Attenuation of morphine tolerance, withdrawal-induced hyperalgesia, and associated spinal inflammatory immune responses by propentofylline in rats.

The activation of glial cells and enhanced proinflammatory cytokine expression at the spinal cord has been implicated in the development of morphine tolerance, and morphine withdrawal-induced hyperalgesia. The present study investigated the effect of propentofylline, a glial modulator, on the expression of analgesic tolerance and withdrawal-induced hyperalgesia in chronic morphine-treated rats. Chronic morphine administration through repeated subcutaneous injection induced glial activation and enhanced proinflammatory cytokine levels at the lumbar spinal cord. Moreover, glial activation and enhanced proinflammatory cytokine levels exhibited a temporal correlation with the expression of morphine tolerance and hyperalgesia. Consistently, propentofylline attenuated the development of hyperalgesia and the expression of spinal analgesic tolerance to morphine. The administration of propentofylline during the induction of morphine tolerance also attenuated glial activation and proinflammatory cytokines at the L5 lumbar spinal cord. These results further support the hypothesis that spinal glia and proinflammatory cytokines contribute to the mechanisms of morphine tolerance and associated abnormal pain sensitivity.     

Ameliorative Effect of Fructo-Oligosaccharide Rich Extract of Orchis latifolia Linn. on Sexual Dysfunction in Hyperglycemic Male Rats

Diabetes mellitus (DM) is one of the most prevalent modern degenerative disease that has been implicated for deleterious effects on male reproductive function possibly due to an increased oxidative stress. Fructans and fructooligosaccharides (FOS’s) which are also considered as functional food components, have been reported to produce a benevolent effect against streptozotocin induced oxidative stress. The aqueous extract of Orchis latifolia rich in FOS’s as well as phytosterols were evaluated for their efficacy against streptozotocin and alloxan induced sexual dysfunction. The behavioral analysis of rats was undertaken to observe the effect on mount, ejaculation and intromission latencies as well as frequencies, hesitation time and copulatory rate. It was observed that hyperglycemia has an adverse effect on overall sexual behavior. The deleterious effect was significantly reduced in animals treated with polysaccharide rich fraction of O. latifolia. The study suggests that the diabetes induced sexual disability may be ameliorated by proper usage of herbal drugs.     

Immunomodulatory Activity of Chlorophytum borivilianum Sant. F

Chlorophytum borivilianum Santapau & Fernandes (Liliaceae) is a very popular herb in traditional Indian medicine and constitute a group of herbs used as 'Rasayan' or adaptogen. Ethanolic extract of the roots and its sapogenin were evaluated for their immunomodulatory activity. Effect of azathioprine-induced myelosuppresion and administration of extracts on hematological and serological parameters was determined. Administration of extracts greatly improved survival against Candida albicans infection. An increase in delayed-type hypersensitivity response (DTH), % neutrophil adhesion and in vivo phagocytosis by carbon clearance method was observed after treatment with extracts. Immunostimulant activity of ethanolic extract was more pronounced as compared to sapogenins. The results, thus justifies the traditional use of C. borivilianum as a rasayana drug.     

There is Only a Modest Increase in Neonatal Respiratory Morbidity Following Early Term Elective Cesarean in a South Indian Population

Objectives

Elective cesarean deliveries (ECD) are still performed prior to 39 weeks. This study aimed to identify risk of neonatal respiratory morbidity (NRM) following ECD near term, in a South Indian population. Specifically, study aimed to measure the additional healthcare burden due to large number of ECDs performed prior to 39 weeks, in this local population.

Methods

We analyzed NRM among 1329 deliveries (584 ECD and 745 spontaneous vaginal delivery, SVD) in a tertiary hospital over 2 years. Neonates were grouped into: A: 35⁺⁰–36⁺⁶ weeks, B: 37⁺⁰–38⁺⁶ weeks, and C: ≥39 weeks. NRM was compared between ECD versus SVD.

