Facilitatory Effects of Perineural Dexmedetomidine on Neuraxial and Peripheral Nerve Block

Abstract Background DXM is an anxiety reducing, sedative, and pain medication. It has been used as adjunct to local anesthetics to improve the quality of perioperative analgesia and prolong its duration. Alpha2-adrenergic agonists have expanded the horizons of regional anesthesia. DXM is a highly selective α-2 agonist similar to clonidine but with a greater affinity for the α-2 receptor. It is the pharmacologically active d-isomer of medetomidine, a full agonist of α-2 adrenergic receptors. Objective The aim of this study is to evaluate the efficacy of DXM as an adjuvant to local anesthetics for intrathecal and supraclavicular blocks compared to LA alone. Methods This is a meta-analysis study. Searches were conducted in PubMed, Ovid/MEDLINE and Embase using free text and controlled vocabulary terms relating to Dexmedetomidine (MeSH). Results will be combined using Boolean operator “AND” with search terms analgesia, anesthesia, adjuvant, local anesthetics, nerve block, perineural, and terms designating route of administration such as neuraxial, intrathecal, supraclavicular, arm, and brachial plexus. Additional non-indexed articles will be retrieved using Google Scholar; and reference sections of retrieved trials will be hand-searched for additional relevant studies. Search will be limited to randomized trials published in English language, conducted on humans over the last 15 years. All protocols were approved by the local ethics committee or institutional review board of their respective institution. Results Throughout the studies reviewed, the dose of DXM was either given through a lumbar puncture performed in lateral or sitting position (range 3ug – 10ug) or via the supraclavicular approach in supine position with arm adducted (range 30ug – 100ug). DXM has been shown to prolong sensory and motor block duration in spinal and supraclavicular blocks. However, sensory and motor block onset has varied greatly from one study to another. DXM has also proved to have no significant adverse effects in the short term. Conclusion The study results indicate that the use of dexmedetomidine as a local anesthetic adjuvant prolongs sensory and motor block duration when administered intrathecally as part of spinal anesthesia or peripherally as part of a supraclavicular block.

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The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis

Human Reproduction Update ◽

10.1093/humupd/dmz014 ◽

2019 ◽

Vol 25 (4) ◽

pp. 486-503 ◽

Cited By ~ 28

Author(s):

Nina Shigesi ◽

Marina Kvaskoff ◽

Shona Kirtley ◽

Qian Feng ◽

Hai Fang ◽

...

Keyword(s):

