Intramuscular ketamine for prevention of postanesthesia shivering in children

OBJECTIVE: To compare the effects of intramuscular ketamine with pethidine and placebo on post operative shivering in children undergoing tonsillectomy. METHODS: A prospective randomized double-blind study was conducted at King Abdulaziz Naval Base Hospital, Jubail, Kingdom of Saudi Arabia, from November 2006 to October 2007. One hundred and twenty children (American Society of Anesthesiologists Grade 1, aged 5-12 years) were enrolled. Children were randomly allocated to receive ketamine 1 mg/kg (group K, n=40), or pethidine 0.5 mg/kg (group P, n=40), or normal saline (group S, n=40) intramuscularly just after induction of general anesthesia. Hemodynamic parameters, oxygen saturation and tympanic temperature were measured and recorded before induction of anesthesia and at regular intervals thereafter. An investigator blinded to the treatment group, graded postoperative shivering using a 5 point scale. RESULTS: The number of patients shivering on arrival to the recovery room and at 10 and 20 minutes after operation were significantly less in groups K (1,1,1) than in group S (19,12,17). No patient that received pethidine shivered. The time to first analgesic requirement in group S was shorter than groups K and P (p=0.001). CONCLUSION: The study indicates that the use of a prophylactic low dose ketamine was found to be effective in preventing post anesthesia shivering in children undergoing tonsillectomy. Ketamine may have at least theoretical advantages over pethidine as regard respiratory depression, nausea, and vomiting.     

Pim-1 kinase antagonizes aspects of myocardial hypertrophy and compensation to pathological pressure overload

Pim-1 kinase exerts potent cardioprotective effects in the myocardium downstream of AKT, but the participation of Pim-1 in cardiac hypertrophy requires investigation. Cardiac-specific expression of Pim-1 (Pim-WT) or the dominant-negative mutant of Pim-1 (Pim-DN) in transgenic mice together with adenoviral-mediated overexpression of these Pim-1 constructs was used to delineate the role of Pim-1 in hypertrophy. Transgenic overexpression of Pim-1 protects mice from pressure-overload-induced hypertrophy relative to wild-type controls as evidenced by improved hemodynamic function, decreased apoptosis, increases in antihypertrophic proteins, smaller myocyte size, and inhibition of hypertrophic signaling after challenge. Similarly, Pim-1 overexpression in neonatal rat cardiomyocyte cultures inhibits hypertrophy induced by endothelin-1. On the cellular level, hearts of Pim-WT mice show enhanced incorporation of BrdU into myocytes and a hypercellular phenotype compared to wild-type controls after hypertrophic challenge. In comparison, transgenic overexpression of Pim-DN leads to dilated cardiomyopathy characterized by increased apoptosis, fibrosis, and severely depressed cardiac function. Furthermore, overexpression of Pim-DN leads to reduced contractility as evidenced by reduced Ca²⁺ transient amplitude and decreased percentage of cell shortening in isolated myocytes. These data support a pivotal role for Pim-1 in modulation of hypertrophy by impacting responses on molecular, cellular, and organ levels.     

Flavonoids from Iris songarica and their antioxidant and estrogenic activity

A new dihydroflavonol, songaricol ( 1) and seven known flavonoids, ayamenin A ( 2), irisflavone A ( 3), 5,7-dihydroxy-2',6-dimethoxyisoflavone ( 4), irilin B ( 5), 5,3'-dihydroxy-7,8,2'-trimethoxyisoflavone ( 6) and irisoid A ( 7) were isolated from rhizome and roots of IRIS SONGARICA. Structure elucidation of 1 was achieved through extensive NMR and circular dichroism techniques. Compounds 1, 5 and 7 showed antioxidant activity in HL-60 cells (IC50 values of 21, 11 and 3.8 microg/mL), whereas 2, 5 and the previously isolated irisone B were able to show estrogenic response (EC50 values of 305.5, 159.7 and 322.0 microg/mL) in yeast cells expressing human estrogen receptor (ER-alpha).     

