Clinical and laboratory evaluation of premature goat kids with and without antenatal corticotherapy

ABSTRACT: This article evaluated the vital parameters, blood gas measurements, cortisol values and radiological findings of goat kids born at term and prematurely during the first 48 hours of life. For this purpose, 24 kids from 24 goats were used and assigned to groups as follows: Group I, eight kids born through cesarean sections performed at 149 days of gestation; Group II, eight kids born through cesarean sections performed at 143 days of gestation; Group III, eight kids born through cesarean sections performed at 143 days of gestation, whose mothers received 20 mg of dexamethasone. Group I had lower heart rate values than the other groups at 60 minutes after birth. In terms of temperature, there was no difference between the groups. The pH values were reduced shortly after birth, rising at 24 and 48 hours in all animals studied. In terms of the cortisol levels, the values increased significantly at birth (M0), with the highest values obtained in animals in group II. These values decreased at 48 hours after birth in the evaluated goats. The animals belonging to group I showed better radiographic aspects, and throughout the 48 hours of evaluation, all newborns exhibited adequate respiratory adaptation. It can be concluded that antenatal dexamethasone administered at 143 days of gestation did not influence neonatal viability, metabolic or radiographic parameters. The metabolic changes found are consistent with the extrauterine adaptation period that animals in this stage of life.

Impact of dexamethasone on persistent symptoms of COVID-19: an observational study

Introduction Dexamethasone has been shown to reduce mortality for patients hospitalised with acute COVID-19 pneumonia. However, a significant proportion of patients suffer persistent symptoms following COVID-19 and little is known about the longer-term impact of this intervention on symptom burden. Methods Patients initially hospitalised with COVID-19 were prospectively recruited to an observational study (April-August 2020) with follow-up at 8 months (Dec 2020-April 2021) post-admission. A review of ongoing symptoms using a standardised systems-based proforma was performed alongside health-related quality of life assessment. In the UK, patients with COVID-19 (requiring oxygen) only received dexamethasone following the pre-print of the RECOVERY trial (June 2020), or as part of randomisation to that trial, allowing for a comparison between patients treated and not treated with dexamethasone. Results Between April to August 2020, 198 patients were recruited to this observational study. 87 required oxygen and were followed up at 8-months, so were eligible for this analysis. Of these 39 received an inpatient course of dexamethasone (cases) and 48 did not (controls). The groups were well matched at baseline in terms of age, comorbidity and frailty score. Over two-thirds of patients reported at least 1 ongoing symptom at 8-month follow-up. Patients in the dexamethasone group reported fewer symptoms (n=73, 1.9 per patient) than the non-dexamethasone group (n=152, 3.2 per patient) (p = 0.01). Conclusions In conclusion, in this case-control observational study, patients who received oral dexamethasone for hospitalised COVID-19 were less likely to experience persistent symptoms at 8-month follow-up. These are reassuring results for physicians administering dexamethasone to this patient group.

Effect of Chronic Exposure to Dexamethasone on Rocuronium-induced Neuromuscular Blockade and Sugammadex Reversal: an in Vivo Study on Rats

Background: Chronic exposure to glucocorticoids is associated with resistance to nondepolarising neuromuscular blocking agents. Therefore, we hypothesised that sugammadex-induced recovery in subjects with chronic exposure to dexamethasone was faster than that in subjects without dexamethasone exposure. Objective: To evaluate the recovery profile of rocuronium-induced neuromuscular blockade after sugammadex administration in rats. Design: An in vivo study on rats.Setting: Asan Institute for Life Sciences, Asan Medical Center, Korea, from April 2017 to October 2017.Animals: Thirty-six male Sprague-Dawley rats.Intervention: Sprague–Dawley rats were allocated to three groups (dexamethasone group, control group, and pair-fed group) for the in vivo study. Dexamethasone group received daily intraperitoneal injections of dexamethasone 500 μg kg-1 or 0.9% saline for 15 days. On the sixteenth day, 3.5 mg kg-1 of rocuronium was administered to achieve complete neuromuscular blockade. Main outcome measures: The recovery time to a train-of-four ratio Results: There were no significant differences in the recovery time to train-of-four ratio to 0.9 among the groups (P = 0.531). The time to second twitch of train-of-four recovery that indicated the duration of rocuronium-induced neuromuscular blockade was significantly shorter in Group D than in Groups C and P (P = 0.001). Conclusion: As previously reported, resistance to rocuronium was observed in rats with chronic exposure to dexamethasone. However, the neuromuscular recovery time after sugammadex administration was not significantly different between groups.