Autoimmune Diseases ◽

Cohort Studies ◽

Meta Analysis ◽

Population Based ◽

Case Control ◽

Controlled Vocabulary ◽

Current Evidence ◽

Free Text ◽

Cross Sectional ◽

Study Results

Abstract BACKGROUND Endometriosis is a chronic gynaecological disorder that affects 2–10% of women of reproductive age. The aetiology of endometriosis is largely under-explored, yet abnormalities in the immune system have been suggested to explain the origin of ectopic endometrial tissues, and an association between endometriosis and autoimmune diseases has been proposed. Evaluation of current evidence investigating the association between endometriosis and autoimmune diseases from population-based studies will facilitate our understanding of the causes and consequences of endometriosis and provide a reference for better healthcare practices population-wide. OBJECTIVE AND RATIONALE The aim of this study was to systematically review the literature on population-based studies investigating an association between endometriosis and autoimmune diseases and to conduct a meta-analysis of combinable results to investigate the extent and robustness of evidence. SEARCH METHODS Four electronic databases were searched (MEDLINE, Embase, Web of Science, and CINAHL) from each database inception date until 7 April 2018. Search terms included a combination of database-specific controlled vocabulary terms and free-text terms relating to ‘endometriosis’ and ‘autoimmune diseases’. Study inclusion criteria focused on peer-reviewed published articles that reported an association between endometriosis and autoimmune diseases, excluding case reports/series, review papers, meta-analyses, organizational guidelines, editorial letters, expert opinions, and conference abstracts. Quality assessment of included studies was performed based on GRADE criteria. Key information of eligible studies was abstracted into a standard form. Meta-analysis was performed for autoimmune diseases with combinable study results from at least three studies investigating an association with endometriosis. For cross-sectional studies and case–control studies, raw data from each study were documented to calculate a Mantel–Haenszel odds ratio with 95% CIs. For cohort studies, an inverse variance probability weighted model was used to pool study results to calculate a rate ratio (a hazard ratio or a standardized incidence rate) with 95% CIs. OUTCOMES A total of 26 published population-based cross-sectional, case–control, and cohort studies that investigated the association between endometriosis and autoimmune diseases met all eligible criteria and were included in the review. The studies quantified an association between endometriosis and several autoimmune diseases, including systemic lupus erythematosus (SLE), Sjögren’s syndrome (SS), rheumatoid arthritis (RA), autoimmune thyroid disorder, coeliac disease (CLD), multiple sclerosis (MS), inflammatory bowel disease (IBD), and Addison’s disease. However, the quality of the evidence was generally poor due to the high risk of bias in the majority of the chosen study designs and statistical analyses. Only 5 of the 26 studies could provide high-quality evidence, and among these, 4 supported a statistically significant association between endometriosis and at least 1 autoimmune disease: SLE, SS, RA, CLD, MS, or IBD. WIDER IMPLICATIONS The observed associations between endometriosis and autoimmune diseases suggest that clinicians need to be aware of the potential coexistence of endometriosis and autoimmune diseases when either is diagnosed. Scientists interested in research studies on endometriosis or autoimmune diseases should consider the likelihood of comorbidity when studying these two types of health conditions. Well-designed large prospective cohort studies with confounding control and mediation quantification, as well as genetic and biological studies, are needed to generate further insights into whether endometriosis is a risk factor for, or a consequence of, autoimmune diseases, and whether these two types of disorders share pathophysiological mechanisms even if they arise independently. Such insights may offer opportunities for the development of novel non-hormonal medications such as immuno-modulators or repurposing of existing immunomodulatory therapies for endometriosis.

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Burden of Congenital Rubella Syndrome (CRS) in Bangladesh: Systematic Review of Existing Literature and Transmission Modelling of Seroprevalence Studies

Infectious Disorders - Drug Targets ◽

10.2174/1871526518666181004092758 ◽

2020 ◽

Vol 20 (3) ◽

pp. 284-290

Author(s):

Jocelyn Chan ◽

Yue Wu ◽

James Wood ◽

Mohammad Muhit ◽

Mohammed K. Mahmood ◽

...

Keyword(s):

Systematic Review ◽

Deterministic Model ◽

Case Series ◽

Controlled Vocabulary ◽

Congenital Rubella Syndrome ◽

Free Text ◽

Childbearing Age ◽

Vaccination Programs ◽

Congenital Rubella ◽

The Impact

Background and Objectives: Congenital Rubella Syndrome (CRS) is the leading cause of vaccine-preventable congenital anomalies. Comprehensive country-level data on the burden of CRS in low and middle-income countries, such as Bangladesh, are scarce. This information is essential for assessing the impact of rubella vaccination programs. We aim to systematically review the literature on the epidemiology of CRS and estimate the burden of CRS in Bangladesh. Methods: We conducted a systematic review of existing literature and transmission modelling of seroprevalence studies to estimate the pre-vaccine period burden of CRS in Bangladesh. OVID Medline (1948 – 23 November 2016) and OVID EMBASE (1974 – 23 November 2016) were searched using a combination of the database-specific controlled vocabulary and free text terms. We used an age-stratified deterministic model to estimate the pre-vaccination burden of CRS in Bangladesh. Findings: Ten articles were identified, published between 2000 and 2014, including seven crosssectional studies, two case series and one analytical case-control study. Rubella seropositivity ranged from 47.0% to 86.0% among all age population. Rubella sero–positivity increased with age. Rubella seropositivity among women of childbearing age was 81.0% overall. The estimated incidence of CRS was 0·99 per 1,000 live births, which corresponds to approximately 3,292 CRS cases annually in Bangladesh. Conclusion: The estimated burden of CRS in Bangladesh during the pre-vaccination period was high. This will provide important baseline information to assess the impact and cost-effectiveness of routine rubella immunisation, introduced in 2012 in Bangladesh.

