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Background and Aims: Hemodynamic instability is most common intraoperative complication after spinal anesthesia during cesarean delivery. Spinal anesthesia causes bradycardia and hypotension via activation of Bezold-Jarisch reflex. Ondansetron is specific 5-HT3 receptor antagonist that alleviates the Bezold-Jarisch reflex lead to decrease hypotension and bradycardia. The present study was done to compare the effect of intravenous ondansetron with placebo for attenuation of spinal induced hypotension, change in heart rate, requirement for vasopressor and incidence of shivering and postoperative nausea- vomiting. Material and Methods: 120 Patients of ASA1/2, age 20-35years, weight 40-60Kgs undergoing cesarean delivery under spinal anesthesia were selected for study. History of PIH, convulsion or allergy to the drug used, requires general anaesthesia for supplementation were excluded from study. Randomization was done by chit in box method. Group O (n=60) received 6mg ondansetron in normal saline intravenously; total volume made 10ml. Group S (n=60) received 10ml normal saline intravenously. Blood pressure and heart rate were checked every 5minutes till the end of the surgery. Data was analyzed by chi square test. Results: Systolic, diastolic and mean blood pressure were found to be higher in group O as compare to group S at different time intervals (P value < 0.05). In group O 67% patients required vasopressors whereas in group S 91% patients required vasopressors. Incidence of nausea and vomiting is less in group O (P value=0.001). Conclusion: Prophylactic intravenous ondansetron causes reduced incidence of hypotension, requirement of vasopressors and Post-operative nausea-vomiting during spinal anaesthesia.
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Background: Caudal analgesia is a good, reliable and easy method to provide intraoperative and postoperative analgesia in the infraumbilical surgery in paediatrics. This study aimed to compare perioperative analgesic efficacy, intraoperative hemodynamics and postoperative side effects of dexamethasone added to caudal ropivicaine in paediatric patients undergoing infraumbilical surgery. Methods: This study was conducted on 60 patients (30 in each group), either gender, age 1to 7yrs, ASA I to III, schedule for lower abdominal surgery. After giving general anaesthesia, caudal block was given in left lateral position. Patients in Group C received 1.0 ml/kg, 0.15% ropivacaine alone and in Group D 1.0 ml/kg, 0.15% ropivicane with 0.2 mg/kg of dexamethasone. Postoperative duration analgesia (FLACC pain score) was assessed. Result: There was no statistically significant difference observed with respect to demographic data, peri-operative heart rate, systolic and diastolic blood pressure and requirement of sevoflurane % concentration in both the groups. After eight, 12 and 24 hours, mean FLACC score was significantly high in children of group C compared to group D (P<0.0001). The mean duration of analgesia was significantly more in group D (946.15+165.42 min ) as compared to group C (420.6+15.35 min) (P<0.0001). No side effects were observed in any of two groups. Conclusion: Caudal administration of dexamethasone to ropivicane significantly increased the duration of post-operative analgesia without any major side effects in children. In paediatric patients by using this simple and safe method, satisfactory analgesia can be provided.
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When considering different treatment modalities for the recent COVID-19 outbreak we need to think of inclusive and well-rounded strategies that tackle more than one aspect of the infection. As COVID-19 has become the recent major concern all over the world; as this virus was able to paralyze most of the human beings’ activities, took away many lives and left governments and people helpless, an urgent solution to eradicate and control the spread of this disease is needed. Specific nutrients with immunological and pharmacological effects, when consumed in amounts above the daily requirement, are referred to as immune-enhancing nutrients. In this review, we’ll go over the possible advantages of supplementing patients with immune-enhancing micronutrients like arginine, glutamine, zinc, copper, and vitamin C. Such nutrients could foster an enhanced immune response by modulating both innate and adaptive mechanisms. Deficiency states are common and further compromise the ability of the body to rid itself of an infectious challenge.
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As of April 13, 2020, A novel coronavirus, also known as COVID-19 or SARS-CoV-2 has been confirmed in 1,858,800 people worldwide, carrying a mortality of approximately 3.4%. As COVID-19 cases increase day by day, scientists are digging to reveal all about this pandemic virus, and many drug suggestions have been under clinical trials to decrease the mortality based on the theory of " cytokine storm- hyperinflammatory status". However new researches and studies have discovered that the reactive oxygen species (ROS) storm instead of cytokine storm is the primary pathogenesis cascade that contributes to the exponential mortality pattern in in late stage COVID-19 infected critically ill patients. The impact of COVID-19 on the health, economic and political systems made it a hot topic for research. Therefore, new drug ideas that deals with the underlining contributors of the disease are needed. In this review article, we aim to introduce a novel management strategy using continuous Desferrioxamine (an iron chelating agent) infusion with adjunctive PRBCs based on the new theory of the disease pathogenesis named as "Iron overload-hyperoxidative status-radical storm" and the extrapolation of the clinical outcomes of this strategy in blood transfusion dependent thalassemia.