Transport of Schisandra chinensis extract and its biologically-active constituents across Caco-2 cell monolayers - an in-vitro model of intestinal transport

We have determined the intestinal transport of Schisandra chinensis extract and its lignans (gomisin A, gomisin N and schisandrin C) in the Caco-2 cell monolayer model. The transport across monolayers was examined for 2 h in absorptive and secretory directions. Quantitation of lignans was performed by HPLC. Out of the three lignans, gomisin A exhibited bi-directional transport, with P(app) values in the range of 25-29 x 10(-6) cm s(-1), indicating a passive diffusion. Gomisin N, mixture and Schisandra extract displayed a higher transport in the secretory direction with efflux ratios in the range of 2.2-5.2. The efflux was decreased in the presence of inhibitors of multidrug resistance protein (MRP) transporter (MK-571) and P-glycoprotein (verapamil) indicating a possible involvement of an efflux pump and MRP in the transport of Schisandra lignans. Poor transport of schisandrin C was observed which could not be quantitated. The permeability of gomisin A in the isolated form was significantly different compared with the mixture or extract.     

Intracuff pressure during one-lung ventilation in infants and children

ObjectiveWe prospectively evaluated intracuff pressure (IP) during one-lung ventilation (OLV) to characterize potential risk associated with overinflation of the cuff used for OLV.DesignProspective observational study over a 2-year period, in infants and children undergoing thoracic surgery. The IPs of the tracheal and bronchial balloon were measured using a manometer and compared to a previously recommended threshold of 30 cmH2O. Data were compared by the device type used to achieve OLV.SettingFreestanding tertiary-care pediatric hospital.ParticipantsPatients ≤ 18 years of age undergoing thoracic procedures requiring OLV.InterventionsMeasurement of IP.Measurements and main resultsThirty patients were enrolled (age 5 months–18 years) with a median weight of 28 kg. Median tracheal and bronchial IPs were 32 cmH2O (range: 11, 90) and 44 cmH2O (range: 10, 100), respectively. The tracheal and bronchial IPs exceeded 30 cmH2O in 13 of 20 patients (65%) and 21 of 30 patients (70%), respectively.ConclusionsIP was high and in excess of recommended levels in most children undergoing OLV. Continuous monitoring of IP may be indicated during OLV to address the risks involved and ensure the prevention of complications related to high IP.Type of studyProspective comparative study.Level of evidenceLevel II.     

FIGO’s PALM–COEIN Classification of Abnormal Uterine Bleeding: A Clinico-histopathological Correlation in Indian Setting

Introduction

Abnormal uterine bleeding (AUB) is the commonest menstrual problem during perimenopause. The International Federation of Gynaecology and Obstetrics working group on menstrual disorders has developed a classification system (PALM–COEIN) for causes of the AUB in non-gravid women. The present study was conducted with the aim to study the two components of this system in clinical practice in general and to establish a clinico-pathological correlation of AUB with context of PALM component in particular.

Materials and Methods

Two hundred and thirty-six perimenopausal women (aged 40 years and above till 1 year beyond menopause) admitted with complaints of abnormal uterine bleeding were studied. After thorough history and examination, a clinical diagnosis was made as per PALM–COEIN classification. Relative contribution of various causes of PALM (structural) and COEIN (functional) components was analysed. After all indicated investigations, endometrial sampling and hysterectomy specimen were assessed by histology. A clinicopathological correlation was analysed statistically.

Result

PALM and COEIN components contributed almost equally for AUB when assessed clinically. On the other hand, the histological examination revealed significantly more cases of PALM (structural or anatomical) component of AUB, i.e. 50.23 versus 63.98 % (p ≤ 0.05) The difference was mainly attributed to the detection of more cases of AUB-M (malignancy and hyperplasia) in highly significant proportions (p ≤ .01) and coexistent cases of AUB-A;L. AUB-L was the commonest (41.1 %) aetiology overall.

Conclusion

The PALM–COEIN classification system should take into account both the clinical and histopathological diagnoses in women having AUB around perimenopause as the two diagnostic modalities are complementary to each other and clinical impression should be placed into proper perspective of this classification in order to optimise outcome.