Synergic Role of Dexamethasone And Lianhua Qingwen Capsule Accelerate Nucleic Acid Negative Conversion In Severe COVID-19 Patients

Background:Corticosteroids were recommended by guidelines in severe or critical COVID -19 patients likely to have acute respiratory distress syndrome. In the treatment strategies of COVID -19 in China, corticosteroids were generally combined with some traditional Chinese medicine, especially Lianhua Qingwen Capsule (LHQW). We aimed to investigate the correlation between dexamethasone with or without LHQW and the nucleic acid negative conversion in severe patients with COVID-19.Methods:The clinical course and nucleic acid negative conversion time of 452 consecutive symptomatic COVID-19 patients admitted to the west campus of Union Hospital in Wuhan from January 31, 2020, to March 13, 2020, were evaluated retrospectively. Results:The duration of virus RNA from positive to negative in the participants was 28 days (interquartile range 21-34 days). Of the 452 patients, 105 (23.23%) subjects received dexamethasone, and 347 (76.77%) did not. Among patients receiving LHQW treatment, the nucleic acid negative conversion time in the dexamethasone group was shorter than that in the no dexamethasone group (𝛽, -4.77; 95% CI, -9.41, -0.12). Although among those who were receiving no LHQW treatment, the effect on shortening nucleic acid negative conversion time of dexamethasone was not observed (𝛽, 5.37; 95% CI,-4.88, 15.62; p interaction = 0.038). Additional multivariable propensity-score analyses yielded consistent results with the unmatched participants (β, -8.61; 95% CI, -16.73, -0.50).Conclusions：In patients hospitalized with COVID-19, the use of dexamethasone resulted in shortening nucleic acid negative conversion time among those who were receiving LHQW, suggesting that LHQW synergic with dexamethasone accelerated the SARS-CoV-2 clearance in severe patients. Trial registration：ECUH 2020-0212, a retrospective study.

Comparison of the Effect of Dexamethasone and Ketorolac on Pain Control in Elective Foot Surgery

Objectives: This study aimed to compare the effect of dexamethasone and ketorolac on pain control in elective foot surgery. Methods: Forty patients visiting Akhtar and Imam Hossein Hospital for lower limb orthopedic surgery were selected. They were randomly divided into two groups: (1) dexamethasone, and (2) ketorolac. The dexamethasone group received eight mg dexamethasone intravenously. Also, 90 mg ketorolac was infused in one liter of normal saline serum for 24 hours for the ketorolac group. Before injection and 2, 4, and 6 hours after the injection, pain control was measured employing the Visual Analog Scale (VAS) score. Corresponding data were then analyzed using the independent t-test. Results: The conclusions revealed that in two and four hours after injection, there was a significant difference between the two groups in the amount of VAS score. That is, the pain was weaker in the ketorolac group than in the dexamethasone group. The findings additionally proved that there was no statistically important difference in pain levels between the two groups six hours after injection. Conclusions: Overall, according to the results of the research, it can be settled that ketorolac is a better drug in foot surgery pain control than dexamethasone.

