Datura stramonium Leaf Extract Toxic Effects on Testis in Swiss Albino Mice Mus muscullu

The notorious weed, jimson weed (Datura stramonium L.) is a hallucinating plant with both poisonous and medicinal properties. The neurotoxicity of the plant is attributed to the presence of tropane alkaloids which contain a methylated nitrogen atom (N-CH3) that block neurotransmitters in the brain. Ethno-medicinally, the frequent recreational abuse of D. stramonium has resulted in toxic syndromes. This investigation has been designed to examine the toxicity and describe the possible changes in the structural function of vital organs, following the oral intubation of non-lethal doses of Datura stramonium leaves crude aqueous extract. Through preliminary trials, crude aqueous extract. Of 200mg leaves per kilogram body weight was established as a tolerable non-lethal dose. Three doses 0.36, 0.7, and 4 mg/kg were orally weekly, administered to the male mice in a 0.1 ml volume. Acute toxicity studies were accomplished through oral intubation of three dosages in each case. Observation and mortality were reported for 24 .48, 72 hours Prolonged toxicity was performed through the administration of weekly, single doses oral for 40 days. The observation was made on the mice's body weight, , and histological abnormality of a testis organ.

Carnosic Acid Alleviates Levodopa-Induced Dyskinesia and Cell Death in 6-Hydroxydopamine-lesioned Rats and in SH-SY5Y Cells

The present study investigated the impact of carnosic acid (CA) from rosemary on the levodopa (L-dopa)-induced dyskinesia (LID) in rats treated with 6-hydroxydopamine (6-OHDA). To establish the model of LID, 6-OHDA-lesioned rats were injected intraperitoneally with 30 mg/kg L-dopa once a day for 36 days. Rats were daily administrated with 3 or 15 mg/kg CA by oral intubation prior to L-dopa injection for 4 days. Rats pretreated with CA had reduced L-dopa-induced abnormal involuntary movements (AIMs) and ALO scores (a sum of axial, limb, and orofacial scores). Moreover, the increases of dopamine D1-receptor, p-DARPP-32, ΔFosB, p-ERK1/2, and p-c-Jun ser63, along with the decrease in p-c-Jun ser73, induced by L-dopa in 6-OHDA-treated rats were significantly reversed by pretreatment with CA. In addition, we used the model of SH-SY5Y cells to further examine the neuroprotective mechanisms of CA on L-dopa-induced cytotoxicity. SH-SY5Y cells were treated with CA for 18 h, and then co-treated with 400 μM L-dopa for the indicated time points. The results showed that pretreatment of CA attenuated the cell death and nuclear condensation induced by L-dopa. By the immunoblots, the reduction of Bcl-2, p-c-Jun ser73, and parkin and the induction of cleaved caspase 3, cleaved Poly (ADP-ribose) polymerase, p-ERK1/2, p-c-Jun ser63, and ubiquitinated protein by L-dopa were improved in cells pretreated with CA. In conclusion, CA ameliorates the development of LID via regulating the D1R signaling and prevents L-dopa-induced apoptotic cell death through modulating the ERK1/2-c-Jun and inducing the parkin. This study suggested that CA can be used to alleviate the adverse effects of LID for PD patients.

A Case of Unanticipated difficult Intubation in a patient posted for C5-C6 Posterior Fixation

Management of a “difficult airway” poses one of the most relevant and challenging tasks for anesthesiologists. Unanticipation with difficult airway and endotracheal intubation during the conduction of general anesthesia may result in complications and fatality. We report the case of a 14 yr old boy for planned C5-C6 spine fixation under general anaesthesia. Unanticipated difficult oral intubation after three failed attempts, managed by a stylleted cuffed endotracheal tube, head up tilt of the operation table, shoulder support, cricoid pressure and rotation of the endotracheal tube anticlockwise at the glottic opening.

Nurses’ Perceptions of Barriers to Out-of-Bed Activities Among Patients Receiving Mechanical Ventilation

Background Delays in early patient mobility are common in critical care areas. Oral intubation with mechanical ventilation is negatively associated with out-of-bed activities. Objectives To explore nurses’ mobility practices for patients with oral intubation and mechanical ventilation and identify barriers related to patient, nurse, and environment-of-care factors specific to this population. Methods In this cross-sectional, descriptive study in a medical intensive care unit, mobility was defined as standing, sitting in a chair, or walking. A total of 105 patients who met predefined mobility criteria and their 48 nurses were enrolled. Nurses were interviewed about mobility practices at the ends of shifts. Descriptive statistics summarized nurse and patient characteristics and mobility barriers. Results Patients were deemed ready to begin mobility within a mean (SD) of 41.5 (34.8) hours after oral endotracheal intubation. Two-thirds of nurses reported that they never or rarely got these patients out of bed. Only 12.4% of patients had a clinician’s activity order. Common patient-related barriers were uncooperative behavior (21.9%) and active medical issues (15%), even in patients who met mobility criteria. Nurse-related barriers were concerns for patient safety, specifically falls (14.3% of patients) and harm (9.5%). The environment of care posed very few barriers; nurses rarely mentioned that lack of help (13.3% of patients) or lack of clinician’s activity order (5.7%) impeded mobility. Conclusions Mobility practices were nonexistent in these patients despite patients’ being deemed ready to begin out-of-bed activities. Nurses must be attentive to their unit’s mobility culture to overcome these barriers.