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Emotional Eating and Weight Status in Adolescents: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18030991 ◽

2021 ◽

Vol 18 (3) ◽

pp. 991

Author(s):

Christine A. Limbers ◽

Emma Summers

Keyword(s):

Systematic Review ◽

Weight Loss ◽

Emotional Eating ◽

Weight Status ◽

English Language ◽

Gastric Bypass Surgery ◽

Study Results ◽

Weight Outcomes ◽

Prospective Association ◽

The One

Background: Despite evidence that emotional eating is associated with weight gain in adults, less is known about this association in adolescents. The purpose of the current study was to conduct a systematic review to assess the association between emotional eating and weight status in adolescents. This study also sought to describe existing measures of emotional eating in adolescents and explore weight-loss interventions that assessed emotional eating in relation to weight status in this population. Methods: Two independent reviewers searched the database PubMed for published or in press peer-reviewed studies that assessed the association between emotional eating and weight status in adolescents aged 12 to 19 years. Studies were excluded from this review if they were not written in the English language, did not include a measure of emotional eating, or were a dissertation study. Results: A total of 13 studies met full inclusion criteria and were included in the systematic review. Of the six longitudinal studies in the review, only one found a prospective association between emotional eating and weight status. The Dutch Eating Behavior Questionnaire was the most widely used measure of emotional eating in the systematic review (n = 6; 46.2%). The one intervention study included in this review found that baseline emotional eating was not associated with weight outcomes 2 years following gastric bypass surgery in obese Swedish adolescents (13–18 years). Conclusions: While there were some inconsistent findings across the studies included in this review, taken as a whole, the results largely do not support an association between emotional eating and elevated weight status or reduced weight loss in adolescents.

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The use of thesauri in online retrieval

Journal of Information Science ◽

10.1177/016555158400800204 ◽

1984 ◽

Vol 8 (2) ◽

pp. 63-66 ◽

Cited By ~ 8

Author(s):

C.P.R. Dubois

Keyword(s):

Information Retrieval ◽

Data Base ◽

Case Studies ◽

Controlled Vocabulary ◽

Free Text ◽

Data Bases ◽

Online Data ◽

Controlled Vocabularies ◽

Semantic Maps ◽

Actual Use

The controlled vocabulary versus the free text approach to information retrieval is reviewed from the mid 1960s to the early 1980s. The dominance of the free text approach following the Cranfield tests is increasingly coming into question as a result of tests on existing online data bases and case studies. This is supported by two case studies on the Coffeeline data base. The differences and values of the two approaches are explored considering thesauri as semantic maps. It is suggested that the most appropriate evaluatory technique for indexing languages is to study the actual use made of various techniques in a wide variety of search environments. Such research is becoming more urgent. Economic and other reasons for the scarcity of online thesauri are reviewed and suggestions are made for methods to secure revenue from thesaurus display facilities. Finally, the promising outlook for renewed develop ment of controlled vocabularies with more effective online display techniques is mentioned, although such development must be based on firm research of user behaviour and needs.

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Bibliographic database access using free-text and controlled vocabulary: an evaluation

Information Processing & Management ◽

10.1016/j.ipm.2004.01.004 ◽

2005 ◽

Vol 41 (4) ◽

pp. 873-890 ◽

Cited By ~ 22

Author(s):

Jacques Savoy

Keyword(s):

Controlled Vocabulary ◽

Free Text ◽

Bibliographic Database ◽

Database Access

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Automated Navigation of Method Time Measurement Tables for Automotive Assembly Line Planning

Volume 4: 18th Design for Manufacturing and the Life Cycle Conference; 2013 ASME/IEEE International Conference on Mechatronic and Embedded Systems and Applications ◽

10.1115/detc2013-13325 ◽

2013 ◽

Author(s):

Rahul Renu ◽

Matthew Peterson ◽

Gregory Mocko ◽

Joshua Summers

Keyword(s):

