Comparative Study between Bupivacaine-Dexmedetomidine versus Bupivacaine-Dexamethasone in Skin Infiltration as Post-Operative Analgesia for Patients undergoing Abdominoplasty Surgeries

Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Aim of the Work To compare skin infiltration with bupivacaine-dexmedetomidine mixture versus bupivacaine-dexamethasone mixture for analgesia in abdominoplasty under general anesthesia. Patients and Methods A prospective randomized clinical trial study was conducted in Ain Shams university hospital on 40 adult patients undergoing Abdominoplasty surgeries. The patients were randomly divided into two groups using their computer-generated random numbers will be enrolled in group I for bupivacaine-dexmedetomidine and group II for bupivacaine-dexamethasone. Results This study demonstrated that the addition of dexmedetomidine to wound infiltration with local anesthetics improves postoperative pain and reduces the need for analgesics. Conclusion Wound infiltration with bupivacaine -dexmedetomidine mixture provides prolonged local anesthetic effect, decreases the need for rescue analgesics, and provides better sedation than bupivacaine–dexamethasone mixture in patients undergoing Abdominoplasty surgeries.

A comparative study between bupivacaine-dexmedetomidine mixture versus bupivacaine-magnesium mixture in Pre-incision skin infiltration for para-umbilical hernia repair regarding their intraoperative and postoperative analgesic effect

Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Aim of the Work to compare skin infiltration with bupivacaine-dexmedetomidine mixture versus bupivacainemagnesium mixture for analgesia in patients undergoing para-umbilical hernia repair under general anesthesia. magnesium. Results This study demonstrated that the addition of dexmedetomidine to wound infiltration with local anesthetics improves postoperative pain and reduces the need for analgesics which can be explained by different mechanisms: inhibition of painconduction in C -fibers, decreased in the production of inflammatory cytokines, the vasoconstrictive effect of 2 on vascular smooth muscle prolongs the time of analgesia, inhibition of tetrodotoxin-sensitive Na+ channels, and the absorption of dexmedetomidine to systemic circulation resulting in supraspinal analgesia. Patients and Methods A prospective randomized clinical trial study was conducted in Ain Shams university hospital on 44 adult patients undergoing para umbilical hernia or infra umbilical incisional hernia repair. The patients were randomly divided into two groups using their computer-generated random numbers will be enrolled in group D for bupivacaine-dexmedetomidine and group M for bupivacaine- Conclusion Pre-skin incision wound infiltration with dexmedetomidine–bupivacaine mixture provides prolonged local anesthetic effect, decreases the need for rescue analgesics, and provides better sedation than bupivacaine–magnesium sulfate mixture or bupivacaine alone in patients undergoing surgeries for hernia repair.

The new external drug for the treatment of psoriasis based on inhibition of serine proteases

Background: Psoriasis is a chronic inflammatory immune-mediated disease characterized by an increased rate of keratinocyte division. The results of recent studies have made it possible to establish that the cytokines of the IL-36 family occupy a significant place in the initiation and regulation of the inflammatory process in psoriasis. IL-36 is in an inactive form and proteolytic processing is required for its activation in the skin, which is possible with the participation of neutrophilic serine proteases. Localization of these enzymes in the upper layers of the epidermis suggests the clinical efficacy of a topical targeted drug that inhibits serine proteases, sivelestat. On the basis of this active substance, we have created a drug in an external dosage form and conducted an experimental study of its effectiveness on a laboratory model of psoriasis. Aims: to evaluate the therapeutic efficacy of sivelestat in a laboratory model of imiquimod-induced psoriasis. Materials and methods: In the experiment, 40 inbred BALB/c mice were used, which were randomized into 4 groups of 10 each. An imiquimod-induced model of psoriasis was used. Mice of group No. I - without therapy (control), No. II - ointment (vaseline) containing 1% sivelestat, No. III - cream (lanolin + olive oil + water in equal proportions) containing 1% sivelestat, No. IV - betamethasone cream dipropionate 0.05%. Clinical assessment of skin rashes was performed using the PASI-modified method (mPASI), as well as histological and immunohistochemical examination of the skin. Results: When evaluating clinical manifestations, it was found that the total mPASI index when using sivelestat cream decreased by 50%, and sivelestat ointment - by 36%. The histological examination showed that the thickness of the epidermis in the groups where the therapy was applied was 2.4-3.6 times less than in the control group. An immunohistochemical study of the skin found that after treatment with sivelestat, the number of CD3 + cells in the skin was 1.8-2.2 times less, and the level of proliferative activity (Ki-67 + cells) was 2.3-2.9 times less. lower than in the group without therapy Conclusions: On a laboratory model of imiquimod-induced psoriasis, it was found that a serine protease inhibitor (sivelestat) has a therapeutic efficacy comparable to a strong topical glucocorticosteroid drug (betamethasone dipropionate 0.05%). A pronounced resolution of the elements of the skin rash, a reduction in the thickness of the epidermis, a decrease in skin infiltration with T-lymphocytes and a normalization of the rate of cell division of the epidermis and dermis are shown. Suppression of the activity of IL-36-mediated inflammation in the skin by means of topical inhibitors of serine proteases is a promising new direction in the treatment of patients with psoriasis.

