Hypoglycaemic Activity of Extra Virgin Avocado (Persea americana) Oil and Extra Virgin Coconut (Cocos nucifera) Oil on Alloxan-induced Diabetic Rats

Diabetes mellitus is a chronic, metabolic disorder characterized by abnormal elevation of blood glucose levels (hyperglycaemia). Despite significant milestones achieved using conventional drugs in managing the disease, there are some drawbacks associated with their use such as drug resistance, adverse drug effects, high cost, and sometimes outright therapeutic failure. The urgent need to bridge this therapeutic lacuna calls for further exploration and investigation of other treatment options. This study therefore aims at evaluating the antidiabetic potentials of virgin avocado oil and virgin coconut oil in alloxan-induced diabetic rats. Animals were divided into 5 groups of five rats each. Group 1 (negative control) received 10 ml /kg/day of normal saline, group 2 (diabetic control) -10 ml/kg/day of normal saline; group 3 received extra virgin avocado oil (1 ml/250 g) body weight, group 4 received extra virgin coconut oil (2 ml/kg) bodyweight, and group 5 received 10 mg/kg/day of metformin. Treatments were administered orally for 15 days. Extra virgin avocado oil and extra virgin coconut oil respectively showed significant antidiabetic activities, and may be beneficial for management of diabetes mellitus.

A comparative study on the effectiveness of budesonide nasal irrigation versus normal saline nasal irrigation in post endoscopic sinus surgery patients

: Comparative studies evaluating budesonide and saline nasal irrigations for patients with polyposis/ rhinosinusitis are deficient in the current literature. This study aimed to evaluate the effectiveness of budesonide nasal irrigations compared with saline irrigations during postoperative care of patients with rhinosinusitis.: A total of 100 patients who underwent functional Endoscopic Sinus SurgeryESS) were randomly divided into two groups (A and B) of 50 participants each (normal saline [NS] + budesonide irrigation and NS irrigation alone, respectively). Pre- and post operative evaluation was done with a 22-item sinonasal outcomes test (SNOT-22), and Lund Kennedy endoscopic (LKE scores) in second and sixth week. : The condition of the patients significantly improved in both intervention arms related to SNOT-22 and LKE score at each postoperative visit (Group A: p<0.001, Group B: p<0.001). The reduction of SNOT 22 score was higher in budesonide group by 10% (mean SNOT 22 score from 33.31 to 15.84) compared to normal saline group (mean SNOT 22 score from 37.49 to 22.24). The reduction of LKEscore was higher in budesonide group by 18.69% (mean LKE score from 4.49 to 2.71) compared to normal saline group (mean LKE score from 5.02 to 4). : Steroid nasal irrigation is a good option in postoperative EES patients. The difference of reduction of both SNOT 22 score and LKEscore was statistically significant (p <0.05 and p<0.01 respectively) by repeated contrast test. This study is one of the few comparative studies evaluating budesonide and saline nasal irrigations in post-ESS patients.

EFFECT OF NEBULIZED KETAMINE AND MAGNESIUM SULPHATE ON INCIDENCE OF POSTOPERATIVE SORETHROAT – A COMPARATIVE STUDY

BACKGROUND: Post-operative sorethroat(POST) following endotracheal intubation is a well-known complication, several methods have been tried to reduce this incidence. We are comparing the effects of nebulized ketamine & Magnesium Sulphate to reduce this. AIMS AND OBJECTIVES: To compare the efcacy of nebulized ketamine and magnesium sulfate in reducing the incidence of POST. MATERIALS AND METHODS: After obtaining Ethical clearance and patient consent, 40 Patients undergoing surgery under general anesthesia were randomized in to two groups. Five minutes prior to the induction of anesthesia, patients were nebulized with Group K = 1 ml of ketamine [50 mg] +4 ml normal saline, Group M = 0.5 ml of Magnesium Sulphate [250 mg] +4.5 normal saline, and Group S – 5 ml normal saline. RESULTS: There is moderate signicant difference between both the groups at 0 hr. No signicant difference between two groups at 2,6,12 and 24 hrs. CONCLUSION: Ketamineand Magnesium sulfate reduce the incidence of POST, are almost similar in their effects.