Software Tool ◽

Controlled Vocabulary ◽

Prototype System ◽

Assembly Process ◽

Line Planning ◽

Assembly Time ◽

Study Results ◽

Automotive Assembly ◽

Cad Models ◽

Assembly Procedure

Assembly process sheets are formal documents used extensively within automotive original equipment manufacturers (OEMs) to document and communicate assembly procedure, required tooling, contingency plans, and time study results. These sheets are authored throughout the vehicle life-cycle. Further, various customers use these sheets for training, analyzing the process, and line-balancing. In this research, the primary focus is the time studies analysis that is completed using knowledge contained within the assembly process sheets. In this research, a method and software tool are developed to utilize coupling between part descriptions and process descriptions for assembly time studies. The method is realized through the development of a standardized vocabulary for describing work instructions, a mapping from work instructions to MTM codes, and a tool for extracting relevant part information from CAD models. The approach enables process planners to establish part-process coupling, author work instructions using the controlled vocabulary, to estimate assembly time. A prototype system is developed and tested using examples from an automotive OEM.

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Evaluating Efﬁcacy and Safety of Intradermal Delivery of Vaccines through Microneedle(s) in Animals: Systematic Review Protocol (Preprint)

10.2196/preprints.29400 ◽

2021 ◽

Author(s):

Ishumeet Kaur Bajwa ◽

Navneet Kaur ◽

Joseph L. Mathew

Keyword(s):

Systematic Review ◽

Animal Models ◽

Risk Of Bias ◽

Controlled Vocabulary ◽

Free Text ◽

Efficacy And Safety ◽

Systematic Review Protocol ◽

Intradermal Delivery ◽

Review Protocol ◽

Intradermal Route

BACKGROUND Microneedles are defined as micron-sized projections that create microscopic holes to the skin on application so that drug molecules can penetrate across the outer layers of the skin into the dermis or deeper. Skin is a natural barrier for defense against invading pathogens. Additionally, the dermis possesses dendritic cells that are efficient for antigen presentation and initiating the cascade of immunogenic responses leading to antibody production. Therefore, intradermal delivery of vaccine antigens could be a safe and less invasive alternative for vaccine delivery compared with conventional intramuscular injection. OBJECTIVE We intend to undertake a systematic review of the literature to evaluate the efficacy and safety of intradermal delivery of vaccines using microneedles in animal models. METHODS In this systematic review, we will consider all study designs evaluating the safety and/or efﬁcacy of intradermal delivery of vaccines using microneedles in animal models. Our search strategy will include free text terms and controlled vocabulary for, “microneedle”, “vaccine”, and “intradermal”. We will search literature through PubMed, Embase, Cochrane, and OpenGrey, and we will not have language or date limits. Two review authors will independently select eligible studies and assess the risk of bias using the SYRCLE’s tool particularly for controlled studies and OHAT Risk of Bias Rating Tool for case studies, case-control studies, non-randomized studies, and cohort studies, and CAMARADES checklist to appraise the quality of the included studies. We will report structured summaries of the included studies and, if possible, conduct meta-analyses. The primary outcome to be measured is the efficacy of vaccine delivered through an intradermal route using microneedle(s) such as parameters of immunogenicity (for example antibody levels), sero-efficacy (for example sero-conversion), protective efficacy, etc. Secondary outcomes would include the safety of vaccines delivered through the intradermal route. This could include parameters to identify and/or quantify the timing and nature of local reactions, bleeding, systemic reactions, and death. Pain response during vaccination delivered through the intradermal route will also be evaluated. RESULTS This is a protocol for a systematic review; therefore, results are not available. CONCLUSIONS This is the first systematic review protocol aiming to assess the evidence on the efficacy and safety of intradermal delivery of vaccines using microneedles in various animal models. The findings will inform the safety and efficacy of intradermal delivery of vaccines in animal models, with the overall goal of considering the method for human vaccination as well. The results of this study will be published in a peer-reviewed journal. CLINICALTRIAL PROSPERO CRD42021236625

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Impact of inquiry-based English teaching through digital applications on primary schoolchildren's reading comprehension and autonomy in pandemic situation

Linguistics and Culture Review ◽

10.21744/lingcure.v5ns3.1845 ◽

2021 ◽

Vol 5 (S3) ◽

Author(s):

Ekaterine Pipia ◽

Irina Chikovani

Keyword(s):

