Effect of amitriptyline and pregabalin on heart rate variability and electrolytes in neurotrophic pain in diabetic patients

Background: The data regarding effects of amitriptyline and pregabalin on heart rate variability in patients with neuropathic pain in diabetic patients are poorly understood in India. The present study was conducted to evaluate the effect of amitriptyline and pregabalin on heart rate variability in diabetic patients with neuropathic pain and their effect on serum electrolyte (sodium and potassium).Methods: The patients include 60 diabetic patients of either sex aged 18-65 years diagnosed with neuropathic pain and divided into two groups. The study was prospective open label and observational study. Group 1 was treated with amitriptyline 10 mg once a day while group 2 with pregabalin 75 mg once a day and HRV, serum sodium and serum potassium levels and pain score were recorded; and data of post-treatment at 2 and 4 weeks were compared with pretreatment values (control). All the statistical analysis was performed by using SPSS 20.0 software.Results: Both the drugs have increased HRV and reduced neuropathic pain intensity after 2 and 4 weeks treatment. The sodium and potassium level were not altered by these drugs. No correlation was observed between HRV and neuropathic pain.Conclusions: In conclusion, both the amitriptyline and pregabalin have significantly increased HRV and reduced the neuropathic pain intensity; but no correlation was observed between increased HRV and reduced neuropathic pain intensity.

Biochemical profile of human infant cerebrospinal fluid in intraventricular hemorrhage and post-hemorrhagic hydrocephalus of prematurity

Background Intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) have a complex pathophysiology involving inflammatory response, ventricular zone and cell–cell junction disruption, and choroid-plexus (ChP) hypersecretion. Increased cerebrospinal fluid (CSF) cytokines, extracellular matrix proteins, and blood metabolites have been noted in IVH/PHH, but osmolality and electrolyte disturbances have not been evaluated in human infants with these conditions. We hypothesized that CSF total protein, osmolality, electrolytes, and immune cells increase in PHH. Methods CSF samples were obtained from lumbar punctures of control infants and infants with IVH prior to the development of PHH and any neurosurgical intervention. Osmolality, total protein, and electrolytes were measured in 52 infants (18 controls, 10 low grade (LG) IVH, 13 high grade (HG) IVH, and 11 PHH). Serum electrolyte concentrations, and CSF and serum cell counts within 1-day of clinical sampling were obtained from clinical charts. Frontal occipital horn ratio (FOR) was measured for estimating the degree of ventriculomegaly. Dunn or Tukey’s post-test ANOVA analysis were used for pair-wise comparisons. Results CSF osmolality, sodium, potassium, and chloride were elevated in PHH compared to control (p = 0.012 − < 0.0001), LGIVH (p = 0.023 − < 0.0001), and HGIVH (p = 0.015 − 0.0003), while magnesium and calcium levels were higher compared to control (p = 0.031) and LGIVH (p = 0.041). CSF total protein was higher in both HGIVH and PHH compared to control (p = 0.0009 and 0.0006 respectively) and LGIVH (p = 0.034 and 0.028 respectively). These differences were not reflected in serum electrolyte concentrations nor calculated osmolality across the groups. However, quantitatively, CSF sodium and chloride contributed 86% of CSF osmolality change between control and PHH; and CSF osmolality positively correlated with CSF sodium (r, p = 0.55,0.0015), potassium (r, p = 0.51,0.0041), chloride (r, p = 0.60,0.0004), but not total protein across the entire patient cohort. CSF total cells (p = 0.012), total nucleated cells (p = 0.0005), and percent monocyte (p = 0.016) were elevated in PHH compared to control. Serum white blood cell count increased in PHH compared to control (p = 0.042) but there were no differences in serum cell differential across groups. CSF total nucleated cells also positively correlated with CSF osmolality, sodium, potassium, and total protein (p = 0.025 − 0.0008) in the whole cohort. Conclusions CSF osmolality increased in PHH, largely driven by electrolyte changes rather than protein levels. However, serum electrolytes levels were unchanged across groups. CSF osmolality and electrolyte changes were correlated with CSF total nucleated cells which were also increased in PHH, further suggesting PHH is a neuro-inflammatory condition.

Electrolytes Levels (Na, K, Cl) in Serum Stored at 4°C Temperature

The samples used for serum electrolyte measurement should be analyzed immediately after being received in the laboratory within 1-2 hours to avoid an increase in the error of the results. Serum should be stored at 4°C for a period to prevent damage. The analyst should consider maximum delay time in the examination to maintain the serum's quality. This study compared the 2-hour and 3-hour delays in sodium (Na), potassium (K), and chlorine (Cl) tests. The method used in this study is an observational analysis with a cross-sectional study design. The samples in this study used 35 patient serum residues. The study was conducted in November 2020 with a continuous sampling technique. Electrolyte levels in the sample were measured by AVL 9180 Electrolyte Analyzer using Ion-Selective Electrode (ISE) method. The differences in electrolyte (Na, K, Cl) levels were analyzed by the Kruskal-Wallis Statistical test at a 95% confidence level. The results showed that the content of sodium, potassium, and chlorine were 0.719; 0.976; and 0.772. This study showed that there was no significant difference in the electrolyte content of sodium (Na), potassium (K), and chlorine (Cl) in the serum directly detected from the serum stored at 4°C for 2 hours and 3 hours. In conclusion, it is acceptable to postpone the serum test for 3 hours with various considerations.