Comparison between Nalbuphine and Ketamine as an adjuvant to Heavy Bupivacaine on Post Dural Puncture Headache

Background Incidence of post dural puncture headache (PDPH) is relatively high, and many methods have been tried to prevent or treat it, but results are not satisfactory. Both Nalbuphine and Ketamine have analgesic effects, and have been used intrathecally with local anesthetics, but their effects on PDPH were not studied. Objective To study the incidence and severity of PDPH when nalbuphine or ketamine was added as an adjuvant to hyperbaric bupivacaine in spinal anesthesia (primary outcome). Secondary outcomes were the effects of adding nalbuphine or ketamine as an adjuvant to hyperbaric bupivacaine on motor and sensory effects, duration of analgesia, hemodynamics and side effects of both of them. Patients and Methods This prospective double-blind, randomized controlled study was conducted on 320 patients, aged 21–60 years of both sexes, ASA physical status I and II, and allocated for lower abdominal, pelvic, or lower limb surgeries under spinal anesthesia, after approval from ethical committee (Assurance No. FWA 000017585) of Faculty of Medicine, Ain, Shams University, Cairo, Egypt. Contact with 17 patients was lost. So, 303 patients completed the study. Patients were divided into 3 equal groups (101 each) according to drugs injected intrayhecally. Group (N): 3 ml of 0.5% hyperbaric bupivacaine with 0.5 mg nalbuphine hydrochloride diluted in 0.5 ml normal saline. Group (K): 3 ml of 0.5% hyperbaric bupivacaine with 25 mg ketamine hydrochloride diluted in 0.5 ml normal saline. Group (C): 3 ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline. Results Incidence of PDPH was statistically significantly less in group N in comparison to Groups K and C, in the first day. But, no statistically significant difference was found between the three groups at 2nd and 3rd days. There was no statistically significant difference between groups according to severity of PDPH by visual analog score (VAS). Group N has the most rapid onset and long duration of sensory block in comparison with groups K and C. There was no statistically significant difference between groups according to onset and duration of motor block and hemodynamic changes. Conclusion Adding nalbuphine, and not ketamine, with hyperbaric bupivacaine in spinal anesthesia decreased incidence of post dural puncture headache, and prolonged the duration of sensory block. Both groups provided adequate anesthesia and analgesia with good hemodynamic stability.

Experimental Research on Intratumoral Injection of Sal Ammoniac Extract in the Treatment of Mouse Liver Cancer

Objective: To study the effect of sal ammoniac extract on the treatment of liver cancer and analyze its possibility of replacing absolute ethanol. Methods: Sixty Kunming mice (5-6 weeks old, 18-22g in weight, male and female in half) were selected and inoculated with 0.1 ml of 1:4 ascitic diluent from mouse liver cancer H22 under the axilla of the right limb. After tumor formation, they were randomly divided into 3 groups with 20 mice in each group. Normal saline (NS), sal ammoniac extract (N), and absolute ethanol (E) were injected into the tumor once a day for four times. The death, tumor weight, tumor inhibition rate, lactate dehydrogenase (LDH), and succinate dehydrogenase (SDH) expression of the mice in each group were analyzed. Results: In the course of treatment, 3 mice died in the normal saline group, 2 mice died in the sal ammoniac treatment group, and 7 mice died in the absolute ethanol group. The tumor weight of the normal saline group, sal ammoniac treatment group, and absolute ethanol group were 1.88 ± 0.26, 1.41 ± 0.49, and 1.51 ± 0.46, respectively. The tumor inhibition rates were 0%, 31.0%, and 21.6%, respectively. Comparing the sal ammoniac treatment group and the normal saline group, t = 3.5133, p = 0.0013; comparing the absolute ethanol group and the normal saline group, t = 2.7926, p = 0.0093. The expression of LDH was 81 ± 10, 51 ± 11, and 32 ± 9 in the normal saline group, sal ammoniac treatment group, and absolute ethanol group, respectively, while the expression of SDH was 80 ± 10, 51 ± 10, and 51 ± 12 in the normal saline group, sal ammoniac treatment group, and absolute ethanol group, respectively. Comparing the LDH of the sal ammoniac treatment group with that of the saline group, t = 8.4264, p = 0.0000; comparing the absolute ethanol group and normal saline group, t = 13.8763, p = 0.0000. Comparing the SDH of the sal ammoniac treatment group with that of the normal saline group, t = 8.1455, p = 0.0000; comparing the absolute ethanol group with the normal saline group, t = 7.2197, p = 0.0000. Conclusion: The traditional Chinese antitumor medicine, sal ammoniac and its main effective components have good antitumor effect, which can be further popularized and applied in clinical practice.

