A Comprehensive Review on Therapeutic Potential on Euphorbia hirta Lin

Euphorbia hirta Linn, a representative of the Euphorbiaceae family, is a widespread annual herb found in wastelands in humid conditions. The plant is high in phytochemicals such as tannin, quercetin, and phytosterol, however there are few phytopharmacological investigations on it. Plant components are normally employed in traditional medicine to treat respiratory problems, gastrointestinal issues, wound healing, and other ailments. The steroid of E. hirta was found to have CNS depressive and muscle relaxant effects, as well as a sub-maximal anti-stress and anxiolytic impact.

Sedation, Analgesia, and Muscle Relaxation During VV-ECMO Therapy in Patients With Severe Acute Respiratory Syndrome Coronavirus Type 2 (SARS-CoV-2): A Single-Center, Retrospective, Observational Study

Objective: The pharmacokinetics and pharmacodynamics of ECMO-supported sedative, analgesic, and muscle relaxants have changed, but there are insufficient data to determine the optimal dosing strategies for these agents. Sedation, analgesia and muscle relaxation therapy for patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) receiving ECMO support are more specific and have not been fully reported. This study observed and evaluated the use of sedative and analgesic drugs and muscle relaxants in SARS-CoV-2 patients treated with VV-ECMO.Methods: This study was a single-center, retrospective and observational study. Our study includes 8 SARS-CoV-2 patients treated with VV-ECMO in an intensive care unit at Shanghai Public Health Center from February to June 2020. We collected the demographic data from these patients and the dose and course of sedation, analgesia, and muscle relaxants administered during ECMO treatment.Results: The doses of sedative, analgesic and muscle relaxant drugs used in patients with VV-ECMO were significant. Over time, the doses of drugs that were used were increased, and the course of muscle relaxant treatment was extended.Conclusion: Sedation, analgesia, and muscle relaxant use require individualized titration in patients with SARS-CoV-2 who have respiratory failure and who are receiving VV-ECMO.

Penerapan Terapi Relaksasi Otot Progresif Untuk Menurunkan Hipertensi Di Desa Glandang Bantarbolang

Hypertension is the increase of blood pressure which is higher than or equal to 140 mmHg at systolic blood pressure and higher or equal to 90 mmHg at diastolic blood pressure. The purpose of this study is to implement actions of progressive muscle relaxant therapy to lower blood pressure on hypertensive patients. This research uses descriptive method and tye subjects of this research are two hypertension clients with blood pressure higher than 140/100 mmHg at Glandang Village, Bantarbolang. Intervention is done by giving progressive muscle relaxation therapy for six days and is done once a day. The result of the study shows a drop in blood pressure on both clients, for client 1 to drop blood pressure from 160/100mmhg to 130/90mmhg and for the second client to drop in blood pressure from 170/100mmhg to 130/100mmhg. The study of the case indicates that progressive muscle relaxation therapy reduces blood pressure on hypertensive people. It is recommended for nurses or people working in health field to provide therapy in order to lower blood pressure in the form of progressive muscle relaxation therapy in hypertensive people.Keywords: Progressive Muscle Relaxation, Hypertension AbstrakHipertensi merupakan penyakit the silent killer yang menyebabkan 1 dari 3 orang dewasa terkena penyakit hipertensi dan diperkirakan 7,5 juta kematian didunia ini akibat hipertensi. Pada umumnya penyakit hipertensi ini tidak disadari oleh penderitanya, 50% penderita hipertensi tidak memperlihatkan pertanda yang pasti, terutama apabila sedang dalam taraf awal. Tujuan studi kasus ini adalah untuk mengaplikasikan tindakan terapi relaksasi otot progresif untuk menurunkan tekanan darah pada penderita hipertensi. Rancangan Karya Tulis Ilmiah ini menggunakan metode studi kasus deskriptif dengan subyek dua klien hipertensi yang mengalami tekanan darah tinggi diatas 140/100mmHg di Desa Glandang Bantarbolang. Intervensi yang dilakukan adalah pemberian terapi relaksasi otot progresif selama enam hari dan dilakukan satu kali sehari. Hasil studi ini menunjukan adanya penurunan tekanan darah pada kedua klien, untuk klien 1 mengalami penurunan tekanan darah dari 160/100mmHg menjadi 130/90mmHg dan untuk klien kedua mengalami penurunan tekanan darah dari 170/100mmHg menjadi 130/90mmHg jadi rata-rata penurunan tekanan darah dari kedua klien adalah untuk tekanan darah sistolik sebanyak 30-40mmHg dan untuk tekanan diastolik sebanyak 10mmHg. Simpulan studi kasus ini menunjukan bahwa terapi relaksasi otot progresif mampu menurunkan tekanan darah pada penderita hipertensi. Saran bagi tenaga kesehatan diharapkan dapat memberikaan tindakan terapi untuk menurunkan tekanan darah yang berupa terapi relaksasi otot progresif pada penderita hipertensi.Kata kunci: Relaksasi Otot Progresif, Hipertensi