Comparative study between intravenous versus perineural dexamethasone in prolonging the analgesic effect of supraclavicular plexus nerve block in hand surgeries

Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stays and an increased likelihood of chronic pain. Systemic analgesics (opioids and non-opioids) have long been used for postoperative pain, then neuroaxial or peripheral nerve blocks were employed. Local anesthetics alone were used, then various adjuvants were added to achieve quick, dense and prolonged block. Objective To study the effect of dexamethasone as an adjuvant to bupivacaine either intravenous or perineural in ultrasound guided supraclavicular brachial plexus block in hand surgeries regarding the onset of the block, the duration of the block, the effect on postoperative analgesic requirements as well as anticipated complications. Patients and Methods In our study, 50 patients were randomly divided into 2 equal groups. perineural group received bupivacaine (0.5%) concomitant with 8 mg dexamethasone and Systemic group in which 8 mg of dexamethasone were injected systemically. All patients received equal volumes of 20 milliliters. Results Our study showed that addition of a8 milligram of dexamethasone to bupivacaine in ultrasound-guided supraclavicular nerve block shortened the onset times of sensory and motor blocks and significantly prolonged their durations. In addition, dexamethasone prolonged the duration of analgesia of the plexus block significantly, as proved by the time of request of first analgesia. Moreover, in perineural dexamethasone group, postoperative analgesic requirements were greatly lesser than that of bupivacaine groups. Addition of dexamethasone perineural also did not affect the hemodynamics to a significant level. This makes perineural dexamethasone with bupivacaine more superior than the use of bupivacaine with addition of intravenous dexamethasone. Conclusion The use of ultrasonography in performing the supraclavicular nerve block, decreased significantly the incidence of complications such as pneumothorax or intravascular injection and hence, lowered the incidence of systemic toxicity of local anesthetics.

Evaluating Effect of Prophylactic Intravenous Dexamethasone in Post Spinal Shivering: A Single Centre Randomised Controlled Study

Introduction: Shivering is a common side effect of central neuraxial anaesthesia. Intravenous pethidine is commonly used in reducing shivering but has been associated with significant opioid side effects. Dexamethasone as a powerful anti-inflammatory and analgesia agent is postulated to inhibit inflammatory mediators’ release thus inhibiting central thermoregulatory centre, potentially attenuating post spinal shivering. This double-blinded randomised controlled study was to determine the ability of intravenous dexamethasone in decreasing the incidence, severity and the need for treatment for post spinal shivering. Methods: We recruited 72 patients requiring spinal anaesthesia and randomised them to receive either dexamethasone 0.1 mg/kg (up to 8 mg) or normal saline (placebo). We observed their tympanic membrane temperatures, mean arterial pressures and shivering scores at regular intervals up to 2 hours post-spinal or till end of surgery (minimum 30 minutes post spinal). Results: Both groups showed consistent and comparable drop in tympanic membrane temperatures and mean arterial pressures after spinal anaesthesia, except at 15 minutes in which patients of dexamethasone group demonstrated significantly higher temperatures than saline group (p=0.04). There were also significantly less patients in the dexamethasone group reporting incidence of visible shivering as compared to the placebo group (p=0.003). No significant difference was seen in severity of shivering or usage of pethidine. Conclusion: Dexamethasone has the potential to mitigate the reduction in core body temperature, especially at 15 minutes post spinal. It can reduce the incidence of clinically significant visible grade of shivering post spinal.

Perineural dexamethasone reduces rebound pain after ropivacaine single injection interscalene block for arthroscopic shoulder surgery: a randomized controlled trial

Background and objectivesA single injection interscalene block (ISB) is a common regional analgesic technique in patients undergoing arthroscopic shoulder surgery. However, rebound pain after ISB resolution may reduce its overall benefit. Our primary aim was to assess whether perineural dexamethasone reduces the intensity and incidence of rebound pain in patients undergoing arthroscopic shoulder surgery under general anesthesia combined with a preoperative single injection ISB.MethodsThe patients were randomly assigned to receive single injection ISB using either 0.5% ropivacaine (control) or 0.5% ropivacaine containing 5 mg of dexamethasone. The primary outcomes were the pain score difference before and after ISB resolution, and the incidence of rebound pain. The secondary outcomes were the onset and duration of rebound pain, the presence of sleep disturbances due to postoperative pain, the first time when an analgesic was requested, and pain scores at various predefined time points.ResultsPain increase following ISB resolution was lower in the dexamethasone group compared with the control group (4.5±2.4 and 6.9±2.2, respectively, p<0.001). The incidence of rebound pain was significantly lower in the dexamethasone group compared with the control group (37.1% and 82.9%, respectively, p<0.001). The controls experienced greater sleep disturbance during the postoperative period compared with those who received ISB with perineural dexamethasone.ConclusionsPerineural dexamethasone added to ISB using ropivacaine led to a much smoother resolution of ISB, reflected in a significantly smaller increase in pain after block resolution, a lower incidence of rebound pain and a lower sleep disturbance during the first postoperative week.Trial registration numberClinical Trial Registry of Korea (KCT0004418).