Regulatory T Cells Exhibit Interleukin-33-Dependent Migratory Behavior during Skin Barrier Disruption

Regulatory T cells (Tregs) suppress immune responses and maintain immunological self-tolerance and homeostasis. We currently investigated relationships between skin barrier condition and Treg behavior using skin barrier-disrupted mice. Skin barrier disruption was induced by repeated topical application of 4% sodium dodecyl sulfate (SDS) on mice. The number of CD4+ forkhead box protein P3 (Foxp3)+ Tregs was higher in 4% SDS-treated skins than in controls. This increasing was correlated with the degree of acanthosis. The numbers of interleukin (IL)-10+ and transforming growth factor (TGF)-β+ Tregs also increased in 4% SDS-treated skins. Localization of IL-33 in keratinocytes shifted from nucleus to cytoplasm after skin barrier disruption. Notably, IL-33 promoted the migration of Tregs in chemotaxis assay. The skin infiltration of Tregs was cancelled in IL-33 neutralizing antibody-treated mice and IL-33 knockout mice. Thus, keratinocyte-derived IL-33 may induce Treg migration into barrier-disrupted skin to control the phase transition between healthy and inflammatory conditions.

Long-term complete remission under TDM1 and local radiotherapy treatment on an inflammatory HER2-positive breast cancer

Premenopausal female patient is diagnosed at the age of 45 for locally advanced inflammatory HER2-positive breast cancer with axillary node involvement. Her disease reveals bad prognostic factors. In spite of radical mastectomy after intensive neoadjuvant treatment based on chemotherapy and trastuzumab-pertuzumab, early skin infiltration recurrence overcomes. She receives local radiotherapy and TDM1 therapy as first advanced disease line. Toxic side effects are not relevant. She achieves four-years-long disease-free survival. Precise treatment selection is challenging but can find out cancer defeat.

Review Paper on Iontophoresis

The ongoing endorsement of lidocaine hydrochloride and epinephrine joined iontophoresis for confined agony treatment by FDA has empowered the picking up enthusiasm for iontophoresis tranquillize conveyance system for the transdermal conveyance of medications. This system of encouraged development of particles over a film affected by a remotely implied electric potential contrast remains one of utmost encouraging bodily skin infiltration improving strategy. The justification overdue utilizing this procedure remains the capacity of technique to build the foundational conveyance of great atomic weight mixes with precise information energy and least between topic changeability in any case accomplished just when parenteral course of organization is utilized. As of late, great saturation of bigger peptides alike insulin has had been accomplished by this method being mixed through concoction accompaniments. This audit quickly depicts the features that influence iontophoresis tranquillize conveyance and abridges the investigations directed as of late utilizing this procedure so as to accomplish higher foundational ingestion of the medications having low latent dispersion in any case. The impact of pervasion enhancers (synthetic enhancers) on iontophoresis motion of medications has likewise been depicted. Present survey additionally gives an understanding into invert iontophoresis. Different constraints that influence transdermal retention of medications by iontophoresis comparable medication fixation, extremity of medications, and pH of contributor arrangement, nearness of co-particles, ionic quality, and terminal extremity and so on have additionally been inspected in detail.