Evaluation of Anti-depressant, Anti-anxiety and Muscle Relaxant Activity of Hydroalcoholic Extract of Aerva javanica Roots

Aims: To evaluate anti-depressant, anti-anxiety and muscle relaxant activity of hydroalcoholic extract of Aerva javanica roots in various experimental animal models. Study Design: Animal study. Place and Duration of Study: The study was conducted in Bilwal Medchem and Research Laboratory, Jaipur from July 2021-August 2021. Methodology: The root powder of Aerva javanica was extracted with hydroalcoholic solvent (70% ethanol). The hydroalcoholic extract at three doses 100 mg/kg, 200 mg/kg, and 400 mg/kg was checked for anti-depressant and skeletal muscle relaxant activity in the experimental animal models. To determine the anti-depressant activity tail suspension test, locomotor activity, open field test, and MAO inhibitor assay were done; to determine the anti-anxiety activity hole board test was used; and to determine the skeletal muscle relaxant activity rotarod test, grip strength test, and chimney test were done. Results: In the tail suspension test, the extract at 200 mg/kg and 400 mg/kg significantly reduced the duration of immobility compared to normal control (p<0.0001). The extract at dose 400 mg/kg significantly reduced MAO-A and MAO-B activity compared to the normal control group (p<0.01 and p<0.05, respectively). The extract at 200 mg/kg and 400 mg/kg were able to decrease locomotor activity in actophotomoter and increased time spent in centre square in open field test revealing the sedative effect of the extract. In hole board test, the extract at dose 400 mg/kg and 200 mg/kg significantly increased number of head dip count (p<0.0001 and p<0.001) respectively. In the rotarod test, the extract at dose 200 and 400 mg/kg decreased the time spent on the rotating rod (p<0.0001), compared to normal control. Similarly, in the grip strength test the extract at dose 200 and 400 mg/kg decreased the time spend on suspended wire revealing the skeletal muscle relaxant property of the test extract. Conclusion: Based on the result, it can be concluded that the extract exert anti-depressant, anti-anxiety and skeletal muscle relaxant like activity in the experimental rat which was hypothesized to be attributed to the flavonoids present in the hydroalcoholic root extract of Aerva javanica.

Cardiac impact of high-frequency irreversible electroporation using an asymmetrical waveform on liver in vivo