Results

Majority (433/584) of ECDs were performed between 37⁺⁰ and 38⁺⁶ weeks. Overall, 32% received steroid prophylaxis. Of 1329 newborns, 18/584 (3.82%) in ECD and 6/745 (0.8%) in SVD group developed NRM (p value of 0.004, OR 3.9, CI 1.54–9.93). Need of respiratory support among ECD was 4.28% compared to 0.53% in SVD (p < 0.001, OR 8.28; CI 2.86–23.94). However, comparing neonates born by ECD between groups B Vs C; there was only a modest increase in NRM (2.07 vs 0.9%; p 0.48, OR 2.3 with CI 0.29–18.4) and in need of respiratory support (2.54 vs 0.9%; p 0.47, OR 2.84; CI 0.36–22.2).

Conclusion

NRM following early term ECD continues to be a healthcare burden in India. Interestingly in this South Indian population, early term ECDs caused only modest increase in NRM, and this ethnic variation requires further evaluation to determine ideal time for ECD in local population.

     

Incidence and management of diaphragmatic palsy in patients after cardiac surgery

Background:

Diaphragm is the most important part of the respiratory system. Diaphragmatic palsy following cardiac surgery is not uncommon and can cause deterioration of pulmonary functions and attendant pulmonary complications.

Objectives:

Aim of this study was to observe the incidence of diaphragmatic palsy after off pump coronary artery bypass grafting (OPCAB) as compared to conventional CABG and to assess the efficacy of chest physiotherapy on diaphragmatic palsy in post cardiac surgical patients.

Design and Setting:

An observational prospective interventional study done at a tertiary care cardiac centre.

Patients:

2280 consecutive adult patients who underwent cardiac surgery from February 2005 to august 2005.

Results:

30 patients out of 2280 (1.31%) developed diaphragmatic palsy. Patients were divided based on the presence or absence of symptoms viz. breathlessness at rest or exertion or with the change of posture along with hypoxemia and / or hypercapnia. Group I included 14 patients who were symptomatic (CABG n=13, post valve surgery n=1), While Group II included 16 asymptomatic patients (CABG n=12, post valve surgery n=4), 9 patients (64%) from Group I (n=14) and 4 patients (25%) from group II showed complete recovery from diaphragmatic palsy as demonstrated ultrasonographically.

Conclusion:

The incidence of diaphragmatic palsy was remarkably less in our adult cardiac surgical patients because most of the cardiac surgeries were performed off pump and intensive chest physiotherapy beginning shortly after extubation helped in complete or near complete recovery of diaphragmatic palsy. Chest Physiotherapy led to marked improvement in functional outcome following post cardiac surgery diaphragmatic palsy.We also conclude that ultrasonography is a simple valuable bed-side tool for rapid diagnosis of diaphragmatic palsy     

Simplified lansoprazole suspension— a liquid formulation of lansoprazole— effectively suppresses intragastric acidity when administered through a gastrostomy

OBJECTIVE: Lansoprazole suppresses intragastric acidity when given as nonencapsulated intact granules. Because the administration of granules via small-bore tubes may still be problematic, we studied the effect of a liquid formulation of lansoprazole obtained by suspending the contents of a standard 30-mg capsule in 10 cc of 8.4% NaHCO3. METHODS: Six men with an established gastrostomy had a baseline 24-h intragastric pH study. Through the gastrostomy, they then received 7 days of once-daily dosing with 30 mg lansoprazole as intact granules in orange juice. After a 7-day washout period, they then received 7 days of once-daily dosing with the liquid formulation. Intragastric pH monitoring was repeated after each dosing period. RESULTS: Baseline mean intragastric pH was 1.8 +/- 0.5 (SD). This increased to 4.5 +/- 0.5 with lansoprazole granules in orange juice, and to 5.1 +/- 1.1 after the liquid formulation. At baseline, intragastric pH was >3, 4, and 5 for 19.5%, 12.7%, and 8.1%, respectively, of the 24-h recording period. Corresponding values after lansoprazole granules in orange juice were 77.5%, 67%, and 49.6% (p < 0.01 for each comparison with baseline). After the liquid formulation, the corresponding values were 84%, 77.9%, and 65.9% respectively (p < 0.01 for each comparison with baseline; p > 0.05 for each comparison with lansoprazole granules in orange juice). CONCLUSIONS: A liquid formulation of lansoprazole suppressed intragastric acidity when given through a gastrostomy. The degree of suppression was comparable to that obtained with intact nonencapsulated granules in orange juice.