The influence of neuromuscular blockade on phase lag entropy and bispectral index: A randomized, controlled trial

The aim of this study is to compare the effects of neuromuscular blockade (NMB) on phase lag entropy (PLE) and the bispectral index (BIS). We recorded the BIS, electromyograph (EMG) activity on a BIS monitor (EMG_BIS), PLE, and EMG activity on a PLE monitor (EMG_PLE) in 40 patients receiving general anesthesia. During the awake state, we analyzed the changes in parameters before and 2 min after the eyes were closed. During sedation, we compared the changes in the parameters before and at 4 min after injecting rocuronium (group R) or normal saline (group C) between the two groups. During anesthesia, we compared the changes in parameters before and at 4 min after injecting sugammadex (group B) or normal saline (group D) between the two groups. During the awake state, the BIS, EMG_BIS, and EMG_PLE, but not PLE, decreased significantly with closed eyes. An effect of EMG on the BIS was evident, but not on PLE. During sedation, the BIS decreased with the decrease in EMG_BIS regardless of NMB caused by rocuronium, but NMB decreased PLE, although the degree of the decrease in EMG_PLE after NMB was similar to that after placebo. To determine the effect of NMB on electroencephalograms (EEGs) in groups R and C, we plotted the power spectra before and at 4 min after injecting rocuronium or normal saline. Changes in slow and delta frequency bands were observed at 4 min after injecting rocuronium relative to before injecting rocuronium. There was no effect of EMG on either the BIS or PLE during anesthesia. In conclusion, the effect of electromyograph activity and/or neuromuscular blockade on BIS or PLE depends on the level of consciousness.

Loss of Autophagy Causes Increased Apoptosis of Tibial Plateau Chondrocytes in Guinea Pigs with Spontaneous Osteoarthritis

Objective The goal of the present study was to observe the effect of autophagy in tibial plateau chondrocytes on apoptosis in spontaneous knee osteoarthritis (OA) in guinea pigs. Design Fifty 2-month-old female Hartley guinea pigs were divided into a normal group (10 animals, all euthanized after 7 months) and an OA group (40 animals, 10 of which were euthanized after 10 months). Immunohistochemistry, RT-qPCR and Western blotting were used to evaluate autophagy levels, intracellular glycogen accumulation and apoptosis in tibial plateau chondrocytes in vivo and in vitro. The remaining 30 guinea pigs in the OA group were divided into 3 groups: a rapamycin group, a normal saline group, and a 3-methyladenine (3-MA) group. Intracellular glycogen accumulation and chondrocyte apoptosis were assessed by altering the level of autophagy in chondrocytes in vivo. Results When spontaneous OA occurred in guinea pigs, autophagy levels in tibial plateau chondrocytes decreased, while intracellular glycogen accumulation and the rate of chondrocyte apoptosis increased. After enhancing the level of autophagy in tibial plateau chondrocytes in guinea pigs with OA, intracellular glycogen accumulation and the rate of chondrocyte apoptosis decreased, while inhibiting autophagy had the opposite effects. Conclusion The results indicate that the function of autophagy in chondrocytes may at least partly involve the catabolism of glycogen. In guinea pigs with OA, the level of autophagy in tibial plateau chondrocytes decreased, and chondrocytes were unable to degrade intracellular glycogen into glucose, leading to less energy for chondrocytes and increased apoptosis.

Perioperative Normal Saline Administration and Delayed Graft Function in Patients Undergoing Kidney Transplantation: A Retrospective Cohort Study