Background High-Frequency Irreversible Electroporation (H-FIRE) is a novel technology for non-thermal ablation. Different from Irreversible electroporation (IRE), H-FIRE delivers bipolar electrical pulses without muscle contraction and does not cause electrolysis. Currently, little is known regarding the cardiac safety during the administration of H-FIRE on liver. The aim of this study was to evaluate the changes of electrocardiogram (ECG) and biomarkers of cardiac damage during asymmetrical waveform of H-FIRE therapy in vivo. Methods The swines (n = 7) in IRE group, which used 100 pulses (2200 V, 100–100 μs configuration), were administrated with muscle relaxant under anesthesia. In the absence of muscle relaxant, 7 swines in H-FIRE group were performed with 2400 pulses (3000 V, 5–3–3–5 μs configuration). Midazolam (0.5 mg/kg) and xylazine hydrochloride (20 mg/kg) were given to induce sedation, followed by Isoflurane (2.5%, 100% oxygen, 3 L/min) to maintain sedation in all the swines. Limb lead ECG recordings were analyzed by two electrophysiologists to judge the arrhythmia. Cardiac and liver tissue was examined by pathology technique. Results The ablation zones were larger in H-FIRE than IRE. Both IRE and H-FIRE did not affect the autonomous cardiac rhythm. Even when the electrical signal of IRE and H-FIRE fell on ventricular vulnerable period. Moreover, cTnI in IRE group showed an increase in 4 h after ablation, and decreased to baseline 72 h after ablation. However, cTnI showed no significant change during the administration of H-FIRE. Conclusions The study suggests an asymmetrical waveform for H-FIRE is a promising measure for liver ablation. The results were based on normal liver and the swines without potential cardiac diseases. With the limitations of these facts, asymmetrical waveform for H-FIRE of liver tissue seems relatively safe without major cardiac complications. The safety of asymmetrical waveform for H-FIRE needs to evaluate in future.

Comparison of the TOFscan and the TOF-Watch SX during pediatric neuromuscular function recovery: a prospective observational study

Background TOFscan is a three-dimensional acceleromyography neuromuscular monitoring device that does not require initial calibration before muscle relaxant injection. This study aimed to compare TOFscan with TOF-Watch SX, the currently widely accepted uni-dimensional acceleromyography, for use among the pediatric population. We aimed to assess the agreement between TOFscan with TOF-Watch SX in the pediatric population’s neuromuscular recovery. Methods A total of 35 children aged 6–12 years were enrolled. Prior to any muscle relaxant injection, TOFscan and TOF-Watch SX were applied at each opposite arm and monitoring began concurrently throughout neuromuscular recovery. Calibration was performed for TOF-Watch SX, and train-of-four values were recorded every 15 s. Agreement between the two devices was evaluated with Modified Bland-Altman analysis. Results The bias between TOF-Watch SX and TOFscan were all within the 95% limits of agreement. The bias and standard deviation were smaller and the limit of agreement was narrower in the normalized group than in the non-normalized group [normalized bias −0.002 (95% CI, −0.013 to 0.010), standard deviation (SD) 0.111 vs non-normalized bias 0.010 (95% CI, −0.003 to 0.0236), SD 0.127]. Conclusions TOFscan reliably demonstrated lack of bias and good concordance with TOF-Watch SX throughout the neuromuscular recovery, especially when normalized. Despite technical limitations, the two devices were unbiased along the path of spontaneous and pharmacological reversal in pediatric patients. Trial registration ClinicalTrials.gov NCT03775603. Registered on 13 March 2018

Persistent Opioid Use After Cardiac Implantable Electronic Device Procedures

Background: Prescription opioids are a major contributor to the ongoing epidemic of persistent opioid use (POU). The incidence of POU among opioid-naïve patients after cardiac implantable electronic device (CIED) procedures is unknown. Methods: This retrospective cohort study used data from a national administrative claims database from 2004 to 2018 of patients undergoing CIED procedures. Adult patients were included if they were opioid-naïve during the 180-day period before the procedure and did not undergo another procedure with anesthesia in the next 180 days. POU was defined by filling an additional opioid prescription >30 days after the CIED procedure. Results: Of the 143 400 patients who met the inclusion criteria, 15 316 (11%) filled an opioid prescription within 14 days of surgery. Among these patients, POU occurred in 1901 (12.4%) patients 30 to 180 days after surgery. The likelihood of developing POU was increased for patients who had a history of drug abuse (odds ratio, 1.52; P =0.005), preoperative muscle relaxant (odds ratio, 1.52; P <0.001) or benzodiazepine (odds ratio, 1.23; P =0.001) use, or opioid use in the previous 5 years (OR, 1.76; P <0.0001). POU did not differ after subcutaneous implantable cardioverter defibrillator or other CIED procedures (11.1 versus 12.4%; P =0.5). In a sensitivity analysis excluding high-risk patients who were discharged to a facility or who had a history of drug abuse or previous opioid, benzodiazepine, or muscle relaxant use, 8.9% of the remaining cohort had POU. Patients prescribed >135 mg of oral morphine equivalents had a significantly increased risk of POU. Conclusions: POU is common after CIED procedures, and 12% of patients continued to use opioids >30 days after surgery. Higher initially prescribed oral morphine equivalent doses were associated with developing POU.