Effects of head positions on awake fiberoptic bronchoscope oral intubation: a randomized controlled trial

Background There are many factors affecting the success rate of awake orotracheal intubation via fiberoptic bronchoscope. We performed this study was to investigate the effects of head positions on awake Fiberoptic bronchoscope oral intubation. Methods Seventy-five adult patients, received general anaesthesia were included in this study. After written informed consent, these patients were undergoing awake orotracheal intubation via fiberoptic-bronchoscope and according to the head position, the patients were randomized allocated to neutral position group (NP group), sniffing position group (SP group) or extension position group (EP group). After sedation the patients were intubated by an experienced anesthesiologist. The time to view the vocal cords, the percentage of glottic opening scores (POGO), the time to insert the tracheal tube into trachea and the visual analog scale (VAS) scores for ease experienced of passing the tracheal tube through glottis, the hemodynamic changes and the adverse events after surgery were recorded. Results The time to view the vocal cords was significantly shorter and the POGO scores was significantly higher in the EP group compared with the other two groups (P < 0.05); The SpO2 in the EP group was higher than NP group at before intubation and higher than SP group and NP group at immediate after intubation (P < 0.05); The time to insert the tracheal tube into trachea, the VAS scores for passing the tracheal tube through glottis, the coughing scores had no significant differences among groups (P > 0.05). There were also no significant differences regard to the incidence of postoperative complications, mean arterial pressure and heart rate among the groups (P > 0.05). Conclusions The head at extension position had a best view of glottic opening than neutral position or sniffing position during awake Fiberoptic bronchoscope oral intubation, so extension position was recommended as the starting head position for awake Fiberoptic bronchoscope oral intubation. Trial registration Clinical Trials.gov. no. NCT02792855. Registered at https://register.clinicaltrials.gov on 23 september 2017.

Vocal cord granuloma after transoral thyroidectomy using oral endotracheal intubation: two case reports

Background Transoral thyroidectomy can be performed using nasal or oral intubation. Recently, we encountered two cases of vocal cord granuloma that were suspected to result from intraoperative compression by the oral endotracheal tube. Cases presentation Two women underwent transoral endoscopic thyroidectomy with oral endotracheal tubes fixed at the mouth angle. Their initial postoperative recovery was uneventful, but they developed hoarseness 2 months after the surgery. Subsequent strobolaryngoscopy revealed vocal cord granulomas at the side of contact of the endotracheal tube. One patient received medication and voice therapy, and her granuloma shrank significantly one month later. The other patient underwent granuloma resection. Thereafter, the symptoms improved in both the patients. Conclusions Oral intubation with tube placement at the mouth angle might result in the formation of vocal cord granulomas. Therefore, we suggest positioning the tube at the midline to avoid excessive irritation on one side of the vocal cord.

Congenital Arhinia—A Case Report

Congenital arhinia is a seldom defect and may be associated with other facial and systemic defects. It is described as complete absence of nose. Case Report: Neonates are obligate nasal breathers but our neonate with complete absence of nose adjusted well to breathing through mouth without any need of urgent ventilator support or tracheostomy. Conclusion: Neonates may adapt breathing through mouth and bypass major respiratory support that is oral intubation or tracheostomy.

Two Endotracheal Tubes in One Trachea with a Traumatic Injury

Background. Traumatic airway injuries often require improvising solutions to altered anatomy under strict time constraints. We describe here the use of two endotracheal tubes simultaneously in the trachea to facilitate securing an airway which has been severely compromised by a self-inflicted wound to the trachea. Case Presentation: A 71-year-old male presented with a self-inflicted incision to his neck, cutting deep into the trachea itself. An endotracheal tube was emergently placed through the self-inflicted hole in the trachea in the ED. The patient was bleeding profusely, severely somnolent, and desaturating upon arrival to the operating room. Preservation of the tenuous airway was a priority while seeking to establish a more secure one. A video laryngoscope was used to gain a wide view of the posterior oropharynx and assist with oral intubation using a fiberoptic scope loaded with a second endotracheal tube. The initial tube’s cuff was deflated as the second tube was advanced over the fiberoptic scope, thereby securing the airway while a completion tracheostomy was performed. Conclusions. Direct penetrating airway trauma may necessitate early, albeit less secure, intubations though the neck wounds prior to operating room arrival. The conundrum is weighing the risk of losing a temporary airway while attempting to establish a more secure airway. Here, we demonstrate the versatility of common anesthesia tools such as a video laryngoscope and a fiberoptic bronchoscope and the welcome discovery of the trachea’s ability to accommodate two endotracheal tubes simultaneously so as to ensure a patent airway at all points throughout resuscitation.

Transoral per punctum excision of an impacted parotid duct stone of unfavorable direction: a case report

Background In the literature, the reported parotid duct stones that did not respond to the conservative measures are few. The present work reported and described the diagnosis and treatment of a case of impacted parotid duct stone that was surgically removed through minimally invasive transoral per punctum approach. Case presentation On examination of a 27-year-old male with left intermittent parotid swelling and pain for 1 year, a stone was palpated in the left buccal mucosa region near the orifice of the parotid duct. Ultrasonography (US) showed left Stensen’s duct distal stone. Under general anesthesia and oral intubation, the stone measuring about 1 cm in length was felt transversely located (directed at a right angle with the orifice of the duct). A small mucosal incision was done at the upper lateral part of the punctum; pus came out, and then the stone bulged from the orifice and was pushed outside. Recovery was event-less; postoperative paracetamol was sufficient to relieve pain, and the patient was discharged a few hours after the surgery. Conclusion The transoral per punctum excision of an impacted parotid duct stone appears to be a reliable minimally invasive effective and safe procedure. The unfavorable direction of the parotid duct stone might be a cause of failure of the conservative treatment for this stone.