Background Perioperative normal saline administration remains common practice during kidney transplantation. The authors hypothesized that the proportion of balanced crystalloids versus normal saline administered during the perioperative period would be associated with the likelihood of delayed graft function. Methods The authors linked outcome data from a national transplant registry with institutional anesthesia records from 2005 to 2015. The cohort included adult living and deceased donor transplants, and recipients with or without need for dialysis before transplant. The primary exposure was the percent normal saline of the total amount of crystalloids administered perioperatively, categorized into a low (less than or equal to 30%), intermediate (greater than 30% but less than 80%), and high normal saline group (greater than or equal to 80%). The primary outcome was the incidence of delayed graft function, defined as the need for dialysis within 1 week of transplant. The authors adjusted for the following potential confounders and covariates: transplant year, total crystalloid volume, surgical duration, vasopressor infusions, and erythrocyte transfusions; recipient sex, age, body mass index, race, number of human leukocyte antigen mismatches, and dialysis vintage; and donor type, age, and sex. Results The authors analyzed 2,515 records. The incidence of delayed graft function in the low, intermediate, and high normal saline group was 15.8% (61/385), 17.5% (113/646), and 21% (311/1,484), respectively. The adjusted odds ratio (95% CI) for delayed graft function was 1.24 (0.85 to 1.81) for the intermediate and 1.55 (1.09 to 2.19) for the high normal saline group compared with the low normal saline group. For deceased donor transplants, delayed graft function in the low, intermediate, and high normal saline group was 24% (54/225 [reference]), 28.6% (99/346; adjusted odds ratio, 1.28 [0.85 to 1.93]), and 30.8% (277/901; adjusted odds ratio, 1.52 [1.05 to 2.21]); and for living donor transplants, 4.4% (7/160 [reference]), 4.7% (14/300; adjusted odds ratio, 1.15 [0.42 to 3.10]), and 5.8% (34/583; adjusted odds ratio, 1.66 [0.65 to 4.25]), respectively. Conclusions High percent normal saline administration is associated with delayed graft function in kidney transplant recipients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Study on antihyperglycemic effect of bromocriptine in dexamethasone induced hyperglycemic wistar rats

Background: Diabetes mellitus is a chronic metabolic disorder that develops due to insulin deficiency or insulin resistance. Recent animal and human studies have reported bromocriptine to be effective in the management of type 2 diabetes mellitus. The present study was done to evaluate the antihyperglycemic effect of bromocriptine in dexamethasone induced hyperglycemic rats.Methods: Male wistar rats were used and divided into 5 groups. Dexamethosone was used to induce hyperglycemia in group B-E. Group A was the untreated control group, group B was the standard control group, group C was the oral 10 mg/kg of bromocriptine dissolved in 0.9% normal saline, group D was the oral 20 mg/kg metformin dissolved in 0.9% normal saline, group E was the oral 10 mg/kg bromocriptine+20 mg/kg metformin dissolved in 0.9% normal saline. Fasting blood glucose, post prandial blood glucose and body weight was estimated on day 1, 15, 30.Results: It was seen that dexamethasone induced hyperglycemia and increase in body weight in male wistar rats, which were significantly controlled by oral bromocriptine and bromocriptine with metformin combination.Conclusions: Results obtained from this study showed that bromocriptine can be a promising drug with novel mechanism to treat type 2 diabetes mellitus.

Post-operative wound infiltration with dexmedetomidine and magnesium sulphate as adjuvant to levobupivacaine for lumbar laminectomy: a prospective, double blinded, randomized controlled study

Background: Wound infiltration with local anaesthetic is safe and effective technique for providing postoperative analgesia following lumbar laminectomy. The objective of this study was to compare the efficacy of local wound infiltration on postoperative analgesia with levobupivacaine, levobupivacaine plus magnesium sulphate and levobupivacaine plus dexmedetomidine in patient undergoing lumbar laminectomy.Methods: Ninety adult patients were randomly allocated into three groups. After the completion of lumbar laminectomy, the drug was locally infiltrated into the paravertebral muscles on either side. Group L received 10 ml of 0.5% levobupivacaine plus 10 ml normal saline, group LM received 10 ml of 0.5% levobupivacaine plus 500 mg magnesium sulphate (1 ml) plus 9 ml normal saline, group LD received 10 ml of 0.5% levobupivacaine plus 50 µg dexmedetomidine (0.5 ml) plus 9.5 ml normal saline. Postoperative visual analogue scale (VAS) pain score at 0, 1, 2, 4, 6, 8, 12 and 24 hours, time to first rescue analgesic drug and its total dose, quality of recovery score (QoR) and side effects were noted.Results: Postoperative VAS was significantly higher in group L as compared to group LM and LD (p<0.05). The time to first rescue analgesic drug was significantly longer in group LD (11.07±7.20 hr) than group LM (6.20±2.64 hr) and group L (3.93±2.70 hr) (p<0.001). The QoR score was significantly better in group LD as compared to group LM and L postoperatively (<0.01).Conclusions: Addition of magnesium sulphate or dexmedetomidine to levobupivacaine for local wound infiltration demonstrated enhanced postoperative analgesia.