Evaluation of Selected Flavonoids for the Anthelmintic and Skeletal Muscle Relaxant Activity using Animal Models

Most fruits and vegetables contain flavonoids, a type of phytonutrient. As well as carotenoids, they're responsible for fruits and vegetable brilliant hues. Some other phytonutrients such as flavonoids are strong antioxidants with anti-inflammatory and immune properties. There are many flavonoids, including anthocyanins, flavones, flavonols, flavonoids, and isoflavonoids. Quercetin and chrysin were chosen for the investigation. Humans and other animals can contract Helminthiasis (helminthiases), sometimes known as worm infection. Tapeworms, roundworms, and flukes are only a few of the parasites that exist. Skeletal muscle relaxants are used to treat spasticity caused by upper motor neuron syndromes and muscle discomfort or musculoskeletal spasms created by peripheral disturbances. Samples of quercetin and chrysin were generated in the presence of 0.5% SCMC suspension at concentrations of 10, 20, 30, and 40 mg/ml, and then analyzed. To keep track of photocell beam disruptions, a six-digit counter was utilized (locomotor activity). It was time to turn on the actophotometer and examine the locomotor behavior of each rat for five minutes. The basal activity levels of all the animals were recorded. Keywords: Flavonoids, Anthelmintic, Skeletal Muscle relaxant, animal models

Comparative evaluation of efficacy of muscle relaxant, vasodilator and combined intralesional steroid with hyalaronidase use in oral submucous fibrosis

Oral Sub Mucous Fibrosis (OSMF) is a disease , which predominately occurs in Indians and South East Asians. It is characterised by mucosal rigidity of varying intensity due to fibroelastic changes of the juxta-epithelial layer, resulting in a progressive inability to open mouth. The main concern in the condition is the management of trismus and burning sensation of oral mucosa. this study was conducted to compare various medical treatment protocol of OSMF, so as to arrive at definitive and effective protocol for the management of OSMF. 105 patients of OSMF attending the ENT OPD and satisfying the criteria for inclusion were enrolled for the study. The subjects were randomly divided into age sex matched into three study groups( Dexa with hyaluronidase , Oral vasodilator, Muscle relaxant) in which the relief in symptoms was noted. Lycopene was given in all patients. Group A, patients were given intralesional injection Dexamethasone with Hyaluronidase biweekly for five weeks and marked improvement was seen in cases of pain with spicy food 13 cases (76.47%), followed by decreased in mouth opening 9 cases (56.25%). In Group B, oral vasodilator Tablet Pentoxifylline 400 mg TDS was given and showed improvement in difficulty in protruding tongue in 9 cases (60%), pain with spicy food 8 cases (50%), decreased mouth opening 6 cases (37.5%), oral ulceration 3 cases (42.85%). In Group C with muscle relaxant Tablet Myosone 50 mg BD showed improvement pain with spicy food 8 cases (42.10%), decreased mouth opening 8 cases (42.10), difficulty in swallowing 3 cases (37.5%). As there is still paramount of controversy regarding the ethology of OSMF there is no definite treatment protocol. Patients which received intralesional dexamethasone and hyaluronidase along with oral lycopene showed better clinical and symptomatic improvement in comparison to others groups, which at present appears to the best option for OSMF.