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Now, Enveloped positive single stranded RNA-coronavirus is considered the most world concern. The discovery of the new pathogenesis of SARS-COV-2 is requiring us to think out of the box in order to manage this pandemic outrageous virus that has took many lives and still does. Up to this date, 18th of April, 2,256,844 coronavirus confirmed cases and around 154,350 deaths all over countries and territories. General clinical presentation of the infection includes fever, dry cough and shortness of breath and may develop to acute respiratory distress syndrome ARDS, pneumonia, sepsis multi-organ failure, respiratory arrest and eventually causing death. COVID-19 is more likely to affect elderly with comorbidities, requiring ICU admission and mechanical ventilation. Therefore, finding novel treatment approaches is of crucial importance. Disseminated intravascular Coagulation (DIC) is a common complication in hospitalized patients especially ICU patients. Recently, coronavirus was observed to attack heme on the 1-beta chain causing iron-porphyrin dissociation. Heparin pleiotropic effects of anticoagulation and RBC protective effect, makes it a drug of choice in management of COVID-19. It is reported in literature that heparin and heparin like compounds due to polysaccharide component have high inhibitory effects on microbial invasion of red blood cells RBC. The dual benefit of heparin can be of significant importance in COVID-19 and especially for complicated cases and most susceptible individuals.
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Around 2 million individuals all over the globe are infected with the novel coronavirus 2019 that has emerged from Wuhan, China. It has rapid spreading rate by small droplets coming from sneezing or coughing of infected individual or asymptomatic carrier individual. The current management strategy is supportive; mainly hemodynamic and respiratory support. Fatalities are caused by severe pneumonia, sepsis, multi-organ failure, respiratory arrest and heart attack. Recent COVID-19 reports suggest a relation between hyper oxidative stress, caused by viral infection generally and heme dissociation particularly, and increased clinical deterioration of the patients. Patients suffers from cytokine storm and hyper-inflammatory status. In addition, they might be suffering from free heme accumulation and radical storm. Symptomatic and supportive treatments are needed at the same time side by side. ). There are a lot of research and clinical trial to find a treatment or vaccine for this pandemic and only some of them were applied in clinical practice. Adjuvant micronutrients support is expected to decrease the oxidative stress status in these patients especially critically ill. Micronutrients includes vitamins C, A, E and trace element selenium are known for their anti-inflammatory and anti-oxidant effect.Through this review article, we highlight potential effect of use of antioxidant-4 cocktail COVID-19 infected patients.
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The whole world agrees on the significance of finding a vaccine or a drug that will aid in the eradication of the novel SARS-COV-2 infection, this extremely contagious virus has gained the characteristic of being pandemic according to the world health organization, in addition to its reputation as a virulent and notorious virus that has succeeded to position the humanity in a critical situation in many settings as financial, political and health-wise. When taking the new theory of COVID-19 pathogenesis into consideration, which is “radical storm- hyperoxidative” in combination with “cytokine storm hyper-inflammatory status”, we need to think of a drug that effects on both mechanisms of the pathogenesis. This dissertation investigates the potentiality of antiplatelet agents specifically Ticagrelor (due to its antiviral characteristics) rather than other agents in decreasing the hyper-viscosity syndrome complication of COVID-19, and reduce the patient's transformation to further late-stage issues such as disseminated intravascular coagulopathy (DIC) that is a direct way for death.
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The Coronavirus disease 2019 (COVID-19) has been a global outbreak and emergency declared by the WHO. Yet no conformed vaccine or drug that will end this pandemic crisis as it takes months if not years to develop as well as it is costly and the process to deliver the drug to the whole world is long while people are dying from the deadly virus. The hyper-oxidative stress that resulted from the pathogenesis of SARS-CoV-2 leads to detrimental consequences and multiple organ failures that leads to sudden death. As it’s evident from the free radical theory, the release of oxidative iron from hemoglobin overwhelms the natural detoxifying mechanisms leading to prolonged and persistent hypoxia. Antioxidants like N-Acetyl cysteine are suggested as a viable therapeutic approach for attenuating tissue damage induced by oxidative stress. An overreaction of the immune system will develop as a form of systemic inflammatory response, which is called a cytokine storm. Unlike free radical theory, cytokine storm theory may not always lead to multiorgan failures and death. This emphasizes the seriousness of free radical theory and the promising role of antioxidant use in SARS-COV-2 in infected critically ill patients. Therapeutic infusion of N-Acetyl cysteine will increase the levels of glutathione which counteracts the catastrophic action of free radicals by boosting cellular defense against oxidative stress.
