0.01) as independent predictors of negative outcomes. There was a significant association between negative outcomes and decreased patient satisfaction, and patients who reported negative outcomes were less likely to agree to endoscopy in the future. CONCLUSIONS: Serious adverse events were rare after endoscopy performed by gastroenterology fellows. Contacting patients 30 days after outpatient endoscopy significantly improved the detection of negative outcomes. Although the majority of negative outcomes were minor, these adverse events were associated with decreased patient satisfaction.     

Political Imprisonment and Adult Functioning: A Life Event History Analysis of Palestinians

Political imprisonment is a traumatic event, often accompanied by torture and deprivation. This study explores the association of political imprisonment between 1987 and 2011 with political, economic, community, psychological, physical, and family functioning in a population‐based sample of Palestinian men ages 32–43 years (N = 884) derived from a dataset collected in 2011. Twenty‐six percent (n = 233) had been politically imprisoned. Men imprisoned between 1987 and 2005 reported functioning as well as never‐imprisoned men in most domains, suggesting that men imprisoned as youth have moved forward with their lives in ways similar to their nonimprisoned counterparts. In an exception to this pattern, men imprisoned during the Oslo Accords period (1994–1999) reported higher levels of trauma‐related stress (B = 0.24, p = .027) compared to never‐imprisoned men. Men imprisoned since 2006 reported lower functioning in multiple domains: human insecurity (B = 0.33, p = .023), freedom of public expression (B = ?0.48, p = .017), perceived government stability (B = ?0.38, p = .009), feeling broken or destroyed (B = 0.59, p = .001), physical limitations (B = 0.55, p = .002), and community belonging (B = ?0.33, p = .048). Findings pointed to the value of examining the effects of imprisonment on functioning in multiple domains.     

Short- and long-term risk stratification in acute coronary syndromes: the added value of quantitative ST-segment depression and multiple biomarkers.

OBJECTIVES: The purpose of this study was to develop 30-day and 1-year risk stratification models for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients that incorporate quantitative ST-segment depression and novel biomarkers. BACKGROUND: Several novel biomarkers have changed the risk profile of ACS; thus, the reassessment of traditional indicators such as ST-segment depression in this new context is warranted. METHODS: Multivariable logistic regression was used to identify significant predictors of 30-day death and death/myocardial infarction (MI) and 1-year mortality in 7,800 NSTE-ACS patients enrolled in the GUSTO-IV (Global Utilization of Strategies to Open Occluded Arteries-IV ACS) trial between 1998 and 2000. RESULTS: Among all other predictors, the degree of ST-segment depression had the highest prognostic value for 30-day death, 30-day death/MI, and 1-year death. Troponin T (TnT), creatinine clearance, N-terminal pro-brain natriuretic peptide (NT-proBNP), heart rate, and age were also highly influential on adverse outcomes. Unlike TnT and NT-proBNP, C-reactive protein was only predictive of long-term death. In contrast to mortality, the contribution of TnT to predicting 30-day death/MI increased, whereas NT-proBNP's role was attenuated. The discriminatory power was excellent (c-index [adjusted for over-optimism]: 0.82 [30-day death]; 0.72 [30-day death/MI]; 0.81 [1-year]). CONCLUSIONS: In this large contemporary study of NSTE-ACS patients, novel insights into risk stratification were observed-in particular, the utility of quantitative ST-segment depression and multiple biomarkers. Collection of these indicators in future NSTE-ACS populations is recommended to evaluate generalizability and clinical application of these findings.     

Correlation of Pretreatment Hemoglobin and Platelet Counts with Clinicopathological Features in Colorectal Cancer in Saudi Population

Background/Aims:

In Saudi Arabia, colorectal cancers (CRCs) are registered as the second most common cancers. However, no data has been reported about correlation of the severity of the anemia and pretreatment platelets level with clinicopathological features of CRCs. We aimed to evaluate the association between pretreatment hemoglobin and platelets level and the clinicopathological features of CRC patients in Saudi Arabia.

Materials and Methods:

Between September 2005 and November 2011, One hundred and fifty-four confirmed CRC patients underwent thorough physical examination, blood investigations, endoscopic ultrasonography (EUS), and computed tomography (CT) for staging before surgery. Findings of physical assessment, EUS, CT, and pathological specimens were correlated with pretreatment hemoglobin and platelets levels the Pearson-Kendall tau correlative coefficients.

Results:

The mean age of cohort was 56.6 years (range: 26-89). Left-sided CRC were predominant (97 patients; 63%). Mean size of primary tumor was 6 cms (1-18) SD ± 3.55. Mean values of hemoglobin, red blood cells, hematocrit, white blood cells, and platelets were 11.9 SD ± 2.3, 35.5 SD ± 5.7, 4.43 × 10⁶/mL SD ± 0.6, 7.67 10⁶/mL SD ± 2.44, and 343 × 10³/mL SD ± 164.4, respectively. Pretreatment hemoglobin was inversely correlated with primary tumor size (R: 0.71, R^2: 1.55, P = 0.0001) and nodal status (R: 0.02, R^2: 0.05, P = 0.01). Right-sided CRC had significantly low pretreatment hemoglobin levels (P = 0.001). Interestingly, pretreatment thrombocytosis was seen only in right-sided CRC (P = 0.0001).

Conclusion:

Pretreatment anemia and thrombocytosis were found mainly in right-sided CRCs and advanced primary and nodal stages. Pretreatment hemoglobin and thrombocytosis can be considered as useful prognostic markers in CRC patients.