COMPARISON OF HYDRODISECTION INJECTION BETWEEN TRIAMCINOLONE ACETONIDE VERSUS DEXAMETHASONE IN CARPAL TUNNEL SYNDROME

Background: Carpal tunnel syndrome (CTS) is the most common nontraumatic peripheral neuropathy, which is caused by suppression of the median nerve below the transverse carpi ligament. Local corticosteroid injection is considered the fastest and most effective method for improving symptoms that occur in CTS. There are several corticosteroid agents that can be used, but there are no objective standards that can explain the most ideal drugs. Objective: To compare the effectiveness of hydrodisection injection therapy of triamcinolone acetonide versus dexamethasone on carpal tunnel syndrome. Methods: This study involved 30 participants who were diagnosed with CTS and fulfilled the inclusion criteria and no exclusion criteria were obtained. Participants were divided into two treatment groups; the first group (n = 15) injected with Triamcinolone Acetonide (TCA) 10mg / 1ml and lidocaine 1% 1 ml and the second group (n = 15) injected with Dexamethasone 4mg / 0.8ml and lidocaine 1% 1 ml. The NRS, FSS, and SSS parameters were assessed before injection and 4 weeks after injection in each agent. Then compared these parameters at 4 weeks after injection compared to the TCA group with the dexamethasone group. Results: NRS score before and 4 weeks after TCA injection (sig 0.000; p <0.05), SSS (sig 0.001; p <0.05) and FSS (sig 0.020; p <0.05), and NRS score before and 4 weeks after dexamethasone injection (sig 0.001; p <0.05), SSS (sig 0,000; p <0.05) and FSS (sig 0,000; p <0.05). At 4 weeks after injection of TCA compared to dexamethasone there were no significant results on NRS (sig 0.237; p> 0.05) and FSS (sig 0.119; p> 0.05), while SSS values were significantly different (sig 0.027; p <0.05). Conclusion: Significant improvement in NRS, FSS and SSS score was obtained at 4 weeks after hydrodisection injection, both with TCA and dexamethasone. At 4 weeks after TCA injection compared to dexamethasone, there were no significant differences in NRS and FSS scores, whereas SSS score differed significantly. Both injection agents are equally effective in treating CTS, but dexamethasone produces a better improvement in SSS score.

Comparing the Effect of Facial Compression Bandage to That of Systemic Dexamethasone on Postsurgical Sequels after Extraction of Impacted Mandibular Third Molars: A Split-mouth Randomized Clinical Trial

AIM: The present study aimed to compare the clinical efficiency of facial pressure bandage, to that of intramuscular injection of dexamethasone (8 mg) on postsurgical sequels (swelling, pain, and trismus) of extraction of impacted mandibular third molar. METHODS: The study implemented a randomized split-mouth design. Patients with symmetrical bilateral impacted molars were eligible for the present trial. Sides were randomly assigned to two groups: pressure bandage group and dexamethasone group. The evaluated postsurgical sequels were extraoral swelling, trismus, and pain after 48 h and 7 days. RESULTS: The study included 42 impacted third molars (n = 42) in 21 patients with a mean age of 23.4 years. Most participants were females (66.7%). The mean postoperative swelling rates after 48 h and 7 days in pressure bandage group were found to be comparable to those of dexamethasone group. No significant difference was found in the mean rates of postoperative trismus between study groups after 48 h and 7 days. Differences in mean pain level scores between the pressure bandage group and dexamethasone group were statistically insignificant after 48 h and 7 days. CONCLUSION: The study findings showed that the effect of the pressure bandage was comparable to dexamethasone effect on the postsurgical sequels after surgical extraction of impacted mandibular third molars.