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Background: Recently, sepsis associated with gram negative bacteria (GNB) have increased globally in critically ill patients in which infection by these GNB increases mortality, morbidity, and cost expenditure. A difficult to treat GNBs infections are belonged to multi-drug resistant MDR-Enterobacteriaceae.spp including CRE, since they are susceptible to a limited number of antibiotics. the importance to conserve colistin susceptibility by combination with other available antibiotics (ABs) is an imperative and of an urgent priority of our responsibility to mitigate the emerging of pan-resistant GNB (PR-GNB). The aim of this study is to compare efficacy outcomes of using colistin/high dose meropenem [Group I] with Colistin monotherapy [Group II] in critically ill patients who had sepsis caused by CRE regarding hemodynamics, infectious values, and overall major clinical outcomes in septic critically ill patients. Methods: We perform a retrospective analysis of 102 septic critically ill patients admitted to the adult ICU between April 2017 and April 2019. All patient’s continuous variables were expressed as Mean ±SD by using the independent T-Test. Using of Chi Square test to express categorical variables, as numbers with percentages. Results: the mean overall age of 58.4±9.95 years. 56 subjects (54.90%) were male and 52 subjects (50.98%) were female. Objectively, the hemodynamic parameters were positively and significantly higher in Group I versus Group II. The %∆ CRP: ALB and (NEavg) were in Group II significantly higher than Group I (269%±33%, and 7.12±0.19, 179%±30% and 6.05±0.07, respectively). The 28-day survival was significantly higher in Group I (48 (80.0%)) versus Group II (40 (64.5%)). In contrast, the ICU stay days, early, late, and 28-day mortality overall 28-day ICU mortality was higher in Group II versus Group I. Conclusion: In conclusion, our study has shown that colistin is more effective with a significant positive impact on clinical outcomes when us
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Objectives: Non-nutritional sources of sodium are commonly encountered in hospitalized patients who are used carbapenems to treat non-carbapenemase producing multi-drug resistant gram-negative bacteria. Meropenem and Imipenem/Cilastatin are the most two widely used carbapenems in most medical centers including our institution. The non-nutritional sources of sodium from both tested carbapenems may have a detrimental effect on critically ill patient’s organ functions and may be an independent risk factor for mortality. The primary objective of our study is to investigate the significance difference of non-nutritional associated hypernatremia (NNAH) risk between Meropenem (Group I) versus Imipenem/Cilastatin (Group II). Methods: Our study was retrospectively carried out for critically ill patients admitted to King Hussein Medical Hospital (KHMH) wards between April 2017 and Dec 2019 Patients were excluded if they discharged or died before completed 2 days of the tested ABs during their admission. Collected continuous data were analyzed using Independent T-Test while Chi Square Test were used for dichotomous data analysis and to determine the NNAH risk in both tested groups. Corrected sodium level (cNa+) level of 145 mEq/l will be considered the cutoff point for hypernatremia. Results: The mean overall age was 59.62±1.59 years, and 57 subjects (71.25%) were male. The overall risk of NNAH was 5.1% (4 patients). Critically ill patients who were on Meropenem had the highest risk of NNAH (7.9%, 3 patients) contrast on Imipenem /Cilastatin (2.4%, 1 patient).Conclusion: Our results demonstrate that empirical or targeted use of β-lactam Carbapenems either Meropenem or Imipenem/Cilastatin is an independent risk of NNAH especially in case of high dose Meropenem.
ABSTRACT
Coronavirus disease (COVID_19) is an emerging respiratory virus. The World Health Organization (WHO) declared COVID-19 a global pandemic. Health professionals are looking forward to effectively and safely treat the infected patient by drug repositioning or to develop a vaccine and prevent the contagion. Recently, researchers tried to find a treatment for COVID-19 ,such as hydroxychloroquine . HCQ have side effects as Gastrointestinal upset (vomiting and diarrhea), Patients with long-term exposure to HCQ suffer from severe side effects, such as retinopathy, circular defects (or bull’s eye maculopathy) , HCQ are metabolized in the liver with renal excretion of some metabolites, hence they should be prescribed with care in people with liver or renal failure, there is raise concerns about reports of COVID-19 causing liver and renal impairment, which may increase the risk of toxicity of HCQ when it is used to treat COVID-19. this problem leading us to looking for a safer alternative. The treatment of COVID-19 still not optimize, depending on treating symptoms or the complication patient develops and monitoring. Also, considering risk factors for the disease. Propranolol is the best alternative for HCQ as an effective and safe drug. At this review we have suggested propranolol which is a nonselective beta-blocker that blocks the action of catecholamines (adrenaline and noradrenaline) at both beta-1 and beta-2 adrenergic receptors ) to be used safely as renin inhibitor , red blood cell invasion inhibitor, cardiovascular complication mitigator , and anticatabolizer in management of complicated COVID-19 infected patients with positive clinical outcomes.