Biochemical Profile of Human Infant Cerebrospinal Fluid in Intraventricular Hemorrhage and Post-hemorrhagic Hydrocephalus of Prematurity

BACKGROUND Intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) have complex pathophysiology involving inflammatory response, ventricular zone and cell-cell junction disruption, and choroid-plexus (ChP) hypersecretion. Increased cerebrospinal fluid (CSF) cytokines, extracellular matrix proteins, and blood metabolites have been noted in IVH/PHH, but osmolality and electrolyte disturbances have not been evaluated in human infants with these conditions. We hypothesized that CSF total protein, osmolality, electrolytes, and immune cells increase in PHH. METHODS CSF samples were obtained from lumbar punctures in control infants and infants with IVH prior to development of PHH and any neurosurgical intervention. Osmolality, total protein, and electrolytes were measured in 52 infants (18 controls, 10 low grade (LG) IVH, 13 high grade (HG) IVH, and 11 PHH). Serum electrolyte concentrations, and CSF and serum cell counts within 1-day of clinical sampling were obtained from clinical charts. Dunn or Tukey’s post-test ANOVA analysis were used for pair-wise comparisons. RESULTS CSF osmolality, sodium, potassium, and chloride were elevated in PHH compared to control (p=0.012 - <0.0001), LGIVH (p=0.023 - <0.0001), and HGIVH (p=0.015 - 0.0003), while magnesium and calcium levels were higher compared to control (p=0.031) and LGIVH (p=0.041). CSF total protein was higher in both HGIVH and PHH compared to control (p=0.0009 and 0.0006 respectively) and LGIVH (p=0.034 and 0.028 respectively). These differences were not reflected in serum electrolyte concentrations nor calculated osmolality across the groups. However, quantitatively, CSF sodium and chloride contributed 86% of CSF osmolality change between control and PHH; and CSF osmolality positively correlated with CSF sodium (r,p=0.55,0.0015), potassium (r,p=0.51,0.0041), chloride (r,p=0.60,0.0004), but not total protein across the entire patient cohort. CSF total cells (p=0.012), total nucleated cells (p=0.0005), and percent monocyte (p=0.016) were elevated in PHH compared to control. Serum white blood cell count increased in PHH compared to control (p=0.042) but there were no differences in serum cell differential across groups. CSF total nucleated cells also positively correlated with CSF osmolality, sodium, potassium, and total protein (p=0.025-0.0008) in the whole cohort. CONCLUSIONS CSF osmolality increased in PHH, largely driven by electrolyte changes rather than protein levels. However, serum electrolytes levels were unchanged across groups. CSF osmolality and electrolyte changes were correlated with CSF total nucleated cells which were also increased in PHH, further suggesting PHH is a neuro-inflammatory condition.

Studying the electrolyte changes in ileal urine at the time of radical cystectomy and ileal conduit diversion

To the Editor, Radical cystectomy (RC) for bladder cancer is a life-changing surgery, associated with high morbidity and mortality rate. Ileal neobladder seems as an attractive way for urine management post cystectomy but would carry the risk of retaining urine in the ileal pouch for a long time, resulting in serum electrolyte changes, that may add to the patients’ morbidity. EAU guidelines recommend against ileal neobladder for patients with liver and renal disorders, as well as for patients > 80 years old [...].

EVALUATION OF THE EFFECTS OF PHOTOTHERAPY ON VARIOUS BIOCHEMICAL PARAMETERS IN NEONATAL HYPERBILIRUBINEMIA

BACKGROUND: Neonatal jaundice has been the most common physical nding during the earlier week of life. High values of unconjugated bilirubin can develop encephalopathy and later kernicterus. The aims of phototherapy are to avoid the occurrence of encephalopathy or kernicterus. Phototherapy has many side effects like dehydration, temperature instability, skin rashes, retinal damage, hypocalcemia, electrolyte imbalance. AIM: Aim is to investigate the effect of phototherapy in full term neonate with unconjugated hyper bilirubinemia on various biochemical parameters before and after >48 hr phototherapy. MATERIAL AND METHODS: The study was conducted in the department of pediatrics, S.P.M.C.H.I. (J.K. Lon Hospital) and hospitals attached to SMS Medical College, Jaipur, Rajasthan from June 2019 – July 2020. It was a Hospital based prospective comparative observational study. The required sample size was at least 154 Full term neonates (37 completed weeks to 42 weeks) with unconjugated Hyperbilirubinemia receiving phototherapy ≥ 48 hr. All data were collected and analyzed with the help of suitable statistical parameters. RESULTS: Present study found that all parameters ( Serum Bilirubin, Urea, Creatinine, Calcium, Total Protein, And Albumin except Serum Electrolyte) has shown similar trends i.e. statistically signicant ndings in both groups before and after phototherapy. Whereas serum electrolyte has different pattern in both groups, it showed statistically signicant results only in group-I. CONCLUSION: our study concluded that phototherapy is benecial modality with judicious calculation of the risk benet ratio.