Academic Performance ◽

Reading Comprehension ◽

English Language ◽

Language Teaching ◽

English Language Teaching ◽

Autonomy Development ◽

Study Results ◽

Before And After ◽

Quantitative Manner ◽

The Impact

Considering the urgency of integrating technologies in the contemporary classrooms, the aim of the presented study has been shaped to outline the impact of inquiry-based English language teaching through digital applications on primary learners’ reading comprehension and autonomy development during a pandemic outbreak of COVID-19. The research context has been designed in a quantitative manner to analyze experiment results and compare control and treatment group learners’ reading comprehension and academic achievement levels as well as to measure primary schoolchildren’s level of autonomy before and after the treatment. The subjects’ autonomy level, curiosity and interest in reading through digital applications before and after the experiment have been evaluated through pre and post-experimental questionnaires. Learning processes of two experimental and two control groups were compared to create four research contexts for the study. Discrepancy between inquiry-based teaching through a digital library and a traditional way of teaching reading has been emphasized in the study results. The obtained data has been analyzed using SPSS to compare the academic performance results. The study revealed that inquiry-based English language teaching through digital applications highly enhanced the primary learners’ academic performance in reading and increased their motivation level to study independently.

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A COMPARATIVE STUDY OF 0.5 % BUPIVACAINE WITH FENTANYL VERSUS 0.75% ROPIVACAINE WITH FENTANYL IN EPIDURALANESTHESIA FOR ABDOMINAL HYSTERECTOMY

10.36106/ijsr/6408418 ◽

2021 ◽

pp. 71-73

Author(s):

Pravin Vijayan ◽

Debarshi Jana

Keyword(s):

Motor Block ◽

Sensory Block ◽

Local Anaesthetics ◽

Abdominal Hysterectomy ◽

Controlled Study ◽

Rescue Analgesia ◽

Study Results ◽

Duration Of Surgery ◽

Group B ◽

Time To Onset

INTRODUCTION Abdominal hysterectomy (AH) is a quite common gynaecological surgical procedure and electively done under central neuraxial blockade. AH is performed for malignant as well as benign indications such as uterine leiomyoma, persistent vaginal bleeding, or pelvic organ prolapse. AIMS AND OBJECTIVES Compare the onset of motor and sensory block. Find out the duration of the sensory and motor blockade. Observe intraoperative hemodynamic changes and assess post-operative analgesia requirements in 24 hour. Duration of analgesia assessed by requirement of rst rescue analgesic. Observe any untoward incident during intraoperative and post-operative period and managed accordingly MATERIALS AND METHODS Study Area: Department of Anesthesiology & critical care, DARBHANGAMEDICALCOLLEGE AND HOSPITAL. Study Population: Adult patients (30- 65 years) undergoing elective abdominal hysterectomy with regional anaesthesia were included for this study. Study Period:January 2019 to March 2020 Sample Design: Subjects were divided into two groups (n=35) equal in numbers and they sampled as per computerized randomization chart. These patients were divided into two groups, group B (with epidural 0.5% bupivacaine and 100g fentanyl) and group R (with epidural 0.75% ropivavaine and 100g fentanyl). Study Design: Prospective, open, randomized, controlled study. RESULTS: In Our study showed that 3.38kg/m2 and 24.86 3.60 kg/m2in group B and R respectively. The duration of surgery was 100.86 9.35minutes and 98.86 8.32 minutes and the duration of stay, was4.86 0.81days and 4.60 0.914 days in group B and group R respectively. Now with comparison of both groups, time to onset of sensory block (uptoT6) has signicant variation. But the other parameters namely, time to onset of motor block, two segment regression or duration of sensory block, rescue analgesia timing and complete motor recovery time were comparable and not signicant statistically in both groups. SUMMARY & CONCLUSIONS To conclude that in the present study using 0.5% bupivacaine with fentanyl and 0.75% ropivacaine with fentanyl epidurally, ropivacaine produced an earlier onset but similar duration of sensory block. The onset, quality and duration of motor block werecomparable in both the groups. It is important that new local anaesthetics with lower cardiotoxic property are adopted to ensure that regional techniques using large amounts of local anaesthetics remain safe with minimal complications. The recovery prole of ropivacaine may be useful where prompt mobilization is require

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